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(NOT) only candies - Herbs activities, interactions, cross reactions




From prehistoric times, man learned that plants had nutritional but also "healing" properties. The "men of medicine" were replaced / associated in different cultures by men of medical science. Chinese, Indian, Egyptian medicines originated Hippocratic medicine. Dioscorides, military physician, and Plinius (Naturalis Historia) wrote the first encyclopedic treatises. Galen - from which “galenic” derives - described more than 400 herbal medicaments for properties and indications


So began to appear the "Gardens of the simple", where "simple" indicated plant varieties with medicinal virtues. In spedali monacus infirmarius was distinguished by monacus medicus


Capitulare de Villis Charlemagne and the XII Salernitana School, with Trotula de Ruggiero, as well as Matteo Silvatico in the XIII-XIV century brought to the tradition of 7 annual and 7 perennial medicinal plants in every house garden. Then from Colombo all the New World and other Continents exploratory brought many "new" plant species.


Linnaeus in 1700 elaborated the classification system that we still use today. Phytotherapy was the main medical treatment, so Pasta, Duprez, Malibran… were treated with phytotherapy, not with IPPs and Steroids.


But the problems with plants were many, about harvesting, conservation, risks of molds and other deteriorating contaminants… so in 1870 in Germany salicylic acid was synthesized, marketed in 1874, with a price 10 times lower than that obtained from willow extracted salicylic acid. Bayer in 1879 synthesized acetylsalicylic acid: Acetilspirsäure. Aspirin was born and with it pharmaceutical chemistry, but only in 1970 its mechanism of action was fully understood.


According to the WHO (World Health Organization) who issues the Traditional Medicine Strategy since 2002-2005, now operating 2014-2023, about 80% of the African population and 40% of Chinese use herbal products as primary health care. No less than 60% of the world population relies on herbal remedies / phytotherapeutic drugs with an expenditure of around 60 billion dollars / year. The medicinal plant industry is worth about $ 100 million and the trade in medicinal plants and phytotherapeutic drugs is growing annually by about 15%.


So alkaloids, molds etc. contributed to the birth of a large part of "chemical" pharmacology. But the pharmacology of the new millennium turns back to plants for new active ingredients, especially in oncology, but not only. In 2015 Nobel Prize went to To You You for arthemisin discovery and its great affect in treating malaise, one the plagues still hitting our planet.


But the birth of information technology and the "fashion" of the natural also reported deviations similar to those of the times of Paracelsus, in the Renaissance. If today we ask Google “Voice and phytotherapy/ herbal…” we have millions of results !!! Should the oral tradition be replaced by the virtual tradition?


Herbs have active principles, interactions and cross reactions, as “official” drugs have

In a survey by Surow and Lovetri 60% of 142 singers in 90s were regularly taking herbs, some for more than 5yrs because of cold, allergies, hoarseness, singing problems, mostly if slight, but, as those Authors underlined, advertisements and books rarely indicate risks or drug interactions, look for authorized sites which may offer certified help


We should know that some herbal components, like licorice root have some steroidal activity, while adulteration of herbal products with exogenous glucocorticoids is a recurrent problem encountered locally in illegal products masquerading as “traditional medicine”.


Let’s point out some herbs and their actions as described in literature

1) Herbs with anticoagulant actions *

Dong Quai (angelica sinensis) and Fennel : coumarin Willow, primrose, cowslip and jack in the pulpit : salicylates Garlic, ginger, ginkgo biloba : inhibit platelets aggregation

(* let’s remember that Anticoagulants Treatments already require to avoid diet with many vegetables rich in vit K like Kale, Spinach, Brussels sprouts, Collard greens, Mustard greens, Turnip greens, Swiss chard, Broccoli, Asparagus, Chamomile or green tea, Seaweed or also interfere with warfarin like Cranberry juice, Grapefruit juice, Alcohol

So if you have an anticoagulant treatment, check with your Physician not only your diet but also if you take herbs which might enhance anticoagulant actions with risks of hemorrage)


2) Herbs with diuretic action elder (sambucus), feverfew (tanacetum parthenium), dandelion (taraxacum officinale), and nettles (urtica dioica) used as antiallergic . Well diuretic action might be useful in loosing weight, but care not to lower blood pressure or dehydrate too much!



3)Herbs with hormonal activities Dong Quai and licorice increase both estro and androgenic activities and may interfere with pitch, Yam has strong progesterone activity, Hops high estrogen content, Melatonin at high doses arrives to be contraceptive, Yohimbe may increase testosterone (so caution mostly with women)


4) Herbs with effects on blood pressure St. John's wort (hypericum), an herb often used for its mood elevating effect, has a monoamine oxidase (MAO) inhibitor effect. Use of MAO inhibitors along with narcotics is linked with substantial incidence of high fever and coma, so ask your Physician, mostly if a Neurologist or Psychiatrist before assuming it. Concurrent use of hypericum and decongestants, caffeine, asthma inhalers, amphetamines, or products containing the aminoacid tyramine such as aminoacid supplements, beer, red wine, yogurt, fermented or smoked foods can lead to dangerous elevation of blood pressure. Ma huang (ephedra) is an herb also known as ephedra that has an epinephrine-like effect and is specifically contraindicated against use with MAO inhibitors (such as St. John's wort). Ginseng raises blood pressure and also lowers blood sugar. Licorice root is a potent antidiuretic and leads to accumulation of fluid and subsequent problems such as hypertension.


5) Herbs with effects on photosensitization. Many herbs, including St. John's wort, dong quai, celery, and yarrow (achillea ) have a photosensitizing effect and should be used cautiously, if strong sun exposure is likely, to avoid serious sunburn injuries. To be remembered mostly in athletes and performers.


6) Herbs with effects on immune system A host of herbs are reported to strengthen or boost the immune system: multiple sclerosis and arthritis may be worsened . Common cold current evidence in the literature suggests that echinacea has a benefit in decreasing the incidence and duration of the common cold; but large-scale randomized prospective studies controlling for variables such as species, quality of preparation and dose of echinacea, method of cold induction, and objectivity of study endpoints evaluated are needed before echinacea for the prevention or treatment of the common cold can become standard practice. It’s also known that echinacea must be avoided in human immunodeficiency (HIV) infections and concerns have been raised that prolonged use for more than 6-8 weeks might cause immunosuppression in many people.


7) Herbs with effects on allergies Herbs may counteract with other herbs allergenic power. So echinacea should be avoided if one is allergic to sunflowers, honey should be avoided in all with poliallergies to plants inhalants, chamomile, dandelion, goldenseal, parsley, fennel, celery, anis, kummel… cross react with ragweed (ambrosia), artemisia and compositae, while birch - used as antinflammatory and antitussive in Northern Europe- may cross react with fennel or celery but also with apple or potato…and nettle cross-reacts with parietary


8) Herbs with toxic effects. This is more “familiar “ to us, how many poisons come from herbs in many books or movies! Chaparral and comfrey are hepatotoxic if taken internally, Lobelia has a strong nicotine like effect: doses over 50 mg of dried lobelia can suppress breathing, depress blood pressure, and even lead to coma. Jimsonweed (stramonium) has recreational use but highly risk of poisoning. When not paid enough attention in harvesting and preparing belladonna alkaloids has been found in some herbal teas, as well as contamination with digitalys lanata (Lanoxin) of plantain. Aconitum spp., used in Chinese herbal medicines, contains highly toxic alkaloids, levels of which are reduced by boiling. If incorrectly processed aconite is used, the resulting product can be fatal.


9) Herbs with other effects Ginseng lowers blood sugar and should not be used by people who are hypoglycemic. Sage contains can trigger seizures in epileptics. Peppermint relaxes smooth muscle and can promote gastroesophageal reflux. Chewing the leaves of feverfew is a folk remedy for use as an expectorant but can cause mouth sores. Astragalus and goldenseal should not be used in the presence of fever


A main problem is : am I harvesting, buying assuming , the “right” plant?


In Sisymbrium Project in 2018 in Milan people were asked to search for spontaneous plants of hedge mustard. Most of reports were incorrect, regarding plants “just similar” but not related at all. They confused hedge mustard with other similar but ineffective plants.

Assuming herbal treatments mean to be sure of the right plant, the right part of the plant, the right extraction, the right conservation, the right process to ensure effects WITH NO HARM!


Take Home Message

Herbs are treatments

They have active principles with effects on many human receptors

Most of these receptors are involved in Upper Airways and Voice

In Light /Mild Professional Voice Emergencies some herbs might be useful

Mostly if the Professional does not accept Official Pharmacopea


Herbs are treatments

They have active principles with cross react with some drugs or some human functions

Medicorum Theatri (and all other Physicians) should know IF their Patients use Alternative Treatments and WHICH

So to avoid prescriptions with possible interactions with herbs

Herbs may help in emergencies like cold, hoarseness, dryness, allergies

Herbs may facilitate hemorrhages, hypotension, allergies,

LIKE DRUGS ALSO HERBS MAY BE TOXIC


REFERENCES

1. WHO global report on traditional and complementary medicine 2019. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.

2. “Herbs_for_Voice_ database_public_version_20190503” Harvard University


3. Calcinoni O. Sisymbrium “Singersʼ plant” efficacy in reducing perceived vocal tract disability. J Otolaryngology-ENT Res 2017. doi:10.15406/ joentr.2017.08.00243


4. Borgonovo G, Zimbaldi N, Guarise M, De Nisi P, De Petrocellis L, Schiano Moriello A, Bassoli A. Isothiocyanates and glucosinolates from Sisym- brium officinale (L.) Scop. (“the Singersʼ Plant”): isolation and in vitro as- says on the somatosensory and pain receptor TRPA1 channel. Molecules 2019; 24: E949

5. Calcinoni O, Borgonovo G, Cassanelli A, Banfi E, Bassoli A. Herbs for Voice Database: Developing a Rational Approach to the Study of Herbal Remedies Used in Voice Care. J Voice. 2021 Sep;35(5):807.e33-807.e41. doi: 10.1016/j.jvoice.2019.12.027. Epub 2020 Jan 31. PMID: 32008898.

6. Luo X, Zhang Y, Li H, Ren M, Liu Y, Liu Y, Zhang Y, Kuang Z, Cai Y, Chen Y, Ni X. Clinical Evidence on the Use of Chinese Herbal Medicine for Acute Infectious Diseases: An Overview of Systematic Reviews. Front Pharmacol. 2022 Feb 25;13:752978. doi: 10.3389/fphar.2022.752978. PMID: 35281902; PMCID: PMC8914111.

7. Fung FY, Linn YC. Steroids in traditional Chinese medicine: what is the evidence? Singapore Med J. 2017 Mar;58(3):115-120. doi: 10.11622/smedj.2017016. PMID: 28361161; PMCID: PMC5360864

8. Surow JB, Lovetri J. "Alternative medical therapy" use among singers: prevalence and implications for the medical care of the singer. J Voice. 2000 Sep;14(3):398-409. doi: 10.1016/s0892-1997(00)80085-5. PMID: 11021507.

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