by Matthew Wood
After the food/toxins have entered the body through the gut wall, they are met by a frenzied, stirred-up army of newly minted white blood cells ready to pounce on the innumerable “bad guys” that snuck in with the more innocent food/toxins. Each time we eat, the bone marrow is signaled to manufacture millions of new white cells expressly for this meal.
In old-time medicine, doctors and folk healers used to differentiate a certain kind of malnutrition associated with the spleen. The person was pale, sallow, had low energy, poor digestion, “slow loss of flesh” (as Cook says), and loose stools. In Maine they still say a person or cow that doesn’t gain weight well is “spleeny,” and in the South they used to speak of people who were “born tired.” Because of the massive amount of food we have today in the First World, we don’t see much of this. However, there is another problem that we do see.
We may have plenty of food—too much—but it contains many more toxins than our ancestors were confronted with, and it may be that we have to produce more white blood cells with every meal than did our forebears. When I take a leukemia case, I often find that there was some poison or toxin, possibly just a spider bite, that set off an immune reaction that perhaps overstimulated white-cell production and led to the pathological production of mutated white cells—leukemia. The increasing levels of this disease—especially in children, who have a more sensitive gut—may possibly be replacing the “spleeny” problems of the past.
Cook gives a list of remedies under the heading “assimilation,” which I have reproduced exactly below, except for my addition of Ceanothus and Geum urbanum. Almost all of these remedies combine astringence, stimulation, and the sweet or nutritive taste. Where one of these properties is missing, Cook tells us to supplement it. These are exactly the kind of remedies that suit “spleen yang deficiency,” in the terminology of TCM, though the Chinese do not use the astringent property as much as we do in the West, preferring the warmth or stimulation which is also found in these agents. The sweet taste is also perfect because, according to TCM, it guides the herb to the spleen.
Assimilation: • Ceanothus (sweet, astringent) • Comptonia (sweet, pungent, and astringent, this agent is more like a “spleen yang tonic” than any other in the American materia medica; promotes digestion gently, and assimilation strongly; diarrhea) • Filipendula (“sub-acute and chronic diarrhea, scrofulous character, where the assimilative organs are at fault”—Cook) • Geum urbanum (sweet, astringent, pungent; diarrhea, dysentery, weakness, and debility; “vinous” tincture—Grieve) • Geum virginianum (sweet, astringent, pungent; curdy diarrhea, wasting) • Gnaphalium (sweet, slightly pungent and aromatic; wasting, weakness of organs) • Myrica (pungent, astringent; atonic GI mucosa with catarrh; weak peripheral circulation) • Nymphaea (mucilaginous and astringent; GI and vaginal yeast) • Populus tremuloides (bitter, astringent, sweet) • Rheum (astringent, bitter, acrid; curdy diarrhea, lack of assimilation, tumid abdomen in children) • Rumex crispus (elongated, red tongue, with heavy white or yellow coating; yeast and heat; thrush in babies; borborygmus) • Scrophularia • Verbascum (one of the best for promoting absorption—Cook).
RHUBARB (RHEUM SPP.)
To the extent that rhubarb is used today in Western herbalism, it is mostly as a laxative, in small doses, in formulas, and almost never as a specific, simple, or single remedy. I thought, however, to remedy that with a portrait of its specific uses, both as a laxative for constipation, and in smaller doses as a tonic for diarrhea. A good account of the constitutional indications calling for rhubarb as a laxative is given by Huang Huang in his excellent Ten Key Formula Families in Chinese Medicine (1994). William Cook’s A Physiomedical Dispensatory (1869) also gives us a wonderful account of the properties of rhubarb.
Today we can get Asiatic rhubarb (Rheum palmatum, R. officinale) at no great cost; but perhaps many people such as myself, who grew up with rhubarb in the garden, have wondered whether common rhubarb could be used in place of the medicinal rhubarb.
Culinary rhubarb (Rheum rhaponticum) was developed by English market gardeners, who had been employed by traders in herbal drugs in an attempt to grow rhubarb at home and reduce the cost of bringing it from China through Russia and Turkey. This strain grew well, but failed as a drug. The gardeners, however, found a market for it, and rhubarb became a beloved pie-plant in the northern world, where fruit is less available in early spring.
Cook wondered about this, and tried the domesticated plant in place of the expensive trade item. “The density is less than that of the Asiatic species,” he wrote, “and the center of the root is sometimes even short and spongy. The odor of this species is faint, and not so agreeable as that of the foreign roots; the taste is bitterish astringent, mucilaginous, and not gritty nor always pleasant.” (I would say it is more “acrid” than “bitter,” and more “sour” than “astringent.”) Though “less agreeable to the taste, somewhat more astringent, and distinctly mucilaginous,” continues Cook, the “impression upon the system is nearly identical with the foreign species, though about twice the quantity is required” (Cook 1869).
The taste of Chinese rhubarb (Rheum palmatum) is “heavy, compact, oily, and fragrant, with a bitter and nonastringent taste,” according to Huang Huang. He used large doses of this plant for an excess constitution. “The ancients metaphorically referred to radix et rhizoma rhei (da huang) as the general who has the power to knock down doors and suppress turmoil” (Huang 1994, 113). The actions of large doses are “harsh,” so one needs to know how to use this agent. Dr. Huang treats us to a description of both the indicated constitutional type and the symptom presentation.
The energetic condition is one of interior full heat: excess is seen in constipation and fullness, heat in tenderness, tissue and mental irritability, fever, and the “red, tough, firm tongue body with a dry, scorched-yellow coating.” Huang, in fact, calls the latter “rhubarb tongue.” The complexion is full and red, the lips often dark-red, and if there is mucus it is thick and adhesive. In addition to the heat symptoms, there tend to be symptoms of blood stagnation, giving a purple cast to the dark-redness of the complexion or tongue. The heat rises and causes swollen glands, fever, headache, dizziness, mouth sores, herpes, redness in the eyes, and other symptoms.
Although it is frequently used in acute febrile conditions, Chinese rhubarb is also associated with a particular constitutional type. This person is big, with firm muscles, yet lazy, a red, oily complexion, thick lips on the dark-red side, a large, self-indulgent appetite, stuffiness in the chest, and an aversion to heat. Huang mentions a dry mouth, but these people can have excessive salivation (a symptom from the homeopathic provings).
In emphasizing the basic energetics and organ affinities, but not as much the fixed syndromes or disease names, Huang Huang’s approach is very similar to that of the eclectics such as Scudder, and some of the physiomedicalists.
Cook describes the use of rhubarb, in smaller doses, for a constitution that is almost the opposite of the one described by Huang. Doses of twenty to forty grains are laxative, but in four- to eight-grain doses, three times a day, “it soothes irritability of the stomach and promotes digestion.” It is especially indicated in “those forms of indigestion accompanied by acidity, laxity of the gastric structures, morning looseness of the bowels, and sallow countenance. A portion of its good effects is due to its mild stimulation of the bile ducts, leading to ejection of bile” (Cook 1869).
For diarrhea and dysentery, Cook recommends two large doses three hours apart to loosen impacted material, followed by small doses thereafter until the looseness subsides. This approach leaves a gentle tonic effect from the astringency. “It is well adapted to children of scrophulous habits, with a tumid abdomen.” I remember as a child that some kids seemed to crave rhubarb stalks, and ate them raw straight out of the garden. This suggests that it possesses some kind of deep nourishing effect, and Cook hints that this is so. “It seems to improve the assimilative powers well and, like Geum, Myrica, and a few oth
er agents, to give firmness and activity to lax mesenteries in scrophulous constitutions.” Like Geum, Rheum is indicated for the “curdy diarrhea” that Cook considered a characteristic of lack of assimilation.
These two different presentations illustrate opposite profiles, and demonstrate how many herbs normalize between two opposite conditions. (This principle was introduced in Part I, in the discussion of the rebound effect, and primary and secondary symptoms.)
Liver
Food, routinely digested in the stomach and assimilated through the lymph system and portal vein, would be highly toxic for us if we injected it directly into our bloodstream. Therefore, it needs to be detoxified in order to be made safe. For this reason, I do not call it “food,” but “food/toxins.” The job of the liver is to shield the rest of the body from this wave of toxic material, and render it into useful nutrition and replacement parts. The liver is usually thought of as the center of detoxification, but it is also the center for producing cell food. The liver is said to be in charge of the “preparatory” metabolism, while the cells themselves perform the “secondary” or cellular metabolism.
This liver does this through the breakdown and rebuilding of chemicals in the food/toxins. The metabolic process is divided into two camps: the catabolism (breaking down) and anabolism (building up). Michael Moore used to like to talk about the “catabolic dominant” and “anabolic dominant” constitutions—the former tearing down a lot of toxins, and latter making a lot of metabolites. A big, heavy man himself, he frequently joked about the “anabolic greaseball” who loved rich foods and overbuilt the blood, carbs, lipids, and proteins in the body.
Food/toxins enter the body through the cell walls lining the intestines. The water-soluble carbs and proteins are picked up by the capillaries feeding the portal vein and brought directly to the liver, while the oil-soluble lipids are absorbed into the lymphatic ducts and taken on a circuitous journey up to the chest, dumped into the bloodstream, and finally brought to the liver. The proteins are manufactured into substances that regulate the blood. The sugars were already broken down to glucose in the intestines; they are stored in the liver as glycogen, or sent on to the cells for use or storage. Fats and oils are processed into cholesterol—the lipid “coin of the realm” from which everything oil-soluble is made in the body.
The liver even handles some minerals. Old blood cells are broken down to extract iron-rich salts, which combine with cholesterol to form the bile. This is secreted by the hepatic cells and collected, managed, and released by the gall bladder. Much of the bile is reabsorbed so that the valuable bile salts can be reused. The liver also breaks down hormones and other metabolites made in the body after they have served their purpose.
Midway through catabolism, there is a point where metabolites need to be stabilized by an antioxidant to prevent oxidation. Antioxidants must be consumed in food, in the form of fruits and vegetables. If they are not, incompletely metabolized “free radicals” will get into the bloodstream and cause inflammation. These attract oxygen, which inserts itself into a weak molecule and “blows it up.” This uncontrolled chemical activity causes the “weathering” or aging of tissues. We see, therefore, why the liver is associated with uncontrolled heat processes in the body, both in Eastern and Western herbalism. We also see why antioxidants are now a nutritional fad—they have been recognized as preventing this destructive process.
If a person consumes too much food or too many toxins, requiring lots of hepatic work and lots of antioxidants, the load of unmetabolized junk can back up down the portal vein. More arterial blood is needed in the liver to complete metabolism, and this takes it away from the brain and other organs, leading to a prolonged episode of sluggishness after the meal or drug or alcohol use—a hangover. In traditional Western herbalism, the idea of a “toxic liver” or “toxic blood” is very important. This describes the sluggish hepatic function, or acute or chronic hangover due to excessive consumption of food, drugs, or alcohol. The symptoms of a sluggish liver are like those of a hangover, but are chronic. The unresolved metabolic waste products and free radicals produce toxic heat symptoms, such as skin conditions including eczema and acne.
The liver undertakes literally thousands of jobs. building up and tearing down metabolites. We could not dream of an herb or drug for every individual pathway or enzyme—nor does biomedicine. Instead, we need to have an overview of the liver, and treat the major processes by which these thousands of operations take place.
The liver is like a furnace: it needs oxygen (from arterial blood), a valve (arterial-tension regulation), fuel (food/toxins carried in from the portal vein), fire (metabolic energy), and an outlet (bile). It also needs to be cleansed; this is done by lymph and venous blood. Liver remedies, therefore, act to: (1) increase arterial circulation to the liver by promoting capillary development (Lavandula), relieving arterial tension (Agrimonia), and thinning the blood (Achillea, Angelica); (2) decrease venous and portal congestion (Collinsonia, Aesculus, Potentilla); (3) keep lymphatic drainage clear (Calendula, Scrophularia); (4) promote metabolism of proteins (Urtica), lipids (Arctium), glucose (Vaccinium myrtillus), and poisons (Larrea, Silybum); (5) boost both catabolism (Arctium, Larrea) and anabolism (Mahonia, Lycopodium); (6) protect liver cells (Curcuma, Silybum); and (7) produce and clear bile (Chelidonium, Hydrastis, Taraxacum).
In addition, the general body environment needs to be kept in good order so as not to overburden the liver. “Toxic liver,” “liver congestion,” or metabolic disorder can occur from a low thyroid condition, but can also cause it (Wilson’s Thyroid Syndrome), since the liver needs to process thyroxine. Liver congestion also occurs with toxic buildup in the extracellular matrix (Stellaria media), a leaky gut sending in too many toxins (Iris, Althaea), and poor elimination (by skin, kidneys, and intestine) throwing toxins back into the body.
Many liver problems in the past were due to malaria, which caused swelling of the liver and spleen. Since many of our old liver remedies (Euonymus, Veronicastrum, Chelone) come from this period, they are no longer as useful as they once were. I have only used Chelone twice in thirty-five years, for travelers who picked up malaria in Central America. At the same time, our knowledge and skill level with these herbs has dropped off, so we don’t understand how to use them as well.
Toxic, Congested Liver (Low Catabolism): • Achillea (congestion; poor lipid metabolism—M. Moore) • Allium sativa (garlic) • Angelica • ARCTIUM (poor lipid metabolism, low bile production; skin rashes, acne, scalp) • Astragalus • Azadirachta (general detoxifier, immune tonic, anti-inflammatory) • BERBERIS (damp and heat; low-grade bacterial infections, chronic ill health; dull-minded, shattered physically and mentally) • BETA (poor lipid metabolism—Weiss; said to regenerate hepatocytes) • BUPLEURUM (fullness in chest, hypochondrium; mood swings; wiry and/or thin pulse) • CEANOTHUS (lymphatic support) • Centaurium (clears damp heat—Hobbs) • Chelone (pain from left side of liver down to navel) • Chionanthus (stimulating, bitter) • Cichorium (cooling; low bile production and ejection) • Citrus limonum (torpor) • COLLINSONIA (for stagnation in portal vein backing up toxins to liver and gall bladder) • CURCUMA (stimulating anti-inflammatory, protectant, regenerative, bile stimulant; combine with pepper and bromelain) • Cynara (for poor metabolism of fats) • Fumaria • Galium (lymph nodes) • Glycyrrhiza (protectant) • Helianthus (one of the best detoxification oils in Ayurvedic “oil-pulling”) • Hepatica (soothing and tonic) • Hydrastis (low bile production) • IRIS (congestion; leaky gut) • Juglans cinerea (sluggish bile) • Juglans nigra (leaky gut—needs confirmation) • LARREA (depression from excess toxins; small dose) • Lavendula (externally, to support liver capillary bed—Gümbel) • Linaria (jaundice) • MAHONIA (dry skin, constipation; low catabolism and anabolism) • Menispermum (when Smilax “proves ineffective, invariably yellow parilla [Menispermum] will take over and relieve—possibly cure—it”—Bartram) • Nux vomica (homeopathic) • Oplopanax • Picraena (regenerates, tones) • Planta
go (protectant) • Polygonatum • Prunella (liver fire, sore throat) • Raphanus • Rehmannia (impaired function, hepatitis, liver damage, poisoning; uncooked root) • Rhamnus (torpor, congestion, constipation) • Rumex crispus (red and yellow complexion) • Schisandra (protectant) • Scolopendrium • Silybum • Smilax • Solidago (skin rashes, acne; scalp) • Stellaria (on hot spots; swollen nodes; external) • TARAXACUM (heat, swollen tissue; mapped tongue) • VERONICASTRUM (depression; small dose) • Withania.
Hangover: • Larrea (dark circles under eyes) • Linaria (dark circles under eyes) • Mahonia (dark circles under eyes) • Nux vomica (homeopathic; grumpy).
Low Anabolism (“Liver Blood Deficiency”): • AGRIMONIA (pale-yellowish complexion) • Artemisia absinthium (hard liver pulse—Wood) • BETONICA (wan, leaden complexion) • LYCOPODIUM (withered, full of gas, dry) • MAHONIA (constipation, dry skin, acne, eczema, unhealthy scalp) • Polygonatum (to protect liver, treat fatty liver, bring down high blood pressure) • SALVIA (senescence; low in the liver pulse—Bonaldo) • WITHANIA.
Note: This condition, different from normal blood deficiency, is called “liver blood deficiency” in TCM, or “liver not breeding blood” (Culpeper). Typical symptoms when the liver is involved are: sallow, pale, dry complexion, with atrophy and wasting.
Liver Swelling, Pain: • Agrimonia (cirrhosis; dark, sallow skin; low anabolism) • Angelica (low metabolism—needs confirmation) • BUPLEURUM (pain in hypochondrium and chest) • Calendula (hepatitis, jaundice) • Chelidonium (hepatitis, jaundice) • Chelone • Chionanthus (sallow, dirty-looking skin, with hepatic tenderness, expressionless eyes; fats in stool) • CNICUS (intermittent chills of hepatitis) • Collinsonia • CURCUMA (anti-inflammatory, regenerative; combine with pepper) • Echinacea (abscess) • Euonymus (stomach upset with hepatic torpor) • Galium (fatty liver; hepato-protective) • Hydrangea (inactive liver associated with irritated kidneys) • Hydrastis • Iris versicolor (abscess, fatty liver) • LARREA • Lycopodium (dry, thin; low anabolism; cirrhosis) • Mahonia (stomach upset with hepatic torpor) • PEUMUS • Podophyllum (full, bloated, sallow complexion with inactive liver, or chills; full pulse; tiny dose) • Polemonium (chronic liver disease) • Polymnia (rub ointment over liver or spleen) • Senecio aureus (very small dose) • SILYBUM (mushroom poisoning, alcoholism, hepatitis, abscess) • Taraxacum (heat and swelling) • Veronicastrum (full, inactive liver, hepatitis, pain, depression) • Vitis (leaf tea).