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Clinical Herbalism http://www.grianherbs.com/herbalism.ppt Guido Masé [email protected] (802) 229-5895 Roots • • • • • Traditional Chinese Traditional European Native American Eclectic Modern European Astragalus, Huang qi • Astragalus membranaceus • Member of the Fabaceae (Leguminosae). Composite leaf, delicate yellow-pink flowers that mature to small pods. Strong branching yellow root used for medicine. • Warming Yang immune tonic, lung tonic Hawthorn • Crategus species • Member of the Rosaceae. A beautiful white-flowered tree, used in Europe for hedgerows. The berries are traditionally used. • Warming, nutritive cardiovascular tonic and normalizer. Can be of support in depleted, depressive conditions. Echinacea • E. purpurea, E. pallida, E. angustifolia • Member of the Asteraceae (Compositae). A perennial favorite with prolific flowers, all parts of this plant are used for medicine. Root, seed and unopened green flower buds are strongest. • Cooling, disperive, antiinfective, anti-poison herb. Powerful and effective in acute conditions. Therapeutic ideas • “Energetics”: Yin/Yang, Fluids, Spirit • Physiological concepts • Enhancing absorption/metabolism/elimination • "Tonification" • Empiricism • Scope of practice Yin and Yang • Cold/Hot • Sedating/Stimulating • Deep (Chronic)/ Superficial (Acute) Vital Fluids • Humors • Tissue states – – – – Hot Dry Wet Cold • "Vital Force" Plant spirit medicine • Meaning through experiential relationship • Plants as archetypal symbols • Connection with Homeopathy • Long-term healing: “life-changing” Physiological concepts • Vis medicatrix naturae – The healing power of Nature • Holism – Looking for broad, underlying pattern • Extensive tissue/organ interconnection – Feedback is everywhere – homeostasis is subtle Holism • Reflection of pattern at many levels of being – Self-similarity exists at every level. All levels interact to form the whole. • Intervention can be broadly effective when initiated at any level – Broad-stroke physiology centered more on process/relationship – Herbs are complex crude preparations understood holistically – Essential role of nutrition in therapy; herbs as "special foods" Nature of Herbalist / Client relationship is crucial • • • • Intake process can take hours Emphasis on story, context and meaning Increasing client’s connection to medicine A partnership that educates and empowers the client to take responsibility for wellness Extensive tissue/organ interconnection • • • • Autonomic nervous reflexes Immune / lymphatic Endocrine / Adrenal Shared characteristics – Innervation – Mucosa Enhancing elimination • • • • • Liver function Digestive strength (helps absorption, too) Kidney function Expectoration Lymphatic function MILD IRRITANTS / TISSUE STIMULANTS WITH OVERALL COOLING FUNCTION “Tonification” A tonic brings a system towards optimal homeostasis / efficiency • Specific type – – – – Cardiovascular Digestive Endocrine Immune • Systemic / broad type – Ginseng, e.g. LONG-TERM, AKIN TO FOODS Scope of practice • Acute treatment / limitations • Chronic treatment / limitations • Importance of inter-modality work – – – – – Acupuncture Massage / bodywork Counseling Nutrition Modern Medicine Nature of the Materia Medica Archetypal herbal actions Enhancing Elimination / Counterirritating • • • • • Rubefacient Cholagogue Diuretic / Diaphoretic Expectorant Lymphatic Relaxing / Soothing • • • • • Sedative Hypnotic Antispasmodic Anti-inflammatory Demulcent Countering pathogens • • • • Antifungal Antibiotic Antiviral Anthelmintic "Tonifying" • • • • • Digestive bitter Immune tonic / modulator Cardiovascular tonic Endocrine tonic Nervine tonic Multi-function • Multi-function tonic • "Alterative" Phytochemistry • • • • Chemical classes Standardization Dosage and safety considerations Pharmakokinetics Astragalus, Huang qi • Polysaccharides • Phytosterols / Saponins • Generally safe and mild; β-sitosterol gentle antiinflammatory • Polysaccharides important immune tonics1 • Mostly water-soluble Hawthorn • Flavonoids • Vitamin C (like most Rosaceae) • Sugars • Very mild, akin to food. Antioxidant value (flavonoids); reduces LDL oxidation and vascular damage2 • Mostly water-soluble Echinacea • Alkyl amides • Polysaccharides • Inulin & starches • Strong effect from alkyl amides (immune activating, anti-inflammatory)3 plus polysaccharide effect • Inulin starch beneficial for intestinal flora • Generally safe, but more powerful in flavor and effect • Better solubility in 50% ethanol "Energetics" • Signatures • Spirit / "Intelligence" • Temperament – Hot / Enhancing / Stimulating – Cool / Eliminating / Sedating • Taste • System affinity • Amphoteric Case 1: Recurrent Staphylococcus infection • • • • Male, age 34 Original infection in foot, with extensive inflammation and lymphatic involvement. Left untreated for 2 weeks. Initial treatment with IV antibiotics, unknown type, resolved the dramatic symptoms fairly quickly. Herbal therapy sought for eruptions (few localized furuncles) six months after initial treatment. Furuncles tender but not itchy, appearing on R leg and hip, chest. First recommendations: – Drastically reduce sugar and refined starch consumption – Echinacea tincture, 3ml every 2 hours as anti-inflammatory and antibiotic – Calendula and Zingiber (Ginger) tea, 32 fl. oz. daily – External applications: Maleleuca (Tea tree) and Zingiber Based on: “trapped, stagnant heat” and “deficient circulatory energy” i.e. latent infection, need for increased circulation and therefore immune response • First results: – – – After 24 hours, client reports less tenderness and reduction in number of furuncles After 72 hours most furuncles have disappeared No recurrence for 3 months • • • Client returns with similar symptoms; same treatment is repeated with good success (though improvement is not as rapid). Two months later, client returns. Symptoms began similarly, but now furuncles have become exacerbated (within 48 hours) and skin necrosis has begun in two areas. Client presents with two ulcerations, diameter approx. 2 cm, where the skin is completely gone and underlying tissue is revealed, surrounded by an inflamed area of 6-8 cm in diameter. Beginnings of lymphatic involvement. Recommendations: – – • Results: – – • Same as initial protocol, but with the addition of Baptisia tinctoria (2 ml TID) as a more powerful antiseptic and lymphatic External applications of beeswax-based salve with Commiphora (Myrrh) and Maleleuca (Tea tree) under sterile bandages, along with suggestions on proper hygiene. Surrounding inflammation much reduced within 48 hours. Salve modified to feature Symphytum (Comfrey) to speed growth of new dermis, along with nightly fresh Symphytum poultices. New skin forming within 1 week; diameter of ulcerations down to 1 cm. Improvement continues over next week until fully resolved. Additional information: – – In an attempt to arrive at the underlying imbalance that allows the infection to recur, client reveals emotional and personal trauma surrounding the initial presentation and first recurrence. Client is troubled by threats from an individual who “hates him”. Recurrences seem to occur around times of stress and tension with this individual. • Final Assessment: – • Long-term solution: – – • Stagnant “damp heat” as a result of blockage in the flow of internal energy. This flow has been blocked as part of an emotional pattern which is disallowing proper immune function. Infections are recurring partly because of an immune response weakened by the underlying infection itself; partly because of stress-related immune suppression; and partly because of an unwillingness and a fear to confront an abusive situation. Traditional purification ritual involving Artemisia (Mugwort, Wormwood). These herbs are strewn about the dwelling; burned as incense; and taken internally as a tea for the day and night of the ritual. Emotional fear and anger are identified, acknowledged, externalized, and released through compassion-based imagery and meditation. The herbs used have both spiritual/emotional and somatic function: all members of the Artemisia family contain powerfully antiseptic volatile oils (thujone, e.g.) Immune enhancing protocol is recommended for an additional 6 months: daily tea of Astragalus and Ganoderma (Red Reishi polypore mushroom), 16 fl.oz. Final Results: – Client has been free of infection to date. Immune-enhancing protocol slowly discontinued after 6 months. Case 2: Integrative treatment: brain tumor • • • • • Female, age 53 Tumor in motor cortex, diagnosed from symptoms of Bell’s palsy (rt. side of face), arm weakness, difficult speech and fine motor movement. Confirmed by MRI, 9/04, when tumor size was assessed at 1.5 cm diameter. After initial courses of radiation and chemotherapy, surgery was attempted (Dana Farber Oncology) 3/05. Tumor had reached diameter of 4 cm. Surgery largely successful, with no complications (although impossible to remove entire tumor due to location). Client begins dietary regimen on the advice of a nutritionist. 9 servings of fresh fruit/veg per day; 4 servings of whole grain and/or legumes daily; fish as major protein source. Addition of yogurt and flax seed oil. Organic, hormone and antibiotic-free foods are stressed. Colorful (flavonoid-rich antioxidant) foods are emphasized. Follow-up visit 6/05: MRI shows no signs of tumor. Chemotherapy continues; client WBC counts are very low, especially neutrophils. RBC borderline-low. Motor symptoms are not much improved; anticonvulsants are prescribed. Client seeks herbal support 8/05, primarily to address low WBC counts but also to add another level of protection against tumor recurrence and perhaps an alternative to anti-convulsant medication • Initial assessment: • Vital, strong, motivated individual who is eating an incredibly healthy diet and wishes to pursue all available treatment strategies for her condition. • Immune function / WBC count is low most probably as a result of chemotherapy treatment. • Tumor was aggressive, but seems “under control” at the present moment from excellent, mutimodality care. • Motor symptoms are distressing to an active, energized, professional woman. This may be related to trauma and resultant cerebral inflammation/oedema and may take time to resolve. • Intake process reveals mild hypoglycemia, a lifelong “concern” • Initial recommendations: • Tincture of Astragalus, 3ml BID • Digestive bitters (Dandelion, Artichoke, Burdock), 3ml 15 min. before meals • Supercritical CO2 extract of Maitake, Reishi, Chaga (medicinal mushrooms) 2ml BID • Tincture of Verbascum (Mullein), 1ml BID • “Immune broth” recipe using organic beef bones, Astragalus, Ganoderma. 8 fl.oz. daily. • Silybum (Milk Thistle) standardized extract 240mg daily Astragalus, mushrooms and broth all help increase WBC and RBC counts. Digestive bitters are tonic, help elimination and liver function, and address hypoglycemia. Mullein root a specific for neuromotor symptoms. Milk thistle supports liver function (aids in processing chemotherapy). • Results: • After 6 weeks, WBC and neutrophil counts are within normal ranges, even with the same dosage of chemotherapy. RBC low end of normal. Liver and kidney enzymes are fine. • Client, in consultation with oncologist, has halved the dose of anti-convulsant medication. Symptoms are slightly improved, esp. hand movement and speech. • Client has noticed improvement in digestive function, especially bowel movement consistency and regularity (side-effect of digestive bitters). • MRI reveals no tumor or re-growth of any kind. • Treatment is modified to include Trifolium (Red Clover), Rosmarinus (Rosemary), and Crategus (Hawthorn) for anti-tumor, anti-oxidant, and cerebral vascular health. These are taken in tea form • • After an additional 6 weeks, motor symptoms continue to (very gradually) improve. CBC still completely within normal ranges. Chemotherapy and nutritional intervention continue. MRI still reveals nothing of note in the affected area. Liver enzyme levels are lower than before initiating herbal treatment. It has been 14 months since diagnosis; 9 months since surgery. Herbal therapy can provide a significant benefit when used alongside conventional tumor treatment. It encourages stronger immune function; manages the side-effects of medication; and can provide mild symptomatic relief. Communication between practitioners accomplished, for the most part, through the client. Case 3: Chronic bronchitis • • • • • Female, age 57 Complains of yearly recurrences of bronchial infection (diagnosed by MD). Antibiotic therapy temporarily effective, but respiratory infection usually recurs at least once in the season. Each bout can last 2 weeks, with protracted chest congestion for an additional 4-6 weeks. No fever. Non-smoker. No hazardous environmental conditions (chemicals, allergens, molds, etc…) identified. Diet consists of refined wheat flour as main carbohydrate source; much dairy; few vegetables, mostly canned or frozen (not fresh). Assessment: – • Long-term lung weakness, perhaps from overuse of antibiotics. Current acute presentation of bronchitis. Poor exercise regimen. Poor diet needs improvement. Initial Recommendations: – – – – Tea of Glycyrrhiza (Licorice), Sambucus (Elder), and Zingiber (Ginger) to warm, soothe, and stimulate expectoration. 32 to 64 fl.oz. daily. Tincture of Echinacea, 3ml five times daily. Tincture of Inula (Elecampane) 3ml TID as an expectorant. Extensive dietary recommendations focus on whole foods, less dairy, and warming spices that stimulate circulation (Garlic, Cayenne, Ginger, etc…) Follow-up visit scheduled in one week. • Results: – – – Respiratory infection resolved, mostly. Some expectoration continues but mucus production is easy, and the mucus is clear (no longer dark yellow). No antibiotics used. Treatment is altered to remove Echinacea and Inula, and focus instead on strengthening “lung qi” and rebuilding immunity. “Immune broth” of Astragalus, Ganoderma, and Urtica (Stinging Nettle) is recommended as a winter tonic. Brew by simmering for 8 hours; strain; freeze in ice cube trays and use two cubes daily in 8oz of hot water. Initial tea is still part of treatment for at least another week. Follow up this fall: client reports no bronchitis this season, and has been taking “Immune broth” since midSeptember. Diet has improved a bit, mostly by the addition of whole fresh vegetables Clinical Herbalism http://www.grianherbs.com/herbalism.ppt Guido Masé [email protected] (802) 229-5895 Notes • • • • 1) A study on the immune receptors for polysaccharides from the roots of Astragalus membranaceus, a Chinese medicinal herb. Biochem Biophys Res Commun. 2004 Aug 6;320(4):1103-11 2) Flavonoids: a review of probable mechanisms of action and potential applications. American Journal of Clinical Nutrition, Vol. 74, No. 4, 418-425, October 2001 http://www.ajcn.org/cgi/content/full/74/4/418 3) Macrophage activating effects of new alkamides from the roots of Echinacea species. J Nat Prod. 2005 May;68(5):773-6. Additional resources: – – – – – www.grianherbs.com http://www.herbalgram.org/ http://ns2.rt66.com/hrbmoore/index.html/) http://www.henriettesherbal.com/ http://www.americanherbalistsguild.com/