Bitters (Bitterstoffe) L. Maiwald, Wu

A different evaluation is given by the pharmacologist, on the basis of
the separate constituents shown to be in bitters preparations, than that
based on medical therapeutical experience. According to R.F. Weiss (2),
the characteristic property of the bitterness is only a qualitative description
without the possibility of a detailed analysis.



There is a large number of drug plants with a bitter taste. They are now
grouped under the name Amara (bitter medicine), and are then further subdivided
on the basis of additional characteristics. In the group called Amara
tonica
, are placed ones that are pure bitters in the more narrow sense,
where the promotion of the stomach secretion is emphasized over other characteristics.



This group is narrowed, if one considers the clearly exciting effect of
some bitters preparations, which in practice can be seen. These find application
for the activation of the appetite, and simultaneously for the improvement
the overall state of health, because they generally excite the bodily functions.



What “target group” is best suited for bitters?

Target groups for a treatment with preparations of bitters are for the doctor
therefore, above all, patients in convalescence after long-standing infections,
and patients with chronic gastro-intestinal ailments. Also long-term illnesses
with gastrointestinal digestive weakness are successfully treated with bitters,
likewise persons with weak constitution and lowered autonomic nervous system
tone. Under this category, one finds numerous patients with disturbances
of the nutrition and health of the nerves, in the sense of a decreased reaction
ability of the autonomic nervous system.



The effect of the plant-based bitters manifests first after a longer moderate
course of treatment use. This is especially important to consider, not only
for the gastrointestinal effect but also for the general stimulating and
tonic one.



With a single dose one notices only enhancement of the salivary and stomach
secretion. Occaisionally even these effects are only small. The practical
therapeutical experience with amara in medical practice is essentially larger
than the number of recognized proven effects.



Since ancient times, amara preparations are typical remedies for general
medical practice because of their range of use. However, they are less useful
for application in the hospital, because there, one expects, and is dependant
on, an immediate effect.



Indications for Amara

From a therapeutic perspective, these are the applications for bitters:



1. The general loss of zest, life, well-being (loss of livliness) (slowing
down of the life processes [In German = Tonusverlust] [from slow-down of
the vital energy of the body begins to effect the vitality of the body,
especially the autonomic nervous system-conditioned lowered gastrointestinal
tonus, with the consequence of lowered blood supply, with intestinal stresses,
without sufficient secretions and slowed-down peristalsis



Such conditions, apart from convalescence, also found with exhaustion and
in general and/or constitutionally-conditioned weaknesses.



2. The deficiency of appetite and the necessity of the acceleration of the
gastric [nutritional passage] as well as the stimulation of the stomach
secretion. The most favorable patent remedies that have proven themselves
in medical practice are tinctures given as drops, or small amounts of tea
taken before meals. Both dose forms should be taken before relatively small
meals, and tea only in cold form. The success in application is tied with
a long continued therapy.



There are prepared mixtures of bitters known, such as tincturea amara,
tinctura stomachica and elixir amara. Especially favored are
dose forms in wine (vinum amarum, vinum china, vinum Condurango).
Besides that, there are preparations of bitter drugs (mixtures), which together
with spasmolytic and carminatives are effective remedies for therapeutic
applicaiton.



From a pharmacological perspective, bitters are evaluated in a different
way. [The above evaluation was from a medical perspective). One ascribes
to them a significance as stimulants of salivation, stomach and gall secretions,
because of their intensly bitter taste.



In addition to these effective bitter drugs, others are separated (or delineated),
in which different pharmacologic effects are more significant, than the
effect on saliva and stomach acid production. To this group belongs cinchona,
strychonos seed, aloe and heart-glycoside drugs (leaves of digitalis). The
generally tonifying effect of the bitter tonics is not especially valued
from a pharmacologic perspective.



On the basis of accompanying constituents, by which the bitter taste is
modified, one descriminates (differentiates) pharmacologically



1. Amara pura

2. Amara mucilaginosa

3. Amara aromatica



Chemically-pharmacologically, bitter drugs do not belong to a unique class
of substances. Here is in its multidue (xx?) a parallel to see, the manifoldness
of drugs containing bitters. Among the bitter drugs there are many conspicuous
which have in their content terpenoid glycosides and compounds with lactone
groups.



The pharmacologic recommendation for therapeutic applicaiton., is differentiated
according to the evaluation. The need for stimulating the appetite, weakness
conditions, anemia, and convalescence are taken as indications. As a recognized
effect, however, there is only the reflex effect of the stimulation of the
salivary gland and stomach secretions happening via the vagus nerve.



It is postulated that bitters trigger in this way, a mechanism that effects
immediately an improved nutritional utilization and increased or heightened
resorptivity. Although, in animal tests a blood pressure lowering and positive
inotropic effect has been proven, likewise also a bacteriocidal effect of
many bitter drugs, these properties are pharmacologically not passed on
to the clinical therapists as recommendations for application.



Pharmacologically, there remains the important immediately recognizable
strong increase of the production of salivary-and stomach secretion, as
it has been achieved with the drugs wormwood, gentian and hops. Consequently,
from a pharmacologic perspective, the therapeutic uses for bitter drugs
is different from that of the doctor based on the daily experience with
patients.



[This is the crux of the issue between scientists and herbalists–it depends
on one’s perspective, ed.).



Regarding the forms of preparation, it is pharmacologically and medically
significant that bitters are not obtained as pure substances for economic
reasons, and therefore they are at our disposal only in the form of the
plant’s own constituent complexes.



[life grows out in many directions at once, so it can make use of (medicinal
substances) that life itself has evolved, ed.].



The application of bitters happens in the form of extracts, as has already
described. Thus, the frequently used tincture formulas and tea preparations
represent complex substance combinations.



THE MOST IMPORTANT BITTER DRUGS



The significant bitter drugs in our culture, are today recognized as:

Wormwood

Bitter orange peel

Blessed thistle

Centaurium

Lemon peel

Condurango

Gentian

(yellow root)

Buckbean.



In order to show whether a preparation of bitter drugs can also change intra-gastral
digestive processes beyond the known stimulating effect on the saliva and
stomach secretions, in a group experiment of 20 volunteer test subjects,
gastric proteolysis has been examined under continuous control formation
of breakdown products. Corresponding to mdical experience and to pharmacologic
recommendation it could be shown that the addition of bitter concentrates
to the high-protein test drink as a stomach tonic during the intra-gastric
protyolisis of the stomach chyme does improve the acid production and supports
the albumic splitting (3). It was even shown that the applied stomach tonic
acted sex-specifically, by affecting in males an earlier and stronger, and
in female a later and weaker effect on the acid production and of proteolysis.



Through the (sequence) of the experiment the evaluation of any effect other
than a local one was excluded. Any further lead of the taste sensation as
causative for improved gastric production and proteolysis through the stomach
tonic needs therefore no further discussion. The ascertained effect of the
drug mix on the acid secretion and gastric proteolysis happened during the
gastric phase of the stomach secretion.This confirms the assumption, that
the stomach tonic attains its effect in a humoral way, that is, via the
release of gastrin.



The acceleration of the proteolytic effect through the bitters concentrate
is to be explained via the accelerated release of acid and the proteolysis-promoting
pH value which is thereby reached earlier. The examination has in any case
yielded that bitter drug concentrates, independant of the taste sensation,
directly affects the enteral regulation via gastric mechanisms.



This finding corresponds to the examinations via the gastrointestinal effect
of Harpagohytum procumbens undertaken by Zimmermannof. He discovered
the bitter drug action as a side effect during the testing of the drug as
a rheumatic rhemedy. This effect might also be equated to gentian. Zimmermann
was able to note that disease symptoms of the upper small intestine, with
disturbances of cholerase and cholekinese, but also clinically-latent pancriatic
gland participation, experienced a distinct improvement after several days’
administration of Harpagophytum as a tea. Impressive for him was the improved
cholekinese, which corresponded to a bitters effect, just as described for
gentian.



The result of my own investigations complement the findings of Zimmermann
et al. (5) –bitters obviously improve gastric self-regulation and
thereby undoubtedly contribute to an improved functioning of the subordinated
organs, the pancreatic and bile duct [systems] (gall-path system), which
depend on the stomach’s function in their readiness to secrete.



The significance of Amara is not yet fully known

On the basis of communicated reports, the general statement is permissible,
that the significance of amara is not yet fully known and therefore needs
to be further examined medically and pharmacologically.



If one (as Zimmerman writes) can also not yet explain the much-discussed
double-effects such as that of China bark as tonic and fever medicine, Strichnos-seed
as tonic and synapse poison, that of plantain herb as bitter and antiobiotic,
Devil’s Claw as rheumatic remedy and antiphlogistic, anti-allergic and amarum,
then these facts represent a genuine challenge for the clinic, in practice
and in the lab to explain effects and effectiveness objectively. To this,
correspond results of the newest examinations of bitter drugs in their effect
on the gut-associated immune system. It has been shown, that in cases of
inflammatory stomach-intestinal diseases of diverse types and location,
there is a heightened sIgA-level to be found in the saliva.



Bitters, used in therapy, bring about a significant change in the sIgA-concentration,
whereby in healthy people, gentian brings a lowering, China-bark, however,
a raising of the concentration. In patients with inflammatory stomach-intestinal
diseases a significant decrease of the sIgA in the saliva has been noticed
through therapy with gentian, which correlated with their clinical results
(picture).



Further significant results of examinations (studies, investigations) about
the effectiveness of bitter drugs in the treatment of gastrointestinal diseases
are, therefore, surely to be expected.



Translated from Zeitschrift für Phytothereapie 8: 186-188 (1987)



English translation Copyright March, 1991 by Shanti Coble and Christopher
Hobbs



All Rights Reserved



Christopher Hobbs L.Ac.

Christopher Hobbs LAc AHG Written by Christopher Hobbs LAc AHG

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