The problem of heavy metals in herbal medicines

On the one hand herbal medicine is great, it tends to be more gentle, to not have withdrawals, allows synergistic combinations of herbs to create complex actions, and often is much milder in side effects. Tonic herbalism as taught by some practitioners of Indian and Chinese medicine emphasises taking specific herbs like ashwagandha or panax ginseng, long term as supportive agents for overall health and longevity. As long as the herbs suit the individual and there are no contra indications, this does not seem like an unreasonable idea. However, there is a danger in this, and that comes in the form of contamination, and is especially an issue using imported herbs from countries like China and India.

Contamination in herbs can be due to the presence of herbicides or pestidicides, but some of the greatest concern at the moment is the presence of heavy metals that may have accumulated in the plant whilst growing in polluted conditions (Ernst, 2002). This is particuarly true for countries with poor standards of environmental control and with terrible pollution problems. One such country is China, I was struck when travelling China some ten years ago by railway, how built up and polluted the city, countryside, and air was. It was not until we reached the Himalayan mountains far in the West until this dissapeared. It is important when practising herbalism that the user of herbs is aware of potential contamination issues in widely available supplements from abroad. It is sensible especially when dealing with herbs that come from countries, such as China and India, to ask for a certificate of analysis to determine whether the material has contamination with heavy metals. The company should be able to provide lab results.

Edzard Ernst writes in his review article, on the subject of contamination in herbal medicine, that, “…Woo reported the detection of toxic heavy metals that exceeded Singapore’s legal limits in 42 Chinese proprietary medicines. They collected 2080 samples of such medicines in Singapore and tested them for heavy metal content. Forty-two different medicines were found to contain metals in amounts exceeding the legal limits. Mercury was found in 28 products, lead in eight, arsenic in six and copper in one. One product contained both mercury and lead and another product contained both mercury and arsenic.” (Ernst, 2002).

Heavy metals can accumulate in the human body and may cause serious damage thus completely going against the point of tonic herbalism. It is best to seek out suppliers who do reliable transparent testing or grow far away from polluted areas. For example, Na’vi Organics provides lab results on request, this is from their website (

“In 2015, we were very fortunate to find a wonderful producer to work with in China. They have a very strict sourcing policy and a passionate in-depth knowledge of Traditional Chinese Medicine. After sampling their products and getting to know them, we were satisfied by their dedication to clean sourcing, high quality, and attention to detail during the processing involved. With this new partnership, we began to offer a select range of tonic herbs.

Since making a choice to stock some products that are produced in China, we understandably began to receive emails from customers expressing their concern regarding potential environmental pollutants. In response to this, all our products produced in China have Certificates of Analysis available on request”.

I can recommend reading Edzard Ernt’s review article listed below.


Ernst, Edzard. “Toxic heavy metals and undeclared drugs in Asian herbal medicines.” Trends in pharmacological sciences 23.3 (2002): 136-139.

Panax ginseng, the life root

Panax ginseng has held an important position in the traditional Chinese medicine (TCM) for a long time. In the first great Chinese herbal text, The Pen Tsao Ching, which was supposedly compiled by the emperor-sage Shen Nung around 3000 B.C. Shen Nung, he recommended ginseng for ‘enlightening the mind and increasing wisdom’, he also said, ‘continuous use leads to longevity’ (Castleman, 2001). Panax ginseng is known in TCM as a Qi tonic, that is known is boost the bodies overall energy and well-being. Not in a short-term stimulating way like caffeine, but in a more gentle building way over the longer term.

A scientific term for ginseng is ‘adaptogen’ which means a substance that increases resistance to non-specific stress, they are thought to have a balancing role to play on the body. Panax ginseng is thought to be useful for; normalizing immune function, chronic fatigue syndrome, boosting digestive power, male reproductive health, and longevity. One of the primary groups of bioactive molecules in ginseng are the ginsenosides and are thought to be capable of maintaining homeostasis and have anti-inflammatory, anti-oxidant, anti-apoptotic, and immune-stimulatory activities (Cho, 2012). It is a good adaptogen for supporting the immune system and nootropic to support concentration. I’ve noticed taking panax ginseng over a few months eliminated my seasonal allergy and improved my resistance to common colds so I did not get the cold I do every year at the same time. I did have to take it for a few months beforehand to build the immune system for the Winter.

There is an increasing body of scientific experiments, including well-controlled work on humans, that supports the use of panax ginseng as an useful medicinal herb. We can see from these 3 studies that panax ginseng affects the nervous and immune systems in humans.

Alzheimer disease: In a human study the authors found 4.5 grams of Korean white ginseng powder taken daily over 12 weeks improved cognitive parameters in Alzheimer disease patients significantly compared with a placebo (Lee, et al., 2008).

Chronic fatigue: A human study applied 1 or 2 grams of ethanol extract of Korean ginseng daily for 4 weeks (Kim et al., 2013). Serum levels of reactive oxygen species and malondialdehyde were lowered compared with the placebo (markers of oxidative stress). Symptoms of chronic fatigue were significantly lowered compared with the placebo.

Allergic rhinitis: Another human study examined whether 3 capsules 2 times (250 mg/capsule) of Korean red ginseng daily for 4 weeks reduced symptoms of allergic rhinitis, they found a significant effect was observed compared with the placebo (Jung et al., 2011).

Some herbalists will warn of panax ginseng being too stimulating or just for old people. I think this is an over generalization. Finding a good dose amount and timing is important. I take panax just in the morning and have found it a pleasant experience. Panax combines well with ashwagandha because it is calming and grounding. TCM superior tonic herbs it is often taken alongside include astragalus, he shou wu, and schizandra.

It is hard to obtain good quality panax ginseng as the roots must be at least six years old for the proper effects to manifest. I have used Korean red panax ginseng w/o artificial processing from 6-year-old roots and I was greatly impressed, surely it has earned its place as one of the worlds great tonic herbs. It is expensive, but I think it is often worth it.

Another point to make is there are other types of ginseng. For example, American ginseng is more calming, cooling, and moistening, but has many of the same benefits. As far as I am aware this is the only other type of ‘true’ ginseng. Again, sourcing good quality American ginseng may be difficult. There is also Siberian ginseng which isn’t in the same genus, but has similar effects.

Here are some properties of panax ginseng.

Actions: Qi tonic, adaptogen, nootropic, immune tonic, male aphrodisiac, anti-depressant

Specific indications include: Fatigue, cognitive problems, low sex drive, general weakness and debility, depression, weak appetite, pale, prone to colds and flu, weak immune system, allergies

ADD/ADHD, Alzheimer’s, dementia, fibromyalgia, allergies, CFS, depression.

Energetics: Panax ginseng is warming and moistening.

Combinations: With ashwagandha to build energy and health. With St. John’s wort for mood.

Contra-indications: High BP. Do not use caffeine while taking panax.



Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471.

Cho, Ik-Hyun. “Effects of Panax ginseng in neurodegenerative diseases.” Journal of ginseng research 36.4 (2012): 342.

Kim, Hyeong-Geug, et al. “Antifatigue effects of Panax ginseng CA Meyer: a randomised, double-blind, placebo-controlled trial.” PLoS One 8.4 (2013): e61271.

Jung, Jae-Woo, et al. “Therapeutic effects of fermented red ginseng in allergic rhinitis: a randomized, double-blind, placebo-controlled study.” Allergy, asthma & immunology research 3.2 (2011): 103-110.

Lee, Soon-Tae, et al. “Panax ginseng enhances cognitive performance in Alzheimer disease.” Alzheimer Disease & Associated Disorders 22.3 (2008): 222-226.

A guide to treating insomnia with herbal medicines

Whilst mild insomnia may be treated more easily, for instance, just with one or two herbs (e.g. American skullcap) or better simple lifestyle changes, treating a more serious case is harder. It has taken me considerable work to learn what helps. Before going into the herbs, these are some basic lifestyle pointers that might help;

1. Exercise during the day and eat healthily, but do neither 1 hour before sleep.
2. Do not stare at bright screens at least 1 hour before sleep.
3. For the hour before bedtime aim to lie horizontally, remain awake, and relax. Avoid watching TV and excess conversation.
4. Cultivate a calm mind using techniques like meditation, qi-gong, yoga, etc.
5. Fix the time you get into bed, and when you get up, even on weekends.

The nervine herbs

Although lifestyle changes can get you a long way, certainly herbs are often required to induce and maintain sleep. The nervine herbs are those that act on the nervous system and we are looking for those with a sedative action. A lot of people use adaptogens for sleep, but sometimes this can be a mistake as they can over stimulate. Comparatively important Western nervine herbs like American skullap are being over looked. It is important to make the point that if the insomnia is bad, then one or two simple herbs is unlikely to work. What is required is a complex synergistic formula. I am now going to go briefly through some of the stronger sleeping herbs, before describing a few formula that may help.



One of the great European hypnotic nervines. Used in herbal sleep formula throughout Europe and America. Induces sleepiness instead of just reducing anxiety like most sleep herbs, but does not maintain sleep well by itself. Tolerance is acquired rapidly, but it is suitable for long term use. Often combined with hops in a simple formula, but I haven’t found this combination that useful and we will talk about better combinations later. It isn’t very suited to daytime use as can cause sleepiness. It is also an effective antispasmodic and may help reduce muscle tension. Valerian is best used in an extra concentrated dried tincture or better yet fresh tincture. Doses are 10-15 drops and upwards. It is drying and warming on the constitution.

American skullcap


American skullcap is a Native American remedy and is probably the most important nervine sedative in Western herbalism. In the specific form of a fresh tincture it is gentle in its relaxing effect and suitable for daytime use, but also effective to induce and maintain sleep. It is effective from 10-15 drops upwards. This is my favorite nervine herb, the dried tincture is almost useless, but people continue to sell it. If you have a good quality tincture the herb should cause a gentle relaxing feeling on the upper skull, especially the first time you use it, hence the name. It is also an effective antispasmodic and may help reduce muscle tension. American skullcap is cooling and slightly drying on the constitution.

Lemon balm

This is another European herbal remedy and is verstaile in terms of its actions. It is a nice sedative, gently relaxing which can help support healthy sleep. It is suitable for daytime use as well. It also has a nootropic action, so boosts cognitive abilities, whilst also functioning as an anti-depressant. Again it is reasonable to start around 10-15 drop doses and work up, especially when combining with other herbs. Like skullcap, a fresh tincture is preferred, but a recently dried one will also function. It is also an effective carminative and may help reduce excess gas. Lemon balm is cooling and drying on the constitution.

Magnolia bark


This is a traditional Chinese herbal medicine. It seems to be a pretty good sedative. I have been using 400mg capsules of the bark powder 1-2 per night. Otherwise known as, ‘houpo’, it has been traditionally used in China and Japan for the treatment of anxiety, asthma, depression, gastrointestinal disorders, headache, and other disorders. It is warming and drying to the constitution.

Passionflower is traditionally combined with hops and valerian for sleep, but I prefer to combine it with valerian and skullcap.

Calafornia poppy is another good option that I have used since originally writing this article. It is effective at higher doses such as 90 drops or so and may be combined with other great sleeping herbs such as skullcap and valerian.

An energetic spectrum of sleeping herbal remedies

Another problem is people on the whole under appreciate herbal energetics, it isn’t that complicated to understand. This system common to ancient Greek, Chinese, and Indian medicine classes herbs by their energetic effect on the body in terms of the 4 elemental forces (warming, cooling, drying, moistening). If excess drying and cooling herbs are taken, constipation and dry skin will start to take over. This is especially easy to do in the vata constitution (people who tend to weak digestion, pale skin, and dry skin). Let’s take a look at the energetic properties of common sleeping herbs and their strengths.


We can see the issue with the Western nervine herbs, all of them, apart from hawthorn and milky oat seed are drying on the constitution. When taking these drying nervine herbs just once daily, this may not be enough to see constitutional dryness appearing. However, if using a sleep formula consisting purely of drying herbs especially in a vata person twice daily or more, dry skin will likely occur and constipation. A solution is to formulate with moistening herbs like hawthorn berry and milky oat seed. Hawthorn berry is my favourite moistening nervine herb, it supports regular bowel movements and reduces dry skin. This can balance out drying nervines nicely. I have less confidence in milky oat seed, but this might be because our oat seed is not as good as that available in the USA.


These formulas are quite strong, if you haven’t already tried lifestyle or individual herbs or pairs first – best to do this. A fresh tincture of American skullcap is good to start with. Start with lower doses first and be cautious if combining with sedative drugs.

Formula I

This triplet is well suited to inducing and maintaining sleep and there is excellent synergy here. Add hawthorn berry if dryness occurs (15-30 drops).

Fresh American skullcap (1 part)
Fresh lemon balm (1 part)
Valerian (1 part)

Dosage: Between 30-75 drops may be taken before bed, leaving an hour gap.
Contraindications: Be careful if using sedative drugs at the same time. Not for use by pregnant or breast-feeding women.

Formula II

This is stronger and can be taken as a single dose before bed. I believe this to be as effective as many conventional sleeping pills. Other sleeping herbs to consider include; magnolia bark, califorian poppy, and lemon balm. It may be helpful to rotate the formula. I have taken this six herb formula long term and found it very good.

Fresh American skullcap (1 part)
Passionflower (1 part)
Extra concentrated valerian (1 part)
German chamomile (1 part)
Lavender tincture (1 part)
Motherwort (1 part)

Dosage: Between 30-90 drops may be taken once before bed, leaving an hour gap.
Contraindications: Be v. careful if using sedative drugs at the same time. Not for use by pregnant or breast-feeding women.


These are on the whole less suited to fixing sleep as they boost stamina and focus. However, there are some that are more relaxing, especially ashwagandha and holy basil. KSM66 ashwagandha is more stimulating compared with the traditional root powder.

Adaptogens that are suitable for sleep: Ashwagandha, holy basil, reishi, schisandra, cordyceps.


The search for herbal treatments for chronic pain

Chronic pain is a signal of some underlying problem, like a injury that has failed to heal, autoimmune condition, vitamin deficiency, gut dysbiosis, mechanical wear and tear, nerve damage, there are so many possible reasons. When using herbs to go after chronic pain, which can be due to many possible causes, it can be helpful sometimes to focus less on the specific diagnosis, and more the type of pain. Is it in the muscles, the nerves, or inflammatory? Then matching with these types of pain are herbal actions; antispasmodic, nervine, and anti-inflammatory/ alterative. This is a simple way to approach the situation. It is also important to learn the specific indications of each herb (their specialities) and also their energetics (warming, cooling, moistening, drying). Each herb often has certain affinities for particular tissues or organs in terms of its medicinal effect.

There are many causes of chronic pain, but generally, it is appropriate to make sure the diet is well balanced, without processed foods, refined sugar, and contains plenty of vegetables and fruits, whole grains, or if you eat meat, wild or grass-fed animal derived meats. The Paleolithic and ketogenic diets are worth considering. Yoga, Qi-gong, or other physical exercises should be used in any holistic strategy. However, there are a wide variety of chronic pain conditions that are not well understood and don’t yield to changing the diet, conventional medicine, acupuncture, chiropractor, or physiotherapy.

Traditionally, herbal therapies have been used for chronic pain and there are a wide variety of herbs to consider. However, they are suited for different kinds of chronic pain, so it is instructive to further break them down by action, affinity for body systems, energetics, and for treating certain diseases.

Anti-inflammatory and immune balancing

These herbs can oftentimes help reduce inflammation without overly suppressing the immune system. A few of these herbs are adaptogens from TCM and Ayurveda, they are known as Qi or rasayana tonic herbs in these systems of medicine and have a range of uses beyond reducing inflammation. They often help calm the nervous system as well, for example, and can reduce fatigue as they help boost energy reserves. They may have a balancing role to play on the immune system. Another herbal derivative we might put here is CBD, but I have included cannabis in the anodyne section.

Turmeric: General widely used Ayurvedic anti-inflammatory, appropriate for different types of inflammation. Applied especially in musculoskeletal conditions.

Boswellia: Another popular option from the Ayurvedic system of medicine. Often applied alongside turmeric for musculoskeletal conditions, but also has an affinity for the bowel and may help with disorders like Crohn’s disease and ulcerative colitis.

Chinese skullcap: A TCM herb that is often used in musculoskeletal conditions, but also in allergies. The Chinese skullcap, Scutellaria baicalensis, is often confused with its American relative, Scutellaria lateriflora, which is more of a sedative to help sleep and can help with conditions such as epilepsy. Chinese skullcap is more of an anti-inflammatory, but also seems to have some sedative properties.

Reishi: Increasingly used adaptogenic medicinal mushroom from TCM that contains triterpenes that are anti-inflammatory, but also contains polysaccharides that stimulate the immune system. Used in inflammation of the bowel, but also more generally in fighting chronic infections and inflammation. Reishi is also a relaxing adaptogen and may help improve sleep, anxiety, and reduce fatigue.

Slippery elm: A medicine from traditional Western herbalism that is very specific to the GI tract and reducing inflammation here. It comes from a bark of a tree and contains mucilage and tannins which are thought to form a soothing coating in the digestive tract. Slippery elm may interfere with the absorption of pharmaceutical drugs taken at the same time. WebMD recommends taking it at least one hour before or after taking other medication.

Ashwagandha: A widely appropriate Ayurvedic adaptogenic herb, that is often used in treating musculoskeletal pain related conditions, including fibromyalgia, rheumatoid arthritis, and osteoarthritis. Is also is applied in many disorders that effect the nervous system such as insomnia, anxiety, neuralgia, and multiple sclerosis. May help relax tense muscles. I have found the KSM-66 extract effective.

Gotu kola: Another Ayurvedic herb, often used alongside ashwagandha. Specific for conditions involving hot inflamed joints or skin, such as rheumatoid arthritis or psoriasis. It is applied by herbalists alongside ashwagandha and sarsaparilla in treating arthritis. Also used to treat nerve pain. Best used in a fresh tincture.

Holy basil: An Ayurvedic herb, used with reishi in treating allergies, but also useful for chronic inflammation and infections. Similar to ashwagandha and gotu kola in terms of medicinal potential and can be applied to help nervous system problems such insomnia, anxiety, depression, and neuralgia.

Sarsaparilla: Originally brought to Europe from Mexico by the Spanish. Sarsaparilla has a specificity towards chronic inflammation, and has been used to treat rheumatoid arthritis and psoriasis. It may be combined with gotu kola for a stronger anti-inflammatory action.


These herbs can reduce muscle tension that may be helpful in conditions such as fibromyalgia and sciatica. Many of these also may help sleep as they have a hypnotic or sedative action, hypnotics are stronger than sedatives, which are in turn stronger than relaxants. Magnesium should also be considered as a cheap and safe muscle relaxant, sometimes a nutritional deficiency may be underlying or contributing to a pain disorder, herbs cannot correct that.

Valerian: One of the great European nervines. Commonly known for its ability to help insomnia as it is a hypnotic, but this herb is an effective anti-spasmodic (calms muscles) and carminative (reduces excess digestive gas). May have a role to play in reducing pain where there are tense muscles. Can be used to help disrupted sleep related to chronic pain in a synergistic manner alongside other sedative herbs like American skullcap and lemon balm.

Black cohosh: A potent Native American remedy, traditionally used for rheumatic conditions such as arthritis and fibromyalgia. It also appears to be quite a strong anti-depressant and can help insomnia as it is a nervine relaxant. Only small doses of tincture are required (5-30 drops).

Blue vervain: Bred in North America from European vervain. A small amount of blue vervain goes a long way (1-10 drops). However, it is very bitter, cooling, and drying, therefore can be used alongside warming and moistening herbs. Traditionally applied especially against epilepsy, but also has a role in reducing anxiety. Reduces tension all over the body, particularly noticeable in the neck and shoulders.

Crampbark: Is commonly combined with valerian in treating muscle cramps.

Lobelia: Another herb used in dropwise doses (1-10 drops), effective at relaxing muscles, may also help anxiety and sleep.

American skullcap: A nervine tonic and sedative, good for helping restore normal sleep and may help nerve pain. Best used in a fresh tincture. Should notice a gentle relaxing sensation in the top of the head, if the quality is good, when taking 10-15 drops or so of the tincture. Although it is fine to take more, 30-60 drops for example. It is thought by herbalists to have a gentle restorative effect on the nervous system over time. It does not tend to over sedate. Good for nerve pain with St. John’s wort, this is a simple nerve pain pair.

Kava: A traditional remedy from the South Pacific, it is a strong hypnotic so may help sleep. Often taken for fibromyalgia and is an effective antispasmodic for muscle spasms. May have a role to play in reducing neuralgia. Is not considered suitable for those with a history of liver problems and there is potential for addiction at higher doses.


These are herbs that reduce pain. Jamaican dogwood, Californian poppy, kratom, and cannabis are more like conventional painkillers. As well as being anodyne, St. John’s wort is thought by herbalists to have a more restorative role on the nervous system.

Jamaican dogwood: From the bark of the tree and one of the stronger anodyne herbs in traditional Western herbalism. Good for pain, but also improving sleep where disrupted due to chronic pain. It also is antispasmodic and hypnotic. Has a strong taste. I think kratom or CBD is better. I have had headaches from higher doses of this one.

Californian poppy: Grows brilliant bright orange flowers. A gentler nervine than Jamaican dogwood, we might call it a sedative, suitable for reducing pain and improving sleep. I find you need at least 90-120 drops of this one to feel the effects, but it is very good, the dried tincture works well.

Cannabis: Legal hemp extracts that contain phytocannabinoids are often used to treat chronic pain and CBD is one of those compounds that has gained huge popularity. It is suitable for treating both inflammatory and neuropathic pain.

Kratom: A strong, versatile pain-killing herb from Asia, that may produce some similar effects to opioid drugs (at 4-8 gram doses). Contains mitragynine and 7-hydroxymitragynine that can bind to the body’s opioid receptors and provide pain relief. It also has anti-inflammatory properties. It is suitable in treating inflammatory and neuropathic pain. Has some potential for withdrawal symptoms if taking long-term high doses, to avoid this strains can be rotated, doses maintained quite low (e.g. 3g), or taper when coming off it.

St. John’s wort: A European nervine tonic, anodyne, relaxant, and anti-depressant. Specific for nerve pain, but also may improve sleep alongside other nervines, anxiety, and mood. Best used in a fresh tincture. The best option for nerve pain I think, alongside ashwagandha.

Circulatory stimulants

Certain herbs are thought to herb boost circulation and the supply of oxygen and nutrients to damaged tissues.

Prickly ash: A native American remedy from the bark of a North American tree, it is said to be a specific for nerve pain (according to Matthew Wood), like St. John’s wort. They are often used together for this reason. Prickly ash is also anodyne. Traditionally, prickly ash was used for rheumatism.

Ginkgo: The leaf extract comes from the ginkgo tree which is the oldest surviving species of tree in the world. However, traditional indications for ginkgo are less clear than other herbs, mainly because the leaf extract only became popular last century and has been used mainly as a nootropic. It has been found useful for various cognitive and circulatory problems.

Digestion modulating

Triphala: This is used is Ayurveda to normalise the digestive system and may be useful in disorders with a digestive component to them. Many chronic illnesses may be related to poor gut health. Triphala may be used for both constipation and diarrhea. Potentially useful for UC, IBS, IBD, and Crohn’s. This is an energetically balanced triplet of herbs.

Alterative herbs

These herbs are quite specific for reducing chronic inflammation and are thought to work by stimulating the excretory organs and altering metabolism in the body in poorly understood ways. They could also be classed as anti-inflammatory, as sarsaparilla is another alterative mentioned earlier, however, they are thought by herbalists, in some cases, to have a more curative role.

Nettles: Traditional Western herbalism speaks very highly of nettles and its chronic pain indications include arthritis and gout. Nettles is high in protein, vitamins, and minerals, so makes an excellent all round nutritive tonic. May be used alongside dandelion and burdock as a long-term traditional Western herbalism style treatment for arthritis.

Constructing a formula

Here is a basic formula for reducing nerve pain, and may have a renewing effect on the nervous system as a whole. It has an anti-inflammatory property due to the ashwagandha, for the nervous and musculoskeletal systems.

For more details on constructing herbal formula that are more specific to certain conditions, I would recommend Matthew Wood’s the Earthwise Herbal (2009) books, of which there are two, and particularly Maria Groves Body into Balance (2016).

American skullcap (fresh tincture) (1 part)
St. John’s wort (fresh tincture) (1 part)
Ashwagandha KSM-66, 2-4 capsules per day (400mg)

Dose: 20-90 drops 2-3 times daily.
Do not use when pregnant or breastfeeding. Be careful if combining with sedative drugs regarding dose. St. John’s wort may not be appropriate alongside drugs as it may reduce their effect, best to consult a doctor if you are in this situation.


Herbs can help chronic pain, to manage and reduce it, improve mood and energy, and help sleep, perhaps they may even cure the condition, but it is important to have realistic expectations as they often are not miracle cures for complex conditions. They can also cause side effects and may even be dangerous. It is better if you are thinking of treating your self or others with medicinal herbs to first learn traditional herbalism. I recommend first reading text books by Maria Groves, David Winston, and Matthew Wood. Depending on the individual and how much this appeals to you it may be better to visit a local herbalist or naturopath. However, the truth on the matter is our non-toxic time tested medicinal herbs are underrated by society and they are far more effective and safe than we may have been led to believe.

Further reading:

Note: See the text books in the references section to learn more about how to use these herbs in more detail. It is good to develop an understanding of herbal energetics before using medicinal herbs, in case problems related to dryness are encountered, for example. This is an ancient system of dividing herbs into warming, cooling, drying, and moistening. For researching drug-herb interactions and contra indications, Examine and WebMD are helpful. Many of the above herbs are not at all safe during pregnancy or breast feeding.


Groves, Maria. Body into Balance. Storey Publishing, 2016.

Hoffman, David. Holistic herbal. Element Books, 1988.

Panossian, Alexander. “Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals.” Annals of the New York Academy of Sciences (2017).

Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.

Wood, Matthew. The Earthwise Herbal: A Complete Guide to New World Medicinal Plants. North Atlantic Books, 2009.

Is the fruiting body or mycelium better for reishi mushroom extracts?

The reishi mushroom has an ancient history of use in China, for over 2000 years, and is indicated for longevity, cancer treatment, autoimmune diseases, anxiety, insomnia, and cardiovascular health, amongst other uses (Dudhgaonkar et al., 2009). It is accepted that it is the triterpenes in reishi which are responsible for its anti-inflammatory activity, while its polysaccharides stimulate the immune system. However, there is controversy surrounding whether the fruiting body (above ground part) or mycelium (root like structure) is better for medicinal purposes. Many companies are selling only mycelium grown on grain (rice), which is cheaper, but opposed to tradition. Traditionally, it was the fruiting body of reishi that was used as a medicine (Jong and Birmingham, 1992) and linked with longevity. So, the question is, how much does this matter?

Despite their different locations, both the mycelium and fruiting body contain similar medicinal compounds, such as the polysaccharides and triterpenes (Jong and Birmingham, 1992). However, there are more specific dissimilarities between these molecules between the two parts of the fungus. For example, gandoderic acids (triterpenes) A, B, and H have been detected only in the fruiting body, whereas, gandoderic acids R, S, and T were found in the mycelium. To extract the triterpenes efficiently alcohol is required. This is important, as traditionally just a hot water extraction has been used when TCM doctors ask for a decoction to be made. However, many of the polysaccharides are in fact hot water soluble (Sone et al., 1985) and so hot water can be used to extract them. Therefore, a dual hot water and alcohol extraction of reishi is preferred. Both polysaccharides from the fruiting body and mycelium have been shown to be active against tumours in vivo model studies (Sone et al., 1985).

Figure 1. (left) Mycelium from an oyster mushroom, these are often grown in either flasks or petri dishes for scientific studies. (right) A Reishi fruiting body, the part traditionally used as a medicine in humans.

Another point made in the review article is that a bitter taste has long been associated with the medicinal properties of reishi, and it is the triterpenes which taste bitter (Jong and Birmingham, 1992). Therefore, when testing different extracts of reishi, a bitter taste is a good sign. The fruiting body is supposed to taste particularly bitter. If anti-inflammatory activity is desired (from triterpenes), therefore it probably is best to go for the fruiting body of reishi.

Reishi should not be considered a single medicine and its properties change depending on the life cycle, extraction location, extraction method, and growing environment of the mushroom. The fruiting body has been most studied scientifically, however the mycelium also receives a great deal of attention in studies as well. The two currently highest impact papers on reishi, one published in PNAS describing anti-tumour activity (Liao et al., 2013) and another in Nature Communications describing a therapeutic effect on obesity (Chang et al., 2015), both in mice, used a fruiting body extract or a mycelium body extract, respectively. Various human studies have used the fruiting body extracts, but also spore extracts (Tang et al., 2005; Zhao et al., 2012). It is far from clear whether the mycelium, fruiting body, or spore extracts are preferred, it may emerge to be the case they are better for different applications. However, both, the fruiting body and mycelium both contain potent immune stimulating polysaccharides that may be good for boosting immune defence.

Growth of mycelium for studies is often done in shaking flasks where substrates like glucose are added (Yang et al., 1998). They also may be grown in petri dishes in solid culture (Heleno et al., 2012). Another common method is growing mushrooms on brown rice as a substrate and it has been shown that reishi, grown on brown rice, has anti-inflammatory properties (Hasnat et al., 2015). So, it appears that a variety of ways of growing reishi and extractions from different parts of the fungi all have medicinal activity. It is hard to form a consensus viewpoint of what is better from scientific papers at the moment, more research is required, but it is good to remember the fruiting body of reishi is the most studied scientifically.

I currently prefer reishi that is grown in a way similar to how it grows in nature. This is on logs and organically. I also prefer a dual extract using water and alcohol of the fruiting body, not mycelium. This is in line with the traditional use of the mushroom, except a decoction avoids use of alcohol and therefore will be lacking in triterpenes compared with the more modern duel extract. It is possible to get a duel extracted tincture from herbalists or make your own which should be effective, although powdered capsules are reasonable as well.


Chang, Chih-Jung, et al. “Ganoderma lucidum reduces obesity in mice by modulating the composition of the gut microbiota.” Nature communications 6 (2015): 7489.

Dudhgaonkar, Shailesh, Anita Thyagarajan, and Daniel Sliva. “Suppression of the inflammatory response by triterpenes isolated from the mushroom Ganoderma lucidum.” International immunopharmacology 9.11 (2009): 1272-1280.

Jong, S. C., and J. M. Birmingham. “Medicinal benefits of the mushroom Ganoderma.” Advances in applied microbiology. Vol. 37. Academic Press, 1992. 101-134.

Hasnat, Md Abul, et al. “Anti-inflammatory activity on mice of extract of Ganoderma lucidum grown on rice via modulation of MAPK and NF-κB pathways.” Phytochemistry 114 (2015): 125-136.

Heleno, Sandrina A., et al. “Fruiting body, spores and in vitro produced mycelium of Ganoderma lucidum from Northeast Portugal: A comparative study of the antioxidant potential of phenolic and polysaccharidic extracts.” Food Research International 46.1 (2012): 135-140.

Liao, Shih-Fen, et al. “Immunization of fucose-containing polysaccharides from Reishi mushroom induces antibodies to tumor-associated Globo H-series epitopes.” Proceedings of the National Academy of Sciences 110.34 (2013): 13809-13814.

Sone, Yoshiaki, et al. “Structures and antitumor activities of the polysaccharides isolated from fruiting body and the growing culture of mycelium of Ganoderma lucidum.” Agricultural and biological chemistry 49.9 (1985): 2641-2653.

Tang, Wenbo, et al. “A randomized, double-blind and placebo-controlled study of a Ganoderma lucidum polysaccharide extract in neurasthenia.” Journal of medicinal food 8.1 (2005): 53-58.Yang, F-C., and C-B.

Liau. “Effects of cultivating conditions on the mycelial growth of Ganoderma lucidum in submerged flask cultures.” Bioprocess Engineering 19.3 (1998): 233-236.

Zhao, Hong, et al. “Spore powder of Ganoderma lucidum improves cancer-related fatigue in breast cancer patients undergoing endocrine therapy: a pilot clinical trial.” Evidence-Based Complementary and Alternative Medicine 2012 (2012).

Mixing adaptogens and nervines

This article is a brief guide to the adaptogens and nervines and how we could go about combining them. They are two powerful classes of herb useful for many problems. Although, it is better to use them after developing a good understanding of their traditional indications and contra indications.

It is thought adaptogens operate through gently modulating the sympatho-adrenal or hypothalamic-pituitary-adrenal axes of the endocrine system (Reviewed by Panossian, 2017), which are related to stress response, to adapt the organism to dealing with stress. These herbs are known as the Qi tonics or rasayana herbs in traditional Chinese or Ayurvedic medicine, respectively. They are called Qi tonics because they all have this characteristic of increasing a person’s overall energy or Qi. However, they are not simple stimulants like coffee, they also have a relaxing property to them which makes them so unique. Nervine herbs on the other hand, aside from the nervine stimulants, act to relax the nervous system to differing degrees. We may also define additional actions for nervines and adaptogens. For instance, the nervine American skullcap is also a nervine tonic and is thought to be effective for restoring normal sleep patterns. While the nervine lemon balm is also an effective carminative suited for reducing excessive digestive gas.

As well as herbal actions, adaptogens and nervines also have specific indications and affinities for different systems of the body. For example, astragalus and reishi are potent immune stimulators and so are suited for protecting against infections, while he shou wu and ashwagandha have an affinity for the male reproductive system and may improve sexual performance and drive. One common characteristic to adaptogens is they tend to be quite multi-purpose, like an herbal swiss army knife. Importantly, adaptogens and nervines also have different energetic properties, which relate to how warming, cooling, drying, or moistening they are on the individual’s constitution.


(above) American skullcap, a nervine tonic and sedative. Best in a fresh tincture form.


We have learnt from knowledge passed down through the generations that herbs, including adaptogens and nervines have certain energetic properties (i.e. warming, cooling, moistening, drying) (Figure 1). These should, ideally, be taken into account when selecting an adaptogen or nervine. A common finding, for example, if taking a drying herb like prickly ash, is that certain people who tend towards dryness (i.e. dry skin, constipation) tend to get dried out skin. This would be especially true for the vata constitution in Ayurveda (cold and dry). I observed this for the first time when testing prickly ash on myself, being a vata constitution dominantly, I was interested to see the skin almost immediately dry out and parts turn red on my hands after taking small doses of this potent herb (5-10 drops). Some time later, I also observed after taking a little too much ashwagandha, my hands dried out again. Ashwagandha is a drying and warming herb in Ayurveda.

Although some people still do not believe in herbal energetics, the same system of medicine based on heating, cooling, drying, or moistening herbs is found within ancient Greek, Ayurvedic, and traditional Chinese medicine. Perhaps, it is one of those things you must see for yourself first hand. David Winston provides more detailed information on energetics which are related to the taste of the herbs in his book, Adaptogens: herbs for strength, stamina, and stress relief (Winston, 2007).


Figure 1. Energetic properties of common nervine and adaptogen medicinal herbs.

The nervous-endocrine system spectrum

Another way of viewing adaptogens and nervines is to examine how stimulating they are to the nervous system (Figure 2). Certain adaptogens, such as Asian ginseng tend to be more stimulating and may cause insomnia, while ashwagandha tends to be more calming and therefore potentially useful for sleep. It has been said young people are usually more suited to less stimulating adaptogens as they often have more energy or Qi, while for older people the converse applies. More stimulating adaptogens may be taken in the morning only if an individual finds them overly stimulating.

Adaptogens combine well with the nervine herbs because they may reinforce their relaxing activity and allow a more complex combination of herbal actions. For instance, combining a calming adaptogen such as ashwagandha with the nervine tonic, American skullcap, amplifies the calming activity of ashwagandha and creates a relaxing pair for the nervous system. This could be useful for those persons suffering with nervous over excitation like, insomnia and or anxiety.


Figure 2. The nervous-endocrine system spectrum.

Formulation strategies

Typical considerations when choosing herbs for a formula that mixes adaptogens and nervines are; constitution (e.g. pitta, vata, kapha), diseased tissue state (e.g. hot (inflamed), cold, wet, dry, tense, relaxed), actions, affinities, and specific indications of the herb. It is also appropriate to consider when using an adaptogen that some people are more prone to insomnia and are very sensitive and so may respond better to a calming adaptogen such as ashwagandha or holy basil. Equally, some people may have a lot of dry skin going on and therefore a moistening nervine like hawthorn berry may be more appropriate. I recommend studying Matthew Wood’s The Earthwise Herbal books for a more complete explanation of constitutions and tissue states (Wood, 2009).

It also is important to read up on contra indications for herbs, these can be obtained from the herbal encyclopedia on this site or webMD or other sites and text books.

A simple way widely practiced is to just pick an herb by its action, e.g. nervine sedative. Although this can work well and there is room for a variety of different ways of deciding which herb to use, I think it is good to learn from the ancient traditions of the world such as Ayurveda and TCM.

Specific indications

We will now turn to examine some specific indications from traditional knowledge and (preliminary) scientific studies. These indications have been collected from traditional text books and scientific studies, they usually come from multiple independent sources. References for specific indications are included in the herbal encyclopedia. I have also tested many of these on myself and can therefore confirm many of the indications.


Ashwagandha: Insomnia, anxiety, nerve pain, sexual/ reproductive problems, autoimmune diseases, fatigue, musculoskeletal conditions such as fibromyalgia and both types of arthritis, cognitive problems such as ADD, ADHD, and dementia.

Asian ginseng: Autoimmune diseases, allergies, fatigue, cognitive problems, sexual and reproductive problems in men, fibromyalgia, longevity.

Gotu kola: Anxiety, nerve pain, fatigue, rheumatoid arthritis, psoriasis, dry scaly skin, cognitive problems, autoimmune diseases, longevity.

Holy basil: Autoimmune diseases, nerve pain, anxiety, insomnia, boosting strength of the immune system, cognitive problems, allergies.

Rhodiola: Depression, fatigue, longevity, cognitive problems, recovery from brain injury.

He shou wu: Sexual weakness/debility in men, musculoskeletal conditions, constipation, inflammation of the GI tract, fatigue.

Schisandra: Anxiety, insomnia, fatigue, liver complaints and disorders, weak digestion, hypertension, palpitations, poor appetite.

Reishi: Anxiety, insomnia, fatigue, asthma, inflammation of GI tract, musculoskeletal conditions, weak immune system, allergies, cancer, longevity.

Licorice: Fatigue, inflammation of GI tract, dry cough, constipation.

Cordyceps: Asthma, autoimmune diseases, fatigue, sexual problems in men, weak immune system.

Astragalus: Weak immune system, fatigue, allergies, poor appetite.

Shatavari: Sexual problems in both sexes (but particularly women), fatigue, insomnia, inflammation of GI tract.


St. John’s wort: Nerve pain, anxiety, depression, stabbing pains, muscle pains, shooting pains, nerve irritation.

American skullcap: Insomnia, anxiety, nerve pain, tense muscles, muscle pain.

Milky oat seed: Emotionally unstable, depression, insomnia, anxiety.

Blue vervain: Muscle tension, anxiety, insomnia, epilepsy.

Kava: More severe insomnia, anxiety, pain, muscle tension.

Lemon balm: Insomnia, anxiety, cognitive problems, excess digestive gas, depression.

California poppy: Nerve pain, chronic pain, insomnia, anxiety.

Valerian: Tense muscles, insomnia, anxiety.

Hawthorn: Hypertension, constipation, ADHD, dry skin.

Example adaptogen or adaptogen-nervine pairs

A nice way of working on a formula is thinking about pairs we might use. We could build on these to make a triplet, or just use a more simple pair, depending on need. All of the pairs below are geared towards tonifying and building ones health, energy, and well being. There is quite a lot of overlap in terms of effect, but ashwagandha is more calming and panax more energizing.

These are pairs I have personally tried together and liked. Note, panax ginseng is contra indicated with high BP and ashwagandha with hyper thyroidism and St. John’s wort has a few potential issues, best to read about St. John’s wort in more detail here.

Panax ginseng and ashwagandha: Will increase depleted energy levels and vitality long term. Should have a positive impact on emotions and anxiety. Ashwagandha is good for muscleoskeletal and nervous system inflammation and pain. Will increase male sex drive. Ginseng should boost appetite and boost immune health as a preventative medicine. 6-year-old roots of Korean red ginseng are recommended and KSM-66 ashwagandha is a nice choice. This is pretty energetically balanced in terms of dryness and moisture, but towards the warming side.

Ashwagandha and St. John’s wort: A strong Indian-Western nerve tonic pair, suitable for neuropathic pain, muscleoskeletal inflammation, lowering anxiety, and improving the emotional state. Will increase energy more gently than by using panax ginseng. St. John’s wort should be used in a fresh as possible tincture from the fresh flowers.

Ashwagandha and American skullcap: This pair is well suited to anxiety and insomnia and have good anxiolytic synergy together. Does not cause daytime sleepiness. May be tried for nervous system damage and pain. Ashwagandha is good for muscleoskeletal pain and inflammation.

An example of mixing adaptogens and nervines

You can do a lot with nervines and adaptogens.  This is just an example of what we might consider when formulating. Tissue state is NA because the nervous system does not have wet, cold, dry, and hot states in the same way the joints or lungs do, for example.

St. John’s wort, skullcap, and ashwagandha are some of the best tonics for vata, they are only slightly drying, and are calming, and restorative. Particularly skullcap and ashwagandha are good for sleep. Although as previously mentioned, too much ashwagandha will dry out vata type people especially. Vata is symbolic of the wind element in Ayurveda with a tendency to change, these people may be hypermobile, thin, prone to anxiety and insomnia, dryness, weak digestion, and pale skin.

The addition of the moistening nervine, hawthorn berry, which I find effective in preventing dryness, means the below formula is suitable for vata dominant types or people prone to dryness.

In terms of actions, we have a strong nervine tonic element to the formula with St. John’s wort and ashwagandha.

Constitution: Dry cold/hot. Vata-pitta.
Condition/s: Tingling pains, insomnia. Vata aggravation.
Tissue state/s: NA
Systems/: Nervous system
Action/s: Nervine tonic, adaptogen, analgesic, nootropic, sedative, antidepressant
Energetics: St. John’s wort (warming, drying), ashwagandha (warming, drying), hawthorn berry (cooling, moistening)
Contraindications: Any pharmaceutical drugs, especially SSRIs because of St. John’s wort. High BP because of panax ginseng. Ashwagandha is contra indicated with hyper thyroid.


There is, unfortunately, a lack of scientific knowledge surrounding the medicinal properties of plants compared with mainstream drugs, however, what we do have is some strong traditional knowledge. I think it is best to research over multiple traditional sources when deciding to test a medicinal plant on yourself or others. If there are many different herbalists seemingly independently suggesting a plant is good for something, this is of course a good sign.

It is important to remember that herbs may interact with drugs, sometimes in a dangerous manner so this must be properly researched or a doctor consulted. However, sometimes herbs may help get a person off drugs, so it may work both ways. In my own practice, I have been able to safely remove myself from the drug, lyrica, using herbs like American skullcap and ashwagandha. Some medicinal herbs have specific contra indications like panax ginseng and high blood pressure, that are good to know about. However, as for the herbs described on this site, the truth is they are safer than drugs when used correctly. It is a widespread misbelief they are dangerous or ineffective.

Herbalism of different varieties is being more widely practised by folk herbalists, including bio-hackers, who will use just about anything and are very keen on scientific studies while they often shun traditional knowledge. I think what is needed is a more balanced approach drawing from the great herbal teachers of the world as well as any scientific developments. After all science will always have an incomplete understanding of medicinal herbs, it is up to the herbalists to experiment to find new specific indications and formula.

Further reading

David Winston:

Cautions and contraindications

Using adaptogens for energy instead of good sleep, lifestyle, and eating habits will lead to a sleep debt and burnout. Stimulating adaptogens may be best taken in the morning to avoid insomnia. We recommend reading this PDF by Paul Bergner, an herbalist highly experienced with using the adaptogens if you are thinking of using them on yourself or on others (link).


Panossian, Alexander. “Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals.” Annals of the New York Academy of Sciences (2017).

Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.

Groves, Maria. Body into Balance. Storey Publishing, 2016.

Wood, Matthew. The Earthwise Herbal: A Complete Guide to New World Medicinal Plants. North Atlantic Books, 2009.

Ashwagandha, an Indian ginseng

Ashwagandha is one of the most well known and universally praised plant medicines and has been used in Ayurveda or traditional Indian medicine for at least 3000 years (Castleman, 2001). In the Charaka Samhita it is recommended as a whole-body tonic, particularly for emancipation, reproductive ability, and longevity.

In Ayurveda, it is classified as a rasayana or rejuvenator herb otherwise known as adaptogen in Western science, or Qi tonic in traditional Chinese medicine. While Qi tonics may all be quite different in a way, they have the joint property of activating or stimulating the nervous system while still relaxing. It is thought this is because their modulation of the human stress response system, somehow gently priming it to balance stress hormones such as cortisol, relax, and energise (Reviewed by Panossian, 2017). These tonics can help reduce fatigue and contribute to overall well being. I believe ashwagandhas medicinal properties extend far beyond one pathway and molecular target and there is now increasing evidence to support its broad medicinal properties in humans. We can see just from these human studies it has likely anti-inflammatory properties (as can help osteoarthritis), anxiolytic properties (helps anxiety), stamina boosting properties (helps fatigue), and modulates hormones of the body (relieves mild thyroid failure).

Anxiety: One study (n = 64, double blind placebo controlled) found that with treatment of 300 mg extract of ashwagandha root twice daily reduced stress significantly versus a placebo (Chandrasekhar et al., 2012). Adverse events were mild and similar to the placebo.

Osteoarthritis: A study (n=60, double blind placebo controlled) on patients with osteoarthritis knee pain found that either 250mg or 125mg of ashwagandha per day over 12 weeks found a significant reduction in pain in either group, with the 250mg treatment resulting in a stronger effect (Ramakanth et al., 2016).

Mild thyroid failure: Another study (n=50, double blind placebo controlled) found patients who took 600mg ashwagandha daily for mild thyroid failure (subclinical hypothyroidism) significantly normalised their thyroid indices (Sharma et al., 2017).

Fatigue: One study (n = 100, open label, placebo controlled) observed significant improvements in fatigue in breast cancer patients taking ashwagandha (Biswal et al., 2013).


Why ashwagandha is particularly special among the adaptogens, in my view, is because it is so gentle and relaxing for the whole nervous system. Dosage may be adjusted to the level even in sensitive persons such as myself it actually helps sleep, by calming the nerves, but also provides that gentle calm energy that I think is conductive to the healing process. Whilst it is a fairly strong anti-convulsant and anxiolytic similar to lyrica, I have found withdrawal from ashwagandha does not cause a withdrawal like lyrica does. Quite why we continue to take mainstream anti-anxiety medications on mass, well, I will leave you to figure that out.

Ashwagandha is quite suited to treating vata aggravations (often nervous system imbalances), while having an anti-inflammatory nature suited to treating certain autoimmune conditions. This includes a variety of types of chronic pain conditions especially muscleoskeletal or neurological diseases. Expect to see an increasing level of scientific support for ashwagandha in coming years, but the truth is: ashwagandha is a powerful and gentle healing herb for a range of conditions.


Actions: Rasayana, adaptogen, nervine tonic, nootropic, immune tonic, antirheumatic, aphrodisiac

Specific indications include: Joint or muscle pains and aches, fatigue, red hot inflamed joints or skin, anxiety, cognitive problems, low sex drive

Example diseases: 
Osteoarthritis, ADD/ADHD, Alzheimer’s, dementia, rheumatoid arthritis, fibromyalgia, stress linked hypertension

Energetics: Ashwagandha is warming and slightly dry. Ashwagandha balances vata and kapha, in excess, because of its heating nature it can imbalance pitta. It is also important to watch out for excess dryness if taking ashwagandha.

Form: I prefer KSM-66 overall. KSM-66 is more energising, the traditional root powder is better for sleep.

Dose: Between 1-4 300mg capsules of KSM66 may be used per day. For a tincture, an approximate dose is 10-60 drops, 2-3 times daily.

Contraindications: It is best to avoid ashwagandha if you have hyperthyroidism as it stimulates the thyroid. It also should be used with caution if combining with sedative medication as may interact unfavourably or enhance effects of these. It may cause GI distress on occasion.

Combines well with: Fresh skullcap tincture for a worn out depleted nervous system with insomnia, fatigue, and anxiety. With a fresh St. John’s wort tincture for nerve pain. Alongside gotu kola and calamus root to treat nerve damage. With gotu kola and sarsaparilla for treating inflammatory arthritis.



Biswal, Biswa Mohan, et al. “Effect of Withania somnifera (Ashwagandha) on the development of chemotherapy-induced fatigue and quality of life in breast cancer patients.” Integrative cancer therapies 12.4 (2013): 312-322.

Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471.

Chandrasekhar, K., Jyoti Kapoor, and Sridhar Anishetty. “A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults.” Indian Journal of Psychological Medicine 34.3 (2012): 255.

Gardner, Tanya, and A. H. P. Level. “The Characteristics, Benefits and Application of Ashwagandha in the West.” Image 2 (2015): 2.

Panossian, Alexander. “Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals.” Annals of the New York Academy of Sciences (2017).

Ramakanth, G. S. H., et al. “A randomized, double blind placebo controlled study of efficacy and tolerability of Withaina somnifera extracts in knee joint pain.” Journal of Ayurveda and integrative medicine 7.3 (2016): 151-157.

Sharma, Ashok Kumar, Indraneel Basu, and Siddarth Singh. “Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial.” The Journal of Alternative and Complementary Medicine (2017).

What is an adaptogen herb?

In the Soviet Union in the mid-1950s adaptogens were defined by Nikolai Vasilievich Lazarev as harmless substances that can increase resistance to non-specific stress. Adaptogenic herbs are known as either ‘rasayana’ or ‘Qi tonic’ herbs in Ayurvedic and Chinese medicine, respectively. Although every adaptogen is often very different from one another and suited to different people, they are used by herbalists to treat a wide array of disorders, including fatigue, stress, immune, sexual, or nervous system problems, and depression (Winston, 2007). A popular current theory that may explain their broad applicability is that these herbs primarily modulate the sympatho-adrenal or hypothalamic-pituitary-adrenal axes of the endocrine system to adapt the organism to dealing with short or long-term stress (Panossian, 2017). Hormones such as cortisol are modulated in level by adaptogens and have receptors on both immune and nerve cells.

Recent molecular studies demonstrate adaptogen treatment can be considered to have a vaccination type effect on these stress response system. For example, it has been shown in C. elegans that adaptogens can induce translocation of the DAF-16 transcription factor from the cytoplasm into the nucleus, favouring an increased synthesis of proteins involved in stress resistance (Wiegant et al., 2009). Research on the ADAPT-252 compound (rhodiola, schisandra, eleutherococcus) shows that adaptogens can increase the synthesis of the heat shock protein HSP70 in vivo, a mediator of the adaptive stress response (Hernández‐Santana et al., 2014). The compromised ability of neurons to express HSP70 is associated with aging-related neurodegeneration and HSP70 application has been found to extend lifespan of animals and improve memory. This article describes in more detail the biology, history, and science surrounding the adaptogenic herbs. First we will need to delve into some terminology.

Figure 1. The adaptogen herbs eleutherococcus, schisandra, and rhodiola (from left to right).

Core terminology

Endocrine system:
The endocrine system is the series of glands that release hormones into the blood to be carried to distant target organs. The major endocrine glands include; the pineal gland, the pituitary gland, pancreas, ovaries, testes, the thyroid gland, the parathyroid gland, and the adrenal glands.

The adrenal cortex: The adrenal cortex is the outer part of the adrenal gland and produces hormones such as cortisol and aldosterone.

Hypothalamus: The hypothalamus is a region of the brain containing small nuclei with a variety of functions, one of the most important of these is to link the nervous system with the endocrine system via the pituitary gland.

Pituitary: The pituitary or ‘master’ gland is a pea-sized structure found at the base of the brain immediately below the hypothalamus, to which it is attached via nerve fibres. It produces important hormones such as adrenocorticotropic hormone, growth hormone, thyroid stimulating hormone.

Hypothalamic-pituitary-adrenal (HPA) axis: The HPA axis comprises of 3 organs and their direct interactions, namely, the hypothalamus, the pituitary gland, and the adrenal glands. It is a major neuroendocrine system that controls reactions to stress and regulates many processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure.

Sympatho-adrenal-system (SAS): The SAS is a physiological connection between the sympathetic nervous system and the adrenal medulla and is important in the bodies response to outside stimuli. The SAS plays an important role in maintaining glucose levels, blood pressure, and other metabolic pathways that couple with bodily responses to the outside environment.

Cortisol: Cortisol is a steroid hormone that is produced by the adrenal glands which sit on top of each kidney. When released into the bloodstream it then acts on many different parts of the body and helps the body respond to stress, increases metabolism of glucose, controls blood pressure, and reduce inflammation.

Adrenocorticotrophic hormone-releasing factor (CRF): CRF is released by the paraventricular nucleus of the hypothalamus in response to stress. Its primary function is the stimulation of the pituitary synthesis of ACTH, as part of the HPA axis.

Vasopressin (AVP): AVP is a hormone synthesized in the hypothalamus and is released into the circulation. It plays a key role in maintaining osmolality (the concentration of dissolved particles, such as salts and glucose, in the serum).

Adrenocorticotrophic hormone (ACTH): ACTH is produced by the pituitary gland and its primary function is to stimulate the production and release of cortisol from the adrenal gland cortex.

Adrenaline: Adrenaline is a hormone released from the adrenal glands, together with noradrenaline, its primary role is to prepare the body for fight or flight.

Corticosteroids: Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates. Glucocorticoids are a class of corticosteroids of which cortisol is one. There are also synthetic analogues of these hormones.

Nitric oxide (NO): NO is a key regulator and mediator of numerous processes in the nervous, immune, and cardiovascular systems. For instance, it stimulates vascular smooth muscle relaxation resulting in arterial vasodilation and increasing blood flow.

Heat shock proteins: Heat shock proteins are a family of proteins that are made by cells in response to stress. They chaperone other proteins, guarding them from folding improperly, going astray, or misassembling while forming larger protein aggregates.

HPA axis biology and its dysregulation in disease

HPA axis activity is modulated by CRF and AVP which are secreted from the hypothalamus (Figure 2). These activate the secretion of ACTH from the pituitary which then activates the secretion of the glucocorticoids (or cortisol in humans) from the adrenal cortex (Pariante et al., 2008). Glucocorticoids interact with receptors in various tissues including back at the HPA axis, which is a classic feedback inhibition loop. In this loop, glucocorticoids inhibit both CRF and AVP from the hypothalamus and ACTH from the pituitary. Although still quite poorly understood, cortisol alters the function of the immune system and influences both macrophages and lymphocytes (Padgett, 2003). Both these types of cell are directly responsive to cortisol through the glucocorticoid receptor that they express. This provides a direct link between stress and the immune system.


Figure 2. The influence of stress upon the HPA axis.

The strong anti-inflammatory effects of synthetic glucocorticoids (steroids) in drug therapy are similar to the effects of endogenous glucocorticoids released via the adrenal cortex (Morand, 2001). Defects in HPA axis function are implicated in animal models of rheumatoid arthritis and are hypothesised to contribute towards the disease. Manipulation of HPA axis-driven endogenous anti-inflammatory responses may provide a method for the therapeutic manipulation of inflammatory diseases.

As well as the immune system, glucocorticoids are also known to regulate neuronal survival, neurogenesis, the sizes of complex structures (e.g. the hippocampus), and emotions (Pariante et al., 2008). Reflecting on the HPA axis and its link between stress and the nervous system we are unsurprised to find that it has been found dysregulated in psychiatric disorders, particularly in major or melancholic depression. A significant percentage of depressed patients have increased levels of cortisol in the saliva, plasma, urine, and increased size and activity of the pituitary and adrenal glands. Evidence from clinical studies suggests that childhood trauma is associated with sensitisation of the neuroendocrine stress response, glucocorticoid resistance, increased CRF activity, immune activation, and reduced hippocampal volume (Heim et al., 2008). These neuroendocrine features mirror those found in cases of major depression. The diseases where a dysregulated HPA axis is thought to occur are listed below in Table I.

Table I: Diseases associated with suppression or activation of immune-mediated inflammation through defects in the HPA axis or its target tissues (adapted from Chrousos, 1995)
Suppression of immune meditated inflammatory reactions Activation of immune meditated inflammatory reactions
Increased HPA-axis activity Decreased HPA-axis activity
Melancholic (major) depression Rheumatoid arthritis
Chronic stress Adrenal insufficiency
Chronic alcoholism Seasonal or atypical depression
  Chronic fatigue or fibromyalgia
  Resistance to glucocorticoids
  Rheumatoid arthritis
  Steroid resistant asthma
  Systemic lupus erythematosus

The history of adaptogens

In the late 1940s, scientists of the Far Eastern Division of the Soviet Academy of Sciences in Vladivostok, Siberia, started to study herbs that caused a state of ‘non-specifically increased resistance’ of an organism using animal models and humans (Davydov and Krikorian, 2000). Later, Dr Nikolai Vasilievich Lazarev (1895-1974) a then leading figure in Soviet pharmacology proposed to the scientific community in the mid-1950s that herbs or other substances which could bring about an increased non-specific resistance to stress be called ‘adaptogens’. In the Soviet literature of the time other terminology to describe adaptogenic herbs included, ‘revitalizing therapies’, ‘tonic herbs’, and ‘immunomodulatory substances’. The properties of these adaptogens were outlined in a publication by Brekhman in the 1960s (Brekhman, 1968) as follows:

  1. The action of an adaptogen should be innocuous and cause minimal disturbance to the normal physiological functions of an organism. It must be absolutely harmless.
  2. An adaptogenic agent should not be active only in a specific context or against a particular background. It must have a broad therapeutic spectrum of action.
  3. The action of an adaptogen has to be non-specific, and so resistance to a wide variety of action of harmful factors, whether of a physical, chemical, or biological nature, has to increase.
  4. An adaptogen has to have a normalising or stabilising action independent of the direction of previous changes.

This somewhat vague definition is not widely known or accepted by mainstream medicine and has been subject to scrutiny for lack of precision (Davydov and Krikorian, 2000). However, the term adaptogen has been refined and defended in work by Alexander Panossian and his colleges (Panossian et al., 2005; Panossian, 2017; Panossian et al., 1999).

Mechanism of action of the adaptogens

It has been proposed, based on animal and human studies, that the action of adaptogens in a single dose is useful in situations that require a rapid response to stress (e.g. heavy exercise) and is related with the modulation by adaptogens of the SAS (Panossian et al., 2005). The SAS provides a rapid response to a stressor and results in increased levels of ATP, NO, cortisol, and various neuropeptides. A characteristic behaviour of adaptogens is that they act as eustressors (or good stressors) and as mild stress mimetics that induce stress-protective responses (Panossian, 2017). Adaptogen treatment can be considered to have a vaccination type effect on the stress response system. For example, in humans, compared with a placebo the adaptogen schisandra increases NO and cortisol in blood plasma and saliva prior to physical exercise, in a similar manner to what normally happens during physical exercise (Panossian et al., 1999). Then, after exercise, in the adaptogen treatment group there are no further increases in NO and cortisol which is related to the enhancement of ordinary physical performance. In addition, it has been observed in C. elegans that adaptogens induce translocation of the DAF-16 transcription factor from the cytoplasm into the nucleus, favouring an increased synthesis of proteins involved in stress resistance and longevity (Wiegant et al., 2009). In this study, it was similarly concluded to the human study, adaptogens are experienced as mild stressors which promote increased stress resistance and, at least in C. elegans, a longer lifespan.

The repeated action of adaptogens on chronic illness is related with the modulation by adaptogens of the HPA axis, which plays a role in the reaction and adaptation to repeated stress (Panossian et al., 2005). To recap, stress triggers secretion of CRF from the hypothalamus, followed by the secretion of ACTH from the pituitary, this stimulates the release of adrenal hormones and NPY to help cope with the stress. Feedback inhibition is initiated by cortisol secreted from the adrenal cortex, which binds to the glucocorticoid receptors (GR) in the brain. This inhibitory signal stops the stress induced release of cortisol and thus cortisol decreases to normal levels in the blood. However, in depression, this feedback inhibition of cortisol via the GR appears blocked and cortisol content in the blood of depressive patients is chronically high (Jovicic et al., 2015). This phenomenon is associated with impaired memory and ability to concentrate, fatigue, and other problems. It is known that the GR are phosphorylated by an enzyme called JNK and this is associated with increased glucocorticoid resistance, increased phosphorylation of GR is observed in patients with depression. Adaptogens stimulate the formation of HSP70 which suppresses elevated JNK and cortisol in the stress response (Panossian, 2017). Thus, adaptogens may help restore a blocked feedback inhibition of the stress response in depressive patients.

Central players modulated by plant adaptogens (such as rhodiola, eleutherococcus, schisandra, ginseng, withania) include the stress hormones cortisol and neuropeptide Y (NPY) and several important mediators of the adaptive stress response (such as NO, stress-activated protein kinases, heat shock proteins (HSP70 and HSP25), and the FOXO transcription factor) (Panossian, 2017). Using experimental models, it has been demonstrated the compromised ability of neurons to express HSP70 is associated with aging-related neurodegeneration (Bobkova et al., 2015). HSP70 treatment has been found to extend lifespan of animals and improve learning and memory, increase curiosity, decrease anxiety, and help preserve synaptic structures that are known to degrade with age. Other studies imply reduced ability to express HSP70 in response to stress may be a common event underlying the aging process (Heydari et al., 1994). Therefore, HSP70 is a candidate pharmacological target of antiaging therapies (Panossian, 2017), although, synthetic chemicals used to induce HSP70 are cytotoxic and are unsafe. However, plant adaptogens have been used safely over a wide dose range (including up to 3000 mg/kg of rat body weight) even with repeated long-term administration (months). The individual plant adaptogens rhodiola, schisandra, eleutherococcus, and their formulation as ADAPT-232, stimulates the expression of HSF-1 and HSP72 in ex vivo neuroglia, provokes HSP72 release from cells, and increases expression of HSP70 in vivo (Panossian et al., 2009; Chiu et al., 2004; Hernández‐Santana et al., 2014; Lee et al., 2009; Li et al., 2014). Of these studies, for example, it was observed continued intake of rhodiola root extract significantly reduced swimming fatigue by increasing glycogen levels, boosted energy generated by lipogenic enzymes, and significantly upregulated HSP70 mRNA (Hernández‐Santana et al., 2014).

Further work on the adaptogen formula, ADAPT-232, has found it promotes expression and release of HSP72 from glioma cells and this requires the action of HSF1 or NPY (Panossian et al., 2012). HSF1 and NPY are likely primary upstream molecular targets of adaptogens in neuroglia. ADAPT-232 appears to act on NPY expression through the upregulation of HSF-1, which lies upstream of HSP72 expression and release. Additionally, ADAPT-232 upregulates both HSP70 and NPY ex vivo (Asea et al., 2013). The activation of NPY by ADAPT-232 promotes HSP70 expression in neuroglia, which helps to maintain homeostasis. It is thought that the induction and release of stress-induced hormone NPY and the stress-induced chaperone HSP70 into circulation is an innate defence response to mild stress and this increases tolerance, adaption, and may also confer longevity (Panossian, 2017). This pathway promotes adaptive and stress-protective effects via varying molecular components throughout the central nervous, sympathetic, endocrine, immune, cardiovascular, and gastrointestinal systems.

Figure 3. More adaptogen herbs. Asian ginseng, rhodiola, and withania (ashwagandha) (from left to right).

It has been demonstrated rhodiola, schisandra, eleutherococcus, withania, and ginseng extend the life span of the nematode C. elegans when stressed (Wiegant et al., 2009; Lee et al., 2007; Kumar et al., 2013), the fruit fly (D. melanogaster) (Jafari, 2007), and the yeast S. cerevisiae (Bayliak et al., 2011). An age-related decline in the ability to induce HSP70 was found in nervous system tissue, (Sherman et al., 2001; Winklhofer et al., 2008) in skeletal and cardiac muscle, and in the liver (Gagliano et al., 2007). It is also noteworthy, inhibition of HSF1 and HSP70 expression occurs in Alzheimer’s disease and is associated with the accumulation of plaques of aggregated β-amyloid peptide (Bhat et al., 2004). Also, it is the heat shock proteins that protect liver cells from the toxic effects of alcohol, heavy metals, xenobiotics, and oxidants. It is known the age-related decline of HSP70 expression contributes to the reduced efficacy of liver detoxification function in aged individuals (Gagliano et al., 2007). A 4-month study in 2-year-old rats showed that, in comparison with a control group, the ADAPT-232 group demonstrated higher liver detoxifying function, better CNS function (memory and learning ability), no development of cardiac insufficiency and hypercholesterolemia, less stress sensitivity, no impaired apoptosis, and no spontaneous tumour promotion (Makarov et al., 2007).


Recent work on the adaptogens in experimental systems has given new insights into the molecular basis on their action on stress response. While no single pathway is responsible for their action, new targets include the heat shock proteins (e.g. HSP70), NPY, and HSF-1. The increase by adaptogens of HSP70 is an interesting discovery since traditionally they have been viewed as life span increasing and this protein is a target of modern longevity research. As discussed in this article, in various experimental (non-human) systems, adaptogens and adaptogenic formula result in increased life expectancy under stressful conditions. It will be interesting to determine whether the same pathways that are involved in this phenomenon in models are also activated in humans with adaptogen treatment. The next part in this article series will be on the adaptogen materia medica and their traditional indications.

For further information regarding the recent scientific developments surrounding the adaptogens, a recent review by Alexander Panossian has been the source of much of the information contained in this article (Panossian, 2017). For more traditional insights into the adaptogenic herbs there is David Winston’s book entitled, ‘Adaptogens: Herbs for Strength, Stamina, and Stress Relief’ (Winston, 2007).

Cautions and contraindications

Whilst adaptogens are potentially useful medicines and foods, they can cause insomnia and over stimulation in some individuals (especially the more stimulating ones; e.g. rhodiola, schisandra, Asian ginseng) and depending on them for energy instead of good sleep and eating habits will lead to a ‘sleep debt’ and eventual burnout. It is also sensible to consider the energetic properties of each adaptogen. For instance, schisandra is a drying adaptogen and in a person prone to dryness (e.g. dry skin and slow bowel habits), it may well aggravate this tendency in the longer term. It is best to study the traditional use of the adaptogenic herbs alongside any scientific papers. I recommend reading this PDF by Paul Bergner, an herbalist highly experienced with using the adaptogens if you are thinking of using them on yourself or on others (link).


Asea, Alexzander, et al. “Evaluation of molecular chaperons Hsp72 and neuropeptide Y as characteristic markers of adaptogenic activity of plant extracts.” Phytomedicine 20.14 (2013): 1323-1329.

Bayliak, Maria M., and Volodymyr I. Lushchak. “The golden root, Rhodiola rosea, prolongs lifespan but decreases oxidative stress resistance in yeast Saccharomyces cerevisiae.” Phytomedicine 18.14 (2011): 1262-1268.

Bhat, Ratan V., Samantha L. Budd Haeberlein, and Jesús Avila. “Glycogen synthase kinase 3: a drug target for CNS therapies.” Journal of neurochemistry 89.6 (2004): 1313-1317.

Bobkova, Natalia V., et al. “Exogenous Hsp70 delays senescence and improves cognitive function in aging mice.” Proceedings of the National Academy of Sciences 112.52 (2015): 16006-16011.

Brekhman, I. Eleutherokokk (Eleutherococcus). Nauka Publishing House, Leningrad, USSR in Russian. (1968)

Chiu, Po Yee, and Kam Ming Ko. “Schisandrin B protects myocardial ischemia-reperfusion injury partly by inducing Hsp25 and Hsp70 expression in rats.” Molecular and cellular biochemistry 266.1 (2004): 139-144.

Chrousos, George P. “The hypothalamic–pituitary–adrenal axis and immune-mediated inflammation.” New England Journal of Medicine 332.20 (1995): 1351-1363.

Davydov, Marina, and A. D. Krikorian. “Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look.” Journal of ethnopharmacology 72.3 (2000): 345-393.

Gagliano, Nicoletta, Fabio Grizzi, and Giorgio Annoni. “Mechanisms of aging and liver functions.” Digestive diseases 25.2 (2007): 118-123.

Heim, Christine, et al. “The link between childhood trauma and depression: insights from HPA axis studies in humans.” Psychoneuroendocrinology 33.6 (2008): 693-710.

Hernández‐Santana, Aaron, et al. “A Rhodiola rosea root extract protects skeletal muscle cells against chemically induced oxidative stress by modulating heat shock protein 70 (HSP70) expression.” Phytotherapy research 28.4 (2014): 623-628.

Heydari, A. R., et al. “Hsp70 and aging.” Cellular and Molecular Life Sciences 50.11 (1994): 1092-1098.

Jafari, Mahtab, et al. “Rhodiola: a promising anti-aging Chinese herb.” Rejuvenation research 10.4 (2007): 587-602.

Jovicic, Milica J., et al. “Modulation of c-Jun N-terminal kinase signaling and specific glucocorticoid receptor phosphorylation in the treatment of major depression.” Medical hypotheses 85.3 (2015): 291-294.

Kumar, Ranjeet, et al. “Withania somnifera root extract extends lifespan of Caenorhabditis elegans.” Annals of neurosciences 20.1 (2013): 13.

Lee, Fang-Tsai, et al. “Chronic Rhodiola rosea extract supplementation enforces exhaustive swimming tolerance.” The American journal of Chinese medicine 37.03 (2009): 557-572.

Lee, Joon-Hee, et al. “Effects of ginsenosides, active ingredients of Panax ginseng, on development, growth, and life span of Caenorhabditis elegans.” Biological and Pharmaceutical Bulletin 30.11 (2007): 2126-2134.

Li, Libo, et al. “Schisandrin B attenuates acetaminophen‐induced hepatic injury through heat‐shock protein 27 and 70 in mice.” Journal of gastroenterology and hepatology 29.3 (2014): 640-647.

Makarov, V. G., et al. “Potential use of plant adaptogen in age related disorders, celebration of the centennial birth of Hans Selye, Budapest, Hungary.” Cell Stress Chaperones 242 (2007).

Morand, Eric F., and Michelle Leech. “Hypothalamic–pituitary–adrenal axis regulation of inflammation in rheumatoid arthritis.” Immunology and cell biology 79.4 (2001): 395-399.

Padgett, David A., and Ronald Glaser. “How stress influences the immune response.” Trends in immunology 24.8 (2003): 444-448.

Panossian, A. G., et al. “Effects of heavy physical exercise and adaptogens on nitric oxide content in human saliva.” Phytomedicine 6.1 (1999): 17-26.

Panossian, Alexander, and H. Wagner. “Stimulating effect of adaptogens: an overview with particular reference to their efficacy following single dose administration.” Phytotherapy Research 19.10 (2005): 819-838.

Panossian, Alexander, et al. “Adaptogens exert a stress-protective effect by modulation of expression of molecular chaperones.” Phytomedicine 16.6 (2009): 617-622.

Panossian, Alexander, et al. “Adaptogens stimulate neuropeptide Y and Hsp72 expression and release in neuroglia cells.” Frontiers in neuroscience 6 (2012).

Panossian, Alexander, et al. “Synergy and antagonism of active constituents of ADAPT-232 on transcriptional level of metabolic regulation of isolated neuroglial cells.” Frontiers in neuroscience 7 (2013).

Panossian, Alexander, Patricia L. Gerbarg, and George Canguilhem. “Potential use of plant adaptogens in age-related disorders.” Complementary and Integrative Therapies for Mental Health and Aging (2015): 197.

Panossian, Alexander. “Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals.” Annals of the New York Academy of Sciences (2017).

Pariante, Carmine M., and Stafford L. Lightman. “The HPA axis in major depression: classical theories and new developments.” Trends in neurosciences 31.9 (2008): 464-468.

Sherman, Michael Y., and Alfred L. Goldberg. “Cellular defenses against unfolded proteins: a cell biologist thinks about neurodegenerative diseases.” Neuron 29.1 (2001): 15-32.

Wiegant, F. A. C., et al. “Plant adaptogens increase lifespan and stress resistance in C. elegans.” Biogerontology 10.1 (2009): 27-42.

Winklhofer, Konstanze F., Jörg Tatzelt, and Christian Haass. “The two faces of protein misfolding: gain‐and loss‐of‐function in neurodegenerative diseases.” The EMBO journal 27.2 (2008): 336-349.

Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.

Seeking herbal options for fibromyalgia

Fibromyalgia is present in as many as 2% to 8% of the population and is characterized by widespread neuropathic pain, and is often accompanied by fatigue, insomnia, and cognitive problems (Clauw et al., 2014). However, it is far from well-defined and it has been suggested fibromyalgia may be characterised as a kind of ‘bodily distress syndrome’, along with chronic fatigue syndrome, irritable bowel syndrome, and similar overlapping disorders (Wolfe et al., 2014). There are numerous nonpharmacological therapies for fibromyalgia such as exercise and cognitive behavioural therapy and also pharmacological therapies, such as tricyclics (e.g. amitriptyline), serotonin norepinephrine reuptake inhibitors (e.g. cymbalta), and gabapentinoids (e.g. lyrica) that may prove effective (Clauw et al., 2014). Amitriptyline and cymbalta have anti-depressant actions, while lyrica is an anti-convulsant. However, while some patients are satisfied with conventional approaches, many are left without anywhere near satisfactory relief. This article will discuss alternative approaches to treating fibromyalgia, mainly diet and traditional herbal medicine.


The Paleolithic diet has become popular with the mantra ‘eat the foods you were designed to eat’, this is a good option for individuals with fibromyalgia (Cordain, 2012). The idea is to return to foods similar to those we ate when evolving in the Paleolithic era, 2.6 million years to 10,000 years ago. This is when our bodies adapted genetically to eating a certain diet. The Paleo diet includes vegetables, fruits, nuts and seeds, grass (not grain) fed meats, and wild seafood. It is a plant based diet, around 80% vegetables and fruits, 20% meats. All grains (including breads, pasta, gluten-free, etc), legumes, diary, refined sugar, added salt, processed foods are removed.

It has been suggested a gluten free diet may help treat some cases of fibromyalgia (Isasi et al., 2014). Gluten sensitivity, which is a non-celiac reaction to gluten by the immune system, may be related to the development and severity of fibromyalgia. There is evidence a mostly raw vegan diet may reduce fibromyalgia symptoms (Kaartinen et al., 2000). This is a particularly good option for vegetarians, however, it contains very little B12, therefore supplementation with B12 would be sensible. There is some degree of overlap between the Paleo diet and the raw vegan diet described in this paper, as both favour a plant based diet and reject refined sugars and processed foods. This kind of approach will increase the overall health of the body through greater intake of fruits, vegetables, and fibre.

Vitamin D and magnesium

It has been suggested vitamin D deficiency may contribute to disease severity and fatigue in patients with fibromyalgia (Solmaz et al., 2015). In one study, the authors observed a negative correlation between fatigue and vitamin D level in fibromyalgia patients. They also found a similar relationship between pain scores and vitamin D level. While these data are not fully conclusive, it is certainly worth considering supplementation of vitamin D and magnesium if you are suffering with fibromyalgia. In another study, the authors found statistical improvement of tender joints and depression with magnesium treatment, but the effects were not as strong when the drug amitriptyline was used instead (Bagis et al., 2013). Both applied together were found to work better than either applied alone.

Traditional herbal medicines

Whilst conventional drugs like lyrica, amitriptyline, and cymbalta may prove helpful for fibromyalgia patients, they may result in unwanted side effects leading to discontinuation or they may not work for some aspects of the disease. Herbs tend to be gentler on the body and by combining multiple herbs with different actions it is possible to create a more complex formula that may approach treating fibromyalgia from a few different angles.

For instance, herbs like St. John’s wort and black cohosh have anti-depressant properties and may relieve some of the emotional burden associated with fibromyalgia, whilst they also have an analgesic effect and so target the nerve pain. Black cohosh and ashwagandha have an anti-spasmodic property and should help painful tight muscles, while skullcap has a nervine tonic action that should help to restore normal sleep patterns. When combined in this way, herbs may be more powerful than a single herb acting alone.



Ashwagandha or withania somnifera has been used in Ayurveda for at least 3000 years (Castleman, 2001). It is mentioned in the ancient text, the Charaka Samhita, that recommends the root as a whole-body tonic, particularly for emancipation, reproductive powers, and longevity. It is classified as a rasayana in Ayurveda, or restorative herb for the body, also known as an adaptogen (Winston, 2007). Adaptogens are thought to work on the adrenal glands and modulate cortisol levels, amongst other mechanisms, to the effect of buffering the body against non-specific stress (Singh et al., 2011). Since fibromyalgia can be seen as a ‘bodily distress syndrome’, reducing the impact of stress in the body could have a significant positive impact.

Ashwagandha is known to have a profound anti-anxiety effect observed in human double-blind placebo controlled studies (Chandrasekhar et al., 2012). It also has an antispasmodic effect (Mishra et al., 2000), and may help relax painful tight muscles which are found in some fibromyalgia patients. Furthermore, ashwagandha is classified as a nervine tonic and so is thought by herbalists to have a restorative effect on the nervous system. There is data that suggests it helps nerves regenerate (Nakayama et al., 2007), supporting this theory to some degree. It’s gentle stimulating effect that occurs over time may help to treat the fatigue often associated with diseases. Overall, ashwagandha is an important herb for a worn out, stressed nervous system.

Black cohosh


Black cohosh or cimicifuga racemose was originally used by the Native Americans as a medicine as they boiled its roots in water and drank the decoction for fatigue and arthritis (Castleman, 2001). It subsequently became known as an herb for all kinds of rheumatism including those types involving muscular pains (Hoffman, 1988). Similar to St. John’s wort, black cohosh also has quite a strong anti-depressant action so can help lift some of the psychological burden associated with fibromyalgia (Gladstar, 2000). It also acts as a nervine sedative so may help related sleep troubles (Jiang et al., 2015). While, similar to ashwagandha, it has an antispasmodic action, capable of relieving the painful tight muscles that may be associated with the disease. Black cohosh is often combined with ashwagandha in various formula to target fibromyalgia by herbalists (Winston and Kuhn, 2000).



Reishi or ganoderma lucidum is a mushroom has been used as a medicine in China for over 2000 years. It is traditionally used to replenish the Qi or vital energy, relax the mind, relieve asthma, and for many other conditions (Benzie, 2011). It was thought by ancient Chinese doctors to increase the duration of lifespan (Babu, 2008). Preliminary results indicate reishi has anti-convulsant, neuroprotective, and anti-inflammatory properties (Liu et al., 2003; Aguirre-Moreno et al., 2013). A double-blind placebo controlled clinical trial supports a medicinal effect of reishi against emotional disturbance (Tang et al., 2005). Reishi is classified as an adaptogen and nervine tonic by herbalists, similar to ashwagandha, and is thought to have wide ranging anti-stress and nerve restorative effects in the body.

Reishi also has an effect on the gut, as in mice reishi has been found to reduce obesity via the modulation of gut flora (Chang et al., 2015). Reishi acts as a prebiotic and may help balance the gut environment which is typically dysregulated in fibromyalgia. It also has a role in the treatment of fatigue associated with fibromyalgia because it gently stimulates an individual’s energy with time. Although, it also can also over stimulate some people, so a tincture can be used together with nervines, then the dose can easily be reduced if necessary. The traditionally used part of the mushroom is the fruiting body, that grows above the ground.

St. John’s wort


St. John’s wort or hypericum perforatum has a history of medicinal use that dates back to the ancient Greeks (Castleman, 2001). The Greek physician Dioscorides recommended flower extracts as a treatment for sciatica. It has been shown to have an anti-depressant action by many well controlled clinical studies (Ng et al., 2017), however, perhaps most of all, herbalists see it as a nervine tonic. It is thought St. John’s wort helps heal nerves and also has an analgesic effect, therefore has applications in treating many kinds of neuropathic pain (Winston, 2007). St. John’s wort is best in the form of a fresh tincture of the flowers, the colour of the tincture should be deep red to indicate its potency.



American skullcap or scutellaria lateriflora was used by the Native Americans in North America as a sedative and tonic (Barceloux, 2008). Fresh aerial parts of the plant made into a tincture are indicated for anxiety, insomnia, painful tight muscles, and nerve pain. A tincture made from dried leaf material has a lot less medicinal power, but is widely marketed and sold anyway. Skullcap is thought to have a renewing effect on the nervous system and may help direct it towards health and balance (Hoffman, 1988). A mood elevating effect has been shown for skullcap in a double-blind placebo controlled human study (Brock et al., 2014), but I have only noticed a calming effect personally. St. John’s wort and black cohosh have a stronger mood elevating property. The anti-anxiety effect of skullcap has been verified in a well-controlled human study (Wolfson et al., 2003)

Kava kava


Kava or piper methysticum is consumed traditionally by the Polynesians from New Guinea to Tahiti who have an ancient tradition of consuming the herb in ‘kava circles’ (Castleman, 2001). In the South Pacific, kava has been used as a treatment for headache, colds, arthritis, and as a sedative and aphrodisiac. The Eclectic physicians used kava for urinary tract pain, renal colic, chronic urethritis, neuralgia, mouth and throat pain, and dyspepsia (Kuhn and Winston, 2000). Kava is a strong sedative or hypnotic and can help both sleep and pain in fibromyalgia. It can be addictive, so high doses should be avoided. Best not combined with alcohol, it may stress out the liver. Do not use in individuals with a history of liver disease, with hepatotoxic drugs, or in pregnant or breast-feeding women.

Formulation notes

The below formula is an example of a compound of different nervines discussed that should help address the disease pattern of fibromyalgia. However, there are many different kinds of fibromyalgia, therefore personalisation may well be necessary for a better result. There may be underlying digestive problems or poor diet that may be necessary to improve upon. Also, different types of constitution may respond better to certain herbs, for example, ashwagandha is a little more suited to vata type people (cold and dry) as it is warming.

Nervine tonic and adaptogen compound

Ashwagandha (warming, drying)
Black cohosh (cooling, drying)
Kava kava (warming, drying)

Contraindications: Not for use during pregnancy and when breastfeeding. If on sedative medication be highly cautious regarding dose. Not for use in people with history of liver problems. Be very cautious if combining with drugs or alcohol, it is best not to do this because of the kava. Black cohosh is best used in small doses, for example, 5-30 drop doses.


Nature has provided many different solutions to help treat fibromyalgia and related conditions such as CFS. Perhaps the most important part of treating such a condition is the restoration of a normal sleep pattern, for this, the gentle sedative tonic American skullcap may help, or kava kava if a stronger nervine is required. Mild adaptogens such as ashwagandha and reishi also have a central role with their gentle calming yet activating action upon the nervous system. This article has given some nervine and adaptogenic herbs that could be used in the construction of a herbal formula for fibromyalgia.

Note: If you are not fully comfortable with a DIY approach for your condition for any reason, please do not hesitate to contact a local professional herbalist for more tailored assistance.


Aguirre-Moreno, Alma, et al. “Anticonvulsant and neuroprotective effects of oligosaccharides from Lingzhi or Reishi medicinal mushroom, Ganoderma lucidum (Higher Basidiomycetes).” International journal of medicinal mushrooms 15.6 (2013).

Babu, P.D. and Subhasree, R.S., 2008. The sacred mushroom “Reishi”-a review. The American-Eurasian Journal of Botany, 1(3), pp.107-110.

Barceloux, Donald G. Medical toxicology of natural substances: foods, fungi, medicinal herbs, plants, and venomous animals. John Wiley & Sons, 2008.

Benzie, Iris FF, and Sissi Wachtel-Galor, eds. Herbal medicine: biomolecular and clinical aspects. CRC Press, 2011.

Bagis, Selda, et al. “Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder?.” Rheumatology international 25.3 (2005): 188-190.

Bagis, Selda, et al. “Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia?.” Rheumatology international 33.1 (2013): 167-172.

Brock, C., Whitehouse, J., Tewfik, I., & Towell, T. (2014). American Skullcap (Scutellaria lateriflora): A Randomised, Double‐Blind Placebo‐Controlled Crossover Study of its Effects on Mood in Healthy Volunteers. Phytotherapy Research, 28(5), 692-698.

Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471.

Chandrasekhar, K., Jyoti Kapoor, and Sridhar Anishetty. “A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults.” Indian Journal of Psychological Medicine 34.3 (2012): 255.

Chang, Chih-Jung, et al. “Ganoderma lucidum reduces obesity in mice by modulating the composition of the gut microbiota.” Nature communications 6 (2015).

Clauw, Daniel J. “Fibromyalgia: a clinical review.” Jama 311.15 (2014): 1547-1555.

Cordain, Loren. AARP The Paleo Diet Revised: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. John Wiley & Sons, 2012.

Hoffman, David. Holistic herbal. Element Books, 1988.

Kuhn, Merrily A., and David Winston. Herbal therapy and supplements: a scientific and traditional approach. Lippincott Williams & Wilkins, 2000.

Jiang, K., et al. “Black cohosh improves objective sleep in postmenopausal women with sleep disturbance.” Climacteric 18.4 (2015): 559-567.

Gladstar, Rosemary, and Pamela Hirsch, eds. Planting the future: saving our medicinal herbs. Inner Traditions/Bear & Co, 2000.

Isasi, Carlos, et al. “Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia.” Rheumatology international 34.11 (2014): 1607-1612.

Kaartinen, K., et al. “Vegan diet alleviates fibromyalgia symptoms.” Scandinavian journal of rheumatology 29.5 (2000): 308-313.

Mishra, Lakshmi-Chandra, Betsy B. Singh, and Simon Dagenais. “Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review.” Alternative medicine review 5.4 (2000): 334-346.

Ng, Qin Xiang, Nandini Venkatanarayanan, and Collin Yih Xian Ho. “Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis.” Journal of Affective Disorders 210 (2017): 211-221.

Liu, Y. H., et al. “Effectiveness of Dp2 nasal therapy for Dp2-induced airway inflammation in mice: using oral Ganoderma lucidum as an immunomodulator.” Journal of microbiology, immunology, and infection= Wei mian yu gan ran za zhi 36.4 (2003): 236-242.

Nakayama, Natsuki, and Chihiro Tohda. “Withanoside IV improves hindlimb function by facilitating axonal growth and increase in peripheral nervous system myelin level after spinal cord injury.” Neuroscience research 58.2 (2007): 176-182.

Singh, Narendra, et al. “An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda.” African Journal of Traditional, Complementary and Alternative Medicines 8.5S (2011).

Solmaz, D., et al. “AB0944 Vitamin D Deficiency Might Contribute Fatigue and Disease Activity in Patients with Fibromyalgia.” (2015): 1215-1215.

Tang, Wenbo, et al. “A randomized, double-blind and placebo-controlled study of a Ganoderma lucidum polysaccharide extract in neurasthenia.” Journal of medicinal food 8.1 (2005): 53-58.

Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.

Wolfe, Frederick, Brian T. Walitt, and Winfried Häuser. “What is fibromyalgia, how is it diagnosed, and what does it really mean?.” Arthritis care & research 66.7 (2014): 969-971.

Wolfson, P., and D. L. Hoffmann. “An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers.” Alternative therapies in health and medicine 9.2 (2003): 74.


The alterative herbs

The alterative herbs occupy an important position in traditional Western herbalism, although we have only a little information about how they work, many different and diverse traditional sources can attest to their medicinal efficiency. Overall, they are thought to work by acting as ‘cleansing’ agents, meaning they stimulate the activity of the excretory organs such as the liver and kidneys to remove unwanted materials from the body. Unfortunately, this is one of the least satisfying definitions we have of any herbal action and is regularly subject to scrutiny. However, what is clear is alteratives do work for certain kinds of problems and people, we just don’t know exactly how yet.

Alteratives appear to beneficially alter the course of chronic diseases with a specificity towards certain diseases that involve chronic inflammation or ‘damp heat’; such as psoriasis, acne, and rheumatoid arthritis. There is some preliminary scientific support for these ideas we will discuss later. As the definition is vague, it can be helpful to study some example definitions of an alterative from traditional herbalism text books. Of these examples, I find Maria Groves to provide the most clear and succinct definition.

David Hoffman: ‘Alteratives gradually alter and correct a ‘polluted’ condition of the blood stream and restore a healthier functioning. The way alteratives work is poorly understood, but they certainly work…(they are) perhaps the herbs most often used in the context of skin conditions, the roots of which lie deep within the metabolism of the individual. They cleanse the whole of the body, but their activity is focused in different areas, some in the kidneys, some in the liver… and they have to be chosen according to their specific indications’ (Hoffman, 1988).

Harvey Felter: ‘A drug which causes a favourable change or alteration in the processes of nutrition and repair, probably through some unknown way improving metabolism.’ (Felter, 1922).

John Scudder: ‘We suppose… They may change the condition of the blood by a direct influence exerted upon it… They may in some manner effect the removal of the worn-out tissues, and favour the process of nutrition… They may neutralize or change the character of decomposing or noxious agents that exist in the system as the result of some pathological process, or that have been introduced from without… They undoubtedly favor elimination by stimulating the excretory organs to increased activity.’ (Scudder, 1898)

Maria Groves: ‘Alteratives improve the body’s detoxification processes and efficient removal of metabolic wastes. They often encourage detoxification of the blood and interstitial fluid via the liver, lymphatic system, and the kidneys’ (Groves, 2016)

Alterative actions

Different alteratives have greater or lesser affinities for different excretory organs, but what is in common is they will stimulate activity of a particular organ to increase elimination. To explain further, Maria Groves subdivides alteratives to include those with the following actions (Groves, 2016):

Lymphagogues (lymph stimulants/ movers): Burdock root, red clover, sarsaparilla

Choleretics and cholagogues (liver stimulants/ movers): Dandelion, burdock root, yellow dock root

Diuretics (kidney stimulants/ movers): Dandelion, nettles, sarsaparilla

We will now turn to examine some of the classic alteratives from Western herbalism, considering both traditional knowledge and preliminary scientific data. One of the most well known and researched is sarsaparilla.



Sarsaparilla is a woody trailing perennial vine that may refer to one of a number of similar species scattered throughout the world (Kuhn and Winston, 2000). Sarsaparilla is cultivated in Mexico, Jamaica, China, and Central and Southern America. ‘Sarsaparilla’ as a name comes from Spanish words, prickly (zarsa), vine (parra), and small (illa). It is said sarsaparilla was used by the ancient Greeks as an antidote to poisons, however, it only became widely popular in Europe medicinally during the 16th century when Spanish explorers discovered the Caribbean species (Castleman, 2001). Native Americans and also Caribbean Indians used sarsaparilla to treat skin and urinary diseases. They saw sarasaparilla as a tonic herb for preserving youth and strength. Mexican sarsaparilla was transported to Spain around 1530 and then used as a treatment for syphilis and also as a ‘strengthening tonic’. It was used by Nicholas Culpeper, a famous 17th century English herbalist, for rheumatism and ‘many kinds of diseases’ (Culpeper, 1814).

In more modern times, David Hoffman in his text Holistic Herbal mentions sarsaparilla is a widely applicable alterative and that it may be used to aid proper functioning of the body as a whole (Hoffman, 1988). It is indicated for scaly skin conditions like psoriasis and also as part of a wider treatment for rheumatism, especially rheumatoid arthritis. For psoriasis, sarsaparilla is often combined with similar alteratives to increase medicinal power such as burdock root and yellow dock. Sarsaparilla roots contain a high relative abundance of steroidal saponins that are related to its medicinal properties (Challinor et al., 2012). Steroidal saponins display a range of bioactivities, including cytotoxic, hemolytic, anti-inflammatory, anti-fungal, and anti-bacterial properties.

Sarasaparilla is a relatively well studied alterative and preliminary studies give us insights into how alteratives may function physiologically. For example, gout is a disease associated with the accumulation of urate in the blood stream. In one study, the authors found an extract of sarsaparilla was effective in enhancing urate excretion via the kidneys of hyperuricemic mice (Wu et al., 2014). This supports the role of alteratives in the stimulation of the excretory organs that results in removal of unwanted compounds from the body. Another similar study investigated metabolic syndrome. Metabolic syndrome is a metabolic disorder associated with an increased risk of developing kidney failure, cardiovascular, and cerebrovascular diseases. In this study, using a mouse model of metabolic syndrome, the authors found sarsaparilla root extract was able to control weight gain and was able to decrease elevated levels of triglycerides (fatty molecules) by 60% (Amaro et al., 2014). This study supports the traditional role of alteratives as beneficial modulators of metabolism. While these studies were conducted in animal models, which are not as reliable, there is one human clinical trial of great interest.

In the 1940s when there was more interest in sarsaparilla, one study observed a greater improvement with sarsaparilla extract treatment in psoriasis patients opposed to those patients who received a placebo (Thurmon et al., 1942). 18% of those patients treated with the sarsaparilla extract experienced total remission, while only 6% on the placebo. This study was published in the New England Journal Of Medicine, a prestigious journal. However, in these early days experimental standards were less demanding and this clinical trial does not seem to have been blinded and statistical analysis was not performed. Regardless of this, I think this study shows great promise for the medicinal potential of sarsaparilla in humans. Perhaps in the future, as herbs become more popular again in Western culture as medicines, further studies will expand on the role of sarsaparilla extracts in treating psoriasis and other chronic inflammatory diseases.

Note: Alteratives are often rather drying to the constitution, so care must be taken not to dry some one out too much by using moistening herbs or avoiding the more drying alteratives. More moistening alteratives include red clover and burdock. They also have been known to be too much for older weak people to handle who may respond better to tonification (i.e. use of the adaptogens). It is best to generally proceed with caution with these herbs.


Amaro, Carol Arely Botello, et al. “Hypoglycemic and hypotensive activity of a root extract of Smilax aristolochiifolia, standardized on N-trans-feruloyl-tyramine.” Molecules 19.8 (2014): 11366-11384.

Challinor, Victoria L., et al. “Steroidal saponins from the roots of Smilax sp.: structure and bioactivity.” Steroids 77.5 (2012): 504-511.

Culpeper, Nicholas. Culpeper’s complete herbal. (1814).

Felter, Harvey. The Eclectic Materia Medica, Pharmacology, and Therapeutic (1922)

Groves, Maria. Body into Balance. Storey Publishing. (2016).

Hoffman, David. Holistic herbal. Element Books. (1988).

Kuhn, Merrily A., and David Winston. Herbal therapy and supplements: a scientific and traditional approach. Lippincott Williams & Wilkins, 2000.

Scudder, John. The American Eclectic Materia Medica and Therapeutics (1898)

Thurmon, Francis M. “The treatment of psoriasis with a sarsaparilla compound.” New England Journal of Medicine 227.4 (1942): 128-133.

Wu, Xiao-Hui, et al. “Smilax riparia reduces hyperuricemia in mice as a potential treatment of gout.” The American journal of Chinese medicine 42.01 (2014): 257-259.