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Prostatitis

Prostatitis is inflammation of the prostate gland. There are different forms of prostatitis, each with different causes and outcomes. Acute prostatitis and chronic bacterial prostatitis are treated with antibiotics; chronic non-bacterial prostatitis or male chronic pelvic pain syndrome, which comprises about 95% of prostatitis diagnoses, is treated by a large variety of modalities including alpha blockers, physical therapy, psychotherapy, antihistamines, anxiolytics, nerve modulators and more.[1] Benign prostatic hyperplasia (BPH) occurs in older men; the prostate often enlarges to the point where urination becomes difficult. If the prostate grows too large it may constrict the urethra and impede the flow of urine, making urination difficult and painful and in extreme cases completely impossible. BPH can be treated with medication or with surgery that removes part of the prostate. The surgery most often used in such cases is called transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. Older men often have corpora amylacea (amyloid), dense accumulations of calcified proteinaceous material, in the ducts of their prostates. The corpora amylacea may obstruct the lumens of the prostatic ducts, and may underlie some cases of BPH.

Prostate Cancer

Prostate cancer is one of the most common cancers affecting elderly men in developed countries and a major cause of death. Regular rectal exams are recommended for older men to detect prostate cancer early. Research has shown that regular ("more than five times per week"[2]) masturbation can cut the risk of prostate cancer by up to 66%. This is because regular ejaculation reduces the buildup of carcinogenic deposits in sperm which can damage the cells lining the prostate. This also applies to frequent sexual intercourse although the risks associated with STD's have been shown to increase risk of prostate cancer[3]. Once the lining of the prostate is affected with cancer, the only known treatments are surgery and radiation therapy. Both may limit the ability to have erection afterwards.

ProstateLess Herbal Tonic
Specific herbs for the promotion of prostate health and protection from disease or the development of abnormal cells are used in herbal medicine.

Prostate disorders and treatments
The prostate gland is about the size and shape of a chestnut. It surrounds the urethra, directly below the bladder. This gland slowly grows in size until about 30 years of age (except at puberty when it has a rapid increase in size). After this its size remains the same until about 45 years of age when the gland begins to enlarge again. Prostate enlargement in older men, when not accompanied by malignant changes is described as benign prostatic hypertrophy/hyperplasia (BPH). BPH is the most common benign tumour to affect men. By 60 years half of all men will suffer from BPH; by 85 years 90% of men suffer from BPH.
In a healthy young man 95% of androgens (mostly testosterone) are produced in the testicles, with 5% coming from the adrenals. Approx 98% of testosterone circulating in the bloodstream is technically unavailable as it is attached to proteins, predominantly a protein called sex hormone binding globulin (SHBG). The remaining 2% is known as ‘free testosterone’ and it is this testosterone that produces almost all the physiological effects.

Andropause
In the aging male, testosterone levels gradually decline, oestrogen becomes more prominent and SHBG production increases. This can lead to a state technically now recognised as andropause. Unlike female menopause which occurs relatively rapidly over 5-10 years, male andropause occurs in a much more gradual way, beginning in the thirties. As decline does not result in complete deficiency, therefore ‘androgen decline in aging males’ (ADAM) is probably a more accurate descriptive term (Barker and Meletis 2004:61).
Castrated men do not develop BPH so it is concluded that BPH is an androgen-dependent disease. Although testosterone levels decrease as men age, they continue to produce and accumulate high levels of the particularly active form of testosterone in the prostate called dihydrotestosterone (DHT). The prostate is oestrogen sensitive and thus the increased growth might be connected to the natural androgen reduction found in old age, which leaves the normally present oestrogen unopposed (Macfarlane et al 2000: 536).
Prolactin increases with age and research has shown that prolactin raises DHT levels in the prostate.

Causes and risk factors for BPH and prostate cancer
Uncertainty still surrounds the causes of BPH and prostate cancer. There is a genetic link: if you have a first degree relative who has had prostate cancer the risk for malignancy is twice that of the general population (Yance and Valentine 1999:340). Other possible risk factors are:
Vasectomy
History of sexually transmitted diseases
Multiple sexual partners and frequent sexual activity begun early in life
Sexual abstinence
Mother took pregnancy or growth hormones during the pregnancy
Frequent exposure to cadmium (welding, electroplating, battery making)
Athletes who use steroids

BPH: symptoms, signs and complications
Progressive urgency and frequency of urination with getting up at night to empty the bladder (nocturia). Urethra obstruction by the prostate causes bladder enlargement and results in incomplete bladder emptying, with urine stagnation predisposing to urinary tract infections. This may result in overflow incontinence or complete urine retention.

Prostate Cancer; Signs and Symptoms
Possible warning signals include: pronounced nocturia (getting up at night to empty the bladder), blood in the urine or semen, forked urine stream, pain in the lower back, hips or upper thighs, anaemia, weight loss, prostate feels hard and nodular, and raised PSA.
Diagnosis:
Digital rectal examination
Transrectal ultrasonography
Urinalysis
Cystoscopy and post voiding residual urine measurement
Prostate specific antigen (PSA) blood test
If cancer is suspected: a prostate needle biopsy

PSA blood test
Currently, if the PSA reads over 4.1 nanograms per millilitre a biopsy will be recommenced. If the biopsy is positive, the decision will be made as to whether the tumour is severe enough to require treatment – usually surgery or radiation therapy (New Scientist 2406, 02-08-2003, 7).
The problem is that a PSA blood test is not specific, as both benign and malignant epithelial cells produce PSAs. The accuracy potential of PSA testing is increased by noting that PSAs can be differentiated as being either free or protein-bound
- high ratio free to protein-bound antigens indicates a benign condition
- high ratio bound indicates prostate malignancy.

Urine test
It has been found that the PCA3 gene is over-expressed in malignant prostate tissue and this can be noted in urine samples. This could provide a much more accurate and faster diagnostic procedure but further trials are still in progress to confirm these findings before this method will become widely available (Medical Research News 2005).

Treatments available
There are many treatments available. Recent research supports the use of ultrasound to destroy prostate cancer cells as researchers suggest it is as effective as cutting the tumour out with surgery, but with far fewer side effects. It has been described as 80% successful at eradicating the cancer, a similar rate to surgery, but impotence was seen in only 40% of cases, about half as many as with surgery. Furthermore, incontinence was reported in just 8% of patients after their treatment, a threefold decrease (www. newscientist.com: 2004).
If malignancy of the prostate is diagnosed, then treatments can include radical prostatectomy or radiotherapy (both treatments carry a high risk for impotency and incontinence).

Godshaer Herbalist's 16 Dietary and Lifestyle Recommendations for Prostate Health

1. Reduce saturated animal fats (e.g. meat, meat fat and dairy products). High saturated fat diets have been linked to an increase in prostate cancer development. Meat is also a rich source of the amino acid trytophan, which has been found to increase prolactin levels in the body (Murray and Pizzorno 1998: 756).
2. Reduce cholesterol. Free radical damage caused by high cholesterol levels is thought to be particularly carcinogenic and toxic to the prostate (Murray and Pizzorno 1998: 756). See Cholesterol Tonic
3. Pumpkin seeds – high in zinc, important amino acids and essential fatty acids. (in the Balkan countries where large amounts of pumpkin seeds are traditionally eaten, low levels of prostate cancer have been recorded).
4. Zinc is an important mineral for prostate health as it inhibits 5-alpha reductase, androgen receptor binding and pituitary prolactin secretion body (Murray and Pizzorno 1998: 756).
5. Essential fatty acids. Adequate levels are needed by the body for maintaining the health of every living cell and for correct hormone production. Research has found that patients with BPH have less than average levels of omega 3 fatty acids in their blood, whilst patients with prostate cancer have significantly less omega 3 fatty acids in their blood (Nick 2004: 74).
6. Avoid constipation. One tablespoon of linseed with breakfast, on muesli, porridge etc or added to a glass of water. Linseeds also contain essential fatty acids and to release them they need to be crushed using a coffee grinder. Increasing the intake of natural fibre in the form of fresh fruit and vegetable will help prevent any constipation and will improve the health of the colon. This latter point is very important considering the close proximity of the prostate to the colon and the fact that malignant cells most often develop in the region of the prostate closest to the rectum. You can take the ABC Daily Powder or one of our MoveMore tonics for bowel regulation.
7. Repopulate the gut with healthy bacteria. Systemic overgrowth of candida albicans is often associated with prostate problems. The intake of one to ten million Lactobacillus acidophilus and Bactobacillus bifidum is recommended for 2-3 weeks following any internal antibiotic use. See also our ThrushLess Tonic.
8. Restrict alcohol, especially beer. Hops in beer are implicated in raising the body’s prolactin levels and research has shown that any high alcohol consumption is associated with increased BPH development body (Murray and Pizzorno 1998: 756). If you have alcohol problems you can take our herbal medicine to help you get over alcohol addiction.
9. Drink enough fluids. Due to urination difficulties, some BPH sufferers restrict fluid intake. This can cause dehydration and encourage the development of bladder infections. Therefore fluid intake needs to be encouraged but it is recommended that most fluids should be consumed during the day to avoid worsening nocturia. ProstateLess Tonic improves bladder control; or you can try WaterLess Tonic.
10. Vitamin D from sunlight. Maintain adequate regular exposure to natural sunlight as it is linked to reduced prostate cancer incidences. The use of vitamin supplementation D may be useful (Cancer Research vol 65, p.5470 – New Scientist).
11. Avoid decongestants; antihistamines and antidepressants whenever possible as they can exacerbate the symptoms of urine obstruction (Thomas 1998:5). If you have to take such sprays or drugs like prozac you might want to try our HayFever Tonic or DepressionLess Tonic.
12. Increase exercise, especially to the pelvic region e.g. pelvic floor exercises, dancing, fast walking, swimming), and wear loose cotton boxer shorts. These measures all increase blood flow to the prostate and encourage its health by allowing proper nutrients to the cells and removal of toxins. Exercise also helps to maintain more youthful testosterone levels. One study, using just a moderate amount of exercise, found that testosterone levels in the male subjects increased by 39% (Barker and Meletis 2004:63).
13. Reduce excess weight. Peripheral oestrogen levels are high in obese men because peripheral aromatisation (the conversion of testosterone to oestrogen under the influence of the enzyme aromatase) occurs mostly in fatty tissue (Sciarra and Toscano 2000:214). To help you lose weight try our WeightLess Tonic, or do the LemonDetox Programme.
14. Reduce stress levels. Researchers examined the PSA tests of 318 men and they found that men with high levels of stress were three times more likely to have abnormal PSA tests than men with low levels of stress (Waznicki 199:1). Animal studies have demonstrated that both long and short-term stress reduces blood flow to the prostate (Thomas 1988:4). Help lower your stress and worry with our WorryLess Tonic.
15. Caution with contraceptive and morning after pill. A recent study on mice indicates that oestrogen-like chemicals commonly found in oral contraceptives could deform the prostate gland of embryos. This is a concern as prostate deformities have been linked to prostate cancer and bladder disease in later life. Up to 3% of women taking oral contraceptive drugs become pregnant without their knowledge, and continue exposing the foetus to the contraceptive drug many months into pregnancy (Proceedings of the National Academy of Sciences (DOI:10.1073/pnas.0502544102)).
16. Sexual activity. Regular ejaculations appear to provide a protective effect. Recently a study which followed nearly 30,000 men over eight years showed that those that ejaculated most frequently were significantly less likely to develop prostate cancer. The group with the highest lifetime average of ejaculations (21 times per month) were provided with the best protection as they were a third less likely to develop prostate cancer, compared to the reference group who ejaculated 4-7 times per month. To help with potency you can take our aphrodisiac herbal medicine Herbal V8 Tonic.

Controversy surrounds the exact causes of BPH and prostate cancer, with the long held belief that the main culprit is testosterone and its more active form DHT being now challenged in some quarters. Possible causes are many but some studies suggest it results from a hormonal imbalance resulting in an accumulation of oestrogen with the effects of testosterone and DHT only playing a secondary role. In fact some controversial treatments have actually involved giving testosterone hormone replacement to the aging male. This is obviously not without considerable risk but a more youthful hormone balance can be encouraged naturally and more safely by reducing the body’s oestrogen load e.g. by increasing phytoestrogen intake and avoiding xenoestrogens, losing weight and exercise etc.

Two Important Herbs for BPH

Saw Palmetto berries (Serenoa serrulata or S. repens)
Currently Saw Palmetto is principally associated with the treatment of BPH but also has a generally supportive effect on the whole male reproductive system. Manin active ingredients are found in it s lipid content: free fatty acids (including lauric, myristic and loeic acids), together with triglycerides, diglycerides and monoglyycerides, phytosterols (mainly beta sitosterol) and fatty alcohols. Also contains flavonoids and polysaccharides.
A very active lipase during ripening and drying of the fruit causes splitting of the triglycerides into free fatty acids. This gives the berries their characteristic rancid odour and taste which according to Mills and Bone (2000:524), may account for the occasional digestive upsets, reported from Serenoa usage.
Actions: inhibition of 5-alpha-reductase. This enzyme is responsible for converting testosterone into its more potent form: DHT. It is also thought to inhibit DHT from binding to the prostate androgen receptors. This inhibitory effect on 5-alpha-reductase is 5,600-40,000 times weaker than that produces by the drug Finasteride. The Serenoa extract is normally given in doses 100 times greater than those used with Finasteride, meaning clinical potency is actually only approximately 60 times weaker (Mills and Bone 2000:534-5).
Inhibition of oestrogen and prolactin. Animal studies have demonstrated serenoa’s sitosterol glycosides as having oestrogenic effects, but a more recent study has reversed this view, and it is now thought Serenoa actually inhibits oestrogen. There is some evidence that Serenoa also inhibits prolactin, another hormone connected with prostate growth stimulation (Bone 1998:17).
Spasmolytic activity. A study on rat bladder, aorta and uterus, demonstrated that a liposterolic extract of Serenoa resulted in spasmolytic activity. According to Bone (1988:16) this and other trials have indicated this action results from ‘alpha-adrenoceptor and calcium blocking activities’.
Anti-oedematous and anti-inflammatory actions have been demonstrated through research trials, with the latter action being shown to result from inhibition of cyclo-oxgenase and 5-lipoxygenase (Mills and Bone 2000:526).
Serenoa was previously thought to only relieve the signs and symptoms of BPH, but recent research indicates it can also reduce the size of prostate epithelial tissue (Overmyer 2000:1).
Numerous clinical trials have been conducted on the efficacy and safety of Serenoa. The general consensus of these trials is that Serenoa impr9ves urological symptoms and flow measures and is comparable to finasteride in effectiveness, but produces fewer adverse effects.
Side effects. No contraindications, cautions or known adverse drug interactions are given by the German Commission E. the only side effect noted, was that in rare cases mild gastrointestinal upsets had been reported (Blumenthal et al 2000:338).
The standardised extract used fro 3 months or more is associated with inhibited libido in male patients, whereas it has been noted that this adverse effect is not found when the tincture of Serenoa is used.

Stinging Nettle root (Urtica dioica radix)
The root has been given Commission E approval for the treatment of BPH.
Actions. Aromatase inhibition. This enzyme mediates the conversion of androgens into oestrogens. It was found to weakly inhibited by the sterols and hydroxyl fatty acids (Konrad 1999:46).
Inhibition of Na+K+-ATPase in BPH tissue. Sterols such as 4-en-e-one stigmasterol and compesterol were found to inhibit Na+K+-ATPase in BPH tissue, an action which may cause suppression of prostate cell metabolism and growth (Hirano et al 1994:30).
Inhibition of sex hormone binding globulin (SHBG). This has been attributed to the lignans. In the body SHBGs increase with age. As SHBGs bind more readily with androgens, this leaves a higher proportion of free oestrogen. In this active state, the oestrogen could bind with oestrogen receptors on the prostate, stimulating its growth (Rose 1998:1-2).
Inhibition of cell proliferation. The lignan, urtica dioica aggluginin (UDA) has been shown to have a direct inhibition of cell proliferation of HeLa cells (Konrad et al 2000:46).
Inhibition of cell proliferation and anti-inflammatory. Polysaccharides in an aqueous root extraction have been shown to produce anti-inflammatory and anti-proliferative activity on prostate cells (Konrad 2000:46).
Konrad et all suggest that results obtained using Nettle root have been comparable to finasteride usage but they point out that the nettle extract demonstrated neither 5-alpha-reductase inhibition nor anti-androgen activity.
Safety. There are no known contraindications or drug interactions associated with Urtica.
Generally Urtica root appears to be a well-researched, effective and safe herb for the treatment of BPH and presumably would work well in combination with a 5-alpha-reductase inhibiting herb such as Serenoa, as the mode of action diffes and therefore the therapeutic approach will be broadened and complemented.

Other important herbs for prostate health
There are modern, advanced botanic medicines that are specific for the prostate gland health, along with supportive herbs to improve or act in synergy with other herbs in their action. Included are such herbs like Saw Palmetto, Nettle root, buchu, uva ursi, couch grass, black cohosh, wild carrot, horsetail herb, gravel root, cleavers, hydrangea, juniper berry, mitchella, propolis, thuja, red clover, corn silk.

Find out about herbal medicine for treatment of this condition

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Our herbal tonic medicines are carefully prepared on a personal and individual basis for your healing by medical herbalist Alan Hopking MA MNIMH MRCHM FINEH. Only whole herbs are used in our herbal medicines. Nothing else is added. If you have symptoms which you consider might be helped with herbal medicine please contact herbal practitioner Alan Hopking for a friendly confidential professional consultation. Telphone using our freephone 0500 90 96 97.
Once you have received your herbal prescription you can contact Alan Hopking at any time for more free advice (preferably by email). When you have completed your bottle of herbal medicine and if you want a repeat prescription you are requested to phone or email so that your progress can be assessed and adjustments made if necessary so that there is no break in your treatment. To order or re-order, click here.

UK Government Dept - MHRA

General advice to consumers on the use of herbal remedies from the Medicines Healthcare products Regulatory Agency

From the website of the Medicines Healthcare products Regulatory Agency (www.mhra.gov.uk) Department of Health, UK

• Remember that herbal remedies are medicines. As with any other medicine they are likely to have an effect on the body and should be used with care.
• Herbal remedies may sometimes interact with other medicines. This makes it particularly important to tell your doctor or pharmacist if you are taking a herbal remedy with other medicines such as prescribed medicines (those provided through your doctor or dentist).
• Treat with caution any suggestion that a herbal remedy is '100% safe' or is 'safe because it is natural'. Many plants, trees, fungi and algae can be poisonous to humans. It is worth remembering that many pharmaceuticals have been developed or derived from these sources because of the powerful compounds they contain. Any medicine, including herbal remedies, which have an effect on the body should be used with care.
• Treat with caution any herbalist or other person who supplies herbal remedies if they are unwilling or unable to provide written information, in English, listing the ingredients of the herbal remedy they are providing.
• If you are due to have a surgical operation you should always remember to tell your doctor about any herbal remedy that you are taking.
• Anyone who has previously experienced any liver complaint, or any other serious health complaint is advised not to take any herbal remedy without speaking to their doctor first.

PRECAUTIONS:

Pregnant/Breast-feeding mothers
Few conventional medicines have been established as safe to take during pregnancy and it is generally recognised that no medicine should be taken unless the benefit to the mother outweighs any possible risk to the foetus. This rule should also be applied to herbal medicinal products. However, herbal products are often promoted to the public as being “natural” and completely “safe” alternatives to conventional medicines. Some herbal ingredients that specifically should be avoided or used with caution during pregnancy. As with conventional medicines, no herbal products should be taken during pregnancy unless the benefit outweighs the potential risk.

Volatile Oils

Many herbs are traditionally reputed to be abortifacient and for some this reputation can be attributed to their volatile oil component.(6) A number of volatile oils are irritant to the genito-urinary tract if ingested and may induce uterine contractions. Herbs that contain irritant volatile oils include ground ivy, juniper, parsley, pennyroyal, sage, tansy and yarrow. Some of these oils contain the terpenoid constituent, thujone, which is known to be abortifacient. Pennyroyal oil also contains the hepatotoxic terpenoid constituent, pulegone. A case of liver failure in a woman who ingested pennyroyal oil as an abortifacient has been documented.

Uteroactivity

A stimulant or spasmolytic action on uterine muscle has been documented for some herbal ingredients including blue cohosh, burdock, fenugreek, golden seal, hawthorn, jamaica dogwood, motherwort, nettle, raspberry, and vervain. Herbal Teas Increased awareness of the harmful effects associated with excessive tea and coffee consumption has prompted many individuals to switch to herbal teas. Whilst some herbal teas may offer pleasant alternatives to tea and coffee, some contain pharmacologically active herbal ingredients, which may have unpredictable effects depending on the quantity of tea consumed and strength of the brew. Some herbal teas contain laxative herbal ingredients such as senna, frangula, and cascara. In general stimulant laxative preparations are not recommended during pregnancy and the use of unstandardised laxative preparations is particularly unsuitable. A case of hepatotoxicity in a newborn baby has been documented in which the mother consumed a herbal tea during pregnancy as an expectorant. Following analysis the herbal tea was reported to contain pyrrolizidine alkaloids which are known to be hepatotoxic.

Breast-feeding mothers

A drug substance taken by a breast-feeding mother presents a hazard if it is transferred to the breast milk in pharmacologically or toxicologically significant amounts. Limited information is available regarding the safety of conventional medicines taken during breast-feeding. Much less information exists for herbal ingredients, and generally the use of herbal remedies is not recommended during lactation.

Paediatric Use

Herbal remedies have traditionally been used to treat both adults and children. Herbal remedies may offer a milder alternative to some conventional medicines, although the suitability of a herbal remedy needs to be considered with respect to quality, safety and efficacy. Herbal remedies should be used with caution in children and medical advice should be sought if in doubt. Chamomile is a popular remedy used to treat teething pains in babies. However, chamomile is known to contain allergenic sesquiterpene lactones and should therefore be used with caution. The administration of herbal teas to children needs to be considered carefully and professional advice may be needed.

Perioperative use

The need for patients to discontinue herbal medicinal products prior to surgery has recently been proposed. The authors considered eight commonly used herbal medicinal products (echinacea, ephedra, garlic, ginkgo, ginseng, kava, St John’s Wort, valerian). On the evidence available they concluded that the potential existed for direct pharmacological effects, pharmacodynamic interactions and pharmacokinetic interactions. The need for physicians to have a clear understanding of the herbal medicinal products being used by patients and to take a detailed history was highlighted. The American Society of Anaesthesiologists (ASA) has advised patients to tell their doctor if they are taking herbal products before surgery and has reported that a number of anaesthesiologists have reported significant changes in heart rate or blood pressure in some patients who have been taking herbal medicinal products including St John’s Wort, ginkgo and ginseng. MCA is currently investigating a serious adverse reaction associated with the use of ginkgo prior to surgery. In this case, the patient who was undergoing hip replacement experienced uncontrolled bleeding thought to be related to the use of ginkgo.

From the website of the Medicines Healthcare products Regulatory Agency (www.mhra.gov.uk) Department of Health, UK

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Godshaer Herbal Clinic
Advanced Botanical Centre of Medicine
Ducking Stool Lane
Christchurch
Dorset
BH23 1DS
UK

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Freephone UK 0500 90 96 97

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alanhopking@godshaer.co.uk

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Disclaimer and pledge

As a professional herbal practitioner I am in practice in conformity with the laws of England and the 1968 Medicines Act. The UK legislative provisions for herbal medicine are to be found in the Medicines Act 1968, Section 12, paragraphs 1 & 2, and Section 56, paragraphs 1 & 2.

Section 12:1 specifies exemption for herbal medicines from licensing provided that they are supplied subsequent to private personal consultation. Section 12:2 exempts herbal medicines provided that they are produced according to standard traditional, non-industrial methods. It also specifies that no written claims may be made for the use of the remedy.

Therefore at Godshaer Herbalist no claims about any medical condition regarding the herbal medicines prescribed by Alan Hopking are made. Indeed, be it a doctor, surgeon or herbal practitioner, the successful outcome of our treatments cannot with any certainty be predicted, let alone guaranteed. Further, following UK and EU law, the information on this web site attach no medical claims and no claims concerning the medicinal herbs mentioned relating to any medical conditions listed. All the herbal prescriptions are unlicensed and made by Alan N. Hopking at the address of Godshaer Herbalist for patients of Alan N. Hopking.

I pledge that, I shall do all I can, using my knowledge of herbal medicines and natural treatment, to help you regain your deserved health.
Alan Hopking MA MNIMH MRCHM FINEH

All our herbal medicines are made from the raw herb at our dedicated clinic and dispensary in Ducking Stool Lane. We collect the fresh herbs, or import the dry herb. They are organic if at all possible. We only use whole herbs. We are against the use of standardized extracts, or the concentration of herbs by adding more of the active constituent. We recommend you do not use such products in any form (dry, in capsules or as tincture extracts). To use our herbal tonics you should follow the prescribed dose. Any side effects or problems should be reported to us.