HERBAL MEDICATIONA Clinical and Dispensary Handbook

A. W. Priest and L. R. Priest

LONDON

L. N. FOWLER & CO. LTD.

1201-1203 High Road, Chadwell Health,Romford, Essex RM6 4DH

Foreword

This handbook is issued with the needs of clinical students and newly qualified practitioners in mind. It presumes an adequate knowledge of pre-clinical sciences as well as a sound basis of naturopathic and physiomedical philosophy. As such, it is a handbook in the true sense of the term, not aiming to provide the completeness and depth of a textbook, but giving in the first part a concise review of the principles of physiomedical treatment, and in the second and third parts an immediately available reference for clinical prescribing and dispensing.

The objective in physiomedical treatment is the state of the individual patient. The presenting syndrome is no more than a pointer to the physiological imbalances existing at deeper levels, and serves but to focus the personal evaluation. The pursuit of mere symptom relief and clinical expediency, to the negligence of the deeper considerations, paves the way to chronic disease. To restore equilibrium on all levels within the individual organism is to achieve health.

This publication provides an opportunity to express thanks and appreciation to Albert Orbell, FNIMH, whose basic clinical training so soundly inculcated these therapeutic principles.

London, 1982. A. W. and L. R. Priest

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Contents

PART 1 - THERAPEUTIC PRINCIPLES 6

Introduction 7Historical 7Diagnosis 8Medication 9Prognosis 10

Eliminative Functions 12Functional regulation 13Skin 15Lungs 16Bowel 16Kidneys 18

Circulatory Dynamics 20Vascular balance 20Blood distribution 23Cardiac function 24Circulatory control in the febrile state 24Clinical approach 26

Nervous Equilibrium 28Basic physiology 28Physiomedical principles 30Systemic reactions 31Visceral functions 32Trophorestoration 34Peripheral symptoms 35Pain 36Motor activity 36

Organ Inferiorities 38Organ remedies (trophorestorative) 40

Alterative Changes 41

Reflex Influences 44Practical corollaries 45Techniques 45Typical problems 46

Clinical Prognosis 49

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PART 2 - MATERIA MEDICA 52

Classification of Materia Medica 53

Materia Medica Schedules 55GENERAL STIMULANTS 55

Capsicum minimum 55Myrica cerifera 55Xanthoxylum americanum 55Zingiber officinale 55

GENERAL RELAXANTS 56Lobelia inflata 56Cypripedium pubescens 56Dioscorea villosa 56Asclepias tuberosa 56

GENERAL ASTRINGENTS 57Euphrasia officinalis 57Geranium maculatum 57Hamamelis virginiana 57Rubus idaeus 57Salvia officinalis 57

ALTERATIVES 58Arctium lappa 58Baptisia tinctoria 58Echinacea angustifolia 58Fucus vesiculosus 58Iris versicolor 59Phytolacca decandra 59Polymnia uvedalia 59Rumex crispus 59Scrophularia nodosa 59

GENERAL TONICS 60Agrimonia eupatoria 60Betonica officinalis 60Cola vera 60Hydrastis canadensis 60Populus tremuloides 60

NERVINES 61Anemone pulsatilla 61Avena sativa 61Cimicifuga racemosa 61Humulus lupulus 61Hypericum perforatum 61Matricaria chamomilla 62Passiflora incarnata 62Scutellaria lateriflora 62Turnera diffusa 62Valeriana officinalis 62Verbena officinalis 62Viburnum opulus 63Viscum album 63

DIURETICS 64Barosma betulina 64Eupatorium purpureum 64Galium aparine 64Juniperus communis 64Zea mays 64

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DIAPHORETICS 65Achillea millefolium 65Eupatorium perfoliatum 65Nepeta cataria 65Sambucus nigra 65

DEMULCENTS 66Althaea officinalis 66Symphytum officinale 66Ulmus fulva 66

ORGAN REMEDIES: HEART 67Cactus grandiflorus 67Convallaria majalis 67Crataegus oxycantha 67Leonurus cardica 68

ORGAN REMEDIES: PULMONARY 69Inula helenium 69Lycopus virginicus 69Marrubium vulgare 69Prunus serotina 69Pulmonaria officinalis 69Solidago virgaurea 70Sticta pulmonaria 70Trifoleum pratense 70Tussilago farfara 70Verbascum thapsus 70

ORGAN REMEDIES: GASTRO-INTESTINAL 71Alpinia officinarum 71Berberis aquifolium 71Cassia angustifolia 71Collinsonia canadensis 71Gentiana lutea 71Juglans cinerea 72Rhamnus purshiana 72Rheum officinalis 72Rosmarinus officinalis 72Spiraea ulmaria 72

ORGAN REMEDIES: LIVER, GALL-BLADDER, PANCREAS 73Berberis vulgaris 73Chelidonium majus 73Chelone glabra 73Chionanthes virginica 73Leptandra virginica 73

ORGAN REMEDIES: KIDNEYS AND BLADDER 74Capsella bursa-pastoris 74Equisetum arvense 74Rhus aromatica 74Uva ursi 74

ORGAN REMEDIES: GENITAL 75Aletris farinosa 75Caulophyllum thalictroides 75Helonias dioica 75Mitchella repens 75Nymphaea odorata 75Salix nigra 76Senecio aureus 76Serenoa serrulata 76Trillium pendulum 76Viburnum prunifolium 76

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PART 3 - HERBAL PREPARATIONS 77

Introductory 78Herb gathering 78Drying and processing 79Comminution 79Plant constituents 80

Fluid Preparations 82Infusions and decoctions 82Tinctures 83Fresh plant tinctures 84Medicinal syrups 86Infused oils 87Fluid extracts 89

Dry Preparations 94Powders 94Capsules 95Pastilles 95Tablet triturates 95

Preparations for External Use 97Emulsions 97Lotions and liniments 102Ointments and creams 103Plasters 106Pessaries and suppositories 108

Problems of Dispensing 110Solubility and miscibility 110Precipitation 111Incompatibility 112

Appendix 1 113Standards, weights and measures 113References 114

Appendix 2 116Fluid preparations 116Dry preparations 119Preparations for external use 119Suppositories 120

Index to the Materia Medica Schedules 122

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Part 1

THERAPEUTIC PRINCIPLES

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Introduction

The system of herbal medicine evolved in North America during the latter half of the nineteenth century is known as `physiomedicalism', and as such is a product of the vitalistic philosophy which regards the `vital force' as controlling the organism. According to the physiomedical philosophy, the manifestations of health and disease are considered as the aggregate expression of this vital force as it endeavours to maintain the functional integrity of the organism.

It is implicit in the modern concept of `vital force' that the term implies (a) a directive intelligence, and (b) a principle of energy, governing and activating a living organism. It is also implicit that all functional operations are the result of the vital force acting through cellular functions, and that imperfect response at the cell level is the result of internal or external obstructions or restrictions.

The vital force is always resistive, eliminative and reconstructive in intent when the organism is affected by the invasion of inimical substances, forces or influences. In this context, the term invasion covers all possible influences and conditions, whether internal or external, endotoxic or exotoxic, which are inimical to cell function. It includes (a) bacterial and virus invasion, (b) climate: terrestrial and extraterrestrial forces, (c) the autotoxaemia of the nature-cure school of thought, and (d) saturation with allopathic drugs or the products of disease suppression.

Functional perversions are to be considered as the secondary effects of cellular disturbance, and are to be distinguished from constructive organismic responses. Human physical perfection is archetypal, not individual. Hence, habitus typology, differences of temperament, organ inferiorities and hereditary weakness must all be considered in the individual case.

Historical

The physiomedical system developed progressively during the nineteenth century as the result of the practices which were initiated by Samuel Thomson, and later developed and matured in the work of Wooster Beach, W. H. Cook, T. J. Lyle and J. M. Thurston. It was with the practice of Samuel Thomson and his successors that emphasis was placed upon the essential vital integrity of the organism, and that symptoms were to be interpreted as the efforts of the organism to rid itself of toxic encumbrance. Thus, it may be fairly asserted that the hygienic philosophy now embraced by the term Naturopathy in reality commenced with Samuel Thomson before 1800, rather than with the later German pioneers of nature cure and natural hygiene.

In the work of Samuel Thomson (1769-1843) the emphasis is upon the elimination of accumulated toxins, hence his procedures to promote rapid diaphoresis by vapour baths and internal stimulants, and alimentary elimination by emesis and enemata. Wooster Beach (1842) added the concept of `equalising the circulation', a concept developed further by W. H. Cook in correlating the functions of the circulatory and nervous systems (Science and Practice of Medicine, 1879) and introducing the idea of functional disturbances reflecting the `overcontraction' or `over-relaxation' of tissue conditions. J. M. Thurston (Philosophy of

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Physiomedicalism, 1900) recognised that behind all local phenomena stands the autonomic nervous system and the focus of consideration swung to a general or local assessment of autonomic balance.

According to classical theory, the therapeutic objective is achieved by the application of the principles of the existing functional state or tissue condition, in the effort to restore equilibrium between contraction (hypertonia) and relaxation (hypotonia). To achieve this, both Lyle and Thurston stressed that there must be some reassessment of anatomical and physiological values. This does not imply the necessity for finding new facts, but rather the arrangement of available facts into a new hypothesis with different values and stresses.

Diagnosis

"In the impossibility of scientific definition the range of pathology is vaguely settled by a general understanding as to what may be called disease, and in this settlement are included all the states which are distant from health, whether they be in the way of diverging from it, or in that of returning to it."

(James Paget, per Thurston)

The object of herbal medication is to assist function towards normality. It is therefore necessary to be able to recognise those conditions which are impeding function as distinct from those which reflect positive eliminative or reconstructive action by the vital force. This requires a true interpretation of symptom values and tissue states.

The treatment of surface symptoms may be `herbal' but not `physiomedical'. Radical treatment aims at the underlying conditions as revealed by an interpretation of the whole syndrome, consisting of:

(a) Symptoms: the subjective and objective superficial evidence of systemic disturbance.

(b) Functional disorders: variations from the normal standard of performance or balance of function in any organ or system, reflecting imbalance of autonomic function.

(c) The true disease state involving organic changes in cells and tissues.

The limit of treatment is restoration to a state of relative functional equilibrium and optimum trophic state, subject to the tendencies and predispositions of the physiological and temperamental typology.

To achieve this end it is not sufficient to append a diagnostic `label' and thereupon to assume that treatment follows some standard pattern irrespective of the individual case. Proper diagnosis must be an evaluation of the syndrome in terms of physiomedical principles, in order that effective measures may be applied to restore the balance as between contraction and relaxation, stimulation and inhibition. The secret of good therapy is to recognise the limitations of functional flexibility and vital resource inherent in the particular constitution under treatment, hence the importance of typological assessment as a background to specific treatment.

It is important to assess the vital state in relation to the extent of organic pathology or general systemic encumbrance, especially in the acute crisis. The vital state may be:

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(a) Positive: the symptoms represent positive eliminative or reconstructive action-the healing crisis of Naturopathy.

(b) Tolerant: relative equilibrium and compensation is established and the encumbrance tolerated in various tissues.

(c) Negative: the symptoms represent a forced reaction to a progressive encroachment of obstructive conditions and pathological deterioration, but ineffectually in ultimate result, leading to low-grade chronic symptoms-the disease crisis of Naturopathy.

This assessment of the vital state is necessary before undertaking measures which might disturb the compensations and adaptations forming part of a state of vital tolerance. A positive crisis will seldom need more than sensible nursing, whereas a negative disease crisis will require strong support of all the vital functions if chronic sequelae are to be avoided.

Medication

The criterion for assessing the value of any medicinal substance must be decided in relation to the ultimate effect upon vital integrity, as the medicine either:

(a) produces increased vital integrity and assists in restoring balance and eliminating obstructive conditions, or

(b) produces decreased integrity by suppressing vital reactions and obstructing the organism in its eliminative efforts.

On this basis, the evident suppressive and obstructive effects of allopathic sedatives and pain killers, given without regard to the resolution of the underlying condition but merely to allay superficial symptoms, are to be condemned.

Herbal medication, directed to resolve the causative conditions, will achieve a constructive effect and the relief of symptoms without suppressing the vital effort. However, the reappearance of previously repressed symptoms must be allowed for during the course of resolution, and treatment pursued to complete recovery. The great value of herbal medicines is to supply reconstructive forces and materials not available to the organism because of inherent or acquired defects, to arouse the vital integrity to eliminate obstructive conditions, and to counter the effects of previous drug medication. For these reasons, such medicines are a necessary adjunct to any general nature cure regimen.

The general principles deciding the order of medicinal treatment are as follows:

(a) Review the efficiency of the depurative functions and balance the circulatory and nervous systems, avoiding deep alterative changes while there remains any deficiency in the eliminative organs or in the transport systems.

(b) Carefully assess any particular organ or system weakness before stimulating activity which would throw extra strain upon that system. This applies especially to the condition of the heart and lungs.

(c) Assess the degree of general encumbrance in relation to the energy reserve, and avoid promoting an acute eliminative phase until the reserve has been sufficiently restored.

It is especially important that the last assessment includes an estimation of long-term drug saturation, since certain alterative herbal medicines may react strongly under such conditions.

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These considerations determine the agents chosen for the compound prescription, whether providing a mild action over a long period, or a stronger short-term action, or even a controlled alternation of such actions. Not only the choice of agent varies, but the level of dosage may be well below that generally considered to be the physiological dose.

A further point to be regarded in prescribing is the estimation of nervous reserve, and the control of the stimulus intensity. Beyond the short emergency or temporary expedient, no stimulation can achieve much in the presence of nervous exhaustion. The stimulant is not a substitute for the nervine tonic and trophorestorative, in conjunction with physiological rest. The stimulus level must be strictly controlled to yield a positive anabolic response. Excessive stimulus becomes an added irritant and has a catabolic effect, although it may mislead for the time that it whips the depleted organism into apparently better function.

Prognosis

The physiological basis of physiomedical practice was first established by W. H. Cook, and it is in the ideas postulated by him that there emerges the concept of a vital force working through an organism. It is in the interpretation of the phenomena of illness that the elements of prognosis arise, in regarding the symptoms as the expression of the vital force in overcoming the conditions of disease, even if ineffectually:

"The oscillations in the symptoms make known the preponderance of chances in favour of life or death. The more fully, firmly and steadily the functions of a part are carried on, the more favourable are the chances; but feebleness, curtailment, or irregularity in the functions are unfavourable insofar as they mark a diminished vital control."

W. H. Cook: Science and Practice of Medicine, 1879.

It is in assessing the state of the vital force from the expression of the symptoms, against the background of typology and genetic inheritance, that the difficulties of prognosis and practice arise. Even in the varying degrees of contraction or relaxation, as may occur in all functional disturbances, the prognosis is often indefinite, in spite of the fact that the conditions are completely understood, and this because human response is itself a variable.

It was in realising this difficulty that J. M. Thurston attempted to define such terms as-vitality, vital resistance, reserve vitality, and life tenacity-and linked his definitions with the humoral typology, in order to provide some means of assessment of qualities not amenable to direct measurement, but only to be deduced clinically from an overall interpretation of the symptoms and the history.

The treatment of any chronic disease syndrome aims to restore relative equilibrium, wherein the ultimate prognosis is subject to latent imbalance and organ or system insufficiency arising from psychosomatic predication and genetic deficiencies. Two fundamental influences are to be considered in the ultimate prognosis:

(a) the personality structure, and(b) the hereditary pattern of organ/system inferiority,

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which not only will limit and decide the measure of immediate response, but also the predisposition to relapse and recur.

To the degree that any syndrome arises from the psychosomatic impact of the personality structure, then in the absence of personality change or adjustment, freedom from physical symptoms may have to depend upon the continued use of herbal medication to offset the pathological influences. For this reason, certain patients return again and again for the same basic medication, notwithstanding a variety of superficial symptoms.

Genetically determined organ and system inferiority may slowly improve to some extent on a long-term programme of trophorestorative medication, subject always to age, environment and previously suppressed acute phases. Such medication for chronic insufficiency conditions will be thought of in terms of months and years, rather than the days and weeks of the typical acute and sub-acute illness.

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Eliminative Functions

Eliminative functions are commonly considered solely in terms of the specific organs of elimination, especially the large bowel and the kidneys, but in fact, problems concerned with the body's ability to eliminate waste materials should be considered at three levels:

i. Intra-cellular: the interplay of electrolyte functions and the diffusion of chemical ions across the cell membrane.

ii. Organismic: the processes of intermediate metabolism.iii. Special organs of excretion: specific functions to eliminate unusable end

products and chemical wastes.

Each step in the chain of intermediate metabolism, the synthetic (anabolic) or reductive (catabolic) sequence of organic compounds, ultimately results in some chemical by-product which needs to be eliminated, the final stage being an excretion of the substance from within the organismic boundary. Failure to secure this final stage must imply the precipitation and storage of the material within the organism in a manner which will not immediately obstruct the various metabolic reactions essential for the continuance of life. It is this accumulation of waste material in various tissues which is referred to as `encumbrance'. The mobilisation and ultimate elimination of this stored material is considered under the heading: Alterative Changes, and it is for this reason that J. M. Thurston declined to use the term alterative, but referred to herbal agents having such mobilising properties as `eliminative vaso-tonics'.

Apart from the more immediate problems of intermediate metabolism concerned with chemical chain reactions, two overriding organismic requirements for systemic elimination were understood from the earliest days of physiomedical practice. The need for adequate thermotaxis and hydration formed the basis of Samuel Thomson's approach to `encumbrance' in the use of internal stimulants and vapour baths. To raise the thermal level at the same time as to employ applications of water or steam to assist elimination through the skin and mucous membranes was the foundation of his treatment.

Chronic sub-thermal conditions within the organism immobilise the transport systems and inhibit the total eliminative processes at all levels. Similarly, chemical reactions and buffer mechanisms are greatly reduced or altogether inhibited when tissues are dehydrated, whereas the stasis induced by over-hydration blocks the cellular transudations and fluid exchanges. Thus two simple investigations should always be made before the special organs of excretion are considered:

i. The general average level of body temperature, ii. The degree of tissue hydration.

A record of the morning and evening temperatures over at least fourteen days, and a simple test for the renal excretion of water, should supplement the clinical observations.

Systemic accumulation of metabolic waste products, from whatever cause, will from time to time be the subject of some form of vicarious elimination, thus the very common catarrhal

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conditions affecting the mucous membranes throughout the respiratory, alimentary and genito-urinary systems. The presence of catarrh anywhere in the body should dictate the following steps of investigations:

i. Review the acid/base balance of the typical diet. Any diet providing a predominance of acid residues is likely to produce systemic catarrh.

ii. Ascertain the average body temperature level by plotting the morning and evening temperatures for a minimum period.

iii. Carry out clinical tests for renal insufficiency.iv. Prescribe simple tests for intestinal motility-toxic reabsorption can exist in spite of

daily defaecation where transit through the gut is unduly prolonged.

While constipation is an obvious cause of systemic catarrh in the presence of a diet high in carbohydrates and fats, some degree of renal insufficiency is often responsible for chronic respiratory catarrh.

Secretion and excretion are functions directly subject to the control of the autonomic nervous system through the vaso-motor function. Any disturbance of autonomic balance in the direction of local or general sympatheticotonia will affect elimination detrimentally. Such a disturbance may arise directly from structural problems affecting the spinal somatico-visceral reflexes, or indirectly from anxiety mechanisms reflecting psycho-somatically.

Local conditions affecting individual eliminative organs should be considered under the following headings:

i. The functional state of the organ-whether showing over-relaxation or over-contraction as evident from physical examination or the changes in the excreted material.

ii. The trophic condition.iii. The presence of local pathology.

Positive evidence of organic pathology, indicating a breakdown of the cellular elements from malignant, degenerative, traumatic or, inflammatory processes, dictates a quite different course of action from that required in case of simple functional disturbance. Similarly, if the organ is hypotrophic, the prescription of herbal medicines regulating function must be suitably modified. These aspects are considered in the chapter on Organ Inferiorities.

Functional regulation

Certain general principles of functional regulation were brought forward in the classical texts:

i. Slow organs (e.g. liver) require slow remedies.ii. Rapidly acting organs (e.g. kidneys) require rapidly acting remedies.iii. Conditions suddenly arising require prompt and strong impressions.iv. Conditions slowly arising require slow steady impressions.

(after W. H. Cook)

Excretory functions should not be unnecessarily forced, since if stimulated excessively in relation to the reserve capacity of the organ, function will become exhausted and a crisis may be precipitated.

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Obstruction of the special eliminative organs leading to accumulation of secretory/excretory products will produce systemic irritation and toxic effects upon the nervous system. Skin eruptions, general sluggishness and blunted sensibilities may be evident long before the more serious degrees of acidosis: uraemia, ketosis, cholesteraemia, etc. Such obstructions are bound to produce back pressure upon the arterial or venous circulations. (See chapter: Circulatory Dynamics.)

Lesser degrees of over-contraction or over-relaxation of organ function are confusing in that the same endpoint syndrome may be produced. For example, haemorrhoids commonly arise as a sequel to portal back-pressure, but this fact alone does not indicate whether liver and intestines are over-contracted or over-relaxed. Thus, there is a need always to pursue investigations beyond the presenting symptoms in order to discover the direction of functional disturbance.

Medication for individual organs must to some extent aim at the tissue primarily at fault-nervous, vascular, parenchymatous or connective. To take the simple example of constipation due to disorder of emptying the lower bowel, that due to insufficiency of the motor nerve impulse would call for Turnera, whereas that arising from muscular insufficiency indicates Juglans. Similarly, vascular stasis from portal back pressure requires Collinsonia with hepatics, whereas connective tissue laxity needs Capsella with Ruta. A careful history including a precise description of the function of defaecation and the nature of the `stool', together with a local examination, must evaluate these differences. Of course, there will be many cases where the tissue conditions are mixed, but the primary weakness usually focuses some constitutional deficiency reflecting the basic typology.

The specific organs of elimination may now be considered:

i. Skin- perspiration, and the vicarious elimination of insoluble materials by ulceration.ii. Lungs- the elimination of carbon dioxide as the end product of many metabolic

chemical reactions.iii. Bowel- the elimination of residues, insoluble materials and chemical by-products.iv. Kidneys- the elimination of excess water and soluble chemical end-products, especially

those concerned with electrolyte balance.

The large surface area available for both the external skin and the internal `skin' (= mucous membranes) appears to be utilised by the organism for the vicarious elimination of waste products, especially during febrile reactions. The obnoxious and characteristic odours of many of the specific fevers evidence this fact. Metabolic wastes which can be eliminated by transudation through these surfaces are the product of the greatly increased catabolism characteristic of the acute crisis, and explain the use of vapour baths, water packs, enemata and emesis as measures to assist this accelerated elimination.

In chronic problems, insufficiency of the special organs of elimination, bowel and kidneys, may mean some form of vicarious excretion through the respiratory mucous membranes (catarrhal exudations) and skin (furunculosis, acneform eruptions, etc.). The presentation of such symptoms should always raise the question of insufficiency of the intestinal and renal functions. Routine examination of the skin and upper respiratory passages is a necessary preliminary to the investigation of bowel and kidney conditions:

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Colon

Kidneys Lungs

Skin

Skin

A consideration of conditions typical of the febrile state is a useful guide to the examination of the skin in problems of chronic disease involving insufficient elimination. The function of the skin being largely insensible, signs of disturbance are less readily apparent than becomes evident during acute reactions.

In the febrile state, if sweat glands are relaxed and capillary circulation good, then perspiration will be increased and warm, whereas if there be undue relaxation in both sweat glands and capillaries, perspiration will be cold with a recession of blood from the surface giving a flaccid and shrunken feel to the skin. Such a reaction of peripheral relaxation, pallid skin and cold sweat is also familiar in shock with syncope. When such conditions are found in chronic disease it is usual to find the skin pallid and cold, but perspiration will be limited to a cold moistness of the palms of the hands. The restoration of better function requires a planned programme of surface stimulation from sun, air and water, including wet and dry skin friction. Such medication as is indicated will be directed to the peripheral capillaries. (See chapter: Circulatory Dynamics.)

The deficient secretions of a hot, dry skin during a fever are restored by using relaxing diaphoretics, e.g. Asclepias, Corallorhiza, etc., combined with tepid sponging or whole body packs. Such a skin in chronic conditions tends to be thin, dry, tight and irritable, often with some rash, and lacking the soft texture provided by the normal thickness of subcutaneous tissue. The functional insufficiency of this chronic state may be slowly and partially restored by alteratives having a special direction to the surface, e.g. Rumex crispus, Arctium lappa sem., Pulsatilla, etc.

Whether chronically over-contracted or over-relaxed, the skin contribution to systemic elimination is greatly reduced, with the burden being thrown on the pulmonary mucous membranes and the renal function. Either functional disturbance leads to trophic degeneration of the skin. Effective treatment of this insufficiency must have regard to the route by which deterioration occurred, so that it becomes essential to differentiate chronic over-contraction from over-relaxation:

1. Contracted: the skin is dry and thin, tight and irritable at first, but becoming toneless and increasingly pigmented as atrophy proceeds. Herbal medication consists of the long-term use of specific alteratives rather than relaxants.

2. Relaxed: the skin is cold, moist and puffy, becoming slack and pallid with increasing atrophy. Astringent capillary stimulants together with progressive skin friction and sun and air bathing provide the course of restoration.

As with all programmes of trophorestoration, the choice of herbal medicines is from those having a mild but persistent and cumulative influence.

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Lungs

Although the proper function of the lungs in taking up oxygen and eliminating carbon-dioxide affects systemic elimination at the level of intermediate metabolism, this system also provides a large surface area throughout the bronchial tree for the vicarious elimination of those waste substances which are able to transude through the mucous membranes. Any insufficiency of the liver or kidneys in excreting the by-products of carbohydrate and protein metabolism may throw the burden of excretion on to the respiratory system. Obvious clinical examples are provided by the presence in the breath of the products of uraemia and ketosis, but less serious degrees of such insufficiency may be an underlying cause of chronic respiratory catarrh. The first step in the investigation of all such catarrhs should be a review of the efficiency of liver, kidneys and bowels.

Bowel

If the bowel is visualised as the simple central tube seen in the earthworm, then it can be more readily appreciated that the contents of this tube are still `outside' the organism. The purely eliminative aspects of intestinal function concern two applications of this fact:

i. The integrity of the wall of the intestine, as the ability to absorb nutritional material while screening off waste and toxic substances, is fundamental to the problem of elimination, and-

ii. The motility of the intestine, in regulating the speed of transport of the content through the gut, consequently determines the degree of fermentative and putrefactive change taking place in the content and the duration of contact of such degenerative matter with the absorptive surfaces.

In thus interpreting the potential problems of elimination, the physiomedical treatment is seen to be concerned with the functional condition and trophic state of the intestinal mucosa, and the regulation of intestinal motility. The balance of these considerations will be involved both in problems of nutrition (mal-absorption syndromes), and autointoxication (re-absorption of putrefactive residues).

The basic principles of physiomedical treatment must be applied to the four tissues concerned: muscular, connective, vascular and nervous, before the condition can be evaluated and medication prescribed in conjunction with dietetic and other restorative measures. Fortunately, the simple clinical methods of inspection, palpation and percussion are available, since the greater part of the bowel is accessible to physical examination, and the anus and rectum readily inspected with simple instruments. Over-contraction or over-relaxation of the intestine locally or generally may be deduced from the findings, and some assessment made of the trophic state.

It would be beyond the scope of a handbook to describe all the detailed techniques of physical examination, but certain typical disturbances may be mentioned by way of illustration. Spasticity of the small intestine and the descending colon is a common finding on palpation of the lower left abdominal quadrant, whereas percussion can be relied upon to reveal the dilated over-relaxed caecum or gastroptosis. Laxity of the parietes with fluid accumulation and pendulous abdomen is in marked contrast to the hypotrophic scaphoid abdomen, and the medicinal treatment required will be equally contrasting.

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Variations of tonicity and trophicity in the gross structures are also reflected in the fine structures of the mucosa with the associated secreting glands. The function of selective filtration from the gut content may be affected by over-contraction or over-relaxation, on the one hand preventing the transudation of nutritional materials and electrolytes required, and on the other allowing passage of waste substances which should be eliminated. Over-relaxation of the surface of the large intestine affecting those areas concerned with the normal re-absorption of electrolytes may result in re-absorption of such toxic substances. Acneform eruptions may be a form of vicarious elimination of these toxins, and if so, the condition will respond slowly to treatment of the bowel condition. Juglans cinerea with other suitable tonics and astringents (Hydrastis, Spiraea, Rubus ideaus, etc.) will favourably influence the eruption.

In the uncomplicated case, constipation may be designated as spastic or atonic, the differential diagnosis largely depending upon the character of the `stools'. In the spastic condition they are likely to be pebbly, or small and hard, whereas in the atonic state they are bulky and difficult to pass, not only on account of the size or shape, but also because of weak expulsive power. Associated with this state of the bowel there may be chronic dysfunction of the autonomic nervous system as some degree of over-contraction or over-relaxation respectively.

The conditions typical in each case require an appropriate combination of herbal medicines which will balance the function of the intestine together with the liver and autonomic nervous system. Thus:

Spastic: Leptandra - as a relaxing hepaticDioscorea - as an autonomic relaxantJuglans - as a gentle laxative (aqueous extractive in syrup form)

Atonic: Berb vulg. - as tonic cholagogueTurnera - as an autonomic tonicJuglans - as a motor tonic to the intestine (alcoholic tincture)Senna - as a tonic laxative (syrup)

To this basis may be added medication to mucous membrane, secretory glands, connective tissues, etc., as may be required, as well as positive or diffusive stimulants. Capsicum may be added in case of extreme intestinal torpor, whereas Lobelia is occasionally useful to contribute its powerful relaxing property in spastic and spasmodic conditions. Zingiber may be added as a diffusive stimulant to prevent tenesmus and to improve response to the basic medication.

Diarrhoea, as well as constipation, may be a result of the failure of the liver to secrete and excrete bile, hence hepatics and/or cholagogues are usually needed. Diarrhoea and dysentery are sometimes eliminative, but also arise from relaxed conditions of the mucous membranes. Such conditions require mild tonic astringents having a special sphere of action on the small and large intestine. Summer diarrhoea in children responds well to Spiraea ulmaria administered as an infusion.

Kidneys

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Since the kidneys are rather inaccessible to direct physical examination, assessment of functional disturbance must largely depend upon examination of the excreted material, and the deductions from general observation. While the usual routine examination of the urine for albumin, sugar and blood, serves the obvious purpose of screening for specific pathologies, it provides little indication of renal competence in terms of the excretion of chemical wastes and water. Simple clinical tests for the ability of the kidneys to concentrate urine and to eliminate excess water should always be undertaken.

Clinical experience has shown that some herbs restore the renal ability to excrete excess water and are thus valuable in problems of water retention. Others assist in the elimination through the kidneys of the products of metabolic disturbance, as in gout and arthritis. Such remedies are not necessarily diuretic, but may influence the chemical exchanges at the general metabolic level (alteratives). Thus, diuretics may be simply classified in two groups:

i. Those which increase the excretion of water,ii. Those which promote elimination of soluble chemical wastes, especially the

urates.

In general, it may be assumed that the tissue structure of the kidneys will reflect a similar state and integrity to that of more accessible organs, so that gross over-contraction or over-relaxation may be deduced, and relaxing or astringent diuretics prescribed accordingly. However, repeated checks on the urine and comparative evaluation of 24-hour samples taken throughout a course of treatment are necessary to ensure the proper selection and dosage level of diuretic remedies.

Certain herbal agents have acquired a reputation for promoting the elimination of specific end-products, e.g. Eupatorium purpureum for stones and gravel, Zea mays for uric acid and urates, and Barosma betulina for suppurative material, whereas others, such as Althaea, Eryngium and Symphytum, will reliably treat conditions of irritation and sub-acute inflammation. In all sub-acute and chronic conditions it should be decided whether the functional and organic pathology indicates:

i. An unresolved acute state, ii. An idiopathic chronic state involving tissue breakdown,iii. A chronic state involving simple retrograde metamorphosis as in fibrotic or sclerotic

change

The first possibility will involve irritation and possible discharge of albumin and blood. The second is more likely to be indicated by the presence of these together with pathological urinary deposits. The third possibility may show no more than a chronically reduced capacity to excrete the normal constituents.

This differentiation will decide the overall therapeutic approach. Sub-acute conditions will often resolve by the development of a more acute phase which then runs its full course. This is especially likely if a previous acute phase had been suppressed by antibiotic or other drug medication. Diuretics chosen will need to be largely relaxant and demulcent. If there had been no previous suppression then it is likely that failure to resolve the condition is due to simple nervous exhaustion, in which case nervines rather than diuretics are needed. Under these circumstances it is not surprising if the response to nervine medication is an immediate elevation of body temperature and the production of a more positive acute phase, leading to ultimate resolution.

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Chronic states involving tissue breakdown or retrograde metamorphosis require an adjustment of the diet to give maximum relief to renal function. This adjustment would vary from complete fasting to a restrictive diet involving some degree of protein control. Herbal medication is directed to the trophic restoration of the organ. (See chapter: Organ Inferiorities.)

Since renal function is very subject to the effects of chill and postural stress affecting the dorso-lumbar spinal reflex area, measures to recover good posture, together with counter-stimulant liniments to the loin are frequently indispensable adjuncts to direct medication for the kidneys. (See chapter: Reflex Influences.)

The level of blood pressure is always to be considered in relation to renal function. The complaint of more frequent micturition during the night should alert the practitioner to an investigation of the circulatory apparatus and to question myocardial sufficiency. Likewise, sclerotic tissue changes affecting the secreting organs and involving more difficult transudation across membrane barriers will require an increased vascular pressure to ensure a sufficient level of organ function. Relative ischaemia in any part of the body due to sclerotic changes is frequently overlooked, and may demand that diuretics be combined with such agents as Cimicifuga for the fibrous and sclerotic degeneration, together with local vasto-stimulants and general support to the systolic blood pressure.

The pulse indications in acute and sub-acute phases are of considerable value. Eupatorium purpureum is a suitable renal relaxant where there is deficient renal secretion in the presence of a large and firm pulse. If the pulse tends to be small and showing irritability, then Zingiber should be added as a diffusive stimulant. But where the pulse inclines to depression during acute phases, the Zingiber is increased and some Capsicum added. (See chapter: Circulatory Dynamics.)

In chronic conditions Juniperis could be combined with the Eupatorium if a moderate relaxing and stimulating impression were needed. Definitely chronic states are best met by slowly acting remedies with some mild diffusive stimulation in support.

The following general clinical notes are of considerable practical value:

i. If renal function is only slightly affected, the use of milder agents, e.g. Eupatorium purpureum, is to be preferred, of which a frequent small dose well diluted is used.

ii. Diuresis and diaphoresis are to some extent reciprocal functions. Diaphoresis should be promoted to relieve renal stress, especially in febrile conditions.

iii. Proper stimulation to the liver function also greatly relieves the kidneys.iv. The relaxing nervines, e.g. Cypripedium, Scutellaria, etc., increase the output of urine

from their generally relaxing effects, assuming that excretion is not already affected by overrelaxation.

v. Constipation aggravates catarrhal conditions of the renal apparatus. Keep the bowel function free and the liver active.

vi. The addition of Zingiber to diuretic prescriptions will provide the necessary diffusive stimulation where there is a chronically sluggish function.

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Circulatory Dynamics

The circulatory system consists of the heart, arteries, capillaries and veins. In assessing direct therapeutic measures to influence this system the following considerations arise:

(a) Cardiac muscle: tonicity, trophicity and vasomotor function.(b) Arteries: the state of vasocontraction or vasorelaxation existing generally or locally.(c) Capillary bed: the contractility of the capillaries and terminal arterioles and venules.(d) Veins: general tonicity and the importance of the portal circulation.

The relationships may be schematically presented thus:

Cardiac

Venous Arterial

Capillary

from which it is evident that no part of this cycle can be influenced without there will be repercussions throughout the whole system.

Vascular balance

The classical injunction to `equalise the circulation' involves first an assessment of the arterial-capillary-venous balance. Since circulatory disturbances usually begin in the smaller vessels, and bearing in mind that the capacity of the capillary bed is so very much greater than the arterial, it follows that medication for the circulatory system should always begin with adjustment of the basic capillary state, as determined from a close examination of the skin and subcutaneous tissues, especially of the extremities. Since the latent contractility of the capillaries can be increased or diminished, two long-term tendencies are possible.

Persistent capillary contraction constitutes an arterial impediment which excites a stronger reflex reaction and the onset of an inflammatory response, this being the organismic mechanism to resolve an obstruction. As such, it is a common feature of any acute or sub-acute condition where the tissues involved radiate the heat of inflammation, and in which the decreased function of the secretory glands results in dryness of the skin or mucous membrane with increased sensibility, irritability and pain. Where the condition becomes chronically established, the tissues concerned become dehydrated and hypotrophic. Thus, the direction of therapeutic influence must be towards restoring relaxation and hydration, and where the surface and extremities show chronic conditions of heat and dryness with irritability, the need is for diffusive stimulants and relaxing diaphoretics acting at the capillary level.

Persistent capillary relaxation is reflected in the flaccidity of the tissues and organs concerned in which there is pallor from deficiency of blood supply, over-hydration from disturbed fluid balance, coldness and feebleness. Such a condition affecting the peripheral circulation will at

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first show a cold clamminess of the skin, but this will ultimately become flaccid and shrunken from the recession of blood from the surface. In this case, the therapeutic influence must arouse capillary tone, provide an outward radiation of heat and astringe the terminal venules to promote fluid re-absorption. Thus the need for astringing capillary stimulants, e.g. Myrica cerifera with Capsicum or Zingiber.

It is evident from the above that the first step in medicating for circulatory disturbances is to decide upon the surface and peripheral conditions as they may reflect either:

(a) Dryness and irritability with local heat in the more acute phases,requiring diffusive stimulation and relaxation, or

(b) Clamminess, flaccidity and coldness, requiring astringing stimulants affecting the periphery.

Capillary agents are all active diaphoretics and as such form a prominent part of medication for fevers, but because of this tend to be overlooked in chronic conditions. There is a general direction of action in relation to capillary agents, since relaxing agents expend their power more towards the surface, while stimulating astringents tend more towards the centre. Thus, stimulant astringents such as compound tincture of Myrica are indicated in collapse and exposure, while diffusive relaxants are required in shock and hysteria.

Apart from capillary medication, it is useful to consider the circulatory apparatus as:

(a) Left cardiac and arterial,(b) Right cardiac and venous, including portal.

Capsicum is probably the best general stimulant to cardiac function for both left and right sides, and will be combined either with those agents influencing the arterial system, or with those supporting the venous system and portal circulation. In the nature of its structures, the venous system seldom requires relaxation but always more or less support, and bearing in mind the dependence upon general neuromuscular tonus and the state of the portal circulation, it can be understood how it is that a condition of arterial tension with venous obstruction is shown in many subacute and chronic states of the abdominal organs. Since portal obstruction is more often due to hepatic and intestinal tension, then the appropriate medication includes such agents as Dioscorea villosa and Viscum album as autonomic relaxants in circulatory problems involving an elevated systolic pressure.

These differential considerations are assisted by close observation of the pulse and blood pressure levels, including the pulse pressure ratio. A low systolic level with pallid extremities draws attention to a left cardiac and arterial insufficiency, while a cyanotic tinge with a puffy appearance of the subcutaneous tissues suggests involvement of the right cardiac and venous function. For clinical purposes the diastolic level of blood pressure may be taken to reflect the general state of tissue tension, so that values below normal for the age indicate a need for measures to increase tone and tensile strength in the vascular system. The systolic level should bear a proper relationship to the diastolic level. It will be remembered that the normal ratios of systolic/ diastolic/pulse pressure are as 3:2:1. It is sound clinical practice to maintain the pulse pressure at an index of 1 by influencing systolic or diastolic levels as required, that is, by a cardio-arterial or peripheral influence respectively, but always subject to organic pathology. For example:

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(a) Reduction of a high systolic level in the presence of general sclerotic conditions results in cerebral ischaemia with consequent depression and `hypotensive' vertigo.

(b) Similarly, reduction of a high systolic level which is due to renal pathology will result in functional insufficiency of the kidneys.

In such cases, the systolic level should not be reduced without a similar decline in diastolic level, following a true resolution of the causative conditions.

The pulse varies according to typological response and condition in

which the rate reflects cardiac response, the pulse-pressure reflects arterial/venous balance, and the pulse wave suggests autonomic and nervous state. The following are the simple clinical indications:

Pulse thin and tense -relaxPulse full and sluggish -stimulate and tonePulse imperceptible -build up graduallyPulse bonding -relax by diaphoresis

Some guide to the grade of response: sthenic/asthenic is provided by the `cardiovascular index', a useful clinical indication of the flexibility of the vascular system. This index is an assessment of the circulatory tension as shown by the simple formula: Pulse rate X (Systolic + Diastolic). Taking the standard normals we have say: 72 X (120 + 80) = 14,400. In practice, the normal range is taken to be 12,000-14,000, and the following remarks noted for other readings:

Below 12,000 -asthenic syndromes, wasting pathologies, chronic depressive states.14,000-20,000 -degrees of circulatory tension Over 20,000 -cardio-renal-vascular pathologies Over 25,000 -danger of cerebral haemorrhage

The more abnormal the reading, whether plus or minus, then the slower should be any fundamental alterative change. The first consideration must be the restoration of systemic equilibrium and the state of pathologically affected organs, and only secondarily the elimination of systemic `toxins'. The choice of agents would be for those which are mildly toning or relaxing as required, so that any `stress-factor' of the prescription is absolutely minimal and the possibility of systemic decompensation avoided.

Compensatory mechanisms within the CVI level should be noted. An increased pulse rate may compensate a declining systolic pressure, indicating the need to support the myocardium. Where such an increase occurs during treatment to reduce a high systolic level, the progressive reduction should be held back until a normal pulse rate indicates restored compensation. In this way, ischaemic headaches, anginal reactions and other disturbing symptoms can be avoided.

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Blood distribution

The fact that the total capacity of the capillary bed is hundreds of times greater than that of the arterial system implies that the , regional distribution of the blood depends entirely upon effective vasomotor control, by which means local vaso-relaxation is balanced by vaso-contraction elsewhere, in order to secure functional, sufficiency of blood to any one organ or part of the body.

This principle is exploited therapeutically in the treatment of various functional disturbances, and the classical literature refers to:

(a) Equalising the circulation as between the upper and lower circuits, and as between the inner and outer circuits.

(b) Promoting perspiration in febrile conditions by diaphoresis to relieve the recession of blood upon the internal organs.

However, since local hyperaemia is likely to result in local ischaemia elsewhere, especially if total blood volume is low, then the principal becomes an important consideration in equalising the circulation where the local symptoms suggest ischaemia. Fainting due to shock is an obvious example of the effect of splanchnic vaso-relaxation producing a transient cerebral ischaemia, but a similar mechanism can be the reason for the depressive vertex headaches of menstruation. From this it follows that medicinal treatment may have to be directed to mechanisms remote from the area of symptoms.

Such shunt reactions are frequently at the basis of many functional disturbances, and three potential conditions of chronic imbalance should always be reviewed: cerebral/splanchnic, cerebral/peripheral and visceral/peripheral. For example, the heavy depressive vertex headaches (ischaemic) occurring under conditions of splanchnic vaso-relaxation require the splanchnic vaso-contracting property of say Collinsonia, rather than the common headache remedies acting upon the cerebral circulation. Similarly, the hyperaemic headache secondary to gastric-bilious dysfunction responds to such splanchnic vaso-relaxants as Dioscorea. Hyperaemic headaches commonly occurring during the acute febrile reaction may be modified by giving agents to relax the peripheral circulation, especially where the surface is hot (sthenic grade), in which case some general nervine relaxant may also be added. Thus, a combination of Asclepias, Cypripedium and a possible addition of Zingiber will relieve the head.

The relationship of the viscera to the periphery is of profound importance, in that the somatico-visceral reflex areas may be treated by counter-stimulant measures to influence specific organs. The most important area for such treatment is the thorax, bearing in mind the vulnerable condition of the lungs to surface chill. The vascular engorgement of the pulmonary capillaries in pneumonia arising from exposure could certainly be treated by internal remedies to displace the blood to other areas, and a favourite combination consists of Dioscorea to expand the splanchic field with Asclepias to relax the periphery, and Zingiber to provide an outward diffusion of the circulation. But in addition to the internal medication, strong counter-stimulant oils or liniments applied to the chest wall also bring the blood back to the surface and relieve the inner congestion. Indeed, counter-stimulation of this nature will be all that is required in the milder congestive conditions affecting the lungs and bronchi. (See chapter on Reflex Influences.)

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In the simpler conditions of vasomotor imbalance, as for example in children suffering from cold feet and a hot head, a nervine relaxant such as Matricaria will be all that is necessary to equalise the circulation. The same phenomenon occurring in the elderly as a chronic problem producing insomnia is probably better treated by evening hot foot baths containing mustard or capsicum, followed by massage of the feet with a counter-stimulant oil.

Cardiac function

Direct medication for the cardiac function will be less frequently necessary if the peripheral circulatory function is first adjusted. However, the trophic state of the myocardium itself may require assistance, and in this it is necessary to remember that any trophorestoration requires an adequacy of vasomotor relaxation, so that agents are chosen which will influence the coronary vascular supply. Phytolacca would be a suitable choice for the purpose.

Remedies to influence the tonicity are chosen with respect to the vascular conditions. For example, Cereus is contra-indicated in high systolic pressure, while Crataegus may be better avoided in very low systolic pressure. Convallaria as an agent which tends to slow the pulse rate may not be the best choice in conditions of marked bradycardia. Capsicum as the best general tonic for both sides of the heart must yet be used conservatively in the presence of poor trophic reserve. Anginal tendencies due to cardiac vasospasm will require a cardiac neuromuscular relaxant such as Ballota, or one of the more powerful antispasmodics. Combining these considerations, the following compounds are suggested by way of example:

Crataegus + Phytolacca + Ballota-as trophorestorative where systolic pressure is high.

Cereus + Phytolacca + Capsicum-as trophorestorative where systolic pressure is low.

Circulatory control in the febrile state

There are three basic objectives in the treatment of the febrile condition:

1. To remove the causative obstructions.2. To equalise the circulation.3. To recuperate the exhausted tissues and organs.

The fact of a febrile condition, that is, a general organismic response primarily involving the circulatory and vaso-motor functions, emphasises certain aspects of treatment, no matter the specific cause. The pattern of the acute phase may be simply indicated thus:

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-and without careful adjustment of the prescription to accord with these changing conditions, treatment will remain crude and empirical.

During the first phase (A) the herbal compound needs to ensure an adequate combustion level, which must be sufficient to overcome the causative obstructions. An inadequate response during this phase, or worse still, the use of sedative influences (e.g. aspirin or other depressants), will abort the vital reaction at the outset. The following medication may be needed to ensure that pyrexia reaches an adequate level:

Sufficient peripheral astringency: Achillea, Myrica.Nervine support: ScutellariaCardiac support: Capsicum, Crataegus, Leonurus

In addition, avoid sedation during this phase, do not relax prematurely, and take care with stimulus intensity.

During the second phase (B) the prescription aims to relax undue tension and to assist in the mobilisation and elimination of the products of combustion. To this end, the moderate stimulation and astringency which characterises any required first stage medication gives way to the principle of diffusive stimulation and relaxation classically associated with the treatment of the acute febrile condition. Local capillary and surface relaxation is achieved by the use of suitable diaphoretics such as Achillea, Nepeta and Eupatorium perfoliatum, while diuretics, expectorants, laxatives, etc. are chosen according to the organ or system at the centre of the reaction. Nevertheless, relaxation is controlled to maintain sufficient combustion for the proper completion of this phase, while stimulants of the stronger class (e.g. Capsicum) are used conservatively and not prematurely, if required at all.

It is almost inevitable that the strong and prolonged vital activity of the second phase will result in systemic and organ depletion, together with general nervous exhaustion. During the third phase (C) the levels of pulse, temperature and blood pressure are the guide to a gradual modification of the prescription towards a compound of mild trophic restoratives and tonic astringents. Suitable agents are: Agrimonia for systemic weakness, Chelone or Taraxacum for the liver function, Uva ursi for the kidneys, and Scutellaria and Turners for the central and autonomic systems respectively. All of these agents are trophorestorative as well as being mildly tonic or astringent.

The function level of the cardiovascular system alters in harmony with the above three phases and is a guide to the purely circulatory adjustments supporting the local medication. The pulse-temperature-respiration ratios need to be monitored to prevent wide departures from the normal relations:

80 pulsations88 pulsations96 pulsations

104 pulsations112 pulsations120 pulsations128 pulsations

- 18 respirations- 18 respirations- 21 respirations- 23 respirations- 25 respirations- 27 respirations- 28 respirations

- 99 deg, F- 100 deg, F- 101 deg, F- 102 deg, F- 103 deg, F- 104 deg, F- 105 deg, F

(after J. H. Greer)

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These values are to be taken as relative, not absolute, and must be related to typology and the known individual standard, as well as to the system affected. For example, acute involvement of the lungs would show relatively higher respiration rates.

Relative to this, the balance of arterial/venous function may require adjustment by adding relaxants, stimulants or contractants as may be suggested by the peripheral and pulse indications:

SthenicA++ V+

NormalA+ V=

HyposthenicA= V-

AsthenicA- V--

LobeliaCypripediumAsclepias

A-RN-RP-R

Normal complex for location and phase

ZingiberMyrica

V-SV-C

XanthoxylumZingiberMyrica

A-SV-SV-C

The expected condition for any febrile state is one of increased arterial activity with normal venous activity (A + V=), and as such will require the basic prescription for the organ or system affected according to the phase of the condition. The hyperactivity associated with the extreme sthenic reaction requires the addition of such relaxants as Lobelia for the arterial excitement, Cypripedium for the nervous erethism, and Asclepias to relax a hot and dry periphery, either singly or in combination and added to the basic prescription in appropriate dosage. The asthenic extreme will similarly require support on the venous-capillary side by the addition of Zingiber as a venous stimulant and/or Myrica as a venous stimulating astringent, and even Capsicum or Xanthoxylum as arterial stimulants where reaction is declining.

Clinical approach

Medication to adjust circulatory imbalance should be reviewed in the following order:

1. Remove obstructions in the secreting and eliminative organs-liver, spleen and intestines largely affecting the venous side, and kidneys and skin affecting the arterial side. Active or passive hyperaemia of these organs profoundly affects the circulation.

2. Regulate the peripheral capillary field according to the indications provided by an examination of the skin and subcutaneous tissues. The greater the obstruction in the capillaries, the more decided the arterial and venous disturbance. Suitable relief to the capillary system will favourably influence cardiac excitement. On the other hand, when the failing circulation begins to show itself at the periphery in the elderly, diffusive stimulation to the capillary function must always be included. By this means, direct cardiac support needs only to be minimal. Strong local or central stimulants should always be combined with diffusives. Typical stimulants for the capillary field are Asarum canadense and Zingiber. Typical relaxants are Sambucus and Asclepias.

3. Regulate arterial-venous balance. Examine the extremity vessels for distension or imperceptibility, the nail beds and skin for pallor or cyanosis. Review the pulse and blood pressure, and check the balance of cardiac sounds on auscultation. From these findings decide upon the need to treat the left cardiac-arterial function or the right

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cardiac-venous function. Arterial tension, reflected in firmness of the pulse and a relatively high systolic blood pressure, calls for relaxation. In the absence of vascular sclerotic changes, and presuming reasonable capillary balance, the condition is likely to be a general hypertension requiring neuromuscular relaxants, or some focal or visceral obstruction needing specific local medication. It may thus follow that a relaxing hepatic, or diaphoretic, or emmenagogue, in relieving the local tension may so relieve the arterial system as to be followed by a normally balanced circulation.

When the cardiac and arterial structures are too relaxed in a general sense, then positive stimulation and cardiac support is indicated. In this case, a close watch must be kept on the pulse pressure ratio and pulse rate, since a relatively low systolic pressure should not be raised at the cost of unduly increasing the pulse rate. For this reason, a central cardiac stimulant such as Capsicum is used in strict moderation. The somewhat slower action of an arterial stimulant such as Xanthoxylum may be preferable, with or without the diffusion of Zingiber or the astringency of Myrica. Typical agents for the left cardiac and arterial system are:

Stimulants: Capsicum, Xanthoxylum.Relaxants: Lobelia, all diffusive diaphoretics.Neuromuscular relaxants: Cypripedium, Viburnum opulus.

From the basic structure of their walls, consisting of a relatively higher proportion of elastic connective tissue and a lower proportion of plain muscle fibre, the right-cardiac and venous system rarely needs relaxation. Stimulants and tonics are usually required, with more or less astringency according to the distension of the peripheral veins, and with more or less direct support to the right ventricle according to the degree of peripheral cyanosis. Thus, a selection from the following agents is made, bearing in mind the involvement of the portal circulation. Typical agents for the right-cardiac and venous system are:

Tonics: Gentiana, Hydrastis (portal), Helonias.Astringent tonics: Myrica, Collinsonia (portal), Lycopus virginicus (right cardiac).

4. Assess the state of the myocardium and the quality of the valve sounds at the apical positions to determine the need for myocardial support and trophorestoration. In the absence of gross disturbances, conduct periodic exercise tolerance tests to provide a measure of the effectiveness of trophorestorative medication. Meanwhile, all medication for the heart and circulation must defer to the prime need for restoring cardiac reserve and capacity.

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Nervous Equilibrium

In all chronic degenerative conditions it is necessary to assess the nervous state, to determine the nervine support, and to take into consideration the tone and balance of the autonomic nervous system. In the treatment of acute and sub-acute conditions the problem of local circulatory congestion or ischaemia is resolved by appropriate regulation of the vaso-motor function.

The basic principle of physiomedical treatment to assess over-contraction or over-relaxation of function is easily realised in relation to the muscular system and the glandular system, but less easily in relation to the nervous system. However, if for contraction a condition of hyperfunction is understood, and for relaxation one of hypofunction, then it follows that symptoms of over-sensitivity, excitement, irritability, etc., represent the state of nerve `contraction', while those of an opposite state of function represent nerve `relaxation'. In view of the directive control exercised by the nervous system over the muscular and glandular tissues, it is clearly necessary to decide whether the functional disturbances in those tissues arise from the tissues themselves or are merely reflective of a disturbed nervous equilibrium.

Basic physiology

The fundamental properties of the animal cell are: irritability, conductivity, contractility, metabolic function and reproduction. The specialisation of organismic functions requires that these cell-properties be selectively developed, and in the nerve cell the functions of irritability and conductivity support the essential purpose of transmitting impulses from the receptor organ (dendrites) along the axon to the effector terminus.

The basic unit of all divisions of the nervous system: central, peripheral, sympathetic and parasympathetic, is the simple reflex arc, of which the essential components are:

-from which it may be readily appreciated that certain problems are fundamental to this basic mechanism of physiological control. These problems are:

i. The threshold level of sensory reception. ii. The synaptic resistance affecting the transmission of the impulse from one

nerve fibre to the next.iii. The conditions at the point of effector contact which determine the response of

the tissue cells activated.

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Sensory reception, synaptic transmission and effector contact involve problems of electrolyte balance and organic chemical mediation, in which the availability of calcium ions and the state of potassium-sodium balance at the tissue-cell membrane are basic considerations. Thus, assessment of the electrolyte background and the restoration of specific deficiencies, constitute the first steps in the treatment of any nervous disorder.

The co-ordination and control of the visceral functions is the concern of the autonomic nervous system, in which the two components sympathetic and parasympathetic-are complementary. The pattern of the reflex arc existing in the parasympathetic system may be suggested thus:

-and that for the sympathetic system thus:

It can be generally assumed that the sensory receptors of the parasympathetic afferent nerves are concerned with control and regulation of the special visceral function, whereas those of the sympathetic afferent nerves, which relay to the appropriate spinal segment as the viscero-somatic reflex, will be concerned with the transmission of visceral disturbance and experienced somatically as referred pain, as well as with the initiation of the reflex contraction of those skeletal muscles overlying the affected viscus. In this way, it is seen that the sympathetic reflex is concerned with protective conditioning and adaptation to any local `emergency' situation, whereas the parasympathetic reflex is concerned solely with the regulation of vegetative function.

The duel nerve supply to the visceral organs from sympathetic and parasympathetic sources provides that balance and contrast of function necessary to adapt the simple vegetative condition to the special demands of environmental changes. This balance is reflected in the state of glandular secretion and viscero-motor function, as well as in the long-term trophic state of the organ concerned. Both glandular secretion and trophic condition are the result of adequate vaso-relaxation, so that in long-continued sympatheticotonia (e.g. anxiety states) the trophic condition of the vegetative organs suffers from chronic vaso-constriction.

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Physiomedical principles

With this background in mind, one may approach the particular system of classification proposed by J. M. Thurston, the last and most important contributor to the original American school of physiomedicalism. Thurston stressed the paramount importance of the autonomic nervous system in terms of vaso-motor regulation of visceral functions:

i.Secretion and excretion is directly related to the vaso-motor regulation of the blood supply.

ii. Viscero-motor activity will regulate the motility (parasympathetic) and sphincter function (sympathetic) of the intestine.

iii. Trophic state is the resultant of vaso-motor control of the blood supply to the intrinsic parenchymatous cells.

The balance of function as between contraction and relaxation, stimulation and sedation, may be schematically presented thus:

Stimulate

Contract Relax

Sedate

-in which the vertical axis represents the nerve impulse transmitted over the reflex circuits, and the horizontal axis the state reflected in the plain muscle fibres of the end organs. The functional activity of the autonomic nervous system varies between the exaggeration of the inflammatory state and the depression of the moribund condition, whereas the balance of the vaso-motor function is reflected in the degree of plain muscle contraction.

J. M. Thurston classified herbal remedies according to their effects upon:

1. The functional state and trophic condition of the nerve cells of the central and intermediate ganglia, including the synaptic conditions at the exchange stations (i.e. remedies acting centrally or systemically)

2. The balance of sympathetic/parasympathetic function affecting the local enteric plexus and post-ganglionic fibres, as reflected in:

i. the vaso-motor nerves controlling the blood vessels, ii. the viscero-motor nerves to the longitudinal (parasympathetic) and circular

(sympathetic) plain muscle fibres, iii. the secreto-motor nerves to the glandular structures,

(i.e. remedies acting locally to restore normal autonomic balance).

3. Loss of normal tissue conditions affecting the muscular, cellular, and glandular structures in the organs, resulting in a deficient, response to stimuli (i.e. remedies acting locally to restore organ tonicity and trophicity).

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The sympathicomimetic or parasympathicomimetic actions of various drugs derived from botanical sources, such as: muscarine, eserine, pilocarpine, nicotine, atropine, hyoscine, etc., are well established by pharmacological research, and although these substances find no place in physiomedical practice, yet they establish that herbal sources are available for the subtle chemical valencies necessary to modify disturbed chemical mediation at synaptic contacts, and also to affect the response of organ tissue-cells. Disturbances are deduced clinically from the pattern of the presenting symptoms, and Thurston's scheme of classification is intended to provide a framework .for the assessment of a syndrome specific to the patient - not to a medical name.

Systemic reactions

The first group of herbal remedies are those acting centrally and systemically to affect the overall level of dynamic activity expressed by total metabolic function. In this the antonomic nervous system is concerned solely with the co-ordination of systemic functions in they interests of life itself, and the diagnostic purpose is therefore to assess the general adequacy of this total function. The considerations are exemplified most clearly in the febrile reaction, in which systemic; relaxants or stimulants are used according to the presenting conditions.

The over-reactive state, the sthenic response, is shown by undue nerve tension and involuntary muscle contraction, with hyper-pyrexia and excessive pain, and in the extreme hypersthenic typology may lead to the development of congestion and destructive processes. Under these circumstances, it may become necessary to use the more powerful herbal sedatives directly affecting the nervous system, but in general, the preferred technique is the use of peripheral relaxants and powerful diaphoretics to diffuse the intensity outwards to the surface, where appropriate hydrotherapy and local applications control the reaction within safe limits. Where the general pyrexial activity is focused upon a particular organ or system, then local ganglionic relaxants will feature in the prescription. Appropriate herbal medicines are:

Systemic relaxants:Asclepias, Cypripedium, Lobelia.

Cerebrospinal relaxantsCerebral – PassifloraMeningeal – CimicifugaSpinal meningeal – Cypripedium

Ganglionic relaxants:Cardiac – PhytolaccaGastric – LobeliaHepatic – LeptandraIntestinal – CassiaRenal – VerbenaUterine – SenecioPulmonary – Asclepias

(after J. M. Thurston)

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Milder degrees of reaction involving some obvious irritability of the nervous system may be treated by using diaphoretics having nervine relaxant properties. All diaphoretics by reducing peripheral sensory irritation will to some extent soothe the nervous system, but the following are especially appropriate for the minor febrile reactions of children: Nepeta, Matricaria, Pulsatilla, Sambucus.

The under-reactive state, the asthenic response, is likely to be more often presented in clinical practice. As a feature of the tardy resolution of febrile conditions, it can lead to that chronic `irritability with weakness' so frequently encountered in the sickly child, but whether derived as a post-febrile syndrome or developed as a deteriorating succession of minor ailments, it is shown by a general sub-reaction of the organism with hypothermia, pulse/temperature disparity in fevers with inability to produce an adequate level of pyrexia, and progressive cachexia.

This general state of autonomic depression may be atonic, atrophic, or a mixture of both, in which the abnormally depressed functional activity arises from a general deficiency of reserve energy in the nerve cells. Within the limitations of the trophic state, the agents to meet this condition: nervine stimulants, are capable of arousing the latent energy potential:

General stimulants:Capsicum, Xanthoxylum.

Cerebrospinal stimulants:Cerebral – ColaSpinal - Viburnum opulus

Gangionic stimulants:Cardiac - Eupatorium aromaticumPulmonary - Populus candicansAlimentary – Chelone Hepatic – EuonymusRenal – Barosma

Muscular stimulants:Voluntary - Fraxinus americanusInvoluntary – Myrica

(after J. M. Thurston)

Insofar as these herbal agents act directly upon intra-cellular conditions, their influence is not confined to nerve cells. Indeed, many of them would be classified as alteratives with a secondary action upon a specific tissue, organ or system.

Visceral functions

Since the autonomic nervous system is predominantly one of motor nerves which activate the plain muscle fibres in the end organs, then in the presence of normal sympathetic / parasympathetic balance any excess or deficient degree of visceral function will reflect either:

i. Exaggeration or depression of the local autonomic ganglionfunction, or

ii. Disturbed tonicity/trophicity of the receptor tissues in the end organ.

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Visceral symptoms arising from the former condition will be met by appropriate ganglionic relaxants or stimulants which will normalise the vasomotor function, whereas any deficient response in the organ tissues themselves will require the use of organ remedies and trophorestoratives. (See chapter: Organ inferiorities.)

However, conditions may arise in which the overall symptom picture reflects an unduly stressed sympathetic or parasympathetic function, as may be found in various psychosomatic syndromes. Such symptoms are largely due to the imbalance of autonomic function as it affects the visceral motor and secreto-motor nerves. Treatment for such conversion symptoms is essentially by direct psychotherapy, but meanwhile the somatic disturbances may be relieved by herbal medicines which relax the excess degree of function.

Sympatheticotonia mainly arises on a background of chronic fear and anxiety, but also from prolonged anger and sometimes from injury or infection. Typical symptoms are:

i. Intestinal tract: reduced digestive secretions and contraction of the circular sphincter muscles of stomach and intestines, giving rise to digestive insufficiency and intestinal colic.

ii. Cardiac: functional tachycardia and increased blood pressure.iii. Uterus: contraction of circular muscle fibres giving rise to spasmodic

dysmenorrhoea.

-which may be variously relieved by such agents as: Ballota, Pulsatilla, Lycopus, Caulophyllum, etc.

Parasympatheticotonia may be idiopathic, but may also arise locally as a reflex disturbance initiated in some other part of the parasympathetic distribution. Typical symptoms are:

i. Intestinal tract: hypermotility and spasticity, hyperchlorhydria leading to ulceration of the mucosa.

ii. Pulmonary: dyspnoea and hypersecretion, as in asthmatic and hay fever syndromes.

-which may be relieved by such agents as: Dioscorea, Humulus, Spiraea, Lobelia, Viburnum, etc.

It should not be assumed that herbal autonomic relaxants are necessarily either sympathetic or parasympathetic in a strictly selective manner, since many such agents appear to correct an excess degree of action on either side.

Apart from the general effects of sympathetic or parasympathetic action, local problems of excessive vaso-constriction or vaso-relaxation may arise. Cerebral vaso-constriction resulting from somatic conditions affecting the upper dorsal sympathetic fibres (as from osteopathic lesions) will be helped by Phytolacca or Scutellaria. Similarly, uterine vaso-constriction arising from spinal disturbances (somatic-visceral reflex) may be relieved by Senecio aureus or Caulophyllum. Hepatic and portal vaso-relaxation secondary to chronic visceroptosis will respond to Juglans and Collinsonia.

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Trophorestoration

Trophic degeneration of the autonomic vaso-motor function resulting in a degree of insufficiency of vegetative action may arise from some form of neuron poisoning, and is a common sequel to the use of drugs containing heavy metals. Similarly, the more serious infections, especially tubercular and syphilitic, may be responsible for neuron degeneration. Apart from these possible causes, severe nutritional disturbances arising not so much from dietary inadequacy as from chronic circulatory insufficiency may be the responsible factor.

Special cell function depends entirely on sufficient quantity and quality of its blood supply, and neurons which are enclosed within the cerebrum and the spinal column are especially vulnerable to conditions which restrict or limit that blood supply. Cerebral ischaemia as a sub-clinical condition may be due to chronic pooling of the blood in the splanchnic distribution or may arise from vaso-constriction of the cerebral vessels. Local ischaemia of the spinal cord may result from chronic spondylitic lesions which gradually starve the segment, producing retrograde changes. The osteopathic philosophy does not overemphasise the importance of the somatico-visceral reflex with all that is implied in terms of spinal segmental influence.

Patients with early and simple forms of nervous hypotrophicity will often have a normal level of tonicity. Such patients are functionally stable but easily exhausted. In such cases, the choice of nervine tonic trophorestorative must have such a grade of power as to build up the nervous reserve over a fairly long period without disturbing function in the direction of undue stimulation or relaxation. Patients will complain either of tension or depression if the level of medication is too great in either direction or the choice of agent unsuitable. Alternatively, they may complain of the development of headache-dull vertex headache in the case of hypotension, or tense throbbing headache in hypertension. The same remarks apply to medication for the nervous tissue as in relation to other organs or systems requiring trophorestoration and alterative action, that is:

i. Medication to adjust tonicity requires moderate to full dosage, on a short-term basis.

ii. Medication to adjust trophicity and threshold response needs small doses prescribed on a long-term basis.

In this connection it is common practice for the former to be given as a compound of liquid extracts or tinctures, while the latter is administered as a pill or tablet. The technique of giving trophorestorative medicines in this way is to ensure a slow and even intake of the prescription, so producing minimal functional reaction with progressive restorative effect.

According to J. M. Thurston, all degenerative syndromes arise from trophic deficiency. For such conditions affecting the cerebro-spinal and ganglionic centres, nervine trophorestoratives are required:

Cerebro-spinal:General systemic - Avena saliva, Cola vera.Cerebral - Avena saliva, Cimicifuga.Motor nerves - Cola vera, Alpinia.Optic nerves - Phytolacca, Caulophyllum.Spinal cord - Aletris, Turnera.Mental states - Humulus, Helonias.

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Ganglionic:General systemic - Hydrastis, Myrrha.Cardiac-Cereus, Convallaria.Hepatic-Dioscorea.Gastro-intestinal-Viburnum prunifoleum, Prunus serrulata.

(after J. M. Thurston)

Peripheral symptoms

The modification of the simple reflex arc in its position as the lower motor neuron, and the connections with the sympathetic afferent fibres at the level of each spinal segment, establishes the physiological basis for understanding the common functional disturbances encountered in general practice:

This schematic presentation contains the elements for interpreting the clinical syndrome, thus:

i. Visceral pain is largely experienced as being `referred' over the area of distribution of the corresponding peripheral afferent nerve.

ii. Skeletal muscle contraction responds equally to a visceral afferent stimulus as to a peripheral afferent stimulus, hence the reflex contraction of muscles overlying an injured or inflamed internal organ.

iii. The response of the peripheral motor nerve to reflex sensor impulses is conditioned by the influence of the upper mot" neuron (largely inhibitory), and so will reflect the central nervous conditions of undue sensitivity or exhaustion.

Disturbances involving the nervous system will on the one hand give rise to pain or other sensation seemingly originating in peripheral structures, and on the other hand will reflect in some increase.' decrease in motor activity. Thus in every clinical case the individual syndrome needs to be analysed in order to decide whether such disturbances are due to the nervous system itself or to the internal and external organs and structures innervated. Insofar as the internal organs " have a dual afferent nerve supply, sympathetic and parasympathetic then symptoms will include peripheral pain (sympathetic) together with a consciousness of disturbed function (parasympathetic).

Muscle cell function, both skeletal and visceral, is basic to all dynamic activity. Function suffers where there is a loss of balance of complementary action: either the tendency to

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contractility increases while the power of relaxation diminishes, or laxity of the structures becomes more marked as the power of contraction becomes reduced. The longer the disturbance of equilibrium is continued, the greater the disposition to remain in an abnormal state.

Pain

Since pain is obviously a sensory nerve phenomenon it can be counteracted by influences which either sedate the nerve function or block, transmission at the threshold response. Attempts to do this with he medicines are no more physiomedical than the use of aspirin. Irritation of the sensory nerve giving rise to the painful reflex may arise from:

i. Passive fluid pressures and local chemical changes resulting from ineffective local or general circulation and drainage.

ii. Pressure of contractile tissue as in local spasms, or local ischaemia from vasomotor spasm.

In both of these situations the nervous system is merely conveying awareness of a disorder, and treatment should be directed to the causative conditions.

However, before such treatment can be initiated it is necessary evaluate the painful sensations. Pain experienced in a particular locality may arise directly from causes in that locality or may be referred from skeletal conditions more centrally placed and served by the same segmental reflex, or may be referred from visceral conditions by the sympathetic afferent fibres. For example, a sensation of pain experienced unilaterally in the lower abdomen may arise from a local muscle or peritoneal lesion, or may be referred from a lesion of the twelth rib, or may arise reflexly from a disease of the ovary.

Pain arising from local skeletal conditions is usually best treated by local measures (see chapter: Reflex influences). The pain referred from proximal skeletal lesions may also be so treated once located, but circulatory and visceral disturbances will require more or less systemic treatment in addition to local measures where possible.

Neuralgic and other conditions which are secondary to circulatory insufficiency, painful swelling from local oedema, and threatened gangrenous conditions, will require variable circulatory stimulants. The patient suffering from general neuralgia is notoriously deficient in energy, since the constitutional conditions which favour the development of such symptoms are always deteriorative. Painful irritation from active hyperaemia is best treated with diffusive relaxants to divert the blood flow, whereas blood vessel distension and passive congestion needs more positive stimulation.

Pain due to various spasms of the alimentary tract, to angina and cardiospasm, and to local constrictions, will require local and general relaxants. Pain from simple irritation will respond to such agents as Cypripedium or Cimicifuga, whereas such remedies would be unsuitable for depressed conditions.

Motor activity

The motor component of the peripheral reflex arc reacts directly to the volitional impulses received through the upper motor neuron as well as reflexly to impulses received from the sensory fibres of the peripheral and sympathetic connections at the same segmental level.

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Setting aside the specific patterns of neurological disease and conversion hysteria, there remains the simple interpretive value of motor activity in assessing functional conditions of the cerebro-spinal nervous system.

Symptoms of irritability and restlessness have important implications for supportive treatment to the nervous system in any acute or chronic illness. The existence of irritability implies a lowered threshold of reaction or a state of `tension' of the nerves. On the other hand, abnormal reduction of sensibility implies a raised threshold of reaction or a state of `laxity' of the nerves as occurs in narcosis and submetabolic conditions, senile and other degenerations. Since the threshold of reaction is conditioned by the electrolyte balances, then special attention should be given to assessing potassium/sodium balance and calcium/magnesium balance as shown by other symptoms.

Physical fatigue will result in nervous tension if rest and relaxation are withheld. This common condition reflects the same principle as that basic to asthenic irritability. The fact of asthenia implies a deficit of energy reserve, in which the organism can never rest for long enough to increase systemic trophicity. The resultant increase of muscle tonus is the necessary compensation to maintain function, but this in turn results in increased afferent sensitivity and initiates a vicious circle of excessive kinetic discharge to the point of exhaustion (neurasthenia). This type of nervous irritability does not call for relaxation, but forprofound nervine and systemic trophorestoration. '`

There is another condition of nervous irritability which is due, chronic low-grade inflammatory action - an unresolved acute condition either because the original constructive inflammatory reaction suppressed at an early stage, or because the vitality level was too to produce an effective response. Such irritability illustrates the connection between a chronic visceral afferent stimulus and the corresponding motor activity. These conditions commonly arise from the drug suppression of acute eliminative phases, especially those involving nose, throat and ears. If the condition is uncomplicated (not previously suppressed) then all that is required is a course of nervine tonic and trophoresorative medication combined with a local alterative and organ trophorestorative. If, however, the condition arises as secondary to a suppressed focus, then caution must be adopted in order to avoid uncontrollable acute reactions.

Nervine relaxants are agents which reduce the irritability of nerve cells, whereas nervine stimulants and trophorestoratives are indicated to increase functional response. Kinetic phenomena take place against the background of the trophic state wherein the reflex response reflects the nervous tone, and the central nervous response (upper neuron) is inhibitive or regulatory. In the absence of central inhibition, spasticity arises in the peripheral arc, hence in the presence of central nervous exhaustion the peripheral irritability is increased, whereas in the presence of total nervous exhaustion irritability is decreased and there is general collapse. For these reasons, such powerful nervine relaxants as Cypripedium, Lobelia, etc., should be used only where there are clear evidences of a hypersthenic condition. In other conditions, nervine relaxants should be supported by stimulants and/or trophorestoratives - if used at all.

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Organ Inferiorities

The considerable reserve of function possessed by all organs may be gradually reduced by retrograde tissue change, or by some active pathology which progressively encroaches upon the special parenchymatous cells, without the onset of noticeable symptoms. Indeed, for so long as minimal functional demands are met there will often be nothing to indicate the steady deterioration in reserve capacity.

Unfortunately, the point must eventually be reached when some extra demand or emergency situation arises, however slight, when the organ `inferiority' is thrown into sharp relief, and demands priority of consideration in formulating the appropriate prescription. In this way, the unsuspected existence of an old cardiac lesion may intrude upon the treatment of a simple febrile reaction, a renal condition be the underlying cause of persistent bronchial catarrh, and a pancreatic insufficiency the reason for chronic undernutrition and weight loss.

Organ inferiority may arise from various bases: i. As a genetic weakness or developmental limitation.ii. As a permanently damaged organ following acute involvement during

childhood.iii. As the subject of retrograde tissue change consequent upon disturbed

nutrition.iv. As a focus of malignant destruction.

Organs communicating directly with the exterior, such as the lungs or the alimentary system, are more likely to give early warning of active pathologies than those organs, such as the liver, spleen, kidneys and pancreas, concerned with intermediate metabolism. Otherwise, the tendency for organ function to fall off, in spite of an increased level of medicinal stimulus should be a warning to adopt a programme of trophorestoration. Such a possibility should be kept in mind whenever specific organ function is being stimulated in the treatment of a general systemic condition, as when renal function is activated in the treatment of `rheumatism' or the liver function in conditions of the blood.

Treatment of an organ suffering some active pathological process must be aimed at the process rather than at the organ. Such pathologies are generally systemic, in which the organ is merely the focus, as in tuberculosis or cancer. Meanwhile, the treatment schema is established to give maximum relief to the organ concerned by reducing functional demand to a minimum.

Deterioration of an organ arising from some degeneration not involving infection or neoplasm, as from fatty degeneration, simple atrophy, or sclerotic change, is theoretically reversible providing tissue recovery is possible. Retrograde metamorphosis of nerve tissue, in which there has been a replacement by connective tissue cells, is not so reversible, and while many neurological conditions may be arrested, full recovery cannot take place. Many skeletal conditions involving muscle degeneration, in which there has been a simple fibrotic deterioration, are reversible given time, functional stimulus, and an adequate blood supply.

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Tissue changes involving retrograde metamorphosis originate in diminished neuro-vascular control. Therapeutics is consequently limited to re-establishing normality of nervous and circulatory supply in conjunction with the supply of proper materials for cell nutrition. It can do no more than to normalise the extra-cellular environment in this way-assuming that as much is possible. The restoration of conditions within the cell must depend upon other and more subtle factors, since although the vaso-motor function by controlling the blood volume regulates the trophic state, it cannot influence what is an inherent and intrinsic function of that particular type of cell. The therapeutic measures will therefore include:

i. Vaso-stimulants with vaso-relaxants or vaso-contractants according to the aetiological factors behind atrophic or retrograde change.

ii. Direct nervine tonics affecting the local ganglionic plexus.iii. Direct organ or tissue remedies.

Chronic failure in any excretory function arises from two causes:

i. Excessive vaso-constriction leading to reduced secretory activity, or excessive vaso-relaxation leading to stasis.

ii. Feebleness in the parenchymatous function, usually the resultof reduced trophicity.

In the former case the requirement is for vaso-motor adjustment, whereas in the latter a functional stimulant and/or organ trophorestorative is needed. Thus the distinction is made between influencing the function of an organ and influencing the trophic state of that same organ. For example, a liver which is over-relaxed in its function will be favourably influenced with Berberis vulgaris, whereas if its function is over-contracted it will require Leptandra. If it is not the function that requires medication but the trophic state, then neither of these remedies would be satisfactory, but instead Dioscorea would be indicated.

Concealed trophic insufficiency may be represented schematically as follows:-from which it can be appreciated that for so long as normal function demand remains within

the limit of reduced trophicity there will be no symptoms of insufficiency, but as soon as extra function demand exceeds such limit, then symptoms of functional insufficiency will arise and there will be progressive evidence of disparity.

Attempting to produce an adequate function by using stimulants may result in rapid exhaustion of all reserves, and under these conditions functional demand must be reduced to within the existing capacity. For example, where a condition of cardiac weakness or damage (infarct) prevents more than a very limited degree of physical activity, then the programme of remedial exercise must be strictly controlled. The trophorestorative stimulus of such a

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programme is necessary to recovery, yet will have a positive effect only if it remains well within the reserve capacity.

In the case of an excretory organ, the reduced eliminative capacity may require maximum offloading to other eliminative organs. The blood in particular may need the strongest possible support from alterative and antiseptic herbal medicines to prevent chemical and bacterial degeneration.

It is a most important principle in the treatment of an organ inferiority to reduce the functional demands upon the organ to an absolute minimum, while at the same time introducing the trophorestorative medicinal programme. Dietetic adjustment is especially important in this context:

i. In renal insufficiency limit all protein foods, even to the point of some weight loss, and control fluids. If there is no blatant renal damage conduct simple clinical tests for water concentration and elimination.

ii. In liver and pancreatic insufficiency reduce all carbohydrates to minimum energy requirements.

iii. In gastro-intestinal insufficiency be prepared to assist nutrition by the use of predigested foods, gluten-free diets, etc. The normal secretions may be supplemented by the prescription of dilute hydrochloric acid, pepsin, papain, etc.

It is of great importance in these conditions to have a positive programme and an imaginative assessment of what might be achieved, meanwhile bearing in mind the typological limitations.

Organ remedies (trophorestorative)

Trophorestorative remedies generally involve a gentle degree of relaxation combined with mild stimulation, and are thus suited to long-term administration. The degree of vaso-relaxation induced by such remedies may be sufficient without combining an autonomic ganglion vasorelaxant, but where the organ decline is on a background of chronic vaso-constriction then such an addition will be necessary. Similarly, in conditions of excessive relaxation and torpor, the addition of a minor complement of tonic-stimulant (shown in brackets below) will be required. The majority of organ remedies also possess alterative properties.

Central nervous system (cerebrum)HeartLungsStomachLiverSpleenPancreasDuodenumSmall intestineColonKidneysUterus

-Scutellaria (Betonica)-Crataegus (Cereus)-Inula, Verbascum-Chelone (Gentiana)-Dioscorea (Hydrastis)-Polymnia uvedalia-Iris-Chionanthes-Berberis aquifolium-Juglans-Verbena (Barosma)-Senecio (Aletris)

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Alterative Changes

The dictionary definition of an alterative medicine has been given as:

"A medicine that alters the process of nutrition, restoring in some unknown way the normal functions of an organ or of the system . . . re-establishing healthy nutritive processes."

(Blakiston's Medical Dictionary)

The implications of this definition are wide, and include considerations of deficient nutrition, obstructed function and trophorestoration. Physiomedical practice has applied the term 'alterative' to herbal medicines which may serve in any one or more of the following ways:

i. As a source of special nutrients, especially of electrolytes and trace elements, and as hormone and enzyme equivalents and catalysts, which appear to exercise a subtle but unknown influence upon the processes of intermediate metabolism.

ii. As `eliminative vasotonics', to use Thurston's terminology, being agents which cleanse the blood, mainly by affecting liver and spleen functions, e.g. Iris versicolor, Polymnia uvedalia.

iii. As' medicines which act upon the eliminative functions of the lymphatic system, e.g. Phytolacca, Scrophularia.

iv. As agents which influence the endocrine gland functions, e.g. Fucus, Serenoa, Turnera.

-from which it is seen that the quality of the blood tissue is central to the concept of alterative action. Just as vaso-motor regulation influences the quantitative aspect of blood supply in any trophorestorative programme, so alterative influences may be necessary to improve the qualitative state.

It is assumed that alterative medicines act primarily on the blood to:

i. Restore nutritional status in terms of electrolyte functions and protein balance.ii. Cleanse the blood of impurities by affecting mechanisms of intermediate metabolism.

Alterative function thus relates to two principal considerations - nutrition and toxicity, and most chronic syndromes are combinations of these factors, in addition to the local and systemic organ pathologies. Other agents are referred to as alteratives if they have a specific local trophorestorative function, especially in removing obstruction to normal function arising from disturbed metabolic exchanges or backpressure from faulty elimination by particular organs. Thus, in the case of liver function, secretory insufficiency may suggest the need for organ trophorestoration by improved blood supply (vaso-relaxation), whereas excretory insufficiency may require hepatics and cholagogues having alterative properties, e.g. Iris versicolor, Berberis vulgaris.

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In chronic conditions involving considerable systemic encumbrance, the rate of alterative change and release must be conditioned by two estimations:

i. Stimulus requirement: to determine the choice of agent, or if only one is appropriate, the intensity of dosage.

ii. The level of eliminative activity, if necessary safeguarding reactions on to other systems; e.g. the addition of Hydrastis to a prescription containing Echinacea in order to offset the tendency of the latter to produce an eliminative skin rash.

Alteratives generally act slowly to promote a steady toning and restorative impression. As a class they include relaxing, stimulating and toning influences. In chronic conditions the more stimulating agents are required, or if necessary, alteratives plus stimulants, but the choice and combination must have due regard to the vulnerability of the blood to general toxaemia if acute eliminative crises are not to be unnecessarily precipitated. Every alterative change leading to increased eliminative activity must be made by and through the blood, yet the blood condition must be maintained within very narrow limits of function if acute and dangerous toxaemia is to be avoided. This depends entirely upon ensuring that the intensity of medication directed at the lymph and cell levels of function is always in minor proportion to that influencing the special organs of excretion. The level of stimulus must be well within systemic capacity.

Similar considerations apply to the nutritional aspects of these problems. The blood is relatively remote from the tissue cell. It affects the latter through the medium of the lymph and extra-cellular fluid, so that in the long run its quality must predicate upon the intra-cellularly fluid. An `impoverished' blood, to use the terminology of John Skelton, cannot but result in a deficient state of the extra- and intra-cellular fluids, and the tardy reaction to alterative influences is readily appreciated in remembering that blood plasma volume at 5% of body weight must first influence the interstitial fluids at 15% of body weight, which in turn must influence the intra-cellular fluids at 50% of body weight, not to mention the intervening problems of biochemical and biophysical exchange across membrane barriers.

The diagnostic approach to any chronic problem must always take into account the historical sequence and antecedent conditions leading up to the present state, insofar as these will dictate the speed and extent of corrective medicinal influences. Thus, the speed of eliminative resolution will decide the depth and sharpness of alterative action, remembering that the 5% blood volume referred to above will provide something of a `bottleneck' in the presence of a drastic alterative influence operating at the cell level (50%). Such an influence could be potentially embarrassing in the presence of low buffer reserves and a delicately poised homoeostasis.

Because of these factors it is to be expected that alterative reaction will necessarily be slow. Chronic conditions may require perhaps two to three years of medication to secure a fundamental tissue change. However, since the prescription is likely to carry other influences apart from alteratives, it is necessary to remember:

i. Eliminative action and functional regulation will require a level of medication approaching the physiological dose and prescribed on a relatively short-term basis.

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ii. Alterative action and trophorestoration will require a small or very small dosage level prescribed on a long-term basis.

In the same way, where general systemic encumbrance is the result of deficient thermotaxis rather than from the excessive ingestion of proteins, starches and sugars, then the level of stimulus to combustion should be gradually introduced and increased, subject to observations of the cardiovascular index. The more serious encumbrances from exotoxicosis and drug saturation provide grave clinical risks. The dangers of a re-emergence of pneumonia where this has been suppressed on several occasions by antibiotic and sulphonamide drugs, or the precipitation of heavy metals previously ingested, are very real possibilities in the use of powerful herbal alteratives.

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Reflex Influences

Local stimulant applications in one form or another have been used from earliest times. Whether applied as a simple infusion, or by wrapping leaves around a part, or by pounding the roots and applying the pulp to a wound, it was long ago realised that local healing or resolution could be thereby expedited. In modern practice the use of oils, liniments, ointments, paints and sprays, constitutes a valuable part of physiomedical therapeutics.

Any local stimulant depends for its action and effectiveness upon the integrity of the reflex arc, and its employment must therefore be decided by:

i. whether the local conditions require an accelerated circulatory and nervous response, and

ii. whether the vital reserve is such as to allow an adequate reaction.

It is accepted that inflammation is a natural effort directed to the repair of injured or diseased tissues, yet while this is readily acknowledged in theory it is often overlooked or neglected in practice. It implies that any latent or chronic condition can only be resolved by way of acute activity, and such an acute phase brings its own problems, which must be anticipated and allowed for. To arouse increased local activity in a leg ulcer without anticipating that such will throw increased demands upon the local lymphatic drainage is to risk converting a reasonably comfortable condition into a highly intolerable state.

The prejudicial and beneficial effects of counter-stimulant applications arise directly from their power of increasing the nutritive activity of the local structures by reason of increased stimulation and vasodilatation. Such an effect is detrimental in any local acute inflammation, and beneficial wherever an inflammatory response is required. The spontaneous inflammatory phase must be watched to see that it passes over to the stage of resolution. Any intervening period of stasis calls for local counter-stimulation in order to complete the inflammatory effort prior to resolution. This principle applies not only to external lesions but also to internal visceral inflammations. Whether of pneumonia, laryngitis, or low-grade intestinal inflammatory states, the acute phase should develop and resolve within a certain appropriate time cycle. A tardy inflammatory phase invariably leaves a low-grade irritable sub-febrile condition with protracted resolution, and it is in such conditions that a local counter-stimulant embrocation applied to the overlying dermatomes helps to restore and complete the inflammatory phase. In these days of suppression by antibiotics the unresolved inflammatory or febrile stage is common, and the exploitation of reflex techniques increasingly required.

However, before any local activity is excited, some assessment of the reserve vitality needs to be made. Stimulants have less effect in asthenic conditions, so that the more active the vitality, the more readily a part inflames in response to injury or stimulus. No local stimulant can be expected to arouse a response in the presence of systemic depletion and exhaustion. Indeed, this principle applies to all medication, and as W. H. Cook has stated, to use too much stimulus too early in a febrile condition is to risk a later period of inertia while the nervous system recovers, and exactly the same principle must apply locally even if on a smaller scale.

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Practical corollaries

The following practical corollaries are derived from the above theoretical principles:

i. Irritant applications are contra-indicated in all states of acute inflammation, whether in deep or superficial structures.

ii. Stimulation of chronically diseased states or conditions, in which vitality is low and nutrition defective, gives good results provided the organism is not altogether too weak to respond. There will be no harm if the reaction fails providing the technique is not too violent.

iii. Where local passive congestion results from general debility or exhaustion of vaso-motor control, controlled stimulation is always beneficial.

iv. Where stasis and delayed resolution has occurred during an acute inflammatory phase, gentle stimulation will restore and hasten the natural process to proper termination.

v. Stimulant applications produce active congestion commensurate with the degree of intensity. The response to such stimulation is according to the local or systemic vitality.

vi. The pain of a local injury in the young and healthy is a sufficient natural stimulus to determine repair. For this reason, local or general anaesthetics should be avoided where such pain is tolerable.

vii. Disease is the expression of defective nutrition or tissue degeneration, in which the support of the constitution is the first essential in treatment.

viii. Counter-stimulation has no place in treatment except where local or general vitality is low and healthy function or restoration has failed.

The practical application of these principles and corollaries within the sphere of general practice includes the following measures:

i. To stimulate the processes of repair and restoration in weakly constitutions or in the elderly, where repair may be so slow or insufficient as to require assistance.

ii. To encourage a reversal of retrograde metamorphosis, as in treating arthrosis of a joint or recovering the normal tone and elasticity of muscle tissue.

iii. To relieve pain, especially that arising from deep congestive conditions, and that of neuralgia left by a chronic state of low-grade inflammatory response. Also to relieve pain which is a `prayer for nutrition', and so relieved by any stimulus which improves circulation locally.

iv. To promote the absorption and removal of pathological products,as in fibrous deposits and hardened glands.

Techniques

It needs to be stressed that whenever counter-stimulation is used for the purpose of accelerating local nutrition, then the local benefit is at the expense of the rest of the body. It also follows that the more numerous the local areas being stimulated the less response will be obtained at each, a point which has to be remembered with those patients who wish to attack every painful location at once with a counter-stimulant embrocation.

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It is evident that conservation and augmentation of vital energy should come first in the treatment of every condition showing nervous and systemic exhaustion. The respect of this principle covers many seemingly contrary practices, as for example in febrile conditions, in which counter-stimulation is contra-indicated unless it is apparent that vitality is insufficient and thereby leading to local visceral congestion.

Excessive or violent counter-stimulants are seldom required. A slow and gradual stimulation is better, especially in children and the elderly, so that any prescription used should always be adjusted in power to accord with the vitality condition, the age, and to the individual sensitivity of response.

Many materials have been used as counter-stimulants, some of which have a blistering effect, including mustard, turpentine, cantharis, acetic acid and local cautery. Such materials are seldom used in physiomedical practice, where the preference is for milder substances, especially the essential oils of plants. The commonly used oils are:

Relaxant oils: Lobelia herb/seed Matricaria flowers.Stimulant oils: Cajuput Caryophyllum Origanum Capsicum (in order of intensity of stimulus).Auxiliary oils: Eucalyptus - antiseptic and aerosol. Rosmarinus - nervine restorative. Serenoa - local tissue trophorestorative. Fucus - discutient.

Infused oils and plasters are made from Capsicum, Lobelia, Fucus, and Symphytum, using the dry powers in an oil or wax base (see Part 3 on Herbal Preparations).

With these simple elements one can achieve a variable degree of intensity, and make combinations to incorporate any auxiliary effect in addition to the simple excitation of the reflex arc.

Typical problems

The first of the applications given above was to stimulate the processes of repair and restoration in weakly constitutions. A frequent problem in the treatment of children, the elderly, and the asthenic type generally, is that febrile responses tend to be poor and not carried through to a clean resolution. Consequently, wherever an acute reaction has become somewhat static, or worse still, has left a protracted condition of incompletely resolved acute congestion, then there is a need for counter-stimulant measures. There could be no better example than in the chronic bronchitic states where the unresolved acute phases each year leave a sequel of irritant cough and wheezing dyspnoea. The use of a counter-stimulant embrocation applied nightly on retiring over the bronchial area, together with an internal trophorestorative mixture, will provide a smooth and effective resolution of the condition-at least for the time being. Similarly, where the suppressive action of antiobiotic medication has

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left a sub-acute congestion and enervation. In managing these situations, regard must be had for the vital reserve of the patient, in that stimulus value and rate of resolution must be well within the patient's capacity.

The restoration of normal tissue integrity is far too often considered impossible. It is certainly true that one cannot hope to reverse the changes of advanced sclerosis of the spinal cord, or the advanced arthritic infiltration of a joint cavity, but given time and sustained medicinal action, a few apparent `miracles' can be achieved. There is nothing more gratifying than the Fucus plaster treatment of early osteo-arthritis of a peripheral joint, as in the saddle joint of the thumb, the wrist, or the acromio-clavicular joint. In such cases the arthrosis has usually advanced no further than the capsular tissues so that complete recovery is possible.

The technique of using resolvent plasters over arthritic joints must be flexible enough to allow sufficient drainage of the breakdown products. The standard application of a Fucus plaster just large enough to cover the joint is kept in position by adhesive or crepe bandage according to convenience, and left for 2-3 days. It is then removed and the area given contrast water compressing several times during the following 24 hours in order to clear the breakdown products from the joint. A further plaster is then applied and the treatment continued in a similar manner. If too much local oedema and pain develops, then the period of plaster application is reduced while the period of contrast compressing is increased. Alternatively, the Fucus plaster may be alternated with a Lobelia plaster, still with intervening days for contrast compressing. This is usually sufficient for the acute reaction to subside and for the products of inflammation to be dispersed. The technique is appropriate for painful hallux valgus with bunion and early arthritic changes, over painful Heberden's nodes, patella arthritis, and similar joint capsule infiltrations.

Just as Fucus plaster seems to have the effect of reducing local exostosis and clearing arthritic products, so Comfrey plaster appears to have the effect of restoring calcium density to the tissue over which it is applied. Local Comfrey plasters will be found of great value when applied over sites of weak ligamentous action as well as over sites of fracture or sprain. Without the use of such plasters applied over the sacro-iliac ligaments, many low back strains arising from hyper-mobile sacro-iliac joints will persist. Similarly, these plasters are applied with excellent effect over the external ligaments of the ankle joint, and to the wrist joint. Of course, systemic medication to increase calcium metabolism may also be required, as also a special remedial exercise for strengthening the affected ligaments. In the use of all plasters it has been found that a 3-day application followed by a 1-day rest gives the best effect.

The relief of neuralgia left by a chronic low-grade inflammatory reaction is often a problem. A common example is the facial neuralgia induced by a chronic dental problem, and another is the sciatic irritability remaining after the correction of an old sacro-iliac lesion. Such conditions have been caused by the long-term irritation of the nerve reflex from sub-acute inflammatory conditions, and will be found to respond to the use of a mild counter-stimulant liniment if patiently persisted in. In such cases it is useful to add other agents to the stimulant compound, such as oil of Hypericum for the after effects of dental extractions, or oil of Rosemary for sciatic pain. If necessary the counter-stimulant combination can be emulsified to carry suitable tinctures.

There are conditions where pain is a `prayer for nutrition', and where any measure which increases the local circulatory supply rapidly eases the pain. The pain of a wound is very often so, and in locations where the part is subject to chill and circulatory stasis a warm

47

mildly stimulating salve is indicated. A similar common condition is that of joint ligament strain wherein it is found that pain develops slowly and is aggravated after continuous use or stress affecting the joint, and that such pain is eased immediately by rest. In this case the need is to build the integrity of the capsular tissues and check ligaments controlling the joint, and the techniques include the use of Comfrey plasters locally in conjunction with the use of a mild counter-stimulant liniment. In such conditions the objective is a local trophorestoration, and what is required is a mild long-term influence which will gently induce a gradual strengthening of the tissues involved. Much patient reassurance may be needed in the early weeks of treatment when there is apparently little to show for the efforts.

The reabsorption of pathological and fibrous deposits may be greatly assisted by local applications. Whether the lesion is the small and irritating cyst that appears on the eyelid, or a large indurated testicle, it can gradually reduce and resolve under the influence of a discutient compound. A compound of extracts of Fucus, Trifoleum and Phytolacca, dispensed as a paste with a lanolin base and kept in continuous contact with the condition, is often very effective for reducing such conditions as well as fibrous and glandular tumours. Similarly, nodular fibrosis of the mammary glands can be favourably influenced by regular massage with an emulsion of tincture of Phytolacca with a minor complement of infused oil of Capsicum, once the possibility of malignant change has been excluded. Regular daily contrast baths or compresses, followed by gentle massage with a mixture of the infused oils of Capsicum, Fucus and Lobelia, balanced according to the condition, will greatly assist the restoration to normal texture and flexibility of skeletal muscles.

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Clinical Prognosis

The physiological basis of modern herbal practice was first established as such by W. H. Cook, in whose work the concept of a vital force working through an organism emerges, and in which the symptoms of illness are regarded as the expression of the vital force in overcoming the conditions of disease, even if ineffectually. The art of assessing the state of vital control from the expression of the symptoms, against the background of typological limitations, is central to the difficulty of clinical prognosis.

A thorough study of human typology gives an accuracy of prognosis not achieved in any other way. Restoration to normal signifies a restoration to the `status quo ante', to a point reasonably within the limits of organismic compensatory mechanisms. More than this cannot be achieved by medicinal substances, since the typological bias determines the limit of improvement. It therefore becomes a matter of some clinical importance to be able to assess the disease tendencies peculiar to the individual patient, which continue in spite of the adoption of a hygienic programme.

The general clinical prognosis to a large extent rests upon the assessment of qualities not amenable to direct measurement, but only to be deduced from an overall interpretation of the typology, the symptoms and the history. In this assessment one needs to differentiate the vertical and horizontal factors derived from the history and various methods of investigation used in naturopathic practice:

i. Vertical: an assessment of the state of the patient at any one moment of time, the prevailing disturbance of functions, and the state of vitality.

ii. Horizontal: an assessment of the historical sequence of functional disturbance and the evolution of pathology. In particular affording a study of the vitality pattern as it responded to, endured, and finally resolved the various crises in the past.

It is largely on the evidence of the horizontal assessment that a prognosis is based. With this in mind, it should be remembered that certain diagnostic techniques yield a vertical assessment only, e.g. radiesthesia, Chinese pulse diagnosis; while other techniques may be misleading if it is not fully appreciated that the apparent indications reflect the horizontal rather than the vertical state of affairs, e.g. iris diagnosis.

In any assessment of prognosis, the following simple schema suggests the fundamental considerations:

Functional

Cell Organism

Structural

This is indeed a problem of relationships, since the organism exists by virtue of the cell, yet the cell depends upon the efficiency of the organism; functional disturbances lead to

49

structural changes, and structural changes produce functional disturbances. The most difficult aspect of the individual problem is to decide upon the particular level of approach in order to change the vicious circle of disease and deterioration into the virtuous circle of health and restoration. Until one can achieve this as an imaginative appraisal of the patient's condition and potential, then the whole therapeutic approach is confused and tends to become a simple empiricism.

At the cell level of function, health is predominantly a question of electrolyte sufficiency and balance together with the function of protein. But the dependence of the cell upon its immediate environment throws into relief the problems of processing and transporting these substances through the intermediate fluid and membrane barriers, so that the giving of various plant substances to supply such deficiences may be ineffective. The study of the homoeopathic drug pictures of individual minerals and trace elements is appropriate to the assessment of cell function, even if herbal sources of these minerals and elements are preferred in medication. Failure to respond to such medication may indicate the need to use dynamised homeopathic potencies, such as are exploited in the biochemic system of W. H. Schussler.

The nature and degree of tissue degeneration within the organism, as it may affect the vital organs and systems, is assessed with regard to the limits of possible trophorestoration. The physio-medical assessment of the tissue state is according to the following schema:

Hypertonia

Hypertrophia Hypotrophia

Hypotonia

The combination of the elements of tissue state obviously gives rise to the two extremes:

i. Hypertonicity with hypertrophicity = sthenic response,ii. Hypotonicity with hypotrophicity = asthenic response,

-and these two extremes are at the basis of many systems of typological classification. They constitute the hypersthenic and asthenic habitus types, and have a more or less close relationship to the pyknic/asthenic types of Kretschmer, and the endomorphic/ectomorphic types of Sheldon.

However, life (and classification) is seldom so easily reducible to a simple concept, and it is the mixed syndrome which provides the clinical difficulty. The combination of hypertonicity with hypotrophicity is especially confusing, until it is remembered that hypotrophicity may be reached either by way of hypertonia or hypotonia. In the former case tissue nutrition suffers from prolonged vaso-constriction, whereas in the latter case nutrition is equally obstructed from fluid stasis.

Whenever muscles are obviously spastic it is tempting to use some form of relaxation. Whether by remedial exercise, manipulation, or herbal medicines, the immediate objective is to relax that which is hypertonic. Yet hypertonicity of muscle tissue is a mechanism for compensating hypotrophicity of connective (supportive) tissue. In such a condition it will be

50

found that the use of relaxants merely aggravates the total state, or at best provides a very short term relief. This is a common problem with the asthenic type (ectomorphic) in which the skeletal hypertonicity/hypotrophicity reflects the low level of absorption and utilisation of the calcium salts. The condition may thus be regarded as one where the deficiency at the cell level is compensated by adaptations at the organismic level, and in the typical asthenic constitution, it is not relaxation of the skeletal muscles that is required, but a total trophorestoration with especial emphasis upon alimentation. The very fact of an ectomorphic typology implies an endomorphic insufficiency, and justifies the traditional use of herbal `tonic-bitters'-an obvious indication for the low digestive function with slow motility and poor absorption.

It will be appreciated that the two routes by which hypotrophic states are reached reflect opposite conditions of hydration. Hypertonicity/hypotrophicity syndromes involve a progressive degree of tissue dehydration, whereas hypotonicity/hypotrophicity conditions tend towards over-hydration. The state of tissue hydration needs always to be allowed for in assessing the response to treatment and the ultimate prognosis, and as far as possible, corrective influences should be included in the course of medication. Similarly, the tendency for the organism to suffer an increasing degree of hypothermia as age advances, invariably requires the inclusion of gentle diffusive stimulation in prescriptions for the elderly.

It is to be realised that medication and treatment for all chronic problems relates to the general prognosis as well as to the specific diagnosis. Those individual and personal factors which condition the prognosis also demand some adaptation of the prescription suggested by the diagnosis. This is to say, that the vertical condition is never more than a focal point in the horizontal assessment. Were this to be completely understood and accepted, then the standard treatment of disease `entities' and diagnostic `labels' would be seen to be incomplete, and efforts re-directed to the treatment of the whole individual.

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Part 2

MATERIA MEDICA

52

Classification of Materia Medica

The fundamental basis of physiomedical classification is in accordance with the principle:

Stimulate – Relax – Contract

-whereas the secondary or subsidiary basis of classification is in terms of the local or regional action. Thus, diuretics are agents having a specific action on the renal function, diaphoretics on the sudoriferous function, hepatics on the liver, etc. This classification is largely derived empirically.

As stated in Part 1: Introduction, the physiomedical assessment must establish the need for relaxation or contraction, either generally or locally, in conjunction with whatever degree of stimulation is required, but it is also apparent that there may be different and even conflicting requirements for specific organs and systems within the same syndrome.

The schedules of materia medica given in the following pages are arranged to give this information, so that any agent may be selected which will provide just that influence which is required to meet the case, and in the intensity preferred. The first three schedules-Stimulants, Relaxants, Astringents-give those agents commonly used for their general systemic effects. The remaining schedules divide the materia medica according to the secondary classification into tonics, diuretics, diaphoretics, nervines, organ remedies, etc., and give under the heading: Special Characteristics the relevant information as to stimulating, relaxing or astringing (contracting) properties.

It will become evident from a study of the schedules that not only is the type of action available, but also the intensity of action. Intensity of action may be partly met by variation of the dosage, but this does not altogether meet the case. The choice of agent must be made not only with respect to its specific action, but also with regard to the intensity required at the time. For example, in selecting a suitable expectorant to dislodge accumulated mucus from the bronchi one is aware that Sanguinaria canadensis is very powerful for the purpose, yet its power would be quite contraindicated in pulmonary tuberculosis where its use might provoke a dangerous haemoptysis. In such a condition, the expectorant value of Inula helenium or Symphytum officinale would be preferred, since these agents also provide an auxiliary influence more suited to the overall syndrome.

The information contained in the schedules is largely derived from the classical works of Beach, Cook, Thurston, and Lyle. These works are at present out of print and generally unavailable. The information given has been further cross-checked against more recent publications, especially:

Naturae Medicina and Naturopathic DispensatoryA. W. Kuts-Cheraux, B.S., M. D., N. D., Editor-in-ChiefPublished by American Naturopathic Physicians and SurgeonsAssociation Des Moines, Iowa, U.S.A. 1953

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Homoeopathic Materia MedicaWilliam Boericke, M.D.Published by Boericke and Runyon, Boericke and Tafel, Inc.Philadelphia, U.S.A. 1927

These volumes will provide that expansion of detailed information necessary for the study of each individual patient.

The range of dosage for each herb, as given in most of the relevant publications, provides only a very approximate guide to the use of the herb as a single agent. The art of prescribing herbal medicines in combination is one requiring considerable experience of clinical practice. The best suggestion to make for the benefit of the clinical student is that each prescription should be checked to ensure that the maximum dose for each of the more powerful herbal medicines has not been exceeded. The letter placed against the name of the agent in the index is to provide such guidance, thus:

A - the maximum individual dose of the fluid extract (1:1) is 60 minims/4 mls.

B - the maximum dose of the fluid extract (1:1) is 30 minims/2 mls.

C - the maximum dose of the fluid extract (1:1) is 15 m./1 ml.

X - special care is needed to check the appropriate level for the specific preparation being used.

-such limits to apply whether given in combination or as single agents.

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Materia Medica Schedules

GENERAL STIMULANTSSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueCapsicum minimum Vaso-motor and neural stimulant. Stimulates the heart and increases

arterial force and frequency. Centrifugal action extending to

capillaries. Indicated where reaction is tardy and there is general lethargy.

Increases secretory and motor activity of gastro-intestinal system.

Rubefacient and vaso-dilator (topical).

AntisepticTonic

Colds, chills, congestion-very sensitive to cold and damp.

Cold extremities with cyanosis.

Rheumatism, lumbago, neuralgia.

Generally give small frequent doses for cumulative reaction.

Shock of injury, cold sweats—

With Cinnam. and Caryoph.

Nervous depression— In very small doses + nervines.

Delirium tremens— With nervines.

Uterine and ovarian congestion—

Lobelia renders more diffusive.

Sprains, bruises, joint pains—

As liniment with Lobelia

Myrica cerifera Positive diffusive stimulant –

arouses circulation and eliminative organs.

Indicated for a soft, compressible pulse and peripheral laxity.

For heavy catarrhal states of mucous membranes-removes thick, viscid secretions from gastro-intestinal tract.

Positive influence upon the uterus and the venous system.

AstringentDeobstruentTonic

Colds and acute febrile reactions

As Ess. Myrica comp. to generate heat and induce perspiration.

Scrofulous, tubercuous tendency.

Prolapsus uteri, menorrhagia.

Leucorrhoea, atonic vaginitis—

As douche.

Gastro-intestinal cararrh. Nasal polypi— Powdered herb as snuff

Xanthoxylum americanum Positive diffusive stimulant-

induces free arterial/capillary circulation, restores vascular tone.

General stimulant for relaxed and feeble conditions and atonic digestive states.

Excellent stimulant tonic and alterative for convalescence and the elderly.

AlterativeDiaphoreticTonic

Chronic rheumatic conditions—

With Phytolacca.

Neurasthenia-poor assimilation.

Gastric distension, eructations and flatulence.

Loss of sensitivity in injured nerves.

Zingiber officinale Diffusive stimulant for simple

atony of alimentary organs and circulation.

Gentle diffusive effects suitable for children and the elderly.

CarminativeExpectorant

Colds and chills— As initial stimulant diaphoretic.

Flatulence and internal congestion, painful alimentary spasms.

Diarrhoea from over-relaxation

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GENERAL RELAXANTSSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueLobelia inflata General systemic relaxant with

diffusive stimulation - best where arterial action is strong. Equalises circulation and relieves vascular tension.

Vaso-motor stimulant-increases the activity of vegetative processes.

Influences glandular system and respiratory tubuli.

Contra-indicated in nervous prostration, shock and paralysis. Of brief continuance in asthenic conditions.

StimulantDiaphoreticExpectorantEmetic

Dislocations, trauma, hernias—

To relax tension and spasm, add more or less stimulation.

Spasmodic and membranous croup, pertussis, bronchial asthma, bronchitis, pleurisy—

As Syr. Lobel. acet.

Hepatitis, jaundice, nausea, hepatic congestion—

As emetic.

Convulsions— With Caulophyllum.

High blood pressure, intestinal obstruction, neurasthenia—

As enema: Lobelia 1. Nepeta 2. Zingiber 1. Pinus can. 2. (4 dr. powder to 3 pints water)

Sprains, boils, swollen joints

As local plaster with Capsicum.

Cypripedium pubescens Relaxant for all states of nervous

tension-esp. from physical conditions.

Allays pain and induces sleep. Special influence on the

autonomic N.S. Nervous irritability from

functional pelvic disturbances and menopause.

Neuromuscular tremors and twitchings.

AntispasmodicTonic

Acute hysteria, emot. tension—

As rectal injection with Lobelia.

Anxiety states with insomnia—

With Humulus for depression.

Nervous headache, neuralgia, nervous irritation/debility— With Scutellaria and tonics.

Nymphomania, seminal emissions— With Salix nigra.

Dysmenorrhoea— With Cimicifuga + Zingiber. Nervous palpitation /

tachycardia— With Cereus.Dioscorea villosa Autonomic nerve relaxant,

especially for gastro-intestinal conditions, vegetative neuroses and hyperaesthesiae.

Rheumatic syndromes arising from hepatic and intestinal dysfunction.

AntispasmodicAntibiliousDiaphoretic

Bilious colic, flatulence, gastrointestinal irritation.

Neuralgic conditions. Dysmenorrhoea, uterine

pains— With Valeriana +

Cimicifuga. Nervousness, restlessness

and pains of pregnancy— With Viburnum opul. +

Mitchella.Asclepias tuberosa Peripheral and capillary relaxant-

influences a flow towards the surface.

Autonomic stimulant: slows heartbeat, increases volume and frequency of respiration.

Influences skin, mucous and serous structures.

ExpectorantAntispasmodic

Catarrhal complaints from cold and damp; hard, dry cough.

Bronchitis, pleurisy, peritonitis. With Lobelia + Zingiber.

Pneumonia— With Dioscorea + Zingiber. Influenza— With Solidago + Zingiber. Intercostal rheumatism— With Ballota nig. Eruptive diseases— Generally in hot infusion.

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GENERAL ASTRINGENTSSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueEuphrasia officinalis Mild stimulating, astringent. Vaso-constrictor to vessels of

nasal and conjunctival mucous membranes.

Specific for congestive conditions of the eyes with profuse lachrymation.

Scrofulous eyes in children.

Tonic Catarrhal blepharitis, rhinitis, sinusitis and conjunctivitis—

Local bathing/douching with a weak decoction.

Hay fever, acute coryza, irritable sneezing and lachrymation.

Rheumatic choroiditis and corneal opacity—

Locally, with Hydrastis.

Geranium maculatum Positive tonic astringent for

treatment of discharges due to over- relaxation.

Excessive mucous discharges, passive haemorrhages and ulceration of the alimentary mucous membranes.

Pulmonary and urogenital haemorrhages.

StypticTonic

Catarrhal gastritis, summer diarrhoea, chronic dysentery— With Hydrastis.

Menorrhagia, metrorrhagia, post-partum haemorrhage, leucorrhoea, due to atonic conditions— Oral and local.

Bleeding wounds, teeth sockets—

Powdered root as local styptic.

Hamamelis virginiana Mild, diffusive, cleansing

astringent. Passive haemorrhages of

pulmonary, gastro-intestinal and genital organs.

Bruised soreness of affected parts, especially from relaxed conditions.

Venous congestion, atony or laxity.

SedativeTonic

Diarrhoea and dysentery— With Ulmus fulva. Protruding, bleeding

haemorrhoids— With Calendula or Stellaria. Vulval bruising after

childbirth— Locally as compresses or

cream with Calendula. Vaginal laxity with

tenderness— Inflamed sore throat— As spray, with Tr.

Phytolacca fr. Varicose veins— Oral and local. Sore and bloodshot eyes— With Calendula.

Rubus idaeus Mild, soothing, astringent tonic-

allays nausea, sustains the nerves and tones the mucous membranes.

Preparatory parturient (contra-indicated where there is a history of precipitate labours).

Stimulant Acute and chronic dysentery— Oral and rectal injection.

Summer diarrhoea in children.

Uterine haemorrhage, menorrhagia— With Myrica or Hydrastis.

Leucorrhoea— As douche of the weak decoction.

Ophthalmia— As lotion with Hamamelis. Sore throat and hoarseness

— As gargle with dilute

Acetum.Salvia officinalis Carminative, stimulating

astringent-especially suitable for weak, pale, atonic patients.

Cold preparations check excessive perspiration from circulatory debility.

StimulantCarminative

Gastric debility and flatulence.

Night sweats. Sore, ulcerated throat— As gargle with Tr. Myrrh.,

or honey and raspberry vinegar.

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ALTERATIVESSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueArctium lappa General alterative: influences

skin, kidneys, mucous and serous membranes, to remove accumulated waste products.

Specific for eruptions on the head, face and neck, and for acute irritable and inflammatory conditions.

DiureticDiaphoreticDemulcent

Eczema, psoriasis, dermatitis—

Oral and topical-with Rumex cr.

Boils, carbuncles, styes, sores.

Rheumatism, gout and sciatica.

Vaginal tissue laxity.

Generally prefer the seeds for skin diseases and scrofulous conditions. Combine with: Zingiber-for diffusive effects; Hydrastis-for tonic effects.

Baptisia tinctoria Stimulating, antiseptic alterative:

specific for septic conditions with ulceration and tissue degeneration.

Influences the glandular system and both sides of metabolism.

Suitable for asthenic conditions.

AntisepticDiscutient

Ulcerative colitis, amoebic dysentery, intestinal toxaemia.

With Myrrha for offensive secretions and putresence.

Tonsillitis and quinsy— As gargle with Phytolacca Eruct.

Erosion of cervix— As local tampon with Calendula.

Surface ulceration— As poultice with Ulmus fulva.

After typhoid inoculations.

Echinacea angustifolia Stimulating alterative: promotes

suppuration and increases natural resistance to infections.

Specific for endotoxaemia, exotoxaemia, toxaemic and cancerous cachexia, and malignant degeneration of acute toxic conditions.

AntisepticAntibioticAntitoxin

Septic infections, septicaemia.

Furunculosis, carbuncles— Oral, and local poultices. Ulcerative pharyngitis,

tonsillitis and stomatitis— As gargle or spray Eczema from blood

conditions— With Baptisia + Hydrastis. Gastric and duodenal ulcers

— As antiseptic, with

Hydrastis. Enteritis— To control putrefactive

changes.Fucus vesiculosus Gently stimulating alterative:

suited to cold, torpid and fatty conditions.

Influences mucous and serous membranes, lymphatics and thyroid gland.

Improves nutrition in supplying trace elements, iodine and minerals.

DiureticDeobstruent

Hypothyroid obesity, myxoedema.

Plethoric dropsy (fluid imbalance).

Rheumatism and arthritis (associated with emotional shock or thyroid disturbance)-

Commence with small dose and gradually increase.

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ALTERATIVES—continuedSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueIris versicolor Positive alterative for chronic,

torpid conditions: influences glandular system, lymphatics, liver and gall ducts, and intestinal glands.

Specific for hepatic congestion due to venous or lymphatic stasis.

DiureticCholagogueStimulant

Chronic hepatic and rheumatic conditions, toxic sciatica.

Scrofulous skin conditions, herpes, eczema, psoriasis.

Enlarged thyroid gland.

Iris is an excellent alterative addition to hepatic medicines.

Uterine fibroids— With Hydrastis and Chelone.

Phytolacca decandra Stimulating and relaxing

alterative: promotes the removal of catabolic wastes and the products of fatty degeneration.

Specific for skeletal congestions, and for serous and glandular tissues.

EmeticCathartic

Chronic rheumatism and arthritis, neuralgia and lumbago—

With Cimicifuga + Xanthoxylum.

Tonsillitis and parotids— Oral and gargle-with Myrrhae.

Mastitis, mammary congestion—

As poultice, liniment or plaster.

Ovaritis, orchids. Enlarged thyroid and

lymphatics.Polymnia uvedalia Stimulating alterative with

specific influence upon liver-spleen-lymphatic functions.

Discutient Acute splenitis. Benign indurated swellings

of mammary glands or lymph nodes—

Oral, and local plasters.

Rumex crispus General tonic alterative with

special influence upon skin eruptions.

Natural source of iron salts.

TonicLaxative

Simple deficiency anaemias. Eczema, psoriasis, urticaria

— With Syr. Taraxacum.

Prurigo. Itching haemorrhoids— Oral, and local suppository.

Scrophularia nodosa Gently stimulating and relaxing

alterative with lower abdominal and pelvic emphasis.

Deobstruent to enlarged and engorged lymph glands.

DiureticDepurativeAnodyne

Chronic skin diseases, eczema and psoriasis.

Combine with hepatics and stimulating diuretics.

Mammary tumours and nodosities, enlarged glands— With Phytolacca, Iris.

Haemorrhoids— Local ointment of herb digested in a suitable base.

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GENERAL TONICSSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueAgrimonia eupatoria Gently stimulating tonic with

gastro- intestinal emphasis: suitable for infants and the elderly.

Influences mucous membranes, promotes assimilation, and restores debilitated conditions.

DiureticAstringentDeobstruent

General alimentary weakness, marasmus, hepatic atrophy.

Enuresis (atonic), relaxed bowel, leucorrhoea (relaxed states), urinary incontinence.

Combine according to location: Intestinal: with hepaticsGenerative: with uterine tonicsBronchi: with pectoralsBladder: with Capsella.

Rheumatism and arthritis— With Chelone.Betonica officinalis Gently stimulating tonic with

emphasis upon the cerebral circulation.

Especially indicated for neuralgic and ischaemic conditions affecting the head.

NervineStomachic

Gastralgia, dyspepsia. Chronic rheumatism and

sciatica—With Cimicifuga -E Scutellaria.

Phrenitis, ischaemic headache—

With Cimicifuga for sclerotic changes.

Hysteria, pains in the head and face, neuralgias.

Lack of concentration, forgetful—

With Rosmarinus or Carduus.

Cola vera Cerebro-spinal stimulating tonic

and trophorestorative: counters fatigue, increases respiration and stimulates voluntary muscles.

Suitable for neuromuscular hypofunction arising from illness or depression.

NervineCardiacDiuretic

Neurasthenic, melancholia. Adjunctive to Betonica. Chronic neuralgia— With Pulsatilla. Convalescence— Use small doses for cumulative

influence as restorative. To sustain physical and

mental exertions.

Hydrastis canadensis Mild, positive, permanently

stimulating vaso-tonic with especial influence upon the portal system, entire venous system and right heart.

Trophorestorative to mucous membranes when irritated, inflamed or ulcerated.

AlterativeLaxativeAntiseptic

Catarrhal conditions of mucous membranes, especially gastric.

Orificial soreness or discharge, conjunctivitis, keratitis, tonsillitis, pharyngitis, vaginitis, cervicitis (topical).

Combine according to location:Gastro-intestinal: JuglansRespiratory: SymphytumRenal: Eupatoreum purpureumGenital: MitchellaPortal: with hepatics.

Populus tremuloides Bitter tonic for all general uses, Especially for post-febrile

debility. Stimulates appetite and aids

digestion. Suitable for the elderly.

Diuretic Dyspepsia, flatulence (debility).

Uterine, vaginal, anal weakness— With Capsella or Uva-ursi.

Diarrhoea, dysentery (atonic).

Catarrh of the bladder

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NERVINESSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueAnemone pulsatilla Stimulating and relaxing nervine

with especial reference to the organs of special sense.

Stimulates gastro-intestinal and hepatic functions.

SedativeAlterativeAnodyne

Functional neuroses: heart and pelvic organs— With Cimicifuga/Aletris.

Vasomotor instability, menopausal flushes, dysmenorrhoea—

With Viburnum opulus / prunus.

Amenorrhoea, leucorrhoea. Nervous exhaustion,

neurasthenia. Neural irritation, head

neuralgia. Catarrhal ophthalmic— With Euphrasia. Catarrhal otitis— With Verbascum.

Avena sativa Gently stimulating nervine tonic

and cerebral trophorestorative, especially for weakly and anaemic conditions.

Indicated for reflex nervous irritation from other disorders.

StimulantNutrient

Irritation and depression with dysmenorrhoea— With Aletris or Mitchella.

Hysteria, insomnia— Frequent doses at short intervals.

Neurasthenia and neuroses— With Scutellaria.

Nervous exhaustion and debility from chronic disease— With Turnera.

Cimicifuga racemosa Stimulating and relaxing diffusive

nervine, meningeal relaxant and cerebrospinal trophorestorative.

Influences autonomic activity: increase of secretory and peristaltic action.

Trophorestorative to pelvic viscera.

Especially indicated for spasmodic symptoms of toxic origin.

AlterativeAntispasmodicSedative

Muscular and crampy pains. Intestinal spasticity,

flatulence. Pertussis, asthma, chorea— With Cypripedium or

Caulophyllum. Rheumatism, sciatica,

neuralgia, rheumatoid arthritis—

With Xanthoxylum.

Atonic uterus, ovarian neuralgia, leucorrhoea, dysmenorrhoea—

With Leonurus and Caulophyllum.

Tinnitis aurium— With Cinchona or Xanthoxylum.

Humulus lupulus Stimulating and relaxing nervine

cerebrospinal trophorestorative. Tonic relaxant to liver/gall ducts. Allays irritation and promotes

sleep.

SedativeAnodyneAnaphrodisiac

Hysteria, dysmenorrhoea— With Valeriana. Nervous exhaustion— With hepatic tonics. Pruritus, nymphomania— With Camphora as

suppository. Facial and brachial

neuralgia. Local inflammatory and

irritable conditions— As poultice.Hypericum perforatum Sedative nervine for muscular

twitching and choreiform movements- especially indicated for nerve injuries to the extremities and teeth/gums.

Promotes elimination of catabolic waste products.

SedativeAlterativeVulnerary

Painful injuries to sacral spine and coccyx. Traumatic shock

Haemorrhoids with pain/bleeding.

Facial neuralgia after dental extractions, toothache—

Massage face with diluted oil.

61

Neurasthenia, chorea, depression.

NERVINES—continued…Special Characteristics Auxiliary Individual Indications Combinations and TechniqueMatricaria chamomilla Stimulating nervine: indicated for

conditions of neural irritability with sthenic background.

CarminativeAntispasmodic

Flatulence, colic; abdominal distension and spasms.

Premenstrual irritability and if spasmodic dysmenorrhoea.

Infantile convulsions from colic, teething, earache, etc.

Passiflora incarnata Relaxing nervine, cerebral

vasorelaxant-relieves cerebral irritation.

Indicated for conditions of agitation and exhaustion with muscular twitching.

AntispasmodicSedativeAnodyne

Mild convulsive or tremulous states-unrest and agitation.

Restlessness and wakefulness in infants and the elderly— With Humulus.

Childhood convulsions, spasms and teething.

Scutellaria lateriflora Diffusive, stimulating and

relaxing nervine-cerebral vasodilator and trophorestorative.

Indicated for- nervous irritation of the cerebrospinal nervous system.

SedativeAntispasmodic

Functional nervous exhaustion, postfebrile nervous weakness.

Chorea, hysteria, agitation and epileptiform convulsions—

With Pulsatilla or Cimicifuga.

Insomnia, nightmares, restless sleep— With Passiflora.

Turnera diffusa Stimulating tonic nervine and

spinal trophorestorative with especial influence upon the generative system.

TonicAphrodisiac

Frigidity, impotence, senile decline.

To establish normal menstruation at puberty.

Anxiety neurosis— With Scutellaria.Valeriana officinalis Soothing, diffusive, relaxing and

stimulating nervine. Indicated for the relief of nervous

irritation, and to support atonic and functional nervous disorders.

SedativeAntispasmodic

Nervous excitability— With Passiflora. Nervous insomnia— With Humulus. Nervous palpitation— With Convallaria. Flatulent colic, abdominal

cramp, gastrodynia, diarrhoea—

With Dioscorea and Zingiber.

Menopausal dysfunction, retarded and scanty menstruation— With Pulsatilla.

Nervousness of children, chorea.

Verbena officinalis Relaxing and stimulating nervine

with especial influence on hepatic and renal autonomic function.

Indicated for catarrhal conditions of gastro-intestinal and auxiliary organs.

AlterativeTonicAntispasmodic

Nervous depression and weakness convalescence and debility.

Acute spasms of bronchitis and pertussis.

Amenorrhoea, dysmenorrhoea and difficult menstruation.

62

63

NERVINES—continued…Special Characteristics Auxiliary Individual Indications Combinations and TechniqueViburnum opulus Relaxing and stimulating nervine,

cerebrospinal vaso-stimulant. Restores sympathetic /

parasympathetic balance-has a specific action to relieve voluntary and involuntary muscular spasms.

AntispasmodicTonic

Colicky pains and spasms of tubular organs: gastro-intestinal and genito-urinary— With Dioscorea.

Atonic conditions of pelvic organs: menses scanty and delayed.

Viscum album Stimulating and relaxing nervine. Motor and vasomotor relaxant to

gastro-intestinal and genito-urinary functions from parasympathetic action.

Antispasmodic Metrorrhagia, post-partum haemorrhage, endometritis.

Congestive headache, hypertension and cardiac hypertrophy— With Crataegus and Tilia.

Rheumatic and gouty syndromes, neuralgia and sciatica.

64

DIURETICSSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueBarosma betulina Diffusive, stimulating and toning Diuretic for chronic atonic

conditions. Increases excretion of water,

removes uric acid debris, and is cleansing and toning to the mucous membrane.

Soothing to the pelvic nerves.

TonicCarminativeAntiseptic

Dropsical conditions, gravel—

Chronic atonic conditions— With Juniperus for greater

stimulation. Mucopurulent discharges,

gleet, cystitis, urethritis— With Althaea as demulcent. Vesico-renal irritations in

the elderly. Pelvic congestion— With uterine tonics.

Eupatorium purpureum Relaxing, mildly stimulating

diuretic and pelvic visceral tonic. Increases excretion of solids and

prevents precipitation of urates. Indicated for atonic conditions

with dysuria.

Emmenagogue Strangury, stricture, inability to micturate, chronic cystitis.

Urinary calculi— Use strong decoction. Gout, lumbago, rheumatism

— Excellent addition to

alteratives. Uterine and vaginal

irritation, general pelvic weakness— With Mitchella.

Galium aparine Soothing, relaxing and diffusive

diuretic: increases aqueous excretion, corrects inability to pass normal catabolic wastes, and relieves irritation.

Preferred diuretic for exanthemas.

Aperient Dropsy, renal obstructions— With Barosma or Uva-ursi.

Bladder stone, gravel, calculi.

Scalding micturition, dysuria, irritable bladder, cystitis— With Althaea as demulcent

Enuresis in children— With Rhus aromatica. Skin eruptions, eczema,

psoriasis.Juniperus communis Stimulating diuretic: indicated for

renal torpidity and scanty secretion of urine in the elderly.

Produces renal vaso-dilatation. Contra-indicated: in

acute/chronic nephritis and pregnancy.

StimulantCarminativeAntiseptic

Dropsy from renal suppression.

Cystic catarrh, renal congestion.

Atonic amenorrhoea, dysmenorrhoea from sluggish conditions.

Use small dosages, and combine with Althaea, Uva-ursi, etc. to counter irritability.

Rheumatic pain in muscles and joints, gout, sciatica—

Oral, and local liniment of oil.

Zea mays Soothing and toning demulcent

diuretic, suitable for conditions in children.

Frees the circulation of urea and relieves cystic irritation arising from excess of urates and phosphates.

DemulcentAntiseptic

Renal/cystic inflammatory states— Always with Althaea.

Enuresis— With Agrimonia + Capsella. Ammonia in the urine in

infants. Enlarged prostate with

retention or suppression of urine.

65

DIAPHORETICSSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueAchillea millefolium Mild, slow and stimulating

diaphoretic: indicated for the first stage of acute febrile reactions.

For atonic and relaxed tissues where there is free discharge or passive haemorrhage of bright red blood.

Cold preparations stimulate the appetite and tone the digestive organs.

AstringentStimulantTonic

Acute stage of colds, influenza and respiratory catarrhs—

In hot infusion-with Sambucus and Mentha piperita.

Chronic diarrhoea and dysentery— Cold preparations.

Epistaxis, intestinal haemorrhage and bleeding haemorrhoids.

Uterine haemorrhage, profuse and protracted menstruation— With Capsella.

Leucorrhoea, vaginal laxity— With uterine tonics.

Eupatorium perfoliatum Stimulating, tonic and

antispasmodic diaphoretic: indicated for influenza) epidemics and febrile conditions arising in marshy districts.

Acts upon the gastro-hepatic organs and promotes secretion and excretion of bile.

StimulantTonicAntispasmodic

Influenza) colds and fevers with night sweats and aching bones.

With Achilles for first stage and Pulsatilla during third stage.

Pulmonary inflammation / catarrh with cough and chest soreness— With Asclepias and Inula.

Post-influenza) gastric irritation with biliousness / constipation—

With Chelone and Syr. Juglans.

Skin diseases and eruptive fevers of hepatic origin—

With stimulants.

Nepeta cataria Relaxing and diffusive nervine:

produces free perspiration without increasing internal heat.

Influences the circulation, soothes the nervous system, relieves irritation.

Especially suitable for conditions in infants and children.

DiaphoreticAntispasmodicCarminative

Childhood fevers— With Zingiber as required. Flatulent colic, abdominal

cramp, colonic pain and invagination—

Rectal injections of a weak infusion with Dioscorea.

Restlessness, nervous irritation— With Matricaria.

Functional menstrual disturbances, amenorrhoea and dysmenorrhoea.

Convulsions, hysteria, insomnia.

Sambucus nigra Mild diffusive and relaxing

diaphoretic with alterative properties: indicated for children subject to frequent febrile reactions.

Relaxing to the eliminative organs, soothing to the nervous system and gently laxative.

AlterativeDiuretic

Colds/fevers with dry, hot skin— With Achilles and Pulsatilla.

Chronic nasal catarrh / sinusitis— With Pulsatilla.

Dry coryza, spasmodic croup— With Trifoleum.

Weakening night sweats— With Salvia. Skin eruptions from

metabolic disturbance, eczema, dermatitis—

Excellent addition to alteratives.

66

DEMULCENTSSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueAlthaea officinalis Soothing demulcent: indicated for

inflamed and irritated states of mucous membranes.

Particularly suitable for the elderly with chronic inflammatory conditions affecting the gastro-intestinal system or genito-urinary tract.

EmolientDiureticExpectorant

Acute respiratory disease— As demulcent syrup to support pectorals and expectorants.

Gastro-enteritis, peptic ulcer, cystitis, urethritis—

Cold water infusion with aqueous Calendula / Hydrastis as a drink.

Inflammation of mouth and throat—

Infusion with Myrrh as gargle.

Inflamed haemorrhoids, ophthalmia Compresses of decoction.

Inflamed and gangrenous wounds— With Ulmus as poultice.

Burns and scalds— Burns and scalds— Bedsores— Ointment (5% powder). Abscesses, boils, ulcers— Poultice or ointment.

Symphytum officinale Soothing demulcent: gently

stimulating tonic to the mucous membrane, allays irritation and encourages cell growth (allantoin content).

Increases expectoration and tones the bronchi, especially suitable for conditions involving capillary haemorrhage or excessive mucus.

Astringent Coughs and colds— Valuable addition to cough syrups.

Gastric and duodenal ulcer—

With aqueous Hydrastis.

Gastro-intestinal inflammation.

Haemoptysis, haematemesis— With aqueous Calendula.

Pruritus ani— Local compresses. Chronic suppurative

ulcerations— Embrocation, poultice or

ointment. Bruised and damaged joints

and muscles, pulled tendons—

Infused oil of the leaves or plaster of the powdered root.

Delayed union of fractures— Local plaster.

Traumatic injury to the eye—

Local compresses of decoction.

Ulmus fulva The best demulcent for internal

and external use: lubricates and soothes alimentary mucosa, relieves intestinal irritation, and quietens the nervous system.

EmollientPectoralDiuretic

Acute gastric and duodenal ulcer, gastritis, gastric weakness—

As gruel of the powdered bark.

Diarrhoea, dysentery, enteritis— Infusion as rectal injection.

Inflammation of mouth and throat—

Infusion as mouthwash or gargle.

Vaginitis— Irrigation with infusion. Burns, scalds, abrasions— Dressing of paste with Ol.

lini. Haemorrhoids, orificial

fissures— Compresses of mucilage. Varicose ulcers— Poultice until free of pus. Abscesses, boils, carbuncles

— Poultice or ointment.

Inflamed wounds and ulcers—

Poultice-with Althaea / Lobelia.

Swollen glands— Poultice-with Phytolacca rad.

67

ORGAN REMEDIES: HEARTSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueCactus grandiflorus Stimulating cardiac tonic and

trophorestorative: elevates arterial tension and accelerates, increases and regulates the pulse.

Stimulating to spinal nerves and motor centres.

Principal action upon the circular muscle fibres of heart and arterioles.

Indicated for conditions of dilatation and atony from muscular laxity.

TonicDiuretic

Incipient cardiac incompetence.

Cardiac weakness with atheroma or arteriosclerosis— With Crataegus.

Low blood pressure and anaemia.

Mural and aortic insufficiency.

Dilatation, angina, oedema. Climacteric bradycardia and

cardiac neurosis. Exophthalmic goitre with

cardiac symptoms.Convallaria majalis Cardiac tonic and ganglionic

trophorestorative: increases coronary circulation and myocardial action.

Suitable for all cardiac disturbances, but especially indicated in conditions of incipient decompensation.

Diuretic Acute heart failure with oedema— Tinct. Convallaria flor.

Dyspnoea, orthopnoea, anasarca.

Congestive heart failure— With Leonurus. Cardiac asthma, anginal

syndromes. Endocarditis— With Echinacea and/or

Phytolacca. Mitral insufficiency,

dilatation.Crataegus oxycantha Cardiac tonic trophorestorative:

increases and sustains action of heart and arterioles, with principal influence on the myocardium.

Improves coronary circulation, restores myocardial reserve, and regulates disturbances of rhythm.

TonicDiuretic

Myocardial degeneration and/or coronary sclerosis in elderly—

With sufficient Cactus / Capsicum to sustain function.

Hypertension— With Viscum-Tilia-Scutellaria.

Cardiac weakness after infections.

Acute myocardial insufficiency— Following Digitalis therapy.

Tachycardia, extra-systoles— With Convallaria/Pulsatilla.

Angina, palpitation, vertigo— With Pulsatilla.

Fatty degeneration, hypertrophy.

68

ORGAN REMEDIES: HEART – continued…Special Characteristics Auxiliary Individual Indications Combinations and TechniqueLeonurus cardica Diffusive, stimulating and

relaxing, antispasmodic nervine: indicated for reflex conditions affecting cardiac function, and as a simple cardiac tonic.

Influences pre-menstrual nerve tension and muscular rigidity.

NervineEmmenagogue

Anaemic nervousness and insomnia— With Senecio/Mitchella.

Chlorotic hysteria / palpitation— With alteratives.

Cardiac debility, tachycardia— With Aletris/Pulsatilla.

Cardiac and vegetative neuroses— With Convallaria/Melissa.

Hyperthyroid cardiac reactions— With Lycopus.

Pre-menstrual tension, congestive amenorrhoea or dysmenorrhoea--

With Caulophyllum / Zingiber.

69

ORGAN REMEDIES: PULMONARYSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueInula helenium Gently stimulating tonic

expectorant for chronic catarrhal conditions: warming, strengthening and cleansing to pulmonary mucous membranes.

Indicated for chronic pectoral states with excessive catarrhal expectoration and/or a tubercular diathesis.

DiaphoreticDiureticAlterative

Bronchial and gastric cararrh.

Chronic bronchitis, tuberculosis— With Symphytum.

Pneumoconiosis, silicosis— With demulcents. Pertussis— With Trifoleum. Emphysematous conditions. Chronic cough in the elderly

— With Sticta.Lycopus virginicus Aromatic and toning astringent,

tonic and sedative, affecting the mucous membrane.

Has a specific pulmonary influence, equalises the circulation and balances the autonomic nervous system.

Vascular sedative and haemostatic.

AstringentTonicSedative

Phthisis with free expectoration— With Inula/Symphytum.

Passive haemorrhages: epistaxis, haemoptysis, haematemesis.

Chronic circulatory disorders with tachycardia— With Convallaria.

Hyperthyroid conditions, nervous tachycardia and palpitation.

Marrubium vulgare Gently diffusive tonic

expectorant: relieves hyperaemia and congestion, decreases discharge where secretion is too free.

PectoralDiureticStomachic

Colds, bronchitis, catarrh— With Inula or Prunus. Asthma, with moist

expectoration, aphonia and dyspnoea.

Catarrhal dyspepsia— Cold infusion as a general tonic

Prunus serotina Mild, soothing, stimulating

astringent: tonic expectorant for acute irritable coughs, quietens nervous irritability and relieves arterial excitement.

Sedative for conditions of prolonged irritation.

AstringentExpectorantSedative

Chronic bronchitis with debility.

Catarrhal dyspepsia, weak digestion in the elderly.

Chronic diarrhoea— With Myrica as decoction. Weak throat— With Solidago as throat

pastille. Ophthalmia— As lotion to soothe and tone.

Pulmonaria officinalis Demulcent pectoral tonic for

general pulmonary conditions where a gentle tonic is required.

DemulcentTonic

Coughs, colds, influenza. Bronchial and catarrhal

states. Inflammation of throat or

lungs.

70

ORGAN REMEDIES: PULMONARY – continued…Special Characteristics Auxiliary Individual Indications Combinations and TechniqueSolidago virgaurea Stimulating and slightly

astringent tonic antiseptic to the mucous membrane. Specific for putrescent conditions.

Suitable for bronchial disease in the elderly.

Promotes renal excretion of fluid where micturition is scanty.

AntisepticDiaphoreticDiuretic

Influenza, repeated colds. Catarrhal bronchitis with

purulent expectoration. Putrescent tonsillitis— Acetous infusion as gargle. Naso-pharyngeal catarrh

with sneezing and excessive mucus.

Acute/chronic nephritis with albuminuria/haematuria.

Sticta pulmonaria Pectoral astringent and tonic:

relieves irritation and congestion of the neck and shoulders where there is pain, soreness and stiffness.

Indicated for acute and sub-acute inflammatory conditions with bronchial irritation and dry, hacking cough.

AstringentExpectorant

Acute coryza with profuse watery secretion. Sinusitis.

Influenza, bronchial catarrh. Dry cough with

wheezing/tightness. Croup, pertussis— With Trifoleum. Chronic asthma and hay

fever. Haemoptysis— With Lycopus/Hydrastis.

Trifoleum pratense Mild, stimulating and relaxing

alterative with a special affinity for the throat and salivary glands.

Especially indicated for debilitated children with chronic bronchial or throat conditions.

AntispasmodicSedativeExpectorant

Salivary gland congestion. Spasmodic or croupy

coughs. Pertussis— With Syr. Lobel. acet. Pharyngeal inflammation /

infection. With Solidago as gargle. Chronic skin eruptions— With Arctium red./Rumex.

Tussilago farfara Diffusive expectorant, sedative

and demulcent: suitable for debilitated and chronic conditions, especially where there is a tubercular diathesis.

StimulantRelaxant

Chronic pulmonary conditions— With Inula/Verbascum.

Chronic emphysema and silicosis—

To ease persistent cough.

Pertussis, asthma— Supportive as demulcent and expectorant.

Verbascum thapsus Demulcent and alterative:

soothing, relaxing and stimulating in pulmonary conditions. Influences mucous, serous and glandular structures.

AstringentDiuretic

Paroxysmal laryngeal cough—

With Sambucus/Trifoleum.

Irritable chronic bronchitis. Pleurisy with exudation. Hay fever, asthma— With Grindelia.

71

ORGAN REMEDIES: GASTRO-INTESTINALSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueAlpinia officinarum Stimulating, aromatic alterative:

indicated for atonic, depressed states of the digestive tract; prevents fermentation and relieves flatulence.

StimulantCarminativeDiaphoretic

Flatulent dyspepsia— With Dioscorea. Suppressed menstruation— With Matricaria/Zingiber. Lymphatic swellings— With Phytolacca/Trifoleum. Uterine fibroids— Oral, local suppository.

Berberis aquifolium Mildly stimulating tonic hepatic

and alterative: influences alimentary mucous membrane, stimulates glandular elements and improves nutrition.

Promotes the elimination of catabolic residues and stimulates recuperation

AlterativeTonic

Catarrhal disorders of stomach, intestines and urinary organs.

Hepatic torpor, bilious headache.

Eczema, herpes, psoriasis, acne, facial blotches and pimples— With Rumex/Arctium rad.

Cassia angustifolia Intestinal ganglionic vaso-

relaxant. Specific influence upon lower

bowel to restrict fluid reabsorption.

Excites colicky contractions.

TonicLaxativeCathartic

To produce rapid catharsis— Single full dose.

Tonsillitis, diphtheria, eruptive diseases (from constipation)—

As first dose, and to abort development of condition.

Remittent/intermittent fevers— Regulate to keep bowel free

Acute haemorrhoids: to ease liver and gall-bladder function— Small doses every 3 hours.

Collinsonia canadensis Stimulates, cleanses and tones the

alimentary mucous membrane-slightly astringent: suitable for catarrhal and atonic conditions.

Vaso-contracting to the portal system; indicated for pelvic/rectalcongestion secondary to portal back-pressure and venous stasis.

AlterativeDiureticTonic

Gastro-enteritis with diarrhoea— With Spiraea/Rubus idaeus.

Haemorrhoids— With Juglans/Leptandra. Layngeal inflammation /

catarrh— With Hydrastis/Myrrha. Influenza, acute/chronic

pleurisy, colds and fevers. Leucorrhoea— Oral. With Lamium album

as local douche.Gentiana lutea Intense, bitter, stimulating tonic:

influences digestive organs, mucous membranes, and the portal circulation.

Indicated for atonic and sub-acid states: slowly promotes peristalsis and facilitates assimilation.

CholagogueAnthelminticEmmenagogue

Languid conditions and general debility, anorexia, alimentary insufficiency—

Best in small doses combined with milder agents and carminatives.

Portal congestion— With Collinsonia/Hydrastis. Biliousness and jaundice.

72

ORGAN REMEDIES: GASTRO-INTESTINAL – continued….Special Characteristics Auxiliary Individual Indications Combinations and TechniqueJuglans cinerea Gently stimulating hepatic /

cathartic: influences peristalsis and tones the alimentary mucous membrane.

Specific action upon the lower bowel, relieves the portal system and decongests the liver.

HepaticAlterativeVermifuge

Chronic constipation, intestinal toxaemia—

Aqueous extract-add Zingiber to prevent griping.

Diarrhoea and dysentery— Tincture-with Rhei co. Haemorrhoids, portal

congestion— With Collinsonia. Pin/thread worms in

children— With Chelone. Skin eruptions from faulty elimination— With Taraxacum.

Rhamnus purshiana Very bitter tonic; slow, mild

hepatic: influences stomach, liver, gall-ducts and bowel.

Specifically indicated for inactivity of the lower bowel.

TonicLaxative

Chronic constipation— With Syr. Juglans. Haemorrhoids. Chronic dyspepsia with

hepatic torpor or cirrhosis. Jaundice.

Rheum officinalis Mild stimulating tonic to

alimentary mucous membrane, liver and gall-ducts-removes viscid mucus. (Small doses-tonic hepatic, large doses-cathartic.)

CatharticAstringent

Full catharsis— Add Dioscorea/Zingiber. Diarrhoea and dysentery,

summer diarrhoea— As tonic hepatic to cleanse

and tone the bowel. Functional dyspepsia— With Hydrastis/Leptandra.

Rosmarinus officinalis Diffusive stimulant and relaxing

tonic with special influence upon stomach and cerebrum: soothes the nervous system, and is tonic to the vaso-motor function and peripheral circulation.

Suitable tonic for the elderly.

NervineAstringentDiuretic

Atonic conditions of the stomach.

Gastric headache. Adolescent hypotonia,

asthenia with pallid complexion.

Circulatory weakness following stress or illness.

Spiraea ulmaria Mild stimulating tonic astringent:

relieves genito-urinary irritation. Restores normal balance to

gastric secretory function.

Stomachic Alterative Diuretic

Summer diarrhoea in children.

Diarrhoea, bowel disturbance.

Dyspepsia with hyperchlorhydria— With Agrimonia.

Eructations, oesophageal burning.

Febrile conditions with excessive heat—

Strong infusion-small cup every 2-3 hours.

73

ORGAN REMEDIES: LIVER, GALL-BLADDER, PANCREASSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueBerberis vulgaris Stimulating tonic hepatic:

influences the mucosa generally, removing mucoid accumulations and controlling excess secretion.

Improves appetite, digestion and assimilation. Indicated for gouty constitutions.

Alterative AntisepticLaxative

Biliary catarrh with constipation and jaundice.

Gastritis, biliousness— Small doses-with Prunus/Populus.

Debility in convalescence— Small doses-with alteratives.

Ulcerative stomatitis— Mouth wash of decoction. Eczema of the hands.

Chelidonium majus Active cholagogue with influence

upon the spleen: stimulates the pancreas, and affects mesentery and lymphatics.

Indicated for lethargic states subject to weather changes.

Spasmolytic to gall-ducts and bronchi.

AlterativeDiureticDemulcent

Hepatitis, jaundice, gallstones—from obstructive pathology.

Indigestion, spastic constipation.

Intestinal putrefaction. Eczema and scrofulous

diseases— Oral and local.

Ophthalmia, conjunctivitis— Lotion of infusion.

Chelone glabra A mild hepatic influencing the

mucous membranes: stimulates the appetite and tones the stomach.

Suitable for children and the elderly.

Indicated for gastro-intestinal disturbances after prolonged illness.

CholagogueTonicVermifuge

Atonic conditions, malaise and debility, convalescence—

Use freely with more stimulating agents.

Dyspepsia, mal-assimilation— With suitable alteratives.

Round and thread worms— Frequent doses until purgation.

Colitis from hepatic dysfunction.

Chronic jaundice.Chionanthes virginica Relaxing and stimulating hepatic

and alterative: stimulates the discharge of bile, promotes digestion of fats.

Corrects excessive discharge of mucus into the gastro-intestinal tract.

CholagogueTonicDiuretic

Duodenal catarrh, hepatic torpor, catarrhal jaundice, gallstones— With Berberis.

Alimentary glycosuria. Pancreatic disease and

glandular disorders. Chronic disease of

liver/spleen.Leptandra virginica Mild relaxing hepatic for torpid

and congestive conditions: influences liver tubuli to assist secretion of bile, cleanses the alimentary tract of viscid mucus, and stimulates peristalsis.

CholagogueCatharticAntiseptic

Hepatitis, cholecystitis. Chronic hepatic torpor— Combine with stimulating

agents. Non-obstructive jaundice. Febrile states (to clear

bowel)— With diffusives. Rectal prolapse /

haemorrhoids— With Collinsonia. Skin eruptions— With alteratives.

74

ORGAN REMEDIES: KIDNEYS AND BLADDERSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueCapsella bursa-pastoris Mildly relaxing and gently

stimulating to the kidneys and urinary tract: relieves atonic and catarrhal conditions, and controls haemorrhages.

Tonic to the pelvic organs. Especially indicated when the

urine is heavy with phosphatic and `brick-dust' sediments.

DiureticAstringent

Vesico-renal irritation from atonic states. Enuresis— With Agrimonia.

Passive capillary haemorrhages, functional menorrhagia, bleeding fibroid tumours, metrorrhagia—

Fresh plant preparations are best for haemorrhages.

Congestive leucorrhoea. Internal haemorrhage of

lungs and bowels, recurrent epistaxis—

Haemorrhoids—

With more powerful astringents when necessary.

Equisetum arvense Principal action on the bladder:

increases connective tissue tone and resistance.

Stimulating tonic diuretic, gradually increasing the flow of urine.

Controls inflammatory conditions.

Astringent in passive haemorrhages.

DiureticStimulantTonicAstringent

Acute cystitis with stricture and urethritis—

With Zea mays or Triticum repens for demulcent support.

Enuresis/incontinence in children and the elderly. Haematuria.

Oedematous catarrhal congestion of pelvic organs and tissues.

Renal calculi— Infusion of the green herb. Dropsy. Metabolic oedema

of legs— Cold water infusion.

Enlarged/inflamed prostate gland.

Rhus aromatica Stimulating, toning and astringent

to genito-urinary and gastro-intestinal mucosa.

Especially indicated for frequency of micturition due to atonic conditions.

Influences renal tubular reabsorption.

AstringentTonic

Enuresis, polyuria, haematuria.

Haemorrhagic tendencies at the menopause.

Diarrhoea, dysentery, cholera infantum.

Diabetes insipidus.

For all uses, with:Geranium, to reinforce astringency;

Capsicum/Xanthoxylum, for greater stimulation and quicker result.

Uva ursi Increases renal circulation and

stimulates tubular function. Restores mucous membrane of

urinary and genital structures, especially when pale, flabby and oedematous.

Indicated for chronic conditions.

AstringentTonicAntiseptic

Chronic vesical irritation with pain and catarrhal discharge.

Chronic urethritis. Cystitis, haematuria,

enuresis— With Rhus aromatica. Atonic leucorrhoea, profuse

menstruation, uterine prolapse, vaginal laxity— With Mitchella.

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ORGAN REMEDIES: GENITALSpecial Characteristics Auxiliary Individual Indications Combinations and TechniqueAletris farinosa Gently stimulating and toning:

mainly influences female generative system.

Indicated for dysfunctions arising from lack of tone and anaemia, especially at the menopause.

Cerebrospinal trophorestorative (spinal).

TonicStomachic

Amenorrhoea, dysmenorrhoea— With Caulophyllum.

Leucorrhoea (atonic-anaemic).

Premature/profuse menstruation.

Impotence and sterility— Continue for some months. Parturient: prevents

miscarriage— With Viburnum /

Caulophyllum. Dyspepsia of pregnancy— Small doses 2-3 times daily.

Caulophyllum thalictroides Gently diffusive stimulating

relaxant: uterine vaso-dilator, antispasmodic in all spastic and irritable states.

Indicated for atonic conditions and for deficient contractions in parturition.

Cerebrospinal trophorestorative (optic).

NervineAntispasmodicDiuretic

Metritis, endometritis, ovaritis.

Dysmenorrhoeic colic. Urethritis, vaginitis, thrush

— Oral, and local douche. Restlessness during

pregnancy— With Scutellaria. Menopausal pains and

discomforts— With Cimicifuga. Uterine sub-involution.

Helonias dioica Positively stimulating in

depressed function of uterus and ovaries: tones pelvic tissues, promotes appetite and assimilation.

Reproductive tonic for both sexes. Cerebrospinal trophorestorative

(mental).

Diuretic Uterine stony/prolapse, vaginal laxity, menopausal debility—

In general, give small doses 3-6 times daily.

Leucorrhoea, menorrhagia, post-partum haemorrhage—

With Viburnum + Dioscorea.

Threatened miscarriage— Small dose every 15-60 minutes.

Anorexia, anaemia, sterility.

Mitchella repens Moderately stimulating tonic for

weak and feeble conditions: influences the pelvic organs, stomach, bowel, kidneys and nervous system.

Indicated for female weakness: improves neuromuscular/vascular tone of uterus.

TonicDiureticAstringent

Neurasthenia, irritability— With Avena sativa. Enlarged atonic uterus— With Aletris/Helonias. To facilitate parturition— With Caulophyllum. Uterine bleeding from

weakness, post-partum haemorrhage.

Spermatorrhoea. Leucorrhoea.

Nymphaea odorata Mild astringent tonic: reduces

mucous discharge. Indicated for weakness of the

pelvic organs.

DemulcentAntiseptic

Acrid leucorrhoea, ulceration of the cervix, vaginal laxity—

Local douche or suppository.

Cystic catarrh, prostatitis. Aphthous sore mouth— Decoction as mouthwash. Purulent ophthalmia— Decoction as lotion/wash. Diarrhoea, dysentery.

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ORGAN REMEDIES: GENITAL – continued…Special Characteristics Auxiliary Individual Indications Combinations and TechniqueSalix nigra Genito-urinary tonic: allays

irritation and restores vigour to the generative organs of both sexes.

Positive bitter tonic nervine.

NervineAstringentAnaphrodisiac

Cystitis, ovaritis, prostatitis Vaginitis, leucorrhoea— As douche of decoction. Proctitis— As rectal injection of

decoction. Spermatorrhoea,

masturbation.Senecio aureus Specific tonic to the nervous and

muscular structures of the uterus: relaxing and slowly stimulating in hyperaemic and atonic conditions.

Uterine ganglionic vaso-relaxant.

DiureticAstringentEmmenagogue

Dysmenorrhoea (anaemic/atonic)—

With Viburnum opul. / Caulophyllum.

Menses retarded or suppressed—

With more positive emmenagogues.

Menses premature or too profuse.

Atonic leucorrhoea. Functional amenorrhoea

(asthenia). Ovarian/tubal dysfunctions. Prostate enlargement

(atonic).Serenoa serrulata Genito-urinary tonic alterative:

influences glandular tissues and mucous membranes.

Indicated for wasting diseases and conditions: promotes tissue nutrition.

DiureticSedative

Atony of pelvic organs— With Senecio. Wasting of testes,

impotence, undeveloped mammary glands.

Enuresis/incontinence in children and the elderly.

Trillium pendulum Genito-urinary astringent tonic:

General action on the mucous membrane and specific for pelvic organ weakness.

Indicated for passive haemorrhages of uterine, gastric or rectal origin.

AlterativeAstringent

Leucorrhoea, prolapse, vaginal weakness.

Uterine haemorrhage— Local tampons of decoction. Menopausal menorrhagia. Passive haemorrhage from

fibroids.

Viburnum prunifolium Soothing, stimulating astringent

tonic especially influencing the genito-urinary system.

Indicated for spasms of tubular organs: stomach, intestines, bladder, uterus.

NervineAntispasmodicAstringentDiuretic

Uterine prolapse, vaginal laxity.

Atonic amenorrhoea— With Senecio. Passive/menopausal

menorrhagia. Morning sickness, false

labour pains, threatened abortion.

Excessive lochial discharge.

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Part 3

HERBAL PREPARATIONS

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Introductory

The preparation of a herbal medicine, whether intended for internal or external use, for a long-term or short-term therapeutic objective, is always related to the specific problem in the patient, rather than to a named medical syndrome. That being so, then the following instructions are concerned solely with those operations best described as `compounding and dispensing', and not with the production and manufacture of set formulae on a large scale for retail distribution. Hence all the procedures described require no more than the simple hand tools and bench techniques of the consultant herbalist or naturopath, and are directed to the dispensing of an individual personal prescription.

The objectives of the prescription will decide which special properties of the plant are required, and this in turn will determine the state and part needed: whether fresh plant or dried root, bark, stem, leaves or flowers. Unfortunately, the available commercial extractives, produced almost entirely from dried herbal material, are insufficient for professional needs, and the conscientious practitioner will inevitably require to collect many of his own medicinal plants, especially those required for mother tinctures and fresh plant preparations. Thus, the ultimate objective in the personal prescription will influence the conditions of gathering the raw material, and will decide the means and menstrua for the extraction of the specific properties needed.

Herb gathering

The times for gathering herbs will depend upon the part of the plant to be used. The following are the general rules for collecting plant material:

Leaves, stems and foliage: when fully matured, usually before full development of the flower.

Flowers: when fully developed, that is, when aromatic principles are readily detectable by smell, or oil content is evident, etc.

Roots: in the early spring before the sap rises, or in the late autumn when the aerial parts have died back.

Seeds, fruits, berries: when fully ripened.

Barks, root-barks: in the autumn and winter (discard the rough exterior portion of barks).

-but some compromise and specific adaptation may be needed. For example, Ballota nigra is best gathered when the flower is at full maturity, and both flowers and leaves exude the particular odour of the essential oil upon which the therapeutic activity may largely depend. This may mean that some leaves have begun to wither, and in fact the gatherer needs to be rather particular in accepting or rejecting certain plants. Such a standard of selectivity in gathering is unlikely to be achieved by commercial interests, in which there is a tendency to harvest before full maturity to avoid or offset degenerative processes during drying and storage.

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Drying and processing

Aerial parts and roots should be cut into fine transverse sections while still green and then dried. The following are the necessary conditions for drying:

(a) Dry all plants, roots, barks and fruits in the shade. Never expose to direct sunshine, and dry within a room or shed rather than out of doors where atmospheric conditions are likely to vary greatly.

(b) Do not dry too quickly, especially if the material contains natural oils. The drying room temperature should not exceed 85 deg. F.

(c) The atmosphere of the room should be dry and free from dusts and insects.

(d) The plant material should be spread out in shallow trays or on shelves to avoid dense massing, which would tend to give rise to fermentation or moulding. Fruits and moist thick roots are especially vulnerable.

The various extractive processes consist of the treatment of plant tissue by suitable solvent liquids, whereby the medicinally active principles are dissolved out, leaving behind the cell tissue and inert matter. Typical solvents are: water, wine, vinegar, alcohol, oil, glycerine and aether. A menstruum is chosen which is a selective solvent, one which will completely dissolve the desired constituents but will dissolve little or none of the inert matter. The raw material will require further treatment by some method of comminution to reduce it to a fine or coarse powder of variable particle size to suit the extractive method chosen.

Comminution

Various mechanical grinders are available for particle size reduction of dry plant material. Fresh plant material intended for tincturing is preferably minced (soft aerial parts) or sliced (roots), and simple hand-powered domestic utensils are usually adequate. Dry plant material may be reduced to coarse particles in a heavy iron mortar where only very small quantities are involved, otherwise, hand- or electric-powered grinders are necessary. A hand-powered disc mill is adequate for granulating all but the hardest roots (e.g. Collinsonia, Phytolacca). The latter are best purchased from the supplier in powdered form.

Powdered herbs are graded commercially according to mesh size. For example, a number 10 powder is that which would pass through a sieve having 10 meshes to the linear inch. There are five grades generally available from suppliers (subject to an order for minimum quantity) as follows:

Coarse (No. 20), moderately coarse (No. 40) and moderately fine (No. 50)-as drugs intended for maceration and percolation.

Fine (No. 60) and very fine (No. 80)-for pills, tablets, dispensed powders and suspensions.

Water causes expansion of drugs and easily penetrates, whereas 60% or more of alcohol in solution hardens vegetable tissue so that a higher degree of comminution is required for those agents which need a strong alcoholic menstruum.

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Plant constituents

All fluid preparations require that the medicinally active constituents be dissolved out by treating the plant material with a suitable solvent. The aim should be to obtain maximum extraction of these constituents while yet leaving behind cell tissue and inert matter. The common preparations are: infusions, decoctions, tinctures, fluid extracts and soft or powdered extracts. Such preparations are referred to as galenicals.

The following considerations arise in relation to fluid preparations:

i. Size reduction-comminution by suitable means to a size suited to the proposed method of extraction.

ii. Extraction by a menstruum which is a selective solvent for the properties required.

iii. Dilution or concentration of the extractive solution to a certain standard.iv. Clarification of the finished product by filtration or sedimentation.v. Recovery of the residual menstruum from the marc.

Before deciding upon a suitable menstruum, it is necessary to know the solubility of the various typical constituents of medicinal plants:

Glycosides: soluble in water and alcohol. Glycosides are rendered inactive by hydrolysis in aqueous solutions, but this may be largely controlled by the alcohol content of the menstruum.

Saponins: soluble in water. Saponins undergo hydrolysis with formation of sugar and precipitation. This reaction is partially controlled in alcoholic solutions.

Enzymes: soluble in water, insoluble in alcohol. Enzymes are rendered inactive in alcoholic solutions and are destroyed by high temperatures. Thus, the deliberate addition of alcohol to a fresh plant tincture containing glycosides is to prevent destruction of the latter by enzymes as well as to inhibit hydrolysis.

Alkaloids: soluble as such in alcohol and aether, slightly soluble in water. Alkaloids generally exist in the plant as alkaloidal salts which are soluble in both alcohol and water. Alkaloids may be unstable on heating.

Tannins: soluble in water and glycerine.

Essential oils: very soluble in alcohol and aether, slightly soluble in water. Essential oils are odoriferous, volatile at low temperatures, and vaporised by boiling water. They are slightly soluble in cold water, and form the basis of the various medicinal waters.

Resins: soluble in alcohol, insoluble in water. Resins are also soluble in oils and aether, and in plants are often combined with essential oils as balsams. Resins will melt at a temperature near to that of boiling water.

Gums: are contained in abundance in vegetation. Being soluble in water, the liquid state in the plant is termed a mucilage, and it is only the dry concrete state of the substance which is referred to as a gum. Mucilages are of use in medicine for their lubricating and soothing qualities, and often provide some degree of nutrition. Gums are insoluble in alcohol, and where gums are undesirable in any preparation, a solvent is chosen that will inhibit solution of the gummy constitutents.

Gum-resins: soluble partly in water and partly in alcohol.

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Proteins: Albumins are soluble in water, insoluble in alcohol and are coagulated by heat. Globulins are insoluble in water and alcohol as such, but soluble in saline solutions.

Proteins are considered to be undesirable in pharmaceutical preparations as being inert and liable to putrefactive processes. Physiomedical authorities, especially J. M. Thurston, have always reserved opinion on this matter and have not accepted the orthodox view that medicinal action is solely due to the so-called active principles. Modern research on plant medicines tends to confirm this reservation.

Where it is desired to remove protein from a fluid preparation, the following means are available:

i. Using alcoholic solution as the solvent.ii. Precipitating the proteins from an aqueous extraction by adding alcohol

afterwards.iii. Coagulation and precipitation by heat, either by boiling the plant as part of the

extractive process, or by boiling the aqueous extract.iv. Precipitation by adding acids.

Fixed oils: soluble in aether and petroleum, insoluble in water and not volatilised by boiling. Fixed oils in plant material exist largely in the seeds or fruits, from which it is removed by expression or decoction. More than a small proportion of fixed oil in a plant tissue will greatly reduce the solvent action of alcoholic/aqueous solutions. In such cases, defatting is a necessary preliminary if the oil is not required.

It will be seen from a study of the above notes that alcohol is necessary in liquid preparations for the following reasons:

i. To control hydrolysis of glycosides and saponins.ii. To dissolve and carry alkaloids, resins and essential oils.iii. To inhibit the solution of undesirable constituents, especially the inert gummy

substances.iv. To inactivate enzymes which are destructive to alkaloids.

It may also be necessary to avoid high temperatures during the extract processing, since heat may:

i. destroy enzymes required,ii. drive off volatile constituents: essential oils, iii. coagulate plant proteins

required, dissolve out too much inert material: gums, etc.iii. coagulate plant proteins required,iv. dissolve out too much inert material: gums, etc.

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Fluid Preparations

By far the greater proportion of herbal prescriptions consists of compounds of fluid preparations: infusions, decoctions, tinctures, fluid extracts, syrups, elixirs, and since there are variable standards and procedures concerning these preparations, some confusion arises in deciding when any particular preparation is to be considered the one or the other. The concentration of the agent in the final fluid preparation may vary from 1 part in 1 to 1 part in 20 (w/v), and although a fluid extract is commonly 1:1, whereas an infusion is usually 1:20, it by no means follows that the drug/fluid ratio is the deciding factor. A tincture is classically a preparation based upon maceration in solution of alcohol, yet alcohol is certainly also necessary in the making of fluid extracts and may be added to infusions and decoctions for preservation. Moreover, an `aqueous' tincture contains no alcohol. Greatest confusion exists in deciding the difference between:

i. Infusions and decoctions. ii. Decoctions and tinctures. iii. Concentrated decoctions and fluid extracts. iv. Tinctures and fluid extracts.

Bearing in mind the solubilities of the typical plant constituents, it would seem that the best solvent for general use would be a mixture of water and alcohol, with or without glycerine to dissolve tannins. The alcohol proportion must be sufficient to hold the resins, alkaloids and essential oils, but not so high as to prevent solution of plant proteins and valuable enzymes where these constituents are desired. Prolonged subjection to heat processing is best avoided, even with infusions and decoctions which require the use of boiling water. With these points in mind, physiomedical authorities differ from orthodox pharmacists in the formulae for solvent solutions and menstrua, as well as in the directions for extract processing.

Infusions and decoctions

Infusions and decoctions are similar in being weak extracts of herbs usually made by adding boiling water, or by boiling for a specified time. The exact proportion of herb to water varies, but the standard is 1 oz. of the dried herb to 1 pint of water as finished infusion or decoction. The nature of the plant material will determine the technique to be employed, but as a general rule the harder parts of the plant, such as roots or bark, are treated by decoction, and the lighter aerial parts by infusion.

A typical infusion is made by pouring 1 pint of boiling water on to 1 oz. of herb placed in an infusion jug or earthenware teapot. Place the lid on the jug or pot immediately, and set aside in a warm place for 10-15 minutes, stirring from time to time. Then allow to settle and decant, or strain and filter. In general, the best form of the herb for infusion is as a fine granulation (similar to Indian or China tea). If powders are used, then they should be no finer than No. 20 powder in the case of aerial parts, and in these circumstances filtration through cotton or filter paper is essential (the Melitta type coffee filter is excellent for the purpose).

The proportion of 1 oz. to 1 pint for infusions is not a fixed rule. J. H. Greer (Physician in the House, 1897) recommends a smaller quantity to the pint-say half-ounce-for bitter herbs, and

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still less for stimulants such as capsicum, prickly ash bark and ginger root. The usual wineglassful dose (2 fluid ounces) of an infusion three times daily for a chronic condition used on a long-term basis would tend to be too high, and in such cases a strength of half-ounce to the pint will be sufficient.

Aromatic drugs and those containing tannin or volatile oils are preferably treated with warm rather than boiling water in order to conserve the therapeutic value. In such cases, the material should steep for half an hour or longer. In a few cases, cold water should be used, e.g. Prunus virginicus, and the material left to macerate for at least 24 hours.

A typical decoction is made by pouring 1'/a pints of cold water on to the plant material, say 1 oz., set aside for 12 hours, then bring to the boil and continue boiling for 10-20 minutes. Strain off, and make up to 1 pint in volume by pouring more hot water through the herb in the strainer. Since the method of decoction is reserved for the harder materials, it will also be necessary to reduce the particle size to that of fine granulation (similar to finely ground coffee). Where drugs contain aromatic principles, then the method of closed percolation could be used (as for coffee), or the drug should be reduced to very fine powder and treated by infusion in a closed vessel.

Mucilages are infusions or decoctions of herbs having marked mucilaginous properties. They must be made entirely according to the specific technique for the agent, the proportion of water being adjusted for the mucilaginous property concerned and the strength desired.

If infusions and decoctions are to be stored, then some preservative such as alcohol, chloroform, glycerine, sulphur dioxide, etc. will need to be added.

Tinctures

Tinctures are alcoholic solutions of the active properties of plant material. Not all substances contained in herbs are sufficiently soluble in water, even when using the relatively high proportions of infusions and decoctions (product/drug ratio = 20 :1), and aqueous extracts may contain too much gum or inert matter. The usual menstruum used in tinctures is therefore a solution of alcohol in water.

All official tinctures are made with alcoholic solution or pure alcohol, the majority of herbal tinctures containing 60% alcohol. The official definition of a tincture is stated to be a product which:

i. Contains at least 45% alcohol.ii. Has a product/drug ratio of at least 4:1. (Most B.P.C. herbal tinctures are 10:1.)

This is to distinguish concentrated infusions and decoctions which are seldom more than 25% alcohol, and fluid extracts which usually have a product/drug ratio of 1:1.

J. M. Thurston (Physiomedical Pharmacy, 1897) did not agree with such a high proportion of alcohol for tincturing and considered that even for agents containing volatile, resinous or gum-resinous principles, a much more normal therapeutic value is obtained with a menstruum of 30-40% alcohol. The British Herbal Pharmacopoeia (1972), for the most part gives a 45% alcohol menstruum for simple herbal tinctures, but higher alcohol proportions for those plant materials with a high resinous or volatile oil content. The lower alcohol

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proportion advocated by physiomedical writers means that 73% proof spirit (brandy) could be used to make tinctures on a smaller domestic scale (73% proof spirit = approx. 42% alcohol). While this would be rather expensive for making dry plant tinctures, the cost is acceptable for fresh plant preparations.

The particular uses for tinctures are in those cases where heat or other processing would destroy the properties of the agent. They are more easily made than fluid extracts, they keep indefinitely, and do not contain an undue quantity of gum or inert matter. The mixture of alcohol and water is capable of extracting all the medicinally active constituents. The actual processing techniques of maceration and percolation are similar to those described under fluid extracts.

Tinctures may be prepared from finely granulated or powdered plant material. It does not follow that it is always best to have the drug powdered, since subsequent percolation or filtration may be very slow, or the percolator may be clogged altogether. On the other hand, the particle size must be sufficiently small to allow full extraction during the process of maceration. A further practical difficulty at present is that supplies of dry herbs, roots and barks are for the most part too coarsely cut, and preliminary treatment with a hand granulator is essential. When this granulated material is packed into the macerating vessel it will be found that a solvent solution volume of five times the weight of the herb is required to cover the material. A smaller particle size would need less menstruum to cover, but it is convenient to work to the same standard proportion for all tinctures. The following technique is suggested:

Herb, root or bark-granulated or powered . . . . . . . . 4 oz. (100 g.)

Solution of alcohol (15-45%) . . . . . . . . . . . . . . . . . 20 oz. (500 ml.)

Place together in a closed vessel (say: Kilner 2 lb. size bottling jar). Macerate for 10 days, shaking daily. Transfer to filter or percolator and filter freely to recover 20 oz. (500 ml.), adding distilled water to the marc as may become necessary.

Where the active constituents in the herb are completely water soluble, a 15% alcoholic menstruum is quite sufficient to preserve the tincture.

In this case, a good quality dry or medium sweet sherry wine can be used as the menstruum.

Fresh plant tinctures

Tinctures made from `green' herbs and roots are for the most part not available from commercial suppliers. In many cases, the therapeutic potency of fresh plant tinctures greatly exceeds that of the dry plant equivalents, and such agents as Phytolacca, Thuja and Ballota are preferred in the fresh plant form. Homoeopathic mother tinctures of herbs are almost always from the fresh plant, since the dry plant products provide less satisfactory potencies.

Where it is desired to make a fresh plant tincture with a view to subsequent homoeopathic potentisation, then the strict directions of the Homoeopathic Pharmacopoeia of the United States, 7th edition 1964, should be followed. This source gives precise details on fluid content of the moist magma, alcohol strength to be used for the mother tincture, and alcohol dilutions for the lower potencies.

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The essential basic requirements of fresh plant tinctures are:

i. The material must be processed as soon as possible after gathering.ii. No heat is to be used at any stage of preparation.

The fresh plants are gathered when free from rain or dew and collected in plastic bags which are then sealed to prevent drying out of the material during the few hours before being processed. Providing the material is clean and can be guaranteed to be free from pollution, washing is not necessary. Otherwise, the material is washed in cold water and then well drained. Even so, the raw material should be weighed before and after washing in order to make allowance for the retained water. Fresh roots will require particular care in cleaning off earth, embedded grit and small stones, if one is to safeguard the cutting edge of the mincer.

The material is then reduced to small particle size. Light aerial parts may be finely chopped with a view to pressing in due course in a tincture press. Alternatively, the herb may be put through a mincer, a method also suitable for fine roots or small whole plants. Large roots are better thinly sliced, especially if rather soft and starchy, e.g. Symphytum. Minced material may be ultimately pressed if not too mucilaginous, or filtered in a percolator. Berries and fruits need merely to be bruised or crushed.

The reduced plant material is then macerated in a solution of alcohol. In view of the high product/drug ratio, high alcohol proportions are unnecessary. A 25-40% alcoholic menstruum is sufficient even for plants containing essential oils, so that on a small scale of production diluted brandy, the corresponding commercial tincture (dry plant), or even dry sherry wine (17% alcohol) is suitable. However, the high moisture content of the fresh plant must be remembered when computing the alcohol content necessary as a minimum to preserve the final tincture, and where it is necessary to preserve alkaloidal value or inhibit enzyme destruction of active principles, then the alcohol proportion will need to be higher. Tinctures intended for external use only may be prepared with diluted industrial or isopropyl alcohol. A small proportion of glycerine (say 5%a) in the menstruum is useful in preventing sedimentation and helping to buffer incompatible solubilities, but this should not be added if it is intended to use the fresh plant tincture for making tablets or pilules.

After the material has macerated for at least 10 days, it is transferred to the tincture press or percolator for expression or filtration. In the case of filtration in a percolator, allow the completion of free percolation, and then add water to the marc to displace the residual tincture held in the marc by capillarity. Alternatively, the residual tincture may be left in the marc, and the wet marc infused in boiling oil to be later used as a basis for ointment. This economical method is very useful with such plants as Stellaria, Sambucus, Calendula, etc. in the making of emulsion creams.

Because of the variable water content of the moist magma, it is difficult to be precise about the quantity of menstruum required for each one pound of fresh plant material, since this will differ from plant to plant and will also be affected by the amount of retained washing water, or the degree to which the plant may have dried out since gathering. The best method is to allow the minced material to drop from the mincer into a dish containing the menstruum. When the mixture has reached the consistency of a thick soup it can be transferred to a closed vessel for maceration. Thinly sliced roots should be layered into the macerating vessel and then just covered with the menstruum. Bruised berries and fresh fruits (e.g. Crataegus berries, Phytolacca berries) lightly crushed should be placed in the vessel in such a way as to avoid

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massing, which would prevent the macerating action of the solvent solution. In such cases the tincture is filtered off and the residual marc used to make a syrup.

Medicinal syrups

Just as `tinctures' are likely to be produced commercially by adding fluid extract to dilute alcohol, so the modern practice of making a medicinal syrup by adding fluid extract to simple syrup is equally unsatisfactory. It is commonly acknowledged that for the majority of herbal simples, an infusion or decoction is the most powerful medicinal preparation, and the old physiomedicalists would consider no other form in the treatment of acute conditions where immediate and powerful remedial effects are required. When infusions and decoctions are prepared for such use then no problem of preservation arises, but for ordinary clinical dispensing such preparations need to be preserved, either by adding alcohol, chloroform or sulphur dioxide, or better still, by making a syrup.

Certain herbal preparations need to be in syrup form for best effect. Many liver relaxants, laxative compounds and cough mixtures are preferable as syrups. Cough medicines also need to be emollient and mucilaginous, so that a compound of decoctions is an ideal basis for such medicines. Thus, there are various clinical situations where the medicinal syrup will have little value unless based upon a concentrated decoction.

For sugar to be an adequate preservative, it must be present in the syrup in the proportion of 2:1 w/v, that is, 2 parts by weight of sugar to I part by volume of water, hence the well-known formula for simple syrup: 2 lb. white sugar to 16 fluid ounces of distilled water, and as such will keep indefinitely. However, since this proportion constitutes a super-saturated solution, then not only must the solution be boiled gently until all the crystals of sugar have completely dissolved, otherwise it will re-crystallise, but it is also prone to re-crystallise on long storage in the stock bottle. It is found that a proportion of 2 16. sugar to 1 pint of water avoids this difficulty, and at the same time will provide adequate preservation, providing the dispensary is kept cool, and storage is not too prolonged, and in the busy practice problems of precipitation or deterioration seldom arise for medicinal syrups made from concentrated decoctions in this way. An example of the simple technique is as follows:

Syrupus Chelone

Balmony herb-cut (Chelone glabra) . . . . . . 8 oz. (200 g.) Boiled or distilled water . . . . . . . . . . . . . . . 80 oz. (2 litres)

Make a decoction by bringing the water to the boil, stirring in the herb and boiling gently for 10 minutes. Strain or express the decoction, transfer to a water bath and reduce at 140-160 deg. F. down to 20 oz. (500 ml). Transfer the concentrated decoction to a saucepan, add 2 16. (800 g.) of granulated white sugar and stir over gentle heat until the sugar has completely dissolved. When cool pour into a 40 oz. (1 litre) bottle. (Figures in brackets are the metric alternatives.)

It will be seen that the product/drug ratio is 5:1, with a dose level of 1-2 teaspoons (5-10 ml.) of the medicinal syrup. This method is particularly suitable for all water-soluble agents and completely avoids the use of alcohol, chloroform or toxic chemical preservatives.

Opportunities also arise for using the dry plant or fresh plant marc to make a medicinal syrup after the first tincture has been filtered off. This may be done as a particular technique in the case of agents which have a dual action, e.g. Juglans cinerea, where an alcoholic extractive

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may be used as an astringent tonic in diarrhoea, and an aqueous syrup as a laxative in constipation. In other cases, further maceration with water or weak sugar solution may provide the best method for extracting the residual properties. For Juglans cinerea proceed as follows:

Butternut rootbark (Juglans cin.) in coarse powder . . . 8 oz.

40% alcohol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 oz.

Macerate in a closed vessel for 10 days. Transfer to the percolatorand recover 32 oz. by free percolation, adding distilled water to themarc as may be necessary. This is set aside as he tincture.

Transfer the marc to a covered vessel over mater-bath and add sufficient water to cover well. Digest at a heat of 140-160 deg. F. for 2 hours, then transfer to the percolator. Percolate freely until the marc is exhausted. Reduce the percolate over a water-bath to 10 oz. in which dissolve 1 lb. sugar. This produces 1 pint of Syrup of Juglans of moderate strength.

Many fresh fruits and berries are best extracted and stored in syrup forms. J. M. Thurston preferred such a preparation for Phytolacca berries. The presence of sugar in the extractive, either as medicinal syrup, elixir, or saccharo-alcoholic fluid extract is useful to keep pectin and other substances in solution.

Some of the older physiomedical authors, notably Wooster Beach (Reformed Practice of Medicine, 1859) and J. H. Greer (A Physician in the House, 1897), while acknowledging the need to use alcohol in the extractive process, yet preferred to remove it from the final product and to rely upon sugar as the preservative. The following directions are condensed from J. H. Greer:

To make 80 oz. syrup

1 lb. drugs in coarse powder to be macerated for 24 hours in a solution of alcohol (1 part) in water (8 parts) sufficient to cover the drugs. Strain off and set aside this first solution.

Cover again with warm water and allow to stand for 4 hours. Percolate this to recover 1 quart, which add to the first alcoholic solution. Add 4 lb. white sugar to the combined fluids, place over gentle heat to melt the sugar and drive off the alcohol, and reduce to 76 fluid ounces. To this add 4 oz. glycerine as preservative.

The above technique is satisfactory for all but highly resinous drugs or those where the properties would be lost by heating. The glycerine only helps the preservation, but does hold in solution the alcohol-soluble constituents which would otherwise tend to precipitate. The alcohol proportion could be increased to 25% if necessary.

Infused oils

It is often not realised that a fixed oil will take up certain properties of plants by hot infusion or decoction. Such properties are naturally oil-soluble, and consist of essential oils, aromatic principles, resins and oleo-resins. A small range of such infused oils can form the basis for various topical preparations: lotions, liniments, ointments, plasters and suppositories.

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Infused oils may be prepared from the finely powdered herbs: Capsicum, Fucus, Lobelia and Symphytum, in the proportion of 1 part powder by weight to 10 parts rapeseed oil by volume, by the process of decoction. Such infused oils may be prescribed singly or in combination as mildly stimulating, relaxing or toning liniments for various skeletal problems, or as the basis for stronger preparations when the therapeutic effect is reinforced by the addition of the more powerful essential oils-Caryophyllum, Origanum, Salvia, Lobelia, etc.

The following example illustrates the method for infused oil of Capsicum, which serves as a model for all others:

Capsicum minimum-in fine powder . . . . . . . . . . . . 4 oz. (100 g.)Oil of Rapeseed . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 oz. (1 litre)

Mix together smoothly, place in a closed vessel over a water-bath and digest at 140-160 deg. F. for 4 hours. Then remove from heat, allow to cool, and leave for 12 hours for the powder to settle. Then carefully pour off the clear oil.

Instead of combining the infused oils for an individual prescription, stock combinations may be prepared from the mixed powders, leaving the oil-saturated marc to be used as the basis for counter-stimulant plasters. (See section on Plasters.)

Just as fresh plant tinctures are in many cases better than their dry plant counterparts, so lotions, ointments and other forms of surface medication based upon fresh plant oil infusions may be preferred to dry plant products. The first step in the process is to digest the fresh plant material: flowers, leaves, sliced roots, etc. in hot olive oil for 1 hour over a water-bath. Since the same agents are often also needed as tinctures, it serves a dual purpose to use the saturated tincture mare to make the oil infusion after the first percolate has been recovered. Thus, the wet mare is placed in a vessel, just covered with olive oil, heated to simmering point and kept at a steady heat sufficient to drive off the residual menstruum and to reduce the mare to a crisp state. The oil is then strained off, allowed to cool, filtered and bottled. Of course, the quantitative ratios are not critical for this type of preparation, but then vital medicines of this nature do not depend upon a quantitative principle.

Where it is desired to avoid the use of heat in preparing the infused oil, and this especially applies to preparations from flowers, e.g. Calendula, Sambucus, etc. the following method is used:

Fill a Kilner preserving jar of the required size with alternate layers of cotton-wool and flowers, each layer not exceeding onequarter of an inch. Layer lightly and do not compress, so that interspaces are left. Fill up the jar with olive oil, seal the jar with cap and screw lid, and set aside in a cool dark place for one month. In due course, remove the contents of the jar, keeping the whole together and the layering intact as far as possible, and place in a tincture press. Press out the oil by slow steady pressure. Filter if necessary to remove particles and dust. Preferably store in brown glass bottles.

The fresh plant infused oils are held in stock for the dispensing of individual prescriptions for emulsions, creams, ointments and oil-based suppositories. Because of its greater oleaginous property, olive oil is preferred as the basis for these, whereas infused oils intended for liniments or rubbing oils are better prepared from rape-seed oil which is less greasy.

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Fluid extracts

Fluid extracts are concentrated alcoholic or aqueous extracts of herbal material in which the product/drug ratio is officially 1:1, that is: 1 part by weight of the finished fluid extract represents the soluble content of 1 part by weight of the crude drug. Fluid extracts thus represent highly concentrated preparations as compared with infusions, decoctions or tinctures.

Reference to the considerations stated in the `Introductory' chapter under `Plant constituents' will show the need to employ either water or a solution of alcohol as the solvent of the essential properties of the drug concerned, but as stated in the section on `Tinctures', very high alcohol proportion is not favoured. The physiomedical view that the value of the whole plant should be represented, rather than that one isolated constituent should be the objective, resulted in the evolution of J. M. Thurston's `normal' fluid extracts and the avoidance of high alcoholic extractions, even for resinous drugs. These `normal' fluid extracts consist of the extraction by boiling water, or by maceration with the smallest possible percentage of alcohol. The old herbalists and doctors of the physiomedical school considered the most potent therapeutic agent to be a hot infusion. The quantity of water used in an infusion or decoction is such that in most cases at least enough of the resinous and aromatic properties for the immediate purpose are dissolved out, as well as the plant proteins and other valuable constituents.

However, fluid extracts are not merely concentrated decoctions, and the following considerations must decide the extraction technique to be employed in any particular case in order to ensure that the extract is a balanced product representing the whole herb or part accordingly:

1. Many herbs contain thermolabile constituents which are destroyed by high temperatures. The prolonged processing and reduction by heat involved in 1:1 fluid extracts would tend to render them inert.

2. According to J. M. Thurston, even resinous preparations need no more than a 33% alcohol solution.

3. Where not otherwise contra-indicated, boiling water will extract sufficient of the resinous principles for general use, and at the same time will extract other properties-proteins, enzymes, etc.-which may be an essential part of the plant property.

Arising from these considerations, a physiomedical fluid extract should involve (i) the lowest possible level of heat processing and evaporation, (ii) the lowest possible proportion of alcohol in the menstruum consistent with the best representation of the whole plant value, (iii) the use of distilled water generally as the best menstruum, and (iv) the use of minimum alcohol, glycerine or sugar as preservative of the final product.

It is obvious that those agents whose properties are fully soluble in water may be produced without alcohol, and extracts of such materials will be made on a basis of hot decoction or cold maceration as may be appropriate. (See Appendix 2 for J. M. Thurston's list of agents suitable for making `normal' fluid extracts.)

Apart from those herbs where the mucilaginous property is particularly required, in which case the preferred preparation will be an infusion, decoction or syrup, the first step in the

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making of a fluid extract consists of macerating the herb in hot or cold water for a specified time, to be followed by percolation until the material is exhausted. The best technique is that of double or triple maceration adopting the principle of the reserved percolate.

The fact that the minimum drug/percolate ratio is 1:4 and that fluid extracts are officially required to be 1:1, means that the total volume of percolate must be reduced in volume by evaporation. It is in this matter that herbal practice differs from orthodox pharmacy. J. M. Thurston used a 1:2 standard, and the writers have found that the adoption of a 1:3 or 1:4 proportion avoids many difficulties of evaporation and precipitation which otherwise arise. Nor is there any need to reduce down to 1:1 only to dilute again when dispensing. The use of minimal heat and minimal alcohol, together with minimal evaporation results in a product which accords with physiomedical objective rather than with the pharmaceutical.

The maceration process is achieved by placing the drug and menstruum in a closed vessel for the prescribed time: generally 7-10 days. The plant material must be reduced to a state of fine granulation in order that the volume of menstruum will be sufficient to cover. The proportions used are similar to those stated for tinctures: 1 part drug (w) with 5 parts of menstruum (v). The vessel is shaken daily to ensure redistribution of the fluid, and at the end of the required time the content is transferred to the percolator.

The process of percolation consists of the transit of the menstruum through a column of the drug placed in a conical percolator. Percolation must be preceded by maceration, even if only for a short time in the percolator itself. The passage of the menstruum through the drug is controlled by a valve at the outlet of the percolator which allows for a variable rate of flow of the menstruum, although this rate of flow will also depend upon the particle size of the drug and the nature of the material. Practical experience will decide the most suitable degree of granulation to ensure that the marc does not clog in the percolator and so prevent the flow of liquid through the column. The addition of further quantities of menstruum to the percolator is continued until the drug is exhausted, i.e. almost clear menstruum flows from the outlet valve.

To some extent the processes of maceration and percolation overlap, especially in double and triple maceration where successive quantities of menstruum are added to the marc with intervening free percolation. On the other hand, the longer the time value of the percolation process, the more it equates with maceration. A blend of the two operations extending over several days can give virtually complete extraction of the medicinal principles. Two methods are described:

i. Triple maceration with free percolation. ii. Controlled percolation.

Triple maceration with free percolation

i. Macerate the drug in 5 times its own weight of menstruum: 15%, 25% or 60% alcohol with a small proportion of glycerine if required. The macerating vessel is preferably sealed so that the contents may be shaken thoroughly once every day to redistribute the menstruum. Continue for 7-10 days.

ii. Transfer the contents to the percolator and allow free percolation. This will yield about three-fifths the original fluid volume and is set aside as the Reserved Percolate "A".

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iii. The outlet to the percolator is closed, cold water equal in volume to the reserved percolate is added to the marc in the percolator, and maceration continued for 24 hours. At the end of this time, the percolator valve is released and free percolation allowed, yielding a quantity roughly equal in volume to the water added. This is set aside as percolate "B".

iv. Process iii. is repeated, and a further quantity of percolate ultimately collected-"C". If thought necessary, the process could be repeated again, but twice is usually the useful limit of the method.

v. The second and third percolations, B and C, are mixed and reduced over a water bath to that volume which when added to the Reserved Percolate will produce a final volume of X4, that is, the final extract will have a product/drug ratio of 4:1

It will be seen from the above that the final extract will consist of three-fourths of its volume which has not been subjected to any heating process, and one-fourth which has been subjected to minimal heating (140-160 deg. F.) during evaporation. Since the reserved percolate porportion of the original menstruum is three-fifths, and the remaining alcohol distributed throughout the subsquent percolates is driven off during evaporation, then the final product contains an alcohol proportion approximately three-fifths of that contained in the original menstruum, i.e. about 11+%, 18+% or 37+% of the final volume as the case may be. In this connection, extracts intended for long storage should be protected by at least 15% alcohol. Fractionation of the alcohol percentage in the final product may result in slight precipitation of the alcoholsoluble constituents, but in practice little trouble is experienced.

Controlled Percolationi. Moisten the powdered drug with part of the menstruum and set aside for 4 hours.ii. Lightly pack into the percolator, close the outlet, add more menstruum until the marc

is just covered, and leave to macerate for 24 hours.iii. Set the outlet valve to give the desired rate of flow-usually 120-200 drops per minute.

Allow about three-quarters of the final volume to percolate, which set aside.iv. Continue the percolation by adding more menstruum to the percolator until the drug is

exhausted. Reduce this quantity over a water bath to the amount necessary to make up. to the final volume when added to that set aside.

Where the properties of the plant are sufficiently soluble in boiling water and not affected by heat, then the method of J. M. Thurston for `Normal' fluid extracts is available, thus:

i. Place the powdered drug in a vessel, pour on twice the amount of boiling water (w/v) stirring thoroughly, cover tightly and keep hot in a hot water or steam bath at a temperature of 160 deg. F. for 10-12 hours.

ii. Transfer to a percolator (made of metal or heat-resistant glass) and displace a volume equal to the amount of boiling water originally used by adding more hot water on top of the marc as may be necessary.

iii. Allow to cool and filter.

This method yields an aqueous extract with a product/drug ratio of 2:1. These preparations are found to be generally satisfactory for water-soluble agents. They need to be preserved with chloroform, alcohol or sulphur dioxide. It should be emphasised that the drugs need to be in moderately fine powder (Mesh 50) if this quantity of menstruum is to be sufficient, and

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even so, the mare needs to be kept topped up by adding a little water from time to time while on the water bath. (See appendix for Thurston's original list of agents suited to this method.)

J. M. Thurston's method for alcoholic fluid extracts is as follows:

i. Macerate the powdered drug in a menstruum consisting of 16 oz.alcohol, 22 oz. Water for every 1 lb. of drugs.ii. Let stand for 8-10 days, frequently stirring and changing the mixture in order to redistribute the drug and menstruum.iii. Transfer to the percolator and displace 32 oz. of percolate for every 1 lb. of drugs, adding hot water to the marc as necessary. This constitutes the fluid extract.iv. Percolation with added hot water may be continued until a further 12 oz. percolate per pound is obtained, to which sufficient granulated sugar is added to make 16 oz. of syrup.

(See appendix for Thurston's original list of agents suited to this method.)

For the extraction of gum-resins, Thurston prefers a glycero-alcohol menstruum, using 10 oz. alcohol, 8 oz. glycerine and 20 oz. distilled water (v/v/v) for each 1 lb. of drugs, the glycerine being included for its solvent action upon the gums. This menstruum is especially suitable for such agents as: Myrrh, Asafoetida, Peruvian balsam, Tolu balsam, Benzoin, and Guaiacum gum.

For the extraction of some resinous plants Thurston prefers a saccharo-alcohol solvent, using 10 fl. oz. alcohol, 10 oz. sugar, and 20 fl. oz. water to each 1 lb. of powdered drugs. This is suitable for such agents as: Kino gum, Angelica, Balm of Gilead buds, Cinnamon, Cloves, juniper berries, Prickly Ash berries, etc. In all cases, the drug is macerated and subsequently percolated with cold water to obtain 32 fl. oz. for each 1 lb. of the agent.

A review of the above methods for fluid preparations reveals the essential characteristic of each type. Both infusions and decoctions are treatments by boiling water, the former by pouring on the already boiling liquid, and the latter by prolonged boiling. Being relatively dilute and prepared for immediate use, they will usually ensure sufficient content of those constituents otherwise regarded as needing an alcoholic menstruum for extraction and solution.

By contrast, tinctures and fluid extracts are concentrated forms prepared by cold maceration, the latter process being a more prolonged method designed to ensure complete and fully representative extraction, but both involving the use of alcoholic solutions where the plant constituents require it. While a concentrated decoction, or a medicinal syrup based upon such a decoction, may be little different from an aqueous fluid extract, such a case will be limited to those herbs whose properties can be held in aqueous solution and are not volatile or otherwise destroyed by heat.

The excessively concentrated fluid extracts of orthodox pharmacy, generally having a product/drug ratio of 1:1, show considerable disadvantages in practice, especially as assessed by the available commercial preparations. Such a concentration can only be achieved by submitting the total percolate to reduction by evaporation involving the use of heat, with consequent caramelisation and loss of volatile constituents in spite of reduced pressure techniques. The super-saturation produced is very subject to sedimentation and gelatinisation in the stock bottle, and the high concentration of alcohol soluble resins produces heavy precipitation on dispensing in mixtures. As J. M. Thurston remarks:

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". . . they are inelegant and unwieldy in dispensing. They cannot be added to even a syrup without rendering it turbid and unsightly." (Lyle: Physiomedical Therapeutics, 1897)

The purpose of a physiomedical fluid extract is to represent the plant properties in their normal proportions, not to produce a preparation selective of the supposedly active constituents. As long ago as 1859, Wooster Beach sounded the warning in relation to such pharmacological fragmentation:

"The application of chemistry to vegetable substances belonging to the materia medica, as far as it relates to their ultimate analysis, has hitherto proved of little utility in discovering much satisfactory relation between the composition and the medical powers or properties of the substance analysed. The proximate principles which chemistry develops in many plants are at present well known, and although it is true that the general individual properties of each of these principles are tolerably well understood, yet as found com-pounded by the hand of Nature in different specimens and at different seasons in the same specimens, little will be gathered in this study which can materially aid the practical physician in the course of his duties."

(Beach: Reformed Practice of Medicine, 1859)

From this point of view, a study of the total `drug picture' as reflected in homoeopathic investigation will be of greater clinical utility than the academic knowledge of particular constituents whose isolated pharmacological reactivity gives a distorted picture of the functional complex of the total plant substance.

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Dry Preparations

A large body of professional opinion is convinced that all forms of processing tend to destroy the therapeutic value of plant medicines. Such opinion prefers the administration of the crude herb in powdered form: for acute conditions and short-term therapy as infusion, decoction or tincture, and for long-term use in the form of some unprocessed medication-powder, pill, tablet or capsule made up from the crude drug.

Powdered herbal drugs have certain definite advantages:

i. The agent exists in a constant state, and may be standardised if necessary by the addition of some inert powder to dilute the potency of a particular batch.

ii. The powder is stable on storage, assuming proper conditions, and retains its medicinal value for longer than a liquid extract derived from it.

iii. Powder is easily transported and is less expensive than any preparation derived from it.

iv. The concentration of active constituents is maximal compared with all fluid preparations.

Because of these considerations, herbal powders are very suited to long-term administration, either as simple powders, filled gelatine capsules, pills or compressed tablets. Orthodox experience in relation to the use of Digitalis seems to confirm this view, since it was found that a simple compressed tablet of the powdered leaf provided the best form for administering the total alkaloids. The only disadvantage of using powdered crude herbs is that the digestion may be too weak to extract full value from the crude state.

Powders

Any prescription may be dispensed as a compound powder consisting of the correct proportions of the dried powdered agents. It is important to ensure that the powders are all of an equal degree of comminution, otherwise the finer particles will drift to the bottom of the container. Such powders may be administered by swallowing with water, or by mixing with honey or other suitable vehicle, or each dose may be infused by pouring on boiling water. The fact that the digestive process must extract the properties of the prescription provides a slower and more even absorption. As a rule, much lower doses of the powders are required to produce the results obtainable with extracts.

There are a few local and external uses for powders:

P. Lycopodium-a very soothing dusting powder for infants.

P. Myrrha-an antiseptic dusting powder for septic wounds and ulcers when a dry dressing is preferred.

P. Myrica-an astringent dusting powder for the nasal mucosa, polypi, etc.

P. Quillaia-a very little puffed into the nostrils to induce sneezing in order to expel some nasal obstruction.

-as well as various possible compounds for the relief of nasal catarrh.

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Capsules

Empty gelatin capsules are obtainable in various sizes for the prescribing of powder compounds in elegant form. A disadvantage arises in the natural limit of dose per capsule, and the labour of filling the capsules by hand.

Another use for capsules arises in dispensing fluid extracts which are first dried down into lactose. This method is suitable for single tinctures or combinations of fluid extracts and tinctures in which the menstruum consists of alcohol and water, but is not suitable for those containing glycerine. The tincture or compound is mixed with an equal weight of lactose and exposed to normal room temperature in a shallow vessel. The menstruum will slowly evaporate and leave the lactose saturated with the medicinal principles. The powder is then triturated to an even smoothness and the capsules filled. This method is especially suitable for obtaining a dry preparation from a fresh plant tincture where it is desired to avoid heat or other processing.

Pastilles

Where extracts contain glycerine, a suitable dry preparation can be made by incorporating the fluid extracts with glycero-gelatin and running into moulds. If necessary in order to provide an effective dose in each pastille the extract or mixture may first be reduced in volume over a water-bath. The proportions necessary for the pastille mixture are:

Tinctures, extracts or mixtures . . . . . . . . . . . . . . 1 part (v)Glycero-gelatin . . . . . . . . . . . . . . . . . . . . . . . . . . 1 part (w)

Melt the glycero-gelatin over a water-bath, add the fluids and stir to mix thoroughly. Run the mixture into a pastille mould which has been lubricated with almond oil. After setting, remove the pastilles from the mould and leave for at least 24 hours exposed to a dry atmosphere. Considerable shrinking of the pastilles will then occur, leaving a product which will slowly disintegrate in the mouth, or be absorbed in the stomach when swallowed whole. The technique is thus particularly appropriate for medication to the mouth and throat.

Tablet triturates

This method is suitable where the dose is small and the medicament is in the form of a tincture or fluid extract containing alcohol but not containing glycerine. The tincture is simply mixed with lactose in the proportions necessary to make a stiff' paste and then pressed into the perforations of the top plate of a triturate mould. The filled top plate is then pressed on to the base plate so as to push through the moist moulded tablets, and the tablets left to dry. Leave for about 1 hour and then push the tablets off' lightly into a shallow plate or dish to complete drying. Failure to detach the half-dry tablets from the mould may give rise to spoiling because of adhesion to the mould.

Where it is required to ensure a specific quantity of tincture or fluid extract in each tablet, then the required quantity of fluid medication is dried down into sufficient lactose needed to mould a specific number of tablets. Thus, assuming a mould of 100 X 2 gr. perforations, the quantity of lactose required is 200 gr. If the dose per tablet is to be 5 minims of tincture then 1,000 minims of fluid medication must first be dried down into the lactose and the tablets subsequently moulded by mixing with an appropriate solution of alcohol.

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There is an increasing tendency to use low potency triturations of herbal powders according to the homoeopathic method, especially where the herb is a rich natural source of some mineral, e.g. Horsetail or Bamboo as a source of natural silica. The usual potency for such tablets is lx or 2x (D-1 or D-2). The powder must be fine or very fine, and a small electric grinder or laboratory hammer mill is necessary to reduce the particle size from that produced by the disc mill. If ordering such powders from the supplier, specify a No. 80 powder. Proceed as follows:

i. Measure out 1 part of herbal powder, place in a mortar and grind down to the finest possible powder.

ii. Now add to the mortar 2 parts of powdered lactose and triturate with the herbal powder for 10 minutes.

iii. Now add to the mortar 3 parts of lactose and continue the trituration for 20 minutes.

iv. Finally add a further 4 parts of lactose and continue the trituration for a further 30 minutes.

The result will be a powder containing 1 part herb and 9 parts lactose which has been continuously triturated for 1 hour. This constitutes a lx potency of the herb. Tablets may be moulded from this powder using sufficient 60% alcohol or brandy for the purpose. The 2x potency is made by a similar trituration process commencing with 1 part of the 1 x potency and progressively adding lactose in the manner shown above.

Small quantities of herbal tablets may be moulded using a triturate mould in cases where the quantity involved does not warrant the making of pills by hand. For this purpose the finely powdered herb is mixed with powdered gum acacia in the proportion of 1 part acacia in 20 of the mixture. Add sufficient 25% alcohol solution to make a stiff paste and mould in the usual way.

All of the above methods: powders, capsules, pastilles and triturate tablets, are suited to physiomedical practice where it is necessary to have available such techniques as are appropriate for handling small quantities of individual prescriptions. Both pills and compressed tablets are unsuitable, since relatively large quantities of a fixed formula must be made, and it is probably more satisfactory to have such pills or tablets made commercially to specified formulae. Pills may be made from herbal powders or solid extracts. Compressed tablets are made from herbal powders and require the use of large and expensive machinery.

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Preparations for External Use

The use of preparations applied to the surface of the body, or to the readily accessible cavities, is an important aspect of herbal medicine. The intimate connection between the dermatomes and the visceral systems can be fully exploited in various local applications to the skin, quite apart from the obvious role of lotions, ointments and other protective or restorative medication.

Given the nature of the skin structure and function, these local applications for the most part must be based upon oils and fats, which serve to carry the medication to the part involved. Where such medication is fully soluble in the base no particular dispensing problem arises, but where it is necessary to use aqueous or alcoholic liquids, then certain problems of solubility and miscibility must be considered.

Alcohol, glycerine and water are mutually miscible, but all are immiscible with a fixed oil. Some method is therefore necessary in relation to any aqueous compound containing a fixed oil, in order to maintain a homogenous state of the mixture and a stable distribution of the constituents. The secret of a good liniment or cream is to understand and apply the principles of emulsions, especially in deciding upon the suitable technique and choice of emulgent for the particular constituents involved.

Emulsions

Emulsions are mixtures of oil and water in which either fluid may be the continuous phase containing the other, the disperse phase. Thus, an oil-in-water emulsion consists of the oil split up as small globules and carried in the water, whereas a water-in-oil emulsion consists of water as the disperse phase split up as small globules and carried in the continuous phase, the oil. The dispensing problem is to maintain the emulsion by preventing the two phases from separating out, and this is accomplished by the addition of substances, emulgents, which lower the surface tension between the two phases. Fairly stable oil/water emulsions may be prepared without the use of an emulsifying agent when the concentration of the oil is very low and the oil is volatile. This fact is applied in the extemporaneous preparation of the various medicinal waters, e.g. Aq. Cinnamom. dest., in which the oil is present to a maximum of 2%.

An oil/water emulsion may be freely diluted with water, since this is the continuous phase, but only to a very slight extent with oil. Similarly, a water/oil emulsion can only to a limited degree be used to carry aqueous medicaments. This needs to be remembered in the dispensing of lotions and liniments where fluid extracts are added to a simple emulsion base. Viscosity is an important factor in the stability of emulsions, hence the use of gums to support the emulsifying action of other emulgents.

The commonly used emulgents in herbal practice are soaps and natural colloids. The former are used in the preparation of liniments for external use, whereas the latter are better avoided for that purpose as being too sticky.

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Soaps: Potassium and sodium soaps are oil/water emulsifiers. Calcium and magnesium soaps are water/oil emulsifiers. This also applies to the spontaneous emulsions formed when alkali hydroxides are shaken up in solution with fixed oils, in which a small quantity of soap is formed from the interaction of the hydroxide with free fatty acid.

Colloids: of long use in general pharmacy Gums/mucilages: acacia, tragacanth, agar, Irish moss. Lanolin, beeswax. Egg yolk, cholesterol. Saponins, quillaia, senega. Proteins: gelatin, casein. Carbohydrates, starch.

These emulgents produce oil/water or water/oil emulsions as follows:

Oil/water emulsions:Acacia-generally best for extemporaneous use, tragacanth and agar. Soft soap (sodium), hard soap (potassium).Egg yolk, starches, saponins.

Water/oil emulsions:Wool alcohol, lanolin. Beeswax. Calcium and magnesium soaps.

Of these, acacia gum is usually the most suitable for dispensing individual prescriptions to be taken internally, and the soaps for making liniments and embrocations. Beeswax and lanolin are the common emulgents for compounding ointments and creams. Sodium benzoate and chloroform are used to preserve emulsions where necessary.

When because of faulty dispensing technique the disperse phase does not remain evenly suspended and the phases separate into two distinct layers, the emulsion is said to `crack'. Cracking may not occur immediately but only after standing for some hours. (The souring of milk is a typical example of an emulsion cracking as the result of a change in pH due to bacterial action.) The common causes for the immediate cracking of the emulsion are as follows:

i. The presence or addition of incompatible substances which precipitate the colloidal emulsifier, e.g. alcohol precipitates acacia, other gums and proteins.

ii. The destruction of soaps by adding acids.iii. The presence of electrolytes in the mixture which are antagonistic to the

production of a spontaneous emulsion.iv. Extreme temperature changes: chemical reactions are accelerated at high

temperatures. Emulsions may crack on freezing.v. Attempting to increase the disperse phase beyond a certain limit, especially the

addition of aqueous extracts to a simple water/oil emulsion base.vi. The addition of substances which increase the difference of specific gravity

between the two phases, e.g. solvent aether will decrease the specific gravity of the oil phase, whereas glycerine will increase that of the aqueous phase.

The relative proportions of the two phases of the emulsion, the disperse phase and the continuous phase, have a bearing upon the state of the emulsion. Where the proportion of oil in an oil/water emulsion is small, the globules of oil even though dispersed will tend to form a layer at the top of the liquid. This phenomenon is described as `creaming' and is familiar in milk. Creaming should not be confused with cracking, since the completely homogenous

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state of the emulsion is readily restored by shaking for a few moments, and will only slowly resume the creamed appearance.

Creaming may to some extent be avoided by ensuring a closer phase volume ratio. A disperse phase of 30-60% is most stable. The following measures will help to prevent creaming:

i. Ensure very small globule size of the disperse phase. A hand homogeniser is a useful tool.

ii. Keep the difference in specific gravity of the two phases as small as possible. Avoid the addition of substances which would increase this difference (e.g. solvent aether, glycerine, etc.).

iii. If necessary and possible, increase the viscosity by adding gums such as agar or tragacanth.

iv. If heat is used, maintain the even distribution of the disperse phase while cooling, either by continually stirring in a vessel or shaking in a bottle.

v. Ensure very small globule size of the disperse phase. A hand homogeniser is a useful tool.

Emulsifying agents (Emulgents)

The methods available for the use of the common emulsifying agents are as follows:

Acacia gumEmulsions made from acacia gum are broken by acids and strong alcohol solutions. The amount of acacia required to maintain the emulsion depends upon the quantity of oil present and is computed as follows:

(a) Fixed oils: Allow 1 part gum with 2 parts water to every 4 parts oil (wvv).(b) Volatile oils: Allow 1 part gum with 2 parts water to every 2 parts oil.

Where the emulsion is to contain two or more oils, perhaps fixed and volatile together, the quantity required is calculated for each oil and the whole is used to make the primary emulsion with the mixed oils.

Two dispensing techniques are available, the Dry-gum method and the Wet-gum method:

(a) Dry-gum method: Triturate the oil with the powdered acacia in a dry glass mortar. Add the water all at once and triturate rapidly until a thick cream is formed (the primary emulsion). Gradually add the remainder of the aqueous liquid with constant trituration.

(b) Wet-gum method: Make a mucilage of acacia by triturating the powdered gum with the water. Add the oil a little at a time with constant trituration, if necessary adding a little more water from time to time to maintain a suitable consistency. Continue the trituration for a short time after all the oil has been added. Finally make up to final volume with the remainder of the aqueous liquid.

The wet-gum method is suitable for viscid substances such as Peruvian balsam or copaiba, but otherwise is less reliable and more difficult to use than the dry-gum method. Resinous

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tinctures added to an emulsion based on a gum such as acacia will not require any other suspending agent. (See the section on Dispensing for the need to suspend diffusible precipitates.)

Where emulsions contain less than 10%a oil they will readily cream. Where possible, it is advisable to add sufficient of a bland fixed oil to produce at least this proportion in the mixture and to emulsify accordingly. This applies to prescriptions for internal use containing say halibut oil, wheat germ oil, etc. in which the 10% volume should be made up by the addition of olive oil.

Agar and TragacanthAgar is obtained in fine powder, strips or shredded. It dissolves in boiling water and sets to form a jelly when using a proportion of 0.5% or more (over 1% would set solid). Tragacanth is similar. Neither are good emulgents since they form an emulsion which is too coarse, but both are used with other emulgents to increase viscosity and prevent creaming.

Irish MossA thick mucilage is made by boiling the moss in water (1 part to 40) and then straining the decoction through cotton or a fine strainer. Emulsions are very stable and will stand without creaming, but as with agar and tragacanth, Irish moss makes a coarse emulsion which needs to be put through a hand homogeniser. Preservation is also required.

SoapsThe proportion of soap required, whether soft or hard, is as follows: 1 part of soap to 10 parts of oil (wv), or 1 part of soap to 5 parts of fat. The methods are:

Soft soap: Put the soap in a glass mortar, add three times as much water as soap and triturate to form a cream. Gradually add the oil or melted fat while triturating continuously. Add the aqueous liquids to the required volume.

Hard soap: Dissolve the finely shredded soap in five volumes of water over a hot water bath. Transfer the soap solution to a hot mortar and add the oil or melted fat gradually while triturating. Then add the aqueous liquid slowly while continuing the trituration.

Spontaneous soaps are formed from the reaction of free fatty acids and alkalis in solution, from which it follows that the dispensing technique of making emulsions by this method is suitable only for fixed oils containing sufficient free fatty acid. A common example is the use of afresh saturated solution of calcium hydroxide for compounding liniments.

Technique 1-Shake together the oil and alkaline solution vigorously until a cream is formed. Dilute to volume with the aqueous liquid.

Technique 2-Powder any dry ingredients, triturate the oils with the powder, add the alkaline solution and triturate briskly to form a cream. Add other liquid ingredients to the required volume.

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Egg yolkEgg yolk has twice the emulsifying power of gum acacia (weight for weight). The average yolk weighs about half an ounce and is sufficient to emulsify 4 oz. of any fixed oil, or 2 oz. of volatile oil. The resulting emulsion is not broken by acids.

Technique-Separate the yolk and stir until homogenous. Dilute with three times as much water and shake together in a bottle. Add the oils and shake vigorously.

SaponinsThe saponins present in quillaia and senega will maintain a temporary emulsion by lowering the interfacial tension between oil and water and so producing smaller globules on shaking together. Since the phases will thereby take longer to separate on standing, this technique is suitable where only a temporary state of emulsion is required.

Technique:

Quillaia: 1 dr. of the tincture (1:20) will emulsify 1 dr. of volatile oil or 1 oz. of fixed oil. Dilute the tincture with twice the volume of water and place in a bottle. Add the oil and shake. Adjust to volume by adding aqueous liquid gradually.Saponin BPC: 4 gr. dissolved in 2 dr. water to emulsify 1 oz. of fixed oil.

Wool fatAdeps lame anhydrous when used alone will emulsify half its own weight of aqueous liquid. When first diluted by mixing with fixed oils or soft paraffin, it will emulsify many times its own weight. For this reason, the mixture of wool fat and fixed oil or soft paraffin is a common base for the extemporaneous dispensing of ointments made by incorporating fluid extracts or tinctures.

Technique-Melt the wool fat in oil, pour in the aqueous liquid and stir continuously to form a cream.

BeeswaxA solution of beeswax in a fixed oil is able to form a water/oil emulsion with a small proportion of aqueous liquid. Its use is generally restricted to the compounding of certain herbal plasters, e.g. Empl. Calendula.

While the above emulsifying agents cover a considerable range of possible surface applications, the ultimate choice of preparation must depend upon the dermatological considerations in relation to the skin lesion itself. Both the type of application: lotion, liniment, ointment or plaster, and the base used to carry the medication, will vary according to the following considerations:

i. A greasy base obstructs normal skin function by suppressing the radiation of heat and the secretion of perspiration. Such a base is unsuitable for inflammatory conditions and should be avoided, for example, in acute eczema. On the other hand, it provides protection for open wounds, especially on exposed parts difficult to cover with a mechanical dressing. In the natural folds of the skin a greasy base may also prove to be irritant by promoting too much local heat.

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ii. Emulsions of oil and water, either oil/water or water/oil, have a generally cooling effect. Where there is excessive skin secretion, an oil/water emulsion is preferable as more easily helping to dissipate the secretion. As the condition dries back and there is greater need to restore the natural oils and fats to the skin then the emulsion can be changed to a water/oil type. In this way, a whole range of lotions and ointment-creams may serve the treatment of eczematous conditions in various stages of resolution.

iii. It follows from the above comments that irritant and heating effects should be avoided in acute inflammatory lesions, but that these same effects may be exploited in the treatment of chronic lesions: cold sores and indolent ulcers.

iv. Emulsions are preferable for use on newly formed tissue, for example, around a recovering varicose ulcer. Oil/water emulsions, either lotions or ointments, are preferable for hairy parts.

v. The long-term use of surface applications must be related to the skin type, whether dry or greasy, since oil-absorbing emulsions tend to extract oils from the skin, whereas water-absorbing compounds may dehydrate.

Lotions and liniments

The term lotion is usually applied in referring to external applications in a liquid state, used for the direct medication of eyes, ears, skin lesions, and other surface structures. The term liniment or embrocation refers to those local applications used for counter-stimulant or reflex effects designed to influence the deeper structures. Even the internal viscera may be influenced by liniments used over the segmentally related dermatomes. From the comments made concerning dermatological considerations, it is likely that lotions will be aqueous liquids or oil/water emulsions, whereas liniments are usually oils or water/oil emulsions. An example of a simple lotion for dermatitis could be:

Tinct. Stellaria med. (low alcohol) . . . . . . . . . . . . . 25%Infused oil of Stellaria med . . . . . . . . . . . . . . . . . . 25%Borax-4% of aqueous content . . . . . . . . . . . . . . . . qsAq. Sambucus flor. . . . . . . . . . . . . . . . . . . . . . . . . ad 100%

Borax produces a spontaneous soap by reaction with the fixed oil of the Stellaria oil infusion. Alternatively soft soap could be used as the emulgent. The emulsion produced is an oil/water emulsion and as such is cooling and soothing. For practical dispensing convenience it is useful to keep a solution of soft soap available for the rapid dispensing of similar specific prescriptions. (See Formulary.)

The above simple approach to the dispensing of oil/water lotions is available for all other fresh plant and dry plant tinctures when used in conjunction with infused oils or plants, or with such oils as olive oil or sweet almond oil which may be included for their own special properties. The relative proportions of aqueous and oily liquids may be varied according to the requirements of the case.

In the nature of the conditions, the stimulating and heating properties of oil are necessary requirements in any liniment, so that the infused oils of natural herbal stimulants, such as capsicum, lobelia, etc. serve as powerful counter-stimulants for rheumatic conditions of the skeletal structures, as well as for reflex effects upon the lungs and other viscera. Such oils,

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whether individually or combined are used as such, but appropriate essential oils may be added for an increased penetrating or supportive effect. An example is given in the following formula for a chest liniment:

01. Cinnamonum . . . . . . . . . . . . . . . 1 part01. Carophyllum . . . . . . . . . . . . . . . 1 part01. Eucalyptus . . . . . . . . . . . . . . . . . 2 parts01. Lobelia dil. . . . . . . . . . . . . . . . . . 4 parts (See Formulary.)01. Ballota nig. Infus . . . . . . . . . . . . ad 16 parts.

A similar example is provided by the formula for a general massage liniment:

01. Carophyllum . . . . . . . . . . . . . . . 1 part01. Origanum . . . . . . . . . . . . . . . . . 1 part01. Gaultheria . . . . . . . . . . . . . . . . . 2 parts01. Lobelia infus. (1:10) . . . . . . . . . . ad 16 parts.

Water/oil emulsions may be compounded as liniments where it is necessary to combine aqueous fluid extracts with the infused oils. In such cases the aqueous extracts may be diluted with sufficient solution of calcium hydroxide (water/oil emulgent) and/or a sufficient proportion of lanolin (10-20%) may be melted and combined with the oil. Oil/water emulsions using soft soap solution or tincture of quillaia are also possible.

Ointments and creams

The purpose of all ointments and creams is to enable a medicinal substance to be held in continuous contact with the part affected. The usual means to secure this is to use a base or carrier which is relatively stable, and not subject to rapid evaporation or diffusion. Thus, an ointment consists of (a) medicinal agent, and (b) base-some compound of hydrocarbons: natural oils and waxes.

The term `cream' is used when the final compound is light and easily spread, and is generally an emulsion. Most herbal ointments are emulsions, since this type of preparation best meets the dermatological requirements. The disadvantage of emulsions is that they tend to dry out on storage, so that only small quantities should be prepared at a time from the basic infused oils and tinctures.

In the dispensing of ointments regard must be had for the properties of the base proposed:

i. Animal fats such as lard are liable to rancidity. Benzoated lard is sometimes used in commercially prepared herbal ointments but is not favoured, since it is unduly heating and stimulating. Compounds of soft paraffin with lanolin and beeswax are very popular since they never go rancid and will take up and hold a fair amount of aqueous liquid to make a water/oil emulsion, and thus serve for the extemporaneous dispensing of special ointment prescriptions containing fluid extracts. (See Formulary for simple base formula.)

ii. Ointments based upon the infused oils of fresh plants are prepared by incorporating beeswax and lanolin in the oil to make a stiff base. Such a base will also hold a proportion of fresh plant tincture to make an emulsion cream.

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iii. The consistency of ointments may be varied by using different proportions of wax. Hard paraffin replaces soft paraffin in ointments based upon the latter where it is necessary to increase consistency as for use in warmer climates or seasons.

iv. Many medicaments are insoluble in the base. Some herbal ointments consist of the very finely powdered herb suspended in the base, e.g. Ung. Althaea rad., Ung.. Gallae. All essential and fixed oils are soluble in the hydrocarbon, vegetable oil and wax bases. Aqueous liquids, fluid extracts, tinctures and waters are not soluble in the base and must be handled as emulsions.

v. Paraffin as such has no emulsifying property, but when used to dilute anhydrous lanolin it will greatly increase the capacity of lanolin to take up aqueous liquids. The same comment applies to the dilution of lanolin with vegetable oils.

vi. Preservation of ointments during storage may be necessary. Animal fat (lard/suet) as a base requires the addition of benzoic acid to prevent the development of rancidity. Commercial fluid extracts and tinctures contain sufficient preservative to keep the ointment unless diluted with water, in which case it may be necessary to add further preservative. Aqueous extracts, or fluid extracts preserved with glycerine only will require further preservative-glycerine being hygroscopic will take up atmospheric moisture and give rise to the development of a mould on the surface of the ointment. All alcoholic preparations are sufficiently preserved, but if the alcohol proportion is high they will not make an emulsion with borax or calcium hydroxide, and the ointment may be unduly irritant.

The choice of ointment or cream will depend upon the patient, the condition and the purpose. Non-penetrating bases (paraffins) are used for their protective function as in barrier creams and on open lesions. Penetrating bases (containing lanolin) are used where definite penetrative action is required, as in healing medicinal creams and counterstimulant preparations. Water-miscible bases are best for carrying bacteriostatic medication. Paraffins do not readily penetrate the skin, whereas animal and vegetable fats and oils do penetrate, hence the emphasis upon lanolin and vegetable oils with beeswax or Japan wax to stiffen. Since oil/water emulsions more readily diffuse an aqueous based medicament than do greasy bases or water/oil emulsions, it is often preferable to prescribe a suitable lotion rather than an ointment.

Ointments are prepared in three ways:

FusionWhere the medicinal agent is oil-soluble (resins, oleo-resins, turpentines and oils) and mixes easily and evenly with the base, then the ointment is prepared by simple admixture. In the case of essential oils or substances mobilised by heat, the medicinal agent must be incorporated into the cold base with a spatula. This group includes those made by hot infusion of the fresh or dried herb in oil or fats.

TriturationWhere the base is soft and the medicament is either a powder or an aqueous liquid (fluid extract) the ointment is prepared by trituration of the medicament and base with a bone spatula until the mixture is quite even. This group includes many herbal formulae, and it is

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essential to ensure that the material is in the finest possible state of powder and free from all grittiness in those ointments made by triturating the powdered herb with the base.

EmulsionsThis method requires the use of an emulgent to form a water/oil emulsion. The most usual is a combination of lanolin and beeswax, the former especially being able to hold many times its own weight of aqueous liquid when diluted with paraffins or vegetable oils. The emulsion is sometimes helped by using sufficient borax or calcium hydroxide with the aqueous portion. (Borax has been frequently used in creams in the very small quantity required to facilitate the emulsion and to maintain it during the cooling of the mixture. It is basically an o/w emulgent but there is phase reversal on cooling. The creation of a spontaneous soap by this method is possible only with those vegetable oils and fats which contain free fatty acids. Paraffins do not contain free fatty acids, and some vegetable oils contain too little, e.g. sweet almond oil.)

The following are some general notes on the preparation of ointments:

i. Eye ointments, lotions and creams must not contain irritant substances, e.g. benzoic acid or benzoated bases.

ii. Lanolin may be hydrous or anhydrous-the former contains 30% water. Anhydrous lanolin will emulsify half its own weight of water, but many times its own weight when mixed with other oils or fats. It is too sticky to use alone.

iii. When using highly volatile substances, e.g. camphor, menthol, volatile oils, etc. use as little heat as possible, or complete the heating process before adding such ingredients.

iv. If incorporating fluid extracts into a base to form an ointment, do not add the extracts while the base is very hot-near or above the boiling point of alcohol.

v. The order for melting the base ingredients is-waxes, wool alcohol, spermacetti, lanolin, beeswax, soft paraffin. It is necessary to stir continuously while such mixtures are cooling to avoid the tendency for the base ingredients to separate out.

FormulaeThe formulae for official ointments, simple ointment, ointment of wool alcohols, hydrous ointment, etc., are published in the British Pharmacopoeia, as also in the Extra Pharmacopoeia of Martindale. These official ointment bases can be used for the extemporaneous dispensing of herbal ointment prescriptions. The formulae for herbal ointments of all kinds were published in the National Botanic Pharmacopoeia (N.I.M.H., 1932). The following are the author's own adaptations of traditional formulae to illustrate the various methods:

Cold Cream:

White beeswax . . . . . . . . . . . . . . . . 2 oz.Anhydrous lanolin . . . . . . . . . . . . . . 1 oz.Soft white paraffin . . . . . . . . . . . . . . 16 oz.Almond oil . . . . . . . . . . . . . . . . . . . . 4 oz.

Melt the wax, lanolin and paraffin in order at low heat. Add the oil.Triple rose water . . . . . . . . . . . . . . . 2 oz.Mucilage of tragacanth . . . . . . . . . . 4 oz.Borax . . . . . . . . . . . . . . . . . . . . . . . . 2 dr.

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Dissolve the borax in the aqueous liquids which have been heated to the same level as the fats.

Add the aqueous liquids to the oils and stir in one direction until cool and set. Thirty minims of oil of rose-geranium may be stirred into the ointment just before setting. This makes a good stiff barrier cream, protective and soothing to roughness and chaps of the skin, as for application to the buttocks of infants. (An example of an emulsion.)

Marshmallow and Slippery Elm ointment: Anhydrous lanolin . . . . . . . . . . . . . 2 oz. Yellow beeswax . . . . . . . . . . . . . . . 2 oz. Soft paraffin . . . . . . . . . . . . . . . . . . 12 oz. Powdered marshmallow root . . . . . 4 oz. Powdered slippery elm . . . . . . . . . . 4 oz.

Melt the fats together to form a base.

Macerate the marshmallow root in the melted base for 1 hour over a hot water bath kept at a temperature of 160 deg. F. and when cool add the slippery elm bark by trituration. This is an excellent `drawing' ointment for boils and ulcers. (An example of fusion /trituration.)

Chickweed Cream: iInfused oil of fresh chickweed . . . . . . . . . . . . . . . . . . . . . . . . . 16 ozWhite beeswax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 oz.cation to the skin to mobilise the medicament.Anhydrous lanolin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 oz.Fresh plant tincture of chickweed . . . . . . . . . . . . . . . . . . . . . . 8 oz.Borax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 dr.

Melt the wax and lanolin at low heat and add the oil after heating to the same temperature. Dissolve the borax in the tincture, raise to the same heat, and add to the oils. Stir in one direction until cool.

This makes a light emulsion cream for general purposes and for eczemas. Elder flower cream and Calendula cream may be made in the same way. (An example of a soap emulsion cream.)

The above representative formulae for emulsion cream and ointment may be adapted to any purpose by varying the composition of the two phases-oil and aqueous. Any aqueous fluid may be substituted for the water. In using fresh plant tinctures it is important that only tinctures with a low alcohol proportion (up to 25%) be used, otherwise a soap is not formed. However, the alcohol proportion must be sufficiently high, otherwise a mould will develop on the cream. Even so, such creams will store for only a short time.

Plasters

Plasters are medicated compounds intended to be spread on linen, cotton or other suitable material for the purpose of securing certain local effects, as:

i. Local action upon superficial or deep skeletal structures, e.g. Empl. Fucus co., Empl. Symphytum co.

ii. Counter-stimulant effects, e.g. Empl. Capsic. et Lobelia, Empl. Belladonna.

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iii. Vesicant effects, e.g. Empl. Croton, Empl. Cantharidin. Vesicant plasters, although common to continental practice, are seldom used by English practitioners.

In making suitable plaster material the object is to mix therapeutically inert substances with various medicaments to form a mass which when spread will be rendered adhesive and flexible by the warmth of the body. The preparation of suitable plasters thus presents the following dispensing problems:

i. To obtain a form of medicament soluble in the base if it is desired to `run' the plaster instead of manual spreading.

ii. To form a base which will not be sticky or unduly greasy at normal temperature, but which will melt sufficiently on application to the skin to mobilise the medicament.

As in preparing ointments, the cerate base consists of a suitable penetrating compound, such as paraffin with lanolin, or the official ointment of wool alcohols, which is stiffened by adding sufficient quantity of some wax: Japan wax, beeswax or hard paraffin. The following formula is preferred:

Plaster base:Japan wax . . . . . . . . . . . . . . . . . . . . 4 oz. (100g.)Castor oil . . . . . . . . . . . . . . . . . . . . 2 oz. (50ml.)Anydrous lanolin . . . . . . . . . . . . . . 2 oz. (50ml.)Soft paraffin . . . . . . . . . . . . . . . . . . 8 oz. (200 g.)

Melt the wax over a hot water bath, then add the lanolin, paraffin and oil. Melt together and stir while cooling.

The following example will illustrate the simple technique for spread plasters:

Empl. Capsic. et Lobelia: Pulv. Lobelia fol. . . . . . . . . . . . . . . 4 oz. (100g.)Pulv. Capsicum . . . . . . . . . . . . . . . 1 oz. (25g.)Plaster base . . . . . . . . . . . . . . . . . . 16 oz. (400g.)

Melt the base over a hot water bath and stir in the mixed powders. Digest at 160 deg. F. for 4 hours, stirring up the powder occasionally. Continue to stir while cooling in order to keep the powders evenly distributed. When just warm spread on suitable material-say 3" open wove cotton bandage-for cutting to size as required.

Plasters consisting of emulsions where the medicament is a fluid extract are handled similarly, e.g. Empl. Calendula. By using oil soluble materials which fuse with the base, it is possible to `run' the plaster. That is, to pass a 3" bandage through the melted mixture in a basin, the bandage soaking up sufficient of the material and so making a light and elegant plaster material which can be cut into strips or rolled up. Thus, in the above capsicum and lobelia plaster, oil-soluble capsicine and oil of lobelia may be used instead of the powders.

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Similar `run' plasters may be made from solutions of fluid extracts or tinctures in a base of glycero-gelatin. Such non-greasy plasters are suitable for extremity conditions, e.g. varicose veins, arthritic nodules, etc. where a thin and light dressing is required. For example:

Tincture of Capsicum . . . . . . . . . . 10%Tincture of Lobelia . . . . . . . . . . . . 25%Glycero-gelatin base . . . . . . . . . . . ad 100%

Melt the glycero-gelatin over low heat, stir in the tinctures, and run a strip of 3" bandage through the mixture when just above setting point.

(Note: astringent medicaments containing tannins are not suitable for use with glycero-gelatin.)

Reference was made in the section on infused oils to the possibility of using the residual marc in the preparation of plasters. Thus, in the case of capsicum and lobelia plaster first prepare the infused oil from the mixed powders digested in oil of rape seed in the proportion of 1:10. Filter off the infused oil through filter paper until no more will flow from the marc (about 20% of the original oil will remain held in the marc by capillarity). Lanolin and beeswax are melted together and the oily marc mixed in to make the plaster mass. Thus:

Pulv. Lobelia fol. . . . . . . . . . . . . . . . 4 oz.Pulv. Capsicum . . . . . . . . . . . . . . . . . 1 oz. Infuse in 50 oz. oil of rape seed. Filter off 40 oz.

Residual oil in marc . . . . . . . . . . . 10 oz. Anhydrous lanolin . . . . . . . . . . . . . 2 oz.Japan wax . . . . . . . . . . . . . . . . . . . 4 oz

Melt the wax and lanolin over a hot water bath, mix in the oilsaturated marc, and stir while cooling to achieve an even suspension of the powders. Spread on suitable material.

Pessaries and suppositories

Pessaries and suppositories are preparations of medicinal agents held in an inert base, and intended to be used within the vaginal and rectal cavities. Since the immediate tissues involved are the mucous membranes, a gelato-glycerine base is preferred to the traditional cocoa butter wherever possible. This choice has the advantage that aqueous and spirituous extracts are fully soluble in the base, whereas the use of cocoa butter as a base requires an emulsifying agent to keep the medicament evenly suspended.

Glycero-gelatin base (unofficial) may be prepared for storage as follows:

Powdered gelatin . . . . . . . . . 1 part by weight, say – 1 oz.Glycerine . . . . . . . . . . . . . . . 1 part by volume, say – 1 fl. oz.Distilled water . . . . . . . . . . . 1 part by volume, say – 1 fl. oz.

Mix the glycerine and water, stir in the gelatine, and heat the mixture over a hot water bath until the solution is clear. Pour into a shallow dish or tray to set. The required amount for any specific suppository prescription may then be cut as required from the sheet of glycero-gelatin.

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Medicinal agents are added to the melted base in the following

Glycero-gelatin. . . . . . . . . . . . 3 parts by weight, say-3 oz.Medicament (water-soluble) . 2 parts by volume, say-2 R. oz.

Stir the fluids into the melted base until the mixture is clear, and run into prepared moulds which have been lubricated with almond oil.

(See Formulary for some typical prescriptions.)

Herbal extracts containing more than a small amount of tannins cannot be combined with glycero-gelatin in this way since the mass becomes insoluble. Many extracts contain minor proportions of tannates, and these do not occasion difficulty if the pessaries or suppositories are freshly made for each patient and used within a week or so. In any case, if glycero-gelatin suppositories are exposed to the atmosphere they will steadily lose water and will shrink. This fact is utilised in making glycero-gelatin pastilles where a density of base is required which will only slowly dissolve in the mouth, whereas in the case of rectal or vaginal medication, it is better that the base be rapidly mobilised. For this reason, suppositories should be stored in air-tight containers and be freshly made as required.

Where the tannic acid content is high, as in many of the powerful herbal astringents, or where it is desired to store the suppositories for longer periods, then cocoa butter must be used as the base. In order to avoid the difficulty of making cocoa butter emulsions, it is a good plan to incorporate the medicament in the state of a dry powdered extract. All fluid extracts can be dried down into lactose and thus incorporated. An excellent vaginal astringent pessary is made in this way using powdered extract of acacia catechu in a cocoa butter base (5%" w/w).

In using cocoa butter (Ol. Theobroma) too much heat should not be used in the melting, otherwise there will be considerable delay in setting. Shredding the cocoa butter first will avoid the need to use more than minimal heat. The medicaments to be incorporated are rubbed down on a slab with a little of the cocoa butter and then mixed with the remainder of the melted cocoa butter. The mixture is allowed to cool until it is not too thick to pour, and then moulded. Allowance must be made for the fact that this base shrinks on cooling, so that the mould cups must be somewhat overfilled to be levelled off with a sharp knife after setting. The moulds must be lubricated with a special soft soap solution (see Formulary).

Suppositories and pessaries may be made from fat-based ointments or infused oils. All that is required is that some 10-20% of spermacetti or beeswax is melted and mixed evenly with the heated ointment or oil. Thus, a suppository for haemorrhoids may be made by adding 10% spermacetti to ointment of fresh pilewort (Ung. Ranunculus virid.). Similarly, a vaginal pessary may be made from the infused oil of fresh white deadnettle (Lamium alb.) by the addition of 15% spermacetti. Where the medicament is oil-soluble and in minor proportion in the suppository, cocoa butter may be used providing sufficient beeswax is added as may be necessary to maintain the critical melting point.

Bearing in mind the disadvantages of cocoa butter and glycero-gelatin as given below, it will be found generally sufficient to use the former for oil-soluble medicaments and the latter for aqueous medicaments. The disadvantages of the two common suppository bases are as follows:

Cocoa butter: difficult to handle with unstable heating and melting points. Admixture of oil will require a proportion of beeswax to compensate.

Glycero-gelatin: incompatible with tannins, develops mould on storage, shrinks and increases density on exposure to normal atmosphere.

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Problems of Dispensing

The greater proportion of herbal prescriptions intended for oral use are in liquid form, that is, they are mixtures of liquid extracts, tinctures, concentrated decoctions and syrups. The advantages of medicines dispensed in this form are:

i. There is a maximum flexibility of adjustment of the individual prescription for the patient, remembering that the proportion of each constituent will vary according to the changing symptom picture as the pathology resolves.

ii. Fluid forms are more quickly effective than pills and tablets, and so are more suited to acute conditions. This difference of availability and mobilisation of the medicament is an important consideration in the choice of dispensing technique in long-term and short-term prescribing.

iii. Certain medicines are only effective for their purposes if administered as liquids. Herbal medicines given for their mucilaginous properties could not be dispensed in solid or concentrated form to achieve the same purpose.

iv. Some substances, e.g. essential oils, must be diluted td avoid adverse or uncomfortable reactions.

The dispensing of such mixtures may give rise to certain problems of precipitation and incompatibility, since it is evident from a consideration of the different solvent solutions discussed under fluid preparations that difficulties of mutual solubility and miscibility will arise.

Solubility and miscibility

Water is almost a universal solvent, but in clinical dispensing it is not possible to restrict operations to the sole use of water since it cannot carry a sufficient concentration of essential oils, aromatic substances, resins, gum-resins and other substances which are fully soluble in alcohol solutions of varying strengths. Although water and alcohol are mutually miscible, any mixture of the two which results in a lower alcohol proportion in the final product must give rise to precipitation of alcohol-soluble substances which were completely soluble at the higher alcohol percentage. Similarly, water-soluble constituents such as the gums, which are not soluble in alcohol, will be precipitated if the alcohol proportion of the final mixture is higher than existed in the original decoction or extract containing the gum. In all these cases, the substances which can no longer be held in solution at the changed alcohol/water ratio are precipitated in the form of minute particles which either diffuse throughout the volume as a colloidal suspension, or settle to the bottom of the container as a diffusible or indiffusible precipitate.

Where plant proteins exist in solution in the original extract or tincture, they may be precipitated as colloidal suspensions if the final mixture involves a change of pH. Such colloidal solutions are usually stable in slightly acid or slightly alkaline media, so that if this is the only problem involved in the mixture, then to stabilise the pH by a small addition of aromatic ammonia solution will often clear a cloudy precipitate arising from this cause.

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Other colloids may be precipitated by heat and will not be reversible. Mixtures containing heat-reversible jellies such as gelatin, agar, pectin, etc. which are often used as emulgents or suspending agents, if subjected to undue heat may result in the cracking of the emulsion or precipitation of the suspension. Similarly, where essential oils such as those of clove, cinnamon or sage are to be suspended in a cough mixture having a base of Irish moss mucilage, the addition of the oils must await the cooling of the base, otherwise the oils will separate out and evaporate from the surface of the mixture, or all be contained in the first few doses.

Precipitation

If the content of a mixture is such that precipitation of alcohol-soluble constituents is quite unavoidable, then steps must be taken to ensure an even distribution of the precipitate. In many cases, a resin or other alcohol-soluble material will be precipitated in such fine particles as to constitute a colloidal suspension, which will remain evenly distributed for long enough after the bottle has been shaken for the dose to contain the proper proportion of the resin. Thus, no other action need be taken than to direct the patient (on the label) to shake the bottle before each dose. Such a precipitate is referred to as diffusible.

Where resins or oleo-resins precipitate and agglomerate on being added to mixtures, then it is necessary to add a suspending agent in order to keep the substance evenly distributed in the mixture. The principle involved is to maintain an even suspension of the precipitate by adding a suitable gum, and both acacia and tragacanth are commonly used for the purpose of increasing the viscosity of the mixture to ensure the necessary suspension.

One of the following two methods is used according to the prescription, remembering that some resinous tinctures will not really need a suspending agent unless vulnerable to the presence of electrolytes in the mixture, or unless some other problem of incompatibility arises (see below).

Method 1Use compound tragacanth powder (Pulv. Tragac. co-see Formulary) where indiffusible solids are present or the vehicle is chemically reactive:

(a) Triturate the compound tragacanth powder with sufficient of the vehicle in a mortar to form a cream, then gradually add the remainder.

(b) Pour in the resinous tincture slowly while stirring.(c) Strain the mixture through a fine mesh strainer.

The quantity of compound tragacanth powder required is calculated at 10 grains for each fluid ounce of the final mixture 1 g. to 50 ml.).

Method 2Use mucilage of tragacanth (1.25% w/v) where the prescription allows for not less than 25% of the final volume to be included as mucilage:

(a) Mix the mucilage with an equal volume of the vehicle.(b) Pour in the resinous tincture slowly while stirring.(c) Shake vigorously together and then add the remainder of the mixture.

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In the above methods, the `vehicle' is the remainder of the prescription required, not including the resinous tincture or extract. If two or more resinous extracts are to be included they may be first mixed together providing there is no chemical incompatibility and the alcohol percentages are approximately the same.

Some resinous tinctures are better suspended with mucilage of acacia, others with tragacanth. Experience will decide which gum is best to use for suspending any particular resinous preparation. The following common resins in herbal practice should be dispensed according to method 1, using compound tragacanth powder: guaiacum, jalap, podophyllum, scammony and myrrh-especially if electrolytes are present in the mixture. Otherwise, mucilage of tragacanth is generally sufficient, but is not suitable for the tinctures of benzoin or tolu, which are dispensed using mucilage of acacia. If the prescription cannot accommodate the necessary volume of mucilage of acacia or tragacanth, then some of the vehicle must be used to prepare the initial suspension. It is generally good practice to use mucilage of acacia or tragacanth for the suspension of all resinous precipitates even when readily diffusible. In a simple way, using only one resinous tincture in a mixture, it will usually be sufficient to mix the tincture with an equal volume of mucilage as the first operation in dispensing the mixture before adding the other ingredients.

Incompatibility

The problem of precipitation on mixing fluid preparations has been considered above. Purely physical incompatibility as with insoluble powders must be dealt with by the addition of some thickening agent to maintain the particles in suspension, at least for long enough to pour the dose and so ensure the proper proportion of suspended solids.

Chemical incompatibility may arise when dispensing mixtures. This is considerable in allopathic prescriptions which may contain chemical substances, but in herbal practice only a few points need attention:

i. Precipitation of insoluble substances: dilute to the maximum before admixture, and add a suspending agent if the precipitate is indiffusible.

ii. Alkaloidal incompatibility: alkaloids may be precipitated by alkaline substances, tannic acid or salicylates. Since tannic and salicylic acid salts occur very frequently in herbal drugs, it is necessary to watch carefully when dispensing extracts containing alkaloids. The importance lies in the fact that the alkaloidal content of the prescription may be concentrated in the last few doses of the bottle. Although the precipitate will usually take the form of a diffusible solid, it is nevertheless advisable to protect the mixture by adding a suspending agent.

iii. Menthol and thymol are precipitated on adding the alcoholic solution to water, and do not diffuse well even when using a suspending agent.

iv. Iron salts are incompatible with tannic acid or tannates.v. Liquid extract of liquorice is incompatible with acids. A diffusible precipitate

is formed.

Since the astringent qualities of many roots and barks depend upon the presence of tannates or tannic acid, the dispensing of any strong astringent within a mixture should automatically raise the question of other agents in the same mixture which contain alkaloids. Fortunately, the presence of salicylic acid is much less common, and only three agents-Salix alba, Salix nigra and Spiraea ulmaria-need to be remembered.

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Appendix 1

Standards, weights and measures

Clinical dispensing involves the use of suitable measures and accepted standards. Both the metric system and the Imperial system of weights and measures are in current use, and although there is an increasing use of the metric system, yet the recourse to old herbals and pharmacopoeias requires a knowledge of the Imperial system, especially the Apothecaries measures.

The confusion experienced by most students with respect to the Apothecaries and Avoirdupois systems need not arise if it is remembered that the only unit common to both systems is the grain, and that the Imperial Standard Pound = 7,000 grains. Between these limits of grain and pound the two standards, Apothecaries and Avoirdupois, differ, although using certain terms apparently common to both systems:

Avoirdupois: 1 lb. = 16 oz. = 7,000 grains. Therefore: 1 oz. = 437.5 grains.

Apothecaries (Troy) weight is based on the grain, thus: 20 grains = 1 scruple 60 grains = 1 drachm (3 scruples) 480 grains = 8 drachms = 1 oz.

Thus: 1 oz. Avoirdupois = 437.5 grains Imperial. . 1 oz. Apothecaries = 480 grains Imperial.

All measurements for volume (capacity) in the Imperial system are based upon the Imperial Standard Gallon, which is the volume of 10 Imperial standard pounds of distilled water at 62 deg. F. temperature, thus:

1 gallon = 8 pints (10 lb.) = 160 fl oz. = 70,000 grains. 1 pint = 20 fluid ounces. 1 lb. = 16 fluid ounces. 1 fluid ounce = 8 fluid drachms = 480 minims. 1 fluid drachm = 60 minims.

It will be seen from the above that there is a relationship between solid and fluid measures in terms of water. Care must be taken in dispensing drachms and ounces to ensure that either fluid measure or solid measure is intended. The former is a measure of volume for which graduated glass measures are used, and which ignores the specific gravity of the substance. The latter is a measure of weight in which liquids are weighed in suitable vessels on scales.

It needs to be remembered that 1 fl. oz. of water contains 480 minims, but weighs 437.5 grains. Thus, to make a percentage solution where a solid is dissolved in a liquid (w/v), calculate on 437.5 grains to the ounce. If it is a liquid in a liquid (v/v), calculate on 480 minims to the ounce. If it is a solid in a solid (w/w), keep to one scale or the other-Apothecaries, Avoirdupois or Metric.

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Useful conversion equivalents: Imperial/Metric

1 pound1 ounce1 grain1 gramme

= 453.59 grammes.= 28.35 grammes.= 0.065 grammes.= 15.43 grains.

1 pint1 fluid ounce1 fluid drachm1 kilogram

= 567.93 ml.= 28.4 ml.= 3.55 ml.= 2lb. 3.27 oz.

Standard conventions:Apothecaries symbols:

Weight- Grain = gr. Scruple = Э

Drachm = Ʒ Ounce = ℥

Fluid- Minim = m. Drachm = ƷPint = O. Ounce = ℥

Arabic numerals are used with words, placed before: e.g. 2 dr. Roman numerals are used with symbols, placed after: e.g. 3ii. Half is written: ss. Thus-ass = half-drachm. Never use g. for grain, this symbol is reserved for gramme.

Domestic measures:Since domestic utensils may give up to 30% variation of capacity, it is preferable to use a graduated measure glass. These should be issued to patients whenever absolute accuracy of dosage is required. Otherwise, the following approximate measures will suffice:

1 fluid drachm2 fluid drachms 4 fluid drachms 1 fluid ounce

= 4 ml. = 8 ml. = 15 ml= 30 ml

= 1 large teaspoonful.= 1 dessertspoonful.= 1 tablespoonful.= 2 tablespoonsful.

When dispensing in the metric system, it is preferable to issue a graduated plastic measure cup to each patient.

It is a standard rule to weigh solids and to measure liquids by volume. In using glass measures for dispensing liquids the correct reading is taken from the lowest level of the meniscus-check the reverse side markings against the facing graduations.

References

Pharmacology comprises pharmacy and dispensing. A pharmacopoeia is a volume of formulae and standards for medicines. The British Pharmacopoeia lays down a legal standard for those medicinal substances in the approved list, and medicinal preparations labelled `B.P.' must conform to that standard. The Pharmaceutical Society has attempted to establish standards for a supplementary list by the issue of the Pharmaceutical Codex, largely

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recognised unofficially. Such preparations are labelled B.P.C. Early editions of the Codex contain many excellent monographs on herbal medicines, for example, the 1923 edition contains monographs on over 140 of the common herbs in current use, with directions for preparing the official tinctures and extracts.

The National Botanic Pharmacopoeia, 1932, published at the direction of the National Institute of Medical Herbalists Ltd., similarly attempted to establish standards for many of the tinctures, extracts, compounds and formulae used in herbal practice. A more recent publication, the British Herbal Pharmacopoeia, 1974, issued by the Scientific Committee of the British Herbal Medicine Association, is a useful source of reference covering pharmacognosy of almost all of the agents in professional use, and includes brief clinical indications. A favourite source of reference for clinical detail and evaluation of the `drug-picture' of each remedy is Boericke: Homoeopathic Materia Medics with Repertory, 1927, published by Boericke and Runyon, Inc., New York. This volume includes many of the North American herbs which form such a valuable part of the physiomedical system of practice.

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Appendix 2 Formulary

Fluid preparations

Agents in common use whose properties are fully soluble in water and therefore suited to use as simple infusions or decoctions:

Agrimonia eupatoriaAlthaea officinalisAngelica archangelicaArctium lappaArtemisia vulgarisAsclepias tuberosaBryonia albsCaulophyllum thalictroidesChelone glabraCypripedium pubescensCytisus scopariusDaucas carolsDicentra canadensisDioscorea villosaErythraea centauriumFucus vesiculosusGalium aparineGeum urbanumGentians lutesGlechoma hederaceaGlycyrrhiza glabra

Hieraceum pilosellaJateorhiza calumbaLinum catharticumMenyanthes trifoliataPetasites vulgarisPolygonum bistortaPotentilla tormentillaRhamnus catharticsQuercus roburRhamnus purshianaScutellaria laterifloraRumex crispusSmilax ornataSwertia chirataSymphytum officinalisStillingia sylvaticaTaraxacum officinaleTrifoleum pratenseTriticum repensTussilago farfaraViscum album

In order to avoid the relatively difficult processing required for making fluid extracts, the following agents are best prepared and stored as tinctures containing 40% alcohol or more as indicated:

Asafoetida (60%)Barosma betulinaCapsicum minimumCimicifuga racemosa (60%)Convallaria majalisGrindelia camporumGuaiacum officinale (60%)Humulus lupulus (50%)Hydrastis canadensis (50%)Hypericum perforatum

Lobelia inflataMyrica cerifera (50%)Myrrhae (60%)Rosmarinus officinalisSanguinaria canadensisThuja occidentalisValeriana officinalisViburnum opulusXanthoxylum americanumZingiber officinale

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The following list of agents in common use were included in J. M. Thurston's original list for preparation as `normal' fluid extracts:

Anthemis nobilisArctium lappaAsclepias tuberosaBaptisia tinctoriaBarosma betulinaBerberis aquifoliumCapsella bursa-pastorisCapsicum minimumCascara sagradaCaulophyllum thalictroidesChelone glabraCimicifuga racemosaCollinsonia canadensisCypripedium pubescensDioscorea villosaEuonymus atropurpureusEupatorium perfoliatumEupatorium purpureumGentiana luteaHamamelis virginianaHelonias dioicaHydrastis canadensisLeonurus cardiacaLeptandra virginica

Lobelia inflata Lycopus virginicus Mitchella repens Myrica cerifera Nepeta cataria Phytolacca decandra Podophyllum peltatum Prunus serotina Quercus robur Rhus glabra Rumex crispus Salix alba Salix nigra Senecio aureus Solidago virgaurea Taraxacum officinale Trillium pendulum Turnera diffusa Valeriana officinalis Verbascum thapsus Viburnum opulus Xanthoxylum americanum Zea mays Zingiber officinale

J. M. Thurston's list of agents for which an alcohol solution menstruum is suggested is as follows:

Apium graveolens Arctium lappa sem.Barosma betulinaCascara sagradaFucus vesiculosusGuaiacum officinaleHamamelis virginianaLeonurus cardiacaLeptandra virginicaMentha piperita

Mentha pulegiumNepeta catariaPinus canadensisRumex crispusSalix nigraSanguinaria canadensisTurnera diffusaValeriana officinalisXanthoxylum americanumZingiber officinale

The following popular infusions, decoctions and syrups have been selected from the classical works of Wooster Beach and John Skelton. Although the recipes were originally published more than one hundred years ago, these preparations have continued in clinical use:

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Mucilage of Slippery ElmPour 2 pints (1 litre) of boiling water on to I drachm (3 grammes) of powdered slippery elm bark. Let stand for 1 hour to form a mucilage.

Infusion of BonesetPour I pint (500 ml.) of boiling water on to 1 ounce of boneset herb (Eupatorium perfoliatum) in a covered vessel. Stand for 2 hours, then take a wineglassful dose frequently for colds and fevers.

Infusion of ElecampanePour I pint (500 ml.) of boiling water on to 1 ounce (25 g.) of finely cut elecampane root (Inula helenium). Infuse for 20 minutes, strain, and add I ounce of honey to the liquid. Dose: 2-4 fluid ounces every 2 hours as a stomachic and pectoral tonic.

Infusion of LinseedsMacerate I ounce (25 g.) of linseed meal in 2 pints (1 litre) of boiling water for 4 hours in a closed vessel set in a warm place. Strain and use freely in wineglassful doses as a demulcent in pulmonary and cystic conditions.

Infusion of HyssopInfuse 1 ounce (25 g.) of cut hyssop (Hyssopus officinalis) in 1 pint (500 ml.) of boiling water for 30 minutes. Strain, and add i ounce of honey to the infusion. The dose for children is 2 dr. to I oz. according to age, used as a relaxing expectorant in asthmatic and croupy conditions.

Decoction of SarsaparillaSimmer 1 oz. (25 g.) of bruised sarsaparilla root (Smilax ornata) in 1 pint (500 ml.) of boiling water for sufficient time to exhaust the drug. Sweeten with sugar. Dose: 1 teacupful three times daily as an alterative for blood conditions.

Decoction of BurdockSimmer 1 oz. (25 g.) of cut burdock root (Arctium lappa) in 30 fl. oz. (750 ml.) of water down to 1 pint (500 ml.). Strain, and use 1 teacupful three times daily as an alterative for blood conditions.

Expectorant SyrupTake St. John's wort (Hypericum perforatum) 2 oz. and garden sage (Salvia officinalis) 1 oz. Simmer in 3 pints of soft water down to 2 pints. Express when cool, filter, add 2 lb. white sugar and 2 oz. syrup of lobelia. Simmer the whole in a covered vessel over a water bath for 1 hour. Cool and bottle for use. Dose: 1 teaspoonful to 1 tablespoonful according to age, 4-6 times daily for inflammatory and irritable conditions of the pulmonary organs.

Pulmonary SyrupHorehound herb cut (Marrubium vulgare)-2 oz. Coltsfoot herb (Tussilago farfara)-2 oz. Wood sanicle herb (Sanicula europaea)-2 oz. Simmer the herbs in 6 pints of soft water down to 5 pints. When cool, express, filter, add 5 lb. white sugar, tincture of pleurisy root 3 fl. oz., syrup of lobelia 2 fl. oz., and antispasmodic tincture 1 fl. oz. Simmer the whole in a covered vessel over a water bath for 2 hours. Skim and bottle for use. Dose: 1 dessertspoonful to 1 tablespoonful 4-6 times daily in all respiratory diseases.

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Syrup of LobeliaMacerate 2 oz. of powdered lobelia herb (Lobelia inflata) in 1 pint of malt vinegar for 12-14 days. Filter and add 1 lb. white sugar. Gently simmer over low heat for 30 minutes. Skim and bottle.Antispasmodic tinctureLobelia (herb/seed) powder . . . . . . . . . . . . 4 dr.

Skunk cabbage . . . . . . . . . . . . . . . . . . . . . . 2 dr.Scullcap . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 dr.Cayenne . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 dr.Alcohol (70% proof spirit) . . . . . . . . . . . . . 1 pint.

Macerate for 14 days, shaking the vessel daily. Express and filter. Dose: 10-60 drops. For spasmodic conditions, cramps, convulsions, etc.

Dry preparationsSuitable throat pastille for simple sore throat:

F. E. Hydrastis . . . . . . . . . . . . . . . . . . . . . . 30m.Tr. Myrrha . . . . . . . . . . . . . . . . . . . . . . . . . 1 dr.F.E. Salvia offic. . . . . . . . . . . . . . . . . . . . . 1 fl. oz.Glycero-gelatin .. . . . . . . . . . . . . . . . . . . . . 1 oz.

Melt the glycero-gelatin over a hot water-bath, stir in the agents one at a time, and run into a lubricated pastille mould.

A throat pastille for simple aphonia:F.E. Collinsonia can. . . . . . . . . . . . . . . . . 6 dr.Tr. Phytolacca dec. Eruct. . . . . . . . . . . . . . 2 drGlycero-gelatin . . . . . . . . . . . . . . . . . . . . . 1 oz.

Melt the glycero-gelatin, stir in the agents, and run into a lubricated mould.

Preparations for external use

Mucilage of AcaciaThe standard mucilage is 40% w/v. To make 20 fl. oz. (500 ml.) take 8 oz. (200 g.) of powdered acacia gum and rub down with 10 fl. oz. (250 ml.) of distilled water in a glass mortar. Set aside for several hours for the gum to dissolve completely, and then add sufficient distilled water to make up to the final volume. If needing to preserve the mucilage for storage, allow for adding 1 fl. oz. (25 ml.) of spirit of chloroform 1:20 as part of the final volume. Shake well and set aside for 12 hours.

Mucilage of TragacanthThe standard mucilage is 1.25% w/v. To make 20 fl. oz. (500 ml.) take a 20 oz. bottle which is quite dry inside, run in I fl. oz. of spirit of chloroform 1:20 (25 ml.), stopper the bottle and shake vigorously so that the whole of the inside of the bottle is covered with the spirit. Using a wide-mouth dry funnel, drop in 120 gr. (6.25 g.) of powdered tragacanth gum and again shake vigorously. Pour in all at once enough distilled water almost to fill the bottle, shake thoroughly, and finally top up with more water. Set aside for 24 hours to produce a completely homogenous solution.

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Solution of Soft SoapSoft soap. . . . . . . . . . . . . . . . 1 partDistilled water . . . . . . . . . . . 3 parts

Place the soap and water in a Kilner-type storage jar. Seal the lid and allow to stand for 24 hours, shaking fairly frequently to encourage solution of the soap. When fully dissolved, transfer to a dispensary stock bottle for use.

Calendula blasterF.E. Calendula. . . . . . . . . . 4 fl. oz. Beeswax . . . . . . . . . . . . . . . 4 oz. Anhydrous lanolin . . . . . . . 4 oz.

Evaporate the Calendula extract to half its volume and stir into the melted mixture of beeswax and lanolin. Spread on 3" bandage for use as a haemostatic or healing plaster.

Simple ointmentA base for extemporaneous ointments:

Anhydrous lanolin . . . . 5 parts Melt the ingredients togetherBeeswax . . . . . . . . . . . 10 parts over a water bath. Stir conSoft paraffin . . . . . . . . 85 parts tinuously while cooling.

Suppositories

Calendula and HydrastisF.E. Hydrastis . . . . . . . . . . . 1 dr. F.E. Calendula . . . . . . . . . . . 4 dr. Glycerine . . . . . . . . . . . . . . . 5 dr. Distilled water . . . . . . . . . . . ad 2 oz. Glycero-gelatin . . . . . . . . . . 3 oz.

Mix the fluids together and add to the melted glycero-gelatin, stirring together until the mixture is a clear solution. Mould into 30 gr. suppositories or 60 gr. pessaries.

Cypripedium compoundTr. Cypripedium . . . . . . . . . 1 oz.F.E. Senecio aur. . . . . . . . . . 4 dr.Glycerine . . . . . . . . . . . . . . . 4 dr.Glycero-gelatin . . . . . . . . . . . 3 oz.

Mix the fluids together and add to the melted glycero-gelatin, stirring together until the mixture is a clear solution. Mould into 30 gr. suppositories or 60 gr. pessaries.

01. Lobelia dilMethod 1-using undiluted alcohol.

Place 8 oz. powdered lobelia herb/seed in a Kilner jar and pour on 40 fl. oz. undiluted isopropyl or industrial alcohol. Macerate for 10 days. Displace the saturated alcohol by filtration, adding more alcohol to the marc in the filter in order to recover 40 fl. oz. menstruum. Place the menstruum in a shallow dish or butcher's tray and allow the alcohol to

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evaporate at room temperature until the menstruum has concentrated down to 8 fl. oz. The evaporation may take up to 7 days according to the temperature and humidity of the atmosphere. When sufficiently reduced, transfer the menstruum to a large bottle with closure and add 8 fl. oz. suitable fixed oil (rapeseed, olive, arachis, etc.) which shake vigorously together and then leave to stand for a short time. Meanwhile, fit a conical glass percolator with an outflow tap or closure device. Again shake up the oil/menstruum mixture, fill the bottle with water (at least 20 fl. oz.), shake all vigorously together and pour into the glass percolator with the outflow closed off. Leave for the liquids in the percolator to layer-a lower layer of water and alcohol, and an upper layer of fixed oil carrying the oil of lobelia. When the layers are quite clearly demarcated, run off the aqueous layer by opening the percolator tap until the oil level just reaches it. Then run off the oil layer into a separate vessel or bottle. This method tends to waste rather more of the oil of lobelia because of the change of solvents, and is also a longer and more tedious process than the solvent nether method given below. Moreover, the method is only suitable for those plant oils which dissolve in alcohol.

01. Lobelia dilPlace 8 oz. powdered lobelia herb/seed in a wide mouth glass-stoppered jar and cover with solvent nether. Seal the glass stopper with soft paraffin and leave to macerate in the nether for 48 hours, shaking up several times daily to redistribute the menstruum. Drain off the saturated nether into a bottle through filter paper placed in a fluted glass funnel, adding more nether as necessary to exhaust the marc. Pour this aetherial tincture into a shallow bowl containing 8 fl. oz. of suitable fixed oil (rapeseed, olive, arachis, etc.) and set aside for the nether to evaporate off at normal room temperature. The resulting oil dilution of the nether-soluble constituents of lobelia represents a ratio of 1:1 with the dried herb/seed.

(Special caution: Do not expose solvent nether anywhere near an open flame or source of heat, and ensure adequate ventilation during evaporation. Most plastics are soluble to nether.)

Suppository mould lubricantIn using cocoa butter to make suppositories the moulds must be lubricated with the following solution:

Soft soap . . . . . . . . . . . . . . . . . . . . . 7 parts Isopropyl alcohol . . . . . . . . . . . . . . 14 partsGlycerine . . . . . . .. . . . . . . . .. . . . .. 1 partDissolve and mix together.

Compound Tragacanth PowderPowdered tragacanth gum. . . . . . . . . . . . . 1 partPowdered acacia gum . . . . . . . . . . . . . . . . 1 partPowdered starch . . . . . . . . . . . . . . . . . . . . 1 partPowdered sucrose . . . . . . . . . . . . . . . . . . . 3 parts

Mix thoroughly together in a mortar. Store for use.

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Index to the Materia Medica Schedules

A— the maximum individual dose of the fluid extract (1:1) is 60 minims/4 mls.

B— the maximum dose of the fluid extract (1:1) is 30 minims/2 mls.

C— the maximum dose of the fluid extract (1:1) is 15 minims/1 ml.

X— special care is needed to check the appropriate level for the specific preparation being used.

-such limits to apply whether given in combination or as single agents.

Achillea millefolium.....................................................................................................................................65Agrimonia eupatoria.....................................................................................................................................60Aletris farinosa..............................................................................................................................................75Alpinia officinarum......................................................................................................................................71Althaea officinalis.........................................................................................................................................66Anemone pulsatilla.......................................................................................................................................61Arctium lappa...............................................................................................................................................58Asclepias tuberosa........................................................................................................................................56Avena sativa..................................................................................................................................................61

Baptisia tinctoria...........................................................................................................................................58Barosma betulina..........................................................................................................................................64Berberis aquifolium......................................................................................................................................71Berberis vulgaris...........................................................................................................................................73Betonica officinalis.......................................................................................................................................60

Cactus grandiflorus.......................................................................................................................................67Capsella bursa-pastoris.................................................................................................................................74Capsicum minimum......................................................................................................................................55Cassia angustifolia........................................................................................................................................71Caulophyllum thalictroides...........................................................................................................................75Chelidonium majus.......................................................................................................................................73Chelone glabra..............................................................................................................................................73Chionanthes virginica...................................................................................................................................73Cimicifuga racemosa....................................................................................................................................61Cola vera.......................................................................................................................................................60Collinsonia canadensis..................................................................................................................................71Convallaria majalis.......................................................................................................................................67Crataegus oxycantha.....................................................................................................................................67Cypripedium pubescens................................................................................................................................56

Dioscorea villosa..........................................................................................................................................56

Echinacea angustifolia..................................................................................................................................58Equisetum arvense........................................................................................................................................74Eupatorium purpureum................................................................................................................................64Eupatorium perfoliatum................................................................................................................................65Euphrasia officinalis.....................................................................................................................................57

Fucus vesiculosus.........................................................................................................................................58

Dosage

AAABAXABB

BABAA

XA

C Tr.ABBABBCABCA

A

CABAA

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Galium aparine..............................................................................................................................................64Gentiana lutea...............................................................................................................................................71Geranium maculatum....................................................................................................................................57

Hamamelis virginiana...................................................................................................................................57Helonias dioica.............................................................................................................................................75Humulus lupulus...........................................................................................................................................61Hydrastis canadensis.....................................................................................................................................60Hypericum perforatum..................................................................................................................................61

Inula helenium..............................................................................................................................................69Iris versicolor................................................................................................................................................59

Juglans cinerea..............................................................................................................................................72Juniperus communis.....................................................................................................................................64

Leonurus cardica...........................................................................................................................................68Leptandra virginica.......................................................................................................................................73Lobelia inflata...............................................................................................................................................56Lycopus virginicus........................................................................................................................................69

Marrubium vulgare.......................................................................................................................................69Matricaria chamomilla..................................................................................................................................62Mitchella repens............................................................................................................................................75Myrica cerifera..............................................................................................................................................55

Nepeta cataria...............................................................................................................................................65Nymphaea odorata........................................................................................................................................75

Passiflora incarnata.......................................................................................................................................62Phytolacca decandra.....................................................................................................................................59Polymnia uvedalia........................................................................................................................................59Populus tremuloides......................................................................................................................................60Prunus serotina..............................................................................................................................................69Pulmonaria officinalis...................................................................................................................................69

Rhamnus purshiana.......................................................................................................................................72Rheum officinalis..........................................................................................................................................72Rhus aromatica.............................................................................................................................................74Rosmarinus officinalis..................................................................................................................................72Rubus idaeus.................................................................................................................................................57Rumex crispus..............................................................................................................................................59

Salix nigra.....................................................................................................................................................76Salvia officinalis...........................................................................................................................................57Sambucus nigra.............................................................................................................................................65Scrophularia nodosa......................................................................................................................................59Scutellaria lateriflora....................................................................................................................................62Senecio aureus..............................................................................................................................................76Serenoa serrulata...........................................................................................................................................76Solidago virgaurea........................................................................................................................................70Spiraea ulmaria.............................................................................................................................................72Sticta pulmonaria..........................................................................................................................................70Symphytum officinale..................................................................................................................................66

Trifoleum pratense........................................................................................................................................70Trillium pendulum........................................................................................................................................76Turnera diffusa..............................................................................................................................................62Tussilago farfara...........................................................................................................................................70

A

AAB

BBBCA

AA

AA

AAXB

AAAB

AA

CCAAAA

ABABAA

AAAAAACBAAA

ABA

124

Ulmus fulva..................................................................................................................................................66Uva ursi.........................................................................................................................................................74

Valeriana officinalis......................................................................................................................................62Verbascum thapsus.......................................................................................................................................70Verbena officinalis........................................................................................................................................62Viburnum opulus..........................................................................................................................................63Viburnum prunifolium..................................................................................................................................76Viscum album...............................................................................................................................................63

Xanthoxylum americanum............................................................................................................................55

Zea mays.......................................................................................................................................................64Zingiber officinale........................................................................................................................................55

A

-A

CAAAAB

A

AC

125