[Fwd: FYI - nephropathy]

[Guest guest]

Regarding the article on nephropathy and chinese herbs, although I agree with

Z'ev on the other possibilities, I nevertheless believe that the following is

the 'bottom line' here:

 

<< Vanherweghem calls for herbal substances to be " subjected to the same

> stringent scrutiny and controls as common drugs. " >>

 

As a professor of criminology over the past 25 years, a few things come to

mind here, namely the process of the creation of deviance/criminality for the

purposes of passing new legislation. The process begins when a group desires

a certain outcome (perhaps banning of herbs, in this case), and then begins

the campaign to bring about the desired result. It starts with generating

broad awareness of the problem by making claims of its dangerousness designed

to create a sense that certain conditions are problematic and pose a present

or future danger to society. Secondly, they must then create the impression

that rules are needed around this issue as none currently exist. They call on

experts in the field and disseminate their opinions as testimonial fact

throughout society via the media. It's packaged in rhetoric to be compelling:

dramatic statistics, horrific pictures, etc are used to create fear and

loathing of the condition or behavior they want to control. The wording

chosen to represent the claim tends toward the moral highground

(ie:AMA/patient health/proper treatment) and it attacks opposing views in the

attempt to assert the public good. The situation with herbs and nephropathy

seems to be at this phase.

Next, they have to compete with media space, which is limited, so they get

famous sponsors for public endorsement. At this point it could whip the

public into a panic and create a media feeding frenzy. If this happens, the

issue takes off on a life of its own, as we witnessed with the Y2K scare.

Then, once the public has been sufficiently swayed and strong enough public

support exists, legislation is passed which serves to outlaw the condition or

behavior, or in this instance, the product.

 

Like I said, the statement printed above smacked of this, especially the

reference to scrutiny as drugs. One of the reasons why herbs are not

subjected to FDA approval is the fact they they are defined as nutritional

supplements and NOT drugs. This is a dangerous sentence, and we shouldnt

disregard its potentially lethal ramifications for our profession.

GGabrielle

[Guest guest]

what does anyone make of this? It keeps happening all over the world.

 

" Mitchell B. Stargrove, N.D., L.Ac. " wrote:

 

> Chinese herbs may cause kidney failure

>

> February 14, 2000

> NEW YORK, (Reuters Health) -- Another report has surfaced to remind

> us that just because a remedy or nutritional supplement is " herbal, "

> that does not make it harmless. A team of doctors from Taiwan report

> the cases of 12 patients with kidney failure apparently caused by

> taking Chinese herbs.

> " The risk of using uncontrolled herbal medicines warrants our urgent

> attention, " stated the group of physicians from Cathay General

> Hospital in Taipei, led by Dr. Chwei-Shiun Yang. " Obviously; the

> incidence of herbal medicine-induced (kidney damage) is more common

> than previously perceived. "

> The doctors describe 12 Chinese patients seen over a 3-year period,

> all of whom had unexplained kidney failure. Tests showed that these

> patients had interstitial nephritis (inflammation of the kidney

> tissues) and severe damage to the kidney tubules. The only thing

> these patients had in common was that they had each taken Chinese

> herbs for some reason: for weight control, as a nutritional

> supplement, or to treat a non-kidney disease.

> The patients had taken Chinese herbs of various kinds and from

> various sources, for periods of time ranging from 3 to 18 months,

> although several patients did not know how long they'd taken the

> herbs. The doctors diagnosed all 12 patients with Chinese herbs

> nephropathy, a condition first identified in Belgium in 1992 when

> over 100 patients taking " slimming herbs " at a weight loss clinic

> experienced similar unexplained kidney failure. The harmful

> ingredient in the herbal preparation in these cases was thought to be

> aristolochic acid.

> But Yang and colleagues note that the role of aristolochic acid, the

> substance thought to cause the Belgian kidney failures, was never

> definitely proved. In the Taiwanese patients, no one ingredient

> common to all 12 patients could be identified. The doctors suggest

> that " unidentified phytotoxins (plant-derived poisons) other than

> aristolochic acid might induce this unique toxic (kidney disease). "

> Writing in the February issue of the American Journal of Kidney

> Diseases, Yang and colleagues suggest that " it is crucial to

> investigate the possible role of herbal remedies when faced with an

> interstitial nephritis of unknown origin. "

> In an editorial in the same issue, Dr. Jean-Louis Vanherweghem of the

> Universite Libre de Bruxelles in Brussels, Belgium, observes that

> " numerous myths have grown around medicinal herbs and their healing

> powers. " But, he warns, " many plants contain substances toxic to

> humans and therefore -- not surprisingly -- to the human kidney. "

> Vanherweghem calls for herbal substances to be " subjected to the same

> stringent scrutiny and controls as common drugs. "

> * * * * * * * * * * * * * * * * * * * * * * *

>

> Mitchell B. Stargrove, N.D., L.Ac. <Mitch

>

> Integrative Medical Arts Group, Inc. * IBISmedical.com

> 4790 SW Watson Avenue, Beaverton, OR 97005 * 503.526.1972 fax: 503.641.6541

> Integrative Medicine, Natural Health and Alternative Therapies

> Interactions: IBIS Guide to Drug-Herb and Drug-Nutrient Interactions

> IBIS Medical Software: Integrative BodyMind Information System * HealthWWWeb

> http://www.choicesforhealth.com http://www.integrativemedicalarts.com

 

 

[This message contained attachments]

[Guest guest]

It seems to me that the following possibilities have to be considered:

1) Practitioners of Chinese medicine are over-prescribing formulas with too

many ingredients at too high a dosage

2) Practitioners are using an overly allopathic approach to using herbal

medicine. . ..trying to replicate drug effects with natural medicinals,

thus increasing the possibility of iatrogenesis.

3) There is some toxicity in the herbal supply, similar to what was found

in Chinese prepared medicines.

4) Many people are self-medicating with Chinese herbs.

 

I think it would be interesting to hear what Andrew Ellis has to say about

all of this.

 

 

 

 

 

 

 

 

> " " <herb-t

>

>what does anyone make of this? It keeps happening all over the world.

>

> " Mitchell B. Stargrove, N.D., L.Ac. " wrote:

>

>> Chinese herbs may cause kidney failure

>>

[Guest guest]

A good point. . . .there is no doubt that a certain faction in the medical

world does pass these herb fear things around. However, this report has

Dr. Eisenberg and Ted Kaptchuk's names on it. They are both proponents of

Chinese medicine, so why would they put their names on it if there wasn't

some weight to it?

 

 

 

 

 

>Fourwolves

>

>Regarding the article on nephropathy and chinese herbs, although I agree with

>Z'ev on the other possibilities, I nevertheless believe that the following is

>the 'bottom line' here:

>

><< Vanherweghem calls for herbal substances to be " subjected to the same

> > stringent scrutiny and controls as common drugs. " >>

>

>As a professor of criminology over the past 25 years, a few things come to

>mind here, namely the process of the creation of deviance/criminality for the

>purposes of passing new legislation. The process begins when a group desires

>a certain outcome (perhaps banning of herbs, in this case), and then begins

>the campaign to bring about the desired result. It starts with generating

>broad awareness of the problem by making claims of its dangerousness designed

>to create a sense that certain conditions are problematic and pose a present

>or future danger to society. Secondly, they must then create the impression

>that rules are needed around this issue as none currently exist. They call on

>experts in the field and disseminate their opinions as testimonial fact

>throughout society via the media. It's packaged in rhetoric to be compelling:

>dramatic statistics, horrific pictures, etc are used to create fear and

>loathing of the condition or behavior they want to control. The wording

>chosen to represent the claim tends toward the moral highground

>(ie:AMA/patient health/proper treatment) and it attacks opposing views in the

>attempt to assert the public good. The situation with herbs and nephropathy

>seems to be at this phase.

>Next, they have to compete with media space, which is limited, so they get

>famous sponsors for public endorsement. At this point it could whip the

>public into a panic and create a media feeding frenzy. If this happens, the

>issue takes off on a life of its own, as we witnessed with the Y2K scare.

>Then, once the public has been sufficiently swayed and strong enough public

>support exists, legislation is passed which serves to outlaw the condition or

>behavior, or in this instance, the product.

>

>Like I said, the statement printed above smacked of this, especially the

>reference to scrutiny as drugs. One of the reasons why herbs are not

>subjected to FDA approval is the fact they they are defined as nutritional

>supplements and NOT drugs. This is a dangerous sentence, and we shouldnt

>disregard its potentially lethal ramifications for our profession.

>GGabrielle

>

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>

>Chronic Diseases Heal - Chinese Herbs Can Help

[Guest guest]

In a message dated 2/16/00 12:26:55 PM, herb-t writes:

 

< Vanherweghem calls for herbal substances to be " subjected to the same

> stringent scrutiny and controls as common drugs. " >>

 

Sounds like a mantra we are to hear more often as they become more afraid of

our successes. What WE have to do is to develop PR to counter this sort of

thing explaining how professional herbalists don't have this sort of problem,

and that none of these people were going to a professional Oriental Medicine

practitioner. I suspect that this sort of information was not in the article.

David Molony

[Guest guest]

I wanted to comment on two of 's comments:

 

<<It seems to me that the following possibilities have to be considered:

1) Practitioners of Chinese medicine are over-prescribing formulas with

too

many ingredients at too high a dosage>>

 

Probably not. I believe that schools today are teaching students to

under-prescribe when dealing with raw herbs. Formulas I get from the

Pacific College clinic are less than half the strength of those I've

gotten in Chinatown and are less effective. And when I was in China, a

days dosage of raw herbs was likely to fill a dinnerplate an inch

deep.(Hospital context).

 

<<3) There is some toxicity in the herbal supply, similar to what was

found

in Chinese prepared medicines.>>

 

Clearly there are toxic herbs which need to be used judiciously and

pollution concerns are very real. But I think the prevalence of new

forms of medicines are a greater problem. If I boil raw herbs, I can

visually inspect the quality, smell, and check for substitutions, but I

cannot do so with a powdered extract, capsule or tincture. (Substitutions

were involved in the Belgian case and powdered extracts in Taiwan.)

Further a powdered extract or tincture may be utilized very differently

in the body than a decoction. I find that the Chinese Modulars tinctures

affect me too strongly and not necesarily with the full medicinal

intention of the formula- perhaps some constituents are overemphasized by

the alcohol and others are lost. I am suspicious of the mechanics of

producing powdered extracts without losing at least volatiles. And I

know that the constituents of many herbs change when dried, altering

effectiveness.

 

[Let me admit at the outset that I do not understand the dry extraction

process and would appreciate explanations from those of you involved in

preparation companies.]

 

My background is in western herbalism and I know that standardized

extracts, or powders rarely convey the same healing actions of

traditionally prepared herbs. Solvents may be used to extract

constituents, which may be directly toxic in their own right, but also

often obtain compounds that would be missing from a decoction, methanol

tincture or medicinal wines. Components which may be traditionally

indigestible may become bioavailable, causing side effects. (There were

virtually no human cases of photosensitivity with St. John's wort at

normal antiviral, vulnurary or depression dosages until strong

standardized extracts became available, and I've seen SJW side effects

disappear when clients return to classical tinctures.) And encapsulated

extracts which end up in the stomach or gut before breaking down miss the

direct lymph stimulation in the mouth and throat and the ability to

taste-trigger organs to send out appropriate juices or other compounds.

 

Powders also break down faster than whole herbs. And it is easier to

overdose with powders or extracts, as was mentioned.

 

I've been looking at herbal quality and administration in a western

context for a while and generally find that while adulturation, organic

growing conditions and appropriate harvesting and handling can be insured

with care, the intracacies of herbal preparation are less well known and

vary significantly between ethical manufacturers, large or small. In

Chinese medicine, with its multitudes of preparations taking place, the

problem may be exacerbated. Perhaps our colleges of Traditional Oriental

Medicine will need to train students in both the techniques and

pharmacokinetics of traditional medicine making.

 

Karen Vaughan

CreationsGarden

***************************************

Email advice is not a substitute for medical treatment.

 

 

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[Guest guest]

Zev-

 

Nah, twice the quantity (9g. v. 4g.) doesn't translate to twice as

effective. It isn't a one to one correspondence by any means. I've

noticed the much higher herb quality at Pacific, especially in the

rhyzomes which are fruity and moist. I'm not suprised if it's from

Spring Wind.

 

Gil- Good catch on the ethanol. I'll have to time my medication better

so I can review emails in that space between wooziness and pain.

 

<Karen, I like your NY chutzpah!> Hey, I'm just a transplanted

(Northern) California girl ;-)

 

Karen Vaughan

CreationsGarden

***************************************

Email advice is not a substitute for medical treatment.

" If you want the rainbow, you gotta put up with the rain. " --Dolly Parton

 

______________

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Juno now offers FREE Internet Access!

Try it today - there's no risk! For your FREE software, visit:

http://dl.www.juno.com/get/tagj.

[Guest guest]

I Agree to an extent with Gabrielle. There are several MDs known to me

personally who would like to ban the use of herbs prescribed by anyone except

MDs (who btw are not trained in herbology in any basic form). So this does to

some degree present a potential problem.

The other point needed to be made is the extremely low percentage of

iatrogenically induced illness based upon the total number of people given

chinese herbals by trained practioners around the world.

I think we ought to be aware of potential side-effects fo our prescriptions

when we prescribe them to our patients just as we would be aware of potential

organ dmage or pneumothorax issues with acupuncture.

As Zev said, there are many possible reasons for problems with prescription,

one of which needs to be seriously addressed in our western culture; that is,

many practioners seem to believe we can use the best of both western dx and

asian dx, combine them together and treat accordingly (eg treating all

endometriosis as if it were a blood stasis issue rather than taking the time

to truly diagnose possible phlegm, damp-heat, etc patterns.

We have a long tradition of 'safe' treatment on record and when people are

treated in accordance with their pattern, we are treating in the best style

that we can with the least side-effects.

Not all medicinals are safe as not all drugs are safe - when used properly

they are safer than when self-prescibed or used without prescribing by

patterns.

[Guest guest]

>Karen S Vaughan <creationsgarden

>

>I wanted to comment on two of 's comments:

>

><<It seems to me that the following possibilities have to be considered:

>1) Practitioners of Chinese medicine are over-prescribing formulas with

>too

>many ingredients at too high a dosage>>

>

>Probably not. I believe that schools today are teaching students to

>under-prescribe when dealing with raw herbs. Formulas I get from the

>Pacific College clinic are less than half the strength of those I've

>gotten in Chinatown and are less effective. And when I was in China, a

>days dosage of raw herbs was likely to fill a dinnerplate an inch

>deep.(Hospital context).

 

I wasn't referring to students in american schools. . . .I was referring to

pracititioners in Taiwan, mainland China and in Chinese communities, which

tend to use stronger formulas with more ingredients.

>

><<3) There is some toxicity in the herbal supply, similar to what was

>found

>in Chinese prepared medicines.>>

>

>Clearly there are toxic herbs which need to be used judiciously and

>pollution concerns are very real. But I think the prevalence of new

>forms of medicines are a greater problem. If I boil raw herbs, I can

>visually inspect the quality, smell, and check for substitutions, but I

>cannot do so with a powdered extract, capsule or tincture. (Substitutions

>were involved in the Belgian case and powdered extracts in Taiwan.)

>Further a powdered extract or tincture may be utilized very differently

>in the body than a decoction. I find that the Chinese Modulars tinctures

>affect me too strongly and not necesarily with the full medicinal

>intention of the formula- perhaps some constituents are overemphasized by

>the alcohol and others are lost. I am suspicious of the mechanics of

>producing powdered extracts without losing at least volatiles. And I

>know that the constituents of many herbs change when dried, altering

>effectiveness.

 

Can you document what you feel with the modulars more specifically?

>

 

>

>My background is in western herbalism and I know that standardized

>extracts, or powders rarely convey the same healing actions of

>traditionally prepared herbs. Solvents may be used to extract

>constituents, which may be directly toxic in their own right, but also

>often obtain compounds that would be missing from a decoction, methanol

>tincture or medicinal wines. Components which may be traditionally

>indigestible may become bioavailable, causing side effects. (There were

>virtually no human cases of photosensitivity with St. John's wort at

>normal antiviral, vulnurary or depression dosages until strong

>standardized extracts became available, and I've seen SJW side effects

>disappear when clients return to classical tinctures.) And encapsulated

>extracts which end up in the stomach or gut before breaking down miss the

>direct lymph stimulation in the mouth and throat and the ability to

>taste-trigger organs to send out appropriate juices or other compounds.

 

Liquid water-alcohol extracts do that as well. What you are saying seems

very speculative to me.

>

 

>Powders also break down faster than whole herbs. And it is easier to

>overdose with powders or extracts, as was mentioned.

 

I don't agree here, either. Raw formulas tend to be more difficult to

digest, and the patients have to know how to decoct properly.

 

 

 

 

>

>.

>

>

[Guest guest]

I have noticed that someone wrote " methanol tinctures " . Methanol is extremely

toxic so it should not be used to tincture.

 

There has been problems with toxic metals present in herbs and formulas; reasons

vary from contamination to grinder hammermill wear. Most practitionners of TCM

that I know have their favourite source of herbs , patent medicines and other

therapeutic agents. One can observe the successful and knowledge

practitionners.

 

Some times " toxic " metals are added to the formulas as part of the formulas.

Right or wrong ? Up to the doctor, IMO.

 

Some chinese herbs and formulas will benefit from tincturing, others not.

 

Examples;

 

Tienchi benefits from tincturing.

 

Water does not extract all the valuble components of ginseng.

 

Formulas such as po chai pills, Huanglien, Yin Chiao Chih tu pien work great as

they are available as pills so why fool around with it ?

 

Other formulas can also be tinctured: experienced therapists on this list are

working with these and dosages may vary as will the phytochemical content and

pharmacokinetics. A careful review of relevant litterature shows that some

herbs were extracted BC with distilled spirits and distilled vinegars.

 

Cheers,

 

Gilbert

[Guest guest]

Some additional thoughts on Karen's comments:

I don't think the issue is extracts vs. powders vs. decoctions so much .

.. . . .I think all these methods are there to provide variety and improve

patient compliance, be available for different situations clinically. I

use them all. . . .the main issue is quality and potency, and quality of

preparation. Like with food or clothing, there is cheap food and clothing

and quality food and clothing. Herbal medicine is the same. It is the

combination of PROPER DIAGNOSIS, and choosing medicinals accordingly, that

assures clinical efficacy and prevents iatrogenesis. And even then,

accidents can happen due to human error.

 

P.S. Really, Chinatown herbs twice as powerful as PCOM clinic? PCOM, at

last inquiry uses herbs from Andy Ellis's Spring Wind, which are top grade

medicinals.

 

Karen, I like your NY chutzpah!

 

 

 

 

 

 

 

 

 

>Karen S Vaughan <creationsgarden

>

>I wanted to comment on two of 's comments:

>

 

>

>Probably not. I believe that schools today are teaching students to

>under-prescribe when dealing with raw herbs. Formulas I get from the

>Pacific College clinic are less than half the strength of those I've

>gotten in Chinatown and are less effective. And when I was in China, a

>days dosage of raw herbs was likely to fill a dinnerplate an inch

>deep.(Hospital context).

>

[Guest guest]

I thik this was related to the Taiwan scenario and may provide some history.

David

 

 

The Herbal History of Digitalis: Lessons for Alternative Medicine

 

 

 

 

To the Editor: Popular and medical literature, such as the article by Dr.

Eisenberg and colleagues,1 on use of alternative medicine and herbal remedies

triggered memories of our student days in 1942-1945 when we were assailed by

extensive discussions of the merits of various digitalis preparations.

Methods of standardization were most important when evaluating which

preparation to prescribe. Especially treacherous were the preparations

labeled " Digitalis USP XI, " which were about twice as potent as those labeled

" Digitalis USP X. " 2

 

 

One of us (E.L.D.) who is an avid collector of old books recalled a relevant

chapter in an old edition of The Dispensatory of the United States of

America.3 It was enlightening to read the detailed description of the unique

difficulties in elucidating the various properties of the wide variety of

active compounds in the digitalis leaf. Cats, pigeons, frogs, and people were

test subjects. There were descriptions of at least 12 varieties of digitalis

plants, all having active compounds of varying qualities. There were 40

different methods of standardization of biological effects. At least 6

different biologically active chemical variations showing cardiac effects, as

well as others, were identified from the seeds. Deterioration of potency was

noted after a number of months even when the preparations were kept

hermetically sealed. The different compounds had various absorption rates

from the gastrointestinal tract and there were variations from batch to batch

depending on growing conditions.

 

 

This chapter is a compendium of the problems that beset anyone using herbal

remedies. We recommend this chapter to physicians sailing the uncharted

waters of " natural products. " The hazards and adverse effects of these

substances are unknown at present, particularly in the presence of other

medications and various diseases.

 

 

We who prescribe for patients in this day and age are truly blessed by the

availability of pure and well-standardized drugs with well-known effects,

both major and minor. The herbal remedies labeled as " dietary supplements " by

the Food and Drug Administration have unknown effects, potency, and quality

control. The risks of their use remain unclear. Any reader wishing a copy of

the chapter referenced may contact the authors. Old textbooks can be a

valuable source of information. Their lessons should be preserved.

 

 

 

 

 

George Ritter, MD

 

Providence Hospital

 

Southfield, Mich

 

 

Eugene L. Dembicki, RPh

 

Henry Ford Fairlane Medical Center

 

Dearborn, Mich

 

 

 

 

 

 

 

1. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine

use in the United States, 1990-1997: results of a follow-up national survey.

JAMA. 1998;280:1569-1575 MEDLINE

 

 

2. Fahr G. The treatment of cardiac irregularities. JAMA. 1938;111:2268-2270.

 

 

3. Osol A, ed, Farrar GE, ed. The Dispensatory of the United States of

America. 25th ed. Philadelphia, Pa: JB Lippincott; 1955:444-460.

 

 

 

 

 

 

In Reply: We agree with Dr Ritter and Mr Dembicki and thank them for

reminding us that experiences with digitalis provide an important precedent

for evaluating the current resurgence of interest in botanical medicine.

Digitalis, one of the most effective drugs ever developed from a plant,

underscores the difficulty of evaluating herbal products.

 

 

Indeed, many currently popular " natural products " 1, 2 have similar problems.

These include: (1) little data concerning adverse effects and drug-herb

interaction; (2) little or no evidence of efficacy; (3) inadequate scientific

assessment of active chemical constituents and insufficient information

concerning optimal preparation and dosages; (4) lack of consistency in

chemical compositions between different manufacturers or between different

batches of the same manufacturer; (5) chaotic or commercially determined

forms of standardization; (6) contradictory and difficult to interpret

traditional claims; and (7) poor monitoring for deterioration of potency,

contamination, and adulteration. All these problems need to be addressed by

increased research efforts, improved government regulation, and postmarketing

vigilance.

 

 

We also want to point out that there may be other modern parallels to the

digitalis story. William Withering (1741-1799) first learned the value of

foxglove from an old woman in Shropshire, " who had sometimes made cures after

the more regular practitioners had failed. . . . This medicine was composed

of twenty or more different herbs; but it was not very difficult . . . to

perceive that the active herb could be no other than the foxglove. " 3 Foxglove

was generally not used by trained or lay herbalists because it was considered

toxic and dangerous.4, 5 The use of such a potent substance, without the

refinement of modern disease classification and precise quantitative

pharmaceutical standardizations, undoubtedly would have caused considerable

toxicity. Withering knew that the other 19 or so herbs in the mixture were

relatively inert.

 

 

The solution is not as clear with many of the herbs sold on the modern US

market, as it is doubtful that many have the therapeutic potency or the

toxicity profile of foxglove. In fact, popular herbalism (with its slogan of

" botanicals are safer " ) has abandoned most of the obvious pharmacologically

active herbs (such as belladonna, ergot, and colchicum) to the pharmaceutical

industry, since their therapeutic window is so narrow and misuse can be

deadly. We feel that the most pressing problem with contemporary botanicals

is their potential for drug-herb interaction.6 At this point, however, we

must acknowledge that this assessment is conjectural and must be subjected to

prospective surveillance and scientific inquiry.

 

 

We share the authors' concerns regarding the preservation and appreciation of

old medical texts. It would be marvelous to have the original accounts of

foxglove serve as required reading for today's physicians, nurses, and

pharmacists.

 

 

 

 

 

David M. Eisenberg, MD

 

Ted J. Kaptchuk, OMD

 

Beth Israel Deaconess Medical Center

 

Boston, Mass

 

 

 

 

 

 

 

1. Huxtable RJ. The myth of beneficent nature: the risks of herbal

preparations. Ann Intern Med. 1992;117:165-166. MEDLINE

 

 

2. Winslow LC, Kroll DJ. Herbs as medicines. Arch Intern Med.

1998;158:2192-2199. MEDLINE

 

 

3. Aronson JK. An Account of the Foxglove and Its Medical Uses, 1785-1985,

Including a FacsimiIe of the Original Monograph. London, England: Oxford

University Press; 1985.

 

 

4. Estes JW, White PD. William Withering and the purple foxglove. Scientific

American. 1965;212:110-119.

 

 

5. Groves MJ, Bisset NG. A note on the use of topical digitalis prior to

William Withering. J Ethnopharm. 1991;35:99-103.

 

 

6. Miller LG. Herbal medicinals: selected clinical considerations focusing on

known or potential drug-herb interactions. Arch Intern Med.

1998;158:2200-2211. MEDLINE

 

------------------