NMT150 Bot Wk9 General LBP Lecture Material (1) PDF

The use of Botanicals in Non-specific Back Pain Chris Pickrell, ND, Herbalist, TCM Practitioner Key Actions: Adaptogen, Anti-inflammatory Find the cause: most cases are the result of a lack of physical activity and poor...

The use of Botanicals in Non-specific Back Pain Chris Pickrell, ND, Herbalist, TCM Practitioner Key Actions: Adaptogen, Anti-inflammatory Find the cause: most cases are the result of a lack of physical activity and poor posture over time, and can best be viewed as conditions of lifestyle. Key treatment principles: Rule out injury. Physical activity needs to be part of the treatment plan. Pro tip: Treat the adrenals  Botanicals in General LBP Rhodiola rosea (Rhodiola) FEATURED HERBS IN THIS SECTION Panax ginseng (Korean red ginseng) Rhodiola rosea (Rhodiola) Panax quinquefolius (North American Smilax officinalis (Sarsaparilla) ginseng) Eleuthrococcus senticosus (Eleuthro) Withania somnifera (Ashwagandha) Astragalus membranaceus (Astragalus) Rehmania glutinosa (Rehmania)  Botanicals in General LBP CASE PRESENTATION – Low Back Pain A 32-year-old male presents with generalized low back pain. He denies an acute injury, but says he may have tweaked it once while helping his friend move a couch up the stairs in his early twenties. He describes the pain as a dull ache that is worse from prolonged sitting, standing, or walking. When it gets bad, he will take an extra-strength tylenol or muscle relaxant, which generally relieves the pain. OUTCOME MEASURES Improve physical strength and posture Decrease need for NSAIDs RELEVANT BOTANICAL ACTIONS TO CONSIDER PRIMARY SECONDARY or OTHERS TO CONSIDER SUPPORTIVE Adaptogen Anti-inflammatory Analgesic Hepatic  Botanicals in General LBP Withania somnifera FEATURED HERBS BY BOTANICAL ACTION Actions Herbs Adaptogen Rhodiola (Rhodiola rosea) North American ginseng (Panax Sarsaparilla (Smilax officinalis) quinquefolius) Eleutherococcus senticosus Ashwagandha (Withania somnifera) (Eleuthro) Anti- Turmeric (Curcuma longa) Actea racemosa (Black cohosh) inflammatory Devil’s claw (Harpagophytum Polygonum cuspidatum (Japaneses procumbens) knotweed) Frankincense (Boswellia serrata) Polygonatum biflorum (Solomon’s Cat’s claw (Uncaria tomentosa) seal)  Botanicals in General LBP Analgesic Corydalis (Corydalis yanhusuo) Valerian (Valeriana officinalis) Kava kava (Piper methysticum) Cannabis (Cannabis indica) Cayenne (Capsicum annua) Jamaican dogwood (Piscidia St. John’s wort (Hypericum piscipula), perforatum) Wild lettuce (Lactuca virosa) HERB SELECTION Withania somnifera 60 Rhodiola rosea 30 Formula Zingiber officinalis 10 100mL Dosage Tincture 2 teaspoons (10mL) twice a day between meals. Cautions, Rhodiola can be too stimulating for some people and may cause Contraindications dizziness, palpitations, or feelings of anxiety. This can be balanced by and Potential Side adding herbs like Rehmannia. Effects Relevant Herb-Drug None significant Interactions Other Effective Stretching and strengthening are the most effective therapies Therapies Focus on toning core strength, especially the lower abdominals Local Heat is almost always helpful, and may be more effective acutely than OTC pain meds. Acupuncture in these cases is almost always beneficial Ensure nutritional macros and micros are being achieved regularly Pro Tip: if there is a general progression of insidious onset joint pain characterized by achiness, evaluate protein intake.  Botanicals in General LBP TCM INTEGRATION – Low Back Pain Non-specific, insidious low back characterized by dull ache and weakness is associated with weakness of the Kidneys. Usually, this is most commonly seen with Kidney Qi (or source Qi) and Kidney Yang deficiency, though it is possible to have Kidney Qi, Yin, and Yang all in decline.  Botanicals in General LBP SELECTED MONOGRAPHS Siberian ginseng (Eleuthrococcus senticosus) Primary Actions: Adaptogen. Constituents: Eleutherosides A-E: Saponins (eleuthroside A), propanoid glycosides (eleuthroside B, syringin), lignanas (eleuthroside E, syringaresinol) Indications: Stress, exhaustion, insomnia, mild depression Cautions/Contraindications: None significant, may potentiate cardiac medications. Extra Information: Eleuthro (along with Ashwagandha) is our archetypal adaptogen. Increases resistance to oxygen deprivation of the heart. Considered useful for conditions influenced by the stress response such as angina, HTN, hypotension, chronic bronchitis, and cancer. Panax ginseng (Korean red ginseng) Primary Actions: Stimulating adaptogen, immune stimulant, libido stimulant, cardiotonic Constituents: Triterpene glycosides (ginsenosides), steroidal saponins Indications: Debility and convalescence (low dose), depression, end-of-life care Cautions/Contraindications: Non-toxic, but can be overstimulating to some individuals, particularly where yin has been weakened through excessive use of stimulants. CI in hypertension and other heat conditions. Preg A, Lact C. Extra Information: An excellent herb, often underused out of fear of its stimulating properties or overused because of its stimulating properties. A truly fortifying and whole-system adaptogen when used appropriately (by matching dose to condition and vitality), especially in combo with other herbs. Traditionally used in TCM to mobilize the essence of an elder near death so that the family would have time to gather for farewells. Part Used: Root. Red ginseng is the steamed root, while white ginseng is the unprepared root of the same species. The steamed red root is preferred. Daily Therapeutic Dose Tincture: 2–10 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 3–10 g dried root Pairs Well With: Astragalus membranaceus and Rehmannia glutinosa for convalescence after blood loss. Ganoderma lucidum for depression. Centella asiatica for mental clarity and focus. Closest Substitute: Rhodiola rosea  Botanicals in General LBP Panax quinquefolius (American ginseng) Primary Actions: Immune stimulant, immune modulator, antiviral, adaptogen, mild lymphatic Constituents: Triterpene glycosides (ginsenosides), steroidal saponins Indications: Chronic infections, convalescence, debility, ME Cautions/Contraindications: Considered safe. Safety rating during pregnancy and lactation not established. Extra Information: Tonic-adaptogen. Generally considered one of the best immune stimulating herbs. Debate exists as to whether this herb is cooling, neutral, or slightly warming and as to whether it is drying or moistening. Current commercially available varieties tend to be slightly warming, slightly stimulating, and moistening. Part Used: Root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 3–6 g dried root Pairs Well With: Echinacea spp. for acute viral infections Closest Substitute: Codonopsis pilosula, Panax ginseng Rehmannia glutinosa (Rehmannia) Primary Actions: Adaptogen Constituents: Starches, iridoids, organic acids, sterols Indications: Convalescence and patterns of deficiency, anxiety, insomnia, palpitations, secondary amenorrhea Cautions/Contraindications: Considered safe, can be eaten in small amounts as food. Quite dense and rich, Rehmannia is cautioned in those with weak digestion. Safety rating during pregnancy and lactation not established Extra Information: A fundamental convalescence herb, Rehmannia is best used when there is deficiency but no stagnation. Rehmannia is prepared by cooking the root in rice wine until soft, then drying it in the sun. The result is a sweet and tasty preparation used in TCM to nourish the Blood, Yin, and augment the Essence. Part Used: Prepared root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 9–30 g prepared root  Botanicals in General LBP Pairs Well With: Angelica sinensis for deficient female hormone patterns. Urtica dioica leaf and Avena sativa as nutritive restoratives. Closest Substitute: Polygonum multiflorum Rhodiola rosea (Rhodiola) Primary Actions: Adaptogen, vascular tonic Constituents: Polyphenols (rosavin, salidroside), proanthrocyanidins, quercitin Indications: Fatigue from overwork, lowered libido, ongoing physical or mental stress, altitude sickness, ischemic heart disease Cautions/Contraindications: Though not considered toxic, like Panax ginseng, rhodiola may be too stimulating for individuals showing signs of restlessness, insomnia, dizziness, or anxiety. Safety rating during pregnancy and lactation not established. Extra Information: A potent adaptogen. Works best when used in three-week cycles. Used acutely during or preceding times of known physical or mental stress. Part Used: Root Daily Therapeutic Dose Tincture: 6–15 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 4–12 g dried herb or powder Pairs Well With: Centella asiatica and Bacopa monnierii for cognitive enhancement. Eleutherococcus senticosus as fortifying adaptogen. Closest Substitute: Smilax officinalis Smilax officinalis (Sarsaparilla) Primary Actions: Adaptogen, alterative, anti-inflammatory Constituents: Saponins based on the aglycone sarsapogenin, sterols, volatile oils Indications: Eczema, psoriasis, BPH, waning libido, RA, gout Cautions/Contraindications: Considered safe. Safety rating during pregnancy and lactation not established. Extra Information: Excellent tonic, useful in cases of fatigue following intense physical activity, especially when associated with joint pain. One of the original roots in root beer. Part Used: Root and rhizomes Daily Therapeutic Dose Tincture: 3–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 6–12 g dried root  Botanicals in General LBP Pairs Well With: Polygonum multiflorum and Urtica dioica root as a male tonic. Vanilla extract, soda water, and a tsp of honey as a pleasant fortifying beverage. Closest Substitute: Hemidesmus indicus, Rhodiola rosea Withania somnifera (Withania) Primary Actions: Adaptogen, hypotensive, immune modulator, anti-inflammatory, nootropic Constituents: Steroidal lactones (withanolides), alkaloids Indications: Fatigue, nervous exhaustion, chronic inflammatory disease, anemia, lowered libido, convalescence, hypothyroid presentations Cautions/Contraindications: Considered safe. Preg B, Lact C. Extra Information: An excellent non-stimulating adaptogen useful in promoting performance and recovery without the symptoms of overstimulation. Sometimes thought of specifically as being useful as an adaptogen for the thyroid. Part Used: Root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 6–10 g dried herb or powder Pairs Well With: Schisandra sinensis and Zingiber officinalis as non-stimulating tonic for weakened vitality (Qi) with excess fluids, especially of the digestive system. Rumex crispus, Centella asiatica, and Ganoderma spp. for physical endurance and improving red and white blood cell counts. Closest Substitute: Eleutherococcus senticosus Bonus Material – The Mushrooms Chaga (Inonotus obliquus) Primary Actions: Tonic, particularly male tonic; anti-tumour, anti-viral, anti-inflammatory Constituents: Steroidal triterpenenoids, Inositol, Protein-polysaccharides, betulin (concentrated from the host), ergosterol, melanin Indications: Active cancers, particularly cervical; viral infections, HIV, decreased libido Cautions/Contraindications: Considered safe. Extra Information: Becoming commercially popular for its tonic properties, an effective mushroom in combo formulas. Grows on ailing birch trees.  Botanicals in General LBP Reishi (Ganoderma lucidum) Primary Actions: Immunomodulator, immunostimulant, anti-viral Constituents: B-Glucans, carbohydrates, triterpenoids Indications: Anemia of chronic disease, long term infections, cancer recovery, HIV, ME, general convalescence, asthma, COPD. Cautions/Contraindications: Considered safe, long history of use. Extra Information: Can be intentionally grown on impregnated logs. Ganoderma applanatum (Artist's Conk) and Ganoderma tsugae (Tsugae mushroom) grow commonly in Southern Ontario forests. Although some differences exist, research and most practitioners consider Ganoderma species to be medicinally interchangeable. Shiitake (Lentinula edodes) Primary Actions: Potent immunomodulator, immune stimulant, hepatic, anti-tumour, anti-viral Constituents: B-Glucans, lentinan, ergosterol, Eritadenine Indications: Anemia of chronic disease, long term infections, some active cancers, HIV, ME, general convalescence, elevated cholesterol, possibly herpes infections. Cautions/Contraindications: Considered safe, long history of culinary use Extra Information: Safe, tasty, relatively inexpensive, effective medicine. Turkey tail (Trametes versicolor) Primary Actions: Anti-tumour, immune stimulant, anti-microbial Constituents: B-Glucans, PSK, PSP, ergosterol Indications: Active cancers, particularly gastric cancers; active infections, convalescence Cautions/Contraindications: Considered safe. Extra Information: Pairs well with other mushrooms in combo. Requires long decoction for optimal extraction.