Welcome to Module
Herbal Support for Common Complaints


By the end of this module, you will have learned:

OVERVIEW OF IMMUNE FUNCTION
IMMUNE RESPONSE
COMPONENTS OF THE IMMUNE SYSTEM
Immune Response Cells
Immune-Related Organs and Tissues
IMMUNOMODULANTS
IMMUNE STIMULANTS
BODY ECOLOGY: BUILDING HEALTHY TERRAIN
SUPPORTING THE BODY WITH A HEALTHY DIGESTIVE SYSTEM
CHOOSING FOODS THAT SUPPORT HEALTHY TERRAIN
Wild Food
Whole Food
CLEANSING AND DETOXIFICATION TO SUPPORT TERRAIN
MINIMIZING EXPOSURE TO ENVIRONMENTAL TOXINS IN THE HOME
TONIC AND ADAPTOGEN HERBS
RESPIRATORY HEALTH
The Upper Respiratory System
The Common Cold
Allergies
Cough
Bronchitis
COLD AND FLU RECIPES

OVERVIEW OF IMMUNE FUNCTION

The fundamental purpose of the immune system is to protect the body from disease. This primarily means protecting against viruses, bacteria, and other disease-causing microbes—otherwise known as germs—along with other pathogens such as parasites and certain species of fungi. The immune system also scavenges dead or injured cells and tissues and removes abnormal cells as they develop.

The immune system does all of this defense work by recognizing what is "self" (the normal or healthy cells and tissues of the body) and what is "non-self" (pathogenic invaders such as bacteria and parasites, and other foreign compounds), and acting to remove or defend against anything that is recognized as "non-self." Anything that triggers this "non-self" reaction by the immune system is broadly considered an antigen.

Any disease-causing microorganism (i.e., a bacteria, virus, or fungus) is considered a pathogen. Antigens can come from pathogens, but they can also be found on foreign substances such as pollen, dust, or even some types of foods. Most pathogens are infectious organisms that will trigger some degree of immune response in everyone, but response to specific antigens is much more individualized. Most people will get sick if they're exposed to a flu virus (a pathogen), but not everyone has an allergic response to the same pollen antigens.

Both pathogens and antigens trigger an immune response when the body recognizes them as "non-self." The reaction may be localized—for example, itchy eyes and a runny nose after you inhale dust or pollen—or systemic, such as fever and muscle aches throughout your body when you have the flu. These are both instances in which the body is working to eliminate a pathogen or antigen; once the "non-self" substance is gone, the immune system slows its defense response and those symptoms of immune reaction begin to subside.

At least, that's what happens in a healthy immune system. When the immune system is out of balance, however, three general patterns of disease can arise:

  1. Overactivity or hyperreactivity to antigens, often resulting in allergies and excess inflammation.
  2. Underactivity or failure to respond to antigens, as in the case of immunodeficiency diseases.
  3. Breakdown in "self"/"non-self" recognition, where the immune system attacks the body even in the absence of pathogens or foreign substances, as in autoimmune disease.
In addition to the simple presence of antigens and the basic functionality of the immune response, herbalists and other holistic health practitioners take into consideration the idea of biological terrain, or the health of the organism as a whole. Terrain theory is the idea that the internal strength or balance of the individual is responsible for protecting them from disease or illness. It's sometimes described as an alternative to germ theory, but modern terrain theory doesn't necessarily mean that germs aren't the immediate cause of disease; it simply suggests that pathogens are able to take advantage of an environment in which they can proliferate and the immune system can mount the most effective response within the environment of a balanced organism.

IMMUNE RESPONSE

The immune system responds to different types of "non-self" antigens through a complex network of cells and chemical signalling molecules. Although the immune system works together as a whole, it's often discussed in terms of two primary types of immune response: innate and acquired immunity.

Innate immunity, also called non-specific immunity or immune resistance, is the defense system with which we are born; it is the first line of defense against pathogens and injuries and protects against infection in a generalized way. The skin and respiratory and digestive mucosa are key players in innate immunity, offering chemical and physical protection from pathogens; sweating, coughing, and sneezing are part of innate immune response as are the enzymes in tears and acids in the gastrointestinal tract, mucus, and saliva (MedLine Plus, 2018).

Acquired immunity, also called adaptive or specific immunity, allows cells to respond in a targeted way to specific antigens. If the innate immune response isn't sufficient to address a pathogen, it will activate the second line of defense, the adaptive immune response. This response includes memory cells that learn to recognize specific antigens, and can then mount a rapid and efficient defense against those antigens in the future. Adaptive immune response is slower to take effect against a new or unfamiliar pathogen—usually several days, rather than a few hours—but very efficient in defending against antigens it has previously encountered. (This is why we are said to "acquire immunity" against certain infectious diseases—after the first time they're encountered, the adaptive immune response "remembers" the pathogen and steps in to quickly fight off infection.)

Passive immunity is the result of antibodies that are directly introduced from another organism. For example, passive immunization occurs in newborns as a result of antibodies from the placenta and later, from mother's milk. Passive immunity also occurs from vaccinations that protect against pathogens (such as hepatitis and tetanus). Passive immunity gives immediate resistance to a pathogen, but it doesn't allow the body's own adaptive immune system to "recognize" the pathogen and produce its own antibodies, so it doesn't confer long-term resistance (MedLine Plus, 2018)


COMPONENTS OF THE IMMUNE SYSTEM

. The immune system is comprised of a team of organs and defense cells spread throughout the body; in order to successfully infect a human host, foreign organisms must pass through multiple layers of this protective network.

The first boundary to infection is the external immune response: the healthy antibacterial terrain of our skin, tears, mucus, saliva, and stomach acid. Normal skin is tough and generally impermeable to bacteria and viruses and it contains specialized cells that send early warning signs to the immune system when they detect foreign substances or pathogens.

Germs that pass through the nasal passage and lungs are trapped in mucus and swallowed, so they can be neutralized by digestive enzymes and acids in the stomach. Tears capture and expel germs before they can enter the body through the eyes. In this way, the body's external defenses keep most germs in circulation at bay.

If these physical and chemical barriers fail, the internal immune response sets in. The internal immune response identifies the pathogen and communicates with other cells to organize and coordinate the immune response to eliminate or suppress the germs. The internal immune response includes both innate (non-specific) resistance and acquired (specific) immunity.

The cascade of immune response takes places throughout the tissues of the body— immune cells need to be able to respond to pathogens anywhere they're found—but there are a number of immune-specific cells and tissues. Next we'll take a look at some of these key players.

Immune Response Cells

The primary immune response cells are types of white blood cells (WBCs), also known as leukocytes.
These are very specialized cells able to chase and engulf other cells and bacteria. They do not replicate themselves; instead they are produced in the bone marrow.
Leukocytes are divided into subtypes, according to their structure and unique functions:

Granulocytes: Immune responders found in the blood and tissues; granulocytes help fend off pathogens and are involved in inflammatory immune processes. There are three types of granulocytes: neutrophils, basophils, and eosinophils. Granulocytes are all phagocytes—they ingest and dispose of pathogens and dead or dying cellular debris.

Macrophages: Another type of phagocyte, macrophages help with cleaning up cellular debris and pathogens; they also play a special role in bridging the innate and acquired immune response phases by activating lymphocytes.

Lymphocytes: WBCs that are particularly concentrated in the lymphatic system; there are two types of lymphocytes, T-cells and B-cells, which are both activated during the acquired immune response.

B-cells: Lymphocytes that produce antibodies (proteins that precisely target and neutralize an individual antigen). B-cells also act as an amplifier during the immune response, using chemical signaling to activate more T-cells.

T-cells: Lymphocytes that directly attack pathogen-infected cells and release cytokines—chemical signals—that direct the progression of the immune response. T-cells develop into specialized subtypes with different functions: T-helper and T-killer cells, memory T-cells, and regulatory T-cells.



Immune-Related Organs and Tissues


Lymphatic system: The lymphatic system, also known as the lymph system, is a network that passively carries lymph fluid throughout the body, using the everyday movement of the body's skeletal and smooth muscles, and removes waste, dead cells, toxins, and pathogens. Lymph fluid originates as interstitial fluid that surrounds cells; it collects in lymph capillaries and then moves upward through the body toward the neck, where it eventually drains into venous circulation. Along the way, lymph fluid passes through masses of specialized tissue, known as lymph nodes, which act as filters. (These are the "glands" that may swell during infection, although they're not technically glands.)

Spleen: Located on the left side of the abdomen, near the stomach, the spleen produces lymphocytes and acts as a large lymph node, filtering out microorganisms and old red blood cells from the blood. It also acts as a storage reservoir for leukocytes (white blood cells), particularly the monocytes that move quickly to the site of inflammation to destroy pathogens and cellular debris. The spleen has a number of immune functions and anyone who has had their spleen removed due to injury or illness has a much higher risk of developing infection.

Bone marrow: A soft, spongy tissue found in the center of the large skeletal bones, bone marrow is a key component of the immune system, as it is the primary site of both red and white blood cell production. White blood cells have a lifespan of about 10 days, so they must be produced continually for normal immune function; consequently, bone marrow diseases have a profound effect on immune health.

Thymus gland: Located between the breastbone and the heart, the thymus gland acts as a training ground for immature T-cells. After production in the bone marrow, young T-cells move to the thymus, where they are exposed to various antigens and learn to differentiate between "self" and "non-self" cells. The size and activity of the thymus gland naturally decrease with age; this is linked with a decline in adaptive immune function among the elderly.

IMMUNOMODULANTS

Immunomodulant herbs have an amphoteric effect on immune function—they can both enhance the body's natural defenses to improve resistance and help rebalance an overreactive immune response, as in the case of allergies and hypersensitivities.
Many herbal immunomodulants, such as eleuthero (Eleutherococcus senticosus) root and reishi (Ganoderma lucidum) mushroom, are also adaptogens. This makes sense when you consider that adaptogens help the body respond in a non-specific way to all types of stress—infection and illness are certainly physiological stressors!
Astragalus – Astragalus membranaceus (Fabaceae) – Root

In Chinese medicine, astragalus is a classic immunomodulant. It is nourishing and sweet, and like all adaptogens can be taken long-term as a tonic. In fact, astragalus is often cooked into rice or taken as food in soups and broths all winter long to ward off illness.

Actions: Adaptogen, antioxidant, antiviral, cardiotonic, hepatic, hypotensive, immunomodulator, kidney tonic

Energetics: Slightly warming and moistening

Use: Astragalus is perhaps the most well-known of the immunomodulant herbs, and with good reason; it has been used for thousands of years in Chinese medicine to strengthen and restore vitality, and is now frequently used in Western herbalism to support both innate and acquired immunity and to boost deficient white and red blood cell counts. It's an excellent choice for promoting overall resistance, rebuilding reserves during convalescence, and supporting a depleted individual with low immune function; it can also help shift from immune hyperreactivity to a more normalized response, making it useful in long-term management of allergies and other reactive inflammatory conditions (Mao et al., 2004; Matkovic et al., 2010).

Astragalus also has a protective effect on the liver, and, taken together, these qualities make it useful as a support during some types of drug therapy to help minimize side effects.

It's often used alongside chemotherapy drugs, particularly in modern Chinese protocols, and multiple trials have shown that use of astragalus-based herbal formulas can increase the effectiveness of some types of chemotherapy while reducing their side effects (Wang et al., 2016).

In Chinese medicine, astragalus is considered a tonifying herb for both the qi and the Blood; in this system, tonic herbs are not used during acute illnesses such as colds and the flu. Some Western herbal practitioners also consider astragalus contraindicated during acute illness, while others specifically suggest it as an immune support during viral infection (Mills & Bone, 2005).

Safety: Astragalus may increase the effects of corticosteroids and cyclophosphamide in individuals with autoimmune disease (Gardner & McGuffin, 2013).

Dose: Decoction: 9-30 g dried root/day divided into 1-3 doses; Tincture: 2-4 mL (1:2, 30%) 2x/day (Mills & Bone, 2005).
Shiitake – Lentinula edodes (Marasmiaceae) – Mushroom

Shiitake is a mushroom native to China, Japan, and other parts of Asia that typically grows on broadleaf trees, including the shii tree, from which the mushroom takes its common name. It is among the most well-known of the mushrooms used in herbalism and is particularly well-suited for use as a therapeutic food—it has a long culinary history and a rich, earthy taste.

Actions: Antiviral, hepatic, hypocholesterolemic, immunomodulant

Energetics: Neutral to warming and slightly moistening

Use: Like other mushrooms used in herbalism, shiitake contains polysaccharides that stimulate immune function, notably T-cell activity. Compounds in shiitake also support the function of the innate immune response by stimulating white blood production and activity of natural killer cells (Stamets, 2002).

Several clinical trials have examined the therapeutic use of shiitake; one trial found that simply consuming 5-10 grams of dried shiitake mushrooms daily for 4 weeks increased levels of natural killer and T-cells, both important immune responders, and caused a decrease in markers of inflammation (Dai et al., 2015).

Shiitake mushrooms are both tasty and nutrient-rich, containing vitamins B2 and C, minerals such as potassium, calcium, and magnesium, essential amino acids, and, if grown in sunlight, vitamin D2 (Smith et al., 2002); they can easily be used fresh or dry in food-based preparations, including soup stocks and stir fries. Preparing high-quality tinctures of shiitake or other mushrooms is more complex than a simple maceration-extraction, and requires a two-phase extraction method that combines a water-based decoction with an alcohol-based extract.

Safety: Shiitake is food-like and generally well-tolerated, although large amounts may cause gastrointestinal disturbance in sensitive individuals. If you have autoimmune disease or are taking immunosuppressant drugs, therapeutic doses of shiitake are best used under the guidance of an experienced practitioner; culinary use is generally considered safe (Gardner & McGuffin, 2013).

Dose: Decoction (as tea or broth): 6-16 g dry mushroom daily, simmered for at least 1 hour (Hobbs, 1998).
IMMUNE STIMULANTS

Unlike immunomodulants, which can balance the immune response in either direction, immune stimulants turn up the volume of the immune response. They are often taken at the onset of illness and can be used throughout the acute phase of infection to help reduce its duration and intensity. During acute illness—at the start of a cold, for example—immune stimulants need to be taken frequently throughout the day, and sometimes even once or twice during the night, in order to keep the active compounds circulating throughout the body.
Echinacea – Echinacea spp. (Asteraceae) – Root, aerial parts
The root of this native North American perennial is one of the most commonly used herbs, which is one reason it's listed as an at-risk plant, so be sure to purchase only sustainably cultivated echinacea, or grow your own! Echinacea is a prairie flower that prefers full sun; it is drought-tolerant, easy to grow from root divisions or starts, and attracts butterflies and other pollinators.

Actions: Alterative, antimicrobial, immunomodulant, immune stimulant, lymphatic, sialagogue

Energetics: Cooling

Use: Echinacea is primarily an immunostimulant, but it can also have a role in addressing allergies and autoimmunity. It is frequently used at the onset of infections—especially upper respiratory infections with swollen glands—for colds, the flu, and sinus, throat, and lung infections; it can also used be used to help resolve infected wounds and improve lymphatic function (Awang, 1999).

In contemporary herbalism, echinacea is often recommended for short-term use. If you're trying to stave off upper respiratory infection, any herb, including echinacea, should be used as soon as possible after the onset of symptoms—but that doesn't mean echinacea is contraindicated after the first day or two of illness. In vitro research looking at the effect of echinacea in cells infected with rhinovirus, the microbe that causes the common cold, found that echinacea upregulates the activity of healthy cells, while simultaneously reducing the inflammatory activity of infected cells (Sharma et al., 2006). Thus, while echinacea does stimulate the immune system, it can also have overall anti-inflammatory activity during infection; this is one mechanism for its anti-inflammatory and vulnerary actions, and suggests that it can be appropriate to use echinacea throughout the course of active illness and infection.

If your tongue starts to tingle after taking an echinacea tincture—congratulations! This means your tincture is potent and contains all the right compounds. If you're troubled by the temporary tingle, try diluting it with extra water.

Safety: Individuals with allergic sensitivity to other plants in the Asteraceae (daisy) family may be sensitive to echinacea. There is a theoretical concern with the use of echinacea in systemic diseases such as tuberculosis, human immunodeficiency virus (HIV), and autoimmune diseases, but definitive data supporting or refuting this theoretical concern is lacking (Gardner & McGuffin, 2013).

Dose: Tincture: 1-5 mL (1:5, 50%) 3x/day (Mills & Bone, 2005); for acute situations, 30 drops every hour (Buhner, 2012).
Garlic – Allium sativum (Amaryllidaceae) – Bulb

Garlic is beloved by herbalists and cooks alike for its strong flavor and long history of use as a culinary herb, immune booster, and heart-helper. Garlic can be grown in almost any climate and acts as a beneficial companion in the garden—some of the same compounds that promote cardiovascular health act as natural insect deterrents and fungicides for other plants growing nearby.

Actions: Anti-inflammatory, antimicrobial, cholagogue, diaphoretic, diuretic, expectorant, hypolipidemic, hypotensive

Energetics: Warming

Use: Garlic is strongly antimicrobial, with an affinity for the digestive and respiratory systems. It may act directly against pathogenic organisms in the gut, and active volatile oils are excreted through the lungs and the skin—as you (or your friends) may have noticed, if you're a garlic lover! While this helps counteract infection, it also causes a notable body aroma that makes some people averse to using garlic therapeutically. Encapsulated aged garlic extract causes less odor on the breath and skin, and appears to improve overall immune function (Percival, 2016), although it is unlikely to have the same direct antimicrobial activity.

In addition to its direct action on pathogens, garlic can also ease some of the discomforts of a cold through its anti-inflammatory action, as well as shorten the duration of infection by stimulating the immune system, thinning mucus, and, by acting as a diaphoretic, helping to resolve fever.

To retain garlic's beneficial properties it should not be heated at a high temperature or for too long. Spread on toast or add to tea towards the end of steeping time and add plenty of sweetener and lemon!

Safety: Not surprisingly, the most commonly reported side effect from garlic use is halitosis. Gastric upset and reflux can occur in sensitive individuals. Those with gastrointestinal sensitivities or ulcers may find that garlic aggravates their condition. Use only culinary amounts if taking blood thinners and during pregnancy, in the postpartum period, and during lactation. Avoid 2 weeks before and after surgical procedures (Mills & Bone, 2005).

Dose: A clove of garlic can be eaten daily for general support or 1 clove of garlic can be taken 3x/day during acute infections (Hoffmann, 2003).
BODY ECOLOGY

It's not just what we eat that matters, however, it's also what our body can do with what we eat—even if we have a healthy diet, the body may be unable to properly assimilate the nutrients in the food that we eat by moving them out of the gut and into our cells and tissues.
As food passes through the GI tract, it's exposed to mechanical processes (chewing and muscular contractions) and chemicals (stomach acid and digestive enzymes) that break it down into smaller particles from which nutrients can more readily be extracted. The GI tract contains a number of specialized cells organized into layers of tissue; the innermost layer (the lining of the GI tract) comes into direct contact with the things we ingest and is called the epithelium.

Gut epithelial tissue has a number of unique jobs in maintaining the health of not just the digestive system, but the whole body. For example, it contains cells that communicate with the immune system—since the gut is one of the primary places pathogenic organisms can enter the body, immune cells monitor and respond to what's happening inside the digestive tract. The gut also needs to let nutrients into the bloodstream that are needed throughout the body, so the epithelium is selectively permeable, meaning only certain types of molecules are able to cross.

Like all mucosal tissues, the gut lining is susceptible to irritation and inflammation; when either occur, it can affect the terrain of the body as a whole in a number of ways, including altering immune response, allowing unwelcome molecules into the bloodstream, and failing to absorb vital nutrients.

The gut-brain axis is another example of the central importance of digestive health in overall terrain. We have an entire network of nerves in the GI tract (the enteric nervous system, which you'll learn more about in Unit 4) that is so extensive that it's sometimes called the second brain! This is a two-way communication network—it's not just the brain telling the gut how to digest food, the gut is also sending signals to the brain, including information about pain and other stressors.
You may already be aware that the food choices you make may profoundly impact your health. On a basic nutrient-function level, we need fats, proteins, carbohydrates, and an array of phytonutrients (plant chemicals) to build and maintain cells and the function of every organ in the body. We're also learning more and more about the impact of different food choices on health and wellbeing in some surprising ways, ranging from the negative impact of chemical fertilizers on gut health and gluten intolerance (Samsel & Seneff, 2013) to the demonstrated link between processed "junk" foods and depression (Lassale et al., 2018).

There's no one right diet for everyone—dietary choices are both highly personal and highly individual. The whole grains that cause one person to thrive may leave someone else feeling lethargic and bloated; a coconut milk and hemp seed smoothie might leave one person energized all day, but make someone else nauseous and itchy! There are a few benchmarks that most individuals can use, however, regardless of the specifics of their diet, to choose foods that support the body's vitality.

Wild-harvested foods are gathered from their natural habitat, rather than produced under controlled conditions on a farm. Wild foods have to be tough—the individual plants are both cooperating and competing with weather conditions, soil microbes, fungi and viruses, and other plant species around them. They've had millennia to develop adaptations, and in many cases the chemical compounds that have health benefits for humans, like flavonoids and organic acids, are actually part of the plant's defense system against browsing insects and larger animals.

In contrast, agriculture favors cultivars that have often been selected for their sweetness, size, uniform harvest time, or storage characteristics. This may involve a trade-off for content of vitamins, minerals and other trace nutrients; wild-harvested plants often have higher amounts of minerals and other micronutrients and contain a more diverse array of nutrient compounds than farmed produce (Milton, 2003).

There's also an educational benefit—and, it can be argued, an energetic or spiritual benefit—to harvesting some of your own food from the wild. It requires you to attend to the rhythm of the season and to learn about your immediate bioregion, the specific plants and ecosystems that surround you:
When does this particular plant bud, bloom, and die back?
How does the health of the plant population change year after year?
What other plants are growing nearby?


Whole Food

"Whole food" has become quite the buzzword in the last few years, thanks in large part to Michael Pollan, the eponymous supermarket chain, and, of course, the Internet and its vast number of food blogs. What's most surprising about whole foods is not that they're trending—it's the fact that we ever strayed from eating whole foods as the "norm!" Just two or three generations ago, food was food; it might have been dried, pickled, or preserved with salt or sugar, but that's about it. Now we do need to talk about whole foods, to differentiate them from a glut of inexpensive, readily available, ultra-refined processed "food products," which sometimes include more additives than actual food ingredients.

There's little room left to doubt that the overload of sugar, corn syrup, salt, and chemical additives in many highly processed foods are contributing to the modern epidemic of chronic metabolic diseases like hypertension, diabetes, and even some types of cancer (Rauber et al., 2018). And, as mentioned above, recent research has shown that high consumption of processed foods isn't just associated with depression, it actually increases your risk of developing depression (Lassale et al., 2018). The big problem with highly refined foods is that, first, they generally lose many of the original nutrients during the refining process—for example, when refined into white flour, whole grains lose almost all of their fiber content, along with vitamin E, B vitamins, magnesium, potassium, zinc, and iron (Haas, 1992). Another major problem is that highly refined, nutrient-poor foods simply crowd out more nutrient-rich foods from the diet—we're often eating highly processed foods instead of nourishing whole foods, not in addition to them.

The point here is not to demonize all processed foods—for one thing, "processed" is a relative term: even homemade sprouted sourdough bread is a processed food, since we had to mill the wheat berries to produce the flour! The occasional packaged snack won't cause a heart attack and busy modern lives necessitate compromise, but regardless of the basis of our diet—Mediterranean or paleo, low-carb, Whole30, or vegan—emphasizing whole foods is possibly the best dietary choice we can all make.

Does eating organic really matter? In 2012, a widely reported meta-analysis of published research concluded that there is no clinically relevant difference in nutrient content between organic and conventionally grown produce, but they did find, not surprisingly, that conventionally grown foods carry a substantially higher risk of contamination with pesticide residues (Smith-Spangler et al., 2012). The study's authors concluded that there was little health benefit to consuming organic food, but if you're concerned about the strong association between pesticide or herbicide exposure and neurological diseases, endocrine disorders, antibiotic resistance, and cancer (Sanborn et al., 2007; Benbrook, 2012) you might well beg to differ! In a published rebuttal to these conclusions, one pesticide researcher outlined the evidence for his claim that replacing conventionally grown fruit with organic fruit confers a 94% reduction in health risk (Benbrook, 2012)! A more recent population study also determined that consumption of organic food is inversely correlated with cancer risk—in other words, eating more organically produced food is associated with a lower rate of cancer (Baudry et al., 2018).

In the context of terrain and detoxification, consider that pesticides are one of the many exogenous compounds that must be metabolized in the liver before being excreted. Total body burden theory posits that an inability to efficiently metabolize and excrete these types of compounds is implicated in a range of health issues, from hormone disruption to autoimmune disorders; while we don't have sufficient clinical evidence to prove the connection between pesticide residues, metabolic detoxification, and health risks, we can choose to protect the terrain of our bodies—and of ecosystems as a whole—by choosing organically grown foods where possible.

Turning our awareness to how and what we eat and how food affects us and the world is part of the holistic lens through which we as Nutritional Therapist view life.

What and how we choose to eat have enormous effects on our health and on the health of the planet. Even so, eating is often an unconscious act. Many of us find it difficult to find time to sit down and enjoy a meal without needing to multitask as we chew. The vast amounts of diet theories, books, and recommendations on what to eat that bombard us daily can contribute to anxiety about our food choices. In addition, many people struggle with food addiction and negative body image, which adds another layer of emotional complexity to the act of eating.

While it may take some effort, shifting from unconscious eating habits to more mindful ones is an essential step toward a balanced relationship with food. With that in mind, we propose that you consider the following questions as you weigh all aspects of food: nutrition, health, ecology, farm workers, plants, animals, and our own individual communities. In assessing how food or food preparation affects you and the wider world, some questions to ask yourself include:

  • Where did my food grow?
  • How was it produced and by whom?
  • How do I feel when/after I eat this food?
  • How does the production of this food affect the whole community—not only humans, but all other beings, rivers and streams, the atmosphere, and the soil?
  • Did the agricultural practices used to produce this food harm the earth?
  • Did the practices used to produce this food cause another being to suffer unnecessary pain, discomfort, and/or loss?
  • Are whole, local foods affordable for all people in my community?
  • Am I eating mostly whole, unprocessed food?
  • Are the foods on my plate fresh, with lots of colorful fruits and vegetables?
  • Am I listening to my body when I choose food to eat?
  • Do I eat on the run or while engaged in other activities?
  • Is eating a joyful experience, full of flavor, connection, and vitality?
While shopping or choosing foods, take time to consider a few of these questions. Making note of your answers or other questions that arise will help you gain clarity about your own food choices and help you recognize emotional patterns associated with the food that you eat and the way that you eat it. When we start to think about the impact that food has on our health, the opportunities for cultivating wellness in our own lives are extended beyond the apothecary and into the kitchen. Each meal we prepare is a chance to invite in wellness, connect with plants and nature, and fully realize our beautiful, vital selves!

Fasting and cleansing have been used therapeutically since at least the time of ancient Greek medicine and in our long agrarian past, early spring may have required a limited diet, at least in colder climates, as winter food stores dwindled and the first fresh spring greens came on. But do we need to fast, cleanse, and detoxify? (The Internet certainly thinks so!)

There is certainly an argument to be made that modern humans need support for detoxification even more than our ancestors did—we are exposed to a mind-boggling array of synthetic chemical compounds in our food, water, and environment, which our bodies may not be able to effectively process and fully eliminate. Fortunately, the human body has a built-in detoxification system: the liver.


As far as detoxification goes, the liver's job is essentially to clean out chemical compounds that the body can't use and repackage them so they can be sent out as waste through the kidneys and GI tract. In order to get these compounds "out the door," enzymes from the liver need to break them down into smaller molecules and then bundle them up again in a more excretable form. This two-step process is the basis of metabolic detoxification. If the liver can't do this work efficiently, unprocessed compounds build up in the body and can cause cellular damage and ultimately contribute to disease processes. When people talk about "cleansing the body of toxins," this generally means allowing the body to do a more efficient job of eliminating these damaging compounds so that they don't remain in the body and build up in various body tissues.

There are many different approaches to cleansing and detoxification, ranging from mild to extreme. The "Heroic Medicine" tradition used strong cleansing and detoxification practices, including violent purgatives and bloodletting on the farthest end of this spectrum. Today's popular, quick-fix cleansing programs that rely on a combination of juice or water fasting, laxatives, and diuretics can also fall into this camp, depending on how they're applied.

In contrast, we can also promote detoxification using a slower and more nourishing or building approach. Dr. Aviva Romm uses an excellent metaphor to explain this approach: if we want to keep the outside of our body clean, it's better to take a shower every day, rather than taking 10 showers a day for a week (Romm, 2018). That's not to say there can't be a time and a place for an intensive fasting or detox program—but it's not necessarily the best approach for everyone, at every stage of health. If we're already in a deficient state—poorly nourished, showing signs of depletion, exhaustion, cold or dry conditions, or burnout—intensive fasting and purification is generally contraindicated. Likewise, it can be helpful to take our cues from the rhythm of the seasons; winter may not be the best time for a detox diet of raw, cooling foods and juicing out-of-season fruits and vegetables! But in springtime, after we've spent a few months eating a protein and fat-heavy diet and building up our reserves, we may feel ready to spend a week or two grazing on fresh new green vegetables and enjoying the tonifying herbs that crop up in spring.

Pesticide residues and other synthetic chemicals in foods and drinking water
are one source of these environmental toxins; the chemical cleaners we use in our homes are another. Taking a look at the warning labels on many common cleaners is eyebrow-raising! In addition to potentially harmful dermatologic and respiratory effects, some common household chemicals contain endocrine disruptors—chemicals that can cause metabolic and sex hormone disturbance by interacting with human hormone receptors (Dodson et al., 2012).

Unfortunately, these substances aren't confined to harsh cleaning agents—they can also be found in many cosmetics, sunscreens, and other personal care products—but replacing household cleaners with these simple, safe, and effective alternatives will give you a good start. There are also a number of "safe and natural" cleaning product lines on the market, but these require a keen eye for labeling, as they may still contain problematic chemicals.

  • White vinegar: Sanitizes and deodorizes (after it dries, that is!); dilute in water for general use.
  • Baking soda: Eliminates odors; scouring agent.
  • Borax: Cleaning and scouring agent; removes stains; antifungal.
  • Hydrogen peroxide: Antibacterial agent; stain remover.
  • Lemon juice: Removes stains and odors.
  • Liquid castile soap: Can be used for general cleaning and as a dish soap.
TONIC AND ADAPTOGEN HERBS

When we explore the use of herbs for keeping the general terrain of the body healthy, we might come across two terms: tonics and adaptogens. There's also a somewhat blurry line between tonic herbs and adaptogenic herbs—all adaptogens are tonics, to some degree, but not all tonics are adaptogens! Let's unravel this knot by sorting out these terms.
Tonic Herbs

strengthen the body through a general tonifying effect or through specific organ affinities by improving function, nourishing, and restoring health and vitality. A key property of tonic herbs is that, when used consistently for a period of time, they can restore the health of the organ system or the organism as a whole, so that improved function remains even after the herb has been discontinued. Tonic herbs are particularly indicated when there is a deficiency condition.

Often, herbs have a specific tonifying effect on a single body system, but may have multiple properties that work synergistically to tonify that system. Hawthorn is great example of a cardiovascular tonic: it improves circulation to the heart, promotes overall cardiac function, helps decrease elevated blood pressure, and protects the blood vessels from damage and inflammation, ultimately providing a "gentle and sustained reversal of degenerative, age-related changes" (Hoffmann, 2003, p. 542).

We also draw on the concept of tissue tone when we talk about herbal tonics. To restore tone is simply to return to a balanced, or appropriate, level of tension. Think of the tender stem of a dandelion: it needs to have enough strength to hold up the blossom without drooping, enough flexibility to sway with the wind, and enough "juiciness" to transport water and nutrients up from the roots. (A more prosaic example might be a laundry line: if your line is too slack, it will flop about and your laundry will drag on the ground; if it's too taut, your line will quickly fray in even a slight breeze.) When we talk about tonifying mucous membranes, we mean restoring function so that they are neither too lax (think leaky-faucet sinus conditions) or too tense (think constipation).

We may also refer to the activity of an organ system when we discuss herbal tonics. When we talk about tonifying the nervous system, for example, we might be referring to relaxing an overactive nervous system or stimulating function where there is underactivity.

You may also have heard the term "spring tonic" used to describe herbs or herbal formulas. These are just what they sound like: tonifying herbs—nutritive, restorative, enlivening—that typically appear in early to mid-spring (dandelion, anyone?). Many of these herbs are either lymphatic or digestive tonics, which is why they're often used as part of a spring cleansing and detoxification plan.

Here are just a few examples of tonic herbs, paired with organ systems:

Cardiovascular tonics: motherwort (Leonurus cardiaca) aerial parts, hawthorn (Crataegus spp.) berry and aerial parts, and garlic (Allium sativum) bulb

Uterine tonics: raspberry (Rubus idaeus) leaf, lady's mantle (Alchemilla vulgaris) aerial parts, and rose (Rosa spp.) petal

Nervous system tonics: oat (Avena sativa) milky tops, lion's mane (Hericium erinaceus) mushroom, and St. John's wort (Hypericum perforatum) aerial parts

Liver tonics: milk thistle (Silybum marianum) seed, turmeric (Curcuma longa) root, and dandelion (Taraxacum officinale) root

Kidney tonics: goldenrod (Solidago spp.) aerial parts, nettle (Urtica dioica) leaf, and horsetail (Equisetum arvense) leaf

Digestive tonics: artichoke (Cynara scolymus) leaf, angelica (Angelica archangelica) root, and bee balm (Monarda fistulosa) aerial parts

Respiratory system tonics: astragalus (Astragalus membranaceus) root, mullein (Verbascum thapsus) leaf, reishi (Ganoderma lucidum) mushroom

Adaptogenic Herbs

As mentioned above, all adaptogens are tonics—in fact, adaptogens are sometimes specifically classed as endocrine system tonics, though they can have an effect on other body systems as well.
As a brief introduction, it's helpful to know a few key points about adaptogenic herbs (also known as adaptogens):

  • Adaptogens have a normalizing effect on the body, particularly through their work to balance the endocrine system, helping to improve the body's ability to respond to both physical and emotional stressors with increased resilience.
  • Adaptogens may also have a balancing effect on the immune system, nervous system, or other systems of the body.
  • Adaptogens are not all the same; just like other herbs, there are nuances in their energetic and organ system affinities. Some adaptogens, such as ashwagandha (Withania somnifera) root, are more nourishing and building; others, such as rhodiola (Rhodiola rosea) root, are more stimulating.
  • Many adaptogens need to be taken over an extended period of time in order to see their full restorative benefit. (This is true of many other tonic herbs, as well.)
Adaptogenic herbs include eleuthero (Eleutherococcus senticosus) root, tulsi (Ocimum tenuiflorum) aerial parts, rhodiola (Rhodiola rosea) root, ashwagandha (Withania somnifera) root, reishi (Ganoderma lucidum) mushroom, schisandra (Schisandra chinensis) berry, and astragalus (Astragalus membranaceus) root.


THE RESPIRATORY SYSTEM

The lungs are among our largest organs, extending from the windpipe to the top of the diaphragm muscle, below the heart. Amazingly, only about 10% of the space occupied by the lungs is actually solid tissue; the rest is filled with air and blood (Huelitt & Clement, 2017).
The primary job of the lungs is, of course, to quickly and efficiently exchange oxygen from the air with carbon dioxide from the blood. This means that in addition to nourishing the body, the lungs are also a site of waste elimination.

Somewhat like the digestive system, the lungs are a nexus of interaction and exchange between the inner environment and the outer world; in both a spiritual and a basic physiologic sense, our breath connects us with the rest of the planet, and perhaps particularly to the plant kingdom, which so generously provides us with oxygen.


The upper respiratory system includes the nose, sinuses, pharynx (the part of the throat just behind the mouth), and the upper portion of the larynx (above the vocal folds). Fine hairs at the nostril openings and on the mucous membranes that line the sinuses passages act as filters to trap and remove pollutants and pathogens and help to humidify and warm the air. Two of the most common upper respiratory complaints are rhinitis and sinusitis, both of which may be caused by allergens, or viral, bacterial, or fungal infections.
The Common Cold

The common cold, another common upper respiratory complaint, is an acute viral infection of the respiratory tract and can result in inflammation of any or all of the upper respiratory organs. Colds by themselves are normally self-limiting and not serious, though they can leave the body vulnerable to more significant conditions, particularly bacterial respiratory infections.

Early stages of upper respiratory infections, such as colds and the flu, are considered exterior conditions; during this phase, the infection has not moved deeply into the lungs and the body can often swiftly "throw off" the virus, especially if given herbal support. Many herbal formulas intended for the first signs of infection include diaphoretic herbs, which help induce a sweat and encourage the "breaking" of a fever. Diaphoretics help to keep the infection from progressing to a more serious interior condition with deeper respiratory involvement. (See Lesson 1 for more information about immune stimulating herbs to help with the common cold.)

As with other tissues of the body, herbalists often look to the condition of the upper respiratory mucous membranes as a reflection of both local and systemic terrain; the color and condition of the mucus produced gives us information about what's going on in the respiratory system as a whole. Clear, runny, copious mucus is common in allergies, as well as in the common cold; it is generally associated with damp conditions and sometimes a lax tissue state. White, thickened mucus is often associated with a more cold and deficient internal state. Yellow or green mucus indicates the presence of oxidized white blood cells, and means that a higher degree of inflammation and/or infection is present; these are both generally heat conditions. (Note that the presence of green or yellow mucus is not an inherent indicator of either bacterial or viral infection, both of which can also be present when there is clear or white mucus discharge.)

Herbs that help bring upper respiratory disharmony back into balance include mucous membrane tonics, astringents, and anticatarrhals.

Mucous membrane tonics have an overall restorative effect on the mucosa of the body; mucous membrane tonics with a particular affinity for the upper respiratory system include goldenseal (Hydrastis canadensis) root, goldenrod (Solidago spp.) aerial parts, nettle (Urtica dioica) leaf, plantain (Plantago spp.) leaf, and elder (Sambucus canadensis or S. nigra) flower. (Note that goldenseal should be obtained only from sustainably cultivated sources.)

Astringents help to tighten up overly lax or leaky tissue, particularly mucous membranes. Astringents indicated for the respiratory system include goldenrod (Solidago spp.) aerial parts, plantain (Plantago spp.) leaf, ground ivy (Glechoma hederacea) aerial parts, and sage (Salvia officinalis) aerial parts.

Anticatarrhals help to ease excess mucus production or congestion, often by thinning the mucus and/or soothing mucosal inflammation. Anticatarrhal herbs include elder (Sambucus canadensis or S. nigra) flower, catnip (Nepeta cataria) aerial parts, ground ivy (Glechoma hederacea) aerial parts, and goldenrod (Solidago spp.) aerial parts.

As you may have noticed, many astringent herbs are also anticatarrhal, and, conveniently, many of the upper respiratory mucous membrane tonics are also astringent anticatarrhals! (Isn't Mother Nature brilliant?)

Always remember to take a holistic approach when choosing herbs; if tissues are already dry, hot, and irritated, a heavy-handed approach with anticatarrhal herbs can worsen the condition; in this case, stick with the anticatarrhal herbs that are also mucous membrane tonics, such as goldenrod or elderflower or add demulcent herbs to balance out your formula. Demulcents are moistening herbs that help to soothe inflamed and irritated mucosa, and are particularly indicated during laryngitis, pharyngitis, or any upper respiratory condition with dry mucosa; marshmallow (Althaea officinalis) leaf, flower, and root and licorice (Glycyrrhiza glabra) root are demulcents commonly used for upper respiratory conditions.


Allergies

Allergic rhinitis or sinusitis is a hypersensitivity reaction of the immune system, in which a person develops reactivity to otherwise harmless foreign substances. In allergic rhinitis, the immune system responds to an antigen—pollen, for example—by creating antibodies, unique proteins that are keyed to individual antigens. The next time pollen arrives in the body, these antibodies recognize that pollen as an antigen; the antibodies then bind to the pollen and set off the alarm response that results in local inflammation and triggers the array of familiar allergy symptoms: itchy eyes, sneezing, and mucus secretion. In addition to the localized reaction, some individuals experience fatigue, headache, and sleeplessness.

Although the allergic response is an acute issue, the immune hypersensitivity that underlies it is a chronic condition that requires long-term systemic support. Anti-inflammatory, mucous membrane tonic, astringent, and anticatarrhal herbs, such as goldenrod (Solidago spp.) aerial parts (astringent, anticatarrhal, mucous membrane tonic, anti-inflammatory), fresh nettle (Urtica dioica) leaf (astringent, anti-inflammatory), and plantain (Plantago spp.) leaf (astringent, mucous membrane tonic, anti-inflammatory) are all helpful for soothing the extreme discomfort of allergic sinusitis. Immunomodulant herbs and adaptogens, such as reishi (Ganoderma lucidum) mushroom and astragalus (Astragalus membranaceus) root can be used to help rebalance the immune system over time.

As with all chronic issues, we can also look to the health of the digestive system. Poor digestive and hepatic function are associated with increased body burden, and the accumulation of partially metabolized compounds in turn leads to immune hyperreactivity. Supporting the basic tissue state and function of the gut, and promoting good lymphatic and hepatic clearance, with herbs such as artichoke (Cynara scolymus) leaf and milk thistle (Silybum marianum) seed will help build a healthy terrain that can decrease immune sensitivity and allergic response.

Finally, an often-overlooked step in working with allergic rhinitis is removing, or at least minimizing, contact with the irritant or allergen; this can include practical changes such as the use of air filters, more frequent cleaning to remove dust, and the use of allergen-reducing pillow covers. Neti pot or other nasal lavage techniques are also useful in physically removing the irritant from the tissue, which helps reduce the severity of the allergic response (Tomooka et al., 2009).


Cough


Though they are often considered an annoyance, coughs do have an important function: expelling mucus from the respiratory tract. To facilitate this function, herbalists seek to promote expectoration (to aid the body in removing mucus from the bronchial tree), soothe irritation and inflammation of the respiratory passages, and tonify the respiratory tissue to help ward off recurrent infections.

A cough can present in a variety of ways, depending on the individual's tissue state and the immediate cause of the cough. A cough is somewhat like a fever: it has an important role, so we don't want to suppress it, but it can cause significant discomfort, so we do want to manage it. If a cough results from a dry, irritated tissue state, demulcent expectorants are needed to help loosen "stuck" mucus.

Marshmallow (Althaea officinalis) leaf, flower, and root, licorice (Glycyrrhiza glabra) root, and plantain (Plantago spp.) leaf are all demulcent expectorants. If there is a damp, congested tissue state, stimulating expectorants are more appropriate to help thin mucus and promote its upward movement out of the lungs. Stimulating expectorants include elecampane (Inula helenium) root, balsamroot (Balsamorhiza sagittata) root, and grindelia (Grindelia spp.) aerial parts.

The tissue state or energetic presentation of a cough can change as the underlying disorder progresses. For example, a cold may start out with a tickly, dry cough and irritated throat, but a couple of days later you may develop a thick, croupy-sounding chest cough with an abundance of phlegm. In the first case, you might not even choose expectorants, and rely on simple demulcents to soothe the tissue; in the second, stimulating expectorants would be called for.

When there is a very strong, wracking, or persistent cough, it may be appropriate to use antitussives, also known as respiratory antispasmodics—herbs that help quiet the cough reflex and relax the diaphragm and respiratory muscles—along with the appropriate expectorants and tonics. This is particularly true if the individual is coughing with enough force or frequency that they feel pain in the chest walls and muscles, or have a hard time drawing a full breath or sleeping through the night. (These are also signs that it may be time to check in with a health care provider, especially if the cough is lingering.) All musculoskeletal relaxant herbs can be helpful here, though wild cherry (Prunus serotina) bark is particularly useful.

Bronchitis

Acute bronchitis is most commonly the result of a viral respiratory infection that leads to a secondary bacterial infection of the bronchi, but it can also result from inhaled pollutants like smoke or dust. Most of the time, acute bronchitis is self-limiting, though painful and unpleasant while it lasts! However, in chronically ill or immunocompromised individuals, or those with chronic lung or heart disease, bronchitis has the potential to lead to serious complications if not addressed promptly and by a health care provider.

Symptoms of acute bronchitis include excessive mucus production in the lower respiratory system (sputum), cough, and sometimes fever; there may be slightly labored respiration and the presence of inflammation and mucus in the bronchi causes pain and fatigue. In bronchitis, the cough typically progresses through different tissue states; as David Hoffmann (2003) explains, "At first the cough is very dry, but as the lungs produce additional mucus in response to the infection, the cough becomes easier and less painful as the mucus lubricates the bronchi" (p. 323).

Expectorants and demulcents can be used for the cough that accompanies bronchitis, as described above, along with immune stimulants, such as echinacea (Echinacea spp.) root, andrographis (Andrographis paniculata) aerial parts, and spilanthes (Spilanthes acmella) whole plant to combat infection. If the individual has compromised lung or immune function, it's important to give substantial immune support to prevent development of pneumonia or other complications. Following the acute phase of illness, pulmonary tonics and restorative, nourishing herbs, including appropriate adaptogens, can be helpful, as it can take some time to recover fully from a bout of acute bronchitis. Pulmonary tonics include mullein (Verbascum thapsus) leaf, elecampane (Inula helenium) root, and astragalus (Astragalus membranaceus) root.

Steam inhalation and aromatherapy can also be used to address bronchitis. A few drops of eucalyptus (Eucalyptus spp.) essential oil on a cotton ball placed on top of a vaporizer in a bedroom at nighttime will allow the volatile oils to travel throughout the air.

Chronic bronchitis is a non-infectious, long-term condition that results in continual inflammation of the bronchi. It can result from repeated bouts of severe, acute bronchitis, extended exposure to environmental pollutants, or, most commonly, from smoking. Chronic bronchitis can range in severity, and in severe cases can result in an irreversible and potentially life-threatening obstructive lung condition.

Chronic bronchitis always requires medical attention; however, herbal support from an experienced practitioner can be an appropriate adjunct to conventional care, and may include the use of expectorant, anticatarrhal, and tonic herbs, along with attention to the individual terrain of the body and an emphasis on robust nutritional support.

COLD AND FLU RECIPES
1. Echinacea Root Tincture

The folk method of tincturing is quite simple. When you use the folk method, no measurement is required!

Ingredients

Finely chopped echinacea (Echinacea spp.) root, fresh or dryAlcohol (at least 80 proof): vodka or organic grain alcohol

Directions
  • Place the roots into a glass jar and fill about ¾ full.
  • Pour the vodka over the herb slowly, taking time to poke the mixture with a clean spoon or chopstick to distribute the alcohol completely through the herb material. Make sure that the herb is completely covered with alcohol.
  • Screw on a tight fitting lid, placing natural waxed paper under the lid to prevent corrosion and leaching.
  • Gently rock the jar back and forth making sure that the root is well-saturated.
  • Label and keep the jar in a cool dark place for 4-6 weeks. During this time, be sure to check on the tincture often and gently roll the jar back and forth in your hands, observing the alcohol levels. If there is any uncovered herb you will need to add additional alcohol to completely cover the plant material.
  • After 4-6 weeks, strain the tincture, bottle in a glass jar or bottle, and label.




2. Elderberry Syrup

Elderberries contain high levels of vitamins A and C and are chock-full of antioxidants. This syrup can be taken daily to strengthen the immune system or as needed to soothe a sore throat or ease a stubborn cough. It can also be taken during a cold or the flu to help decrease the duration of the illness. Remember, children under 1 year of age should not be given honey.


Ingredients

¾ cup fresh or ½ cup dried elder (Sambucus canadensis or S. nigra) berry4 cups water3 tbsp fresh ginger (Zingiber officinale) rhizome, chopped3 whole cloves (Syzygium aromaticum)3 sticks cinnamon (Cinnamomum spp.)1½ cups raw honey


Directions

  • In a large, covered stock pot, bring the water, berries, fresh ginger root, cloves, and cinnamon sticks to a boil.
  • Reduce the heat and simmer until the liquid is reduced by half and 2 cups remains in the pot.
  • Allow the mixture to cool just enough to handle.
  • Strain the herbs and return the liquid to the pot.
  • Add honey and stir to dissolve.
  • Pour the syrup into glass jars, label, date, and refrigerate.
  • Suggested usage for adults is 1 tablespoon up to 3x/day and for children is 1 teaspoon up to 3x/day.

Additional Resources (open in a new window):
Adaptogens by David Winston and Steven Maimes
Alchemy of Herbs by Rosalee de la Forêt
Beyond Pesticides-Eating with a Conscience Guide: https://www.beyondpesticides.org/resources/eating-with-a-conscience/overview
Environmental Working Group's Dirty Dozen: https://www.ewg.org/foodnews/dirty-dozen.php
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