Ayurvedic Medicine

Ayurvedic medicine (Ayurveda; http://nccam.nih.gov/health/ayurveda/introduction.htm; accessed 30 September 2013) originated in India. Its aim is to integrate and balance the body, mind and spirit because it is believed that this helps prevent illness and promote wellness. Many therapies employed in Ayurvedic medicine are also used on their own as CAM – for example, herbs, massage and specialized diets. Some of the products may be harmful (causing adverse effects or interacting with conventional medicines). Different systems used to treat oral diseases, individually or in combinations, include Acacia chundra Willd, Adhatoda vasica Nees, Mimusops elengi L., Piper nigrum L., Pongamia pinnata (L.) Pierre, Quercus infectoria Olivier, Syzygium aromaticum L., Terminalia chebula Retz and Zingiber officinale Roscoe.

Cam in other Cultures

Details of African, American Indian, Latin American, Caribbean and other important CAM can be found at: http://www.ncbi.nlm.nih.gov/pmc/journals/970/ and http://americanindianhealth.nlm.nih.gov/ (both accessed 30 September 2013).

Herbal Medicines

Many conventional drugs that have been proven to be effective originated from plant sources. Examples include aspirin (from willow bark), digoxin (foxglove), morphine (opium poppy) and quinine (cinchona bark). However, natural does not signify safe. Some plant products (e.g. opioids, cocaine and peyote) are addictive (Ch. 34) and many are highly toxic; for example, some Chinese weight-loss herbs are nephrotoxic, and kava-kava (Piper methysticum) is hepatotoxic. Chamomile, liquorice root, quassia and red clover all contain coumarin derivatives and can provoke a bleeding tendency. Some other herbal products may impair platelet aggregation, thus prolonging bleeding (Table 26.2). Herbals that pose a risk for cardiac patients are shown in Box 26.1.

Some herbal drugs appear to be effective and fairly safe, and there are reliable published data supporting a potential medicinal role for aloe vera, melatonin, saw palmetto and St John’s wort (Table 26.3). Reliable published data on efficacy are weaker for gingko biloba and alpha-lipoic acid, and are contradictory for valerian and echinacea. Research into the safety and efficacy of most herbals has been limited because of product variability, lack of controlled studies and few legal controls (Appendices 26.1 and 26.2).

Aloe Vera

Aloe vera, derived from Aloe barbadensis Miller, contains many constituents, some of which purportedly have anti-inflammatory, antiseptic and/or analgesic properties. These include:

Aloe may have healing and protective effects against radiation damage, and anti-inflammatory, antiviral and antiseptic properties. There are reports of efficacy in seborrhoeic dermatitis, psoriasis, herpes, burns, wound healing, pressure ulcers, mucositis, radiation dermatitis, acne, lichen planus and aphthous stomatitis.

Aloe may cause redness, burning, a stinging sensation and, rarely, dermatitis. Abdominal cramps, diarrhoea, red urine, hepatitis, dependency or worsening of constipation are also possible. Its laxative effect may cause electrolyte imbalances (low potassium levels). Prolonged use (in animals) has reportedly increased the risk of colorectal cancer.

Oral aloe is not recommended during pregnancy due to theoretical stimulation of uterine contractions, and if taken by breast-feeding mothers it may sometime causes gastrointestinal distress in the nursing infant. Aloe reduces the effectiveness and may increase the adverse effects of digoxin and digitoxin, due to its potassium-lowering effect. It decreases blood sugar levels and thus may interact with hypoglycaemic drugs and insulin. Aloe should not be taken for 2 weeks prior to any surgical procedure, as it may cause increased bleeding.

Further information on aloe is available at: http://umm.edu/health/medical/altmed/ (under ‘Herb’ and ‘Herb Interaction’) and http://nccam.nih.gov/health/aloevera (both accessed 30 September 2013).

Gingko Biloba

The flavonoids found in ginkgo may help prevent or reduce retinal problems and age-related macular degeneration; they may also enhance neuropsychological/memory processes, and possibly are effective in Alzheimer disease, improving cognitive performance, global function and activities of daily living, and, at least in vitro, inhibiting amyloid-beta aggregation and caspase-3 activation (Ch. 13). Meta-analyses comparing ginkgo with acetylcholinesterase inhibitors in Alzheimer disease have shown similar clinical efficacy, with an additional safety benefit for ginkgo. Ginkgo might cause early labour; it might also interfere with diabetes management, provoke seizures or cause a bleeding disorder.

Ginkgo can interact with some medications, including anticonvulsants, antidepressants (SSRIs – may increase the risk of serotonin syndrome), antihypertensives, and drugs such as warfarin, clopidogrel, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). It is recommended that ginkgo be stopped at least 2 weeks before surgery.

More information is available at: http://umm.edu/health/medical/altmed/herb/ginkgo-biloba and http://www.nlm.nih.gov/medlineplus/druginformation.html (both accessed 30 September 2013).

Melatonin

Melatonin taken in the evening in the new time zone will reset the biological clock and alleviate (or prevent) symptoms of jet lag. Melatonin helps determine when a woman starts to menstruate, the frequency and duration of menstrual cycles, and when a woman stops menstruating (meno/>