Herbal bitters: their role in appetite, blood glucose management, and obesity

I am excited to be traveling to the annual American Herbalists' Guild symposium. I'll be presenting a few classes, but below are the notes for a review of the recent research on herbal bitters. Lots of interesting material has come out in the last few years to improve our understanding of how these medicinal plants work in our physiology. I include some practical clinical observations and implications as well.

Summary: Bitter herbs have a well-deserved reputation as digestive aids in most systems of traditional medicine, and in many systems of cuisine. The ability of bitters to support balanced secretion and motility, especially in the gastric phase of digestion, relies on a few important mechanisms that are mediated through taste receptors (T2R family) and involve neuronal, hormonal, and vascular effectors. New research is uncovering additional interesting facts about bitter tasting herbs: first, not all bitter flavors are alike, and a certain degree of variability exists in their effects and spheres of action. Second, additional mechanisms involving adipose tissue, inflammatory mediators, the microbiome, and hepatic glucose balance reinforce the idea that certain bitter herbs may be one of the best strategies for the management of blood sugar and lipid imbalances, the regulation of appetite, and the reversal of the metabolic syndrome.

Background: bitter taste receptors: traditional and modern understanding

The current understanding of our ability to sense taste transcends the classical notions that specific areas on the tongue correspond to specific flavors, or that taste perception is indeed localized to the tongue. Wolfgang Meyerhof studies molecular genetics at the German Institute of Human Nutrition and has provided extensive research into the structure, coding sequences, and function of bitter taste receptors (TAS2Rs, aka T2Rs, a family of G-protein coupled receptors). Some interesting points include the facts that T2Rs present numerous different isoforms, able to sense over 100 different bitter tastants and their combinations [Ref: Meyerhof W, Batram C, Kuhn C, Brockhoff A, Chudoba E, Bufe B, Appendino G, Behrens M. 2010 The molecular receptive ranges of human TAS2R bitter taste receptors. Chemical Senses. 35(2):157-70]; they relay information from the tongue to the nucleus tractus solitarius (medulla) and from there to the hypothalamus using proteins such as alpha-gustducin; and participate in parasympathetic activities such as increased oral and gastric secretions [Ref: Meyerhof, Wolfgang, et al. "Human bitter taste perception." Chemical Senses30.suppl 1 (2005): i14-i15.] More recent research by Meyerhof and others indicates that, unlike most stimulus/receptor pairs in human physiology, the expression of T2Rs increases (to a point) the more stimulus is presented: that is, the more we taste bitter, the more we are able to experience its effects [Ref: Behrens M, Meyerhof W. Bitter taste receptors and human bitter taste perception. Cell Mol Life Sci. 2006 Jul;63(13):1501-9.] What we may, in fact, be noticing is that the human physiology _under_expresses T2Rs until an adequate amount of bitter stimulus is present, at which point a "normal" level of expression is achieved.

Perhaps more interestingly when we consider the inflammatory nature of chronic disease, especially the metabolic syndrome, emerging research is indicating that high levels of pro-inflammatory compounds also serve to _over_express T2Rs, leading to a highly aversive response to even small amounts of the bitter flavor [Ref: Feng, Pu, et al. "Regulation of bitter taste responses by tumor necrosis factor." Brain, behavior, and immunity (2015).] Taste-sensitive cells throughout the body have highly tuned TNF receptors (tumor necrosis factor, a pro-inflammatory compound).
Reducing inflammatory load seems to reduce bitter taste receptor expression, which is of interest when we consider that the effects of phytochemicals associated with bitter taste often are anti-inflammatory.

The neuronal feedback elicited by T2R stimulation (via cranial nerves VII-facial, IX-glossopharyngeal and X-vagus) helps control the cephalic and gastric phases of digestion, coordinating secretion and motility by increasing the former and decreasing the latter. This process has been extensively studied and is well-reviewed by Catia Sternini [Ref: Sternini, Catia. "Taste receptors in the gastrointestinal tract. IV. Functional implications of bitter taste receptors in gastrointestinal chemosensing." American Journal of Physiology-Gastrointestinal and Liver Physiology 292.2 (2007): G457-G461.] The net result is improved molecular breakdown of macronutrients in the chyme that enters the intestinal phase of digestion, as well as slower delivery of those digested products. This underlies the traditional indications for digestive bitters: dyspepsia, indigestion and reflux, gas and bloating. But the slower delivery of metabolized carbohydrates to the small intestine also has a role to play in post-prandial (after-meal) glycemia.

It has been clear for some time that T2R stimulation modulates levels of hormones associated with appetite: ghrelin, a hunger hormone, increases at first. But reduced gastric motility leads to a feeling of fullness, and this, coupled with increased levels of hormones associated with satiety (fullness) such as peptide YY (PYY) and glucagon-like-protein 1 (GLP-1), leads to less caloric intake overall [Ref: Janssen, S. et al. Bitter taste receptors and α‑gustducin regulate the secretion of ghrelin with functional effects on food intake and gastric emptying. Proc. Natl Acad. Sci. USA 108, 2094–2099 (2011).] The modulation of these hormones was long thought to be connected to neuronal reflexes, but emerging research shows that the taste cells themselves function as enteroendocrine cells, are present throughout the GI tract, and secrete appreciable levels of their own hormones into the gastrointestinal circulation. Bitter-tasting substances can harness these enteroendocrine cells and contribute to local secretions that affect absorption, appetite, and the metabolism of fat and carbohydrates [Ref: Posovszky C, Wabitsch M, Regulation of Appetite, Satiation, and Body Weight by Enteroendocrine Cells. Part 1: Characteristics of Enteroendocrine Cells and Their Capability of Weight Regulation. Horm Res Paediatr 2015;83:1-10] and [Ref: Palatini, Kimberly, et al. "Diverse Classes of Bitter Phytochemicals Modulate Carbohydrate Metabolism and Immune Responses through Gastrointestinal Bitter Taste Receptors." The FASEB Journal 29.1 Supplement (2015): 405-5.] Thus, bitters may act directly as endocrine triggers, not requiring intervention by the central nervous system.

Another fascinating result of experimental research underscores yet another effect of herbal bitters. A recent review article by Julie Whitehouse and others [Ref: McMullen, Michael K., Julie M. Whitehouse, and Anthony Towell. "Bitters: Time for a New Paradigm." Evidence-Based Complementary and Alternative Medicine 2015 (2015).], lends evidence to the hypothesis that certain bitters (particularly the more strongly-flavored, classic "eupeptic" herbs gentian and wormwood) increase blood flow to the GI tract. This post-prandial hyperemia is achieved, interestingly, via peripheral vasoconstriction and localized (mediated by enteroendocrine cells again) vasodilation. The overall shifting of circulatory volume can act as a negative cardiac chronotrope and inotrope (reducing frequency and strength of heart muscle contractions), and is most likely the reason (rather than increased tone along the vagus nerve) why this phenomenon has been observed after the consumption of bitters. Practically speaking, this suggests that herbal bitters should include at least one of these classic "eupeptics" for maximal effect - for not all bitter tastants elicit the same effects, and not all reduce ingestion of calories equally, as Lindsay Schier observed [Ref: Schier, Lindsey A., Terry L. Davidson, and Terry L. Powley. "Ongoing ingestive behavior is rapidly suppressed by a preabsorptive, intestinal “bitter taste” cue."American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 301.5 (2011): R1557-R1568.]. Additionally, Whitehouse notes that the vascular shift is almost instantaneous (within 5 minutes) after T2Rs in the tongue are stimulated by strong bitter flavors. This implies that one can take bitters before, during, or even after a meal and that the effects can still be beneficial (consuming them 10-15 minutes before eating is not necessary).

Clinical implications: Appetite, glycemia, lipidemia, hypertension and the metabolic syndrome

It appears that our ability to detect and respond to bitter tastants such as those found in bitter herbs is variable, and connected to the internal and external environment. This is the first step in realizing their therapeutic potential: as we age, the expression of T2Rs decreases naturally, and sometimes (in the absence of any bitter stimulus) appears to decrease beyond "normal" expression. This "normal" level can, however, be restored by applying regular bitter taste stimuli. The "bitter deficiency syndrome" hypothesized by James Green in The Male Herbal (J. Green, 2007) has indeed been documented. Women [Ref: Feeney E, O'Brien S, Scannell A, Markey A, Gibney ER. 2011 Genetic variation in taste
perception: does it have a role in healthy eating? Proceedings of the Nutritional Society.
70(1):135-43.] and children [Ref: Negri, Rossella, et al. "Taste perception and food choices." Journal of pediatric gastroenterology and nutrition 54.5 (2012): 624-629.] have much lower levels of obesity when they perceive higher levels of bitterness. Additionally, individuals with high bitter sensitivity have improved blood glucose control, as extensively investigated by Cedrick Dotson at the University of Florida [Ref: Dotson, Cedrick D., et al. "Bitter taste receptors influence glucose homeostasis." PloS one 3.12 (2008).].

The intersection between bitters and inflammation is of particular interest, as is the potential for a post-prandial GI hyperemia (and a resultant reduced load on the heart and arterial system). First, a strong aversive response to bitterness by an individual who has little experience with the flavor may be indicative of a high background level of pro-inflammatory compounds such as TNF. As the aversion decreases, one could expect that the cholagogue, GI anti-inflammatory, hepatic "cooling" effect might be contributing to reduced inflammation (an interesting balance point between increased expression through T2R stimulation and decreased expression via reduced TNF). Second, reduced inflammation plus reduced cardiovascular load and stress are essential components to any therapy designed to address the metabolic syndrome - and through a wide range of mechanisms, bitters appear to do just that. The connection between the bitter flavor and the heart in some traditional healing systems is of note here, as well. Kimberly Palatini's research, mentioned above, suggests that bitters modulate immune responses in the GI tract and in the physiology overall - while balancing and regulating every aspect of carbohydrate absorption and metabolism, increasing glucose tolerance and insulin sensitivity. Of course, improved insulin sensitivity is a direct consequence of reducing high levels of pro-inflammatory compounds: TNF, as well as series-2 prostaglandins, have all been linked to insulin resistance.

Regulation of appetite, leading to the epidemiologic results observed (lower obesity rates), occurs by a variety of mechanisms. The first is related to motility: through cranial nerve feedback, bitters delay gastric emptying leading to a more rapid sensation of fullness. But just as importantly, wide-ranging effects on satiety, appetite, and carbohydrate metabolism, storage and processing are mediated through enteroendocrine cells - which turn out to be sophisticated "tastebuds" with chemoreceptors on the luminal side and the ability to secrete hormones on the basolateral side. T2Rs are found on P/D cells in the stomach, which secrete hormones involved in fat metabolism and insulin sensitivity (increasing both); on I cells in the duodenum which reduce food intake and stimulate CCK; and on the all-important L cells in the small and large intestines, which secrete PYY (satiety) and GLP-1 (insulin sensitivity) [Ref: Posovszky, Carsten, and Martin Wabitsch. "Regulation of appetite, satiation, and body weight by enteroendocrine cells. Part 1: characteristics of enteroendocrine cells and their capability of weight regulation." Hormone Research in Paediatrics 83.1 (2015): 1-10.]. The recent research and potential of bitter tastants in regulating appetite, obesity and the metabolic syndrome are well-reviewed by Sarah Calvo and Josephine Egan in Nature Reviews [Ref: Calvo, Sara Santa-Cruz, and Josephine M. Egan. "The endocrinology of taste receptors." Nature Reviews Endocrinology 11.4 (2015): 213-227.].

And while bitters have important effects on preventing (and perhaps treating) insulin resistance and diabetes, as we have seen from the mechanisms above, I have also seen them correct episodes of transient, non-emergent hypoglycemia on many occasions. Since hypoglycemia in a non-insulin-dependent patient may actually be evidence of disregulated glucose homeostasis and metabolism (a consequence of insulin over-secretion earlier), this does not come as a surprise. Another mechanism whereby bitters correct transient hypoglycemia may involve "tricking" the hypothalamus into believing food is being consumed. This effect may seem like a simple novelty, but it becomes very clinically relevant when you consider the intense sugar cravings experienced during these episodes. If we had a tool to trick the hypothalamus into believing the craving had been satisfied, our patients could make more rational judgements for nutrition (nuts or other sources of fat and protein). Bitters can provide just such a tool.

T2R receptors, and enteroendocrine G-protein-coupled receptors in general, are receiving sustained attention as potential targets for reversing insulin resistance. Exciting research is coming out of Cedrick Dotson's office (mentioned above), who is stimulating T2R receptors with bitter tastants and comparing the insulin-sensitizing effects to the opposite effects found by stimulating sweet taste receptors (T1Rs) [Ref: Dotson CD, Vigues S, Steinle NI, Munger SD. T1R and T2R receptors: the modulation of incretin hormones and potential targets for the treatment of type 2 diabetes mellitus. Curr Opin Investig Drugs 2010; 11: 447–454.].

Finally, many bitters (especially the more "nutritive" bitters, such as dandelion, chicory, elecampane, angelica and burdock) possess appreciable quantities of pre-biotic starches and can deliver these important nutrients when consumed at clinically relevant doses. Oligosaccharides such as inulin can have useful regulatory effects on bowel function, and over time contribute to lower blood glucose, lower lipid levels, and better satiety [Ref: Nishimura, Mie, et al. "Effects of the extract from roasted chicory (Cichorium intybus L.) root containing inulin-type fructans on blood glucose, lipid metabolism, and fecal properties." Journal of Traditional and Complementary Medicine (2015).]. This may be in part due to mechanical effects (such as an osmotic laxative effect), but may also be due to changes in enteroendocrine cell hormone production associated with a shift in microbial populations. A fascinating study by Patrice Cani hinted at just this type of effect in a small (n=10) group [Ref: Cani, Patrice D., et al. "Gut microbiota fermentation of prebiotics increases satietogenic and incretin gut peptide production with consequences for appetite sensation and glucose response after a meal." The American journal of clinical nutrition 90.5 (2009): 1236-1243.] As Steven Abrams noted, this effect is best observed with long-term, habitual use: prebiotics, when combined with calcium (see dandelion root), reduce body mass index better than a placebo control (n=96, one year)[Ref: Abrams, Steven A., et al. "Effect of prebiotic supplementation and calcium intake on body mass index." The Journal of Pediatrics 151.3 (2007): 293-298.].

Conclusion: The digestive-enhancing effects of bitters are well documented, but may be just the beginning of what these traditional preparations have to offer. When consumed in a formula that includes both "eupeptic", strong bitters such as gentian and wormwood, and "nutritive" bitters rich in pre-biotic starches, and taken habitually in material doses, they exert clinically relevant effects on the metabolic syndrome. Appetite, carbohydrate and lipid metabolism all are regulated. Inflammation and cardiovascular load are reduced. Bitters accomplish this through a variety of mechanisms, including neuronal, endocrine, immunologic, and vascular. They most likely need not be consumed too far ahead of a meal, but at any point before, during, or after, and at relatively high doses for the most substantial effects. Given the resurgence of interest in these traditional preparations from those well-versed in the beverage alcohol and cocktail world, we as herbalists may have at our disposal a powerful, flavorful tool for addressing obesity and the metabolic syndrome - one our patients can relate to, and easily incorporate into their lives as a daily habit.

Plant saponins

This is the transcript of a talk I gave recently (at the Traditions herb conference in New Mexico), and focuses specifically on a class of plant chemicals: the saponins. However, it is also a great example of how plant chemistry, in general, works: "promiscuous" phytochemicals (as Chatterjee describes them) finding effects in multiple areas of the body, and being affected by the body in turn. This is the beauty of herbal medicine: the context matters as much as the chemical does. No wonder we obsess about "constitutions", "energetics", and other systems-based ways of describing phytohominid interactions.

We are moving away from the idea that isolated, targeted chemicals – be they steroids, antibiotics, or other agents active at specific receptor sites in the human body – are the only way (or even the most efficient way) to achieve health-promoting effects.  This is progress. But herbalism has more to offer to the field of medicine than simple polypharmacy: medicinal plants and their chemical cocktails don’t just act on the system, the way a drug might, they interact with it. This means that, when taken habitually the way most herbal prescriptions are, herbs enmesh themselves into our tissues and processes, and their effects have as much to do with what the body does to the herbs as with what the herbs do to the body. Plant saponins are perhaps the best example of this, acting on every level from the formula to the internal organs and everything in between, changing their conformation and altering their behavior as they move through the physiology and interact with its denizens. If we can understand how a human being and a cocktail of botanical saponins relate to one another, then we don’t just open a door to new formulation tricks and pharmacodynamic mechanisms – we get a visceral sense of how truly non-static herbal chemistry is, how it flows and changes, how different contexts affect it in different ways. And this may be the most important piece.

What is a saponin?

In its simplest form, these chemicals consist of a water-loving (hydrophilic) chunk attached to an oil-loving (hydrophobic) chunk. Often, the hydrophilic piece is a sugar molecule, or perhaps a short chain of sugar molecules, and there can be more than one chain on each saponin. The hydrophobic side is usually a hydrocarbon – either a net of carbon rings (triterpenoid) or a steroid-like structure. But since one piece of the molecule mixes well with water and the other doesn’t, saponins (as the name implies) can have noticeable soap-like effects, forming foams and acting as cleansers (soapwort, Saponaria, has long been prized as an easy and abundant botanical detergent).

The basic test for saponins in a plant is easy. Make a strong infusion (leaves) or decoction (roots/barks) of the plant in question. Strain into a 250ml graduated cylinder, and cool. Shake it vigorously for one minute. If a honeycomb-shaped bubble lattice at least 2cm (a little less than 1 inch) persists in the cylinder for ten minutes, you can be positive that the plant is rich in saponins.

Have you ever tasted soap? You may not have. It is quite bitter, eliciting the typical aversive responses of moderate-to-strong bitter flavors. Saponins, with a few exceptions (like licorice), are generally just as bitter. Their flavor is an important part of their medicinal effects, especially early on in their journey into the human physiology.

It is still a matter of debate as to why plants produce these molecules. Some believe they act as browsing deterrents, because of their bitterness. Others have documented antifungal and antibacterial qualities which may help protect plants from infection. Still others hypothesize that the hydrophobic backbone serves as a sort of “ferry” for the sugar molecules, allowing them to cross barriers they normally couldn’t. I suspect that all these stories are true, at least in some part.

The physics of saponins in water solutions

The foam you see when shaking a cup of licorice tea is only the most macroscopic part of the picture. Inside the cup, the soap-like molecules are arranging themselves into interesting little “bubbles”, known as micelles, with the hydrophilic sugar tails sticking out into the water and the hydrophobic backbones clustering together in the middle of the bubble. This is quite interesting in and of itself, as we will see, but imagine for a moment if there were other molecules in the tea – say, for instance, that you had added some propolis tincture to really help with your client’s bronchial cough – that weren’t very water-soluble. If you’ve ever tried adding a dropper of propolis tincture to a glass of water, you’ll know that the resins it contains immediately separate from the solution, turning the glass cloudy and leaving a ring of sticky material behind. If you add that same dropper to a strong, foamy licorice decoction and shake it up quickly, the effect is much less pronounced: the hydrophobic resins are trapped inside the saponin micelles, mixing with the hydrophobic backbones, and stay in solution much better. This effect is known as emulsification.

These two effects – the foaming, and the emulsification – have numerous practical applications, and you don’t need a lot of saponin to achieve them. For instance, soft drink manufacturers add saponins to their products to improve the quality and persistence of the foam “head” [Ref: A.J. Mitchell, Formulation and Production of Carbonated Soft Drinks]. I favor a combination of hawthorn, gotu kola, and turmeric for chronic ligament and connective tissue injury, and for a long time formulated this tincture blend with two parts hawthorn and turmeric, and one part gotu kola. But the turmeric tincture, extracted at a much higher percentage of alcohol, would always separate, sometimes clogging the dropper, once it got diluted by the other two and all its hydrophobic constituents fell out of solution. The problem was solved by adding horse chestnut tincture, from a saponin-rich seed,  to the mix (one part out of five). The curcuminoids stayed in solution, no more clogging, and horsechestnut’s anti-inflammatory power helped make the formula even more effective.

The British Pharmaceutical Codex recommends a ratio of 1 part Quillaja tincture (the soapbark tree, from Chile) to 8 parts resins or fatty acids to achieve an effective emulsion. This highlights the effectiveness, even at low concentration, of saponins as blending agents.

The emulsifying, blending quality of plant saponins in a multi-constituent herbal formula, especially if it contains high- and low-alcohol tinctures mixed together, is really useful. And it may underlie the traditional wisdom of using plants like licorice as “harmonizers” and “binders” in the formula: not only does the pleasant flavor help in compliance, but the physics of the saponins in solution ensures that all constituents remain equally suspended in the blend – in harmony.

Act I – the gastric phase of digestion

First off, taste. The activity of saponin-rich plants like yucca, fenugreek, and even ginseng begins with their ability to stimulate bitter taste receptors – soap-like, after all. From here you get many of the benefits of bitter tastants, and these actions are reinforced once the saponins reach the stomach and duodenum: secretions increase, movement of smooth muscle in the gut becomes less spasmodic and better synchronized, valves close up. This may be part of the reason why so many saponin-rich plants (again, with the exception of licorice) are good at controlling blood sugar spikes: the food we eat doesn’t get to the intestinal phase as quickly, so it doesn’t flood the bloodstream with glucose.

Another interesting topical effect of saponins relies on the intimate connection between the mucous membrane of the GI tract and the respiratory system. Pick your saponin-rich herb: licorice, Senega snake root, yucca root, Platycodon, fenugreek – almost all have at least some degree of expectorant activity. This is probably due to what Simon Mills calls “acupharmacology” – the fact that our gut lining is connected to other tissues in the body via nerve fibers, particularly the vagus nerve, allows a slight irritation to affect those other tissues by reflex. So saponins encourage the upward movement of material from the lungs by slightly irritating the stomach lining with their soap-like quality.

Yet another effect relies on the physical properties of saponin micelles. When bile, which contains appreciable quantities of cholesterol, is released into the duodenum, some of the hydrophobic cholesterol is trapped in the micelles. It is then excreted at higher levels in the stool, instead of being re-absorbed and circulated in the blood. There has been a lot of animal research confirming this mechanism [Ref: Sautier, C., et al. "Effects of soy protein and saponins on serum, tissue and feces steroids in rat." Atherosclerosis 34.3 (1979): 233-241], but it also helps explain the cholesterol-lowering effect of ginseng saponins [Ref: Kim, Seung-Hwan, and Kyung-Shin Park. "Effects of Panax ginseng extract on lipid metabolism in humans." Pharmacological Research 48.5 (2003): 511-513.]

At this point, the molecules are still very similar to what they were in your tea or tincture. But once they enter the duodenum and start to meet pancreatic amylases (starch-digesting enzymes) and eventually gut flora, things start to get interesting.

Act II – the intestinal phase of digestion

The entire GI tract is a sophisticated chemosensory organ – meaning, it’s really good at tasting, and not just the tongue. While bitter taste receptors persist throughout the gut, you also start to see lots of lymphatic tissue associated with the mucous membrane once you get past the stomach and its high-acid environment. In these areas, immune cells proliferate and sample the contents of the food we eat, all the while interacting with members of the microbiome. It’s a deep and rich conversation down there, and we are just barely beginning to understand the language. One thing that seems clear is that many of the signals that travel back and forth are expressed in sugar chains, or chains of sugar, fat, and protein – because that’s  what is found on the outside of most viruses and bacteria (with some exceptions, like the cyst form of Borrellia, the Lyme disease spirochete, which is naked can thereby evade immune detection). What is so interesting is that the saponin micelle, with its core of hydrophobic molecules and all the little sugars sticking out, looks a lot like a small microbe. Couple this with the fact that it’s never just one kind of saponin, but the sugar chain shapes and sizes vary dramatically (ginseng, for example, has over 100 [Ref: Shin, Byong-Kyu, Sung Won Kwon, and Jeong Hill Park. "Chemical diversity of ginseng saponins from Panax ginseng." Journal of Ginseng Research (2015).]), and you have the potential for a very fascinating little micelle to interact with the microbiome and the immune cells in the gut’s lymphatic tissue. Plant saponins are one of the most powerful ways for the vegetable kingdom to participate in the immunologic conversation that takes place inside the human being.

The interaction with the microbiome continues. Many saponins get broken in half once they meet pancreatic amylases, which can break sugar-to-sugar bonds, or gut flora, which can digest sugar chains for energy. But not all members of the microbiome feel the same way about saponins: probably because they are so ubiquitous in the traditional human diet, our long-term partners (the beneficial flora) aren’t harmed, and can harvest the sugars for energy. But yeasts and pathogenic bacteria that may be overgrowing in the case of dysbiosis can be damaged by saponins, whose soap-like quality melts their outer membranes. Many saponin-rich plants, like chapparal (Larrea) are excellent anti-parasitics and can help correct dysbiosis.

When you stop to think about the recent interest in the microbiome and immune system for modulating our mental health and perception of stress, our inflammatory balance, and our overall relationship with the world, you can begin to see how relevant a cocktail of plant saponins might be. The effects on immunologic tissue in the GI tract and gut flora balance is a big part of the adaptogenic, anti-inflammatory, immunomodulating effects of saponin-rich plants like Panax and Astragalus.

Some [Ref: Robb Wolf, Paleo Solutions] worry that the soap-like quality of plant saponins can “punch a hole in the lining of your gut,” contributing to leaky-gut syndrome and inflammation. In fact, these molecules can be quite toxic to fish and reptiles who lack the ability to metabolize them, and have been used as fish poisons. In these cases they do actually cause a breakdown reaction in tissues and blood cells of the animals. Fortunately, mammals seem immune to these effects (as long as the saponins aren’t injected intravenously), because our digestive enzymes and gut flora separate the hydrophilic sugars from the hydrophobic backbones, thereby destroying the soap-like effect. The hydrophobic metabolites are often absorbed into the blood, sometimes pretty quickly (less than 90 minutes), but they do no damage once they’re separated from the sugars [Ref: Lee, Jayeul, et al. "Studies on absorption, distribution and metabolism of ginseng in humans after oral administration." Journal of ethnopharmacology122.1 (2009): 143-148.]

It is these metabolites that feature prominently in the final act – but what is fascinating is that the metabolites would probably never be absorbed whole into our bloodstream if they didn’t come attached to those sugar chains. In essence, the sugars protect the hydrophobic metabolites from digestion and breakdown in the gastric phase and shield them from microbial metabolism by locking them into those little micelles. A sort of molecular enteric coating. Without it, glycyrretinic acid (the metabolite of glycyrrhizin, a licorice saponin) would never make it into our bloodstream [Ref:  崎谷陽子, et al. "Rapid estimation of glycyrrhizin and glycyrrhetinic acid in plasma by high-speed liquid chromatography." Chemical and Pharmaceutical Bulletin 27.5 (1979): 1125-1129.]

Act III – the blood and tissues

Now stripped of its sugar chains, what was once a saponin is now an aglycone – a sugarless molecule. The first tissue it encounters may be the liver (though being hydrophobic, many aglycones are absorbed into lymphatics and wind their way up to the heart instead. Soon, though, they all will visit the liver). Here, the aglycone travels across the cell membrane and begins to interact with the expression of DNA, affecting the types and quantities of proteins that are produced. Some aglycones from fenugreek saponins, for instance, seem to increase liver cells’ sensitivity to insulin, and decrease cholesterol production – thereby reinforcing the effects the saponin had in act I. Still in the liver, aglycones may interact with enzymes responsible for metabolizing sex and steroid hormones, contributing to a balancing and adaptogenic effect. Sometimes this can be quite powerful: glycyrrhetinic acid, the aglycone from licorice, slows the breakdown of secretions from the adrenal cortex such as cortisol (a stress steroid) and aldosterone (which makes us retain sodium). Taken in large quantities for long periods, it can cause fluid retention and high blood pressure.

Many saponin aglycones have noticeable anti-inflammatory effects, through a wide range of mechanisms. Some inhibit cyclooxygenases – sort of like a gentle aspirin – while others increase the presence of anti-inflammatory hormones, still others (like the aescin aglycones from horse chestnut) tone the tissue of the capillaries and venules, decreasing leakage, swelling, and pain. These actions synergize with the immunological activity exerted in act II, where the saponins talked to lymph tissue and microbiome, to reinforce the overall anti-inflammatory effect.

Because of their fat-soluble nature, a good portion (though not all) of saponin aglycones can cross the blood-brain barrier and affect the production, distribution, and balance of key neurotransmitters, particularly the ones involved in the stress response. Many adaptogens (like licorice, codonopsis, ginseng, eleuthero) rely on this activity. That horse chestnut and fenugreek lack adaptogenic activity speaks to the circulation of their aglycones: they may not be as effective at modulating the relevant hormones because they simply can’t get there.

In conclusion, we can use the example of plant saponins to illustrate the complex and multiple ways that herbal medicines interact with our physiology. They change us, in gentle but profound ways, and yet they are also themselves changed. Without this two-way interaction, none of the activities we reviewed would be possible. But what is even more interesting is that, depending on the context, all or none of these actions may be present: the same root may work differently in different folks. Codonopsis saponins might help correct dysbiosis in one individual, by preferentially feeding beneficial flora and contributing to the destruction of pathogens. This, coupled with the interaction of saponin micelles with immune cells in gut lymph, might help restore emotional and spiritual balance for that specific individual. But for another, it may be the codonopsis aglycone, interacting with the metabolism of stress hormones, that keeps their mood balanced: adrenal spikes flatten out, blood sugar normalizes, emotions stop their roller-coaster ride. The physiology can avail itself of any or all of these actions depending on what is lacking, or out of balance: and unlike single molecules like caffeine or convallotoxin, none are ever strong enough to disrupt a system already in balance. Consider saponins as great harmonizers: first in your formulas, then in your gut, and finally in your blood vessels, liver, and endocrine cells. 

Waterfowl, new moon

... with due respect to the loons ...

The great blue heron, so still, is like
a standing piece of driftwood, silver-gray cyan,
like when wood sees the pond water too long
and then, pushed up by a frost heave,
sun-bleaches and molders, gathering color.
Her neck feathers are fine grain exposed by years,
the pith and heartwood interweaving,
immobile, strong, fixed quiet to watch.

But when the neck coils down to spring
and wings open, stretching out tips
to catch sun rays in between,
you can feel the air compress
and watch her rise
as if a cord had lifted her from the granite
that lies half sunk beneath the glassy surface.

In my time I too
hope to rise that way,
fast and light and lifted,
not like the loons, who cry and flap,
and beat the water,
needing their slow, heavy ascent
to raise red eyes over the treeline.

The Kitipa boma

"The house is like a dark womb - and heavy, smoky - with a giant red eye at its core."

This boma - a Swahili word that means fence, or fortification - was about a two hour drive from Wasso hospital. We rode with ten other people in a broken-down Toyota pickup, pausing at river crossings to fill the radiator with the thick, greenish-brown water. The Maasai call their homes "engang" - the dwelling - and we arrived just before sunset, after walking about half a mile over short grasses and rocky outcrops.

Kitipa, the patriarch, was waiting, resting on a stoop just outside his home. The huts are arrayed in a circle around a thorny fence that holds the cattle at night - safe from the lion's attack, guarded by young men of the boma. Kitipa's hut is first on the right of the entrance to the cattle enclosure, a place of honor. We gave him our hand to shake, Uli bowed her head in respect and he touched it lightly. Then we moved on to his first wife's house, the next one on the right. She is the mother of my friend Nicholas, who invited us here.

"We will go into the house now," Nicholas said. It is hard to describe the home well. A small wooden door guards the entrance - about five feet tall and two feet wide. There are no windows. The outside is covered in cob made of cow dung - worn-down patches are updated with fresh dung from time to time. Thicker sticks are interwoven with a special branch - a wattle, of sorts - which serves as a scaffold for the cob. On either side of the door are branches of the sandpaper tree, Cordia monoica, placed there to protect the home from storms.

We entered into a very small antechamber. It was very dark. Immediately the senses were overwhelmed by an oppressive, acrid, hot smoke, only somewhat relieved by bending over and keeping the head low. Right in front of us, a small door led to the calves: their room occupies a third of the house. A left turn, then a right turn, led to the central dwelling space.

Here, surrounded by three gray stone slabs embedded vertically in the ground, the hearth fire was glowing. Two built-in beds, enclosed almost completely by some wattling, faced the fire and also served as sitting places. Built-in wattle shelves held cups, metal plates, calabashes of milk, tools - but you couldn't see anything, even after our eyes acclimatized to the dark. The ceiling had a crisscross network of sticks, wattle, and twigs disappearing into the darkness. Smoky cobwebs hung everywhere. The beds, made of thin sticks laid across a support structure, were covered in rawhide.

"We will not be cooking in here," Nicholas said. "It would be too hot". I was grateful. We were joined by Nicholas' brother Mangoiye, whom I had helped through a deep, feverish illness last year, and spent hours drinking hot, sweet milk, eating beans and rice, and telling stories of Maasai rituals, childhood and marriage, strange shape-shifting flesh-eating demons, warriors and cattle - all while sitting around the unblinking red eye of the hearth-fire embers.

Time came for sleep, and we reclined on the rawhide beds. It was warm, pitch black, and we could hear the low breathing of the calves. Nicholas bolted the door shut, from the inside, with a short stick polished from years of use. I fell asleep quickly - though Nicholas reminded me that at least one of the young men from the boma would be outside, guarding the cattle, keeping them safe inside their acacia thorn enclosure.

The season had been dry: no rain to green up the grass, to fatten the cattle. Almost everyone we talked to, from Wasso to the outlying bomas, complained that crops were failing, animals were hungry, rain was missing. But when I got up that night, slid the long, smooth stick out of its leather guide, and went outside to go to the bathroom, I was grateful for the cloudless sky. A huge field of stars, the galaxy silver and rippling, bright blazes of meteor trails filled my view from horizon to horizon. No human light in sight. I went back inside, overwhelmed and yet somehow so peaceful. I bolted the door, imagining what a privilege it would be to sleep out under those stars, resting with the cattle.

The next morning we woke with the roosters. A bright shaft of sunlight pierced through the home from a small hole in the eastern wall. The inside was so smoky, so dusty - you could see the beam like a shaft of pure glittering gold. We touched it, played with it like little children. Then, after some hot sweet milk, we walked outside. Mangoiye and boys were branding calves, using red-hot irons from a fire started by friction (using myrrh-tree fireboards). Immobilized by ropes, the calves made no sound as their skin, singed, let off trails of smoke into the morning air. Before walking back to the main road to get a ride back home, we talked of trees, medicine, colonial times and old games Kitipa used to play. He has many cattle, many children - a rich man.

The road home was dusty, hot and sunny. We were glad to return to hospital work, our home and our friends (and a hot-ish shower). That night we sat and talked by porch light, telling stories of the Maasai: the heat, the smoke, the dirt, the milk, the stars. We had made plans to return, speak with those who know more of the medicine trees, spend more nights in the dark of the boma home. Maasai life. If is difficult, conservative, in many ways oppressive. But in many places it is still an intact tradition - mostly, at least - and it feels special to interface with such a slice of human experience. It was an honor and a privilege.

The next morning, we experienced another privilege. The call came in - lion bite! We rushed to the minor theater. A young man, Maasai by dress, was lying on the table. Anne began chest compressions - his heart had stopped - while I took his head and positioned it to open his airway. Suddenly, he drew a huge, raspy breath. Intermittent, struggling breaths followed. I found a rapid, thready pulse on the carotid, Steve counted beats per minute on the radius. 145. We inspected his body: nothing on the legs, but his left arm had a series of deep punctures. Then we came to his head. Eye - lacerated. Pupils - fixed. Fracture above the nose. Through two gashes on either side of his head, white matter, thick and sticky, was exuding. We all realized his injuries were overwhelming: the lion had hit him in the head, his breathing sped then slowed, his heart was jumping fast and erratic. So, over the next twenty minutes, we held him as his breaths came fewer and fewer between, as his heart rate slowed, his pulse weakened. Sister Philippina poured holy water over his forehead. "Because we believe God is great." Steve lost the radial pulse. I lost the carotid. Robin stopped hearing heart sounds. He was gone.

Then the story came in from the family. He had been outside, underneath the stars, the night before, guarding the cattle in a boma's acacia enclosure. A lion had come and surprised him, he didn't have a chance to protect his head. The lion then took a cow and retreated into the night. The man was strong - he struggled a long time, refusing to give up - but in the end passed on to the fields and forest. As we felt his pulse slip away, a light rain started to fall, beating on the hospital's tin roof.

Wasso beat

Rhythm courses blood red
In waves of morning clouds
Marked by cattle bells.
The day breathes hot and wide,
Shadows race across the hill
Until they tire into long blue threads.
Then the cows return, in line,
Brown and white and black,
Driven down the long cracked wash,
Dusted rusty red.

Herbal Medicine in East Africa - our first week

The last leg of our journey to Wasso was on a small, six-seater airplane. In fact, we needed two planes to carry our team of four herbalists, one medical doctor, two medical students and my daughter Uli. It was a beautiful day to fly. A slight overcast, with a cloud ceiling at 7,500 feet, prevented the jarring updrafts that can make for very bumpy rides. We kept low, just under the clouds, flying close to mountainsides covered with cedar forests. Crossing over the Rift Valley, we flew just north of Ol Donyo L'Enkai, the Maasai volcano god, and over the spectacular Lake Natron which was swirling with all sorts of colors: blue to muddy brown, pink, white, emerald green, and all the shades between. As we approached the highlands of the Serengeti (Wasso is on the Eastern edge), the clouds and land met and we flew closer and closer to the hills.
Our pilot, Pat Patten, leads the Flying Medical Service and has well over thirty years of service under his belt in this part of the world. Everyone knows him, and he serves not only as a physician but also as a sort of messenger between the far-flung communities in the area. To signal our arrival at Wasso hospital, he flew down close, pulling a hairpin turn right over the hospital on his way to the long, grassy airstrip. "Only a few termite hills left of the center line," Pat remarked. "Should be a smooth landing." It certainly was. We were greeted at the airport and rode the short distance to the hospital in a land rover and on the back of an open Toyota pickup. It was Easter sunday. The town was still.

After the long weekend, we began our work at the hospital. We were lucky to have had a few days to explore, building our improvised apothecary from the abundant local plants. I noticed that everything seemed about a month behind where it had been last April. Perhaps this was because of a long drought: the rains hadn't come when expected, and rather than beginning in February had waited until March. But now, after just a few strong thunderstorms, the land had burst into green. Resurrection plants were blooming. The aloe sent up tall, riotous red flower spikes. The acacias were covered in delicate, fern-like new leaves - a stark contrast to their long white thorns. We collected Usnea, Bidens, aloe, local mallows and nettles and even a species of Spilanthes. We picked leaves of holy basil off bushes that were ten feet tall. As we were walking by the stream, we found an old Acacia nilotica. The bark is used for intestinal complaints, and has a fantastic combination of tannins and demulcent starches, along with bitter compounds. I'd been chewing on small twigs for myself, and wanted to collect some for patient use. But as we were looking at the tree, an elderly Maasai couple came up to see what we were doing. The mzee (elder) began to explain that the inner bark of the main trunk is the best part to use. But as he attempted to harvest some with his panga (machete), the bibi (grandmother) pushed him aside and pulled out a stout hatchet, long-handled with a metal head. She made short work of the trunk, stripping the rough, dark outer bark from the soft middle layer which we collected for medicine. We left with a backpack full.

Now here for our first week, we are beginning to get into a good workflow. Minor theater is always busy, especially in the mornings: crush wounds with fractures from stonework; burns, cuts and lacerations. An infant with an extensive wound, from the hip to past the knee, revealing underlying muscle and a completely visible knee articulation. A tibia fracture right above the ankle. We are using honey, aloe, and usnea powder and cutting down on iodine (and completely cutting out the bleach that is still used by hospital staff). But perhaps more importantly, herbalists are following physicians on morning rounds in the inpatient wards - male, female, and pediatric - to take case histories, conduct physical exams, and formulate plans for herbal support. We take turns harvesting and preparing medicine, juicing plants and brewing teas and decoctions, for dispensing on the wards. Many blends are nutritive - Urtica and Chenopodium - for the ever-present malnutrition and anemia. Others support organ function, enhance circulation, and provide herbal antibiotic support, using primarily Bidens pilosa, Leonotis species, and Usnea (the latter for urinary complaints). There are a few cases of cholecystitis, with thickly coated yellow tongues, for which we are using a rough, bitter plant in the genus Aspilia. Ginger compresses provide anti-inflammatory support. And finally, respiratory cases of asthma, bronchiolitis, and tuberculosis receive twice-daily fresh whole-leaf eucalyptus steams. One barrel-chested man who may perhaps have obstructive pulmonary disease and pleurisy is always of good humor, smiling and laughing after his steam treatments. The obvious crackles in the lower left lobe of his lungs have disappeared after two days. A three-year-old boy, bright-eyed and curious, has stopped coughing from a combination of antibiotics and herbal bronchiodilators/antispasmodics.

I am extremely grateful to Steven Byers, Iris Gage, and Rob Shapero for their work at the hospital. By acting together as a team, we are able to reach all cases that are amenable to herbal support in a way that would be impossible for a lone herbalist. We spend hours wild-haresting in the countryside and making simple medicine. We help hospital staff by cleaning, folding gauze, and treating wounds. We improve the quality of life of patients who rarely have access to pain and inflammation control. And today we will walk the countryside accompanied by my friend Manasse, who was born and raised just a few miles from here, received his degree as a nurse midwife, and has been studying and practicing herbal medicine. He speaks English well and also knows the Maasai language, so with his assistance we can begin a more systematic catalogue of local medical knowledge - relying on recordings to document informed consent. Our long-term goals include training local staff to continue the practice of herbal medicine here. Everyone is so receptive and interested: our role is to help the hospital administration to realize the benefit of traditional knowldege, judiciously applied, for improving patient care. If we succeed, we will be out of a job here. And that is by far the best possible outcome.

Should you feel lost

It's cold enough to start the car
ten minutes before
it's time to leave -
try to find an island of warmth
in the sharp, vast morning,
set aside respite as you
rush through,
scrape off soft, thin frost
as if it weren't a miracle

A Dram of Bitters

A little something to start the week. It comes from Rebecca Seiferle's excellent collection, called "Bitters", which holds poems that explore, and sometimes celebrate, the challenging times of life. And isn't it curious that, at these times, we as humans have turned to bitter herbs? Bitters are endemic. They are a part of us, as surely as we are a part of this green world. If you're traveling far afield this week, may your road shine clear before you. If you are finding comfort in the warmth of your own kitchen, may your hearth fire burn bright. Either way, may you taste sweet earth.

A Dram of Bitters
Rebecca Seiferle
originally published by Copper Canyon Press, 2001

"Bitters" are not bitter, are not
injurious, ancient instruments
of torture, cruel flavorings
of death, are not "the proper pain
of taste" (according to Bain, the baneful),
but a small bottle of bitters, a drop
or two, makes the orange juice brilliant
in a glass of gin and quiets
the stomach when it is unsettled
by true bitterness - whatever
in the world is "hard to swallow"
or admit, the crumb of cruelty
caught in one's craw, the iron bit
gnashing in one's teeth, the baleful
bile of "what has to be"
tasted to extremity.
Which is probably why
the British, intoxicated
in South America, copyrighted the recipe
into the colonial world
to try and make purgative,
a medicinal substance,
out of their own doubtful history,
caught between sour peevishness
and virulence of action
and of feeling - chugging the wild plenty
of the bitters down. But, no, bitters
is something more than "a noggin
of lightning, a quartern of gin." A secret
recipe distilled from the bark of the tree
of life, the original verb of an aboriginal sensitivity, the surviving
noun of a cloud canopy in Venezuela, the genealogy
of a mindful tribe, the undiscovered draught
of mercy - not extract of gentian
or quinine or wormwood, those Old World
poetic distillations - but something vegetable,
persistent, extending roots into the world.
An autochthonic brew. Who tastes it,
tastes sweet earth.

Eddies

A short stroll on a warm day in early winter. The white flowers of black hellebore. The push and pull leaves eddies.

When the sun grows weak, extinguished
By time too long spent in southern seas
And tricks you, who know the season
(The last squash rotting in the field,)
There still comes a prodigal warmth
That settles over the green,
Unlocks the frost,
And stills the coldest wind.
Set loose the scent of leaf-mould,
Flower Helleborus black,
The lovelies grace the forest path
As you pull back.

Hawthorn - Legends, Pharmacology, Recipes

The following is a summary of a class on ecological integration, bioflavonoids, and the Hawthorn tree. I will present these stories and review the research at the upcoming 2014 HerbFolk gathering - I hope you can attend!

 

Hawthorn blooms in May, often in the first week of the month in warmer climates, though it takes a little longer to get into bloom in Vermont. Often called "lady of the May", the tree has always been associated with a feminine energy, an embodiment of the white Goddess. The May is a time of fertility - newly tilled fields are rich and ready to support abundant growth. Lambs, newly born, are active and running over short, fresh grass. It seems that all of life is pollinating and growing with rich and brilliant green. Over all this cavorting rules the Hawthorn.

A compound is secreted by its flowers, almost a pheromone to us and certainly attractive to pollinating insects. You'll find this compound in some other flowers of the Rosaceae - cherry blossoms smell similar, for example. It's called triethylamine, and its odor is very characteristic. When Hawthorn flowers first bloom, locals say the trees smell of arousal, juicy and enticing. So it is perhaps no coincidence that triethylamine is found in abundant concentrations in human semen and vaginal secretions, and is in part responsible for their characteristic odor. The lady of the May gets us thinking about fertility right away.
But triethylamine is also a byproduct of the degradation of flesh - or, to put it more bluntly, it can smell like rotten meat. It all has to do with the aromatic context, the floral versus the musky, and can evoke very different reactions. As Hawthorn's blooms begin to fade, the smell shifts, and the locals say the tree smells of death. Hawthorn, with her flame-red berry, reminds us that fire kindles, but it also destroys. Don't bring her into your home when she's in bloom, or death will surely follow.

As a ruling, archetypal spirit, for me Hawthorn embodies the flux of creation and destruction more than any other plant. She represents the circulation between activity and rest, between systole and diastole, between love and anger, life and death. Sitting at the bookends of the time of growth, she guards the seasonal shifts - but rooted at the edge of the field, she also guards the border between the wild and the hearth. She loves humans, and thrives with our touch, but she remains forever untamed, her children unruly, her thorns toxic. Her leaves, flowers, and berries yield a medicine that governs the fluxing heart, the person, the community, the culture. No wonder the locals leave any lone Hawthorn well alone: you don't mess with such a powerful ecological thermostat.

What does it mean to be such a nexus in the ecology? What does it feel like? I'm not sure Hawthorn knows - at least not in the way we imagine "knowing". Picture an old clearing, now surrounded by forest on all sides, where a Hawthorn has been living for a hundred years. She's more ragged now than in her youth, but still produces abundant berries, and remembers the farmer who planted and tended her many years before. It's late September, early morning, the air is cool and smells moist but not heavy. A thrush on her way south flies in. There are asters and goldenrods in the middle of the clearing, mixed with the grasses. Field mice look up as the thrush alights on a branch. Try to feel that whole thing. Fill in the pieces - what insects are on the plants? On the soil surface? What spiders spin between the branches? Wind and water, morning sun and moist soil, all that grows and moves and lives and dies and rots, if it all wanted to send a message to the thrush, how would it? How would the thrush hear?

***

The first story comes from the epic of Gilgamesh, which is a four-thousand-year-old tale from the fertile crescent, the land we now call Iraq. Gilgamesh is the ruler of a city, the first city, which he holds almost in defiance of the gods who created the world. In punishment for his arrogance, the gods bring forth Enkidu, who is as wild as Gilgamesh is civilized. Raised by the beasts of the mountains, Enkidu sets out to destroy the city of Uruk and take down its ruler. But Gilgamesh uses a prostitute to seduce Enkidu, and tames him, seeing in his rival a shadow-side of himself. The two become like brothers. Uruk thrives - and the pair of warriors now sets out to cut timber from an ancient cedar grove, and slay the giant who guards it. They succeed, and return to the city with their bounty.
Ishtar, the goddess of the evening star, of love and war, who conquered the underworld and was the undoing of many before Gilgamesh, attempts to seduce him upon his return to Uruk. This effort fails. Enraged, she attempts to kill him using a magical bull, but this too fails: Gilgamesh and Enkidu slay the bull, and sacrifice it not to the goddess, but to their own glory, and to their city. Ishtar demands retribution, and the gods curse Enkidu with a slow, fatal disease that saps him of energy, wisdom, flesh, and, finally, life. As Enkidu descends into madness, he struggles against the wildness that inexorably eats away at his civilized life.
After his companion dies, Gilgamesh despairs. He casts away all the glory of Uruk and wanders through the wilderness, trying to find a way to restore his companion to life, while at the same time confronting his own mortality. He is about to give up his quest when, finally, an ancient hero from the time before the floods reveals to him the secret of immortality: if he journeys to the bottom of the ocean, he will find a white-flowered Hawthorn that bestows eternal life. Gilgamesh plunges into the depths, and emerges with the flowering branch, immortal and radiant.
Immediately he seeks to bring this power back to Uruk, to share the secrets of his quest. But in a final cruel twist, a serpent steals the Hawthorn branch away from him. The specter of death returns. He makes his way to Uruk, wiser but also resigned to his human fate.

This is a story of the taming of the wild, but it also reminds us that the wild - whether we find it in the wasteland, or in the depths of our internal ocean, is the sine-qua-non of eternal life. And there, guarding, giving and taking away, is the Hawthorn tree. What does it mean to be immortal? How would we achieve long life, even immortality? How would the thrush hear?


***

An ecology may not be immortal, but it certainly transcends our human experience. Just as the Hawthorn holds the key to immortality in the old mythology, it may also hold the messages that the ecology uses to knit its components together. These messages are how the thrush hears, it is how we hear, and if we listen to them and allow our organisms to commune with them the way the thrush communes with the Hawthorn berry on her way south, we may indeed achieve a measure of immortality. At least a transcendence that allows us to become a fully integrated part of the ecology. We have been walking around half-dead, unable to mix with the energies and fluxes of the world around us, sort of like a brain half-removed from its blood supply, sluggish, forgetful, tired.

The ecology has hormones, just as any living being has hormones. These are chemical messengers secreted into the distribution channels of the organism, the usefulness of which is evident locally but also systemically as they travel from their sites of secretion to their target organs. The flavonoids and other allied polyphenols are some of the best examples of such ecological hormones, and show us tangibly how cross-kingdom signaling knits the ecology together. For example:

- flavonoids, as pigments, serve as pollinator "on-ramps" guiding insects to nectar and anthers. They also guide beneficial insects (like the silkworm to the mulberry tree via the compound morin). [Simmonds, Monique SJ. "Importance of flavonoids in insect–plant interactions: feeding and oviposition." Phytochemistry 56.3 (2001): 245-252.][Ishikawa, Shigeo, Tuneo Hirao, and Narihiko Arai. "Chemosensory basis of hostplant selection in the silkworm." Entomologia experimentalis et applicata 12.5 (1969): 544-554.]
- anthocyanidins, a type of flavonoid polymer, are sensitive to pH and as an unripe, sour fruit ripens to sweetness, their color changes from green to pink to purple. The thrush knows this, and so do we. [Liu, Pengzhan, Heikki Kallio, and Baoru Yang. "Phenolic compounds in hawthorn (Crataegus grayana) fruits and leaves and changes during fruit ripening." Journal of agricultural and food chemistry 59.20 (2011): 11141-11149.]
- flavonoids (isoflavones in particular) are secreted by rootlets of legumes to attract symbiotic Rhizobium bacteria, which participate in nitrogen fixation, nourishing the plant, the bug, the soil. It's how the ecology harvests nitrogen from the air using all its players and the hormones that knit them together. [Hartwig, Ueli A., Cecillia M. Joseph, and Donald A. Phillips. "Flavonoids released naturally from alfalfa seeds enhance growth rate of Rhizobium meliloti." Plant Physiology 95.3 (1991): 797-803.]
- flavonoids also control unwanted bacterial and fungal incursions, by stimulating plant immunity and altering local flora so it can out-compete pathogens. They do this in part by inhibiting quorum sensing in pathogenic bacteria, so the bad bugs can't tell when there are enough of them to cause damage, and never begin the secretion of toxic chemicals. [Vikram, A., et al. "Suppression of bacterial cell–cell signalling, biofilm formation and type III secretion system by citrus flavonoids." Journal of applied microbiology 109.2 (2010): 515-527.][Quave, Cassandra L., et al. "Effects of extracts from Italian medicinal plants on planktonic growth, biofilm formation and adherence of methicillin-resistant Staphylococcus aureus." Journal of ethnopharmacology 118.3 (2008): 418-428.]
- flavonoids and polyphenols, which taste bitter to us (see citrus bioflavonoids in the white albedo of an orange, or the potent quercetin in Solidago species), are strong neurotoxic insecticides that help protect plants and are overexpressed when an insect feeds on a plant. We, who consume them in limited doses, derive an adaptive benefit from the challenge they pose. [Harborne, Jeffrey B., and Renée J. Grayer. "Flavonoids and insects." The Flavonoids. Springer US, 1994. 589-618.]

What becomes really interesting is noting that plants under stress begin to overproduce these important ecological hormones. Wendell Combest, a pharmacologist at Shenandoah University, analyzed the various parts of ground ivy (Glechoma), comparing the leaf, flower, stem, and gall. You may have seen these small green-red balls that occasionally swell on the trailing stems of ground ivy. Out of all the parts analyzed, the red tissue of the gall showed the highest concentrations of polyphenols. Others have studied crops exposed to different stressors - and found higher concentrations of these important eco-hormones [Treutter, Dieter. "Managing phenol contents in crop plants by phytochemical farming and breeding—visions and constraints." International journal of molecular sciences 11.3 (2010): 807-857.]. When a plant is challenged, it expresses chemistry to help it, but also to help those who consume it. In the clearing, the Hawthorn elaborates chemistry that directly represents the state of stress of the clearing itself. Its inhabitants, and its visitors too, get to plug into this signal net and adapt.

And who is to say that a well-adapted human, exposed to a cocktail of challenging polyphenolic chemistry from the berries and fruits she consumes, isn't a better component of the ecology? Hawthorn would say she is. Hawthorn would encourage her to consume flowers, leaves and berries - thereby to live long, realize the benefits of herbal medicine, and spread the wild trees and plants for the benefit of bacteria, soil, air, and thrushes. Maybe immortality means connecting to these wild signals. We live forever, if only for a moment.

>> Elixir of Immortality - Hawthorn Wild Weed Blend
The key for this one is that at least one of the ingredients be a plant you harvested close by, one that knows your ecology as well as you do. In this sense, the local plants you find are the most important ingredients.

Hawthorn berries (fresh ideally, though dry will do) 2 cups, packed well
Cinquefoil (Potentilla spp., fresh or dry) 1 cup chopped, or cut-and sifted herb
Rose buds (dry is ideal, more aromatic) 1 cup whole buds, coarsely chopped

Use a quart-sized mason jar. Fill with herbs, then cover with a mixture made of 50% vegetable glycerin and 50% apple cider vinegar. You will probably need around 9-10 ounces of each fluid depending on the amount of dry herbs. Close tightly and shake daily for two weeks, then strain and enjoy 2-3 teaspoons a day.

This is a Rose family blend. It is loaded with the important chemistry - bitter, astringent tannins; sour bioflavonoids; aromatic volatiles; demulcent starches and sugars; and many trace minerals. Cinquefoil, a favorite of Jupiter and the Earth element, grounds the blend while Rose lifts it up and Hawthorn holds the center. For a more bitter blend, substitute Agrimony for Cinquefoil if you have it available. If you can't find either one, try common Avens (Herb Bennett, Geum urbanum) as a substitute.

***

The next story comes from modern-day Ireland - or, at least, it's only about thirty years old. Apparently, during the construction of a car factory there, workers were at a loss as to what to do with an old Hawthorn in the middle of the site. Not being fools, they refused to uproot it and worked around it until construction had to grind to a halt. The project manager called in a bulldozer operator from England (of course) who promptly ripped the old Hawthorn out of the ground, casting it aside. There are numerous other stories of these fairy trees getting uprooted: one tells of hundreds of white mice escaping from the hole, another talks of dark vines grabbing and swallowing the unwitting humans who disrupted the tree. In this particular tale, nothing that dramatic happens. Everyone gets back to work, and the task of the day is pouring massive concrete foundation columns, fifteen feet tall and three feet wide, to serve as supports for the roof of the factory. They finish the day's work in good order, and the workers go home to sleep.
The next morning, upon returning to the job site, there is surprise and consternation because every single concrete column has been moved three feet to the left. No one can explain exactly how this could have happened, and no evidence of the heavy machinery that would be required can be found. Undaunted, the foremen order the columns moved back. The work is done, and everyone goes home to sleep.
As you might guess, the columns are moved again the following morning, this time three feet to the right. Stubbornly, orders are given to reset them in their proper place. But of course, the next morning the columns are all off again. Now quite angry, the project managers call a meeting to determine who's responsible for the three days of lost productivity, hoping to correct the problem once and for all. From the back of the room, a rather short gentleman stands up and says, simply, "You must give us back our tree". Anything's worth a try, came the wise (though reluctant) response, and the Hawthorn was rescued and replanted in its hole. It remained in the courtyard, twisted and gnarly, and construction proceeded without further setback.

So, perhaps Hawthorn isn't simply a gift we can connect with on our journey to immortality. Perhaps it's also an important element of proper function. Acting as an integrated organ in the ecology isn't a luxury for us - it may be a necessity.

***

The story of the Blutsauger is the story of a German vampire. In the north, this being is also known as a Nachtzehrer or "Night Waster". These twisted undead creatures roam the night looking for blood to fill their empty hearts, and their lot is cast by being the first person to die of an epidemic disease, or by dying in a particularly violent and gruesome way. In many different ways, the Hawthorn is seen as the primary protective force against these bloodsuckers, against the wasting and weakness they cause in their victims. The first is to carve sharp stakes of Hawthorn wood and nail down the corpse of the deceased, through the head or heart, so that it cannot escape its coffin. Another is to scatter Hawthorn flowers over the grave, so that the Blutsauger has to stop and collect the blossoms and, forgetting all else, be surprised and destroyed by the rising sun. Finally, Hawthorn boughs can be hung around the house (outside, of course) to protect the family from the night wasting.

In all of these examples, we see that Hawthorn can play a role in the interplay of life and death, as we've seen in the old myths, but it can also have an effect on influences that disrupt the flow of blood. The Latin name of the tree, Crataegus, is thought to derive from the Greek krataigos, which means strength and resilience, but it also is a direct cognate of crataegon, a word the Romans used to refer to the heart itself. The crataegon was not only the heart, where life-giving oxygenated blood mixed with the spent venous flow, but it was also a great bowl used at feasts to mix water and wine together. It is important to remember that, although the grape was the primary fruit fermented into wine, the Romans (and likely many others before them) fermented Hawthorn berries and honey into meads as well. Mixed in the crataegon, the liquor gave life to the heart, and the tree of resilience inherited the name.

Of course we know now how valuable Hawthorn is for the human heart, strengthening it in times of weakness and protecting it from over-exertion, keeping it supple and responsive [Pittler, Max H., Katja Schmidt, and Edzard Ernst. "Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials." The American journal of medicine 114.8 (2003): 665-674.][Walker, Ann F., et al. "Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial." British journal of general practice 56.527 (2006): 437-443.][Verma, S. K., et al. "Crataegus oxyacantha-A cardioprotective herb." Journal of Herbal Medicine and Toxicology 1.1 (2007): 65-71.]. If there is a single place in our bodies where the essences of life are mixed and circulated, it would have to be the heart - a tireless pulsing flow, holding two aspects of our vital fluid side by side. The arterial blood on the left glides powerfully out through the aorta while the venous blood on the right seeps slowly into the heart and is gently pushed along to the lungs. Any hardening or stiffness, eddies in the smooth flow, pinches or restrictions can compromise this great mixing bowl over time, and sap vitality from its host. Hawthorn addresses all these concerns, and it also balances the active pushing, the systole, with the rest and refilling, the diastole - the muscle works more efficiently, pressure stays balanced, vitality holds poise. Many berries and their polyphenols can contribute to this cause - grapes, with resveratrol; blueberries, with anthocyanins; goji, with is diverse flavonoid cocktail. But it is the Hawthorn that is the crataegon itself.
So much of a necessity is this tree, that without it, the heart's failure becomes the first reason we die. Like the spirit of a child from whom love is withheld, our great mixing bowl of life withers and fails, weakened before its time. Heart disease in the western world is a painful example of plant deficiency syndrome: we pass by the clearing, we can't see the Hawthorn exchanging hormones with the thrush, we wall ourselves off from the dance that we can truly never leave. The brain of the unloved child doesn't choose its fate: that's  the family, as an organism, at work. In the same way the American heart doesn't choose to fail: that's the culture at work. And don't you think the Hawthorn suffers too?

>> The Red Ones - Hawthorn Heart Blend
All the herbs in this formula reinforce the action of the heart while helping it relax and work more efficiently, too. The addition of chile should be to taste - I have attempted a guideline dosage but everyone's preferences vary.

Hawthorn berries (fresh or dry), 2 cups, packed well
Dan Shen root (fresh if you have it, or dry Salvia milthiorrhiza), 1 cup, chopped and packed well
Chile pepper (fresh, ripe red Tabasco chile), 2 peppers, coarsely chopped

Use a quart-sized mason jar. Fill with the herbs, then cover with 20-24 ounces of 100 proof (50%) vodka. Cover tightly, and shake daily for two to four weeks, then strain and take 1/2 teaspoon twice a day.
The herbs in this blend are traditionally used as cardiovascular tonics, particularly indicated in the prevention of or recovery from heart attack and stroke. Use caution mixing this blend with conventional blood thinners: Dan Shen may potentiate their effects. If you can, spend some time looking at the fresh root of Dan Shen - it's red, remarkably so, and its branched taproots are very similar to the branching coronary artery.

***

The last story is from Italy.
Once upon a time, out in the countryside, lived a young girl and her aging grandmother. They lived in a very small, thatched-roof cottage with a very small fireplace, surrounded by a barren, prickly hedge and yellow grass. Every day the grandmother would go out and collect what little wood she could find to start a fire and cook the meager food the two had to share. But it happened one day that she became quite ill, and did not have the strength to rise from bed to do her chores.
It was winter, and a cold fog hung over the fields. The fire had long since burned out, and the two were hungry. So the young girl, whose name was Serenella, resolved to venture out on her own. "Perhaps I can find some twigs for the fire, and warm my grandmother," she thought. Pretty soon she came to the stump of an old oak tree, and was trying to pry off pieces of bark for the fire when she felt someone tugging at her hair. When she turned around, she stood before a beautiful woman, cloaked in thin fabric that looked like wisps of valley fog, radiant and white.
"Those pieces of wet bark won't do anything to warm your house or fill your belly" she said. "Take this wool from me instead," and she handed Serenella an armload of freshly-sheared fleece. "If you spin this wool into yarn for me, and bring the balls of yarn back to this tree stump, you will have a roaring fire and a pot of soup in your hearth every day."
Serenella was overjoyed, and gladly took the fleece, though all she could think on her walk back to the cottage was how she hadn't spun a day in her life, and how was she going to comply with the fairy's wishes? But when she got back a fire was blazing and hung over the flames was a bubbling pot of soup. She warmed herself and poured some soup into a bowl for her grateful grandmother. Then she began the work of spinning.
Inside the pile of fleece was a small wooden drop-spindle. She fastened some of the wool to it, and, twisting and pulling, she slowly began to spin some yarn. It was tedious work, and the thread broke often at first, but with patience she got better and better until, after a week's time, all the wool was spun. Serenella set out immediately to find the oak stump again. When she got there, she placed the ball of yarn into the stump. But before she could turn around to go back home, the fairy reappeared to take her gift.
"The yarn is lumpy and uneven, I know, but it is the first wool I've ever spun, and I will do better next time," Serenella pleaded.
Looking at her with kind eyes, the fairy broke off  pieces of yarn from the ball and handed them back to her, along with a fresh pile of fleece. "Take these threads and fashion them into stars, and hang them on your hedge for me," she said. "And spin this new wool into more thread." At that she disappeared into the mist.
Serenella walked back homeward, overjoyed that her work had been good enough, and when she got to the dry hedge that encircled her cottage, began to fashion tiny, white, woolen stars. She was about to start hanging them when a little thrush landed on the ground next to her.
"How strange to see you here in the cold season," she said to the bird.
"Alas, when fall came I hurt my wing and couldn't fly away with my brothers and sisters! So now I am trapped here in the cold, and I will surely die if you don't give me your white stars to make a warm nest..." the bird replied.
Serenella was torn. She had promised the fairy that she would hang the woolen stars on the hedge. But in the end, she felt so sorry for the thrush that she gave him the stars.
Inside the cottage, a strong fire burned as it had been doing for the whole week, fresh soup was in the pot, and bread in the cupboard. The grandmother, though still gravely ill, was smiling more and her appetite had improved a little. Serenella started spinning.
After another week, she had finished more yarn, stronger and more even this time. She returned to the oak and the fairy reappeared, and again asked her to hang more stars on the hedge alongside last week's, and again gave her fresh wool to spin. But again, right as Serenella was about to hang the stars, the thrush came asking for a fresh lining for his nest.
"The rains came, and my nest is cold and wet!" he pleaded. "Sweet girl, please give me more of your wonderful stars that I might outlive this cold winter." And again, Serenella gave him her white, woolen stars.
Week after week this ritual repeated itself, the cottage fire kept burning bright, food was always in the pot, and grandmother kept getting stronger and stronger. Finally, the cold began to let up. It was a rainy April, and so every week the thrush kept asking for fresh stars to keep his nest dry. Every week there was new yarn to spin. The valley started greening up, and the early spring flowers were blooming. Until one day, when Serenella brought her yarn to the old oak stump, the fairy had no new fleece to give her.
"Your grandmother is better now," she said, "and I need you to collect all the stars you hung on the hedge and bring them back to me." And, as usual, she disappeared into a swirl of fog.
Crestfallen, Serenella made her way back home, knowing she had no stars to collect. When she got close to the cottage, the little thrush alighted on her shoulder.
"Why so sad?" he asked.
"The kind fairy wants me to return her magic stars, but I have none because I gave them all to you!" she exclaimed.
"Don't worry, little one," the thrush replied. "My brothers and sisters are back home now, and we are all most grateful to you. Tomorrow is the first of May: go out tonight, under the moonlight, and you will find your stars."
Unconvinced, Serenella went straight back home, her downcast eyes fixed on the path, to find her grandmother stirring the soup and stacking firewood. Grandmother truly was better now, the pink color back in her face and the sparkle back in her eyes. They shared a meal, and went to sleep. But in the late hours of the night, the young girl awoke to the sound of thrushes singing in the hedge outside. She went out barefoot, and under radiant moonlight, found that her whole hedge had burst into bloom, white blooms like stars. An incredible fragrance filled the air, rich and floral and wild.
"My stars!" she cried out, overjoyed. "I will pick these to bring to the fairy!"
As she spoke these words, the fairy appeared before her and took her hand, which already held one of the fragrant flowers.
"Dear Serenella," she said, "I am the Lady Whitethorn, and you have shown me the true kindness of your heart. From now on, your hedge will bloom and fruit and give you what you need to keep your grandmother strong. You can trade the berries for meat and grain. It will help you as you helped the thrush."
She disappeared in a cloud of mist, leaving Serenella there on May eve, under the moonlight, surrounded by thrush-song, wild fragrance, and a field of stars.

>> The Three Flowers - Appreciation and Open Heart Blend
Despite containing a root, this mix makes a great and effective infusion. Consumed regularly, its side effects include a more balanced blood pressure. Since it's made with equal parts by volume, the recipe can easily be scaled up to make a big jar full of tea herbs.

Hawthorn leaf and flower (dry), one tablespoon chopped or cut-and-sifted herb
Linden flowers (dry), one tablespoon chopped or cut-and-sifted herb
Peony root (dry), one tablespoon coarsely chopped root

Use a large (12-16 ounce) tea mug, or a 16-ounce French press. Place the herbs in the bottom and add hot water just off the boil. Cover promptly and steep, for at least 20 minutes but up to 4 hours. Strain, press and drink daily. This tea blend opens the heart in many different ways, helping us to appreciate the simple things that are in front of us, like family, a warm hearth, wildflowers, and birdsong. The addition of antispasmodic, sweet Peony root helps to relax tissue and vessels, reinforcing the tonic and aromatic Hawthorn and Linden.

***

I leave you with a poem by Kathleen Raine. We are the ecology. It enmeshes in us, and we in it.

The Traveller.

A hundred years I slept beneath a thorn,
Until the tree was root and branches of my thought,
Until white petals blossomed in my crown.

A thousand years I floated in a lake
Until my brimful eye could hold
The scattered moonlight and the burning cloud.

Mine is the gaze that knows
Eyebright, asphodel, the briar rose.
I have seen the rainbow open, the sun close.

A wind that blows about the land,
I have raised temples of snow, castles of sand,
And left them empty as a dead hand.

A winged ephemerid I am born
With myriad eyes and glittering wings
That flames must wither or waters drown.

I must live, I must die,
I am the memory of all desire,
I am the world's ashes, and the kindling fire.

Our dream is real

This is a transcript / copy of my presentation at the recent Urban Moonshine herbal conference up here in Vermont, on the shores of Lake Champlain, at beautiful Shelburne Farms. It was a great event, I was honored to be able to address the whole group and talk about how to leverage the strengths of herbal medicine to address some emergent threats to medicine as a whole.

Herbalists are all anarchists to a certain degree. In the sense that we want weeds, diversity, and decentralization. Of course we're also dreamers... Sometimes we dream for a really long time! Did you hear a couple of years back about this seed researchers found in Siberia, buried by some squirrel almost 32,000 years ago? They coaxed it into germinating, and it grew and flowered into this beautiful white flower, a plant the world hasn't seen for thousands of years, and that seed held its essence for so long, perfectly encapsulated. That's amazing to me. When I was in Ireland, I was speaking to a botanist who told me how, during the last glaciation, the tops of some hills were left uncovered by the ice sheets, like islands in a slow, white river, and pre-glaciation plants survived up on those hilltops, kept the memory of those old times and re-populated the island after the glaciers retreated. Dreaming of warmer times. Holding the essence. Herbalists are kind of like that too, in a way.

But I'm not here this morning to talk about herbalists. I'm here to talk about medicine.

One thing I noticed in East Africa, where I had the privilege of working for a bit this Spring, was that the system of traditional medicine is being forgotten. Old timers took me around, stripped bark off trees, pointed out how to prepare it in different ways for different conditions. They know this stuff! But the younger folks know it a lot less. They understand that this knowledge exists, they are very curious about it, but it felt very strange when it was me telling them about the medicinal uses of plants that grow all around them, and not the other way around. This is happening all over the world, I fear - it's happening in Italy and the rest of Europe, in Central and South America, and native plant knowledge is endangered in the United States too (see Carlos Ramirez, 2007). Maybe the exporting of Western culture is displacing these older, native systems of medicine - the young Maasai could show me pictures from their Facebook feeds on their cell phones, but couldn't tell me much about the different Acacia species growing by the river. Who's going to keep the roots of medicine alive?

Another thing I noticed, and this was mostly in conversation with the physicians at this rural hospital, was that antibiotics don't really work very well anymore. Pathogen resistance is a very real problem down there. Part of the issue is that folks can buy amoxicillin over the counter, and they do, and take it for every minor respiratory complaint. They take it for three or four days, feel better, then stop. We know it's not the antibiotic making them feel better, it's just a self-limiting viral infection, but the trend continues. So amoxicillin doesn't work at all anymore. Other antibiotics are failing, too - because specific testing is difficult, docs will just prescribe strong, broad-spectrum agents and pathogens are developing resistance to these, too. One physician told me of an untreatable urinary tract infection in an 8-month-old child. She had tried a series of antibiotics. None had worked. She developed a fever - and of course here we're getting concerned about her kidneys, but no antibiotics were working, not penicillin, not sulfa drugs, not cipro. She had multi-drug-resistant E. coli. The physician needed this stuff vancomycin, a ridiculously strong intravenous antibiotic, but unfortunately it was a 9-hour drive away. Eventually it happened, probably not timely enough, and the child improved but having to use vancomycin for a UTI is crazy, because it's the end of the line in terms of antibiotic treatment: if it doesn't work, that's it.

The WHO is recognizing this, and just this month put out a strongly-worded position paper advising physicians to drastically cut back on antibiotic prescriptions, especially in the developing world where they are so often overused. And you know bacteria are savvy, and very well connected: if they're learning these skills in Africa, they'll soon have them the world over. It's kind of like carbon emissions.

We know more and more that the "war on germs" is misguided, for many different reasons. Minnesota just passed a law banning Triclosan - you know about this stuff? It's the agent in antibacterial soaps and cleansers. Promotes bacterial resistance, is a known endocrine disruptor, and is no better than regular soap and water to slow the spread of infectious germs. So great, good job Minnesota, thank you WHO, we're thinking about these issues now - but who's going to help the little girl with the multi-drug-resistant UTI? She has a fever today.

Another thing I noticed is that there aren't enough people in medicine. The hospital I worked at is understaffed - especially in terms of those who can provide basic wound care, nutrition advice, nursing care. Those who practice medicine one-on-one, intimately, are hard to come by. This is hardly a problem limited to the developing world! Primary care providers are scarce here in the US. One in five graduates go into primary care after training. Why? Because all the docs choose to specialize - they go into cardiology, they go into oncology, they fill these specialties because that's where all the patients are, that's where all the money is. Everyone has heart disease. Everyone has cancer. I may be wrong, but it seems to me that if we had more health care providers working one-on-one, intimately, with patients, we might make headway in the prevention of heart disease and cancer. The way to meet these diseases isn't years after they develop, with high-priced and specialized interventions. Why are healthcare costs going up? I wonder. Who is going to work intimately with patients to help prevent the top causes of mortality in our culture?

So medicine is facing huge challenges. They move through the landscape of modern healthcare like giant, unseen beasts we can't seem to control. Everyone is looking for a way to stop them. No one knows what to do, how to track the problem, what the problem even is. Is it economic? Do we need better drugs? Where's the enemy? And at the same time here we are, in our meadows, in our gardens, in our clinics, kitchens, production labs. Where we experience deep, blissful connections with plants and place. Where we watch body, mind and spirit heal and grow. In a dream where there is no separation between us and ecology, between spirit and form. In our dream of flowers.

But there's another problem, too. It's very obvious in this country, but it has occurred, at different times and in different ways, all over the world. We have been wounded - wounded with weapons like the Flexner report, which basically outlawed herbal medicine in the US at the beginning of the 20th century. Wounded by witch hunts, wounded by imperialistic culture and colonialism, wounded by a creeping poison that would seek to co-opt and dilute our diverse, anarchical traditions. Wounded by organizations that would seek to outlaw, trademark, or patent our tradition for profit. Wounded by harsh skepticism (which sometimes borders on racism) aimed at ideas such as qi, vital force, viriditas, the healing power of nature - aimed at our dream.

So that's where we closed the last century, and where we begin this new one. In a dream of flowers, but wounded, wary, unsure if our dream can help to solve the challenges that medicine is facing all over the world, unsure if we even want to wake up and help to fix medicine.

I'd like to tell you a story about the Maasai lands. I was drawn to it because it's ostensibly the story of a young warrior, the best endurance runner of his tribe, and those of you who know me know I like to run, I had a great time running in the savannah and exploring. But really, like all good stories, it's about more than that.

When young Maasai men begin puberty, they stop cutting their hair and leave their villages to gather in "warrior camps", where they train in survival, tracking, endurance, fighting and hunting. Usually this training continues until age 30, and during this time warriors help keep everyone in the surrounding areas secure. Sankei was one such warrior. He wasn't the strongest, nor the bravest, and certainly not best with the spear, but there was one thing he could do well: run for a long, long time without getting tired. This served his companions well on hunting expeditions, where he was often the scout.

One night while they were sitting around the fire, Sankei and his companions heard a rumble which began to grow stronger and stronger, until they could feel the ground shaking beneath them. It was like thunder deep underground, under a clear starry sky. After a minute or so, the sound retreated and faded into the distance. Everyone went out to see if they could discover its source, to no avail. The next night the sound returned, and it was stronger than before, to the point where the warriors were a bit scared to go out into the night to investigate. When, on the third night, the sound came so close they feared their camp would be overrun, the warriors decided that they must track down its source during the day, lest it trample them completely when night returned. Looking at each other, they were all reluctant to accept the mission. Finally it was decided that Sankei would set off the next morning, and that if he wasn't back by early afternoon, his companions would come find him.

It took Sankei little time to find the first tracks. They were enormous, bigger than an elephant's, and led off into the dry savannah. He followed them at a good pace, mindful of his water supply which he carried in a hollow calabash gourd secured with a beaded leather strap. Eventually he reached a dry riverbed, and the tracks stopped completely. No trace on either side, nor upstream or down. Sankei looked up at the noon sun straight overhead, and took another sip of water. The supply was getting low. Time for a rest, he thought.

Perhaps it was the heat of the day, or the exhaustion of the run, or the frustration at having lost the tracks of the giant beast, but Sankei didn't stop to think before lifting a large stone to use as a seat under a shady acacia nearby. As soon as he picked it up, a scorpion hidden underneath climbed onto his foot and stung him with his sharp tail, injecting him with venom. If you know scorpions, you know that while they may not always be lethal, their sting can cause serious distress. Sankei knew he was in trouble. His foot was sore already. Soon it would be throbbing in pain. Forget about running - he would be lucky if he could walk using his stick for support.

In a strange way, this made his resolve all the more adamant. He walked back to the tracks and now, somehow, saw that they clearly crossed the river and headed towards distant hills. Hobbling on his wounded foot, he started to follow them. The sun began its journey down from the top of the sky. He took his last drink from the calabash.

Soon, Sankei felt like he was in a new country. Could I have wandered so far to have lost my bearings, he thought to himself. The trees were unfamiliar. The boulders unrecognized. But still the tracks continued, and still he followed them, with a severely swollen foot and a piercing pain spreading up his leg. He was beginning to feel light-headed, and knew he needed water. That was when he saw the silhouette of a giant baobab tree, halfway up a short hill, not too far away. There he knew he could find shelter, food, and water. He could rest there, and his companions would find him. With his last bit of energy, he dragged his bad leg behind him in a quest to reach the baobab.

He was almost under the tree's branches when he heard the sound, except now it was impossibly close, shaking everything around him, appearing out of nowhere with a deafening roar. His only reaction was to spin around, and in so doing he lost his balance, falling backward just as a colossal rhinoceros charged past him, missing him by inches. The rhino kept charging, straight towards the baobab tree, and when he reached it, head down, plunged his horn deep into the trunk. Sankei watched, stunned, as the rhino bellowed and heaved trying to get loose - to no avail. Finally, with all the muscles of his powerful neck and shoulders rippling with strength, the rhino gave a final twist, and the horn splintered and cracked right off his head. Howling in pain he ran off, defeated.

Slowly Sankei crawled to the tree. From where the horn was embedded in the tree trickled a stream of fresh water. He washed his face, and drank deeply. His wound still throbbing, he propped himself up against the trunk, and fell asleep as the sun went down.

Now what you may not know about baobab trees is that they only flower once a year, at night. The sweet flowers are pollinated by bats, then drop from the tree before sunrise. It happened that, as Sankei slept that night, the baobab bloomed, and was covered with a mass of delicate white flowers. And as the night wore on, before the first rays of the sun, Sankei was covered with them too as each one floated gently to the ground.

The first thing to wake him was the sound of his companion's voice. His friends were crowded around him, shaking him, trying to get him up. He opened his eyes and smiled, telling the story of the huge rhinoceros, the thundering beast he'd tracked, how it had been defeated by the baobab tree. He tried to get up to point out the tree to the other warriors, and show them the massive horn - but his foot, red and throbbing, could not hold him.

His friends looked puzzled at his story. As they stepped aside, Sankei saw a different landscape: acacia trees, a dry riverbed, a large stone. This was where he'd been stung by the scorpion! What was going on? Finally one warrior spoke, saying that they'd found him here, passed out, his foot obviously wounded by a venomous creature. "Your story, Sankei," they told him, "must have been a dream".

As they made their way back to warrior camp, Sankei began to believe that, in fact, he had only been dreaming. The story did seem remarkable, both because of his endurance and because of his sheer luck. Still, he had a strong feeling that the rhino or whatever it was wouldn't return. After the ol'oiboni treated his foot, he left the group to go rest. Sitting there, alone, inside a small mud hut, he began to remove his cloaks in preparation for some good, well-deserved sleep. When he took off his last layer, a delicate, white baobab flower fell to the ground at his feet.

My friends, our dream of flowers isn't a dream. We were all at that baobab tree, we all know it can stop the unseen beast in its tracks. We all drank of its life-giving water. That's why we are all here now. Knowing our dream is real is exciting, it's inspiring, but it should be sobering too. It's up to us to move forward, to track down the challenges of modern medicine until they run smack into the deep, rooted plant wisdom we all have tasted. We have to move forward in spite of our wounds, in spite of how comfortable our dream may feel, in spite of the bullying, derision, co-opting and outright murder that may have wounded us. What does moving forward mean? Think about it today. As you talk about new, accessible models of clinical practice. About using our bodies to relate to and understand a new kind of medicine. About building spirit-bridges to heal people and place. About growing medicine, and applying it to new and intractable diseases - or learning how to treat old problems in new ways. About how to do all this with respect for tradition and a powerful sense of honor. Think about it as you walk by the lake and through the forest and meadows. Our ancestors are counting on us. Twenty-first century medicine is counting on us.

In moving forward, one thing that seems clear to me is that there can be no "us" and "them". Maintaining these  distinctions only keeps the wounds open. In truth, we are all just warriors training together: companions on the journey of medicine, be we herbalists, nurses, physicians, or pharmacists. Companions who work in hospitals, in offices, on tilled soil, in wild valleys, over a massage table, in laboratories. It just so happens that we are all struggling with scary, unseen threats right now, and our companions need help. It just so happens that our companions think we're in a some sort of dream when we tell them about the baobab tree, about the medicine we've found in a weedy, flowering, abandoned lot. Friends, I am here to tell you that the medicine is real. I am here to tell you that the dream is real.