20: Veterinary Herbal Medicine: A Systems-Based Approach

CHAPTER 20 Veterinary Herbal Medicine: A Systems-Based Approach



This chapter reviews traditional and scientific approaches to the use of herbal medicine in treating an array of conditions by system.


Clinically, it is common to find more than one system affected, so it is important to consider the whole patient and not just the diagnosis or system. In this section formulas are offered as starting points; however, it is intended that they should be modified to match the needs of the individual patient wherever possible (see Chapter 19).


Frequently treatment with orthodox medicine has already been implemented. In the authors’ experience herbal medicines can frequently be used alongside the conventional approach but can also be used instead in many instances, particularly for complicated or chronic conditions. Care should always be taken to consider possible drug-herb interactions and herb-herb interactions, dosing, and the vitality of the patient. Inexperienced veterinary herbalists are advised to cross reference with the monographs and chapters pertaining to prescribing and pharmacology. In many cases below, studies are described that involve experimental animal models and herb extracts (as opposed to whole herbs). It is important to maintain proper perspective on if and how these studies relate to clinical patients, whether they are safe in the species of interest, and how dosing of an herb might differ from doses described in the studies.



HERBS FOR BLOOD AND IMMUNOLOGIC DISORDERS


Of all the systems discussed in this section, the immune system is at once the most difficult and the most self-evident to treat. Practitioners are frequently asked how to “stimulate the immune system,” yet herbalists and scientists alike realize that the complexity of immune function makes this effort at least naïve and at best inadvisable. Immune function represents an ecologic balance within the body that is attained with contributions from endocrine and neurologic activities. It has even been recognized that the “invaders” fought by the immune system are not all bad—we may even need our viruses to help us fend off the development of tumors and our bacteria to maintain normal immune function.


So any attempt to modify immune function must take into account the relationship between the patient and all functions of the immune system, as well as the environment and its microbial influences that interface with the forward defenses of the immune system. In this sense, traditional concepts of clinical disease and empirically determined treatments may be even more useful than evidence-based guidance, simply because our knowledge of the complexities of immune function is so limited. We truly must treat an entire patient, instead of bone marrow and secondary immune organs.


Similarly, disorders of the blood are about more than just the bone marrow. For instance, hyperlipidemia in people is surely not just a problem with the blood—it is a lifestyle problem in many cases. Although this section is all about blood and immune disorders, every condition that is listed requires a global approach to treatment. Herbs inherently provide complex actions that address more than one deranged process in the body.



Mechanisms of Interest



Adaptogens


These plants have been noted both traditionally and in human clinical trials and animal studies to increase resistance to stress, which predisposes animals to disease, including infection. Adaptogens generally work by modulating the hypothalamic-pituitary-adrenal axis, but many have other effects as well, such as modulation of immune function.





BACOPA (BACOPA MONNIERI):


Rai and colleagues (2003a) showed that a dose of 40 mg/kg of a standardized extract reversed stress-induced ulcer development, and higher doses (80 mg/kg) additionally prevented increases in adrenal gland weight in rats.



ELEUTHERO (ELEUTHEROCOCCUS SENTICOSIS):


Water extracts high in isofraxidin and eleutherosides B and E (especially E) reduced corticosterone levels in stressed mice (Kimura, 2004). On the contrary, in human athletes, Eleuthero slightly worsened a hormonal indicator of stress after 6 weeks of training. The athletes were administered 8 mL daily of a 33% hydroethanolic extract (Gaffney, 2001).









Blood Tonics


These herbs are used both for frank anemia and for the traditional Chinese medicine signs of “Blood Deficiency,” which include dry and itchy skin, dream-disturbed sleep, dry coat, and dry eyes.







Immune Modulators


A Medline search on “immune” and “herbal” would suggest that a legion of plants may stimulate some aspect of immune function. The problem here is that most studies have been conducted in vitro or at best in experimental animals and most of these plants have not been used traditionally for immune support. The herbs described below give researchers plenty to explore and are those that are deemed most useful by herbalists. Immune stimulant herbs have been implicated in reactivation or worsening of autoimmune disease, and they should be used with caution in these patients (Lee, 2004c).




ECHINACEA (ECHINACEA SPP):


Extracts have been shown to increase phagocytic activity in human peripheral monocytic cells, to promote production of various cytokines, and to enhance natural killer cell function, all of which involve the innate immune system as opposed to specific, adaptive processes. Most clinical studies in humans have involved upper respiratory infection and, in fact, Echinacea may shorten the duration of the common cold (Percival, 2000), depending on the form administered. Echinacea is often recommended for chronic recurrent viral upper respiratory infection in cats, and some practitioners use Echinacea to treat patients with retroviral infection. Although some practitioners caution against the long-term use of Echinacea because toxicity or autoimmune conditions may result, this concern has not been well documented. However, immunostimulants are probably best used as pulsed treatments if they are administered on a long-term basis, because full response to treatment is probably reached in a few weeks and does not continue to increase. In a 4-day observational study conducted at the Ohio Eclectic College in 1935, students were administered Echinacea before meals and at bedtime. Leukocyte counts increased 24 to 48 hours after initiation of treatment. Short-term (2- to 4-week), on-off administration is most sensible. The Echinacea monograph (see Chapter 24) describes studies in swine and horses that suggest immune modulating effects in these species.




GINSENG POLYSACCHARIDES AND SAPONINS:


These have shown immunostimulating capacity in vitro and in animal models (Kitts, 2000). In one study, rats with chronic Pseudomonas aeruginosa lung infection were administered extracts of Panax ginseng; the treated group exhibited higher bacterial clearance and lower serum immunoglobulin levels than did the untreated group, which suggests enhancement of cell-mediated immunity (Song, 1998).



THUNDER GOD VINE (TRIPTERYGIUM WILFORDII):


This herb appears to be a true immune suppressant. Extracts of this plant have been investigated in human clinical trials for the treatment of rheumatoid arthritis, myasthenia gravis, lupus erythematosus, graft rejection, asthma, and other immune-mediated problems, generally with positive results (Tao, 2000; Tao, 2002). Various trials have shown reductions in interleukin (IL)-6, IL-5, IL-2, NF-kappaB, and CD 4+ levels, caused by an extract or by single constituents such as triptolide. In one trial, it was effective for rheumatoid arthritis when applied topically (Cibere, 2003). The plant has some toxicity, most notably causing infertility in both males and females.




Antihyperlipidemics



GARLIC (ALLIUM SATIVUM):


This herb has shown modest efficacy in lowering cholesterol and triglyceride levels in laboratory animals and people (Ackermann, 2001). Garlic has the potential for causing Heinz body anemia in dogs and especially in cats. Many veterinarians, however, use garlic for their patients and monitor blood parameters.




GUGULIPID (COMMIPHORA MUKUL):


This herb contains resins that have been shown to have cholesterol- and triglyceride-lowering activity in humans (Singh, 1994) and laboratory animals. However, the overall effect is mild to moderate compared with cholesterol-lowering drugs used in people (Caron, 2001).



GLOBE ARTICHOKE (CYNARA SCOLYMUS):


This herb has been shown in human clinical trials to lower cholesterol and triglycerides, at doses ranging from 900 to 1920 mg per day. Globe artichoke leaf extract not only increases choleresis and, therefore, cholesterol elimination, but it also has been shown to inhibit cholesterol biosynthesis (Kraft, 1997b). It is suggested that a possible mechanism of action might be the indirect inhibition of hydroxymethylglutaryl–CoA reductase (HMG-CoA) (Gebhardt, 1998). In vitro studies have documented a concentration-dependent inhibition of de novo cholesterol biosynthesis in cultured rat and human hepatocytes for globe artichoke leaf extract given at 0.03 to 0.1 mg/mL (Petrowicz, 1997).



Hemostatics


Many hemostatics in Western herbal medicine are astringent and exert their effects through direct contact with skin or mucous membranes to stop bleeding via a styptic action. The concept is different in Chinese medicine, where bleeding may be due to Excess Heat in the blood (so it should be cooled) or Blood Stasis (which causes bleeding by allowing blood to back up and subsequently “overflow,” or extravasate, around the area of stasis). A bruise is an example of Blood Stasis, and hematochezia and epistaxis are often due to Blood Heat.





REVIEW OF SPECIFIC HEMATOLOGIC AND IMMUNOLOGIC CONDITIONS







Immune Deficiency or Suppression



Therapeutic rationale




Patients with poor immunity should be prescribed herbs from three main groups:





Echinacea and Astragalus are two of the most popular “immune” herbs in human herbal medicine. Echinacea improves phagocytosis and generally enhances immune surveillance. It must be used in high doses during acute infections, such as infected wounds or viral infections. In humans, doses of 20 to 30 mL per day can be taken; it takes about 3 days for phagocytic activity to peak. Many studies that detract from the benefits of Echinacea are flawed by incorrect dosing and improper extract type. Echinacea can be used for chronic bacterial and viral infections, postviral syndromes, acquired immunodeficiency syndrome resulting from feline leukemia virus (FAIDS), in the appropriate formulas, autoimmune disease and long-term allergies and intolerances. It can be used during chemotherapy or pneumonia, and for chronic purulent or pyodermic skin infection—at relatively high doses in all cases (in humans, 15 mL per day for serious chronic states of immune deficiency). Doses as high as 40 mL on the first day followed by 16 mL daily were used in one positive clinical trial (Goel, 2004). Astragalus, on the other hand, is more appropriately used as a preventive measure during disease outbreaks or for chronic immune incompetence and autoimmune disease (especially nephritis). The dose in humans is between 20 and 40 mL per week. High dosing in the case of Echinacea is an important consideration because it does influence efficacy.


A prescription for general immune support follows:
















Echinacea 40%
Oregon grape root 20%
Astragalus 20%
Licorice 20%


Infection


Infections are addressed in this text within the sections on specific systems or organs in which they occur. Herbalists generally develop formulas that combine antimicrobial activity, organ support, and immune stimulation (where appropriate). For instance, a formula for pneumonia might include antimicrobials such as thyme and sage, immune support from Astragalus and Echinacea, and expectorants such as elecampane and horehound. It should be noted that some of these herbs have multiple indications that magnify their effects on the respiratory tract (Thyme is both antimicrobial and expectorant, Echinacea is an immune stimulant and an antimicrobial, and Astragalus is an immune stimulant that is specifically associated with the lung in traditional Chinese medicine).


Herbal management of infections should include the following:








HERBS FOR CANCER



General Considerations


Cancer biology is yet to be fully understood. Cellular mutation may occur as a result of free radical damage (with activation of oncogenes or suppression of tumor suppressor genes) and genetic susceptibility and toxicity (e.g., hepatopathogenic toxins). In traditional herbal medicine, cancer is nearly always viewed as a sign of systemic toxicity. However, immune dysregulation has to be considered, and can occur with stress, toxin, heavy metal and pesticide exposure, dysbiosis, hormonal imbalance, nutrient imbalance, infection, inflammation, and radiation. Chemotherapy is also a major cause of immune dysregulation; for example, vincristine is weakly myelosuppressive, and cyclophosphamide and glucocorticoids are strongly myelopsuppressive.


Many chemotherapeutic drugs currently in use in medicine were first identified in plants, including taxol, vinblastine and vincristine, and etoposide and teniposide (Boik, 1996). Herbs offer a rational potential in the treatment of cancer in animals; however, it is important to note that herbs may be used for purposes other than direct antitumor activity. On the other hand, just about any selection of herbs prescribed to treat a patient will more than likely have some anticancer activity because of the presence of widely occurring anticancer constituents like flavonoids.


Although little research has been conducted in cats and dogs specifically, a plethora of research pertains to rats, mice, hamsters, and guinea pigs. At least pocket pets are amply catered to if they are diagnosed with cancer! Herbs can be used to help manage the effects of chemotherapy; to assist in recuperation after chemotherapy, radiation, or surgery; to complement conventional cancer treatment; to provide an alternative to conventional treatment in some cases; to assist in cancer prevention; and to support various systems that are affected by cancer. One of the approaches used by veterinary herbalists is to treat cancer as a chronic disease, with emphasis on improving the health of the whole body, regardless of the presence of cancer. Anecdotal evidence from veterinary herbalists indicates that herbs offer improved quality of life and may support remission in some cases.


The rational use of herbal medicine for the treatment of patients with cancer depends on a growing understanding of the biological mechanisms by which cancer cells proliferate, maintain life, and die. These include differentiation (the maturation process of cells), angiogenesis (the growth of new blood vessels into tumors), apoptosis (programmed cell death), invasion (the spread of the tumor mass into adjacent tissue), metastasis (the spread of tumor cells to distant locations), mitosis (the proliferation of cells), and evasion of the immune system. As these mechanisms have become elucidated, their weak points have been identified and have become the targets of research that is both conventional and complementary (Boik, 1996). The selection of several herbs that have different mechanisms of action provides a broad spectrum of anticancer activity. A holistic strategy that incorporates all elements discussed here is proposed under “Review of Strategies for Cancer Prescriptions” at the end of this section.




Adaptogens


This strategy recognizes that a patient can live with cancer as opposed to having to die of cancer. Many of our elderly animal patients, in particular, have never been in better health than when they are on herbal and nutritional treatment, even though they have cancer, because the prescriptions that they are given promote overall health. Herbs should be used to strengthen body resistance, and vitality is enhanced through the use of adaptogens. Most adaptogens also have anticancer activity.






Immune Modulators


Most conventional chemotherapeutic agents are immunosuppressant and cytotoxic in nature, and they exert a variety of adverse effects that are particularly evident in cancer chemotherapy. Botanically based immunomodulators and immune stimulators are employed as supportive or adjuvant therapy to overcome the adverse effects of these agents and to restore normal health. Many of these herbs also have anticancer activity. Immune-modulating herbs can also be employed when chemotherapy is not used. (See “Immune System Herbs” earlier in this chapter or refer to individual monographs in this book for additional details.)




Anticancer Mechanism of Selected Herbs and Constituents










CORDYCEPS (CORDYCEPS SINENSIS):


Controlled, open-label clinical studies have found that Cordyceps appeared to restore immune cell function in patients with advanced cancer who were given conventional cancer therapies (Zhou, 1995; Zhu, 1998b). Of 59 patients with advanced lung cancer, 95% were able to complete chemotherapy and radiotherapy with the use of Cordyceps compared with 64% of controls. More than 85% of Cordyceps-treated patients showed more normal blood cell counts versus 59% of controls (Zhu, 1998b). A study in patients with various types of tumors found that a cultured mycelium extract of Cordyceps (6 g/d for over 2 months) improved subjective symptoms in most patients. White blood cell counts were maintained at <3000/mm3, and tumor size was significantly reduced in approximately half of patients (Zhu, 1998b).





ASHWAGANDHA (WITHANIA SOMNIFERA):


This herb demonstrates antitumor properties in mice and protects against induced carcinogenic effects. It also reverses the adverse effects of a carcinogen (urethane) on total leukocyte count, lymphocyte count, body weight, and mortality (Singh, 1986). Significant increases in hemoglobin; red blood cell, white blood cell, and platelet count; and body weight were observed in cyclophosphamide-, azathioprine-, and prednisolone-treated mice that were given Withania versus controls (Ziauddin, 1996).



OTHER HERBS








Alteratives


In traditional herbal medicine, alteratives represent a key strategy for the treatment of cancer. Alteratives act through the lymphatic, blood, and eliminatory systems to facilitate and enhance the breakdown and removal of metabolic wastes. They are also used to improve the absorption and assimilation of nutrients. Alteratives are thus considered to be “blood purifiers” or “detoxifiers”, believed to circulate and improve blood flow, while removing waste from blood and lymph. The function of these herbs is to optimize the body’s eliminative functions performed via the liver, kidneys, lungs, and gastrointestinal system.


Ideally, these herbs are chosen according to their other actions and affinities for particular organs or systems, so as to maximize their benefit. For example, poke root and cleavers are specific for the lymphatic system. Many of these herbs contain alkaloids and flavonoids and have documented anticancer activity; many others have not been studied. Modifying prescriptions every 2 to 3 months reduces the risk of potential toxicity associated with some of these herbs.


Alteratives include the herbs listed here:




Antioxidants


Herbs with potent antioxidant activity generally have anticancer activity as well. Whether to use antioxidants concurrently with chemotherapy or radiotherapy has been questioned. Chemotherapy and radiotherapy cause DNA damage to both normal cells and cancer cells by causing free radical damage; one concern is that antioxidants will reduce the efficacy of treatment. On the other hand, antioxidants protect healthy tissue from damage, and after and between conventional treatment, antioxidants continue to offer benefit as anticancer agents themselves. Anecdotal evidence provided by veterinary herbalists indicates that herbal antioxidants can continue to be used alongside conventional treatment without adversely affecting the outcome.







MILK THISTLE (SILYBUM MARIANUM):


Silymarin and silibinin (silybin) are antioxidants that react with free radicals, transforming them into more stable, less reactive compounds (Morazzoni, 1995). The cancer chemoprevention and anticarcinogenic effects of silymarin have been shown to be caused by its major constituent, silibinin (Bhatia, 1999). Its antitumor effect occurs primarily at stage I tumor promotion; silymarin may act by inhibiting COX-2 and IL-1α (Zhao, 1999). Such effects may involve inhibition of promoter-induced edema, hyperplasia, the proliferation index, and the oxidant state (Lahiri-Chatterjee, 1999). Silibinin may also have anti-angiogenic effects (Yang, 2005; Singh, 2005).



TURMERIC (CURCUMA LONGA):


The abilities of turmeric to scavenge radicals, reduce iron complex, and inhibit peroxidation may explain the possible mechanisms by which turmeric exhibits its beneficial effects in medicine (Tilak, 2004). The anticancer properties of curcumin have been demonstrated in cultured cells and animal studies. Curcumin inhibits lipoxygenase activity and is a specific inhibitor of COX-2 expression. It halts carcinogenesis by inhibiting cytochrome P450 enzyme activity and increasing levels of glutathione-S-transferase (Chauhan, 2002).



DAN SHEN (SALVIA MILTIORRHIZA):


Dan shen is a potent antioxidant that demonstrates free radical scavenging activity (Xia, 2003). Recent studies showed that one of its tanshinone constituents possesses cytotoxic activity against many kinds of human carcinoma cell lines, induces differentiation and apoptosis, and inhibits invasion and metastasis of cancer cells. Its mechanisms are believed to be inhibition of DNA synthesis and proliferation of cancer cells; regulation of the expression of genes related to proliferation, differentiation, and apoptosis; inhibition of the telomerase activity of cancer cells; and change in the expression of cellular surface antigen (Yuan, 2003).



BILBERRY (VACCINIUM MYRTILLUS):


The anthocyanosides in bilberry inhibit protein and lipid oxidation (Morazzoni, 1995). Components of bilberry have been reported to exhibit potential anticarcinogenic activity in vitro, as demonstrated by inhibition of the induction of ornithine decarboxylase (ODC) by the tumor promoter phorbol 12-myristate 13–acetate (TPA) (Bomser, 1996).



SCHISANDRA (SCHISANDRA CHINENSIS):


Schisandra lignans act as free radical scavengers and inhibit iron-induced lipid peroxidation and superoxide anion production (Lu, 1992). Geranylgeranoic acid, a constituent of Schisandra, has been shown to induce apoptosis in a human hepatoma–derived cell line (Shidoji, 2004).





ROSEMARY (ROSMARINUS OFFICINALIS):


Several extracts and constituents of rosemary have exhibited antioxidant activity (ESCP, 1999). The volatile oil was reported to be toxic to leukemia cells (Ilarionova, 1992). Topical administration of a methanol extract 5 minutes before application of carcinogens to the dorsal surface of mice reduced the irritation and promotion of tumors. Application of rosemary extract before carcinogen application reduced the formation of metabolite–DNA adducts by 30% and 54%, respectively (Huang, 1994). In rats, dietary supplementation with 1% rosemary extract for 21 weeks reduced the development of induced mammary carcinoma in the treated group, compared with the control group (40% vs 75%, respectively) (Singletary, 1991).






Anticancer Action by Organ/System


Following is a brief review of just some of the herbs that may be beneficial for the treatment of particular organ/system cancers. It is intended as a starting point rather than a comprehensive review. In vivo studies are discussed; herbs that are supported by in vitro studies are only listed.



Respiratory system: small cell lung carcinoma





GREEN TEA AND BLACK TEA (CAMELLIA SINENSIS):


Consumption of tea (Camellia sinensis) has been suggested to prevent cancer, heart disease and other diseases. Animal studies have shown that tea and tea constituents inhibit carcinogenesis of the skin, lung, oral cavity, esophagus, stomach, liver, prostate and other organs (Lambert 2003). For example, mice were given decaffeinated green or decaffeinated black tea in their drinking water before, during, and after treatment with a carcinogen. Mice that received 0.63% or 1.25% green tea, or 1.25% black tea, exhibited a reduction in liver tumor numbers of 54%, 50%, and 63%, and a decrease in the mean number of lung tumors of 40%, 46%, and 34%, respectively, compared with controls (Cao 1996). In some experiments, reduction in tumor number and size has been observed in the tea-treated groups; in other experiments, decreased tumor incidence has also been observed (Yang 2005). Black tea preparations have been shown to reduce the incidence and number of spontaneously generated lung adenocarcinomas and rhabdomyosarcomas in mice; they also were noted to inhibit the progression of lung adenoma to adenocarcinoma. In many of these experiments, tea consumption resulted in reduced body fat and body weight; these factors may also contribute to the inhibition of tumorigenesis (Yang, 2005).

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Jul 18, 2016 | Posted by in PHARMACOLOGY, TOXICOLOGY & THERAPEUTICS | Comments Off on 20: Veterinary Herbal Medicine: A Systems-Based Approach

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