More Mosquito-Borne Diseases--Dengue, Chikungunya, Zika, and West Nile

Disclaimer.  I am not a licensed health practitioner.  This is just another post on an item you might wish to have available if needed so that a physician can treat you and your family as best as possible.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care.  A qualified, licensed physician or other medical provider should be consulted before beginning any herbal or conventional treatment.

A previous post covered the most common mosquito-borne disease that has historically affected us in the US, yellow fever.  But it doesn't get much coverage in the press and it's not currently a threat.  So people are far more concerned with Zika and West Nile.

Zika.  Most people bitten by mosquitoes carrying the Zika virus have no symptoms or only a mild form of the illness.  However, others have more serious cases and in pregnant women there is the threat of microcephaly developing in the unborn child.  Local transmissions of Zika virus occurred in Florida and Texas in 2016 and 2017.  The most common symptoms are fever, rash, joint pain, conjunctivitis, headache, and muscle pain, which can last several days to a week, and which are very similar to dengue and Chikungunya.  While most people do not become very ill, there are a small number of fatal cases.  The treatment is rest and fluids to prevent dehydration.  The CDC advises Tylenol for pain and fever and warns against taking aspirin.  Take the usual precautions when dealing with any bodily fluids. 

Chikungunya.  Most cases occur in Africa and Asia, with almost all cases among Americans originating in those visiting foreign countries.  While the CDC distribution map suggests that Chikungunya is found in the US, there was only one case in the American Caribbean islands in 2013. There was one locally acquired case in Texas in 2015.  There were twelve locally acquired cases in Florida in 2014.  The rest of the cases in the US were from travelers. Most people who become infected will develop symptoms three to seven days after being bitten.  The symptoms are very similar to dengue and Zika., with the most common symptoms being fever and joint pain.  Other symptoms include headache, muscle swelling, and a rash.  Most patients feel better within seven days, but for some, the joint pain persists for months.  Chikungunya is not often fatal, but the symptoms can be disabling and severe.  There is no vaccine to prevent the disease nor medicine to treat it.  Those most at risk for developing a severe case of the disease are newborns, those over 65, and those with high blood pressure, diabetes, or heart disease.  The CDC advises Tylenol for pain and fever and warns against using aspirin.

Dengue.  This tropical disease very rarely occurs in the US.  Local outbreaks have occurred in Hawaii, Texas, and Florida; the Aedes aegypti mosquitoes responsible for spreading dengue live below 35 degrees latitude and 3000 feet altitude.    Dengue is found in over 100 countries, and 40% of the world's population lives in areas at high risk for dengue.  Four to seven days after a bite, about 25% of individuals infected with dengue will become sick, and the disease can range from mild to severe.  About 5% of individuals will develop severe dengue.  Those most at risk for severe dengue are people who have had dengue in the past, infants, and pregnant women.  Symptoms of dengue include a sudden high fever plus any of the following:  nausea, vomiting, rash, aches and pains, especially behind the eye, and muscle and joint pain.   There is no vaccine and no medications beyond supportive care. Warning signs of severe dengue usually begin 24-48 hours after the fever has subsided and include belly pain and tenderness, vomiting (at least three times in 24 hours), bleeding from the nose or gums, vomiting blood or blood in the stool, and feeling tired, restless or irritable.  Severe dengue is a medical emergency.

West Nile.  This virus is transmitted to horses, people, and birds.  Unlike many of the other mosquito-borne diseases, WNV actually occurs in most of the US.  It usually causes no symptoms in 80% of people bitten; however, 20% will develop a fever with other symptoms of body aches, rash, nausea, vomiting, joint pain, headache, and/or diarrhea.  Severe illness with WNV can occur at any age, but the elderly are most at risk.    There have been 42,000+ cases of WNV in the US in the past 20 years.  Of these, 19,000 experienced neurological symptoms.  Just under ten percent of these people died.  West Nile virus is most commonly spread through mosquito bites, though it may also occur through blood transfusion or from mother to baby during pregnancy or through breast milk.  In about 1 in 150 patients, WNV can become life-threatening within a few hours and require hospitalization.  The development of encephalitis or meningitis includes the following symptoms:  high fever, headache, neck stiffness, stupor, disorientation, tremors, coma, vision loss, numbness, and paralysis.  About 10% of those who develop encephalitis or meningitis symptoms die.  Some effects to the central nervous system may be permanent. 

Japanese encephalitis.  This virus is transmitted by mosquito bites.  However, the virus does not replicate in sufficient numbers for person to mosquito to person infection to occur.  For this reason and because this disease does not occur in the US it will not be addressed here.  There is a vaccination for it for people traveling to Asia.


Links to related posts:
Book Review:  Herbal Antivirals
Catnip (mosquito repellent)
Permethrin (mosquito repellent and insecticide)

For further reading:
https://www.cdc.gov/niosh/topics/outdoor/mosquito-borne/default.html
https://www.health.state.mn.us/diseases/mosquitoborne/diseases.html
https://deteroutdoor.com/blog/5-dangerous-diseases-transmitted-mosquitoes/
https://portal.ct.gov/Mosquito/Diseases/Mosquito-Transmitted-Diseases
http://npic.orst.edu/pest/mosquito/index.html
http://npic.orst.edu/faq/mosqtrvl.html
https://www.cdc.gov/westnile/prevention/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fwestnile%2Ffaq%2Frepellent.html
https://www.cdc.gov/features/StopMosquitoes/
https://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_us.pdf
https://www.doomandbloom.net/dengue-fever-in-the-u-s/

 5 february 2020

Preventing Mosquito Bites

Disclaimer.  I am not a licensed health practitioner.  This is just another post on knowledge and understanding you might wish to acquire in advance of a disaster in case no higher care is available.  As long as our society is functioning, you should leave anything more substantial than applying a Band-Aid to the professionals.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care. 

Mosquitoes and the diseases they transmit truly are not much of a threat currently in the United States, even in more tropical locations.  Air-conditioning, functioning sanitation systems, and municipal spraying programs for killing mosquitoes have kept mosquito populations in check.

When things take a turn for the worse in our society, however, those niceties will slowly disappear.  Swimming pools, if not maintained, become breeding grounds for mosquitoes.  More time spent outdoors means more mosquito bites.  For most of us for most of our lives, mosquito bites have been an annoyance to be avoided if possible, but not something deadly, and the truth is that for most of us in the US, that will continue.  Mosquito bites will merely be an annoyance, especially as long as the cooler temperatures last.

But you never know.  An awful lot of people got stressed with the Zika hysteria just a few years ago.  We've been blessed to be spared from deadly mosquito-borne diseases.  That may not always be the case, however.  One-hundred-fifty years ago, the Deep South of the United States experienced a  particularly lethal strain of yellow fever.  In fact, Memphis was host to six major yellow fever epidemics throughout the 1800s.  In her book The American Plague, Molly Caldwell Crosby shares a particularly fascinating account of one of the deadliest epidemics in American history, the 1878 yellow fever epidemic, which killed over 30% of the population in Memphis alone.

In a grid-down scenario or economic collapse, could this bit of history repeat?

There are dozens of diseases transmitted by mosquitoes; most are found only in third-world tropical countries.  And the illnesses are managed quite differently, so each will have to be addressed in other articles.  Today's focus will be on preventing bites, and most of us are already familiar with that.  However, read on.  I'm willing to bet there is something for everyone to learn, and the two minutes it takes to read this post will be worth it even if it only prevents one bite.


TIPS FOR PREVENTING BITES

• Use mosquito repellents.  In the US, the Environmental Protection Agency advises using only EPA-approved repellents.  EPA-approved repellents display an EPA registration number.  No number=not approved.  Listed below are the EPA-approved mosquito repellents.  If your repellent does not have at least one of these ingredients, it's not approved.  And the higher the percentage, the longer-lasting each application and the more effective.  Supposedly.  
• DEET
• Picaridin
• oil of lemon eucalyptus (not for children under 3 years)
• IR3535
• 2-undecanone
• para-methane-diol
• Apply repellents properly.  If using sunscreen and mosquito repellent, apply the sunscreen first.   Also, mosquito repellent should only be applied to exposed skin, not under clothing.  Do not use on babies younger than two months.  Instead, cover babies well with clothing and protect them with mosquito netting over their cribs and strollers.
• Experiment now.  If you're going to use natural or DIY repellents, try them out now to determine whether they are effective for you--whether they will actually repel the mosquitoes in your area.  Some natural repellents may be species-specific in their efficacy.
• Treat clothing and gear with permethrin or buy permethrin-treated clothing.  The permethrin treatment, even if you DIY it, lasts through several washings.  Do not apply permethrin to the skin.  
• Wear light-colored clothing and cover the skin as much as possible.  Also, clothing with a tight weave, especially those made with synthetic fibers and anything with an SPF rating, can prevent mosquitoes from biting through your clothing. 
• Mosquito-proof your home.  
• Mosquitoes generally stay within 1-3 miles from where they hatched.  
• Remove standing water from around your home and any debris where they can lodge.
• Inside your home, keep a few fans running.  Have you ever noticed that mosquitoes disappear when the wind comes up?  Mosquitoes can't fly well in the wind.  So use a fan to your advantage and bring that wind indoors.  
• Repair all window and door screens. 

Some people are just genetically prone to attract mosquitoes, and there's nothing that can be done to change that.  My husband and two of my children are mosquito magnets, whereas mosquitoes usually totally ignore me.  However, taking the above steps will go a long way towards preventing bites and the resulting discomfort.  And if we can prevent bites now when they're only an annoyance, we'll be better prepared to prevent them when they could be transmitting disease.

Links to related posts:
Lice  
Scabies
Bedbugs
Permethrin
Ticks
Yellow Fever  

For further information:
https://www.cdc.gov/niosh/topics/outdoor/mosquito-borne/default.html
https://www.health.state.mn.us/diseases/mosquitoborne/diseases.html
https://deteroutdoor.com/blog/5-dangerous-diseases-transmitted-mosquitoes/
https://portal.ct.gov/Mosquito/Diseases/Mosquito-Transmitted-Diseases
http://npic.orst.edu/pest/mosquito/index.html
http://npic.orst.edu/faq/mosqtrvl.html
https://www.cdc.gov/westnile/prevention/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fwestnile%2Ffaq%2Frepellent.html
https://www.cdc.gov/features/StopMosquitoes/
https://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_us.pdf
https://www.prevention.com/health/g20513318/stop-mosquito-bites/

 3 february 2020

The Medicinal Uses of Passionflower and Passion Fruit

Passiflora spp.

I’ve quickly scrolled past any references to the medicinal uses of passionflower for years.  One quick look at that beauty tells you it belongs in a tropical climate with some humidity.  There is no way it’s going to do well in a high desert with a short growing season. 

Apparently I shouldn’t be so judgmental.

When I spotted the passionflower seeds at the feed store last week, I was really surprised.  After all, stores usually only carry seeds that will actually grow in the area.  So I took a look at the packet and was sufficiently suckered into bringing it home.  Since passionflower needs warmth to germinate, I started several seeds in a damp paper towel on the mantle.  I later put the rest of them out in the ground and we’ll see what we end up with.

But because it was still a little chilly, I decided I’d rather stay in bed and see what my herbal references had to say about passionflower.  I expected only two of them to mention it.  As a matter of fact, six of them cover the medicinal uses, and peer-reviewed journals address many more.

Before getting into the actual medicinal uses, it’s important to note that there are several species of passionflower.  Passiflora incarnata is what has been historically used for medicinal purposes.  Passiflora edulis is most commonly cultivated for commercial production of the passion fruit sold in grocery stores.  Researchers note that the medicinal effects may differ from one species to the next, though little research has been conducted on this aspect.[1]

Nutritional value.  Passion fruit is significant source of vitamins A, C, riboflavin, and niacin, as well as the minerals calcium, iron, copper, phosphorus, and potassium.[2]  The mineral content of the peels and seeds is particularly high.[3]

EFFECTIVE AGAINST

·       Bacteria

o   Gram-positive

§  Listeria monocytogenes[4]

§  Propionibacterium acnes[5]

o   Gram-negative

§  Escherichia coli[6]

·       Fungi

o   Aspergillus niger[7]

·       Viruses

o   Epstein-Barr[8]

PREPARATIONS

Infusion:  1-2 teaspoons of dried herb (no roots) boiled 5-10 minutes in 2 cups water.  Strain and use 3 times per day and before bed.[9]

Capsules:  1-2 350 mg capsules, 1-2 times per day.[10]

Tincture:  Fresh flowering herb is preferred, 1:2; dried herb 1:5; 50% alcohol.  Take ½-1½ teaspoons up to 4 times per day.[11]

USAGE

·       Cardiologic

o   Hypertension[12] [13] [14]

§  Fruit peel[15]

§  Peel tincture[16]

·       Gastrointestinal

o   Diarrhea[17]

o   Hemorrhoids[18]

o   Worms[19]

·       Neurological

o   ADHD[20]

o   Anxiety[21] [22] [23] [24]

§  Aerial parts[25]

o   Convulsions[26]

o   Depression

§  Aerial parts[27]

o   Headaches[28]

o   Insomnia[29] [30] [31] [32]

§  Aerial parts[33]

§  Vine infusion[34]

o   Nervous tension[35] [36]

o   Neuralgia[37]

·       Respiratory

o   Asthma[38]

§  Fruit peel extract[39]

o   Bronchitis[40]

·       Skin

o   Abscesses

§  Poultice[41]

o   Boils

§  Poultice[42]

o   Burns[43]

§  Poultice[44]

o   Wounds

§  Root infusion[45]

·       Urogenital

o   Dysmenorrhea[46]

o   Menopause[47]

·       Other

o   Alcohol withdrawal[48]

o   Anti-fatigue[49]

o   Memory improvement[50]

o   Morphine addiction[51]

o   Opioid addiction[52]

SYNERGISMS

Combines well with St. John’s wort if a stronger sedative is desired.[53]  Works well with valerian in resolving heart palpitations.[54]

CONTRAINDICATIONS

Not to be used during pregnancy.[55] [56] [57]  Not to be used for more than 2-3 weeks at a time.[58]  Not to be used with anti-coagulants.[59]

---

[1] Alexandre Fonseca, et al., Purple passion fruit (Passiflora edulis f. edulis): A comprehensive review on the nutritional value, phytochemical profile and associated health effects, Food Research International, Vol 160, 2022, https://www.sciencedirect.com/science/article/pii/S0963996922007232?via%3Dihub (accessed 15 May 2023).

[2] Alexandre Fonseca, et al., Purple passion fruit (Passiflora edulis f. edulis): A comprehensive review on the nutritional value, phytochemical profile and associated health effects, Food Research International, Vol 160, 2022, https://www.sciencedirect.com/science/article/pii/S0963996922007232?via%3Dihub (accessed 15 May 2023).

[3] Alexandre Fonseca, et al., Purple passion fruit (Passiflora edulis f. edulis): A comprehensive review on the nutritional value, phytochemical profile and associated health effects, Food Research International, Vol 160, 2022, https://www.sciencedirect.com/science/article/pii/S0963996922007232?via%3Dihub (accessed 15 May 2023).

[4] B. Ghada, B., et al., Recovery of Anthocyanins from Passion Fruit Epicarp for Food Colorants: Extraction Process Optimization and Evaluation of Bioactive Properties, Molecules, 2020, Vol 25, https://www.mdpi.com/1420-3049/25/14/3203 (accessed 15 May 2023).

[5] Nelva K Jusuf, et al., Antibacterial Activity of Passion Fruit Purple Variant (Passiflora edulis Sims var. edulis) Seeds Extract Against Propionibacterium acnes, Clinical, Cosmetic and Investigational Dermatology, 2020, Vol 13, https://www.tandfonline.com/doi/full/10.2147/CCID.S229743 (accessed 15 May 2023).

[6] B. Ghada, B., et al., Recovery of Anthocyanins from Passion Fruit Epicarp for Food Colorants: Extraction Process Optimization and Evaluation of Bioactive Properties, Molecules, 2020, Vol 25, https://www.mdpi.com/1420-3049/25/14/3203 (accessed 15 May 2023).

[7] B. Ghada, B., et al., Recovery of Anthocyanins from Passion Fruit Epicarp for Food Colorants: Extraction Process Optimization and Evaluation of Bioactive Properties, Molecules, 2020, Vol 25, https://www.mdpi.com/1420-3049/25/14/3203 (accessed 15 May 2023).

[8] Stephen Harrod Buhner, Herbal Antivirals, 2013, 112.

[9] Rebecca L. Johnson, Guide to Medicinal Herbs, 2010, 39.

[10] Rebecca L. Johnson, Guide to Medicinal Herbs, 2010, 39.

[11] Stephen Harrod Buhner, Herbal Antibiotics, 2012, 374.

[12] Sam Coffman, Herbal Medic, 2014, 276.

[13] Alexandre Fonseca, et al., Purple passion fruit (Passiflora edulis f. edulis): A comprehensive review on the nutritional value, phytochemical profile and associated health effects, Food Research International, Vol 160, 2022, https://www.sciencedirect.com/science/article/pii/S0963996922007232?via%3Dihub (accessed 15 May 2023).

[14] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[15] Ronald Ross Watson, , et al., Oral administration of the purple passion fruit peel extract reduces wheeze and cough and improves shortness of breath in adults with asthma, Nutrition Research, Vol 28 No 3, 2008, https://www.sciencedirect.com/science/article/abs/pii/S0271531708000183 (accessed 15 May 2023).

[16] Alexandre Fonseca, et al., Purple passion fruit (Passiflora edulis f. edulis): A comprehensive review on the nutritional value, phytochemical profile and associated health effects, Food Research International, Vol 160, 2022, https://www.sciencedirect.com/science/article/pii/S0963996922007232?via%3Dihub (accessed 15 May 2023).

[17] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[18] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[19] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[20] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[21] Sam Coffman, Herbal Medic, 2014, 276.

[22] Rebecca L. Johnson, Guide to Medicinal Herbs, 2010, 39.

[23] Alexandre Fonseca, et al., Purple passion fruit (Passiflora edulis f. edulis): A comprehensive review on the nutritional value, phytochemical profile and associated health effects, Food Research International, Vol 160, 2022, https://www.sciencedirect.com/science/article/pii/S0963996922007232?via%3Dihub (accessed 15 May 2023).

[24] Ronald Ross Watson, , et al., Oral administration of the purple passion fruit peel extract reduces wheeze and cough and improves shortness of breath in adults with asthma, Nutrition Research, Vol 28 No 3, 2008, https://www.sciencedirect.com/science/article/abs/pii/S0271531708000183 (accessed 15 May 2023).

[25] Alexandre Fonseca, et al., Purple passion fruit (Passiflora edulis f. edulis): A comprehensive review on the nutritional value, phytochemical profile and associated health effects, Food Research International, Vol 160, 2022, https://www.sciencedirect.com/science/article/pii/S0963996922007232?via%3Dihub (accessed 15 May 2023).

[26] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[27] Alexandre Fonseca, et al., Purple passion fruit (Passiflora edulis f. edulis): A comprehensive review on the nutritional value, phytochemical profile and associated health effects, Food Research International, Vol 160, 2022, https://www.sciencedirect.com/science/article/pii/S0963996922007232?via%3Dihub (accessed 15 May 2023).

[28] Sam Coffman, Herbal Medic, 2014, 276.

[29] Sam Coffman, Herbal Medic, 2014, 276.

[30] Alexandre Fonseca, et al., Purple passion fruit (Passiflora edulis f. edulis): A comprehensive review on the nutritional value, phytochemical profile and associated health effects, Food Research International, Vol 160, 2022, https://www.sciencedirect.com/science/article/pii/S0963996922007232?via%3Dihub (accessed 15 May 2023).

[31] Ronald Ross Watson, , et al., Oral administration of the purple passion fruit peel extract reduces wheeze and cough and improves shortness of breath in adults with asthma, Nutrition Research, Vol 28 No 3, 2008, https://www.sciencedirect.com/science/article/abs/pii/S0271531708000183 (accessed 15 May 2023).

[32] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[33] Alexandre Fonseca, et al., Purple passion fruit (Passiflora edulis f. edulis): A comprehensive review on the nutritional value, phytochemical profile and associated health effects, Food Research International, Vol 160, 2022, https://www.sciencedirect.com/science/article/pii/S0963996922007232?via%3Dihub (accessed 15 May 2023).

[34] Rebecca L. Johnson, Guide to Medicinal Herbs, 2010, 39.

[35] Rebecca L. Johnson, Guide to Medicinal Herbs, 2010, 39.

[36] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[37] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[38] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[39] Ronald Ross Watson, , et al., Oral administration of the purple passion fruit peel extract reduces wheeze and cough and improves shortness of breath in adults with asthma, Nutrition Research, Vol 28 No 3, 2008, https://www.sciencedirect.com/science/article/abs/pii/S0271531708000183 (accessed 15 May 2023).

[40] Ronald Ross Watson, , et al., Oral administration of the purple passion fruit peel extract reduces wheeze and cough and improves shortness of breath in adults with asthma, Nutrition Research, Vol 28 No 3, 2008, https://www.sciencedirect.com/science/article/abs/pii/S0271531708000183 (accessed 15 May 2023).

[41] Sam Coffman, Herbal Medic, 2014, 276.

[42] Sam Coffman, Herbal Medic, 2014, 276.

[43] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[44] Sam Coffman, Herbal Medic, 2014, 276.

[45] Rebecca L. Johnson, Guide to Medicinal Herbs, 2010, 39.

[46] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[47] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[48] RVA Schunck, et al., Standardized Passiflora incarnata L. Extract Reverts the Analgesia Induced by Alcohol Withdrawal in Rats, Phytotherapy Research, August 2017, Vol 31 No 8, https://pubmed.ncbi.nlm.nih.gov/28568647/ (accessed 15 May 2023).

[49] Min Hu, et al., Anti-fatigue activity of purified anthocyanins prepared from purple passion fruit (P. edulis Sim) epicarp in mice, Journal of Functional Foods, Vol 65, 2020, https://www.sciencedirect.com/science/article/pii/S1756464619306498 (accessed 15 May 2023).

[50] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[51] K Janda, et al., Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review, Nutrients, 19 December 2020, Vol 12 No 12, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766837/ (accessed 15 May 2023).

[52] L Izolan, et al.,  Sintocalmy, a Passiflora incarnata Based Herbal, Attenuates Morphine Withdrawal in Mice. Neurochemical Research, May 2021, Vol 46 No 5, https://pubmed.ncbi.nlm.nih.gov/33544325/ (accessed 15 May 2023).

[53] Charles W. Kane, Medicinal Plants of the Western Mountain States, 2017, 284.

[54] Charles W. Kane, Medicinal Plants of the Western Mountain States, 2017, 303.

[55] Sam Coffman, Herbal Medic, 2014, 276.

[56] Rebecca L. Johnson, Guide to Medicinal Herbs, 2010, 39.

[57] Z Ozturk, et al., Pregnancy outcomes in psychiatric patients treated with passiflora incarnate, Complementary Therapies in Medicine, February 2018, Vol 36, https://pubmed.ncbi.nlm.nih.gov/29458926/ (accessed 15 May 2023).

[58] Sam Coffman, Herbal Medic, 2014, 276.

[59] Rebecca L. Johnson, Guide to Medicinal Herbs, 2010, 39.