Herbal Therapy & Elder Health


Psychology of Aging

This is a major part of the way people age. Social and individual assumptions about age and its consequences can lock people into a series of self-fulfilling expectations. The following listings are taken from an excellent self-help book :


Fries, James F. Aging Well. Addison Wesley, Reading (1989)

They succinctly review some of the issues that are in play, whether they be inherent in the aging process or aspects of the cultural overlay.





‘The Disease of Stereotypes’

Dr. Fries puts attention on stereotypical assumptions about the elderly
as they are often implicated in the complex of social and familial interactions that can re-enforce illness. He suggests viewing these stereotypes in a different way such that the resulting attitudes and responses become more life affirming.


Old stereotypesNew stereotypes


Physical


Feeble — Active

Slow — Is deliberate & effective

Gets in the way — Compensates for limitation

Drives slowly & discourteously — Is sensitive to courtesy issues

Causes accidents to others — Uses time positively

Nonproductive — Contributes in unusual ways


Mental


Crotchety, irascible — Wisdom and counsel

Opinionated, impossible, rigid — Learns actively

Not open to new ideas — Seeks new inputs

Repeats the same old stories — Has huge store of accumulated memories

Overtly critical of other generations — Has unique perspectives and experiences

Lives in the past — Seeks new experience


Social


Needs to be patronized — Empathic and helpful

All old people are about the same — Rich network of good friends

Uses up family resources — Volunteers constructive efforts

Requires pseudodeferences — Seeks and enjoys activities

Poses an economic threat — Relative affluence

Aged individuals are marking time to death — Looks forward and plans




In his excellent book, Dr. Fries draws some general conclusions which
lead to some clear and practical insights. To again quote from Aging
Well
:


  • Avoid Learned Helplessness. Consider setbacks as accidental, isolated events that will be over soon.
  • Develop Self-efficacy. Recognize that your choices can change your future, and exercise your right to choose.
  • Choose the right coping strategies. With personal crises, work to see a good side to them, and cope by using humor and altruism.
  • Use the Life Cycle to your Advantage. Use the positive attributes of age to achieve the goals of age.

Some basic principles of aging well

  • MAINTAIN INDEPENDENCE
  • MODERATE HABIT
  • KEEP ACTIVE
  • BE ENTHUSIASTIC
  • BE POSITIVE
  • BE INDIVIDUAL

Spiritual and Socio-Economic Issues

There are not only biological and psychological factors involved in aging. Sociological, economic and spiritual issues also play a profound role, but an adequate discussion of this complex of factors is beyond the scope of this course (or the skill of this author). A couple of brief points must be made however. Age is not a disease. Death is not an evil to be avoided at all costs. Our culture has developed some distorted perceptions about old age, seeing it as the undesirable mirror image of youth. This blinkered perception ignores the incredible value of wisdom and experience, denying our elders a say or seeing their contribution as being desirable. Our whole culture is suffering as a result. We are dealing with spiritual issues here. There needs to be an affirmation of aging and death, seeing it as the rite of passage it is. Much of the illness of elders is either a result of or aggravated by socio/economic issues that are not medical at all. Issues such as isolation and poverty may take the form of cardiovascular disease but won’t be helped by Hawthorn. If our culture is going to evolve into a `kinder gentler’ one, then attention must be given to these thorny questions.



Toning and Nurturing Health in Elders

A basic premise of this course is that phytotherapy can nurture health and not simply treat illness. This strength of this approach lies in the use of tonics and gentle effect or remedies, using the stronger effectors only where absolutely necessary. This is also the basis for herbal treatment for elders, thus everything covered in the course so far has relevance to the treatment of the individual concerned. Perhaps the most outstanding contribution that herbs can make to the health care of our elders is through system tonics. Tonics and gentle normalizer remedies not only avoid most side effect complications but offer possibilities for the maintenance of wellness and prevention of many problems associated with aging. Please review the material covering wellness and prevention discussed in the last lesson.



Prescribing Issues Unique to Elders

When considering herbal therapy it is important to acknowledge some of the age related pharmaco-kinetic and pharmaco-dynamic changes that occur. Safe drug or herb prescribing for older patients has to be based upon an understanding of the changes that occur to absorption, distribution and elimination mechanisms in the aging process. Taking such issues into consideration helps avoid many complications. Whilst such concerns are not as important for the phytotherapist, they still exist. A brief review of some of the factors involved for both plant extracts and chemical drugs might be helpful. Pharmacological research suggests that the most important issues to consider are :


  • `Drug’ absorption. For a chemical or plant extract to enter the blood stream when taken by mouth, the absorptive lining of the gastrointestinal tract must be healthy. Medicines must remain in contact with the lining for an adequate amount of time for absorption to occur. There must also be an adequate blood flow to and from the site of absorption. Normal age related changes impact all of these factors. There is a reduction in mucosal surface area, reduction in blood flow to the intestines and changes in secretions.
  • Plasma binding. Plant constituents are transported via the blood once they have been absorbed from the intestines. The more complex molecules are in a form that is often bound with a blood chemical such as albumin. Such protein bound drugs can compete for binding sites, which in turn may have a profound effect upon availability of medications.
  • Distribution around the body. With advancing age the proportion of body water and lean body mass decreases whilst body fat increases. This favors the distribution of fat soluble constituents over water soluble.
  • Elimination. The effect of a medicine is ended by it being eliminated from the body or its being changed into some inactive form. This will involve liver metabolism, kidney function, and elimination at other sites around the body. All of these factors become less efficient with age.

As with children, our elders have special needs and plants address these needs. Whenever possible focus upon the tonics and normalizers. The most relevant remedies are pointed out in each section below. Care must also be given to dosage, because of the range of issues touched upon above. In general a lower dosage is used than for younger adults. For details of the standard pharmaceutical formulae used to convert adult dosage to that appropriate for any particular age, please refer to James Green’s Medicine Maker’s Handbook, part of the supplemental reading material. The main concern is that of `paradoxical’ reactions. It is not unusual for medicines to have an opposite effect to that expected with very elderly people. As an example consider that the tranquilizer valium can have a marked stimulating effect upon the nervous system in some elders. This is an unpredictable response, so careful initially careful observation of a patients response is crucial. Be aware of potential paradoxical responses to herbal medications.



Prevention and Herbal Treatment of Disease






Cardio-Vascular System

The cardio-vascular tonics offer a range of remedies uniquely suited for treating problems of the heart and blood vessels in elders. Whilst they do not have the dramatic, rapid and often life-saving effects of many of the drugs currently used, they have a definite advantage when addressing the chronic degenerative conditions often found in this age group. A range of cardio-vascular remedies are appropriate for Elders, each having its distinct area of application. Diuretics can also be especially valuable. Please review these remedies :



Achillea millefolium (Yarrow)

Aesculus hippocastanum (Horsechestnut)

Allium sativum (Garlic )

Crataegus spp. (Hawthorn)

Ginkgo biloba (Ginkgo)

Leonurus cardiaca (Motherwort)

Taraxacum officinale folia (Dandelion leaf)

Tilia spp. (Linden flowers)

Vaccinium myrtillus (Bilberry)

Viburnum opulus (Crampbark)


A basic premise of this course has been the use of tonics and gentle effect or remedies, using the stronger effectors only where absolutely necessary. As this is also the basis for herbal treatment for elders, suggested treatments outlined in the chapter on cardio-vascular problems are relevant here. An important exception may be the use of Sarothamnus scoparius (Broom) in the treatment of hypotension. It should be avoided as it might prove too strong in some elderly people. Please refer to the following sections :

More than with any other age group it is essential to avoid the inappropriate use of cardiac glycoside containing herbs. Because of the pharmacodynamic and pharmacokinetic changes discussed above, it is all too easy to build up toxic levels of these chemicals. If such support of heart function is needed, it is safest to use the glycosides in a standardized form to ensure dosage is correct. This is almost impossible with the leaf of Foxglove, thus pointing to the value of pharmaceutical preparations of the digitalis glycosides. These are only obtainable via prescription. Please refer to the section on the Cardio-vascular system for a discussion of cardio-active and cardio-tonic remedies. Such potent treatment is not always necessary and, more importantly, not the only option. Remember the cardio-tonic remedies such as Crataegus spp. (Hawthorn), the best known and possibly the most valuable tonic remedy for the cardiovascular system found in the plant kingdom.


A brief review of Crataegus might be helpful, bearing in mind that this invaluable heart remedy does not contain cardiac glycosides. Crataegus spp. can be considered a specific remedy in many cardio-vascular disease. A tonic in the true sense, the therapeutic benefits are only gained when a whole plant preparation is used. When the isolated constituents were tested separately in the laboratory, their individual effects were insignificant, whilst the whole plant has unique and valuable properties. A mulit-center double blind clinical trial done in 1981 demonstrated marked improvement of heart function in patients with reduced cardiac output. Following a four year study commissioned by the German Federal Ministry of Health, Crataegus spp. has gained full recognition as a heart remedy in Europe. The monograph concludes that the herb has these properties :


  • it is positively inotropic,
  • it is positively chronotropic & dromotropic
  • it increases coronary and myocardial circulation, through a dilation of the coronary arteries.

The Ministry concluded that its main clinical applications are in the long-term treatment of `loss of cardiac function’, any situation where there is a subjective feelings of congestion and `oppression’ in the heart region, mild arrhythmia’s and especially for conditions of the aging heart that do not warrant the use of Foxglove. Most significantly is the finding that no contra-indications or side effects were noted at all. Research suggests that much of its observable effects can be explained by the improvement in coronary circulation. It dilates the coronary arteries, relieving cardiac hypoxemia, thus reducing the likelihood of anginal attacks and relieves its symptoms. The herb thus directly effects the cells of the heart muscle, enhancing both activity and nutrition.


It is quite different in activity to the cardiac glycoside containing remedies. They impact the contractile fibres, whilst Crataegus is involved in the availability and utilization of energy. This facilitates a gentle but long term, sustained effect on degenerative, age-related changes in the myocardium. It does not produce rapid results but they are persistent once achieved. Any degenerative condition of the cardio-vascular system will benefit from its use. Some specific examples are myocardial problems, coronary artery disease and its associated conditions. Angina pectoris and similar symptoms will be eased and prevented. Where no disease state exists but a gradual loss of function is happening because of old age, Crataegus is a specific. Because of its lack of toxicity, accumulation or habituation, it may be used long term, attaining the therapeutic goals safely, especially in the elderly. It speeds recovery from heart attacks and lowers essential hypertension. Used in conjunction with other hypotensives, Crataegus will help keep the heart healthy, preventing the development of coronary disease. It will guard against heart weakness following infectious disease such as pneumonia or diphtheria.




Respiratory System


A life-time of exposure to air pollution and cigarette smoke (whether their own or others) will damage even the strongest lungs. A range of remedies appropriate for respiratory problems in Elders, each having its distinct area of application. Please review these remedies and ensure their various actions are familiar to you :



Allium sativum (Garlic)

Asclepias tuberosa (Pleurisy Root)

Chondrus crispus (Irish Moss)

Hyssopus officinalis (Hyssop)

Inula helenium (Elecampane)

Leonurus cardiaca (Motherwort)

Marrubium vulgare (Horehound)

Prunus serotina (Wild Cherry Bark)

Pulmonaria officinalis (Lungwort)

Thymus vulgaris (Thyme)

Tussilago farfara (Coltsfoot)

Verbascum thapsus (Mullein)


A number of stronger effectors may be found useful in more intransigent conditions, but these should be reserved for the cases where the gentler herbs have not produced the results desired. Thus:


Sanguinaria canadensis (Blood Root)

Lobelia inflata (Lobelia)

Grindelia camporum (Gumweed)


Treatments outlined in the chapter on respiratory problems are relevant here. Please refer to the following sections :




Nervous System


A range of remedies appropriate for neurological problems in Elders, each having its distinct area of application. Please review these remedies and ensure their various actions are familiar to you : Nervine Tonics




Avena sativa (Oats)

Hypericum perfoliatum (St. John’s Wort)

Scutellaria spp. (Skullcap)

Verbena officinalis(Vervain)




Relaxant



Cimicifuga racemosa (Black Cohosh)

Hyssopus officinalis (Hyssop)

Lavandula spp. (Lavender)

Leonurus cardiaca (Motherwort)

Matricaria recutita (Chamomile)

Melissa officinalis (Balm)

Tilia spp. (Linden)




Hypnotic



Eschscholzia californica (Californian Poppy)

Matricaria recutita (Chamomile)

Passiflora incarnata (Passion Flower)

Valeriana officinalis(Valerian)




Antidepressant



Avena sativa (Oats)

Artemisia vulgaris (Mugwort )

Hypericum perfoliatum (St. John’s Wort)

Lavandula spp. (Lavender)

Verbena officinalis (Vervain )



Treatments outlined in the chapter on nervous system problems are relevant here. Please refer to the following sections :

Ginkgo and Alzheimer’s Disease The herb industry and the supplement manufacturers are making some dramatic claims for Ginkgo (Ginkgo biloba) in the treatment of dementia and Alzheimer’s disease. It is worth reviewing some of the research that has been done. What follows is taken papers in the book : Fünfgeld, E.W. (Ed.). Rökan, Ginkgo biloba. Recent Results in Pharmacology and Clinic. Springer-Verlag, Berlin 1988 Alzheimer’s disease is a neurological disorder of the brain which, whilst once thought rare, is now considered the largest single cause of senile dementia. Senile dementia, a condition of irreversible mental deterioration, always involves memory loss and is almost always accompanied by numerous other difficulties in mental function. Current studies suggest that 1% of the population in developed countries with a large proportion of elderly people is affected. The brain develops `neuritic plaques’, which consist of degenerating nerve terminals and other materials associated with the appearance of fibrous structures, called the neurofibrillary tangle, within nerve cells. One proposed cause of the growths has been the decline observed in the brain’s production of acetyl-choline. Recent studies show that the diseased brain also metabolizes glucose at diminished levels and that abnormally high levels of aluminum and silicon occur. No allopathic cure exists for the disease. Attention is being given to Ginkgo leaf (Ginkgo biloba) in the treatment of such problems, with much of the clinical and pharmacological research coming from France. The herb has a classical reputation as an anti-microbial and anti-tubercular agent.1 However new research has shown a profound activity on brain function and cerebral circulation. Clinically it seems to be effective in patients with vascular disorders, in all types of dementia and even in patients suffering from cognitive disorders secondary to depression, because of its beneficial effects on mood. Of special concern are people who are just beginning to experience deterioration in their cognitive function.


Gingko might delay deterioration and enable such people to maintain a normal life. The earlier treatment begins, the better the prognosis, especially in Alzheimer’s. Even in advanced cases, however, improvement may begin almost immediately and continues over many months. This property is important because every cell of the body will suffer when there is an inadequate supply of blood, leading to lack of energy, susceptibility to infection, decreased mental and physical function etc.. Dementia in the elderly usually related to inadequate circulation. Laboratory studies of Gingko show it to reduce vascular, tissue and metabolic disturbances as well as their neurological and behavioral consequences. Several membrane mechanisms seem to be involved including protection of the membrane ultra structure against free radicals. This activity has exciting implications with the new insights about aging and free radicals. The uniqueness of the pharmacological properties of Gingko lies in its focusing its effects on tissue that is experiencing oxygen lack, by increasing the flow of blood into is chaemic tissue.2


It may help by:


  • raising levels of glucose and ATP in the cell, thus maintain energy levels.
  • stabilizing cellular membranes including the blood brain barrier, thus reducing any cerebral edema and hypertension.
  • slowing the onset of dementia resulting from sclerosis of cerebral arteries
  • ameliorating the effects of progressive cerebral circulatory insufficiency due to age
  • decreasing the consumption of insulin, thus of potential use in diabetic angiopathy, especially as it has minimal impact on glucose metabolism, making it appropriate for diabetics, who generally suffer from insufficient circulation.
  • being hypotensive and peripherally vaso-dilating, offering a treatment for hypertension, as an aid in recovery from coronary thrombosis, and intermittent claudication.

Ginkgo has marked effects on neurophysiology, but it also seems to concentrate in the vascular and endocrine systems that strongly affect the function of the nervous system. This especially so in the adrenal gland, responsible for producing dopamine, epinephrine and norepinephrine as well as intermediary products required in the formation, activity and metabolism of other neurotransmitters. Ginkgo is also, through its affects on blood flow, able to improve the availability of acetylcholine, another important neurotransmitter. These effects include:

  • stimulation of the synthesis of important neurotransmitters, thus increasing the capacity for physical activity, both voluntary and involuntary functioning (e.g. digestion, blood pressure regulation, hormone secretion, blood sugar regulation).
  • increasing the flow of blood to the brain & stimulating the growth of receptor sites, leading to increased cerebral capacity, manifested by improved memory and reasoning power, improved mood, improved reaction time, alertness and speech.
  • inhibiting the synaptic breakdown of neurotransmitters and so increasing their availability during neural stimulation. This will increase the efficiency of the nervous system, and thus improve mood, memory and self- mastery.

It is prescribed in orthodox medicine for a number of neurological and behavioral disorders of the elderly, in peripheral vascular deficiency and in some functional disorders of the ear, nose, throat and eye. Numerous controlled clinical trials have been conducted to justify this use and these excellent clinical findings are in agreement with pharmacological data currently available. Experimentally, Gingko extract is active on cerebral circulation, on neuronal metabolism threatened by oxygen lack, on neurotransmission and on neurone membrane lesions caused by free oxygenated radicals.3 Improvement of the functioning of the auditory nerve of the ear is discussed further in the section on Tinnitus.4 The herb offers much hope as a treatment in all types of dementia, and even in patients suffering from cognitive disorders secondary to depression, because of its beneficial effects on mood. Of special concern are people who are just beginning to experience deterioration in their cognitive function. Ginkgo might delay deterioration and enable these subjects to maintain a normal life.


Anyone can benefit from the use of Ginkgo, whether they are already experiencing the effects of aging on mental function, or just approaching that point. In addition, the herb is quite safe even in doses many times higher than those usually recommended.5 From the experimental and clinical findings it appears that the herb may act on a number of major elements in the causation of both Alzheimer’s and dementia. Current ideas about causes of Alzheimer’s include (amongst other things) free radical damage, vascular insufficiency, ischemia, cholinergic and noradrenergic dysfunction. Clinically Ginkgo is active on circulatory functions, on neuronal and metabolic consequences of ischemia and hypoxia, on neurotransmission, and on membrane resistance to free radical damage. All of clinical studies so far confirm that the diverse physiological effects of Ginkgo lead to positive effects on behavior, sense of well-being, decreased hospitalization and capacity for self-sufficiency. Free radicals have been implicated in the aging process and degenerative disease. The flavonoids of ginkgo, including quercetin, are extremely potent oxygen scavengers. Possessing a particular affinity for the central nervous system as well as the adrenal and thyroid glands, the herb is ideal for protecting the heart, blood vessels, and brain against the destructive impact of free radicals.


  • In one in vitro study it destroyed free radicals, blocking their formation and inhibiting membrane lipid peroxidation, a destructive effect for which free radicals are partly responsible. The herb also stimulates the biosynthesis of prostanoids, vaso-dilators having a hypotensive effect.
  • One of the side-effects of diabetes in rats is the gradual impairment of eye sight, thought to be due to free oxygenated radicals damaging the retina. Ginkgo significantly prevented the onset and severity of this damage.
  • Ginkgo improved visual acuity in patients suffering from senile macular degeneration, a condition that involves free radicals damage.
  • A protective effect against argon laser induced damage of retinal cells was found. Pretreatment with Ginkgo, by capturing free radicals, prevented significant tissue damage.

Clearly Ginkgo could be important herbal contribution to the treatment and prevention of Alzheimer’s disease. The French workers suggest that this herb fulfills the conditions laid down by the W.H.O. concerning the development of drugs that are both effective and safe against cerebral aging.6It would seem that yet again the plant kingdom is truly supplying our needs.




Digestive System


A wide range of remedies appropriate for digestive problems in Elders exist. Of the many possibilities, please review these remedies and ensure their various actions are familiar to you :



Agrimonia vulgare (Agrimony)

Althaea officinalis (Marshmallow)

Carduus marianum (Milk Thistle)

Chondrus crispus (Irish Moss)

Filipendula ulmaria (Meadowsweet)

Foeniculum vulgare (Fennel)

Gentiana lutea (Gentian)

Matricaria recutita (Chamomile)

Mentha piperita (Peppermint)

Rumex crispus (Yellow Dock)

Symphytum officinale (Comfrey )

Ulmus fulva (Slippery Elm)


Treatments outlined in the chapter on digestive problems are relevant here. Please refer to the following sections :

It is in the area of general symptomatic relief of digestive upsets that herbs have so much to offer. Using safe, normalizing herbal remedies it is possible to avoid the complication of side effects and minimize paradoxical reactions or synergistic drug interactions. This is especially the case where the digestive symptoms are produced by essential allopathic medication. A review of the sections indicated above will be helpful here.




Urinary System


Please review these remedies, each appropriate for urinary problems in Elders, ensuring their various actions are familiar to you :



Galium aparine (Cleavers)

Agropyron repens (Couchgrass)

Achillea millefolium (Yarrow)

Arctostaphylos uva-ursi (Bearberry)

Taraxacum officinalis folia (Dandelion leaf)

Sambucus nigra (Elder)


Treatments outlined in the chapter on respiratory problems are relevant here. Please refer to the following sections :




Reproductive System


Please review these remedies, each appropriate for problems of the reproductive system in Elders, ensuring their various actions are familiar to you :



Caulophyllum thalictroides (Blue Cohosh)

Chamaelirium luteum (False Unicorn Root)

Cimicifuga racemosa (Black Cohosh)

Leonurus cardiaca (Motherwort)

Mitchella repens (Partridge Berry)

Sabal serenoa (Saw Palmetto)

Senecio aureus (Life Root)

Turnera diffusa (Damiana)

Viburnum opulus (Cramp Bark)

Viburnum prunifolium (Black Haw)

Vitex agnus-castis (Chasteberry)


Treatments outlined in the chapter on respiratory problems are relevant here. Please refer to the following sections :




Musculo-Skeletal System


There are a range of remedies appropriate for musculo/skeletal problems in Elders, each having its distinct area of application. Please review these remedies and ensure their various actions are familiar to you :



Apium graveolens (Celery Seed)

Angelica archangelica (Angelica)

Betula spp. (Birch)

Cimicifuga racemosa (Black Cohosh)

Dioscorea villosa (Wild Yam)

Filipendula ulmaria (Meadowsweet)

Menyanthes trifoliata (Bogbean)

Salix spp. (Willow Bark)

Urtica dioica (Nettles)

Tussilago farfara (Coltsfoot)


A number of stronger effectors may be found useful in more intransigent conditions, but these should be reserved for the cases where the gentler herbs have not produced the results desired. Thus:


Guaiacum officinale (Guaiacum)

Zanthoxylum americanum (Prickly Ash)

Harpagophytum procumbens (Devil’s Claw)


Treatments outlined in the chapter on musculo/skeletal system are relevant here. Please refer to the following sections :

The phytotherapist has, yet again, the gift of toning herbs for use in these problems. The emphasis on toning throughout the course bears fruit with the muscle and joint problems. There is usually no need to resort to intense treatments as the milder `anti-rheumatics’ are often effective, given time. This is not to claim that such treatments will completely remove osteo-arthritis and its damage in someone who has had it for years. However they will feel better and move to the best place they can be taking into account any structural damage that has occurred over the years. It is always important to address, as a priority, any digestive symptoms that may be present with older patients with rheumatic conditions.





Osteoporosis





Skin


As with all of the body systems there are a range of remedies appropriate for skin problems in Elders, each having its distinct area of application with some for external use only. Many of the essential oils are helpful as topical application. Please review these remedies and ensure their various actions are familiar to you :



Galium aparine (Cleavers)

Urtica dioica (Nettles)

Trifolium pratense (Red Clover)

Viola tricolor (Heartsease)

Plantago media (Plantain)

Leonurus cardiaca (Motherwort)

Stellaria media (Chickweed)

Calendula officinalis (Wild Cherry Bark)

Hypericum perforatum (St., John’s Wort)


Treatments outlined in the chapter on respiratory problems are relevant here. Please refer to the following sections :

Prescription Drug Reactions – Possible Herbs to Ameliorate Reaction Common Drug Side-Effects

Symptom (Possible Drug Triggers) Drowsiness (Anti-histamines, codeine, tranquilizers, sedatives) Nausea (Almost anything) Ulcers (Aspirin, other nonsteroidal anti-inflammatory drugs) Dizziness (Drugs used for treating hypertension, plus others) Bleeding (Aspirin, heparin, anti-coagulants) Bruising (Aspirin, steroids e.g. prednisone) Skin eruptions (Antibiotics, almost anything) Memory loss/confusion (Tranquilizers, codeine, sedatives, anti-histamines) Fluid retention (Anti-inflammatory drugs, steroids, many others) Diarrhoea (Some antacids, almost anything)




Footnotes


1. Bensky & Gamble: Chinese Herbal Medicine , 1986, Eastland Press.


2. Clostre F: From the body to the cell membrane: the different levels of pharmacological action of Ginkgo biloba extract. PRESSE MED 1986 Sep 25; 15(31):1529-38.


3. Gautherie et.al.: Vasodilator effect of Gingko bilobaextract determined by skin thermometry and thermography. THERAPIE (Sep-Oct 72) 27(5):881-92.


4. Stange et.al.: Adaptational behaviour of peripheral and centralacoustic responsesin guinea pigs under the influence of various fractionsof an extract from Gingko biloba. ARZNEIM FORSCH (1976) 26(3):367-74.


5. Warburton DM: Clinical psychopharmacology of Ginkgo bilobaextract PRESSE MED 1986 Sep 25; 15(31):1595-604.


6. Allard M: Treatment of the disorders of aging with Ginkgobiloba extract. From pharmacology to clinical medicine. PRESSE MED 1986 Sep 25; 15(31):1540-5.

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David L. Hoffmann BSc Hons MNIMH Written by David L. Hoffmann BSc Hons MNIMH

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