49-year-old female (Heron’s patient no. 1)

Multiherb tincture containing 8% chaparral,^d ≤ 32 mL taken over 3.5 mo; proposed as a treatment for allergies

Concurrent drug use: estrogens, progesterone, fluticasone nasal spray

Concurrent herbals use: numerous

Subject reported dizziness when 10 mL was taken at one time

General clinical history and physical examination findings were unremarkable; clinical lab tests were virtually unchanged, including serum liver enzymes, BUN, creatinine, glucose, electrolytes, bilirubin, iron ferritin, lipoproteins, and CBC; no elevations in liver function tests that would have indicated liver damage (Heron and Yarnell, 2001)

52-year-old female (Heron’s patient no. 2)

Multiherb tincture containing 8% chaparral, ≤ 240 mL taken over 5 mo; proposed as a treatment for respiratory symptoms of allergies

Concurrent medications: loratidine, clonazepam, zolpidem, valproic acid, thyroid hormone

Concomitant botanicals use: numerous

No elevations in liver function tests that would have indicated liver damage; changes in clinical laboratory values were likely related to concurrent medications; subject had chronic low WBC and platelet counts and low HDL cholesterol; TSH was high necessitating change in medication dose (Heron and Yarnell, 2001)

53-year-old male (Heron’s patient no. 3)

Multiherb tincture containing 7% chaparral, ≤ 34 mL taken over 40 d; proposed as treatment for painful axillary lymphadenopathy, which was later diagnosed as malignant melanoma, 5 mL, 1×/d

Recurrence: 5 combined mL tincture, 3×/d plus topical chaparral in castor oil

Clinical lab tests included serum liver enzymes, BUN, creatinine, glucose, electrolytes, bilirubin, iron ferritin, lipoproteins, and CBC

No elevations in blood levels of hepatic enzymes that would indicate liver damage

Subject’s clinical laboratory values did change in a manner consistent with the eventual diagnosis of malignant melanoma; the disease had metastasized (Heron and Yarnell, 2001)

51-year-old female (Heron’s patient no. 4)

Multiherb tinctures containing 10% chaparral, 5 mL, 3×/d, ≤ 138 mL taken over 3–4 mo; proposed as aid in weight-loss program

General clinical history and physical examination findings were unremarkable; clinical lab tests were virtually unchanged, including serum liver enzymes, BUN, creatinine, glucose, electrolytes, bilirubin, iron ferritin, lipoproteins, and CBC