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Herbs

An herb is a leaf, flower, stem, seed, root, fruit, or bark that is used for medicinal purposes, food flavoring, or for fragrant properties. However, herbs often rely on tradition and testimonials, not on extensive scientific testing.

More than one third of Americans use herbs for health purposes. Nurses need accurate information about the uses, effects, risk/benefits, safety and efficacy of these herbal remedies for patient teaching and providing holistic health care.

Not all individuals tell their healthcare provider that they are using herbal remedies. This website provides quick and practical information about these most popular medicinal herbs.

Caution should always be used when taking these herbs because of their potential for harmful effects.

Blue Cohosh (Caulophyllum thalictroides) - May induce labor Borage (Borago officianlis) - Living causing cancer Calamus (Acorus calamus) - Associated with malignant tumors Chaparral (Larrea divaricata) - Liver toxicity Colt's foot (Tussilago farfara) - Cancer causing and liver toxicity Comfrey (Symphytum officinale) - Liver cancer and Veno-occulusive disease Ephedra (Ephedra sinica) - High dosages can lead to asphyxiation and heart failure Germander (Teucrium chamedrys) - Liver toxicity Licorice (Glycrrhiza glabra) - Liver toxicity Poke Root (Phytolacca americana) - Poisonous, containing toxic lectins Sassafras (Sassafras albidum) - Liver cancer in small animals (still on the market)

There is a specialized vocabulary that is used to describe the properties of herbs and how they are prepared. Some common terminology is listed here.

Abortifacient an agent that induces expulsion of the fetus. Adaptogen herbs that act in a nonspecific way to strengthen the body and increase resistance to
disease and stress.

Astringent - An agent that contracts organic tissue, thus reducing secretions. Calmative - An agent with mild sedative or tranquilizing properties. Decoctions - Teas in which the water and herbs are boiled or simmered. Emmenagogue - An agent that promotes menstrual flow.

Infusions - Teas made from the delicate part of a plant, such as leaves, berries, flowers.
is heated to a boil and the herbs are added. The infusion is then steeped.

Water

Salves and ointments - combinations of herbs, wax and oils for external applications. Tinctures - Infusions with an alcohol base. They are very concentrated, long lasting, and stable.

Liability Issues

There are liability issues associated with the regulation and use of herbal products. Before you decide to use an herbal remedy, there are several important issues related to regulation, labeling and use. The FDA does not approve herbal products as medications. They are classified as dietary supplements. Herbs cannot be patented. Therefore, drug manufacturers have little incentive to invest in clinical research studies. The only legal requirement is in labeling herbal remedies or marketing herbal remedies is the sale of such products can not be promoted as preventing or treating disease. The FDA issued under the Dietary Supplement and Health Education Act of 1994 allows these products to be labeled with statements explaining their purported effects on the structure or function of the human body or their role in promoting general well-being. There are a wide range of dosages and prices of herbal products. There is a lack of quality standards and controls.

Most medical insurance policies do not cover alternative therapies, although coverage for this has increased in recent years.

Clinical Documentation for Nurses


Below are suggestions to be used when documenting interactions with consumers about herbal remedies.

Document all nurse-client interaction related to herbal remedies.

Recommend follow-up with a health care provider. (MD or NP)

Record products and dosages clients are taking. Document that the client is aware that the FDA does not regulate herbs.

Document discussion of safety and efficacy guidelines as well as safe use.

Safety and Efficacy Issues


With the passing Dietary Supplement Health and Education Act (DSHEA) of 1994, the production of herbal remedies increased. However they do not require approval by the FDA. Safety and efficacy is not guaranteed. Problems include: 1. Varying amounts of herbal products. 2. Additive effects of an active drug, that produces adverse effects. 3. Contamination of herb with toxic pathogens and/or chemicals. 4. Accidental substitution of a herb with a toxic species. 5. Labeling - does not include proper dosing guidelines or warnings. They must provide a disclaimer stating the FDA has not reviewed the herb and it is not intended to be used as a drug. Only 7 herbs are approved by the FDA 36 are considered by the German Commission E to be effective

Guidelines for safe use of herbal remedies for the consumer and the nurse to educate

Clarify a correct diagnosis from a health care provider to rule out serious illness.

Evaluate the consumer's knowledge and comfort level with the use of herbs.

Buy herbs from a reputable source/manufacture.

Seek knowledgeable sources for information on herbal remedies.

Avoid herbs during pregnancy especially during the 1st trimester of pregnancy or if trying to get pregnant.

Do not take if lactating.

Do not give herbs to ababy or young children.

Keep out of reach from children.

Do not take a large quantity of any one herbal remedy.

Only herbs buy when the plants and their quantities are listed on the packet (no guarantee of safety)

Current Research
There are many research trials in alternative and complementary medicine currently in progress at the National Institutes of Health, however three clinical trials listed below deal specifically with herbs. 1. Drug Interaction Study of Tegretol (Carbamazepine) and St. John's Wort in Normal Volunteers. Purpose: To determine if interaction between Tegretol and St. John's Wort can interfere with the drug's effectiveness. ( http://clinicalstudies.info.nih.gov ) 2. Study of Possible Mood Changes and Mechanism of Action of St. John's Wort Purpose: To test normal volunteers whether St. John's Wort will alter mood and if so, by what means. ( http://clinicalstudies.info.nih.gov/detail/A_1999-M-0151.html ) 3. Ginkgo Biloba Prevention Trial in Older Individuals Purpose: To identify dementia, specifically Alzheimer's disease, and will include mortality and changes functional status.( http://nccam.nih.gov/ ) Alternative Medicine: What work. Fugh-Berman, Adriane. Baltimore, MD: Williams & Wilkins, 1997. Alternative Remedies [CD-ROM]. Blake, Steve. St. Louis, MO. Mosby, 1999.

Encyclopedia of Complementary Health Practice. Clark, Carolyn. (Ed.). New York: Springer Publishing Company, 1999. Fundamentals of Complementary and Alternative Medicine. Micozzi, Marc. (Ed.). New York: Churchill Livingstone, 1996. Healing Practices: Alternative Therapies for Nursing. Fontaine, Karen. Upper Saddle River, NJ: Prentice Hall, 2000. Nurse's Handbook of Alternative & Complementary Therapies. Springhouse. Springhouse, PA: Springhouse Corporation, 1998. PDR for Herbal Medicines. Gruenwald, J. Brendler, T., Jaenicke, C., eds. Montvale, New Jersey; Medical Economics Company, Inc.; 1998 Professional's Handbook of Complementary & Alternative Medicines. Charles W. Fetrow and Juan R. Avila. Springhouse Corporation 1999. The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies. Barrie R. Cassileth. WW Norton 1998. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Blumenthal M, Busse W. Goldberg, A, et al. Austin, Texas. American Botanical Council; 1998. The Herbal Menopause Book. McQuade Crawford, A. Freedom, California: The Crossing Press. 1996. Tyler's Herbs of Choice. Robbers, J. E., Tyler, V. E., Binghamton, New York: Haworth Press; 1998. Tyler's Honest Herbal. Foster, S., Tyler, V. E., Binghamton, New York; Haworth Press; 1998.

Organizations American Botanical Council PO Box 144345, Austin, TX 78714-4345 The Herb Research Foundation 1007 Pearl St. Suite 200, Boulder, CO 80302 The American Holistic Nurses Association, P.O. Box 2130, Flagstaff, Arizona 86003 Center of Complementary and Alternative Medicine at the National Institutes of Health. NIH, P.O. box 8218, Silver Spring, Maryland 20907

Journals American Herb Association Quarterly - an association of Medical Herbalists to promote understanding, acceptance and ecological uses of herbs. Newsletters to bring you the latest information. HerbalGram - copublished by the American Botanical Council and Herb Research Foundation.

The Review of Natural Products - published by Facts and Comparisons, as a loose-leaf on a quarterly basis.

On-line Resources National Center for Complementary and Alternative Medicine: http://nccam.nih.gov/ American Holistic Nurses Association: http://ahna.org/ American Botanical Council: http://www.herbalgram.org/ Integrative Medicine Nursing Consult: http://www.onemedicine.com Prescribers Letter: http://www.NaturalDatabase.com Nursing Network: http://www.nursingnetwork.com/title.htm

http://www.salisbury.edu/nursing/herbalremedies/Resources.htm