Historically, herbal dosing was developed through empirical trial, observation, experience and long-term use. Effective doses, preferred formulations and the knowledge of optimal remedies was passed through the generations (1).

Traditional texts often describe dosing in experiential terms, such as a glass or handful, or an amount tolerated. While these measures may appear imprecise from a modern or conventional perspective, they reflect a responsive approach to medicine — trial and error.

Doses were often adjusted according to the strength of the herb and individual’s response over time. Sometimes doses may have to be adjusted according to the strength and purity of a batch of herbs, as differences in harvesting, drying, storage and processing can impact the strength of the actives. The importance of feedback and adjustment of doses was a valuable part of traditional practice (2).

Plant and formulation factors 

The characteristics of the herb itself must be considered when determining an appropriate dose. Herbs differ widely in their strength, safety profile and therapeutic range; these differences directly inform how they should be used (3). Nutritive herbs such as nettle (Urtica dioica) or dandelion (Taraxacum officinale) are rich in minerals and phytochemicals which are often used in generous doses over extended periods of time for their vast medicinal benefits ranging from anti-inflammatory to blood tonic effects (4,5).

In contrast, aromatic and bitter herbs tend to act more immediately on digestion, circulation and the nervous system and may produce noticeable effects at relatively small doses. For example, peppermint (Mentha x piperita, M. arvensis) stimulates taste receptors and digestive reflexes; even modest amounts can have carminative effects and stimulate gut motility (6).

Similarly, aromatic nervines such as lavender (Lavandula angustifolia) or lemon balm (Melissa officinalis) can have calming effects at relatively low doses (7). Some herbs have a narrow safety profile therefore require great precision and clinical judgement when dosing. Lily of the valley (Convallaria majalis) a cardiotonic can be highly toxic even in small over-doses (8). Hence, careful dosing, appropriate training and awareness of contraindications is so important.

Today, for most people dosing from raw or unprocessed material may be confusing. Telling someone to take a pinch of a powdered herb can lead to significant dosing variability, as a pinch can range on average from 0.3 g to 0.6 g. This variability could lead to double the dose which could have adverse effects rather than a therapeutic benefit. Therefore, quantifying a pinch as a definitive value (e.g., “a pinch is 0.3 g”) makes dosing reproducible, and standardises the process.

When using leaves in preparations (i.e. add two leaves) this can also have inconsistent dosing effects. The variable size, condition and stage of maturity of the leaf can also impact the efficacy of dosing. Furthermore, dried and fresh material will have different effects; dried material may be more concentrated, and the composition of bioactive compounds may have changed (i.e., essential oils may evaporate during drying). All these factors can impact the effective dosing of herbals (2,9,10,11).

Even among commonly used herbs, factors such as duration of use, interactions and individual sensitivity must be considered. For these reasons, effective dosing relies on familiarity with both traditional dosages and contemporary safety data, allowing herbs to be used confidently and appropriately.

Individual factors 

Determining an appropriate dose always begins with the person. Age, gender, body composition, digestive capacity, liver and kidney function, comorbidities and individual sensitivity all influence how someone may respond. A healthy adult with good digestion may require and safely tolerate a higher therapeutic dose to achieve a clinical effect.

In contrast, an older or frail adult, a child, or someone with comorbidities may only tolerate lower doses and respond better when doses are gradually introduced and increased. Response to doses also varies depending on individuals’ experiences as some people may respond to very small doses, particularly with aromatic, bitter or nervine herbs; while others can tolerate larger doses before any clinical response is seen.

Effective dosing, therefore, relies not on standardised quantities alone, but on careful assessment of the individual’s capacity to receive, process and respond to herbal medicines (12).

The nature of the condition being treated is equally important when determining dose. Acute and relatively minor health conditions often respond best to higher or more frequent dosing over a short period of time, with the aim of supporting the body through a transient physiological challenge.

For example, in the early stages of an upper respiratory tract infection (i.e., cold/flu), herbs such as elderberry (Sambucus nigra) or echinacea (Echinacea purpurea) may be taken as tinctures or infusions regularly to support immune and inflammatory responses, soothing symptoms and reducing recovery time.

Acute musculoskeletal pain (i.e., sprain/strain or minor injury) may respond well to short-term internal use of anti-inflammatory herbs such as turmeric (Curcuma longa) alongside topical applications of arnica (Arnica montana) or rosemary (Salvia rosmarinus) (7,12).

On the other hand, chronic conditions usually require low to moderate doses taken consistently over a longer period. Chronic digestive disorders, hormonal imbalances or stress-related conditions often respond better to sustained doses that work gradually with underlying physiological patterns rather than attempting rapid relief of symptoms.

The use of ashwagandha (Withania somnifera) for reducing stress and anxiety can take up-to two weeks before a clinical effect is observed, as the adaptogen regulates cortisol and other hormones (13). When managing on-going or chronic conditions high doses may be poorly tolerated and unnecessary, therefore a “low and slow approach” would allow for cumulative effects and monitoring to take place (14).

Most conventional pharmaceutical medicines have standard formula and doses. There is a comprehensive pharmacopeia which makes production scalable and reproducible. Aspirin is an example of a synthetic medicine (originally isolated from willow (Salix alba)) whereby a single active compound (acetylsalicylic acid) was identified, and chemically synthesised (15).

The therapeutic effects are evidence based with randomised controlled trials (RCTs) to validate the efficacy. For most herbal medicines, there is often not a single isolated compound responsible for the therapeutic effects. Instead, herbal medicines are a complex mixture with many active constituents.

The mixture of compounds are known to work synergistically to have a therapeutic effect; hence, isolating a single compound would not be as therapeutically beneficial (16). For this reason, dosing is rarely about achieving a precise milligram quantity of one active ingredient. Instead, it involves establishing an effective therapeutic relationship between the plant, the preparation and the person taking it.

Finally, the form of preparation has a significant impact on dosing. Teas and decoctions favour water-soluble constituents and are often taken in larger volumes. Powders and capsules rely on digestion and absorption and may therefore require higher quantities to achieve an effect.

Tinctures are more concentrated and allow for flexible, incremental dosing. Herbal dosing tends to operate within broader therapeutic ranges than pharmaceutical drugs, allowing for a greater degree of flexibility and individualisation. The dose is shaped not only by pharmacology, but also by constitution, strength, sensitivity and condition treated (11).

In practice, standardising dosing of herbals is best approached using clearly defined therapeutic ranges rather than fixed doses. Replacing ambiguity in dosing by eyeballing, using a cupful or a few drops/leaves, by standard measures such as volumes for liquids (i.e., millilitre for tinctures) and weights for solids (i.e., gram for dried herbs), can improve dosing. Where reputable suppliers have preparations available with clear strength and doses these may be a preferred option to use. 

It is important to regularly review an individual’s response to herbals, and educate them of the signs of efficacy, intolerance and adverse effects so that dosing can be refined over time. One of the strengths of herbal medicine is that it is responsive. Signs that a dose may be too low include a lack of change to symptoms, after an appropriate trial period, or progress which prematurely stalls.

On the other hand, signs that a dose may be too high may include digestive discomfort, headache, nausea or exacerbation of symptoms. Hence, herbal dosing is a dynamic process. Ongoing observation, communication with practitioners and adjustments are integral to safe and effective herbal practice (17).

There is no single answer to the question of how much is enough when it comes to herbal dosing. Effective dosing emerges from the relationship between plant, preparation and individuals, informed by knowledge, use and experience of the person and practitioners.

1. Bhamra SK, Slater A, Howard C, Heinrich M, Johnson MRD. Health care professionals’ personal and professional views of herbal medicines in the United Kingdom. Phytotherapy Research. 2019;33(9):2360-2368. https://doi.org/10.1002/ptr.6418 
2. Kofi Busia. Herbal medicine dosage standardisation. Journal of herbal medicine. 2024;46:100889-100889. https://doi.org/10.1016/j.hermed.2024.100889 
3. Jürges G, Sahi V, Rios Rodriguez D, et al. Product authenticity versus globalisation—The Tulsi case. Aravanopoulos FA, ed. PLOS ONE. 2018;13(11):e0207763. https://doi.org/10.1371/journal.pone.0207763 
4. Devkota HP, Paudel KR, Khanal S, et al. Stinging Nettle (Urtica dioica L.): Nutritional Composition, Bioactive Compounds, and Food Functional Properties. Molecules. 2022;27(16):5219. https://doi.org/10.3390/molecules27165219 
5. Kania-Dobrowolska M, Baraniak J. Dandelion (Taraxacum officinale L.) as a Source of Biologically Active Compounds Supporting the Therapy of Co-Existing Diseases in Metabolic Syndrome. Foods. 2022;11(18):2858. https://doi.org/10.3390/foods11182858 
6. Hirata M, Fornari Laurindo L, Dogani Rodrigues V, et al. Investigating the Health Potential of Mentha Species Against Gastrointestinal Disorders—A Systematic Review of Clinical Evidence. Pharmaceuticals. 2025;18(5):693. https://doi.org/10.3390/ph18050693 
7. Chevallier A. Herbal Remedies. DK Pub.; 2007.
8. Currie GM, Wheat JM, Kiat H. Pharmacokinetic Considerations for Digoxin in Older People. The Open Cardiovascular Medicine Journal. 2011;5(1):130-135. https://doi.org/10.2174/1874192401105010130 
9. Nakra S, Tripathy S, Srivastav PP. Drying as a preservation strategy for medicinal plants: Physicochemical and functional outcomes for food and human health. Phytomedicine Plus. 2025;5(2):100762. https://doi.org/10.1016/j.phyplu.2025.100762 
10. Bhamra SK. Investigating the Use and Identity of Traditional Herbal Remedies amongst South Asian Communities Using Surveys and Biomolecular Techniques. Published thesis (PhD). 2016.
11. Wilde M. Doses and Measures. Napiers. Published August 3, 2021. Accessed January 14, 2026. https://napiers.net/blogs/news/doses-and-measures 
12. Tyson RJ, Park CC, Powell JR, et al. Precision Dosing Priority Criteria: Drug, Disease, and Patient Population Variables. Frontiers in Pharmacology. 2020;11. https://doi.org/10.3389/fphar.2020.00420 
13. Fuladi S, Emami SA, Mohammadpour AH, Karimani A, Manteghi AA, Sahebkar A. Assessment of Withania somnifera root extract efficacy in patients with generalized anxiety disorder: A randomized double-blind placebo-controlled trial. Current Clinical Pharmacology. 2020;15. https://doi.org/10.2174/1574884715666200413120413 
14. Frost R, Bhamra SK, Heinrich M. Herbal Products and Antidepressants: A Safe Combination or a Risky Mix? Phytotherapy Research. Published online January 13, 2026. https://doi.org/10.1002/ptr.70173 
15. Mahdi JG, Mahdi AJ, Mahdi AJ, Bowen ID. The Historical Analysis of Aspirin discovery, Its Relation to the Willow Tree and Antiproliferative and Anticancer Potential. Cell Proliferation. 2006;39(2):147-155. https://doi.org/10.1111/j.1365-2184.2006.00377.x 
16. Efferth T, Koch E. Complex Interactions between Phytochemicals. The Multi-Target Therapeutic Concept of Phytotherapy. Current Drug Targets. 2011;12(1):122-132. https://doi.org/10.2174/138945011793591626 
17. Bhamra SK. The revival of herbal medicines. Prescriber. 2024;35(6):13-16. https://doi.org/10.1002/psb.2157 

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 

Aotearoa New Zealand (NZ) has a devoted and dedicated group of medical herbalists through the New Zealand Association of Medical Herbalists (NZAMH), an organisation which has been in existence since the 1930s. 

As with many countries, the Aotearoa NZ health system is under strain with growing demands from an increasing and aging population, an aging medical workforce and a preference for urban rather than rural practice. In some parts of the country, patients may sometimes wait several weeks to get an appointment with a general practitioner (GP) (1).

Given the above, and the many benefits that plant medicine can have on human health, the NZAMH has for many years been seeking some form of statutory regulation to facilitate increased public access to practitioner expertise and reduce pressure on other areas of the health workforce. In Aotearoa NZ, this entails becoming a registered health profession under the Health Practitioners Competence Assurance Act (HPCAA). Initial attempts by the NZAMH looked promising, with a letter of acceptance to proceed to the next stage received from the then Minister of Health in 2007. Subsequent changes of Government and ongoing reviews of the Act however, have further delayed this process. 

While a growing number of New Zealanders are consulting with medical herbalists and naturopaths for a range of chronic and acute health problems, generally there is no state funding support towards the treatment costs. However, Aotearoa NZ has a unique injury-based system – the Accident Compensation Corporation (ACC), a scheme which provides financial and health service support to all New Zealanders after injury, including certain natural medicine modalities (2).

NZAMH has persistently promoted the benefits of practitioner-provided herbal medicine, and its ability to foster a more prevention focused healthcare system, thus saving healthcare costs overall. It has had some wins with insurance company recognition, and supported the establishment of herbal clinics where some of its members work with those experiencing substance use or mental health disorders. 

Before the arrival of Europeans, Aotearoa NZ Māori used a variety of native plants in their healing practices. Sadly, this was largely suppressed following European colonisation, as was the Māori language and many other aspects of a rich indigenous culture. 

Traditional knowledge lived on, however, through the oral tradition of many elders (kaumātua, and kuia — wise elderly men and women, respectively), the observations and subsequent texts of early botanists and European migrants, and the dependency also of early Europeans on native plants and indigenous knowledge for many healthcare needs. A herbal pioneer in colonial Aotearoa NZ was Mother Mary Joseph Aubert, a French nun who migrated there in the late 19^th century. Having studied botany and chemistry, she learned the properties of Aotearoa’s NZ native plants applying knowledge learned from Māori women and healers. She went on to manufacture and sell liquid herbal combinations (3,4). 

During World War II, the Māori battalion, which fought throughout the Middle East and Europe, had native plants such as koromiko (Hebe salicifolia) to help with diarrhoea, or kumerahou (Pomaderris kumeraho) for chest infections, sent from home. Such was the reputation and esteem of Māori medicine that remedies were sought and valued on the other side of the globe to Aotearoa NZ in the midst of war (5).

In recent decades, traditional Māori medicine (Rongoa Māori), as well as the Māori language and culture itself, has undergone an impressive revival in Aotearoa. Rongoa Māori medicine is a holistic form of healing, making use not only of the medicinal plants of Aotearoa, but also of various forms of massage and spiritual healing. Several rural communities have rongoa Māori healing centres near hospitals and there are moves towards more collaborative care (6,7) . In recognition of the value and importance of traditional medicine, Rongoa Māori treatments are now available for rehabilitation and certain other conditions through the ACC (2).   

Western medical herbalists have also increasingly incorporated native plants into their materia medica, and many of these have been made available to herbal practitioners for the past 40 years as tinctures or liquid extracts. These are generally used in the Western way, most commonly as ingredients in liquid formulations and products for both internal and topical use.

The unique healing properties and other benefits of certain native plants in Aotearoa NZ, are also recognised and utilised by elements of the natural health product industry in Aotearoa NZ. Several of these, such as mānuka (Leptospermum scoparium), kānuka (Kunzea ericoides), kawakawa (Piper excelsum) and horopito (Pseudowintera colorata), are ingredients in commercial products used for common health conditions, and their use is increasingly being supported by scientific publications including a growing number of clinical trials. Mānuka honey and mānuka oil have both become highly sought after in global markets, for their antimicrobial and many other healing properties (8,9).

Regulations in Aotearoa NZ are in a desperate need of an update, to not only better recognise the large skillset of trained practitioners, but also to better regulate herbal products. Medical herbalists are largely unregulated but are impacted by the 1981 Medicines Act, which regulates all medicines in the country. This Act was briefly replaced by the Therapeutic Products Act 2023 but then repealed in 2024 after a change in Government (10). The 2023 Act was the first to specifically address natural health products and start to define and better acknowledge Natural Health product practitioners. 

While herbal medicine itself is not well regulated in New Zealand, education is government recognised for a degree level programme. The Bachelor of Natural Medicine taught through the South Pacific College of Natural Medicine (SPCNM) receives Government funding and students have access to loans and allowances. The education environment in herbal medicine and naturopathy has changed greatly in recent years — in the 2000s there were six colleges throughout the country, but this has now reduced to one. South Pacific College is based in Auckland and has been in existence since 1967. It is well regarded with the highest category awarded by the NZ Qualifications Authority, indicating excellent teaching and organisation. The College boasts an on-site medicinal herb garden which is used both in teaching and community classes. 

Herbal education has changed over the years, not only with fewer providers delivering, but also in the development of stronger curricula, educating practitioners with a robust understanding of evidence-based practice. The complexity of health problems requires practitioners to have a more detailed understanding of subjects, such as differential diagnosis and herb-drug interactions. 

For those wanting to see a qualified medical herbalist, it is recommended to look for a member of the NZAMH — registered members are listed on the website. South Pacific College also runs a community clinic, Paua Clinic, from their premises in Ellerslie, Auckland. During the academic year, the public can consult with a senior student supervised by an experienced practitioner, at very reasonable rates. 

Apart from herbal practitioners, there is a flourishing and growing natural health product industry in Aotearoa NZ, with hundreds of small, medium and large businesses operating in this sector. Industry is represented by Natural Health Products NZ, formed in 2002. As successively bigger annual summits and industry wide surveys show, the natural health products sector has grown steadily to contribute more than $1.5 billion annually to the Aotearoa NZ economy (11). 

Medicinal cannabis has also become more popular in recent years, with a number of companies now cultivating and producing products in that area, although consumer access is still somewhat limited, due to the regulatory environment.

Aotearoa New Zealand is a significant producer of food and beverages and exports of these make up a large percentage of its economy and GDP. With changing consumer preferences and a need for the country to further diversify its current agriculture-based economy to become less dependent on animal-based products, the natural health industry and herbal medicines are gaining ground and being more recognised as future export earners. The diverse geography and unique features of the Aotearoa NZ environment, including different microclimates, make it ideal to cultivate numerous species. A range of species — such as echinacea (Echinacea spp.), ginkgo (Ginkgo biloba), green tea (Camellia sinensis), barley grass (Hordeum vulgare), saffron (Crocus sativus) and ginseng (Panax ginseng) — are already being cultivated, for export as well as grown for the local market. 

With ongoing unsettled times owing to geopolitical events and the increasing impacts of climate change and extreme weather events, many consider Aotearoa NZ as an ideal country to grow and supply medicinal plants as well as food and beverages, to both domestic and export markets. Extending the number of species and increasing supply volumes grown locally, are seen by industry advocates as important priorities (12).   Field trials are underway involving cultivation of several species of Asian, European and American plants. These are aimed at optimising agronomy, production efficiency and reliability, and quality. 

With a population of only 5.4 million, and a land mass the same as that of the UK, Aotearoa NZ has many vibrant rural communities, and a strong network of farmers and scientists, that have historically enabled it to adapt relatively quickly to geopolitical events or changes in trading relationships. These qualities, combined with the growing interest and use of indigenous species, and outstanding and committed education providers, practitioners and industry advocates, mean that herbal medicine is very much alive and well in Aotearoa New Zealand!

1. Medical Council of New Zealand. Workforce Survey Report 2024. Wellington, NZ: Medical Council of New Zealand; 2024.
2. ACC. Accessing ACC’s Rongoā Māori Service. Auckland, New Zealand: ACC; 2025. Accessed October 9, 2025. https://www.acc.co.nz/im-injured/what-we-cover/using-rongoa-maori-services
3. Museum of New Zealand Te Papa Tongarewa. Mother Aubert’s medicines. Collections Online. Accessed October 9, 2025. https://collections.tepapa.govt.nz/topic/2077.
4. Munro J. The story of Suzanne Aubert. Auckland, New Zealand; Auckland University Press; 1996.
5. Brooker SG, Cambie RC, Cooper RC. New Zealand Medicinal Plants. Published by Reed Books, Auckland, 1987. 
6. Healthpoint. Te Houtaewa Māori Charitable Trust — ACC-registered Rongoā Māori. Auckland, New Zealand: Healthpoint; 2025. Accessed October 13, 2025. https://www.healthpoint.co.nz/community-health-and-social-services/acc-registered-rongoa-maori/te-houtaewa-maori-charitable-trust/.
7. Stephens M, Eason, C, Mead A, Chu A, McGowan PR, Rasmussen P, Foster M. He Huarahi Hou: exploring the genesis of a unique approach and design of a regional pharmacopoeia. AlgerNative: An International Journal of Indigenous Peoples. 2025. 1-13. https://doi.org/10.1177/11771801251356030 
8. Mathew C, Tesfaye W, Rasmussen P, Peterson GM, Bartholomaeus A, Sharma M, Thomas J. Mānuka Oil-A Review of Antimicrobial and Other Medicinal Properties. Pharmaceuticals (Basel). 2020 Oct 26;13(11):343.
9. Rasmussen PL, Honey as a medicine: Special properties of mānuka honey. Pharmacy Today, 1 Oct 2024; ISBN 1170-1927. The Health Media Ltd, Auckland. 
10. Ministry of Health. Regulating medicines, medical devices and natural health products. Wellington, New Zealand: Ministry of Health; last updated April 14, 2025.
11. Natural Health Products New Zealand. www.naturalhealthproducts.nz.
12. Rasmussen PL, ‘Why New Zealand Grown Herbs are Best’. www.herbblurb.com. June 21, 2019.

Most of us are already likely to be familiar with the qualities and names of these four Humours:

• Air: Sanguine or blood humour — hot and wet
• Fire: Choleric humour — hot and dry
• Earth: Melancholic humour — cold and dry
• Water: Phlegmatic humour — cold and wet

Perhaps the first guiding concept of humoral theory that we have not retained in the Western biomedical model is the role of cycles in health and disease.

In all ancient medical systems and traditions, rhythm and cycles are understood as the core expression of life, and the loss of cycle is associated with sickness and ill health.

We frequently find the ancient concept of dynamic cosmic change and repetitive cycles expressed through the symbol of a circle; it has no beginning, no end, it is in continual motion. It also corresponds to the world around us; the circular and cyclical nature of the sun and moon, the circle and cycle of the continual dance of day and night, the cycle of the four seasons coming, going and returning, the circle and cycle of being born from the earth and returning to the earth at death.

The humours themselves are bodily manifestations of the phases of movement in this cycle, a movement we see reflected in the seasonal cycle; winter — cold and wet, through spring — hot and wet, to summer — hot and dry, and back again through autumn — cold and dry. This humoral cycle is seen in the life cycle with spring being birth and youth, summer adulthood, autumn middle age, and winter old age and death. 

The activity of the humours in the body is likened to the seasonal changes that make up the annual cycle of growth and regeneration in the world around us. If the seasonal temperaments are in balance and there is a year without extreme heat and drought, or without extreme cold and wet flooding the land; everything grows well, and there will be a plentiful harvest. 

Similarly, if the humours are well balanced like good seasons, the vitality of the body is nourished. This living vitality then manifests in the body as healthy and strong ‘spirits’. Loss of health arises when one aspect of the cycle becomes excessive and overwhelms the body. 

A fever may be likened to a heat wave in the summer, which although can be made easier by finding a cool breezy place offering instant respite, it will only properly resolve when the balancing coolness of autumn arrives. 

When treating a fever, we must first address the excess temperature by using cooling strategies, such as swabbing with a tepid cloth and giving antipyretics, such as willow (Salix alba). But, we also need to find a way to move things on to the next cooler phase, for instance using sweat inducing and immune stimulating diaphoretics (traditional cleansing cathartic herbs) such as vervain (Verbena officinalis) or elder (Sambucus nigra). This is like moving the fever cycle from being stuck in summer heat into the cooler days of autumn. 

It is then important to consider what excess humour initially overwhelmed the system and lead to the depletion of the vital spirit and its innate heat, as it is this heat that confers protection against any ‘invasion of poisons’ (infection and fevers).

When the underlying temperamental balance is lost, the most powerful way of bringing the balance back is through using sympathetic supportive strategies, even if we have to initially respond with countering ‘antipathetic’ interventions to address the immediate imbalance.

Sympathetic supportive strategies consist of:

• Restoring and nourishing weakened tissues and organs ensuring that their temperament is returned to normal.
• Supporting any weakened ‘spirits’, including the organs that they reside in — the heart, the head, the liver, the reproductive organs.
• Using constitutional medicines that help to balance the individual’s dominant humour, or effects of their stage of life.

Even today when we ask someone if they are in ‘good spirits’, or if they are feeling ‘dispirited’ we are continuing the use of these ancient humoral concepts in our language.

In humoral physiology there are four spirits which arise in the body.

• The vital spirit resides in the heart and consists of the innate heat and radical moisture. It activates all the bodily functions, gives the body its vitality, and protects it from infection.
• The natural spirit resides in the liver, it enables digestion and the dispersal of the humours in healthy blood.
• The animal spirit resides in the head, corresponds to the element ether, and initiates motivation, movement, and sensory perception.
• The procreative spirit resides in the testes, ovaries and womb. It arises as desire and provides the ability to conceive and procreate.

As the loss of correct temperament is the main underlying cause of sickness, we need to look at its main possible causes.

1. Life stage
2. Constitution
3. External influences

Lifecycle 

Each stage of life is dominated by a particular humour, during each phase it is more likely that a loss of temperament will be caused by the dominant humour of that stage becoming an overwhelming influence: 

• Youth: Sanguine / air 
• Adulthood: Choler / fire 
• Middle age: Melancholic / earth 
• Old age: Phlegm / water

Individual constitution 

Each person is born with a constitutional temperament, and this remains the same throughout life. We can quickly recognise the dominant temperament of some people, in others it may be a bit more subtle. We automatically recognise ‘warm’ people and ‘hot’ fiery people, as well as those who are ‘cool and chilled’, or perhaps even ‘cold’.

Determining a person’s constitution is important, as the temperament that dominates is always most likely to be the underlying cause of an imbalance for any individual. Having this temperament as a dominant influence in our bodies makes it always most likely to be the one which will become excessive.

Sanguine / air constitution 

We all know the energetic, explorative, creative, embracing but slightly flighty types, the ones who can’t stay still for too long, who being similar to an energetic youngster have an exuberant sanguine/air temperament.

Choleric / fire constitution

These are those with a strong personal drive, focus, high motivation, and often low tolerance of failure and a short temper, this typifies the time of our lives when we are working toward goals as adults and corresponds to the choleric/ fire temperament. 

Melancholic / earth constitution

We expect these types to be more introverted, solitary and studious, also reliable and trustworthy, often going deeply into ideas, but often prone to getting a bit stuck. This corresponds to middle age, when we slow down, become steadier and more anchored in our lives. This more grounded energy is the melancholic/earth temperament.

Phlegmatic / water constitution

Like the water element that rules them, phlegmatics are more likely to accommodate and flow with others, being more tolerant, but also a bit dreamy, and prone to getting overwhelmed. This corresponds to becoming an elder, with the wisdom of age making one more tolerant, and being able to let go of fixed ideas and attitudes. This softer gentler energy corresponds to the phlegmatic/water temperament.

Each of these four temperaments may manifest in combination with another, one still being the dominant aspect and one being secondary. 

External factors affecting the temperament

In humoral medicine, there is a recognition that external factors have a very important influence on health and disease. These are seen as influences that arise from outside of the body rather than from its own nature, thus they are named the ‘six non-naturals.’ 

Air

The natural temperament of air is cold and moist like the lungs. When hot it may irritate the naturally damp lungs and blood, and when too cold and moist it may add to excess moisture causing putrefaction and infection. Each constitution is balanced by air of the opposite temperament — cool air for hot people, etc. Purity of air is of utmost importance.

Diet

Foods all have an intrinsic heat or cold, and each of the different constitutions are challenged or benefitted by them. In summer, the digestive heat is more dispersed due to the summer heat, and in winter, digestive heat is concentrated in the body. This corresponds to us eating more lightly in the summer with a preponderance for cooling foods such as lettuce, chicory and cucumber. Hotter people have stronger digestive heat and better digestion than cool phlegmatics, who benefit from always adding warming herbs, spices and pepper to their food.

Exercise and rest

Exercise activates innate heat and energises the body. The heat of excess exercise damages the body, and lack of exercise leads to stagnation and congestion.

Sleep and wakefulness

Sleep is brought on by the rising upwards of a sweet calming restoring vapour from the heart to the head. It has a moistening and refreshing effect on the brain and the nerves. During sleep the innate heat settles in the liver completing digestion and the production of the humours. Insomnia dissipates the spirits and dries the brain.

Retention and evacuation

The body has a retentive faculty associated with the Earth element and the spleen, and an expulsive faculty associated with the Water element, the bowels and bladder. If either faculty is lowered through disease, an excess of the retentive melancholic humour, or inadequate innate heat or moisture to activate the expulsive faculty then blockage occurs. This kind of congestion can lead to melancholic vapours rising up from the spleen effecting the heart, stomach and head.

Perturbations of the mind and emotions

The maintenance of a calm state throughout the body and mind is beneficial to health. Reducing stress and releasing extreme emotions through cathartic activities is very helpful.  Singing, dancing, and expressing emotions in a healthy way are all considered very important, especially to the health of the vital spirit. Activities that promote joyfulness and practicing kindness are as important as any other measure we may take to maintain health.

Although the physiological and anatomical descriptions that underpin the historic humoral model now seem to be redundant due to our advances in the understanding of human biology and physiology, we shouldn’t discount the many important insights it can offer which have been drawn from millennia of medical observation and practice. Through embracing the humoral system, we gain a therapeutic model with which we can anchor our herbal practice to a holistic core.

Kava-kava (Piper methysticum) is a plant whose roots and other parts have long been used in traditional medicine, and ceremoniously, in Pacific countries for its calming effects. There is modern evidence for its anxiolytic activity, suitable to the management of mild anxiety states. 

Anxiety disorders are the most prevalent among disorders and are a leading cause of disability and economic inactivity. The evidence for efficacy for current over-the-counter and prescription medicines is often lacking, and adverse effects, most especially dependency and withdrawal symptoms, remain a concern for pharmaceutical medications (1). 

Demand for kava as a self-prescribed anxiolytic increased through the 1990s with many products of variable quality being introduced to the UK market, most without regulatory oversight. Medicinal kava products were used elsewhere, and in Germany an estimated 350,000 annual prescriptions were written, with more than one million monthly doses (2).

In 2001, following reports associating kava consumption with incidents of liver damage around the world, the UK Committee on the Safety of Medicines set up an Expert Working Group (EWG) to evaluate the signals. The EWG determined that, against a lack of consistent evidence of sufficient benefit, kava was associated with an unacceptable risk of idiosyncratic hepatoxicity, which could not be minimised or prevented by any regulatory measures other than the removal of kava products from the market. The Statutory Instrument, The Medicines for Human Use (Kava-kava) (Prohibition) Order 2002 followed this assessment (3). However this Order states that the prohibition shall not apply to a medicinal product which is “the subject of a UK marketing authorisation, certificate of registration or traditional herbal registration within the meaning of the Human Medicines Regulations 2012”.

Also in 2002, the UK Food Standards Agency Committee on Toxicity made a similar risk assessment in publishing its own advice on the herbal preparation of kava in foods, which led in turn to the enactment of the Kava-kava in Food (England) Regulations 2002 (4).

Under the Human Medicine Regulations 2012 and subsequent case law applying EU wide medicines legislation, it is almost certain that any future kava product permitted onto the UK market would be determined firstly as a medicinal product, with the subsequent benefit-risk assessment. 

N.B. In UK and EU law, foods have no therapeutic effects or benefits, so no benefit/risk balance can apply. Food safety assessments are made without regard to health benefits.

The Novel Food Regulation 2015/2283 (NFR) provides the harmonised legal framework for non-medicinal products. The NFR takes precedence over national laws in EU member states regarding the marketing of foods and supplements, so because kava has not been listed in the EU’s Union List of Novel Foods, it cannot be sold or marketed anywhere in Europe. However, enforcement is carried out by national authorities, which can lead to variable application.

France and Austria have banned kava outright on the basis of ‘legitimate concerns’ (i.e., public health) and these bans remain valid as long as they do not conflict with EU law (e.g., free trade).

In Germany, court decisions have dismissed the regulator’s ban on kava on the argument that this was disproportionate and unsupported by current evidence. The full legal implications including as an EU Member State are still being worked through the courts.

In the US, kava is legally and widely sold as a dietary supplement, with ‘structure/function’ claims often implying benefits for relaxation and stress relief. In 2020 the Food and Drug Administration (FDA) published a redacted memorandum specifying that kava is not considered Generally Recognised as Safe (GRAS) (5), therefore making kava an unapproved food additive. However, this does not extend to its use as a food (kava steeped in water) or its use as a dietary ingredient (6). The state of Hawaii determined that kava (‘awa’) in its traditional form is GRAS (7).

The Therapeutics Goods Administration initially banned kava and then, after a re-assessment, permitted it with limits of no more than 125 mg kavalactones in solid dosage forms, or 3 g limit in teabags to a maximum daily dose of 250 mg kavalactones. Selected kava preparations continue to be approved as ‘Listed Medicines’ (available over-the-counter for self-treatment) and traditional kava beverages are similarly available.

Benefit

The effect of the prohibition order outside Pacific regions and the USA was markedly to restrict the clinical research necessary to update the British EWG negative assessment. Most human studies have been conducted in Australia. The published clinical trials there have demonstrated that kava extracts can reduce anxiety and depression symptoms (8,9,10). One 2004 review concluded that “kava is the only botanical anxiolytic whose efficacy is supported by evidence from a systematic review of randomized placebo-controlled trials (evidence Level 1 of the National Health and Medical Research Council of Australia)” (11). More recent meta-analyses also support kava’s efficacy in reducing anxiety symptoms, although the effect size in cases of generalised anxiety disorder (GAD) is small (12,13).

It is relevant that by definition GAD requires a medical practitioner’s diagnosis, so the new evidence points to benefits appropriate to self-management of mild to moderate anxiety (3) and this may be the most appropriate indication for future kava use (14).

The new clinical trial data do help to fill gaps in the evidence base for efficacy that was initially considered by the EWG, when they found a mismatch between products for which there was benefit and those more widely available.

Further investigations have identified effects on GABA activity in humans (15,16,17). Another review summarises the potentially positive profile of kava in relation to cancer (18), and there are additional pharmacological updates (19,20,21,22).

In relation to the following section, adverse events in clinical trials associated with kava treatment were not significantly different from those associated with placebo.

Risk assessments

In fulfilment of a pledge by UK Ministers to review the 2002 order within two years, the UK medicines regulator, the MHRA, engaged in a public and international consultation. In October 2005, the EWG, having considered the responses and new evidence available at the time, concluded that the prohibition order remained “justified and proportional”. Notably, however, the EWG was concerned that “further structured research into the precise mechanism of hepatoxicity was required and that although the data presented justified the original prohibition, it also raised many new questions.”

The EWG noted a particular link to idiosyncratic hepatoxicity, which may have involved herb-drug interactions: “Although its specific route of metabolism has not been established, it has been found to induce and inhibit a variety of cytochrome P450 isoforms in vitro and, as such, has the potential to be associated with significant herb-drug interactions.” Ultimately, however, the EWG could not identify a mechanism of hepatoxicity for kava: “none of the proposals could account for all of the cases and many of the proposed mechanisms of hepatotoxicity appeared implausible.”

In one significant initiative to update safety data since this incomplete conclusion a Monograph and Therapeutic Compendium (a quality, therapeutic, and safety review) on kava is being produced by the American Herbal Pharmacopoeia. This work includes authorship and peer review by medicinal plant experts, including physicians, pharmacologists, pharmacognosists, and experts in pharmacokinetics, toxicology, and herb–drug interactions.

The monograph is being finalised for publication, but a pre-published draft of the safety section includes the following conclusion. “Based on critical assessments, any direct hepatotoxic potential for kava is rare and idiosyncratic, or confounded with use of other hepatotoxic substances, including medications. Hepatotoxicity was rarely reported when kava was used within its traditional context.”

Finally, the continued availability of kava in Australia has not been accompanied by adverse event signals from the Therapeutic Goods Administration. In 2019, a relative harm assessment concluded that kava was the least dangerous of 22 substances known to be used for their psychoactive effects (23). Nor are there signals emerging from Poisons Units or elsewhere in the USA.

Quality issues

The EWG added “One of the main pieces of data that would have been useful is a systematic evaluation of the Kava products available, with an audit of the source material used. It would be extremely useful to have a more systematic evaluation of the constituents of the various Kava cultivars to try to determine what the differences are and whether or not these constituents have a significant role in hepatotoxicity.”

Since the prohibitions, quality control standards have been developed internationally to ensure proper identity, purity, and quality of traded material. These have been reviewed in a useful 2016 technical report published by the FAO and WHO (24).

In its conclusion to the 2005 EWG re-evaluation the UK MHRA stated it will “review any new evidence that is submitted in relation to the issue of hepatotoxicity suspected to be associated with Kava and will re-evaluate the prohibition of Kava in unlicensed medicines if significant new data are received.”

There does appear to be a case for such a review to consider the regulated release of kava back into the market, with clear quality standards, controlled dosage, and safety advice including its use with other medications. There could be considerable benefits in having an effective self-care option for people in the wider population and workforce who are suffering increasing levels of anxiety. 

In response to a recent submission raising these points, the UK MHRA recalled that the 2002 Prohibition Order does not exclude applicants applying for a Traditional Herbal Medicine Registration or a ‘Marketing Authorisation’ (full medicines licence) under The Human Medicines Regulations 2012. In this latest response the MHRA stated: “Should a Traditional Herbal Registration or a Marketing authorisation application for a Kava medicinal product be submitted to the MHRA, safety would be reviewed on an application-specific basis and on the currently available evidence” (25). There is, therefore, no prospect of a general review of kava’s safety in use without a manufacturer making a specific application. In the UK and Europe, food use is also unlikely to be permitted while the medicine bar remains.

Regulation is of course an incomplete measure of public protection or restriction: kava is accessed frequently on the internet, without quality control or information as to its safest use.

1. Garakani A, Murrough JW, Freire RC, et al (2020) Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Front. Psychiatry 11:595584
2. Ulbricht C. Basch E, Boon, H et al (2005) Safety review of kava (Piper methysticum) by the Natural Standard Research Collaboration. Expert Opin. Drug Saf. 4, 779–794
3. https://tinyurl.com/4j7de38e
4. https://tinyurl.com/4ukrs44a
5. https://tinyurl.com/tcw7fwwj
6. https://tinyurl.com/4bm83re3
7. https://tinyurl.com/wewhxncu
8. Sarris J, Stough C, Bousman CA, et. (2013) Kava in the treatment of generalized anxiety disorder: a double-blind, randomized, placebo-controlled study. J Clin Psychopharmacol. 33(5): 643-8.
9. Sarris J, Kavanagh D, Byrne G, et al. (2009). The Kava Anxiety Depression Spectrum Study (KADSS): a randomized, placebo-controlled crossover trial using an aqueous extract of Piper methysticum. Psychopharmacology, 205, 399-407. 
10. Sarris J, Byrne GJ, Bousman CA, et al (2020). Kava for generalised anxiety disorder: A 16-week double-blind, randomised, placebo-controlled study. Aust N Z J Psychiatry 54(3): 288-2976
11. Jorm AF, Christensen H, Griffith KM, et al. (2004). Effectiveness of complementary and self-help treatments for anxiety disorders. Med J Aust 181: S29-S46
12. Oo S, Henderson P, Pak S. (2018). Kava for Generalized Anxiety Disorder: A Review of Current Evidence.. Journal of alternative and complementary medicine, 24 8, 770-78 
13. Smith K, Leiras C. (2018) The effectiveness and safety of Kava Kava for treating anxiety symptoms: A systematic review and analysis of randomized clinical trials. Complement Ther Clin Pract. 33: 107-117
14. Thomsen M. Schmidt M (2021). Health policy versus kava (Piper methysticum): Anxiolytic efficacy may be instrumental in restoring the reputation of a major South Pacific crop. J Ethnopharmacol 268: 113582.
15. Cribb L, Sarris J, Savage KM, et al (2023). Effect of kava (Piper methysticum) on peripheral gene expression among individuals with generalized anxiety disorder: A post hoc analysis of a randomized controlled trial. Phytother Res 37:5897-5903.
16. Savage K, Sarris J, Hughes M, et al. (2023). Neuroimaging Insights: Kava’s (Piper methysticum) Effect on dorsal anterior cingulate cortex GABA in generalized anxiety disorder. Nutrients 15:4586
17. Savage K, Firth J, Stough C, Sarris J. (2018). GABA-modulating phytomedicines for anxiety: A systematic review of preclinical and clinical evidence. Phytother Res 32:3-18.
18. Soares RB, Dinis-Oliveira RJ, Oliveira NG. (2022) An Updated Review on the Psychoactive, Toxic and Anticancer Properties of Kava. J Clin Med. 11(14):4039
19. White CM. 2018. The Pharmacology, pharmacokinetics, efficacy, and adverse events associated with kava. J Clin Pharmacol 58:1396-405.
20. Bian T, Corral P, Wang , et al. 2020. Kava as a clinical nutrient: Promises and challenges. Nutrients 12: 3044
21. Meesakul P, Shea T, Wong SX, et al. (2023) Hawaiian plants with beneficial effects on sleep, anxiety, and mood, etc. Pharmaceuticals (Basel) 16:1228
22. Zhang W, Yan Y, Wu Y, et al. (2022) Medicinal herbs for the treatment of anxiety: A systematic review and network meta-analysis. Pharmacol Res 179:106204
23. Bonomo Y, Norman A, Biondo S, et al. (2019). The Australian drug harms ranking study. Journal of Psychopharmacology 33(7): 759–768
24. FAO/WHO (2022) Kava: a review of the safety of traditional and recreational beverage consumption: a technical report (https://tinyurl.com/yrecnu2u)

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.

1. Chattu VK, Manzar MD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare (Basel). 2018;7(1):1. doi:10.3390/healthcare7010001
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.

Herbal syrups have to be one of the most loved herbal medicines by all, especially children. They are simple and fun to make whilst having a naturally sweet and beautiful taste. Syrups are a brilliant way to carry herbs that also captures their unique taste profile, where alcohol preparations such as tinctures may overpower.

Syrups can be made using honey, maple syrup or cane sugar. Cane sugar is a simple carbohydrate that can be used 2:1 (two parts sugar to one parts herb) whereas honey would need a higher ratio of 3:1 to act as an effective preservative.

Syrups are made from strong teas or decoctions that have been gently concentrated through a process of slow and gentle simmering. Follow the steps below to make a herbal syrup.

Herbal syrup instructions

1. For floral or herbaceous plant parts a strong tea infusion is made simmering on a low, gentle heat for 20 minutes (roots, fruits or barks would need a longer simmer of up to 1.5 hours). Usually enough water is added to cover the herb (dried or fresh herb can be used), the ratio would be so the herb is covered but also so the bottom of the pan would not be visible whilst moving a spoon through the mixture.
2. During simmering, stir occasionally with a wooden spoon (if using berries or roots use a potato masher to press the plant material, extracting more of the goodness for your medicine).
3. After simmering for the appropriate time, remove from heat and strain the infusion/ decoction using a muslin cloth on a fine sieve into a sterile container.
4. Return the infusion/ decoction to a clean pan and on the lowest heat setting add the appropriate ratio of sugar or honey until dissolved.
5. Cool the syrup, store and label in sterile glass bottle/ container in the fridge. A syrup can last between 6 months to a year in the fridge.

Calming chamomile honey syrup

Ingredients

• Chamomile (dried) 100g
• Lavender (dried) 100g
• Purified / Spring water approx 200ml (enough to cover herb well)
• Honey (approx 2 x 500g jars)

How to make chamomile honey syrup

To make this syrup follow the above instructions. Chamomile and lavender work both on the nervous and digestive systems. This sweet syrup would be helpful for anxious children who may be experiencing related digestive issues.

This same method can be used for herbs such as i.e. thyme and marshmallow (for respiratory support) or elderberry and rosehips (for immune support), experiment with blends of different plants to build up your home apothecary!

The chamomile and lavender syrup can be taken by the teaspoon up to 3 times daily. The honey syrups can be taken according to herb dosage instructions as per tinctures (see herb monographs for specific information on each herb).

Tinctures are made using either alcohol or glycerin. Vegetable glycerin is a clear, odorless liquid with a syrup-like consistency. It is usually made from vegetable oils such as soy, palm or coconut oil using high temperature and pressure, that splits the glycerin molecule from the fatty acids.

While sweet, it is not metabolised by the body like sugar. Look for an organic, sustainably harvested, non-GMO glycerin to use in medicine making (check the Resources section at the bottom).

The benefit of using glycerin is both for those wishing to avoid alcohol consumption, but an added bonus for using glycerin is that it is an excellent preservative of fresh plant juices, particularly for aromatic plants such as lemon balm, rose, violet etc. Glycerin however, is not as effective in extracting compounds from dried herb matter as an alcohol tincture.

Read our article How to make a herbal tincture.

Glycerite tincture instructions

1. Fill a clean (sterile) jar with, chopped fresh plant material or half-full of dried plant material (dried material will expand as the glycerin is absorbed).
2. A glycerite tincture should contain a minimum of 55% glycerin to herb ratio. For fresh plants, add enough glycerin to fully cover the plant matter, filling the jar to within one inch of the top. For dried herb, dilute glycerin with distilled water in a 3:1 ratio (3 parts glycerin to one part water) and fill the jar with mixture to within one inch of the top
3. Use the end of a clean wooden spoon to gently press the herb under the glycerin to ensure release of air bubbles and allow maximum coverage of materials.
4. Replace the lid and label jar.
5. Macerate or infuse the tincture for between 4-6 weeks, gently shaking the bottle every two days. Top up with glycerin as necessary if plant material is too exposed above the glycerin.
6. After 4-6 weeks, strain the tincture into a clean bowl using a muslin cloth (coffee filter paper works but very slowly; nut milk bags are also effective). With clean hands, gather corners of muslin cloth together, squeezing the tincture out until there is barely a drop left. The last few squeezes will have add some very potent mixture to the final tincture so don’t give up squeezing too quickly!
7. Finally, bottle and label your glycerite tincture. It stays in date for up to a year.

Lemon balm glycerite tincture

Ingredients

• Lemon balm (fresh leaves)
• Vegetable glycerin

How to make lemon balm tincture

Lemon balm is gently nervine and works to support our nervous system through stressful times. It is also indicated for digestive upsets and in respiratory complaints. The lemon balm tincture can be taken by the teaspoon up to twice daily.

Herbal infused or ‘macerated’ oils are a wonderful way to preserve herbs for use in topical conditions. They are also quick and incredibly simple to make and diverse in their applications.

There are a number of different methods to make herbal oils both for use in medicine and for culinary use. This method is called the solar infusion and relies on a warm sunny window.

Herbal infused oils can be used neat or can be made into salves or ointments and also blended into creams, so they are a fantastic base from which to explore other herbal preparations.

For best results use dried herbs (fresh herbs add a water element to oil, which can lead to spoiling), there are different methodologies for fresh herb oils.

Carrier oils that are ideal for topical use include sunflower and olive oils, both excellent carriers whilst offering some resistance to oxidation and rancidity. Herbs that are commonly used in herbal infused oils include calendula, St John’s wort, chickweed and plantain, all having their own unique medicinal qualities.

The most simple way to make an infused oil is as follows.

Herbal-infused oil instructions

1. Add dried herbs in a dry, sterilised container and cover with your chosen carrier oil; usually, the oil should sit 1 inch above the top of the herbs.
2. Use a spoon to press and mix the herb/ oil so that all surfaces of the herb matter is coated and no air bubbles remain.
3. Place a square piece of natural waxed paper or greaseproof paper on top of the jar, then seal jar with a tightly fitting lid.
4. Place the jar in a sunny window for between 4-6 weeks to infuse. The warmth of the sunlight will help to extract the compounds from the herbs into the oil. Stir or shake the mixture every few days.
5. When the infusion time is up, line a sieve with of muslin cloth (folded to layer up) and filter. the mixture into a clean bowl. Gather the corners of the cloth up and squeeze strongly, squeezing as much oil from the herb as possible
6. Cover and let aside overnight in a cool, dark location to allow for any herb sediment to settle at the bottom of the jar. You can also strain the oil through an unbleached coffee filter to remove fine sediment.
7. Pour the oil into dry, sterilised, dark-coloured glass bottles. You can add a couple of drops of Vitamin E into your final oil to slow down the oxidisation process, giving the oil a shelf life of around 1 year.
8. Label your infused oil, and store in a cool, dark place.

Calendula-infused oil

Ingredients

• Calendula petals
• Sunflower oil

How to make an oil infused with calendula

Calendula infused oil can be used directly on the skin to treat all manner of skin inflammations and in first aid for minor cuts, grazes, bruises, sprains and strains. Calendula oil is also useful for slow healing wounds and for the healing of minor burns. This blend can be used as and when needed, up to 3 times a day.

A herbal balm is made from a herbal infused oil, simply adding a wax element such as beeswax or (vegan) carnauba wax. Balms and salves are subsets of an ointment. Salves are typically softer, where as a balm or ointment is more solid. The benefit of infusing a wax into an oil to create balms/ salves/ ointments is that it increases binding to the skin, more successfully than an oil alone, they are also potentially, slightly less messy to use than oils.

Learn more about How to make a herbal balm.

Herbal balm instructions

1. Using a double boiler/ Bain Marie or a water bath method, on a gentle heat. Add your infused oil into the clean pan.
2. Add around 8- 12 % beeswax and gently stir with a silicone or wooden spoon until the wax has fully dissolved into the oil. Remove from the heat.
3. You can add an essential oil at this stage if desired; approx 10 drops (depending what is being used). Essential oils act as a preservative but also help to assist circulation and better absorption into the skin.
4. Slowly pour the mixture into a clean, dark glass jar. Cover but do not close the lid firmly until the balm has fully set/ solidified.
5. Label your jar and close the lid firmly. Store in a cool, dark place. Balms/ Salves/ Ointments should last for unto a year.

Calendula balm

Ingredients

• Calendula-infused oil
• Sweet orange or chamomile pure essential oil
• Beeswax (unfiltered pellets or solid form)

How to make calendula balm

Calendula balm can be used directly on the skin to treat all manner of skin inflammations and in first aid for minor cuts, grazes, bruises, sprains and strains. Calendula is also useful for slow healing wounds and for the healing of minor burns. This balm can be used as and when needed, up to 3 times a day.

For more information on uses of the herbs discussed in this article or other herbs you may wish to explore in medicine making using these recipes, visit our Herbs section.

Medicine making books and other resources

• The Handmade Apothecary by Vicky Chown and Kim Walker
• Hedgerow Remedies by Julie Barlett Bruton and Matthew Seal
• A Herbal Book of Making and Taking by Christopher Hedley
• The Herbal Medicine-Maker’s Handbook: A Home Manual by James Green
• The Herbarium is also a fantastic resource for medicine-making instructions and recipes.
• Earth Song Seeds also provides some very useful information on how to prepare herbs under the “How to…” section

Many are familiar with Hippocrates being considered the ‘father’ of medicine, and with his aphorisms such as ‘Let your food be your medicine and your medicine be your food’ or ‘Nature knows best’. But in fact Hippocrates and his fellow physicians have much more to impart.

I discovered this when I read their writings in detail in the English translation of the Hippocratic Corpus, and strove to understand the milieu in which they were written. The Corpus comprises roughly 60 treatises written by different physician-healers in the late 5^th century and the early decades of the 4^th century BC.

Written texts on this scale were a recent development. The texts include a diverse range of topics and reflect differing, sometimes even contradictory theories, as the authors explored and tried to establish just what the best approach is for discovering the causes of disease, and what are the best methods and medicines to relieve suffering.

They detail the powers of botanical medicines and how to apply them, based on insights into how the body in a holistic sense is constituted and responds to disease as well as lifestyle and environmental factors.

Practical, theoretical and philosophical insights are evidenced in ancient medical texts. The physicians’ experience and their writings were so transformational that they were collected together, studied and revered from that era and on into the next 2000 years.

What is not often appreciated is the conceptual background amongst Greeks of this time. From about the 6^th century BC, Greeks in both a practical and a philosophical sense innovatively began to explore the origins of human existence, of the universe, the phenomenal world and the human body in radical new ways.

Their insights contrasted with the traditional gods-centred view of their societies, in which certain gods were associated with healing and teaching medical skills – e.g. Apollo, Artemis, Aescleplius. Instead these early thinkers conceived unifying eternal principles.

The Kosmos is the divine ultimate source and sustainer of everything. The Kosmos was also spoken of as the “Holos” or Whole – a term often found in the medical writings and from which we derive the word ‘holistic’.

Some writers particularly emphasised Nature (in Greek physis from which we get the words physician, physics) itself as the divine principle in the phenomenal realm. Nature is a universal force combining elements of fire, water, earth and air, and including a fifth element aither, which regulates their qualities of heat, cold, moisture and dryness in the world of living things, the earth, climate, weather and so on.

For example, Empedocles (c 494-434 BC) describes the workings of Nature in terms of the divine Sphere, within which the forces of Love and Strife attract or disrupt the harmonious “mixture” of the elements, and qualities and forms which derive from them.

The medical authors sought to understand the individual constitution – how the elements and qualities expressed themselves in the body, how the parts of the body are all interconnected and sensitive to one another.

Human existence is a microcosm of the universal macrocosm, so understanding and living according to the laws of Nature fosters harmony both with the phenomenal world and with our best self. Some thinkers describe the ultimate purpose of humans is to find their true nature by returning to union with the Divine principle within.

That there was a close relationship between Greek philosophical ideas and medicine is revealed in Plato’s Symposium. Each guest at the dinner is invited to speak on Love. Plato (c 427-347 BC) includes a physician, Erixymachus, as one of the guest, whose words echo the themes above:

“The business of what we call medicine, which is, in a word, the knowledge of the principles of love at work in the body in regard to repletion and evacuation. The most skilful doctor is the doctor who can distinguish between noble and base loves in this sphere, and the man who can cause a body to change the latter for the former and can implant love in a body which lacks but needs it, and remove it where it already exists, will be a good practitioner. He must be able to bring elements in the body which are most hostile to one another into mutual affections and love; such hostile elements are the opposites hot and cold, wet and dry and the like; it was by knowing how to create love and harmony between these that our forefather Asclepius, as our poets say and as I believe, founded our craft.” (1)

This world view is amply reflected in the writings of Hippocratic physicians who endeavoured to follow the ‘healing power of Nature’ as guide in medical practice, by which they meant a scrupulous, rational study of the natural world and human body in order to derive knowledge and the skills with which to both to maintain health and treat diseases. This continued to form the background to subsequent medical practices and texts in subsequent centuries.

Ancient medicine recognised the importance of foods and dietary regimens for both health and in treating disease. This was combined with exercise, rest and therapeutic baths and amplified with a pharmacy of medicinal herbs, and the therapeutic uses of oils, waxes, wines, waters, clays and minerals (blood-letting is evidenced but not routine).

In the Hippocratic work Regimen II. LIV. (2), the author describes the qualities of many herbs and foods, along with their effects on the body: “Purslane when fresh cools, when preserved it warms… Mint warms, passes easily by urine, and stops vomiting” – an effect we still observe today (2).

The Hippocratic physicians were the first to practise recording the case histories of individual patients and the outcomes of their treatments. These can be read in the work of several Epidemics treatises where we find individually named persons, with their addresses recorded. This invaluable approach has continued through the centuries to be a feature of Western medicine.

We learn more of early herbal pharmacy, the way the actions of herbs were understood, how they were sourced and applied from the writings of Theopharastus (c317-287 BC) and Dioscorides (c40-90 AD).

Theophrastus was a pupil and later the successor to Aristotle in the Lyceum school in Athens. Inspired by Aristotle’s systematic investigative approach to nature, he focused on the plant kingdom and is credited with being the first botanist, although he also thought and wrote about many other topics. He left two surviving works on plants, Enquiry into Plants and On the Causes of Plants.

These include many medicinal herbs with details of how they were gathered or cultivated, and used practically. He carefully observed plants in terms of their forms, and modes of reproduction, for which he is credited with being the first botanist. These works later became inspirational to the renewal of learning during the Renaissance, and for Linnaeus himself.

Dioscorides’s De Matiera Medica – On the Materials of Medicine – is a Greek text of five volumes which includes about 850 medicinal substances, the majority of which are herbs. It survived into the early modern medicine via translations in Aramaic, Arabic, and then Latin, becoming accessible in English with a first inclusion of his information in Henry Lyte’s A Niewe Herbal, 1578, which itself was based on Flemish and French translations. Take a look at Dioscorides’s text (3).

Fast forward to the 1980s when Professor John Riddle re-evaluated Dioscorides’ understanding of the effects of the herbs. Though Dioscorides didn’t have the benefit of modern biochemistry, Riddle found his grouping together of herbs with “drug affinities” revealed accurate knowledge of their effects in and on the human body, as confirmed by modern chemical analysis of their properties (4).

Galen of Pergamon (c129-216 AD) was a Greek physician living several hundred years after Hippocrates during the early Roman Empire. He became physician to the emperor Marcus Aurelius. Galen built on the learning of previous generations. He revered ‘Hippocrates’ and based his approach to medicine on the texts which had been gathered together under his name.

However, though ‘following’ Hippocrates in all things, as he saw it, he in fact applied himself to discovering more about the human body, developed innovative methods of treatment and took advantage of the expanded repertoire of medicinal herbs available from the empire.

He emphasised using the importance of understanding the patient in his or her full complexity, based on judging the ‘mixture’ or temperaments of the elements in the individual. These influence not only the condition but the person’s response to treatments.

Like the Hippocratic physician, his therapy was to be tailored to the patient. This constitutional approach was not always possible, of course. Galen was for a time a physician to gladiators where he practised what today would be emergency medicine, and he paid close attention to the effects of their wounds, and the internal workings of the body which they revealed. He applied his skills as a surgeon, using the medicines of the day in wound healing.

In his prolific writings he called for the use of the best quality of medicines, he emphasised that the physician must carry out investigations of his own into the body and the herbal medicines, not relying on received convention, in order to understand from his own experience. His results were constrained by the context of the times; some things he got wrong. He made significant advances in knowledge himself, discovering the difference between venous and arterial circulation, and theorising that the blood received oxygen from the lungs.

There are many other ancient writers whose texts survive, for example Pliny, Celsus, Soranus, Rufus of Ephesus, Alexander of Tralles. The knowledge of these earliest practitioners was essentially still the basis of medicine and domestic medicine until the discoveries of pharmaceutical sciences in the 19th and especially 20th century, for example, the anti-inflammatory effects of aspirin and quinine, and the role of antibiotics.

Yet aspirin was derived from the age-old use of willow bark for fevers, quinine from the South American use of cinchona bark, and digoxin from the folk use of the foxglove.

Since the last quarter of the 20^th century traditional medicines – previously dismissed as of little use and “merely old wives tales” have not only been sought after again by the public but become the subject of research and development as a source for new orthodox medicines. For example, Dr. Cassandra Quave’s work at Emory University (6).  

With the acceleration of science and its discoveries from the mid-19^th century and continuing today herbalists have responded with innovations in training and practice, mindful to incorporate what is useful and appropriate for the best interests of their patients.

They also learn and adopt from their own experience improved therapeutic approaches, selecting the herbal prescription for a patient both in the light of ongoing research and holistically according to the patient’s individual nature and circumstances. They also continue to use many of the herbs in the ancient pharmacy, such as St John’s wort, agnus castus, yarrow, walnut, vervain. By doing my own research, I realised how the influence of the roots of Greek medicine continues to flow like a living sap into the many branches of modern herbalism (5).

1. Hamilton, Walter. Translator. Plato The Symposium. Harmmondsworth, England: Penguin Classics, 1971.
2. Jones, W.H.S. Translator. Hippocrates, Volume IV. London: William Heinemann, 1979.
3. Several blogs on the Herbal Research Network website address topics in the history of Western herbal medicine and include many more resources and references.
4. Riddle, John. Dioscorides on Pharmacy and Medicine. Austin: University of Texas Press, 1985.
5. Pitman Vicki. The Nature of the Whole, Holism in Ancient Greek and Indian Medicine. New Delhi: Motilal Barnasidass, 2006.
6. Quave C. Quave Research Group. Etnobotanica.us. https://etnobotanica.us/. Published 2022. Accessed August 30, 2022.

Until recently, the uterus and the placenta were thought to be germ-free and sterile to keep the baby safe from infection. But at just one week old, babies have a complex collection of microbes in their guts. It was thought that a baby received its first dose of bacteria as it passed through the vagina or from the mother’s skin if the child was born via C-section.

We now know that there are microbial inhabitants in the placenta (which nourishes the growing foetus through the umbilical cord) and these closely resemble those that live in the mouth (1). Also, that a disturbance of these bacteria may well be responsible for pre-eclampsia during pregnancy.

A broad range of bacteria are present, including those necessary for metabolising some of the vitamins and nutrients needed by the foetus. The acquisition of the microbiota continues over the first few years of life, and in fact an infant’s GI tract microbiome begins to resemble that of an adult as early as 1 year old. 

Although it was previously thought that the infant gut microbiota would resemble that of an adult by the age of 3, recent studies indicate that the microbiota continues to evolve in both pre-adolescents and 20-year-olds (2). The adult microbiome consists of over a trillion bacterial cells and up to an estimated 1,000 different bacterial species, communities of symbiotic, commensal and pathogenic bacteria along with fungi and viruses.

The predominant organisms found in healthy human large intestine are Gram-negative Bacteroidetes and Gram-positive low-GC Firmicutes, but this varies greatly between individuals. Once established, the composition of the gut microbiota is relatively stable throughout adulthood but can be altered as a result of bacterial infections, antibiotic treatment, lifestyle, surgical, and a long-term change in diet (3).

Common complaints in babies and children include digestive disorders, infections, respiratory problems, skin conditions, nervous or cognitive disorders, allergies and auto-immune disorders.  All these may well have something in common:

• Gut dysbiosis: An altered microbial state in the gut, either lack of bacterial biodiversity or overgrowth of pathogenic microorganisms (SIBO) 
• Leaky gut syndrome: A healthy GI tract serves as a barrier preventing undigested food particles, microbes, toxins and other unwanted substances from entering the body through the bloodstream. When the intestinal epithelium becomes damaged, substances can ‘leak’ into the body where they are attacked by the immune system, which leads to inflammation.

These can affect digestion and absorption of nutrients, disturb immune function and trigger inflammation.

Antibiotics

Even a single dose of antibiotics can create permanent changes in our gut flora, and sometimes the healthy bacteria never fully recover from strong rounds of antibiotics.

The state of the mother’s gut flora during pregnancy and birth

Some bacterial species are more common and others less common in women who give birth prematurely – before 37 weeks of pregnancy – than the typical bacterial profile of the women who go full term.

It has been found that gum disease raises the risk of premature birth. Oral bacteria from diseased and bleeding gums can allow harmful bacteria to reach and colonise the placenta, potentially triggering premature birth (4).

The microbiota that an infant begins to acquire depends strongly on mode of delivery. Twenty minutes after birth, the microbiota of vaginally delivered infants resembles the microbiota of their mother’s vagina, while infants delivered via Caesarean section harbour more microbial communities typically found on human skin.

Nutrition during the first few years of a child’s life

• Diets high in sugar, refined carbohydrates and processed foods and low in fermentable fibre (prebiotics) can contribute to small intestinal bacterial overgrowth (SIBO). Avoiding foods that feed pathogenic bacteria, and consuming fibre-rich foods that feed commensal bacteria can help restore the balance.
• Eating a diet too high in protein, especially if that animal protein has been treated with antibiotics, can disrupt the microbiota.

The Importance of breastfeeding

Every mother produces complex sugars (oligosaccharides). More than 200 human milk oligosaccharides (H.M.O.s) have been identified. They are the third-most plentiful ingredient in human milk, after lactose and fats, and their structure ought to make them a rich source of energy for growing babies—but babies cannot digest them.  

H.M.O.s pass through the stom­ach and the small intestine unharmed, landing in the large intestine, where most of our bacteria live. If babies cannot digest them, they must be food for the microbes!

Bifidobacteria are more com­mon in the stools of breast-fed infants than bottle-fed ones. Human milk contains several oligosaccharides that cow milk does not.

Poor digestion

If our digestive energy is low, enzymes are not secreted as they should be, and food can remain partially digested in the gut, ferment and promote dysbiosis and leaky gut syndrome which can lower resistance to disease.

Mento-emotional state

Stress can severely compromise the quality of our digestive function. We now know that there is a direct connection between the central nervous system and the enteric nervous system in the gut that has been coined the “gut-brain axis”.  When we are stressed, mentally, emotionally or physically, the sympathetic nervous system overrides the functions of the parasympathetic nervous system.

Digestion gets deprioritised because it is less vital to our immediate survival. These factors work together to affect the gut flora, impair nutrient absorption and predispose to leaky gut syndrome.

It is thought that changes in dietary patterns over the last few decades combined with overuse of antibiotics could result in each generation beginning life with a smaller population of ancient microbes than the last as well as being a primary contributor to the epidemic of obesity, diabetes, IBS and allergies that we see today.

This firstly involves taking a detailed case history of the child and examining the body, paying attention to their build, skin and hair type, body temperature, digestion and bowel function, as well as temperament. Tongue and pulse diagnosis are valuable diagnostic tools.

Re-establishing homeostasis in the gut can bring profound healing to the entire body, relieving digestive symptoms as well as disorders of the immune system, nervous system and skin.

Herbal medicines provide us with the solution to many problems in babies and children associated with disruption of the microbiome. We have…

Herbal antimicrobials to prevent the use of allopathic antibiotics:

• Echinacea (Echinacea purpurea/angustifolia)
• Turmeric (Curcuma longa)
• Elder (Sambucus nigra)
• Pau d’arco (Tabebuia impetiginosa)
• Sage (Salvia officinalis)
• Thyme (Thymus vulgaris)
• Burdock (Arctium lappa)
• Cat’s claw (Uncaria tomentosa)
• Andrographis (Andrographis paniculata)
• Basil (Ocimum spp)
• Oregano (Origanum vulgaris)
• Garlic (Allium sativum)

Digestives and carminatives to enhance appetite, digestion, absorption and prevent fermentation in the gut.

Spices such as ginger, cinnamon, cardamom, coriander, clove and black pepper are some of the best remedies for the digestion and for increasing immunity. These can be added to cooking and made into tasty hot teas for all the family.

Take ginger for example. Its pungency warms and strengthens digestion, stimulates the flow of digestive juices and invigorates the whole body. It is highly antiseptic, activates immunity, dispels bacterial and viral infections.

A hot cup of ginger tea is an excellent remedy for the first signs of colds, coughs or flu and will help to clear catarrh. 2-3 cups can be sipped through the day.

Antimicrobial digestives to inhibit and combat small intestinal bacterial overgrowth (SIBO):

• Rosemary (Rosmarinus officinalis)
• Thyme (Thymus vulgaris)
• Cinnamon (Cinnamomum spp)
• Cardamom (Elletaria cardamomum)
• Long pepper (Piper longum)
• Garlic, onion (Allium spp)
• Ginger (Zingiberis off)
• Elecampane (Inula helenium)
• Turmeric (Curcuma longa)
• Cumin (Cumin cuminum)
• Chamomile (Chamomilla recutita)

Astringent herbs to restore the gut wall in leaky gut syndrome:

• Marigold (Calendula off)
• Plantain (Plantago spp)
• Rose (Rosa spp)
• Yarrow (Achillea millefolium)
• Raspberry and blackberry leaves (Rubus spp)
• Tormentil (Potentilla spp)
• Oak bark (Quercus robur)
• Agrimony (Agrimonia eupatoria)
• Meadowsweet (Filipendula ulmaria)
• Elderflower (Sambucus nigra)
• Pomegranate (Punica granatum)

Nervines and relaxants to balance the nervous system:

• Chamomile (Chamomilla recutita)
• California poppy (Eschscholzia californica)
• Lemon balm (Melissa officinallis)
• Ashwagandha (Withania somnifera)
• Rose (Rosa spp)
• Bacopa (Bacopa monieri)
• Lavender (Lavendula spp)
• Lime flower (Tilia europea)
• Wild oat (Avena sativa)

The ways of prescribing herbal medicines vary considerably according to the condition being treated, the herbs employed, the age and build of the child, their constitution, even the time of year. The easiest way is in food.

Babies

• Umbilical powdered herbs
• Teas in bottles/off the spoon
• Teas/dilute tinctures/glycerites/hydrosols in syringes
• Baths/sponging
• Oils/massage including foot massage
• Burners in rooms/on radiators/lights

Children

• Hot/cold infusions and decoctions
• Syrups
• Powders rolled in honey, fruit concentrate, ghee, smoothies, warm water/milk
• Tinctures and glycerites
• Herbal baths – dilute essential oils, infusions, fresh herbs in muslin
• Tablets/capsules for older children
• Hand & foot baths
• Inhalations
• Massage – dilute oils/liniments, chest rubs etc
• Ointments, lotions and creams
• Compresses
• Hydrosols
• Suppositories

Chronic conditions generally require mild herbal remedies which can safely be given, generally 3 times daily, over months at a time if necessary.

Acute conditions may require stronger herbs given up to every 2 hours.

For example, dandelion root has mild laxative properties which can be given to regulate digestion and elimination over a period, while senna root or castor oil have stronger laxative action for acute constipation or to clear heat quickly during a fever.

Some conditions, particularly fevers, colds, catarrh and problems associated with cold, require herbs to be given in hot preparations. Others such as urinary problems are better suited to cool preparations.

Skin problems may improve more rapidly with herbal teas as opposed to tinctures, while tinctures may be preferable when more concentrated medicines are required such as the treatment of a virulent infection.

1. Olaniyi KS, Moodley J, Mahabeer Y and Mackraj I (2020) Placental Microbial Colonization and Its Association With Pre-eclampsia. Front. Cell. Infect. Microbiol. 10:413. doi: 10.3389/fcimb.2020.00413
2. Hollister EB, Riehle K, Luna RA, et al. Structure and function of the healthy pre-adolescent pediatric gut microbiome. Microbiome. 2015; 3:36. doi: 10.1186/s40168-015-0101-x.
3. Juan Miguel RodrÍguez, Kiera Murphy, Catherine Stanton, R. Paul Ross, Olivia I. Kober, Nathalie Juge, Ekaterina Avershina, Knut Rudi, Arjan Narbad, Maria C. Jenmalm, Julian R. Marchesi & Maria Carmen Collado (2015) The composition of the gut microbiota throughout life, with an emphasis on early life, Microbial Ecology in Health and Disease, 26:1, DOI: 10.3402/mehd.v26.26050
4. Saini R, Saini S, Saini SR. Periodontitis: A risk for delivery of premature labor and low-birth-weight infants. J Nat Sci Biol Med. 2010 Jul;1(1):40-2. doi: 10.4103/0976-9668.71672. PMID: 22096335; PMCID: PMC3217279.

A strain is caused by overstretching a muscle and/or a tendon (1), usually caused by overstretching the fibres, leading to bruising, pain, spasms, weakness, oedema (swelling) inflammation, and cramping in the muscle, and even tears in the muscle fibres (2). A sprain, in contrast, is injury to a ligament, which connects bone to bone, and is often caused by a sharp twisting motion. The symptoms are often similar to those of a strain.

Treatment of sprains and strains should be approached carefully, particularly when in the acute stage, immediately following the injury.

The role of aromatherapy here is primarily to help reduce swelling and pain through the gentle application of anti-inflammatory essential oils, and to help move lymph around the area, through the use of astringent essential oils and herbal extracts. Since temperature also has a role to play with the reduction of pain and swelling, it is advisable to use a cool pack alongside the oil blend to aid the healing process. Although the injury is acute, applying neat or undiluted essential oils to the skin is not advised, since it may cause irritation or damage to the skin.

Instead, a strong blend of around 5% can be made and applied to the area, then occluded with a cold compress, and alternated with a hot compress if desired, to increase blood flow to the area and speed up the absorption of the remedy. A carrier oil will be needed to dilute the blend; a herbal-infused oil such as arnica is helpful for addressing bruising, for example. Alternatively, witch hazel (Hamamelis virginiana), which is astringent, can be blended with a dispersant such as Solubol, and the essential oils added and applied to the area with a cold flannel.

Safety note: Do not mix witch hazel and essential oils without the dispersant, since oil and water will not mix and thus the essential oils would effectively be neat, and undiluted, and could irritate the skin.

Suggested blend for sprains and strains

5% blend

• 10ml Arnica Arnica montana-infused carrier oil e.g. Sunflower (Helianthus annuus) (or 10ml of Witch Hazel / Solubol mixture as described above)
• 10 drops (total) of cooling, anti-inflammatory astringent essential oils, to include any of the following:
  • Grapefruit (Citrus paradisii): Lymphatic drainage, astringent (Safety note: Phototoxic. Avoid application before exposure to sunlight.)
  • Juniper (Juniperus communis): Lymphatic drainage, astringent
  • German Chamomile (Matricaria recutita): Anti-inflammatory
  • Roman Chamomile (Chamaemelum mobile): Anti-inflammatory
  • Peppermint (Mentha piperita): Cooling, analgesic (Safety note: do not use whilst pregnant, breastfeeding or with children under 2 years old.)
  • Lavender (Lavandula angustifolia): Anti-inflammatory, analgesic

Stir well to combine, and apply to the affected area using gentle massage. Cover with a cold flannel or ice pack if desired.

Please note: Only use on small, injured areas, not suitable for full-body

Many of my clients exercise regularly, but also have desk-based jobs. This means that they often arrive at the clinic with various low-level aches, pains and tension which they are unable to relieve through stretching at home.

Usually poor posture or overuse of the muscle are to blame for these kinds of aches and pain, and symptoms can include pain, inflammation, oedema (swelling), tightness or tension, and reduced motion in the affected area. Also tendonitis, plantar fasciitis, or carpal tunnel syndrome may be the result of repetitive strain injury (RSI). In such instances, there are several treatment options available to clients, both at home and on the massage couch.

Preventative measures include regular stretching as part of the working day (3), and post-exercise, to ensure the muscles are adequately moved and stretched, and tension build up is prevented. Supportive desk chairs, mouse mats, and armrests can prevent RSI in the wrists, for example, and support healthy back posture whilst seated (4).

Maintaining a regular physical practice such as gentler forms of yoga, e.g. yin yoga, can also be enormously helpful for maintaining flexibility, since they focus on releasing the fascia that connects the musculoskeletal system (5), reducing tension in the muscles and keeping joints mobile. Mixing up exercise regimes and not over-working one muscle group can also help to prevent muscle pain from overuse (RSI).

However, there are always times when we might overdo it on a run or in the gym, sit for too long at our desks, or lift something heavy. We then wake up the next morning with a crick in the neck, sore legs, or a painful shoulder. Perhaps we even suffer from a ‘pinched nerve’ due to the inflammation in the surrounding muscle tissues. In these cases, aromatherapy can be a gentle and enjoyable way to help alleviate pain and tension, and to help relax and release muscle tissue.

Since pains and tension of this type tend not to be as limiting or acute as sprains, strains and other injuries, they require a different approach to treatment. Ingrid Martin recommends the use of “strongly analgesic and cooling” (6) essential oils for pain caused by overuse of a muscle, however, oils that are considered warming are also useful for longer-term chronic stiffness (7) and tension.

Some useful oils for chronic pain, tension and RSI

Carrier oils

St John’s Wort (Hypericum perforatum): herbal infused oil, e.g. sunflower Helianthus annuus. A carrier oil infused with St John’s Wort is extremely anti-inflammatory, and is recommended for bruising, reddened skin, as well as being calming for neuralgia and sciatica (inflamed nerves). The herb gives its carrier oil a gorgeous blood red colour.

Jojoba (Jojoba sinensis): Actually a liquid wax, jojoba absorbs very easily into the skin, having a similar molecular structure to that of skin’s natural sebum. It is also anti-inflammatory and is often recommended for treating arthritis and other inflammatory conditions, so can be useful for relieving chronic joint pain.

Essential oils

Cooling, anti-inflammatory essential oils such as those mentioned above for the treatment of acute injuries can also be applied here, but sometimes a more “warming” approach is needed, particularly in cases of stiffness and stagnation in the muscles and joints. Some of these oils include:

Cinnamon (Cinnamomum verum): A warming, stimulating oil that has antirheumatic properties. A lovely addition to a muscle-warming blend.

Safety note: This oil should be treated with caution and not used above 0.1% in any blend due to its skin-sensitising properties (8).

Black pepper (Piper nigrum): Another stimulating, warming oil, with anti-inflammatory and analgesic properties (9). This oil promotes good blood circulation and is particularly recommended for overworked muscles, chronic inflammation, stiffness, and both osteoarthritis and rheumatoid arthritis (10).

Safety note: Use in low doses on sensitive skin.

Rosemary (Salvia rosmarinus): A stimulating, invigorating oil, which is an excellent vasodilator (11) and can alleviate muscle tension and pain through bringing blood to the area. “Stiffness and the related pain are usually relieved if local circulation is improved” (12) states Ingrid Martin.

Marjoram (Origanum majorana): Primarily a relaxant and hypotensive oil, which I use a lot in my clinic for clients with muscular pain and tension. Due to its ability to act on the nervous system as well as on smooth muscle tissue (13), it is a powerful oil for treating physical conditions such as muscle aches and rheumatism (14) caused by excessive tension in the body. It is an excellent accompaniment to some of the more stimulating, anti-inflammatory oils mentioned above.

I would normally combine these oils at no more than a 2% dilution in an appropriate carrier oil for use in massage during a treatment, however I regularly make muscle rubs and balms for clients to take home, as these can be useful to carry with them for use at home, work and more.

Usually, a product at a 4-5% dilution is prepared, using a mixture of carrier oils, essential oils and waxes to create a thick balm that is solid at room temperature. This is then applied three times a day to the affected area. A balm of this strength, however, would be too strong for a full-body massage, and is designed for localised, topical use only.

Muscle rub/balm recipe

Makes 1 ~60ml pot

Ingredients

• 7.15ml Beeswax (or soy wax)
• 50ml Carrier oil (e.g. herbal infused St John’s Wort oil)
• 57 drops (~2.85ml)  total essential oil (from list above)

Method

1. Use a bain-marie over a low heat to melt the carrier oils and wax together. Stir until completely melted and combined.
2. Take off the heat. Allow to cool to 50-60 degrees centigrade. If the essential oils are mixed in before the mixture is left to cool much of the essential oils will be evaporated and lost.
3. Add up to 57 drops of essential oils, from those listed above
4. Stir well to combine, pour into a 60ml sterilised tin and allow to cool
5. When solid, the balm is ready to use. Use within 6 months.
6. Apply topically to the affected area up to three times per day, massaging gently.

Fibromyalgia is a chronic health condition that can affect the whole body (15). Symptoms include increased sensitivity to pain, tenderness and soreness, fatigue, and stiffness. Brain fog, insomnia and digestive issues can also be accompanying symptoms. Whilst it has a strong muscular component, when treating fibromyalgia, an aromatherapist will take into consideration the symptoms as a whole, and create a blend of oils according to each individual’s unique needs.

Massage can be a wonderful way to treat fibromyalgia and other chronic muscular conditions, since it works not only on the site of the pain, i.e. the muscles, but on the emotional body and nervous system, too.

A 2014 systematic review concluded that “Massage therapy with duration ≥5 weeks had beneficial immediate effects on improving pain, anxiety, and depression in patients with [Fibromyalgia]. Massage therapy should be one of the viable complementary and alternative treatments for [Fibromyalgia]” (16) although more, large-scale research is needed to provide confirmation of the findings.

My favourite essential oils for treating fibromyalgia are those that work synergistically on the nervous system as well as the physical body, since my clients presenting with fibromyalgia often experience depression, anxiety, and frustration along with their chronic pain.

Inhalation as well as topical application of essential oils is key in treatment of conditions such as this, since inhalation is the most effective method of application of aromatherapy for psychotherapeutic effect (17).

Coriander seed (Coriandrum sativum)

Coriander seed is analgesic and antispasmodic, but also a powerful antidepressant oil. It is also excellent for digestive issues, and in Traditional Chinese Medicine, it is indicated for clearing ‘painful obstruction’ which refers to rheumatic pain (18).

Marjoram (Origanum majorana)

Marjoram is mentioned above, and is an excellent dual function oil, working to calm the nervous system whilst simultaneously relaxing the muscle tissue

Grapefruit (Citrus paradisii)

Grapefruit is also mentioned above; a “cooling, cleansing and decongesting” (19) oil that is helpful for clearing the mind, stimulating lymph and can help ease feelings of frustration and tension.

Safety note: Phototoxic. Avoid application before exposure to sunlight.

Cardamom (Elettaria cardamomum)

Cardamom is a digestive oil, helpful for treating IBS and other digestive complaints that are often associated with Fibromyalgia. It is also considered a “gentle tonic of the brain and nervous system”(20) and therefore complements the more stimulating oils with its gentler nature.

Melissa or lemon balm (Melissa officinalis)

Melissa is one of the most regularly-used oils in my clinic. Particularly as an inhalation oil, it works beautifully, though I often include it in massage blends, too. Analgesic and anti-inflammatory, it is also calming and sedative, so can be wonderfully effective for calming the nerves and the muscle tissues. The fresh or dried leaves can also be taken as an infusion in hot water.

Safety note: Safe for topical use at dilutions of 1% or less. Melissa should be avoided if pregnant or breastfeeding.

A balm or oil blend for fibromyalgia can be made in much the same way as in the other recipes suggested above, though for full-body application, the dilution of essential oils should be no more than 2% in total, with those essential oils which are potential irritants or sensitisers being used at their much lower, appropriate dilutions.

Alternatively, a bath oil at a 2% dilution could be prepared. Heat aids the absorption of essential oils into the bloodstream, and the steam will increase the evaporation, aiding inhalation and speeding up the therapeutic properties. Equally, the heat will help to increase blood flow to the sore muscles as well as releasing tension. For a further benefit, Epsom salts (Magnesium sulphate) may be added to the bath.

The magnesium in these healing salts is known for speeding up muscle recovery and reducing inflammation (21), as well as for reducing tiredness and fatigue more generally so it may be helpful for post-workout recovery too. It can cause dehydration, though, so make sure to top up on water before and after an Epsom salt bath.

It is clear that aromatherapy products such as massage oils, therapeutic baths and muscle rubs have a large part to play in the prevention and treatment of both chronic and acute musculoskeletal conditions. These recipes and oil blend suggestions have been specifically designed for treatment of the conditions explored here.

Do check allergy information and consult a health professional before using these products on children, if you have any health conditions, are pregnant or breastfeeding.

1. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 209.
2. Mulcahey, MD, FAAOS, M., 2020. Sprains, Strains and Other Soft-Tissue Injuries – OrthoInfo – AAOS. [online] Orthoinfo.aaos.org. Available at: <https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/> [Accessed 29 July 2022].
3. nhs.uk. 2019. Common posture mistakes and fixes. [online] Available at: <https://www.nhs.uk/live-well/exercise/strength-and-flexibility-exercises/common-posture-mistakes-and-fixes/> [Accessed 29 July 2022].
4. Pruthi, M.D., S., 2021. Office ergonomics: Your how-to guide. [online] Mayo Clinic. Available at: <https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/office-ergonomics/art-20046169#:~:text=If%20you%20 sit%20behind%20a,joints%20stay%20 comfortable%20at%20work.> [Accessed 29 July 2022].
5. Morris, N., 2022. 5 Common Questions About Yin Yoga. [online] Yoga International. Available at: <https://yogainternational.com/article/view/questions-about-yin-yoga> [Accessed 29 July 2022].
6. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 211
7. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 211
8. Tisserand, R. and Balacs, T., 2000. Essential oil safety. London: Churchill Livingstone, pp.129-130.
9. Caddy, R. Essential oils in colour (2nd ed.). Amberwood Publishing. 1997, pp 8.
10. Caddy, R. Essential oils in colour (2nd ed.). Amberwood Publishing. 1997, pp 8.
11. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 121
12. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 121
13. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 100
14. Caddy, R. Essential oils in colour (2nd ed.). Amberwood Publishing. 1997, pp 49.
15. nhs.uk. 2022. Fibromyalgia. [online] Available at: <https://www.nhs.uk/conditions/fibromyalgia/> [Accessed 29 July 2022].
16. Li, Y., Wang, F., Feng, C., Yang, X. and Sun, Y., 2014. Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. PLoS ONE, [online] 9(2), p.e89304. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/> [Accessed 29 July 2022].
17. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, pp 15.
18. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, pp 64.
19. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, pp 80.
20. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, pp 57.
21. Cleveland Clinic. 2022. Epsom Salt: Potential Benefits and How to Use It. [online] Available at: <https://health.clevelandclinic.org/7-things-you-probably-didnt-know-about-epsom-salt/#:~:text=Epsom%20salt%20is%20used%20to,recovery%20period%20after%20a%20workout.> [Accessed 29 July 2022].

Bibliography

• Caddy, R. Essential oils in colour (2nd ed.). Amberwood Publishing. 1997
• Cleveland Clinic. 2022. Epsom Salt: Potential Benefits and How to Use It. [online] Available at: <https://health.clevelandclinic.org/7-things-you-probably-didnt-know-about-epsom-salt/#:~:text=Epsom%20salt%20is%20used%20to,recovery%20period%20after%20a%20workout.> [Accessed 29 July 2022].
• Li, Y., Wang, F., Feng, C., Yang, X. and Sun, Y., 2014. Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. PLoS ONE, [online] 9(2), p.e89304. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/> [Accessed 29 July 2022].
• Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007
• Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005
• Morris, N., 2022. 5 Common Questions About Yin Yoga. [online] Yoga International. Available at: <https://yogainternational.com/article/view/questions-about-yin-yoga> [Accessed 29 July 2022].
• Mulcahey, MD, FAAOS, M., 2020. Sprains, Strains and Other Soft-Tissue Injuries – OrthoInfo – AAOS. [online] Orthoinfo.aaos.org. Available at: <https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/> [Accessed 29 July 2022].
• nhs.uk. 2019. Common posture mistakes and fixes. [online] Available at: <https://www.nhs.uk/live-well/exercise/strength-and-flexibility-exercises/common-posture-mistakes-and-fixes/> [Accessed 29 July 2022].
• Pruthi, M.D., S., 2021. Office ergonomics: Your how-to guide. [online] Mayo Clinic. Available at: <https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/office-ergonomics/art-20046169#:~:text=If%20you%20sit%20behind%20a,joints%20stay%20comfortable%20at%20work.> [Accessed 29 July 2022].
• Tisserand, R. and Balacs, T., 2000. Essential oil safety. London: Churchill Livingstone
• https://www.herbalreality.com/conditions/musculoskeletal-system/

Here is a non-exhaustive list of plant/substance classification terms according to Western herbal actions and pharmacology. Click on the name of the herbal action to see a list of all herbs with this action.

Adaptogens are strengthening herbs that help us adapt to stress by interacting with the endocrine system. They help normalise metabolism and nourish the tissues. Examples include licorice (Glycyrrhiza glabra), ashwagandha root (Withania somnifera), rhodiola root (Rhodiola rosea) and ginseng root (Panax ginseng)

Alteratives are herbs that ‘alter’ the condition in a tissue by eliminating metabolic waste via the liver, large intestine, lungs, lymphatic system, skin and kidneys. Examples include burdock root (Arctium lappa), dandelion root (Taraxacum officinalis), cleavers (Galium aparine), poke (Phytolacca decandra) and nettle leaf (Urtica dioica).

Amphoterics are herbs that bring balance to different organs, tissues and systems by regulating hyper and hypo functioning. Amphoterics create harmony. Examples include licorice root (Glycyrrhiza glabra), oatstraw flowering tops (Avena sativa), hawthorn berry (Crataegus oxycanthoides).

Analgesics are medications that are applied internally or externally to reduce pain, Many of them work by depressing the functions of the central nervous system. Examples of effective analgesics include Jamaican dogwood (Piscidia erythrina), pasqueflower (Anenome pulsatilla), California poppy (Eschscholzia californica), corydalis (Corydalis yanghusuo) and wild lettuce (Lactuca virosa). Topically, aconite (Aconitum napellus) and cayenne (Capsicum minimum) are powerful anodynes.

Anthelmintic plants kill or assist in the expulsion of intestinal worms. These plants include andrographis (Andrographis paniculata), cloves (syzygium aromaticum), feverfew (Tanacetum parthenium) and myrrh (commiphora molmol).

Anti-inflammatory herbs reduce inflammation in the body. There are different systems in the body that anti-inflammatory plants target. For example for the gastrointestinal tract chamomile, fenugreek and meadowsweet are useful. For the musculoskeletal system rosehips, turmeric and celery seed are useful. For inflammation against immune mediated inflammation gotu kola (centella asiatica), rehmannia (rehmannia glutinosa) and feverfew (tanacetum parthenium) can be useful.

Antimicrobials are herbs that interfere with the proliferation and life-cycle of microbes; bacteria, fungi, and viruses. Examples include thyme leaf (Thymus vulgaris), echinacea (Echinacea species), elderberry (Sambucus nigra).

Antioxidant substances that protect against oxidation and degradation from free radical damage. Plants rich in antioxidant include bacopa (bacopa monnieri), bilberry (vaccinium myrtillus), green tea (camelia sinensis) and thyme (thymus vulgaris).

Antirheumatic medicines prevent or relieve rheumatic symptoms such as joint pains, limited mobility and swelling. Plants that have this effect include celery seed (apium graveolens), black cohosh (cimicifuga racemose), nettle leaf (urtica dioca), devils claw (harpagophytum procumbens) and willow bark (salix alba).

Antispasmodic plants reduce or relieve smooth muscle spasm. They can be helpful for an array of issues including menstrual cramps. Also known as spasmolytics, these plants include aniseed (Pimpinella anisum), blue cohosh (caulophyllum thalictroides), cramp bark (viburnum opulus) and lavender (Lavandula angustofolia).

Antitussive a substance that reduces the amount of, or severity of coughing. Licorice, peppermint and bupleurum are examples of this.

Aphrodisiac herbs are those that nourish, build and stimulate sexual desire and potency. Examples include saffron (Crocus sativa) and ashwagandha root (Withania somnifera).

Astringents contain tannins that act to precipitate proteins and draw tissues together, tightening and toning them to reduce secretions and discharge. Astringents also tend to stop bleeding and can act on tissues with which there is no direct contact. Examples include raspberry leaf (Rubus ideaus), Lady’s Mantle leaf (Alchemilla vulgaris), agrimony leaf (Agrimonia eupatoria), shepherd’s purse leaf (Capsella bursa-pastoris), witch hazel leaf (Hamamelis virginiana) and yarrow leaf (Achillea millefolium).

Bitters stimulate digestion by enhancing digestive secretion and peristaltic movements of the gut. They act via a reflex from the taste buds to the brain then through the vagus nerve to the whole digestive system. Often these herbs are combined with warming digestives to balance the cold nature of bitters. Examples include artichoke leaf (Cynara scolymus), gentian root (Gentiana lutea), wormwood leaf (Artemisia absinthium), Oregon grape root (Mahonia aquifolium), goldenseal root (Hydrastis canadensis).

Bronchodilator plants cause widening of the bronchi. The bronchi are any of the major air passages of the lungs which diverge from the windpipe. Plants with this action include ephedra (ephedra sinica), nigella sativa and bala (Sida cordifolia).

Cardiotonics are herbs that bring order and strength to the cardiovascular system, speed up or slow down the heart as needed. Examples include hawthorn berry and leaf (Crataegus oxycanthoides), motherwort leaf (Leonurus cardiaca), Lily of the Valley leaf (Convalleria majalis), garlic bulb (Allium sativum), lime flower (Tilia platyphyllos), mistletoe leaf and berry (Viscum album).

Carminative herbs are high in essential oils and help ease digestion by relieving gas, spasms and cramps. Examples include aniseed (Pimpinella anisum), fennel seed (Foeniculum vulgare) and peppermint leaf (Mentha piperita).

Cholagogues and choleretics: Cholagogues promote the production of bile in the liver. A choleretic a type of cholagogue that promotes the release of bile from the gall bladder into the duodenum. Cholagogues have an alterative and laxative effect. Cholagogues are contra-indicated if there is acute liver failure, obstructive jaundice, painful gallstones or cholecystitis. Examples include celandine leaf (Chelidonium majus), barberry root (Berberis vulgaris), dandelion root and leaf (Taraxacum officinalis root), and blue flag root (Iris versicolor).

Demulcents are soothing mucilaginous and silky herbs that can be taken internally to soothe and protect damaged or inflamed tissue. Examples include slippery elm bark (Ulmus rubra), marshmallow root (Althea officinalis) and limeflower (Tilia cordata).

Depurative is a substance that improves detoxification and aids elimination to reduce the accumulation of metabolic waste products within the body. They were formerly known as alteratives or blood purifiers and are largely used to treat chronic skin and musculoskeletal disorders. Depurative plants include burdock, echinacea root (echinacea angustofolia), nettle leaf (urtica diocia) and yellow dock (rumex crispus).

Diaphoretics are herbs that cause sweating by increasing circulation in the periphery of the body. Usually used to help to relieve fevers, some examples are Yarrow aerial parts (Achillea millefolium), Elder flowers (Sambucus niger), ginger root (Zingiber officinalis).

Diuretics are herbs that stimulate the flow of urine, and help remove fluids from the body. Common examples are dandelion leaf (Taraxacum officinalis), burdock root (Arctium lappa) and corn silk (Zea mays).

Emmenagogues are herbs that stimulate and promote menstruation. Examples include marigold flowers (Calendula officinalis) and chaste tree fruits (Vitex agnus-castus), turmeric root (Curcuma longa).

Expectorants are herbs that assist the body in expelling mucus from the upper respiratory tract. Examples include licorice root (Glycyrrhiza glabra), elecampane root (Inula helenium) and Thyme leaf (Thymus vulgaris).

Febrifuge or antipyretic plants reduce or prevent fever. Rehmannia (rehmannia glutinosa), rhubarb root (rheum palmatum), yarrow (achillea millefolium) and willow bark (salix alba) all have antipyretic properties.

Galactagogues are herbs that encourage the flow of breast milk. Examples include Fennel seed (Foeniculum vulgare), Celery seed (Apium graveolens) and Shatavari root (Asparagus racemosus).

Hepatics are herbs that generally support liver function by decongesting as well as supporting bile flow. Examples include dandelion root (Taraxacum officinalis), yellow dock root (Rumex crispus), turmeric root (Curcuma longa).

Hypnotics and sedatives are plants that promote a deep and relaxing sleep. They may work through muscle relaxant properties, through the action of volatile oils on the limbic system, or through the presence of alkaloids that affect the central nervous system. Chamomile flowers (Matricaria recutita), lime flower (Tilia platyphyllos), lemon balm leaf (Melissa officinalis), wood betony aerial parts (Stachys betonica), skullcap leaf (Scutelleria lateriflora), wild lettuce leaf (Lactuca virosa), passionflower aerial parts (Passiflora incarnata), ashwagandha root  (Withania somnifera), valerian root (Valeriana officinalis), corydalis root (Corydalis yanhusuo), Californian poppy aerial parts (Eschscholzia californica).

Hypolipidemics are herbs which mildly reduce serum lipids, including triglycerides and cholesterol. Examples include hawthorn berry and leaf (Crataegus oxycanthoides), turmeric root (Curcuma longa), guggulu resin (Commiphora mukul), garlic bulb (Allium sativum), and cayenne fruit (Capsicum annuum).

Hypotensives act to reduce high blood pressure by relaxing muscles or through a calming effect upon the central nervous system. Examples include hawthorn berry and leaf (Crataegus oxycanthoides), garlic bulb (Allium sativum), lime flower (Tilia platyphyllos), cramp bark (Viburnum opulus), valerian root (Valeriana officinalis), motherwort leaf (Leonorus cardiaca) and mistletoe leaf and berry (Viscum album)

Immunomodulants restore balance to a dysfunctional immune system. These are often used in chronic autoimmunity, such as Crohn’s and multiple sclerosis. Many immunomodulants are adaptogens, and vice versa. Examples include reishi mushroom (Ganoderma lucidum), Astragalus root (Astragalus membranaceus), licorice root (Glycyrrhiza glabra), Siberian ginseng root (Eleuthrococcus senticosus), ashwagandha root (Withania somnifera) and cordyceps (Cordyceps sinensis).

Immunostimulants stimulate the immune system to protect against infection, including non-specific mechanisms, and the specific mechanisms of humoral and cell-mediated immunity. Many immunostimulants are antimicrobials and vice versa, and are used in both acute and chronic infection. Examples include echinacea root and leaf (Echinacea spp.), Garlic bulb (Allium sativum), myrrh resin (Commiphora myrrha), thyme (Thymus vulgaris, andrographis leaf (Andrographis paniculata) and wild indigo (Baptisia tinctoria).

Laxative herbs are those that stimulate or promote bowel movements. There are different types of herbs; gentle aperients, like dandelion root (taraxacum officinalis), that have a mild effect; bulk-forming laxatives, like flaxseed (Linum usitatissimum), that increase the water and bulk of the stool; stimulant laxatives is senna leaf (Senna alexandria) that invigorate the muscles of the lower bowel to create a stronger motion. 

Nervines are herbs that soothe the nervous system and have a calming effect on the emotions. Examples include oatstraw flowering tops (Avena sativa), passionflower (Passiflora incarnata), lavender (Lavandula officinalis), St. John’s Wort (Hypericum perforatum), Rosemary leaf (Rosmarinus officinalis), and gotu kola leaf (Centella asiatica).

Relaxant plants promote relaxation and can reduce tension. Herbs with this property include passionflower (Passiflora incarnata) and valerian (valeriana officinalis).

Rubefacients are applied externally and cause a mild local irritation and draw blood to the area through capillary dilation. Rubefacients are used to enhance blood supply to localized areas to remove congestion and promote healing. Examples include cayenne fruit (Capsicum minimum), mustard seed (Brassica spp.), ginger root (Zingiber officinalis), and peppermint leaf (Mentha piperita oil).

Sedatives are substances that reduces activity, particularly in the nervous system and decreases nervous tension. It may alleviate pain, anxiety or spasm and induce sleep. Sedatives include Californian poppy (eschscholzia californica), hops (humulus lupulus), true unicorn (aletris farinosa), and valerian (valeriana officinalis).

Sialogogues are medications that stimulate the production of saliva to treat dry mouth, poor digestion, receding gums and infection including prickly ash bark (Zanthoxylum americanum), echinacea root (Echinacea spp) and spilanthes flower (Spilanthes acmella).

Stimulant substances raise levels of physiological or nervous activity in the body. Plants that are stimulating include cacao, coffee, green tea (Camelia sinensis), yerba mate (Ilex paraguariensis), kola nut (cola nitida) and guarana (Paullinia cupana).

Stomachic promote the appetite or assist digestion, for example psyllium husk is a bulk laxative that supports the digestive tract.

Thymoleptic medicines modify people’s moods, and oftentimes are antidepressants. Plants that have this action include St John’s Wort (Hypericum perforatum), lavender (Lavandula angustifolia) and saffron (Crocus sativus).

Tonics is a slightly controversial term as it seems to apply to herbs that bring tone to an organ or tissue. It is also used to refer to herbs that help the whole system to function better acting as general energy boosters. Examples of herbs that bring tone to the tissues are the astringent goldenseal (Hydrastis canadensis) and ground ivy (Glechoma hederacea). Those that bring energy are cacao (Theobroma cacao), oatstraw flowering tops (Avena sativa) and ashwagandha root (Withania somnifera).

Trophorestorative are substances that which has a healing and restorative action on a specific organ or tissue. Nervous system restoratives include oat straw (avena sativa), skullcap (scuttelaria lateriflora) and damiana (Turnera diffusa).

Uterine tonics are substances that increase the tone of the uterine muscle. Uterine tonics include black cohosh (Cimicifuga racemose), blue cohosh (Caulophyllum thalictroides), false unicorn root (Chamaelirium luteum) and true unicorn (Aletris farinosa).

Vasodilators are substances that dilates or widens the blood vessels, for example olive leaves (olea europea).

Vulneraries are wound-healing herbs used internally and externally. Astringent herbs such as witch hazel (Hamamelis virginiana) and shepherd’s purse leaf (Capsella bursa-pastoris) directly stop bleeding and promote the formation of an eschar (scab). Mucilaginous herbs such as plantain leaf (Plantago lanceolata) and selfheal leaf (Prunella vulgaris)  soothe inflammation. Some vulneraries are used internally to speed tissue healing, including marigold flower (Calendula officinalis), plantain leaf (Plantago lanceolata), selfheal leaf (Prunella vulgaris), and marshmallow root (Althaea officinalis).

These are based on a combination of Galenic, Thompsonian, Eclectic and Physiomedical approaches.

Treatment plans developed within the Thompsonian and Eclectic traditions looked to find harmony and vitality within the tissue states, with a focus on:

1.  relaxation of tissues
2.  contraction of tissues
3.  stimulation of circulation and vital force
4.  soothing irritated tissues where there is excess
5.  nourishing and deficiency in the tissues, organs and vital force
6.  neutralisation of excess toxins and stagnation

Over time, and with enhanced knowledge of anatomy and physiology, the Physiomedicalists developed a specific set of therapeutics to restore health:

Eliminative functions at the intra-cellular, organ and specific organs of elimination (skin, lungs, bowels and kidneys).

Circulatory dynamics involve the state of capillary contraction or relaxation. Relaxing diaphoretics or stimulating astringents are used to restore balance to the circulatory system. 

Nervous equilibrium through regulating levels of irritation or depression of the nervous system. Nervine relaxants and sedatives as well as nervine stimulants focusing on specific organs are utilised.

Trophorestoration is required when any tissue or organ expresses a deficiency of vitality and tone caused by hereditary patterns or overexposure to irritation or depression.

Alteratives enhance the eliminative function of the organs as well as enhance digestion and nutritional absorption.

The three primary energetic qualities are temperature, tone and moisture. These are used to describe body systems, organs and tissues in the body. They help herbalists understands the patterns of a patient’s condition, so they can prescribe herbs personalised for them and their constitution. 

Temperature in herbalism does not just refer to somebodies body temperature, it also refers to their level of metabolic activity. 

Tone (energetic diagnostics) refers to how tense or relaxed tissues are. Tone is used to describe the status of the lining of organs called epithelium or to describe the level of integrity of muscles and other tissues. Healthy tone of the tissues or muscles will usually correspond with balanced function of the organs and with a relaxed, and easy composure or stance.

Too much tension impedes flow, and flaccidity means that function is at less than optimum. Herbs can affect tone in many different ways. Some herbs are able to increase tone and others are able to relax the tissues where there is excess tension or constriction- see the definitions of ‘relaxants’ and ‘tonics’ for more information on herbal energetics relating to tone. 

Moisture (energetic diagnostics) as a word used in energetic diagnostics may be relating to over production of fluids in the body (i.e. phlegm, mucous, digestive fluid). Excess fluid production is often also associated with poor tone and flaccidity in the tissues. There may also be problems with tissue function. It can also be as a result of overstimulation or be associated with specific environmental or dietary triggers such as allergens.

Patients may also experience symptoms of congestion and stagnation in the tissues.  Mineral imbalance, heart or kidney problems may also be indicated where there is ‘excess moisture’, congestion or fluid retention in the body. The nature of the condition would require specific treatment that targets the unique condition of the patient.

Heat (energetic diagnostics)is the term used to describe inflammation and excitation in the tissues. This pathological heat may be caused by excess toxins in circulation around the body, viruses and other pathogens but it classically refers to inflammation or excitation in the tissues which may have a number of different causes. For example, it may also be linked with hormonal or immunological imbalances or excess stress hormones which can lead to over function and inflammation. Indicators of excitation and heat can include inflammation in the joints, irritation, swelling, dryness (e.g in hair and skin, or if one is abnormally thirsty), an overactive thyroid and irritability.

Allergic reactions can also be thought of as excessive excitation in tissues. Cooling herbs may be used to decrease inflammation or heat as well as herbs that moderate the activity of the tissues. Not all cooling herbs are suitable in all cases of heat and excitation. A herbalist will select a combination of herbs to address the unique circumstances of the patient.

Cooling (herbs) may be used for conditions that are classified as hot or inflammatory by nature. They work via a number of different actions – some by reducing inflammation, others by detoxifying the blood or lymph or by moderating the function of specific tissues. Diaphoresis is another cooling action of herbs which works by stimulating the sweat reflex and reducing heat in the body through the skin.

Examples of cooling herbs include; cleavers or burdock due to their ability to help decrease toxicity and stagnation in the tissues via the lymphatic system. Bitter herbs such as andrographis and dandelion have a systemic cooling effect due to their ability to enhance metabolic function and support liver detoxification which reduces inflammatory toxins in circulation around the body. The nature of the herbs chosen depends on the affected tissues and the unique presentation of the patient.

Coldness (energetic diagnostics) is the opposite of heat and excitation in the tissues of the human body. It is present when there are deficient or inadequate levels of activity and metabolic function. It can indicate low vitality and over time may lead to damage and death in tissues. Characteristics include being unusually physically cold, patients may also have low energy levels and suffer from fatigue, being prone to illness and infection and low metabolic rates. Warming herbs may be used to increase the circulation or stimulate tissue function depending on what is required. However- not all warming herbs are suitable in all cases of coldness.

For example, sometimes the issue is more associated with damage and fragility in the cardiovascular system- hot stimulating herbs in this circumstance may be too pushy before work has begun to address the structural integrity of the cardiovascular system. A herbalist will always select a combination of herbs based on the unique circumstances of the patient.

Warming (herbs) Warming herbsare typically ‘hot’, ‘spicy’ or ‘pungent’ due to the presence of aromatic oils. Generally these herbs bring ‘warmth’ to the tissues by stimulating circulation and dilating the micro-capillaries thus creating an opening effect within the cardiovascular system that increases blood movement and therefore perfusion to the tissues. Warming herbs are often also diaphoretic- meaning that they stimulate the sweat reflex- this action could be seen as a contradictory as it is essentially ‘cooling’.

However, the action of warming herbs remains to increase peripheral circulation and therefore is classified as warming to the body tissues. Some examples include chilli, garlic, horseradish, cinnamon and ginger. The nature of the herbs chosen depends on the affected tissues and unique presentation of the patient. Due to their potent nature, a herbalist will usually only use a small amount of aromatically hot, warming herbs in a formula.

Drying (herbs) tend to have astringent or tonic qualities. This means that they pucker the tissues thus increasing their barrier functions. Drying herbs may have diuretic actions which work by increasing the output of fluid from the body. They may also be astringent due to tannin content. Drying herbs are used to help tonify the tissues to reduce excess secretions, phlegm or mucous.

Drying herbs may also be used to help in tissue healing particularly where they have become flaccid and lacking in tone. Drying herbs include rose, lady’s mantle, blackberry leaf, raspberry leaf, agrimony and elderflower. Not all drying herbs will be suitable in all cases of moist/ excess fluid type conditions. Tannin rich herbs are also limited to short term use. A herbalist will select a combination of herbs based on the unique circumstances of the patient.

Dry (energetic diagnostics) in energetic herbalism dryness means tissues are atrophied or insufficiently nourished. This leads to the, ineffective balance of fluids in the cells. This either be relating to a deficiency in fats, oils or fluids but it is also sometimes related to under function of the tissues.

Some herbal actions that cause drying are diuretics and astringents as they stimulate the release of fluids. Indicators of dryness and atrophy can be dry skin/hair/eyes, constipation with hard stools, joint stiffness and cracking, dry skin conditions such as eczema and psoriasis. Moistening herbs are indicated for dry tissue states to nourish and support the effective balance of fluid and oils in the tissues.

Damp stagnation occurs when too many fluids build up, which leads to a lack of proper clearance and movement and therefore becomes stagnant. Elimination and detoxification is reduced, as is nutrient absorption. It is similar to what happens to a pool of water if it is not flowing or is not drained. Characteristics include swollen tissues, oedema, brain fog and lethargy.

Moist (herbs) Moistening herbs bring a demulcent or soothing effect to inflamed or dry tissues. These herbs may be used where there is irritation due to dryness or lack of productivity in the tissues. Moistening herbs tend to be rich in mucilage (a carbohydrate rich plant substance) that forms a slippery and softening protective layer over the tissues. Sometimes herbs have a moistening effect due to oil content or by their ability to nourish the tissues- others by their ability to deliver or stimulate fluid production in certain tissues.

Moistening herbs that are rich in mucilage include herbs such as marshmallow, slippery elm, psyllium and aloe vera. Oily moistening herbs coconut oil and castor oil. Herbs that stimulate the production of fluids may include;  fenugreek;  and maca. These all effect different tissues so the nature of the herbs chosen depends on the affected tissues and unique presentation of the patient.

Constriction can be both physically restricting and mentally and emotionally. For example, it can restrict the movement of fluids and blood, as well as creativity. Symptoms of this tissue state can include muscle tension, spasms, insomnia, anxiety, emotional irritability and exhaustion. 

Atony is used to describe states where tissues are without tone, flaccid, and too relaxed to be working at optimum. They often overflow with fluids as they can’t hold onto them, and this can include runny mucus or diarrhoea. Indicators of lax/atony include poor muscle tone, weak tissues, clammy skin and random sweats.  

• Bone, K. (2007) The ultimate herbal compendium: A desktop guide for herbal prescribers. Warwick, Qld.: Phytotherapy Press. 
• Maier, K. and Gladstar, R. (2021) Energetic herbalism: A guide to sacred plant traditions integrating elements of vitalism, ayurveda, and Chinese medicine. White River Junction, VT: Chelsea Green Publishing. 
• Priest, A and Priest, L. (1983) Herbal Medication, A clinical dispensary handbook. Daniel Company for National Institute of Medical Herbalists, UK.
• For more information on Western herbal formulations, read our article The art and science of herbal formulation: Western herbal medicine

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1. G.Vighi et al. “Allergy and the gastrointestinal system.” Clinical and experimental immunology vol. 153 Suppl
2. Suppl 1 (2008): 3-6. 2L.Galluzzi et al. “Autophagy in malignant transformation and cancer progression.” The EMBO journal vol. 34,7 (2015): 856-80.
3. P.Kuballa et al.Autophagy and the immune system. Annu Rev Immunol. 2012;30:611-46.
4. L.Shen et al. “Dietary PUFAs attenuate NLRP3 inflammasome activation via enhancing macrophage autophagy.” Journal of lipid research vol. 58,9 (2017): 1808-1821.
5. J. Bland The long haul of COVID-19 recovery: immune rejuvenation versus immune support. IHCAN April 21
6. Abdurachman,et al. “The role of psychological well-being in boosting immune response: an optimal effort for tackling infection.” African journal of infectious diseases vol. 12,1 Suppl 54-61. 7 Mar. 2018
7. Y. Barak The Immune system and happiness Autoimmunity reviews Vol 5, 8, Oct 2006 pp 523–527.
8. S. Brod et al ‘As above, so below’ examining the interplay between emotion and the immune system Immunology. June 2014.
9. M. Irwin et al. Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. FASEB J. 1996 Apr;10(5):643–53.
10. L.M. Jurkić, et al. Biological and therapeutic effects of ortho-silicic acid and some ortho-silicic acid-releasing compounds: New perspectives for therapy. Nutr Metab (Lond) 10, 2 (2013).
11. Harvard Medical School. “Bile acids may help regulate gut immunity and inflammation.” ScienceDaily. www.sciencedaily.com/ releases/2020/01/200103141047.htm accessed 3/12/20.
12. M.Wammers et al. “Reprogramming of proinflammatory human macrophages to an antiinflammatory phenotype by bile acids.” Scientific reports vol. 8,1 255. 10 Jan. 2018
13. Q.Mu et al. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol. 2017 May 23;8:598.
14. P.D.Cani, et al Metabolic endotoxemia initiates obesity and insulin resistance. Diabetes. 2007 Jul;56(7):1761-72.
15. G.C. Brown The endotoxin hypothesis of neurodegeneration. J Neuroinflammation 16, 180 (2019).
16. C. Franceschi, et al. Inflammaging: a new immune–metabolic viewpoint for age-related diseases. Nat Rev Endocrinol 14, 576–590 (2018).
17. N.Jones et al. Fructose reprogrammes glutamine-dependent oxidative metabolism to support LPS-induced inflammation. Nat Commun 12, 1209 (2021).
18. L H Zhu et al, Constituents from Apium graveolens and their anti-inflammatory effects. J Asian Nat Prod Res. 2017 Nov;19(11):1079-1086.
19. M.Souissi et al. Antibacterial and anti-inflammatory activities of cardamom (Elettaria cardamomum) extracts: Potential therapeutic benefits for periodontal infections. Anaerobe. 2020 Feb;61:102089.
20. J.C.Clemente et al. The role of the gut microbiome in systemic inflammatory disease. BMJ 2018;360:j5145.
21. S.Alavi, et al. Interpersonal Gut Microbiome Variation Drives Susceptibility and Resistance to Cholera 22)
22. Infection. Cell. 2020. 22Vulnerability of the industrialised microbiota https://science.sciencemag.org/content/366/6464/eaaw9255/tab-pdf.
23. Gut Microbiota May Influence COVID-19 Severity, Immune Response – Medscape – Jan 11, 2021.
24. Stefani Lobionda, et al. “The Role of Gut Microbiota in Intestinal Inflammation with Respect to Diet and Extrinsic Stressors.” Microorganisms vol. 7,8 271. 19 Aug. 2019
25. Davani-Davari, Dorna et al. “Prebiotics: Definition, Types, Sources, Mechanisms, and Clinical Applications.” Foods (Basel, Switzerland) vol. 8,3 92. 9 Mar. 2019.
26. I.D. Croall et al. Cognitive Deficit and White Matter Changes in Persons With Celiac Disease: A Population-Based Study, Gastroenterology, Volume 158, Issue 8, 2020, Pages 2112-2122.
27. Rosenberg, Stanley (2017) Accessing the Healing Power of the Vagus Nerve.
28. Vasefi, Maryam et al. “Diet Associated with Inflammation and Alzheimer’s Disease.” Journal of Alzheimer’s disease reports vol. 3,1 299-309. 16 Nov. 2019
29. E. Schirmer,et al. Bisphenols exert detrimental effects on neuronal signaling in mature vertebrate brains. Commun Biol 4, 465 (2021).
30. Endothelium and cardiovascular diseases: vascular biology and clinical syndromes. Editors Protasio L. et al 2018.
31. Steven R Gundry, Correction to: Abstract 10712: Mrna COVID Vaccines Dramatically Increase Endothelial Inflammatory Markers and ACS Risk as Measured by the PULS Cardiac Test: a Warning, Circulation, 8 Nov 2021 2021;144:A10712
32. R.Kesavan et al.Gentiana lutea exerts antiatherosclerotic effects by preventing endothelial inflammation and smooth muscle cell migration. Nutr Metab Cardiovasc Dis. 2016 Apr;26(4):293-301.

With the rising popularity of essential oils in recent years, increasing biodiversity losses worldwide, and the very real impacts of climate change becoming ever clearer and more urgent, talk within the aromatherapy community has turned towards the sustainability of essential oils.

There are questions to be asked surrounding the environmental and social impacts of using these precious medicines. How sustainable actually is this natural form of medicine? Are there steps we can take to mitigate the impacts of essential oil use? Are there other factors at play that influence sustainability?

First, it’s important to put this into context. Of around 350,000 scientifically-known and documented vascular plants (1), those that are known to be medicinal represent roughly 25,790 and of those, around 1500 are aromatic, which is approximately 6% of all known plants. About four hundred species of aromatic medicinal plants are commonly traded for aromatherapy purposes worldwide, which includes essential oils, absolutes, and hydrosols (2).

The State of the World’s Plants and Fungi (SOTWPF) report published by the Royal Botanic Gardens, Kew in 2020 states that two in five plants are threatened with extinction. This means 40% of all recorded plant species, and should ring alarm bells for everyone, as human-led practices such as agriculture, climate change and biological resource use are amongst the primary reasons for this threat (3).

10% of aromatic plants are currently listed as threatened according to The International Union for Conservation of Nature (IUCN) (4). Practices such as deforestation, clearing and using plants with no or unsustainable plant regeneration practices, monocropping and overharvesting wild species all contribute to the unsustainable production and use of essential oils, and therefore increase the likelihood of more species being added to the red list of endangered species.

Simultaneously, these practices damage the biodiverse ecosystems which support the growth of our aromatic plants in the first place. The approach of destroying whole areas of forest to harvest just one aromatic tree does not make sense from a biodiversity standpoint, but there are adaptations we can implement in farming and production of essential oils which can reduce and mitigate the harmful effects of these practices.

Demand for medicinal and aromatic plants is undoubtedly on the rise. The world has seen “a threefold increase in global trade in medicinal and aromatic plants since 1999” (5) which is largely due to the growing popularity of spas, natural cosmetics, pharmaceuticals, and aromatherapy.

According to The Business Research Company’s 2022 report, the global essential oils market size is expected to grow from $12.36 billion in 2021 to $13.58 billion in 2022 at a compound annual growth rate (CAGR) of 9.90%.

The global essential oils market share is expected to grow to $21.85 billion in 2026 at a CAGR of 12.62% (6). This projected growth brings with it concern surrounding the profitability of the essential oil and aromatherapy sector for large companies that hold a large market share, many of whom have come under scrutiny for promoting dubious practices.

The 2020 Netflix documentary series “(Un)well” shed light on controversial practices within the essential oil industry (7), and should perhaps make us consider the lengths certain companies will go to in order to profit. It is unclear which, if any, environmental sustainability protocols are taken into account or adhered to by big players in the sector, and as such, extra care should be taken and due diligence carried out on any essential oil suppliers.

This, however, requires knowing which questions to ask them, what documentation or records should be available, and how to choose oils to minimise our impact as individual consumers or therapists.

The IUCN labels species as “critically endangered”, “endangered” or “vulnerable”, and as such, a good place to start when sourcing essential oils is to avoid any that come from plants which feature on this list. Agar wood (Oud) Aquilaria malaccensis , Spikenard Nardostachys jatamansi, Sandalwood Santalum album, Palo Santo Bursera graveolens, Atlas Cedar Cedrus atlantica and Rosewood Dalbergia sissoo are all examples of threatened species which should be avoided due to their precarious existence.

In general, harvesting essential oils such as those listed above, which are taken from the heartwood of the tree, has a particularly negative impact on habitats since the whole tree needs to be cut down in order to access the essential oil.

Frankincense (Boswellia carterii) is an extremely popular essential oil, yet its popularity, coupled with the effects of climate change, mean that this once-abundant oil is now in short supply (8). Boswellia forests aren’t able to regenerate fast enough to keep up with the current demand, and so due to over-harvesting, many have disappeared.

Unsustainable harvesting methods include “making a higher number of cuts per tree to extract as much sap as possible and tapping the trees all year round rather than seasonally” (9) which doesn’t allow sufficient time for trees to recover. Furthermore, these intensive practices “weaken the trees, impeding their regrowth and ultimately killing them” (10).

Also take a look at our article on the sustainability of frankincense.

Sustainability isn’t just an environmental concern, however. Frankincense comes primarily from Somalia, Africa, India, Oman, and Yemen (11) where climate change will hit hardest (12), and where harvesting is often one of the main livelihoods for local populations.

There are increasing reports of frankincense resin tappers risking their lives “by climbing up cliffs to find new sources”(13) of frankincense, and there have been “reports of people suffering injuries including breaking legs and in some cases death” (14).

Unfortunately, frankincense may quickly be becoming one of the most unethical and unsustainable essential oils available.

It is clear that wider socioeconomic factors such as safety, and the longevity of local livelihoods merit serious consideration as well as the adoption of more sustainable practices when it comes to the production and consumption of essential oils.

Initiatives such as the ‘Adapting Agriculture to Climate Change’ programme, led by the Crop Trust in partnership with Kew and others, will be key in addressing the environmental, social and economic changes which will be caused by global warming.

Essential oil production has a high mass-to-yield ratio, since in order to produce essential oil, large quantities of aromatic plants are required.

For example, 10,000 lbs of rose petals, 250 lbs of lavender, 6,000 lbs of melissa, or 1,500 lbs of lemons respectively are required to produce just one 1 lb of essential oil (15).

In terms of yield, this is extremely low, and so the question of whether the process and extraction of essential oils is wasteful warrants consideration.

Despite Calendula’s popularity in the cosmetic and pharmaceutical industries, a 2020 Colombian study of a supply chain for Calendula officinalis essential oil production found that “high amounts of exhausted biomass (more than 95% w/w) are produced and wasted” (16) in the course of its production.

However, the research revealed several key touchpoints within the supply chain where opportunity exists to reduce emissions (changing how the oils are distilled, for example) and also to contribute to the “social development of farmers” (17) in Colombia through using the exhausted biomass leftover from the plant matter as a “potential high-value “non-conventional agro-industrial feedstock” (18).

More research into using aromatic plants as feedstock for agriculture is needed, yet this does seem to represent a possible solution to one of the issues associated with essential oil production and waste.

Another study focused on the opportunity to use waste from the food industry to produce essential oils, namely citrus peel leftover from juicing (19). Whilst several extraction methods including steam distillation, cold-press and solvent extraction, were tested, solvent-free microwave extraction was identified as the most effective in this study.

This method would probably produce resulting essential oils which would be unsuitable for therapeutic use, but the trials do represent an interesting experiment and opportunity to close the gaps in food production cycles through potentially bridging industries and creating a more circular economy.

FairWild are also a fantastic initiative, and their mission is “to enable transformation of resource management and business practices to be ecologically, socially, and economically sustainable throughout the supply chain of wild-collected products. These include plants, fungi, and lichen – wild resources under enormous pressure worldwide.”

Using essential oils with respect is one way we can minimise our consumption of essential oils and therefore our impact on the environment. For most aromatherapy products we make at home, we only need to use very small amounts of essential oils. Despite their comparatively low yield of plant matter to essential oil, they are extremely concentrated plant extracts, so little is needed to produce excellent therapeutic and aromatic effects. If stored in an airtight bottle away from light and heat, they have a good shelf life – several years, in fact, which makes them a good investment.

Since essential oils can be used to make home-made cosmetics, therapeutic herbal remedies and cleaning products, they can be harnessed in this way to reduce the number of products we buy in single-use plastics from large corporations. This has a positive environmental impact in an indirect way, since by making our own products in reusable glass bottles, for example, we’re creating less waste from other sources.

Finding alternatives to endangered species is also a key way we can reduce our impact when using essential oils. In the podcast An Aromatic Life, during episode #13, Conservation and Sustainability of Aromatic Medicinal Plants, guest Dr. Kelly Ablard advises that we should look at the chemical composition of vulnerable aromatic plants, as well as their therapeutic and energetic factors.

She suggests that instead of buying essential oils from vulnerable plants, this information will allow us to choose a chemically, therapeutically and energetically similar essential oil to ensure we are not contributing to the precarity of vulnerable species. For example, Ho Leaf Cinnamomum camphora (Linalool ct.) is suggested as an alternative to Rosewood, Dalbergia sissoo, and even practices like choosing an oil which is taken from the leaf or branch of a tree as opposed to the heartwood, which requires cutting down the whole tree, would be preferable (20).

One of the very best ways to increase our understanding of how the use of essential oils affects sustainability is through education. Learning about our local aromatic plant species, and plants in general, is key to understanding the ecosystem of which we are a part, and therefore respecting it as a diverse network of intersecting factors that deserves respect. Rather than placing ourselves at the centre of the ecosystem, biocentrism (21) takes the view that humans are just one part of this system, yet it is clear that despite this, we have a great deal of power to influence the whole network substantially, for better or worse, through our choices on both an individual and collective level.

Below are some tips to help you ensure that your essential oil purchases are as informed as possible.

Organic vs non-organic: Which way to go?

Using organic essential oils is recommended, both for therapeutic and environmental reasons. Minimising the amount of harmful pesticides we are putting on our land and onto our bodies is key to public and planetary health. The Soil Association lists lower emissions, lower levels of pollution, and more stored carbon as just three key reasons that organic farming is beneficial (22).

Purchasing power: Know your facts

Asking your supplier the right questions is key to understanding where your oils come from, and how they are produced. A good supplier will often know their farmers and distillers personally, understand and be able to provide you with information on the farming and production practices, and take great care to make it clear exactly how they source essential oils sustainably. Beware of woolly, vague or contradictory information, and essential oils that seem cheap. If it looks too good to be true, chances are it is.

The COSMOS-standard has also been created as a criteria for sustainable cosmetics. Many large businesses subscribe to this, although more need to still.

Whilst individual consumers and therapists are not the main culprits when it comes to harmful essential oil production practices, by making small changes and demanding a level of accountability from our suppliers, we can effect positive change within the essential oil market.

Purchasing oils in small quantities, as needed, and choosing high quality, organic ingredients sourced from trusted suppliers is a good rule of thumb. Checking the IUCN red list before buying, and eliminating use of vulnerable species will also help.

There is no need to stop using essential oils, they are wonderful for physical, mental, and spiritual health – but do stay informed so you can use them responsibly.

1. Antonelli, A.*et al (2020). State of the World’s Plants and Fungi 2020. Royal Botanic Gardens, Kew. DOI: <https://doi.org/10.34885/172>
2. Galia, F. (2021). #13: Conservation and Sustainability of Aromatic Medicinal Plants with Dr. Kelly Ablard. [podcast] An Aromatic Life. Available at: <https://open.spotify.com/episode/4HBsd3PDhwJTzFZHkD7KJe> [Accessed 12th May 2022].
3. Antonelli, A.*et al (2020). State of the World’s Plants and Fungi 2020. Royal Botanic Gardens, Kew, p.14. DOI: https://doi.org/10.34885/172
4. Galia, F. (2021). #13: Conservation and Sustainability of Aromatic Medicinal Plants with Dr. Kelly Ablard. [podcast] An Aromatic Life. Available at: <https://open.spotify.com/episode/4HBsd3PDhwJTzFZHkD7KJe> [Accessed 12th May 2022].
5. Unknown. Cites.org. 2022. Medicinal and aromatic plants | CITES. [online] Available at: <https://cites.org/eng/prog/medplants> [Accessed 12 May 2022].
6. Unknown. 2022. With The Growing Spa Industry, The Essential Oils Market Is Set To Reach $21 Billion By 2026 As Per The Business Research Company’s Essential Oils Global Market Report 2022. [online] GlobeNewswire News Room. Available at: <https://www.globenewswire.com/news-release/2022/03/30/2413070/0/en/With-The-Growing-Spa-Industry-The-Essential-Oils-Market-Is-Set-To-Reach-21-Billion-By-2026-As-Per-The-Business-Research-Company-s-Essential-Oils-Global-Market-Report-2022.html> [Accessed 12 May 2022].
7. The Guardian. 2022. The dark side of wellness: behind a Netflix series on a murky industry. [online] Available at: <https://www.theguardian.com/tv-and-radio/2020/aug/12/unwell-netflix-series-dark-side-of-wellness-industry> [Accessed 12 May 2022].
8. Fobar, R. 2019. Frankincense trees—of biblical lore—are being tapped out for essential oils. [online] Available at: <https://www.nationalgeographic.com/animals/article/frankincense-trees-declining-overtapping> [Accessed 12 May 2022].
9. Unknown. 2019. Essence + Alchemy. Essential Oils – Ethical + Sustainability Issues — Essence + Alchemy. [online] Available at: <https://www.essenceandalchemy.co.uk/lab-notes/ethical-and-sustainability-issues-of-sourcing-essential-oils> [Accessed 12 May 2022].
10. Unknown. 2019. Essence + Alchemy. Essential Oils – Ethical + Sustainability Issues — Essence + Alchemy. [online] Available at: <https://www.essenceandalchemy.co.uk/lab-notes/ethical-and-sustainability-issues-of-sourcing-essential-oils> [Accessed 12 May 2022].
11. Fobar, R. 2019. Frankincense trees—of biblical lore—are being tapped out for essential oils. [online] Available at: <https://www.nationalgeographic.com/animals/article/frankincense-trees-declining-overtapping> [Accessed 12 May 2022].
12. Law, T. Time. 2019. Climate Change Will Impact the Entire World. But These Six Places Will Face Extreme Threats. [online] Available at: <https://time.com/5687470/cities-countries-most-affected-by-climate-change/> [Accessed 12 May 2022].
13. Unknown. 2019. Essence + Alchemy. Essential Oils – Ethical + Sustainability Issues — Essence + Alchemy. [online] Available at: <https://www.essenceandalchemy.co.uk/lab-notes/ethical-and-sustainability-issues-of-sourcing-essential-oils> [Accessed 12 May 2022].
14. Unknown. 2019. Essence + Alchemy. Essential Oils – Ethical + Sustainability Issues — Essence + Alchemy. [online] Available at: <https://www.essenceandalchemy.co.uk/lab-notes/ethical-and-sustainability-issues-of-sourcing-essential-oils> [Accessed 12 May 2022].
15. Yeager, N. 2017. Earth Island Journal. The Environmental Impact of Essential Oils. [online] Available at: <https://www.earthisland.org/journal/index.php/articles/entry/the_environmental_impact_of_essential_oils/> [Accessed 12 May 2022].
16. González-Aguirre, J.A., Solarte-Toro, J.C, Cardona Alzate, C.A, 2020. Supply chain and environmental assessment of the essential oil production using Calendula (Calendula officinalis) as raw material  [online] Heliyon, Volume 6, Issue 11, 2020, e05606, ISSN 2405-8440, https://doi.org/10.1016/j.heliyon.2020.e05606. Available at <https://www.sciencedirect.com/science/article/pii/S240584402032449X> [Accessed 12 May 2022].
17. González-Aguirre, J.A., Solarte-Toro, J.C, Cardona Alzate, C.A, 2020. Supply chain and environmental assessment of the essential oil production using Calendula (Calendula officinalis) as raw material  [online] Heliyon, Volume 6, Issue 11, 2020, e05606, ISSN 2405-8440, https://doi.org/10.1016/j.heliyon.2020.e05606. Available at <https://www.sciencedirect.com/science/article/pii/S240584402032449X> [Accessed 12 May 2022].
18. González-Aguirre, J.A., Solarte-Toro, J.C, Cardona Alzate, C.A, 2020. Supply chain and environmental assessment of the essential oil production using Calendula (Calendula officinalis) as raw material  [online] Heliyon, Volume 6, Issue 11, 2020, e05606, ISSN 2405-8440, https://doi.org/10.1016/j.heliyon.2020.e05606. Available at <https://www.sciencedirect.com/science/article/pii/S240584402032449X> [Accessed 12 May 2022].
19. Teigiserova, D., Tiruta-Barna, L., Ahmadi, A., Hamelin, L. and Thomsen, M., 2021. A step closer to circular bioeconomy for citrus peel waste: A review of yields and technologies for sustainable management of essential oils. Journal of Environmental Management, [online] 280, p.111832. Available at: <https://www.sciencedirect.com/science/article/pii/S0301479720317576?via%3Dihub> [Accessed 12 May 2022].
20. Galia, F. (2021). #13: Conservation and Sustainability of Aromatic Medicinal Plants with Dr. Kelly Ablard. [podcast] An Aromatic Life. Available at: <https://open.spotify.com/episode/4HBsd3PDhwJTzFZHkD7KJe> [Accessed 12th May 2022].
21. Pediaa.Com. 2022. What is the Difference Between Anthropocentrism Biocentrism and Ecocentrism – Pediaa.Com. [online] Available at: <https://pediaa.com/what-is-the-difference-between-anthropocentrism-biocentrism-and-ecocentrism/#:~:text=Biocentrism%20and%20Ecocentrism-,Definition,the%20ecosystem%20as%20a%20whole> [Accessed 12 May 2022].
22. Unknown. Soilassociation.org. 2022. Organic is Better for the Planet | Soil Association. [online] Available at: <https://www.soilassociation.org/take-action/organic-living/why-organic/better-for-the-planet/#:~:text=There%20are%20multiple%20benefits%20of,Capture%20and%20store%20more%20carbon> [Accessed 12 May 2022].

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

With so many options to choose from, how do you choose which herbs to grow? A good starting point is to do some research into which herbs are best suited for the climate and growing space you have and to consider which medicinal herbs you may want or need in your life.

Is your garden sunny or shady? Is there a specific condition you would like to treat? Or are there specific herbs you feel drawn to? You’ll normally find there are a few key herbs that are perfectly suited for both you and your garden.

It may be that you are someone who suffers from nervous tension and happen to have a shady garden – a perfect opportunity to grow skullcap, lemon balm and St. John’s wort. Or perhaps you have rich, loamy soil in a sunny garden and just want herbs that can be harvested for herbal teas, in which case you can’t go wrong with the likes of chamomile, fennel and catnip.

Or do you just love bright colours and aren’t so bothered about its uses; if so, fill your garden and brighten your life with the oranges and yellows of calendula, California poppy and meadow arnica.

It always helps to have some knowledge of a plant’s natural habitat and – where possible – to make those plants feel at home by mimicking or matching some of those conditions in your garden.

Obviously, the easiest approach is to grow native plants that are already very much at home in our own climate. The likes of marshmallow and meadowsweet, for example, will cope just fine with the wettest and frostiest of British winters.

But if you are growing medicinal herbs such as lavender, thyme or sage, which are native to the Mediterranean, it helps to grow them in a warm, sheltered spot, and maybe even add some sand into your soil to improve drainage and prevent waterlogging.

South-facing walls of a house can create remarkably warm micro-climates that can be perfect for sun-loving herbs.

Some herbs grow in very specific environments. Gentians, for example, are most commonly found growing in high mountain pastures. Obviously, it’s hard to replicate mountain conditions in an English garden, but you can mimic some of the mountain environment by creating a rock garden and growing your gentians somewhere that is shaded from the heat of the midday sun.

Similarly, there are quite a few woodlands herbs that naturally grow in the shade of trees in rich, loamy soil that is the result of many years of rotting autumn leaves. Goldenseal, Himalayan valerian and black cohosh are examples of herbs that thrive when they are grown in shaded areas with compost made from leaf litter.

Herbs come in all shapes and sizes. From the tiny Lily of the Valley to the majestic 8 foot Angelica, your choice of medicinal herbs will always be influenced by the size of your growing area.

Allow each plant sufficient space to grow into and don’t forget that – if you have a small garden – you can use vertical space as well.

Codonopsis and passion flower are two beautiful climbers that can be trained up a trellis, and there are many shade-loving herbs, such as sweet woodruff and Tibetan gentian that can happily grow in their shade.

When choosing medicinal herbs to grow it helps to know the difference between annual, biennial and perennial plants. The majority of medicinal plants are perennial. In other words, they live for many years; their foliage usually dies back in the winter and grows back in the spring.

Perennials can be slow growing and need plenty of care when they are young, but once established they require little maintenance other than occasional weeding, watering and cutting back.

Annual plants complete their life cycle in one growing season. They are reliant on seeds for their survival, and as a result they tend to be prolific self-seeders. So, although annual herbs such as German chamomile, calendula and California poppy only live for one season, they can easily be encouraged to return year after year simply by allowing the seeds to mature and fall onto the beds where they have grown.

Biennials are plants that take two growing seasons to complete their life cycle. Angelica, mullein and burdock are examples of biennial plants; they usually produce a rosette of leaves in the first year and flower in the second. Like the annuals, you’ll need to sow fresh seed every year if you want your favourite biennials to be in flower every summer.

There are many ways to prepare land for growing medicinal plants – too many to cover here, but in essence the main principle is to encourage natural soil health through organic practices such as using a mulch or cover crop and adding compost where appropriate.

The no-dig method, as taught by Charles Dowding, is a favourite of ours – partly because it doesn’t disturb the ecology of the soil, and also because it can significantly reduce the amount of time spent on weeding.

But before you order a trailer of rotted manure to pour over your lawn (a common no-dig practice), it is important to consider the effect of soil nutrition on the medicinal properties of the plants. Many of the healing compounds found in medicinal herbs are produced in response to environmental stress or external threats.

For example, lavender grown at a high altitude in more nutrient depleted soil has higher levels of essential oils – most likely a result of having to tolerate greater solar-radiation and nutrient stress. So it’s not always best to grow herbs in rich, loamy soils as we would with our vegetables; plants that are grown in poor soils may be smaller in size but can produce much higher quality herbal medicines.

Interestingly, research has shown that herbs grown using organic practices (i.e. without artificial fertilisers), contain higher levels of secondary plant phytonutrients such as the protective polyphenols and flavonoids. The same applies to herbs grown in wild settings. So when it comes to preparing your land, sometimes less is more.

Once you’ve chosen your medicinal herbs and prepared your land, it is time to introduce the plants. Essentially, you have three main options; you can start by sowing seed, you can take cuttings from existing plants, or you can buy new plants (either potted of bareroot).

There is something very satisfying about raising plants from seed; it helps create a stronger relationship with the plants that can add another layer of potency if and when you use them to prepare herbal medicines.

Looking after your seedlings requires patience and care, and most herb growers will agree that the more you give to the plants, the more you receive in return.

There are of course some disadvantages when growing from seed; not everyone has suitable indoor growing space, and it takes longer to reach maturity. Many perennial herbs, such as echinacea, wild bergamot and St John’s wort, will only start to produce flowers in their second year. So, if you prefer not to wait that long and are willing to spend more money, then buying mature plants may be the best solution.

Having raised your seedlings or purchased your plants and planted them in a suitable location in your garden, ensuring that tender plants are protected from late frosts, all you really need to do is keep on the top of the weeds, water them when needed, and protect them from potential pests.

Most herbs are quite resilient and suffer few problems with pests and diseases, but there are a few potential issues to keep an eye on. Seeds waiting to germinate can be a tasty snack for birds and mice; young seedlings can be susceptible to slugs and aphids; and herbs of all sizes can attract hungry rabbits and deer.

Protecting the plants with some kind of physical barrier (traps, mesh cages or fencing) is an effective way to keep larger creatures away. And there are many organic practices for dealing with smaller critters; aphids, for example, can easily be controlled by releasing ladybird or lacewing larvae – both available from Dragonflii.

If you do experience repeated issues from certain pests, you can normally find herbs that are resistant to the pest in question. For example, slugs appear to have no interest in valerian, licorice mint and sweet woodruff. And both deer and rabbits have no interest in lovage, thyme or mullein.

But if you are growing mullein, keep an eye out for the brightly coloured ‘mullein moth caterpillars’, which – as the name suggests – are big fans of the mullein’s soft, juicy leaves. Left to their own devices they can decimate a plant in no time.

The interval between sowing and harvest can vary enormously. Annuals, by their very nature, are quick to grow and can only be harvested in the first year. German chamomile, for example, starts producing flowers in less than 3 months from sowing. But some perennials take a lot longer; Panax ginseng, for example, should be grown for 6 years before its roots are ready for harvest.

The harvest time and frequency will of course depend on the part of the plant that is harvested. Leaves, flowers and seeds can be harvested repeatedly without any serious detriment to the plant; harvesting roots on the other hand is less sustainable, usually requiring the whole plant to be uprooted and new plants grown in its place.

That said, it is possible, for example, to dig around the base of a marshmallow plant to harvest some of the surface roots without killing the plant. And if you only have a few precious echinacea plants, you don’t need to use the roots – their seeds are also packed with the same immune-boosting tingly alkylamides, and when ground up into a powder make a surprisingly delicious tea.

Once harvested, there are many ways to process them into different herbal preparations, but this is a big topic – one that we will look at in more detail later in the year as it is a special skill to harness all the healing vitality of medicinal herbs.

Until then, happy growing!

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/