Aches and pains

If you travel to areas where no osteopaths or chiropractors are to be found, you can buy or hire a small electronic device which will get rid of many simple neck, back or muscle pains. Transcutaneous electrical neural stimulation (TENS) reduces or eliminates pains by bombarding nerve endings with weak, adjustable, high frequency electrical stimuli through adhesive electrodes placed on the skin. These appear to be received by the brain in place of the pain stimuli (Lewith GT, Horn S, Drug Free Pain Relief, Wellingborough, Northants: Thorsons, 1987: 18, 25, 56-61).

Appendicism

Although acute appendicitis is nearly always a surgical condition, appendicism is a symptomatic discomfort in the region of the appendix. The routine emergency treatment for this is Iris tenax 2 every two hours.

Bruising

Apply Arnica montana tincture or oil to the area if the skin is unbroken. If the skin is broken, use a lotion of Hamamelis macrophylla (20 drops of tincture to 50 ml of distilled water). Also, take Arnica montana 3CH internally.

If you’ve bruised the bones, apply a lotion of Ruta graveolens (20 drops to 50 ml of distilled water) and take Ruta graveolens 3CH internally. For bruising of nerve rich areas like fingers, toes or spine, make up a lotion of equal parts of Hypericum perforatum tincture, alcohol fortis (95 per cent v/v alcohol) and distilled water, and rub it onto the injured area (if the spine) three times daily, or apply it onto cottonwool, then daub (if the extremities).

Burns and scalds (first degree)

Add 12 drops of Urtica urens to 50 ml of distilled water, or make up a lotion of Hamamelis macrophylla (20 drops to 50 ml of distilled water), then saturate a sterile gauze or dressing and place it over the burn. Moisten it again (in place) whenever it begins to dry out.

If you don’t have this tincture to hand and you’re out in the countryside, a lotion made by pouring boiling water onto freshly picked stinging nettles will do as well. Blisters should not be opened or drained.

Another possibility is to apply Echinacea angustifolia as a cleansing wash and then as a moist dressing.

Cold injuries and frostbite

Lie on your back. Initially, very gently rub the affected area with snow (forceful massage or compression is harm ful) and follow this by applying some room temperature (not icy) water to warm up slowly. This prevents your body from making vascular changes too suddenly, resulting in thickening of the blood. Only after you’ve taken this step should you move on to rapid rewarming using moist heat, keeping the water temperature like that of bath water (between 31-37 degrees C).

After rewarming, paint the affected part with Benzoin (Lindera). If frostbite occurs in the feet and hosiery is stuck to the affected limb, rub olive oil over the Benzoin tincture. The best next step is simply to expose the body part to air at room temperature (21-24 degrees C). Avoid using the affected part until the extent of any damage has been determined by a health professional.

Dysentery (with fever)

Stay in bed, keep warm and drink lots of water or fennel tea. If the condition is acute, take five to ten drops of Cuphea viscosissima; for a chronic condition, take ten drops of Vaccinum myrtillus every eight hours. As soon as you can, have yourself checked out for parasitic intestinal infection.

Electric shock

(including lightning stroke)

Make sure the current is switched off. If this is impossible, free the person from the source of the current while using an insulating material such as heavy duty insulating gloves, something made of wood or rubber, or even a folded newspaper. You can even use the victim’s clothing, so long as it is absolutely dry and you don’t touch his skin. If his breathing is failing or has stopped, begin resuscitation immediately.

Phosphorus 6CH is the homoeopathic drug of choice for the effects of lightning and electric shock.

Haemorrhage

The patient should be reassured and put to bed, avoiding any excitement and all stimulants. For external haemorrhages, apply pressure (20 minutes) and sterile cellulose alginate, a seaweed compound which is absorbed without causing local irritation (available from a pharmacy). Give Acalypha indica 6CH (or Achillea millefolium 3CH) and also possibly menadione (vitamin K3).

Hiccoughs

(persistent, severe and rapid)

The best homoeopathic remedy for hiccoughs that won’t go away is 60 drops of Scutellaria lateriflora 3DH repeated every two hours, or a single dose of Moschus moschiferus lCH. Stramonium 6CH (Datura) is another possibility. If none of the above is to hand, one foolproof method is rebreathing using a paper bag. Another is to have the victim drink a glass of water while using the fingers to press down just in front of the tragus, the little flap of cartilage at the opening of the ear, on both sides of the head.

High blood pressure

To help lower both systolic and diastolic blood pressures, take Spartium scoparium lCH three times a day. For dangerously elevated blood pressure, try to find a qualified acupuncturist, as classical acupuncture procedures are known to reduce high blood pressure speedily.

Insect bites or stings

Apply tincture of Ledum palustre to the sting. If you don’t have it on hand, you’ll get equally quick results from tincture or cream of Arnica montana, Calendula officinalis or Urtica urens.

Supplement this by taking two 15 drop doses of Grindelia robusta 10 minutes apart. For extremely red inflammation with excessive sensibility to touch or pain, gently massage the area and take a single dose of Cantharis vesicator 30CH. For a sting on the tongue or in the mouth, take one tablespoonful (15 ml) of Calendula officinalis tincture, pour it into the mouth and keep it there for as long as possible. The mother tincture of Pyrethrum parthenium applied to the skin will relieve the discomfort and hot sensations produced by stings or bites. An added advantage is that it repels insects.

Jellyfish sting

Rub on Acidum aceticum 1x to any affected areas.

Nausea and vomiting

Where no form of food is tolerated, the remedy of choice is 10 drops of Amygdalus persica or ucurbita pepo, or Zingiber officinale lx as an alternative. As soon as you can, investigate the possibility of parasitic infection if pregnancy or a hangover is not the obvious cause.

Septic conditions

Take 20 drops of Echinacea angustifolia in bottled or mineral water every two hours. The tincture can also be used locally as a cleansing and antiseptic wash.

Sunstroke or heatstroke

Take Glonoinum 6CH every two hours until you get relief from the bursting, pulsating headache, which cannot bear motion. Also apply a solution of Calcarea chlorinata (one part to ten of

distilled water) to any sunburnt skin.

If you don’t have that remedy to hand, a mixture of equal parts of freshly squeezed lemon juice and bottled or mineral water applied twice a day will minimize the ill effects. Stay in a cool, shady room. In severe cases, use whatever means are available to lower temperature, such as tepid sponging and constant vigorous massage of the extremities to promote circulation of the blood, which will cool the affected areas. The goal is to reduce rectal temperature (measured by a rectal thermometer) to 39 degrees C.

Wounds

For lacerated wounds, apply a lotion of Calendula officinalis (20 drops to 50 ml of distilled water) locally. Also, take Calendula officinalis 3CH internally every two hours.

For incised wounds, apply a lotion of Hypericum perforatum (20 drops to 50 ml of distilled water) and take Hypericum perforatum 3CH internally every hour.

Finally, for puncture wounds, apply a lotion of Ledum palustre (20 drops to 50 ml of distilled water) locally and take Ledum palustre 6CH internally every hour.

!AHarald Gaier

Harald Gaier is a registered osteopath, naturopath and homoeopath.

(Copyright is retained by the author.)

You may need stitches for:*

* Deep cuts [more than 0.25 inches (6.35 mm) deep] that have jagged edges or that gape open

? Deep cuts that reach down to the fat, muscle, bone or other deep structures

* Deep cuts over a joint, especially if the cut opens when the joint is moved or if pulling the edges of the cut apart shows fat, muscle, bone or joint structures

* Deep cuts on the hands or fingers

* Cuts on the face, lips or any area where there is concern over possible scarring (for cosmetic reasons). Cuts on the eyelid often need sutures for both functional and cosmetic reasons

* Cuts longer than 0.75 inches (19.05 mm) that are deeper than 0.25 inches (6.35 mm) when the edges are pulled apart

* Cuts that continue to bleed after 15 minutes of direct pressure

* Puncture wounds where the cosmetic appearance of the wound will be greatly improved or where stitching is needed to restore function, such as in an injury to a tendon or ligament.

You may not need stitches for:

* Cuts with smooth edges that tend to stay together during normal movement of the affected body part

* Shallow cuts less than 0.25 inches (6.35 mm) deep that are less than 0.75 inches (19.05 mm) long

* Puncture wounds
These wounds tend to be smaller, and stitches don’t speed healing or reduce scarring

These wounds tend to be deep, narrow and hard to clean, which increases the risk for infection. Stitching such a wound may seal the bacteria in, increasing the risk of infection

If such a wound becomes infected, it will usually drain better and heal faster if it is not stitched.

* These types of cuts need to be evaluated by a health professional, but may not always require stitching.

WDDTY panellist Melvyn Werbach has gathered a wealth of scientific evidence showing that nutritional support furthers wound healing (Nutritional Influences on Illness: A Sourcebook of Clinical Research, Wellingborough, Northants: Thorsons, 1989: 446-8):

* vitamin A (retinol, retinal and retinoic acid): can make scar tissue strong and resistant to tearing

* vitamin B1 (thiamine): a deficiency interferes with collagen synthesis

* vitamin B5 (pantothenic acid): can accelerate normal healing

* vitamin C (ascorbic acid): promotes formation of elastin and collagen; a low C intake may impair healing

* vitamin E (any tocopherol, tocol or tocotrienol): may facilitate skin-graft healing

* copper: makes strong bonds in collagen

* manganese: makes collagen

* zinc: stimulates wound healing in zinc-deficient patients only; after surgery, accidental trauma or burns, blood zinc decreases while urinary zinc excretion increases

* L-arginine: accelerates healing and may minimise immediate postinjury weight loss (but, in those with acute low l-lysine, may trigger a herpes simplex outbreak)

* essential fatty acids: necessary for transporting substances across cell membranes; deficiencies are associated with very slow and imperfect wound healing.

Although herbal ointments will stimulate cell repair in open injuries, wound healing responds better to treatment with moist herbal compresses. After a while, wound healing using ointments will stop. However, several days of moist dressings will produce a clean wound base, better able to respond to further treatment.

The successful treatment of wounds is seen when the dressing is changed often and when the plant extracts used are varied as required. Sterile gauze compresses should be soaked in preboiled filtered water and placed onto the wound. Herbal tinctures or decoctions may be added to the preboiled water first or may even replace it.

Poorly healing wounds should be bathed in camomile (Matricaria chamomilla: 1 g of flowers to 1 L of water) between dressings (Zeitschr Hautkr, 1987; 62: 1262, 1267-71).

Despite its popularity for wounds, Arnica montana is poorly tolerated by a small number of people and must never be applied to unbroken skin (British Herbal Pharmacopoeia, vol II, West Yorkshire: Scientific Committee of The British Herbal Medicine Association, 1979: 9-11).

Very painful wounds can be promptly relieved by applying tincture of Populus candicans (balm of Gilead) (Willard T, Textbook of Modern Herbology, Calgary, Alberta: CW Progressive Publishing, 1988: 227).

For ulcers that won’t heal, 15-20 drops of digitalis (foxglove) applied to the ulcer two or three times daily will promote skin formation. (Do not attempt this without the constant supervision of a qualified practitioner.) Massaging any protruding veins with the fingertips in a soft, gentle manner also helps (Med Klin, 1965; 60: 2028; Wien Med Wochenschr, 1969; 49: 850).

Topical application of tea tree (Melaleuca alternifolia) oil or lotion has been shown to be useful in helping to heal canker sores, athlete’s foot, burns, herpes simplex, impetigo, infections of the nailbed, psoriasis and tinea (Austr J Pharm, 1988; 69: 276-8). Tea tree oil may be diluted with olive oil.

The Blackfoot Indians in the Western US traditionally applied the leaves of Artemisia frigida (pasture sagewort) to wounds to reduce swelling, and many traditional cultures from diverse parts of sub-Sahara Africa apply a close relative, Artemisia afra Jacq (wild wormwood), to stimulate wound healing (Pharmazie, 1949; 4: 463).

Topical application of a salve made from Echinacea angustifolia (purple cone flower – not E. purpurea, the most common form) can promote wound healing (Med Klin, 1984; 79: 580-3).

Calendula officinalis (common marigold) is often used as a moist compress (one tablespoonful of the dried flower boiled up briefly in 500 mL of water) (Weiss RF, Herbal Medicine, Gothenburg: Ab Arcanum, 1988: 344).

Hydrocotyle asiatica (Centella asiatica, South African pennywort, gotu kola) has a long history of successful use in African, Chinese and Ayurvedic herbal medicine. Controlled trials have produced excellent results in the healing of surgical wounds, skin ulcers, punctures, lacerations, surgical skin cuts, skin grafts and even tears resulting from childbirth. The herb mainly supports the development of normal connective tissue (Herbs Spices Med Plants, 1988; 3: 146-73).

Aloe vera, used topically, has moisturising, anti-inflammatory and mildly antiseptic effects, all at once. It speeds wound healing as a liquid tincture, but has been shown to retard it as a gel and should not be used on deep, vertical surgical wounds (such as in laparotomy or caesarean section). The wound healing properties of aloe vera has been seen in cases of frostbite, burns, electrical injury and damage from intra-arterial drug abuse. Aloe vera has even demonstrated an ability to reverse tissue death in drug-abuse patients (Phytother Res, 1993; 7: S48-52).

Glycosaminoglycans, as a fine powder of calf tracheal cartilage digested by hydrochloric acid plus pepsin, may accelerate wound healing if applied topically, and will probably increase the flexibility of any resulting scar (JAMA, 1965; 192: 352-6).

A word of warning against the use of sugar pastes or honey for wounds. Although they facilitate wound healing by reducing the amount of water within the wound, which significantly retards bacterial growth (J Exp Pathol, 1990; 71: 155-70), sugar pastes have been known to bring on sucrose-induced osmotic nephrosis, a form of acute kidney failure, after only four days of treatment (Lancet, 1987; i: 1034-5). Although this condition appears to occur only in patients with preexisting kidney problems, extreme caution is essential. Nevertheless, sugar-based pastes have proved to be very useful for healing infected bedsores (Lancet, 1987; i: 1485-6).

Harald Gaier is a registered homoeopath, naturopath and osteopath.

Like other health professionals, homeopaths honor the special role that surgery and surgeons have in health care. Homeopaths are not against surgery, because certain conditions are simply not treatable without it. At the same time, however, surgery is often performed unnecessarily. It is performed when other, safer measures can be effectively used. It is performed too early when the body can sometimes heal itself. And it is performed inappropriately, primarily because surgeons only know surgery and don’t know what else to do (the law of hammers pervades many professions: when you are a hammer, everything becomes a nail).

Even when surgery is successful, this does not necessarily mean that the person is “cured.” Surgery may, for instance, remove an abscess, a tumor, kidney stones or gallstones, or other diseased parts, but because this removal doesn’t change the underlying pathological processes that created them in the first place, it is understandable and even predictable that people tend to reexperience their ailments.

Even if the ailment seems to have disappeared, homeopaths do not believe that a curative process has always taken place. While the initial complaint may have been eradicated, sometimes more serious pathology develops shortly after the surgery. Although doctors tend to believe that this is a “new” disease, homeopaths theorize that the surgery probably suppressed the original ailment.

This critique of surgery is not meant to devalue its appropriate use in treating various congential deformities, structural problems, severe injuries, or life-threatening pathological conditions. As previously stated, homeopaths are not against the judicious use of surgery.

When possible, homeopaths first attempt to to see if treatment with an individualized homeopathic medicine can prevent the need for surgery. Patients and even homeopaths are sometimes surprised and impressed at the significant results that homeopathic medicines can provide–not that they can do the impossible, but they can often elicit a healing response when conventional therapeutics cannot.

The integration of homeopathic medicines with surgical care uses the best of both worlds to create comprehensive and ultimately more effective health care.



Homeopathic Medicines Before and After Surgery

Once it is determined that surgery is medically necessary, homeopathic medicines can reduce complications of surgery and augment healing so that people can recover more quickly afterward.

Surgeons commonly ask patients not to take any food, drink, or drugs prior to surgery. While it makes sense to avoid food, drink, and conventional drugs, there have never been any reported problems from taking homeopathic remedies prior to surgery.

Some homeopaths recommend Ferrum phos 6, four times a day for two days, prior to surgery in order to prevent infection and hemorrhaging.

Homeopathic medicines can also help people deal with the various emotions they are experiencing prior to surgery. Gelsemium 6 or 30 is a common remedy for the person who experiences great anxiety, apprehension, weakness, and trembling prior to surgery. Aconitum 6 or 30 is indicated when the person is terrified about surgery and thinks that he will die from it.

Take either Gelsemium or Aconitum the night before the surgery and another dose upon waking in the morning. If fear and/or anxiety is felt after surgery, take one to three more doses.

One double-blind, randomized trial on 50 children who underwent surgery showed that 95% of those given the homeopathic medicine Aconitum experienced significantly less post-operative pain and agitation.¹ Aconitum was chosen because it is a common remedy for ailments in which sudden and violent onset of shock or trauma is a primary indication, as well as symptoms of fear and anxiety, which are especially common emotions experienced by children prior to surgery.

Arnica is another common homeopathic medicine given to people before and after surgery because of its ability to reduce surgical shock and minimize bleeding. Surgical shock is a condition that trauma or surgery can cause in which all the capillaries and small blood vessels are filled with blood at the same time. A randomized, placebo-controlled, crossover study showed that Arnica significantly decreased bleeding time.²

The late British homeopathic physician Donald Foubister recommended Arnica 30 the night before surgery, another dose the morning of the surgery, another dose just prior to the surgery, and different medicines afterward, depending upon the type of surgery and the symptoms the patient feels.

Homeopathic medicines can also be beneficial for patients who undergo long-term intravenous (IV) therapy. Frequent insertion of an IV commonly causes phlebitis (inflammation of the vein) and hematoma (the pooling of blood under the skin); a double-blind study using Arnica 5c found that it can effectively reduce and prevent such problems.³ The study showed significant benefits from Arnica, including reduced pain. Besides subjective improvement, there were also objectively measured increases in blood flow and in blood coagulation factors.

While Arnica is the primary remedy to be taken just prior to the majority of surgeries, there are a certain number of operations for which Dr. Foubister commonly recommended other remedies. For surgery involving cartilage and periosteum, as is often occurs in the knee or elbow, it is recommended to take Ruta 30 the evening before, the morning of the operation, and immediately afterward. For hemorrhoidal surgery, it is recommended to take either Staphysagria 30 or Aesculus 30 in a similar pattern as described for Ruta. And for circumcision, Staphysagria 30 and Arnica 30 should be given similarly as above.

The following are common recommendations for after surgery. Please note that the length of time of treatment can and should be different with each patient, depending upon the intensity of symptoms. Doses should generally be taken as long as pain persists, though they should not be taken for more than a couple of days, unless the person is still in pain and the remedy is providing obvious relief. Arnica 6, 12, or 30 should be given for at least two doses after surgery, approximately one hour apart. In addition to this remedy, the following remedies should be given one hour after the last dose of Arnica:



Gynecological surgery:

–Dilation and curettage: Belladonna 30, every 6 hours

–Hysterectomy: Causticum 30, three times a day (some homeopaths
recommend Staphysagria 6 or 30, three times a day)

–Caesarean section or episiotomy: Staphysagria 30 or Bellis perennis 30,
three times a day

–Abortion or miscarriage: Ignatia 30, every four hours

–Plastic surgery on the breast: Bellis perennis 6 or 30, three times a day

–Amputation of the breast or a lump: Hamamelis 30, every 4 hours


Circumcision: Staphysagria 30 and Arnica 30, every four hours for a day.


Prostate surgery: Staphysagria 30, three times a day


Abdominal surgery: Staphysagria 30 or Bellis perennis 30, three times a
day


Appendectomy: Rhus tox 30, three times a day


Gastrectomy: Raphanus 30, three times a day


Gall bladder surgery: Lycopodium 30, three times a day


Eye surgery: Ledum 30, every four hours


Tonsillectomy and adenoidectomy: Rhus tox 30, every four hours


Orthopedic surgery

–involving cartilage or periosteum: Ruta 30, every four hours

–involving the spine: Hypericum 30, every four hours

–Surgery for bullet wounds and/or stab wounds: Staphysagria 30, four
times a day


Plastic surgery: Arnica 30 (internally) and Calendula, (externally) four
times a day


Amputation: Hypericum 30, every four hours


Hemorrhoids: Staphysagria 30 or Aesculus 30, every four hours for two

or three days* Varicose veins: Ledum 30, three times a day


Dental surgery: Hypericum 30 and Ruta 30, alternating every two to four
hours



Homeopathy for Specific Ailments After Surgery

Readers who experience symptoms or syndromes discussed elsewhere in this book should review those chapters. For instance, if you have urinary symptoms after surgery, which is common when catheterization takes place, consult the section on bladder infection in the section on Women’s Conditions (even if you are a man; see: WOMEN). If you are now suffering from acute insomnia, consult the chapter on Insomnia (sorry, not included online).

Some common conditions after surgery for which homeopathic medicines are often effective include the following:


Fear of Death
Aconitum 30 is indicated (every hour for up to four doses).



Bleeding

Arnica 30 helps to slow or stop bleeding after surgery. Phosphorus 30 is the primary remedy for helping to stop bleeding when Arnica does not work adequately. Ipecacuanha 30 is indicated when there is much bleeding of bright red blood, often accompanied by nausea. Secale 30 is effective in treating uterine bleeding that is aggravated by heat and relieved by cold. Cinchona 30 is helpful for people whose bleeding and general loss of fluids lead them to feel weak and faint and have ringing in the ears. This remedy is sometimes indicated several weeks, months, or years after much fluid has been lost, after either an illness or an operation. Arsenicum 30 is useful when profuse bleeding leads to great weakness, burning pains, restlessness, anxiety, and fear, along with a characteristically large thirst for only sips at a time.

Dose: Take the remedy every hour until bleeding stops, not more than four doses. If bleeding has not significantly slowed, consider another remedy. The next day, take one more dose of whichever works to reduce the possible complications of blood loss.



Trauma to Tissue

Arnica topically and Arnica 6 or 30 are useful when the muscle feels bruised or swollen and when there is any pooling of blood under the skin. Hamamelis topically and Hamamelis 6 or 30 are effective when the person has weak veins, passive hemorrhage, bleeding hemorrhoids, or varicose veins. Capillaries are enlarged and congestion is marked. Calendula in external application (gel, ointment, tincture, spray) is indicated to heal wounds or incisions. Bellis perennis 6 or 30 is a remedy for use after abdominal surgery and when deep internal tissue has been traumatized.

Dose: Apply external remedies at least once a day, and apply again if bathing washes them off. Generally, only two to eight doses of the internal remedy over a two day period will be necessary to complete the healing process.



Wound Infection

External applications of Calendula and Hypericum, either alone or preferably together, help to both prevent and treat infection of surgical wounds. If pus has developed and caused hypersensitivity of the wound, Hepar sulphur 30 is recommended. Because Hepar sulphur is an effective remedy for helping to push out splinters, pieces of glass, and various foreign objects that get stuck under the skin, it also has a tendency to push out surgical stitches. Thus it is not recommended to use this remedy when there are stitches, except towards the end of the healing process, when their removal is part of the healing. If the wound becomes purplish, Lachesis 30 or Gunpowder 30 is indicated. If there is much burning in the wound or wound area, Sulphur 30 is helpful.
Dose: Apply external remedies at least once a day, and apply again if bathing washes them off. Take internal remedies every two to four hours during the first 24 hours and four times a day for two to five more days.



Scarring and Adhesions:

Apply Thiosinaminum tincture externally or use an external combination formula that also contains Calendula (some injury gels include these ingredients). Take Graphites 12 internally.

Dose: Apply external remedies at least once a day, and apply them again if bathing washes them off. You may need to do this for several weeks or months. Internal remedies should be taken three times a day for two days, and if necessary, repeated one month later.



Constipation

Raphanus 6 or 30 is indicated when there is constipation with no urgings for a stool and/or when there is painful gas; see also the chapter on Digestive Disorders for other potential medicines for constipation.

Dose: Take this remedy three times a day for up to four days.



Nausea and Vomiting

Nux vomica 6 or 30 is good for violent retching, especially when there is generally ineffectual retching that does not lead to vomiting. Phosphorus 6 or 30 helps to prevent or treat nausea after surgery; it is indicated when the patient has a strong thirst for ice drinks; he or she may also have a concurrent headache. Ipecac 6 or 30 is effective for persistent nausea with vomiting, when vomiting does not provide relief. Arsenicum 6 or 30 treats violent and incessant vomiting which is made worse by drinking water, especially cold water, or eating. There may also be burning pain in the stomach. See also chapter on Digestive Disorders.

Dose: Take a remedy every two hours during intense symptoms and every four hours during less intense discomfort. If improvement is not obvious after 24 hours, consider another remedy.



Gas
Carbo veg 6 or 30 helps people who suffer from great distension and offensive gas, who get some relief from release of gas, and who desire carbonated drinks because they seem to help them release gas. Cinchona 6 or 30 is useful when there is more pain than distension, frequent rumbling in the abdomen, and no relief from releasing gas. Raphanus 6 or 30 is a common remedy for people who have a distended abdomen but are unable to expel gas. Because this condition is extremely common after surgery, especially abdominal surgery, this remedy is often indicated. Colocynthis 6 or 30 is effective when there is more pain than distension, and also cramps that are relieved by bending over.

Dose: Take a remedy every two hours during intense pain and every four hours during mild discomfort. If improvement is not obvious after 24 hours, consider another remedy.

Bedsores
(see the chapter on Conditions of the Elderly for details)

Resources

¹J.P. Alibeau and J. Jobert, “Aconit en Dilution Homeopathique et Agitation Post-Operatoire de l’enfant,” Pediatrie, 1990, 45 (7-8): 465-66.

²J. Baillargeon, et.al., “The Effects of Arnica Montana on Blood Coagulation: A Randomized Controlled Trial,” Canadian Family Physician, November 1993, 39:2362-67.

³C. Amodeo, et.al., “The Role of Arnica in the Prevention of Venous Pathology from Long-term Intravenous Therapy: Evaluation of Platelet Aggregation,” Ninth National Conference of the Italian Society for Vascular Pathology, Capanello, June 6-9, 1987. The study included 39 patients, including 21 undergoing intravenous feeding, nine in infusion protracted beyond 72 hours, and nine in chemotherapeutic treatment.

The basic principle of homeopathic medicine is that a small dose of a substance will help cure that which it causes in overdose. Although this principle may be a bit confusing at first, it actually makes a lot of sense. Modern day physiology and biology are confirming a basic premise of homeopathy which recognizes that symptoms are efforts of the organism to adapt to stress or infection. Symptoms are therefore understood as the way the “bodymind” is trying, although not always successfully, to re-establish homeostasis or balance. Since symptoms are the best efforts of the organism to attempt to heal itself, it is best to avoid treating or suppressing specific symptoms, and it is preferred to aid and stimulate the body’s defense and immune processes.

The homeopathic medicines are able to stimulate the defense system, since they, like conventional immunizations and allergy treatments, give small doses of what causes a condition in order to stimulate the immune system. Homeopathic medicines, however, are distinctively different from immunizations and allergy treatment, since the homeopathic medicines are more individually prescribed to people, given in much smaller and less toxic doses, and used for both prevention and treatment of a person.

Homeopathic medicine developed much of its popularity in the United States and Europe because of its success in treating people with cholera, scarlet fever, yellow fever and other infectious diseases that were ravaging populations. More recently homeopathic medicine has developed a reputation of suc-cessfully treating people with various chronic complaints. What many people do not know about homeopathy is that it also provides many valuable medicines in treating people who suffer from accidents and injuries. When these medicines are used in conjunction with conventional first aid procedures, the risk of long-term damage from an injury can be significantly decreased and the healing process can be noticeably enhanced.

One must study homeopathic medicine for many years in order to learn how to prescribe the correct medicine for people with chronic conditions. One can, however, learn to use the medicines for first aid very easily. Whereas treatment of a person’s acute or chronic disease requires strict individualization of the person’s total physical and psychological state, treatment for accidents and injuries does not require such individualized presciption. The reason for this difference is that people with acute or chronic diseases have distinct or subtlely different symptoms and causes of their condition, and thus need a different medicine to begin their curative process. People with injuries tend to experience very similar symptoms and usually need a similar metabolic stimulus to heal their complaint. Basically, when different people cut themselves, get burned, break a leg or injure themselves in some other way, they all tend to need a similar stimulus to heal their injury.

Homeopathic medicines for first aid and sports injuries are very easy to prescribe and are usually very effective in reducing pain of the injury and speeding the healing process. It is thus no wonder that many superstar athletes have heard about homeopathy and have begun to benefit from its use. Football superstar O.J. Simpson, tennis player Boris Becker, New York Knick coach Pat Riley, ex-Yankee pitcher Jim Bouton, and pro golfer Sally Little are but some of the athletes who spell relief with H-O-M-E-O-P-A-T-H-Y.

The following medicines are used to treat people in first aid situations. There are other homeopathic medicines that can also used, but these are the most commonly used medicines for the conditions described.

NOTE: Homeopaths use the latin names for their medicines since a similar nomenclature is needed to converse with homeopaths throughout the world.



ARNICA (mountain daisy)

ARNICA is mentioned first because it is a medicine par excellence for the shock or trauma of any injury. It is necessary to treat an injured person for shock first unless the injury is very mild or unless the person is bleeding so profusely that stopping the bleeding should be attended to immediately. Since ARNICA is the first medicine prescribed in numerous types of injuries, it is the most common medicine used in first aid. It helps reduce shock, relieve pain, diminish swelling, and begin healing. ARNICA is a great medicine for injuries to muscles, especially when there is pain from overexertion.

ARNICA is also an excellent medicine before or after surgery since the body experiences a state of shock from these medical procedures. It is used as well before and after dental surgery, and before, during, and after labor to help the mother and infant deal with the shock and stress of birth.

Common conditions for use: Shock or trauma of injury; surgical shock; muscle injuries.



HYPERICUM (St. John’s Wort)

HYPERICUM is an excellent medicine for injuries to nerves or to injured parts of the body which are richly supplied with nerves (fingers, toes, the spine). Generally, such injuries have sharp or shooting pains, and the injured part is very sensitive to touch. HYPERICUM is also good for old injuries to nerves which still seem to both the person.

King George VI of England was so impressed by the effectiveness of HYPERICUM that he named his prize racehorse after it.

Common conditions for use: Injuries to nerves.



URTICA URENS (Stinging Nettle)

As you might have predicted from learning about the law of similars, URTICA URENS is the medicine of choice for burns (stinging nettle, as you may know, causes a burn upon contact with the spine of the plant). URTICA URENS in external application is also helpful in diminishing the pain of the burn and in promoting healing. Such application should be diluted approximately one part of URTICA URENS with ten parts water.

Common conditions for use: burns.



LEDUM (Marsh Tea)

LEDUM is the best medicine for puncture wounds, whether it be from a needle, a nail, or other sharp object. Deep punctures or punctures from rusty nail should receive medical attention, but this should not delay you from taking LEDUM which has no side-effects and which can be helpful in healing wounds and preventing tetanus. LEDUM is also commonly prescribed for insect stings and animal bites. It’s applicable as well to people with severe bruising (black eyes or blows from firm objects), especially if the affected part feels cold and yet feels relieved by cold applications.

Common conditions for use: puncture wounds; insect bites.



RHUS TOX (Poison Ivy)

Although some people cringe when they even hear someone mention poison ivy, it is an obten prescribed homeopathic medicine (in non-toxic homeopathically prepared dose!). It is a great medicine for certain types of skin conditions (since it causes them!) as well as for numerous other conditions which homeopaths have found it causes in overdose. One of the conditions it causes in overdose is the rupturing of ligaments and tendons. Because of this, it is the most common medicine prescribed for sprains and strains, especially the type of sprain and strain that is worse upon initial motion but that is better upon continued motion. It is also a medicine given for dislocated joints. ARNICA is another medicine to condition for dislocations.

Common condition for use: Sprains or strains.



RUTA (Rue)

RUTA is the medicine given for severe sprains where the person has a torn or wrenched tendon, split ligament, or bruised periosteum (bone covering). It is also the most common medicine prescribed for recent or old injuries to the knee or elbow. As such, it is one of the medicine prescribed for “tennis elbow.”

Common conditions for use: Severe sprain; injury to the bone.



SYMPHYTUM (Comfrey)

Homeopaths, like herbalists, use SYMPHYTUM for fractures. Homeopaths, however, give their medicine in potentized dose rather than in teas and poultices as done by herbalists. Although one must go to a physician to have the fracture re-set and placed in a cast, SYMPHYTUM will relieve pain and promote rapid healing of the fracture. Besides its application in fractures, SYMPHYTUM is a great medicine for injuries to the eyeball, bones around the eyes, and the cheekbones.

Common conditions for use: Fractures; facial injuries.



External Applications


Some homeopathic medicines are used externally,* including:



CALENDULA (Marigold)

CALENDULA TINCTURE (in an alcohol base), GEL, SPRAY, and OINTMENT are invaluable external applications in treating cuts and abrasions. CALENDULA is known to have antiseptic properties due to its organic iodine content. CALENDULA helps stop bleeding, inhibits infection, and promotes granulation of tissues to help heal wounds and burns. CALENDULA TINCTURE should not be applied directly on a cut since its alcohol content causes stinging pain. It is best to dilute this tincture with a little water. If you’d like to avoid this effort, you can instead directly apply CALENDULA GEL, SPRAY, or OINTMENT.

Note: CALENDULA works so rapidly in healing the skin that it is not recommended for use in deep cuts. In deep cuts CALENDULA sometimes can close and heal the outside skin before the tissue underneath is completely healed.

Common conditions for use: Cuts, abrasions, burns.



HYPERICUM (St. John’s Wort)

HYPERICUM TINCTURE is recommended as an external application in treating deep cuts since it helps heal internal structures as well as the skin. It also has the ability to close open wounds and thus sometimes prevents the need for stitches. HYPERICUM is also used for septic (infected) wounds (CALENDULA, in comparison, is primarily good for clean uninfected cuts). HYPERICUM TINCTURE, like other external applications which have an alcohol base, should be diluted prior to application.

Common conditions for use: Deep cuts, infected cuts.

General Rules for Determining Dosage


People who are beginners in homeopathy should primarily use the 6th potency (written on the bottom as “6x” or “6c”) or the 30th potency (“30x” or “30c”). The 6x is a dose of the medicine that has been diluted 1:10 six times with vigorous shaking between each dilution, while the 6c has been diluted 1:100 six times. Only homeopathic practitioners who have a great deal more knowledge of homeopathy should use the higher potencies (200x, 1000x, or higher). It is important to remember that homeopathic medicines are more powerful the more they experience “potentization”–the pharmaceutical process of dilution and shaking. Higher potencies thus should be used with great care.

Homeopaths have found that injured people tend to need more frequent repetition of doses shortly after injury. One may need to prescribe a medicine every 30 to 60 minutes immediately after severe injury. After a couple of hours, the frequency of doses can diminish to every other hour or every fourth hour, depending upon the severity of pain. Doses every four hours or four times a day are common when a person has a non-severe injury. A person will generally not need to take a medicine for more than two to four days, except in fractures or severe sprains where one to three doses daily for five to seven days are common.

The basic principle of how to determine dosage is: The more severe the condition, the more often will its repetition be necessary.

It is important to remember that a medicine should only be taken as long as the person experiences pain. Do not continue taking the medicine unless there are still symptoms. The basic idea is to take as little of the medicine as possible and yet enough to lessen pain and stimulate one’s healing powers.



Administration of the Medicine


The medicine should be taken into a “clean mouth.” Food, drink, tobacco, toothpaste, and other substances should not be put into the mouth for at least 15 minutes before or after the dose. It is generally best to place the medicine underneath the tongue.

Homeopaths have found that some substances can neutralize the effects of the homeopathic medicines. Although there is some controversy around which substances are implicated more than others, it is best to avoid the following substances for at least 48 hours after taking the final dose: coffee, camphorated products (including lip balm, counter-irritant muscle relaxing cremes, Tiger’s balm), strong herbal teas, mentholated products, cough drops, and mouthwash.

Care and Storage of Homeopathic Medicines


Special handling and storage of the homeopathic medicines are needed in order to avoid possible contamination. When the medicines are correctly handled and stored, homeopaths have found that they can last for several generations. Since it is very difficult to determine if the medicines have been contaminated, one should take the following precautions to prevent potential problems.

–The medicines should be kept away fraom strong light, from temperatures higher than 100 degrees, and from exposure to strong odors like camphor, menthol, mothballs, or perfumes.

–The medicines should always be kept in the container in which they were supplied and never transferred to any other bottle which has contained other substances.

–The medicine shold be opened for administration of the medicine for the minimum time possible. One should be careful not to contaminate the cap or cork before replacement.

–If, by accident, more pills than the number specified in the prescribed dose are shaken out of the bottle, do not return them to the container; throw the excess away to avoid possible contamination.

How do I Learn More About Homeopathy?

The best source of homeopathic books, tapes, home medicine kits, and software is:

Homeopathic Educational Services

2124B Kittredge St.

Berkeley, CA 94704

(510) 649-0294

(510) 649-1955 (fax)

In fact, using homeopathic medicines for injuries is considerably easier than treating common diseases because treatment for injuries does not require a high degree of individualizing of remedies that is typical in treating diseases. When two people have sprained ankles, they each need a similar homeopathic remedy to heal them, while two people suffering from arthritis generally require different remedies which are individualized to their unique pattern of symptoms.

Homeopathic medicine should be taken in conjunction with, not in replacement of, conventional first aid measures.

The chart of this page summarizes key homeopathic medicines for common injuries. However, for greater detail and further information on the homeopathic treatment of sports injuries, see the three books listed at the bottom of the page.



Single Remedies and Formulas

Homeopathic medicines are available as single remedies or as formulas of two or more remedies mixed together. Formulas are a more user-friendly way to use homeopathic medicines since the indications for their use are extremely clear. The use of several remedies in a formulas provide a more broad spectrum effect not available in a single remedy. Because injuries sometimes involve muscle, nerve, and bone tissue, it sometimes makes sense to use formulas to help to heal the various tissues involved.

Single remedies are more recommended for injuries when you know the correct medicine to give and when you wish to give a higher potency of a remedy than is available in formulas. Formula products usually contain remedies in the 3, 6, or 12th potencies, while people with severe pain may receive more rapid benefit from the 30th potency.

The “x” after the potency number (as in 6x) refers to the number of times in which a medicine is diluted 1:10, while the “c” after the potency number (6c) is diluted 1:100 (it will be easy to remember the difference between “x” and “c” by simply remember their meaning as Roman numerals). Two hundred years of homeopathic clinical experience has found that the higher the potency, the more powerful and faster the medicine acts. However, the higher the potency used, the more accurate the remedy must be for the injured or sick person. Because of this, it is recommended to use the 30th potency when the user is very confident that the remedy used is the correct one. When one is not as confident, the 6th or 12th potency is indicated, or one can consider using a homeopathic formula.



Frequency of Dose

When taking homeopathic medicines it is recommended to take as few doses as necessary but as many as are required when experiencing pain. At first when there is the greatest amount of pain and discomfort, you may need to take the remedy every hour. Usually after four doses, you can reduce the frequency to every other hour, and as the intensity of pain diminishes, taking a dose every four hours is common.

If no improvement is noticeable after one or two days, it is not recommended to take further doses.



External Applications

Although most homeopathic remedies are in pill form for internal consumption, there are a select number of homeopathic medicines which are available in external applications. Some external applications are in ointments, gels, or sprays. Although they have a similar degree of efficacy, each has certain benefits and detriments.

Ointments are made from a petroleum base which doesn’t allow the skin to breath as well, but they tend to work well because they are not easily washed or wiped off. Gels and sprays allow the skin the breath more, but they are more easily washed or wiped off. Gels are my personal favorite because they are not as easily washed off.





INDICATION MEDICINE DOSE

Shock and trauma of injury Arnica 6,12,30

30 preferred



Injury to the soft tissue/muscle Arnica 6,12,30

Arnica external

Formula external



Injury to nerves or parts of Hypericum

the body rich with nerves (feet, Hypericum external
fingers, back);
injuries with Formula external
shooting pains
6,12,30



Sprains/strains Arnica (immediately
after injury)
6,12,30

Rhus tox* 6,12,30

Bryonia** 6,12,30

Ledum (for easily
sprained ankles)
6,12,30

Arnica external Injury Formula external

Tendonitis Rhus tox* 6,12,30

Bryonia** 6,12,30

Arnica external

Injury Formula external



Severe sprains (wrenched tendons, Rhus tox* 12,30

split ligaments) Bryonia**
12,30

Ruta (if Rhus tox or Bryonia aren’t effective) 12,30

Bellis perennis (when
cold applications cannot be tolerated)
12,30



Dislocation Arnica 12,30

Hypericum (if
shooting pains)
12,30



Injuries to periosteum (bone-covering) Ruta 6,12,30

Arnica external

Injury Formula external



Injuries to knee or elbow Ruta 6,12,30

(includes shin splints) Rhus tox* 6,12,30

Arnica external

Injury Formula external



Fracture Symphytum

(Take Arnica for shock of injury)
6,12,30

Arnica external

Injury Formula external



Head injury (immediately after injury) Arnica 12,30

Old head injury Natrum sulphicum 12,30



Slow repair of fractures Calcarea phos.
6,12



Bruises/Contusions Arnica 6,12,30

(no break in the skin) Arnica external

Injury Formula external



Bleeding Arnica 12,30



Nosebleeds Phosphorus
12,30



Blisters Calendula external



Cuts Calendula external



Lacerations (deep cuts) Hypericum external (1st)

Calendula external (after deep cut begins to heal)

Staphysagria 12,30



* Rhus tox is indicated when the person experiences the “rusty gate” syndrome: there is great pain upon initial motion but some relief on continued motion.

** Bryonia is indicated when the person experiences increased pain and discomfort the more motion they do.





Useful Books

Stephen Cummings, M.D., and Dana Ullman, M.P.H., Everybody’s Guide to Homeopathic Medicine, Los Angeles: Jeremy Tarcher, 1991.

Steven Subotnick, D.P.M., Sports and Exercise Injuries: Conventional, Homeopathic and Alternative Treatments, Berkeley: North Atlantic, 1991.

Dana Ullman, M.P.H., Discovering Homeopathy, Berkeley: North Atlantic, 1991.

These requirements are based on maintaining a positive nitrogen balance in children and an even to positive nitrogen balance in adults. Protein is the nitrogen-containing nutrient. As it is broken down for excretion, it must be replaced by dietary nitrogen so protein formation can continue. In the healthy adult, nitrogen equilibrium, or zero balance, is the ideal, while a positive nitrogen balance is needed during times of illness and healing. In children, when growth is occurring regularly, a positive nitrogen balance is necessary, as it is in pregnancy.

As discussed in the previous section, Food Complementarity, the protein requirements are also based on the protein quality, as measured by the biological value (BV). Protein is also measured by the way it supports growth; this measurement, called the protein efficiency ratio (PER), is determined by feeding an animal a particular protein food and measuring its growth.

The reference protein for determining the biological value of foods is that of eggs (ovalbumin), the food with the highest BV at 94 percent (although mother’s milk is valued at 100 percent). Next are fish at 75–90 percent, rice at 86 percent, legumes at 70–80 percent, and meats and poultry at 75–85 percent. Corn, an incomplete protein, has approximately 40 percent biological value.

Protein Excess

There is definite concern that the developed countries are overconsuming protein, especially from meat and dairy foods. Since nearly 700 million people in the world are protein deficient, it seems ludicrous that Americans and people in other well-to-do countries consume so much. But we could be paying the price!

The RDA protein standards may be highly overestimated; and grams of protein daily. The World Health Organization more conservatively puts our protein needs at about half of the U.S. government minimum levels, or 0.45 grams of protein per kilogram of ideal body weight.

The Western world definitely has less deficiency disease than parts of the Third World, such as Africa, the Near and Far East, and Central and South America. But we also have far more chronic and degenerative diseases, such as arthritis, diabetes, cardiovascular disease, and cancer. All of these problems have dietary correlations, some of which are shown in specific studies, but many that, in my opinion, will be discovered in future years with research into the nutritional components of disease. Eventually, through knowledge and behavior, we need to find the right balance in our diet.

Protein Deficiency

With all the worldly and space technology and the wealth of resources we possess, much of the world’s population is yet impoverished and near starvation. Thousands of children and adults die daily from lack of nourishing food, and protein is of key importance. In areas where meats and milk products are not plentiful and where often only one or two food sources are available, such as rice, wheat, corn, or potatoes, people are not getting the complete balance of amino acids and protein needed to sustain the body. They go into negative nitrogen balance and begin to experience weight loss, fluid retention, weakness, hair loss, and the inability to heal wounds.

The name for protein deficiency disease is kwashiorkor, a Ghanian word for “the evil spirit that infects the child.” Protein deficiency is a wasting disease that in its severe state leads to death. It is curable, of course, with consumption of complete protein foods or supplements. Marasmus, another protein deficiency disease associated with calorie or food deficiency, comes from a starvation diet and results in complete loss of energy and tissue wasting. Also called “protein-calorie malnutrition” (PCM), it is the world’s most widespread and correctable malnutrition problem, killing millions yearly.

The Western world’s example of protein deficiency is mirrored in the alcoholic, who obtains a large portion of his or her calorie intake from carbohydrates in the form of ethyl alcohol. Food and protein consumption may be minimal. Malnutrition and fat accumulation in the liver lead to rapidly advancing demise unless alcohol is reduced and nutrition is increased. Cirrhosis, scarring, and malnutrition of the liver is one of the top ten degenerative diseases leading to death in the United States.

Recently there has been worldwide concern over hunger, malnutrition, and starvation. It certainly seems that a primary part of our responsibility on this planet is to feed all the people adequately. After all, on an individual or family level, food, shelter, and clothing come before fancy cars, exclusive restaurants, and trips to the Caribbean. Donations to hunger projects, attending fundraising music concerts, and helping to raise money ourselves are short-term ways to feed some hungry people, but there are other approaches too. Currently, on a global level, higher precedence is given to using land for grazing meat-rendering animals than for growing grain for direct human consumption. Many acres of grain and plant proteins are used to feed a small number of cattle and still more grain is used to feed poultry. This grain could feed many more people than can the meat of dead chickens! A reduction in animal meat production and an increased emphasis on vegetable and grain foods would help feed the impoverished everywhere. Yet perhaps the most important contibution we can make towards reducing hunger and starvation in the world is by helping and teaching people to plant and harvest their own food sources.

The herbalists of ancient times knew about the powers of St. John’s wort, and they used it for a wide variety of ailments. However, Western medicine discarded the ancient knowledge, dropping the study of herbs from medical school curricula. In its assumption that the old teachings were unscientific old wives’ tales, the medical profession lost touch with these gifts of the natural world.

In this chapter, we’ll first look at the history of this fascinating plant. I’ll then discuss St. John’s wort’s antidepressive effects and its numerous other benefits.

An Ancient Medicine Rediscovered

St. John’s wort presents a wonderful paradox. Known to healers for thousands of years, it has become an overnight sensation in the modern media. No doubt utilized by some of the earliest civilizations, the oldest records of its use come from Greek and Roman times, according to herbalist Christopher Hobbes. Dioscorides, the foremost Greek herbalist, recommended it for sciatica and malaria relief, and as a diuretic and female tonic. Pliny the Elder, the Roman naturalist, found it effective against snakebite when mixed with wine. (We’re not sure whether the wine was to be mixed with the herb, or just drunk to take one’s mind off the pain!)

The botanical name Hypericum comes from the Greek words yper, meaning upper, and eikon, or image. The Greeks and Romans believed that St. John’s wort protected them from evil spirits and witches’ spells, and often placed the herb in their homes and above statues of their gods. Perhaps the spirits and spells referred to depression and anxiety, mental disorders with no obvious physical cause.

The early Christians incorporated many ancient beliefs into their new religion. Preexisting spring rituals, for instance, were renamed as saints’ feast days. In this tradition, Christian mystics named Hypericum after St. John the Baptist. It was traditionally collected on St. John’s Day, June 24, and soaked in olive oil for days to produce a blood-red anointing oil, said to symbolize the blood of the saint.

By the thirteenth century, belief in the herb’s mystical power was well established. People brought the flowers of the plant into their houses on Midsummer Eve, or St. John’s Eve (June 23), to protect them from the powers of evil. In another common practice, they put the plants under their pillows on St. John’s Eve. According to legend, the saint would appear in a dream, give his blessing, and protect the sleeper from dying during the following year. St. John’s wort was also burned in bonfires on St. John’s Eve to drive away evil spirits, purify the air, and protect crops.

According to the traditional doctrine of signatures, an herb’s physical appearance gives an indication of its specific healing power. Red plants, reminiscent of blood, were felt to be good for wound healing. The red oil in St. John’s wort was no exception. Crusaders not only carried the plant to protect themselves from sorcery, but also used the soaked flowers and leaves as an ointment to help heal the wounds of battle. Physicians in the sixteenth century found the herb to be very effective for treating deep wounds. The first London Pharmacopoeia, published in 1618, recommended that the flowers be placed in oil and allowed to stand for three weeks. The resulting tincture was used for wounds and bruises. Other traditional folk uses for St. John’s Wort include the treatment of gout, rheumatism, and jaundice.

When the first European colonists arrived in North America, they found that the Native Americans were already familiar with the herb. The latter used it for diarrhea, fevers, snakebite, and wounds and other skin problems. It later served as a valuable medicine for treating soldiers’ wounds during the Civil War. St. John’s wort was also prescribed by the homeopaths of the period for a variety of ailments, as it is to this day. (For a list of the active ingredients in St. John’s wort and their effects, see “The Many Active Ingredients in St. John’s Wort” )

Unfortunately, toward the end of the nineteenth century, the medical establishment in the United States turned its back on traditional folk remedies. Teachings that had been passed down through the ages were dismissed as primitive superstition. Medical researchers considered most of the complex chemical constitution of a plant to be extraneous, and their objective was to isolate the plant’s so-called “active ingredient.” Now, of course, we realize these “extras” are often the ingredients that hold the secret to a plant’s strength and healing power.

Medical authorities established what we now know as conventional medicine, focusing their attention on medical and surgical techniques, and manufactured drugs. They lobbied Congress and the state legislatures for the prohibition of herbal medicine, which had a chilling impact on the legitimate use of herbs to promote health. Current laws still restrict the use of specific healing claims on herbal medicine labels. Only recently has conventional medicine begun to explore once again the potential contributions that herbs can make to health.

St. John’s Wort and Depression

Conventional medicine may be scratching its collective head about the value of St. John’s wort, but that hasn’t stopped ordinary people such as Kate from reaping its benefits, including its remarkable ability to fight depression.

Kate, a 48-year-old married author and public speaker, had a super-busy lifestyle, with frequent deadlines and an intense travel schedule, and it had caught up with her. “While on an impossible deadline, I had a total collapse. I was exhausted, stressed, and depressed. My doctor put me on Prozac, but it made me even more depressed, and then, I couldn’t sleep. He gave me sleeping pills that zonked me, and that was it. I stopped the Prozac. Then I read about St. John’s wort, and thought I’d try it, 250 milligrams twice daily. I figured it couldn’t hurt! Three weeks later, my husband Mike suddenly noticed: ‘You’re different! You seem more relaxed, less tense. What’s going on?'”

Kate hadn’t told him she was taking St. John’s wort, but her change in attitude was obvious. “One of the most dramatic things I began to notice is I felt happy and ebullient in the mornings, which I never was before. It was never like this on Prozac. I’m more energetic and focused, and there’s more laughter!”

Her good news continued. “Our sex life has always been very sporadic and difficult. Four weeks after starting St. John’s wort, we had a sexual experience that was distinctively different from any we have had in our twenty years together. I felt an openness, a sexuality, that was a pervasive feeling, coming from my very core. It was extraordinary for me, and Mike was just swept away. I don’t think I’d ever felt that way, even when I was younger. And this openness has continued.”

In a separate conversation with me, Mike was even more effusive than Kate. “I can’t believe how she’s changed. She’s always been so tense, barely available, especially when she’s stressed. Now, she’s a delight. We are having the time of our lives!”

This all sounds too good to be true, you might say. Maybe it’s an isolated incident, or simply the power of suggestion as a result of all the positive publicity surrounding St. John’s wort. How representative is Kate? According to the research I have read, reports from other physicians and practitioners, and my own clinical experience-hers is not an isolated case.

In fact, one of my colleagues, a holistic physician, had been asked by a woman in his yoga class what he knew about St. John’s wort. He gave her what information he had. Two months later, she came running up to him in class, exclaiming, “I must thank you. The St. John’s wort changed my whole life, my outlook, everything. It’s like a veil lifted from around my head. I’ve never felt so good. And I’m dreaming again, and remembering my dreams. I can hardly believe it!”

Contemporary Research Proves the Value of St. John’s wort

In Germany, where herbal medicine is a standard part of the medical-school curriculum, 80 percent of German doctors prescribe herbs such as St. John’s wort on a regular basis. Not surprisingly, a great deal of the research on this most valuable herb has been conducted in Germany.

Mild to moderate depressions respond well to treatment with St. John’s wort. More than twenty studies involving thousands of patients confirm the herb’s ability to reduce and often eliminate the symptoms associated with these conditions. Compared with both placebos-inert comparison substances-and various antidepressant drugs, St. John’s wort has come out on top every time.

The herb’s success rate as an effective antidepressant is between 60 to 80 percent, a rate equal to that of prescription drugs such as Prozac, with far fewer side effects. A drug monitoring study published in 1994 looked at the experiences of 3,250 patients who were treated with St. John’s wort. It found that only 2.4 percent of these patients reported any side effects at all, a rather remarkable finding when you consider that Prozac produces side effects at least ten times more frequently, and that even the placebos produced side effects.

Scientists are not yet sure of exactly how St. John’s wort works. For example, a preliminary National Institute of Mental Health (NIMH) in vitro, or test tube, study indicates that St. John’s wort has a high affinity for GABA receptor sites in the brain (see Chapter 3 in St. John’s Wort: Nature’s Blues Buster). The amino acid GABA (gamma-amino-butyric acid), plays a role in mood regulation: GABA levels are low in people with depression, and GABA-enhancing agents show both antidepressant and antianxiety effects. Despite the herb’s Valium-like effect on anxiety, there is a lack of sedation, which is an obvious advantage in treatment.

Let’s see how St. John’s wort can help several specific problems.

Sleep Disorders and Insomnia

One of St. John’s wort’s major advantages over prescription antidepressant medications is its ability to promote a better quality of sleep. Unlike St. John’s wort, most antidepressants lengthen the time it takes to enter the REM (rapid eye movement) sleep phase, reducing or even eliminating REM sleep. Far from inactive during sleep, the subconscious mind is busy analyzing the day’s events and processing feelings during the dreaming or REM phase. This is essential for mental health.

Pete is an example of someone whose sleep disorder was relieved by a combination of St. John’s wort and sedating herbs.

Pete, a 40-year-old businessman, blamed his inability to sleep on his stressful job. He would toss and turn, worrying about his work problems and about being too tired to handle them the next day. He was always exhausted from lack of sleep.

Dreading the thought of another tormented night, Pete asked his family doctor for a sleeping pill prescription. Fortunately for him, his doctor was aware of natural alternatives, and suggested an herbal approach to the problem. For the insomnia, he recommended an herbal combination of valerian and kava, both excellent sedating herbs, and for the underlying depression, St. John’s wort. Pete was then able both to get to sleep and to remain asleep through the night. Just having sufficient rest was enough to help his mood. Then, after a few weeks, the St. John’s wort began to work more noticeably, and he could feel his mood lift further, and he had less need for the other herbs.

Had Pete gone the standard medical route, the requested sleeping pill prescription would have handled the symptom-temporarily. The downside would have been habituation, in which he would have needed increasing doses for the same result, in addition to the lack of REM sleep.

St. John’s wort is also helpful for insomnia in general, not just that associated with depression. Prescription sedatives often produce grogginess or a hangover effect the next morning, and can also be addictive. St. John’s wort, on the other hand, works with the body’s own sleep-promoting mechanism to bring on restful sleep. It harmoniously enhances the natural actions of the brain, instead of drugging it into submission. Consequently, one awakens feeling more relaxed and refreshed. Since it can take a week or so for this effect to begin, St. John’s wort is recommended mainly for recurring insomnia, and not just an occasional night of tossing and turning.

Seasonal Affective Disorder (SAD)

St. John’s wort can also be used to treat SAD. As we saw in Chapter 2, persons with SAD, a form of major depression, are profoundly affected by the lack of sunlight that occurs in autumn and winter. This triggers biochemical changes in the brain, directed by the brain chemicals melatonin and serotonin, and leads to such symptoms as depression, impaired concentration, anxiety, marked decrease in energy and libido, and carbohydrate cravings. Also, like bears preparing to hibernate, these people eat more, gain weight, and need more sleep.

Scientists have found light therapy to be effective in treating SAD. Light therapy consists of exposing the individual to a set of full-spectrum fluorescent lights during the early morning and evening hours. Alternatively, lighted visors can be worn that shine light through the eyes and into the pineal gland. This stimulates the production of melatonin, a hormone associated with cyclic bodily processes. St. John’s wort can be combined with light therapy for greater effect. In the view of herbalist Terry Willard, the herb “brings light into dark places.” He finds it extremely effective in treating the rampant SAD that occurs during the long, dark winters of northern Canada, where he lives and works.

Premenstrual Syndrome (PMS)

PMS is a common complaint that produces both physical and mental symptoms. Since some of its mental symptoms are similar to those experienced during depression, including irritability, tension, and restlessness, it should come as no surprise that St. John’s wort can help. For centuries, herbalists have recognized the herb’s value in treating discomforts associated with the menstrual cycle, and it remains a most widely utilized natural treatment for PMS, as well as menstrual cramps. The latter is likely due to the herb’s ability to reduce uterine levels of prostaglandins, substances that can promote inflammation. You will often find women’s tonics that contain St. John’s wort in combination with other ingredients that function in a similar manner.

What to Expect and When to Expect It

As with most antidepressants, it may take three or four weeks before you notice a significant effect. Larger dosages are unlikely to reduce this time lag. On the other hand, positive results often occur sooner. For example, within a week to ten days, many people notice improved sleep: better quality, fewer interruptions, and even more dreaming. After one to two weeks, there may be improvements in appetite, energy levels, and physical well-being. By the second or third week, there is a reduction in emotional symptoms, with less anxiety, a more positive mood, and a greater sense of peace.

Many of my patients report positive effects almost immediately, with a sensation in their brains of “a weight being lifted,” decreased anxiety, and an enhanced ability to concentrate. We don’t know if this is a “real” response, or simply a placebo effect brought on by positive expectations. It is also important to remember that as with any remedy, natural or synthetic, St. John’s wort affects different people in different ways. Some people experience changes sooner or later than average, and some don’t experience changes at all.

How does St. John’s wort work? At this point, it is hard to give a definitive answer. While initially thought to be an MAO inhibitor, St. John’s wort is more likely similar in its action to the SSRIs such as Prozac (see Prozac and Beyond-The Synthetic Antidepressants). These reduce the rate at which the brain cells reabsorb serotonin, leaving more of the neurotransmitter molecules in the synapses, thereby enhancing receptor-site activity. And, as I’ve said before, in people who are depressed, the brain’s receptor sites are often less sensitive than normal, and it is possible that the herb enhances the sensitivity of these sites. It has also been suggested that St. John’s wort inhibits interlukin-6, a chemical messenger that mediates the stress response. This gives St. John’s wort an antistress effect.

In any case, do not expect instant results, like Rob did.

Rob, an artist acquaintance of mine, was a moody, impulsive guy who, for example, would go from being excited about a project to forgetting about it entirely. He heard about St. John’s wort, and thought it might smooth out his moods. He asked my opinion, and I agreed that it was worth a try. He began that very day. When he didn’t feel any different an hour after his first capsule, he took another. And another. By the end of the day, he had taken four. Then he called me, asking why it wasn’t working! I explained that St. John’s wort was not a stimulant, nor was it rapid in its action. Rather, the antidepressant effects accumulate over time, and that he had to take it regularly for a few weeks before he would begin to notice a difference. Rob was disappointed.

Rob seemed to be caught up in the “take a pill for fast, fast relief” mentality.

Some depressions may not respond at all to St. John’s wort, depending on the source of the depression. Take Gretchen, for example.

Gretchen, a bright, creative hairstylist and artist, had been depressed for a couple of weeks. “I was going home at night and crashing, not wanting to see anyone. I just wanted to sleep when I wasn’t working. I had read about St. John’s wort, and decided to try it for two weeks. Nothing changed. Then I remembered that I have a tendency to be anemic.” When her iron was low, Gretchen would feel tired and depressed. “I went off to the health food store, bought some iron, took it daily, and within a week, was feeling normal.”

Was this a St. John’s wort failure? I don’t think so. Rather, Gretchen is a great example of someone who understands her own body, looks for a recognizable pattern, and feels confident enough to take charge of her own health when necessary. Before assuming that the source of a depression is a neurotransmitter imbalance, you should look for a nutritional deficiency or other physical disorder. We will look at this in more detail in Nutritional Approaches to Mental Health.

When there is a neurotransmitter imbalance, my preference is to start with St. John’s wort, unless in one of the exception major depression or bipolar disorder. This herb still has many advantages over the synthetic antidepressants.

St. John’s Wort’s Effects on Other Disorders

Though current attention focuses on St. John’s wort’s role in the treatment of depression, the herb has been shown to have many other valuable medical uses as well. Studies have shown that St. John’s wort has broad antiviral and antibacterial properties, and relieves inflammation. This confirms its traditional usage as an excellent treatment for wounds and burns. Also, St. John’s wort may be useful in cancer treatment.

How can one herb produce so many different benefits? St. John’s wort is a complex mixture of at least ten groups of active ingredients (see chart), each with its own effects. It works with our bodies to achieve healing in multiple ways. A manufactured drug, in contrast, is aimed at one specific target, and often produces negative side effects when its action expands beyond that target. The opposite is true of herbs such as St. John’s wort, which contain compounds that work together to accomplish more than any one component could do on its own. Rather than unwanted side effects, you receive bonus healing effects.

It is also important to remember that the holistic view of medicine does not separate illness into two neat stacks, physical ailments and mental ailments. To begin with, many physical disorders can lead to depression, and depression in turn can lead to physical illness. In addition, the mind-body continuum has common influences, and imbalances can be bodywide in nature. Therefore, the use of St. John’s wort, by relieving your physical problems, may very well help lift your mood.

Antiviral Actions

St. John’s wort has been shown to have dramatic antiviral activity, although in dosages much higher than those required to treat depression. Experiments, both in test tubes and in animals, have indicated that two of the active chemicals in the plant, hypericin and pseudohypericin, are clearly effective against a number of retroviruses, including the herpes and hepatitis C viruses. The herbs show significant activity against influenza types A and B; the vesicular stomatitis virus, which causes inflammation of the mouth; and even the Epstein-Barr virus, which is associated with infectious mononucleosis and chronic fatigue syndrome.

Hypericin and pseudohypericin show great promise for several reasons. They inactivate or interfere with the ability of viruses to reproduce. They are also able to cross the blood-brain barrier, an organic safety mechanism that prevents many substances from reaching the brain. Intended to filter out toxic substances, this barrier also denies entry to many beneficial ones. The ability to cross this barrier is particularly meaningful in dealing with viruses that target the brain.

In several cases, the two chemicals have proven effective in preventing disease after a single oral or intravenous dose. This is highly unusual, since viruses are normally much more resistant than that to treatment. Compared with other antiviral medications, St. John’s wort has very few side effects, although there can be some phototoxicity, or extreme sensitivity to light, when it is administered in very high doses. Researchers are now studying the potential of hypericin against other viruses.

At New York University, Dr. Daniel Meruelo and Dr. Gad Lavie are researching the use of hypericin in fighting the human immunodeficiency virus (HIV), the virus associated with acquired immunodeficiency syndrome (AIDS). In mice, hypericin has been shown not only to inactivate the virus, but also to shield the membranes of healthy cells from attack. No other current antiviral drug is able to do this. It is also possible that hypericin, if added to donated blood, may protect transfusion recipients from becoming infected with HIV.

In Cooper and James’s study of thirty-one AIDS patients, the researchers found a 13 percent increase in counts of T helper cells (T cells), an important component of the immune system, after one month of supplementation with St. John’s wort. This higher level was maintained after four months. In a study by Stenbeck and Wernet, sixteen patients saw their counts of CD4, another immune-system component, either improve or remain stable when they took St. John’s wort over a forty-month period. Only two of the sixteen developed the kinds of opportunistic infections that often affect people with faulty immune systems. These studies indicate that St. John’s wort may very well play an important role in the fight against AIDS, and research is continuing in this area.

It is worth noting that, so far, the antiviral research has been done using refined synthetic hypericin, identical to natural hypericin but lacking the other medicinal compounds found in the whole herb. Unrefined St. John’s wort extract has been shown clinically to have antiviral properties, but no study has yet been done comparing the two forms.

Wound-Healing and Antibacterial Actions

Several studies have confirmed the traditional use of St. John’s wort in wound healing. Hyperforin and novoimanine, antibiotic chemicals found in the plant’s flowers and leaves, are at least partly responsible for these antibacterial and healing properties. One German study showed that an ointment containing the herb reduced healing time dramatically and resulted in less scarring. First-degree burns healed within forty-eight hours, and third-degree burns healed three times faster without the usual formation of scar tissue.

A friend of mine verified St. John’s wort’s healing powers through personal experience. When her four-year-old son accidentally scalded his hand with boiling water, she immediately applied St. John’s wort oil to the site. The pain ceased, and he stopped crying. The redness cleared in a few days, with none of the blistering or scarring that generally follows such a burn.

St. John’s wort acts against a wide variety of bacteria. In one study, it was found to be more effective than the antibiotic sulfanilamide against the Staphylococcus (staph) bacteria responsible for many hospital epidemics. The bacterium that causes tuberculosis, the fungus Candida, and the gastrointestinal parasite Shigella have all responded to St. John’s wort. These findings are particularly important because of the increasing incidence of antibiotic-resistant strains of bacteria.

Anti-Inflammatory and Immune-Enhancing Actions

St. John’s wort has been used for centuries to reduce inflammation and to stimulate the immune system. Ointments containing the herb have been valuable tools for medics on the fields of battle until this century, when they were replaced by synthetic drugs. It appears that the flavonoid component in the herb is the main anti-inflammatory agent, although others contribute to its immune-enhancing activity. Russian researchers recently discovered that this complex herb contains substances that both stimulate and suppress immunity. This allows St. John’s wort to boost the ability of the immune system to fight infection, while at the same time decreasing the immune processes that promote inflammation in wounds and other injuries. Substances that can perform such balancing acts are called tonics, or adaptogens. A synthetic drug only has one active ingredient, so it simply can’t manage such a harmonious balancing of the body’s immune response. This is one of the main advantages of herbal remedies.

Someone who has learned about St. John’s wort’s immune-boosting powers is Renata.

Renata, a 38-year-old woman with severe chronic fatigue syndrome, was depressed and constantly exhausted. She consulted a doctor at a major university medical center, who simply recommended that she rest. Then, a clerk in a health food store suggested St. John’s wort in 300-milligram capsules. Renata took a capsule twice a day before increasing her intake to three times a day. Within a few weeks, her depression lifted and her energy began to return. By six weeks, not only was she free of symptoms, but she noticed that she did not get her regular attack of herpes in conjunction with her period, a common occurrence in susceptible women. Moreover, a year later, Renata is still taking St. John’s wort and remains completely symptom-free.

This case is a great illustration of St. John’s wort’s multiple functions. Renata’s experience is particularly remarkable considering the usual difficulty in treating herpes. (For more information on chronic fatigue syndrome, see Nutritional Approaches to Mental Health)

St. John’s wort and Cancer

There is promising research showing that St. John’s wort has anticancer effects. It also has been shown to be effective in preventing cell damage from radiation, including damage to delicate intestinal lining and bone marrow cells in test animals. I believe that if these results can be replicated in human beings, this herb could be used during radiation therapy as an additional, or adjunctive, treatment for the cancer itself, as well as for protection from radiation damage.

St. John’s wort is an excellent antidepressant that also provides a remarkable range of other healing properties. Its ability to fight viruses is giving new hope to patients with diseases as varied as herpes and AIDS, while its wound-healing and antibacterial actions can offer protection against the multitude of potentially dangerous organisms in the world around us. Even better, its complex structure allows it to balance the immune system, helping to control inflammation as it boosts the body’s ability to fight off disease. In the next chapter, I will explain how to use St. John’s wort.

The signs of vascular disease appear on the legs as loss of hair, thinning and atrophy of the skin, non-healing sores, or even blackened toes from gangrene, and pain on exercise. In the heart, the signs are pain or pressure in the chest, shortness of breath or unusual fatigue. It can also affect the brain, causing loss of memory and confusion, momentary lapses of consciousness (sometimes called a TIA, or transient ischemic attack), or eventually strokes.

One of the most effective treatments for arteriosclerosis is being ignored and even maligned by mainstream practitioners. This treatment is known as chelation therapy, and it has been a successful treatment for over forty years. What is chelation therapy all about?

EDTA (Ethylene diamine tetra acetic acid) is a synthetic amino acid which has the ability to attach itself to metals and minerals, forming a particular kind of bond called a chelate, from the Greek word for claw. Heavy metals have a great affinity for EDTA and form strong bonds.

In the 1950’s, EDTA was found to be an effective treatment for lead toxicity. In many cases, patients who coincidentally had symptoms of heart disease, such as angina, improved while undergoing treatment. Since that time, a number of studies have confirmed the effectiveness of chelation therapy for blood vessel disease, including improved blood flow to the heart, the legs and the brain. They have been published in reputable journals by experienced physicians and medical researchers.

Two events slowed down the growing use of EDTA in traditional medical settings. The patent on EDTA expired in the 1960’s. Drug companies no longer had incentives to pursue or finance studies on the drug. The development of the heart-lung machine allowing open-heart surgery paved the way for more mechanical solutions to heart disease. Coronary artery bypass surgery has become a multi-billion dollar industry, including numerous unnecessary procedures. Estimates are that 50-75% of the surgery being done is unnecessary. Other studies show that non-surgical treatment is better than surgery.

The exact action of EDTA in improving blood vessel disease is not clear, and it probably works by several mechanisms. One effect of EDTA is to bind calcium in the blood stream, and alter the intracellular balance of calcium with magnesium. Calcium accumulates inside the cells with age, and this excess can disrupt enzyme systems. Pushing more magnesium into cells allows them to relax, and this opens up the circulation. There are also several other potential mechanisms of action.

One theory of aging and degenerative disease is the “free-radical theory.” Free radicals are highly active molecular fragments formed during the production of energy in the cells. They have high energy, like sparks in a fireplace, and this energy can be used by the body, when properly handled. However, if these free radicals get out of control they can cause damage to surrounding tissues, just as sparks that get out of the fireplace can cause the rug to catch fire. Excess free radicals contribute to the obvious signs of aging such as wrinkling and loss of elasticity of the skin, and the deposition of age pigment (commonly called liver spots). Internal damage, such as heart disease and cancer, is less visible but even more serious.

In addition to the formation of free radicals in the body, you are exposed to them in the environment. They are found in cigarette smoke in high amounts, and also in polluted air. (Large numbers of people who do not smoke have been found to have significant levels of cotinine, a nicotine derivative, in their blood, in most cases even if they do not live with a smoker. ) Free radicals are produced by radiation and rancid oils, by hydrogenated oil such as those found in margarine and shortening, and by ultraviolet light, and many therapeutic drugs increase metabolism and the action of liver enzymes that can increase free radicals.

Heavy metals cause direct toxicity to tissues, poisoning enzyme systems and especially affecting the nervous system. One of the most interesting properties of EDTA is the removal of lead and other metals. Iron is a transition metal, and it accumulates in the body with age and dietary excess, especially from meat. Excess accumulation of iron leads to the production of free radicals. Heavy metals are directly toxic. Removal of iron and heavy metals with chelation is thought to help prevent and reverse the tissue damage of a variety of diseases, including vascular disease.

Free radicals, with their high energy levels, are thought to contribute to the development of heart disease, cancer, arthritis, and certain immune system disorders. A study in Zurich, Switzerland showed a markedly lower incidence of cancer among patients who had received chelation therapy. This makes a strong case for chelation inhibiting free radicals.

For protection from free radicals, your body has a number of defenses. You produce enzymes that are free radical scavengers, such as superoxide dismutase, glutathione peroxidase, and catalase. These require trace mineral cofactors such as zinc, manganese, selenium, and copper. Many other nutrients are also anti-oxidant free-radical scavengers. These include vitamins C and E, beta-carotene, bioflavonoids and other plant pigments, coenzyme Q10, and sulfur-containing amino acids such as cysteine and methionine. These protect you from aging and degeneration. A comprehensive approach to treatment is more effective than any one treatment alone. This includes diet, exercise and stress management, as well as dietary supplements.

The nutritional components of a treatment program using EDTA chelation play several roles. One is the above-mentioned supportive role in the free-radical scavenging activity of chelation. Other nutrients act to help with vascular disease in different ways. For example, the B-vitamins folic acid, pyridoxine (B6), cobalamin (B12), and betaine help to lower blood levels of homocysteine, a metabolite implicated in higher rates of vascular disease. Coenzyme Q10 also helps directly with heart muscle function and lowering blood pressure. Hawthorne berry extracts act similarly. Supplements of the amino acid taurine help to increase the strength of the heart muscle.

Another role of dietary supplements is to replace those that are removed by the chelation itself. Because EDTA binds with minerals, it removes some of those that you want to keep. Chelation treatments remove large amounts of zinc and manganese, and these need to be replaced with supplements in order to assure the safety of chelation treatment. Chelation reduces vitamin B6 levels, and supplements help are essential.

Although most patients are treated with chelation for vascular disease, it has many other benefits, as well as a value as preventive medicine. Specific benefits are found in diabetic arterial disease, macular degeneration, decreased mental function from vascular disease, osteoporosis, intermittent claudication (leg pain on exercise), scleroderma, and other conditions.

There have been no serious side effects from EDTA-chelation treatment since the 1950’s, when it was first being administered. We have learned much about the treatment since then, and it is now safely administered by physicians trained by the American College for Advancement in Medicine (ACAM). There is a specific, safe protocol for EDTA-chelation administration.

Doctors critical of chelation therapy are usually unfamiliar with the literature and have no experience with the treatment in practice. Studies are in the design and production phases to further document the value of chelation for these controversial uses. A protocol sanctioned by the FDA was being conducted at army hospitals but for a variety of reasons it was stopped. Other studies have also been mysteriously blocked when they were well on their way to implementation.

The recent (1994) study from New Zealand on chelation and peripheral vascular disease does not discredit chelation therapy, although that was the conclusion of the authors. In that small study, which was mainly of smokers with severe disease, the “placebo” group actually received effective intravenous chelating agents-vitamin B1 and vitamin C–although weaker than EDTA. Sixty per cent of both groups improved. That is a large number for placebo effect, and argues that the control group received some effective agents. In five of the evaluations, the EDTA group did significantly better than the control group after only 20 treatments-too few for smokers with severe disease. None of the tests were better in the control group. Even the conservative Harvard Heart Letter said that “this study is unlikely to lay the chelation controversy to rest,” and rightly so, since the results showed benefits from chelation. (Statistically, there was one “outlier” in the control group. Removing his aberrant results from the evaluation, shows that the EDTA group did remarkably better than the controls.)

For further information, I recommend Bypassing Bypass by Elmer Cranton, MD, an in depth look at chelation with a chapter on free radical theory. My own booklet on the subject is shorter but still gives a good overview. It will be a Good Health Guide published by Keats Publishing when it comes out in June of 1998.

Heart disease is the number one killer in America. Bypass surgery is expensive and risky, and has not been shown to be of clear benefit for the majority of patients who have bypasses. It is important to consider the value of chelation therapy, which has so many direct and side benefits with so few negative side effects. If you have vascular disease, it would be worthwhile to look for a doctor who does chelation therapy as part of a comprehensive approach to treatment. You can find one through the American College for Advancement in Medicine (800-532-3688, or on the web at http://www.acam.org).

Michael Janson, M.D. is the Past President of both the American College for Advancement in Medicine (ACAM), and the American Preventive Medical Association (now the American Association for Health Freedom), and he is a charter member of the American Holistic Medical Association. He is the author of The Vitamin Revolution in Health Care (1996, Arcadia Press), Chelation Therapy and Your Health, All About Saw Palmetto and Prostate Health, and Dr. Janson’s New Vitamin Revolution. He publishes a
monthly newsletter, Dr. Michael Janson’s Healthy Living, available for free by Email (newsletter@drjanson.com). Dr. Janson is an international professional speaker on the subject of health and nutrition, dietary supplements and alternatives in medicine.
He practices in Arlington, Massachusetts (781-641-1901). You can find more information at his website: http://www.drjanson.com.

2 Meltzer LE; Ural E; Kitchell JR. The Treatment of Coronary Artery Heart Disease with Disodium EDTA, Metal-Binding in Medicine, 132, Seven MJ (Ed), 1960, JB Lippincott Philadelphia.

3 Cranton EM; Frackelton JP. Current Status of EDTA Chelation Therapy in Occlusive Arterial Disease, J Adv Med, Spring/Summer 1989, 2(1/2):107-19.

4 Chappell LT, Stahl JP. The correlation between EDTA chelation therapy and improvement in cardiovascular function: a meta-analysis. J Adv Med 1993; 6: 139-160.

5 Olszewer E, Carter JP. EDTA chelation therapy in chronic degenerative disease. Med Hypoth 1988; 27:41-49.

6 Casdorph HR. EDTA chelation therapy: efficacy in arteriosclerotic heart disease J Hol Med 1981; 3:53-59.

7 Graboys TB, Biegelsen B, Lampert S, Blatt CM, Lown B. Results of a second-opinion program for coronary artery bypass grafting surgery. JAMA 1987; 258: 1611-1614.

8 CASS principal investigators, et al., Coronary Artery Surgery Study (CASS): Circulation, Nov 1983; 68(5);939-950

9 Cranton EM, Frackelton JP. Free radical pathology in age-associated diseases: treatment with EDTA chelation, nutrition and antioxidants. J Hol Med 1984; 6: 6-37.

10 Pirkle JL, et al. Exposure of the US population to environmental tobacco smoke: the Third National Health and Nutrition Examination Survey, 1988 to 1991. JAMA, 1996 Apr 24; 275(16):1233-40

11 Blumer W, Cranton EM, Ninety percent reduction in cancer mortality after chelation therapy with EDTA. J Adv Med 1989; 2:183

12 Selhub J, et al. Association between plasma homocysteine concentrations and extracranial carotid-artery stenosis. N Engl J Med 1995 Feb 2;332(5):286-91

13 Langsjoen P, et al. Treatment of essential hypertension with coenzyme Q10. Mol Aspects Med 1994;15 Suppl():S265-72

14 Fujita T, Sato Y, The hypotensive effect of taurine. J Clin Invest 1988 Sep;82(3):993-7

15 Cranton EM; ed: A textbook on EDTA chelation therapy. J Adv Med 1989; 2: 1-416.

16 Ibid.

17 van Rij AM, et al., Chelation therapy for intermittent claudication. A double-blind, randomized, controlled trial. Circulation, 1994; 90:1194-1199

Among the many medicinal herbs used throughout the long history of Occidental
culture, St. John’s wort, Hypericum perforatum L., has always been
and still is of great interest. From the time of the ancient Greeks down
through the Middle Ages, the plant was considered to be imbued with magical
powers and was used to ward off evil and protect against disease. As a practical
folk-remedy, it has been used widely to heal wounds, remedy kidney troubles,
and alleviate nervous disorders, even insanity.

In the last thirty years Hypericum perforatum has undergone extensive
clinical and laboratory testing. The present article reviews the plant’s
botany, history of use, chemistry, pharmacology, pharmacodynamics, medical
uses, and preparations.

Botany

Taxonomy and Description
St. John’s wort is a member of the genus Hypericum, of which there are 400 species worldwide.
There is some disagreement as to the plant’s family, some placing Hypericum in the segregate family Hypericaceae, while others place it in the family Guttiferae. However, most researchers now think that the
morphological and chemical differences of the two families are insufficient to justify separating them (1,2).

The plants are described as glabrous perennials, erect and usually woody at the base. The ovate to linear
leaves are sessile, opposite, and well-supplied with translucent glandular dots. The regular flowers have five
short, subequal, entire, imbricate, basally connate sepals, and five persistent-withering yellow petals. The
ovary is superior, capsicular, and three-styled. Stamens are many, arranged in bundles of threes, and the
flowers are profuse, arranged in branched cymes which bloom from June until September. In the absence of
insect pollination, apomixis commonly occurs.

St. John’s wort should not be confused with rose of sharon (H. calycinum), a common
ornamental ground-cover in the United States. Rose of sharon flowers and leaves are much larger than those
of St. John’s wort (though interestingly, anti-biotic substances have been extracted from H.
calycinum that are similar in activity to substances in H. perforatum (3).

Range and Habitat

St. John’s wort is native to Europe, West Asia, North Africa, Madeira and the Azores, and is naturalized in
many parts of the world, notably North America and Australia (4,5). The plant spreads rapidly by means of
runners or from the prodigous seed production and can invade pastures, disturbed sites, dirt roads, the sides
of roads and highways, and sparse woods.

In the western United States, St. John’s wort is especially prevalent in northern California and southern
Oregon, hence one of its common names, “Klamath Weed”. Because of the known photosensitizing
properties of the plant, which can be toxic to cows and sheep, it has been considered a pest in some places.
Prior to 1949, it was estimated to inhabit 2.34 million acres of rangeland in northern California. For years
an attempt was made to control the plant with herbicides6, but with little success.

The solution to the problem with St. John’s wort in northern California finally proved to be with biological
methods of control, not pesticides. In 1946, the leaf-beetles Chrysolina quadrigemina Rossi, and to
a lesser extent C. hyperici Forst, were introduced from Australia, where it had been observed that
they had a voracious appetite for Hypericum. Their appetite proved to be so voracious, in fact, that
by 1957 northern California’s stands of St. John’s wort were reduced to only 1% of their original number (5).

Ironically, however, at the time of release of the Chrysolina beetles in California, it was not known
that herbalists would one day keep Hypericum populations well under control.

Etymology of Nomenclature

The name Hypericum is ancient and may have several derivations. Yperikon was first
mentioned by Euryphon, a Greek doctor from 288 BC (7). Pliny called the ground pine Hyperikon,
though also chamaepitys and corion (8). One common explanation for the name
Hypericum is that it may derive from ereike (heather) and hyper (above) (9). However,
although one Greek species of Hypericum looked similar to heather (though it grew taller), it seems
more likely that the name derives from eikon (a figure, possibly an unwanted apparition) and
hyper (above), which relates to the ancient use of St. John’s wort to exorcise evil spirits or
influences (10), since the plant may have been placed over religious icons as a symbol of protection. Linnaeus,
who described the genus, thought that Hypericum came from yper (upper) and eikon
(an image) (vv11).

The common name, St. John’s wort, is obviously a reference to St. John. Its earliest use may date back to the
6th century AD when, according to Gaelic tradition, the missionary St. Columba always carried a piece of
St. John’s wort because of his great regard for St. John (12). Some early Christian authors claimed that red
spots, symbolic of the blood of St. John, appeared on leaves of Hypericum spp. on August 29, the
anniversary of the saint’s beheading, while others considered that the best day to pick the plant was on June
24, the day of St. John’s feast (10). In the Christian tradition, St. John represents light, hence the flowers were
taken as a reminder of the sun’s bounty (13).

History of Use

Dioscorides, the foremost herbalist of the ancient Greeks, mentions four species of Hypericum–
–Uperikon, Askuron and Androsaimon, and Koris–which he recommends
for sciatica, “when drunk with 2 heim of hydromel (honey-water).” He also claims that it “expels many
cholerick excrement, but it must be given continuously, until they be cured, and being smeared on it is good
for ambusta (burns).” H. crispum and H. barbatum, he writes, have “a diuretical facility….and
of moving ye menstrua. The seed being drunk for 40 days drives away tertians and quartans (fevers occurring
every 3 or 4 days, possibly malaria)” (14).

Theophrastus recommends H. lanuginosum, a Greek species, for external application, while Pliny
says it should be taken in wine against poisonous reptiles. H. coris, another Greek species, was
mentioned by Hippocrates and Pliny (15). Although many older authors attest that the ancients knew of
Hypericum as Fuga daemonum and used it to drive away demons, none make reference to
any specific writers (16). Dioscorides, Pliny, and Theophrastus do not mention either this name or this use of
the plant, but herbalists from the 16th and 17th centuries commonly mention the name.

In the early humoral system of medicine, Galen considered Hypericum to be hot and dry, while
Paracelsus wrote of the plant in the early 1500’s that it could be used as an amulet against enchantments and
apparitions (17). St. John’s wort was used in early pre-Christian religious practices in England, and it has
many legends written about it (18). For instance, one belief was that bringing the flowers of St. John’s wort
into the house on a midsummer eve would protect one from the evil eye, banish witches, etc. Another belief
was that that if one slept with a piece of the plant under one’s pillow on St. John’s Eve, “the Saint would
appear in a dream, give his blessing, and prevent one from dying during the following year” (17). The favor St.
John’s wort enjoyed is well expressed in the following poem (19):

St. John’s wort doth charm all the witches away.

Round your neck a charm of a similar kind.

Several noted English herbalists, reflecting the general beliefs of their time, wrote very favorably of the
virtues of St. John’s wort. For instance, Gerard (ca. 1600) tells of the ointment he made of the plant as being
a “most precious remedy for deepe wounds”, and adds that “there is not a better natural balsam….to cure any
such wound” (20).

Culpeper (ca. 1650), who was fond of ascribing astrological signs to medicinal herbs, says that
Hypericum “is under the celestial sign Leo, and the dominion of the Sun.” He goes on to say that “it
is a singular wound herb, healing inward hurts or bruises,” and that as an ointment “it opens obstructions,
dissolves swelling and closes up the lips of wounds.” Also, he claims it is good for those who “are bitten or
stung by any venomous creature, and for those that cannot make water”–which use modern science
confirms–and adds that the plant helps with “sciatica, the falling sickness and the palsy” (21).

Other early uses of Hypericum include as an oil (made by macerating the flowering tops of the plant
in oil and then placing them in the sun for two or three weeks), which was “esteemed as one of the most
popular and curative applications in Europe for excoriations, wounds, and bruises” (22). This preparation was
even used by the surgeons to clean foul wounds, and was official in the first London Pharmacopeia as
Oleum Hyperici (23).

Other popular folk-uses for St. John’s wort have included: as a decoction for gravel and ulcerations of the
ureter (24); for ulcerations of the kidneys, febrifuge, vermifuge, jaundice, gout, and rheumatism (25); as an
infusion (1 ounce of herb to 1 pint water) for chronic catarrhs of the lungs, bowels, or urinary passages; and
as a warm lotion on injuries to the spinal cord, for lacerated or injured nerves, bed sores, and lock-jaw (26).

The native American Indians used several indigenous species of Hypericum as an abortifacient,
antidiarrheal, dermatological aid, febrifuge, hemostat, snake bite remedy, and general strengthener. After St.
John’s wort was introduced by European settlers, they used it as well for similar conditions (27,28).

As for the young United States, St. John’s wort was not well-known and was rarely mentioned by prominent
writers on the subject of medicinal plants. One of the first references to the plant is from Griffith (1847),
who says it can be used as an oil or ointment for ulcers, tumors, and as a diuretic (29). Even the Eclectics,
medical doctors from the late 1800’s and early 1900’s who favored herbs in their practice, did not use St.
John’s wort much.

Nonetheless, King, in his Dispensatory (1876), mentions its use in urinary affections, diarrhea,
worms, jaundice, menorrhagia, hysteria, nervous imbalances with depression, and its usual external
applications, including the use of the saturated tincture as a substitute for arnica, in bruises (30). In the later
Felter-Lloyd revision of King’s Dispensatory, tincture of St. John’s wort, in a dose of 10-30 drops
mixed with 4 ounces of water, taken in teaspoonful doses every 1-2 hours, is prescribed for spinal irritation,
shocks, concussions, puncture wounds, and hysteria (31).

Today, modern American herbalists still use St. John’s wort for many of the same conditions for which it has
been recommended throughout the ages (32,33).

Chemistry

The genus Hypericum has an exceedingly complex and diverse chemical makeup. H.
perforatum has been most intensively studied, but there is data available on 66 other species (34). The
compounds that have been identified from H. perforatum can be divided into several classes, which
are summarized along with their pharmacological activity in Table 1.

Table 1. Summary of Constituents and Activity from Hypericum perforatum

The hyperin and tannin content of H. perforatum is higher at growth temperatures above 14
degrees C. (tannin, 15.06% of dry weight) than below (13.42%). Both hyperin and rutin content is higher in
dry conditions (1.25% and 2.32% respectively) than wet conditions (no figure given and 1.89%,
respectively). Hyperin content is highest at 7pm (84). Total tannin content is highest when the buds are
forming, just prior to flowering, in June (85,86).

Higher amounts of flavonoids, including rutin, quercetin, and hyperin occur in plants of northern slopes
with few generative shoots (87). Flavonoid content (rutin, hyperin, quercetin, and quercitrin) is highest in the
leaves of St. John’s wort, and is at maximum concentration during full bloom. In the flowers, the content of
flavonoids is highest at the start of flowering, falling sharply during flowering (88).

St. John’s wort (flowers) had the highest content of flavonoids (11.71%) of any of 223 species tested (89).

Pharmacology

Extracts of the flowering tops of Hypericum perforatum have shown a variety of effects in the
laboratory, including psychotropic activity, wound and burn-healing activity, bactericidal effect against
pathogens in pyelitis and cystitis, anti-viral effects, sunscreen activity (disputed), antidepressive activity,
and diuretic, anthelmintic, and mildly uterotonic activity (90, 91, 92). Although much more work needs to be
done to validate the use of St. John’s wort for the many uses it finds in clinical and common practice, there
are a few laboratory studies which corroborate its use for some of these conditions and point the way for
further research.

Following is a summary of the laboratory work that has been conducted on the pharmacological effects of
St. John’s wort extract or oil.

Anti-depressive and Psychotropic Activity

Among the most common psychiatric illnesses today are depression, mania, (abnormal elation with
irritability), bipolar affective disorder, characterized by swings between depression and mania, and
schizophrenia. One of the best-known (but contoversial) theories hypothesizes that depression is caused by
deficiency or decreased effectivness of norepinephrine and serotonin, acting as nerve-impulse transmitting
substances (neurotransmitters), in particular nerve pathways. One method for treating depression uses the
monoamine oxidase (MAO) inhibitors which retard one of the enzymes responsible for monoamine (a
precursor) breakdown, increasing the concentration of neurotransmitters in the central nervous system (93,
94).

Because of St. John’s wort’s history of use for psychiatric conditions, it was tested for MAO inhibiting
activity. Suzuki, et al. (1984), in an international effort, first demonstrated that xanthones, common in the
Guttiferae (the family of St. John’s wort) and the Gentianaceae (Gentian family), inhibit both type A and B
monoamine oxidase. Among these is the compounds isogentisin, which has been found in some species of
Hypericum, but not H. perforatum (95, 96). A further study by the same group found that
hypericin from H. perforatum irreversibly inhibits type A and B MAO in vivo. The authors
stress, however, that although this study is suggestive, no definite conclusion can be drawn yet regarding St.
John’s wort’s antidepressant activity (97).

A standardized (hypericin) extract of H. perforatum has been tested in various animal models
generally used for determining antidepressant activity, and has been found to enhance the exploratory
activity of mice in a foreign environment, extended the narcotic sleeping time dose-dependently, and has
shown reserpine antagonism and decreased aggressive behavior in socially isolated male mice (98).

Muldner and Zoller (1984), in a clinical trial with 6 depressive women, 55-65 years old, measured
smetabolites of noradrenaline and dopamine in the urine, and found that after taking a standardized
hypericin extract, there was a significant increase in 3-methoxy-4-hydroxyphenylglucol, a marker for the
beginning of an antidepressive reaction. The same research team, working with 15 women taking a standard
hypercin extract, demonstrated an improvement in symptoms of anxiety, dysphoric mood, loss of interest,
hypersomnia, anorexia, depression (worse in the morning), insomnia, obstipation, psychomotoric
retardation, and feelings of worthlessness. They reported no side-effects (99).

Wound and Burn Healing

In a number of studies St. John’s wort extracts have demonstrated anti-bacterial and wound-healing activity.
For instance, two widely prescribed Russian preparations of Hypericum, novoimanine and imanine,
have been tested for Staphylococcus aureus infection in vivo and in vitro, and been
found to be more effective than sulfonilamide (100, 101, 102). Hyperforin, a bicyclic tetraketone from H.
perforatum, is reported to be a main antibiotic constituent of novoimanine (103).

One German patent mentions that an ointment containing an extract of St. John’s wort flowers shortened
healing time of burns and showed antiseptic activity (104). According to the report, first degree burns healed
in 48 hours when treated with the ointment, while second and third degree burns healed without keloid (a
type of scar tissue) formation three times faster than burns treated by conventional methods.

Other reports include that a freeze-dried St. John’s-wort extract suppressed inflammation and leukocyte
infiltration in vivo (105), and that St. John’s wort oil has been used in commercial products as a sun
screen. However, reports of its efficacy in this latter regard are contradictory (106, 107).

Anti-viral Effects

International interest increased in St. John’s wort after researchers from New York University medical center
and the Weizmann Institute of Science in Israel demonstrated that two compounds from the plant strongly
inhibit a variety of retroviruses in vitro and in vivo (108). Several points bear citing from their
report:

• “When the compounds interact with the infecting particles shortly after in vivo administration,
  disease is completely prevented.”
• “Preliminary in vitro studies with pseudohypericin indicate that it can
  reduce the spread of HIV.”
• The total yield of hypericin and psuedohypericin from H.
  triquetrifolium Turra was 0.04%.
• The compounds were still effective when administered orally or
  i.p. within 1 day of infection.
• No serious toxic side effects were noticed after testing over 800 mice
  with the compounds. Administration of the compounds did not result in abnormalities in any of a wide
  variety of clinical tests performed on the animals.
• Hypericin shows toxicity to some human cells at very
  high concentrations (>10 ug/ml, or lower for some cell types). Pseudohypericin is less toxic. Fortunately,
  the compounds show remarkable antiviral potency “after one administration of a relatively small dose of the
  compounds.”
• “The compounds directly inactivate the virions or interfere with assembly or shedding of
  assembled viral particles.”
• “The compounds can cross the blood-brain barrier” (important for HIV
  infection).

One word of caution, however: although Hypericum extracts appear promising for the treatment of
retroviral infections, including HIV, it must be stressed that there has been no clinical evidence of its
efficacy in humans to date (for HIV infection), and several questions remained unanswered. For instance,
there is no information about the concentration needed for efficacy, even if the compounds are effective in
HIV infection in humans. Furthermore, if a large concentration is effective, is it close to the
photosensitizing dose? Also, it must
be pointed out that the total content of these two compounds in Hypericum is quite low (dried H.
perforatum has been reported to contain 0.24% hypericin109), consequently, a standardized extract (to
hypericin content) may be the surest way to administer the plant for viral therapy.

Clinical Applications

Clearly, the potential scope of clinical application of St. John’s wort is extensive. However, if one narrows the focus down to those activities that are most mentioned, such as anti-bacterial, anti-phlogistic, diuretic,
and anti-depressive, specific clinical applications become more restricted.

In modern European medicine, St. John’s wort extracts are included in many over-the-counter and
prescription drugs for mild depression, and have clinical application for bed-wetting and nightmares in
children. The extract is included in diuretic preparations, and the oil is taken internally by the teaspoon to
help heal gastritis, gastric ulcers, and inflammatory conditions of the colon (using a retention enema) (110).
The oil is also used extensively in burn and wound remedies, externally.

Table 2, taken from the German Health Department’s official monograph on St. John’s wort (1984),
summarizes the current clinical applications of the plant (105,106).

Table 2. Clinical Indications for St. John’s wort
Herb source: flowers of Hypericum perforatum, “gathered during the time of blooming or of the
dried parts above the ground, as well as their preparations, in effective dosages.”

Clinical applications: Internally: “psychovegetative disturbances, depressive states, fear and/or
nervous disturbances. Oily hypericum preparations during dyspeptic disturbances.” Externally:
“Oily hypericum preparations for the treatment or after treatment of sharp or abrasive wounds, myalgias
(muscular pain) and first degree burns.”

Contraindications: “None known.”
Side effects: “Photosensitization is possible, especially in light skinned people.”
Interference with other drugs: “None known.”
Dosage schedule: Average daily dose recommended is 2-4 grams of the powdered herb, or 0.2-1.0 g
hypericin as a powdered extract.
Method of use: “Cut or powdered plant, liquid and solid forms for oral administration. “Liquid and semi-
solid forms for external use.”
Effects: Mild anti-depressant action (monoamineoxidase [MAO] inhibitor), oily preparations have
antiphlogistic activity. “Diuretic activity,…direct effect on smooth musculature.”

Toxicity

Besides its long history of use as a medicinal plant, St. John’s wort is also known as a photosensitizing
plant that can cause sickness and even death in grazing animals (when large amounts are eaten), particularly
cattle, sheep, horses, and goats, but also rabbits and rats111. This toxic activity of St. John’s wort was first
noted in the literature by Cirillo (1787), and since then, there have been many papers published, and the
effect mentioned numerous times (112). The plant, however, does not seem to be a major threat to livestock,
because the first symptoms of Hypericum intoxication includes loss of appetite, which makes the
absorption of the photodynamic pigment, hypericin, self-limiting (113).

In the case of Hypericum toxicity, the compound hypericin is absorbed from the intestine and
concentrates near the skin. When the skin of the animal is exposed to sunlight, an allergic reaction takes
place. Oxygen is necessary for the photodynamic hemolysis, leading to tissue damage. In the absence of
sunlight, a reaction will not occur, and the compound does not show particular toxicity. (114, 115) This first
type of reaction is called ‘primary photosensitization’ (116). Another, more serious type, is secondary
photosensitization, where the liver and other internal organs can be damaged (117).

Cattle appear to be more sensitive to the phototoxicity of hypericin than sheep. In one test with cattle, a
single dose of 1 g per kg bodyweight of dried Hypericum showed no photosensitization or changes
in liver enzymes, but 3-4 g did. If humans were as sensitive to hypericin as cattle, this dose would correlate
to 59 gms for a 130 lb individual. Importantly, hypericin does not seem to be accumulative. (118)

Although there have been a considerable number of studies published demonstrating the phototoxicity of
hypericin in various animal species (119, 120), a thorough search by this writer brings to light no evidence that
there has ever been a case involving human toxicity.

Some authors recommend caution when using large quantities of St. John’s wort extract for medicinal uses,
particularly for people with fair skins, who should not expose themselves to strong sunlight during
Hypericum therapy (121). Judging by the available literature, a very moderate dose, up to 4 g of the
dried herb, 30 ml of the 1:5 tincture (40% EtOH), or 240 grams of the 1:5 powdered extract per day
(standardized to 0.125% hypericin), should not pose a problem, if sunlight restriction is followed (122, 123),
especially given the widespread use of H. perforatum extracts in Europe. One major product is
recommended by the manufacturer to be taken as 40 mg tablets (1-2 tablets, 3 times a day).

Preparations

Hypericin was more effectively extracted with glycol and sunflower seed oil when the moisture content of
the herb was between 50 and 70%, and 2-7 times higher at 70 degree C. than at 20 degree C. The menstruum
was saturated after 12 hours and 24 hours respectively, but it took 3-4 extractions to exhaust the herb (124).
The total extraction in one hour of hypericin with ethanol was not dependent on water content of the herb.
The authors conclude that ethanol is the most suited menstruum for the extraction of dried material (125).

Freshly air-dried herb was moistened to 70-72% moisture and extracted at 70 degree at 1:7 with sunflower
seed oil. The total content of hypericin was 2.5 mg%, and extracting the marc with ethanol could increase
the content to 3.32 mg% (a 25% increase)(126).

Hypericin content of a juice of H. perforatum and a powdered extract dropped by 14% during 1 year,
and the dry extract remained stable, when stored at 20 degree C. When stored at 60 degree C., the hypericin
content dropped 33%, 33%, and 47% from a powdered extract, tablets, and liquid juice, respectively (127).

In one extensive study, up to 80% of the hypericin was destroyed by drying of the fresh plant in
sunlight (128). For this reason, modern herbalists generally grind the fresh tops of Hypericum
and immediately macerate them in olive oil or sunflower seed oil. The oil is then pressed and filtered after
two weeks, and should be stored in amber bottles away from heat and light. An alcoholic tincture is made in
the same way, macerating the fresh, ground tops in 70% ethyl alcohol and 30% distilled water.

St. John’s wort is currently official in the pharmacopeias of Czeckoslovakia, Poland, Roumania, and Soviet
Union (129).

Identification and Adulteration

For identification of cut and sifted material from the commercial drug market, note the two opposite ridges
on the stems. These are prominent, and an important character in differentiating different Hypericum
species (see Fig. 1).

Ideally, the commercial drug should consist mostly of flowering tops, but in common practice the whole
above-ground plant with a considerable quantity of stem may be present. Flowers that are present should
consist of 70-90% (or more) with immature capsules, otherwise the plants may have been harvested too late
in the season. The hypericin content declines immediately after anthesis (flower maturity and pollination).

The leaves, when observed with a 10X hand lens, should be characterized by many punctate glands, clearly
distinguishable by holding them up to a light source. The flowers will all contain fragments of the persistent
dried petals, which may have red glands (appearing black) around the perimeter.

The taste (and smell) of St. John’s wort is characteristicly slightly sweet, bitter, and astringent.

A commercial oil or tincture of Hypericum should be vivid, almost fluorescent red. If the preparation
is pale red to pink, the hypericin content, and thus the quality of the product, is suspect.

Several methods are given in the literature for the TLC and HPLC identification of hypericin (130, 131, 132,
133, 134, 135, 136, 137, 138), and Katalin et al (1982) report on the histological examination of St. John’s
wort leaves (139).

Since tannins play a role in the therapeutic action of St. John’s wort extracts, standardization with this
fraction has been recommended (liquid extract containing 1% tannins) (140).

Literature
Review: An earlier review (1969) covers the history, development and photodynamic effect, chemical
constituents, synthesis of hypericin, pharmacology and uses with 127 references (in German)
141.

1. Robson, N.K.B. 1977. Bull. Br. Mus. (Nat. Hist.), Botany 5:293.

2. Taskhtajan, A.L. 1980. Bot. Rev. 46: 225.

3. Shakirova, K.K., et al. 1970. “Antimicrobial properties of some
species of St. John’s wort cultivated in Uzbekistan,” Mikrobiol. Zh. (Kiev) 32: 494-7 (CA 74: 34570d).

4. Hickey, M. & C. King. 1981. 100 Families of flowering plants, Cambridge University Press, Cambridge.

5. Wichtl, M. 1986. “Hypericum perforatum L. –Das Johanniskraut”, Zeitschrift fur Phytotherapie
3: 87-90.

6. Campbell, M.H., et al. 1979. “Effect of time of application of herbicides on the long-term
control of St. John’s wort (Hypericum perforatum var. angustifolium),” Aust. J. Exp. Agric. Anim.
Husb. 101: 746-8.

7. Pickering, C. 1879. Chronological History of Plants, Little, Brown & Co., Boston.

8. Jones, W.H.S. 1964. Pliny–Natural History v. VI: 8, 53. Harvard University Press, Cambridge.

9. Bailey,
L.H. 1930. The Standard Cyclopedia of Horticulture, Macmillan, London.

10. Fernie, W.T. 1897. Herbal
Simples, John Wright & Co., Bristol.

11. Jaeger, E.C. 1972. A Source-Book of Biological Names and
Terms. Charles C. Thomas, Springfield, IL.

12. Vickery, A.R. 1981. “Traditional uses and flolklore of
Hypericum in the British Iles”, Economic Botany 35: 289-295.

13. Fernie, Herbal Simples.

14. Gunther, R.T. 1933. The Greek Herbal of Dioscorides, Hafner Pub. Co. (1968).
15. Pickering, op cit.

16. Vickery, op cit.

17. Alleyne, J. 1733. A New English Dispensatory, Tho. Astley, London.

18. Pratt, A. 1898.
The flowering plants, grasses, sedges, and ferns of Great Britain, Frederick Warne & Co., London.

19. Vickery, op cit.

20. Gerard, J. 1633. The Herbal. Revised and enlarged by T. Johnson, reprinted by Dover
Publications, NY (1975).

21. Culpeper, N. 1847. The Complete Herbal, Thomas Kelly, London.

22. Fernie,
op cit.

23. State Historical Society of Wisconsin. 1944. Pharmacopoeia Londinensis of 1618 reproduced in
facsimile, Madison.

24. Hill, J. 1808. The Family Herbal, C. Brightly & T. Kinnersley, Bungay.

25. Greene,
T. 1824, The Universal Herbal, Caxton Press, London.

26. Fernie, op cit.

27. Moerman, D.E. 1986.
Medicinal Plants of Native America. University of Michigan Museum of Anthropology, technical reports,
number 10, Ann Arbor.

28. Vogel, V. 1970. American Indian Medicine, University of Oklahoma Press,
Norman.

29. Griffith, R.E. 1847. Medical Botany, Lea & Blanchard, Philadelphia.

30. King, J. 1876. The
American Dispensatory, 10th ed., Wilstach, Baldwin & Co., Cincinnati.

31. Felter, H.W. & J.U. Lloyd.
1898. King’s American Dispensatory, 18th ed., reprinted by Eclectic Medical Publications, Portland, OR.

32. Lust, J. 1974. The Herb Book. Bantam, NY.

33. Moore, M. 1979. Medicinal Plants of the Mountain
West, Museum of New Mexico Press, Sante Fe.

34. Kitanov, G.M. & K.F. Blinova. 1987. “Modern
state of the chemical study of species of the genus Hypericum.” Chemistry of natural compounds 23:
151-66.

35. Brockmann, H., et al. 1974. “Zur isolierung und konstitution des
pseudohypericins,” Tetrahedron Lett. 23: 1991-4.

36. Dorossiev, I. 1985. “Determination of
flavonoids in Hypericum perforatum,” Pharmazie 40: 585-6.

37. Mathis, C. & G. Ourisson. 1963.
“Etude chimio-taxonomique du genre Hypericum,” Phytochemistry 2: 157-171.

38. Okpanyi,
S.N. & M.L. Weischer. 1987. “Experimental animal studies of the psychotropic activity of a
Hypericum extract,” Arzneim.-Forsch 37: 10-13.

39. Meruelo, D., et al. 1988. “Therapeutic
agents with dramatic antiretroviral activity and little toxicity at effective doses: Aromatic polycyclic diones
hypericin and pseudohypericin,” Proc. Ntl. Acad. Sci. 85: 5230-34.

40. Kitanov, G. 1983.
“Determination of the absolute configuration of ctechins isolated from Hypericum perforatum,”
Farmatsiya (Sofia) 33: 19-22 (CA 99:50290j).

41. Wichtl, op cit.

42. Derbentseva, et al. 1972. “Effect
of tannins from Hypericum perforatum on influenza viruses,” Mikrobiol. Zh. (Kiev) 34: 768-72.

43.
Karryev, M.O. & N.F. Komissarenko. 1980. Izv. Akad. Nauk Turkm. SSR, Ser. Biol. Nauk 1980: 52-7. (CA
93: 182809w).

44. Dorossiev, I, op cit.

45. Stoyanova, A., et al. 1987. “Thin-layer chromatography of
extracts of Hypericum perforatum,” Farmatsiya 1: 8-13 (CA 107:205272q).

46. Hoelzl, J. & E.
Ostrowski. 1987. “St. John’s wort (Hypericum perforatum L.) HPLC analysis of the main components
and their variability in a population,” Dtsch. Apoth. Ztg. 127: 1227-30 (CA 107:112686).

47.
Berghoefer, R. & J. Hoelzl. 1987. “Biflavonoids in Hypericum perforatum. Part 1. Isolation of 13,II8-
biapigenin,” Planta Med. 53: 216-17.

48. Koget, T.A. 1972. “Determination of the amount of
quercitrin in Hypericum perforatum,” Khim. Prir. Soedin. (2): 242-3 (CA 77:45514b).

49.
Maksyutina, N.P. & T.A. Koget. 1971. “Polyphenols from the grass Hypericum perforatum and the
preparation novoimanin,” Khim. Prir. Soedin. 7: 363-7 (CA 75:115923u).

50. Holzl, J. & E.
Ostrowski. [d.m.]. “Analysis of the essential compounds of Hypericum perforatum,” Planta
Medica [v.m.]: 531.

51. Vasil’chenko, et al. 1986. “Analgesic action of flavonoids of Rhododendron
luteum Sweet, Hypericum perforatum L., Lespedeza bicolor Turoz. and L. hedysaroides (Pall.) Kitag,”
Rastit. Resur. 22: 12-21 (CA 104:142140k).

52. Dittmann, J., et al. 1971. “Normalizing glucose
metabolism in brain tumor slices by hyperoside,” Arzneim.-Forsch. 21: 1999-2002.

53. National
Academy of Sciences. 1975. “Herbal Pharmacology in the People’s Republic of China,” N.A.S.,
Washington.

54. Vasilchenko, E.A., et al. 1986. “The analgesic effect of flavonoids of Rhododendron
luteum Sweet, Hypericum perforatum, Lespedeza bicolor Turoy and L. hedysaroides (Pall),” Kitaz.
Rastit. Resur. 22: 12-21.

55. Nielsen, M. & P. Arends. 1978. Phytochemistry 17: 2040.

56. Suzuki, O., et
al. 1984. Planta Med. 50: 272.

57. Hostettmannn, K. & H. Wagner. 1977. Phytochemistry 16: 821.

58.
Denisova-Dyatlova, O.A. & V.I. Glyzin. 1982. Glyzin. Usp. Khim. 51: 1753.

59. Karryev, op cit.

60. Ayuga,
C. & Rebuelta, M. 1986. “Comparative study of phenolic acids of Hypericum caprifolium Boiss. and
Hypericum perforatum L.,” An. R. Acad. Farm. 52: 723-7 (CA 107: 74319k).

61. Ollivier, B., et al.
1985. “Separation and identification of phenolic acids by high-performance liquid chromatography
and ultraviolet spectroscopy. Application to Parietaria officinalis L. and to Saint-John’s-wort (Hypericum
perforatum L.).” J. Pharm. Belg. 40: 173-7.

62. Guevich, A.I., et al. 1971. “Hyperforin, an
antibiotic from Hypericum perforatum,” Antibiotiki 16: 510-2.

63. Brondz, I., et al. 1983. “The
absolute configuration of hyperforin, an antibiotic from Hypericum perforatum L., based on the crystal
structure determination of its p-bromobenzoate ester,” Acta Chem. Scand., Ser. A A37: 263-5 (in
English).

64. Gurevich, A.I., et al. 1971. “Hyperforin, an antibiotic from Hypericum
perforatum,” Antibiotiki (Moscow) 16: 510-13 (CA 75:95625t).

65. Negrash, A.K. & P.Ya.
Pochinok. 1972. “Comparative study of chemotherapeutic and pharmacological properties of
antimicrobial preparations from common St. John’s wort,” Fitonotsidy, Mater. Soveshch. 6th, Meeting
date 1969, 198-200 (CA 78:66908u).

66. Sticher, O. 1977. “Plant mono-, di- and sesquiterpenoids
with pharmacological or therapeutical activity,” in New Natural Products and Plant Drugs with
Pharmacological, Biological or Therapeutical Activity, ed. by H. Wagner & P. Wolff, Springer-Verlag, NY.

67. Khosa, R.L. & N. Bhatia. 1982. “Antifungal effect of Hypericum perforatum,: J. Sci. Res. Plants
Med. 3: 49-50.

68. Chialva, F., et al. 1981. “Study on the composition of the essential oil from
Hypericum perforatum L. and Teucrium chamaedrys L.,” Riv. Ital. EPPOS 63: 286-8 (CA 96:11497a).

69. Mathis, C. & G. Ourisson. 1964. Phytochemistry 3: 133.

70. Mathis, C. & G. Ourisson. 1964.
“Etude chimio-taxonomique du genre Hypericum-IV,” Phytochemistry 3: 377-8.

71. Brondz, I.,
et al. 1983. “n-Alkanes of Hypericum perforatum: a revision”, Phytochemistry 22: 295-6.

72.
Mathis, C. & G. Ourisson. 1964. “Etude Chimio-taxonomique du genre hypericum-III,”
Phytochemistry 3: 133-141.

73. Brondz, I. & T. Greibrokk. [d.m.]. “n-1-alkanols of Hypericum
perforatum”, Journal of Natural Products 46: 940-1.

74. Snider, S.R. 1984. “Octacosanol in
Parkinsonism [letter],” Ann. Neurol. 16: 723.

75. Yamashita, M, et al. 1986. “Aqeuous
compositions containing octacosanol,” Japanese patent: JP 86263937, date: 861121.

76. Hohnen oil
co., Ltd. 1985. “Encapsulated health food supplements,” Japanese patent: JP 85149367 A2,
date: 850806.

77. Mori, M. 1982. “n-hexacosanol and n-octacosanol: feeding stimulants on the larvae
of the silkworm, Bombyx mori,” J. of Insect Physiology 28: 969-73.

78. Tandan, R. & W.G. Bradley.
1985. “Amyotrophic lateral sclerosis: part I. Clinical features, pathology, and ethical issues in
management,” Ann. Neurol. (USA) 18/3: 271-80.

79. Gonsette, R.E. 1982. “Treatment of
multiple sclerosis,” Bull. Soc. Belge. Ophtalmol 199-200: 275-80.

80. Noris, F.H., et al. 1986.
“Trial of octacosanol in amyotrophic lateral sclerosis,” Neurology (USA) 36/9: 1263-64.

81.
Costes, C. & T. Chantal. 1967. “Carotenoid pigments of the petals of the inflorescence of St.-John’s-
wort (Hypericum perforatum),” Ann. Physiol. Veg. 9: 157-77 (CA 68:66335y).
82. Kitanov, op cit.

83. Mathis C., & G. Ourisson. 1964. “Etude Chimio-taxonomique du genre Hypericum-V.”,
Phytochemistry 3: 379.

84. Prokosheva, L.I. & L.V. Shatunova. 1985. “Content of active substances
in the aboveground parts of Hypericum perforatum,” Rastit. Resur. 21: 461-3.

85. Gozin, A.A. & V.S.
Yasnetsov. 1979. “Effect of mineral fertilizers on the content levels of biologically active substances
in common St.-John’s-wort,” Depositied Doc., VINITI 1108-79, 8 pp. Avail. VINITI (CA
92:127708s).
86. Razinskaite, D. 1970. “Active substances of St.-Joh’s-wort. 1. Dynamics of the level
of tannins,” Liet. TSR Mokslu Akad. Darb., Ser. C (1): 47-53 (CA 73:127742f).
87. Zhebeleva, T.I.
1973. “Effect of ecological conditions on the morphology and flavonoid accumulation of Hypericum
perforatum,” Rast. Resur. 9: 402-4 (CA 80:12660e).

88. Razinskaite, D. 1971. “Active
substances of Hypericum perforatum St. John’s wort). 2. Flavonoids and dynamics of their content”,
Liet. TSR Mokslu Akad. Darb., Ser. C (1): 89-100 (CA 75:72427r).

89. Tsitsina, S.I. “Results of
studying some medicinal plants containing flavone compounds,” Tr. Bot. Sadov, Akad. Nauk Kaz
SSR 11: 111-14 (CA 73:32345q).

90. Morelli, I., et al. 1983. “Selected Medicinal Plants,”
FAO Plant Production and Protection Paper 53/1, Rome.

91. [author missing]. 1981. “Uterotonic
action of extracts from a group of medicinal plants,” Vet. Med. Nauki 18: 94-8.

92. [author missing].
1988. Fitoterapia 59: 165.

93. Vander, A.J., et al. 1970. Human Physiology, McGraw-Hill Book Co., NY.

94. American Medical Association. 1983. AMA Drug Evaluations, AMA, Chicago.

95. Suzuki, O., et al.
1980. “Inhibition of type A and type B monoamine oxidase by isogentisin and its 3-0-
glucoside,” Planta Medica 39: 19-23.

96. Suzuki, et al. 1981. “Inhibition of type A and type B
monoamine oxidases by naturally occurring xanthones,” Planta Medica 42: 17-21.

97. Suzuki, O., et
al. 1984. “Inhibition of monoamine oxidase by hypericin,” Planta Medica 50: 272-4.

98.
Okpanyi, Von S.N. & M.L. Weishcer. 1987. “Tierexperimentelle Untersuchungen zur psychotropen
wirksamkeit eines Hypericum-extraktes,” Arzneim.-Forsch. 37: 10-13.

99. Muldner, Von H. & M.
Zoller. 1984. “Antidepressive wirkung eines auf den wirkstoffkomplex hypercin standardisierten
hypericum-extraktes,” Arzneim.-Forsch. 34: 918.

100. Negrash, A.K., op cit.

101. Aizenman, B.E.
1969. “Antibiotic preparations from Hypericum perforatum,” Mikrobiol. Zh. (Kiev) 31: 128-33,
(CA 70: 118006e).

102. Derbentseva, N.A. & A.S. Rabinovich. 1968. “Isolation, purification, and
study of some physicochemical properties of novoimanin,” in Novoimanin Ego Lech. Svoistva, 15-18,
Edited by: Solov’eva, A.I., “Naukova Dumka”: Kiev, USSR.

103. Gurevich, A.I., op cit.

104.
Saljic, J. 1975. “Ointment for the treatment of burns,” Ger. Offen. 2,406,452 (CL. A61K), 21
Aug 1975 (CA 83: 197797).

105. [author missing]. 1981. “Anti-inflammatory action of a group of
plant extracts,” Vet. Med. Nauki 18: 87-94.

106. Proserpio, G. 1976. “Natural sunscreens:
vegetable derivatives as sunscreens and tanning agents,” Cosmet. Toiletries 91: 34, 39-44, 46.

107.
Morelli, I., op cit.

108. Meruelo, D., G. Lavie & D. Lavie. 1988. “Therapeutic agents with dramatic
antiretroviral activity and little toxicity at effective doses: aromatic polycyclic diones hypericin and
pseudohypericin,” Proc. Natl. Acad. Sci. 85: 5230-5234.

109. Scheel, L.D. 1972.
“Photosensitizing agents,” in Toxicants Occuring Naturally in Food, National Academy of
Sciences, Washington.

110. Weiss, R.F. 1988. Herbal Medicine, Beaconsfield Publishers Ltd,
Beaconsfield, England.

111. Scheel, L.D., op cit.

112. Marsh, C.D. 1930. “Toxic effect of St.
Johnswort (Hypericum perforatum) on cattle and sheep,” USDA Technical bulletin No. 202.

113.
Araya, O.S., op cit.

114. Garrett, B.J., et al. 1982. “Consumption of poisonous plants (Senecio
jacobaea, Symphytum officinale, Pteridium aquilinum, Hypericum perforatum) by rats: chronic toxicity,
mineral metabolism, and hepatic drug-metabolizing enzymes,” Toxicology Letters 10: 183-88.

115.
Pace, N. & G. MacKinney. 1941. “Hypericin, the photodynamic pigment from St. John’s wort,”
Journal of the Am. CHem Soc. 63: 2570-74.

116. Clare, N.T. 1952. “Photosensitization in diseases of
domestic animals,” Review Sweries No. 3 of the Commonwealth Bureau of Animal Health,
Commonwealth Agricultural Bureaux, Bucks, England.

117. James, L.F. & A.E. Johnson. 1976.
“Some major plant toxicities of the western United States,” J. of Range Manag. 29: 356-63.

118. Araya, O.S., op cit.

119. Zaichikova, S.G., et al. 1985. “Study of the healing properties and
determination of the upper parameters of toxicity of Hypericum,” Farmatsiya 1: 62.

120. Roth, L., et
al. 1984. Giftpflanzen–Pflanzengifte, ecomed, Munich.

121. Weiss, R.F., op cit.

122. Merck 1907 Index.
Merck & Co., Rahway, NJ.

123. Todd, R.G. 1967. Martindale’s Extra Pharmacopoeia, The Pharmaceutical
Press, London.

124. Georgiev, E., et al. 1985. Effect of solvent and moisture of St. John’s wort on
extraction of some biologically active substances. II. Extraction of hypericin with glycol,” Nauchni Tr.
– Vissh Inst. Khranit. Vkusova Prom-st., Plovdiv 32: 257-63 (CA 105:29872h).

125. Georgiev, E., et al.
1985. “Effect of solvent and moisture of St. John’s Wort on extraction of some biologically active
substances. I. Extraction of hypericin with glycerides and ethyl alcohol,” Nauchni Tr. Vissh Inst.
Khranit. Vkusova Promst., Plovdiv 32: 251-6 (CA 105:29871g).

126. Georgiev, E., et al. 1983.
“Extraction of Hypericum perforatum L.,” Nauchni Tr. – Vissh Inst. Khranit. Vkusova Prom-st.,
Plovdiv 30: 175-83 (CA 101: 197996n).

127. Adamski, R. & E. Styp-Rekowska. 1971. “Stability of
hypericin in juice, dry extract, and tablets from Hypericum perforatum plants,” Farm. Pol. 27: 237-41
(CA 75:91286k).

128. Araya, O.S. & E.J.H. Ford. 1981. “An investigation of the type of
photosensitization caused by the ingestion of St. John’s wort (Hypericum perforatum) by calves,” J.
COmp. Path. 91: 135-41.

129. Todd, R.G. (ed.). 1977. Martindale’s Extra Pharmacopoeia, The
Pharmaceutical Press, London.

130. Hoelzl, op cit.

131. Dorosiev, I. 1985. “Determination of
flavonoids in Hypericum perforatum,” Pharmazie 40: 585-6 (in English).

132. Ollivier, op cit.

133.
Pachaly, P. 1984. “Thin layer chromatography in the pharmacy: Practical examples,” Dtsch.
Apoth. Ztg. 124: 2153-61.

134. Freytag, W.E. 1984. “Determination of hypericin and
pseudohypericin in Hypericum perforatum L. with HPLC,” Dtsch. Apoth. Ztg 124: 2383-6.

135.
Vanhaelen, M. & R. Vanhaelen-Fastre. 1983. “Quantitative determination of biologically active
constituents in medicinal plant crude extracts by thin-layer chromatography-densitometry. I. …..Hypericum
perforatum…Silybum marianum..(and others),” J. Chromatogr. 281: 263-71 (in English).

136. Chialva,
F. , et al. 1983. “Direct headspace gas chromatographic analysis with glass capillary columns in
quality control of aromatic herbs,” J. Chromatogr. 279: 333-40 (in English).
137. Holzl, J. & E.
Ostrowski, op cit.

138. Steinbach, R.A. 1981. “Problems in the purification and standardization of
plant drugs, for example, Hypericum,” Z. Angew. Phytother. 2:221-4 (CA 98: 113563c)

139. Katalin,
L., et al. 1982. “Ultrastructural Examination of leaf differentiation in St. John’s wort”, Herba
Hung. 21: 21-37.

140. Azaryan, R.A. 1985. “Standardization of [quality indexes for the medicinal]
herb Hypericum perforatum,” Farmatsiya (Moscow) 34: 18-21 (CA 104: 56271x).
141. Schilling, W.
1969. “A Review…..,” Praep. Pharm. 5: 125-34.