WMMII-Lesson11

Western Materia Medica Pain By Terry Willard ClH, PhD Botanicals Pain

Pain is transmitted to the brain from sensory nerves. Substances that decrease pain either interfere with the ability of nerves to conduct messages, or alter the brain’s capacity to receive sensations.

Pain may be a symptom of an underlying pathological condition, such as inflammation. It may also be due to other causes, such as bruising, infection, burns, headaches, or sprains and strains. Use caution when treating pain without understanding its cause—this may delay diagnosis of conditions that could continue to worsen without medical attention.

Checklist for Pain D-phenylalanine (DPA), Vitamin B12, American scullcap, Arnica, Cannabis, Cayenne (capsaicin; topical use only), Corydalis, Cramp bark, Feverfew, Passion flower, Phyllanthus, Piscidia erythrina, St. John’s wort, Valerian, Willow.

Symptoms of pain include discomfort that is often worsened by movement or pressure and may be associated with irritability, problems sleeping, and fatigue. People with pain may have uncomfortable sensations described as burning, sharp, stabbing, aching, throbbing, tingling, shooting, dull, heavy, and tight.

Lifestyle changes that may be helpful: Body weight may be related to pain tolerance. One study indicated women who are more than 30% above the ideal weight for their age experience pain more quickly and more intensely than do women of ideal weight.1 No research has been found that investigated the effect of weight loss on pain tolerance.

Exercise increases pain tolerance in some situations, in part because exercise may raise levels of naturally occurring painkillers (endorphins and enkephalins).2,3,4 Many types of chronic pain are helped by exercise, though some types of physical activity may aggravate certain painful conditions. People who want to initiate an exercise program for increasing pain tolerance should first consult a qualified health professional.5,6,7,8

Western Materia Medica Pain By Terry Willard ClH, PhD Botanicals

Nutritional supplements may be helpful: Certain amino acids have been found to raise pain thresholds and increase tolerance to pain. One of these, a synthetic amino acid called D-phenylalanine (DPA), decreases pain by blocking the enzymes that break down endorphins and enkephalins, the body’s natural pain-killing chemicals. DPA may also produce pain relief by other mechanisms which are not well understood.9,10,11

D-phenylalanine (DPA)

Other amino acids may be beneficial in reducing pain. In the central nervous system, L-tryptophan serves as a precursor to serotonin. Serotonin participates in the regulation of mood and may alter responses to pain. In a preliminary trial, 2,750 mg per day of L-tryptophan decreased pain sensitivity. Another preliminary trial found that L-tryptophan (500 mg every four hours) taken the day before a dental procedure significantly decreased the postoperative pain experienced by patients. In another preliminary trial 3 grams of L-tryptophan taken daily for four weeks significantly decreased pain in a group of people with chronic jaw pain. No research has been published investigating the pain control potential of 5- hydroxytryptophan (5-HTP), another serotonin precursor, that, unlike L-tryptophan, is currently available without a prescription.12,13

L-tryptophan Vitamin B12 has exhibited pain-killing properties in animal studies. In humans with vertebral pain syndromes, injections of massive amounts of vitamin B12 (5,000 to 10,000 mcg per day) have reportedly provided pain relief. Further studies are needed to confirm the efficacy of this treatment.14,15

Western Materia Medica Pain By Terry Willard ClH, PhD Botanicals

Herbs that are helpful: Capsaicin is an extract of cayenne pepper that may ease many types of chronic pain when applied regularly to the skin. In animal studies, capsaicin was consistently effective at reducing pain when given orally, by injection, or when applied topically. 16,17 A controlled trial in humans found that application of a solution of capsaicin (0.075%) decreased skin sensitivity to all noxious stimuli.18 In several uncontrolled and at least five controlled clinical trials, capsaicin has been consistently shown to decrease the pain of many disorders, including trigeminal neuralgia, shingles, diabetic neuropathy, osteoarthritis, and cluster headaches.19,20,21,22,23 For treatment of chronic pain, capsaicin ointment or cream (standardized to 0.025 to 0.075% capsaicin) is typically applied to the painful area four times per day.24 It is common to experience stinging and burning at the site of application, especially for the first week of treatment; avoid getting it in the eyes, mouth, or open sores.

Chinese researchers also note that 75 mg per day of THP (an alkaloid from the plant corydalis) was effective in reducing nerve pain in 78% of those tested.25

Relaxation exercises may decrease the perception of pain. Pain increases as anxiety increases; using methods to decrease anxiety may help reduce pain. In one controlled hospital study, people who were taught mind-body relaxation techniques reported less pain, less difficulty sleeping, and fewer symptoms of depression or anxiety than did people who were not taught the techniques.26,27

Acupuncture has been shown to decrease pain by acting on the enkephalin-based, pain-killing pathways. In 1997, the National Institutes of Health (NIH) stated that acupuncture is useful for muscular, skeletal, and generalized pain, as well as for anesthesia and postoperative pain. The NIH statement was based on a critical review of over 67 controlled trials of acupuncture for pain control.28

Western Materia Medica Pain By Terry Willard ClH, PhD Botanicals

Hypnosis has been shown to significantly reduce pain associated with office surgical procedures that are performed while the patient is conscious (i.e., without general anesthesia).29 In one study people, who were undergoing office surgical procedures, received standard care, structured attention or self-hypnotic relaxation. Those using self-hypnosis had no increases in pain during the procedures, compared to those in the other groups. Hypnosis also appeared to stabilize bleeding, decrease the requirement for narcotic pain drugs during the procedure, and shorten procedure time.

References:

1..Pradalier A, Willer JC, Dry J. Pain sensitivity in obese individuals. Ann Med Interne (Paris) 1982;133:528–31.

2..Guieu R, Blin O, Pouget J, Serratrice G. Nociceptive threshold and physical activity. Can J Neurol Sci 1992;19:69–71. 3..Fordyce W, McMahon R, Rainwater G, et al. Pain complaint—exercise performance relationship in chronic pain. Pain 1981;10:311–21.

4..Schwarz L, Kindermann W. Changes in beta-endorphin levels in response to aerobic and anaerobic exercise. Sports Med 1992;13:25–36 [review] 5..Ferrell BA, Josephson KR, Pollan AM, et al. A randomized trial of walking versus physical methods for chronic pain management. Aging (Milano) 1997;9:99–105. 6..McCain GA. Nonmedicinal treatments in primary fibromyalgia. Rheum Dis Clin North Am 1989;15:73– 90 7..Kottke TE, Caspersen CJ, Hill CS. Exercise in the management and rehabilitation of selected chronic diseases. Prev Med 1984;13:47–65 [review] 8..Cowan P, Lovasik DA. American Chronic Pain Association: strategies for surviving chronic pain. Orthop Nurs 1990;9:47–9 [review] 9..Ehrenpreis S. Analgesic properties of enkephalinase inhibitors: animal and human studies. Prog Clin Biol Res 1985;192:363–70. 10..Guisti P, Carrara M, Cima L, Borin G. Antinociceptive effect of some carboxypeptidase A inhibitors in comparison with D-phenylalanine. Eur J Pharmacol 1985;116:287–92 11.. Walsh NE, Ramamurthy S, Schoenfeld LS, Hoffman J. D-phenylalanine was not found to exhibit opiod receptor mediated analgesia in monkeys. Pain 1986;26:409–10. 12..Shpeen SE, Morse DR, Furst ML. The effect of tryptophan on post-operative endodontic pain. Oral Surg Oral Med Oral Pathol 1984;58: 446–9. 13..Seltzer S, Dewart D, Pollack RL, Jackson E. The effects of dietary tryptophan on chronic maxillofacial pain and experimental pain tolerance. J Psychiatr Res 1982–83;17(2):185–6. 14..Hanck A, Weiser H. Analgesic and anti-inflammatory properties of vitamins. Int J Vitam Nutr Res Suppl 1985;27:189–206. 15..Hieber H. Treatment of vertebragenous pain and sensitivity disorders using high doses of hydroxocobalamin. Med Monatsschr 1974;28:545–8 16..Santos AR, Calixto JB. Ruthenium red and capsazepine antinociceptive effect in formalin and capsaicin models of pain in mice. Neurosci Lett. 1997;235:73–6.

Western Materia Medica Pain By Terry Willard ClH, PhD Botanicals

17..Otsuki T, Nakahama H, Niizuma H, Suzuki J. Evaluation of the analgesic effects of capsaicin using a new rat model for tonic pain. Brain Res 1986;365:235–40. 18..Nolano M, Simone DA, Wendelschafer-Crabb G, et al. Topical capsaicin in humans: parallel loss of epidermal nerve fibers and pain sensation. Pain 1999;81:135–45. 19..Hautkappe M, Roizen MF, Toledano A, et al. Review of the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction. Clin J Pain 1998;14:97–106 [review]

20..Fusco BM, Giacovazzo M. Peppers and pain. The promise of capsaicin. Drugs 1997;53:909–14 [review]. 21..Robbins WR, Staats PS, Levine J, et al. Treatment of intractable pain with topical large-dose capsaicin: preliminary report. Anesth Analg 1998;86:579–83 22..Zhang WY, Li Wan Po A. The effectiveness of topically applied capsaicin. A meta-analysis. Eur J Clin Pharmacol 1994;46:517–22 [review] 23..Ellison N, Loprinzi CL, Kugler J, et al. Phase III placebo-controlled trial of capsaicin cream in the management of surgical neuropathic pain in cancer patients. J Clin Oncol 1997;15:2974–80. 24..Rains C, Bryson HM. Topical capsaicin. A review of its pharmacological properties and therapeutic potential in post-herpetic neuralgia, diabetic neuropathy and osteoarthritis. Drugs Aging 1995;7:317–28 [review 25..Lin DZ, Fang YS. Modern Study and Application of Materia Medica. Hong Kong: China Ocean Press, 1990, 323–5. 26..Robin O, Vinard H, Vernet-Maury E, Saumet JL. Influence of sex and anxiety on pain threshold and tolerance. Funct Neurol 1987;2:173–9 27..Rybarczyk B, DeMarco G, DeLaCruz M, Lapidos S. Comparing mind-body wellness interventions for older adults with chronic illness: classroom versus home instruction. Behav Med 1999;24:181–90. 28..U.S. Department of Health and Human Services. Public Health Service. Acupuncture. NIH Consensus Statement 1997;15:1–34 29..Lang EV, Benotsch EG, Fick LJ, et al. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 2000;355:1486–90.

Western Materia Medica Pain By Terry Willard ClH, PhD Botanicals

Western Materia Medica Arnica montana By Terry Willard ClH, PhD Asteraceae ES Arnica montana, Family Asteraceae

Common names: Leopard's bane, Mountain Tobacco, Fallkraut (German)

Plant description: This common perennial herb is typically from 30 to 60 cm tall and has bright yellow flower heads which can manifest singly or in numbers. The leaves are opposite, simple, and can be either entire or toothed. The root stalk is ascending or horizontal. The stalkless pappus is hair-like with white or brown bristles

Rhizome about 5 cm. (1 3/4 inches) long and 3 or 4 Mm. (1/8 to 1/6 inch) thick; externally brown, rough from leaf-sears; internally whitish, with a rather thick bark, containing a circle of resin-cells, surrounding the short, yellowish wood-wedges, and large, spongy pith. The roots are numerous, thin, fragile, grayish-brown, and with a thick bark containing a circle of resin-cells. Odor somewhat aromatic; taste pungently aromatic and bitter (U. S. P.).

Habitat, ecology and distribution: Europe, Russia, Siberia, Canada, and north- western United States; mountain areas and moist upland meadows

Part used: Flowers, roots.

Harvesting and collection: Arnica thrives in a mixture of loam, peat, and sand. It may be propagated by root division or from seed. Divide in spring. Sow in early spring in a cold frame, and plant out in May. The root is collected in autumn after the leaves have died down.

History: Although usually taken in homeopathic preparations, the mother tincture is sometimes used as well. Internally, it is valuable for mental and physical shock, pain and swelling, dental extraction, sprain of joints, fractured bones, headache and concussion. One will recover from these better than with morphine, taking no more then five drops of tincture every three to four hours. Some doctors have used arnica for internal bleeding and inflammation of the mouth and throat. Except in emergencies, arnica should not be used internally without practitioner direction. It can however be taken as homeopathic arnica.

Western Materia Medica Arnica montana By Terry Willard ClH, PhD Asteraceae ES

In Russia, the herb has been used internally to promote bile, reduce cholesterol, to stimulate the central nervous system and to stop bleeding, boils and inflammation of the genitals, as well as to strengthen a weak heart. Externally arnica is used as a tincture or salve, and promotes the healing of wounds, bruises, sprains, and irritation. When the surface skin is broken, it will stop pain, but should be diluted tenfold. If applied undiluted the strong tincture can cause blistering. As a poultice or compress the infusion is useful, and the compress can be placed on the stomach to successfully relieve abdominal pains. A salve can be made by heating one ounce of the flower with one ounce of cold-pressed olive oil in a water bath (i.e., double-boiler) for a few hours. Strained, it is good for chapped lips, inflamed nostrils, bruises, joint pain, skin rash, and acne. 1,2,3

Arnica acaulis, Arnica cordifolia and Arnica latifolia appear in Native American ethno-botanical literature. The Thompson, Shuswap and Catawba Indians used the plant although detailed applications are not available.4

Constituents: The flower of arnica contains from 0.3% to 1.0% of a viscous volatile oil which in turn is made up of approximately 50% fatty acids. The most prominent fatty acids are palmitic, linoleic, myristic and linolenic acid. The aromatic constituents are terpenes, Helenalin thymol, thymol methyl ether and derivatives. Arnica also contains a resin, arnicin (a bitter principle), Sesquiterpene lactones (including the pseudoguanolidesarnifolin, the arnicolides, helenalin, and the recently isolated 6-0isobutyryl-tetrahydrohelenalin and 2 [[beta]]-ethoxy-6-0-isobutyryl-2, 3-dihydrohelenalin, dihydrohelenalin), Flavonoids (such as eupafolin, patuletin, spinacetin and the less commonaciniatin, and methylated flavonoids including betuletol and hispidulin), tannin, a steroid (arnisterin, arnidiol), flavones, choline, betaine, inulin, luteine, phytosyerol, trimethylamine, xanthophyll and carotenoids.5,6,7,8

Arnica's polysaccharides resemble the active alkaloids of echinacea, both in structure and in activity.

Medical Research: In Germany, arnica is one of the most prescribed herbal remedies for stimulating the immune system. Arnica extract increases resistance to bacterial infection by stimulating phagocytosis of the bacteria involved, notably Listeria monocytogenes and Salmonella typhimurium. It has been found to stimulate phagocytosis in laboratory animals.

Arnica has been shown to be an immuno-stimulant, as both the sesquiterpene lactone helenalin and the polysaccharide fraction stimulate phagocytosis. Sesquiterpene lactones are known to have anti-inflammatory activity and their biological effects appear to be mediated through immunological processes. As helenalin is one of the most active, this might help account for the use of Arnica for pain and inflammation.

Western Materia Medica Arnica montana By Terry Willard ClH, PhD Asteraceae ES

Arnica is commonly applied for its sprain and bruise healing capability. The flavones are considered to be adrenalin-like precursors, which can cause a fall in blood pressure, with a cardiotonic substance. Arnica has been found to strengthen circulation by stimulating coronary heart vessels and by increasing heart capacity. Dihydrohelenalin and helenalin and their esters are analgesic, antibiotic and anti-inflammatory. Helenalin can be allergenic and causes contact dermatitis in sensitive people. Arnica in small doses is known to immuno- stimulate. Arnica is very commonly used in homeopathic formulas. 9,10,11,12,13,14

Toxicity: Severe irritation to the mucous membrane of the GI tract can occur from taking large doses of tincture internally. As little as 30 ml (1 oz.) of 20% tincture can cause serious but not fatal symptoms. A fatal dosage is listed as low as 60 ml. It is regarded as unsafe by the USA FDA on the grounds that it contains substances affecting the heart and vascular systems. It can produce violent toxic gastroenteritis, nervous disturbances, changes in pulse rate, intense muscular weakness, collapse and death. There is no known antidote to Arnica’s poisonous effect.

Taken externally there is relatively little toxicity, though a few sensitive individuals have slight dermal irritation. This botanical is often used internally and externally in homeopathic preparations where toxicity is not a concern.15,16

Herbal action: Nervine, local stimulant, antibacterial, diaphoretic, emollient, diuretic, expectorant, vasodilator and vulnerary.

Indications: Muscular soreness and pain from strains or over-exertion; advanced stage of disease, with marked enfeeblement, weak circulation, and impaired spinal innervation; embarrassed respiration; lack of control over urine and feces; sleeplessness from impeded respiration, and dull precordial pain from "heart-strain;" muscular pain and soreness when the limbs are moved; tensive backache, as if bruised or strained; cystitis, with bruised feeling in bladder, or from a fall or blow; headache, with tensive, bruised feeling and pain on movement; hematuria, with dull, aching lumbar pain, or from over-exertion. Beneficial for all cases of debility with enfeebled circulation.17

Contraindications and cautions: Although used effectively externally for bruises, sprains etc., repeated application can cause irritation, blistering, skin inflamation, causing eczema, peeling, blisters, or other skin conditions. Most herbalists suggest that

Western Materia Medica Arnica montana By Terry Willard ClH, PhD Asteraceae ES

Arnica should not be used internally unless under the supervision of a qualified practitioner.

Medicinal uses: Germany alone has manufactured more than 100 drug preparations containing this herb. Applied topically as a cream, ointment, liniment, salve, or tincture, arnica has been used by both Europeans and Native Americans to soothe muscle aches, reduce inflammation and heal wounds. While arnica has also been used internally as an herbal remedy for certain heart disorders, it should only be used in this way under the supervision of a healthcare provider. In fact, arnica in herbal form is primarily restricted to topical (external) use because it can cause serious side effects when it is used internally.

In small doses arnica accelerates the pulse, increases the perspiration, excites a flow of urine, and occasionally causes headache and giddiness. It is esteemed as a stimulant in typhoid fever and other adynamic febrile (fever related) diseases, in chronic palsy, and amenorrhoea; also as a tonic in chronic rheumatism, and as a tonic and diuretic in the asthenic forms of dropsy.

Scudder (Spec. Med.) writes: "I have frequently prescribed it for lame back, backache, and feelings of debility and soreness in the small of the back. It is only useful in those cases where there is feebleness, with deficient circulation; but in these the influence is direct and permanent."

Arnica has a pronounced action upon the medulla and spinal cord while reducing depression. The keynote for arnica is spinal and vagal enervation. It should be used for a deficient nervous response, sluggish vascular power, and in almost all conditions in which prevails the triad-torpor, debility, and depressed function. It can also be used for severe exhaustion where spinal innervation is poor, control over the sphincters lost, and there is feeble respiration due to central vagal impairment. It is a most important stimulant and beneficial in Fibromyalga. Arnica is especially good when breathing is only a force of the will, and becomes weak and shallow when the patient drops into sleep. When myalgia is caused by exposure, or when muscular soreness and pain are due to strain, overexertion, or sudden jars or blows, the administration of arnica internally, in small doses preferably, and the diluted tincture applied locally are among the most serviceable of measures. Arnica frequently relieves "heart-strain" due to exertion, overwork, or from long marching.18

Western Materia Medica Arnica montana By Terry Willard ClH, PhD Asteraceae ES

Used by the Eclectics for typhus and typhoid fever 5-minim doses of the Tincture as a stimulant; larger doses as an antipyretic when patient is of sthenic reaction. In small doses it is also used for rheumatism and gout.

Matthew Wood states: “When I first started to work with Arnica an image popped into my mind which perfectly sums up the essence of this plant. A young boy, perched on a high rock, tries to decide whether it will be too far to jump, or not." This picture expresses the need for the ego to unfold through challenges, but also the susceptibility to ego bruising. Such challenges are more especially a part of childhood--perhaps even boyhood. At the same time it captures the tendency to physical over-exertion, strain, sprains and bruises.”19

The Flower Essence Repertory (FES's) description of the flower remedy Arnica: "Arnica helps to heal deep-seated shock or trauma which may become locked into the body and prevent full healing recovery. Especially during accidents or violent experiences, the Higher Self or soul dissociates itself from the body and may never properly re-enter certain parts of the body despite seeming recovery. This remedy can be especially helpful for unlocking many puzzling or psychosomatic illnesses which do not respond to obvious treatment."20

Energetics: Holmes lists this herb as a bit sweet, bitter, and pungent with a neutral warming and secondary cooling effect and neutral moisture. The secondary energies are restoring, relaxing and stimulating. It enters the Heart and Pericardium meridians influencing the medulla and spinal cord, nerves, heart and lung. The organism is warmth and Air, increasing Vayu, while decreasing Pitta and Kapha.21

Pharmacy and dosage: Tincture B.P. 5 - 30 drops Tincture USP 10 - 30 drops

For tender feet a foot-bath of hot water containing 1/2 oz. of the tincture has brought great relief. Applied to the scalp it will make the hair grow.

References

1. Duke, J.A., Handbook of Medicinal Herbs, CRC Press Inc., Boca Raton FL, 1985. p.64. 2. Willard T; Edible and medicinal Plants of Rocky Mountains ans nieghbouring territories 3. Grieve, M., A Modern Herbal (Vol. 1 - A-H), Dover Publications, Inc., New York, 1974. p.55. 4. Moerman, D.E., Medicinal Plants of Native America, University of Michigan Museum of Anthropology, Technical Reports, Number 19, Ann Arbor, Michigan, 1986, Vol.1, p.58. 5. Leung, A.Y., Encyclopedia of common natural ingredients used in food, drugs, and cosmetics, John Wiley & Sons Inc., New York, 1980. p.34. 6. Youngken, H.W., Textbook of Pharmacognosy, Blakiston, Toronto, 1950. p.879. 7. Grieve, M., A Modern Herbal (Vol. 1 - A-H), Dover Publications, Inc., New York, 1974. p.55.

Western Materia Medica Arnica montana By Terry Willard ClH, PhD Asteraceae ES

8. Duke, J.A., Handbook of Medicinal Herbs, CRC Press Inc., Boca Raton FL, 1985. p.64. 9. Leung, A.Y., Ibid. p.24. 10. Youngken, H.W., Textbook of Pharmacognosy, Ibid. 11. Squire, P.W., Squire's Companion to the Latest Edition of the British Pharmacopeia, J & A Churchill, London, 1908. p.193. 12. Grieve, M., A Modern Herbal, Jonathan Cape, London, 1931, p.55. 13. Culbreth, D.M.R., A Manual of Materia Medica and Pharmacology, Eclectic Medical Publications, Portland OR , 18?? (Repr. 1983). p.147.

14. Duke, J.A., Handbook of Medicinal Herbs, CRC Press Inc., Boca Raton FL, 1985. p.64. 15. Leung, A.Y., Ibid. 16. Brinker, F., An Introduction to the Toxicology of Common Botanical Medicinal Substances, thesis, National Coll. of Naturopathic Medicine, Portland OR, 1982 - 83. p.15. 17. Kings :http://www.ibiblio.org/herbmed/eclectic/kings/arnica.html

18. Felter Specific medications 19. Wood Mathew: Herbal Wisdom. 20. Flower Essence Repertory; (p.285) 21. Holmes, P., The Energetics of Western Herbs (2 vols.), Artemis Press, Boulder CO, 1989, p.255.

Western Materia Medica Hypericum perforatum By Terry Willard ClH, PhD Clusiaceae

Hypericum perforatum -St. John’s Wort Family Clusiaceae

Common names: Klamath weed, John’s wort, amber touch-and-heal, millepertuis, goatweed, rosin rose.

Plant description: Perennial, woody creeping root. The stem is dual edged, branching and erect above, curled below, 3 - 6 cm in height. The leaves are numerous, elliptical or ovate, obtuse, opposite, entire, pale green in color and with pellucid dots. The flowers are numerous, bright yellow, densely forked and with terminal panicles.

Part used: Herb top, flower

History: The history behind the name St. John’s wort is wonderful in itself. The reason this European native herb is called St. John’s wort is because it first flowers on St. John’s Day, right before the summer solstice. Fortunately, it continues to flower all summer long, so we don’t have to be in a hurry to harvest it. The flowering at such an auspicious time was not lost on the medieval Catholic peasants. When viewed from the top (not the side) the small stems create a perfect cross. This symbolism became attached to the plant and the peasant folks came to believe the plant offered protection for everything from lightning to witch craft.

The scientific name Hypericum perforatum is also highly symbolic. The genus name comes from the Greek word hypericon, meaning to place “above the icon.” This attribute was popularized in the Middle Ages, when the herb was considered to protect people against demons, witchcraft and lightning.

If you hold the leaf up to the sunlight, you can see little perforations in it – hence the species name perforatum. This phenomenon suggested its use for pin and needle perforations of the skin in the form of wounds. In turn, this fueled more the belief that the plant could protect a person from occult voodoo practices (psychic attacks caused by poking pins into effigy dolls).

Paracelsus considered it almost a universal medicine or panacea, because of its ability to rid the patient of the psychic energies of possession, ghosts and spooks. St John’s wort was also applied to many forms of insanity and other health issues like epilepsy, schizophrenia, hallucinations and paralysis.

The famous German naturopath, Father Sebastian Kneipp, who created several water cures, said that this plant was the “perfume of God” and the “flower of the fairies.” Foreign to North America, the Europeans brought it over as a medicine, and by the

1800's it had completely naturalized to the local habitat. Many American Indian tribes soon revered this plant. The question is how did the Indian tribes learn of its medicinal value? Matthew Wood relates many great stories and insights about this herb in his excellent publication, The Book of Herbal Wisdom. He asked one of his teachers, an Indian elder, how the Native people knew so much about the use of this foreign plant? The story goes that the elder explained the European ‘little people’ told the North American ‘little people’ and they told their healers.

St. John's wort is used in all pulmonary complaints, bladder trouble, dysentery, worms, diarrhea, depression, jaundice and cancer.1,2 It can be found in the herbals of Gerard (1597), Hill (1751), Withering (1796) and the Eclectics.3

A number of Hypericum species were used by Amerindian tribes. Records of the use of H. perforatum are known for the Cherokee, Iroquois and the Montagnais.4 All these tribes seemed to have used the plant as a febrifuge/cough medicine however, the Cherokee made very broad use of the plant.

Constituents: St. John's Wort is known to contain a volatile oil, a resin, a tannin, an alkaloid and napthodianthrones ( hypericin 0.0095 -0.5%, pseudohypericin, isohypericin and emodin- anthrone), phloroglucinols (hyperforin 2 - 4.5%, adhyperforin 0.2 - 1.9%) flavonoids (proanthocyanidins, kaempferol, luteolin, myricetin, quercetin, quercitrin, isoquercitrin and others) plus caffeic, chlorogenic, ferulic, stearic, palmitic and myric acids; carotenoids, GABA and others.5,6,7,8

Medical Research: St. John's Wort has a solid reputation as an antidepressant.9 The alkaloid is said to have a tonic effect on the ventricles of the heart, the aorta and arterioles.10 It is also useful for pulmonary complaints, bladder trouble, suppression of urine, dysentery, worms and nervous depression.1112

The tranquilizing quality was once attributed to hypericin, but now it is believed to be another constituent or a combination of several constituents. Even small amounts have been found to be effective, by increasing blood flow to stressed tissue. This blood flow has also been shown to be hypotensive, reduce capillary fragility and to enhance uterine tone. St. John’s wort may cause photosensitivity in a very small group of individuals.13,14

St John's Wort has antibacterial and antiviral activity against a range of organisms including tuberculosis, Gram positive organisms, Micrococcus, Bacillus, and influenza A/PR8.15,16,17,18 Tests at the U.S. National Cancer Institute have shown that an extract of St. John’s Wort has promise as a cure for cancer.19

Western Materia Medica Hypericum perforatum By Terry Willard ClH, PhD Clusiaceae

Toxicity: It is considered safe for human consumption but hypericin has been sh own to produce photosensitivity in cattle and a very small number of sensitive humans.20

Herbal action: Aromatic, astringent, resolvent, expectorant and nervine.

Indications: depression, stress, pain, antiviral.

Contraindications and cautions: A very small group of people experience photosensitivity, and hypertension has also been observed in some people.

Medicinal uses: When I first started using St. John’s wort heavily in my clinic, it was in the mid to late 80's. Back then it was rarely used for depression, because it was principally known as an antiviral. This was just after HIV was discovered as the cause of AIDS, and the natural medicine community was looking for a strong, natural antiviral. St. John’s wort seemed to be one of the solutions, as not only did it function to destroy viruses, it was particularly effective for retro-viruses. One of the chemicals in St. John’s wort, hypericin, was shown to act as the antiviral agent. However, the first major problem was the quantity required for therapeutic results. Clients took between 10 and 30 capsules a day to reach the levels of hypericin needed. It seemed to control viruses for several of my AIDS patients. Hypericin also seemed to be beneficial for another growing health issue, the chronic Epstein-Barr virus, later renamed chronic fatigue syndrome (and subsequently determined not to be a virus, after all). The second problem was, of course, the expense and inconvenience of taking these large quantities of capsules. The third problem was more mysterious. Several of my patients, who went through the hassle and expense of swallowing these large quantities, found that they became ‘allergic’ to commercial refrigeration units. As bizarre as that may sound, these individuals complained that refrigerators caused a full body sensation right down to their finger tips and toes, “like a dentist drilling into an unfrozen, sore tooth.” This pain was acute and occurred only when they were within about 10 feet or so of a commercial refrigeration unit; the kind found in a supermarket. Shopping was extremely unsettling for these people. I learned later that this was a known side effect of hypericin.

This side effect captured my interest, because I suspected that there was some kind of electromagnetic interference going on between St. John’s wort and the electrical system of the refrigerator. This gave me the impression that this herb worked more on the subtle bodies than the physical body of a person. Not long after these strange events, herbal practitioners began to notice that St. John’s wort seemed to alleviate depression for many people with dramatic health issues. Extensive research in Germany eventually confirmed the antidepressant quality of St. John’s wort and stimulated the large push for its use in that area.

Was the full body tooth pain almost a homeopathic ‘proving’ of what was happening in these sensitive patients? Bingo! This remedy is used by homeopaths, in its diluted form for injuries to nerves, especially in fingers, toes and ‘nails’. Excessive painfulness in

Western Materia Medica Hypericum perforatum By Terry Willard ClH, PhD Clusiaceae

these areas is a guiding symptom for its use. It relieves pain even better than morphine. Its homeopathic mind attributes are anxiety, such as falling from heights, shock and melancholy. It is specific for puncture wounds, especially for pain after operations, or when a person is cut by the scalpel. It is also used specifically for pain in the lower back, or the coccyx, after a fall on your tail bone or after child birth. So, St. John’s wort was revealing more of its personality to me.

In Europe, St. John’s wort is considered beneficial during children’s developmental stages of growth and for aging; for bed-wetting in young children, menstrual problems (cramping, irregularities and pain) and menopause. It is thought to be very useful for people with a sensitivity to weather changes (at the one drop dosage level). I have used it extensively during winter months for seasonal affective disorder (SAD) with great success (at full dose).

Matthew Wood claims that St. John’s wort is a great remedy for the solar plexus, the center which is often associated with self-esteem issues. It also improves the gut-level instinct and thus, will help people deal with unconscious sensitivities.

Hypericin All of this still does not answer our initial question; how does St. John’s wort work? There are several European companies that are trying to tell us that, in order to get results for depression, we have to use St. John’s wort with a specific amount (0.3%) of hypericin present. It was proven back in 1996 that hypericin was not the active ingredient for the anti-depressant function in St. John’s wort. Even with hypericin removed from the plant, it still worked as an anti-depressant. There is no doubt it alleviates mood disorders, as we use it for literally thousands of patients who come through the clinic every year. It is even more effective than most pharmaceutical anti-depressants. In Germany, St. John’s wort is prescribed five times more often than pharmaceuticals for depression. This still doesn’t tell us how it works.

One thing we do know is that it blossoms and matures when the sun is at its height in June each summer. In fact, the levels of several of the active constituents are directly determined by the amount of available sunlight. In cloudy years, the chemical levels are low; in sunny years, the quantities are higher. St. John’s wort appears to concentrate sunlight in itself. In fact, one of the risks with this herb is that if white-faced cows or sheep eat large quantities, they develop sun sensitivity and grow huge skin ulcers. This observation lead to the erroneous idea that people should not go out in the sun when using the herb therapeutically. In an Internet poll I was involved in, only 3 documented cases of this side effect were reported. The poll consisted of feedback from more than 100 million combined doses per year from both practitioners and manufacturers. So, there is a 0.003% chance that this might happen, far below the level of any real risk.

But this function of St. John’s wort gives us a clue as to how it works. Isn’t depression like a dark cloud overshadowing a person’s life? St. John’s wort appears to bring a ray of

Western Materia Medica Hypericum perforatum By Terry Willard ClH, PhD Clusiaceae

sunshine into ‘cloudy’ situations. I think of it as a herbal solar battery, so that is why I continue to give it to SAD people.

From a flower essence point of view, St. John’s wort illuminates consciousness, and gives light-filled awareness and strength. It is used for people who are experiencing overly expanded states which may lead to psychic and physical vulnerability; for deep fear and disturbed dreams. In general I find it useful for people who are emotionally over- sensitive or overly receptive. It is recommended for people who have an overly active psychic life –for example, when the astral body expands greatly during sleep. This expansiveness in the astral body can be associated with attacks from elemental or other entities. Again, we find that the theme of protection from psychic attack has stayed with the plant throughout the ages.

Energetics Traditional Chinese(related species H. japonicum) is bitter, sweet, slight flavor; mild and cold properties. Its action is to cleanse dampness-heat, dispel heat, and remove toxins.21

Other Holmes lists St. John's Wort as a bit bitter, sweet and astringent, with a cool, dry property. Its secondary quality is relaxing, restoring, astringing and stimulating. St. John's Wort enters the Lungs, Kidneys, and Bladder meridians, influencing the lungs, intestines, kidneys, bladder, nerves and blood. The organism is air and warmth.22 Tierra describes St. John's Wort as bitter and cool. It influences the Liver, Kidneys, Spleen and Stomach meridians.23

Pharmacy and dosage:

Physical Capsule 300 mg, 3 times daily Infusion 1 - 2 tablespoons Fluid extract (1:1) 20 - 30 drops; 3 times daily

Etheric Fresh Fluid Extract 1 - 3 drops; 1 - 3 times daily

Astral (emotional) Flower essence 5 drops; 3 times daily or as needed

Mental

Homeopathic 6 - 30x; 3 times daily or as needed

Official Recognition and Medical References

Western Materia Medica Hypericum perforatum By Terry Willard ClH, PhD Clusiaceae

USA Dietary supplement Escop requires 0.04 % napthodianthrones France Approved for topical applications Germany Commission E UK Legal Category (Licensed Products) for external use, in BHP

REFERENCES

1. Grieve, M., A Modern Herbal, Jonathan Cape, London, 1931, p.707.

2. Duke, J.A., Handbook of Medicinal Herbs, CRC Press Inc., Boca Raton FL, 1985. p.243 3. Crellin, J.K. and Philpott, J., Herbal Medicine: Past and Present (Vol. II), Duke University Press, London, 1990, p.376-377. 4. Moerman, D.E., Medicinal Plants of Native America, University of Michigan Museum of Anthropology, Technical Reports, Number 19, Ann Arbor, Michigan, 1986, Vol.1, p.230. 5. Upton R, et al, St. John’s Wort; American Herbal Pharm and Therapeutic Compendium; July, 1997. 6. Spoerke, D.G., Herbal Medications, Woodbridge Press Publ. Co., Santa Barbara CA, 1980. p.164. 7. Heinerman, J., The Science of Herbal Medicine, BiWorld Publ., Orem UT, 1979. p.115. 8. Duke, J.A., Handbook of Medicinal Herbs, CRC Press Inc., Boca Raton FL, 1985. p.243. 9. Spoerke, D.G., Herbal Medications, Ibid. 10. Heinerman, J., The Science of Herbal Medicine, Ibid. 11. Upton ibid 12. Grieve, M., A Modern Herbal, Jonathan Cape, London, 1931, p.707. 13. Gallam, et al., Quaderni Fitoterapia (Milan) #8, 1-47. 14. Shipochiliev, T., Extract from a group of medicinal plants enhancing the uterine tonus, Vet. Sci. 28(4), 94- 98 1960. 15. Bystro, N.S., et al., The structure of hyperforin, Tetahedron Letters 2719, 1975. 16. Fitzpatrick, F.K., Plant substances active against Mycobacterium tuberculosis, Antibiot & Chem 4(5), 528 - 536, 1954. 17. Osborn, E.M., Brit. J. of Exp. Path. 24, 227, 1 -45, 1943.

18. Shakirovo, K.K., et al., Antimicrobial properties of some species of St. Johns wort, Mikrobiol Zhurnal 32, 494-97, 1970. 19. Duke, J.A., Ibid. 20. Spoerke, D.G., Herbal Medications, Ibid. 21. Hsu, H.Y., Chen, Y.P., et al., Oriental Materia Medica: a concise guide, Oriental Healing Arts Institute, Long Beach, CA, 1986, p.201-202. 22. Holmes, P., The Energetics of Western Herbs (2 vols.), Artemis Press, Boulder CO, 1989, p.454. 23. Tierra, M., Planetary Herbology, Lotus Press, Santa Fe, NM, 1988, p.199-200.

Western Materia Medica Piscidia erythrina By Terry Willard ClH, PhD Leguminosea

Piscidia erythrina - Jamaica Dogwood Family Leguminosae

Plant description: A tree with very valuable wood and with the foliage and habit of Lonchocarpus. The pods bear four projecting longitudinal wings. The outer surface is yellow or greyish brown, the inner surface is lighter colored or white, and a peculiar blue color when damp. The inner bark is very fibrous and dark brown, tastes very acrid and bitter, and produces a burning sensation in the mouth with a strong disagreeable smell like broken opium.

Macroscopical: Curved or channelled pieces 5-10 cm long and 2-6 cm wide. The outer surface is orange- brown where cork is present and grey-brown where it is exfoliated. Externally thin longitudinal ridges and fissures, inner surface red-brown and longitudinally furrowed. It is fracture tough and fibrous. Odor faint; taste bitter and acrid.

Microscopical: Red-brown powder, pitted walled parenchymatous cells of the phloem, some containing spherical starch grains 1 mm in diameter, singly or in groups of three or four. Lignified fibres, long and narrow, occur in bundles covered by regular cells containing a single prismatic crystal of calcium oxalate. Bundles of fibers are interspersed with medullary ray parenchyma and groups of lignified thick walled oval sclereids.

Habitat, ecology and distribution: West Indies, Florida, Texas, Mexico, the northern part of South America.

Part used: root and root bark

History: The pounded leaves and young branches were used to poison fish by filling an open crate with the branches and dropping it into the water. It is then swilled about until the water is impregnated with the liquid from the leaves, etc.; this quickly stupefies the fish and enables the fishers to catch them quickly. In commerce the bark is found in quilled pieces, 1 or 2 inches long and 1 inch thick. As early as 1844, Western scientists discovered that Jamaica dogwood had pain-relieving and sweat-promoting properties.

Constituents: resins (piscidin, jamaicin, ichthynone), amorphous alkaloid, an isoflavonoid (sumatrol), rotenones (lisetin, piscerythrone and piscidone), organic acids (piscidic, fukiic, methylfukiic), beta-sitosterol, around 2% tannins.1

Western Materia Medica Piscidia erythrina By Terry Willard ClH, PhD Leguminosea

Medical Research: Piscidia is a powerful sedative, used in the treatment of painful conditions such as neuralgia and migraine. It may also be used for the relief of ovarian and uterine pain. Its main use is for insomnia due to nervous tension or pain. Piscidia bark can calm the cough reflex and reduce fevers. Animal studies have shown that Jamaica dogwood may promote sleep, relieve pain, reduce smooth muscle spasms, relieve cough, and reduce fever and inflammation.2,3

Toxicity: This remedy should be used only under the supervision of a qualified practitioner. It may cause gastric disturbances and nausea. It should not be used in pregnancy, bradycardia or cardiac insufficiency.

Herbal action: Anodyne; Hypnotic; Sedative; Antispasmodic; Antitussive; Anti- inflammatory; Antipyretic; Hypotensive

Indications: Insomnia; Nervous excitement; Pain; Neuralgia; Migraine; Dysmenorrhoea; Toothache; as Antispasmodic in Whooping cough & Asthma

Contraindications and cautions: It is important to note that Jamaica dogwood is a highly potent herb with potentially toxic effects, if used in large amounts. Dosage varies from person to person. Jamaica dogwood has been used extensively throughout Central and South America as a fish poison. This herb also contains a substance known as rotenone that has been used in insecticides to control lice, fleas, and larvae. However, rotenone is believed to be relatively harmless to warm-blooded animals including people (when used at recommended doses).

Medicinal uses: Jamaica dogwood possesses active properties and its chief uses include controlling pain and producing sleep. It increases the salivary and cutaneous secretions; slows the pulse; it increases the arterial tension, succeeded by a fall of tension due to a weakening of the heart; it dilates the pupils, except when passing into a state of asphyxia, when contraction takes place; it does not affect the irritability of the motor nerve fibers, nor does it attack the peripheral sensory nerve endings; it reduces reflex action by stimulating Setschenow's centers, and induces a tetanoid condition by stimulation of the spinal marrow; finally it is narcotic to frogs, rabbits, and men. Piscidia

Western Materia Medica Piscidia erythrina By Terry Willard ClH, PhD Leguminosea

destroys life by causing heart failure or by arresting respiratory action. Unpleasant results have been occasioned by even small doses of piscidia; among these are nausea, vomiting, headache, etc. Convulsions were provoked in the case of a woman who had been given a 1/2-drachm dose for hemicrania. The drug is recommended to replace opium, chloral, and similar narcotics.

Energetic: It is strongly warm to the parasympathetic nervous system activity and skin activity. It is warm to lymphatic system function and mucosal activity. It is strongly cool to central nervous system activity and musculoskeletal function. It is weakly cool to adrenal stress, to cardiovascular system function, to lower GI activity, and lower urinary activity. Furthermore it is weakly cool to renal activity, reproductive system function, thyroid stress and upper GI activity.4

Pharmacy and dosage:.

Dried root bark: 1 to 4 g (or equivalent in decoction) three times daily Fluid extract: (1:1 in 30% alcohol) 1 to 2 ml three times daily; or 2 to 8 ml per day (1:1 in 60% ethanol) Tincture (1:5 in 45% ethanol): 5 to 30 drops (1 to 2 mL) three times per day

Caution: Use with care. Response is highly individual, so start with a low dose. Availability: This herb is wildcrafted and locally abundant in at least one growth area.5

REFERENCES

1.Bradley, P.R.(Ed.), British Herbal Compendium Volume I, British Herbal Medicine Association, 1992. 2.Mills, S., The Complete Guide to Modern Herbalism, Thorsons, Great Britain, 1994. 3.Hoffmann, D., The New Holistic Herbal, Element, Dorset, 1990 4.Moore, M. 1995. Herbal Energetics Charts, Southwest School of Botanical Medicine 5.Moore, M. 1995. Herbal Materia Medica 5.0, Southwest School of Botanical Medicine

Western Materia Medica Piscidia erythrina By Terry Willard ClH, PhD Leguminosea

Western Materia Medica Salix alba By Terry Willard ClH, PhD Salicaceae

Salix alba - Willow, Family Salicaceae

Common names and related species: Salix fragilis. S. purpurea and related spp

Plant description: These temperate shrubs and trees come from a very complex genus. The branches are flexible with alternate, short petioled, lanceolate, entire or finely serrated leaves with small or conspicuous stipules. The dioecious flowers are cylindrical catkins while the fruit is a one-celled ovule with two-valve capsule containing many tiny seeds with silky down. This exceedingly variable genus usually likes moist areas. The thin bark is prepared in channelled pieces 1 - 2 cm wide and 1 - 2 mm thick. The outer surface is glossy, smooth or slightly wrinkled longitudinally, varying in color between gray, brownish and brownish-yellow to greenish in color. The inner surface is striated, fibrous, smooth, pale-brownish or cinnamon colored. The bark is easily torn longitudinally but transverse breakage is difficult. The transverse section exhibits numerous minute, tangentially arranged groups of blast fibres under a lens. The odor is slight with an astringent to slightly bitter taste.1,2

Micromorphology consists of 2 - 3 rows of cork fiber cells with strongly thickened and suberised, but not lignified, outer cell walls, that bulge outward; no stone cells from phloem, having prismatic crystals of calcium oxalate.1

Habitat, ecology and distribution: In moist area along streams and slight bogs

Part used: bark collected during the growth period from young branches

History: The oldest documentary evidence of the use of Salix is contained in a clay tablet dating from about 700 BC. Besides other Assyrian-Babylonian recipes, it also depicts willow leaves. The analgesic and antifebrile properties of willow bark have been known since the ancient civilizations of India and Egypt. As long ago as 1763, bark stripped from the branches of the willow tree was pulverized and first employed for the treatment of malaria (marsh fever). In the nineteenth century the active agent salicin was first isolated in crystalline form, and soon afterwards salicylic acid was produced synthetically. In 1897 the German pharmacist and chemist Felix Hoffmann had a stroke of good luck: he prepared acetylsalicylic acid (ASA).

Western Materia Medica Salix alba By Terry Willard ClH, PhD Salicaceae

This herb was used by many Amerindian nations for venereal disease, bruises, throat constriction, internal bleeding, and headaches. This herb been used in Europe and the Orient as an analgesic for many centuries. We can find this herb in Gerard (1597), Stone (1763), Dunglison (1839), National Dispensatory (1880), USD 24th edition (1947).

Constituents: Phenolic glycosides (2.5 - 11% very variable between species and by season), salicylates (usually as salicortin, an ester of salicin), salicin, tremulacin; flavonoids (1-4.5%); tannins (8-20%) mostly catechin type. Salicin content: S. alba 0.5 - 1.0%, S. purpurea 6.1-8.5%, S. daphnoides 4.9-8.4%, S. fragilis 3.9 - 10.2% (highest in spring then summer, lowest in winter). Some of the same chemicals can be obtained from various species of Populus and Betula. 2,3 Common assays include salicin by TLC against standard, total salicin by HPLC, TLC screening for individual phenolic glycosides.4

Medical Research: Both chemicals, salicortin and tremulacin, are slowly hydrolyzed in the intestinal tract into salicin. Salicin is hydrolyzed (by micro flora of the intestinal tract) into aglycone saligenin which in turn is oxidized in the blood and liver into salicylic acid. Salicylic acid is the natural forerunner of aspirin (acetylsalicylic acid) and has the same analgesic properties with less side effects and no action on the platelets. The salicylates work as an analgesic by acting on local tissue and associated sensory nerves. They also inhibit prostaglandins in the E2 series as well as the neutrophil action involved in inflammation. Salicin is excreted in the urine as a salicyluric acid acting as an efficient analgesic for urethral and bladder irritability. It has been employed as a short duration bitter, improving digestion and appetite, but can cause constipation if used long term.5,6,7

Though the strength of willow extracts is less than that of ASA, the duration of action is slightly longer.8 One trial has found that a combination herbal product including 100 mg willow bark taken for two months improved functioning via pain relief in people with osteoarthritis. Another trial found that 1360 mg of willow bark extract per day (delivering 240 mg of salicin) for two weeks was somewhat effective in treating pain associated with knee and/or hip osteoarthritis. Use of high amounts of willow bark extract may also help people with lower back pain. One four-week trial found 240 mg of salicin from a willow extract was effective in reducing exacerbations of low back pain.9,10,11

Willow extracts standardized for salicin content are available. The commonly recommended intake of salicin has been 60–120 mg per day. However, newer studies suggest a higher salicin intake of 240 mg per day may be more effective for treating pain. A willow tea can be prepared from 1/4–1/2 teaspoon (1–2 grams) of bark boiled in about 7 ounces (200 ml) of water for ten minutes. Five or more cups (1250 ml) of this

Western Materia Medica Salix alba By Terry Willard ClH, PhD Salicaceae

tea can be drunk per day. Tincture, 1–1 1/2 teaspoons (5–8 ml) three times per day, is also occasionally used.12,13

Toxicity: None found, but excessive doses would not be advisable (as with all salicylates). It is listed in Germany as having a possible salicylate interaction, but no credible reference could be found.

Herbal action: Anti-inflammatory, analgesic, antipyretic, anti-rheumatic, astringent, anti- inflammatory, tonic.

Indications: Muscular, lower back pain, headaches, arthritis.

Contraindications and cautions: ASA is well known to cause GI irritation. This reaction is not common with the natural product willow bark. Salicin passes unchanged through the stomach and is not converted into salicylic acid by intestinal bacteria and is most functional once it reaches the liver and the site of the inflammatory lesion. The risk of side effects is extremely low. Since salicylates compete with uric acid for renal excretion. Willow is contraindicated in the treatment of chronic gout. Although such symptoms are less likely from willow than from aspirin, people with ulcers and gastritis should, nevertheless, avoid this herb. As with aspirin, willow should not be used to treat fevers in children since it may cause Reye’s syndrome.14

Medicinal uses: Dr. Sigrun Chrubasik, a doctor from Freiburg, Germany, practicing general medicine, joined forces with Dr. Elon Eisenberg and other colleagues of the “Rappaport Faculty of Medicine” in Haifa (Israel), and they enrolled in their study 210 patients suffering from back pain.15 The patients were divided into three groups. The first group was treated with willow bark extract in a daily dose of 120 mg salicin, the second group received 240 mg salicin, while the third group – without knowing what was going on – received only an ineffective placebo. The success of treatment was measured by the number of patients who had become pain-free by the fourth week of treatment.

Evaluation of the results by a medical statistician of the University of Heidelberg, Germany, was quite unequivocal: many patients in the high dose group were relieved of their pain after only one week. After four weeks the proportion of pain-free patients in the

Western Materia Medica Salix alba By Terry Willard ClH, PhD Salicaceae

240 mg group were 39 percent, in the low dose group 21 percent, and in the placebo group only 6 percent. An allergic reaction occurred in only one of the patients treated with willow bark.

In the meantime, Prof. Dr. Sigrun Chrubasik had completed a further study of 228 patients. In this study she compared the pain relieving effect of willow bark with the efficacy of the most modern contemporary anti-rheumatic, the selective cox-2 inhibitor rofecoxib. The outcome: “the willow bark extract with 240 mg salicin per day is just as effective as the selective cox-2 inhibitor, but considerably less expensive”. In the scientist’s opinion, because of its more favorable risk-benefit relationship, the willow bark extract should be tried before NSAR drugs or cox-2 inhibitors are prescribed. Prof. Chrubasik: “Willowbark extract is the most potent phytoanalgesic at present available; it not only alleviates pain but also has an anti-oxidative action and, to a lesser extent, a cartilage-protecting action.

Energetics Traditional Chinese (S. babylonica), bitter, cold property, entering the stomach and liver meridians; expels wind, removes dampness, promotes diuresis, removes swelling due to wind-dampness.16

Other

Holmes describes willow as astringent, a bit bitter, cool and dry with secondary qualities of calming, astringing and stabilizing movement. It enters the Bladder, Kidney and Heart meridians, clearing heat and reducing inflammation.17 Tierra lists willow as bitter and cold, affecting the Liver, Kidney and Heart meridians.18

Pharmacy and dosage: Pharmacy and dosage. Dosages Dried bark 1 - 2 g or decocted, tid Extract (1:1 25%) 5-8 ml considered 20 - 40 mg of total salicin

Much milder than aspirin therefore large doses are usually needed.

Official Recognition UK General Sales, Schedule 1, Table A Belgium Accepted for specific indications No. 367 Jan 91 France Accepted for specific indication No. 90/92 Germany Kommission E 1984 5.12.84

Related species: Salix nigra (Black Willow) —Sexual erethism, irritability, and passion; libidinous thoughts; lascivious dreams; nocturnal emissions; mild

Western Materia Medica Salix alba By Terry Willard ClH, PhD Salicaceae

nymphomania, erotomania and satyriasis; cystitis, urethral irritation, prostatitis, and ovaritis, and allied disorders following in the wake of sexual abuse or excesses.

Action and Therapy.—Salix nigra is a remedy of great value in a restricted field in therapeutics. While the bark and its preparations have long been recognized as possessing antiseptic and detergent properties, the use of the aments is of more recent date and confined almost wholly to the generative organs. To be of value, however, only the freshly gathered aments should enter into its preparations to insure medicinal results. Above all other uses, its greatest value is that form of sexual erethism and irritability due chiefly to an irritative condition of the urethra resulting in spermatorrhea, and less in such sexual perversions as give rise merely to physiological losses; nor can it take the place of the knife when losses are due to conditions requiring surgical correction. In well indicated cases it proves to be an effective and valuable anaphrodisiac and tonic. The mental emotions play a lesser part in the disorders requiring salix nigra; but when the genital tract is sensitive, when the bladder becomes involved, and when sexual excesses and masturbation are the causal factors, it is a remedy of first importance. Secondarily, it is not without value where the mentality of the victim is at fault, but will be found to moderate passion and strengthen the reproductive tract when pollutions are the result of sexual intemperance, libidinous thoughts by day, and lascivious dreams by night. (Kings, Felter)

The bark of black willow is recommended as a poultice in gangrene, and as an external application to foul and indolent ulcers and rhus poisoning, in which it stands unrivaled. It is made by simmering the powdered bark in cream. It has also been successfully used in various swellings of the neck. Internally, the root is a bitter tonic, effectual in intermittents. Some have highly recommended it in asthma and gout. At the present day the bark is seldom employed and the aments now furnish the preferred drug. A decoction of the black willow buds or aments, taken internally and applied locally, is useful in gangrene; and drunk freely, it proves to be a powerful anaphrodisiac, suppressing venereal desires for a long time, and also highly recommended in the treatment of spermatorrhoea. This statement, written years ago by Prof. King, has been abundantly verified in the last few years by practitioners of all schools of medicine. The drug is not only an anaphrodisiac, but by controlling genital irritability it becomes a marked sexual sedative and tonic. As Prof. Bloyer has aptly remarked, it is not a remedy for physiological losses, nor is a beneficial action to be expected in cases requiring operative measures at the hands of the orificial surgeon. Its field of action is in those functional wrongs of the reproductive organs that are due largely to the irritability of same parts, and thought to be less due to mental or emotional causes. However, sexual passion from any functional cause is moderated by it, and it is especially adapted to the disorders of the sexually intemperate male or female, and of the youth, subject day or night to libidinous suggestions and lascivious dreams terminating in pollutions, while for those extreme forms of sexual perversion, satyriasis, erotomania, and nymphomania, it is more nearly specific than any other agent. Not only does salix nigra act as a check to

Western Materia Medica Salix alba By Terry Willard ClH, PhD Salicaceae

sexual passion and misuse, but it proves a useful tonic and sedative to many conditions following in the wake of sexual intemperance, among which may be mentioned spermatorrhoea in its varied forms, prostatitis, cystitis, and ovaritis. Specific Salix nigra is the preparation most largely used by Eclectic practitioners, and is to be preferred, for the fresh aments can not be procured at all times for the preparation of the decoction. The dose is from 10 to 60 drops, 3 or 4 times a day.

REFERENCES

1. Corfield, C.E. (ed.), British Pharmaceutical Codex (1934), The Pharmaceutical Press, London, UK, 1934, p. 918. 2. Stille: ND p1248 3. Bradley, P.R., British Herbal Compendium (Volume 1), British Herbal Medicine Association, Bournemouth, Dorset, U.K., 1992, p. 224. 4. Bradley, P.R., Ibid. 5. Bradley, P.R., Ibid.

6. ND p.1248 7. Moore, M., Medicinal Plants of the Mountain West, Museum of New Mexico Press, Santa Fe, NM, 1979, p. 161. 8. . Bradley PR (ed). British Herbal Compendium, vol 1. Bournemouth, Dorset, UK: British Herbal Medicine Association, 1992, 224–6.

9. Mills SY, Jacoby RK, Chacksfield M, Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: A double-blind study. Br J Rheum 1996;35:874–8. 10. Schmid B, Tschirdewahn B, Kàtter I, et al. Analgesic effects of willow bark extract in osteoarthritis: results of a clinical double-blind trial. Fact 1998;3:186. 11. Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: A randomized double-blind study. Am J Med 2000;109:9–14. 12. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 230. 13. Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: A randomized double-blind study. Am J Med 2000;109:9–14. 14. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 230. 15. Chrubasik, Sigrun ; American Journal of Medicine;Vol. 109, No. 1, 1st July 2000, pp. 9-14 16. Hsu, H.Y., Oriental Materia Medica: a concise guide, Oriental Healing Arts Institute, Long Beach, CA, 1986, p. 351. 17. Holmes, P., The Energetics of Western Herbs (2 volumes), Artemis Press, Boulder, CO, 1989, p. 525. 18. Tierra, M., Planetary Herbology, Lotus Press, Sante Fe, NM, 1988, p. 202.

Western Materia Medica Tanacetum Partheium By Terry Willard ClH, PhD Asteraceae

Tanacetum parthenium (syn. Chrysanthemum parthenium) Family Asteraceae (Compositae) Synonyms Featherfew, featherfoil, flirtwort, bachelor's buttons, Pyrethrum parthenium. Description This composite plant has numerous, small, daisy- like inflorescences, consisting of yellow heads and white rays. The central floret is nearly flat (not conical like chamomile). The stems are hairy, about .3 - .7 m tall; leaves alternate, downy with short hairs or nearly smooth — about 10 cm long and 5 cm wide, bipinnafided, with serrated margins, petioles flat above and convex beneath. Feverfew has a bitter smell, being particularly disliked by bees. Pyrethrum, an alternative genus name, is derived from the Greek pur (fire), due to the hot taste of the root. Feverfew is thought to be a corruption of the word febrifuge, from its tonic and fever dispelling properties. Parts Used All aerial parts, but mostly the leaves. Constituents

This plant is rich is sesquiterpene lactones (with α-methylenebutyrolactone structures) specifically parthenolide (0.1 - 0.9%), others including, 3-beta- hydroxyparthenolide, seco-tanapartholides A & B, canin (chrysartemin A), artecanin, epoxyartemorin and others. There are several other sesquiterpenes that are more volatile, such as camphor, farnesene and germacrene as well as monoterpene volatile oils such as pinene, bornyl acetate and bornyl angelate. There is only one species of Feverfew, but the main constituent — parthenolide — varies greatly in the various biotypes. There are some biotypes, e.g. those from Mexico and East Serbia, which have no sesquiterpenes. The Canadian Health Protection Branch states that the concentration should be no less than 0.2 % parthenolides to be recognized for migraine claims. Accurate assaying of this herb is therefore very important.1,2,3,4,5 Published assay methods include parthenolide analysis by HPLC, sesquiterpene lactone identification by infrared spectroscopy. Mode of Action The most well-studied use of Feverfew is its ability to stop or reduce migraine. The exact mechanism has not been worked out, yet what is known is that Feverfew inhibits blood platelet aggregation and secretory activity in platelets and polymorphonuclear leucocytes. The migraine prophylactic action is thought to be due to a serotonin (5-HT) antagonist action, inhibiting its release into the blood, thus

Western Materia Medica Tanacetum Partheium By Terry Willard ClH, PhD Asteraceae

reducing platelet aggregation. This might be due to neutralizing of sulphydryl (thio) groups on specific enzymes that are fundamental to platelet aggregation and secretion. This mechanism is thought to be due to the α-methylenebutyrolane group as this group is known to have anti-inflammatory action. Serotonin is the most important vasoactive amine mediating vascular headaches, while also acting to lower pain threshold. Feverfew has been shown to inhibit prostaglandin biosynthesis, interfering with the action PA2 at the beginning of the arachidonic acid cascade rather than at the cyclo-oxygenase stage. Parthenolide has been shown to markedly interfer with both contractile and relaxant mechanism in blood vessels.6,7 One authority (D Awang) now feels that parthenolide is not the active constituent, or at least not the sole active ingredient, as one study showed no clinical results for migraine when there was adequate amounts of pathenolide.8 The anti-inflammatory action of Feverfew has been demonstrated in clinical settings continuously. This is probably due to inhibition of the release of damaging material from white blood cells in the inflamed area. The inflammatory action of Feverfew has been disputed in a double-blind study on rheumatoid arthritis patients. This study showed little effect. In this study, patients took only small amounts of Feverfew (75 mg dried herb) along with ASA, which may have reduced the effectiveness of Feverfew. The amount of parthenolides varies greatly between ecotypes. Some ecotypes have no parthenolides. This herb depends on the parthenolides as well as possibly other constiuents for its mode of action. Feverfew, therefore, should only be used for the above conditions when these active constituents are of a guaranteed potency. Feverfew is often used in weight lose formula to enhance the function of thermogenis, by blocking c- AMP from epinephrine receptor sites. Therapeutic action Aperient, febrifuge, carminative, bitter, stimulating emmenagogue, tonic, nervine. Energetics Holmes describes it as bitter and a bit pungent with cool and dry properties; with secondary characteristics of restoring, stimulating and relaxing. It enters into the Spleen, Liver, Kidney, Bladder, Chong and Ren meridians. Holmes also suggests Feverfew can be used for treating liver Qi stagnation. It is also used for nervous ailments when there is damp/cold obstruction. 9 Tierra lists Feverfew as bitter, cool and affecting the Stomach and Liver meridian.10 Folklore This herb has been used since the time of Dioscorides (78 A.D.) for fevers, coughs, colds and for wheezing. Gerard (1597) described it as hot and dry noting that it "cleanseth, purgeth or scoureth, openeth and fully performeth all that bitter things can do". John Quincy (1719) used it as an emmenagogue, considering it a `hystericks' for the uterus as well as giddiness. We find scattered uses throughout the ages but few are as specific as what Culpeper said "it is very effectual for pain in the head".11 It has a long history being used for migraine and arthritis as well as nervousness and lowness of spirit due to female complaints. Some of the uses that have been recorded are anemia, earaches, dysmenorrhea, dyspepsia, trauma, and intestinal parasites. The tincture of the extract relieves the pain and swelling caused by insect bites. Feverfew has been used in the garden to control noxious pests, but can also inhibit bees from pollinating nearby plants.12,13,14

Western Materia Medica Tanacetum Partheium By Terry Willard ClH, PhD Asteraceae

Dosage (may vary due to sesquiterpene content) Dried leave or infusion 1 - 2 g Tincture (1:5, 25% ethanol) 4 - 6 ml Fluid extract (1:1) 1 - 2.0 ml Powder solid extract (4:1) 100 - 500 mg Toxicity and Contraindications There has been no toxicity found in the studies observed. This herb has been used for centuries without ill-effect. Some sensitive people have been known to get mouth ulcerations from chewing the fresh leaves. Skin rashes have also been noticed in some sensitive pickers. This herb is contraindicated in the last stage of pregnancy, even though some caution is appropriate for its use throughout the whole pregnancy, because of its ability to inhibit arachidonic acid (necessary for uterine contractions). Official Recognition and Medical References UK No product license granted France Accepted for specific indications ( No. 90/22 bis) Canada DIN available if parthenolide content is above 0.2% PDR for Herbal Medince p. 1171 Escop March 96

References

1. Bradley, P.R., British Herbal Compendium (Volume 1), British Herbal Medicine Association, Bournemouth, Dorset, U.K., 1992, p. 96. 2. Murray M; The Healing Power of Herbs; Prima; Rocklin CA; 1992, p188 3. Tyler, V.E., Herbs of Choice, Pharmaceutical Products Press, New York, NY, 1994, p. 126. 4. Duke, J.A. CRC Handbook of Medicinal Herbs, CRC Press, Boca Raton, FL, 1985, p. 118. 5. Awang, D.V.C., Feverfew, Pharm. J. and Can Pharm J 1989, 122, 266-270. 6. ESCOP Monographs on the Medincinal Uses of Plant Medicne ; Tanaceti parthenii Herba; March 1996 7. Leung, A.Y. and S. Foster, Encyclopedia of Common Natural Ingredients: Used in Food, Drugs, and Cosmetics, John Wiley & Sons, Inc., New York, 1996, p. 246 8. Awang D; Parthenolide: The Demise of a Facile Theory of Feverfew Activity; Journal of Herbs, Spice and Medicinal Plants; Vol 5(4) 1998, 95-98. 9. Holmes, P., The Energetics of Western Herbs (2 volumes), Artemis Press, Boulder, CO, 1989, p. 283. 10. Tierra, M., Planetary Herbology, Lotus Press, Sante Fe, NM, 1988, p. 159. 11. Crellin, J.K. and Philpott, J., Herbal Medicine: Past and Present (Vol. II), Duke University Press, London, 1990, p 209 12. Grieve, M. A Modern Herbal, Jonathan Cape Ltd., London, 1931, p. 310. 13. Murray ibid 14. Duke, J.A. Ibid.

Western Materia Medica Tanacetum Partheium By Terry Willard ClH, PhD Asteraceae