Male - Finesse in herbal prescribing

Cabrera, Chanchal

Medical Herbalism 10-31-96 8(3): 1, 5-11

About one-third of my clinical practice now comprises cases of fibromyalgia. The rest present with conditions such as acne, ulcers, PMS, menopause, arthritis and a host of other common complaints. These are all usually treated successfully by the simple application of sound dietary principles and the use of nourishing, cleansing, balancing, and tonifying herbs appropriate to the affected part. A few cases, however, are so complex and baffling that it takes a very careful analysis to determine the most effective treatment. Such a case is described below, a case that beautifully illustrates what I refer to as the finesse of herbal prescribing.

This approach enables the skillful practitioner to apply differential assessment to the choice of plant remedy. Each plant has primary, secondary, tertiary, even quaternary levels of influence in the body, and knowing these subtleties can help to ensure that each plant you use has the widest possible beneficial application. With this knowledge it is possible to customize formulas for clients with great precision and to use fewer herbs to produce therapeutic effects. This is turn allows you to use greater volumes of certain herbs and thus to obtain a stronger, more reliable response.

Introduction

The patient was aged 67 when he presented in my clinic in July 1995. He was suffering from complete urinary incontinence and impotence, secondary to surgery for prostate cancer. This was complicated by an acute allergic reaction to experimental drugs given to him in a clinical trial.

In 1990 he had suffered from acute myeloid leukemia which went into remission after chemotherapy with an experimental new drug. When he was diagnosed with prostatic cancer in 1994 he accepted another experimental drug and hoped for positive results. The drug was cyproterone acetate administered orally. This is routinely used for advanced, terminal prostatic cancer but is recently being researched for use in the early stages, such as was the case for Mr. P. Within a few minutes of taking the first dose Mr. P. experienced numbness and tingling in the mouth and his eyes and lips swelled. He called the oncologist who gave him the medicine, who then prescribed Benedryl to reduce the histamine response. The patient was asked to remain on the experimental drug. In fact, he was asked to remain on it for the next 13 weeks, despite continued attacks of anaphylaxis and despite the need for continual use of Benedryl and, later on, Reactine. He developed hives as well, sometimes having to immerse his whole body in a cold bath to cool the itching.

When his PSA refused to abate, his surgeon decided to operate. In August 1994 he underwent surgery, which left him completely incontinent and impotent. When he first came to see me he was required to use 6 or more incontinence pads daily, the worst time being in the evenings and when physically active (walking, cycling etc.). He had no urinary urge at all except for the first voiding in the morning and consequently no bladder control. He had undergone some acupuncture sessions a few months previously that had been somewhat helpful but his situation had plateaued since then. Fortunately he was suffering from no infections or irritations and there was no blood or pus in the urine. His PSA levels had been zero since the surgery.
 

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He stopped the drug regimen after 13 weeks but continued to get swelling, numbness, tingling and severe hives frequently. He was unable to isolate any particular patterns or triggers for the allergies. He was using Benedryl prophylactically every night and taking Reactine several times a week to quell acute episodes. He used calamine lotion topically for relief from the itching.

His energy remained quite good. He worked full time as an accountant and regularly walked to and from work, a distance of some 2 to 3 miles each way. He skied a lot in the winter and hiked in the summer. He suffered from occasional night cramps in the quadriceps muscles. His digestive and respiratory systems were functioning well. He had previously suffered from a mild episode of congestive heart failure while in hospital with the leukemia, but was taking no medication for it. He had longstanding fungal infections in the nails of some fingers and toes.

He was divorced, with grown children, so he often ate alone and not very well. He ate fish, chicken, or turkey daily with red meat a few times a month. He drank a gallon of milk a week and ate quite a bit of cheese. He drank soda pop and sweetened iced tea daily. He drank 1 or 2 coffees a day and had a whiskey most nights after work, and wine as well on the weekends.

Clinical assessment and therapeutic approach

The patient was fortunate to have the cancer successfully removed before it spread to other areas of the body. Urinary incontinence and/or impotence is common after prostate surgery, something that patients, including this man, may not be informed of. In my therapeutic approach I was able to concentrate on the presenting problems of incontinence and impotence as well as dealing with the allergic response, and did not have to worry unduly about the cancer except to address some issues in his diet and lifestyle.

Further investigation revealed that his bladder filled and emptied normally, but he seemed to be lacking any sensory information from the bladder. Thus it emptied by reflex from distention rather than by a conscious or deliberate voiding due to sensations of fullness. He was not constantly dribbling as is the case in true overflow incontinence; nor did he have stress incontinence or the total incompetence of the urinary sphincter most common after prostatic surgery. The morning urge to void indicated that the underlying problem could not be that sensory nerves were accidentally severed during the surgery. Part of my therapeutic plan, therefore, was to strengthen the innervation of the bladder outlet area and to tone the sphincter.

The allergic response was a Type I (Anaphylaxis) reaction. It was my judgement that the initial stimulus of the experimental drug had so stressed and disrupted his immune system that he was tending to react acutely to a host of different and previously benign stimuli. In my opinion, there were several aggravating factors: the stress of his physical deterioration, poor diet, excessive use of alcohol and possibly some unknown immune modulating effect of the drug itself.
 

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At the time of the first consultation I didn’t know what items in his diet or daily activities he was reacting to, so I advised him to follow some sensible precautions for avoiding exposure to airborne allergens, and to follow a rotation diet. In people with multiple allergies I often find a tendency to develop a sensitivity to any food which is eaten too frequently. The person often craves the very foods to which they are reacting. It is helpful to follow a rotation diet where food items and food families are only consumed every 4 or 5 days. This minimizes the allergic load from foods that are craved, and prevent allergies from developing to new foods that might be overconsumed. If this can be followed for several months, many allergies will spontaneously resolve by themselves.

Tincture formula:

Ephedra sinensis (Ma Huang)         1:3 10 mLs

Urtica dioica (Nettles)            1:3 20

Chamomilla recutita (Chamomile)    1:3 10

Arctium lappa (Burdock)         1:4 10

Hypericum perforatum (St. Johnswort)    1:3 20

Equisetum arvense (Horsetail)         1:3 20

Polygonum bistorta (Bistort)         1:4 10

100 Mls Total sig. 5 Ml tid aq. cal. ac

Ephedra sinensis (Ma huang); Ephedraceae

The aerial parts of this spiky bush are used in Traditional Chinese medicine as a bronchial dilator to treat what western medicine calls asthma. It was this action which led to the herb being studied as an adrenergic agent.

Constituents

Alkaloids, up to 1-2% chiefly l-ephedrine with smaller amounts of d-pseudoephedrine Saponins

Tannins and catechin

Actions and Therapeutic use

The action of ephedrine closely resembles that of epinephrine, an adrenal hormone, and both have and has a pronounced adrenergic effect upon the body. Ephedrine enhances the release of norepinephrine from the vesicles of the nor-adrenergic nerve endings, and also inhibits the reabsorption of nor-epinephrine by these nerve endings. The net effect is to increase the availability of norepinephrine at the post-synaptic membrane and thus to increase tissue response to epinephrine. An alkaline urine tends to prolong the overall effect by decreasing excretion (Zeylstra). It is reported to have a marked anti-spasmodic effect, especially upon smooth muscle and is strongly anti-edematous in the mucus membranes particularly of the nose and upper respiratory system (Grieve). It is also a vaso-constrictor and so helps to reduce swelling in affected tissues (Lewis and Lewis).
 

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In clinical practice I have observed that Ephedra seems to combine particularly well with both Urtica dioica (stinging nettle) and Chamomilla recutita (chamomile) in the treatment of allergic reactions ranging from hives to rhinitis to asthma. Ephedra is also considered to combine very effectively with Hypericum perforatum in treating incontinence and enuresis (Zeylstra). Sensible caution is urged when using this herb. It causes amphetamine-type reactions in overdose or in sensitive individuals. Effects may include heart failure, stroke, psychosis, and death.

It is contraindicated in individuals with hypertension, heart or thyroid disease, diabetes, anxiety, insomnia, fatigue/exhaustion, or difficulty in urination due to benign enlargement of the prostate. Side effects of nervousness, tremor, sleeplessness, loss of appetite, or nausea may occur.

Urtica dioica (Stinging Nettle); Urticaceae

The aerial parts are gathered just before flowering and may be juiced and preserved with alcohol or glycerine, or they may be dried for use in tincture or tea. The sting is neutralized by alcohol, heat, and drying.

Constituents

Flavonoid glycosides including kaempferol, isorhamnetin and isoquercitrin and rutin).

Amines including histamine, choline, acetylcholine and serotonin

Minerals including high amounts of potassium, calcium and silicic acid

High amounts of chlorophyll and carotenoids

Triterpenes and sterols including beta sitosterol

(Bradley)

Actions and therapeutic use

Nettle is mostly recognized as being an excellent diuretic (Bradley) especially for cardiac oedema, venous insufficiency and where there is excessive uric acid building up in the tissues (Weiss). It is also recommended for its astringent and toning properties especially in the urinary tract (Grieve). Urtica works well for severe cases of hives. Nettles also have a long tradition of use as an anti-rheumatic agent. This might be due to its ability to induce the excretion or uric acid, its anti-allergic effects, or other effects.
 

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Chamomilla recutita (German Chamomile); Asteracea

This sweet-scented annual flower produces pollen to which many people are allergic. Paradoxically, the dried plant extract may conversely be used to reduce IgE-mediated allergy reactions.

Constituents

Azulene, chamazulene and bisobolol are sesquiterpens derivatives and are lipid soluble. The azulene and chamazulene are derived from matricine which turns blue with heat so steam distillation of chamomile yields an essential oil with a blue color. All of these sesquitepenes are notably anti-inflammatory and spasmolytic. They are strongly decongestant to the tissues. Chamazulene has been found to be strongly anti-bacterial, acting against a variety of bacteria.

(Willard; Weiss)

Actions and therapeutic use

Chamomile has a long tradition of use for smooth muscle relaxation, used to ease digestive cramping, gas, menstrual cramps, asthma, and to lower the blood pressure.

In my experience, There are some herbs which seem to ‘marry’ very well, to achieve a synergy of effect where the whole is greater than the sum of the parts. Such a synergy is held by Urtica, Chamomilla recutita and Ephedra sinesis in the treatment of inhalant or ingested allergens.

Arctium lappa (Burdock); Asteraceae

The roots of this common roadside plant are harvested in the fall of the first year of growth or in the spring of the second year. They have a very long folk history as a blood cleanser, anti-allergenic, and depurative.

Constituents

Inulin (a complex polysaccharide) up to 45%

A complex volatile oil @ 0.1%

Phenolic acids including caffeic, chlorogenic, isochlorogenic and others

Acetylenic compounds, some containing sulphur

A bitter compound called arctiin

Lignans called A and B Lignaol
 

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Phytosterols

Mucilage

Minerals including calcium, phosphorus, iron and sodium

Vitamins including thiamine, riboflavin, niacin and ascorbic acid.

(Willard; Bradley; Grieve)

Actions and therapeutic use

Burdock root is considered to have diuretic and diaphoretic actions, to stimulate hepato-biliary function and to be useful, internally and externally, in the treatment of skin diseases (Bradley). Both inulin and the polyacetylenes are theoretically capable of stimulating immune response which may account for the success of this herb when treating immune dysfunctions. The bitter, arctiin, stimulates the whole digestive function including the liver. Burdock may also aid in the balancing of blood sugar levels.

Hypericum perforatum (St. Johnswort); Hypericaceae

This is a perennial plant, originally from Europe but now growing prolifically in warm temperate climates including California, eastern and central USA and Canada and throughout much of Europe.

Constituents

The red pigment carried in tiny black oil glands on the leaves and flowers mostly consists of dianthrone derivatives including hypericin, pseudohypericin, frangula-emodin and anthranol

An essential oil, carried in the white glands on the leaves and flowers, contains the monoterpenes alpha and beta-pinene, myrcene and limonene, and the sesquiterpenes caryophyllene and humulene

Catechin and epicatechin

Flavonols including hyperoside, quercetin, isoquercitrin, rutin, methyl-hesperidin and kaempferol

Coumarins including umbelliferone and scopoletin

Phenolic acids including caffeic, chlorogenic, genistic and ferulic

Beta sitosterol

Carotenoids and xanthones
 

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(Hobbs; Moore)

Actions and Therapeutic uses

Overall, Hypericum has a tissue specificity for nervous tissue and the bladder where it acts as a tonic and regenerator. It appears to have a specific regenerative effect upon the nervous supply of the trigone (outlet) of the bladder where it serves to improve nervous control of the voiding reflex (Zeylstra). Weiss states that its is most effective in psychogenic bladder problems, and probably works through its antidepressant effect. Hypericum is a reliable antidepressant — the leading antidepressant by sales volume in Germany — and may also have burn-healing effects.

Equisetum arvense (Horsetail); Equisetaceae

This is a perennial herb, growing from a creeping rootstock which may spread underground to cover a large area. It is botanically related to the conifers and exhibits alternation of generations with a fruiting body appearing early in the year to be succeeded later in the spring by the vegetative part. The Latin name comes from equus meaning horse and seta meaning bristle. Correct species identification is very important because some species (eg. E. palustre) contain potentially toxic alkaloids. Microscopy and thin-layer-chromatography are required for exact identification. There are two major chemotypes of E. arvense - one from Europe and one from Asia and North America. They are distinguished by the differing flavonoid content but both types are medicinally active.

An incorrect rumor circulating about horsetail is that it can deplete the body’s thiamine — Vitamin B1 — if taken long term. The rumor is based on the fact that fresh equisetum contains the enzyme thiaminase, which can break down thiamine. Drying, alcohol extraction, and stomach acid all denature thiaminase, and there is no evidence that it has a physiological effect in humans in the forms and amounts used. The Canadian government allows the sale of horsetail preparations only if thiaminase inactivity can be proven.

Constituents

Minerals between 3 - 16% in the fresh plant. The major mineral component is silica @ 5-8% equivalent to 2 - 3% of elemental silicon. Potassium, aluminum and manganese are also present.

Saponins - chiefly equisetonin.

Flavonoids up to 1% - chiefly quercitin glycosides as well as kaempferol, apigenin and other flavonols and flavones. The European chemotype contains quercitin 3-0-sophoroside and the 4’-0 glucosides of protogenkwanin and genkwanin. The Asian and American chemotype contains flavone 5-glucosides.

Phenolic acids including protocatechuic and caffeic acids in the methyl ester form.
 

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Alkaloids are absent except for a trace of nicotine and occasional traces of others dependent upon location.

A variety of organic acids including aconitic, tannic, oxalic, malic and acetic.

Betasitasterol.

(Zeylstra; Bradley; Willard)

Actions and Therapeutic uses

This herb has a mildly diuretic action. Diuretic effects may be tempered by the presence of significant quantities of astringent tannic acids which provide a tonic and strengthening effect upon the walls of the bladder. It is this tonifying effect hat is sought in urinary incontinence, rather than the diuretic effect.

Horsetail exhibits antibiotic properties when applied topically in the form of a skin wash and also in the urinary tract. It is especially active against staphylococcus aureus and streptococcus pyogenes (Bradley).

Polygonum bistorta, bistortoides (Bistort, Knotweed); Polygonaceae

This is a common roadside weed found in cooler temperate climates. It grows prolifically in northern Europe, central Asian uplands, and west of the Rocky mountains in North America. The name comes from the Greek poly meaning many and gonu meaning knees, and the Latin bis meaning twice and torta meaning twisted. Thus, ‘many knees twice twisted’ referring to the jointed stems and twisted rhizomes.

Constituents

Tannins - between 15 and 20% in the root

Gallic and oxalic acids

Vitamin C

Actions and Therapeutic uses

The primary therapeutic activity of this plant is conferred by the very high tannin content. They are strongly astringent, anti-inflammatory and antimicrobial. Additionally they are tonic to mucous membranes, improving their integrity and reducing excessive mucous production in the digestive and urinary tracts. It is especially indicated for diarrhoea and dysentery as well as being used topically for leucorrhoea, inflammations of the mouth and tongue, laryngitis, nasal polyps and hemorrhoids. It has traditionally been used for hematuria, incontinence and nocturnal enuresis (Chiej; Hoffmann; Pojar and MacKinnon; Mills).
 

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A close relative (Polygonum aviculare) is notably high in silica and exhibits similar connective tissue tonic properties as horsetail.

Therapeutic rationale

The intention of this formula was to address both symptomatic and underlying causative issues. Ephedra and hypericum were included to tone the trigone of the bladder and improve nervous control of urination. Ephedra, chamomilla and urtica were used to reduce type I allergic responses. Polygonum and equisetum were used to tone the bladder and urinary tract and improve the integrity of the tissues. Arctium was included for its traditional action as a blood cleanser. Chamomilla and hypericum were used for the psychic stress associated with his condition.

Additionally he was given a liquid concentrate of grapefruit seed extract (Nutribiotic) to apply to the nail beds to combat the fungal infection. He was instructed to use it diluted in a hand soak daily.

I also recommended that he reduce or stop the intake of alcohol and caffeine, both of which are notable diuretics and which were probably aggravating the problem. As well, I suggested that the high intake of dairy products may be contributing to the allergy problem by stressing the epithelial linings of the lung and digestive tract and that he should also reduce this.

Second visit - August 1995 (one month)

At this time he reported good compliance with the dietary adjustments I had suggested. He had reduced alcohol consumption to weekends only, was having one or two coffees a week and had reduced his dairy intake a little. He was no longer experiencing leg cramps and the fungal infection in the nails was improving a little.

His allergic episodes were, if anything, slightly more frequent although less severe and less long-lasting. He was using Benedryl only 1 - 2 times week (compared with almost daily use at the time of the initial consultation) and the Reactine 2 - 3 times a week for quick relief. I described to him how sometimes allergies may get worse before improving as the body labors to cleanse the system, in this case perhaps due to the effects of arctium.

The incontinence was considerably improved. Some days he was requiring only one pad during the day although there was still some worsening in the evening and with physical activity.

His herbal formula on this occasion was repeated.

Third visit - September 1995 (two months)

On this visit he reported that his diet continued to improve with very little coffee or dairy products, lots of fresh fruit and vegetables, almost no alcohol and little sugar. The nail infection was significantly improved and he was feeling quite happy with all these changes. The allergic reactions had almost disappeared. He was using no Benedryl or Reactine at all and had only had two very mild outbreaks of hives in the past month.
 

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The incontinence was at about the same level as at the previous appointment - one or two pads through the day and a little worse in the evening. He had been to see his urologist again and a cystoscopic examination had revealed massive scarring at the urethral outlet. The urologist suggested that this was interfering with normal nervous impulse transmission to the trigone area and possible inhibiting adequate closure of the sphincter. A urethral dilation was performed which had left him feeling quite sore for a few days but which had no impact on the incontinence. The impotence continued to be a concern.

I suggested that the urethral scarring might be improved by the use of castor oil packs over the affected area. He was given a bottle of castor oil and instructions on using it daily for an hour at a time.

The herbal formula was adjusted at this time to replace the chamomile with Panax ginseng. This was done because his allergic outbreaks were significantly reduced but the impotence and incontinence continued to bother him. I believed that a strong male (yang) tonic like ginseng might be helpful as a fortifying tonic herb.

Fourth visit - November 1995 (four months)

On this occasion, he reported that he had recently seen another urologist for urinary dynamic and erectile function tests and would forward the results to me. He had been offered a biofeedback course through the hospital outpatients department and was quite keen to do this. It was hoped that this would assist him in regaining control over the bladder function.

The hives were infrequent, mild and short-lived. The incontinence continued as reported in the previous visit. He had been doing the castor oil packs regularly.

His herbal formula was repeated but this time at the reduced dose of 5 Ml twice a day. The intention here was to try to slowly reduce the amount of herbal medicine and see how well his body could sustain the improvement. I believed that the combination of castor oil packs, biofeedback, and gentle, background herbal support should be sufficient to carry him on.

Fifth visit - January 1996 (six months)

A relapse of the diet over Christmas (taking more sugar, alcohol, coffee and fried or processed foods) had resulted in a flare up of the hives. Some of the outbreaks had been quite severe but he had only taken Benedryl twice.

One night he had drunk rather a lot of alcohol and decided to take 2 aspirins to try to ward off a hangover. Within 2 hours he had considerable facial swelling and severe facial pain which lasted several hours and for which he took a Benedryl. I suggested to him that, although this wasn’t a full blown anaphylactic attack to aspirin, it would probably be advisable for him to wear a bracelet or pendent for emergency warning.
 

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The incontinence had not changed and he continued to hold his own with one or two pads a day. He was a little less regular with the castor oil packs over Christmas but expected to get back to routines shortly.

Because of the recurrence of hives, I suggested that he undergo Vega testing to determine what specific allergies he had as well as any significant organ weaknesses or other hidden stressors. Vega testing is technically called electroacupuncture and has been used for many years in Europe. Using positive and negative electrodes it is possible to measure currents in the body (purportedly in the meridians) that change on exposure to allergens. Users of this system report it to be very accurate, cheap and painless. However, no properly objective clinical trials have yet been done to determine just how useful it may be.

Results from the urinary dynamics and erectile function tests revealed normal bladder filling and emptying and ability to achieve and maintain a drug induced erection but significantly impaired voluntary nervous control of the genito-urinary tract. In other words, everything worked normally except that he had no control over it. This confirmed the previous suspicion that scar tissue from the prostate surgery was impeding normal innervation.

His herbal formula was repeated at the dose of 5 mL two times daily.

Sixth visit - February 1996 (seven months)

The Vega tests gave some quite predictable results — significant stress in the region of the prostate, bladder, rectum and anus. Interestingly, it also showed significant stress in the choroid, retina, and optic nerve, especially on the right side. Guided by this I examined his eye with an ophthalmoscope and, while I was able to see clearly through the left eye to the retina and to assure myself that there was nothing abnormal to see, I was unable to get to the right retina at all. There was considerable corneal opacity and the fluid of the anterior chamber appeared clouded as well. On questioning, Mr. P. revealed that he had indeed had right eye trouble some years previously and, in fact, had retinal repair surgery, after which he developed a cataract. A corneal transplant had been carried out but the transplant had clouded over. He had never bothered to tell me because it didn’t seem relevant to his other health concerns. He was probably right in that regard, but I was very interested that the Vega test revealed information that neither I nor the Vega technician had any idea about. This only served to reconfirm my belief in the value of this diagnostic tool.

He was found to have a variety of food allergies including corn, wheat, casein (milk protein) and eggs.

He had suffered three very mild bouts of hives and had not used any Benedryl at all. He had begun the biofeedback therapy for the incontinence but so far was not noticing any change in bladder control.

His herbal formula at this time was adjusted to replace the polygonum with Rhus aromatica which may have a somewhat more tissue specific action on the urinary tract. The dose was also reduced to 5 mL once a day.
 

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Rhus aromatica (Sweet sumach); Anacardiaceae

There are several species of sumach, of which the sweet and the smooth (R. Glabra) are medicinal and R. toxicodendron (poison ivy / oak) and several others are quite toxic. The sweet sumach grows prolifically in waste grounds across the eastern USA and Canada. The root bark or the ripe berries are used medicinally.

Constituents

A high percentage of tannins and tannic acids

A turpentine-like balsam and an oleo-resin are exuded by the fresh cut wood

(Felter and Lloyd; Hutchens)

Actions and Therapeutic uses

The Eclectic physicians considered this herb to be of special value in the urinary tract. They recommended it for diabetes and other excessive discharges of the kidneys including endogenous diuresis, incipient albuminuria and acute or chronic hematuria. It was considered to be of special value in enuresis with atony and irritability of the urinary tract. The specific indications quoted by Lloyd and Felter are “For the person whose stools are profuse, skin cool and sallow, pulse small and feeble, loss of flesh, flabby abdomen, tongue pale, moist and trembling, weakness in the lower limbs, lassitude and languor.”

Due to its strongly astringent nature, sweet sumach may also be employed wherever strong tannin action is required. In burns, bloody diarrhoea, hemoptysis, haematemesis, excessive leucorrhea and all other mucous secretions or bleeding conditions.

Seventh and subsequent visits

There has been no further progress with the problem of incontinence. He is much better than when he began herbal treatment but the biofeedback did not cause further improvement after the herbs had done what they could. He continues to use the castor oil packs to attempt to reduce internal scarring of the tissues. My prognosis in this regard is that we have probably seen just about the all the healing we can expect, although another series of acupuncture treatments might be worthwhile trying now that the situation has changed somewhat from when he last had acupuncture.

As long as he maintains a rotation diet and avoids his specific allergens he has basically no more outbreaks of hives. When they do occur he is able to identify the culprit quickly. He uses no Benedryl or Reactine at all now.

His nail bed fungal infection is much improved. He now uses the Nutribiotic lotion undiluted directly onto the nail bed and it seems to be more effective.
 

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Analysis

This was a particularly challenging case because of the iatrogenic nature of the problem. Lingering stress from the anesthetic may have had an effect. The extreme immune response to the cyproterone acetate presumably served to seriously disrupt immune function and allow the plethora of allergies to develop. The incontinence and impotence was due to the surgical intervention causing mechanical damage to the nerve and blood supply into the region, complicated by excessive scar tissue formation. This is a well-known complication of prostate surgery. The impotence was almost certainly aggravated by the cyproterone acetate, which reduces the sexual drive and inhibits spermatogenesis. the drug also has known adverse effects on the liver, and may have played a role in the exacerbation of the allergies.

Cabrera References

Bradley, P., editor. British Herbal Compendium, vol. 1, The British Herbal Medicine Association, 1992

Chiej, R. Encyclopedia of Medicinal Plants. MacDonald Publishing, 1984

Felter, H.W. and Lloyd J.U. Kings American Dispensatory. Eclectic Medical Publications, 1898

Grieve, M. A Modern Herbal. Cresset Press, 1931 (reprinted 1991),

Hobbs, C., HerbalGram. No. 18/19, Fall 1988/Winter 1989

Hoffmann, D. The New Holistic Herbal. Findhorn Press, 1983

Hutchens, A. Indian Herbology of North America. Merco, 1973

Lewis, W. and Lewis M. Medical Botany. Wiley Interscience, 1977

Mills, S.Y. Dictionary of Modern Herbalism. Healing Arts Press, 1988

Moore, M. Medicinal Plants of the Pacific West. Red Crane Books, 1993

Pojar, J. and MacKinnon, A. Plants of Coastal British Columbia. Lone Pine Publishing, 1994

Vogel, H.C.A. The Nature Doctor, Keats Publishing, 1991

Weiss, R. Herbal Medicine, 1988, Arcanum Press.

Willard, T. The Scientific Herbal, 1991 Wild Rose Publications

Zeylstra, H. Lecture notes, 1985 - 88
 

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