Author Archives: jcourie

AHP Internship

August 1, 2018 By in Communication, Discernment, Inquisitiveness, Integrity, Internship, Mindfulness, Professional Knowledge, Research, Skills Tags:

For the Summer 2018 Trimester I conducted a 0.5 credit hour with American Herbal Pharmacopoeia.  Under the supervision of the AHP Executive Director Roy Upton I contributed to the upcoming monograph on Anemopsis Californica.  This monograph will serve a complete and critical review of the traditional and scientific literature regarding the efficacy and safety of yerba mansa.   I feel especially lucky to be working on a monograph with AHP because I feel that it is an organization conducting vitally important work for the field of herbal medicine.  My perspective is that there is a direct association between the work that Lloyd, Felter, Scudder and King etc were doing a century ago and the work that AHP is doing now.

Aside from the deliverables, the metrics associated with a quality internship program necessarily center around the opportunities it provides for students to develop the soft skills that will facilitate their transition to professional life.   This internship experience challenged me to continue developing competency in many of the soft skills articulated in as learning goals for the internship.   Four skills that I was able to identify significant self progress in are: Written communication skills, the MUIH value of discernment, critical thinking skills, and professionalism.

While the monograph is ultimately the intellectual property of AHP a small sample of the work I conducted for the internship can be exemplified by this chart of the ethnobotanical use of Anemopsis.

Communities

Reference

Internal Use

Colds

 
Tübatulabal ,
 Maricopa, Pima,
Diné, Luiseño and
  Chumash Pericú
   Chumash and
 southern Paiute

Larsen 1992; Wheeler-
Voegelin 1938; Wyman
and Harris 1979;
Dimayuga et al.;
Russell 1908; Stoffle
and Dobyns 1982;
1983; Timbrook 2007;
Train etal 1974

Dysentery

 
Yaqui and
 Tarumari

Boido 1894

Diuretic

Diné

 
Wyman and Harris 1979

Tuberculosis

Diné, Pima

 
Wyman and Harris
1979; Russell 1908

Gangrene

 
Yaqui and
 Tarumari

Boido 1894

General pain

 
Chumash and
southern Paiute,
    Kumeyaay

Russell 1908; Stoffle
and Dobyns 1982,
1983; Timbrook 2007;
Train et al. 1974;
(Wilken, 2012)

menstrual
   cramps

Costanoan, Ohlone

Bocek 1984

 
Blood purifier

Luiseño and
  Chumash

Gardner 1965; Jepson
1909; Kroeber et al.
1908; Sparkman 1908;
Train et al. 1974

Asthma

 
Luiseño and
Chumash Paiute

Gardner 1965; Jepson
1909; Kroeber et al.
1908; Sparkman 1908;
Train et al. 1974;
Rhode 2002

Indigestion

 
Chumash and
southern Paiute,
    Kumeyaay

Russell 1908; Stoffle
and Dobyns, 1982,
1983; Timbrook 2007;
Train et al 1974;
(Wilken, 2012)

Venereal
 disease

Tübatulabal ,
 Maricopa, Pima
   Chumash and
southern Paiute,
      Hopi

Larsen 1992; Wheeler-
Voegelin 1938;
(Sánchez, 1999)

Emetic

Papago, Pima

 
Castetter and
Underhill 1935;
Russell 1908

Diabetes

 
Tübatulabal ,
Maricopa, Pima

Larsen 1992; Wheeler-
Voegelin 1938

Malaria

 
Yaqui and
 Tarumari

Boido 1894

Topical Use

 
Wounds Bruises
and Sores

Luiseño and
Chumash Yaqui and
 Tarumari Pericú
 Costanoan Zuni,
 Pueblo, Navajo,
  Kumeyaay, Hopi

Gardner 1965; Jepson
1909; Kroeber et al.
1908; Sparkman 1908;
Train et al. 1974
Dimayuga et al.;
Bocek 1984; Curtin
1997; (Wilken, 2012);
(Sánchez, 1999)

Rheumatism

Paiute

 
Train et al., 1974;
Larsen 1992

Gargle

 
Zuni, Pueblo,
    Navajo

Curtin 1997

 

Anemopsis californica flickr photo by wallygrom shared under a Creative Commons (BY-SA) license

Patterns of Growth: Formulation methods

March 1, 2018 By in Evidence-Based Practice, Inquisitiveness, Research Tags:

Very early in the program at MUIH, students are tasked with conducting an individualized evidence based formulation over the course of a trimester.  Once in clinic we conduct the same rigorous formulation but the time it takes is reduced to a few hours at most.  Reviewing and recollecting on the work associated with this initial formulation in Materia Medica I compared with the time it takes to formulate for a client in clinic is one of the most illustrative ways for a student to realize the growth they have experienced throughout the program.  This was the first formulation I generated for another human as part of Materia Medica I

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Pathophysiology of HSV Infections

March 1, 2018 By in Evidence-Based Practice, Inquisitiveness, Research Tags:

What follows is an summary narrative of the pathophysiology of Herpes simplex infections.   While the paper does not contain any direct reference to herbal interventions, it does exemplify the necessity to cultivate a deep understanding of the varying physiologic processes involved in movements away from health.  It also highlights how an integrative perspective necessitates viewing not just the pathophysiology of a disease process but also how that disease process integrates to effect other organ systems.  Furthermore it reinforces the utility of looking at the “Big picture” of diseases and determining how often times they are the result of evolutionary adaptive responses.

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Assessing Literature using the PRISMA statement: NSIADS vs. Curcuma Longa

March 1, 2018 By in Inquisitiveness, Research Tags:

Excluding aspirin, chronic use of NSAIDs is cardiotoxic and nephrotoxic (Curiel & Katz, 2013).  It’s a safe bet that all of us, irrespective of our chosen field, will interact with many clients who use NSAIDs chronically.  Therefore, it is relevant to have an awareness of the literature surrounding the  methods of managing subjective pain that are included to our modalities.

One traditional phytotherapeutic intervention for pain management is turmeric.   From the perspective of western herbalism the assertion that turmeric is effective at pain management is uncontroversial.  The more important question as a clinical herbalist would be, is turmeric safe?  Safety is a critical area where it is incumbent on herbalists to stay appraised of all of current research. 

One summary source on turmeric is a narrative review by Kamala Krishnaswamy MD (Krishnaswamy, 2008).  This review offers persuasive arguments for turmeric’s many uses and indications.  I am including it in case any of you haven’t been part of a discussion of the varied therapeutic properties of turmeric.  Unfortunately, due to its unsystematic nature its validity is low, and since it does not contain a discussion on the safety of turmeric it cannot serve as relevant source on the question of turmeric safety.

A relevant and valid summary source on turmeric is a systematic review entitled “The Safety and Anti-Inflammatory Activity of Curcuimin” (Chainani-Wu, 2003).  This systematic review’s goal was to use electronic searches to compile the literature on turmeric safety.  It did not provide numeric analysis of the findings, but by avoiding this it was able to discuss both in-vitro and both human and animal in-vivo studies in the qualitative synthesis.

Another summary source on turmeric is a meta-analysis entitled “Zingiberaceae extracts for pain: a systematic review and meta-analysis” (Lakhan, Ford, & Tepper, 2015).  In the context of PRISMA, this paper’s reporting is valid with key discussions in each of the typical main sections of a published paper.  Attention is given to the search and selection in the methods section and the results section includes a forest plot.  One key limitation to this paper is that it is not looking exclusively at turmeric, but the entire zingiberaceae family.  The paper is also hampered by a small sample size of relevant papers although the selection criteria which leads to this small sampling is robust and justified.   

In conclusion, all the publications discussed are relevant to the discussion of turmeric as an herbal intervention. But the Systematic Review by Chianani-Wu is valid, generalizable, and relevant to our initial question as to the safety of turmeric as an intervention.

References:

Chainani-Wu, N. (2003). Safety and Anti-Inflammatory Activity of Curcumin: A Component of Tumeric (Curcuma longa). Journal of Alternative & Complementary Medicine, 9(1), 161–168. http://doi.org/10.1089/107555303321223035

http://www.ncbi.nlm.nih.gov/pubmed/12676044

—

Curiel, R. V., & Katz, J. D. (2013). Mitigating the Cardiovascular and Renal Effects of NSAIDs. Pain Medicine, 14(suppl 1), S23–S28. http://doi.org/10.1111/pme.12275

http://www.ncbi.nlm.nih.gov/pubmed/24255997

—

Krishnaswamy, K. (2008). Traditional Indian spices and their health significance. Asia Pacific Journal of Clinical Nutrition, 17 Suppl 1, 265–268.

http://www.ncbi.nlm.nih.gov/pubmed/18296352

—

Lakhan, S. E., Ford, C. T., & Tepper, D. (2015). Zingiberaceae extracts for pain: a systematic review and meta-analysis. Nutrition Journal, 14, 50. http://doi.org/10.1186/s12937-015-0038-8

http://www.ncbi.nlm.nih.gov/pubmed/25972154

A snapshot of my career goals from midpoint in my coursework

March 1, 2018 By in Community, Life Long Learning Tags: 
This is a reflection post from the MUIH course 
Herbal Therapeutics II.  It reflects my perspective
on herbalism and my career goals in herbalism at 
the time. I have chosen to include it in an 
unedited format primarily to provide a juxtaposition
between my goals at that point in the program and 
my current goals as articulated elsewhere on this 
site. I feel that it is insightful to see which of 
my positions have evolved and which are largely the same.

Career goals:

Put simply: I’m going to focus on practicing clinical herbalism at the lowest possible sustainable rate in underserved populations. 

I am also going to process/manufacture and distribute herbal extracts at the lowest possible sustainable rate, ideally at scale in partnership with others who share my priorities. 

Our increasingly damaged and violent planet is reaching a tipping point.  There is much to be done, and being unwilling to compromise on certain concepts is a necessary step to fostering true and lasting change.   Collaboration is a necessary tool for working in a pluralistic society, but there are gradients to collaboration and, for me at least, there are lines I refuse to cross.   

One of the main theses of Marx’s “Capital” is that capitalism is predicated on the presupposition that consumers will act as if they have an encyclopedic and constantly updated knowledge of the real cost of things.  The fact is they never do.  This is the central method by which people are exploited.  The unseen hand is only able to regulate markets in a population of equals, and if there is one thing that characterizes this epoch, it is the ossification and entrenchment of inverse power relationships.   

So despite the inevitable derision of some of my peers and industry leaders, I’m not profiting off the backs of people who have been tricked by repetition and fundamental cognitive bias into thinking that 30ml of herb X is “worth” 15-20 dollars when really it’s “worth” 10 or 6 or even less when it’s produced at scale.   Primates are susceptible to “anchor bias” in many scenarios but none is more exploitative than in pricing for services. 

The challenge should be on me as a clinician and a producer to figure out a way to practice and produce sustainably at the lowest price.   It shouldn’t be on the people who need services and medicine to coming up with an extra money to pay which is in most cases an arbitrarily defined price for the betterment of shareholders or buffer the cost of my startup. 

Basically, my job is to help eliminate suffering and return the planet to balance in any way I can.  So I’m not asking the suffering to pay for my swimming pool, just for my dinner, so I have the energy to practice tomorrow.

I guess its the distinction between business and service.  We have a lot of business “serving” the community, but I think that sometimes service is twisted to mean little better than forcing a kid to say “my pleasure” after they take your order.

Furthermore, this system also functions on the presupposition that capital is spent freely and all choices are equal because all exchanges are equitable in the great equalizing abstraction of exchange value and the “market.” That’s just plainly not the case in health. 

Health choices, especially in vulnerable or exploited populations, are almost always made under some type of duress. 

I’m here on earth to eliminate suffering, the herbal degree and the herbal path are literally a means to an end for me and not the end itself.  I also think as healers we need to go where we are most needed, and the people who really need us, in my experience, are almost always the ones who can afford it the least.

There are many organizations and initiatives which are fairly easily accessible around these topics.  It’s about forming partnerships of like minded people who share similar goals.  The infrastructure for these types of lowest possible cost initiatives has already begun to be established in my local community.

On the Eastern Shore of Maryland there are also opportunities to enhance regional biodiversity.  This is where the ability to work with differing stakeholders that don’t necessarily share the same agendas becomes important.

One method of enhancing biodiversity that is by convincing local large to medium scale farmers to transition a portion of their arable land to medicinal perennial polyculture. 

Farmers in this region face increasingly stringent restrictions associated with stormwater and nutrient runoff management.  The ability to leverage automation at scale is beginning to face pressures such as is increasing incidence of glyphosphate resistance in “weeds” such as the Palmer Amaranth.   

Additionally, the markets for monocropped grain are now global markets, so the local prices are highly sensitive to non local disruptions and surpluses, subsidies prop up a significant portion of our grain industry.

Many of these same challenges face the medicinal herb farmer but are buffered by the very nature of polyculture.  Furthermore, perennial polyculture farming is better capable of absorbing the rising cost of carbon based fuels.   

Farmers who have spent their entire lives working with the earth and operating in the market understand these pressures better than most and all that remains is to make the case to them to dip their toes in the water. 

The best way to do this is through providing successful local examples and recruiting other stakeholders through workshops and a mutual support association.   

A stellar example of this kind of work occurring in other regions is the Appalachian Herb Growers Association (https://appalachianherbgrowers.com/).  This organization is constrained by their funding model of working in the traditional tobacco production counties in VA. 

I want to facilitate the spread of this type of farming on the Eastern Shore by ideally either partnering and working with existing organizations or creating a similar organization for the Shore if the existing organizations are unable for whatever reason to spread to this region

Collaborative Product Development Assignment

March 1, 2018 By in Communication, Ethics, Mindfulness, Teamwork Tags:

One of our many brainstorming sessions

This collaborative assignment with Andrea Miller is an exposition and outline of the typical factors that modern western herbalists account for when formulating according to an evidence based perspective that is informed by traditional use.

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Reflections on Scientific Writing ISCI610B

March 1, 2018 By in Communication, Mindfulness Tags:

Final papers are a recurrent element within academics.  But there are few classes where the final product has external relevance.   In many cases demonstrating competence is the main utility involved in writing papers and any relevance to external parties is secondary.  Of course, from a metacognitive standpoint, all of the artifacts produced as coursework can serve as external indicators of internal development.  But this utility is still within the context of the writing reflecting something about the student as opposed to the student contributing and original discussion that is useful for peers.

This class was different in that the main learning goals were focused on becoming an effective communicator to external stakeholders, specifically in the context of scientific writing.   I think the class was effective at facilitating development in this area.

Science writing is both similar and distinct from other types of narratives.  It is similar in that it relies on competency in the same basic skills associated with any narrative form such as proper grammar.  It is also similar in that scientific writing must be coherent and facilitate reader comprehension.  But scientific writing is distinct because it requires that additional layers of rigor and synthesis be applied to the narrative.  Hyperbole and rhetoric, which are powerful tools for persuasion in other areas of narrative become potential sources for the introduction of bias.   Scientific writing also relies heavily on the passive voice and when done well, directly addresses any limits of research or inconsistencies in research even if they constitute an uncomfortable presence to a clean and tidy discussion.   In this way, scientific writing is more cautious than other types of persuasive writing, but it is also ultimately more honest.

Another way that this course shaped my perspective on writing is the new awareness that elegant writing can be simple writing.  Effective scientific writing needs to actively synthesize complex information and then leverage the reader’s anticipated concept of how information “should” flow to enhance comprehension.  This is distinct from other forms of writing where the emphasis is placed more on producing a comprehensive narrative and expecting the reader to synthesize their own meaning from the text.  Many examples of profoundly important professional writing are, by design, open to many interpretations.  Effective science writing avoids this level of ambiguity and it should be capable of this specificity irrespective of the intended audience.

Despite it’s continued flaws and amateur provenance, I think the small literature review that I completed over the course of this class is an effective example of original science writing.   I think in hindsight, this project served as an important moment in the transition from “writing as student to relay information about myself” to “writing as professional contributing to the global body of science.”   There is a rubicon like element to this transition too.  I have noticed that in the other classes I am taking the way that I write and the way that I use citations has transitioned from one that reinforces my existing bias to one that strives to eliminate it.

I do want to continue building skills related to writing scientifically.  I have decided to participate in the poster symposium and look for other methods of writing scientifically while at MUIH. 

Sample proposed intervention for a Nonspecific Autoimmune Condition

February 28, 2018 By in Discernment, Quality Assurance Tags:

Five years ago client suddenly presented with acute high fever and severe pain leading to hospitalization and severe intervention of high dose steroids. After almost 3 weeks in the hospital and investigation of various diseases she was diagnosed with a non-specific autoimmune condition. She remained on high dose steroids for almost two years, each time she lowered her dose the inflammation increased and she was hospitalized.
After almost two years, she became pregnant at which time she ceased the steroids and had no recurrence of the autoimmune disease while pregnant and 6 months later. After 6 months, she recently had a full recurrence with hospitalization and life threatening inflammation and fever.
Sleeps poorly, 4-5 hours per night and then can’t sleep anymore. Bloodwork reveals elevated liver enzymes. Also concerned about cold hands and feet even when in warm places.

Body Type: Client is observed as fairly deficient woman of average height and weight with typical steroid side effects in her appearance. She appears pale and fatigued, with dark circles under her eyes.
Tongue: pale, glistening with little coat, puffy with scallops. Exercise: no formal exercise, has 2 small children
CV: Hypertension as a medication side effect.
Skin/joints: Joints are painful and stiff at times.
Digestion: Client reports limited digestive tolerance for foods. Reports raw foods, lots of vegetables and o most fruits cause her to have gas, distension, bloating and loose stools. Cannot tolerate fried or oily foods.
Urinary and Respiratory: Nothing notable
Pshyc / Social: Supportive family and colleagues. She is frustrated with her health and lack of
medical care to support her condition.
Medications: methotrexate 2.5mg, prednisone 40mg / day, beta-blocker Herbs and Supplements: none

Client is frustrated with her current health state. Despite getting the best care she can find because of her location and connections within the medical community, she has never gotten better. Life “looks grim” and she can’t imagine how long she can “ live this way”.

 

Gently incorporating walks  is a great first step.  Another idea might be to engage in a class at the Y or Curves or the local gym.  Once recent review proposed a hypothesis that exercise as an intervention could inhibit TNF-α production and increasing anti-inflammatory cytokines.  The mechanism they proposed involved recent recognition of skeletal muscle as an “endocrine organ” which expresses and secretes cytokines which exert endocrine/paracrine effects (Perandini et al., 2012). If she uses the Y she can most likely enjoy use of a sauna which could also prove helpful (Crinnion, 2011). In my limited experience,  people with cold and damp energetics tend to enjoy saunas.

From a dietary standpoint I initially thought that probiotics could be considered a good first choice for a dietary intervention but then I read a 2013 review of the recent literature at that time, and realized that this is actually a controversial subject. The author argued that there was enough evidence of probiotics such as  Lactobacillus casei actually stimulating of T helper mediated immune responses, to warrant caution.  The author did identify studies that showed an anti-inflammatory effect from increased production if interleukin-10 (Özdemir, 2013).

In clients who present with complex conditions like this are probiotics are a good choice to address the food sensitivities and poor digestion the client is experiencing or is the auto-immune imbalance severe enough to warrant caution?

Another dietary change the client could make would be to explore alternatives to soda such as La croix or pelegrino.  To go even further the client might consider exploring alternatives to cold drinks altogether.  Cold drinks suck up stomach chi to keep the “oven” at operating temperature and cause stagnation in the periphery.     Quick prepackaged teas such as morning thunder (caffine), hibiscus, orange zinger, rasberry zinger etc are varied enough in flavor to remain interesting.  I would point out to the client that diet and digestive health are going to play a significant role as allies in her return to balance, she may want to consider a referral to a nutrition specialist for an advanced consultation.

Herbs:

4g Cordyceps sinensis cordyceps dried mycelia powder 2:1

4g Curcuma Longa Turmeric dried rhizome powder

Yogurt with live active cultures

Powders are compounded for client.  Client mixes 4 grams of powder into a serving of the yogurt and eats this B.I.D.  Turmeric is kind of intense this way but this seems more convenient than pills and the powders are ideal for these plants.

Tincture:

6ml Apium gravolens dried seed ethanolic extract 1:2

2ml Smilax spp dried root ethanolic extract 1:2

1ml Zanthoxylum clava-herculis prickly ash fresh bark ethanolic extract 1:2

Formula is compounded for client.  Client takes 3ml of tincture T.I.D. Directly on the tounge or with a small amount of water or juice.

Monthly Cost:

38.40 for the powder

82.20 for the tincture

120.60 Total.

Smilax spp. is a building anti-inflammatory alterative that has exhibited hepaprotective effects in (ethically flawed) animal models.  Flavonoids isolated from Sasparailla have also demonstrated selective suppression of lymphocyte function. Curcuma Longa turmeric, is a pungent drying herb that down-regulates the constitutive activity of NF-kB, decreases expression of NF-kB target genes COX-2 and cyclin D1 and significantly inhibits cellular production of pro-inflammatory mediators TNF-a and NO.  Turmeric also inhibits release of MCP-1 from adipocytes. Apium graveolens is a warming seed that can serve a dual purpose of helping to bring balance to the inflammatory response as well as the digestive process.  Cordyceps sinensis, Dong Chong Xia Cao is a warm cardiotonic adaptogen that is useful as an immunomodulator.  Cordyceps has been shown to modulate cytokyne levels.     Zanthoxylum clava-herculis, prickly ash is a warming and diffusive herb that Traditionally was used for  Chronic rheumtism, deficient digestion and circulation, and pertinent to this client, cold hands and feet (Grieve, 1971) and (Priest & Priest, 1983).

Rehmmmania glutinosa is recommended by Kerry Bone for clients to prevent the suppressive effect of steroid use on endogenous steroids, but it’s contraindicated in excessively damp clients so while it was initially in the formula but I left it out.  I would be interested to know if anyone considers this a mistake, and that it would have been useful for this clien (Bone & Mills, 2013).

Turmeric potentially interacts with the P-glycoprotien substrates and same the CYP450 substrate as prednisone.  Natural Standards lists interactions between immunosuppressants and cordyceps as a moderate risk level but all of the studies are in vitro.   The botanical safety handbook lists cordyceps as interaction class “A” and actually discusses another in-vitro study which explores aqueous extractions of  cordyceps  combined with methotrexate (Nakamura et al., 2003).  Other studies have discussed immune suppressing effects of cordyceps (Chen, Shiao, Lee, & Wang, 1997).   Based on what I know now it seems like cordyceps is appropriate for use in auto-immune conditions.  But then again, this could be a totally aggressive and irresponsible formula for a deep and serious imbalance like this and the equivalent of running around squirting pokeroot 1:1 into the mouths of random neighborhood children.   I have marked cordyceps for further research but it won’t occur in time to be relevant to this weeks discussion so this is the formula I am going with based on the limited materia medica I have internalized so far.   

References:

Bone, K., & Mills, S. (2013). Principles and practice of phytotherapy: modern herbal medicine (2nd ed). Edinburgh: Churchill Livingstone, Elsevier.

Chen, Y. J., Shiao, M. S., Lee, S. S., & Wang, S. Y. (1997). Effect of Cordyceps sinensis on the proliferation and differentiation of human leukemic U937 cells. Life Sciences, 60(25), 2349–2359.

Crinnion, W. J. (2011). Sauna as a valuable clinical tool for cardiovascular, autoimmune, toxicant- induced and other chronic health problems. Alternative Medicine Review: A Journal of Clinical Therapeutic, 16(3), 215–225.

Grieve, M. (1971). A modern herbal; the medicinal, culinary, cosmetic and economic properties, cultivation and folk-lore of herbs, grasses, fungi, shrubs, & trees with all their modern scientific uses. New York: Dover Publications.

Nakamura, K., Konoha, K., Yamaguchi, Y., Kagota, S., Shinozuka, K., & Kunitomo, M. (2003a). Combined effects of Cordyceps sinensis and methotrexate on hematogenic lung metastasis in mice. Receptors & Channels, 9(5), 329–334.

Nakamura, K., Konoha, K., Yamaguchi, Y., Kagota, S., Shinozuka, K., & Kunitomo, M. (2003b). Combined effects of Cordyceps sinensis and methotrexate on hematogenic lung metastasis in mice. Receptors & Channels, 9(5), 329–334.

Özdemir, Ö. (2013). Any role for probiotics in the therapy or prevention of autoimmune diseases? Up-to-date review. Journal of Complementary & Integrative Medicine, 10. https://doi.org/10.1515/jcim-2012-0054

Perandini, L. A., de Sá-Pinto, A. L., Roschel, H., Benatti, F. B., Lima, F. R., Bonfá, E., & Gualano, B. (2012). Exercise as a therapeutic tool to counteract inflammation and clinical symptoms in autoimmune rheumatic diseases. Autoimmunity Reviews, 12(2), 218–224. https://doi.org/10.1016/j.autrev.2012.06.007

Priest, A. W., & Priest, L. R. (1983). Herbal Medication: a clinical and dispensary handbook. London: Fowler.

Professional Project Planning

February 16, 2018 By in Blog, Community, Life Long Learning Tags:

This is my project plan for HRB780 I plan to begin work on it immediately. I plan to solicit collaborators and fellow interested researchers and conduct a literature review of how whole plant based interventions are used integratively with biomedicine for sexually transmitted diseases (STDs).  The narrative review will discuss the the current state of the relevant literature sections that focus on current research findings regarding the use of traditional whole plant therapies as well as the intersection and potential additive and synergistic interactions of herbs and antibiotics. The information compiled in this literature review would be presented as an annotated bibliography, a narrative review focusing on therapeutics, and a poster targeted at other professional herbalists.   Ultimately the narrative review is to be submitted for publication in journals.

Working on a detailed project plan is an empowering experience within the larger curriculum.

Being able to realistically develop an outcome based plan requires demonstrating professional knowledge, evidence based research and analysis, teamwork and communication skills, and a desire to continue learning as one begins building a professional career.   

In this way, it becomes a metric for assessing how well the planner is able to “learn through doing”  that the integration of seemingly disparate skills becomes a central component of working competently as a professional.

Creating SMART based learning outcomes introduces an awareness of the need to divide large projects into discrete tasks; encumber adequate resources to realistically achieve those tasks; and produce professional work that can be completed within a scheduled amount of time.   All of these components are critical elements of working professionally and contributing to meaningful advancement of the chosen field of study.

Using planning tools such as the provided spreadsheet where factors or time, resources, and stakeholders are identified allows one to work on projects of increasing complexity in a meaningful way by developing an ability to view a project as a series of discrete tasks.  This reduces the cognitive load associated determining what needs to be worked on at any given time.  But it also introduces a necessity to remain realistic about the amount of time and resources that need to be allocated for each part of a project.  Time based task lists also build an awareness of the need for focus and discipline in completing projects in one’s professional life.

Selected Bibliography

February 11, 2018 By in Blog, Research, Research
The following list is a selected bibiograpy of texts that inform my clinical practice.
I intend to add hyperlinks to the open material and links to amazon for the books in copyright
Balick, M. J., Weil, A., Mattern, V., & Low Dog, T. (2014). Rodale’s 21st-century herbal: a practical guide for healthy living using nature’s most powerful plants. New York, NY: Rodale.
Balles, T. (2004). Dancing with the ten thousand things: ways to become a powerful healing presence. New York; Lincoln, Neb.: iUniverse, Inc.
Blumenthal, M., Busse, W. R., & Bundesinstitut für Arzneimittel und Medizinprodukte (Germany) (Eds.). (1998). The complete German Commission E monographs, Therapeutic guide to herbal medicines. Austin, Texas : Boston: American Botanical Council ; Integrative Medicine Communications.
Bone, K. (1996). Clinical applications of Ayurvedic and Chinese herbs: monographs for the Western herbal practitioner. Warwick, Qld.: Phytotherapy Press.
Bone, K. (2003). A clinical guide to blending liquid herbs: herbal formulations for the individual patient. St. Louis, Mo: Churchill Livingstone.
Bone, K., & Mills, S. (2013). Principles and practice of phytotherapy: modern herbal medicine (2nd ed). Edinburgh: Churchill Livingstone, Elsevier.
Braun, L., & Cohen, M. (2010). Herbs & natural supplements: an evidence-based guide (3rd ed.). Sydney; New York.: Elsevier Australia.
Braun, L., & Cohen, M. (2015a). Herbs and natural supplements an evidence-based guide. (4th ed., Vol. 2). Edinburgh: Churchill Livingstone.
Braun, L., & Cohen, M. (2015b). Herbs and natural supplements an evidence-based guide. (4th ed., Vol. 1). Edinburgh: Churchill Livingstone.
British Herbal Medicine Association (Ed.). (1983). British Herbal Pharmacopoeia. Bournemouth: British Herbal Medicine Association.
Chevallier, A. (1996). The encyclopedia of medicinal plants (1st American ed). New York : Boston: DK Pub. ; Distributed by Houghton Mifflin.
Conway, P. (2011a). Phytotherapy in context. In The Consultation in Phytotherapy (pp. 1–38). Elsevier. Retrieved from http://linkinghub.elsevier.com/retrieve/pii/B9780443074929000072
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Energetics and pharmacology of sour plant acids

February 11, 2018 By in Blog, Inquisitiveness, Integrity, Professional Knowledge, Research, Research Tags:

Introduction

In the traditional energetic model of western herbal medicine (WHM) one way of conceptualizing energetics is to view them through the lenses of three distinct axes.   One lens is energy production which conventionally covers a gradient from cold, cooling, neutral, to warming, hot etc.  Another lens is tissue density, which ranges from moistening, through balancing, to drying.  A final lens involves tone which comprises concepts such as lax, tense, constricting, relaxing, and nourishing among others (Easley & Horne, 2016; McDonald, 2017).   

An intuitive understanding of energetics still exists at the heart of modern allopathic biomedicine where increasingly sophisticated diagnoses are paired with interventions designed to create increasingly sophisticated opposite effects. This awareness of opposites has been grounded in the logic of energetics since the time of Galen of Pergamum.  Despite the perceived imprecision that modern reductionist perspectives attribute to energetics, they remain a profound a diagnostic method in most traditional and integrative modalities (East Asian Medical Studies Society, 1985; McDonald, 2017).

Varying traditional energetic models differ somewhat in how they address sour botanicals.  In Western herbal medicine (WHM), plant medicines are typically considered cooling, drying, and nourishing (Easley & Horne, 2016).  In Traditional Chinese Medicine (TCM) the five element school considers sour botanicals to be moistening and softening whereas the taste/action school views sour plants as primarily astringent and fluid retaining (Kastner, 2009).

Ultimately, this paper proposes that the energetics attributed to sour plants represent a way to understand the pharmacologic actions provided by the constituents of those botanicals.  This method of understanding can be applied to acidic and astringent constituents biosynthesized at distinct and increasingly complex layers of the shikimic acid metabolic pathway.   Furthermore, the presence of lower pH constituents that trigger sour taste can provide insight into the therapeutic utility of sour plants even if the sour constituents are not the most therapeutically important constituents associated with the plants, as in the case of Schisandra chinensis (Turcz.) Baill.

Molecular perspective on Sour Taste

Our increasingly granular understanding of sour taste transduction (STT) remains imperfect.  While a complete picture of the intracellular response involved in sour taste is still hazy, the current consensus is that STT is mediated through potassium ion (k+) channels.  Specifically, nonselective cation transient receptor potential channels in the polycystic disease family PKD2L1 (a.k.a. TRPP3) and PKD1L3 (a.k.a TRPP1) (Ishimaru et al., 2006). The genes for these polycystins have been identified in both mouse and human genomes (Li, Tian, Sung, & Somlo, 2003).  When the PKD2L1 cells are selectively ablated in animal models, acid induced nerve responses are nearly eliminated (Chandrashekar et al., 2009).

Intracellular acidification also plays a role in the sour taste response. Weak acids can elicit a stronger sour response by diffusing along the lipid bilayer where stronger acids with the same pH are unable to diffuse across the cell membrane.  Ye et. al. explored the differing theories for how cytosolic acidification could impact action potentials in sour taste cells and demonstrated that sour taste cells are excited by the direct blocking of resting k+ currents in PKD2L1 cells (Ye et al., 2016).

The presence of the inward-rectifier k+ channel (KIR2.1) in PKD21L cells was identified as initiator of the pH sensitive k+ conductance up to a point.  KIR2.1 receptors are also present on non-sour taste receptors cells.  The higher density of KIR2.1 on the cell surface of non-sour taste receptors such as TRPM5 creates an insensitivity to intracellular acidification and greatly increases the number of channels that need to be closed to reach the action potential needed for the cell to fire.  So it is not just the interaction of intracellular pH on PKD21L, but also the lower magnitude of k+ current that triggers the sour response. Ye et. al. also demonstrate that in the presence of increased intracellular pH, zinc ion (Zn2+) proton conductance is displayed in PKD21L cells but not in TRPM5 cells.  This leads to the K+ current being blocked in sour taste cells exclusively (Ye et al., 2016).   This coupling of intracellular pH with inhibition of KIR2.1 provides insight into why weak acids are more sour than strong acids at similar ph.

Sour and astringent tastes are frequently conflated and occur simultaneously in a number of sour plants, despite relying on a taste mechanism other than STT, many astringent herbs are frequently classified energetically as cooling and drying with a sour taste such as Camellia sinensis(L.) Kuntze and Hamamelis virginiana L. (Easley & Horne, 2016). From a molecular perspective the sensation of astringency has been shown, unlike sour, to be a combination of the chemosensory and mechanosensory function of the trigeminal (TG) nerve perception of astringent phenols via G Protien-Coupled (GPRC) receptors and mechanical stimulation.  This conclusion was corroborated by results of both in-vitro and in-vivo experiments with plant phenols such as epigallocatechin gallate (EGCG) (Schöbel et al., 2014).    EGCO comprises as much as 25% of dried C. sinensis (Grigoras & Purdel, 2013).

Biosynthesis of phenolic sour and astringent constituents

Sour and astringent plant phenolics are biosynthesized along many increasingly complex points along the shikimic acid metabolic pathway with some exceptions using the acetate and malonate pathways.   This shikimic pathway is not present in Animalia, but many of the acids produced on the shikimate pathway are necessary components in animal metabolism.   This need for exogenous essential acids is one narrative for the convergent evolution of sour taste.

Shikimate biosynthesis gives rise to the citric, phenolic and fatty acids.  These acids share the presence of a carbonyl group (-CO) and a hydroxyl group (-OH).  When these functional groups bond they form a new functional group known collectively as the carboxyl (-COOH) acid group.  Carboxyl groups readily esterify with other hydroxyl groups.  The lower molecular carboxylic acids are also known as “weak” acids in that they are generally less acidic than the mineral acids.  They readily form hydrogen bonds and are therefore highly polar and water soluble.  This solubility leads to high bioavailability in water extractions (Ganora, 2009).  Many of the astringent tannins are further synthesized by reactions involving gallic acid whereas as higher molecular weight sour phenols are synthesized involving reactions involving cinnamic acid (Kennedy, 2014).     

The inclusion of a carboxyl group both in precursor metabolites as well as higher molecular weight phenolic constituents ensures that both low and high molecular weight phenolic compounds are often present in many therapeutic botanicals.  The presence of the arguably simpler carboxyl acids makes them prime candidates for being able to initiate STT by inhibiting both KIR2 and k+ ion receptors on PKD2L1 and PKD1L3 cells.  Similarly, many botanicals with complex phenolic therapeutic constituents such as hydrolyzable or condensed tannins also contain significant amounts of constituents which will trigger either STT or the sensation of astringency.

Chlorogenic Acids

One group of phenolic acids produced early in the shikimic pathway are the chlorogenic acids (CA).  A representative of this group is 3-O-caffeoylquinic acid (3CQA).  It is present in many notably sour plants such as Coffee arabicia L., Camellia sinensis(L.) Kuntze, Cratageus spp., and many of the Vaccinium such as V. macrocarpon Aiton and V. corymbosum L.  Clinical trials of this constituent lend credence to the traditional energetic claims that sour plants can be cooling and drying and relaxing to tissue.

One controlled clinical trial explored the effects of CA on nitric oxide (NO), endothelial function via flow mediated dilation (FMD) and blood pressure in healthy human subjects.  The researchers found a significant reduction in systolic blood pressure (SBP) (−2.41 mmHg, 95% CI: −0.03, −4.78; P = 0.05) as well as diastolic (DBP): (−1.53 mmHg, 95% CI: −0.05, −3.01; P = 0.04).  They did not observe a significant change in FMD or NO levels (Mubarak et al., 2012).   A more recent clinical trial with a wider range of CAs included did observe a higher FMD (p = 0.151), as well as reductions in SBP (p = 0.684) and DBP (p = 0.835) (Ochiai, Sugiura, Otsuka, Katsuragi, & Hashiguchi, 2015).   A third clinical study exploring the effects of CA from green coffee extract found significant reductions in blood pressure (SBP p <0.001, DBP p<0.05) in the intervention group, these researchers propose the possible mechanism may be NO mediated vasodilation (Watanabe et al., 2006).

An inflammatory state with many discrete inputs is implicated in the pathogenesis of liver fibrosis.   Hepatic cell lysis leads to an initial cytokine release which triggers Kupffer cells to release even more cytokines.  Newly activated hepatic state cells also release cytokines as they produce extracellular matrix in response to injury.   Lipopolysaccharides from gram negative bacteria also sensitize liver endothelial cells to produce cytokines.  While gold standard human studies of the effect of CA on inflammation are largely absent from the literature, there are a number of promising in-vitro studies.  CA was found to decrease the degree of hepatic fibrogenesis in-vitro.  It was also found to inhibit the activation of hepatic state cells and decrease the expression of toll-like receptors, nitric oxide synthase and COX-2 and serum levels of tumor necrosis factor, and interleukins 6 and 1B in cell matrixes treated with carbon tetrachloride (Shi et al., 2013).  The effects of CA on hepatic ischemia and reperfusion (H-I/R) was also explored by another team of researchers in-vitro.  Using an animal model CA was found to significantly attenuate serum alanine aminotransferase levels, portal inflammation, hepatocyte necrosis, hepatic lipid peroxidation and inflammatory cytokine levels at doses of 10 mg/kg (2840.4±688.8 U/L, P<.01).   Histologic results produced suggest that CA is a potent inhibitor of the pro-inflammatory protein high mobility group box 1 (HMGB1), TLR, Nuclear Factor Kappa B, and Interferon regulatory factor 1 all of which are significant contributors to the pathophysiology of H-I/R (Yun, Kang, & Lee, 2012).

The cooling, nourishing, and softening effects of CA on human endothelial cells and the promising in-vitro studies pursuant to the liver inflammation argues for the inclusion of botanicals rich in CA when addressing imbalances that give rise to tension and heat in the cardiovascular and hepatic systems.

Epigallocatechin gallate (EGCG)

Oligomeric proanthocyanidins are a class of condensed tannins that form an important group of constituents present in sour botanicals.  They are high molecular weight compounds capable of crosslinking with, and ultimately precipitating, proteins.   The flavan-3-ol EGCG is a catechin of this class that is present in large amounts in Camellia sinensis(L.) Kuntze a notable astringent botanical (Ganora, 2009).  There are an increasing number of human trials exploring the therapeutic effects of EGCG.

One recent study explored the effects of green tea on women with inflammatory lesions associated with acne vulgaris.  Patients in the intervention group were given an extract standardized to 856mg of EGCO and assessed after 4 weeks.  The researchers found a significant reduction in the number of inflammatory lesions (p = 0.46) leading to a lower score on the Cardiff Acne Disability Index (p = 0.28). The researchers also observed significant reductions in total cholesterol levels within the GTE group (Lu & Hsu, 2016).  Another phase II clinical trial explored the efficacy of a topical preparation of EGCG (AverTeaX, Camellix) in reducing the duration and severity of Herpes labialis.  The researchers observed a 50% reduction in episode duration in the intervention group (p=.0016).  They posit the mechanism is a result of EGCG directly binding to lipid membrane proteins (Zhao et al., 2015).    The effect of EGCG on interstitial cystitis has also been explored clinically.  A study published in the Journal of Surgical Research explored the effects of EGCG supplementation in-vivo as well as on cultured cell samples from the same test subjects.  The intervention group experienced significant reductions in total scores on an analog scale cystitis severity assessment tool.  The researchers also explored the effects of EGCG in-vitro on inflammatory markers and observed increased expression of purinergic X receptors and Y receptors in bladder urothelial cells derived from the IC patients.  They also recorded reduced expression of inflammatory markers iNOS, phosphorylated Akt, and NF-kB (Liu et al., 2013).  EGCG has also been studied as a possible intervention in ulcerative colitis.  After 56 days of therapy, 66.7% of the intervention group displayed improved scores on the Mean UC Disease Activity Index (p = 0.03) (Dryden, Lam, Beatty, Qazzaz, & McClain, 2013).

Ultimately, further research is needed.  While these studies involved small populations, and comprised results from both human and cellular models, they do contribute to the mounting evidence that phenolic tannins from a plant that is considered sour and astringent can serve therapeutically by providing pharmacological effects that manifest in cooling and drying actions on both internal and external inflammatory imbalances.  While not covered in this paper, other clinically important sour botanicals that are high in tannins that are considered cooling and drying include Arctostaphylos uva-ursi (L.) Spreng, Hamamelis virginiana L., Paeonia lactiflora Pall, and Quercus alba L. (Skenderi, 2003).

Schisandrins

Lignans form another class of phenolic compounds comprised of phenlpropanoid derived hydroxycinnamyl alcohols.  Some therapeutically important lignans exist exclusively in sour plants, such as Schisandra chinensis (Turcz.) Baill.   While considered to encompass all five flavors, S. Chinensis fruit contains a large number of sour phenolics that trigger STT such as malic, tartaric, nigranoic citric, acidargolic and other carboxylic acids.  Schisandra also contains the higher molecular weight lignans schisandrin, schisandrins A-C, schizabdrols, schisantherins and gomasin A.

An exhaustive review of S. Cinensis was conducted by Panossian & Wikman in the Journal of Ethnopharmacology.  In the review, they outline much of the previous Soviet and post-Soviet era in-vivo research. They summarize evidence that schisandra increases endurance, provides a local anti-inflammatory effect, modulates gastric hypersecretion, as well as reducing the severity of gastric and duodenal ulcers (Panossian & Wikman, 2008).  A more recent review discussed results that provide convergent in-vitro evidence that schisandra lignans are also effective vasorelaxants by activating eNOS activity in endothelial cells, as well as exhibition anti-inflammatory characteristics by inhibiting a number of pro-inflammatory cytokines in myocardial tissues (Chun, Cho, So, & Jeon, 2014).  Similar in-vitro evidence of the anti-inflammatory effects on the hepatic respiratory and neurological system are covered in another recent review (Szopa, Ekiert, & Ekiert, 2017).  Schisandra has also been shown to improve liver function in healthy patients as well as patients with Hepatitis-C (Chiu, Chen, Tzeng, & Wang, 2013; Melhem et al., 2005)   Despite its comparatively recent entry into the WHM materia medica schisandra occupies a clinically important niche. From an energetic standpoint, schisandra exhibits cooling and nourishing properties towards inflamed tissue in many disparate organ systems such as the hepatic, cardiovascular and respiratory systems.

Conclusion

Plant energetic classifications are both elegant and messy.  Therapeutic plants are complex and traditional energetics represents one of the earlier methods of organizing them in a useful manner. Energetic classifications derive largely from the intimate experience and hard work of practitioners who worked with botanicals in a therapeutic context over the last two millennia.   Our increasingly granular understanding of receptor based pharmacology continues to deepen our understanding, and in many cases, these new insights serves to confirm the wisdom of the earlier energetic classifications.

Hopefully, this paper clarifies the link between acidic and astringent plant metabolites of varying molecular weights and the energetic qualities ascribed to them in traditional literature.  This paper also serves as an exposition of one method for approaching therapeutic botanicals based on constituent profile.  “Working backwards” to energetics from a chemical and pharmacological perspective grounded in the constituent’s biosynthetic pathway.  Integrating this modern perspective affords a practitioner the ability to develop a richer understanding of the mechanisms underlying traditional energetics and ultimately inform a more thorough clinical perspective that integrates well with modern biomedicine, to the benefit of the client/patient.

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Ye, W., Chang, R. B., Bushman, J. D., Tu, Y.-H., Mulhall, E. M., Wilson, C. E., … Liman, E. R. (2016). The K+ channel KIR2.1 functions in tandem with proton influx to mediate sour taste transduction. Proceedings of the National Academy of Sciences, 113(2), E229–E238. https://doi.org/10.1073/pnas.1514282112

Yun, N., Kang, J.-W., & Lee, S.-M. (2012). Protective effects of chlorogenic acid against ischemia/reperfusion injury in rat liver: molecular evidence of its antioxidant and anti-inflammatory properties. The Journal of Nutritional Biochemistry, 23(10), 1249–1255. https://doi.org/10.1016/j.jnutbio.2011.06.018

Zhao, M., Zheng, R., Jiang, J., Dickinson, D., Fu, B., Chu, T.-C., … Hsu, S. (2015). Topical lipophilic epigallocatechin-3-gallate on herpes labialis: a phase II clinical trial of AverTeaX formula. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 120(6), 717–724. https://doi.org/10.1016/j.oooo.2015.08.018

Extraction technique effects on constituent profile: Turnera diffusa

February 11, 2018 By in Blog, Discernment, Inquisitiveness, Quality Assurance, Research Tags:

Assume that we are dealing with T. diffusa and not T. umifolia which is a small but significant adulterant in commerce.  The constituent profile for these closely related plants is very distinct (Schäffer, Gröger, Pütz, & Zimmermann, 2013). Let’s also assume a holistic perspective as opposed to a reductionist one (i.e. Galen vs Paracelsus) and grant a-priori that extracting a full constituent profile of the whole plant is the optimal extraction goal for therapeutic use within the modality of modern Western Herbal Medicine (WHM). 

Obviously, the easiest way to get the whole plant is by consuming fresh powdered leaf.

For many people who seek the therapeutic benefits of damiana this is an impractical method.  Ethanolic extractions can extend the life of a product to bring it to a wider market out of season.

Damiana is not in E.S.C.O.P’s monographs or  Hoffman’s “Medical Herbalism”,  In Bone’s “Guide to Blending Liquid Herbs” no discussion of constituents occurs.  In the Commission E monographs it is listed as an “Unapproved Herb.”   It is listed in the 1983 “British Herbal Pharmacopoeia” which states that T. diffusa has 0.5-1% or green volatile oil (which is mirrored in Grieve’s “Modern Herbal”) , 5-7% of a bitter substance, “damianin”, and 3-4% if a mixture of resins, tannins, starch, gum and fixed oils (British Herbal Medicine Association, 1983).    The constituents listed for Damiana in “Herbs and Natural Supplements 4th Edition) are: Alkaloids, flavonoids, arbutin (glycosated hydroquinone), essential oils containing caryophylline, delta-cadinene, beta-elemene and 1,8-cineole,  0.26% tertraphylin and possibly caffine (Braun & Cohen, 2015).  Skinderi corroborates the above, but lists the volitale oil as containing: 1,8-cineole, pinenes, thymol, o-cadinene (Skenderi, 2003).  Potter’s description of the constituent profile is similar (Williamson, 2003).

So a polity of authoritative texts list the constituents of damiana as follows with parts per million (ppm) as referenced from Jim Duke’s ethnobotanical database (Duke, 2016):

 

  • Alkaloids
    • caffeine
  • Phenols
    • Flavonoids
      • arbutin – 7000ppm
      • tannins – 75,000 ppm
    • Glycosides (cyanogenic)
      • tertraphylin B (barterin)
    • Bitter substance
      • damianin – 70,000ppm
    • Terpenes
      • resins (note: resins are composed of more than just terpenes) – 65,000 ppm
      • volatile oil
        • caryophylline
        • delta-cadinene
        • beta-elemene
        • 1,8-cineole – 1100ppm
        • pinenes
          • alpha pinine – 100ppm
          • beta pinine – 100ppm
        • thymol
        • o-cadinene
      • polysaccharides
        • starch
        • mucilage (actually an exopolysaccharide)
        • gum 150,000 ppm
      • protein
        • albuminoids 150,000 ppm

 

The main concern with extraction is ensure that the polarity of the solution is effective to fully extract the constituents. The because of the presence of oils and resins, a supercritical C02 (SCE) extraction stands a chance of getting a fuller constituent profile of these constituents (Ganora, 2009).  An ethanolic concentration of 20% is considered the lowest for shelf stability (Ganora, 2009).   The polysaccharides are typically water soluble.  The glycosides are soluble in water or ethanol, ideally hot.  The terpenes will require a high percentage ethanol solution. The flavinoids are all over the map but glycerin is a useful method for preventing the tannins from precipitating (Ganora, 2009). 

With damiana, as with many plants, any single extraction method is going to come with some compromises.   Lisa Ganora recommends using a medium ethanolic extraction method of 55-65% ethanol (Ganora, 2009).  The BHP calls for 60% ethanol. 

Based on my research and a full constituent assessment, an extraction of 30:10:60 (H20, Glycerite, Ethanol) will create a high polarity solution without being high enough to cause the tannins to precipitate out and take other important constituents with them. This may provide a fuller extraction even if many of the constituents facilitated by the addition of glycerin are not “active”.

So in conclusion:  Whole plant, hot tea, SCE, or a combination of ethanol/glycerin are effective ways of extracting damiana.

References:

 

Bone, K. (1996). Clinical applications of Ayurvedic and Chinese herbs: monographs for the Western herbal practitioner. Warwick, Qld.: Phytotherapy Press.

Bone, K. (2003). A clinical guide to blending liquid herbs: herbal formulations for the individual patient. St. Louis, Mo: Churchill Livingstone.

Braun, L., & Cohen, M. (2010). Herbs & natural supplements: an evidence-based guide (3rd ed.). Sydney; New York.: Elsevier Australia.

Braun, L., & Cohen, M. (2015). Herbs and natural supplements an evidence-based guide. (4th ed., Vol. 1). Edinburgh: Churchill Livingstone.

British Herbal Medicine Association (Ed.). (1983). British Herbal Pharmacopoeia. Bournemouth: British Herbal Medicine Association.

Duke, J. A. (2016). Dr. Duke’s Phytochemical and Ethnobotanical Databases. Ag Data Commons. Retrieved from https://doi.org/10.15482/USDA.ADC/1239279

European Scientific Cooperative on Phytotherapy (Ed.). (2003). ESCOP monographs. [Hauptbd.]: […] (2. ed., completely rev. and expanded). Exeter: ESCOP [u.a.].

Ganora, L. (2009). Herbal constituents: foundations of phytochemistry : a holistic approach for students and practitioners of botanical medicine. Louisville, Colo.: Herbalchem Press.

Hoffmann, D. (2003). Medical herbalism: the science and practice of herbal medicine. Rochester, Vt: Healing Arts Press.

Schäffer, M., Gröger, T., Pütz, M., & Zimmermann, R. (2013). Assessment of the presence of damiana in herbal blends of forensic interest based on comprehensive two-dimensional gas chromatography. Forensic Toxicology, 31(2), 251–262. https://doi.org/10.1007/s11419-013-0186-5

Skenderi, G. (2003). Herbal vade mecum: 800 herbs, spices, essential oils, lipids, etc., constituents, properties, uses, and caution. Rutherford, N.J: Herbacy Press.

Williamson, E. M. (2003). Potter’s herbal cyclopedia: the most modern and practical book for all those interested in the scientific as well as the traditional use of herbs in medicine. Saffron Walden: C.W. Daniel.

Research Summary: Plant based interventions for drug resistant infections.

February 11, 2018 By in Blog, Communication, Inquisitiveness, Mindfulness, Research, Research Tags:

Growing antimicrobial drug resistance is a significant global health problem (Weber, 2005).   There is a need for both novel antimicrobial interventions as well as methods for preserving the efficacy of existing interventions to address this issue.  Clinically, this rise in bacterial resistance has prompted recommendations that allopathic doctors prescribe fewer antibiotics. This in turn, has led to a search for alternatives (MacKay, 2003).  Research using current drug discovery technologies has provided evidence to support the traditional claims for many plant based interventions (Graziose, Lila, & Raskin, 2010).   Garlic (Allium sativum L.) has been used in traditional medicine to treat infections for millennia (Koch & Lawson, 1996).

A recent literature search of controlled clinical trials provided scant and conflicting results on garlic’s efficacy as an antimicrobial. Some trials provide preliminary evidence that garlic is effective against salivary Streptococcus mutans (Chavan, Shetty, & Kanuri, 2010) and chronic oral candidiasis (Bakhshi, Taheri, Basir Shabestari, Tanik, & Pahlevan, 2012).  Yet, an earlier systematic review of controlled clinical trials found that garlic provided no significant effect against Helicobacter Pylori (Martin & Ernst, 2003).   Furthermore, no human trials looking for a synergistic effect between garlic and the existing complement of pharmaceutical antibiotics were found in the literature.  This gap in the literature was unexpected primarily due to an increasing body of basic science on the efficacy of garlic as an antimicrobial both independently and in synergy with existing antimicrobial interventions.

In disk diffusion tests of Candida albicans, the antimicrobials fluconazole and itraconazole combined with Fresh Garlic Extract (FGE) showed greater inhibition zones against multi drug resistant C. albicans than the drugs alone (P<0.01) (Li et al., 2015).   Disk diffusion tests with methicillin-resistant Staphylococcus aureus and the drugs cefoxitin, oxacillin, and piperacillin showed larger inhibition zones (P <0.01) but the factorial analysis showed no positive interaction effects (P>0.05) (Li et al., 2015).   Applying the same test methodology to Pseudomonas aeruginosa resulted in a strong positive interaction between FGE and the anti-microbials cefotaxime & ceftriaxone (P < 0.01) (Li et al., 2015).   Despite larger inhibition zones, the anti-microbials levofloxacin, cefazolin and ampicillin did not show positive interaction effects with FGE on P. Aeruginosa (P>0.05) (Li et al., 2015).

An in-vitro disk/well diffusion study focused on Staphylococcus aureus isolates resistant to ampicillin with a mean minimum inhibitory concentration (MIC) of 24 μg/ml.  In all samples S. aureus showed statistically significant dose dependent increase in the zone of inhibition at FGE concentration 12.5 mg/ml and higher compared with the control (P>0.05).  The addition of 30-60 mg/ml of FGE reduced the MIC of ampicillin to 0.6-1.2 μg/ml (Pillai, Trivedi, & Bhatt, 2013).   Other well diffusion tests with the species Escherichia coli, Klebsiellosis pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Staphylococcus aureus all showed dose-dependent increases (P <0.05) in the zone of inhibition at FGJ concentration of 10% and higher compared to control (Yadav, Trivedi, & Bhatt, 2015).

Based on the increasing body of evidence for garlic’s bactericidal effects, a call for further research is justified.  Research is needed that more fully explores the phytochemical mechanisms that contribute to the possible synergistic effects of garlic with our existing antimicrobial arsenal.  Further clinical trial research is also needed to discover if there are replicable and generalizable garlic interventions that could be relevant to current clinical practice.

    

References:

Bakhshi, M., Taheri, J.-B., Basir Shabestari, S., Tanik, A., & Pahlevan, R. (2012). Comparison of therapeutic effect of aqueous extract of garlic and nystatin mouthwash in denture stomatitis. Gerodontology, 29(2), e680–e684. https://doi.org/10.1111/j.1741-2358.2011.00544.x

Chavan, S. D., Shetty, N. L., & Kanuri, M. (2010). Comparative evaluation of garlic extract mouthwash and chlorhexidine mouthwash on salivary Streptococcus mutans count – an in vitro study. Oral Health & Preventive Dentistry, 8(4), 369–374.

Graziose, R., Lila, M. A., & Raskin, I. (2010). Merging traditional Chinese medicine with modern drug discovery technologies to find novel drugs and functional foods. Current Drug Discovery Technologies, 7(1), 2–12.

Koch, H. P., & Lawson, L. D. (1996). Garlic: the science and therapeutic application of Allium sativum L. and related species (2nd ed). Baltimore: Williams & Wilkins.

MacKay, D. (2003). Can CAM therapies help reduce antibiotic resistance? Alternative Medicine Review: A Journal of Clinical Therapeutic, 8(1), 28–42.

Martin, K. W., & Ernst, E. (2003). Herbal medicines for treatment of bacterial infections: a review of controlled clinical trials. Journal of Antimicrobial Chemotherapy, 51(2), 241–246. https://doi.org/10.1093/jac/dkg087

Pillai, R., Trivedi, N. A., & Bhatt, J. D. (2013). Studies on in vitro interaction of ampicillin and fresh garlic extract against Staphylococcus aureus by checkerboard method. Ancient Science of Life, 33(2), 114–118. https://doi.org/10.4103/0257-7941.139053

Li, G., Ma, X., Deng, L., Zhao, X., Wei, Y., Gao, Z., … Sun, C. (2015). Fresh Garlic Extract Enhances the Antimicrobial Activities of Antibiotics on Resistant Strains in Vitro. Jundishapur Journal of Microbiology, 8(5). https://doi.org/10.5812/jjm.14814

Yadav, S., Trivedi, N. A., & Bhatt, J. D. (2015). Antimicrobial activity of fresh garlic juice: An in vitro study. AYU: An International Quarterly Journal of Research in Ayurveda, 36(2), 203–207. https://doi.org/10.4103/0974-8520.175548

Weber, C. J. (2005). Update on Antimicrobial Resistance. Urologic Nursing, 25(1), 55–57.

FORMULA All Purpose skin support salve With Calendula Comfrey Chamomile and Plantain

February 11, 2018 By in Blog, Discernment, Extracts, Oil, Quality Assurance, Research, Skills, Topical Preparations Tags:

Calendula, comfrey, plantain and chamomile all have a long history of traditional use as skin supporting herbs.  They also share many of the same actions (Wichtl and Bisset, 1994).  The Commission E expanded monograph indicates the use of calendula for poorly healing wounds, bruises, boils and rashes.  Similarly, comfrey is indicated for pain, inflammation contusions and injuries although it is contraindicated for deep puncture wounds.  Plantain is a vulnerary and  anti-microbial and anti-inflammatory.   

The components of the salve are 90.8% Infused oils and ethyl-oil extractions, 9% beeswax and  0.2% Lavandula angustifolia essential oil.  The infused oil formula consists of: 7 parts Calendula officinalis infused olive oil, 6 parts Plantago major infused olive oil,  5 parts Symphytum officinalis sweet almond oil  and 2 parts of Matricaria recutita ethyl-oil extract comprised of M. recutita infused apricot kernel oil with an  of  M. recutita 1:5 60%.

The calendula and chamomile were harvested from my garden in late summer of 2015, dried on racks and stored in amber bottles in a climate controlled room.  The dried organic c/s plantain leaf which originated in Bulgaria, was purchased from Mountain Rose Herbs Lot 22223.  The beeswax is also from mountain rose, Lot# B8589.  The dried organic c/s comfrey leaf which originated in Croatia, was purchased from Starwest Botanicals Lot# 62288.  The M. recutita tincture was produced in January 2016 using the scientific maceration method. The olive and sweet almond oils of unknown origin were purchased from Essential Depot. Their 25 digit batch numbers are available upon request.  The Turkish apricot kernel oil is beauty aura brand with no batch number but an expiration date of 12/1/2017.   The oils were all infused using the “warm digestion method” (Green, 2002, p. 194.)

The ethyl-oil extraction was chosen for chamomile as a method of increasing the quantity of terpenes such as alpha-Bisabolol, matricarin and matricin, the distinctive chamazulene and phenolic coumarins relative to volume of chamomile infused oil in the final product.  These constituents are considered to be anti-inflammatory (Hoffman, 2003) and contribute to chamomile’s vulnerary properties (Braun & Cohen, 2010).   All of these constituents are well extracted in hydroethanolic solutions. The ethanol and water can then be evaporated increasing the levels of constituent in the oil solution.

Organoleptically all of the infused oils embody the energetics of the infused herbs.  The calendula oil is an orange yellow in color indicating a good extraction of the carotenoids and has the aromatic qualities of the flower. The comfrey oil and was an opaque dark green in color  and had the grassy sweet smell of steroidal saponins.  The plantain oil was also an opaque dark green in color and had the distinctive pepper scent of plantain tea.  The chamomile oil was a rich translucent and had the characteristic aromatic and bitter scent of the therapeutic volatile oils and coumarins as well a yellow color tint.  The chamomile oil was translucent.  None of the infused oils had the scent of fixed carrier oil.

To create the salve all glassware and containers were sterilized.  150ml of chamomile was combined with 100ml of M. recutita  1:5 60% in a boiling flask and heated to 130F until the ethanol and h20 have evaporated.  The ethanol was vented during this process.  This yielded 150ml of chamomile ethyl-oil extract.  This was combined with 550ml of the calendula oil, 475ml of plantain oil, 325ml of the comfrey oil and 165g of beeswax shavings.   The mixture was covered, heated to 150F until the beeswax was melted.  The mixture was blended with a stick blender until uniform consistency was reached.  A small sample was frozen to check viscosity of the final mixture.  3ml of lavandula angustifolia essential oil was added and the mixture was stick-blended again.   The  mixture was poured off into containers capped and allowed to dry. After wastage, the yield was approx. 1600ml  13  four oz jars and 2 1oz tins were filled.

The salve is a yellow in color with a slight front scent of lavender and a sweet scent of the combined aromatics of the infused oils. It is initially greasy but ultimately is absorbed leaving a slight sheen on the skin.  I was aiming for a salve without overpowering scent that was on the softer side so it cold be spread on wounds.

Next time I make it I would source higher quality oils, use exclusively almond and apricot oil instead of olive oil. I would also source better jars because some of the blue chipped off during boiling.

References:

Braun, L., & Cohen, M. (2010). Herbs & natural supplements: An evidence-based guide. Sydney: Elsevier Australia

Green, J. (2000). The herbal medicine-makers’ handbook: A home manual. Freedom, CA: The Crossing Press.

Hoffmann, D. (2003). Medical herbalism: The science and practice of herbal medicine. Rochester, VT: Healing Arts Press.

Wichtl, M. and N.G. Bisset (eds.). 1994. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers.

Kudzu Research

February 11, 2018 By in Blog, Inquisitiveness, Research Tags:

Kudzu research

One area of herbal medicine that I find exciting is the stream of new basic research that seeks to explore the actions associated with traditional medicinal herbs.  I think this research is important for a number of reasons.  Clinical herbalists need to have a modern perspective when considering safety of traditional herbs, one example of this is comfrey, the use of which continues to be controversial.   Anotther reason to stay appraised of basic research is that this flow of research serves as the wellspring that ensures that Western Herbal Medicine continues to evolve and grow it’s materia medica.    

Pueraria lobata (Willd.), kudzu is a notorious invasive species in North America.  In the early 1900’s over a million acres of kudzu were planted in the southeastern United States.  Initially as garden ornamentals and later to combat soil erosion where it quickly began to outcompete and kill the local plant species including trees.  The entire southeastern quarter of the United States is considered infested with kudzu.

The silver lining in this story is that P. lobata, also known as gé gēn is both edible and one of the 50 fundamental herbs of Traditional Chinese Medicine (TCM).   In that modality, it has been used for millennia as a heat and toxin dispelling herb that protects the liver and kidney useful for migraine and cluster headaches tinnitus, vertigo and to mitigate the effects of moderate or even excess alcohol consumption.  It’s use dates back to at least the time of Shen Nong’s “Herbal Classic”. 

The isoflavone daidzein (DA) and it’s glucosides puerarin (PE) and daidzin are the current kudzu constituents of active research.

An animal model (and therefore ethically flawed) study produced results that suggest that PE treatment ameliorates renal fibrosis by inhibiting oxidative stress damaged caused by rapid oxidation species induced-epithelial cell apoptosis through modulating the mitogen-activated protein kinase signaling pathways (Zhou et al., 2017).  Another small double blind cross over study found that 1200mg of PE daily altered alcohol consumption in humans, resulting in decreased sip size and number of sips to finish a beer.  Subjects also and took longer to consume each beer and latency to opening the next beer was increased (Penetar et al., 2012).  This alcohol modulating effect was also observed in another small, between-subject, double-blind, placebo controlled study that reported a 34-57% reduction in number of drinks consumed each week in the intervention group (Lukas et al., 2013).

A heartbreaking randomized placebo controlled study assessed the effect of a PE coated dressing on burn victims.  The study found that interleukin-1 levels were decreased and interleukin-4 levels were increased.  Furthermore the pro-inflammatory P2X7 receptor gateway and peripheral blood mononuclear cell concentrations were reduced in the group treated with PE. Overall the inflammation and associated pain involved in dressing changes of burn patients were relieved by PE treatment (Zhang et al., 2013) 

Cytotoxic effects have also been attributed in-vitro to constituents of P. lobata as well. Puerarin 6″-O-xyloside demonstrated anti-tumor effects on the human lung carcinoma A549 cell line (Chen, Chen, Wang, & Zhang, 2016).

While larger studies are needed, in this small sampling of studies we see modern results that corroborate the traditional understandings of kudzu’s nephroprotective, heat dispersing, and anti-inflammatory effects.  There is evidence that backs up kudzu’s use as a modulator of alcohol consumption as well.   Preliminary results of cytotoxic effects of constituents in kudzu are promising as well.  These recent studies are exciting because they recontextualize the narrative around this plant from “folk” wisdom to modern research.  These studies also provide tantalizing glimpses into the wisdom of the traditional Chinese materia medicas and their venerable authors.

References:

Chen, T., Chen, H., Wang, Y., & Zhang, J. (2016). In vitro and in vivo antitumour activities of puerarin 6″-O-xyloside on human lung carcinoma A549 cell line via the induction of the mitochondria-mediated apoptosis pathway. Pharmaceutical Biology, 54(9), 1793–1799. https://doi.org/10.3109/13880209.2015.1127980

Jung, H. W., Kang, A. N., Kang, S. Y., Park, Y.-K., & Song, M. Y. (2017). The Root Extract of Pueraria lobata and Its Main Compound, Puerarin, Prevent Obesity by Increasing the Energy Metabolism in Skeletal Muscle. Nutrients, 9(1). https://doi.org/10.3390/nu9010033

Lukas, S. E., Penetar, D., Su, Z., Geaghan, T., Maywalt, M., Tracy, M., … Lee, D. Y.-W. (2013). A standardized kudzu extract (NPI-031) reduces alcohol consumption in nontreatment-seeking male heavy drinkers. Psychopharmacology, 226(1), 65–73. https://doi.org/10.1007/s00213-012-2884-9

Penetar, D. M., Toto, L. H., Farmer, S. L., Lee, D. Y.-W., Ma, Z., Liu, Y., & Lukas, S. E. (2012). The isoflavone puerarin reduces alcohol intake in heavy drinkers: a pilot study. Drug and Alcohol Dependence, 126(1–2), 251–256. https://doi.org/10.1016/j.drugalcdep.2012.04.012

Ulbricht, C., Costa, D., Dam, C., D’Auria, D., Giese, N., Isaac, R., … Windsor, R. C. (2015). An evidence-based systematic review of kudzu (Pueraria lobata) by the Natural Standard Research Collaboration. Journal of Dietary Supplements, 12(1), 36–104. https://doi.org/10.3109/19390211.2014.904123

Zhang, J., Li, X., Gao, Y., Guo, G., Xu, C., Li, G., … Liang, S. (2013). Effects of puerarin on the inflammatory role of burn-related procedural pain mediated by P2X(7) receptors. Burns: Journal of the International Society for Burn Injuries, 39(4), 610–618. https://doi.org/10.1016/j.burns.2012.08.013

Zhou, X., Bai, C., Sun, X., Gong, X., Yang, Y., Chen, C., … Yao, Q. (2017). Puerarin attenuates renal fibrosis by reducing oxidative stress induced-epithelial cell apoptosis via MAPK signal pathways in vivo and in vitro. Renal Failure, 39(1), 423–431. https://doi.org/10.1080/0886022X.2017.1305409

Sample Health Policy Statement for women’s health/OB/GYN practitioners in a hospital setting

February 11, 2018 By in Blog, Communication, Integrity, Judgement, Professional Knowledge Tags:

Health Policy Statement for women’s health/OB/GYN practitioners of Hospital “X”

A significant number of women use herbal products both during pregnancy and while nursing, there are indications that the use of herbal products is increasing globally (Kennedy, Lupattelli, Koren, & Nordeng, 2016).    

A central component of a patient centered approach to wellness is patient preference.  The hospital also acknowledges that in many cases botanical interventions are a compelling choice compared with pharmaceutical interventions.

When assessing the appropriateness of phytotherapeutic interventions for pregnant or lactating patients the following guidelines are recommended:

  • Patients are advised to fully disclose any supplements or herbs they are taking, and consult with staff member before beginning any new course of herbs during all trimesters of pregnancy as well as during the period the patient is nursing.
  • The quality and provenance of herbs or supplements is a central component of ensuring a comprehensive safety assessment so it is advised that clients disclose the specific products and brands they are using or considering using.  This extends to homeopathic remedies and flower essences.   
  • As a general guideline herb or supplement use during the first trimester is discouraged.
  • There are many routes in which herbs can affect fetuses, newborns, and nursing infants so it is advised that patients fully disclose botanical products and supplements that are taken internally or topically throughout the course of their pregnancy and/or nursing period
  • The hospital is in the process of drawing up a list of common botanical products  that are generally considered safe based on a polity of primary and secondary sources for the following conditions:
    • Nausea
    • UTIs
    • Reflux
    • Iron deficiency anemia
    • Constipation
    • Insomnia
    • Varicosities
    • Hypertension / Preeclampsia
    • Uterine irritability
    • Preterm labor
    • Lactation promotion
  • This list is intended to serve as a tool for Doctors and is not intended to supersede or replace expert medical opinion.

References:

Kennedy, D. A., Lupattelli, A., Koren, G., & Nordeng, H. (2016). Safety classification of herbal medicines used in pregnancy in a multinational study. BMC Complementary and Alternative Medicine, 16. https://doi.org/10.1186/s12906-016-1079-z

Herbs for under 5 dollars a month

February 11, 2018 By in Blog, Community, Ethics, Integrity, Judgement, Skills Tags:

Accessibility, as well as sustainability for me are central concepts in the modality of Western Herbalism.  What follows are some herbs and dosage regimens that would cost under 5 dollars a momnth.   These herbs all have a therapeutic benefit for frequently encountered imbalances. 

MRH = Mountainroseherbs.com

  • Ashwagandah – 453g (MRH) Daily 1g dose .033 a gram or 96 cents a month
  • Celery Seed – 453g for 8.00 (MRH) Daily 2g dose 0.035 a dose, or 96 cents a month
  • Cacao powder – 1359g for 17.00 (Amazon) Daily 1.5g Dose 0.0125 a dose or 56 cents a month
  • Cinnamon – 453g for 11.68 (Amazon) Daily 1g Dose 0.02 a dose77 cents a month
  • Gymnema sylvestre 453g for 9.00 (MRH) Daily 3g Dose 0.05 a dose $1.78 a month

Total herb Cost: 5.03

Ashwagandah is hypocholesteroemic, lowers cortisol, and has been traditionally used as what we now would consider an adaptogen.  Stressed, underserved populations would benefit from a low cost adaptogen.  Dosage varies wildly by source.  1g is probably a minimum therapeutic dose.

Celery seed is has been shown to have anti-inflammatory properties and is useful in the treatment of rheumatism and arthritis.   Dosage starts at 0.5g TID by decoction or capsule (Bone, 2003) and (Braun & Cohen, 2015).

Theobroma cacao is a powerful antioxidant with hyoplipidemic and hypotensive properties (Braun & Cohen, 2015).  The dosage advice varies widely 1.5g is a low therapeutic dose.

Cinnamonium verum enhances insulin sensitivity, and has demonstrated hypoglycemic and anti atherosclerotic activity (Braun & Cohen, 2015.) Dosage ranges from 1 to 4g.

Gymnema exhibits a broad range of therapeutic effects as an effective natural remedy for diabetes, besides being used for arthritis, diuretic, anemia, osteoporosis, hypercholesterolemia, cardiopathy, asthma, constipation, microbial infections, indigestion, and anti-inflammatory (Tiwari, Mishra, & Sangwan, 2014)

Ashwaganda, cinnamon and cocoa can be mixed with oats into a ball with peanut butter or rolled oats and packed for work or mixed into cereal or yogurt in the morning.   All of these powders with the exception of cinnamon because of it’s strong taste can be mixed into pretty much everything without too much trouble.   Cinnamon can be incorporated into dishes that benefit from it as a spice.   The Gymnema and the Celery could be taken as a water extraction and flavored with the cinnamon.   In addition to incorporating these as foods they could be taken directly as powders of put into capsules although with all the delicious ways of using these herbs in foods, capsuling them seems like a waste of time.

References:

Bone, K. (2003). A clinical guide to blending liquid herbs: herbal formulations for the individual patient. St. Louis, Mo: Churchill Livingstone.

Braun, L., & Cohen, M. (2015). Herbs and natural supplements an evidence-based guide. (4th ed., Vol. 2). Edinburgh: Churchill Livingstone.

Tiwari, P., Mishra, B. N., & Sangwan, N. S. (2014). Phytochemical and Pharmacological Properties of Gymnema sylvestre: An Important Medicinal Plant. BioMed Research International, 2014. https://doi.org/10.1155/2014/830285

Spiritual Wellness

June 2, 2016 By in Healing Presence

In many ways, it is easy to find context and maintain a healing presence when the person you are working with has already identified ways that they would like to enhance their wellness.  A clear, oversimplified example of this would be someone who is pre-diabetic asking for salutogenic inputs they can implement. The client, in their resoluteness, is already on the path to wellness.

Spiritual wellness is a wellness input that I initially did now see how I could work with a person on.  Initially in my mind I thought, “Well, they are either spiritual or they aren’t.”  I realize now this was me superimposing my narrative over these concepts.

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Reflections on the learning process and Healing Presence

June 1, 2016 By in Healing Presence

When I try to ascribe a metacognitive narrative to the learning process at MUIH, I keep thinking of Ken Wilber’s model of states and stages.

Patricia Bombard, who maintains a personal site dealing with the evolution of consciousness, provides a succinct summary of the distinction. She writes, “Wilber uses the term ‘states’ to refer to personal experiences of conscious awareness. ‘Stages’ are labels that help us to identify or measure our inner growth and development” (Bombard, 2013). Wilber’s own writing clarifies the distinction between these concepts. He writes in Integral Vision: “Where states of consciousness are temporary, stages of consciousness are permanent” (Wilber, 2007).

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Witch Hazel Dosing Overview.

May 21, 2016 By in Research

Hamamelis Virginiana has an interesting range of doses.  It also excels as a simple.   This research I conducted as part of the HRB 600 coursework at MUIH is an attempt to recognize and articulate complex and multidisciplinary questions and ideas around how to utilize herbal medicine in health and wellness practices.  One of the questions central to the practice of herbal medicine is the question of dosing.  Witch hazel is an interesting plant to discuss because it’s common usage in modern culture is as a distillate which does not contain many of the constituents that made it a popular remedy in the 19th centrury.

Witch Hazel.

Thomson was a big proponent of witch hazel.

Thompson sums up one extreme end of the spectrum by stating, “A tea made of the leaves, is an excellent medicine in many complaints, and may be freely used to advantage” (Thompson, 1825).

Felter advises a dosage of specific medicine Hamamelis should contain 5 to 60 minims or drops (Felter, 1922) which in modern terms is ~0.3ml. – 3.7ml. Notably he does not specify which solvent to use to make the specific medicine.  Michael Moore’s introduction to the SWBS release of Felter’s opus points out that “You cannot translate a Specific Medicine into “tincture” or “fluidextract”. The latter are generic or standard strengths applied across the board to ALL botanicals. A Specific Medicine represented the greatest strength, without degradation, for a particular plant, using anywhere from several to all of the solvents to achieve this” (Moore, 2001).

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Herbcalc 0.1 Beta.

May 21, 2016 By in Blog, Extracts, Research

Herbcalc 0.1 is released for beta testing.

Herbcalc came out of my experiences in HRB622 at MUIH.  It is at it’s essence an attempt to demonstrate my application of rational understanding of extraction protocols, including properties of common solvents (e.g. water, alcohol and oils) and the solubility of various herbal constituents to produce quality herbal preparations.

Please access it here

Its intended to ultimately be a convenient way to conduct the important calculations for ethanolic percolation and maceration as well as oil infusions.

A picture of samuel thomson

Samuel Thomson could have used Herbcalc.

As development progresses, there will be error checking for common errors along with a list of likely constituent profiles based on chosen menstruum.

Additionally a list of references for traditionally  popular and frequently used ratios will be available for commonly used species (example: echinacea)

Finally by the 1.0 release there will be an option to print out a form for inclusion in a medicine making journal that will have the core elements needed to facilitate cGMP compliance for those herbalists concerned with that or rich and detailed journal entries for D.I.Y. practitioners.

The folk method is a noble and storied tradition with a legitimate place in phytotherapeutics, but Herbcalc will serve as a useful tool for those who desire consistency in production,  and a clearer understanding of what the constituent profile is of an extraction they are conducting.

Herbcalc is inspired by the remarkably useful Soapcalc which serves as an invaluable resource to home artisan soap makers.

 

Eyebright and the Ethics of Wildcrafting.

May 20, 2016 By in Blog, Integrity, Medicinal Gardening, Professional Knowledge, Research, Skills Tags:
Eyebright

Eyebright: at risk.

This paper was a result of my work in HRB 622.  But I think it reinforces and demonstrates the learning I acquired in HRB605.  I feel that this paper indicates one method of how to apply traditional knowledge and evidence based data by assessing a variety of plant classification systems, including phytochemistry, botanical, cultural and bioregional, to improve human health.  The comparison of constituents found in eyebright and plantain provides a convincing case for how phytochemistry and evidence based data can inform and build on the traditional body of knowledge that comprises western herbalism.

 

Eyebright and the Ethics of Wildcrafting.

Plantago Major

The Noble Plantain

Wildcrafting is an important component of traditional herbal medicine. Many herbalists would argue that wildcrafting and encountering species in their native habitats is a necessary component in developing a competent and meaningful relationship with with those plants. There is also an argument that as a result of complex mechanisms such as hormesis cultivated plant specimens have the potential of containing a subtly different, and often weaker, constituent profile. Other herbalists will argue that these differences between wild and cultivated plants are negligible in a therapeutic context and the solution to over-harvesting of wild therapeutics is to use only cultivated varieties.

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