The Four Elements Theory in Clinical Practice by lillian E Stanshury, N.D. lntroduction Treatment and Discussion The elegant and simplistic truth that underlies Four Sheila needed cooling and relaxing therapies. The vas- Elements philosophy appears to transcend cultures, culature was too tight causing hypertension, the skele- healing traditions, and the ages. The following is a tal muscles were too tight causing fibromyalgia, and brief discussion and a few cases to demonstrate inte- the digestive musculature was too spastic, while the grated and updated Four Elements thinking. This dis- acid secretion was excessive but enzyme secretion cussion does not adhere strictly to the classical notion deficient. Now that her menses had ceased, she was no of the Four Elements Theory but rather mixes several longer ridding herself of excess heat, resulting in interpretations of the basic concept for a broad view. symptoms of heat and congested blood. Relaxation, The illustrations are my own but relate most closely to meditation, yoga, and motionlessness were recom- Jill Stansbury anthroposophical philosophy, which itself &aws from mended, and though practiced and cultivated in the the older classical Four Element tradition. The fol- office, were opposite to her nature and difficult to Jlll Stansbury marntains lowing cases are examples drawn from a forthcoming adopt. Herbs with a cooling and moistening effect longer article (Stansbury, Four Elements Theory, One were needed to balance the excess heat and fire. a busy private practice tn Herbalist s Musings, in press). southwest Washington state Over time the following herbs and approaches were most beneficial to Sheila: specia iz ng in botanical and Four Elements Cases A Fiery Constitution nutritional medicine. She also Pancreatin Sheila, a 53 year-old menopausal loved the woman, 3 times daily, 1 with each meal chairs the Botanical lt4ed cine damp, cool northwest weather and preferred the end- Calcium/Magnesium Department at the Nat onal less rain, to the short sunny summer months. When I to per day found she loathed the only two weeks of 90 degree :ypply !,ooolOlsolmO Col ege of Naturopathrc weather we receive, I knew she had found the right Tincture: Equal parts Medicine in Portiand, Oregon. place to live, and I had found a classic fiery constitu- Cimicifuga racemosa Jill writes and ectures widely tion. Rauwolfia serpentina Tilia spp. on the toprcs of herbs and Sheila was thin but muscular, energetic and hard work- Angelica sinensls healing. 5he s a contributrng ing, and was noted by her grown children to have hard- 112lsp 4 times daily ly sat down in their entire childhood. She had a glow- edltor for the lournals ing rosy complexion and an out-going, talkative per- Capsules Nutrition Science News sonality. Sheila's complaints were hypertension, some- Fresh ground and encapsulated, equal parts and Medical Herbalbm, times as high as l70ll02,lifelong insomnia currently Centella asiatica worse than ever, digestive upset with frequent burning Equisetum arvense and writes for many popular pain and belching, and a tendency to constipation. The Urtica dioica hea th magaz nes. She is complaint for which she sought help, however, was 2 pills three times a day the author of the book pains fibromyalgia characterized by tight burning in Tea all her muscles. She was very athletic and active her Herbs for Health and Healing. 2 oz Althea root entire life, and the present muscle pain limited her gar- 1 oz Glycyrrhiza shredded root dening, work, and other activities. Now post- 1 oz Dioscorea villosa rool menopausal, Sheila previously had heavy frequent 4 oz Avena dried oats and straw menses, but had never become anemic. The hyperten- Decoct 2 tsp per cup, drink 3 or more cups a day sion, insomnia, and muscle tightness all worsened around the time her menses stopped. Sheila ate very well but very sparsely, not wanting to spend her time Kava (Piper methysticum) once tried for her sitting down eating, preferring to stay on her feet and fibromyalgia, insomnia, and hypertension, improved busy. She cooked organic foods for herself and partner, her muscle stiffness but caused oral ulceration when mainly fresh fruits and vegetables. She could not toler- taken by tincture, and burning in the stomach when ate spicy foods as they worsened her digestive upset, taken as capsules. Kava is a member of the pepper and quickly caused flushing of her face and hot per- family (Piperaceae) and like spicy foods, kava may be spiration. A single digestive enzyme supplement with too hot for a person with excess heat and fire of the a small amount of HCL immediatelv worsened the digestive system. (Otherwise, kava is one my favored digestive symptoms. herbs for muscle spasticity.) HCl, being a strong acid 46 Spring/Summer 2002 t- Gasc Hrstory -l ! €c itself is a fiery compound and hence worsened her improvements over time. Aloe juice (Aloe vera), gotl sense of peptic burning. Digestive enzymes, on the kola tea andjuice where available (Centella asiatica), other hand, being proteins, have a bufiering effect on and fresh oat milk tinctures and oahneal foods (Avena digestive pH while promoting digestion. By reducing sativa)were also used as moistening, tissue restorative the build-up of "digestive fire" enz)'rnes such as lipase, plants in teas, drinks, and tincture blends and also pancreatin, amylase, might be helpful for a person with appeared to have improved her digestive slmptoms. heat symptoms in the digestive system, as would cool- One might be tempted to give alteratives such as ing, moistening mucous membrane tonics. Ultimately, Taraxicum, Berberis, Rumex, and others to stimulate the enzyme-based supplement Pancreatin was found to digestion, however since these herbs tend to promote be helpful for Sheila's symptoms of digestive burning. HCL and clear dampness, they might further dry out It was as ifall the heat and fire had burned and dried the whole body. out the mucous and other liquid (enzyme) secreting Plants relaxing to the muscles and the mind were also tissues of her digestive mucous membranes, usually indicated. While kava is relaxing to the mind and did one of the more moist parts of the body. improve her sleep and muscle pain, it had to be aban- A tincture of Salvia fficinalis (sage) taken at the time doned as mentioned above. Other considerations for of the menopausal transition worked very well to alle- Sheila include black cohosh, a grounding, nervine for viate hot flashes and excessive heat sensation, but hormonal balancing, but arguably too warm for her. caused dryness of the mouth over time. Salvia has a Rauwolfia is a bold but reasonable choice given her warming and drying nature, and the qualities of fire alarming hlpertension. Being a powerful centrai nerv- are also warm and dry, and when used repetitively ous system depressant, this root was considered appro- worsened the symptoms of fire in this patient. Althea priate for the case. Rauwolfia also possesses terrestri- and Symphytum tinctures used to correct the warming al leaves, leaf rypes that hold themselves horizontally effects of the Salvia, reduced but did not eliminate the and hug the ground. Rauwolfia sedates restless energy problem. and grounds it, while relaxing the vasculature and improving hypertension. Tinctures of Cimicifuga, Moistening herbs possess strong water effects and may Rauwolfia, and Angelica roots were combined with heat and balance excess fire. improve symptoms nervine vasodilator leaves of Tilia, and used effective- roots and fresh leaves (Althea species) soothe Mallow ly for her hypertension and fibromyalgia. burning in mucous membranes. Mallow root tea improved Sheilah constipation somewhat, but did little Earthy, grounding plants such as those high in miner- noticeable for her flashes and upper GI symptoms in als may also balance excess fire. In Shelia's case, min- abut may have contributed to the continued gradual erals, representative ofthe earth realm, could physical- Journal of the American Herbalists Guild 47 ly anchor down volatile energy. Biochemically high Amber would benefit from drying and fluid moving mineral content herbs assist the kidneys in balancing therapies. Strong drying agents to balance the excess water and electrolytes, which may improve her hyper- water include tannins and astringent herbs, and those tension. Furthermore, high mineral content plants may with hot dry tastes such as th1.'me, chaparrel, cinna- improve connective tissue regeneration and improve mon, Geranium, Quercus, and others. Mineral herbs mucous membrane and musculoskeletal repair and help the kidneys in eliminating excessive fluid miner- regeneration. Green leaves are among the most miner- als, and proteinaceous wastes. And according to the al rich plant parts, and nettles (Urtica dioica), horsetail Law of Similars, gritty high mineral herbs are also (Equisetum), gotu kola (Centella asiatica), and oat indicated for hard rocklike swellings and inflamma- straw (Avena sativa) have excellent mineral content. tions in the body. Some of the classic botanical "lym- Capsules of ground nettles, horsetail, and gotu kola phatic herbs" such as Phytolacca, Iris, Ceqnothus, were dispensed to take at 6 "00" capsules of ground Galium, Calendula, Aesculus, neffles and many others dried plant leaves each day. may help move excessive fluid by a variety of mecha- nisms. Some of these mechanisms include: providing A Watery Constitution minerals for the kidneys to spend eliminating wastes. Ambeq a 35 year-old slightly obese woman came in Another mechanism is improving the uptake of tissue for fibrocystic breast disease of a severe variety char- and lymphatic fluids into venous return by moderating aclertzed by frequent large breast cysts in addition to capillary permeability. Those herbs classified as the presence of the more classic chronic fibrocystic "blood movers" or fluid movers in Traditional Chinese Medicine and other energetic include lesions. The cysts occurred once or twice a year, in the systems Angelica sinensis, Leonurus cardiaca, Aesculus hip- lateral porlions of both breasts and were accompanied pocastanum, Ginkgo biloba, garlic and many others.