New for Fall 2012: Jade Defense REISHI

Since I have written at length about Jade Defense elsewhere, I invite you to read that post if you are new to the formula or want to refresh your memory.  In today’s post I will ramble a little bit about what makes this year’s Jade Defense “new and improved.”

Extraction Method:

The first thing is that compared to last year, I got a little bit more sophisticated in my extraction technique.  I typically make my liquid extracts as a mixed water/alcohol percolation, all the herbs ground up, moistened overnight, and extracted together in one fell swoop over the course of a day.  Last year’s Jade Defense veered from that protocol in that the aralia was extracted separately with pure ethanol as a fresh plant, and also I used the reflux feature of my Soxhlet Extractor to do a second extraction of the remaining herbs without added solvent.  I was quite pleased with the outcome, and in fact caught only one cold last winter (I attribute this defeat not to a failure of Jade Defense but to my staying up too late on New Year’s Eve).

This year, based on the fact that Jade Defense packs much of its immune-stimulating punch due to the water-soluble polysaccharides in a few of its key herbs, I first performed a pure ethanol extraction of the polysaccharide-rich astragalus and ganoderma (more on the ganoderma in a minute), and the aralia as well almost as an afterthought, to pull out ethanol-soluble medicinal compounds.  Then, after pressing the dregs, I performed a low-heat water extraction of the same herbs over several hours.  Finally I combined the two extracts, with each other and with the standard ethanol/water percolation of the remaining herbs in the formula (atractylodes, Siberian Ginseng, and ledebouriella). 

The result is a murky brown fluid that, when allowed to settle, shows components of different densities forming layers and clouds of various supersaturated solutes. Some people prefer their tinctures cloudless and pristine, and in fact I usually adhere to this esthetic standard in my medicines.  But in this particular case, I don’t mind at all because the result is so worthwhile.  The parts that settle out do so not because they are somehow rendered inactive; they are simply present in too high a concentration to be held in solution by the ethanol/water mix of the final tincture.  So, to get the maximum benefit out of your polyssacharide-boosted Jade Defense, you just have to remember to shake the bottle well before you take a dose.

Dosage:

Jade Defense is a formula that should be taken long-term to build the immune system.  Last year, I fear there were people who got one two-ounce bottle, took it for two weeks, went off of it, and then got sick a few weeks later.  So, to encourage you to do it right this year, Jade Defense REISHI is being distributed in four-ounce bottles.  If you take the recommended half-teaspoon dose twice a day (in the morning and late afternoon, on an empty stomach), one bottle should last you about a month.  If you prefer using a dropper for accurate dosing, transfer some of your Jade Defense REISHI to a dropper bottle AFTER SHAKING THOROUGHLY and take an equivalent amount (this should be about four full squirts, but you should calibrate this against a half-teaspoon baker's measuring spoon to make sure).  I like to mix it with a little hot water, but it can also be enjoyed straight up or on ice.

Reishi:

The new addition to this year’s formula is a medicinal mushroom most commonly known by its Japanese name, “reishi,” which is the Japanese pronounciation of its Chinese name, “ling zhi.”  Its Latin binomial is Ganoderma lucidum.  Reishi’s 43.3 Mb genome was sequenced earlier this year, yielding fascinating new information on the fungus’ metabolic pathways that result in the over four hundred bioactive compounds it produces.

Reishi holds a special place in the world of Chinese medicine.  Since ancient times it has been revered as a medicine of almost supernatural power.  In fact, the “rei” part of “reishi” (“ling” in Chinese) is a character that means something like “miraculous,” “mysterious,” or “supernatural.”  And the “shi” part (“zhi” in Chinese”) is a special character that is not used to refer to ordinary mushrooms but to semi-divine “excrescences” that, according to Daoist scholar Fabrizio Pregadio “pertain to an intermediate dimension between mundane and transcendent reality.”

What would lead the ancient Chinese emperors and sages to hold this fungus in such high regard?  One factor was its rarity (only in recent decades has it been successfully propagated and made widely available to consumers).  Another reason is surely its health effects.  Reishi was thought to confer longevity and even immortality on its ingesters.  Finally, as with most “sacred” plants used by humans, reishi-lovers probably appreciated its effects on their state of mind.

Health:

Fortunately for us, two millennia of anecdotal evidence about reishi’s health effects are backed up by much modern research.  Reishi is easily one of the best-researched medicinal herbs in the world.  What scientists have found is that reishi’s health effects are produced by two main classes of compounds: triterpenoids and polysaccharides.

The triterpenoids in reishi are all modifications of lanosterol, which is the precursor of all steroid hormones including ergosterol, which functions in fungal cell membranes much as cholesterol does in animals. However, reishi produces more than 150 different triterpenoids, begging the question: why?  Most likely, due to their bitter flavor, at least some of these triterpenoids are useful as anti-predation chemicals (animals don’t enjoy eating them).  Others probably play different roles in fungal biology.  Over many many generations of selection, the reishi mushroom has produced a startling array of triterpenoids, which, lucky for us, exhibit a number of health effects in humans.  Chief among these are liver-protectant, anti-hypertensive, anti-cholesterol, and anti-allergy effects of a subset of triterpenoids known as ganoderic acids.

The second major class of bioactive compounds found in reishi is the polysaccharides.  These are extremely large macromolecules that, together with abundant chitin, form the structural matrix of the mushroom’s body.  These are the substances that makes a mushroom rubbery/spongy, and the polysaccharides are also secreted by fungi and algae to help them stick to surfaces they are growing on, and to keep them from drying out.  Beta-glucans – one type of polysaccharide found in reishi as well as in yeast, some grains, and in other fungi – have been shown to have immune system stimulating effects.  It turns out that a receptor on the surface of human innate immune cells binds to beta-glucan, allowing the immune cells to recognize it as “non-self” and mount an immune response.  Because a part of these giant polysaccharides is structurally similar to signature molecules found on the cell membranes of bacteria, the body is in effect tricked into strengthening its immunity when there is in fact no actual threat.  The end result is an increased ability to fight pathogens and protect from disease. Animal studies show that beta-glucans and a number of different polysaccharides in reishi exhibit other effects, most importantly anti-tumor, radiation-protective, anti-inflammatory, and hypoglycemic effects.  While the mechanisms underlying these effects are poorly understood, I conclude that anybody wishing to strengthen their immune system, especially those fighting cancer or trying to avoid it, stand to benefit from supplementing with reishi.

Finally, drawing more from traditional therapeutic use than from contemporary research, reishi is an excellent herb for the lungs.  Like most mushrooms, it is yin-nourishing, with much of its yin-nourishing effect centered on the lungs.  This makes it useful for many kinds of cough, asthma, and bronchitis, and also makes it a good partner to the astragalus and aralia in Jade Defense, which strengthen the qi of the lungs to ward off cold and flu.

Mental Effects:

Reishi exhibits paradoxical central nervous system effects.  Some people say it energizes them, while others find it sedating and helpful for insomnia.  I believe this is because there are multiple (or at least two) substances in it with different mental effects, and that some are soluble in alcohol and others in water.  Due to the structural similarity of reishi triterpenoids to steroid hormones, it is quite likely that one or more triterpenoids are stimulating to the human nervous system much like steroids can be.  So a reishi extract that was made primarily using ethanol or another triterpenoid-friendly solvent could be expected to make you slightly wired.  Whereas other substances extracted using water may be responsible for any sedative effect.  My friend Gus used to get a dark reishi extract that was legendary for its sleepy feel-good effect (my buddy Andy Seplow has sourced some more recently that he says is comparable; if you’re interested in sleepy reishi you should contact him).

This issue suggests a future experiment in which I will separately extract reishi using alcohol and water, and evaluate each for mental effects.  I will report back once these experiments are concluded.

In the meantime, beware that THIS reishi extract that is included in Jade Defense REISHI may be stimulating to some folks.  I found this to be the case during my first week of organoleptic product testing.  I kept finding myself awake at night having all sorts of deep and interesting thoughts.  When it finally occurred to me that this was due to my evening dose of Jade Defense REISHI, I reduced my consumption to one daily morning dose, and was able to sleep again.  So if you find yourself suffering from insomnia after starting your course of Jade Defense REISHI, try taking your second dose earlier in the day, and/or reducing your second dose.  If this still doesn’t work, you can reduce your consumption to just once a day in the morning, as I have done (your stash of Jade Defense REISHI will also last twice as long!).  The jury is still out on whether the once daily dose will confer equivalent immune-stimulating benefit – I suppose we will find out this coming cold season.

NOTE:  when I say "mental effects," we're talking subtle.  These are not the magic mushrooms favored by Deadheads and other psychonauts!  I find the subjective effect of reishi to be, excuse the expression Buddhist literalists, to be very Zen: a centered alertness and creativity that keeps me feeling good and gets me through the day.

Rant:

But all this talk of steroids, triterpenes, polysaccharides, etc. kind of misses the point.  We always want to know what does what, why does this stuff work, what molecules go to what receptors and what the hell is going on here?  That’s just the way our minds work, and I think it’s great that there are people studying this stuff.  And it sure is fun tossing around words like "triterpenoid."  But what I think is even greater is that there is this mushroom that grows in the wild, that people have been ingesting for many centuries because of what it does for their health and because they like the way it makes them feel.  And it’s not only this mushroom!  There are thousands of plants and fungi and bugs and animals that have medicinal effects in humans, that people have figured out over hundreds of generations.  Why do we insist on all these scientific studies to validate this stuff?  Why don’t we trust that people got it right?  Why would they keep ingesting some yucky-tasting fungus if it didn’t do them any good?  And why wouldn't they notice what it was doing for them, and compare notes, and pass this information along?  There’s an arrogance underlying the modern skeptico-medicalist presumption that much of natural healing is just old wives’ tales.  In fact, there’s usually a good reason why old wives tell their tales and old herbalists keep using their favorite herbs. 

There’s a divestment of our own authority, and our own wisdom, if you will, when we rely on scientific studies or Dr. Oz to tell us what’s good for us.  We should instead be curious, and open, and rational and critical too, as we make our way through life eating and drinking and trying things out in our quest to be whole and healthy and happy.  How does this make you feel?  If you feel worse, stop doing it.  If it makes you feel better, maybe it’s a good thing.  Stay aware.  Use common sense.  Live in balance with the seasons.  Take it easy.  Move your body.  Eat real food.  Take herbs when necessary.  Grow them in your garden and nibble on them fresh (I'd be happy to give you a gotu kola baby or a dokudami next spring).  Generally speaking, we should be able to take care of ourselves, health-wise, and be enjoying ourselves in the process.  The underlying philosophy of Green Monkey Pharmacy is essentially one of self-reliance.  Take responsibility for your own health!  See a doctor when you have to, get your annual checkup, but for most of the rest you can take care of yourself!  Start now with Jade Defense REISHI to stay healthy through the fall and winter.

Nasal/Sinus Formula: Relief from Allergies and Congestion

Ingredients:

Chai hu – Bupleurum chinense root

Huang qin – Scutellaria baicalensis root

Ban xia – Pinellia ternata rhizome (treated)

Sheng jiang – Zingiber officinale root (fresh)

Da zao – Zisiphus jujuba fruit

Xin yi hua – Magnolia liliflora bud

Cang er zi – Xanthium sibiricum fruit

Bai zhi – Angelica dahurica root

Shi chang pu – Acorus gramineus rhizome

Jie geng – Platycodon grandiflorum root

Ju hua – Chrysanthemum morifolium flower

Ge gen – Pueraria lobata root

Sheng gan cao – Glycyrrhiza uralensis root

Pu gong ying – Taraxacum officinale root and leaf (tinctured fresh)

Water

Ethanol

Honey

Effects:

Reduce or eliminate symptoms of seasonal allergies, especially runny or stuffed nose.  Resolve long-lasting cold whose main residual symptom is stuffy nose and blocked sinus.

Dosage:

Standard dose is four full squirts of the dropper, twice a day.  For some people the standard dose is overly drying; if you find this is the case for you, try a smaller dose until you hit upon the right dose for you.  If you predictably suffer from seasonal allergies, combine with Jade Defense and begin this regimen a month or so ahead of your allergy season – three squirts Jade Defense and one squirt Nasal/Sinus Formula, twice a day.  For snotty colds and sinus infections, combine with Virus Killer (forthcoming from Green Monkey Pharmacy).  The best way to take this formula is to squirt the tincture directly into your mouth and hold it in your mouth for maximum buccal absorption so that some of the anti-allergy components in the herbs can directly enter the affected tissues of the face, bypassing the general circulation.  This is one formula that I don't recommend thinning down in boiled water; you don't want to boil off the volatile components that give it much of its anti-allergy power.

Product Description:

This formula is built on Xiao Chai Hu Tang (“Minor Bupleurum Decoction”) from the Shang Han Lun or “Treatise on Cold Damage,” one of the earliest (220 CE) and most famous books of Chinese medicine.  The original formula was designed to treat the shaoyang or “lesser yang” stage of a disease, when a pathogen has neither completely penetrated the body’s defenses nor been successfully fended off.  This “not in, not out” status describes allergies and unresolved colds, making this an ideal formula for treating both.

The original formula consists of chai hu (bupleurum), huang qin (scutellaria), ban xia (pinellia), sheng jiang (fresh ginger), ren shen (ginseng root), da zao (jujube date) and zhi gan cao (cured licorice root).  In my version I substitute dang shen (codonopsis) for ginseng and uncured licorice for cured licorice, and add a number of other herbs to make the formula more effective for nasal and sinus symptoms.  Xiao Chai Hu Tang is an energetically very interesting formula.  The main herb, chai hu, is cool and outthrusting, making it effective for clearing a pathogen (whether virus or pollen) from the in-between zone where it resides.  Chai hu also moves stagnant qi, making it a good herb for soothing the out-of-sorts feeling that an allergy or head cold can produce.  Huang qin is a major heat-clearing and dampness-drying herb that pairs nicely with chai hu to vent the pathogen in a shaoyang-type disorder.  Huang qin also pairs well with ban xia, which is one of the major herbs for treating phlegm of all types.  Interestingly, in light of its inclusion in this allergy formula, recent research shows that one of the major components of huang qin, known as baicalein, inhibits mast cells and therefore minimizes histamine release and allergy symptoms.  The remaining herbs in the original formula – sheng jiang, ren shen/dang shen, da zao, and sheng gan cao – strengthen the qi to help keep the pathogen from penetrating further.  The da zao and sheng gan cao also serve to balance the drying nature of ban xia and some of the other herbs that I add to the original formula.

Since this is a remedy for allergies and lingering colds with predominantly nasal symptoms such as stuffiness and runny nose, I have added additional herbs for this purpose.  Xin yi hua (magnolia bud), cang er zi (cocklebur), and bai zhi (angelica dahurica root) are the trinity typically employed for this purpose, to which I add shi chang pu (acorus rhizome).  Shi chang pu is traditionally used to “open the portals” of the sensory organs in heavy-duty conditions like seizures and disorientation.  In larger doses it is mildly psychoactive; in our smaller dose it serves as one more opener of the nose and sinuses.  Next year I will add silver beach bur, the local coastal ragweed, which like its other ragweed cousins is excellent for treating the very allergies its copious pollens produce in many people (as of today it hasn’t flowered yet, and I prefer the idea of using the flowering plant rather than just the foliage).

Finally, ju hua (chrysanthemum), jie geng (platycodon), ge gen (kudzu root), and fresh tincture of dandelion were added.  Ju hua addresses the itchy and dry eyes that accompany many allergies.  Jie geng together with the licorice directs the formula to the throat region, which is often itchy and irritated.  Ge gen directs the formula to the regions of the nose and sinuses, and, together with sheng gan cao and da zao, helps to offset the drying nature of the formula.  Pu gong ying (dandelion) is added not because it is an anti-allergy herb per se (although, together with the ju hua and huang qin, it is useful for hot red itchy eyes), but because it is a premier liver herb and spring is the season of the liver so it supports this organ during the season that it is most stressed.  I am not as gung ho about “detoxifying” as many in the alternative medicine community, but in this context of seasonal allergies I do believe that it is useful to add a detoxifying herb like dandelion to the mix, to make the formula work better.

Production Notes:

3.75 liters of an alcohol-water blend was slowly percolated through 1.25 kilogram of pre-moistened ground-up herbs to produce about 3 liters of tincture.  200 ml of dandelion fresh tincture was added directly to the resulting tincture.  Strength of the final tincture is about 1:2.5. 

Something Else You Can Do to Treat Allergies and Stuffy Nose:

When they find out that you suffer from allergies, about 95% of people in Santa Cruz will immediately tell you to use a neti pot.  For the small minority of readers who are unfamiliar with the neti pot, it is essentially a small pitcher designed to pour warm salt water through your nostrils to flush out your nasal passages.  Generally, I think this is good advice for people suffering from allergies, since the salty water flushes through the nasal cavity and nasopharynx where pollens and other allergens can adhere.  I prefer to use a plastic squeeze bottle rather than the traditional neti pot, since with the squeeze bottle you have the advantage of being able to force the saline through your sinuses and nasal passages with some pressure.  For colds, I find the nasal flush more useful towards the end of a stuffy-nosed cold – it’s really satisfying to see those deposits of snot getting flushed out.  In my experience, at the beginning of a stuffy-nosed cold, using the neti pot just makes me more stuffed up.  If you are new to the neti pot, have someone show you how to do it, or Google “neti pot” on the Internet – there are hundreds of people out there who are very excited to share the technique with you.

Cool Lady: Menopausal Hot Flash Formula

Ingredients:

Bie jia – 
Amyda sinensis turtle shell

Qing hao – 
Artemisia annua herb

Sheng di huang – 
Rehmannia glutinosa root (uncured)

Shu di huang – 
Rehmannia glutinosa root (cured)

Yin chai hu – 
Stellaria dichotoma root

Di gu pi – 
Lycium chinense bark

Han lian cao – 
Eclipta prostrata herb

Mu dan pi – 
Paeonia suffroticosa root bark

Zhi mu – 
Anemarrhena asphodeloides rhizome

Bai shao – 
Paeonia alba root

Water

Ethanol

Effects:

Eliminate or reduce perimenopausal and menopausal hot flashes and night sweats.  In Chinese medical terms, this formula primarily cools vacuity heat and secondarily nourishes the yin.  Cool Lady may also help with excessive menstrual bleeding, which is often due to too much “heat,” and there are herbs here that clear heat and stop bleeding.

Dosage:

Start with four full squirts of the dropper, twice a day.  This should eliminate or reduce your hot flashes quickly, within a matter of days.  If not, try more – five or six squirts.  Once you are feeling better, start reducing the twice-daily dose. Play around with the dosage, constantly trying to achieve your minimum effective dose.  After several weeks of being blissfully hot flash free, try weaning yourself completely and then use Cool Lady only on an as-needed basis.  I recommend thinning it down in a small glass of water, mostly because I personally can’t stand the taste of mu dan pi (tree peony root bark), which predominates.  Squirt the tincture into a cup of freshly boiled water to evaporate most of the alcohol if you wish to avoid alcohol. 

Background:

The Chinese talk a lot about yin and yang – you could say that it is the fundamental organizing principle behind all forms of classical Chinese culture, from painting to warfare to medicine.  In the human body, yin is the soft parts, the interior, the lower portion, and yang is the hard parts, the exterior, the upper portion.  Most importantly for our present purposes, yin is the watery, fluid aspect of ourselves – the ocean that we internalized when we crawled out of the sea many eons ago.  And yang is the fiery aspect – the flame of digestion, the heat of passion, the slow burn of life and growth.  Modern life is extremely yang: full force, relentless forward movement, constant stimulation and activity with too little time for the quintessential yin “activities” of sleep and rest.  The result is that we almost literally burn out, like soup that has been left on the fire too long.  Add to that the fact that both yin and yang naturally get depleted with age, and that women lose some of their yin on a monthly basis (blood is a subset of yin in the body), and you end up with a deficit of both – and for many women, a comparatively larger deficit of yin.  So, even though the yang fire is low, the yin water is even lower so the fire appears to flare.  This flaring, known as “yin vacuity fire,” can manifest as a hot flash.  What I love about this description of what’s going on in the body is that although it appears to be so poetic and metaphorical, it is actually extremely accurate and useful: the medicine that evolved from this way of thinking really works.  I would go so far as to say that this is why Chinese medicine truly shines when it comes to women’s health.  Yin-yang theory is an excellent basis for understanding much of nature, but it is especially good for diagnosing and treating women, who with their monthly cycles embody the ebb and flow of yin and yang, making them easier to treat.

Product Description:

This formula is a variation of Qing Hao Bie Jia Tang (“Artemisia and Turtle Shell Decoction”), first put down in writing in 1798 in a book on infectious disease.  The original formula was designed to treat injury to the yin in the wake of a febrile disease, with night fevers that recede in the morning.  My friend and teacher Andy Ellis first suggested to me years ago that I use it to treat hot flashes, saying it was stronger and more effective than most of the usual menopause formulas.  I’ve found him to be right!  And I am especially happy with this particular version, since it works so well.

The original formula consists of bie jia (turtle shell), qing hao (artemisia herb), sheng di huang (uncured rehmannia root), zhi mu (anemarrhena root), and mu dan pi (tree peony root bark).  The crux of this formula is the pairing of turtle shell, which is deeply yin-nourishing, with artemisia, which clears heat.  Note that this is Artemisia annua, the source of the sesquiterpene lactone artemisinin (widely used in combination malaria treatments and off-label as a cancer treatment), not the Artemisia absinthium that shows up in my home-made absinthe or the Artemisia vulgaris that I use for making moxa.  Although sheng di huang (uncured rehmannia root) and zhi mu (anemarrhena root) are considerd to be somewhat yin-nourishing, they are primarily heat-clearing herbs, as is mu dan pi (tree peony root bark), the remaining herb in the original formula.  Therefore, you can see that this formula is more about clearing the vacuity heat than it is about nourishing yin per se.

To make my version of this formula more yin-nourishing, I have added shu di huang (cured rehmannia root), which strongly nourishes the yin and the blood, and han lian cao (eclipta herb), which also tonifies the yin while at the same time clearing vacuity heat (eclipta also has the reputation, both in Chinese medicine and in Indian Ayurveda, of turning grey hair black again).  Additionally, the herbs di gu pi (lycium bark) and yin chai hu (stellaria root) are included for their specific effect of clearing yin vacuity heat.  Finally, a small amount of bai shao (peony root) is included to “preserve the yin.”  Bai shao has an astringency that hold the yin in and helps prevent night sweats.  It is also a major blood-tonifying herb that regulates the menses and smoothes the qi and blood in conditions such as abdominal pain, cramps, and all-around yuckiness-feeling.  Bai shao is one of my favorite herbs.

It is not uncommon for women to experience excessive menstrual bleeding during the transition to menopause.  This is because, as it heats up, the blood turns "reckless" and overflows.  Fortunately, many of the herbs here help stop menstrual bleeding: sheng di huang, mu dan pi, di gu pi, han lian cao, yin chai hu, and bai shao all help in some way to regulate and stop menstrual bleeding.  For this reason, this formula can be very useful not just for perimenopausal and menopausal women, but for any woman who experiences heavy periods due to heat in the blood.  It is possible to suffer from menorrhagia due to other causes, so if you are experiencing heavy menstrual bleeding with no hot flashes or other menopausal symptoms, you should get checked out by a practitioner of Chinese medicine to determine the cause of your heavy bleeding.  Or you can try some Cool Lady and, if it works, conclude that you have some sort of blood heat or yin vacuity heat going on.

Production Notes:

2.5 liters of an alcohol-water blend was slowly percolated through one kilogram of pre-moistened ground-up herbs to produce about 2 liters of tincture.  A second percolation of 500 ml. boiling water was performed to better extract the more water-soluble yin-nourishing herb constituents, and the resulting fluid was added to the main tincture.  Strength of the final tincture is 1:2.5. 

I can’t help but put in a plug here for Spring Wind Herbs, the source for most of the dried bulk herbs that go into my tinctures (and owned and run by the aforementioned Andy Ellis).  A lot of bulk Chinese herbs out there are in pretty sorry shape.  Not only is misidentification and mislabeling of herbs a problem in the industry; even if the herb is the correct plant, there’s a lot of dusty musty stuff out there whose colors and aromas are indistinct and which has probably sat in a warehouse for months, being nibbled on by rats and bugs.  Not so Spring Wind Herbs!  Opening the sealed plastic bags of Spring Wind herbs is a feast for the senses.  The qing hao in this formula is the freshest, most vibrant qing hao I’ve ever seen: so green, so fragrant!  And the mu dan pi, also so strongly aromatic (if yuckily so).  The sheng di huang and shu di huang are notoriously difficult to grind, so I was extremely pleased to be able to get them pre-ground to a fine powder (how do they do it? first freeze-dry, then grind?).  Thank you Spring Wind!

Other Considerations:

You shouldn’t rely exclusively on Cool Lady to nourish your yin and clear your heat.  Stop being so yang’d out.  Slow down.  Rest more.  Spend time communing with earth and ocean.  Incorporate more yin-nourishing foods into your diet, like seaweeds (wakame, kombu, hijiki), leafy greens, mung beans, oysters, fish, mushrooms.  Drink enough water.  Cut down on, or eliminate, things that burn the yin, like alcohol, cigarettes, and spicy fried foods.  Because Cool Lady is more heat-clearing than yin-nourishing, you may find that it gets rid of your hot flashes, but when you stop taking it the hot flashes come back.  If you follow the dosage recommendations above and find that your hot flashes return after you have weaned yourself from the herbs, you should take a more straightforwardly yin-nourishing formula such as Liu Wei Di Huang Tang (available in most natural food stores in pill form) in conjunction with Cool Lady.  Take the Liu Wei Di Huang Tang regularly and long-term, adding Cool Lady at low dose or as needed.  Cool Lady is not meant to be used long-term, as the preponderance of cooling herbs may dampen the digestive fire and end up causing loose stools or diarrhea.  If your digestion is weak to begin with, try smaller doses and take them after meals rather than before.  If this doesn’t work for you, let me know, and we can discuss herbal strategies for protecting the digestion while concurrently nourishing yin and clearing vacuity heat.

Anti-Inflammatory Blend: Natural Relief for Chronic Pain

Ingredients:

Yan hu suo – 
Corydalis yanhusuo rhizome

Hu zhang – 
Polygonum cuspidatum root/rhizome

Dan shen – 
Salvia miltiorrhiza root

Ji xue teng – 
Millettia dielsiana root and vine

Dang gui – 
Angelica sinensis root

Chuan xiong – 
Ligusticum wallichii root

Sang ji sheng – 
Viscum album stems

Wei ling xian – 
Clematis chinensis root

Sheng gan cao – 
Glycyrrhiza uralensis root

Yarrow – 
Achillea millefolium (fresh-tinctured)

Ethanol

Water

Effects:

Reduce pain and inflammation after traumatic injury and in chronic pain conditions like osteoarthritis, fibromyalgia and chronic regional pain syndrome, and autoimmune diseases such as lupus and rheumatoid arthritis.  People suffering from menstrual cramps, abdominal masses, heart pain, or chronic headaches may also benefit, though they should probably see a practitioner for a customized herb formula.

Dosage:

Four full squirts of the dropper, twice a day.  I recommend thinning it down in a small glass of water.  If you wish to avoid alcohol, you can squirt the tincture into a cup of freshly boiled water to evaporate most of the alcohol.  I suggest taking it before breakfast and before dinner, to get the herbs into your bloodstream without competition from food (although, if the herbs make your stomach feel funny, take them after a meal rather than before).  I also suggest starting out with a small dose (one full squirt), and increasing to two squirts, three squirts, and finally four squirts over the course of a week or two.  Though I list the standard dose as four squirts twice a day, you should experiment and establish for yourself your own personal minimum effective dose, and stick to that.  Keep in mind that these are herbs, not drugs, and you should not expect an instant analgesic effect as you would with Advil or morphine.  Rather, stay consistent with your twice-daily doses and expect results in a few days to a week.  Finally, I don’t recommend taking anything (aside from food and some food-like herbs) all the time, forever.  It’s good to show the body what is possible, then encourage it to achieve that on its own.  So, when you start to notice a decrease in pain and inflammation, take advantage of your improved condition to start walking again, or going to your restorative yoga class, and then take a break from the herbs.  If the pain comes back you can start with the herbs again.

Cautions and Contraindications:

This formula should not be used if you are pregnant or think you may be pregnant.  Also, I would not recommend this formula if you are already on coumadin or other blood-thinners.  Aside from that, my opinion is that this formula is quite safe.  When taking any substance into the body, there is always a risk of some idiosyncratic adverse effect or undesirable interaction with something else you are taking.  On the one hand, this leads many physicians to be unnecessarily conservative about their patients mixing herbs with medications, and this prevents the patient from getting the optimum results that could be had.  On the other hand, there are definitely herbs that affect the metabolism of drugs in the body, leading to an overdose of whatever drugs you are on (if the herb inhibits the metabolic enzymes that should be hacking the drug apart in your liver at a predictable rate) or an underdose (if the herb promotes the enzyme and it dissembles your medication before it can do any good).  As far as I know, no comprehensive survey of Chinese herbs has been done as far as their effects on metabolic enzymes goes.  Since the typical herb formula contains eight or more herbs, there is always the risk that some herb in there will affect an enzyme and mess with your drug metabolism.  For this reason I typically don’t prescribe herbs while a patient is undergoing chemotherapy – I want the chemo to do its job and would feel horrible if my herbs made chemo ineffective or unnecessarily toxic for my patient.  Please note that this formula contains at least two herbs – corydalis yanhusuo and salvia miltiorrhiza – that may inhibit cytochrome P450, a family of key metabolic enzymes.  So, if you are taking any medications and are concerned about potential herb-drug interactions, you should not take this formula.  However, in addition to this formula providing its own pain-relieving and anti-inflammatory effects, its inhibition of cytochrome P450 means that you may be able to lower the dosage of whatever drug you are taking to achieve the same effect it was having at a higher dose.  If you are the adventurous sort and have an open-minded doctor with whom you could keep close tabs on your blood chemistry and state of health, the combination of this formula and whatever else you are taking could be a productive foray into integrative medicine that could potentially result in weaning you from what becomes an unnecessary prescription medication.  Finally, don't discount the possibility that a prescription drug that you are on is causing your pain in the first place. Countless medications, among them such common drugs as Lipitor, Premarin, and Xanax, cause joint pain in certain percentages of patients.  If it's medically feasible, and with the collusion of your doctor, try taking a break from a drug you're on and see if your pain goes away.

Background:

To understand this formula, we need to appreciate the Chinese medical understanding of pain.  There is a famous saying in acupuncture that asserts, “Where there is free flow there is no pain.  Where there is pain, there is no free flow.”  “Free flow” refers to the flow of qi (energy) and blood through the channels of the body.  What impedes this free flow?  Anything from injury, to inactivity, to improper body mechanics, to stress, to genetic and pathogenic factors can cause the stagnation that leads to pain.  Many Chinese formulas for the treatment of pain focus on pathogenic factors such as wind, dampness, heat, and cold.  I prefer to focus on resolving the stagnation of qi and especially of blood, since all chronic pain has a strong qi and blood stagnation factor, regardless of its ultimate origin.

Product Description:

The two main herbs are yan hu suo (corydalis) and hu zhang (polygonum cuspidatum or Japanese knotweed).  The corydalis is energetically “warm” and the knotweed is “cold,” so together they create a balanced formula that is able to treat hot conditions exhibiting redness and swelling (think rheumatoid arthritis) as well as cold conditions (like osteoarthritis that gets worse in cold weather).  Corydalis is a genus of about 470 species in the Fumariaceae family, sometimes treated as a subfamily of the Papaveraceae, whose star performer is the opium poppy.  Given this family resemblance, it is not surprising that our corydalis exhibits pain-killing properties.  Yet, the analgesia induced by corydalis is not due to opioids; rather, it contains other alkaloids such as corydaline and tetrahydropalmatine whose combined efficacy (according to my trusty Chinese Herbal Medicine Materia Medica by Bensky and Gamble, 1993 edition) is about 40% that of morphine.  If that is true, this is some significant pain-killing action indeed.  The other main herb, Japanese knotweed, is not one of the most popular herbs used in traditional Chinese medicine, where it shows up in formulas for inhibited menstrual flow, certain types of jaundice, liver cancer, cough, and skin infections.  But in Japanese folk medicine, it reigns supreme as a treatment for pain of all sorts.  In fact, its Japanese name – itadori – literally means “pain remover.”  This herb has become a major commercial source of resveratrol, the substance in red wine that has been much-researched for its effects on life extension with purported anti-cancer, anti-inflammatory, blood sugar lowering, and other beneficial effects.  It also contains emodin, which is a laxative, so if you find that this formula makes you go poop more than you like, you’ll know why and you can lower the dose.

Most of the other herbs also fall in the blood-moving category and contribute to the pain-reducing effects of the main herbs.  Chinese angelica, millettia, and sang ji sheng (mistletoe that is parasitic on mulberry) are blood tonics as well as blood movers – which is to say, they build and nourish the blood in addition to moving it.  Dan shen (red sage root) is a wonderful herb that is excellent for resolving blood stasis generally, but deserves special mention for its ability to treat chest pain.  When my mother developed angina some years ago, I put her on a formula in which dan shen was the main herb, and it helped to control her symptoms.  The only herb here that is not a blood mover is wei ling xian (clematis root).  It falls in the category of herbs that dispel wind-dampness, and I include it here because it is a great herb for joint pain of all kinds.

Finally, there is one fresh herb in the mix, and that is yarrow.  Yarrow is one of my favorite plants.  It has been used in Europe since ancient times as an effective digestive, fever-reducer, and blood-stauncher.  It is not a major herb in Chinese medicine, though the Chinese recognize its above-listed traits and, depending on the source, also praise its ability to relieve pain, regulate menstruation, and resolve heat and toxin (treat boils and abscesses and other infections).  Traditionally the whole above-ground plant is used, but lately I’ve been making a fresh tincture from just the deep green feathery leaves, on a hunch that yarrow’s pain- and inflammation-relieving virtues reside there.  Yarrow is one source for the brilliant blue chemical azulene, which is known to be a potent anti-inflammatory (I think, but am not sure, that azulene is only produced at high heat during steam distillation, though I believe that its precursor chamazulene is extracted during maceration and contributes to yarrow’s anti-inflammatory effect).  The yarrow in this particular batch of Anti-Inflammatory Blend is particularly magical, since half of it was picked at dawn on the winter solstice by my daughter Sara and me, after a memorable all-night sweat lodge (the other half was picked at the height of summer).  I think of yarrow as having a “clearing” effect that includes a clearing of whatever is gumming up the channels and blood vessels.  From a Chinese medical standpoint, I think that in addition to being blood-moving and improving the circulation per se, yarrow (along with the clematis) also “pushes” pathogenic factors out of the channels and collaterals.  It is this same spicy pushiness that makes yarrow effective in resolving fevers.  Although it is only about one-tenth of the formula, yarrow’s soapy-bitter flavor (along with dang gui’s pungent celery-ness) predominates, which makes me think of it as an especially strong player in the “team” that comprises this formula.  As an aside, I believe that yarrow is an aphrodisiac for ladybugs.  Over the years I have observed, both in the garden and in the wild, that ladybugs love this plant and can often be found on it in pairs, humping their little hearts out!  What significance this holds for humans, if any, I cannot say.

Production Notes:

Three liters of an alcohol-water blend was slowly percolated through one kilogram of pre-moistened ground-up herbs to produce 2.5 liters of tincture.  To this was added 300 ml. of fresh yarrow tincture, made with 95% pure ethanol.  Estimated strength of final tincture is between 1:2 and 1:3. 

Other Considerations in the Treatment of Pain:

In traditional Chinese medicine, acupuncture is generally used as an adjunct treatment for most diseases – by needling points at the surface of the body, we believe that we can affect the goings-on deep within the body.  For most illnesses, herbal medicine is usually the primary treatment, since the herbs actually go deep into the organs, where they are needed, to do their work.  But for the treatment of pain, especially musculoskeletal pain, acupuncture should be the primary treatment.  This is because most pain conditions are lodged in the connective tissue, and that is where the acupuncture needles go to free up the restrictions that accompany most pain patterns.  Whether you think of these restrictions as myofascial trigger points or stagnation of qi and blood in the channels, acupuncture is uniquely qualified to directly treat these impediments to free flow. Massage, gua sha (scraping), cupping, and moxibustion can also be very helpful in the treatment of pain conditions.

But acupuncture, massage, etc. are relatively passive processes.  You just lie there while somebody manipulates your body.  You get up feeling better, and then launch right back into ways of moving and living that bring the pain back.  Many pain conditions involve lifestyle components like posture and gait, and level and nature of activity.  Posture and gait are two of the main contributors to osteoarthritis, and they are quite difficult to correct on your own.  If you suspect that your pain is at least partially a result of the way you hold your body and move it in space as you go about your daily life, you may want to consider a series of sessions with a physical therapist, occupational therapist, or practitioner of Feldenkrais or other movement education therapies.  Often, not just how we hold ourselves but what we actually physically do or don’t do with our bodies ends up causing pain.  If you are getting carpal tunnel syndrome or some other pain associated with sitting at a computer, you should look into ergonomic considerations like chair height, computer monitor position, keyboard and mouse shape, etc.  And take more breaks!  If your lifestyle is somewhat sedentary, make the decision to exercise more.  Build it into your routine: go for a half-hour walk every morning, or a bike ride, or whatever.  If that sounds excessive, make it every other day, or even once a week for starters – the body recognizes and responds to regularity and consistency in any form.  I recommend yoga as a great system of building strength as well as flexibility.  But be careful: I have seen many injuries (including my own!) from yoga done over-enthusiastically.  Best to start with a super-mellow beginner’s class, or better yet a class specifically designed for people with pain and mobility issues. If you are in too much pain to exercise, first do a course of Anti-Inflammatory Blend and acupuncture/massage/Feldenkrais, then start exercising as these therapies make the pain more manageable.  A water exercise class is a great way to reintroduce movement into your life if other forms of exercise are too challenging.  If you suffer from chronic pain, regular exercise will help you feel better.

Finally, I should mention more conventional approaches to the treatment of pain.  Starting with the least potentially harmful: Advil (ibuprofen) is, in my opinion, a wonder drug for musculoskeletal pain.  If my back goes out, or a rib, I immediately pop four Advils and keep doing that twice a day for two to three days.  I have found that during those first couple days it is best to just lay low and not try too hard to fix things.  On day three or so I will have my kids administer scraping and cupping and some acupuncture.  In the meantime, Advil is the ticket!  It’s usually the first recommendation of most doctors as well, for most pain.  I am not so comfortable with Advil for long-term pain management.  There are real issues of liver toxicity and deterioration of the stomach lining, and I don’t like the thought of being dependent on a chemical that, although it reduces pain, isn’t really good for you.  So, for chronic pain I prefer the methods outlined in this article.

Next is cortisone.  Cortisone, along with adrenaline, is a glucocorticoid – one of the main hormones released by the body in response to stress.  During the course of human evolution, it really helped to have an amazing endogenous anti-inflammatory kick in instantly when a boulder crushed your leg or a wildcat chomped off your hand.  Similarly, a cortisone injection can provide immediate relief for the pain of a rotator cuff injury or other non-healing lesion.  Cortisone should not be discounted if you are in a lot of pain and other therapies haven’t helped.  But repeated cortisone treatments is not a good idea because of several negative side effects.  Cortisone reduces inflammation quite miraculously, but it also depresses the immune system, diminishes tissue integrity, and can lead to conditions such as osteoporosis, diabetes, and glaucoma.  Not recommended for long-term use.

Opioid drugs such as hydrocodone and morphine control pain very effectively, but this relief can come at quite a cost.  First of all, your central nervous system is affected and you aren’t quite yourself when under their influence.  Second, they depress vital functions such as digestive system motility (leading to constipation) and breathing (in the best cases leading to cough suppression when it is needed, but in the worst case to death from respiratory failure).  Most significantly, it is very easy to get addicted to these substances.  “Legal heroin” is not an inaccurate phrase.  You start out following the doctor’s dosage recommendation, and you are amazed at how much better you feel.  But, over time, your body gets used to that dosage and your pain returns, so you take just a little bit more to get relief.  And so on, until you are addicted, and when you realize this and try to wean yourself, that’s when you feel really crappy and want to get back on it so that you don’t feel so damn miserable.  Not recommended except for emergencies and end-of-life pain relief.

Finally, there is surgery.  Unfortunately, surgery is a real crapshoot.  It may make you feel way better.  It may fuck you up really bad.  It’s possible, even likely, that you will never regain full range of motion in the body part that was operated on.  If you end up with a condition where the doctors are recommending surgery, you owe it to yourself to do a lot of homework, research the statistics on recovery and success rates, and get second and third opinions before making a decision.  If you do decide to have surgery, be prepared for a long recuperation, and to put in a lot of work.  If you do your physical therapy, take your herbs and supplements, do acupuncture, do the movement therapies, stay tuned in to your body and keep pushing it to its maximum ability to heal, there is a good chance that you will have a favorable outcome, that you will have your body back and be out of pain.

Concluding Remarks

Clearly, pain is a vast and complex subject that includes everything from hormonal imbalances to physical structural anomalies to psycho-emotional factors to existential considerations.  As the Buddha so perceptively remarked 2,500 years ago, “Life is suffering.”  It would be unrealistic to claim that Green Monkey Pharmacy’s Anti-Inflammatory Blend can eliminate all pain.  But this is a good formula that I’ve been getting good results with in the year or so that I’ve been experimenting with it.  I’d be very interested in getting your reports on how it’s working for you.  If it’s not working as well as you’d like as a stand-alone treatment, please consider some of the recommendations I’ve made in this article.