Lesson 5: Cautions and contraindications according normal functions or life stages

Breastfeeding

Acorus contraindicated
Artemisia abs.  contraindicated
Berberis contraindicated
Chelidonium contraindicated
Cimicifuga contraindicated
Convallaria contraindicated: until more is known
Hydrastis contraindicated
Juniperus contraindicated: until more is known
Lobelia contraindicated
Mentha pul. contraindicated
Phytolacca contraindicated
Piscidia contraindicated
Rheum contraindicated
Ruta contraindicated
Salvia off. contraindicated: except to reduce milk flow
Sanguinaria contraindicated: until more is known
Sarothamnus contraindicated
Thuja contraindicated
Cinnamomum bark contraindicated or caution: avoid if there are strong heat signs
Foeniculum contraindicated or caution: aqueous infusion only (ESCOP), but ▶ note below
Panax gin. contraindicated or caution: avoid if mother or child are hot or restless
Sanguisorba  contraindicated or caution: avoid if there is a tendency to constipation
Vitex contraindicated or caution: avoid doses > 250 mg/day (B&M)
Apium seeds caution
Capsella caution
Eucalyptus globulus oil caution: no cautions or contraindications for leaf
Filipendula caution
Glechoma caution
Hedera caution caution until more is known
Humulus caution
Hypericum caution
Isatis leaf (Da Qing Ye) caution
Petroselinum caution: unless it is requicontraindicated to contraindicateduce milk flow
Rhamnus caution
Rumex caution: theoretical concern due to anthroquinones
Tanacetum caution
Turnera caution: if insomnia, restlessness, overstimulation, or mental disturbance

Foeniculum: No adverse reports in humans. Compatible with breast feeding (B&M). It is my opinion that some texts may be over-cautious. For example, ESCOP states that Foeniculum should only be taken in aqueous infusion during lactation. But it is used throughout the world to treat insufficient lactation, and in this database is included in the combinations Verbena 1 and Verbena 2 for this purpose.

If the practitioner is not comfortable with using Foeniculum as a tincture during lactation, then it is possible to convert these two combinations to grams of dried herbs, and take them as an infusion or decoction. ▶ Converting to grams in Dose and Dispensing.

The practitioner must make their own decisions based on the data available.
No adverse reports in humans.

A 2020 study by Pourjafari F, et al. reported that a hydroalcoholic extract of Foeniculum, fed to pregnant mice, improved folliculogenesis and total antioxidant capacity level in female mice offspring.

▶ Premature thelarche in “C&C Gynaecological Disorders”

Children

The following herbs can be used with children, with caution, and in lower doses, but it is better to try milder herbs first.

Ephedra contraindicated or caution: avoid in children under 6 years (M&B Safety), only prescribe with herbs that moderate its effects, eg. Glycyrrhiza,  Schisandra, or Zingiber
Piscidia contraindicated or caution: should never be used for children unless milder herbs have first been tried, and should never be used for exhausted, cold children
Rhamnus contraindicated or caution: avoid for children under 10 years old (ESCOP)
Rheum contraindicated or caution: avoid for children under 10 years old (ESCOP)
Valeriana contraindicated or caution: avoid for children under 3 years old; for older children, milder anxiolytics should be triedfirst
Anemone caution: first try Chamomilla or Passiflora
Humulus caution: first try Chamomilla or Passiflora, if Humulus is used, add a little Zingiber for cold or exhausted children
Lobelia  caution: best prescribed with a half dose of a moderating herb, eg. Zingiber
Populus tre. caution: theoretical concern about hypersensitivity to salicylates and Reye’s syndrome, although non-acylated salicylates (as in Populus) may not cause this reaction

Conception

▶ also Infertility

Four herbs, Juniperus, Rosmarinus, Ruta, and Trigonella, are contraindicated in this database, both for the man and the woman, at least one month before conception. This is due to one or more research reports for each of these herbs suggesting that there may be anti- sperm or anti-implantation effects.

Juniperus  One study reported anti-implantation effects, and another reported abortifacient activity in rats.

Rosmarinus  No adverse reports in humans. One rat study reported anti-implantation effects, and another rat study reported reduction in sperm motility. However a study with boars reported improvement in fertility, and a more recent rat study also reported improvement in fertility.

Ruta graveolens Ruta species have been reported to have anti-androgenic, sperm immobilization, and anti-implantation effects in animals.

Trigonella There is a theoretical concern that Trigonella may reduce male and female fertility, but it has not been clearly demonstrated that the above-mentioned therapeutic doses have adverse effects in humans. Until more is known, it might be prudent to avoid Trigonella while trying to conceive (JR).

► discussion in M&B Safety25.

However, most curry powders contain Trigonella (fenugreek seeds), and people in India eat curry daily. Since India has a population of 1.4 billion, one might question whether Trigonella effectively reduces conception rates.

Over-caution I am aware that contraindications, for Rosmarinus and Trigonella especially, may be being overcautious, especially since there are no adverse reports in humans, and some of the animal studies were done with daily amounts equivalent to up to 70 g of herb per day for an adult human.

Couples with fertility problems However, it is my opinion that, especially for couples with reduced fertility, who are trying for conception, it is prudent to avoid these four herbs until more is known.

Menopause

In general, herbs that may aggravate heat sensations should be avoided or used with caution:

▶ Heat sensations in Lesson 6.

There are exceptions to this, for example, if there was a previous history of cold sensations before the menopause, the patient may be given a dropper bottle of Zanthoxylum tincture, and instructed to add a few drops to each dose of the main prescription, if they get too cold.

Menstruation

▶ also Menorrhagia

A few herbs should be avoided, or used with caution, just before and during menstruation for patients who have heavy menstrual flow at these times, to avoid aggravation of bleeding.

Salvia miltiorrhiza contraindicated or caution: depending on severity of menorrhagia
Salvia officinalis contraindicated or caution: depending on severity of menorrhagia

Pregnancy

Introduction: In this database, in the Cautions section for a particular combination, it may say that the combination is contraindicated in pregnancy. For example, for Artemisia 7 it says:

Contraindicated: ▶ Cautions Appendix for Achillea, Angelica archangelica, Angelica sinensis, Artemisia absinthium, Cinchona, Zingiber.

This does not mean that all the herbs listed are completely contraindicated in pregnancy. Some of them are, such as Cinchona, but others, such as Zingiber can be used in pregnancy with caution, depending on the patient’s state. Details are given in the C or C entry for the herb in database.

Over-caution: The inclusion of a herb in the lists below for a particular combination does not necessarily mean that there has been a clinical report of adverse effect in humans.

It may mean that there is a theoretical concern about one of its constituents, when used as an isolated chemical, at doses above therapeutic level for the herb.

Also, it may mean that there has been one text that suggesting contraindication, but without giving citations or explanation, which in some cases was contradicted by later studies. Details are given in the C or C entry for the herb in database.

I have perhaps been overcautious in this database, but is the practitioners responsibility to make their own decisions, on the basis of all available data, including online sources.

Review of safety in pregnancy: For a discussion of herb safety during pregnancy, the reader is recommended to The Essential Guide to Herbal Safety by Mills and Bone on pages 89-105 and page 228 of the 2005 edition of that book.

Acorus contraindicated
Apium (seeds) contraindicated?
Arctostaphylos contraindicated
Arnica (internally) contraindicated
Artemisia abs. contraindicated
Berberis contraindicated
Calendula contraindicated?
Capsella contraindicated?
Chelidonium contraindicated
Cimicifuga contraindicated: except to assist childbirth
Commiphora contraindicated: not contraindicated in Western tradition, but contraindicated in Chinese medicine
Convallaria contraindicated: until more is known
Hydrastis contraindicated: avoid in pregnancy, except for short-term use to assist labor
Hyssopus contraindicated?
Isatis leaf (Da Qing Ye) contraindicated: Isatis root (Ban Lan Gen) can be used in pregnancy instead of Isatis leaf
Juniperus contraindicated: until more is known
Mentha pul. contraindicated 
Nepeta contraindicated?
Petroselinum contraindicated?: theoretical concern about apiole, especially with the seeds
Phytolacca contraindicated
Piscidia contraindicated
Polygonum bis.  contraindicated: if there ia a tendency to constipation
Potentilla contraindicated: if there is a tendency to constipation
Quercus contraindicated: if there ia a tendency to constipation
Rheum species  contraindicated
Ruta contraindicated
Salvia mil. contraindicated
Salvia off. contraindicated
Sanguinaria contraindicated: until more is known
Sarothamnus contraindicated
Thuja contraindicated: theoretical concern about thujone
Trigonella contraindicated?: until more is known, but it has not been clearly demonstrated that it has adverse effects in therapeutic doses in humans
Verbena contraindicated: contraindicated by BSH, reasons unknown
Cinnamomum bark contraindicated or caution: contraindicated if there are strong heat signs
Glycyrrhiza glabra contraindicated or caution: caution if mild to moderate hypertension,  contraindicated if severe hypertension in pregnancy
Leonurus car. contraindicated or caution: no adverse reports; contraindicated by some texts, but recommended by others
Lobelia  contraindicated or caution: avoid in pregnancy, unless experienced with the use of this herb; eg. for difficult labor by experienced practitioner
Panax gin. contraindicated or caution: avoid if woman is hot, restless, hyperactive, bipolar, manic, anxious, mentally disturbed, or with tachycardia, insomnia, irritability, or headache
Rhamnus pur. contraindicated or caution: theoretical concern due to hydroxyanthracenes
Sanguisorba contraindicated or caution: caution until more is known, avoid if tendency to constipation
Vitex contraindicated or caution: use with caution, and only in the early stages for corpus luteum insufficiency (B&M)
Zingiber contraindicated or caution; avoid in high doses, or if there are heat sensations
Aloe caution
Angelica arc.  caution
Angelica sin. caution
Eucalyptus globulus oil caution: no cautions or contraindications for leaf
Filipendula caution?
Foeniculum caution
Glechoma caution
Hedera caution until more is known
Hypericum caution
Marrubium caution 
Myrica caution?
Prunus ser.  caution
Rumex caution: theoretical concern due to anthroquinones
Tanacetum caution
Turnera caution: if insomnia, restlessness, overstimulation, or mental disturbance
Zanthoxylum ame. caution: if there are heat sensations