CHAPTER SIX
How herbs are to be used
Even the most ancient documents about the use of herbs present numerous methods of applying the various plants to produce a desired effect. Some are ground to powder and swallowed down much as one uses black pepper with foods; some are boiled in water, as one would boil beans in making a soup, and others are steeped in hot water to make a tea; some are extracted in a liquor to make a tincture. Yet others are applied topically in various forms, including baths, poultices, and plasters. All of these methods of application have come down to the present time, and Künzle had mentioned them in his book.
In the 21st century, herbal preparations are being altered somewhat to address concerns about their lack of convenience. Preparation time, which could easily be an hour or two for cooking up tough herbs in decoction, or which could involve a week or two for soaking herbs in a wine to make a tincture, is virtually eliminated by purchasing prepared forms of herbs. Topical applications that are messy, that stain clothes or bedding, that are smelly, greasy, or sticky are mostly rejected. They are being replaced by conveniently packaged liquids and creams that soak into the skin immediately and leave little or no residue, having been reformulated to eliminate ingredients that produce unpleasant results.
For example, Künzle was an advocate of healing baths to be given along with therapeutic teas, for which he eventually developed a simpler method. For rheumatoid arthritis, he wrote:
Suddenly, you can no longer walk. You feel a stinging and gnawing pain in your knees or thighs or you can no longer raise your arm. There is a tormenting rheumatic pain in your should blade and joints….If you want to get rid of this malicious visitor quickly, in just five to seven days, just proceed as follows:
Take one or two fern roots (Dryopteris filix) which are still fresh inside (dried and cut up, they lose all their strength in a few days), cut them into small pieces, but do not wash them. Put the pieces in a small bag and lay or tie it on the affected area and leave it there until the pain has vanished. Often, all pain disappears in just half a day. If the whole back is afflicted you need more roots and a larger bag to place on it. If you are unable or unwilling to stay in bed, bathe the afflicted limb the same day (but not the same half-day) in a fern-root concoction for half an hour.
Drink either a good mulled wine or an elderberry tea at bedtime. A goat's beard (Spiraeae ulmaria) infusion prepared with wine is even better. Continue this treatment for four to six days and you will be cured. However, if your rheumatism is not just a sudden attack but an affliction of many years standing, and perhaps you are already 60 or more years old, take baths in fern-root concoctions or fern-root extracts. As well as this, drink a tea made from birch leaves (Betula alba), goat roots, restharrow (Ononis repens), and goose grass (Galium verum) every day, taking a sip every hour. Thus, you may be cured in three to six weeks, depending on the severity and length of your affliction.
The results sound wonderful, but the procedures seem unattainable, especially if one must get fresh fern roots, and a variety of uncommon herbs. His solution? A factory has prepared his Rheuma-Tea formula that could be purchased in drug stores and Filix, a fern extract made from the fresh fern roots, that can be applied as an embrocation several times daily.
These, and other measures aimed at the goal of making herbs more acceptable to busy people, remove the issue (for the herb user) of how to properly identify the herbs, when to collect them, how to dry them, and how to make them into various forms for administration. The more convenient formulations in finished form leave the following questions:
In this chapter, some general answers to these questions will be provided.
It is normally the task of the medical practitioner to provide a clear diagnosis of what the problem is, giving it a name when available, and revealing, when known, the nature of the pathological processes occurring in the body that need to be addressed. For an individual who leads an essentially healthful lifestyle, and who responds to minor ailments by quickly making small corrections, selecting herbs to treat the symptoms that arise may be an easy matter. For those who have been burdened with various ailments since childhood (or, at least, for many years) and those who have squandered good health with bad habits, the situation is more difficult and often requires a professional diagnosis.
With basic diagnostic information in hand, one can select an herbal formula that has effects consistent with the condition to be relieved. Modern herb products that are available over the counter are designed for treating disorders that are not so complex and serious that one needs a prescription by a health professional. The common areas of concern are these: acute, self-limiting infections, such as common cold, rhinitis, and influenza; emotional and nervous disorders, such as mild anxiety, stress, depression, and insomnia; digestive system distress related to eating habits and to the effects of emotions, such as dyspepsia, change in appetite, gas and bloating, diarrhea and constipation; aches and pains, such as arthralgia, minor injuries, and muscular tension; and functional disorders that are not extreme, such as mild hypertension, mild diabetes, menstrual disorders, menopausal syndrome, obesity, or mild liver inflammation. People with more serious disorders may also make use of the herbs available over the counter, but should maintain medical monitoring of the disorder and use of appropriate prescribed medical therapies. Thus, for diabetes, Künzle recommended certain herbs for the early stages, but suggested that the herbs could "help to sustain" the effects of insulin for the advanced cases.
Most often, only one or two remedies are offered (by any one manufacturer) for each of the categories of ailment, thus the consumer is not faced with a difficult decision amongst many possibilities. Each manufacturer will have their favored remedy for a particular type of ailment, and selection among the different manufacturers usually is based on one's trust in their product quality rather than the specific ingredients used for a particular ailment.
Professional herb prescribers, of which there are scant few available (mainly acupuncturists and naturopathic doctors), have the luxury of selecting among numerous ingredients, formulating a remedy specifically aimed at the needs of a patient, and adjusting the formula over time in an attempt to get the most efficacious treatment. Even then, many herb prescribers come to rely on a few trusted formulations that are used for a wide range of disorders in many different people. These trusted formulations typically become a line of manufactured products, such as those prepared on the basis of Künzle's work.
In sum, with the availability of easy-to-use manufactured products that are now labeled with their main indications for use, most people do not have to make any hard decisions in selecting the herbs to use. For those who are better educated about herbs, one can examine not only the use that is described on a package, but the functions of each of the ingredients to determine whether or not an herbal formula is suited to your needs.
Determining the amount of an herb to use has always been a difficult task for herbalists, and approximate quantities are usually cited in the herb guides. For the majority of herbs that have a mild to moderate action, and which are used in the European system (where over the counter remedies dominate), the standard amount recommended is in the range of 1-6 grams of dried crude herbs for a one day dose (in preparation of teas), to be doubled in some cases where rapid action, high body weight, or seriousness of symptoms calls for it.
During the 20th century, dosage standardization has become the normal practice. It will be stated, for example, that the dosage of an herb should be 3.0 grams for one day. The apparently precise figure may give the impression that there is an exact science of herbal dosage, but that is misleading. What has happened, instead, is that several authorities have agreed that 3 grams is a reasonable amount to suggest as efficacious, yet well within the safety limits that have become a central concern. The added decimal point (changing a dosage statement of 3 grams to 3.0 grams) is only a reflection of the fact that some herbs are recommended in non-integral amounts, such as 4.5 grams, so that the decimal point is included, but should not be taken as implying precision.
The dosage indicated in a monograph for a single herb is usually based on the amount of that herb when used by itself. In actual practice, herbs are often used in combinations, sometimes relying on several herbs that have the same basic properties, even overlapping active constituents. In the formulas, the amount of each individual herb is often lower than the amount that is described in the literature for the herb used by itself. A total daily dose of herbs in a formula might range from 6-12 grams for the over-the-counter type remedies.
When describing the use of herbs, there are often two or more actions attributed to each herb. There may be different dosage requirements for the different actions. For example, if one wishes to get an effect of an herb on the stomach, then the dosage needed is usually quite small. This is because all of the herb ingredients consumed will be in the stomach, the target of its action, in their full dosage at the time it is consumed. By contrast, if one wishes to treat a sinus infection or aching feet, the dosage of the same herb (assuming that this one herb is reputed to treat both the stomach and these other body parts) would usually have to be higher. This is because the herb ingredients will be dispersed throughout the entire blood stream by the time they reach the part of the body to be affected, and will be greatly diluted.
Manufactured herbal products usually incorporate an herb into a complex formulation for which only one of the many potential uses of the herbs is being relied upon. Its dosage within the formulation is determined by the herbalist who has designed the herbal mixture so as to address the intended application.
The total dosage of the formula to be taken is suggested on the product package. This dosage is always a conservative recommendation, and, unless indicated otherwise, is the amount suggested for an adult. It has to be a suitable dosage for the consumers who have a small body weight, such as a petite woman who might have a weight of only 50 kg (110 pounds) or less and for people who are highly sensitive to things they consume, such as herbs. Therefore, those with higher body weight, some of whom will easily be double this weight, will often do better by taking up to twice the recommended amount. Since it is not possible to list all the variables affecting dosage and the suggestions to adjust for each variable, the label has to reflect the conservative approach. The herb formulas provided to the public are mild ones (the drastic ones are saved for prescription by health professionals or simply give way to the drastic drugs that are heavily regulated).
Generally speaking, to keep within safe bounds, one can use 1-2 times the dosage suggested on package labels. Using less than the recommended amount may prove adequate for some individuals, but will usually result in little therapeutic effect. For teas, they may become a simple beverage, rather than a medicinal.
During Künzle's time, and for most of the history of herbal medicine, getting herbs and then preparing them for use was not an easy task. Surely, plants of various types grew nearby, but the right ones might be some distance away, or might not be available during the season for which they were needed. Cooking up herbs on today's ranges is far easier than with past kitchen fires. Taking the herbs, or administering them topically, was often an unpleasant experience. Therefore, the rule for duration of herb use was a simple one: just as long as absolutely necessary, no longer. Herbal therapies were often described in terms of curing a disease. A person would be ill, they would take their herbs, their condition would improve, and then they would lead a healthier life.
In the case of his Spring Tea, Künzle had to remind people of the importance of taking it for at least a week or two. Of course, some serious diseases required longer therapies. Künzle mentions that for persons stricken by consumption (tuberculosis) and already given up on by their physicians (there was no medical cure at the time), some had been cured completely by "prolonged use" of juice of the chickweed. In modern medical practice, antibiotics have to be administered for months to fully get rid of tuberculosis and the herbs would likely have taken at least as long. In another instance he recommends wormwood to be used "over a long period of time" to cure dropsy. In modern practice, leg edema (formerly called dropsy) is usually treated by diuretics, and these are taken for months. For gout, arthritis, and other serious disorders, Künzle recommends cowslip, but advises (based on the recommendation of Father Kneipp) that it is useful only if used "for a long period." The designation "prolonged use" or "long period" is necessarily unclear, as the duration will no doubt vary from person to person, but is determined by when the patient feels that the disease is gone. Compared to the standard duration of use of herbs, which, in Herbs and Weeds, usually does not exceed a fortnight (two weeks), such references are to taking herbs for several weeks or months.
Our modern situation has changed greatly. Now that herbal preparations are relatively convenient to use and are readily available all year; most people can take them for a long time. Therefore, the question of duration of taking herbs is no longer limited to as short as possible. Some of the conditions treated by short-term use of herbs are now treated by drugs, either to cure them (e.g., with antibiotics) or allow them to be better tolerated (e.g., with symptom relieving medicine for cold or flu). However, many diseases that lead people to consider herb therapy cannot be cured, only controlled. The percentage of people living with various cardiovascular diseases (atherosclerosis, hypertension, post-stroke syndrome, heart failure), chronic pulmonary diseases (such as asthma, chronic obstructive pulmonary disease, emphysema), cancer, nervous system diseases (including severe cases of attention deficit disorder, bipolar disease, multiple sclerosis, Parkinson's disease, Alzheimer's disease), hormone-based metabolic disorders (diabetes, hypothyroidism), autoimmune diseases (e.g., arthritis, lupus, scleroderma), and others is huge. For these people and many others, taking drugs every day is a simple habit, if an undesired but necessary one. Taking herbs every day then would seem to have the potential for widespread acceptance.
For many of the medicinal herbs, there is simply no historical experience of taking the herbs for very long periods of time. Whether such a practice would ultimately be helpful or occasionally harmful is not known. There are a few herbs that have been consumed daily for extended time periods and seem to be of benefit, or, at the least, of no harm. These include all the kitchen herbs and spices used in various countries and the beverage teas (notably Camellia sinensis, the green and black teas, as well as chamomile, peppermint, and ginger), many of which end up in medicinal preparations. So, one can say that there is a precedent for using several ingredients of medicinal herb formulas on a daily basis, but there is also some lack of knowledge about the prolonged use for many of the other ingredients.
The same situation applies to the drugs that people take. Many of these drugs were developed during recent decades and the duration of use for which there is accumulated experience is often limited. We are in uncharted territories when it comes to taking medicinals, be they plant or synthetic drugs, which are now being applied continuously.
Over-the-counter drug products usually carry the following caution: if the condition persists, see your doctor. This is a good suggestion for the use of herbs as well. If the condition continues despite the use of herbs at the proper dosage and for a reasonable period of time (e.g., a few weeks) without obvious improvement, then one should check with a doctor to make sure that the symptoms are not part of something that is quite serious and requiring more aggressive action.
Most herbal formulas sold over the counter provide about a 5-10 day supply of the herbs, enough to give a reasonable try to see whether or not it will be of help. Sometimes it is enough to completely treat the condition of concern. In most cases, regular use of the herbs over a period of many weeks or even months can be safely undertaken if they have proven helpful at a low dose (e.g., within the package recommendations, perhaps adjusted upward for body weight as indicated above). If a higher dose is needed in order to get results, then prolonged use should be undertaken with medical supervision. The herbs in Künzle's teas that have come down to us today have been approved by the German Commission E, indicating that there is no harm known from consuming them in the usual manner, which is for several days, weeks, or even a few months.
There are occasional recommendations by well known herbalists for the daily use of herbs as a preventive against disease. Many people are familiar with the Oriental claim, promoted mainly by the Koreans but arising from Chinese tradition, that taking ginseng every day will prevent disease and prolong life. For the most part, Künzle did not recommend daily use of prophylactic herbs for overall health care, and, instead, recommended a daily regimen of healthy living (see Chapter 4). One of his main suggestions, in terms of things to consume daily, was to take porridge, which he called "the food of our ancestors." Another relatively long term treatment was the "fig cure" for chronic constipation, which was based on daily consumption of dried figs that had been soaked in water overnight (drink the water and eat the figs). The same result could be obtained, he said, by using dried pears, prunes, or apricots, though he especially liked the figs because of the small seeds. These treatments were to be carried out for a month or two. He also advised substituting coffee by a beverage product, then available in Switzerland, made from dried figs, called Virgo.
Künzle occasionally recommended a prophylactic herb regimen carried out over a long time for specific disorders, but not on a daily basis. For example, he pointed out that people who are fat, red in the face, and who suffer from vertigo or fainting fits, should beware of suffering a stroke. The vertigo and fainting fits that he refers to are what we today call temporary ischemic attacks (TIAs), which are mini strokes that often precede a potentially fatal stroke (being obese and having a red face are characteristics of people who eat lots of meat and drink lots of alcohol: risk factors for stroke). He suggested that such individuals drink, for three to four days each month, a cup or two of tea made from some species of Potentilla (silverweed). As another example, he suggested that painters daily take one to two teaspoons of wormwood extract (boiled in wine, drunk rather hot), because this eliminates white lead. Obviously, this would not need to be done when painting jobs were not in progress.
Thus, the best way to use herbs is to take them daily over a period of several days to treat a disorder, or take them from time to time to alleviate an acute condition, but don't plan on taking one of them all the time. Let the fruits, vegetables, grains, and beans, carefully prepared and eaten in a relaxed atmosphere be your daily herbs and utilize the medicinals to assist in times of need. For general health purposes, herbal beverage teas can be used in rotation, getting the benefits of numerous herbs.
Aside from reminding readers of the suggestions in Chapter 4 about a healthy life style, there are only a few additional requirements to point to.
The most common adjunct to consumption of herbs to improve health is to use topical treatments. Künzle especially suggested medicinal baths, which could be made, for example, by putting fern root (Dryopteris filix) tea into the bath tub or into a foot bath (for gout and other foot pains). The club-moss (Lycopodium; not truly a moss) was suggested for the same applications, but especially for leg cramps, when applied by bath. Similarly, goutwort (Aegopodium podagaria) was suggested in hip baths, foot baths, and whole bath tubs for gout, sciatica, and arthralgia. As an alternative to bathing in a solution of the herb extract, one could apply an ointment or liniment with concentrated herb extract to the affected areas.
Today, topical application of herbs is often accomplished by using manufactured liniments, essential oils, and creams. For disorders of the limbs, topical applications greatly contribute to the efficacy of any herbal treatment and sometimes stand alone as therapies, especially for those who have sensitive stomachs and don't tolerate the herbs used for limb pains.
In addition to topical application of herbs, other treatments applied to the surface of the body may be of help. These include massage (perhaps with medicated oils) and application of heat and cold, as recommended by Father Kneipp's water treatments. Specific exercises might also be given; for example, to deal with constipation or organ prolapse, one might be directed to undertake a series of exercises to tone up the abdominal muscles.
Herbs have a reputation for being beneficial and lacking harm. For the most part, the gentle herbs included in over-the-counter herbal products fit that description well. Nonetheless, worries about the use of herbs arise from time to time. In particular there are the concerns of a mother for the well being of the fetus she carries or the nursing child and then the concerns, more often voiced by the chronically ill and the elderly, of combining herbs with the prescription drugs they have been given.
Throughout history, herbs have been used by women during pregnancy to treat related disorders and, at the time of delivery, to ease childbirth; afterwards they have been used to treat any complications from the delivery. Künzle said that every woman in childbed [after delivery] should drink as much as possible of the herb tea made of lady's mantle (Alchemilla vulgaris) to improve the flow of milk.
Today, with the knowledge that many substances can adversely affect the fetus and that some powerful drugs can be transferred via the breast milk, many women worry about the potential adverse effects of herbs at this sensitive time. The rule of thumb should be this: if herbs are not really necessary, don't use them and then don't worry. If they are needed, use them modestly and there should still be no need to worry. Keep the dosage on the low side, and use the herbs only as long as necessary. Check the literature for cautions about using herbs during pregnancy.
The concern about taking herbs during the time of breast feeding (which should be for many months, if not a year), appears to be exaggerated. Most healing herbs yield miniscule amounts of their constituents into the milk and thus the infant receives inconsequential doses. It is advisable to watch out for cases of skin rashes or diarrhea that might suggest an allergic sensitivity to tiny amounts, but such instances will be very rare.
As to the combination of herbs with drugs, there is little known about the interactions. The possibility for adverse consequences is a function of the dosage, and, therefore, persons who are concerned about possible interactions are advised, like the pregnant women, to use herbs in modest dosage. To minimize the potential for interactions, take the herbs and drugs at different times, at least an hour apart. That will not only separate them in the digestive system, but also likely keep the blood levels of each one from reaching their peak at the same time. Studies of herb-drug reactions reported in the medical literature indicate that they are rare and mostly involve one herb (St. John's Wort, an ingredient in some of the Künzle formulas sold today) and one drug group (anticoagulants, mainly Warfarin).
In Künzle's time, the issue of combining herbs and drugs didn't arise much. The usual procedure was different than what might arise today. A person would try herbs first, and, if they failed to provide adequate results, then the physician would be consulted for drugs or even surgery; or, modern medicine would be tried first, and if that failed, herbs would be resorted as the next attempt. Rather than mixing the two, they would be tried sequentially, with only a few exceptions.
As mentioned in the above section on duration of use, the modern situation has presented some unique concerns. Nowadays, people may undertake a drug therapy that has no known end in sight. At the same time, herbs may be desired to treat yet another condition or to attempt to provide additional relief for the same condition as addressed by the drug. It may even be hoped that after using both together for a while, the drug can be deleted. Therefore, the use of herbs and drugs together has become a common consideration. It was reported recently that American seniors (those 65 years of age or over) will typically receive 14 prescriptions for drugs each year.
With the rapid advances in medicine, as well as in nutrition, hygiene, and safety practices, resulting in longer life of the people, the probability of using drugs regularly will increase. And, with more people turning to herbs, this means that drugs and herbs will be routinely used together. If you suspect that an herb and a drug that you are taking are incompatible, cease taking the herbs. Otherwise, unless there are reliable warnings against the combinations, the moderate use of herbs taken at times different than the drugs should be considered the norm. In literature surveys of herb-drug interactions, the incidence rate of such events appears to be very low.