Āyurveda is a 5000-year-old all-encompassing system of medicine and philosophical guide to aligned living. It is both a system of curative medicine and preventative health through diet, lifestyle, rituals, ethical living, herbs and more. Ayurveda considers good health as far more than the absence of disease. To thrive with optimal health, we need to cast the net much wider.

How vibrant and alive do you really feel in the body, how calm and focused do you feel in the mind, how settled do you feel in your emotions and how nurtured do you feel from your social network and environments? All these elements contribute to our well-being.

Immunity is often only really considered during illness yett the immune system is constantly working in the background, maintaining health throughout life, bringing balance, homeostasis, healing wounds, and resisting invading pathogens. Immunity is the front-line defence of physical existence. 

In modern science, immunity refers to the system that protects the body from illness and infections that are caused by foreign invaders (pathogens), such as bacteria, viruses, fungi and toxins that cause disease in the body.

Bala, ojas and the three dimensions of strength
How the body responds to infectious conditions is deeply influenced by our underlying health or what is known as our bala (inner strength). Sage Vāgbhaṭa explains that bala sustains life, supports endurance, and determines resistance to disease, however the depletion leads to vulnerability (1). In Ayurveda, immunity is understood through three pillars of strength (bala):

• Hereditary (sahaja bala) — our innate immunity and strength we are born with
• Seasonal (kālaja bala) — immunity influenced seasons, stage of life, time
• Established (yuktikṛta bala) — acquired immunity developed through diet and lifestyle and self-care 

While we may not have total control over our encounters with infections or diseases, we have the power to navigate how our body responds. Through conscious choices in diet and lifestyle, we can build our immune resilience. This adaptive immune resilience is known as vyādhi-kṣhamatva’and it has two fundamental aims:  

• To maintain resistance to disease by building strength (bala)
• To enhance our capacity to adapt, recover and rebuild ojas after illness 

In other words, as mentioned in Charaka Saṃhitā scripture (2)Vyādhi-kṣamatva is both the art of preventing the onset of disease and of reducing disease severity once it has manifested. Immunity in Ayurveda is not merely about fighting disease, but about sustaining strong healthy body tissues from within that subsequently preserves vitality (ojas) (3) and supports long-term resilience (bala).

The purpose of immunity is to help us maintain balance in a world that is constantly changing. Today, immune challenges show up as infections, allergies, intolerances, autoimmune patterns, hormonal imbalance, and sensitivity to stress — all signs that the system is struggling to adapt.

Building strength (bala) and vitality (ojas) happens gradually over time and our task is to support our immunity through daily choices in diet, routine, rest, and how we relate to stress. When bala and ojas are strong, the immune system responds well, neither overreacting nor underperforming, but constantly adjusting to restore equilibrium.

From an Ayurvedic perspective immunity becomes compromised by a gradual wearing down of the body’s ability to adapt and self-regulate. The gradual loss of resilience reflects how well digestion (agni), doṣic balance and the body channels have been functioning over time. As these elements become strained, bala declines, and the formation of ojas is compromised. Some key factors that weaken immunity over time include:

• Improper diet, poor gut microbiome and ongoing digestive issues such as irregular or weak agni (visamāgni/mandagni) — disturbing how the body tissues get nourished.
• Nervous system dysregulation caused by excessive vāta, ongoing stress, negative mindset and emotions
• Lack of recovery time after an illness prevents the immunity from being fully recharged.
• Ongoing misalignment to daily and season rhythms including poor quality and lack of sleep, irregular eating patterns, lack of or excessive exertion.
• Excessive or prolonged cleansing or long-term stimulating / suppressive medications.

75–80% of immunity is formed in the gut, so it’s only as strong as agni (digestive fire). We are what we digest, and healthy ojas formation is the result of the healthy nourishment of the body tissues.

Through the Ayurvedic pathological lens immunity weakens when:

• Agni (digestive and metabolic fire) becomes impaired
• Āma (metabolic waste) accumulates
• Doṣas (vāta, pitta, kapha), the body’s functional intelligence becomes chronically aggravated
• Dhātus (tissues) are under-nourished, reducing ojas (the subtle essence of immunity and vitality)

Ayurveda aims to rebalance us at the root level. There are no short cuts to long-lasting wellness. The focus is to restore the doṣas to equilibrium, clear toxins from deep within and rebuild strength in every body tissue, rejuvenating the body at a cellular level.

The two-stage process of restoring mind-body-emotional balance.

1. Langhana – Lightening and cleansing therapies, including palliative measures and purification practices such as fasting, pañcakarma, to reduce excess, clear toxins and restore balance.
2. Rasāyana – Rejuvenation therapy focused on rebuilding strength in the tissues after cleansing. This includes supportive ahāra and vihara – wholesome diet, proper daily routines, good conduct and medicines when necessary.

Ayurvedic immune support through rasāyana

Rasāyana (rejuvenation therapy) focuses on protecting and rebuilding ojas. Through supportive diet, lifestyle adjustments, and targeted tonics, rasāyana helps restore strength, resilience, and long-term wellbeing, especially during periods of depletion or vulnerability.

In Ayurveda, herbs and home remedies are selected according to their energetic qualities — taste (rasa), potency (vīrya), action, and post-digestive effect (vipāka) — and the way they influence the doṣas, body tissues, channels, senses, and mind. This is the same principle applied to food, reinforcing the Ayurvedic view that food itself is medicine.

Immune-supportive herbs are traditionally used to build yuktikṛta bala, support digestion, clear metabolic waste, and nourish ojas. Classical formulations such as the Ayurvedic elixir Chyawanprāsha is valued for its holistic rejuvenating qualities.  Sitopalādi, Tālisādi are valued for their respiratory-supporting qualities. Single herbs such as tulsi (Ocimum sanctum), guduchi (Tinospora cordifolia), amalakī (Emblica officinalis), turmeric (Curcuma longa), garlic (Allium sativum), ginger (Zingiber officinale), shatavari (Asparagus racemosus), and ashwagandha (Withania somnifera) are commonly used to support resilience, digestion, vitality, and stress adaptation.

How herbs are taken is equally imperative. Traditional carriers (anupāna) such as milk, ghee, water and honey help guide the action and absorption of herbs to specific tissues. Rasāyana herbs are always personalised and used consciously, since herbal remedies work gently with a cumulative and nourishing approach to immune health as opposed to the quick fixes, we have become accustomed to. 

Actively cultivating yuktikṛta bala, begins with the first pillar of life in Ayurveda: satmya āhāra, a diet that is suitable for one’s constitution, digestive capacity, and current state of balance.

The body is shaped by what we are able to digest and assimilate making seasonal, local, whole foods the most supportive. Home-cooked, freshly prepared warm meals and slower cooking methods are becoming rare, yet they are the foundations for digestive and immune health. Our modern pace and reliance on processed foods weaken digestion (agni), contributing to rising food intolerances and gut imbalance. Stale, leftover, and heavily processed foods contain little vital energy (prāna) and do not support the formation of ojas.

Meals such as soups, stews, and gently spiced dishes provide grounding, easily absorbed nourishment for our immunity. A balanced immune-supporting diet may include wholesome grains and legumes, eggs or ethically sourced meats where appropriate, seasonal fruits and vegetables, nuts and seeds, and healthy fats such as ghee.

The connection between digestive health and immune resilience makes prebiotics and probiotics a vital part of the dietary mix. Traditional foods such as takra (spiced buttermilk) and fermented vegetables help support gut flora.

Eating consciously, in appropriate portions, and avoiding excess are just as important as food quality. Diets rich in vitamin C, zinc, healing spices, and warming teas gently kindle agni and support long-term resilience.

Building strength (bala)

Certain foods are traditionally known to build strength and resilience (rasāyana), including milk, ghee, green gram, figs, dates, and almonds. These are best supported with digestive spices and ingredients such as ginger, cumin, lemon, takra, and fresh seasonal fruits.

Movement, rest, and rhythm

Balanced exercise (vyayāma) is key to maintaining and build strength (bala), yet ensuring ojas is not depleted. Too little movement can lead to stagnation; excess can deplete strength. Regular conscious movement such as walking, yoga, strength training, massage, or breath-led practices support immunity, lymphatic flow, and the movement of prāna (life force energy). Just like the ebb and flow of life, it is equally important knowing when to rest and recover. 

Mind, breath, and emotional balance

Ayurvedic wellness is complete only when the mind, senses and emotions are cared for alongside the body. Chronic stress, mental overload, and emotional strain can erode bala. Practices such as conscious breathing, meditation, mudras, mantras, prayer, time in nature, and grounding routines help regulate the nervous system and restore balance. Traditional therapies like shiro-abhyanga (head massage) and shirodhāra (oil pouring on the 3^rd eye), along with medhya rasāyana, further support mental clarity and resilience when needed.

1. Vāgbhaṭa. Aṣṭāṅga Hṛdaya. Sūtrasthāna 11.1–2. Translated by Murthy KRS. Varanasi, India: Chowkhamba Krishnadas Academy; 2008.
2. Agniveśa, Charaka. Charaka Saṃhitā. Sūtrasthāna, Chapter 28, verse 7. In: Sharma RK, Dash B, trans. Charaka Saṃhitā (Text with English Translation). Vol 1. Varanasi, India: Chowkhamba Sanskrit Series Office; 2014.
3. Agniveśa, Charaka. Charaka Saṃhitā. Sūtrasthāna, Chapter 28, verse 7. In: Sharma RK, Dash B, trans. Charaka Saṃhitā (Text with English Translation). Vol 1. Varanasi, India: Chowkhamba Sanskrit Series Office; 2014.

The health of the body and the presence or absence of inflammation is dependent on the health and proper functioning of all systems and organs. Just because a knee joint is swollen and sore doesn’t mean that the knee joint can be treated alone. Any malfunctioning body systems or organs will also need to be treated and returned to health to treat the knee. This is always more obvious when there is inflammation throughout the body, such as in fibromyalgia or rheumatoid arthritis, but it applies to almost all chronic inflammatory processes.

The immune system is the key to inflammation, but it doesn’t work alone; it requires all body systems to play their role well in a complex interconnecting dance that will maintain a harmony of health when it functions as it should. A strong immune system will maintain a healthy body.

The gut plays a vital part in immune system homeostasis, as most immune cells are in the gut. If the gut is not healthy, the immune system won’t be healthy, and there will be chronic inflammation to one extent or another. This is something that the older traditional medicine systems knew, and those who practise herbal medicine today also know. The health of the body begins in the gut (1).

In most cases of chronic inflammation, the initial problem begins in the gut, generally with the diet. Either too many inflammatory foods such as sugar, trans fats or refined grains are present, or foods are eaten to which there is an intolerance, most commonly dairy or wheat.

The immune system can be seen as the housekeeping system of the body. It protects us from pathogenic organisms and removes or isolates dead or malignant body cells and foreign bodies.

Innate or non-specific immunity is the immunity we were born with and refers to the general protective function of the immune system. It includes the barrier functions of the skin and internal mucous membranes in the mouth, digestive system, lungs and urinary system. It also includes tears in the eye and ear wax.

Macrophages are also part of the innate immune system, and they can eat or phagocytose foreign particles to render them harmless. Fever is an innate immune response that creates a hostile environment for an invading microorganism and stimulates the immune response.

Adaptive or specific immunity develops over time in response to exposure to various antigens. It involves lymphocytes B cells and T cells – which produce specific antibodies against the invader (B lymphocytes) and has various cytotoxic mechanisms (T lymphocytes) to clear up dead or compromised tissue cells. These cells also have an ability to remember earlier invasions which means that future attacks are more efficiently dealt with.

A healthy immune system will recognise which cells it needs to attack and recognise healthy self-tissue. But if it is under too much pressure, for example, chronic inflammation, this is when the immune system can turn on the host body, attacking self cells and creating autoimmune disease.

Removal of dysfunctional, dead and dying tissue cells is also part of autophagy (literally, self-eating). This process can be seen as a spring clean of the body and may be important in protection from cancer (2)  and also involves both specific and non-specific immunity and can be made more efficient by exercise and fasting with the overall effect of cell regeneration and recycling cellular nutrients (3).

The process of autophagy has been shown to be optimised by a diet low in refined starch and sugar and high in omega-3 fatty acids (4,5).

Herbs and nutrition directly affect the immune system, but all body systems are vital here, so any attempt to improve the health of the immune system must also look at the whole. Emotional health also affects the immune system, hence the field of psychoneuroimmunology. Stress or social isolation will weaken immune function, whereas a relaxed nervous system creates a strong immune system. This connection has been demonstrated many times in studies (6,7,8).

Lack of sleep is strongly linked with a weak immune system and a much-increased risk of cancer. A study involving sleep restriction in healthy young men where sleep was only allowed between ten in the evening and three in the morning resulted in a seventy per cent reduction of natural killer cells plus reduced cellular immune response – both vital in a normal immune system which amongst other things also protects us from cancer.

After one night of recovery sleep, only part of the immune system returned to normal – the conclusion was that even a modest disturbance of sleep reduces the natural immune response (9).

A good and varied diet is important for a healthy immune system. Particularly important vitamins and minerals include vitamins D and C and zinc and selenium. Good sources of vitamin C include most fresh fruit and vegetables; vitamin D is best obtained from sunlight exposure or a supplement. Food sources of vitamin D include oily fish, mushrooms and eggs. Zinc is found in red meat, shellfish, legumes, nuts and seeds. Selenium is found in brazil nuts, fish, poultry and sunflower seeds.

The gut microbiome needs to be healthy for a strong immune system, so fermented foods such as sauerkraut or kefir are helpful. These must be unpasteurized so that the beneficial bacteria are still present.

Short term fasting will have a stimulant effect on the immune system, just as will raising the body’s temperature in a sauna or steam room. This type of stimulation is useful when an immediate effect is needed for an acute situation.

Herbs that affect the immune system can be subdivided into immune modulators or tonics – these are slower acting and can be used long term to improve immune function in those with chronic infection, autoimmune disease or lowered immunity; and herbal antimicrobials that practically attack and kill invading microorganisms.

Immune modulating herbs include echinacea (Echinacea purpurea and E. angustifolia), astragalus (Astragalus membranaceus), marigold (Calendula officinalis), wild indigo (Baptisia tinctoria), Siberian ginseng (Eleutherococcus senticosus), ginseng (Panax ginseng), ashwagandha (Withania somnifera), and all the medicinal fungi including (Trametes versicolour) and reishi (Ganoderma lucidum). Many immune-modulating herbs are also adaptogens, so they will support the endocrine and nervous systems, supporting immunity.

A herb that strengthens connective tissue, hence reinforcing the immune system’s barrier function, is horsetail (Equisetum arvense); this plant contains very high amounts of silicic acid or silica, which is water-soluble and required by all connective tissue (10).

Lymphatic herbs may also have a role to play in promoting autophagy. These might include cleavers (Galium aparine), heartsease (Viola tricolour), and figwort (Scrophularia nodosa).

Herbal antimicrobials include garlic (Allium sativum), thyme (Thymus spp), oregano (Origanum majorana), sage (Salvia officinalis) and walnut (Juglans nigra).

The digestive tract’s general health depends on the health of the gut, its microbiome, and the liver. Any treatment of inflammation anywhere in the body requires that the gut and the liver are healthy and functioning well.

There is a three-way interaction between the microbiome present in the digestive system, bile acids produced by the liver, and the immune system, which results in an inflammatory response, healthy or otherwise.

Bile acids are the main component of bile, produced by the liver and secreted into the small intestine via the gallbladder, where its main function is to digest fats and oils from the diet. However, they also have an important role in the inflammatory process.

After bile acids have processed fats, they travel down the digestive tract, where they are modified into immune regulating molecules by gut bacteria. One type of immune regulating molecule will activate effector helper T cells (Th17) which are pro-inflammatory. For example, when an infection needs dealing with, another type activates regulatory T cells (Tregs) that are anti-inflammatory and necessary when the infecting pathogen has been killed. These should balance each other out to maintain good intestinal health.

Low levels of Tregs have been seen in those with inflammatory bowel disease and are linked with low bile acids (11).

Cholestasis is where there is a decrease in bile flow and is associated with impaired immunity and ability to fight infection and increased inflammation. (12)

Improving the liver’s health will improve bile acid function, and most people will benefit from improving liver health.

Remove anything causing harm to the liver, such as alcohol or toxic chemicals. Medication may also be causing a problem, and if it cannot be removed, then work with diet to ameliorate the problem as much as possible.

Diet should be organically grown foods as much as possible in order to ensure minimal chemical residues. The Pesticide Action Network UK’s website an idea of how many pesticides and herbicides are used on many types of fruit and vegetables; therefore, it is possible to decide which foods should be bought as organic.

Some foods are good at supporting the liver; these include lemon and lime; bitter salad leaves such as dandelion, chicory and endive; dark green leafy vegetables, particularly the brassica family; olive oil and olives. Coffee is also a useful liver herb, if not overindulged.

The hepatic herbs for the liver need to be chosen carefully to support whatever is going on. If someone has an overactive, hot liver and is given liver stimulant herbs, they will become hot, flushed and emotional.

These people need calming and cooling liver tonics such as agrimony (Agrimonia eupatoria), burdock (Arctium lappa), chamomile (Matricaria chamomilla), dandelion (Taraxacum officinale), vervain (Verbena officinalis) or yarrow (Achillea millefolium). And those with a cold, stagnant liver need the more stimulating liver herbs such as angelica (Angelica archangelica), artichoke (Cynara scolymus), barberry (Berberis vulgaris), marigold (Calendula officinalis), milk thistle (Silybum marianum), or yellow dock (Rumex crispus).

The gut wall lining from mouth to anus is made up of many layers. The inner layer is the mucosa, in which there are mucous secreting cells and epithelial cells. This lining is permeable but very selectively, allowing only a few small molecules to pass through once digested and made safe to enter the bloodstream. The body secretes a protein called zonulin which increases intestinal permeability because sometimes this is required, but this is a controlled and immediately reversible permeability. But zonulin is also secreted when there is inflammation in the gut from food sensitivities, diet, infections, etc.

When this wall is subjected to prolonged inflammatory damage, the tight junctions between cells can widen, allowing larger molecules to pass through, creating more inflammation due to the activation of the immune system and more food sensitivities. So food sensitivities are a cause of, and a result of, increased intestinal permeability.

The increased intestinal permeability is termed leaky gut and is a major player in chronic inflammation and may also be a key process in the development of autoimmune diseases (13).

When the gut lining becomes less efficient and the digestive secretions of the stomach decrease due to poor health or ageing, the ability of the digestive tract to digest food and obtain nutrients will decrease. In this case, symptoms such as bloating, reflux, gas and feelings of fullness will appear, and food intolerances start to increase. These symptoms may also be due to eating the wrong foods. Still, they often indicate that digestive capability has been compromised, which, in turn, will impact the microbiome, the liver, and nutrient availability for the immune system. All of these have an impact on overall inflammation in the body.

Bacterial endotoxin is a lipopolysaccharide LPS found in the cell walls of gram-negative bacteria, which are found in large numbers in the gut, the gums, and other tissue when there is bacterial infection or dysbiosis. When they remain in the intestines, they don’t cause a problem, but when the bacteria die off and there is a degree of gut leakiness, then the released LPS can move through the intestinal wall and into the bloodstream, where they will initiate inflammation. Evidence shows that this process is important in the development of inflammation linked with obesity and diabetes and may be a major cause overall of chronic inflammation (14) and of brain microglial activation, which promotes neurodegeneration of the brain (15).

A diet high in trans fats or constant snacking can also cause a dysbiosis that increases LPS production (16), and a diet high in fructose causes LPS-induced inflammation (17).17 It has been shown that celery (Apium graveolens) contains aglycones which show potent inhibitory activity against LPS-induced nitric oxide production in macrophages.

Cardamom significantly decreases the secretion of inflammatory mediators secreted by lipopolysaccharide-stimulated macrophages.

Leaky gut and digestive ability are closely linked; once the correct diet for the individual has been found, the rest will follow. Healing a leaky gut must commence with a good diet with no inflammatory foods.

Removing processed foods and replacing them with healthy food can turn around an inflamed digestive system within a couple of months. Bone broths, when long-cooked, release collagen peptides that support the repair of the intestinal wall. Gum acacia is another supplement that appears to be able to heal damaged tissue, possibly by supporting that part of the microbiome that improves tight junctions in the intestinal lining (20). Herbs can help repair the gut wall, and those containing mucilaginous polysaccharides such as Aloe vera (Aloe barbadensis), marshmallow root (Althaea officinalis), and slippery elm (Ulmus fulva), and also many seaweeds are often used to improve mucosal health.

These herbs are easiest to take as powders in tablespoonful doses and can be mixed with stewed apples (peel and all), which contain large amounts of pectin, which is also a good gut healer.

Marigold (Calendula officinalis) and plantain (Plantago spp.) are both inflammation-mediating herbs excellent at wound healing. Simmering the dried or fresh herbs for 20–30 minutes makes a strong decoction. Ideally, this would be drunk on an empty stomach after at least a 12 hour fast. Make it the night before and drink the next morning. A dose of a handful of the dried herb in about 250ml of water daily would be fine.

Improving digestive function requires the involvement of bitter herbs and aromatic digestive herbs. These should be chosen to suit the person, making distinctions between warming and cooling bitters (see liver herbs above).

Most culinary herbs and spices such as black pepper, mustard, ginger, coriander and cumin will help digestion and can be taken before eating, with food or afterwards if needed.

If these are not enough, bitter herbs can be used, ideally before a meal but also useful afterwards. I have a formula for a digestive bitters tonic, which has been the most popular formula I have ever made, and hundreds of people have found it useful. The mix contains warming and cooling bitter herbs and aromatic herbs, which together really help digestion:

• 3 parts artichoke (Cynara scolymus)
• 2 parts (Angelica archangelica)
• 2 parts blessed thistle (Carbenia benedicta)
• 1 part fennel seed (Foeniculum vulgare)
• 1 part gentian (Gentiana lutea)
• 1 part bitter orange peel (Citrus aurantium fr.)
• 1 part ginger (Zingiber officinale)
• 1 part centaury (Centaurium erythraea)

Take anything from twenty drops to a teaspoonful of tincture in a bit of water as needed.

The combination works best as a tincture as it becomes quite unpleasant as tea. As a tincture, it is pleasant to take if a little bitter to those who are not used to bitter tastes. Everyone gets used to it after a few days.

The human body is an ecosystem, part of which includes a vast number of different microbial organisms which play a vital role in the proper function of our bodies. The role of the gut microbiome is well recognised in the inflammatory process, and the inflammatory process has been shown to have deleterious effects on the microbiome (21).

It has also been well recognised that pre-industrial peoples have a similar microbiome wherever they live in the world. Those living in industrialised areas have a very different, less healthy microbiome due to three main reasons: the presence of antibiotics, a diet of processed food, and a much more sanitised environment.

However, there is no such thing as a “normal” microbiome; it is always individual, so testing to determine a microbiome to see if it is “healthy” is not that useful. A microbiome will contain not only bacteria but also viruses, fungi and parasites, and its makeup will be affected by everything from conception onwards. It is considered that the most influence comes from the first one thousand days of life, including time in utero. However, it can be improved and repaired at all stages of life.

One hundred years ago, the killer diseases worldwide were pneumonia, tuberculosis and infectious gut diseases. Nowadays, these have been supplanted in the richer, western world by the killer inflammatory diseases – cardiovascular disease, cancer and diabetes. So as a population, we have learned how to manage bacteria but overmanaged them so that we killed all micro-organisms, beneficial and pathogenic, without the understanding that we actually needed the beneficial ones

For example, a study has shown that the presence of a bacterium Blautia obeum in the gut can protect against cholera by a number of different mechanisms, including its interaction with bile salts. The study found that B. obeum was prevalent in the microbiome of people studied in Bangladesh. Those from Bangladesh had a much more diverse microbiome than a similar number of people from the USA (22).

The functions of these beneficial microbiotas are numerous and very important to our health. Our understanding of the functions and health of the microbiota has only really developed in recent years, and more and more connections have been drawn between this new industrial microbiota and chronic inflammatory diseases. We still don’t know the full story yet, but it is developing (23).

There is evidence that dysbiosis weakens the immune defences “thereby predisposing to more severe SARSCoV-2 infection and contributing to ‘long COVID.’” (24).

The factor with the most effect on the microbiome is diet, and we need a good variety of foods to feed a large variety of microorganisms. The average modern western diet contains a tiny variety of different plant foods, in some cases less than ten. In contrast, the diet of older generations may well have contained at least one hundred different plant foods.

It is now understood that if we eat at least thirty different plant foods in a week, we will have a much healthier microbiome than if we only ate ten different ones. It’s actually not that difficult to eat such a variety, as plant foods include all grains, nuts, seeds, fruit and vegetables.

One important change in diet from the less developed to the developed world was the reduction of both soluble and insoluble plant fibre based complex carbohydrates found in plants such as legumes, whole grains and vegetables. These were replaced by simple carbohydrates, the refined and processed grains and sugar that make up the modern diet, which is much less useful to the microbiome and shown to have altered its structure and function, resulting in dysbiosis (defined as unnatural changes in the composition of the microbiome) and leading to chronic inflammatory disease.

Stress can also have a significant impact on the microbiome this can be physical or mental stress and can include overworking, sleep deprivation, pollution, local climate change and lack of exercise. Social interaction and physical activity also have an impact on gut and body health (25).

There are several ways to improve the microbiome, but it is most important first to improve the gut’s health, i.e. improve the terrain. If there is a leaky gut, then this needs dealing with first.

The bacteria in the gut microbiome need prebiotics to feed on for their health. The breakdown products of this digestion are short-chain fatty acids released into the blood circulation, which have beneficial effects on the whole body (26).

They are a particular kind of dietary fibre that the gut microbiota selectively uses and are vital to the microbiome’s health. Good prebiotic fibre containing foods include Jerusalem artichokes, apples, bananas, asparagus, leeks, onions, oats, barley, and linseeds. Acacia gum and slippery elm (Ulmus fulva) are also excellent prebiotic sources.

Probiotics, the bacteria that can support the microbiome and be ingested in capsules or drinks, are useful but are only temporary residents of the gut and only serve a purpose while they are being taken. In order to encourage the microbiome to flourish, the terrain needs to be right, so prebiotics, a healthy diet and a healthy gut wall are most important.

Garlic (Allium sativum) is useful as it is a prebiotic and antimicrobial to pathogenic microorganisms. Fermented foods and drinks such as sauerkraut, kimchi, kombucha and kefir are most useful here too, and as they are food and drink can be taken daily at a much lower cost than probiotic supplements. However, if these are purchased rather than homemade, it is important that they are unpasteurized so that the beneficial bacteria are still present. Eating avocados also seems to support healthy gut flora.

The nervous system comprises two main parts, the central nervous system, which includes the brain and spinal cord, and the peripheral nervous system, which includes nerves branching off from the spinal cord and extending to all parts of the body.

These nerves carry messages or information in their nerve cells or neurons between the brain and the body, which control every action.

There is a strong bi-directional connection between the brain and the gut via the cranial and the vagus nerves and the entire peripheral nervous system. So anything that affects the gut will affect the brain and vice versa. When there is an inflammatory state in the gut, it will affect the brain – this is apparent in patients with inflammatory bowel diseases such as coeliac disease, where there is also a high incidence of brain inflammation visible on an MRI scan (27).

Or, if the gut is on fire, then the brain will also be on fire.

The action of the vagus nerve is very linked with inflammatory states in the body. The vagus nerve, so-called because it wanders through the body like a vagabond – originates in the brain, travels down the neck, through the chest, to the abdomen creating an interconnected network between the brain, digestive system, lungs, heart, liver and kidneys.

Its principal function is to send messages to the brain from the organs, so the brain is aware of how they are functioning. The vagus is also able to assess immune function too.

The vagus nerve controls the parasympathetic nervous system – so it is vital in winding down from any sympathetic nervous system activity. The sympathetic nervous system is activated by increased cortisol in the fight or flight response created by a stressful situation.

Keeping this balance between parasympathetic and sympathetic is vital for health. It was a matter of life or death to have that sympathetic response when we were out hunting or being hunted back in the stone age. Still, those who don’t deal well with stress and anxiety find themselves in the sympathetic mode more or less constantly and unable to revert to relax mode, which is parasympathetic dominance.

The sympathetic response releases hormones such as adrenalin and cortisol, resulting in a raised heart rate, tense muscles (ready to run), sweating, slowed digestion and a feeling of increased energy due to gluconeogenesis (the generation of new glucose by the liver). It also releases the hormone renin from the kidneys, increasing blood pressure and metabolism.

Understanding the stress response is simple if we consider the domestic cat – they are masters of relaxation (parasympathetic dominance). Still, when necessary, they can spring into fast action to hunt or to run from a dog (sympathetic dominance) and then straight back to sleep again afterwards as though nothing had happened.

Generally, the parasympathetic response is anti-inflammatory, and the sympathetic response is pro-inflammatory, especially if out of control. So chronic stress is a major cause of inflammation.

Stress results in the release of inflammatory cytokines through the effect on sympathetic and parasympathetic nervous system pathways. These cytokines have been found to interact with neurotransmitter metabolism and neuroendocrine function. Poor sleep results in lowered vagal tone, increased inflammation, and inflammation results in poor sleep.

Pro-inflammatory cytokines IL-6 and TNF alpha daytime secretion are increased in insomniacs which causes more inflammation and contributes to the chronic inflammatory diseases so common today – type two diabetes, cancer, osteoarthritis and cardiovascular disease.

Improving vagal tone will help the body to relax better after any stress. There are several methods of improving the tone, and the results will reduce inflammation. These need doing long term and daily for several weeks to get results:

• Cold exposure will activate the vagus nerve, and regular cold exposure can lower the sympathetic response and increase parasympathetic activity via the vagus nerve: cold showers, or at least cold face wash.
• Deep and slow breathing activates the vagus nerve, reduces anxiety and increases parasympathetic response. Aim at six breaths a minute as diaphragmatic breathing with the expansion of the stomach.
• Singing, humming, chanting, and gargling activate the throat muscles and stimulate the vagus nerve.
• Probiotics – healthy gut bacteria improve brain function by affecting the vagus nerve.
• Meditation – can increase vagal tone.
• Eye exercises – without moving the head facing forward, look to the right for one minute, then to the centre, then left for one minute, breathing slowly as you do it. This exercise can be done sitting or lying down (28).
• Omega-3 fatty acids – increase vagal tone and vagal activity. For example, oily fish, flaxseed oil, and walnuts.
• Exercise – stimulates the vagus nerve.
• Massage can stimulate the vagus nerve – also reflexology and the Bowen technique.
• Socialising and laughing stimulate the vagus – and stimulating the vagus often causes laughter.

Anything that causes inflammation in the gut will affect the brain, so in order to protect the brain and nervous system, it is vital to follow an anti-inflammatory diet. There are suggestions that non-coeliac gluten sensitivity may be of prime importance here, but all pro-inflammatory foods should be avoided (29).

Plastics, in particular the plasticisers bisphenol A BPA, and bisphenol S BPS, are also implicated in causing inflammatory damage to nerve cells, so avoiding all plastic wraps and bottles is a good move (30).

Herbs to improve nervous system health will be nervine tonics, nervine relaxants and adaptogens. Many of these double up as inflammation mediating herbs, and notable herbs which do this are chamomile (Matricaria recutita), lemon balm (Melissa officinalis), linden flower (Tilia europaea), St John’s wort (Hypericum perforatum), skullcap (Scutellaria lateriflora), ashwagandha (Withania somnifera), rose root (Rhodiola rosea) and schisandra (Schisandra chinensis).

Endothelial cell health is another important factor in the inflammatory process.

Endothelial cells form the lining of all blood and lymph vessels in the body. They are there to act as a barrier between blood and lymph and the rest of the body tissues. They are also selectively permeable to some chemicals to move into body tissues and permeable to carbon dioxide to move into the bloodstream from tissues. This permeability is a very important function that, among many other things, maintains the blood-brain barrier, which protects the brain from toxic chemicals.

Another main function of endothelial cells is maintaining the elasticity of blood vessels to allow them to constrict and dilate – vasoconstriction and vasodilation in order to control blood flow and blood pressure. Endothelial cells synthesise nitric oxide (NO), which acts as a vasodilator, and also catecholamines which act as vasoconstrictors.

Reduced NO production and/or bioavailability is considered the central mechanism responsible for endothelial dysfunction (31). NO also acts as an anticoagulant to prevent anything from sticking to the endothelial cell wall.

The endothelium also has a role to play in wound healing – controlling platelet aggregation and a clotting factor to prevent further bleeding, but also they are involved in fibrinolysis, which dissolves clots and prevents thrombosis.

If there is a chronic inflammatory process, then damage to the endothelium will result in a loss of elasticity, resulting in poor vasodilation, which results in hypertension; it also results in increased coagulation incidences as it tries to heal itself. This process results in thrombosis, heart and kidney disease, neurological disease and pulmonary disease. Insulin resistance and diabetes are inflammatory and will also damage the endothelium, hence the link between diabetes and cardiovascular disease. With age, diabetes, hypertension, smoking, and inactivity, endothelial cells lose function.

A recent study looking at mRNA COVID vaccines concluded that the mRNA vaccines dramatically increase inflammation on the endothelium and T cell infiltration of cardiac muscle and may account for the observations of increased thrombosis, cardiomyopathy, and other vascular events following vaccination (31).

• Avoid smoking, inactivity, obesity, sugar and refined carbohydrates.
• Eat more plants, especially whole grains, nuts and seeds, herb teas, green tea, cocoa, and dark chocolate, which all increase endothelial nitric oxide, one of the most helpful ways of supporting the endothelium.
• Spices improve endothelial function – turmeric, ginger, cinnamon and black pepper. Foods to improve microcirculation include chocolate, berries, garlic, beetroot and green tea.

Often the heroic methods of modern medicine – the surgery and medications – are required when heart disease becomes severe, but in the earlier stages, or when things are stabilised, there are plenty of herbal interventions that can help.

The main mechanisms of action of the most commonly used hypertension medications are calcium channel blockade, beta-adrenergic blockade and angiotensin-converting enzyme inhibition. Herbs have been shown to act by all of these mechanisms as well.

Herbs that will support endothelial function include ginkgo (Ginkgo biloba), hawthorn (Crataegus oxyacantha), red sage (Salvia miltiorrhiza), rose hips (Rosa canina), reishi (Ganoderma lucidum), ginger (Zingiber officinale). Gentian (Gentiana lutea) has been shown to prevent endothelial inflammation (32).

1. G.Vighi et al. “Allergy and the gastrointestinal system.” Clinical and experimental immunology vol. 153 Suppl
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3. P.Kuballa et al.Autophagy and the immune system. Annu Rev Immunol. 2012;30:611-46.
4. L.Shen et al. “Dietary PUFAs attenuate NLRP3 inflammasome activation via enhancing macrophage autophagy.” Journal of lipid research vol. 58,9 (2017): 1808-1821.
5. J. Bland The long haul of COVID-19 recovery: immune rejuvenation versus immune support. IHCAN April 21
6. Abdurachman,et al. “The role of psychological well-being in boosting immune response: an optimal effort for tackling infection.” African journal of infectious diseases vol. 12,1 Suppl 54-61. 7 Mar. 2018
7. Y. Barak The Immune system and happiness Autoimmunity reviews Vol 5, 8, Oct 2006 pp 523–527.
8. S. Brod et al ‘As above, so below’ examining the interplay between emotion and the immune system Immunology. June 2014.
9. M. Irwin et al. Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. FASEB J. 1996 Apr;10(5):643–53.
10. L.M. Jurkić, et al. Biological and therapeutic effects of ortho-silicic acid and some ortho-silicic acid-releasing compounds: New perspectives for therapy. Nutr Metab (Lond) 10, 2 (2013).
11. Harvard Medical School. “Bile acids may help regulate gut immunity and inflammation.” ScienceDaily. www.sciencedaily.com/ releases/2020/01/200103141047.htm accessed 3/12/20.
12. M.Wammers et al. “Reprogramming of proinflammatory human macrophages to an antiinflammatory phenotype by bile acids.” Scientific reports vol. 8,1 255. 10 Jan. 2018
13. Q.Mu et al. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol. 2017 May 23;8:598.
14. P.D.Cani, et al Metabolic endotoxemia initiates obesity and insulin resistance. Diabetes. 2007 Jul;56(7):1761-72.
15. G.C. Brown The endotoxin hypothesis of neurodegeneration. J Neuroinflammation 16, 180 (2019).
16. C. Franceschi, et al. Inflammaging: a new immune–metabolic viewpoint for age-related diseases. Nat Rev Endocrinol 14, 576–590 (2018).
17. N.Jones et al. Fructose reprogrammes glutamine-dependent oxidative metabolism to support LPS-induced inflammation. Nat Commun 12, 1209 (2021).
18. L H Zhu et al, Constituents from Apium graveolens and their anti-inflammatory effects. J Asian Nat Prod Res. 2017 Nov;19(11):1079-1086.
19. M.Souissi et al. Antibacterial and anti-inflammatory activities of cardamom (Elettaria cardamomum) extracts: Potential therapeutic benefits for periodontal infections. Anaerobe. 2020 Feb;61:102089.
20. J.C.Clemente et al. The role of the gut microbiome in systemic inflammatory disease. BMJ 2018;360:j5145.
21. S.Alavi, et al. Interpersonal Gut Microbiome Variation Drives Susceptibility and Resistance to Cholera 22)
22. Infection. Cell. 2020. 22Vulnerability of the industrialised microbiota https://science.sciencemag.org/content/366/6464/eaaw9255/tab-pdf.
23. Gut Microbiota May Influence COVID-19 Severity, Immune Response – Medscape – Jan 11, 2021.
24. Stefani Lobionda, et al. “The Role of Gut Microbiota in Intestinal Inflammation with Respect to Diet and Extrinsic Stressors.” Microorganisms vol. 7,8 271. 19 Aug. 2019
25. Davani-Davari, Dorna et al. “Prebiotics: Definition, Types, Sources, Mechanisms, and Clinical Applications.” Foods (Basel, Switzerland) vol. 8,3 92. 9 Mar. 2019.
26. I.D. Croall et al. Cognitive Deficit and White Matter Changes in Persons With Celiac Disease: A Population-Based Study, Gastroenterology, Volume 158, Issue 8, 2020, Pages 2112-2122.
27. Rosenberg, Stanley (2017) Accessing the Healing Power of the Vagus Nerve.
28. Vasefi, Maryam et al. “Diet Associated with Inflammation and Alzheimer’s Disease.” Journal of Alzheimer’s disease reports vol. 3,1 299-309. 16 Nov. 2019
29. E. Schirmer,et al. Bisphenols exert detrimental effects on neuronal signaling in mature vertebrate brains. Commun Biol 4, 465 (2021).
30. Endothelium and cardiovascular diseases: vascular biology and clinical syndromes. Editors Protasio L. et al 2018.
31. Steven R Gundry, Correction to: Abstract 10712: Mrna COVID Vaccines Dramatically Increase Endothelial Inflammatory Markers and ACS Risk as Measured by the PULS Cardiac Test: a Warning, Circulation, 8 Nov 2021 2021;144:A10712
32. R.Kesavan et al.Gentiana lutea exerts antiatherosclerotic effects by preventing endothelial inflammation and smooth muscle cell migration. Nutr Metab Cardiovasc Dis. 2016 Apr;26(4):293-301.

Chaga (Inonotus obliquus) is a black, parasitic mushroom, which looks on the outside like a lump of burnt, craggy charcoal; it belongs to the Hymenochaetacea family of fungi. The genus Inonotus is widespread is widespread in North America, Asia and Europe and comprises around 100 species, represented in Europe by four species, one of which is Inonotus obliquus.

The term ‘chaga’ most probably derives from Russian; chaga is also known as birch conk (a woody growth), clinker polypore, cinder conk and black mass, and may usually be found on the boles of birch trees, (1) though occasionally on other trees: on alder, ash, beech, chestnut, hornbeam, plane-tree, poplar, maple, rowan, oak, walnut, and willow. However, reports on the growth of chaga on trees besides beech are often unreliable as the fungus growing on the other kinds of tree are similar and often confused with chaga. (2)

Chaga grows externally on the bark of the host tree, be it living, dead, standing or fallen. Under the black surface, the chaga mycelium is an orange/brown colour. It causes the decomposition of live boles and usually grows to around between 25-40 centimetres; it dries to a consistency similar to that of hard cork. Chaga usually infects trees that are 30-40 years old through wounds in the bark and can continue to grow on the bole for another 30-80 years. On old trees the growth of chaga can exceed 50 cm in diameter. (3)

Low in calories, high in fibre, and rich in minerals and vitamins, chaga has been used as a traditional medicine in various cultures since time immemorial, particularly in Russia, China, Poland (4) and the Baltic countries. It is also used for food in China. (5) Chaga is used to treat diabetes, parasites, tuberculosis, inflammation, gastro-intestinal problems, heart disease and several kinds of cancer. (6)

Perhaps the oldest reference to the use of chaga as a medicine is by Hippocrates (c. 460–370 BCE) in his Corpus Hippocraticum, in which is described the use of infusions of chaga to wash wounds. (7)

For medicinal treatments chaga is usually ground to a fine powder and made into a tea, which tastes like mushrooms. It is also available in capsule form as a supplement, sometimes in combination with other mushrooms, such as cordyceps.

However, many commercial products are simply unprocessed powdered chaga without having been extracted. This means the active compounds are not bioavailable and so one must be careful when buying a product that the quality is good and that the preparation process is clearly explained if it is simply a powder and not an extract.

The chaga mushroom has been the subject of many scientific investigations to explore its medicinal properties, particularly by researchers in South Korea. (8) Chaga has been shown to be effective in reducing cancerous tumours, thereby suppressing the progression of cancer, through promoting energy metabolism. (9)

In the semi-autobiographical novel Cancer Ward by Aleksandr Solzhenitsyn, set in Russia and first published in 1968, cancer patients are prescribed chaga tea.

Several studies on mice and on human cells in vitro have demonstrated the effectiveness of chaga as an anti-tumour agent, effective in the treatment of several kinds of cancers, including cancer in the colon, (10) liver, (11) prostate, breast, (12) lung, stomach, and cervix. (13)

Compounds known as triterpenes/triterpenoids have been extracted from chaga and found to be effective in killing breast cancer cells. (14)

The chaga fungus contains inotodiol (a lanostane triterpenoid), which has anti-tumour properties. (15) Inotodiol and betulin (another triterpenoid with a lupane structure) are found almost exclusively in the fungus growing on birch trees. (16)

Betulin forms up to 30% of the dry weight of silver birch bark; it is found in large amounts in chaga and has anti-cancer properties. (17) It is currently believed that the anti-cancer potential of the mushroom is primarily due to the high content of polysaccharides (18) in the mushroom. (19)

Chaga has the full spectrum of immune-stimulating phytochemicals found in other mushrooms, such as in maitake and shitake, (21) which are widely consumedin Japan. It has been found that the compounds in mushrooms in general that inhibit tumour growth do so mostly by stimulating the immune system. (22)

Chaga may be useful as an immune enhancer in people with either suppressed or compromised immune systems, who may develop auto-immune diseases such as psoriasis, rheumatoid arthritis or type 1 (auto-immune) diabetes. Chaga is a potent immune modulator and could also be used to treat people whose bone marrow has been damaged by chemotherapy. (23)

Many studies have confirmed chaga’s anti-inflammatory properties. (23) One study (24) concluded that chaga could be useful to treat inflammation, notably in bowel disease. It has now evident that inflammation is implicated in numerous health issues, including anxiety, unipolar and bipolar depression, schizophrenia, post-traumatic stress disorder, asthma, rheumatoid arthritis, cardiovascular disease, obesity, diabetes, osteoporosis, Alzheimer’s disease, certain cancers and stroke.

Eight out of ten of the leading causes of death in the USA involve inflammation. (25) More research is needed for specific inflammatory processes and conditions, however it would be a viable investigation route to see how chaga can effect illnesses where inflammation is involved.

Besides being anti-inflammatory, chaga is also rich in anti-oxidants, (26) the main anti-oxidants being polyphenols and triterpenoids. As noted above, triterpenoids are effective against some forms of cancer. Antioxidants can prevent or reverse damage to cells caused by aging, the environment or lifestyle.

Polyphenols can help manage both blood pressure and blood sugar levels, and reduce chronic inflammation. There are around 8,000 kinds of polyphenols, which are in many kinds of foods in greater or lesser quantities. Some of the commonly consumed polyphenols include flavonoids, such as quercetin and catechins, which are in fruits; capsaicinoids, in chili peppers; lignans and stilbenes, in vegetables and whole grains; resveratrol in red wine; and ellagic acid in berries.

High levels of anti-oxidants are in chokeberries, elderberries and blueberries. (27) However, several surveys indicate that the highest levels, by far, of anti-oxidants in plant sources are in chaga. (28)

Chaga is particularly rich in the antioxidant known as superoxide dismutase (SOD), which has been shown to reduce free radical damage, preventing wrinkles and having an anti-cancer effect. (29) Several extracts from chaga, including polysaccharides, have also been shown to have neuroprotective effects in degenerative diseases such as Alzheimer’s and Parkinson’s. (30)

Studies on the effect of particular compounds in chaga have indicated that after four weeks they can significantly reduce the body weight, blood glucose levels, and plasma insulin levels of mice with diabetes. (31) It has been shown that the polysaccharides in chaga have hypoglycaemic activity, reducing blood sugar levels. (32)

Other studies, (33) also on rats and mice, confirm that chaga is antioxidant, can reduce blood sugar, and provided further indications that chaga would most probably be effective against diabetes in humans.

Two studies suggest the anti-bacterial and probiotic effect of chaga; another study indicates the anti-parasitic properties of polysaccharides in extracts from chaga. (34) The betulin in chaga can easily be converted to betulinic acid, which has been shown to have antiviral activity against HIV and malaria. (35)

Polysaccharides extracted from chaga have been shown to be effective against other viral infections, including herpes, feline influenza (and other feline viral infections), and hepatitis C. (36)

It has been found that chaga modulates immune responses through secretion of cytokines in immune cells, and regulates antigen-specific antibody production. Chaga can increase serum levels of chemoprotective cytokines, (37) which are proteins that regulate the immune system and stimulate white blood cells, which protect against harmful bacteria and viruses.

Cytokines are also implicated in SARS-Covid infection, which causes illness through a cytokine ‘storm’. The triterpenoid inotodiol found in chaga, mentioned above, has been found to induce the proliferation of T-cells, which act against viral infection. (38) So, it may be that chaga can protect against the SARS-Covid virus.

Besides its other effects, chaga has also been shown to be able to reduce levels of total cholesterol in rats, (39) high levels of some forms of cholesterol being a factor in heart disease. It seems that it is the antioxidant effect of chaga that reduces cholesterol.

It has also been found that the polysaccharides in chaga increase in mice the production of sperm and testosterone, and ameliorate impaired reproductive function. (40)

Birch trees are native to northern latitudes of the world: to Russia, Siberia, northern Europe, Canada, Alaska, northern China and Korea. There are far more birch trees in Scotland than in England. The ancient Balts, Slavs and Finns regarded the birch as a sacred tree.

In pre-Christian Ireland, birch was considered as one of seven sacred trees. (41) The name ‘birch’ derives from the Proto-Indo-European (PIE) root *bher∂g, which means ‘shine’/’brilliance’/’white’, reflected in names such as Albert, Herbert and Robert. (42)

The Celts saw in the birch the deity Brigit/Brigid, whose name derives from the same root, *bher∂g. Brigit was the muse of healers and bards in pre-Christian Ireland, where smitten boys would place fresh, green birch twigs in front of the house of the one they were courting. (43)

Birch twigs used to be used in Europe for the beating of bounds and the flogging of delinquents – and formerly lunatics – to expel evil spirits. In Scandinavia the first leaves of birch mark the beginning of the agricultural year. The witches’ broom used to be made from birch and ash. (44)

In India, the birch tree is called bhūrja in Sanskrit. In north India, texts used to be inscribed on birch bark, which is used by North American Ojibwa Indians for many other purposes, such as for tools, mats, canoes and baskets. (45) The sap of birch trees is used to make a sugar substitute, known as xylitol. Birch sap has less sugar than maple and is used as a syrup by Lithuanians. (46)

In herbal medicine the sap of birch is believed to stimulate urine and bile, purify the blood, and strengthen the urinary tract. (47) Tea made from the leaves of white birch is used for dissolving kidney stones and as a laxative. Twigs and leaves are added to bath water as a treatment for itchy skin and hair loss, while the inner bark is simmered for fever. (48)

In the last couple of decades, numerous scientific studies have indicated the potential for chaga to treat several common diseases, including cancer and diabetes, as an immune-system booster, as an antioxidant, and against harmful viruses.

Although the scientific tests so far have been almost exclusively conducted on rats and mice, and many of these studies lack in-depth experiments, (49) it seems highly likely that such effects would be replicated at least to some degree in humans. It should, however, be cautioned that chaga can prevent blood clotting, (50) so it should not be used by anyone using blood-thinning medication.

As mentioned above, the birch tree is revered in several cultures, notably by the Balts, Slavs and Finns. It has been suggested by some commentators (51) that this reverence for the birch tree may derive from the fact that one of the main places where the red, spotted, fly-agaric mushroom (Amanita muscaria) may be found is beneath birch trees.

Fly-agaric has psychedelic effects and is used for shamanic purposes in some cultures in Siberia and North America. (52) It was famously, though incorrectly, (53) identified in the late 1960s by R. Gordon Wasson – one of the great mycologists of the 20^th century – as the ‘nectar of immortality’, the ritual drink known as soma, (54) which is revered by the Brahmins of India. However, leaving this suggestion aside, perhaps, as a speculation, reverence for the birch tree has, instead, practical roots in the ancient use of chaga as a wondrous medicine.

1. Betula fontinalis, Betula lenta, Betula lutea, Betula papyrifera, Betula pendula (silver birch), Betula pubescens/alba (white birch).
2. Szychowski et al. (2021:293).
3. Szychowski et al. (2021:293).
4. Inonotus obliquus is a partially protected species in Poland (Szychowski 2021:293).
5. Ma et al. (2013.
6. Kim (2005).
7. Szychowski et al. (2021:294).
8. For a recent, comprehensive review of the scientific literature on research into the medical potential of chaga, see Szychowski (2021).
9. Arata et al. (2016).
10. Lee et al. (2015).
11. Youn et al. (2008).
12. Ma et al. (2013).
13. Chung et al. (2010).
14. Zhao et al. (2016).
15. Chung et al. (2010).
16. Phillips (2006:310). Betulin is also found in red alder (Alakurtti et al. 2006) and a few other plants (Moghaddam (2012).
17. Alakurtti et al. (2006).
18. Three important polysaccharides – starch, glycogen and cellulose – are composed of glucose.
19. Szychowski et al. (2021:299).
20. Kim (2005).
21. Borchers et al. (2008:259).
22. Kim (2005).
23. Ma et al. (2013).
24. Mishra et al. (2012).
25. Slavich (2015).
26. Cui et al. (2005); Liang et al. (2009).
27. In one survey (WebMD 2020) it is reported that the foods with the highest levels of antioxidants are (per half-cup serving) chokeberries (1,123 mgs), elderberries (870 mgs), blueberries (535 mgs) and blackcurrants (485 mgs). Blackberries, raspberries and strawberries have around 160 mgs. Per ounce, cloves contain 542 mgs, and peppermint 427 mgs. Dark chocolate has 249 mgs per tablespoon (milk chocolate has just 35 mgs). Of all nuts, the most polyphenols are in chestnuts, with 347 mgs per ounce. Other sources of polyphenols include flax seeds (229 mgs per tablespoon); a small artichoke has around 260 mgs; a small red onion has around 170 mgs; an olive has around 20–25 mgs; and a cup of coffee has about 35 mgs of polyphenols.
28. Acai berries reportedly contain 165 oxygen radical absorbent capacity (ORAC) units, pomegranates 105, and blueberries 24; chaga contains 1,104 (Chichaga 2015; Wild Kingdom 2022).
29. Younus (2018).
30. Szychowski et al. (2021: 295).
31. Wang et al. (2017).
32. Szychowski et al. (2021:299).
33. Cha et al. (2006); Diao et al. (2014); Sun et al. (2015); Wang et al. (2017).
34. Szychowski et al. (2021:296).
35. Alakurtti et al. (2006); Moghaddam et al. (2012).
36. Szychowski et al. (2021:294, 296).
37. Kim (2005); Ko et al. (2011).
38. Maza et al. (2021).
39. Sun et al. (2015).
40. Ding et al. (2020).
41. Graves (1977:253).
42. Online Etymological Dictionary (2022).
43. Müller-Ebeling et al. (2003:8).
44. Graves (1977:166, 173).
45. Nyholm (2022).
46. Chepaitis (2016).
47. Müller-Ebeling et al. (2003:7).
48. Hopman (1995:187).
49. Szychowski et al. (2021:298).
50. Hyun et al. (2006).
51. For example: Müller-Ebeling et al. (2003:10).
52. Morgan (1995:106–110).
53. See Clark (2020).
54. See Wasson (1969).

An allergy (or hypersensitivity reaction) is our body’s immune response to something that is normally harmless like food, pollen or dust. The immune system protects us through innate (barriers) and acquired (programmed or learned) responses. With an allergy our immune systems are responding to triggers called allergens to disarm it or flush it from our system.

We may be affected by itchy skin, sneezing or watery eyes. However, in extreme cases, an individual may experience a life-threatening anaphylactic reaction, and the numbers of people living with allergies as chronic conditions is rising.

An allergy is signified by the release of the antibody immunoglobulin E (IgE) which increases following a cascade of events involving white blood cells T- and B- Cells, Eosinophils, Mast Cells and sometimes Basophils.

White blood cells are like the soldiers of our immune system, going out to destroy anything harmful like viruses and bacteria. They communicate through chemicals like cytokines, and antibodies. The following gives a simplified account of what happens during an allergic reaction:

Exposure to environmental allergen à Allergen uptake by antigen-presenting cells and digestion into peptide fragments à Activation of a Th2 cell response à Cytokine release (IL-4, IL-5, IL9, IL13) triggering 1) Eosinophil cells multiply and release contents 2) B cells release IgE, and 3) mast cell degranulation and release of contents.

Mast cells are types of white blood cells that release histamine and other compounds that orchestrate the allergic response. Eosinophils are a different type of white blood cell that also release compounds that cause mucus secretion at sites and smooth muscle contraction. The release of inflammatory compounds like prostaglandins and leukotrienes cause inflammation and worsen the symptoms (14). Allergies are diagnosed through measuring IgE, cytokines and white blood cell biomarkers.

Allergies manifest in many ways affecting our digestive tract, skin and respiratory systems. They are increasing in prevalence and becoming more severe, with an estimated 44% of the UK adult population suffering from an allergy such as allergic rhinitis, atopic dermatitis, allergic asthma and food allergy (1).

In Europe, it is predicted that 50% of people will be living with allergies by 2025, with pollution thought to add to the problem (2). In China, a population study found asthma to be on the rise and associated with high levels of environmental pollution (12).

In children around the world, eczema, rhinitis and asthma, food allergies are increasing in prevalence, and a global map of food allergy data shows the widespread nature of the problem (17).

Changes in genes cannot account for the recent and rapid rise in allergy, so what can? For food allergy, egg and milk are most common allergens in children, whereas in adult’s fish and shellfish are more involved. Are food allergies connected to our food systems that have become more homogenous and mass-produced (17)?

What about environmental pollutants? It was recently said that “chemical pollution has passed a safe limit for humanity” (4). Research indicates that air pollution from traffic increases the risk of childhood asthma, and possibly food allergy, eczema and hay fever (2).

Co-exposure of a respiratory allergen with diesel exhaust lowers a surfactant protein required for healthy lung function and alters immune regulation (18). Phthalates used as plasticisers in home products like vinyl flooring reduce lung function in allergic patients and boost macrophages and cytokine activity causing an inflammatory response (13).

Pesticides pose a particular risk, and these synthetic chemicals designed to control insects, weeds and fungi pests readily enter our food chain through exposure on farms or in our back gardens, research by Greenpeace in 2015 gives a thorough account (7). In a US cohort study, participants with high levels of urinary dichlorophenols (chemicals used as pesticides and in water chlorination) were more likely to be sensitive to food allergens (11).

In agricultural settings, the impact of multiple pesticides on respiratory function in farmers through allergic and non-allergic pathways is even more acute (10). Perhaps most concerning is the potential effects on children’s health. Pesticides are implicated in the rise of many childhood disorders, and for asthma, pesticide exposure can increase the likelihood of being diagnosed with asthma by the age five as well as exacerbating symptoms by causing bronchial constriction (15).

There are many challenges to address to tackle the rise in allergic disease and underlying connection to environmental pollutants and pesticides. How do we strengthen our body’s resilience or reduce levels of pollution and pesticide use? This article won’t tackle all of this, but one topic of mounting interest is the role of our body’s microbes.

Research shows that pesticides alter the composition of the human gut microbiota where the link to health is well-established (also read “The effects of modern life on our gut health and what to do about it” which goes into more detail about it). More of an unknown is the effect on microbiota metabolism, with the possibility that the bacteria in our gut are transforming the pesticides into more toxic compounds (19).

Also, is the microbiota a link between pesticides and the allergic response? In food allergy, individuals have a disrupted microbiome. Certain microbes are important for allowing T cells (a kind of white blood cell) to function effectively, and in this case affects the body’s ability to maintain a tolerance to food (3).

Probiotics (live microorganisms that are beneficial when consumed) may offer a solution to restoring microbiota function and remediate against pesticide damage. Lactobacillus promotes detoxification and strengthens host immunity in response to environmental contaminants, although more research in humans is needed (6).

Whilst our inner microbial diversity is important, scientists are also looking at the role of our outer connections too – the biodiversity of the natural world and its importance in creating the resilience needed for life. In one comprehensive review, the authors describe how urban environments disrupt the composition of our skin and airway microbiota. Revegetating and providing green spaces may re-introduce valuable microbiota species into the environment to help restore harmony (8).

In Finland, a 10-year Allergy Program successfully reduced the growing prevalence of asthma and allergic disease, alongside less severe symptoms and a 50% decrease in hospital days in those affected. Part of the intervention was improving resilience through boosting contact with the natural environment and eating more healthily, alongside changes to healthcare management (9).

In answer to the second challenge in reducing pollution and pesticide, the discussion is beyond the scope of this article. However, Organic Farming is clearly a means of reducing synthetic pesticide use, and research shows it can restore the lost microbial communities of the soil, including valuable bacterial and fungal groups (16). Therefore, organic methods could also contribute to the idea of resilience through enhancing the microbial diversity in the environment, alongside its other benefits through enhancing biodiversity.

Allergies are on the rise in children and adults, and there is little doubt that environmental pollutants including pesticides exacerbate illness. As we inhale and ingest these chemicals, our immune systems become overwhelmed and hypersensitive as part of a protective response.

As the burden increases, the response can become more severe, and many people are either living with more severe allergy or experience multiple ones. Our microbes are important regulators of our immune system and may worsen the situation through either being disrupted or inadvertently transforming these chemicals into further toxic compounds.

Research is helping us understand how we are impacting our health through damaging our delicate natural ecosystem, and we need to consider the system as a whole in order to address problems like the rising prevalence of allergy.

1. Allergyuk.org. https://www.allergyuk.org/wp-content/uploads/2022/01/Allergy-UK-Annual-Review-2020-2021.pdf. Published 2021. Accessed February 18, 2022.
2. Dantzer J, Keet C. The Influence of Childhood Traffic-Related Air Pollution Exposure on Asthma, Allergy and Sensitization: A Systematic Review and a Meta-analysis of Birth Cohort Studies. Pediatrics. 2015;136(Supplement_3):S233-S234. doi:10.1542/peds.2015-2776w
3. Bunyavanich S, Berin M. Food allergy and the microbiome: Current understandings and future directions. Journal of Allergy and Clinical Immunology. 2019;144(6):1468-1477. doi:10.1016/j.jaci.2019.10.019
4. Chemical pollution has passed safe limit for humanity, say scientists. the Guardian. https://www.theguardian.com/environment/2022/jan/18/chemical-pollution-has-passed-safe-limit-for-humanity-say-scientists. Published 2022. Accessed February 18, 2022.
5. User S. Allergy. EFA. https://www.efanet.org/inform/patient-evidence/allergy. Published 2022. Accessed February 18, 2022.
6. Feng P, Ye Z, Kakade A, Virk A, Li X, Liu P. A Review on Gut Remediation of Selected Environmental Contaminants: Possible Roles of Probiotics and Gut Microbiota. Nutrients. 2018;11(1):22. doi:10.3390/nu11010022
7. Astley R, Connor K. Pesticides and our Health – Greenpeace International. Greenpeace International. https://www.greenpeace.org/international/publication/7113/pesticides-and-our-health/. Published 2015. Accessed February 18, 2022.
8. Haahtela T, Alenius H, Lehtimäki J et al. Immunological resilience and biodiversity for prevention of allergic diseases and asthma. Allergy. 2021;76(12):3613-3626. doi:10.1111/all.14895
9. Haahtela T, Valovirta E, Saarinen K et al. The Finnish Allergy Program 2008-2018: Society-wide proactive program for change of management to mitigate allergy burden. Journal of Allergy and Clinical Immunology. 2021;148(2):319-326.e4. doi:10.1016/j.jaci.2021.03.037
10. Hoppin J, Umbach D, Long S et al. Pesticides are Associated with Allergic and Non-Allergic Wheeze among Male Farmers. Environ Health Perspect. 2017;125(4):535-543. doi:10.1289/ehp315
11. Jerschow E, McGinn A, de Vos G et al. Dichlorophenol-containing pesticides and allergies: results from the US National Health and Nutrition Examination Survey 2005-2006. Annals of Allergy, Asthma & Immunology. 2012;109(6):420-425. doi:10.1016/j.anai.2012.09.005
12. Lin J, Wang W, Chen P et al. Prevalence and risk factors of asthma in mainland China: The CARE study. Respir Med. 2018;137:48-54. doi:10.1016/j.rmed.2018.02.010
13. Maestre-Batlle D, Huff R, Schwartz C et al. Dibutyl Phthalate Augments Allergen-induced Lung Function Decline and Alters Human Airway Immunology. A Randomized Crossover Study. Am J Respir Crit Care Med. 2020;202(5):672-680. doi:10.1164/rccm.201911-2153oc
14. Oettgen H, Broide D, Church M, Martinez F, Broide D, Holgate S. Introduction to mechanisms of allergic disease. 2012:1-32. doi:10.1016/B978-0-7234-3658-4.00005-6
15. Panna.org. https://www.panna.org/sites/default/files/KidsHealthReportOct2012.pdf. Published 2013. Accessed February 18, 2022.
16. Peltoniemi K, Velmala S, Fritze H, Lemola R, Pennanen T. Long-term impacts of organic and conventional farming on the soil microbiome in boreal arable soil. Eur J Soil Biol. 2021;104:103314. doi:10.1016/j.ejsobi.2021.103314
17. Prescott S, Pawankar R, Allen K et al. A global survey of changing patterns of food allergy burden in children. World Allergy Organization Journal. 2013;6:21. doi:10.1186/1939-4551-6-21
18. Ryu M, Lau K, Wooding D, Fan S, Sin D, Carlsten C. Particle depletion of diesel exhaust restores allergen-induced lung-protective surfactant protein D in human lungs. Thorax. 2020;75(8):640-647. doi:10.1136/thoraxjnl-2020-214561
19. Yuan X, Pan Z, Jin C, Ni Y, Fu Z, Jin Y. Gut microbiota: An underestimated and unintended recipient for pesticide-induced toxicity. Chemosphere. 2019;227:425-434. doi:10.1016/j.chemosphere.2019.04.088

Echinacea is one of the most widely used and well researched Herbal Medicines today. Most popular for its use in treatment of respiratory infections, such as the common cold, influenza, laryngitis and tonsillitis. It also has a reputation as an immune stimulant, often being used to treat viral symptoms and acute infections by enhancing the immune function (1, 2).

There are in fact several species of Echinacea, for most of which there has been little to no chemical or pharmacological research, meaning there is very little known about their medicinal potential scientifically. There are three main species of Echinacea used in Herbal Medicine today. Often referenced together in modern herbal literature as ‘Echinacea spp’.

Echinacea is often used by Herbalists in allergic and autoimmune conditions and in management of infections (4, 5). The Echinaceas are sometimes described, maybe more accurately as immune ‘modulators’ rather than ‘stimulators’. An example of what is often seen in herbal medicine – a moderating effect created by a synergy of the active chemistry rather than a singular mechanism created by one isolated compound.

These most well known members of the Daisy (Asteraceae) family are all commonly named under ‘purple coneflower’. These include; Echinacea purpurea (broad leaved or common purple coneflower), E. angustifolia (narrow leaved purple coneflower) and E. pallida (pale purple coneflower).

The most easily cultivated of the three is E. purpurea making it the most widely used today, it is also popular because all parts of the plant can be used (leaf, flower, seed and root). Most preparations of the Echinaceas are made from the roots of the plant.

The Echinaceas are often referenced together with their actions and applications listed in summary under the heading of ‘Echinacea spp’, which would suggest that they can all be used interchangeably. However, this seems possibly to overlook the variations among them that could, under comparison, suggest otherwise.

There are very few reviews available that compare the actions of Echinacea spp, this article hopes to assess the available literature and summarise the known information, in hope to either defining how each of these plants could be best applied or confirming the assumption that they are medicinally interchangeable. First of all, let’s take a look at the basic photochemistry to investigate any possible variations in their chemical composition.

A number of active compounds have been isolated in all three species (1,2,3,4,5). Among all three species there is a unanimous presence of the following compounds;

• Essential oils, which lend to Echinaceas distinct (and slightly varied) aromatic qualities.
• Polysaccharides (compounds commonly found to have an effect on the immune system).
• Sesquiterpenes (common constituents found in the Asteracea or Daisy family that effect the immune system and protect against oxidative stress).
• Glycosides
• Inulin
• Resins
• Betaine

The three Echinaceas all have phytochemical (biologically active compounds found in plants) similarities as listed above however there are notable variations, particularly around the identity and concentration of some of the key constituents. The table below shows the variation in presence of some of the more notable compounds present in each species;

*** strong concentration                                      ** moderate concentration                       *mild concentration

There is a clear variation in presence and concentration of a number of the key active compounds in the Echinacea spp. With this in mind, we can start to gain some understanding of the possible diversity in their effects and medicinal applications by exploring the actions of each of these compounds.

• Glycosides (echinacoside) were found to be in the highest concentration in E. angustifolia and E. pallida, largely absent in E. purpurea these compounds display antibiotic and anti-microbial activity (4, 5).

• Alkyladmides, (the compound that produces the tingling in the mouth sensation) are key in Echinaceas immunological activity. These are only present in E. purpurea and E. angustifolia. Alkylamides exhibit immunomodulatory activity (8), an in vivo study found this effect to be seemingly most pronounced in the lungs (9). Many herbalists will say that the presence of the tingling sensation in Echinacea is the sign of a potent and effective medicine.
• Polysaccharides are present in all three Echinaceas, the highest concentration of them however is found in E. purpurea. Polysaccharides are known for their actions in reducing the ability for pathogens (such as bacteria’s and viruses) to penetrate the tissues. Research shows that Polysaccharide compounds work in a number of ways, enhancing virus specific immune function. The polysaccharide fraction present in all three Echinaceas will therefore play a role in Echinaceas ability to reduce viral replication in early stages of a virus (4, 5).
• Polyacetylenes (volatile oils) however are only present in E. Pallida, these compounds are powerfully antibacterial and antifungal (4). Research has also found these compounds to exhibit cytotoxic activity (cytotoxic- an agent that may stop cancer cells from dividing and growing and may cause tumors to shrink in size) (6). The Polyacetylenes are also found to have significant anti-inflammatory effects (7).
• The compound that produces the sharp taste, also responsible for a mild analgesic effect is Isobutylalkylamines (Echinacein), which is shown to be in highest concentration in E. purpurea (4).

In view of the diverse and varied chemical concentrations in each of the three Echinaceas we can see that some unique strengths are held by these plants individually. Chemically E. purpurea and E. angustifolia are most similar, with minor differences in potency and some unique higher concentrations of certain compounds.

By view of the chemistry it may seem that E. pallida is be best applied for infections and inflammations, with a higher presence of antibacterial and anti-fungal compounds. Let’s take a look at what is being said about these three individual plants in the modern and traditional herbal literature.

E. purpurea and E. angustifolia are the most widely available over the counter Echinaceas commercially. Both are widely available in dried or tincture form.

Many herbalists use a combination of E. purpurea and E. angustifolia. This is readily available from herbal suppliers as a 50/50 mix, understandably to benefit from their chemical similarity’s, whilst drawing on their unique strengths, adding more potency to the medicine overall.

Both are also readily available separately, however E. pallida is less available overall. Certainly E. pallida is rarely stocked by herbalist suppliers nor commercially in the West.

It is clear that all three are more than valid in a modern herbalist’s dispensary and certainly in a home apothecary. Perhaps it is that the former two Echinaceas came into the limelight at an earlier point in time, creating a focus on a number of the compounds that they have in common, as there is also significantly less available literature and research on E. pallida.

E. purpurea

E. purpurea is mildly sweet and sour in taste and is energetically neutralising (both displaying warming and cooling actions). Cooling could be explained by the removal of toxicity (inflammation- heat) from the blood, yet warming by its energetic nature in allowing balanced regulation of blood temperature (2).

Whole plant preparations were shown to be effective in treatment of allergies (4) also modulating the immune function in autoimmunity (5).

E. purpurea is traditionally referred to as a potent blood tonic, both acting on detoxification of the blood and the liver. Enhancing the liver function to remove waste and toxicity, also raises the liver metabolism which enables balanced regulation of blood temperature whilst reducing inflammation in the body (2).

E. angustifolia

With a moderate pungency and mildly bitter tones, E. angustifolia exhibits a cooling effect, much the same as E. purpurea, by its action to detoxify the blood and lymphatic systems (10).

Traditionally E. angustifolia is held in high esteem for use as a blood tonic, specifically in treatment of toxic conditions of the blood. Both elevating the natural defence immunity in the circulation and aiding in the removal of toxins from the blood and lymphatic systems (5, 8, 10).

Applied for both internal and external, viral and bacterial infections, preventing the spread of infection and aiding in repair of tissue damaged by infection (5).

Specific for use in treatment of the common cold, influenza particularly where the lungs are indicated (3), 8).

E. pallida

It seems less common where the Echinaceas are discussed within modern herbals to find separate information about E. pallida, although it is almost always included under the generalised information about the Echinacea spp. In cases where the Echinaceas are discussed in separate monographs, often the focus seems to set either upon E. purpurea or E. angustifolia, but rarely E. pallida alone.

However, in the limited information available E. pallida is often referred to as most specific in supportive treatment for influenza and the common cold (11). Reducing the symptoms and lessening  the duration of upper respiratory tract infections (12). In view of the chemical composition as listed above, it was also seem E. pallida could hold some value in supportive treatment of cellular abnormalities and cancer, in an integrated approach with other treatments, and also in bacterial and fungal infections (6).

Echinacea is safe for most people, including those with immune problems, though it is wise to avoid if on strong immunosuppressive prescriptions. 

Echinacea is in the Asteraceae plant family, and occasionally people exhibit allergic reactions to plants in this family (including daisies and chamomile). If a child has a known allergy to this plant then it is best to avoid giving them echinacea. 

In 2012 a warning was issued by the MHRA that as a precautionary measure the remedy echinacea should not be given to children under 12 years old, due to a small risk of a severe allergic reaction which outweighed any benefits (5). 

However, since this time, there has been research demonstrating the significant benefits of echinacea for children in reducing RTI’s and subsequent antibiotic use with minimal allergic reactions within the study group (6). This was based on a specific extract of echinacea, but suggests that unless there is a specific known allergy to this plant family then echinacea can have many benefits to children’s immunity.

Many herbalists use a combination of E. purpurea and E. angustifolia. Seemingly the combination of these two plants in a medicine creates a good balance of the most desirable compounds, at least in terms of immunological activity. Creating a medicine with potent anti microbial and antiviral action, that can be used broadly.

All three Echinaceas clearly hold great value in treatment of respiratory tract infections. Perhaps E. purpurea and E. angustifolia more specifically for their immunomoduatory effects, blood conditions and infections.

Where E. pallida is possibly most appropriate for management of milder respiratory tract infections, and fungal infections. There could also be a case, given the chemical similarities of E. angustifolia  and E. pallida for combining the two to access higher overall concentrations of antibiotic compounds, creating a higher potency for the treatment of bacterial and fungal infections.

On review of the available pharmacological and traditional data on each plant, it is not entirely possible to conclude on separate applications for these medicines, however it is clear that they are all highly valuable medicines for treatment of infections. Perhaps they can all lend to each other in combination where required, adding to their strengths to create a more potent overall effect. Many herbal medicines are enhanced or altered by combining with other plants and it seems clear that the Echinaceas are no stranger to this notion.

As ever when working one to one with a patient, a herbalist will create a tailored approach, where the full picture of health and imbalance can be addressed, combining herbs that best suit the constitution and circumstances of the individual to create a lasting resolution. Check out our page where to find a herbalist.

If nothing else, the differences in chemical concentrations among the Echinaceas may suggest a case for an enhancing companionship between them, on the basis of what is being addressed in the individual case, selecting herbs that harmonise to best support the specific presentation of the patient.

1. Bone, K. and Mills, S. (2013). Principles and practice of Phytotherapy modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier.
2. Kenner, D. and Yves Requena (2001). Botanical medicine : a European professional perspective. Brookline, Mass.: Paradigm Publications.
3. Spelman, K. (n.d.). Echinacea spp.: A Monograph & What’s New. [online] Available at: https://www.americanherbalistsguild.com/sites/default/files/spelman_kevin_-_echinacea_update.pdf.
4. Mills, S.Y. (1993). The Essential Book of Herbal Medicine. Editorial: Penguin.
5. Hoffmann, D. (2003). Medical Herbalism – principles and practices. Inner Traditions Bear And Comp.
6. Chicca, A. et al (2008). Cytotoxic activity of polyacetylenes and polyenes isolated from roots of Echinacea pallida. British Journal of Pharmacology, [online] issue 153(5). Available at: https://pubmed.ncbi.nlm.nih.gov/18193076/ [Accessed 18 Jan. 2022].
7. Feizlmayr, E. et al. (2009). Polyacetylenes and polyenes from Echinacea pallida and their anti-inflammatory activity in vitro. Planta Medica. Issue 75. volume 9.
8. Cech, N. et al. (2006). Liver Enzyme-Mediated Oxidation of Echinacea purpurea Alkylamides: Production of Novel Metabolites and Changes in Immunomodulatory Activity. Planta Medica, issue 72. Volume 15.
9. Goel, V. et al. (2002). Alkylamides of Echinacea purpurea stimulate alveolar macrophage function in normal rats. International Immunopharmacology,  Volume 2. Issue 2-3).
10. Frawley, D. and Vasant Lad (2016). The yoga of herbs : an Ayurvedic guide to herbal medicine. Delhi: Motilal Banarsidass.
11. British Herbal Medicine Association. Scientific Committee (2003). A guide to traditional herbal medicines : a sourcebook of accepted traditional uses of medicinal plants within Europe. London: British Herbal Medicine Association.
12. Government of Canada, H.C. (2004). Monograph. [online] webprod.hc-sc.gc.ca. Available at: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monoReq.do?id=79&lang=eng.
13. 13. Pizzorno J, Murray M, Joiner-Bey H, The Clinician’s Handbook of Natural Medicine. 2^nd ed. St Loius, Missouri: Churchill Livingstone Elsevier; 2008. 
14. 14. F, Paparo L, Nocerino R. et al. Specific gut microbiome signatures and the associated pro-inflamatory functions are linked to pediatric allergy and acquisition of immune tolerance. Nat Commun, 12:5958;2021. https://doi.org/10.1038/s41467-021-26266-z 

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What is inflammation, and should I worry about it?

Inflammation has received a significant amount of negative press in recent years, with numerous scientific studies citing it as the biggest health threat facing humans (1) and as the “most significant cause of death in the world today” (2). But science also teaches us that inflammation is the body’s normal immune response to trauma(3,4)infection or injury, and a helpful ally in the fight against infection and disease. So which is it, friend or foe?

Acute or chronic?

The answer may not be so straightforward as we first hoped, but thankfully research that can clarify the muddied waters of inflammation and health does exist. Key to determining whether inflammation may be harmful or helpful to us is understanding the difference between acute and chronic inflammation. Acute inflammation is a natural bodily immune response to invading pathogens, injury or disease.

There are a number of visual clues (known as the five ‘cardinal signs’ in ancient times (5)) which can help us detect whether the inflammatory process is happening in our bodies. These signs, which were coined by the ancient Romans and Greeks, are redness, swelling, heat, pain and loss of function (6).

Most of us will be familiar with these signs – on cutting a knee, twisting an ankle or even breaking a bone, within minutes, our body – when functioning correctly – triggers them by sending blood to the injured site along with numerous cells such as macrophages which repair and protect the damaged tissue (7), and others which fight off disease, like neutrophils (8).

When inflammation gets out of hand

But what happens when inflammation becomes chronic? Recent research has shown that there are a number of environmental, social and lifestyle factors that can actually increase the likelihood of developing systemic chronic inflammation (SCI) (9).

Whilst inflammation in and of itself does not necessarily pose a problem, when ongoing, it can lead to a number of diseases that “collectively represent the leading causes of disability and mortality worldwide” (10).These diseases include type 2 diabetes, hypertension, cardiovascular disease, different types of cancer, neurodegenerative and autoimmune diseases, osteoporosis and even mental health conditions like depression (11).

The wider factors at play

Chronic inflammation has a number of possible causes, including immune disorders, ongoing infection, auto-inflammatory disorders caused by cell defects and exposure to irritants, to name a few (12). However, our modern, urban environments, sedentary lifestyles, nutrient-poor diets and increasing lack of physical activity can all play a role in contributing to chronic inflammation (13) and sending the body’s immune response into overdrive, which in turn may create a “chicken-and-egg” (13) cycle of inflammation-disease-inflammation.

What can we do about inflammation?

But whilst the long lists of risk factors and diseases can seem extensive and scary, there are a number of lifestyle changes we can make as individuals which can help to reduce the likelihood of developing chronic inflammation and its associated conditions. Where appropriate, making some changes to our diet, such as eating more nutrient-dense foods, increasing physical activity (within our ability), avoiding chemical irritants and environmental pollutants and maintaining good sleep hygiene can all help to prevent inflammation (14,15).

However, it bears acknowledging that some communities and individuals are much better equipped to tackle public health issues such as SCI than others. Health (in)equity is an urgent worldwide concern, and social factors such as economic status have proven to have a significant influence on variations in population health and mortality rates (16).

Aromatic approaches to treating inflammation

Whilst it cannot legitimately be suggested that aromatherapy alone can cure diseases associated with chronic inflammation, it’s clear that herbal and holistic health disciplines such as aromatherapy have a key role to play in supporting us on an individual level with both chronic and acute inflammation and ultimately increasing quality of life. Increasing quality of life is something we believe should be at the forefront of healthcare priorities.

Let’s take Osteoarthritis (OA) and Rheumatoid arthritis (RA) as examples. Whilst RA is an auto-immune disease, and OA is a degenerative joint disease (17), it’s thought that it is possible for both to be hereditary, too (18,19). This would suggest that sufferers might be in a position where they are managing the effects of inflammation, rather than eliminating it completely. You can read about arthritis and herbalism here, as well as the Ayurvedic perspective.

Indeed it may not be possible, or desirable, for everyone suffering from forms of Arthritis to eliminate the symptoms; constantly striving to do so may cause emotional distress. It is in the short-term ‘flare-up’ treatment (acute) and the management of ongoing (chronic) conditions that aromatherapy can play a part. There are a number of essential and carrier (base) oils that can be used in topical and inhalation blends to treat both forms of Arthritis as well as numerous other inflammatory conditions.

Treating acute flare-ups vs. chronic inflammation

During Rheumatoid arthritic flare-ups, for example,  joints can become tender, swollen, and even deviate, becoming deformed (20). These symptoms can appear suddenly, causing intense pain and heat in the joint. In Osteoarthritis, inflammation tends to appear in the later stages of the disease (21), and as such, the Aromatherapist’s focus will tend to be on pain management and joint mobility.

Which method should I choose?

Aromatherapists work with many methods of application in their practice. Typically, preparations can range from inhalers to oil blends, creams to balms, aromatic soaks to sprays. It’s important to choose the most appropriate method of application to ensure the treatment is targeted to the condition, pleasant and easy to use since this will ensure effective outcomes for the patient or client.

In both cases of Arthritis mentioned above, a Clinical Aromatherapist would likely decide to prepare a product for the client to use topically (on the joint itself) such as a balm, cream or ointment made from a mixture of essential and base oils. This method of application allows the active constituents in the oils to permeate the skin barrier and target the affected site quickly, whilst providing some immediate relief (for more acute conditions) through the gentle application of a soothing ointment.

An ointment is an excellent choice in this case for practical reasons, too – it’s easy to apply morning and night, and can be carried in a bag or pocket when the patient is out and about. For other inflammatory conditions such as coughs and colds, another method such as inhalation might be more suitable.

Essential oils for inflammation

There are several oils that can be a useful addition to any budding aromatherapist’s natural first-aid kit. For acute inflammatory blends, specific oils indicated include those which are strongly analgesic (pain-relieving) and anti-inflammatory. German chamomile (Matricaria recutita), lavender (Lavandula angustifolia) and turmeric (Curcuma longa) all have strong anti-inflammatory properties (23) and can be useful additions to ointments targeting acute inflammation.

For more chronic conditions, either pain-relieving (analgesic) ‘cooling’ oils such as peppermint (Mentha piperita), or indeed ‘warming’ oils like ginger (Zingiber officinalis) and Black Pepper (Piper nigrum) can also be combined in a blend to provide relief.

Carrier oils: Therapeutic in their own right

Base oils (carrier oils) are also important additions since they both serve to dilute and blend the essential oils safely, whilst having therapeutic properties of their own. They can also aid absorption of the essential oils, which are the primary active ingredient in the product.

Carriers such as almond (Prunus amygdalis), apricot (Prunus armeniaca) and jojoba (Simmondsia chinensis) oil are particularly useful here. Almond oil is slow-absorbing, allowing for application of the ointment over a long period of time, which is ideal for chronic conditions. Apricot, on the other hand, is light and easily-absorbed, so ideal for fast-acting ointments. Jojoba, which is actually a wax, mimics the chemical structure of skin’s sebum, so is easily tolerated and helps balance the skin’s moisture levels (23). 

Carrier oils infused with a herb (macerations) are also extremely useful additions, adding another layer of therapeutic intervention to products. Particularly indicated for topical application for inflammatory conditions is St John’s wort (Hypericum perforatum) infused oil, which has a beautiful deep-red colour.

Blending for synergy: Working holistically

Aside from targeting solely the physical symptoms which are presenting, the Aromatherapist may also consider including an oil in an anti-inflammatory blend that assists with any emotional aspects of suffering with inflammatory conditions. Both sweet orange (Citrus aurantium var. dulcis) and cardamom (Elettaria cardamomum) are good anti-depressive oils, for example, and can help to uplift the spirits of the patient or client if they are suffering from stress or low mood as a result of their physical condition.

This synergistic approach to treatment is one that all good Aromatherapists will take, since aromatherapy, like herbalism, tends to focus on the person and their unique situation first and foremost, and not on the presenting symptoms alone.

Ultimately, if we try to look at inflammation not as a villain or harbinger of bad news and disease, but as a messenger with something important to tell us, our fear of inflammation may subside. Usually, inflammation is a sign that our body is doing its job to protect us from disease, and knowing this, we can perhaps begin to tune in to its signals and warning signs.

We might decide to make changes to our lifestyle that support us with our long-term health, preventing inflammation from becoming chronic and problematic, whilst enlisting our herbal and aromatic allies to address and calm acute and chronic conditions as and when they arise.

Please note: You should always consult a qualified Aromatherapist before applying any essential oil to the skin and always dilute to the appropriate ratio before application. Never ingest essential oils, unless under the guidance of a qualified, licensed Medical Aromatherapist or Medical Herbalist.

1. Pahwa R, Goyal A, Bansal P, et al. Chronic Inflammation. [Updated 2021 Sep 28]. In: StatPearls [online]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493173/
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6. Punchard N, Whelan C, Adcock I. J Inflamm. 2004;1(1):1. doi:10.1186/1476-9255-1-1 Available from: https://journal-inflammation.biomedcentral.com/articles/10.1186/1476-9255-1-1
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9. Furman D, Campisi J, Verdin E et al. Chronic inflammation in the etiology of disease across the life span. Nat Med. 2019;25(12):1822-1832. doi:10.1038/s41591-019-0675-0. Available from: https://www.nature.com/articles/s41591-019-0675-0
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13. Unknown. Understanding acute and chronic inflammation. Harvard Health. [online] https://www.health.harvard.edu/staying-healthy/understanding-acute-and-chronic-inflammation. Published 2020. Accessed October 21, 2021.
14. Unknown. Understanding acute and chronic inflammation. Harvard Health. [online] https://www.health.harvard.edu/staying-healthy/understanding-acute-and-chronic-inflammation. Published 2020. Accessed October 21, 2021.
15. Furman D, Campisi J, Verdin E et al. Chronic inflammation in the etiology of disease across the life span. Nat Med. 2019;25(12):1822-1832. doi:10.1038/s41591-019-0675-0. Available from: https://www.nature.com/articles/s41591-019-0675-0
16. Mackenbach J, Kunst A. Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997;44(6):757-771. doi:10.1016/s0277-9536(96)00073-1. Available from: https://pubmed.ncbi.nlm.nih.gov/9080560/
17. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007:212-213.
18. Chen D, Shen J, Zhao W et al. Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone Res. 2017;5(1). doi:10.1038/boneres.2016.44 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240031/
19. Bullock J, Rizvi S, Saleh A et al. Rheumatoid Arthritis: A Brief Overview of the Treatment. Medical Principles and Practice. 2018;27(6):501-507. doi:10.1159/000493390 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422329/
20. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 211-213.
21. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 211-213.
22. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 211-213.
23. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 150-157
24. Wölfle U, Seelinger G, Schempp C. Topical Application of St. Johnʼs Wort (Hypericum perforatum). Planta Med. 2013;80(02/03):109-120. doi:10.1055/s-0033-1351019 Available from: https://pubmed.ncbi.nlm.nih.gov/24214835/

• Actor J. K, 2 – Cells and Organs of the Immune System, Editor(s): Actor, J.K. Elsevier’s Integrated Review Immunology and Microbiology (Second Edition), W.B. Saunders, 2012, ISBN 9780323074476, doi: 10.1016/B978-0-323-07447-6.00002-8 Available from: https://www.sciencedirect.com/science/article/pii/B9780323074476000028
• Ali O. A, Mooney D. J. 31 – Converging Cell Therapy with Biomaterials, Editor(s): Craig Halberstadt, Dwaine Emerich. Cellular Transplantation, Academic Press, 2007, ISBN 9780123694157, doi: 10.1016/B978-012369415-7/50032-6. Available from: https://www.sciencedirect.com/science/article/pii/B9780123694157500326?via%3Dihub
• Bullock J, Rizvi S, Saleh A et al. Rheumatoid Arthritis: A Brief Overview of the Treatment. Medical Principles and Practice. 2018. doi:10.1159/000493390 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422329/
• Chen D, Shen J, Zhao W et al. Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone Res. 2017. doi:10.1038/boneres.2016.44 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240031/
• Furman D, Campisi J, Verdin E et al. Chronic inflammation in the etiology of disease across the life span. Nat Med. 2019 doi:10.1038/s41591-019-0675-0. Available from: https://www.nature.com/articles/s41591-019-0675-0
• Mackenbach J, Kunst A. Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997. doi:10.1016/s0277-9536(96)00073-1. Available from: https://pubmed.ncbi.nlm.nih.gov/9080560/
• Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007. ISBN: 0-7817-5345-7
• Oxford University Hospitals NHS Foundation Trust. Inflammatory diseases. OUH, NHS, Oxparc. https://www.ouh.nhs.uk/oxparc/information/diagnoses/inflammatory-diseases.aspx. Published 2021. Accessed October 21, 2021.
• Pahwa R, Goyal A, Bansal P, et al. Chronic Inflammation. [online] [Updated 2021 Sep 28]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493173/
• Punchard N, Whelan C, Adcock I. J Inflamm. 2004;1(1):1. doi:10.1186/1476-9255-1-1 Available from: https://journal-inflammation.biomedcentral.com/articles/10.1186/1476-9255-1-1
• Unknown. Fighting Inflammation. Harvard Health. [online]. https://www.health.harvard.edu/staying-healthy/understanding-inflammation. Published 2021. Accessed October 21, 2021.
• Unknown. Understanding acute and chronic inflammation. Harvard Health. [online]. https://www.health.harvard.edu/staying-healthy/understanding-acute-and-chronic-inflammation. Published 2020. Accessed October 21, 2021.
• Wölfle U, Seelinger G, Schempp C. Topical Application of St. Johnʼs Wort (Hypericum perforatum). Planta Med. 2013.  doi:10.1055/s-0033-1351019 Available from: https://pubmed.ncbi.nlm.nih.gov/24214835/

Pain, especially chronic pain, can be extremely debilitating. In 2016 the British Pain Society researched the population to find that more than two fifths of the UK population (around 28 million adults) live with pain that lasts for 3 months or longer. Overall, 14.3% had chronic pain that was either moderately or severely disabling (1). This problem is not just prevalent in the UK but is common globally.

Common treatments include opioids like codeine (or in extreme cases morphine), and NSAID’s like ibuprofen. The problem is that the long-term use of NSAID’s can lead gastrointestinal problems like stomach ulcers, and in some cases issues with kidneys and the liver. Opioids are also highly addictive and have caused a devastating opioid crisis leading the destruction of hundreds and thousands of lives (2). Furthermore opioids do not actually work very well for neuropathic pain (3).

What causes pain is multifaceted, and varies from person to person.  For example the cause can be inflammatory in nature as pain is one of the five symptoms of inflammation (along with heat, swelling, redness and loss of function). This is predominantly down to the immune system.

Neuropathic pain is caused by the nervous system, and flare ups are often spontaneous without stimulation. Neuropathic pain can feel like electric shocks, tingling, numbness, pins and needles, shooting, stabbing or burning pain. There is a neurotransmitter called substance P that acts as a nociceptor, meaning it detects pain. It is found in specific sensory nerves, predominantly in the brain and spinal cord and reacts to potentially damaging stimuli by causing pain. It is an important factor in both inflammatory and neuropathic pain.

There is also mental and emotional factors when it comes to how we experience pain. Though of course some events and conditions cause us to feel pain, in many cases (in particular chronic pain conditions) the way we perceive pain effects the severity. This is why some people use modalities such as hypnotherapy to deal with chronic pain conditions.

Thankfully there are solutions and a particularly useful one is the use of cannabidiol (CBD). This is a molecule from cannabis and hemp which are both in the Cannabaceae family. Both clinical studies and real-world evidence show that CBD can be helpful for pain issues ranging from dysmenorrhoea to multiple sclerosis.

Here we will briefly explain what the endocannabinoid system is and how it is involved with pain, as well as what CBD is.

The endocannabinoid system (ECS) was discovered in Israel around 30 years ago, which in science terms is very new (8). Different receptors such as CB1 and CB2 were discovered, as were the endocannabinoids that bind to them. Endocannabinoids are neurotransmitters that the body makes naturally, and they bind to endocannabinoid receptors.

These include anandamide, derived from the Sanskrit word for “bliss”. Anandamide binds to the CB1 receptor and when stimulated it gives us pleasurable feelings. Phytocannabinoids are plant derived compounds that also bind to our cannabinoid receptors. CBD is an example of this, as is THC  (there are many more phytocannabinoids too).

The endocannabinoid system’s  main function is to regulate the nervous and immune system, and to promote a state of balance and equilibrium (also known as homeostasis). This is why it is implicated in so many different illnesses and conditions. Both inflammation and the nervous system are frequently involved with pain.

Two of the main receptors in the ECS are the CB1 and CB2 receptors. There are CB1 receptors that “monitor” the passing on of pain signals from painful stimuli, and research shows these are heavily involved with the analgesic effects of CBD and THC (tetrahydrocannabinol- the psychoactive part of the plant) (4).

CB2 receptors are also present on the microglial nerve cells, which are specific immune cells for the nervous system that remove damaged nerves and infection. They are involved with inflammation. It is through this that CB2 has been shown to be important for reducing cytokine-mediated neuroinflammation which can be a very significant factor for pain (5). There are a whole plethora of ways that the ECS is involved with pain, and here we have explained just a couple.

Both anecdotal and clinical evidence has shown it has a therapeutic effect for an array of different things including issues with pain. CBD is a non-psychoactive part of the cannabis plant so does not make people “high”, which is partially why it is such a welcome medicine for many.

Pain signals are sent from one neuron to the other in a forward-facing direction. However, the endocannabinoid system’s signals fire in the opposite direction (a process called retrograde signalling). This means the endocannabinoid receptors are on the cell that are producing the pain signal. If we activate these receptors through phytocannabinoids like CBD or THC , it means less pain signals are released which is why CBD can be analgesic.

CBD is often used for pain associated with inflammation, exercise, joint pain, arthritis, period pain and sometimes even to help deal with pain from serious conditions like cancer pain.

One way that it is suggested that CBD affects pain is through the GPR3 receptor in the brain and spinal cord, which is involved with pain reception. It could also be due to serotonin stimulation, as well as working on the opioid receptors μ and δ for pain regulation.

Anti-inflammatory effects through inhibiting TNF-α cells are also another potential way of reducing pain. TNF-α is a signalling molecule used by the immune system to communicate the need for more white blood cells to relocate to a certain spot. Whilst this can be useful, it causes an inflammatory response which can lead to pain. New mechanisms of action continue to be proposed as more and more is being discovered about CBD’s pharmacology and the ECS (6).

One study assessed CBD’s impact on patients with issues from multiple sclerosis to spinal cord injuries. They were assessed for pain, muscle spasms, bladder control and tremors and CBD on its own was shown to be useful for pain in comparison to placebo (6).

Another study across eight weeks showed that 50 out of 94 patients (53.2%) were able to reduce their use of opioids for pain management, with 2 people eliminating the use of them completely (6). CBD was also associated with a reduction in a variety of inflammatory mediators such as nitric oxide, lipid peroxide, prostaglandin E_{2 ,}which is perhaps some of the ways it works for chronic pain (6).

CBD has even been shown to be effective when applied topically, and many people use it as a muscle rub and for arthritic pain. Transdermal CBD gel significantly reduced joint swelling and pain and reduced pro-inflammatory biomarkers in a study done on rats with arthritis (7).

There is much conflicting information online about CBD and doses. Clinical trials (scientific studies on people) often use significantly higher doses than what is suggested commercially. The amount everybody needs varies depending on the condition being treated, the height and weight of a patient as well as the potency of the product. This is further complicated by the fact that all of our bodies metabolise medicines at different rates.

Products vary greatly in strength and quality. For example, some products only state how many milligrams are in a bottle and not the percentage strength. The more the milligrams, the stronger the product so 50mg in a 100ml bottle will be much weaker than 500mg in a 10ml bottle.

Clinical trials usually use 300 to 600mg a day for anxiety, though doses as low as 15mg have been shown in acute doses to be effective for anxiety (11). For epilepsy doses of between of 200mg to 300mg have been shown to be useful (10). Dosages of up to 1500mg/day of CBD have been shown to be effective and well tolerated (9).

Our best advice is to start slow and build up until you find the perfect dose for you. There will be an element of trial and error, but potential side effects and toxicity are minimal and personalised medicine is best.

There are thousands of CBD products on the market and it can get overwhelming knowing which is best. Our advice is to go for something that has been lab tested (so they can guarantee there are medicinal levels of CBD in the product). Also go for a full spectrum extract which includes the other plant molecules instead of CBD isolated by itself.

This will boost the bioavailability and efficacy of the CBD, and also research now shows that other parts of the plant are useful medicinally instead of CBD alone. Organic is best, as products are usually made using CO2 extraction which unfortunately also concentrates pesticides in the oil as well. We recommend oil as fat helps CBD be absorbed into the body better.

Finally if you want it to work fast, then hold the drops under your tongue. This means they go straight into your blood stream, avoiding filtration through your gut and liver. This makes for speedy absorption and means you will get the most out of your product.

As with all plant medicines it is the complexity in molecules that optimise both safety in efficacy. The best CBD extracts include an array of phytocannabinoids such as CBDn, CBC, CBDVa, CBG, CBDa, CBC and CBGa. They also contain essential oil compounds and terpenes like myrcense, alpha and beta-pinene, linalool, terpinolene, humulene, carophyllene oxide and beta-carophyllene. 

Finally, it must be mentioned that pain is usually treated in a multi-dimensional way. Exercise, diet, therapy, heat, massage, acupuncture and mixed herb formulas are all tools used to treat pain holistically. CBD is not an exclusive cure and a herbalist would always recommend taking it as part of a multi-herb complex along with other classic pain relievers such as boswellia, turmeric, valerian, cramp bark and corydalis. Treatment will be personalised and catered to an individual, as what is causing pain will vary from person to person. This is why we always recommend seeing a herbalist, and you can find one in our resources section.

1. British Pain Society. The silent epidemic – chronic pain in the UK | News | British Pain Society. Britishpainsociety.org. https://www.britishpainsociety.org/mediacentre/news/the-silent-epidemic-chronic-pain-in-the-uk/. Published 2016. Accessed September 24 2021.
2. Mcgreal C. ‘A cartel shouldn’t get away with this’: anger at opioid settlements that exclude admission of wrongdoing. the Guardian. https://www.theguardian.com/us-news/2021/jul/25/opioids-manufacturers-buying-their-way-out-of-accountability-families. Published 2021. Accessed September 27, 2021.
3. Przewlocki R, Przewlocka B. Opioids in Neuropathic Pain. Curr Pharm Des. 2005;11(23):3013-3025. doi:10.2174/1381612054865055
4. Woodhams S, Sagar D, Burston J, Chapman V. Pain Control.; 2015:119-143.
5. Fine P, Rosenfeld M. The Endocannabinoid System, Cannabinoids, and Pain.
6. Urits I, Gress K, Charipova K et al. Use of cannabidiol (CBD) for the treatment of chronic pain. Best Practice & Research Clinical Anaesthesiology. 2020;34(3):463-477. doi:10.1016/j.bpa.2020.06.004
7. Hammell D, Zhang L, Ma F et al. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. European Journal of Pain. 2015;20(6):936-948. doi:10.1002/ejp.818
8. Hanuš L. Discovery and Isolation of Anandamide and Other Endocannabinoids. Chem
   Biodivers. 2007;4(8):1828-1841. doi:10.1002/cbdv.200790154
9. Bergamaschi MM, Queiroz RH, Zuardi AW, Crippa JA. 2011. Safety and side effects of cannabidiol, a cannabis sativa constituent. Curr Drug Saf. 6(4):237-49.
10. Devinsky O, Cilio MR, Cross H, Fernandez-Ruiz J, French J, et al. 2014. Cannabidiol: Pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia. 55(6):791-802.
11. Blessing E, Steenkamp M, Manzanares J, Marmar C. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015;12(4):825-836. doi:10.1007/s13311-015-0387-1

Traditional herbal practices approached inflammatory problems in radically different ways. Although there is huge diversity of traditions and cultural variations these approaches were surprisingly consistent. Importantly they also accord with modern findings about the mechanisms of inflammatory and immunological diseases.

Inflammation starts as a healthy though robust response to an assault on the tissues. It is invoked when trouble cannot be cleared in the usual quiet ways. It is the body’s way of bringing reinforcements while also making clear that there is a threat that should be taken seriously.

The initial stages we can all recognise were classically described in ancient Greece as rubor, calor, tumor and dolor: redness, heat, swelling and pain. They describe the activation at the site of the assault of chemical agents (cytokines) like histamine, TNF-alpha and the interleukins, leading to increased circulation (redness and heat), movement of defensive white blood cells and fluids out of the circulation into the tissues (swelling), and activation of pain fibres by cytokines (so that proper notice is taken of the injury).

In the case of bacterial infections the inflammatory process can lead to accumulation of dead cells known as pus. When this extraordinary burst of activity has done its job the inflammation subsides and tissue resolution heals the damage.

All this is healthy and should not be suppressed, unless the defence is so robust that it risks damaging the body. Problems really start when the inflammation becomes chronic, in other words the initial healthy response does not finish the job. This may be because of repeated assaults, diminished vigour, or immunological complications.

As we have seen the immediate medical response when this happens is to provide anti-inflammatories. By contrast the traditional medicine response is to ask: how can we support healthy inflammation so that it finishes the job?  The term ‘anti-inflammatory’ does not fit well with traditional medicine.

So where can herbs act to help inflammation finish the job and move on?

One of the oldest tricks in healthcare is to heat an inflamed area. This sounds counter-intuitive: ‘you are making the inflammation worse?!’ However, it is very simple. By increasing blood flow to an inflamed area you are doing what the inflammatory response has to do by invoking painful cytokines: to bring more circulation and white blood cells into the affected area, and then to flush it out.

One very obvious benefit in supporting inflammation is that it also relieves the accompanying pain. Most people will know about the soothing effects of a hot water bottle or hot pack on a sore muscle or joint and many will also have applied heating liniments with similar benefits (1).

The most dramatic effects however come from the careful use of dressings of mustard or chilli powder, particularly over arthritic joints. These can be applied as a poultice, spread onto a gauze of cloth dressing under a hot wet wrap (checking from time to time that the expected redness does not go too far towards blistering – although this used to be a more heroic version of the same principle).

In the case of an affected hand or foot this could take the form of a mustard bath, in which mustard powder is dissolved into as small a quantity of water as possible, and the joint immersed in it (to keep the bath hot it is best to put the small container into a larger bowl of hot water). People who use this approach usually report not only immediate pain relief but longer-term reduction in the arthritis. In country districts there is another heroic tradition of beating the affected joints with stinging nettles – the ‘counter-irritation’ pain relief more than outweighs the nettle irritation. There is modern evidence that this works (2).

This approach can also be provided internally and there are many ‘heating’ remedies, usually spices, that have been used to reduce inflammatory conditions over many centuries. A classic example of this is our first alternative to anti-inflammatories.

Anti-inflammatory alternative: Ginger

Ginger has been perhaps the most valuable natural commodity in human history, valued for its dispersive heating effects across the body, as an antidote to all forms of symptoms exacerbated by cold and damp. There is increasing evidence that it also reduces inflammation in arthritis as well as more insidious forms associated with metabolic syndrome and diabetes (3,4,5).

Other systemic heating inflammatory modulators of this type include chilli/cayenne, containing the now standard pain-relieving constituent capsaicin, and turmeric.

All inflammatory responses start in the same place: the endothelial lining of our blood vessels. When tissues come under attack from infection or damage they release chemical messengers (cytokines) which change the properties of the endothelial cells.

It makes them ‘sticky’ (like viscose) to passing white blood cells and when these attach in turn transforms them too. Activated white blood cells start pushing their way between endothelial cells to move into the tissues behind (a process known as ‘extravasation’) and once there become totally transformed into prize fighters, including the ‘big eaters’ or macrophages.

In many long-term inflammatory problems endothelial dysfunction has been identified as a core factor exacerbating this initial response. This applies to overt inflammatory diseases like rheumatoid arthritis (6) as well as chronic metabolic and circulatory inflammations associated with cardiovascular disease (7), diabetes, dementia and neurological diseases (8). Endothelial dysfunction is increasingly implicated as a factor also in serious Covid-19 infections (9).

Most plants support endothelial integrity. Many do this through increased nitric oxide activity (10). Especially useful plants are spices and any with high polyphenol content, such as red or blue fruits, cocoa, hawthorn, and turmeric (see below). Our exemplar here is green tea.

Anti-inflammatory alternative: Green tea

This most popular drink in the world is also stacking up impressive research credentials in reducing inflammatory markers and signs associated insulin resistance, body weight, raised fat levels, type 2 diabetes and notably cognitive function. These are all chronic inflammatory states and the key role of green tea is to protect endothelial integrity in the face of such long-term stress (11,12,13).

In the Nativity story the three wise men bear gifts for the baby Jesus. Interestingly two of these most valuable commodities were resins: frankincense and myrrh, having in effect twice the heft of gold! These resins featured also in another Biblical story when King Solomon took the Queen of Sheba as his wife, so conveniently gaining access to the world’s centre of resin production in East Africa.

Powdered myrrh (guggul) was history’s most powerful antiseptic, used in wound dressings and also to mummify (ie stop the putrefaction of) dead bodies. Frankincense (boswellia, olibanum) was used more for its powerful aroma, to be burnt in religious ceremonies, but was also used as a medicine, especially for the gut and lungs.

Other popular resinous medicines were propolis (from bees), Balm of Gilead (another Biblical remedy), liquidamber, and from South America Tolu balsam. Most of these were used particularly in the mouth and throat.

Resins are insoluble in water and it was only with distillation of alcohol that liquid versions became available. However with the invention of glass their use fell into decline, especially by the analytical scientists arriving several hundred years ago, as resins notoriously coat glassware and can ruin expensive laboratory equipment.

So from being the most valued commodities resins almost disappeared from attention. However herbal practitioners never lost their respect for these remedies. High-alcoholic resin extracts are perhaps the most powerful gum, mouth and throat remedies available. As well as having a direct antiseptic activity their most striking impression is that they mobilise local submucosal white blood cell defences.

This is most noticeable in the throat and resinous solutions can transform throat inflammations, reducing pain, swelling and being ideal treatments when there are swollen lymphatic glands in the neck. This latter effect gives these remedies powerful benefits for a wide range of associated upper respiratory conditions. A practical point to note is that these resins are best combined with a strong licorice extract (see below) as this has the interesting property of helping the resins stay in solution when water is added; they also make the resinous taste more palatable.

Although resins are likely to be relatively easily denatured and dissipated further down the gut, one of them, frankincense/boswellia in relatively high doses is traditionally used here.

Anti-inflammatory alternative: Boswellia

Long used in Ayurvedic medicine in the treatment of arthritic and lung inflammatory conditions as well as in the gut, boswellia has attracted new research interest. There is growing evidence that this resinous remedy has appreciable effects in modulating inflammation through the body, including in relieving osteoarthritis (14).

There are also laboratory studies that demonstrate that other constituents, boswellic acids, inhibit inflammatory enzyme 5-lipoxygenase (LOX): this makes them distinct from and safer than COX-inhibiting NSAIDs like iboprufen (15).

In traditional medical language inflammation is a defence measure that involves the body heating up an area so as to eradicate an intrusion (often classified as ‘cold’). In other words it is a vital and essentially healthy response to a threat. Fever is understood in the same way.

So as indicated above, the traditional approach starts with supporting the inflammation and even adding more heat. However it was also easily understood that the healthy response could overshoot and the vital response could become harmful.

Here ‘cooling’ remedies were considered. These have a dangerous edge to them as too much cooling was always seen as harmful (the ultimate cold body is the corpse) and many of the remedies used in extreme conditions were suppressants, or even poisonous in quantity.

However one major group of cooling remedies were exalted for their non-suppressant qualities: the bitters.

Bitter remedies were universally classified around the world as ‘cooling and drying’, applied particularly to ‘hot/damp’ conditions. Translated this meant that they were particularly appropriate for infective or inflamed conditions affecting the digestive system and particularly the liver. Bitter remedies were therefore go-to treatments for hepatitis, food poisoning, gut infections, appendicitis etc.

They were also standard fever management tools, cooling excessive temperatures, especially where the fevers were linked to the gut. Many of them have reputations for relieving inflammatory conditions throughout the body, such as the use of berberine-containing remedies like barberry, Oregon grape, coptis and golden seal internally in skin disease, urinary and respiratory conditions, and the widespread use of the wormwood (Artemisia) family for chronic infective and inflammatory conditions. Our choice here however is Andrographis.

Anti-inflammatory alternative: Andrographis

The Ayurvedic ‘king of bitters’ is renowned as expected for its digestive effects, being a classic bitter digestive stimulant. However it was also used for a much wider range of inflammatory conditions around the body, in the urinary tract, respiratory system and skin and joints. Recent evidence has focused on its benefits in managing upper respiratory infections (16).

Probably the first use of plant remedies was as wound dressings, and plants often contain very useful soothing and healing constituents. Mucilages, gums and tannins all have direct physical effects on exposed tissues. Gums and mucilages add their own soothing mucus layers where a surface is dry and inflamed. Tannins actually knit the exposed proteins to form a leather-like seal.

Any herbs with high levels of these constituents will be suitable to contain an inflammation on the skin, on accessible mucosal surfaces and also on the lining of the digestive tract. Classic mucilaginous remedies like slippery elm, aloe vera and gum Arabic, and the tannin-rich witch hazel, meadowsweet, and for external use only, oak bark and galls and comfrey are all effective. Such effects are transient but except for the risks of heavy tannin consumption the repeated use of such remedies can help keep the relevant inflammation contained.

There is one soothing remedy that is not based on these constituents that however earns its star-rating in the soothing category.

Anti-inflammatory alternative: Liquorice

One of the most widely used remedies in traditional medicine, the various species of licorice contain soothing saponins with interesting physical properties on mucosal surfaces (17), that includes reducing surface inflammation (18).

A version of liquorice was long used as a prescription medicine for peptic ulceration before the arrival of H2-blockers, again for its interaction with mucosal physiology (19), and there is new evidence for benefits there, possibly including in managing Helicobater pylori infections (20).

The mucosal properties of liquorice are also apparent remotely in its extraordinary reputation in inflammatory conditions of the respiratory tract, where it appears to act amphoterically to reduce both dry (including asthmatic symptoms) and congested bronchial conditions. Liquorice has widespread application to other inflammatory problems, including liver disease (21), and potentially much more widely (22).

No review of alternatives to anti-inflammatories could be complete without turmeric and an introduction to the likely critical role of a healthy gut and microbiome. A healthy gut population is increasingly cited as key to healthy inflammatory responses around the body and in preventing against inflammatory diseases (23).

Anti-inflammatory alternative: Turmeric

Turmeric brings another important dimension into the work to reduce inflammatory damage: its effects in the gut. There is certainly evidence of wide ranging effects around the body (24). 

Much of the impact of turmeric and its curcuminoid constituents is in the gut, particularly given the poor absorption of curcumin. This includes importantly a likely reduction in the absorption through the gut wall of disease-causing inflammatory metabolites, lipopolysaccharides, from gut bacteria (25,26).

Turmeric is also a significant prebiotic (27,28,29), not by providing food for healthy gut flora but apparently engaging in the crosstalk between gut wall, bile and the bacterial population (30). As well as having local benefits in managing inflammatory bowel disease (31), these effects in the gut are implicated in the systemic activity of turmeric and curcumin (32).

1. Malanga GA, Yan N, Stark J. (2015) Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 127(1): 57-65. doi: 10.1080/00325481.2015.992719
2. Randall C, Randall H, Dobbs F, et al. (2000) Randomized controlled trial of nettle sting for treatment of base-of-thumb pain. J R Soc Med. 93(6): 305-9. doi: 10.1177/014107680009300607
3. Wilson PB. (2015) Ginger (Zingiber officinale) as an Analgesic and Ergogenic Aid in Sport: A Systemic Review. J Strength Cond Res. 29(10): 2980–2995
4. Al-Nahain A, Jahan R, Rahmatullah M. (2014) Zingiber officinale: A Potential Plant against Rheumatoid Arthritis. Arthritis. 159089
5. Grzanna R, Lindmark L, Frondoza CG. (2005) Ginger – an herbal medicinal product with broad anti-inflammatory actions. J Med Food. 8(2): 125–132
6. Yang X, Chang Y, Wei W. (2016) Endothelial Dysfunction and Inflammation: Immunity in Rheumatoid Arthritis. Mediators Inflamm. 2016: 6813016. doi: 10.1155/2016/6813016
7. Endemann DH, Schiffrin EL. (2004) Endothelial dysfunction. J Am Soc Nephrol. 15(8): 1983-92. doi: 10.1097/01.ASN.0000132474.50966.
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Allergies (also known as “hypersensitivities”) are due to overreactions of the immune system to substances that do not necessarily elicit immune responses in the majority of people. Hypersensitivities are grouped into four types: I, II, III and IV. These groupings are based on which white blood cells (WBCs) and tissues of the immune system are activated and how long it takes for a reaction to occur.

The two types of hypersensitivities that are referred to as allergies, are type I or ‘immediate’ hypersensitivities, and type IV or delayed type hypersensitivities (DTH).

The cells and pathways involved in type 1 hypersensitivities are mast cells, IgE and the release of histamine. An antigen induces the formation of IgE antibodies, in individuals with an atopic predisposition, via B lymphocytes. Reactions occur only after a requisite initial exposure, in which the primed mast cells bind IgE and start the degranulation process. This commonly involves the respiratory, gastrointestinal and/or the skin and occurs within minutes to hours.

In type IV hypersensitivities, or DTH, instead of involvement of the antibody IgE, T lymphocytes are involved and the onset of symptoms take hours to days to appear. CD4⁺ , T helper cells, in response to haptens (small antigens), release cytokines/chemokines which can recruit macrophages to a site (such as in the tuberculin-type response due to a TB test) inducing local inflammation.

In the case of Type IV interactions the immune system does not need to be primed but does go through a sensitization phase. The outcome is acute inflammation and possibly edema. The skin is often the obvious site of DTH reactions (redness, swelling, hardening of the skin, rash, dermatitis).

The PPARs constitute a set of three receptor sub-types which are members of the nuclear receptor superfamily of ligand-activated transcription factors. They are encoded by distinct genes that function as lipid sensors that regulate gene expression in many metabolically active tissues (6).

The PPARs, so named because in early research it was found that PPAR-δ stimulation resulted in the increase in peroxisomes, have a significant role in cellular energy balance, fuel utilisation, the metabolism of fatty acids and other lipids, the generation and remodeling of adipose tissue and fibrotic and hypertrophic responses in the heart and vascular wall.

Many of these actions are via interactions with nuclear factors such as NFκB, NFAT and activator protein 1 (AP-1), thus modulating expression of pro-inflammatory cytokines and adhesion molecules, and altering cell signaling pathways (7,8). Thus, PPARs, in response to stressors, play a role in the complex orchestration of adaptive cellular physiology working in a concerted mode with the vitamin D receptor and the retinoic acid receptor (RXR).

PPARs have been found to be involved in inflammation and carcinogenesis, and other immune activity. Thus, many pharmaceutical companies have been involved in PPAR research in search of the perfect ligand in areas such as diabetes, obesity, cardiovascular disease and immunology with drug development in mind.

The endogenous ligands to the PPAR sites were originally unknown, earning the PPARs the name “orphan nuclear receptors”. Key to this discussion, PPARγ plays a significant role in allergic response, specifically PPARγ (9-15).

The high-affinity IgE receptor Fc epsilon RI (FcεRI), found on mast cells and basophils, plays a central role in IgE-mediated inflammatory reactions. PPARγ agonists have been shown to inhibit the expression of CD117 (tyrosine-protein kinase KIT or mast/stem cell growth factor receptor) and FcεRIα (9,11), and the maturation of bone marrow‑derived mast cells, as well as inhibiting the formation of granules and reducing the expression of β‑hexosaminidase (a marker of mast cell degranulation) and induce mast cell progenitor apoptosis (9).

Finally, a reduction in mast cell histamine content (15), histamine release (11,15) and suppression of body temperature increase in anaphylaxis models has been documented (12). Human trials of PPARγ agonist on patients with atopic dermatitis has demonstrated a decreased total body surface area involvement, severity of lesions, and number of flares with PPARγ agonists (16).

In allergic asthmatic patients a down-regulation of PPARγ expression has been observed in lung tissue (17,18) and noted to be a potential factor in dysregulation of pulmonary homeostasis (17). While in steroid resistant asthmatic smokers an inhaled PPARγ agonist has shown improvements in lung function superior to steroid inhalation (19).

Human data in a month long double-blind randomized controlled trial, with a PPARγ agonist vs. placebo reduced the late asthmatic response by 15% and a reduction of exhaled nitric oxide by 14% (20). Another double blind RCT of a PPARγ agonist in severe asthmatic patients was found not to have a positive outcome (21).

While PPARγ as a pharmacological target has strong preclinical data, the evidence in clinical trials is not robust. It may be that PPARγ needs concurrent support by engaging other pharmacological targets within a physiological network of allergic reactions. Intriguingly, PPARγ is now considered part of the endocannabinoid system (22-26).

The CB2 receptor is a G protein-coupled receptor located on T & B lymphocytes, as well as natural killer cells, macrophages, neutrophils and mast cells (27). The CB2 receptor has been found to play a significant role in immune dynamics including the resolution of inflammation, cancer, atherosclerosis, osteoporosis and chronic pain (28). The CB2 expression in lymph nodes and spleen is higher than in peripheral blood cells and is different in various immune cell populations; B cells > NK cells > monocytes > neutrophils > CD8 T-cells > CD4 T-cells (29,30).

CB2 is a particular attractive for cannabinoid agonists selective for this site because of a paucity of psychomimetic activity. Nonetheless, in the face of remarkable volumes of preclinical data, only one CB2 potential drug molecule (cannabinor) has made it to phase II clinical trials (31). Other human data comes from marijuana smokers provide insight as to the effects of CB2 ligands on immune function. Lung alveolar macrophages removed from marijuana smokers have diminished capacity for the generation of TNF, gmCSF and IL-6 (inflammatory cytokines) (32).

Notably, CB2 ligands have demonstrated the inhibition of FcεRI-induced degranulation in mast cells in a concentration dependent manner. GPR55 (a putative CB3 receptor) also appears to show the same effect. CB1 appears not to have a role in inhibition of mast cell degranulation (33).

CB2 agonist have also shown a role in the retention of immature B cells in the bone marrow (34) and demonstrated a significant decrease in CXCR4 (a chemotactic chemokine) in bone marrow cells (34). CB2 is involved in the inhibition of lymphocyte recovery after bone marrow transplantation as well (35).

Other data suggest that cannabinoids can inhibit the production of TNF and other cytokines by several different pathways, some independent of cannabinoid receptors (27). Conversely, cannabinoids have also been shown to increase the production of cytokines (including TNF, IL-1, IL-6, and IL-10) if administered with appropriate immune stimulation (bacteria or antigens) (27) or, in some cases, without immune stimulation (36). Challenging a common misconception of CB2, this strongly suggest true immunomodulation and not simple immunosuppression.

The use of herbal remedies as a substitute for medical care is growing rapidly (37). An observation by this author is that in the United States, due to lack of s public health care system, every recession is accompanied by an increase in the sales of natural products. This is likely due to health insurance being tied to employment. As U.S. citizens lose their jobs, they also lose their health insurance.

Intriguingly, laboratory studies suggest that in some cases the overall pharmacological effects and therapeutic efficacies from medicinal plants may not derive from a single compound but from several compounds generating synergic activity (38-42). Synergy as a pharmacological construct, is often cited as a general mode for the biological activity of these compounds (38-43).

Preparations of Echinacea spp., have been used for more than a century for treatment of a variety of infections (44). More than 3 million physician prescriptions for Echinacea preparations are written annually in Germany (45) where there are more than 800 Echinacea products on the market (46). Most preparations are derived from the aerial parts of E. purpurea and underground parts of E. purpurea, E. angustifolia, or E. pallida (47).

Although controversial, the Echinacea spp. are often used interchangeably for the treatment of colds, flus, respiratory infections, and inflammations (48). Echinacea is documented to have immunostimulating, anti-viral, antibacterial, antifungal, insecticidal properties and anti-inflammatory properties (47,49).

Despite some negative outcomes in a few clinical trials using echinacea to treat upper respiratory infections, there are enough positive data in the human trials to offset the negative results. As a result, the meta-analyses that have been performed suggest that Echinacea products are effective (50-53).  A Cochrane review reports some Echinacea preparations may be better than placebo and that the majority of the Echinacea studies demonstrate positive results (51).

A meta-analysis by Schoop et al. (52), reports that standardised extracts of Echinacea were effective in the prevention of symptoms of the common cold as compared with placebo. Islam and Carter (53) conclude that there is a beneficial effect from Echinacea, but also suggest that differences in products and doses make evaluation challenging (51).

Linde et al. (50) suggest that there is evidence, although inconsistent, that Echinacea is effective in treating URIs. A meta-analysis of studies with children  (< 18 y/o) found that Echinacea reduces the incidence of URIs by 40% (54). Finally, the most recent meta-analysis finds that the evidence supports Echinacea’s benefit in decreasing the incidence and duration of the common cold in adults (55).

Echinacea’s effectiveness is believed to be related more to the enhancement of innate immunity, rather than antimicrobial activity (49,56) The stimulation of innate immunity by Echinacea extracts are well established (57-65). Studies have reported that echinacea extracts have the ability to activate human phagocytic function both in vitro and in vivo (58,59,61,66-68). Additionally, the plant has shown ex vivo immune stimulation in human immunodeficiency disorders (60).

The immunomodulatory effects are believed to be mediated by induction of cytokines from macrophages and antioxidant activity (49,69). However, some people, mostly those who are not experienced with the clinical use of echinacea, believe that echinacea products are simple immunostimulating and as such, would be contraindicated in an attenuating an acute immune response. Only recently has basic research supported a biphasic response, clinicians who have extensive experience with echinacea preparations have been aware of this for many decades.

The search for endogenous ligands for the cannabinoid receptors has led to the discovery of several polyunsaturated compounds derived from fatty acids, mostly arachidonic acid (70).  These fatty alkylamides, although not as widespread as other classes of natural products, are relatively abundant in plants, and occur in a variety of families, including the Asteraceae, Brassicaceae, Leguminosae, Piperaceae, and Rutaceae (71). Examples of plant species containing alkylamides similar to those of Echinacea spp. can be found in Spilanthes and Zanthoxylum species (28).

The alkylamides found in echinacea species and other medicinal plants, have been of pharmacological interest since humans first noted the tingling and numbing effect from chewing plants rich in these compounds (72).

The anaesthetizing tingling of these compounds is associated with activation of tactile and thermal trigeminal neurons (73). This property was utilized by native Americans (74) and eventually by physicians in the early 20^th century for a variety of purposes including toothache and infections (75). Alkylamides were later recognized as insecticidal by a number of researchers (72,76-78) but eventually interest in these compounds waned. Nevertheless, these fatty acid derivatives have become a subject of renewed interest in the last few decades due to their recent identification as cannabinoid ligands (28,79-81).

The endogenous cannabinoid ligands are the fatty acid metabolites, known as eicosanoids (82). These endocannabinoids (e.g. anandamide from the Sanskrit term “ananda,” meaning bliss and 2-arachidonoyl glycerol) are structurally similar to the alkylamides, which are also fatty acid derivatives, and show nanomolar affinity for the type-2 cannabinoid receptor (CB2).

The affinity of the alkylamides for the CB2 are in the same range as the endogenous ligand anadamide (79). Research supports this, E. purpurea extracts demonstrate that particular isobutylamides modulate TNF mRNA expression in monocytes via CB₂ receptors (79,81). Alkylamides binding to CB2 increased IL-8 and monocyte chemoattractant protein, both proinflammatory proteins (79).

This may offer new insight into not only the mode of activity of Echinacea, but also immunology. Nadja Cech’s group, in collaboration with Bastyr University demonstrated a typical cannabinoid response from both extract and alkylamides of Echinacea; select isobutylamides from E. purpurea  inhibited IL-2 expression in T-helper cells (83). Additionally, recent work demonstrates a T_H-biasing effect, in which T_H1-cell activity is suppressed and T_H2-cell activity is increased (80). The cannabinoids show the same effect and this makes a case for the treatment of chronic inflammatory diseases by CB2 ligands (27).

Some have suggested since alkamides have anti-inflammatory activity, this is the primary effect of echinacea preparations (84). Anti-inflammatory activity has been verified through the inhibition of cyclooxygenase and 5-lipoxygenase (47) and the inhibition of IL-2 (83). Nonetheless, there is quite a collection of peer-reviewed research that shows immunostimulation by echinacea extracts and its compounds (57-68).  

As for echinacea and PPAR activity, in the author’s hands, we observed inhibition of IL-2 via PPARγ activation (85). We also found that a large number of the alkylamides across the spectrum of unsaturation that differentiate this class of compounds activate PPAR (89). 

Previous research has also demonstrated that Echinacea extracts inhibit mast cell degranulation. The authors of this research concluded that inhibition of mast cell activation coupled with the well-established inhibition of proinflammatory cytokine effects by alkylamide rich Echinacea extracts suggest utility in allergic diseases (90).

The alkylamides are not the only active constituents. There are other compounds in the Echinacea spp. that deserve mention. Three other constituent groups have shown activity; the hydroxycinnamates (caftaric acid, caffeic acid, chlorogenic acid, cichoric acid, cinnamic acid, cynarin, echinacoside etc.), polysaccharides, and glycoproteins (91,92).

Another phytocompound found in Echinacea, as well as cinnamon, clove, rosemary and black pepper, and such medicinal plants as Bidens pilosa, Angelica archangelica and Apium graveolens, isβ-caryophyllene (BCP), a sesquiterpene. BCP is considered a phytocannabinoid as it binds CB2. Research shows that via a CB2 mode of activity BCP has demonstrated significant cardioprotective effects in preclinical research in induced myocardial infarction models. Notably, BCP reduced the myocardial expression of inflammasome proteins including NLRP3, procaspase-1 and pro-IL-1β via TLR4 mediated NF-κB/MAPK signaling in CB2 dependent manner. Moreover, BCP enhanced the expression of the CB2 receptor and PPARγ and activated myocardial CB2 receptors resulting in the mitigation of oxidative injury (93).

Considering the number of phytochemical families that are active, the explanations of the effect of Echinacea include suggestions that the activity may be due to an entourage effect (85). There has also been in vitro antioxidant activity demonstrated by the hydroxycinnamates for both E. purpurea and E. angustifolia extracts (94,95). However, antioxidant activity will be addressed in the next section on Taraxacum officinale.

One of the most ubiquitous medicinal plants, dandelion (Taraxacum officinale) is well-known as a food due to its rich content in nutrients. Although considered by many to be an annoying weed, every traditional culture that has a native Taraxacum species has found medicinal use for this versatile genera (97). Unfortunately, dandelion is often overlooked due to is prevalence. An initial clue into its medicinal properties is provided by the name Taraxacum which is derived from the Greek words “taraxis” for inflammation and “akeomai” for curative (98).

Moreman (74) reviews use of dandelion by various tribes of the native North American culture shows use various parts of the dandelion for food and medicine. For example, the spring stems and leaves were used as vegetables and eaten to build the blood for conditions such as anemia and as a laxative-tonic, while decoctions of the roots were taken for stomach pain and to produce postpartum milk flow. Infusions of leaf and root were taken for kidney trouble and dropsy and used as a bitter tonic, the flower blossoms were taken for menstrual cramps.

In traditional Chinese medicine Taraxacum mongolicum is thought to have activity in a variety of health benefits (99), this includes clearing heat, especially of the liver and urinary tract and to promote lactation (100). In traditional Ayurvedic medicine T. officinale is used similarly as in TCM and said to be valuable in liver disorders and a useful diuretic (101) and to clear heat (102). An early 19^th century reference suggests that Taraxacum was used for chronic inflammation, digestive problems, as well as cirrhosis (103).

Although the diuretic properties are well known and recently observed in the first human trial (104), this brief overview will focus on the immune properties of dandelion.

The anti-inflammatory activity of dandelion is most likely partially due to its antioxidant activity and its hepatic activity. Recall that the liver is a key lymphatic organ with the largest population of fixed macrophages (Kupffer cells) of any bodily tissue and is therefore influential on the reticuloendothelial system and immune response.

Much of the traditional use of dandelion has supported hepatic activity for dandelion, indications such as liver and/or gall-bladder inflammation and stasis, cholelithiasis, metabolic toxicity, jaundice, hepatitis, and dyspepsia secondary to deficient bile secretion (105).

Medicinal plant preparations in general that have hepatic activity are likely to also influence Kupffer cells, although in varying degrees. This obviously can lead to immune up or down regulation. As a hepatic anti-inflammatory, dandelion, at least in clinical observations, appears to also have a systemic anti-inflammatory effect.  Phenolic compounds are believed to provide some of the anti-inflammatory activity (98).

A large portion of the research on the activity of dandelion has focused on the antioxidant activity (99,106-109). Past research reports significant antioxidant activity, typical for polyphenol rich plants, and inhibition of inducible nitric oxide synthase (iNOS), as well as synergic activity with other micro and phyto-nutrients such as the ubiquitous catechins and ascorbate (99,106,107).

Sumanth and Rana (108) confirmed an antioxidant effect and observed increases in the levels of superoxide dismutase, catalase and glutathione using a hydroethanolic preparation. Zhu et al (109) using a hydroethanolic extract, confirmed Rana’s results in finding increased superoxide dismutase, catalase, glutathione levels along with peroxidase levels and also found reduced lipid peroxidation.

Hu and Kitts (99) demonstrated protection of cells from peroxyl-radical-induced intracellular oxidation speculating that the protection may have been the result of scavenging of intercellular and intracellular peroxyl radicals by a phenolic rich extract from dandelion flowers. This team also showed a synergic effect with α-tocopherol and a 40% ascorbate equivalence which they believed was responsible in regenerating the α-tocopherol. Thus, dandelion’s antioxidant activity is established.

Antioxidant activity has generally been accepted to be a mode of activity for immunomodulation (110-112). Both anti-inflammatory and antiallergic properties are known to be induced be particular antioxidants (113). The reduction/oxidation (redox) reactions that are crucial to immune function can lead to tissue damage, allergy and autoimmune diseases if balance in this system is lost. 

Research has confirmed that polyphenols can make improvements in the overall redox status of immune cells (114). In compromised subjects (aged or diseased) this can lead to enhancements in such functions as chemotaxis capacity, microbicidal activity, lymphoproliferative response to mitogens, interleukin-2 (IL-2) and tumor necrosis factor (TNF alpha) release (111).

For example, in preclinical (in vivo) models many of the gallate derivatives have exhibited inhibition of histamine release from mast cells (murine model) (112). Additionally, the catechins are known to significantly inhibit type IV allergies in murine models (110). Finally, kaempferol has shown positive effects on IL-4 and JAK3-dependent responses suggesting that compounds rich in this compound may have positive influence on allergies, autoimmune conditions and cancer (115).

Another pathway where dandelion has exhibited activity is in the nitric oxide (NO) pathway. NO is an important effector molecule that plays a role in the majority of the steps of inflammation, and if unchecked, can also lead to tissue damage, inflammation and is involved in allergic response (116). Taraxacum extracts and individual constituents have demonstrated inhibition of inducible nitric oxide from immune cells (99,117).

It must be kept in mind that many of these effects are based on in vitro and in vivo preclinical research. Regardless, the bottom line is that in the previously mentioned cases the treatments with echinacea and dandelion were effective. From an energetic model of medicine many of the pathways discussed can be seen as leading to a reduction in the “heat” of a system.

That is, the inflammatory process is interrupted or reduced and therefore the overall effect of this process can be seen as “cooling” the inflammatory processes. Considering the combination of E. purpurea extracts and T. officinale extracts we have multiple modes of activity including affecting key messenger molecules (see Table 1). The alkylamides via CB2 may down regulate cytokine production. Additionally, the inhibition of cyclooxygenase and lipoxygenase, as well as antioxidant activity, are likely responsible for the effects in the patients discussed above.

Hydroxycinnamates, present in both plants, especially cichoric acid and caffeic acid are some of the most efficient antioxidants from natural sources (118). Additionally, direct activity on mast cell degranulation is a strong possiblity, considering the modes of activity of CB2 and PPARγ and the speed in which these patients recovered from an acute hypersensitivity.

An interesting thought lies in the potential of the improvement in other tissues and biochemical pathways influencing hypersensitivities that extracts of T. officinale radix and E. purpurea radix may have. In other words, this likely served as more than a treatment for downregulating an immune process.

Rather, there were likely beneficial effects related to other activities, and other undiscussed constituents of the plants that are still unseen. As the late, great herbalist Michael Moore once said “the advantage of medicinal plants is that they are broad spectrum and naturally dilute. The disadvantage of medicinal plants is that they are broad spectrum and naturally dilute.” 

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The temperature and humidity of the climate fluctuates from season to season, day to day and during the day night cycle. It is also markedly different according to which geographical region we live in. Despite all of these fluctuations, the body must maintain its own balance between extremes of heat and cold on the one hand and dampness and dryness on the other. Temperature and fluid balance profoundly affects flow.

Temperature: Heat and cold

Did you know that you can hear the difference between hot and cold water? Try it out, in a blind test, have a friend pour hot water into a cup and cold water into a cup and ask you which is which, ten times out of ten you will give the right answer. This is something that we know but we don’t know we know!

It is a knowing we aren’t necessarily aware we have. But why do they sound different? They sound different because temperature affects the viscosity or ‘thickness’ of the water. At low temperatures, water is more viscous and flows slower and less freely. At higher temperatures it is less viscous and flows faster and more freely. This is easier to see in a thicker substance like honey.

Our blood is a fluid and it obeys these same principles. If our body fails to maintain a warm enough temperature, the Chinese observed that ‘flow’ or circulation of fluids start to ‘congeal’ and flow less smoothly. If the solution to inflammation is promotion of flow, then restoring this flow is key. If the fluids of the body are cold, then quite simply, we need to warm them up.

One of the first herbs we will go to when blood is not flowing due to cold is Cinnamon. Cinnamon is spicy sweet and warm. It also has an amazing ability to promote flow out towards the limbs and extremities. The spiciness invigorates the flow of blood and the sweet flavour harmonises.

If there is chronic stagnation of flow in the blood from cold over a period time, this can lead to a more entrenched stagnation. One might think of how a river can start to get silted up and blocked over time. When the water stands still, it stagnates. In this kind of situation, we need something not only to warm the flow and invigorate the blood, but also to go a little deeper and stir up the metaphorical silt sitting at the bottom.

And now we get to solve ‘the turmeric paradox’. Turmeric is spicy and warm, but it is also bitter. The warmth and spiciness, like Cinnamon, warms and invigorates the blood. However, the bitterness drives the effect deeper and has a ‘dredging’ effect. In the Chinese materia medica it is said to have the ability to disperse clumping in the circulation.

So, turmeric powerfully restores flow and through this helps reduce inflammation. In the right circumstances, it does this in the best way. Instead of suppressing the natural inflammatory healing response, it assists it and makes it more efficient.

Chronic blood stagnation is one of the most common effects of ageing. As we age, our constitutions weaken and so does our circulation. Over time, the circulation of blood stagnates, so much so that it can be visible to the eye, for example with varicose veins. This makes turmeric an ideal tea for the elderly.

Turmeric actually came later on to the Chinese pharmacopeia, with its origins in Central Asia and long being used by Ayurveda and Middle-Eastern medicine traditions. However, when it arrived, brought to China along the Silk Road, the Chinese embraced it, classified it and it quickly became a frequently used herb within the medicine.

Too much heat in the blood can also affect circulation. Heat can cause the blood to move ‘recklessly’ and to flow outside of the vessels. It can also dry the body out and cause dehydration. For this reason, Chinese medicine also uses cooling herbs to treat flow. However, we are warm-blooded mammals with a necessity to keep our body temperature elevated against the forces of nature.

Consequently, we must always be careful not to cool the body down too much and lose the root of our energy. For this reason, Chinese medical practitioners prescribe herbal formulae and balance the temperature by combining both warming and cooling herbs.

Fluid balance: Dampness and dryness

We probably all know someone who had terrible chronic aches and pains in the body and then they went on holiday and they all disappeared. The UK has a damp climate. Excessive dampness obstructs flow. If someone suffers from pain caused by excessive dampness and they go to a hot dry country, perhaps to a desert environment, the climate becomes the cure.

In Chinese medicine, there are countless different ways we can deal with damp in the body: we can give herbs to transform it; to dry it; to leach it out through the urine; to take it out through the bowel; to disperse it; or even in some cases, to sweat it out. By getting diagnosed from a well-trained practitioner, they can make a nuanced decision in choosing the correct strategy to deal with the damp in the body.

Even though there are many different herbs and strategies to deal with damp, there is one which is used in everyday cooking in China that is very safe, very effective and has a wide variety of applications. Its Chinese name is Yi Yi Ren and it is variously called Job’s Tears, Coix seed or Chinese pearl barley in English. It has a bland taste.

Bland foods sometimes have the ability to ‘leach’ damp out through the urination. You can cook with it and put it in your food or you can boil it in water and drink it as a tea. The Chinese consider it particularly effective in treating damp that lodges in the joints.

One of its great benefits is that it not only drains damp, but also clears stagnant heat while at the same time having a nourishing quality. This gives it a very balanced effect. It is a medicinal which is very often found in damp type pain conditions.

Dryness causes the blood flow to stagnate, just as water lacks the power to flow when there is insufficient amounts. For dryness, we can use the sweet flavour to moisten and the sour flavour to astringe and help retain the fluid we have. A classic Chinese medicine combination for pain is to bring together the sweetness of licorice root with the sour, bitter, cool but nourishing quality of white peony root. These two herbs combined are one of the most famous two herb combinations for pain, particularly when the cause is lack of fluids.

Just getting started… This is a brief introduction to Chinese medicine thinking on how herbs influence flow but there are so many more factors that Chinese medicine practitioners consider.

The Chinese understood that the body has a mechanism to open and close towards the exterior. If its cold the pores will close down and warmth and fluids will flow more interiorly to protect the internal organs. If it is hot the pores open and warmth and fluids flow to the exterior to help the body cool down.

If this opening and closing of ‘the exterior’ of the body becomes unregulated it can also profoundly affect the quality of flow in the body and the temperature and fluid balance. Chinese medicine has innumerable tomes just dedicated to this question and how to address these imbalances with different herbs and formulae.

Opening, exterior releasing, sweat promoting herbs tend to be spicy like ginger and cinnamon. Closing, exterior consolidating herbs tend to be sour like white peony root. When you pair these herbs together they balance opening and closing and regulate the exterior. Now you know why ginger, lemon and honey is so good for colds!

You can use this spaImagine for a moment, something that makes you really angry, properly furious. Now become aware of your physical body. You may be aware that you are clenching muscles up and down the body, your heart rate may have gone up, you may feel hot, flushed and red in the face, mind racing.

Emotions have a tangible and profound effect on flow in the body and effect everything from our internal organs to the blood circulation. If emotions are unregulated, either over-expressed or repressed, they constantly through our physiological balance out. Many Chinese herbs have profound effects on our emotions through re-establishing flow.

Many of these herbs have powerful aromas that harmonise the mind but also move our qi. When our qi moves, our blood moves. Examples of these would include mint, rose or jasmine.

Many diseases and ailments also cause inflammation, pain or discomfort. Constipation can cause heat, dryness and stagnation in the body. Diabetes can cause peripheral neuropathy, numbness in the extremities. The after effects of severe colds and flus can lead to chronic pain as is being seen worldwide in the now common presentation of ‘Long Covid’. The skilled diagnosis and intervention of a Chinese herbalist can at the least ameliorate the symptoms of these internal conditions but in many cases get right to the root of them and restore the whole body back to balance.

So far we have only talked about taking herbs internally. However, herbs are just as often used as externally applied oils, creams and pastes especially when treating pain. They are most commonly added to a base of Camphor and Menthol.

Camphor is very warming and Menthol is very cooling. Which creates a powerful dynamic. They are both also very aromatic. Aromatic herbs ‘penetrate’ deeply into the tissues and they also powerfully move stagnated fluids. Different herbs are added to this base to create different effects; some more warming, some more cooling; some more draining and drying, some more nourishing.

Please note: Camphor and Menthol are powerful ingredients and should only be prepared by professionals. Camphor is only suitable for external use and should not be taken internally.

The number of Chinese herbs in active use is enormous, each with their own character and specific uses. When combined together into different formulas, they can be tailored to have highly specific effects particular to individual patients’ needs. The Register of Chinese Herbal Medicine (RCHM) requires high quality degree-level qualifications for membership assuring the public that the practitioner can provide a skilled, professional and safe service. RCHM practitioners also use herbs from approved suppliers that are checked for safety and quality on the one hand and ethical sourcing. No animal products or endangered species are used.

Chinese herbal medicine has successfully been used to treat pain conditions, from the mild to the severe, from the acute to the chronic for thousands of years. It is our hope that we can raise awareness of the great depth of practice that it has to offer.

If you would like to find out more about herbal medicine in the UK or find a practitioner, you can visit the Register of Chinese Herbal Medicine at www.rchm.co.uk. You can also follow us on Facebook at https://www.facebook.com/RegisterofChineseHerbalMedicine.

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Echinacea (Echinacea spp., Asteraceae)

Preparations made from aerial and root parts of echinacea, mainly E. angustifolia and E. purpurea, are popular and scientifically supported options for the prevention and treatment of the common cold. Echinacea extracts contain a mixture of compounds with cytokine-suppressing and -inducing effects, suggesting that echinacea extracts and alkaloids may be useful for treating allergic and inflammatory responses.

Echinacea extracts have also demonstrated immunosuppressive effects, which may be beneficial in COVID-19 patients where the inflammatory response is exacerbated. The risk of herb-drug interactions with echinacea is deemed low.

Elderberry (Sambucus nigra, Adoxaceae)

Elderberry juice has long been used as a diaphoretic in the treatment of the common cold. It also has immunomodulatory properties. Elderberry extracts have shown antiviral effects against influenza virus A and B in vitro and in human clinical trials. Despite these promising results, they cannot be extrapolated to suggest a positive effect in patients with COVID-19 as there are no scientific data available. The available evidence suggests there is a low risk of adverse effects when using elderberry before SARS-CoV-2 infection or in the early stages of infection.

South African geranium (SAG; Pelargonium sidoides, Geraniaceae)

SAG roots and rhizomes possess immunostimulant activity as assessed in several in vitro models. More than 30 clinical trials have been conducted with an SAG extract (Eps 7630^®; Umckaloabo^®; Dr. Willmar Schwabe GmbH & Co. KG; Karlsruhe, Germany) in the treatment of acute respiratory tract infections. The promising antiviral effects and strong safety profile of the extract warrant further clinical investigation.

Medicinal mushrooms and fungal preparations

Medicinal fungi are an expanding area of research, with oyster mushroom (Pleurotus ostreatus, Pleurotaceae); Ganoderma spp. (Ganodermataceae), chaga (Inonotus obliquus, Hymenochaetaceae); caterpillar fungus (Ophiocordyceps sinensis, Ophiocordycipitaceae); and maitake (hen-of-the-woods; Grifola frondosa, Meripilaceae) drawing the most interest.

Other mushrooms have been clinically studied with focuses on the treatment of cancers, immunological diseases, and immune-adjuvant therapy. Clinical and animal studies have demonstrated that the bioactive polysaccharides or polysaccharide-protein complex from medicinal fungi enhance innate and cell-mediated immune responses. Data with chemically well-defined fungal ingredients in COVID-19 patients are needed to evaluate whether specific fungi could be beneficial.

Adaptogens are natural compounds that increase the body’s adaptability, resilience, and survival in nonspecific ways. While more than 100 medicinal plants have been identified to possess apoptogenic activity, only a few have been shown to exhibit multitarget effects on the neuroendocrine-immune system.

These include andrographis (Andrographis paniculata, Acanthaceae), eleuthero (Eleutherococcus senticosus, Araliaceae), ginseng (Panax spp., Zingiberaceae), rhodiola (Rhodiola rosea, Crassulaceae), schisandra (Schisandra chinensis, Schisandraceae) and ashwagandha (Withania somnifera, Solanaceae).

In addition to affecting the immune response, the ability of these adaptogens to alleviate stress-induced mental and behavioral disorders is relevant as these conditions have increased due to the COVID-19 pandemic.

Licorice (Glycyrrhiza spp., Fabaceae)

Licorice spp., primarily Glycyrrhiza glabra, G. inflata, and G. uralensis, root contains bioactive compounds that possess anti-inflammatory and antiviral effects. β-Glycyrrhetinic acid, a metabolite of one of these components, may enhance the activity of hydrocortisone, suggesting that the coadministration may have a therapeutic effect in inflammatory lung diseases. More studies are needed to gain new insights on the potential role of licorice or its components in the treatment of COVID-19.

Turmeric (Curcuma longa, Zingiberaceae)

Curcumin, the main bioactive component of turmeric, has demonstrated activity against a variety of viruses by interfering with critical steps of the viral replication cycle. Curcumin also blocks cytokine release, which has translated to clinical improvements in animal models of diseases where a cytokine storm affects morbidity and mortality outcomes. Taken together, curcumin may theoretically be of benefit in COVID-19 pathophysiology and clinical manifestations.

Frankincense (Boswellia spp., Burseraceae)

Frankincense inhibits inflammation through the cyclooxygenase (COX) pathway. Most studies have reported moderate anti-inflammatory efficacy with frankincense as a mono-product and in combinations with other herbs, suggesting its use as a promising approach for the treatment of COVID-19-related inflammatory complications.

Salicylate drugs of botanical origin

A range of herbs contain salicylic acid derivatives. These include 

• Willow spp. Salicaceae
• meadowsweet (Filipendula ulmaria, Rosaceae)
• Birch (Betula spp., esp. Betula lenta, Betulaceae)
• Wintergreen (Gaultheria procumbens, Ericaceae) oil

While preparations derived from these botanicals are often used externally, there is no evidence for negative side effects in the context of COVID-19.

There exists no evidence that the immunomodulating herbs discussed here would exacerbate a cytokine storm, and herb-drug interactions are not expected.

Botanical drugs and supplements continue to gain interest from researchers as potential therapeutic agents for SARS-CoV-2 drug development. Still, research exploring the mechanisms of action and efficacy of these herbs in the content of SARS-CoV-2 exposure is needed. In either case, despite the lack of strong clinical data to support active recommendations, the current evidence suggests these botanicals are safe enough to permit use by the public with the appropriate caution.

The authors declare no conflicts of interest.

The general consensus is, unfortunately, that climate change and environmental factors stemming from it, such as air and chemical pollution, pesticides, insecticides, heavy metals, wildfires, soil quality degradation, longer flowering seasons due to heatwaves (hence longer exposure to pollen), all contribute to the rise seen in allergies in the recent decades. (2, 3, 4) Interestingly, plants growing in polluted areas with higher exposure to carbon dioxide also release more pollen. (4)

Air pollution is implicated in worsening allergic reactions in city dwellers especially, when the grasslands and thus the exposure to grass pollens in the cities are reducing in the last two decades. Cross-reactivity reactions predispose sensitive individuals to pollen and certain food allergies. (5)

Toxicity and oxidative stress

As external factors befall on wide population, it is clear that internal factors play a major and most likely the decisive role in individual susceptibilities in developing various allergies.

Exposure to toxins and allergens creates oxidative stress in the body, immune dysregulation and consequent inflammatory response. (6) For those individuals who have lowered antioxidant status in their tissues (because of lack of nutrients due to poor diet or genetic predisposition in detoxifying chemicals, toxins and heavy metals) this would add to their load of risk factors.

Gut, lungs and skin microbiome disturbances

Herbalists have always paid attention to gut integrity and the latest scientific research confirms the importance of gut microbiome in many inflammatory conditions, including allergies and asthma. (7) The significance of more recently discovered skin and lungs microbiome and its protective effects is also been investigated. (8)

Dysbiosis – a disturbed gut microflora, is the epicentre of immune and inflammatory imbalances leading to allergic reactions. (9) Gut microflora in children can be affected by a variety of components, such as use of antibiotics, the use of probiotics, dietary fats and fibre, and more. The rise in C-section births might be a possible risk factor in some children for developing allergies. (10)

On the other hand, the protective effect of breastfeeding (especially for 6 weeks to 6 months) is also well documented. (11) In adults, the use of antacids (PPIs), antibiotics, NSAIDs and other medications is hugely disruptive to microbiome and the gut lining integrity, leading to dysbiosis and increased permeability of the intestines (‘leaky gut’).  Food allergies are also linked with dysbiosis. (12) The main culprits are peanuts, cow milk, wheat, egg, soy, fish, shellfish and tree nuts.

The importance of healthy mucosal layer and its protective function is well known, but recently its immune function also has been recognised. (13)

Immune dysregulation and inflammation

As previously mentioned, the imbalances in gut microbiome lead to immune dysregulation, which in turn creates inflammation. Allergies are driven by T helper (Th) 2 responses, mast cell activation and the release of numerous inflammatory cytokines, such as  IL-4 and IL-13 and histamine. (14)

Adding fermented foods or probiotics and eating plenty of dietary fibre has a huge protective role in gut health. Prebiotics are also very important. Commensal gut bacteria ferments fibre into short-chain fatty acids (SCFA), which supports gut lining integrity and regulates immune system response via gut-associated lymphatic tissue (GALT). (15, 16) The latest research shows that regulatory T cells (Treg) have an important balancing effect on immune system and can dampen an allergic response triggered by T helper (Th) 2 cells. (17) 

The older concept of “hygiene hypothesis” introduced by David Strachan in 1989 has been explored for several decades and suggests that increased hygiene and smaller families (less siblings) lead to reduced exposure to infections and can predispose children to developing allergies later on. (18)

This partly can be explained by a lack of protective bacteria. Furthermore, research shows that decreased intestinal microbial diversity is an important risk factor for increased susceptibility to allergies. (19)

The newer biodiversity hypothesis has expanded the understanding of various internal and external factors affecting the microbiome. (20)

As the biodiversity in nature surrounding us (our external microbiome) is reducing and changing, so is our inner microbiome becomes diminished, its diversity reduced, and it has to adapt to changes. The immune system (and the nervous system, for sure!) is trying to catch up and this leads to rise in allergies and immune dysregulation.

It is widely recognised that herbal medicine can help to address the above-mentioned complexities and to correct the arising imbalances in the body. To meet and correct the imbalances arising from such above-mentioned complexities the multifaceted approach employing complex herbal medicines is needed.

Obviously, the herbalists look at the individual’s constitution and their presenting symptoms, which will direct their choice of herbs. Here some possible, more general herbal choices used in treating allergies will be discussed. The list of herbs is not complete and other choices can be made as required.

Allergic rhinitis (AR)

Main signs & symptoms are runny nose with clear mucus, congestion and sneezing. Eyes can also be affected.

In traditional western herbalism, according to Matthew Wood (2004), this energetic picture of AR could be described as a predominantly damp and cold tissue state, with deficiency underneath. The use of warming, aromatic, spicy, clearing, astringent herbs is indicated to reduce catarrh (damp), clear congestion, reduce allergic response, support the mucosal lining.

Nettle (Urtica dioica)

Clinical experiences shared by many herbalists and scientific analyses of the plant, as well as traditional uses across many countries brings nettle into forefront of a group of herbs used for allergies. (22, 23, 24) Sambucus nigra – elderberries and elderflowers are traditionally also used to support immunity, to reduce catarrh, clear congestion, reduce inflammation. (22)

Zingiber officinalis – ginger is a warming, aromatic, pungent spice, which helps to reduce catarrh and nasal congestion. (25) Curcuma longa – turmeric is probably one of the most researched herbs. Traditional and scientific research shows a strong anti-inflammatory effect, useful in allergies and other inflammatory conditions. (26)

• Urtica dioica folia
• Sambucus nigra (flos & fructus)
• Zingiber officinalis
• Curcuma longa

Vitamin C (citrus, peppers, broccoli, blackcurrants) and quercetin (onions, apples, citrus, green leaves) can be added as supplements or through foods. Black pepper is great to clear runny nose and is traditionally used in Ayurvedic medicine to clear catarrh. Warm aromatic and astringent teas – ginger, cinnamon, green tea, can be very useful.

In chronic AR or prevent recurrent episodes, immune modulating herbs such as Astragalus membranaceus can be added to the mix or used in between the flare ups (27).

Urticaria / hives

Main signs and symptoms are red itchy wheels and rash on the skin

In traditional western herbalism, this energetic picture of urticaria could be described as a predominantly a hot tissue state. The stagnation of the tissues (especially the liver and lymph) might be present. Stress is often a strong aggravator, as well as eating allergenic foods.

The use of cooling, detoxifying herbs, having a traditional ‘alterative’ action on the tissues – cleansing and clearing, to help to reduce inflammation, modulate the immune response, support the integrity of the gut and the function of the liver. Nervous system support is often needed in this condition.

German chamomile (Matricaria recutita)

German chamomile is traditionally used in Europe as a tea for allergies, congestion, to reduce inflammation and pain. It also has an anxiolytic and calming effect (28) Caution- sensitivity to Asteraceae family can cause allergic reactions. Albizzia julibrissin – Albizzia or silk tree is traditionally used in TCM and Ayurvedic medicine to help to reduce allergic reactions and ameliorate symptoms such as itching or wheezing. (29)

It is also has a calming, anxiolytic and antidepressant effect, as indicated in ethnobotanical studies and traditional uses. So it can be very useful in various acute and stressful allergic conditions, including urticaria.

• Urticaria dioica folia
• Matricaria recutita
• Albizzia julibrissin
• Arctium lappa radix

Externally creams are used in the herbal clinical practice with Stellaria media – chickweed or Aloe vera to help to reduce itchiness and soothe skin irritations. Vitamin C and quercetin supplements could be useful too, as well as pre- & probiotics (if not further causing more histamine release) to support gut microbiome.

Asthma

Main symptoms are wheezing, cough, tightness of chest, shortness of breath, which might be aggravated on physical exertion, exposure to cold air, on exposure to allergens or with emotional stress.  

Asthma is a complex inflammatory disease. Depending on the severity of it, whether it is chronic or acute, and on the constitutional individual’s type, in traditional western herbalism the energetic picture of asthma could be described as a deficient and stagnant condition with an accumulation of damp, heat, cold or/and dryness in the tissues.

The use of herbs to help to reduce inflammation (heat), reduce cough, expel mucus (damp),  relax bronchospasm, modulate the immune response, support the integrity of the gut and microbiome. Nervous system support is also often needed in this condition and herbs traditionally called nervines can be very helpful.

Herbs

• Curcuma longa
• Inula helenium
• Thymus vulgare
• Verbascum thapsus
• Glycyrrhiza glabra (31)

Herbs to feed gut microbiome, to support biodiversity of microflora and gut health, to support digestion and intestinal absorption, such as Arctium lappa radix and Inula helenium are traditionally used by herbalists. Mucosal membranes and epithelial integrity can be supported by using mucilage – rich herbs such as Althea offcinalis, Aloe vera or Glycyrrhiza glabra.

As allergies always have an inflammatory component, increasing anti-inflammatory unprocessed plant-based foods in the diet is important, as well as feeding the microbiome with plenty of fibre and staying hydrated to support elimination processes.

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According to Ayurveda, skin has seven layers, corresponding to the seven dhatus. Similarly, in modern physiology, skin has been found to have seven layers, stratum corneum, on the surface, stratum lucidum, stratum granulosum, stratum spinosum, stratum basale, the basement membrane and the dermis.

At the same time, the epidermis of the skin, as whole, is seen as an secondary (upadhatu) of plasma tissue (rasa dhatu), and the dermis as part of muscle tissue (mamsa dhatu). Skin belongs to bahya marga, the external pathway of disease, and as such is very vulnerable to toxins carried by plasma rasa) and blood (rakta dhatus) during the spreading (prasara) stage of disease, accounting for the relatively common nature of skin inflammations. 

Let us turn our attention first to atopic dermatitis (AD). Also called eczema, this condition is due to a hypersensitivity reaction in bahya marga, leading to long-term skin inflammation which creates itchy and scaly skin. Long-term irritation and scratching may cause the skin to thicken and develop a leathery texture. If the ear canal is affected there may be discharge from the ears (for pictures of atopic dermatitis, for atopic dermatitis on ankles, for atopic dermatitis on arms, for atopic dermatitis in infancy).

Atopic dermatitis is most common in infants, often clearing by the age of three, while in adults it becomes a yapya condition that persists or recurs throughout the lifetime. In infants, lesions of AD begin on the cheeks, elbows and knees, while in adults the lesions are more commonly found on the knees and elbows alone.

Typically, AD occurs on the flexor surfaces (the parts of the skin that touch when a joint bends). It arises most often where there is a family history of atopic conditions such as hay fever, asthma and eczema. Because skin belongs to bahya marga, AD is typically the first condition in the atopic picture, later followed by asthma or allergic rhinitis as the atopic process moves from the prasara stage to localize in prana vaha srotas (1).

A combination of genetic factors (adi bala pravrutta), doshic skin type (dosha bala pravrutta), exposure to environmental allergens (parya varana) and immunological reactivity (pittaja), come together to create the tendency to AD. (1) Vata skin is more prone to AD because of dryness and pitta skin because of its greater irritant response. Manasaja or psychogenic causes also play a part, as stress can trigger an outbreak of AD in both children and adults. Annaja or dietary causes are extremely important in AD, and so are agantu causes or infective agents.

In one study, 56% of children with AD were found to have food allergies that could trigger the condition. (3) Major food allergens associated with AD are eggs, cow’s milk, wheat, soy and peanuts (1, 3). Most patients with AD are colonized with Staphylococcusaureus instead of healthy, normal skin flora (1). Hence secondary (anubandha) Staphylococcus aureus overgrowths or infections are typical and can create AD relapses (1, 4).  Although AD is not in itself infectious, lesions infected with Staph. aureus can be passed on to others.

Dermatitis treatment

Because AD is a multi-factorial condition, it can only be addressed effectively in a holistic manner, taking into account emollients for doshic skin type, removal of environmental toxins, pacification of pitta and cleansing of pitta ama with a herbal blends such as guduchi and neem or Neem and Sarsaparilla, dietary modifications to address annaja causes and ointments to address infective agents. Neem or coconut oil will act as excellent pitta emollients and can be mixed with neem powder as an anti-infective agent. For psychogenic causes, counselling, stress management, yoga and meditation will be beneficial.

Case studies: Patient A

A thirteen year old pitta prakruti girl presented in great distress with AD that affected her arms and face. As a teenager, she found an assault on her appearance to be unbearable. Fortunately for the practitioner, her exasperation rendered her a highly compliant patient. She agreed to use Neem and Sesame oil and to take triphala and an herbal formula containing guduchi, turmeric, neem and manjista with aloe vera as an carrier (anupan). She was even willing, in her desperation, to follow a one month exclusion diet, eliminating eggs, cow dairy products, wheat, soy and peanuts from her diet completely.

We explained to her that exclusion diets are only effective if followed meticulously. “This is an experiment. You don’t have to eat this way for the rest of your life.” Within two weeks of the exclusion diet, her skin had cleared completely. She then began challenging the allergens, one allergen per week. The challenge process used was to eat a significant amount of the suspected item, wait two days and then eat it again.

During this process, she learnt that dairy products were the trigger food for her unwanted symptoms. She thus became a staunch devotee of the casein-free diet.  She continued her herbal regimen for three more months to ensure that pitta was pacified and pitta toxins removed, after which she remained symptom free by following her prescribed diet.

Case studies: Patient B

A forty two year old pitta woman presented with eczema localized to the fourth finger of her left hand. The symbolism of this location was not lost on us and we explored emotional causes in detail. She had a history of relationships with unavailable men and had remained unmarried as result. Currently, she was in her first promising relationship, with a man who wished to marry her and adopt a family. It is worth noting that her AD remained intractable when treated with a similar herbal regimen to the one which proved highly effective for patient A. 

In her case, emotional toxins were of more significance than physical ones. Accordingly, we started her on brahmi tea to help move the emotional toxins.  On her third follow up she had an epiphany, realizing that she feared intimacy and had created the eczema, “To make sure I can’t wear a wedding ring.”  Following this realization, her eczema rapidly cleared. I last met her in the grocery store. She was proudly wearing a wedding ring and carrying her adopted son in her arms.

Turning now to psoriasis; this is a condition opposite in many ways to AD. Psoriasis is a non-contagious, genetically based condition that typically appears as inflamed, oedematous skin lesions. The lesions are red and are covered with distinctive silvery white scales.

It is a lifelong illness for which there is no known cure, although it can be quite effectively managed Ayurvedically. Severe cases often move into asthi dhatu, presenting with pitted nails and painful joints. Unlike AD, psoriasis typically manifests on extensor surfaces, is not associated with atopy and does not result in frequent staphylococcal skin infections. 

It also begins in an older age group, with typical onset between the ages of ten and forty rather than in infancy. Although psoriasis is one of the most common skin conditions, affecting over 7 million Americans, its aetiology has long been poorly understood. It is now widely accepted as an auto-immune disorder sharing the same disease pathways as rheumatoid arthritis and inflammatory bowel disease (6, 7, 8).

In psoriasis, the journey of the keratinocytes from stratum basale to stratum corneum is shortened from 311 to 36 hours (5). The epidermal layer of the skin becomes thicker and cells are distributed abnormally (5).

Psoriasis treatment

As an auto-immune condition, psoriasis requires a rather different treatment protocol than AD. It is not sufficient to clear pitta toxins and return pitta to its seat. In addition, anti-inflammatory herbs are needed, while pancha karma is necessary to reverse the disease pathways involved in auto-immunity.

Case studies: Patient C

A forty five year old pitta woman presented with psoriasis on her scalp and extensor surfaces.  She was vata provoked and under great stress as she was conflicted in her marriage and currently involved in an extra-marital affair. She was given a medicated ghee containing ashwagandha, neem and manjista to apply topically, and an herbal formula which also included ashwagandha and manjista, but not neem, on account of her vata provocation.  It is important to note the value of ashwagandha in dry, scaly skin conditions such as psoriasis, and also the role vata provocation may play in flaring up the condition. She took Brahmi tea to help her depression and stress and a formulation of guduchi and guggulu as an anti-inflammatory helpful in many auto-immune conditions. With this herbal regimen and a pitta-soothing diet, her psoriasis began to improve gradually. 

She then did seven days of pancha karma treatments using Refresh Pitta Massage Oil with a few drops of added cold pressed neem oil for therapeutic massage (abhyanga), amalaki for its mild laxative effect (virechan) and decoctions of Dashamoola and Guduchi for basti. After this process, the psoriasis went into complete remission for the first time since its onset at the age of fifteen. She continued to maintain this level of improvement except for a small patch on her scalp, which would flare up whenever she stepped out of integrity with herself in terms of relationships. It was as if this remaining patch on her head acted as a kind of visible moral compass, calling her back to the journey of truth and compassion for self and others. 

Both AD and psoriasis are quite prevalent inflammatory skin conditions which are very responsive to the holistic approach of Ayurveda. By combining topical and systemic herbs, appropriate diet and lifestyle, pancha karma therapies and emotional awareness, these conditions can be effectively cured or brought into remission.

1. Donald Y.M. Leung, Mark Boguniewicz, et al, New insights into atopic dermatitis J. Clin. Invest. 113(5): 651-657 (2004).
2. Gupta, Gupta (1998) Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. British Journal of Dermatology 139 (5).
3. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients J Pediatr. 1985 Nov;107(5):669-75.
4. James J. Leyden¹¹Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, U.S.A., Richard R. Marples¹¹Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, U.S.A. and Albert M. KligmanStaphylococcus aureus in the lesions of atopic dermatitisBritish Journal of Dermatology Volume 90 Issue 5 Page 525-525, May 1974.
5. Gerald D Weinstein, Jerry L McCullough and Priscilla A Ross Cell Kinetic Basis for Pathophysiology of Psoriasis Journal of Investigative Dermatology (1985) 85, 579–583; doi:10.1111/1523-1747.ep12283594.
6. Davidson, A, Diamond, B: Autoimmune diseases. N Engl J Med 2001 345: 340–350.
7. Frank O Nestle and Michel Gilliet, Defining Upstream Elements of Psoriasis Pathogenesis: An Emerging Role For Interferon Journal of Investigative Dermatology (2005) 125, xiv–xv; doi:10.1111/j.0022-202X.2005.23923.x.
8. Joshi R. Immunopathogenesis of psoriasis. Indian J Dermatol Venereol Leprol [serial online] 2004 [cited 2008 Jun 15];70:10-2.