Managing Pediatric Case Studies with Botanical Medicine and

Managing Pediatric Case Studies with Botanical Medicine and Nature Cure Sheila Kingsbury, ND, RH (AHG)

Useful Modalities for Pediatrics • • Hydrotherapy Botanicals Nutrition Homeopathy

Assessment Guidelines • Vitality of the child (including vitals) • Smile, Play, Energy level normal • Crying, Distressed, Irritable • Eye contact • Airway • Secretion, Stridor, Foreign Body • Respiratory Rate, use of Accessory muscles, Oxygen saturation • Circulation • Color – Pale, mottled, HR, Capillary Refill, Temperature of Hands and Feet • ENT • Muscle tone • Lethargy, Drowsiness, Responsiveness • Asymmetry in limb movements or muscle contraction • Pupil contraction

Pediatric dosing of Botanicals Clark's Rule uses Weight in Lbs, NEVER in Kg. Here is the formula: Adult Dose (in m. L) X (Weight [lbs] ÷ 150) = Childs Dose Example 11 year old girl / 70 Lbs 5 ml X (70 ÷ 150) = Child's Dose 5 ml X (. 47 )= Child's Dose 5 ml X. 47 = 2. 34 ml – (can round up to 2. 5 ml or ½ tsp)

Pediatric dosing of Botanicals Young's Rule Youngs Rule uses age. (which makes it easier to remember, the word young refers to age) Here is the formula: • Adult Dose (in m. L) X (Age ÷ (Age+12)) = Child's Dose Example 11 year old girl / 70 Lbs 5 ml X (11 ÷ (11+12)) = Child's Dose 5 ml X (11 ÷ 23) = Child's Dose 5 ml X. 48 = Child's Dose = 2. 4 ml (round up to 2. 5 ml or ½ tsp)

Pediatric Dosing of Botanicals • Newborns to 6 months -avoid unless you have experience and training working with this population. In many cases you can give the medicine to moms if they are nursing and administer them to the child that way, though no actual dose measurement is available. If I do use them directly with the child, I use extremely safe herbs in the dosages of usually 1 -10 drops of usually a water extraction. The frequency will depend on the illness and the child. Please refer to Simon Mills and Kerry Bone’s The Essential Guide to Herbal Safety for herbal safety in lactation. • 6 months -12 months- doses vary but for most of herbs I use with kids, I would consider 10 drops to 1 ml per dose for some of the tinctures and glycerites and 10 drops to 5 ml (1 teaspoon) for teas per dose. (Note: some teas can go much higher, especially if they are being used for nutritional value). • 1 -3 years of age – Generally, with this group I’d use drop doses still for tinctures and glycerites but can extend up into 30 drops (1 ml) per dose or up to a ¼ of the adult dose for the 3 year olds. • 4 -6 year olds – ¼ to 1/3 of the adult dose which translates to be 1 -5 mls per dose for most herbs I’d use for children. • 7 -12 year olds – 1/3 to ½ of the adult dose for most herbs which translates 2 -7 mls for most herbs I’d use for children.

Some of the top herbs for children: • Astragalus root (Astragalus membraneceous) • Calendula (Calendula officinalis) • Catnip (Nepeta cataria) • Chamomile flowers (Matricaria recutita) • Cinnamon powder (Cinnamomum spp. ) • Cleavers (Galium aparine) • Echinacea root (Echinacea angustifolia) • Elderberry and flower (Sambucus nigra) • Eyebright (Euphrasia officinalis) • Elecampane root (Inula helenium) • Fennel or Anise seed (Foeniculum vulgaris or Pimpinella anisum) • Lemon Balm (Melissa officinalis) • Licorice root or powder (Glycyrrhiza glabra) • Mahonia/Hydrastis root (Mahonia spp. Or Hydrastis canadensis) • Marshmallow root and powder (Althaea officinalis) • Nettles (Urtica dioica) • Oat pods (Avena sativa) • Peppermint/Spearmint (Mentha piperita or Mentha spicata) • Plantain (Plantago majora or Plantago lanceolata) • Thyme (Thymus vulgaris) • Uva Ursi (Arctystaphylos uva ursi) • Wild Cherry bark (Prunus serotina)

Asthma Case - Julie CC: 11 year old Caucasian female with cough. • S: // Began 2 weeks ago with a cold, had a fever for one day, nasal congestion, mild cough, malaise. All improved by day 3 except for cough which lingered on, not better, not worse. Her energy is a little bit lower because of the cough disrupting her sleep. • PMHx: Her medical history includes frequent ear infections and eczema as a child. • FHX: Mom has some food sensitivities which manifests mainly in digestive issues (gas, bloating, tending toward diarrhea. No formal Dx of IBS ever made) , brother has had eczema, ear infections and frequent URI’s, Dad has history of eczema and seasonal allergies but no asthma. • Medications: She is not currently on any medications or supplements. Allergic to bee stings but no other known allergies.

Asthma case – Julie • O: // • Vitals: Ht: 4’ 5”, Wt. 110; HR 92, RR 16, Pulse ox 96%, BP 100/72; • General: Color- unmottled, pink healthy skin tone, capillary refill < 2 s. • Lungs: Clear but shallow, mild wheezing elicited on forced expiration. • ENT: ears non-injected, TM and COL visible B/L, mild clear fluid in middle ear B/L; Throat – no PND, no erythema, no tonsillar lymphadenopathy or exudate; Nose- clear, no discharge, pink mucosal walls. • Peak Flow: 200 (71% of predicted 280 normal value for her age, gender and ht/wt).

Asthma case - Julie • A: // Asthma, cough-variant (ICD 10: J 45. 991) • P: // • Recommended Albuterol inhaler (due to child’s bee allergies parents were advised to only use inhaler at hospital the first time so they declined prescription against medical advice) • Urgent Herbal Formula • Peak flow meter was sent home with instructions to monitor sx • Lung tonic formula • Cod Liver Oil – 1 Tbsp/daily • Probiotics – High-potency 1 capsule daily • Quercitin powder 500 mg daily

Urgent Herbal Asthma Formula • • • Viburnum prunifolium Ammi vishnaga (Khella) Capsicum spp. Thymus vulgaris Crataegus spp Nepeta cataria glycerite 10 ml 5 ml 2 ml 5 ml 3 ml • Sig ½ dropperful (15 drops) to 1 dropperful (1 ml) • Repeat in 5 -10 minutes if needed • If severe breathing difficulty, use inhaler or call 911

Lung tonic formula • • • Ligusticum porteri glycerite Prunus serotina glycerite Inula helenium glycerite Glycyrrhiza glabra Thymus vulgaris 40 ml 20 ml 25 ml 15 ml • Sig 1 tsp (5 ml) BID for 1 month • ROC in 1 week with home data collection • ROC in 1 month – to review plan

Constituents of the anti-asthma herbal formula ASHMI(TM) synergistically inhibit IL-4 and IL-5 secretion by murine Th 2 memory cells, and eotaxin by human lung fibroblasts in vitro. • Anti-asthma herbal medicine intervention…a combination of three traditional Chinese medicinal herbs developed in our laboratory, [including Gancao, aka Glycyrrhiza glabra] has demonstrated efficacy in both mouse models of allergic asthma, and a double-blind placebo-controlled clinical trial in patients with asthma. • “…Gancao extracts and ASHMI (the combination of individual extracts) inhibited production of interleukin (IL)-4 and IL-5 by murine memory Th 2 cells and eotaxin-1 production by HLF-1 cells. ” • Journal of Integrative Medicine, May 2013

Thymol and Thymoquinone effects • In vitro acetylcholinesterase inhibitory properties of thymol, carvacrol and their derivatives thymoquinone and thymohydroquinone. Thymol is a derivative of Thymoquinone is a strong inhibitor of acetylcholinesterase and its derivatives – thymol and carvacol - have similar, though weaker effects. . Phytotherapy Research, 2007 • Effectiveness of thymoquinone in the treatment of experimental asthma. “All histological parameters…were found to be significantly better. . . and demonstrated that thymoquinone administration alleviates the pathological changes of chronic asthma. ” Clinical Therapeutics 2013

Pneumonia case - Eva • CC: 3 year old Caucasian female with cough and fever • S: // Eva came down with a cold 3 days ago. She had a runny nose and mild fever. Mom treated with Elderberry syrup (1 tsp/day) and Immune Glycerite (WWH) 2 droppersful TID. • PMHx: Child has a history of mild eczema, occasional URI and neonatal jaundice but otherwise has been in good health. • O: // • Vitals: HR 100, RR 20, Temp 100. 1 F • General: Patient is crying off and on and holding onto Mom more than usual. Skin color is normal, Capillary refill is < 2 s and hands and feet are warm. • ENT: Profuse clear to slightly yellow nasal discharge. • Lungs: Mild crackles heard in lower left lobe with inspiration and mild congestion audible in bronchioles but clears with crying.

Pneumonia case - Eva • A: // Pneumonia, uncomplicated (ICD 10: J 18. 9) • P: // Lung Antimicrobial formula 1 tsp QID Immune Glycerite (WWH) 1 tsp TID Sambucus berry syrup 1 tsp TID Modified Constitutional Hydrotherapy Antibiotic prescription to be filled if no improvement or worsening within 24 hours. • Referred for chest x-ray but parents refused at this time • • •

Lung Antimicrobial Formula • • Inula helenium glycerite Ligusticum porterii glycerite Hyssop officinalis Verbascum olympicum glycyerite Mahonia spp. glycerite Galium odorata glycerite Thymus vulgaris 20 ml 30 ml 15 ml 20 ml 15 ml 10 ml • 4 oz bottle (120 ml) 1 tsp QID – gives 6 days worth • 24 hour follow up by phone – fever down, happier, playing more, sleeping better. Coughing is productive and mucus is thinning and more clear. Continued plan for 2 more days and most symptoms had resolved.

Eczema case - Joshua • CC: 2 year old Asian male with Pruritic Eczema since 6 months of age. • S: // Eczema began at about 6 months of age with small red itchy bumps that quickly turned to dry scaly pruritic patches on his arms, legs and abdomen. • Parents felt it got worse after they began vaccinations. • They have tried hydrocortisone creams, Aveeno lotions, Aquafor lotions but nothing seems to work and it has gotten worse over time. • Eczema is now on his cheeks as well. He itches until it bleeds especially in his sleep. • He was breastfeed for the first 2 months then switched to formula. They tried soy formula but that made it worse. They did switch to a more hydrolyzed formula around 8 months of age which gave mild improvement for awhile. • Solid foods were introduced at age 6 months (rice cereal, bananas, avocados, applesauce). Began drinking milk instead of formula at 1 year of age and introduced meats, cheese and beans. • Avoided soy initially but then added it in around 18 months and saw no changes.

Eczema case - Joshua • O: // • Vitals: HR 100, TEMP 97. 9 F, RR 22 • General: WD/WN 2 year old male who presents with both parents. Makes eye contact and plays well in office. • Skin: Dry, erythematous patches with mixed maculopapular lesions and excoriations on dorsal surfaces of legs, arms and cheeks. Also present in antecubita areal and the popliteal fossa – these areas were moist with macular erythema. • ENT: TM’s and COL visible b/l, mild clear fluid in middle ear bl/, noninjected, non- bulging. Non-erythematous throat with PND, Nasal passages clear and pink, • Lymph: Mild cervical lymphadenopathy. • Respiratory: clear to auscultation, no adventitious sounds heard. • Cardiovascular: RRR, no murmurs, clicks, or rubs.

Eczema case - Joshua • A: // Atopic dermatitis, unspecifcied ( ICD 10: L 20. 9) • P: // • Homeopathic Mezereum 1 M unit dose for the significant itching • Didn’t make much improvement • Homeopathic Sulfur 30 c 3 -5 pellets once a day for 3 days. Began next and saw some improvement – did a 1 M constitutional dose • Plantago/Calendula baths 3 x/week – began after Homeopathics for skin healing • Remove rice, dairy, soy from diet for 2 weeks – began after constitutional homeopathic dose. Parents struggled with rice but did remove dairy and soy consistently.

Herbal baths • Make strong tea in a 5 quart pan of water (1 cup of each herb) boil for 5 minutes, let sit for another 20 minutes. • Strain and pour into bath water. • Let child remain in bath for a minimum of 10 -15 minutes to allow for maximum exposure to the botanical mixture and for pours to open enough for some to soak in. • Note: Botanically infused oils worth considering but often don’t have the same impact. I’ve done creams following baths that have helped reduce itching in many situations.

Normal Pediatric Sleep Patterns • 0 -1 month – awake briefly every hour or two, with one longer 3 -5 hour stretch per 24 hour period. Sleeping most of the time with an average of 16 ½ hours per day. • 1 -6 months – awake for gradually longer periods of time, may still be awake at odd times of day or night. Would still expect feeding every 1 -3 hours during the day and every 3 -5 hours at night. Still sleeping most of the time – with an average of 12 -14 hours a day. • 6 months- 18 months – more variable from child to child. Still needs to eat every 2 -3 hours (for breastmilk or formula plus introducing solid foods). Will still wake at night to feed but will vary from frequent to 1 -3 times a night. Napping usually 2 times a day. Average sleep is 10 - 14 hours a day. • 18 months – 2 years – Napping will change to 1 time a day in most children by 2 years of age. Nighttime sleeping pattern begins to get more dependable after the 18 m growth spurt, though day to day fluctuations are normal. Average sleep is 10 -12 hours a day. • 2 -5 years – child should be able to sleep through the night most nights. One nap a day is also normal but not all kids need it after age 2. Average sleep is 10 hours a day. • 5 -10 years – average sleep is 10 hours a day • 10 -18 – average sleep is 8 ½ -10 hours a day

Sleep case - Annie CC: Well child visit – 3 months of age, questions about sleep, feeding and weight gain • S: // Annie has been breastfeeding since birth, gained well from the 2 nd week on and was in the 50 th percentile for weight and 60 th percentile for height by her 2 nd month check up. • Parents report today that her feeding has been very fussy and sleep has been erratic and they are concerned that she may not be feeding enough. She nurses every 1 ½ hours on average, often cluster feeds on and off. • She usually sleeps for 1 -2 hours and has one 3 -5 hour sleep somewhere in the middle of the night/early morning. • She has been waking every hour some nights and cluster feeding in the middle of the night. Still manages at least one 3 hour stretch of sleep per 24 hour period. Her fussing and crying periods seem to be more frequent. • Her urine and stool output has been its usual amount but stools have a slightly green tinge to them.

Sleep case - Annie • O: // • Vitals: HR 126, RR 48, Temp 98. 2 F. Wt. 12 lbs. 5. 5 oz and 23. 5 inches, • General: WD/WN 3 mo child who appears in NAD in office. • EENT: ears and nasal passages clear, mouth and tongue pink with normal suckling movements and no palpable abnormalities. • Neuro: Reflexes : Rooting, moro and babinski reflexes observed. • MSK: Ortlani-Barlow negative. Muscle tone WNL and symmetrical. • Skin: skin color and tone WNL and with no abnormalities, • Development: Makes brief eye contact, notices movements in the room, turns head towards sounds and smiles at parents. • Respiratory: CTA and without adventitious sounds. • Cardiovascular: Heart sounds were with regular rate and rhythm and no audible murmurs. Capillary refill < 2 s

Sleep case - Annie • A//: Well child, 50 th Percentile for Weight, 60 th Percentile for Height. Gaining weigh well and normal for developmental milestones • P: // • Child is gaining weight well and continuing with normal development. We discussed normal patterns of fussiness in relation to growth spurts and normal sleep pattern expectations. • Gave recommendations for lukewarm baths before bed with relaxing music, relaxing aromatherapy and bedtime routine to help them get through this stage.

Sleep case 2 - Peter CC: 3 year old male with sleep disturbance • S: // Peter has had sleep issues off and on for the last year. Bedtime is 8 pm and he usually takes 1 -2 hours to fall asleep and wakes 1 -2 times a night wanting to get up and play. Gets up around 6 am and won’t go back to sleep at that time. • He has napped about once a day since he was about 18 months old, usually for 30 min to 1 hour. He still naps but he fights it more and if he does nap it is still 3045 minutes. • SHx: The family recently moved from Romania last year for his father’s work. He has no siblings but parents are considering having another child. • Diet: His diet consists of various cereals with milk for breakfast, usually crackers and cheese for mid-morning snack, maybe a piece of fruit. PB & J sandwich or yogurt for lunch, with occasional vegetables or fruits. Dinner is usually soup (chicken or beans for protein), sometimes a turkey or chicken casserole with rice or potatoes. • Minimal electronic games, TV, etc. in the home. No traumatic events in the home or family aside from the recent move. Sleeps in his own room since the move. • Family HX: No noteworthy family history.

Sleep case 2 - Peter • O: // • Vitals: HR 98, RR 22, TEMP 98. 4 F • General: NAD, Makes eye contact and plays normally in office. Answers brief questions about his toys and his activities, follows simple directions. • EENT: WNL, no middle ear fluid, PND or nasal discharge. • Respiratory: CTA, no adventitious sounds. • Cardiovascular: RRR, no audible murmurs. • MSK: Gait and muscle tone WNL and symmetrical. • Skin: Skin tone and coloring is WNL. • Neuro: Patient is A & O x 4

Sleep case 2 - Peter • A: // Sleep disorder, unspecified (ICD 10: G 47. 9) • 8 -9 hours of sleep on good nights – not great but not horrible. Likely almost ready to drop the nap soon. May need more protein and definitely needs more vegetables to get the necessary mineral intake. • P: // • Botanical Sleep formula – 5 ml at bedtime (again in another hour if • • • needed) each night. Discuss bedroom/sleep hygeine Relaxing baths 2 -3 times a week (Lukewarm water, 1 -2 drops of Lavender essential oil) Olive oil massage of arms, legs, hands and feet (add in 2 -5 drops of Lavender, Vetiver or Sandalwood and Cedar and 1 -2 drops of Sweet Orange EO) Calcium/Magnesium 1: 1 (500 mg each plus Vit D) liquid 1 Tbsp per night. Increase vegetable and protein intake throughout the day

Sleep case 2 - Peter • Botanical Sleep Formula • • • Scutellaria laterifolia glycerite Eschscholzia californica Nepeta cataria glycerite Passiflora incarnata Matricaria chamomilla 15 ml 10 ml 5 ml • 2 oz bottle. Sig 1 tsp at bedtime (can do up to 2 doses an hour apart if needed)

A double-blind, placebo-controlled investigation of the effects of Passiflora incarnata (passionflower) herbal tea on subjective sleep quality. • Ten participants also underwent overnight PSG (polysonography) on the last night of each treatment period. Of six sleep-diary measures analyzed, sleep quality showed a significantly better rating for passionflower compared with placebo (t(40) = 2. 70, p < 0. 01). These initial findings suggest that the consumption of a low dose of Passiflora incarnata, in the form of tea, yields short-term subjective sleep benefits for healthy adults with mild fluctuations in sleep quality. • Phytotherapy Research, Aug 2011

Approaches to Compliance

Rethink • Does it have to be that herb? • Is a glycerite appropriate for that herb? • Is there some other form of preparation that could be used?

Flavoring • Fruit teas • Syrups • Emulsions • Basic emulsion recipe: 1 gram of powdered gum tragacanth or gum acacia 15 ml of water 15 ml glycerin 30 ml of essential oil (some work better than others) Mint, sweet orange, cinnamon, fennel are some of my favorites Mix the gum and essential oil together in a mortar and pestle. Mix water and glycerin and add slowly to the gum mixture while stirring with the pestle in one direction. There will be a characteristic “clicking” sound (like lip-smacking) when the mixture has emulsified.

Creative Botanical Formula Examples

Chicken Pox Formula For a 4 oz bottle: • • Valeriana officinalis glycerite – 15 mls Trifolium pratense tincture – 15 mls Echinacea spp. root glycerite – 20 mls Glycyrrhiza glabra tincture – 15 mls Tilia spp. tincture – 20 mls Nepeta cataria glycerite – 15 mls Arctium lappa glycerite – 15 mls Sig: ½ - 1 tsp every few hours while symptoms are present. Note from Mary Bove: Valerian helps soothing itching, burdock helps to calm skin inflammation. Give 5 ml every 2 -3 hours (helps keep the intensive itching at bay and gives immune support to help clear the virus) Prescribe with Heron Botanicals Achilles Ointment or Calendula tincture topically dabbed on each pox without re-dipping. Could be used for other pruritic skin conditions too

Comparative assessment of dermal wound healing potentials of various Trifolium L. extracts and determination of their isoflavone contents as potential active ingredients. • The aqueous methanolic extracts of Trifolium canescens and Trifolium pretense var. pratense possessed better wound healing activity compared to the other extracts and control groups. The animal groups treated with the Trifolium canescens extract demonstrated increased contraction (48. 96%) on excision and a significant increase in wound tensile strength (35. 6%) on incision models. The main compounds were detected as genistein and biochanin A for Trifolium canescens. • Journal of Ethnopharmacology, 2013

Antiviral formula • • • Melissa officinalis (Lemon Balm )glycerite Sambucus nigra (Elderberry) glycerite or syrup Glycyrrhiza glabra (Licorice) glycerite Nepeta cataria (Catnip) tincture Tilia europea (Linden flower) tincture Mentha piperita (Peppermint) tincture 15 ml 10 ml 5 ml Note: Spearmint glycerite is so much better than Peppermint tincture but I have to make it myself.

Digestif tea • Foeniculum vulgare (Fennel) seed • Elettaria cardamomum (Cardamom) seed • Glycyrrhiza glabra (Licorice) root Equal parts – 2 tsp. per cup of water. This mixes nicely in coconut or almond milk too

Go to Sleep Elixir • Matricaria chamomilla glycerite 10 ml • Passiflora incarnata glycerite 10 ml • Tilia europea tincture 15 ml • Lavendula officinalis tincture 5 ml • Eschscholzia californica tincture 10 ml • Rosa spp. (Rose petal) glycerite 10 ml • Sweet Orange emulsion 5 drops

Rootbeer Syrup • 2 parts Pimpinella anisum (Anise) • 2 parts Sassafras albidum (Sassafras) • 1 part Smilax spp. (Sarsaparilla) Decoct the herbs in water – just enough to keep them covered – for about 20 -30 minutes. Let water cook down to just above the herbs. Remove from heat, strain and add about 1 part honey (to taste but enough to make a thin syrup from, you will need more honey if you wish to preserve this syrup for a while). Pour a couple of Tablespoons of the syrup into a glass and add carbonated water to make an herbal soda.

Lemon-Lime Spirit Lifting Soda • Melissa officinalis (Lemon Balm) – • ½ cup fresh, chopped • Mentha spicata (Spearmint) • 2 Tbsp fresh, chopped • Tilia europea (Linden flowers) 2 Tbsp • Cymbopogon spp. (Lemongrass) 1 Tbsp • Citrus x limon (chopped lemon peel - fresh) 3 tsp. • Citrus aurantifolia (Lime peel -chopped 2 tsp. or 1 T lime juice (or both)) • 1/3 cup simple syrup Cover with about 1 ½ cups of water. Bring water to a boil first then add herbs. Steep for 15 min. Strain and add syrup.

Immune Support Formula • Astragalus membranaceous glycerite: 40 ml • Sambucus nigra glycerite: 20 ml • Oplopanax horridum: 15 ml • Galium aparine glycerite: 15 ml • Cinnamonum aromaticum: 10 ml • Schisandra chinensis: 20 ml

Immune Support tea formula Equal parts of: • Glycyrhiza glabra (Licorice root) • Cymbopogen spp. (Lemongrass) • Matricaria chamomilla (Chamomile) • Hibiscus rosa-sinensis flowers (Hibiscus) • Galium aparine (Cleavers) • Rosemarinus officinalis (Rosemary)

References: • Beck, JJ. Addition of methyl thioglycolate and benzylamine to (Z) – ligustilide, a bioactive unsaturated lactone constituent of several herbal medicines. An improved synthesis of (Z)-ligustilide. J Nat Prod 1995 Jul; 58(7): 1047 -55. • Bordbar, N. et al. The effect of glycyrrhizin on maturation and T-cell stimulating activity of dendritic cells. Cell Immunol. 2012 Nov; 280(1): 44 -9. • Bove, Mary Encyclopedia of Natural Healing for Children and Infants. 2 nd Ed. Mc. Graw-Hill, June, 2001 • Cometa, MF. Et al. In vitro relaxant and spasmolytic effects of constituents from Viburnum prunifolium and HPLC quantification of the bioactive isolated iridoids. J Ethnopharmacol 2009 Jun 22; 123(2: 201 -7. • Fathiazad, F. Phytochemical analysis and antioxidant activity of Hyssopus officinalis L. from Iran. Adv Pharm Bull 2011; 1(2): 63 -7. • Jayaprakasam, B. Constituents of the anti-asthma herbal formula ASHMI(TM) synergistically inhibit IL-4 and IL-5 secretion by murine Th 2 memory cells, and eotaxin by human lung fibroblasts in vitro. J Integr Med. 2013 May; 11(3): 195205. • Jang, HY. Et al. Capsicum annuum L. methanolic extract inhibits ovalbumininduced airway inflammation and oxidative stress in a mouse model of asthma. J Med Food 2011 Oct 14 (10); 1144 -51.

References • Jukic, M. In vitro acetylcholinesterase inhibitory properties of thymol , carvacol, and their derivatives thymoquinone and thymohydroquinone. Phytother Res. 2007 Mar; 21(3): 259 -61 • Kalemci, S. Effectiveness of thymoquinone in the treatment of experimental asthma. Clin Ter. 2013 May-June; 164(3). • Kemmerich, B. Evaluation of efficacy and tolerability of a fixed combination of dry extracts of thyme herb and primrose root in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo controlled multicentre clinical trial. Arzneimittelforschung. 2007; 57(9): 607 -15. • Kolaarzyk, E. Et al. Diet with high antioxidant capacity as important factor in primary and secondary asthma. Przegl Lek. 2015; 72(12): 743 -6. • Marzian, O. Treatment of acute bronchitis in children and adolescents. Non-interventional postmarketing surveillance study confirms the benefit and safety of a syrup made of extracts from Thyme and Ivy leaves. MMW Fortschr Med. 2007 Jun 28; 149 (27 -28 Suppl): 69 -74. • Mc. Intyre, Anne. Herbal Treatment of Children: Western & Ayurvedic Perspectives. Butterworth. Heinemann, September, 2005. • Mills, Simon and K. Bone, Principles and Practice of Phytotherapy, 2 nd Ed. , Churchill-Livingstone, 2013. • Ngan, A. A double-blind, placebo-controlled investigation of the effects of Passiflora incarnata herbal tea on subjective sleep quality. Phytother Res 2011, Aug; 25(8): 1153 -9. • Parente LM. Wound Healing and Anti-Inflammatory Effect in Animal Models of Calendula officinalis L. Growing in Brazil. Evid Based Complement Alternat Med. 2012; 2012: 375671 Epub 2012 Jan 24. • Renda, G. Comparative assessment of dermal wound healing potentials of various Trifolium L. extracts and determination of their isoflavone contents as potential active ingredients. J Ethnopharmacol 2013 Jul 9; 148(2): 423 -32. • Samuelsen, AB. The traditional uses, chemical constituents and biological lactivities of Plantago major L. A review. J Ethnopharmacol 2000 Jul; 71(1 -2): 1 -21.