Yohimbe

Yohimbe

Keywords: yohimbe bark, yohimbine, yohimbine hydrochloride
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information



Introduction
This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. yohimbe--common names, uses, potential side effects, and resources for more information. The yohimbe tree is a tall evergreen that is native to western Africa. The bark of the tree contains a chemical called yohimbine. The amount of yohimbine in dietary supplements may vary; some yohimbe products have been found to contain very little yohimbine. However, a standardized form of yohimbine--yohimbine hydrochloride--is available as a prescription medicine that has been studied and used for the treatment of erectile dysfunction.
Common Names--yohimbe, yohimbe bark
Latin Names--Pausinystalia yohimbe

What It Is Used For
Yohimbe bark has traditionally been used in Africa as an aphrodisiac (to increase sexual desire).
The herb is currently used for sexual dysfunction, including erectile dysfunction in men.

How It Is Used
As a dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs., the dried bark of the yohimbe tree is used as a tea and taken by mouth. An extract of the bark is also put into capsules and tablets.

What the Science Says
It is not known whether yohimbe is effective for any health conditions because clinical trials have not been conducted on the bark or its extract.*
*Although numerous studies of the prescription medicine yohimbine hydrochloride have been conducted, their results cannot be interpreted as evidence for the dietary supplement yohimbe.

Side Effects and Cautions
Yohimbe has been associated with high blood pressure, increased heart rate, headache, anxiety, dizziness, and sleeplessness. Yohimbe can be dangerous if taken in large doses or for long periods of time.
People should use caution if taking yohimbe with MAO inhibitors or medicines for high blood pressure. Yohimbe should not be combined with tricyclic antidepressants or phenothiazines (a group of medicines used mostly for mental health conditions such as schizophrenia).
People with kidney problems and people with psychiatric conditions should not use yohimbe.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Sources
Yohimbe bark extract. Natural Standard Database Web site. Accessed on February 5, 2007.
Yohimbe. Natural Medicines Comprehensive Database Web site. Accessed on February 5, 2007.
Yohimbe bark. In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:429-431.


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Valerian

Valerian

Keywords: all-heal, garden heliotrope, insomnia, anxiety, depression, headache

Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information




Introduction
This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. valerian--common names, uses, potential side effects, and resources for more information. Valerian is a plant native to Europe and Asia; it is also found in North America.Common Names--valerian, all-heal, garden heliotrope
Latin Names--Valeriana officinalis
What It Is Used For
Valerian has long been used for sleep disorders and anxiety.
Valerian has also been used for other conditions, such as headaches, depression, irregular heartbeat, and trembling.

How It Is Used
The roots and rhizomes (underground stems) of valerian are typically used to make supplements, including capsules, tablets, and liquid extracts, as well as teas.

What the Science Says
Research suggests that valerian may be helpful for insomnia, but there is not enough evidence from well-designed studies to confirm this.
There is not enough scientific evidence to determine whether valerian works for anxiety or for other conditions, such as depression and headaches.
NCCAM is funding a study to look at the effects of valerian on sleep in healthy older adults and in people with Parkinson's disease.

Side Effects and Cautions
Studies suggest that valerian is generally safe to use for short periods of time (for example, 4 to 6 weeks).
No information is available about the long-term safety of valerian.
Valerian can cause mild side effects, such as headaches, dizziness, upset stomach, and tiredness the morning after its use.
Tell your health care providers about any herb or dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs. you are using, including valerian. This helps to ensure safe and coordinated care.

Sources
Office of Dietary Supplements and National Center for Complementary and Alternative Medicine. Questions and Answers About Valerian for Insomnia and Other Sleep Disorders. Office of Dietary Supplements Web site. Accessed May 3, 2006.
Valerian. Natural Medicines Comprehensive Database Web site. Accessed May 3, 2006.
Valerian (Valeriana officinalis L.). Natural Standard Database Web site. Accessed May 3, 2006.
Valerian root (Valeriana officinalis). In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:394-400.
Awang DVC, Leung AY. Valerian. In: Coates P, Blackman

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Turmeric

Turmeric

Keywords: turmeric root, Indian saffron, curcumin
On this page
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information



Introduction
This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. turmeric--common names, uses, potential side effects, and resources for more information. Turmeric, a shrub related to ginger, is grown throughout India, other parts of Asia, and Africa. Known for its warm, bitter taste and golden color, turmeric is commonly used in fabric dyes and foods such as curry powders, mustards, and cheeses. It should not be confused with Javanese turmeric.
Common Names--turmeric, turmeric root, Indian saffron
Latin Names--Curcuma longa

What It Is Used For
In traditional Chinese medicineA whole medical system that originated in China. It is based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. Practices such as herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi. and Ayurvedic medicineA whole medical system that originated in India. It aims to integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga., turmeric has been used to aid digestion and liver function, relieve arthritis pain, and regulate menstruation.
Turmeric has also been applied directly to the skin for eczema and wound healing.
Today, turmeric is used for conditions such as heartburn, stomach ulcers, and gallstones. It is also used to reduce inflammation, as well as to prevent and treat cancer.

How It Is Used
Turmeric's finger-like underground stems (rhizomes) are dried and taken by mouth as a powder or in capsules, teas, or liquid extracts. Turmeric can also be made into a paste and used on the skin.

What the Science Says
There is little reliable evidence to support the use of turmeric for any health condition because few clinical trials have been conducted.
Preliminary findings from animal and laboratory studies suggest that a chemical found in turmeric--called curcumin--may have anti-inflammatory and anticancer properties, but these findings have not been confirmed in people.
NCCAM-funded investigators are studying the active chemicals in turmeric and their effects--particularly anti-inflammatory effects--in people to better understand how turmeric might be used for health purposes.

Side Effects and Cautions
Turmeric is considered safe for most adults.
High doses or long-term use of turmeric may cause indigestion.
In animals, high doses of turmeric have caused liver problems. No cases of liver problems have been reported in people.
People with gallbladder disease should avoid using turmeric as a dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs., as it may worsen the condition.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Sources
Turmeric. Natural Medicines Comprehensive Database Web site. Accessed on December 27, 2006.
Turmeric (Curcuma longa Linn.) and curcumin. Natural Standard Database Web site. Accessed on December 28, 2006.
Turmeric root. In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:379-384.

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Thunder God Vine

Thunder God Vine
Keywords: thunder god vine, lei gong teng, inflammation. rheumatoid arthritis

Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information
Introduction
This fact sheet provides basic information about the herb thunder god vine-common names, uses, potential side effects, and resources for more information. Thunder god vine has been used in China for health purposes for more than 400 years.
Common Names—thunder god vine, lei gong teng
Latin Names—Tripterygium wilfordii

What It Is Used For
Thunder god vine has been used in traditional Chinese medicine for conditions involving inflammation or overactivity of the immune system.
Orally, thunder god vine is taken for excessive menstrual periods or autoimmune diseases, including rheumatoid arthritis, multiple sclerosis, and lupus.
Thunder god vine preparations are also applied to the skin for rheumatoid arthritis.

How It Is Used
Extracts are prepared from the skinned root of thunder god vine.

What the Science Says
Laboratory findings suggest that thunder god vine may fight inflammation, suppress the immune system, and have anti-cancer effects.
Although early evidence is promising, there have been few high-quality studies of thunder god vine in people. Results from a small study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) suggest that an oral extract of the herb may improve rheumatoid arthritis symptoms in some patients. A larger NIAMS-funded study is comparing thunder god vine with a conventional medicine for rheumatoid arthritis.
A small study on thunder god vine applied to the skin also found benefits for rheumatoid arthritis symptoms.
There is not enough scientific evidence to assess thunder god vine's use for any other health conditions.

Side Effects and Cautions
Thunder god vine can cause severe side effects and can be poisonous if it is not carefully extracted from the skinned root. Other parts of the plant-including the leaves, flowers, and skin of the root-are highly poisonous and can cause death.
The extract of thunder god vine used in the NIAMS study was well tolerated. However, thunder god vine can cause diarrhea, upset stomach, hair loss, headache, menstrual changes, and skin rash.
Thunder god vine has been found to decrease bone mineral density in women who take the herb for 5 years or longer. This side effect may be of particular concern to women who have osteoporosis or are at risk for the condition.
Thunder god vine decreases sperm count and so may be associated with male infertility.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

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St. John's Wort and Depression

St. John's Wort and Depression

Introduction
Key Points
About St. John's Wort
About Depression
What the Science Says About St. John's Wort for Depression
Side Effects and Risks
Herbal Products: Issues To Consider
For More Information
Selected Sources
Introduction
St. John's wort is a plant with yellow flowers that has been used for centuries for health purposes, such as for depression and anxiety. This fact sheet answers some frequently asked questions about St. John's wort and depression, and summarizes what the science says about its effectiveness and the research being done.

Key Points
Studies suggest that St. John's wort is of minimal benefit in treating major depression. A study cofunded by the National Center for Complementary and Alternative Medicine (NCCAM) found that St. John's wort was no more effective than placebo in treating major depression of moderate severity. There is some scientific evidence that St. John's wort is useful for milder forms of depression.
St. John's wort interacts with certain drugs, and these interactions can limit the effectiveness of some prescription medicines.
St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe and, in some cases, may be associated with suicide. Consult a health care provider if you or someone you care about may be experiencing depression.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About St. John's Wort
St. John's wort (Hypericum perforatum) is a long-living plant with yellow flowers whose medicinal uses were first recorded in ancient Greece. It contains many chemical compounds. Some are believed to be the active ingredients that produce the herb's effects, including the compounds hypericin and hyperforin.
How these compounds actually work is not yet fully understood, but several theories have been suggested. Preliminary studies suggest that St. John's wort might work by preventing nerve cells in the brain from reabsorbing the chemical messenger serotonin, or by reducing levels of a protein involved in the body's immune system functioning. St. John's wort has been used over the centuries for mental conditions, nerve pain, and a wide variety of other health conditions. Today, St. John's wort is used for anxiety, mild to moderate depression, and sleep disorders.
In Europe, St. John's wort is widely prescribed for depression. In the United States, there is public interest in St. John's wort as a treatment for depression, but it is not a prescription medicine; it is, however, one of the most commonly used herbal supplements.
In the United States, St. John's wort products are sold as:
Capsules and tablets
Teas—the dried herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. is added to boiling water and steeped
Liquid extracts—specific types of chemicals are removed from the herb, leaving the desired chemicals in a concentrated form.

About Depression
Depression is a medical condition that affects nearly 21 million American adults each year, according to the National Institute of Mental Health. Mood, thoughts, physical health, and behavior all may be affected. Symptoms of depression commonly include:
Persistent sad, anxious, or "empty" feelings
Feelings of hopelessness and/or pessimism
Feelings of guilt, worthlessness, and/or helplessness
Restlessness or irritability
Loss of interest or pleasure in activities that the person once enjoyed
Fatigue and decreased energy
Difficulty concentrating, remembering details, and/or making decisions
Insomnia, early–morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Persistent aches or pains, headaches, cramps, or digestive problems that do not ease with treatment.
Depression comes in several forms and its symptoms and severity can vary from person to person. For example:
In major depression (also called major depressive disorder), people experience symptoms that interfere with their ability to work, study, sleep, eat, and take pleasure in activities they once enjoyed. Symptoms last for at least 2 weeks but frequently last for several months or longer.
In dysthymia (also called dysthymic disorder), a less severe, but more chronic form of depression, people experience symptoms that are not as disabling but keep them from functioning well or feeling good. Symptoms last at least 2 years. Many people with dysthymia also have episodes of major depression.
In bipolar disorder (also called manic–depressive illness), people have periods of depressive symptoms that alternate or may co-exist with periods of mania. Symptoms of mania include abnormally high levels of excitement and energy, racing thoughts, and behavior that is impulsive and inappropriate.
In addition, milder forms of depression exist that fall into the category of minor depression. In minor depression, people experience the same symptoms as major depression, but they are fewer in number and are less disabling. Symptoms last at least 6 months but less than 2 years continuously.
Depression can be treated effectively with conventional medicineMedicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals such as physical therapists, psychologists, and registered nurses., including antidepressants and certain types of psychotherapy.

What the Science Says About St. John's Wort for Depression
Scientific evidence regarding the effectiveness of St. John's wort for depression is inconsistent. An analysis of the results of 37 clinical trials concluded that St. John's wort may have only minimal beneficial effects on major depression. However, the analysis also found that St. John's wort may benefit people with minor depression; these benefits may be similar to those from standard antidepressants. Overall, St. John's wort appeared to produce fewer side effects than some standard antidepressants.
One of the studies included in the analysis was cofunded by NCCAM and two other components of the National Institutes of Health (NIH)—the National Institute of Mental Health and the Office of Dietary Supplements. This study found that St. John's wort was no more effective than placebo in treating major depression of moderate severity. However, the antidepressant sertraline, used in one arm of the study, also showed little difference from placebo.

Side Effects and Risks
The most common side effects of St. John's wort include dry mouth, dizziness, diarrhea, nausea, increased sensitivity to sunlight, and fatigue.
Research has shown that taking St. John's wort can limit the effectiveness of some prescription medicines, including:
Antidepressant medicines
Birth control pills
Cyclosporine, a medicine that helps prevent the body from rejecting transplanted organs
Digoxin, a medicine used to strengthen heart muscle contractions
Indinavir and other medicines used to control HIV infection
Irinotecan and other anticancer medicines
Warfarin and related medicines used to thin the blood (known as anticoagulants)
When combined with certain antidepressants, St. John's wort also may increase side effects such as nausea, anxiety, headache, and confusion.

Herbal Products: Issues To Consider
Herbal products such as St. John's wort are classified as dietary supplements by the U.S. Food and Drug Administration (FDA). The FDA's requirements for testing and obtaining approval to sell dietary supplements are different from its requirements for drugs. Unlike drugs, herbal products can be sold without requiring studies on dosage, safety, or effectiveness.
The strength and quality of herbal products are often unpredictable. Products can differ in content not only from brand to brand, but from batch to batch. Information on labels may be misleading or inaccurate.
In addition, "natural" does not necessarily mean "safe." Many natural substances can have harmful effects–especially if they are taken in large quantities or if they interact with other supplements or with prescription medicines.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

NCCAM Research on St. John's Wort
Recent projects supported by NCCAM include studies of the:
Safety and effectiveness of St. John's wort for the treatment of minor depression
Safety of St. John's wort for the treatment of social anxiety disorder
Effectiveness of St. John's wort for the treatment of obsessive–compulsive disorder
Effects of St. John's wort on how well birth control pills work
Possible adverse interactions of St. John's wort and narcotic pain medicines
Safety and effectiveness of St. John's wort for attention deficit hyperactivity disorder

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St. John's Wort

St. John's Wort

Keywords: hypericum herb, klamath weed , goat weed, depression, anxiety
Keywords: hypericum herb, klamath weed , goat weed, depression, anxiety
Keywords: hypericum herb, klamath weed , goat weed, depression, anxiety
Keywords: hypericum herb, klamath weed , goat weed, depression, anxiety
On this page:
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information


Introduction
This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. St. John's wort--common names, uses, potential side effects, and resources for more information. St. John's wort is a plant with yellow flowers.
Common Names--St. John's wort, hypericum, Klamath weed, goat weed
Latin Name--Hypericum perforatum

What It Is Used For
St. John's wort has been used for centuries to treat mental disorders and nerve pain.
In ancient times, herbalists wrote about its use as a sedative and a treatment for malaria, as well as a balm for wounds, burns, and insect bites.
Today, St. John's wort is used by some for depression, anxiety, and/or sleep disorders.
How It Is Used
The flowering tops of St. John's wort are used to prepare teas and tablets containing concentrated extracts.

What the Science Says
There is some scientific evidence that St. John's wort is useful for treating mild to moderate depression. However, two large studies, one sponsored by NCCAM, showed that the herb was no more effective than placebo in treating major depression of moderate severity.
NCCAM is studying the use of St. John's wort in a wider spectrum of mood disorders, including minor depression.

Side Effects and Cautions
St. John's wort may cause increased sensitivity to sunlight. Other side effects can include anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction.
Research shows that St. John's wort interacts with some drugs. The herb affects the way the body processes or breaks down many drugs; in some cases, it may speed or slow a drug's breakdown. Drugs that can be affected include:
Indinavir and possibly other drugs used to control HIV infection
Irinotecan and possibly other drugs used to treat cancer
Cyclosporine, which prevents the body from rejecting transplanted organs
Digoxin, which strengthens heart muscle contractions
Warfarin and related anticoagulants
Birth control pills
Antidepressants
When combined with certain antidepressants, St. John's wort may increase side effects such as nausea, anxiety, headache, and confusion.
St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe. Anyone who may have depression should see a health care provider. There are effective proven therapies available.



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Soy

Soy
Keywords: soy, cholesterol, isoflavone, hot flashes, menopause

SoyKeywords: soy, cholesterol, isoflavone, hot flashes, menopause
SoyKeywords: soy, cholesterol, isoflavone, hot flashes, menopause
On this page
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information
Introduction
This fact sheet provides basic information about soy-uses, potential side effects, and resources for more information. Soy, a plant in the pea family, has been common in Asian diets for thousands of years. It is found in modern American diets as a food or food additive. Soybeans, the high-protein seeds of the soy plant, contain isoflavones-compounds similar to the female hormone estrogen. This fact sheet highlights what is known about soy when used by adults for health purposes.
Common Names—soy
Latin Names—Glycine max

What It Is Used For
People use soy products to prevent or treat a variety of health conditions, including high cholesterol levels, menopausal symptoms such as hot flashes, osteoporosis (a condition in which bones become thin and brittle), memory problems, high blood pressure, breast cancer, and prostate cancer.

How It Is Used
Soy is available in dietary supplements, in forms such as tablets and capsules. Soy supplements may contain isoflavones or soy protein or both.
Soybeans can be cooked and eaten or used to make tofu, soy milk, and other foods. Also, soy is sometimes used as an additive in various processed foods, including baked goods, cheese, and pasta.

What the Science Says
Research suggests that daily intake of soy protein may slightly lower levels of LDL ("bad") cholesterol.
Some studies suggest that soy isoflavone supplements may reduce hot flashes in women after menopause. However, the results have been inconsistent.
There is not enough scientific evidence to determine whether soy supplements are effective for any other health uses.
NCCAM is supporting ongoing studies of soy, including its effects on women's arteries and bones after menopause.

Side Effects and Cautions
Soy is considered safe for most people when used as a food or when taken for short periods as a dietary supplement.
Minor stomach and bowel problems such as nausea, bloating, and constipation are possible.
Allergic reactions such as breathing problems and rash can occur in rare cases.
The safety of long-term use of soy isoflavones has not been established. Evidence is mixed on whether using isoflavone supplements, over time, can increase the risk of endometrial hyperplasia (a thickening of the lining of the uterus that can lead to cancer). Studies show no effect of dietary soy on risk for endometrial hyperplasia.
Soy's possible role in breast cancer risk is uncertain. Until more is known about soy's effect on estrogen levels, women who have or who are at increased risk of developing breast cancer or other hormone-sensitive conditions (such as ovarian or uterine cancer) should be particularly careful about using soy and should discuss it with their health care providers.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
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Saw Palmetto

Saw Palmetto

Keywords: American dwarf palm tree, cabbage palm, benign prostatic hyperplasia, enlarged prostate

On this page
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information


Introduction
This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. saw palmetto--common names, uses, potential side effects, and resources for more information. Saw palmetto grows in the southern United States.Common Names--saw palmetto, American dwarf palm tree, cabbage palm
Latin Names--Serenoa repens, Sabal serrulata

What It Is Used For
Saw palmetto is used mainly for urinary symptoms associated with an enlarged prostate gland (also called benign prostatic hyperplasia, or BPH).
Saw palmetto is also used for other conditions, including chronic pelvic pain, bladder disorders, decreased sex drive, hair loss, and hormone imbalances.

How It Is Used
The ripe fruit of saw palmetto is used in several forms, including ground and dried fruit or whole berries. It is available as a liquid extract, tablets, capsules, and as an infusion or a tea.

What the Science Says
Several small studies suggest that saw palmetto may be effective for treating BPH symptoms.
In 2006, a large study of 225 men with moderate-to-severe BPH found no improvement with 320 mg saw palmetto daily for 1 year versus placebo. NCCAM cofunded the study with the National Institute of Diabetes and Digestive and Kidney Diseases.
There is not enough scientific evidence to support the use of saw palmetto for reducing the size of an enlarged prostate or for any other conditions.
Saw palmetto does not appear to affect readings of prostate-specific antigen (PSA) levels. PSA is protein produced by cells in the prostate. The PSA test is used to screen for prostate cancer and to monitor patients who have had prostate cancer.

Side Effects and Cautions
Saw palmetto may cause mild side effects, including stomach discomfort.
Some men using saw palmetto have reported side effects such as tender breasts and a decline in sexual desire.
Tell your health care providers about any herb or dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs. you are using, including saw palmetto. This helps to ensure safe and coordinated care.




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Red Clover

Red Clover

Keywords: cow clover, meadow clover, wild clover, menopausal symptoms

On this page
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information


Introduction
This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. red clover--common names, uses, potential side effects, and resources for more information. Like peas and beans, red clover belongs to the family of plants called legumes. Red clover contains phytoestrogens--compounds similar to the female hormone estrogen.
Common Names--red clover, cow clover, meadow clover, wild clover
Latin Name--Trifolium pratense

What It Is Used For
Historically, red clover has been used for cancer and respiratory problems, such as whooping cough, asthma, and bronchitis.
Current uses of red clover are for menopausal symptoms, breast pain associated with menstrual cycles, high cholesterol, osteoporosis, and symptoms of prostate enlargement.
How It Is Used
The flowering tops of the red clover plant are used to prepare extracts available in tablets and capsules, as well as in teas and liquid forms.

What the Science Says
Although several small studies of red clover for menopausal symptoms had mixed results, a large study found that red clover had no beneficial effects on menopausal symptoms.
There is not enough scientific evidence to determine whether red clover is effective for any other health conditions.
NCCAM is studying red clover to learn more about its active components and how they might work in the body, including a clinical trial investigating the safety and effectiveness of red clover for menopausal symptoms.

Side Effects and Cautions
Red clover seems to be safe for most adults when used for short periods of time. No serious adverse effects have been reported.
Because red clover contains estrogen-like compounds, there is a possibility that its long-term use would increase the risk of women developing cancer of the lining of the uterus. However, studies to date have been too brief (less than 6 months) to evaluate whether red clover has estrogen-like effects on the uterus.
It is unclear whether red clover is safe for women who are pregnant or breastfeeding, or who have breast cancer or other hormone-sensitive cancers.
Tell your health care providers about any herb or dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs. you are using, including red clover. This helps to ensure safe and coordinated care.

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Peppermint Oil

Peppermint Oil

Keywords: irritable bowel syndrome, indigestion




On this page
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information


Introduction
This fact sheet provides basic information about peppermint oil--uses, potential side effects, and resources for more information. The herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. peppermint, a cross between two types of mint (water mint and spearmint), grows throughout Europe and North America. Peppermint is often used to flavor foods, and the leaves can be used fresh or dried in teas.
Common Names--peppermint oil
Latin Names--Mentha x piperita

What It Is Used For
Peppermint oil has been used for a variety of health conditions, including nausea, indigestion, and cold symptoms.
Peppermint oil is also used for headaches, muscle and nerve pain, and stomach and bowel conditions such as irritable bowel syndrome.

How It Is Used
Essential oil of peppermint can be taken in very small doses in capsule or liquid forms. The essential oil can also be diluted with another oil and applied to the skin.

What the Science Says
Results from several studies suggest that peppermint oil may improve symptoms of irritable bowel syndrome.
A few studies have found that peppermint oil, in combination with caraway oil, may help relieve indigestion, but this evidence is preliminary.
Although there are some promising results, there is no clear-cut evidence to support the use of peppermint oil for other health conditions.

Side Effects and Cautions
Peppermint oil appears to be safe for most adults when used in small doses. Possible side effects include allergic reactions and heartburn.
Capsules containing peppermint oil are often coated to reduce the likelihood of heartburn. If they are taken at the same time as medicines such as antacids, this coating can break down more quickly and increase the risk of heartburn and nausea.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

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Noni

Noni
Keywords: noni, morinda, indian mulberry, hog apple, canary wood, antioxidant, cancer, breast cancer

On this page
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information
Introduction
This fact sheet provides basic information about noni-common names, uses, potential side effects, and resources for more information. Noni is an evergreen shrub or small tree that grows throughout the tropical regions of the Pacific Ocean, from Southeast Asia to Australia and especially in Polynesia.
Common Names—noni, morinda, Indian mulberry, hog apple, canary wood
Latin Names—Morinda citrifolia

What It Is Used For
Noni has been traditionally used in Polynesia as a dye, but it also has a history of use as a topical preparation for joint pain and skin conditions.
Today, people drink noni fruit juice as a general health tonic, as well as for cancer and chronic conditions such as cardiovascular disease and diabetes.

How It Is Used
Traditionally, the leaves and fruit of noni have been used for health purposes.
Today, the fruit is most commonly combined with other fruits (such as grape) to make juice. Preparations of the fruit and leaves are also available in capsules, tablets, and teas.

What the Science Says
In laboratory research, noni has shown antioxidant, immune-stimulating, and tumor-fighting properties. These results suggest that noni may warrant further study for conditions such as cancer and cardiovascular disease. However, noni has not been well studied in people for any health condition.
Recent NCCAM-funded research includes a study on noni for cancer to determine its safety and potential effects on tumors and symptoms. The National Cancer Institute is funding preliminary research on noni for breast cancer prevention and treatment.

Side Effects and Cautions
Noni is high in potassium. People who are on potassium-restricted diets because of kidney problems should avoid using noni.
Several noni juice manufacturers have received warnings from the U.S. Food and Drug Administration about making unsubstantiated health claims.
Although there have been few reported side effects from using noni, its safety has not been adequately studied.
There have been reports of liver damage from using noni. It should be avoided if you have liver disease because it contains compounds that may make your disease worse.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

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Noni Noni Noni Noni Noni Noni Noni Noni Noni Noni Noni Noni Noni Noni

Milk Thistle

Milk Thistle

Keywords: mary thistle, holy thistle, silybum marianum, hepatitis, liver inflammation, gallbladder

Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information


Introduction
This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. milk thistle--common names, uses, potential side effects, and resources for more information. Milk thistle is a plant that is native to the Mediterranean region. It has been used for thousands of years as a remedy for a variety of ailments, especially liver problems.
Common Names--milk thistle, Mary thistle, holy thistle. Milk thistle is sometimes called silymarin, which is actually a mixture of the herb's active components, including silybinin (also called silibinin or silybin).
Latin Name--Silybum marianum

What It Is Used For
Milk thistle is believed to have protective effects on the liver and improve its function. It is typically used to treat liver cirrhosis, chronic hepatitis (liver inflammation), and gallbladder disorders. Treatment claims also include:
Lowering cholesterol levels
Reducing insulin resistance in people with type 2 diabetes who also have cirrhosis
Reducing the growth of cancer cells in breast, cervical, and prostate cancers
How It Is Used
Milk thistle is a flowering herb. Silymarin, which can be extracted from the seeds (fruit), is believed to be the biologically active part of the herb. The seeds are used to prepare capsules containing powdered herb or seed; extracts; and infusions (strong teas).

What the Science Says

There have been some studies of milk thistle on liver disease in humans, but these have been small. Some promising data have been reported, but study results at this time are mixed.
Although some studies conducted outside the United States support claims of oral milk thistle to improve liver function, there have been flaws in study design and reporting. To date, there is no conclusive evidence to prove its claimed uses.
NCCAM is supporting a phase II research study to better understand the use of milk thistle for chronic hepatitis C. With the National Institute of Diabetes and Digestive and Kidney Diseases, NCCAM is planning further studies of milk thistle for chronic hepatitis C and nonalcoholic steatohepatitis (liver disease that occurs in people who drink little or no alcohol).
The National Cancer Institute and the National Institute of Nursing Research are also studying milk thistle, for cancer prevention and to treat complications in HIV patients.
Side Effects and Cautions
In clinical trials, milk thistle generally has few side effects. Occasionally, people report a laxative effect, upset stomach, diarrhea, and bloating.
Milk thistle can produce allergic reactions, which tend to be more common among people who are allergic to plants in the same family (for example, ragweed, chrysanthemum, marigold, and daisy).
It is important to inform your health care providers about any herb or dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs. you are using, including milk thistle. This helps to ensure safe and coordinated care.
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Licorice

Licorice

RootKeywords: sweet root, gan zao, chinese licorice, Hepatitis C

On this page
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information

Introduction
This fact sheet provides basic information about licorice root--common names, uses, potential side effects, and resources for more information. Most licorice is grown in Greece, Turkey, and Asia. Licorice contains a compound called glycyrrhizin (or glycyrrhizic acid).
Common Names--licorice root, licorice, liquorice, sweet root, gan zao (Chinese licorice)
Latin Name--Glycyrrhiza glabra, Glycyrrhiza uralensis (Chinese licorice)


What It Is Used For
Licorice root has been used as a dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs. for stomach ulcers, bronchitis, and sore throat, as well as infections caused by viruses, such as hepatitis.

How It Is Used
Peeled licorice root is available in dried and powdered forms.
Licorice root is available as capsules, tablets, and liquid extracts.
Licorice can be found with glycyrrhizin removed; the product is called DGL (for "deglycyrrhizinated licorice").

What the Science Says
A review of several clinical trials found that glycyrrhizin might reduce complications from hepatitis C in some patients. However, there is not enough evidence to confirm that glycyrrhizin has this effect.
There are not enough reliable data to determine whether licorice is effective for stomach ulcers.

Side Effects and Cautions
In large amounts, licorice containing glycyrrhizin can cause high blood pressure, salt and water retention, and low potassium levels, which could lead to heart problems. DGL products are thought to cause fewer side effects.
The safety of using licorice as a supplement for more than 4 to 6 weeks has not been thoroughly studied.
Taking licorice together with diuretics (water pills) or other medicines that reduce the body's potassium levels could cause dangerously low potassium levels.
People with heart disease or high blood pressure should be cautious about using licorice.
When taken in large amounts, licorice can affect the body's levels of a hormone called cortisol and related steroid drugs, such as prednisone.
Pregnant women should avoid using licorice as a supplement or consuming large amounts of licorice as food, as some research suggests it could increase the risk of preterm labor.
Tell your health care providers about any herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. or dietary supplement you are using, including licorice root. This helps to ensure safe and coordinated care.

Sources
National Center for Complementary and Alternative Medicine. Hepatitis C and Complementary and Alternative Medicine: 2003 Update. National Center for Complementary and Alternative . Natural Medicines Comprehensive Database Web site. Accessed on May 30, 2006.
Natural Standard Research Collaboration. Licorice (Glycyrrhiza glabra L.) and DGL 2006.
Licorice root. In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:233-239.
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Lavender

Lavender

Keywords: English lavender, garden lavender, anxiety, hair loss, alopecia areata

Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information



Introduction
This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. lavender--common names, uses, potential side effects, and resources for more information. Lavender is native to the Mediterranean region. It was used in ancient Egypt as part of the process for mummifying bodies. Lavender's use as a bath additive originated in Persia, Greece, and Rome. The herb's name comes from the Latin lavare, which means "to wash."
Common Names--lavender, English lavender, garden lavender
Latin Names--Lavandula angustifolia

What It Is Used For
Historically, lavender was used as an antiseptic and for mental health purposes.
Today, the herb is used for conditions such as anxiety, restlessness, insomnia, and depression.
Lavender is also used for headache, upset stomach, and hair loss.

How It Is Used
Lavender is most commonly used in aromatherapyA therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled to promote health and well-being., in which the scent of the essential oil from the flowers is inhaled.
The essential oil can also be diluted with another oil and applied to the skin.
Dried lavender flowers can be used to make teas or liquid extracts that can be taken by mouth.

What the Science Says
There is little scientific evidence of lavender's effectiveness for most health uses.
Small studies on lavender for anxiety show mixed results.
Some preliminary results indicate that lavender oil, combined with oils from other herbs, may help with hair loss from a condition called alopecia areata.

Side Effects and Cautions
Topical use of diluted lavender oil or use of lavender as aromatherapy is generally considered safe for most adults. However, applying lavender oil to the skin can cause irritation.
Lavender oil is poisonous if taken by mouth.
When lavender teas and extracts are taken by mouth, they may cause headache, changes in appetite, and constipation.
Using lavender with sedative medications may increase drowsiness.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

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Kava

Kava

Keywords: kava kava, awa, kava pepper, anxiety
On this page
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information


Introduction
This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. kava--common names, uses, potential side effects, and resources for more information. Kava is native to the islands of the South Pacific and is a member of the pepper family.Common Names--kava kava, awa, kava pepper
Latin Names--Piper methysticum

What It Is Used For
Kava has been used as a ceremonial beverage in the South Pacific for centuries.
Kava has also been used to help people fall asleep and fight fatigue, as well as to treat asthma and urinary tract infections.
Topically (on the skin), kava has been used as a numbing agent.
Today, kava is used primarily for anxiety, insomnia, and menopausal symptoms.

How It Is Used
The root and rhizome (underground stem) of kava are used to prepare beverages, extracts, capsules, tablets, and topical solutions.

What the Science Says
Although scientific studies provide some evidence that kava may be beneficial for the management of anxiety, the U.S. Food and Drug Administration (FDA) has issued a warning that using kava supplements has been linked to a risk of severe liver damage.
Kava is not a proven therapy for other uses.
NCCAM-funded studies on kava were suspended after the FDA issued its warning.

Side Effects and Cautions
Kava has been reported to cause liver damage, including hepatitis and liver failure (which can cause death).
Kava has been associated with several cases of dystonia (abnormal muscle spasm or involuntary muscle movements).
Kava may interact with several drugs, including drugs used for Parkinson's disease.
Long-term and/or heavy use of kava may result in scaly, yellowed skin.
Avoid driving and operating heavy machinery while taking kava because the herb has been reported to cause drowsiness.
Tell your health care providers about any herb or dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs. you are using, including kava. This helps to ensure safe and coordinated care.

Sources
National Center for Complementary and Alternative Medicine. Kava Linked to Liver Damage. National Center for Complementary and Alternative Medicine Web site. Accessed at Kava. Natural Medicines Comprehensive Database Web site. Accessed March 30, 2006.
Kava (Piper methysticum G. Forst). Natural Standard Database Web site. Accessed March 30, 2006.
Kava kava rhizome (root). In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:221-225.


NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCAM.
NCCAM Publication No. D314May 2006
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Horse Chestnut

Horse Chestnut

Keywords: buckeye, Spanish chestnut, chronic venous insufficiency

Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources
For More Information


© Steven Foster
Introduction
This fact sheet provides basic information about horse chestnut--common names, uses, potential side effects, and resources for more information. Horse chestnut trees are native to the Balkan Peninsula (for example, Greece and Bulgaria), but grow throughout the northern hemisphere. Although horse chestnut is sometimes called buckeye, it should not be confused with the Ohio or California buckeye trees, which are related but not the same species.Common Names--horse chestnut, buckeye, Spanish chestnut
Latin Names--Aesculus hippocastanum
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What It Is Used For
For centuries, horse chestnut seeds, leaves, bark, and flowers have been used for a variety of conditions and diseases.
Horse chestnut seed extract has been used to treat chronic venous insufficiency (a condition in which the veins in the legs do not efficiently return blood to the heart). This condition is associated with varicose veins, pain, ankle swelling, feelings of heaviness, itching, and nighttime leg cramping.
The seed extract has also been used for hemorrhoids.
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How It Is Used
Horse chestnut seed extract standardized to contain 16 to 20 percent aescin (escin), the active ingredient, is the most commonly used form. Topical preparations have also been used.
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What the Science Says
Small studies have found that horse chestnut seed extract is beneficial in treating chronic venous insufficiency and is as effective as wearing compression stockings.
There is not enough scientific evidence to support the use of horse chestnut seed, leaf, or bark for any other conditions.
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Side Effects and Cautions
Homemade preparations of horse chestnut should not be used. Raw horse chestnut seeds, leaves, bark, and flowers contain esculin, which is poisonous.
When properly processed, horse chestnut seed extract contains little or no esculin and is considered generally safe. However, the extract can cause some side effects, including itching, nausea, or gastrointestinal upset.
Tell your health care providers about any herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. or dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs. you are using, including horse chestnut. This helps to ensure safe and coordinated care.
Top
SourcesHorse chestnut. Natural Medicines Comprehensive Database Web site. Accessed May 3, 2006.
Horse chestnut. Natural Standard Database Web site. Accessed May 3, 2006.
Horse chestnut seed extract. In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine Expanded Commission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:201-204. chronic venous insufficiencychronic venous insufficiencychronic venous insufficiencychronic venous insufficiencychronic venous insufficiencychronic venous insufficiencychronic venous insufficiencychronic venous insufficiencychronic venous insufficiencychronic venous insufficiency

Hoodia

Hoodia
Keywords: Kalahari cactus, Xhoba

Keywords: Kalahari cactus, Xhoba


On this page
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources

Introduction
This fact sheet provides basic information about the herb hoodia--common names, uses, potential side effects, and resources for more information. Hoodia is a flowering, cactus-like plant native to the Kalahari Desert in southern Africa. Its harvest is protected by conservation laws.
Common Names--hoodia, Kalahari cactus, Xhoba
Latin Names--Hoodia gordonii

What It Is Used For
Kalahari Bushmen have traditionally eaten hoodia stems to reduce their hunger and thirst during long hunts.
Today, hoodia is marketed as an appetite suppressant for weight loss.

How It Is Used
Dried extracts of hoodia stems and roots are used to make capsules, powders, and chewable tablets. Hoodia can also be used in liquid extracts and teas.
Hoodia products often contain other herbs or minerals, such as green tea or chromium picolinate.

What the Science Says
There is no reliable scientific evidence to support hoodia's use. No studies of the herb in people have been published.

Side Effects and Cautions
Hoodia's safety is unknown. Its potential risks, side effects, and interactions with medicines and other supplements have not been studied.
The quality of hoodia products varies widely. News reports suggest that some products sold as hoodia do not contain any hoodia.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Sources
Hoodia. Natural Medicines Comprehensive Database Web site. Accessed on May 16, 2007.
Hoodia (Hoodia gordonii). Natural Standard Database Web site. Accessed on May 16, 2007.
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Hawthorn

Hawthorn

HawthornKeywords: English hawthorn, heart failure

Related Topics
"What's in the Bottle? An Introduction to Dietary Supplements"
Herbal Supplements: Consider Safety, Too
Herbs at a Glance Series Treatment Information
By treatment or therapy
By disease or condition
On this page
Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions
Sources


Introduction
This fact sheet provides basic information about hawthorn--common names, uses, potential side effects, and resources for more information. Hawthorn is a spiny, flowering shrub or small tree of the rose family. The species of hawthorn discussed here are native to northern European regions and grow throughout the world.
Common Names--hawthorn, English hawthorn, harthorne, haw, hawthorne
Latin Names--Crataegus laevigata (also known as Crataegus oxyacantha), Crataegus monogyna

What It Is Used For
Hawthorn fruit has been used for heart disease since the first century. It has also been used for digestive and kidney problems.
More recently, hawthorn leaf and flower have been used for heart failure, a weakness of the heart muscle that prevents the heart from pumping enough blood to the rest of the body, which can lead to fatigue and limit physical activities.
Hawthorn is also used for other heart conditions, including symptoms of coronary artery disease (such as angina).

How It Is Used
The hawthorn leaf and flower are used to make liquid extracts, usually with water and alcohol. Dry extracts can be put into capsules and tablets.

What the Science Says
There is scientific evidence that hawthorn leaf and flower are safe and effective for milder forms of heart failure.
There is not enough scientific evidence to determine whether hawthorn works for other heart problems.
NCCAM is supporting research studying the mechanisms by which hawthorn may affect heart failure.

Side Effects and Cautions
Hawthorn is considered safe for most adults when used for short periods of time. Side effects are usually mild and can include upset stomach, headache, and dizziness.
Drug interactions with hawthorn have not been thoroughly studied. It was once thought that hawthorn interacted with the heart medicine digoxin. However, a very small study in people without heart conditions found no interaction, but evidence is limited.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Sources
Busse WR, Juretzek W, Koch E. Hawthorn (Crataegus). In: Coates P, Blackman M, Cragg G, et al., eds. Encyclopedia of Dietary Supplements. New York, NY: Marcel Dekker; 2005:337-347.
De Smet PA. Herbal Remedies. The New England Journal of Medicine.
Hawthorn. Natural Medicines Comprehensive Database Web site. Accessed on December 5, 2006.
Hawthorn (Crataegus laevigata, C. oxyacantha, C. monogyna, C. penagyna). Natural Standard Database Web site. Accessed on December 5, 2006.
Hawthorn. In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:182-191.
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green tea

Introduction

Introduction
What It Is Used For
How It Is Used
What the Science Says
Side Effects and Cautions

This fact sheet provides basic information about green tea--common names, uses, potential side effects, and resources for more information. All types of tea (green, black, and oolong) are produced from the Camellia sinensis plant using different methods. Fresh leaves from the Camellia sinensis plant are steamed to produce green tea.Common Names--green tea, Chinese tea, Japanese tea
Latin Names--Camellia sinensis
Keywords: Chinese tea, Japanese tea, cancer, mental alertness

What It Is Used For
Green tea and green tea extracts, such as its component EGCG, have been used to prevent and treat a variety of cancers, including breast, stomach, and skin cancers.
Green tea and green tea extracts have also been used for improving mental alertness, aiding in weight loss, lowering cholesterol levels, and protecting skin from sun damage.

How It Is Used
Green tea is usually brewed and drunk as a beverage. Green tea extracts can be taken in capsules and are sometimes used in skin products.

What the Science Says
Laboratory studies suggest that green tea may help protect against or slow the growth of certain cancers, but studies in people have shown mixed results.
Some evidence suggests that the use of green tea preparations improves mental alertness, most likely because of its caffeine content. There are not enough reliable data to determine whether green tea can aid in weight loss, lower blood cholesterol levels, or protect the skin from sun damage.
NCCAM is supporting studies to learn more about the components in green tea and their effects on conditions such as cancer, diabetes, and heart disease.

Side Effects and Cautions
Green tea is safe for most adults when used in moderate amounts.
Green tea and green tea extracts contain caffeine. Caffeine can cause insomnia, anxiety, irritability, upset stomach, nausea, diarrhea, or frequent urination in some people. Caffeine can also raise blood pressure, and in very high doses, it can cause seizures, delirium, or irregular heart rhythms.
Green tea contains small amounts of vitamin K, which can make anticoagulant drugs, such as warfarin, less effective.
Tell your health care providers about any herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. or dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs. you are using, including green tea. This helps to ensure safe and coordinated care.
Top
Sources
National Cancer Institute. Tea and Cancer Prevention. National Cancer Institute Web site. Accessed May 1, 2006.
Green tea. Natural Medicines Comprehensive Database Web site. Accessed May 1, 2006.
Green tea (Camellia sinensis). Natural Standard Database Web site. Accessed May 1, 2006.

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Fibromyalgia

About Fibromyalgia
Fibromyalgia syndrome is a common and chronic disorder characterized by widespread muscle pain, fatigue, and multiple tender points. The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Tender points are specific places on the body—on the neck, shoulders, back, hips, and upper and lower extremities—where people with fibromyalgia feel pain in response to slight pressure.
Although fibromyalgia is often considered an arthritis-related condition, it is not truly a form of arthritis (a disease of the joints) because it does not cause inflammation or damage to the joints, muscles, or other tissues. Like arthritis, however, fibromyalgia can cause significant pain and fatigue, and it can interfere with a person's ability to carry on daily activities. Also like arthritis, fibromyalgia is considered a rheumatic condition.
You may wonder what exactly rheumatic means. Even physicians do not always agree on whether a disease is considered rheumatic. If you look up the word in the dictionary, you'll find it comes from the Greek word rheum, which means flux—not an explanation that gives you a better understanding. In medicine, however, the term rheumatic means a medical condition that impairs the joints and/or soft tissues and causes chronic pain.
In addition to pain and fatigue, people who have fibromyalgia may experience
sleep disturbances,
morning stiffness,
headaches,
irritable bowel syndrome,
painful menstrual periods,
numbness or tingling of the extremities,
restless legs syndrome,
temperature sensitivity,
cognitive and memory problems (sometimes referred to as “fibro fog”), or
a variety of other symptoms.
Fibromyalgia is a syndrome rather than a disease. Unlike a disease, which is a medical condition with a specific cause or causes and recognizable signs and symptoms, a syndrome is a collection of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause.
Who Gets Fibromyalgia?
What Causes Fibromyalgia?
How Is Fibromyalgia Diagnosed?
How Is Fibromyalgia Treated?
Will Fibromyalgia Get Better With Time
What Can I Do To Try To Feel Better?
What Are Researchers Learning About Fibromyalgia?
Where Can I Get More Information About Fibromyalgia?
Key Words
Information Box
Tips for Good Sleep
Who Gets Fibromyalgia?
According to a paper published by the American College of Rheumatology (ACR), fibromyalgia affects 3 to 6 million — or as many as one in 50 — Americans. For unknown reasons, between 80 and 90 percent of those diagnosed with fibromyalgia are women; however, men and children also can be affected. Most people are diagnosed during middle age, although the symptoms often become present earlier in life.
People with certain rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus (commonly called lupus), or ankylosing spondylitis (spinal arthritis) may be more likely to have fibromyalgia, too.
Several studies indicate that women who have a family member with fibromyalgia are more likely to have fibromyalgia themselves, but the exact reason for this — whether it be hereditary or caused by environmental factors or both — is unknown. One study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is trying to identify if certain genes predispose some people to fibromyalgia.
What Causes Fibromyalgia?
The causes of fibromyalgia are unknown, but there are probably a number of factors involved. Many people associate the development of fibromyalgia with a physically or emotionally stressful or traumatic event, such as an automobile accident. Some connect it to repetitive injuries. Others link it to an illness. People with rheumatoid arthritis and other autoimmune diseases, such as lupus, are particularly likely to develop fibromyalgia. For others, fibromyalgia seems to occur spontaneously.
Many researchers are examining other causes, including problems with how the central nervous system (the brain and spinal cord) processes pain.
Some scientists speculate that a person's genes may regulate the way his or her body processes painful stimuli. According to this theory, people with fibromyalgia may have a gene or genes that cause them to react strongly to stimuli that most people would not perceive as painful. However, those genes—if they, in fact, exist—have not been identified.
How Is Fibromyalgia Diagnosed?
Research shows that people with fibromyalgia typically see many doctors before receiving the diagnosis. One reason for this may be that pain and fatigue, the main symptoms of fibromyalgia, overlap with many other conditions. Therefore, doctors often have to rule out other potential causes of these symptoms before making a diagnosis of fibromyalgia. Another reason is that there are currently no diagnostic laboratory tests for fibromyalgia; standard laboratory tests fail to reveal a physiologic reason for pain. Because there is no generally accepted, objective test for fibromyalgia, some doctors unfortunately may conclude a patient's pain is not real, or they may tell the patient there is little they can do.
A doctor familiar with fibromyalgia, however, can make a diagnosis based on two criteria established by the ACR: a history of widespread pain lasting more than 3 months and the presence of tender points. Pain is considered to be widespread when it affects all four quadrants of the body; that is, you must have pain in both your right and left sides as well as above and below the waist to be diagnosed with fibromyalgia. The ACR also has designated 18 sites on the body as possible tender points. For a fibromyalgia diagnosis, a person must have 11 or more tender points. (See illustration on page 5.) One of these predesignated sites is considered a true tender point only if the person feels pain upon the application of 4 kilograms of pressure to the site. People who have fibromyalgia certainly may feel pain at other sites, too, but those 18 standard possible sites on the body are the criteria used for classification.
The location of the nine paired tender points thatcomprise the 1990 American College of Rheumatologycriteria for fibromyalgia.
How Is Fibromyalgia Treated?
Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Many family physicians, general internists, or rheumatologists (doctors who specialize in arthritis and other conditions that affect the joints or soft tissues) can treat fibromyalgia.
Fibromyalgia treatment often requires a team approach, with your doctor, a physical therapist, possibly other health professionals, and most importantly, yourself, all playing an active role. It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these various professionals can help you improve your quality of life.
You may find several members of the treatment team you need at a clinic. There are pain clinics that specialize in pain and rheumatology clinics that specialize in arthritis and other rheumatic diseases, including fibromyalgia.
In June 2007, the U.S. Food and Drug Administration approved Lyrica* (pregabalin) as the first drug to treat fibromyalgia. Doctors also treat fibromyalgia with a variety of medications developed and approved for other purposes.
Following are some of the most commonly used categories of drugs for fibromyalgia:
* Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.
Analgesics
Analgesics are painkillers. They range from over-the-counter acetaminophen (Tylenol) to prescription medicines, such as tramadol (Ultram), and even stronger narcotic preparations. For a subset of people with fibromyalgia, narcotic medications are prescribed for severe muscle pain. However, there is no solid evidence showing that narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential that the person taking them will become physically or psychologically dependent on them.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
As their name implies, nonsteroidal anti-inflammatory drugs, including aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Anaprox, Aleve), are used to treat inflammation. Although inflammation is not a symptom of fibromyalgia, NSAIDs also relieve pain. The drugs work by inhibiting substances in the body called prostaglandins, which play a role in pain and inflammation. These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.
Antidepressants
Perhaps the most useful medications for fibromyalgia are several in the antidepressant class. Antidepressants elevate the levels of certain chemicals in the brain, including serotonin and norepinephrine (which was formerly called adrenaline). Low levels of these chemicals are associated not only with depression, but also with pain and fatigue. Increasing the levels of these chemicals can reduce pain in people who have fibromyalgia. Doctors prescribe several types of antidepressants for people with fibromyalgia, described below.
Tricyclic antidepressants—When taken at bedtime in dosages lower than those used to treat depression, tricyclic antidepressants can help promote restorative sleep in people with fibromyalgia. They also can relax painful muscles and heighten the effects of the body's natural pain-killing substances called endorphins.
Tricyclic antidepressants have been around for almost half a century. Some examples of tricyclic medications used to treat fibromyalgia include amitriptyline hydrochloride (Elavil, Endep), cyclobenzaprine (Cycloflex, Flexeril, Flexiban), doxepin (Adapin, Sinequan), and nortriptyline (Aventyl, Pamelor). Both amitriptyline and cyclobenzaprine have been proved useful for the treatment of fibromyalgia.
Selective serotonin reuptake inhibitors—If a tricyclic antidepressant fails to bring relief, doctors sometimes prescribe a newer type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). As with tricyclics, doctors usually prescribe these for people with fibromyalgia in lower dosages than are used to treat depression. By promoting the release of serotonin, these drugs may reduce fatigue and some other symptoms associated with fibromyalgia. The group of SSRIs includes fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
SSRIs may be prescribed along with a tricyclic antidepressant. Doctors rarely prescribe SSRIs alone. Because they make people feel more energetic, they also interfere with sleep, which often is already a problem for people with fibromyalgia. Studies have shown that a combination therapy of the tricyclic amitriptyline and the SSRI fluoxetine resulted in greater improvements in the study participants' fibromyalgia symptoms than either drug alone.
Mixed reuptake inhibitors—Some newer antidepressants raise levels of both serotonin and norepinephrine, and are therefore called mixed reuptake inhibitors. Examples of these medications include venlafaxine (Effexor) and nefazadone (Serzone). Researchers are actively studying the efficacy of these newer medications in treating fibromyalgia.
Benzodiazepines
Benzodiazepines help some people with fibromyalgia by relaxing tense, painful muscles and stabilizing the erratic brain waves that can interfere with deep sleep. Benzodiazepines also can relieve the symptoms of restless legs syndrome, which is common among people with fibromyalgia. Restless legs syndrome is characterized by unpleasant sensations in the legs as well as twitching, particularly at night. Because of the potential for addiction, doctors usually prescribe benzodiazepines only for people who have not responded to other therapies. Benzodiazepines include clonazepam (Klonopin) and diazepam (Valium).
Other medications
In addition to the previously described general categories of drugs, doctors may prescribe others, depending on a person's specific symptoms or fibromyalgia-related conditions. For example, in recent years, two medications — tegaserod (Zelnorm) and alosetron (Lotronex) — have been approved by the FDA for the treatment of irritable bowel syndrome. Gabapentin (Neurontin) currently is being studied as a treatment for fibromyalgia.
Other symptom-specific medications include sleep medications, muscle relaxants, and headache remedies.
People with fibromyalgia also may benefit from a combination of physical and occupational therapy, from learning pain-management and coping techniques, and from properly balancing rest and activity.
Complementary and alternative therapies
Many people with fibromyalgia also report varying degrees of success with complementary and alternative therapies, including massage, movement therapies (such as Pilates and the Feldenkrais method), chiropractic treatments, acupuncture, and various herbs and dietary supplements for different fibromyalgia symptoms. (For more information on complementary and alternative therapies, contact the National Center for Complementary and Alternative Medicine.
Though some of these supplements are being studied for fibromyalgia, there is little, if any, scientific proof yet that they help. The FDA does not regulate the sale of dietary supplements, so information about side effects, the proper 12 dosage, and the amount of a preparation's active ingredient may not be well known. If you are using or would like to try a complementary or alternative therapy, you should first speak with your doctor, who may know more about the therapy's effectiveness, as well as whether it is safe to try in combination with your medications.
Will Fibromyalgia Get Better With Time?
Fibromyalgia is a chronic condition, meaning it lasts a long time — possibly a lifetime. However, it may comfort you to know that fibromyalgia is not a progressive disease. It is never fatal, and it won't cause damage to your joints, muscles, or internal organs. In many people, the condition does improve over time.
What Can I Do To Try To Feel Better?
Besides taking medicine prescribed by your doctor, there are many things you can do to minimize the impact of fibromyalgia on your life. These include:
Getting enough sleep—Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. (Even so, many people with fibromyalgia have problems such as pain, restless legs syndrome, or brain-wave irregularities that interfere with restful sleep.
Exercising—Though pain and fatigue may make exercise and daily activities difficult, it's crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise and build their endurance and intensity slowly. Although research has focused largely on the benefits of aerobic and flexibility exercises, a new NIAMS-supported study is examining the effects of adding strength training to the traditionally prescribed aerobic and flexibility exercises.
Making changes at work—Most people with fibromyalgia continue to work, but they may have to make big changes to do so; for example, some people cut down the number of hours they work, switch to a less demanding job, or adapt a current job. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job. An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift.
If you are unable to work at all due to a medical condition, you may qualify for disability benefits through your employer or the Federal Government.
Social Security Disability Insurance (SSDI) and Supplemental Security Insurance (SSI) are the largest Federal programs providing financial assistance to people with disabilities. Though the medical requirements for eligibility are the same under the two programs, the way they are funded is different. SSDI is paid by Social Security taxes, and those who qualify for assistance receive benefits based on how much an employee has paid into the system; SSI is funded by general tax revenues, and those who qualify receive payments based on financial need. For information about the SSDI and SSI programs, contact the Social Security Administration. (See

Eating well—Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.
Tips for Good Sleep
Keep regular sleep habits. Try to get to bed at the same time and get up at the same time every day — even on weekends and vacations.
Avoid caffeine and alcohol in the late afternoon and evening. If consumed too close to bedtime, the caffeine in coffee, soft drinks, chocolate, and some medications can keep you from sleeping or sleeping soundly. Even though it can make you feel sleepy, drinking alcohol around bedtime also can disturb sleep.
Time your exercise. Regular daytime exercise can improve nighttime sleep. But avoid exercising within 3 hours of bedtime, which actually can be stimulating, keeping you awake.
Avoid daytime naps. Sleeping in the afternoon can interfere with nighttime sleep. If you feel you can't get by without a nap, set an alarm for 1 hour. When it goes off, get up and start moving.
Reserve your bed for sleeping. Watching the late news, reading a suspense novel, or working on your laptop in bed can stimulate you, making it hard to sleep.
Keep your bedroom dark, quiet, and cool.
Avoid liquids and spicy meals before bed. Heartburn and latenight trips to the bathroom are not conducive to good sleep.
Wind down before bed. Avoid working right up to bedtime. Do relaxing activities, such as listening to soft music or taking a warm bath, that get you ready to sleep. (An added benefit of the warm bath: It may soothe aching muscles.)

What Are Researchers Learning About Fibromyalgia?
The NIAMS sponsors research that will improve scientists' understanding of the specific problems that cause or accompany fibromyalgia, in turn helping them develop better ways to diagnose, treat, and prevent this syndrome.
The research on fibromyalgia supported by NIAMS covers a broad spectrum, ranging from basic laboratory research to studies of medications and interventions designed to encourage behaviors that reduce pain and change behaviors that worsen or perpetuate pain.
Following are descriptions of some of the promising research now being conducted:
Understanding pain—Because research suggests that fibromyalgia is caused by a problem in how the body processes pain — or more precisely, a hypersensitivity to stimuli that normally are not painful — several NIAMS-supported researchers are focusing on ways the body processes pain to better understand why people with fibromyalgia have increased pain sensitivity.
Previous research has shown that people with fibromyalgia have reduced blood flow to parts of the brain that normally help the body deal with pain. In one new NIAMS-funded study, researchers will be using imaging technology called positron emission tomography (PET) to compare blood flow in the brains of women who have have fibromyalgia with those who do not. In both groups, researchers will study changes in blood flow that occur in response to painful stimuli.
Researchers speculate that female reproductive hormones may be involved in the increased sensitivity to pain characteristic of fibromyalgia. New research will examine the role of sex hormones in pain sensitivity, in reaction to stress, and in symptom perception at various points in the menstrual cycles of women with fibromyalgia and of women without it. The results from studying these groups of women will be compared with results from studies of the same factors in men without fibromyalgia over an equivalent period of time.
Another line of NIAMS-funded research involves developing a rodent model of fibromyalgia pain. Rodent models, which use mice or rats that researchers cause to develop symptoms similar to fibromyalgia in humans, could provide the basis for future research into this complex condition.
Understanding stress—Medical evidence suggests that a problem or problems in the way the body responds to physical and/or emotional stress may trigger or worsen the symptoms of any illness, including fibromyalgia. Researchers funded by NIAMS are trying to uncover and understand these problems by examining chemical interactions between the nervous system and the endocrine (hormonal) system. Scientists know that people whose bodies make inadequate amounts of the hormone cortisol experience many of the same symptoms as people with fibromyalgia, so they also are exploring if there is a link between the regulation of the adrenal glands, which produce cortisol, and fibromyalgia.
Another NIAMS-funded study suggests that exercise improves the body's response to stress by enhancing the function of the pituitary and adrenal glands. The hormones produced by these two endocrine glands are essential to regulating sleep and emotions, as well as processing pain.
Improving sleep—Researchers supported by NIAMS are investigating ways to improve sleep for people with fibromyalgia whose sleep problems persist despite treatment with medications. One team has observed that fibromyalgia patients with persistent sleep problems share characteristics with people who have insomnia, such as having erratic sleep and wake schedules and spending too much time in bed. This team is testing whether strategies developed to help insomnia patients will also help people with fibromyalgia achieve deep sleep, which eases pain and fatigue. Preliminary results show that sleep education, which teaches good sleep habits, and cognitive behavioral therapy, which includes sleep education and a regimen to correct poor habits and improper sleep schedules, both reduce insomnia.

Looking for the family connection—Because fibromyalgia appears to run in families, one group of NIAMS-supported researchers is working to identify whether a gene or genes predispose people to the condition.
Another team is trying to determine if fibromyalgia is more common in people with other conditions, such as serious mood disorders, that tend to run in families. Specifically, the group is studying the prevalence of psychiatric disorders and arthritis and related disorders in people with fibromyalgia and their first-degree relatives (parents, children, sisters, brothers) as compared to people with rheumatoid arthritis and their relatives. The group is exploring whether clusters of conditions exist in families, which might shed light on shared common risk factors or disease processes.
Studying and targeting treatments—NIAMS recently funded its first study of a drug treatment for fibromyalgia. The study will measure the effectiveness of gabapentin, an anticonvulsant medication, in reducing symptoms of fibromyalgia. Gabapentin has been found to relieve chronic pain caused by nervous system disorders, and it was recently approved by the FDA for the treatment of persistent, severe pain that can follow an episode of shingles.
Scientists recognize that people with fibromyalgia often fall into distinct subgroups that adapt to and cope with their symptoms differently. They also realize that these subgroups may respond to treatments differently. One NIAMS-funded team of researchers has divided people with fibromyalgia into three groups based on how they cope with the condition. Relative to other chronic pain patients, those in the first group have higher levels of pain and report more interference in their life due to pain. They also have higher levels of emotional distress, and feel less control over their lives and are less active. The second group reports receiving less support from others, higher levels of negative responses from significant others, and lower levels of supportive responses from significant others. Those in the third group are considered adaptive copers; they have less pain, report less interference in their lives due to pain, and have less emotional distress. Members of this last group feel more control over their lives and are more active. On the premise that the better you understand the subgroups, the better you can tailor treatments to fit them, the researchers now are trying to design and test different programs for each group, combining physical therapy, interpersonal skills training, and supportive counseling.

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Adrenal glands—A pair of endocrine glands located on the surface of the kidneys. The adrenal glands produce corticosteroid hormones such as cortisol, aldosterone, and the reproductive hormones.
Arthritis—Literally means joint inflammation, but is often used to indicate a group of more than 100 rheumatic diseases. These diseases affect not only the joints but also other connective tissues of the body, including important supporting structures, such as muscles, tendons, and ligaments, as well as the protective covering of internal organs.
Analgesic—A medication or treatment that relieves pain.
Connective tissue—The supporting framework of the body and its internal organs.
Chronic disease—An illness that lasts for a long time, often a lifetime.
Cortisol—A hormone produced by the adrenal cortex, important for normal carbohydrate metabolism and for a healthy response to stress.
Fibrous capsule—A tough wrapping of tendons and ligaments that surrounds the joint.
Fibromyalgia—A chronic syndrome that causes pain and stiffness throughout the connective tissues that support and move the bones and joints. Pain and localized tender points occur in the muscles, particularly those that support the neck, spine, shoulders, and hip. The disorder includes widespread pain, fatigue, and sleep disturbances.
Inflammation—A characteristic reaction of tissues to injury or disease. It is marked by four signs: swelling, redness, heat, and pain. Inflammation is not a symptom of fibromyalgia.
Joint—A junction where two bones meet. Most joints are composed of cartilage, joint space, fibrous capsule, synovium, and ligaments.
Ligaments—Bands of cordlike tissue that connect bone to bone.
Muscle—A structure composed of bundles of specialized cells that, when stimulated by nerve impulses, contract and produce movement.
Nonsteroidal anti-inflammatory drugs (NSAIDs)—A group of drugs, such as aspirin and aspirin-like drugs, used to reduce inflammation that causes joint pain, stiffness, and swelling.
Pituitary gland—A pea-sized gland attached beneath the hypothalamus at the base of the skull that secretes many hormones essential to bodily functioning. The secretion of pituitary hormones is regulated by chemicals produced in the hypothalamus.
Sleep disorder—A disorder in which a person has difficulty achieving restful, restorative sleep. In addition to other symptoms, people with fibromyalgia usually have a sleep disorder.
Tender points—Specific places on the body where a person with fibromyalgia feels pain in response to slight pressure.
Tendons—Fibrous cords that connect muscle to bone.
Acknowledgments
The NIAMS gratefully acknowledges the assistance of Deborah Ader, Ph.D., NIAMS, NIH; Karen Amour and Lynne Matallana, National Fibromyalgia Association, Orange, CA; Michele L. Boutaugh, M.P.H., Arthritis Foundation, Atlanta, GA; Daniel Clauw, M.D., and Leslie Crofford, M.D., University of Michigan, Ann Arbor; and Tamara Liller, National Fibromyalgia Partnership, Linden, VA, in the preparation of this booklet.