Comfrey Herb Description - Drug Interactions, Dosage and Some of its Useful Properties

Taxonomic Class

Boraginaceae

Common Trade Names

Wise Woman Comfrey Salve. Several combination products are avail­able, including Alticort, Atri-Res, Black Ointment, C&F Formula, Comfrey/Aloe Capsules, Comfrey and Fenugreek, EB5 Footcare Formula, EB5 Toning Formula, #483 Oxox Cell Activator, Goldenseal Salve, H-Complex, Heal-All Salve, Kytta-Plasma f, Kytta-Salbe F, Liniment Virtue, Muco-Plex, Mucoplex, Mustard Salve, Pain-Less Rub, Plantain Salve, Procomfrin, Respa-Herb, Simicort, Super Salve, T­ANEM, T-ASMA, T-BC, T-BF, Traumaplant, T-SLC, and T-ULe.

Common Forms

Comfrey is available as a blended plant extract also known as “green drink,” homeopathic preparations, a poultice or liniment, a tea (dried leaf and whole root), and a topical cream or ointment and in bulk roots or leaves, capsules, elixir, mucilaginous decoctions, powder, and tincture. Pyrrolizidine alkaloid (PA)-free comfrey preparations are also available. Commercial root preparations are available, but they are not recommended for internal or external use because of their high concentration of PAs. Comfrey is available in combination products in veterinary medicine for topical treatment of muscle strains and ruptures and for oral administration as an antidiarrheal.

Source

An oil is extracted from the leaves and roots of Symphytum officinale, a member of the borage family. Comfrey is a perennial herb that grows in temperate regions, including western Asia, North America, and Australia.

Chemical Components

Comfrey contains a few compounds that show medicinal activity. Mucilage, a mucopolysaccharide of fructose and glucose, is concentrated in the root up to 29%. Allantoin, asparagine, beta-sitosterol, consolicine, consolidine, isobanerenol, lithospermic acid, PAs (up to 0.7% in dried root materials), rosmarinic acid, silicic acid, stigmasterol, symphytocynoglossin, tannins, and triterpenoids (including symphytoxide A) are also found in the plant.

Actions

Mucilage is reported to possess demulcent properties by forming a protective film to soothe irritation and inflammation. Allantoin is claimed to be a cell-growth stimulator, accounting for comfrey’s ability to stirn ulate wound healing and tissue regeneration. Tannin provides the as­tringent properties and rosmarinic acid imparts anti-inflammatory properties. The triterpenoid symphytoxide A is reported to possess hypotensive activity.

Reported Uses

The application of comfrey is limited to claims for healing wounds. Historically, comfrey was used for several internal ailments, such as ulcers of the bowel, stomach, liver, and gallbladder, but because the alkaloids are converted to toxic metabolites by liver enzymes after being ingested, internal use is no longer recommended.

External application of comfrey products is not considered as dangerous as oral administration. Externally, it is used for bruises and sprains and to promote bone healing.

The anti-inflammatory effects of comfrey were analyzed in 41 patients with musculoskeletal rheumatism. Twenty patients were treated with a PA-free ointment and the remainder received placebo for 4 weeks. Significant improvement was reported with the ointment compared with placebo in patients with epicondylitis and tendovaginitis, but no difference was found in patients with periarthritis .

Dosage

The oil from the leaves and roots can be incorporated in creams and ointments or used in a compress. Ointments and other external preparations are typically made with 5% to 20% comfrey. Comfrey should be applied topically on unbroken skin for less than 10 days or a maximum of 6 weeks per year in amounts at or below a daily dosage of 100 mcg of the unsaturated PAs.

Although comfrey has been used as a tea or taken in capsule form, it is not recommended for internal use because of its toxicity.

Adverse Reactions

CNS: chills, fever.

GI: abdominal pain, diarrhea, hematemesis, poor appetite, vomiting.

Hepatic: hepatotoxicity. exfoliative dermatitis, jaundice.

Other: weight loss, cancer (several animal studies report hepatocellular adenomas and urinary bladder tumors caused by PAs in comfrey death.

Interactions

Eucalyptus: May increase the risk of PA toxicity because of enzyme induction by eucalyptus. Avoid administration with comfrey.

Other PA-containing herbs: May increase risk of toxicity. Herbs that contain PAs include agrimony, alkanna, alpine ragwort, borage, colt’s foot, dusty miller, golden ragwort, goundsel, gravel root, ground’s tongue, hemp, petasties, and tansy ragwort. Avoid administration with comfrey.

Contraindications And Precautions

Internal use of comfrey is contraindicated because of hepatotoxicity. Because PAs are teratogenic and excreted in breast milk of animals, comfrey is contraindicated in pregnant or breast-feeding patients and in young children. It is also contraindicated in patients who are hypersensitive to comfrey and in those with a history of hepatic disease.

Special Considerations

Caution the patient not to use the root for medicinal purposes.

Instruct the patient to apply the mature leaves externally on intact skin for only a limited period; caution him not to use the leaves on open wounds.

Monitor wound appearance and size if the patient is taking comfrey to promote healing.

Assess for signs and symptoms of hepatotoxicity.

Comfrey either alone or in combination has been reported to cause abdominal pain, chills, death, diarrhea, exfoliative dermatitis, fever, hematemesis, jaundice, poor appetite, vomiting, and weight loss .

Alert Several studies report on hepatic veno-occlusive disease caused by PAs in the plant .

Caution the patient against consuming comfrey.

Advise the patient to try commercially available antiseptic ointments and creams before attempting to use comfrey to promote wound healing.

Advise women to avoid using comfrey during pregnancy or when breast-feeding.

Points of Interest

Comfrey has been used since the time of the ancient Greeks and Romans. In the Middle Ages, it was commonly applied as a poultice for treating broken bones, giving rise to the common names of boneset, knitback, and knitbone.

The botanical genus name, Symphytum, originates from the Greek physician Disocorides some 2,000 years ago and is derived from the Greek word sympho, meaning to unite. The common name, comfrey, is derived from the Latin confirmare, which means to heal or unite.

Commentary

Although comfrey has a long history of therapeutic claims for several ailments, it is potentially hepatotoxic and thus should not be consumed. Anecdotal reports and animal studies suggest medicinal benefit for wound healing. Commercially available topical antiseptic agents are probably safer and more effective.

Allergic Rash – Treatment for Curing it Fast and Effectively

What do doctors call this condition?

Allergic purpura

What is this condition?

Allergic rash is an inflammation of the cells that line the blood vessels, accompanied by allergic symptoms. The disorder affects the skin, urinary tract, digestive tract, and the joints. If allowed to develop fully, allergic rash is persistent and debilitating, and may lead to serious kidney disease. An acute attack of allergic rash may last several weeks, and death may result, usually from kidney failure. However, with appropriate treatment, most people recover from the disease.

Allergic rash affects more males than females and is most common in children ages 3 to 7 years.

What causes it?

The most common cause of allergic rash is thought to be an autoimmune reaction, in which the body’s immune system responds to a bacterial infection (such as strep) by attacking the tissues of its own blood vessel walls. Typically, symptoms first appear 1 to 3 weeks after an upper respiratory infection. Other possible causes include allergic reactions to certain drugs and vaccines, insect bites, and foods (such as wheat, eggs, milk, or chocolate).

What are its symptoms?

Typically, the person with allergic rash has small, flat, purple skin blotches of varying size, caused by blood leaking from damaged blood vessels into the skin. These blotches usually appear in symmetrical patterns on the arms and legs and are accompanied by itching. prickling, and tingling. Swelling may sometimes occur elsewhere on the body, such as on the face, hands, feet, or genitals.

In children, the skin blotches tend to be raised, firm, and swollen; they may expand and bleed. Tiny purple or red spots may appear on the legs and buttocks and near the genital and rectal areas.

In about 25% to 50% of cases, allergic rash also causes kidney inflammation, bleeding from the kidney or from the tissues lining the bladder or urethra, or a serious kidney disease called glomerulonephritis.

How is it diagnosed?

Because no test clearly identifies allergic rash, the doctor diagnoses the condition by carefully observing symptoms, often during the person’s second or third allergic attack. X-rays reveal swollen areas in the small bowel. Tests may also show blood in the urine and stools as well as evidence of kidney problems. Before diagnosing allergic rash, the doctor must rule our other types of rash.

How is it treated?

The doctor will work to manage symptoms. For example, to treat severe allergic rash, he or she may prescribe steroids to relieve swelling and pain relievers to alleviate joint and stomach pain. If allergic rash causes chronic kidney disease, the person may benefit from Imuran, a drug that suppresses the immune system. The doctor will also try to identify any substance that may be causing an allergic reaction. An accurate allergy history is essential.

What can a person with allergic rash do?

• Eliminate known rash-causing foods from your diet.

• After the acute stage, be sure to immediately report any recurrence of symptoms (most common about 6 weeks after symptoms first appear). Return for follow-up urinalysis .

Bitter Melon Drug Information - Precautions to be kept in mind while using Bitter Melon

Taxonomic Class

Cucurbitaceae

Common Trade Names

None known.

Common Forms

Available in a decoction or tincture and as juice or a whole fruit.

Source

Bitter melon is derived from the tropical tree Momordica charantia, which is native to Asia, East Africa, South America, and parts of the Caribbean. Seeds, vines, and leaves are used medicinally, but the fruit of the tree is most commonly used and generally thought to be the safest.

Chemical Components

Bitter melon contains the proteins alpha- and beta-momorcharin, along with serine protease inhibitors BGIA (bitter gourd inhibitor against amino acid-specific proteins) and BGTI (bitter gourd trypsin inhibitor). Also present is the plant protein MAP30; charantin, which is a mixture of steroidal saponins; and insulin-like peptides and alkaloids.

Actions

Recombinant MAP30 has been shown to inhibit HIV-1 and to have antitumorigenic effects with no untoward effects on normal human cells. MAP30 also may enhance the activity of dexamethasone and indomethacin as weak HIV antagonists by causing inactivation of viral DNA and specific cleavage of 28 S ribosomal RNA .

A crude extract of bitter melon was reported to be both cytostatic and cytotoxic to human leukemic lymphocytes and yet had no harmful effect on normal human lymphocytes in vitro . These effects were observed within 2 hours, and the researchers theorize that the effect may result from quick entrance of the factor into the cells.

A later study in mice led to the conclusion that the antileukemic properties exhibited by bitter melon may be caused, at least in part, by the activation of natural killer cells in the host .

Reported Uses

Bitter melon has been used as a food substance and to treat cancer, diabetes, and some types of infections. Beer, soups, and teas have been made from both the leaves and the fruit. Wax produced by the berries has been used in candlemaking.

A 1981 study measured the effect of a fruit extract of bitter melon on nine patients with type 2 diabetes. The extract was given and followed by a glucose tolerance test, which revealed an improvement in glucose tolerance that was small but possibly clinically significant. No increase in serum insulin levels was noted in these patients.

Dosage

The typical dose is one small unripe melon, the equivalent of about

50 ml of juice in divided doses b.i.d. or t.i.d. Up to 100 ml of the decoction or 5 ml of the tincture may be consumed daily, also in divided doses. No dosing information for patients with renal or hepatic impairment is available.

Adverse Reactions

GI: diarrhea, stomach pain (overdose).

Interactions

Antidiabetics: May cause additive effects, resulting in excessive hypoglycemia. Monitor blood glucose levels and patient closely.

Contraindications And Precautions

Bitter melon is contraindicated in patients with hypoglycemia because it may exacerbate this condition, causing dangerously low blood glucose levels. It is also contraindicated in young children, who may be overly sensitive to the hypoglycemic effect. Avoid using bitter melon in women who are pregnant because alpha- and beta-momorcharin have abortifacient properties . Data regarding the use of bitter melon in women who are breast-feeding are lacking.

Special Considerations

No dosage form can effectively mask the extremely bitter taste of bitter melon and its preparations.

Monitor the patient for adverse GI reactions because they may be signs of overdose.

Monitor the patient’s blood glucose levels if he is taking bitter melon for its hypoglycemic effect.

Commentary

The best-substantiated use for bitter melon is as an antidiabetic agent. Without clinical data on effective dosing and predictability of response, bitter melon should be used with care and probably not with other antidiabetic drugs until more is known about its potency. Bitter melon may show some value as adjunctive therapy for HIV-infected or leukemic patients in the future, but additional studies are needed to fully evaluate its efficacy and clinical relevance. Use of bitter melon as an anti-infective remains unsubstantiated.