DRUG-HERB AND DRUG-SUPPLEMENT INTERACTIONS
ROLE OF DIETARY SUPPLEMENTS IN MODERN LIFE
Many people today take dietary supplements, herbal remedies, botanicals, and other “natural products” as part of their daily wellness regimen. Dietary supplements come in the form of pills, powders, or liquids and are widely available. Note that in the United States, herbs and herbal remedies are regulated as dietary supplements.
DO SUPPLEMENTS PREVENT OR TREAT DISEASE?
While there is a lot of evidence that dietary supplements help to prevent and treat nutrient deficiency, there is less evidence about the usefulness of dietary supplements in preventing or treating disease. In an evidence-based study of the links between nutritional supplements and mood and neurological disorders, antioxidants, omega-3 fatty acids, quercetin, folate, and zinc demonstrated benefit for depression. Elsewhere, research indicates that pomegranate may ward off infection, turmeric has been studied for Alzheimer disease, rheumatoid arthritis, and prostate and colon cancer, and ginger has proven effective for nausea and vomiting.
DOES MY SUPPLEMENT OR HERB INTERACT WITH MY PRESCRIPTION DRUG?
Although herbs and herbal remedies are regulated as dietary supplements and not as drugs, prescription drugs and herbs may interact in harmful ways. Some supplements decrease the effects of a drug. Others may increase a drug’s effects and produce unwanted side effects.
Significantly, there is extensive evidence that St. John's wort interacts in dangerous, sometimes life-threatening ways, with a variety of prescription drugs including birth control pills, antidepressants, and some HIV drugs. There is still a lot we don’t know.
TELL YOUR HEALTH CARE PROVIDER
It’s important to tell your health care provider about all dietary supplements and drugs you take so they can help you avoid harmful interactions.
WHERE DO I LEARN MORE?
National Center for Complementary and Integrative Health
Fact sheets on specific herbs or botanicals
MedlinePlus of the U.S. National Library of Medicine
Drugs, Herbs and Supplements page
Tarascon Pocket Pharmacopoeia 2020 Richard J. Hamilton, M.D., Editor-in-Chief. Ten pages detailing possible drug interactions with commonly used herbs.
Herbal Contraindications and Drug Interactions 2010 Frances Brinker, N.D. Comprehensive guide to drug-herb interactions with additional extensive appendices addressing common conditions, medications and nutritional supplements, and influences on phase I, II, and III metabolism.
Disclaimer: Information in this blog is presented for educational purposes only. Not intended to diagnose, treat, cure, or prevent any disease. The use of herbal preparations is not recommended without seeking the advice of a health care provider. Substances in herbal preparations may interact with prescription drugs to eliminate therapeutic efficacy or induce toxicity.
The role of Chinese herbs in the treatment of novel coronavirus
TRADITIONAL CHINESE HERBAL REMEDIES
As evidenced by a February 18th tweet from China Xinhua News, healthcare practitioners across China are relying on centuries-old remedies to treat the novel coronavirus. In the absence of targeted drugs and vaccines, with continual updates to the national diagnosis and treatment program for novel coronavirus, the role of traditional Chinese medicine (TCM) is on the rise. More COVID-19 patients are being treated with Chinese medicine or integrated Western-Chinese medicine, and the role of TCM herbal prescription formulas is expanding. What formulas are they using? What do the properties of these herbs tell us about TCM approaches to the virus?
USE OF CHINESE HERBS TO TREAT THE CORONAVIRUS
With an array of treatment methods and a wealth of experience in its arsenal, Chinese medicine has been used to fight plagues and epidemics for thousands of years. The focus of TCM is not just the virus itself but also symptoms and changes to the body caused by the invasion of the virus. Treatment starts with the patient as a whole, to identify patterns and then dispel sickness and support health.
HERBAL FORMULA USAGE RATES 80% TO 95%
Reports from throughout China indicate TCM formula usage rates of 80% to 95% in confirmed cases of novel coronavirus. One specialist described isolation wards containing a mix of mild, typical, and severe cases of novel coronavirus. Typical cases are characterized as imaging findings in the lungs but the absence of disease progression to respiratory failure. In hospitals, traditional Chinese medicine plays a significant role in regulating diarrhea, constipation, and other gastrointestinal symptoms; in addition, intervention with Chinese medicine may stop the condition from progressing to the severe and critical stages.
WHAT FORMULAS ARE BEING USED? WHAT FORMULAS HAVE BEEN VALIDATED?
The National Health Commission and the State Administration of Traditional Chinese Medicine recommend Qingfei Paidu decoction (清肺排毒汤); clinical observation and data analysis have been performed on the therapeutic efficacy of this classical TCM formula. One formula for Qingfei Paidu decoction appearing on multiple sites, including Baidu, listed 21 ingredients. The top ingredients in terms of quantity are calcium sulfate, Radix bupleuri (common name bupleurum, effective in the treatment of alternating chills and fever; may induce headache or nausea), Poria cocos (efficacy in draining dampness and transforming phlegm; concurrent administration of diuretics contraindicated), Radix dioscoreae (Chinese yam, known to tonify qi and yin of the lungs, spleen, and stomach; may have hypoglycemic effects, use with caution in comorbid hepatobiliary disease).
Pneumonia Formula No. 1 (肺炎一号), developed by the Chinese Medicine Department at Guangzhou Eighth People's Hospital, and its variations Pneumonia Formula No. 2, Pneumonia Formula No. 3, Pneumonia Formula No. 4, and Pneumonia Formula No. 5 are also in use. Formula No. 1 has achieved favorable clinical results in Guangzhou. Formula No. 1 includes two herbs that clear heat and relieve toxicity, Flos lonicerae (honeysuckle flower) and Fructus forsythiae (forsythia fruit), along with 16 other ingredients.
In Chinese medicine, the treatment regimen adopted varies by person. If a patient is in poor physical condition, dispelling disease is not enough, treatment must focus on supporting health. For example, in those with poor appetite it is necessary to focus on spleen health; in patients with damp-heavy qi and thick tongue coating it is necessary to improve the flow of urine. Ear needling (acupuncture) may be used to treat the patient’s psychological state and resolve issues of insomnia, in order to restore the patient’s biological clock.
Just as treatment varies by individual patient, the virus varies by region. This too is a factor in treatment selection. It would not be appropriate to select one uniform formula for the entire nation.
NOT ADVOCATED FOR THE HEALTHY
NOT ADVOCATED FOR THE PREVENTION OF CORONAVIRUS
According to the head of a university of traditional Chinese medicine, the entire populace does not need to take this medicine. Healthy people need to improve resistance in order to avoid getting sick. High-risk populations, including healthcare providers, may take herbal remedies as appropriate.
Practitioners emphasized that these are treatment prescriptions and are not recommended as preventive prescriptions. The general public should not self-administer these prescriptions.
This blog briefly examines TCM principles and herbal remedies in light of recent Chinese media reports on novel coronavirus treatment in China. This examination is not intended to replace medical advice from a trained and qualified professional, and the use of herbal preparations is not recommended without the advice of a healthcare provider. Substances in herbal preparations may interact with prescription drugs to eliminate therapeutic efficacy or induce toxicity.
In the chill of winter, we gravitate to warmth and light.
Originating in northeastern China, central Mongolia, and Manchuria, the root of the herbaceous perennial Astragalus membranaceus or 黃芪 (huangqi) is a staple of traditional Chinese medicine. Mild in strength, with a sweet and slightly warm nature and an affinity for the spleen and lungs, astragalus is used as a general tonic to improve endurance, immune resistance, and energy, and to promote blood flow to the surface. Astragalus is useful for viral infections and increases the action of interferon alpha-1. It tonifies the spleen, the qi, and the blood. It is indicated for energy deficiency, fatigue, prolapse of rectum, womb, or other organs, profuse sweating due to external “empty” ailments, stubborn abscesses, facial swelling, and diabetes.
The use of astragalus root as a general tonic dates to the 28th century BCE and the mythical Chinese ruler Shennong, the legendary author of the first materia medica. Astragalus root has a long, cylindrical taproot, which is internally yellowish in color, but rootlets should be absent. The constituents of astragalus root include triterpenoid saponins, astragalosides I-VIII, astramembranins I and II, isoglavones including formononetin and kumatakenin, and polysaccharides known as astrogaloglucans. There is anecdotal but little clinical evidence that astragalus alone or in combination aids in the treatment of the common cold or impaired immunity. Clinical studies supported by data from over 1000 patients in China confirm the use of astragalus as an immunostimulant for use in colds and upper respiratory infections. It is also used prophylactically. In general, astragalus is well tolerated but should probably be avoided in autoimmune diseases.
WINTER TONIC SOUP
Traditionally, the roots of Astragalus membranaceus are added to soup before the cold season to prevent respiratory ailments. Astragalus is an adaptogen and increases qi. The recommendation is to eat astragalus soup daily for one to three months to build immunity for the winter.
Root herbs astragalus, ginseng, eleuthero
Six cups low-salt soup broth
2 tablespoons olive oil
2 cloves garlic
1-2 pounds chicken (optional - for added immunity)
2 cups of chopped greens (spinach, chard, kale)
4 sprigs of parsley
2-3 sprigs of sage
6 slices of ginger root
Step 1: Soak root herbs in large pot with soup broth while preparing Steps 2 and 3.
Step 2: Mince garlic, chop carrots and onion. Sauté in olive oil over low heat until onions are translucent.
Step 3: Add chicken to above and brown on both sides.
Step 4: Add sautéed carrots, onions, and garlic, as well as chopped greens, sprigs of parsley and sage, slices of ginger, and chicken to soup broth.
Step 5: Simmer soup 3-4 hours, then remove root herbs, ginger slices, and sprigs of parsley and sage.
Step 6: Season to taste with salt and pepper or soy sauce/hot oil/sesame oil.
Information in this blog is presented for educational purposes only. The use of herbal preparations is not recommended without seeking the advice of a healthcare provider. Substances in herbal preparations may interact with prescription drugs to eliminate therapeutic efficacy or induce toxicity. In theory, astragalus may enhance the activity of drugs for diabetes and hypertension. Avoid astragalus root if you already have cold, flu, or fever.
Kerilyn Sappington is the founder of Integrative Translations, which specializes in Chinese-to-English and Spanish-to-English translation of conventional and complementary medicine.