Herbal Medicines

Echinacea 
- wounds and infection, used for cold and flu
- stimulates phagocytosis?
- murky evidence of efficacy

Methods: 

- Three preparations of echinacea, with distinct phytochemical profiles, were produced by extraction from E. angustifolia roots 

- 437 volunteers were randomly assigned to receive either prophylaxis (beginning seven days before the virus challenge) or treatment (beginning at the time of the challenge) either with one of these preparations or with placebo. 

- The results for 399 volunteers who were challenged with rhinovirus type 39 and observed in a sequestered setting for five days were included in the data analysis.

Results: 

- There were no statistically significant effects of the three echinacea extracts on rates of infection or severity of symptoms. Similarly, there were no significant effects of treatment on the volume of nasal secretions, on polymorphonuclear leukocyte or interleukin-8 concentrations in nasal-lavage specimens, or on quantitative-virus titer.

Ephedra 
- Ephedrine - sympathomimetic
- Used for respiratory symptoms in chinese medicine
- Abuse: performance enhancer, stimulant, weight loss
- Linked to increased risk of MI and stroke - potentially even hypersensitivity myocarditis

Garlic 
- Platelet inhibition - should be discontinued 1 week before surgery
- Has been associated with reduced size of plaque in placebo controlled trial (athersclerosis 1999)

Ginko 
- Terpenoids and flavonoids
- Vasoregulation? Effect on platelets?
- Should be discontinued 1week before surgery

Ginseng 
- Terpenoids and flavenoids and ginsenosides
- Antioxidant? Effects on blood glucose?

Kava
- Anxiolytic, sedatives, anti-epileptic
- Kavalactones
- Sedation via GABA
- Rare instances of severe hepatotoxicity

J Clin Psychopharmacol. 2013 Oct;33(5):643-8. doi: 10.1097/JCP.0b013e318291be67.

Kava in the treatment of generalized anxiety disorder: a double-blind, randomized, placebo-controlled study.

Sarris J1, Stough C, Bousman CA, Wahid ZT, Murray G, Teschke R, Savage KM, Dowell A, Ng C, Schweitzer I.

Abstract

Kava (Piper methysticum) is a plant-based medicine, which has been previously shown to reduce anxiety. To date, however, no placebo-controlled trial assessing kava in the treatment of generalized anxiety disorder (GAD) has been completed. A total of 75 participants with GAD and no comorbid mood disorder were enrolled in a 6-week double-blind trial of an aqueous extract of kava (120/240 mg of kavalactones per day depending on response) versus placebo. γ-Aminobutyric acid (GABA) and noradrenaline transporter polymorphisms were also analyzed as potential pharmacogenetic markers of response. Reduction in anxiety was measured using the Hamilton Anxiety Rating Scale (HAMA) as the primary outcome. Intention-to-treat analysis was performed on 58 participants who met inclusion criteria after an initial 1 week placebo run-in phase. Results revealed a significant reduction in anxiety for the kava group compared with the placebo group with a moderate effect size (P = 0.046, Cohen d = 0.62). Among participants with moderate to severe Diagnostic and Statistical Manual of Mental Disorders-diagnosed GAD, this effect was larger (P = 0.02; d = 0.82). At conclusion of the controlled phase, 26% of the kava group were classified as remitted (HAMA ≤ 7) compared with 6% of the placebo group (P = 0.04). Within the kava group, GABA transporter polymorphisms rs2601126 (P = 0.021) and rs2697153 (P = 0.046) were associated with HAMA reduction. Kava was well tolerated, and aside from more headaches reported in the kava group (P = 0.05), no other significant differences between groups occurred for any other adverse effects, nor for liver function tests. Standardized kava may be a moderately effective short-term option for the treatment of GAD. Furthermore, specific GABA transporter polymorphisms appear to potentially modify anxiolytic response to kava.

Medicinal Mushroom
- Ganoderma lucidum
- Ling zhi/reishi
- Terpenoids

Milk thistle 
- silymarin - biologically active flavenoids
- supposedly protects hepatic cells and promotes regeneration

St John's Wort
- Inhibits Ser/Norepi/DA reuptake
- 2002 NIH study: both this drug (and zoloft) ineffective against
- P450 inducer - but not immediate. Can take several weeks of use before the cyp induction becomes obvious
- can cause serotonin syndrome in combination with other drugs that affect serotonins.

Valerian 
- Sedative, sleep aid
- Valepotriates
- Works via GABA
- Can potentiate sedative, can cause benzo-like withdrawal.

Fish Oil (omega 3) 
- EPA and DHA

Methods: double blind, placebo control, randomized.  n=12,536, subjects with diabetes/impaired glucose tolerance at high risk for cardiovascular events. Outcome: death from cardiovascular events.

Results: 

- Median follow up of 6.2 years

- Incidence of the primary outcome not significantly different between two groups

- No significant effect on the rates of major vascular events, death from any cause, or death from arrhythmia 

- Triglyceride levels were reduced by 14.5 mg per deciliter (0.16 mmol per liter) more among patients receiving n–3 fatty acids than among those receiving placebo (P<0.001), without a significant effect on other lipids. 

- Adverse effects were similar in the two groups.

Glucosamine/Chondroitin 
- Sea cucumber - 15% mucopolysaccharides
- "reduces pain"
- No definitive evidence that it is superior to placebo for either pain reduction or slowing loss of cartilage