African serpentwood

Hypertension in a tense, agitated, sleepless patient who does better with a sedating than a stimulating approach, with blood pressure and mood monitored

Restless agitation with insomnia and a pounding heart, where a small, supervised dose is chosen over a pharmaceutical tranquilizer

Overview. Rauvolfia vomitoria is a shrub or small tree of the dogbane family found across tropical West and Central Africa. The root and root bark are the medicine; the species name refers to the vomiting produced by the bark at high dose. The root has among the highest reserpine contents in the genus and was a major commercial source of reserpine in the twentieth century. In African traditional medicine it is the classical remedy for madness, agitation and high blood pressure, and in the Western materia medica it sits beside Rauvolfia serpentina as a restricted alkaloid plant.

Clinical Notes. This is a drug plant and should be prescribed with the same seriousness as reserpine itself. The alkaloids deplete norepinephrine, dopamine and serotonin from nerve terminals, so blood pressure, heart rate and mood all fall together.

Conservation. Wild harvesting of roots for the reserpine trade has depleted some populations, and the species is protected or regulated in parts of its range; use cultivated or sustainably sourced material.