The need for long-term thinking in medicine: Cinnamon as a case study

Here in Vermont, we are approaching the first anniversary of a storm that, over less than a day, poured an incredible amount of rain over the mountains, down the streams, and into narrow river valleys. The hill towns were quickly overwhelmed and literally swept away on huge torrents of water. These types of events are outliers, “hundred-year” floods. We tend not to think about them until they happen. If a river floods one spring, and washes away our garden, we could just build a retaining wall and be fine for years. But in Vermont, it seems that sort of thought process may have contributed to the severity of last summer’s event: narrower valleys, more constrained riverbeds, actually increased the torrent’s force and destructive power. As we rebuild, civil engineers are taking this into account.

In fact, there is a growing realization in many professions and disciplines that we need to approach the world with much more long-term thinking. Perhaps pumping out wetlands and building cities isn’t the best idea. It might be smart to consider sources of energy that aren’t going to run out fairly soon. When educating, connection to long-term curiosity might be better than passing the next test. Social and ecological concerns in market-based economies might trump the need to make a buck.

I dare say that medicine is beginning to embrace this trend, too – or at least people are. People who are interested in real food that may not require contaminating the water supply to cultivate, and who feel like this food might be better for their long-term health (though missing the tasty nacho cheese). People who consider a fever the sign of a healthy reactive response, and watch it for a bit rather than immediately suppresing it. People who are beginning to think that diabetes may be connected as much to ubiquitous, unregulated sugar in the food supply as it is to increased weight, lack of exercise, or “poor self-control”.

Which brings me to cinnamon. A recent meta-review found a small but significant effect from the powdered bark of this fragrant member of the Laurel family in treating the elevated blood sugar levels associated with Type 2 diabetes. I recommend this plant to clients concerned about this disease, either as part of breakfast or – my favorite – mixed with stevia, almond butter and cacao and rolled into “bliss balls”. It is best to take it regularly, as part of a long-term habit that includes real, bitter food and lots of movement. In this context it’s delicious, easy to take (doses are in the teaspoon range), and effective. 

The effect is, indeed, small when observed in isolation and for short periods of time. But diabetes (at epidemic levels) isn’t a problem that develops overnight, folks. I doubt anyone in the food industry, somewhere between the middle of the 19^th century and the middle of the 20^th, was saying “whoa - wait a sec, guys. I think that all this tasty sweet stuff (and elimination of all botanical biodiversity in the diet) might actually lead to epidemic levels of a sugar-metabolism disease in the next century!” No, that would have required seriously long-term thinking in matters of public health. And a little more knowledge of the human body.

Well, today we have a little more of  both. But research still looks at botanicals for three to four months most of the time – and this is partly because research is still beginning. When more time and interest are devoted to certain plants, such as the 2012 analysis that showed soy food consumption leads to lower recurrence of estrogen-positive breast cancer, striking results are revealed. But even this research only followed ten thousand women for seven years. Would that we had multi-generational followup data for cinnamon, endive, and dandelion roots! We might see a reversal of the grand experiment in carbohydrate refinement that gave us the current diabetes epidemic.

Short-term thinking gives us a need for dramatic, immediate results that might fit within the constraints of our current research model. This is great for many acute and chronic diseases, but not as great for matters of public health or for analyzing cultural patterns that lead to the diseases themselves.  Often, we learn about these matters from retrospective studies – discovering a problem after it’s already well-established. Long-term thinking takes a break and asks “if left alone, what might this situation look like?” Long-term thinking wonders how the river might handle a hundred-year flood if we hadn’t intervened to alter its course, how a population’s blood sugar might look if we hadn’t altered its food supply. 

Type 2 diabetes is a long-term effect of short-term thinking (satisfy my hunger now, and in a way that can be easily produced, stored, transported and packaged!) Its solution has to be based in long-term thinking, and part of that might very well include herbs such as cinnamon. The reason they are important is that, unlike a pharmaceutical solution, they provide an inroad to self-care based on whole plants and food – elements of life which, along with movement, end up being the keys to successful prevention of diabetes. If your mother started making cinnamon bliss balls when you were little, you might grow up eating them and eventually making them for your friends and family. Who knows what other bizarre plants you might consume along the way. Lo and behold, two generations later population levels of diabetes, obesity and heart disease are lower. I’d give you a rose to celebrate, but we all know there’s no research showing roses are effective as mood-lifters.

Some argue that, since the effect of a botanical such as cinnamon is small compared to conventional drugs, it should be rejected as part of our approach to diabetes. Ironically, the argument is that using cinnamon perpetuates a pill-driven, not lifestyle-driven, mentality for handling the disease. Call me crazy, but I’d respectfully argue that it’s probably pharmaceuticals that are driving this mentality, and that the search for a cinnamon capsule as an “alternative” is a first baby-step towards a different way. In the hands of an herbalist, baby steps turn into hikes in the forest. That could be a good thing – and a complex, multi-layered approach to diabetes that includes cinnamon most certainly is. 

Say what you will about an over-reliance on short-term clinical trials to drive therapy (or just read the British Medical Journal). Aside from the caveats (some of which I mention above), the approach is often a good one. But the offhand rejection of botanicals such as cinnamon, especially when they show promise, is actually harmful to public health. It is also a product of very short-term thinking. This is a problem that we need to resolve if we want to advance the cause of medicine and improve global quality of life – and herbalists, as those who, across the world, know what local plants do, are well placed to be part of the solution. Herbalists know the plants, but they also know that moving your vegetables over a little and supporting the community of cattail and calamus by the riverbank might be a better choice than a retaining wall, though it requires a (small) sacrifice in the short-term. Herbalists know that a bouquet of flowers makes you happy even though there’s not a single study out there to prove it. And they are usually inspiring teachers, too – the perfect choice for a diabetic patient. 

All this requires a change in thinking about medicine. We need to be looking further over the horizon, at a future where the advancement of our species sometimes includes a return to older technologies – not because they’re old, but because they’re damn smart in a long-term context. A future where we observe and mimic nature in designing our systems not because it’s “natural” but because, in the end, it’s in our own self-interest (global warming? Hundred year flood?). Herbal medicine fits in perfectly here. It is the precise modality that offers cultural connection, self-empowerment, ecological awareness, and effective remedies! It is both a blueprint for the future and a safety net for the present. As a design element for the next century of medicine, it can bring long-term thinking into a branch of science struggling with its own pressing challenges, helping it to harness the tools of complexity and deep ecology that are driving other industries. Long-term, complex herbal therapy won’t look as flashy in the short term – but that does not mean it has no value. Give it time, and skilled hands – a garden takes a season to come to fruit.

Urban Moonshine's herbal conference report

The recent week of warmth and humidity has taken a turn towards cooler weather today, and the south winds are freshening up and blowing in across the lake from the northwest now. But the full height of Summer’s glory was on display this Saturday, when over one hundred people from across Vermont and beyond attended Urban Moonshine’s first annual herb conference and the evening festivities that followed. I had an amazing time.

Rosemary Gladstar, our friend and ongoing source of inspiration, kicked off the event by describing the success herbal medicine has enjoyed – in our communities and on the national stage – but also by exhorting us to keep up the momentum and find new, creative ways to bring the plants into the lives (and kitchens) of those who need them most. Then we broke into class sessions held in yurts, out in green fields with sweeping views, or on the trail in the forest. Larken shared thoughts on differentiating and applying the nervine herbs; Betzy toured a huge group around the gardens and fields; Jeff shared his knowledge of medicinal herb cultivation; Melanie set loose the herb spirits by crafting flower essences on a truly perfect, sunny day; Mary gave a case-based overview of some herbal strategies for kids; Layla was the diva of essential oils; and Brendan taught how to fit Western herbs into the energetic and spiritual framework defined by classical Taoist Chinese medicine.

Throughout the day, Jovial and the Urban Moonshine crew took complete care of every detail, making sure there was plenty of water, energy tonic, and, of course, herbal bitters. They coordinated classes, showed folks to the pond for a refreshing afternoon swim, and prepared our dinner (along with Woodbelly Pizza, who trucked in their wood-fired oven and baked pies non-stop). And after browsing the herbal products marketplace, Colleen and Peter planted themselves behind the bar and served a range of  home-created cocktails to the assembly of herbalists: drinks such as the “Dreamer”, featuring crushed mugwort leaves, as well as more classic mixes (a great negroni, for instance). A fiery-orange moon came up over the Eastern ridge and the music got turned up.

As is so often the case for me at these types of gatherings, I loved my side-conversations with folks in the in-between times. I especially enjoyed talking with Brendan and his wife Liz, who are acupuncturists practicing at Jade Mountain Wellness and study medicine and philosophy in an ancient Taoist lineage. We mostly discussed how “wood” (as in the phase of change associated with spring) dominates our culture: we are immature, impulsive, infatuated with our newest technological marvels (fortunately, I had just finished swimming so my smartphone was far, far away). While there is nothing wrong with the pursuit of new things, we tend to discard our older ways much too quickly – and, of course, medicine is a great example of this pattern. Nothing wrong with antibiotics, I love the stuff when it’s needed: but do we really have to use them for every little infection? Probably not. You could make the same case for steroids, narcotics, anti-inflammatories – you name it. Brendan’s point was that, in being so “wood”-centered, we are overtaxing “metal”, which is charged with keeping the sprouting wood under control. Metal connects to ancestor wisdom. It connects to wild, animal nature. It connects to bonfires and howling to the moon. Too focused on wood we are, and metal suffers. If we fed our wild side a bit more, if we could learn to retain a measure of ancestor-wisdom, we might not be turning to our internet devices every thirty seconds. Just sayin’.

Of course, that is precisely what this gathering of fine herb-folk is promoting. And while the conference and party were a success, I am also extremely grateful to Urban Moonshine who is donating all the profits to our community clinic, where we work with folks who often have no money and provide them with long-term access to experienced practitioners, along with teas, powders and tinctures as needed, for as long as is needed. You can learn more about this work at the Vermont Center for Integrative Herbalism.

I taught a little class on herbal extraction and the distillation of herbal spirits. It was fun. Here’s the handout if you are interested.

Aromatic plants – cultivating the scented garden within.

It is legend that, some twenty-five hundred years ago, a ruler of  Babylon (or was it Niniveh?) commissioned a wondrous garden, terraced up from the flat plains between the rivers of the Fertile Crescent. Its levels were built of huge slabs of stone, elaborately carved and supported by high vaulted colonnades. Huge amounts of soil were transported to create hills and fields in this garden many, many feet above street level. Sundry species of trees, shrubs, flowers and herbs were brought in to plant its winding paths. Using giant corkscrew pumps, thousands of gallons of water were moved against gravity on a daily basis to keep the garden lush and green. The ancient historians named it one of the seven wonders of the world, and marveled at this oasis, high above the incessant bustle of the city, smoothed with endless marble and steeped in a deep, seductive fragrance from the constant bloom of aromatic plants. 

 It is also said that it was in fact the queen who, longing for her homeland in the rich, flowering hills of the north, had pleaded with her husband for a retreat that could remind her of her younger days, of her family, and of what brought her joy. Watching her languish in the hot, humid, noisy city at the heart of his kindgom, he met her request in grand style - and her Hanging Gardens have been the stuff of myth ever since. But while some may wonder at the choice of such a garden to appease the restless spirit, it makes perfect sense to me: a retreat of roses and jasmine, lavender and linden is the perfect prescription not only for bringing a quiet respite in the middle of a hectic life, but also for re-inspiring and re-awakening the joy and creativity of childhood. Furthermore, the fact that it was literally floating above the day-to-day activity of the city serves as a fitting metaphor for the scented garden itself: a time apart, uplifted, serene.

Think of the last time you received a bouquet of flowers, or brushed past a patch of mint in a field, or simply stood in the deep part of a forest and smelled, just smelled, the earth, the spruce, the moss. Chances are you experienced a moment where you lost track of your responsibilities, your desires, your plans and just existed in the fragrance. If even for a second, you tapped into a very primeval state of being: it is childlike, flowing, and free. In such a state, it is difficult to be judgemental, anxious, rigid, sad, or angry - and this may be why we so often give gifts of scented flowers when we want to nurture an atmosphere of love, understanding, and joy. 

 This fact may also underlie the nearly universal practice of burning scented plants, resins, and oils to alter the "energy" of a room or space: it clears the mind, sets the stage for creative, spiritual work, and attunes us to the present moment. Cultural rituals have harnessed the power aromatic plants hold over us and have embedded their use into the peak times of our lives: at birth and death; during marriage celebrations; as a cornerstone of purification ceremonies; during the dark, wintry months when the light is low; as part of meditative practice. Perfumery and aromatherapy have long recognized the power scent has on the human spirit - even real estate marketing suggests that a home, when appropriately scented, may put prospective buyers in a relaxed, comfortable mindset. In the ancient world, a thousand years before the Hanging Gardens were built, priests in the old stone temples along the Nile were mixing kyphi, the sweet and spicy incense sacred to the pharaos. 

 But the Egyptian ceremonies didn't only involve smoke and scent. Often, the priests leading the rituals would also ingest a good amount of kyphi, powdered and dissolved in wine, as a sort of primitive herbal extract. Here the truest power of scented herbs is revealed: when they are ingested, their action is magnified and lasts much longer. The smell may awaken us, bring us into the present moment, and help us flow through change more gracefully: but once the aromatic plants enter our bodies, their volatile constituents first relax our bellies, then disslove into our bloodstream and reach all of our internal organs. If there is underactivity in an organ or tissue, fragrant plants can "wake it up" (think of ginger, or peppermint). Conversely, if a tissue is overly tense, aromatic herbs "loosen the knot" (like fennel seeds after a huge meal, or lavender oil during a massage). Net result: a more balanced state of internal tension. Since forever, herbalists have called many of these plants “nervines”, loved the scented brews they yield, and prized them as stress-tamers, tonics for the nerves. 

 More modern research gives us two interesting pieces of information to help understand how this works: first, the chemicals in highly scented plants (specifically, their volatile oils) have the ability to alter the way smooth muscle contracts, depending on its current state of tension. Smooth muscle is found in the lining of all our hollow organs - lungs, gut, bladder, and uterus - as well as in the heart and blood vessels. Plants that affect smooth muscle can thereby affect how we perceive our internal state - and anyone who has experienced a spasming, crampy belly knows what a dramatic impact this can have. It is fascinating to note, however, that the place in the brain tasked with assessing this "internal state" is exactly the same place most affected by the perception of smell itself! The limbic system, a complex of brain structures known for its processing of emotion and its ability to guide "executive function" (our ability to flow through tasks efficiently and productively), is where all of this information is integrated. Aromatic plants thus have a dual effect: their smell immediately awakens and engages the limbic system, and if consumed, their chemistry helps adjust internal tension, removing the distractions that keep us from the present moment. When they are ingested, clinical research always shows the same results: more balanced mood, more restorative sleep, better attention, and an ability to move through challenging tasks more smoothly (and joyfully).

If you are seeking respite from the demands of the modern world and the bustle of the city, the scented garden and incense-filled temple may well be the answer. But fragrant herbs are the way to take your garden with you, to suffumigate your own internal temple. There are so many options available to help with the milder cases of restless or despondent spirit: sedatives for anxiety and insomnia, stimulants for apathy and sluggishness, narcotics to escape, concentrated extracts of botanicals like kava or St. Johnswort, and designer drugs for depression and the mental malaise of today's life. Unlike all of these, aromatic herbs are not strongly mind-altering, are safe and non-habit-forming, and quite easy to grow and use! They are part of a very old toolkit available to humans, and many animals before us, to enter more fully into the flow of life. When led by scent, we follow a path through a garden where intuition and emotion, more than analysis and control, dominate the landscape. 

For now, happy Full Moon, happy First Harvest. Our gardens are in fullest bloom. But since I so often turn to these gifts during the darker months of the year, when night is deep and one can't often see the path to brighter days, I leave you with the words of Margared McKenny, recalling her own garden on a January dawn:

                "The snow still lies upon the ground,

                And yet I feel

                The shadow of the scent of flowers;

                Breathless the firs against the gray -

                So still the air

                That hung upon a bare rose spray

                Are drops of rain

                Left there by midnight showers -

                (.....)

                Black head atilt

                A chickadee

                Whistles the first love-notes of the year."

               

The Natural Products Industry that Isn’t.

                A few evenings ago I was sitting on a rough cedar deck, watching sunlight orange across the tops of the poplar and maple canopy, and thinking how nice it was to be visiting my friend’s house in the forest: the nestled feeling, the total privacy, the familiar smells. He confessed  that, sometimes, he too liked to imagine his house from the perspective of a guest, walking through his gardens, up the wooden steps, and into the kitchen with the eye of an outsider, taking the time to appreciate it without the preconceptions and perceptual habits that develop after living in a place for an extended period of time. Perhaps it was the effects of the mixture of Schisandra kombucha, gin, and tonic water we were drinking, but this short exercise in mindfulness seemed to me as both a useful habit to practice and also a profoundly important skill for the modern human. We are so entrenched in our politics, our communities, our niches and worldviews that, without occasionally looking at life from outside the fences, we might run the risk of missing out on an important and useful perspective.

                I have also been thinking a lot about the Food and Drug Administration recently. Don’t get me wrong – there are serious issues around funding, connections to the food and pharma lobbies, and separation from nature that continue to concern me about this regulatory body’s work. But I have been trying to walk these familiar corridors (herbalists versus the FDA) with an outsider’s eye. In the last year, there have been more and more inspections of natural product manufacturing facilities. The government is trying to identify “new” dietary ingredients and regulate their use. There is both clamor and confusion rising up from those who make and sell products that are used under the umbrella of “complementary and alternative medicine”.  What is going on here, and why? What might we learn by observing the situation?

                Since 1994, when the US Congress passed the Dietary Supplements Health and Education Act (DSHEA), we have seen many, many new “dietary supplements” on the shelves of our food stores and pharmacies. Many of these products have come on to the market because DSHEA allows a fuzzy “gray zone” between food and medicine: while recognizing that supplements are more than vegetables, it doesn’t require that they be tested for safety and efficacy the way prescription and over-the-counter drugs are. This has allowed a profitable industry to grow in the United States, where annual sales of products labeled as “natural” and falling under the legal aegis of DSHEA top $28 billion, according to the Nutrition Business Journal. (http://newhope360.com/2010-supplement-business-report-0)

                Out of these annual sales, herbal products account for about five billion annual dollars, or just under 18% of the total. Within this five billion, it is hard to assess what percentage of products are made from refined, concentrated botanical constituents (such as curcuminoids, or silymarin) versus crude whole-plant encapsulations, tea blends, and tinctures – but suffice it to say, the bulk of that five billion annual dollars is not finding its way into the pockets of small-scale, heart-centered local herbalists! So, in sum, at least 82% and probably over 90% of what makes up the “natural products” industry isn’t “natural” at all: it is either a cocktail of vitamins and minerals, a sports nutrition or meal replacement product built up from processed constituents, or some other mixture of naturally-derived, refined, or outright synthetic ingredients. We may have encountered pieces of these products in nature at some point, but never at these doses. In certain cases, they are completely new to our physiologies.

                Take the case of grapefruit seed extract. The FDA has been warning manufacturers of this “natural” antiseptic and antibiotic agent that their products may contain triclosan (an antiseptic linked with bacterial resistance and toxicity); the American Botanical Council suspects that these extracts are adulterated purposefully to increase their antibiotic power (http://cms.herbalgram.org/herbalgram/issue94/QUALCONTROL_gfse.html). Others feel that the extensive processing that the original grapefruit seed slurry undergoes actually generates triclosan-like compounds (http://herbsandinfluenza.com/blog/2006/12/22/grapeseed-extract-explained/). Regardless, you either have an adulterated product (falsely labeled!), or a product that has undergone extensive chemical alteration, resembling grapefruit seeds less than high fructose corn syrup resembles an ear of corn. This isn’t a natural product at all.

                So whether it be an antibiotic derived from chemical manipulation, a mega-dose vitamin, a solvent-extracted slurry of connective tissue from a shark, or a digestive enzyme obtained from a genetically-modified Aspergillus fungus, I fear that our “natural” products bear little resemblance to those found on the shelves of natural food stores in the 1980s.  Even more disturbingly, most of what’s out there (with a few rare exceptions, like folic acid) shows very little evidence of helping for any problem whatsoever. Where do we see a consistent body of research and a rich depth of traditional use? It’s in herbal medicine – less than 1/5 of what’s on the shelves. Most of these other “natural” products are marketed on the basis of petri dish experiments, fruit fly studies from fifty years ago, anecdotal testimonials, or in some cases, just snazzy packaging. Some of them contain toxic, drug-like ingredients. It is no wonder the FDA is trying to get a handle on this situation (as it already has with the amphetamine-like additive DMAA http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm302133.htm). It is also no wonder that we are starting to see more and more reports of vitamins, minerals, and other supplements potentially doing us more harm than good: they are at best weak drugs, and at worst untested, potentially unsafe, chemical additives.

                What put this over the top for me was a discussion I had when I recently visited Bastyr University, the premier training ground for naturopathic physicians in the United States. Out of the 299 credits required for graduation, there are five credits devoted specifically to botanical medicine. Over seventeen are assigned to physical medicine (somatic therapies involving touch, manipulation, etc), and over eight for homeopathy (http://www.bastyr.edu/academics/areas-study/study-naturopathic-medicine/naturopathic-doctor-degree-program#Curriculum). Where are the herbal materia medica classes? Where are the topics on complexity in medicine, the study of interactions between multilayered living botanicals and multilayered living humans? These are the roots of naturopathic medicine, but they seem to be nourishing less and less of the Bastyr curriculum these days. So can we really be surprised that some practitioners recommend abstracted, drug-like “natural” products to their patients instead of teaching them to brew tea and walk in the forest?

                Natural products aren’t real, folks – but fortunately,  herbal medicine is. Herbal medicine is traditional medicine – for over 80% of the world, but for us in the “developed” world, too. Along with ancient somatic and energetic therapies like massage and acupuncture, all tied together by a rich and meaningful mythology, herbal medicine makes up this tradition. Modern alternatives – be they the mainstream technological medicine, or “CAM” technological medicine – are just that: a different choice, some of which is well validated for use in health care, some of which lacks any validation whatsoever. But neither prescription drugs, over-the-counter pills, or that 80% of “natural” dietary supplements can come close to providing the breadth, depth, and accessibility of true traditional medicine. 

                It is time for herbalists to affirm that our plants are not “complementary and alternative” to technological medicine. Our medicine is real, and just as real vegetables are not a complement to frozen dinners and meal replacement shakes, true botanical medicine is not some kind of extra adjunct to pharmaceuticals and surgical interventions. It is a birthright. It is a daily gift. Its memory is visibly encoded in our genetic material. And it is being practiced everywhere, in kitchens and apothecaries, in modern production facilities and improvised forest clinics. We as herbalists – the growers, the clinicians, the wildcrafters, the medicine-makers, the keepers of wortcunning, the storytellers – have been sinking our roots back into the tradition over the last few decades. Now, having moved well past the embryonic stage, and our cotyledons fully unfurled, it is time to rise up and proclaim what makes us unique: we are traditional medicine, we are integrated ecology, we are plants. Argue all you want about what is “mainstream” and what is “alternative” – we as herbalists are neither. We are tradition, we hold the roots. Now let’s stand up and let others know the deal.  As Rima Staines simply put it (http://intothehermitage.blogspot.com/2012/01/rise-root.html): rise and root. Think as a plant does: up, up! and down, down! One movement in many directions, many directions with one focus.

A brief and practical introduction to pulse and tongue assessment

Any assessment or diagnostic technique that seeks to make sense of what’s happening inside the human system is inherently pretty complex – be it a modern tool such as a CT scanner, or a traditional device such as the stethoscope. Interpretation is tricky, and the background knowledge required can often be intimidating. While using the tongue and pulse to get a glimpse inside the human body is not an exception, one can nevertheless glean really useful, actionable information with even a basic understanding of the technique. This basic understanding can become richer and deeper with ongoing practice. The complexity evidenced in traditional texts on the subject should not be a reason to keep you from experimenting!

Basics: Excess / deficient. Hot / cold. Dry / moist. The polarities!

            Pick two people and look at their faces. Feel their skin. Who is more red? Whose skin more dry? Who speaks more loudly and often? Who is more reserved and shy? The answers to these questions are clinically relevant, and it is in these basic categories that we will try to fit our observations of pulse and tongue. They have been universally recognized in traditional healing systems, from Chinese yin/yang theory to the Western humors.

The Pulse: Neuromuscular tension and tone

            When feeling the pulse, set your fingers on the radial artery. It can be found on the palm side of the wrist, right where the hand (thumb side) ends. You can often find a pair of strong tendons here; feel for the pulse in the little “trench” just above these.

            What we can learn from pulses: relative state of anxiety, tension, stress. Underactivity in the heart, vessels, and spirit (or, conversely, overactivity). 

            Herbs we can use to rebalance pulse: aromatic plants, and sometimes rooty, nourishing adaptogens. Archetypal plant for the pulse: Holy Basil (Tulsi – ocimum sanctum).

            Polarities to observe:

-         The pulse has a depth. It is right on the surface, somewhere in the middle, or deep down. This is determined by the amount of pressure required to find it. Surface pulse with no depth indicates “paper fire” (quick burnout, moody and changeable, hyper then crashing. Consider lavender, linden). Deep pulse that’s hard to find can mean depletion (hard to get going, tends to depression, fatigued. Consider ashwagandha, ginger, cayenne, green tea).

-         The pulse has a width. Think of the artery as a river, ideally flowing through the middle channel of depth. If it’s full and noticeable at all depths, it might be called “flooding” (excess function, high blood pressure, over-intensity. Consider motherwort, rose). If it’s thin and feels like a string, it might be called “tight” (high tension, excess sympathetic discharge. Consider motherwort again, lemon balm, scullcap). If it’s just thin, it might be a sign of deficiency and we would turn to the nourishing herbs (ashwagandha, oat, licorice, American ginseng).

-         The pulse has a speed. This is a pretty classic assessment: greater physical activity usually raises the pulse rate. When sitting, speedy pulses usually indicate anxiety or poor physical conditioning. Aromatic plants and exercise are called for. In extreme situations (requiring hospitalization: shock, toxicity, severe dehydration) you can see rapid, thin pulses too – but hopefully you won’t ever run in to these as they are emergency situations.

-         The pulse should respond to breath. Feeling the pulse, have the person take a deep, full breath slowly. The pulse should quicken on inhale, and slow down noticeably on exhale. Failure to do so indicates poor heart rate variability: if the pulse has low depth, feels thin or absent, consider nourishing and building here (ashwagandha, oat, licorice, American ginseng). If the pulse is of surface depth, flooding, or tight consider aromatherapy, and any aromatic plants (chamomile, linden, lemon balm, scullcap, mint, rose, yarrow).

-         The pulse should come back well after being completely blocked. Occlude the artery by pressing hard, then feel for the return of blood. Slow return to the “normal” state (taking more than 1 second) may indicate blood stagnation (purple color, cold, areas of chronic pain. Consider yarrow, elderflower, Salvia milthiorrhiza)

Basically, aromatic nervines make great teas and are often just the ticket for an imbalance in the pulse. This is because the radial pulse reflects the degree of sympathetic, or fight-flight, tone really well, and these plants are supremely useful for those who have either excessive or deficient tension in their systems. They modulate how we respond to change in the world within and without – and if we’re not doing a great job of it, the pulse tells us. If the pulse truly seems weak, sunken, and/or thin, you might want to add nourishing adaptogens as well to provide a literal foundation for stress hormone production, not just a way to balance response.

The Tongue: state of the mucous membranes

            When looking at the tongue, ask the person to really open wide and stick their tongue out completely. Then, tell them to relax it (often the “sticking out” causes the tongue to get really tight and weirdly-shaped).

            What we can learn from the tongue: relative state of activity and moisture of the membranes that line the GI tract, but also the respiratory passages by reflex. Degree of inflammation. Degree of swelling / moisture.

            Herbs we can use to rebalance the tongue: bitter and astringent plants. Archetypal plant for the tongue: Agrimony (Agrimonia eupatoria).

            Polarities to observe:

-         The tongue has a body color. This is the general hue of the tongue itself, not its coating, and indicates the degree of blood flow and activity in the mucous membranes. Pale tongue can indicate anemia, poor nutrition (consider yellowdock, rehmannia, protein). Red tongue indicates inflammation and irritation (consider dandelion and also slippery elm or meadowsweet depending on dry vs moist below). Purple: blood stagnation (see above).

-         The tongue has a coat. It should be whitish/gray, and relatively thin. Absent coat calls for soothing, especially with a red body (consider slippery elm, licorice, flax seed meal). Thick coat calls for bitters, especially if the coat has any signs of yellow in it – though watch for coffee stains! (consider dandelion, yellowdock, burdock)

-         The tongue has a shape, largely determined by its moisture (though the coat can tell us about moisture, too). Wider, thicker, glistening tongues indicate a swollen, boggy gastric mucous membrane. Often there will even be the scallops of tooth marks on the side (consider specific bitters such as goldenseal or barberry, but also meadowsweet, cleavers). Thin, wrinkly tongues indicate an atrophied, dry gastric mucous membrane (consider dietary oils such as sesame, bitters, and potentially soothers such as slippery elm especially with redness).

Basically, bitters are often a great choice for any tongue signs, except maybe in cases where the tongue is really pale and wet and there are symptoms of looseness in the bowel. This is because bitter herbs stimulate and awaken digestive function, and tone the mucous membranes in the process. They help us deal well with what comes to us from the world outside (most often food) by making sure that the interface (the mucous membrane) is functioning well. The tongue is a convenient piece of mucous membrane we can always observe!

Conclusion

            None of the diagnostic signs are infallible, of course – and should always be read in the context of symptoms and case presentation. The assessment of pulse and tongue can precede the oral interview, and guide it: for instance, feeling a tight and rising pulse with poor response to breath, you might want to ask about tension, anxiety, and a difficult response to life’s changes and stresses. Or noticing a dry and red tongue, you might ask about heartburn and/or constipation. Conversely, the assessment can come at the end of the oral interview, and be used to corroborate information obtained through conversation. Finally, the maxim: treat the person, not the tongue (or pulse)!

Plant allies for winter health

Enhancing immune activity

Why: Herbal allies to combat respiratory infection as it begins.

Echinacea, Andrographis, Elderberry, Hyssop, Garlic, Osha

These agents provide an immediate “boost” to immune function, particularly the body’s ability to produce antibodies against viral infections. Will shorten the duration of common winter infections, and can also be used longer-term as preventative agents particularly for those more at risk.

How to take: most acute-use antiviral herbs can be taken whole, or with minimal processing. I often will simply nibble on a small (1”) piece of Echinacea root, or an even smaller piece of Osha root, when the first warning signs of illness begin. Stored in a glass mason jar in a cool cabinet, they will keep at least a year.

Elderberry seems best taken as a syrup. These preparations are pretty widely available, or you can make your own by mixing an equal volume of fresh berry juice with raw honey, and storing in the fridge. The honey is really medicinal too! 2 TBS three to five times daily is typical.

Andrographis is extremely bitter and hard to take straight. Often, we recommend a tablet or capsule of this plant, at a dose of 400mg three times a day, again at the first signs of trouble.

Hyssop makes an excellent though somewhat biting tea, and Garlic can be included with food (though the more raw, the better).


“Deep” immunity

Why: Enhancement of our own immune function, to clear infection more quickly if it does begin, and help get rid of lingering problems or break the pattern of repeated illnesses.

Astragalus, Medicinal mushrooms, Spikenard, Tulsi

Good policy for anyone, these tonics are most indicated in conditions of convalescence, to rebuild strength, or in cases of repeated infection every season. Taken consistently, they will also improve immune activity, helping to shorten lingering colds and flus, and prevent them to begin with.

How to take: these herbs are an easy addition to your regular stock-making routine. If you’re not making stock regularly (once a week or so), consider doing it! Save your vegetable scraps and peels and any animal bones, and simmer them with Astragalus root ( ½ cup per gallon), dried mushrooms (Reishi, Turkey Tail, about ½ cup total per gallon) and some spikenard root (Aralia racemosa, about 2 TBS per gallon). This last one is especially indicated to help bring up vitality and kick out lingering congestion. Also, see a specific recipe variant in the “recipes” below.

Tulsi (aka Holy Basil) is a wonderful tea herb. Start it up in September if there are concerns about the coming season.



Adjusting mucous membrane function

Why: Our respiratory mucosa is our first line of defense. Ensuring it is not swollen, stuck, and/or inflamed not only improves symptoms immediately, but also improves defense.

Reducing swelling: Goldenseal, Barberry, Osha
Reducing thick secretions: Echinacea, Horseradish
Reducing dryness and irritation: Propolis, Licorice

How to take: These strong herbs usually don’t require a high dosage to accomplish their goals. Part of this may be due to the fact that reflex action mediates their effects – horseradish makes your eyes water, for instance, even though none is ever put in your eyes. So I usually suggest tinctures, good to have on hand and already picked out depending on what your respiratory passages tend to feel like when you get sick. Of these liquid extracts, try taking 15 drops or so every couple of hours and seeing how it makes you feel.


Protecting and toning the respiratory tract

Why: If lungs are consistently affected. This isn’t an issue for everyone, but if it tends to be, best to include these herbs right away before the illness gets there.

Thyme, Garlic, Usnea

These herbs are especially useful for those whose lungs are prone to weakness (history of pneumonia, repeated bouts of bronchitis or bacterial infection, or smokers).

How to take: Thyme can be inhaled as a steam by brewing strong tea and breathing deeply. After that, go ahead and drink the tea too! With a little raw honey. Usnea lichen is eaten whole, or taken as a capsule – though I really like the effect of the raw herb as it goes down the throat. It kills viruses and bacteria that contribute to sore throat, and enhances lung immunity once you absorb it internally. 1-2 grams of Usnea twice daily is usually plenty.


Encouraging lymphatic activity

Calendula, Cleavers

Useful in the latter phases of an illness, after the fever or acute symptoms have abated, to clear lingering inflammation and hasten recovery. Can also be used right at first if there is a history of lymph node (gland) tenderness.

How to take: Most often as teas. The extra fluid is really helpful too. 4-6 TBS per quart of water.


Encouraging circulatory activity

Ginger, Garlic, Cayenne

This often is all you’ll need for a common cold in those of strong constitution. Helpful for all to stimulate warmth, encourage perspiration and speed recovery, but particularly indicated in a colder person.

How to take: Special hot sauce? Or a home-made version thereof where the above three herbs are blended, to taste, with apple cider vinegar. Try ½ teaspoon twice a day to start.



Herbal Recipes for Winter Health

Remember that, when using herbs for healing and wellness, it is important to bring their powers into your life from many different angles – use a tea, tincture, and/or an aromatherapy steam to reinvigorate a weak constitution, and think preventatively to strengthen immunity during times of good health.

Immune ‘soup’:

This simple blend can serve as a base for any soup, or can be taken ‘as is’. It strengtens the immune system and can help prevent weakness during the winter months. It is quite powerful, but as with any herbal tonics (blends designed to strengthen over the long term) it is best used on a regular, daily basis.

Astragalus (Astragalus membranaceus) root 1 cup of dry root

Ashwagandha (Withania somnifera) root ½ cup dry root

Red Reishi (Ganoderma lucidum) mushroom ½ cup dry mushrooms

Burdock (Actium lappa) root ½ cup dry or fresh root

Garlic (Allium sativum) bulb 4 minced cloves

Take the above ingredients, and simmer them, covered, in a pot with 2 quarts of spring or well water (this process is called a decoction). Simmer on very, very low heat for at least one hour (in China, these types of tonics are often simmered for a whole day – a crock pot can be helpful. Be sure to keep an eye on the soup, and add water as needed. Don’t scorch the pot!). Strain and serve, perhaps with a little honey, or freeze for storage. The daily dose is 8 fluid ounces (1 cup).

Get creative with this soup! Add onions, carrots, seaweed (dulse, arame for example) and salt to taste. You can also add cabbage, potatoes, and cooked beans to make it more of a hearty meal. Or herbs and spices like Cayenne, Thyme, and Parsley. These soups remind us that our daily food is our best medicine!



Tea #1 – For lung congestion

Sometimes a cold can ‘go down’ into the lungs, making it difficult to breathe and producing a deep and sometimes painful cough. In these cases, this blend can help.



Mullein (Verbascum thapsus) leaves 3 Tablespoons dry leaves

Thyme (Thymus vulgaris) leaves 1 Tablespoon dry leaves

Licorice (Glycyrrhiza glabra) root 1 Tablespoon dry root

Ginger (Zingiber officinalis) root powder 2 Teaspoons dry powder



Place all the ingredients in a teapot or mason jar, add 1 Quart of boiling-hot water, cover, and steep for 15 to 20 minutes (this process is called an infusion), then strain. Drink the whole quart over the course of a day. You can prepare this tea the night before, and let it steep all night if you’d like, but I have found that teas for colds and flus work better if you drink them hot.

Add honey to taste.




Tea #2 – For nose and sinus congestion

Often times the worst part of a cold is a stuffy nose. This blend can help relieve that congestion, drying up the nasal passages a bit. It is also useful, I’ve found, after the worst of a cold or flu is done, to help relieve lingering symptoms of congestion.


Elder (Sambucus nigra) flowers 2 Tablespoons dry flowers

Red Clover (Trifolium praetense) flowers 2 Tablespoons dry flowers

Catnip (Nepeta cataria) leaves 1 Tablespoon dry leaves

Ginger (Zingiber officinalis) dry root powder 1 Teaspoon dry powder

Place all the ingredients in a teapot or mason jar, add 1 Quart of boiling-hot water, cover, and steep for 15 to 20 minutes (this process is called an infusion), then strain. Drink this quart of tea over the course of 4 hours, then repeat if necessary. You can add a little honey to taste if desired, although I’ve found too much sweetness can make nasal congestion worse.




Tincture – Echinacea purpurea

Tinctures are alcohol-based extracts of herbs. Usually quite potent and concentrated, they require a solvent such as Vodka to create. The dose is usually much, much smaller than that of a tea.

Echinacea (Echinacea purpurea) root 2 or 3 Tablespoons fresh or dry

Vodka (100 proof) 8 fluid ounces (1 cup)

Chop the root as finely as is possible, and place it in a jar you can close securely (mason jars work well, I’ve found). Pour the vodka over the chopped root, close the jar, and shake it really well for at least 30 seconds. Label your tincture (name of herb and date are the mimimum requirements) and put it in a cool, dark place. Shake it well at least every other day.

After two weeks (better yet, wait four weeks if you can), strain your tincture, discard the spent roots, wash out the jar, and put the tincture back in. It should have turned a nice reddish-brown color, and is ready to use!

Echinacea tincture is taken 1 teaspoon at a time, in a little water, once every hour when you feel the first signs of a cold or a sore throat.




Aromatherapy steam

This process is very useful to help relieve congestion in the nose and lungs. Usually best to do at night, before bed, to clear the breathing passages and encourage restful sleep.
Boil a pot of water. When the water is hot, remove from heat and place it on a safe surface (a stone or trivet works well).
Add 2 drops each of these essential oils (highly concentrated plant essences – use only a few drops, never internally, and be careful because, undiluted, they can irritate the skin):
Rosemary
Thyme
Eucalyptus
Cover your head with a towel and breathe in the steam for 5-10 minutes.