Guest guest Posted September 7, 2003 Report Share Posted September 7, 2003 I have been reading the posts to this list for several months now, without an introduction to the group, and this is the first time I have responded. These recent postings on herbs are greatly appreciated! As an introduction, before entering the AOM field, I was a direct-entry midwife. I came to midwifery with a background in Western Herbalism, and was of the three founders of Equinox Botanicals. I graduated from the Colorado School of Traditional , completed the Blue Poppy OB-Gyn Certificate course, and now am the Campus Director of Southwest Acupuncture College in Boulder where I also teach a few courses. I wanted to respond to this posting on goldenseal, in particular, to the cautions about prescribing it to pregnant or nursing mothers. These precautions are repeated for the Chinese herbs that also contain berberine, Huang qin (Radix Scutellariae Baicalensis) and Huang lian (Rhizoma Coptidis), and Huang bai (Cortex Phellodendri) I have not seen in print in the AOM field much about the reasons behind this beyond the usual cautions about the cold nature of these herbs and the possibility of damage to the spleen. There are some sources in the direct-entry midwife world that report that goldenseal may induce uterine contractions, and the same is repeated in Bensky concerning research on berberine. Dosages are not specified. I know of no anecdotal evidence that any of these plants produce uterine contractions, nor any personal experience along those lines. I have used small amounts (usually 4 gr for a two-day bao) of huang lian for the appropriate patterns in formulas for the treatment of morning sickness or hyperemesis gravidarum with no side effects. Perhaps others on this list can address the uterine contractility precaution. I want to outline a bit more info on the precaution about the use of berberine-containing herbs in later pregnancy and in nursing mothers. I have less practical experience in this area, as the patterns that may appear in the later months of pregnancy, in the neonate, or the nursing mother IMO are better treated with other kinds of medicinals. Specifically clearing heat by nourishing yin, phlegm-heat reducers such as zhu ru (Caulis Bambusae In Taeniis), wind-heat herbs, or any of our many other choices that do not contain berberine. Western Herbalist Michael Moore's website contains pages and pages of abstracts on western, and some Chinese herbs. He posts several studies that discuss the clinical studies that show that berberine interferes with the blood-brain barrier in neonates and can contribute to brain damage due to jaundice (a disease state called kernicteris). You can find these at www.swsbm.com/Abstracts/coptis-AB.txt. Throughout the 70s and 80s, newborns were often subjected to hospital isolation, repeated heel sticks, cessation of nursing, phototherapy, and even blood transfusions to prevent the development of kernicteris when what they had was normal physiologic jaundice. It became apparent that while the disease of kernicteris was deadly serious, not all the mechanisms were known. What is known is this. In the fetus, due to placental circulation, the blood is only about 50% oxygenated, and the HCT of a newborn is 43-61%. With the circulatory changes at birth, the neonate no longer needs such a high concentration of red blood cells, and they are metabolized. Part of the break down of these red blood cells is the production of a fat soluble pigment, bilirubin. These increased levels of bilirubin will cause neonates to become jaundiced. The neonate must convert this fat soluble pigment into a water soluble pigment in order to excrete it from the intestinal tract. The short story is that this conversion happens in the liver and involves binding of these pigments to serum albumin and other proteins. It was discovered in premature infants, infants with anoxia at birth, infants with blood incompatibilities or other metabolic disorders that high levels of unbound bilirubin (bilirubin not bound to albumin) cross the " blood-brain barrier " and damage brain cells to the point of causing serious neurologic damage or even death. It is apparent that normal physiologic jaundice (in the first week after birth) or in some infants, breastmilk jaundice (a reaction to the presence of some fatty acids in some mother's milk in the first 1-2 weeks of life) do not have serious neurologic effect, as long as those infants are well nourished (plenty of calories and proteins from adequate breastmilk), are born at term, have not experienced anoxia at birth, do not have a blood incompatibility or other metabolic disorder. Or - if they are not exposed to berberine prenatally or in mother's milk. Moore's website posts two studies in China that concluded that exposure to berberine (for a week) does interfere with the binding of bilirubin to albumin and does increase the possibility that the resultant higher levels of unbound bilirubin will cross the blood-brain barrier. It is for this reason, along with the the more standard ones, that berberine-containing Chinese herbs should be not used in pregnant women and nursing mothers. This research sited on Moore's website used the administration of berberine alone. While noted increased levels of jaundice in newborns in a region of China where huang lian was apparently a popular tea to administer to newborns somehow led to the research, the research did not specify that any higher incidence of neurologic problems also occurred. I do not know of any research about berberine-levels from the use of these herbs in formulas, but perhaps others here do. My intuitive perspective on whether the use of these medicinals in the context of a formula will mitigate the effects of berberine alone is that berberine is such a strong active component that no accompanying medicinals will nullify its possible deleterious effect in the neonate. The studies showed that the effect of displacing bilirubin from serum protein took several days of exposure to berberine. I don't know how long it would take to clear a pregnant women's system, once administered. I stated earlier that I have used small doses of huang lian before 16-17 weeks of pregnancy, when the pattern clearly indicated its use. I would urge Chinese Herbalists to not use such medicinals, and to counsel their patients to avoid goldenseal as well after 16 weeks, as a reasonable precaution. Even when used, it should be with confidence in the pattern diagnosis and at low doses for short periods of time. Valerie Hobbs, L.Ac. Dipl. Ac., Dipl CH _______________ Send and receive larger attachments with Hotmail Extra Storage. http://join.msn.com/?PAGE=features/es Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 7, 2003 Report Share Posted September 7, 2003 At 7:12 AM +0000 9/7/03, VALERIE HOBBS wrote: >I wanted to respond to this posting on goldenseal, in particular, to the >cautions about prescribing it to pregnant or nursing mothers. These >precautions are repeated for the Chinese herbs that also contain berberine, >Huang qin (Radix Scutellariae Baicalensis) and Huang lian (Rhizoma >Coptidis), and Huang bai (Cortex Phellodendri) -- Valerie, Thank you for your excellent post on berberine. My only quibble is that I cannot find a reference to support the statement that huang qin contains berberine (whereas huang lian & huang bai do). If it does not, I believe this supports the traditional use of huang qin to calm the fetus. Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 7, 2003 Report Share Posted September 7, 2003 I've carried that misconception a long time. Thanks for clarifying. V - Rory Kerr Sunday, September 07, 2003 11:27 AM Re: Berberine At 7:12 AM +0000 9/7/03, VALERIE HOBBS wrote: >I wanted to respond to this posting on goldenseal, in particular, to the >cautions about prescribing it to pregnant or nursing mothers. These >precautions are repeated for the Chinese herbs that also contain berberine, >Huang qin (Radix Scutellariae Baicalensis) and Huang lian (Rhizoma >Coptidis), and Huang bai (Cortex Phellodendri) -- Valerie, Thank you for your excellent post on berberine. My only quibble is that I cannot find a reference to support the statement that huang qin contains berberine (whereas huang lian & huang bai do). If it does not, I believe this supports the traditional use of huang qin to calm the fetus. Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 7, 2003 Report Share Posted September 7, 2003 Dear Valerie, Thank you for all that interesting information on berberine. A question: would the possible harm to the infant be ONLY during that period of time when the baby is affected by jaundice (say, the first week of life)? Then later, say at 3 weeks or 3 months, if indicated, could you give the baby berberine-containing formulas? Julie Chambers, L.Ac. 735 Navy Street Santa Monica, CA 90405 (310) 452-0441 www.juliechamberslac.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 7, 2003 Report Share Posted September 7, 2003 On Sunday, September 7, 2003, at 12:12 AM, VALERIE HOBBS wrote: Valerie, I also appreciate your posting very much. I studied with Michael Moore in the 70's, trekking and picking herbs as well as classroom work. His website is excellent, lots of no longer extant textbooks from the Eclectics are among the 'pickings'. Golden Seal is another one of those herbs that has been abused by 'if a little is good, more is better', and 'cures everything' mentality. So your warnings are well taken. I would point out though, that since Chinese prescriptions are designed to treat specific patterns with combinations of medicinals, that the dangers of berberine toxicity are greatly reduced. We just need to be cautious in pregnancy, and make sure our pattern differentiation is accurate. > I have been reading the posts to this list for several months now, > without > an introduction to the group, and this is the first time I have > responded. > These recent postings on herbs are greatly appreciated! > > As an introduction, before entering the AOM field, I was a direct-entry > midwife. I came to midwifery with a background in Western Herbalism, > and was > of the three founders of Equinox Botanicals. I graduated from the > Colorado > School of Traditional , completed the Blue Poppy OB-Gyn > Certificate course, and now am the Campus Director of Southwest > Acupuncture > College in Boulder where I also teach a few courses. > > I wanted to respond to this posting on goldenseal, in particular, to > the > cautions about prescribing it to pregnant or nursing mothers. These > precautions are repeated for the Chinese herbs that also contain > berberine, > Huang qin (Radix Scutellariae Baicalensis) and Huang lian (Rhizoma > Coptidis), and Huang bai (Cortex Phellodendri) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 7, 2003 Report Share Posted September 7, 2003 Physiologic jaundice clears in the first week, and breastmilk jaundice in the first three. Neonatal liver and bowel function completes its shift by about the third week as well. There would be little likelihood of a problem after this time. To be conservative, I think after 6 weeks of age would be a very safe margin. Valerie >Julie Chambers <info > > >Re: Berberine >Sun, 07 Sep 2003 12:14:37 -0600 > >Dear Valerie, > >Thank you for all that interesting information on berberine. A question: >would the possible harm to the infant be ONLY during that period of time >when the baby is affected by jaundice (say, the first week of life)? Then >later, say at 3 weeks or 3 months, if indicated, could you give the baby >berberine-containing formulas? > > > > >Julie Chambers, L.Ac. >735 Navy Street >Santa Monica, CA 90405 >(310) 452-0441 >www.juliechamberslac.com > > > > >Chinese Herbal Medicine, a voluntary organization of licensed healthcare >practitioners, matriculated students and postgraduate academics >specializing in Chinese Herbal Medicine, provides a variety of professional >services, including board approved online continuing education. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 8, 2003 Report Share Posted September 8, 2003 Valerie - THANK YOU! This is great information. Unfortunately, it is not just duirng the 70 - 80's that neonates were subjected to the type of treatment that you describe below. MY daughter, born in 2000 ( born at 36 weeks with a midwife birth in a hospital) ended up in the NICU because she aspirated some milk at her first feeding. I insisted on continuing to breastfeed. She developed jaundice and we remained in the NICU for 9 days with daily needle sticks, intense pressure to discontinue breastfeeding and phototherapy - as well as threats that I was killing my daughter and that they would have to transfure her. It was horrible and had I not had some knowledge about breastmilk jaundice and the common occurences of neonatal jaundice I don't know what I would have done. This is great info and I really appreciate it. Marnae >Throughout the 70s and 80s, newborns were often subjected to hospital >isolation, repeated heel sticks, cessation of nursing, phototherapy, and >even blood transfusions to prevent the development of kernicteris when what >they had was normal physiologic jaundice. It became apparent that while the >disease of kernicteris was deadly serious, not all the mechanisms were >known. > >What is known is this. In the fetus, due to placental circulation, the blood >is only about 50% oxygenated, and the HCT of a newborn is 43-61%. With the >circulatory changes at birth, the neonate no longer needs such a high >concentration of red blood cells, and they are metabolized. Part of the >break down of these red blood cells is the production of a fat soluble >pigment, bilirubin. These increased levels of bilirubin will cause neonates >to become jaundiced. The neonate must convert this fat soluble pigment into >a water soluble pigment in order to excrete it from the intestinal tract. >The short story is that this conversion happens in the liver and involves >binding of these pigments to serum albumin and other proteins. > >It was discovered in premature infants, infants with anoxia at birth, >infants with blood incompatibilities or other metabolic disorders that high >levels of unbound bilirubin (bilirubin not bound to albumin) cross the > " blood-brain barrier " and damage brain cells to the point of causing serious >neurologic damage or even death. > >It is apparent that normal physiologic jaundice (in the first week after >birth) or in some infants, breastmilk jaundice (a reaction to the presence >of some fatty acids in some mother's milk in the first 1-2 weeks of life) do >not have serious neurologic effect, as long as those infants are well >nourished (plenty of calories and proteins from adequate breastmilk), are >born at term, have not experienced anoxia at birth, do not have a blood >incompatibility or other metabolic disorder. > >Or - if they are not exposed to berberine prenatally or in mother's milk. > >Moore's website posts two studies in China that concluded that exposure to >berberine (for a week) does interfere with the binding of bilirubin to >albumin and does increase the possibility that the resultant higher levels >of unbound bilirubin will cross the blood-brain barrier. It is for this >reason, along with the the more standard ones, that berberine-containing >Chinese herbs should be not used in pregnant women and nursing mothers. > >This research sited on Moore's website used the administration of berberine >alone. While noted increased levels of jaundice in newborns in a region of >China where huang lian was apparently a popular tea to administer to >newborns somehow led to the research, the research did not specify that any >higher incidence of neurologic problems also occurred. I do not know of any >research about berberine-levels from the use of these herbs in formulas, but >perhaps others here do. My intuitive perspective on whether the use of these >medicinals in the context of a formula will mitigate the effects of >berberine alone is that berberine is such a strong active component that no >accompanying medicinals will nullify its possible deleterious effect in the >neonate. > >The studies showed that the effect of displacing bilirubin from serum >protein took several days of exposure to berberine. I don't know how long it >would take to clear a pregnant women's system, once administered. I stated >earlier that I have used small doses of huang lian before 16-17 weeks of >pregnancy, when the pattern clearly indicated its use. I would urge Chinese >Herbalists to not use such medicinals, and to counsel their patients to >avoid goldenseal as well after 16 weeks, as a reasonable precaution. Even >when used, it should be with confidence in the pattern diagnosis and at low >doses for short periods of time. > >Valerie Hobbs, L.Ac. >Dipl. Ac., Dipl CH > >_______________ >Send and receive larger attachments with Hotmail Extra Storage. >http://join.msn.com/?PAGE=features/es > > > > >Chinese Herbal Medicine, a voluntary organization of licensed healthcare >practitioners, matriculated students and postgraduate academics >specializing in Chinese Herbal Medicine, provides a variety of >professional services, including board approved online continuing education. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 8, 2003 Report Share Posted September 8, 2003 Valerie - THANK YOU! This is great information. Unfortunately, it is not just durng the 70 - 80's that neonates were subjected to the type of treatment that you describe below. MY daughter, born in 2000 ( born at 36 weeks with a midwife birth in a hospital) ended up in the NICU because she aspirated some milk at her first feeding. I insisted on continuing to breastfeed. She developed jaundice and we remained in the NICU for 9 days with daily needle sticks, intense pressure to discontinue breastfeeding and phototherapy - as well as threats that I was killing my daughter and that they would have to transfuse her. It was horrible and had I not had some knowledge about breastmilk jaundice and the common occurences of neonatal jaundice I don't know what I would have done. This is great info and I really appreciate it. Marnae At 07:12 AM 9/7/2003 +0000, you wrote: >I have been reading the posts to this list for several months now, without >an introduction to the group, and this is the first time I have responded. >These recent postings on herbs are greatly appreciated! > >As an introduction, before entering the AOM field, I was a direct-entry >midwife. I came to midwifery with a background in Western Herbalism, and was >of the three founders of Equinox Botanicals. I graduated from the Colorado >School of Traditional , completed the Blue Poppy OB-Gyn >Certificate course, and now am the Campus Director of Southwest Acupuncture >College in Boulder where I also teach a few courses. > >I wanted to respond to this posting on goldenseal, in particular, to the >cautions about prescribing it to pregnant or nursing mothers. These >precautions are repeated for the Chinese herbs that also contain berberine, >Huang qin (Radix Scutellariae Baicalensis) and Huang lian (Rhizoma >Coptidis), and Huang bai (Cortex Phellodendri) I have not seen in print in >the AOM field much about the reasons behind this beyond the usual cautions >about the cold nature of these herbs and the possibility of damage to the >spleen. > >There are some sources in the direct-entry midwife world that report that >goldenseal may induce uterine contractions, and the same is repeated in >Bensky concerning research on berberine. Dosages are not specified. I know >of no anecdotal evidence that any of these plants produce uterine >contractions, nor any personal experience along those lines. I have used >small amounts (usually 4 gr for a two-day bao) of huang lian for the >appropriate patterns in formulas for the treatment of morning sickness or >hyperemesis gravidarum with no side effects. Perhaps others on this list can >address the uterine contractility precaution. > >I want to outline a bit more info on the precaution about the use of >berberine-containing herbs in later pregnancy and in nursing mothers. I have >less practical experience in this area, as the patterns that may appear in >the later months of pregnancy, in the neonate, or the nursing mother IMO are >better treated with other kinds of medicinals. Specifically clearing heat by >nourishing yin, phlegm-heat reducers such as zhu ru (Caulis Bambusae In >Taeniis), wind-heat herbs, or any of our many other choices that do not >contain berberine. > >Western Herbalist Michael Moore's website contains pages and pages of >abstracts on western, and some Chinese herbs. He posts several studies that >discuss the clinical studies that show that berberine interferes with the >blood-brain barrier in neonates and can contribute to brain damage due to >jaundice (a disease state called kernicteris). You can find these at >www.swsbm.com/Abstracts/coptis-AB.txt. > >Throughout the 70s and 80s, newborns were often subjected to hospital >isolation, repeated heel sticks, cessation of nursing, phototherapy, and >even blood transfusions to prevent the development of kernicteris when what >they had was normal physiologic jaundice. It became apparent that while the >disease of kernicteris was deadly serious, not all the mechanisms were >known. > >What is known is this. In the fetus, due to placental circulation, the blood >is only about 50% oxygenated, and the HCT of a newborn is 43-61%. With the >circulatory changes at birth, the neonate no longer needs such a high >concentration of red blood cells, and they are metabolized. Part of the >break down of these red blood cells is the production of a fat soluble >pigment, bilirubin. These increased levels of bilirubin will cause neonates >to become jaundiced. The neonate must convert this fat soluble pigment into >a water soluble pigment in order to excrete it from the intestinal tract. >The short story is that this conversion happens in the liver and involves >binding of these pigments to serum albumin and other proteins. > >It was discovered in premature infants, infants with anoxia at birth, >infants with blood incompatibilities or other metabolic disorders that high >levels of unbound bilirubin (bilirubin not bound to albumin) cross the > " blood-brain barrier " and damage brain cells to the point of causing serious >neurologic damage or even death. > >It is apparent that normal physiologic jaundice (in the first week after >birth) or in some infants, breastmilk jaundice (a reaction to the presence >of some fatty acids in some mother's milk in the first 1-2 weeks of life) do >not have serious neurologic effect, as long as those infants are well >nourished (plenty of calories and proteins from adequate breastmilk), are >born at term, have not experienced anoxia at birth, do not have a blood >incompatibility or other metabolic disorder. > >Or - if they are not exposed to berberine prenatally or in mother's milk. > >Moore's website posts two studies in China that concluded that exposure to >berberine (for a week) does interfere with the binding of bilirubin to >albumin and does increase the possibility that the resultant higher levels >of unbound bilirubin will cross the blood-brain barrier. It is for this >reason, along with the the more standard ones, that berberine-containing >Chinese herbs should be not used in pregnant women and nursing mothers. > >This research sited on Moore's website used the administration of berberine >alone. While noted increased levels of jaundice in newborns in a region of >China where huang lian was apparently a popular tea to administer to >newborns somehow led to the research, the research did not specify that any >higher incidence of neurologic problems also occurred. I do not know of any >research about berberine-levels from the use of these herbs in formulas, but >perhaps others here do. My intuitive perspective on whether the use of these >medicinals in the context of a formula will mitigate the effects of >berberine alone is that berberine is such a strong active component that no >accompanying medicinals will nullify its possible deleterious effect in the >neonate. > >The studies showed that the effect of displacing bilirubin from serum >protein took several days of exposure to berberine. I don't know how long it >would take to clear a pregnant women's system, once administered. I stated >earlier that I have used small doses of huang lian before 16-17 weeks of >pregnancy, when the pattern clearly indicated its use. I would urge Chinese >Herbalists to not use such medicinals, and to counsel their patients to >avoid goldenseal as well after 16 weeks, as a reasonable precaution. Even >when used, it should be with confidence in the pattern diagnosis and at low >doses for short periods of time. > >Valerie Hobbs, L.Ac. >Dipl. Ac., Dipl CH > >_______________ >Send and receive larger attachments with Hotmail Extra Storage. >http://join.msn.com/?PAGE=features/es > > > > >Chinese Herbal Medicine, a voluntary organization of licensed healthcare >practitioners, matriculated students and postgraduate academics >specializing in Chinese Herbal Medicine, provides a variety of >professional services, including board approved online continuing education. > > > > Quote Link to comment Share on other sites More sharing options...
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