lecture 1- musculoskeletal system · advanced clinical herbalism: musculoskeletal system weakness...

Advanced Clinical Herbalism: Musculoskeletal System

Introduction to the Musculoskeletal SystemOne of the primary reasons people go to see a doctor these days is for physical pain- whether acute or chronic. To have skill sets and holistic tools to assist someone in the treatment and management of their pain is one of the most important strategies one must have as a practitioner of holistic herbal medicine. The ability to get someone off standard over-the-counter anti-inflammatory drugs or the more powerful prescription opiate class of drugs can provide an extremely valuable service to our clients, preventing addictions as well as nasty side effects from those potent little pills. Thus our focus on treatment of the musculoskeletal system here has a primary focus on the treatment of pain, inflammation, and other challenges of this all important system of the body.

The Physical System• Anatomy and Physiology- The musculoskeletal system provides the baseline structure and

form of the physical body, giving it its shape, tone, support, and capacity for movement. While we tend to simply think of it as bones and muscles, upon deeper evaluation one finds that there are many other important tissues involved, including tendons, ligaments, cartilage, teeth, and the various fluids and sacs that give it motility, flexibility, and motion. The nervous system deeply innervates this system and becomes all important in its treatment. All of these various components of the musculoskeletal system are important to consider in its holistic treatment, as they are all interconnected and interdependent upon one another- there is an underlying unity behind these tissues. Let’s take a look at a few of these components of the musculoskeletal system and study their underlying physiological functions and anatomical characteristics.

• Synovial Fluid: Much of the musculoskeletal system is not directly innervated by the circulatory system, but rather has a medium, which we call the synovial fluid- the function of which is to carry nutrients and oxygen from the blood and bathe the tissues in it. The joints of the body are encased in these fluid filled sacs (mucous membranes) which maintain the lubrication of the structures. This is highly important because the joints are constantly moving and thus produce friction- without the synovial fluid and sac they would grate bone-on-bone and ultimately wear out (think of a car engine without oil). We can consider this fluid to be the quintessential yin of the joints and musculoskeletal system. Much of the underlying state of the tissues energetically can be traced back to the condition of the synovial fluid. The synovial membrane is what holds the fluids in place and can actually become torn and allow the fluids to leak out, which is what occurs in a torn spinal disc, the meniscus of the knee, or bursa in any joint. These membranes are classically healed with Goldenseal (Hydrastis canadensis).

• Cartilage: This form of connective tissue provides flexibility for the movement of the joint, as well as structures that prevent it from moving inappropriately, in the wrong directions, or overextending beyond its limits. Like all connective tissues, cartilage is extremely dependent upon minerals for sustaining it’s strength and flexibility, especially the mineral silicon which we find is very high amounts in 2 western herbs: Horsetail (Equisetum arvense), and Oat Grass (Avena sativa)- note: here we are talking about the grass of Oats, not the milky seed used as a nerve tonic, they are 2 quite different remedies even though they are from the same plant. It is this silica which makes cartilage hard and strong, yet pliable and flexible. Whenever there is a

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weakness in the cartilage, it will often show up in other structural tissues of the body, especially the hair, skin and nails. This could be slow growing hair, skin or nails, an inability for the skin to heal properly or in good time, hair or nails that easily breaks or splits, or is simply weak. This may not simply have to do with an adequate amount of minerals in the diet, but with the bodies innate capacity to properly absorb and distribute those nutrients.

• Tendons and Ligaments: These 2 other forms of connective tissue are in essence one and the same, the only difference being to what other types of tissues they are attached to. Tendons connect bones to muscles, whereas ligaments attach bones to bones. For all intensive purposes, they are similar to cartilage in their function: allowing movement, flexibility and providing structure for the body. Of primary importance with the health of tendons, ligaments as well as cartilage is that they maintain their nutrition and lubrication. It is when they become malnourished, dried, and/or atrophied that they begin to loose their tone, stretch, weaken and loose their function.

• Bones: Bones are the most solid aspect of the human organism, providing the baseline structure from which all of our muscles, tissues, organs and systems are connected, protected, and founded upon. In fetal development, the bones are formed through the deposition of calcium into cartilaginous tissues. It’s easy to think of the bones are simply hard structures which are solid, but in fact there are blood vessels which deliver nutrients, oxygen and carry away wastes. Healthy bones should be slightly pliable and flexible and yet hard, sturdy and strong, consisting of about 70% calcium phosphate and 30% calcium carbonate, as well as silica and a few other minerals. The process of building bone is complex and requires many other co-factors, nutrients and enzymes that actually carry calcium from the blood into the bones, thus just taking plain calcium supplements is typically not enough to adequately build bone.

• Muscles: We are not going to go through every muscle in the body here, as there are hundreds if not thousands. Rather we want to look at the 2 primary types of muscles in the body, what we call striated or skeletal muscles and smooth muscles. Skeletal muscles are the larger muscles of the body whose function is voluntary movement- IE they are under our conscious control. Smooth muscles are those which line the various organs and tissues of the body and are controlled by the autonomic nervous system, thus they are outside of our conscious control. Examples of this would be the peristaltic movements of the intestinal tract, the cramping of the uterine muscles during menstruation, or tightening and relaxing of the arterioles. Most often in the treatment of pain we are working with the skeletal muscles, but in certain situations relaxation of the smooth muscles is important as well, especially in treating spasm of the ureters, gall ducts, intestines, bronchioles, or uterus. Generally speaking our remedies for the muscles are anti-spasmodics, or relaxants.

• Nerves: While typically thought of as an entirely different system, it’s important to consider the nervous system in it’s relationship to the musculoskeletal system, as the muscle fibers are directly innervated by nerve fibers. It is through the pulsation of the nerves that the muscles operate properly. An important point to consider in regards to the nerves is that in order for them to effectively conduct their electrical signaling, there must be adequate amounts of electrolytes (minerals) throughout the synaptic cleft as well as good health of the myelin



sheath, which is a layer of connective tissue surround the nerve fibers. Thus some nervous system issues can be associated with connective tissue problems and not necessarily directly nerve related. Holistic treatment of the musculoskeletal system should also take the nerves into consideration as well, especially with sharp shooting pains that travel a specific pathway, chronic tension and spasm. We will cover the nervous system in more detail on it’s own in a future class.

Another point worth mentioning here is the importance of the blood and its circulation in the treatment of the musculoskeletal system, for stagnant or deficient blood can certainly be a contributing factor that must be addressed.

Lastly, the joints themselves are where all of the above parts come together into a cohesive unity. They are comprised of bone, muscle, tendon, ligament, cartilage, circulation, and nerve tissue. During the course of treatment of the joints, it is important to consider all of the composite parts and tissues which comprise it, where the root of the problem is, and to administer remedies which will act upon the appropriate parts.

Pathological Patterns and Tissue States• 6 Tissue States: From an energetic perspective, pain is not simply pain. Rather, there are

different underlying manifestations of pain which require different courses of treatment and remedy selection. In our modern world, most people treat pain by simply popping an aspirin or some other NSAID (Non-Steroidal Anti-Inflammatory Drug), or by taking a popular herb like Willow bark (Salix alba) or Turmeric (Curcuma longa). In regards to the plants, many people find little to no relief, not because the herb isn’t working, but because the herb was not matched with the underlying tissue state pathology behind the pain. Rather than suppressing the pain with an anti-inflammatory (be it drug or plant), we want to correct the underlying tissue state that is causing the pain, which brings us to our tissue states. Traditional models of medicine typically classified musculoskeletal pain into 4 primary categories, those which are caused by deposits of damp, cold, heat, or dryness.

“We can well see the pivotal position which the primal yin fluid of the joints, the synovial fluids, plays in the health of the muscular and skeletal system. It feeds and cleans the cartilaginous parts, and lubricates the cartilage, bone, tendons, and muscles. If it dries out the

joint will become stiff, malnourished, and perhaps inflamed. [dry/atrophy] If it becomes stagnant the joint will become ‘dirty’ and inflamed. [damp/stagnation] And if it collects in

excess, the joint will be puffy, swollen, and subject to backing-up stagnation from the kidneys and lymphatics. If the joint is supplied by a rich bloodstream, full not only of food and

oxygen, but of immune factors, the joints will tend to become hot from a high metabolic rate and immune activity. [heat/excitation] Conversely, poor circulation leaves the joint cold and

malnourished. [cold/depression]”-Matthew Wood (note: author added italicized tissue state notes in brackets)

• Heat/Excitation: This tissue state is obviously very similar to inflammation, and thus oftentimes most musculoskeletal pain symptoms are attributed to it. This lends an approach of using “anti-inflammatory” substances (be them drug, herbal or otherwise) to reduce the pain and heat. Though as stated above, there can be pain and even



inflammation due to different underlying causes which must be teased out. Our characteristic symptoms for heat/excitation will be the sensation of heat in the joints, redness to the skin, pain feels better upon icing, swelling and tenderness, sharp intense pain (as opposed to dull pain), inflammation of the bursa, and autoimmune conditions like rheumatoid arthritis, fibromyalgia, or lupus. The tongue will typically be red in color and pointed in shape, the pulse typically rapid, superficial and bounding. This tissue state responds well to cooling remedies which contain anti-oxidants, bioflavonoids, chlorophyll, plant acids, and other constituents which sedate inflammation and heat. Many are in the Rosaceae: Wild Cherry (bark, fruit) (Prunus spp.), Yarrow (Achillea millefolium), Hawthorn berry (Crataegus spp.), California Poppy (Eschscholzia californica),

• Cold/Depression: With the depressed tissue state, we can see generalized weakness in the joints due to lack of circulation of blood, depressed nerve function from injury or neurological weakness, or through overall metabolic depression and cold. The central fire in the solar plexus does not radiate out to the periphery and disseminate oxygen and nutrients, as well as the overall vital force. This leads to cold, stiff joints and achy muscles worse with cold and damp weather and often better with a bit of movement. There is typically cold skin, poor circulation to the extremities (IE cold hands and feet), and paleness to the skin. Herbs for this tissue state will typically always be warming, pungent, circulatory stimulants. A few remedies include St. John’s Wort (Hypericum perforatum), Calamus (Acorus calamus), Rosemary (Rosmarinus officinalis), Ginger or Wild Ginger (Zingiber officinale or Asarum canadensis), Gravel root (Eupatorium purpureum), Turmeric (Curcuma longa), Sarsaparilla (Smilax spp.), Sassafras (Sassafras albidum), Prickly Ash (Xanthoxylum americanum), and other pungent spices such as Black Pepper (Piper nigrum).

• Dry/Atrophy: Here we see the intrusion of vata into the joints leading to coldness and dryness- the classic cold, dry, “creaky” feeling in the joints where they tend to pop a lot. Actually joints which pop frequently are said to be relieving excess vata or wind from the joint. This is a very important tissue state to learn to assess, as dryness will have a serious adverse impact upon the joints- impairing mobility, increasing pain and stiffness, withering and loss of strength. This is most common in elderly people, who are in the vata stage of life and tend towards increasing levels of dryness systemically throughout the body. General signs and symptoms would be dry skin and mucosal membranes (constipation, respiration etc.), musculoskeletal weakness, withering and wasting of the muscles, malnutrition and wasting, joints dry, creaking, and cracking. The tongue will typically be dry. Some of our best remedies will be those which contain high levels of oils, especially fixed oils, and that promote lubrication and moisten the tissues. Examples include: Burdock root (Arctium lappa), Pleurisy root (Asclepias tuberosa), Licorice (Glycyrrhiza glabra), Angelica (Angelica archangelica), Solomon’s Seal (Polygonatum spp.), Dragon root (Smilacina racemosa), Horsetail (Equisetum arvense), and Mullein (Verbascum thapsus).

• Damp/Stagnation: The root of our common word rheumatism comes from the Greek word for dampness, rheuma. This primarily denotes dampness and pain the joints, or the muscles, but in the old days it was not differentiated as it is in modern biomedicine



(fibromyalgia denotes muscles, arthritis denotes joints). But the root of it was seen to be in the fluids surrounding the musculoskeletal tissues, which is quite sensitive to changes in diet, weather, and the seasons- something modern medicine completely ignores. We can think of this tissue state as a degree of systemic toxicity of metabolic waste products which then lodge in the joints and trigger an inflammatory response. Many of our remedies used here are actually detoxifying alterative remedies which help to purge these metabolic waste products from the tissues, and open the channels of elimination for evacuation. General signs and symptoms would be worse from cold and damp weather, better with heat, overall fatigued, sluggish sensations with heaviness, dull achy musculoskeletal pain especially after sleeping. There may be accompanying hypothyroidism. A few remedies here include: Devil’s Claw (Harpagophytum procumbens), Turmeric (Curcuma longa), Dandelion root (Taraxacum officinale), Poke (Phytolacca decandra), Goldenseal (Hydrastis canadensis).

• Damp/Relaxation: In the lax tissue state, an excess amount of fluids are either leaving the body or traveling and residing in inappropriate places in the body. In regards to the musculoskeletal system, this can lead to calcium being leeched from the bones and being flushed out in the kidneys- leading to demineralization of the bones and thus osteoporosis or at the least weakened bones. The excess of minerals being circulated from the bones could also make one more prone to mineral deposits in the joints or in the kidneys (stones). Laxity also indicates a lack of tone, which can impact the connective tissues making them overly flexible and able to stretch too far, thus straining the joints. Because this tissue state has a potent impact upon venous circulation, ulcerations in the legs and passive venous congestion often go along with it. The primary remedies used in this tissue state are: Oak bark (Quercus alba), Royal Fern (Osmunda regalis), Sumach (Rhus typhina), and Sage (Salvia officinalis).

• Wind/Tension: This tissue state is especially important and relatively easy to determine. It is essentially associated with spasm in the muscles, where they become overly contracted or twisted and are unable to fully relax. This can lead to sharp pains, especially if the nerves are involved, especially upon movement. The symptoms can either be chronic, or true to the wind state, come and go sporadically with no seeming pattern to it. Generally the symptoms are worse from cold and respond well to heat and warmth which allows the muscles to relax. There can be poor local circulation and ths stagnant blood from arteriole constriction. The pulse will often feel tense, hard, and wiry, the tongue may shake or vibrate upon leaving the mouth. The first and foremost important remedy here would be Magnesium, which most people are incredibly deficient in and is responsible for muscular relaxation. I always give that first and then move on to herbs. Our primary category of herbs would be spasmolytics (relaxants) and nervine sedatives/hypnotics. Some great anti-spasmodics here are: Lobelia (Lobelia inflata), Wild Yam (Dioscorea villosa), Black Cohosh (Cimicifuga racemosa), Crampbark (Viburnum opulus), Valerian (Valeriana officinalis), Hops (Humulus lupulus), Pulsatilla aka Wind Flower (Anemone pulsatilla), Indian Warrior, Parrot’s Beak, and Elephant’s Head (Pedicularis spp.), Boneset (Eupatorium perfoliatum), Teasel (Dipsacus sylvestris), Wild Lettuce (Lactuca virosa- only in low dose here!),



A very common pattern we will see in the pain complex is the accumulation of dampness and heat within the joints- leading to swollen, puffy, inflamed, and painful joints. This is often due to underlying weak digestion, consumption of incompatible foods, and the accumulation of ama, or toxins within the channels of the body. From an Ayurvedic perspective it is due to deficient agni or digestive fire. This is essentially leaky gut syndrome pathology leading to toxin accumulation in the liver, blood, skin, and the joints and muscles.

Evaluation CriteriaCentral to our evaluation criteria of the musculoskeletal system is the determination of the underlying energetic pattern, achieved via the 6 tissue states above. Of course many of these tissue states often manifest together. The most important of these indications is to determine whether the tissues have an excess of moisture or dryness, for they will lead to radically different therapeutics. From there it’s important to see into the relative temperature, hot or cold.

There are no specific positions on the pulse or tongue that indicate the underlying state of the musculoskeletal system, thus our primary evaluation criteria must arise through good intake and interview skills. Knowing the onset of the pain is important, along with any dietary and lifestyle factors that may contribute to the underlying cause. Leaky gut syndrome and potential food intolerances must be addressed, as they are often at the root of systemic inflammatory conditions- especially those with an autoimmune component.

Lastly, one of the most vitally important components for your evaluation criteria in regards to the treatment of pain is to take a symptom score. You need to have written down in your notes the frequency, timing, and severity of the pain so that you are able to track your results. Also good to note is the impact upon sleep and any improvements there as well.

The Energetic SystemFrom an astrological perspective, we see that the musculoskeletal system has a few primary rulers that are important to take into consideration. First and foremost of these is Saturn, who rules all of the structural components of the body: connective tissues, tendons, ligaments, cartilage and bones, as well as the joints themselves. These are all ruled by Saturn as well as Capricorn, the 10th Sign of the zodiac who is also ruled by Saturn. The Sign of Capricorn specifically relates to the knees, but as his ruling Planet is Saturn he takes governance of the bones and skeletal system as a whole. As the 10th Sign, the 10th House becomes an important area of the chart to consider as well. It’s important to remember that the joints themselves are also ruled by Saturn and Capricorn, as the hard structural materials, but the fluids and moisture within the joint are ruled by the opposing Sign, Cancer. This is similar to how the teeth are ruled by Saturn and Capricorn, but the gums and mucosa of the mouth by the Moon and Cancer. The muscles themselves are ruled principally by Mars, and inflammation as a whole by Mars.

So we have Saturn and Mars being our primary Planetary rulers of the bones and muscles, as well as the pain, inflammation and discomfort often associated with musculoskeletal issues. According to Cornell, the different areas of the body as ruled by the Signs (Aries in the head down to Pisces in the feet) may point to where in the body certain musculoskeletal issues may



reside, based on the position of either Saturn or Mars. Thus issues with the ankle connective tissues would be indicated by Saturn in Aquarius, the muscles of the arms and hands Mars in Gemini etc.

It’s important to remember and consider the reflex action of a Planet to the Sign opposite and squaring it’s placement. Thus the issues with the connective tissues in the ankles may manifest with Saturn being in the opposite Sign of Aquarius, Leo, or in one of the squaring Signs (90 degrees away) with either Scorpio or Taurus. This reflex action is important to remember, especially if you don’t see the Planet residing in the actual Sign corresponding to the area of the body afflicted. Houses can also be looked at in this regard, but these are typically tertiary to Sign reflexes. So perhaps Saturn isn’t in either Aquarius, Leo, Scorpio, or Taurus, but rather is residing in the 11th House (who rules Aquarius and thus corresponds to the ankles). This can start to make things a little confusing at first, but is oftentimes the secret key to opening up the chart to see the underlying influences if you cannot readily find it upon initial observation. It takes you deeper into the astral territory into the root astral causes.

Treatment then comes into the territory of sympathetic medicines associated with Saturn in order to rebuild, remineralize, and strengthen the structural tissues of the body. Anti-pathetic remedies of the Moon and Venus help to moisten and lubricate dried out tissues and cool down any excessive heat. Saturn also cools down the inflammation of Mars. Mars as anti-pathetic to Saturn helps to warm up and disperse stuck cold in the joint.

Primary Herbal Actions• Anti-Spasmodic: This is likely one of our most specific actions for the musculoskeletal

system, for they operate either directly upon the muscular tissues themselves, or indirectly via the nerve innervation to the muscles. Many cases of pain in the musculoskeletal system can be broken down into either tension and spasm, or inflammation (of course with multiple possible underlying tissues states). But tension and spasm is strictly under the wind/tension tissue state, and is principally treated with anti-spasmodics. I like to differentiate anti-spasmodics into a few categories, primarily those that are nervine sedatives or hypnotics, and those which are not.

Here are some good anti-spasmodics which are not necessarily strong hypnotics (though some may settle the nerves a little): Lobelia (Lobelia inflata), Wild Yam (Dioscorea villosa), and Crampbark (Viburnum opulus). Here are anti-spasmodics that will have a strong nervine actions: Valerian (Valeriana officinalis), Hops (Humulus lupulus), Pasque Flower/Pulsatilla (Anemone pulsatilla), Wild Lettuce (Lactuca virosa), Black Cohosh (Cimicifuga racemosa), Blue Cohosh (Caulophyllum thalictroides), Jamaican Dogwood (Piscidia piscipula)and Pedicularis species IE Indian Warrior, Parrot’s Beak, Elephants Head (Pedicularis spp.). Note: prior to using any of the above remedies, or at least to use in conjunction with them, should always be magnesium! Ideally 600 mg a day in divided doses.

• Anodyne/Analgesic: These words are often used interchangeably to describe a plant that will facilitate in the relief of pain. Now, pain is a relatively broad term, as people can experience pain for any number of reasons: inflammation, cramping or spasm, swelling, dampness and cold, heat and dryness, etc. Therefore our anodyne/analgesic materia medica



is relatively broad and due to numerous other actions each individual plant may have. Ginger is analgesic because it brings warmth and circulation to the local tissues and the oil has some numbing properties, whereas Willow bark is analgesic because it is bitter, cooling and draining to accumulated fluids in the tissues, as well as has a minuscule amount constituents which module inflammation. Other herbs yet are analgesic because they are anti-spasmodic, others because they are inflammation modulating, others still because they sedate the nerves.

When treating pain, it’s good to determine what the underlying cause of the pain is (whether it be damp or dry, hot or cold, in the muscles, connective tissues, nerves, or of inflammation, spasm and the like) and to select remedies that are appropriated for the specificity of the person’s discomfort. Some of our most common anodynes in the western materia medica include: California Poppy (Eschscholzia californica), Jamaican Dogwood (Piscidia piscipula), Wild Lettuce (Lactuca virosa), Valerian (Valeriana officinalis), Meadowsweet (Filipendula ulmaria), Willow bark (Salix spp.), Pedicularis species (Pedicularis spp.), Black Cohosh (Cimicifuga racemosa), and Kava-Kava (Piper methysticum).

• Circulatory Stimulant: These are extremely important in musculoskeletal conditions marked by coldness and/or dampness. By opening up the flow of blood throughout the system, the tissues are bathed in fresh oxygen and necessary nutrients, and any accumulated waste products stagnating and collective in the tissues are flushed out and carried to the appropriate channel for elimination. Many of our circulatory stimulants are also pungent digestive stimulants which assist in strengthening the digestive fire- a highly important consideration especially for chronic musculoskeletal conditions. A few reliable circulatory stimulants include: Cayenne (Capsicum annuum), Rosemary (Rosmarinus officinalis), Celery seed (Apium graveolens), Prickly Ash (Xanthoxylum americanus), Ginger (Zingiber officinale), and Angelica (Angelica archangelica),

• Diuretic: The diuretic action can prove to be extremely beneficial for certain musculoskeletal issues, primarily those due to accumulation of dampness in the tissues, metabolic waste products, and mineral deposits. By flushing out the tissues and the kidneys the body is able to remove the inflammatory trigger behind the pain. Chronic inflammation also tends to produce a hefty amount of metabolic waste products which can further congest and stagnate the blood and tissues. Of course there are many many diuretics in our western materia medica, but there are a few with specific applications in musculoskeletal pain and have secondary actions which are uniquely supportive. A few remedies are: Celery Seed (Apium graveolens), Pipsissewa (Chimaphila umbellata), Yarrow (Achillea millefolium), Boneset (Eupatorium perfoliatum), Gravelroot (Eupatorium purpureum), Dandelion leaf (Taraxacum officinale), Nettle (Urtica dioica), and Horsetail (Equisetum arvense).

• Rubefacient/Counterirritant: A rubefacient, also known as a counterirritant, is a topical application of plants, often through the use of a liniment, or even just using the fresh or powdered herb, to the afflicted area. They work through stimulating local circulation, bringing fresh blood supply and thus oxygen, nutrients, as the ability to carry away metabolic waste products. In this way, a rubefacient equally detoxifies and decongests the local tissues and brings them the nourishment they need for optimal function. Because it is a



topical application, they only work on the local tissue to which they are applied and may only have a short term effect (depending on the herb).

One of the most classic rubefacient herbs is fresh Nettle leaf (Urtica dioica). Of course this treatment can only be applied in the springtime when fresh leaves are available. Otherwise these remedies are typically pungent, circulatory stimulants with some analgesic properties: Horseradish (Armoracia rusticana), Cayenne (Capsicum annuum), Wintergreen (Gaultheria procumbens), Peppermint essential oil (Mentha piperita), Mustard seed (Brassica nigra), Rosemary essential oil (Rosmarinus officinalis), and Ginger (Zingiber officinale). Note: people with sensitive skin should test these remedies on a small area first before larger application as they can irritate the skin.

• Nervine: Nervines have a broad range of support for the musculoskeletal system and for general pain symptoms. As we have seen, the entire musculoskeletal system is directly innervated by neural tissue, making them inextricably linked. A majority of the materia medica acting upon the nervous system in a sedative fashion is also directly anti-spasmodic for skeletal and smooth muscles. They are especially useful in chronic pain conditions, where the pain levels are to the extent of the client loosing sleep and developing a certain degree of anxiety, frustration and stress because of it. They are obviously specifically indicated in pain directly associated with the nerves, such as sciatica or pinched nerves.

Strong nervines are also beneficial in pain management in that they can help the client to a certain degree distance their conscious awareness from the pain so that they are better able to function in their daily life. While not nearly effective as their pharmaceutical counterparts, sometimes simply by inducing a hypnotic or mildly narcotic state, a strong nervine can help someone to manage their pain while the underlying root causes are addressed.

Our stronger nervine materia medica in this regard includes: Valerian (Valeriana officinalis), Jamaican Dogwood (Piscidia piscipula), Hops (Humulus lupulus), Passionflower (Passiflora incarnata), Pedicularis (Pedicularis spp.), and Kava-Kava (Piper methysticum). Two other remedies that are extremely important for nerve specific pain are St. John’s Wort (Hypericum perforatum) and Prickly Ash (Xanthoxylum americanum).

• Nutritive Tonic: These would be our mineral rich remedies which can facilitate in rebuilding weakened connective tissues, bones and other structural elements of the body. They of course cannot replace an adequate nutrient dense diet and should also be used in conjunction with appropriate digestive reparation protocols to enhance absorption of nutrients in the gut. A few of our nutrient dense, remineralizing herbs include: Nettle leaf (Urtica dioica), Horsetail (Equisetum arvense), Comfrey (Symphytum officinale), Dandelion leaf (Taraxacum officinale), Alfalfa (Medicago sativa), Kelp and other sea vegetables, and bone broth. The latter, while not technically considered an herb, is an animal based medicine/food that is one of the most nutrient dense “superfoods” for rebuilding bones, teeth, connective tissues and other structural components of the body.

From a dietary perspective, nutrient dense soups, broths and stews with animal protein (lamb being best), dark leafy greens, mushrooms, sea vegetables and digestive stimulant herbs are a



must. These not only help repair the gut lining, but also provide deep vital nourishment for the body in an easily digestible form.

• Astringent: This category of plants are going to be best used whenever there is any indication of relaxed tissues. They are most definitely contraindicated whenever there is over-tonicity, that is too much tone in the tissues, with it’s peak being spasm and cramping. But for connective tissues that have been over stretched or strained, a good astringent can help to tighten those tissues back up to their proper tone. These are also beneficial for pain associated with prolapsed tissues or organs. Our best astringent in the west is of course Oak bark (Quercus spp.), but to mention a few others: Willow (Salix spp.), Sumach (Rhus typhina), Horsetail (Equisetum arvense), Sage (Salvia officinalis), and Nettle (Urtica dioica).

• Alteratives: This category of herbs is especially useful for people with arthritic pains due to damp accumulation, leaky gut pathology, liver stagnation, and generalized “bad blood.” By draining and drying the damp accumulation, cleansing the bloodstream and moving the liver we can correct the underlying cause of the pain. Standard alteratives can be applicable here, such as: Dandelion (Taraxacum officinale), Poke (Phytolacca decandra), Nettle (Urtica dioica), Burdock (Arctium lappa), Oregon Grape (Mahonia aquifolium), etc.

• Anti-Inflammatory: This is another one of those very general herbal actions that contains an extremely wide range of plants. It’s not a very good term used to describe plants, as herbs typically are not directly anti inflammatory (like drugs are), but rather many herbalists prefer to use the term inflammation modulating. This describes their actions much better, as plants tend to slightly dampen down the inflammatory process as opposed to turn the entire thing off. This is because inflammation is in and of itself a healing response of the body- to shut it down completely is to override the vital intelligence of the organism. While inflammation is typically considered a heat response, it’s important to remember that one can be inflamed due to an underlying tissues state that is not directly heat/excitation. We can have damp-heat, heat from cold, or heat from dryness (yin deficiency). In regards to the musculoskeletal system, inflammation is a peripheral response to something deeper that is occurring, be it an injury, overuse, or a response to a food antigen.

It’s important to know that herbs alone will not take away someone’s inflammation! Rather, it has to be approached from a holistic standpoint, with proper diet and lifestyle adjustment, adjunct therapies such as hydrotherapy, massage, chiropractics, body work, and sometimes even surgery. Also, plants are typically inflammation modulating due to different reasons, both energetically and chemically. Some are warming, others are cooling, some contain essential oils, others resins, and still others have salicylates or steroidal saponins. Most plants will also have their own unique affinities for different organ systems, secondary actions and uses. With that information in mind about each plant, you can select an appropriate inflammation modulating herb or herbs to add to a broad spectrum pain formula.

With that, here are a few plants that have traditional and modern use in the treatment of the musculoskeletal system that have displayed inflammation modulating properties: Turmeric (Curcuma longa), Yarrow (Achillea millefolium), Angelica (Angelica archangelica), Willow (Salix alba), Meadowsweet (Filipendula ulmaria), Quaking Aspen (Populus tremuloides), Birch (Betula



spp.) note the latter 4 contain salicylates, Devil’s Claw (Harpagophytum procumbens), Black Cohosh (Cimicifuga racemosa), Blue Cohosh (Caulophyllum thalictroides), Licorice root (Glycyrrhiza glabra) and Wild Yam (Dioscorea villosa).

• Emollient/Demulcent: Lastly we come to our demulcents and emollients. Typically these actions are looked at synonymously, but they are actually different. The first difference is that often people say a demulcent in an internal use and an emollient is a topical use. Another level of it is that a demulcent is moistening and soothing to dryness, whereas an emollient is a softening action- meaning that it helps to smooth out hardness and roughness in the tissues. That all being said, more often than not, something that is demulcent is also emollient and vica-versa. These actions are quite beneficial for the musculoskeletal system particularly when there is an underlying dry/atrophy tissue state, wasting of the tissues, stiffness and tension, and a lack of lubrication and moisture in the joints, skin, and mucosal membranes. Of course our general demulcents Slippery Elm (Ulmus rubra) and Marshmallow (Althea officinalis) are good for generalized dry/atrophy, but there are other remedials more specific for the joints. Here we have Pleurisy root (Asclepias tuberosa), Mullein (Verbascum thapsus), Solomon’s Seal (Polygonatum spp.), Dragon root aka False Solomon’s Seal (Smilacina racemosa), Burdock (Arctium lappa), and Licorice (Glycyrrhiza glabra).

Common SymptomsApart from injuries to the musculoskeletal system, a majority of symptoms and issues associated with these tissues are categorized as rheumatic diseases, of which there are over 100. Generally speaking they share common symptoms, such as pain, stiffness, and swelling in the joints, muscles, bones, and connective tissues of the body, leading to decreased mobility. It’s important here to differentiate the term arthritis which is often used relatively loosely. Arthritis is specifically inflammation of the joints and is but one type of rheumatic disease.

• Injury (Strains, Sprains, etc.): This is likely one of the most common reasons for musculoskeletal pain. Old or new injuries can very well be treated through the use of herbs and a few homeopathics to great effect, either by strengthening damaged tissues, relieving stagnant blood, resetting bones, and the like. To define a few terms, a strain is simply when a muscle is overextended or pulled, whereas a sprain involves tearing of muscle fibers or the blood vessels- hence a sprain is considered a more serious injury than a strain. These 2 common forms of injury are treated quite well simply with Arnica (Arnica montana) and/or Yarrow (Achillea millefolium). These 2 plants help to relieve stagnant blood and bruising, and the accompanying pain.

• Fibromyalgia: This disease is associated with chronic long standing pain in the skeletal muscles of the body- the old doctors loosely called it rheumatism. In our modern day, the root of fibromyalgia is linked with leaky gut syndrome and food intolerance, thus healing the gut lining and removal of food allergens becomes a primary focus of treatment, along with relieving discomfort and pain as much as possible. From an Ayurvedic perspective, fibromyalgia is said to be a disease of cold, tension and dryness, or vata, which has become lodged within the joints and muscles. It is typically considered difficult to treat without the underlying gut restoration protocols and cannot easily be relieved by simple anti-



inflammatories (drugs or plants). Lifestyle adjustment becomes of prominent importance, along with regulation of ones energy expenditure and not pushing physical limits too far. A single day of overexertion (which can be as simple as walking to the mailbox) can put one in bed for days on end due to exceedingly heightened inflammatory response. It’s worth noting also that there may be a link between fibromyalgia and hypothyroidism, which can lead to excessive “humors” to deposit in the joints and muscles.

• Osteoporosis: This is generalized weakness and demineralization of the bones. It typically occurs in the elderly and can be associated with menopausal women with lower estrogen levels (estrogen keeps bones strong). Bones can become weakened due to a number of reasons. One is simply constitutional weakness, another could be poor digestive function and absorption of minerals into the tissues. There may be chronic inflammation, hormonal or pH imbalances which lead to leeching of calcium from the bones which acts as an alkaline buffer. Lifestyle factors are certainly contributors as well, such as sessile lifestyle, little to no weight bearing exercise, poor diet with lack of protein and minerals, leaky gut syndrome, antibiotic or other prescription drug usage (side effects), endocrine imbalances, etc. Generalized support for osteoporosis or simply malnourished bones includes remedies which correct gut health, digestion and absorption of nutrients, nutritive tonic herbs which are mineral rich, primarily Nettle leaf (Urtica dioica), Horsetail (Equisetum arvense), and Oat Grass (Avena sativa). Mineral supplementation of not only Calcium, but Magnesium and other co-factors (especially vitamin K2) are extremely important. The supplement “Bone-Up” by Jarrow Formulas is an excellent remineralization formula for the bones that I have seen work wonders.

• Broken Bone: Injuries to the extent of broken bones often go beyond the scope of simple herbalism and into other therapies such as chiropractics and modern medicine. Yet, there are a few remedies which are extremely beneficial in helping bones to reset into their proper place and facilitate the healing process in general. The main remedies here include Boneset (Eupatorium perfoliatum)- though this remedy is disputed amongst herbalists as to whether it really does work in this way, if we observe Native American uses it was indeed their main remedy used for this. Comfrey (Symphytum officinale) is our primary European herb used to heal the bones, though it can lead to overgrowth and seal the bone back in incorrect places. According to Matthew Wood, “Comfrey will also seal a bone up before it is properly set, whereas Boneset, Mullein, and Gravel root will all increase secretion around the bone, get it snuggled into place, and then start setting it up. Comfrey is probably best in old people, where it is simply hard to get bone growth started.”

• Arthritis: As mentioned above, arthritis literally means inflammation of the joints. There are 2 primary manifestations of arthritis, the first being osteoarthritis and the second being rheumatoid arthritis. Osteoarthritis, also called degenerative joint disease, is the most common form of arthritis which affects millions of modern Americans. This is a gradual decay and wearing down of the cartilage in the joints, decreasing the cushioning in the joints. Rheumatoid arthritis on the other hand, is a degenerative autoimmune disease, where the immune system it literally attacking the joints and structural tissues of the body- primarily the connective tissues. This leads to chronic pain the joints, difficulty with movement, swelling and inflammation and eventual malformation of the joints to the point of



becoming crippled. This malformation and extreme welling often occurs in the fingers. It often manifests symmetrically in the body (IE both hands, both feet, both elbows etc.)

Like many autoimmune conditions, it’s root could be seen as the in the gut, with the lining being overly permeable and leaky, with the presence of systemic inflammation due to chronic ingestion of an intolerant or allergenic food. According to Matthew Wood, the roots of autoimmunity in general can be seen as 2-fold: 1) the mineralocorticoid side of the adrenal cortex is overactive, leading to heightened immune sensitivity and excessive heat, or 2) the glucocorticoid side of the adrenals is excessive leading to poor detoxification and the eventual lodging of toxins in the joints and connective tissues which ignite an autoimmune response (what the old doctors called “bad blood” or damp/heat and the need for alteratives). Thus we see this associated with 2 primary possible tissue states, heat/excitation (glucocorticoid) or damp/stagnation (glucocorticoid). But beneath all of this is likely some form of food intolerance and leaky gut, which would cause the adrenals to express this imbalance to begin with and thus takes it back a step further towards the root cause.

There are multiple expression of what many people term arthritis, which would be various manifestations of inflammation within the musculoskeletal system. Examples would be bursitis or tendonitis

• Gout: Traditionally considered a disease of kings or the wealthy, gout is a lifestyle symptom, associated with excessive consumption of acidic foods, red meat and alcohol. It is essentially deposits of uric acid within the joints, most commonly the big toe as it is the furthest from the heart and has the weakest circulatory innervation. While a few simple herbs have a great track record in the treatment of gout, the ultimate and only true cure is prevention through appropriate moderation of the diet and alcohol intake. The 2 most popular remedies in history used here are Cherry (fruits primarily) and Nettle leaf (Urtica dioica). Both are excellent diuretics, cooling, anti-oxidant remedies which help to remove the inflammation and reduce the deposition of uric acid. Celery seed (Apium graveolens) is also considered a specific for the treatment of gout.

Materia MedicaDue to the fact that there are a relatively limited number of symptoms associated with the musculoskeletal system, with pain being the primary one, I decided to discuss specific remedies and materia medica in it’s own section. Now a lot of herbalists tend to think that there isn’t much we can do for pain, since we don’t quite have the “big guns” that the doctors have- like the major pain medicines (IE opiates). But when we begin to observe our materia medica and the vast properties of herbal medicines, we begin to see that our plants have the capacity to target multiple pathways associated with the pain response that gets deeper to the root cause and can be much more effective in its treatment than a drug. We also see that through using plants and holistic therapeutics we can correct other underlying issues that contribute to the pain response. A lot of this comes down to correcting systemic inflammation, food allergens, and gut restoration.

It’s very easy to tunnel in on someone’s chronic pain and to try to “make the pain go away,” and in the process loose sight of the whole patient. If we loose sight of the whole person, then



we forget to try and restore their entire organism back to balance and end up trying to treat a symptom- the pain. When you focus in on the pain, you start to think about plants like drugs- using “anti-inflammatory” plants, much like doctors use anti-inflammatory drugs. This approach more often than not, doesn’t work! We want to take a holistic approach to the person, as well as to our use of plants. But most important, is to remove the root cause of the pain by any means necessary, which typically necessitates branching outside of the territory of herbalism. Of course, some causes cannot be removed, in which case we must do whatever we can to improve the quality of life of the person.

Some of the generalized types of pain people can experience are trauma, inflammation, muscular spasm or laxity, vascular pain (like headaches) or deeper metabolic pain (this could be differentiated by worse or better in the evening or morning, cycles throughout the body at different times). Pain is oftentimes so much more than just the localized pain. It is a process that progresses from the local area to other areas of not just the body, but the mind as well. We can think of this process as beginning with the localized area of the pain, the injury or what have you. Then there’s a compensation pain as we attempt to guard ourselves from the pain, which can then radiate to another part of the body, leading to tension, spasm or pain elsewhere. From there is the psychological and emotional stressors in response to the pain, loss of sleep and eventually depression if the pain becomes chronic. That depression is natural, as it is a reorganization of the psyche in order to incorporate the pain into ones life.

Below is a chart from Paul Bergner outlining the pain complex and some possible herbal actions to mediate that aspect of the complex:

Aspect of Pain Complex Potential Herbal Actions

Pain triggering chemical release Anti-inflammatory, counterirritant, circulatory stimulant

Edema Circulatory stimulant, diuretic, alterative

Compensatory muscle tension guarding painful area

Antispasmodic, relaxant, counterirritant

Compensatory systemic tension Antispasmodic, relaxant

Reactive systemic nervous excitability Sedatives, nervine relaxants

Eventual nervous depression Nervine tonics, antidepressants

Psycho-spiritual reaction Flower essences, homeopathy, spagyrics

Constitutional or metabolic aggravators Appropriate constitutional considerations. Systemic heat, cold, excess, deficiency, chi constraint, etc. hot-cold-moist-dry; liver moving



Below are details on some herbs commonly used in the treatment of pain and the musculoskeletal system. They have variously been organized by herbal actions or tissue state as needed.

Anodyne• California Poppy (Eschscholzia californica): This is one of our best anodyne remedies in the

western materia medica, meaning that it will help to slightly numb out an excessive pain response. It is especially beneficial because it also combines an antispasmodic and nervine action along with it, making it like a formula unto itself, useful for pain when there is an accompanying nervous stress response and insomnia with cramping and tension. While it is a poppy, Eschscholzia does not contain opiate compounds like it’s cousin the Opium Poppy. It’s taste is quite bitter and acrid, indicating it’s usefulness in heat excitation tissues states as well as wind/tension. The best preparation is of the fresh whole plant while in flower- roots, stems, leaves and flowers. There is a signature on the leaves of this plant, with the lining of the tips being red in color, in contrast to the silvery blue color of the rest of the leaves. I postulate that this is a signature of heat forcing itself out through the periphery, driven to the surface, with tension trapping it there. This is one of our top anodyne medicines in the western materia medica that makes an excellent lead herb in a pain formula. It’s also worth mentioning that this is considered one of the best nervine medicines for children, though the taste makes it rather difficult for administration.

• Wild Lettuce (Lactuca virosa): Another of the great anodynes, Wild Lettuce contains a milky white latex which contains compounds similar to opiate like constituents. It requires preparation which will make it more concentrated than a standard tincture, often achieved through macerating the fresh plant material in 95% alcohol multiple times and then gently evaporating off some of the alcohol to concentrate it. I have found that it responds well to Soxhlet extraction. Some patient herbalists will only collect the white latex and prepare a medicine from that, which was traditionally called lactucarium, or “lettuce opium.” It is an excellent anodyne herb for relieving pain, as well as a pretty potent nervine hypnotic. Important to consider is that it is a very bitter remedy which in higher doses will be quite cooling, to the point of damaging a cold constitution and decrease ones will power and motivation. Proper dosage varies amongst herbalists, with some saying teaspoon doses are necessary to achieve benefit, though Matthew Wood, true to his essence, uses very low doses of 1-3 drops. When studying his work on this plant, it’s important to understand that the specific indications he gives are for the low dosage at which he administers it- primarily being pain associated with cold invasion in the body. Note that this is an extremely bitter plant, which at higher doses would be contraindicated for cold type pain. He says it is specific for a slow and hard pulse, when cold “has invaded the body, causing hardness, stiffness, and pain.” It’s a specific remedy for low back pain, of which it combines nicely with Wild Ginger (Asarum caudatum). Because of it’s strong bitter taste, it also moves stuckness in the liver, especially when it is due to high levels of androgen hormones (IE testosterone) which can be difficult for the liver to metabolize. In higher doses it would be

Sleep disturbance Sedatives, hypnotics

Aspect of Pain Complex Potential Herbal Actions



indicated for heat/excitation tissue states, in lower doses cold/depression, either high or low doses it is indicated for wind/tension.

• Jamaican Dogwood (Piscidia piscipula): This remedy has been used for a long time by the Eclectics and Physiomedicalists for the treatment of pain. Like the other 2 above, it is an excellent nervine sedative remedy as well making it useful for people in pain and loosing sleep because of it. This is a powerful plant, and should be used with a bit of caution, as it can potentiate the action of other sedative remedies and make people drowsy, and toxic doses can lead to labored breathing, paralysis, and spinal convulsions. The British Pharmacopia recommends 2-4 mL of the tincture as needed- a pretty high dose, so we should be okay to use this remedy with our standard dosage suggestions. With the combination of nervine, anti-spasmodic, and anodyne actions, it is one of our best remedies in the treatment of pain, as it has a numbing effect upon the nerves and profound muscular relaxation. The Eclectic Finley Ellingwood states Jamaican Dogwood is “indicated in the three following conditions: (1) spasmodic affections; (2) neuralgic affections; (3) cerebral excitation.” Again this points out its actions as an anti-spasmodic and nervine sedative. The latter point, cerebral excitation, would show that it is useful when there is excess nervous activity and insomnia from overthinking or general excitability- the nerves are on edge. It is useful in gall stone and renal colic, as well as intestinal cramping- though Wild Yam (Dioscorea villosa) is a bit more specific for the latter.

• Pedicularis (Pedicularis spp.): These herbs are commonly referred to as Betony, but I prefer to call them Pedicularis to avoid confusion with European Wood Betony (Stachys officinalis). There are various species of Pediculars, including Indian Warrior (Pedicularis densiflora) and Elephant’s Head (Pedicularis groenlandica), among others. These members of the Scrophularaceae (Figwort and Mullein are in that family too) are some of our best musculoskeletal relaxants and anodyne remedies, primarily when the pain is rooted in the muscles. Thus they are chiefly anti-spasmodic remedies and combine well with others of this nature, but they are so useful for pain in the muscles that I decided to put them here in the anodyne category. An important consideration in these plants is that they are “parasitic” plants, meaning that they will uptake constituents from other plants growing around them. Thus take great care while harvesting, making sure they are not growing around other plants which may be toxic, such as Poison Hemlock, Lupine, or Senecio. I have personally found that a simple pair of Pedicularis (I was using P. densiflora) and Pulsatilla (Anemone occidentalis) produces a nice, warm cozy, sinking sensation in the muscles, unwinding tension and promoting a deep restful sleep. In this regard it combines nicely with other nervines, anti-spasmodics, and anodynes. Excessive consumption may lead to a wobbly feeling in the legs and perhaps a little drowsiness, so exercise caution with large quantities of use during the daytime.

Anti-Spasmodics- Wind/Tension• Lobelia (Lobelia inflata): We visit once again our great anti-spasmodic wind remedy Lobelia.

While it is extremely beneficial for all manner of muscular spasm, such as in the uterus, gall ducts, ureters, or GI, it also proves of benefit for skeletal muscle cramping as well, and can be applied topically as well as taken internally. Where Lobelia truly shines in it’s application here though is for torsion of the muscles, when there has been injury that involves the



muscles twisting and torquing in various directions, literally bending ones frame out of shape. This is especially useful in the case of car accidents, in which it combines quite nicely with Black Cohosh (Cimicifuga racemosa) when there is whiplash involved. The old physicians of the 1800’s stated quite well that Lobelia “equalizes the charge on the nerves,” just as Cayenne pepper “normalizes the circulation.” This is a powerful herbal pair with far reaching application in the treatment of musculoskeletal pain. It’s important to remember that Lobelia truly likes to be delivered in formula, as it is a “conductor” and likes to “boss other remedies around,” telling them where to go in the body for best effect. Thus including a small portion (say between 3-10%) in a formula can be extremely beneficial, especially whenever there is tension and spasm involved.

• Crampbark (Viburnum opulus): This remedy was discussed in relative detail under the female reproductive system, as it is one of the chief remedies used to relax uterine spasm during menstruation. I mention here again because it’s important to remember that Crampbark is not just a “women’s herb,” but a powerful anti-spasmodic with systemic application. It is another one of our acrid remedies with relaxant actions, potentially due to its content of valerianic acid, which is present in Valerian root as well. An important thing to keep in mind about Crampbark is that it has a stronger affinity for the smooth muscles as opposed to skeletal muscles, making it more applicable in cramping pains surrounding the organs. That being said, it can be included in a formula for skeletal muscle cramping as well with positive effect.

• Black Cohosh (Cimicifuga racemosa): This is another one of our great North American anti-spasmodic remedies that is often pigeonholed as a “women’s medicine,” yet has further reaching capacities outside simply being used for menstrual cramps and estrogen deficiency. This is an incredible relaxant anti-spasmodic for both smooth and skeletal muscles, especially when they are bound up from whiplash- a signature the flowering stalk carries as it whips around in the wind. To quote Matthew, “It is a remedy that both generates fluids and unbinds them, so that there is better flow of fluids in the organism, especially the all-important cerebrospinal fluids surrounding the nerves. Hence it is indicated in nervousness, spasm, convulsions, menstrual cramps, back pain and spinal injury.” I have used Black Cohosh in formula with Mullein and Devil’s Club for back pain and seen it work wonders, not only at reducing the tension in the muscles, but reducing inflammation, lubricating the synovial fluids between the vertebrae, and allowing the cerebrospinal fluid to become “unbound.” It is especially useful for the psychological dynamics around chronic pain when it enters a dark and brooding depressive phase, when people’s entire reality begins to revolve around the pain, when their identity is “bound” to it and they feel as it they have a black cloud hovering over them.

• Other important anti-spasmodics to keep in mind are: Wild Yam (Dioscorea villosa), Pulsatilla (Anemone pulsatilla), Pedicularis (Pedicularis spp.), Blue Cohosh (Caulophyllum thalictroides), and our nervine anti-spasmodics like Valerian (Valeriana officinalis), Hops (Humulus lupulus), Wild Lettuce (Lactuca virosa) and Passionflower (Passiflora incarnata).

Dry/Atrophy



• Mullein (Verbascum thapsus): Typically thought of primarily as a respiratory medicine, Mullein also has applications in the musculoskeletal system, as pioneered by Matthew Wood. This made sense to me, as the alchemists always classified the planetary ruler of Mullein to under Saturn- which always bothered me as I only thought of it as being used for the lungs (and thus figured it should be ruled by Mercury!). The root of Mullein has been used in this way to increase lubrication of the synovial fluids in the joints and between the vertebrae, the leaves being used to help set bones back into their proper place. I’ve heard a handful of case histories where the leaf taped over a misplaced rib set it back into place overnight! A rather magical property of this plant.... it is a bit mysterious. But, if we look to the taste and actions, it makes sense. Mullein is a salty remedy with some mucilage in it, showing that it increases secretions, lubricates and strengthens the mineral matrix- a nice set of actions for a joint. My summary of Mullein is that it softens that which has turned hard. We can think of this as softening the muscles surrounding an out of place bone or dislocated joint, and increasing the fluid secretions surrounding it allowing it to set back in place easier. The flowering stalk is a striking signature for the spine of which many propose it is a specific for. I’ve given it to dozens of people (including a chiropractor who used it extensively in his practice) who all said that their adjustments held longer than before, and went back into place with much more ease. I have combined it with Black Cohosh (Cimicifuga racemosa) and Devil’s Club (Oplopanax horridus) for this purpose to great effect. The latter remedy also holds a signature for the spine with it’s tall erect stalks, and through building up the kidneys can help strengthen the solar plexus, posture, and core strength. Herbalist Jim McDonald has long used Mullein root tea to straighten and take kinks out of the spine.

• Solomon’s Seal (Polygonatum spp.): This is likely one of our most important remedies for the musculoskeletal system, as it holds a broad range of actions upon the connective tissues, joints, fluids, muscles and bones. It is a sweet tonic, indicating it’s usefulness in dry/atrophic tissue states and has a cooling demulcent nature, useful for excess heat and inflammation. The roots hold signatures for the joints, as they look like bones and connective tissues. This remedy can be considered an amphoteric, meaning that it will act upon the tissues as they are needed- specifically in regards to their tone: if they are overly lax it will tighten them up, and if they are overly tones they will loosen up. Solomon’s Seal will help damp down an excessively inflamed joint, nourish and repair the tissues involved, and increase the synovial secretions to maintain it’s proper lubrication. Because it has such a strong affinity for the connective tissues, it also has applications in prolapsed organs. From a Chinese perspective, it would be considered a yin tonic, due to its moistening nature. This is especially useful, for many of our herbs are on the drying side- adding a bit of this herb to a formula can be extremely beneficial for balancing its constitutional effects. A specific thing about this remedy is that it is best used for the joints themselves, and not so much pain in the muscles- there you would want to reach for specific remedies for the muscles themselves, like Black Cohosh (Cimicifuga racemosa), Pedicularis (Pedicularis spp.), or Teasel (Dispacus sylvestris).Worth mentioning here is Dragon root, aka False Solomon’s Seal (Smilacina racemosa), a remedy which is used essentially the same as True Solomon’s Seal. The main difference here though is that Dragon root is best used when there is excessive bruising associated with musculoskeletal injuries.



• Pleurisy root (Asclepias tuberosa): Like Mullein, Pleurisy root is another remedy that is typically only thought of in its applications for treatment of the respiratory system. As it’s name implies, it has uses in treating inflammation and infection of the pleural membrane surrounding the lungs, essentially a fluid filled sac. It is also one of our best relaxant diaphoretics used in the treatment of fever. Though it does not merely relax peripheral tension to relieve internal fluids, it also functions in the generation of internal fluids, shunting the flow away from the kidneys and towards the lungs and skin. In this regard, it is especially useful for dryness of the joints, increasing the fluids within them and thus lubrication. It is indicated for acute bursitis and arthritis, especially when the joints have adhesions and crack and pop upon movement due to an excess of heat drying out the fluids. Pleurisy root is also well indicated for old injuries that never fully recovered. It combines well with other dry/atrophy remedies like Solomon’s Seal and Mullein.

• Licorice (Glycyrrhiza glabra): I wanted to briefly mention Licorice here, first because it is an excellent cooling, moistening demulcent remedy that can be formulated in tincture with other herbs, moistening their often drying effects. But we also see it is an incredible inflammation modulating plant. One of the ways it achieves this effect is by enhancing the life span of our bodies endogenous cortisol- our bodies innate anti-inflammatory compound. When someone has chronic inflammation over a long term period of time, the adrenal glands can gradually become exhausted from trying to maintain adequate cortisol levels of tamp down the inflammation. Over time, this response becomes weakened along with the glands, and the pain can worsen. Licorice helps to lengthen the half-life of cortisol so it remains active for longer in the body. As an adaptogen, it helps to rebuild fatigued adrenals as well as helps the liver to detoxify these hard to metabolize hormones. This is an extremely beneficial plant to consider in the treatment of pain, especially when there is a strong stress component associated with it. It is one of the best plants to combine with Turmeric (Curcuma longa) to enhance it’s palatability as well as modulate the overly drying properties of this potent anti-inflammatory remedy (it’s one of the only remedies I feel comfortable calling an anti-inflammatory so strong are it’s effects). I personally was using a simple triplet of Licorice, Turmeric and Solomon’s Seal for an old shoulder injury of my own and found it to be extremely beneficial in decreasing the pain and inflammation, and increasing the range of motion.

• Comfrey (Symphytum officinalis): One of our great bone menders and healers, Comfrey has a wide range of application for the musculoskeletal system- as indicated by an old folk name “knitbone.” Simple Comfrey leaf poultices were used to help heal broken bones and rebuild the surrounding connective tissues. Though there is warning here. Just as Comfrey can heal a wound too rapidly and not allow it to properly drain, so too can it heal a bone too quickly, setting it in the improper place. Thus, this remedy should only be used once the bone is properly set back into place- from there it is incredible in it’s actions. The allantoin found in this remedy stimulates cellular reproduction and growth, and the high mineral and nutrient content helps to nourish and strengthen the structural tissues. Always important to remember about this plant is it’s content of pyrollizidine alkaloids (PA’s) which make internal use questionable, especially for long periods of time. For it’s musculoskeletal actions, topical applications of Comfrey are sufficient and none short of profound. The best way to apply it is to take the fresh leaves, pound and moisten them, and apply over the



wounded area to form a kind of cast. Another method of application would be to make a strong infusion of the leaves, strain, and use that to hydrate bentonite or other form of medicinal clay. Apply this clay pack quite thick to the affected area, and wrap with a gauze or cloth soaked in the Comfrey tea. An important point is that you want to apply the clay as thick as you want it to penetrate into the tissues- thus to reach the bone requires a relatively thick layer. As a drawing agent, Comfrey can also be used for swollen, achy, inflamed and toxic joints, assisting in the removal of metabolic waste products. The mucilaginous properties likely increase the fluids within the joints and around connective tissues. Again, exercise caution in using this plant in regards to leading to overgrowths on the bone or other tissues. It’s generally suggested to do only a few days worth of treatments, then have a few days off to begin again.

• Horsetail (Equisetum arvense): I mention this remedy under the atrophy tissue state due to it’s ability to help to rebuild connective tissues and bone. This is primarily associated with it’s extremely high levels of silica. Another Saturnian remedy, Horsetail has a longstanding traditional use for building the structural elements of the body: bone, cartilage, tendons, and ligaments, as well as hair, skin and nails. One of the specific indications for it is when people’s nails become pitted, broken, and thin, the skin does not heal quickly or properly, and the hair is dry and easily cracked or split. It is said that the Horsetail person (or those with silica deficiency) tend to be nervous and overwhelmed and get in habitual patterns of biting their nails, twirling their hair, and picking at their skin. For rebuilding damaged joints, it is paired quite nicely with Solomon’s Seal. It is important to observe proper harvesting techniques with this remedy- only plants growing in the shade should be picked, and it is best done in the early spring before the finger-like fronds descend too far down the stalk. Generally anything at a 45 degree angle or higher is acceptable, anything below that is too far gone and may concentrate too many minerals for safe use. It is best taken as a tea, acetate (vinegar) or spagyric in order to get the minerals. Many materialists note that the silica within Horsetail is not bioavailable for the human organism to absorb and assimilate, also that most people do have a silica deficiency because it is a very abundant mineral. From the vitalist perspective though, it may not necessarily be that Horsetail is providing the physical compounds of silica, but rather the intelligence of silica- that is, how to utilize in the body most efficiently and effectively.

Circulatory Stimulants- Cold/Damp• Prickly Ash (Zanthoxylum americanus): This remedy from the eastern United States is an

excellent circulatory stimulant that also combines a diffusive action throughout the nervous system. It acts upon the crux of the nervous and circulatory systems. The diffusive effect is felt immediately after taking a few drops of a well made tincture- it tingles throughout the tongue and mouth, increasing salivation profusely! It is a great remedy to add as a driver to a formula to open up the circulation and move the herbs to the systems of the body with more ease. But in the treatment of pain, it is one of the best for nerve pain (along with St. John’s Wort). It is best used when there is shooting running pains along a nerve, numbness or tingling sensations, and arthritis in the joints from cold and dampness. Matthew always says about this remedy that it is specific for people in severe pain, to the point of describing it as torture. It is applicable in any manner of nerve injury or pain- from toothache to sciatica. According to Matthew Wood, Rue (Ruta graveolens), used as a homeopathic remedy



acts similarly to Prickly Ash as a irritating stimulant and will oftentimes work if Prickly Ash does not for nerve pain. They are in the same family (Citrus).

• Celery seed (Apium graveolens): This is an old remedy with a longstanding use as an “anti-rheumatic” herb- that is, used to treat rheumatism. I don’t put that under herbal actions because anti-rheumatic isn’t technically an herbal action, rather it tells us what it is used for. Celery seed is a warming pungent remedy through it’s volatile oil content, which increases circulation of the blood and yet contains a complex of flavonoids which modulate inflammation and is thus cooling. The furanocoumarins (apigravin, bergapten, celerin etc.) likely have a slight blood thinning property, allowing the blood to flow into hard to reach places- especially certain connective tissues like cartilage which are not directly innervated by the circulation. It has a strong diuretic action, which is responsible for much of its benefit in the treatment of rheumatism and draining dampness accumulated in the joints. Celery seed also has mild anti-spasmodic and nervine actions which make it also suitable for treating musculoskeletal pain. Through it’s diuretic action, Celery seed is said to facilitate in the removal of metabolic waste products that stagnate and accumulate in the joints, removing deposits of calcium and uric acid- hence it’s extreme benefit in the treatment of gout. Matthew Wood describes it well, “Like many salty emollients it penetrates into calcified or hard deposits, breaks them up, brings material back into the bloodstream and out through the kidneys, while increasing the flow of water through cartilage and joint, which is essential for their cleansing and feeding.”

• Rosemary (Rosmarinus officinalis): This is another traditional European specific for rheumatic pain. It makes sense, as Rosemary combines the actions of circulatory stimulant to expel damp accumulation, anti-spasmodic for muscular tension, and inflammation modulating. It is also a slight diuretic to help drain excess moisture. There is an old recipe in European medicine called “the water of the Queen of Hungary” which was essentially an infusion of flowering Rosemary tops in wine. This was used by the old Queen of Hungary Elizabeth in the 14th century to cure her rheumatism and gout. By increasing circulation, draining dampness, and warming up the system it is an invaluable remedy in treatment of cold musculoskeletal issues. It can also be applied topically as an infused oil, or essential oil diluted in a carrier for cold achy joints and muscles.

• Ginger (Zingiber officinalis): Another of our great simple and straightforward circulatory stimulants. Ginger can be added to formulas as a driver, like pretty much all of the remedies in this category, in order to open up the circulation and warm up with the periphery. But, also worth noting is that Ginger is also one of great inflammation modulating remedies and can be used for hyper-inflamed states. The strength of it is that it is warm and not overly hot and will typically not overheat someone (unless the medicine is made abnormally strong which is unnecessary). Like Rosemary, it makes an excellent liniment for topical application as well.

• Cayenne (Capsicum annuum): Cayenne can be used internally as a circulatory stimulant and driver in herbal formulas, but also operates biochemically on the pain response. It does so by draining “substance p” from the local area and thereby has an analgesic effect. This use is



typically achieved through topical application though, either by delivering the powder in a small amount of carrier oil or in a salve.

• Turmeric (Curcuma longa): And we come to Turmeric, the rock star of the herb world these days. It’s claim to fame? Inflammation. This remedy is so good at reducing inflammation it can almost be compared to an NSAID- it’s the only remedy I feel truly confident to call an “anti-inflammatory” as opposed to an inflammation modulator. It is commonly sold in herb commerce as a standardized extract, 95% curcumin, which is the constituent complex shown to have remarkable anti-inflammatory properties. Yet, standardized extracts is applying a biomedical approach to herbs, and through isolating those compounds other things may be left by the wayside which are synergistic in their effects. While Turmeric is an extremely valuable anti-inflammatory plant, it is important to not forget it’s other extremely beneficial actions, as well as it’s humoral effects. Anyone taking Turmeric will immediately note that it is quite pungent and warming, and very drying. Thus we want to be cautious in using this plant in our clients that are particularly hot and dry in their constitution- IE pittas. I personally find Turmeric to be extremely aggravating and have a few other friends who say the same. Of course, it can be formulated in a way to balance out that effect, the most common plant of which to put it with being Licorice (Glycyrrhiza glabra). In Ayurveda, they prepare it as “golden milk,” Turmeric powder mixed in warmed milk and honey, typically along with some other spices like Cardamom. The honey and milk modulate the drying effects and cool it down a bit.

Turmeric is not just anti-inflammatory, but acts as a potent circulatory stimulant, digestive bitter and carminative, hepatic decongestant and hepatoprotective remedy. It kindles the digestive furnace, decongests the liver and gall bladder, increases bile secretions, and moves the blood throughout the circulatory system. In this way, it is also a valuable alterative remedy with applications in chronic damp/heat conditions, skin problems, liver stagnation and even deeper seated liver disease (combines well with Milk Thistle and Dandelion root in that way). Thus, when you think of Turmeric, don’t just think of it in regards to musculoskeletal materia medica, but as an integral part of liver, digestive, circulatory, and detoxifying materia medica as well.

A Few Other Remedies• Teasel (Dipsacus sylvestris): This remedy has been gaining a lot of popularity over the last few

decades as a primary remedy in the treatment of Lyme’s Disease, in particular the inflammation, joint and muscular pain associated with it. Simply by gazing upon this intense looking thistle, one can see that it has a certain sharpness to its presence that indicates the Fire Element or Mars, and thus it’s usefulness in the treatment of inflammation. The large leaves form a sort of cup that holds water at the base of the stalk, a signature for the joints of the body and their fluid filled sacs. It is primarily used when the joints have been damaged from injury and are chronically inflamed and swollen. William LeSassier noted that it is specific for when the joint has completely lost its function, “had a use, but lost it.” This is also indicative of the mental state that may accompany such injuries, when people felt like they had a purpose which was lost due to the injury. It can be used as a simple to help people recover from surgery and repair damaged joints and muscles, or in formula with other remedies like Black Cohosh (Cimicifuga racemosa), Pedicularis (Pedicularis spp.),



Solomon’s Seal (Polygonatum spp.), and/or Lobelia (Lobelia inflata). In Lyme’s disease, it is possible that it may aggravate the condition at first as it “ferrets the spirochetes out of the deeper muscles and reanimates the system.” (Wood)

• Boneset (Eupatorium perfoliatum): As the name indicates, this is a classic remedy used to help in the resetting of bones. Many an herbalist will deny any association with this plant being used in a such a manner, as the old doctors of the 1800’s didn’t mention it being used in this way, but the indigenous people of North America definitely used it for setting bones. Most people attribute the name to its use as a fever medicine when there is deep seated pain in the muscles, joints and bones (of which it is also of great benefit). Another Saturnian medicine, Boneset is said to hold the intelligence the structures of the body- it knows where the proper placement of the bones are, how to reset them, and how to repair the bones and connective tissues in the surrounding area. There are multiple case histories of people using Boneset to heal broken bones- in the forms of tinctures or teas. This is a relatively magical property of this plant that is kind of difficult to explain rationally.... some hypothesize that it returns the bone to a stem cell phase so that it can regrow. How else can we explain this plan helping bones to literally regrow inches in length? If you or anyone else you know breaks a bone, start here before reaching for Comfrey as there is less risk of overgrowth of the tissues as there is with Comfrey.

• Devil’s Claw (Harpagophytum procumbens): This remedy originally comes to us from southern Africa, but has been used in western herbalism to the point of it essentially being a western herb now. There is a strong signature on the plant where the seed pods look like a misshapen hand (IE Devil’s Claw) that has been afflicted by rheumatoid arthritis. It has a remarkably bitter taste and is used as an alterative to detoxify the liver, blood, and GI. It’s primary actions are as an inflammation modulator, anodyne and bitter tonic for the liver and gallbladder. As a bitter, it is used for draining damp accumulation in the system, especially in the joints, and is specific for symptoms which are worse in cold damp weather. Research has shown that it helps the kidneys to eliminate uric acid more efficiently (gout) and also has applications in lowering cholesterol and high blood sugar levels. This paints a nice picture for when Devil’s Claw is best applied: kapha type constitutions with damp-heat in the joints, high blood sugar levels and cholesterol, poor digestion and low bile output by the liver and gall bladder. The poor digestion makes one more prone to toxic accumulations (canker or ama) in the joints. This is one of those remedies that requires consistent long term use in order to achieve the full benefits- at least 9 weeks is generally suggested.

• St. John’s Wort (Hypericum perforatum): Most herbalists tend to think of St. John’s Wort as a nervous system remedy used for depression and melancholy, or as a topical puncture wound medicine. But it’s affinity for the nervous system makes it applicable specifically for nerve related pain. It’s sphere of influence for the musculoskeletal system is thus not specific for that system, but oftentimes pain in the muscles and bones involves the nerves, for that reason I have included it here. We want to reach for St. John’s Wort whenever there is shooting sharp nerve pain that travels a very specific pathway in the body. The nerves will be inflamed, painful, with associated heat and redness and oftentimes accompanying muscular spasm. It is a specific for pinched or damaged nerves from injury or otherwise, which it combines very nicely with Prickly Ash (Zanthoxylum americanus). Over long terms



of use, it acts as a nerve trophorestorative and can help to repair damaged nerve tissue. For this it combines very well with Milky Oats (Avena sativa), Skullcap (Scutellaria lateriflora), Lion’s Mane mushroom. It also makes an excellent topical application as an infused oil.

• Willow (Salix alba): No discussion of pain would be complete without at least mentioning Willow bark, likely one of the first herbs most people think of in the treatment of musculoskeletal or other forms of pain. This is because of the presence of salicylate compounds which resemble aspirin. What most folks don’t know, is that one would have to consume nauseatingly large amounts of the decocted bark (somewhere around a few oz) to get a mere 1/4 of a baby aspirin. Thus, from a biochemical perspective, Willow bark is not operating on the pain response simply because it contains some aspirin-like constituents. That being said, it does have ancient use in the treatment of rheumatic pains, gout, inflammations of all sorts, and fever- though I do not recommend it in the treatment of fever for it is likely to be more of a suppressive action. Looking at the energetics of Willow, we see that its taste is bitter, acrid, astringent, and cooling. This makes it especially beneficial in painful symptoms associated with excessive heat and dampness. Think of it for a puffy, swollen, inflamed joint when there is poor digestion and leaky gut syndrome. The bitters facilitate digestion as a whole and the astringency helps to tone up leaky gut tissues. For headaches, it may aggravate a cold/deficiency type headache, but will likely be beneficial for a hot pounding excess type headache by helping to cool and drain the vital force down.

• Cannabis (Cannabis indica): This remedy is gathering a lot of attention these days thankfully not through it’s use as a “consciousness adjuster,” but through it’s medicinal virtues. It is not a plant I have much experience with clinically but there is now mountains of research on it being used in the treatment of chronic pain associated with cancer, fibromyalgia, rheumatism, and a whole lot more. It’s actions being a combination of anodyne, analgesic, anti-spasmodic, anti-inflammatory, and narcotic/hypnotic gives it a nice spectrum of influence on the pain response. Of course with the advent of strict CBD containing plant material makes this remedy much more available to people who would benefit from it but would rather not experience the adjustment in their consciousness. As I said, I do not have much experience with it in this regard, but always like to recommend to people that excessive use of this plant in forms that do alter consciousness can lead to other constitutional, physiological, and psychological challenges down the road- primarily due to its impact upon the nervous and endocrine systems, sleeping and eating patterns, and the spirit. It’s value it likely just beginning to be understood and I expect to see if being more integrated into modern herbal medicine than it has in hundreds of years (the Eclectics and Physiomedicalists have it in most, if not all of their materia medicas....)

Topical Applications• Ginger• Rosemary• Lobelia• Cayenne• Nettle (fresh leaf)• Peppermint (or menthol crystals)• St. John’s Wort



• Cannabis

A few homeopathics:• Bryonia: Worse with movement and use due to dryness and lack of fluids in the joints and

muscles.

• Rhus toxicodendron: Worse with inactivity, cold and damp, better with movement and warmth.

• Arnica: Injury with excessive bruising, broken bones and pain. 30c as soon as possible is best.I fell off a 10 foot loft in my yurt a number of years ago and landed right on my low back on the spine- it hurt pretty bad to say the least. 30c Arnica under the tongue and 15 minutes later I was back to work pain free. There was slight bruising the next morning which was gone by the end of the day. This is a must in your herbal first aid kit.

• Cell Salts: Calcium phosphate, magnesium phosphate, potassium phosphate, and sodium phosphate, Calcium fluoride & silica as well.

Other Contributing Factors

• NSAID’s (Non-Steroidal Anti-Inflammatory Drugs): These are the most widely used over the counter drugs in the world, used to treat headaches, pain, inflammation and fevers. They operate by directly turning off the inflammatory process mediated by an enzyme called Cyclooxygenase (COX). They are thus called COX inhibitors. While they are extremely palliative for acute symptoms, they operate through a suppressive mechanism which ultimately leads to further complications, especially with chronic use. This is why learning effective herbal and natural therapeutics for the treatment of pain is so critical because you can get people off of these drugs and prevent much more serious symptoms from arising in the future. Some of the side effects of NSAID’s include:

• Heartburn, abdominal pain, low appetite, diarrhea or constipation • Gastric or duodenal ulcers and gastrointestinal bleeding (over 9000 Americans die each

year from this serious side effect)• Note: main side effect is essentially triggering leaky gut syndrome.

• Headache, insomnia, dizziness, confusion• Skin problems• Interstitial nephritis, renal failure, blood in urine, cystitis, vaginal bleeding• Angina, arrhythmia, increasing risk of congestive heart failure, palpitations, edema

It is best to slowly wean someone off of NSAID’s, especially if they are taking them daily, as there is typically a rebound healing crisis that occurs from the vital force being suppressed for too long.

• Narcotics: For serious chronic pain sufferers, many allopathic physicians will place them on very powerful prescription narcotics based on opiates. These include drugs like Vicodin, Percocet, Oxycotin, etc. These drugs do not necessarily take the pain away, but rather



produce an altered state of consciousness (really a suppressed state of consciousness) that distances ones awareness from the pain. The pain isn’t gone, it just seems as if it is far away. They are extremely addictive and have a wide range of side effects such as suppressed appetite, constipation, liver stagnation, sleep disturbance, and drowsiness. The withdrawal symptoms are severe and similar to that of withdrawal from heroin: fever, musculoskeletal cramping, diarrhea, headache, nausea, vomiting, restlessness, and severe pain. These powerfully addictive narcotics are not only damaging to the human organism physically, but spiritually as well, as they disconnect our conscious awareness from our life force, loosing our presence in our daily life, suppressing our will power, dull our minds, and depress our spirits. Not to mention dealing with the demon of addiction. Herein lies another reason why having strategies and therapeutics can be of great benefit for our clients with chronic pain.

Nutritional Factors• Essential Fatty Acids: This is our fish oils and omega 3 fatty acids. Ideally 1000 mg of EPA a

day is the best place to start. Note this is 1000 mg of EPA, not 1000 mg of fish oil. If you read the bottles, many of them have 1000 mg of fish oil but only a 150 mg or so of EPA, the rest is a small amount of DHA and saturated fat, which won’t do much good. My favorite fish oil product is EPA Extra by Nordic Naturals.

• Magnesium: Extremely important for inflammatory pain as well as muscular spasm. “The magnesium deficient muscle is spasmodic” (Paul Bergner). Really indicated for tension and stiffness in the muscles. 600 mg a day in divided doses is a good place to start.

• Glucosamine sulfate: This is a very common supplement used by people with arthritis which has been shown to facilitate the reconstruction and healing of cartilage. It is an amino sugar (an amino acid and a simple sugar) which is used as the structural base for building connective tissues and the lubricating fluids surrounding them. Glucosamine is typically manufactured within the body from the amino acid glutamine and glucose, but sometimes is insufficient to maintain musculoskeletal health. Standard dose is 500 mg 3x a day. This supplement is best for wear and tear type musculoskeletal issues (osteoarthritis). Most of the time you will find glucosamine in combination with chondroitin, which is essentially filler and less active, making the product cheaper (glucosamine is expensive). So if you are going to recommend this to someone, it’s best to have them just take the glucosamine alone.

• MSM (Methylsulfonylmethane): This is a sulfur mineral which helps to rebuild connective tissue and the structural elements of the body (hair, skin, nails). This is an incredible mineral that works wonders! I can’t highly recommend it enough. I had a client who had a torn ACL in his knee, he took 12,000 mg a day and in 4 weeks was walking on it with no pain. 6000 mg a day is a good place to start.

Lifestyle Factors• Weight management and diet• Food allergens and leaky gut syndrome (antibiotic usage)• Hydrotherapy



• Body work: cranio-sacral therapy, osteopathic manipulation, chiropractic adjustments, structural integration, etc.

• Intermittent fasting: this is best for the damp accumulation pattern type pains. Not best for the dry type joint pain or in the elderly. This would include fasting from a food allergen.

Materia Medica

By Herbal Action

Anti-SpasmodicLobelia (Lobelia inflata)Wild Yam (Dioscorea villosa)Crampbark (Viburnum opulus)Black Haw (Viburnum prunifolium)Peony (Paeonia lactiflora)Black Cohosh (Cimicifuga racemosa)Blue Cohosh (Caulophyllum thalictroides)Valerian (Valeriana officinalis)Hops (Humulus lupulus)Pasque Flower/Pulsatilla (Anemone pulsatilla)Wild Lettuce (Lactuca virosa)Jamaican Dogwood (Piscidia piscipula)Pedicularis (Pedicularis spp.)

Circulatory StimulantsCayenne (Capsicum annuum)Rosemary (Rosmarinus officinalis)Celery seed (Apium graveolens)Prickly Ash (Xanthoxylum americanus)Ginger (Zingiber officinale)Angelica (Angelica archangelica)Turmeric (Curcuma longa)Myrrh (Commiphora myrrha)Osha (Ligusticum porteri)

AnodyneCalifornia Poppy (Eschscholzia californica)Jamaican Dogwood (Piscidia piscipula)Wild Lettuce (Lactuca virosa)Valerian (Valeriana officinalis)Meadowsweet (Filipendula ulmaria)Willow bark (Salix spp.)Pedicularis (Pedicularis spp.)Black Cohosh (Cimicifuga racemosa)Kava-Kava (Piper methysticum)



Musculoskeletal TonicsSolomon’s Seal (Polygonatum spp.)Mullein (Verbascum thapsus)Dragon root (Smilacina racemosa)Pleurisy root (Asclepias tuberosa)Nettle leaf (Urtica dioica)Horsetail (Equisetum arvense)Comfrey (Symphytum officinale)Dandelion leaf (Taraxacum officinale)Alfalfa (Medicago sativa)Boneset (Eupatorium perfoliatum)

DiureticsCelery Seed (Apium graveolens)Pipsissewa (Chimaphila umbellata)Yarrow (Achillea millefolium)Boneset (Eupatorium perfoliatum)Gravelroot (Eupatorium purpureum)Dandelion leaf (Taraxacum officinale)Nettle (Urtica dioica)Horsetail (Equisetum arvense)

AlterativesDandelion (Taraxacum officinale)Poke (Phytolacca decandra)Nettle (Urtica dioica)Burdock (Arctium lappa)Oregon Grape (Mahonia aquifolium)Celery seed (Apium graveolens)Red Clover (Trifolium pratense)Yellow Dock (Rumex crispus)etc.

“Anti-Inflammatory”Turmeric (Curcuma longa)Ginger (Zingiber officinale)Rosemary (Rosmarinus officinalis)Yarrow (Achillea millefolium)Chamomile (Matricaria recutita)Licorice (Glycyrrhiza glabra)

Nervine Hypnotics (stronger- nighttime use)Valerian (Valeriana officinalis)Passionflower (Passiflora incarnata)Hops (Humulus lupulus)



Pedicularis (Pedicularis spp.)Wild Lettuce (Lactuca virosa)California Poppy (Eschscholzia californica)Skullcap (Scutellaria lateriflora)

Nervine Sedatives (milder- daytime use)Chamomile (Matricaria recutita)Lemon Balm (Melissa officinalis)Catnip (Nepeta cataria)St. John’s Wort (Hypericum perforatum)Blue Vervain (Verbena hastata)Lavender (Lavandula angustifolia)

Simple FormulationsAn ideal herbal formula for pain will have a blend of various herbs with different herbal actions to cover the broadest spectrum of influence upon the entire pain complex. Thus, a good general formula will typically have the following elements: anodynes, antispasmodics, nervines, and hypnotics.

Anti-Spasmodic TripletBlack Cohosh (Cimicifuga racemosa)Wild Yam (Dioscorea villosa)Crampbark (Viburnum opulus)

Anodyne CompoundPedicularis (Pedicularis spp.)California Poppy (Eschscholzia californica)Wild Lettuce (Lactuca virosa)Jamaican Dogwood (Piscidia piscipula)

Nerve Pain TripletSt. John’s Wort (Hypericum perforatum)Kava-Kava (Piper methysticum)Prickly Ash (Zanthoxylum americanus)

Circulatory Stimulant TripletCayenne (Capsicum annuum)Rosemary (Rosmarinus officinalis)Prickly Ash (Zanthoxylum americanus)

Inflammation Modulating PairTurmeric (Curcuma longa) 60%Licorice (Glycyrrhiza glabra) 40%



Damp-Heat CompoundDevil’s Claw (Harpagophytum procumbens) 25%Turmeric (Curcuma longa) 20%Dandelion root (Taraxacum officinale) 15%Burdock root (Arctium lappa) 15%Nettle leaf (Urtica dioica) 10%Celery seed (Apium graveolens) 10%Poke root (Phytolacca decandra) 5%

Myalgia Triplet* Willow bark (Salix spp.) 50%Angelica (Angelica archangelica) 25%Nettle leaf (Urtica dioica) 25%

*This comes from David Hoffman

Pain and Sleep FormulaJamaican Dogwood (Piscidia piscipula) 20%Valerian (Valeriana officinalis) 15%Wild Lettuce (Lactuca virosa) 15%Pedicularis (Pedicularis spp.) 15%Crampbark (Viburnum opulus) 15%Turmeric (Curcuma longa) 10%Licorice (Glycyrrhiza glabra) 10%

Joint BuilderSolomon’s Seal (Polygonatum spp.) 20%Horsetail (Equisetum arvense) 20%Nettle leaf (Urtica dioica) 20%Boneset (Eupatorium perfoliatum) 20%Rosemary (Rosmarinus officinalis) 20%

Dry Creaky JointsSolomon’s Seal (Polygonatum spp.) 25%Mullein (Verbascum thapsus) 25%Pleurisy root (Asclepias tuberosa) 25%Licorice (Glycyrrhiza glabra) 15%Turmeric (Curcuma longa) 10%

Powder FormulaThis one comes from Paul Bergner. It is an excellent example of using corrigants to modulate the energetics and taste of a formula, as well as using a different delivery medium for the desired effect. This was given to a women with autoimmune pleuritis and prevented her from needing to take prescription steroids! Powerful formula, yet simple.



Turmeric (Curcuma longa) 3 partsLicorice (Glycyrrhiza glabra) 2 partsPlantain (Plantago major) 2 partsRose flower (Rosa spp.) 1 partAnise (Pimpinella anisum) 1 part

These are combined as powders. Fill a jar 1/2 way with the powders, then add honey until jar is approximately 3/4 of the way full, then add fresh citrus juice (either lemon or lime). Mix well and take 1 tsp 3x a day to start. Yummy!

Traditional North American Arthritis TripletPoke root (Phytolacca decandra)Black Cohosh (Cimicifuga racemosa)Prickly Ash (Zanthoxylum americanus)


lecture 1- musculoskeletal system · advanced clinical herbalism: musculoskeletal system weakness...

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