DIETARY SUPPLEMENT HEALTH AND EDUCATION ACT OF 1994

1
DIETARY SUPPLEMENT HEALTH AND EDUCATION ACT OF
1994

• DEFINITION OF DIETARY SUPPLEMENT
• is a product (other than tobacco) that is
  intended to supplement the diet that bears or
  contains one or more of the following dietary
  ingredients a vitamin, a mineral, an herb or
  other botanical, an amino acid, a dietary
  substance for use by man to supplement the diet
  by increasing the total daily intake, or a
  concentrate, metabolite, constituent, extract, or
  combinations of these ingredients.
• is intended for ingestion in pill, capsule,
  tablet, or liquid form.
• is not represented for use as a conventional
  food or as the sole item of a meal or diet.
• is labeled as a "dietary supplement."
• includes products such as an approved new
  drug, certified antibiotic, or licensed biologic
  that
• was marketed as a dietary supplement or
  food before approval, certification, or license
• (unless the Secretary of Health and Human
  Services waives this provision).

2
SAFETY

• Under DSHEA a dietary supplement is adulterated
  if it or one of its ingredients presents "a
  significant or unreasonable risk of illness or
  injury" when used as directed on the label, or
  under normal conditions of use (if there are no
  directions).
• A dietary supplement that contains a new dietary
  ingredient (i.e., an ingredient not marketed for
  dietary supplement use in the U.S. prior to
  October 15, 1994) may be adulterated when there
  is inadequate information to provide reasonable
  assurance that the ingredient will not present a
  significant or unreasonable risk of illness or
  injury
• The Secretary of HHS may also declare that a
  dietary supplement or dietary ingredient poses an
  imminent hazard to public health or safety

3
NUTRITIONAL SUPPORT STATEMENTS

• Claims may not be made about the use of a dietary
  supplement to diagnose, prevent, mitigate, treat,
  or cure a specific disease (For example, a
  product may not carry the claim "cures cancer" or
  "treats arthritis." )
• Appropriate health claims authorized by FDA--such
  as the claim linking folic acid and reduce risk
  of neural tube birth defects and the claim that
  calcium may reduce the risk of osteoporosis--may
  be made in supplement labeling if the product
  qualifies to bear the claim.
• Manufacturers may describe the supplement's
  effects on "structure or function" of the body or
  the "well-being" achieved by consuming the
  dietary ingredient. To use these claims,
  manufacturers must have substantiation that the
  statements are truthful and not misleading and
  the product label must bear the statement "This
  statement has not been evaluated by the Food and
  Drug Administration. This product is not intended
  to diagnose, treat, cure, or prevent any disease."

4
Black Cohosh

• Action Antispasmodic, regulates menses,
  astringent, diuretic, cough suppressant, and
  diaphoretic. Astringent and sedative.
• Medicinal uses Delayed painful menstruation and
  ovarian cramps.
• Menopausal symptoms
• Rheumatic pains, muscular and neurological pain.
• Side effects low
• Dose20-80mg std ext. (2xd)
• 250-550 mg freeze dried root

5
Chemistry, Functions, Toxicity

• Steroidal terpenes, cimigoside, acteina,
  isoflavone, formononetine
• Vascular and estrogen-like action, suppress
  LH,(?)
• Contraindicated during pregnancy (uterine
  contraction)

6
Herb Drug Interaction

• Anesthetics, antihypertensive, sedatives may
  increase hypotensive effect
• Estrogens, hormonal contraceptives may increase
  effects.
• Possible interaction with tamoxifen (Nolvadex)

7
Bilberry

• Actions vasoprotective, anti-edema,
  anti-inflammatory, astringent.
• Medicinal usesacute diarrhea and mild
  inflammation of the mucus membranes. Prevent
  capillary fragility (eye disorders, macular
  degeneration)Varicose veins, thrombosis and
  angina.
• Side effectsnone
• Dose 80-100mg std ext (2xd)

8
Chemistry, Functions, Toxicity

• Active componentsAnthocyanoside, tannins,
  flavonoids
• Reduction of vascular permeability and tissue
  edema, aid in micro vascular blood flow, retina,
  macular degeneration
• Hepatic dysfunction (if tannin high)

9
Herb Drug Interaction

• Anticoagulants/antiplatelet
• Dont take with alcohol Disulfiram-like reactions
• Dont take it during breast-feeding

10
Chamomile

• Actions Anti-inflammatory, antiseptic, sedative,
  antispasmodic.
• Medicinal Uses Gastrointestinal disorders.
  Calming and sedative effect general relaxation.
  Childrens cold, eye wash, skin treatment.
• Side effects low
• Dose 1-3 teaspoon decoction
• tincture 1-4 ml in a cup water
• oil1-2 drop (150 dilution)

11
Chemistry, Functions, Toxicity

• Volatile oils a-bisabolol, chamazulene, (?
  inflammation, fever)
• flavonoids apeginin, luteolin, quercetin
  (inflammation, sedative, antioxidant)
• CNS action is through benzodiazepine receptors
• Orally used to treat diarrhea, anxiety,
  restlessness, flatulence , teas mainly used for
  sedation or relaxation.
• Topically reduce inflammation, induce healing of
  wounds and burns
• Toxicity contact dermatitis, allergic reactions
• GI nausea, vomiting
• Anaphylaxis in case of extreme sensitivity

12
Herb Drug Interaction

• Antiplatelet and anticoagulants (warfarin,
  aspirin, heparin, NSAIDs, clopidogrel,
  eptifibatide, tirofiban, ticlopidine,
  dipyridamole and COX-2 inhibitors

13
Dong Quai

• Actionsadaptogenic, restores menstrual
  regularity, reduces PMS, prevents anemia,
  digestive bitter
• Medicinal uses Female hormonal balance, high
  iron content (anemia treatment), promotes
  circulation and bile secretion.
• Side effects low
• Dose 125-500 mg std ext(eve)
• tincture 1-2 teaspoon

14
Chemistry, Functions, Toxicity

• At least six coumarin derivatives (anticoagulant,
  vasodilating, antispasmodic activity)
• N-buthylphtalide, nicotinic acid, safrole,
• Vitamins A, E, B12
• Weak estrogen-agonist activity, treats blood
  deficiency, chronic hepatitis and cirrhosis,
  irregular menstruation.
• High dose cytotoxic, bleeding tendency ,first
  trimester abortive) dont use in acute virus
  infection

15
Herb Drug Interaction

• Enhance anticoagulant effect
• Increased risk of photosensitivity

16
Echinacea

• Actions immuno-stimulant, anti-inflammatory,
  vulnerary, lymphatic.
• Medicinal Uses preventive use in case of colds
  and flu at early stage of infections. Wound and
  burns. Infections of urinary tract. Inflammation
  of the mouth and pharynx.
• Side effects low
• Doses tincture15-30 drops 2-5 times the first
  day /2x the following days.

17
Chemistry, Functions, Toxicity

• Alkylamides, caffeic acid derivatives,
  polysaccharides, essential oils, polyacetylene
  flavonoids
• Stimulates phagocytosis, mobility of leucocytes,
  respiratory cellular activity
• Allergic reactions, angioedema, urticaria,
  anaphylaxis

18
Herb Drug Interaction

• Alkylating agents anticancer therapy drugs
• azathioprine (Imuran) CellCept cyclosporine
  (Neoral, Sandimmune) Prograf Rapamune Zenapak
• Liver enzyme influence/clearance
• Allergy drugs such as Allegra
• Antifungal drugs such as ketoconazole (Nizoral)
  and Sporanox
• Cancer drugs such as etoposide, paclitaxel,
  vinblastine, or vincristine
• Drugs for high cholesterol such as lovastatin
• midazolam (Versed)
• Oral contraceptives

19
Evening Primrose

• Actions Anti-inflammatory, anti-allergic,
  corrects omega-6 deficiency, hypotensive
• Medicinal Uses PMS, atopic dermatitis,
  rheumatoid arthritis, CFS, ulcerative colitis,
  IBS, hypertension, mastalgia
• Side effects low
• Doses250-500 mg/ day
• 600mg arthritis, hypertension, cardiovascular
  disorders

20
Chemistry, Functions, Toxicity

• PUFA, gamma linoleic acid
• Anti-inflammatory, intestinal Ca absorption,
• Hypotensive, inhibit gastric mucosal damage
• Headache, mild nausea, arachidonic acid build up

21
Herb Drug Interaction

• Avoid concomitant use with phenothiazines.
• Contraindicated in epilepsy

22
Feverfew

• Actions Anti-inflammatory, vasodilator,
  anti-pyretic, antispasmodic, bitter
• Medicinal Uses Prophylaxis and treatment of
  migraine. Cough, colds, febrile diseases, nervous
  debility, worm infestation, dyspepsia.
• Side effects low-medium
• Doses 50-200 mg/day tincture 5-20 drops

23
Chemistry, Functions, Toxicity

• Sesquiterpene lactons parthenolide, (and
  derivatives) canin, balchanin, volatile oils,
  flavonols.
• Extracts inhibit the release of serotonin from
  platelets
• Inhibits platelet aggregation
• Inhibits arachidonic acid pathway,
  (prostaglandins and leukotrienes)
• Inhibits release of granule contents from white
  blood cells
• Contraindicated in pregnancy, inflammation of
  oral mucosa (ulceration)

24
Herb Drug Interaction

• None documented
• potential antithrombic effects
• Potential interaction with nonsteroidal
  anti-inflammatory drugs (NSAIDs)

25
Garlic

• Action Lipid lowering, Anti-hypertensive,
  anti-thrombic, anti-oxidant, anti-fungal,
  anti-bacterial anti-tumor
• Medicinal Uses lower serum cholesterol and
  triglyceride elevate HDL, treatments of
  infections, high blood pressure ,
• Stroke and cancer of GI tract prevention.
• Side effects low-medium
• Doses up to 1 g of std ext 2-5mg allicin.

26
Chemistry, Functions, Toxicity

• alliin, converted by the enzyme alliinase to
  allicin.
• Functions Antibacterial/Antifungal-
  Antimycotic/Antiviral- Hypoglycemic -
  Anticoagulant (antiplatelet aggregating) -
  Fibrinolytic activity enhancement - Lipid
  lowering- Antioxidant/Anticancer - Hypotensive
  - Hepatoprotective- Immunomodulatory
• Large oral intakes can lead to gastrointestinal
  symptoms, changes to intestinal flora and
  allergic reactions.
• Garlic is contraindicated before surgery

27
Herb Drug Interaction

• Acetaminophen and other drugs metabolized by
  CYP2E1
• Anticoagulants, NSAIDs, prostacyclin
• Antidiabetics
• Herbs exert anticoagulation, antihyperglycemic
  effect

28
Gingko

• Actions Anti-PAF, anti-oxidant, circulatory
  stimulant, vasodilation.
• Medicinal Uses effective in the management of
  cerebral insufficiency, dementia and circulatory
  disorders. Altitude sickness, tinnitus, PMS,
  headache, migraine, eye problems, allergies
• Side effects very low
• Doses 120-160mg/day std ext

29
Indications Traditionally known as an
anti-microbial anti-tubercular agent, new
research has shown a profound activity on brain
function and cerebral circulation. Clinically
it is proving effective in a range of vascular
disorders.
30
Precautions and dosage Few, if any side effects
have been documented Gastric disturbance ,
headache and allergic skin reaction observed
after prolonged administration. Dosage Typical
daily dose is 120-160mg. Available in capsules
40,60 or 120 mg of a concentrated (501) leaf
extract. Tincture 1-2 ml. Interaction
anticoagulants, antiplatelet (affects) platelet
activating factor Insulin and oral hypoglycemic
agents elevated glucose because increased
clearance of insulin and sulfunylureas Thiazide
diuretics increased blood pressure Trazodone
combination with ginkgo caused coma (in
Alzheimers)
31
Ginger

• Actions Antiemetic, anti-inflammatory, digestive
  stimulant, antiplatelet, spasmolytic,
  carminative.
• Medicinal uses relieving motion sickness, used
  in variety of GI disorder, prevent lipid
  peroxidation, treat parasitic infections,
  circulatory stimulant (positive inotropic),
  arthritis
• Side effects low
• Doses0.5-1g of fresh or dried root
• 500 mg candy, 1-2ml tincture

32
Chemistry, Functions, Toxicity

• volatile oils and nonvolatile pungent compounds
  (zingeberene, curcumene, farnesene, and gingerol,
  shogaol)
• The following functions have been tested
  experimentally
• Anti-emetic activity, Antiserotoninergic activity
  and gastrointestinal motility effect,
• Muscular contractility in the gastrointestinal
  tract.
• Ability to neutralize toxins and anti-tumor
  effect.
• Anti-inflammatory effect.
• Immune system potentiation
• Platelet aggregation ,Fibrinolysis
• No toxicity (at pharmacologic dose) dont use it
  for morning sickness

33
Herb Drug Interaction

• Large doses may increase bleeding time
• Large doses cardiac arrhythmias, depression

34
Ginseng (Panax)

• Actions Adaptogenic, tonic, immunomodulator,
  cancer preventive.
• Medicinal Uses general performance under stress,
  congestive heart failure, elevates HDL,
  impotency, non-insulin dependent diabetes,
  preventive in certain types of cancer.
• Side effects low
• Doses05-2g dried root
• 1-5ml tincture

35
Chemistry, Functions, Toxicity

• Ginsenosides, biotin, B1,B2, B12, panthotenic
  acid, nicotinic acid,
• Increase T-cell activity, stimulates interferon ,
  HDL production, accelerate nuclear RNA production
• Ginseng abuse syndrome (increased motor activity,
  diarrhea, nervousness, insomnia, hypertension,
  edema)

36
Herb Drug Interaction

• Anticoagulants (warfarin)
• Antidiabetics, insulin increases hypoglycemic
  effect
• Drugs metabolized by CYP3A4 (inhibits the enzyme
  system)
• MAO inhibitors, phenelzine, hypericin (tremor,
  headache, mania)

37
Goldenseal

• Actions antispasmodic, weak antibiotic,
  expectorant, laxative, bitter hepatic.
• Medicinal Uses stimulate bile secretion,
  inflammatory conditions of the mucous membranes
  (respiratory, GI,) external applications
• Side effectslow-medium
• Doses 250-300 mg fd ext. 05-1g dried root
  (capsule)

38
Chemistry, Functions, Toxicity

• Alkaloids, berberine, hydrastine, volatile oils,
  chlorogenic acid
• Anti-inflammatory, antihemorrhagic,
  immunomodulatory, muscle relaxant, hydrastin
  causes peripheral vasoconstriction, berberine
  antibacterial
• CNS depression, paralysis, seizures
• Asystole, bradycardia, respiratory depression
• Abdominal cramp nausea, diarrhea
• Anemia, leukoppenia
• Contact dermatitis

39
Herb Drug Interaction

• Anticoagulants , sedatives, proton pump
  inhibitors (H2 antagonists), allergic drugs,
  antidepressants
• Unpredictable ACE inhibitors such as captopril,
  enalapril, lisinopril, and Monopril
• Beta blockers such as atenolol, metoprolol, and
  propranolol
• Calcium channel blockers such as nifedipine,
  Norvasc, and verapamil
• Diuretics such as Dyazide, furosemide, and
  hydrochlorothiazide

40
Hawthorn

• Actions Cardio tonic, cardioprotective,
  antioxidant, hypotensive antiarrhytmic
• Medicinal Uses traditional drug to treat heart
  problems, hypertension, diuretic for kidney
  problems
• Side effects none
• Doses 1-3g flower leaves or berry, by infusion
  fluid extract 3-6 ml, tincture 1-2 ml (3xd)

41
Chemistry, Functions, Toxicity

• Flavonoids and procyanidins primarily responsible
  for action
• cAMP phosphodiesterase inhibition, slowly
  developing actions.
• The combined pharmacological effects are
  positively inotropic, chronotropic and
  dromotropic. Its negative bathmotropic effect
  makes this herb unique among anti-arrhythmic
  drugs, plus antilipidemic.
• No toxicity has been noted

42
Herb Drug Interaction

• Antiarrhytmics the herb action is similar to
  class III antiarrhytmics
• Antihypertensive nitrates increased risk of
  hypotension
• Cardiac glycosides increased risk of cardiac
  toxicity.

43
Kava-kava (Piper methysticum)
Parts used roots, rhizomes Properties bitter,
pungent, warming herb, diuretic, relieves pain,
relaxes spasm, stimulant effect on circulatory
and nervous system Constituents kava lactones /
pyrones, kavain, dihydro-kavain methysticin,
yangonine, Medicinal use nervous anxiety,
stress, restlessness, insomnia The sedative
effect of kava-pyrones might be mediated via the
GABA-A receptor.
44
Precautions and dosage Patients should not use
kava without first obtaining medical advice, and
doses should not exceed 300 mg/day. In one
clinical trial using WS 1490, the occurrence of
adverse effects was rare. Only two reports
(stomach upset in both cases) were rated as
possibly related. The most commonly reported
adverse effect of kava usage is kava dermopathya
yellow, scaly, leprosy-like eruption of the skin
and inflammation of the eyes. The drug
contraindicated during pregnancy or nursing. It
is also contraindicated in patients with
endogenous depression because it increases the
danger of suicide. Daily dose equivalent of 60
to 120 mg kava lactones.
45
Possible interaction between kava-lactones and
pharmaceutical drugs.

• The drug may enhances the effectiveness of
  barbiturates and other psychopharmacological
  agents.
• Kava lactons inhibit Cytochrome P-450
• Drug clearance is slowing down, extended effect
  or toxicity
• Deficiency of CYP2D6 (7-9 of Caucasian
  population)
• People should avoid kava predisposed to liver
  problem or already taking drugs that have adverse
  effect on the liver.

46
Milk thistle

• Actions hepatoprotective, antioxidant,
  cholerectic
• Medicinal Uses regeneration of hepatocytes,
  cirrhosis, poisonous, alcoholic liver damage,
  fatty liver, expelling gallstone.
• Side effectsnone low
• Doses 140 mg (2xd std for sylimarine) 1-5ml
  tincture

47
Chemistry, Functions, Toxicity

• Silymarin may stimulate the action of nucleolar
  polymerase A, resulting in an increase in
  ribosomal protein synthesis, thereby stimulating
  the regenerative ability of the liver and the
  formation of new hepatocytes.
• Silybin, the active constituent of silymarin has
  been reported to work as an antioxidant,
  scavenging free radicals.

48
Herb Drug Interaction

• Aspirin improve clearance in patients with
  cirrhosis
• Cisplatin prevent kidney damage
• Disulfiram drugs containing alcohol may cause
  disulfiram like reactions
• Tacrine reduces adverse cholinergic effects
• Hepatotoxic drugs prevent liver damage caused by
  butyrophenones, phenothiazines, phenytoin,
  acetaminophen, and halothane.

49
Saw Palmetto

• Actions Diuretic, urinary antiseptic,
  anti-inflammatory, spasmolytic, endocrine agent
• Medicinal Uses treat mild to moderate BPH,
  inflammation of respiratory and genitourinary
  tract
• Side effects none-low
• Doses160 mg (2xd std lipophylic ext) or 2-4 ml
  tincture

50
Chemistry, Functions, Toxicity

• It contains sterols, flavonoids, water-soluble
  polysacharides and fatty oil.
• Antiandrogenic, antiestrogenic and
  anti-inflammatory actions
• The oily fraction inhibits in vitro testosterone
  5a-reductase activity, an enzyme in male hormone
  metabolism. 5 a-reductase converts testosterone
  to dihydrotestosterone. The overproduction of
  dihydrotestosterone is responsible for prostate
  enlargement.
• No toxic or health hazard, occasional stomach
  complaints

51
St. Johns Wort

• Actions Antiviral, nervine, antidepressant,
  antiseptic
• Medicinal Uses treatment for mild to moderate
  depression, neuralgia , sciatica, muscular
  rheumatism, menopausal anxiety, bruises, shingles
• Side effects low
• Doses 300 mg std ext 0.3 hypericin 3xd 3-6 ml
  liquid ext

52
Herb-Drug Interaction

• St. John's wort may interact with oral
  contraceptives
• protease inhibitors (such as indinavir and
  ritonavir, which are used to treat HIV infection
• MAOIs and other antidepressants
• immunosuppressant cyclosporine
• Cardiac glycosides digoxin
• iron supplements
• the anticoagulant warfarin

53
Uva-ursi

• Actions Astringent, antibacterial, mild
  diuretic, urinary antiseptic.
• Medicinal Uses urinary tract infections
  including cystitis, nephritis, urethritis, yeast
  infection early stage of genital herpes
• Side effectslow-medium
• Doses 1 tsp in 0.5 L water boiled for 15 min.
  1-4 ml tincture in a glass of water.

54
Chemistry, Functions, Toxicity

• Leaves contain hydroquinone derivatives
  arbutin, methylarbutin, ericolin, ursone, gallic
  acid ellagic acid, tannin (5-7)
• Arbutin is hydrolyzed to hydroquinone which acts
  as a mild astringent and antimicrobial in
  alkaline urine.
• Ursolic acid is contributing to the diuretic
  effect.
• Adverse reactions seizures, tinnitus, nausea,
  irritation of the bladder and UT mucous membrane,
  hepatotoxicity.

55
Herb Drug Interaction

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and
  Corticosteroids Arbutin increases the inhibitory
  action of prednisolone and dexamethazone on
  contact dermatitis, allergic-type
  hypersensitivity and arthritis.
• Diuretics enhanced effects

56
Valerian

• Actions Anxiolytic, mild sedative, hypnotic,
  spasmolytic
• Medicinal Uses insomnia, nervous unrest, stress
  and neuralgia, depression and anxiety
• Side effectslow
• Doses 400-500 mg liquid ext capsules of 100,
  250, 380, 400, 445, 475, 500, 1000 mg
• tablets 160 mg 550 mg

57
Chemistry, Functions, Toxicity

• Sesquiterpenes (volatile oils) and valepotriates
  (iridoid triesters).
• Acts via a central adenosine mechanism (partial
  agonist)
• Inhibits cAMP accumulations
• No clearly identified toxicities in humans
• Possible adverse reactions
• CNS headache, morning drowsiness, restlessness.
• CV cardiac disturbances
• GI GI complaints
• Withdrawal symptoms

58
Drug-herb Interaction

• No drug interactions have been reported in humans
  
• Potential reaction with barbiturates and
  benzodiazepines
• Contraindicated while undergoing treatment with
  barbiturates
• May be helpful in easing withdrawal from
  benzodiazepines.

59
Vitex

• Actions prolactin inhibitor, dopamine agonist ,
  exert progesteronic effect in women and
  anti-androgenic in men
• Medicinal Uses PMS, menstrual irregularities,
  menopausal symptoms and fibroids, increase
  lactation, impotence, BPH
• Side effects none-low
• Doses 150-330 std ext
• (0.5 agnuside) (2xd)

60
Chemistry, Functions, Toxicity

• Iridoid glucosides agnuside, aucubin luteolin
  like flavonoids, triterpenoids, alkaloid
  vitricine.
• Antiandrogenic, anti-inflammatory, progesteronic
  effect
• Female endocrine, reproductive disorders and
  hormonal imbalance, ovarian insufficiency
  inadequate lactation, PMS
• Headache, increased menstrual flow

61
Drug-herb Interaction

• Antihypertensive (antagonistic effect)
• Beta-blockers possible risk of hypertensive
  crisis

62
Stress

• Every living organism is maintaining a complex
  dynamic equilibrium or homeostasis.
• Stress is a mutual actions of forces that take
  place across any section of the body and it is a
  state of threatened homeostasis.
• The human body reacts to stress by activating
  complex behavioral and physiologic responses.
• (Hans Selye)

63
Herbal Stress Management
Daily mild Lemon balm (Melissa officinalis) Tilia
europea Skullcap (Scutellaria sp) Chamomile
(Matricaria recutita) Mugwort (Artemissa
vulgaris) Oat (Avena sativa) Lavender (Lavendula
officinalis) Short term extreme Passionflower
(passiflora incarnata) Valerian (Valeriana
officinalis) Skulcap (Scutellaria sp) Wild
lettuce (Lactuca virosa) Long standing Ginseng
(Panax , Quintifolum, Eleutherococcus)
64
Herbs used in depression Mugwort (Artemissa
vulgaris) California Poppy (Eschscholtzia
californica) St. Johns Wort (Hypericum
perforatum) Lemon Balm (Melissa
officinalis) Basil (Ocimum basilicum) Passion
Flower (Passiflora incarnata) Marijuana (Cannabis
sativa) Kava-kava (Piper methysticum)
65
Herbs used in anxiety and headache

• Anxiety Headache
• Black Cohos Catnip
• Hops black pepper
• Jamaican dogwood green tea
• Kava-kava damiana
• Lemon balm feverfew
• Mugwort gingko
• St. Johns wort meadosweet
• Valerian saffron
• rosemary
• wild ginger
• yerba mate
• willow

66
Herbs used in Common Cold

• Anise Bayberry Burdock Catnip
• Cinnamon Coltsfoot Echinacea Ephedra
• Garlic Hyssop Linden Licorice
• Onion Pau darco Pennyroyal Peppermint
• Rose hip Saw palmetto Sweet violet Vervain
• Willow Yarrow Yerba santa Meadowsweet

67
Herbs used in kidney and bladder disorders

• Asparagus Blackthorn Borage
• Buchu Capsicum Celery
• Coriander Corn silk Devils claw
• Horsetail Juniper Marshmallow
• Parsley Pau darco Sarsaparilla
• Schisandra Soapwort Stone root
• Uva ursi