4.17.2014

An East African Materia Medica

Serengeti



Introductory notes: the plants referenced here are ones I have been using in the highlands of north-central Tanzania, at an elevation between 7,500 and 8,500 feet from sea level. The climate is generally moderate, with mornings in the 50s and daytime highs in the 80s. It is the rainy season right now - the flora will be different in the drier months (May to October). Generally, one could find these species in a broad area from lake Victoria in the west, north past Nairobi in Kenya, out to the Ethiopian highlands in the east and down past the Ngorongoro crater in the south.
I reference plants that I have been able to positively identify, gather, prepare and apply myself. Preparation notes are included. Botanical names, as well as Swahili (Swa.) and Maasai (Maa.) names are included if known. Clinical outcomes and observations are from my herbal practice in the context of Wasso District Hospital over the course of about four weeks of work. Patient volume varies; on a typical day there will be five or six patients returning for acute wound care, two or three new acute wounds of varying severity, two or three chronic wounds or infections, and between two and six cases from the internal medicine wards (chronic asthma, diabetes, hypertension, peptic ulcer, HIV and its complications).
Patient diets are generally similar, and quite simple: rice and cornmeal are the chief carbohydrates, and beans the chief source of protein. There are some tomatoes, cabbage greens and carrots used, and occasional meat (goat, beef). Sources of fat (used in abundance) are questionable, consisting mostly of refined vegetable oils. In the context of the hospital, dairy products are virtually absent. One conspicuous factor is the ubiquitous use of soda (often up to six or more bottles a day) which is in large part at the root of the cases of diabetes and gastrointestinal ulcer - the latter also connetected to the near-universal Heliobacter pylori infection and the frequent, indiscriminate use of antibiotics.
This inappropriate use of over-the-counter (black market) antibiotics, as well as prescribed antibiotics in the hospital setting, have led to both gastrointestinal disturbance and antibiotic resistance, particularly in cases of cutaneous staphylococcus infection (but also typhoid and pneumococcus). This makes the use of herbal medicine all the more valuable and important. Wound management in acute cases usually involves simply a liquid iodine solution, though in chronic wounds I used herbal treatment exclusively. Aside from that, unless otherwise noted in discussing specific cases, treatment used was entirely herbal.




Achillea millefolium (Yarrow): truly a wound plant like no other. Luckily, there is a fair supply planted as an ornamental in the hospital garden. Daily preparation involves gathering a large handful of leaves and a flowerhead or two, coarsely chopping, placing them in a bowl and using just enough hot water to cover the herb. Then the mixture is blended and the juice strained and pressed. Yarrow juice is used as a wound wash for chronic ulcerations in cases of leprosy, diabetic foot ulcer, or unaddressed infected wounds. Apply liberally to gauze and use to scrub and irrigate the wound, cutting away necrotic tissue as necessary, twice daily. Saturate and pack gauze into deeper wounds if prurulent discharge is present (wet-to-dry dressing, iodine alternative, very effective).


Zanthoxylum chalybeum (Maa: loisugi): a bitter, pungent preparation is made by collecting the bark (outer and inner, after removing knobs and thorns), cutting into coarse strips, and decocting about one cupful of shredded bark to 1/2 gallon of water for 15-20 minutes. The decoction is yellowish-brown and can be used to irrigate wounds (mixed with yarrow juice) and internally for peptic ulcer and as a bitter digestive tonic, dosed at about 2 ounces of decoction twice a day before meals. One patient (who began his treatment with two days of goldenseal [Hydrastis] powder, 1/4 tsp. twice daily before food but then switched to this decoction) remarked that his after-meal symptoms of burning pain were completely resolved. He had previously tried a range of antibiotic treatments with no success.


Bidens pilosa: I tried this weedy plant as an alternative to yarrow for washing wounds, with limited success. It seems to lack some of the topical astringent hemostatic effect of yarrow. However, it is quite useful taken as a juice for internal use, particularly in cases where vitality is weak, there is anemia and/or fatigue, or the tissue (internal or external) seems in need of drying or toning. When these constitutional signs accompany infection, Bidens provides valuable systemic anti-infective support. This was particularly evident in a case of leprosy, where yarrow and usnea powder helped the lesions considerably, but failed to completely resolve the issue until Bidens was added. The aerial parts are harvested daily from specimens that have just started flowering (no seedheads), the leaves garbled from the stems, placed in a bowl and barely covered with cold boiled water. Then the mixture is blended and the juice strained and pressed. Patients take around two ounces of juice three times a day. The juice will keep at room temperature for 48 hours, but any leftovers should be discarded after that.


Usnea spp. (barbata / longissima): this hardy and cosmopolitan lichen can be identified by the white inner fungal cord (medulla) and the green outer algal cortex which can be "stripped" from the medulla as one might do with electrical wire. It grows at higher elevations, hanging off old tree branches closer to the hilltops, blowing in the near-constant wind. Here you can find it by the bagful. I have been using it primarily as a wound powder, particularly in long-standing damp lesions where I leave it embedded in the tissue for two days at a time before cleaning it out with yarrow/loisugi mixtures. It helps to form a nice matrix for granualtion tissue, while preventing infection and drying suppuration very effectively. In the leprosy case, it actually embedded itself into new skin, forming a sort of hybrid usnea-callous that closed the wound while also providing excellent protection from the pressure and friction that caused the lesions to re-open (Mycobacterium leprae can infect peripheral nerves leading to loss of sensation, certainly the case in my patient). My preparation method involved sun-drying the lichen until it was brittle (thereby increasing usnic acid content, too), then just cutting it for 15-20 minutes with a serrated blade until it became a mass of green powder and tangly white strands. The mass gets passed through a mesh strainer to leave only a fine, green powder which is liberally applied to wounds.
A note regarding leprosy: dressing the wounds is often counterproductive. They are moist and ooze quite a bit, and enclosing the discharge actually retards healing. Twice daily application of usnea powder to replace any that fell off during walking does the trick after a week to ten days, along with Bidens internally and good foot hygiene. Patient was discharged with a big wad of lichen to use and apply as a spit poultice (small amount at a time) should any further wounds develop. He had been in the hospital for six weeks before we began herbal treatment. Antibiotics had been used (internally and topically), along with bleach soaks, to little effect.


Argemone mexicana (Maa: langanum): a britsly Papaveracea with a bright orange latex and beautiful flower, it usually grows as a weed in planted fields. It is used by the Maasai as an immediate antiseptic and hemostatic treatment for minor cuts and wounds - really useful on trail walks. The latex, which flows profusely when any part of the plant is broken, tastes remarkably like celandine's. I regret not having had the opportunity to try it in cases of cholecystitis, though there was one patient who did come through minor theater with that condition. It was a very instructive abdominal exam, with all the classic signs in the right upper quadrant and referred scapula pain too. Ultrasound was inconclusive in her case. She was sent home and told to avoid fats before we got a chance to start herbal treatment.


Zingiber officinale (Swa: ntangawezi): this famous rhizome needs no picture nor description. It is readily available, still covered in red soil, at the weekly market in town. I purchased a big pile of it for the equivalent of about $2. While I made the occasional anti-nausea tea (for Westerners), the main use of this plant was as an anti-inflammatory circulatory stimulant to support the healing of chronic diabetic foot ulcers. I had two patients whom I followed with this treatment, along with caring for their primary wound and conducting daily foot and leg massages to promote lymphatic drainage. The procedure for preparation was simple: grate the fresh rhizome (about 1 TBS), add about 1 cup boiling water, let steep five minutes or so, then saturate a clean cloth with the infusion and apply hot to the foot. Before applying, I would take the leftover grated rhizome and apply it to the dorsum of the foot, then wrap it up. This happened twice daily.
A note regarding diabetic foot ulcers: one patient developed the ulcer after stepping on an acacia thorn which pierced her flip-flop and went straight through her foot, emerging from the top a bit lateral and proximal to her big toe. The resultant abscess had to be surgically opened, and a chronic wound developed. It was about the size of a nickel when I first saw it, and the whole foot was noticeably edematous. She could not walk on it. Daily bleach soaks and antibiotics had not really helped for the five weeks she'd been doing them. Within three days of using ginger and eliminating the bleach, the swelling began to subside and peripheral pulses returned. After about a week, the foot was almost normal in size, and the ulceration had reduced dramatically in diameter and depth (yarrow juice + usnea powder). Her course of antibiotics had ended a few days before. After two weeks she was walking pain-free, the ulceration was gone and fresh pink skin remained, and she was discharged with a big bag of prickly pear cactus pads.


Opuntia ficus-indica (prickly pear, Swa: freisha): an exotic cactus, the prickly pear has naturalized extensively across the Tanzanian highlands. Some specimens I've seen are over ten feet tall, bristling all over with long spines and tiny, fiberglass-like hairs that are perhaps even more of a hazard than the visible thorns. The fruits are starting to ripen here right about now, and can be used medicinally, but I harvested the wide pads by scraping them clean of spines with my knife's edge, then cutting the pads. Some clinical research looks at the fire-roasted pads (used as a food source in the American southwest), but I just went ahead and juiced them fresh. A little water is added to the chopped, cleaned pads (scraped, washed, and towel-dried), then they are blended and the juice is taken, at doses of about 1/2 cup full, twice daily before meals. I used this juice, sometimes spiced with a teaspoon of cinnamon powder if available, for managing elevated blood sugar associated with diabetes.
A note on diabetes: this is a relatively new disease here. None of the Maasai I worked with knew of any diabetics in their community. The cases were in overweight, non-Maasai community members, and staff members at the hospital. Once again, it seems to be a disease of relative affluence connected perhaps to that wonderful American export, the sugary soda, which is shared at almost every social gathering and can be a bit of a branded status symbol. Blood glucose levels are measured here as they are in Europe: in millimoles per liter, unlike in the US where the units are milligrams per deciliter. The conversion is based on the molecular weight of glucose (one mole of C6H12O6 is 180 grams), so 10mmol/L = 180mg/dL. That's a pretty high fasting level! The guideline is 6mmol/L, or about 104mg/dL, for a fasting blood glucose. One staff member at Wasso Hospital went from 10.4mmol/L to 7.8mmol/L in less then a week using Opuntia and cinnamon (and strictly avoiding soda). This result was a bit amazing to me, but isn't out of the realm of possibility (she was certainly pleased). Some confounding factors: I'm uncertain whether she had drunk any soda before her first test (would definitely have skewed the result, but even after a soda your BG shouldn't be 180); two different lab techs conducted the two tests (you might say lab work is objective, but I'm not so sure). Regardless, her BG levels have been a lot better in the mornings with the Opuntia juice than suggested by past test(s).


Aloe spp. (vera, alata, ferox. Swa: msubili): This succulent, rich in soothing gel, is a classic burn remedy. To be honest, I used it mostly for our family and other Westerners transiting through the guest house - but was also able to apply it on the more superficial burns I saw in minor theater. It is excellent to relieve pain and speed healing for superficial burns, but I'm not confident enough in its antiseptic power to recommend it on full-thickness burns after the top charred layer of skin sloghs off. However, with extensive burns, one of the major risks after infection is dehydration - and aloe can help a lot for that. One child who had been sweeping the floor of her home was extensively, though not deeply, burned when her wrap caught fire. Both arms and the back and front of her torso suffered partial thickness burns, and the evaporative fluid loss was high. The healthy skin on her legs showed pretty substantial dehydration, despite a lot of drinking. We used aloe five or more times a day (training her parents on how to apply it), and silver cream just twice over a week, and there was no infection and much less dehydration.
Preparing aloe is fairly easy. You cut whole leaves, then remove the spines on the sides of the leaves (taking care not to cut too deeply and expose the demulcent pulp). Then, simply cut cross-sections of leaf, peel off the green parts, and mush up the gel in a container. Apply liberally to the affected areas. One note: the stuff is remarkably bitter. Wash your hands after preparing.


Phytolacca dodecandra (Maa: ol'diangorras): I was excited to find the orange-red berries of this local species of pokeroot. It grows vigorously, more vine-like than its American cousin, and has a thick and juicy root. With some coaxing, I was able to harvest a fairly sizeable chunk. From this I cut wide slices, which were then pounded and the juice strained out. I used about 1/2ml of this juice on myself at first, then closer to 1ml twice daily for an HIV patient who had lymphatic swelling in cervical, axillary and inguinal nodes. She saw some improvement from this approach - not a dramatic reduction in swelling, but a marked reduction in tenderness. I searched extensively for cleavers (Galium), but was unable to find this species outside of the Ngorongoro crater rim. Needing a lymphatic, I opted to try this Phytolacca and was not displeased with the results. The flowers smell amazing, kind of like lilacs. The Maasai (at least those I spoke with) only know it as a poison plant and warned me against eating the berries.


Eucalyptus globulus (Swa: Makaratusi): These trees were planted by colonists, and now there are some huge specimens, usually along main roads but often in the more secluded (and less fumigated) corners of the villages, by streams. Many trees have been cut down, especially those next to cultivated fields, as they tend to suck up all available water and can contribute to crop loss during drought. Nevertheless, the leaves are abundant and quite fragrant, and I would place whole branches, slightly broken up, in pots of steaming water for patients in the pediatric ward who had chest congestion. The steam smelled nice, nobody complained, and some of the patients remarked that they were breathing more easily after taking big inhalations of the steam. This was especially evident in a case of chronic asthma, aggravated by the dusty conditions here, where eucalyptus steam inhalation provided almost immediate relief. Use a towel over your head for maximum steam concentration.


Olea africana (Maa: ol'orien): These strange looking olive trees live quite a long time, and have thick, gnarly trunks that end in a burst of spindly branches, loaded with leaves and olive-like fruits with little seeds that mature to an unpalatable orangeish color. I harvested the leaves to use as a treatment for hypertension. This condition is relatively rare (most blood pressures were in the 100/60 range) but more and more folks are experiencing higher blood pressures and atherosclerosis these days - even in the Maasai community. I'm not sure exactly why this is. Nevertheless, I'd give out bagfuls of fresh olive leaves, with the instructions to chop or pound a good handful and steep in a pint of hot water, drinking daily in two divided doses. Results took time - at least a couple of weeks - but I was able to see a small but consistent drop (5-10pts systolic) in blood pressures for those taking these leaf teas consistently.
The Maasai used the leaves for malaria and fever. Given their anti-inflammatory and potentially antiviral effects (extrapolating from research on the European cousin of this tree), these traditional uses make sense.


Commiphora africana (Swa: mturituri): I was introduced to this species as a remedy for colds: the resin that exudes from the bark of older trees is traditionally steamed and inhaled. Also, the root of younger trees is wonderfully fragrant and actually sweet - a remarkable surprise. But seeing as how I couldn't find enough resin, and eucalyptus was working well for chest congestion, I recommended the bark of this plant be chewed as a remedy for high cholesterol and atherosclerosis. I am extrapolating here from research on its cousins C. mol-mol (guggul) and C. myrrha (myrrh), and it is too soon to tell what kind of effect it may have had, but between that and the daily 3-4 cloves of garlic I am optimistic. One gentleman accosted me for a consultation on cholesterol and atherosclerosis while I was buying bar soap to do my laundry at the little shop across the street. He needed some exercise too - I suggested some brisk walking and less hanging out at the shop drinking soda.


Urtica massaica: Oddly, the Maasai didn't have a name for this ferocious species of nettle, preferring instead to give it a wide berth on the trail. The stinging hairs on this plant are stiff and potent even after drying, and can be two to three inches long on the stem. The plants grow to over six feet in height, out in the full sun. The sting persists for 24-48 hours, depending on how deep you're stung, and caused an immediate urticaria rash on my skin (U. dioica just doesn't do that for me). So I started using scissors to harvest the green tops, pre-flowering, and would juice them to a dark-green-black frothy fluid. Delicious. I'd combine it with the juiced berries of Cyphostemma (see below) to make a nutritive tonic for anemic patients. One cupful a day seemed like a good dose. Good nutrition, especially for moms and kids, is really important here: many are anemic, blood is difficult to obtain, and malnutrition is rampant.
Another use of this juice was for symptoms of allergy and upper respiratory congestion in Westerners unaccustomed to the dust and allergens of this environment. Half a cup of fresh nettle juice, once or twice a day, reduced eye itching and nasal congestion. Overall, it is a very nutritious, very drying herb.

Cyphostemma serpens (Swa: mwengele, Maa: ol'kilenyei): this viney, trailing plant drapes itself over low acacias and on termite hills. It produces clusters of berries, which the Maasai harvest while still green to use as a food and especially as a tonic for children. The tuberous root can also be boiled and eaten, though I didn't try this. The fruits have an agreeable sour green flavor, and I expect they contain a fair amount of organic acids and perhaps even ascorbates - a great supplement indeed! So I'd harvest clusters of the berries and juice them up, often with nettles, to add into the diets of those needing a special boost. 1/4 cup of the blend for kids, 1/2 cup or more for adults, once or twice a day.
Traditionally, the Maasai add the fruit pulp to milk and feed it to kids to help them grow stronger.


The bitters: I used the bark of Acacia species for this purpose, primarily for myself, my family, and the Westerners with digestive complaints. I preferred loisugi for local folk, as it seems to be more of a tissue tonic for long-standing gastrointestinal inflammation. The acacias are bitter and, depending how they are processed, possess a varying amount of tannins which can be useful if there are digestive complaints accompanied by loose stools or diarrhea.

Acacia nilotica (Maa: ol'kiloriti): this is an excellent and useful tree though, like most Acacia species, it is viciously thorny. It has a characteristic shaggy, dark brown bark and rounded, yellow pom-poms for flowers. The Maasai go at the trunk with a machete, gathering the middle, soft, tannin-free bark layer. The outer bark is very astringent, and serves as an anti-diarrheal. The innermost layer is very bitter, and acts as a purgative. But the soft middle stuff - just right. At special dates two or three times a year, they boil handfuls of it in a goat stew which is eaten to "cleanse and renew the belly". It is moderately bitter, somewhat reminiscent of yellowdock root in flavor, and small sips (1-2 oz) of the decoction before meals improve appetite and regulate bowel function well.
I myself became quite fond of using the younger branches of this tree, adopting another common Maasai habit. Stripped of thorns, they make excellent toothbrushes and lack the inner purgative bark layer. So, after the morning run and before breakfast, I'd walk around chewing on a six-inch chunk of twig, swallowing the bitter and slightly astringent juice, and rubbing my teeth and gums with the juicy fibrous end.


Acacia drepanolobium (Maa: ol'munishui): nicknamed "whistling thorn" because of the big, dark, hollow galls that catch wind with a characteristic whistle, the Maasai use its roots as parturients to help expel the afterbirth. This is actually a big issue in the local community, with many women suffering prolonged post-partum hemorrhages that can be life-threatening. But I didn't use this tree for that. The inner bark makes another excellent digestive bitter, but it is a bit more pungent and almost numbing to chew, reminding me slightly of kava. Another traditional use is for sore throats, which makes sense (though no throats were sore at Wasso). I used an infusion of the inner bark, about 1 TBS per cup of hot water, with a little honey as a pleasant evening after-dinner digestif. Supposedly these trees, which can grow to 15 feet, are the giraffe's favorite food. I witnessed them browsing on some one afternoon. They have some tricky lips, getting around those thorns.
Walking through the bush, you move from green grass, yellow-barked acacias, red soil and a winding stream into denser forest with loisugi, vines, and epiphytes. Then you pass under a nilotica branch and find yourself on rich, black soil in a sparse forest of whistling thorns. There is a hiss in the air. The trees have a conical growth pattern and a grayish, mottled bark. This, along with the dark galls that look like black spruce cones, makes you feel like you just stepped into a grove of old spruce, towards the top of a mountain on the East Coast of the US. For a moment, the thorns look like needles. Then you see two Maasai kids, long sticks in hand, pushing goats through the thicket - and you're back under the hot sun.


Leonotis mollissima (Maa: ol'bibi): I first grew this plant back in Vermont, where I knew it as "wild dagga". I've smoked the leaves, and it is a mild euphoriant (very short acting). Here, it is an ever-present weed. If the bark of the whistiling acacia is a bitter with mild carminative action, leonotis is first and foremost a digestive antispasmodic, and a decent digestive bitter after that. It is a Lamiacea after all. I recommended the fresh leaves, two or three at a time, for intestinal cramps and spasms where it provides fairly rapid and welcome relief. It is similar to horehoud (Marrubium) in flavor and texture, and shares with it the presence of the bitter lactone marrubiin.


The aromatics: there are numerous scented plants everywhere. Most don't have specific uses, though the locals will rub them on their bodies as perfume, both to increase attractiveness and to repel biting insects. One aromatic plant, Hosnum suave, is eaten by hunters to improve focus during early morning hunts and also to disguise their body odor as the aromatic oils exude through their pores ("that's all the animal will smell", I was told). But there are a few that are, like most aromatics, used as diaphoretics, carminatives, and nervines - as pleasant beverage teas.

Ocimum kilimandsharicum (Swa: kirumbasi): spicy and rich in eugenol and camphor, this plant reminds me a lot of O. sanctum (tulsi, holy basil). It doesn't have quite as intense of a bite. Traditionally, it is used for fevers and upper respiratory infections where I have no doubt it functions as a mucolytic, diaphoretic, and antiviral (it is also rich in rosmarinic acid). I mostly recommended it as a tea, refreshing and carminative after meals, and also as a morning beverage for those who didn't want chai or coffee. It's stimulating and enlivening.


Lippia kituiensis (Maa: ol'sinoni): an indigenous species used by the Maasai for its carminative and diaphoretic effects, it is also called simply "wild tea", because its leaves make a delightful, airy, somewhat citrusy infusion that is excellent in the early evening after a day's work. I consider it a gentle local nervine, similar to lemon balm in its effects though less dry. There is ongoing research looking at its potential antimalarial activity.


There are many other interesting plants. Solanaceae: I harvested and dried Datura stramonium leaves, but was unable to convince an asthma patient that steeping them in Konyagi (some kind of distilled Tanzanian spirit that may start with fermented ginger root) was actually going to yield anything medicinal. Withania somnifera grows wild (I did point its root out to a gentleman who was interested in greater sexual vigor, translating the Ayurvedic name "ashwagandha" as best I could). Solanum incanum, the "Sodom's apple", is everywhere and used for everything from scrubbing pots (its gritty leaves) to dressing wounds (the fresh fruit juice), though I never felt drawn to using it. Lamiaceae: wild patchouli was an awesome discovery. Rosaceae: so many different kinds of wild hybiscus, red flowering, yellow flowering, delicate white flowering. Asteraceae: the important Artemisia annua and some of its cousins grow wild, a treasure against malaria. Very few if any plants are truly dangerous, if you're careful about where you step and avoid the thorns. Euphorbia candelabra, which drips a caustic white latex, may be an exception: it blisters the skin and causes temporary blindness.

In the end, I can only repeat what I've said before: plants are communion. If you get to know them, if you allow them to become a part of you by eating them, drinking their infusions, merging their tissue with yours like usnea in a wound, you become part of the land you're in. If you want to know a place, walk outside. Hold people's hands. Eat what grows. You'll never be the same.

So I leave you with one last plant.
Commelina benghalensis (Maa: engaiteteyai): this is a simple and common spiderwort, and grows in shady places. I'd find it covered in dew on my way back home, in the early morning. The Maasai ol'oiboni, or shaman-healer, uses it as a way to bless and protect those who have come seeking health. Dipping the fresh plant fronds in raw milk, he sprinkles the petitioner with the magical infusion, releasing negative influences and promoting wellness and growth. May your life be blessed. May no thorns find your feet. And may you have joy in simple things, wealth in those you love.


7 comments:

Giovanni Mase' said...

Carissimo Guido
Bello incredibile quanto la natura puo offrire solo che abbiamo la pazienza di ascoltarla. A presto magari rivederci ad Amsterdam il 24 mattina.
Papà

HABIBI said...

Really enjoyed your fascinating article Guido. Thank you.

Cassandra Sears said...

so lovely :) Thanks for sharing.

awarenivore said...

I just LOVE aloe...something about the herb agrees with me, even though it's so bitter. And your accounts are amazing - the use of fresh juice is so potent, and it's something I often forget about...using only dried roots or leaves as teas. The water element plus tasting the herb like that in the mouth, in the cells...I just imagine they drink it much much more quickly and easily. I am inspired by your great work, knowledge, enthusiasm for the world, people and plants. Much love, Adena

Michael DeMarco said...

Superlative post!

rose of Walk in the Woods, LLC said...

Wow. Such beauty *and* great information too!
Loved reading your process for usnea. And then some!
Thanks for sharing.

Rebecca said...

This is fabulous. Thank you.