BP Balance by Dr. Stan Guberman

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

• Age-related cognitive decline. It is unclear if oral honeysuckle extract is beneficial in patients with age-related cognitive decline. Details: A small clinical study in elderly adults shows that taking honeysuckle (Lonicera caerulea) berry extract 200-400 mg, 90 minutes prior to a cognitive test, improves episodic memory, but not working memory or executive function tasks, when compared with placebo (103876). The long-term effects of honeysuckle on cognitive decline are unclear.
• Atopic dermatitis (eczema). Although there has been interest in using topical honeysuckle for atopic dermatitis, there is insufficient reliable information about the clinical effects of honeysuckle for this purpose.
• Bronchiolitis. Intravenous honeysuckle has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in children with respiratory syncytial virus (RSV) infection shows that intravenous administration of a combination of honeysuckle, Baikal skullcap, and forsythia might decrease the duration of symptoms of bronchiolitis when compared with a control group (12613). It is unclear if these findings are due to honeysuckle, other ingredients, or the combination.
• Diabetes. Although there has been interest in using oral honeysuckle for diabetes, there is insufficient reliable information about the clinical effects of honeysuckle for this purpose.
• Dyspepsia. It is unclear if oral honeysuckle flower bud extract is beneficial in patients with dyspepsia. Details: A small clinical study in patients with functional dyspepsia shows that taking honeysuckle (Lonicera japonica) flower bud extract 125 mg twice daily for 8 weeks improves gastrointestinal symptom scores when compared with placebo (103877).
• Postoperative infection. Topical honeysuckle has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large open-label trial in adults with obstructive sleep apnea recovering from uvulopalatopharyngoplasty shows that gargling with honeysuckle in combination with numerous other herbs 25 mL for 5 minutes 4 times daily for 2 weeks does not reduce post-operative wound infection when compared with saline placebo (112867). The interpretation of this study is limited by the unclear dose of honeysuckle.
• Postoperative pain. Topical honeysuckle has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large open-label trial in adults with obstructive sleep apnea recovering from uvulopalatopharyngoplasty shows that gargling with honeysuckle in combination with numerous other herbs 25 mL for 5 minutes 4 times daily for 2 weeks improves post-operative resting, swallowing throat pain, and patient comfort when compared with saline placebo (112867). It is unclear if this effect is due to honeysuckle, other ingredients, or the combination. The interpretation of this study is also limited by the unclear dose of honeysuckle.
• Pruritus. Although there has been interest in using topical honeysuckle for pruritus, there is insufficient reliable information about the clinical effects of honeysuckle for this purpose.
• Respiratory tract infections. Although there has been interest in using oral honeysuckle for various respiratory tract infections, including bronchitis, the common cold, influenza, and pneumonia, there is insufficient reliable information about the clinical effects of honeysuckle for these conditions.
• Rheumatoid arthritis (RA). Although there has been interest in using oral honeysuckle for RA, there is insufficient reliable information about the clinical effects of honeysuckle for this purpose.
• Urinary tract infections (UTIs). Although there has been interest in using oral honeysuckle for UTIs, there is insufficient reliable information about the clinical effects of honeysuckle for this purpose.
• Wound healing. Although there has been interest in using topical honeysuckle for wound healing, there is insufficient reliable information about the clinical effects of honeysuckle for this purpose. More evidence is needed to rate honeysuckle for these uses.

(Read more about HONEYSUCKLE)

POSSIBLY EFFECTIVE

• Angina. Low-quality clinical research shows that oral or intravenous Panax notoginseng may improve the frequency and severity of angina symptoms. Details: Meta-analyses of low-quality clinical research in patients with angina shows that Panax notoginseng administered intravenously or orally 200-400 mg 2-3 times daily for 2-6 weeks, in addition to conventional medicine, increases the number of patients who achieve a 50% improvement in angina pectoris symptoms by approximately 1.2-fold when compared with conventional medicine alone (94321,94326,94378). Panax notoginseng also reduces angina attack frequency by about 2 attacks per week but does not reduce the incidence of intractable angina pectoris (94321).
• Intracranial hemorrhage. Low-quality clinical research shows that intravenous Panax notoginseng saponins may improve recovery and mortality in patients with intracranial hemorrhage. Details: A meta-analysis of low-quality clinical research in patients with intracranial or intracerebral hemorrhage shows that treatment with Panax notoginseng saponins 140-600 mg intravenously daily for 2-10 weeks increases the odds of improvement by 2.7-fold when compared with conventional treatment alone. A subgroup analysis also suggests that treatment within 48 hours reduces the risk of mortality by 55% when compared with conventional treatment alone (94324).
• Stroke. Low-quality clinical research in patients with ischemic stroke shows that oral or intravenous Panax notoginseng may improve recovery as well as neurologic and functional scores. Details: Three meta-analyses of clinical research in patients with ischemic stroke show that treatment with oral or injectable Panax notoginseng 150-1080 mg daily for 3 days to 6 months with or without standard treatment improves neurological status and increases the overall response rate and improvement rate by around 20% when compared with conventional medicine alone or control (94373,109523,112463). Treatment with Panax notoginseng also improved some measures of activities of daily living (109523,112463). Additionally, preliminary clinical research in patients with a recent anterior cerebral ischemic stroke shows that taking Panax notoginseng root (sanchitongtshu) extract, containing 100 mg of panaxatriol saponins, orally three times daily with aspirin 50 mg daily for 28 days improves neurological deficit scores and activities of daily living scores when compared with placebo and aspirin (17183). There is evidence that Panax notoginseng may benefit stroke sequalae beyond the acute period of symptoms. A very large clinical study in adults with mild to moderate ischemic stroke shows that taking Panax notoginseng saponins 60 mg twice daily for 3 months within 14 days of stroke symptom onset in addition to standard care increases the proportion of patients with functional independence at 3 months by 7%, the number of patients with no or minimal disability at 3 months and 12 months by 5% and 3%, respectively, and leads to greater improvements in neurological deficits and activities of daily living when compared with placebo. However, Panax notoginseng does not improve functional independence at 12 months or reduce the risk of recurrent stroke or composite cerebrovascular events when compared with placebo (112464).

POSSIBLY INEFFECTIVE

• Myocardial infarction (MI). Low-quality clinical research shows that oral Panax notoginseng may not reduce the risk of MI in patients with coronary heart disease. Details: A meta-analysis of two small clinical trials in patients with existing coronary heart disease shows that that taking a specific Panax notoginseng product (Xuesaitong soft capsule, Shenghuo Pharmaceutical Holdings) 240 mg orally twice daily along with conventional therapy for 4 weeks does not reduce the risk of MI when compared with conventional therapy alone (94321).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Atherosclerosis. Although there has been interest in using oral Panax notoginseng for atherosclerosis, there is insufficient reliable information about the clinical effects of Panax notoginseng for this purpose.
• Athletic performance. It is unclear if oral Panax notoginseng is beneficial for improving athletic performance. Details: A meta-analysis of small clinical studies in generally healthy adults shows that taking Panax notoginseng 200-1350 mg or ginsenoside Rg1, a constituent of Panax notoginseng, 5 mg orally once daily for 1-30 days before running or cycling increases exercise endurance when compared with control (109672). One clinical study of untrained adults shows that taking Panax notoginseng root powder 1350 mg daily for 30 days increases cycling endurance by at least 7 minutes when compared with baseline (94384). The validity of this study is limited by the lack of a comparator group.
• Bleeding. Although there has been interest in using oral Panax notoginseng for bleeding, there is insufficient reliable information about the clinical effects of Panax notoginseng for this purpose.
• Bruises. Although there has been interest in using topical Panax notoginseng for bruises, there is insufficient reliable information about the clinical effects of Panax notoginseng for this purpose.
• Coronary heart disease (CHD). It is unclear if oral Panax notoginseng is beneficial for improving platelet aggregation and coagulation in patients with CHD. Details: A meta-analysis of clinical studies in patients with CHD and ischemic stroke shows that taking Panax notoginseng preparations including Panax notoginseng saponins (PNS) or panaxatriol saponins (PTS) with aspirin reduces platelet aggregation rate when compared with aspirin alone. Subgroup analysis suggests that the two formulations differ in their effect on biomarkers of platelet aggregation and coagulation. PTS increases prothrombin time and prothrombin time-based international normalized ratio (PT-INR) compared with aspirin alone. Meanwhile, PNS reduces fibrinogen and D-dimer compared with aspirin alone. Neither Panax notoginseng preparation changed platelet counts when compared with aspirin alone (112462).
• Exercise-induced muscle soreness. It is unclear if oral Panax notoginseng is beneficial for reducing exercise-induced muscle soreness. Details: Preliminary clinical research in well-trained males shows that taking Panax notoginseng, 4 grams orally one hour before a downhill run, then every 4 waking hours for 48 hours, and then twice daily for 48 hours, modestly reduces delayed onset muscle soreness at 96 hours, but not at earlier time points, when compared with baseline (94320). The validity of this study is limited by the lack of a comparator group.
• Hepatitis. Although there has been interest in using oral Panax notoginseng for hepatitis, there is insufficient reliable information about the clinical effects of Panax notoginseng for this purpose.
• Hypertension. Although there has been interest in using oral Panax notoginseng for hypertension, there is insufficient reliable information about the clinical effects of Panax notoginseng for this purpose.
• Nonalcoholic steatohepatitis (NASH). Although there has been interest in using oral Panax notoginseng for NASH, there is insufficient reliable information about the clinical effects of Panax notoginseng for this purpose.
• Osteoarthritis. Oral Panax notoginseng has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with knee osteoarthritis shows that taking two capsules, each containing 400 mg of a combination of Panax notoginseng, Siberian ginseng, and rehmannia, orally daily for 6 weeks moderately improves physical function scores, but not pain or stiffness scores, when compared with placebo (74950). It is unclear if these effects are due to Panax notoginseng, other ingredients, or the combination.
• Rheumatoid arthritis (RA). Although there has been interest in using oral Panax notoginseng for RA, there is insufficient reliable information about the clinical effects of Panax notoginseng for this purpose.
• Ulcerative colitis. Rectal Panax notoginseng has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults admitted to the hospital with mild to moderate ulcerative colitis lesions shows that administering a 1-gram suppository containing Panax notoginseng and multiple other ingredients rectally for 3 months improves diarrhea and bloody stool symptom scores when compared with a 0.8-gram suppository containing the same ingredients. Recurrence at 12 months occurred in approximately 10% of the patients who received the higher-dose combination product compared with 47% of patients who received the lower dose. Patients in each group received 2 suppositories twice daily for the first month, 1 suppository twice daily for the second month, and 1 suppository once daily for the third month. Each suppository contained Panax notoginseng 36 grams, cortex phellodendri 120 grams, radix Sanguisorbae 120 grams, arnebia root, 120 grams, radix pulsatillae 120 grams, rhizoma coptidis 120 grams, cortex fraxini 120 grams, rhizoma corydalis, pericarpium papaveris 72 grams, radix sophorae flavescentis 72 grams, and rhizoma bletillae 72 grams (109673). The interpretation of these results is limited by the lack of comparison to placebo or active control with known effectiveness for ulcerative colitis. Additionally, it is unclear if these effects are due to Panax notoginseng, other ingredients, or the combination.
• Venous thromboembolism (VTE). It is unclear if oral or intravenous Panax notoginseng is beneficial for the prevention of postoperative deep vein thrombosis (DVT). Details: A meta-analysis of randomized controlled trials in adults undergoing surgical treatment for a fracture shows that using a Panax notoginseng injection, alone or in combination with other anticoagulants, for 3-14 days reduces the risk of DVT by 58% when compared with active control, such as low-molecular weight heparin (LMWH) or rivaroxaban (105510). The validity of these findings is limited by the high heterogeneity of the included studies. A prospective study in post-surgical adults using LMWH shows that taking a specific Panax notoginseng tablet (Xuesaitong, Hunan Xiangya Pharmaceutical Company) 100 mg three times daily reduces the risk of DVT by 44% when compared with LMWH alone (109674). The validity of this study is limited by lack of randomization. More evidence is needed to rate Panax notoginseng for these uses.

(Read more about PANAX NOTOGINSENG)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Rheumatoid arthritis (RA). Clinical research shows that taking a combination of self-heal, Clematis mandshurica, and Chinese cucumber 200 mg three times daily for 6 weeks is as effective as celecoxib 200 mg twice daily for reducing pain and disease activity associated with RA. There was no difference between groups in the use of rescue medication or the response rate (101041). It is unclear whether these effects are due to self-heal, the other ingredients, or the combination. More evidence is needed to rate self-heal for this use.

(Read more about SELF-HEAL)

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)

POSSIBLY SAFE ...when used orally and appropriately, short-term. Panax notoginseng has been used with apparent safety in doses of 100-400 mg 1-3 times daily for up to 6 weeks (17183,94321,94326,94378,94384,109674). ...when given as an injection, under medical supervision. Panax notoginseng extract has been used with apparent safety in doses of 400-800 mg daily for up to 10 weeks (94324,94326,94373,98976,109523). There is insufficient reliable information available about the safety of Panax notoginseng when administered rectally.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally (5559). Ginsenoside Rb1, an active constituent of Panax notoginseng, has teratogenic effects in animal models (10447).

(Read more about PANAX NOTOGINSENG)

There is insufficient reliable information available about the safety of self-heal.

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

(Read more about SELF-HEAL)

(Read more about CHRYSANTHEMUM)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, honeysuckle might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.  Details In vitro research shows that polyphenols extracted from honeysuckle can inhibit platelet aggregation (12610).

(Read more about HONEYSUCKLE)

ASPIRIN Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking Panax notoginseng concomitantly with aspirin may increase the risk of adverse effects from both products.  Details Animal research shows that taking Panax notoginseng extract with aspirin increases blood levels of salicylic acid by approximately 50% and blood levels of Panax notoginseng by 75% to 196%. This effect may be due to increased absorption of both products (94322,96219).

CAFFEINE Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking Panax notoginseng may decrease the levels and clinical effects of caffeine.  Details Animal research shows that administering Panax notoginseng intravenously for 7 days before intraperitoneal injection of caffeine can decrease maximal blood levels of caffeine by 37%. This interaction is attributed to the ability of Panax notoginseng to increase the activity of cytochrome P450 1A2 (CYP1A2) enzymes (94319).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking Panax notoginseng might reduce the levels and clinical effects of CYP1A2 substrates.  Details Animal research shows that administering Panax notoginseng intravenously for 7 days before intraperitoneal injection of caffeine can decrease maximal blood levels of caffeine by 37%. This interaction was attributed to the ability of Panax notoginseng to increase the activity of CYP1A2 (94319).

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking Panax notoginseng concomitantly with warfarin may increase the risk of bleeding.  Details Animal research shows that taking Panax notoginseng concomitantly with warfarin increases plasma warfarin levels, prothrombin time, and international normalized ratio when compared with control. In vitro research also suggests that Panax notoginseng may downregulate expression of cytochrome P450 3A4 enzymes, which may affect warfarin metabolism (109676).

(Read more about PANAX NOTOGINSENG)

(Read more about SELF-HEAL)

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 ...Orally, honeysuckle seems to be well tolerated. No adverse effects have been reported. There is insufficient reliable information available about the safety of honeysuckle when used topically. However, a thorough evaluation of safety outcomes has not been conducted.

Immunologic ...Topically, applying honeysuckle to the skin has been associated with contact dermatitis in a case report (12611). Orally, a case of biopsy-confirmed allergic drug eruption is reported in a young adult male after taking honeysuckle granules 30 grams over a 24-hour period. Symptoms resolved with discontinuation of honeysuckle and 2-weeks of antihistamine and glucocorticoid therapy (112866).

(Read more about HONEYSUCKLE)

General ...Panax notoginseng seems to be generally well tolerated when used orally or intravenously.
Most Common Adverse Effects:
Orally: Dry mouth, flushed skin, insomnia, nausea, nervousness, rash, vomiting.
Intravenously: Headache, itching, rash.
Serious Adverse Effects (Rare):
Intravenously: Fever, pustular drug eruption.

Dermatologic ...Orally, Panax notoginseng can cause flushed skin (5558). When given orally or intravenously, rash has been reported (94321,94324,94326,94378,98976). There is a case of interstitial granulomatous drug reaction in a 73-year-old male who had been using oral Panax notoginseng extract for 2 months. The condition repeated after 5 days of intravenous use at a later time. The skin condition gradually cleared after use of the product was discontinued (94316). In a retrospective review of hospital records of 30,884 patients, a specific Xueshuantong injection (XSTI) containing Panax notoginseng saponins was associated with a 4% incidence of skin reactions, including redness, itching, and maculopapules (98976).

Gastrointestinal ...Orally and intravenously, Panax notoginseng can cause dry mouth, nausea, and vomiting (5558,94321,98976). In one case report, a patient developed a large submucosal hematoma extending from the hypopharynx to lower esophagus after taking one oral dose of an unknown quantity of Panax notoginseng and hirudin (109671). It is unclear if this event was due to Panax notoginseng, hirudin, or other factors.

Immunologic ...Intravenously, Panax notoginseng saponins have been associated with five cases of pustular drug eruption due to acute generalized exanthematous pustulosis. The skin eruption was associated with fever and an increased neutrophil count in some cases. Symptoms were deemed to be probably or likely due to the Panax notoginseng product (94327). In a retrospective review of hospital records of 30,884 patients, a specific Xueshuantong injection (XSTI) containing Panax notoginseng saponins was associated with a fever frequency of 0.2%, edema frequency of 0.1%, and anaphylactic reactions in 0.03% (98976).

Neurologic/CNS ...Orally, Panax notoginseng can cause nervousness and insomnia (5558). Intravenously, Panax notoginseng has been reported to cause headache (94326,94378). In a retrospective review of hospital records of 30,884 patients, a specific Xueshuantong injection (XSTI) containing Panax notoginseng saponins was associated with a headache frequency of 0.3% and paresthesia frequency of 0.1% (98976).

(Read more about PANAX NOTOGINSENG)

General ...Orally, self-heal has been reported to cause nausea, vomiting, and diarrhea. Orally and topically, self-heal has been reported to cause allergic reactions in sensitive individuals (12).

Gastrointestinal ...Orally, self-heal has been reported to cause nausea, vomiting, and diarrhea (12). A combination product containing self-heal, Clematis mandshurica, and Chinese cucumber has been reported to cause epigastric pain, abdominal discomfort, nausea, reduced appetite, and dyspepsia. It is not clear if these effects are due to self-heal, the other ingredients, or the combination (101041).

Immunologic ...Orally and topically, self-heal has been reported to cause allergic reactions, including rashes and swelling of the throat, lips, and tongue, in sensitive individuals (12).

(Read more about SELF-HEAL)