3/22/10


PaBent’s
details

•  Sex:
Male

Case
history
–
lower
back
pain

•  Date
of
birth:
1925

•  Profession:
researcher
in
biochemistry


•  Date
of
first
consultaBon:
Nov
2001

Anna
Newton
BA
BSc
 •  PresenBng
symptom:
severe
lower

Medical
Herbalist
MCPP
MNIMH
 back
pain
of
few
months
duraBon


1
 2


Previous
medical
history
 InvesBgaBons
and
diagnosis

•  Severe
pain
in
lumbar
region,
worse
for

MIR
scan:


walking
and

standing

• R
lateral
and
posterior

•  MedicaBon:

 displacement
of
lumbar

1.  muscle
relaxant
(Methocarbamol)
 vertebrae
L3,L4,L5

2.  NSAID
(Ibuprofen)


• degeneraBve
changes

characterisBc
of

3.  calcium
channel
blocker
(Amlodipine)
 osteoarthriBs

•  Weak
response
to
analgesic
medicaBon
 • spinal
stenosis

plus
side
effects
(skin
rash,
indigesBon)

(scoliosis
may
have
been

•  Low
mood,
symptoms
of
benign
prostaBc
 acquired
in
childhood)

hypertrophy

3
 4


Diet
and
lifestyle
 IniBal
prescripBons

•  Poor
diet
(meat
3
x
day,
veg)
 2001
 2003
 2006

•  Large
alcohol
intake
(1/2
boYle
of
wine
 Harpagophytum
 Hypericum
 Hypericum

Dioscorea
 Guaiacum
 Apium

per
day)

Salix
alba
FE
 Viburnum
prun.
 Boswelia

•  Walking
a
dog
for
5min,
4
x
day
(no
 UrBca
rad.
 Apium
 Curcuma

other
exercise)
 Carduus
 Menyanthes
 Viburnum
op.

•  Supplements:
vit
E,
mulBvitamins,
garlic
 Galium
 Dioscorea

tablets
 Outcome:
about
60‐80%
improvement
in
pain
frequency
and

intensity,
no
need
for
ibuprofen
but
occasionally
taking

muscle
relaxant
1
x
day
(Methocarbamol)

5
 6


1

 3/22/10


IniBal
prescripBons
 Final
prescripBon

2005
–
ointment

 2006
–
ongoing

Base:
Arnica,
Symphytum,
Echinacea
(10g
of
each)
 Saligesic
:
1
tablet
per
day

Tinctures:

Salix
alba
FE
2ml,
Symphytum
root
5ml,

(extract
of
Salix
purpurea,
each
tablet





















Vib.op
2ml,
Capsicum
20gY

contains
extract
equivalent
to
8g
stem
bark;

Infused
oils:
Symphytum
3ml,
Hypericum
3ml

stand.
to
salicin
60mg)

EssenBal
oils:
cajaput,
lavender,
peppermint,
wintergreen


























(5‐10gY
of
each)

Outcome:

‐virtually
pain
free


Outcome:
the
ointment
helped
but
the
paBent
found
it

difficult
to
apply

‐walking
20
min
4
x
day

7
 8


Comparison
of
Salix
purpurea

and
 Comparison
of
Salix
purpurea

and

Salix
alba
cons0tuents
 Salix
alba
cons0tuents


ConsBtuent
 Salix
purpurea
 Salix
alba


B
Schmid,
I
KöYer,
L
Heide
‐
European
journal
of
clinical

pharmacology,
2001
–
Springer.
PharmacokineBcs
of
salicin
amer

Phenolic
glycozides,
 oral
administraBon
of
standardised
willow
bark.

of
which
salicylates

6.1‐8.5%
(total
 0.5‐1%
(total

predominate
(e.g.
 “Salicylic
acid
was
the
major
metabolite
of
salicin
detected
in

salicin
=
 salicin)
 salicin)
 the
serum
(86%
of
total
salicylates),
besides
salicyluric
acid

2‐(hydroxymethyl)phenyl‐ (10%)
and
genBsic
acid
(4%).
Peak
serum
levels
of
salicylic
acid

b‐d‐glucopyranoside)
 were
on
average
1.2
mg/l....(which
is)
much
lower
serum

salicylate
levels
than
observed
amer
analgesic
doses
of
syntheBc

salicylates.
The
formaBon
of
salicylic
acid
alone
is
therefore

unlikely
to
explain
analgesic
or
anB‐rheumaBc
effects
of
willow

bark.”


9
 10


References


B
Schmid,
I
KöYer,
L
Heide
‐
European
journal
of
clinical

pharmacology,
2001
–
Springer.
PharmacokineBcs
of
salicin
amer

oral
administraBon
of
standardised
willow
bark.


BriBsh
Herbal
Compendium,
BHMA,
vol1


S.Mills,
K.Bone,
The
essenBal
guide
to
herbal
safety,
Churchill

Livingstone,
2005


11


2