Symptomatic Cough

Clinical Considerations
➤ General comments
– Coughing clears foreign particles and accumulated mucus from the respiratory passages.
– Coughing is a response to foreign particles caused by stimulation of neuroreceptors located on the larynx and esophageal bifurcation at the opening of the stem bronchi. The stimulus is usually mechanical, but sometimes also chemical or thermal in nature. The cough reflex travels through the afferent nerve fibers to the cough center of the medulla oblongata. Additional cough receptors are located in the bronchi, alveoli, and throat. A smaller number of receptors can be found in the nose and paranasal sinuses. Connected to the cough center are receptors in the auditory canal, esophagus, and stomach. Coughing is induced when these receptors are stimulated.
– Coughing for reasons other than to eject mucous secretions and foreign particles places unnecessary strain on the respiratory tract and should therefore be treated. Expectoration should be boosted through appropriate measures.
– If the cough becomes chronic, a thorough work-up should be performed to determine the cause and to initiate the proper treatment measures. Apart from lung and heart disease, other common causes include medications, such as ACE inhibitors, and environmental factors, such as irritant gases, cigarette smoke, and solvents.

➤ Herbal and general treatment measures
– Herbal remedies that quiet coughing (antitussives) or promote the ejection of mucus (expectorants) are delivered either by inhalation or orally.
– Herbal antitussives with central effects: The essential oil in eucalyptus leaves (cineol) and licorice root may have central effects.
– Herbal antitussives with peripheral effects reduce the sensitivity of cough receptors in the mucous membranes of the mouth and throat as well as in the esophagus and stomach.
– Anticoughing teas can help to liquefy thick mucous secretions. The secretolytic and expectorant actions of certain essential oils develops more effectively when the preparations are inhaled or taken in extract form. Saponincontaining herbs, on the other hand, should be administered by mouth since they work by stimulating the sensitive fibers of the gastric mucosa. The reflex stimulus is then passed on to the bronchial mucosa.
– Some herbal remedies have an additional anti-inflammatory effect (e. g., licorice root and sundew herb) or bronchospasmolytic effect (e. g., sundew herb, peppermint oil, and licorice root).

➤ Clinical value of herbal medicine
– Herbal remedies that liquefy the mucus have antitussive efficacy.
– All the specified herbal preparations are used for symptomatic treatment of coughs.

Recommended Herbal Remedies (Overview)
Demulcents
– Action: Reduction of coughing. The active constituents in some herbal demulcents (e. g., marshmallow root, ribwort plantain herb, Iceland moss) are transported by the mucus to the receptors in the mucous membranes of the mouth and throat. Those of others (e. g., naphthoquinone derivatives in sundew herb) take effect in the bronchial mucosa. Iceland moss contains bitter principles that additionally stimulate the production of saliva and digestive juices, thereby triggering a swallowing reflex that decreases the cough reflex.

• Antitussives
• Secretolytics and expectorants
• Antispasmodics
• Antiphlogistics

Range of Applications in Unspecific Dry Cough
➤ General comments
– Symptomatic treatment is justifiable if the cause of coughing cannot be identified or if the environmental factors causing the coughing cannot be eliminated. Herbal remedies with primarily antitussive and anti-inflammatory effects should be used.
– Aromatic oils such as anise oil, eucalyptus oils, fennel oil, menthol, peppermint oil, and thyme oil are useful. When allowed to dissolve in the mouth, they not only have a pleasant taste but also stimulate the swallowing reflex, which can be further enhanced by adding sugar or other sweeteners.

• Demulcents
• Antitussives
• Antiphlogistics

➤ Tea Rx: Althaeae radix 25.0, Foeniculi fructus 10.0, Lichen islandicus 10.0, Plantaginis lanceolatae herba 15.0, Liquiritiae radix 10.0, Thymi herba 30.0. Steep 1 tablespoon in 1 cup of boiled water. Sweeten and drink the fresh tea slowly and as hot as tolerable. Take 1 cup, several times a day.
➤ Dosage and administration: Commercial preparations (e. g., capsules, cough drops, lozenges, cough syrup) should be taken several times a day, as directed on the product label.
➤ Clinical value: For adjunctive treatment.
➤ Differential diagnosis: Chronic bronchitis.

Range of Applications in Bronchial Asthma
➤ Preliminary remarks
– The chronic inflammatory process associated with bronchial asthma is controlled by T-helper cells and effector cells involved in the inflammatory response. Eosinophil granulocytes and other cells are typically found in inflamed bronchial tissues and bronchoalveolar fluids.
– The main goals of therapy are to reduce inflammation and eliminate bronchospasms.

➤ Recommended herbal preparations: Eucalyptus oil in various forms
– Eucalyptus oil is often used in steam inhalers, or as a rub. Small amounts can be found in cough lozenges or cough syrups.
– Eucalyptus oil is is only rarely availaible in capsule or tablet form in the United States and is little used in these forms.
– Clinical value: For adjunctive treatment. A cortisone-reducing effect has also been reported.
Warning: Asthma patients are often allergic to essential oils.

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Bronchitis Natural Cures

Clinical Considerations
➤ General comments
– Acute bronchitis
• Usually caused by an ascending viral infection. Irritant bronchitis is due to the inhalation of toxic or allergic substances.
• The disease is marked by abnormal mucus production and impaired ejection of mucus from the bronchi. The bronchial passages become obstructed owing to the thick mucous secretions and inflammation. Coughing and phlegm production, the hallmark symptoms of bronchitis, ultimately occur.
• The initial symptoms are dry cough accompanied by a burning sensation in the chest. The cough gradually becomes productive and increasingly troublesome. The viscosity of the mucus starts to decrease over the course of time (2 to 3 weeks).
• Yellowish-green mucus is indicative of secondary bacterial infection.

Note: If there is severe coughing (especially with a presumed lung involvement), frequent relapsing, or persistent coughing with expectoration, the patient should consult a physician to assess the need for antibiotic treatment.
• Complications: The primary complication is chronic bronchitis, which can cause irreversible damage to the mucous membranes. The damaged membranes provide a foundation for further complications, such as pulmonary emphysema, bronchiectasis, and bronchopneumonia.

– Chronic bronchitis
• Smoking is usually responsible for the persistence of bronchitis. Chronic adenovirus infection may be another cause.
• Increased quantities of CD8+ T lymphocytes can be found in the larger airways (beneath the basal membrane). The bronchial glands are swollen, and large quantities of neutrophil granulocytes and macrophages are present, even in the alveolar fluid.

➤ Herbal and general treatment measures of bronchitis
– Increasing the fluid intake is essential. In mild cases, the patient should drink large quantities of tea made from herbs selected according to the type of cough.
– Herbal preparations with soothing effects are to be applied first. Expectorants, preferably those with antispasmodic or immunostimulatory effects, can be prescribed later if necessary.

➤ Clinical value of herbal medicine
– The objective of herbal treatment is to prevent complications. Treatment should therefore be initiated in the early stages of disease.
– Herbal medicinal products containing single or multiple ingredients can decrease the viscosity of mucus, counteract inflammation, ease bronchospasms, and stimulate the immune system.
– In chronic bronchitis, herbal remedies are used for adjunctive treatment.

Recommended bronchitis Herbal Remedies (Overview)
Demulcents
➤ Marshmallow root (Althaeae radix); mallow leaf and flower (Malvae folium cum flores); ribwort plantain (Plantaginis herba)Iceland moss (Lichen islandicus); mullein (Verbasci flos).
– Action: Antitussive.
– Contraindications: None known.
– Dosage and administration: Oral dosage forms should be used. For dosage
recommendations, see the application in question.
– Side effects: None known.

Secretolytics and Expectorants
➤ Aromatic herbs and pure essential oils: Aniseed (Anisi fructus); fennel seed (Foeniculi fructus); thyme (Thymi herba); eucalyptus oil (cineol); camphor tree Cinnamomum camphorae aetheroleum); peppermint oil (menthol); pine needle oil (Piniaetheroleum).
➤ Saponin-containing herbs: Primula root (Primulae radix); mulleinflower (Verbasci flos); licorice (Liquiritiae radix).
– Action: Mucolytic and expectorant.
– Contraindications: Peppermint oil and preparations containing menthol and camphor as well as eucalyptus, pine, and spruce needle oils should never be applied to the face, especially the nose, of infants.
– Dosage and administration: See instructions for the specific application in question.
– Side effects
• Eucalyptus oil: Internal administration of large quantities of eucalyptus oil can lead to the passage of gallstones or kidney stones or to stomach irritation, cramps, tachycardia, and cyanosis. Eating large amounts of eucalyptus candy can induce nausea and vomiting in children.
• Licorice: Aldosterone-like side effects such as edema and hypokalemia, when larger quantities are consumed.
• Saponin-containing herbs: The consumption of large quantities can irritate the stomach.
• Cineol activates the hepatic enzyme system that metabolizes foreign substances, possibly weakening and/or shortening the therapeutic action of other active principles.
• Although rare, contact eczema may occur.

Bronchospasmolytics
➤ Thyme (Thymi herba); ivy leaf (Hederae helicis folium); primula root (Primulae radix); licorice root (Liquiritiae radix).
– Action: Relieve bronchial muscle spasms.
– Contraindications: None known.
– Dosage and administration: See instructions for the specific disease in question.
– Side effects
• Licorice.
• Ivy leaf and primula root: Large quantities of saponin-bearing herbs can irritate the stomach.

Antiphlogistics
➤ Ivy leaf (Hederae helicis folium); primula root (Primulae radix); ribwort plantain (Plantaginis herba); licorice (Liquiritiae radix); Iceland moss (Lichen islandicus).
– Action: Anti-inflammatory.
– Contraindications: None known.
– Dosage and administration: See instructions for the specific application in question.
– Side effects: Described above.

Antibiotics and Immunomodulators
➤ Thyme (Thymi herba); ivy leaf (Hederae helicis folium);nasturium (Tropaeoli herba); horseradish root (Amoraciae radix).
– Action: Reduces the likelihood of a secondary bacterial infection.
– Contraindications: Horseradish should not be used by individuals with peptic ulcers or nephritis, and should not be administered to children under 4 years of age.
– Dosage and administration: See instructions for the specific disease in question.
– Side effects: Those of ivy leaf are described above. Horseradish root can cause isolated allergic side effects; higher doses of the herbal remedy can cause gastrointestinal upsets.

Antitussives
➤ Sundew herb (Droserae herba).
– Action: Relieves dry cough by reducing the cough reflex.
– Contraindications: None known.
– Dosage and administration: See instructions for the specific disease in question.
– Side effects: None known.

Range of Applications in Acute Bronchitis
Internal Remedies
➤ Chest tea, Rx: Standard license: Anisi fructus (chopped) 15.0, Liquiritiae radix 25.0, Althaeae radix 35.0, Malvae folium 25.0.
➤ Cough and bronchial tea Rx: Anisi fructus 10 g, Plantaginis herba 30 g, Liquiritiae radix 30 g, Thymi herba 30 g.
– Dosage and administration: One teaspoon of either tea mixture per cup, 3 to 4 times a day. Commercial preparations should be used as directed on the product label.
– Clinical value: When treatment is initiated early, the combined administration of oral herbal remedies with topical remedies and inhalants can be sufficient treatment in many cases.

External Remedies of bronchitis
➤ Thyme; eucalyptus oil; dwarf pine oil; peppermint oil; spruce needle oil; camphor.
– Dosage and administration: Apply to the skin or use for inhalation several times a day. Should be used as directed on the product label.
– Clinical value: See internal remedies.

Range of Applications in Chronic Bronchitis
Immunostimulants
➤ Purple echinacea herb (Echinaceae purpureae herba) and paleflowered echinacea root (E. pallida radix).
– Dosage and administration: Liquid tinctures, 1:4, 2–4 mL are added to a little water and taken orally, 4 to 5 times daily.
– Clinical value: No comparable synthetic drug preparations exist. Echinacea’s immunostimulatory action takes effect within 24 hours. These products are safe to use, even by patients on concomitant antibiotic treatment. Symptomatic Treatment

➤ The purpose of symptomatic treatment is to promote the ejection of mucus in subacute or chronic bronchitis and to counteract inflammation.
➤ Thyme herb; primula root; ribwort plantain herb; ivy leaf (use commercial products only); cineol. See overview on p. 155.
– Tea Rx: Primulae radix, Thymi herba, Plantaginis herba, aa ad 100 g.
– Dosage and administration: 1 teaspoon per cup, 3 to 4 times a day. Commercial preparations should be used as directed on the product label.
– Clinical value: The specified herbal remedies are generally well tolerated and useful for adjunctive treatment.

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Colds and Flu Natural Treatments

Colds and Flu

Clinical Considerations
➤ General comments
– Colds and flu are the most common reasons for the loss of working hours.
– Around 90 % of all catarrhal disorders are caused by viruses, especially rhinoviruses. Secondary bacterial infection can also develop. Viral and secondary bacterial infections are especially common in individuals with temporary or permanent asthenia of the unspecific (congenital) or specific (acquired) immune system.
– Drafts, cold weather, excessive indoor heating, stress, and loss of sleep are factors that promote the development of colds. When the body (especially lower body) is subjected to hypothermia or ischemia, it responds by reducing the blood flow to the mucous membranes in the upper respiratory passages. This and the drying of the mucous membranes due to excessive room heating promote the growth of pathogens.

➤ Herbal and general treatment measures
– Once a cold has fully developed, treatment focuses on alleviating typical symptoms, such as a runny nose, sore throat, and hoarseness with or without fever. Nasal douches, throat wraps, inhalation, sweat-inducing agents (diaphoretics), and baths with aromatic herbs have proved to be effective. Cold remedies usually contain secretolytic and expectorant herbs with essential oils, mucilage, and saponins.
– Hot baths for colds and flu are prepared with aromatic oils, such as spruce oil, pine needle oil, eucalyptus oil, thyme oil, camphor and/or menthol.
– The administration of a diaphoretic tea after a hot bath can enhance the febrifuge effects of the treatment.

➤ Clinical value of herbal medicine in colds and flu: All measures that improve the natural function of the mucous membranes of the upper respiratory tract, alleviate cold symptoms, and strengthen the immune system, can be recommended for symptomatic treatment of all virally induced catarrhal disorders. There are no comparable synthetic drug preparations. Self-treatment measures should be coordinated with the help of a physician.

Recommended Herbal Remedies for cold and flu(Overview)

Immunostimulants
➤ Purple echinacea herb (Echinaceae purpureae herba); paleflowered echinacea root (Echinacea pallidae radix); wild indigo (Baptisiae tinctoriae radix); and arbor vitae tips (Thujae occidentalis stipites).

Note: The efficacy of other plant parts of the two Echinacea species has not been convincingly demonstrated, although the roots of E. purpurea, and especially E. angustifolia are frequently thought to be more potent in North America.
– Action
• Echinacea: Certain compounds in echinacea (arabinogalactans, arabinogalactan proteins) enhance the body’s nonspecific immune defenses by activating the granulocytes and macrophages, thereby improving the body’s capacity to phagocytose viruses and bacteria. Activated macrophages secrete interleukin-1, interleukin-6, and tumor necrosis factor,substances that stimulate the specific immune system and protect the cells from viral attacks. These mechanisms are activated when the pathogen comes in contact with the oral mucous membranes.
• Caffeic acid derivatives such as chicoric acid and alkylamides are responsible for the antiviral effect of purple echinacea juice.
• Echinacea juice inhibits hyaluronidase, thereby reducing the permeability of the blood vessels and inhibiting the spread of local infection.
• Clinical and postmarketing surveillance studies indicate that echinacea juice and alcoholic extracts of Echinacea pallida root increase the time until the occurrence of a new infection. In those who already have a cold, the course of the infection is less severe and the symptoms subside more quickly. Since many antibiotics can suppress the immune system, these herbal remedies should be helpful in patients with bacterial infections.
• Wild indigo promotes the release of interleukin 1 and stimulates the production of interferons.
• Arbor vitae stimulates the T cells, increases interleukin-2 secretion, and has a direct antiviral effect.
– Indications: Viral and bacterial infections of the upper respiratory passages.
– Contraindications: See cautions noted on labels of commercial products.
– Dosage and administration: Oral echinacea preparations are available. Based on the current data, combinations of Echinacea root (E. purpurea, E. pallida), wild indigo (Baptisia tinctoria), and arbor vitae tips (Thuja occidentalis) appear to be superior to preparations with Echinacea alone. Further in-depth studies are needed for final clarification.
• Flavored liquid products containing coneflower preparations that include glycerine instead of alcohol are popular for children.
– Side effects: None known for oral administration.

Diaphoretics (Sweat Inducers)
➤ Elder flower (Sambuci flos); yarrow flower and leaf (Millefolii herba); and linden flower (Tiliae flos).
– Action: Elder, yarrow, and linden flowers have febrifuge and anti-inflammatory effects due to the inhibition of prostaglandins by their flavonoid constituents. Prostaglandins play a role in fever development. Linden flower tea also induces nonspecific activation of the immune system. Yarrow has anti-inflammatory properties.
– Indications: Viral and bacterial infections of the upper respiratory passages.
– Contraindications: None known.
– Dosage and administration: Elder flower.
– Side effects: None known.

➤ Vitamin C Supplements
– Black currant (Ribes nigrae fructus); rose hip peel (Rosae pseudofructus).
– Action: Increases the stores of vitamin C, yielding unspecific enhancement of the immune system.
– Indications: For prevention and treatment of upper respiratory tract infections.
– Contraindications: None known.
– Dosage and administration:• Black currant juice: Dilute with hot water. Drink 1 glass with meals at noon and in the evening. Can be used by patients in all age groups.
• Rose hip tea: Steep 2–5 g of the herb in 1 cup of boiled water for 15 to 30 minutes. Take one cup, several times a day.
• Cold rose hips tea is an effective thirst quencher for patients with fever.
Note: These preparations have relatively low concentrations of vitamin C, and their beneficial action depends also on their flavonoid or anthocyanin content. Their effectiveness is not proven with clinical trials; they fall more into the realm of pleasant-tasting home remedies.
– Side effects: None known.

Remedies to Apply at the First Signs of a Cold
Circulatory Stimulants
➤ Powdered black mustard seed (Sinapis nigrae semen) or white mustard seed (Sinapis albae semen).
– Action: Mustard stimulates the blood flow in the mucous membranes of the mouth and nose by reflex mechanisms. It can prevent the outbreak of a cold if treatment by footbath is started early enough.
– Contraindications: Powdered mustard seed should not be used by patients with kidney diseases or by children under 6 years of age due to transdermal absorption of mustard oil.
– Dosage and administration: Powdered mustard seed should not be applied to mucous membranes. When used for footbaths, add enough warm water to cover the feet and ankles.
Warning: After treatment, all mustard particles should be removed by rinsing the skin with warm water. Prolonged exposure can cause skin irritation and blistering, especially in patients with sensitive skin.
– Side effects: Prolonged use (>2 weeks) of strongly heated preparations externally can lead to skin burns and nerve damage.

Diaphoretics (Sweat Inducers).
– Contraindications: None known.
– Dosage and administration: The tea should be taken as hot as tolerable during the early afternoon.
– Linden flower tea: 2 teaspoons per cup.
– Diaphoretic tea Rx: Sambuci flos 35.0, Tiliae flos 25.0, Liquiritiae radix 10.0, Rosae pseudofructus 30.0. Use 1 teaspoon per cup of boiled water.
Warning: Diaphoretic teas should not be taken on a full stomach.

Nonspecific Immunostimulants
➤ Vitamin C supplements.
➤ Immunomodulators.
– Dosage and administration: Oral dosage forms are used. Treatment should be continued for at least 5 to 6 days.
• Liquids: 20 to 40 drops (up to 2–4 mL [2 to 4 droppersful]), 3 to 4 times a day.
• Solids: 1 to 2 lozenges, tablets or capsules, 3 times a day, as directed on the product label.
Note: Echinacea should be taken at the first signs of a cold. The efficacy of the herbal remedy is questionable when treatment is started at the climax of the disease. The preventive effect of echinacea is still under investigation. Chronic Infections of the Upper Respiratory Tract

➤ Purple echinacea leaf juice, liquid extracts of the root of E. purpurea or E. angustifolia, or a combination of various parts of the two species can be very helpful in chronic upper respiratory tract infections and recurrent colds. Products manufactured from the fresh, or recently-dried plants are preferred by most herbalists.
➤ The usefulness of echinacea preparations past 2 weeks or so is still controversial and requires further clinical studies. Oral administration of alcoholic extracts and homeopathic tinctures (mother tinctures to D2 tinctures) is reported to be more effective than other preparations. The current data suggest that preparations combining echinacea with other herbs are more effective than echinacea alone.
➤ Siberian ginseng (Eleutherococcus senticosus) may also be useful.
Warning: The immune status of severely ill patients should be checked before starting immunostimulatory therapy. Supposed risks must be carefully weighed against the expected but unproven benefits of treatment.

Patients with Low Resistance to Infection
➤ Echinacea.
– Dosage and administration: Oral dosage forms are used. In the early phases of manifest disease, administer for a period of no less than 6 days and no more than 14 days.
• Liquids: 30 to 40 drops, 3 to 4 times a day.
• Solids: 1 to 2 lozenges, tablets of capsules, 3 times a day, as directed on the label.

Chronic Recurrent Respiratory Tract Infections
➤ Echinacea.
– Dosage and administration: Liquid oral preparations

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Diseases of the Nose and Nasal Sinuses and Herbal Remedies

Clinical Considerations

➤ General comments
– Acute catarrhal rhinitis (head cold)
• Head colds are most commonly caused by viruses, especially rhinoviruses.
• The preliminary stage is marked by nasal dryness, often with sneezing or severe itching.
• This is followed by a catarrhal stage with profuse discharge of watery mucus. Yellowish-green mucus is indicative of a secondary bacterial infection.
• After a few days, the viscosity of the nasal mucus increases, and the nasal membranes become inflamed, swollen, and congested. Drainage of mucus is impaired, and the local immune defenses are weakened. Sinusitis can develop if marked swelling of the paranasal sinuses occurs.
• The symptoms of a harmless head cold normally subside within a week.

– Acute sinusitis
• Acute sinusitis is characterized by congestion of the entire nasal sinus system. Individuals with congenitally narrow sinuses or narrowing of the sinuses due to chronic allergy-related inflammation are especially prone to sinusitis.
• Sinusitis often occurs secondary to rhinitis.
• The lack of sufficient drainage of mucus leads to an oxygen deficiency and inadequate mucous membrane function. The membranes start to produce a very thick discharge (dyscrinism) that is an ideal breeding ground for bacteria. The mucociliary clearance mechanisms responsible for transporting the discharge out of the mucous membranes become inactivated.
• Acute sinusitis is marked by a clear feeling of malaise, usually with fever and unpleasant sensations in the cheeks, eyes, or temples ranging from pressure sensations to severe pain. Earaches can also occur. The condition can become chronic if acute episodes do not fully subside before the next bout. Chronic sinusitis can lead to massive changes in the mucous membranes

➤ Herbal and general treatment measures
– All patients with respiratory tract infections should drink plenty of fluids.
– Nasal douches with isotonic saline solution are helpful, especially in the first two stages of acute rhinitis.
– The sooner herbal remedies are administered, the better the chance of successful treatment.
– Different herbal remedies have different effects. Some stimulate the immune system, whereas others counteract inflammation. Combinations of remedies can therefore be very useful.

➤ Clinical value of herbal medicine: Herbal remedies for acute rhinitis (head colds) are cheap and safe. They do not damage the mucous membranes of the nose, even when used for long periods of time, if administered at low doses. In the case of sinusitis, a qualified physician should determine whether antibiotic treatment is necessary. Herbal treatments are always useful adjunctive measures.
Recommended Herbal Remedies (Overview)
Antiphlogistics

➤ Chamomile flower (Matricariae flos, see p. 47).
– Indications: Acute rhinitis.
– Contraindications: Known allergy to plants from the Asteraceae (aster or daisy family).
– Action: The essential oil in chamomile is not irritating to the mucous membranes. Two of its constituents, β-bisabolol and chamazulene, counteract inflammation.
– Dosage and administration: Inhalation: Add 2 to 3 tablespoons dried chamomile flower, 1 teaspoon chamomile extract, or 5 drops of the essential oil to boiling water and inhale, several times daily (see p. 18). If this is not possible, administer chamomile nose drops or chamomile cream to each nostril, 3 to 4 times a day.
– Side effects: None known. Cold Receptor Stimulators

➤ Peppermint oil (from the leaves of Mentha piperita L. (see p. 103)); Mentha arvensis var. piperascens (mint oil; sometimes mislabeled as peppermint oil); menthol; camphor tree (see p. 45).
– Action: These preparations stimulate cold receptors in the nose, making it easier to breathe. They also have secretolytic, antimicrobial, and antiviral effects, but do not reduce swelling of the mucous membranes. The remedies are generally safe, except in the specified contraindications.
– Indications: Acute rhinitis.
– Contraindications: Exanthematous skin and childhood diseases, bronchial asthma. Infants and small children should not inhale peppermint oil or use nasal ointments containing menthol. Camphor should not be used during pregnancy or lactation. Individuals with hypertension or heart failure should use it with caution. Warning
• When administered to infants and small children, peppermint oil and preparations containing menthol and camphor can trigger respiratory problems ranging from shortness of breath and choking to laryngeal spasms or cardiovascular problems. These herbal remedies should never be applied to the face or to large areas of the chest or back of infants and small children.
• Do not apply peppermint oil, mentholated nasal ointments or camphor to the eyes or to broken skin. Camphor should not be allowed to come in contact with the mucous membranes.
– Dosage and administration: Peppermint oil: Add 2 to 4 drops of peppermint oil to boiling water and inhale, several times a day, or apply 1 drop of the oil directly below the nostrils (school-aged children and adults only). Camphor: Apply the ointment directly to the chest, several times a day, to inhale the vapors. Nasal ointment: Apply a pea-sized amount to the nostrils, 3 to 4 times daily.
– Side effects: Allergic skin reactions and unpleasant local sensations can occur in isolated cases (in conjunction with mentholated nasal ointments).Rare incidences of contact eczema (camphor) have also been reported.

Immunostimulants
➤ Purple echinacea herb (Echinaceae purpureae herba); Paleflowered echinacea root (Echinaceae pallidae radix).
– Action: Increases the ability of granulocytes and macrophages to ward off disease. The immunostimulatory effect of echinacea develops over a few days of oral administration. No comparable synthetic preparations exist.
– Indications: Chronic sinusitis.
– Contraindications: Chronic-progressive systemic diseases (e. g., tuberculosis), leukoses, inflammatory rheumatic diseases, multiple sclerosis, HIV infection, known hypersensitivity to composite plants, autoimmune diseases. Warning: In severely ill patients, the patient’s immune status should be checked before starting immunostimulatory therapy. The expected benefits of treatment must clearly outweigh the potential risks.
– Dosage and administration: Liquid tinctures are widely available that include either or both of E. purpurea and E. angustifolia. The roots, leaves, seeds, or flowers are included in many products, and are sometimes blended.
• Flavored liquid products that include glycerin instead of alcohol are popular, especially for children.
– Side effects: Rarely, allergic skin reactions, which disappear after use is discontinued.
– None of the available data confirms the efficacy of oral echinacea preparations for sinus infections. Compound Remedies for Acute Sinusitis

➤ We do not recommend single-component commercial preparations for this indication.
– Action: See those of the individual herbs contained in compound remedies. Herbal remedies are highly recommended for adjunctive treatment of acute sinusitis.
– Indications: Acute sinusitis; adjunctive treatment of chronic sinusitis.
– Contraindications: See cautions noted on labels of commercial products.
Warning: The patient should consult a physician if the symptoms persist for more than 7 to 14 days or re-occur periodically. Pregnant women should not use echinacea unless directed by a qualified health care practitioner.
– Dosage and administration: Oral preparations should be used as directed on the product label.
– Side effects: Occasionally allergic reactions in the skin, respiratory tract, and gastrointestinal tract. Although rare, stomach complaints, nausea, vomiting, and diarrhea can occur.
– Interactions: See cautions noted on labels of commercial products.

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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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