Luo Bu Ma Tablets by Plum Flower

There is insufficient reliable information available about the effectiveness of Asian water plantain.

(Read more about ASIAN WATER PLANTAIN)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Angina. Although there has been interest in using oral chrysanthemum for angina, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Asthenopia (eye strain). Oral chrysanthemum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with asthenopia shows that taking one of three doses of a combination tablet containing chrysanthemum extract 75 mg, 125 mg, or 175 mg with various other ingredients orally once daily for 90 days modestly improves symptoms of eye fatigue, such as tearing, soreness, dryness, and foreign body sensation, when compared with placebo. There were also improvements in macular function. The other ingredients included black currant extract 100-233 mg, goji berry extract 75-175 mg, lutein ester 12-28 mg, and zeaxanthin 1.2-2.8 mg (106306).
• Common cold. Although there has been interest in using oral chrysanthemum for the common cold, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Diabetes. Although there has been interest in using oral chrysanthemum for diabetes, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Headache. Although there has been interest in using oral chrysanthemum for headache, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• HIV/AIDS. Although there has been interest in using oral chrysanthemum for HIV/AIDS, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Hyperlipidemia. Although there has been interest in using oral chrysanthemum for hyperlipidemia, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Hypertension. Although there has been interest in using oral chrysanthemum for hypertension, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Osteoarthritis. It is unclear if oral chrysanthemum is beneficial in patients with osteoarthritis. Details: Clinical research in patients with mild knee osteoarthritis shows that taking a specific chrysanthemum extract (GreenCross Wellbeing Corporation) 250 mg orally daily for 12 weeks reduces certain pain scores by 30% when compared with baseline. This was also statistically significant when compared with the 14% reduction in those taking placebo. However, other pain scores and stiffness scores were not different between groups. In addition, the clinical significance of these potential improvements is unclear (106308).
• Stroke. It is unclear if oral chrysanthemum is beneficial in patients with stroke. Details: Preliminary clinical research in adults with ischemic stroke shows that taking chrysanthemum extract 200 mg orally twice daily for 4 days improves stroke symptom scores when compared with control (110511).
• Ulcerative colitis. Although there has been interest in using oral chrysanthemum for ulcerative colitis, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose. More evidence is needed to rate chrysanthemum for these uses.

(Read more about CHRYSANTHEMUM)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Angina. It is unclear if oral hawthorn is beneficial in patients with angina. Details: Preliminary clinical research in patients with angina taking chronic beta-adrenergic receptor blockers or ACE inhibitor therapy shows that taking a hawthorn (Crataegus pinnatifada) extract 100 mg orally three times daily for four weeks improves angina and electrocardiogram (ECG) findings and reduces nitroglycerin intake when compared with placebo (19242). Other preliminary clinical research in patients with unstable angina shows that taking hawthorn 10 grams and hu zang 15 grams orally daily for 4 weeks does not reduce the frequency of angina pectoris attacks when compared with control. However, taking hawthorn and hu zang improved some subjective symptom scores and quality of life scores (109610).
• Anxiety. Oral hawthorn has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A clinical study in adults with mild to moderate generalized anxiety shows that taking a specific product (Sympathyl, not available in the US) containing hawthorn, magnesium, and California poppy for 90 days modestly improves anxiety scores when compared with placebo (12583). Also, a clinical study in adults with adjustment disorder and anxious mood shows that hawthorn, in combination with black horehound, passion flower, valerian, kola nut, and guarana, modestly improves anxiety scores when compared with placebo (6250). It is unclear if these effects are due to hawthorn, other ingredients, or the combination. Another small clinical study in healthy adults shows that taking a combination of herbal extracts containing hawthorn, passionflower, ballota, and valerian root daily for 14 days reduces subjective anxiety and objective sympathetic and autonomic nervous system activation in response to a psychosocial stressor when compared with placebo (111222). It is unclear if these effects are due to hawthorn, other ingredients, or the combination.
• Arrhythmia. Although there has been interest in using oral hawthorn for arrhythmia, there is insufficient reliable information about the clinical effects of arrhythmia for this condition.
• Atherosclerosis. Although there has been interest in using oral hawthorn for atherosclerosis, there is insufficient reliable information about the clinical effects of arrhythmia for this condition.
• Cardiovascular disease (CVD). Although there has been interest in using oral hawthorn for CVD, there is insufficient reliable information about the clinical effects of arrhythmia for this condition.
• Cognitive function. Oral hawthorn has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: In a preliminary clinical trial, a single dose of 25 drops of a combination product of D-camphor and hawthorn berry extract (Korodin) was superior to placebo for increasing cognitive performance in elderly female patients as measured by visuomotor speed and information processing capacity. The active treatment group showed an improvement in attentional and mental performance (19240,91504).
• Congestive heart failure (CHF). The evidence on the effects of oral hawthorn in patients with CHF is conflicting. Although some older research suggests it may be beneficial, more recent, larger studies suggest it may actually increase the risk for complications. Details: There is contradictory evidence about the effects of hawthorn extract in heart failure patients. Several clinical studies show that taking specific hawthorn leaf and flower extracts (LI 132, Faros 300, Lichtwer Pharma; WS 1442, Crataegutt forte, Dr. Willmar Schwabe Pharmaceuticals; or HeartCare, Nature's Way) 240-600 mg daily improves ejection fraction and exercise tolerance, reduces subjective symptoms, and decreases the risk of death in patients with New York Heart Association (NYHA) stage II heart failure. In these studies, the maximum effect was usually seen after 6-12 weeks of treatment (8279,8280,11449,19221,19223,19225,19226,19227,19228). Another clinical trial shows that hawthorn extract (WS 1442, Crataegutt forte, Dr. Willmar Schwabe Pharmaceuticals or HeartCare, Nature's Way) 1800 mg daily, combined with diuretic therapy, improves exercise tolerance and reduces subjective symptoms in NYHA stage III heart failure. In this study, maximum effect was usually seen after 16 weeks of treatment (8281). In another trial, patients with NYHA II heart failure taking either hawthorn (LI 132, Faros) 300 mg three times daily or captopril 12.5 mg three times daily experienced similar improvements in cardiac performance and symptoms (19230). However, other clinical research suggests no benefit and possible harm with hawthorn. A large-scale clinical trial (SPICE) in patients with NYHA stage II or III heart failure shows that taking specific hawthorn extracts (WS 1442, Crataegutt forte, Dr. Willmar Schwabe Pharmaceuticals; HeartCare, Nature's Way) 900 mg daily for 24 months, in combination with conventional treatment, does not decrease hospitalization due to progressive heart failure, non-fatal myocardial infarction, or cardiac death (17203). Another clinical trial in patients with NYHA stage II or III heart failure shows that taking these same specific hawthorn extracts at the same dose for up to 6 months does not slow the progression of heart failure when compared with placebo (19222). In a retrospective analysis of this study, it was shown that heart failure progression was significantly increased in patients taking hawthorn when compared with placebo. The rate of death was also increased by 1.7% over placebo, and heart failure-related hospitalizations increased by 8% over placebo in patients treated with hawthorn (16824).
• Hyperlipidemia. Although there has been interest in using oral hawthorn for hyperlipidemia, there is insufficient reliable information about the clinical effects of arrhythmia for this condition.
• Hypertension. It is unclear if oral hawthorn is beneficial for lowering blood pressure. Details: One preliminary clinical trial showed that taking hawthorn standardized extract 1,000-2,500 mg daily for three days does not significantly reduce blood pressure in hypertensive or prehypertensive patients when compared with placebo (19244). However, another study in patients with diabetes and hypertension shows that taking a specific hawthorn extract (LI 132) 1,200mg daily for 16 weeks significantly decreased diastolic, but not systolic, blood pressure when compared with placebo (19245).
• Orthostatic hypotension. Oral hawthorn has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in older adults with orthostatic hypotension shows that taking a specific combination product containing hawthorn and camphor (Korodin Herz-Kreislauf-Tropfen) 25 drops orally three times daily for 7 days attenuates the blood pressure reduction upon standing when compared with placebo. Signs and symptoms of orthostatic hypotension such as dizziness, blurry vision, and falls also seem to be reduced when compared with baseline (39614,39617). A meta-analysis of 4 studies shows that giving single doses of 20-25 drops of the same combination product increases systolic and diastolic blood pressure when compared with placebo (103620). However, the studies have methodologic problems and, while 2 were conducted in females with orthostatic hypotension, the others involved health young adults or normotensive elderly subjects. The effect of hawthorn alone for treatment of orthostatic hypotension has not been determined. The combination product used in these studies is not available in the US. More evidence is needed to rate hawthorn for these uses.

(Read more about HAWTHORN)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Rheumatoid arthritis (RA). Clinical research shows that taking a combination of self-heal, Clematis mandshurica, and Chinese cucumber 200 mg three times daily for 6 weeks is as effective as celecoxib 200 mg twice daily for reducing pain and disease activity associated with RA. There was no difference between groups in the use of rescue medication or the response rate (101041). It is unclear whether these effects are due to self-heal, the other ingredients, or the combination. More evidence is needed to rate self-heal for this use.

(Read more about SELF-HEAL)

There is insufficient reliable information available about the safety of Asian water plantain.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about ASIAN WATER PLANTAIN)

POSSIBLY SAFE ...when used orally and appropriately, short-term. A specific extract of chrysanthemum (GreenCross Wellbeing Corporation) has been used with apparent safety at a dose of 250 mg daily for up to 12 weeks (106308). There is insufficient reliable information available about the safety of chrysanthemum when used topically.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about CHRYSANTHEMUM)

POSSIBLY SAFE ...when used orally and appropriately, short-term. Hawthorn preparations in doses of up to 1800 mg daily seem to be safe when used for up to 16 weeks. Although hawthorn might be safe for long-term use, current studies have not evaluated safety past 16 weeks (8279,8280,8281,10144,17203,104689). There is insufficient reliable information available about the safety of hawthorn when used topically.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about HAWTHORN)

There is insufficient reliable information available about the safety of self-heal.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about SELF-HEAL)

(Read more about ASIAN WATER PLANTAIN)

(Read more about CHRYSANTHEMUM)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, hawthorn may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.  Details In vitro and animal research shows that hawthorn can inhibit platelet aggregation (95528,95529,95530,95531). However, its effect in humans is unclear. One observational study shows that patients taking hawthorn shortly before undergoing coronary artery bypass graft (CABG) surgery or valve replacement surgery have a 10% incidence of postoperative bleeding, compared with 1% in those who never consumed hawthorn extract (95527). However, clinical research shows that taking a specific preparation of dried hawthorn leaves and flowers (Crataesor, Soria Natural Lab) 800 mg three times daily for 15 days does not affect platelet aggregation or levels of thromboxane B2, the metabolite of thromboxane A2, in healthy humans (54664).

BETA-BLOCKERS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use might cause additive effects on blood pressure and heart rate.  Details Some evidence shows that hawthorn might lower blood pressure and heart rate (12595,19245).

CALCIUM CHANNEL BLOCKERS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use might cause additive coronary vasodilation and hypotensive effects.  Details Some evidence shows that hawthorn might lower blood pressure due to vasodilatory effects (12595,19245).

DIGOXIN (Lanoxin) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, hawthorn might potentiate the effects and adverse effects of digoxin.  Details Hawthorn appears to improve cardiac output (12595); however, hawthorn does not appear to affect digoxin pharmacokinetics (19249).

NITRATES Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, concomitant use might cause additive coronary vasodilatory effects.  Details Some evidence shows that hawthorn might lower blood pressure due to vasodilatory effects (12595,19245).

PHOSPHODIESTERASE-5 INHIBITORS Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, concomitant use might result in additive vasodilation and hypotension.  Details Hawthorn might inhibit PDE-5 and cause vasodilation (12595).

(Read more about HAWTHORN)

(Read more about SELF-HEAL)

General ...There is limited information available about the potential adverse effects of Asian water plantain. Orally, it has been used as a part of Traditional Chinese Medicine (TCM) with apparent safety; there have been no reported adverse effects in most patients. However, one case of hepatotoxicity and nephrotoxicity has been reported with the use of a combination TCM product containing Asian water plantain (99434).

Hepatic ...One case report of drug-induced systemic toxicity, including hepatotoxicity, has occurred in a 59-year-old man with chronic hepatitis B who had taken six doses of a combination product containing Asian water plantain 3 weeks prior to admission. He presented with gum bleed and petechiae, and his admission lab values indicated fulminant liver failure. His condition progressed to include renal failure and eventual death after 4 weeks. It is not clear if Asian water plantain, the other ingredients, or the combination caused this toxicity. However, the authors identified Asian water plantain as the likely causative ingredient based on animal research (99434).

Renal ...One case report of drug-induced systemic toxicity, including nephrotoxicity, has occurred in a 59-year-old man with chronic hepatitis B who had taken six doses of a combination product containing Asian water plantain 3 weeks prior to admission. He initially presented with hepatic failure, which progressed to include renal failure and eventual death after 4 weeks. It is not clear if Asian water plantain, the other ingredients, or the combination caused this toxicity. However, the authors identified Asian water plantain as the likely causative ingredient based on animal research (99434).

(Read more about ASIAN WATER PLANTAIN)

General ...There is currently a limited amount of information on the adverse effects of chrysanthemum. A thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Topically: Allergic reactions, contact dermatitis, eczema, urticaria.
Serious Adverse Effects (Rare):
Topically: Asthma.

Immunologic ...Topically and via occupational exposure, chrysanthemum can cause allergic reactions. Chrysanthemum allergy symptoms can include urticaria, contact dermatitis, eczema, actinic reticuloid photosensitivity dermatitis, pollinosis, rhinoconjunctivitis, and asthma (5552,5554,5556,5557,6958,42842,42845,42849,42859,42867,42893,42872,42873,42874)(42879,42880,42881,42882,42883,42887,42888). There are numerous case reports and studies showing that allergies to Chrysanthemum are very common, with an estimated 60% of Europeans being allergic (19149,42847,42856,42854).

(Read more about CHRYSANTHEMUM)

General ...Orally, hawthorn seems to be well tolerated when used appropriately. Topically, no adverse effects have been reported, although a thorough evaluation of safety outcomes has not been conducted.
Serious Adverse Effects (Rare):
Orally: Multiorgan hypersensitivity reactions resulting in acute renal failure have been reported rarely.

Cardiovascular ...Orally, tachycardia (with facial pains) of uncertain relationship to hawthorn was reported in a multicenter clinical trial (54640). Palpitations (19244) were reported in three patients in a large surveillance trial of 3,664 patients with cardiac failure (54692) and in 11 patients with congestive heart failure (CHF) in a literature review of 5,577 patients (19247). Circulation failure has been reported in two patients with CHF in a literature review of 5,577 patients (19247). Incidences of hospitalization, hospitalization due to CHF, worsening of CHF, angina, and atrial fibrillation have also been reported with the use of hawthorn extract WS 1442 (Crataegutt forte), although it is unclear if these events are related to hawthorn supplementation or existing CHF (19222). In clinical trials, chest pain (8281), short-term increases in blood pressure (19240), and other non-specific heart problems (17203) have also been reported following the use of various hawthorn preparations (e.g. WS 1442, Korodin).

Dermatologic ...Orally, erythematous rash has been reported in patients with CHF in a literature review of 5,577 patients (19247). Non-specific rashes and itching (19222,19243) as well as toxiderma from the fruits of hawthorn (54670) have also been reported.

Gastrointestinal ...Orally, rare abdominal discomfort of uncertain relationship to hawthorn has been reported in a large clinical trial, surveillance study, and a literature review (19247,54640,54692). Digestive intolerance (19241), diarrhea (19243), flatulence (8281), gastroenteritis (8281), increased bowel movements (19243), obstipation (8281), mild and rare nausea (10144,19247,19244), nutritional and metabolic problems (17203), and other non-specific gastrointestinal effects (19222), have also been reported. Furthermore, gastrointestinal hemorrhage has been reported in two patients with CHF in a literature review of 5,577 patients (19247).

Musculoskeletal ...In clinical trials, arthritis (8281), back pain (8281), weakness (19243), and other non-specific musculoskeletal effects (19222) have been reported following the use of various hawthorn preparations g. WS 1442, CKBM-A01).

Neurologic/CNS ...Orally, headache and dizziness/vertigo were reported in two patients in a large surveillance trial of 3,664 patients with cardiac failure (54692), in 15 patients with CHF as reported in a literature review of 5,577 patients (19247), and in a varying number of clinical trial participants (8281,19222,19244). Incidences of fainting (19222), fever (17203), and infrequent, mild and transient sleepiness have also been reported (19221,54692).

Psychiatric ...Orally, agitation was reported in a large surveillance trial of 3,664 patients with cardiac failure (54692).

Pulmonary/Respiratory ...Orally, bronchitis has been reported following the use of hawthorn extract WS 1442 (8281).

Renal ...A case of multiorgan hypersensitivity reaction and acute renal failure following the consumption of C. orientalis has been reported (54654).

Other ...Flu-like syndrome (8281) and other non-specific infections have been reported following the use of the hawthorn extract WS 1442 (17203,19222). Hawthorn has also been reported to cause nosebleeds (8281,10144).

(Read more about HAWTHORN)

General ...Orally, self-heal has been reported to cause nausea, vomiting, and diarrhea. Orally and topically, self-heal has been reported to cause allergic reactions in sensitive individuals (12).

Gastrointestinal ...Orally, self-heal has been reported to cause nausea, vomiting, and diarrhea (12). A combination product containing self-heal, Clematis mandshurica, and Chinese cucumber has been reported to cause epigastric pain, abdominal discomfort, nausea, reduced appetite, and dyspepsia. It is not clear if these effects are due to self-heal, the other ingredients, or the combination (101041).

Immunologic ...Orally and topically, self-heal has been reported to cause allergic reactions, including rashes and swelling of the throat, lips, and tongue, in sensitive individuals (12).

(Read more about SELF-HEAL)