Блог Анкара

The 5th Wave By Rich Tennant

We’ll – whisper your name – when your migraine medication is ready.*

In this part. . .

/%/ow that you’re in a Part D plan, I help you deal with # W Many situations that can arise. For those of you who’ve joined a plan for the first time, I begin by explaining what happens immediately after enrolling. Then I consider in detail many aspects of receiving Medicare drug coverage — things you need to know about filling your prescriptions, falling into or avoiding the coverage gap (the infamous "doughnut hole"), lowering your drug costs, switching from one Part D plan to another or being dropped from a plan, using your Part D coverage in a long-term care facility, filing complaints against your plan, and appealing against decisions your plan makes that you don’t agree with.

Whether you’re new to Part D or already a veteran of the program, you’ll find a lot of useful information and tips here to help you. This part is your go-to reference section for navigating Part D from the inside in all sorts of circumstances.

Chapter 13

In This Chapter

^ Defining your goals for emotional and behavioural change

^ Motivating yourself

^ Recording your progress

F

■ f we had to define the purpose of therapy, its purpose would Not Be to

Make you a straighter-thinking, more rational person. Rather, the purpose of therapy is to help you achieve your goals. Thinking differently is one way of achieving those goals. CBT can help you change the way you feel and behave. This chapter helps you define your goals and suggests some sources of inspiration for change.

Aaron Beck, founder of cognitive therapy, says that CBT is whatever helps you move from your problems to your goals. This definition emphasises the pragmatic and flexible nature of CBT, and encourages clients and therapists to select from a wide range of psychological techniques to help achieve goals in therapy. The crucial message though, is that effective therapy is a constructive process, helping you to achieve your goals.

Putting SPORT Into I/our Goals

Many people struggle to overcome their problems because their goals are too vague. To help you develop goals that are clearer and easier to set your sights on, we developed the acronym SPORT, which stands for:

Specific: Be precise about where, when, and/or with whom you want to feel or behave differently. For example, you may want to feel concerned rather than anxious about making a presentation at work, and during the presentation you may want to concentrate on the audience rather than on yourself.

Positive: State your goals in positive terms, encouraging yourself to develop more, rather than less, of something. For example, you may want to gain more confidence (rather than become less anxious) or to hone a skill (rather than make fewer mistakes).

Think of therapy as a journey. You’re more likely to end up where you want to be if you focus on getting to your destination rather than on what you’re trying to get away from.

Observable: Try to include in your goal a description of a behavioural change that you can observe. Then, you can tell when you’ve achieved your goal because you can see a specific change.

If you’re finding it hard to describe an observable change, think to yourself: ‘How would the Martians, looking down from Mars, know I felt better simply by watching me?’

Realistic: Make your goals clear, concrete, realistic, and achievable. Focus on goals that are within your reach, and that depend on change from you rather than from other people. Try to visualise yourself achieving your goals. Realistic goals help you to stay motivated and focused.

Time: Set a timeframe to keep you focused and efficient in your pursuit of a goal. For example, if you’ve been avoiding something for a while, decide when you plan to tackle it. Specify how long and how often you wish to carry out a new behaviour, such as going to the gym three times a week for an hour at a time.

Some goals, such as recovering from severe depression, can vary a lot in terms of how long they take to achieve. Setting schedules too rigidly can lead you to become depressed or angry at your lack of progress. So, set your deadlines firmly but flexibly, accept yourself if you don’t achieve them on time, and persevere!

Homing In on HouJ \lou Want to Be different

Defining your goals and writing them down on paper forms the foundation of your CBT programme. This section helps you identify how you may want to feel and act differently.

Setting goals in relation to your current problems

To set a goal concerned with overcoming an emotional problem, you first need to define the problem, which we talk about in Chapter 6 (where we explore unhealthy emotions and behaviours and their healthy counterparts). Also refer to Chapter 7, in which we explore how attempts to make yourself feel better can sometimes make problems worse.

A Problem statement Contains the following components:

Feelings/emotions

A situation or theme that triggered your emotion

The way you tend to act in the situation when you feel your problem emotion

Befitting how you Want to feet as an alternative

CBT can help you attain changes in the way you feel emotionally. For example, you may decide that you want to feel sad and disappointed, rather than depressed and hurt, about the end of your marriage.

Aiming to feel ‘okay’, ‘fine’, or ‘relaxed’ may not fit the bill if you’re dealing with a tough situation. Feeling negative emotions about negative events is realistic and appropriate. Keep your goals realistic and helpful by aiming to have healthy emotions. Try to maintain an appropriate level of emotional intensity when faced with difficult events (take a look at Chapter 6 for more on healthy emotions).

Defining how you Want to act

The second area of change that CBT can help you with is your behaviour. For example, after going through a divorce, you may decide that you want to begin seeing your friends and return to work, instead of staying in bed and watching TV all day.

You can also include changes to your mental activities within your goal, such as refocusing your attention on the outside world or allowing Catastrophic (upsetting or worst-case scenario) thoughts to simply pass through your mind (refer to Chapter 5 for more on this).

Making a statement

A goal statement Is very similar to a problem statement – they have the same components, but the emotions and behaviours are different. A good goal statement involves the following:

To feel_(emotion)

About_(theme or situation) and

To_(behaviour).

So, for example, you may want to feel Concerned (emotion) about Saying something foolish at a dinner party (situation) and to Stay at the table in order to make further conversation (behaviour).

Maximising \lour Motivation

Motivation has a funny way of waxing and waning, just like the moon. Luckily, you don’t necessarily have to feel motivated about changing before you can take steps forward. Motivation often follows rather than precedes positive action – often people find they ‘get into’ something once they’ve started. This section suggests some ways to generate motivation and encourages you to carry on working towards goals in the temporary absence of motivation.

Identifying inspiration for change

Lots of people find change difficult. Your motivation may flag sometimes, or you may not ever be able to imagine overcoming your difficulties. If either of these situations sounds familiar to you, you’re in good company. Many people draw on sources of inspiration when starting with, and persevering through, the process of overcoming emotional problems. Sources of encouragement worth considering include the following:

Role models who have characteristics you aspire to adopt yourself.

For example, you may know someone who stays calm, expresses feelings to others, is open-minded to new experiences, or is assertive and determined. Whether real-life or fictional, alive or dead, known to you or someone you’ve never met, choose someone who inspires you and can give you a model for a new way of being.

Inspirational stories of people overcoming adversity. Ordinary people regularly survive the most extraordinary experiences. Stories of their personal experiences can lead you to make powerful personal changes.

Focus on taking a leaf out of an inspirational individual’s book, not on comparing yourself negatively with someone’s ‘superior’ coping skills.

Images and metaphors. Thinking of yourself as, for example, a sturdy tree withstanding a strong wind blowing against you, which can be an inspiring metaphor to represent you withstanding unreasonable criticism.

Proverbs, quotes, and icons. Use ideas you’ve heard expressed in novels, religious literature, films, songs, or quotes from well-respected people, to keep you reaching for your goals.

Focusing on the benefits of change

People often maintain unhelpful patterns of behaviour (such as, consistently arriving late for work) because they focus on the short-term benefit (in this case, avoiding the anxiety of being on a crowded bus or train) at the time of carrying out that behaviour. However, away from the immediate discomfort, these same people may focus on wishing they were free from the restrictions of their emotional problem (being able to travel carefree on public transport).

Completing a cost-benefit analysis

Carrying out a Cost-benefit analysis (CBA) to examine the pros and cons of something can help galvanise your commitment to change. You can use a CBA to examine the advantages and disadvantages of a number of things, such as:

Behaviours: How helpful is this action to you? Does it bring short-term or long-term benefits?

Emotions: How helpful is this feeling? For example, does feeling guilty or angry really help you?

Thoughts, attitudes, or beliefs: Where does thinking this way get you? How does this belief help you?

Options for solving a practical problem: How can this solution work out? Is this really the best possible answer to the problem?

When using a CBA form such as the one shown in Table 8-1, remember to evaluate the pros and cons:

In the short-term In the long-term For yourself For other people

Try to write CBA statements in pairs, particularly when you’re considering changing the way you feel, act, or think. What are the Advantages Of feeling anxiety? And the Disadvantages? Write down pairs of statements for what you feel, do, or think Currently, And for other, healthier alternatives. Tables 8-2 and 8-3 show a completed CBA form. You can find a larger, blank cost-benefit analysis form in Appendix B, which you can photocopy and fill in.

I may end up running off atthe I’ll be able to concentrate on what’s being

Mouth and people might not like me. said and I won’t seem so distracted.

Table 8-3 Second Cost-Benefit Analysis: ‘Costs and Benefits of Preparing in My Head What I’m Going to Say Before Speaking’

Costs Benefits

I can’t relax into the conversation. I may think of something funny or entertaining to say.

Sometimes, I feel like the conversation moves on before I’ve had the chance to thinkof the right thingto say. I cantake more care not to offend people.

After you’ve done a CBA, review it with a critical eye on the ‘benefits’ of staying the same and the ‘costs’ of change. You may decide that these costs and benefits are not strictly accurate. The more you can boost your sense that change can benefit you, the more motivated you can feel in working towards your goals.

Write out a motivational flashcard that states the Benefits of change And Costs of staying the same, Drawn from your cost-benefit analysis. You can then refer to this to give yourself a motivational boost when you need it.

A large aspect of achieving a goal, whether learning to play the guitar or building up a business, is about accepting temporary discomfort in order to bring long-term benefit.

Recording your progress

Keeping records of your progress can help you stay motivated. If your motivation flags, spur yourself on towards your goal by reviewing how far you’ve come. Use a problem-and-goal sheet like that in Figure 8-1, to specify your problem and rate its intensity. Then define your goal, and rate your progress towards achieving it. Do this at regular intervals, such as every one or two weeks.

1. Identify the problem you’re tackling. Include information about the emotions and behaviours related to a specific event. Remember, you’re feeling an Emotion About a Situation, Leading you to Behave In a certain way.

2. At regular intervals, evaluate the intensity of your emotional problem and how much it interferes with your life. 0 equals no emotional distress, and no interference in your life, and 10 equals maximum possible emotional distress, at great frequency, with great interference in your life.

3. Fill in the goal section, keeping the theme or situation the same, but specifying how you wish to feel and act differently.

4. Rate how close you are to achieving your goal. 0 equals no progress whatsoever, at any time, and 10 means that the change in your emotion and behaviour is completely and consistently achieved.

Using the form below, identify one of the main problems you wish to work on in therapy. A problem statement includes information about the emotions and behaviour related to a specific situation or event. For example: ‘Feeling depressed about the end of my marriage leading me to become withdrawn and spend until around 6pm each day in bed’ or ‘Feeling anxious about social situations leading me to avoid going to pubs, restaurants, and meetings, or to be extremely careful about what I say

If I do socialise’. Think of writing your problem statement as filling in blanks: Feeling_(emotion) about_(situation), leading me to_(behaviour).

Use the same format to identify the goal you would like to achieve, but this time specify how you would like things to be different in terms of your emotions and behaviour.

Rate how close you are to achieving your goal. 0 = No progress whatsoever 10 = Goal achieved and sustained consistently

Change doesn’t happen overnight, so don’t rate your progress any more frequently than weekly. Look for Overall Changes in the Frequency, intensity, And Duration Of your problematic feelings and behaviours.

Mercurial desires

People often find that they want to change their goals on a whim or a fancy. For example, you may have a goal of being more productive and advancing your position at work. Then, after going to a Summer Solstice rave, you decide that really your goal is to be free and to travel the world, communing with the essence of life. Whatyou choose asyour definitive goal is upto

You. But be wary of being influenced too easily by whatever’s foremost in your mind. Constantly abandoning former goals and adopting new ones can be a mask for avoidance and procrastination. Use the SPORT acronym, as described atthe start ofthis chapter, to assess the durability and functionality of each of your chosen goals.

In This Chapter

^ Finding out about different types of herbal medicine ^ Understanding how it works

^ Discovering what herbal medicine can be good for ^ Knowing what to expect in a typical consultation ^ Knowing how to find a safe and effective herbalist

Erbal medicine is the oldest and most widely used form of medicine in the world today. All ancient cultures and folk medicine traditions used

Herbal remedies and even today around 80 per cent of the world’s population

Are said to use plants as their main form of medicine.

Many common Western medical drugs are actually based on plants, and modern research has enabled the active ingredients of different medicinal plants to be isolated so that we can have a better understanding of how they work in the body.

Herbalists specialising in Western medical herbs, or herbs from other traditions, such as the Chinese, Ayurvedic, Tibetan, and Japanese herbal medicine systems, are now quite widespread in the Western world.

In this chapter, I delve briefly into the history of herbal medicine and also consider how it is practised today. I take a look at different types of herbal medicine, discuss what herbal medicine is used for, and consider the evidence for its effectiveness.

I tell you what a typical herbal medicine consultation is like and I end with some tips on how you can make your own herbal remedies.

Finding Out about Herbal Medicine

Herbal medicine is the use of plant materials to prevent and treat disease. Various parts of the plant may be used such as the root, berries, bark, leaves, and flowers, and these may be made into ointments, tinctures, teas, creams, powders, and pills.

You can obtain herbal remedies over the counter, make them up at home, or have them prescribed by a professional herbalist. Herbal remedies and herbal medicine consultations are hugely popular and to protect the public various steps are underway to regulate both herbal medicine as a profession and herbal remedies sold to the public.

Since herbal medicine is so widespread, and the predominant form of medicine in many parts of the world, some argue that it should not even be regarded as a form of complementary medicine at all, but rather a type of mainstream medicine. In addition, in some countries such as Japan you have to be medically qualified in order to prescribe herbs. However, in the UK, US, Australia, and some other countries herbal medicine has the status of a complementary therapy and it is therefore included as such in this book.

A (very) brief history of herbal medicine

All ancient cultures and their peoples evolved some sort of herbal medicine using local plants for health and healing. The ancient Greeks, Egyptians, Persians, Chinese, Indians, Tibetans, and Native Americans are all known to have made good use of herbs. Several of these cultures also developed comprehensive Materia medica, Ancient texts outlining different plants and their medicinal uses, which are used even today. Herbal know-how was developed initially using trial and error and then formulations were refined as knowledge grew. Travelling physicians and monks also played an important role in the development of herbal medicine as they grew plants, experimented with remedies, and took news of different herbal cures between countries and cultures.

In the Middle Ages, several individuals in religious settings made detailed studies of plants and used them to treat both their religious community and the lay communities in their locality. Hildegard of Bingen, for example, a German girl who was sent to join a religious community from the age of eight after having a series of mystical visions, rose to head her religious community and wrote many accounts of the healing properties of plants.

Others didn’t fare as well and many wise women who’d mastered the use of herbs as medicines are believed to have been burnt at the stake as witches because of their so-called powers.

The Doctrine of Signatures is an idea that became widespread in the 17th-century based on a religious belief in the unity of all things in nature. The idea is believed to have originated from a young German shoemaker, Jakob Bohme, who was shown in a vision the design of God’s creation, which involved a divine imprint on all living things just waiting to be revealed. The alchemist Paracelsus expanded this idea and suggested that close observation of the colour and form of plants could give vital signs as to

Their medical use. For example, a plant with yellow flowers or sap may be used to treat jaundice, while one with a leaf the same shape as the liver may be used to treat liver diseases. Paracelsus called this idea the Doctrine of Signatures and published a book describing many plants, their signatures, and possible medicinal uses. This concept can also be found in some Native cultures, and is an attractive idea that sometimes turned out to be correct but often was not and is nowadays generally disregarded.

The invention of the printing press in the 15th-century meant that herbal knowledge could be spread more widely, and pioneers such as the alchemist Paracelsus and later the 17th-century botanist and physician Nicholas Culpeper wrote herbal texts that had a profound impact on the theory and practice of herbal medicine. Paracelsus travelled widely, picking up tips on medicinal remedies and compiling them into various texts outlining the medicinal properties of different plants. He was also responsible for popularising the idea of the ‘Doctrine of Signatures’.

^jOOTf Nicholas Culpeper, an English physician, botanist, herbalist, and astrologer, Ј/^m ^\ was against many of the barbaric practices and high fees charged by most doctors in his day. Having married into a wealthy family he was able to treat many patients for free and he also firmly believed in empowering people to treat themselves. He published a low-cost pamphlet on herbal medicinal cures, which became a bestseller, much to the anger of many of his greedy physician colleagues! He also wrote a large number of academic texts on herbs and their healing properties, which are still used as a valuable reference by herbalists today.

With scientific advances in the 18th-century, herbal medicine began to fall out of favour, and by the 20th-century, with the development of medicinal drugs such as penicillin (used to treat infections) and insulin (used to treat diabetes), herbal medicine had been relegated to a side note in mainstream medical practice. Laboratory work was increasingly used to isolate individual ingredients from plants and to test their medicinal effects. As a result many compounds have been isolated and reproduced synthetically to form modern pharmaceuticals. For example, the compound digoxin, extracted from foxglove (Digitalis purpurea), Was isolated and used to make heart medications, and extracts of salicylic acid from willow bark (Salix alba) To make aspirin.

Modern scientific work on plants has also increased the sophistication of knowledge and training in the therapeutic use of plants and today herbalism has come back into prominence as a major healthcare profession.

Herbal medicine today

In the UK, herbal medicine is currently going through a process of voluntary regulation. Until this regulation is completed, anyone can call themselves a herbalist, so check details of your herbalist’s training and experience. British medical herbalists and phytotherapists have normally undergone lengthy training and are members of a reputable professional association that controls standards of training and practice (see the later section ‘Finding a Good Medical Herbalist or Phytotherapist’). In the US, no formal register of herbalists exists and laws regulating the practice of herbal medicine vary from state to state.

Herbal medicine is hugely popular in other countries around the world, from the African countries, to South America, to Australasia, and is recognised by the World Health Organisation (WHO) as an important system of medicine.

Many modern herbalists now use herbs from more than one tradition around the world.

Grasping the idea behind herbal medicine

The world has around 422,000 different species of flowering plants (as estimated by plant conservationist Dr David Bramwell), of which only a tiny proportion has been investigated scientifically for their medicinal properties. Yet it is known, from those that have been investigated, that plants contain a great variety of active ingredients that can have powerful effects on different body systems or individual organs. For example, some may have a general relaxant or stimulant effect while others can specifically alter heart rate, lower blood pressure, induce vomiting, alter liver function, and so on. Their effects may also be different when used singly or in combination with other plants.

In herbalism, the idea is to use plants to stimulate the body’s natural healing ability and restore balance. Herbalists need to have a comprehensive understanding of the constituents of different plants, the appropriate uses of different herbal formulations, the effects of different plants and herbal formulations on the body, their role in the treatment of different diseases, and also possible interactions of different herbs with each other or with standard medicinal drugs.

Herbalists generally believe in the Theory of Synergy, That is, that the whole plant has a more potent therapeutic effect than individual ingredients of the plant in isolation. The Theory of Synergy thus relates to the idea of the perfection inherent in nature. For example, the plant meadowsweet contains salicylic acid, which is the basis for the drug aspirin (willow bark also contains this compound). Salicylic acid or aspirin taken in isolation can trigger stomach irritation or even bleeding. Yet meadowsweet also contains mucilaginous compounds, that is, compounds that form a mucous-like coating to soothe and protect internal tissues. Thus use of the whole plant can counteract the possible harmful effect of salicylic acid taken on its own.

Another example of the Theory of Synergy is the use of pharmaceutical diuretics (drugs designed to get rid of water retention by stimulating urination) compared to herbal ones. Diuretic drugs can cause a loss of the mineral potassium in the body, which has to then be replaced with potassium supplements. In contrast, dandelion leaves, used by herbalists, have a strong diuretic effect but also contain potassium thus preventing any lowering of potassium levels.

Exploring Different Types of Herbal Medicine

The main types of herbal medicine practised currently in the West are: Western, Chinese, Japanese, Tibetan, and Ayurvedic herbal medicine.

Western herbal medicine

Western herbal medicine has its roots in the Greek and Roman medical traditions and also incorporates influences from other cultures including the Native American tradition. (The herb Echinacea, for example, mentioned later in this chapter as an immune booster, was a centuries-old Native American herbal remedy that was gifted by a tribal chief to the naturopath Alfred Vogel, who brought its seeds to Europe for cultivation. Read more about this story in Chapter 13 on naturopathy.) Western herbal medicine is based on herbs that grow freely in Europe and America, many of which have now been extensively researched. Some are common garden herbs such as parsley (a diuretic that helps ease water retention) or camomile (for easing tension and aiding relaxation). However, some Western herbalists also now use herbs from other parts of the world.

Most responsible Chinese herbal practitioners are very concerned about protecting endangered plant and animal species. Traditionally, Chinese herbal medicine has included extracts from certain rare plants and various animal body parts, such as rhinoceros horn or bile from the gall bladder of bears. The Register of Chinese

Herbal Medicine (Www. rchm. co. uk) prohibits its members from using such ingredients, but Chinese herbal medicine practitioners who are not members of this organisation may not be so scrupulous. To ensure that you’re doing your bit to protect endangered species, checking membership and ingredients is always best.

Chinese herbal medicine

Herbal medicine is a branch of the thousands of years old system of Traditional Chinese Medicine (TCM). Based on ancient texts such as the Shang Han Lun (The Discussion of Cold-induced Disorders), Several hundred different types of plant materials, as well as some non-plant ingredients (such as animal products or minerals) form the basis of Chinese herbal formulae. Often, several herbs are combined in one formula and the herbs are generally given in their raw form to be made into teas, or in the form of herbal pills. Formulae are designed to rebalance the Yin And Yang In the body and the Five Elements (for more about these, see Chapter 4) and are tailored directly to the patient, often based on ancient formulae.

Sv—

Japanese herbal medicine

The Japanese herbal medicine tradition, known as Kanpo, Is based on the same principles as Chinese herbal medicine but aims to identify and treat the overall constitution, or Sho, Of the patient. This tradition also generally uses smaller numbers of ingredients than Chinese herbal formulae and the herbs are usually given in the form of fine powders. For more about Kanpo, Check out Chapter 7.

Tibetan herbal medicine

In Tibetan herbal medicine, the roots, leaves, flowers, bark, and fruits of plants are mainly used together, sometimes with crushed minerals and gemstones and very occasionally with animal products. Formulae are based on the centuries-old medical texts, the ‘Four Tantras’, called the RGyud bzhi (pronounced ‘gyu-zhee’), and usually contain a number of ingredients. The aim is to balance the Three Humours of wind, bile, and phlegm. The remedies are usually given as pills or ointments, but sometimes decoctions or powders

Are used. Many include the plant myrobalam (Terminalia chebula), Which, according to the Tibetan medical texts, is said to help cure all diseases.

Precious Pills Are a highly prized special form of Tibetan herbal medicine. These contain extracts from gemstones such as lapis lazuli and are identified by the different colours of silk in which they are wrapped. Herbs are classified according to various properties such as ‘warming’ or ‘cooling’ and are carefully harvested and prepared according to the seasons and their inherent properties. For example, warming herbs may be dried in the sun to increase their warming properties while cooling herbs are prepared in cool shade. For more on Tibetan medicine, take a peek at Chapter 6.

Ayurvedic herbal medicine

^ALEfl/- Ayurvedic herbal medicines are used to balance the Doshas (humours) that make up the three constitutional types of Vata (wind), Pitta (choler or bile), ‘ /— ^ ‘ and Kapha (phlegm). The medicines are made from plant materials such as leaves, flowers, and fruits, and may also contain spices, ground minerals and gemstones, animal fats (including Ghee, Or clarified butter), beeswax, and honey. Different plants are classified according to their tastes, potencies, and effects on the body. The herbs may be prescribed individually or in combinations and are usually given in the form of pills, powders, teas, oils, or decoctions. For more on Ayurvedic medicine, have a look at Chapter 5.

Discovering Whom and What Herbal Medicine Is Good For

Herbal medicine is used for a wide range of disorders amongst people of any age group. Common conditions treated by herbalists include the following:

Eczema

Asthma and other respiratory problems I Digestive problems I Migraine and headaches

Joint problems

Urinary problems I Circulatory problems I Menstrual and menopausal imbalance I Insomnia I Anxiety

Evidence that it works

Studies around the world have demonstrated the effectiveness of herbal medicine for a wide range of conditions. New regulations on herbal products in some countries (which mean that medical claims for individual herbal products have to be backed by scientific evidence) have also provided added impetus for research work.

Here are just a few of the individual herbs that now have a good body of evidence to support their use for different conditions.

Echinacea: Shown to boost white blood cell count and support immune function.

Garlic: Proved to lower ‘bad’ (low density lipoprotein) cholesterol (see Chapter 12 for more about this) and shown to be effective in reducing the severity and duration of colds and flu.

Ginger: Found to help prevent or reduce travel sickness, morning sickness, and nausea associated with chemotherapy.

Ginkgo biloba: Found to improve memory and blood circulation.

Hawthorn: Shown to support circulation and heart function.

Peppermint: Found to ease digestive irritation.

Saw palmetto: May play a role in preventing prostate enlargement.

St John’s Wort: An effective anti-depressant. In Germany it is said that doctors prescribe this more often than anti-depressant medication to treat depression.

Other research has also investigated the use of specific herbal formulae such as Chinese herbal formulae used in the treatments of eczema and asthma. Much research has also been carried out on Japanese and Ayurvedic herbs.

You can find lots of good studies investigating the effectiveness of herbal medicine on the following Web sites:

I Cochrane Library: Www. cochrane. org/reviews/clibintro. htm

NHS Complementary and Alternative Medicine Specialist Library:

Www. library. nhs. uk/cam

I PubMed: Www. nlm. nih. gov/nccam/camonpubmed. html American Botanical Council: Www. herbalgram. org

When not to use herbal medicine

Just because herbs are natural doesn’t necessarily mean that they’re safe. Some herbs, such as belladonna, are poisonous, while others can have potent interactions with standard medicines. For example, ginkgo biloba, which has a blood-thinning effect, should not be combined with other blood-thinning medication. Also, St John’s Wort isn’t recommended for use at the same time as anti-depressant medication or drugs for asthma or high blood pressure and has been found to interact with the contraceptive pill and make it less effective. However, if you’re already taking one of these herbs and medications simultaneously don’t simply stop taking the herb because this can cause dangerous increases in blood levels of the drug you’re taking. Instead, consult your GP or a herbalist as soon as possible for advice.

Herbal medicines may also be contaminated, for example with heavy metals, or be unstandardised, meaning that they may contain little or no active ingredients. Unlicensed herbal medicines may also be labelled incorrectly or contain substitute plants or even pharmaceutical ingredients, such as steroids found in some Chinese ‘herbal’ creams for eczema.

Only buy or use herbal products from reputable practitioners and suppliers that clearly label their products and ensure that they meet industry and legislative standards for quality and safety. In the UK, regulated herbal products always have either a Product Licence (PL) number or a Traditional Herbal Registration (THR) number on the label, so look out for these.

Always ask your herbal practitioner or product supplier to give you products clearly labelled in English, including ingredients and dosage instructions.

Additional herbal safety advice, and warnings about particular products found to be unsafe, can be found on the Medicines and Healthcare products Regulatory Agency (MHRA) Web site at Www. mhra. gov. uk.

Contra-indications for herbal medicines should also be carefully followed, for example, some aren’t suitable for use during pregnancy, while others that may make you sleepy aren’t suitable for use while driving or operating heavy machinery. Consuming alcohol or taking recreational drugs is also inadvisable while taking herbal medicine.

In the case of serious diseases such as cancer, insulin-dependent diabetes, epilepsy, and HIV infection, among others, herbal medicine may play a part in an overall health programme but is not a substitute for orthodox medical care.

Herbal medicines need to be used with care by:

I Pregnant or breastfeeding women I Children I The elderly

And herbal medicine needs to be avoided if you are:

I About to undergo surgery (since some herbal medicines may alter the effects of anaesthetics or drugs used in surgery).

I Suffering from liver disease, since some herbs may affect liver function or cause toxicity.

What to Expect in a Typical Consultation

A consultation with a herbalist normally starts with some general discussion about your health.

Questioning

Your herbalist will ask about your medical history and general health as well as your current symptoms. Usually you will also be asked questions about your general diet, lifestyle, emotional health, and stress levels.

Always remember to inform your practitioner if you’re taking any form of medication, such as blood pressure medication or anti-depressants, or are on the contraceptive pill or hormone replacement since these medications may interact with herbs that the practitioner decides to recommend for you.

Diagnostic methods

Medical herbalists are also trained in standard forms of medical diagnosis and so may take your pulse, check your blood pressure, listen to your chest, and so on. Practitioners of Chinese, Ayurvedic, Tibetan, or Japanese herbal medicine may also use forms of Oriental or Asian medical diagnosis such as tongue, face, and Oriental pulse diagnosis (for more on these, check out the chapters in Part II of this book).

The herbalist then usually identifies a particular herb, or a combined herbal formula, to balance your body system(s) or organ(s) that have been identified as being imbalanced and diagnosed as underlying your current symptoms.

Your herbalist may also give you advice on diet and lifestyle.

Treating with herbal remedies

Herbal medicines may be taken in a variety of different ways. Here are some of the most common applications used by herbalists:

I Creams: Emulsifying wax is melted in a glass bowl over a pan of boiling water and finely chopped fresh or dried plant materials are added. Glycerine and water may also be added and the mixture slowly stirred and then strained through a press, cooled, and stored in glass jars. The cream can be applied directly to your body and is often used in the treatment of eczema or other skin conditions.

Decoctions: The plant material is placed in a saucepan and covered with water, which is brought to a simmer and kept simmering until the liquid has reduced by about a third. It is strained and kept cool or refrigerated for use at regular intervals during the day. Decoctions may be used for many different conditions.

Herbal teas/infusions: Plant ingredients such as bark, leaves, or flowers may be infused in boiled water, steeped for a few minutes, strained and drunk as a tea. These are also sometimes known as ’tisanes’. Infusions are weaker than decoctions but may be a useful part of treatment for mild ailments, for example camomile tea to relax at bedtime or peppermint tea to aid digestion.

I Herbal oils: Plant ingredients may be infused in hot or cold oil (usually olive, almond, or canola oils) and stored in dark glass bottles ready for use (many oils deteriorate when exposed to light). These may be used for massage purposes, for example oils based on arnica or silver birch for easing muscular and arthritic pain or sports injuries, or for culinary use.

I Macerations: These are the same as infusions (see above) except the plant materials are soaked in cold water and left overnight before being strained the following morning and then drunk. Some herbs such as valerian (for promoting relaxation and treating insomnia and anxiety) are better soaked in cool than hot water.

Ointments: Lard, vegetable fat, and/or beeswax are melted in a pan or in a glass bowl over boiling water. Finely chopped dried or fresh herbs are added and left to steep for 10 to 15 minutes. The mixture is strained through a fine cloth and poured into dark, glass jars and allowed to cool and set before being sealed. Herbal ointments may be used for cuts, grazes, skin infections, joint and muscle problems, and more.

I Poultices and compresses: These are used to enable the body to absorb herbal compounds via the skin. A poultice is a moist paste of crushed fresh herbs applied directly to the skin or wrapped in gauze and held in place for an hour or so or even overnight. A compress involves soaking a clean piece of muslin, gauze, or cotton in a hot decoction or infusion and applying it to the affected area and replacing once cooled. Poultices and compresses are good for bruises, swellings, cramps, skin problems, and so on.

I Syrups: A herbal infusion is made and then unrefined sugar or honey is added, stirred, and boiled until the sugar or honey has dissolved and the liquid has become thick and syrupy. It is cooled and stored using corks or non-sealant lids to prevent the bottle exploding if the sugars ferment! Syrups are often used for coughs and other respiratory complaints.

Tablets and capsules: Plant materials can be dried and made into pills or tablets, or powdered and used to fill capsules, and can then easily be taken at exact dosages at regular intervals.

I Tinctures: Plant material is soaked in alcohol in water for one to two weeks, to extract the active ingredients, and then strained (through muslin or using a specially designed press) and bottled in dark glass bottles. Herbal tinctures are used for many types of conditions.

Duration and frequency

The first session with a herbalist is usually around 60 minutes. Follow-ups – usually after two to four weeks – are generally 15 to 30 minutes.

Often only one or two sessions are needed for minor ailments, but if you have a long-standing problem, such as chronic eczema or asthma, then treatments spaced out over several months may be needed. Herbal treatment may be adjusted at each follow-up.

At the end of the treatment, you’ll be told how, and how often, to take the herbal remedies given, and you’ll be advised about any possible side effects.

Knowing Whether Your Herbal Medicine Treatment Is Working

Herbal medicines generally take some time to work. Most take at least a few days, and often longer, before they become fully effective in the body, although some are much more fast-acting. Occasionally, symptoms may flare up with herbal treatment before they get better but this effect isn’t very common and should only be short lived if it does occur.

Here are some tips for when you’re taking herbal medicine:

I If you experience a marked increase in the severity of your symptoms or any pain, nausea, or other side effect, always contact your herbalist, or doctor, as soon as possible to discuss these.

I Ask your herbalist what improvements you can realistically expect over what sort of timescale.

I For best results, follow the instructions for taking the herbal remedy exactly, as well as any other dietary or lifestyle advice given.

I If you have no improvement after a course of treatment, then your herbal medicine may need adjusting, so it’s important to maintain follow-up with your practitioner. If, even after adjustment, you obtain no relief from your symptoms, then you may need to consider another form of therapy. Discuss this situation with your practitioner.

If you experience any significant adverse reaction to any herbal medicinal product, you should report it immediately using the Yellow Card system on

Www. mhra. gov. uk or on Phytonet at Www. escop. com/phytonet. htm.

Common Questions about Herbal Medicine Treatment

Here are some questions that I’m often asked about herbal medicine:

Do they taste horrible? Sometimes, yes! Some herbs are bitter but liquorice is often added to sweeten the taste. In the case of herbal infusions or decoctions, you can add a little honey to sweeten the taste if you want. Most are palatable or can be disguised in juice or food.

Can I expect any side effects? Herbal medicines of good quality prescribed by a trained herbalist and taken correctly are normally be safe to take and cause no side effects.

How long will they take to work? Herbal medicines aren’t quick fixes and generally take longer to work than standard medications.

I Can I make the remedies myself? Some simple herbal remedies can be made for home use (see the nearby sidebar for an example), but medicinal prescriptions should only be prepared by a fully trained and experienced herbalist or produced by a reliable and reputable supplier.

You can have a lot of fun making your own herbal teas (also known as tisanes or infusions). Creating your own tea means you can use the freshest of ingredients for really great taste, plus there’s no need to drink all the bleaching agents and chemicals that go into making fine, white tea bags. Here’s how:

Place a handful of fresh herb leaves, such as rosemary, thyme, basil, parsley, mint, or camomile flowers, or 1 to 2 teaspoons of the dried herb, in a tea pot.

Add two mugfuls of freshly boiled water, stir, and steep for eight minutes.

Strain and pour.

I If wished, add a teaspoon of honey to sweeten or a slice of lemon, lime, or fresh ginger for added ‘zing’.

I If using the herb for medicinal purposes (such as peppermint to ease irritable bowel), then drink a cup of the herb tea three to five times daily.

If wished, you can make up a large batch, and store it in a cool place and drink it throughout the day. Any liquid not consumed in 24 hours can be given to your house or garden plants.

Take a look at Chapter 26 for more ideas on home herbal use.

Finding a Good Herbalist

To find a qualified Western herbalist or phytotherapist in your area contact one of the following:

The National Institute of Medical Herbalists (NIMH) (Tel: 01392 426 022; Www. nimh. org. uk). Members have the letters MNIMH or FNIMH after their names.

I The College of Practitioners of Phytotherapy (Herbal Advice Line: 0906 802 0117; Www. phytotherapists. org). Members have the letters MCPP after their names. Various types of herbalists are also listed on the Unified Register of Herbal Practitioners (Www. urhp. com).

The Association of Master Herbalists (Www. associationofmaster Herbalists. co. uk)

I The International Register of Consultant Herbalists and Homeopaths (IRCH) (Tel: 01792 655 886; Www. irch. org)

You can find Chinese herbal practitioners via the Register of Chinese Herbal Medicine (RCHM) (Www. rchm. co. uk). Kanpo Practitioners can be contacted via the British Kanpo Association (Tel: 020 7722 3939). Tibetan physicians can be contacted via the Tibet Foundation (Tel: 0207 930 6001; www. Tibet-foundation. org). For details of contact organisations for Ayurvedic physicians, see those listed at the end of Chapter 5 on Ayurvedic medicine.

You can find general information about European herbal practitioners and regulation on the Web site of the European Herbal and Traditional Medicine Practitioners Association (Www. ehpa. eu).

In the US, where there’s currently no national system regulating the practice of herbal medicine, you can contact practitioners via the American Herbalists Guild (Www. americanherbalist. com), or via bodies representing different types of practitioners using herbal medicine. These include:

I The American Association of Naturopathic Physicians (Toll free: 00 1 866 538 2267; Www. naturopathic. org). Naturopaths are trained to use botanical medicines.

The American Association of Oriental Medicine (Toll free: 00 1 866 455 7999; Www. aaom. org) or the Acupuncture and Oriental Medicine Alliance (Www. aomalliance. org). These organisations include acupuncturists who may also practise Chinese herbal medicine, depending on the laws in different states.

I The National Ayurvedic Medical Association (Tel: 00 1800 669 8914; Www. ayurveda-nama. org). Practitioners use Ayurvedic herbal medicine.

In Australia, you can contact practitioners via the National Herbalists Association of Australia (NHAA) (Tel: +61 (2) 8765 0071; Www. nhaa. org. au).

Other ways of finding a herbalist include:

I Asking friends, family, and colleagues for personal recommendations.

I Asking your doctor for a referral (some have links to local practitioners or even a herbal practitioner in their surgery).

I Visiting the teaching clinics at herbal medicine colleges. All students practise under close supervision from experienced practitioners and fees are low compared to private practice.

Finding out more about the safe practice of herbal medicine

Lots more useful information about the safe practice of herbal medicine, and the regulation of herbal medicine practitioners, can be found via the following links:

British Herbal Medicine Association (BHMA): Www. bhma. info

I Plant Medicine: Www. phytotherapy. info

European Scientific Cooperative on Phytotherapy (ESCOP): Www. Escop. com

European Herbal Practitioners Association (EHPA): Www. ehpa. eu.

This association represents around 2,000 European practitioners of Western, Chinese, Tibetan, Japanese, and Ayurvedic herbal medicine.

American Botanical Council (ABC): Www. herbalgram. org

Counting the cost of herbal medicine

Initial herbal medicine consultations can cost from Ј35 to Ј90, while follow-up sessions are in the region of Ј15 to Ј35. Herbal medicine treatments on the NHS are free but usually exclude the cost of the herbal medicines. Some private health insurance schemes cover herbal medicine treatment. Some herbalists offer concessions for retired persons or those on benefits. Ask for details.

Ensuring satisfaction

If you’re dissatisfied with your treatment, first talk things over with your practitioner. If you think that the practitioner has been negligent, incompetent, or unethical in any way, contact their professional association, who should have a formal complaints procedure in place.