Two Immortals- Help with Menopausal Symptoms and Hypertension

Er Xian Tang (Two Immortals Teapills)

TCM action: warm kidney yang, tonify kidney essence, and drain deficient fire

Last year one of my esteemed herbal teachers, Leslie Tierra, talked about the great results that she was getting treating women with Er Xian Tang who had yin deficiency with deficient fire. This peaked my interest and I started to look at the history and herbs that comprised the formula. In a nutshell, deficient fire is often seen in women who are experiencing pre and post menopausal symptoms which might include hot flashes, night sweats, facial and malar flushing, irritability, palpitations, insomnia, decreased sex drive and vaginal dryness to name a few.

The formula Er Xian Tang was developed in the 1960’s at a hospital affiliated with Shanghai College of Traditional Chinese Medicine. Er Xian Tang was designed as a treatment for cases of hypertension (Western terminology) where there was a combination of kidney yang deficiency and deficiency fire of the kidney, two seemingly contradictory conditions. Yang deficiency include signs of internal cold and weakness including coldness, lassitude, edema of the legs, loose stools, sterility or infertility, frequent urination, urinary incontinence, while the signs listed above indicate deficiency of Kidney fire.

A comparison of the role of the heart and kidney in allopathic and TCM can be helpful in understanding the intent of the formula. Er Xian Tang treats renal hypertension.   Renal hypertension from an allopathic perspective results impaired functioning of the kidneys, reduced urinary elimination and excessive renin (a protein and enzyme secreted by the kidneys) production. The heart sends a continuous supply of oxygenated blood around the body. The kidney filters the blood, extracting waste in the form of urine, and also helps regulate the water and salt levels to control blood pressure. When the heart is no longer pumping efficiently it becomes congested with blood, causing pressure to build up in the main vein connected to the kidneys and leading to congestion of blood in the kidneys. The kidneys suffer from the reduced supply of oxygenated blood. When the kidneys become impaired, the hormone system, which regulates blood pressure, goes into overdrive in an attempt to increase blood supply to the kidneys resulting in renal hypertension. This eventually damages the heart, which has to pump against higher pressure, in the arteries.

In TCM Er Xian Tang treats kidney yang deficiency and deficiency fire of the kidney. In TCM, according to the five elements theory, the Heart is categorized as yang and the Kidneys are considered yin. Normally, the Heart yang (fire) descends and joins with the Kidney-yang to warm and propels kidney-yin (water) to ascend to nourish heart yang (fire) to prevent it from hyperactive. Think of it as a continual loop with fire warming the kidneys, while water helps to contain heart fire. Or as Western medicine describes: the heart sends a continuous supply of oxygenated blood to organs including the kidneys that help to regulate water and salt levels to control blood pressure. In both systems the heart and the kidneys are closely related, with a mutually dependent function. If this functional relationship becomes abnormal in TCM it results in a condition termed “non-coordination between the heart and the kidney”.

This gets us back to yin deficiency with deficient fire. In Chinese medicine, the Heart and Kidney energies should work together. The Heart sends Fire down to warm the Kidneys: in return, the Kidneys send pure fluids up to nourish the Heart. In Heart and Kidney Yin deficiency with Deficient Heat the downward action or upward action is severely reduced. This leaves too much Yang (fire), due to lack of cooling Yin (water), hence deficient heat, resulting in night sweats, insomnia, and steaming bone syndrome. Normally you expect to see symptoms of deficiency fire of the kidney associated exclusively with yin deficiency, yet in this case, this type of fire is described as yang excess which arises from an imbalance of yin and yang (the deficient yin can not control the yang). When yin and yang are both deficient, one can experience symptoms of each deficiency, which may either flip back and forth between the two or manifest simultaneously.

Er Xian Tang, Two Immortals

Xian Mao-Curculigo, Golden Eye-Grass Rhizome

Tastes and Energies: spicy-hot,

Category: Tonify the Yang

Actions: Warm Kidney yang and tonify Kidney essence,

Contraindications: Yin Deficiency w/ Heat

Yin Yang Hou-Epimedium Leaf

Tastes and Energies: spicy, sweet, warm,

Category: Tonify the Yang

Actions: Warm Kidney yang and tonify Kidney essence, tonify Yin, harnesses Liver yang,

Contraindications: Yin deficiency w/ Heat

Ban Ji Tian-Morinda Root

Tastes and Energies: spicy, hot, toxic,

Category: Tonify the Yang

Actions: warm Kidney yang and tonify Kidney essence,

Contraindications: Yin deficiency w/ Heat amp heat

Huang Bai-Phellodendrum Bark, Amur Cork-Tree Bark

Tastes and Energies: bitter, cold

Category: Clear Heat Dry Dampness

Actions: nourish Kidney yin and drain fire from deficiency, used for steaming bone disorder, night sweats.

Contraindications: Spleen Qi Deficiency w/ Cold

Zhi Mu-Anemarrhena Rhizome

Tastes and Energies: bitter, sweet, cold

Category: Clear Heat, Drain Fire

Actions: nourish Kidney yin and drain fire from deficiency, nourish yin and moistens dryness, generates fluids and clears heat.

Contraindications: Spleen Qi Deficiency, diarrhea

Dang Gui-Angelica Sinensis Root

Tastes and Energies: sweet, spicy, warm

Category: Tonify the Blood

Actions: Moistens and nourishes the blood and regulates the penetrating and conception vessels. Invigorates blood, moistens the intestines, increases circulation

Contraindications: Spleen Qi Deficiency, dampness

Er Xian San cautions:  during pregnancy, during early states of acute illness, loose stools, diarrhea, poor appetite or chronic digestive weakness.

The intriguing aspect of Er Xian Tang is that it contains herbs that are contraindicated (not used) in cases of yin deficiency with deficient fire. It contains hot natured herbs, Xian Mao, Yin Yang Hou, and Ban Ji Tian, which tonify yang but can also increase fire. The formula also contains Huang Bai and Zhi Mu that are bitter and drying, which may damage yin. Huang Bai and Zhi Mu are considered a traditional Dui Yao, or herbs that are often used together to reinforce and complement each other. Together they clear heat, enrich yin and drain deficient fire. Huang Bai is bitter, cold, consolidates yin, drains deficient fire, while Zhi Mu, is sweet, cold, enriches yin, moistens dryness, and supplements the kidneys. Dang Gui builds blood, increases red cell proliferation, normalizes heart contractions and dilates coronary blood vessels increasing peripheral blood flow. Huang Bai and Zhi Mu are cold energetically and help to balance the spicy and heating energies of Xian Mao, Yin Yang Hou, and Ban Ji Tian.

Er Xian Tang serves as an example of evolving TCM formulation, where a new formulations are being utilized to address modern disharmonies by combining strongly warming yang tonics with cold, fire-purging herbs. In this case and the studies that have been conducted the formula appears to be effective for hypertension and for some other applications, such as menopausal syndrome and male infertility.

Additional notes:

Xian Mao and Yin Yang Huo are used to tonify the kidney and according to the Taoist’s aid in prolonging life. The name “Two Immortals” references the use of the word Xian.   Xian Mao was named in the Bencao Gangmu (by Li Shizhen; 1596) as one of the herbs believed to contribute to immortality. Xian Ling Pi (Epimedium, now know as Yin Yang Huo) alludes to the immortals’ intelligent nature, boosts the qi and strengthens the will. Around 100 B.C., a poem about attaining immortality, the ode Yuan Yu (Journey to Remoteness, or Roaming the Universe) was written. It depicts the transition to immortality:

Having heard the precious teaching, I departed,

And swiftly prepared to start on my journey.

I met the feathered ones at Cinnabar Hill,

I tarried in the ancient Land of Deathlessness.

In the morning, I washed my hair in the Hot Springs of Sunrise,

In the evening, I dried myself where the suns perch.

I sipped the subtle potion of the Flying Springs

And held in my bosom the radiant metallous jade.

My pallid countenance flushed with brilliant color,

Purified, my Jing began to grow stronger,

My corporeal parts dissolved to a soft suppleness,

And my spirit grew lissome and eager for movement.

 

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More Than Medicinal: Herbal Love Medicine

I recently finished teaching a wildcrafting class on medicinal herbs of Central Oregon. This year I incorporated other cultural uses of plants, in particular, focusing on “Love Medicine”.love   Native peoples used plants, not only as medicine, but also for their ability to affect an outcome. Daniel Moerman, author of Native American Ethnobotany, offers a compilation of ethnographies with over a hundred stories of tribal use of plants including ceremonial, hunting, witchcraft and love medicine.

The term love medicine was used for plants that were often suggested by tribal healers, elders or through the oral transfer of information to have powers beyond their medicinal attributes. Both men and women would use various plants as love charms to lure potential suitors or hold the attention of a “special person”.   In researching this topic it is a bit murky how the plants were utilized. In some cases special perfumes were prepared, in others, rituals were conducted with specific plants. In the book Plains Apache Ethnobotany by Julia A. Jordan people spoke about tribal members who specialized in preparing “love medicines”. In this book, the author describes the use of perfumes that were worn during certain times and specific places. In Daniel Moerman’s book he briefly describes how various plants were used or prepared. As contemporary herbalism as evolved over the last century, many of these spirit-based uses are being lost to us. With that in mind, here are some plants surrounding Central Oregon and how they were used as “love medicine”.

Aquilegia formosa

Aquilegia formosa

Various species of columbine were used as Love medicine. Western Columbine (Aquilegia formosa) was used by the Thompson Indian’s who used it as a charm for women “to gain the affection of men”. The Pawnee along with the Ponca’s used the crushed seeds of columbine, as a love charm also used columbine as love medicine.

larkspur

Delphinium menzieessi

Larkspur, (Delphinium menziessi)- a plant that was toxic to livestock and considered poisonous ironically was used for love medicine. The Thompson tribe’s women used it “to help them obtain and hold the affection of men”, although it wasn’t clear on how it was utilized.

MeadowrueMeadowrue, of which Central Oregon has a few species was not used by local tribes but was used by the Potawatomi as both hunting and love medicine. The seeds were mixed with tobacco by and smoked by men when going to call upon a favorite lady. Meadowrue, (Thalictrum occidentale), was used by the Thompson as a poultice on open wounds for healing. Meadowrue’s root contains berberines, one of the few plants aside from Oregon Grape Root to contain that particular constituent. It was used to loosen phlegm, as blood medicine, and as an analgesic. The powdered fruits were mashed into a paste with water and used on the skin and hair.

spreading-dogbane-apocynum-androsaemifolium-01

apocynum-androsaemifolium

Spreading Dogbane (Apocynum androsaemifolium)-although considered toxic was used extensively by Native Americans as love medicine. The Okanagan-Colville tribe chewed the leaves and the juice, as well as, smoked the dried leaves as an aphrodisiac (Not advised). If you break a spreading dogbane stem or leaf, you will see that the plant contains a bitter, sticky, milky white sap. The sap contains cardiac glycosides that are toxic to humans. The root also contains a potent cardiac stimulant, cymarin. These toxic compounds help protect spreading dogbane from grazing animals. Despite its toxicity, the plant has been used medicinally for a variety of ailments. However, this plant is best enjoyed for its beauty and not as a medicine. Native Americans used the tough fibers of this and other native dogbanes to make threads and cord.

Platanthera leucostachys_Mono Lake Cty Park_2002-07.05

Platanthera leucostachys

Bog Orchid (Platanthera leucostachys)-a plant we recently identified in the Ochoco Mountains, was used extensively by the Thompson tribe as a wash for various joint and muscle aches. It was used in the sweat lodge for rheumatism. Women “hoping to gain a mate and have success in love” used the Bog Orchid as love medicine as a wash. Although I could find no report of its toxicity, it was only used externally, so beware.

arrowhead

Sagittaria latifolia

Arrowhead, (Sagittaria latifolia) which is found in northern Jefferson County and on the west side crest of the Cascades was used as love medicine by the Thompson is usually found at the margins of ponds or marshes. The enlarged rounded starchy tubers from the plant form at the ends of underground plant runners (rhizomes). When dislodged from the mud, these tubers will float to the surface. They are edible, and may be boiled or baked and eaten as a potato-like food. Native Americans harvested and consumed these tubers, which in some areas were known as wapato. The Thompson spoke about its use as a love charm and for witchcraft.

pineappleweek

Matriciaria disoidea

Pineappleweed (Matriciaria disoidea)- was used by native peoples ranging from Alaska to Montana. A close relative to German Chamomile it had similar uses for digestion and fevers.   Native peoples used the aromatic plants as perfume, sometimes mixing them with fir or sweet-grass and carrying the mixture in small pouches to concentrate the fragrance. Pineappleweed, provided a pleasant smelling insect repellent, and the fragrant dried plants were used to line cradles and stuff pillows.  The Okanagan-Colville buried the tops of Pineappleweed mixed with human hair to prevent loved ones or relations from going away.

prairie smoke

Geum triflorum

Prairie Smoke or three-flower avens (Geum triflorum)-is in the rosaceae family; so that tells us that it probably has astringent actions. Avens were used by many native peoples ranging from toothache remedies, fevers, antidiarrheal, gastrointestinal and as a gynecological aid. Primarily the roots were used. Several tribes used it for love medicine, including the Iroquois, who used the compounded roots as an emetic to vomit and cure themselves of love medicine. The Okanagan-Colville used and infusion of the roots as a love potion by a woman who wanted to win back the affection of a man. Mathew Woods wrote about it in his book The Earthwise Herbal: A Complete Guild To New World Medicinal Plants. He spoke about the roots of avens containing phenols, tannins and essential oil, along with noting that he felt Prairie Smoke has an affinity to the female system: the latter for Stagnant blood .

sierra shoot star

Dodecatheon jeffreyi

Last but not least Sierra Shooting Star or Tall Mountain Shooting Star (Dodecatheon jeffreyi) was used as love medicine by the Thompson tribe. Women used the flowers “to obtain the love of men and to help them control men”.

This is just a small sampling of the vast number of plants that were utilized. As the profession of herbalism evolves in North America there is greater and greater emphasis being put on evidenced based medicine and a movement away from traditional knowledge along with the reduction in the number of the plants that are used in commerce. Despite this tendency towards retraction, my hope is that we continue to keep love 2plant stories, and other cultural values which plants offer, alive.

Wildcrafting: Developing a bioregional approach to herbalism

Much has been written about the importance of developing a bioregional approach to herbalism particularly in relationship to sustainability.  As anSlide01 herbalist having an understanding of your bioregion allows you to more fully engage with your surroundings and to have an intimate knowledge of its micro environments and plant populations.  Many of the “popular” herbs that we rely on are grown all over the world.   Their energy footprint including transportation costs, etc., as well as, the sometimes unethical practices of harvesting can be mitigated by utilizing herbs “outside your door”.  I believe our challenge as herbalist’s is to discover, utilize and teach others about what grows locally, so we can become more self-reliant and less dependent upon mail order herbs.  This article is an outline of the process that I have used and teach in my bioregional wildcrafting classes.

Slide04Defining a bioregion:  This is a helpful process in trying to understand the various ecosystems that encompass a specific area and to being able to identify various plant populations that grow within in them.  In my case I live in Central Oregon (Crook, Deschutes and Jefferson counties) which comprises a variety of ecosystems.  Using the following link: http://www.plantmaps.com/interactive-oregon-ecoregions-l4-map.php  which is specific to Oregon I have identified the various ecosystems that the Environmental Protection Agency (EPA) has defined that make up the area that I live.  I assume that these interactive maps are available for all parts of North America.

Plant Identification:  This by far is the most challenging part of the process and I have spent endlessSlide09 hours scouring photo’s and plant descriptions to determine a plants identity. We are fortunate that we live in an era where there are so many resources available to us including on-line plant databases, plant identification apps and books.  Searching for plant lists is another helpful tool.  These lists are often available through native plant societies, university databases, herb schools and various other sites.

Here are a few links for plants specific to Oregon:

http://science.halleyhosting.com/nature/bloomtime/lists/or/or.html

http://www.oregonflora.org/atlas.php

http://www.botanicalstudies.net/botany/plantlists.php

Slide06Before you start this process it is vitally important to identify poisonous plants that grow in your area.  Typically I will review plant lists and determine if the plant that is listed has a history of use (see traditional use section below). Having a plant list in hand is a great first step, but you still have to be able to positively identify plants that you find.  Having a basic understanding of botany is particularly helpful in reading through plant descriptions or having the ability to identify plant families at least narrows down the Slide17possibilities.  Having a working knowledge of plant families can be quite helpful in at least narrowing down your search. A great book is Thomas Elpel’s “Botany in a Day: the Patterns Method of Plant Identification” and his website:   http://www.wildflowers-and-weeds.com/Plant_Families/Plant_Families_Index.html

In looking for a plant identification book I prefer one that is indexed by the color of the flowers the number and type of leaf pattern.  A rule of thumb is to identify the plant from three different sources before making the final confirmation as to its identification.   There are some excellent websites featuring photos of plants in the Pacific Northwest, Mark Turner’s book and internet site is extremely helpful:  http://www.pnwflowers.com.

Finally Hitchcock and Cronquist book “Flora of the Pacific Northwest” is an invaluable resource for species identification.  Once you have identified the plant then researching its medicinal value is the next step in the process.

Traditional Uses:  There are numerous books written about the medicinal value of medicinal herbs although they tend toroot digging feature more common or popular herbs.  In my bioregion which is mostly scrub and sagebrush these are not helpful.  Identifying Native American use of plants has been the most helpful path as I have found.  For my area I have identified the following Native American tribes who have used plants specific to my bioregion.

  • Cowlitz-South central Washington
  • Klamath-Southern Central Oregon
  • Okanagon-Colville reservation in Washington and British Columbia border.
  • Warm Springs-North central Oregon
  • Paiute-Great Basin region, Warm Springs reservation*
  • Shuswap-Southern interior plateau of British Columbia
  • Skagit- Upper, Northern Cascade Range, Washington
  • Snohomish-Northeastern side of Puget Sound, Washington
  • Thompson-Southwestern British Columbia
  • Umatilla-along the Umatilla and Columbia Rivers in Oregon
  • Washo-Near Lake Tahoe on the Calif.-Nevada border.

*Confederated Tribes of Warm Springs Indian Reservation comprised of Warm Springs, Paiute and Wasco tribes.

Armored with this information I have done searches and read some of the original ethnographies that are available through inter-library loan.  Additionally I have almost wore out my copy of Daniel Moreman’s amazing book “Native American Medicinal Plants“.   Two other invaluable books in researching traditional uses are Steven Foster and Christopher Hobbs, “Western Medicinal Plants and Herbs” and  “American Medicinal Plants” by Millspaugh.  It is important to recognize that the information we have available is by no means exhaustive and only a reflection of the information that was collected through a colonial framework.

index

Rosa woodsii

Materia Medica:  Once you have identified the plant’s traditional and/or contemporary uses it is helpful to start to categorize its medicinal properties so that you can incorporate into your materia medica and medicine making, noting which parts of the plant are used.  For example, if a plant is within a certain family such as Rosaceae you already know that it is probably astringent due to the tannins. For example Woods’ Rose (Rosa woodsii) was used by the Paiute tribes as a decoction of the root for diarrhea, a poultice of various parts of the plant as a burn medicine, a decoction of the inner bark of the shrub for colds, a poultice of the mashed fungus galls for open boils, and an infusion of the leaves were taken as a spring tonic.  The Thompson tribe used the hips to help women in labor to hasten delivery and a decoction of the roots were taken by women after childbirth to tonify the uterus.  They also made a decoction of branches of rose, chokecherry and willow for diarrhea and vomiting.  Pioneer women used the hips of wild rose in jelly, pudding and syrups.  Knowing these uses helps you to incorporate it into your arsenal for addressing any number of conditions where you might have used other astringent herbs.

lomatium dissectum

Lomatium dissectum

Another example is Fernleaf Biscuitroot (Lomatium dissectum) which was used by the numerous tribes including the Paiute, Northern Paiute, Thompson and Okanagan-Colville tribes.  It was used as a dermatological aid for sores, for pulmonary issues including tuberculosis, as an analgesic for pain and arthritis, a decoction of the roots was taken for colds and numerous other uses. In looking at contemporary information on this plant, it has been found to have antimicrobial and antiviral potential.   It is fairly easy to see how one could incorporate the roots into oil for salves, cooked roots into cough medicine and roots soaked in alcohol as a liniment.

Astragalus purshii

Astragalus purshii

Research pays off, for example some plants have a documented use of being used internally yet they have emetic potential such as Wooly-pod Milk Vetch (Astragalus purshii).  Astragalus purshii  was  primarily used externally as a wash, although the Kawailsu tribe did use it internally for menstrual pains.  As a dermatological aid a decoction of the whole plant was used as a wash for the head, hair and body.  It was also used in the sweat lodge as a disinfectant, and was poured over hunting equipment, when the hunter was having “bad luck”. Since it does mention that it could be an emetic I would recommend only using this plant externally.  It is important to be stewards of the land therefore ensuring continued abundance of the plants that we harvest.  There are several websites that outline the steps to take to ensure we are properly caretakers of our bioregion.  Explore, learn and share your knowledge.

Ethical Wildcrafting and Stewardship:

  1.  Follow the abundance
  2. Avoid and protect unusual, threatened and endangered plants
  3. Gather in small, thoughtful numbers
  4. 
Browse, don’t graze
  5. 
Know where (and where not) to harvest
  6. Be okay with an empty basket
  7. Err on the side of less
  8. Promote abundance
, spread seeds, try to take parts of roots, not the entire plant
  9. Harvest to the plant’s needs
  10. 
Bring the right tools
  11. Assess for environmental toxins
  12. Share your gratitude-giving thanks

https://www.unitedplantsavers.org/images/pdf/2012_nursery_directory.pdf

http://7song.com/files/Wildcrafting%20Herbalist.pdf