Editor's Note: The first part of this article was published in the 2019 March issue.
Clinical Observations
Clinically I have observed improvement in a wide range of presentations and their associated symptoms. The typical dose of sublingual oil is .5 - 1ml of organic whole plant hemp CBD oil at a concentration of 50 mg/ml, one to two times per day.
The most tangible positive effect is on the Heart shen, Heart qi and Liver qi. It is my observation that the oil regulates both Heart and Liver qi and in doing so it has a pronounced calming effect on the body as a whole. Mood and sleep improve within a week of beginning daily doses, anxiety lessens, and anger becomes more manageable. Another positive effect is on the Spleen qi. Most notable is that the oil appears to consolidate Spleen qi, in the sense that it grounds the Spleen (and Heart) qi. This leads to increased concentration and mental energy, which is a common, documented result of using whole plant hemp CBD oil, especially in cases of Attention Deficit Hyperactivity Disorder (ADHD).
Another positive action is the oils effect on yin and blood. Because CBD oil is a rich source of amino acids and naturally occurring nutrients including omega 3 fatty acids, vitamins A, C, and E, B complex vitamins, zinc, calcium, potassium, magnesium, phosphorus, iron, and beta-carotene, it directly benefits yin and blood. These nutrients are known to support overall health on many levels along with healthy tissue formation, and strong nails and hair – all of these relate directly to a healthy state of yin and blood.
And finally, the bitter taste, and strong anti-inflammatory action of whole plant CBD oil, along with its ability to settle anxiety, improve insomnia, generally settle the Heart and calm the shen, are clear indicators of the substances' heat clearing action. However, the bitter taste and cooling action does not have adverse effects on the Spleen and Stomach qi, which is wonderfully beneficial for its continual use.
The carrier oil must be considered and in this case the oil being discussed is in organic industrial hemp seed oil. The hemp seed has been used in Chinese herbal medicine for centuries, with its primary therapeutic effect being that it nourishes yin fluids, and moistens the bowel. Using the hemp seed oil without the seed retains the action of nourishing yin fluids, but lessens its effect of moistening the bowel directly. The seed itself plays a more direct role in moistening the bowel and stool, whereas the oil alone in nourishing to yin.
Contraindications & Pharmaceutical Interactions
As far as Chinese herbal medicine cautions, or contraindications it would appear there is none of the typical – digestive upset, yang rising, drying, cold, hot, or excessively tonifying for example. However, when using CBD in conjunction with pharmaceutical medication, herbal and supplement therapies the information below should be taken into consideration.
CBD with low (<.03 percent) levels of THC has very few, if any side effects at any dose. According to a World Health Organization (WHO) report published in November 2017, CBD has been found to have very low toxicity to humans and animals. Studies have failed to show any detrimental acute dosage associated with CBD use. The only cautions and side-effects appearing with higher concentrations of THC, which is not covered in this article.
CBD, when ingested, does have an impact on the liver's cytochrome P450 enzyme action and function. This enzyme is responsible for the metabolism of many compounds found in pharmaceuticals as well as CBD. If CBD occupies the site of the cytochrome P450 enzyme, then any pharmaceutical that requires that same process will not be metabolized as quickly (if at all), leading to potential higher blood concentrations of the medication. Researchers have recognized that this is very much dependent upon the amount of CBD ingested, the individual themselves, and whether the CBD is whole plant or in isolate form. Most research is performed using a CBD isolate rather than whole plant. Whole plant contains synergistic properties that may positively affect metabolism and interaction.
Dose does matter, but the cut-off dose has not been determined. A report from a 2013 clinical trial using Sativex, a product from GW Pharmaceuticals, found no interactions with the CYP450 enzymes when 40mg of a whole plant CBD sublingual spray was administered. However, a 2015 clinical trial designed to study the effects of using 25mg oral CBD as an adjuvant treatment to clobazam for children with refractory epilepsy, found when used together there were elevated serum clobazam levels. This report confirms the use of both compounds simultaneously, affects the metabolism of the anti-epileptic medication that employs the cytochrome P450 enzyme. The WHO report recognized the association between CBD, and the cytochrome P450 enzymatic process, but stated that at this time it is not clear whether these effects occur at physiological (normal) concentrations.
As a result of ingested CBD employing the cytochrome P450 enzyme and its potential effects on the function of that enzyme and its metabolism of other compounds that use the enzyme, anyone who takes the medications listed below should consult with the prescribing doctor or health care professional before beginning hemp CBD products. This is particularly important for those who wish to use or are using CBD isolate products. However, with sublingual administration of the CBD oil bypasses the digestive system and liver detoxification pathways.
Common medications that use the cytochrome P450 enzyme include:
- Anesthetics
- Angiotensin II blockers
- Anti-arrythmic medication
- Anti-diabetic medication
- Antibiotics
- Antihistamines
- Antidepressants
- Anti-epileptics
- Antipsychotics
- Antiretrovirals
- Benzodiazepines
- Beta blockers
- Blood thinning agents
- Calcium channel blockers
- Non-steroidal anti-inflammatory drugs
- Proton pump inhibitors
- Statin medication
Adverse interactions between hemp CBD and pharmaceuticals are rare however, those using or suggesting the use of hemp CBD must be cognizant of possible interactions. From the current information available, interactions may occur with extremely high doses of whole plant CBD or (especially) CBD isolate, used in conjunction with pharmaceuticals that have a narrow therapeutic range, and strong adverse side-effects and should be monitored closely or avoided. The ideal solution in these cases would be one in which the pharmaceutical use and dose is monitored during the introduction of hemp CBD to determine if a dose adjustment (of the pharmaceutical) is necessary.
References
- Bensky D, Clavey S, et al. Chinese Herbal Medicine: Materia Medica, Third Edition. Vista, CA: Eastland Press, 2004.
- Leinow L, Birnbaum J. CBD: A Patients Guide to Medicinal Cannabis-Healing without the High. New York: Penguin Random House, 2017.
- Scheid V, Bensky D, et al. Chinese herbal medicine: formulas & strategies, 2nd revised edition. Vista, CA: Eastland Press, 2009.
- CBD effects on Concentration and Focusing. 3 CBD Oil Side Effects, 2019.
- Fugh-Berman A, Wood S, et al. Medical Cannabis Adverse Effects. Department of Health: Government of the District of Columbia, 2019.
- Steffens S, Pacher P. Targeting canna-binoid receptor CB2 in cardiovascular disorders: promises and controversies. BJP, 2012.
- Geffrey AL, Pollack SF, et al. Drug Interaction between clobazam and cannabidiol in children with refractory epilepsy. Epilepsia, 2015 Aug;56(8):1246-51.
- Devitt-Lee A. CBD-Drug Interactions: Role of Cytochrome P450. Project CBD, 8 Sept 2015.
- Cannadibol (CBD) Pre-Review Report: Agenda item 5.2. World Health Organization (WHO), Nov 2017.
Christine Cannon received her education at the Colorado School of Traditional Chinese Medicine. She has been in clinical practice in Colorado and Hawaii since 1993, and provides Chinese herbal medicine, acupuncture, and dietary and lifestyle counseling in both the private practice and teaching clinic setting. Cannon completed two clinical internships in China, both with an emphasis on Chinese herbal medicine and received her clinical doctorate in acupuncture and Oriental medicine (DAOM) in 2014.