Dr. Shen's Women's Precious by Shen Herbal Products

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Each tablet contains: Proprietary Blend 750 mg: Dang Gui (Tang Kwei), White Peony root (Bai Shao), Shu Di Huang root (Chinese foxglove root, rehmannia glutinosa radix), Szechuan Lovage root (chuan xiong, liguistici wallichi), Dang Shen root (poor man's ginseng), Bai Zhu rhizome (atractylodes macrocephala), Fu Ling (China root), Zhi Gan Cao ( Chinese Licorice ) root baked with Honey .

Brand name products often contain multiple ingredients. To read detailed information about each ingredient, click on the link for the individual ingredient shown above.

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Effectiveness view details

Below is general information about the effectiveness of the known ingredients contained in the product Dr. Shen's Women's Precious. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ATRACTYLODES (Bai Zhu)

INSUFFICIENT RELIABLE EVIDENCE to RATE

Abdominal pain. Although there has been interest in using oral atractylodes for abdominal pain, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
Anorexia nervosa. Although there has been interest in using oral atractylodes for anorexia nervosa, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
Cachexia. It is unclear if oral atractylodes is beneficial in patients with cachexia. Details: Preliminary clinical research in people with gastric cancer-related cachexia shows that taking an isolated constituent of atractylodes, atractylenolide I, 1.32 grams orally daily for 7 weeks moderately improves appetite scores and functional ability scores when compared with fish oil 0.45 grams (15706).
Common cold. Although there has been interest in using oral atractylodes for the common cold, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
Diarrhea. Although there has been interest in using oral atractylodes for diarrhea, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
Gastroesophageal reflux disease (GERD). Although there has been interest in using oral atractylodes for GERD, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
Influenza. Although there has been interest in using oral atractylodes for Influenza, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
Intracranial hemorrhage. Atractylodes 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 subdural hematoma (CSDH) who underwent burr hole surgery shows that taking atractylodes rhizome as part of traditional Japanese medicine products also containing Asian water plantain, mushrooms, and cinnamon for 3 months reduces postoperative recurrence of CSDH when compared with usual care. Subgroup analysis suggests the combination treatment containing atractylodes may be most effective for the acute on chronic CSDH subtype (112827). It is unclear whether these effects are due to atractylodes, other ingredients, or the combination.
Lung cancer. Although there has been interest in using oral atractylodes for lung cancer, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
Obesity. Although there has been interest in using oral atractylodes for obesity, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
Peritoneal dialysis. Although there has been interest in using oral atractylodes for peritoneal dialysis, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
Rheumatoid arthritis (RA). Although there has been interest in using oral atractylodes for RA, there is insufficient reliable information about the clinical effects of atractylodes for this purpose. More evidence is needed to rate atractylodes for these uses.

(Read more about ATRACTYLODES)

CODONOPSIS (Dang Shen)

INSUFFICIENT RELIABLE EVIDENCE to RATE

Asthma. Although there is interest in using oral Codonopsis lanceolata for asthma, there is insufficient reliable information about the clinical effects of codonopsis for this condition.
Cancer. Although there is interest in using oral Codonopsis lanceolata for cancer, there is insufficient reliable information about the clinical effects of codonopsis for this condition.
Dyspepsia. Although there is interest in using oral Codonopsis lanceolata for dyspepsia, there is insufficient reliable information about the clinical effects of codonopsis for this condition.
Hyperlipidemia. Although there is interest in using oral Codonopsis lanceolata for hyperlipidemia, there is insufficient reliable information about the clinical effects of codonopsis for this condition.
Obesity. Although there is interest in using oral Codonopsis lanceolata for obesity, there is insufficient reliable information about the clinical effects of codonopsis for this condition.
Respiratory tract infections. Although there is interest in using oral Codonopsis lanceolata for respiratory tract infections, including bronchitis and tuberculosis, there is insufficient reliable information about the clinical effects of codonopsis for these conditions. More evidence is needed to rate codonopsis for these uses.

(Read more about CODONOPSIS)

DONG QUAI (Dang Gui)

INSUFFICIENT RELIABLE EVIDENCE to RATE

Atopic dermatitis (eczema). Although there is interest in using oral dong quai for atopic dermatitis, there is insufficient reliable information about the clinical effects of dong quai for this condition.
Chronic kidney disease (CKD). There is limited evidence on the use of dong quai in patients with CKD. Details: A large propensity score-matched observational study over 15 years in Taiwanese adults with CKD suggests that taking dong quai is associated with a 5.1% risk of end-stage renal disease (ESRD) and 38% risk of overall mortality when compared with 7% and 56%, respectively, in controls. Higher cumulative doses (i.e., 15 grams or more) and longer duration of exposure (i.e., > 60 days) are also associated with fewer ESRD events (112362). However, the interpretation of these findings is limited by the lack of exact dosage information and retrospective study design.
Coronary heart disease (CHD). Intravenous dong quai has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with CHD shows that injecting 20 mL of an intravenous solution containing dong quai, ginseng, and astragalus (Yi-qi Huo-xue Injection) daily for 2 weeks reduces the frequency and severity of angina episodes when compared with placebo. It also seems to increase exercise tolerance and improve left ventricular function when compared with placebo (33046). It is unclear if these benefits are due to dong quai, other ingredients, or the combination.
Dysmenorrhea. Although there is interest in using oral dong quai for dysmenorrhea, there is insufficient reliable information about the clinical effects of dong quai for this condition.
Hypertension. Although there is interest in using oral dong quai for hypertension, there is insufficient reliable information about the clinical effects of dong quai for this purpose.
Idiopathic interstitial pneumonia. Oral dong quai has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of 17 studies conducted in China in patients with idiopathic interstitial pneumonia concludes that adding traditional Chinese medicine combinations containing dong quai root and astragalus root to treatment with conventional medicines improves pulmonary function index, six-minute walking distance, and the Borg scale of perceived exertion when compared with conventional treatment alone (103618). The included studies are of low quality, include a range of treatment durations from 1-12 months, and vary in the conventional medicines and Chinese herb combinations used. The doses of dong quai used were not stated.
Infertility. Although there is interest in using oral dong quai for infertility, there is insufficient reliable information about the clinical effects of dong quai for this condition.
Iron deficiency anemia. Although there is interest in using oral dong quai for iron deficiency anemia, there is insufficient reliable information about the clinical effects of dong quai for this condition.
Menopausal symptoms. There is inconsistent and contradictory evidence about the effect of dong quai on menopausal symptoms. Benefits have only been seen when it is used in combination with other ingredients; its effect when used alone is unclear. Details: Some clinical research shows that taking dong quai, 1.5 grams three times daily for 24 weeks, does not affect menopausal symptoms (738). Other clinical research shows that dong quai improves menopausal symptoms when used in combination with other constituents. In one clinical trial, taking five chewable tablets of a specific combination of dong quai and chamomile (Climex) daily for 12 weeks reduced the frequency and severity of hot flushes when compared with placebo (48445). In another trial, taking a combination providing dong quai 75 mg, along with American ginseng, black cohosh, milk thistle, red clover, and vitex agnus-castus (Phyto-Female Complex) twice daily for 3 months reduces menopausal symptoms, including the number and intensity of hot flushes, the number of night sweats, and sleep quality (19552). Taking another combination product containing dong quai, burdock root, licorice root, motherwort, and Mexican wild yam root, 500 mg three times daily for 3 months, also reduces menopausal symptoms when compared with placebo (48522). It is unclear if the beneficial effects in these studies were due to dong quai, other ingredients, or a combination of ingredients.
Migraine headache. Oral dong quai has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with menstrual migraine shows that taking a combination of soy isoflavones 60 mg, dong quai 100 mg, and black cohosh 50 mg daily for 24 weeks reduces the frequency of attacks when compared with placebo (35797). It is unclear if this effect is due to dong quai, other ingredients, or the combination.
Osteoporosis. Although there is interest in using oral dong quai for osteoporosis, there is insufficient reliable information about the clinical effects of dong quai for this condition.
Peptic ulcers. Although there is interest in using oral dong quai for peptic ulcers, there is insufficient reliable information about the clinical effects of dong quai for this condition.
Premature ejaculation. Topical dong quai has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: In one preliminary clinical trial in patients with premature ejaculation, a multi-ingredient cream preparation (SS Cream) containing dong quai, Panax ginseng root, Cistanches deserticola, Zanthoxyl species, Torlidis seed, clove flower, Asiasari root, cinnamon bark, and toad venom was applied to the glans penis 1 hour prior to intercourse and washed off immediately before intercourse. Patients using the cream had significantly improved ejaculatory latency when compared with placebo cream (2537). It is unclear if this effect is due to dong quai, other ingredients, or the combination.
Premenstrual syndrome (PMS). Although there is interest in using oral dong quai for PMS, there is insufficient reliable information about the clinical effects of dong quai for this condition.
Psoriasis. Although there is interest in using oral dong quai for psoriasis, there is insufficient reliable information about the clinical effects of dong quai for this condition.
Pulmonary hypertension. Preliminary clinical research shows that intravenous dong quai may be effective in patients with pulmonary hypertension. Details: Some preliminary clinical research in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension shows that intravenous administration of 250 mL of a solution containing dong quai 25%, once daily for 5-10 days, reduces pulmonary arterial pressure and pulmonary vascular resistance when compared to baseline (48438,48442,48443). The validity of these findings is limited by the lack of comparator groups.
Rheumatoid arthritis (RA). Although there is interest in using oral dong quai for RA, there is insufficient reliable information about the clinical effects of dong quai for this condition.
Stroke. Preliminary evidence does not support the use of intravenous dong quai for acute ischemic stroke. Details: Preliminary clinical research in patients with acute ischemic stroke shows that administering 200 mL of a solution containing dong quai 25% intravenously daily for 20 days does not improve neurological symptoms when compared with dextran-40 (48483). More evidence is needed to rate dong quai for these uses.

(Read more about DONG QUAI)

HONEY

POSSIBLY EFFECTIVE

Burns. Topical application of gauze containing honey seems to improve burn healing. Details: Honey applied directly in gauze applications seems to improve formation of granulation tissue and speed healing time in partial thickness burns. The benefits of honey appear to be comparable to topical antibiotics, including silver sulfadiazine and moisture permeable polyurethane dressing (OpSite) (395,396,397,398,399,14317,55175,55200,55204,55264)(91363,97696). In these studies, honey has been used under dressings or impregnated in gauze as needed for up to 12 weeks. The duration between changing of dressings or gauze has varied (395,396,397,398,399,55175,55200,55204,55264,91363). One small clinical study in adults with moderate burns shows that early surgical intervention with tangential excision and skin grafting appears to improve outcomes when compared with honey (7848). However, poor study design limits the reliability of these findings.
Cough. Most studies show that oral honey reduces cough in children. It is unclear whether oral honey is beneficial for cough in adults. Details: Clinical research shows that taking honey 2.5-10 mL (0.5-2 teaspoons) at bedtime reduces nighttime cough frequency and severity and improves sleep when compared with placebo in children aged 2 years and older with upper respiratory tract infections (URTIs) (15910,55253,97693,103959). Honey also appears to be at least as effective as the cough suppressant dextromethorphan in typical over-the-counter doses (15910,17299,97693). The effects of honey on cough duration are not known (97693). One clinical study in children 1-5 years of age with URTIs and cough for up to 7 days shows that acacia honey is similarly effective to a honey-flavored placebo, given as 3 mL one hour before bedtime for 2 consecutive nights, for reducing cough frequency and severity and improving sleep (110003). However, this study may have been inadequately powered to detect a difference between groups. A meta-analysis of the available research suggests that honey does not improve cough in adults when compared with usual care (103959). However, due to the small number of available studies, the analysis might have been inadequately powered to detect a smaller magnitude of benefit. Some research in adults has also evaluated honey in combination with other ingredients. In adults with post-infectious cough of at least 3 weeks' duration, taking 25 grams of a paste in a warm water solution providing honey 20.8 grams and coffee 2.9 grams every 8 hours for one week reduces cough frequency by about 93% when compared with baseline. Those taking prednisolone experienced a cough reduction of 20% (91367). It is unclear if this effect is due to honey, coffee paste, or the combination.
Diabetic foot ulcers. Topical honey seems to be beneficial for diabetic foot ulcers. Details: A meta-analysis of mainly lower quality clinical trials including 267-616 patients with diabetic foot ulcers shows that applying dressings impregnated with honey for 1-2 weeks shortens the wound debridement and healing time and increases the rate of wound healing by moderate to large amounts when compared with other dressings (101032). Individual clinical studies also show that using dressings impregnated with manuka honey (Medihoney Tulle Dressing) or beri honey decreases healing time for diabetic foot ulcers by 11-12 days and reduces the need for antibiotics when compared with saline-soaked gauze (19739,91364,97701).
Dry eye. Specific manuka honey eyedrops seem to be modestly beneficial for improving symptoms of dry eye. Details: Most clinical research shows that specific honey products might be helpful for symptoms of dry eye (97694,97695,105231,105234). Preliminary clinical research shows that applying a specific manuka honey product (Optimel Manuka Plus Dry Eye Drops, Melcare Biomedical Pty Ltd) 2-3 times daily for 14 or 28 days reduces some, but not all, measures of eye discomfort (97694,105234). In patients with dry eye due to contact lenses, dry eye symptoms were reduced by about 18% when compared with baseline (97694). In patients with general mild dry eye symptoms, preliminary clinical research shows that symptoms were reduced by about 52% when compared with baseline (105234). These improvements were significant when compared with lubricant drops (97694,105234). Specific honey products also seem to be beneficial for dry eye associated with meibomian gland dysfunction. In these patients, preliminary clinical research shows that using Optimel Manuka Plus Eye Drops (Melcare, Biomedical Pty Ltd) or Optimel Antibacterial Manuka Eye Gel (Melcare Biomedical Pty Ltd) twice daily for 3 or 8 weeks along with warm compresses improves the function of the tear glands (97695,105231). In one study, 73% to 95% of participants using the honey products required less lubricant, compared with 48% of participants using warm compresses alone. However, the honey products did not improve bacterial counts, redness, or dryness (97695). In another study, eye dryness, lid margin, conjunctival redness, and meibomian gland function were modestly improved when compared with baseline. All improvements were statistically similar to the control group receiving a lubricant. However, patients using a lubricant did not experience an improvement in eye dryness when compared to baseline (105231).
Herpes labialis (cold sores). Applying honey to cold sores may heal lesions 2-4 days faster than conventional therapies. Details: A meta-analysis of three clinical trials, including one relatively large study, in patients with herpes labialis shows that applying honey to lesions 4-5 times daily reduces lesion healing time by around 2 days, although it does not improve pain when compared with acyclovir 5% cream (108526). Also, a small crossover trial in patients with recurrent cold sores shows that applying medical grade honey three times daily to lesions at the onset of symptoms or blistering reduces lesion healing time by around 4 days and improves symptoms such as pain and itching when compared with conventional treatments, which ranged from prescription antivirals to herbal remedies and wound care products (108527).
Herpetic gingivostomatitis. Slowly swallowing honey seems to be beneficial for herpetic gingivostomatitis treatment in children. Details: Clinical research in children aged 2-8 years with primary herpetic gingivostomatitis shows that use of a local honey 5 mL every 4 hours with slow swallowing, in combination with acyclovir 15 mg/kg five times daily for 7 days, results in the clearing of oral lesions 3 days faster when compared with acyclovir and a placebo syrup. Drooling and difficulties eating also improved faster, and pain and the need for analgesics were reduced. Fever and extra-oral lesions were not improved (101038).
Oral mucositis. Rinsing the mouth with and then slowly swallowing honey seems to be beneficial for oral mucositis prevention or treatment, although most research is lower quality. Details: Although contradictory evidence exists (55219,91361), most research shows that honey may have some benefit in preventing or reducing symptoms of oral mucositis (16352,55133,55137,55202,55241,55245,55265,91368,97704,104562). A meta-analysis of eight trials shows that applying honey reduces the development of intolerable oral mucositis lesions by approximately 52%. Applying honey to lesions also appears to reduce pain associated with oral mucositis; however, the number of studies included in this latter analysis was small (101035). Another meta-analysis suggests that pure natural honey may be more effective than manuka honey or local honey for treating oral mucositis (101034). However, these analyses have significant quality issues. They included studies that did not fit inclusion criteria and omitted studies that did fit inclusion criteria (103967). The majority of these studies have had patients rinse with and then slowly swallow up to 20 mL honey three times or more daily, usually before radiation therapy, 15 minutes after radiation therapy, and 6 hours after radiation therapy or at bedtime. Some studies have used honey topically or as ice chips or lozenges (16352,55133,55137,55202,55219,55241,55265,91361,97704,101034)(101035,104562). Also, rinsing the mouth and swallowing a paste of honey or honey and coffee 10 mL every 3 hours for one week has been used (91368). Preliminary clinical research in patients undergoing chemoradiation and using conventional treatments shows that a combination of licorice powder 5 grams mixed in honey and applied twice daily along with oral licorice powder 500 mg twice daily for 6 weeks also seems to reduce the risk of oral mucositis and severe symptoms when compared with conventional treatments alone (104562). However, it is not clear whether any benefit in this study is due to honey, licorice, or the combination. In pediatric intensive care patients aged 2-16 years, preliminary clinical research shows that applying a local honey, 1-1.5 grams/kg in two divided doses, with a spoon to the inside of the mouth, teeth, lips, and tongue, reduces the severity and development of oral mucositis when compared with using chlorhexidine. However, honey was not as effective as topical vitamin E (101036).
Rosacea. Topical honey seems to be beneficial for rosacea. Details: Clinical research in adults shows that applying a 90% medical-grade kanuka honey (Honevo) with glycerin to affected areas twice daily for 8 weeks and washed off after 30-60 minutes is more effective than Cetomacrogol, an emollient, for improving symptoms of rosacea. Approximately twice as many patients responded to the honey product when compared with Cetomacrogol cream (97699).
Wound healing. Topical honey seems to improve the healing of various types of wounds, although the optimal formulation and application regimen remains unclear. Details: Several small clinical trials and case reports describe the use of honey or honey-impregnated dressings for various types of wounds, including post-surgical wounds, chronic leg ulcers, abscesses, burns, abrasions, lacerations, and skin graft donor sites. Honey seems to improve granulation and epithelialization, reduce odors and purulent exudate, help clean the wound, increase eradication of infection, reduce pain, and decrease time to healing (7847,7849,14317,16354,16355,16357,16358,16360,16362,16369)(16372,16374,55109,55130,55144). Meta-analyses of clinical research show that applying honey reduces healing time of partial thickness burns by 4.7 days when compared with conventional dressing and about 5 days when compared with silver sulfadiazine. Honey also appears to improve healing time for postoperative wounds when compared with antiseptic washes followed by gauze (55264). In some reports, wounds healed with honey after failing previous treatments (16369,16371). Honey applied directly to wounds appears to be comparable to hydrogels such as carboxymethylcellulose, povidone iodine, and hypochlorite solutions (16355,16358,16360,16376,55235). Honey dressings also appear to be comparable to hydrocolloid dressings, paraffin gauze, nanocrystalline silver, and saline-soaked gauze (16358,16360,16372,55101). However, poor study design limits the reliability of some of these findings. Trials cannot be directly compared due to variation in wound type and severity, patient characteristics, honey type and processing, dressing techniques, treatment duration, and concomitant use of antibiotics. Adequate blinding is also difficult to achieve due to the distinctive properties and smell of honey (16360). Many of the clinical trials used manuka honey, which is derived from the nectar of Leptospermum scoparium and is gamma irradiated to inactivate bacterial spores (16355,16357,16362,16369,16371). Other trials used unprocessed honey (16358,16372). Honey dressings are typically changed every 24-48 hours, although in some cases dressings are changed only twice weekly (16355,16362,16372,16374,55101,55130,55235). In children aged 2 months to 14 years, honey soaked gauze has been packed into wounds twice daily until closure (16376). When used directly, unprocessed honey or manuka honey 15-30 mL has been applied and covered with sterile gauze and bandages or a polyurethane dressing. When applied directly, honey is typically used every 12-48 hours, although in some cases it has been used only once weekly (16354,16358,16369,16372,16376,55144).

POSSIBLY INEFFECTIVE

Acne. Topical honey does not seem to be beneficial for acne. Details: Clinical research in adolescents and adults 16 years of age and older shows that applying a 90% medical-grade kanuka honey (Honevo) with glycerine to the face twice daily after using an antibacterial soap does not improve facial acne when compared with antibacterial soap alone (97700).
Hyperlipidemia. Oral honey does not seem to improve lipid levels in patients with hyperlipidemia. Details: A meta-analysis of 15 small clinical studies in patients with hyperlipidemia shows that taking honey 20-75 grams daily for up to 4 months does not reduce total cholesterol, low-density lipoprotein (LDL) cholesterol, or triglyceride levels when compared with control (108533).
Rhinosinusitis. Intranasal honey does not seem to be beneficial for improving symptoms of chronic rhinosinusitis. Details: A small clinical study in adults who have undergone maximal medical and surgical treatment for allergic fungal rhinosinusitis shows that using 2 mL of an intranasal spray containing honey 50% in saline once daily at night for 30 days does not reduce symptoms when compared with usual treatment (55216). Manuka honey nasal spray also does not seem to work better than saline spray in adults with chronic rhinosinusitis. A small clinical study shows that manuka honey 10% (Medihoney, Derma Sciences) in saline sinus irrigation twice daily for 30 days is no more effective than saline irrigation for reducing overall symptoms (97705). Additionally, a small clinical study in patients with recalcitrant chronic rhinosinusitis shows that using manuka honey 16.5% twice daily augmented with 1.3 mg/mL methylglyoxal sinonasal rinses for 14 days is no better than taking targeted oral antibiotics and performing normal saline rinses twice daily (103969). However, this study was not adequately powered to detect a difference between treatment groups. Additional research is needed to determine if honey-containing nasal sprays are beneficial in circumstances with limited access to antibiotics or nasal steroids, or in patients with high immunoglobulin E (IgE) levels (55216,97705). Intranasal honey has also been evaluated in patients recovering from surgery for rhinosinusitis. A small clinical study in adults with chronic rhinosinusitis who have undergone endoscopic sinus surgery shows that applying 2 mL of Tualang honey to the nasal dressing, which remains in place for one week, results in similar improvements in symptoms when compared with a triamcinolone-containing dressing at 7, 14, and 28 days after surgery. However, at 3 months after surgery, triamcinolone seems to provide further improvement in rhinosinusitis symptoms and surgical recovery when compared with honey (108529).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Allergic rhinitis (hay fever). It is unclear if oral honey is beneficial for hay fever. Details: Preliminary clinical research shows that consuming honey one tablespoon (20 grams) daily, in addition to standard treatment, does not improve allergy symptoms (14319). Other preliminary clinical research shows that ingesting honey 1 gram/kg daily for 4 weeks, in addition to taking loratadine 10 mg daily, may improve allergic symptoms during treatment and for up to 4 weeks following cessation of treatment. However, it's not clear if this improvement is significant when compared with loratadine alone (91360).
Alveolar osteitis. It is unclear if oral honey is beneficial for alveolar osteitis. Details: A small, low-quality clinical study in patients with alveolar osteitis after dental surgery shows that applying gauze soaked in 2 mL of honey, 3 times over 10 days, improves healing, pain, and formation of granulation tissue when compared with baseline (103961).
Asthma. Oral honey has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One preliminary clinical study shows that taking a combination of honey and black seed modestly improves measures of lung function when compared with baseline in patients with moderate to severe asthma. However, another preliminary clinical study using this combination did not show improvement on all measures. Both studies were small and may not have been adequately powered to detect a difference in outcomes (105228). Other preliminary clinical research shows that taking a combination of honey and celery seed modestly improves some measures of lung function when compared with baseline (105228). It is unclear whether any benefit is due to honey, the other ingredient, or the combinations. Additionally, the validity of these studies is limited by the lack of a comparator group.
Athletic performance. Although there is interest in using oral honey to improve athletic performance, there is insufficient reliable information about the clinical effects of honey for this purpose.
Atopic dermatitis (eczema). It is unclear if topical honey is beneficial for atopic dermatitis. Details:In patients with bilateral atopic dermatitis, a small preliminary clinical trial shows that topical application of manuka honey to one site overnight for 7 days improves lesions when compared to baseline (105239). The validity of this finding is limited by the lack of a placebo comparator group.
Blepharitis. It is unclear if topical honey is beneficial for blepharitis. Details: A small clinical study in patients with blepharitis shows that applying MGO Manuka Honey microemulsion (Manuka Health New Zealand Ltd) eye cream to closed eyelids nightly for 3 months improves symptoms of dry eye and reduces ocular mites and bacterial load when compared with no intervention (103962). The validity of this finding is limited by the lack of a placebo comparator group.
Cataracts. Although there is interest in using topical honey for cataracts, there is insufficient reliable information about the clinical effects of honey for this condition.
Catheter-related infections. It is unclear if topical medical honey is beneficial for preventing catheter-related infections in patients on hemodialysis or in those with diabetes. Details: Preliminary clinical research shows that manuka honey (Medihoney, Medihoney Pty Ltd) applied three times weekly to the exit sites of tunneled, cuffed central venous hemodialysis catheters is as effective as mupirocin ointment in reducing the incidence of catheter-associated infection and bacteremia. It may also be associated with a lower rate of bacterial resistance than mupirocin (16361). A retrospective analysis also found that use of povidone iodine for dialysis catheter site care is associated with a 58% increased cumulative incidence rate of exit-site infections or peritonitis when compared with use of medical honey. Patients were followed from catheter insertion until catheter removal, transplant, death, or end of treatment (101039). However, well-designed clinical research shows that application of antibacterial honey (Medihoney Antibacterial Wound Gel, Comvita) 10 mg at the exit site along with standard care is no more effective than standard care alone for reducing dialysis-related infections (91362). It is unclear if honey reduces the risk of catheter-related infection in patients with diabetes. Some evidence shows that applying an antibacterial honey product approximately doubles the risk of infection and peritonitis in patients with diabetes when compared with no honey (91362). However, a large retrospective analysis found that exit-site application of honey was associated with a lower chance of peritoneal dialysis-related infection when compared with povidone iodine, even in patients with diabetes (101039).
Chemotherapy-related fatigue. Oral honey has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with breast cancer and chemotherapy-related fatigue shows that taking a specific product (Jollab tonic beverage) containing honey, saffron, and rose water, as 20 mL three times daily for 4 weeks, reduces scores on a cancer fatigue scale when compared with placebo. Scores on a visual analog fatigue scale and on a fatigue severity scale were only improved when compared with baseline, not placebo (110001).
Corneal opacity. Although there is interest in using topical honey for corneal opacity, there is insufficient reliable information about the clinical effects of honey for this purpose.
Corneal ulceration. It is unclear if honey-containing ophthalmic drops are beneficial for corneal ulceration. Details: A small clinical study in patients with foreign body-induced corneal ulceration shows that applying ophthalmic drops containing honey into the affected eye every 6 hours for 14 days might speed up healing of corneal epithelial defect, but does not improve corneal infiltration, when compared with using ciprofloxacin eye drops. The honey in these drops was produced from the nectar of various ziziphus species (103968). The validity of this study is limited by its small size and short duration.
Diabetes. It is unclear if oral honey is beneficial for diabetes. Details: In patients with type 2 diabetes, small clinical trials show that taking honey 50 grams or 1-2.5 grams/kg daily for 8 weeks increases glycated hemoglobin (HbA1c) levels by a small amount (55182,105235). However, lower doses of 5-25 grams daily for 16 weeks or 0.5 grams/kg daily for 12 weeks seem to have no effect on HbA1c and may modestly reduce levels when compared to baseline or no treatment (105230,105236). Also, although some research disagrees, taking honey does not seem to affect fasting levels of insulin or glucose, or measures of insulin resistance (105230,105235,105236). There is conflicting evidence regarding the effects of honey on lipid levels in patients with diabetes. Some preliminary clinical research shows that consuming honey 0.5-2.5 grams/kg daily modestly decreases total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides, and modestly increases high-density lipoprotein (HDL) cholesterol (55182,105230), while other research does not show any effect on plasma lipids (105236). In patients with type 1 diabetes, one clinical study shows that taking honey 0.5 mL/kg daily for 12 weeks decreases fasting blood glucose, total cholesterol, triglycerides, and LDL cholesterol when compared with control (55263).
Diabetic neuropathy. It is unclear if oral honey is beneficial for diabetic neuropathy. Details: In patients with mild to moderate diabetic neuropathy who are taking antidiabetes medications and gabapentin, preliminary clinical research shows that taking honey 0.5 gram/kg daily in water for 3 months modestly reduces nerve pain and improves quality of life when compared with baseline. Nerve conduction was generally not affected (105230). The validity of this study is limited by the lack of an appropriate control group.
Diarrhea. Small clinical studies suggest that oral honey is beneficial in children and infants with diarrhea. Details: One small clinical study in children and infants with gastroenteritis shows that adding honey to oral rehydration solution (ORS) at a concentration of 50 mL per liter ORS decreases the frequency of vomiting and diarrhea, and reduces recovery time when compared with ORS alone (55194). Other clinical research shows that adding honey to ORS at the same concentration reduces the duration of diarrhea by about 1.4 days when compared with standard ORS in infants and children with bacterial gastroenteritis, but not when all types of gastroenteritis are considered (55273). Another small clinical study in children hospitalized with acute diarrhea shows that taking 1.5-2 mL of honey every 6 hours for 5 days plus 5 mL of zinc gluconate syrup, providing 5 mg of elemental zinc, every 6 hours for 10 days reduces the duration of diarrhea by 6.5 hours and the duration of hospitalization by 24 hours when compared with zinc gluconate alone (108534).
Dry mouth. It is unclear if oral honey is beneficial for dry mouth associated with intubation. Details: Preliminary clinical research in a small group of intubated adults in an intensive care unit shows that applying Indonesian honey 20 mL to all areas of the mouth with a brush and gauze swab twice daily for 3 days, in addition to standard oral care with 20 mL chlorhexidine gluconate 0.2%, improves overall oral health scores on a modified Beck Oral Assessment Scale when compared with chlorhexidine alone (110002).
Dysmenorrhea. It is unclear if oral honey is beneficial for dysmenorrhea. Details: Preliminary clinical research shows that taking honey 1.2 mg/kg daily, starting on the 15th day of the menstrual cycle and continuing until the onset of menstruation, is comparable to mefenamic acid 250 mg every 6 hours for reducing pain associated with dysmenorrhea (97702).
Gingivitis. It is unclear if chewing "leather" made from manuka honey is beneficial for gingivitis. Details: Preliminary clinical research shows that chewing "leather" made from manuka honey after meals for 21 days reduces plaque severity and the number of bleeding sites when compared to baseline in patients with gingivitis and plaque (55091).
Hemorrhoids. Topical honey has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that applying a spoonful of a mixture containing equal volumes of honey, olive oil, and beeswax to the skin twice daily for up to 4 weeks reduces bleeding and itching when compared to baseline in patients with hemorrhoids (34100). It is not clear if these effects are due to honey, the other ingredients, or the combination.
Genital herpes. It is unclear if topical honey is beneficial for genital herpes. Details: Preliminary clinical research shows that applying a gauze soaked with honey four times daily to the lesion until healing does not improves symptoms or healing time (55095).
Impaired glucose tolerance (prediabetes). It is unclear if oral honey is beneficial for prediabetes. Details: Preliminary clinical research shows that taking honey does not improve glycemic control or lipid levels in patients with prediabetes. In one study, taking honey (Dutch Gold Honey) providing 50 grams of carbohydrates daily for 2 weeks does not improve these measures when compared with sucrose or corn syrup providing similar amounts of carbohydrates (105238). In another study, taking Malaysian Kelulut honey (Bayu Kelulut) 30 grams daily for 30 days was not beneficial (105237). The validity of these studies is limited by the lack of an appropriate control group.
Leishmania lesions. It is unclear if topical honey is beneficial for leishmania lesions. Details: Some research shows that honey might prevent the healing of leishmania lesions. One preliminary clinical study shows that applying honey-soaked gauze onto leishmania lesions twice daily for 6 weeks in addition to receiving a glucantime injection reduces the proportion of patients with healed wounds by about 28% when compared with glucantime injection alone (55118).
Male infertility. Intravaginal honey has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that applying 10 mL of a combination mixture containing various bee products intravaginally immediately before or after each coital act, beginning one day after the last menstruation and continuing for three menstrual cycles or until pregnancy, increases pregnancy rate from 3% to 8% when compared to standard intrauterine insemination in couples having difficulty getting pregnant due to male asthenozoospermia. However, since all unsuccessful couples were crossed over to the alternative treatment after 2 months, the causality of successful pregnancy is unclear. The mixture consisted of Egyptian bee honey 100 grams, royal jelly 3 grams, and bee bread 1 teaspoon, which was diluted in saline in a 1:1 ratio prior to application (55131).
Malnutrition. It is unclear if oral honey is beneficial for malnutrition in children. Details: Preliminary clinical research in infants and children with a mean age of 11-13 months with protein-energy malnutrition (PEM) shows that honey improves weight and other biomarkers when compared to control. Honey 2 mL/kg diluted in water was used daily for 2 weeks in combination with conventional nutritional rehabilitation (55196,55210).
Menopausal symptoms. It is unclear if oral honey is beneficial for metabolic control in postmenopausal individuals. Details: In postmenopausal individuals, preliminary clinical research shows that taking Tualang honey 20 grams daily for 4 months results in a slight increase in low-density lipoprotein (LDL) cholesterol and fasting blood sugar when compared with baseline. However, there were no statistically significant differences in lipid profile, glycemic control, or bone density when compared with low-dose hormone replacement therapy (105241). The validity of this study is limited by its short duration and lack of blinding.
Necrotizing fasciitis. It is unclear if topical honey is beneficial for necrotizing fasciitis. Details: Preliminary clinical research has shown conflicting results with the use of honey, applied directly and covered with a dressing or applied as a honey-soaked gauze, given as an adjunct to antibiotics, for the treatment of Fournier's gangrene, a type of necrotizing fasciitis (55106,55293,55295,55315,91363).
Obesity. It is unclear if oral honey is beneficial for metabolic control in adolescents with obesity. Details: Preliminary clinical research in obese prepubertal females on a calorie-reduced diet shows that consuming a wild flower and thyme honey product (Attiki) 15 grams daily for 6 months does not improve levels of glucose, insulin, or blood lipids when compared with a marmalade control (101037).
Osteoarthritis. Oral honey has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults 40-85 years of age with knee osteoarthritis shows that taking a specific product (G-rup syrup, Yas Daru Pharmaceutical Co.) containing honey 150 mg/mL and ginger extract 100 mg/mL in a dose of 30 mL twice daily for 12 weeks reduces pain scores on a visual analog scale and improves scores on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) when compared with baseline. Total WOMAC scores decreased by about 7 in the active group and by 4 in the placebo group (110000). The validity of this finding is limited by the lack of statistical comparison to the placebo group. Additionally, it is unclear whether these changes would be considered clinically significant.
Peptic ulcers. Although there is interest in using oral honey for peptic ulcers, there is insufficient reliable information about the clinical effects of honey for this condition.
Postoperative pain. Several small clinical studies suggest that topical honey may reduce pain after tonsillectomy in children and adults. Details: A meta-analysis of low-quality clinical research in children 3 years and older immediately post-tonsillectomy shows that honey might reduce pain, analgesic use, and night-time awakening by a small to moderate amount in the week after surgery when compared with placebo or control. In these studies, honey was used in doses ranging from 4-15 mL every hour or once daily for 1-7 days (97703). A small observational cohort in adults post-tonsillectomy has found that applying honey 20 grams to the oral cavity for 5 minutes, 8 times daily for the first 5 days after surgery, is associated with reduced pain and bleeding when compared with usual treatment (103963). Another small clinical trial in adults post-tonsillectomy shows that gargling and then swallowing a solution containing 15 mL of honey mixed with 5 mL of water for two minutes every 6 hours for 10 days reduces pain and analgesic use when compared with placebo or no treatment (108530).
Pressure ulcers. It is unclear if topical honey is beneficial for pressure ulcers in children. Details: Preliminary clinical research in critically ill children aged 2 months to 17 years shows that use of a manuka honey dressing reduces the median time to complete healing of pressure ulcers by approximately 2 days when compared with standard wound care. In addition, complete healing was about 1.9 times more likely in children given the honey dressing. However, there were no differences in the proportion of children with complete healing or treatment failure, or in the duration of stay in the ICU or hospital (105229).
Pruritus. It is unclear if topical honey is beneficial for pruritus due to intertrigo. Details: Preliminary clinical research shows in adults with intertrigo that applying a honey cream (Medihoney Barrier Cream, Derma Sciences, Inc.) topically twice daily for 21 days reduces pruritus complaints when compared with zinc oxide ointment (55258).
Radiation dermatitis. It is unclear if topical honey is beneficial for treating radiation dermatitis. Details: Clinical research shows that applying honey gauze (HoneySoft) once daily to radiation-induced skin wounds does not increase the speed of wound healing when compared with paraffin gauze in patients with severe radiation-induced dermatitis (55105).
Radiation-induced esophagitis. It is unclear if topical honey is beneficial for radiation-induced esophagitis. Details: In patients with radiation esophagitis, preliminary clinical research shows that taking liquid manuka honey 10 mL or honey lozenges providing 10 mL of dehydrated manuka honey four times daily for 4 weeks does not improve pain on swallowing when compared with standard supportive care. However, only 14% of patients using liquid honey reported opioid use, compared with 37% of those given only supportive care (97698).
Sinonasal polyposis. It is unclear if intranasal honey is beneficial in patients recovering from surgery for sinonasal polyposis. Details: A small clinical study in patients recovering from sinus surgery for nasal polyposis shows that intranasal irrigation with a diluted processed honey spray four times daily starting the day after surgery does not improve healing or reduce polyp recurrence when compared with normal saline irrigation (108528).
Sunburn. Although there is interest in using topical honey for sunburn, there is insufficient reliable information about the clinical effects of honey for this purpose.
Tooth extraction. It is unclear if topical honey is beneficial for wound healing after tooth extraction. Details: A small clinical study in children that had a tooth extraction shows that applying a thin layer of Iranian Kurdistan Mountains honey with a cotton swab and keeping the swab in place for 45 minutes seems to reduce wound size more rapidly when compared with using normal saline (103966). The validity of this finding is limited because a large percentage of study participants were excluded from the final analysis.
Vaginal candidiasis. It is unclear if intravaginal honey is beneficial for vaginal candidiasis. Details: In patients with vulvovaginal candidiasis, preliminary clinical research shows that applying 5 grams of a vaginal gel containing honey 50% nightly for 8 days is as effective as the same amount of clotrimazole 1% cream for reducing burning and sensitivity and improving culture results. Honey also reduces vaginal discharge in almost twice as many patients as those using clotrimazole (105227). More evidence is needed to rate honey for these uses.

(Read more about HONEY)

LICORICE (Chinese Licorice)

POSSIBLY EFFECTIVE

Atopic dermatitis (eczema). Some clinical research suggests that topical licorice seems to improve symptoms of atopic dermatitis. Details: Applying gel formulations containing 1% or 2% licorice root extract three times daily for 2 weeks seems to reduce erythema by 35% to 61%, edema by 57% to 84%, and itching by 44% to 73%. The 2% gel seems to be more effective than the 1% gel (59732).
Canker sores. Some clinical research suggests that topical licorice patches and mouth rinses seems to reduce ulcer size and pain in patients with recurrent aphthous stomatitis. Details: Clinical research shows that applying an oral patch containing licorice 0.015-0.229 mg/kg for 16 hours each day for 8 days does not affect ulcer healing time, but reduces ulcer size and post-stimulus pain, when compared with placebo (59769). A small clinical study also shows that applying bioadhesive hydrogel patches containing 1% licorice extract reduces the pain, as well as the diameter of necrosis and inflammatory halo of recurrent canker sores, when compared to baseline (59781). Mouth rinses containing licorice have also been used. One clinical study shows that swishing a diphenhydramine and 5% licorice extract solution around the mouth for about 3 minutes four times daily until the sores have healed reduces the average time to healing by 1.5 days when compared to a solution containing diphenhydramine alone. Pain was reduced by up to 69% more in those using licorice extract (104564). Another small clinical study shows that gargling with licorice extract four times daily for 2 days has a large beneficial effect on pain and ulcer size when compared with using a placebo gargle. The licorice extract was made by boiling licorice root 40 grams in one liter of water for 30 minutes and cooled (110319). In addition, preliminary clinical research shows that gargling with warm water containing deglycyrrhizinated licorice powder 200 mg four times daily for 7 days improves pain in 75% of patients by day one and results in complete healing in 75% of patients by day three (59857).
Endotracheal intubation-related adverse effects. Some clinical research suggests that using licorice as a gargle or lozenge prior to endotracheal intubation can reduce adverse effects like sore throat and cough. Details: A meta-analysis of 5 clinical trials in patients undergoing elective surgical procedures shows that topical use of licorice, either as a gargle or lozenge, prior to endotracheal intubation reduces the risk for sore throat by 56% and reduces the risk for cough by 39% when compared with a control group at 24 hours post-extubation (100985). One clinical study included in this analysis shows that sucking on a single lozenge (Sualin, Hamdard Pharma) containing licorice extract 97 mg beginning 30 minutes prior to intubation reduces the risk for cough immediately after extubation by 56% when compared with a sugar candy lozenge. However, it doesn't seem to reduce cough at 30 minutes, 12 hours, or 24 hours post-extubation. This lozenge also appears to reduce the risk for sore throat by about 32% at 12 and 24 hours post-extubation, but not immediately or 30 minutes after extubation (25670). Additional clinical studies included in the meta-analysis show that gargling with fluid prepared with licorice 0.5 grams for at least one minute beginning 5 minutes prior to endotracheal intubation reduces the incidence and severity of post-extubation sore throat and coughing when compared with a water control (26464,59793).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Acne. Topical licorice has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with mild to moderate acne associated with mask wearing shows that topical application of a combination of licorice root extract 0.3%, calendula 4%, and snail secretion filtrate 40% (AI complex) to the face twice daily for 12 weeks modestly reduces inflammatory, but not non-inflammatory or total, acne lesions when compared with placebo. There was no difference in overall treatment success, defined as at least almost clear skin or a large improvement (110322). It is unclear if any benefits are due to licorice, other ingredients, or the combination.
Addison disease. Although there has been interest in using oral licorice for Addison disease, there is insufficient reliable information about the clinical effects of licorice for this condition.
Adrenal insufficiency. Although there has been interest in using oral licorice for adrenal insufficiency, there is insufficient reliable information about the clinical effects of licorice for this condition.
Allergic rhinitis (hay fever). It is unclear if using a licorice-containing nasal irrigation suspension improves symptoms in patients with allergic rhinitis. Details: A clinical study in patients with allergic rhinitis shows that using a nasal irrigation suspension containing licorice extract 900 mg daily for 1 month improves symptoms such as nasal blockage, rhinorrhea, sneezing, postnasal discharge, and olfactory disturbance when compared with baseline (108569). Although the study also utilized mometasone 2 mg nasal spray and isotonic saline nasal irrigation as comparators, symptom improvement was observed in all three groups, and there was no statistical comparison of outcomes between groups.
Antipsychotic-induced hyperprolactinemia. Oral licorice has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in females with risperidone-induced hyperprolactinemia shows that taking a combination of licorice and peony (Peony-Glycyrrhiza Decoction; PGD) 45 grams daily for 4 weeks reduces prolactin levels to a similar extent as bromocriptine (59775). However, another study shows that taking the same product at the same dose for 16 weeks has no effect on prolactin levels in females with antipsychotic-induced hyperprolactinemia when compared with placebo. Although the prolactin-related adverse event questionnaire total score was moderately improved, there was no effect on clinically meaningful symptoms or menstrual resumption (97219). Both studies show no effect on psychotic symptoms (59775,97219). Preliminary clinical research in male patients with antipsychotic-induced hyperprolactinemia shows that taking an herbal extract containing licorice and peony (shakuyaku-kanzo-to) 2.5 grams three times daily reduces prolactin levels after 4 weeks, but does not have a significant effect on prolactin levels 4 weeks after treatment cessation (59907).
Bleeding. Topical licorice might reduce bleeding when used in combination with other ingredients; its effect when used alone is unclear. Details: Some preliminary clinical research shows that topically applying 4 mL of a specific product (Ankaferd Blood Stopper, Mefar Ilaç Sanayi A.S.) containing licorice, Alpinia, thyme, stinging nettle, and common grape vine reduces bleeding, but does not improve the surgical time for episiotomy repair, when compared with saline (31010). Other preliminary clinical research shows that ampules of this same product placed in empty alveolus for up to 20 minutes reduces bleeding in postsurgical dental patients with increased bleeding tendency (31002).
Cancer-related pain. It is unclear if oral licorice is beneficial for pain in patients with cancer. Details: Preliminary clinical research shows that taking a 1:1 combination of licorice root and peony root, along with a Taiwanese tonic vegetable soup comprised of lily bulb, lotus seed, and jujube fruit, reduces pain levels in terminal cancer patients when compared with patients consuming only the soup or the regular hospital diet (59770).
Chronic fatigue syndrome (CFS). Although there has been interest in using oral licorice for CFS, there is insufficient reliable information about the clinical effects of licorice for this condition.
Colic. Although there has been interest in using oral licorice for colic, there is insufficient reliable information about the clinical effects of licorice for this condition.
Coronavirus disease 2019 (COVID-19). Oral licorice has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients hospitalized in Egypt with moderate COVID-19 shows that administering oral licorice extract 300 mg (standardized to contain glycyrrhizin 60 mg) once daily and Boswellia serrata extract 300 mg twice daily for 14 days, along with following an institution-based COVID-19 treatment protocol, may modestly improve mortality and time to recovery when compared with patients receiving the standard protocol alone. The standard treatment protocol included acetaminophen, azithromycin, vitamin C, zinc, and enoxaparin (108579). It is unclear if any effect is due to licorice, Boswellia serrata, or the combination.
Dental caries. It is unclear if oral licorice is beneficial for the prevention of dental caries. Details: One clinical study in adults shows that swishing 15 mL of a solution containing licorice extract 1% once nightly before bed for 5 days may reduce the acid production of cavity-causing bacteria, which may modestly reduce cavity risk, when compared with using a saline solution (108567). The validity of this study is limited by the short duration of treatment and follow-up.
Dental plaque. It is unclear if licorice toothpaste or mouthwash is beneficial for reducing plaque. Details: Preliminary clinical research shows that using 0.25% or 0.50% glycyrrhizin-containing toothpaste twice daily does not reduce the amount of plaque, gingivitis, or bleeding in patients with proper dental hygienic measures when compared with the same toothpaste without glycyrrhizin (59812). Also, other preliminary clinical research shows that using glycyrrhizin-containing mouthwash for 3 days does not significantly reduce plaque levels (59855).
Depression. It is unclear if adding oral licorice to standard treatment is beneficial for improving depression. Details: A very small, nonblinded clinical study in hospitalized adults with major depressive disorder shows that adding licorice extract 1400 mg daily, standardized to glycyrrhizin 7% to 8%, to standard treatment for 2 weeks improves depression rating scores when compared with baseline, although these improvements were numerically similar to those seen with standard treatment alone. Patients in the treatment group also took oral magnesium citrate 300 mg daily to prevent magnesium depletion. The validity of this finding is limited due to the small size of the study, short duration of treatment, and unclear reporting (108575).
Diabetes. Although there has been interest in using oral licorice for diabetes, there is insufficient reliable information about the clinical effects of licorice for this condition.
Dry mouth. It is unclear if rinsing the mouth with licorice is beneficial for dry mouth in people on hemodialysis. Details: Preliminary clinical research in hemodialysis patients with dry mouth shows that rinsing with a licorice mouthwash containing 8.34 grams of licorice concentrate per 500 mL of water with every meal for 10 days does not affect salivary flow rate, but reduces subjective feelings of dry mouth by about 28%, when compared with a water-based mouthwash and control group (97220).
Dysmenorrhea. It is unclear if oral licorice is beneficial for reducing pain. Details: Preliminary clinical research shows that taking a syrup providing licorice extract 750 mg twice daily for the first 5 days of the menstrual cycle reduces pain as effectively as ibuprofen 400 mg every 8 hours in patients with moderate or severe dysmenorrhea (104558).
Dyspepsia. Oral licorice might improve symptoms of dyspepsia when used in combination with other ingredients; its effect when used alone is unclear. Details: Various combination products manufactured by Steigerwald Arzneimittelwerk GmbH have been evaluated for dyspepsia. Two specific combination products containing licorice root (Iberogast; STW-5-S) seem to improve symptoms of dyspepsia. The combinations include licorice plus milk thistle, peppermint leaf, German chamomile, caraway, celandine, angelica, and lemon balm either with (Iberogast) or without clown's mustard plant (STW-5-S) 1 mL three times daily for 4 weeks (19532). A meta-analysis of studies using the Iberogast product shows that taking 1 mL orally three times daily over a period of 4 weeks reduces severity of acid reflux, epigastric pain, cramping, nausea, and vomiting when compared with placebo (13089). Also, using a preparation containing clown's mustard plant, German chamomile, peppermint, caraway, licorice, and lemon balm (STW 5-II) 1 mL three times daily for up to 12 weeks improves dyspepsia symptoms in 40% more patients when compared with placebo (12724).
Familial Mediterranean fever. It is unclear if oral licorice is beneficial for familial Mediterranean fever. Details: Preliminary clinical research shows that taking a combination of licorice, andrographis, Siberian ginseng, and schisandra (ImmunoGuard, Inspired Nutritionals) four tablets three times daily for one month reduces the duration, frequency, and severity of attacks of familial Mediterranean fever in children when compared with placebo (12382). It is unclear if these effects are due to licorice, other ingredients, or the combination.
Helicobacter pylori. It is unclear if oral licorice is beneficial for Helicobacter pylori eradication. Details: Some preliminary clinical research shows that adding licorice (D-Reglis, Iran Darouk Pharmaceutical Co.) 380 mg twice daily to conventional clarithromycin-based triple therapy for 14 days improves eradication rate by an additional 21% when compared with conventional treatment alone. However, any additional benefit might be limited to patients with peptic ulcer disease (97221). Other preliminary clinical research shows that taking a combination of licorice extract 100 mg and Lactobacillus paracasei HP7 in 150 mL of fermented milk daily for 8 weeks does not increase eradication rates when compared with fermented milk alone, although it may improve gastrointestinal symptom scores, decrease the gastric load of Helicobacter pylori, and improve some measures of inflammation when compared to baseline (100984).
Hepatitis. Evidence for the use of intravenous licorice in the management of hepatitis B and C is mixed. Details: In some preliminary clinical research, a specific glycyrrhizin-containing intravenous preparation (Stronger Neominophagen C, Minophagen Pharmaceutical Co. Ltd.) appears to reduce mortality due to viral hepatitis by about 50% (3250). Other clinical research suggests that this same product reduces serum alanine aminotransferase (ALT) in hepatitis C patients but does not improve hepatitis C virus (HCV)-RNA levels (3247,59712,59721,59920). When used long-term, this preparation seems to reduce the risk of hepatocellular carcinoma in hepatitis C patients when compared to long-term use of other supplements, such as vitamin K (59905). This product has been used in various doses: 40 or 100 mL, containing 2 mg glycyrrhizin, 1 mg cysteine, and 20 mg of glycine per mL of solution, administered daily for 4-8 weeks, followed by 40 or 100 mL 2-7 times weekly for 2-16 weeks, has been used (3250,59905,59915); 40-120 mL diluted in 100 mL of 5% glucose solution and administered three times weekly for 4 weeks (59712,59721); 100 mL, which contained 200 mg glycyrrhizin, administered undiluted six times weekly for 4 weeks (59721); or 60 mL administered three times weekly for 16 weeks (59920). Other research shows that this preparation reduces ALT, aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (GGT) in patients with hepatitis B virus (59915). Oral licorice has not been evaluated for this purpose.
Hypercholesterolemia. It is unclear if oral licorice is beneficial for improving cholesterol. Details: Preliminary clinical research shows that taking licorice root extract 0.1 grams daily for one month reduces plasma total cholesterol levels by 5%, plasma low-density lipoprotein (LDL) cholesterol levels by 9%, and plasma triglyceride levels by 14% when compared with baseline in patients with moderate hypercholesterolemia (59725). The validity of these findings is limited by the lack of a comparator group.
Hyperkalemia. It is unclear if oral licorice is beneficial for reducing potassium levels. Details: Some clinical research in adults with diabetes and hypoaldosteronism suggests that taking glycyrrhizin 150 mg daily decreases potassium levels when compared with calcium polystyrene sulfonate (59897). Also, one very small clinical study in patients with anuria shows that taking glycyrrhetinic acid 1 gram daily for 2 weeks seems to decrease plasma potassium, but does not improve blood pressure, when compared with placebo (59723).
IgA vasculitis. Oral licorice has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small retrospective study in patients aged 5-36 years with newly diagnosed IgA vasculitis shows that taking compound glycyrrhizin (Eisai Pharmaceutical Co, Ltd) three times daily along with loratadine, calcium, vitamin C, rutin, and other unspecified conventional treatments is associated with an improvement in cutaneous purpura symptoms and time to symptom regression when compared with placebo. After 1 month, the rate of complete resolution and time to regression in the treatment group was 82% and 5 days, respectively, compared with 65% and 8 days, respectively, in the placebo group. Compound glycyrrhizin contained glycyrrhizin, glycine, and methionine and was dosed by age, with a dose of 25 mg daily in those 12 years or younger and 50 mg daily in those over 12 years (108580).
Irritable bowel syndrome (IBS). Oral licorice has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that a formulation containing licorice root, slippery elm bark, lactulose, and oat bran daily for 2 weeks improves stool consistency and increases bowel movement frequency by 20% in individuals with constipation-predominant IBS when compared to baseline. Symptoms of abdominal pain, bloating, straining, and global severity might also be reduced (35462). The validity of these findings is limited by the lack of a comparator group. Additionally, it is unclear if any benefits are due to licorice, other ingredients, or the combination.
Lichen planus. It is unclear if intravenous licorice is beneficial for lichen planus. Details: A very small clinical study shows that intravenous administration of 0.2% glycyrrhizin solution, 40 mL daily for 4 weeks, improves clinical symptoms of oral lichen planus in a greater percentage of patients with chronic hepatitis C when compared with dental cleaning (59903). There is no evidence suggesting that oral licorice is beneficial.
Liver cancer. Although there has been interest in using oral or intravenous licorice preparations for liver cancer, there is insufficient reliable information about the clinical effects of licorice for this condition.
Melasma. Topical licorice has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that applying a topical cream (Clariderm Clear, Stiefel Laboratories Inc.) containing 7% licorice, emblica, and belides twice daily for 60 days is as effective as a cream containing 2% hydroquinone for lightening the skin in patients with melasma (59824). It is unclear if this effect is due to licorice, other ingredients, or the combination.
Menopausal symptoms. It is unclear if oral licorice is beneficial for reducing hot flash frequency or severity. Details: In one preliminary clinical study, taking licorice root extract 330 mg orally three times daily for 8 weeks modestly reduces the frequency of hot flashes by about 1.3 per day and the severity of hot flashes by about 40% when compared with placebo (94659). However, another preliminary clinical study shows that taking a specific licorice root extract (D-Reglis, Iran Darouk Pharmaceutical Co.) 650 mg orally daily for 90 days does not reduce the number or severity of hot flashes when compared to baseline (25694).
Muscle cramps. It is unclear if oral licorice is beneficial for muscle cramps due to cirrhosis or hemodialysis. Details: Preliminary clinical research shows that taking a specific combination of licorice and peony (shakuyaku-kanzo-to) might reduce muscle cramps in patients with hepatic cirrhosis or in patients undergoing hemodialysis when compared to baseline (13550,13551,13552). This combination was taken as 6-7.5 grams daily in up to three divided doses for 2-4 weeks in two studies (13550,13552). In a third study, the combination was taken as 2.5 grams during hemodialysis with self-administration at the onset of muscle cramping (13551).
Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral licorice is beneficial for NAFLD. Details: A small clinical trial in females with NAFLD shows that taking licorice extract (Shirin Darou Company, Shiraz, Iran) 500 mg twice daily for 12 weeks improves some measures of liver health and glycemic control when compared with placebo. Modest improvements occurred in levels of alanine aminotransferase, as well as in measures of insulin resistance and severity of liver steatosis based on ultrasonographic evaluation. There were no effects on body mass index (BMI), plasma lipids, fasting blood glucose, or other liver enzymes. All patients were also given weight loss and healthy lifestyle advice (110320). Preliminary clinical research shows that taking licorice root extract 2 grams daily for 2 months reduces liver function enzyme levels in patients with NAFLD when compared to pre-treatment (59841). It is unclear if this reduction is clinically significant.
Obesity. It is unclear if oral licorice is beneficial for weight loss. Details: Preliminary clinical research shows that taking a specific licorice flavonoid oil (Glavonoid) 300 mg daily for 8 weeks has no effect on weight or body fat when compared with placebo in obese patients (17727).
Oral mucositis. It is unclear if oral or topical licorice is beneficial for the prevention or treatment of chemotherapy- or radiation-induced oral mucositis. Details: In patients with head and neck cancer undergoing chemoradiation, preliminary clinical research shows that using oral and topical licorice powder twice daily in addition to conventional treatments for 6 weeks reduces the overall incidence of mucositis and also reduces the risk of developing severe oral mucositis to 15.5%, compared with 20% in those using topical honey and 43% in those using conventional treatments alone. Licorice treatment consisted of yastimadhu powder 5 grams mixed in honey for topical application in the mouth, as well as yastimadhu capsule 500 mg twice daily orally (104562). A small clinical trial in patients with head and neck cancer and oral mucositis currently undergoing radiation therapy shows that applying a mucoadhesive film containing licorice to the upper lip mucosal surface four times daily for 4 weeks, in conjunction with standard oral care, improves pain scores, mucositis grading, and ulcer size when compared with placebo film (108572). The validity of this finding is limited due to the short duration of treatment and exclusion of patients with severe mucositis.
Osteoarthritis. Although there has been interest in using oral licorice for osteoarthritis, there is insufficient reliable information about the clinical effects of licorice for this condition.
Osteoporosis. Although there has been interest in using oral licorice for osteoporosis, there is insufficient reliable information about the clinical effects of licorice for this condition.
Parkinson disease. It is unclear if oral licorice is beneficial for improving Parkinson disease symptoms. Details: A small clinical study in patients with Parkinson disease shows that taking licorice extract 136 mg (containing glycyrrhizin 12.14 mg, polyphenols 136 mcg, and flavonoids 2.6 mcg) in a 5 mL syrup twice daily for 6 months improves Parkinson symptoms, tremor, and overall daily activities when compared with placebo (102961).
Peptic ulcers. Evidence for the use of oral licorice for peptic ulcers is mixed. Details: There is some evidence that taking 6-12 tablets each containing deglycyrrhizinated licorice 380 mg, bismuth subnitrate 100 mg, aluminum hydroxide gel 100 mg, magnesium carbonate 200 mg, sodium bicarbonate 100 mg, and powdered alder buckthorn bark 30 mg (Caved-S, Cedona) in up to three divided doses daily for 4-16 weeks might accelerate the healing of peptic ulcers (11312,11313). Some clinical research also shows that this product is as effective as carbenoxolone sodium (Biogastrone) when taken at doses of two tablets three times daily after meals for 4 weeks (59871). In contrast, taking deglycyrrhizinated licorice (Ulcedal, Cedona, and others) 450-1000 mg three to five times daily for 4-8 weeks or glycyrrhizinic acid-reduced licorice 760 mg three times daily for 6 weeks does not seem to reduce the need for medication, pain, burning, or other discomfort in patients with peptic ulcers when compared with placebo (59864,59865,59873,59874).
Physical performance. It is unclear if oral licorice is beneficial for improving physical performance in older females. Details: A small clinical trial in healthy females 59 years and older shows that taking licorice flavonoid oil 300 mg orally daily for 16 weeks in addition to strength training does not improve walking speed or other measures of functional mobility when compared with strength training alone (102960).
Polycystic ovary syndrome (PCOS). Oral licorice has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research shows that taking licorice root extract 2250 mg daily along with Ceylon cinnamon, levant berry, St. John's Wort, peony, and tribulus for 3 months with lifestyle modification improves symptoms of PCOS, including a reduction in oligomenorrhea/amenorrhea by 33% and the number of days between menstrual cycles by 43 days when compared with lifestyle modification alone. Although conception rate increased 4-fold in the intervention group, live birth rate was similar between groups (97216). The effect of licorice alone for the treatment of PCOS is unknown.
Prostate cancer. Although there has been interest in using oral licorice for prostate cancer, there is insufficient reliable information about the clinical effects of licorice for this condition.
Psoriasis. It is unclear if topical licorice is beneficial for improving psoriasis symptoms. Details: Preliminary clinical research shows that using a topical cream containing licorice extract and milk proteins twice daily for 4 weeks does not reduce the duration of corticosteroid cream therapy in patients with palmar and/or plantar psoriasis, but may improve skin peeling, the area of skin affected, and some subjective symptoms, when compared with corticosteroid cream alone (59823).
Systemic lupus erythematosus (SLE). Although there has been interest in using oral licorice for SLE, there is insufficient reliable information about the clinical effects of licorice for this condition.
Tuberculosis. Although there has been interest in using oral licorice for tuberculosis, there is insufficient reliable information about the clinical effects of licorice for this condition.
Urticaria. Oral licorice has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of clinical research in adults with chronic urticaria shows that taking compound glycyrrhizin, containing glycyrrhizin, N-acetyl cysteine, and glycine, as 50-75 mg three times daily along with desloratadine 5-8.8 mg daily for 4 weeks improves response rate, cure rate, and recurrence rate when compared with desloratadine alone (108571). However, most studies included in the meta-analysis were low quality, and all studies were conducted in China. Higher quality studies in other geographic locations are needed to confirm these findings.
Vitiligo. It is unclear if the licorice constituent compound glycyrrhizin is beneficial for vitiligo. Details: A meta-analysis of 14 clinical studies in patients aged 3-68 years old with vitiligo shows that taking licorice constituent compound glycyrrhizin 25-75 mg 3 times daily for 2-6 months with standard treatment improves effectiveness, cure rate, and immune-mediated inflammatory markers when compared with standard treatment alone (112232). More evidence is needed to rate licorice for these uses.

(Read more about LICORICE)

LOVAGE (Szechuan Lovage)

INSUFFICIENT RELIABLE EVIDENCE to RATE

Diabetic nephropathy. Preliminary clinical research shows that taking a specific combination tablet containing lovage root, centaury herb, and rosemary leaf (Canephron N, Bionorica), as two tablets three times daily for 6 months in conjunction with antidiabetes medication and enalapril 20 mg daily, reduces microalbuminuria by 73% and the albumin to creatinine ratio by 46%, increases high-density lipoprotein (HDL) cholesterol by 25%, and lowers triglyceride levels by 43% when compared to baseline. These improvements are greater than those observed for patients treated with antidiabetes medications and enalapril alone (91726). More evidence is needed to rate lovage for this use.

(Read more about LOVAGE)

PEONY (White Peony)

INSUFFICIENT RELIABLE EVIDENCE to RATE

Aging skin. It is unclear if topical peony is beneficial in patients with aging skin. Details: Preliminary clinical research shows that using a cosmetic ingredient containing 0.5% paeoniflorin, a constituent of peony root, for 8 weeks can reduce facial wrinkles when compared with baseline (68356). The validity of this finding is limited by the lack of a comparator group.
Anal fissures. Although there has been interest in using topical peony for anal fissures, there is insufficient reliable information about the clinical effects of peony for this purpose.
Ankylosing spondylitis. Small, low-quality clinical studies suggest that oral peony, as total glucosides of peony (TGP), may improve disease symptoms in patients with ankylosing spondylitis. Details: A meta-analysis of 3 clinical trials in patients with ankylosing spondylitis (AS) shows that taking TGP 0.6 grams 3 times daily with conventional medical treatment for 12-24 weeks improves the AS disease activity score when compared with conventional treatment alone. TGP also improves inflammatory markers including erythrocyte sedimentation rate, C-reactive protein, tumor necrosis factor alpha, and interleukin-6 (112861). The reliability of these findings is limited by the low to very low quality of the included studies. Additionally, all of the studies were conducted in China; it is unclear if findings can be applied to other geographical regions and populations.
Antipsychotic-induced hyperprolactinemia. Oral peony has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in females with risperidone-induced hyperprolactinemia shows that taking a specific combination of peony and licorice (Peony-Glycyrrhiza Decoction; PGD) 45 grams daily for 4 weeks is similarly effective to bromocriptine for reducing prolactin levels (59775). A similar trial in males with antipsychotic-induced hyperprolactinemia shows that taking an herbal extract containing peony and licorice (shakuyaku-kanzo-to), 2.5 grams three times daily, reduces prolactin levels after 4 weeks of treatment when compared with baseline. Prolactin levels returned to baseline 4 weeks after treatment cessation (59907). The validity of this study is limited by the lack of a comparator group. Subsequently, a higher quality clinical trial in females with antipsychotic-induced hyperprolactinemia shows that taking a peony and licorice decoction (PGD) 45 grams daily for 16 weeks does not improve prolactin levels or clinical symptoms when compared with placebo (97219). However, a small clinical trial in adults with schizophrenia and sexual dysfunction due to antipsychotic-induced hyperprolactinemia shows that taking a similar PGD formulation for 8 weeks improves sexual function scores and prevents further increases in prolactin levels when compared with a non-treated control group (112412). It is unclear if any effects are due to peony, licorice, or the combination.
Atherosclerosis. Although there has been interest in using oral peony for atherosclerosis, there is insufficient reliable information about the clinical effects of peony for this purpose.
Chronic fatigue syndrome (CFS). Although there has been interest in using oral peony for CFS, there is insufficient reliable information about the clinical effects of peony for this purpose.
Cirrhosis. Although there has been interest in using oral peony for cirrhosis, there is insufficient reliable information about the clinical effects of peony for this purpose.
Cough. Although there has been interest in using oral peony for cough, there is insufficient reliable information about the clinical effects of peony for this purpose.
Dysmenorrhea. Although there has been interest in using oral peony for dysmenorrhea, there is insufficient reliable information about the clinical effects of peony for this purpose.
Dyspepsia. Although there has been interest in using oral peony for dyspepsia, there is insufficient reliable information about the clinical effects of peony for this purpose.
Diabetic nephropathy. It is unclear if oral peony is beneficial in patients with diabetic nephropathy. Details: Preliminary clinical research in Chinese adults with diabetic nephropathy shows that taking total glucosides of peony (TGP) 600 mg three times daily in conjunction with losartan 100 mg daily for 6 months does not improve urinary albumin excretion rate when compared with losartan alone. Taking TGP in conjunction with losartan also did not affect serum creatinine, fasting glucose, glycated hemoglobin (HbA1c), triglycerides, or total cholesterol when compared with losartan alone (98466).
Epilepsy. It is unclear if oral peony is beneficial in patients with epilepsy. Details: Preliminary clinical research in children 1-14 years of age with intractable epilepsy shows that taking peony root extract orally 20 mg/kg twice daily for 4 weeks reduces weekly seizure frequency and average seizure duration by 80% and 83%, respectively, when compared with baseline. Approximately 63% of subjects reported a reduction in seizure frequency of at least 50% when compared with baseline. The validity of this study is limited by the lack of a comparator group (106851).
Gout. Although there has been interest in using oral peony for gout, there is insufficient reliable information about the clinical effects of peony for this purpose.
Hepatitis. Although there has been interest in using oral peony for hepatitis, there is insufficient reliable information about the clinical effects of peony for this purpose.
Juvenile idiopathic arthritis (JIA). Small clinical studies suggest that oral peony, as total glucosides of peony (TGP), may modestly improve symptoms in patients with JIA. Details: A pooled analysis of low-quality clinical research in Chinese children 1.5-14 years of age with JIA shows that taking TGP 30-180 mg/kg daily or 600-1800 mg daily in conjunction with methotrexate for 9-26 weeks improves the odds of overall response rate by 1.5 to 2.5 times when compared with methotrexate alone. TGP also reduces erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels when compared with methotrexate alone. Preliminary subgroup analyses suggest that TGP is not effective for JIA if it is taken for 8 weeks or less (92785). Another meta-analysis of 7 small to moderate-sized clinical trials in children with JIA also shows that taking TGP 0.3 mg/kg, 30-60 mg/kg, or 1200 mg daily with conventional treatment for 12-24 weeks improves effectiveness rates when compared with conventional treatment alone. TGP also reduces ESR, CRP, and tumor necrosis factor alpha (TNF-α) (112861). The reliability of these findings is limited by the variability in the quality of the included studies. Additionally, all of the studies were conducted in China; it is unclear if findings can be applied to other geographical regions and populations.
Mastalgia. Although there has been interest in using oral peony for mastalgia, there is insufficient reliable information about the clinical effects of peony for this purpose.
Migraine headache. Although there has been interest in using oral peony for migraine, there is insufficient reliable information about the clinical effects of peony for this purpose.
Muscle cramps. Oral peony has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary, low-quality, clinical research shows that taking a specific combination of peony and licorice (shakuyaku-kanzo-to) orally, 2.5-6 grams daily for up to 4 weeks, relieves muscle cramps when compared to baseline in patients undergoing hemodialysis (13551,13552). The validity of these studies is limited by the lack of a comparator group. It is also unclear if this effect is due to peony, licorice, or the combination.
Neuropathic pain. Although there has been interest in using oral peony for neuropathic pain, there is insufficient reliable information about the clinical effects of peony for this purpose.
Osteoarthritis. Some low-quality clinical studies suggest that oral peony, as total glucosides of peony (TGP), may modestly improve symptoms in patients with osteoarthritis. Details: A meta-analysis of 4 moderate-sized clinical trials in adults with osteoarthritis shows that taking TGP 0.6 grams 2 or 3 times daily with conventional medical treatment for 4-12 weeks improves joint pain when compared with conventional treatment alone (112861). The reliability of these findings is limited by the low quality and high heterogeneity of the included studies. Additionally, all of the studies were conducted in China; it is unclear if findings can be applied to other geographical regions and populations.
Pancreatitis. It is unclear if rectal peony is beneficial in patients with pancreatitis. Details: Preliminary clinical research in adults with moderate to severe acute pancreatitis shows that rectal administration of 150 mL water containing 15 grams of red peony root granules twice daily for 7 days in addition to standard care reduces the time to resolution of abdominal pain and normal bowel habits by 25% when compared with a placebo enema. Additionally, patients receiving red peony root had an average 2-day reduction in hospital stay and a greater improvement on the modified Balthazar CT score when compared with placebo (104283).
Polycystic ovary syndrome (PCOS). Oral peony has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research shows that taking peony root extract 2250 mg daily, along with Ceylon cinnamon, levant berry, St. John's wort, Tribulus, and licorice, during the follicular phase of the menstrual cycle for 3 months reduces the rate of oligomenorrhea or amenorrhea by 33% and the time between menstrual cycles by 43 days when compared with lifestyle modification alone. Taking this combination also improves quality of life by about 30% and modestly reduces body weight and body mass index when compared with lifestyle intervention alone. Although taking this combination improved conception rate by 4-fold, live birth rate was similar to lifestyle intervention alone (97216). It is unclear if these effects are due to peony, the other ingredients, or the combination.
Premenstrual syndrome (PMS). Although there has been interest in using oral peony for PMS, there is insufficient reliable information about the clinical effects of peony for this purpose.
Psoriasis. It is unclear if oral peony is beneficial for plaque psoriasis. Details: Preliminary clinical research in Chinese adults with moderate to severe plaque psoriasis shows that taking total glucosides of peony (TGP) 600 mg three times daily in conjunction with acitretin for 12 weeks does not improve plaque size or severity when compared with acitretin alone. However, taking TGP in combination with acitretin might increase the number of patients achieving a 50% reduction in plaque size when compared with acitretin alone (97950).
Psoriatic arthritis. Small, low-quality clinical studies suggest that oral peony, as total glucosides of peony (TGP), may improve symptoms in patients with psoriatic arthritis. Details: A meta-analysis of 2 small clinical trials in adults with psoriatic arthritis shows that taking TGP 0.6 grams 3 times daily with conventional medical treatment for 12-24 weeks improves Psoriasis Area and Severity Index (PASI) scores and the inflammatory marker erythrocyte sedimentation rate when compared with conventional treatment alone (112861). The reliability of these findings is limited by the low quality and high heterogeneity of the included studies. Additionally, all of the studies were conducted in China; it is unclear if findings can be applied to other geographical regions and populations.
Respiratory tract infections. Although there has been interest in using oral peony for respiratory tract infections, there is insufficient reliable information about the clinical effects of peony for this purpose.
Restless legs syndrome (RLS). Oral peony has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of 12 low-quality clinical studies in Chinese patients with RLS shows that taking peony-containing combination herbal preparations along with conventional therapy appears to improve sleep quality and decrease RLS symptoms when compared with conventional therapy alone. A few of the studies included in this analysis also suggest that taking peony-containing herbal products alone might be more effective than conventional therapy for RLS (100991). The peony-containing products included in this analysis contained between 4-15 other herbal ingredients. It is unclear whether the effects are due to peony, other ingredients, or the combination.
Rheumatoid arthritis (RA). It is unclear if oral peony is beneficial in patients with RA; evidence is conflicting. Details: Although low-quality clinical research in patients with RA has shown that use of total glucosides of peony (TGP) in conjunction with standard treatment for 4-24 weeks reduces inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein when compared with standard treatment alone, effects on RA symptoms are conflicting (92786,101245,112861). A pooled analysis of clinical research in adults with RA shows that taking TGP in conjunction with leflunomide for 4-24 weeks is less effective for reducing RA symptom scores than taking leflunomide alone (92786). In contrast, another pooled analysis of clinical research in adults with RA shows that taking TGP for 12-24 weeks in combination with methotrexate improves swollen joint count, but not other symptoms such as morning stiffness and tender joint count, when compared with methotrexate alone. Preliminary subgroup analyses also suggest that taking TGP in conjunction with methotrexate might reduce overall adverse effects when compared with methotrexate alone (101245). Of note, the dose of TGP used is not reported in most trials included in these two analyses. Another meta-analysis of 10 mostly small to moderate-sized clinical trials in adults with RA shows that taking TGP 0.6 grams 1-3 times daily with conventional medical treatment for 12-48 weeks improves symptoms as evaluated with the Disease Activity of 28 joints (DAS28) scale when compared with conventional treatment alone (112861). However, these analyses are all limited by the low quality of the included studies. Additionally, all of the included studies were conducted in China; it is unclear if findings can be applied to other geographical regions and populations.
Sjogren syndrome. It is unclear if oral peony is beneficial in patients with Sjogren syndrome. Details: Some clinical research in Chinese adults with Sjogren syndrome shows that taking total glucosides of peony (TGP) 600 mg three times daily for 24 weeks improves overall symptoms, with the greatest effects on symptoms of dry eye and fatigue, when compared with placebo (100992). An earlier and smaller clinical study from the same research group found that taking TGP at the same dose and duration improved symptoms of dry mouth, but did not reduce overall symptom scores or other markers of disease, when compared with placebo (97949). However, this study was not adequately powered to detect differences in overall symptom scores between TGP and placebo.
Spasticity. Although there has been interest in using oral peony for spasticity, there is insufficient reliable information about the clinical effects of peony for this purpose.
Systemic lupus erythematosus (SLE). Small clinical studies suggest that oral peony, as total glucosides of peony (TGP), may modestly improve disease activity scores in patients with SLE. Details: A meta-analysis of 13 small to moderate-sized, low-quality clinical studies in patients with SLE shows that taking TGP 0.6 grams 2-3 times daily or 1.2 grams twice daily for 1-6 months in conjunction with conventional treatment modestly improves the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score when compared with conventional treatment alone. Analyses of secondary endpoints which were not available for all studies show that TGP also improves markers of SLE disease activity, including erythrocyte sedimentation rate (ESR) and C-reactive protein, reduces the average daily dose of glucocorticoids and the cumulative dose of cyclophosphamide, and decreases the rate of disease recurrence (110432). However, the validity of the findings from this meta-analysis is limited by the heterogeneity of the included studies, which enrolled patients of varying age and disease severity. Additionally, a similar meta-analysis of 8 small to moderate-sized, low-quality clinical studies in adults with SLE shows that taking TGP 0.6 grams 2-3 times daily for 3-12 months in conjunction with conventional treatment of glucocorticoids and/or immunosuppressants improves SLEDAI scores when compared with conventional treatment alone. TGP also improves markers of inflammation such as ESR, levels of immunoglobulins A, G and M, and complement 3 and 4 (112862). The validity of these finding is also limited by substantial heterogeneity which may be due to differences in conventional therapies. In addition, all of the studies included in these meta-analyses were conducted in China; it is unclear if findings can be applied to other geographical regions and populations. More evidence is needed to rate peony for these uses.

(Read more about PEONY)

PORIA MUSHROOM (Fu Ling)

INSUFFICIENT RELIABLE EVIDENCE to RATE

Cancer. Although there is interest in using oral poria mushroom for cancer, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
Chronic fatigue syndrome (CFS). Although there is interest in using oral poria mushroom for CFS, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
Chronic kidney disease (CKD). Although there is interest in using oral poria mushroom for CKD, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
Coronavirus disease 2019 (COVID-19). Although there has been interest in using oral poria mushroom for COVID-19, there is insufficient reliable information about the clinical effects of poria mushroom for this purpose.
Dementia. Although there is interest in using oral poria mushroom for dementia, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
Diabetes. Oral poria mushroom has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of generally small clinical trials in patients with type 2 diabetes shows that taking Chinese herbal medicine combinations containing poria mushroom for 2-24 weeks along with hypoglycemic medications modestly reduces fasting blood glucose and glycated hemoglobin levels when compared with control groups taking hypoglycemic agents only. There were also modest improvements in levels of triglycerides and low-density lipoprotein (LDL) cholesterol and in insulin sensitivity (111920). Given the large number of other ingredients in the available formulations, it is unclear if any beneficial effects are related to poria mushroom, other ingredients in the formulation, or their combination.
Diarrhea. Although there is interest in using oral poria mushroom for diarrhea, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
Endometriosis. Although there is interest in using oral poria mushroom for endometriosis, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
Influenza. Oral poria mushroom has only been evaluated for influenza vaccine enhancement in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in healthy adults shows that taking a product containing poria mushroom extract, rosemary extract, and aloe gel powder twice daily for 28 days prior to and following an influenza vaccination does not affect upper respiratory tract illness symptoms, severity, duration, or medication-related use when compared with taking placebo (111921). It is unclear if this study was large enough to detect differences between groups. Also, the effect of poria mushroom itself on influenza vaccine enhancement is unclear.
Tinnitus. Although there is interest in using oral poria mushroom for tinnitus, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
Urinary tract infections (UTIs). Although there is interest in using oral poria mushroom for UTIs, there is insufficient reliable information about the clinical effects of poria mushroom for this use. More evidence is needed to rate poria mushroom for these uses.

(Read more about PORIA MUSHROOM)

REHMANNIA (Shu Di Huang)

POSSIBLY EFFECTIVE

Chronic kidney disease (CKD). Oral rehmannia acteosides might reduce proteinuria when used in conjunction with angiotensin II receptor blockers in patients with CKD. Details: A large clinical trial in adults with chronic glomerulonephritis shows that taking rehmannia acteosides extract 400 mg twice daily, in conjunction with irbesartan 150 mg daily, for 8 weeks decreases proteinuria by 36%, compared with a reduction of 28% with irbesartan alone (93662).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Aplastic anemia. It is unclear if oral rehmannia is beneficial in patients with aplastic anemia. Details: A small clinical study in adults with aplastic anemia shows that taking rehmannia polysaccharide (dose unknown), in conjunction with stanozolol, increases the incidence of symptom remission by 45% when compared with stanozolol alone (70704).
Atopic disease. Although there has been interest in using oral rehmannia for atopic disease, there is insufficient reliable information about the clinical effects of rehmannia for this purpose.
Diabetes. Although there has been interest in using oral rehmannia for diabetes, there is insufficient reliable information about the clinical effects of rehmannia for this purpose.
Diabetic nephropathy. Oral rehmannia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large clinical study in adults with chronic kidney disease due to type 2 diabetes receiving standard care with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker shows that taking a specific combination product (Rehmannia-6, PuraPharm) containing rehmannia, Japanese cornel dogwood, wild yam, poria mushroom, Asian water plantain, and peony root bark twice daily for 48 weeks modestly slows the decline in kidney function when compared with standard care alone (112821). It is unclear if this effect is due to rehmannia, other ingredients, or the combination.
Metabolic syndrome. Although there has been interest in using oral rehmannia for metabolic syndrome, there is insufficient reliable information about the clinical effects of rehmannia for this purpose.
Obesity. It is unclear if oral rehmannia root extract is beneficial in patients with obesity. Details: A very small clinical study in females with obesity shows that taking steamed rehmannia root extract 4 grams twice daily for 8 weeks decreases waist circumference by 2.6%, but does not affect body weight or body fat percentage, when compared to baseline (93660). The validity of these findings is limited by the lack of a control group.
Osteoporosis. Although there has been interest in using oral rehmannia for osteoporosis, there is insufficient reliable information about the clinical effects of rehmannia for this purpose.
Rheumatoid arthritis (RA). Although there has been interest in using oral rehmannia for RA, there is insufficient reliable information about the clinical effects of rehmannia for this purpose. More evidence is needed to rate rehmannia for these uses.

(Read more about REHMANNIA)

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Safety view details

Below is general information about the safety of the known ingredients contained in the product Dr. Shen's Women's Precious. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ATRACTYLODES (Bai Zhu)

There is insufficient reliable information available about the safety of atractylodes.

PREGNANCY: POSSIBLY UNSAFE
when used orally. In animals, atractylodes has caused reproductive toxicity, including fetal death, as well as changes in gestation, growth, and skeletal formation (94304).

LACTATION:
There is insufficient reliable information available about the safety of atractylodes when used during breast-feeding.

(Read more about ATRACTYLODES)

CODONOPSIS (Dang Shen)

POSSIBLY SAFE ...when used orally and appropriately. Traditionally, aqueous extract of codonopsis 6-9 grams daily has been used with apparent safety (12).

POSSIBLY UNSAFE ...when used orally in large amounts. Large doses of codonopsis (30-60 grams) have been associated with adverse effects including chest pain, arrhythmia, visual impairment, dizziness, and other conditions (12).

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

(Read more about CODONOPSIS)

DONG QUAI (Dang Gui)

POSSIBLY SAFE ...when used orally and appropriately. Dong quai has been used with apparent safety in a dose of 4.5 grams daily for 24 weeks, or in combination with other ingredients in doses of up to 150 mg daily for up to 6 months (19552,35797). ...when used intravenously as a 25% solution, in a dose of 200-250 mL daily for up to 20 days (48438,48442,48443,48483).

POSSIBLY UNSAFE ...when used orally in large amounts, long-term. Theoretically, long-term use of large amounts of dong quai could be harmful. Dong quai contains several constituents such as bergapten, safrole, and isosafrole that are considered carcinogenic (7162). There is insufficient reliable information available about the safety of dong quai when used topically.

PREGNANCY: POSSIBLY UNSAFE
when used orally. Dong quai has uterine stimulant and relaxant effects (8142); theoretically, it could adversely affect pregnancy. Observational research has found that intake of An-Tai-Yin, an herbal combination product containing dong quai and parsley, during the first trimester is associated with an increased risk of congenital malformations of the musculoskeletal system, connective tissue, and eyes (15129).

LACTATION:
Insufficient reliable information available; avoid use.

(Read more about DONG QUAI)

HONEY

LIKELY SAFE ...when used orally and appropriately (13160,14319). Concerns about botulism pertain only to children under 12 months of age and not to adults (13160). ...when used topically and appropriately. A specific commercially available wound dressing containing manuka honey (Medihoney) is approved as a medical device by the US Food and Drug Administration (FDA) (16353,16355,16357,16362,16369,16371). Some evidence suggests other honey preparations can also be used safely when applied to the skin or used to rinse the mouth (395,396,397,398,399,7847,7849,13133,14317)(16358,16372,97704,101034,108530).

POSSIBLY SAFE ...when properly diluted honey is used intranasally. Manuka honey 16.5% solution has been used with apparent safety as a nasal rinse twice daily for 14 days (103969). ...when specific, medical-grade honey products are used in eye drops. A specific product (Optimel Manuka Plus Eye Drops, Melcare Biomedical Pty Ltd) has been used safely 2-3 times daily for up to 4 weeks (105231,105234).

LIKELY UNSAFE ...when honey produced from the nectar of rhododendrons is used orally. This type of honey contains grayanotoxins, which may lead to cardiovascular symptoms, such as arrhythmias, hypotension, chest pain, bradycardia, syncope, asystole, various types of heart block, and myocardial infarction (12220,55119,55122,55125,55126,55129,55141,55142,55157)(55163,55170,55171,55180,55183,55190,55224,55233,55234,55239)(55248,55260,55261,55280,55281).

CHILDREN: LIKELY SAFE
when used orally and appropriately, short-term in children at least 12 months of age (15910,17299,55210,55253,97693).

CHILDREN: POSSIBLY UNSAFE
when used orally in children less than 12 months of age. Ingestion of raw honey contaminated with Clostridium botulinum spores can cause botulism poisoning in infants under 12 months of age (13160,55067,55290,91359). This is not a danger for older children or adults. Medical-grade, sterilized honey has been used with apparent safety in the formula of premature newborns at doses of up to 15 grams daily for up to 2 weeks (97697).

PREGNANCY AND LACTATION: LIKELY SAFE
when consumed in food amounts. The concern about botulism pertains to children under 12 months of age and not to pregnant adults (13160). There is insufficient reliable information available about the safety of honey when used for medicinal purposes when pregnant or breast-feeding.

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LICORICE (Chinese Licorice)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Licorice has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when licorice products that do not contain glycyrrhizin (deglycyrrhizinated licorice) are used orally and appropriately for medicinal purposes. Licorice flavonoid oil 300 mg daily for 16 weeks, and deglycyrrhizinated licorice products in doses of up to 4.5 grams daily for up to 16 weeks, have been used with apparent safety (6196,11312,11313,17727,100984,102960). ...when licorice products containing glycyrrhizin are used orally in low doses, short-term. Licorice extract 272 mg, containing glycyrrhizin 24.3 mg, has been used daily with apparent safety for 6 months (102961). A licorice extract 1000 mg, containing monoammonium glycyrrhizinate 240 mg, has been used daily with apparent safety for 12 weeks (110320). In addition, a syrup providing licorice extract 750 mg has been used twice daily with apparent safety for 5 days (104558). ...when applied topically. A gel containing 2% licorice root extract has been applied to the skin with apparent safety for up to 2 weeks. (59732). A mouth rinse containing 5% licorice extract has been used with apparent safety four times daily for up to one week (104564).

POSSIBLY UNSAFE ...when licorice products containing glycyrrhizin are used orally in large amounts for several weeks, or in smaller amounts for longer periods of time. The European Scientific Committee on Food recommends that a safe average daily intake of glycyrrhizin should not exceed 10 mg (108577). In otherwise healthy people, consuming glycyrrhizin daily for several weeks or longer can cause severe adverse effects including pseudohyperaldosteronism, hypertensive crisis, hypokalemia, cardiac arrhythmias, and cardiac arrest. Doses of 20 grams or more of licorice products, containing at least 400 mg glycyrrhizin, are more likely to cause these effects; however, smaller amounts have also caused hypokalemia and associated symptoms when taken for months to years (781,3252,15590,15592,15594,15596,15597,15599,15600,16058)(59731,59740,59752,59785,59786,59787,59792,59795,59805,59811)(59816,59818,59820,59822,59826,59828,59849,59850,59851,59867)(59882,59885,59888,59889,59895,59900,59906,97213,110305). In patients with hypertension, cardiovascular or kidney conditions, or a high salt intake, as little as 5 grams of licorice product or 100 mg glycyrrhizin daily can cause severe adverse effects (15589,15593,15598,15600,59726).

PREGNANCY: UNSAFE
when used orally. Licorice has abortifacient, estrogenic, and steroid effects. It can also cause uterine stimulation. Heavy consumption of licorice, equivalent to 500 mg of glycyrrhizin per week (about 250 grams of licorice per week), during pregnancy seems to increase the risk of delivery before gestational age of 38 weeks (7619,10618). Furthermore, high intake of glycyrrhizin, at least 500 mg per week, during pregnancy is associated with increased salivary cortisol levels in the child by the age of 8 years. This suggests that high intake of licorice during pregnancy may increase hypothalamic-pituitary-adrenocortical axis activity in the child (26434); avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about LICORICE)

LOVAGE (Szechuan Lovage)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Lovage has Generally Recognized As Safe status (GRAS) for use in foods in the US (4912).

POSSIBLY SAFE ...when used orally and appropriately, short-term (12). Lovage root 36 mg daily, in combination with centaury and rosemary (Canephron N, Bionorica), has been used with apparent safety for 6 months (91726).

PREGNANCY: LIKELY UNSAFE
when used orally; lovage is reported to have uterine and menstrual stimulant effects (12).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about LOVAGE)

PEONY (White Peony)

POSSIBLY SAFE ...when used orally and appropriately, short term. Total glucosides of peony has been used with apparent safety in doses of up to 1800 mg daily for up to 12 months (92786,97949,97950,98466,100992,110432,112861,112862). Peony root extract has been used with apparent safety at a dose of 2250 mg daily for up to 3 months (97216). There is insufficient reliable information available about the safety of peony when used orally, topically, or rectally, long-term.

CHILDREN: POSSIBLY SAFE
when used orally and appropriately, short-term. Total glucosides of peony has been used with apparent safety in children 1.5-4 years of age at doses up to 180 mg/kg daily or 1.2 grams daily for up to 12 months (92785). Peony root extract 40 mg/kg daily has also been used with apparent safety in children 1-14 years of age for 4 weeks (106851).

PREGNANCY: POSSIBLY UNSAFE
when used orally. Preliminary research suggests that peony can cause uterine contractions (13400). However, other preliminary research suggests a combination of peony and angelica with or without motherwort, banksias rose, and ligustica, might be safe (11015,48433). Until more is known, avoid use.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about PEONY)

PORIA MUSHROOM (Fu Ling)

There is insufficient reliable information available about the safety of poria mushroom.

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

(Read more about PORIA MUSHROOM)

REHMANNIA (Shu Di Huang)

POSSIBLY SAFE ...when used orally and appropriately, short term. Rehmannia root extract 4 grams daily or rehmannia leaf extract 800 mg daily has been used with apparent safety for 8 weeks in clinical studies (93660,93662).

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

(Read more about REHMANNIA)

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Interactions with Drugs view details

Below is general information about the interactions of the known ingredients contained in the product Dr. Shen's Women's Precious. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ATRACTYLODES (Bai Zhu)

ANTICOAGULANT/ANTIPLATELET DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, atractylodes might increase the risk of bleeding when used concomitantly with anticoagulant and antiplatelet drugs.

Details

Laboratory research suggests that atractylenolides II and III, constituents of atractylodes, reduce platelet activation (94299). So far, this has not been shown in humans.

AROMATASE INHIBITORS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, atractylodes may have an additive effect when used with other aromatase inhibitors.

Details

Laboratory research suggests that atractylodes and its constituents exhibit aromatase inhibitor effects (94302).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

Interaction Rating = Minor Be watchful with this combination.

Severity = Insignificant • Occurrence = Possible • Level of Evidence = D

Theoretically, atractylodes might decrease the levels of CYP1A2 substrates.

Details

In animals, atractylodes administered at high doses has been shown to induce CYP1A2 activity (112828). This effect has not been shown in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Minor Be watchful with this combination.

Severity = Insignificant • Occurrence = Possible • Level of Evidence = D

Theoretically, atractylodes might increase the levels of CYP3A4 substrates.

Details

In animals, atractylodes administered at high doses has been shown to inhibit CYP3A1 activity, which is a homolog to the human CYP3A4 enzyme (112828). This effect has not been shown in humans.

HEXOBARBITAL

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, taking atractylodes may prolong the therapeutic and adverse effects of hexobarbital.

Details

In animals, atractylodes has been shown to prolong the effects of hexobarbital (94303). These effects have not been shown in humans.

(Read more about ATRACTYLODES)

CODONOPSIS (Dang Shen)

ABIRATERONE (Zytiga)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, taking codonopsis root with abiraterone might reduce the levels and therapeutic effects of abiraterone.

Details

Animal research in rats shows that intragastric administration of codonopsis root along with abiraterone every 2 days for 2 weeks seems to increase the clearance of abiraterone and reduce the overall exposure and time to maximum concentration (105912). This interaction has not been reported in humans.

ANTICOAGULANT/ANTIPLATELET DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Theoretically, codonopsis liquor might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.

Details

A small clinical study in adults with coronary heart disease shows that consuming Codonopsis pilosula liquor for 4 weeks inhibits platelet aggregation but does not affect tissue-type plasminogen activator (t-PA) or plasminogen activator inhibitor (PAI) (43888).

ANTIDIABETES DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, codonopsis might increase the risk of hypoglycemia when taken with antidiabetes drugs.

Details

Laboratory and animal research suggest that codonopsis has antidiabetic effects (110743).

(Read more about CODONOPSIS)

DONG QUAI (Dang Gui)

ANTICOAGULANT/ANTIPLATELET DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.

Details

Animal studies suggest that dong quai has antithrombin activity and inhibits platelet aggregation due to its coumarin components (6048,10057,96137). Additionally, some case reports in humans suggest that dong quai can increase the anticoagulant effects of warfarin (3526,6048,23310,48439). However, clinical research in healthy adults shows that taking 1 gram of dong quai root daily for 3 weeks does not significantly inhibit platelet aggregation or cause bleeding (96137). Until more is known, use dong quai with caution in patients taking antiplatelet/anticoagulant drugs.

ESTROGENS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, dong quai may reduce the effects of estrogens.

Details

Dong quai has estrogenic effects (6180,7860,15108,15535,48459). Theoretically, concomitant use of large amounts of dong quai might interfere with hormone replacement therapy due to competition for estrogen receptors.

WARFARIN (Coumadin)

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = D

Dong quai may increase the risk of bleeding when used with warfarin.

Details

Case reports suggest that concomitant use of dong quai with warfarin can increase the anticoagulant effects of warfarin and increase the risk of bleeding (3526,6048,23310,48439). In one case, after 4 weeks of taking dong quai 565 mg once or twice daily, the international normalized ratio (INR) increased to 4.9. The INR normalized 4 weeks after discontinuation of dong quai (3526).

(Read more about DONG QUAI)

HONEY

ANTICOAGULANT/ANTIPLATELET DRUGS

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = D

Theoretically, honey may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.

Details

In vitro, honey inhibits platelet aggregation and increases the time to clotting (55222). Furthermore, animal research suggests that feeding mice large doses of honey for 12 days increases bleeding time when compared with no intervention (103964). However, these effects have not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Minor Be watchful with this combination.

Severity = Mild • Occurrence = Possible • Level of Evidence = B

Theoretically, honey might decrease levels of drugs metabolized by CYP3A4, but research is conflicting.

Details

Some clinical research shows that honey induces CYP3A4 (55116). However, other clinical studies found no effect on CYP3A4 activity (55208). Different honey preparations may have different effects on CYP3A4.

PHENYTOIN (Dilantin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, honey might increase levels of phenytoin.

Details

In an animal model, the rate and extent of absorption of phenytoin was increased by honey (20352). This effect has not been reported in humans.

(Read more about HONEY)

LICORICE (Chinese Licorice)

ANTIHYPERTENSIVE DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Theoretically, licorice might reduce the effects of antihypertensive drugs.

Details

In human research, licorice increases blood pressure in a dose-dependent manner (1372,7620,59877).

CISPLATIN (Platinol-AQ)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, licorice might reduce the effects of cisplatin.

Details

In animal research, licorice diminished the therapeutic efficacy of cisplatin (59763).

CORTICOSTEROIDS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use of licorice and corticosteroids might increase the side effects of corticosteroids.

Details

Case reports suggest that concomitant use of licorice and oral corticosteroids, such as hydrocortisone, can potentiate the duration of activity and increase blood levels of corticosteroids (3252,12672,20040,20042,48429,59756). Additionally, in one case report, a patient with neurogenic orthostatic hypertension stabilized on fludrocortisone 0.1 mg twice daily developed pseudohyperaldosteronism after recent consumption of large amounts of black licorice (108568).

CYTOCHROME P450 2B6 (CYP2B6) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, licorice might increase levels of drugs metabolized by CYP2B6.

Details

In vitro research shows that licorice extract and glabridin, a licorice constituent, inhibit CYP2B6 isoenzymes (10300,94822). Licorice extract from the species G. uralensis seems to inhibit CYP2B6 isoenzymes to a greater degree than G. glabra extract in vitro (94822). Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2B6; however, these interactions have not yet been reported in humans.

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, licorice might increase levels of drugs metabolized by CYP2C19.

Details

In vitro, licorice extracts from the species G. glabra and G. uralensis inhibit CYP2C19 isoenzymes in vitro (94822). Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2C19; however, this interaction has not yet been reported in humans.

CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, licorice might increase levels of drugs metabolized by CYP2C8.

Details

In vitro, licorice extract from the species G. glabra and G. uralensis inhibits CYP2C8 isoenzymes (94822). Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2C8; however, this interaction has not yet been reported in humans.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP2C9.

Details

There is conflicting evidence about the effect of licorice on CYP2C9 enzyme activity. In vitro research shows that extracts from the licorice species G. glabra and G. uralensis moderately inhibit CYP2C9 isoenzymes (10300,94822). However, evidence from an animal model shows that licorice extract from the species G. uralensis can induce hepatic CYP2C9 activity (14441). Until more is known, licorice should be used cautiously in people taking CYP2C9 substrates.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.

Details

Pharmacokinetic research shows that the licorice constituent glycyrrhizin, taken in a dosage of 150 mg orally twice daily for 14 days, modestly decreases the area under the concentration-time curve of midazolam by about 20%. Midazolam is a substrate of CYP3A4, suggesting that glycyrrhizin modestly induces CYP3A4 activity (59808). Animal research also shows that licorice extract from the species G. uralensis induces CYP3A4 activity (14441). However, licorice extract from G. glabra species appear to inhibit CYP3A4-induced metabolism of testosterone in vitro. It is thought that the G. glabra inhibits CYP3A4 due to its constituent glabridin, which is a moderate CYP3A4 inhibitor in vitro and not present in other licorice species (10300,94822). Until more is known, licorice should be used cautiously in people taking CYP3A4 substrates.

DIGOXIN (Lanoxin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use of licorice with digoxin might increase the risk of cardiac toxicity.

Details

Overuse or misuse of licorice with cardiac glycoside therapy might increase the risk of cardiac toxicity due to potassium loss (10393).

DIURETIC DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use of licorice with diuretic drugs might increase the risk of hypokalemia.

Details

Overuse of licorice might compound diuretic-induced potassium loss (10393,20045,20046,59812). In one case report, a 72-year-old male with a past medical history of hypertension, type 2 diabetes, hyperlipidemia, arrhythmia, stroke, and hepatic dysfunction was hospitalized with severe hypokalemia and uncontrolled hypertension due to pseudohyperaldosteronism. This was thought to be provoked by concomitant daily consumption of a product containing 225 mg of glycyrrhizin, a constituent of licorice, and hydrochlorothiazide 12.5 mg for 1 month (108577).

ESTROGENS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, licorice might increase or decrease the effects of estrogen therapy.

Details

Theoretically, licorice might interfere with estrogen therapy due to estrogenic and anti-estrogenic effects (7860,16058).

LOOP DIURETICS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, loop diuretics might increase the mineralocorticoid effects of licorice.

Details

Theoretically, loop diuretics might enhance the mineralocorticoid effects of licorice by inhibiting the enzyme that converts cortisol to cortisone; however, bumetanide (Bumex) does not appear to have this effect (3255).

METHOTREXATE (Trexall, others)

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = D

Theoretically, licorice might increase levels of methotrexate.

Details

Animal research suggests that intravenous administration of glycyrrhizin, a licorice constituent, and high-dose methotrexate may delay methotrexate excretion and increase systemic exposure, leading to transient elevations in liver enzymes and total bilirubin (108570). This interaction has not yet been reported in humans.

MIDAZOLAM (Versed)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Theoretically, licorice might decrease levels of midazolam.

Details

In humans, the licorice constituent glycyrrhizin appears to moderately induce the metabolism of midazolam (59808). This is likely due to induction of cytochrome P450 3A4 by licorice. Until more is known, licorice should be used cautiously in people taking midazolam.

P-GLYCOPROTEIN SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, licorice might decrease the absorption of P-glycoprotein substrates.

Details

In vitro research shows that licorice can increase P-glycoprotein activity (104561).

PACLITAXEL (Abraxane, Onxol)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, licorice might decrease plasma levels and clinical effects of paclitaxel.

Details

Multiple doses of licorice taken concomitantly with paclitaxel might reduce the effectiveness of paclitaxel. Animal research shows that licorice 3 grams/kg given orally for 14 days before intravenous administration of paclitaxel decreases the exposure to paclitaxel and increases its clearance. Theoretically, this occurs because licorice induces cytochrome P450 3A4 enzymes, which metabolize paclitaxel. Notably, a single dose of licorice did not affect exposure or clearance of paclitaxel (102959).

WARFARIN (Coumadin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, licorice might decrease plasma levels and clinical effects of warfarin.

Details

Licorice seems to increase metabolism and decrease levels of warfarin in animal models. This is likely due to induction of cytochrome P450 2C9 (CYP2C9) metabolism by licorice (14441). Advise patients taking warfarin to avoid taking licorice.

(Read more about LICORICE)

LOVAGE (Szechuan Lovage)

DIURETIC DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, lovage root might interfere with diuretic therapy due to its aquaretic effects (512).

Details

Some diuretics include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, Hydrodiuril, Microzide), and others.

(Read more about LOVAGE)

PEONY (White Peony)

ANTICOAGULANT/ANTIPLATELET DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, combining peony with anticoagulant or antiplatelet drugs might increase the risk of bleeding.

Details

In vitro research suggests that peony might have antiplatelet, anticoagulant, and antithrombotic effects (92787).

CLOZAPINE (Clozaril)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, peony might increase the levels and clinical effects of clozapine.

Details

In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on cytochromes P450 (CYP) 1A2 and CYP3A4 (92790). This effect has not been reported in humans.

CONTRACEPTIVE DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, peony might interfere with contraceptive drugs due to competition for estrogen receptors.

Details

In vitro and animal research shows that peony extract has estrogenic activity (100990). Concomitant use might also increase the risk for estrogen-related adverse effects.

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.

Details

In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4 (92790). This effect has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.

Details

In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4 (92790). This effect has not been reported in humans.

ESTROGENS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use of large amounts of peony might interfere with hormone replacement therapy and/or increase the risk for estrogen-related adverse effects.

Details

In vitro and animal research shows that peony extract has estrogenic activity (100990). Theoretically, peony might compete for estrogen receptors and/or cause additive estrogenic effects.

PHENYTOIN (Dilantin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = D

Theoretically, peony might reduce the levels and clinical effects of phenytoin.

Details

Animal research shows that taking peony root reduces levels of phenytoin (8657). Some researchers suggest that peony root might affect cytochrome P450 (CYP) 2C9, which metabolizes phenytoin. However, preliminary research in humans shows that peony root does not alter levels of losartan (Cozaar), which is also metabolized by CYP2C9 (11480).

(Read more about PEONY)

PORIA MUSHROOM (Fu Ling)

ANTICHOLINERGIC DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, poria mushroom might decrease the clinical effects of anticholinergic drugs.

Details

In animal research, poria mushroom essential oil reduces acetylcholinesterase activity (111917). This interaction has not been shown in humans.

CHOLINERGIC DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, poria mushroom might have additive effects when used with cholinergic drugs.

Details

In animal research, poria mushroom essential oil reduces acetylcholinesterase activity (111917). This interaction has not been shown in humans.

CNS DEPRESSANTS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, taking poria mushroom extract may enhance the therapeutic and adverse effects of sedatives.

Details

Animal research shows that poria mushroom extract has sedative properties (111916). This interaction has not been shown in humans.

(Read more about PORIA MUSHROOM)

REHMANNIA (Shu Di Huang)

ANTIDIABETES DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, rehmannia might increase the risk of hypoglycemia when taken with antidiabetes drugs.

Details

Animal research shows that rehmannia may have hypoglycemic effects (15061,93668).

ANTIHYPERTENSIVE DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, rehmannia might increase the risk of hypotension when taken with antihypertensive drugs.

Details

Animal research shows that rehmannia may have hypotensive effects. Laboratory research shows that formulations of dried and processed rehmannia root inhibit angiotensin-converting enzyme (ACE) (104272).

(Read more about REHMANNIA)

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Adverse Effects view details

Report an Adverse Reaction to Dr. Shen's Women's Precious

Below is general information about the adverse effects of the known ingredients contained in the product Dr. Shen's Women's Precious. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ATRACTYLODES (Bai Zhu)

General ...There is currently a limited amount of information on the adverse effects of atractylodes. A thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Allergic reaction, dry mouth, nausea.

Gastrointestinal ...Orally, atractylenolide I, an isolated constituent of atractylodes, can cause bad taste, nausea, and dry mouth (15706).

Immunologic ...Atractylodes can cause an allergic reaction in people sensitive to the Asteraceae/Compositae family (12450). Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs.

(Read more about ATRACTYLODES)

CODONOPSIS (Dang Shen)

General ...Orally, codonopsis seems to be well tolerated when used appropriately; however, a thorough evaluation of safety outcomes has not been conducted.
Serious Adverse Effects (Rare):
Orally: Allergic reactions such as anaphylaxis.

Cardiovascular ...Orally, very large doses of codonopsis (30-60 grams) may cause chest pain or arrhythmia (12).

Gastrointestinal ...Orally, very large doses of codonopsis (30-60 grams) may cause throat pain and loss of voice (12).

Immunologic ...Orally, codonopsis can cause allergic reactions including anaphylaxis and urticaria. In one case report, an 18-year-old male developed anaphylaxis after ingesting codonopsis roots. In an oral re-challenge test, he developed anaphylaxis and urticaria again 30 minutes after consuming 20 grams of codonopsis root. Although codonopsis is in the same family as mugwort, the patient did not appear to be sensitized to mugwort pollen (100060).

Neurologic/CNS ...Orally, very large doses of codonopsis (30-60 grams) may cause vision problems, dizziness, loss of balance, leg spasms, and confusion (12).

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DONG QUAI (Dang Gui)

General ...Orally, dong quai is generally well-tolerated.
Most Common Adverse Effects:
Orally: Burping and flatulence.
Intravenously: Headache.

Cardiovascular ...Orally, dong quai might cause hypertension; according to one case report, a parent and breastfed infant experienced hypertension (195/85 mmHg and 115/69 mmHg, respectively) after the parent consumed a soup containing dong quai root (48428).

Dermatologic ...Dong quai contains psoralens that may cause photosensitivity and photodermatitis (10054,10057,48461).

Endocrine ...In a case report, a male developed gynecomastia after ingesting dong quai tablets (48504).

Gastrointestinal ...Orally, burping and gas may occur with dong quai (738).

Hematologic ...In one case report, a 55-year-old female with protein S deficiency and systemic lupus erythematosus (SLE) had temporary vision loss in the left eye from hemiretinal vein thrombosis three days after taking a phytoestrogen preparation containing dong quai 100 mg, black cohosh 250 mg, wild Mexican yam 276 mg, and red clover 250 mg (13155). It is unclear if dong quai contributed to this event.

Neurologic/CNS ...Dong quai given orally or by injection may be associated with headache (738,48438).

Oncologic ...Dong quai contains constituents that are carcinogenic; however, whether these constituents are present in concentrations large enough to cause cancer with long-term or high-dose use is unknown (7162).

Pulmonary/Respiratory ...A pharmacist experienced allergic asthma and rhinitis after occupational exposure to dong quai and other herbs (48435).

(Read more about DONG QUAI)

HONEY

General ...Orally and topically, honey is generally well tolerated in those at least 1 year of age. When given intranasally or into the eyes, honey seems to be well tolerated. However, honey containing grayanotoxins, which are found in rhododendrons, is likely unsafe and should be avoided.
Most Common Adverse Effects:
Orally: Nausea, stomach pain, and vomiting.
Topically: Burning, pain, and stinging.
Intranasally: Burning and nausea.
Ocular: Stinging.
Serious Adverse Effects (Rare):
Orally: Case reports of botulism in infants have occurred. Anaphylaxis has been reported in sensitive individuals. Honey from the Black Sea coast of Turkey, which is derived from the nectar of rhododendrons, has caused respiratory depression, dizziness, sweating, weakness, bradycardia, atrioventricular (AV) block, hypotension, cardiac arrhythmias, and myocardial infarction within a few minutes to several hours after consumption.

Cardiovascular ...Honey from the Black Sea coast of Turkey has been linked with a unique form of poisoning. Honey from this region sometimes contains excessive concentrations of grayanotoxins from rhododendrons, which can cause bradycardia, atrioventricular (AV) block, cardiac arrhythmias, myocardial infarction, and hypotension within a few minutes to several hours after consumption (12220,55110,55126,55129,55238,55269,55270,55280). Fatalities have not been reported. Patients typically respond to fluids and reversal of cardiac conduction abnormalities with atropine.

Dermatologic ...Topically, the use of honey applied to wounds can cause local pain, stinging, and burning in about 5% of patients, some of whom stop treatment as a result (16356,16357,16358,16361,91362,97694,96595). Theoretically, honey may cause excessive drying of wounds, which could delay healing. This can be managed by application of saline packs as needed (7850).

Gastrointestinal ...Orally, honey may cause mild nausea, vomiting, and stomach ache (12220,55119,55190,55294,97693). Honey from the Black Sea coast of Turkey has been linked with a unique form of poisoning. Honey from this region sometimes contains excessive concentrations of grayanotoxins. These toxins can cause increased salivation, nausea, and vomiting within a few minutes to several hours after consumption (12220,55119,55190,55294). Intranasally, honey may cause nausea (55216).

Immunologic ...Orally, honey can cause allergic reactions, including anaphylaxis (6,11,108531,108532). These reactions may be due to various components of the honey, including the honey itself, pollen, or bee secretions (91370). When used topically, local allergic reactions have been reported in people with pre-existing atopy (16356,55118). Allergic contact dermatitis related to honey enriched with propolis has been reported (91365).

Neurologic/CNS ...Orally, honey may cause nervousness, insomnia, and hyperactivity in children (91366,97693). Honey from the Black Sea coast of Turkey has been linked with a unique form of poisoning. Honey from this region sometimes contains excessive concentrations of grayanotoxins, which can cause dizziness, sweating, and weakness within a few minutes to several hours after consumption (12220,55110,55119,55296).

Ocular/Otic ...When used in eye drops, transient stinging has been reported rarely (105231,105234).

Pulmonary/Respiratory ...When used intranasally, a burning sensation of the nasal passages has been reported (55216). Honey from the Black Sea coast of Turkey, which sometimes contains excessive concentrations of grayanotoxins, can cause respiratory depression within a few minutes to several hours after consumption (12220,55110,55119,55296).

Other ...Some honey is contaminated with Clostridium botulinum spores, which poses a risk to infants (6,11,13160,55067,55290,91359). Botulinum spores can proliferate in the intestines of infants and cause botulism poisoning (55112). However, this is not a concern for older children and adults.

(Read more about HONEY)

LICORICE (Chinese Licorice)

General ...Orally, licorice is generally well tolerated when used in amounts commonly found in foods. It seems to be well tolerated when licorice products that do not contain glycyrrhizin (deglycyrrhizinated licorice) are used orally and appropriately for medicinal purposes or when used topically, short-term.
Most Common Adverse Effects:
Orally: Headache, nausea, and vomiting.
Topically: Contact dermatitis.
Intravenously: Diarrhea, itching, nausea, and rash.
Serious Adverse Effects (Rare):
Orally: Case reports have raised concerns about acute renal failure, cardiac arrest, cardiac arrhythmias, hypertension, hypokalemia, muscle weakness, paralysis, pseudohyperaldosteronism, and seizure associated with long-term use or large amounts of licorice containing glycyrrhizin.

Cardiovascular ...Orally, excessive licorice ingestion can lead to pseudohyperaldosteronism, which can precipitate cardiovascular complications such as hypertension and hypertensive crisis, ventricular fibrillation or tachycardia, sinus pause, and cardiac arrest. These effects are due to the licorice constituent glycyrrhizin and usually occur when 20-30 grams or more of licorice product is consumed daily for several weeks (781,15590,15592,15594,15596,15597,15599,15600,16835,97213) (104563,108574,108576,110305,112234). In one case report, an 89-year-old female taking an herbal medicine containing licorice experienced a fatal arrhythmia secondary to licorice-induced hypokalemia. The patient presented to the hospital with recurrent syncope, weakness, and fatigue for 5 days after taking an herbal medicine containing licorice for 2 months. Upon admission to the hospital, the patient developed seizures, QT prolongation, and ventricular arrhythmia requiring multiple defibrillations. Laboratory tests confirmed hypokalemia and pseudohyperaldosteronism (112234).
However, people with cardiovascular or kidney conditions may be more sensitive, so these adverse events may occur with doses as low as 5 grams of licorice product or glycyrrhizin 100 mg daily (15589,15593,15598,15600,59726). A case report in a 54-year-old male suggests that malnutrition might increase the risk of severe adverse effects with excessive licorice consumption. This patient presented to the emergency room with cardiac arrest and ventricular fibrillation after excessive daily consumption of licorice for about 3 weeks. This caused pseudohyperaldosteronism and then hypokalemia, leading to cardiovascular manifestations. In spite of resuscitative treatment, the patient progressed to kidney failure, refused dialysis, and died shortly thereafter (103791).

Dermatologic ...There have been reports of contact allergy, resulting in an itchy reddish eruption, occurring in patients that applied cosmetic products containing oil-soluble licorice extracts (59912). There have also been at least 3 cases of allergic contact dermatitis reported with the topical application of glycyrrhizin-containing products to damaged skin. In one case report, a 31-year-old female with acne presented with a 2-year history of pruritic erythematous-scaly plaques located predominantly on the face and neck after the use of a cosmetic product containing licorice root extract 1%. The patient had a positive skin patch test to licorice root extract, leading the clinicians to hypothesize that the use of benzoyl peroxide, a strong irritant, might have sensitized the patient to licorice (108578). Burning sensation, itching, redness, and scaling were reported rarely in patients applying a combination of licorice, calendula, and snail secretion filtrate to the face. The specific role of licorice is unclear (110322).
In rare cases, the glycyrrhizin constituent of licorice has caused rash and itching when administered intravenously (59712).

Endocrine ...Orally, excessive licorice ingestion can cause a syndrome of apparent mineralocorticoid excess, or pseudohyperaldosteronism, with sodium and water retention, increased urinary potassium loss, hypokalemia, and metabolic alkalosis due to its glycyrrhizin content (781,10619,15591,15592,15593,15594,15595,15596,15597,15598)(15600,16057,16835,25659,25660,25673,25719,26439,59818,59822)(59832,59864,91722,104563,108568,108574,110305,112234). These metabolic abnormalities can lead to hypertension, edema, EKG changes, fatigue, syncope, arrhythmias, cardiac arrest, headache, lethargy, muscle weakness, dropped head syndrome (DHS), rhabdomyolysis, myoglobinuria, paralysis, encephalopathy, respiratory impairment, hyperparathyroidism, and acute kidney failure (10393,10619,15589,15590,15593,15594,15596,15597,15599)(15600,16057,16835,25660,25673,25719,26439,31562,59709,59716)(59720,59740,59787,59820,59826,59882,59889,59900,91722,97214,100522) (104563,108576,108577). These effects are most likely to occur when 20-30 grams of licorice products containing glycyrrhizin 400 mg or more is consumed daily for several weeks (781,15590,15592,15594,15596,15597,15599,15600,16835,108574). However, some people may be more sensitive, especially those with hypertension, diabetes, heart problems, or kidney problems (15589,15593,15598,15600,59726,108576,108577) and even low or moderate consumption of licorice may cause hypertensive crisis or hypertension in normotensive individuals (1372,97213). The use of certain medications with licorice may also increase the risk of these adverse effects (108568,108577). One case report determined that the use of large doses of licorice in an elderly female stabilized on fludrocortisone precipitated hypokalemia and hypertension, requiring inpatient treatment (108568). Another case report describes severe hypokalemia necessitating intensive care treatment due to co-ingestion of an oral glycyrrhizin-specific product and hydrochlorothiazide for 1 month (108577). Glycyrrhetinic acid has a long half-life, a large volume of distribution, and extensive enterohepatic recirculation. Therefore, it may take 1-2 weeks before hypokalemia resolves (781,15595,15596,15597,15600). Normalization of the renin-aldosterone axis and blood pressure can take up to several months (781,15595,108568). Treatment typically includes the discontinuation of licorice, oral and intravenous potassium supplementation, and short-term use of aldosterone antagonists, such as spironolactone (108574,108577).
Chewing tobacco flavored with licorice has also been associated with toxicity. Chewing licorice-flavored tobacco, drinking licorice tea, or ingesting large amounts of black licorice flavored jelly beans or lozenges has been associated with hypertension and suppressed renin and aldosterone levels (12671,12837,97214,97215,97217,108574). One case report suggests that taking a combination product containing about 100 mg of licorice and other ingredients (Jintan, Morishita Jintan Co.) for many decades may be associated with hypoaldosteronism, even up to 5 months after discontinuation of the product (100522). In another case report, licorice ingestion led to hyperprolactinemia in a female (59901). Licorice-associated hypercalcemia has also been noted in a case report (59766).

Gastrointestinal ...Nausea and vomiting have been reported rarely following oral use of deglycyrrhizinated licorice (25694,59871). Intravenously, the glycyrrhizin constituent of licorice has rarely caused gastric discomfort, diarrhea, or nausea (59712,59915).

Immunologic ...There have been reports of contact allergy, resulting in an itchy reddish eruption, occurring in patients that applied cosmetic products containing oil-soluble licorice extracts (59912). There have also been at least 3 cases of allergic contact dermatitis reported with the topical application of glycyrrhizin-containing products to damaged skin. In one case report, a 31-year-old female with acne presented with a 2-year history of pruritic erythematous-scaly plaques located predominantly on the face and neck after the use of a cosmetic product containing licorice root extract 1%. The patient had a positive skin patch test to licorice root extract, leading the clinicians to hypothesize that the use of benzoyl peroxide, a strong irritant, might have sensitized the patient to licorice (108578).

Musculoskeletal ...In a case report, excessive glycyrrhizin-containing licorice consumption led to water retention and was thought to trigger neuropathy and carpal tunnel syndrome (59791).

Neurologic/CNS ...Orally, licorice containing larger amounts of glycyrrhizin may cause headaches. A healthy woman taking glycyrrhizin 380 mg daily for 2 weeks experienced a headache (59892). Intravenously, the glycyrrhizin constituent of licorice has rarely caused headaches or fatigue (59721). In a case report, licorice candy ingestion was associated with posterior reversible encephalopathy syndrome accompanied by a tonic-clonic seizure (97218).

Ocular/Otic ...Orally, consuming glycyrrhizin-containing licorice 114-909 grams has been associated with transient visual loss (59714).

Pulmonary/Respiratory ...Orally, large amounts of licorice might lead to pulmonary edema. In one case report, a 64-year old male consumed 1020 grams of black licorice (Hershey Twizzlers) containing glycyrrhizin 3.6 grams over 3 days, which resulted in pulmonary edema secondary to pseudohyperaldosteronism (31561). Intravenously, the glycyrrhizin constituent of licorice has caused cold or flu-like symptoms, although these events are not common (59712,59721).

(Read more about LICORICE)

LOVAGE (Szechuan Lovage)

General ...A high-quality assessment of the adverse effects of lovage has not been conducted. However, long-term oral use of lovage may result in an increased risk of phototoxic reactions, including photosensitivity (2,5,6,8,11,12). Topical exposure may also result in photosensitivity or contact dermatitis (60058,94098).

Dermatologic ...Orally, long-term use of lovage may result in an increased risk of phototoxic reactions, including photosensitivity (2,5,6,8,11,12). Avoid excessive exposure to the sun or UV light if using lovage (2,12). A case of contact dermatitis has been reported in a 31-year-old female who applied undiluted lovage essential oil to the skin for 2 weeks. The skin healed after receiving topical and systemic steroids (94098). A case of photosensitivity has also been reported secondary to harvesting lovage (60058).

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PEONY (White Peony)

General ...Orally, peony seems to be well tolerated when used alone and as part of Chinese herbal formulas.
Most Common Adverse Effects:
Orally: Abdominal distension, anorexia, diarrhea, gastrointestinal discomfort, nausea.
Topically: Dermatitis.

Dermatologic ...Topically, peony has been reported to cause contact dermatitis (13555).

Endocrine ...Orally, a specific traditional Chinese medicine preparation called DDT has been reported to lower follicle-stimulating hormone (FSH) levels and increase estradiol levels. It is not known if this effect is due to peony or the other ingredients (48404). Another specific traditional Chinese medicine preparation, Toki-shakuyaku-san, has been reported to increase plasma progesterone levels in some patients. It is not known if this effect is due to peony or the other ingredients (15294).

Gastrointestinal ...Orally, peony and total glucosides of peony (TGP) have been reported to cause gastrointestinal discomfort, including abdominal distension, anorexia, diarrhea, and nausea, in some patients (13538,92785,97949,98466,100992). In one clinical study, diarrhea was reported in 5% of patients taking TGP 600 mg three times daily for 24 weeks versus 1% of patients taking placebo (100992).

Hematologic ...Orally, there is one case report of easy gum bleeding, epistaxis, and skin bruising with an international normalized ratio (INR) above 6 in a 61-year-old male who was previously stable on warfarin therapy. This patient had switched from one brand of quilinggao, a popular Chinese herbal product, to another brand 5 days prior. This product contained Fritillaria spp. (beimu), Paeonia rubra, Chinese peony (chishao), Lonicera japonica (jinyinhua), and Poncirus trifoliata (jishi). The patient's INR decreased to 1.9 after temporary withdrawal of warfarin therapy. Upon re-initiation of quilinggao, his INR increased to 5.2. It is not known if the increased INR is due to peony or the other ingredients (68343).

(Read more about PEONY)

PORIA MUSHROOM (Fu Ling)

General ...Orally, poria mushroom seems to be well tolerated. However, a thorough evaluation of safety outcomes has not been conducted.

Immunologic ...Allergic reactions have been reported rarely, including allergic rhinitis and allergic asthma (12).

(Read more about PORIA MUSHROOM)