The "Best Of The Best" Herbs (4)

2001 Alan Keith Tillotson

Understanding Herbs

LICORICE ROOT

Latin: Glycyrrhiza glabra

Sanskrit: Madhukam

Chinese: Gan cao, Zhi gan cao

WHAT IT DOES: Licorice root is sweet in taste and cooling in action. It detoxifies poisons from the blood and liver, and reduces general inflammation and pain. It moistens and heals the lungs and digestive tract.

RATING: Silver

SAFETY ISSUES: Do not use during pregnancy. Do not use high doses or for a prolonged period of time unless under the care of a qualified health care practitioner. Use cautiously with kidney disease, liver disorders, or if taking thiazide diuretics, cortisone or cardiac glycosides. Licorice prolongs the half-life of cortisone. *The DGL form of licorice is free of side effects.

STARTING DOSAGE:

• Crude powder: one to three grams three times per day, up to six weeks

• Concentrated 4:1 granules: 150-250 mg. three times per day

Licorice root is one of the most widely used herbs in the world. Every major medical tradition uses it as medicine, usually describing its effects as cooling and tonifying. TCM doctors use it in two forms. Regular licorice root is considered to have an intrinsic harmonizing effect useful for reducing side effects from large combinations of other potent herbs, and for disguising their bitter or acrid flavors. Licorice is said to strengthen the digestion and the hormonal systems and moisten the lungs. TCM doctors also use a honey-fried form to warm digestion when indicated. TAM doctors use licorice root to reduce the pain of sore throat and ulcers, to subdue poisons, and as a major ingredient in cough syrups.

Almost 50 years ago, a scientist by the name of Revers reported that licorice paste reduced abdominal symptoms and caused radiographic evidence of ulcer healing. However, about 20% of patients developed edema, headache and other symptoms due to overdose, leading to a loss of enthusiasm (Schambelan, 1994). This led to the development of DGL (deglycyrrhizinated licorice), a form of licorice that does not contain the agents responsible for the side effects. The de-acidified DGL tablet or capsule form used in Europe and America seems devoid of any side effects, and is effective for healing the intestinal membranes.

Paul Bergner, editor of Medical Herbalism, wrote an article citing recent Japanese and Chinese research highlighting the numerous positive and protective effects licorice root exerts on the liver. Its anti-hepatotoxic effects make it useful in treating chronic hepatitis and possibly cirrhosis. Licorice root contains plant (phyto) estrogens similar to those found in soy (Zava et al., 1998), and has an estrogen-like effect, binding strongly to estrogen receptors. This makes it a good treatment for easing hot flashes, though I would do this only at recommended doses in a formula with other herbs.

Many patients express concerns about using licorice because they have seen negative press coverage of this herb. It is important to understand that these reported concerns are dose-related. Licorice is traditionally used as approximately five percent of a formula, and that is what I usually do with it. If a patient takes the typical six to nine grams of concentrated 4:1 powder per day, this works out to about 1.2-1.8 grams of licorice, well within recommended dosage levels. Personally, I've never seen any of the potassium depletion and sodium retention effects described in the literature, and the pharmacologists I've consulted with assure me that such effects are rare, and easily reversible simply by stopping use.

The various components of licorice root act in a number of different ways in the test tube, on animals and on humans. It is important to keep in mind that specific results of scientific studies, such as the ones listed below, often relate to particular components of licorice. By examining these various reports you will be able to see the general pattern of cooling and detoxification noted by ancient doctors.

Research highlights

• We now know that the negative effects of licorice overdose, such as blood pressure elevation and fluid retention, are caused primarily by its dose-dependent inhibition of a specific enzyme called 11-HSD. Analysis reveals that this inhibition occurs only after multiple doses of 1.5 grams per day of pure glycyrrhizic acid. Daily doses of 500 mg. or less cause little or no problem (Krahenbuhl et al., 1994, Heilmann et al., 1999, White et al., 1997). In other words, licorice root is safe when used in proper dosage.

• According to several studies, DGL licorice is a very effective ulcer treatment (Morgan et al., 1985, Morgan et al., 1982, Morgan et al., 1987, Russell et al., 1984, Tewari and Wilson, 1973).

• Glycyrrhizin is a major anti-inflammatory compound found in licorice. Its antiinflammatory action is due in part to the selective inhibition of thrombin (a clotting factor), which results in the removal of blood congestion. Glycyrrhizin was the first such compound to be isolated from a plant (Francischetti et al., 1997)

• Glycyrrhizic acid, a component of licorice roots, was found to inhibit the growth and cytopathology of several unrelated DNA and RNA viruses without affecting cell activity and ability to replicate. Glycyrrhizic acid irreversibly inactivates herpes simplex virus particles (Pompei et al., 1979). For this reason, licorice tincture or paste can be applied directly to lesions.

• In animal studies, licorice root has been shown to enhance liver detoxification of poisons, causing significant increases in liver and urinary excretion of acetaminophen (Moon and Kim, 1997).

• The complex sugars found in licorice root and many other herbs stimulate macrophages (immune cells), but some scientists have expressed concerns that the effects seen in laboratory experiments might have been overstated and due solely or in part to bacterial contamination. However, additional studies determined that macrophage stimulation by licorice root still occurred in plants grown in aseptic conditions (Nose et al., 1998).

• A compound in licorice root called beta-glycyrrhetinic acid has been identified as a potent inhibitor of a certain cascade of inflammatory immune system chemicals (Kroes et al., 1997).

• Licorice extract, along with glutathione and the bioflavonoids, belongs to a class of substances known as "desmutagens." Scientists Kada and Shimoi categorized these molecules according to their unique ability to bind to toxic chemicals and cancercausing agents (Shankel et al., 1993).

• DGL can be used as a mouthwash for small mouth ulcers (Das et al., 1989), and may reduce stomach bleeding caused by aspirin (Rees et al., 1979)

• Licorice alcohol extract contains a subclass of polyphenol flavonoids called isoflavones that may reduce the negative effects of LDL cholesterol, and reduce atherosclerotic lesion areas in mice (Fuhrman et al., 1997, Aviram, 1996). This effect was later shown to be similar to that of the bioflavonoid quercetin (Belinky et al., 1998).

• Licorice root has an effect on corticosteroid metabolism that links it to certain receptors in the brain and may eventually lead to applications in studies of mood, neuronal survival, and feedback related to blood pressure. Researchers hope to develop useful means to target specific action sites on the brain (Seckl, 1997).

• A licorice root extract, mostly glycyrrhizin (a saponin extracted from licorice) has been shown pharmacologically to stimulate interferon (Eisenburg, 1992), suggesting that a combination might be more effective than either along. A clinical test on humans showed results for hepatitis C (a reduction in viral load and ALT), but results failed to achieve significance (Abe et al., 1994).

LONG PEPPER

Latin: Piper longum

Sanskrit: Pippali

WHAT IT DOES: Long pepper is pungent in taste and hot in action, and tonic. It improves appetite and digestion, helps control coughs and asthma, and increases absorption of other nutrients and herbs

RATING: Silver, as it contains both tonic effects as well as some restrictions

SAFETY ISSUES: Use cautiously with stomach weakness or hyperacidity. Do not use continuously in high dose for longer than two weeks. Low dosage (as a spice) is safe for long term use.

STARTING DOSAGE:

• Dried powder: 200-mg concentration, one and-a-half grams two to three times per day (larger amounts--up to 30 grams per day--may be used if cooked for two hours)

Long pepper is an interesting medicine. It is one of three parts of the famous Ayurvedic digestive formula called trikatu (the other two are black pepper and ginger root). Long pepper is pungent and stimulating to the appetite, and can be added to the diet to improve nutrient absorption. TAM doctors use it for bronchitis, asthma, cough and fever, and to stimulate the medicinal effects of other herbs.

Scientific attention has focused on piperine, an alkaloid found in long pepper and black pepper, which stimulates an enzyme that promotes amino acid uptake from the digestive tract and increases heat in the GI tract. Piperine appears to increase blood concentrations of turmeric root (Shoba et al., 1998). Therefore, instead of using the more expensive and perhaps slightly dangerous turmeric extract called curcumin, all you may need to do is add either of the peppers to ordinary turmeric root, about 5% by weight, for short periods of time (perhaps a few weeks at most).

Numerous studies of long pepper show blood levels of various vitamins and nutrients to increase by as much as 30% when ingested concurrently. Nonetheless, I do not recommend long-term continual use due to the herb’s strongly spicy quality. Atal (1985) estimated that the inhibition effect lasts only 1-6 hours in animals, and this makes it very useful with ingested nutrients. However, if long pepper is taken continuously or in excess, it could also keep toxic molecules from being metabolized and excreted. I add long pepper or trikatu to herbal formulas for short periods of use to aid digestion when weak, especially if the patient has signs of mucous. TAM doctors report that long pepper reduces colic pain and mucus, and can be used for cough and asthma. It stimulates the medicinal effects of other herbs. Unlike black pepper, long pepper is reputed to have tonic qualities--good for long life.

Research highlights

• Piperine has an affinity for fatty tissue, where it interacts with the cell membranes. Its components are absorbed very quickly across the intestinal barrier, increasing permeability (Johri et al., 1992), so researchers theorize that it attaches to various molecules and helps them across (Khajuria et al., 1998).

• Piperine’s most important action may be the inhibition of liver and intestinal glucuronidation, which allows molecules to flow into the blood without being excreted (Atal et al., 1985).

• Especially interesting to me was one study published in Planta Medica showing how piperine dramatically increased blood concentrations of turmeric root, one of my favorite anti-inflammatories (Shoba et al., 1998).

• Long pepper also has some mild liver-protective activity (Koul and Kapil, 1993).

MAITAKE MUSHROOM

Latin: Grifola frondosa

Japanese: Mushikusa

English: Hen-of-the-Woods

WHAT IT DOES: Maitake Mushroom is sweet in taste and neutral in energy. It is a nourishing adaptogenic tonic that helps nourish the immune system and identify, target and destroy invaders, including cancer cells.

RATING: Gold

SAFETY ISSUES: None known

STARTING DOSAGE:

• Fresh mushroom: one-half cup cooked, two to three times per week

• Dried fruiting body capsules: two 500-mg capsules two to three times per day.

• Extract tincture (one gram mushroom = 30 drops): 15-30 drops two to three times per day

• Proprietary D-fraction liquid: five to 25 drops two times per day.

Maitake mushrooms are a wonderful food tonic, illustrating Nature's ability to harness her magic. They have been harvested in Eastern North America for years and sold to restaurants as a delicacy. The Japanese retrieve them from the mountains of Northeast Japan. Now that they are becoming available commercially as foods, make sure to include them in your diet. When eaten whole, they tonify the body, increase energy, keep the immune system healthy, and increase longevity. We use maitake extracts as a staple in our treatment of immune-compromised cancer patients. The extracts contain high levels of beta-glucan, a well-researched immune system activating agent.

Research highlights

• Extracts from maitake show anti-tumor action by directly activating various immune system components, including macrophages, complement, cytokines, natural killer (NK) cells, and tumor necrosis factor (Borchers et al., 1999; Nanba et al., 1997; Kurashige et al., 1997).

• Beta-glucan seems to override the normal resistance of tumor cells to the cytotoxic activation of phagocytes and NK cells. This allows the complement part of the immune system to function against tumor cells in the same way that it normally functions against bacteria and yeast (Kubo et al., 1999).

• Maitake mushroom has demonstrated an ability to alter fat metabolism in animal studies by inhibiting both the accumulation of liver lipids and the elevation of serum lipids (Kubo et al., 1996).

• The fruiting body of maitake was confirmed to contain substances that exhibit antidiabetic activity, as illustrated by its ability to lower blood glucose levels (Kubo et al., 1994).

• Feeding studies show that maitake mushroom can lower blood pressure in hypertensive rats (Kabir and Kimura, 1989).

• It is important to note that despite the similarities of the anti-cancer substances (including glucans) found in various mushrooms, they differ in their effectiveness against specific tumors and in their ability to elicit immune responses (Borchers et al., 1999).

MILK THISTLE SEED

Latin: Silybum marianum

WHAT IT DOES: Milk thistle seed is sweet in taste and cooling in action. It strongly protects, repairs and nourishes the liver, stomach and intestines.

RATING: Silver

SAFETY ISSUES: Milk thistle may speed clearance of pharmaceutical drugs. Use cautiously (consult your physician) if taking drugs which require adequate blood levels, such as cardiac glycosides or cyclosporine.

STARTING DOSAGE:

• Concentrated standardized silymarin capsules (70-210 mg): one to two pills, two to three times per day

• 1:5 Tincture: 20-40 drops three times per day

Milk thistle is a true liver tonic, useful for treating numerous liver and gall bladder conditions including hepatitis and cirrhosis. Milk thistle seeds are especially useful whenever chemicals, alcohol, chemotherapy, or medicines compromise the liver. It reverses toxic liver damage and protects against hepatotoxic agents, including the deathcap toadstool. (Amanita phalloides) It is used for this purpose in European hospitals. It also stimulates protein synthesis in the liver, helping with the formation and growth of healthy new liver cells by selectively inhibiting certain inflammatory chemicals in liver cells (Thamsborg et al., 1996). At our clinic, I like to combine milk thistle seed with dandelion root and turmeric root to create a simple liver tonic which heals, repairs, detoxifies and gently stimulates the liver.

When I was growing up in the 1950's and 60's, it was commonly believed among Western physicians that nothing could repair a severely damaged liver. This changed with the emergence of milk thistle. However, in TAM and TCM there are numerous liver herbs, some perhaps stronger than milk thistle, and there is a wide breadth of knowledge concerning how to use them to benefit the liver.

The benefits of milk thistle and other liver agents were well known by the Eclectic physicians. Dr. Finley Elingwood's 1919 classic, American Materia Medica, Therapeutics and Pharmacognosy, describes in detail how milk thistle improves "general bilious conditions" such as jaundice, hepatic pain and swelling. The Eclectics also used it to treat congestion in the spleen, kidneys and veins. Its range of action is very wide.

Research highlights

• Milk thistle "has been shown to have clinical applications in the treatment of toxic hepatitis, fatty liver, cirrhosis, ischemic injury, radiation toxicity, and viral hepatitis via its anti-oxidative, anti-lipid peroxidative, antifibrotic, anti-inflammatory, immuno-modulating, and liver regenerating effects" (Luper, 1998).

• In a unique application of this herb, Russian scientists have studied the addition of milk thistle to bread to observe its effects on health and metabolism. They reported that the addition of silybum marianum to bread products exerted a general restorative influence, increasing internal protection resources, capacity for work and vital activity (Gil'miiarov et al., 1998).

• In a double-blind study examining patients with liver cirrhosis due to alcohol, after five years there were almost three times as many deaths in the control group as in the group taking milk thistle (Benda et. al, 1980). A later study illustrated similar results (Ferenci P et al., 1989).

• In a model designed to examine the effect of alcohol on pregnant women, a group of rat pups that received a diet consisting of 35% ethanol exhibit marked mental deficits, including poor social memory. The group that received silymarin in addition to the ethanol scored much better, indicating a protective effect (Reid C et al., 1999).

• Because it contains polyphenolic antioxidants, milk thistle may also have potential as a cancer preventative agent (Zhao et al., 1999). Noting that most antioxidants afford protection against tumor promotion, in a complex study measuring several parameters, researchers reported the protective effect of silymarin on tumor promotion, indicating that it exhibited highly protective effects against tumor promotion (Lahiri-Chatterjee et al., 1999).

• Milk thistle was found to have an anti-cancer effect on both breast and prostate cancer (Zi X et al., 1998). It also protects the kidneys against toxicity from the chemotherapeutic agent cisplatin in animal models, without reducing its effectiveness against cancer (Bokemeyer et al., 1996, Gaedeke et al., 1996). It also protects against the kidney toxicity of cyclosporine, an anti-rejection drug (Zima. et al., 1998).

• Studies have also shown a protective effect of silymarin on stomach and intestinal membranes (Alarcon de la Lastra et al., 1995). This may be due to a selective increase in total glutathione content in the liver, intestine and stomach found in animal studies (Valenzuela A et al., 1989).

MILKY OAT SEED

Latin: Avena sativa

 WHAT IT DOES: Milky oat seed is sweet in taste, and mildly stimulating and cooling in action. It restores strength to the nervous system when exhausted, and reduces craving for tobacco and drugs.

RATING: Gold

SAFETY ISSUES: none known

STARTING DOSAGE: • Tincture (1:2): 20-40 drops three to four times per day

Milky oat seed is a mild but reliable remedy for strengthening the entire nervous system after periods of prolonged stress. The seed is harvested when it becomes milky. Growers must squeeze the seeds each day until the milky juice oozes out, which only occurs for 5- 8 days. Once collected, the juice must immediately be turned into a tincture. It is used to treat nervous debility, stress, weak nerve force, anxiety, depression and the accompanying exhaustion, and general fatigue (Felter, 1922). A chief virtue of milky oat seed is its extreme tolerability by otherwise highly sensitive patients who have difficulty withstanding treatment with stronger tonic herbs. It seems to exert an immediate effect (necessary when patients exhibit extreme anxiety and nervousness) as well as a long-term strengthening benefit. I often combine it with scullcap, which has stronger sedative action. Good alternatives include "Avena-Scullcap compound" made by Herb Pharm and "Phytocalm formula" made by Herbalists and Alchemists. These formulas have seen many of our patients through severely stressful periods, and have helped many more avoid resorting to stronger Western medications. It is safe for use by everyone, even infants.

Herbalist David Winston, who maintains a fabulous private herbal medicine library, reports that milky oat seed was used extensively by Eclectic physicians, and he mentioned finding a pamphlet detailing its use for treating morphine addiction as far back as the 1880's. European herbalists have also traditionally used it to treat opium addiction (Jack, 1971). Numerous studies serve to substantiate, at least partially, claims of the herb’s usefulness in addiction control, including its effectiveness as an aid for smoking cessation. Although the research done so far is sparse, the clinical results I have seen remain impressive.

Dr. John Christopher, a well-known herb doctor of the last generation, tells the story of a patient who brewed a tea of skullcap, milky oat seed and a few other nervines, and left it to cool on the stove. Her infant child climbed up on the counter and drank about five or ten times the adult dose, prompting her to call Dr. Christopher in hysterics. He calmed her down and told her the child would be fine. After a very long sleep, the mischievous infant awoke well rested and in good spirits.

Research highlights

• In a placebo-controlled study, researchers gave a fresh alcohol extract of mature oat plant to heavy smokers. The extract was found to reduce cigaretteusage significantly more than the placebo (Anand, 1971).

• In another study, a tincture of oat seed taken with malic acid and apple juice for four weeks led to a 67% reduction in cigarette consumption (Raffalt and Andersen, 1975).

• Chemical studies have revealed that the addition of water to milky oat seed causes a significant loss of potency. Water extracts have not been significantly more effective than placebos in studies of its ability to control addictions (Gabrynowicz 1974, Bye et al., 1974)

• Pharmaceutically prepared fresh alcohol extracts of both fresh oat plants and oat seeds have exhibited activity as nicotine and morphine antagonists (Connor et al., 1975).

• Additionally, out of a group of ten male chronic opium addicts taking a 2-ml dose (about 30 drops) three times per day of oat tincture, six gave up opium without serious withdrawal symptoms. During a follow-up period of three to 19 months, the six successful participants were able to stay off opium completely (Anand, 1971).

MILLETTIA STEM

Latin: Millettia species, Spatholobus suberectus

Chinese: Ji xue teng

English: Chicken blood vine

WHAT IT DOES: Millettia stem is sweet in taste, and warming in action. It nourishes the blood and bone marrow, moves the blood, and reduces muscle and joint pain in deficiency syndromes.

RATING: Silver. Use cautiously if taking blood-thinning medication.

SAFETY ISSUES: None known

STARTING DOSAGE: dried crude powder or concentrated dried decoction

• Dried crude powder: nine to15 grams per day

• 4:1 concentrated dried decoction: three to six grams per day.

Millettia stem is another of the TCM "moving blood" and "supply blood" herbs used normally to treat problems such as anemia, dysmenorrhea, irregular menstruation and amenorrhea. Because it is a stem, TCM doctors say it is useful to treat muscle and joint pain by opening obstructions to Qi flow in the meridians. Because it both nourishes and moves the blood, it a good choice for patients with deficiency. We always include it in formulas for cancer patients suffering from leukopenia due to radiation or chemotherapy, along with other herbs from the same category such as dang gui root, carthamus flower, white peony root, salvia root and cooked rehmannia root. In severe cases of anemia, it is useful to dissolve concentrated granules of these herbs into molasses to form a paste and spoon-feed it to the patient. I would use up to one tablespoon every two to three hours, adding some ginger root if there is a digestive problem.

Research highlights

• Pharmacological studies in China show that the blood forming effects take place in the bone marrow, significantly stimulating hematopoiesis while exerting a beneficial effect on the marrow microenvironment. Microscopic examination has shown a reduction in hyperplasia, and an increase in the proliferation of micro-vessels (Su et al., 1997). 

• Clinical studies in China on cancer patients with impaired immune function various compound formulas using millettia stem have shown increases in white blood cell function, hemoglobin, and platelets (reported in Dharmananda, 1999).

MUIRA PUAMA

Latin: Ptychopetalum species

Spanish: Muira puama

English: Potency bark

WHAT IT DOES: Muira puama is sweet in taste and warming in action. It increases sex drive and stimulates nervous system energy.

RATING: yellow, due to limited mode of action

SAFETY ISSUES: none known

STARTING DOSAGE:

• 1:4 tincture: 20-40 drops two to four times per day, up to 60 drops for a single dose

Note: Muira puama must be used in tincture extracted form.

Muira puama is a Brazilian rain forest herb traditionally used as an aphrodisiac, as is obvious from the English translation of its name. It is used to treat male impotence, low sex drive and female frigidity. Researchers in Europe and Japan have studied the balsam, an aromatic oily extract of the herb, since 1969 (Auterhoff and Momberger, 1971; Iwasa and Kimura, 1969). According to Italian research reports in the popular press, muira puama produces an androgenic effect similar to yohimbe bark (an alkaloid of which is now a prescription medicine), but without its side effects. It is reputed to exert an awakening effect on sexual desire in both sexes, as well as an increase in the production of sperm in men. The exact mechanism of action is currently unknown.

At our clinic, we find muira puama quite effective as a short-term remedy. However, good holistic medicine dictates the additional need to identify underlying causes of the problem that should be treated long-term. Fortunately, the quick results this herb produces in many cases give the patients confidence to pursue further treatment.

Research highlights • The Institute of Sexology in Paris, France did a clinical study of muira puama with male patients complaining of low sex drive and the inability to maintain an erection. In many cases, the herb proved effective within two weeks. At a daily dose of about 30-90 drops of the 1:4 tincture extract, 62 percent of patients with loss of libido claimed that the treatment had "a dynamic effect', and 51 percent of patients with erection failure also reported improvement (Waynsberg, 1990).

MYRRH GUM

Latin: Commiphora myrrha, Commiphora molmol

Sanskrit: Daindhava

Chinese: Mo yao

WHAT IT DOES: Myrrh gum is bitter in taste, aromatic, and cooling in action. It invigorates the blood and reduces pain and swelling caused by blood stasis.

RATING: Red

SAFETY ISSUES: Do not use if pregnant. Do not use with excessive uterine bleeding. Do not use with evidence of kidney dysfunction or stomach pain.

STARTING DOSAGE:

• Dried gum powder: one to three grams per day

• Concentrated dried decoction extract: 250-750 mg per day

Myrrh gum has an intense dark color, reflecting its medicinal potency. It exerts a strong and certain action against specific types of pain and swelling, such as that of rheumatoid arthritis. It is strong enough to soften hard swellings and carbuncles. Like all plant resins, myrrh can also lower blood cholesterol levels by binding to lipids (Michie and Cooper, 1991; reported in Bensky and Gamble, 1993). Biblical references to "frankincense and myrrh" refer to this herb along with boswellia gum, which is another useful resinous anti-inflammatory. Eclectic physicians considered myrrh tincture to be the most effective topical medicine for treating sore and spongy gums. The tincture is diluted down to 10-15% with water and applied directly to the gums. It is also useful as a gargle for spongy enlarged tonsils (Felter, 1922). They use it for similar applications in India, with the addition of honey and rose petals to the solution (Nadkarni, 1954).

At our clinic we use both of these plants frequently when there is painful swelling in the joints. The action is often broader and more satisfying than that of aspirin and other NSAID compounds alone. I do not use myrrh by itself. It's simply too strong. I prefer to use it as a smaller part of a formula, perhaps 5%, and just for a month or two.

The practice of using single strong anti-inflammatories, which block chemical actions, can often create side effects. We are now beginning to gain a scientific understanding of why the common practice of mixing anti-inflammatory herbs, found in all herbal cultures, is so effective. If you completely block a chemical pathway the body is using for some purpose, like ridding itself of a toxin, it will often express its displeasure by creating a side effect, a chain of chemical events. The different herbs work in a myriad of ways, with actions on many different chemical pathways. If you gently moderate several of these pathways, the result will often be a significant reduction of pain and swelling without side effects. Hopefully, then, by working in concert with changes in diet and lifestyle, the body can overcome the original imbalance or causative factors and come to a more complete resolution.

Research highlights

• In an attempt to determine the cause of its effectiveness, researchers examined the individual ingredients of an herbal formula used traditionally by Kuwaiti diabetics to lower blood glucose. Only myrrh and aloe gums effectively improved glucose tolerance in both normal and diabetic rats (Al-Awadi and Gumaa, 1987).

• Mixing myrrh gum into vinegar increases its ability to remove blood congestion and relieve pain (reported in Yeung, 1983).

NEEM LEAF & OIL

Latin: Azadirachta indica

Sanskrit: Nimba

WHAT IT DOES: Neem leaf is bitter in taste and cold in action. It reduces fever and inflammation, reduces itching, and kills microbes and fungus. Neem oil is used externally to heal wounds and boils.

RATING: Red

SAFETY ISSUES: Do not use for longer than three weeks due to dampening effect on digestive, sexual and reproductive functions. Do not use this products unless under the guidance of a properly trained professional.

STARTING DOSAGE:

• Dried powder: one to two grams two times per day

• 1:5 tincture: 10-20 drops two times per day

• Concentrated powder extract: 150-250 mg two to three times per day

Ayurvedic doctors use neem leaves for skin diseases, itching, and fever, especially malarial fever. They also use it internally and externally for all forms of fungal and other infections. We use concentrated neem leaves at our clinic to treat skin diseases with severe itching, and intestinal problems related to candidiasis or other fungal infections. We often combine neem in formulas with other anti-fungal plants, and tell patients to restrict sugar intake and take acidophilus capsules. This helps kill the "bad guy" intestinal bacteria, restricts their favorite fuel (sugar), and adds "good guy" acidophilus back into the intestine. A few weeks on this sort of anti-fungal program can work wonders with these types of infections, even is persistant cases.

Neem oil is used in India in numerous varieties of hair lotion, medicated soap and toothpaste. It is considered to be effective as a topical treatment for chronic skin conditions, ulcers and leprosy. The warm oil is also useful when applied to treat ear infections (Chadha et al., 1985). Traditionally used to treat malaria, neem is a very bitter and potent plant, so it should be used only when other methods have failed.

Research highlights

• Oral administration of dry neem leaf for 24 days resulted in a reduction in the weight of the seminal vesicles and prostate of albino rats, showing an anti-androgen effect (Kasutri et al., 1997). However, it is important to note that the dosage—20-60 mg per day—was much higher than the recommended human dose. A review of the toxicity data by the Pharmacognosy department at the University of Utrecht in the Netherlands concluded, "reported toxicity of preparations and isolated compounds are low, except for the seed oil" (Van der Nat et al., 1991).

• Test tube studies of neem seed extract on the human malaria parasite showed strong inhibitory effect by way of a different mechanism of action than other anti-malaria drugs. Neem seed is active not only against the parasite stages that cause the initial clinical infection but also against the stages responsible for malaria transmission (Dhar et al., 1998).

• When applied to the skin, solutions of 1-4% neem oil in 96-99% coconut oil afforded 81-91% protection against mosquito bites for 12 hours (Mishra et al., 1995, Sharma et al., 1993).

• When applied with urea to rice crops, lipid neem extracts slowed mosquito breeding, reduced incidence of Japanese encephalitis, and significantly increased grain yield in a cost-effective manner (Rao et al., 1995).

• In a study of 814 people with scabies, topical application of a skin paste made of neem leaves (4 parts) and turmeric root (1 part) cured 97% of the cases within three to 15 days of treatment (Charles & Charles, 1992).

• The insecticide activity of neem extracts seems to come from its ability to reduce appetite and disrupt growth in certain insects, including mosquitoes (Ley, 1990).

• Application of neem oil appears to induce a strong blockage of fertility. In a controlled study of fertile female Wistar rats, a single intrauterine dose of neem oil caused a 100% infertility rate for periods of 100 to 180 days, while all the control animals became pregnant. Within five months, more than 50% of the test females regained fertility. There was no visible effect on ovarian function (Upadhyay et al., 1990).

• In a related study, the researchers discovered that neem oil acts as an alternative to vasectomy. As with females, a single-dose injection of neem oil in male rats caused infertility for 8 months, blocking sperm production without affecting testosterone (there did appear to be a reduction in testicular size). The effects may be due to a local immune response against the sperm (Upadhyay et al., 1993).

• In an unrelated study, oral administration of neem extract for 10 weeks caused a significant decrease in total testosterone in male rats. There were no cytotoxic effects (Parshad et al., 1994).

• The anti-fertility effect of neem oil was also reported in rhesus monkeys (Bardhan et al., 1991).

• Oral administration of neem seed extract (Praneem) caused abortion early on in the pregnant female baboons and bonnet monkeys. The treatment was tolerated well, and tests of blood chemistry and liver function were normal. The primates regained fertility subsequent to treatment (Mukherjee et al., 1996).

• As a result of the aforementioned effects, researchers investigated neem oil for hormonal properties. They found that it had no estrogenic, anti-estrogenic or progesterone-related activity. They concluded that since the post-coital contraceptive effect of neem oil seems to be non-hormonal, it is less likely to elicit side effects than the steroidal contraceptives (Prakesh et al., 1988).

OREGANO OIL & LEAF

Latin: Origanum vulgar, O. species

WHAT IT DOES: Oregano oil is pungent in taste, aromatic and warming. It penetrates into the system, breaks up congestion and kills microbes. Oregano leaf stimulates appetite and detoxifies food.

RATING:

• Leaf: gold

• Oil: red

SAFETY ISSUES: Do not use oil without diluting it. Do not exceed recommended dosage. Direct contact with oil to sensitive areas of skin, eye or mouth can cause severe burns.

STARTING DOSAGE:

• Sinus drops with oil: one to five drops of oil diluted in one ounce of water or olive oil

• Internal use of oil: one to three drops of oil diluted in one ounce of water, several times per day. Shake well before using

• Leaf: add fresh or dried leaf freely to foods

The Greek name for this useful herb spice is origanos, or "delight of the mountains." Oregano can and should be used freely as a spice in salads and soups, as it lowers the concentration of microbes in food. The essential oil contains volatile oils, complex chemicals that are known for the odor they emit as they turn to gas. These gases generally have antiseptic, anti-microbial and anti-oxidant effects as they disperse aggressively throughout the body. Carvacrol and thymol, two volatile oils found in oregano, are known to thin mucus, relieve coughing, and relax muscle spasms. These actions make the herb a very useful treatment for lung disorders, including pneumonia, sinus congestion, hay fever, chronic bronchitis and rhinitis.

In our clinic, we add oregano oil to water or olive oil to make sinus drops—snort two or three drops as often as desired to open congestion and kill microbes. Patients who are plagued by frequent sinus infections (accompanied by gunky green mucous) find that keeping these drops around the house can stop these infections before they take hold. To kill stubborn toenail fungus, put two or three drops of undiluted oregano oil on a cotton pad and tape it directly to the toenail. You might need to do this twice per day for a couple of months. The penetrating quality of the vapors permeates deeply enough to root out and kill fungus lurking below the nail bed. For a stronger effect, soak the toenails in vinegar every day to make them more porous, and add some neem leaf extract to the oregano oil.

My friend Bob Klezics, who along with his affable partner Art Paviglianiti owns our local health food store Harvest Market, came to me complaining of chronic chest congestion. He had found some relief with herbs, but found that he had to keep taking the herbs or the problem would return. He finally discovered Oregamax, a commercial product made from a particularly potent form of Greek oregano, and his congestion disappeared in two or three days, never to return.

Research highlights

• In a test of oregano, mint, basil, sage and coriander essential oils for activity against yeast and fungi, oregano proved to be the strongest, inhibiting the yeast broth completely at 1,000 parts per million (Basilico and Basilico, 1999).

• In studies against food borne pathogens, oregano oil proved effective against numerous species, including Bacillus cereus (Ultee et al., 1999); Salmonella enteritidis (Koutsoumanis et al., 1999); Acinetobacter baumanii, Aeromonas veronii biogroup sobria, Candida albicans, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella enterica subspecies enterica serotype typhimurium, Serratia marcescens and Staphylococcus aureus (Hammer et al., 1999); and Giardia duodenalis (Ponce-Macotela et al., 1994).

• Oregano leaf is one of six herbs found in a particular screening to contain a high concentration of phytoprogesterones (Zava et al., 1998).

• Food studies on oregano leaf indicate that it stimulates appetite when added to pasta in tomato sauce (Yeomans et al., 1997), and has the same effect when added to animal feed (Villalba and Provenza, 1997). In an interesting show of instinctive intelligence, 250 pregnant women reported aversion to meats, poultry and sauces flavored with oregano (Hook, 1978).

• In an investigation of 60 plants, Dr. James Duke, author of The Green Pharmacy, and one of the world's leading experts on medicinal plant chemicals, reported that wild oregano contained the highest levels of antioxidants (reported in Duke, 1997). It is especially high in vitamin E compounds, especially gamma-tocopherol (Lagouri and Boskou, 1996).

PEPPERMINT LEAF & OIL

Latin: Mentha piperita

Chinese: Bo he (M. haplocalyx)

Sanskrit: Putani (M. arvensis)

WHAT IT DOES: Peppermint leaf is sweet and peppermint oil is sweet and slightly pungent in taste. Both are aromatic and cooling in action. Peppermint leaf cools and soothes the throat, lungs, stomach and mind. Peppermint oil reduces intestinal spasms internally, and calms itching externally.

RATING: Silver

SAFETY ISSUES: None known.

STARTING DOSAGE:

• Tea: one to two teaspoons of leaf per cup of water

• Enteric-coated oil capsule: two milliliters (ml) two times per day between meals

The wonderful aroma of peppermint tea comes from the release of soothing volatile oils into the air. The immediate pleasurable reaction everyone has to this scent speaks volumes about what this plant can do. It has a mild anesthetic action on the intestine, so it is useful for treating nausea, morning sickness, vomiting, and stomach pain, especially when combined with ginger root. It also exhibits a mild anti-inflammatory action and can be used with honey or ginger as a simple remedy for colds, fevers and flu. Peppermint tea is good for bad breath, and TCM doctors use similar mint species to treat sore throat, red eyes, headache, and cough. Because it has a soothing effect on the mind, it is also a helpful in easing painful periods and lessening general anxiety.

Herb Pharm makes an almost magical peppermint remedy called Grindelia-Sassafras compound, that our patients love. It relieves the unbearable itch associated with poison oak, ivy & sumac.

Peppermint oil is prescribed specifically to treat Irritable Bowel Syndrome (IBS), a problem which accounts for 50 percent of all visits to gastrointestinal doctors. Studies show peppermint oil directly relieves intestinal smooth muscle spasms and promotes rhythmic peristaltic movement, usually working within a few weeks (Hawthorne et al., 1988). Before using the oil, make sure that you are truly suffering from intestinal spasms, and not a more serious inflammatory colitis. Menthol crystals can be extracted from mint oils, and these have a wonderful anesthetic action on the skin, due to a stimulation of the nerves that perceive coldness. You can apply a few drops of peppermint oil to a cloth and wipe down the body to cool down a fever.

PHELLODENDRON BARK

Latin: Phellodendron amurense

Chinese: Huang bai

WHAT IT DOES: Phellodendron bark is bitter in taste and cold in action. It reduces inflammation and dampness, especially from the lower parts of the body. It has broadspectrum anti-bacterial and anti-viral activity.

RATING: yellow, due to limitations of use

SAFETY ISSUES: Do not use during pregnancy. Avoid long-term use due to alkaloid content.

STARTING DOSAGE:

• Dried powder: three to10 grams per day

• 4:1 dried decoction: one to three grams per day

“Huang” means yellow in Chinese, and phellodendron bark is one of the "three huangs," or bright yellow plants used for treating inflammation and infection (the other two are scute root and coptis rhizome). The yellow color comes from an alkaloid called berberine, a substance that is slightly-to-mildly toxic in pure form, which is why it is not recommended for use in pregnancy. Berberine is also found in goldenseal root (Hydrastis canadensis), Oregon grape root(Mahonia aquifolium) and several other wellknown herbs.

The clinical differentiation among these three yellow TCM plants serves as an excellent argument against concentrating on a single chemical or group of chemical compounds in a plant. While valuable at times, this practice can limit our perspective. It is tempting to make a general statement that all plants containing berberine are basically the same in their actions. However, TCM doctors tell us that scute root is most useful for treating inflammation in the lungs and upper respiratory tract, including allergies. On the other hand, coptis rhizome is useful for treating upper body inflammation, but not allergy. Rather, it is most effective when there is strong heat in the heart and other organs, high fever, and sore throat. Phellodendron bark is more appropriate for treating inflammation in the lower parts of the body and for heat cause by deficiency. For menopause, a deficiency condition, it can be used to control hot flashes. In the lower parts of the body it is used to control thick yellow vaginal discharges, hemorrhoids, foul-smelling diarrhea and dysentery. It is also used to treat dampness and heat in the legs, such as red, swollen and painful knees, legs or feet. A fellow herbalist from New York was suffering from a chronic and painful lower leg and skin inflammation. An experienced herbalist, but not in TCM, she tried various formulas in vain. When Nai-shing prescribed a phellodendron bark formula, her problems disappeared.

TCM doctors offer the insight that phellodendron bark can be used when there is weakness and nutrient deficiency present, while coptis rhizome should be avoided in such cases. In 1999, a member of the herbalists’ Internet group in which I participate was suffering from a persistent lower leg inflammation. A formula containing coptis rhizome proved ineffective, so Nai-shing substituted phellodendron bark, which resoled the problem within a few weeks.

Research highlights

• Berberine comprises only about 0.6 to 2.5% of the plant's material, so researchers decided to study the rest of the plant without this compound. The berberine-free fraction of phellodendron bark exhibited anti-ulcer activity, anti-inflammatory properties, reduction of gastric acid secretion, and anti-cholera toxin effects (Uchiyama et al., 1989).

• Chinese studies on phellodendron bark show a broad-spectrum antibiotic effect against organisms that cause diptheria, dysentery, typhoid fever, staph infections, pneumonia, conjunctivitis, trachoma and meningitis. It is often used in injectable form (reported in Huang, 1999, reported in Yeung, 1983).

• Others have shown action against various forms of candida, as well as viruses (Park et al., 1999).

• In tests examining eight different herbs, phellodendron bark proved to be the most potent suppressor of immune inflammation in animal graft-versus-host reactions (Mori et al., 1994). In a later study, the same researcher discovered that unlike cortisone-like drugs, phellodendron bark did not suppress antibody production (Mori et al., 1995).

• Studies also indicate a possible applicaqtion in cataract prevention. A water extract of phellodendron bark and aralia cortex applied to the eye lenses of diabetic rats "dramatically" reduced high sorbitol levels as well as other cataract-causing chemicals (Lee et al., 1999).

• Many herbalists believe that berberine-containing herbs only work topically, not internally. Dr. Duke reports that there is increasing evidence of systemic antimicrobial effects (Brennan, M. 2000).

PINELLIA TUBER

Latin: Pinellia ternata

Chinese: Fa ban xia

WHAT IT DOES: Pinellia tuber is pungent in taste and warming in action. It dries up and dissolves mucus in the lungs, stomach and intestines, and stops nausea and vomiting.

RATING: Yellow, due to limitations in use and potential minor toxicity.

SAFETY ISSUES: Pinellia must be processed prior to use, to remove toxic elements (Li et al., 1991, reported in Yeung, 1983). The traditional method is to cook it with ginger, vinegar and/or alum. Do not use during pregnancy. Do not use long term. Do not use with bleeding disorders. Use only under the guidance of a trained professional.

STARTING DOSAGE:

• Dried powder (purified): two to six grams per day

• 4:1 dried decoction: 500-1000 mg per day

Pinellia tuber is perhaps the strongest TCM herb for removing phlegm. We use it very frequently at our clinic to treat coughs and upper respiratory infections with thick and tenacious phlegm. It is useful in the digestive system when there are signs of nausea, poor digestion and overall sluggishness, with a thick white coating on the tongue. It can be used to stop chronic diarrhea due to poor digestion. It is almost always prescribed in formulas along with tangerine peel and/or ginger root to promote a more effective action (synergy).

A classic formula considerd the best one for mucus reduction anywhere in the lungs or digestive tract is called two-cured decoction (er chen tang). It consists of pinellia tuber, tangerine peel, poria mushroom and honey-fried licorice root.

Research highlights

• In animal experiments, taste stimulation by pinellia tuber caused suppression of gastric vagus nerve activity, while stimulation with ginger root caused an increase in nerve activity. The mixture of the two herbs had a neutral effect. This demonstrates the rationale behind traditional use of the two herbs together (Niijima et al., 1998).

• The reticuloendothelial system (RES) consists of phagocytic immune cells (those that eat foreign materials and particles). The RES exists primarily in the liver, and it helps attack cancer cells (Baas et al., 1994). In pharmacological studies of pinellian G, a complex sugar extracted from pinellia tuber, researchers recorded significant RES- stimulating activity and a reduction in inflammation (Tomoda et al., 1994). This may partially explain the herb’s anti-phlegm activity.

PORIA MUSHROOM

Latin: Poria cocos

Chinese: Fu ling

WHAT IT DOES: Poria mushroom, actually the sclerotium (hardened mass enveloping the mushroom), is bland and sweet in taste, and neutral in action. It promotes fluid discharge and strengthens digestion.

RATING: Silver

SAFETY ISSUES: None known. Use cautiously in dehydrated patients.

STARTING DOSAGE:

• Dried powder: six to18 grams per day

• 4:1 concentrated dried decoction: one and-a-half to four and-a-half grams per day

Poria mushroom is commonly used in TCM because it is a gentle and safe aid for removing stagnant fluids (dampness) from the digestive system. In our clinical practice, perhaps as many as 40% of our patients have impaired or sluggish digestion, and many of them cannot tolerate strong herbs at first. Poria is an excellent choice in these cases, as it safely improves digestion. It is also used for urinary difficulty and edema. It can be used freely. Recently, studies have shown it to have immune system benefits similar to those of other medicinal mushrooms, though perhaps milder. The difficult to obtain inner part of the sclerotium found near the root is called poria spirit (fu shen), and is used to calm anxiety.

Research highlights

• Japanese scientists reported that Poria mushroom stimulated various immune system chemicals (interleukins and tumor necrosis factor), while suppressing a growth factor (Yu et al., 1996). • It has also been shown to slow tumor growth in mice (Kaminaga T, et. al, 1996), and to prevent pathological changes to the kidneys of mice with nephritis (Hattori et al., 1992).

• The saponins found in poria mushroom possess a calming effect on digestion that proved strong enough to prevent vomiting in frogs who were given an emetic agent (Tai T et al., 1995).

PRICKLY ASH BARK

Latin: Xanthoxylum species， Zanthoxylum species

African: Fagara/Yeah/Igi-ata

WHAT IT DOES: Prickly ash bark is pungent in taste and hot in action. It stimulates the circulation and breaks up blood congestion.

RATING: yellow, due to limitations in use.

SAFETY ISSUES: Do not use during pregnancy or if taking blood thinning medications. Use with caution if you have stomach or intestinal inflammation.

STARTING DOSAGE:

• Powder: 250-750 mg two to three times per day

• Decoction: one teaspoon of bark in one cup of water two to three times per day

• 1:5 Tincture: 10-20 drops two to three times per day

Note: tincture is preferred form due to ease of use.

Prickly ash bark stimulates the circulation, lymphatic system and mucous membranes. It is effective in treating chilblains (constriction of small arteries), leg cramps, varicose veins, ulcers and other problems resulting from blood congestion and cold. Various related species can be found around the world, but they contain different amounts and types of phytochemicals. In Nigeria, people use the root of fagara as a chewing stick to aid in oral hygiene. And in Nigeria and Ghana, a decoction of the root bark is a common treatment for toothache pain, childbirth pain and trauma, and as also used as a general tonic (Iwu, 1993).

Doctors in Nigeria use fagara (F. zanthosyloides) to reduce the painful crisis of the genetic disease, sickle cell anemia (Iwu, 1993). This herb has a variety of unusual properties that reduce platelet and blood cell sticking. After reading the reports from Nigeria many years ago, I decided to try fagara's relative prickly ash bark for the same indication. I made a simple tincture of 50% prickly ash bark and 50% ginkgo leaf, and gave it to a young African-American girl in the first grade who constantly missed school and needed to be hospitalized 3-4 times per year due to the painful sickle cell crisis. I gave her about 25 drops three times a day. She immediately stopped having serious problems, her thinking was no longer fuzzy, the frequency of her attacks went down to about one per year, and the severity of the attacks decreased appreciably. This success has continued through the years, as long as she takes her medicine. I saw her last year, and she has blossomed into a beautiful junior high school student, the sickle cell disease now only a bit-player in the background of her life.

Another of my patients had lived with the disease his entire life, with almost constant pain, and bimonthly crisis. I gave him 35 drops three times per day, and he immediately improved in the same way as the young girl. This improvement in both frequency of attacks and level of pain has persisted in three of my long-term patients over many years. The wholesale cost of this medicine is less than $20 per month at full dosage. My biggest fear is that this knowledge will be co-opted by a pharmaceutical company, and made available to the many suffering children only at an exorbitant cost.

Research highlights

• We do not know the full extent or the cause of the anti-sickling activity of Zanthoxylum species plants. Researchers have identified several types of coumarins been (Chen et al., 1995), as well as various alkaloids that reduce platelet sticking (Sheen et al., 1996; Ko et al., 1990).

• Among the agents know to possess anti-sickling inhibitory activity at low concentrations are the aqueous extract of the roots of Zanthoxylum xanthoxyloides (anti-sickling ether fraction), vanillic acid, parahydroxybenzoic acid and paraflurobenzoic acid (Osoba et al., 1989).

• In vitro testing of 43 African plants traditionally used to treat malaria have shown strong anti-malarial action in four of the plants, including the Zanthoxylum chalybeum species of prickly ash. The other plants that demonstrated this action against malaria were Cissampelos mucronata, Maytenus senegalensis, and Salacia madagascariensis (Gessler et al., 1994).

In 1995 I wrote the following letter, which was printed in my local paper. Unfortunately there has been no follow up.

News Journal (Wilmington, DE)--February 10, 1995

To the editor:

This is in response to your article Tuesday Jan. 31, 1995 reporting on the use of the cancer drug hydroxyurea for reducing the crisis of sickle cell anemia in adults. The article is noteworthy not for what it says, which is quite accurate, but for what it omits. For instance, it omits the fact that this treatment is currently not recommended for children due to its severe side effects. According to the PDR, it requires close physician supervision (weekly blood tests), because it “causes bone marrow depression, leukopenia, anemia, ... affects DNA synthesis ... may be mutagenic,” and is a “known teratogenic agent in animals.” This risk is balanced against a 50% reduction in sickle cell crisis episodes. It might be interesting to ponder why our scientists have not heard of the Fagara chewing stick (Zanthoxylum spp.), a widespread plant species found in the forest savanna mosaic of the lowland rain forest in west tropical Africa. It has been reported since as early as 1975 that "the root extract and the aromatic acids have been shown to significantly reduce the painful crisis of sickle-cell patients. " In fact, the crude extract is currently dispensed by the Nigerian health service for the management of sickle-cell anemia. Far from having side effects, it is used freely in Africa as a chewing stick to prevent tooth decay, a tea for pain during childbirth, and as a tonic for general body weakness. It is considered quite safe for use by children.

Sincerely,

Alan Tillotson