Curing Pills by Plum Flower

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Abdominal pain. Although there has been interest in using oral atractylodes for abdominal pain, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Anorexia nervosa. Although there has been interest in using oral atractylodes for anorexia nervosa, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Cachexia. It is unclear if oral atractylodes is beneficial in patients with cachexia. Details: Preliminary clinical research in people with gastric cancer-related cachexia shows that taking an isolated constituent of atractylodes, atractylenolide I, 1.32 grams orally daily for 7 weeks moderately improves appetite scores and functional ability scores when compared with fish oil 0.45 grams (15706).
• Common cold. Although there has been interest in using oral atractylodes for the common cold, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Diarrhea. Although there has been interest in using oral atractylodes for diarrhea, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Gastroesophageal reflux disease (GERD). Although there has been interest in using oral atractylodes for GERD, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Influenza. Although there has been interest in using oral atractylodes for Influenza, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Intracranial hemorrhage. Atractylodes has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with chronic subdural hematoma (CSDH) who underwent burr hole surgery shows that taking atractylodes rhizome as part of traditional Japanese medicine products also containing Asian water plantain, mushrooms, and cinnamon for 3 months reduces postoperative recurrence of CSDH when compared with usual care. Subgroup analysis suggests the combination treatment containing atractylodes may be most effective for the acute on chronic CSDH subtype (112827). It is unclear whether these effects are due to atractylodes, other ingredients, or the combination.
• Lung cancer. Although there has been interest in using oral atractylodes for lung cancer, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Obesity. Although there has been interest in using oral atractylodes for obesity, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Peritoneal dialysis. Although there has been interest in using oral atractylodes for peritoneal dialysis, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using oral atractylodes for RA, there is insufficient reliable information about the clinical effects of atractylodes for this purpose. More evidence is needed to rate atractylodes for these uses.

(Read more about ATRACTYLODES)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Osteoarthritis. A small clinical study in patients with osteoarthritis of the knee shows that taking a combination herbal extract (SKI 306X) of Chinese cucumber, Clematis mandshurica, and Prunella vulgaris 200 mg, 400 mg, or 600 mg three times daily for 4 weeks reduces pain and improves physical function when compared with placebo (100753). More evidence is needed to rate Chinese cucumber for this use.

(Read more about CHINESE CUCUMBER)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Angina. Although there has been interest in using oral chrysanthemum for angina, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Asthenopia (eye strain). Oral chrysanthemum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with asthenopia shows that taking one of three doses of a combination tablet containing chrysanthemum extract 75 mg, 125 mg, or 175 mg with various other ingredients orally once daily for 90 days modestly improves symptoms of eye fatigue, such as tearing, soreness, dryness, and foreign body sensation, when compared with placebo. There were also improvements in macular function. The other ingredients included black currant extract 100-233 mg, goji berry extract 75-175 mg, lutein ester 12-28 mg, and zeaxanthin 1.2-2.8 mg (106306).
• Common cold. Although there has been interest in using oral chrysanthemum for the common cold, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Diabetes. Although there has been interest in using oral chrysanthemum for diabetes, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Headache. Although there has been interest in using oral chrysanthemum for headache, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• HIV/AIDS. Although there has been interest in using oral chrysanthemum for HIV/AIDS, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Hyperlipidemia. Although there has been interest in using oral chrysanthemum for hyperlipidemia, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Hypertension. Although there has been interest in using oral chrysanthemum for hypertension, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Osteoarthritis. It is unclear if oral chrysanthemum is beneficial in patients with osteoarthritis. Details: Clinical research in patients with mild knee osteoarthritis shows that taking a specific chrysanthemum extract (GreenCross Wellbeing Corporation) 250 mg orally daily for 12 weeks reduces certain pain scores by 30% when compared with baseline. This was also statistically significant when compared with the 14% reduction in those taking placebo. However, other pain scores and stiffness scores were not different between groups. In addition, the clinical significance of these potential improvements is unclear (106308).
• Stroke. It is unclear if oral chrysanthemum is beneficial in patients with stroke. Details: Preliminary clinical research in adults with ischemic stroke shows that taking chrysanthemum extract 200 mg orally twice daily for 4 days improves stroke symptom scores when compared with control (110511).
• Ulcerative colitis. Although there has been interest in using oral chrysanthemum for ulcerative colitis, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose. More evidence is needed to rate chrysanthemum for these uses.

(Read more about CHRYSANTHEMUM)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Intestinal parasite infection. It is unclear if oral costus root is beneficial in children with intestinal parasite infections. Details: Preliminary clinical research in children shows that taking a single dose of costus root 50 mg/kg reduces the number of nematode eggs per gram of feces similarly to treatment with pyrantel pamoate (1516). More evidence is needed to rate costus for this use.

(Read more about COSTUS)

There is insufficient reliable information available about the effectiveness of Japanese mint.

(Read more about JAPANESE MINT)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Hyperlipidemia. Preliminary evidence shows that consuming Job's tears 60 grams daily in place of rice for 4 weeks can significantly lower total and low-density lipoprotein (LDL) cholesterol in patients with hyperlipidemia (15368). More evidence is needed to rate Job's tears for this use.

(Read more about JOB'S TEARS)

POSSIBLY EFFECTIVE

• Alcohol use disorder. Oral kudzu seems to be beneficial for reducing alcohol consumption in heavy drinkers; however, it may not be beneficial in those with chronic alcohol use disorder. Details: Some research shows that heavy drinkers who take a specific kudzu root extract (Alkontrol-Herbal; NPI-031; Natural Pharmacia International, Inc.) 0.5-1 grams three times daily for 1-4 weeks consume less beer when given an opportunity to drink and may have more abstinent days (13085,92257). Other research shows that binge drinkers who take kudzu extract 2 grams as a single dose 2.5 hours prior to a 90-minute binge drinking episode consume 37% fewer beers than those taking placebo (92258). However, kudzu does not seem to decrease the craving for alcohol (10386,13085,57948,92257). Kudzu extract also does not seem to improve sobriety in people with chronic alcohol use disorder (10386).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Although there is interest in using oral kudzu for allergic rhinitis, there is insufficient reliable information about the clinical effects of kudzu for this condition.
• Angina. Although there is interest in using the injectable kudzu constituent puerarin for angina, there is insufficient reliable information about the clinical effects of oral kudzu for this condition.
• Angioplasty. Although there is interest in using the injectable kudzu constituent puerarin in patients undergoing percutaneous transluminal coronary angioplasty (PTCA), there is insufficient reliable information about the clinical effects of oral kudzu for this condition.
• Athletic performance. Oral kudzu has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study in healthy males shows that taking capsules containing kudzu isoflavone extract 180 mg, soybean peptides 600 mg, taurine 200 mg, and ginseng saponins 120 mg daily in two divided doses for 15 days can significantly increase time to exhaustion during exercise when compared with placebo (57945).
• Back pain. Although there is interest in using the injectable kudzu constituent puerarin for back pain, there is insufficient reliable information about the clinical effects of oral kudzu for this condition.
• Cluster headache. Although there is interest in using oral kudzu for cluster headache, there is insufficient reliable information about the clinical effects of kudzu for this condition.
• Coronary heart disease (CHD). Although there is interest in using the injectable kudzu constituent puerarin for CHD, there is insufficient reliable information about the clinical effects of oral kudzu for this condition.
• Diabetes. It is unclear if oral kudzu is beneficial for diabetes. Details: Preliminary clinical research in adults with type 2 diabetes shows that taking oral puerarin, a kudzu constituent, 250 mg three times daily in addition to rosiglitazone 4 mg daily for 12 weeks reduces blood glucose levels and glycated hemoglobin (HbA1c) when compared to baseline (57951). The effect of kudzu alone is unclear. Additionally, the lack of a comparator group limits the validity of this finding.
• Diabetic nephropathy. It is unclear if oral kudzu is beneficial for diabetic nephropathy. Details: Preliminary clinical research in patients with diabetic nephropathy shows that taking puerarin, a kudzu constituent, 250 mg three times daily in addition to rosiglitazone 4 mg daily for 12 weeks improves laboratory measurements of kidney function, including serum creatinine, blood urea nitrogen, and urinary albumin, when compared to baseline (57951). The effect of kudzu alone is unclear. Additionally, the lack of a comparator group limits the validity of this finding.
• Hangover. Although there is interest in using oral kudzu for hangover, there is insufficient reliable information about the clinical effects of kudzu for this condition.
• Heart failure. Although there is interest in using the kudzu constituent puerarin for heart failure, there is insufficient reliable information about the clinical effects of kudzu for this condition.
• Hypertension. It is unclear if oral kudzu is beneficial for hypertension. Details: Preliminary clinical research in adults with hypertension shows that taking kudzu powder 1.5 grams twice daily for 12 weeks decreases systolic blood pressure by 16% and diastolic blood pressure by 12% when compared to baseline (92261). The validity of this finding is limited by the lack of a comparator group.
• Menopausal symptoms. Small clinical studies suggest that oral kudzu may modestly improve menopausal symptoms. Details: Preliminary clinical research shows that taking kudzu 25 mg, 50 mg, or 100 mg daily for 6 months during perimenopause improves climacteric symptoms based on a modified Green climacteric scale when compared with baseline (57890,57942). Other preliminary clinical research in patients with menopausal symptoms shows that taking kudzu extract 0.84-2.52 grams daily for 4 weeks, providing puerarin 113-338 mg daily, modestly reduces overall menopausal symptoms when compared with baseline (108154). The validity of the findings from these studies is limited by the lack of a comparator group. Other clinical research shows that taking kudzu 50 mg daily for 6 months during perimenopause reduces vasomotor symptoms similarly to taking conjugated equine estrogen 0.625 mg with or without medroxyprogesterone acetate 2.5 mg daily (57927).
• Migraine headache. It is unclear if oral kudzu is beneficial for migraine headache. Details: Preliminary clinical research in adults with migraine shows that taking one capsule of kudzu (Kuzik) daily, providing an unspecified dose of kudzu, for 90 days reduces the number of headache attacks per month by about 3, with approximately 50% of patients achieving a 50% reduction in monthly headache days when compared with baseline. There were also modest improvements in disability and medication use (108155). The validity of these findings is limited by the lack of a comparator group.
• Myocardial infarction (MI). Although there is interest in using the injectable kudzu constituent puerarin for MI, there is insufficient reliable information about the clinical effects of oral kudzu for this condition.
• Obesity. It is unclear if oral kudzu is beneficial for obesity. Details: Preliminary clinical research in adults with obesity shows that taking a kudzu extract 300 mg daily for 12 weeks reduces visceral fat and body mass index (BMI) when compared with placebo. However, doses of 200 mg do not seem to be as effective (57954).
• Postmenopausal conditions. It is unclear if oral or intravaginal kudzu is beneficial for postmenopausal conditions. Details: A small clinical study in postmenopausal individuals shows that taking kudzu containing isoflavones 100 mg orally once daily for 3 months improves flexible thinking and attention when compared with control. However, it does not appear to improve total cholesterol, low-density lipoprotein (LDL) cholesterol, or sex hormone levels (11386). Another small clinical study in postmenopausal individuals shows that taking kudzu 20 mg, 30 mg, or 50 mg daily for 24 weeks improves vaginal dryness and pH when compared with baseline, but not when compared with placebo. It also decreases a specific biomarker of bone turnover, called bone alkaline phosphatase, when compared with placebo (57924,57929). It is unclear if this correlates with improved bone density or with a reduced risk of osteoporosis. Kudzu has also been evaluated as an intravaginal gel. One small clinical study shows that applying 0.5 grams of kudzu 6% gel into the vagina every night for 2 weeks, followed by 3 nights each week for 9 weeks, improves vaginal symptoms of dryness, soreness, irritation, and abnormal discharge similarly to conjugated estrogen cream applied on the same schedule. However, kudzu gel is less effective than conjugated estrogen cream for improving overall vaginal health (96740). Another small clinical study of postmenopausal patients shows that applying 0.5 grams of kudzu 6% gel intravaginally every night for 3 weeks increases vaginal arterial blood flow and restores atrophic vaginal tissue when compared with placebo after 12 weeks (110702). In contrast, a similar study shows that applying 0.5 grams of kudzu 5% gel into the vagina every night for 2 weeks, followed by 3 nights each week for 10 weeks, does not improve vaginal symptoms when compared with placebo gel (105521). However, the study may have been inadequately powered to detect a difference between groups.
• Rhinosinusitis. Although there is interest in using oral kudzu for rhinosinusitis, there is insufficient reliable information about the clinical effects of kudzu for this condition.
• Stroke. Although there is interest in using the injectable kudzu constituent puerarin for stroke, there is insufficient reliable information about the clinical effects of oral kudzu for this condition. More evidence is needed to rate kudzu for these uses.

(Read more about KUDZU)

POSSIBLY EFFECTIVE

• Gingivitis. Magnolia bark extract might modestly reduce gum bleeding and inflammation when added to gum or toothpaste. Details: One clinical study shows that chewing gum containing magnolia bark extract plus xylitol for 5 minutes three times daily for 30 days reduces gingival bleeding by 33%, compared with 24% after chewing gum containing xylitol alone (92459). Another clinical study in adults with gingivitis shows that using a fluoride toothpaste containing magnolia extract 0.3% twice daily reduces gingivitis severity by about 0.27 points on the gingival index after 3 months, compared to 0.15 points for patients using the toothpaste without magnolia extract (92464).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. Although there is interest in using topical magnolia for aging skin, there is insufficient reliable information about the clinical effects of magnolia for this purpose.
• Allergic rhinitis (hay fever). Although there is interest in using oral magnolia for hay fever, there is insufficient reliable information about the clinical effects of magnolia for this condition.
• Anxiety. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in healthy females with mild anxiety shows that taking a proprietary blend of magnolia and phellodendron bark extract (Relora, Next Pharmaceuticals), standardized to 1.5% honokiol and 0.1% berberine, 250 mg three times daily for 6 weeks reduces temporary feelings of stress-induced anxiety almost 2-fold when compared with placebo. However, taking this product does not seem to improve long-standing feelings of stress-induced anxiety (34246). It is unclear if this effect is due to magnolia, other ingredients, or the combination. Additionally, this study was funded by the supplement manufacturer.
• Dental plaque. It is unclear if oral magnolia is beneficial in patients with dental plaque. Details: Clinical research in adults with gingivitis shows that using a toothpaste containing 0.3% magnolia extract twice daily modestly reduces plaque severity by about 0.41 points on the mean plaque index after 3 months, compared to a 0.27 point reduction for patients using the toothpaste without magnolia extract (92464). While statistically significant, this improvement might not be clinically meaningful.
• Diabetes. Although there is interest in using oral magnolia for diabetes, there is insufficient reliable information about the clinical effects of magnolia for this condition.
• Headache. Although there is interest in using oral magnolia for headache, there is insufficient reliable information about the clinical effects of magnolia for this condition.
• Menopausal symptoms. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A moderate-sized clinical study in postmenopausal patients shows that taking a specific combination of magnolia, Vitex agnus-castus, soy isoflavones, vitamin D, and lactobacillus (Estromineral Serena Plus, Meda Pharma SpA) daily for one year decreases the frequency and intensity of hot flashes and improves sleep quality and the ability to fall asleep when compared with soy isoflavones alone (95031). Additionally, a small clinical study shows that taking this same product daily for one year improves vasomotor symptoms, mood disorders, somatic symptoms, sleep disorders, blood pressure, and glycemic control when compared to baseline (110708). However, the validity of these findings is limited by a lack of control group. Overall, it is unclear if the effects of this magnolia-containing product in postmenopausal patients are due to magnolia, other ingredients, or the combination.
• Obesity. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in overweight females who report stress eating shows that taking a specific product containing a combination of bark extracts of magnolia plus phellodendron (Relora, Next Pharmaceuticals, Inc.) 250 mg three times daily for 6 weeks seems to prevent weight gain, compared with a 1.5 kg weight gain in those taking placebo (14349). This finding is limited because differences between groups were not statistically compared. Furthermore, it's unclear if this product induces weight loss.
• Postpartum depression. It is unclear if oral magnolia tea is beneficial for preventing postpartum depression. Details: A small clinical study in healthy postpartum patients shows that drinking 1 cup of magnolia tea daily for 3 weeks may improve depressive symptoms and sleep efficiency when compared with usual care alone. Magnolia tea (plant part unspecified) was steeped in 300 mL of hot water for 12 minutes prior to consumption (105089).
• Stress. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small low-quality clinical trial in moderately stressed healthy adults shows that taking a proprietary blend of magnolia and phellodendron bark extract (Relora, Next Pharmaceuticals) 250 mg twice daily for 4 weeks improves overall mood and decreases stress when compared with placebo (94904). It is unclear if this effect is due to magnolia, other ingredients, or the combination. Additionally, this study was funded by the supplement manufacturer. More evidence is needed to rate magnolia for these uses.

(Read more about MAGNOLIA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Mosquito repellent. Clinical research shows that applying patchouli oil 20% to the skin provides complete protection against mosquitos for 123 minutes. When added to a mixture of turmeric oil and Zanthoxylum limonella oil, complete protection lasted for 390 minutes, indicating synergistic activity (100669).
• Stress. Preliminary clinical research in nurses shows that inhalation of patchouli oil for 20 minutes once daily for 2 doses reduces self-reported stress scores and increases compassion satisfaction scores when compared with placebo inhalation. Inhalation of patchouli oil did not appear to affect self-reported burnout or markers of stress such as blood pressure and heart rate (104776). More evidence is needed to rate patchouli oil for these uses.

(Read more about PATCHOULI OIL)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cancer. Although there is interest in using oral poria mushroom for cancer, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Chronic fatigue syndrome (CFS). Although there is interest in using oral poria mushroom for CFS, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Chronic kidney disease (CKD). Although there is interest in using oral poria mushroom for CKD, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Coronavirus disease 2019 (COVID-19). Although there has been interest in using oral poria mushroom for COVID-19, there is insufficient reliable information about the clinical effects of poria mushroom for this purpose.
• Dementia. Although there is interest in using oral poria mushroom for dementia, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Diabetes. Oral poria mushroom has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of generally small clinical trials in patients with type 2 diabetes shows that taking Chinese herbal medicine combinations containing poria mushroom for 2-24 weeks along with hypoglycemic medications modestly reduces fasting blood glucose and glycated hemoglobin levels when compared with control groups taking hypoglycemic agents only. There were also modest improvements in levels of triglycerides and low-density lipoprotein (LDL) cholesterol and in insulin sensitivity (111920). Given the large number of other ingredients in the available formulations, it is unclear if any beneficial effects are related to poria mushroom, other ingredients in the formulation, or their combination.
• Diarrhea. Although there is interest in using oral poria mushroom for diarrhea, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Endometriosis. Although there is interest in using oral poria mushroom for endometriosis, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Influenza. Oral poria mushroom has only been evaluated for influenza vaccine enhancement in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in healthy adults shows that taking a product containing poria mushroom extract, rosemary extract, and aloe gel powder twice daily for 28 days prior to and following an influenza vaccination does not affect upper respiratory tract illness symptoms, severity, duration, or medication-related use when compared with taking placebo (111921). It is unclear if this study was large enough to detect differences between groups. Also, the effect of poria mushroom itself on influenza vaccine enhancement is unclear.
• Tinnitus. Although there is interest in using oral poria mushroom for tinnitus, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Urinary tract infections (UTIs). Although there is interest in using oral poria mushroom for UTIs, there is insufficient reliable information about the clinical effects of poria mushroom for this use. More evidence is needed to rate poria mushroom for these uses.

(Read more about PORIA MUSHROOM)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cancer. Observational research has found that daily intake of oranges and/or tangerines is associated with a reduced odds of developing nasopharyngeal carcinoma when compared with consuming oranges and/or tangerines less than once a week (28608). More evidence is needed to rate tangerine for this use.

(Read more about TANGERINE)

There is insufficient reliable information available about the safety of atractylodes.

PREGNANCY: POSSIBLY UNSAFE
when used orally. In animals, atractylodes has caused reproductive toxicity, including fetal death, as well as changes in gestation, growth, and skeletal formation (94304).

LACTATION:
There is insufficient reliable information available about the safety of atractylodes when used during breast-feeding.

(Read more about ATRACTYLODES)

POSSIBLY SAFE ...when the fruit is used orally as food (12).

LIKELY UNSAFE ...when the unprocessed root is used orally or by injection. Extracts of unprocessed Chinese cucumber root can be toxic (6). There is insufficient reliable information available about the safety of Chinese cucumber fruit, seed, or processed root extract when used orally in medicinal amounts.

PREGNANCY: LIKELY UNSAFE
when the fruit, seed, or root are used orally or by injection. Unprocessed Chinese cucumber root can be toxic. Chinese cucumber fruit and seeds are thought to have abortifacient effects and possible teratogenicity (6).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about CHINESE CUCUMBER)

POSSIBLY SAFE ...when used orally and appropriately, short-term. A specific extract of chrysanthemum (GreenCross Wellbeing Corporation) has been used with apparent safety at a dose of 250 mg daily for up to 12 weeks (106308). There is insufficient reliable information available about the safety of chrysanthemum when used topically.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about CHRYSANTHEMUM)

LIKELY SAFE ...when used in amounts commonly found in foods. Costus oil has Generally Recognized As Safe (GRAS) status for use in foods in the US (4912).

UNSAFE ...when aristolochic acid-contaminated costus products are used orally. Costus root is commonly contaminated with aristolochic acid, which is nephrotoxic and carcinogenic. The US Food and Drug Administration (FDA) considers all products containing aristolochic acid to be unsafe and adulterated. Only products analytically verified to be aristolochic acid-free should be used (6118). There is insufficient reliable information available about the safety of non-contaminated costus when used orally or topically in medicinal amounts.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about COSTUS)

POSSIBLY SAFE ...when the oil is used orally and appropriately (2). ...when used topically and appropriately (2). There is insufficient reliable information available about the safety of Japanese mint for its other uses.

CHILDREN: LIKELY UNSAFE
when the oil is used topically on the faces of infants and children, particularly in the nasal area, it can trigger glottal or bronchial spasm, asthma-like attacks, or even respiratory failure (2). There is insufficient reliable information available about Japanese mint used for medicinal purposes; avoid using.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about JAPANESE MINT)

POSSIBLY SAFE ...when consumed orally and appropriately as a food. Job's tears has been safely eaten in amounts up to 60 grams daily for 4 weeks (15368). There is not enough information available to know if Job's tears extracts from the root or seed are safe when taken as a supplement.

PREGNANCY: POSSIBLY UNSAFE
when used orally. In animal models, Job's tears seed extract induces embryo toxicity and increases uterine contractions during pregnancy (15373); avoid using during pregnancy.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about JOB'S TEARS)

POSSIBLY SAFE ...when used orally and appropriately. Kudzu appears to be safe for up to 4 months (10386,11386,92257). ...when used intravaginally and appropriately. Kudzu 5% to 6% gel has been used with apparent safety for up to 12 weeks (96740,105521,110702).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about KUDZU)

POSSIBLY SAFE ...when used orally and appropriately, short-term. A specific product containing magnolia extract and phellodendron extract (Relora, Next Pharmaceuticals, Inc.) has been used with apparent safety in clinical trials at a dose of 250 mg two to three times daily for up to 6 weeks (14349,34246,94904). ...when used topically in a toothpaste for up to 6 months (92464).

PREGNANCY: UNSAFE
when the magnolia flower bud is used orally due to reports of uterine stimulant activity (11953). There is insufficient reliable information available about the safety of using magnolia bark during pregnancy; avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about MAGNOLIA)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Patchouli oil has Generally Recognized As Safe (GRAS) status for use as a food additive in the US (4912). There is insufficient reliable information available about the safety of patchouli oil when used orally in medicinal amounts or when used topically or by inhalation.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about PATCHOULI OIL)

There is insufficient reliable information available about the safety of poria mushroom.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about PORIA MUSHROOM)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Tangerine has Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of tangerine when used orally or topically as a medicine.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about TANGERINE)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, atractylodes might increase the risk of bleeding when used concomitantly with anticoagulant and antiplatelet drugs.  Details Laboratory research suggests that atractylenolides II and III, constituents of atractylodes, reduce platelet activation (94299). So far, this has not been shown in humans.

AROMATASE INHIBITORS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, atractylodes may have an additive effect when used with other aromatase inhibitors.  Details Laboratory research suggests that atractylodes and its constituents exhibit aromatase inhibitor effects (94302).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Possible •  Level of Evidence = D Theoretically, atractylodes might decrease the levels of CYP1A2 substrates.  Details In animals, atractylodes administered at high doses has been shown to induce CYP1A2 activity (112828). This effect has not been shown in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Possible •  Level of Evidence = D Theoretically, atractylodes might increase the levels of CYP3A4 substrates.  Details In animals, atractylodes administered at high doses has been shown to inhibit CYP3A1 activity, which is a homolog to the human CYP3A4 enzyme (112828). This effect has not been shown in humans.

HEXOBARBITAL Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking atractylodes may prolong the therapeutic and adverse effects of hexobarbital.  Details In animals, atractylodes has been shown to prolong the effects of hexobarbital (94303). These effects have not been shown in humans.

(Read more about ATRACTYLODES)

(Read more about CHINESE CUCUMBER)

(Read more about CHRYSANTHEMUM)

(Read more about COSTUS)

(Read more about JAPANESE MINT)

(Read more about JOB'S TEARS)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, kudzu may increase the risk of bleeding if used with antiplatelet or anticoagulant drugs.  Details Kudzu isoflavones are reported to have antiplatelet activity (13278,13291).

ANTIDIABETES DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, taking kudzu with antidiabetes drugs might increase the risk of hypoglycemia.  Details Kudzu might lower blood glucose levels and have additive effects in patients treated with antidiabetic agents (13285,13292,57868,57951). The dose of diabetes medications might need to be adjusted.

CAFFEINE Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking kudzu with caffeine might increase levels of caffeine.  Details In healthy males injected with the kudzu constituent puerarin, caffeine clearance and metabolism is inhibited (23583). This effect has been attributed to inhibition of cytochrome P450 1A2 (CYP1A2) enzyme, which is involved in caffeine metabolism. It is unclear if taking kudzu orally would have this same effect.

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, kudzu might alter the effects of estrogen therapy.  Details Some research suggests that kudzu has estrogenic effects (11386,57874,57877). This may enhance or inhibit the effects of estrogen therapy.

HEPATOTOXIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use might have additive hepatotoxic effects.  Details There is some concern that kudzu can adversely affect the liver (88777,92259,92260,92262).

METHOTREXATE (Trexall, others) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking kudzu with methotrexate might increase the risk of methotrexate toxicity.  Details Preclinical research suggests that kudzu extract greatly reduces the elimination and increases the toxicity of methotrexate. Kudzu might inhibit organic anion transporters (OATs) that are responsible for hepatobiliary and renal excretion of anions, similar to the interaction between methotrexate and non-steroidal anti-inflammatory drugs (NSAIDs) (13296).

TAMOXIFEN (Nolvadex) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Theoretically, kudzu might interfere with tamoxifen activity.  Details Some research suggests that kudzu may have estrogenic effects (11386,110702).

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, magnolia might have additive effects and increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.  Details In vitro research shows that the chemicals magnolol and honokiol, isolated from magnolia bark, inhibit platelet aggregation that is experimentally induced by collagen and arachidonic acid. However, they do not inhibit platelet aggregation that is induced by adenosine diphosphate, platelet-activating factor, or thrombin (18273). This interaction has not been reported in humans.

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of large doses of magnolia bark and CNS depressants might have additive effects.  Details In vitro and animal research shows that constituents extracted from magnolia bark, especially honokiol and magnolol, have sedative effects. These effects may be due to the inhibition of catecholamine release and modulation of gamma-aminobutyric acid-A (GABA-A) receptors (11946,11952).

(Read more about MAGNOLIA)

(Read more about PATCHOULI OIL)

ANTICHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, poria mushroom might decrease the clinical effects of anticholinergic drugs.  Details In animal research, poria mushroom essential oil reduces acetylcholinesterase activity (111917). This interaction has not been shown in humans.

CHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, poria mushroom might have additive effects when used with cholinergic drugs.  Details In animal research, poria mushroom essential oil reduces acetylcholinesterase activity (111917). This interaction has not been shown in humans.

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking poria mushroom extract may enhance the therapeutic and adverse effects of sedatives.  Details Animal research shows that poria mushroom extract has sedative properties (111916). This interaction has not been shown in humans.

(Read more about PORIA MUSHROOM)

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Unlikely •  Level of Evidence = B In vitro, tangeretin, a constituent of tangerine, induces a 52% increase in the metabolism of midazolam by cytochrome P450 3A4 (CYP3A4) (28609). This suggests that tangeretin may stimulate CYP3A4 activity. However, in humans, drinking tangerine juice 200 mL slightly delayed the absorption, but did not affect the metabolism, of midazolam, a CYP3A4 substrate (28609). Theoretically, tangerine juice might increase CYP3A4 activity and decrease levels of drugs metabolized by this enzyme. However, this effect is unlikely.  Details Some drugs metabolized by CYP3A4 include amitriptyline (Elavil), amiodarone (Cordarone), citalopram (Celexa), felodipine (Plendil), lansoprazole (Prevacid), ondansetron (Zofran), prednisone (Deltasone, Orasone), sertraline (Zoloft), sibutramine (Meridia), and many others.

(Read more about TANGERINE)

General ...There is currently a limited amount of information on the adverse effects of atractylodes. A thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Allergic reaction, dry mouth, nausea.

Gastrointestinal ...Orally, atractylenolide I, an isolated constituent of atractylodes, can cause bad taste, nausea, and dry mouth (15706).

Immunologic ...Atractylodes can cause an allergic reaction in people sensitive to the Asteraceae/Compositae family (12450). Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs.

(Read more about ATRACTYLODES)

General ...Orally, Chinese cucumber fruit can cause mild diarrhea and gastric discomfort. Unprocessed Chinese cucumber seed can cause gastric discomfort and pain, nausea, vomiting, and diarrhea (12).
Unprocessed Chinese cucumber root is toxic, particularly when injected. Injections of trichosanthin, a constituent of Chinese cucumber, can be fatal. They can also cause severe reactions including seizures, fever, lung and cerebral edema, cerebral hemorrhage, and heart damage. People receiving trichosanthin injections to cause abortion can develop a severe allergy. After a single exposure, the risk of anaphylaxis from a second exposure can persist for more than a decade (6).

Gastrointestinal ...Orally, Chinese cucumber fruit can cause mild diarrhea and gastric discomfort. Unprocessed Chinese cucumber seed can cause gastric discomfort and pain, nausea, vomiting, and diarrhea (12).

Immunologic ...People receiving injections of trichosanthin, a constituent of Chinese cucumber, to cause abortion can develop a severe allergy. After a single exposure, the risk of anaphylaxis from a second exposure can persist for more than a decade (6).

Other ...Unprocessed Chinese cucumber root extracts are toxic, particularly when injected. Injections of trichosanthin, a constituent of Chinese cucumber, can be fatal. They can also cause severe reactions including seizures, fever, lung and cerebral edema, cerebral hemorrhage, and heart damage (6).

(Read more about CHINESE CUCUMBER)

General ...There is currently a limited amount of information on the adverse effects of chrysanthemum. A thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Topically: Allergic reactions, contact dermatitis, eczema, urticaria.
Serious Adverse Effects (Rare):
Topically: Asthma.

Immunologic ...Topically and via occupational exposure, chrysanthemum can cause allergic reactions. Chrysanthemum allergy symptoms can include urticaria, contact dermatitis, eczema, actinic reticuloid photosensitivity dermatitis, pollinosis, rhinoconjunctivitis, and asthma (5552,5554,5556,5557,6958,42842,42845,42849,42859,42867,42893,42872,42873,42874)(42879,42880,42881,42882,42883,42887,42888). There are numerous case reports and studies showing that allergies to Chrysanthemum are very common, with an estimated 60% of Europeans being allergic (19149,42847,42856,42854).

(Read more about CHRYSANTHEMUM)

General ...There is limited reliable information available about the adverse effects of costus when used orally or topically.

Immunologic ...Orally and topically, costus might cause allergic reactions, including contact dermatitis (11,73140,73155,73281,73284,73288).

Oncologic ...Costus root is commonly contaminated with aristolochic acid, which is carcinogenic (6118).

Renal ...Costus root is commonly contaminated with aristolochic acid, which is nephrotoxic (6118).

(Read more about COSTUS)

General ...Japanese mint can cause stomach upset when taken orally, dermatitis when used topically, and flushing, headache and allergic reactions when inhaled (2,11,18).

Dermatologic ...Topically, Japanese mint may cause contact dermatitis (11,18).

Pulmonary/Respiratory ...Topically, use of Japanese mint oil on the face in children can trigger glottal or bronchial spasm, asthma-like attacks, or respiratory failure (18). When inhaled, the vapor from Japanese mint oil can cause flushing, headache, or worsening bronchial asthma spasms (11,18).

(Read more about JAPANESE MINT)

General ...Orally, Job's tears is generally well tolerated when consumed as a food (15368). There is no good scientific evidence on the safety and adverse effects of Job's tears taken orally in medicinal amounts.

Dermatologic ...Oral use of Job's tears has been associated with Baboon syndrome -- a condition characterized by a red and itchy rash most often located on the buttocks. In one case report, a 53-year-old woman taking a specific Job's tears-containing supplement (Ibane, JW Pharm) from South Korea experienced severe red and itchy skin around her trunk and groin area. While the supplement also contains riboflavin, pyridoxine, ascorbic acid, nicotinamide, biotin, and L-cysteine, Job's tears was thought to be the cause of this patient's reaction. After two weeks of not taking the supplement the patient's skin returned to normal (95438).

(Read more about JOB'S TEARS)

General ...Orally and intravaginally, kudzu seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Elevated liver transaminases.

Cardiovascular ...Orally, side effects of kudzu reported in clinical trials have included palpitations and chest discomfort; however, these effects did not occur more frequently than with placebo (57924,57927).

Dermatologic ...Orally, a side effect of kudzu reported in one clinical trial has included urticaria; however, this effect did not occur more frequently than with placebo (57924). There is one case report of allergic reaction following use of a combination herbal product (Kakkonto) containing kudzu involving a maculopapular eruption starting on the thighs and spreading over the entire body (13111,57886).

Gastrointestinal ...Orally, some side effects of kudzu reported in clinical trials have included nausea, dyspepsia, and bloating; however, these effects did not occur more frequently than with placebo (57927,57942).

Genitourinary ...Intravaginally, irritation of the vulva has been reported with kudzu gel. These cases were generally mild and transient (110702).

Hematologic ...Intravenously, the kudzu derivative, puerarin, has caused intravascular hemolysis (13298,15025,57947).

Hepatic ...Orally, there are several cases reports of liver injury following use of kudzu involving elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels (88777,92260).

Neurologic/CNS ...Orally, a side effect of kudzu reported in one clinical trial has included dizziness; however, this effect did not occur more frequently than with placebo (57924).

Other ...Orally, a side effect of kudzu reported in one clinical trial has included mastodynia; however, this effect did not occur more frequently than with placebo (57942).

(Read more about KUDZU)

General ...Orally, magnolia seems to be well tolerated.
Most Common Adverse Effects:
Topically: Contact dermatitis.

Dermatologic ...Topically, magnolia bark has been associated with reports of allergic contact dermatitis (92463,92468,95030,110709). In several cases, the use of anti-aging facial creams containing magnolia bark extract was associated with allergic contact dermatitis of the face (92463,92468,95030). In one case, the use of a vaginal gel containing magnolia bark extract was associated with allergic contact dermatitis of the vulva (110709). Symptoms typically resolve with the use of topical corticosteroids and discontinuation of magnolia bark extract (95030,110709). Patch testing suggests that the magnolia bark extract constituents magnolol and honokiol are responsible for this adverse effect (110709).

Endocrine ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported thyroid dysfunction (14349). However, it's not known if this side effect is related to magnolia or some other factor.

Gastrointestinal ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported heartburn (14349). However, it's not known if this side effect is related to magnolia or some other factor.

Neurologic/CNS ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported shaking hands and perilabial numbness. Another patient reported fatigue and headache (14349). However, it's not known if these side effects are related to magnolia or some other factor.

Psychiatric ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported sexual dysfunction (14349). However, it's not known if this side effect is related to magnolia or some other factor.

(Read more about MAGNOLIA)

General ...No adverse effects have been reported (104776). However, a thorough evaluation of safety outcomes has not been conducted.

(Read more about PATCHOULI OIL)

General ...Orally, poria mushroom seems to be well tolerated. However, a thorough evaluation of safety outcomes has not been conducted.

Immunologic ...Allergic reactions have been reported rarely, including allergic rhinitis and allergic asthma (12).

(Read more about PORIA MUSHROOM)

General ...Orally, very few adverse effects have been reported with the medicinal use of tangerine. However, a thorough evaluation of safety outcomes has not been conducted.
Topically, contact dermatitis has been associated with tangerine essential oil (28610).

Dermatologic ...According to one case report, the essential oil of tangerine in a fragrance has been associated with contact dermatitis (28610).

Gastrointestinal ...In a case report, a 5 year-old patient had a phytobezoar that included tangerine residues (28611). In another case report, orange and tangerine caused obstruction of the small intestine (28612).

(Read more about TANGERINE)