Medicinal plants in the treatment of locomotor disorders. Nóra Papp

Transcription

1 Medicinal plants in the treatment of locomotor disorders Nóra Papp

2 Pain: 2 groups of medicines: with plants source (1) major analgetics: morphin (2) non steroidal anti-inflammatory drugs (NSAID): acetylsalicylic acid (cyclooxigenase inhibitor) COX inhibitors from plants: chamomille: chamazulen, -bisabolol, apigenin olive oil: oleokantal NSAID side effects: nausea, vomiting, dyspepsia, bleeding, reversible kidney insufficiency, skin reactions, liver damages Chronic pain: in rheuma, osteoarthritis: ointments causing hyperemia - e.g. tincture of paprika, camphor content, methyl salicylic acid

3 Neuralgia Muscular pain Plant name Drug name Plant name Drug name Mentha canadensis Mentha x piperita Pinus mugo Pinus silvestris Pinus pinaster Menthae arvensis aetheroleum partim mentoli privum Menthae piperitae aetheroleum Pini pumilionis aetheroleum Pini silvesrtis aetheroleum Terebinthini aetheroleum ab pinum pinastrum Arnica montana Eucalyptus globulus Eucalyptus sp. Rosmarinus officinalis Arnicae flos Arnicae tinctura Eucalypti aetheroleum Rosmarini folium Rosmarini aetheroleum Capsicum annuum var. minimum, C. frutescens Capsici tinctura normata

4 Muscular cramp Arthralgia Plant name Drug name Plant name Drug name Capsicum annuum var. minimum Capsicum frutescens 1. Capsici fructus 2. Capsici oleoresina raffinata et quantificata 3. Capsici tinctura normata Harpagophytum procumbens, H. zeypheri Harpagophyti radix Harpagophyti radix extractum siccum Salix daphnoides Salix fragilis Salix purpurea Salicis cortex Salicis corticis extractum siccum + Arnica montana, paprika species, eucalyptus, pines, rosmary

5 Rheuma Plant name Drug name Betula pubescens Betula pendula Betulae folium Urtica dioica Urtica urens Urticae folium Betula pubescens Betula pendula + Arnica montana, paprika species, eucalyptus, pines, rosmary, Salix sp.

6 Muscular pain

7 Cinnamomum camphora (L.) Sieb. et Presl. camphor tree China, East Asia

8 Cinnamomum camphora Drug: Camphorae aetheroleum Camphora (= white crystallized powder extracted from the woody part by water distillation) compounds: essential oil, 5 chemotypes in China: camphor type, linalool type, cineol type, borneol type, isonerolidol type use: preparation of camphor, extraction of essential oil, antirheumaticum, cosmetics Note: the use of camphor containing products should be avoided by children under 3-4 years.

9 FoNo VII preparations Pasta antirheumatica Spiritus capsici Spiritus menthae cum sale Unguentum contra rheumam

10 Arthralgia

11 Capsicum annuum var. minimum (Mill.) Heiser Capsicum frutescens L. chili pepper Solanaceae native to tropical regions in America into Europe: by Spanish people Albert Szent-Györgyi: Nobel prize (vitamin C) capsaicines in the therapy in India, China, Japan

12 Drug: mature fruit (1) Capsici fructus (Ph. Eur 4., Ph. Hg. VIII.) (2) Capsici oleoresina raffinata et quantificata (Ph. Eur. 5.) (3) Capsici tinctura normata (Ph. Eur. 5.) Drug Capsaicinoid content (1) 0,4% (2) 6,5-8% (3) 90% The drug should be dried at low temperature (carotenoids!).

13 Main compounds: 0,01-0,2% capsaicinoides (pungent) 0,3-0,8% carotenoids: - and β-caroten, capsanthin, capsorubin steroid glycosides flavonoids fatty oil vitamin A and C OH O CH 3 CH 2 NH C (CH 2 ) 4 CH CH CH O capsaicin CH 3 CH 3 Human clinical studies: neuropathy with diabetes, neuralgia with chronic postherpes, rheumatic pains, neuropathic analgesics in cancer therapy

14 Traditional use: - externally: rheuma, neuralgia, hair loss - internally: digestive problems (dried fruit and tincture), spice Therapeutic use: - tendonitis, rheuma, neuralgia, neuropathy with diabetes, lumbago Doses: - standardized products: half-solid (0,02-0,05% capsaicinoid), fluid (0,005-0,01% capsaicinoid)

15 Side effects: - allergic reactions, mild gastrointestinal problems Contraindications: - in duodenal ulcer - on injured and inflamed skin - in the same place for 2 days, then a break for 14 days - around the eyes Interactions: - not known

16 Harpagophytum procumbens (Burch.) DC. Pedaliaceae - in deserts in Africa - Greek harpagos : hook (fruit) - by South African rural people in Europe in the 20th century - limited African export!

17 Drug: cm long, 3-5 cm in diameter, brown bitter root with secondary thickening (1) Harpagophyti radix (Ph. Eur. 4., Ph. Hg. VIII.) (2) Harpagophyti extractum siccum (Ph. Eur. 6.) Drug Harpagosid content (1) 1,2% (2) 1,5% H. zeypheri: lower content of compounds

18 Main compounds: 0,5-3,5% iridoid gylcosides: - harpagosid phytosterols flavonoids triterpenes sugars Tóth L.: Gyógynövények, drogok, fitoterápia. Kossuth Kiadó, Debrecen, Human clinical studies: rheuma, back pain, possible reduction of the dose of steroidal and non steroidal anti-inflammatory drugs.

19 Traditional use: - internally: gastrointestinal and liver disorders, fever, analgesics - externally: wound, injuries, furuncles Therapeutic use: - complementary treatment of degenerative locomotor diseases (arthrosis) (per os) - digestive problems, loss of appetite Doses: - loss of appetite: 1-3 g/day, tea - locomotor diseases: 4,5 g (2-3 months) - fluid extract: 0,1-0,25 ml/day, 3x; (1:1, 25% ethanol) - in products: mg harpagosid content

20 Side effects, contraindications: - gastrointestinal discomfort, diarrhoea - gastric and duodenal ulcer, gall stones - pregnancy, lactation Interactions: - with antacids

21 Arnica montana L. Asteraceae - in high mountains in Europe - protected plant! - substitutive plant: A. chamissonis (North America)

22 Drug: (1) Arnicae flos (Ph. Eur 4., Ph. Hg. VIII.) (2) Arnicae tinctura (Ph. Eur 4., Ph. Hg. VIII.) Drog Sesquiterpene content (1) 0,4% (2) 0,04%

23 Main compounds: 0,2-0,8% sesquiterpene lactones: - helenalin, dihydro-helenalin O flavonoids 0,2-0,3% essential oil O HO O - thymol helenalin Sesquiterpene lactones: they inhibit the activity of transcription factors; inflammatory mediators do not develop. Thymol, sesquiterpene lactones: antimicrobial effect. Few human studies.

24 Use: only externally (extract with water-alcohol, oil) - in posttraumatic or postoperative condition: haematoma, strain, oedema with bone fracture - tendonitis, rheuma Doses: - creams, ointments, gels: they contain 5-25% tincture or fluid extract; 3x daily - 2 g drug into 100 ml water - homeopathy (internally!): individual therapy

25 Side effects, contraindications: - internally!: toxicity (symptoms: headache, abdominal pain, apnoe) - frequent allergic contact dermatitis - in long-term use: dermatitis with oedema - Asteraceae cross allergy Interactions: - not known

26 Eucalyptus globulus Labill. Myrtaceae - Australia - leaf: essential oil cavities

27 Drug: leaves collected from the elder branches; spicy fragrance; first a burning, then a cooling taste (1) Eucalypti folium (Ph. Eur 4., Ph. Hg. VIII.) (2) Eucalypti aetheroleum (Ph. Eur 4., Ph. Hg. VIII.) (1): in toto: 20 ml/kg, ground: 15 ml/kg Essential oil: colorless or yellow, fresh, mild camphor-like fragrance; the skin irritative compounds are removed from the oil

28 Main compounds: 0,5-3% essential oil: - 1,8-cineol, pinen, camphen flavonoids tannins O Human clinical studies: with cineol, respiratory diseases. Use: - ethnomedicine: gastrointestinal and urogenital disorders, anti-inflammatory drug - externally: rheuma, arthralgia, muscular pain, back pain Doses: - linimentum: 25 V/V% oil - ointment: 1,3% V/m oil, max. 3x/day

29 Side effects, contraindications (external use): - pregnancy, lactation - local use: burning sense, irritation - children under 5 years, patients suffering from bronchial asthma - for children: on the face, around the nose Interactions: - not known

30 Rosmarinus officinalis L. Lamiaceae - evergreen semishrub - 17th century: Aqua Reginae Hungariae - spice, liqueures - food industry (preservatory)

31 Drug: (1) Rosmarini folium (Ph. Eur 4., Ph. Hg. VIII.) (2) Rosmarini aetheroleum (Ph. Eur 4., Ph. Hg. VIII.) (1): 12 ml/kg essential oil 3% hydroxi cinnamic acid content (determined in rosmarinic acid) Essential oil: in leaves and flowering stems; yellow, fresh

32 1-2,5% essential oil: - 1,8-cineol, borneol, camphor diterpenes: (antioxidant) - carnosol, rosmanol flavonoids triterpenes hydroxi cinnamic acid derivatives: - rosmarinic acid, caffeic acid O 1,8-cineol HO camphor O No human clinical studies. HO CH CH COOH caffeic acid

33 use (externally): - rheuma, arthralgia, circulatory problems doses: - ointments: 6-10% essential oil - bath: 50 g drug into 1 L water Side effects, contraindications: - pregnancy, lactation - individual allergy, contact dermatitis - essential oil can cause epileptic attack and improves blood pressure - use as a bath should be avoided in fever Interactions: - not known

34 Pinus sylvestris L. Pinaceae Pinus mugo L. Pinus pinaster Aiton

35 Drugs: P. sylvestris: (1) Pini silvestris aetheroleum (Ph. Eur 4., Ph. Hg. VIII.) (2) Colophonium (Ph. Eur 4., Ph. Hg. VIII.) (residue after the distillation of essential oil from resin) P. mugo: (1) Pini pumilionis aetheroleum (Ph. Eur. 5.) P. pinaster: (1) Terebinthini aetheroleum ab pinum pinastrum (Ph. Hg. VIII.)

36 Main compounds: essential oil: - α- and β-pinen, borneol abietic acid Colophonium: non volatile diterpene resin acids HOOC No human clinical studies. use (externally): - rheuma, arthralgia, neuralgic pain doses: - ointments: some drops of essential oil - bath: 0,025 g essential oil into 1 L water for min - Colophonium: in ointments, plasters / skin irritative

37 Side effects, contraindications: - pregnancy, lactation - individual allergy, contact dermatitis - essential oil: improves blood pressure - use as a bath should be avoided in fever and heart insufficiency - long-term storage: oil can become irritative Interactions: - not known

38 Medicinal plants containing salicylates

39 Salicylates 18th century: Edmund Stone, English priest use of the bark of Salix sp. instead of the expensive bark of Cinchona pubescens for fever antipyretic effect of salicylic acid is known since 1763 acetyl-salicylic acid (Aspirin) In the body: O OH OH OH O glü OH OH salicin salicyl alcohol salicylic acid (COX inhibitor)

40 Salicylates Filipendula ulmaria (1) herb Fraxinus excelsior (2) bark Populus tremula (3) bark and leaf (1) (3) (2) They are not used in the therapy nowadays.

41 S. daphnoides Vill. Salix purpurea L. Salicaceae S. fragilis L.

42 Drug: bark of young branches, one-year old branches (1) Salicis cortex (Ph. Eur 4., Ph. Hg. VIII.) (2) Salicis corticis extractum siccum (Ph. Eur. 6.) (1) Salicylic acid derivatives determined in salicin : 1,5% Main compounds: 1-10% phenolic compounds: - salicin, salicyl alcohol, salicortin 8-20% tannins: gallic acid types flavonoids Few human studies: osteoarthritis, back pain, arthralgia. 1 study: it was compared with the COX-2-inhibitor rofecoxib.

43 use: - arthralgia, antipyretic effect doses: - fluid or solid preparation: standardized for mg salicin - drug: 2-4 g/dose, 6-12 g/day, in cold water for 8 hours or boiling for 5 min - standardized preparations are more safety then the tea Side effects, contraindications: - pregnancy, lactation - gastrointestinal problems (tannins) - NOT USE for patients suffering from aspirin sensitivity - in children with fever (Reye syndrom) - NOT USE: patients with asthma, diabetes, gout, liver and kidney disorders, furuncle Interactions: - do not combine with drugs containing salicylates or NSAID

44 Rheuma

45 - use for 2000 years - pressed sap for snake bite, toxication - Roman soldiers: hit the painful body parts with herb for arthralgia - nowadays: chlorophyll, fibers, fodder, vegetable, hair cosmetics, diuretic Urtica dioica L. Urticaceae Urtica urens L.

46 Drug: (1) Urticae folium (Ph. Eur 4., Ph. Hg. VIII.) (2) Urticae dioica ad praeparationes homeopaticas (Ph. Eur.4., Ph. Hg. VIII.) Ethnomedicine: seed Recent phytotherapy: root for BPH

47 Main compounds in herb: caffeic acid derivatives: - caffeoil-malic acid flavonoids sterols - β-sitosterol chlorophyll vitamins: - B, C, K biogen amines (hystamin, serotonin) HO sitosterol CH 2 CH 3 Compounds in the root: special fatty acids, sterols, lignans, lectins There are human studies!!!! The effective compounds are not clear.

48 use (external and internal): - rheuma, arthralgia, diuretic doses: - drug: 8-12 g/day, tea - tincture: 2-6 ml (1:5 25% ethanol), 3x daily Side effects, contraindications: - pregnancy - individual allergy - in oedema based on kidney or heart diseases Interactions: - not known

49 Betula pendula Roth. Betulaceae - ethnomedicne in North Europe: for rheuma, diuretic tea (leaf) - beer from the young branches, fermented wine from the sap extracted from the trunk in spring - resin glandules on the young branches - other drug: B. pubescens (protected!)

50 Drug: leaf collection in May-June (1) Betulae folium (Ph. Eur 4., Ph. Hg. VIII.) - flavonoid content determined in hyperosid: 1,5% Main compounds: 3% flavonoids: - hyperosid, kaempferol 0,1% essential oil triterpenes hydroxi cinnamic acid derivatives: caffeic acid potassium (K) OH O O Gal OH HO O HO OH hyperosid HO CH CH COOH There are no human clinical studies.

51 traditional use: - rheuma, arthralgia, gout - Romania: leaves are put on the bed or into the bath doses: - drug: 2-3 g/dose, 2-3x/day - preparations: standardized for mg flavonoids - pressed sap: 3 x 15 ml - tincture: 2 ml, 3x (1:10) Side effects, contraindications: - pregnancy, lactation - oedema based on kidney or heart diseases Interactions: - not known