by Matthew Wood
A “specific indication” does not just indicate a specific remedy; it also indicates a condition of the tissues to which the plant is remedial. The above tongue condition indicates excessive heat (carmine-red color, pointed shape) with stagnant blood (blueness). Also, stagnant blood is less fluid, so the blue part of the tongue is drier. From another perspective, heat is burning off some of the fluids so that the center is drier and blood thicker as fluids are driven off through the periphery (causing moist sides). This condition is surprisingly common.
Another specific indication for yarrow is reddish skin with prominent blue (but not swollen) veins running through the redness. My interpretation would be that this shows that the veins are full and stagnant and block the capillaries from emptying as quickly as they should. This results in a congested capillary bed that causes redness on the skin. This is shown by the red periphery of the tongue with the blue in the center.
Yarrow is both a stimulant and an astringent, and it is thought that much of its healing power comes from its ability to stimulate and astringe (contract and tone) the veins, thus relieving capillary-blood stasis. British herbalist Christopher Hedley once explained in a lecture I attended that prickly ash (Zanthoxylum) is used in British herbalism in combination with yarrow because the former floods the capillaries with blood while the later drains them away through increased venous flow.
In addition to showing an organ affinity with the veins, capillaries, and circulation, these specific indications for yarrow also reveal the energetic condition: heat, or excess yang, is displayed in the red, pointed tongue, but this is combined with cold, depression, or yang deficiency (blue center).
Yarrow is an aromatic herb with a lot of volatile oils and a pungent, bitter, astringent taste. We associate the properties pungent, aromatic, and having volatile oils with stimulation, so it is probably through stimulating the veins and relieving stagnation that the capillaries are emptied. With no neuromuscular structure to speak of, veins are easily relaxed, and capillaries easily become engorged. These conditions respond to astringence. As a stimulating astringent, yarrow is a great remedy for severe, bright-red, hemorrhagic bleeding, an engorged endometrium, excessive menstrual bleeding, hemorrhoids, and varicose veins. The bitter elements in yarrow increase secretions to moisten the center of the body and tongue.
A further specific indication for yarrow comes from William LeSassier. He called it a “feathered tongue.” This is one of the first facts I learned from William when I first met him. He considered yarrow specifically indicated when the center of the tongue shows a split or crack, especially if this opened up into dark-red tissue crisscrossed by little lines, so it looks like a “feather” in the center of the tongue. This indicates “heat attacking the blood” in TCM terminology. The expression refers to inflammation that severely irritates arterial vessels. The location in the center of the tongue refers us to the center of the body, especially the digestive tract, where the arterial vasculature is particularly inflamed. This extreme form of heat irritates the capillaries and tends to be associated with ulceration and hemorrhage. That was typical of William: the first time he met me he described my own tongue without seeing it.
Now let’s say the reader does not know how to interpret the tongue. It is still possible to understand yarrow in terms of symptomology alone, without reference to tongue evaluation. First of all, yarrow is indicated when a bruise is red and blue, showing inflammation and spilled blood. That is also an indication for arnica (Arnica montana) and safflower (Carthamus tinctoria), but it differentiates from other remedies where the bruise colors are blue and gray, blue, green, yellow and gray, blue and yellow, or blue and black. Yarrow also is for prominent blue veins between reddish surfaces, as mentioned above.
Many herbalists know that yarrow is indicated in bright-red hemorrhaging—not without reason was it once named “herba militaris.” These include cases of nosebleed, hemorrhages from accidents, bleeding from the lungs or GI, bleeding hemorrhoids, and especially in menstrual bleeding with bright-red hemorrhaging. Because herbs sometimes normalize two opposite states, it is also occasionally a remedy for amenorrhea. Yarrow is indicated in some cases of endometriosis, uterine fibroids, and excess menstrual conditions—but observe how we subordinate the name of the disease to the characteristic pathology.
Just as we compared the bruising of yarrow with other remedies, we also want to compare the hemorrhaging. Yarrow is indicated by bright-red bleeding, while shepherd’s purse is indicated by dark, oozing blood, sumach by watery blood, goldenseal by clean cuts, and St. John’s wort by pain. Yarrow also acts as a diaphoretic to promote sweating in fever. The bright-red hemorrhage has its analogy in strong fever brought on by exposure to the elements; we look for a fever with reddish skin.
These are examples of clear specific indications. By themselves, they offer an understanding of the pathology, energetics (capillary heat, venous relaxation, stagnation of the blood), organ location (capillaries, veins, circulation), and correspondence to the actions and tastes (aromatic, bitter, astringent). Yet they do not “name” the disease, which might be acute fever, enterocolitis, hepatitis, hemorrhoids, varicose veins, endometriosis, bleeding uterine fibroids, excessive menstrual bleeding, brain-surgery trauma, spinal injury, etc. I have used yarrow in all of these cases.
A “specific indication” is very different from what the homeopaths call a “characteristic,” though it is more similar to the detailed “keynote” symptom. A “characteristic” symptom usually does not point out the pathological context, as a specific indication does. It may indicate a specific remedy or (like a specific indication) a few to pick among. A “keynote” is a complex of characteristic symptoms that very reliably points to a specific remedy, but also does not usually indicate the pathological context. A specific indication, by contrast, points to a specific remedy (or perhaps a few) as well as the pathological context.
A good example of a characteristic symptom is the classic homeopathic indication for Bryonia alba—“worse from motion.” The person who needs Bryonia feels sharp pain on attempting movement of, for instance, chest, elbow, wrist, or muscles, or the passage of a bowel movement down the intestines. This almost always gives the answer away: use Bryonia, and chalk up another cure for homeopathy. However, the homeopathic literature does not appear to be interested in the pathophysiological meaning of this symptom.
We of the herbal persuasion, using Bryonia, would tend to think of this symptom as indicating drying-out of lubricating fluids—serous, synovial, or mucosal—so that parts are not lubricated when they move but instead catch against each other, causing sharp pain.
With the limited medical background of his era, Scudder laid out a simple approach to healing using indications. His method was more empirical (observational and pragmatic) than philosophical, dogmatic, or systemic. He relied largely on diagnosis from the general appearance and condition of the tongue, skin, pulse, and major symptoms revealed by the sick person. In the end, his system resembles Traditional Chinese Medicine—a method that similarly relies on the same sort of diagnosis and premodern understanding of anatomy, physiology, and pathology.
Scudder’s approach is especially similar to the method taught by Huang Huang in Ten Key Formula Families in Chinese Medicine (1994). Huang lays out the profile of the herb. He says this is traditionally called the “presentation.” He includes characteristic symptoms from the tongue, pulse, and other salient symptoms, the energetics, organ affinities, and major pathological observations. Many of his symptoms are actually specific indications that link one herb with one pathological presentation. He maximizes the description of the agent and its characteristics while minimalizing the “syndrome” or disease name to which it is traditionally linked in TCM. This is exactly what Scudder does.
Traditional Chinese Medicine is, of course, one of the most highly developed energetic systems in the world. However, it does not rely upon a single remedy, as Scudder often does. The profile of the remedy and the spe
cific indications are usually not as highly developed. Huang Huang is an exception. He places less emphasis on TCM syndromes or “disease names” and more on specific indications from the pulse, tongue, appearance, and the tissues themselves. Thus, he speaks of the “rhubarb tongue” and its accompanying constitution. Though he doesn’t use individual specifics, he uses the classic TCM formulas very specifically for each pathological presentation.
Specificity developed very slowly in Western herbalism. The Greeks were not great herbalists like the American Indians, but were good “food doctors,” largely considering herbs to be specialized foods. Therefore, they associated them with the four qualities (hot, cold, damp, and dry), organ affinities, and actions, but did not fine-tune the indications. They used them in formulations, whereas the American Indians, as well as European peasants, often used specifics and developed specific indications as well as formulas. Specific indications were revived by David Winston, myself, and the late Australian herbalist Dorothy Hall. William LeSassier was another practitioner of specific medicine, but he did not publish much, so we are dependent on our memories of him, and his recorded lectures.
The most useful books on specific indications (in addition to those written by myself) are Dorothy Hall’s Herbal Medicine, Dietrich Gümbel’s Herbal Essences and Aromatherapy, anything by John Scudder or Finley Ellingwood, and Huang Huang’s Ten Key Formula Families in Chinese Medicine. William Salmon’s The English Herbal, or Botanologia (1710) is the best of the Renaissance herbals for specificity since he actually gives a “specifickation” for each herb.
The Magic of Specific Indications and Keynotes
These kinds of symptoms are not just important for precision in herbal practice; they are mneumonic devices. They may be seemingly forgotten, but when a patient presents with the symptom, the specific or keynote often pops into the mind of the practitioner. Only then, sometimes, does the logic of the indication reveal itself.
Our Native teacher, Tis Mal Crow, used these keynotes very consciously. He never explained what he was doing, but he would slow down his speech and ennunciate the symptom very clearly. It was always the same words, no matter how many times we heard him. For Smilacina he would slowly say “when the child cries without reason” or (less slowly) “the PMS psychobitch from hell.” Who could forget such descriptions? (For both these applications use Smilacina as a smudge). Tis Mal was trained in Indian medicine, not only how to use plants, but how to influence the mind, and he took this type of education very seriously.
I recognized the technique when first I heard Tis Mal, because I had already observed it in the writings of the eclectic physicians and in the teaching of William LeSassier. He too was an esotericist trained to influence the mind, not just to “explain things.” I have known educators who knew their material but didn’t know how to plant these specific indications and keynotes in the memory. They were not as effective. I’ve known others who, hearing the method used once, immediately adopted it.
A keynote or specific indication always needs to be short, simple, and to the point. A good example is “tortured to capture the breath,” a symptom for agrimony flower essence (or the herb) that goes back to one of Dr. Bach’s protégés. It is not “tortured capture of the breath.” That would indicate the person finally did catch the breath. But imagine the person who, for minutes, an hour, or longer, can’t capture the breath; this person is “tortured to capture the breath.” Once seen, it is not something forgotten, and there really is no other description. Yet if one had not seen such a terrible presenting symptom, one would think the exact words did not matter. One might read such a symptom and forget about it, but when a person presents the phrase flashes up from the memory into awareness. I know, because I had that experience with this exact symptom.
Specific indications and keynotes can be honed and refined to perfection through experience in the field. Usually, however, they simply pop up into the mind, from the experience at hand. The first keynote Tis Mal gave, “when the baby cries without reason,” was an exact translation from the words of his teacher. The second was the product of experience.
Taste
I only added this category in the last phase of manuscript preparation but, as mentioned above, it is often an important part of the “internal repertory” a practitioner uses to analyze the case according to actions and energetics. The taste acts as the reference point for the actions, energetics, and properties of the herb, so that many practitioners will be thinking to themselves, “what taste is right for this condition?” Following are the major tastes, grouped by tissue state and followed by their actions and energetics.
Tissue State Taste or Sensation Action
Excitation
Sour (small doses)
cooling
Bitter almond
cooling
Citric acid (lime, lemon)
cooling
Wet (cucumber, melon)
cooling
Sweet narcotic
sedative
Sweet aromatic
blood-thinning, cooling
Depression
Pungent, aromatic, spicy
warming
Hot, burning
warming
Piney, resinous
stimulating
Diffusive (tingly)
stimulating
Sweet aromatic
blood-thinning, stimulating
Bitter aromatic
antiparasitic stimulating
Atrophy
Wet
moistening
Mucilaginous (tacky)
moistening
Emollient (salty)
softening
Oily, nutty
moistening, nourishing
Sweet
nourishing
Meaty
nourishing
Bitter
digestive
Earthen (mineral taste)
mineralizing
Stagnation
Bitter
digestive
metabolic
laxative
(Sometimes other flavors also act on this tissue state.)
Tension
Acrid (bilious taste)
diaphoretic
relaxant
emetic
entheogenic (spiritually mind-altering)
Relaxation
Astringent
closes pores
stops flux
tones tissue
hardens
In Ayurvedic medicine, the sour flavor is considered warming, in large doses—acids burn. In small doses, or naturally occurring in fruits, however, it is cooling—illustrated by the fact that we eat fruits for their cooling effect in the hot summer.
What I have called the “sweet narcotic” flavor is found in Papaver, Eschscholzia, Aesculus hippocastanum, Tilia, and some other plants that are sedative and anodyne (pain-relieving).
Tastes operate by contraries, so that remedies address conditions with the opposite qualities: sour, cooling fruits (which are refrigerant, antifebrile, sedative, and sometimes anodyne) are used to reduce heat and excitation; damp mucilage remedies are moistening for dry conditions, and usually also nourishing or cooling. Pungent, hot, spicy herbs stimulate the circulation and are therefore used to warm and stimulate a cold, stagnant condition.
Formulary
At the end of most sections I have placed a short formulary. These are only advisory and not intended to be comprehensive; nor do they explain the logic behind the formulations as elegantly as Huang Huang does in Ten Key Formula Families in Chinese Medicine. Also, there is very little discussion of remedy preparation, which is widely available elsewhere.
For American herbalists, I recommend Classical Formulas in the Western Herbal Tradition, a beautiful formulary by Les Moore (2002). The author has collected many of the great formulas of Western herbalism and, even more significantly, has developed extensive indications for them. He treasures our history, and for this I highly appr
eciate and recommend his work.
For British herbalists, I recommend the British Herbal Pharmacopeia 1983. Fine, simple formulations are also given by A.W. and L.R. Priest in Herbal Medication (1984, 2001). Many of the great British formulas were directly borrowed from physiomedicalism, and are therefore influenced by American herbalism, but others are native to the United Kingdom.
Sources
The backbone of The Earthwise Herbal Repertory is the short repertory in my earlier The Book of Herbal Wisdom (1997), which drew on my own experiences, those of friends and acknowledged masters, and the great books they composed. My list of sources was very short (primarily David Hoffman’s Holistic Herbal). The enlarged effort includes more sources, including Michael Moore’s Herbal Repertory in Clinical Practice (1994); Herbal Remedies (2001) by Asa Hershoff and Andrea Rotelli; the British Herbal Pharmacopoeia 1983; Thomas Bartram’s Encyclopedia of Herbal Medicine (1995); John Sherman’s The Complete Botanical Prescriber (1993); William Boericke’s Pocket Manual of Homoeopathic Materia Medica (1927), including a repertory by his brother, Oscar Boericke; and Adaptogens: Herbs for Strength, Stamina, and Stress Relief by David Winston and Steven Maimes (2007).
Ranking of Symptoms
The homeopathic repertory ranks symptoms into three or four grades, from less common to frequently encountered. Again, because we as herbalists focus less on symptoms than homeopaths do, we don’t have a well-developed system for grading or ranking of symptoms. However, Herbal Remedies by Asa Hershoff and Andrea Rotelli (2001), and the British Herbal Pharmacopoeia 1983, rank remedies for us. I have used these books, plus my own experience and that of others, to grade remedies.