herbal pharmacology: case based studies with guido masé, rh … · 2017-03-03 · depression,...

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Herbal Pharmacology: Case Based Studies with Guido Masé, RH (AHG)

Hosted by Anna Claire LottiAHG Education Coordinator

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Guido Masé RH(AHG)

*A case-based approach

Part IV

*Tissue-level activity

Central nervous system

Peripheral nervous system

Receptor / enzyme interaction

Lymphatic channels / Immune cells

Cardiac effects

Alkaloidal activity on S/A node

Hepatic effects

Hormone metabolism / enzyme interaction

Toxicity

Central effects (limbic, frontal, default action network)Peripheral effects (vanilloid receptors, chemosensing receptors)

Peripheral nervous system:

Sensory receptors (TRPV-1) aka vanilloid receptors

(examples of receptor modulation)

Cardiac muscle depolarization (Activation of contraction)

Cardiac activity – alkaloids (and cardio glycosides)

Lymphatic channels and immune system: innate immune activation / conversation, helper T cell modulation

Steroid dehydrogenase binding pocket

Steroid hormone metabolism (cortisol/cortisone)Also occurs in the kidney

Male, 38 years old

Received diagnosis of “prurigo nodularis”, body-wide itching characterized by widespread lesions that can be open

Of unknown etiology – usually tied to stress, itch-scratch cycle

Diet is good, GI habits regular, but anxiety level high!

Sleep, cardiovascular function normal – unless sleep is disrupted by itching (1-2 nights / week)

Constitutional notes:

Slender, very fidgety, scattered

Easily startled, constant motion

Somewhat dry

Potentially applicable chemical classes:

Volatile oils

Piperidine alkaloids – capsaicin (really a pseudo-alkaloid)

Steroidal saponins (adaptogenic effect)

Constitutional notes:

Need central nervous system support

Need “vata-pacifying” oil - sesame

Potentially applicable chemical classes:

Volatile oils

Cadinene – Scutellaria lateriflora

Yaghmai, M. S. Volatile constituents of Scutellaria lateriflora L Flavour and Fragrance Journal, John Wiley & Sons, Ltd., 1988, 3, 27-31

Potentially applicable chemical classes:

Piperidine (psuedo)alkaloids

Capsaicin – Capsicum spp

Ständer S, Luger T, Metze D. Treatment of prurigo nodularis with topical capsaicin. J Am Acad Dermatol. 2001 Mar;44(3):471-8.

Potentially applicable chemical classes:

Steroidal saponins

Panax quinquefolius

Kim TW, Choi HJ, Kim NJ, Kim DH. Anxiolytic-like effects of ginsenosides Rg3 and Rh2 from red ginseng in the elevated plus-maze model. Planta Med. 2009 Jun;75(8):836-9.

Male, 38 years old

Recommendations:

Topical capsaicin cream .025% TID if possible

Scutellaria 60ml, Panax 60ml 5ml TID

Sesame oil (raw) topically after shower

… 24 hours …

“You are crazy and torturing me!!!”

… 72 hours …

“The itching is gone!”

… 1 week …

“I will need more of the tincture formula.”

Lesions fading slowly, much improved

Female, 59 years old

Episodes of cardiac tamponade, uncertain etiology

Heart weakened: hypotension, fatigue, irregular rhythms

Otherwise extremely healthy, moderately active, good food including lots of hawthorn already

Constitutional notes:

Cool – unexpectedly so

Irregularity noticeable in a weak pulse

Very, very easy fatigability (new to her)

Potentially applicable chemical classes:

Quinolizidine alkaloids – sparteine e.g.

Bioflavonoids

Constitutional notes:

Fatigue is secondary to heart weakness

Potentially applicable chemical classes:

Quinolizidine alkaloid

Sparteine – Cytisus scoparius

M Raschack. Actions of sparteine and sparteine derivatives on the heart and circulation. Arzneimittel-Forschung, 1974

Female, 59 years old

Recommendations:

Fresh Scotch Broom flower extract, 10 gtt BID

Continue with high flavonoid (catechin) intake:

Hawthorn, blueberries

… 3 weeks …

Mild improvement in energy.

Noticeably more regular pulse

… 6 weeks…

Energy better, but improvement has stalled

Consider: adaptogens?

Ashwagandha / Rhodiola / Panax?

Trauma?

Post-traumatic stress disorder?

Anxiety associated with terminal disease?

Intractable depression?

Substance abuse/addiction?

- pattern-breaking (“default-mode network”)

Openness, creativity, meaning, happiness

Persistent changes from one dose

Roland GriffithsJohns Hopkins

Psilocybin: oceanic boundlessness, fear of ego dissolution, visualsFear in over 1/3 of participants, but significant benefits in depression, PTSD, anxiety, addiction

Griffiths, Roland R., et al. "Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance.” Psychopharmacology 187.3 (2006): 268-283.

Entheogens

Roland GriffithsJohns Hopkins

Psilocybin: increase in “openness” domain – clinically observed, reported by family/friends @ 6mo follow-up

MacLean, Katherine A., Matthew W. Johnson, and Roland R. Griffiths. "Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness." Journal of Psychopharmacology 25.11 (2011): 1453-1461.

Also:

Griffiths et al 2008: 14 month follow-upGriffiths, Grob et al 2013: anxiety + cancer

Entheogens

Roland GriffithsJohns Hopkins

Good review of overall effects of psilocybin on mental health:Griffiths, Roland R., and Charles S. Grob. "Hallucinogens as medicine."Scientific American 303.6 (2010): 76-79.

Johnson, Matthew W., et al. "Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction." Journal of Psychopharmacology (2014): 0269881114548296.

Experiment on tobacco cessation.80% stayed quit at 6mo follow-up….after one session!

Entheogens

Robin L Carhart-Harris (Imperial College, London)Clinical trial in the Lancet

One of the first prospective trials for psilocybin in cases of depression that didn’t respond to treatment.

Carhart-Harris, Robin L, et al. " Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study." The Lancet: Psychiatry (2016): pre-publication

12 patients. Two sessions, with escalatingdose of psilocybin.All patients reported anxiety during onset.All patients showed improvement at:1 week and 3 months in:depression, anxiety, anhedonia

Entheogens

Potential mechanisms for indole alkaloids:

- Increased DOPA re-uptake- 5-HT2A receptor hyper-excitability?

- prefrontal cortex, other cortical areas (<5% overall neurons)- Once excited, spread to other cortical areas

Openness, creativity, meaning, happinessPersistent changes from one dose

Martin, David A., and Charles D. Nichols. "Psychedelics Recruit Multiple Cellular Types

and Produce Complex Transcriptional Responses Within the Brain."

EBioMedicine 11 (2016): 262-277.

Potential mechanisms for indole alkaloids:

- Decreased activity in the default mode network- Pre-frontal cortex, medial temporal cortex, hippocampus and

limbic system- Sense of self, others, and emotion

Openness, creativity, meaning, happinessPersistent changes from one dose

Carhart-Harris, Robin L., et al. "Neural correlates of the psychedelic state as determined

by fMRI studies with psilocybin." Proceedings of the National Academy of Sciences

109.6 (2012): 2138-2143.

Indole alkaloids:

Psilocybin (Psilocybe cubensis)

Indole alkaloids:

Psilocybin (Psilocybe cubensis)

Ibogaine

Serotonin

From 1979, Japan, 2 cases of pseudoaldosteronism

Women aged 68 and 71

275mg to 550mg glycyrrhizin for 1.5 to 6 months (6-12g root)

Results: hypertension, elevated plasma sodium, disruption of renin-aldosterone system, edema

Effects continued for 1 month after discontinuation, then slowly renormalized

TAKEDA, R.; MORIMOTO, S.; UCHIDA, K.; NAKAI, T.; MIYAMOTO, M.; HASHIBA, T.; YOSHIMITSU, K.; KIM, K. S. & MIWA, U. Prolonged Pseudoaldosteronism Induced by Glycyrrhizin. EndocrinologiaJaponica, 1979, 26, 541-547

TAKEDA, R.; MORIMOTO, S.; UCHIDA, K.; NAKAI, T.; MIYAMOTO, M.; HASHIBA, T.; YOSHIMITSU, K.; KIM, K. S. & MIWA, U. Prolonged Pseudoaldosteronism Induced by Glycyrrhizin. EndocrinologiaJaponica, 1979, 26, 541-547

TAKEDA, R.; MORIMOTO, S.; UCHIDA, K.; NAKAI, T.; MIYAMOTO, M.; HASHIBA, T.; YOSHIMITSU, K.; KIM, K. S. & MIWA, U. Prolonged Pseudoaldosteronism Induced by Glycyrrhizin. EndocrinologiaJaponica, 1979, 26, 541-547

TAKEDA, R.; MORIMOTO, S.; UCHIDA, K.; NAKAI, T.; MIYAMOTO, M.; HASHIBA, T.; YOSHIMITSU, K.; KIM, K. S. & MIWA, U. Prolonged Pseudoaldosteronism Induced by Glycyrrhizin. EndocrinologiaJaponica, 1979, 26, 541-547

Male, 20 years old

Post-mononucleosis: weak, fatigued, experiences recurrent upper respiratory infection. EBV infection Sx began 3 mo ago

Generally healthy, fit, eats well. Occasional tobacco.

Hypersensitivity developing: chemicals, cleaners, laundry –with runny nose, itchy eyes

Constitutional notes: some yellowing

signs on tongue, occasional orbital

headache

Potentially applicable chemical classes:

Triterpenes (medicinal mushrooms)

Steroidal saponins (adaptogenic / immunologic effect)

Polysaccharides

[potentially, also, other cases: Echinacea/Hyssop/Baptisia 2wk]

Constitutional notes:

Need hepatic support?

Potentially applicable chemical classes:

Triterpenoids (steroidal) – from medicinal mushrooms

Ganoderma lucidum

Lin JY, Chen ML, Lin BF. Ganoderma tsugae in vivo modulates Th1/Th2 and macrophage responses in an allergic murine model. Food Chem Toxicol. 2006 Dec;44(12):2025-32.

Potentially applicable chemical classes:

Steroidal saponins

Panax quinquefolius

Luo YM, Cheng XJ, Yuan WX. Effects of ginseng root saponins and ginsenoside Rb1 on immunity in cold water swim stress mice and rats. Zhongguo Yao Li Xue Bao. 1993 Sep;14(5):401-4.

Potentially applicable chemical classes:

Flavonolignans

Silymarin – Silybum marianum

Bakhshaee M, Jabbari F, Hoseini S, Farid R, Sadeghian MH, Rajati M, Mohamadpoor AH, Movahhed R, Zamani MA. Effect of silymarin in the treatment of allergic rhinitis. OtolaryngolHead Neck Surg. 2011 Dec;145(6):904-9.

Male, 20 years old

Recommendations:

Astragalus root powder, 10g QD mixed with nut butter/honey

Tincture of 30ml Ganoderma, 90ml Panax. 5ml BID

Ground Silybum seed, 5g BID mixed with cooked grains

… 2 weeks …

1 recurrence of fever, 36 hours

Energy improving (slowly)

Tongue clear

… 6 weeks …

Much better. Back to work full-time,

exercise regime restarted

Consider your level of familiarity with the following concepts

Epithelial effects:What tissues?What actions?Botanical examplesRelevant constituents

Endothelial effects:Endothelial surfaceVascular / arteriolar / capillary smooth muscleBotanical examplesRelevant constituents

Consider your level of familiarity with the following concepts

Immunologic effects

Primary area(s) of influence from botanicals

Relevant constituents

Lymphatic effects

Role of coumarins

Fluid retention and the kidney

Coumarins and blood clotting

Consider your level of familiarity with the following concepts

“Acupharmacological” effects

Useful model for understanding oral dosing

Autonomic nervous system’s role

Protein/receptor-mediated effects

Cell surface

Nuclear

Transcription regulation

Metabolic enzymes (Liver phase 1, steroid) + consequences

Consider your level of familiarity with the following concepts

EpigeneticsMethylation of DNA backboneAcetylation / modification of histonesNotable phytochemical constituentsConsequences (note: phyto “antioxidants”? estrogens?)

Nervous systemAcupharmacologyLimbic system modulationPeripheral / Central receptor influencesNeuromuscular polarization effects

Consider your level of familiarity with the following concepts

Pharmacokinetics (how the body affects constituents)

Glycosylation / deglycosylation + relevant molecules

Absorption enhancement

Mechanical “trapping” in GI tract

Motility modification

Hepatic metabolic enzymes (Phase 1 and 2)

Route(s) of excretion

Consider your level of familiarity with the following concepts

Toxicity

Pyrrolizidine alkaloids

Cardioactive alkaloids / glycosides

Tropane alkaloids

Emesis through irritation (alkaloids, saponins)

Potential interactions

Additive synergy

Hepatic metabolism

Guido Masé RH(AHG)

aradicle.blogspot.com

Thank you!!