Inflammation is one of the body’s primary mechanisms for removing metabolic byproducts, debris and foreign agents. It enables the body to remove damaged cells, neutralize toxins, and fight bacteria, fungi and viruses.
We have already discussed inflammation in the section on the liver, and we will discuss it here from a slightly different angle. int the sections on the immune system (overview and players), we’ll examine it again from yet another angle.
The main physiological components of inflammation are pain, heat and swelling. Pain is the nervous system’s response to heat and irritation when the body initiates the inflammation process to burn away offending agents.
Swelling and redness appear as fluids leak out of capillaries that have dilated in response to heat. Inflammation goes through several stages before finally allowing the body to heal. Like a police force that is prompt and efficient, inflammation is usually our friend, and it is part of the healing process. But when it gets out of control, then it becomes a problem.
When cells sustain damage or tension from infection, wounds or poisons, allergens or other triggers, they release chemicals that start the inflammation process. The basic process involves first an increased flow of blood to the area, followed by an increase in capillary permeability to allow the immune system access to the area, and finally the arrival of white blood cells (WBC). The WBC’s release various chemicals, a process called chemotaxis, all of which cause the heat, redness, pain and swelling. The WBC’s and their chemical weapons destroy invaders and remove debris. The increased fluids present also contains nutrients to initiate repair processes as the inflammation hopefully recedes. Acute inflammation is usually self-limiting.
Inflammation is always present in our bodies at low, silent levels, and this is buffered by our nutrient and defensive capabilities. When our system is in balance, destructive and nutritive processes deal with foreign agents efficiently and our tissues are protected. However, moderate or even mild long-term inflammation can be damaging to our health. Chronic inflammation differs from acute inflammation in that there is usually less heat and pain present. Also, there are changes in the balance of immune-messaging molecules towards unhealthy ratios of WBC’s and increases of inflammatory chemicals (reported in Bland, 1999).
The more obvious signs of long-term inflammation can include fluid retention, musculoskeletal pain and stiffness, skin rashes or outbreaks, allergies, intestinal pain, neurological and mental symptoms such as anxiety and depression, diarrhea or constipation, chronic red eyes, chronic post-nasal drip, burning sensations, poor concentration and memory, and poor digestion.
Modern biomedicine analysis shows us how long-term mild inflammation (at levels just slightly above normal) can contribute to the development of arteriosclerosis, arthritis, calcium deposits, autoimmune issues, chronic fatigue, skin diseases, cancer and numerous other conditions. In lupus, for example, low level immune autoantibodies may be present for up to 7 years before the development of symptoms.
Our cells have their own signaling systems designed for self-protection during acute inflammation, but they can be overwhelmed if the battle goes on too long. This is why severe or long-term inflammation can be damaging to the body (reported in Bland, 1998, reported in Pizzorno 1996). For example, we now know that various inflammatory triggers in the blood causes the release of damaging chemicals, including vascular adhesion molecules (VCAMS) or intracellular adhesion molecules (ICAMS), both of which help initiate common forms of heart disease, such as arterial clogging and heart attacks (Ridker et al., 1998).
Review of Common Sources of Chronic Inflammation
Herbalists offer several explanations for the preponderance of chronic inflammatory conditions in our modern society, noting that in traditional societies we see much less of it (Bergner, 1997). Following is a list of common causes of inflammation.
• Incomplete or poor diet, which leads to basic nutrient deficiencies and eventually immune system weakness or poor repair processes.
• Dietary intake of low quality fats and oils, which leads to increased production of inflammatory chemicals.
• Insufficient dietary intake of fresh fruits and vegetables, which leads to deficiencies in carotenes, flavonoids and other anti-inflammatory plant nutrients.
• Digestive imbalances in the intestines, which lead to intestinal dysbiosis and production of toxic gases and inflammatory compounds that enter the blood.
• Exposure to environmental toxins, heavy metals, chemicals, or prescription pharmaceuticals.
• Genetic errors of metabolism that alter body chemistry toward inflammation.
• Lack of exercise, which leads to cardiac weakness and eventually to poor supply of oxygen and nutrients to tissues and failure to neutralize and carry away wastes.
• Weakness or failure in one of the detoxification organs or systems, such as liver, lungs, kidneys, skin, urinary system, lymphatic system, venous system or bowels.
• Congestion or blockage in the vessels or organs, which leads to the accumulation of waste materials.
I could offer numerous examples to support all of the above causative factors. Instead, I will discuss a single chilling example. Scientists have been reporting the presence of pesticides in the amniotic fluids of pregnant women since the early 1980’s (Saxena et al., 1980) to the present day.. In 1996, Bosse’s group reported that ” We analysed polychlorinated biphenyl (PCB), DDT, hexachlorocyclohexane (HCH), and heptachlor in subcutaneous fat tissue and other tissues (placenta, liver, kidney, lung, brain, thymus, muscle, heart) of 34 fetuses and dead children. These substances were found regularly in placenta, in fetal subcutaneous fat tissue and in fetal organs. They therefore can influence possibly early and sensitive stages of intrauterine development.” (Bosse, et. al, 1996).
Herbal medicines can be of course be of great benefit in reducing inflammation, as long as you realize that using herbs to block inflammation without dealing with these causative factors will not work anywhere as near as well. Since our root causes range from the subtle (genetic imbalances) to the gross (poor nutrition), we have to examine different methods. Our solutions must proceed from understanding both the causal process and the symptoms. Traditional herbal systems compare this to treating the root and the branches of an ailing tree.
To quickly remove toxins from the blood we can use detoxification methods especially of the liver and the bowel. It is interesting to note that, in nature, animals fast when they are ill and sometimes eat grass to induce vomiting. Detoxification has long been a part of all the major herbal healing systems. In Ayurveda it was elevated to the status of one of the original eight branches of medicine (Panchakarma Vidhi). Even today, the use of emetics to cleanse the stomach of poisons is a standard ER treatment.
All of us recognize the importance of cleansing our skin by bathing, cleansing our food by washing it before use, and so forth. In herbal medicine this concept can be expanded to encompass ideas such as cleansing the colon with laxatives or washing the sinuses to treat chronic sinusitis. Sweating therapy is used to stimulate removal of oils and fluids. Fasting is used to change metabolism at first towards a catabolic phase, where chemicals and toxins are released from storage and broken down, eventually leading to an anabolic phase where rebuilding of healthy new tissue occurs. I should mention that in Ayurvedic medicine, there are strict rules about who should and should not undertake cleansing therapy. They had strict rules that the very weak or very ill should avoid fasting and strong purgatives or laxatives.
Detoxification can be accomplished by short-term use of any herbs that stimulate one of the eliminative organs, including skin (sweating agents), lungs (expectorants), kidneys (diuretics), intestines (laxatives), lymphatic system (oils) or liver (cholagogues and choleretics). Note that there is some risk involved if you don’t know what you are doing
Fasting involves abstinence from all food and drink for a specific period of time. Fasting has proven beneficial for many conditions, including heart disease, pancreatitis, PCB and DDT contamination, autoimmune diseases, arthritis, food allergy, psoriasis, eczema, IBS, asthma and depression. Immune function is stimulated in the days and weeks following a fast, as well as a general sense of well being. (Salloum and Burton 1989).
Fasting has even been shown to help regenerate the immune system.
And it is a well know strategy to prolong life.
A short fast (3-5 days) can be implemented on a Wednesday or Friday to allow for rest on the weekend. Many people like to do this at the end of winter, calling it “spring cleaning.” Make the last meal one of only fresh fruits and vegetables, or vegetable soup. Drink only spring or distilled water during the fast. Rest as much as possible, only doing light tasks such as walking and bathing. Bathe frequently, but only use warm water, not hot water. Break the fast with only fruit on the first meal, followed by vegetable soups the rest of the day. Return to normal foods the following day.
Laxatives such as rhubarb root or castor oil are easy to use to cleanse the colon. You can also use any commercial herbal laxative pill, though I prefer balanced herbal laxative formulas. Laxatives flush out stores of endotoxins from the bowel, speeding recovery from both chronic degenerative and acute febrile diseases (Wenlong, 1994). One reason this is helpful in detoxification may be that endotoxins increase free radical production in the liver (Thurman et al., 1998).
Acupuncture for Inflammation
If a patient has acute inflammation affecting the soft tissues or the nervous system, I often send them to Nai-shing for for treatment at our Acupuncture Clinic in Delaware. Acupuncture has been shown in a number of studies to quickly down-regulated inflammatory white blood cells, and, most impressively, even save lives against deadly sepsis in hospitals.
Traditional Analysis of Inflammation
Ayurvedic doctors focus not on the innumerable specific toxins, but on restoration of balance to the carrier mechanisms. They call these mechanisms toxic bile (Pitta dosha), salty mucus (Kapha dosha) and putrefactive gases (Vata dosha), all identified by direct observation and by inference. If there is inflammation with toxic gases, the affected tissue or organ will exhibit more pain, stiffness and gradual degeneration. If there is inflammation with toxic bile, there will be relatively more heat and rapid tissue destruction. If there is more toxic mucus there will be more heavy sensation, swelling and blockage. By looking for the relative preponderance of these symptoms in addition to the usual signs of pain, heat, redness and swelling, it is possible to fine tune herbal choices. If the inflammation has more swelling, for example, herbs from the heat removing group would be chosen along with a small amount of herbs from the diuretic group. If there is more pain and dryness, herbs from heat removing group would be given along with a small amount of herbs from the nervine group.
TCM doctors observe that chronic inflammation often involves blood stagnation or a heat and dampness condition. In cases of blood stagnation you would mainly use herbs from the blood moving group along with herbs from the heat removing group. Analyzing still further, if the blood stagnation is caused by Qi restriction, herbs that release the restriction, such as bupleurum root, would be most useful. If the blood stagnation is caused by deficiency of Qi (because Qi moves the blood), add ginseng root or astragalus root to the heat removing and blood moving herbs. In the presence of heat and dampness, choose herbs from the heat removing group along with a small amount of herbs from the diuretic group or dampness removing group. There are many more possibilities, but this should give you a general idea. Obviously, it takes a trained herbalist to make the best herb choices in each condition.
Removing blood inflammation – Looking at the Process
It is not enough to know the causes and type of inflammation to formulate the proper treatment protocol. You also have to understand where you are in the process. For example, if the inflammation results from external trauma, the initial treatment should include herbs that focus on the immediate problem, followed by wound-healing herbs such as tien chi root. If the inflammation results from an infection, the focus treatment should involve cooling herbs with anti-microbial properties, such as isatis root or forsythia flower. If the inflammation results from weakness and deficiency, you would use nutrient herbs like flaxseed oil or maitake mushroom or tonic anti-oxidant herbs like amla fruit.
Naturopaths and holistic MD’s rely on scientific research and specialized tests to identify the inflammatory chemicals that are out of balance in different types of disease, and explain why. For example, it is important to know that cases of eczema can involve weak action of the delta-6-desaturase enzyme, which can affect the body’s levels of prostaglandins. Knowledge of this problem allows the Naturopath to choose evening primrose oil as a remedy, because it bypasses the missing chemical link, neutralizing the inflammatory process (Pizzorno, 1996). Similarly, knowing that the inflammation of multiple sclerosis relates to problems digesting dietary fats gives us a clinical treatment advantage.
It is also very important to identify the location of the inflammation. This knowledge enables TCM doctors to use specific plants for specific organs. Originally believed to be something of a “voodoo” custom this is now a widely accepted herbal practice. The breakthrough in understanding lies in the concept of tissue-specific anti-oxidant activity. It turns out that many plant chemicals such as carotenoids and flavonoids have affinities for specific tissues. Part of this can be explained by whether the plant nutrients are fat or water soluble, but there is more to it than that. For example, milk thistle seed phytochemicals go to the liver (Hikino, 1984), ginkgo leaf chemicals increase glucose and oxygen transport across nerve cell membranes (DeFeudis, 1991), and lycopene from tomatoes goes to the macula (Abel, 1999). Since my earliest days as an herbalist I have trusted the observations of traditional doctors regarding the use of specific herbs to treat tissue or organ-specific inflammation or deficiency. It’s nice to now know my faith has a basis in science.
Common Herbal Treatments for Inflammation
Anti-inflammatory herbs can be grouped according to the specific organs and tissues they treat most effectively. Following are some common classifications.
•Intestinal Inflammation– choose from beet root, bromelain, scute root, coptis rhizome, boswellia gum, licorice root, dandelion root, phellodendron bark, sarsaparilla root, triphala and turmeric root. To coat and soothe irritation, use slippery elm bark. To flush out inflammation, use rhubarb root for one or two days.
• Joint inflammation– choose from boswellia gum, bromelain, scute root, flaxseed oil, guggul gum, myrrh gum, phellodendron bark, and turmeric root. If there is deficiency, choose from deer antler, amla fruit, alfalfa leaf, dry ginger, raw rehmannia root or wheat sprouts. The nutritional supplement glucosamine sulfate is also useful for deficiency joint inflammation as is the traditional Ayurvedic tonic Yogarajaguggulu. For topical treatment apply castor oil packs.
• Kidney inflammation– choose from akebia (mu tong or A. trifoliata), alisma rhizome (ze xie or A. plantago-aquatica), capillaris (yin chen hao or Artemisia capillaris), phellodendron bark and stinging nettle leaf or seed. If there is deficiency, choose from astragalus root, cordyceps mushroom, rehmannia root (cooked and raw), and shilajatu . For topical treatment apply castor oil packs.
• Lung inflammation– choose from beet root, boswellia gum, scute root, chrysanthemum flowers, garlic bulb, tulsi, peppermint leaf and turmeric root. If there is deficiency, choose from American ginseng root, cordyceps mushroom, reishi mushroom, schisandra berries and wild asparagus root.
• Sinus inflammation – choose from scute root, echinacea, forsythia flower, honeysuckle flower (jin yin hua or Lonicera japonica) and wild chrysanthemum flower. To soothe the sinuses, put a few drops of flaxseed or sesame oil mixed with white sandalwood oil in each nostril.
• Skin inflammation- choose from burdock root, dandelion root or leaf, moutan bark, neem leaf, red clover blossom, red peony root, and turmeric root. If there is deficiency, use dang gui root, gotu kola, raw rehmannia root, shilajatu or shou wu root. Skin inflammation sometimes yields to one or two days of bowel flushing with laxatives like rhubarb root or castor oil. For topical treatment, apply fresh aloe vera gel or aloe preparations with olive oil, black tea bags, or castor oil. For itching, use tinctures with menthol crystals derived from mint oils.
• Stomach inflammation – choose from scute root, coptis rhizome, fresh ginger root, peppermint leaf, burdock root, boswellia gum, fennel seed, licorice root, kudzu, triphala and turmeric root. To coat and soothe irritation, use flaxseed oil (long term) or slippery elm bark (short term).
• Thyroid inflammation – choose from bugleweed (Lycopus virginicus), capillaris (yin chen hao or Artemisia capillaris), scute root, gardenia fruit (zhi zi or Gardenia jasminoides) and prunella (Xie ku cao or P. vulgaris).
• Pancreas inflammation- choose from moudan bark (Mu dan pi or Paeonia suffruticosa) persica seed (Tao ren or Prunus persica), carthamus flower, gorgon fruit (dong gua ren or B. hispida), guggul gum, rhubarb root (small amounts), bromelain, and shilajatu.
Nervous System Inflammation
Nerve inflammation has to be treated differently, because the ver sensitive nervous system tissues are highly protected. For example, your nerves are coated in fatty myelin, then there is a peri-neural sheath. You brain and spinal cord have the 22 skull bones, the three thick protective meninges, and the blood brain barrier. As a result, it takes a long time for nerves to get inflamed, and many medicines, including herbs, do not get into inflamed nerves for healing purposes.
Treating Serious Inflammation
The general list of herbs offered above only provides a starting point. There are so many inflammation-related diseases, and we will be going into greater detail in other sections.
For complex cases, a series of steps is often needed, which not only takes time, but also explains why so many people resort to immune system suppression rather than go through a long complex precess prescribed by an alternative medicine doctor.
However, when immune suppression fails as it often does with steroids and immunosuppressants, patients often become more willing to put in the time, money and effort it takes to solve their problems.
Alan Tillotson, registered herbalist, Wilmington Delaware 19808