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.