Medical Herbalism: Clinical Articles and Case Studies    

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Cardiovascular system case studies

by Christopher Hedley, M.N.I.M.H.

Medical Herbalism 07-31-95 9(2/3): 3

The following case studies are not a blueprint for practice. They are given as examples of the general principles of modern British practice and as a basis for the discussion of herbal treatments and strategies. All patients are individuals and they provided me with far more information than the bare bones given here.

Case 1

“Heart Problems”

Patient

Female, 56 years old, a teacher. Presented with, “a heart condition”. Murmurs. Episodes of tachycardia especially at night. Worse under stress. Breathless on exercise. Has collapsed when running. Feels the cold easily. Has adverse reactions to orthodox medication.

Medical History

Cardiac arrest when under anaesthesia 15 years ago. Rheumatic fever at 16, valves tested OK at the time. ‘Angina* as a child which cleared up on stopping milk. Father died of heart attack at 48. EGG unclear. Hospital thinks ‘possibly a structural defect*.

Severe viral meningitis at 33 and viral encephalitis at 36. Since then prone to episodes of chronic fatigue.

Pituitary hypofunction diagnosed at 21, treated successfully but night sweats ever since.

Osteoarthritis in hands and hips for some 10 years. Was a dancer. Irritable Bowel Syndrome off and on, which responds to peppermint oil capsules.

Diet and Lifestyle

Good. Lots of organic vegetables. Fish or meat twice weekly. Regular exercise and rest.

Herbs

Tincture

Hawthorn berries (Crataegus oxycantoides)     25 ml
 
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    Medical Herbalism: Clinical Articles and Case Studies

Linden (Tilia europea) flowers            25 ml

Vervain (Verbena officinalis) herb    20 m1,

Echinacea (E. angustifolia) root        10 ml

Prickly ash (Zanthoxylum spp) bark    10 ml

Horsetail (Equisetum arvense)        10 ml.

Sig 5ml tds.

Linden flower is my herb of choice for circulatory problems associated with stress. Vervain is used as a general tonic and the horsetail for bone problems. There is not actually enough horsetail in this prescription to be helpful. I referred her to a shiatsu practitioner for her joint problems, which was effective.

Tincture

Lily of the Valley (Convallaria majalis)     20 ml

Rescue Remedy (Bach Flower)            4gtt.

Sig 5 gtt prn

This remedy is for the attacks of tachycardia. Lily of the Valley is probably the most popular cardiac glycoside- containing remedy used in the UK. It acts quickly, improving heart efficiency and slowing tachycardia.

Progress

Both remedies were effective. Treatment is ongoing, since there is a lot of tidying up to do. This lady is very plucky and a joy to treat but tends to go at life full on. During the course of treatment she changed to a less stressful job.

Comments

It is well worth giving an extra remedy for relief from tachycardia. I tend to use Lily of the Valley based drops or Valerian (Valeriana spp) and Hawthorn, according to indications.

Case Study 2

Angina in Elder

Woman 82. Basically fit and vital. Irish country bred. Angina more or less controlled by her medication. She came because she was breathless on exertion and had trouble getting up the hill going home. BP 180/85. Seems a touch anemic. Otherwise healthy although stressed by noisy neighbors.
 
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Medication

Isosorbide trinitrate slow release bds.; Glycerol trinitrate, sublingually pm; Atenolol, a beta blocker, 50mg daily, of which she was only taking half; Coamilozide, a potassium-sparing diuretic. Slow release Aminophylline, a theophylline-based bronchodilator.

Herbs

Tincture

Hawthorn berry tincture.

Sig 5m1 tds.

Also ‘Floredix* a propriety Swiss Iron tonic.

 Sig 10 ml bds.

Progress

This worked for six months. She was able to get around more easily. Then: giddiness, tinnitis, flushing in the face, Raynaud*s and eczema. All set off by renewed neighbor aggravation. Later compounded by botched bunion operation. This situation went on for some 7 years. She would come back from time to time, I think mainly to share her worries.

Comments

This case illustrates the main problem with treating heart conditions when orthodox medication is already prescribed. Many of the symptoms were side effects of the drugs she was taking. In such cases herbs can only be used for supportive treatment but it is difficult to get people to take them for long enough to make a significant difference since the drugs are relieving their symptoms. It is possible to wean patients off heart medication but very difficult by the time they have built up to several drugs. In such cases careful analysis of the medication is required, at the very least because it will give clues to the medical history. Elderly people have usually been trained to leave their health management up to their doctors and often have only the haziest idea of their medical history. Analysis of their medication is often the only way we have of determining previous diagnoses, although I never got to the bottom of why she was prescribed a bronchodilator.
 
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Case Study 3

Poor circulation

Patient

Female, 28 years old. A teacher. Presented with “poor circulation” and chronic constipation. Very cold hands and feet, prone to chilblains, postural hypotension. Gets hot and cold attacks. Occasional attacks of dizziness. Seemed depressed under a business-like exterior.

Medical History

Prone to tension headaches, migraines, and stress insomnia. Menstrual cycle erratic. Pre-menstrual depression and tiredness. Was on the contraceptive pill which caused spotting. Vaginal thrush on and off. It later transpired that she was in an unhappy marriage and worked late hours at school as a distraction.

Diet

Composition OK, but undereats and eats too many sweets.

Herbs

Tincture

Hawthorn berries    20 ml

Yarrow (Achillea millefolium)        20 ml

Yellow dock (Rumex crispus) root    20 ml

Feverfew (Tanacetum parthenium)    10 ml

Chasteberry (Vitex agnus-castus)    10 ml

Chinese Angelica (Angelica sinensis)    10 ml

Rose flowers (Rosa spp.)         10 ml.

Sig 5m1 tds.

Infused oil of Cayenne, Ginger and Mustard for application to (unbroken) chilblains.

Bach Flower remedy: This changes over time.

Progress

Marked improvement over 4 months. I changed the dock and angelica for rhubarb(Rheum spp) and prickly ash bark (Zanthoxylum spp.) after two months. Family aggravation at Christmas brought her relationship issues to a head. I taught her a basic co-counselling technique, ie. listening to each other, and this eased the stress greatly. Which, in turn, lifted her depression.
 
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Comments

It is always worth adding a remedy which works out from the heart, such as Hawthorn or Rosemary, when working with very poor circulation. But the original formula wasn*t warm enough, relying too much on the ‘cool* vasodilators Hawthorn and Yarrow.

Case Study 4

Leg aches in elderly male

Man 75, still working part-time as a teacher of photography. Presented with leg pains, initially on exercise but now all the time. Stopping him from doing the things he enjoys. Generally fit. Was playing golf twice weekly. A hot constitution. Smokes 12 cigarettes a day. All hospital tests negative. Mild varicosities. Tired. Chronic, mild constipation – taking senna tablets regularly.

Medical History

Prostatic hyperplasia. Operation 20 years ago, repeated 6 months ago. No symptoms at present. History of acid indigestion.

Diet

Goodish. Avoids milk products. Lots of home grown vegetables. 3 glasses of wine daily.

Herbs

Tincture

Hawthorn (Crataegus oxycantoides)            20 ml

Yarrow (Achillea millefolium)                20 ml

Sage (Salvia off)                        20 ml

Rhubarb (Rheum spp.)                    10 ml

Horse Chestnut (Aesculus hippocastanum)        10 ml

Melilot (Melilotus off.)                    10 ml

Siberean Ginseng (Eleutherococcus senticosus)        10 ml.

Sig 5mi tds.
 
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This prescription works on the whole circulatory system. Starting with the hawthorn for heart and arteries, rhubarb for liver, yarrow for veins and small blood vessels. Horse Chestnut and Melilot is a popular combination in Europe for treating symptoms arising from varicose veins. The Sage and Siberean Ginseng are put in as general tonics. (“If you have sage in your garden you may live to be 105").

Progress

A marked improvement over three months and he never gave up smoking! It is one of the pleasures of this work to make dramatic improvements in people*s quality of life with such simple measures.

Comments

The hospital had told him that he had nothing wrong with his circulation and they didn*t know why his legs hurt. But non- specific leg pains must have a circulatory component. Working on improving all aspects of his circulation did the trick. ‘Cool* vasodilators were used here since the patient was constitutionally warm.

Most elderly people will have circulatory problems of some sort. Some herbalists add Capsicum to prescriptions for elderly people as a matter of course. This is not my habit but I find small doses of Lily of the Valley will benefit most elderly patients.

Case #5

Circulatory problems

Male, 54 years old. Pipe fitter and welder. “Would like something for my circulation”.

Medical History

Heart attack 3 years ago. Broken pelvis followed by thrombosis 10 years ago. Leg still swells from time to time. A few minor varicosities. Various accidents, left with various aches and pains. Pains in the chest — hospital says from shoulder damage. ECG, angiogram and cholesterol tests all OK.

Lifestyle

Diet good, lacto-vegetarian. Fit, regular yoga and weight training.

Herbs

Tincture

Hawthorn berries (Crataegus oxycantoides)     30 m1

Yarrow (Achillea millefolium)             25 ml
 
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Horse Chestnut (Aesculus hippocastanum)    15 ml

Melilot (Melilotus off.)                15 ml

Lily of the Valley (Convallaria majalis)        15 ml.

Sig 5 mI tds.

Progress

He took the herbs for 3 months, gradually reducing the dose. 2 months later he rang up to say that he had developed angina and been in hospital for an angioplasty, which hadn*t worked. He went back on the prescription, which he kept up for 7 months. He was doing well when last heard of.

Comments

There didn*t seem to be anything really wrong with him but he is a healer and taking psychic development classes. He said that he felt that ‘his circulation could do with some herbs*. I have learned not to ignore such signs and he turned out to be accurate in his assessment. He said that taking the medicine ‘helped with his psychic development* but he stopped taking it when he quit the classes. Two months later he came down with the angina. There is a lesson in this.

Case History 6

Mild Stroke

Male, 55 years old. Taxi driver. Mild stroke, recovered well except for feeling tired. BP 122/82.

I had treated this man for some years for a variety of complaints. He tends to get very tense, which is disguised by his ability to relax very quickly and easily. His BP has varied from 90/60 to 130/98. It has never been consistently high, although it has tended to creep up over the last few years, since he started his present job.

The stroke came after a day driving around worrying about the coming election. He was frightened that the conservative party would get back in despite all the indications to the contrary. It started with wavy vision followed by confusion and loss of speech. He never lost consciousness and his BP, taken afterwards, was normal.

Lifestyle

Diet excellent, was greatly improved some years ago by attending Italian cookery classes. Doesn*t exercise despite being constantly encouraged to by me and nagged to by his family.
 
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Herbs

Tincture

Ginkgo (Ginkgo biloba)                25 ml

Skullcap (Scutellaria lat