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References - Herbal Support for Chronic Suboptimal Immune Function Associated with Stress and Fatigue

1. Thomsen M. Phytotherapy desk reference. 5th ed. 2020.

2. Singh N, Bhalla M, De Jager P, Gilca M. An overview on ashwagandha: a rasayana (rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med. 2011;8(5 Suppl):208-213. DOI: 10.4314/ajtcam.v8i5S.9

3. Bone K. The ultimate herbal compendium: a desktop guide for herbal prescribers. Warwick: Phytotherapy Press; 2007.

4. Bone K, Mills S. Principles and practice of phytotherapy: modern herbal medicine. 2nd ed. London: Churchill Livingstone; 2013.

5. Barrett B. Medicinal properties of Echinacea: a critical review. Phytomedicine. 2003 Jan;10(1):66-86. DOI: 10.1078/094471103321648692

6. Zheng Y, Ren W, Zhang L, Zhang Y, Liu D, Liu Y. A review of the pharmacological action of astragalus polysaccharide. Front Pharmacol. 2020;11:349. DOI: 10.3389/fphar.2020.00349

7. Liu P, Zhao H, Luo Y. Anti-aging implications of Astragalus membranaceus (huangqi): a well-known Chinese tonic. Aging Dis. 2017 Dec;8(6):868-886. DOI: 10.14336/AD.2017.0816

8. Hobbs C. Medicinal mushrooms: an exploration of tradition, healing, & culture. Summertown; Botanica Press; 1995.

9. Venturella G, Ferraro V, Cirlincione F, Gargano ML. Medicinal mushrooms: bioactive compounds, use, and clinical trials. Int J Mol Sci. 2021 Jan;22(2):634. DOI: 10.3390/ijms22020634

10. Marciano M, Vizniak N. Quick reference evidence informed botanical medicine: herbs, nutrition, hormones and medications. Vancouver: Professional Health Systems; 2018.

11. Paul S, Chakraborty S, Anand U, Dey S, Nandy S, Ghorai M, et al. Withania somnifera (L.) Dunal (ashwagandha): a comprehensive review on ethnopharmacology, pharmacotherapeutics, biomedicinal and toxicological aspects. Biomed Pharmacother. 2021 Nov;143:112175. DOI: 10.1016/j.biopha.2021.112175

12. Prabu PC, Panchapakesan S. Prenatal developmental toxicity evaluation of Withania somnifera root extract in Wistar rats. Drug Chem Toxicol. 2015 Jan;38(1):50-56. DOI: 10.3109/01480545.2014.900073

13. Complementary Medicines Australia [Internet]. Submission to the public Therapeutic Goods Administration Consultation: changes to permissible ingredients - low-negligible risk [updated 2019 Oct; cited 2022 Sep 15].

14. Foong SC, Tan ML, Foong WC, Marasco LA, Ho JJ, Ong JH. Oral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants (review). Cochrane Database Syst Rev. 2020;5:CD011505. DOI: 10.1002/14651858.CD011505.pub2

15. Yang Y, Tai Y, Fu Y. Postpartum hypogalactia modern treatment of traditional Chinese medicine. Curr Res Med Sci. 2023 Jun;2(2):95-102. DOI: 10.56397/CRMS.2023.06.13

16. Gardner Z, McGuffin M. American Herbal Products Association’s botanical safety handbook. 2nd ed. Boca Raton: CRC Press; 2013.

17. Singh N, Bhalla M, De Jager P, Marilena Gilca M. An overview on ashwagandha: a rasayana (rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med. 2011;8(5 Suppl):208-213. DOI: 10.4314/ajtcam.v8i5S.9

18. Katz M, Adar Levine A, Kol-Degani H, Kav-Venaki L. A compound herbal preparation (CHP) in the treatment of ADHD: a randomized controlled clinical trial. J Atten Disord. 2010;13(3):281-291. DOI: 10.1177/1087054709356388

19. Mishra RK, Trivedi R, Pandya MA. A clinical study of ashwagandha ghrita and ashwagandha granules for its brumhana and balya effect. Ayu. 2010 Jul-Sep;31(3):355-360. DOI: 10.4103/0974-8520.77164

20. Ogal M, Johnston SL, Klein P, Schoop R. Echinacea reduces antibiotic usage in children through respiratory tract infection prevention: a randomized, blinded, controlled clinical trial. Eur J Med Res. 2021 Apr;26(1):33. DOI: 10.1186/s40001-021-00499-6

21. Minetti AM, Forti S, Tassone G, Torretta S, Pignataro L. Efficacy of complex herbal compound of Echinacea angustifolia (Imoviral® Junior) in recurrent upper respiratory tract infections during pediatric age: preliminary results. Minerva Pediatr. 2011 Jun;63(3):177-182.

22. Saunders PR, Smith F, Schusky RW. Echinacea purpurea L. in children: safety, tolerability, compliance, and clinical effectiveness in upper respiratory tract infections. Can J Physiol Pharmacol. 2007 Nov;85(11):1195-1199. DOI: 10.1139/Y07-103

23. Cohen HA, Varsano I, Kahan E, Sarrell EM, Uziel Y. Effectiveness of an herbal preparation containing echinacea, propolis, and vitamin C in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled, multicenter study. Arch Pediatr Adolesc Med. 2004 Mar;158(3):217-221. DOI: 10.1001/archpedi.158.3.217

24. Parnham MJ. Benefit-risk assessment of the squeezed sap of the purple coneflower (Echinacea purpurea) for long-term oral immunostimulation. Phytomed. 1996;3(1):95-102. DOI: 10.1016/S0944-7113(96)80020-1

25. Hui X, Wang S, Lu S, Liu Y, Zhang ZP, Lian WJ, et al. Clinical effect of Astragalus membranaceus injection on viral myocarditis in children: an overview of systematic reviews and evidence mapping. Pharmacol Res. 2023 Sep;8:100270. DOI: 10.1016/j.prmcm.2023.100270

26. Zhang L, Wang X, Wang D, Guo Y, Zhou X, Yu H. Adjuvant treatment with yupingfeng granules for recurrent respiratory tract infections in children: a systematic review and meta-analysis. Front Pediatr. 2022 Dec;10:1005745. DOI: 10.3389/fped.2022.1005745

27. Wang W, Jing W, Liu Q. Astragalus oral solution ameliorates allergic asthma in children by regulating relative contents of CD4+CD25highCD127low Treg cells. Front Pediatr. 2018 Sep:6:255. DOI: 10.3389/fped.2018.00255

28. Lee D, Lee SH, Song J, Jee HJ, Cha SH, Chang GT. Effects of astragalus extract mixture HT042 on height growth in children with mild short stature: a multicenter randomized controlled trial. Phytother Res. 2017;32(1):49-57. DOI: 10.1002/ptr.5886

29. Su G, Chen X, Liu Z, Yang L, Zhang L, Stålsby Lundborg C, et al. Oral astragalus (huang qi) for preventing frequent episodes of acute respiratory tract infection in children. Cochrane Database Syst Rev. 2016;12:CD011958. DOI: 10.1002/14651858.CD011958.pub2

30. Zou C, Su G, Wu Y, Lu F, Mao W, Liu X. Astragalus in the prevention of upper respiratory tract infection in children with nephrotic syndrome: evidence-based clinical practice. Evid Based Complement Alternat Med. 2013;2013:352130. DOI: 10.1155/2013/352130

31. Chan WK, Lam DTW, Law HKW, Wong WT, Koo MWL, Lai ASY, et al. Ganoderma lucidum mycelium and spore extracts as natural adjuvants for immunotherapy. J Altern Complement Med. 2005 Dec;11(6):1047-1057. DOI: 10.1089/acm.2005.11.1047

32. Shing MK, Leung TF, Chu YL, Li CY, Chik KW, Leung PC, et al. Randomized, double-blind and placebo-controlled study of the immunomodulatory effects of Lingzhi in children with cancers. J Clin Oncol. 2008;26(15). DOI: 10.1200/jco.2008.26.15_suppl.14021

33. Henao SLD, Urrego SA, Cano AM, Hiuita EA. Randomized clinical trial for the evaluation of immune modulation by yoghurt enriched with β-glucans from lingzhi or reishi medicinal mushroom, Ganoderma lucidum (Agaricomycetes), in children from Medellin, Colombia. Int J Med Mushrooms. 2018;20(8):705-716. DOI: 10.1615/IntJMedMushrooms.2018026986

34. Majeed M, Nagabhushanam K, Murali A, Vishwanathan DT, Mamidala RV, Mundkur L. A standardized Withania somniferra (Linn.) root extract with piperine alleviates the symptoms of anxiety and depression by increasing serotonin levels: a double-blind, randomized, placebo-controlled study. J Integr Complement Med. 2023 Oct. DOI: 10.1089/jicm.2023.0279

35. Ibrahim M, Pawar G, Khan N, Gudalwar B, Khan S, Mazhar M. Therapeutic effect of Withania somnifera (ashwagandha) on depression: a comprehensive review. Natr Resour Human Health. 2024;1-10. DOI: 10.53365/nrfhh/177661

36. Siwek M, Woroń J, Wrzosek A, Gupało J, Chrobak AA. Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs. Front Pharmacol. 2023 Sep:14:1271776. DOI: 10.3389/fphar.2023.1271776

37. Elkhateeb WA, Daba GM, Elnahas MO, Thomas PW. Anticoagulant capacities of some medicinal mushrooms. RCH J Pharma Sci. 2019;5(3):1-9. DOI: 10.20431/2455-1538.0504001

38. Tao J, Feng KY. Experimental and clinical studies on inhibitory effect of Ganoderma lucidum on platelet aggregation. J Tongji Med Univ. 1990;10(4):240-243. DOI: 10.1007/BF02887938

39. Shulman S, Sharma S, Cracchiolo B, Shubhangi K, Sifonios A. Intraoperative bleeding associated with preoperative use of Ganoderma lucidum supplements. Open J Anesthesiol. 2014;4(6):46733. DOI: 10.4236/ojanes.2014.46018

40. Acar D, Gülpembe M, Akıllı NB, Çalık SG, Köylü R, Günaydın YK, et al. Melena associated with Ganoderma lucidum: a case report. JAEMCR 2015;6:7-9. DOI: 10.5152/jaemcr.2015.741

41. Manno ML, Montinaro AM. Suspected interaction of Ganoderma lucidum on warfarin therapy in hemodialysis patient. La Rivista Italian del Med di Lab. 2020 Dec;16(4):305-308. DOI: 10.23736/S1825-859X.20.00080-8

42. Chan SW, Tomlinson B, Chan P, Lam CWK. The beneficial effects of Ganoderma lucidum on cardiovascular and metabolic disease risk. Pharm Biol. 2021;59(1):1159-1169. DOI: 10.1080/13880209.2021.1969413

43. Mikulska P, Malinowska M, Ignacyk M, Szustowski P, Nowak J, Pesta K, et al. Ashwagandha (Withania somnifera)—current research on the health-promoting activities: a narrative review. Pharmaceuticals. 2023;15:1057. DOI: 10.3390/pharmaceutics15041057

44. Chea KL, Norhayati MN, Yaacob LH, Eahman RA. Effect of ashwagandha (Withania somnifera) extract on sleep: a systematic review and meta-analysis. PLoS One. 2021;16(9):e0257843. DOI: 10.1371/journal.pone.0257843

45. Langade D, Kanchi S, Salve J, Debnath K, Ambegaokar D. Efficacy and safety of ashwagandha (Withania somnifera) root extract in insomnia and anxiety: a double-blind, randomized, placebo-controlled study. Cureus. 2019 Sep;11(9):e5797. DOI: 10.7759/cureus.5797

46. Tandon N, Yadav SS. Safety and clinical effectiveness of Withania somnifera (Linn.) Dunal root in human ailments. J Ethnopharmacol. 2020 Jun:255:112768. DOI: 10.1016/j.jep.2020.112768

47. Gannon JM, Brar J, Rai A, Chengappa KNR. Effects of a standardized extract of Withania somnifera (ashwagandha) on depression and anxiety symptoms in persons with schizophrenia participating in a randomized, placebo-controlled clinical trial. Ann Clin Psychiatry. 2019;31(2):123-129.

48. Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012 Jul;34(3):255-262. DOI: 10.4103/0253-7176.106022

49. Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA. 2001 Jul;286(2):208-216. DOI: 10.1001/jama.286.2.208

50. Neuwirthová J, Urbánková P, Smilek P. Immunostimulatory and anticancer effect of reishi and coriol extracts at the level of clinical studies and their implementation in practice. Klin Onkol. 2020;33(6):426-434.

51. Milosavljevic A, Barnes J. Ganoderma lucidum. J Prim Health Care. 2023;15(3):290-292. DOI: 10.1071/HC23105

52. Sum SS-M, Ziegler J. Lingzhi and cordyceps: two commonly used Chinese medicinal herbs, safe or not? Nutr Clin Pract. 2016 Oct;31(5):695-697. DOI: 10.1177/0884533616662990.

53. Vaidya VG, Gothwad A, Ganun G, Girme A, Modi SJ, Hingorani L. Clinical safety and tolerability evaluation of Withania somnifera (L.) Dunal (ashwagandha) root extract in healthy human volunteers. J Ayurveda Integr Med. 2024 Jan-Feb;15(1):100859. DOI: 10.1016/j.jaim.2023.100859

54. Sharma AK, Basu I, Singh S. Efficacy and safety of ashwagandha root extract in subclinical hypothyroid patients: a double-blind, randomized placebo-controlled trial. J Altern Complement Med. 2018 Mar;24(3):243-248. DOI: 10.1089/acm.2017.0183

55. Gannon JM, Forrest PE, Chengappa KNR. Subtle changes in thyroid indices during a placebo-controlled study of an extract of Withania somnifera in persons with bipolar disorder. J Ayurveda Integr Med. 2014 Oct-Dec;5(4):241-245. DOI: 10.4103/0975-9476.146566

56. Hayashi M, Hamada H, Azuma S-I, Hayashi K. Painless thyroiditis by Withania somnifera (ashwagandha). Cureus. 2024;16(3):e55352. DOI: 10.7759/cureus.55352

57. Kamal HI, Patel K, Brdak A, Heffernan J, Ahmad N. Ashwagandha as a unique cause of thyrotoxicosis presenting with supraventricular tachycardia. Cureus. 2022 Mar;14(3):e23494. DOI: 10.7759/cureus.23494

58. Curry KM, McNeil LE, Flores A, Fuks J. Thyrotoxicosis with ashwagandha: a case report. Soc Sci Res Net. 2019 Dec. DOI: 10.2139/ssrn.3506409

59. Van Der Hooft CS, Hoekstra A, Winter A, De Smet PAG, Ch Stricker BH. [Thyrotoxicosis following the use of ashwagandha]. Ned Tijdschr Geneeskd. 2005 Nov;149(47):2637-2638.

60. Denisow-Pietrzyk M, Pietrzyk Ł, Denisow B. Asteraceae species as potential environmental factors of allergy. Environ Sci Pollut Res Int. 2019;26(7):6290-6300.

61. Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Ann Allergy Asthma Immunol. 2002;88(1):42-51. DOI: 10.1016/S1081-1206(10)63591-0

62. Kakanovic S, George S, Topham E. Don’t miss shiitake dermatitis: a case report. Br J Gen Pract. 2014 Aug;64(625):426-427. DOI: 10.3399/bjgp14X681193

63. Hérault M, Waton J, Bursztejn AC, Schmutz JL, Barbaud A. [Shiitake dermatitis now occurs in France]. Ann Dermatol Venereol. 2010 Apr;137(4):290-293. DOI: 10.1016/j.annder.2010.02.007

64. Pole S. Ayurvedic medicine: the principles of traditional practice. Philadelphia: Churchill Livingstone; 2006.

65. Bani S, Gautam M, Sheikh FA, Khan B, Satti NK, Suri KA, et al. Selective Th1 up-regulating activity of Withania somnifera aqueous extract in an experimental system using flow cytometry. J Ethnopharmacol. 2006 Aug 11;107(1):107-115. DOI: 10.1016/j.jep.2006.02.016

66. Khan B, Ahmad SF, Bani S, Kaul A, Suri KA, Satti NK, et al. Augmentation and proliferation of T lymphocytes and Th-1 cytokines by Withania somnifera in stressed mice. Int Immunopharmacol. 2006 Sep;6(9):1394-1403. DOI: 10.1016/j.intimp.2006.04.001

67. Sun LZ, Currier NL, Miller SC. The American coneflower: a prophylactic role involving nonspecific immunity. J Altern Complement Med. 1999 Oct;5(5):437-446. DOI: 10.1089/acm.1999.5.437

68. Park S, Lee MS, Jung S, Lee S, Kwon O, Kreuter MH, et al. Echinacea purpurea protects against restraint stress-induced immunosuppression in BALB/c mice. J Med Food. 2018 Mar;21(3):261-268. DOI: 10.1089/jmf.2017.4073

69. Groom SN, Johns T, Oldfield PR. The potency of immunomodulatory herbs may be primarily dependent upon macrophage activation. J Med Food. 2007 Mar;10(1):73-79. DOI: 10.1089/jmf.2006.233

70. Gertsch J, Schoop R, Kuenzle U, Suter A. Echinacea alkylamides modulate TNF-alpha gene expression via cannabinoid receptor CB2 and multiple signal transduction pathways. FEBS Lett. 2004 Nov;577(3):563-569. DOI: 10.1016/j.febslet.2004.10.064

71. Liu WH, Zhang JZ, Liu SJ, Qiu HN, Guo JX, Liu B. [Effect of radix astragali drug serum on NK cell activity and expression of KLRK1]. Prog Mod Biomed. 2014;14(24):4637-4640.

72. Ning KJ, Ruan XC, Lu JF, Cheng YX. [Effects of Huangqi on phagocytic activity of peritoneal macrophage of mice]. Zhongguo Zhong Yao Za Zhi. 2005 Nov;30(21):1670-1672.

73. Park HJ, Kim HY, Yoon KH, Kim KS, Shim I. The effects of Astragalus membranaceus on repeated restraint stress-induced biochemical and behavioral responses. Korean J Physiol Pharmacol. 2009 Aug;13(4):315-319. DOI: 10.4196/kjpp.2009.13.4.315

74. Wachtel-Galor S, Benzie IFF. Ganoderma lucidum (lingzhi or reishi): a medicinal mushroom. In: Benzie IFF, Wachtel-Galor S, editors. Herbal medicine: biomolecular and clinical aspects. 2nd ed. Boca Raton: CRC Press/Taylor & Francis; 2011. Chapter 9.

75. Braun L, Cohen M. Herbs & natural supplements, volume 2: an evidence-based guide. 4th ed. Sydney: Churchill Livingstone; 2015.

76. Natural Medicines Database [Internet]. Denver CO: TRC Healthcare; 2023. Reishi mushroom; 2022 Aug [cited 2023 Sep 1]. Available from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=905

77. Mikolai J, Erlandsen A, Murison A, Brown KA, Gregory WL, Raman-Caplan P, et al. In vivo effects of ashwagandha (Withania somnifera) extract on the activation of lymphocytes. J Altern Complement Med. 2009 Apr;15(4):423-430. DOI: 10.1089/acm.2008.0215

78. Salve J, Pate S, Debnath K, Langade D. Adaptogenic and anxiolytic effects of ashwagandha root extract in healthy adults: a double-blind, randomized, placebo-controlled clinical study. Cureus. 2019 Dec;11(12):e6466. DOI: 10.7759/cureus.6466

79. Choudhary D, Bhattacharyya S, Joshi K. Body weight management in adults under chronic stress through treatment with ashwagandha root extract: a double-blind, randomized, placebo-controlled trial. J Evid Based Complementary Altern Med. 2017 Jan;22(1):96-106. DOI: 10.1177/2156587216641830

80. Schapowal A, Klein P, Johnston SL. Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials. Adv Ther. 2015 Mar;32(3):187-200. DOI: 10.1007/s12325-015-0194-4

81. Abdel-Naby Awad OG. Echinacea can help with azithromycin in prevention of recurrent tonsillitis in children. Am J Otolaryngol. 2020 Jul-Aug;41(4):102344. DOI: 10.1016/j.amjoto.2019.102344

82. Tiralongo E, Lea RA, Wee SS, Hanna MM, Griffiths LR. Randomised, double blind, placebo-controlled trial of echinacea supplementation in air travellers. Evid Based Complement Alternat Med. 2012;2012:417267. DOI: 10.1155/2012/417267

83. Ritchie MR, Gertsch J, Klein P, Schoop R. Effects of Echinaforce® treatment on ex vivo-stimulated blood cells. Phytomedicine. 2011 Jul;18(10):826-831. DOI: 10.1016/j.phymed.2011.05.011

84. Agnew LL, Guffogg SP, Matthias A, Lehmann RP, Bone KM, Watson K. Echinacea intake induces an immune response through altered expression of leucocyte hsp70, increased white cell counts and improved erythrocyte antioxidant defences. J Clin Pharm Ther. 2005 Aug;30(4):363-369. DOI: 10.1111/j.1365-2710.2005.00658.x

85. Brush J, Mendenhall E, Guggenheim A, Chan T, Connelly E, Soumyanath A, et al. The effect of Echinacea purpurea, Astragalus membranaceus and Glycyrrhiza glabra on CD69 expression and immune cell activation in humans. Phytother Res. 2006 Aug;20(8):687-695. DOI: 10.1002/ptr.1938

86. Zwickey H, Brush J, Iacullo CM, Connelly E, Gregory WL, Soumyanath A, et al. The effect of Echinacea purpurea, Astragalus membranaceus and Glycyrrhiza glabra on CD25 expression in humans: a pilot study. Phytother Res. 2007 Nov;21(11):1109-1112. DOI: 10.1002/ptr.2207

87. Weng XS. [Treatment of leucopenia with pure Astragalus preparation-- an analysis of 115 leucopenic cases]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1995 Aug;15(8):462-464.

88. Hou YD, Ma GL, Wu SH, Li YY, Li HT. Effect of radix astragali seu hedysari on the interferon system. Chin Med J (Engl). 1981 Jan;94(1):35-40.

89. Latour E, Arlet J, Latour EE, Juszkiewicz A, Łuczkowska K, Marcinkiewicz A, et al. Standardized astragalus extract for attenuation of the immunosuppression induced by strenuous physical exercise: randomized controlled trial. J Int Soc Sports Nutr. 2021 Jul;18(1):57. DOI: 10.1186/s12970-021-00425-5

90. Dai X, Stanilka JM, Rowe CA, Esteves EA, Nieves C, Spaiser SJ, et al. Consuming Lentinula edodes (shiitake) mushrooms daily improves human immunity: a randomized dietary intervention in healthy young adults. J Am Coll Nutr. 2015;34(6):478-487. DOI: 10.1080/07315724.2014.950391

91. Chen SN, Nan FH, Liu MW, Yang MF, Chang YC, Chen S. Evaluation of immune modulation by β-1,3; 1,6 D-glucan derived from Ganoderma lucidum in healthy adult volunteers, a randomized controlled trial. Foods. 2023 Feb;12(3):659. DOI: 10.3390/foods12030659

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