Where low mood and melancholia has not reached the status of clinical depression, there are remedies derived from nature which offer natural approaches to lifting the spirits. In observing the cyclical patterns of nature, we can be afforded some comfort in the knowledge that as humans, we are a part of this cycle and feeling the need for rest and a turning inwards is a reflection of this rhythm.  At the very darkest, coldest, lifeless part of the year when many animals hibernate and are in a state of metabolic depression, studies have demonstrated neurobiological similarities to clinical depression, including changes in cortisol, neurotransmitters, metabolism and other biomarkers (3). Occurring at the same time, seeds and rootstocks are also at their most potent, conserving energy to use later for spring growth (4). 

Hibernating animals rest in the awareness that they will emerge with the next turn of the seasons. For many centuries humans have adapted to the cold, quiet darkness with a shared instinct to foster joy, connection and ritual such as the northern hemisphere midwinter festivals, Christmas, the Roman Saturnalia, Jewish Hannukah, Slavic Koliada, pagan Yule, Persian Yalda, or Asian Dongzhi, are all a call for celebration and community. Earlier in the season the Hindu festival Diwali symbolizes the victory of light over darkness and good over evil. Often the best way to beat the winter blues is in accepting the inherent cyclical nature of the world, and that  darkness has its role in the cycle as the precursor of light and life.

Being able to get out for a walk in nature, taking a moment to observe and be present with the plants, can be enormously enriching and mood enhancing, offering a subtle but profound healing opportunity. Nature can also be brought into the home— in Japan, small gardens are often found on doorsteps, balconies and small corners, bringing life to dense  urban landscapes. Tending a garden, even in pots, is a great source of serenity. The act of walking can also be significant as exercise is an efficient and rapid way to stimulate neurotransmitters including serotonin and dopamine which are responsible for uplifting mood  (5). 

In respecting the cycle of the seasons one is also in connection with the natural instinct to sleep and eat more. In Ayurveda winter is known as kapha time, time to build resources for the hungry gap in spring, when historically people would have worked hard to get the crops in and be left with limited food supplies. A gentle increase in body weight during winter is a normal physiological response to reduced activity, daylight and hormonal shifts, this often reverses itself in spring (6). Similarly, the need for extra sleep and change is impacted by lower light and colder temperatures (7).  

The following plants bring some of the comforting qualities of nature to support the body and mind during the winter period. Each is a powerful tool for lifting the spirits. The best approach is to get to know each herb as an individual first. Ideally, make a single preparation, perhaps a cup of strong tea or decoction, and build up towards a higher dose, the maximum from the range provided below. Taken in this form, at robust levels, benefits can be rapidly felt  and it is soon possible to work out which is most helpful. They can be experimented with to discover which ones resonate best with the body’s constitution. 

These herbs are not antidepressants in the conventional sense. Instead, in different ways they strengthen the constitution, offer a sense of calm and an ability to cope better, whilst also reducing inflammatory pressures on the brain.St John’s wort, widely thought of as a herbal antidepressant, is traditionally used as a tonic specific for the winter months to help bring in the light, offering a feeling of resilience (8). 

For more in depth information on these herbs, please see our herbal monographs. 

Brahmi (Bacopa monnieri)

A classic Ayurvedic brain tonic, and saponin-rich adaptogen, Brahmi appears to work in a number of ways to protect brain cells and improve cognitive functions, especially when these are challenged by long-term stresses, illnesses and ageing (9). It has been used to help recover from chronic fatigue and associated low energies. Brahmi is also calming and helps directly in anxiety and tension conditions, and in helping cope with stress (9,10).

The recommended dose is 2–6 grams of the dried leaf per day, either as  tea or, as popularly taken in India, several teaspoons of the fresh leaf juice (9). Dosages are meant as a guideline only, and it is recommended to consult a medical herbalist for safety considerations. 

Cinnamon (Cinnamomum verum)

This common spice offers an organoleptic treat, with good quality cinnamon stimulating the taste buds and warming the body. Cinnamon is particularly useful in facilitating recovery from illness or chronic fatigue, and especially for those who are particularly prone to feeling the cold (8) It helps restore a healthy appetite and reduce digestive problems such as sluggish digestion that can be associated with being run down. To increase the heating quality and stimulate more warmth, combine it with fresh ginger (Zingiber officinale) in a tea. Cinnamon can be combined with any of the other herbs on this list as a stimulating, warming remedy (9). 

Take a teaspoonful of freshly powdered cinnamon (Ceylon cinnamon has the most complex flavour profile), add 50 ml of boiling water, stir and steep for 5–10 minutes and sip. Feel the mix of spicy and sweet tones reverberating at the back of the mouth, with a slightly woody quality, followed by a warmth emanating from the chest chest. A slight bitterness can be experienced afterwards, with a profound sense of warmth moving throughout the entire body. 

The suggested dose of cinnamon powder is up to 8 grams per day (9).

Gotu kola (Centella asiatica)

This popular traditional Asia restorative tonic is revered in Asia for ‘opening the mind’, sometimes accompanying meditative practices as a tea. Taken in this way, gotu kola offers an initial bitter flavour, followed by an  aromatic sweetness. It has a particular effect in supporting cognitive function, including improving memory and concentration, especially when these are compromised by increased  stress (9,10).

The dose starts at 3 grams of dried leaf per day, titrating up to 30 grams, if the initial dosage has proved effective with no unwanted side effectsGotu kola is traditionally consumed as a tea (8–10). 

Rosemary (Salvia rosmarinus)

There is something inherently uplifting about the smell and taste of this common garden herb— it can be felt heading straight to the brain. Rosemary is an excellent tonic to raise spirits and boost recovery after illness or periods of low energy. Even inhaling the fresh leaf from a garden or window box will stimulate mental energy and the tea taken internally will expand on this effect. 

There is promising evidence that rosemary may reduce inflammatory pressures on the brain now implicated in many conditions associated with low mood and depression, including chronic fatigue syndrome, dementia as well as clinical depression. Further research indicates it can improve cognitive performance in the elderly adding to its reputation as a  brain tonic (11).

Taking rosemary as a tea can be overpowering, however very uplifting. The dose is up to 4 grams a day of the dried leaf (9).

St. John’s wort (Hypericum perforatum)

This is often described as the herbal antidepressant, however it has a much wider range of actions than its mood enhancing properties. The herb and flowers of St. John’s wort have been used in European traditions to relieve nervous tension and anxiety. Importantly, this calming effect is combined with underlying restorative benefits and the plant was also used as a convalescent treatment for melancholic conditions, depression and recovering from illness or trauma (8–10).

This makes St John’s wort ideal in situations where tension and exhaustion combine. Its most useful modern application is towards a programme of recovery from chronic fatigue conditions. It also has a long reputation as a support to those experiencing symptoms during the menopause (8,10).

Note that St John’s wort has been shown as an active inducer of drug metabolism, so it may reduce the activity and active life of many medicines. It is wise to avoid in conjunction with medications and consult a medical herbalist for further guidance (8–10).  it if there are any powerful treatments underway, where reducing the effect of a medicine may be critical.

St John’s wort can come in a variety of preparations, including powder, tincture and tea. It is recommended to combine the herb with others as a tea, for flavour considerations, however the easiest is to take it as a tincture. The traditional calming and tonic dose was the equivalent of 2 to 5 grams of the dried leaf and flowers per day (9). 

1. Heald A, Stedman M, Farman S, Ruzhdi N, Davies M, Taylor D. Seasonal Variation in Antidepressant Prescribing. The Primary Care Companion For CNS Disorders. 2021;23(2). https://doi.org/10.4088/pcc.20m02790 
2. Clery E, Morris S, Cooper C, Das-Munshi J, McManus S, Weich S. Mental health treatment and service use. Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England. Published online 2025.
3. Tsiouris JA. Metabolic depression in hibernation and major depression: An explanatory theory and an animal model of depression. Medical Hypotheses. 2005;65(5):829-840. https://doi.org/10.1016/j.mehy.2005.05.044 
4. Klupczyńska EA, Pawłowski TA. Regulation of Seed Dormancy and Germination Mechanisms in a Changing Environment. International Journal of Molecular Sciences. 2021;22(3):1357. https://doi.org/10.3390/ijms22031357 
5. Ren J, Xiao H. Exercise for Mental Well-Being: Exploring Neurobiological Advances and Intervention Effects in Depression. ProQuest. 2023;13(7):1505. https://doi.org/10.3390/life13071505 
6. Fahey MC, Klesges RC, Kocak M, Talcott GW, Krukowski RA. Seasonal fluctuations in weight and self-weighing behavior among adults in a behavioral weight loss intervention. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. Published online May 15, 2019. https://doi.org/10.1007/s40519-019-00707-7 
7. Honma K, Honma S, Kohsaka M, Fukuda N. Seasonal variation in the human circadian rhythm: dissociation between sleep and temperature rhythm. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 1992;262(5):R885-R891. https://doi.org/10.1152/ajpregu.1992.262.5.r885 
8. Hedley C, Shaw N. Plant Medicine. (Waddell G, ed.). Aeon Books; 2023.
9. Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013.
10. Mcintyre A. Complete Herbal Tutor : The Definitive Guide to the Principles and Practices of Herbal Medicine (Second Edition). Aeon Books Limited; 2019.
11. Rahbardar M, Hosseinzadeh H. Therapeutic effects of rosemary (Rosmarinus officinalis L.) and its active constituents on nervous system disorders. Therapeutic effects of rosemary (Rosmarinus officinalis L) and its active constituents on nervous system disorders. 2020;23(9). https://doi.org/10.22038/ijbms.2020.45269.10541 

Sleep is an altered state of consciousness where changes in the brain’s activity take place (3), and it is essential for human life.

Although sleep is in part for resting, it is also actually quite a busy time for the body and it requires a certain amount of energy to maintain good quality sleep. Sleep is the time for cellular repair and is where maintenance mechanisms are actioned and healing for the body occurs.

Normal sleep consists of two parts: non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. NREM is broken down into stages 1 -3, and stage 4 of sleep is where REM sleep takes place (4).

These four stages of sleep are thought to gradually merge (3, 5):

Stage 1

This is where the transition between wakefulness and sleep which is normally up to about 5 minutes in duration. During this stage the person may have fleeting thoughts and if they wake think they have not been sleeping. Many people struggle with this stage as it takes them a while to get to sleep.

Stage 2

Light sleep is the first stage of true sleep.  There may be fragments of dreams and the duration is around 10 – 60 minutes.

Stage 3

Moderately deep sleep, referred to as slow-wave (SWS) sleep.  During this stage the body temperature and blood pressure tend to decrease, this usually occurs around 20 minutes after falling asleep. This stage of sleep is thought to be critical to restorative sleep, allowing for growth and recovery of the body. Experts believe it also is vital for the immune system and other bodily processes (5).

Stage 4

The deepest level of sleep, REM sleep. Duration 10 – 60 minutes. The eyes may move rapidly (hence the name). Most vivid dreaming usually occurs during REM sleep.

Sleep ideally consists of a single block of three to five cycles of sleep stages, usually happening during the night (6).  Typically a person goes from stage 1 – 4 of sleep in less than an hour and during a typical night’s sleep of 7 – 8 hours there will be approximately 3 – 5 episodes of REM sleep as a person passes between NREM sleep and REM sleep, with REM sleep occurring approximately every 90 minutes.

A baby’s sleep consists of around 50% of REM sleep, whereas in adults it usually makes up about 25% of sleep.  Although it is not fully understood, this high level of REM sleep in infants suggests that it is important for the maturation of the brain. Neuronal activity is high in REM sleep, brain blood flow and oxygen use are equal to or higher in REM sleep than in intense mental or physical activity while awake (3), indicating that sufficient energy is required to actually be able to sleep well and access all the stages of sleep.

Sleep is in part a time when organising and housekeeping in the brain takes place and is thought to play a vital role in retention of new learning (7). This may be considered again in the context of new-born babies who need between 14 – 17 hours of sleep per day (2). This is because aside from supporting the growth which is taking place in their bodies, they are creating neural networks as they learn new information about the world. Sufficient sleep necessary to facilitate this.

Sufficient good quality sleep is necessary for physical and mental health, and for quality of life.  Sleep is known to be important for regulation of the nervous system, helps with overall resilience, immune system function, ability to deal with stress, mental and emotional health. It is vital for the maintenance of overall health and wellbeing.

Sleep deprivation disturbs the circadian physiology, exerting a negative impact on the brain and behavioural functions, and can cause neuroinflammation and oxidative stress (8). Long term, this can lead to neurodegenerative issues. Mental health issues such as depression have also been linked to neuroinflammation now. Circadian rhythms are natural changes in physiology over a 24-hour day-night period, particularly hormone levels which typically influence sleep and wake cycles and our ability to fall asleep easily at night.

There is an ever-increasing body of evidence to suggest that insufficient sleep contributes to a host of adverse medical and mental dysfunctions, such as unbalanced body systems, increased incidence of cardiovascular morbidity, increased chances of diabetes mellitus, obesity, issues with cognitive function, increased accidents, and depressive symptoms (1).

It is suggested that sleep plays a key role in the optimization of energy as during sleep energy reserves are redirected to processes such as maintenance of cells, anabolism (‘rebuilding’ and repair), immune function, and neural plasticity (6).

Neural plasticity refers to the capacity of the nervous system to modify itself both functionally and structurally in response to experience and injury. Ultimately it ensures the healthy development and function of the nervous system (9) which can also impact on memory.

A recent study has found that sleep also seems to play a role in facilitating the clearance of molecular waste products from the brain which accumulate during waking hours (10). The authors noted that sleep seems to increase the brain’s interstitial volume (meaning the space between the tissues), and that the impact of one night of complete sleep deprivation on the molecular clearance was not recouped in the following 2 -3 night’s sleep.

This potential build-up of molecular waste in the brain which may occur as a result of consistent sleep deprivation is of particular relevance when considering the development of neurodegenerative health conditions such as Alzheimer’s disease (10).

For adults, 7 – 9 hours of sleep per night are usually recommended (2). Although there is a lot of focus on the number of hours of sleep, and whilst this is important, it is also necessary to consider sleep quality and whether the time spent sleeping is actually restorative.

The smooth progression through the stages of the sleep cycle is necessary multiple times during a sleep period to ensure that the rest taken whilst sleeping is high-quality and actually restorative (5). An example of this is the suggestion that whilst sleep stages each have their unique qualities, it is also thought that the change between SWS in NREM sleep stage 3 and REM sleep stage 4 is actually important for memory (7).

It is clear to see that although sleep is in some ways a time of rest from our usual waking activities, there is actually still a lot of activity going on during sleep which can be thought of as the ‘behind the scenes’ housework to keep everything functioning well. This is particularly true for the nervous system, and this requires a certain amount of energy to maintain.

Insufficient sleep is a prominent problem in today’s modern 24-h society, with the increased usage of smart phones and electronic devices worsening this epidemic (1).

Problems with sleep are often caused by (2):

• Environmental issues: Night-time noise, screen light from phones, TVs and tablets, and light from the outside can trick your body into delaying sleep. Air pollution can also disrupt your sleeping patterns.
• Life events: You may feel distracted, stressed or worried about something going on in your life while you’re trying to go to sleep, which can affect your ability to relax.
• Thinking cycle: Anxious thoughts about not getting enough sleep can cause distress, which can prevent you from relaxing and falling asleep. This can become a vicious cycle. Also an overactive mind when going to sleep delays sleep latency.
• Lifestyle: Developing poor habits around sleep, such as not having a regular routine, can cause problems.
  • Not having a regular sleep-awake routine
  • Eating late at night
  • Consuming alcohol, nicotine or caffeine around bedtime
  • Vigorous exercise late at night
  • Using smart devices (phones, tablets etc.) before bed
  • Checking and responding to work emails outside of working hours

It’s common for most people to experience periods of poor sleep at some point in life, but short bouts of sleep problems don’t usually result in health problems. However, consistently poor sleep can begin to contribute to health issues, including being a symptom and cause of mental health problems (2).

‘Tired but wired’ is a phrase coined to explain when the nervous system is in overload (in sympathetic or ‘fight and flight’ mode) and it can become difficult to switch off. Although one may feel tired or even exhausted, falling asleep (known as ‘sleep latency’) and/or maintaining sleep can become difficult. This is partly because of higher than normal levels of the hormone cortisol tend to circulate the bloodstream when we are over-stressed.

When the body is functioning well, cortisol levels naturally dip at night as part of the circadian rhythm, easing us into a restful night’s sleep. Understanding this contextualises why and how living removed from the rhythms of nature can have an impact on our sleep.

In addition to this from a holistic perspective when the nervous system is depleted due to chronic stress, we are tired and really need sleep. There are often not actually enough energy resources available to achieve and maintain the good quality sleep we really need.  This can become a vicious cycle where the over-tiredness prevents sufficient sleep, and the lack of sleep exacerbates stress on the body and further inhibits the capacity to sleep well.

This is where herbs can really help to reset this cycle.  Herbs which are classed as nervous system tonics can be helpful in restoring the nervous system so that it becomes less frazzled, which can be considered energetically as providing ‘food’ to the nervous system so that it has the sufficient nourishment required to maintain sleep. 

Herbs which are classified as adaptogens can also be beneficial to help reset the stress response, allowing the nervous system to function well, and redress the natural balance of stress hormones throughout the sleep-waking cycle of the circadian rhythm. 

In addition to this, herbs classified as sedatives and hypnotics can assist with getting off to sleep (sleep latency), and often have additional benefits of helping with anxiety or nervousness which often accompany sleep issues. However, the primary goal with herbal support is always to rebalance the body by addressing the root cause of issues.

This means that the natural processes can be restored and systems can function in a healthy way. Therefore, herbs which act as hypnotics and sedatives are only recommended as short-term solutions while the body systems are further restored and regulated, and lifestyle factors are addressed so that a healthy sleep cycle can be re-established.

It is best to note when considering herbal support for sleep is that if there are underlying factors at the root of sleep issues then these must be addressed alongside taking herbs. In the case of long-term issues then the guidance of a herbalist is recommended to tailor a personalised treatment plan. You can find clinical herbalists on our “Where to find a herbalist” page.

Valerian (Valeriana officinalis)

Valerian is traditionally considered a convalescent tonic to calm the nervous system and enhance its function. Its name comes from the Latin valere – meaning “to be strong, powerful, healthy”, which explains why, although it is typically considered to be a hypnotic and sedative herb, it can in some people also be stimulating due to providing an increase in vital energy.

Despite this, it is often helpful in restoring the nervous system. Therefore even in cases where it is stimulating as a bedtime remedy, it can sometimes be beneficial to continue taking the herb to help restore the nervous system so that deeper more relaxed sleep can be accessed eventually.

Valerian is often helpful when there is difficulty getting to sleep or staying asleep. It is particularly helpful when this is accompanied by emotional stress, excitability, or a sense of irritability. This is because it not only provides the tonic support to rebuild the nervous system allowing deeper more nourishing sleep to be possible, but it also has a sedative effect so can also be beneficial in assisting with getting off to sleep.  Valerian is also a muscle relaxant so can be a great support where muscle tension is present along with sleep issues.

Ashwagandha (Withania somnifera)

This is a tonic for both the nervous system and for restoring sleep.  It is best thought of as when the body is too exhausted or worn out to be able to sustain good quality sleep, because sleeping also requires a certain amount of energy. When one becomes “tired and wired” the depth of good quality sleep can become difficult to sustain.  In these instances, ashwagandha helps on a deeper level than simply sedating or aiding falling asleep, it can be considered as laying a deep restorative foundation which provides a base from where better-quality sleep becomes possible, allowing the body to truly rest and restore. 

Occasionally because of this restorative effect ashwagandha can sometimes be felt as stimulating, in which case it can be taken during the daytime rather than at night, where it will still have a restorative effect which will over time nurture better quality sleep.  Ashwagandha is considered an adaptogenic herb, so it also improves the bodies resilience to stress, and helps to reset the balance of the stress response. This makes it particularly beneficial when frazzled nerves and being overly stressed is a factor in sleep issues.

St John’s wort (Hypericum perforatum)

This is a nervous system tonic which is traditionally used for insomnia, particularly when emotional stress, anxiety, or depression are also a factor.  Because of its restorative effect on the nervous system, St John’s wort can benefit the onset of sleep and staying asleep (insomnia which involves waking in the night and difficulty getting back off to sleep is common feature of depression).

Passionflower (Passiflora incarnata)

This is helpful in cases where sleep issues are accompanied by anxiety, excitability or irritability.  Traditionally it has been given as a tea by Native Americans for sedative and anxiolytic effects and continues today to be given for this and its hypnotic effect.

Passionflower can aid getting off to sleep, as well as staying asleep.  It is considered particularly beneficial where circular thinking is preventing sleep onset (for example, worrying and repetitive over thinking). Passionflower helps to switch off this thinking and so getting to sleep becomes easier. It is also a nervine so helps to relax the nervous system and assists the ability to stay asleep.

Vervain (Verbena officinalis)

This herb is not particularly sedative as such, but as more of a tonic for the nervous system it tends to relax the body, energetically bringing a sense of grounding.  This can allow a better quality of sleep which will be overall deeper and more nourishing, especially when combined with other herbs which have sedative or hypnotic qualities such as valerian or passionflower. Herbalists may consider it for people who feel they sleep lightly, wake easily, or simply do not feel well rested after sleep. The grounding effect allows the sleep to become deeper.

Hops (Humulus lupulus)

Hops can be helpful when there is difficulty getting off to sleep or in staying asleep.  It tends to be hypnotic and mildly sedative and is particularly helpful if sleep issues are accompanied by a sense of excitability or restlessness, and also for people who experience excessive libido.  It is also beneficial for people experiencing sleep issues associated with the menopause.  It is best avoided in depression due to its slightly depressive effect.

Chamomile (Matricaria recutita)

This is a well-known remedy for sleep and suitable for children due to its gentleness. However, it is traditionally said of chamomile that ‘gentleness should not be confused with weakness’.  Although gentle in nature due to its calming effect Chamomile can be a simple but beneficial sleep remedy. It can be taken as an evening drink to aid getting off to sleep, particularly when sleep issues are accompanied by a feeling of restlessness or mild anxiety.

Limeflower (Tilia spp.)

Popular in France where it is a common home remedy taken as a relaxing evening drink to aid getting off to sleep.  It is relaxing and helpful if anxiety accompanies sleeplessness.

Skullcap (Scutellaria laterflora)

This is a wonderful herb when sleep issues are due to emotional stress, or when excitability, irritability, or anxiety are present with sleep issues.  It is a tonic for the nervous system, and as with other nervous system tonics it helps to restore the ability to achieve good quality deep sleep. It is also sedative so aids getting off to sleep. Herbalists consider it to have an affinity with the head (from the name skullcap), and is helpful to stop worrying about things that you cannot do anything about.

Lemon balm (Melissa officinalis)

Helpful for promoting better sleep quality, a calming herb that blends well with chamomile and lime flower for a pleasant tasting evening beverage. It is also considered energetically helpful for nightmares, and irritability in children and the elderly.

Key components to healthy sleep are ensuring healthy sleep routines and where possible eliminating or managing stressors which may be contributing to a lack of sleep.

The following guidelines have been recommended by Mental Health UK (2) as tips for getting a good night’s sleep:

• Create a regular sleeping pattern of sleeping and waking
• Create a restful sleeping environment (dark, peaceful and a comfortable temperature)
• Assess your stressors from work (for example workload, commute, work environment and boundaries at work)
• Regular exercise releases stress from the body, and tires us out in a healthy way so we can slip into a deep regenerative sleep. Avoid vigorous exercise too close to bedtime when possible as this can keep you awake.
• Be mindful of food and drink consumption. Caffeine takes at least 5 hours to leave the body and massively disrupts sleep for most people, as does alcohol. A herbal tea in the evening from the plants mentioned above could be a wonderfully soothing alternative.
• A sleep diary can be helpful for seeing how much sleep you are actually getting, allowing you to analyse your patterns and take informed action.
• A wind down routine will help you to relax before bed and nurtures a good night’s rest. This can include a warm bath, some gentle yoga or a relaxing and quiet podcast or music. Its important to support the transition between the day’s chores and activities and rest.
• Write down your thoughts, especially if you tend to lie and think about all you have to do the next day. Simply writing these down allows us to release them and have a clearer mind so we can get to sleep more quickly. 
• Create and maintain good sleep hygiene by avoiding bright lights at bedtime and screens for at least 30 minutes to an hour before bed.

In addition, Yoga Nidra can be helpful for re-establishing healthy sleeping habits.  It is also referred to as ‘Yogic sleep’, and is a guided relaxation practice which accesses the space between the conscious and subconscious mind, aiding the release of physical and mental tension, and promoting deep relaxation.

It helps to re-establish balance in the body-mind complex, nourishing the nervous system, and can be a great aid for re-establishing the balance and energy resources necessary to access sufficient good quality sleep. Yoga Nidra can be practised during the daytime, or as part of a wind-down routine before going to bed at night.

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2. Sleep and mental health. Mental Health UK website. https://mentalhealth-uk.org/help-and-information/sleep/. Accessed December 3, 2022.
3. Tortora, G, Derrickson, B. Principles of Anatomy and Physiology. Vol. 1. 13^th ed. Asia: John Wiley & Sons; 2011.
4. Patel AK, Reddy V, Shumway KR, et al. Physiology, Sleep Stages. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK526132/ Accessed December 8, 2022.
5. Stages of Sleep. Sleep Foundation Website. https://www.sleepfoundation.org/stages-of-sleep.  Accessed December 3, 2022.
6. Nollet M, Wisden W, Franks NP.Sleep deprivation and stress: a reciprocal relationship. Interface Focus. 2020;10:20190092. http://dx.doi.org/10.1098/rsfs.2019.0092. (Accessed 02.12.22).
7. Newbury, CR, Crowley R, Rastle K, & Tamminen J. Sleep deprivation and memory: Meta-analytic reviews of studies on sleep deprivation before and after learning. Psychological Bulletin. 2021;147(11):1215–1240. https://doi.org/10.1037/bul0000348.
8. Bishir M, Bhat A, Essa MM, Ekpo O, Ihunwo AO, Veeraraghavan VP, et al. Sleep Deprivation and Neurological Disorders. BioMed Research International. 2020;5764017. https://doi.org/10.1155/2020/5764017.
9. R, Bernhardi LE, Eugenín J. What Is Neural Plasticity?. Adv Exp Med Biol. 2017;1015:1-15. doi:10.1007/978-3-319-62817-2_1.
10. Eide PK, Vinje V, Pripp AH, Mardal KA, Ringstad G. Sleep deprivation impairs molecular clearance from the human brain. Brain. 2021;144:3: 863–874. https://doi.org/10.1093/brain/awaa443.

By resonating with us at all speeds of vibration, from the spiritual to the material, plants have the potential to heal us on every level of our being. Yet this is not all; something about flowers is particularly special, as if they express the essential nature of all flowering plants and convey their messages to us in all their variation of purpose. They are vital to the plant’s survival and represent the peak of plants’ evolution.

The first organisms were single-celled bacteria living in the sea. Then came algae, which are believed to be the ancestors of all other plants, followed by fungi, mosses and lichens. Ferns, taller plants and then trees such as giant horsetails came next, followed about 200 million years ago by plants bearing seeds known as gymnosperms – of which the wonderful ginkgo tree is a living example, as are conifers.

Flowering plants, botanically known as angiosperms, evolved about 140 million years ago, the earliest of them probably resembling a magnolia tree. In botanical terms, a flower represents a reproductive structure made up of modified leaves which attract insects and a variety of other small creatures in order to ensure their cross-fertilisation and reproduction and hence their survival.

This was a far more sophisticated means of reproduction than had gone before. The cones of conifers have sperm cells packed tightly in pollen grains relying on the wind to blow them to the ovules of female cones. Spores of fungi and mosses are also vulnerable to the vagaries of the wind. More than 80 per cent of all green plants are flowering plants and every flower has the same purpose, to ensure that male pollen grains from the stamens of one flower come into contact with the stigma of a female pistil.

The intricacies of nature are amazing in their perfection. The stigma produces special secretions making sure that no pollen from other species than its own germinates, and once the right pollen has germinated, it extends a tube into the stigma down its style and makes contact with the ovary below, where two male pollen cells fertilise three female cells. An embryo is thereby produced with a food store wrapped up neatly in a seed capsule and primed to spark into life once it is in favourable conditions.

The beautiful colours and shades of flowers, their enormous variety of shape, size and pattern, as well as their wonderful perfumes, are all developed to attract specific pollinators – insects, birds, moths, beetles, even snails. The evolutionary links between the form, colour, nectar and scent of flowers and the sensory perceptions of their pollinators is truly fascinating.

One of the earliest pollinators was the beetle, which crawled into primitive flowers to eat pollen, distributing grains around the area and enabling self-pollination. More evolved species of flowers developed nectar-secreting glands to attract flying insects that would brush against the pollen and so carry it to other flowers.

Flowers with tubular shapes developed simultaneously with those insects and birds with a sucking proboscis or beak sufficiently long to reach the nectar. Some flowers, such as antirrhinums, will only open when the right size pollinator lands on its lower lip. In some flowers, patterns such as lines or spots on the petals, as seen in horse chestnut and eyebright, point the way to the nectar to a hungry insect. Scents wafting through the air will attract pollinating insects from huge distances, as will bright colours to those insects with good sight. Some flowers only emit their scents at night when their colour fades; many, including evening primrose, open only at night to attract night-flying moths.

It is clear that one of the vital roles of flowers is to ensure the continuation of their species and therefore their survival. Flowering plants make up 80 per cent of all plants on the planet, and we as human beings also depend on plants for our survival. Flowers are absolutely essential to all human life. Not only do flowers convey messages to their pollinators, but the early herbalists believed that flowering plants embodied messages regarding their healing virtues in their shape, colour, form and pattern.

The delicate drooping blooms of the purple Pasque flower certainly do intimate the sad drooping head of the nymph Anemone, forsaken by her lover, Zephyr the Greek god of the West wind. This points towards the flower’s famous healing powers for women feeling similarly forsaken and forlorn when taken as a homeopathic remedy.

By contrast, the bright blue, purple and yellow heart-shaped flowers of heartsease have a much more uplifting nature, with their ability to heal the heart and lift the spirits.

Heartsease has been used by healers for thousands of years as a love potion and to bring comfort to those feeling hurt, rejected, lonely or broken hearted as Shakespeare well knew,

Yet mark’d I where the bolt of Cupid fell: It fell upon a little western flower, Before, milk-white, now purple with love’s wound, And maidens call it love-in-idleness
– Midsummers Night’s Dream

The healing potential of flowering plants is an integral part of the deep bond that exists between humans and nature. That flowers have the ability to heal us, not only physically but also emotionally and spiritually, is something that has been recognised and utilised as far back as we know. Now in the 21st century with evidence of the healing role of flowers going back 60,000 years, we are still striving to understand the totality of their significance in our lives.

Flowers have been used in many different ways for healing, in a variety of herbal preparations, as essential oils, homeopathic remedies and flower essences. Each system of medicine claims a certain mode of action or vibrational level of healing for its own. One thing is clear to me from the flowers’ history of healing: the essence of the flower that permeates every remedy has the same healing potential that permeates the essence of our being.

The art of healing comes from nature and not from the physician.
Therefore, the physician must start from nature with an open mind
– Paracelsus (c. 1493–1541)

It is best to pick the flowers you are planning to use first thing in the morning on a fine dry day once the dew has dried, so they are as fresh as possible. Choose the healthiest looking plants, remove any soil and old leaves or flowerheads and check for insects. The sooner you make the flowers up into your preparations the better, so they don’t lose any of their vibrancy and medicinal effects.

There are many ways that you can take healing flowers to benefit from their remedial effect. The easiest way to do this is in food and drink by using edible flowers and culinary herbs and herbal teas, which many people may be doing without realising their medicinal benefits.

A man may esteem himself happy when that which is his food is also his medicine
– Henry David Thoreau (1817–1862)

Salads with basil, coriander, nasturtiums and chives, vinaigrettes with garlic, fish with dill or wild garlic, new potatoes with fresh mint, casseroles with thyme and pizza with oregano are all very familiar. Once your food is absorbed from the digestive tract, the nutrients and therapeutic constituents of the plants enter the bloodstream and then circulate around the body.

Your favourite culinary flowers and herbs all contain volatile oils that lend their wonderful flavours and scents. These oils have antioxidant and antimicrobial effects, helping to protect the body against stresses of all kinds and to ward off a wide variety of infections, which would have been vital for health as well as enhancing culinary skills in the days before fridges, when food may have been less than fresh.

Edible flowers don’t just heighten the visual impact and the flavour of our food, they can also contribute a wide range of nutrients and medicinal compounds. Almost all of them contain vitamins A and C and mineral such as calcium, phosphorous, iron and potassium.

They are also rich in antioxidants which give the flowers and leaves their colours. Pigments that make carnations red, chrysanthemums and calendula orange for example, are rich in antioxidant polyphenols including flavonoids which protect the body against oxidative stress and may help prevent chronic diseases such as heart disease and cancer.

Calendula flowers contain more flavonoids known as lutein and zeaxanthin (that help protect the eyes from age-related disorders) than cabbage, kale or spinach and nasturtiums are also rich in them. Violets are a good source of another bioflavonoid called rutin which protects the blood vessels from damage and reduces inflammation. Apparently, even though it is an ancient practice, there is a scientific name for people who eat flowers for food, it is called floriphagia!

Let your food be your medicine and your medicine be your food
– Hippocrates (c.460BC–c. 370BC)

Vitamins

• Vitamin A: Dandelion, squash flowers, basil, dill, peppermint, rosemary, sage, coriander, lavender, violets
• Vitamin B: Peppermint, sage, coriander, garlic, dandelion, sunflowers, feverfew, peppermint, hibiscus
• Vitamin C: Echinacea, borage, nasturtium, garlic, peppermint, rosehips, dandelion, dill, rocket, rosemary, basil, sage, coriander, oregano, roses, purslane, calendula, fennel, violets
• Vitamin D: Dandelion, rosehips, nasturtiums
• Vitamin E: Dandelion, skullcap, sage, rose, sunflowers
• Vitamin K: Basil, sage, coriander, dandelion

Minerals

• Calcium: Bergamot, chamomile, fennel, marshmallow, sage, dill, peppermint, rosemary, garlic, oregano, coriander, dandelion, lavender, borage, violets, hibiscus
• Iron: Peppermint, bergamot, nasturtium, begonia, French marigold, dianthus, rosemary, day lily, skullcap, peony, lavender, dill, sage, coriander, oregano, dandelion, echinacea, calendula, chamomile
• Magnesium: Rosemary, day lily, wood betony, basil, dill, peppermint, sage, oregano, coriander, dandelion, dianthus, sunflowers
• Manganese: Basil, dill, rosemary, peppermint, sage, chrysanthemum, coriander, garlic, oregano, dandelion
• Potassium: Dandelion leaf, peony, bergamot, day lily, dianthus, fennel, rosehips, dill, rosemary, peppermint, oregano, violets, wild pansy
• Zinc: Chamomile, day lily, skullcap, peony, bergamot, dandelion, marshmallow, rosemary, peppermint, sage, caraway, garlic, coriander leaf
• Chromium: Coriander, hibiscus, dandelion
• Copper: Skullcap, sage, day lily, fuchsia, bergamot, peony, dill, rosemary, peppermint, wild garlic, coriander, dandelion
• Selenium: Garlic, coriander, fennel, basil, chamomile, St John’s wort, oregano, sage, rosemary, lime flowers

You can also prepare a variety of different floral preparations including tinctures, elixirs, oxymels and honeys.

These floral preparations can be made with single plants and then when needed you can combine several together to address the health problem you are trying to resolve or you can make ready-made combinations all in the same preparation for treating common ailments such as colds and coughs, digestive troubles, stress and insomnia when they arise.

A good example of a popular and old fashioned cold and catarrh remedy is a combination of equal parts of peppermint, elderflowers and yarrow.

You can also make preparations to apply to the skin as it is very absorbent and covers a large surface area for absorption. Tiny blood capillaries under the surface of the skin take the medicinal compounds in the flowers into the bloodstream and from there they are circulated throughout the body.

Infusions of flowers can be used as hand and foot baths, infused or diluted essential oils can be massaged into the skin, tincture-based rubbing lotions can be applied to the skin as can ointments and creams, compresses and poultices. In addition, fresh flowers and leaves can be applied directly such as yarrow, marigold or lavender flowers to staunch bleeding from minor cuts and abrasions and relieve minor burns.

The conjunctiva of the eye will also absorb floral extracts. A calendula, elderflower or chamomile eyebath or compress can be used to relieve sore and inflamed eyes. The nose and the nerve endings lying in it can provide another therapeutic pathway which we use when we smell a flower or use oils for inhalations.

When we use a hot tea or a few drops of essential oil in hot water as an inhalation, the messages from the aromatic flowers are carried directly to the brain and are also taken into the lungs where they are absorbed with oxygen into the bloodstream and circulated throughout the body.

In their practices herbal practitioners often encounter patients who report they are depressed or have symptoms that suggest depression might be a diagnosis. In many cases these symptoms are linked to highly stressful situations (also to wider world events), in which anxiety may also strongly feature, or to grief or loss.

Or they are confused with other problems, such as fatigue conditions, chronic viral or other infections and immunological conditions, so that it is sometimes difficult to assess whether the depression is or should be a distinct diagnosis.

Sometimes patients will say that the doctor has said they have depression, while another response could be “so would I in that situation!” For the herbal practitioner the treatment of the patient’s ‘depression’ is generally more productive if it is seen as in the context of another problem. So one question often features: should there be distinct diagnosis of depression here, or is this person depressed as an obvious response to a challenging situation or other health issue?

The conventional psycho-medical definition of depression is enshrined in the current standard text DSM-5, the official manual of the American Psychiatric Association. This outlines criteria to make a clinical diagnosis. The individual must be experiencing five or more symptoms during the same 2-week period, at a level that generates clinically significant distress or impairment in social, occupational, or other important areas of functioning, and at least one of the symptoms should be 1 or 2.

1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities (‘anhedonia’) most of the day, nearly every day.
3. Significant weight loss or weight gain, or decrease or increase in appetite nearly every day.
4. A slowdown of thought and a reduction of physical movement (observable by others).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, or a suicide attempt, or a specific plan for committing suicide.

This diagnosis makes the case for a distinct medical condition that should be treated separately from other factors. However, it excludes the result of substance abuse or another medical condition. In making this latter point it thus skirts over many everyday encounters in herbal practice.

Medicalising depression also overlooks a much wider conversation about its place in human history and society, its role historically in the religious path, the prominence ‘melancholics’ (from the Greek for ‘black bile’) have had in the creative arts, from cave paintings (often done in very dark places a very long way from the light) through Michelangelo and van Gogh, to British comics like Spike Milligan and Tony Hancock.

How would the British fortunes through World War II have changed if Churchill had been cured of his depression? And what to make of the startling observation that biochemical and metabolic changes of depression are also found in animal hibernation?(3) It is the practitioner’s calling to reduce suffering wherever possible but the extent to which depression is woven into the human (and even animal) condition means that at the least approaches should avoid simplicity. Simple reliance on antidepressants may not meet all the needs of someone who is prone to depressive episodes.

However there is no doubt that in its most severe forms depression is a force to itself, accompanied by biochemical and metabolic changes in the body, and that direct antidepressant prescriptions may be important and even life-saving.

Clinically diagnosed depression can be unipolar or bipolar.

Unipolar depression

Unipolar depressive disorders are typically classified as follows in DSM-5:

• Major depressive disorder (MDD) characterised by deep sadness, apathy, irritability, disturbed sleep, disturbed appetite, weight loss, fatigue, poor concentration, guilt and persistent thoughts of death – lasting longer than 2 weeks and not linked to recent grief, substance abuse or a medical disorder.
• Dysthymic disorder, which consists of a pattern of chronic, ongoing mild depressive symptoms that are less severe than major depression.
• Seasonal affective disorder (SAD), which is related to seasonal changes. The prevalence increases with increasing latitude and it can be treated by light therapy. Symptoms include lack of energy, weight gain and carbohydrate craving.

Antidepressants were designed to treat patients experiencing MDD, especially with suicidal thoughts or exhibiting other forms of self-endangerment. The severity of some major depressive symptoms makes referring to specialist care a priority, with any herbal approaches in supportive mode (although also see the discussion on inflammatory mechanisms for some potentially more significant contributions).

In this classification, herbal medicine starts as potentially appropriate for mild to moderate manifestations, found in dysthymic disorders, and particularly in helping with the often accompanying anxiety.

Bipolar disorder

Formerly referred to as manic depression, there are different bipolar conditions. Each include phases of mania or hypomania alternating with depression, or euphoria with anhedonia.

Hypomania is a distinct period of abnormally and persistently increased activity or energy, inflated self-esteem or grandiosity, decreased need for sleep, talkability, distractibility, increased goal seeking, risky, inappropriate or even dangerous activities (eg unrestrained buying sprees, sexual indiscretions, or foolish business investments), that lasts most of the day for at least four consecutive days. These episodes include a noticeable change from usual behaviour and function, observable by others, though not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.

Mania is diagnosed after at least a week of such symptoms and additionally when the mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

The main categories of bipolar identified in DSM-5 are as follows.

• Bipolar I disorder. There has been at least one manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes 
• Bipolar II disorder. There has been at least one hypomanic episode but not full mania.
• Cyclothymic disorder. At least two years of multiple periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).
• Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing’s disease, multiple sclerosis or stroke.

Bipolar II disorder is not a milder form of bipolar I, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II can be depressed for longer periods, which can cause significant impairment and its own dangers. The timing of symptoms may include additional diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Although bipolar disorder can occur at any age, typically it is diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and may vary over time.

There are various theories about the causes of major depression. These include the monoamine-deficiency hypothesis (including reduced levels or excessive uptake at nerve synapses of serotonin and norepinephrine) and a dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis with an abnormal stress response and elevated cortisol, perhaps linked to earlier traumatic events (4).

Standard antidepressant medicines focus on specific mechanisms of major depressive disorders. They include selective serotonin re-uptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) mixed norepinephrine or serotonin uptake inhibitors, dopamine or norepinephrine uptake inhibitors, and norepinephrine uptake inhibitors.

SSRIs (such as citalopram, sertraline and fluoxetine or Prozac) are now front-line pharmacotherapies in the treatment of major depressive disorder. Since their formulation over 40 years ago, there have been several conflicting studies exploring their efficacy, especially in the case of bipolar disorder (5).

Moreover the nature of their therapeutic effect has also remained elusive, with several hypothesises pertaining to neurotransmitter and endocrine modulation proposed. While the medications are better tolerated than their predecessors, the side effect profile of SSRIs is substantial and sometimes persisting.

Other ‘second generation’ types of antidepressant prescription include serotonin–norepinephrine reuptake inhibitors (SNRIs such as venlafaxine) and norepinephrine reuptake inhibitors (NRIs – eg reboxetine). SSRIs have largely replaced ‘first generation’ tricyclic antidepressants (although amitriptyline, which inhibits reuptake of both serotonin and norepinephrine, is still widely prescribed) and monoamine oxidase inhibitors (MAOIs) that inhibit the breakdown of the brain monoamines serotonin, dopamine, and norepinephrine.

All types of antidepressant are associated with potentially serious side effects and with variable levels of efficacy (6). It is worth noting that the evidence shows that antidepressant drugs are largely ineffective in patients with subthreshold to mild depression when compared to placebo. In spite of this evidence, antidepressants are increasingly prescribed for less severe forms of depression (7).

In widespread efforts to manage depression without medicines the most widely adopted option is cognitive behavioural therapy (CBT) in which sufferers are helped to shift their perceptions of their circumstances. The evidence for the benefits of ‘talking therapies’ is generally positive and comparable with antidepressants, although not perhaps as overwhelming as some advocates have claimed (8,9,10).

Other psychological therapies, including simple forms of behavioural activation in community settings, and e-health apps (11,12,13) (especially with some personalisation (14)), have been found to be also helpful, especially in helping mild to moderate depression (15), anxiety with depression, and in children (16).

Variations include the use of mindfulness (17), meditation (18), and creative therapies (19,20,21). The benefits of exercise in relieving depression have been posited, especially in ‘green spaces’ (22), although the evidence base here is not yet clear (23,24,25). The lessons from work with talking therapies techniques could be applied by herbal and other practitioners, and in one form or another may feature in some consultations already.

Light therapy has been found helpful for seasonal affective disorder (26).

Impaired cerebral circulation is another factor of depression (27), with evidence that cardiovascular disease is linked with depression and makes it worse (28). In a systematic review and meta-analysis a close association between depression and endothelial dysfunction was established (29).

Low systolic blood pressure was also associated with depression in men aged 60 to 89 years (30). There is evidence that chronic stress leads directly to challenges to the blood-brain barrier and subsequent inflammatory changes associated with depression (see below) (31, 32)

The exact cause of bipolar disorder is unknown, implicated processes include disturbances in neuronal-glial plasticity, monoaminergic signalling, inflammatory homoeostasis, cellular metabolic pathways, and mitochondrial function. Genetic factors are particularly important (bipolar disorder is 70% more common in people who have a first-degree relative, such as a sibling or parent, with the condition). Lithium is the gold standard mood-stabilising agent for bipolar treatment, as a metal ion that interacts with sodium function reflecting the core physiological disruptions associated with these conditions (33).

As discussed in Herbal Reality’s article on neuroinflammation, there is considerable evidence that depression may usefully be understood as an inflammatory disorder. Recent evidence has confirmed the interaction of inflammatory changes with established neurobiological correlates of major depressive disorder: depletion of brain serotonin and dysregulation of the HPA axis (34).

Key agents inflammation in the central nervous system are the blood-brain barrier that mediates between the nervous tissue and the wider body, and a range of support cells  in the nervous system (‘glia’ – particularly microglia).  Depression has been notably associated with activation of microglia, even being termed a ‘microgliopathy’ (35,36).

It has been demonstrated that depressed patients present neuroinflammatory alterations, including changes in T-cell population (37), and have high blood levels of inflammatory cytokines (with levels of IL-1β, IL-10, and TNF-α correlated to depression severity, with IL-8 inversely so) (38).

Depression is also strongly linked to infections, especially viral infections (39). These are likely also related to microglial activation (40).

There is a promising line of thought for the herbal practitioner faced with even severe depression. Inflammatory provocations can be linked to a leaky gut wall: to raised IgA/IgM responses to lipopolysaccharides (LPS) from Gram-negative gut bacteria (41,42). LPS are used in research to generate depressive behaviour, and their depressant effects have been confirmed in human studies. Manipulations of the gut microbiota (including microbial transplants) have been postulated as ways to prevent or treat depression (45).

However it is important to note that inflammation does not act in isolation in provoking depression. Vulnerability to inflammatory harm appears to be modified by pre-existing socio-behavioural factors. A placebo-controlled study in 115 healthy adults of the effects of an infusion of gut derived LPS (in this case an endotoxin from E. coli), showed that expected increases in proinflammatory cytokines and subsequent depressed mood were moderated by baseline levels of perceived stress, sensitivity to social disconnection, and the severity of symptoms of anxiety and depression.

These background factors were associated with increased activation of pro-inflammatory transcription control pathways (e.g. NF-κB) in response to endotoxin (46).

There is a reasonable evidence base for the benefits of herbs in ameliorating symptoms of depression. Indeed this may also hold for the consumption of more fruit and vegetables (47). In a wide-ranging review of natural constituents with antidepressant activity one paper suggests that many herbal remedies may hold some modest promise (48). There are also encouraging reports for spices in general (49), saffron (50,51) and lavender (52).

The most well-known herbal remedy at least for mild to moderate depression is St John’s wort. However the mechanisms of antidepressant action remain various, even elusive, and likely linked to several different constituents. Initial biochemical studies reported that St John’s wort is a weak inhibitor of monoamine oxidase-A and -B activity, downregulates beta-adrenergic receptors, upregulates serotonin 5-HT(2) receptors, that it inhibits the uptake of serotonin, dopamine and noradrenaline (norepinephrine) at synapses.

Other studies suggest that St John’s wort is involved in the regulation of genes that control hypothalamic-pituitary-adrenal axis function. Many of the pharmacological activities appear to be attributable to the naphthodianthrone hypericin, the phloroglucinol hyperforin and flavonoids (53,54).

In western herbal medicine there has been a group of remedies referred to as ‘nervine tonics’ or ‘nervous trophorestoratives’.  These have emerged in recognition that nervous conditions of tension, fatigue, debility and depression are all linked. This category of remedies were seen to restore energies and build up strength, hence ‘trophorestoratives’.  It is worth noting that this is a modern development: in the past it seemed there was less focus on such applications, and these qualities were generally ignored in old herbals.

Plant remedies used as nervous system trophorestoratives include oatstraw, St. John’s wort, vervain (Verbena officinalis) and from the USA damiana (Turnera aphrodisiaca) and skullcap. From outside the Anglo-American traditions, gotu kola, schisandra (Schisandra chinensis), Panax ginseng, Siberian ginseng, ashwagandha and other adaptogens have been quickly adopted to this role.

Some of the remedies above can be particularly useful in managing anxiety with depression, a common presentation to the herbal practice. To these can be added valerian and passionflower to ease nervousness and anxious feelings.

Other traditional tonics and adaptogens with potential in supporting people with depression (notably when associated with fatigue and chronic stress) include, brahmi (55) and rhodiola (56).

One promising approach is to tackle the circulatory involvement in depression with herbs that improve circulation to the brain. Ginkgo started its use in Germany specifically for this purpose, and rosemary likely has similar promise.

However the most interesting and promising prospect in the long term will be to tackle the inflammatory factors in depressive illnesses. This is a much more substantial topic, covered to some extent in the piece on neuroinflammation, and deserving future development.

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35. Yirmiya R, Rimmerman N, Reshef R. (2015) Depression as a microglial disease. Trends Neurosci. 38(10): 637-658. doi: 10.1016/j.tins.2015.08.001.
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37. Maes M, Stevens W, DeClerck L et al. (1992) Immune disorders in depression: higher T helper/T suppressor-cytotoxic cell ratio. Acta Psychiatr Scand. 86(6): 423-31. doi: 10.1111/j.1600-0447.1992.tb03292.x.
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It is difficult to point at one solid piece of data or theory as to why men are in the situation we find ourselves today.

In my work with men, I believe the underlying themes point towards a number of different reasons:

• Lack of purpose or meaning in life
• The addiction to short term gratification – Food, material positions, sex, gambling etc.
• Poor male mentoring influence – No father in the childhood home or strong, well rounded male figures in the patient’s life
• The glorification of violence, money and tyrannical power as a pursuit to meaning
• Trauma
• Adverse childhood events (2)
• A society that values academic pursuits instead of a well-rounded, meaningful spiritual pursuit towards discovering truth and purpose
• Poor boundaries and a lack of assertiveness
• Lacking healthy morals

In my clinic I work with mostly young men aged 20-35. Many are what I consider to be “lost”. Lacking meaningful careers, healthy relationships, filled with anxiety, depression and substance abuse.

The focus of understanding the male patient first comes with detailing physiological complaints but often turns into uncovering the life plan or life pattern that the individual is stagnant in, stuck in or struggling to break. It is therefore crucial to help the man see his body is deeply connected to what he surrounds himself with or ingests.

Poor dietary choices and substance misuse are critical to discuss as they often underpin a self-medication process that many men are sucked into in order to cope. This is linked to lacking internal resources and the lack of action on the areas of their life that need attention.

Younger male patients are often unaware of how their behaviours are intricately linked with short term gratification (3). Preferring to engage in behaviours that offer very short term relief through dopaminergic activity (drugs, food, gambling, pornography, spending excessive amounts of money etc). However, this can be a problem that affects men at any age.

Older men tend to live more meaningful lives in terms of family commitments, children and job/career. They are more dominant in manifesting a stronger sense of purpose, responsibility and meaning. But the juggling of such responsibilities can become overwhelming and as such promote a background feeling of instability that men can find difficult to comprehend.

This follows the theory of the ‘U-shaped happiness curve’ (4) which shows data from across the world pointing towards life satisfaction dropping in the age range of 40-50. These also happen to be the years with peak responsibilities when it comes to jobs, finances, children and hobbies. Exhaustion and stress become entrenched within the man who struggles with his demanding work/life balance. Selye’s general adaptation syndrome (5) provides key parts to how the stress response can become overloaded and middle-aged men living a manifested life are easily overburdened around this age.

The “mid-life crisis” plays into this phenomenon of men being unsatisfied in their mid-forties, and seeking other pursuits to alleviate the burden.

At all ages it would seem men have many areas of their life that they consciously or unconsciously do not speak about for reasons such as fear of judgement, ridicule or a general lack of awareness that they need attention.

Humans are innately gifted at using things in their environment to bring about a change. Abuse and/or misuse of foods, medicine and drugs will often feature in a male patient seeking help for mental health problems. It is an important subject to understand here in that the patient is merely seeking a change in their experience of reality by using foods and substances to cope with, change or repress a human sensation or emotion they are struggling to comprehend.

I find that substances play differing roles for men, mainly dependant upon age. Younger men tend to use substances in more social settings as a means to engage with the group. This is predominantly the “party” scene. Large gatherings of people help the individual find more meaning, but they often include substance abuse as a social dynamic.

Solitary substance use tends to be more Cannabis in the younger generation of men. Cannabis is often used for anxiety and insomnia in the home, with stimulants such as cocaine and amphetamine being more favoured when in a group setting. In this case the substances are not necessarily stress related, or due to such a lack of responsibilities, but more associated with escapism.

Substances easily creep in with older men to cope with the increasing demands of a responsible life filled with a mortgage, marriage and children. Excessive Coffee often features in the morning due to poor cortisol awakening response (6), sugary foods during the day due to glucose needs impacted by stress, and alcohol in the evening to switch off and sleep.

Whilst every man is unique in presentation the following protocol is one I use with the most success:

• Detailed analysis and discussion of childhood experiences, family life, living situation, diet, substance misuse and physiological complaints.
• Introduction of agreements surrounding action that needs to be worked upon to become more of the man they wish to be.
• Agreements on changing diet and reducing substance misuse.
• The withdrawal of substances needs to be aligned with the practitioner attempting to understand what the male patient is using them for (repression of emotions, escapism, social connection, physical pain etc).
• Herbal treatment should be initially aimed at balancing the autonomic nervous system, fortifying the man’s energy reserves and reducing inflammation. This is often done with tonics, adaptogens, relaxants and anxiolytics.
• Younger men in their 20’s tend to be needing help to manifest more of the life they want by accepting the meaningful pursuit of responsibility. Herbs that change blood dynamics are more helpful here to break internal stagnancy which will be reflected in their external reality.
• Older men over 40 tend to need more help with finding calm, peace and a restructuring of the overburdening of responsibilities. Herbs that help reduce inflammation and calm the nervous system tend to be more relevant in this age group.
• Subsequent treatment should be aimed at working alongside new found goals, visions or thoughts towards a particular challenge, block and project they find meaning in. Nootropics are useful here.
• In all stages of treatment the consultations should encourage a significant amount of time towards facilitating the man to understand his life is more within his control than what he initially realises. Talking therapy, coaching and herbs are supporting him to become more manifested as a well-rounded and balanced individual.
• Men are likely to hold onto emotions for fear of judgement. When information is shared or released it is to be celebrated and encouraged by operating through a safe container in which information is received, discussed openly and new perspectives offered. This encourages trust and recognition that the male patient learns is not just acceptable but needed to unburden himself of the psychological weight that carrying around shame, guilt, anger, fear and resentments can bring upon the body.
• Nootropics are more likely to produce desired affects once inflammation, autonomic nervous system function, gut health and blood pressure have all found a more regulatory nature. I find that giving nootropics too early into treatment will lack the desired outcome.
• As treatment progresses, remember that the practitioner will produce lasting change by focusing on the life plan resolution and transformation rather than the disease. If you focus solely on the disease and treat only at the physiological level of illness you may not induce the psyco-spiritual changes that assist men to learn how they can master more control of their internal and external reality.

The following herbs are ones I use continuously with my male patients.

Gotu kola (Hydrocotyle asiatica)

• Actions: Nootropic, anti-inflammatory, brain tonic, warming
• Used for: Balancing the autonomic nervous system (ANS). Prolonged stress will cause a dysregulation that is perpetuated even at rest. Gotu Kola help stabilise and module the ANS. Helpful for anxiety.

Tulsi (Ocimum sanctum)

• Actions: Lung tonic, antidepressant, aromatic, stress relieving, adaptogen
• Used for: Stagnation in mind and body. It is a highly aromatic herb that focuses on expelling mucus in the lungs and digestion. Perfect for supporting a male patient who is a chronic smoker and/or substance user addicted to behavioural patterns that have caused stagnation.

He shou wu (Polygonum multiflorum radix)

• Actions: Adaptogen, blood tonic, kidney tonic, alterative, rejuvenative, nervine
• Used for: Exhaustion and depletion associated with chronic stress. Pain and weakness in the lower back, knees and tendons. A tonic for the adrenals, liver and pancreas.

Maca root (Lepedium meyenii radix)

• Actions: Boosts fertility, rejuvenative, aphrodisiac, sexual tonic
• Used for: A native to the high Andean mountains of Peru. It was supposedly eaten by Inca warriors before going into battle as well as being given as a gift to newly married couples (7). Useful for men of any age who are exhausted, suffering with low libido and a general feeling they are severely lacking physiological power.

Damiana leaf (Turnera diffusa folia)

• Actions: Antidepressant, aphrodisiac, anxiolytic, relieving stress
• Used for: Improving decision making associated with fear of the unknown. Relaxing the mind and stimulating change.

Wu wei zi (Schisandra chinensis fructus)

• Actions: Adaptogen, aphrodisiac, nervine, astringent, antidepressant
• Used for: Originally used by Siberian hunters to improve eyesight, strength and resilience during challenging pursuits. Wu Wei Zi is an adaptogen that has affinity for improving the health of the liver and the vitality of the kidneys. I often use it with male patients who have a lot of repressed anger that needs to be expressed and integrated.

Borage (Borago officinalis)

• Actions: Adrenal tonic, anti-inflammatory, diuretic
• Used for: Improving adrenal vitality and regulation. A hyperactive fight or flight response will tax energy levels and Borage is often supportive of improving energy levels, giving the man more resources (energy) with which to take action to bring about further resolution and change.

Rosemary (Rosmarinus officinalis)

• Actions: Nootropic, antidepressant, stimulates circulation and improves blood flow
• Used for: Young male patients who are often lazy, lacking motivation and need to create momentum. Rosemary improves blood dynamics which are often stagnant in young men, reflecting a much needed change in behavioural patterns towards creating the life they want.

1. https://www.mentalhealth.org.uk
2. https://mft.nhs.uk/rmch/services/camhs/young-people/adverse-childhood-experiences-aces-and-attachment/
3. https://www.psychologytoday.com/gb/blog/the-modern-brain/201909/the-real-issue-instant-gratification
4. https://www.inc.com/jeff-haden/scientists-just-discovered-mid-life-crisis-peaks-at-age-47-heres-how-to-minimize-effect-of-happiness-curve.html
5. https://www.medicalnewstoday.com/articles/320172
6. Lovallo. W.R, Whitsett. T. L, al’Absi. M, Sung. B. H, Vincent. A. S, Wilson, M. F. (2005) Caffeine Stimulation of Cortisol Secretion Across the Waking Hours in Relation to Caffeine Intake Levels, Psychosomatic Medicine, 67(5): p. 734-739.
7. https://charli-cohen.com/maca-the-mysterious-superfood-and-hormone-balancer/

The term adaptogen was first used by scientist Nikolay Lazarev in 1947 to describe substances that can improve an organisms ‘non-specific’ resistance to stress (1). In 1968 the definition was elaborated by fellow Soviet pharmacologists Brekhman and Dardymov to mean a substance that (2)

• is non-toxic, and causes minimal disturbance to the organism
• is non-specific in pharmacological action, improving the organisms resistance to a broad range of stressors
• tend to have a ‘normalising’ effect on body systems – reducing excess, and raising deficiency

This reflected an attempt to provide scientific support for a common theme in holistic herbal medicine – restoring balance and supporting the body’s natural adaptive resilience.

Not surprisingly herbs with these reported adaptogenic properties remain an attractive prospect for herbalists and patients. As would be expected from such a broad action adaptogens are employed for a whole host of conditions. However, the main therapeutic focus is reducing the extent of the body’s stress response, and improving recovery. Relatedly they will be used to improve stamina and support people with chronic conditions, and improve concentration.

While the word adaptogen is a very recent term, it is not without precedent in the long history of herbal medicine – the preservation and adaptation of herbal uses on which much pharmacological investigation is based. Exploring the histories of the most well known adaptogens shows the connections between their classifications in a variety of herbal traditions and their reinterpretation as adaptogens in the twentieth century.

• Eleutherococcus senticosus (Rupr. & Maxim.) Maxim.
• Family: Araliaceae
• Synonym: Acanthopanax senticosus (Rupr. & Maxim.) Harms)

While commonly known as Siberian ginseng, it has a wider distribution, growing wild across Northeastern and Central China, North Korea, South Korea, Far Eastern Russia and Japan (3).

It grows as a shrub, reaching heights of around 5 to 8 feet, and its light brown stems are covered in prickly spines. Each palmate leaf consists of five leaflets of varying size. It favours the cool semi-shade of mixed mountainous forests.

It produces tiny white flowers in mid-summer, borne on umbels, that produce clusters of black fruits. It is mainly the rhizome with the roots that is used in herbal medicine.

Eleutherococcus senticosus was the main herb of interest to the early researchers on adaptogens in the Soviet Union, and apparently found favour as a replacement for another member of the Araliaceae plant family, Panax ginseng, when supplies were low. Dr. Brekham researched and promoted the herb for convalescents, aiding immunity after surgery and protecting well-being. The herb found favour amongst Soviet athletes as an endurance aid, who then shared its use at international events (4).

It has a long history of use in Traditional Chinese Medicine, first recorded in the Shennong Ben Cao Jing c.220 A.D., and is mainly employed today in a range of combination prescriptions for various conditions.

It is recommended for general invigoration of Qi, with a particular affinity for the kidneys and liver, supporting their effective functioning, which leads to improvements in the health of the musculoskeletal system (5). It was traditionally used by people living in the subarctic forest regions of Siberia to improve quality of life and protect against infections (6).

• Panax ginseng C.A. Mey.
• Family: Araliaceae

Commonly known as Korean ginseng, it is historically associated with the country due to the reputation of the quality of the rhizome that grows there, that is still widely exported and remains an important souvenir for Chinese tourists visiting South Korea. Though like the so-called Siberian ginseng it has a wider distribution than its name suggests – spreading wild across North-Eastern China, North Korea, South Korea, and some regions of Far Eastern Russia (7).

It has a similar appearance to its close relative, though without the very spiney stem and having yellowish to pink flowers on its umbels that produce red rather than black fruits. It shares a similar habitat.

Again, it is the rhizome which is used medicinally, which makes it more at risk of overharvesting and it is now mostly cultivated due to the loss of wild plants, though semi cultivated ‘wild’ ginseng fetches a premium on the market while allowing stocks to be replenished.

The genus name shares the same etymology as panacea, coming from the Ancient Greek pân meaning “all” and ákos meaning “cure”, named for its supposed reputation in Chinese and Korean medicine. Chinese botanist Shiu Ying Hu argued in her 1976 paper that this reputation was based on a misrepresentation of its use in Chinese medicine which was “very specific and restricted”.

This was because it was only prescribed for patients “who have the jo (“weak”) symptoms and who need the pu (“tonic”) remedies”, out of ten possible symptom groups with matching remedy types (8). And in Chinese materia medica texts it is generally recommended for the following conditions – lassitude and anorexia, shortness of breath and low voice, diabetes, insomnia and impotence, and for each condition there is a specific combination of other herbs used alongside ginseng (9).

Despite these specific understandings of prescribing in a clinical tradition, Panax ginseng has gained a reputation across the world, including in China and South Korea, as a general tonic and health supplement on its own, to support peak performance at work, in sport and in the bedroom. It is sold as powder, pills, dried root, infused in wine, cooked in soup and in teabags.

• Rhodiola rosea L.
• Family: Crassulaceae (10)

Both fresh and dried, the root has a rich earthy rose like aroma, hence the species name ‘rosea’ and the common names roseroot and rosewort. It is also known as arctic root due to its affinity for icy habitats, and goldenroot on account of its yellow flowers. It grows upright to around 70cm high, with a fleshy stem and leaves.

Swedish botanist Carl Linnaeus recommended it for “headaches, “hysteria”, hernias, discharges, and as an astringent”(11). Tracing the longer history of the use of roseroot is harder because little detailed work has been published in English as far as I’m aware.

For example, there is debate over whether or not Vikings used it for endurance during their long journeys, which seems likely considering the uses we know of today, but there are very little textual records from this period and only a few studies on the archaeobotanical record. However, the root is used today for a range of conditions across its wide distribution – Arctic and mountainous regions of Europe, Asia and North America, covering around 30 countries (12).

According to a review of traditional uses the Sámi people chew on root pieces during long journeys and use it for urinary infections, Inuit people use the root for infections, colds, fatigue, and toothache, and for mental and physical rejuvenation. Evenki people in North-Eastern Russia use it as a ‘universal’ medicine. Elsewhere it is commonly used for fatigue, strengthening the body, mental stamina, stress relief and as a tonic (13).

It has become popular in recent years in commercial preparations for its advertised adaptogenic properties. The plant is of conservation concern due to climate change and overharvesting for the herbal medicine trade in certain areas (14).

Other herbs most commonly referred to as adaptogens are:

• Astragalus (Astragalus mongholicus Bunge (syn. Astragalus membranaceus Fisch. ex Bunge))
• Ashwagandha (Withania somnifera (L.)
• Schisandra (Schisandra chinensis (Turcz.) Baill.)
• American ginseng (Panax quinquefolius L.).

Mills and Bone, in their widely referenced book Principles and Practice of Phytotherapy extend the definition of adaptogen to:

• Goji berry (Lycium spp.)
• Codonopsis (Codonopsis pilosula (Franch.) Nannf.)
• Echinacea (Echinacea spp.)
• Gingko (Gingko biloba L.)
• Gotu kola (Centella asiatica (L.) Urb.)
• Tribulus (Tribulus terrestris L.) (15)

In addition to these herbalist David Hoffman lists many more as adaptogens. Many of these are in the same family as the ginsengs discussed above:

• Wu jia pi (Eleutherococcus sessiliflorus (Rupr. & Maxim.) S.Y.Hu)
• Japanese angelica tree (Aralia elata (Miq.) Seem.)
• Manchurian aralia (Aralia elata var. glabrescens (Franch. & Sav.) Pojark)
• Sakhalin spikenard (Aralia cordata Thunb.)
• Asian devil’s club (Oplopanax elatus (Nakai) Nakai)

And in diverse plant families:

• Silk tree (Albizzia julibrissin Durazz)
• Chickpea (Cicer arietinum L.)
• Indian hoppea (Hoppae dichotoma  Willd.)
• Guduchi (Tinospora cordifolia (Willd.) Hook.f. & Thomson)
• Arogyappacha (Trichopus zeylanicus Gaertn.)
• Holy basil (Ocimum tenuiflorum L.)
• Hardy rubber tree (Eucommia ulmoides L.)
• Maral root (Leuzea carthamoides (Willd.) DC.)
• And one species of mushroom, also popular for supporting immunity: lingzhi or reishi (Ganoderma lingzhi (Sheng H. Wu, Y. Cao & Y.C. Dai))(16)

As would be expected all these herbs have a long tradition of use both in the regions they grow and through international trade, combine this with the general nature of their actions and you can see how they have been employed for more conditions than it is possible to account for here.

There are however common themes that emerge when connecting these traditions to their more recent classification as adaptogens – the use for fatigue, general debility, endurance, resilience, as a tonic a ‘universal’, for support of the body as a whole or for optimal function of specific organs or systems.

One of the scientists who defined the term adaptogen distinguished it from a herbal tonic in 1968, describing a tonic action as increasing work capacity and correcting weakness and lack of tone, and from a stimulant which provides a temporary increase in work capacity, followed by a decrease (17).

It should also be noted that when studying traditional medical systems the word ‘tonic’ is often simply a translation into English of words that could be understood quite differently within those cultures, that may be closer to or further from the definition of adaptogen.

Some biochemists have argued that the term adaptogen should not be used as it cannot be linked to a few clear ‘mechanisms of action’ based on isolated compounds, and that scientists should ignore “the fact that the word ‘adaptogen’ was ever invented. While others argue the effect is the same as that of a placebo (18).

The original definition of adaptogen was very clear on the non-specific action, and it is seen as a useful way to bridge different approaches to philosophies of healing.

Despite some scepticism, many researchers are still looking to test the adaptogenic theory, and have focused on many different specific actions to understand the possible effects of these herbs on the body. Some areas that the action is understood in biochemistry are as follows – more efficient use of glycogen, regulating metabolism, inhibiting stress hormones binding to receptors, relaxation of blood vessels, antioxidant activity, steroidal activity, immunostimulant, immunomodulatory, hepaprotective, and antifatigue activities (19).

In some cases, as with Panax ginseng, a herb can contain chemicals that have opposing actions that may explain the adaptogenic effect, for example both hypotensive and hypertensive effects (20).

And for randomised controlled trials the focus is normally on work capacity and endurance for exercise, oxygen consumption, heart rate, respiratory exchange rate, blood pressure, blood glucose, tests of cognitive performance, as well as more subjective measures of wellbeing.

The search for a or cure all is not new, the phrase panacea was used for many different species of plants across ancient Greek and Roman texts, that have been linked to the contemporary names lovage (Levisticum sp.), yarrow (Achillea sp.), centaury (Centaurium sp.), tarhan herb (Echinophora), and species of the genus Opopanax, known in English as ‘all heal’.

While the term ‘adaptogen’ is a very recent development in the history of herbal medicine it is not without precedent. It seems there has always been a desire for a general tonic that can provide support to the body’s own resilience, and it is based on real benefits that people have experienced from taking these herbs. While it is not surprising that the idea of a ‘cure all’ plant raises scepticism, when the use of a herb is understood within its specific context it generally becomes clear that different adaptogens will be used for different patients and different manifestations of conditions in clinical practice.

It has become popular among herbalists, probably because it covers the complexity of using plants as medicines while connecting to a pharmacological approach. The ‘non-specific’ action that is so frustrating to biochemical models that rely on isolation and reduction, holds within it an awareness of complexity and the unknown, and of the workings of the body as a whole that may be more than the sum of its parts. More research is still being done to understand how the specific pharmacological actions connect to the more general outcomes in patients, and there are many more herbs that may demonstrate adaptogenic properties that have had very little research on them.

1. Marina Davydov and A. D. Krikorian, ‘Eleutherococcus Senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an Adaptogen: A Closer Look’, Journal of Ethnopharmacology 72, no. 3 (1 October 2000): 345–93, https://doi.org/10.1016/S0378-8741(00)00181-1.
2. I I Brekhman and I V Dardymov, ‘New Substances of Plant Origin Which Increase Nonspecific Resistance’, Annual Review of Pharmacology 9, no. 1 (April 1969): 419–30, https://doi.org/10.1146/annurev.pa.09.040169.002223.
3. POWO, ‘POWO’, Database, Plants of the World Online. Facilitated by the Royal Botanic Gardens, Kew., 2022, https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:90431-1. Accessed 15/02/2022.
4. Tracy Lee Bleakney, ‘Deconstructing an Adaptogen: Eleutherococcus Senticosus’, Holistic Nursing Practice 22, no. 4 (August 2008): 220–24, https://doi.org/10.1097/01.HNP.0000326005.65310.7c.
5. Erich Stöger, Chinese Herbal Medicine: Materia Medica (Eastland Press, 2004).
6. Linzhang Huang et al., ‘ChemInform Abstract: Acanthopanax Senticosus: Review of Botany, Chemistry and Pharmacology’, Die Pharmazie 66 (1 February 2011): 83–97, https://doi.org/10.1691/ph.2011.0744.
7. POWO, ‘POWO’. https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:91472-1. Accessed 15/02/2022.
8. Shiu Ying Hu, ‘The Genus Panax (Ginseng) in Chinese Medicine’, Economic Botany 30, no. 1 (1976): 11–28.
9. Yao-Zu Xiang et al., ‘A Comparison of the Ancient Use of Ginseng in Traditional Chinese Medicine with Modern Pharmacological Experiments and Clinical Trials: USE OF GINSENG IN TCM AND CLINICAL TRIALS’, Phytotherapy Research 22, no. 7 (July 2008): 851–58, https://doi.org/10.1002/ptr.2384.
10. A. Panossian, G. Wikman, and J. Sarris, ‘Rosenroot (Rhodiola Rosea): Traditional Use, Chemical Composition, Pharmacology and Clinical Efficacy’, Phytomedicine 17, no. 7 (1 June 2010): 481–93, https://doi.org/10.1016/j.phymed.2010.02.002.
11. Carl von Linné, Materia Medica (Holmiae: Typis ac sumptibus Laurentii Salvii, 1749), https://www.biodiversitylibrary.org/bibliography/72911. Quoted in Panossian, Wikman, and Sarris, ‘Rosenroot (Rhodiola Rosea)’.
12. POWO, ‘POWO’, Database, Plants of the World Online. Facilitated by the Royal Botanic Gardens, Kew., 2022, https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:315148-2. Accessed 15/02/2022.
13. J.A. Brinckmann, A.B. Cunningham, and David E.V. Harter, ‘Running out of Time to Smell the Roseroots: Reviewing Threats and Trade in Wild Rhodiola Rosea L’, Journal of Ethnopharmacology 269 (April 2021): 113710, https://doi.org/10.1016/j.jep.2020.113710.
14. Brinckmann, Cunningham, and Harter.
15. S. Mills and K. Bone, ‘Principles and Practice of Phytotherapy. Modern Herbal Medicine.’, 2000, xx + 643 pp.
16. David Hoffmann, Medical Herbalism: The Science and Practice of Herbal Medicine (Inner Traditions / Bear & Co, 2003).
17. Committee on Herbal Medicinal Products (HMPC), ‘Reflection Paper on the Adaptogenic Concept’ (European Medicines Agency, May 2008), https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-adaptogenic-concept_en.pdf.
18. Davydov and Krikorian, ‘Eleutherococcus Senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an Adaptogen’.
19. David Winston and Steven Maimes, Adaptogens: Herbs for Strength, Stamina, and Stress Relief (Inner Traditions / Bear & Co, 2007); Mills and Bone, ‘Principles and Practice of Phytotherapy. Modern Herbal Medicine.’; Joanne Barnes, Linda A. Anderson, and J. D. Phillipson, Herbal Medicines, 3rd ed (London ; Grayslake, IL: Pharmaceutical Press, 2007).
20.  Barnes, Anderson, and Phillipson, Herbal Medicines. 333.

Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged periods of stress.

It manifests as low resilience, depression, cynicism, emptiness, feeling trapped, feeling ineffective, detached from the world, apathetic, insomnia and feelings of overwhelm.

As a term, it was originally used to describe the fallout from long-term stress caused by work, but a semantic shift and improved understanding means that we may apply it to any areas of life that cause such feelings of hopelessness.

Burnout goes beyond stress, it is a diminished capacity to deal with life’s stressors and needs urgent addressing for healing – it is essentially end-stage stress, cannot be sustained and, unlike stress, may feel never-ending and insurmountable to the sufferer.

There are no official figures of burnout sufferers as whilst the WHO have recognised it as an official “syndrome” (related to workplace stress only), it is yet to make it to the DSM-5 as a medical diagnosis. It can only be a matter of time for it to be officially recognised as there is no doubt that burnout is on the rise, and incredibly impactful on the lives of sufferers.

There are many contributing factors to the rise in burnout:

• Poor sleep
• Reliance on devices/never switching off
• Changes in how we nourish our bodies
• Poor work/life balance
• Adverse childhood events
• Inability to say “no” and the glorification of busyness
• Money issues and lack of access to resources

In more recent times, Covid and the seemingly never-ending pandemic was (and is) one of those challenges that rendered us with little control. The reality for many is that their mental health has been challenged. In fact, the Centre for Mental Health UK predicts that up to 10 million people (almost 20% of the population) will need either new or additional mental health support as a direct consequence of the pandemic. This has, without doubt contributed to the sudden rise in burnout sufferers in recent times.

• Onset and maintenance insomnia, and excessive daytime sleepiness
• Fatigue
• Food intolerances
• IBS
• Dysregulated blood sugar
• Low immunity/susceptibility to infection
• Headaches
• Unexplained pain
• Panic attacks
• Hypo arousal of the HPA (hypothalamic-pituitary-adrenal) axis – flattened cortisol curve
• Acne, psoriasis, eczema, and other skin disorders
• Brain fog and cognitive decline

Our diet has a huge impact on our physiology and nervous system response, thus our mental health. Whilst it’s not possible to simply eat oneself out of an anxious or burnt-out state, the potential for what we eat, or importantly what we don’t eat, and when and how we eat it, to influence our mental health is often seriously overlooked.

How we eat is indicative of what is going on in our lives, and a lot of people’s eating habits have changed over the past two years of lockdown. The way we feel about food and our ability to nourish ourselves affects our mood and sense of self.

Allostatic load is defined as “wear and tear on the body” which accumulates as an individual is exposed to repeated or chronic stress, anxiety, or burnout. As food can affect burnout, so can burnout can affect how we absorb and respond to the food that we eat.

Increased output of our stress hormones and continued HPA-axis activation leads to systemic inflammation which can (amongst other things) drive food intolerances through altered tight junctures in the gut lining. Furthermore, dysregulated cortisol levels have been shown to affect the composition of bacteria in the gut.

Whilst structurally the same as the brain, our gut-derived serotonin has localised effects on the digestive system, such as the perception of nausea, pain and drives peristalsis (the rhythmical movement of the gut muscles to transport food through the tract). Whilst there is still much to be understood about the effect of peripheral serotonin on mood, what has been determined is that the production and release of serotonin from the enterochromaffin (EC) cells in the gut can be controlled by our gut bacteria.

Long term stress and burnout may impair our cell-mediated acquired immunity, leaving us more susceptible to viral, bacterial and yeast infections.

Staying up late

We have a wealth of streaming services at our fingertips, providing more incentive to stay up late. Screens emit blue light which interfere with our melatonin production, which means that when we do make it to bed after a series binge it takes us longer to fall asleep, and when we do drop-off, our sleep has less of the vitally restorative REM sleep stages. Sleep is so crucial to our mental and physical well-being that even the smallest sleep deprivation can have a deep impact.

Hooked on our devices

In this modern world we are always connected via our devices. Endless scrolling of Instagram feeds, designed to hook us in, and boundary-less colleagues and clients who see no harm in popping a “quick email” at midnight keep us in an aroused and stressed state. This is incredibly stimulating to our nervous system, putting us into flight-or-flight mode, which upregulates the production of stress hormones. Continued and chronic hyperarousal of our fight-or-flight response over time can lead to a freeze state, which some proponents of polyvagal theory believe to be similar to “burnout”.

Inability to say “no” and the glorification of busy

We now equate busyness to productivity and a characteristic of a successful life – often we have created this busyness to distract from our unfulfilled needs. We have designed our life to distract us from those uncomfortable feelings – we keep ourselves busy on social media, social engagements, in our work, and in our inability to say no, and it is stressful. The truth of the matter is that busyness does not result in greater productivity, and that busyness is contributing to a culture of continuous anxiety and stress.

Reaching for quick and easy foods

A typical western diet is nutrient-void and inflammatory to the body, and the mind. The western diet is rich in refined sugars, white and processed flours and simple carbohydrates, processed meats, and food additives, and contains low amounts of fibres, vitamins, minerals, complex carbohydrates and other plant-derived phytonutrients and antioxidants.

When we are busy, stressed or suffering burnout, what’s on our plate and how we nourish our body might become an afterthought, or we may not have the capacity to think about how to eat to improve our well-being. Fast foods can become a go-to as it requires little thought, despite the detrimental effect it can cause.

Whilst we cannot merely eat ourselves out of burnout, we can certainly modulate what we eat and the way we eat it to lessen the physiological impact of burnout on the body, and by giving our brains all it needs to repair, provide ourselves with all the tools to begin healing. Highlighting specific foods that may have an impact on brain chemistry can be useful, yet when a person has reached burnout stage it may be more helpful to look at how they are eating as opposed to concentrating on nutrients specific to a handful of foods.

Marrying your macros

When carbohydrates are broken down and have been eaten alone or without sufficient fats and proteins, they cause a spike in blood sugar, the body uses this quick energy as accessible and immediate, followed by a quick drop. We are not only quickly hungry again as the insufficient energy has not sustained us, but this is an incredibly inflammatory process for the body.

This is blood sugar imbalance or the “Blood Sugar Rollercoaster” and it’s not a ride we want to be on. Our body tries to reach homeostasis, and to do so releases cortisol – our stress hormone. So, ensuring you are pairing carbohydrates (preferably complex) with good fats and proteins will slow the rate of absorbency, and breakdown of sugars.

Avoiding fasting/eating regular meals

Our body doesn’t know why there’s a lack of food by design, it just knows that it must prioritise the search for it and scarcity of food is a stressor for our body. Too much circulating cortisol diminishes our ‘non-essential’ functions such as hair growth, libido, our reproductive system and sleep, because our body doesn’t know it’s truly safe to conceive or sleep under all this threat and escaping the stressor is priority.

A diverse range of foods

An ‘ecosystem’ of varied bacteria greatly impacts our mental. Different bacterial strains perform diverse beneficial functions, and each strain thrives off the consumption of different foods. Complex carbohydrate plant foods provide fibre as an important cornerstone of our diet. Our bodies do not have the enzymes to digest these – that is a job for our gut flora. These prebiotic foods nourish the good bacteria in our gut which are responsible for producing many of our mood-supportive neurotransmitters.

A Mediterranean diet

The Mediterranean diet has long been associated with a reduction in the risk of depression, and now emerging research shows that it may be a useful tool in the prevention or treatment of burnout.

A diet rich in a variety of vegetables (including dark leafy green), fruits (including berries for their antioxidant power), legumes, nuts, seeds, whole grains, olive oil, oily fish and a low intake of highly processed food and red meat, reduces inflammation and provides nutrients that are depleted when mental health is challenged. Stress is nutritionally very expensive on the body, so replenishing these stores is vital in healing.

Staying hydrated

Dehydration can mimic feelings of anxiety or panic; our bodies can feel fatigued and our brains sluggish. Our blood is 92% water, and so the smallest decrease can cause blood pressure to drop. Our bodies like homeostasis, so will create alarm (increased stress hormones) to alert us to the imbalance. Staying hydrated is the quickest and easiest win for our mental and physical health, and easy to forget when in a burnt-out state.

• Improved boundary setting and learning to say “no”
• Prioritising deep rest to heal
• Ensuring that at least 2 out of 3 meals per day are nutritionally dense
• Setting limits on our device usage
• Daily movement, even just a short walk
• Forest bathing and getting out in nature to increase GABA
• Assess and act upon any nutritional deficiencies in the body
• Improve gut health
• Daily movement, even just a short walk
• Taking time to eat undistracted to improve digestion
• Practice good sleep hygiene
• Avoid reliance on alcohol and limit intake

Self-forgiveness is key here. Whilst nutrition is a very important part of the healing process, it is not the only component of recovery. Not everyone loves to cook, or has the time, means or access to resources to create nutritious meals from scratch every day – a lot can be done with convenience foods and combining cheaper products.

Asking for help, from either partners, friends, or local resources such as food banks and charities may prove beneficial. The rise in austerity has meant that there are some wonderful free food sharing apps that have emerged in recent years and contacting your local welfare group may point you in the direction of valuable resources in your community.

The adage “prevention is better than cure” is certainly true when it comes to burnout. Recognising the warning signs of stress and taking preventative measures to mitigate its impact can prevent the transition to burnout. This isn’t always possible, often times we cannot remove ourselves from a chronic stressor before it is too late. When one has reached burnout, recognising that healing is not linear but rather undulating over time, is very important.

Often when we are at rock bottom, we can feel impatient to be better, and steps back can feel like colossal failure. Reminding oneself of the process and trusting in it will give the impetus to continue even when it feels hard. Understanding that as humans we are designed to heal and are always in a state of flux – whilst not everyone has the capacity to be fully cured (trauma will always leave its mark), everyone has the capacity to heal.

• Castro-Sepulveda, M., Ramirez-Campillo, R., Abad-Colil, F., Monje, C., Peñailillo, L., Cancino, J. and Zbinden-Foncea, H., 2018. Basal Mild Dehydration Increase Salivary Cortisol After a Friendly Match in Young Elite Soccer Players. Frontiers in Physiology, 9.
• Centreformentalhealth.org.uk. 2022. Covid-19 and the nation’s mental health: October 2020 | Centre for Mental Health. [online] Available at: <https://www.centreformentalhealth.org.uk/publications/covid-19-and-nations-mental-health-october-2020> [Accessed 9 February 2022].
• Chellappa, S., Steiner, R., Oelhafen, P., Lang, D., Götz, T., Krebs, J. and Cajochen, C., 2013. Acute exposure to evening blue-enriched light impacts on human sleep. Journal of Sleep Research, 22(5), pp.573-580.
• Christ, A., Lauterbach, M. and Latz, E., 2022. Western Diet and the Immune System: An Inflammatory Connection.
• Esquivel, M., 2020. Nutrition Strategies for Reducing Risk of Burnout Among Physicians and Health Care Professionals. American Journal of Lifestyle Medicine, 15(2), pp.126-129.
• Generoso, J., Giridharan, V., Lee, J., Macedo, D. and Barichello, T., 2021. The role of the microbiota-gut-brain axis in neuropsychiatric disorders. Brazilian Journal of Psychiatry, 43(3), pp.293-305.
• Loopstra, R., Lambie-Mumford, H. and Fledderjohann, J., 2019. Food bank operational characteristics and rates of food bank use across Britain. BMC Public Health, 19(1).
• Marik, P. and Bellomo, R., 2013. Stress hyperglycemia: an essential survival response!. Critical Care, 17(2), p.305.
• McEwen, B., 1993. Stress and the Individual. Archives of Internal Medicine, 153(18), p.2093.
• Morey, J., Boggero, I., Scott, A. and Segerstrom, S., 2015. Current directions in stress and human immune function. Current Opinion in Psychology, 5, pp.13-17.
• Mozaffarian, D., 2016. Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity. Circulation, 133(2), pp.187-225.
• Nakamura, Y., Walker, B. and Ikuta, T., 2016. Systematic review and meta-analysis reveals acutely elevated plasma cortisol following fasting but not less severe calorie restriction. Stress, 19(2), pp.151-157.
• Queen, D. and Harding, K., 2022. Societal pandemic burnout: A COVID       legacy.
• Tähkämö, L., Partonen, T. and Pesonen, A., 2018. Systematic review of light exposure impact on human circadian rhythm. Chronobiology International, 36(2), pp.151-170.
• Zong, Y., Zhu, S., Zhang, S., Zheng, G., Wiley, J. and Hong, S., 2018. Chronic stress and intestinal permeability: Lubiprostone regulates glucocorticoid receptor‐mediated changes in colon epithelial tight junction proteins, barrier function, and visceral pain in the rodent and human. Neurogastroenterology & Motility, 31(2), p.e13477.

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

Psilocybin is a naturally occurring tryptamine alkaloid discovered within the hundred plus species of psychedelic mushrooms occurring in many of the temperate or tropical climates of the world. Most commonly referenced as being an isolated constituent within the fungi genus of Psilocybe (4), psilocybin is just one constituent within a cocktail of potent compounds found within psychoactive mushrooms. Other constituents found within the Psilocybe genus include the alkaloid psilocin and a range of beta-carbolines including harmane and harmine. Both of which are potent inhibitors of monoamine oxidase enzyme (5).

The average psilocybin content within the psilocybe species is about 1%. Meaning one gram of mushrooms provides approximately 10mg of psilocybin (6). A number of modern human trials using psilocybin to treat depression follow the guide of 20mg-30mg psilocybin per 70kg of human body weight (7).

Like many psychoactive compounds, psilocybin exerts its effect on the nervous system via the 5-HT2A receptor. This is the same receptor targeted by selective serotonin reuptake inhibitor (SSRI) anti-depressant drugs. The difference is that psilocybin works as an agonist of the receptor, thereby producing a different and a potentially much more profound psychoactive reaction than SSRI.

This much needed help is looking like it is found within one of nature’s most magical gifts, the humble psychedelic mushroom. In recent decades ethnobotanists have discovered that the use of mushrooms for religious, healing and divinatory experiences spans across multiple indigenous cultures. From a herbalist’s point of view, what unites all of the global distribution of psychedelic mushrooms is the collection of potent neuro-active metabolites that inhabit each mushroom. Psilocybin being one of these inherent metabolites of particular interest to scientists, researchers and psychiatry.

The traditional view taken by governments of the world is one of great caution and criminality when considering the cultivation, possession, consumption and/or prescription of psilocybin containing mushrooms. The majority of countries around the world have legislation that makes it illegal to pick, grow, possess and consume psilocybin containing mushrooms.

After many decades of protest by indigenous communities, scientists and organisations such as the Multi-disciplinary Association for Psychedelic Studies (MAPS) endlessly campaigning for the safe and legal use of psilocybin containing mushrooms we can now see a positive momentum of change across the western world.

In November 2019 the United States Food and Drug Administration granted the Usona Institute ‘Breakthrough Therapy’ designation to conduct clinical trials on the use of psilocybin for treating MDD [viii]. This phase 2 trial involving 80 participants is due to finish in Spring 2021 (9) with results most likely showing psilocybin can produce sustained and substantial decreases in symptoms of anxiety and depression.

These healing effects have been shown before in sporadic trials with some even reporting sustained improvements in depressive symptoms following a single high dose treatment of psilocybin at the 6 month follow-up for almost 80% of the participants involved (10).

In 2016 the Beckley Foundation, based in London (UK) published results from a trial that involved 12 patients with moderate to severe, treatment resistant depression (11). After prescribing two dosages (10mg and 25mg, seven days apart) in a supportive setting, 67% of patients were depression free one week after treatment.

42% were still in remission three months later. These results are revolutionary when compared to conventional pharmaceutical options. Similar research has also been explored with other plant based psychedelic treatments for depression such as Ayahuasca (12).

Given the current conventional medical paradigm of patenting medicines, the trials involving psilocybin for depression remains in this exploratory stage. It could be that in years to come as more evidence emerges on how therapeutic isolated psilocybin can be, that we see a global distribution of this treatment. This does however bring up the question as to how taking isolated psilocybin on its own as a patented medicine compares to using the whole mushroom as found in the wild or through cultivation. This is a debate that has gone on for many decades between herbalists, pharmacists and scientists. The discussion of reductionism versus holism.

Many users of psilocybin containing mushrooms consume the whole mushroom on its own without considering the legal situation or cost of attaining a pharmaceutical isolate of psilocybin. This is all with the backdrop of the growing movement towards drug decriminalisation moving through the world, particularly the U.S.

In November 2020 the state of Oregon went further than decriminalisation and became the first state in the U.S to pass legislation that legalised the medicinal use of psilocybin (13). At the moment this doesn’t mean that whole psilocybin containing mushrooms can be openly sold at dispensaries like cannabis is, but it does mean they are drafting proposals for how and which treatment centres can provide psilocybin for those who wish to explore this method of treatment. This may follow other examples around the world, such as Holland, where Psilocybin mushrooms in the form of truffles are offered as a tool for healing and self-development (14).

It is forecasted that as more research on psilocybin is produced and the evidence-base is enhanced, then it is inevitable that more parts of the world will follow the path that medicinal cannabis has taken. Fewer prosecutions and ‘turning a blind eye’ to decriminalisation, to legalisation for medical treatment, and finally to potential legal cultivation, possession and consumption.

It remains to be seen how this movement of research, science, recreational use and overall discussion will lead us to. Each individual country will decide on the path they decide to take but it finally feels like the healing role of our more misunderstood plant and fungi allies is finally being acknowledged.

1. Davis, A. K. Barrett, F. S. May, D. G. et al. (2020) Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder – A Randomized Clinical Trial, JAMA Psychiatry, 10.1001/jamapsychiatry.2020.3285
2. Greenberg, P. E. Fournier, A. A. Sisitsky, T. Pike, C. T. Kessler, R. C. (2015) The Economic Burden of Adults with Major Depressive Disorder in the United States (2005 and 2010), Journal of Clinicla Psychiatry, Feb;76(2): p. 155-162.
3. Nemeroff, C. B. (2007) Prevalence and Management of Treatment-Resistant Depression, Journal of Clinical Psychiatry, 68 Suppl 8: p. 17-25.
4. Peredy, T. Bradford, H. (2014) Mushroom, Psilocybin, Encyclopaedia of Toxicology (Third Edition), p. 418-419.
5. Blei, F. Dorner, S. Fricke, J. Baldeweg, F. Trottman, F. Komor, A. Meyer, F. Hertwick, C. Hoffmeister, D. (2019) Simultaneous Production of Psilocybin and a Cocktail of β‐Carboline Monoamine Oxidase Inhibitors in “Magic” Mushrooms, Chemistry – A European Journal, Vol. 26 (3) p. 729.734.
6. https://psychedelicreview.com/chemical-composition-variability-in-magic-mushrooms/
7. https://newatlas.com/johns-hopkins-psilocybin-study-finds-optimum-beneficial-dosage/18981/
8. https://www.businesswire.com/news/home/20191122005452/en/FDA-grants-Breakthrough-Therapy-Designation-Usona-Institutes
9. https://usonaclinicaltrials.org/major-depressive-disorder-psilocybin-clinical-trial-psil201
10. Griffiths, R. R. Johnson, M. W. Carducci, M. A. et al. (2016) Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial, The Journal of Psychopharmacology, Dec;30(12): p. 1181-1197.
11. Carhart-Harris, R. L. Bolstridge, M. Rucker, J. Day, C. M. J. Erritzoe, D. Kaelen, M. et al. (2016) Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study, Lancet Psychiatry, May 17.
12. Jimenez-Garrido, D. F. Gomez-Sousa, M. Ona, G. Dos Santos, R. G. Hallak, J. E. C. Alcazar-Corcoles, M. A. Bouso, J. C. (2020) Effects of Ayahuasca on mental health and quality of life in naïve user: a longitudinal and cross-sectional study combination, Scientific Reports 10, 4075.
13. https://www.nytimes.com/interactive/2020/11/03/us/elections/results-oregon-measure-109-legalize-psilocybin.html
14. https://www.synthesisretreat.com

I hardly ever treat anyone without including some herbs for nourishing and supporting their nervous system. Any imbalance causes there to be stress in the system. From an Ayurvedic perspective, ‘stress’ can disturb the quality of vata that is responsible for smooth flow of information and regulation of our bio-rhythms, which can cascade impacting the other doshas, pitta  and kapha. This leads to chronic stress also being implicated in most degenerative diseases from heart disease to diabetes to cancer.

Vata is the quality associated with change, movement and lightness. All stress involves some change, and severe stress usually involves some form of ‘shock’ to the system. To find balance means you have to digest the shock and adapt to the stress. Along with basic breathing exercises and massage, plants are of course valuable stress managers. Herbalists will usually make a tailor-made prescription to suit each individual’s needs. Some of Ayurveda’s renowned plants are:

Ashwagandha

Withania somnifera’s potent nourishing and adaptogenic abilities to help us cope with stress makes it my favourite plant to prescribe for supporting resilience. I normally dose at 2–5 g/day as a powder (capsule or in some almond milk) or 10–25% of a liquid tincture prescription.

I use it whenever there is any sign of deficiency, coldness or weakness leading to tiredness or debility. This makes ashwagandha the herb of choice when there is any chronic imbalance that results in depletion and convalescence. Its grounding and stabilising effects help in insomnia, palpitations and anxiety.

Its nourishing properties help stabilise weight and enhance vitality. As one of Ayurveda’s premier rejuvenating rasayana plants, used to extend the quality and quantity of life, it gives deep and enduring energy to the immune, reproductive, structural and nervous systems. By helping to support thyroid, brain, pancreatic and heart function it brings strength to the organs responsible for the foundation of our health. At a cellular level ashwagandha enhances our Heat shock protein response to stress — meaning we can tolerate more stress for longer with less harm — as well as enhancing glutathione recovery, so essential for consistent cellular rejuvenation.

Brahmi

Bacopa monnieri is a wonderful cooling herb for the nervous system and mind. Named after ‘brahman’ or the ‘universal consciousness’, it is renowned for influencing the quality of consciousness and it balances all three dosha. Clinical studies have shown that Brahmi can help increase cognition, memory and concentration whilst also greatly improving anxiety. I normally dose it at 2–3 g/day as a powder or 10–15% of a liquid tincture prescription.

I use it whenever there is any signs of mental or emotional imbalance resulting in nervous anxiety or debility. I specifically think of using it whenever there is nervous depletion resulting from excess work or thinking leading to anxiety and brain fatigue. Its ability to bring mental clarity makes it useful when an emotional experience(s) is too difficult to digest and we can become stuck in a repetitive cycle of feelings potentially leading to depression.

Its impact of the 5-HTP and serotonin pathways are valuable here . Its effects on improving cognition, enhancing learning and memory as well as regenerating brain cells indicate its use in Alzheimer’s, ADHD and autism, but also in any form of mental illness from depression to eating disorders.

All of this helps bring vitality and energy back, which is also shown in its impacts on the thyroid. It is also a useful addition to formulas used to heal hot skin conditions from acne, eczema to psoriasis which if they aren’t caused by any nervous system imbalances can ceryainly cause them.

Gotu kola

Hydrocotyle asiatica’s greatest asset is its ability to penetrate deeply into the circulatory system and carry its consciousness enhancing properties into the brain. I give it at 3–10 g/day as a powder (or capsules) or 10–25% of a liquid tincture prescription.

Whenever a client needs relaxing in order to think clearly I will consider gotu kola. It relaxes the channels of circulation, allowing more blood to flow whether this is needed for nutrition or wound healing. Either way, it reduces the stress of ’trauma’ caused by a wound, shock, skin disease, inflammation or mental fog. As it balances all three dosha it removes the ‘shock’ of doshic imbalance.

Commonly used in Alzheimer’s, epilepsy, spasmodic disorders, skin inflammations associated with stress and joint inflammations. It is also used to help prevent deep vein thrombosis. By normalising the cell adhesion molecule function it enhances cellular communication and promotes cellular intelligence. Gotu kola is true food for the mind.

Tulsi

Ocimum tenuiflorum (syn. O. sanctum) or holy basil is one of my favourite nervines. Its light aromatic scent is wonderful for lifting the spirits and alleviating a tired mind, even mild depression. I include it in a mix as 2–6 g powder per day or as herbal tea or at 5–15% of a liquid tincture prescription. It is packed with essential oils that help to open the lungs, and relax tension.

Tulsi is very useful for headaches, allergic irritation, nervous digestion and when taken as a strong herbal infusion, the physical ache associated with ‘flu and colds. It has become considered as an adaptogen in some circles with its ursolic acid content showing potent cellular repair and cortisol regulating effects.

Vacha

Acorus calamus is used in both Ayurvedic and Chinese medicine for ‘opening the mind’ and bringing clarity whenever there is sluggishness and mental fog. Its pungent and bitter flavour helps it penetrate its healing potential deep into the mind.

This warming quality ‘cooks’  and scrapes accumulations that are obstructing clear thinking. Used at 1–3 g/day (powder) or 5–7.5% of a liquid tincture prescription. It has a strong acrid taste and so should be used at a low dose. And not just because of the dose. It contains B-asarone at various levels depending on the country of origin due to its chromosomal make up so just use short term at a low dose.

Vacha’s ability to aromatically awaken digestion and clear mucus from the body indicates it whenever there is ‘stuck’ behaviour leading to depression, speech impediments and emotional stagnation with a heavy kapha type or cold vata type person. Called vacha meaning ‘speech’ in Sanskrit, its traditional use speaks volumes for the insights our ancestors discovered about plants for such specific uses.

A 43 year old woman presented with anxiety, ‘butterflies’ and poor sleep following a bout of intense stress. Her appetite is good but her digestion has become erratic resulting in bloating, constipation and general abdominal discomfort. Whilst she isn’t usually an anxious person, she has been fixed in this place for a while can’t stop her mind dwelling on the issue and is anxious about its impact on her health and mood.

She is now regularly fatigued and has developed restless legs and the occasional palpitation at night. She has a fast, thin and thready pulse high in vata quality with a pale tongue with teeth marks. A recent healthcheck showed Blood pressure and thyroid levels were all fine with no other symptoms of note. Otherwise she has a good diet- bar a bit too much sugar and coffee. Diagnosis is vata imbalance with nervous system (majja dhatu) involved with vata. So we decided to calm vata, strengthen the nervous system and nourish digestion:

• Home made relaxing tea with chamomile, fennel seed, gotu kola, liquorice and ashwagandha
• Home self-massage with warm sesame oil with patchouli and boswellia
• Daily breathing practice of rhythmical breathing
• We had a full discussion on the importance of supporting the digestive system and ‘feeding the fire’ agreeing on a diet of less coffee and sugar and more warm foods including almonds, nutmeg, hemp seed oil, ghee, rice pudding and saffron. Ensuring the herbs and spices are visible and tasty in each meal.
• Tincture (but it could have been a powder mix) 1–2 tsp three times daily in warm water

Prescription

• Ashwagandha root 25
• Gotu kola leaf 15
• Brahmi leaf 15
• Tulsi leaf 10
• Vacha root 5
• Motherwort aerial parts 10
• Rose flower 5
• Fennel seed 5
• Liquorice root 5

Taken as 5 ml (1 tsp) three times daily before food in a little warm water

The ashwagandha, gotu kola, brahmi all help to settle anxiety and calm tension. Vacha’s moving pungency is a specific for enkindling digestion and opening consciousness, combining well with the tulsi. Gotu kola and brahmi help with repetitive thoughts. Motherwort, rose and ashwagandha are good for palpitations.

They are also excellent for healing emotional trauma with vata aggravation. The vacha and fennel strengthen and warm digestion and help to move the aggravated rising vata energy downwards. Sweet licorice builds endurance and combines very well with ashwagandha as a tonic to reduce vata anxiety.

After a couple of months, she felt more settled and her digestion was much more reliable. We moved onto just the herbal tea and some ashwagandha powder with the breathing and massage becoming integral parts of her regular routine.

• Bradwejn J, et al. A double-blind placebo-controlled study on the effects of gotu kola on acoustic startle response in healthy subjects. J Clin Psychopharmacol 2000;20:680-4. https://doi.org/10.1097/00004714-200012000-00015
• Cesarone MR, Belcaro G, De Sanctis MT, Incandela L, Cacchio M, Bavera P, Ippolito E, Bucci M, Griffin M, Geroulakos G, Dugall M, Buccella S, Kleyweght S, Cacchio M. Effects of the total triterpenic fraction of Centella asiatica in venous hypertensive microangiopathy: a prospective, placebo-controlled, randomized trial. Angiology 2001;52(Suppl 2):S15-18.
• Cesarone MR, et al. Evaluation of treatment of diabetic microangiopathy with total triterpenic fraction of Centella asiatica: a clinical prospective randomized trial with a microcirculatory model. Angiology 2001;52(Suppl 2):S49-54.
• Dadkar VN, Ranadive NU, Dhar HL (1987) Evaluation of antistress activity of Withania somnifera. Indian Journal of Clinical Biochemistry 2, 101-108.
• Davis L, Kuttan G (2000) Immunomodulatory activity of Withania somnifera. Journal of Ethnopharmacology 71, 193–200. https://doi.org/10.1016/s0378-8741(99)00206-8
• Mishra LC, Singh BB, Dagenais S. Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review. Altern.Med Rev. 2000;5:334-46.
• Pointel JP, et al. Titrated extract of Centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs. https://doi.org/10.1177/000331978703800106
• Russo and F. Borrelli Phytomedicine, Bacopa monniera, a reputed nootropic plant: an overview . Volume 12, Issue 4, 20 April 2005, Pages 305-317. https://doi.org/10.1016/j.phymed.2003.12.008
• Russo A, Izzo AA, Borrelli F, Renis M, Vanella A. Free radical scavenging capacity and protective effect of Bacopa monniera L. on DNA damage. Phytother Res. 2003 Sep;17(8):870-5. https://doi.org/10.1002/ptr.1061
• Sharma R et al: Efficacy of Bacopa monnieri in revitalizing intellectual functions in children; J Res Edu Indian Med pp 1-12, Jan-June 1987.
• Singh RH, Singh L: Studies on the anti-anxiety effect of the  Medhy Rasayan drug, Brahmi (Bacopa monniera Wettst.) – Part 1; J Res Ayur Siddha 1 pp 133-148, 1980.
• Stough C, Lloyd J, Clarke J, Downey LA, Hutchison CW, Rodgers T, Nathan PJ. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl). 2001 Aug;156(4):481-4. https://doi.org/10.1007/s002130100815

Books

• Caldecott T. Ayurveda: The Divine Science of Life. St. Louis, MO: Mosby Elsevier; 2006.
• Pole S. Ayurvedic Medicine: The Principles of Traditional Practice. London: Churchill Livingstone; 2006.
• Gogte VM. Ayurvedic Pharmacology and Therapeutic Uses of Medicinal Plants. Mumbai: Bhartiya Vidya Bhavan; 2000.
• Bhavamisra. Bhavaprakash Nighantu: Authentic Text with English Translation and Notes. Varanasi: Chaukhambha Orientalia; 2007.
• Sharma PC, Yelne MB, Dennis TJ. Database on Medicinal Plants Used in Ayurveda. New Delhi: Central Council for Research in Ayurveda & Siddha, Dept. of ISM & H, Ministry of Health & Family Welfare, Government of India; 2002.
• Williamson EM. Major Herbs of Ayurveda. London: Churchill Livingstone; 2002.
• Government of India, Ministry of Health and Family Welfare. The Ayurvedic Pharmacopoeia of India. New Delhi: Ministry of Health and Family Welfare, Dept. of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH); 1989.