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Chapter One

Using Herbs Safely

Why Herbs?

Why herbs? Walk the aisles of any drugstore or supermarket, and you’ll see hundreds of “over-the-counter” remedies. Why not use them? And beyond that, why not rely on just what the doctor gives you? In 2006, Americans walked right past standard remedies to spend $22.3 billion on herbal supplements. They would not be spending that kind of money if they didn’t see some kind of attraction. What draws people to herb use?

Gentleness

One reason people turn to herbal remedies is gentleness. Herbs are typically less refined, less distilled than standard remedies.

For example, Mormon tea contains pseudoephedrine, the same active ingredient as the over-the-counter cold remedy Sudafed®. The actions of Mormon tea aren’t as harsh, however, because the plant contains less of the active ingredient than Sudafed, the plant’s pseudoephedrine is buffered by other ingredients, and it hasn’t been distilled to magnify the effect. Furthermore, with Mormon tea, you get the liquids that are so crucial to a cold, and you get the warmth and the steam, which soothe irritated tissues. Moreover, you don’t get the fillers and the red dye #40. Similarly, if you compare prescription sleep aids with herbal remedies, you’ll see the difference between something that knocks you out and something that helps you sleep. Even if you don’t appreciate the difference in the evening, you will in the morning when you’re trying to clear the residual from your system.

In short, one of the differences between herbal care and standard Western medicine can be the difference between a nudge and a shove. Mormon tea, willow bark, thyme, eucalyptus, peppermint—all these herbs have distilled, more potent counterparts in over-the-counter medicines. Using the herbal version sometimes gives you the option of taking a gentler amount of the active ingredient.

It is not true, however, that all herbal remedies are less potent than their counterparts. Some are more potent, perhaps dangerously so. If you use Listerine®, for example, you get the disinfectant properties of thymol (an active ingredient in thyme) in a well-tested form. If you decide to “go herbal” and use the essential oil of thyme or thymol straight, you could kill yourself with it if you don’t take proper precautions. Though, in general, herbs are gentler than their refined counterparts, some herbs are not at all subtle in their effects. If you’re going to use herbs, especially internally, you must know the difference between the two.

Complexity

Another benefit that draws people to herbal remedies is the complexity of herbs. Most prescription and over-the-counter medicines have one or two active ingredients in some kind of carrier. By contrast, herbs usually contain a blend of several chemicals, each with active properties.

What that means is that sometimes herbs are a fortunate blend of several active ingredients working in concert. For example, arnica contains not just the anti-inflammatory compounds that it’s famous for, but also chemicals that function as antiseptics and anesthetics. Some herbs—hops for example—don’t have a single verifiable active ingredient, but all the ingredients together have a verifiable cumulative effect, especially when blended with other herbs. In other words, one reason to use herbs is a faith—and I choose that word deliberately—in nature’s benevolent complexity. A corollary of that statement of faith is the belief that when we refine an herb into a single active ingredient, we may be refining out benefit as well as “inactive” ingredients.

Is such faith warranted? Partially. To be honest, though, herbs’ complexity can be either the good news or the bad news. The bad news is that you may be getting problematic ingredients with helpful ones. For example, borage oil contains a powerful anti-inflammatory, but it also contains the liver toxin pyrrolizidine. Licorice is an outstanding remedy for coughs, but it also contains glycyrrhizin, which messes up the electrolyte balance of the body. The bottom line is that some herbs have a beneficial complexity; some have hidden harmful ingredients. Only careful investigation will tell you which is which.

Novel Effects

Another reason people use herbs is to gain effects not available in standard Western medicines. If you go to your doctor and ask for something to help keep you from getting a cold this winter, chances are the doctor won’t be able to help you. The herbal shop down the street, however, has echinacea, andrographis, elderberry, astragalus, and all manner of other exotic sounding herbs, each claiming to offer help in warding off a cold. Similarly, if you go into the doctor with a bruise from heavy training, the doctor will probably tell you to ice it and hope for the best. Go to the local herb shop, and the proprietor may give you arnica, bromelain, perhaps some comfrey.

For most people, money, time, or just a fear of doctors has created a line between significant ailments and ordinary ones. If annoyance with a physical problem exceeds a certain level, they’ll go into the doctor. Below that threshold, however, is where they turn to herbs. Frankly, this realm of “ordinary ailments” is where herbs excel. They can help clear up minor annoyances, they can help foster health and well-being, and they can make you feel better while you’re healing. An herb may not “cure” a cold, but neither will a visit to the doctor. Furthermore, a nice cup of chamomile tea will probably make you feel better than sitting for a couple of hours in a doctor’s waiting room.

Herbs typically are gentler, have fewer side effects, treat not just major physical malfunctions but minor day-to-day physical annoyances, and they don’t require a trip to the doctor. Perhaps that’s why sales of herbs have taken off in the last decade. However, with the rise in herb use has come a rise in the number of people being careless in their use of herbs, some fatally so.

Safety with Herbs

First, let me say that this section is not for the attorneys of this world; it’s for you and me. It is my attempt to nudge you in the direction of healthy attitudes toward herb use. In my research, over and over again, I’ve run across an appallingly cavalier attitude toward herbs. Many people put herbs in their mouths and on their skin without a single thought to their side effects or their interactions with other herbs, prescription drugs, and over-the-counter remedies. They don’t bother to look into an herb’s background or track record, but rather take the herb in response to the latest news report, or worse yet, magazine ad. What I offer to you here is a reality check, something to think about before you begin experimenting with the herbs in this book.

Principle Number One:

Just because it’s natural doesn’t mean you can be as stupid as you want with it. Some herbs are poisonous. Even those that aren’t can make you quite miserable if you use them badly. A few years ago, kava was the flavor of the month. Health food magazines, television health reporters, and of course vitamin and herb stores were touting it as a near-magical stress-buster. People started taking it by the handful. Then the reports of liver failure started floating in. The numbers weren’t huge, but a few otherwise healthy people damaged their liver to the point of needing a liver transplant. The FDA jumped in and issued an advisory. Herbalists replied, citing all the people using kava who don’t need liver transplants. The debate continues to rage. Google “kava, liver,” and you’ll get an overview of the arguments, both rational and irrational. Yet one fact is not really in dispute: you can be stupid with kava. You can be stupid with any herb.

The point is this: You wouldn’t pull bottles from a pharmacist’s shelves and try two of these, four of those and a small handful of that. Yet you’d be surprised at how many people do something very similar with herbs. Herbs work in the body using the same mechanisms of action as drugs do. They interact like drugs do. They have safe and unsafe doses like drugs do. And they can do you a world of hurt if misused, just like drugs do. “Natural” does not mean “harmless.” If you don’t know where the line is between “safe” and “stupid” for any given herb, don’t use it.

Principle Number Two:

Just because it looks like the herb in question doesn’t mean it is the herb in question. Plants are trickier than you might think to identify in the wild. For example, comfrey and foxglove—the plants themselves as they grow in the wild—look quite alike. Moreover, the range for comfrey and the range for foxglove overlap considerably; the two can grow side-by-side. What would happen then if you decide to harvest your own comfrey and end up with foxglove by accident? Brew some comfrey tea, and it will probably clear your sinuses. Brew some foxglove tea, and it could very easily stop your heart.

Each species of herb has enough variety that only a fool tries to make an identification based on pictures in a book. If you don’t have the benefit of training with a reputable herbalist, don’t go collecting in the wild.

Similarly, if you want to try growing your own herbs, the wisest course is to get some training from an experienced herbalist. You want to be sure you know which of the plants you planted is the herb and which is a weed. You’ll need help sorting through nurseries and seed companies, to learn which have good seeds and cuttings and which don’t. Besides, without the right care and harvesting, herbs can lose potency and effectiveness. In short, if you want to start your herb use with the seed or the plant, get some hands-on training.

Principle Number Three:

Not all herb companies are reputable: Let the buyer beware. So you’ve decided not to go harvesting in the woods on your own and are now standing in your local herb shop surrounded by hundreds of bottles and dozens of different brands. How do you know what you’re looking for?

Even herbs purchased in health food stores can be problematic. Packages of herbs from the Far East, South America, and Eastern Europe usually contain the herb stated on the label. Sometimes, though, they contain something completely different. Stories of mislabeled herbs can even be found in the U.S. and Europe, where labeling laws are stricter. The unfortunate fact is this: Though mislabeling is uncommon, all it takes is one mislabeled bottle to spoil your day completely.

Even if the packaging company has harvested the right herb and packaged it in a bottle with the right label, the herb still may not be healthy or effective. Offering herbs for sale involves far more than picking leaves and stuffing them into bottles. Potency can decline quickly with poor growing practices or sloppy handling. Label information varies widely from product to product. The “recommended daily dose” can be a very arbitrary thing (or not mentioned at all) on some of the poorer quality brands. Some herbs have been found to be contaminated with metals, prescription drugs, micro-organisms, and other unhealthy ingredients.

How do you know you are getting good quality herbs? Here are a few general principles: First, countries with low levels of regulation tend to turn out the least consistent quality. The Far East, South America, and Eastern Europe are typically less reliable because of lax regulation. The U.S. has truth in labeling laws—the herb in the bottle must legally be the herb named on the label—but it has very little regulation of herb quality. Potency, therefore, is an iffy thing for some U.S. companies. Some U.S. companies turn out great herbs, some very poor herbs. It takes a bit of sleuthing to figure out which is which. European countries, most notably German and the U.K., will, in general, have tighter regulations than North and South American countries. Consequently, in general, the quality of their herbs tends to be higher.

Other indications of quality include in-house testing. A reputable company should do batch checks, and they should have strict quality control policies. If you’re looking for reputable companies, check out their Web site. Those who do in-house testing tend to feature it prominently on their site.

You can also look for quality assurance seals from independent third-party certification programs on the label. One such seal is the NSF International seal. The NSF (formerly the National Sanitation Foundation) inspects both the herb itself and the manufacturing process. Those products that pass inspection are allowed to bear the NSF seal. What the seal means is that not only is the herb inside the bottle the herb on the label, but no additional herbs are present that aren’t on the label. The NSF seal says nothing about potency, however, just purity of product and accuracy of labeling.

American Herbal Products Association (AHPA) members agree to abide by a code of ethics. That code includes ethical business practices, protection of endangered species of herbs, truth in labeling, disclosure of added constituents, and warnings about safety issues involved in herb use. The association relies on members to regulate themselves, but members who are found to be out of compliance can be expelled from the association.

The United States Pharmacopeia seal

Used with the permission of the United States Pharmacopeia

The USP seal says a little more than that of the NSF or AHPA. “USP” stands for “United States Pharmacopeia.” USP is an independent, self-sustaining, nonprofit, science-based public health organization. The USP seal on a bottle of herbs says that the label on the bottle actually contains what it claims on the label. It also says that the product doesn’t contain harmful levels of specified contaminants, that the binders or capsules containing the herb will break down and release in the body, and that the company making the herbs uses good manufacturing processes. In other words, if a bottle of herbs bears the USP seal, that means that the herb is pure, uncontaminated, and potent. The seal also says that the shelf life dates are reliable and that the suggested doses on the label are reasonable. The tests and standards used by USP are recognized by the FDA. In other words, the USP seal is probably your best indication of quality in American-made herbal supplements.

Let’s say that you are back in the herb shop and faced again with a choice of which herb to buy. None of the bottles carry third-party seals. You don’t know anything about the brand names. How can you minimize your risks? According to one study, price seems to be a fairly reliable mark of quality.² If one brand is significantly cheaper than the others, be suspicious. On the other hand, if an herb is standardized to one of its active ingredients, that’s a good sign. Check where the herbs were grown or harvested. If they were imported from a country with poor regulation—China, an Eastern European country, a South American country—be cautious. German, Swedish, Finnish, or British manufacturing companies tend to be more reliable. In fact, since the advent of the European Union, the quality of all European herbs is becoming more consistently regulated and consequently better. (What this tight regulation means for the availability of herbs and herbal advice is another, more complex and hotly debated issue, but regulation has made the quality of the herbs sold more reliable.)

If you plan to use herbs regularly, find a brand or a distributor who offers consistent quality and buy each time from them. What you don’t want to do is to buy from hotdog_joe73 or zhangsherbs on eBay or some random Web site. Hot Dog Joe or Zhang may sell great herbs, but you have no way of telling. The material in the capsule may be the best herb you’ve ever used or it may be wallpaper paste.

Principle Number Four:

Never look solely at the common name for an herb. Always check the scientific name for an herb. Not only does one plant often look like another, the names of plants can be similar as well. For example, gotu kola (Centella asiatica) is not the same as kola (Cola acuminata). Gotu kola has adaptogenic and wound healing properties. Kola (kola nut or “cola”) is the stimulant found in colas. “Gardenia” in the United States is a pleasant ornamental (but not medicinal) flower, composed of several species in the Gardenia genus. In China, “gardenia” refers to Fructus Gardeniae, a medicinal herb.

Quite aside from the obvious possibilities for confusion between common names is the issue of which species are most potent. For example, some species of echinacea work better than others. Do the contents of your bottle of echinacea contain one of the better species or one of the cheaper, less effective species? The only way to know is to check the scientific name.

Principle Number Five:

Homeopathy is not herbalism. Creams and other products made using homeopathic methods will often have the same name as herbal creams. The two, however, are not interchangeable. For example, homeopathy uses arnica just as herbalism does. In fact, in the U.S. most arnica cream offered for sale in herb shops is homeopathic arnica, not an herbal preparation. The two are made using very different processes. Homeopathy leaves very little of the herb in question in the final product. It also uses the resulting preparation differently. Look for either the abbreviation HPUS, or a number followed by X, e.g. 10X. That means it’s a homeopathic formula, not an herbal one. It also means that this book says nothing about that particular formula, its use, or its potential effectiveness.

Principle Number Six:

If you diagnose yourself, you have only yourself to blame if you’re wrong. Just because you think you know what you’re treating doesn’t mean you’re right. Diagnosing yourself and treating yourself with herbs can delay a much-needed trip to the doctor.

That being said, we all do it. We all look at life’s injuries and ailments and say, “Nah, I don’t have to go in to the doctor. It’s just a ___.” Be aware, though, that treating symptoms can mask a larger, more serious underlying condition. Taking responsibility for your health means not just learning which herb to use when, but also when to put away the herbs and seek professional help.

Principle Number Seven:

An herb is more than just its component compounds. Just because the plant has been found to contain a compound that is helpful to you doesn’t mean the whole plant will be helpful. The great advantage, and the great problem, with herbs is their complexity. On the one hand, you have all kinds of chemicals and compounds working together to achieve effects that no single compound could achieve. On the other hand, just because a single helpful compound can be isolated in the lab, that doesn’t mean the herb taken in its entirety will behave like that single compound. An herb containing a known anti-inflammatory won’t necessarily behave like an anti-inflammatory if other compounds buffer that action.

What does that mean in practice? It means you should be cautious about taking an herb just because you know it contains something useful. Laboratory analysis of the active ingredients of an herb can give us some idea of its healing potential, but it is no substitute for long-term, human clinical trials. How do you know an herb is safe, reliable, and effective? You know that only if it’s been used on large numbers of people, studied and found to be so. Frankly, we aren’t there with most herbal supplements. Large-scale clinical trials cost money—pharmaceutical-company amounts of money, not small-scale-herb-grower amounts of money. In many cases we have to supplement clinical testing with traditional and anecdotal reports of an herb’s effectiveness. Sure, when researchers find a known active ingredient in an herb, that’s hopeful news. But with medicinal herbs especially, the part is not the whole.

Principle Number Eight:

When you take an herb, you aren’t treating just your condition but your whole body. Just because an herb is a common treatment for what ails you, that doesn’t mean it’s good for your overall health situation. For example, cayenne pepper can help you decongest if you have a cold, but in doing so it can also aggravate a case of high blood pressure. Herbs that work well for adults might be too strong for the young and the old. Look at herbal tests, and you’ll see very few tests on children and seniors. We really don’t know if herbs affect them differently or not. Many herbs are ill-advised for pregnant or nursing women. If you are taking prescription medicines, herbs might decrease their effectiveness or interact with them in a way that’s dangerous. Even the caffeine in your morning coffee can interact with some herbs.

What does that mean? If you are taking medication, if you have a preexisting health problem, or if you are pregnant or trying to become pregnant, the herbal landscape changes for you. You need to talk to an herbalist, naturopath, or informed doctor or pharmacist before using herbs. If you are not fully grown or if you are over 65, you may need to adjust the dosage of herbs you take. Some herbs may be just too strong for you. In other words, experimenting with herbs demands prudence of healthy, young adults. If for some reason you don’t fit into that category, it demands even more prudence of you.

Principle Number Nine:

Just because it’s safe as a food doesn’t mean it’s safe in medicinal doses. Have you ever eaten cayenne pepper, peppermint, or licorice? They’re safe, just food, right? Well, yes and no. When you used cayenne, you probably didn’t steep it in alcohol first. When you used peppermint, you probably used a well-diluted extract made for cooking, not the highly concentrated essential oil. And the licorice? Well, the “licorice” you had may not have contained any actual licorice at all.

Culinary herbs are prepared to bring out the flavor. Medicinal herbs are prepared to bring out the active ingredients. They are much more potent. Even if you’re using them in a way that’s not more potent than you would for cooking (in other words, dried, not made into tinctures or essential oils), you’re probably still taking them in larger quantities. You may be taking them in capsules, which shields your mouth from any irritating properties but not your stomach. You’re probably taking them over a longer period of time. In short, medicinal doses have effects that culinary uses don’t.

And, by the way, did you know that cayenne, peppermint, and licorice can all put you in an emergency room if you use them irresponsibly?

Good Herbal Habits

Are you still reading, still thinking about trying herbs? Have you decided you’re willing to take responsibility for your own herb use? Then let’s look at how to build some good herbal habits, habits that will help keep you safe.

Begin with Professional Help If You Can

If you can find a good herbalist, Eastern or Western, begin with one. He or she can save you a lot of trial and error. Once you get past the “chamomile tea stage” of herb use, you’re looking at real medicine, and you can’t learn the subtleties of real medicine by reading a book or two. If you plan on going beyond the most superficial stages of herb use, you need to find a guide to help you.

Question Everyone

It seems that herb information is everywhere—news programs, grocery store flyers, the Internet. Be aware of people’s motives in telling you that a botanical supplement is good for you. Health food stores want to sell you something. Magazines and news programs want to sell ad space and air time. The traditional medicinal establishment—doctors, hospitals, drug companies—want you to stick with a system that’s comfortable for them, one that they have expertise in (and one that makes them money as well). Herbalists and alternative medicine practitioners also have a bias toward what they know as well. Knowing who your information source is is critical.

Internet sites, especially those trying to sell you something, are notorious for their omissions. For example a study of herbs with toxic effects found that only three percent of the sites surveyed mentioned the toxic effects of borage oil, a drug banned in Germany because of its risks.³ If you are getting the bulk of your herbal information from online herb stores, you have a problem.

Similarly, avoid headline chasing. You’ve probably seen them, the stories on the evening news about St. John’s wort, echinacea, and other popular herbs. They hit big, everyone talks about them, and then they disappear. The media’s herbal “flavor of the month” is often a story based on a single study. That single study is then “spun” to sell papers or air time. Once the herb hits the public and garners interests, other media outlets will jump in to capitalize on that interest. In other words, you’ll learn more about an herb’s popularity from the media than you will about its safety or efficacy. You need to make sure that if you decide an herb is safe enough to try, you do so because of a body of data, not because of the latest media blitz.

Where do you get good herbal information? Government sites tend to be good, very conservative usually, but good. Germany’s Commission E monographs contain a nice blend of science and tradition. The Dietary Supplement Information Board has information about dosage and interactions. The PDR for Herbal Medicine does as well. Check Chapter 6, “Further Resources,” in this book for more ideas about where to look.

Know Where Your Information Comes From

In addition to knowing who’s telling you to use a particular herb, try to trace herb information back to the original research. Frankly, when it comes to herbs, information is patchy. Some herbs have been well researched. Others have not undergone clinical trials at all. Some herbs have a strong consensus of use from culture to culture, past to present. Others have been used for everything under the sun. The only thing that’s certain is that if you are trying to get a picture of an herb’s efficacy, you’ll find a huge spectrum of evidence: in vitro research results, clinical studies, traditional herbalism, folk uses. You’ll often need to make a decision based not on well-designed large clinical trials but on whatever you can get your hands on.

On the one end of the spectrum is the Western medical community. In the United States, the FDA has the final word about herbs and what claims an herb can and can’t make. Herbs are classified as dietary supplements not herbal medicines. If an herb manufacturing companies wants to be able to make medical claims, they will be held to the same standards as prescription drug manufacturers. In other words, they must prove that a discrete component in the herb treats a discrete health problem both in laboratory and clinical trials. The FDA doesn’t care about history, tradition, or anecdotal evidence when it decides what claims herb companies can make about an herb. The FDA wants chemical analysis and large-scale trials. If herbs cannot pass the FDA gatekeepers, those herbs are not considered to be medicine, and they may not make any specific health claims.

Somewhere in the middle of the spectrum is Commission E. Commission E, Germany’s official government collection and analysis of herbal research, is much more likely to listen to traditional use than the FDA. That’s not to say they ignore research and trials. In fact, Germany is known for its herbal research. But if an herb has a strong tradition and is unlikely to hurt you when used properly, Commission E will recommend it. The translated findings of the commission are available but expensive. A more affordable summary is available in Steven B. Karch’s The Consumer’s Guide to Herbal Medicine.

On the other end of the spectrum are the traditional herbalists. Throughout time herbalists of many cultures have been using herbs, experimenting with them, watching their effects and passing that knowledge down from master to apprentice. This knowledge, of course, is only as good at the observer’s ability to watch with a trained, unbiased eye. It is also only as good as the method by which the knowledge is transmitted from teacher to student.

The British approach to herbs is to make this observation and transmission process rigorous. Their National Institute of Medical Herbalists has high standards for membership. British herbalists have had the protection of the crown since Henry VIII’s day, so herbalism students can not only study in small private schools like they do in the U.S. but also in herbal programs in major universities. Mentoring (essentially a sophisticated master–apprentice relationship) has been taken to the extent that students can achieve postgraduate levels of education combining supervised hands-on work and classroom training.

The FDA’s end of the spectrum offers proof of herbs’ effectiveness in terms that someone trained in Western medical ways of thinking can understand. Unfortunately, it doesn’t offer that proof very often because rigorous testing of herbs is not very common. On the other end of the spectrum is much more experience with herbs, but by American medical standards (AMA standards) it’s not very rigorous. Most articles and recommendations come from one source or another. Wise herb users learn what they can from both.

Use a Safe Dose

The advantage of prescription medicine is that it comes in a bottle with very precise instructions on the label. You know that the medicine has been formulated and tested at that standardized level. Using prescription drugs is simple. Herbs don’t have that benefit. Bulk herbs and some bottled herbs have no dosage information at all. Those that do, vary from brand to brand. It’s up to you to seek out information about safe dosage and to follow it.

The Dietary Supplement Information Board, for example, has online information about dosage and safety for a number of herbs. Herbs that have a USP seal on the label will also contain reliable information about dosage.

Once you find that commonly accepted dose, follow it. More is not better for many herbs. Some are toxic at high doses, and it doesn’t take much for the dose to be “high.” Sometimes as little as a drop or two can mean the difference between effective and unsafe. For example, essential oils, the essence of the plant extracted commercially using steam distillation, are very strong. A dose that looks like nothing could be enough to do you serious damage. Always know what preparation you’re taking, how strong it is, and what the maximum dose for that particular preparation is.

Even “food” herbs can be dangerous in large doses. A little cayenne in your chili spices things up, but too much taken in capsule form can damage your liver. A little cinnamon in an apple pie is a wonderful thing; too much cinnamon or cinnamon oil can cause signs of central nervous system shutdown.⁴

With prescription medicine, you expect the drug to jerk you around, to work its effects whether the body wants to go there or not. Herbal medicines, on the other hand, are not a club to beat your body into a cure. Though some work quickly, others are a quiet support for the health that your body wants. The test of whether an herb is working is not always whether you “feel something” immediately after taking it. The test is whether you are healthier in a reasonable amount of time. How long is a “reasonable amount of time”? That depends on the herb. It also brings me to my next point.

If you are going to be taking herbs, you need to know which are short-term herbs and which are long-term herbs. Some herbs, like valerian for example, seem to work better if you take them for a while. Others like ginger or peppermint work quickly and so are typically used as short-term herbs. Some herbs are addictive or lose their effectiveness if you use them too long. Others, those that are primarily antioxidants, for example, work mainly as a health support, and don’t have clear “effects” per se. You need to know which category your herb falls into before taking it.

Research Widely Before Using an Herb

Never take information from just one source (even this one). Cross-check everything for accuracy. The last thing you want to discover the hard way is that the author of some book accidentally misplaced a decimal point when recording dosage. Here are the things you want to cross check before using an herb: dosage, warning signs, contraindications, and interactions.

If you are thinking about using herbs, it’s probably because you have decided to take more personal responsibility for treating your own ailments. What I’m inviting you to think about here is the place that research plays in that personal responsibility. If you use herbs, you must either find a reputable herbalist, or if you want to do it yourself, you must learn what the herbalist knows about the herb you want to use.

Purchase a modern herbal or two. Then go to reputable Web sites for the most recent updates on contraindications. Books can go out of date. Just as I’d rather be treated by a doctor who studied from twenty-first century text books rather than those from the 1850s, I’d rather use herbal information from yesterday than from the 1850s. Web resources are listed in Chapter 6.

Work with your Doctor, but Always Double-check your Doctor

Bottom line: You should always double check any drug, any supplement, any botanical that you put in your mouth. People—be they doctors, authors, herbalists, or pharmacists—all make mistakes. More than 1.5 million Americans each year experience an adverse drug event: receiving the wrong medication, the wrong dose, the wrong instructions for taking the medicine, or some other preventable error. According to the Institute of Medicine (part of the United States National Academy of Sciences), in hospitals, the problem is even worse. In hospitals, if you factor in prescribing, filling prescriptions, administering and monitoring, the error rate rises to an average of one medication error per patient per day.⁵ These are statistics for prescription medicines dispensed by a system with sophisticated checks in place. Now add a self-administered herb or two into the mix, and you see why you need to take responsibility for knowing about doses and interactions.

For everything you take, you should know what it is, why you’re taking it, and have a rough idea of how it works. This is true for prescription drugs, over-the-counter drugs, and botanicals. If you don’t know, ask someone who does.

Check herb–medication interactions for yourself as well. (See Chapter 6, “Further Resources” for places you can check dosage and interaction of herbs.) Again if you see a problem or just have a question, talk with someone who has more training.

Always talk to your doctor and pharmacist about what you’re taking. It’s nice to have a doctor who is savvy about botanicals. Though most aren’t familiar with botanicals and their effects, an increasing number are reconciling themselves to the fact that some patients insist on using them. Even if your doctor is a skeptic and cracks jokes about you’re acting like you have a doctorate in “oregano,” you still need to let him know what you are taking.

Keep a list of everything you’re taking—herbal, prescription, and over-the-counter—and bring it with you to the doctor when you go. Show the list to your pharmacist as well if the doctor prescribes any prescription drugs. Recheck everything with your doctor and pharmacist every time you begin taking a new medication. If you need surgery, speak up if you are taking any botanicals. Some can cause increased bleeding and changes in heart rate and blood pressure. Your doctor has resources and can check interactions even if he was never trained in herbs in medical school.

Pay Attention

Herbs require that you be aware of what’s happening in your body. It’s like people and their cars. Some know every sound, every vibration, every nuance in the steering wheel and gearshift. Others are completely oblivious. They drive day in and day out without a care or a clue until a dashboard light goes on. Even then their first thought is, “How long has that been on? I wonder if I can drive this until the weekend and get it taken care of then.”

If you are careless and clueless about your body, herbs aren’t for you. You probably won’t recognize the signs of when it’s time to stop taking them. And you may not notice their effects, which can be subtle and occur over the span of weeks or months.

Even if you are well in touch with your body and its normal state of health, you still need to pay attention. Keep track of what you’re taking and any reactions you have to it. Keep a record of all the supplements you take—what they are, how much you take, how often, why. Keeping a record of what did and didn’t work can help you next time you want to use the supplement. If you have a bad reaction, write it down. Make sure your family (or whoever has your durable power of attorney for health care) also has a copy of the list. If you get hit by a bus, the emergency room personnel would like to know if you are taking something that affects heart rate, blood pressure, or clotting time.

Reevaluate Periodically

If your health changes, you need to reevaluate the botanicals you take. If you become pregnant or are nursing, you need to talk with your doctor before taking any herbs. Many of the entries in the herbal section of this book say “don’t use this herb if you are pregnant or nursing.” Frankly, we don’t know the effects of most of these herbs on a fetus or a small baby. Until more information becomes available, it’s probably prudent to avoid taking herbs unless specifically told to do so by your doctor. If you are beginning to feel the effects of age, or develop long-term health issues, check with your doctor. All of these factors can influence the way your body uses herbs.

Lock Everything up

If you have young children, lock up your herbs just as you would drain cleaner and paint thinner. Some essential oils and herbs can kill outright. Others can make a child much sicker than an adult taking the same amount. You might consider doing the same thing if you have pets. I once had a cat who dove head first into a wastebasket to retrieve a broken valerian capsule. Not eager to do my own personal animal testing, I took it from her, but not before she’d hauled it halfway across the bathroom floor in her mouth.

A Chinese formula containing multiple interacting herbs

Label Everything

If you make your own preparations, label everything. Never reuse a container unless you completely remove or cover prior labels. If you carry herbs in a separate container (to the gym or dojo), label that container. If it doesn’t have a label, throw it out. You don’t want to guess wrong.

Get Help If You Want to Mix Herbs

Some herbs interact; some even interact in ways we are not yet aware of. A common—though not always smart—way of combining herbs is to mix several that have the properties you are looking for. In other words, you may mix up a remedy that has one herb for swelling, another for pain, another for tissue repair, another to help you sleep. The end result might have all those properties. Or it might be mud, with one herb’s effects canceling out another’s. Or it might be considerably stronger than you anticipate, with one herb’s effects compounding another’s. The wrong combinations can be like a junior chemistry set experiment gone bad.

In other words, mixing herbs is an advanced skill. Stick to either trusted recipes or find a good herbalist if you want to branch into combinations. Commission E also has lists of herbs that can be combined safely.

For those of you used to Chinese medicine, you might be surprised at how many herbs in this book are used as simples, in other words, one herb alone, not in combination with others. Traditional Chinese medicine has an elaborate system for combining herbs. Frankly, it’s much more sophisticated than any herb combining in the West. They combine herbs to compound the effect, to buffer undesirable qualities, and to treat a complex of symptoms and imbalances in the patient. Through centuries of use, they have charted not just the action of herbs but the interactions between herbs. The combinations they have arrived at are not just a cure for symptoms; they are a treatment of the patient, who has not just an injury, but also a body with various balances and imbalances. If you don’t understand the basis for a particular combination, you won’t know if that basis applies to a particular person and his injury.

Let me say it again: combining herbs is an advanced skill. If you aren’t a trained herbalist, get help.

Start Slowly

Take a small amount, well under the therapeutic dose to start. If you buy unstandardized herbs, do this each time you get a new bottle. The potency of herbs varies tremendously. Always have someone else in the house when you’re trying an herb for the first time just in case you have a bad reaction.

Find your own Personal Risk Tolerance

Experimenting with herbs entails some risk. There is no way to eliminate that risk, but you can reduce it. How much you reduce it depends on your own personal tolerance for risk. To get a rough idea of how much risk you are willing to accept, ask yourself these questions:

How much do I trust what I read in books? If you have a low tolerance for this kind of risk, the best idea is to run everything past an herbalist or naturopath. Have them supervise you the first time you try an herb. If you have a moderate tolerance for this kind of risk, try to get corroboration for what you read from another source.

How much do I want to risk interactions between herbs? If you have a low tolerance for this kind of risk, use only simples (single herbs) to reduce the chance of interaction. If you have a moderate tolerance, check the Commission E monographs for information about which herbs combine safely. For an extra margin of safety, you can run any combination in any book past someone with a sound training in combining herbs. Even if you have a high tolerance for risk, at least find some corroboration for your combinations in books or existing products before using them.

How much am I willing to risk illness from taking the wrong herb, the wrong dose, or wrong combination of herbs internally? If you have a low tolerance for this kind of risk, limit your use to topical use only. Some herbs can still hurt or even kill you when applied topically. But simply not putting an herb in your mouth lowers its chances of harming you. If you have a moderate level of tolerance for this kind of risk, check the herb and the dose in at least two sources, check to see if you are allergic to related plants, and then start with a lower dose the first time you try it. Even if you have a high tolerance for this kind of risk, you should use only herbs obtained from trusted sources for internal use.

How much am I willing to risk infection? If you can’t guarantee its sterility, don’t use a topical preparation on an open wound. The use of homemade ointment on open wounds has a long history. That history also includes things like loss of limbs and life to infection. If you have a low tolerance for the risk of infection, don’t use any herbal remedy on an open wound. If you have a moderate tolerance, you might consider only using commercial herbal preparations on open wounds. Reputable companies probably have a better knowledge of and facility for sterile procedures than you do. Even if you have a high tolerance for this kind of risk, you should watch any wounds you treat with herbal preparations for signs of infection and get help immediately if you see anything amiss.

How much do I trust my ability to handle the most potent herbal preparations? If you don’t completely trust yourself to handle the more dangerous preparations, avoid essential oils entirely or at least avoid the ones that are potentially fatal. The good news about essential oils is that they are very concentrated and powerful. The bad news is that they are very concentrated and powerful. One way to skirt the dangers of essential oils is to use them only with professional supervision, and limiting your personal experimentation to whole herbs and the preparations you make from them. In fact, the most conservative course of action is to limit yourself to only those herbs that have a history of use as food (chamomile tea, for example). If you have a higher tolerance for this kind of risk, you should at least use your strictest safe handling procedures when using essential oils. Be careful of unintended residues on utensils. Label everything that contains essential oils. Treat them with extreme respect.

Herbs have tremendous benefits for people seeking more involvement in their own health and well-being. They are not magic bullets, but they have advantages you won’t find in other forms of health care. Using them, however, is a skill like any other. It takes time, effort, and care to master.