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Herbal Tonic Therapy for Chronic Stress

Herbal Tonic Therapy for Chronic Stress

Parasympathomimetics & Adaptogens
By Mitchell Coven, LMT, Medical Herbalist, BS
OVERVIEW:
A great deal of study and attention has been placed on the use of botanical medicine for acute medical needs or to replace pharmaceutical medication. The past decade has seen a resurgence in the use of botanical medicine. The primary focus has been to use botanical medicine in an Allopathic manner. This is especially true in the market places of the natural product industry (health food stores) and mass market (Wal-mart, Costco, super market chains). While this has undoubtedly been a healthier way to approach acute conditions, underlying causes remain untreated. While other traditional healing methods (including Chinese and Ayurvedic) differentiate constitutional patterns and treat system dysfunction and not just symptoms, American herbal consumers are largely unaware or unwilling to educate and treat at a more causative level. Additionally, most know of a better way to eat, exercise and relate emotionally, but cannot or do not do what they know will maximize health.
Stress levels are at unprecedented levels and one way to prevent or more successfully turn around acute conditions is to effect how the body responds to stress. Maximizing stress adaptation allows the body to heal more quickly. Maximizing stress adaptation may prevent chronic symptoms from reoccurring if they are stress mediated. To maximize health, one must look to a patients stress level, their ability to cope and its impact on the symptoms presented to the herbalist.
People are more receptive to taking something to treat stress than to change the cause of the stress. Most cannot or do not have the physical, emotional, mental or financial means to change to a healthier way. Stress levels build to the point where they are never resolved.  Ones day-to-day, week-to-week, month-to-month and decade-to-decade stress levels continue to build. The more unresolved stress that people have, the more likely they are to degenerate along the lines of their constitutional, predispositional or genetic weakness. Chronic health patterns can manifest along these lines. It is common to see more recent stressed out generations of people manifesting their genetic code sooner in years compared to generations past. Even though people are living longer than a couple generations ago, the number of medications taken for their acute and chronic illnesses can be astonishing.  Assuming one cannot change their lifestyle or reduce and resolve enough stress in order for the body to maintain homeostatic health day to day, the need for parasympathomimetic and adaptogenic herbs are indicated.
Autonomic Nervous System
An innate goal of every healthy human system is for the body to seek equilibrium or homeostatic biochemical function. The Autonomic Nervous System (ANS) seeks balance between sympathetic (fight or flight) and parasympathetic (relaxation response) function in response to ones physical, emotional and mental environment. A healthy response to stress activates the Stress Axis (hypothalamus, pituitary, adrenals). It results in secretions of norepinephrine (directly into a target organ to induce specific organ stress response) and epinephrine or adrenalin from the adrenals (secreted systemically into general circulation to induce a whole body stress response). Additionally, the hypothalamus secretes corticotropin-releasing hormone (CRF), which makes the pituitary secrete adrenocorticotropin hormone (ACTH), which then makes the adrenal cortex secrete corticosteroids (cortisol is dominant). The Stress Axis can stay stuck in the on position with or without resolution of the stress, thus taxing the body. Once a stress is resolved, these levels should reduce. Many people do not resolve their stress and therefore, have a chronically elevated sympathetic function. Fatigue and system dysfunction set in as the body begins to loose this adaptive quality.  Sources of stress can be as pervasive as ones job, their living environment, money, competition, reading the “bad news” and living in times of war. Some sources of stress are internally generated and are less obvious. Some people project a controlled exterior and even describe themselves as not having much stress. But internally, they think constantly, worry, may obsess on what is wrong and turn their angst into the dominant component of their life. This can lead to severe anxiety or panic attacks. A metaphoric adrenalizing of their dark side can result.   
Elevated sympathetic or adrenergic function contributes to or results in biochemistry with the following possible symptoms:

? Elevated blood pressure
? Elevated respiratory rate
? Elevated heart rate
? Higher blood sugar levels
? Decreased digestive enzymes
? Decreased sexual drive
? Hypertonic musculoskeletal system (typically contraction and pain)
? Endocrine dysfunction from limbic overload
? Insomnia
? Irregular bowels (constipation, diarrhea, irritable bowel)
? Immune dysfunction (either aggravating deficiency or excess)
? Mood swings

Botanical treatment for any of these symptoms without addressing the stress dysfunction in the ANS (Autonomic Nervous System) can limit one’s results. Often times a patient will comment on a dominant stress preceding the onset of the condition for which they request treatment. Clearly, the best resolution of such a stress is behavioral, but the herbal treatment of choice falls to the Adaptogenic and Parasympathomimetic herbs.
The comments that follow are based on my observations from a clinical practice of over 18 years and supporting research.


BOTANICALS

Adaptogen
Adaptogens are herbs that increase the body’s’ nonspecific resistance to intrinsic and extrinsic physical, emotional, mental and environmental stress factors. They increase the body’s ability to adapt to stress. The term was coined in 1958 by N.V. Lazarev and furthered 10 years later by Dr. I.I. Brekman and Dr. I.V. Dardymov. They modify limbic brain, neuroendocrine and immune system responses to stress. Adaptogens affect the stress axis (hypothalamus, pituitary and adrenals) of the endocrine system. Adaptogens help maintain equilibrium in the endocrine, immune, autonomic, and nervous systems and therefore help prevent systemic health breakdown. By increasing adaptation on all levels described here, one increases their ability to ward off chronic illness and the gradual breakdown that leads to the manifestation of undesirable genetic health predispositions. They are always tonic in approach and function best in a long-term treatment plan.

Eleuthero Root (Eleutherococcus senticosis)
Eleuthero, formerly known as Siberian Ginseng, may be the most researched adaptogen. Extensive clinical research, undertaken by Soviet scientists, shows positive results .One group of compounds, the eleutherosides are thought to be responsible for the adaptogenic activity in the root. Russian cosmonauts, athletes, soldiers, and workers of all classes use Eleuthero to increase work output, reduce sick time and reduce fatigue.  Response to adverse conditions including heat, noise, exertion and workload is enhanced. Athletic stamina improved in Olympic athletes. Recovery time from illness is reduced with Eleuthero. Eleuthero seems well tolerated and should not be confused with Panax species of ginseng.

Ginseng
(Panax ginseng, P. quinquefolium)
Traditional use of ginseng revolved around promoting digestive function, improving nutrition and calming agitation. Current uses overzealously prescribe a stimulant effect similar to caffeine, which Ginseng does not contain. The ginsenosides are thought to be the primary active constituent. Ginseng does seem to affect the stress axis in a positive way when consumed over long periods of time (at least one month) and in sufficient doses (at least three grams per day). Ginseng helps limit the impact of stress and traditionally has been thought to have a calming effect. This may be due to helping one cope with stress and avoid fatigue and is a far different approach from the marketing effort to portray Ginseng as a stimulant and energy herb taken when going to the gym. Also, the difference between Chinese Ginseng and American Ginseng (Panax quinquefolium) may be overblown. Subhuti Dharmananda says ” There is no substantive evidence that any difference in ginsenoside proportions between Asian and American roots produces any difference in clinical effect.” Problematically, Chinese Ginseng contains a variety of banned pesticides, including quintozene. It is far easier to find chemical free American Ginseng.
Contraindicated in high blood pressure

Reishi Mushroom (Ganoderma lucidium)
In Chinese medicine Reishi is called Ling Zhi. It contains a wealth of polysaccharides, triterpenes and alkaloids. As an adaptogen, it is more effective than Panax and much broader in range. It is tonic to the Stress Axis and limbic brain.  Reishi counters chronic fatigue, chronic lethargy and is beneficial in a treatment plan for any condition aggravated by stress. It is an immune enhancing herb in chronic conditions ranging from AIDS, cancer and chronic fatigue as well as to most stress induced immune dysfunction, including deficiency and excess (autoimmune). It is indicated in degenerative conditions, autoimmune conditions and cancer. Reishi has cardiac benefits including lowering cholesterol and high blood pressure. It also shows antihistamine action, antioxidant activity, helps prevent liver necrosis and may assist in oxygen uptake at high altitudes. Reishi has broad application and is best considered, not a medicine for each condition above, but as a tonic in conjunction with other botanicals for the specific symptom. It is best used long term and in this author’s practice, was the first choice for supplementation in answer to the question “what should I take to stay healthy if I will only take one thing”.

Rhodiola Root (Rhodiola rosea)
Rhodiola, also known as Arctic Root, is a newer addition to the American herbal repertory. Utilized by the Russians, it functions as a classic adaptogen. It seems to regulate the adaptive function and therefore helps maintain equilibrium within the stress axis (hypothalamus, pituitary and adrenals) of the endocrine system. It seems that 2 glycosides, rosavin and salidroside are responsible for the roots benefits. Rhodiola helps reduce altitude sickness and increases athletic performance. It increases capacity for exercise and enhances immunity.

Licorice Root (Glycyrrhiza glabra)
Licorice is used in adaptogenic formulas for those under adrenaline stress. It is indicated for the prevention of systemic fatigue as well as for those already fatigued. Licorice has an interesting synergy with the adrenals. It influences adrenaline, cortisol and aldosterone. Licorice has an aldosterone-like effect, which makes the body retain water. For those with low blood pressure and fatigue, it is specifically indicated, as it increases blood volume via its aldosterone effect. Licorice can help other dry conditions such as dry stool, skin, thick lung phlegm and dry throat. For those under stress which manifests as a kidney deficiency presented as needing to wake frequently to urinate at night, resulting in further fatigue by having a poor nights sleep, Licorice is indicated. One must rule out other urinary causes such as urinary tract infections, BPH, prolapsed uterus and drinking too much water before bedtime. Licorice influences the Stress Axis at the adrenals and is considered an adrenal tonic. It also inhibits the breakdown of corticosteroids by the liver and potentiates the effect of cortisol and ACTH. It has anti-inflammatory properties and is useful in helping people wean from corticosteroid drugs or to at least diminish dose. It may be helpful for any inflammatory condition where corticosteroids are indicated. It also shows antiviral, antimicrobial and immunomodulatory activity. It has implications in herpes, HIV, gastric and duodenal ulcers, chronic fatigue and a host of other conditions. It is commonly found in adaptogenic formulations and as a sweet and pleasant tasting herb to help the flavor of herbal formulations.
Contraindicated in pregnancy, high blood pressure

Other notable Adaptogens:
Ashwagandha Root (Withania somnifera)
Schizandra Berry (S. chinensis)


PARASYMPATHOMIMETICS
A parasympathomimetic, both directly or indirectly, increases parasympathetic function and, therefore, reduces sympathetic function. They are indicated for anxiety and stress, to calm and soothe symptoms aggravated by adrenergic stress. Most have limited central nervous system sedation, so parasympathomimetics are preferred during the day to calm internal stress without making one as sleepy as a primary sedative (i.e. Valeriana, Humulus).

Lobelia Herb (Lobelia inflata)
Lobelia must be taken as a fresh plant tincture and in this form is a vagus nerve stimulant and primary parasympathomimetic. The dry form is void of this action and is then primarily an emetic. Lobelia reduces adrenaline and the functional changes that result are diverse (see above). Lobelia assists the type-A adrenergic workaholic, worrier who thrives on doing too much. These are the people who do not simply go to sleep at night, but keep going until they practically pass out and just cannot do anymore. Adrenaline dominance can persist in sleep, resulting in jaw grinding, neck contracting, light sleeping evenings with dreams so active that one wakes exhausted. Lobelia takes down the adrenaline dominance as a predictable parasympathomimetic. It can also reduce daytime adrenergic hyperactivity and calm one to help focus on the task at hand.
Lobelia is also a useful antispasmodic to the respiratory tract, useful in spasmodic cough, asthma, constricted diaphragm and general congestion. Smokers find that the lobeline in Lobelia helps reduce nicotine craving and therefore assists in withdrawal.
Although Samuel Thompson overloaded patients with lobelia to induce an emetic response to heal a variety of ills a treatment perpetuated by Jethro Kloss, low doses of lobelia are safe. A 1:2 fresh tincture requires 5-15 drops for most.
Contraindicated in pregnancy, bradycardia

Pulsatilla Herb (Anemone patens, A. tuberosa, A. hirsutissima)
Indicated for an agitated state of emotional and mental stress where ones adrenalized dark side takes over reason. Feeling of impending doom, hand wringing self-conscious thoughts, fixations on imperfections and compulsive behavior are also indications. Pulsatilla provides vagus nerve stimulation. Pulsatilla in small frequent doses can help acute anxiety or panic attacks. Anxiety can overwhelm and drive exhaustion in deeper if untreated.  It is useful in recovery, panic disorders, drug induced anxiety, situational fear (i.e. fear of flying) as well as long-term anxiety. It must be a fresh plant tincture to obtain these results. Dose is 3-10 drops of the fresh plant tincture. Do not use large doses. It is synergistic with Lobelia and Kava.
Contraindicated in pregnancy, febrile conditions, bradycardia

Kava Root (Piper methysticum)
Kava is a primary anxiolytic and muscle relaxant. It also seems to enhance mental performance. Kava seems to function as a secondary parasympathomimetic. It is arguably the most popular and successful herb used for anxiety. Many studies have been done on Kava regarding anxiety, mental function and also comparing it to benzodiazepine (i.e. Valium) drugs. Kava shows equal efficacy to benzodiazepine drugs while kava actually improves memory and mental performance. Benzodiazepine drugs commonly reduce memory and mental performance. Kava has great therapeutic value for everyday adrenergic stress as well as acute anxiety attacks. After Kava reduces anxiety and stress, it actually improves focus and attention to the task at hand. It is also indicated for hyperactivity.
Stress dominates western culture and harmful sedatives, including prescription and recreational drugs, and alcohol are abused. Even television is used as a sedative. Kava may provide a healthier avenue for stress reduction. Kava has an interesting and varied effect when administered. Some feel mentally focused and stimulated by kava yet others find that when their anxiety and stress are reduced, they are physically, emotionally and mentally exhausted and deeply desire sleep. Some feel their senses become stimulated and sensitized. It is interesting to note that when extremely stressed individuals finally relax, they can associate this with a feeling of euphoria while others associate relaxation as a normal state.
Kava is indicated to help sleep when fatigue is present yet the mind is hyperactive. Kava helps deepen the sleep of light sleepers and those who grind their jaw or awake with a tight and painful neck. As a muscle relaxant, it is indicated for muscle pain from exertion, trauma and in fibromyalgia.
Kava is synergistic with Lobelia and Pulsatilla.
Contraindicated in pregnancy and nursing, potentiates other sedative substances. Recent information suggests that Kava may potentiate elevated liver enzymes if concurrently drinking alcohol or on medication harmful to ones liver. Do not take kava in this situation or if liver enzymes are already elevated.

SUMMARY:
Adaptogens and parasympathomimetics can be used concurrently. Adaptogens are indicated to prevent the effects of stress or to help recover from the fatiguing effects of the manifestations of stress. Unless behavioral changes occur in one’s lifestyle, a lifetime of use would be beneficial. Parasympathomimetics can be used as needed per situation and can provide immediate help. They can also be used as a tonic for chronic anxiety until equilibrium is attained. The way most people in developed nations run their lives, both classes of herbs would provide tonic therapy for the 21st century lifestyle.

References:
Asano K Takahashi T, Miyashita M, et al Effect of Eleutherococcus senticosis extract on human physical working capacity. Planta Med 1986;3:175-7.
Bensky, Dan and Gamble, Andrew Materia Medica, Eastland Press, Seattle, WA 1993
Blumenthal, Mark The ABC Clinical Guide to Herbs, Thieme New York, NYC, NY, 2003
Brekman, II, Maianskii GM. Eleutherococcus: A means of increasing the nonspecific resistance of the organism. Inv Akad Nauk Ser Biol 1965;5:762-65
Brinker, Francis, Herb contraindications and Drug Interactions, Eclectic Medical Publications, Sandy, OR, 1998
Dharmanananda, Subhuti The Nature of Ginseng HerbalGram 2002 issue 54:34-51
Filaretov AA, Bogdanova TS, Mituishov MI, et al. Effect of adaptogens on the activity of the pituitary-adrenocortical system in rats. Biull Eiksp Biol Med 1986;101(5):573-4
Heinze, et al, Pharmacopsychological effects of oxazapam and kava kava extract in a visual search paradigm assessed with evident-related potentials, Pharmacopsychiatry, 1994:27(6):224-230
Malsch U, Keiser M. Efficacy of Kava Kava in the treatment of non-psychotic anxiety, following pretreatment with benzodiazepines, Psychopharmacol, 2001;157(3):277-283
Moore, Michael. Medicinal Plants of the Pacific West, Red Crane Books, Santa Fe, NM, 1993
Moore, Michael. Medicinal Plants of the Mountain West, Museum of New Mexico Press, Santa Fe, NM, 1979
Murray, M, Werbach, M. Botanical Influences on Illness Third Line Press, Tarzana, CA 1994
Ramazanov, Kakir, Appell, Brian. Rhodiola Rosea for Chronic Stress Disorder. National Bioscience Corp, Chester, NY 2002
Willard, Terry Reishi Mushroom Herb of Spiritual Potency and Medical Wonder. Sylvan Press, Issaquah, WA 1990
By Mitchell Coven, LMT, Medical Herbalist, BS.
Vitality Works, Inc. Albuquerque, NM

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