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© Endeavour College of Natural Health endeavour.edu.au
WHMC311
Session 14
Nervous System Disease Part I
Naturopathic Medicine Department
1
© Endeavour College of Natural Health endeavour.edu.au
Topic Overview
o Overview of principles and considerations in herbal
management of the nervous system condition pain.
o Review of herbal actions, indications, applications and
contraindications of: analgesics, sedatives, hypnotics,
tranquilisers, anti-spasmodics, relaxants, nervine tonics,
nervine trophorestoratives, cognition enhancers and
neuroprotectives.
2
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Naturopathic Diagnostics: NS
o Dysfunction of the Central Nervous
System can be seen in abnormalities in
the size and shape of the pupil.
o Also at the following regions: cerebral
(brain) area, spinal area, adrenal area,
nerve rings and iris fibre signs.
o Dysfunctions of the Autonomic Nervous
System may also be seen in Autonomic
Nervous Wreath size, shape, colour and
texture abnormalities.(Jensen, 1952)
3
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Herbal Medicine for the NS
Receptor Activity
o Herbal remedies are not directly
comparable to conventional drugs
in terms of direct action.
o It is most likely that the primary
effect of plant constituents on the
nervous system is on the synaptic
junctions
o Communication junctions are in
receptor sites on pre and post
synaptic membrane(Bone & Mills 2013, p.270)
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Receptor Activity
5
o Ca channel activity – opioid alkaloids, ginseng saponins,
coumarin, scoparone (Capillaris) etc.
o Adrenergic effects – Ephedra, ephedrine,
pseudoephedrine, Angelica sinesis and Cnidium
monnieri (Beta-2-adrenergic)
o Acetylcholine – Solanacea family - Nicotiana tabacum
(tobacco) etc.
o GABA and benzodizepine – Valeriana off, Salvia
miltiorrhiza
o Dopaminergic – Mucuna pruriens, Polygala tenuifolia,
Corydalis ambigua(Bone & Mills 2013, p.270-271)
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Pain
o Pain is a disagreeable subjective physiological and
psychosocial experience that often serves a biological
purpose (warning of injury)
o Highly subjective, pain does not necessarily correlate
with the degree of tissue damage (Sinclair, 2014, p.803)
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Pain Classification
o Somatogenic (direct physiological mechanism or insult)
• Nociceptive (ongoing activation)
• Neuropathic (neurological dysfunction)
Or
o Psychogenic (non organic origin)
o Acute (lasting less than 4 weeks)
Or
o Chronic (longer than 12 weeks)(Sinclair, 2014, p.803-6)
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Pain Management
o Classify/asses the pain
o Identify the cause
o Pain amelioration
o Address the underlying cause
o Address comorbidities (depression, insomnia etc.)
o Enhance mental resilience
o Lifestyle modifications
o Close patient monitoring
o Address social factors(Sinclair, 2014, p.806-7)
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Treatment Considerations
o Ameliorate pain and reduce suffering
• Eschscholzia californica (GABA binding and anxiolytic, possibly
inhibit catecholamine degradation, synthesis of adrenaline and
bind to opiate and benzodiazepine receptors)
• Corydalis ambigua (tetrahydropalmatine – sedative, analgesic,
dopamine receptor antagonist)
• Passiflora incarnate (anxiolytic, hypnotic and mild sedative –
possibly secondary clinical benefit)
• Piper methysticum (anxiolytic, hypnotic, sedative and skeletal
muscle relaxant, lactones DHK and DHM shown analgesic effect
via non-opiate pathways)(Sinclair, 2014, p.809)
9
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Treatment Considerations
o Ameliorate pain and reduce suffering
• Harpagophytum procumbens (iridiod glycosides – anti-inflam
and analgesic, possible iNOS and COX-2 expression through
inhibiting NF-kB and reducing COX-1 activity)
• Salix alba (Acetyl group to salicylic acid led to NSAID and Asprin
development; hyaluronidase/lipoxygenase inhibition, free radical
scavenging may contribute to anti-inflame and analgesic action)
• Piscidia erythrina (central analgesic activity)(Sinclair, 2014, p.810)
10
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Indications for Herbal Analgesics
o Pain associated with
inflammation:
• Arthritis
• Tendonitis
• Myalgia
o Pain associated with
vascular spasm:
• Migraine
• Angina
• Intermittent claudication
11
o Pain associated with
visceral spasm:
• Gall bladder
• Urinary tract
• Intestinal colic
• Spasmodic
dysmenorrhea
o Neuralgic pain (in limited
cases)
• Shingles
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Analgesics
o Some traditional herbal analgesics include:
• Corydalis spp (Corydalis)
• Eschscholzia californica (Californian poppy)
• Salix alba (Willow bark)
• Piscidia erythrina (Jamaican Dog Wood)
• Anemone pulsatilla (Pasque flower)
• Piper methysticum (Kava)
o Topical Analgesics
• Mentha × piperita (Peppermint essential oil)
• Capsicum minimum (Cayenne)
• Arnica montana (Arnica)
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Corydalis ambigua
o Actions
• Bitter, sedative, hypnotic, analgesic, cardioprotective,
anti-arrythmic
o Uses
• Pain, insomnia, cardiac arrythmia, myocardial
ischemia
o Contraindications
• Pregnancy
13
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Treatment Considerations
o Reduce local and systemic inflammation
• Topical anaesthetics – Capsicum frutescans, Piper methysticum,
Gaultheria procumbens (Wintergreen oil), Syzigium aromaticum
• Systemic - Zingiber officinale, Serenoa repends, Curcuma longa,
Glycyrrhiza glabra, Harpagophytum procumbens, Boswellia
serrata, Marticaria recutita, Arnica montana, Salix alba
o Support the immune system
• Dysfunction may impact on autoimmune/infectious disease pain
presentation (Hemidesmus indicus, Tylophora indica, Echinacea
spp. Uncaria tomentose, Andrographis paniculata, Astragalus
membranaceus, medicinal fungi)(Sinclair, 2014, pp.810-812)
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Treatment Considerations
o Support the nervous system
• Psychological consequence of pain exposure and specific
painful diseases affecting the NS such as herpes zoster etc.
• Adaptogens and nervine tonics
• Address insomnia if present - Sedatives and hypnotics
• Psychological – CBT referral, mindfulness/meditation, anti-
depressants and/or anxiolytics(Sinclair, 2014, p.812-814)
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Herbal Sedatives, Hypnotics & AnxiolyticsSedatives Hypnotics Anxiolytics
Withania, Bacopa
Bugle weed
Californian poppy
Chamomile,
Cramp Bark
Hops,
Jamaican Dog Wood
Kava, Lemon balm
Lime Flowers
Mexican Valerian
Valerian, Mistletoe
Passionflower
Peppermint, Skullcap
Ziziphus, Wild Cherry
Californian poppy
Hops
Kava
Mexican Valerian
Valerian
Passionflower
Ziziphus
Bacopa
Californian poppy
Oats Green
Kava
Lavender
Mexican Valerian
Valerian
Neem Leaf
Passionflower
Ziziphus
It can be seen from this
table that many of our
nervine herbs cover a
wide range of nerve
related actions
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Herbal Sedatives,
Hypnotics & Anxiolytics
o Indications
• Modern tension and anxiety syndromes (short term or
intermittent use)
• Insomnia – difficulty getting to sleep first thing at
night.
• Weaning off conventional sedative prescriptions
• Restlessness during convalescence
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Herbal Sedatives,
Hypnotics & Anxiolytics
o Contraindications
• Generally milder than prescribed sedatives and
should not be seen as immediate substitutes in more
serious indications.
• It would be unwise and possibly dangerous to stop
strong medication without careful planning.
• Insomnia marked by increasing restlessness during
the early morning
• Depression
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Antispasmodics and Relaxants
o Some traditional herbal antispasmodics and relaxants:
• Viburnum opulus
• Dioscorea villosa
• Leonurus cardiaca
• Matricaria chamomilla
• Passiflora incarnata
• Piper methysticum
• Scutellaria lateriflora
• Tilia spp
• Valeriana off.
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Antispasmodics and Relaxants
o Indications:
• Anxiety, irritability and restlessness, including in children
• Sleeplessness due to anxiety and irritability
• Nervous dyspepsia
• Irritable bowel and intestinal colic
• Tension headache
• Spasmodic dysmenorrhoea
• Antispasmodics and relaxants may be taken as hot
infusions, though the ordinary tea bag may not be
sufficiently strong compared with a tradition brew.
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Nervine Tonics &
Nervous Trophorestoratives
o Many conditions of tension are linked with fatigue,
debility and depression
o A group of remedies have emerged to meet the needs of
a modern stressed society
o Anti-depressants: Hypericum performatum, Lavandula
officinalis, Crocus sativa, Rhodiola rosea
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Nervine Tonics &
Nervous Trophorestoratives
• Avena sativa
• Hypericum perforatum
• Scutellaria laterifolia
• Turnera aphrodisiaca
• Verbena off.
• Withania somnifera
22
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Nervine Tonics &
Nervous Trophorestoratives
o Indications:
• Nervous exhaustion
• Neuralgia, herpes infections
• Depressive states
• Insomnia (waking in the small hours after getting to
sleep easily)
• Convalescence
• Neurasthenia
23
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Nervine Tonics &
Nervous Trophorestoratives
o Contraindications:
• True trophorestoratives are almost nutritive in their
effects, with few risks of adverse effects except in
those patients with extremely debilitated constitutions.
o Application:
• May be taken as required or before food.
• Long term therapy with trophorestoratives is generally
the norm
24
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Pain Example: Headaches
o Headaches – pain located above the orbitomeatal line.
Primary:
• Tension-type
• Cluster
• Migraine - disabling, primary headache, characterised by
unilateral pulsing pain. With or without aura
Secondary:
• Cranial or cervical vascular disorders, non-vascular disorders
e.g. hypertension
• Substance or withdrawal, infection, homeostatic disorder,
psychiatric(Cottingham, 2014, p.330-331)
25
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Pharmaceutical Management
Non-Opioid Analgesics - Paracetamol
Mode of Action
o Inhibits prostaglandin production within the CNS, with some COX inhibition (no anti-inflammatory benefits) giving it analgesic and antipyretic properties.
Side Effects
o Occasional incidences of skin rash & nausea if used within
therapeutic dose.
o Paracetamol overdose (10-15gms or 20-30 tablets) will cause severe liver damage due to depletion of glutathione, and possibly lead to death. Doses of 50 tablets is usually fatal unless quickly antidoted with acetyl cysteine.
o Liver toxicity appears to be linked to the concomitant use of excessive quantities of alcohol, or overdose
(Bryant & Knights, 2007; Bullock et.al. 2007)
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Pharmaceutical Management
Non-steroidal Anti-inflammatory Drugs (NSAIDs) – ibuprofen, aspirin, diclofenac, indomethacin, piroxicam
Mode of Action
o Non-selectively inhibit the synthesis and release of prostaglandins by inhibiting the cyclo-oxygenase (COX) enzymes in both COX-1 & COX-2 pathways. Also inhibits platelet aggregation.
Side Effects
o Gastro-intestinal (dyspepsia, nausea, vomiting, diarrhoea, constipation, gastritis, and may all potentially lead to ulceration and haemorrhage (COX-1 inhibition)
o Skin reactions, rash, sodium retention, may precipitate asthma attacks .
(Bryant, 2003)
27
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Pharmaceutical Management
COX-2 selective NSAIDs – Celecoxib
Mode of Action
o COX-2 is formed in inflammatory conditions – thus it is this pathway that would seem most appropriate to target when trying to reduce inflammation and pain (Bryant, 2003).
o Don’t inhibit COX-1 so have no GIT side effects or alter platelet aggregation. Useful for patients that can’t use non-specific NSAIDs.
Side Effects
o Associated with an increased risk of cardiovascular and thrombotic adverse effects.
o Renal damage due to inhibition of vasodilator prostaglandins resulting in heart failure and hypertension in some patients.
(Bryant & Knights, 2007; Bullock et.al. 2007)
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Pharmaceutical Management
Opioids – Opium, Morphine, Codeine, Oxycodone, Pethidine, Tramadol etc…
Mode of Action
o Opioids stimulate opioid receptors inhibiting the release of
substance P from the dorsal horn neurons reducing pain sensations
and inhibiting local inflammatory reactions.
o Euphoric action inhibits pain perception.
o Opiate analgesics are useful for relieving intense pain, non
responsive to non-opioid analgesics
o The response can vary dramatically between different opioid drugs,
with different rates of absorption
o The more lipophilic the agent, the better absorbed and the greater
the ability to cross the blood-brain-barrier(Bryant & Knights, 2007; Bullock et.al. 2007)
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Treatment Aims
o Establish the type of headache and underlying cause
o Address of risk factors and triggers (e.g. food
sensitivities and allergic responses)
o Reduce pain and inflammation
o Ensure optimal nutrition and hydration
o Consider detoxification programs to manage medication
overuse headache syndrome
o Assess body mechanics and spinal alignment – refer
o Address lifestyle – exercise, stress reduction (work/life
balance)(Cottingham, 2014, pp.335-342)
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HerbColeus, Zingiber & Turmeric All work on prostaglandin pathway
Corydalis Analgesic – very large doses required
Californian poppy Analgesic
Willow Bark Analgesic and anti-inflammatory
Chaste tree If hormonal relationship
Rosemary Migraine or hypertensive headache
Skullcap Nervine
Valerian Sedative, nervous excitability
Mistletoe Hypertensive headaches and frequent headaches with flushing face
Lavender For depression associated with digestive dysfunction
Catnip Sedative and for nervousness
Passionflower Nervousness, debility with fullness
Action/Indication
31
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Tanacetum parthenium
o Traditionally used for migraines (especially if better with warm
applications)
o Serotonergic pathway addressed by inhibiting phospholipase,
preventing release of 5-HT from platelets and
polymorphonuclear leukocytes
o In-vitro – inhibits nitric oxide release (sensitise migraineurs to
pain and activate vasodilation – trigger)
o May inhibit prostaglandin synthesis
o Long term treatment is necessary - can be up to six months
before effects are noticed(Cottingham, 2014, pp 335-343)
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Neuralgia/Neuropathy
o Neuropathic pain pathophysiology is largely based on the
causative aetiology in many instances; however, it is heavily
characterised by dysfunction of pain fibres of the CNS
Treatment considerations:
o Neuropathy
• Neuro protective
– Ginkgo biloba
• Capillary protective
– Vaccinium myrtillus
o Neuralgia
• Capsicum spp.
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Capsicum minimum
o Capsaicin is an active constituent from the fruit of
Capsicum minimum and other species (Cayenne).
• Binds to vanillinoid receptors, promotes release of
substance P, neurokinin, somatostatin and calcitonin
from peripheral nerve fibres (particularly C fibres in
the slow pain network). Initially worsens pain/itching
• Repeated applications, C fibres are depleted of these
neurotransmitters, and are no longer able to transmit
pain or itch signals.
• With continued use, this effect can be sustained
indefinitely. (Yarnell, Abascal 2008)
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Capsicum minimum
o Conditions in which topical capsaicin has proven effective
in double-blind trials include:
• Various neuralgias
• Diabetic neuropathy
• Dialysis-induced pruritus
• Psoriatic pruritus
• Fibromyalgia
• Osteoarthritis
• Stump pain
• Postmastectomy pain
• Postherpetic neuralgia (Yarnell, Abascal, 2008)
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Herb-Drug Interactions
Opioids
Panax ginseng
o May reduce drug induced tolerance and decrease
adverse effects (Stargrove et al. 2008)
Opioids – Codeine
Fiber
o May prevent gastric upset and constipation. Concurrent
use of water, fibre, and water rich foods that assist with
bowel motion may be beneficial.
Alcohol
o Impaired alertness, constipation, impaired judgment(Braun & Cohen, 2010)
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Herb-Drug Interactions
Paracetamol
o Alcohol may have more potential to cause liver damage when taken together (Braun & Cohen, 2010)
o Syzygium aromaticum (Clove) oil due to potential hepatotoxicity of its eugenol content should not be used together (speculative) (Brinker 2010, p.104)
o Cyamopsis tetragonolobus (Guar gum seeds) and Malusdomestica slows absorption due to slower gastric emptying (Brinker 2010, p.364)
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Herb-Drug Interactions
NSAIDs - Aspirin
Capsaicin
o Found to protect gastric mucosa against aspirin-induced damage.
(Braun & Cohen, 2010)
Grapeseed extract
o Enhances antiplatelet and anti-inflammatory activity of aspirin and may risk of bleeding.
Allium sativum, Zingiber off, Curcumin longa
o Inhibits COX & LOX pathways therefore enhancing the
drug effectiveness. Additive effect.(Sarris & Wardle, 2010)
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Cognition Enhancement
o Cognition encompasses a broad range of brain
processes, the health of which allows for social
connectedness, a sense of purpose and the ability to
function independently.
o Cognitive decline is significant in the elderly population.
Alzheimer’s disease is the most common dementia.
Cerebrovascular disease – brain lesions connected with
cardiovascular health/risk factors
o Traditional herbal remedies address these
39
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Bacopa monnieri
o A traditional Ayurvedic herb used as
a brain tonic, and to improve
memory and learning
o Also used to promote longevity,
nervous deficit due to injury and
stroke
o In India it is called Brahmi - as is
Gotu Kola: Centella asiatica
o The two plants share similar uses,
and they are sometimes confused in
the literature
40
Bacopa monniera (Brahmi)
Centella asiatica (Gotu kola)
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Bacopa monnieri
o An Australian clinical trial examined the long-term effects
of an extract of Bacopa monnieri on cognitive function in
54 healthy human volunteers (Calabrese et.al. 2008)
o The study was of double-blind, placebo-controlled design
in which subjects were randomly allocated to receive
Bacopa or placebo.
o Neuropsychological testing was conducted before
treatment and at 5 and 12 weeks after treatment.
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Bacopa monnieri
o After 12 weeks the largest cognitive change from
Bacopa treatment was a time reduction for the
Inspection Time (IT) test.
o IT is regarded as a measure of the integrity of the early
stages of information processing and may act as a rate-
limiting factor for cognition.
o This indicates that Bacopa significantly improved the
speed of visual information processing.
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Schisandra chinensis
o Lignans from Schisandra chinensis improved
concentration, fine co-ordination and sensitivity in
healthy young male adults as assessed by tasks such as
threading a needle and telegraphic reception and
transmission.
o Schisandra improved vision, enlarged the visual field,
improved hearing and heightened skin sensory
discrimination
o It was thought that those effects are central rather than
peripheral.(Chang HM 1987 as cited in Bone 2003, p.407)
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Panax ginseng
o In a double-blind study on students given Ginseng over
thirty-three days significant improvements in
psychomotor ability and intellectual performance were
observed.
o Nurses switching from day to night duty were evaluated
for competence, mood, wellbeing and psychophysical
performance in a double-blind clinical study of Ginseng
versus placebo.
o Ginseng improved the scores for competence and mood,
and performance on the psychophysical test.(D’Angelo et al,1986)
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Pre-reading for next session
o Reading 1: Braun, L Cohen, M 2010, Herbs and Natural
Supplements: An evidence based guide, 3rd edn, Churchill
Livingstone, Australia pp. 481-489.
o Reading 2: Yeon, KY Kim, SA Kim, YH Lee, MK Ahn, DK Kim, HJ
Kim, JS Jung, SI & OH, SB 2010, ’Curcumin Produces an
Antihyperalgesic Effect via Antagonism of TRPV’ Journal Dental
Research, vol. 89, no. 2, pp. 170-174.
http://jdr.sagepub.com/content/89/2/170.full.pdf+html
o Reading 3: Maroon, JC Bost, JW Maroon, A 2010, ‘Natural anti-
inflammatory agents for pain relief’ Surgical Neurology International,
vol. 80, no. 1.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011108/
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