The Everything Guide to Herbal Remedies: An easy-to-use reference for natural health care

CHAPTER 18

Putting Herbs to Work

Herbs are available today in myriad forms, from fragrant bunches of flowers and leaves to tiny, uniform tablets sealed into plastic bottles. All those choices can be exciting—or unsettling—and many consumers are no doubt missing out on the benefits of herbs because they simply don’t know what to make of them. They also might be unsure of the safe use of herbal remedies: how to take them, how much to take, and where to go for help if they need it.

How Herbs Are Sold

Herbs can be bought—and used—in many different forms. They’re sold individually or in combination formulas, in topical or oral preparations, processed and packaged or au naturel.

• Bulk herbs. This is the plant at its most natural (unless you count the way it was when it was still growing). Bulk, or crude, herbs are the medicinal or therapeutic parts of a plant that have been harvested and separated from the nontherapeutic parts.

• Powdered herbs. These herbs have been dried and ground up. They can be used to make teas, poured into capsules, or taken straight.

• Teas: Infusions and decoctions. A tea or decoction is made by drawing the herb’s constituents—its pigments, essential oils, nutrients, and phytochemicals—into water, which acts as a solvent to dissolve the plant matter (a tea is steeped, a decoction is boiled). Leaves and flowers are generally made into infusions, and roots and bark are made into decoctions.

• Tinctures. A tincture is an herbal extraction that uses a chemical solution (most often alcohol) as the solvent. Tinctures are stronger than crude or powdered herbs and teas/decoctions, and are easy to take (they’re also readily absorbed into your bloodstream).

• Extracts. Herbal extracts are sold as liquids or solids (capsules or tablets) and are also easy to use.

• Essential oils. These are highly concentrated oils—not thick or greasy, but watery and volatile. Essential oils are plant extracts that contain only the “essential” ingredients: the plant’s phytochemicals and its fragrance. Used in aromatherapy, essential oils are either inhaled or applied directly to the skin (usually after being diluted in a carrier oil, such as almond or sesame oil). They’re also incorporated into topical herbal treatments such as lotions and creams.

• Topical treatments. These include ointments (salves), gels, lotions, infused oils, and creams, and can contain wildly varying amounts of herbs. Some have a medicinal or therapeutic dose of something—enough calendula (Calendula officinalis) to relieve your rash, for example—while others have just enough to make the product smell nice.

Many Considerations

Choosing and using herbal remedies shouldn’t be an ordeal, and it shouldn’t require a degree in botany or medicine (or both). But there are a few important issues to consider.

Consider potency: Some herbs can do their work at their natural concentration: Flaxseed (Linum usitatissimum), for example, can be used straight. Other herbs need to be concentrated.

Among the various remedies taken internally, teas have the least potency—and therefore the least medicinal effect. Tinctures are a bit more powerful than teas, extracts are more powerful than tinctures, and concentrated extracts are the most potent.

For example, a handful of ginkgo (Ginkgo biloba) leaves won’t do much for you on its own, as it takes several pounds of natural ginkgo to make a dose of real therapeutic value.

An herbal product that’s been standardized is guaranteed to contain a certain amount of one or more specific compounds, which have been identified as the active, or therapeutic, ingredients. Herbalists agree that the best standardized extracts, at least as far as herbal medicine is concerned, are made from crude (whole plant) extracts, not isolated constituents. Thus, the label will read “Grape Seed Extract with Resveratrol” and not “Resveratrol” or “Antioxidant Complex.” Herbs that are typically sold as standardized extracts include:


• Bilberry (Vaccinium myrtillus)

• Garlic (Allium sativum)

• Ginkgo (Ginkgo biloba)

• Grape (Vitis vinifera)

• Hawthorn (Crataegus monogyna, C. oxyacantha)

• Kava (Piper methysticum)

• Milk thistle (Silybum marianum)

• Saw palmetto (Serenoa repens)

• Saint John’s wort (Hypericum perforatum)


Know What the Pros Know

Unlike pharmaceutical preparations, which typically offer very limited choices (will that be gelcaps or caplets?) or a single, one-size-fits-all formulation, herbs give you a variety of options. Here’s how to navigate them:

Buying in Bulk

Buying bulk herbs is a much more tactile experience than buying ready-made remedies. It also gives you a chance to see exactly what you’re getting. If you have a choice between fresh and dried, herbalists recommend the fresh in most cases.

When you’re buying bulk herbs, be sure to give them a sniff first. Every herb will smell like something, even if it’s just grass.

Not every herb smells like rose petals—and plenty of them don’t. Chamomile (Matricaria recutita) and lavender (Lavandula angustifolia) have a pleasant floral fragrance, and peppermint (Mentha x piperita) and rosemary (Rosmarinus officinalis) smell sharp and appealing. But sage (Salvia officinalis, S. lavandulaefolia) has a musty-old-attic odor, and valerian (Valeriana officinalis) is reminiscent of an old pair of socks.

If you’re buying dried herbs, remember that an herb that’s fragrant when it’s fresh should be fragrant when it’s dried, too. Herbs that are colorful while they’re growing should be colorful in the store (and dried herbs should retain much of the color they had when fresh).

Tincture How-To’s

Most tinctures are made with alcohol, but alcohol-free products made with glycerin are also available. A tincture’s concentration will be listed as a ratio: The first number indicates the amount of herb (this will be a 1), and the second indicates the amount of solution. Many tinctures contain one part herb and five parts solution, and so have a ratio of 1:5. The smaller the second number, the stronger the remedy will be.

Buying Herbal Extracts

Herbal extracts are sold as liquids or solids (capsules and tablets) and can be anywhere from 1 to 100 times more concentrated than crude herbs. The concept works like the one used for tinctures, but it’s explained differently: The first number indicates the concentration, the second represents the herb in its natural state (it’s always a 1). The bigger the first number is, the stronger the preparation will be.

Don’t confuse herbal potency formulas with the one used in homeopathy, which works in the opposite direction: The more a remedy is diluted, the more potent it is believed to be. Homeopathic remedies are classified according to the number of times they’re diluted (the more dilutions, the stronger the remedy), so a 12C or 12X remedy will be stronger than a 6C or 6X (homeopathy also uses a few different potency scales).

For example, an extract that’s four times as strong as the crude herb has a ratio of 4:1. Fluid extracts are often sold in a 1:1 potency, meaning they’re not concentrated.

Advice on Storing

Different herbs and herbal preparations have different considerations, but almost all should be stored the same way: in dark-colored, airtight glass containers kept in a cool, dry place. Herbs can quickly degrade and lose their medicinal muscle when exposed to even small amounts of sunlight and oxygen.

Every herb has its own lifespan, but, generally speaking, you can keep fresh herbs until they get slimy (or until you dry them). Dried herbs will generally keep about a year when stored correctly.

Powdered herbs generally keep just a few months before losing effectiveness. A tincture should be kept in its original container (most likely a dark-colored glass bottle with a dropper top). Stored correctly, tinctures will keep up to two years.

Both dried and liquid herbal extracts should keep about a year. Essential oils will keep indefinitely. Many commercial lotions and potions contain chemical preservatives, which give them the shelf life of a Twinkie (read: forever). But truly natural products contain natural preservatives, such as vitamin E, which don’t last as long.

There’s no official definition of “natural” when it comes to any consumer goods, including herbal products. For example, many cosmetics manufacturers use completely synthetic ingredients like caprylic acid or cetyl alcohol but list them on the label as being “derived from coconut oil.” The only way to be sure a product is natural is to make it yourself.

Generally speaking, you can keep a product that doesn’t contain synthetic preservatives for a few months—or until it changes consistency or starts to smell funny. Keeping it in the refrigerator should extend its life. Always check the expiration date on any packaged herbal product.

Smart Shopping

Health food stores and herbal shops are usually friendly places, but it can be daunting to face row after row of unfamiliar things. Here are a few rules to live (and shop) by:

Buy the Right Herb

Sounds obvious, but many plants have similar names, and buying the wrong one is easier than it sounds. For example, “danshen” sounds a lot like “dang shen,” but danshen (Salvia miltiorrhiza) is used to treat cardiovascular disease, while dang shen (Codonopsis pilosula) is an immune tonic and energy booster. To make things worse, some people spell “dang shen” as “dangshen.” Be sure you know both the common and botanical name of the plant you’re buying.

Buy the Right Part(s)

Some herbs contain several active compounds that deliver very different actions—and these chemicals are found if different parts of the plant. For example, the gel and juice of the aloe (Aloe vera) plant contain several anti-inflammatory chemicals, which can treat burns (externally) and ulcers (internally). But the latex (the milky sap contained in the rind) contains anthraquinones, which work as a potent stimulant laxative. Thus, unless you’re looking for constipation relief, be sure the aloe product you’re buying is made from the gel, not the latex.

Buy the Right Preparation

Some herbs are effective medicines when used externally—but dangerous toxins when ingested. Both arnica (Arnica montana) and comfrey (Symphytum officinale), for example, can treat bruises and muscle aches and are used in a variety of creams, ointments, and other topical treatments. But taken internally, each can cause serious problems (arnica is toxic to the heart, comfrey to the liver). Arnica is used internally in homeopathic remedies (see Chapter 1), but they are extremely dilute and so are completely nontoxic.

Herbs are classified as either wild-grown or farm-grown. Wild-grown herbs, as the name implies, grew on their own and were harvested by people in a process called wildcrafting. Farm-grown herbs were produced commercially.

Some popular medicinal plants, including American ginseng (Panax quinquefolius), echinacea (Echinacea purpurea), goldenseal (Hydrastis canadensis), and kava (Piper methysticum) are threatened or endangered in the wild. Avoid buying them as wildcrafted herbs or products and always buy from a reputable manufacturer, ideally one that uses organically grown herbs.

Most people like the idea of using plants that grew naturally, unfettered by humans and all of our issues. But wild-grown herbs may have been exposed to chemicals and pesticides (they may have grown beside a highway or near a polluted stream). In addition, some herbs are endangered in the wild, meaning they stand the best chance of survival if they’re cultivated commercially.

The best choice is to buy organically grown herbs that were raised in the United States according to our organic standards. That means they were raised without conventional pesticides, artificial fertilizers, or sewage.

Working with a Professional

If you have a serious health concern or are interested in broadening your herbal acumen beyond the basics, find a professional: an herbalist, a natural medicine practitioner, or a conventional doctor who uses herbs. Many doctors who practice complementary and alternative medicine (CAM) incorporate herbs, and although not all are licensed in every state, you can probably find at least one type of practitioner in your area (see Appendix C for some suggestions).

Herbalists

In the United States, there’s no official definition of an herbalist, and there’s no licensing or certification system in place for them. However, the American Herbalists Guild awards certification to herbalists who have at least four years of training and clinical experience. A professional member of AHG is considered a registered herbalist (RH) and will have the designation “RH (AHG)” after his or her name.

Naturopathic Doctors

Naturopaths are fully accredited physicians who have attended a four-year residential medical school and passed a postdoctoral board exam. A naturopath will have the designation “ND”—for Naturopathic Doctor.

Right now, naturopaths are licensed in fifteen states: Alaska, Arizona, California, Connecticut, Hawaii, Idaho, Kansas, Maine, Minnesota (as of July 2009), Montana, New Hampshire, Oregon, Utah, Vermont, and Washington, plus the District of Columbia and the U.S. territories of Puerto Rico and the Virgin Islands.

Chiropractors

Chiropractors, also known as doctors of chiropractic or chiropractic physicians, primarily treat neuromuscular issues—problems in the muscles, bones, and nervous system—like recurrent back pain and headaches. Many incorporate nutritional therapy and herbal medicine into their practices.

Chiropractic is arguably the largest and best known of the CAM professions. There are more than 60,000 practicing chiropractors in the United States, and chiropractic is recognized and licensed in all fifty states. Licensed chiropractors have completed at least four years of professional study and have passed national board and state licensing exams.

Traditional Chinese Medicine Practitioners

Traditional Chinese Medicine (TCM) uses herbs to treat all kinds of conditions and illnesses, which are almost always tied to an imbalance in the body. In TCM, herbs are generally used in combination with other medicinals (which are most often herbs, but can be minerals or animal products). Many formulas contain as many as fifty different components.

TCM practitioners are licensed in forty-three states; states that don’t recognize TCM practitioners are Alabama, Delaware, Kansas, Mississippi, North Dakota, Oklahoma, South Dakota, and Wyoming.

Depending on which state you’re in, licensed practitioners might have a few different designations. For example, a practitioner in Arkansas will be identified as a “DOM,” or Doctor of Oriental Medicine, while his counterpart in New Hampshire will be identified by the letters “LAc” or “Lic.Ac.,” for Licensed Acupuncturist.

Ayurvedic Physicians

Ayurvedic practitioners use herbs as food as well as medicine; herbs are often incorporated into therapeutic massage and other types of bodywork.

According to the National Institutes of Health (NIH), less than half of 1 percent of Americans—only about 750,000 people—have ever used Ayurveda, in part because it can be tough to find a qualified practitioner.

Some Ayurvedic practitioners working in the United States have training in naturopathic medicine, while others studied in India, where Ayurvedic training closely resembles that of U.S. medical schools and can take up to five years. In this country, Ayurvedic medicine is taught at a handful of private institutions.

Right now, there is no national standard for certification or training for Ayurvedic practitioners in the United States.

Ayurvedic practitioners sometimes use the title MD (Ayur.), which is the professional designation given in India. Practitioners who are accredited in the United States have the title DAv, or Diplomate in Ayurvedic Health Sciences, which is conferred by the American Ayurvedic Association.

Putting the Pieces Together

Putting herbs to work means understanding their uses—and limits—and deciding how to use them effectively.

In most cases, there are no ironclad rules when it comes to how much of an herbal remedy to take. All herbs are different, and remedies based on the same herb can vary enormously.

Experts determine what’s known as a therapeutic range for medicines, with the smallest amount that would produce a benefit at one end and the maximum amount that the average person could take without experiencing unwanted effects at the other. Most herbs have a very wide range of efficacy, and it’s nearly impossible to get a toxic dose of many of them. But while large doses of herbal remedies are usually safe, they’re not necessary. The herbs that are in use today got here because they’re effective—and practical.

Most manufacturers err on the cautious side when it comes to dosages, suggesting the lowest possible amount that you’d need to get the results you want.

If you’re using an alcohol-based tincture but are sensitive to alcohol, or if you’re treating a child, you can get rid of a lot of it—not all, but a lot—by putting a small container of tincture into a pot of boiling water for a few minutes. This will allow the alcohol to evaporate.

When determining the best dose, you should always follow the manufacturer’s guidelines. When you don’t have any—the package doesn’t have dosage information or you’ve made the remedy yourself—you can use these. For chronic conditions, adults should take the following doses:


• Tea: 3 to 4 cups a day

• Tincture or syrup: ½ to 1 teaspoon, three times a day


For acute problems, adults should take the following, until symptoms subside:


• Tea: ¼ to ½ cup every hour or two, up to three cups a day


• Tincture or syrup: ¼ to ½ teaspoon every 30 to 60 minutes

The dosages given here are for nonconcentrated products. Because commercial herbal extracts vary widely in their concentration, the best advice for taking a concentrated extract is to check the product’s concentration level (see previous) and divide that by the dosages recommended here. Generally speaking, seniors should take a quarter of an adult dose. For chronic conditions, seniors should take the following doses:


• Tea: ½ to 1 cup, twice a day

• Tincture or syrup: ¼ to ½ teaspoon, twice a day


For acute problems, seniors should take the following, until symptoms subside:


• Tea: 1/8 to ¼ cup every hour or two, up to three cups a day

• Tincture or syrup: 1/8 to ¼ teaspoon every hour


Here are two formulas for determining the best dosage for a child:


• Take your child’s age and add 12, then divide that number by the child’s age. Then multiply the adult dosage by that number.

• Divide the child’s age at his next birthday by 24.


Using these formulas, a six-year-old would get 30 percent of an adult dose, and a twelve-year-old would be given half. If you’re treating a baby younger than six months (and you’re breastfeeding), you can take the appropriate herb yourself—and pass it to your baby via your breastmilk.

A recent study of health care professionals found that a full 79 percent of U.S. physicians and 82 percent of nurses say they recommend dietary supplements—including herbs—to their patients. A roughly equal number of doctors and nurses say they regularly use supplements themselves.

Practical Advice

Here is some advice on using herbs effectively:


• Start slowly. Take the smallest dose that’s sensible, then see how you feel. Nothing? Take a bit more. Remember that herbs are almost always gentler and less potent than their pharmaceutical counterparts, so you don’t want a dramatic reaction. If you’re using an herb that can produce side effects you should exercise more restraint in increasing your dose than if you’re using a more innocuous herb. You also should be more careful about upping the dose if you’re treating a senior or a child.

• Know what you’re doing. Research the condition that you’re treating, including the various treatment options—herbal and conventional—and the benefits of each.

• Don’t overdo it. Adverse reactions from the herbal remedies used most often today are extremely rate, but they can happen—most often when an herb is overused. If you take too much for too long, you can have problems.

• Be a patient patient. Because herbs work subtly, they have what’s known as a long onset of action. Unlike a pharmaceutical painkiller, for example, a dose of willow (Salix alba) won’t get rid of your headache in a half an hour. And if you take psyllium (Plantago ovata, P. psyllium) to help relieve constipation, you’ll have to wait longer than you would if you took a harsh pharmaceutical laxative.

• Take the long view. The general rule of thumb is to give an herbal remedy a few weeks before deciding if it’s working or not. There are some exceptions to this rule: Some herbs work more quickly, but others take longer to produce results.

• Don’t use short-term remedies for long-term problems. If you find yourself constantly reaching for the same type of acute remedy—a laxative to relieve constipation or an antacid to quell heartburn—it’s time to change tactics. Contact a professional, who can help you address the underlying problem.