Gan Mao Qing Re Ke Li (Sugar Added) by Wing Quon Enterprises Ltd.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Amenorrhea. Although there has been interest in using oral Angelica archangelica for amenorrhea, there is insufficient reliable information about the clinical effects of Angelica archangelica for this condition.
• Anxiety. Although there has been interest in using oral Angelica archangelica for anxiety, there is insufficient reliable information about the clinical effects of Angelica archangelica for this condition.
• Cognitive impairment. Oral Angelica archangelica has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: In patients aged 65-85 years with mild cognitive impairment, taking Angelica archangelica extract 20 mg combined with ferulic acid 100 mg (Feru-Guard, Glovia Co. Ltd.) twice daily for 24 weeks improves scores on the Mini-Mental State Examination when compared with placebo (106409).
• Cough. Although there has been interest in using oral Angelica archangelica for cough, there is insufficient reliable information about the clinical effects of Angelica archangelica for this condition.
• Dementia. Although there has been interest in using oral Angelica archangelica for dementia, there is insufficient reliable information about the clinical effects of Angelica archangelica for this condition.
• Dyspepsia. Oral Angelica archangelica has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A specific combination product (Iberogast, Medical Futures, Inc) containing Angelica archangelica root, peppermint leaf, clown's mustard plant, German chamomile flowers, caraway fruit, licorice root, milk thistle fruit, celandine herb, and lemon balm leaves seems to improve symptoms of dyspepsia. A meta-analysis of studies using this combination shows that taking 1 mL orally three times daily for 4 weeks reduces the severity of acid reflux, epigastric pain, cramping, nausea, and vomiting when compared with placebo (13089).
• Flatulence. Although there has been interest in using oral Angelica archangelica for flatulence, there is insufficient reliable information about the clinical effects of Angelica archangelica for this purpose.
• Insomnia. Although there has been interest in using oral Angelica archangelica for insomnia, there is insufficient reliable information about the clinical effects of Angelica archangelica for this condition.
• Nocturia. It is unclear if oral Angelica archangelica is beneficial in patients with nocturia. Details: Clinical research shows that taking a specific Angelica archangelica leaf extract (SagaPro, SagaMedica) 2 tablets daily for 8 weeks does not improve overall nocturia symptoms, including the number of overnight voids or the volume of urine. However, in individuals with a decreased bladder capacity, the number of voids per hour decreases by 43%, compared to 26% with placebo (92461).
• Rheumatoid arthritis (RA). Although there has been interest in using oral Angelica archangelica for RA, there is insufficient reliable information about the clinical effects of Angelica archangelica for this condition.
• Smoking cessation. It is unclear if inhaling the aroma of Angelica archangelica root essential oil is beneficial for people wanting to stop use of tobacco. Details: Preliminary clinical research in patients addicted to dipping, chewing, or smoking tobacco shows that placing a drop of Angelica archangelica root essential oil on tissue paper and inhaling for 2 minutes at least three times a day for 3 days reduces nicotine cravings when compared with baseline (90502). The validity of these results is limited by the lack of a comparator group.
• Stroke. Although there has been interest in using oral Angelica archangelica for stroke, there is insufficient reliable information about the clinical effects of Angelica archangelica for this condition. More evidence is needed to rate Angelica archangelica for these uses.

(Read more about ANGELICA ARCHANGELICA)

There is insufficient reliable information available about the effectiveness of apricot.

(Read more about APRICOT)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. Although there has been interest in using oral bupleurum for asthma, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Autoimmune thyroiditis. Oral bupleurum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with Hashimoto's thyroiditis receiving conventional levothyroxine supplementation shows that taking bupleurum 10 grams in combination with other traditional Chinese medicines for 8 weeks improves thyroid antibody levels, thyroid stimulating hormone levels, depression scores, and anxiety scores when compared with control at 24 weeks follow up. However, TSH levels were normalized by week 8 in both groups, and bupleurum does not improve free T3 or T4 levels (112353). It is unclear if these effects are due to bupleurum, other ingredients, or the combination.
• Cancer. Although there has been interest in using oral bupleurum for cancer, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Depression. Oral bupleurum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of 55 Chinese studies shows that taking herbal combinations which include Bupleurum chinense root for 2-12 weeks slightly reduces depression severity on the Hamilton Rating Scale for Depression (HRSD) when compared with fixed standard doses of selective serotonin reuptake inhibitors (SSRIs). Using bupleurum mixtures in combination with SSRIs greatly reduces depression severity on the HRSD when compared with SSRIs alone (104103). However, the validity of this analysis is limited by considerable heterogeneity amongst the studies, which were generally of low quality and at a high risk of bias. There were 49 different bupleurum-containing formulas used in the included studies, and these contained 103 different herbs. It is unclear whether any effects were due to bupleurum, other herbs, or the combinations. It is also unclear what the depression severity was at baseline, whether SSRIs were given in sufficient doses and durations, and whether patients were treatment-naïve.
• Dysmenorrhea. Although there has been interest in using oral bupleurum for dysmenorrhea, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Epilepsy. Although there has been interest in using oral bupleurum for epilepsy, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Hepatitis B. Oral bupleurum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with chronic hepatitis B shows that taking a specific combination product (sho-saiko-to) 5.4 grams daily for 24 weeks decreases liver enzyme levels when compared with taking this same combination product at a dose of 0.5 grams daily (37391). Another small clinical study in children with chronic hepatitis B shows that taking this same combination product at an unknown dose increases the production of hepatitis B antibodies and increases the clearance of hepatitis B virus when compared with historical controls (37384). However, the clinical significance of these changes is unknown.
• Influenza. Oral bupleurum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with H1N1 influenza shows that taking a specific bupleurum-containing combination decoction (chima qingwen) twice daily for 5 days is as effective as taking oseltamivir 75 mg twice daily for 5 days for improving symptoms by at least 30% (100167).
• Liver cancer. Oral bupleurum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with hepatitis B and liver cirrhosis shows that taking a specific bupleurum-containing combination product (sho-saiko-to, TJ-9, Tsumura and Co.) 7.5 grams daily for 60 months along with conventional medicine reduces the risk of developing liver cancer when compared with conventional treatment alone in patients without anti-hepatitis B antibodies. Taking this combination product did not reduce the risk of developing liver cancer in patients with anti-hepatitis B antibodies (37410).
• Pain. Although there has been interest in using oral bupleurum for pain, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Peptic ulcers. Although there has been interest in using oral bupleurum for peptic ulcers, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Respiratory tract infections. Although there has been interest in using oral bupleurum for various respiratory tract infections, including bronchitis and the common cold, there is insufficient reliable information about the clinical effects of bupleurum for these conditions. More evidence is needed to rate bupleurum for these uses.

(Read more about BUPLEURUM)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Constipation. Oral Corydalis yanhusuo has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with functional constipation shows that taking a specific supplement (Motilitone, Dong-A ST) containing 30 mg of Corydalis yanhusuo and Pharbitis seed extracts three times daily before meals for 24 days improves colonic transit time, stool frequency, and symptoms of abdominal discomfort and pain when compared to baseline. At the start of the study, 63% of patients reported less than one stool per week. At the end of the study, 78% of patients were experiencing one or more stools per week, with 11% of patients reporting more than three stools per week (97159). The validity of these findings is limited by a lack of placebo control group.
• Depression. Although there has been interest in using oral Corydalis yanhusuo for depression, there is insufficient reliable information about the clinical effects of Corydalis yanhusuo for this purpose.
• Dysmenorrhea. Although there has been interest in using oral Corydalis yanhusuo for dysmenorrhea, there is insufficient reliable information about the clinical effects of Corydalis yanhusuo for this purpose.
• Dyspepsia. Oral Corydalis yanhusuo has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One clinical trial in patients with functional dyspepsia shows that taking a specific supplement (Motilitone, Dong-A ST) containing 30 mg of Corydalis yanhusuo and Pharbitis seed extracts three times daily before meals for 4 weeks improves dyspepsia to a similar degree as pantoprazole 40 mg (97158).
• Gastroesophageal reflux disease (GERD). Oral Corydalis yanhusuo has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with GERD shows that taking a specific supplement (Motilitone, Dong-A ST) containing 30 mg of Corydalis yanhusuo and Pharbitis seed extracts three times daily before meals for 4 weeks does not improve symptoms of dyspepsia or quality of life when compared with placebo (97160).
• Headache. Although there has been interest in using oral Corydalis yanhusuo for headache, there is insufficient reliable information about the clinical effects of Corydalis yanhusuo for this purpose.
• Helicobacter pylori. Although there has been interest in using oral Corydalis yanhusuo for Helicobacter pylori, there is insufficient reliable information about the clinical effects of Corydalis yanhusuo for this purpose. More evidence is needed to rate Corydalis yanhusuo for these uses.

(Read more about CORYDALIS YANHUSUO)

POSSIBLY EFFECTIVE

• Alcohol use disorder. Oral kudzu seems to be beneficial for reducing alcohol consumption in heavy drinkers; however, it may not be beneficial in those with chronic alcohol use disorder. Details: Some research shows that heavy drinkers who take a specific kudzu root extract (Alkontrol-Herbal; NPI-031; Natural Pharmacia International, Inc.) 0.5-1 grams three times daily for 1-4 weeks consume less beer when given an opportunity to drink and may have more abstinent days (13085,92257). Other research shows that binge drinkers who take kudzu extract 2 grams as a single dose 2.5 hours prior to a 90-minute binge drinking episode consume 37% fewer beers than those taking placebo (92258). However, kudzu does not seem to decrease the craving for alcohol (10386,13085,57948,92257). Kudzu extract also does not seem to improve sobriety in people with chronic alcohol use disorder (10386).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Although there is interest in using oral kudzu for allergic rhinitis, there is insufficient reliable information about the clinical effects of kudzu for this condition.
• Angina. Although there is interest in using the injectable kudzu constituent puerarin for angina, there is insufficient reliable information about the clinical effects of oral kudzu for this condition.
• Angioplasty. Although there is interest in using the injectable kudzu constituent puerarin in patients undergoing percutaneous transluminal coronary angioplasty (PTCA), there is insufficient reliable information about the clinical effects of oral kudzu for this condition.
• Athletic performance. Oral kudzu has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study in healthy males shows that taking capsules containing kudzu isoflavone extract 180 mg, soybean peptides 600 mg, taurine 200 mg, and ginseng saponins 120 mg daily in two divided doses for 15 days can significantly increase time to exhaustion during exercise when compared with placebo (57945).
• Back pain. Although there is interest in using the injectable kudzu constituent puerarin for back pain, there is insufficient reliable information about the clinical effects of oral kudzu for this condition.
• Cluster headache. Although there is interest in using oral kudzu for cluster headache, there is insufficient reliable information about the clinical effects of kudzu for this condition.
• Coronary heart disease (CHD). Although there is interest in using the injectable kudzu constituent puerarin for CHD, there is insufficient reliable information about the clinical effects of oral kudzu for this condition.
• Diabetes. It is unclear if oral kudzu is beneficial for diabetes. Details: Preliminary clinical research in adults with type 2 diabetes shows that taking oral puerarin, a kudzu constituent, 250 mg three times daily in addition to rosiglitazone 4 mg daily for 12 weeks reduces blood glucose levels and glycated hemoglobin (HbA1c) when compared to baseline (57951). The effect of kudzu alone is unclear. Additionally, the lack of a comparator group limits the validity of this finding.
• Diabetic nephropathy. It is unclear if oral kudzu is beneficial for diabetic nephropathy. Details: Preliminary clinical research in patients with diabetic nephropathy shows that taking puerarin, a kudzu constituent, 250 mg three times daily in addition to rosiglitazone 4 mg daily for 12 weeks improves laboratory measurements of kidney function, including serum creatinine, blood urea nitrogen, and urinary albumin, when compared to baseline (57951). The effect of kudzu alone is unclear. Additionally, the lack of a comparator group limits the validity of this finding.
• Hangover. Although there is interest in using oral kudzu for hangover, there is insufficient reliable information about the clinical effects of kudzu for this condition.
• Heart failure. Although there is interest in using the kudzu constituent puerarin for heart failure, there is insufficient reliable information about the clinical effects of kudzu for this condition.
• Hypertension. It is unclear if oral kudzu is beneficial for hypertension. Details: Preliminary clinical research in adults with hypertension shows that taking kudzu powder 1.5 grams twice daily for 12 weeks decreases systolic blood pressure by 16% and diastolic blood pressure by 12% when compared to baseline (92261). The validity of this finding is limited by the lack of a comparator group.
• Menopausal symptoms. Small clinical studies suggest that oral kudzu may modestly improve menopausal symptoms. Details: Preliminary clinical research shows that taking kudzu 25 mg, 50 mg, or 100 mg daily for 6 months during perimenopause improves climacteric symptoms based on a modified Green climacteric scale when compared with baseline (57890,57942). Other preliminary clinical research in patients with menopausal symptoms shows that taking kudzu extract 0.84-2.52 grams daily for 4 weeks, providing puerarin 113-338 mg daily, modestly reduces overall menopausal symptoms when compared with baseline (108154). The validity of the findings from these studies is limited by the lack of a comparator group. Other clinical research shows that taking kudzu 50 mg daily for 6 months during perimenopause reduces vasomotor symptoms similarly to taking conjugated equine estrogen 0.625 mg with or without medroxyprogesterone acetate 2.5 mg daily (57927).
• Migraine headache. It is unclear if oral kudzu is beneficial for migraine headache. Details: Preliminary clinical research in adults with migraine shows that taking one capsule of kudzu (Kuzik) daily, providing an unspecified dose of kudzu, for 90 days reduces the number of headache attacks per month by about 3, with approximately 50% of patients achieving a 50% reduction in monthly headache days when compared with baseline. There were also modest improvements in disability and medication use (108155). The validity of these findings is limited by the lack of a comparator group.
• Myocardial infarction (MI). Although there is interest in using the injectable kudzu constituent puerarin for MI, there is insufficient reliable information about the clinical effects of oral kudzu for this condition.
• Obesity. It is unclear if oral kudzu is beneficial for obesity. Details: Preliminary clinical research in adults with obesity shows that taking a kudzu extract 300 mg daily for 12 weeks reduces visceral fat and body mass index (BMI) when compared with placebo. However, doses of 200 mg do not seem to be as effective (57954).
• Postmenopausal conditions. It is unclear if oral or intravaginal kudzu is beneficial for postmenopausal conditions. Details: A small clinical study in postmenopausal individuals shows that taking kudzu containing isoflavones 100 mg orally once daily for 3 months improves flexible thinking and attention when compared with control. However, it does not appear to improve total cholesterol, low-density lipoprotein (LDL) cholesterol, or sex hormone levels (11386). Another small clinical study in postmenopausal individuals shows that taking kudzu 20 mg, 30 mg, or 50 mg daily for 24 weeks improves vaginal dryness and pH when compared with baseline, but not when compared with placebo. It also decreases a specific biomarker of bone turnover, called bone alkaline phosphatase, when compared with placebo (57924,57929). It is unclear if this correlates with improved bone density or with a reduced risk of osteoporosis. Kudzu has also been evaluated as an intravaginal gel. One small clinical study shows that applying 0.5 grams of kudzu 6% gel into the vagina every night for 2 weeks, followed by 3 nights each week for 9 weeks, improves vaginal symptoms of dryness, soreness, irritation, and abnormal discharge similarly to conjugated estrogen cream applied on the same schedule. However, kudzu gel is less effective than conjugated estrogen cream for improving overall vaginal health (96740). Another small clinical study of postmenopausal patients shows that applying 0.5 grams of kudzu 6% gel intravaginally every night for 3 weeks increases vaginal arterial blood flow and restores atrophic vaginal tissue when compared with placebo after 12 weeks (110702). In contrast, a similar study shows that applying 0.5 grams of kudzu 5% gel into the vagina every night for 2 weeks, followed by 3 nights each week for 10 weeks, does not improve vaginal symptoms when compared with placebo gel (105521). However, the study may have been inadequately powered to detect a difference between groups.
• Rhinosinusitis. Although there is interest in using oral kudzu for rhinosinusitis, there is insufficient reliable information about the clinical effects of kudzu for this condition.
• Stroke. Although there is interest in using the injectable kudzu constituent puerarin for stroke, there is insufficient reliable information about the clinical effects of oral kudzu for this condition. More evidence is needed to rate kudzu for these uses.

(Read more about KUDZU)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related cognitive decline. It is unclear if oral perilla is beneficial in patients with age-related cognitive decline. Details: Preliminary clinical research in healthy elderly adults shows that taking perilla seed oil 7 mL orally daily for 12 months does not improve cognitive function scores when compared with placebo. However, the study may have been inadequately powered to detect a difference between groups (110612). Other preliminary clinical research in healthy adults at least 60 years of age shows that taking perilla seed oil 1.47 mL orally daily for 12 months does not improve cognitive function scores when compared with baseline. However, taking perilla seed oil 1.47 mL plus ponkan powder 1.12 grams modestly improved cognitive function scores (110615).
• Allergic rhinitis (hay fever). It is unclear if oral perilla is beneficial in patients with allergic rhinitis. Details: Preliminary clinical research in patients with seasonal allergic rhinoconjunctivitis shows that taking perilla extract 50 or 200 mg orally daily for 21 days decreases symptoms such as itchy nose, watery eyes, itchy eyes, and total symptoms when compared with placebo (68658).
• Asthma. It is unclear if oral perilla is beneficial in patients with asthma. Details: Two very small clinical studies in adults with mild asthma show that taking perilla seed oil 10-20 grams orally daily for 4 weeks modestly improves peak expiratory flow, forced vital capacity, and forced expiratory volume in 1 second when compared with baseline and placebo (1338,65485).
• Cancer. Although there has been interest in using oral perilla for cancer, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Canker sores. It is unclear if oral perilla is beneficial in patients with canker sores. Details: Preliminary clinical research in patients with recurrent canker sores shows that using perilla seed oil as the only type of cooking oil for 8 months does not decreases the incidence of canker sores any better than using soybean oil (68676).
• Common cold. Although there has been interest in using oral perilla for the common cold, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Constipation. It is unclear if oral perilla is beneficial in patients with constipation. Details: Preliminary clinical research shows that taking a specific perilla leaf extract (Benegut, Vital Solutions GmbH) 150 mg orally twice daily for 4 weeks does not improve bloating, abdominal discomfort, gas, feelings of fullness, or stool frequency when compared with placebo in healthy adults who complain of gastrointestinal discomfort and reduced bowel movements (94312).
• Cough. Although there has been interest in using oral perilla for cough, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Dementia. It is unclear if oral perilla is beneficial in patients with dementia. Details: Preliminary clinical research in patients with mild to moderate dementia shows that taking perilla seed oil 1 gram orally three times daily for 6 months does not improve cognitive function when compared with placebo (101808).
• Depression. Although there has been interest in using oral perilla for depression, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Headache. Although there has been interest in using oral perilla for headache, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Nausea and vomiting. Although there has been interest in using oral perilla for nausea and vomiting, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Osteoporosis. Although there has been interest in using oral perilla for osteoporosis, there is insufficient reliable information about the clinical effects of perilla for this purpose. More evidence is needed to rate perilla for these uses.

(Read more about PERILLA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Breast Cancer. Although there has been interest in using oral reed herb for breast cancer, there is insufficient reliable information about the clinical effects of reed herb for this purpose.
• Diabetes. Although there has been interest in using oral reed herb for diabetes, there is insufficient reliable information about the clinical effects of reed herb for this purpose.
• Insect bite. Although there has been interest in using topical reed herb for insect bites, there is insufficient reliable information about the clinical effects of reed herb for this purpose.
• Leukemia. Although there has been interest in using oral reed herb for leukemia, there is insufficient reliable information about the clinical effects of reed herb for this purpose. More evidence is needed to rate reed herb for these uses. There is insufficient reliable information available about the effectiveness of reed herb.

(Read more about REED HERB)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Angelica archangelica has Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of Angelica archangelica when used orally or topically for medicinal purposes.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about ANGELICA ARCHANGELICA)

LIKELY SAFE ...when apricot fruit or juice is consumed as food. There is insufficient reliable information available about the safety of apricot fruit, juice, or leaves when used orally for medicinal purposes.

PREGNANCY AND LACTATION: LIKELY SAFE
when apricot fruit or juice is consumed as food. There is insufficient reliable information available about the safety of apricot fruit, juice, or leaves when used orally for medicinal purposes; avoid use.

(Read more about APRICOT)

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts. Bupleurum has been used with apparent safety as part of a multi-ingredient decoction (sho-saiko-to) for up to 5 years (37391,37410). It has also been used with apparent safety as part of another multi-ingredient decoction (chima qingwen) at doses of up to 40 grams bupleurum daily for up to 5 days (100167).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about BUPLEURUM)

POSSIBLY SAFE ...when used orally, short-term. A specific supplement (Motilitone, Dong-A ST) containing Corydalis yanhusuo extract in combination with Pharbitis seed extract has been used with apparent safety in a dose of 90 mg daily for up to 4 weeks in clinical research (97158,97159,97160). There is insufficient reliable information available about the safety of Corydalis yanhusuo when used orally as a single ingredient.

CHILDREN: LIKELY UNSAFE
when used orally in newborns. The berberine constituent of Corydalis yanhusuo can cause kernicterus in newborns, particularly preterm neonates with hyperbilirubinemia (2589).

PREGNANCY: LIKELY UNSAFE
when used orally. Corydalis yanhusuo might promote menstrual flow and stimulate uterine contractions (12). The berberine constituent of Corydalis yanhusuo is thought to cross the placenta and may cause harm to the fetus. Kernicterus has developed in newborn infants exposed to berberine (2589).

LACTATION: LIKELY UNSAFE
when used orally. The berberine constituent of Corydalis yanhusuo and other harmful constituents can be transferred to the infant through breast milk (2589).

(Read more about CORYDALIS YANHUSUO)

POSSIBLY SAFE ...when used orally and appropriately. Kudzu appears to be safe for up to 4 months (10386,11386,92257). ...when used intravaginally and appropriately. Kudzu 5% to 6% gel has been used with apparent safety for up to 12 weeks (96740,105521,110702).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about KUDZU)

POSSIBLY SAFE ...when perilla oil or extract is used orally and appropriately. There is some evidence that perilla can be safely used for up to 12 months (1338,68676,94312,105525).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about PERILLA)

(Read more about ANGELICA ARCHANGELICA)

(Read more about APRICOT)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, bupleurum might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.  Details In vitro research suggests that saikosaponins, constituents of bupleurum, can inhibit platelet aggregation (3159,3156).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, bupleurum might decrease the effects of antidiabetes drugs.  Details Animal research suggests that saikosaponins, constituents of bupleurum, can increase blood glucose (37402,37403).

IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, bupleurum might decrease the effects of immunosuppressants.  Details In vitro and animal research suggests that bupleurum might stimulate immune function (2598,3160,3161).

(Read more about BUPLEURUM)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.  Details Corydalis yanhusuo contains berberine. In vitro and in vivo research suggest that berberine can inhibit platelet aggregation (33660,33694). Theoretically, Corydalis yanhusuo might also inhibit platelet aggregation.

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo may increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Corydalis yanhusuo contains berberine. Clinical research shows that berberine may lower blood glucose levels (20579,34247,34265,34282). Theoretically, Corydalis yanhusuo might also lower blood glucose levels.

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might have additive effects with antihypertensive drugs.  Details Corydalis yanhusuo contains berberine. Animal research suggests that berberine can have hypotensive effects (33692,34308). Also, a clinical study suggests that taking berberine in combination with amlodipine can lower systolic and diastolic blood pressure when compared with amlodipine alone (91956). Theoretically, Corydalis yanhusuo might also reduce blood pressure.

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might increase the sedative effects of CNS depressants.  Details Corydalis yanhusuo contains berberine. Animal research suggests that berberine may have sedative effects (13519,33650,33664,33692). Theoretically, Corydalis yanhusuo might also have CNS depressants effects.

CYCLOSPORINE (Neoral, Sandimmune) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might increase blood levels of cyclosporine.  Details Corydalis yanhusuo contains berberine. Preliminary clinical research shows that berberine can reduce metabolism of cyclosporine and increase serum levels, likely through inhibition of cytochrome P450 3A4 (CYP3A4), which metabolizes cyclosporine (13524). Theoretically, Corydalis yanhusuo might also reduce the metabolism of cyclosporine.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might increase serum levels of drugs metabolized by CYP2C9.  Details Corydalis yanhusuo contains berberine. Preliminary clinical research shows that berberine can inhibit CYP2C9 (34279). Theoretically, Corydalis yanhusuo might also inhibit CYP2C9.

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might increase serum levels of drugs metabolized by CYP2D6.  Details Corydalis yanhusuo contains berberine. In vitro research and preliminary clinical evidence show that berberine can inhibit CYP2D6 (21117,34279,34297). Theoretically, Corydalis yanhusuo might also inhibit CYP2D6.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might increase serum levels of drugs metabolized by CYP3A4.  Details Corydalis yanhusuo contains berberine. In vitro research and preliminary clinical research show that berberine moderately inhibits CYP3A4 (13524,21114,34279,34297). Theoretically, Corydalis yanhusuo might also inhibit CYP3A4.

DEXTROMETHORPHAN (Robitussin DM, others) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo may increase serum levels of dextromethorphan.  Details Corydalis yanhusuo contains berberine. Preliminary clinical research shows that berberine can inhibit cytochrome P450 2D6 (CYP2D6) activity and reduce the metabolism of dextromethorphan (34279). Theoretically, Corydalis yanhusuo may also inhibit the metabolism of dextromethorphan.

LOSARTAN (Cozaar) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might reduce the therapeutic effects of losartan by decreasing its conversion to its active form.  Details Corydalis yanhusuo contains berberine. Preliminary clinical research suggests that berberine can inhibit cytochrome P450 2C9 (CYP2C9) activity and reduce metabolism of losartan (34279). Theoretically, Corydalis yanhusuo might also inhibit the metabolism of losartan.

METFORMIN (Glucophage) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might increase the therapeutic and adverse effects of metformin.  Details Corydalis yanhusuo contains berberine. In vitro and animal studies show that berberine can increase the systemic exposure and half-life of metformin, potentially increasing metformin's effects and side effects. This interaction seems to be most apparent when berberine is administered 2 hours prior to metformin. Taking berberine and metformin at the same time does not appear to increase systemic exposure to metformin (103195). It is unclear if Corydalis yanhusuo might have this same effect.

MIDAZOLAM (Versed) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might reduce metabolism of midazolam, which might increase the risk of severe adverse effects.  Details Corydalis yanhusuo contains berberine. Preliminary clinical research shows that berberine can inhibit cytochrome P450 3A4 (CYP3A4) activity and reduce metabolism of midazolam (34279). Theoretically, Corydalis yanhusuo might also inhibit the metabolism of midazolam.

PENTOBARBITAL (Nembutal) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might increase the sedative effect of pentobarbital.  Details Corydalis yanhusuo contains berberine. Animal research shows that berberine can prolong pentobarbital-induced sleeping time (13519). Theoretically, Corydalis yanhusuo might increase the sedative effects of pentobarbital.

TACROLIMUS (Prograf) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Corydalis yanhusuo might increase blood levels of tacrolimus.  Details Corydalis yanhusuo contains berberine. In a 16-year-old patient with idiopathic nephrotic syndrome who was being treated with tacrolimus 6.5 mg twice daily, intake of berberine 200 mg three times daily increased the blood concentration of tacrolimus from 8 to 22 ng/mL. Following a reduction of the tacrolimus dose to 3 mg daily, blood levels of tacrolimus decreased to 12 ng/mL (91954). It is unclear if Corydalis yanhusuo might have this same effect.

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, kudzu may increase the risk of bleeding if used with antiplatelet or anticoagulant drugs.  Details Kudzu isoflavones are reported to have antiplatelet activity (13278,13291).

ANTIDIABETES DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, taking kudzu with antidiabetes drugs might increase the risk of hypoglycemia.  Details Kudzu might lower blood glucose levels and have additive effects in patients treated with antidiabetic agents (13285,13292,57868,57951). The dose of diabetes medications might need to be adjusted.

CAFFEINE Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking kudzu with caffeine might increase levels of caffeine.  Details In healthy males injected with the kudzu constituent puerarin, caffeine clearance and metabolism is inhibited (23583). This effect has been attributed to inhibition of cytochrome P450 1A2 (CYP1A2) enzyme, which is involved in caffeine metabolism. It is unclear if taking kudzu orally would have this same effect.

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, kudzu might alter the effects of estrogen therapy.  Details Some research suggests that kudzu has estrogenic effects (11386,57874,57877). This may enhance or inhibit the effects of estrogen therapy.

HEPATOTOXIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use might have additive hepatotoxic effects.  Details There is some concern that kudzu can adversely affect the liver (88777,92259,92260,92262).

METHOTREXATE (Trexall, others) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking kudzu with methotrexate might increase the risk of methotrexate toxicity.  Details Preclinical research suggests that kudzu extract greatly reduces the elimination and increases the toxicity of methotrexate. Kudzu might inhibit organic anion transporters (OATs) that are responsible for hepatobiliary and renal excretion of anions, similar to the interaction between methotrexate and non-steroidal anti-inflammatory drugs (NSAIDs) (13296).

TAMOXIFEN (Nolvadex) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Theoretically, kudzu might interfere with tamoxifen activity.  Details Some research suggests that kudzu may have estrogenic effects (11386,110702).

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General ...Orally, Angelica archangelica is generally well tolerated in food amounts. There is limited information available about the adverse effects of Angelica archangelica when used as medicine.
Most Common Adverse Effects:
Orally: Constipation, photosensitivity.

Dermatologic ...Orally or topically, Angelica archangelica might cause photosensitivity reactions (13406). Patients who take Angelica archangelica orally or apply it topically should be advised to avoid prolonged exposure to the sun. Some constituents of the leaves have a strong irritant effect on the skin and mucous membranes, referred to as "angelica dermatitis" (18).

Gastrointestinal ...Orally, Angelica archangelica has been reported to cause constipation in one out of 21 patients taking a specific Angelica archangelica leaf extract (SagaPro, SagaMedica) (92461).

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General ...There is currently a limited amount of information available on the adverse effects of apricot. A thorough evaluation of safety outcomes has not been conducted.

Hematologic ...Orally, a case of post-operative epidural hematoma following spinal surgery was reported in a generally healthy 54-year-old male with no history of medication use and normal pre-operative laboratory results. The patient consumed approximately 8-10 kg of dried apricots in the week leading up to surgery, with the most recent consumption 6 hours prior. Twelve hours post-surgery, his prothrombin time (PT) was modestly elevated, and he complained of right leg weakness. Additionally, thromboelastometry results 3 days post-surgery show prolonged clot formation time (CFT) (115466).

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General ...Orally, bupleurum seems to be well tolerated. However, most research has evaluated bupleurum in combination with other ingredients; the adverse effects of bupleurum when used alone are unclear.

Gastrointestinal ...Orally, a specific bupleurum-containing combination product (sho-saiko-to) has been reported to cause nausea, anorexia, and abdominal fullness (37391). It is unclear if these adverse effects are due to bupleurum, other ingredients, or the combination.

Hepatic ...Orally, a specific bupleurum-containing combination product (sho-saiko-to) has been associated with at least 24 reported cases of hepatotoxicity (92575). It is unclear if these adverse effects are due to bupleurum, other ingredients, or the combination.

Neurologic/CNS ...Orally, a specific bupleurum-containing combination product (sho-saiko-to) has been reported to cause fatigue and paresthesia (37391). It is unclear if these adverse effects are due to bupleurum, other ingredients, or the combination.

Pulmonary/Respiratory ...Orally, combination products containing bupleurum have been reported to cause eosinophilic pneumonia (354), pulmonary edema (361), and multiple cases of pneumonitis (355,356,357,37404). A specific combination product (sho-saiko-to), used in combination with interferon-alpha in patients with chronic active hepatitis, has also been associated with multiple cases of pneumonitis (358,359,360). It is unclear if these adverse effects are due to bupleurum, other ingredients, or the combination.

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General ...Orally, Corydalis yanhusuo is generally well tolerated.
Serious Adverse Effects (Rare):
Orally: Clonic spasms and muscle tremors with high doses.

Musculoskeletal ...Orally, clonic spasms and muscle tremors may occur with overdoses of Corydalis yanhusuo (18).

(Read more about CORYDALIS YANHUSUO)

General ...Orally and intravaginally, kudzu seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Elevated liver transaminases.

Cardiovascular ...Orally, side effects of kudzu reported in clinical trials have included palpitations and chest discomfort; however, these effects did not occur more frequently than with placebo (57924,57927).

Dermatologic ...Orally, a side effect of kudzu reported in one clinical trial has included urticaria; however, this effect did not occur more frequently than with placebo (57924). There is one case report of allergic reaction following use of a combination herbal product (Kakkonto) containing kudzu involving a maculopapular eruption starting on the thighs and spreading over the entire body (13111,57886).

Gastrointestinal ...Orally, some side effects of kudzu reported in clinical trials have included nausea, dyspepsia, and bloating; however, these effects did not occur more frequently than with placebo (57927,57942).

Genitourinary ...Intravaginally, irritation of the vulva has been reported with kudzu gel. These cases were generally mild and transient (110702).

Hematologic ...Intravenously, the kudzu derivative, puerarin, has caused intravascular hemolysis (13298,15025,57947).

Hepatic ...Orally, there are several cases reports of liver injury following use of kudzu involving elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels (88777,92260).

Neurologic/CNS ...Orally, a side effect of kudzu reported in one clinical trial has included dizziness; however, this effect did not occur more frequently than with placebo (57924).

Other ...Orally, a side effect of kudzu reported in one clinical trial has included mastodynia; however, this effect did not occur more frequently than with placebo (57942).

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General ...Orally, perilla seems to be well tolerated. Topically, there is currently a limited amount of information on the adverse effects of perilla.
Most Common Adverse Effects:
Topically: Dermatitis.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis.

Dermatologic ...Topically, perilla may cause contact dermatitis (6,68664,94313).

Immunologic ...Orally, many cases of anaphylaxis have been reported in adults and children who consumed perilla seeds (94313,110611). Some research suggests that oleosin is the major constituent responsible for perilla allergies (110611).

Pulmonary/Respiratory ...Occupational asthma has been reported from breathing in smoke from roasted perilla seeds (94313).

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General ...No adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.

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