Volker Schulz

Medicinal Plants, Phytomedicines, and Phytotherapy

From a historical perspective, the production of medicines and the pharmacologic treatment of diseases began with the use of herbs. Methods of folk healing practiced by the peoples of the Mediterranean region and the Orient found expression in the first European herbal, De Materia Medica, written by the Greek physician Pedanios Dioscorides in the first century AD. During the Renaissance, this classical text was revised to bring it more in line with humanistic doctrines. The plants named by Dioscorides were identified and illustrated with woodcuts, and some locally grown medicinal herbs were added. Herbals were still based on classical humoral pathology, which taught that health and disease were determined by the four bodily humors - blood, phlegm, black bile, and yellow bile. The humors, in turn, were associated with the elemental principles of antiquity: air, water, earth, and fire. The elements could be mixed in varying ratios and proportions to produce the qualities of cold, moist, dry, or warm - properties that also were associated with various proportions of the four bodily humors. Thus, if a particular disease was classified as moist, warm, or dry, it was treated by administering an herb having the opposite property (Juttner, 1983). Plant medicines were categorized by stating their property and grading their potency on a four-point scale as “imperceptible,” “perceptible,” “powerful,” or “very powerful.” Opium, for example, was classified as grade 4/cold. A line of association that linked sedation with “cooling” allowed the empirically known sedative and narcotic actions of opium to be fitted into the humoral system. Pepper was classified as grade 4/dry and warming. The goal of all treatment, according to Hippocrates, was to balance the humors by removing that which is excessive and augmenting that which is deficient” (H.Haas, 1956). Humoral pathology obviously developed into one of the basic principles of conventional medicine.

Gynecologic Indications for Herbal Remedies

Herbal remedies cover a small but very important range of indications in the treatment of gynecologic diseases and functional disorders. They are used principally in the treatment of premenstrual syndrome (PMS), dysmenorrhea, and menopausal complaints in cases where stronger-acting drugs are not indicated or are declined by the patient. Two medicinal plants stand out in the frequency with which they are prescribed for gynecologic complaints: chasteberries (used chiefly for PMS) and black cohosh rhizome (used principally for menopausal complaints) (Schwabe and Rabe, 1995). Table 7.1 also lists four other herbs recommended by Commission E as having gynecologic indications. It can be seen that the range of recommended dosages (column 3 in Table 7.1) is greater for gynecologic herbal remedies than for any other class of phytomedicines. Some of the dosages are many times lower than the traditional single dose of about 1–4 g of crude drug taken in a cup of medicinal tea. There is an urgent need for pharmacologic and clinical studies to investigate the dose-dependency of the actions and efficacy of these drugs.

Skin and Connective Tissues

This chapter deals first with plant drugs that are commonly used for dermatologic indications (local inflammations, eczema, neurodermatitis, acne, wound healing problems). A separate section deals with herbal remedies that are used externally or in some cases internally for the treatment of trauma and its sequelae (bruises, contusions, hematomas, fracture edema) and rheumatic complaints. The chapter concludes with a look at the potential uses of externally applied herbal preparations in the treatment of pain. Given the medical and economic importance of analgesic remedies, it is important to give due attention to possible phytotherapeutic alternatives.

Central Nervous System

The plant kingdom is replete with compounds and mixtures of compounds that have a stimulating or calmative effect on the central nervous system (CNS). In cases where this action is due to a single high-potency compound that can be chemically isolated, such as morphine, cocaine, or atropine, the plant and its preparations are considered to be outside the realm of phytotherapy (see Sect. 1.2). Herbs that contain caffeine are discussed in Sect. 3.2.1.1. Most other herbs affecting the CNS fall under the broad heading of plant sedatives. However, recent controlled therapeutic studies have identified fairly specific indications for three of the psychotropic plant drugs. Thus, ginkgo biloba extract is considered a nootropic agent that is effective in the symptomatic treatment of cognitive deficiencies (Hartmann and Schulz, 1991; Schulz et al. 1997; Le Bars et al., 1997; Ernst and Pittler, 1999). Extracts from St. John’s wort have proven highly effective in the treatment of depression (Harrer, Payk and Schulz, 1993; Muller and Kasper, 1997; Wong et al. 1998), and extracts from the kava root (Piper methysticum rhizome) have shown efficacy as anxiolytic drugs (Volz and Hansel, 1994; Volz, 1997).

Heilpflanzen, Phytopharmaka und Phytotherapie

Pflanzliche Produkte standen — historisch gesehen — am Anfang der Arzneimittelgewinnung und der Krankenbehandlung mit Arzneimitteln. Die heilkundlichen Erfahrungen der Volker des Mittelmeerraumes und des Orients fanden Eingang in die „Materia medica“des griechischen Arztes Pedanios Dioskurides aus dem ersten Jahrhundert unserer Zeitrechnung. Im Zeitalter der Renaissance wurde der antike Text nach Humanistenart gereinigt und rekonstruiert. Die bei Dioskurides genannten Pflanzen wurden identifiziert und im Holzschnitt abgebildet. Da und dort setzte man einheimische Heilpflanzen hinzu. Auf diese Weise wurde die „Materia medica“zum Vorbild der zahlreichen Krauterbucher. Das Therapiekonzept der Krauterbucher war weiterhin das der antiken Humoralpathologie, eine Lehre, wonach die vier Safte — das Blut, der Schleim, die schwarze Galle und die gelbe Galle — die Hauptrolle im normalen und pathologischen Geschehen bildeten. Diese vier Korpersafte wurden zu den Elementarprinzipien der Antike Luft, Wasser, Erde und Feuer in Beziehung gesetzt. Je nach dem Mischungsverhaltnis und Anteil der Elemente ergaben sich die Qualitaten kalt, feucht, trocken und warm, die nun wiederum auf das individuell verschiedene Mischungsverhaltnis der Safte ubertragen wurden, von welchem Gesundheit und Krankheit abhingen. So gab es Krankheiten mit einem feuchten, warmen oder trockenen Charakter, zu denen pflanzliche Mittel von entgegengesetzter Qualitat verabreicht wurden (Juttner, 1983). Die Starke der Wirkung stufte man in einer Gradlinie als unmerklich, merklich, heftig und sehr heftig ein.

Mittel zur Steigerung der Abwehrkräfte

Pflanzliche Arzneimittel werden gern in Therapiekonzepte im Sinne einer „Natur- und Ganzheitsmedizin“ eingebunden. Die streng organbezogene Zuordnung der einzelnen Phytopharmaka bzw.deren Indikationen, wie sie in diesem Buch vorgenommen worden sind, wird daher nicht von allen Arzten und Anwendern geteilt. Bei zwei Praparategruppen ist eine solche anatomisch gepragte Zuordnung uberhaupt nicht moglich. Es handelt sich dabei um Phytopharmaka, die adaptogen bzw. immunstimulatorisch wirken sollen.Unter Adaptogenen versteht man vorzugsweise Praparate, die einen Organismus gegenuber physikalischen, chemischen und biologischen (nicht infektiosen) „Stressoren“ widerstandsfahiger machen sollen, wahrend die so genannten „Immunstimulanzien“ vor allem die unspezifischen korpereigenen Abwehrmechanismen gegen Krankheitserreger, insbesondere gegen virale und bakterielle Infekte, aktivieren sollen.

Haut, Traumata, Rheuma und Schmerz

In diesem Kapitel werden zuerst pflanzliche Zubereitungen behandelt, die in typischer Weise bei dermatologischen Indikationen (lokale Entzundungen, Ekzem/Neurodermatitis, Akne, schlecht heilende Wunden) angewendet werden. In einem separaten Abschnitt werden pflanzliche Arzneimittel zusammengefast, die bei Verletzungs- und Unfallfolgen (Prellungen, Quetschungen, Hamatome, Frakturodeme) sowie bei Arthrosen und rheumatischen Beschwerden zur auseren, teilweise aber auch zur inneren Anwendung empfohlen werden. Abschliesend werden in diesem Kapitel die Moglichkeiten der externen Behandlung von Schmerzzustanden mit Zubereitungen von atherischen Olen dargestellt. In Anbetracht der medizinischen und volkswirtschaftlichen Bedeutung der Schmerzmitteleinnahme verdienen phytotherapeutische Alternativen dieser Art besondere Aufmerksamkeit.

Skin, Trauma, Rheumatism, and Pain

This chapter deals first with plant drugs that are commonly used for dermatologic indications (local inflammations, eczema, neurodermatitis, acne, wound healing problems). A separate section deals with herbal remedies that are used externally or in some cases internally for the treatment of trauma and its sequelae (bruises, contusions, hematomas, fracture edema) and of osteoarthritis and rheumatic complaints. The chapter concludes with a look at the potential uses of externally applied preparations of essential oils in the treatment of pain. One phytomedicine taken orally for the prophylaxis of migraine headache is also included. Given the medical and economic importance of analgesic remedies, it is important to give due attention to possible phytotherapeutic alternatives.

Appendix: The 100 Most Commonly Prescribed Herbal Medications in Germany

The following tables reviewing the 100 most frequently prescribed herbal medications are based on the Public Health Insurance Drug Index as published in the 1996 Drug Prescription Report (Schwabe and Paffrath, 1996). The nomenclature for herbs and herbal products follows the terminology used in the Rote Liste 1995. These 100 herbal products rank among the 1393 most commonly prescribed medications in Germany. They represent approximately 8 % of the total German drug market, with gross pharmacy sales totaling 1.650 billion DM in 1995. Fifty-one of the 100 most commonly prescribed remedies are single-herb products (1.117 billion DM), and 49 are combination products (.533 billion DM). The latter include 22 two-herb products, 15 three-herb products, 3 four-herb products, 5 five-herb products, and 4 products containing from 6 to 13 herbs. The leading indications for herbal remedies listed in order of sales volume (Table A1) correspond to the eight chapter headings in this book. Ginkgo preparations are discussed primarily in Chap. 2 (Central Nervous System), and chamomile preparations for external use (pain, rheumatic conditions, bruises) and anti-inflammatory internal use are discussed in Chap. 8 (Skin and Connective Tissues). The 52 most commonly prescribed single-herb products can be reduced to 27 herbs and plant parts, which are listed in order of sales volume in Table A2.

Herz und Kreislauforgane

Phytopharmaka spielen eine bedeutsame Rolle bei der Behandlung leichter Formen der Herz- und Koronarinsuffizienz, bei der Prophylaxe und Therapie der Arteriosklerose und deren Folgeerkrankungen sowie bei der symptomatischen Therapie der chronischen venosen Insuffizienz. Qualifizierte Nachweise der Wirksamkeit und Unbedenklichkeit liegen allerdings nur fur wenige Drogen vor, namlich fur Weisdorn (Herz- und Koronarinsuffizienz), fur Knoblauch und fur Ginkgo-Extrakt (Arteriosklerose und arterielle Verschlusskrankheit) und fur Roskastanien-Extrakt (chronische venose Insuffizienz). Diesen 4 pflanzlichen Drogen ist daher der Hauptteil dieses Kapitels gewidmet. Weitere Praparate, darunter die so genannten Digitaloid-Drogen sowie pflanzliche Mittel gegen Angina pectoris, Herzrhythmusstorungen, Hyper- und Hypotonie, werden erganzend dargestellt.