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
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.
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. Case Study 3 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.
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.
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 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
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.
Herbs Tincture Ginkgo (Ginkgo biloba) 25 ml Skullcap (Scutellaria lateriflora) 25 ml St. Johnswort (Hypericum perfoliatum) 25m1 Self Heal (Prunella vulgaris) 12.5 ml Wild Oat straw (Avena fatua) 12.5m1. Sig 5m1 tds. This was a tonic to hold him over until the hospital had finished its tests. Progress Hospital tests were non-conclusive. My assessment is that the stroke was caused by transient very high blood pressure brought on by compound stress. He was advised to start taking his stress levels very seriously and to take herbal medication for hypertension until he retires. He promised to take up regular exercise and yoga. Tincture Valerian (Valeriana off.) 25 ml Hawthorn berries (Crataegus oxycantoides) 25 ml Yarrow (Achillea millefolium) 25 ml Linden flowers (Tilia europea) 25m1. Sig 10 ml bid. He didn*t keep this up but did start taking herbal relaxing pills based on Valerian and Skullcap on a regular basis. 6 months later he was still well. Heart Medicines in the European Tradition Christopher Hedley M.N.I.M.H. In
European traditional medicine, the heart was
considered to store the vital
spirit and circulate it around the body via the
arteries. Thus ‘heart*
medicines were usually medicines for the spirit —
for depression and confusion.
Lemon Balm (Melissa off.), for example was
the major heart medicine
in the European tradition. Lily of the Valley (Convallaria
majalis),
which is regarded as a heart herb in modem terms,
was regarded as a ‘head*
herb and used to treat confusion, spirit
disorders, and mental dullness.
Motherwort (Leonurus cardiaca) was used to
treat the syndrome “melancholic
vapors affect the heart.” This is heaviness of
heart, both emotionally
and physically. The main physical symptom is an
irregular heart beat, for
which the herb is still used.
Remedies were also used to protect the heart from excess heat in high fevers. Borage (Borago off.) was much favored for this. Motherwort and borage is a useful combination in thyrotoxicosis, which is a modem version of ‘excess heat attacks the heart*. Rose flowers (any aromatic Rose) were, and are still, much used for the emotional aspects of heart, they are particularly good for people who feel unloved or who have been abused. Regular use of rose tincture alters the whole feeling of the body. Cordials, in the European tradition, are medicines that benefit the heart. They were usually sweet and warming to taste and often made of a combination of syrups and tinctures. Rose cordials are an excellent example. To conclude this commentary, I would like to quote Culpeper: “Regard the heart, keep that upon the wheels, because the sun is the foundation of life, and therefore those universal remedies Aurum Potabile cure all diseases by fortifying the heart” |
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