Comprehensive Study Notes on Phytotherapy for Vocational Matura
General Information and Introduction
These study notes serve as a definitive guide for the Vocational Matura (Poklicna Matura) in the RDN program at the Secondary School of Pharmacy, Cosmetics, and Food (SŠFKZ). The material was compiled by Ajda Štefe under the mentorship of Professor Nadja Prijatelj for the 2025/2026 academic year in Ljubljana. The guide covers a wide range of pathological conditions and their phytotherapeutic treatments, specifically focusing on herbal drugs, active ingredients, and clinical considerations.
Gastric Disorders: Reduced Secretion of Gastric Juice
Gastric juice is a vital digestive fluid containing Hydrochloric Acid (), which maintains an acidic environment with a of . This acidity is essential for converting the inactive enzyme pepsinogen into its active form, pepsin. Pepsin is responsible for the hydrolysis of proteins into smaller polypeptides. A reduction in the secretion of gastric juice is often observed in the elderly as a result of changes in the gastric mucosa. Clinically, this manifests as discomfort, a sensation of tension, and a feeling of fullness in the upper abdomen, typically occurring after meals.
Phytotherapy for this condition involves the use of stomachics, which are agents that stimulate the secretion of gastric juice. These frequently contain bitter principles (bitters) that bind to bitter receptors located at the root of the tongue and within the stomach. Notable herbal drugs used include the root of Yellow Gentian (Gentiana lutea), the herb of Common Centaury (Centaurium erythraea), the flower and herb of Common Yarrow (Achillea millefolium), the herb of Common Wormwood (Artemisia absinthium), and the root or herb of Common Dandelion (Taraxacum officinale). These drugs are also indicated for a lack of appetite.
Peptic ulcers represent a major contraindication for stomachics. A peptic ulcer is a focal lesion on the mucosa of the stomach or duodenum, characterized by burning pain, upper abdominal discomfort, belching, flatulence, rapid satiety, nausea, and vomiting. Specific warnings apply to certain herbs: Common Wormwood contains an essential oil with thujone, which in high doses can cause pain, dizziness, rapid heartbeat, epileptic-type seizures, and uterine contractions leading to miscarriage; thus, it is avoided in adolescents and pregnant or lactating women. Dandelion root and herb are rich in potassium ions (), posing a risk of hyperkalemia, arrhythmia, and cardiac arrest in patients with heart failure, chronic kidney disease, or diabetes. If no improvement is seen within 2 weeks, medical consultation is required. Pharmaceutical forms include medicinal teas and oral formulations, with liquid forms taken 0.5 hours before meals and solid forms taken 1 hour before meals.
Gallbladder and Liver Conditions: Reduced Bile Acid Secretion
Bile is produced in the liver and subsequently concentrated and stored in the gallbladder. Upon the ingestion of fatty foods, bile is secreted into the small intestine to emulsify fats into smaller droplets, facilitating their breakdown by lipases. Bile contains bile acids, cholesterol, and other substances. When bile acid secretion is reduced, patients experience tension, fullness in the upper abdomen, and general discomfort after consuming fat-rich meals. Cholagogues are herbal agents used to increase both the production and secretion of bile acids.
Gallstones (cholelithiasis) occur when the composition of bile changes—specifically when the concentration of bile acids decreases and cholesterol increases, leading to cholesterol crystallization. These stones can cause severe complications. If gallstones are present, the use of cholagogic drugs requires medical supervision. Useful herbs include Yellow Gentian, Common Centaury, Common Yarrow, Common Wormwood, and Common Dandelion. These agents are contraindicated in cases of liver disease or obstructions of the gallbladder and bile ducts, as they can trigger the movement of stones, resulting in biliary colic (cramps), nausea, and vomiting. The same systemic warnings for thujone (in wormwood) and hyperkalemia (in dandelion) apply here as they do for gastric issues. Therapy should be reassessed by a doctor if no improvement occurs within 2 weeks.
Gastrointestinal Distress: Flatulence and Cramps
Flatulence is characterized by discomfort in the lower abdomen, increased gas production and expulsion, and gastrointestinal cramps. Common causes include aerophagia (swallowing air while eating), specific dietary choices, and a deficiency in digestive enzymes. The latter causes unabsorbed nutrients to reach the large intestine, where bacteria ferment them, producing gas. Carminatives are agents that prevent the formation and facilitate the release of gas, while spasmolytics are used to relieve smooth muscle spasms.
Herbal drugs for these conditions primarily include essential-oil-rich plants: Caraway (Carum carvi), Anise (Pimpinella anisum), Fennel (Foeniculum vulgare), Peppermint (Mentha piperita), and German Chamomile (Matricaria recutita). However, significant cautions exist regarding Anise and Fennel essential oils because they contain estragole. Experimental evidence in animals has shown estragole to be carcinogenic, specifically linked to liver cancer. Consequently, their use is discouraged in children, pregnant women, and breastfeeding mothers, while others should limit consumption to 2 weeks. Peppermint is contraindicated in patients with heartburn (GERD), as it can worsen the reflux of gastric contents, and in those with liver or gallbladder diseases due to its cholagogic effect. If symptoms persist for 2 weeks, a doctor should be consulted. Common forms are medicinal teas and oral pharmaceutical forms.
Intestinal Disorders: Constipation
Constipation is defined as the passage of hard stool fewer than two times per week, often caused by diet, stress, lack of physical activity, or colorectal cancer. Laxatives are used to accelerate the emptying of the large intestine. In cases of acute constipation, anthraquinone-containing plants like Alexandria Senna (Cassia senna) and Alder Buckthorn (Frangula alnus) are used. Their mechanism of action involves stimulating peristalsis via contact with the colonic mucosa and altering electrolyte transport to increase the water content in the intestine, thereby softening the stool. These are contraindicated during pregnancy (due to mutagenic potential), lactation (as anthraquinones pass into breast milk), intestinal obstructions, chronic inflammatory bowel disease, kidney disease, and dehydration. Side effects include allergic reactions and discoloration of urine (yellow or red-brown). Overdosing leads to cramps and diarrhea. Chronic use must be avoided (maximum 1 week) to prevent dehydration, hypokalemia ( deficiency), and dependency.
For chronic constipation, or when soft stool is desired (e.g., for hemorrhoids), bulk-forming laxatives containing mucilage are preferred. These include Flaxseed (Linum usitatissimum), Blond Psyllium (Plantago ovata), and Indian Psyllium (Plantago afra). Mucilages swell in water, increasing the volume of the stool and stretching the intestinal wall to trigger movement. Psyllium is safe for pregnant and lactating women, but flaxseed should be avoided by women with hormone-dependent tumors. These products must be taken with ample fluid to avoid obstructions of the throat or esophagus. The effect typically takes 12-24 hours, reaching a maximum after 2-3 days. Because mucilages can delay the absorption of other medications, they should be taken 0.5 to 1 hour apart from other drugs. Diabetic patients must also be cautious as mucilage may delay glucose absorption.
Diarrhea and Dehydration
Diarrhea involves the passage of liquid stool more than three times daily, leading to the dangerous loss of water and electrolytes, known as dehydration. Signs of dehydration include dry mouth, thirst, headache, dizziness, dark urine, muscle cramps, tachycardia, tachypnea, and loss of skin elasticity; severe cases can lead to unconsciousness or death. Causes range from stress and diet to viral or bacterial infections and hypothyroidism.
Adstringents are the primary herbal treatment for diarrhea. They function by coagulating proteins on the surface of the mucosa, creating a protective layer that reduces the secretion of water and electrolytes, prevents the entry of microorganisms (), and neutralizes bacterial toxins. Typical herbal drugs include Oak bark (Quercus species), Tormentil rhizome (Potentilla erecta), and dried Bilberry fruits (Vaccinium myrtillus). These are typically prepared as a decoction, where the drug is boiled in water for 15-30 minutes. Tannins (čreslovine) in these drugs can delay the absorption of other medicines, so they must be administered 1 hour before or after other drugs.
Liver Protection and Travel Sickness
Liver damage can result from alcohol abuse, medications, or fatty liver (steatosis). Steatosis is the accumulation of fats in liver cells, which can progress to hepatitis, cirrhosis, or cancer. Hepatoprotectives are agents that shield the liver from toxins. Specifically, Silymarin (found in Silybum marianum) works by stabilizing cell membranes against toxins, acting as an antioxidant to bind radicals, and stimulating protein synthesis for cell regeneration. It is used under medical supervision for cirrhosis and hepatitis. If signs of jaundice (yellow skin/eyes), light stool, or dark urine appear, immediate medical attention is necessary. Oral forms with standardized extracts are preferred over tea due to the poor water solubility of the active ingredients.
Travel sickness (motion sickness) is managed using antiemetics. The rhizome of Ginger (Zingiber officinale) is a prominent herbal remedy containing essential oils and pungent compounds that prevent nausea and vomiting. It is typically taken in oral pharmaceutical forms 0.5 to 1 hour before travel.
Cardiovascular Health: Hypertension and Lipids
Blood pressure is the force exerted by blood against arterial walls, with an optimal reading of . Hypertension is defined as sustained readings above . The higher number represents systolic pressure (cardiac contraction), and the lower represents diastolic pressure (cardiac rest). Hypertension is a key risk factor for atherosclerosis. Antihipertenzives like Hawthorn (Crataegus), Olive leaf (Olea europaea), and Garlic (Allium sativum) are used to lower blood pressure. Garlic also inhibits platelet aggregation; therefore, it must not be combined with anticoagulants or used before surgery.
Hyperlipidemia refers to elevated blood lipids, including cholesterol (hypercholesterolemia) and triglycerides (hypertriglyceridemia). Atherosclerosis is the buildup of these lipids in arterial walls, leading to narrowing or blockage, which can cause heart attack or stroke. Treatment includes Garlic, which inhibits the synthesis of lipids in the liver, and Psyllium, which binds cholesterol in the gut for excretion. Psyllium should be taken with meals and plenty of water, with effects appearing after several weeks.
Venous Health: Chronic Venous Insufficiency and Hemorrhoids
Chronic Venous Insufficiency (CVI) occurs when venous valves fail or the connective tissue weakens, causing blood to pool. Symptoms progress from ankle swelling (edema) and heavy legs to varicose veins and skin ulcers. Horse Chestnut (Aesculus hippocastanum) is the primary treatment, containing saponins like escin. It acts as an antiedemic by increasing venous tone and decreasing capillary permeability. Peroral treatment takes about 4 weeks to show results and is often long-term.
Hemorrhoids are dilated veins in the rectum or anus, often caused by the straining associated with chronic constipation. Treatment involves adstringents (Oak bark, Witch Hazel) to coagulate proteins, antiseptics to prevent infection, and antiphlogistics (Chamomile) to reduce inflammation. For hemorrhoids caused by constipation, bulking agents like Flax or Psyllium are indicated to soften the stool.
Dermatological Conditions: Inflammations and Infections
Skin inflammation can be caused by UV exposure, heat, chemicals, or allergic reactions. Signs include redness, pain, swelling, and itching. Phototoxic reactions occur when a substance in the skin reacts with UV light. Treatments include adstringents (Oak bark), emollients (Aloe gel) to protect the skin, and antiseptics (Tea tree oil). Antiphlogistics like Marigold (Calendula officinalis), Chamomile, and St. John's Wort are used to promote healing. However, St. John's Wort is highly phototoxic; patients must avoid UV light during use. Full baths are contraindicated for those with extensive skin injuries or acute infections.
Skin infections such as acne, boils, and fungal infections (athlete's foot) are often treated with Tea tree oil (Melaleuca) due to its antiseptic properties. For acne, which is a disease of the sebaceous glands, Tea tree oil helps manage inflammatory pustules. For fungal infections, it is applied topically via cotton or used in foot baths to prevent the infection from spreading to the nails.
Urinary and Reproductive Health
Urinary tract infections (UTIs) are primarily caused by Escherichia coli. Symptoms of cystitis include painful urination of small, cloudy amounts of urine, while symptoms of kidney infection (pyelonephritis) include flank pain, fever, and chills. Treatments include uroantiseptics like Bearberry (Arctostaphylos uva-ursi), which contains arbutin that metabolizes into hydroquinone; antiadhesives like Cranberry (Vaccinium macrocarpon), which prevent bacteria from sticking to the mucosa; and diuretics like Horsetail (Equisetum arvense), Birch (Betula), and Goldenrod (Solidago virgaurea). Bearberry should not be used for more than 1 week, and diuretics are contraindicated in patients with heart failure or chronic kidney disease where fluid intake must be restricted. Cranberries should be avoided by those with a history of kidney stones due to high oxalate content.
For women, Vitex agnus-castus is used to treat Premenstrual Syndrome (PMS) by regulating hormonal balance, though it shouldn't be combined with estrogen. For the climacteric (menopause), Black Cohosh (Cimicifuga racemosa) helps with hot flashes and mood swings, but usage is limited to 6 months due to potential liver risks. Men suffering from Benign Prostatic Hyperplasia (BPH)—a non-cancerous enlargement of the prostate—can use Nettle root (Urtica), Willowherb (Epilobium), Pumpkin seed (Cucurbita pepo), or Saw Palmetto (Serenoa repens). These herbs contain that relieve symptoms such as nocturia (nighttime urination) and weak flow. Saw Palmetto carries a bleeding risk and should be stopped before surgery.
Musculoskeletal and Nervous Systems
Muscle pain from overexertion or sprains (ligament damage) is treated with topical antiphlogistics like Comfrey (Symphytum officinale) and Arnica (Arnica montana). Comfrey contains allantoin to stimulate tissue repair but also toxic alkaloids; it is restricted to 10 days of topical use and never used in pregnancy. For rheumatic diseases like osteoarthritis or rheumatoid arthritis, Devil's Claw (Harpagophytum procumbens) provides systemic anti-inflammatory effects, while topical rubefacients like Pine oil, Eucalyptus oil, or Capsaicin (from peppers) increase local blood flow to relieve pain.
Cognitive health in dementia, a brain disease marked by memory loss, is supported by Ginkgo biloba. Ginkgo improves oxygen supply to the brain and acts as an antioxidant, though its antiplatelet effect makes it unsuitable for those on blood thinners. For tension, restlessness, and insomnia, sedatives (calming agents) and hypnotics (sleep aids) such as Valerian (Valeriana officinalis), Hops (Humulus lupulus), Passionflower (Passiflora incarnata), and Lemon Balm (Melissa officinalis) are used. Valerian requires 2-4 weeks of use for effect.
Stress exhaustion is managed with adaptogens, which increase resistance to stress. These include Rose Root (Rhodiola rosea), Ginseng (Panax ginseng), and Eleutherococcus. Conversely, stimulants like Caffeine-rich Guarana, Tea, or Mate temporarily increase performance but are contraindicated in those with hypertension or ulcers. Depression is treated with St. John's Wort as an antidepressant; however, it interferes with the metabolism of many other drugs by inducing liver enzymes and is phototoxic.
Respiratory Disorders: Colds and Coughs
Colds are viral infections of the upper respiratory tract. Prevention centers on immunostimulants like Echinacea, which boost macrophages and natural killer cells. Nasal congestion (rhinitis) is treated with decongestants like Peppermint oil, though it is avoided in children under 2 to prevent laryngeal spasms. Sore throats are managed with analgesics (Peppermint), antiphlogistics (Chamomile, Sage), and adstringents (Oak bark). Sage should be avoided in pregnancy due to thujone.
Coughs are classified as either dry or productive. Dry coughs are treated with emollients (mucilage-rich plants like Iceland Moss, Marshmallow root, and Plantain) that coat the throat to reduce irritation. Productive coughs require expectorants, categorized into essential oils (Thyme, Eucalyptus, Fennel) and saponins (Liquorice, Ivy, Primrose). Saponins work by irritating the stomach lining to trigger a reflex that increases airway secretions. Liquorice (Glycyrrhiza glabra) is contraindicated in hypertension and kidney disease because it causes sodium () and water retention and potassium () loss. Overdosing on Primrose or Ivy can cause gastric irritation and vomiting.