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 Herbal Medicine: Bitters (Bitterstoffe) L. Maiwald, Wu 
 
A different evaluation is given by the pharmacologist, on the basis of the separate constituents shown to be in bitters preparations, than that based on medical therapeutical experience. According to R.F. Weiss (2), the characteristic property of the bitterness is only a qualitative description without the possibility of a detailed analysis.

There is a large number of drug plants with a bitter taste. They are now grouped under the name Amara (bitter medicine), and are then further subdivided on the basis of additional characteristics. In the group called Amara tonica, are placed ones that are pure bitters in the more narrow sense, where the promotion of the stomach secretion is emphasized over other characteristics.

This group is narrowed, if one considers the clearly exciting effect of some bitters preparations, which in practice can be seen. These find application for the activation of the appetite, and simultaneously for the improvement the overall state of health, because they generally excite the bodily functions.

What "target group" is best suited for bitters?
Target groups for a treatment with preparations of bitters are for the doctor therefore, above all, patients in convalescence after long-standing infections, and patients with chronic gastro-intestinal ailments. Also long-term illnesses with gastrointestinal digestive weakness are successfully treated with bitters, likewise persons with weak constitution and lowered autonomic nervous system tone. Under this category, one finds numerous patients with disturbances of the nutrition and health of the nerves, in the sense of a decreased reaction ability of the autonomic nervous system.

The effect of the plant-based bitters manifests first after a longer moderate course of treatment use. This is especially important to consider, not only for the gastrointestinal effect but also for the general stimulating and tonic one.

With a single dose one notices only enhancement of the salivary and stomach secretion. Occaisionally even these effects are only small. The practical therapeutical experience with amara in medical practice is essentially larger than the number of recognized proven effects.

Since ancient times, amara preparations are typical remedies for general medical practice because of their range of use. However, they are less useful for application in the hospital, because there, one expects, and is dependant on, an immediate effect.

Indications for Amara
From a therapeutic perspective, these are the applications for bitters:

1. The general loss of zest, life, well-being (loss of livliness) (slowing down of the life processes [In German = Tonusverlust] [from slow-down of the vital energy of the body begins to effect the vitality of the body, especially the autonomic nervous system-conditioned lowered gastrointestinal tonus, with the consequence of lowered blood supply, with intestinal stresses, without sufficient secretions and slowed-down peristalsis

Such conditions, apart from convalescence, also found with exhaustion and in general and/or constitutionally-conditioned weaknesses.

2. The deficiency of appetite and the necessity of the acceleration of the gastric [nutritional passage] as well as the stimulation of the stomach secretion. The most favorable patent remedies that have proven themselves in medical practice are tinctures given as drops, or small amounts of tea taken before meals. Both dose forms should be taken before relatively small meals, and tea only in cold form. The success in application is tied with a long continued therapy.

There are prepared mixtures of bitters known, such as tincturea amara, tinctura stomachica and elixir amara. Especially favored are dose forms in wine (vinum amarum, vinum china, vinum Condurango). Besides that, there are preparations of bitter drugs (mixtures), which together with spasmolytic and carminatives are effective remedies for therapeutic applicaiton.

From a pharmacological perspective, bitters are evaluated in a different way. [The above evaluation was from a medical perspective). One ascribes to them a significance as stimulants of salivation, stomach and gall secretions, because of their intensly bitter taste.

In addition to these effective bitter drugs, others are separated (or delineated), in which different pharmacologic effects are more significant, than the effect on saliva and stomach acid production. To this group belongs cinchona, strychonos seed, aloe and heart-glycoside drugs (leaves of digitalis). The generally tonifying effect of the bitter tonics is not especially valued from a pharmacologic perspective.

On the basis of accompanying constituents, by which the bitter taste is modified, one descriminates (differentiates) pharmacologically

1. Amara pura
2. Amara mucilaginosa
3. Amara aromatica

Chemically-pharmacologically, bitter drugs do not belong to a unique class of substances. Here is in its multidue (xx?) a parallel to see, the manifoldness of drugs containing bitters. Among the bitter drugs there are many conspicuous which have in their content terpenoid glycosides and compounds with lactone groups.

The pharmacologic recommendation for therapeutic applicaiton., is differentiated according to the evaluation. The need for stimulating the appetite, weakness conditions, anemia, and convalescence are taken as indications. As a recognized effect, however, there is only the reflex effect of the stimulation of the salivary gland and stomach secretions happening via the vagus nerve.

It is postulated that bitters trigger in this way, a mechanism that effects immediately an improved nutritional utilization and increased or heightened resorptivity. Although, in animal tests a blood pressure lowering and positive inotropic effect has been proven, likewise also a bacteriocidal effect of many bitter drugs, these properties are pharmacologically not passed on to the clinical therapists as recommendations for application.

Pharmacologically, there remains the important immediately recognizable strong increase of the production of salivary-and stomach secretion, as it has been achieved with the drugs wormwood, gentian and hops. Consequently, from a pharmacologic perspective, the therapeutic uses for bitter drugs is different from that of the doctor based on the daily experience with patients.

[This is the crux of the issue between scientists and herbalists--it depends on one's perspective, ed.).

Regarding the forms of preparation, it is pharmacologically and medically significant that bitters are not obtained as pure substances for economic reasons, and therefore they are at our disposal only in the form of the plant's own constituent complexes.

[life grows out in many directions at once, so it can make use of (medicinal substances) that life itself has evolved, ed.].

The application of bitters happens in the form of extracts, as has already described. Thus, the frequently used tincture formulas and tea preparations represent complex substance combinations.

THE MOST IMPORTANT BITTER DRUGS

The significant bitter drugs in our culture, are today recognized as:
Wormwood
Bitter orange peel
Blessed thistle
Centaurium
Lemon peel
Condurango
Gentian
(yellow root)
Buckbean.

In order to show whether a preparation of bitter drugs can also change intra-gastral digestive processes beyond the known stimulating effect on the saliva and stomach secretions, in a group experiment of 20 volunteer test subjects, gastric proteolysis has been examined under continuous control formation of breakdown products. Corresponding to mdical experience and to pharmacologic recommendation it could be shown that the addition of bitter concentrates to the high-protein test drink as a stomach tonic during the intra-gastric protyolisis of the stomach chyme does improve the acid production and supports the albumic splitting (3). It was even shown that the applied stomach tonic acted sex-specifically, by affecting in males an earlier and stronger, and in female a later and weaker effect on the acid production and of proteolysis.

Through the (sequence) of the experiment the evaluation of any effect other than a local one was excluded. Any further lead of the taste sensation as causative for improved gastric production and proteolysis through the stomach tonic needs therefore no further discussion. The ascertained effect of the drug mix on the acid secretion and gastric proteolysis happened during the gastric phase of the stomach secretion.This confirms the assumption, that the stomach tonic attains its effect in a humoral way, that is, via the release of gastrin.

The acceleration of the proteolytic effect through the bitters concentrate is to be explained via the accelerated release of acid and the proteolysis-promoting pH value which is thereby reached earlier. The examination has in any case yielded that bitter drug concentrates, independant of the taste sensation, directly affects the enteral regulation via gastric mechanisms.

This finding corresponds to the examinations via the gastrointestinal effect of Harpagohytum procumbens undertaken by Zimmermannof. He discovered the bitter drug action as a side effect during the testing of the drug as a rheumatic rhemedy. This effect might also be equated to gentian. Zimmermann was able to note that disease symptoms of the upper small intestine, with disturbances of cholerase and cholekinese, but also clinically-latent pancriatic gland participation, experienced a distinct improvement after several days' administration of Harpagophytum as a tea. Impressive for him was the improved cholekinese, which corresponded to a bitters effect, just as described for gentian.

The result of my own investigations complement the findings of Zimmermann et al. (5) --bitters obviously improve gastric self-regulation and thereby undoubtedly contribute to an improved functioning of the subordinated organs, the pancreatic and bile duct [systems] (gall-path system), which depend on the stomach's function in their readiness to secrete.

The significance of Amara is not yet fully known
On the basis of communicated reports, the general statement is permissible, that the significance of amara is not yet fully known and therefore needs to be further examined medically and pharmacologically.

If one (as Zimmerman writes) can also not yet explain the much-discussed double-effects such as that of China bark as tonic and fever medicine, Strichnos-seed as tonic and synapse poison, that of plantain herb as bitter and antiobiotic, Devil's Claw as rheumatic remedy and antiphlogistic, anti-allergic and amarum, then these facts represent a genuine challenge for the clinic, in practice and in the lab to explain effects and effectiveness objectively. To this, correspond results of the newest examinations of bitter drugs in their effect on the gut-associated immune system. It has been shown, that in cases of inflammatory stomach-intestinal diseases of diverse types and location, there is a heightened sIgA-level to be found in the saliva.

Bitters, used in therapy, bring about a significant change in the sIgA-concentration, whereby in healthy people, gentian brings a lowering, China-bark, however, a raising of the concentration. In patients with inflammatory stomach-intestinal diseases a significant decrease of the sIgA in the saliva has been noticed through therapy with gentian, which correlated with their clinical results (picture).

Further significant results of examinations (studies, investigations) about the effectiveness of bitter drugs in the treatment of gastrointestinal diseases are, therefore, surely to be expected.

Translated from Zeitschrift für Phytothereapie 8: 186-188 (1987)

English translation Copyright March, 1991 by Shanti Coble and Christopher Hobbs

All Rights Reserved

Christopher Hobbs L.Ac.
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 About The Author
Christopher Hobbs LAc, AHG Christopher Hobbs is a fourth generation herbalist and botanist with over 30 years experience with herbs. Founder of Native Herb Custom Extracts (now Rainbow Light Custom Extracts) and the Institute for Natural Products......more
 
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