Moxibustion, commonly called “moxa,” is one of the methods used in Traditional Chinese Medicine (TCM) where the downy fluff of the leaves of Artemisia vulgaris (mugwort) is burned directly on or near the skin of specific areas of the body. Mugwort is a member of the Asteraceae family. There are many subspecies in China, Japan and the US. It has analgesic, detoxifying, blood-moving and anti-parasitic properties. In moxibustion, mugwort is processed into a fine wool that can be shaped into cones or formed into rolls that burn quickly at a low temperature.

Moxibustion therapy may be even older than acupuncture, with its origins perhaps stemming from an accidental burn from a spark while sitting near an open campfire. At some time over the course of thousands of years, someone is likely to have experienced the relief of chronic symptoms such as arthritic or rheumatic conditions as a result of the exposure to heat. Moxa has been found to be effective for immuno-compromised, deficient diseases. I don’t think there is another treatment modality that surpasses the benefits that moxa can impart for deficiency diseases, especially diseases caused by a hypo-metabolic, Yang-deficient condition.

Types of Moxa

While there are many ways to use moxa, they all can be divided into two categories: direct and indirect. Direct moxibustion is when a small amount of the herb is burned directly on the skin over selected acupoints or areas of the body. Indirect moxibustion uses moxa rolled into sticks burnt and moved over specific points or areas of the body. For the purposes of the general use recommended in this article, I recommend using only indirect moxibustion. 

Another method that is a step between between indirect and direct moxibustion is the use of stick-on moxa. These are individual pre-formed moxa cones fastened to an adhesive base. When lit and applied to the body, these are burned all the way down, depending on the sensitivity of the patient. Because the moxa herb burns out a few millimeters above the skin, it is not likely to cause a burn or blister in most individuals. (There are several different brands of stick-on moxa cones, but the one that I prefer is Chosei-Kyu, Ibuki stick-on moxa.)

Direct, semi-direct stick-on moxa, or indirect moxa produces degrees of sensation depending on the method and intention of the user. One can use moxa to create a generally warming sensation. Or, one can allow it to burn until one briefly feels a sharp zing, which is considered to be energetically the most powerful approach for moxa.

Uses for Moxibustion

From a TCM perspective, both acupuncture and moxibustion exert therapeutic effects through the vascular and neurologic circulatory systems. However, “moxibustion gives as well as moves,” while acupuncture with needles only “moves.” When treating deficient people only with needles, they may be too weak to mount a strong positive response. However, when treating with moxibustion, it not only stimulates circulation but it gives energy in the form of heat to the areas where it is applied.

Moxa is one of the most effective methods to relieve spasm and pain.  There is an active debate between those in the West who advocate ice to prevent and relieve pain and TCM practitioners who feel that moxa is more permanently effective. Personally, I’ve found the latter to be true but if in doubt, one can first apply an ice pack to treat acute pain and later use moxibustion to effect a more lasting result.

Stomach 36

I believe that just as the medicinal properties of common herbs and weeds found in our environment is our birthright, I believe that the use of at least a handful of common acupoints falls into the same category. Today I'd like to introduce you to the most important acupoint on the body, Stomach 36. It is called Tsu San Li, translated as “Leg Three Miles.” The name comes from the ancient belief that one exhausted from walking such a long distance that they don’t feel they can take another step, can stimulate this point and go another three miles. This belief is so firmly entrenched in Chinese and Japanese folklore that in Japan, where walking long distances was simply the way that people got around, one is cautioned to not undertake such an arduous journey with another who did not first stimulate their Stomach 36 point.

Stomach 36 has so many uses that it is sometimes called ”the point of 100 diseases.” It increases energy, stimulates the immune system, warms the body, treats diseases of the legs, waist, nervous and uro-genital systems, allergic and respiratory diseases and generally physical and mental weakness. While moxibustion on this point may be used on someone with mild hypertension, it is contraindicated for use in acute hypertension.

Finding Stomach 36

To accurately locate Stomach 36, measure four fingers of one hand from the bottom of the knee-cap along the outside margin of the fibula. You should notice a depression at this spot and that is Stomach 36. In general each point should be stimulated for approximately 5 to 10 minutes and there should be a reddening of the skin in the area. Watch a demonstration of moxa on Stomach 36 here.

Doing Moxa at Home

Moxibustion can be self-applied. Before beginning, be sure you are in a well ventilated space. Have a match, lighter or candle to ignite the moxa stick, a non-flammable plate to periodically tap the ashes onto, and a bit of tinfoil to wrap around the tip to snuff it out upon completion of the session. The unused portion of the moxa cigar can be reused until it can no longer be held.

After briefly teaching them how to treat themselves, I commonly send my patients home with a moxa stick and directions on how to warm up Stomach 36 or some other select acupoint. This works wonders on patients undergoing severely debilitating treatments such as chemo-radiation therapy. It not only revives the patient’s energy, but with increased circulation and vitality, their body is better able to utilize the intended benefits of such therapies. This can be done once or twice a week and more often if one is suffering from a disease associated with chronic weakness and deficiency.

In moxibustion, burns can occur accidentally or in a some instances deliberately. Believe it or not, this only makes for a stronger treatment. Not that one should begin by inflicting blisters with the early attempts at self-moxibustion, but if by chance one occurs, the immune response that occurs over a small point has a generally positive effect on the immune system overall. A blister should just be kept clean and covered until it naturally heals.

Where to purchase moxa

Llhasa OMS carries all forms of moxa.

Moxa is even available from Ebay. 

Chosei-Kyu, Ibuki stick on moxa.  These are found online and can even be purchased on Amazon at http://amzn.to/13rwqSW

Moxa rolls are also available from various sources including Amazon at http://amzn.to/13rxmH2

If you want to try the nearly smokeless moxa cigars you can find these at http://amzn.to/13rxmH2. The only drawback I see from these is that, being charcoal of the herb, it takes a little longer to light. I recommend using a candle to ignite these.

In my previous blog, I discussed the little-known use of ragweed for allergies. Another herb that can give over-the-counter antihistamines a run for their money is butterbur (Petasites hybridus). About 20 percent of Americans complain of allergies each year, often interfering with normal work and recreational activities. Butterbur, like ragweed, is a member of the Asteraceae family whose abundant pollen wreaks annual havoc on those who are sensitive to them.

A study published in August 2005 in Phytotherapy Research looked at 330 patients who suffered from sporadic hay fever. The study divided the participants into three groups: the first took 8 mg of butterbur extract three times a day; the second took 180 mg of fexofenadine (Allegra), a common antihistamine, each morning, and the last took a placebo.

At the end of the study, both groups receiving active treatment reported a significant reduction in the nasal congestion and itchy, watery eyes most commonly experienced with hay fever. Most strikingly, there was almost no difference between taking an antihistamine or the butterbur extract, except that some taking the antihistamine complained of drowsiness.

Since antihistamines and butterbur work in different ways, study author Dr. Andreas Schapowal of the Allergy Clinic in Landquart, Switzerland, feels that combining the two drugs would be effective. However, no study has investigated how butterbur works in combination with any other drug.

Butterbur: Antispasmodic and anti-inflammatory properties find use in migraines, allergies

The active ingredients in butterbur extracts are petasin and isopetasin. Petasin reduces spasms in smooth muscle and vascular walls, while isopetasin acts on the system that reduces inflammation. Together, the two act as an effective anti-inflammatory drug with potential in treating many ailments. These anti-spasmodic and anti-inflammatory properties have been demonstrated in pharmacological and experimental systems. Butterbur regulates calcium channels and inhibits the synthesis of the enzymes lipoxygenase and cyclooxygenase.

 Efficacy and tolerability of butterbur was demonstrated in two randomized, double-blind and placebo-controlled clinical trials with more than 300 adult patients and in one open trial in 108 children and adolescents.

Petasin also provides an inhibitory action on the leukotriene and histamine. The former is responsible for the allergic reactions in human body, when the blood vessels are dilated and get permeable causing such symptoms as rhinitis and sneezing. The latter causes inflammation and provokes the symptoms of asthma and hay fever. Therapeutic effects of petasin are applicable for such conditions as kidney stones, menstrual cramps, urinary disorders, and gastrointestinal problems (ulcers in particular) associated with muscle spasms and inflammation. In addition, petasin is known to provide hypotensive actions and strenghthen cardiac tissue.

Medical studies have proved that butterbur extract helps both in prevention and treatment of migraine, especially in severe cases and with fewer side effects (e.g. sedative) than in typical headache preparations. This action is supposedly achieved by relieving pressure on blood vessels and affecting calcium channels. An important feature of the herb's anti-migraine action is that it can be used in adolescents and even children. A study published in January 2005 showed that butterbur extract could help to prevent and reduce migraine symptoms better than placebo.

A few studies have implied that the extract may also be useful in treating asthma, bronchitis, and other respiratory disorders. "Three randomized, placebo-controlled studies of the butterbur extract, Ze 339, in peer-reviewed journals should convince anybody of the efficacy and safety of the medication in allergic rhinitis," said Schapowal.

Astralagin and isoquercitrin are flavonoid glycosides found among the other important chemicals in the herb. They provide anti-depressant properties for the human central nervous system.

Also, anti-oxidant and properties associated with butterbur have been noted in several studies.

The most common pharmaceutical form butterbur is being released in is the supplement called Petadolex. These are the butterbur gelcaps produced for relieving migraine symptoms. There are no recorded adverse reactions to the use of butterbur. However, older studies that have not been duplicated showed that butterbur leaf extract may have caused cancer in animals. Therefore it has gradually faded from human use. The compound responsible for this toxic effect, the pyrrolizidine alkaloid, has since been identified, and newer butterbur supplements are made from only the leaves of a plant (roots contain higher levels of the alkaloid) specially developed to be low in the compound. Now experts say that the herb is safe for use. Due to the risk of PA toxicity, butterbur should only be consumed processed and purchased from the authorized dealers. The raw extract should be avoided.

Historical use of butterbur

Butterbur has a long history of use, possibly dating back to ancient times. Related to comfrey and coltsfoot, it was used to treat asthma and sinus infections. In the 16th century it was described as a “plague flower,” presumably because it may have been found effective in treating this disease. Native Americans used butterbur root for inflammation, hay fever and headaches, much as it is used today.

The size of the leaves made it useful as a head cover, which gave the butterbur its derived generic name. Petasus is a Greek word for a broad felt hat worn by shepherds, hence Petasites is the name of the genus. The plant's common name “butterbur” refers to another function of the leaves: they were used to wrap butter for preserving it and keeping it cool. In some cultures seeds of butterbur are believed to have love divination properties and are used for rituals by young women.

Butterbur is native to Europe as far north as Scandinavia, and is also naturally found in some parts of Asia and North America. It is considered invasive and due to its space and light-consuming habits, butterbur grows with no other plants around its leaves. Favoring clay and sandy loam, it is found in meadows, shades by the waterways, flood plains, marshes, and other damp areas.

The rhizome of the plant is considered to possess most of the beneficial properties associated with butterbur.  It contains bitter resinous juice and has an unpleasant taste. Leaves are used for herbal extracts intended to manage allergies.

Useful links

http://www.naturalhomecures.com/members/allergiestreatment.html 

 http://butterburherb.com/en/index.php 

 http://www.chinese-herbs.org/butterbur/ 

Primavera by Sandro Botticelli, circa 1482

Spring conjures images of life renewed, flowery blooms, love and mating. But for one in five people, it means shutting the windows, missed days at work, and the annual pilgrimage to the local pharmacy to pick up allergy medications, antihistamines, decongestants, combination allergy medicines, and anti-inflammatory medications all with a list of possible adverse reactions, precautions and contraindications. The fact that none offers a cure but only relief is of no matter, because when allergies strike it is relief that is so desperately sought.

Common Ragweed, Ambrosia artemisiifolia

If it is relief that you are after, there is an herb that, for many, effectively relieves hay fever-like allergy symptoms within 15 minutes after ingesting. Believe it or not, it happens to be the highly invasive weed, ragweed (Ambrosia artemisiifolia et spp.). Ragweed is ubiquitous in most parts of the country and ironically is itself responsible for 90% of pollen-induced allergies in the United States. Ragweed is also commonly known as ambrosia or bursage. Ragweed is a member of the Asteraceae family, noted for plants that cause allergic reactions in many. Ragweed is the probably the worst and most notorious of all pollen-caused allergies. In fact, with global warming, there is an increase of pollen generated and a concomitant increase in the prevalence and severity of respiratory allergies.

The great founder of 18^th century homeopathy, Samuel Hahnemann (1755-1843), would love ragweed because it lends proof to a fundamental homeopathic principle, which is “like cures like.” While inhaling ragweed pollen causes mild to severe reactions in those who are sensitive, ingesting 5 to 15 drops of a 5:1 strength herbal extract made from the pre-flowering dried leaves relieves hay fever-like symptoms, not only to ragweed pollen but to all tree pollens, cat and dog dander, mites and mold.

The "like treats like" principle has some possible scientific support. In an attempt to find an easier, more efficient and hopefully cheaper alternative to weekly allergy shots, Dr David Skoner of Allegheny General Hospital discovered that putting liquid drops or a rapidly dissolving tablet of an allergen under the tongue controlled Ragweed allergies enough to negate the need for weekly appointments for allergy shots. He posits that the allergens under the tongue travel directly to lymph nodes where the immune system makes the anti-allergen response to lessen sensitivity, “just like the shots did.” Said Dr. Skoner. This was recently reported in Pittsburgh based WTAE Action News on February 28, 2013.

Santa Cruz County, Calif., happens to be rife with a number of allergy causing pollens, chief of which is from the invasive Acacia tree species. As we age, our immune system eventually wears down; in my case, I notice more that my eyes are more frequently itchy, attested to by the number of OTC eye drops I’ve collected. My friend and colleague Ben Zappin introduced me to some of his ambrosia tincture. He said it is also extremely effective against cat dander. Having two cats and two members of my family who don’t feel it is safe to visit because of cat allergies, I decided to give ambrosia a try. It only took 30 drops of the extract to provide within 15 minutes, complete symptomatic relief for an entire day. I now use it on an as needed basis.

How do we know about ragweed's actions on allergies? In fact very little is known either scientifically or by herbalists about the use of Ragweed for hay fever. It is not mentioned in any of the many herbal texts that I have dating back to the 19th century with the exception of William Cooke’s Physio-Medical Dispensatory where it is described as a stimulating astringent for dysentery, leucorrhea, periodic fevers, and other abnormal discharges with no mention of its use for hay fever symptoms.

In his book Medicinal Plants of the Pacific West, the late herbalist Michael Moore, who personally was close to the traditional Central American native uses of medicinal herbs, describes a standard one- to two-ounce infusion of the flowering herb used for head colds, allergies and moderate histamine reactions.

A more extensive discussion is in herbalist Mathew Wood’s Earthwise Herbal. Wood makes the distinction between allergic symptoms to goldenrod (Solidago spp.) and ragweed and describes how a “nip of the leaf, taken at the time of the allergy, will almost always abort such an (allergic) attack,” with characteristic symptoms of “sneezing, runny nose, bloodshot eyes, swollen capillaries in the eyes, itching of nose and eyes, and in long-term reactions of bronchial congestion.” He offers an energetic description: bitter, pungent and slightly astringent. Wood recommends that the fresh leaves fresh be tinctured 1:2 in 95% alcohol watered down to 70%. He recommends giving only one drop initially to determine sensitivity. If there is no adverse reaction or an improvement in symptoms, five to 10 drops be given every two to three hours as recommended by the early 20^th-century Eclectic herbalist John William Fyfe or 15-20 drops by the contemporary herbalist 7Song.

Herbalist Susun Weed writes in her blog post on ragweed: “The (H)ungarian author (Weixl-Várhegyi László) claims that the he harvests the young plants early, while they are small and eats the plant leaves raw and also dries the rest and makes a powder from it to preserve it for later use for culinary purposes.”  This author claimed to receive this information from a pastor in 1973. Weed also mentions an online discussion where participants shared their personal experiences consuming ragweed tincture and tea with promising results.

I found an interesting reference to it on the Pacific School of Herbal Medicine’s Clinical Tidbits page. There it is stated how it is “well known to herbalists, both mainstream and Californian Native/Hispanic.” The article describes how it slows "copious fluid discharge from the eyes and nose usually within fifteen minutes.” 

Why "Ambrosia?"

Why is this herb, generally considered noxious and invasive, given the name “Ambrosia,” a name whose Greco-roman origins means “food of the gods?”  No one seems to know for sure, but a little known fact offers a clue. It seems that giant ragweed (A. trifida) is a highly nutritious and edible plant suitable for human consumption. The seeds of giant ragweed are 47% crude protein, much higher than any cultivated grain. Furthermore, the plants produce a prodigious amount of seed. According to Roger Wells, a certified wildlife biologist and national habitat coordinator for Quails Unlimited, the seeds contain “the highest amount of metabolizable calories, more even than corn, soybeans, wheat, or any other grain that we know.” Giant ragweed is native to America and has excellent soil-binding qualities. Based on studies in Kentucky of archeological sites,  it was cultivated and nurtured some 2,000 years ago for its nutritional seeds by Native American people living in the Mississippi Valley. Perhaps the name “Ambrosia” may refer to these highly nutritious properties of giant ragweed.

How to Make a Ragweed Tincture

With spring being just a few weeks away, many of you may want to make your own Ambrosia tincture. Following is a recipe I found and intend to follow with my initial explorations using this herb:

1. Trim several flowering tops off the ragweed plants and pack them tightly into a wide mouthed glass jar.
2. Fill the jar with the highest proof vodka or liquor you can obtain such as Everclear.
3. Label the jar with the date and name of the tincture using a marker and scotch tape.
4. Store the jar with ragweed and vodka in a cool, dark place for six weeks.
5. Strain and bottle for use.

The above is adapted from Making a Ragweed Tincture.

Before there was any understanding of biochemical constituents, traditional herbal healing systems relied on flavors as indicators of medicinal properties. (Determining the properties and quality of an herb by its taste, color, texture, etc., is called “organoleptic” assessment.) Traditional herbalists have long associated corrective and potent therapeutic value intrinsic to the flavors, as follows:

Sweet – nourishing, tonic
Pungent or spicy --- metabolically stimulating and warming
Salty – affecting body fluids
Sour – Promoting digestion (as with fermented foods)
Bitter – clearing, detoxifying

To these, Ayurveda adds “astringent” as a sixth flavor, while Traditional Chinese Medicine (TCM) adds “bland” another extra “non-flavor,” so to speak.

Flavors are perceived by taste receptors (taste buds) located on the upper surface of the tongue, soft palate, upper esophagus and epiglottis. The taste receptor cells send information to gustatory areas of the brain that influence our predilection or repugnance to certain foods.

Today, we know that the flavors are generally identified with known biochemical constituents. The bitter taste usually elicits a strong repugnance with the intention to protect us from non-nourishing and possibly poisonous substances. Biochemistry associated with the bitter flavor happens to include a large number of constituents with known therapeutic value such as alkaloids, bitter glycosides and so forth.

However, could it be that the bitter flavor itself, apart from its associated constituents, possesses its own intrinsic therapeutic value?

The well known traditional herbal principle of flavors may have found scientific vindication with this recent paper published in the Journal of the Federation of American Societies for Experimental Biology (FASEB) entitled “Extraoral Bitter Taste Receptors as Mediators of Off-target Drug Effects.” Here, a novel hypothesis offers a possible explanation as to why many drugs seem to affect conditions and diseases other than the ones which they are intended to treat:

“(W)e propose that any drug with a bitter taste could have unintended actions in the body through stimulation of extraoral type 2 taste receptors (T2Rs). T2Rs were first identified in the oral cavity, where they function as bitter taste receptors. However, recent findings indicate that they are also expressed outside the gustatory system, including in the gastrointestinal and respiratory systems. . . Bitter-tasting compounds can have specific physiological effects in T2R-expressing cells. . . . If our hypothesis is confirmed, it would offer a new paradigm for understanding the off-target actions of diverse drugs and could reveal potential new therapeutic targets.”

T2R taste receptors found in the gastrointestinal system may provide a rationale as to why and how bitter flavored herbs (often called “bitters” as they are sold in innumerable alcoholic beverages throughout the world) can be used to treat different physiological diseases. T2Rs found in the respiratory smooth muscle system affect breathing and bronchodilation, which may substantiate at least one aspect of how bitter tasting herbs such as wild cherry bark and elecampane are effective for asthma and other chronic and acute respiratory diseases.

Of course, the authors of this study did not set out to make a statement regarding the efficacy of the flavors associated with herbs, but their research may provide supporting evidence for how the flavor of an herb may direct its effects.

From an herbalist’s perspective, a drug may be viewed in terms of its pharmacological action and its overall metabolically heating or cooling energy. There are many implications with all of this; for example, we may not only understand off-label benefits of certain drugs, but we can also appreciate how certain drugs such as antibiotics, corticosteroids and others, while good for a specific disease, may be especially contraindicated and harmful for some patients more than others.

Here it is again – another influenza epidemic claimed to be the biggest in 10 years. We’re bombarded by the usual display of public health officials including TV doctor-personality Dr. Oz all dutifully encouraging the public to rush to get a worthless flu shot.

Yes, I call flu shots worthless (and wrote about this in a previous blog). The most damning evidence regarding the sham flu vaccine comes from industry independent medical research. The now famous Cochrane library study evaluated over 50 different studies and reports evaluating the efficacy of the flu vaccine and concluded at best a possible shortening of duration of the flu by one day. Dr. Mercola argues that these results are hardly worth the risk of probably grossly unnumbered adverse reactions called such as Guillain-Barré Syndrome, which claim approximately 1.6 cases per million vaccinations.

Recently Dr. Oz did a highly controversial show evaluating the efficacy of the flu vaccine. I generally applaud Dr. Oz for his openness to alternative medicine and his highly entertaining popular TV show where he champions an agenda of health and wellness. He assembled four medical experts including the deputy director of the Center for Disease Control (pro-vaccine), two medical doctors, and a colleague, Dr. Peter Joshi. Dr. Joshi made a damning uncontested statement that depending on the study one reads, if anywhere from 35 to 100 people all received influenza vaccine, perhaps only one may not contract the flu. All the others remained silent providing tacit agreement and Dr. Oz was shocked. However, he concluded with his own version of endorsing the influenza vaccine as a ‘Hail Mary’ play while ignoring all the proven evidence of adverse reactions.

He recommended many of the usual precautions -- frequent handwashing, wearing a protective mask, the use of hand sanitizers, limiting the weakening effects of processed foods, refined foods, white sugar, avoiding crowded public spaces, adequate sleep, and so forth. He also mentioned the evidence-based benefit of elderberry juice or syrup.

There are some effective general protocols and treatments for colds and flu and I’m sure you know of many. Below are links to previous blogs written by myself and Lesley over the past few years which will give you our favorite ways to treat and prevent the flu using herbs and diet.

Wind-Chill Colds and Flu: What They Are and How to Treat Them

QUICKLY CLEARING THOSE WIND-CHILL COLDS AND FLU

That Other Flu Rose: Garlic

Dietary Cold and Flu Prevention Tips

An Herbalist's Autumn, plus Herbal Cold and Flu Prevention Tips

Swine Flu: Media hype and a boon to the pharmaceutical industry

Honeysuckle: Taking the Bitter with the Sweet

Ulcerative colitis affects approximately 100 out of 100,000 people in the United States. Genetic disposition and food sensitivities are common causes. The disease can lead to colon cancer and related conditions of irritable bowel disease and ulcerative Crohn’s disease. Conventional western medicine has no satisfactory cure or treatment for these conditions other than steroids or surgery, but a simple thousands-of-years-old herbal formula with no adverse side effects, broad health benefits, and cheap cost can give relief and possibly even cure when other approaches fail.

Making the distinction between ulcerative colitis disease, irritable bowel disease or ulcerative Crohn’s disease is not so simple. Crohn’s disease, regarded by some as an auto-immune condition, can cause ulceration and problems throughout any part of the GI tract from the esophagus to the anus. Further, Crohn’s may be accompanied by arthritis and symptoms of depression.  Irritable bowel disease and ulcerative colitis involve only the large intestine. Irritable bowel disease manifests as abnormal symptoms of pain, cramping and other disorders but without inflammation and bleeding. Ulcerative colitis, however, is associated with pain and bloody diarrhea.

Recently I had a long-time patient revisit with severe symptoms of chronic ulcerative colitis. This condition afflicted him and his sister for years, suggesting a genetic component to the disease. His symptoms of pain and bloody diarrhea were so extreme that oftentimes he had to suffer from the embarrassment of not being able to make it to the toilet in time.

This man, who appeared strong and fit in all other ways, was in his late 20s to early 30s. He was a vegetarian, adept at yoga, formerly highly successful in a start-up computer company venture, and had no arthritis or depression symptoms, ruling out Crohn’s disease. He did, however, exhibit the severe bleeding, diarrhea and pain characterized by advanced and severe ulcerative colitis.

Over the course of my 40-year practice I had only one other patient with such a severe case of UCD, I was unable to affect a cure with this woman, who eventually moved to Los Angeles and underwent first steroid therapy and finally colon surgery, which are the two primary modes for conventional western treatment.

While western herbal medicine has very limited approach to such chronic conditions, Traditional Chinese Medicine (TCM) does offer a number of possible approaches and formulas for treatment based on a differential diagnosis of a number of symptoms and patterns. Applying these principles, I was able to achieve temporary success in helping this manyto gain control of his condition. However, for various reasons such as cost and accessibility, these were not always available or convenient.

Due to the extreme and frequent loss of blood, reported an uncharacteristic low energy and possible anemia. He also had extreme cold sensitivity which caused me to suspect from a TCM perspective a condition of Spleen Yang Deficiency. I was able to convince him over time to include more animal protein in his diet to help him regain his strength. Though he felt markedly better, neither this nor a number of other self-imposed changes such as a diet free refined sugar, dairy, soy and wheat had an affect on his ulcerative colitis.

Although acupuncture and moxibustion proved to be temporarily effective, it was clear after many treatments that this was not to be a lasting cure.

Triphala

Nearly 20 years ago, I was singularly responsible for introducing the Ayurvedic formula Triphala into the western herb industry. Because of its broad benefit for cleansing the liver and entire GI tract and the fact that its three ingredients, consisting of emblic (amla), beleric (bibhitaki) and chebulic (haritaki) myrobalan fruits correspond to the three humours of Ayurveda, Triphala has risen to become the top-selling formula in the Planetary Herbal line. Indeed, because Triphala is known to detoxify the entire body without causing any weakness or dependency, it is the foundation herbal treatment for all conditions in Ayurveda.

One of the common indications for Triphala is chronic constipation. It is the only formula I have found to be effective for laxative-dependent constipation. Despite the fact that Triphala has such a normalizing effect on the intestines and is good for constipation, it is not considered a laxative by Ayurvedic physicians. In fact, it is considered to be equally effective for treating diarrhea as well as constipation; even so, I was always reluctant to prescribe it when patients had diarrhea, let alone as a primary treatment for chronic ulcerative colitis.

Once again this man, recently returned from Hawaii (he always did best in warm climate), came to my office without an appointment, desperately seeking relief for symptoms of pain and out-of-control bloody diarrhea.

This was on a Friday evening and with not much time I decided to give him Triphala capsules. Not certain this would be enough to remedy his condition I instructed him to drive to Berkeley and purchase bilva (also known as bael) fruit, a known Ayurvedic treatment for diarrhea and dysentery, to take together with Triphala.

We made an appointment to see each other again on Monday.

On Monday afternoon he came in for his appointment grinning from ear to ear and said he was symptom free. As it turned out, he was unable to get to Berkeley and purchase the herb I suggested so on Saturday he commenced taking 9 “00” sized capsules constituting several grams of triphala powder daily, three or more times throughout the day. By the end of Sunday and Monday, the pain, the bleeding and diarrhea stopped completely.

He continues to take lower maintenance doses of Triphala daily. Because Triphala is widely available either in powder (churna) capsule or pill form, it offers the benefit of at least preventing all symptoms of ulcerative colitis and possible long-term cure of this dreadful condition.

Furthermore, one of the fears of colon cancer that can occur with long term ulcerative colitis is mitigated with Triphala’s anti-cancer properties. Last, but not least, the three fruits of Triphala are nutrient dense and impervious to the effects of aging and heat, and constitute one of the richest source of life-affirming antioxidants. This is why Triphala is prescribed to all patients by Ayurvedic doctors and it is why traditionally it is regarded as a household item throughout India.

Triphala is the most prized formula of India’s 5000-year-old Ayurvedic tradition. The origin of its fruits, especially Haritaki (Chebulic myrobalan) is steeped in lore with it being the single cure-all botanical depicted on Tibetan thangkas as being held in the hand of the Medicine Buddha. Only as one begins to understand the profound healing virtues of this formula can one understand the common folk saying of Indian people: “No mother? No worry so long as you have Triphala.”

To learn more about irritable bowel disease, Crohn’s disease and Triphala I encourage you to check out the following sites:

The Wonders of Triphala By Michael Tierra

Triphala by Jim English

The Benefits of Triphala by Tilottama Chatterjee

Ayurveda for Ulcerative Colitis

IBD And IBS Have Similar Symptoms -- How Can We Tell Them Apart?

Books:

The Way of Ayurvedic Herbs by Michael Tierra and K.P. Khalsa (Lotus Press)

Ayurvedic Medicine by Sebastian Pole (Elsevier)

Ayurveda: The Divine Science of Life by Todd Caldecott (Mosby)

The Ayurvedic Encyclopedia by Swami Sadashiva Tirtha (AHC Press)

A few months ago, I found myself asking the question that so many of my students and colleagues were polite enough to not ask me:

“What is an herbalist, author of multiple best-selling books and articles on natural healing, mentor to an entire generation of healers, doing walking around with a pot belly and some 40 to 50 pounds of life-threatening flab?

The truth is, I had tried on numerous occasions to lose weight using various well known methods, including fasting. Fasting certainly works as any caloric reduction would, but the problem is the almost uncontrollable urge to eat anything and everything, especially after completion of a fast. It’s the old ‘action-reaction’ law that haunts everything we try to do.

Basically, whatever one has to say about weight loss, and evidently judging from the plethora of books and experts out there, that’s a lot, it all boils down to caloric restriction and raising one’s metabolism; in other words, less food and more movement.

But there is one more vitally important aspect to weight loss, one that has been the unique aspect of the Weight Watchers method: the psycho-emotional component. It was in September 1961 that Jean Nidetch, an overweight woman from Queens, NY, called a group of friends to share her obsession of eating freshly baked cookies. It was from this that she realized that the most effective keys to weight control was not only the types and amount of foods that one eats but the mental aspects of “empathy, rapport and mutual understanding” that precedes all other measures. Her discovery resulted in a personal 70-pound weight loss and the beginning of one of the most effective weight control organizations in the world. Jean began by turning her weekly cookie eating fests to weekly support gatherings to encourage and help fellow dieters to lose weight and feel healthier. The key was gentle and supportive, personal and collective accountability. With that philosophy at its core, Weight Watchers was organized as a company in 1963.  Instead of counting calories that went into the thousands each day they developed a system of counting only a limited number of points – an important psychological approach that makes the whole thing a lot more practical than counting calories.

Depending on one’s starting weight a fixed number of points is allotted for each day. In order to keep weight loss balanced, and to prevent rebound so that the loss is permanent, the number of points allotted for each day during the weight loss phase continues to slightly diminish as one loses weight. Because many consider Weight Watchers not simply a weight loss method but weight maintenance one as well, when one reaches one’s target weight range, the formula changes to allow more points for weight management. It is at that stage that one can solicit Weight Watchers for free lifetime membership.

Previous to Weight Watchers, I would start a diet program and then find that I was getting nowhere because I always managed to eat more than I needed since I didn’t realize how much that extra slice of bread or ice cream indulgence really cost me in terms of my ability to lose weight. So I failed and gave up.

Next there were the restrictive diet regimes, many if not all of which I know intimately and well, either from personal experience or the countless numbers of patients I’ve supervised over decades. Such programs definitely work for awhile but again the pendulum swings back and before we know it we have driven ourselves insane following some rigid fad dietary regime that denies us access to our favorite foods. This drives to the other end of dietary insanity, where we find ourselves putting on the pounds with beer, pasta, cake, pies, candy, you name it.

Weight Watchers’ success is in the realization that strictly in terms of weight loss, along with food quantity, it is not so much what we eat but how much accountability we keep to others and ourselves.

The funny thing is, I knew that Weight Watchers worked because I tried it several years ago and had indeed lost weight. The problem then was that it was inconvenient to keep a handwritten daily diet diary and making sure that I ate within the personally allotted daily point allowance based on my weight. Nowadays, they still have personal calculator that one can purchase to be sure one stays within the daily allowance, but I personally found that downloading and using the Weight Watchers online app for iPhone (and other smart phones), together with the handy bar scanner where one could scan a product’s bar code to get the number of points for a serving of any packaged food makes the process of weight loss like a game based on the choices I make and am willing to make throughout the day.

Rather than ruling out an indulgence of that wonderful aroma of baked flour, fat, sugar and cinnamon that wafts to my senses between flights in airports, I can look up the points for the Cinnabon and see that yes, I could eat it, but it will cost me an entire day’s worth of 30 points to do so, and isn’t really worth it.

In addition to knowing how many points I am allowed to consume and the convenience of logging these on my iPhone app, what makes Weight Watchers really work for me is going to the weekly weigh-in sessions, which take about 45 minutes each week. So far as I’m concerned, all three components have been an essential part of my commitment.

One of the common complaints about Weight Watchers has been that previously it did not emphasize healthy eating as much. Attempting to maintain its fundamental approach that allows one to eat or drink anything so long as they remain within the point allowance, in recent years Weight Watchers evolved a Points Plus system. This identifies a category of pure, nutrient dense, whole foods in a recommended category of “Power Foods.” Consuming more of these foods leads to greater satisfaction, less hunger and greater health. For example, a cup of rice, whether it is white or brown, is still 5 points. Since it is always about making smart choices, one may choose whether a half cup at approximately 2 points or so together with a high protein food such as an egg, also at 2 points, would be a better and more long lasting satisfying choice. Weight Watchers also allows a limitless amount of vegetables and within reason fresh fruit point-free and they encourage five servings of these daily which goes a long way toward feeling satisfied while losing weight. Because many mistake the need for food with the need for water, Weight Watchers recommends 8 to 10 glasses of water daily. I don’t think this takes into account the increased tendency towards frequent urination that occurs for many as they age.

Often when I counsel patients on diet I ask them to keep a diet diary. Each time they bring it to me I tell them how their food choices may sabotage their efforts to heal. I then began to consider that what was good for the goose just might be good for the gander (me). Serendipitously, this occurred just at the time when I read a study published in the August 2012 edition of the American Journal of Preventive Medicine¹. It was a sizable study involving 1,685 overweight or obese U.S. adults ranging from 25 years and older that found that people who kept food diaries and were only encouraged to eat a healthy diet and keep physically active were able to shed almost 13 pounds on average. According to the senior investigator, Victor Stevens, PhD, senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore., “those who kept food records six days a week -- jotting down everything they ate and drank on those days -- lost about twice as much weight as those who kept food records one day a week or less.”

Much like Weight Watchers, accountability, rather than whether someone ate too much sugar or not enough whole grains or vegetables, was the major reason for the success of this approach to weight loss. This was further emphasized by the fact that these subjects were also required to meet weekly in groups to share their food diaries and brush up on skills like how to judge portion size.

Somehow this rang a bell for me and it didn’t take long for me to reconsider Weight Watchers, the only systematic approach to weight loss that I had tried and achieved a measure of success.

As an Italian, my dietary Achilles' heel is pasta. On New Year’s eve, Lesley and I went to dinner at our favorite newly opened local Italian restaurant (for those of you who live in the Santa Cruz area it’s called Casa Nostra and it happens to be located in my hometown of Ben Lomond). Knowing that we were going to dinner that evening, I had only one meal that day: an 8-point breakfast of whole grain cereal, banana, blueberries, lycii berries, walnuts (the best appetite appeaser), and non-fat milk. This left me with 27 points for the evening, enough to accommodate an uncharacteristic indulgence in a superb marinara meat lasagna. It so happened that theirs was not so much smothered with high calorie cheese but with beef so to my taste the consistency, the health value and the points were better. If I didn’t have so many points to spend, I would have had to consider halving the serving for a meal the next day, instead, I was happy to indulge my epicurean propensity and eat their full portion. When I tabulated the points I found that of even this at best only took up perhaps 12 to 14 of my 27 points remaining. This left room for our stopping after a movie at another excellent local German restaurant (Tyrolean Inn) for their most exquisite warm apple strudel even topped with a dollop of whipped cream!

The next morning I awoke, meditated, got to the bathroom scale, and was delighted to learn that I didn’t gain weight from my on-the-town foray of the previous night. In fact, I even lost a tad. This was even before getting on the elliptical rider, which I alternate with a daily two-mile jog and some weight resistance training and yoga. Besides the self-esteem that many associate with a thinner body, there is the real benefit of the ability to enjoy life more fully. One of my greatest satisfactions is that I can now do all the yoga asanas I once used to do some 20 or so years ago.

And oh, I forgot to tell you how much weight I have lost over five-month period – a whopping 30 pounds! At the young age of 73, I’m rapidly approaching my new weight goal, which may be close to what I was in my late teens. By the way, about four months ago I gifted one of my grown children a Weight Watchers membership and she just let me know that she’s lost 19 pounds to date.

Above: Michael Tierra before (left), and after (right) Weight Watchers

So if you are into making another New Year’s resolution to shed the pounds, I suggest that you consider joining Weight Watchers online and attend the local weekly meetings for at least the first three months. I think the further accountability and the ongoing support from others who are on the same path is well worth the modest expense.

So there you have it! I’ve given you all my new year’s advice for the big question that many have at this time - how to lose weight in this year. May you be as successful and feel as good.

Hawaii is the endangered species capital of the United States, according to paleoecologist David Burney, author of Back to the Future In the Caves of Kauai (Yale, 2010). Closely associated with the work of the National Tropical Botanical Garden (NTBG), Burney and his wife, Lida, also an archeologist, have spent over three decades studying ancient sites around the world looking for answers to the question, “What is it about human arrival in any place that is so inevitably troublesome for nature?” Since 1992, their focus has been the Makauwahi Cave, an ancient volcanic sinkhole adjoining Mahaulepu Beach on the south shore of the island of Kauai, the oldest of the Hawaiian chain. Here they asked, “What has happened there in recent millennia and might happen in the near future, and what can this tell us about the rest of the planet?”

When I was first told about the work at this site by a guide at the nearby Allerton and McBryde Gardens, I was only mildly intrigued. What’s the big deal excavating an area that at most was only occupied by humans for 800 to 1,000 years, and before that no large mammals, and limited plant life? How could anyone get excited about the tedious work of taking deep core samples of earth to sift through in search of bone fragments from extinct birds, shells from extinct snails, and plant pollen also from extinct plant species? But, at the prompting of my guide, and as the cave was located within only five miles of the place where I was staying for three weeks, I purchased an autographed copy of Burney’s book at the NTBG shop.

Several times I would pick up the book and try to get enthused about its contents. Finally, I decided to go on a day excursion with Lesley to visit the cave site. Our concierge didn’t even know about this ‘famous’ place; rather, she pointed us to a more well known cave along the highway 50 miles distant in Hanalei. We looked at the book and said, “Nope, that can’t be it.” In fact, Makauwahi cave was on a nearby horse ranch adjoining our favorite beach. Once part of a huge sugar cane plantation, it was now only accessible along bumpy dirt washboard roads (“Shh! don’t tell the car rental company!”).

After navigating a few especially deep ruts, we came to a place that we thought might be the site described in Burney’s book. This was confirmed when we saw a small sign and a wayside stand with a free guide-map for a trail around the path of the cave. The only other inquisitive folk joining us on the tour were a wonderful family of Japanese.

Indeed the trail was wonderfully marked and the pamphlet informative enough as we hiked along. In the near distance I could see the inviting white sands of Mahaulepu Beach, our ultimate destination. In the meantime we circled the periphery of a deep sinkhole with digging and excavating equipment and deep holes scattered along its sides. This was indeed a perfect place for the sands of time and seas to sweep in and around; there was even a small inlet stream with a swampy area and small bridges conveniently placed for our easy crossing. Considering that Burney was unable to secure funding from the NTBG and wound up raising money to complete this project himself, I offered silent thanks for a job truly well done.

What caught my attention and impressed me most besides the breathtaking vista of a huge crater with mountains circling what was once a mammoth sugar cane field was that the area surrounding the cave was planted with endemic Hawaiian species matching the ancient plant fragments and spores that Burney and company unearthed in the cave below. He is actually trying to ‘rewild’ this area, as it is called in paleoecology terms, by weeding out non-endemic species and planting threatened native plants. An elaborate irrigation system was in place to allow these plants to get started, but will eventually be removed so things can thrive naturally as they once did over 1,000 years ago.

David Burney calls the cave a “poor man’s time machine.” So this is what is meant by the title of his book! I laud his attempt to make his book sound as exciting as “Raiders of the Lost Ark” (which it isn’t,), but the title serves wonderfully the idealistic vision embodied by a noble enterprise -- one that we can all hope will catch on and endure not only on Kauai, but also on other places around the globe as we begin to take the threat of global warning seriously. The excavation and subsequent ‘rewilding’ of Makauwahe Cave and its surroundings can, in the meantime, serve as a place where visitors can experience what it may have been like before humans came to inhabit the land.

It is obvious that David Burney’s adventures in the dark muck of eons of silt, sand and debris is intended to serve as a model of what we as humans, the one species most responsible for devastating nature wherever we have set foot on this planet, can do to make amends and return it to the wild splendor of its prehuman past.

Photos by Michael Tierra

Most herbalists have learned that preparing several herbs in a formula which are extracted together or brewed into a tea causes the infinite number of biochemical constituents to interact and to some extent alter so that a formula has the potential of becoming more than the sum of its parts.  In particular, Traditional Chinese Medicine (TCM) is largely based on the use of time-honored complex herbal formulations.Underscoring this practice is the understanding that the most effective treatment is when both the “root and branch,” that is, the presenting symptoms and underlying constitutional imbalances that give rise to them, are attended to with the various components of any of thousands of different TCM formulas. This is only true to a simpler or lesser extent with the practice of Western herbal medicine.

Western Simpling versus Eastern Formulating

The great late 19^th century North American Eclectic herbalist Dr. John Raymond Scudder wrote an important book entitled “Specific Medicines” where such renowned North American herbs such as goldenseal (Hydrastis canadensis), Echinacea (Echinacea angustifolia) and black cohosh (Cimicifuga racemosa), to name only three, are described in terms of their specific uses and doses. In turn, the great herbal pharmacist John Uri Lloyd of Lloyd Bros. Pharmaceuticals produced outstanding alcohol-based extracts of these herbs, and these were widely used and sold throughout the country. Extracts of single herbs like those created by Lloyd supported the mono-herb therapeutic practice called “simpling.” Modern herbal product lines continue to make extacts of single herbs, easily found in health food stores around the country, and thus the practice of simpling is still common today. Because rows and rows of such single herb extracts are so visible on store shelves, the general public has yet to develop an understanding of the superior therapeutic results a well-crafted herbal formula can produce.

One herb taken repeatedly (unless it is a tonic such as ginseng) is limited in its scope of action and unable to attend to the principle of ‘root and branch’ described above. There is also a greater risk of adverse reaction in the event that some latent toxic reaction to an herb becomes apparent. Western herbalists, including myself, are still dismayed by the liver toxicity, genuine or not, reported when people take herbs such as comfrey, kava or ephedra (often for non-traditional reasons), ultimately resulting in these herbs being banned from commerce. TCM and Ayurvedic formulators neutralize or lessen the toxicity of some herbs either by prior preparation or by carefully combining them with sweet herbs and substances such as licorice, jujube dates, honey or ghee.

This is not to say that professional Western herbalists do not prescribe complex formulations, but with very few exceptions, these are strictly according to individual need and do not achieve the longevity and durability that similar TCM formulas have.  As examples of classic formula building blocks that have stood the test of time, any Chinese herbalist knows that Four-Substance Decoction (Si Wu Tang) consisting of the roots of dang gui (Angelica sinensis), peony (Paeonia lactiflora, bai shao), rehmannia (Rehmannia glutinosa, shu di huang) and ligusticum (Ligusticum chuanxiong, chuan xiong) is for Blood deficiency and can be modified in numerous ways to treat any condition associated with Blood and circulation. Similarly, Four Gentlemen (Si Jun Zi Tang) consisting of ginseng (Panax ginseng, ren shen), atractylodes (Atractylodes macrocephela, bai zhu), poria (Poria cocos, fu ling) and licorice (Glycyrrhiza uralensis, zhi gan cao) is for Qi deficiency and is also subject to countless variations and permutations. These are some of the most famous, and but there are many more like them in Chinese herbal medicine. In Ayurveda, the formula Triphala, consisting of three myrobalan fruits each addressing the excesses of each of the three Ayurvedic humours, is perhaps, in my estimation, the single greatest formula of all time and finds itself embedded in most Ayurvedic formulations as well as prescribed separately as part of a healing program for all patients. No such formulas can be found in Western herbal practice.

Dui yao formulation

Many of the therapeutic goals of an entire TCM formula can come down to the use of two herbs, or dui yao (dui means “two” and yao means “herbs”). In this way large complex formulations can be created based on individual root imbalances and branch symptoms by incorporating specific herb pairs. The increased scope of efficacy of two herbs, rather than one, for a particular condition or symptoms promises a better, more wholistic, healing result. There are many reasons and ways two herbs are mated to interact with each other.  One is pure synergy where both have a similar purpose. Another is complementary where one herb has a primary function, while the other either facilitates that function or counterbalances any possible negative reaction.

Western herbal medicine does have a few such ‘unofficial’ combinations such as echinacea and goldenseal for infections. Dr. Christopher, an exponent of the cayenne (Capsicum spp.) metabolic warming school of Western herbal medicine, recommended combining cayenne, an irritating stimulant, with olive oil to lessen its burning qualities. His 19^th century predecessor, the iconoclastic Dr. Samuel Thompson, frequently combined cayenne with bayberry bark (Myrica cerifera) and ginger (Zingiber officinale) in the famous Composition Powder Formula to achieve a synergistic internal metabolic heating effect which often turned the tide of many acute upper respiratory diseases.

Following are a number of simple Western dui yao or two-herb possibilities that can be considered for effective and efficient formulation:

• Parsley root (Petroselinum crispum) and gravel root (Eupatorium purpureum) for urinary stones
• Elderflower (Sambucus nigra) and yarrow (Achillea millefolium) for colds and flu
• Oregon grape (Mahonia spp.) and wild yam (Dioscorea villosa) for liver and gall bladder complaints
• Dandelion root (Taraxacum officinale) and burdock (Arctium lappa) for detoxification and blood purification; cancer
• Uva ursi (Arctostaphylos uva ursi) and cherry stems (Prunus avium) for cystitis
• Hawthorn (Crataegus monogyna) and motherwort (Leonurus cardiac) for cardiovascular disease
• Gravel root and marshmallow root (Althaea officinale) for urinary stones
• Yerba santa (Eriodictyon californicum) and mullein (Verbascum thapsus) for upper respiratory congestion
• Thyme (Thymus vulgaris) and California poppy (Eschscholtzia californica) for coughs
• Red clover (Trifolium praetense) and burdock root for cancer
• Valerian (Valeriana officinalis) and hops (Humulus lupulus) for insomnia
• California poppy and valerian for insomnia
• Angelica root (Angelica archangelica) and gentian (Gentiana lutea) for digestive disorders
• Slippery elm (Ulmus fulva) and Marshmallow root for gi tract ulcers
• Cascara sagrada (Rhamnus purshiana) and rhubarb (Rheum spp.) for constipation
• Sassafras (Sassafras spp) and sarsaparilla (Smilax spp.) for joint pains
• Black cohosh and blue cohosh (Caulophyllum thalictroides) for menstrual irregularities
• False unicorn root (Chamaelirium luteum) and cramp bark (Viburnum opulus) or black haw (Viburnum prunifolium) for infertility and threatened miscarriage.

Following are some classic TCM dui yao combinations:

• Ginseng and atractylodes for deficient Qi
• Astragalus (Astragalus membranaceus, huang qi) and dang gui for anemia
• Licorice and peony for gastric pains
• Poria and Alisma (Alismatis orientalis, ze xie), for dampness and fluid retention
• Fermented herbs (shen chiu) and hawthorn fruit (shan zha) for digestive weakness
• Ophiopogon (Ophiopogon japonica, mai men dong) and prepared rehmannia for yin deficiency
• Bupleurum (Bupleurum falcatum, chai hu) and white peony for anxiety and mood disorders
• Boswellia  and myrrh (Commiphora spp., mo yao) for rheumatic and arthritic pains

In Ayurveda, the principle of herb pairs is illustrated in the many different guggul formulations. Guggul is a special preparation of Commiphora mukul, which is very closely related to and possibly interchangeable with myrrh. Guggul is deeply detoxifying and is commonly combined with the Triphala. The all-purpose guggul variety is Yogaraj guggul, and it is effective for circulatory conditions, joint pain and stiffness, high cholesterol, thyroid and low metabolism. Other herbs may be added to create various guggul preparations specific for the urinary tract, respiratory conditions, and others. (To my knowledge, the only company carrying an excellent specialty line of various guggul preparations is Banyan Botanicals.) In the western world, guggul is primarily sold because of its ability to lower blood lipids. In my opinion, while guggul is effective for this, only using it for this purpose sells it far short of its potential. It has a much wider application as an anti-inflammatory for a variety of rheumatic aches, pains and strains for which it is a virtual panacea. Sometimes it will show a benefit after one or two doses, but for best results take the indicated dose two or three times daily for at least two weeks.

Extending the dui yao concept to whole formula blending

A practice made possible by the advent of whole formula herb extracts as well as the Plum Flower line of traditional herbal formulas is the expansion of the principle of dui yao further to include the combination of multiple entire or near entire herbal formulas. Like herb pairs, formula pairs are dosed according to the root-branch principle where the branch or primary complaint and symptoms is allotted no less than 30 percent of a formula, while the various underlying deficiencies and excesses are assigned a correspondingly lesser percentage based on the patient’s unique presentation.

In my clinical experience, seldom do I see a patient whose symptoms so neatly correspond to the description of a traditional formulation as described in a book. People present very complex and often what seem like contradictory symptoms, where for example both heat and cold, or yin and yang are imbalanced. In such conditions one can combine formulas with opposite atmospheric (hot or cold) properties so long as the herbs or formulas target different symptoms. For example, a drying formula for the lungs and respiratory tract may be combined with a lubricating or Yin-nourishing formula for the Kidney-adrenals. Here the sovereign rule of prescribing heating or stimulating herbs for cold diseases and cooling, detoxifying herbs for hot or inflammatory diseases is limited to specific organ systems. This is where herb or herbal formula combining really makes the difference over giving one herb for one symptom.

The above touches on higher principles of herbal formulation and practice. Perhaps it is a bit too esoteric for the average consumer, but it is time that the public who looks to herbs for their health needs understand that herbal formulations are often more effective than single herbs. While it may take a bit more work to understand, the art of herbal formulation has been at the heart of herbal medicine for thousands of years and in all ancient cultures.

Once upon a time, when people got sick they knew that that they must “drink their bitter brew” to get well. Presumably this meant some sort of herbal tea or other liquid potion. While native and traditional cultures barely bat an eye as they wash down sometimes large doses of nasty-tasting stuff, taking herbs in this way becomes less appealing as we grow more accustomed to the conveniences and comforts of modern times. Thankfully, we have several options for getting the medicine down, as outlined below.

Teas, Tinctures and other Liquid Preparations

Liquid herbal medications are best for the intestines, stimulating blood circulation and restoring the balance of homeostasis.  Liquid options are especially useful for severe, intractable diseases.

Infusions are made by steeping herbs in a covered vessel of hot freshly boiled water. This prevents the dissipation and evaporation of volatile elements that are considered vital to the therapeutic effect, particularly for diaphoretics.  By such a method one does not get all of the deeper minerals found in popularly infused aromatic herbs such as mint, chamomile, or lemon balm.

A decoction is made by a prolonged cooking method resulting in what the Chinese call a tang or “soup.”  Heavier substances, including hard roots, branches and minerals are boiled (decocted) specifically to extract their deeper constituents. As a result, the more volatile elements are lost during the process of evaporation. Decoctions take anywhere from 20 to 45 minutes; the dregs are strained out and the resulting tea is taken at room temperature.

Extra long boiling is necessary to transform and neutralize toxic elements of certain herbs. This is most important for one of Chinese medicine’s most poisonous but commonly used herbs, fu zi or aconite (Aconitum napellus) also known as “monkshood.”  Most of the time a processed and detoxified version is used, but this too requires about an hour of decocting before it is safe to ingest. Western herbalists never learned or utilized a way to neutralize the poisonous properties of aconite. In fact it was commonly used in ancient times up through the European renaissance as a poison to get rid of someone you didn’t like. Medicinally, only single drop doses diluted in water are used.

Minerals or shells such as crushed gypsum to lower fevers, iron for the blood or oyster shell for calcium, also require extra long boiling. Traditional Chinese Medicines require that these are boiled first and separately for up to 45 minutes before the rest of the formula is introduced.

Pills  

Ever since the 12^th century the Chinese, who invented the pill, have been prescribing them much as we do today. Ancient formulas were often prepared as pills made from milled herbs bound with water, honey, ginger juice, or other substances. In villages in India and China local herbalists still roll pills by hand. Smaller sized pills are favored because they are easier to swallow. Therapeutic dosages of powders or pills range between 3-10 grams daily. That's usually a small handful of pills, taken two or three times a day. Though it may seem like a lot of pills, it's really only a few grams of medicine.

Pills, especially the small teapills manufactured by Chinese pharmacies is most effective for relieving stagnation and congestion and treating wind-cold conditions such as colds and flu. Pills have the advantage of being able to be taken over a prolonged period of time and are therefore best for chronic disease.

Powders

Powders consist of small particles of herbs with multiple surfaces that are particularly beneficial for stomach and intestinal problems.  Powders are also best for suddenly erupting diseases such as a skin rash.

In fact, most traditional cultures would not take herbs as a tea but as raw powders. So long as the powder is either freshly ground or no older than three to six months, this method may be the most efficacious way to ingest medicinal herbs. Taking an herb ground into a powder means that all of it is consumed and nothing is lost through the process of evaporation and volatilization, nor through the extractive process where the extract is siphoned from the “mark” which may still contain some minerals and constituents.

Powders are also cost effective. This is because there is no selective extraction that occurs when we use alcohol or some other extractive to make herbal tinctures, to have the properties evaporate and dissipate as a result of making a hot tea decoction. Therefore, one is actually ingesting the whole herb in powder form.

Indian villagers take herbal powder by smearing it on the palm of the right hand with honey and perhaps a little ghee (clarified butter) and licking it off. Besides the fact that honey and butter tend to make anything tastier, these serve as “carriers” (called anupans in Ayurveda) and are thought to enhance an herb’s therapeutic properties by carrying them into the deeper tissue layers of the body.

Extracts (Tinctures, Glycerites, Aceta)

The constituents of herbs can be extracted by water, alcohol, vinegar, glycerine, or chemical solvents. Most herbalists prefer to use low temperature water extractions rather than the standardized extractions used by “herbaceutical” pill manufacturers. Simply soaking an herb in alcohol, vinegar, or glycerine yields extracts and this method is called “simpling.” They're easy to make and to take.

Strategic timing for taking herbal medicine

Many ask the best time to take herbs. The following is a rough guideline:

Timing around meals

Herbs can be taken before meals to stimulate digestion or when a person’s symptoms occur before eating.

Herbal extract and tinctures can be taken while eating if there is a problem while ingesting food.

Generally speaking “herbal bitters” can be taken in small amount before eating to stimulate the body’s digestive secretions and one’s appetite or after meals to relieve bloating. A teaspoon or tablespoon should be a sufficient dose.

Gastroesophageal reflux (GERD) is a very common complaint, answered by the huge market of antacids and pharmaceuticals with long-term negative side effects. But one of the simplest treatments is to simply go to your spice cabinet, mix together a pinch of every spice and take a teaspoon of the powder washed down with room temperature water.

Herbs that are intended to go to the liver, Kidneys, intestines or reproductive organs are taken after meals.

Often this can be too complicated for people who are on the go to follow so my basic thought is to take herbs regularly before meals. If there is any discomfort, try switching to taking them after meals.

Another simple and basic approach is to take tonic formulas before meals (when you body is most ready to digest food) and the more eliminating and detoxifying formulas after meals.

Other considerations for enhancing the effects of herbal medicines

Temperature

Conditions caused or aggravated by cold should be treated with hot medicines (i.e., teas and decoctions). This would include the early stages of colds as well as respiratory allergies.

If the condition is caused or aggravated by heat, or to provoke urination, give room temperature herbal preparations.

Enhancing additives

When treating low energy, the addition of a little honey or some sweet flavored substances such as jujube or other dates and a small amount of licorice will serve as a carrier for herbs like ginseng.

When treating Kidney adrenals with symptoms of lower back, knee, joint pains, low libido and urinary problems taking the appropriate formula with a pinch of salt or soya sauce will help focus and direct the action of the herbs to the intended Kidney-Adrenals.

When someone is nutritionally compromised and weak, tonic herbs are best taken in soups.

Preparation containers

One should never brew herbal teas in certain types of metal containers. This especially applies to iron or aluminum pots where the soluble metallic ions can alter the chemistry of the medicinal herbs. The ideal medium for preparing herb teas is a clay or glass receptacle. Good quality stainless steel is neutral and does not leach metallic and is therefore also all right to use.