Indian Pipe

Trying to work with local NW herbs presents some unique challenges. There is very little accessible tradition on their use of herbs which are specific to this region. The 19th century American medical traditions (the Physiomedicalists and Eclectics, mostly) did not work with them, and records of Native uses are extremely scanty and vague: it seems that everything was used either for “rheumatism” or tuberculosis. Similarly, because they are not well known or commonly used in the wider herbal traditions, they do not receive much contemporary research. This is where we have to play Shen Nong, and our ability to accurately perceive an herb and its actions becomes most important. Conceptually, I imagine training my ability to recognize herbal actions by working first with better documented herbs (so that I can compare my own insights with those of medical predecessors) before trying to tackle the under-documented local herbs. In reality my curiosity spreads without regard to such schemes.

Anyone reading this who does not know what Indian Pipe looks like should first have a look at the pictures here and here. Indian Pipe is an epiparasite, meaning that it parasitizes certain fungi which in turn parasitize the roots of photosynthesizing plants. Since it does not participate in photosynthesis, it has no need for chlorophyll, allowing its white color. Other saprophytes and parasites, also freed from the green chlorophyll express a variety of colors; the distinct whiteness of indian pipe indicates something particular about this plant. Being freed from the demands of photosynthesizing it is also able to grow under complete shade cover, such as under patches of salal, in places where other plants cannot grow.

While growing from a common, tangled mass or rootlets, each aerial growth consists of one thick, juicy stalk, with a very tough fibrous cord in the middle. There are a number of small, scale-like, vestigal leaves. As it grows, the plant is bent at the top, so that the white flower faces downward. It is pollinated in this position. Then, as the plant ages, the top of the stem straightens out, the leaves and flower petals dry to a black color, leaving a seed pod which looks strikingly like a miniature opium seed pod.

The morphological indications of this plant is quite clear: We might say that this plant is not oriented toward the realm of light, but more accurately those processes pertaining to the upward and outward realm of light are, in this plant, shifted down under the ground. Thus the flower - which in other plants opens toward the sun and provides a plant interpretation of the sun - in this case faces downward, toward the earth where it receives its “light.”
The medical uses of the plant follow quite directly from this observation. It is used as a hypnotic, sedative, and analgesic. I.e., it affects our consciousness, which is our own inner light. What I hope to discover and elucidate in some greater detail are the specific alterations of consciousness this plant effects. Sedatives and analgesics are easily dismissed as symptomatic medicines, appropriate in their place, but holding no great curative potentials. However, if properly understood, they may have something to curative to offer in the right situation.

The aerial parts and the roots of Indian Pipe are both medicinal, although they are reported to have slightly different effects. So far I have only experimented with the aerial parts. My description below pertains to that part; I will be experimenting with the roots in the future. The taste of Indian Pipe tincture is distinctly bland, so bland that I had trouble keeping a mental lock on it. When I did focus on this flavor, I felt as if a heavy blanket were being thrown over me. Everything felt muted. As time progressed, I began to detect blank patches in my sensoria - as though a few frames were missing from the movie, or more accurately as if one corner of one frame was missing, then another corner was missing from the next. My wife and I each discovered that we were increasingly aware of areas of areas of muscular tension in our bodies, and especially in our faces. Those areas began to feel mildly painful. We then fell asleep and experienced extremely vivid dreams. We were notably lethargic into the middle of the next day.

The high level of dream activity corresponds with the awareness of muscular tension: they represent buried features of consciousness returning to awareness. This corresponds also with the plant form: in turning the light of consciousness down under the earth, we loose consciousness of the outward world, but gain consciousness of those factors properly belonging to consciousness which have been deposited into material form.

This is where I suspect the plant could be therapeutic: in treating conditions resulting from psychological tension, and more specifically, tension which the patient has difficulty even becoming aware of. This is not an issue addressed directly, at least in those terms, within CCM. Nevertheless, we can explain this as a reorientation in the consciousness aspect of the water-fire axis. Specifically, in cases where the Water and perhaps Wood have suffered drying (i.e. Metal) displacements in order to allow Fire to continue its activity, Indian Pipe will promote the transition between Fire and Metal, so that the other phases can be restored.

While this herb makes falling asleep feel really good, and makes being asleep really fun, it also leaves me feeling lethargic well into the next day - at least in the doses I have been using it (4-10 drops of my rather strong tincture). Thus this is an herb which seems to call out for usage in formula so that these effects can be moderated.  It also seems very promising for homeopathic use, for those who are interested in that style of medicine.

Yarrow

I begin with the form of the living plant. The stem is is woody, although one senses a resinous quality in it: it is not quite sticky, but feels like it might be.

The leaves are small (both short and narrow) and doubly divided into many thin rays. From each leaf axil, a number of leaves develop - one primary leaf and a number of confused and underdeveloped leaves which range from shorter leaves to partial buds. Leaves appear on the stem even in the superior region, after it begins dividing to form the flowering head. In fact, a leaf appears at the root of each division, showing the continuity between the leafing and flowering processes.

The multiply divided umbellifer-like flowering head repeats the theme of division seen in the leaves. Flowers are small and generally white or white-ish, 5-petaled, attached to small, bulbous calyx.

It grows in direct sunlight and tolerates poor, sandy soil. I find it growing at the beach, often in very sandy soil, along with horsetail (the toughest of the tough) and, surprisingly, coltsfoot.

A few themes emerge from this plant form:

First is the principle of divisions. The leaves are multiply divided, as is the flowering head. Divisions indicate a strong rhythmic process, which is quite normal to find in plant leaves, but in this case extends into the flower. Divisions can also be seen to indicate that the plant has a light, airy nature.

Second, this plant does not make a firm distinction between the leaf and flower processes. Leaves are found surprisingly far upward into the flowering head, while at the same time, the flower begins to assert itself early on, with little undeveloped buds appearing quite far down the stem.

Third, the whole plant has a dry quality: woody stem, fine leaves, small flowers, growing in dry soil. This dryness seems to be of a specific kind that indicates an inner strength. Although the leaves are light and airy, there seems to be an inner force which is held back.

When taking a tincture of yarrow, I find two distinct tastes: a sweet taste and a bitter taste. Concentrating on the sweet flavor I experience an upward opening: I become especially aware of my upper body, head and chest, I wear a gentle smile, everything seems a little lighter and easier. At other times, I feel an expansion in my chest. Concentrating on the bitter flavor I have an experience of inner strength and determination, which is almost like a gathering of the zhi (will). I am reminded of the plant’s ability to grow in very poor soil. Also speaking of determination, Pelikan notes that the plant continues to flower into the winter. It is not clear that it corresponds to a particular taste, but I also find that my guts resettle after taking the tincture. In all this I find that yarrow does not have a significant warming action.

These perceived actions correspond very well with the themes of the plant form. The light, floating, expansive quality matches the light, airy leaves which easily transitions upward into the flower. This is an expansion both upward and outward. Increased blood-flow to the surface is found in the rhythmic property of the leaves moving into the flowering process. The dense strength is like dry, inner force of the plant which grows in difficult, sandy soil and persists into difficult weather. Because this plant allows expansion but also holds onto something for the winter, I would not be too worried about yarrow over-dispersing yang.

We can expand on these parallels between living form and medical function by considering some of the more specific functions for which yarrow is used.

Diaphoretic & peripheral vasodilator - this has been well covered above.

Anti-hemorrhagic - this is the counter pole, the determined holding back

General regulator of blood (“regulates flow of blood to and from the surface, in and out of capillaries, thins and thickens blood”) - this is suggested by the strong rhythmic signature in the plant form.

Digestive tonic - this corresponds to the plant’s ability to grow in poor soil, it is able to extract nutrients in tough conditions. I have not yet uprooted a yarrow plant to examine its root structure.

Anti-spasmodic  (mostly for digestive and gynecological conditions) - this is probably indicated through the rhythmic, airy nature of the plant. It is able to restore healthy rhythms and establish healthy function in relation to the gripping of air /wood-wind forces.

Harmonizing urination: promoting urination & controlling urinary incontinence - if we regard the bladder as part of the surface, then this is not surprising to us given the plant’s regulatory action on the surface.

Here are some more specific use suggestions from the historical record.

Culpeper records yarrow for “the bloody flux, ulcers and fistulas ... It helps the gonorrhea in men and the whites in women.” Cook calls yarrow a stimulant and astringent, moderately slow in action for chronic dysentery and diarrhea, weakness of digestion with weak appetite and feeble looseness of the bowels. He also uses it for leukorrhea and urinary incontinence, as well as spitting and vomiting of blood. Lloyd and Ellingwood state that it is specific for passive hemorrhage (hemorrhage d/t SP not controlling the blood?), however Matthew Wood states that it is specific for hemorrhages with bright red bleeding and contraindicated in passive, dark, coagulated flow. If anyone has further information on this point, please let us know. Lloyd and Ellingwood also use it for irritated mucosa and deficient kidney action, with evidence of poisoning, with or w/o edema. Santillo uses it for hemorrhoids and hemorrhage of the lungs. Mills and Bone list it as a spasmolytic (for dysmenorrhea) which can reduce excessive menstrual bleeding over time, and as an anti-hemorrhagic for menorrhagia. Holmes finds it a “gentle, universal regulator of menstruation” specifically stating that it removes venous congestion in the uterus, stimulates the uterus (relieving delayed periods), and is spasmolytic for spasmodic dysmenorrhea. He also records that it is traditional for neuralgic and rheumatic conditions, especially of the upper trunk. Jeremy Ross states that yarrow can clear retained pathogens and that it has some phlegm-busting ability for both lung hyper-secretion and hyperlipidemia.

Next I will be writing about which pulses that might call for yarrow and possible formulas to use it in.

Herbal Pairing

There are a number of different possible approaches to putting Western and Chinese herbalism into conversation with one another. As has been argued already on this site, however, looking for one-to-one substitutes from one pharmacopeia to the other is probably not the way to success. Rather, we must acknowledge that every herb is different, even, typically, different members of the same genus. I'm an advocate of learning from the beauty and efficiency of the classical Chinese (mainly Shang Han Za Bing Lun) formulas and then applying some of the strategies in broad strokes to Western herbs. In other words, we may not even end up trying to replicate a specific formula, but rather use principles demonstrated in the SHZBL to create our own formulas that, like Zhang Zhong Jing's, are more than the sum of their parts. 

By way of example, take the well-known Shang Han Lun formula Si Ni San. In my understanding, it treats a pattern of slightly cold extremities due to qi constraint in the center. Unlike the Si Ni Tang or Dang Gui Si Ni Tang patient, this person isn't suffering from true cold, and may in fact have significant heat signs and be full of vitality. However, they exhibit an internal tension that prevents the qi from circulating freely, and therefore the blood circulation is also compromised. The formula consists of Chaihu, Baishao, Zhishi, and Gancao. Chaihu is of course the great disperser of constrained qi--but in order to circulate something you need to clear the way first. So I understand the strategy of this formula to be one of "relax, then circulate." The Baishao and Gancao together serve to relax the Liver, easing the tension in the center. It's a way of controlling addressing the Wood-Earth relationship: Baishao restrains Wood in its attack on Earth while Gancao bolsters Earth directly. Then the Chaihu can do its work of freeing up the qi and spreading it out to the limbs. The addition of Zhishi aids in keeping the qi dynamic moving and countering any over-cloying or over-relaxing aspect of Baishao and Gancao. 

So, how to to apply this strategy to Western herbs? In fact, the 19th Century herbalist Sameul Thomson was one step ahead of us.  He was well-known for his use of Lobelia inflata, an idiosyncratic relaxant, as well as Cayenne, an obvious stimulant. While Lobelia is no Baishao and Cayenne certainly no Chaihu, the idea behind combining the two is parallel to the operative one in Si Ni San. As in that formula, there is a principle of relaxing and one of stimulating (moving the qi or blood). In practice, the indications for the two formulas may indeed by similar, as Cayenne is specifically indicated, according to Matthew Wood, by "unequal circulation,"as expressed by out-of-sync pulse qualities, or red-purple complexion, or even varicose veins--and, presumably, by warmth in the center with cold at the periphery. Of course, the proof is in the pudding; it would be interesting to try a Cayenne and Lobelia for a Si Ni San pattern, or vice versa.

Coming finally to the topic of the title, it seems to me that building up a Western formulary should proceed from knowing individual herbs to combining them into pairs. After all, it's combinations like Guizhi-Baishao and Fuzi-Ganjiang that lie at the heart of classical formulation.

By the way, Colorado herbalist Paul Bergner has an excellent lecture available on CD on Herbal Pairing in Western herbalism.  

Hormonal profiles in gynecological conditions

Many books on western herbs describe the gynecological patterns for which various herbs are appropriate in terms of hormonal profiles: estrogen excess, progesterone deficiency, androgen excess, etc. The meaning of these terms might be standard knowledge to some of you, but not for me. The following is a record of my attempt to understand these indications. I do draw rough parallels between these hormonal patterns and familiar CM patterns. I do not mean to establish any one-to-one relationships between biomedical diagnoses and CM pattern differentiations. These comparisons are offered only as an initial attempt to reckon with the hormonal patterns. (Also it would be rather strange if these common hormonal patterns were not reflected some way in our system.)

There are three major hormone groups involved in the menstrual cycle (and gynecology generally): androgens, estrogens, and progesterone. The androgens are generated in the ovaries, adrenal cortex, and fat cells. They are precursors for the other two.
Estrogens are generated primarily in the ovaries, but also in the adrenals, and, during pregnancy, in the placenta. Estrogen is primarily generated during the follicular phase and is considered an anabolic hormone.
Progesterone is dominant during the luteal phase. It is relatively catabolic, but is in fact more regulating than one-sidedly catabolic. It promotes an increased body temperature as the body prepares to incubate a fertilized egg.
Production of both estrogen and progesterone decrease with age. The balance between the two is often more important than absolute levels, although absolute levels are also relevant. Thus we have either four or six different hormonal patterns:
Estrogen dominance
    estrogen excess
    progesterone deficiency
Progesterone dominance
    estrogen deficiency
    progesterone excess
Androgen excess
Androgen deficiency

*

Estrogen dominance is the most widely discussed hormone imbalance. It is considered the classic PMS pattern, and indeed it sounds a lot like the classic “Liver qi stagnation” pattern of dysmenorrhea.
Looking more specifically at estrogen excess, general constitutional signs include: overweight, red flushed face, and warm. Specific menstrual tendencies include: cramping, heavy bleeding. Other signs include gallbladder problems and anxious depression. That sounds a lot like a stagnant and flaring ministerial fire.
Progesterone Deficiency is less obvious. It is typified by irregular periods, clots, heavy bleeding, slow onset of menstruation, water retention, cramps, breast pain, and cyclical headaches. If progesterone is low enough it can lead to anovulation.
During his discussion of Pennyroyal, Michael Moore mentions that progesterone production can be thrown off by a cold, either in the same month or in the preceding month. That reminded me of a Wuling San pattern discussed by Dr. Zeng. Indeed almost all these symptoms, except possibly the cyclical headaches, could be directly explained by an excess or external cold affecting menstruation. There are probably other ways to look at this pattern.

Progesterone dominance is normally seen only perimenopausely, or if there has been a hysterectomy, etc. Estrogen deficiency can also occur in women who are significantly underweight.
Estrogen deficiency is marked by vaginal dryness, an increased incidence of UTIs (because of dryness also affecting the urethra), dry skin, night sweats, panic attacks, and lethargic depression. This constitutes much of the standard menopausal syndrome, which, as we know, is given a number of different CM diagnoses, primarily yin deficiency, blood deficiency, and blood stagnation. My understanding however is that treating this as a Wen Jing Tang pattern is generally more effective than as Liu Wei Dihuang Wan pattern.
Excessive progesterone is characterized by mid-cycle pain (mittelschmerz), decreased quantity of menstrual blood, increased sweating, possible urinary incontinence. Other symptoms include backache, headache, constipation, joint pain, muscular pain, nausea, vomiting, dizziness, hot flashes, palpitations, possible easy bruising, and possible insomnia in long-standing cases.
I do not see this pattern as a clear match for any particular CM diagnosis. My attempts to diagnose this pattern are further complicated by the fact that I have had difficulty discovering which of these symptoms seem to be the most characteristic. The combination of excess sweating and urinary incontinence strongly suggests that taiyang is failing to control the surface, etc. The various types of body pain can also be explained from a taiyang perspective, but I dont think this explains every symptom.
In both cases estrogen disregulations have had a shaoyang-jueyin connection, while progesterone disregulations have had a taiyang connection.

Symptoms of excessive androgenism  include periods that are irregular or absent, acne, male hair patterns (hair on the face, thinning hair on the head), chills, and PCOS.
Androgen deficiency is normally only seen around menopause. Its symptoms are rather vague: low libido, fatigue, decreased sense of well-being, and an increased susceptibility to bone disease. If those were the only symptoms, I would probably diagnose a shaoyin pattern.

Of course we should remember that hormones are not the only biomedical factor affecting menstruation. Among other things, our diagnoses must also reckon with issues such as the quality and balance of the nervous tone and possible changes in the tissue of the reproductive organs.

Please share any other information or perspectives.