Herbs for the Musculoskeletal System

Katinka Locascio, LMT, CSTLena DeGloma, MS, LMT, CD, CLC, CCCE

Class Outline

• Part I: A&P and Tissue States overview• Part II: Conditions and Therapeutics

– Acute vs Chronic Injuries of the MSS– Fibromyalgia– Arthritis – Osteoporosis

• Part III: Recipes

Musculoskeletal System• Comprised of: bones, muscles, cartilage, tendons,

ligaments, joints, and other connective tissue (fascia)• Primary functions: provide form, support, stability, and

movement to the body. • Additional functions: protection of organs, storage for

Calcium, Potassium & Phosphorus, creation of red blood cells (bones), maintain bone health/strength (muscles), thermogenesis (muscles)

• Arises from the embryological Mesoderm• Relationship to: nerves/CNS, fluids (synovial fluid,

cerebral spinal fluid, serous fluid, interstitial fluid, blood), digestive system/microbiome/immune system

Tissues

• Muscles• Connective Tissue

– Bones – Cartilage– Tendons/Ligaments– Fascia

• Nerves

Muscle

• 600-800 skeletal muscles in the human body. • Common conditions: spasm, strains, and tears. Also need

to consider treating bruises, stagnation or congealed blood. • Muscle tissue has good blood flow -- heals well (but

muscles cells do not regenerate). Fiber bundles can get bunched together and adhered. Muscles require Calcium, Potassium and Magnesium for proper function (Mg prevents spasm & Ca allows contraction).

• Herbs: Arnica, Yarrow, Snake Root, Gravel Root, Valerian, Teasel, Bryonia, Lobelia, Blue Vervain, Ginger

• Other Treatments: Massage Therapy (Neuromuscular therapy), Proper movement (yoga, etc), Hydrotherapy (Epsom salt baths), Fire cupping

Muscle

Connective Tissue• One of 4 basic cells types in

the body (CT, nerve, muscle, epithelial)

• Includes tendons, ligaments, fascia, subcutaneous layer of the skin, adipose tissue, bone, and blood

• Fibroblasts secrete ground substance and collagenfibers (very abundant! 25% of all proteins in body are collagen)

• bone= osteocytes; cartilage = chondrocytes

• elastic fibers and reticular fibers further specialize the tissue

• Thixotropy- sol/gel property of CT

Bone

• Bone- Calcium deposits turn cartilage into bone. Bone is alive, well supplied by blood vessels, both strong and flexible at the same time. The external layer receives nourishment from synovial fluids. Broken bones must be set in the right place (Mullein, Bonset, Solomon's seal) before stimulating bone growth (Comfrey, Nettle, Horsetail). Bones either originate from membrane or cartilage

• Herbs: Bonset, Comfrey, Mullein, Horsetail, Nettle, Solomons Seal, Gravel Root, Royal Fern

• Other Treatments: Osteopathy, chiropractic, including: osteoarticular adjustments, boney unwinding, treating scars within bones/between bones, unwinding the periosteum

Tendons/Ligaments– Tendons/Ligaments- Dense Regular CT, pulley system of the

body, lubricated by the bursa, often need to be treated with hydrating, nourishing, lubricating, and emollient herbs; healing time line can be as long as 1 year

– Herbs: True Solomon's Seal, False Solomon's Seal, Joe Pye-Weed, Flax, Gravel Root, Rhus Tox (homeopathic),

– Other Treatments: Cross fiber friction, pumping, restore alignment of joints

Fascia (Connective Tissue)

• Ubiquitous, surrounds all structures and interconnects the body, including muscle fibers, bone, nerves, arteries, veins, organs etc

• Functions: Structure, reduce friction, fluid medium, interconnection as well as containment.

• Other Treatments: Rolfing, osteopathy, connective tissue therapy, Feldenkrais

Nerves• Arises from ectoderm, related to

skin and sense organs • Surrounded by CT sheath (myelin),

some conditions require treatment of the CT rather than the nerve (ieMS)

• Junction with muscles controls all muscle activity (neuromuscular junction)

• In relation to the Cerebral Spinal Fluid (CSF)

• Herbs: St John Wort, Prickly Ash, Wood Betony, Cleavers, Valerian

• Other Treatments: Neuromuscular therapy, Cranial sacral therapy, biofeedback, etc

Joints• Joints (arthroses) are made up of multiple

tissues:– Synovial Membrane- when the membrane is torn the

fluids will leak. Ex: disk, meniscus, bursa. – Synovial Fluid - Distillate of the blood nourishment and

fluid; lubricates and nourishes the joints as well as surrounding structures including capsule, periosteum, and ligaments.

– Herbs – synovial affinity: Pleurisy root- move synovial fluid into the membrane; Goldenseal helps to repair tears in membrane (use after inflammatory phase)

– Other Treatments: Pumping/fluid movement, Acupuncture, Deep Tissue, surgery

– Cartilage- Contains collagen, elastic fibers, & hyaline in chondroitin-sulfate giving it strength and resilience. Takes long to repair because of lack of blood flow. Affinity for silicon. Anerual tissue – no pain.

– Herbs: Horsetail, Milky Oat Tops– Other Treatments: Proper Alignment helps heal by

correcting lines of force (ie Rolfing, Alexander, Osteopathy, Chiropractic, etc)

Other Fluids

• Blood • Interstitial Fluid• Lymph

Six Tissue States

Irritation (Heat)

• Irritation- auto-immune over-reaction, inflammation, (lack of fluids may also be a factor) red, hot, swollen, tender, sharp pain

• Conditions: Arthritis, Acute Injury, and any condition ending in “-itis”

• Herbs: Harpagophytum procumbens (Devils Claw), Prunus avium (Cherry), Rosa spp. (Rosehips), Crataegus spp.(Hawthorne), Sambucus spp. (Elder), Achillea millefolium(Yarrow), Lactic Acid

Depression (Cold)

• Depression: nerve weakness, metabolic depression, cold extremities, arthritic joints, cold/dry skin, congealed blood (from bruises)

• Conditions: Chronic pain, arthritic joints, Fibromyalgia • Herbs: Zingiber officinale (ginger), Hypericum

perforatum (St Johns wort), Rosmarinus officinalis (Rosemary), Panax ginseng (Chinese red ginseng), Carthamus tinctoria (Safflower), Commiphora myrrha(Myrrh gum), Curcuma longa (Turmeric), Cinnamomumcamphora, Allium sativa (Garlic), Piper nigrum (black pepper), Ruta graveolens (Rue), Juniperus virginiana(Juniper), Zanthoxylum americanum (Prickly ash)

• Rosemary is traditionally considered to be a circulatory stimulant. The essential oil is also analgesic, rubefacient/counterirritant, anti-inflammatory, antioxidant, diuretic, and tonic. The essential oil contains 1,8-cineole, borneol, camphor, verbenone, and alpha-pinene.

• Applied topically, the essential oil stimulates the blood supply and is excellent supportive therapy for rheumatic conditions and circulatory problems.

Rosmarinus officinalis

Constriction/Tension (Wind)

• Tension- affects moving parts (muscles, tendons and ligament) tension, pain, spasm, worse from cold, stiffness

• Conditions: Old injuries, Whiplash etc, psychological stress/anxiety, Fibromyalgia

• Herbs: Lobelia inflata, Valeriana officinalis, Viburnum opulus (cramp bark) Humulus lupulus(hops), Agrimonia Eupatoria (agrimony), Actaearacemosa (black cohosh), Caulophyllumthalictroides (blue cohosh), Dipsacus sylvestris(Teasel)

Relaxation (Damp)

• Relaxation: demineralization, lack of Calcium, venous congestion, overly relaxed, overly flexible, weak bones, low immunity, skin moist and soft, achy pains – worse in cold/damp weather

• Conditions: osteoporosis, varicose veins/edema (passive venous congestion)

• Herbs: Quercus alba (white oak), Salvia officinalis (sage), Aesculus hippocastanum (horse chestnut), Collinsonia canadensis (stone root), Osmundaregalis (Royal Fern), Rhus typhina (Sumac)

• Horse Chestnut helps improve and maintain vascular wall integrity by inhibiting the lysosomal enzymes hyaluronidase and elastase, thus reducing the degradation of the extravascular matrix. This in turn reduces capillary hyperpermeability and edema, improves vascular tone & promotes the flow of blood back to the heart.

• A review of 5 clinical studies found horse chestnut (both oral and topical) to be superior to placebo for patients with chronic venous insufficiency at reducing edema, pain, tiredness, tension and pruritus (Suter et al, 2006).

Aesculus hippocastanum

Atrophy (Dry)

• Atrophy- weakness, dryness, lack of lubrication arthritic conditions, dry, weak, thin, withering, painful to move, sharp pains – worse from heat, muscle spasm

• Conditions: psoriatic arthritis, osteoarthritis, muscle atrophy (ie aging MSS), muscle spasm, osteoporosis

• Herbs: Arctium lappa (burdock), Angelica archangelica, Linum usitatissimum (flax seed), Medicago sativa (alfalfa), Stellaria media (Chickweed), Equisetum arvense (horsetail), Polygonatum spp. (Solomon’s seal), Symphytum officinale (comfrey) , Apium graveolens(celery seed), Verbascum thapsus (mullein), Althaea officinalis (marshmallow)

Stagnation/Torpor (Damp)• Stagnation: (toxicity) Fatigue, foggy feeling, dull,

heavy, achy, stiffness in morning, dark urine• Conditions: arthritis worse from damp/cold,

hypothyroidism, fibromyalgia• Herbs: Phytolacca americana (poke root),

Taraxacum officinale (dandelion), Harpagophytum procumbens (devils claw), Inulahelenium (elecampane), Hydrastis canadensis(goldenseal), Juglans nigra (black walnut), Curcuma longa (tumeric), Boswellia serrata(frankincense), Smilax regelii (sarsaparilla), Urticadioica (nettles)

Part II: Conditions & Therapeutics

1. Acute vs Chronic Injuries 2. Fibromyalgia3. Arthritis 4. Osteoporosis

Framework for MSS Disorder Etiology• Many etiologies/subtypes:

1. Functional Pain Disorders / “Central Sensitivity Syndrome”

• No apparent problem at the tissue level (central pain processing dysregulation)

• Ex: Fibromyalgia, TMJ dysfunction, idiopathic low back pain, CFS, IBS, FD, IC

2. Autoimmune disorders • Systemic, inflammatory flare-ups; often GI dysbiosis or

intestinal hyperpermeability & endotoxemia immune sensitization

• Rheumatoid Arthritis, Ankylosing Spondylitis, PMR, MS, possibly fibromyalgia

3. Peripheral Pain • due to acute trauma or other type of apparent tissue

damage (tissue trauma/injury)

Framework for MSS Disorder Etiology4. “Mixed” pain (peripheral & central)

• Many types of chronic pain

5. “Lithiasis” (theory from 19th century medicine) rheumatism is caused by calcification/mineralization and hardening of the muscles/joints (and kidney) –use of antilithic herbs – removes calcifications from kidneys as well as muscles/joint

• eg, Gravel root – traditionally used for kidney stones as well as gout and rheumatism

6. Stagnant/Congealed Blood (TCM) • either dull or sharp fixed pain, old injuries. • Fire cupping, Blood movers, warming circulatory

stimulants, astringents (ginger, yarrow, arnica)

Formulating for Musculoskeletal System

Primary MSS Herbs: • Boswellia• Black cohosh• Solomon’s seal• Cramp Bark• Devil’s Claw• Comfrey• Mullein• Arnica (topically)• Celery seed• Horsetail• Sweet Birch (topically)• Turmeric• Nettles

Secondary Herbs for MSS:• Analgesic, other related systems,

etc:– Horse Chestnut (venotonic)– Dandelion (diuretic, alterative)– Aloe (internally, arthritis)– St John’s Wort (internally &

topically)– Kava (muscle relaxant, anxiolytic)– Corydalis (analgesic, sedative)– California poppy (analgesic,

sedative)– Passiflora (antispasmodic, nervine)– Feverfew (anti-inflammatory)– Jamaica dogwood (analgesic,

sedative)– Valerian (anti-spasmodic, sedative)

Formulating for Musculoskeletal System

• Great synergizers for MSS:– Lobelia

• powerfully releasing, opening, moving, anti-spasmodic – severe spasm/”torsion”

– Ginger • warming, circulatory stimulant, anti-spasmodic, especially to pelvic

area– Licorice

• anti-inflammatory, harmonizing– Clove

• analgesic, warming, moving – for stagnant aching pain– Prickly Ash

• circulatory stimulant, nerve pain– Cayenne

• circulatory stimulant, rubefacient

Soft Tissue Healing (tendons, ligaments, fascia)

• 1-7 days: Inflammatory Phase: Vasodilation (increased blood flow), increased permeability of capillaries (increased interstitial fluids), allows nutrients to flood the area, and contains the injury. Pain is related to pressure from increased fluids, prostaglandins, waste products from bacteria

• Fibrin comes into create a "gooey patch." Needs rest• 7-21 days: Proliferation Phase: Fibroblasts migrate to the area,

Collagen is set town in random "scar tissue" pattern. This tissue is not as strong and re injury is common during this phase

• 21 days-1yr: Maturation Phase: Remodeling, fibroblast migrate along lines of tension and lay down fibers that reinforce tensile strength, irregular directions are reabsorbed. Proper movement and use is important during this phase as well as good circulation.

Acute & Chronic Injuries: Considerations

1. Consider what phase of tissue healing needs to be treated and what the cause of the symptoms is (ie muscle tension, swelling, inflammation etc), is it chronic or acute?

2. Consider what tissue levels are most in need of support: Connective Tissue, Muscles, Fluids, nerves, digestion. And what tissue states are presenting?

3. Consider action of treatment: anti-inflammatory, antispasmodic, rubefacient, dieutetic, circulatory stimulant, analgesic

4. Mode of application: External vs internal treatments5. Consider role of nutrients and gut health on the healing

process. Ex: B12 deficiency (pain/numbness/tingling in extremities and neuropsychiatric symptoms)

Acute & Chronic Injuries• Muscle spasms• Tendonitis (and “new mother’s wrist” or “mother’s

thumb”)• Bursitis • Sprains/strains (including whiplash) • Plantar fasciitis• Nerve impingement (sciatica, TOS, CTS)• Slipped/Herniated/Bulging Discs• Broken Bones• Bruises/contusions

Polygonatum spp.

• True Solomon’s Seal• Family: Asparagaceae• Parts used: Root• Taste: sweet, slightly acrid, cool,

moist• Uses: Muscular and skeletal

tension, adjust tension on ligaments and tendons, bones spurs, repetitive use injuries, calcifications/arthritis, “Yin” tonic (TCM), inflamed digestive system

Actaea racemosa• Black Cohosh (Black Bugbane, Black

Snakeroot, Rattle Root, Rheumatism Weed)

• Family: Ranunculaceae• Parts Used: Root and rhizome • Energetics: Light, acrid, bitter, pungent,

sweet, cooling • Actions: Anti-rheumatic, Anti-

spasmodic, estrogen modulating, uterine tonic, partus preparator

• Uses for MSS: “Bunched up” or dense CSF (ie whiplash), esp w/pain in trapezius muscle (Wood), arthritis, rheumatism, neuralgia, sciatica (Bone)

• Note: (used for menopause and PMS will be discussed in the next class)

Arnica Montana L.• Arnica, A. chamissonis spp.

Floicosa• Family: Asteraceae (daisy)

family• Parts used: Flower heads

Actions: Anti-inflammatory, analgesic, antiseptic, vulnerary (anti-ecchymotic)

• Uses: Used only topically (homeopathic preparation can be used internally), bruises and sprains, acute wound healing when the skin is not broken, swelling, muscle pain, varicose veins and hemorrhoids.

Hypericum perforatumSt John’s WortFamily: HypericaceaeParts used: Flower heads / aerial partsActions: Anti-inflammatory, nervinetonic, astringent, vulnerary, antimicrobial (topically)Uses: sedative and pain relieving effects useful for treating neuralgia, anxiety, tension, and rheumatic pain. Topically can speed the healing of wounds, bruises, useful for mild burns like sunburn.

Fibromyalgia• “Rheumatism” (FM, OA & RA)• Tissue states/energetics: cold, damp, tension/constriction• More women (hormonal & neural differences)• Sx: pain/stiffness (muscles, tendons, fascia –

especially neck, spine, shoulders & hips), TPs (11 of 18), extreme fatigue / brain fog (“Fibro fog”), sometimes depression, sleep disturbances

• Triggers: – physical trauma (esp to trunk) or repetitive injuries– illnesses/infection (Hep C, Epstein-Barr, Lymes, Parvo

virus) – genetics, fam Hx, in utero stressors in mother – HPA

alteration in fetus (pain processing/perception) – early life trauma/stressors, psych stressors,

deployment to war zones– sometimes no trigger– Flare-ups: stress, sleep deprivation

Fibromyalgia

• CNS dysregulation < -- > Autoimmune Spectrum– CENTRAL SENSITIVITY SYNDROME (CSS):

• Strong co-morbidity: CFS, IBS, TMJD (especially in men), IC, idiopathic low back pain & multiple chemical sensitivity

• Volume control theory: pain threshold decreased– Hyperalgesia – normally moderately painful stimuli is debilitatingly

painful – Allodynia – normally non-painful stimuli is painful

– Strong cross-association with autoimmunity – RA, etc.

Fibromyalgia: Therapeutics• Consider whole picture:

– what is this client’s underlying pattern? Triggers, constitution/energetics, autoimmunity vs CNS?

– Check thyroid levels – consider levels of stress/anxiety, sleep/energy

• Primary Herbal Actions: Anti-rheumatics, Anti-spasmodics, Nervines (reduce sympathetic hyperactivity), Anti-inflammatory, Adaptogens/Adrenal tonics

• Secondary Herbal Actions: Depuratives/alteratives, Diuretics, Lymphatics,Immunomodulators, Warming Circulatory Stimulants, Analgesics or Rubefacients

Fibromyalgia: Therapeutics• Herbs: Hypericum, Filipendula, Salix, Viburnum, Passiflora,

Scutellaria lateriflora, Bacopa, Piper methysticum, Zingiber, Galium, Phytolacca, Taraxacum, Valeriana, Actaea, Harpagophytum, Curcuma, Glycyrrhiza, Rehmannia, Astragalus, Eleuthero, Rhodiola, Withania

• Other treatments: massage therapy (trigger point therapy, connective tissue therapy), hydrotherapy (moist heat & Epsom salts), stress reduction/mindfulness meditation

• Nutrition: Magnesium, Vit D, dark berries (anthocyanidins –bilberry, elderberry, etc), elimination diet/food triggers (MSG/aspartame), lightly cooked or raw foods (reduce AGEs), support microbiome

Harpagophytum procumbens• Devil’s claw, Grapple Plant• H. zeyheri - inferior species• Family: Pedaliacea (sesame)• Part Used: root/tuber• Traditional African medicine• Taste/energetics: bitter, acrid,

soothing, cooling• Actions: Analgesic, Anti-rheumatic,

anti-inflammatory, bitter tonic, sedative, diuretic , chrondroprotective (possibly)

• Uses: Arthritis, chronic back pain, tendinitis, dyspepsia, skin lesions (topical)

Devil’s Claw• Constituents: iridoid glycosides (harpagoside, isoharpagoside,

harpagide) .5%-3.3% of the plant (depending on species) – strong anti-inflammatory, bitter – Also sugars, triterpenes, phytosterols, phenolic acids– European Pharmacopoeia recommends minimum of 1.2% harpagoside

in dried herb• Clinical trials – back pain & osteoarthritis superior to placebo (some

for up to 54 weeks, maximum relief after 3-4 months)– 2006 systematic review standardized daily dose of 50-100 mg

harpagoside superior to placebo for low back pain (an unpsecifieddose was equivalent to 12.5 mg per day of the drug Vioxx)

• Dose: 3-6 g per day (lower doses for GI complaints)• Safety: Little to no toxicity at very high doses, no major

contraindications, except theoretical caution with peptic ulcers due to bitter tonic effects on secretions.

• “[Prickly ash’s] action [is] on blood stasis, overcoming capillary engorgement […] Xanthoxylum is specifically indicated […] in relaxation of mucous tissues […] in capillary engorgement in the exanthemata, sluggish circulation…”

- Felter & Lloyd, 1898• Prickly ash is a powerful circulatory

stimulant, local anesthetic/counterirritant, and anti-inflammatory.

Zanthoxylum clava-herculis

Arthritis• Joint disease marked by progressive inflammation/damage

to one or more joints• Common types: Osteoarthritis, Rheumatoid Arthritis, Gout,

Ankylosing Spondylitis, Psoriatic Arthritis, PMR, many more• Etiologies:

1. OA: failed repair of mechanical damage to cartilage & subchondral bone (not merely “wear & tear”)• chrondrocytes unable to maintain homeostatic balance between

matrix synthesis & degradation2. Autoimmune & associations with viral infections, gut-

microbiome-inflammatory response, toxic build-up (RA, AS, etc.)

3. Metabolic issue - uric acid metabolism/excretion by kidney –(Gout)• Associated with DMII, MetS, renal disease, CV disease/hypertension

4. Traditional view: Joints – easy site for toxic accumulation (“bottleneck” in circulation)

Osteoarthritis• Most common joint disorder (50% of adults >65)• NSAIDs may worsen OA

– COX-inhibition pushes AA into the 5-LOX pathway LTs• Linked to CV disease

– ↑ CRP early in disease (inflammatory)– Microvascular pathology (microthrombi & poor venous

circulation) in subchondral bone key role in cartilage degradation/progression of OA

• AGEs from diet in cartilage catabolic activity/oxidative stress

• CNS sensitization to pain – substance P (rubefacients)• Risk factors: obesity, injury, genetics, misalignments,

CV risk factors • Tissue States: dry, hot (during acute)

– too dry to flush out toxins and friction creates heat

Rheumatoid Arthritis• Autoimmune – systemic disease, bilateral joint

inflammation often begins with small joints and progresses– Progressive disease: ankyloses – joint

fixation/deformity atrophy of muscles, impaired mobility

– Systemic effects (during flare-ups): fatigue, depression, malaise, anorexia, low-grade fever, persistent iron-deficiency anemia (need folate supplementation)

– Spasms of surrounding muscles –Tension/Constriction

– Etiology: genetics, viral infections, immune sensitization?

– Tissue States:• Heat/Excitation (immune over-reaction /

autoimmunity) • Toxic Stagnation/Damp (inflammatory responses

initially suppressed to allow a build up of toxicity followed by an overreaction)

• Phlegm (TCM)

Arthritis: Therapeutics• RA:

– Id food allergies (gluten & grains, dairy, corn, pork, lamb, beef, tomato, citrus, egg, sugar, peanuts/tree nuts, soy, coffee)

– Malnutrition/malabsorption is common – vegan diets (78% of patients improved in one study)– Probiotics– EFAs: EPA/DHA fish oil (3 g per day), borage seed oil (2.8 g per day GLA – very

good results in studies), olive oil• OA:

– support cartilage & bone – bone broths, horsetail, glucosamine sulfate (might stimulate body’s production) 500mg 3X/day for at least 2-8 weeks

– Support vascular & microvascular health (microcirculatory stimulants, anti-thrombotic, antioxidant, venotonics: ginkgo, gotu kola, bilberry)

– Reduce AGEs in diet (lightly cooked, cooked in water or raw foods, reduce meats)

– lose weight if overweight• Gout:

– avoid: alcohol & foods high in purines: all meats (especially organ meats), some seafood (sardines, anchovies, mackerel, herring, scallops)

– Avoid hot/cold therapies in acute flare-ups– Avoid herbs high in salicylates (Salix, Filipendula) – inhibit uric acid excretion– Use cherries & other dark berries

Arthritis: Therapeutics• Herbal Actions: Anti-inflammatory, Anti-rheumatic,

Diuretics/kidney tonics (alkalizing), alteratives/depuratives, anti-oxidants, vascular tonics, Rubefacients/counterirritants (ok for OA, not for RA), analgesics– Heat – cooling/sour remedies (rosehips, hawthorne, sheep

sorrel)– Toxic stagnation – alteratives/depuratives (devil’s claw,

dandelion, poke, bupleurum)• Key Herbs: Boswellia, Apium, Harpagophytum, Curcuma,

Urtica, Taraxacum (leaf), Eupatorium purpureum, prunusjuice (gout), Polygonatum, Zanthoxylum, Salix (avoid in gout), Zingiber, Rosa (hips), Centella, Smilax

• Other therapies: massage therapy, contrast baths or hot Epsom salt soaks, urtication, gentle exercise (ROM & appropriate strengthening – work with skilled PT), consider any internal conflict or “friction” in life

Boswellia• Frankincense, Salai guggal• B. serrata, B.carterii• Family: Bursecaceae• Parts used: dried oleo-gum resin• Actions: anti-arthritic, analgesic,

astringent, tonic, anti-inflammatory (crosses BBB), diuretic, expectorant and antioxidant

• Uses: OA, RA, juvenile arthritis, chronic rheumatic disorders, IBD (Crohn’s & UC), diarrhea, dysentery, dysmenorrhea, pulmonary diseases, asthma, general weakness, anorexia, topical for skin problems

Boswellia• May be LOX inhibitor; may also inhibit other

pro-inflammatory enzymes and primary antibody synthesis involved in arthritis.

• Clinical trials:– Arthritis – many with positive results (may be

disease modifying in OA, not just symptomatic control)

– IBD: small pilot study 34 patients with UC 80% went into remission (comparable effects to control group on sulfasalazine) (similar results for Crohn’s and collagenous colitis)

• Burning it has been used to enhance spirituality, mental perception, meditation, prayer, and consciousness.

Boswellia• Constituents: triterpene acids (beta-boswellic acid,

acetylboswellic acids), essential oils (mono- and sesquiterpenes: alpha-pinene, sabinene, alpha-thujene, and (+)-limonene)

• Forms/Dosage:– Dry extract (standardized to 60-70% boswellic acids) in

capsules or tablets: 200-400 mg TID with meals– Dry resin: 2.4 – 4.8 g– Tincture (90% alcohol)– Essential oil or liniment topically – disperse stagnant

blood– Treatment for 2-6 months in many studies

• Safety: very little to no toxicity in acute & long term use, no reported interactions, very limited evidence to be likely safe in pregnancy, likely compatible with breastfeeding, caution if allergic to myrrh

Apium graveolens• Celery seed• Family: Apiaceae• Taste/Energetics: salty, moistening, softening,

cooling, aromatic dispersing effect• Actions: opens kidneys – strongly diuretic (removes

acidic metabolites through urine – alkalizing), carminative stimulant, tonic, nervine, circulatory stimulant to joints

• Constituents: volatile oils, flavonoids, antioxidants, coumarins, linoleic acid

• Forms: dried seeds, capsules, extract, celery seed oil capsules

• Ayurvedic uses: arthritis, water retention, poor digestion

• Other traditional uses: rheumatism, gout, muscle spasms, inflammation, bursitis, and to “calm the nerves” (cooling nervine)

• Caution: active kidney inflammation, photosensitivity

Curcuma longaTurmericFamily: Zingiberaceae• Used for thousands of years in Ayurveda

for purification of blood and skin • TCM: blood/Qi stimulant, analgesic• Use for dry/atrophic tissue• Actions: Anti-inflammatory (inhibits AA

metabolism via COX and LOX inhib), anti-oxidant, hepatic/cholagogue, depurative, neuroprotective, cardiovascular tonic, hypolipidemic, anti-carcinogenic, anti-bacterial

• Fat-soluble phenolic compounds: curcuminoids• take with: fat, piperine, lecithin

• MSS uses: OA, RA, post-operative inflammation, blood stasis, frozen shoulder (TCM), preventing muscle atrophy after traumatic injury

• 4-8 g per day powder; 5-14 ml (1:1)• Caution with gallstones, anti-coagulent

meds

PMR Case Study59 year old Caucasian female artist and professor is seeking relief from Polymyalgia Rheumatica (PMR). Sx: significant pain and loss of range of motion in both of her shoulders and hips that is worse in the mornings. She reports “weakness” and a feeling like there is “something in the joints that shouldn’t be there.” Onset of PMR was one year ago following a tennis injury to her right rotator cuff (torn) and right gluteus maximus (“pulled”). The PMR came as sudden onset following the injury that “almost crippled” her, she was hospitalized and medicated with a high dose of methylprednisolone (20 mg per day) which provided complete relief of symptoms, but as the dose has been systematically reduced over the past year (20 mg 15 mg 7 mg 4 mg 2 mg) to avoid side effects, she continues to experience significant pain in her shoulders and hips. She has also had idiopathic colitis for the past 5 years. Sx: regular bouts of frequent watery diarrhea, urgency to have a bowel movement, painful cramping, gas, and undigested food in her stools. Since the onset of both of these illnesses she has lost 20 pounds and has to “push” for energy.

Osteoporosis• Osteoporosis: disease in which the density and quality

of bone are reduced. As bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs silently and progressively. However, Osteoporosis is a major cause of morbidity in elder patients.

• Affects as many at 18% of US women over 50; and Osteopenia, a more mild version, affects 37-50% of US women over 50

• 90% of bone density achieve by age 20, and the rest by 35. Breastfeeding may increase Calcium absorption. Following menopause there is a 5-7yr rapid decrease in bone density which then tapers off.

• Prevention should focused on education for younger women- Diet, weight baring exercise, avoiding stress, dieting, sodas etc as well as proper nutrition/mineral balance

• Tissue States: Atrophy, Relaxation

Osteoporosis: Therapeutics• Diet and Lifestyle

– Prevention: Weight bearing exercise, decrease sugar and caffeine/processed foods, avoiding stress, avoiding soda, preventing falls., improving gut function/absorption.

– Diet: Moving beyond Calcium and Vit D- Include VitK2, magnesium, phosphorous, manganese, silicon, zinc, boron

– Calcium: 600-1200 mg/day; Magnesium 300-600 mg/day

– Vit D: 400-800 IU/day- promotes the usage and absorption of Calcium, improves muscle function and balance thereby limiting falls

• Herbs– Phytoestrogenic- to reduce bone lossGlycine max, Trifolium pratense, Medicago sativa– Nutritive- Increase bone mineralizationUtrica, Taraxacum, Equisetum arvense, Avena sativa

Equisetum arvense (Horsetail)• Horsetail, Shavegrass• Family: Equisetaceae• Part Used: Aerial parts, harvested

from sunny spots when young• Taste/energetics: earthen, cooling• Actions: Diuretic, astringent, styptic • Indications: affinity for connective

tissue, cartilage, peripheral structures (hair, skin, nails), urinary tract, post trauma and static edema, re-teaches body how to use silica

• Notes: one study showed that lengthy decoctions with heat gave best extraction

Part III: Recipes

Topical Applications• Epsom salt soaks + herbs• Fomentations (e.g., ginger)• Castor Oil packs (optionally infused)

– Other infused oils: SJW, Calendula, Arnica, Comfrey– Essential oil blends in carrier oil

• Liniments– Trauma liniment actions: analgesic, anti-inflammatory, anti-edematic,

circulatory stimulant, blood/qi movers– Great liniments: Kava, cramp bark, prickly ash, gotu kola, ginger,

boswellia, angelica sinensis, sweet birch, black cohosh, solomon’s seal, cayenne, horse chestnut, corydalis, rosemary

• Herbal/Grain Heat packs• Counter-irritant salves/oils (warming/cooling)

– menthol crystals, wintergreen, eucalyptus, camphor, cayenne, ginger, black pepper, mustard seed, horseradish, rosemary, prickly ash

• Herbal Pastes/Plasters (e.g., mustard, others)• Moxabustion• Massage & Fire Cupping (move stagnant blood & qi)

Pain/Tension Tincture

Piper methysticum 4 mlViburnum opulus 3 mlActaea racemosa 3 mlCorydalis yanhuso 3 mlZingiber officinale 1 mlGlycyrrhiza glabra 1 mlClove spirits .25 ml---------------------------------= 15 ml total per day (5 ml TID as needed)

Golden MilkIngredients• 1 1-inch knob fresh turmeric• 1 1/2-inch knob fresh ginger• 2 teaspoons ghee • 1 cup full-fat coconut milk (or other milk)• 1 cup coconut water • 1 tablespoon manuka honey • dash of finely ground black pepper

InstructionsPeel both the turmeric and ginger, then grate them finely into a mortar. Spoon the ghee into the

mortar, and grind the ghee into the turmeric and ginger with your pestle until they form a fine paste.Pour the coconut milk and coconut water into a saucepan, and spoon in the paste plus black

pepper. Turn the heat up to medium-high and warm the ingredients together until little bubbles just begin to creep up the sides of the pot. Turn off the heat and cover the saucepan, allowing the turmeric and ginger to steep about 3 minutes. Strain the golden milk through a fine-mesh strainer or tea strainer into a tea pot. Stir in the Manuka honey and continue stirring until it dissolves. Serve warm.

Massage Oil for Muscle Healing

• 4oz of oil (jojoba, almond etc)• 2d German Chamomile• 2d Roman Chamomile• 2d Frankincense• 3d Lavender• 2d Black Pepper• 3d Ginger• 2d Peppermint(all Essential Oils, d=drop)

Healing Castor Oil

• 12-16oz Castor Oil• 1 cup dried Calendula• 2 Vit E capsules

Allow to infuse for 3-6weeks in sunlight. Then strain and add Vit E. Use topically, wonderful for scar tissue.

Topical Counter-irritation• Mustard Poultice/Plaster: Yellow mustard seed

powder made into a slurry with warm water, smeared onto gauze (folded over) and held over affected joint under a hot wet flannel pad for 15-20 minutes – Occasional checking in to make sure no blisters

• Ingredients for warming and cooling counter-irritant salves: menthol crystals, wintergreen, eucalyptus, camphor, cayenne, ginger, black pepper, mustard seed, horseradish, rosemary, prickly ash

* Avoid in most cases of gout, RA, and during extremely acute flare-ups of inflammatory conditions (OA is often ok) – ask client: does heat help or aggravate?

Epsom Salt Baths

• 1-2 cups Dead Sea Salt• 1-2 cups Epsom Salts• 1-2 cups Baking Soda

Add salts to a warm (but not crazy hot) bath. Soak for at least 17min or until 2 waves of relaxation are felt. You may add any herbs or essentials oils you like.

Thank you!Katinka Locascio, LMT, CST www.earthandskyhealingarts.com

Lena DeGloma, MS, LMT, CD, CLC, CCCEwww.redmoonwellness.com