9

The Materia Medica

The advantages of natural compounds are fewer side effects in comparison to orthodox medical drugs, and the production of synergistic effects for a more positive treatment outcome.

K. KITAZATO, Y. WANG, AND N. KOBAYASHI,
“VIRAL INFECTIOUS DISEASE AND NATURAL
PRODUCTS WITH ANTIVIRAL ACTIVITY”

An illness is like a journey to a far country; it sifts all one’s experience and removes it to a point so remote that it appears like a vision.

SHOLEM ASCH

They do not know very good Latin, these botanists.

ALBERT HOFMANN

I have done extensive monographs, in other works, on many of the herbs suggested in this book. Time and space limitations prohibit repeating them here. I will cover the most important ones (to varying extents) in this volume, including the addition of new material not to be found in the longer monographs (there are always new things I am learning, I am not yet at the point where I put up “keep off the grass” signs and yell at clouds . . . though some of my more prominent herbal friends . . . well, I guess I should skip that part).

The only new, in-depth monograph in this book is on Salvia miltiorrhiza. It is a crucial, foundational herb for these conditions and, as I am discovering, quite a wonderful plant medicine in its own right. I have become very fond of it the last few years. (It’s always this way—some herb begins demanding attention and after a while you listen and find that it is just the new medicine that you needed to learn about.)

If you wish to see the in-depth monographs for the herbs not covered as completely in this volume, here is where you can find them: Polygonum cuspidatum (Japanese knotweed) and Andrographis paniculata are in Healing Lyme (Raven Press, 2005). In Herbal Antibiotics, second edition (Storey Publishing, 2012), you can find Alchornea cordifolia, Artemisia spp. (including the constituents artemisinin, artesenuate, and artemisone), Bidens pilosa, Cryptolepis sanguinolenta, Eleutherococcus senticosus, Eupatorium perfoliatum (boneset), Ganoderma lucidum (reishi), Glycyrrhiza spp. (licorice), Rhodiola spp., and Sida acuta. In Herbal Antivirals (Storey Publishing, 2013), you can find Houttuynia spp. and Scutellaria baicalensis (Chinese skullcap) root, as well as Sambucus spp. (elder), Isatis spp., and Zingiber officinalis (ginger) if you want to. (These latter three can be useful but neither essential nor primary in treating babesiosis, anaplasmosis, and ehrlichosis.) Olea europa (olive leaf and oil) including the constituents oleic and oleanolic acid (also not essential but nevertheless useful) are covered in depth in Healing Lyme Disease Coinfections: Complementary and Holistic Treatments for Bartonella and Mycoplasma (Healing Arts Press, 2013).

MAKING YOUR OWN MEDICINES

I strongly suggest, if you have any inclination at all to do so, that you make your own herbal medicines. There are a number of reasons for this, the most obvious being cost; making your own will lower your cost significantly.

Although herbal medicines are extremely inexpensive compared to pharmaceuticals (and often more effective), treating a long-term, chronic condition can be expensive, especially if you buy them already prepared. This has become especially true as the FDA has begun to exert more control over herbal medicines via its Good Manufacturing Practices regulations, a.k.a. the GMP (not necessarily a good thing), and as the larger herbal companies begin to consolidate their control over the marketplace (very much not a good thing). Those particular marketplace shifts are causing price increases in nearly every area. A small rant . . .

Tiny Rant

The Irrational GMP Rationale

The common and oft-repeated rationale for the GMP is that it will make herbal products safer for the public. This is not actually accurate. The main safety problems that occur with herbal products come, and always have come, from two sources: 1) manufacturing errors by a large company (usually product contamination of one sort or another, always inadvertent) and 2) unscrupulous product creation (specifically: herbal energy pills, weight loss products, and muscle development formulations) by corporations of one sort or another. The small, herbalist-owned companies have never had these kinds of problems; their products are almost always better than those produced by the large companies, they are less expensive, and, based on the public record, they are much safer.

The GMP was developed, and supported, by the big herbal companies (as well as a number of large pharmaceutical companies) in order to control the marketplace . . . and as a response to the FDA looking askance at those two problem areas within the natural products world. It wasn’t really necessary to put the same restrictions on manufacturing on both the large and small companies—these are two different kinds of companies, with entirely different functions and behaviors—yet, they did. Unfortunately, over time, this will lead to the majority of the smaller companies going out of business. When that occurs, fewer herbal formulations will be available and those at a much higher price. Nevertheless, there are still many good small companies in business (the consolidation will take a few years); I recommend my favorites in a section at the end of the book.

Fortunately, neither the GMP or anything else prevents you, nor will prevent you, from making your own medicines. Not only will it be much cheaper for you, but there is something exceptionally wonderful that happens when you work directly with a plant for your healing, when you find it in a field, or grow it in your yard (it may already be there, if you just look around), or even if you buy the plant from a grower (several really good ones in “Sources of Supply,” page 333). When your life is saved by a plant, nothing is ever the same again. This is most especially true if you have developed a personal relationship with the plant from making it into medicine for yourself.

There are a number of good books on making plant medicines. I generally suggest my own in-depth look at it (inevitably), which is included in the second edition of Herbal Antibiotics (it contains, as well, an extensive formulary of over 200 herbs), or Richo Cech’s Making Plant Medicine, third edition (Horizon Herbs, 2000), or James Green’s Herbal Medicine-Maker’s Handbook (Crossing Press, 2000). All are very good.

If you obtain a resale license from your state (easy and inexpensive) and give yourself a business name (e.g., The Get Rich Very Slowly Herb Company) you will be able to buy herbs wholesale from nearly all wholesalers. This will lower your purchase cost of the herbs by anywhere from half to nine-tenths of their retail price.

THE MATERIA MEDICA

I consider the most important herbs/supplements for the conditions discussed in this book (whether primary, foundational herbs or supportive ones) to be Angelica sinensis, Astragalus spp., Bidens pilosa, Ceanothus spp., Chelidonium majus, Cordyceps spp., Crataegus oxyacantha (hawthorn), Cryptolepis sanguinolenta, Eupatorium perfoliatum, Forsythia suspensa, Glycyrrhiza spp., Houttuynia spp., Leonurus cardiaca, Paeonia lactiflora, Panax ginseng, Polygala tenuifolia, Polygonum cuspidatum, Pueraria lobata, Rhodiola spp., Salvia miltiorrhiza, Scutellaria baicalensis, Sida acuta, Silybum marianum (milk thistle seed), Withania somnifera, and the isolated constituents EGCG, genistein, L-arginine, N-acetylcysteine, and quercetin.

The foundational herbs/supplements, essential for either Babesia or Ehrlichia/Anaplasma infections, are Angelica sinensis, Astragalus spp., Bidens pilosa, Ceanothus spp., Cordyceps spp., Cryptolepis sanguinolenta, Glycyrrhiza spp., Houttuynia spp., Pueraria lobata, Salvia miltiorrhiza (danshen), Scutellaria baicalensis, Withania somnifera, and the isolated constituents L-arginine, genistein, and N-acetylcysteine.

We’ll begin with the in-depth look at Salvia miltiorrhiza, followed by briefer looks, in alphabetical order, of the remaining herbs and supplements.

Salvia miltiorrhiza (Danshen)

Family: Lamiaceae

Genus

Salvia (mostly but there is a subgenus involved here as well; see the species section for further obfuscation).

Salvia comes from the ancient Latin word salvus, meaning “safe,” essentially a reference to the extensive and very broad healing properties of this genus. (The word sage is a later derivation. It is Middle English, derived from the Old French term sauge, which was derived from the Latin salvia, meaning “healing plant,” which was derived from, way back there in time, salvus again.)

The salvias are a big genus and after a look at the work of numerous well-degreed taxonomists, I can definitively state that the genus contains 700, or 900, or 1,000 species. So, now you know.

Common Names

Red sage, Chinese sage, danshen (or tanshen), as the case may be. Its pharmaceutical name (sometimes encountered) is radix salviae miltiorrhizae.

Species Used

Well, miltiorrhiza obviously, however . . . there are 36 species of Salvia (and the Salvia subgenus Sclarea) used by Chinese practitioners; all are considered to be, and are, in common parlance, danshen. In traditional Chinese practice (i.e., in China, not in the United States) they are generally considered interchangeable. This has caused much conflict, soul-searching, chemical nitpicking (and fisticuffs) among the Chinese researchers, similar to the DNA-based rearrangement of plants conflicts caused by taxonomists in the West.

There are, according to DNA analysis, three distinct clades of Salvia in the world, each roughly distinguished by geography. Species in Clade I are indigenous to China/Asia; those in Clade II are indigenous to the Mediterranean region; and those in Clade III are specific to the Americas (this is the oldest, most isolated group and includes what many consider the most unusual of the salvias, Salvia divinorum). There are, of course, just to make things more difficult, subcategories called subclades, i.e., subclades A, B, and C. The problem seems to be that the salvias love to interbreed with each other so unique genotypes abound. (Sex, making life difficult for taxonomists everywhere.)

Clade III in the Americas contains the most species, at well over 500. However, in Clade I, which is what we are interested in here, there are 78 (or maybe 84) species, 24 (or maybe 26) varieties, and 8 (or perhaps 10) forma of salvia. (Taxonomists are really sure about those figures.)

Here is how all that classification stuff goes . . . genus then subgenus, species then subspecies, varietas (varieties) then subvarietas, forma and finally subforma. (This is another reason why no one likes taxonomists.)

Of those 78 (or 84) species, 70 (or maybe 75) are endemic to China and, again, 36 (or 23) of those are used as danshen in Chinese medicine.

And because things are not complicated enough, there is a subgenus of Salvia called Sclarea and a number of species within the Sclarea are used interchangeably for Salvia danshens in many Chinese regions. The Chinese Sclarea are clustered together in subclade A (of Clade I), which also contains a number of true salvias, including Salvia przewalskii, a rather medicinally potent member of the group. Clade I, subclade B is generally considered the most medicinally active of the danshens. It contains what are considered to be the most powerful danshens used in herbal practice, specifically Salvia miltiorrhiza, S. miltiorrhiza forma alba,

which is identical to Salvia miltiorrhiza except that it has white flowers (alba means white). Other than that one difference, they are pretty much the same plant when it comes to medicinal actions and usage.

and their very close relatives S. bowleyana, S. cavaleriei varietas simplicifolia, and S. yunnanensis. These five plants are considered to be the strongest interchangeable species of danshen. The other major plant in the danshen group is S. przewalskii, which contains more tanshinone IIA (see rant in appendix) than S. miltiorrhiza, as well as a number of other compounds unique to itself. A number of Chinese researchers and practitioners believe that the plant is a major and rather unique medicinal within the danshens.

Because more than 176 million pounds of danshen are used in Chinese medicine every year, agricultural production cannot keep up with demand and adulteration is a constant problem. S. przewalskii, it turns out, is the most common adulterant of S. miltiorrhiza. Although the Chinese are spending more time analyzing the exact identity of the herbs they sell before they ship them out of the country, the best way to avoid this problem is to grow the plant yourself.

Most of the salvias used as danshen in traditional Chinese medicine do contain the same chemical constituents; the amounts just differ a bit. S. miltiorrhiza is usually considered to be the strongest of the species used and is the one upon which most research has been done. However, a caveat . . . exhaustive analysis of the chemical constituents of S. miltiorrhiza shows a wide variation in those constituents depending on where the plant is grown and when it is harvested. Once again, there is no definitive, final, quantitative analysis of constituents that can be said to be the norm for any plant medicine. (Again, see the rant in appendix.) Things change depending on the ecological scenario in which the plant emerges.

So . . . short answer to species used? The strongest are considered to be Salvia miltiorrhiza, S. miltiorrhiza forma alba, S. bowleyana, S. cavaleriei varietas simplicifolia, S. yunnanensis, and finally S. przewalskii, in that order.

This monograph will focus on S. miltiorrhiza with minor side trips here and there. Please note that the long isolation of the American salvias produced very different compounds over time than those in the Clade I salvias; they are not interchangeable with the Chinese danshens.

Part Used

The root or rhizome depending on who you ask. The species name miltiorrhiza comes from the ancient Greek miltos, meaning “red earth,” and rhiza, meaning “root.” The root of the plant, when harvested, is indeed quite a remarkable and beautiful brilliant red, as are the tincture and the tea.

Habitat and Appearance

Salvia miltiorrhiza grows wild in China on sunny mountainsides, in meadows, on forest margins, and along stream beds, generally up to an altitude of 4,000 feet. It is a perennial growing up to two feet in height and flowers from June to September. The flowers truly are beautiful.

Cultivation

The seeds of the plant tend to be viable for at least three years if not a bit longer. They are, as Richo Cech at Horizon Herbs puts it, a “gratifyingly easy germinator.” Sow in relatively moist, rich, sandy, moderate- to fast-draining soil; germination usually occurs within 10 to 21 days. (Root transplantation will also work if you want to go that way; just dig up the plant, separate the root into two to three pieces, and replant.) Space the plants 9 to 12 inches apart. The plant likes full sun with a bit of dappled shade; it’s heat and drought tolerant (so they say) and likes a bit of regular watering. The herb is hardy to somewhere between 0 and 10 degrees Fahrenheit though there is a bit of controversy around this. I have seen it listed as hardy in USDA zones 5 to 9, and in zones 6 to 10, and in zones 8 to 11; fisticuffs between gardeners, I am sure, occur all the time. It should be heavily mulched to help it overwinter if your area gets colder than 0 or 10 or 15 degrees Fahrenheit, whatever.

Collection and Root Preparation

The root constituents, similarly to red root (Ceanothus spp.), reach their potency after the first good frost. Harvesting in China typically occurs in the fall, usually in the first 10 days of November. Harvesting continues, if necessary, until the beginning of spring. After being harvested, the plants are normally covered with a damp cloth until the roots are uniformly moist, then cut into sections, and allowed to dry in the sun (usually for 30 days). However, there are certain drying dynamics necessary for this root prior to its being made into medicine—that is, if you want it to work as a medicinal. Another rant (the long one is still in the appendix) is in order . . .

Tiny Rant

Irremovable Ignorance

One of the points I have tried to make to new herbalists, herbal schools, and manufacturers over the years is the degree of irremovable ignorance we all possess, and will always possess, when it comes to the natural world. Specifically, every time we think we have a handle on the foundational reality of herbal medicines, we are generally proved wrong. Plants are not linear, mechanical contrivances. They are living entities and what little we learn of them is itself subject to change as the environment in which we are embedded alters itself under pressure—for the plants alter themselves, and their chemical structure, considerably in response to environmental perturbations.

We engage the unknown that surrounds us, attempting to understand the nature of the scenario in which we are enmeshed, but the more we learn about it, as Aldous Huxley once put it, the greater the surrounding darkness.

Despite the fact that I know this, I am continually surprised by my own ignorance as well as my continual inability to reason, often about the most obvious of things. For example: 1) It took 10 years of hearing about estrogenic plants before the thought occurred to me that there might be androgenic plants that contained testosterone (e.g., pine pollen); 2) It took 25 years before I realized that the word alkaloid meant “alkaline-like.” This means, by definition, that the alkaloids in plants do not extract well in alkaline solutions; it takes an acidic liquid to most efficiently extract them. Thus, competent extraction during tincturing needs either water that is slightly acidic or the addition of a teaspoon of vinegar to the water prior to tincturing. This rather elementary fact was not present in any of the herbal texts I had ever read, and none of my teachers mentioned it, nor did any herbal lecturer over a nearly 30-year period.

The subject of the current rant concerns the dynamics that occur when drying herbal medicines. It is a neglected area of awareness, improperly so, and possesses ramifications, obvious ones, that affect the quality of our medicines. (It especially affects the production and effectiveness of this salvia.)

Despite the fact that historical use indicates a wide range of harvesting and drying techniques for medicinal plants, very little work has been done on the constituent alterations that occur in herbal medicines when they are dried or how that alters during various drying approaches. This is a serious oversight. Xiao-Bing Li and his colleagues, in a rather remarkable paper (“Production of Salvianolic Acid B in Roots of Salvia miltiorrhiza [Danshen] during the Post-Harvest Drying Process”), are the first I am aware of to address this oversight with the sophistication it deserves.

They make an obvious observation (I hate it when I miss something this obvious) and articulate an inherent hypothesis lurking within the observation, which they then test. They begin by stating a very common belief about the drying of medicinal plants:

The general belief is that levels of bioactive components in medicinal plants were a pre-harvest accumulation and were decreased in the post-harvest drying process [the decrease worsening] as the temperature increased and the duration was prolonged. Therefore, the fundamental target of research on drying processes for medicinal plants up to now was how to best retain the initial levels of bioactive ingredients, and hence the freeze-drying protocol was recommended as the most suitable method.

They then make the obvious point that . . .

from the point of view of plant physiology, the newly harvested fresh plant materials, especially roots, are still physiologically active organs. . . .

Incredible that none of us recognized this decades ago. They continue . . .

. . . and the drying process is a bona fide dehydration stress to these organs. Thus, the post-harvest drying process, especially at its early stage, could induce a series of anti-dehydration mechanisms including the production or increase of related secondary metabolites of these organs. That is to say, pharmacologically important ingredients of medicinal plants might emerge or increase during a certain period of drying in post-harvest processing. The drying-induced increase of bioactive components might especially be true for some root materials and some types of secondary metabolites with important ecological functions. This physiological peculiarity of the post-harvest plant materials has not been documented aside from the mention of its role in preventing water loss in the drying of fresh ginseng.

So, they test their hypothesis, that is, that some of the active constituents in medicinal plants might just be occurring in response to dehydration stress. Their focus is on the roots of Salvia miltiorrhiza, which, contrary to the normal drying processes of herbalists in the United States, in China are dried in the sun (sun-cured) for a month prior to storage or sale. (There is a reason that the Chinese herbalists have done things a certain way for thousands of years.) They found their hypothesis to be correct, specifically . . .

Salvianolic acid B (SaB), considered one of the major active constituents of danshen, is present in only trace amounts in fresh roots. However, during the drying process there is a surge of that compound within root tissues. As Li et al. note, “Higher temperatures tended to result in a higher yield of SaB.” They tested fairly high temperatures, up to 160 degrees Celsius (322 degrees Fahrenheit). They found that maximal values of SaB occurred between 120 and 130 degrees Celsius (250–270 degrees Fahrenheit). The accumulation of SaB in the roots began to be pronounced at temperatures above 70 degrees Celsius (160 degrees Fahrenheit). As they comment:

SaB has been revealed to be the most abundant ingredient of [dried] Danshen in most research publications up to now. Our result demonstrated for the first time that this compound was actually not an essential ingredient accumulated in the growing and pre-harvest stage in roots of S. miltiorrhiza, but instead was a post-harvest product of the drying process. . . . A significant negative correlation between production of SaB and levels of moisture meant that this compound might be an important anti-dehydration ingredient of the plant, and the mechanism might be closely related to its effective abilities in scavenging the oxygen free radicals. (Li et al. 2012)

Tanshinones, especially tanshinone IIA, for many researchers, are considered to be the most pharmacologically active of the compounds in the roots (again, see appendix). They are also the most prevalent active constituent in the fresh roots at harvesting; however, they, too, increase substantially when dried at heat. Tanshinone IIA increased 50 to 60 percent when the roots were dried at heat; total tanshinones increased 3.5 times.

The researchers dried the roots for 11.5 hours: 6 hours at 50 to 60 degrees Celsius (testing the roots every hour for constituent amounts), 3.5 hours at 70 to 90 degrees Celsius (testing the roots every 30 minutes for constituents), and 2 hours at 90 to 160 degrees Celsius (testing every 20 minutes).

So, in short . . . these roots need to be dried in the sun, preferably inside a house (since it is November), behind glass, where the heat can concentrate in the roots, but not in a covered container (the moisture needs to evaporate), for 30 days. Once the roots are dry, store them whole in plastic bags, in covered plastic tubs, in a dark and cool location. They will last for several years.

Plant Chemistry

There are perhaps a hundred constituents that have been identified in this species so far but that number seems to be increasing daily.

Over 40 tanshinones and their analogs have currently been found in the plant, including the three most commonly used by reductionists as activity markers: tanshinone I, tanshinone IIA, and cryptotanshinone.

A general listing of compounds in this plant includes the abietane diterpenoids: 1,2,5,6-tetrahydrotanshinone I; 1,2-didehydrotanshinone II; 1,2-dihydro-1,6-dimethylfuro[3,2-c]-naptha[2,1-e]oxepine-10,12-dione; 3-hydroxytanshinone IIA; 4-methylenemiltirone; 6,7,8,9-tetrahydro-1, 6, 6-trimethyl furo[3, 2-c]napt ha-[2,1-e]oxepine-10,12-dione; 7beta-hydroxy-8,13,abietadien-11,12-dione; acetyl danshenxinkun A; abietatriene; arucadiol; cryptoacetalide; cryptotanshinone; danshenol A and B; danshenspiroketallactone; danshenxinkun A through D; dehydromiltirone; dihydrotanshinone I; epicryptoacetalide; epidanshenspiroketallactone; formytanshinone I; hydroxytanshinone; isocryptotanshinone; isotanshinone I, IIA, and IIB; ketoisocryptotanshinone; methyl tanshinonate; methylene tanshiquinone; methylenedihydrotanshinquinone; miltiodiol; miltionone I and II; miltipolone; miltirone; neocryptotanshinone; neocryptotanshinone II; nortanshinone; oleoyl danshenxinkun A; oleoyl neocryptotanshinone; przewalskin; przewaquinone; salvinone; salviol; salviolone; secodialdialdehyde; sugiol; tanshinaldehyde; tanshindiol A, B, and C; tanshinketolactone; tanshinlactone; tanshinone I, IIA, IIB, and VI; trijuganone A, B, and C . . .

and the caffeic acid derivatives: 2-(3-methoxy-4-hydroxyphenyl)5-(3-hydroxypropyl)-methoxybenzofuran-3-carbaldehyde; 9''-methyl lithospermate; ammonium potassium; caffeic acid; danshensu; dimethyl lithospermate; ethyl salvialolic acid B; lithospermic acid; lithospermic acid B; magnesium salvianolic acid B; methyl rosmarinate; rosmarinic acid; salviaflaside; and salvianolic acids A, B, C, D, E, F, G, and K.

Other compounds include: protocatechuic acid; protocatechuic aldehyde; ferulic acid; isoferulic acid; yunnanin A; ferruginol; normiltioane; baicalin; beta-sitosterol; isoferulic acid; ursolic acid; lactic acid; genipin, umbelliferone, tormentic acid, and so on.

The medicinal actions of the plant are considered, by reductionists, to be primarily provided by tanshinone IIA, total tanshinone content (despite the more than 40 tanshinones and their analogs, the only markers used are tanshinone I, tanshinone IIA, and cryptotanshinone), and salvianolic acid B. And, in fact, a concerted push for standardization is occurring with this herb—not the tincture or capsules, rather it is for the plant itself. As usual, this perspective is seriously flawed. Again, a rant is in order here and it has been written: see appendix.

Actions

Anticoagulant, antihypertensive, anti-inflammatory, antibacterial (Gram-positive and Gram-negative, broadly so against Gram-positive), antimicrobial, antifibrotic, antioxidant, antianaphylactic, antiatherosclerotic, antineoplastic, analgesic, apoptosis normalizer, vasodilating, sedative, hepatosplenic tonic, cardiotonic, organ protectant (central nervous system, liver, spleen, lungs, heart, bones, red blood cells) and normalizer, immunomodulant.

Uses

I consider this plant specific for liver and spleen enlargement, for normalizing cytokine dysregulation, as a potent anticoagulant and vascular normalizer, and as a generalized full-body organ tonic. It is specifically indicated for use with stealth pathogens and in any condition where sepsis might occur. In cases where intravascular coagulation is a possibility, it is the indicated alternative to Ceanothus spp. (red root). A number of people consider it specific for cancer but I have never used it for that purpose.

Traditional Chinese Medicine (TCM)

Salvia miltiorrhiza (and all the other danshens) have been used in Chinese medicine for two millennia (at least). It was first recorded in the classic Chinese text Shen Nong Ben Cao Jing in the second century CE. The herb is considered to be bitter and cool in the TCM system.

Its TCM functions are: promoting blood circulation and removing blood stasis, clearing heat from the blood, resolving swelling, tranquilizing the mind, regulating menstruation to relieve pain, cooling the blood to relieve carbuncle, and clearing heat and toxic substances.

Indications for use are: irregular menstruation, dysmenorrhea, amenorrhea, postpartum tormina, arthalgia syndrome due to wind-dampness, heat invasion of nutrient yin and blood divisions in epidemic febrile disease, restlessness with disturbance of the mind, pyogenic toxin, enlargement of the liver and spleen.

It is commonly used for: irregular menstruation, amenorrhea, postpartum abdominal pain, pain and stifling sensations in the chest, masses in the abdomen (from blood stagnation), inflamed liver and/ or spleen, pancreatitis, arthritis, traumatic injury, broken bones, pain and bruising, redness, swelling, delirium, high fever, unconsciousness, irritability, insomnia, purpura and petechiae and ecchymosis, vasculitis, endometriosis, fibroids, cysts.

The Chinese have conducted a large number of clinical trials with the herb; see the scientific research section below.

Ayurveda

Not known as far as I can tell.

Western Botanic Practice

Unknown until its recent introduction from China during the past few decades. It is still rarely used in Western practice.

Scientific Research

There are around 2,000 journal articles listed on PubMed, the U.S. National Library of Medicine’s online database of research in the life sciences and biomedical fields. The Chinese database CNKI (Chinese National Knowledge Infrastructure), similar to PubMed, lists over 10,000 journal entries. Google Scholar lists 22,000 or so, which includes another 10,000 entries beyond PubMed and CNKI. All of these articles have been produced in the past 35 years. The following material just catches a few of the highlights. First, however, a crucial comment on the actions of this herb . . .

The herb tends to act as a cytokine normalizer, that is, it modulates cytokine expression during abnormal states. If cytokine activity is inappropriately high, it lowers it, if inappropriately low, it raises it. Thus, studies show that in some circumstances the herb lowers nitric oxide production, in others it raises it. In some circumstances it inhibits caspase activity, in others it raises it. In some instances it stimulates apoptosis, in others it inhibits it.

Salvia miltiorrhiza appears then to be an immune-response adaptogen, specifically for use during altered, and unhealthy, cytokine responses to infection. Comparison of the herb’s pharmacokinetic actions in both disease and non-disease states finds that during disease conditions, the herb’s constituents localize to the sites of damage, where they initiate modulation of the specific types of inflammation that is occurring there. Whereas in non-disease states they don’t seem to produce any cytokine modulating action at all.

For example, in-depth studies in mice found that the cytokine profile was unaltered in healthy mice when the herb was added (in various amounts) to their diets. However, when the mice were intentionally infected with Listeria bacteria the herb modulated the exact cytokine alterations the organisms caused. Thus, again, the herb appears to work as a cytokine-response adaptogen, that is, it normalizes cytokine responses to adverse events, such as microbial infection. With that in mind, here is a look at its cytokine actions from various journal papers.

In Vitro Studies

Salvia miltiorrhiza root inhibits caspase-3 (and caspase-9) activity (thus inducing apoptosis in apoptosis-inhibited cells); inhibits microbial-induced NF-κB signaling in epithelial and endothelial cells (by inhibiting IκB kinase, an enzyme complex that is involved in propagating the body’s cellular response to inflammation); inhibits ICAM-1 (intercellular adhesion molecule 1, present in low concentrations in the cell membranes of leukocytes and endothelial cells, and activated by pathogens to stimulate clustering of leukocytes on endothelial cells); inhibits mast cell degranulation by inhibiting PLCG2 and MAPK; inhibits NADPH oxidase (nicotinamide adenine dinucleotide phosphate oxidase, which produces reactive oxygen species, ROS, which activate an enzyme that stimulates macrophages to adhere to endothelial cells); inhibits the overproduction of IL-12 during acute microbial infection–induced inflammation (thus reducing IFN-γ production as well); inhibits TNF-α and its expression of VCAM-1 (vascular cell adhesion molecule 1, which stimulates the adhesion of various white blood cells to the vascular endothelium; inhibition of VCAM-1 suppresses the adhesion rate of neutrophils to endothelial cells and erythrocyte aggregation as well, thus lowering intravascular coagulation); inhibits E-selectin (which also stimulates the accumulation and adhesion of leukocytes to endothelial cells and their penetration deeper into tissues); inhibits the proinflammatory cytokines IL-1β and IL-6; and inhibits MMP-2 and MMP-9 (matrix metalloproteinases 2 and 9 are enzymes that actively break down collagen, leading to inflammation and damage in the joints), but it also upregulates MMP-2 when necessary to normalize function.

The herb inhibits MCP-1 (monocyte chemoattractant protein 1, a.k.a. CCL2, which recruits immune cells to sites of microbial infection); inhibits ROS production; modulates Bax/Bcl-2 expression (thus normalizing apoptosis dynamics in cells, increasing it where suppressed, decreasing it where stimulated); inhibits overexpression of angiotensin II (which affects both blood pressure and apoptosis); inhibits levels of hydrogen peroxide (H2O2) in damaged cells, thus reducing white blood cell clustering and over-inflammatory responses; stimulates endothelial nitric oxide synthase (eNOS) production (thus creating more nitric oxide production by endothelial cells as well as more L-citrulline); modulates p38 MAPK/JNK activity; inhibits TLR-4 expression (thus reducing hyper immune responses during sepsis); inhibits expression of IL-2, IL-4, and IFN-γ; stimulates production of IL-10 (except when it is dysregulated as in sepsis, in which case it normalizes IL-10 functioning); inhibits PGE2 (prostaglandin E2, which stimulates osteoblasts to increase bone resorption by osteoclasts, thus increasing osteoporosis; it also softens the cervix and stimulates uterine contractions, and induces fever during infections); both increases and decreases inducible nitric oxide synthase (iNOS) and subsequent NO production (depending on which is needed during disease conditions); decreases RANTES (a.k.a. CCL5, which is chemotactic for T cells, eosinophils, and basophils and recruits leukocytes to inflammatory sites; it induces the proliferation and activation of NK cells to inflammatory sites); inhibits CX3CL1 (which potently attracts T cells and monocytes when expressed and promotes adhesion of leukocytes to endothelial cells); inhibits IL-18 and increases IL-13; modulates IL-4 and TGF-β expression (inhibiting or increasing as the case may be); inhibits VEGF (vascular endothelial growth factor); inhibits ERK-1 and ERK-2; inhibits HMGB1 production; and stimulates HMGB1 clearance from the body, making the herb specific for sepsis.

Other in vitro activity includes: strong inhibition of the proliferation of keratinocytes (thus reducing the tendency to psoriasis in the skin); stabilization of mitochondria during microbial assault; inhibition of mitochondrial apoptosis during hypoxia events; inhibition of cancer cell proliferation and stimulation of apoptosis of cancer cells; repression of the accumulation of collagen in damaged organs, thus preventing the development of fibrosis in various diseases of the internal organs (kidneys, liver, lungs, and so on); inhibition of apoptosis in damaged liver cells, protecting from organ failure; decrease in malondialdehyde levels (a marker of oxidative stress); decrease in lactate dehydrogenase and creatine phosphokinase levels; amelioration of reperfusion injury in liver cell mitochondria; inhibition of tyrosinase; stimulation of red blood cell apoptosis during red blood cell infections.

In Vivo Studies

Healthy mice given the herb in their diet as a regular additive did not show any toxic responses, even at high levels of the herb. Nor did the mouse cytokine levels alter. However, when the mice were infected with Listeria bacteria, the herb acted as a very specific immune modulator. The herb inhibited the induction of the particular cytokines the bacteria (tried to) initiate. Host defenses and immune function increased in just the optimum manner to counteract infection. Spleen and liver organs were protected from damage. NO production in the liver was inhibited, thus protecting the liver’s Kupffer cells from damage. (NO production in the spleen was unaffected.) HMGB1 levels remained low in the treated mice but increased four- to tenfold in the untreated mice. Bacterial clearance in the treated group was enhanced; sepsis was significantly reduced. The effects were dose dependent; the higher the dose, the better the outcome.

Rats suffering severe acute pancreatitis or obstructive jaundice, when treated with Salvia miltiorrhiza, experienced decreased mortality, less movement of endotoxins and bacteria through the GI tract membrane into the body, and much less pathological damage to the spleen and thymus than rats who were not given the herb. Plasma levels of endotoxins were considerably lower than in the untreated group. Damaged Kupffer cells in the liver were cleared more quickly, liver function increased, and the liver was protected from damage. The mesenteric lymph nodes in the intestinal tract suffered much less pathological damage; their function was enhanced.

The herb significantly reduces the impacts of ischemia-reperfusion injury in rats. It reduces levels of ALT and AST and increases SOD (superoxide dismutase, an antioxidant defense mechanism). It acts similarly in mice. In response to microbial infection the herb decreases both ALT and AST, decreases NO levels, and reduces the degree of liver injury. In other studies the herb protected mice from potentially lethal microbe-induced liver injury. The CD4:CD8 ratio improved.

The herb plays an important role in protecting and reestablishing the mucosal integrity of the GI tract during infections. Liver injury, for example, is often associated with a significant alteration in the intestinal microflora. Enterococci and enterobacteria populations increase, lactobacilli and bifidobacteria decrease. The intestinal barrier becomes more permeable, allowing toxins and other macromolecules to cross the GI tract barrier into the body.

Importantly, both lactobacilli (Lactobacillus spp.) and bifidobacteria (Bifidobacterium spp.) form biofilms in the intestines. This is a crucial element of the intestinal mucosal barrier. The biofilms formed by these symbiotic bacteria prevent adhesion of pathogenic bacteria to the bowel wall and limit the overgrowth of the normally present Gram-negative bacteria. A reduction in these bacteria, and the loss of the biofilms they create, results in structural and functional damage to the intestinal mucosal barrier, increasing its permeability. This, among other things, increases endotoxin loads in blood plasma, and makes many symptoms worse.

This is another reason why breaking up biofilms as an integral part of treating Lyme-group infections is a bad idea. It not only spreads more of the Lyme-group microbes throughout the body, it damages the mucosal integrity of the bowel, increases endotoxins in the blood, stimulates bowel permeability, and decreases the healthy bowel flora.

Murine (mouse) research with Salvia miltiorrhiza found that the herb restores mucosal integrity, increases the population of healthy bacteria in the bowel (and their biofilms), improves intestinal microcirculation, and lessens portal hypertension. It restores the ecology of the bowel, reduces unhealthy bowel bacteria overgrowth, and increases the levels of healthy bacteria throughout the bowel.

A study of rats with endometriosis found that the herb reduced the cytokine markers associated with that disease, relieving symptoms.

The herb was used to treat chronic cerebral hypoperfusion in male Wistar rats. Levels of microglial activation, myelin basic protein (MBP), and the cytokines COX-2, IL-1β, and IL-6 were measured in the white matter of the brain and the hippocampus. Microglial activation was alleviated, MBP levels increased, and inflammation was reduced. The herb was found to attenuate white matter and hippocampal damage in the brain.

In mice, hypoxia/ischemia was induced, leading to neuronal damage in the brain. However, one day after hypoxia/ischemia, treatment with the herb reversed most of the damage. It showed strong neuroprotective and neurocorrective effects.

Other studies on diabetic rats found that the herb protects peripheral nerve function, alleviating diabetic neuropathy.

Inflammation after spinal cord damage causes apoptosis of affected cells. The use of the herb after injury (in rats) induced “significant” effects. It increased motor function, reduced tissue injury, reduced neutrophil infiltration, reduced myeloperoxidase activity, reduced expression of astrocytes, reduced apoptosis, and decreased expression of a range of inflammatory cytokines.

The herb stimulates osteogenesis (in rats) and bone marrow angiogenesis and inhibits bone resorption by osteoclasts, thus preventing bone loss in osteoporosis. Bone mineral density and mass both increase.

Numerous studies in both rats and mice found the herb to be highly protective of heart function and tissue. It prevents cardiac remodeling in hypertensive rats, reduces fibrosis in heart tissue, reduces fat buildup in arteries, reduces coagulation and thromboembolism tendencies in vascular functioning, reduces hypertension, and improves cardiac functioning.

Human Study

There have been several hundred human trials (at least) with the herb (or its constituents) on a variety of conditions. This includes pancreatitis, oral submucous fibrosis, fatty liver, polycystic ovary syndrome, hyperandrogenism, myocardial damage in people with severe burns, chronic artery disease in diabetics, coronary artery bypass, hypertension, elevated platelet thrombin levels in chronic hemodialysis, chronic heart disease, hypercholesteremia, hyperlipidemia, vascular endothelial dysfunction, chronic hepatitis B, liver cirrhosis, Henoch-Schönlein purpura nephritis, primary nephrotic syndrome, portal hypertension, infantile hypoxic-ischemic encephalopathy, hypertensive cerebral hemorrhage, chronic asthma, cervical erosion, chronic hepatitis, whooping cough, schistosomal hepatomegaly, shock, scleroderma, allergic rhinitis, glaucoma, enlarged spleen, insomnia, and angina pectoris.

Studies have been conducted on its use as prophylaxis for venous thromboembolism and for reducing skin flap ischemia and necrosis after mastectomy (with fewer side effects than pharmaceuticals), protecting the kidney from damage from extracorporeal shock wave lithotripsy during breakdown of kidney stones, ameliorating late-state COPD, preventing ischemic stroke recurrence, reducing damage from traumatic intracranial hematoma, ameliorating chronic fatigue, reducing hyphema, treating acute myocardial infarction, reducing severe inflammation due to infection, alleviating the effects of stroke, counteracting Alzheimer’s disease, and aiding in cancer treatment.

Every study, irrespective of the condition, found the herb effective in helping alleviate or prevent the condition.

Many thousands of people have participated in the various clinical trials, many of them randomized and placebo-controlled. As only one example: An analysis of over 60 randomized clinical trials (with a total of 6,931 people) for the treatment of angina pectoris over a minimum of four weeks found the herb more effective than isosorbide dinitrate (ISDN).

The pharmacokinetics of the herb’s constituents are very good, that is, they cross the GI tract membrane and circulate in high quantities in the blood and throughout the body. They also easily cross the blood-brain barrier. This is primarily due to the herb’s inhibition of P-glycoprotein, one of the major mechanisms preventing compounds from crossing the various barriers that exist in the body.

Preparation and Dosage

There are a number of essential understandings necessary before using this herb. All concern the effects that different preparation methods have on the effectiveness of the herb. These are crucial.

1. As an initial step: please see “Collection and Root Preparation” above. The roots of this plant must be dried in the sun or under heat prior to preparation for the plant to be medicinally active to the degree necessary for use. In other words, the root should never be tinctured fresh. The herb should never be tinctured fresh. The salvianolic acids, such as SaB, are only present in minute quantities in the fresh root.

2. The concentrated powder or granules of this herb should never be used. Exhaustive studies on those compounds have found significant problems. Specifically, the hydrophobic (a.k.a. lipophilic) compounds, i.e., the tanshinones, are difficult to extract, and they are present only in very low quantities in many of the (Chinese-produced) concentrated forms of this herb, primarily because the manufacturers use water as their extractive medium. The hydrophobic compounds do not extract in water and without them the herb becomes significantly less effective for treating disease. Because it is impossible (at this point in time) to determine the extractive process being used in the production of any particular concentrated granules or powders, they should not be used.

3. Tanshinones are lipophilic, that is, “fat loving.” They extract most efficiently in toxic substances such as methanol and hexane. (They do extract in ethanol, just not as efficiently.) Unfortunately, there has been very little work done on the most efficient ways to extract lipophilic compounds from herbs without utilizing sophisticated manufacturing processes. An analysis of the different medicinal components of herbs (which vary widely in their natures) and the most efficient extraction processes that can be used by community herbalists (whether in the United States or Africa or Asia or . . . ) does need to be done.

Community practitioners do know a bit about this kind of difficulty already, but it is not widely recognized for its importance. For example, the extraction of herbs (such as Artemisia annua) containing both hydrophilic and lipophilic constituents in some regions (Asia) is accomplished using heated milk as the extracting medium.

4. Because the hydrophobic tanshinones do not extract well in water, infusions (teas) and decoctions are not recommended for this plant for use in treating the conditions discussed in this book. (The hydrophilic caffeic acid group does extract in water and is useful for a number of conditions, especially protecting endothelial integrity. However, that is not sufficient for counteracting the full range of physiological damage these Lyme coinfections cause. It is especially not sufficient for treating sepsis.)

5. The ethanol/water/herb tincture ratios that are commonly used with this herb vary considerably. In the U.K. the ratio is usually one part herb to three parts liquid (1:3), often with 25 percent alcohol (one part alcohol to three parts water), but I have seen formulations with 35 and 45 percent as well. In the United States 1:2 and 1:2.5 herb-to-liquid ratios are common, usually in 25 percent alcohol. There is also one 1:2 preparation, using cold percolation, with 50 percent alcohol/water, which is the only high-alcohol preparation I could find as this book was being written. (Hopefully this will change shortly.) Note: There are significant problems with any tincture formulation of less than 50 percent alcohol. Specifically . . .

The lipophilic tanshinones (a.k.a. the abietane diterpenoids) will not extract sufficiently in an ethanol concentration that low. (That amount of alcohol is barely enough to keep the tincture stabilized.) Studies of such formulations (in China) consistently find that there are little or no tanshinones present in them. Tinctures of this plant are highly useful as medicines (as is the dried root itself taken as powder or in capsules) but they need to be made with a much higher alcohol percentage than is common on the market. As researchers Song et al. (2009) comment:

Chromatographic profiles from 12 manufacturers showed different patterns. HPLC profiles of granules from manufacturers A, C, G, H, and J were similar to those of aqueous extract of Danshen, which contained hydrophilic compounds but the contents of hydrophobic tanshinones were very low. The samples from B, D, E, F, I and K showed a similar pattern of 70% ethanol extract of Danshen, which contained both hydrophilic phenolic components and hydrophobic tanshinones.

Chinese researchers have found that a 70 percent ethanol extract produces the highest quantities of tanshinones. Other studies have found that a 50 to 60 percent ethanol extractive medium produced the most salvinolic acid B from the dried roots. (A 20 to 30 percent ethanol solvent extracted significantly less SaB than either a 50 or 60 percent solution.) I prefer a 60 percent alcohol to 40 percent water formulation for tincturing the root of this plant; it is what I suggest herein. That will efficiently extract both the hydrophilic and hydrophobic constituents in sufficient quantities for the herb to be useful in treating Lyme coinfections and sepsis.

Tincture

Preparation: 1:3, 60 percent alcohol.

Dosage: Varies considerably, anywhere from 1 to 2 milliliters (20 to 40 drops, a.k.a. a full dropper more or less) to 1 tablespoon, anywhere from 3x daily to every 15 minutes. Dosage specifics are:

• For babesia: ½ teaspoon 3x daily.
• For ehrlichia/anaplasma: 1 teaspoon 3–6x daily.
• For severe pain: up to 1 tablespoon every 15 minutes, reducing the dose as the pain subsides (thanks to Michael and Leslie Tierra for this one).
• For sepsis: 1 tablespoon every 15 minutes to 1 hour depending on severity.

Please note: There are one or two sources on the Internet insisting that this herb must never be taken in tincture form (they don’t say why), however there is no support for this in the literature (in China or elsewhere).

Dried Herb

The dried herb is, in many respects, stronger than a tincture in that all the plant constituents are going into your body full strength. This allows your body to determine what it wants to pull from the herb and what it does not.

The Chinese, for the past two millennia, commonly used the dried herb. Dosage is high, as is normal in China, from 5 to 15 grams (about 1/5 to ½ ounce) up to several times a day. Up to 60 grams (2 ounces or so) is considered an acceptable single dose in severe, acute conditions.

• For babesia: ½ teaspoon powdered root, 3x daily.
• For ehrlichia/anaplasma: 1 teaspoon powdered root, 3–6x daily.
• In acute conditions: 1 tablespoon powdered root, 3x daily.

Infusions and Decoctions

Not recommended for this herb when treating Lyme coinfections or sepsis.

Side Effects and Contraindications

This herb is extremely safe, however since the herb is an anticoagulant, it is contraindicated for those with bleeding disorders (e.g., hemophilia, bleeding ulcers, and so on). Because it stimulates menstruation, it should not be used during pregnancy.

A few people are apparently allergic to this genus (as well as some of the constituents in danshen); rash, itching, and shortness of breath have been reported in a couple of instances. There are a few anecdotal reports of stomachache and/or decreased appetite when the tincture is used.

If side effects occur, stop using the herb.

Herb/Food Interactions

Soy and milk are reported to decrease the effectiveness of the herb; however, extensive searching in numerous databases and texts did not produce any support for this assertion. It seems to be one of those zombie ideas (herban legends) that show up for some reason and never go away no matter how many times you kill them.

Herb/Drug Interactions

The herb is an anticoagulant; it inhibits platelet aggregation and should not be used along with pharmaceutical anticoagulants such as warfarin, heparin, aspirin, and so on. (Excessive aspirin use is also contraindicated.)

Concurrent use of digoxin and danshen may result in falsely elevated serum digoxin concentrations when measured by fluorescence polarization immunoassay. A falsely lowered level may occur when measured by microparticle enzyme microassay.

The herb is a competitive inhibitor of liver CYP3A4, CYP2C9, CYP2E1, CYP2D6, and CYP1A2 activity. CYPs are major enzymes involved in drug metabolism and bioactivation in the liver. Inhibition of CYP3A, for example, has been found to decrease midazolam clearance and may affect the metabolism of other drugs. (There are numerous inhibitors of CYP3A that people commonly ingest, including clarithromycin, erythromycin, grapefruit juice, and quercetin, just so you know.)

Midazolam is used for acute seizures, for moderate to severe insomnia, and for sedation and amnesia prior to medical procedures. It is the most commonly used benzodiazepine as a premedication for sedation. Inhibition of CYP3A slows clearance of the drug from the body by 16 percent and increases the duration of sedation. The amount of losartan, an antihypertensive drug, in circulation is also affected by the herb. The effects on medications seems individual; theophylline, for example, is not affected by the CYP inhibition of the plant.

The root of this plant contains carboxylesterase inhibitors. Carboxylesterase is an enzyme in the human body that acts to metabolize many ingested substances, including drugs, thus increasing their solubility and activity in the body. The inhibition of carboxylesterase can reduce serum levels of the drugs in the body, thus lowering their effectiveness. This particularly affects esterified drug agents such as those in hormone replacement therapies and the anticancer prodrug irinotecan.

A number of constituents of danshen are competitive binders with salicylates (think aspirin) for albumin. Prior use of danshen displaces salicylates from albumin binding. This increases the amount of free salicylates in circulation. Prior use of aspirin displaces danshen binding with albumin; this increases the amount of danshen constituents in circulation.

The herb should be discontinued prior to surgery, not only because of its anticlotting properties but also because of its impacts on common anesthesia interventions.

Finding It

The dried root and tincture of the root are both fairly easy to find. Most of my recommended suppliers (see “Sources of Supply” at the end of the book) carry it. Horizon Herbs carries very high-quality seeds.

Angelica sinensis

This herb is most commonly known as dong quai, or Chinese angelica, which is, in the West, primarily known as a tonic herb for the female reproductive system (the “female ginseng”). The root is what is used.

As with most herbs, it is its general, widely known use that has dominated Western herbal thinking about it over the years. Until now, I haven’t ever thought more deeply about the herb either. Its recurring presence in my research as a specific counteractant for HMGB1-initiated sepsis revealed that there was a lot more to the herb than I had realized. (A frequent occurrence with every plant medicine I have had only a superficial relationship with.)

The herb has been used in Chinese medicine for millennia and is considered specific for tonifying the blood, promoting blood circulation, relieving pain, as a specific for uterine/menstrual problems, and for helping normalize liver, spleen, and heart channels. Its major clinical uses are for dysregulation in menstruation and uterine function, for pain, and for early-stage infections of one sort or another. Nearly all herbalists in the West simply use it for female reproductive dysregulations of one sort or another.

Despite this traditional use, the Chinese have been extending its range considerably the past few decades. It has a profound impact on heart and circulatory functioning, and it acts as a vasodilator, lowering blood pressure and slowing both heartbeat and pulse rate. It functions well as a moderate heart tonic, protecting the heart from damage. The herb is also a moderate anticoagulant (with antifibrotic actions), decreases platelet activity, and stimulates hematopoiesis in the bone marrow (making it good for anemia for instance). Its use increases the numbers and activity of macrophages, fibroblasts, erythrocytes, granulocytes, and lymphocytes in the blood. The herb delays the aging of hematopoietic stem cells by inhibiting oxidative damage to them. It increases both thymus and spleen indices (increasing thymus weight and cellular production), and the numbers of red and white blood cells in peripheral blood, especially during myelosuppression. It increases the percentage of CD4+ cells and modulates the CD4+/CD8+ ratio.

The herb has reliable analgesic actions, helping with general aches and pains but also arthritic, abdominal, and postoperative pain. It has been successfully used in the treatment of chronic hepatitis and cirrhosis of the liver and acts as a hepatoprotector from both chemical and microbial insults. In fact it is pretty reliable for reducing fibrosis in organs, including the lungs, spleen, liver, and kidneys. It has some pretty good actions as a neuroprotector and relaxant. It stimulates the formation of new neural cells in the brain (promoting adult neurogenesis), thus helping to reverse cognitive impairments. It is pretty good at reversing any inflammatory-initiated cognitive impairments in the brain.

It is considered specific for chronic constipation in the elderly. In essence, the herb, as the Chinese have insisted for a while, is good for the heart, spleen, and liver channels.

Angelica has a number of cytokine impacts including rather strong inhibitions on TNF-α, reducing its apoptosis-stimulating actions, reducing the inflammatory pain it causes. It is an MIP-2 inhibitor and an IL-2 upregulator. It reduces NETs formation by inhibiting neutrophil elastase (NE). And it dose-dependently inhibits HMGB1 release and stops the progression of lethal sepsis. Circulating levels of HMGB1 are reduced, as are levels of IL-6. Angelica also inhibits the endothelial cell permeability HMGB1 causes. This is one of the specific herbs for use in treating sepsis and for counteracting myelosuppression and anemia.

Preparation and Dosage

The Chinese often prepare the herb as a decoction, 5–15 grams in water, divided into several doses daily. The powdered root is useful, 1–2 grams 3x daily. Dosage of the tincture of the dried root (1:5, 70 percent alcohol) runs ½ teaspoon–1 tablespoon 3x daily, depending on the severity of the condition.

Note: The herb is useful for pain, especially when combined with Salvia miltiorrhiza; take 1 tablespoon more every 15 minutes for pain, reducing the dosage and frequency as the pain lessens.

Side Effects and Contraindications

No real side effects to the herb; it is contraindicated in pregnancy, especially the first trimester, as it can stimulate menstruation. The herb does soften the bowel contents—not a good idea to use it during bouts of diarrhea.

Herb/Drug Interactions

Shouldn’t really be used with anticoagulants.

Astragalus spp.

This is a huge genus of some 3,000 species that are prevalent throughout the world. The primary species used is Astragalus membranaceus, a.k.a. A. membranaceus var. mongholicus, a.k.a. A. mongholicus and so on, depending on the degree of taxonomitis that is occurring. The root is what is used for medicine.

Astragalus is an immune enhancer, modulator, stimulant, and restorative; antiviral; antibacterial; adaptogen; tonic; antihepatotoxic; hypotensive; diuretic; and organ tonic that enhances function in the lungs, spleen, and GI tract. It protects the heart from numerous insults as well (well, not verbal ones).

As an immune potentiator and modulator astragalus strongly regulates IFN-γ and IL-2 levels. If IFN-γ levels are high, for example, it actively lowers them. The herb enhances CD4+ counts and balances the CD4/CD8 ratio, making it a very useful herb for these types of Lyme coinfections.

It is specific for immune atrophy and enhances function in the spleen and thymus, again making it a nicely functional herb for these conditions. The herb is specific as a preventive for infection from Lyme bacteria and for reducing severity of the disease. It is a very nice immunomodulator for the Lyme group of infections.

Astragalus has been a major herb in Chinese medicine for between 2,000 and 4,000 years. Its traditional uses are for spleen deficiency with lack of appetite, fatigue, and diarrhea. It is specific for disease conditions accompanied by weakness and sweating, stabilizes and protects the vital energy (qi), and is used for wasting diseases, numbness of the limbs, and paralysis. Other uses are: tonifies the lungs, for shortness of breath, frequent colds and flu infections; as a diuretic and for reduction of edema; for tonifying the blood and for blood loss, especially postpartum; for diabetes; for promoting the discharge of pus; for chronic ulcerations, including of the stomach, and sores that have not drained or healed well.

A considerable amount of scientific testing has occurred with astragalus, including clinical trials and both in vivo and in vitro studies. PubMed now lists over 5,700 citations for studies with astragalus and this does not include the many Chinese studies that have never been indexed for it. The Chinese database CNKI now has over 16,000 entries on the herb.

Most of the clinical studies and trials regarding immunostimulation have been focused on the use of astragalus in the treatment of cancer and/or as an adjunct to chemotherapy to help stimulate chemodepressed immune function. A number of other studies have examined its immune effects with a range of different conditions.

The herb has been used with children suffering tetralogy of Fallot after radical operation to correct the condition. Tetralogy of Fallot is a complex of four heart abnormalities that occur together, generally at birth. Surgery is used to correct it. Astragalus was found to decrease abnormal levels of IgG, IgM, C3, C4, CD8+, and CD19+ while increasing levels of CD4+ and CD56+. The ratios of CD4/CD8, CD3/ HLA-DR, and CD3/CD16 normalized between the second and third week of use. IL-6 and TNF-α both began decreasing in the first week and by week four were in the normal range.

When used in the treatment of herpes simplex keratitis, levels of Th1, including IL-2 and IFN-γ, increased and Th2 levels, including IL-4 and IL-10, decreased, showing that the herb modulated Th1 and Th2 levels. This same kind of effect has been found in the treatment of numerous cancers. For example, in a study of 37 lung cancer patients astragalus was found to reverse the Th2 status normally present in that condition. Th1 cytokines (IFN-γ and IL-2) and its transcript factor (T-bet) were enhanced and Th2 cytokines were decreased.

In clinical trials with a number of different cancers and congestive heart conditions, astragalus has been found to increase CD4+ levels, reduce CD8+ levels, and significantly increase the CD4/CD8 ratio. The plant has been found to have a broad immunostimulatory effect. Use of the herb with cancer patients undergoing chemotherapy found that white blood cell counts improved significantly (normalizing). The herb has been found to be specifically useful in preventing or reversing immunosuppression from any source: age, bacterial, viral, or chemical. Phagocytosis is enhanced and superoxide dismutase production from macrophages is increased.

Astragalus has been found to possess anti-inflammatory activity by inhibiting the NF-κB pathway and blocking the effect of IL-1β in leukotriene C production in human amnions. The constituent astragaloside IV inhibits increases in microvascular permeability induced by histamine. The whole herb decoction has been found to reduce capillary hyperpermeability. It is strongly inhibitive of TGF-β as well. It upregulates both IL-12 and MHC-II, inhibits TLR-4 (thus reducing HMGB1 levels), counteracts the suppression of Tregs by HMGB1, and counteracts endothelial cell permeability caused by HMGB1. Numerous studies have found that astragalus counteracts myelosuppression. It stimulates hematopoiesis, increasing blood cell progenitors in the bone marrow, and stimulates the production of both red and white blood cells.

Astragalus has been found to improve anisodine-induced impairment of memory acquisition and alcohol-elicited deficit of memory retrieval. After use of the herb the number of errors were reduced. The plant has been found to exert potent antioxidant effects on the brain, helping to prevent senility.

In one study, 106 newborns with neonatal hypoxic ishemic encephalopathy were separated into two groups. One received oral astragalus granules for seven months, the other nimodipine for three months, then pyritinol for an additional four. There was better recovery in the astragalus group, with less long-term negative effects from the initial condition. The incidence of cerebral palsy was markedly reduced. (Another study used injection, the outcomes were similar.) Studies on the use of astragalus injection in the treatment of cerebral palsy in children found that it significantly reduced symptoms.

Astragalus has been found effective in alleviating fatigue in heart patients and in athletes. In athletes given astragalus, the herb was found to positively influence their anaerobic threshold, enhance their recovery from fatigue, and increase their fatigue threshold.

A double-blind, randomized, controlled trial with 36 adults with chronic fatigue found that a mixture of astragalus and salviae radix (salvia root) significantly decreased fatigue scores.

Preparation and Dosage

Many astragalus formulations are standardized though I’m not sure that the literature really supports standardization with this herb. I think it is more a case of standarditis than anything else. The whole root contains constituents that are essential for carditis and enhanced immune function. And, indeed, the majority of the Chinese studies—clinical and laboratory—were with the whole herb. The herb may be taken as tea, powder, capsules, tincture, or in food.

Tincture

Tincture preparations vary considerably, from 1:2 and 1:3 up to 1:5 and with alcohol concentrations ranging from 25 to 60 percent. There doesn’t seem to be a lot of data on why nor what is the best tincture preparation procedures. However, there is some good data suggesting it be done this way . . .

In general, many of the most potent actions of the plant come from its polysaccharides and polysaccharides are most efficiently released from the root cells by hot water. This is, in part, why many traditional uses of astragalus involve cooking it or using it as a tea.

So, if you are making an extract of, let’s say, 5 ounces of astragalus powder, you would then use anywhere from two to five times the amount of water. Many of the manufacturers whose products I think are good use from 40 to 50 percent alcohol for their astragalus tinctures in either a 1:3 or 1:5 tincture ratio. For this example, let’s do it this way . . .

Preparation: Take 5 ounces of astragalus root powder and 25 ounces of liquid (this makes it a 1:5 ratio). The liquid should be composed of half water and half pure grain alcohol, which will give you a 50 percent alcohol extraction medium. You would be using 12.5 ounces of water. Take the water only (starting with cold water), add the root to it—in a pot—and bring it to a boil. As soon as it comes to a boil, turn off the heat, and cover. Let it steep overnight. In the morning, put the whole mess in a jar, add the alcohol (12.5 ounces), and tighten the lid. Leave for two weeks, shaking when you remember to do so. Then decant.

Dosage: As a tonic, 30–60 drops up to 4x daily. In chronic illness conditions, 1 teaspoon 4x daily. As preventive (from viral infection), 1 teaspoon 4–6x daily. In acute conditions, 1 teaspoon 4–6x daily, generally every 3 hours.

Tea

Put 2 to 3 ounces of herb in a quart of hot water, let steep for 2 to 3 hours, strain, then drink throughout the day.

Powder

In chronic conditions, take 1 tablespoon 3x per day. In acute conditions, 2 tablespoons 3x per day. Your body’s own bile and stomach acids will extract the constituents. You can go higher on these doses if you wish. The Chinese use very large doses of the powdered root, from 15 to 60 grams per day, essentially ½ to 2 ounces per day.

Side Effects and Contraindications

No toxicity has ever been shown from the regular, daily use of the herb nor from the use of large doses. The Chinese report consistent use for millennia in the treatment of colds and flu and suppressed immune function without side effects.

It is contraindicated, however, for some people, in certain kinds of late-stage Lyme disease because it can exacerbate autoimmune responses in that particular disease. For others it can alter the Th1/Th2 balance and reduce the autoimmune dynamics. Whether or not it acts as a modulator seems to depend on individual reactions to the herb; I haven’t been able to find a reason why, for some people, it exacerbates their condition and for others it does not.

Herb/Drug Interactions

Synergistic actions: Use of the herb with interferon and acyclovir may increase their effects. The herb has been used in clinical trials with interferon in the treatment of hepatitis B; outcomes were better than with interferon alone. It has also shown synergistic effects when used with interferon in the treatment of cervical erosion; antiviral activity is enhanced.

Drug inhibitor: Use of the herb with cyclophosphamide may decrease the effectiveness of the drug. Not for use in people with transplanted organs.

Herb/Herb Interactions

Synergistic with echinacea and licorice in the stimulation of immune function.

Finding It

Herb stores everywhere and the Internet.

Bidens pilosa

There are a lot of different species of bidens. Bidens pilosa is the main species used medicinally (or at least on which most of the studies have been done) but there do seem to be a number of others in the genus that historical use and early research indicate can almost certainly be used similarly: Bidens frondosa, B. tripartitus, B. ferulaefolia, B. alba are all fairly potent, frondosa and tripartitus more so than pilosa in their antimalarial effects; B. maximowicziana, B. pinnata, and B. campylotheca are all fairly strong as well. (I use B. pinnata because it grows in my yard as a wild invasive. And, yes, the thousands of seeds that get stuck in my socks and pants every year are irritating.)

The aerial parts of the plant are usually used but the roots will often work as well. (Note: The plant is a great deal more active as an antibacterial and mucous membrane protectant if it is prepared fresh. The dried stuff is just not nearly as good.) The plant was originally native to South America but has escaped and is a potent invasive throughout much of the world. As it does mine, it probably grows around your house someplace.

The bidens are systemic herbal antibacterials with a fairly wide range of action against both Gram-positive and Gram-negative bacteria; they are also active against a fairly wide range of protozoa. They are antimalarial, antibacterial, antimicrobial, antidysenteric, diuretic, hepatoprotective, hypotensive, anti-inflammatory, hypoglycemic, antidiabetic, styptic, vulnerary, immunomodulant, antiseptic, neuroprotectant, blood tonic, astringent, carminative, galactogogue, mucous membrane tonic, and a prostaglandin synthesis inhibitor. In fact, bidens is one of the most potent PGE2 plant inhibitors known. Inhibiting PGE2 counteracts many tick salival proteins as well as stimulating dendritic cell maturation, helping fight the infection.

Bidens is exceptionally good for (in order of potency): 1) any systemic infections that are accompanied by problems in the mucous membranes anywhere in the body, especially chronic diarrhea, dysentery, UTI, vaginitis, and inflamed respiratory passages; 2) systemic staph; 3) malaria, babesia, leishmania.

The plant, in traditional use, has been used as a specific for a number of conditions: headaches, kidney problems, arthritis, ulcers, swollen spleen, coughs, lung and other infections, rheumatism, UTIs, rashes, and inflammation, and it’s seen use as a neuroprotector. It has a long history of this kind of use in both Ayurveda and traditional Chinese medicine.

In China it is used for treating cardiac spasm, itching, gastroenteritis, appendicitis, colitis, irritable bowel syndrome, hemorrhoids, diarrhea, dysentery, difficulty swallowing, sore throat, tonsillitis, esophageal enlargement, jaundice, acute or chronic hepatitis, malaria, boils, abscesses, infections, fever, chills, joint pain, traumatic injury, sprains, swelling, contusions, rheumatoid arthritis, gastric and esophageal cancer, epilepsy in children, infantile fever with convulsions, malnutrition in infants, colds and flu, bronchitis, chest congestion, hemoptysis, allergies, lung irritation, pneumonia, insect bites, scorpion sting, and snakebite.

The Eclectic botanical physicians used it, primarily as an emmenagogue and expectorant, for amenorrhea, dysmenorrhea, uterine problems, severe cough, and asthma, as an infusion. An infusion of the seeds sweetened with honey was used for whooping cough. The plant was thought useful for heart conditions including palpitation, for colds, and for acute bronchial and laryngeal attacks.

The plant is a mucous membrane tonic and will not only stop the inflammation and act as a potent antibacterial in UTI infections but also heal the mucous membranes themselves. It has an affinity for mucous membranes and appears to act as a mucous membrane tonic. It is especially good for UTIs that are treated, return, are treated, return, ad inuretherum, especially if antibiotics have been used. The pain will usually go away in a day or two if you use bidens and within a couple of more days the problem should clear up.

It is specific for reducing elevated levels of uric acid in the blood, i.e., for treating gout or urate-based kidney stones. It is a decent diuretic and stimulates uric acid elimination from the body.

Because it is a mucous membrane tonic and is astringent, powerfully anti-inflammatory, and strongly antibacterial, bidens is specific for a number of troublesome diseases caused by resistant organisms: UTI, chronic diarrhea and dysentery, gastritis and ulcers (anywhere in the GI tract, from mouth to anus), inflamed mucous membranes in colds and flu and respiratory infections of any sort, sore throats from coughs or infection or even overuse of the throat, and vaginal infections. It’s a good plant, too often overlooked.

Several of the plant’s isolated polyacetylenes have been found to be more active than ampicillin, tetracycline, norfloxacin, and amphotericin B during in vitro studies. Ciprofloxacin and ofloxacin were more potent than the plant extracts. In one study, water extracts of the plant were found to be more effective against E. coli and Bacillus cereus than gentamicin. Bidens has been found to potentiate the activity of tetracycline if taken along with that pharmaceutical.

Bidens pilosa was found to be as effective as atropine, promethazine, neostigmine, and hydrocortisone in protecting mice from the venom of Dendroaspis jamesoni, a snake in Cameroon whose venom contains a potent neurotoxin. The plant extract also potentiated the normal anti-venom normally used to treat those snakebites (as did atropine and promethazine). It is a very potent neuroprotector against neurotoxins.

A number of in vivo studies revealed the herbal tincture to be highly antiulcerogenic, inhibiting gastric lesions induced by alcohol, and to be more effective than sucralfate. The herb significantly protected gastric mucosa and initiated mucosal healing through a number of mechanisms.

Bidens has been found to be a strong antioxidant and anti-inflammatory. A double-blind, randomized crossover trial with 20 participants found the herb effective in the treatment of allergic rhinitis. In vitro and in vivo studies have found it highly effective in protecting erythrocytes from oxidative damage. The water-soluble fractions are more antioxidative than ethanol. The plant inhibits COX-2 expression (similarly to ibuprofen) and prostaglandin production. It is a prostaglandin synthesis inhibitor and a significant free-radical scavenger, comparable to alpha-tocopherol. It inhibits histamine release. Bidens also suppresses IL-1β, MAPK, and iNOS and inhibits lipid peroxidation by bacteria as well as NF-κB.

Bidens pilosa is a strong and reliable immune modulator. It has been found to modulate the differentiation of helper T cells and prevent Th1-mediated autoimmune diabetes in non-obese diabetic mice. This has been attributed to a number of polyacetylenic compounds and a butanol fraction. The butanol fraction also reduces Th2-mediated airway inflammation in mice. Hot water extracts of the plant stimulate IFN-γ expression. The plant will increase immune action if it is low, and decrease it if high.

Preparation and Dosage

The plant should be prepared in specific ways to be most effective. The problem appears to be threefold: 1) some of the plant’s most potent constituents begin to degrade as soon as the plant is dried—the plant constituents oxidize easily; 2) heat destroys them as well; and 3) the most potent constituents are considerably more soluble in alcohol than in water. Water infusions still do have a decent range of potency (as can be seen from the plant’s traditional uses as a tea in Africa) but are not nearly what they could be if they are prepared as a cold alcohol/ water maceration. Water extractions of the plant (teas, infusions, decoctions) even if it is dried will possess about half the antibacterial activity of an alcohol tincture (depending on how old they are) but they will possess most or all of the other actions described in this material (antiinflammatory, antiallergenic, immune-modulating, and so on), especially the anti-inflammatory and antipyretic actions. The fresher the dried plant material the better.

Water infusions lose potency fairly rapidly; they should be made and used daily. They won’t keep. Additionally, the older the dried plant is, the less potent it will be—in either water or alcohol. The rapidity of degradation of the plant chemicals is, in part, why so many cultures that don’t normally make alcohol tinctures resort to using the juice of the leaves of this plant, internally and externally, for disease.

So, for this herb, you’ll want to use the tincture of the fresh plant, as follows:

Preparation: Tincture, 1:2, 95 percent alcohol, using the fresh plant leaves and stems.

Dosage: 45–90 drops in water up to 4x daily. In acute conditions (malaria, systemic staph), ¼–1 teaspoon and up to 1 tablespoon in water up to 6x daily for up to 28 days, depending on the severity.

Side Effects and Contraindications

None noted in the literature.

Herb/Drug and Herb/Herb Interactions

None noted, however . . . one study does show bidens potentiating tetracycline. Caution should be exercised in using the plant if you are on diabetes medications as it will alter your blood glucose and insulin levels.

Camelli a sinensis (Green Tea and EGCG)

Green tea contains a number of catechins (which are polyphenols), the primary ones being epigallocatechin gallate (EGCG), epicatechin (EC), and epicatechin gallate (ECG). It also contains some important flavonoids: kaempferol, quercetin, and myricetin. Its myricetin content is higher than that in nearly all other plants. And of course, caffeine. Most of the research has occurred with EGCG but the other constituents are important and should not be neglected. If possible the best approach is to use a product that contains both the polyphenols and the flavonoids. (No, I don’t know of one to recommend.)

Although not commonly thought of as an antibacterial, the catechins in both green and black tea have antimicrobial activity against a number of bacteria, including various mycoplasmas—especially M. pneumoniae and M. orale. They are also strongly reductive of the cytokine cascades various coinfections generate.

EGCG inhibits a wide range of cytokines, including TNF-α, NF-κB, IL-1β, IL-6, IL-8, ERK, CCL2, MMP-2, MMP-9, EGF, VEGF, PI3K, and p38 MAPK. EGCG also reduces peroxynitrite levels, reduces excess uric acid, reduces proteinuria, and protects rats, in vivo, from ischemia-reperfusion caused by bacterial lipopolysaccharides.

EGCG has been found to, in vivo, suppress induced autoimmune encephalomyelitis. It reduces clinical severity by limiting (and preventing) inflammation and reducing neuronal damage. It stops ROS production throughout the central nervous system. It reduces cerebral amyloidosis and modulates cleavage of the amyloid precursor protein. Studies have shown that it reduces age-related memory impairment in mice. EGCG apparently modulates the intracellular levels of free calcium in brain neurons (one of the causes of neuronal problems) and the hippocampus caused in such diseases as Alzheimer’s and a number of coinfections.

EGCG also has some good protection for mitochondria. Besides the anti-inflammatory actions it also increases the accumulation of zinc in the mitochondria and cytosol.

EGCG helps with arthritic inflammation, attenuates the over-expression of pro-inflammatory cartilage cytokines, and modulates the antioxidant status in arthritic rats. It reduces edema in arthritis, suppresses lipid peroxidation, and increases the levels and activity of superoxide dismutase, glutathione, and catalase in cells. It is strongly inhibitive of acetylcholinesterase.

EGCG reduces lesions generated by inflammatory cytokines in peridontitis and colitis. It inhibits angiogenesis and has been found to have a strong impact on cancer cells, inhibiting inflammation and metastasis.

Green tea and EGCG are both synergistic with some herbs and supplements. EGCG, resveratrol, and gamma-tocotrienol (a form of vitamin E) are more effective against breast cancer cells when combined than when separated. The same is true for prostate cancer cells when EGCG is combined with quercetin and genistein. Effectiveness is enhanced against osteosarcoma cells when it is combined with lysine, proline, arginine, and ascorbic acid.

EGCG is synergistic with tetracycline against staph bacteria; it inhibits the efflux pump the bacteria use against the antibiotic. It potentiates betalactam antibiotics against resistant bacterial species. And does the same with carbapenems and ampicillins against MRSA (methicillin-resistant Staphylococcus aureus). It is synergistic with doxycycline.

EGCG and green tea in general have a number of actions that are directly useful during coinfections but there are a number of problems in the use of EGCG as a supplement, essentially its bioavailability. (It also can increase nitric oxide production, a potential problem in some cases, but excellent for treating babesiosis.)

Unfortunately only about 40 percent of the EGCG taken will get through the GI tract membranes. Most of the EGCG absorption takes place in the small intestine but fairly substantial amounts remain in the GI tract. Once it reaches the colon it is metabolized by the microflora in the gut. (Epicatechin gallate levels, if all the catechins are ingested, are much higher in the blood than EGCG levels.) The EGCG that does get into the blood undergoes extensive methylation, glucuronidation, and sulfation in the liver, where it is broken down into much less effective metabolites.

How to Take It

Plasma levels of EGCG are highest if it is taken on an empty stomach just after rising in the morning. Peak plasma concentrations are reached in one to two hours; they remain high for about three hours and then begin to decline, reaching zero by the next morning. (So, you have to take EGCG every three to four hours.)

The amount of EGCG, and the other tea catechins, that gets into the blood and does remain active depends on a number of factors, few of which are usually taken into consideration when using it as a supplement.

1. Serum albumin levels need to be highish. Human serum albumin contributes to transport and stabilization of EGCG and the other catechins. If it is low, bioavailable levels of EGCG are low.
2. EGCG and the catechins degrade in humidity and hot air temperatures. They have to be stored in a cool, dry location to remain active (think “refrigerator”).
3. Since EGCG is a potent antioxidant, exposing it to the air over any length of time will activate its oxidative actions, causing auto-oxidation and rendering it relatively useless once you ingest it.
4. Taking EGCG with hard water affects its absorption into the body. The harder the water, the less that can be absorbed into the body. Soft water is essential.
5. Ingesting it with milk will inactivate it.

The bioavailability of green tea and EGCG can be significantly enhanced, however, if you take them with certain other substances. Quercetin (1,200 mg daily) or ascorbic acid (200 mg) or omega-3 fatty acids (1,000 mg), for instance, will all increase their availability. Quercetin increases the bioavailability of green tea catechins and decreases their methylation, in vitro and in vivo. Quercetin is itself a very good supplement for treating cytokine cascade problems. It inhibits NF-κB, TNF-α, IL-1β, EGF, iNOS, NO, and JNK. I would highly suggest, at minimum, a quercetin/EGCG combination (and no, nobody sells one, so buy them separately). EGCG is also much more effective if combined with resveratrol (knotweed), vitamin E, and/or N-acetylcysteine.

And . . . there is evidence, as usual, that the whole herb—the green tea itself—is and remains much more bioavailable than the isolated constituents.

If you do wish to use EGCG, it is really good, but bear all the necessary restrictions on its use in mind and combine it with other things, most especially quercetin.

Dosage

Try to get a supplement with at least 80 percent total catechins, at least that amount of polyphenols, and 50 percent or so of EGCG. A supplement with the natural green tea flavonoids would be even better. Dosage range is 400 to 800 mg daily. For greater effectiveness in treating Babesia-generated endothelial cell damage, for instance, take it with 1,200 mg quercetin daily—both at the same time, in the morning.

Note: There is about 100 mg EGCG in a cup of green tea. I would imagine that drinking green tea itself throughout the day would be a good approach and it produces better bioavailability.

Comment

EGCG is a very good supplement to use to normalize endothelial cells that are being targeted for inflammation, especially during Babesia and Bartonella infections.

Ceanothus spp. (Red Root)

There are 50 or 60 or a million species of Ceanothus in the Americas, from Canada to Guatemala, no one seems to know exactly how many there are. The genus isn’t native anyplace else but it has been planted as an ornamental throughout the world, especially in Europe. Most species can be used medicinally; the most common are C. velutinus, C. cuneatus, C. integerrimus, C. greggii, and C. americanus. All species are apparently identical in their medicinal actions. My personal favorite is Ceanothus fendleri, a.k.a. Fendler’s ceanothus, which grows in my region and which I have been using for over 25 years.

Red root is an important herb in many disease conditions in that it helps facilitate clearing of dead cellular tissue from the lymph system. When the immune system is responding to acute conditions or the onset of disease, as white blood cells kill bacterial and viral pathogens they are taken to the lymph system for disposal. If the lymph system clears out dead cellular material rapidly the healing process is increased, sometimes dramatically. The herb shows especially strong action whenever any portion of the lymph system is swollen, infected, or inflamed. This includes the lymph nodes, tonsils (entire back of throat), spleen, appendix, and liver. (Yes, it will help reduce an inflamed liver, though milk thistle is better.)

Essentially, if the spleen is swollen, that is, inflamed due to excess cytokine activity and immune cell production, the lymph system clogged, the nodes enlarged, the immune system depressed, and a chronic condition in place, red root is specifically indicated. The herb helps tone and modulate function in the nodes and spleen and is highly protective of the spleen from microbial damage.

Red root has a very long history of use in the Americas. The indigenous cultures used the plant for a wide range of complaints from arthritis to influenza, though it was primarily used as an astringent. The early American herbalists loved it and the Eclectic botanical physicians developed the use of the plant considerably, using it as an astringent, expectorant, sedative, antispasmodic, and antisyphilitic. It was used specifically for gonorrhea, dysentery, asthma, chronic bronchitis, whooping cough, general pulmonary problems, and oral ulcerations due to fever and infection. Its primary use, however, was for enlarged spleen and, to some extent, enlarged liver.

In recent years there has been a minor amount of exploration on the antimicrobial actions of red root. Several of the root compounds have been found active against various oral pathogens including Streptococcus mutans, Actinomyces viscosus, Porphyromonas gingivalis, and Prevotella intermedia. The flowers are active against Staphylococcus aureus and a couple of candida species; the roots probably are, too.

Betulin and betulinic acid, which are fairly prominent in the root, have a broad range of actions, both in vivo and in vitro: antiplasmodial, anti-HIV, anti-inflammatory, anthelmintic, antioxidant, antitumor, and immunomodulatory. Ceanothane, another constituent, is fairly strongly antistaphylococcal, antiplasmodial, and antimycobacterial. It does have some antimicrobial action against protozoa.

There is some evidence that red root’s activity in the lymph nodes also enhances the lymph nodes’ production of lymphocytes, specifically T cells. Clinicians working with AIDS patients, who have historically low levels of T cells, have noted increases after the use of red root. It is especially effective in reducing inflammations in the spleen and liver from such things as excessive bacterial garbage, white blood cell detritus in the lymph, and red blood cell fragments in the blood in diseases like babesiosis. There is clinical evidence that it has broad action throughout the lymph system and helps reduce not only the spleen but also the appendix when inflamed and that it stimulates lymph drainage as well in the intestinal walls.

Preparation and Dosage

Preparation: Tincture of the dried root, 1:5, 50 percent alcohol.

Dosage: 30–90 drops up to 4x daily. In acute conditions, 1 teaspoon up to 6x daily.

Side Effects and Contraindications

No side effects have been noted; however it is contraindicated in pregnancy. It should not be used if there is excessive chance of intravascular coagulation—Salvia miltiorrhiza should be used instead.

Herb/Drug Interactions

Red root should not be used with pharmaceutical coagulants or anticoagulants.

Chelidonium majus (Greater Celandine)

Greater celandine is native to Europe and western Asia; it’s pretty widely established throughout the world now, including North America (some people even say it is native here). And, dear to my heart, it is an invasive, quite common in areas where coinfections are endemic. Specifically, chelidonium is invasive in most of the central and northeastern United States, from Georgia north throughout Canada and west to the Mississippi River. It is also invasive in Montana, Utah, Washington State, and Nebraska.

Greater celandine has a long history of use both in the West and in China. In Chinese medicine the herb has been used to treat blood stasis, as a pain reliever, to promote diuresis in edema, for ascites, for jaundice, and for cough. Its primary functional use in the West has been as a pain reliever, cough suppressant, antitoxin, and anti-inflammatory. It has been used for a very long time as a specific for jaundice, gout, tooth-ache, ulcers, bronchitis, pulmonary infections, eye problems, infected wounds, wasting, GI tract problems, as a topical for abnormal growths, and as a blood tonic.

Its primary use now is as a mild sedative, antispasmodic, detoxifying herb, and for relaxing the muscles of the bronchial tubes, GI tract, and reproductive tract.

The plant has a nice cytokine-cascade suppressive effect. It inhibits NF-κB, TNF-α, IL-6, NO, Rho kinase, ERK, 5-LOX, 12-LOX, IFN-γ, B-cell proliferation, and gamma delta T cells in the spleen. Importantly, it is strongly inhibitive of the overactivation of the P2X(7) receptors in the brain, perhaps more than any other plant, making it specific for the kind of neurological problems that coinfections can cause.

The plant is strongly anti-inflammatory due to its cytokine cascade inhibition, which is part of its pain-relieving actions. It is used in Korea as an anti-inflammatory (among other things) especially in the treatment of rheumatoid arthritis. Studies with mice (in Korea) found that the herb significantly reduced the levels of IL-6 and TNF-α in the spleen and lymph nodes and strongly suppressed the progression of arthritis in the knee joint of mice, as well as “dramatically” reducing the erosion of cartilage in the joint.

It has a decent range of antimicrobial activity. It was found strongly active against Bacillus, Staphylococcus, Streptococcus, Enterococcus (including resistant strains), and 98 percent of human dental plaque pathogens. It has some antiviral actions against HIV, herpes virus, poxvirus, and grippe virus. It is potently active against the tick-borne encephalitis virus in vitro and reduces the impacts of the disease in mice given aqueous extracts, thus making it useful for that particular coinfection of Lyme. And it is antifungal against various candidas, resistant strains as well. It is strongly anthelmintic against Dactylogyrus intermedius parasites in fish. It is a biofilm inhibitor as well—a number of the compounds in the plant are active against the biofilm formation of various Staphylococcus species. It also is inhibitive of bacterial adhesion to human cells, probably from the herb’s content of chelerythrine (see below). This range of actions bears out the plant’s traditional uses for infected wounds and gums.

The plant has shown immunomodulatory activity in the spleen and bone marrow and has been found to strongly stimulate the production and release of bile, to be hepatoprotective and antiulcerogenic, to be antitumor, antispasmodic, radioprotective, and antiosteoporotic—primarily during in vivo and human trials.

One human trial found it to improve cellular and humoral immunity and nonspecific resistance to disease, significantly reducing the number of recurrences in children of chronic tonsillitis. Another clinical trial found that it was effective in reducing severe abdominal pain when compared with placebo.

The traditional uses of the plant and the range of actions that have been verified in scientific studies show it has a broad range of activity in many of the areas where Lyme coinfections have impacts. However, the most interesting are those that occur from one of its major constitutents: chelerythrine.

Greater celandine has over 30 different alkaloids, the main ones being coptisine (as in Coptis chinensis), sanguinarine (as in bloodroot and Mexican and opium poppy), chelidonine, and chelerythrine. The root has the most chelerythrine, running 2 to 3 percent by weight.

Chelerythrine is a very potent, and selective, protein kinase C (PKC) inhibitor (at tiny doses of 0.66 micromolar), ATPase inhibitor, and alanine aminotransferase (ALT) inhibitor. It also very strongly blocks the P2X(7) receptors in the brain that ATP stimulates.

Chelerythrine is also a potent ATPase inhibitor. Babesia, Ehrlichia, and Anaplasma, when acute (and most mycoplasmas), release ATP into the system. ATPase inhibitors can reduce many of the symptoms of more acute coinfections as well as mycoplasmas’ ability to adhere to host cells by 50 percent. Inhibiting ATPase reduces the degree of impact that these coinfections can have on host cells and keeps energy levels higher in the host.

High ATP levels in the brain lead to tremendous damage to the brain and central nervous system (CNS). ATP is also particularly stimulatory of the brain’s P2X(7) receptors. Over time this produces neuronal excitotoxicity. In other words, excessive stimulation of P2X(7) receptors in oligodendrocytes is toxic to those cells. This causes oligodendrocyte death, myelin damage, and axon dysfunction.

Excess ATP production also leads to white-matter ischemia. Loss of motor and sensory function, neurobehavioral problems, and cognitive impairments can all result. Cell damage causes significant ATP release from the damaged cell cytoplasm into the extracellular environment, where it quickly activates P2X(7) receptors on all cells in the brain, including astrocytes. This causes a dramatic increase in intracellular calcium levels, mediated by the P2X receptors, which begins to cause significant damage in the CNS/brain. Levels of ATP (a neuroexcitant) continue to increase and levels of adenosine (a neuroprotectant) to decrease. P2X(7) receptors are highly expressed in microglial cells in the white matter, on all myelin sheaths, and on oligodendrocytes. High levels of ATP immediately cause myelin destruction, oligodendrocyte cell death, and death of the microglia in the white matter, leading to small foci of necrosis throughout the white matter.

Preventing P2X(7) receptor activation has been shown to reduce or even eliminate this. Activation of P2X(7) receptors is a root cause of neural pain as well. Deactivation will help alleviate peripheral nerve pain during many coinfections. Reducing P2X(7) activation will significantly reduce damage to the brain and CNS.

Preparation and Dosage

Preparation: The plant should be tinctured fresh, 1:2, 95 percent alcohol.

Dosage: The typical American dosage is 10–30 drops 3x daily for 30 days. The English dosage is higher, generally 40–80 drops 3x daily. Chinese dosages are usually higher than that. I would begin with the American dosage and see how you respond. Then consider the English dosage if all goes well. In general, use for 30 days, wait a week, reinitiate use as necessary depending on physiological response to the herb.

Chelidonium is an important herb in the treatment of many coinfections, including mycoplasma, especially if there is severe brain and CNS inflammation. There are, however, some side effects to be concerned about.

Side Effects

Chelidonium is used by millions of people worldwide every day. In general, it is very safe. However, in recent years concern has been raised because it occasionally causes severe impacts on the liver. There are some 40 instances in the literature of chelidonium causing liver disease, specifically cholestatic hepatitis. This is jaundice with bile stasis due to severely inflamed intrahepatic bile ducts. More women than men are affected by it, usually older (56 years average), and the herb was taken for about a month before the first symptoms appeared. All recovered upon discontinuance of the herb. Because of this the herb needs to be used with awareness. In general what the herb does, in those it affects this way, is to inflame the bile duct openings, causing them to swell and close. This creates the condition. This action of the herb is, in essence, an overstimulation. Many people use the herb to increase bile flow; for some people it just stimulates things too much. There has been a lot of overreaction to this, especially by herb-hostile physicians. So . . .

To put this in context, many antibiotic drugs will cause this condition; it is not uncommon—though with antibiotic drugs, the condition is not always reversible. Liver damage, often severe, is common as well with acetaminophen (i.e., Tylenol). Death and liver transplants are sometimes necessary. In contrast, this herb is extremely safe. Still . . .

The symptoms of cholestatic hepatitis are jaundice, itching, abnormal stools, and, sometimes, pain in the region of the gallbladder. In general, again, you have to take the herb for at least a month to develop symptoms. If you stop the herb, the condition will improve almost immediately, with no long-term effects. So . . .

Pay attention to the impact the herb has on you and take action accordingly. In spite of this problem greater celandine is a very good herb for some of the Lyme coinfections; its use is warranted.

Contraindications

Obstructed bile duct, pregnancy.

Cordyceps spp.

Cordyceps really is a very potent and very good medicinal with a wide range of actions. And, as you will see, it is very specific for many of the problems that Lyme coinfections cause.

It is a strong immunomodulator and immunoadaptogen, mitochondrial adaptogen (increases oxygen utilization in the mitochondria, stimulates ATP production by the mitochondria, protects mitochondria from adverse events), anti-inflammatory, antioxidant, neuroprotective, antitumor, antimetastatic, hepatoprotective (autoimmune protection, reduces fibrosis, reduces and inhibits cirrhosis, anti-hepatitis B), renoprotective (protects from toxicity, inhibits renal failure, reverses glomerulonephritis), cardiotonic (hypotensive, strengthens heartbeat, antiarrhythmic, improves myocardial ischemia), nerve sedative, sleep regulator, anticonvulsant, antitussive, antiasthmatic, expectorant, bronchial regulator, antipyretic, adrenogenic, steroidogenic, hypolipidemic, hypoglycemic, antibacterial, animicrobial, insecticidal. It is highly protective of the bone marrow, reversing myelosuppression from a variety of causes (microbial to radiation).

Cordyceps is a rather potent immunoadaptogen. If immune activity is high, it reduces it, if low, it enhances it. When taken regularly, if the immune system is stressed by, say, a bacterial organism, the herb will stimulate the immune system in just the right way to respond to the stressor while lowering the levels of or inhibiting entirely the bacterial-induced cytokines that are generated. It affects nearly all the crucial cytokines at play during coinfections.

Specific Uses

The herb is specific for fatigue and weakness, especially after long illness or in chronic infections, poor mitochondrial function, chronic wasting, unproductive cough from no known cause, general inflammation in the brain or joints, mental fog and confusion, low libido, lung infections, kidney infections, thick mucous in the lungs that will not move, immune dysregulation, dizziness, tinnitus, nocturia, cancer. It is especially effective for mycoplasma infections.

In traditional Chinese medicine, cordyceps is described variously as having a neutral property and sweet taste or as being sweet/acrid with a “warm” property. It acts on the lung and kidney channels, is lung-nourishing, kidney-vital-essence- and vital-energy-tonifying, hemostatic, and phlegm resolvent, that is, a mucolytic. It is generally prescribed for overall debility after sickness and for the aged. It is considered to be one of the three primary invigorating medicinals in Chinese medicine along with Asian ginseng and deer antler.

It is specific for tonifying the lungs, arresting bronchial bleeding, dispelling phlegm, chronic cough, asthma, wasting, and tonifying the kidneys. It is also used for impotence, low libido, poor seminal emissions, aching of loins and knees, and as a tonic for spontaneous sweating, aversion to cold, tinnitus, chronic nephritis, general weakness, and sexual hypofunction.

Important

To be effective for anything, cordyceps must be dosed appropriately. That means a minimum dose of 3 grams daily but the best results occur with 6 grams daily as the baseline, especially in acute conditions. The renal studies usually used from 3 to 4.5 grams. This dose range can also work for lung problems, except in truly acute conditions when it should be 6 to 9 grams.

Note: There is a ridiculous herban (or is it urban) legend that if a person has a candida infection (or any kind of yeast or fungal infection or overgrowth, e.g., thrush) they can’t take any kind of mush-room (IT’S A FUNGUS!) as it will cause the yeast/fungal infection to grow out of control. This is totally and completely untrue. It is akin to saying that I have an allergy to eggplant, so I can’t eat any other plants. Some people do have allergic reactions to fungi, and if you do, don’t use this one. But it will NOT, absolutely NOT, cause candida or any other kind of intestinal or systemic yeast or fungal infection to “bloom.”

Preparation and Dosage

Cordyceps needs to be viewed as a medicinal food, not a raw drug to be taken in minute doses. Again, the Chinese tonic dosages are normally rather large, 3 to 9 grams per day, and during acute disease conditions they can go as high as 50 grams, nearly 2 ounces, per day.

The tepid U.S. dosages, 500 to 1,000 milligrams daily, are useless for any active disease condition. I repeat: useless.

If you think of the herb as a food, then eating 2 ounces, say, as you do of asparagus or potatoes, doesn’t seem like all that much. In China, cordyceps is often added to soups and stews (just as astragalus is) as a food ingredient for chronic illness. Sometimes the Chinese decoct it in water and drink it as a tea, however traditional healers for millennia in Tibet and India (and in parts of China) used the herb only after soaking it in an alcohol/water combination, usually the local alcoholic drink. And in fact a number of the constituents are only extractable in alcohol.

The best way to use the herb is either as a powder preparation, taken directly by mouth (allowing the stomach acids and bile, etc., to extract for you), or as a tincture.

Bulk Powder

For Lyme coinfections I would recommend you buy the powder in bulk from someone such as 1stChineseHerbs.com. Dosage: 3–4 tablespoons blended in water or juice 3x daily.

Capsules

The Chinese brands, if you buy capsules, run around 900 to 1,000 mg per capsule and the suggested dose is 6,000 milligrams (6 grams) per day—just for a tonic dose. If you want to use the capsules for an active coinfection I would double that.

Tincture

Preparation: 1:5, 50 percent alcohol.

Dosage: As a tonic, ¼–½ teaspoon 3x daily; for an active infection, ½–1 teaspoon 3–6x daily.

Some sources recommend taking cordyceps with vitamin C to help assimilation. There isn’t anything in the scientific literature on this and the Asians used the herb (and noted its beneficial effects) for thousands of years before vitamin C was discovered, so . . . not sure where that herban legend came from.

Side Effects and Contraindications

There are no side effects noted in the literature. Up to 5 grams per kilogram of body weight per day have been used in rats long term with no side effects. That would be 350 grams—i.e., about 12 ounces or ¾ pound—in a person weighing 150 pounds. Double that dose was used with rabbits for three months with no side effects.

The only reported side effects I can find are occasional reports of dry mouth, nausea, diarrhea. One case of an allergic reaction (a general allergy to fungi) that subsided when the herb was discontinued.

Herb/Drug and Herb/Herb Interactions

Cordyceps sinensis is synergistic with cyclosporin A and the amount of the drug needed is lessened if cordyceps is taken. The hypoglycemic actions of the herb also reduce the dosage needs for those on antidiabetic medications. There is some concern as well that cordyceps might be synergistic or additive with anitretroviral drugs, thus affecting dosage requirements, but nothing has yet been reported in the literature.

Vitamin C is reputed to help assimilation and may, if this is true, increase the impact of the herb in the body.

Finding It

You can get bulk powder and capsules from 1stChineseHerbs.com as well as many other online purveyors. If you want to spend enormous amounts of money, you can also buy the wild-crafted mushroom itself. Or . . . you can join the local mycological society (find a fun one, usually it won’t include guys with mathematically shaven beards) and learn to find it in the wild. In the United States this will almost always be Cordyceps militaris, but this is interchangeable with more traditional Chinese cordyceps (Cordyceps sinensis).

Crataegus oxyacantha (Hawthorn)

The berries of the hawthorn bush (and sometimes the leaves and flowers) have been used as a heart tonic for at least 2,000 years in Western medicine and for a bit less than 700 years in China. They are specific for nearly every manifestation of heart disease: atherosclerosis, cardiac arrhythmia, congestive heart failure, hypertension, and peripheral vascular disease. In vivo studies have found that the herb lowers blood pressure, increases blood vessel dilation throughout the body, lowers cholesterol levels in the blood, and is powerfully antiarrhythmic, slowing and normalizing heartbeat.

In vivo and in vitro studies have shown that hawthorn increases both the amplitude of heart contractions and the heart’s stroke volume. Studies also show that if blood pressure is too low, hawthorn raises it; if it is too high, hawthorn lowers it. It is in fact a normalizer of blood pressure and a regulator of blood flow within the body. Dozens of clinical trials have been conducted with hawthorn extracts on thousands of people with heart disease. All have confirmed the herb’s remarkable effectiveness. In general, hawthorn is a pretty good heart protectant and tonic.

Hawthorn has a direct effect on the diameter of blood vessels and arteries, causing them to dilate, generally through increasing the endothelial cells’ production of NO. (This makes it especially useful during Lyme coinfections.) This increases the oxygen being received by the heart. Hawthorn also changes the rhythm and pattern of the heartbeat. The heart beats more slowly, the beats last longer, and the power is increased. The longer the herb is used, the more healing occurs in vessel walls and the more toned the muscle of the heart becomes.

Hawthorn does have some cytokine inhibitory actions. It inhibits TNF-α, IL-6, NO, and protein tyrosine phosphatase.

Preparation and Dosage

Take 120–900 mg of the herb daily, or ¼–½ teaspoon 3x daily of the tincture (1:5, 60 percent alcohol).

The dosage range in most clinical studies has been from 120 to 900 mg daily. Most of these have used nonstandardized (i.e., raw herb) extracts, either in capsules or as an alcoholic tincture. Some practitioners are suggesting that the extracts be standardized for 1.8 percent vitexin-4'-rhamnoside or 10 percent procyanidin content. I think that a bit of overkill; the herb seems fine all on its own.

Side Effects and Contraindications

Hawthorn is a food-grade herb; it is tremendously safe. It is about as dangerous as its close relative apples. An incredibly tiny number of people have experienced headache, nausea, and palpitations from the herb.

Herb/Drug and Herb/Herb Interactions

The main problem is that hawthorn can lower blood pressure, so if you are taking blood pressure medications, caution is indicated. It may enhance the actions of digoxin. The herb is additive in its effects with knotweed and motherwort. Just take care if you are mixing the herb. Don’t stand up suddenly as you might experience light-headedness.

Stand s l o w l y.

Cryptolepis sanguinolenta

There are a number of species in this genus, most of them in the Asian regions. The primary systemic antibacterial among the genus is Cryptolepis sanguinolenta. This is the species I have used for the past 15 years; it is very reliable as a broad-spectrum antibiotic, especially for protozoal infections and MRSA. Some people think the Ayurvedic species C. buchanani works similarly, I have not seen enough study on it to be sure, nor have I used it. The root is usually the part used medicinally.

Cryptolepis is antiparasitic, antimalarial, antibacterial, antipyretic, hypothermic, antimicrobial, antimuscarinic, renal vasodilator, noradrenergic, hypoglycemic, antithrombotic, anti-inflammatory, antiprotozoal, mildly antiviral.

It is active against a wide range of Gram-positive and Gram-negative organisms, protozoa, and yeasts. Tests have found the plant to be a stronger antibacterial than the pharmaceutical antibiotic chloramphenicol. Generally, it is more broadly active against Gram-positive bacteria (which are usually easier to treat due to their cellular structure) but does have potent activity against a number of Gram-negative bacteria. I have found it specifically effective for systemic infections, especially malaria, MRSA, streptococcus, babesia, campylobacter, urinary tract infections, and sepsis.

Cryptolepis has been successfully used for centuries by traditional African healers in the treatment of malaria, fevers, and diarrhea, which is essentially how it came to the attention of Western practitioners.

Among the traditional healers of Guinea-Bissau it’s used to treat fever, hepatitis, and jaundice. Healers in Zaire and Senegal use it for stomach and intestinal disease. In Ghana it’s used for malaria and fevers; in Nigeria for urinary tract infections, upper respiratory tract infections, colic, and stomach troubles; in Senegal, Democratic Republic of Congo, and Uganda for colic and stomach complaints; for wounds, snakebite, and hernia in Uganda; and in Senegal and Nigeria for venereal disease, rheumatism, and as a general tonic. In the DR Congo it’s used for amoebic infections, including dysentery. Some African practitioners have used it for the treatment of insomnia, and others for hypertension.

Cryptolepis buchanani has been used in traditional Ayurvedic practice for millennia. It is widely distributed throughout Pakistan, India, Nepal, Bhutan, Myanmar, China, Thailand, and Sri Lanka. It is considered an invasive weed in many areas. (A useful sign of medicinal importance.) It’s been used as an antidiarrheal, antibacterial, antiulcerative, anti-inflammatory, blood purifier, demulcent, diaphoretic, and diuretic, and for treating paralysis and rickets and as a general tonic for overall health. It is commonly used for urinary tract infections, for coughs as an expectorant, as a febrifuge (antipyretic), and for abdominal disorders such as dysentery and stomach complaints. In Thailand alcohol extracts of the plant have been used as a primary anti-inflammatory in the treatment of arthritis, muscle and joint pain, and rheumatism.

Cryptolepis was discovered by the West because of the resurgence of pharmaceutically resistant plasmodial parasites. In an attempt to find new treatments for malaria, researchers began looking at traditional treatments for the disease. Initial studies revealed both Cryptolepis sanguinolenta and Artemisia annua as powerfully active against resistant strains. Artemisia was the first to be developed into a drug (with the same predictable problems as most antibacterial pharmaceuticals cause, including resistance); cryptolepis lagged but in the past 15 years a tremendous amount of research has been conducted on the plant. Initially, most of it was concerned with malaria. Cryptolepis is potently active against the malarial parasite, Plasmodium falciparum. (It is also active against other members of the genus: P. berghei berghei, P. berghei yoelii, and P. vinckei petteri.) Scores of studies have found it to be effective against the malarial parasite no matter the degree of its resistance to pharmaceuticals.

The herb has been remarkably potent against malaria in human clinical trials. One such trial compared the effectiveness of cryptolepis (a hot water infusion of the powdered root) with chloroquine, the usual synthetic drug for malaria treatment, in comparative patient populations at the outpatient clinic of the Centre for Scientific Research into Plant Medicine at Mampong-Akuapem in Ghana, West Africa. Clinical symptoms were relieved in 36 hours with cryptolepis, and 48 hours with chloroquine. Parasitic clearance time was 3.3 days in the cryptolepis group, and 2.3 days in the chloroquine group—a remarkably comparable time period. Forty percent of the patients using chloroquine reported unpleasant side effects necessitating other medications, whereas those using cryptolepis reported no side effects.

Because many of the antimalarial compounds in cryptolepis are water soluble and water-soluble extracts had previously worked well in clinical trials, a local company in Ghana hoped that a pre-made tea of cryptolepis would work well against malaria. With 2.5 grams of the dried, powdered root of C. sanguinolenta per bag of tea, the preparation is called Phyto-Laria and can be purchased over the counter in Ghana. (Similar products called Malaherb and Herbaquine are available in Ghana, and another called Malarial is available in Mali.) A clinical trial was carried out. Forty-four people with uncomplicated malaria participated in the trial, which was performed on an outpatient basis. Each participant prepared a strong tea (they steeped the tea bag in hot water for 5 to 10 minutes for each cup of tea) and drank it three times daily for five days. There was a post-treatment followup for the next 28 days. More than half cleared the malarial parasite from their blood within 72 hours; mean clearance time was 82.3 hours. Fever clearance time was 25.2 hours compared with the drug chloroquine’s clearance time of 48 hours. Chills, vomiting, and nausea were cleared in all patients in 72 hours. There were two instances of late recrudescence (return of the disease) but the researchers are unsure whether this resulted from reinfection or relapse; no genetic testing was done on the initial infection. Overall the cure rate was 93.5 percent. Nii-Ayi Ankrah, of the Department of Clinical Pathology at the University of Ghana, remarked, “The present result is indeed welcome news since it advances the vision to incorporate plant medicine into the health care delivery system in Ghana” (Ankrah 2010). How different than in the United States.

Other studies, in mice, have found that the intake of a cryptolepis tea prior to inoculation with the malarial parasite does confer some degree of protection against infection. Taking it daily as a preventive as so many in Africa do seems to work well.

I have found the herb specific for babesial infections, though not quite as effective as it is for malaria. In most people it will clear the infection when used by itself, even those with a wide range of genetic variants. However about 30 percent of people need to utilize the other herbs in the Babesia protocol (see page 94) in order to successfully clear the infection.

Preparation and Dosage

You can take cryptolepis as powder, capsules, tea, or tincture.

Tincture

Preparation: 1:5, 60% alcohol.

Dosage: 20–40 drops up to 4x daily.

• For resistant staph: In the treatment of severe systemic staph infection (whether resistant or not) the usual dose is ½ teaspoon–1 teaspoon 3x daily. In very severe cases up to 1 tablespoon 3x daily can be used.
• For babesiosis and malaria: 1 teaspoon–1 tablespoon 3x daily for 5 to 30 days; repeat if necessary.

Tea

Preparation: Use 1 teaspoon in 6 ounces water to make a strong infusion. While the herb will work if infused in cold water, studies have found that the hot water extraction is more effective. It is nearly as strong as the alcohol tincture.

Dosage: As a preventive, drink 6 ounces once or twice daily. In acute conditions, drink up to 6 cups a day.

Note: The alkaloids in cryptolepis are water soluble, but if the pH of the water is alkaline the alkaloids will not dissolve well. The pH scale ranges from 1 to 14, where 1 is the most acidic, 14 the most alkaline, and 7 neutral. The word alkaloid means “alkaline-like.” The more alkaline water is, the less the alkaloids will dissolve in it. You have to have a pH of at least 6 for the alkaloids to dissolve in the water. Hard water is alkaline. (A water softener makes hard water soft—that is, acidic rather than alkaline.) If you have hard water (you can call your city’s water department to find out the average pH) or if you don’t know, add a teaspoon of vinegar or lemon juice to the boiling water you are using to make your cryptolepis tea.

Capsules

As a preventive, take 3 “00” capsules 2x daily; in acute conditions take up to 20 capsules a day.

Note: Cryptolepis is taken as a regular tonic for years at a time in some parts of Africa and India. One or two cups a day of the tea or two to three droppers of the tincture (60 to 90 drops) a day is fine for extended, long-term use.

Side Effects and Contraindications

None noted. Considerable research has taken place to determine the potential adverse reactions from using the plant, and none have been found, either in human clinical use or with in vivo testing on mice, rats, and rabbits. The plant is taken, often for years, as a general tonic by many people in Africa with no sign of adverse effects. However . . .

Researchers in some instances have noted that people taking cryptolepis have elevated levels of ALP (alkaline phosphatase) and uric acid, which return to normal after the herb is discontinued. There have been no reported side effects from this.

There is one report in the literature of adverse effects of cryptolepis in mouse pregnancy. I can find nothing in traditional use that substantiates an extrapolation to humans nor any studies in the literature that show negative effects for pregnancy in people.

One of the herb’s constituents, cryptolepine, has been found to be cytotoxic, which raises concerns in some people. A few points:

• Cryptolepine is an isolated constituent, and like most isolated constituents that are made into pharmaceuticals, it produces side effects that don’t appear when the whole herb is used. Cryptolepis itself has not been found to be cytotoxic to people.
• The word cytotoxic, when used in reports, generally means it kills cancer cells and indeed cryptolepine does.
• Cryptolepine is cytotoxic because it intercalates DNA. DNA is a double helix, two joined twisted ladders. Cryptolepine inserts itself between the two ladders—that is, intercalates—and as a result interferes with cellular division, which is why it is useful in cancer treatment. Cryptolepine is a potent inhibitor of topoisomerase II, which it inhibits once it intercalates. The function of topoisomerase II is to allow DNA replication by unwinding the DNA helix, using it as a template, and then winding it again after replication. If topoisomerase is inhibited, DNA replication and cellular division can’t occur.

Herb/Drug Interactions

None noted. However . . . cryptolepis has been used in traditional medicine to help rectify insomnia. One mouse study has supported that effect of the plant. There is some potential for the plant to synergize with hypnosedatives or central nervous system depressants. Caution should be exercised. However, there have been no reported adverse effects in these situations to date.

Finding It

The herb has been somewhat difficult to obtain in the United States but more companies are selling it every year. The main supplier I have used over the years is Woodland Essence. Cryptolepis buchanani may (I repeat, may) be a decent substitute for C. sanguinolenta, and it is somewhat easier to find.

Eupatorium perfoliatum (Boneset)

Boneset is antiviral, immunostimulant (increases phagocytosis), diaphoretic, febrifuge, mucous membrane tonic, smooth muscle relaxant, anti-inflammatory, cytotoxic, mild emetic, peripheral circulatory stimulant, gastric bitter, analgesic, and mildly antibacterial. It does have some decent actions against protozoa, especially the malarial parasite; it is something of a midlevel antimalarial herb in its actions. This makes it a fairly nice adjunct for babesiosis, especially when its other actions are taken into consideration.

The plant, indigenous to North America, has been used by Native American peoples for millennia, specifically for intermittent fevers and chills, with pain in the bones, weakness, and debility. The American Eclectics used it for intermittent (i.e., malarial), typhoid, and remittent fevers, and for general debility, pneumonia, cough, epidemic influenza, colds, catarrh, and pains accompanying those conditions. It was one of their primary remedies.

The sesquiterpene lactones in boneset have a large range of actions including some nice immunostimulatory effects. The specific lactone active against the malarial (and babesial) parasite is considered to be a dimeric guaianolide. It has a range of antiplasmodial actions but is strongest against Plasmodium falciparum. The action is mild (compared to herbs such as cryptolepis) but if boneset is added to a traditional anti-protozoal that is strong, such as cryptolepis, the effects are mutually supportive.

I consider the plant a useful adjunct botanical for any intermittent or relapsing infections such as flu, malaria, babesia, and dengue, and not a primary treatment botanical. It will really help lower fevers. It will help with the aches and pains of these kinds of infections. It will make you sweat (if taken hot as a tea, as it should be). And it does help eliminate these kinds of relapsing infections if they just keep coming back no matter what you do. (It is especially good for this purpose if combined with bidens.)

Note: Because of the common name boneset some people think this eupatorium good for setting bones. Others, however, insist that the name came from a common, ancient name for dengue, breakbone fever, and that the herb has never been used for setting bones and, more, indigenous peoples never used it for that either. (Feelings run high.) I have taken various sides in this over the years but did think it highly amusing a number of years ago when a well-respected indigenous herbalist (from the United States) who had used the herb for over 50 years (and who had learned its use from her teacher when she was very small) informed a rather self-satisfied group of herbalists that she used the herb primarily for setting broken bones (as a compress/poultice) and had done so all of her life. (So, now I read fiction novels and don’t think about why it is called what it is called.)

Preparation and Dosage

The herb is bitter, and a tea made from it is about as much fun to drink as a tea made from earwax. Honey helps considerably . . . and if you have the kind of flu where you can’t taste anything. Generally, the herb is taken as tea or tincture but few take the tincture directly on the tongue. Too bitter.

Tea

Cold infusion: 1 ounce of herb in 1 quart boiling water, let steep overnight, strain, and drink throughout day. The cold infusion is better for the mucous membrane system and as a liver tonic. If you want to help fevers, you need to take the tea hot.

Hot infusion: 1 teaspoon herb in 8 ounces hot water, steep 15 minutes. Drink 4–6 ounces up to 4x per day. Boneset is only diaphoretic when hot and should be consumed hot for active infections or for recurring chills and fevers.

Tincture

Fresh herb: Fresh herb in flower, 1:2, 95% alcohol; take 20–40 drops up to 3x daily in hot water.

Dry herb: 1:5, 60% alcohol; take 30–50 drops in hot water up to 3x daily.

• In acute viral or bacterial upper respiratory infections: Take 10 drops of tincture in hot water every 30 minutes up to 6x daily.
• In chronic conditions: If the acute stage has passed but there is continued chronic fatigue and relapse, take 10 drops of tincture in hot water 4x daily.

Side Effects and Contraindications

Boneset is an emetic when taken in large doses, so an early sign that you may be taking too much is nausea. Generally, the cooler the tea the less nausea. The herb may be contraindicated in pregnancy but no one really seems to know why. Sometimes some people have an allergic reaction to plants in this family—chamomile, feverfew, ragwort, tansy—so if you are allergic to those, careful with this one.

Herb/Herb and Herb/Drug Interactions

None noted.

Finding It

Fields and streams in the eastern United States, the Internet, herb stores here and there. Horizon Herbs sells the seeds.

Forsythia suspensa

This is one of the 50 fundamental herbs in Chinese medicine. It is a weeping forsythia, a large shrub, and quite pretty. It has escaped cultivation and is moderately invasive throughout the United States. (Again, an important sign that we are going to be needing its help fairly soon.)

It is called either qing qiao or huang qiao in Chinese medicine, depending on whether the green or fully ripe yellow fruit is used as medicine. The unripe fruit is considered to be the strongest. (Rarely, the stem bark and leaves are used.) The dried fruit, whatever its ripeness, is used for fever, headache, restlessness, delirium, lymph gland enlargement, general inflammations, erysipelas, boils, epidemic febrile diseases, acute liver and kidney infections, swelling in the small bronchioli, tonsillitis, sore throat, retina hemorrhage, and pus formations (foci or necrosis) in organs, especially the lungs.

The herb is a pretty good antiviral as well as being anti-inflammatory, antioxidant, vasorelaxive, antibacterial, antiparasitic, antiemetic, cytoprotective, and diuretic (antiedema). It is primarily used for clearing heat and toxins in Chinese medicine, essentially colds and flus, especially with lung, spleen, liver, kidney, and lymph involvement.

The herb has some good cytokine suppressive effects, especially for those activated by microorganisms. It tends to act most strongly in organs affected by cytokine cascades and to protect them from developing focal necrosis. This makes it a useful plant for Lyme coinfections that affect the organs. But the strongest reason for its presence herein is its impacts on some rather strongly impactive cytokines, especially MPO and HMGB1. This makes it especially useful for sepsis or acute inflammation during coinfections.

Dosage

The Chinese primarily use the dried herb either as tablets (or dried herb) or in a decoction, often in combination with Lonicera spp. The normal dosage is 9 to 15 grams per day, usually in divided doses. It is rarely used by itself.

Side Effects

A rather benign herb; no side effects are noted that I can find. It is recommended to avoid it in pregnancy but I can’t seem to find a reason for that.

Genistein

Genistein, while first found in dyer’s broom (Genista tinctoria, hence its name) is, these days, almost always derived from soy. It is common in lupins, fava beans, soybeans, kudzu, and coffee of all things. Genistein is a rather potent antioxidant and anthelmintic (removing intestinal parasites), but it is primarily known for its estrogenic effects. It is considered a rather potent phytoestrogen. The compound also has a number of other actions including protecting against endothelial barrier dysfunctions caused by cytokines, inhibiting leukocyte-endothelium interactions (making it specific for these Lyme coinfections), and inhibiting cancer formation and angiogenesis (though it can exacerbate breast cancers and inhibit their treatment due to its estrogenic actions). It helps prevent and correct both cardiovascular disease and osteoporosis.

The supplement’s primary use is for treating Ehrlichia coinfections. Genistein inhibits protein histidine and tyrosine kinases. Studies have found that it significantly decreases the numbers of intracellular ehrlichial bacteria during infections. In other words, it specifically inhibits the ability of the bacteria to gain access to their preferred cellular habitat. The bacteria require the rapid activation of protein kinases to gain access to monocytes and macrophages. Genestein prevented the entry, internalization, and proliferation of both Ehrlichia chaffeensis and Neorickettsia risticii, a close relative, into target cells. The higher the concentration of genistein and the earlier it is ingested, the greater the inhibitory actions. The supplement is not directly biocidal against the organisms but rather specifically inhibits their ability to enter and proliferate in target cells, thus stopping the infection.

The supplement is also a fairly strong neutrophil elastase (NE) inhibitor, reducing NETs formation in the body. This makes it highly useful for sepsis.

The supplement is extremely bioavailable. Within one hour plasma levels increase substantially, reaching a maximum concentration around four hours later.

Dosage

Normal dosage is 20 to 80 mg of genistein daily. However for ehrlichial infections a much higher dose is recommended, 250 mg twice daily for 30 to 60 days. (There are some high-dosage formulations on the market; they are much more expensive.) High-dose usage should be limited to 60 days due to potential side effects, especially in men (who are twice as likely to be infected by Ehrlichia anyway).

Side Effects and Contraindications

Overall, this supplement is extremely safe. However, it is a phytoestrogen. It can aggravate breast cancer and interfere with breast cancer treatment. It will raise estrogenic levels in men. It should not be used at this kind of high dosage if you are pregnant or nursing, have breast cancer, or wish to remain manly.

Note: There has been quite a bit of phytohysteria about this supplement and soy in general. However, Asian women and men generally have high levels of genistein in their systems from their regular soy intake (tofu, soy sauce, and so on) without apparently suffering the kinds of impacts phytohysterians routinely regurgitate as imminent. In this instance we are looking at high-dose usage over a limited time frame as an antibacterial interventive.

Glycyrrhiza spp. (Licorice)

Licorice is an unusual medicinal. It is potently antiviral, moderately antibacterial (but fairly strong against a few bacterial species such as Staphylococcus and Bacillus spp.), immune modulating and potentiating, and a very potent synergist. It is one of the best, most widely acting, and useful of all herbal medicines. However, it should rarely be used alone or in large doses for extended periods. There are a lot of unpleasant side effects if it is used alone, at high doses, for too long.

The root is usually what is used medicinally. Licorice has been used as a food plant and medicinal for between four and five millennia. All licorice species have been used as medicine wherever they have grown and by every culture that has had access to them.

Actions

Major broad-spectrum antiviral, potent synergist (enhancing the actions of other herbs and pharmaceuticals), antibacterial, prevents biofilm formation, antistressor, adrenal tonic, thymus stimulant, immunomodulant (will reduce immune levels if they are high, increase them if too low), expectorant, antitussive, antiulcerative, mucoprotective, hepatoprotective, neuroprotective, anti-inflammatory, antioxidative, cardioprotective, anticancer/tumor inhibitor, smooth muscle relaxant, antispasmodic, protects from the effects of radiation exposure, gentle laxative, demulcent, analgesic, antihyperglycemic, reduces gastric secretions, stimulates pancreatic secretions, estrogenic, adrenal cortex stimulant, inhibits the enzymes tyrosinase and xanthine oxidase, antihemolytic.

Licorice is a fairly potent synergist. It has been found to potentiate the action of antituberculosis drugs, increasing positive outcomes in treatment. It potentiates the action of oseltamivir against resistant influenza strains. It reduces toxicity and potentiates other medications in the treatment of rheumatoid arthritis. It potentiates the effect of the neuromuscular blocking agent paeoniflorin. During tincturing it enhances the solubility of compounds from other plants (e.g., the sapogenin isoliquiritigenin from astragalus, the saikosaponins from ginseng) by a factor of up to 570, and it increases the immune-stimulating action of other herbs such as Echinacea purpurea significantly.

It takes four to eight hours (depending on what and how it is taken) for licorice’s glycyrrhizin to reach maximum serum concentration after oral ingestion, then it is slowly excreted, and eventually eliminated entirely about 72 hours after ingestion. (Most of it is gone after 24 hours.) It stays in the body a long time.

Ayurveda

Variously known as mulathi, yasti-madhu, jasti-madhu, madhuka, mithiladki, and so on. The plant is considered cooling, tonic, demulcent, expectorant, diuretic, and a gentle laxative. It’s used for treating poisoning, ulcers, diseases of the liver, bladder, and lungs. It is specific for any inflammation in the mucous membranes anywhere in the body. It is used for cough, sore throat, hoarseness, fever, and as a general tonic in debility from long-term disease conditions, especially pulmonary and GI tract conditions. It is considered a synergist, a specific additive to other herbal formulations.

Traditional Chinese Medicine

Known as gan cao in Chinese medicine, licorice has been used in China for 3,000 years or so. The herb is considered sweet and mild. It regulates the function of the stomach and is a qi tonic, lung demulcent, expectorant, latent-heat cleanser, antipyretic, detoxicant, antiinflammatory, spleen invigorative, and a synergist in many herbal formulations. The herb is used in pharyngolaryngitis, cough, palpitations, stomachache due to asthenia, peptic ulcer, pyogenic infection, ulceration of the skin, hepatitis, encephalitis B, measles, and all types of respiratory infections.

Western Botanic Practice

The ancient Egyptians used the plant as a major medicinal; the plant has often been found in their tombs. The Greek Theophrastus, in the third century BCE, noted the plant’s use for asthma, dry coughs, and respiratory problems. The Romans called the plant liquiritia, eventually corrupted to the word licorice. It was a primary medicine in ancient Rome for coughs. It was used throughout Europe as a primary medicinal and although harvested in the wild originally, it has been a main agricultural crop for over a thousand years.

The American Eclectics used it intensively, as did most medicinal practitioners in the Americas. The Eclectics used it for coughs, catarrhs, irritation of the urinary passages, diarrhea, and bronchial diseases. It was an early agricultural medicinal, grown by most people in their medicinal gardens. The indigenous tribes of the Americas used the indigenous species similarly, that is, for sore throat, chest pains, swellings, coughs, diarrhea, stomachache, fevers, toothache, skin sores, spitting blood, and as a general tonic.

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The medicinal species have been intensely studied for years; there are over 2,000 citations on PubMed alone and thousands more on the Chinese database CNKI.

Licorice and its constituent glycyrrhizin are very reliable immune modulators, raising immune action if needed, lowering it if it is too high. In other words, if an infectious organism begins a cytokine cascade by initiating NF-κB activity (common), the herb will begin to normalize cytokine levels in spite of what the bacteria or viruses are doing. Another component of licorice root, isoliquiritigenin, also has potent effects on cytokines, especially NF-κB. Specifically it blocks the induction of VCAM-1 (vascular cell adhesion molecule 1), E-selectin, and PECAM-1 (platelet endothelial cell adhesion molecule 1). It interferes with THP-1 monocyte adhesion to TNF-α–activated endothelial cells, and abolishes many of the cytokine effects of TNF-α. It does this by blocking the nuclear translocation of NF-κB, essentially acting as an upstream cytokine cascade blocker in bacteria- or virus-initiated inflammatory processes.

In vivo studies have found licorice to be potently antioxidant, to stimulate immune activity, to be anticonvulsant, to be potently antiinflammatory on skin eruptions, to be liver protective, to be cerebroprotective, to heal aspirin-induced ulcers, to be antispasmodic to the lower intestine, to be strongly antitussive, and to protect the mitochondria from damage.

As discussed in chapter 8, licorice and its constituent glycyrrhizin are important adjuncts in treating HMGB1-related sepsis.

Preparation and Dosage

Licorice is used as tincture, as a tea, and in capsules. Again: This herb is best used with other herbs in a combination formula.

One of the primary things to keep in mind when using licorice is that the higher the glycyrrhizin content, the more antimicrobial the herb will be. If you’re using the herb as an antimicrobial you should not use deglycyrrhized licorice.

Tincture

Preparation: Dried root, 1:5, 50% alcohol.

Dosage: 30–60 drops up to 3x daily.

In acute conditions: ½ teaspoon (2.5 ml) 3–6x daily—blended with other herbs—generally for a maximum of 6 weeks at this dose, and only if you take the additional supplements described with the contraindications below.

Infusion

Preparation: ½–1 teaspoon of powdered root in 8 ounces water, simmer 15 minutes, strain.

Dosage: Drink up to 3 cups a day.

In acute conditions: Drink a cup every 2 hours.

Decoction

The traditional preparation in Japan (standard now in the Japanese pharmacopoeia) is as follows: 6 grams powdered root in 500 ml (about 16 ounces) water, bring to a boil, uncovered, and let boil moderately until the liquid is reduced to 250 ml. (This will be fairly mucilaginous.) Then add enough water to bring the volume up to 1,000 ml. Drink throughout the day. Tests in Japan found that this preparation will have about 50 mg/g of glycyrrhizin. (I assume here that the powdered root they used conformed to the Japanese standard of 2.5 percent glycyrrhizin.)

Capsules or Powder

Take 4,000 mg (i.e., 4 grams) daily in three divided doses. Note: ¼ teaspoon of the powder is about 2,000 mg. However . . . Chinese doses run high, as they tend to do, up to 9 grams daily. Oddly, the WHO monograph lists the dosage range as 5 to 15 grams daily, somewhat higher. Assuming that you are getting a 4 percent glycyrrhizin content in the root, that will give you 200 to 600 mg of glycyrrhizin daily, which is the WHO suggested limit. The European Union standards suggest people not consume any more than 100 mg of glycyrrhizic acid per day. In Japan glycyrrhizin intake is suggested to be kept to 200 mg per day. So, as usual, you have a range to choose from. If you are struggling with a severe infection, for which this herb is specific, especially if it is severe encephalitis, there is no reason, keeping the contraindications in mind, not to use the higher WHO dose during limited treatment of 4 to 6 weeks’ duration. Again, please keep in mind the side effects and contraindications.

Side Effects and Contraindications

Generally, licorice is nontoxic, even in high doses. However, long-term use, especially if you use the herb as a single (rather than in combination), and most especially if you use large doses, can cause a number of rather serious side effects. Even the use of a tea over several years will do it, and every now and then, due to the rather good range of effects the herb has, someone does. (This makes anti-herb proponents very excited.)

Note: This herb should rarely be used in isolation or in large doses or for long time periods—that is, longer than 4 to 6 weeks. (However, see the comments in the next paragraph.) The side effects can be severe: edema, weak limbs (or loss of limb control entirely), spastic numbness, dizziness, headache, hypertension, hypokalemia (severe potassium depletion)—especially in the elderly. Additional problems are decreases in plasma renin and aldosterone levels, and at very large doses decreased body and thymus weight and blood cell counts. Essentially, this complex of symptoms is a condition called pseudoaldosteronism, which licorice can and indeed does cause if you take too much of it for too long. However . . .

If you take licorice along with some other supplements, it can reduce or even eliminate the tendency of the herb to produce pseudoaldosteronism. There is an intravenous form of glycyrrhizin commonly used in China that contains 40 mg aminoacetic acid (glycine), 2 mg L-cysteine, 1.6 mg sodium sulfite, and 4 mg monoammonium glycyrrhizinate (glycyrrhizin) per 2 ml vial. Normal dosing is 40 to 60 ml IV and up to 100 ml. The oral therapeutic dose is as high as 200 mg daily. This combination eliminates pseudoaldosteronism as a side effect. You can add both glycine and L-cysteine to your protocol to limit the potential for pseudoaldosteronism if you are taking large doses of licorice for extended periods. (Glycine, minimum 2,000 mg daily; L-cysteine, minimum 500 mg daily.) The addition of potassium (5,000 mg daily) will also help prevent the hypokalemia. Again: Licorice should be taken in combination with other herbs—this reduces the tendency for side effects by itself. And, if you do need to take largish doses of licorice, even with other herbs, for severe infections, please add these supplements to your regimen and carefully monitor for side effects.

Because of licorice’s strong estrogenic activity it will also cause breast growth in men, especially when combined with other estrogenic herbs. Luckily all these conditions tend to abate within 2 to 4 weeks after licorice intake ceases. Caution should be used, however, in length and strength of dosages.

A number of studies have found that large doses of licorice taken long-term during pregnancy have detrimental effects on the unborn children. Low doses are apparently safe. Again, this plant should not be used in large doses or for lengthy periods of time especially if you are pregnant.

The herb is contraindicated in hypertension, hypokalemia, pregnancy, hypernatremia, and low testosterone levels. However, for short-term use in those conditions (10 days or less), in low doses combined with other herbs, it is very safe.

Herb/Drug Interactions

The plant is highly synergistic. It is also additive. It should not be used along with estrogenic pharmaceuticals, hypertensive drugs, cardiac glycosides, corticosteroids, hydrocortisone, or diuretics such as thiazides, loop diuretics, spironolactone, or amiloride.

Finding It

You can buy very good-quality organic licorice root from Pacific Botanicals, my preferred source for high-quality grown herbs. Regrettably there is no way to determine the glycyrrhizin content of their product. (I still like it though; it feels good.) 1stChineseHerbs.com has the Chinese-grown G. glabra, which, while not organic, is definitely supposed to be at least 4 percent glycyrrhizin by weight. Seeds can be had from Horizon Herbs in Oregon or Richters Herbs, an international seed merchant.

Note: Some of the licorice in commerce comes from eastern Europe (which possesses some of the highest levels of soil and air pollution in the world). It makes no sense to buy potentially contaminated herbs to use for their broad-spectrum immune and liver actions.

Houttuynia spp.

Houttuynia cordata is the primary species used. Some people think there is only one in the genus, others two. (Pistols at dawn.) There is a lot of speculation that there are significant subspecies (or chemotypes) of H. cordata, mostly determined by their taste. Whatever it is, there is definitely something going on that the tongue is noticing even if the brain is not. This does have an impact as the herb is reportedly hard to ingest for a number of people—all because of the taste.

The Chinese/Vietnamese chemotype is reported to possess a taste/ smell similar to coriander; the Japanese chemotype, according to one anonymous reporter, has “a strange lemon or orange odour that is often compared with ginger.” To others, however, the taste of the plant, irrespective of chemotype, is apparently very close to rotten fish. This plant may be the herbal equivalent of cilantro. Some people love it but for those who do not, hate is the closest word to describe their reaction.

I have tasted it, and just to be biologically contrary, I experience it in none of those ways. It’s not a lot of fun, but then, I’ve had worse. (Saw palmetto tincture—fetid soap.)

There are a lot of cultivars of this plant; it is common in gardens everywhere, so you get a lot of names for the thing: heart-leaved houttuynia, lizard tail, Chinese lizard tail, chameleon plant (as opposed to the specific variety called ‘Chameleon’), heartleaf, fishwort, fish-mint, bishop’s weed, doku-dami (Japan), and yu xing cao (China). The Chinese name literally means “fishy-smell herb” because, well, it smells like fish—to someone, someplace, I guess. (My favorite synonym is Houttuynia foetida.) Generally, the aerial parts are used for medicine, rarely the roots. The Chinese consider the fresh plant the strongest form of the herb. If you are making tinctures use the fresh plant picked just at flowering.

The herb has a wide range of actions. It is antiviral, antibacterial, antifungal, antimicrobial, anthelmintic, larvicidal, anti-inflammatory, antioxidant, anticancer, immunomodulatory, astringent, diuretic, emmenagogue, febrifuge, hypoglycemic, laxative, depuritive, analgesic, hemostatic, antitussive, antileukemic, and opthalmic.

The herb is specific for respiratory and intestinal infections, mycoplasma infections, any serious infections in the lungs especially with abscesses, infections in the urinary passages and kidneys, genital infections, dysentery and any bacterial diarrheal conditions, various diseases of the eye (fresh juice or tea applied topically), skin infections with pus or boils. It is especially indicated if any of these conditions are accompanied by foul-smelling discharge.

There is a lot of indigenous and local use of the plant throughout its native ranges, for both food and medicine, but the most extensive use of the plant, historically, has been by, no surprise, the Chinese.

In traditional Chinese medicine the herb is considered to be slightly cold, pungent, and specific for the lung channel. It has traditionally been used for removing toxic heat, eliminating toxins, reducing swelling, discharging pus, and relieving stagnation. It is specific for promoting drainage of pus, lung abscess with purulent expectoration, heat in the lung with cough, dyspnea, carbuncles and sores, dysuria, acute dysentery, and acute urinary infections. It is considered latent-heat clearing, antipyretic, detoxicant, anti-inflammatory, and diuretic. It has been traditionally used for virulent carbuncle, lung abscesses, cough with thick sputum, leukorrhea, and edema. The fresh juice for snakebite and skin infections. Common medicinal use in China is for chronic nephritis, inflamed pelvis or cervix (pelvic inflammatory disease), gonorrhea, rheumatism, anal prolapse, hemorrhoids, inflamed respiratory tract (including pneumonia and bronchitis with or without edema), prevention of postoperative infections, inflammation and pus in the middle ear, measles, tonsillitis, chronic sinusitis, nasal polyps, inhibiting anaphylactic reactions, and various cancers.

Most of the scientific studies have occurred in China, often with injectable forms of the herb. Numerous others have been conducted in India and Thailand. Few have occurred in the United States. (The herb tastes funny.) In general, the studies found that the effects were dose dependent—in other words, the more they gave, the better the outcome. Since the herb has shown no toxicity from oral ingestion (up to 16 grams per kilogram in mice, a huge dose), that would indicate that largish doses can be used very effectively.

In vitro studies found that the herb (water extract) significantly increases IL-2 and IL-10 cytokines. IL-10 is also known as cytokine synthesis inhibitory factor; it is an anti-inflammatory cytokine. It essentially downregulates other cytokines and blocks NF-κB activity. It is specific for counteracting the effects of mast cell–initiated allergic reactions, which is why the herb is good for stings and bites and anaphylactic reactions. The herb also stimulates the production of CD4+ lymphocytes. It is especially active in the spleen. The herb reduces Th2 cytokines, specifically IL-4 and IL-5. It inhibits HMC-1 cell migration. It also inhibits topoisomerase 1 activity.

Houttuynia liquid extract protected and restored white blood cell counts in mice X-rayed and administered cyclophosphamide. It normalized connective tissue growth factor and increased levels of adiponectin in streptozotocin-induced diabetes in rats.

The herb (water extract) was used to treat bleomycin-induced pulmonary fibrosis in rats. The herb significantly decreased SOD, malondialdehyde, hydroxyproline, IFN-γ, and TNF-α. The morphological appearance of the lung was markedly improved.

A number of studies found that the herb strongly inhibited induced-oxidation events in rats. It specifically inhibited NF-κB, TNF-α, NO, COX-2, and PGE2. Houttuynia inhibited IgE-mediated systemic passive cutaneous anaphylaxis (PCA) in mice, reduced antigen-induced release of IL-4 and TNF-α, reduced NF-κB, and inhibited degradation of IκB-α. It specifically inhibited antigen-induced phosphorylation of Syk, Lyn, LAT, Gab2, and PLCG2. Further downstream it also inhibited Akt (a.k.a. protein kinase B or PKB) and MAP kinases ERK-1 and ERK-2 and JNK-1 and JNK-2 but not p38.

Extracts of the herb protected rat kidneys when rats were injected with streptozotocin. TGF-β1 and collagen levels in renal tissues decreased; BMP-7 (bone morphogenetic protein 7) increased. A modified form of houttuynin both protected mice from and corrected induced membranous glomerulonephritis in mice. It inhibited the expression of NF-κB and MCP-1.

A water extract of the herb protected rat primary cortical cells from beta-amyloid–induced neurotoxicity, specifically through modulating calcium influx and protecting mitochondria. In another study, the mortality of chicks challenged by Salmonella was significantly reduced when the herb was included in their feed. PGE2 synthesis decreased, CD4+ lymphocytes increased, the CD4+/CD8+ ratio balanced, immune function in all chicks was enhanced.

The herb’s constituents move fairly rapidly into the bloodstream and maintain a high presence. The absorption half-life after oral ingestion is 3.5 hours. The herb’s constituents are present in the highest amounts in the lungs, heart, liver, kidneys, and serum in that order. Elimination of constituents, metabolized or not, in the urine and feces is very low; the main route of excretion is the lungs (breath). Radioactively labeled houttuynin was found to persist in rat tissues for up to 48 hours. The highest levels were in the bronchi (especially at one and four hours postinjection) and in descending order in the gallbladder, liver, ovary, intestine, spleen, kidneys, and lungs. Oral dosing found the highest levels in the bronchi after 24 hours.

Preparation and Dosage

The fresh plant is much more antibacterial/antiviral (as is the tincture made from it) than the dried plant, and it is traditionally pounded to make juice for oral administration internally, or for use externally on wounds or as eye drops. The remaining mashed plant can be used as a paste applied topically to wounds and bites; the decoction (allowed to cool) can be used for an external wash. The Japanese use a tea, taken regularly, as a tonic medicine.

Tincture

Preparation: The tincture of the fresh leaves (1:2, 95 percent alcohol) is the most potent form of the plant as medicine. I would not use a dried plant tincture unless that is all you can find.

Dosage: ¼–½ teaspoon up to 6x daily for viral infections, or ½ teaspoon 3x daily for Lyme coinfections.

There are a few companies selling the tincture for absurd prices, which, given that the plant is an invasive and very easy to grow, I find obscene.

Decoction

Traditionally the herb (sometimes the root) is used, either dried or fresh, to make a decoction. For dried, 15 to 30 grams (about ½ to 1 ounce) of the dried plant is decocted (that is, briefly boiled), allowed to cool, then consumed. For fresh, 30 to 50 grams of the fresh herb is decocted similarly. Examination of the decocted herb has, however, revealed that it loses much of its antibacterial/antiviral actions upon boiling (which is why the Chinese tend to boil it really, really briefly). If decocted intensively, the plant works well to stop diarrhea but is relatively inactive antimicrobially. Apparently the Chinese boil it at all simply to alter the taste; the fishy taste is significantly reduced if even boiled briefly.

Again: It can taste nasty, very fishy, to some, so put it in something with a strong taste to cover it (fish soup?). Otherwise it can be hard to get it down.

Powder

You can also find the powder, sometimes concentrated at 5:1, sometimes just the regular old powdered herb, from some Chinese herb companies. You can encapsulate the powder if you cannot take the taste of the tincture or decoction. I have been unable to locate any pre-encapsulated forms on the market. The herb really isn’t that popular at this point.

If you do encapsulate it yourself, use “00” capsules. I would begin with two capsules 3x daily and see how it goes, adjusting the dose depending on how it works for you. I have never been sure of how to dose the 5:1 concentrated powders that the Chinese often make; presumably you would take one-fifth the dose of the nonconcentrated form.

Side Effects and Contraindications

Fishy-smelling breath (maybe). The taste can be terrible to the point of gagging (some say). Other than the nausea from the taste there are no reported side effects in the literature from oral ingestion of the plant.

It does have emmenagogue actions (though oddly enough the herb is not traditionally used for starting menstruation) so it should not be used in pregnancy. However, a few individual reports from China say it can, very rarely, cause congestion in the vagina (but I can’t really tell what that means).

The Chinese sometimes use it as an injectible and there have been some severe anaphylactic reactions to that. So . . . don’t inject it.

Herb/Drug and Herb/Herb Interactions

None have been noted in the literature or in any anecdotal reports that I can find.

Finding It

If you want a very good fresh tincture at a decent price try Woodland Essence. The dried herb (in both powder and cut form) is available from 1stChineseHerbs.com.

L-Arginine

L-arginine is an amino acid normally present in the body. Its levels can drop during many microbial infections, including those from Babesia, Bartonella, and Mycoplasma. L-arginine is a rather crucial amino acid. It is needed for the replication and division of cells, the protection of endothelial integrity, the healing of wounds, healthy immune function, and proper hormone activity. It is strongly protective of bones and helps repair microbial damage to them. It significantly decreases the amount of time needed for wounds to heal.

L-arginine is important to use during Babesia infections in that it strongly protects the endothelial cells from the kinds of damage the Babesia cause. It reduces the cytokine cascade the protozoa initiate and stops them from creating more habitat.

L-arginine is also potently effective in improving endothelial dysfunction during any type of circulatory system disorder. It normalizes endothelial function, inhibits adhesion to endothelial cells (of all blood cell types), inhibits hyperplasia, reduces endothelial activation, stimulates the production of NO from endothelial cells (which will kill the protozoa), corrects induced NO deficiency in the body, and generally restores healthy vascular functioning.

L-arginine is the primary supplement to use to protect and restore endothelial function during Babesia infection. It will, by itself, counteract the majority of detrimental effects that occur during babesiosis. Studies have found that simply supplementing the body with L-arginine will reduce or even eliminate babesial infection from the body.

Dosage

Take 1 or 2 500 mg capsules up to 3x daily.

Side Effects and Contraindications

L-arginine should be avoided in cases of active shingles or herpes as it can exacerbate the outbreak. L-arginine will not usually initiate an outbreak but once an outbreak occurs, existing viruses can use arginine to enhance their replication.

Supplement/Drug Interactions

L-arginine can affect blood sugar levels and should be used with caution if you are diabetic. It can also lower blood pressure so should be used with caution if you are taking blood pressure medications.

Leonurus cardiaca (Motherwort)

Motherwort is an important supportive herb in that it provides protection for mitochondrial integrity and function and is very good at reducing anxiety and sleeplessness.

Motherwort has been found to be strongly neuroprotective, especially in ischemia-reperfusion–induced mitochondrial dysfunctions in the brain, including the cerebral cortex. It significantly improves neurological outcomes and reduces ischemia-reperfusion impacts in the brain. It decreases ROS levels in the brain mitochondria and, importantly, reduces mitochondrial swelling and restores mitochondrial membrane potential. Motherwort decreases the expression of the Bcl-2 protein in the brain. Increased Bcl-2 levels in the body have been implicated in the generation of various cancers, including prostate, as well as various psychiatric disorders of the central nervous system and autoimmunity problems. Part of the function of the protein is interfering with apoptosis, that is, cell death. Motherwort decreases its expression and increases the levels of Bax. Bax is a protein, closely related to Bcl-2, that acts to increase apoptosis in cells. Bcl-2 and Bax normally exist in a modulated balance and their expression is controlled by a protein, p53. This protein is intimately involved in controlling the emergence of cancers in the body as well as protecting the genome from damage. It is sometimes referred to as “the guardian of the genome.”

Many coinfections decrease Bax and increase Bcl-2. This not only leads to cancer formation by mycoplasmas over long infection periods but also keeps cells that are infected by mycoplasmas from dying. This allows the bacteria to invade cells and scavenge their genome. Physiologically, in this instance, the mitochondria swell as they are infected, but cannot die, and are kept artificially alive while they are scavenged for nutrients. A major outcome of this is loss of energy due to mitochondrial malfunction. More crucially, it leads to damage in the brain that contributes to the psychiatric problems associated with mycoplasma infection.

Motherwort stops this process and protects the mitochondria in the brain, and presumably other cells in that location as well since it also decreases the production, and impact, of ROS in the brain. The herb exerts anti-inflammatory actions throughout the central nervous system and also exerts a moderate pain-relieving action as well. Motherwort contains a number of chemical compounds, among which is ursolic acid, which has been found to be a potent inhibitor of intracellular ROS induced by bacteria. Some studies have found that motherwort is higher in its antioxidative actions than both hawthorn and ginkgo.

Water extracts of motherwort completely inhibit tick-borne encephalitis (TBE) and induce resistance to the TBE virus in mice infected with it.

Motherwort slows and strengthens the heartbeat and has traditionally been used as a heart medicine. It is also a reliable and strong relaxant for anxiety. During anxiety episodes heart rate increases; motherwort calms it down through a variety of mechanisms. In combination with this, it also significantly decreases anxiety by its actions in the central nervous system. Double-blind studies have found it to significantly help in the treatment of anxiety. It also has been found to significantly decrease sensitivity to light—a problem that often occurs during Lyme and a number of coinfections.

Its actions are dose dependent.

Preparation and Dosage

Use the tincture.

Preparation: 1:2, 95 percent alcohol, of the freshly harvested, not dried, plant.

Dosage: ¼ teaspoon up to 6x a day. Fresh plant tincture only.

Side Effects and Contraindications

The herb is contraindicated in pregnancy, stomach irritation has been so rarely reported as to make me question the source, and I don’t know what to make of the one report of diarrhea. Tremendously high levels have been reported to cause uterine bleeding but I can only find one source for this and nothing in the journal papers that are so often hysterical about herbs. The herb has traditionally been used as an emmenagogue, that is, a substance to start a delayed menstrual cycle, so perhaps this is why it is reported to cause uterine bleeding.

The plant does lower blood pressure, so if you already have low blood pressure, be careful with it. But just to make things more difficult the herb is also reported to raise blood pressure. I haven’t seen this in practice in 25 years of use so I am not sure what to make of that assertion.

Herb/Drug and Herb/Herb Interactions

Will produce additive effects if taken along with blood pressure–lowering pharmaceuticals.

N-acetylcysteine (NAC)

NAC is specific for a number of Lyme coinfections. For example, researchers, studying the cytokine impact of M. pneumoniae, found that significant elements of that cascade, specifically intracellular levels of ROS (reactive oxygen species) in epithelial cells, phosphorylation of JAK-2 and STAT-3, STAT-2 DNA-binding activity, and IL-8 expression caused by the bacterial lipid membrane proteins, were inhibited by NAC in a dose-dependent manner. In other words, the higher the dose, the greater the reduction. NAC is a precursor of the potent antioxidant glutathione. During mycoplasma infection of the lungs the ROS it stimulates within the cells also causes DNA double-strand breaks. Researchers found that by stopping the ROS increases the DNA strands remained whole.

NAC also strongly inhibits hydrogen peroxide, a common problem in some Lyme coinfections. Other studies have noted that NAC inhibits the production of TNF-α, PI3K (phosphatidylinositol 3-kinase), p38 MAPK, JNK, IL-6, IL-1β, and MMP-9.

NAC is also strongly mucolytic, meaning it thins, loosens, and clears mucus from the lungs and airways. It is strongly protective of the cilia. NAC is also helpful in septic shock—an overwhelming infection that causes a resultant severe drop in blood pressure. Studies of the supplement in treating septic shock—and endotoxin shock—have found it can reverse those conditions, even if taken post-shock.

More interestingly, the levels of glutathione in red blood cells are significantly increased by NAC, thus protecting them from bacterial oxidation and lysis. TNF-α levels are decreased. (NAC is synergistic with pharmaceuticals and herbs in the protection of red blood cells from oxidative death.) NAC has a strongly protective effect on red blood cells, protecting them from oxidative events. This type of protection also occurs in synovial tissues, where it reduces inflammatory cytokines and inhibits collagenase, which breaks down collagen. And it is also protective throughout the reproductive systems, male and female.

NAC has strong protective effects against neurotoxicity throughout the central nervous system and can correct neurotoxic effects in the brain, especially in the hippocampus. It protects brain mitochondria from oxidative effects, eliminating membrane depolarization, keeping the mitochondria from swelling, bursting, and releasing ATP. It inhibits brain edema and as well acts throughout the entire peripheral nervous system to inhibit inflammation. It has also been found to protect the fetus during development from the impacts of inflammation induced by bacterial membrane lipids. NAC also inhibits biofilm formation by bacteria, reducing that particular form of protection that many bacteria use.

NAC is a very good systemic; it is widely dispersed in the body within one hour and reaches peak at four hours. Levels remain high for 12 hours. It is predominantly concentrated in the liver, kidneys, skin, thymus, spleen, eyes, brain, and serum.

These actions of NAC are consistent whether in vitro, in vivo, or in human studies.

Dosage

The usual dose in most studies on rats has been 20 mg/kg per day. That would translate to 1,400 mg daily for a 150-pound person. However, a University of Florida study with people found that a better dose for adults is 4 to 6 grams per day—for children 60 mg/kg. The best dose for Lyme coinfections, based on this, would be 2,000 mg in the morning and 2,000 mg in the evening just before bed.

Paeonia lactiflora

The root of this peony, and of several others, has been used in Chinese medicine for over 2,000 years. It is variously referred to as white and red peony root, depending (on the colors of the flowers according to some, not so! say others). The root is generally boiled and then dried in the sun and ultimately sliced and stored for use. It is used for nourishing the blood, acting on the liver and spleen channels, reinforcing yin, nourishing the liver to reduce liver pain, and reducing liver yang. It is used for irregular menstruation, liver pain, abdominal spasm and pain, pain in the extremities, and headache due to liver stagnation. It is tonic, anodyne, alterative, diuretic, carminative, lowers fevers, relieves colds, and alleviates neurological problems. It helps protect the brain from the deleterious effects of microbial inflammation. It helps reduce ataxia and is antidepressant. It is an anticoagulant and inhibits platelet aggregation.

The herb is a pretty good cytokine modulator, especially for inflammatory conditions. It downregulates MPO and TLR-4 and HMGB1, making it highly useful in treating sepsis. It also inhibits RAGE, TGF-β, MCP-1, NF-κB, TNF-α, IL-1β, IL-6, p38 MAPK, E-selectin, ICAM-1, PGE2, and IL-17. It upregulates caspase-3, stimulating apoptosis in damaged and infected cells. It reduces microbe-induced permeability of endothelial cells. Like a number of other herbs that possess actions along these lines, the herb helps prevent fibrosis in infected organs such as the liver, lungs, and kidneys. It is particularly good for this. The herb is usually combined with other medicinals.

Preparation and Dosage

Chinese doses are, as usual, high: from 5–10 grams for tonic doses, or 15–30 grams for acute conditions, decocted in water. The tincture (1:5, 60 percent alcohol) dosage is ½–1 teaspoon up to 3x daily. It is usually best combined with other herbs (e.g., angelica for anemia, licorice for dysmenorrhea).

Side Effects and Contraindications

Mild GI tract disturbances, including occasionally diarrhea. Not for use during pregnancy or while on blood-thinning medications.

Panax ginseng

This herb has, perhaps, the longest history of use of any plant in Asian medicine, perhaps as long as 4,000 years in China. The Asian root, this species, is stronger than the American (Panax quinquefolium) . . . more yang as they say. I consider it to be an adaptogenic stimulant, whereas the American root is more tonic in its actions. The herb is primarily considered to be an immunomodulator with a wide range of effects, including increasing androgens for men in middle and old age, and helping alleviate type 2 diabetes. The dried root is usually used for medicine or making tinctures.

Within the Chinese system it is considered to act on the spleen, lung, and heart channels, to powerfully replenish chi, and to tonify the spleen and lungs, calm the nerves, tranquilize the mind, and improve mental power. It is used for shortness of breath, listlessness, weak pulse, deficiency after prolonged illness, and excessive loss of fluids. It is specific for yang depletion (loss of vital energy) with profuse sweating and/ or cold limbs.

In general, the herb improves resistance to stress, increases stamina and endurance, improves overall health and vitality, and increases mental performance.

It is important in the treatment of these Lyme coinfections because of its numerous cytokine and immune effects. It upregulates caspase-3, MHC-II, and IL-12. It inhibits TNF-α, TLR-4, CXCL10, CXCL11, CXCL1, and CCL3 and 4. And it has tremendous impacts on bone marrow progenitor stem cells, strongly counteracting myelosuppression in the marrow. The numbers of all hematopoietic cells are increased by the herb, helping counteract their suppression in the bone marrow. It is markedly good for anemia caused by such suppression.

Preparation and Dosage

In China, the dosage is 5 to 10 grams (as a powder) daily, in 1- to 2-gram doses taken two or three times daily. For deep and prolonged chronic conditions, up to 15 to 30 grams per day are used. Tincture (1:5, 70 percent alcohol) dosages tend to be smallish, from 10 drops up.

Side Effects and Contraindications

Should not really be used with stimulants (caffeine, amphetamines, and so on) and should be avoided if you have high blood pressure or are consumed by anxiety. Not really for use during pregnancy.

Polygala tenuifolia (Chinese Senega Root)

This is one of the 50 fundamental herbs of Chinese medicine and is known as yuan zhi. It is used in China primarily as an expectorant and to help lung inflammations. But it also has strong impacts on cognitive function, enhancing memory, alleviating neurotoxicity, and producing positive impacts in the treatment of Alzheimer’s, dementia, depression, and degenerative diseases. It is a very good anti-inflammatory and inhibits NF-κB, NO, iNOS, COX-2, PGE2, TNF-α, and IL-1β in microglial cells. One of the more important activities of the herb is that it enhances the secretion of nerve growth factor (NGF) in the brain, spinal cord, and peripheral nervous systems. NGF is a small protein that is crucial for the growth, maintenance, and survival of neurons. When neuronal damage occurs, higher levels of NGF are essential in stimulating axonal regeneration. This is perhaps the best plant for stimulation of NGF.

Preparation and Dosage

The dosage is 30 drops of the tincture of the dried root (1:5, 50 percent alcohol) 3x daily for 30 days. It is contraindicated in those with ulcers or gastritis.

Polygonum cuspidatum (Japanese Knotweed)

Japanese knotweed is a world-class invasive originally native to Japan, north China, Taiwan, and Korea. It is another significant invasive that is specific for emerging bacterial infections. The root is the part of the plant used for medicine.

The herb has a wide range of actions: antibacterial, antiviral, antischistosomal, antispirochetal, antifungal, immunostimulant, immunomodulant, anti-inflammatory, angiogenesis modulator, central nervous system relaxant, central nervous system (brain and spinal cord) protectant and anti-inflammatory, antioxidant, antiathersclerotic, antihyperlipidemic, antimutagenic, anticarcinogenic, antineoplastic, vasodilator, inhibits platelet aggregation, inhibits eicosanoid synthesis, antithrombotic, tyrosine kinase inhibitor, oncogene inhibitor, antipyretic, cardioprotective, analgesic, antiulcer (slightly reduces stomach acid and protects against stress ulcers), hemostatic, and astringent.

A broadly systemic plant, Japanese knotweed modulates and enhances immune function, is anti-inflammatory for both arthritic and bacterial inflammations, protects the body against endotoxin damage, and is a potently strong angiogenesis modulator, highly protective of the endothelia of the body. It crosses the blood-brain barrier and is potently anti-inflammatory in the brain and central nervous system. It is highly specific for Bartonella and Lyme disease infections and is a very useful adjunct for a number of the other coinfections, especially when endothelial dysfunction is present.

Knotweed is a very strong inhibitor of cytokine cascades initiated by bacteria. During Lyme infection, for instance, there is a spirochete-stimulated release of a number of matrix metalloproteinases (MMPs). The most common are MMP-1, MMP-3, and MMP-9. Production of MMP-1 and MMP-3 in Lyme arthritis occurs through a particular grouping of pathways—those of the mitogen-activated protein kinases (MAPKs), specifically JNK, p38, and ERK-1 and ERK-2. MMP-9 production occurs through the JNK pathway and another, the PKC-delta pathway.

While there are a number of herbs that can reduce autoinflammatory conditions stimulated by MMP-1 and MMP-3 (e.g., curcumin), the only herb that specifically blocks MMP-1 and MMP-3 induction through these three particular pathways is Polygonum cuspidatum. Resveratrol (one of the plant’s constituents) is also directly active in reducing MMP-9 levels through both the JNK and PKC-delta pathways; it has been found to specifically inhibit MMP-9 gene transcription. Another component of the plant, rhein, inhibits the JNK pathway for MMP-1, MMP-3, and MMP-9 expression. Knotweed is also a formidable inhibitor of NF-κB, IL-8, PI3K, E-selectin, and VEGF.

Polygonum cuspidatum’s constituents cross the blood-brain barrier, where they exert actions on the central nervous system: antimicrobial, anti-inflammatory, as protectants against oxidative and microbial damage, and as calming agents. The herb specifically protects the brain from inflammatory damage, microbial endotoxins, and bacterial infections.

Knotweed enhances blood flow especially to the eyes, heart, skin, and joints. This makes it especially useful in Lyme and its coinfections as it facilitates blood flow to the areas that are difficult to reach to kill the organisms. It is a drug and herb synergist, facilitating the movement of other herbs and drugs into these hard-to-reach places when taken with them.

It is also extremely effective for treating coinfection-initiated inflammatory arthritis. Its most potent constituents are the resveratrols, emodin, and polydatin. The plant root is so high in resveratrols that it is the main source of the supplement throughout the world.

While there is a long historical use of the plant in Asia, especially China and Japan, stretching back 2,000 years, there has been little knowledge of the plant in the West until recently. Research on and subsequent use of the plant as a phytomedicinal has been primarily because of its high content of resveratrol, a potent vasodilator and inhibitor of platelet aggregation (among other things).

The plant’s compounds easily move across the gastrointestinal mucosa and circulate in the bloodstream.

In traditional Chinese medicine the herb is used for invigorating and clearing the blood, and for its antipyretic, detoxicant, antiinflammatory, antirheumatic, diuretic, expectorant, antitussive, and stasis-eliminating and channel-deobstructant actions. Primarily, it is used in the treatment of jaundice, rheumatic pain, strangury with turbid urine and leukorrhea, dysmenorrhea, retained lochia, bleeding hemorrhoids and anal fissure, wounds and injuries.

Other uses include respiratory infections and damage to the skin: scalds and burns, carbuncles, skin infections, snakebite (usually as a poultice). It’s also used for bacterial dysentery, acute infectious hepatitis with jaundice, hepatitis B (surface antigen positive), chronic active hepatitis, neonatal jaundice, cholelithiasis, cholecystitis (with damp heat or severe heat syndrome), trichomonas, bacterial vaginitis, hyperlipidemia, and psoriasis. (Basically, it is used to treat pathogenic heat in the blood, cough from lung heat, constipation from accumulated heat in the GI tract, jaundice and liver inflammation due to damp heat, and accumulated heat in the skin.)

There are literally hundreds of studies on the plant and its constituents. In the West these studies have primarily focused on the actions of resveratrol, followed (in descending order) by the whole plant and the constituents trans-resveratrol, emodin, and polydatin. The scores of clinical and laboratory studies in China have been primarily on the whole plant and the single constituent polydatin.

The plant and its constituent resveratrol interfere with the actions of NF-κB. This transcription factor is strongly linked to inflammatory and immune responses. It is active in the regulation of cell proliferation and apoptosis, cell transformation, and tumor development. It controls the gene expression of cytokines, chemokines, growth factors, cell adhesion molecules, and some acute-phase proteins, including the inflammatory mediators iNOS and COX-2. Bacteria such as Borrellia and its coinfections can activate NF-κB, causing a cascade of immune-mediated cellular reactions. The herb apparently modulates the actions of NF-κB rather than acting simply as its suppressor. Resveratrol also modulates IFN-γ-induced neopterin production and tryptophan degradation. Resveratrol also inhibits IL-6, IL-8, TNF-α, ERK-1, and ERK-2.

Another component of knotweed, emodin, is highly protective of brain neurons and reduces pain by inhibiting the activation of the P2X(7) receptors in the brain. It reduces impacts on the P2X(2/3) receptors as well.

The herb, in fact, is a potent immunomodulator. It normalizes immune response, especially in diseases where autoimmune reactions are stimulated (such as Lyme disease and lupus). It seems able to bring up immune function when necessary and reduce its local manifestations when overstimulated, e.g., in rheumatoid arthritis. This is a very strong aspect of the plant’s actions.

Clinical studies have found the herb to be effective in acute icteric viral hepatitis, inflammation of the bone and bone marrow, psoriasis, herpes, and cervix erosion. The herb and its constituents have also been found to enhance and potentiate the action of other drugs and herbs when taken with them. Japanese knotweed and its constituents also possess strong actions in the central nervous system and brain, and this range of activity is where a great deal of interest in the plant is being generated.

Knotweed and the constituents trans-resveratrol and resveratrol have been found to be strongly neuroprotective through a variety of actions in numerous studies. One of the herb’s mechanisms of action in this regard is as an antioxidant. One study found that resveratrol and trans-resveratrol protected rat embryonic mesencephalic cells from a powerful pro-oxidant, tert-butyl hydroperoxide. Another study found that regular use of trans-resveratrol prevented streptozotocin-induced cognitive impairment and oxidative stress in rats (an Alzheimer’s-like condition). And yet another found that trans-resveratrol protected and reversed many of the impacts of induced stroke in rats.

While the herb’s antioxidant actions are important, trans-resveratrol, for example, has been found in a number of studies to strongly protect neuronal structures from damage through mechanisms other than antioxidant activity alone. Resveratrol has been found specific for protecting the brain from neurotoxic substances such as the beta-amyloid peptides, which are associated with Alzheimer’s disease.

Resveratrol and trans-resveratrol are specific for reducing inflammation in the brain and central nervous system. In spinal cord injuries resveratrol “remarkably” reduced secondary spinal cord edema, significantly suppressed the activity of lactate dehydrogenase, reduced malondialdehyde content in the injured spinal cord tissue, and markedly improved NA+/K+-ATPase activities. It immediately stimulated microcirculation to the injured tissues.

Low-level, chronic inflammation in the brain and central nervous system plays a major role in many neurodegenerative conditions. Both the herb and its constituents are specific for such inflammations. They have been found active for such things as amyotrophic lateral sclerosis and other motor neuron diseases, Parkinson’s disease, Alzheimer’s disease, bulbar atrophy, dementia, Huntington’s disease, myasthenia gravis, stroke, multiple sclerosis, frontotemporal dementia, encephalomyelitis, traumatic brain injury, cerebral ischemia, and so on. The resveratrols specifically protect brain cells from assault, whether chemical or microbial in origin. The herb and its constituents, as well, stimulate microcirculation in the brain.

Preparation and Dosage

Capsules, powder, or tincture.

Capsules: Capsules of pure knotweed root can be had (try Green Dragon Botanicals at www.greendragonbotanicals.com)  or you can buy “resveratrol,” which is in fact only a standardized knotweed root formulation. That is, it is knotweed root standardized for the presence of a certain percentage of resveratrols. Most of the brands on the market are usable. Just make sure they are made from knotweed root (it will say on the package someplace in tiny print) and not grapes. Dosage for Lyme and its coinfections is 3 capsules 3x daily.

Powder: I actually prefer, these days, to use the powdered root in a liquid of my choice, usually 1 teaspoon–1 tablespoon 3x daily. (I am tired of swallowing capsules.)

Tincture: ¼–½ teaspoon of the tincture of the dried root (1:5, 50 percent alcohol) 3x daily.

Contraindications and Side Effects

While a very safe herb, Japanese knotweed is contraindicated in pregnancy. Side effects of high dosages are primarily gastrointestinal in nature—dry mouth, bitter taste in mouth, nausea, vomiting, abdominal pain, diarrhea. If gastrointestinal side effects occur, reduce the dose. A couple of notes . . .

Note: A very few people have reported a loss of their ability to taste from using the herb. This definitely is a potential side effect, even though it occurs in less than 1 percent of the people using the plant. It can take a while to return (months).

Note: Some people have reported rather strong negative physical responses to the Source Naturals resveratrol. I am not sure why this is; however, those that do, having switched to another product by Paradise Herbs, report a better outcome. Just an FYI on that one.

Herb/Drug and Herb/Herb Interactions

Should not be used with blood-thinning agents. Discontinue use of the herb 10 days prior to any surgery. The plant is a synergist and may potentiate the effects of pharmaceuticals and other herbs.

Pueraria lobata (Kudzu)

Though originally native to Japan, kudzu is an invasive vine in the southern United States. It is particularly impressive, being able to grow 12 inches per day and up to 100 feet per year. It can’t be stopped, it can’t be reasoned with, nothing will kill it, and it knows where you live. It is the root that is used for medicine.

Kudzu has long been used in both China and Japan as medicine and food. It increases blood circulation, relieves tension in the face and neck, is somewhat antiviral, lowers blood pressure, and is antiinflammatory. It can help the headaches that occur from encephalitis, will reduce Bell’s palsy, and reduces inflammatory cytokine cascades. Kudzu root has very strong antifever actions as well and will reduce severe fevers fairly quickly; the effects last about eight hours.

Kudzu root and its major constituents (puerarin and kakkalide and irisolidone—a metabolite of kakkalide produced by intestinal microflora that is more potent than kakkalide) inhibit TNF-α, IL-1β, NF-κB, ERK, iNOS, PGE2, COX-2, AP-1 (activator protein 1), ICAM-1, VCAM-1, E-selectin, CRP (C-reactive protein), and the phosphorylation of IκB-α. They have targeted and potent effects on cytokine-activated microglial cells and will reduce damage by cytokines in the central nervous system.

Kudzu and puerarin are strongly protective of the brain and central nervous system, especially in ischemia-reperfusion injury. They have a strong protective effect against beta-amyloid–induced neurotoxicity in hippocampal neurons, protect mitochondria from ROS, and stimulate peripheral nerve regeneration. Neuron pain receptors P2X(3) and P2X(2/3), similar to P2X(7), in the brain are inhibited by puerarin, making this a very good companion herb to use with greater celandine (see page 242). The root is, in fact, strongly antiinflammatory in the brain and central nervous system. It significantly inhibits neutrophil respiratory bursts, reducing autoimmune dynamics in the brain. Similarly to motherwort (page 278), it modulates Bax/Bcl-2 actions in the mitochondria in the brain and inhibits caspase-3 and iNOS expressions. It is strongly neuroprotective during inflammation disturbances in the brain and central nervous system.

It is a good herb for these types of cytokine cascades, especially so since it is invasive and there is no dearth of supply. Anywhere encephalitis occurs and kudzu grows, use kudzu.

Dosage

In traditional Chinese medicine the usual dose is 6–12 grams per day of the powdered root. Normally dosing in the West is 1 gram per day. Tincture (1:5, 50 percent alcohol) dosage for Lyme coinfections is ½ teaspoon 3–4x daily.

Quercetin

Quercetin is abundant in plants, including most medicinal and food plants. We get a lot of it in our diet. It has a wide range of actions, including antioxidant, anti-inflamatory, antiplatelet activity, antineoplastic, antiviral, antihistaminic, and so on. It is of import for use in these types of Lyme coinfections due to its effects in three areas: 1) sepsis; 2) cytokine inflammation; and 3) Ehrlichia/Anaplasma infections.

The supplement inhibits MPO and NE, meaning that it suppresses NETs formation and presence in the body; it also inhibits HMGB1. This makes the supplement, in high doses, very good for treating sepsis. The herb also reduces TNF-α and MIP-2 cytokines. And it is a fairly good inhibitor of histidine kinase, which means it will interfere with or even eliminate the ability of both Ehrlichia and Anaplasma bacteria to infect white blood cells. It is an excellent supplement for all stages of infection by those bacteria, including acute conditions and sepsis.

Dosage

Take 1,000 milligrams 2x daily during treatment of Lyme coinfections.

Side Effects and Contraindications

This supplement is well tolerated—high dosages taken daily for months produced no adverse side effects. It should not be taken along with digoxin; there is a possibility of negative side effects (speculative).

Rhodiola spp.

No one knows just how many rhodiola species there are, but they do guess a lot: 36, or maybe 60, or probably 90. The primary medicinal that most people use is Rhodiola rosea but many of the related species are used medicinally in the regions in which they grow. Because of the interest in R. rosea, the genus is being intensively studied for activity: I have found medicinal studies of one sort or another on R. crenulata, R. quadrifida, R. heterodonta, R. semenovii, R. sachalinensis, R. sacra, R. fastigiata, R. kirilowii, R. bupleuroides, R. dumulosa, R. imbricata, R. rhodantha, and R. integrifolia. The roots are what are used as medicine. All the Rhodiola rosea plants, irrespective of where they grow or in what country, have nearly identical chemistry. They are all perfectly usable as medicine.

Rhodiola is an adaptogen, immune tonic, nervous system tonic, neural protectant, hippocampal protectant and tonic, mitochondrial tonic and protectant, endocrine tonic, adrenal protectant, ergogenic, antidepressant, antifatigue, antistressor, strong antioxidant, potent cardiotonic, potent hypoxia antagonist, anticancer. A mental and muscular stimulant. Possibly a synergist; the plant is a strong inhibitor of CYP3A4 and P-glycoprotein.

It is specific for chronic, long-term fatigue, recurrent infections, recovery from long-term illness and infections, nervous exhaustion, chronic fatigue syndrome, chronic disease conditions with depression, low immune function, brain fog, acceleration of recovery from debilitating conditions.

Rhodiola, as far as I can tell, and in spite of assertions that it is a long-standing traditional Chinese medicinal, was a contribution to the medicinal plant world by the Russians due to their interest in adaptogens. This is pretty much a Russian-introduced category of medicinal herb—a plant that enhances general overall functioning, somewhat like a tonic but one that increases the ability of the organism to respond to outside stressors of whatever sort, diseases included. It enhances an organism’s general resistance to multiple adverse influences or conditions. Rhodiola, like the stronger preparations of eleutherococcus, is considered to be not just adaptogenic but an adaptogenic stimulant—part of the reason it can cause jitteriness and wakefulness in some.

Numerous rhodiola species have been found to be highly neuroprotective and neuroregenerative.

In vitro studies have found that compounds in both Rhodiola sacra and R. sachalinensis protect neurons against beta-amyloid–induced, staurosporine-induced, and hydrogen peroxide–induced death. Salidroside, a common compound in many rhodiolas, protects cultured neurons from injury from hypoxia and hypoglycemia; protects neuronal PC12 cells and SH-SY5Y neuroblastoma cells against cytotoxicity from beta-amyloid and against hypoglycemia and serum limitation; and protects neurons against hydrogen peroxide–induced death. It does so by inducing the antioxidant enzymes thioredoxin, heme oxygenase 1, and peroxiredoxin 1, downregulating the proapoptotic gene Bax, and upregulating the antiapoptotic genes Bcl-2 and Bcl-xL. It also restores mitochondrial membrane potential and intracellular calcium levels following hydrogen peroxide–induced loss.

Studies have shown that Rhodiola rosea enhances the level of 5-hydroxytryptamine in the hippocampus, promotes the proliferation and differentiation of neural stem cells in the hippocampus, and protects hippocampal neurons from injury. R. rosea protects against cognitive deficits, neuronal injury, and oxidative stress induced by intracerebroventricular injection of streptozotocin. Salidroside protects rat hippocampal neurons against hydrogen peroxide–induced apoptosis. A combination of rhodiola and astragalus protects rats against simulated plateau hypoxia (8000 m/24,000 feet). It inhibits the accumulation of lactic acid in brain tissue and serum.

The herb also has a number of antifatigue/antistress actions. In vitro studies found that salidroside stimulates glucose uptake by rat muscle cells, but more importantly, Rhodiola rosea extracts stimulate the synthesis or resynthesis of ATP and stimulate reparative processes in mitochondria.

In vivo trials found that Rhodiola rosea extracts increased the life span of Drosophila melanogaster, lowered mitochondrial superoxide levels, and increased protection against the superoxide generator paraquat; salidroside protected the hypothalamic/pituitary/gonad axis of male rats under intense stress—testosterone levels remained normal rather than dropping, secretory granules of the pituitary gland increased, and mitochondrial cells were strongly protected; R. rosea extract completely reversed the effects of chronic mild stress in female rats; rhodiola suppressed increased enzyme activity in rats subjected to noise stress—alanine aminotransferase (ALT), alkaline phosphatase, and creatine kinase levels all returned to normal, while glycogen, lactic acid, and cholesterol levels in the liver also returned to normal; R. rosea reduced stress and CRF-induced anorexia in rats; and so on.

In one clinical trial 24 men who took rhodiola while living at high altitude for a year were tested to see its effects on blood oxygen saturation and sleep disorders—rhodiola increased blood oxygen saturation significantly and increased both sleeping time and quality; in a double-blind, placebo-controlled study of the effects of R. rosea on fatigue in students caused by stress, physical fitness, mental fatigue, and neuromotoric indices all increased (other studies found similar outcomes); R. rosea intake in a group of healthy volunteers reduced inflammatory C-reactive protein and creatinine kinase in the blood and protected muscle tissue during exercise; Rhodiola rosea in a placebo-controlled, double-blind, randomized study increased physical capacity, muscle strength, speed of limb movement, reaction time, and attention—in other words it improved exercise endurance performance; a phase three clinical trial found that rhodiola exerts an antifatigue effect that increases mental performance and concentration and decreases cortisol response in burnout patients with fatigue syndrome; other studies have found similar outcomes including the amelioration of depression and anxiety.

The plant has also been found to be highly antioxidant in numerous studies, to be liver protective, and to be highly protective of the cardiovascular system.

The plant is adaptogenic, that is, it increases the function of the organism to meet whatever adverse influences are affecting it, whether stress or illness. Most of the attention has been paid to its ability to increase endurance and mental acuity but its effects on the immune system, though less studied than those of eleuthero, are similar.

Dosage

Tincture (dried root, 1:5, 50 percent alcohol) . . .

As a tonic, 30–40 drops 3–4x daily, usually in water.

In acute conditions, ½–1 teaspoon 3x daily for 20–30 days, then back to the tonic dose.

Side Effects and Contraindications

Some people experience jitteriness from the herb; you should not take it at night until you know if you are one of them.

Herb/Drug and Drug/Drug Interactions

None that I can find.

Scutellaria baicalensis (Chinese Skullcap)

S. baicalensis is the primary species used in China and the one meant when Chinese skullcap is talked about. It most definitely does not mean the American skullcap, Scutellaria lateriflora—or any of the other American species. It is the root that is used. (The leaves of the American species, which are the part commonly used, are not suitable for these Lyme coinfections.)

Chinese skullcap has a wide range of actions. It is antiviral, antiinflammatory, antioxidant, nervine, neuroprotective, anodyne, mildly sedative, anticonvulsant, hepatoprotective, antihypertensive, anticholesterolemic, cholagogue, antianaphylactic, antispasmodic, astringent, expectorant, hemostatic, antioxidant, antiangiogenic, antitumor, antimetastic, antibacterial, antifungal, antidiarrheal, antidysenteric, febrifuge, diuretic, and synergist.

Chinese skullcap root is a truly remarkable herb for use during Lyme coinfections. It is a synergist, a cytokine normalizer, and a tonic for much of the body. It is a top-notch herb for respiratory infections, pneumonia, infections that affect the central nervous system (meningitis, encephalitis, mycoplasma, Lyme, and so forth), impaired brain function, fevers, intermittent fevers, GI tract disorders with accompanying inflammation, diarrhea and dysentery, liver and kidney inflammation, urinary tract infections, nervous irritability, epileptic seizures, convulsions, sleep disruptions, and as supportive therapy in cancer. It is also a fairly potent synergist with pharmaceuticals, herbs, and supplements, helping increase the presence of those compounds in the body by getting them past the GI tract and brain barriers.

This species of scutellaria is one of the 50 fundamental herbs of Chinese medicine and has been used in traditional Chinese medicine for over 2,000 years. It is one of the most widely used herbs in Chinese medicine.

It is considered to be bitter and cold, to dispel heat (fever reducer, anti-inflammatory), and to expel damp heat (e.g., lung infections). It is used as a detoxicant, to stop bleeding, and to prevent abnormal fetal movements. It is specific for fever, cough, pneumonia, hemoptysis, jaundice, hepatitis, dysentery, diarrhea, bloody stool, vexation, insomnia, headache, enteritis, acute conjunctivitis, uterine bleeding, abnormal fetal movements, hypertension, carbuncle, and furuncle.

Most of the scientific studies on this plant have been conducted in China and there are a lot of them. The compounds in the root are, not surprisingly, synergistic with each other. All of them that have been studied are potently antiviral, anti-inflammatory, antioxidative, and free-radical scavenging. Wogonin is the most potent NO inhibitor, while oroxylin is the most potent in inhibiting lipid peroxidation. Together they produce effects beyond the individual constituents.

The herb has strong cytokine impacts, reducing NO, iNOS, IL-3, IL-6, IL-17, COX-2, PGE2, NF-κB, IκB-α, IL-1β, IL-2, IL-12, TNF-α, VEGF, and tends to upregulate IL-10. It inhibits the production of IgE, thus suppressing the expression of histamine. It has especially strong impacts in the spleen. It attenuates the activity of c-Raf-1/MEK-1/2, ERK-1 and ERK-2, p38, and JNK MAPKs.

In Vitro Studies

Flavones from the root are strongly neuroprotective. Baicalein strongly inhibits the aggregation of neuronal amyloidogenic proteins and induces the dissolution of amyloid deposits. Wogonin stimulates brain tissue regeneration, incuding differentiation of neuronal precursor cells. Baicalin promotes neuronal differentiation of neural stem/progenitor cells by modulating p-STAT3 and bHLH (basic helix-loop-helix) protein expression. Wagonin is neuroprotective against cerebral ischemic insult, and at tiny micromolar concentrations completely suppresses the activity of NF-κB and inhibits the migration of microglial cells to ischemic lesions, thus reducing inflammation at the site of injury. It inhibits the movement of the cells in response to the chemokine MCP-1. Baicalein attenuates the induced cell death of brain microglia in mouse microglial cells and rat primary microglia cultures by strongly inhibiting NO through the suppression of iNOS. The compound inhibits NF-κB activity in the cells as well.

Baicalin suppresses IL-1β–induced RANKL (receptor activator of NFκ-B ligand) and COX-2 production at a concentration of 0.01 mcg/ml. The longer the constituent is applied the stronger the effect. Used on human peridontal ligament cells it shows highly protective effects. Baicalein inhibits IL-1β and TNF-α–induced inflammatory cytokine production from human mast cells via regulation of the NF-κB pathway. It inhibits NF-κB and IκB-α phosphorylation. Baicalin promotes repair of DNA single-strand breakage caused by hydrogen peroxide in cultured fibroblasts.

There are scores of other in vitro studies such as these, all showing potent anti-inflammatory and cytokine-modulating actions of the herb and its constituents.

In Vivo Studies

In rats, oroxylin A markedly enhanced cognitive and mnestic function in animal models of aging brains and neurodegeneration. Baicalein has been shown to be anticonvulsive, anxiolytic, and sedative in rats.

Flavonoids from the stems and leaves of Scutellaria baicalensis improved memory dysfunction and reduced neuronal damage and levels of abnormal free radicals induced by permanent cerebral ischemia in rats. Other studies found that the compounds could enhance and improve learning and memory abilities and reduce neuronal pathological alterations induced by a variety of chemicals in mice.

The plant reduced symptoms associated with chronic cerebral hypo-perfusion (and chronic lipopolysaccharide infusion), including spatial memory impairments, hippocampal MAPK signaling, and microglial activation.

Baicalein protected mice hippocampal neuronal cells against damage caused by thapsigargin (TG) and brefeldin A (BFA). The constituent reduced TG- and BFA–induced apoptosis of hippocampal cells, reduced the induced expression of endoplasmic reticulum stress-associated proteins, and strongly reduced the levels of MAP kinases such as p38, JNK, and ERK. It reduced ROS accumulation and levels of MMPs. It strongly protected the mitochondria from oxidative damage.

S. baicalensis (in combination with bupleurum) was strongly neuroprotective against iron-induced neurodegeneration in the nigrostriatal dopaminergic system in rat brains, showing it to be useful for treating central nervous system neurodegeneration.

Mice, subjected to transient global brain ischemia for 20 minutes, were treated with baicalein (200 mg/kg once daily). Neuronal damage was minimal compared to controls, and MMP-9 activity in the hippocampus was inhibited. Pretreatment with baicalein was, in addition, found to be preventive.

Wogonin is also strongly protective in the brain. Rats were damaged by either four-vessel occlusion or excitotoxic injury (systemic kainate injection). Wogonin conferred protection by attenuating the death of hippocampal neurons. It inhibited the inflammatory activation of the microglia by inhibiting iNOS, TNF-α, NO, IL-1β, and NF-κB. In vitro studies at the same time found that lipopolysaccharide-activated macrophages were protected similarly.

An ethanol extract of S. baicalensis prevented oxidative damage and neuroinflammation and memory impairments in artificial senescense mice. The hippocampus and the mitochondria were strongly protected and neuroinflammation sharply reduced. Expressions of COX-2, iNOS, NO, PGE2, Bax, cleaved caspase-3 protein were all reduced. Bcl-2 was increased. The effects were dose dependent and were most effective at 100 mg/kg (that would be 7 grams for a 150-pound person, just in the dosage range usually used in China).

Baicalin reduced the severity of relapsing-remitting experimental autoimmune encephalomyelitis induced by proteolipid protein in a mouse model of multiple sclerosis. All the histopathological findings decreased in the mice given the extract.

Baicalein has been found to be antidepressant in animal models of depression. It reversed the reduction of extracellular ERK phosphorylation and the level of BDNF (brain-derived neurotrophic factor) expression in the hippocampus of CMS (chronic mild stress) rat models.

Oral administration of baicalein in mice infected with Sendai virus resulted in a significant reduction of viral titers in the lungs and reduced death rates.

Oral administration of baicalein in mice infected with influenza A virus showed significant effects in preventing death, increasing life span, inhibiting lung consolidation, and reducing lung virus titer in a dose-dependent manner. Amounts as low as 1.2 mcg/ml of baicalin (the metabolite of baicalein) resulted in significant inhibition of the virus. (Note: Plasma levels of baicalin from the ingestion of skullcap root are significantly higher than this after dosing with 3 to 9 grams per day.)

Baicalein and wogonin inhibit irradiation-induced skin damage by suppressing increases in MMP-9 and VEGF through the suppression of COX-2 and NF-κB. S. baicalensis was effective in reducing IL-6 and TNF-α in mouse models of pelvic inflammatory disease; the herb was both anti-inflammatory and antinociceptive. S. baicalensis extract stimulated the formation of red blood cells and their precursors under conditions of cyclostatic myelosuppression and sleep deprivation.

The root decoction has been used in a number of clinical treatment situations in China to effectively treat scarlet fever, chronic bronchitis, and epidemic cerebrospinal meningitis.

Preparation and Dosage

Again, use the root of Chinese skullcap and please do not attempt to substitute the American skullcap for this one. The herb reaches peak levels in the plasma and body organs in about one hour and only lasts in the body for about four hours, so you really do need to dose about every three to four hours.

Tincture

Preparation: 1:5, 50 percent alcohol.

Dosage: ¼–½ teaspoon 3x daily. In acute conditions, double that.

Dried Herb

The Chinese dosages are large, as usual, generally 3–9 grams at a time. Most of the clinical studies and trials used similar dosing. If you are using capsules this is the dosage range you should be exploring, divided into three equal doses every four hours or so.

Side Effects and Contraindications

Side effects from scutellaria are rare, mostly gastric discomfort and diarrhea. It should not be used during pregnancy. Caution should be exercised if you are taking pharmaceuticals as it can increase the bioavailability of the drugs, thus increasing their impacts. It may interact additively with blood pressure–lowering drugs. Type 1 diabetics should exercise strong caution with the herb as it can affect insulin and blood sugar levels.

Herb/Drug and Herb/Herb Interactions

Lots. Chinese skullcap is a synergist, perhaps as efficacious as licorice, ginger, and piperine, and should probably be added to that category of herbs. Among other things it inhibits the NorA efflux pump, which inactivates some forms of antibiotic resistance. Like the other synergists I know of, it is also a strong antiviral, which is beginning to stimulate speculation. Nevertheless, the herb strongly effects pharmaceuticals and herbs taken along with it.

Baicalein, one of the major compounds in S. baicalensis, is synergistic with ribavirin, albendazole, ciprofloxacin, amphotericin B.

S. baicalensis is strongly inhibitive of CYP3A4, a member of the cytochrome oxidase system. It is a type of enzyme, strongly present in the liver, and is responsible for catalyzing reactions involved in drug metabolism. Many of the pharmaceuticals that are ingested are metabolized by the CYP3A4 system, meaning that some portion of the drug is inactivated. In some instances it is the metabolites created by CYP3A4 that are active as medicinals. Since the herb inhibits the CYP3A4 system, dose dependently, it can enhance the presence of a number of drugs in the system, specifically acetaminophen, codeine, cyclosporine, diazepam, erythromycin, and so on. It does affect the degree of antibiotics that enter the system.

One of the herb’s constituents, oroxylin A, is a strong P-glycoprotein inhibitor. P-glycoprotein is strongly present in the blood-brain barrier, the lining of the GI tract, renal tubular cells, capillary endothelial cells, and the blood-testes barrier. It stops substances from crossing over those barriers. Additionally, cancer cells use P-glycoprotein as a form of efflux pump in order to eject from themselves drugs designed to kill them. P-glycoprotein inhibitors allow more of a substance to cross over barriers high in P-glycoprotein. That means that oral ingestion of a substance will produce more of it in the bloodstream if it is also taken with a P-glycoprotein inhibitor. This means that Chinese skullcap will act through two mechanisms to increase drug and herb uptake in the body.

It will also increase the effectiveness of anticancer drugs by inhibiting P-glycoprotein–mediated cellular efflux. Paclitaxel uptake, for example, was increased over twofold when administered with oroxylin A.

The herb ameliorates irinotecan-induced gastrointestinal toxicity in cancer patients.

The herb will increase the uptake of herbal medicines similarly, again by inhibiting the CYP3A4 system and P-glycoprotein.

Finding It

Try any of the suppliers listed in “Sources of Supply” at the end of the book.

Sida acuta

There are a lot of different sidas around the world. They live primarily in the tropics and subtropics but some species extend into temperate regions. The main medicinal species studied has been Sida acuta; however as research has deepened on this species other sidas are coming to light as similarly potent, particularly S. rhombifolia and S. cordifolia. Two other species, S. tiagii and S. spinosa, have not been studied as extensively but their traditional uses, and some research, indicate they may possess the same medicinal actions. The sidas are invasives—in general, potent medicines that are making themselves known through insistence. I like them immensely. In the United States they tend to grow along the Gulf Coast and here and there in New Jersey and Pennsylvania.

The sidas are potent broad-spectrum systemic antibacterial plants with a wide range of actions and contain one of the most potent systemic plant antibacterials, cryptolepine (as does Cryptolepis spp.). They are antimalarial, antiprotozoal, antimicrobial, antibacterial, hematotonic, hematoregenerator, hematoprotectant, antioxidant (mild), anticancer (antineoplastic, antiproliferative), adaptogenic, analgesic, antipyretic, anthelmintic (fresh leaf juice), antiamoebic, antifertility activity (inhibit egg implantation in mice; however, see the discussion of contraindications and side effects, below), insecticidal, anti-inflammatory, hepatoprotective, antivenin, antiulcerogenic, hypoglycemic. They are strongly protective of red blood cells, especially from microbial invasion. They are pretty good adaptogens.

Sida acuta is widely used in traditional medicinal practice around the world to treat malaria, fevers, headache, skin diseases, infected wounds, diarrhea, dysentery, snakebites, asthma, GI tract problems, systemic infections, renal inflammation, toothache, sore gums, hysteria, bruises, eye infections (as eye drops), breast cancer, abscesses, neuralgia, and arthritis. James Duke’s database lists 12 species of sida that have been used in traditional medicine, all for a similar range of complaints. The heaviest hits occur with acuta, cordifolia, rhombifolia, and veronicaefolia.

Various sida species have been used in India for over 5,000 years; it has a long history of use in Ayurvedic medicine. It has a wide range of use, including for nervous and urinary diseases and disorders of the blood and liver, strangury, hematuria, gonorrhea, cystitis, leukorrhea, chronic dysentery, epilepsy, facial paralysis, asthma, spermatorrhea, rheumatism, lingering debility from previous illnesses, intermittent diseases, rheumatic conditions, and cardiac complaints.

In traditional Chinese medicine the plants are used, just not as much. They are considered to be antibiotic, anti-inflammatory, analgesic, diuretic, and tonic. Sidas are commonly used for depression, bronchitis with cough and wheezing, and urinary tract inflammations. Less common uses are for dermatosis, itching, eczema of the scrotum, sores and boils, stomach pain, dysentery, gastritis, enteritis, tonsillitis, liver problems, jaundice, cervical tuberculous lymphadenitis, malaria, colds and flu, kidney stones.

Importantly, sida is an extremely potent protector of red blood cells, strongly active in protecting them from infestation by such organisms as Plasmodium and Babesia. It has been found in vivo to neutralize venom from the snake Bothrops atrox, a common and very poisonous pit viper in South America. The snake’s venom is a hemotoxin that destroys red blood cells (rather than the neurotoxin more common to cobras and rattlesnakes). With snake venom, rather than its antimicrobial actions killing an infective organism, compounds in the plant neutralize a hemotoxic compound. In this sense sida represents a unique category of herbal medicines: hematotonic, hematoregenerator, hematoprotectant. It is especially useful for anemia and I believe there are strong indications that the herb will be significantly useful for the treatment of certain forms of myeloma—cancer of the red blood cells. It is the only herb I know of that is specific in this way for red blood cells.

Sida increases glutathione levels in the blood (important in Lyme coinfections), increases red blood cell numbers (making it good for anemia), and increases total white blood cell count, indicating an immune potentiation effect that may tie in with its reported adaptogenic actions in traditional practice. Numerous studies have found Sida cordifolia to possess very potent anti-inflammatory and analgesic activities, some of these coming from its ability to increase glutathione levels. The sidas are strong inhibitors of lipid peroxidation from bacterial membranes, inhibit quinolinic acid in the brain, and significantly reduce both LOX and COX. (A tincture of the plant has been found as active as the drug selegiline.) Unfortunately, in spite of consistent anti-inflammatory outcomes, few studies have been conducted on the sidas’ effects on cytokine cascades. Use of the plant after myocardial injury showed significantly increased endogenous antioxidants in heart tissue.

In vivo studies have found Sida acuta to have a strong and reliable antiulcer effect—that is, it protects the stomach lining from the formation of induced ulcers. In vivo research has also found a strong analgesic action.

Several compounds from the plant have been found to inhibit induced preneoplastic lesions in mouse mammary tissue. Sida tiagii during in vivo research has been found to have antidepressant and anti-seizure effects (mice).

Tincture and the hot water extract are the strongest medicinal forms of the herb for internal use.

Preparation and Dosage

Tincture

Preparation: Dried leaf, 1:5, 60 percent alcohol.

Dosage: 20–40 drops up to 4x daily. In the treatment of severe systemic staph infection the usual dose is from ½ teaspoon to 1 tablespoon, 3–6x daily. I prefer to not use this high a dosage for longer than 60 days. That is usually sufficient.

Hot Tea

As a preventive, 1–2 teaspoons of the powdered leaves in 6 ounces water, let steep 15 minutes, drink 1–2x daily. In acute conditions drink up to 10 cups a day.

Side Effects and Contraindications

The main side effect I have seen is that, for some people, sida can increase fatigue and symptoms of coinfection. If this occurs, reduce the dose. That will generally end the problem. This kind of side effect is not noted anyplace in the literature. My speculation is that sida breaks down biofilms and, in diseases such as bartonellosis, once that happens, instead of the bacteria being limited to one location, they are then spread more widely throughout the body, increasing their negative impacts. In the literature, there are no side effects noted, known, or reported; however . . .

• The herb is used traditionally to prevent pregnancy. It does interfere with egg implantation in mice. The herb should not be used if you are trying to get pregnant or if you are newly pregnant.
• Even though the herb is traditionally used in pregnancy, caution should be exercised if you are pregnant. I would be uncomfortable using it if I were pregnant but then, I would be uncomfortable anyway if I were pregnant.
• The herb contains ephedrine, although not in large quantities. There has been a lot of inaccurate, hysterical reporting on ephedra, even among researchers who should know better. Wikipedia is now among the worst offenders of overly conservative fearmongering—a departure from its original mission.

Although the main reason cited for banning ephedra in the United States is adverse effects, including death, what is accurate is that:

1. Weight loss and “natural energy” companies were the ones who marketed the supplements containing the herb (usually along with caffeine and other stimulants). Herbalists did not support this use of the herb.
2. People wanting to lose weight or increase their energy took the supplements—often in huge doses, far beyond sanity.

Basically the herb was a way to make money off an aspect of the United States’ cultural insanity about how one should look to be beautiful or how much one should work to be useful, with, of course, predictable results.

In spite of this, the primary reason the ephedra was banned was that meth labs were using the herb to make meth. The adverse reactions from improper use of the herb were just the excuse. Ephedra is very safe when used properly; it really didn’t need to be banned. The companies using it improperly just needed to be prohibited from doing so.

Nevertheless, just be aware that the herb contains minute (I repeat: incredibly tiny) amounts of ephedra and that a mild raciness or wakefulness may occur from using the herb—but it probably won’t.

Herb/Drug and Herb/Herb Interactions

None known or reported; however . . .

• Since the herb is hypoglycemic, it may affect medications for diabetes. Just watch your blood sugar levels if you are diabetic.
• Since the herb contains ephedrine, it probably should not be used with pharmaceuticals that possess similar effects.

Silybum marianum (Milk Thistle Seed)

Milk thistle has a wide range of actions, much of it on the liver. It is a hepatoregenerator, hepatoprotective, hepatotonic, antihepatotoxic, choleretic, anticholestatic, an anti-inflammatory for both the liver and spleen, and an immunostimulant.

Milk thistle is strongly protective of the liver against the deleterious effects of microbial pathogens and chemical toxins. It stimulates the regeneration of damaged liver tissue and will tonify, restore, and normalize liver function. It will reduce liver and spleen inflammation and is particularly useful in combination with red root (Ceanothus spp.; see page 240). It stimulates bile production and flow. It will enhance supportive immune functions, especially the stimulation of IL-4, IL-10, and IFN-γ.

Milk thistle does reduce a number of cytokines as part of its actions. It inhibits TNF-α, NF-κB, E-selectin, hydrogen peroxide, and c-JNK. This herb, if standardized, will strongly protect the liver from inflammatory damage, reduce inflammatory infiltrates, protect the Kupffer cells, reduce ALT and AST levels, and help remodulate the JAK/STAT pathway.

It is specifically indicated in cirrhosis or severe liver impairment, acute or chronic hepatitis, elevated liver enzymes, bile insufficiency, liver or spleen inflammation, feelings of abdominal pressure, fatigue, poor appetite.

Milk thistle is one of the most potent herbs for protecting the liver against hepatotoxins and helping damaged liver tissue to regenerate. It is also the most extensively studied in clinical trial. The major active constituent is believed to be silymarin, which is found only in the seed and pericarp. Silymarin is actually a combination name for three separate constituents of the herb. Milk thistle is also high in a number of other constituents including betane, the primary constituent of beets.

Milk thistle and silymarin have been extensively tested in human trials for many years. Human trials have followed from as few as 6 patients to as many as 2,000 for up to four years. All have found the herb useful.

The trials have found that in cases of chronic alcoholic liver disease, toxic liver damage, type II hyperlipidemia, and “fatty liver,” use of the herb enhanced immune function (T-cell and CD8+ counts were raised); symptoms of tiredness, abdominal pressure, poor appetite, nausea, itching were relieved; superoxide dismutase activity of white and red blood cells increased; significant improvement in liver function occurred; total cholesterol levels decreased; there was normalization of serum transaminases and BSP (sulfobromophthalein) retention; ALT and AST levels decreased; serum total and conjugated bilirubin levels decreased; gamma-Gt and LAP values normalized; a marked decrease in triglycerides occurred; there was improvement in inflammation and toxic/metabolic lesions verified through biopsy; and there was major improvement in liver enzyme activity.

There have been numerous clinical trials focusing on the use of milk thistle seed in treating hepatitis and cirrhosis. In hepatitis B trials there has been marked improvement of hepatic dysfunction and disappearance of HBsAG (the surface antigen of hepatitis B virus) after treatment. Three trials focusing on acute hepatitis found shortened treatment time as determined by ALT levels; improvement of serum levels of bilirubin, AST, and ALT; and much faster return of biochemical values to normal than with placebo. Nine studies focusing on chronic hepatitis found significant improvement in the patient population, normalization of liver function as determined by biopsy, and relief of bloating, abdominal pressure, weakness, nervousness, insomnia. In general, the average time necessary for improvements to be seen in treating hepatitis was 30 to 40 days.

Eleven studies focusing on cirrhosis observed longer mortality rates; significant improvement in liver function tests (especially AST, ALT, and serum bilirubin); regression of inflammatory changes and regression of toxic/metabolic lesions; significant improvement determined by liver cell permeability, metabolic efficiency, and excretory function; reduction of symptoms such as bloating, insomnia, abdominal pressure, and increased body weight.

Perhaps the most impressive studies of the actions of milk thistle have been in cases of poisoning with Amanita phalloides mushrooms. These mushrooms contain one of the most potent liver toxins known—phalloidin. A number of interventions in poisoning cases in Germany found that milk thistle protected the liver from the action of the toxin and reversed the damage to the liver. Optimum results occurred if the poisoning cases were treated within 48 hours. Deaths were reduced from 50 to 10 percent.

Preparation and Dosage

I strongly prefer the use of standardized milk thistle for any disease condition. I feel the seeds themselves are fine for general tonic use, but not so much so if you already are ill.

Standardized tincture: Standardized to somewhere around 80 mg sily-bum flavonoids (40 drops 3x daily) or 140 mg silybum flavonoids (25 drops 3x daily).

Standardized capsules: 1,200 mg daily just before bed.

Note: These dosages can go much higher during acute liver damage.

Side Effects and Contraindications

Milk thistle is a food-grade herb. It is about as dangerous as potatoes. An incredibly tiny number of people have experienced GI tract upsets of various sorts from it.

Herb/Drug and Herb/Herb Interactions

None that I know of.

Withania somnifera (Ashwagandha)

There are six species in this genus. Withania somnifera is the most commonly used, though two other Withania species, Withania obtusifolia and W. coagulans, are used in much the same manner. The root is pretty much all that is used in Western practice but the whole plant is used in the rest of the world.

The root does have a nice range of actions, especially for Lyme coinfections. It is an immune tonic and modulator, stress-protective, alterative, anxiolytic, nerve sedative, neuroprotector, chondroprotector, collagenase inhibitor, alterative, reliable tonic sedative for insomniac conditions (especially if from stress or disease), antifatigue, amphoteric, antioxidant, anti-inflammatory, hematopoietic, antibacterial, diuretic, antipyretic, antitumor, and astringent. The leaves and stems are a nerve sedative, antipyretic, febrifuge, bitter, diuretic, antibacterial, antimicrobial, astringent, antitumor. Seeds: hypnotic, diuretic, coagulant. Fruit: immune tonic, antibacterial, alterative, astringent.

Ashwagandha has been a major medicinal plant in India for at least 3,000 years. They consider it tonic, alterative, astringent, aphrodisiac, and a nervine sedative. It has been used for tuberculosis, emaciation of children, senile debility, general debility, rheumatism, nervous exhaustion, brain fog, loss of memory, loss of muscular energy, and spermatorrhea. Its primary use is to restore vigor and energy in a body worn out by long-term constitutional disease or old age.

Use of the herb (in several studies) found that it produces a marked increase in hemoglobin levels by the end of 30 days. Packed cell volume, mean corpuscular volume, serum iron, and hand grip all increase by 60 days. In a double-blind study with 101 healthy men aged 50 to 59, each took 3 grams per day of ashwagandha for one year. All showed significantly increased hemoglobin and red blood cell counts, improvement in melanin levels, and decreased erythrocyte sedimentation rate, and three-quarters reported increased sexual performance.

The plant (or its extracts) has been found to be analgesic and antipyretic, and the root extract highly chondroprotective of damaged human osteoarthritic cartilage matrix and inhibitive of the gelatinase activity of collagenase type 2 enzyme.

The plant has also shown to have anxiolytic and antidepressant actions, to have strong antioxidant activities, to be neuroprotective (correcting scopolamine-induced memory loss in mice), to stimulate neuritic regeneration and synaptic reconstruction in damaged cortical neurons, and to completely inhibit dendritic atrophy. Treatment of rats for 14 days significantly improved nitropropionic acid–induced cognitive dysfunction and oxidative damage; there have been at least 30 studies finding cognitive improvements in various animal species from the use of the root.

The plant has shown strong anti-inflammatory activity in various rheumatological conditions, it significantly reduces induced leukopenia in mice and significantly increases thyroid production of T3 and T4, and there have been at least 30 studies on the immune-potentiating and immune-modulating actions of the root in various animal species.

Preparation and Dosage

Tincture (dried root, 1:5, 70 percent alcohol), 30–40 drops up to 3x daily. Higher dosages can be used if desired.

Side Effects and Contraindications

Avoid high doses in pregnancy; may be abortifacient in large doses. May cause drowsiness. Take the herb after dinner to find out just how sleepy it makes you before using it during the day. In rare instances: diarrhea, GI tract upset, vomiting at large doses.

Herb/Drug and Herb/Herb Interactions

May potentiate barbiturates (anecdotal); don’t use with sedatives and anxiolytics.