HERBAL MEDICATION

A 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

1
 Contents

PART 1 - THERAPEUTIC PRINCIPLES 6

Introduction 7
Historical 7
Diagnosis 8
Medication 9
Prognosis 10

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

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

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

Organ Inferiorities 38
Organ remedies (trophorestorative) 40

Alterative Changes 41

Reflex Influences 44
Practical corollaries 45
Techniques 45
Typical problems 46

Clinical Prognosis 49

2
PART 2 - MATERIA MEDICA 52
Classification of Materia Medica 53

Materia Medica Schedules 55

GENERAL STIMULANTS 55
Capsicum minimum 55
Myrica cerifera 55
Xanthoxylum americanum 55
Zingiber officinale 55
GENERAL RELAXANTS 56
Lobelia inflata 56
Cypripedium pubescens 56
Dioscorea villosa 56
Asclepias tuberosa 56
GENERAL ASTRINGENTS 57
Euphrasia officinalis 57
Geranium maculatum 57
Hamamelis virginiana 57
Rubus idaeus 57
Salvia officinalis 57
ALTERATIVES 58
Arctium lappa 58
Baptisia tinctoria 58
Echinacea angustifolia 58
Fucus vesiculosus 58
Iris versicolor 59
Phytolacca decandra 59
Polymnia uvedalia 59
Rumex crispus 59
Scrophularia nodosa 59
GENERAL TONICS 60
Agrimonia eupatoria 60
Betonica officinalis 60
Cola vera 60
Hydrastis canadensis 60
Populus tremuloides 60
NERVINES 61
Anemone pulsatilla 61
Avena sativa 61
Cimicifuga racemosa 61
Humulus lupulus 61
Hypericum perforatum 61
Matricaria chamomilla 62
Passiflora incarnata 62
Scutellaria lateriflora 62
Turnera diffusa 62
Valeriana officinalis 62
Verbena officinalis 62
Viburnum opulus 63
Viscum album 63
DIURETICS 64
Barosma betulina 64
Eupatorium purpureum 64
Galium aparine 64
Juniperus communis 64
Zea mays 64

3
DIAPHORETICS 65
Achillea millefolium 65
Eupatorium perfoliatum 65
Nepeta cataria 65
Sambucus nigra 65
DEMULCENTS 66
Althaea officinalis 66
Symphytum officinale 66
Ulmus fulva 66
ORGAN REMEDIES: HEART 67
Cactus grandiflorus 67
Convallaria majalis 67
Crataegus oxycantha 67
Leonurus cardica 68
ORGAN REMEDIES: PULMONARY 69
Inula helenium 69
Lycopus virginicus 69
Marrubium vulgare 69
Prunus serotina 69
Pulmonaria officinalis 69
Solidago virgaurea 70
Sticta pulmonaria 70
Trifoleum pratense 70
Tussilago farfara 70
Verbascum thapsus 70
ORGAN REMEDIES: GASTRO-INTESTINAL 71
Alpinia officinarum 71
Berberis aquifolium 71
Cassia angustifolia 71
Collinsonia canadensis 71
Gentiana lutea 71
Juglans cinerea 72
Rhamnus purshiana 72
Rheum officinalis 72
Rosmarinus officinalis 72
Spiraea ulmaria 72
ORGAN REMEDIES: LIVER, GALL-BLADDER, PANCREAS 73
Berberis vulgaris 73
Chelidonium majus 73
Chelone glabra 73
Chionanthes virginica 73
Leptandra virginica 73
ORGAN REMEDIES: KIDNEYS AND BLADDER 74
Capsella bursa-pastoris 74
Equisetum arvense 74
Rhus aromatica 74
Uva ursi 74
ORGAN REMEDIES: GENITAL 75
Aletris farinosa 75
Caulophyllum thalictroides 75
Helonias dioica 75
Mitchella repens 75
Nymphaea odorata 75
Salix nigra 76
Senecio aureus 76
Serenoa serrulata 76
Trillium pendulum 76
Viburnum prunifolium 76

4
PART 3 - HERBAL PREPARATIONS 77
Introductory 78
Herb gathering 78
Drying and processing 79
Comminution 79
Plant constituents 80

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

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

Preparations for External Use 97

Emulsions 97
Lotions and liniments 102
Ointments and creams 103
Plasters 106
Pessaries and suppositories 108

Problems of Dispensing 110

Solubility and miscibility 110
Precipitation 111
Incompatibility 112

Appendix 1 113
Standards, weights and measures 113
References 114

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

Index to the Materia Medica Schedules 122

5
 Part 1

THERAPEUTIC
PRINCIPLES

6
 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

7
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:

8
 (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.

9
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,

10
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.

11
 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.

12
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
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)

13
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.
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

14
functions. Routine examination of the skin and upper respiratory passages is a necessary
preliminary to the investigation of bowel and kidney conditions:

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.

15
As with all programmes of trophorestoration, the choice of herbal medicines is from those
having a mild but persistent and cumulative influence.

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

16
accumulation and pendulous abdomen is in marked contrast to the hypotrophic scaphoid
abdomen, and the medicinal treatment required will be equally contrasting.

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 hepatic

Dioscorea - as an autonomic relaxant
Juglans - as a gentle laxative (aqueous extractive in syrup form)

Atonic: Berb vulg. - as tonic cholagogue

Turnera - as an autonomic tonic
Juglans - 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.

17
Kidneys
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

18
elevation of body temperature and the production of a more positive acute phase, leading to
ultimate resolution.

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.

19
 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

20
balance, coldness and feebleness. Such a condition affecting the peripheral circulation will at
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:

21
 (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 -relax

Pulse full and sluggish -stimulate and tone
Pulse imperceptible -build up gradually
Pulse 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.

22
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.)

23
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:

24
-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: Scutellaria
Cardiac 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 pulsations - 18 respirations - 99 deg, F

88 pulsations - 18 respirations - 100 deg, F
96 pulsations - 21 respirations - 101 deg, F
104 pulsations - 23 respirations - 102 deg, F
112 pulsations - 25 respirations - 103 deg, F
120 pulsations - 27 respirations - 104 deg, F
128 pulsations - 28 respirations - 105 deg, F
(after J. H. Greer)

25
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:

Sthenic Normal Hyposthenic Asthenic

A++ V+ A+ V= A= V- A- V--

Lobelia A-R Normal complex Zingiber V-S Xanthoxylum A-S

Cypripedium N-R for location Myrica V-C Zingiber V-S
Asclepias P-R and phase Myrica V-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

26
 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.

27
 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.

28
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.

29
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).

30
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 relaxants
Cerebral – Passiflora
Meningeal – Cimicifuga
Spinal meningeal – Cypripedium

Ganglionic relaxants:
Cardiac – Phytolacca
Gastric – Lobelia
Hepatic – Leptandra
Intestinal – Cassia
Renal – Verbena
Uterine – Senecio
Pulmonary – Asclepias
(after J. M. Thurston)

31
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 – Cola
Spinal - Viburnum opulus
Gangionic stimulants:
Cardiac - Eupatorium aromaticum
Pulmonary - Populus candicans
Alimentary – Chelone
Hepatic – Euonymus
Renal – Barosma
Muscular stimulants:
Voluntary - Fraxinus americanus
Involuntary – 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 ganglion

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

32
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.

33
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.

34
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

35
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.

36
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 for
profound 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.

37
 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.

38
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 result

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

39
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) -Scutellaria (Betonica)

Heart -Crataegus (Cereus)
Lungs -Inula, Verbascum
Stomach -Chelone (Gentiana)
Liver -Dioscorea (Hydrastis)
Spleen -Polymnia uvedalia
Pancreas -Iris
Duodenum -Chionanthes
Small intestine -Berberis aquifolium
Colon -Juglans
Kidneys -Verbena (Barosma)
Uterus -Senecio (Aletris)

40
 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.

41
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.

42
 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.

43
 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.

44
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.

45
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

46
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.

48
 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

49
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
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

50
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
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.

51
 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 Dispensatory

A. W. Kuts-Cheraux, B.S., M. D., N. D., Editor-in-Chief
Published by American Naturopathic Physicians and Surgeons
Association Des Moines, Iowa, U.S.A. 1953

53
 Homoeopathic Materia Medica
William 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.

54
 Materia Medica Schedules

GENERAL STIMULANTS
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Capsicum minimum
• Vaso-motor and neural stimulant. Antiseptic • Colds, chills, congestion- • Generally give small
• Stimulates the heart and increases Tonic very sensitive to cold and frequent doses for
arterial force and frequency. damp. cumulative reaction.
• Centrifugal action extending to • Cold extremities with
capillaries. Indicated where cyanosis.
reaction is tardy and there is • Rheumatism, lumbago,
general lethargy. neuralgia.
• Increases secretory and motor • Shock of injury, cold • With Cinnam. and Caryoph.
activity of gastro-intestinal sweats—
system. • Nervous depression— • In very small doses +
• Rubefacient and vaso-dilator nervines.
(topical). • Delirium tremens— • With nervines.
• Uterine and ovarian • Lobelia renders more
congestion— diffusive.
• Sprains, bruises, joint • As liniment with Lobelia
pains—
Myrica cerifera
• Positive diffusive stimulant – Astringent • Colds and acute febrile • As Ess. Myrica comp. to
arouses circulation and Deobstruent reactions generate heat and induce
eliminative organs. Tonic perspiration.
• Indicated for a soft, compressible • Scrofulous, tubercuous
pulse and peripheral laxity. tendency.
• For heavy catarrhal states of • Prolapsus uteri,
mucous membranes-removes menorrhagia.
thick, viscid secretions from • Leucorrhoea, atonic • As douche.
gastro-intestinal tract. vaginitis—
• Positive influence upon the uterus • Gastro-intestinal cararrh.
and the venous system. • Nasal polypi— • Powdered herb as snuff
Xanthoxylum americanum
• Positive diffusive stimulant- Alterative • Chronic rheumatic • With Phytolacca.
induces free arterial/capillary Diaphoretic conditions—
circulation, restores vascular tone. Tonic • Neurasthenia-poor
• General stimulant for relaxed and assimilation.
feeble conditions and atonic • Gastric distension,
digestive states. eructations and flatulence.
• Excellent stimulant tonic and • Loss of sensitivity in injured
alterative for convalescence and nerves.
the elderly.
Zingiber officinale
• Diffusive stimulant for simple Carminative • Colds and chills— • As initial stimulant
atony of alimentary organs and Expectorant diaphoretic.
circulation. • Flatulence and internal
• Gentle diffusive effects suitable congestion, painful
for children and the elderly. alimentary spasms.
• Diarrhoea from over-
relaxation

55
 GENERAL RELAXANTS
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Lobelia inflata
• General systemic relaxant with Stimulant • Dislocations, trauma, • To relax tension and spasm,
diffusive stimulation - best where Diaphoretic hernias— add more or less
arterial action is strong. Equalises Expectorant stimulation.
circulation and relieves vascular Emetic • Spasmodic and membranous • As Syr. Lobel. acet.
tension. croup, pertussis, bronchial
• Vaso-motor stimulant-increases asthma, bronchitis,
the activity of vegetative pleurisy—
processes. • Hepatitis, jaundice, nausea, • As emetic.
• Influences glandular system and hepatic congestion—
respiratory tubuli. • Convulsions— • With Caulophyllum.
• Contra-indicated in nervous • High blood pressure, • As enema:
prostration, shock and paralysis. intestinal obstruction, Lobelia 1. Nepeta 2.
Of brief continuance in asthenic neurasthenia— Zingiber 1. Pinus can. 2.
conditions. (4 dr. powder to 3 pints
water)
• Sprains, boils, swollen • As local plaster with
joints Capsicum.
Cypripedium pubescens
• Relaxant for all states of nervous Antispasmodic • Acute hysteria, emot. • As rectal injection with
tension-esp. from physical Tonic tension— Lobelia.
conditions. • Anxiety states with • With Humulus for
• Allays pain and induces sleep. insomnia— depression.
• Special influence on the
• Nervous headache,
autonomic N.S.
neuralgia, nervous
• Nervous irritability from irritation/debility— • With Scutellaria and tonics.
functional pelvic disturbances and
• Nymphomania, seminal
menopause.
emissions— • With Salix nigra.
• Neuromuscular tremors and
• Dysmenorrhoea— • With Cimicifuga + Zingiber.
twitchings.
• Nervous palpitation /
tachycardia— • With Cereus.
Dioscorea villosa
• Autonomic nerve relaxant, Antispasmodic • Bilious colic, flatulence,
especially for gastro-intestinal Antibilious gastrointestinal irritation.
conditions, vegetative neuroses Diaphoretic • Neuralgic conditions.
and hyperaesthesiae. • Dysmenorrhoea, uterine • With Valeriana +
• Rheumatic syndromes arising pains— Cimicifuga.
from hepatic and intestinal • Nervousness, restlessness • With Viburnum opul. +
dysfunction. and pains of pregnancy— Mitchella.
Asclepias tuberosa
• Peripheral and capillary relaxant- Expectorant • Catarrhal complaints from
influences a flow towards the Antispasmodic cold and damp; hard, dry
surface. cough.
• Autonomic stimulant: slows • Bronchitis, pleurisy,
heartbeat, increases volume and peritonitis. • With Lobelia + Zingiber.
frequency of respiration. • Pneumonia— • With Dioscorea + Zingiber.
• Influences skin, mucous and • Influenza— • With Solidago + Zingiber.
serous structures. • Intercostal rheumatism— • With Ballota nig.
• Eruptive diseases— • Generally in hot infusion.

56
 GENERAL ASTRINGENTS
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Euphrasia officinalis
• Mild stimulating, astringent. Tonic • Catarrhal blepharitis, • Local bathing/douching
• Vaso-constrictor to vessels of rhinitis, sinusitis and with a weak decoction.
nasal and conjunctival mucous conjunctivitis—
membranes. • Hay fever, acute coryza,
• Specific for congestive conditions irritable sneezing and
of the eyes with profuse lachrymation.
lachrymation. • Rheumatic choroiditis and • Locally, with Hydrastis.
• Scrofulous eyes in children. corneal opacity—
Geranium maculatum
• Positive tonic astringent for Styptic • Catarrhal gastritis, summer
treatment of discharges due to Tonic diarrhoea, chronic
over- relaxation. dysentery— • With Hydrastis.
• Excessive mucous discharges, • Menorrhagia, metrorrhagia,
passive haemorrhages and post-partum haemorrhage,
ulceration of the alimentary leucorrhoea, due to atonic
mucous membranes. conditions— • Oral and local.
• Pulmonary and urogenital • Bleeding wounds, teeth • Powdered root as local
haemorrhages. sockets— styptic.
Hamamelis virginiana
• Mild, diffusive, cleansing Sedative • Diarrhoea and dysentery— • With Ulmus fulva.
astringent. Tonic • Protruding, bleeding
• Passive haemorrhages of haemorrhoids— • With Calendula or Stellaria.
pulmonary, gastro-intestinal and • Vulval bruising after • Locally as compresses or
genital organs. childbirth— cream with Calendula.
• Bruised soreness of affected parts, • Vaginal laxity with
especially from relaxed tenderness—
conditions. • Inflamed sore throat— • As spray, with Tr.
• Venous congestion, atony or Phytolacca fr.
laxity. • Varicose veins— • Oral and local.
• Sore and bloodshot eyes— • With Calendula.
Rubus idaeus
• Mild, soothing, astringent tonic- Stimulant • Acute and chronic
allays nausea, sustains the nerves dysentery— • Oral and rectal injection.
and tones the mucous membranes. • Summer diarrhoea in
• Preparatory parturient (contra- children.
indicated where there is a history • Uterine haemorrhage,
of precipitate labours). menorrhagia— • With Myrica or Hydrastis.
• Leucorrhoea— • As douche of the weak
decoction.
• Ophthalmia— • As lotion with Hamamelis.
• Sore throat and • As gargle with dilute
hoarseness— Acetum.
Salvia officinalis
• Carminative, stimulating Stimulant • Gastric debility and
astringent-especially suitable for Carminative flatulence.
weak, pale, atonic patients. • Night sweats.
• Cold preparations check • Sore, ulcerated throat— • As gargle with Tr. Myrrh.,
excessive perspiration from or honey and raspberry
circulatory debility. vinegar.

57
 ALTERATIVES
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Arctium lappa
• General alterative: influences Diuretic • Eczema, psoriasis, • Oral and topical-with
skin, kidneys, mucous and serous Diaphoretic dermatitis— Rumex cr.
membranes, to remove Demulcent • Boils, carbuncles, styes, • Generally prefer the seeds
accumulated waste products. sores. for skin diseases and
• Specific for eruptions on the • Rheumatism, gout and scrofulous conditions.
head, face and neck, and for acute sciatica. Combine with: Zingiber-for
irritable and inflammatory • Vaginal tissue laxity. diffusive effects; Hydrastis-
conditions. for tonic effects.
Baptisia tinctoria
• Stimulating, antiseptic alterative: Antiseptic • Ulcerative colitis, amoebic • With Myrrha for offensive
specific for septic conditions with Discutient dysentery, intestinal secretions and putresence.
ulceration and tissue toxaemia.
degeneration. • Tonsillitis and quinsy— • As gargle with Phytolacca
• Influences the glandular system Eruct.
and both sides of metabolism. • Erosion of cervix— • As local tampon with
• Suitable for asthenic conditions. Calendula.
• Surface ulceration— • As poultice with Ulmus
fulva.
• After typhoid inoculations.
Echinacea angustifolia
• Stimulating alterative: promotes Antiseptic • Septic infections,
suppuration and increases natural Antibiotic septicaemia.
resistance to infections. Antitoxin • Furunculosis, carbuncles— • Oral, and local poultices.
• Specific for endotoxaemia, • Ulcerative pharyngitis,
exotoxaemia, toxaemic and tonsillitis and stomatitis— • As gargle or spray
cancerous cachexia, and • Eczema from blood
malignant degeneration of acute conditions— • With Baptisia + Hydrastis.
toxic conditions. • Gastric and duodenal • As antiseptic, with
ulcers— Hydrastis.
• Enteritis— • To control putrefactive
changes.
Fucus vesiculosus
• Gently stimulating alterative: Diuretic • Hypothyroid obesity,
suited to cold, torpid and fatty Deobstruent myxoedema.
conditions. • Plethoric dropsy (fluid
• Influences mucous and serous imbalance).
membranes, lymphatics and • Rheumatism and arthritis • Commence with small dose
thyroid gland. (associated with emotional and gradually increase.
• Improves nutrition in supplying shock or thyroid
trace elements, iodine and disturbance)-
minerals.

58
 ALTERATIVES—continued
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Iris versicolor
• Positive alterative for chronic, Diuretic • Chronic hepatic and • Iris is an excellent alterative
torpid conditions: influences Cholagogue rheumatic conditions, toxic addition to hepatic
glandular system, lymphatics, Stimulant sciatica. medicines.
liver and gall ducts, and intestinal • Scrofulous skin conditions,
glands. herpes, eczema, psoriasis.
• Specific for hepatic congestion • Enlarged thyroid gland.
due to venous or lymphatic stasis. • Uterine fibroids— • With Hydrastis and
Chelone.
Phytolacca decandra
• Stimulating and relaxing Emetic • Chronic rheumatism and
alterative: promotes the removal Cathartic arthritis, neuralgia and • With Cimicifuga +
of catabolic wastes and the lumbago— Xanthoxylum.
products of fatty degeneration. • Tonsillitis and parotids— • Oral and gargle-with
• Specific for skeletal congestions, Myrrhae.
and for serous and glandular • Mastitis, mammary • As poultice, liniment or
tissues. congestion— plaster.
• Ovaritis, orchids.
• Enlarged thyroid and
lymphatics.
Polymnia uvedalia
• Stimulating alterative with Discutient • Acute splenitis.
specific influence upon liver- • Benign indurated swellings • Oral, and local plasters.
spleen-lymphatic functions. of mammary glands or
lymph nodes—
Rumex crispus
• General tonic alterative with Tonic • Simple deficiency anaemias.
special influence upon skin Laxative • Eczema, psoriasis, • With Syr. Taraxacum.
eruptions. urticaria—
• Natural source of iron salts. • Prurigo.
• Itching haemorrhoids— • Oral, and local suppository.
Scrophularia nodosa
• Gently stimulating and relaxing Diuretic • Chronic skin diseases, • Combine with hepatics and
alterative with lower abdominal Depurative eczema and psoriasis. stimulating diuretics.
and pelvic emphasis. Anodyne • Mammary tumours and
• Deobstruent to enlarged and nodosities, enlarged
engorged lymph glands. glands— • With Phytolacca, Iris.
• Haemorrhoids— • Local ointment of herb
digested in a suitable base.

59
 GENERAL TONICS
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Agrimonia eupatoria
• Gently stimulating tonic with Diuretic • General alimentary Combine according to location:
gastro- intestinal emphasis: Astringent weakness, marasmus, Intestinal: with hepatics
suitable for infants and the Deobstruent hepatic atrophy. Generative: with uterine tonics
elderly. • Enuresis (atonic), relaxed Bronchi: with pectorals
• Influences mucous membranes, bowel, leucorrhoea (relaxed Bladder: with Capsella.
promotes assimilation, and states), urinary
restores debilitated conditions. incontinence.
• Rheumatism and arthritis— • With Chelone.
Betonica officinalis
• Gently stimulating tonic with Nervine • Gastralgia, dyspepsia.
emphasis upon the cerebral Stomachic • Chronic rheumatism and With Cimicifuga -E Scutellaria.
circulation. sciatica—
• Especially indicated for neuralgic • Phrenitis, ischaemic With Cimicifuga for sclerotic
and ischaemic conditions headache— changes.
affecting the head. • Hysteria, pains in the head
and face, neuralgias.
• Lack of concentration, With Rosmarinus or Carduus.
forgetful—
Cola vera
• Cerebro-spinal stimulating tonic Nervine • Neurasthenic, melancholia. Adjunctive to Betonica.
and trophorestorative: counters Cardiac • Chronic neuralgia— With Pulsatilla.
fatigue, increases respiration and Diuretic • Convalescence— Use small doses for cumulative
stimulates voluntary muscles. influence as restorative.
• Suitable for neuromuscular • To sustain physical and
hypofunction arising from illness mental exertions.
or depression.
Hydrastis canadensis
• Mild, positive, permanently Alterative • Catarrhal conditions of Combine according to location:
stimulating vaso-tonic with Laxative mucous membranes, Gastro-intestinal: Juglans
especial influence upon the portal Antiseptic especially gastric. Respiratory: Symphytum
system, entire venous system and • Orificial soreness or Renal: Eupatoreum purpureum
right heart. discharge, conjunctivitis, Genital: Mitchella
• Trophorestorative to mucous keratitis, tonsillitis, Portal: with hepatics.
membranes when irritated, pharyngitis, vaginitis,
inflamed or ulcerated. cervicitis (topical).
Populus tremuloides
• Bitter tonic for all general uses, Diuretic • Dyspepsia, flatulence
• Especially for post-febrile (debility).
debility. • Uterine, vaginal, anal
• Stimulates appetite and aids weakness— With Capsella or Uva-ursi.
digestion. • Diarrhoea, dysentery
• Suitable for the elderly. (atonic).
• Catarrh of the bladder

60
 NERVINES
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Anemone pulsatilla
• Stimulating and relaxing nervine Sedative • Functional neuroses: heart
with especial reference to the Alterative and pelvic organs— • With Cimicifuga/Aletris.
organs of special sense. Anodyne • Vasomotor instability,
• Stimulates gastro-intestinal and menopausal flushes, • With Viburnum opulus /
hepatic functions. dysmenorrhoea— prunus.
• Amenorrhoea, leucorrhoea.
• Nervous exhaustion,
neurasthenia.
• Neural irritation, head
neuralgia.
• Catarrhal ophthalmic— • With Euphrasia.
• Catarrhal otitis— • With Verbascum.
Avena sativa
• Gently stimulating nervine tonic Stimulant • Irritation and depression
and cerebral trophorestorative, Nutrient with dysmenorrhoea— • With Aletris or Mitchella.
especially for weakly and • Hysteria, insomnia— • Frequent doses at short
anaemic conditions. intervals.
• Indicated for reflex nervous
• Neurasthenia and
irritation from other disorders. neuroses— • With Scutellaria.
• Nervous exhaustion and
debility from chronic
disease— • With Turnera.
Cimicifuga racemosa
• Stimulating and relaxing diffusive Alterative • Muscular and crampy pains.
nervine, meningeal relaxant and Antispasmodic • Intestinal spasticity,
cerebrospinal trophorestorative. Sedative flatulence.
• Influences autonomic activity: • Pertussis, asthma, chorea— • With Cypripedium or
increase of secretory and Caulophyllum.
peristaltic action. • Rheumatism, sciatica, • With Xanthoxylum.
• Trophorestorative to pelvic neuralgia, rheumatoid
viscera. arthritis—
• Especially indicated for • Atonic uterus, ovarian • With Leonurus and
spasmodic symptoms of toxic neuralgia, leucorrhoea, Caulophyllum.
origin. dysmenorrhoea—
• Tinnitis aurium— • With Cinchona or
Xanthoxylum.
Humulus lupulus
• Stimulating and relaxing nervine Sedative • Hysteria, dysmenorrhoea— • With Valeriana.
cerebrospinal trophorestorative. Anodyne • Nervous exhaustion— • With hepatic tonics.
• Tonic relaxant to liver/gall ducts. Anaphrodisiac • Pruritus, nymphomania— • With Camphora as
• Allays irritation and promotes suppository.
sleep. • Facial and brachial
neuralgia.
• Local inflammatory and
irritable conditions— • As poultice.
Hypericum perforatum
• Sedative nervine for muscular Sedative • Painful injuries to sacral
twitching and choreiform Alterative spine and coccyx. Traumatic
movements- especially indicated Vulnerary shock
for nerve injuries to the • Haemorrhoids with
extremities and teeth/gums. pain/bleeding.
• Promotes elimination of catabolic • Facial neuralgia after dental • Massage face with diluted
waste products. extractions, toothache— oil.
• Neurasthenia, chorea,
depression.

61
 NERVINES—continued…
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Matricaria chamomilla
• Stimulating nervine: indicated for Carminative • Flatulence, colic; abdominal
conditions of neural irritability Antispasmodic distension and spasms.
with sthenic background. • Premenstrual irritability and
if spasmodic
dysmenorrhoea.
• Infantile convulsions from
colic, teething, earache, etc.
Passiflora incarnata
• Relaxing nervine, cerebral Antispasmodic • Mild convulsive or
vasorelaxant-relieves cerebral Sedative tremulous states-unrest and
irritation. Anodyne agitation.
• Indicated for conditions of • Restlessness and
agitation and exhaustion with wakefulness in infants and
muscular twitching. the elderly— • With Humulus.
• Childhood convulsions,
spasms and teething.
Scutellaria lateriflora
• Diffusive, stimulating and Sedative • Functional nervous
relaxing nervine-cerebral Antispasmodic exhaustion, postfebrile
vasodilator and trophorestorative. nervous weakness.
• Indicated for- nervous irritation of • Chorea, hysteria, agitation
the cerebrospinal nervous system. and epileptiform • With Pulsatilla or
convulsions— Cimicifuga.
• Insomnia, nightmares,
restless sleep— • With Passiflora.
Turnera diffusa
• Stimulating tonic nervine and Tonic • Frigidity, impotence, senile
spinal trophorestorative with Aphrodisiac decline.
especial influence upon the • To establish normal
generative system. menstruation at puberty.
• Anxiety neurosis— • With Scutellaria.
Valeriana officinalis
• Soothing, diffusive, relaxing and Sedative • Nervous excitability— • With Passiflora.
stimulating nervine. Antispasmodic • Nervous insomnia— • With Humulus.
• Indicated for the relief of nervous • Nervous palpitation— • With Convallaria.
irritation, and to support atonic • Flatulent colic, abdominal
and functional nervous disorders. cramp, gastrodynia, • With Dioscorea and
diarrhoea— Zingiber.
• Menopausal dysfunction,
retarded and scanty
menstruation— • With Pulsatilla.
• Nervousness of children,
chorea.
Verbena officinalis
• Relaxing and stimulating nervine Alterative • Nervous depression and
with especial influence on hepatic Tonic weakness convalescence
and renal autonomic function. Antispasmodic and debility.
• Indicated for catarrhal conditions • Acute spasms of bronchitis
of gastro-intestinal and auxiliary and pertussis.
organs. • Amenorrhoea,
dysmenorrhoea and difficult
menstruation.

62
 NERVINES—continued…
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Viburnum opulus
• Relaxing and stimulating nervine, Antispasmodic • Colicky pains and spasms of
cerebrospinal vaso-stimulant. Tonic tubular organs:
• Restores sympathetic / gastro-intestinal and
parasympathetic balance-has a genito-urinary— • With Dioscorea.
specific action to relieve • Atonic conditions of pelvic
voluntary and involuntary organs: menses scanty and
muscular spasms. delayed.
Viscum album
• Stimulating and relaxing nervine. Antispasmodic • Metrorrhagia, post-partum
• Motor and vasomotor relaxant to haemorrhage, endometritis.
gastro-intestinal and genito- • Congestive headache,
urinary functions from hypertension and cardiac
parasympathetic action. hypertrophy— • With Crataegus and Tilia.
• Rheumatic and gouty
syndromes, neuralgia and
sciatica.

63
 DIURETICS
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Barosma betulina
• Diffusive, stimulating and toning Tonic • Dropsical conditions,
• Diuretic for chronic atonic Carminative gravel— • With Juniperus for greater
conditions. Antiseptic • Chronic atonic conditions— stimulation.
• Increases excretion of water, • Mucopurulent discharges,
removes uric acid debris, and is gleet, cystitis, urethritis— • With Althaea as demulcent.
cleansing and toning to the • Vesico-renal irritations in
mucous membrane. the elderly.
• Soothing to the pelvic nerves. • Pelvic congestion— • With uterine tonics.
Eupatorium purpureum
• Relaxing, mildly stimulating Emmenagogue • Strangury, stricture,
diuretic and pelvic visceral tonic. inability to micturate,
• Increases excretion of solids and chronic cystitis.
prevents precipitation of urates. • Urinary calculi— • Use strong decoction.
• Indicated for atonic conditions • Gout, lumbago, • Excellent addition to
with dysuria. rheumatism— alteratives.
• Uterine and vaginal
irritation, general pelvic
weakness— • With Mitchella.
Galium aparine
• Soothing, relaxing and diffusive Aperient • Dropsy, renal
diuretic: increases aqueous obstructions— • With Barosma or Uva-ursi.
excretion, corrects inability to • Bladder stone, gravel,
pass normal catabolic wastes, and calculi.
relieves irritation. • Scalding micturition,
• Preferred diuretic for exanthemas. dysuria, irritable bladder,
cystitis— • With Althaea as demulcent
• Enuresis in children— • With Rhus aromatica.
• Skin eruptions, eczema,
psoriasis.
Juniperus communis
• Stimulating diuretic: indicated for Stimulant • Dropsy from renal
renal torpidity and scanty Carminative suppression.
secretion of urine in the elderly. Antiseptic • Cystic catarrh, renal • Use small dosages, and
• Produces renal vaso-dilatation. congestion. combine with Althaea, Uva-
• Contra-indicated: in • Atonic amenorrhoea, ursi, etc. to counter
acute/chronic nephritis and dysmenorrhoea from irritability.
pregnancy. sluggish conditions.
• Rheumatic pain in muscles • Oral, and local liniment of
and joints, gout, sciatica— oil.
Zea mays
• Soothing and toning demulcent Demulcent • Renal/cystic inflammatory
diuretic, suitable for conditions in Antiseptic states— • Always with Althaea.
children. • Enuresis— • With Agrimonia + Capsella.
• Frees the circulation of urea and • Ammonia in the urine in
relieves cystic irritation arising infants.
from excess of urates and • Enlarged prostate with
phosphates. retention or suppression of
urine.

64
 DIAPHORETICS
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Achillea millefolium
• Mild, slow and stimulating Astringent • Acute stage of colds, • In hot infusion-with
diaphoretic: indicated for the first Stimulant influenza and respiratory Sambucus and Mentha
stage of acute febrile reactions. Tonic catarrhs— piperita.
• For atonic and relaxed tissues • Chronic diarrhoea and
where there is free discharge or dysentery— • Cold preparations.
passive haemorrhage of bright red • Epistaxis, intestinal
blood. haemorrhage and bleeding
• Cold preparations stimulate the haemorrhoids.
appetite and tone the digestive • Uterine haemorrhage,
organs. profuse and protracted
menstruation— • With Capsella.
• Leucorrhoea, vaginal
laxity— • With uterine tonics.
Eupatorium perfoliatum
• Stimulating, tonic and Stimulant • Influenza) colds and fevers • With Achilles for first stage
antispasmodic diaphoretic: Tonic with night sweats and and Pulsatilla during third
indicated for influenza) epidemics Antispasmodic aching bones. stage.
and febrile conditions arising in • Pulmonary inflammation /
marshy districts. catarrh with cough and chest
• Acts upon the gastro-hepatic soreness— • With Asclepias and Inula.
organs and promotes secretion • Post-influenza) gastric
and excretion of bile. irritation with biliousness / • With Chelone and Syr.
constipation— Juglans.
• Skin diseases and eruptive •
fevers of hepatic origin— • With stimulants.
Nepeta cataria
• Relaxing and diffusive nervine: Diaphoretic • Childhood fevers— • With Zingiber as required.
produces free perspiration without Antispasmodic • Flatulent colic, abdominal
increasing internal heat. Carminative cramp, colonic pain and • Rectal injections of a weak
• Influences the circulation, soothes invagination— infusion with Dioscorea.
the nervous system, relieves • Restlessness, nervous
irritation. irritation— • With Matricaria.
• Especially suitable for conditions • Functional menstrual
in infants and children. disturbances, amenorrhoea
and dysmenorrhoea.
• Convulsions, hysteria,
insomnia.
Sambucus nigra
• Mild diffusive and relaxing Alterative • Colds/fevers with dry, hot
diaphoretic with alterative Diuretic skin— • With Achilles and Pulsatilla.
properties: indicated for children • Chronic nasal catarrh /
subject to frequent febrile sinusitis— • With Pulsatilla.
reactions. • Dry coryza, spasmodic
• Relaxing to the eliminative croup— • With Trifoleum.
organs, soothing to the nervous • Weakening night sweats— • With Salvia.
system and gently laxative. • Skin eruptions from
metabolic disturbance, • Excellent addition to
eczema, dermatitis— alteratives.

65
 DEMULCENTS
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Althaea officinalis
• Soothing demulcent: indicated for Emolient • Acute respiratory disease— • As demulcent syrup to
inflamed and irritated states of Diuretic support pectorals and
mucous membranes. Expectorant expectorants.
• Particularly suitable for the • Gastro-enteritis, peptic • Cold water infusion with
elderly with chronic inflammatory ulcer, cystitis, urethritis— aqueous Calendula /
conditions affecting the gastro- Hydrastis as a drink.
intestinal system or genito-urinary • Inflammation of mouth and • Infusion with Myrrh as
tract. throat— 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 Astringent • Coughs and colds— • Valuable addition to cough
stimulating tonic to the mucous syrups.
membrane, allays irritation and • Gastric and duodenal • With aqueous Hydrastis.
encourages cell growth (allantoin ulcer—
content). • Gastro-intestinal
• Increases expectoration and tones inflammation.
the bronchi, especially suitable
• Haemoptysis,
for conditions involving capillary
haematemesis— • With aqueous Calendula.
haemorrhage or excessive mucus.
• Pruritus ani— • Local compresses.
• Chronic suppurative • Embrocation, poultice or
ulcerations— ointment.
• Bruised and damaged joints • Infused oil of the leaves or
and muscles, pulled plaster of the powdered
tendons— root.
• Delayed union of
fractures— • Local plaster.
• Traumatic injury to the • Local compresses of
eye— decoction.
Ulmus fulva
• The best demulcent for internal Emollient • Acute gastric and duodenal
and external use: lubricates and Pectoral ulcer, gastritis, gastric • As gruel of the powdered
soothes alimentary mucosa, Diuretic weakness— bark.
relieves intestinal irritation, and • Diarrhoea, dysentery,
quietens the nervous system. enteritis— • Infusion as rectal injection.
• Inflammation of mouth and • Infusion as mouthwash or
throat— 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, • Poultice or ointment.
carbuncles—
• Inflamed wounds and • Poultice-with Althaea /
ulcers— Lobelia.
• Swollen glands— • Poultice-with Phytolacca
rad.

66
 ORGAN REMEDIES: HEART
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Cactus grandiflorus
• Stimulating cardiac tonic and Tonic • Incipient cardiac
trophorestorative: elevates arterial Diuretic incompetence.
tension and accelerates, increases • Cardiac weakness with
and regulates the pulse. atheroma or
• Stimulating to spinal nerves and arteriosclerosis— • With Crataegus.
motor centres. • Low blood pressure and
• Principal action upon the circular anaemia.
muscle fibres of heart and • Mural and aortic
arterioles. insufficiency.
• Indicated for conditions of • Dilatation, angina, oedema.
dilatation and atony from • Climacteric bradycardia and
muscular laxity. cardiac neurosis.
• Exophthalmic goitre with
cardiac symptoms.
Convallaria majalis
• Cardiac tonic and ganglionic Diuretic • Acute heart failure with
trophorestorative: increases oedema— • Tinct. Convallaria flor.
coronary circulation and • Dyspnoea, orthopnoea,
myocardial action. anasarca.
• Suitable for all cardiac • Congestive heart failure— • With Leonurus.
disturbances, but especially • Cardiac asthma, anginal
indicated in conditions of syndromes.
incipient decompensation. • Endocarditis— • With Echinacea and/or
Phytolacca.
• Mitral insufficiency,
dilatation.
Crataegus oxycantha
• Cardiac tonic trophorestorative: Tonic • Myocardial degeneration • With sufficient Cactus /
increases and sustains action of Diuretic and/or coronary sclerosis in Capsicum to sustain
heart and arterioles, with principal elderly— function.
influence on the myocardium. • Hypertension— • With Viscum-Tilia-
• Improves coronary circulation, Scutellaria.
restores myocardial reserve, and • Cardiac weakness after
regulates disturbances of rhythm. infections.
• Acute myocardial
insufficiency— • Following Digitalis therapy.
• Tachycardia, extra-
systoles— • With Convallaria/Pulsatilla.
• Angina, palpitation,
vertigo— • With Pulsatilla.
• Fatty degeneration,
hypertrophy.

67
 ORGAN REMEDIES: HEART – continued…
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Leonurus cardica
• Diffusive, stimulating and Nervine • Anaemic nervousness and
relaxing, antispasmodic nervine: Emmenagogue insomnia— • With Senecio/Mitchella.
indicated for reflex conditions • Chlorotic hysteria /
affecting cardiac function, and as palpitation— • With alteratives.
a simple cardiac tonic. • Cardiac debility,
• Influences pre-menstrual nerve tachycardia— • With Aletris/Pulsatilla.
tension and muscular rigidity. • Cardiac and vegetative
neuroses— • With Convallaria/Melissa.
• Hyperthyroid cardiac
reactions— • With Lycopus.
• Pre-menstrual tension, • With Caulophyllum /
congestive amenorrhoea or Zingiber.
dysmenorrhoea--

68
 ORGAN REMEDIES: PULMONARY
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Inula helenium
• Gently stimulating tonic Diaphoretic • Bronchial and gastric
expectorant for chronic catarrhal Diuretic cararrh.
conditions: warming, Alterative • Chronic bronchitis,
strengthening and cleansing to tuberculosis— • With Symphytum.
pulmonary mucous membranes. • Pneumoconiosis, silicosis— • With demulcents.
• Indicated for chronic pectoral • Pertussis— • With Trifoleum.
states with excessive catarrhal • Emphysematous conditions.
expectoration and/or a tubercular • Chronic cough in the
diathesis. elderly— • With Sticta.
Lycopus virginicus
• Aromatic and toning astringent, Astringent • Phthisis with free
tonic and sedative, affecting the Tonic expectoration— • With Inula/Symphytum.
mucous membrane. Sedative • Passive haemorrhages:
• Has a specific pulmonary epistaxis, haemoptysis,
influence, equalises the haematemesis.
circulation and balances the • Chronic circulatory
autonomic nervous system. disorders with
• Vascular sedative and tachycardia— • With Convallaria.
haemostatic. • Hyperthyroid conditions,
nervous tachycardia and
palpitation.
Marrubium vulgare
• Gently diffusive tonic Pectoral • Colds, bronchitis, catarrh— • With Inula or Prunus.
expectorant: relieves hyperaemia Diuretic • Asthma, with moist
and congestion, decreases Stomachic expectoration, aphonia and
discharge where secretion is too dyspnoea.
free. • Catarrhal dyspepsia— • Cold infusion as a general
tonic
Prunus serotina
• Mild, soothing, stimulating Astringent • Chronic bronchitis with
astringent: tonic expectorant for Expectorant debility.
acute irritable coughs, quietens Sedative • Catarrhal dyspepsia, weak
nervous irritability and relieves digestion in the elderly.
arterial excitement. • Chronic diarrhoea— • With Myrica as decoction.
• Sedative for conditions of • Weak throat— • With Solidago as throat
prolonged irritation. pastille.
• Ophthalmia— • As lotion to soothe and tone.
Pulmonaria officinalis
• Demulcent pectoral tonic for Demulcent • Coughs, colds, influenza.
general pulmonary conditions Tonic • Bronchial and catarrhal
where a gentle tonic is required. states.
• Inflammation of throat or
lungs.

69
 ORGAN REMEDIES: PULMONARY – continued…
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Solidago virgaurea
• Stimulating and slightly Antiseptic • Influenza, repeated colds.
astringent tonic antiseptic to the Diaphoretic • Catarrhal bronchitis with
mucous membrane. Specific for Diuretic purulent expectoration.
putrescent conditions. • Putrescent tonsillitis— • Acetous infusion as gargle.
• Suitable for bronchial disease in • Naso-pharyngeal catarrh
the elderly. with sneezing and excessive
• Promotes renal excretion of fluid mucus.
where micturition is scanty. • Acute/chronic nephritis with
• albuminuria/haematuria.
Sticta pulmonaria
• Pectoral astringent and tonic: Astringent • Acute coryza with profuse
relieves irritation and congestion Expectorant watery secretion. Sinusitis.
of the neck and shoulders where • Influenza, bronchial catarrh.
there is pain, soreness and • Dry cough with
stiffness. wheezing/tightness.
• Indicated for acute and sub-acute • Croup, pertussis— • With Trifoleum.
inflammatory conditions with • Chronic asthma and hay
bronchial irritation and dry, fever.
hacking cough. • Haemoptysis— • With Lycopus/Hydrastis.
Trifoleum pratense
• Mild, stimulating and relaxing Antispasmodic • Salivary gland congestion.
alterative with a special affinity Sedative • Spasmodic or croupy
for the throat and salivary glands. Expectorant coughs.
• Especially indicated for • Pertussis— • With Syr. Lobel. acet.
debilitated children with chronic • Pharyngeal inflammation /
bronchial or throat conditions. infection. • With Solidago as gargle.
• Chronic skin eruptions— • With Arctium red./Rumex.
Tussilago farfara
• Diffusive expectorant, sedative Stimulant • Chronic pulmonary
and demulcent: suitable for Relaxant conditions— • With Inula/Verbascum.
debilitated and chronic • Chronic emphysema and •
conditions, especially where there silicosis— • To ease persistent cough.
is a tubercular diathesis. • Pertussis, asthma— • Supportive as demulcent
and expectorant.
Verbascum thapsus
• Demulcent and alterative: Astringent • Paroxysmal laryngeal • With Sambucus/Trifoleum.
soothing, relaxing and stimulating Diuretic cough—
in pulmonary conditions. • Irritable chronic bronchitis.
Influences mucous, serous and • Pleurisy with exudation.
glandular structures. • Hay fever, asthma— • With Grindelia.

70
 ORGAN REMEDIES: GASTRO-INTESTINAL
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Alpinia officinarum
• Stimulating, aromatic alterative: Stimulant • Flatulent dyspepsia— • With Dioscorea.
indicated for atonic, depressed Carminative • Suppressed menstruation— • With Matricaria/Zingiber.
states of the digestive tract; Diaphoretic • Lymphatic swellings— • With Phytolacca/Trifoleum.
prevents fermentation and • Uterine fibroids— • Oral, local suppository.
relieves flatulence.
Berberis aquifolium
• Mildly stimulating tonic hepatic Alterative • Catarrhal disorders of
and alterative: influences Tonic stomach, intestines and
alimentary mucous membrane, urinary organs.
stimulates glandular elements and • Hepatic torpor, bilious
improves nutrition. headache.
• Promotes the elimination of • Eczema, herpes, psoriasis,
catabolic residues and stimulates acne, facial blotches and
recuperation pimples— • With Rumex/Arctium rad.
Cassia angustifolia
• Intestinal ganglionic vaso- Tonic • To produce rapid
relaxant. Laxative catharsis— • Single full dose.
• Specific influence upon lower Cathartic • Tonsillitis, diphtheria,
bowel to restrict fluid eruptive diseases (from • As first dose, and to abort
reabsorption. constipation)— development of condition.
• Excites colicky contractions. • 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 Alterative • Gastro-enteritis with
alimentary mucous membrane- Diuretic diarrhoea— • With Spiraea/Rubus idaeus.
slightly astringent: suitable for Tonic • Haemorrhoids— • With Juglans/Leptandra.
catarrhal and atonic conditions. • Layngeal inflammation /
• Vaso-contracting to the portal catarrh— • With Hydrastis/Myrrha.
system; indicated for • Influenza, acute/chronic
pelvic/rectalcongestion secondary pleurisy, colds and fevers.
to portal back-pressure and • Leucorrhoea— • Oral. With Lamium album
venous stasis. as local douche.
Gentiana lutea
• Intense, bitter, stimulating tonic: Cholagogue • Languid conditions and • Best in small doses
influences digestive organs, Anthelmintic general debility, anorexia, combined with milder
mucous membranes, and the Emmenagogue alimentary insufficiency— agents and carminatives.
portal circulation. • Portal congestion— • With Collinsonia/Hydrastis.
• Indicated for atonic and sub-acid • Biliousness and jaundice.
states: slowly promotes peristalsis
and facilitates assimilation.

71
 ORGAN REMEDIES: GASTRO-INTESTINAL – continued….
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Juglans cinerea
• Gently stimulating hepatic / Hepatic • Chronic constipation, • Aqueous extract-add
cathartic: influences peristalsis Alterative intestinal toxaemia— Zingiber to prevent griping.
and tones the alimentary mucous Vermifuge • Diarrhoea and dysentery— • Tincture-with Rhei co.
membrane. • Haemorrhoids, portal
• Specific action upon the lower congestion— • With Collinsonia.
bowel, relieves the portal system • Pin/thread worms in
and decongests the liver. children— • With Chelone.
• Skin eruptions from faulty
• elimination— • With Taraxacum.
Rhamnus purshiana
• Very bitter tonic; slow, mild Tonic • Chronic constipation— • With Syr. Juglans.
hepatic: influences stomach, liver, Laxative • Haemorrhoids.
gall-ducts and bowel. • Chronic dyspepsia with
• Specifically indicated for hepatic torpor or cirrhosis.
inactivity of the lower bowel. • Jaundice.
Rheum officinalis
• Mild stimulating tonic to Cathartic • Full catharsis— • Add Dioscorea/Zingiber.
alimentary mucous membrane, Astringent • Diarrhoea and dysentery, • As tonic hepatic to cleanse
liver and gall-ducts-removes summer diarrhoea— and tone the bowel.
viscid mucus. (Small doses-tonic • Functional dyspepsia— • With Hydrastis/Leptandra.
hepatic, large doses-cathartic.)
Rosmarinus officinalis
• Diffusive stimulant and relaxing Nervine • Atonic conditions of the
tonic with special influence upon Astringent stomach.
stomach and cerebrum: soothes Diuretic • Gastric headache.
the nervous system, and is tonic • Adolescent hypotonia,
to the vaso-motor function and asthenia with pallid
peripheral circulation. complexion.
• Suitable tonic for the elderly. • Circulatory weakness
following stress or illness.
Spiraea ulmaria
• Mild stimulating tonic astringent: • Stomachic • Summer diarrhoea in
relieves genito-urinary irritation. • Alterative children.
• Restores normal balance to • Diuretic • Diarrhoea, bowel
gastric secretory function. disturbance.
• Dyspepsia with
hyperchlorhydria— • With Agrimonia.
• Eructations, oesophageal
burning.
• Febrile conditions with • Strong infusion-small cup
excessive heat— every 2-3 hours.

72
 ORGAN REMEDIES: LIVER, GALL-BLADDER, PANCREAS
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Berberis vulgaris
• Stimulating tonic hepatic: Alterative • Biliary catarrh with
influences the mucosa generally, Antiseptic constipation and jaundice.
removing mucoid accumulations Laxative • Gastritis, biliousness— • Small doses-with
and controlling excess secretion. Prunus/Populus.
• Improves appetite, digestion and • Debility in convalescence— • Small doses-with
• assimilation. alteratives.
• Indicated for gouty constitutions. • Ulcerative stomatitis— • Mouth wash of decoction.
• Eczema of the hands.
Chelidonium majus
• Active cholagogue with influence Alterative • Hepatitis, jaundice,
upon the spleen: stimulates the Diuretic gallstones—from
pancreas, and affects mesentery Demulcent obstructive pathology.
and lymphatics. • Indigestion, spastic
• Indicated for lethargic states constipation.
subject to weather changes. • Intestinal putrefaction.
• Spasmolytic to gall-ducts and • Eczema and scrofulous • Oral and local.
bronchi. diseases—
• Ophthalmia,
conjunctivitis— • Lotion of infusion.
Chelone glabra
• A mild hepatic influencing the Cholagogue • Atonic conditions, malaise
mucous membranes: stimulates Tonic and debility, • Use freely with more
the appetite and tones the Vermifuge convalescence— stimulating agents.
stomach. • Dyspepsia, mal-
• Suitable for children and the assimilation— • With suitable alteratives.
elderly. • Round and thread worms— • Frequent doses until
• Indicated for gastro-intestinal purgation.
disturbances after prolonged • Colitis from hepatic
illness. dysfunction.
• Chronic jaundice.
Chionanthes virginica
• Relaxing and stimulating hepatic Cholagogue • Duodenal catarrh, hepatic
and alterative: stimulates the Tonic torpor, catarrhal jaundice,
discharge of bile, promotes Diuretic gallstones— • With Berberis.
digestion of fats. • Alimentary glycosuria.
• Corrects excessive discharge of • Pancreatic disease and
mucus into the gastro-intestinal glandular disorders.
tract. • Chronic disease of
liver/spleen.
Leptandra virginica
• Mild relaxing hepatic for torpid Cholagogue • Hepatitis, cholecystitis.
and congestive conditions: Cathartic • Chronic hepatic torpor— • Combine with stimulating
influences liver tubuli to assist Antiseptic agents.
secretion of bile, cleanses the • Non-obstructive jaundice.
alimentary tract of viscid mucus, • Febrile states (to clear
and stimulates peristalsis. bowel)— • With diffusives.
• Rectal prolapse /
haemorrhoids— • With Collinsonia.
• Skin eruptions— • With alteratives.

73
 ORGAN REMEDIES: KIDNEYS AND BLADDER
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Capsella bursa-pastoris
• Mildly relaxing and gently Diuretic • Vesico-renal irritation from
stimulating to the kidneys and Astringent atonic states. Enuresis— • With Agrimonia.
urinary tract: relieves atonic and • Passive capillary
catarrhal conditions, and controls haemorrhages, functional
haemorrhages. menorrhagia, bleeding
• Tonic to the pelvic organs. fibroid tumours, • Fresh plant preparations are
• Especially indicated when the metrorrhagia— best for haemorrhages.
urine is heavy with phosphatic • Congestive leucorrhoea.
and `brick-dust' sediments. • Internal haemorrhage of
lungs and bowels, recurrent • With more powerful
epistaxis— astringents when necessary.
• Haemorrhoids—
Equisetum arvense
• Principal action on the bladder: Diuretic • Acute cystitis with stricture • With Zea mays or Triticum
increases connective tissue tone Stimulant and urethritis— repens for demulcent
and resistance. Tonic support.
• Stimulating tonic diuretic, Astringent • Enuresis/incontinence in
gradually increasing the flow of children and the elderly.
urine. Haematuria.
• Controls inflammatory • Oedematous catarrhal
conditions. congestion of pelvic organs
• Astringent in passive and tissues.
haemorrhages. • Renal calculi— • Infusion of the green herb.
• Dropsy. Metabolic oedema • Cold water infusion.
of legs—
• Enlarged/inflamed prostate
gland.
Rhus aromatica
• Stimulating, toning and astringent Astringent • Enuresis, polyuria, • For all uses, with:
to genito-urinary and gastro- Tonic haematuria. Geranium, to reinforce
intestinal mucosa. • Haemorrhagic tendencies at astringency;
• Especially indicated for frequency the menopause. • Capsicum/Xanthoxylum, for
of micturition due to atonic • Diarrhoea, dysentery, greater stimulation and
conditions. cholera infantum. quicker result.
• Influences renal tubular • Diabetes insipidus.
reabsorption.
Uva ursi
• Increases renal circulation and Astringent • Chronic vesical irritation
stimulates tubular function. Tonic with pain and catarrhal
• Restores mucous membrane of Antiseptic discharge.
urinary and genital structures, • Chronic urethritis.
especially when pale, flabby and • Cystitis, haematuria,
oedematous. enuresis— • With Rhus aromatica.
• Indicated for chronic conditions. • Atonic leucorrhoea, profuse
menstruation, uterine
prolapse, vaginal laxity— • With Mitchella.

74
 ORGAN REMEDIES: GENITAL
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Aletris farinosa
• Gently stimulating and toning: Tonic • Amenorrhoea,
mainly influences female Stomachic dysmenorrhoea— • With Caulophyllum.
generative system. • Leucorrhoea (atonic-
• Indicated for dysfunctions arising anaemic).
from lack of tone and anaemia, • Premature/profuse
especially at the menopause. menstruation.
• Cerebrospinal trophorestorative • Impotence and sterility— • Continue for some months.
(spinal). • Parturient: prevents • With Viburnum /
miscarriage— Caulophyllum.
• Dyspepsia of pregnancy— • Small doses 2-3 times daily.
Caulophyllum thalictroides
• Gently diffusive stimulating Nervine • Metritis, endometritis,
relaxant: uterine vaso-dilator, Antispasmodic ovaritis.
antispasmodic in all spastic and Diuretic • Dysmenorrhoeic colic.
irritable states. • Urethritis, vaginitis,
• Indicated for atonic conditions thrush— • Oral, and local douche.
and for deficient contractions in • Restlessness during
parturition. pregnancy— • With Scutellaria.
• Cerebrospinal trophorestorative • Menopausal pains and
(optic). discomforts— • With Cimicifuga.
• Uterine sub-involution.
Helonias dioica
• Positively stimulating in Diuretic • Uterine stony/prolapse,
depressed function of uterus and vaginal laxity, menopausal • In general, give small doses
ovaries: tones pelvic tissues, debility— 3-6 times daily.
promotes appetite and • Leucorrhoea, menorrhagia, • With Viburnum +
assimilation. post-partum haemorrhage— Dioscorea.
• Reproductive tonic for both sexes. • Threatened miscarriage— • Small dose every 15-60
• Cerebrospinal trophorestorative minutes.
(mental). • Anorexia, anaemia, sterility.
Mitchella repens
• Moderately stimulating tonic for Tonic • Neurasthenia, irritability— • With Avena sativa.
weak and feeble conditions: Diuretic • Enlarged atonic uterus— • With Aletris/Helonias.
influences the pelvic organs, Astringent • To facilitate parturition— • With Caulophyllum.
stomach, bowel, kidneys and • Uterine bleeding from
nervous system. weakness, post-partum
• Indicated for female weakness: haemorrhage.
improves neuromuscular/vascular • Spermatorrhoea.
tone of uterus. Leucorrhoea.
Nymphaea odorata
• Mild astringent tonic: reduces Demulcent • Acrid leucorrhoea,
mucous discharge. Antiseptic ulceration of the cervix, • Local douche or
• Indicated for weakness of the vaginal laxity— suppository.
pelvic organs. • Cystic catarrh, prostatitis.
• Aphthous sore mouth— • Decoction as mouthwash.
• Purulent ophthalmia— • Decoction as lotion/wash.
• Diarrhoea, dysentery.

75
 ORGAN REMEDIES: GENITAL – continued…
Special Characteristics Auxiliary Individual Indications Combinations and Technique
Salix nigra
• Genito-urinary tonic: allays Nervine • Cystitis, ovaritis, prostatitis
irritation and restores vigour to Astringent • Vaginitis, leucorrhoea— • As douche of decoction.
the generative organs of both Anaphrodisiac • Proctitis— • As rectal injection of
sexes. decoction.
• Positive bitter tonic nervine. • Spermatorrhoea,
masturbation.
Senecio aureus
• Specific tonic to the nervous and Diuretic • Dysmenorrhoea • With Viburnum opul. /
muscular structures of the uterus: Astringent (anaemic/atonic)— Caulophyllum.
relaxing and slowly stimulating in Emmenagogue • Menses retarded or • With more positive
hyperaemic and atonic conditions. suppressed— emmenagogues.
• Uterine ganglionic vaso-relaxant. • Menses premature or too
profuse.
• Atonic leucorrhoea.
• Functional amenorrhoea
(asthenia).
• Ovarian/tubal dysfunctions.
• Prostate enlargement
(atonic).
Serenoa serrulata
• Genito-urinary tonic alterative: Diuretic • Atony of pelvic organs— • With Senecio.
influences glandular tissues and Sedative • Wasting of testes,
mucous membranes. impotence, undeveloped
• Indicated for wasting diseases and mammary glands.
conditions: promotes tissue • Enuresis/incontinence in
nutrition. children and the elderly.
Trillium pendulum
• Genito-urinary astringent tonic: Alterative • Leucorrhoea, prolapse,
General action on the mucous Astringent vaginal weakness.
membrane and specific for pelvic • Uterine haemorrhage— • Local tampons of decoction.
organ weakness. • Menopausal menorrhagia.
• Indicated for passive • Passive haemorrhage from
haemorrhages of uterine, gastric fibroids.
or rectal origin.
Viburnum prunifolium
• Soothing, stimulating astringent Nervine • Uterine prolapse, vaginal
tonic especially influencing the Antispasmodic laxity.
genito-urinary system. Astringent • Atonic amenorrhoea— • With Senecio.
• Indicated for spasms of tubular Diuretic • Passive/menopausal
organs: stomach, intestines, menorrhagia.
bladder, uterus. • Morning sickness, false
labour pains, threatened
abortion.
• Excessive lochial discharge.

76
 Part 3

HERBAL
PREPARATIONS

77
 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.

78
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.

79
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.

80
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

82
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

83
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.

84
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

85
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

86
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 percolator
and recover 32 oz. by free percolation, adding distilled water to the
marc 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.

87
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

89
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".

90
 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 Percolation
i. 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

91
be in moderately fine powder (Mesh 50) if this quantity of menstruum is to be sufficient, and
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

92
in the stock bottle, and the high concentration of alcohol soluble resins produces heavy
precipitation on dispensing in mixtures. As J. M. Thurston remarks:

". . . 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.

93
 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.

94
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.

95
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.

96
 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.

97
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

98
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 gum
Emulsions 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

99
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 Tragacanth

Agar 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 Moss
A 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.

Soaps
The 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.

100
Egg yolk
Egg 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.

Saponins
The 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 fat
Adeps 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.

Beeswax
A 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.

101
 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 . . . . . . . . . . . . . . . . qs
Aq. 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 part

01. Carophyllum . . . . . . . . . . . . . . . 1 part
01. Eucalyptus . . . . . . . . . . . . . . . . . 2 parts
01. 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 part

01. Origanum . . . . . . . . . . . . . . . . . 1 part
01. Gaultheria . . . . . . . . . . . . . . . . . 2 parts
01. 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:

Fusion
Where 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.

Trituration
Where 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

104
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.

Emulsions
This 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.

Formulae
The 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: i
Infused oil of fresh chickweed . . . . . . . . . . . . . . . . . . . . . . . . . 16 oz
White beeswax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 oz.
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.
iii. Vesicant effects, e.g. Empl. Croton, Empl. Cantharidin.

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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.

109
 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.

110
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 1
Use 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 2
Use 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.

112
 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.

113
Useful conversion equivalents: Imperial/Metric

1 pound = 453.59 grammes. 1 pint = 567.93 ml.

1 ounce = 28.35 grammes. 1 fluid ounce = 28.4 ml.
1 grain = 0.065 grammes. 1 fluid drachm = 3.55 ml.
1 gramme = 15.43 grains. 1 kilogram = 2lb. 3.27 oz.

Standard conventions:
Apothecaries symbols:

Weight- Grain = gr. Scruple =Э

Drachm =Ʒ Ounce =℥
Fluid- Minim = m. Drachm =Ʒ
Pint = 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 drachm = 4 ml. = 1 large teaspoonful.

2 fluid drachms = 8 ml. = 1 dessertspoonful.
4 fluid drachms = 15 ml = 1 tablespoonful.
1 fluid ounce = 30 ml = 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

114
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.

115
 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 eupatoria Hieraceum pilosella
Althaea officinalis Jateorhiza calumba
Angelica archangelica Linum catharticum
Arctium lappa Menyanthes trifoliata
Artemisia vulgaris Petasites vulgaris
Asclepias tuberosa Polygonum bistorta
Bryonia albs Potentilla tormentilla
Caulophyllum thalictroides Rhamnus cathartics
Chelone glabra Quercus robur
Cypripedium pubescens Rhamnus purshiana
Cytisus scoparius Scutellaria lateriflora
Daucas carols Rumex crispus
Dicentra canadensis Smilax ornata
Dioscorea villosa Swertia chirata
Erythraea centaurium Symphytum officinalis
Fucus vesiculosus Stillingia sylvatica
Galium aparine Taraxacum officinale
Geum urbanum Trifoleum pratense
Gentians lutes Triticum repens
Glechoma hederacea Tussilago farfara
Glycyrrhiza glabra Viscum 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%) Lobelia inflata
Barosma betulina Myrica cerifera (50%)
Capsicum minimum Myrrhae (60%)
Cimicifuga racemosa (60%) Rosmarinus officinalis
Convallaria majalis Sanguinaria canadensis
Grindelia camporum Thuja occidentalis
Guaiacum officinale (60%) Valeriana officinalis
Humulus lupulus (50%) Viburnum opulus
Hydrastis canadensis (50%) Xanthoxylum americanum
Hypericum perforatum Zingiber officinale

116
The following list of agents in common use were included in J. M. Thurston's original list for
preparation as `normal' fluid extracts:

Anthemis nobilis Lobelia inflata

Arctium lappa Lycopus virginicus
Asclepias tuberosa Mitchella repens
Baptisia tinctoria Myrica cerifera
Barosma betulina Nepeta cataria
Berberis aquifolium Phytolacca decandra
Capsella bursa-pastoris Podophyllum peltatum
Capsicum minimum Prunus serotina
Cascara sagrada Quercus robur
Caulophyllum thalictroides Rhus glabra
Chelone glabra Rumex crispus
Cimicifuga racemosa Salix alba
Collinsonia canadensis Salix nigra
Cypripedium pubescens Senecio aureus
Dioscorea villosa Solidago virgaurea
Euonymus atropurpureus Taraxacum officinale
Eupatorium perfoliatum Trillium pendulum
Eupatorium purpureum Turnera diffusa
Gentiana lutea Valeriana officinalis
Hamamelis virginiana Verbascum thapsus
Helonias dioica Viburnum opulus
Hydrastis canadensis Xanthoxylum americanum
Leonurus cardiaca Zea mays
Leptandra virginica Zingiber officinale

J. M. Thurston's list of agents for which an alcohol solution menstruum is suggested is as

follows:
Apium graveolens Mentha pulegium
Arctium lappa sem. Nepeta cataria
Barosma betulina Pinus canadensis
Cascara sagrada Rumex crispus
Fucus vesiculosus Salix nigra
Guaiacum officinale Sanguinaria canadensis
Hamamelis virginiana Turnera diffusa
Leonurus cardiaca Valeriana officinalis
Leptandra virginica Xanthoxylum americanum
Mentha piperita Zingiber 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:

117
Mucilage of Slippery Elm
Pour 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 Boneset
Pour 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 Elecampane
Pour 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 Linseeds
Macerate 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 Hyssop
Infuse 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 Sarsaparilla
Simmer 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 Burdock
Simmer 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 Syrup
Take 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 Syrup
Horehound 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 Lobelia
Macerate 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 tincture
Lobelia (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 preparations
Suitable 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 dr
Glycero-gelatin . . . . . . . . . . . . . . . . . . . . . 1 oz.
Melt the glycero-gelatin, stir in the agents, and run into a lubricated mould.

Preparations for external use

Mucilage of Acacia
The 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 Tragacanth
The 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.

119
Solution of Soft Soap
Soft soap. . . . . . . . . . . . . . . . 1 part
Distilled 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 blaster
F.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 ointment
A base for extemporaneous ointments:
Anhydrous lanolin . . . . 5 parts
Beeswax . . . . . . . . . . . 10 parts
Soft paraffin . . . . . . . . 85 parts

Suppositories

Calendula and Hydrastis

F.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 compound
Tr. 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 dil

Method 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

120
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 dil

Place 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 lubricant

In using cocoa butter to make suppositories the moulds must be lubricated with the following
solution:

Soft soap . . . . . . . . . . . . . . . . . . . . . 7 parts

Isopropyl alcohol . . . . . . . . . . . . . . 14 parts
Glycerine . . . . . . .. . . . . . . . .. . . . .. 1 part
Dissolve and mix together.

Compound Tragacanth Powder

Powdered tragacanth gum. . . . . . . . . . . . . 1 part
Powdered acacia gum . . . . . . . . . . . . . . . . 1 part
Powdered starch . . . . . . . . . . . . . . . . . . . . 1 part
Powdered sucrose . . . . . . . . . . . . . . . . . . . 3 parts

Mix thoroughly together in a mortar. Store for use.

121
 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.

Dosage

Achillea millefolium ...................................................................................................................................... 65 A

Agrimonia eupatoria....................................................................................................................................... 60 A
Aletris farinosa ............................................................................................................................................... 75 A
Alpinia officinarum........................................................................................................................................ 71 B
Althaea officinalis .......................................................................................................................................... 66 A
Anemone pulsatilla......................................................................................................................................... 61 X
Arctium lappa................................................................................................................................................. 58 A
Asclepias tuberosa.......................................................................................................................................... 56 B
Avena sativa ................................................................................................................................................... 61 B

Baptisia tinctoria ............................................................................................................................................ 58 B

Barosma betulina............................................................................................................................................ 64 A
Berberis aquifolium........................................................................................................................................ 71 B
Berberis vulgaris ............................................................................................................................................ 73 A
Betonica officinalis ........................................................................................................................................ 60 A

Cactus grandiflorus ........................................................................................................................................ 67 X

Capsella bursa-pastoris .................................................................................................................................. 74 A
Capsicum minimum ....................................................................................................................................... 55 C Tr.
Cassia angustifolia ......................................................................................................................................... 71 A
Caulophyllum thalictroides............................................................................................................................ 75 B
Chelidonium majus ........................................................................................................................................ 73 B
Chelone glabra................................................................................................................................................ 73 A
Chionanthes virginica .................................................................................................................................... 73 B
Cimicifuga racemosa...................................................................................................................................... 61 B
Cola vera......................................................................................................................................................... 60 C
Collinsonia canadensis................................................................................................................................... 71 A
Convallaria majalis......................................................................................................................................... 67 B
Crataegus oxycantha ...................................................................................................................................... 67 C
Cypripedium pubescens ................................................................................................................................. 56 A

Dioscorea villosa ............................................................................................................................................ 56 A

Echinacea angustifolia ................................................................................................................................... 58 C

Equisetum arvense ......................................................................................................................................... 74 A
Eupatorium purpureum ................................................................................................................................. 64 B
Eupatorium perfoliatum ................................................................................................................................. 65 A
Euphrasia officinalis....................................................................................................................................... 57 A

122
Fucus vesiculosus........................................................................................................................................... 58 A

Galium aparine ............................................................................................................................................... 64 A

Gentiana lutea................................................................................................................................................. 71 A
Geranium maculatum..................................................................................................................................... 57 B

Hamamelis virginiana .................................................................................................................................... 57 B

Helonias dioica............................................................................................................................................... 75 B
Humulus lupulus ............................................................................................................................................ 61 B
Hydrastis canadensis ...................................................................................................................................... 60 C
Hypericum perforatum................................................................................................................................... 61 A

Inula helenium................................................................................................................................................ 69 A
Iris versicolor.................................................................................................................................................. 59 A

Juglans cinerea ............................................................................................................................................... 72 A

Juniperus communis....................................................................................................................................... 64 A

Leonurus cardica ............................................................................................................................................ 68 A

Leptandra virginica ........................................................................................................................................ 73 A
Lobelia inflata ................................................................................................................................................ 56 X
Lycopus virginicus ......................................................................................................................................... 69 B

Marrubium vulgare......................................................................................................................................... 69 A
Matricaria chamomilla ................................................................................................................................... 62 A
Mitchella repens ............................................................................................................................................. 75 A
Myrica cerifera ............................................................................................................................................... 55 B

Nepeta cataria................................................................................................................................................. 65 A
Nymphaea odorata ......................................................................................................................................... 75 A

Passiflora incarnata ........................................................................................................................................ 62 C

Phytolacca decandra....................................................................................................................................... 59 C
Polymnia uvedalia.......................................................................................................................................... 59 A
Populus tremuloides ....................................................................................................................................... 60 A
Prunus serotina ............................................................................................................................................... 69 A
Pulmonaria officinalis .................................................................................................................................... 69 A

Rhamnus purshiana ........................................................................................................................................ 72 A

Rheum officinalis ........................................................................................................................................... 72 B
Rhus aromatica............................................................................................................................................... 74 A
Rosmarinus officinalis ................................................................................................................................... 72 B
Rubus idaeus .................................................................................................................................................. 57 A
Rumex crispus ................................................................................................................................................ 59 A

Salix nigra....................................................................................................................................................... 76 A
Salvia officinalis............................................................................................................................................. 57 A
Sambucus nigra .............................................................................................................................................. 65 A
Scrophularia nodosa ....................................................................................................................................... 59 A
Scutellaria lateriflora...................................................................................................................................... 62 A
Senecio aureus................................................................................................................................................ 76 A
Serenoa serrulata ............................................................................................................................................ 76 C
Solidago virgaurea ......................................................................................................................................... 70 B
Spiraea ulmaria............................................................................................................................................... 72 A
Sticta pulmonaria ........................................................................................................................................... 70 A
Symphytum officinale.................................................................................................................................... 66 A

Trifoleum pratense ......................................................................................................................................... 70 A

Trillium pendulum ......................................................................................................................................... 76 B
Turnera diffusa ............................................................................................................................................... 62 A

123
Tussilago farfara............................................................................................................................................. 70 A

Ulmus fulva .................................................................................................................................................... 66 -

Uva ursi .......................................................................................................................................................... 74 A

Valeriana officinalis ....................................................................................................................................... 62 C

Verbascum thapsus......................................................................................................................................... 70 A
Verbena officinalis ......................................................................................................................................... 62 A
Viburnum opulus............................................................................................................................................ 63 A
Viburnum prunifolium ................................................................................................................................... 76 A
Viscum album ................................................................................................................................................ 63 B

Xanthoxylum americanum............................................................................................................................. 55 A

Zea mays......................................................................................................................................................... 64 A
Zingiber officinale.......................................................................................................................................... 55 C

124