The Natural Therapist Vol35 No.3 - Spring 2020 by ANTA

The

Natural

EDITION 35 NO. 3 | SPRING 2020

Therapist ISSN 1031 6965

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Contents Edition 35 No. 3

Spring 2020

築賓 Zhubin Kidney 9 (Kd9) Kaitlin Edin discusses the Kidney 9 and its

Can Olive Leaf Extract Help Support Your Immune System?

intersection point of the Foot Saoyin Channel

Abby Dolphin explores how Olive Leaf can

and the Yin Wei Mai.

help your immune system.

Dr Helen Fitton explores how fucoidan can

Endometriosis: TCM Approach to Diagnosis and Treatment

What are the Best Herbs for Boosting Healthy Sleep?

3 Things to Think About Before Beginning a Spring Cleanse

boost immune responses, dampen allergic

Tony Reid explores how Traditional Chinese

Kerry Bone investigates which key herbs can

Ashleigh Mythen lists three things

responses, explain how fucoidans are not all

Medicine can treat Endometriosis. Tony

help insomnia sufferers improve their sleep.

practitioners need to think about before

the same plus much more.

compares Western Medicine and Eastern

From the Chair 6

Executive Officer Report

ANTA News

8 ANTA News 9 ANTA’s Continuing Professional Education Guidelines

10 Round 1 Graduate Award Winners 2020

Fucoidan - The Immune Health Evidence

beginning a Spring cleanse.

Medicine and how the two approaches can help women with this condition.

EDITION 35 NUMBER 3 – SPRING 2020

ISSN 1031 6965

ANTA BRANCH CHAIR PERSONS

The

Natural Therapist

The Natural Therapist is published by the Australian Natural Therapists Association (ANTA) for natural therapy practitioners. The opinions and views expressed by the contributors and advertisers are not necessarily the opinions and views of ANTA. Every effort is taken to ensure accuracy and ANTA accepts no responsibility for omissions, errors or inaccuracies. ANTA relies on contributors and advertisers to make sure material provided for The Natural Therapist complies with the Australian Consumer Law under the Competition and Consumer Act 2010. ANTA accepts no responsibility for breaches of the Australian Consumer Law by contributors or advertisers. Material in The Natural Therapist is subject to copyright and may not be reproduced in any form without the permission of ANTA and its contributors.

Elizabeth Greenwood • National President • Director of ANTA • National Naturopathy Branch Chair • ICNM Ambassador • CPE/Seminar Chair • CMPAC Director • Registration Chair • Website & Media Chair • ANTAB Committee Member • ANRANT Committee Member Warren Maginn • National Vice-President • Director of ANTA • National Nutritional Branch Chair • TGA Chair • Ethics Panel Chair • ANTAB Committee Member • ANRANT Committee Member Shaun Brewster • National Treasurer • Director of ANTA • National Myotherapy Branch Chair • ANTAB Chair • Health Fund Chair • ANRANT Committee Member Justin Lovelock • Director of ANTA • National Homeopathy Branch Chair • Constitution & Policy Chair • CMPAC Director

• ANTAB Committee Member • ANRANT Committee Member Kaitlin Edin • Director of ANTA • National Acupuncture Branch Chair • ANTAB Committee Member • ANRANT Committee Member Isaac Enbom • Director of ANTA • National Remedial Therapy Branch Chair • ANTAB Committee Member • ANRANT Committee Member Mark Shoring • Director of ANTA • National Multi-Modality Branch Chair • ANTAB Committee Member • ANRANT Committee Member

The

Natural Therapist

Marketing & Production Tasha Kemsley Circulation Enquiries 1800 817 577

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Tony Reid • Traditional Chinese Medicine Industry Advisor Jim Olds • Executive Officer • Company Secretary • Business Plan Chair • CMPAC Director • ANRANT Chair

ANTA NATIONAL ADMINISTRATION OFFICE T: 1800 817 577 | F: (07) 5409 8200 E: info@anta.com.au P: PO BOX 657 MAROOCHYDORE QLD 4558 W: www.anta.com.au

THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 5

ANTA Welcome Spring 2020

From the Chair National Police Checks

Many Members will have noticed the introduction of a number of regulatory changes, the most significant is the compulsory requirement for all ANTA Members to register for a National Police Check by July 1, 2020. This is a different process to the state-based Working With Children (and Vulnerable Persons) Check, depending on which State or Territory you practice in. Some States and Territories in Australia do not have a process in place for those people who do not work in childcare or vulnerable person care centres on a formal basis to register or undergo certification to clear them for work in those professions. It is important and essential to undergo the National Police Check process if you practice in one of these States or Territories. ANTA was approached in 2019 to assist Private Health Fund operators to verify the accountability of its Unregistered Allied Health Provider Members and introduce National Police Check processing. ANTA partnered with National Crime Check to lower the cost and streamline reporting to ANTA and our Members where searches revealed â&#x20AC;&#x153;disclosable outcomesâ&#x20AC;?. This additional layer of reporting has been routine with a majority of negative reports being received in regard to ANTA Members operating across Australia as Allied Health Care Professionals. Many readers will be familiar with the joining and renewal process that includes the completion of an initial and subsequent Statutory Declaration statement that require an honest acknowledegment of any criminal conviction/s in their past. It is the case, some Members may regard this process as their past coming back to haunt them, however there are processes that can occur to offset many fears. By accessing the services of the Office of the Health Ombudsman in each PAGE 6 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

Spring 2020

State that has this service, it is possible to receive a ruling on the current risk to the public for Members with historical convictions. This is a straightforward and seamless process and the outcome may surprise the person/people involved as to the lawful view about whether any current risk may or may not exist. We have experienced a very low number of events where new Members have not read through the questions in the Statutory Declaration when joining ANTA and mindfully enough have omitted vital information the questions in that document are designed to capture. There exists a possibility that a new Member may be afraid the declaration of any record of a criminal offence/s may result in them being denied admission to ANTA. On the other hand, an existing Member may have experienced events while a Member. The same process applies at renewal each year. Unfortunately, termination of Membership can result if ANTA detects it has received a false declaration from a current Member based on the omission of lawfully required, relevant details when completing the declaration when joining, or at renewal. This event may fall under the jurisdiction of Section 3 of the ANTA Constitution. So please read your initial Membership and renewal documents carefully and respond with complete declarations.

ANTA Member Support

I am pleased to report our understanding and support for Registered Training Organisations and Colleges is allowing Student Members to complete their education in a timely manner without sacrificing authentic clinical experiences for potential graduates. If you are unclear about how ANTA is supporting your educational institution, then call the Administration Office and we will explain how any delay in your course completion has been minimised through the

ANTA Welcome Spring 2020

cooperation and support from ANTA that will contribute to your timely graduation. Standards have been maintained and delivery modified to ensure graduates are workplace ready following graduation.

Costs and Fees to Members

ANTA is also conducting a moratorium on Membership fees. Fees have remained the same for over 20 years as a result of sound management and a lean and agile ANTA Administration Team. A slight increase to the lowest tier fees occurred in 2019, however this tier remains the lowest across professional Associations in Australia. We also have payment plans for Members. If you would like more information, please call the ANTA Administration Office during the renewal period. There are no fee increases planned for 2020-21.

tutorials available free of charge to our Members. These resources are available to all Members to contribute/accumulate to your CPE requirements for 2020. Many of our Directors have been and will continue to deliver webinars to ANTA Members free of charge going forward. Stay safe and healthy, Regards

Jim Olds

ANTA Fellow ANTA Executive Officer & Company Secretary BHSc MST, BHSc Comp Med, GC Higher Ed, MSC, Dip Nut, Dip RM, Dip TCMRM.

Continuing Professional Education (CPE)

The ANTA Board Members have also contributed their time, experience, and knowledge to providing fresh, new topics in webinars and

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ANTA News Spring 2020

ANTA News

Continuing Professional Education points will continue for 2020

Important! New condition of Membership - Working with Children Check or Police Check ANTA has been advised by Health Funds that all Members will now require a Working with Children Check or a Police Check to be eligible for Health Fund recognition and ANTA Membership going forward. Please be aware that all Australian States and Territories have different policies and procedures when it comes to these Checks. ANTA requires your document to be emailed as soon as possible. If this is not completed your Health Fund and Membership status might be in jeopardy.

Although 2020 has been a year full of ups and downs, ANTA and the Health Funds still require all ANTA Members to complete their 20 Continuing Prefession Education (CPE) points for 2020. ANTA has offered many free resources from interactive webinars, journals and subscriptions to academic research databases. ANTA requires all CPE activities to be lodged in your Member Centre by the 31st December 2020. If you have issues, please call ANTA on 1800 817 577 or admin@anta.com.au. Please see the next page for ANTA’s CPE Guidelines.

ANTA Partners with

CMBA registered Members do not need to complete this requirement as it is a condition of AHPRA registration. As an Association recognising practitioners within the healthcare industry, ANTA has an obligation to ensure the public’s safety by ensuring all Members have a completed and clear criminal history check.

ANTA is pleased to announce that from April 1, 2020, ANTA’s preferred insurance company is Guild Insurance. Every so often partnerships need to be re-evaulated, that is why during 2019 ANTA National Council undertook a due diligence process to evaulate our Members’ needs with insurance. Guild offers a wide range of attributes that our Members need including qulity of the policy coverage, legal support, commitment to education and risk management, understanding of the profession, pricing and ease of access to the insurer. If you would like to get a free and easy quote, please contact Guild Insurance on 1800 810 213, or visit www.guildinsurance.com.au/professional/naturaltherapists

PAGE 8 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

What is CPE:

ANTA CPE Guidelines

Continuing Professional Education (CPE) is the upgrading or acquisition of knowledge and skills in the accredited modalities that will aid the practitioner in providing the patient with a high standard of health care.

Why is CPE Necessary:

CPE is an important part of providing professional healthcare services to patients and ensures practitioners regularly update their clinical skills and professional knowledge. ANTA requires Members to complete 20 CPE hours annually (January to December). Completion of 20 CPE hours annually is a requirement for your ongoing ANTA Membership. It is also a requirement for provider recognition with all Health Funds and WorkCover authorities (if applicable). Note: If you do not complete 20 hours of CPE annually, your ANTA Membership will be suspended until you have completed the 20 hours required. If you are registered with Health Funds and WorkCover authorities they will terminate your provider recognition. Please note that 1 hour of CPE activity = 1 CPE point. For members registered with Health Funds, please note that they carry out audits of your records each year to ensure 20 hours of CPE have been completed. By the end of each calendar year ensure that you lodge details of 20 hours of CPE on your personal profile within the ANTA Member Centre. We recommend that you also keep a copy of your CPE records (e.g. attendance certificates) in the event of an audit by a Health Fund and/ or ANTA. Other Benefits of CPE • Members are kept informed and up-to-date with the latest developments • Facilitates communication and networking • Encourages further study • Enhances professional standing within the community

Required CPE Hours:

ANTA Members must accumulate a minimum of 20 CPE hours per annum (January to December). At least 50% of CPE hours undertaken must be related to the modalities you are accredited in by ANTA. Note: hours in excess of 20 completed in the current year are not permitted to be carried over to subsequent years. Members registered with CMBA/AHPRA must abide by the CMBA/AHPRA CPD/CPE Guidelines for the modalities of Acupuncture and Chinese Herbal Medicine and must also submit their CPE to ANTA.

CPE Activities:

Members can undertake CPE hours in many ways including the following:

• Attend ANTA free seminars • Research scientific information within the ANTA Member Centre • Participate in research projects involving, or related to, natural therapies • View seminar recordings and seminar presentations • Complete courses on ANTA eLearning Centre • Give lectures/tutorials • Give CPE seminar presentations • Undertake further study • Complete short courses • Contribute an article to the ANTA journal “The Natural Therapist” and ANTA website • Contribute an article to other relevant journals, magazines and publications • Read articles in the quarterly ANTA journal “The Natural Therapist” • Subscribe to and read other professional publications and journals • View webinars • View online DVDs or recordings on relevant topics • Listen to recordings on relevant topics • Radio/TV broadcast on relevant topics • Read and research information on topics relevant to your practice • Attend local practitioner groups/workshops • Conduct volunteer work with community groups involving natural therapies Note: First Aid and CPR courses are not recognised or accepted as CPE by ANTA or Health Funds.

Maintaining your own personal online CPE Record:

ANTA provides Members with simple easy to use online facilities to complete and lodge their CPE hours in their own personal and permanent CPE online record fully maintained with the ANTA Member Centre (Note: your CPE history is retained for future reference and you should not delete any of your online CPE records as ANTA may be required to present them to Health Funds if requested).

To submit/edit/view your CPE hours online with ANTA:

• Sign into the ANTA Member Centre • Click on “CPE Activity” tab • Click on “Add a new CPE Activity” to add a new record or “Edit an existing CPE Activity record” to edit or delete a record

Enter the following details for each activity:

• Date of activity • CPE year (for auto calculation) • Resource, e.g. Book, Course, Seminar, Webinar, etc • Short description of activity (including author or link where applicable) • Number of hours of activity (if an activity is half an hour record as 0.5)

For further information or assistance contact ANTA at admin@anta.com.au or 1800 817 577. THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 9

ANTA News Spring 2020

Round 1 Graduate A

Amiee Lewis

Diane Hockings Daniel Pobi Yi-Chun Shih

Laurel Sepkus Min Cook PAGE 10 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

Martika Nightingale

ANTA News Spring 2020

Award Winners 2020

Winners received $200.00 plus 12 months complimentary membership. Winners had a high range of grades across their course!

Inna Kurlyandchik Daniel Maughan Grace McGregor

Kathryn Khiroya

Congratulations also to Lily Harvey Vanessa Cammarata

Qin Jin

Mark Baldoza THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 11

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Director Article Spring 2020

Kaitlin Edin

Acupuncturist | Eastern Herbal Medicine Chinese Medicine Practitioner National Acupuncture Branch Chair - ANTA

Point Specifics

築賓 Kidney 9 (Kd9)

Considering an acupuncture point in some detail is like looking down a microscope to see the granular nature of the meridian being considered. Another world reveals itself in the microcosm; a startling and fascinating world of terrain, language and philosophy. At this level of concentration, we can develop and deepen our understanding and curiosity for the body and the way in which we treat, close up. And in accordance to the Buddhist concept of interpenetration1 we can see through one point; a jewel in the net, a way of viewing the macrocosm. Just because we go deep and small doesn’t mean that the broader experience of existence is not also apparent, indeed it is all caught in the point; as its web of connections, the meanings and story of the point, the imagination and metaphor of its location and terrain are identified and considered.

So, with this idea in hand, let us sit for a while, and delve into the point specifics of Kidney 9 (Kd 9) 築賓 Zhubin which translates as Guest Housei – Building Guestii – A Guest Serving Our Very Foundationsiii.

Broad brushstrokes of ideas are helpful to give us a sense of orientation, a way of placing ourselves on the map of human experience, but it is in the details and the meaning we draw from them that enables us to remake or redefine our experience, our treatment strategies and the clinical outcomes we are seeking for our clients and patients.

Kidney 9 is also the beginning of the trajectory of the Yin Wei Mai, one of the Eight Extraordinary Vessels. The Wei vessels (yin and yang) are so named the linking vessels which describe the unfolding of yin and yang. They are the vessels responsible for ‘recording the unfolding of one’s life through time and space’ 2. The vessels that link, that hold us together through

Kidney 9 is the intersection point of the Foot Shaoyin Channel and the Yin Wei Mai The Foot Shaoyin channel is otherwise known as the Kidney Channel. Sometimes though it is helpful to consider the channel from the viewpoint of its extended connections, because it reminds us that the Kidney and Heart meridians form a cohesive unit, the Shaoyin. It pushes us to recognise the relationships rather than the separate identity of the channel. And it is these relationships which form the space between things.

THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 13

Director Article Spring 2020

each cycle (of seven or eight years) and help us to connect and maintain a sense of cohesion, from one cycle to another. Transformation without context or linkages would be disorientating and thwart the unique characteristics of the cycle we are in. Each cycle will have a different focus whether that be growth, fertility and maturation, or aging3. As Cecil-Sterman puts it the Wei Mai are ‘analogous to a silk cloth depicting the images and actions of one’s life’ 2. ‘The Yin Wei Mai is the record of change that is imparted to the bodymind’ and the ‘Yang Wei Mai records past actions, the actions that create the cloth’ 2. When it is said that our biography is our biology, we are really referring to the Wei channels.

A note on trajectory points versus opening points of the Eight Extraordinary Vessels from the Classical perspective Modern sources about the Eight Extraordinary Vessels place much emphasis on the opening points, or the Master and couple points. The opening points theory originated in the 11th Century, (the Ming Dynasty) and the idea of the Coupled Pairs of extraordinary meridians with Master and Couple points is a 17th Century theory2. It is not to say that they aren’t useful pairings, or that they can’t be used in Eight Extraordinary Vessel treatments that access the structural aspects of the vessels. There are some very useful treatments especially with the use of ion pumping cords from the Japanese Meridian Therapy traditions that use the standardised pairings4. However, the Classical acupuncture tradition does not use the opening points of the Eight Extraordinary Channels as treatment points2 because it is the trajectory points (among others) that are considered to be more useful and important. And much of what passes for Eight Extraordinary Vessel treatments in other traditions is not considered by Classicists to be working with the yuan qi of the Eight Extraordinary Vessels. [According to Ann Cecil-Sterman, when I wrote to ask her; “The ion pumping cords move wei qi, not yuan qi…Also, any shallow needling is directed at wei qi and not yuan qi”5].

Kidney 9 is also the xi-cleft point of the Yin Wei Mai PAGE 14 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

The character Xi indicates a cleft or fissure. Xi-cleft points are ‘areas where Qi pools or stagnates causing pain’. Because in Chinese Medicine anything that is stagnating is causing blockage and blockage tends to create pain. In treating the primary channels, xi-cleft points are needled and strongly reduced to relieve pain in the channel. They are often very effective for alleviating pain. Lonny Jarrett states that ‘these points on the yang channels…excel at helping move long term stagnation in conjunction with pathological emotions and disorders of spirit’6. In his observation, he has also found that ‘[t]he function of the yang xi-cleft points is related relatively more to issues involving qi and how we act in life, whereas the yin xi-cleft points tend to address issues involving the blood and our internal experience of ourselves’6. When used in Eight Extraordinary Treatments (within a classical tradition) the xi-cleft points can be used singularly in the case of an emergency or they are used together with other points along the trajectory of the channel2 to engage the person being treated with the deeper philosophical, psychological and physiological insights of the yuan qi. Yuan qi is the deepest level of qi. Sometimes termed the ‘source’ or ‘original’ qi, it holds the intrinsic essence of the self. It is the qi that expresses the jing or constitution, the original patterns that come to us from our ancestral lineages and propel us forward into our engagement with the world3.

There are two locations for Kidney 9 (Guest House) The standard and classical location of the point is ‘in the depression below the belly of the gastrocnemius muscle just anterior to the medial border of the Achilles tendon’7. This is, on the line going from Kidney 3 to Kidney 10, about one third of the way or about 5 cun proximal to Kidney 3, and 1 cun posterior to Liver 5 (Liv5)7. The second location of the point, much less commonly used but described in the Japanese tradition of Kiiko Matsumoto ‘is located on a painful spot three fingers below the traditional Chinese location of Kidney 10’8. According to Matsumoto and Euler the “upper Kidney 9” point ‘should be used mainly for the treatment of addictions and was traditionally used for the treatment of morphine addicts’8. While morphine

Director Article Spring 2020

is the term directly quoted here in the source text, morphine addiction should be understood to include opium and laudanum as well. This is because morphine was only synthesised commercially in 1823, and only available in injectable form a decade later, whereas opium has been used since antiquity and laudanum since the 1600s9. [For a fascinating discussion on the history of opium see Lucy Inglis’ Milk Of Paradise: A History Of Opium10].

There are a few ways we can understand the meaning of guest The first meaning of guest is in reference to another, more specifically an embryo. This point and its use is, according to Jarrett, about assisting the developing life in a concrete way, for when ‘a guest in the form of an embryo now lives within the building of the womb…[t]his ‘guest’ must be built within the womb as the commands of jing are implemented by the yuan qi’6. Kidney 9 is a more useful point for nourishing and protecting an embryo than other Kidney channel points.

The name most often used for Kidney 9 is ‘Guest House’ and gives us some very interesting insights to understanding the function and virtue of the point

This is possibly because this point can be used during pregnancy for detoxification. Indeed, I have heard this point being referred to as the Beautiful Baby point, as it is said anecdotally to assist the placenta in flushing out impurities. In the classical and meridian therapy traditions, at the end of each trimester, moxa is applied to stimulate the function of detoxifying the embryo11. The actions of detoxification seem to have a strong moxa focus, rather than needling. Therefore, I would suggest moxa is used rather than needles on this point, although needling is allowable.

When we think of a guest, there is a defined role and expectation that we have of a guest. A guest is someone who has a unique opportunity to see us in our surroundings; they are not family and there is hopefully something of a friend in a guest. Of course, there are good guests and difficult guests. This idea will hold more traction when we look more deeply at the metaphorical nature of the Guest.

Another way we can understand ‘the guest’ is not only as an actual embryo or foetus, but arguably more usefully as the symbolic foetus; a new or emerging perspective within us. This budding consciousness, this insight into ourselves and our life is the guest. The ‘house’ is the way we house this new idea of ourselves, furnished by the Kidney qi and yuan qi as it is engaged through the extraordinary meridians. THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 15

Director Article Spring 2020

Similar to that idea of moxa being used at the transition stages of gestation for the baby’s benefit; at the turn or transition of the post-natal qi cycles of seven or eight years this point can be useful in supporting the guest, that is, furthering the perspective we have already developed. The point can be used at any time for this purpose, but sometimes the changes wrought by fading or emerging cycles are best integrated and recognised by using this point at these times. Jeffrey Yuen articulates it this way: “Kidney 9 gives us the fortitude to bear witness to ourselves, as a point it allows us to play guest to ourselves, so that we can observe who we are and perhaps examine how the social pressures and influences of our lives have moulded and shaped our self” 11. The unwanted or the difficult guest then, in some measure, represents our addictions and our obsessions11.

Further considerations and point combinations for detoxification It is not just in pregnancy that Kidney 9 assists detoxification. A number of different sources agree on the use of this point for detoxification overall. Within the Nagano tradition, Matsumoto uses this point for detoxification due to its diuretic properties. Kidney 9 in combination with Large Intestine 15 (jian yu) can be used as a general treatment for removing impurities especially if there is underlying pain, or the patient has been ‘exposed to strong chemical treatments, radiation or has been poisoned’8. Presumably because Li15 (the meeting point of the Arm Yangming and the Yang Qiao Mai) is considered an ‘essential point for the treatment of skin diseases like rash, hives or eczema’8, it is considered helpful to remove toxicity from the body by engaging the largest organ of the body (the skin). This is a modern or biomechanical view of the connections between Kd9 and Li15. A more interesting approach is to view from a classical lens and to reconsider the Eight Extra Vessel connections. PAGE 16 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

If we remember that the Qiao vessels hold and express the way we ‘feel about ourselves and the outside world in the present moment’, how we stand up, or ‘heel’ to ourselves and the world11. And the Wei vessels are about the recording of changes imparted to the mind and body, together then these two points will bring the consciousness of what has been recorded through the Wei and Qiao vessels namely ‘the pathologies that accumulate during our lives’ 11 into the primary channels (for this is not an Eight Extras Treatment protocol), to be let go via the Large Intestine. Interestingly both of the above points (Kd9 and Li15) within the Japanese tradition are treated with rice grain moxa at least seven or eight times. It should be noted that it is not an arbitrary number of moxa rounds that have been suggested. The cycles of postnatal qi progress in cycles of seven and eight, (as discussed above) and so the use of moxa in this way is then a way of resonating with the Wei and Qiao channels. Kidney 9 is also used in combination with another so called ‘antitoxin’ point Liver 5 (li gou)8, the Luo point of the Liver channel, to assist medication (especially opioid) detoxification. Liv5 has a strong action on the mucous membranes lining the urinary bladder and urinary tract according to Master Nagano, so used together these points assist detoxifying through diuresis8.

Some thoughts on detoxification The metaphorical and symbolic language of Chinese Medicine is something we can tend to overlook. Much

Director Article Spring 2020

of the time, even as acupuncturists we see the body and its aliments through the lens of the biomechanical model. Partly this is because the Eastern medical lens has been poorly understood by those who taught us, but it is also because we are saturated in culturally defined ways of seeing, such that to look in another way requires a determined effort. We are also clinicians busy dealing with the concrete nature of symptoms. We have clinics to run and people to help. If we don’t address the symptoms and provide relief then people aren’t going to come back to us or trust we know what we are doing. It’s easy for our lens to get fixed, our thinking to become rigidly materialistic. Thus, it is due to a number of factors that we can sometimes miss the deeper, interconnected nature of the ideas and the points. And in missing it I mean both that we are not seeing it, and we are yearning for it. This notion of detoxification from an Eastern medical perspective is not only a biological process. As acupuncturists we rest upon scientific but also philosophical traditions (of Daoism, Buddhism and Confucianism) that ascribe a whole other level of meaning to these material processes. Classically, the philosophical and psychological or ‘Jing-Shen’ aspects of the points are considered integral to the function, understanding and use of the points. Jing is held and ruled by the Kidneys and in its expression through the yuan qi represents the self, the dense physical substance of us that is unique within time and space. The Shen is held in the heart and represents the spirit, the ‘divine spark’ if you will, that untainted aspect of ourselves that breathes life into the material substance of the Jing, that aspect that speaks to our sovereignty, our sense of purpose and destiny11. In a sense though we could consider detoxification a form of alchemical transformation. A way of transforming that which is leaden, no longer serving us, poisoning the waters of ourselves into wisdom, knowledge and spirit. If it is a new self that we need to develop and nourish in order to emerge more fully, then the nature of Kidney 9 (Guest House) in detoxifying is an interesting one. Detoxification by its very name is about getting rid of the unwanted stuff. And this seems like a good thing to do. But if we are in a toxic environment how do we detoxify? When we detoxify something, we presume we are making it healthier, and what if healthier also means more sensitive? Are we ready for the sensitivities that come with new ways of seeing?

It is important then that we communicate this possibility and understanding to our patients. Knowing, sometimes is enough to be able to make better decisions in the moment, or to begin the dialogue about change that can be done in a protective manner, nourished by slow progress.

A final word on all of the ‘extraordinary’ channels we work with as acupuncturists For most of us, we are generally working with the Sinew or Primary channels, and this means we are working with the Wei and Ying Qi levels (respectively). Yet it is useful to have a sense of the deeper yuan level and the metaphorical wisdom of ‘Jing-Shen’. Classical acupuncture Eight Extraordinary Vessel treatments work with and at the yuan qi level. And as a system of instruction and protocol it ensures the deepest levels of the body are not accessed without due reverence. You really don’t want someone messing about with the energies of your source without that reverence, do you? Nevertheless, all acupuncture treatments will provide some instruction to the yuan qi, however basic or minute because of the nature of interpenetration and the fractal structure of life, each part reflecting the whole. By treating the exterior, we influence the interior, needling the distal points we effect regions and specific areas that seem on first glance unrelated. As acupuncturists though we are familiar with the interconnectedness of all things. So even if we never do an Eight Extras Treatment or access the yuan qi levels in a strong or direct way, there is still a requirement that we cultivate reverence for the deeper connections of ourselves and for those who seek us out for treatment, because at some point we will touch into the source of another and when we do, we had better be ready.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 17

Add homeopathy to your practice! A range of ready-made first aid kits for your clinic or your clients. Common remedies, easy prescribing with remedy guidebook included in each kit. Full catalogue and price list available. Ring or email us for more information or to place an order.

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Beyond SAGE: New study reveals powerful effect of Sibelius SAGE Brain Health with Age

Several lifestyle factors, including physical activity, mental stimulation, and diet have been linked to maintaining brain health with age. A significant body of epidemiological evidence supports beneficial effects of particular nutrients on healthy ageing of the brain. Among several herbal extracts, Sage (Salvia offinicalis) has shown promise in the area of cognition with significant benefits demonstrated across several clinical trials. This specific variety of sage has a long-standing use as a herbal remedy that can enhance memory and improve cognitive functions. Several clinical trials conducted with sage have demonstrated various actions of the botanical in relation to brain function, including improving attention, mood, and memory, as well as protecting against cognitive decline. The clinical studies performed with Sibelius™: Sage, a proprietary dried sage extract (Salvia officinalis L.), show significant improvements in cognitive performance, including memory, focus and attention; the three main consumer concerns in the brain health market.

Sage and Modern Applications

Sibelius™: Sage is a broad-spectrum extract with multiple modes of mechanisms of action in humans. Researchers have identified at least six areas which influence physiological pathways including, cholinergic, neurotrophic, anti-inflammatory, antioxidant, and anxiolytic/anti-depressive activities, as well as potential protective benefits against amyloid-β peptide toxicity. One of the primary areas of focus is its impact on neurotransmitters. Sage extracts have been shown to inhibit the action on specific enzymes that break down the neurotransmitter acetylcholine. Acetylcholine is found in the brain in areas associated with attention, memory, and motivation. Sibelius™: Sage inhibit enzymes related to the metabolism of other neurotransmitters including dopamine and serotonin. These neurotransmitters are important to focus the attention, or mood - amongst other things - which are consistent with the beneficial effects of Sage extracts shown in human studies. PAGE 18 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

Member Article Spring 2020

Abby Dolphin

Olive Wellness Institute BHSc (Naturopathy)

Can Olive Leaf Extract Help Support Your Immune System? Learn how Olive Leaf Extract could benefit your immune system Your immune system is a complex organisation of cells, hormones and organs that are highly influenced by your diet. A poor diet, particularly a diet low in antioxidants, could contribute to a compromised immune system, potentially increasing the occurrence and symptoms of the common cold and flu1,2. However, eating a healthy diet full of fruit, vegetables and healthy fats, and including natural supplements in your daily regime may help strengthen your immune system1,2,3.

What is Olive Leaf Extract? (And no, it’s not the same thing as Olive Oil) Olive Leaf Extract is a natural supplement derived from the leaves of the olive tree. To make Olive Leaf Extract, these leaves are processed in a way to draw out the most beneficial compounds found in the olive leaf. Olive leaves are high in antioxidants or biophenols. The most prominent biophenols found in olive leaves include Oleuropein and Hydroxytyrosol and its these two biophenols that research suggests are most likely elicit the potential actions and health benefits4. For example, Olive Leaf Extract has been shown to elicit antimicrobial, antiviral and antioxidant actions5.

A study published in the International Journal of Molecular Sciences suggests the amount of biophenols found in the olive leaves exceeds those found in high quality Olive Oil. Results from this study showed the amount of oleuropein found in olive leaf products could reach 134mg/g whereas the amount of oleuropein found in Virgin Olive Oil products could reach 11.2mg/kg. Variability in oleuropein levels in dependent of product analysis and type6. Barbara Barbaro, co-author of the study ‘Effects of the Olive-Derived Polyphenol Oleuropein on Human Health’ states “In light of the unique combination properties of oleuropein it looks like we should go back to the future, and continue to exploit this key dietary component of the Mediterranean Diet to promote human health”6.

Olive Leaf Extract Research Overall, Olive Leaf Extract has not been significantly investigated under human clinical trial conditions and there is an absence of systematic literature reviews, so evidence is derived from limited human trials and traditional, in vitro and animal studies. One recent human study published in 2019 looked at the effect of Olive Leaf Extract on upper respiratory illness (URI) in high school athletes. 32 high school athletes took 20g of Olive Leaf Extract (100mg oleuropein) or placebo daily for nine weeks. Results from this study showed no significant difference in the incidence of URI, however there was a significant 28% THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 19

Member Article Spring 2020

reduction in sick days in those athletes who took Olive Leaf Extract compared to the placebo. The average duration of each URI episode was 9.7 days in the Olive Leaf Extract group and 12.3 days in the placebo group7.

What’s so good about Olive Leaf Extract? Adults usually get between two and four common colds every year8. Over the counter supplements in conjunction with a healthy diet and lifestyle may have the potential to reduce the incidence of common colds. Olive Leaf Extract could impact how your immune system defends itself against infections5. A review article published in Alternative Medicine Review in 2007 looked into the conventional, botanical, and nutritional considerations of the common cold and flu. From this review, in vitro and animal studies showed that Olive Leaf Extract has some potential activity against the influenza virus and that Olive Leaf Extract may reduce the infectivity and inhibit the replication of viruses that cause colds, influenza and lower respiratory tract infections. The body’s response to a viral infection may be enhanced with Olive Leaf Extract as it was suggested to stimulate phagocytosis – further clinical trials in humans are needed to validate these findings5. Interestingly, gargling olive leaf tea may alleviate symptoms of a sore throat – potentially due to a reduction of inflammation and viral infectivity5.

How do biophenols help the immune system? A study published in the Journal of Alternative & Complementary Medicine-New York showed that Olive Leaf Extract had one of the highest antioxidant activities of 55 medicinal herbs tested, including green tea and milk thistle9.

So, can Olive Leaf Extract help improve your immune system? By increasing dietary and supplemental antioxidants, such as those found in Olive Leaf Extract, this in turn could increase your body’s total antioxidant capacity and furthermore protect your body from harmful compounds that may hinder immune system actions. Olive Leaf Extract is a natural supplement, high in antioxidants, that research suggests could help support the immune system when taken correctly. People typically consume 15ml of a liquid Olive Leaf Extract daily or equivalent dose in capsules. Different brands will vary in antioxidant type and strength, make sure to read the label and follow directions for use. Please speak to your healthcare professional to make sure Olive Leaf Extract is suitable for you. If you have any medical conditions or take any medications it is important to make sure they are all safe and compatible with Olive Leaf Extract.

These biophenols found in Olive Leaf Extract may have the potential to protect the body against potential infection by ‘scavenging up’ harmful compounds that we may consume through poor diet and environmental factors10,11,12.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles PAGE 20 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

New Scobiotics science may be the key to understanding gut homeostasis While many things have changed dramatically in the last two thousand years, there are some things that remain undeniably the same. The Hippocrates idiom that “it is more important to know what sort of person has a disease than to know what sort of disease a person has” is not only still relevant, but has proven to be truer now than it ever was in the times of Ancient Greece. We have continued to determine, through trial and clinical observation, that illness can be genetic, epigenetic, metabolic, physiological, infectious or caused by a deficiency. No matter what the cause, all can be very heavily influenced by the patient’s age, gender, lifestyle, and most importantly, the microbiome. We know the gastrointestinal tract is a complex system, responsible for digestion, immunity, absorption of essential nutrients, vitamins and minerals, homeostatic control of energy balance and detoxification. It stands to reason that with such a myriad of key and complex functions, you cannot achieve maximum health without optimising the gut functions and its environment. The alimentary canal is home to what is now believed to be thousands of bacterial strains, which give us tens of trillions of bacteria, producing hundreds of thousands of metabolites, all with specific functions. These bacteria can be generally classified into three categories: parasitic, opportunistic parasites and beneficial probiotics. Gut microbiota and their hosts have a well-established and evolved symbiosis. It has long been understood that the bacteria benefit the host’s metabolism by production of metabolites and chemical messengers and their combination is commonly referred to as a

‘super organism’. But what has been less researched and understood, is the relationship that these bacterial communities have on each other and other microbiota such as yeasts and fungi – and how these syntrophic interactions are thought to be essential in achieving optimal health. Research has revealed a more holistic approach to supporting and restoring gastrointestinal homeostasis by including beneficial bacteria, as well as other potentially beneficial organisms and nutrients. This innovative science has led to the development of Scobiotics™ by practitioner-only brand, Bioclinic Naturals. Scobiotics™ are a more complex form of probiotic that is made up of syntrophic blends of mixed cultures of bacteria, fungi and blue-green algae. The ingredients in Scobiotics™ help increase the production of secondary metabolites specific to areas such as small intestinal bacterial overgrowth (SIBO) or immunity. This means we can deliver personalised solutions for our patients through formulations that are targeted beyond just probiotic strains. Scobiotics™ enhanced metabolite production by synergistic symbiosis also allows probiotics to flourish and multiply faster. Scobiotics™ have many varied uses, as ultimately, the combination of organisms plays a role in nearly every bodily function. The fact that they include beneficial bacteria as well as other beneficial organisms such as yeasts, means that they take into account the complexity of the microbiome or rather, multibiome. In fact, Scobiotics™ may be the key to understanding more about the gastrointestinal tract and how to achieve homeostasis. To find out more about the range visit www.bioclinicnaturals.com.au/scobiotics

THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 21

Folates and responsible prescribing in pregnancy By Samuel Peters (BHSc Naturopathy)

Over the last few years, there has been a concerted push by marketers towards specific forms of folate. Ultimately the clinician must consider current evidence to inform best practice when working with pregnancy and fertility matters. Folate can be found in numerous forms including, natural folates from food, folic acid, folinic acid and 5-methyl-folate, the latter three representing the different supplemental forms of folate. Folic acid has demonstrated efficacy across a broad range of conditions Folic acid has well documented benefits for the prevention of neural tube defects (NTD’s) when supplemented before and during the first trimester of pregnancy.1 The introduction of mandatory fortification of folic acid in Australia in 2009 resulted in a 14% reduction in NTD incidence,2 and the most recent Cochrane review recommends that all women consume an additional 400mcg of folic acid from supplements prior to conception to further reduce NTD risk.1 Supplementation of folic acid before and during pregnancy may also protect against other congenital malformations such as cardiovascular defects, oral clefts, urinary tract defects and limb-reduction defects.3 Clinical studies have found folic acid to have a number of other beneficial effects during pregnancy. Supplementation has been shown to reduce the risk of the development of Autism Spectrum Disorder in the offspring of healthy mothers,4 and in mothers exposed to epileptic drugs, pesticides or air pollution.5-7 Folic acid supplementation during pregnancy has also been shown to reduce the risk of some childhood cancers,3 increase cognitive performance in children in the first decade of life 8 and reduce the risk of postnatal depression.9 No studies have been conducted using 5-methyl folate on the above conditions and due to their differing pharmacological properties, they cannot be assumed bioequivalent. BioMedica Nutraceuticals P 1300 884 702 | www.biomedica.com.au

PAGE 22 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

Folic acid specificity and bioequivalence The finding that exogenous folic acid can prevent many NTD cases is often interpreted as showing NTD’s to be a vitamin deficiency disorder. Indeed, both folate and vitamin B12 deficiency are statistical risk factors for NTD’s. However, maternal folate concentrations in most affected pregnancies are within the normal range, and not all cases of NTD’s are preventable by increasing folate intake. The protective effect seems to be more consistent with a therapeutic-type response rather than addressing a conventional folate deficiency.10 Exogenous folic acid probably prevents many NTD’s by regulating epigenetic modifications (methylation) and/or cell proliferation.11 Therefore the appropriateness of using alternative forms of folate which have differing effects on these pathways is brought into question. It is possible that folic acid could be exerting a pharmacological like effect in preventing NTD’s, effects which may not occur with alternative forms of folate such as 5-methyl-folate. Clinical summary Folic acid has demonstrated a high safety and efficacy profile, across a broad population group, including those with MTHFR polymorphisms.12,13 Whilst no herb, drug or nutrient poses zero risk when supplemented, the weight of evidence would suggest that the benefits of supplementing with at least 400mcg of folic acid leading up to and during pregnancy outweighs any current known or theoretical risks. By contrast, the risks of 5-methyl-folate supplementation are largely unknown and the efficacy in reproductive medicine is also unproven. In serious conditions associated with reproductive outcomes, bioequivalence must be proven and not assumed. For more information, watch our latest Lunch & Learn at biomedica.com.au/lunch References available on request

Member Article Spring 2020

Dr Helen Fitton

Chief Scientist at Marinova Pty Ltd

Fucoidan - The Immune Health Evidence Fucoidans are long chain polysaccharides that occur naturally in the cell walls of brown seaweeds. They function to protect the plant from water-borne pathogens and other environmental challenges. For centuries, fucoidan-containing seaweeds have been prized for their dietary and therapeutic properties. Their medicinal properties have been particularly well documented in Asian cultures where seaweeds have been used to address health conditions that range from nausea, congestion and inflammation through to abscesses and tumours. Despite this long history of seaweeds as medicinal agents, it was not until the twentieth century that fucoidan was first isolated and recognised for its true therapeutic potential. Most of the scientific evidence supporting the physiological benefits of fucoidan has been obtained over the last 30 years. As a result of this evidence, fucoidan extracts are now used in a variety of market applications including in nutritional supplements, medical devices and in topical formulations for skincare and dermatology. Interestingly, a recent placebo-controlled, double-blind clinical study revealed that fucoidan influences over 30 different biological pathways and processes. This Australian research also confirmed previous published findings demonstrating that fucoidan has beneficial effects on immunity, cancer cells, inflammation and neurological function1. The immune-modulatory properties of fucoidan have

been well researched. Given the current global climate - in which the focus on immune health has intensified - it is fitting to review the immune supporting properties of fucoidan. Published papers have reported that fucoidan may exert a range of beneficial effects on the human immune system, including boosting the immune response, the dampening of allergic responses, the activation of dendritic cells, natural killer cells and T cells, and the mobilisation of stem cells. It has also been shown that fucoidan has the potential to boost important antiviral and anti-cancer responses.

Boosting Immune Responses

Immune responses to vaccines or infections are often compromised during periods of ill health and in older people. In research performed in a clinical setting, the ingestion of fucoidan was shown to help boost the immune responses to seasonal influenza vaccinations2. The ingestion of fucoidan has also been shown to increase the anti-pathogenic activity of granulocytes and macrophages in healthy people3. Fucoidans can also promote the maturation of dendritic cells, activate NK cells and promote cytotoxic activity4. Increased immune activity after fucoidan ingestion can even eliminate the tropical protozoan parasite Leishmania, as seen in a mouse model5.

Damping Allergic Responses

Published research has reported that fucoidan can reduce allergic responses after ingestion6 and even THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 23

Member Article Spring 2020

after topical application7. Fucoidan has been shown to suppress the over-expression of the antibody IgE in immune cells in people with allergic dermatitis and can also decrease the actual number of cells producing IgE8. It has been proposed that the mechanism of action for this damping of allergic responses is via upregulation of galactin-9, a protein integral to the regulation of cell-to-cell interactions9,10.

Stem Cell Modulation

Immune function is fundamentally dependent upon the release and mobilisation of stem cells from bone marrow. As stem cells are released from bone marrow, they differentiate into all the different types of immune cells, including neutrophils, macrophages, cytotoxic natural killer (NK) cells, granulocytes and dendritic cells. Fucoidan has been reported to increase levels of the chemokine SDF1 in the blood and elicit the release of stem cells into the peripheral circulation when used intravenously in animal models11. In humans, it has been shown that the oral ingestion of fucoidan over a period of days increases the number/ release of CD34+ haemopoeitic stem cells12. The same study also showed fucoidan increased SDF1 and the number of CXCR4 receptors on stem cells, which may assist in the lodgement of those cells.

Antiviral Activity

Fucoidans can block the entry of coated viruses to cells, thereby preventing or halting the progress of infections. Fucoidan has been shown to be a highly

PAGE 24 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

effective inhibitor of Herpes Simplex viruses (HSV1 and HSV2)13 and influenza viruses14. Oral delivery of fucoidan also inhibits lung damage and clinical signs of respiratory infection in vivo via indirect antiinflammatory activity. A recent Australian study in a severe Influenza A (H1N1) mouse model demonstrated that orally administered fucoidan reduced both clinical symptoms and lung damage15. This research adds to previous data demonstrating that fucoidan inhibits damage in influenza models14,15 and indicates potential for fucoidan to be utilised in nutritional supplements for the management of viral infections where lung damage is occurring. Importantly, even small reductions in lung damage can substantially reduce the overall disease burden. Fucoidan has also demonstrated protection against other common viruses, including Herpes virus infection14,16, several different strains of influenza, including H1N114,17, H5N118, H5N3 and H7N219, and parainfluenza20. Clinically, fucoidan reduced pro-viral loads in patients with HTLV-121 and showed benefits for patients with chronic hepatitis C 22. Fucoidan has also been shown to exhibit activity against Newcastle virus23, canine distemper24 and even the measles virus25.

Not All Fucoidans Are the Same

Fucoidans are a class of natural compounds that

Member Article Spring 2020

have been widely researched and shown to exert beneficial bioactivities in a range of human health settings. Research conducted by Marinova Pty Ltd has confirmed that fucoidan bioactivity is largely dependent upon two key factors, the method of extraction and the seaweed species from which the fucoidan has been derived. These two factors are the ultimate determinants of efficacy. It is important to be aware that studies indicate that some fucoidan preparations sold commercially for use in food and supplements may not contain fucoidan as stated. Indeed some appear to be alternative polysaccharides, whilst others may be substituted with glucose or cellulose. It is therefore, highly recommended that manufacturers verify the provenance and identity of their ingredients before incorporating them into formulations. Consumers themselves are today driving the push for verified and accredited ingredients in the products they purchase. Traditional methods of extraction compromise the integrity and functionality of the resulting fucoidan. Maritech® organic fucoidan remains the world’s only high purity, certified organic fucoidan. Produced in Australia utilising a unique aqueous extraction process, and in accordance with strict sustainability practices, the Maritech® process yields natureidentical extracts of superior quality with enhanced bioactivity.

Global Regulatory Acceptance

In recent years fucoidan extracts have attained regulatory approvals in a number of global jurisdictions for use in food and dietary supplements. Of particular note, Maritech® organic fucoidan extracts from Undaria pinnatifida and Fucus vesiculosus species of seaweeds have been granted ‘Generally Recognised as Safe’ (GRAS) status with the US Food & Drug Administration (FDA)26.

The same fucoidan extracts also have novel foods approval in Europe. In both Canada and Australia, respective agencies have approved a number of listed medicines containing fucoidan extracts. In Australia, fucoidans have been approved in a speciesspecific context for both Undaria pinnatifida and Fucus vesiculosus. They are recognised as listable components of their parental herbal (seaweed) source26. With the demand for innovative ingredients reaching new heights, global interest in high purity, certified organic fucoidan extracts continues to grow. In recent years, fucoidan has earned its rightful place at the forefront of natural therapeutics, with ongoing scientific research continuing to support its benefits across multiple human health indications. For further details visit www.marinova.com.au Dr Helen Fitton is the Chief Scientist at Marinova Pty Ltd. With more than 20 years experience in commercially focused research and development, Dr Fitton is recognised as a world-leading authority on fucoidan compounds. Her area of expertise lies in polymers for biomedical applications, with a focus on natural polysaccharides from marine macroalgae. Dr Fitton holds a BSc (Hons) in Biochemistry from the University of Manchester, a MSc in Mineralised Tissues from University College London and a PhD in Applied Chemistry from Aston University. Dr Fitton has been a key contributor to over 35 published research papers and 3 book chapters, as well as the reviewer of countless fucoidan and macroalgae focused research papers. For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 25

Member Recipes Spring 2020

Introducing - Healthy Recipes Sesame Seed Bars Serves 10

Ingredients

• 2 cups Sesame Seeds (280g) • ½ cup Coconut, shredded (35g) • ½ cup Almond Meal (50g) • ½ cup Hulled Tahini (100g) • ¼ cup Coconut Oil, melted (60ml) • ½ cup Raw Organic Honey or sweetener of choice (125ml) • 1 Vanilla Pod, seeds only • Pinch Salt

Method

1. Line a 22cm square baking tin with baking paper. 2. In a large bowl combine the sesame seeds, almond meal, coconut and salt. 3. Stir through the melted coconut oil, honey, tahini and vanilla until combined. 4. Pour into the lined tin and smooth the top of the mixture with a spatula. 5. Cover with cling wrap and place in the freezer for 1 hour to set. 6. Once set, remove and cut into bars. 7. Store in a sealed container in the fridge.

Gluten Free, Dairy Free, Vegan Option (honey omitted)

Nutritional Information Serving Size 70g Energy (kJ)

Protein

Fat

Saturated

Carbohydrate Sugars

Sodium

1660 kJ

9.5g

32g

9.5g

15.5g

55mg

PAGE 26 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

15.4g

Member Recipes Spring 2020

Rachel Knight is a Chef and Naturopath based in Melbourne. Her passion for food as medicine has led her to a career in educating the importance of good nutrition and how to maintain a healthy balanced diet. She currently teaches primary students the fundamentals of cooking and how to utilise fresh produce from the school garden through the Stephanie Alexander Program. She also works as a Head Chef, Food Editor and Stylist for Natvia and the Sugar Free Living Magazine.

Low Histamine Pesto Spaghetti Serves 4 entrée size

Ingredients

• 1 x 250g packet Casalare Brown Rice Spaghetti • 1 ½ cups Basil Leaves, plus extra for serving • 2 cloves of Garlic • 60g Vegan Fetta, plus extra for serving • 4 Tbsp Extra Virgin Olive Oil • 1 Tbsp Pine Nuts • ½ Onion, diced • Salt and Pepper

Method

1. In a high-speed blender, combine the basil, garlic, fetta and olive oil. Pluse until smooth. 2. In a frying pan over a medium heat, sauté the onion until soft. 3. Cook the spaghetti in a pot of salted boiling water until tender, drain and place into the pan with the onion. 4. Pour over the basil pesto and toss until the spaghetti is coated. 5. Serve topped with extra basil leaves, crumbled vegan fetta and freshly cracked black pepper.

Vegan, Gluten Free, Dairy Free and Low in Histamine

Nutritional Information Serving size 275g cooked pasta Energy (kJ)

Protein

Fat

Saturated

Carbohydrate Sugars

Sodium

1920 kJ

5.2g

24.9g

7.4g

52.4g

198mg

1.2g

THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 27

PAGE 28 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

Member Article Spring 2020

Tony Reid

M.Ac (Acupuncture) M.TCM (Traditional Chinese Medicine)

Endometriosis: A Traditional Chinese Medicine Approach to Diagnosis and Treatment Introduction

According to a recent Cochrane review, ‘Surgical and hormonal treatment for endometriosis have unpleasant side effects and high rates of relapse. In China, treatment of endometriosis using Chinese Herbal Medicine is routine and considerable research into the role of Chinses Herbal Medicine in alleviating pain, promoting fertility and preventing relapse has taken place.’ 1. Moreover, best available current

evidence suggests that in addition to Chinese Herbal Medicine, acupuncture treatment for endometriosis related pain is effective2.

ENDOMETRIOSIS IN WESTERN MEDICINE

does not explain the comparatively low prevalence.

Endometriosis (EM) is defined as the presence of endometrium-like tissue outside the uterus, mostly located in the pelvic peritoneum and around the ovaries. Definitive diagnosis relies on direct visualisation and histological examination of specimens taken at a laparoscopy. Hence, the imprecision of all estimates of prevalence. While asymptomatic cases have been reported, EM mostly causes severe pain, and may also cause infertility in reproductive women. The degree of pain experienced does not necessarily correlate with the severity of the EM deposits, and women with only mild pain may never-the-less have advanced EM, causing unexplained infertility. The prevalence of EM is estimated to be around 10-15% in women of reproductive age. Importantly, it is found in 40–82% of women with chronic pelvic pain. The pathogenesis of EM is presently unknown. Retrograde menstruation is frequently cited as a cause of EM. However, this is a very common event, occurring in 90% of women and

In this article we will examine the Western and Traditional Chinese Medicine approaches to endometriosis and describe treatment protocols using prepared Chinese Herbal Medicines.

Although no causal link has been discovered, several ‘risk factors’ have been identified, i.e. factors that are not necessarily causal but are more commonly seen in women with EM and should therefore arouse clinical suspicion. These are: • A family history of EM • Menstrual cycles shorter than 27 days • Menstrual flow longer than 7 days • Heavy menstrual bleeding • Delayed childbearing or nulliparity • Early menarche • Obstructive uterine anomaly • Low body mass index • Diethylstilbestrol (a synthetic oestrogen) exposure in utero Other risk factors with a weaker association, or with conflicting evidence, include exposure to endocrine disrupting chemicals, less physical activity, consumption of alcohol, caffeine, fat, red meat, ham, THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 29

Member Article Spring 2020

and smoking. EM is less common in women who have had children, are on oral contraceptives, have a higher intake of omega-3 fatty acids and who exercise regularly3,4,5.

Clinical Presentation and Diagnosis

The typical presentation of EM is in a woman of reproductive age who complains of chronic pelvic pain, and possibly also sub-fertility. Symptoms generally begin in adolescence, with dysmenorrhea, often together with heavy menstrual bleeding and bleeding between periods. Clinical suspicion is generally sufficient to initiate therapy, but the diagnosis can only be confirmed by direct visualisation and histological examination of biopsies taken during a laparoscopy. Painful symptoms include painful menstrual cramps that are progressively worsening and becoming continuous, and also dyspareunia. Other localised symptoms due to the impact of EM deposits around the urinary tract and lower gastrointestinal tract include dysuria, hematuria, dyschezia (pain on defecation), constipation, blood in the stools and rectal bleeding, all of which may be cyclic. Medical examination may reveal pelvic mass/es, fixed and retroverted uterus or uterosacral ligament nodularity and tenderness3,4,5.

Medical Treatment Options

The main treatment options are medical and/or surgical. The former includes hormonal therapy and analgesics. Patients are started on one or more of the first line protocols and if the response is not satisfactory, one or more of second line treatment protocols may be provided. • First line: Non-steroidal anti-inflammatories (NSAIDs) to antagonise prostaglandin mediated pain, and low dose combined oral contraceptives to suppress the activity of the ectopic endometrial tissue and induce amenorrhea. • Second line: Gonadotrophin-releasing hormone (GnRH) agonists and antagonists, progestincontaining compounds, danazol (or related androgens). It should be noted that hormonal therapies essentially induce menopause and are therefore only of limited use in women who want to become pregnant. They are also likely to cause unwanted effects of menopausal syndrome, such as hot flushes, vaginal atrophy, loss of bone

density and increased serum lipids4. In addition, women who take GnRH analogues are more likely to experience clinical depression and increased suicidality6. Patients with sub-fertility are treated with controlled ovarian hyper-stimulation and IVF, possibly with therapeutic laparoscopy as an adjunct. Surgical treatment includes excision and removal of extrauterine endometrial tissue, nerve ablation, and, in women who do not wish to become pregnant or have already had children, removal of uterus and ovaries. Surgical removal of visible ectopic endometrial tissue results in pain relief in up to 80% of patients. However, within five years there is an almost 50% recurrence of pain; subsequent surgical treatment for EM has a considerably lower success rate than first time surgery. Medical treatment, as noted above, may have limited efficacy with frequent occurrence of side effects and recurrence of symptoms5,7.

Effect on Mood and Overall Quality of Life

There is an average of 6.7 years delay between onset of symptoms and diagnosis7, which no doubt adds to the distress felt by women with this condition. Similarly, the inevitable loss in work productivity and income place an additional burden on wellbeing7,8. Studies on quality of life show reduced quality of life in all domains: perception of pain, control and powerlessness, emotional well-being, social support, and self-image8. Mood disturbances, such as depression and anxiety are very commonly seen in women with EM. However, only one of the clinical guidelines that were consulted (NICE, RCOG, ESHRE, KSE, RANZCOG, BMJ) includes a section on the assessment and management of depression in these women4,10.

ENDOMETRIOSIS IN TRADITIONAL CHINESE MEDICINE

In contemporary Traditional Chinese Medicine (TCM), as practised within China’s hospital system, the diagnosis and treatment of EM is based on the traditional gynecological disease categories of dysmenorrhea (tong jing) and pelvic mass (zheng jia). Additionally, depending upon the presentation, the traditional categories of infertility and irregular menstruation may also be pertinent. The key pathogenetic process in EM is Blood stasis in the lower Jiao (i.e. in the pelvic cavity), which is the underlying cause of dysmenorrhea and chronic pelvic pain11,12,13. It should be noted that Blood stasis in the lower Jiao is the end result of pathological processes that may have begun in childhood or adolescence. Therefore, while resolving Blood stasis should

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be the primary focus of treatment initially, it is important to also address the various factors that underlie and drive the condition. This is essential if the overall aim of treatment is to restore fertility and normalise the menstrual cycle. Thus, as symptoms begin to improve, the treatment should increasingly focus on these secondary pathogenetic factors.

Pathogenesis of Endometriosis

The internal organ systems that are most closely involved in the control of fertility, menstruation and the menstrual cycle are the Kidney and Liver. Normal female reproductive function, overall, depends upon the state of the Kidney; fertility depends mainly on the Kidney Essence, while normal menstruation depends mainly on the Liver and this organ’s control of the movement of the Qi and Blood. In addition, because of the regular monthly loss of Blood, women are particularly susceptible to three interrelated conditions: Blood deficiency, Blood stasis and deficiency of the Kidney Essence14. Some of the important factors that can interfere with Liver and Kidney function and lead to Blood deficiency or Blood stasis include: • Deficiency of the Kidney: Either constitutional or acquired (due to lifestyle factors, such as poor nutrition, insufficient sleep and overstrain). This can affect every aspect of gynaecological function. • Spleen Qi deficiency: Which may be constitutional or acquired (due to lifestyle choices such as inappropriate diet, over-training and worrying). The important consequences of Spleen Qi deficiency are insufficient Blood production, which affects the Liver, and insufficient Essence production, which affects the Kidney. Another aspect of Spleen function, also relevant in EM, is controlling the Blood to keep it within the vessels. This function may begin to fail when the Spleen is deficient, leading to excessive menstrual blood loss and bleeding between periods. • Retained Damp due to Spleen Qi deficiency: An important pathological consequence of Spleen Qi deficiency is retention of pathogenic Damp, which in turn may develop into Damp-Cold, Damp-Heat or Phlegm, obstructing the normal movement of the Qi and Blood. • Stress and emotional strain: Which interfere with Liver function. This may lead to poor control of Qi movement with stagnation of the Qi, predisposing to Blood stasis. • Invasion by exogenous pathogens: Principally

pathogenic Cold. This may come about due to one or more of the following: prolonged exposure to cold temperature, wearing a wet swimming costume (i.e. not drying off immediately after a swim and allowing the costume to dry by absorbing body heat), over-consumption of iced drinks, cold (refrigerated) foods or Cold-natured foods. The Uterus is more vulnerable during menstruation, particularly in women with constitutional Yang deficiency. When pathogenic Cold invades the Uterus, it causes the Qi and Blood to stagnate. • Sexual activity: During menstruation and sexual activity too early in life may lead to the development of Blood stasis in the lower Jiao13,14.

Diagnosis of Syndrome-Patterns in Endometriosis

Key points in TCM differential diagnosis pertain to distinguishing excess and deficiency; Hot and Cold; Internal organ system involvement (Liver, Spleen or Kidney); and presence of pathogenic factors, such as Damp or Phlegm12,15. Various features associated with the primary symptom (pain), can provide much useful information for differential diagnosis. • Pain that occurs mainly before and during menstrual bleeding, with acute tenderness on palpation indicates an excess condition. • Pain that occurs mainly after menstrual bleeding has ceased, with alleviation by pressure or massage indicates a deficiency type condition.

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• Colicky pain that is alleviated by the application of warmth indicates a Cold type of condition. • Pain that is perceived as burning and is worsened by the application of heat indicates a Hot condition. • Pain that is accompanied by a sensation of distention, with distention more severe than the pain, indicates Qi stagnation. • Strong pain that that is perceived as sharp, stabbing or throbbing, and is relieved after the passage of clotted blood, indicates Blood stasis. • Pain that involves the lateral region of the lower abdomen indicates Liver involvement. • Pain that involves the lumbar region indicates Kidney involvement.

Traditional Chinese Medicine Patterns of Endometriosis

Bearing in mind that the core pathology in EM is Blood stasis, there are several other patterns of imbalance that may accompany the principal pattern. These, together with their key clinical features are outlined below. 1. Qi stagnation: Distending quality to the pain, worsening of pain with emotional strain, sense of tightness in the chest, sighing, wiry pulse that may also be weak and thready. Treatment formulas include Xiao Yao San (Bupleurum & Dang-Gui Formula, a.k.a. Stress Relief 2 Formula); Jia Wei Xiao Yao San (Bupleurum & Peony Formula, a.k.a. Stress Relief 1 Formula); Chai Hu Shu Gan San (Bupleurum & Cyperus Combination, a.k.a. Qi Mover Formula). 2. Cold accumulation a) Excess: Cramping pain with a cold sensation in the lower abdomen and lower back, aggravation of pain by pressure or massage, relief of pain by application of heat, cold limbs and sensitivity to cold, scanty prolonged and dark menstrual flow, long cycle, swollen tongue that may also be purple-hued with a thick or greasy white coat, deep-tight pulse. Treatment formula: Wen Jing Tang (Dang-Gui & Evodia Formula). b) Deficiency (Kidney Yang deficiency): Sensitivity to the cold, cold limbs, dragging or heavy pain that is alleviated by pressure/massage and warmth, pale tongue with a thin white coat, deepweak pulse. Treatment formulas include Fu Gui Ba Wei Wan (Rehmannia Eight Formula, a.k.a. Rehmannia Eight Virality Formula), You Gui Wan (Right Returning Formula). 3. Liver-Kidney deficiency: Pain in the lower abdomen and lower back mainly occurring towards the end of or after menstruation, light menstrual bleeding, thin or scanty tongue coat, deep-weakthready pulse. Treatment formula: Liu Wei Di Huang Wan (Rehmannia Six Formula, a.k.a. Yin Tonic Formula). 4. Qi & Blood dual deficiency: Pain occurs towards PAGE 32 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

the end of or after menstruation, dragging or distending pain in the lower abdomen and perineum, menstrual bleeding is either scanty or profuse, pale complexion, fatigue, poor appetite, dizziness, palpitations, insomnia, pale tongue, weak-thready pulse. Treatment formulas include Gui Pi Tang (Ginseng & Longan Formula, a.k.a. Restore the Spleen Formula), Ba Zhen Wan (Ginseng & Dang-gui Eight, a.k.a. Qi & Blood Tonic 2 Formula). 5. Heat excess: Fever before or during menstruation, dark urine, constipation, irritability, red tongue with a yellow coat, wiry-rapid pulse. Treatment formulas include Xiao Chai Hu Tang (Minor Bupleurum Formula, a.k.a. Resistance 2 Formula), Long Dan Xie Gan Tang (Gentiana Formula, a.k.a. Anti-Inflamm. Formula).

Treatment Protocols with Prepared Chinese Herbal Medicines

The core pathological process in EM is Blood stasis, commonly driven by Kidney deficiency and commonly with development of further pathological changes, such as Phlegm or Heat. There may also be accompanying imbalances that affect the course of the illness, such as Qi stagnation (affecting the Liver), Spleen Qi deficiency and retained Damp. Treatment should begin with the primary focus on resolving Blood stasis and alleviating pain. The main formulas for Blood stasis are: Tong Jing Wan (a.k.a. Menstrual Relief Formula), Gui Zhi Fu Ling Wan (Cinnamon & Hoelen Combination), Huo Luo Xiao Ling Dan (Salvia & Boswellia Formula, a.k.a. Pain-Less Formula), Shao Fu Zhu Yu Tang (Formula to Dispel Stasis in the Lower Abdomen). All formulas, except for the last one mentioned, are available in Australia.

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Although successful treatment has been achieved with protocols involving the prescription of a different formula for each week of the menstrual cycle, this type of protocol is quite difficult to implement in Western clinics; the woman may have an irregular cycle or one that is considerably longer or shorter than 28 days, not to mention issues with patient compliance. A practical approach is to provide Chinese formulas in a prepared form (i.e. pills or capsules) and give the core treatment (i.e. dispel Blood stasis and alleviate pain) during the second half of the cycle, including during menstrual bleeding, and give a ‘constitutional’ treatment (generally tonification therapy) during the first half, beginning from the cessation of bleeding19. In women with pain that occurs throughout the cycle and is not confined to the time of menstrual bleeding, the core protocol may be applied continuously until the symptoms have improved, after which the treatment may be divided as described above.

Core Treatment Protocols

The principle of treatment during the second half of the cycle, up to and including menstruation, is to activate the Blood and dispel stasis to alleviate pain. The choice of formulas depends on two considerations: constitutional strength and severity of the pain. • Tong Jing Wan (a.k.a. Menstrual Relief Formula): For use in most patients with normal to robust constitution. • Gui Zhi Fu Ling Wan (Cinnamon & Hoelen Combination): For women with a more delicate constitution (fatigue, poor appetite, muscular weakness, lack of emotional resilience, weak and/or

thready pulse). • Huo Luo Xiao Ling Dan (Salvia & Boswellia Formula, a.k.a. Pain-Less Formula): To be used as an adjunct to either of the above formulas in cases with severe or refractory pain.

Secondary Treatment Protocols

The following formulas are generally given during the first half of the cycle, beginning after the cessation of menstrual bleeding. 1. Qi stagnation: This pattern is relevant for milder type symptoms with a distending or bloating sensation, poorly localised pain, intermittent pain and pain that is brought on or worsened by emotional strain. • Xiao Yao San (Bupleurum & Dang-Gui Formula, a.k.a. Stress Relief 2 Formula): For deficiency type presentations with pale tongue, and a wiry-thready pulse. • Jia Wei Xiao Yao San (Bupleurum & Peony Formula, a.k.a. Stress Relief 1 Formula): For cases with signs of stagnant Heat: irritability, red eyes, poor sleep, sensations of heat, red tongue tip, wiry-rapid pulse. • Chai Hu Shu Gan San (Bupleurum & Cyperus Combination, a.k.a. Qi Mover Formula): For robust constitution with no signs of deficiency. 2. Cold accumulation: This pattern is characterised by signs of Cold: Sensitivity to the cold (e.g. wearing heavier clothing than normal), cold hands and feet, pallor. • Wen Jing Tang (Dang-Gui & Evodia Formula): For signs of Cold in the lower body (cold abdomen and cold feet on palpation, cold sensation in the lower abdomen and lower

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back), and Heat signs in the upper body (afternoon fever, hot hands, dry mouth and lips). • Fu Gui Ba Wei Wan (Rehmannia Eight Formula, a.k.a. Rehmannia Eight Vitality Formula): For Kidney Yang deficiency with Fluid disorder (Damp, Phlegm-Damp or Water retention): Cold intolerance, low back pain, cold hands and feet, cold lower abdomen, fatigue, polyuria, nocturia, possibly also mild edema in lower limbs, pale tongue that is swollen and moist, deep-weak pulse. • You Gui Wan (Right Returning Formula): For presentations similar to the previous formula, with more pronounced deficiency: severe fatigue, loss of libido, infertility, dizziness, tinnitus. 3. Liver-Kidney deficiency: This is a pattern of combined Liver Blood and Kidney Yin deficiency. The key clinical features include: light menstrual bleeding, thin or scanty tongue coat, deep-weakthready pulse. • Liu Wei Di Huang Wan (Rehmannia Six Formula, a.k.a. Yin Tonic Formula). 4. Qi & Blood dual deficiency: This is a common deficiency pattern with the following clinical features: Pain occurs towards the end of or after menstruation, dragging or distending pain in the lower abdomen and perineum, menstrual bleeding is either scanty or profuse, pale complexion, fatigue, poor appetite, dizziness, palpitations, insomnia, pale tongue, weak-thready pulse. • Gui Pi Tang (Ginseng & Longan Formula, a.k.a. Restore the Spleen Formula): For patients with poor sleep and lower emotional resilience (i.e. a sense of being overwhelmed). • Ba Zhen Wan (Ginseng & Dangui Eight, a.k.a Qi & Blood Tonic 2 Formula): This is a good Qi and Blood tonic for general use and is preferred when prescribing combinations of formulas, as there are fewer ingredients than the other formula, above. 5. Heat excess: This is specifically for use when there is a fever before or during menstruation. Other clinical features include dark urine, constipation, irritability, red tongue with a yellow coat, wiryrapid pulse. • Xiao Chai Hu Tang (Minor Bupleurum Formula, a.k.a. Resistance 2 Formula): For milder conditions with the woman sometimes feeling hot and sometimes feeling cold. • Long Dan Xie Gan Tang (Gentiana Formula, a.k.a. Anti-Inflammatory Formula): For women with a robust constitution and more severe and prolonged signs of Heat. This formula is best used only for short term treatment and may be combined with Blood PAGE 34 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

stasis resolving formula/s during the second half of the cycle.

Empirical Research on Traditional Chinese Medicine Treatments for Endometriosis

In China and Taiwan traditional therapies, such as herbal medicine and acupuncture, comprise an important component of each country’s national health system. Because of this, there is a wealth of data concerning the day to day clinical use of traditional medicines in EM, as well as information gained from ongoing human and animal studies, including the development of innovative treatments16,17,18,19. Two recent review papers on EM treatments in China provide a concise summary of clinical and animal studies with evidence that Chinese Herbal Medicine (CHM) is effective in alleviating dysmenorrhea and pelvic pain, shrinking ectopic endometrial tissue, promoting pregnancy and reducing the recurrence of pain. Commonly used traditional formulas include Xue Fu Zhu Yu Tang (Persica & Cnidium Combination a.k.a. Blood Moving Formula), Xiao Chai Hu Tang (Minor Bupleurum Formula a.k.a. Resistance 2 Formula); Gui Zhi Fu Ling Tang (Cinnamon & Hoelen Combination), as well as several modern empirical formulations, including generically named formulas, such as Tong Jing Wan (Painful Menses Pills) and Nei Yi Fang (Endometriosis Prescription)16,18. In Taiwan, prepared traditional Chinese Herbal Medicines are frequently prescribed for women with EM. Commonly used formulations include: Gui Zhi Fu Ling Tang (Cinnamon & Hoelen Combination); Dang Gui Shao Yao San (Dang-Gui & Peony Combination); Jia Wei Xiao Yao San (Bupleurum & Peony Formula, a.k.a. Stress Relief Formula); Wen Jing Tang (Dang Gui & Evodia Formula); Xue Fu Zhu Yu Tang (Persica & Cnidium Combination a.k.a. Blood Moving Formula)17.

Properties of Commonly Used Herbs for Endometriosis

The major herbal ingredients in formulations that treat EM and associated symptoms have three main modes of action: anti-inflammatory, anti-proliferative and anti-nociceptive (i.e. pain alleviating). The biochemical pathways involved include suppression of cytokines, NF-KappaB and COX-216,18. • Herbs that have shown a marked effect on cytokine suppression in vitro and in animal studies include: White Peony (bai shao), Chinese Angelica (dang gui), Frankincense (ru xiang), Myrrha (mo yao) and Curcuma sp. (jiang huang, yu jin, e zhu). In addition to reducing inflammation, blocking of cytokine pathways helps reduce attachment, angiogenesis and/or proliferation of ectopic

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endometrial tissue in the pelvis. • Herbs that act on the prostanoid pathway to inhibit COX-2 and/or PGE2 include: Licorice (gan cao), Curcuma sp. (jiang huang, yu jin, e zhu), Cinnamon (gui zhi), Poria (fu ling), Scutellaria (huang qin). These actions help to reduce inflammation and inhibit the proliferation of ectopic endometrial tissue. • The other important therapeutic action that contributes towards reducing inflammation and endometrial proliferation is the neutralisation of reactive oxygen species (ROS) through antioxidant effects. Herbs such as Salvia (dan shen), Curcuma sp. (jiang huang, yu jin, e zhu), and Chinese Angelica (dang gui) each contain a variety of potent antioxidant compounds. • Herbal medicines that relieve pain act through various pathways and may have a combination of anti-inflammatory, sedative, hypnotic and muscle relaxant actions, in addition to a direct analgesic effect. Herbs with a marked antinociceptive action include: Coydalis (yan hu suo), Frankincense (ru xiang), Dahurian Angelica (bai zhi), Curcuma sp. (jiang huang, yu jin, e zhu), White Peony (bai shao), Salvia (dan shen) and Myrrha (mo yao)18.

i.e. progressively worsening and debilitating pain as well as infertility, an intensive approach to treatment is justified. This means following a treatment protocol designed to treat EM in every patient with progressively worsening dysmenorrhea, particularly when accompanied by other genitourinary and/or lower GIT symptoms. Treatment should be continued until there have been at least three pain-free cycles. Based on Chinese studies, treatment with herbal formulas is generally continued for three to six months, and up to one year in some cases. Overall, the outcomes of treatment are around 50% complete remission of pain, another 20–30% with improvement in symptoms and another 20–30% with failure of treatment or relapse after cessation of treatment19.

Additional therapies that are effective in the treatment of EM include retention enema with herbal decoctions15,16. The herbs are decocted down to 150200ml, allowed to cool and then injected per rectum and retained for up to two hours, the abdomen being periodically massaged and finally for the last 10-15 minutes, massaging from the lower right quadrant following the colon in an aboral direction to facilitate emptying. The procedure is done once daily in the evening before sleep. There are various formulas that have been used, all containing a majority of Blood moving and pain alleviating herbal ingredients. Some examples include: • Salvia (dan shen), Ligusticum (chuan xiong), Sparganium (san leng), Curcuma zedoaria (e zhu), Boswellia (ru xiang), Myrrha (mo yao), Carthamus (hong hua), Daemonorops (xue jie). • Salvia (dan shen), Fritillaria (zhe bei mu), Boswellia (ru xiang), Myrrha (mo yao), Sargentodoxa (hong teng), Patrinia (bai jiang cao), Cassia (rou gui), Corydalis (yan hu suo), Red Peony (chi shao), Chinese Angelica (dang gui), Persica (tao ren).

Concluding Remarks

Because the definitive diagnosis of EM relies on laparoscopic detection of ectopic endometrial tissue, which for various reasons is not carried out on every woman with prolonged dysmenorrhea, estimates of the prevalence of EM are inevitably quite inaccurate (i.e. between 40–80%). However, in view of the serious consequences of this condition,

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Kerry Bone

Founder and Director of Research at MediHerb Principal of Australian College of Phytotherapy Adjunct Professor of New York Chiropractic College

What are the Best Herbs for Boosting Healthy Sleep? “Scientists have discovered a revolutionary new treatment that makes you live longer. It enhances your memory, makes you more attractive. It keeps you slim and lowers food cravings. It protects you from cancer and dementia. It wards off colds and flu. It lowers your risk of heart attacks and stroke, not to mention diabetes. You’ll even feel happier, less depressed, and less anxious. Are you interested?”. So writes Matthew Walker in Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner, An Imprint of Simon and Schuster, New York, USA, 2017. “Human beings are the only species that deliberately deprive themselves of sleep for no apparent gain”. This quote is again from Matthew Walker, who goes on to assert: “In terms of our natural sleeping tendencies, people can be divided into two broad groups, or ‘chronotypes’: morning larks and night owls. Each group operates along different circadian lines, and there is pretty much nothing owls can do to become larks – which is tough luck, because work and school scheduling overwhelmingly favour early risers”. Owls are often forced, he writes, “to burn the proverbial candle at both ends. Greater ill health caused by a lack of sleep; therefore, befalls owls, including higher rates of depression, anxiety, diabetes, cancer, heart attack and stroke”. PAGE 40 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

Dr Michael J. Breus gives a dire warning concerning sleep deprivation: “Populations are at greater risk for a number of chronic diseases and mental health disorders, as well as challenges to daily life and relationships. These are dangerous and expensive problems” 1. Hence from the perspective of natural therapies, improving sleep quality should not be just regarded as an end in itself. Restoring healthy sleep forms an important core strategy for many health problems, as listed above. Our brain uses sleep to process the experiences of the day. During NREM (non-rapid eye movement) sleep, we move information from short-term in the hippocampus into long-term memory. It frees up space in short-term memory for the next day and allows us to have access to past knowledge in the future. During REM (rapid eye movement) sleep we now take this new knowledge and compare it to our total catalogue of past experiences and knowledge. This allows us to make connections between things learnt in the past and this new knowledge. Plus, another rather extraordinary thing happens: the area of our brain dedicated to rational thought goes offline. This allows us to make seemingly unrelated connections that consolidate our knowledge base and

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boost creative thinking2. During the night as we sleep, we move between REM and NREM sleep several times, a phenomenon that can be recorded by polysomnography. The resultant pattern is termed sleep architecture.

Improving sleep naturally might save lives!

In a widely publicised 2012 article, a group of United States scientists found a strong association between the use of modern hypnotic drugs (sleeping pills) and increased risk of death. The study’s principal author, Dr Daniel Kripke, had been interested in this association for more than a decade. At least 24 published studies have examined mortality linked to hypnotic drug consumption, with 18 (p<0.05) reporting significant positive associations3. The analysis of these by Kripke and co-workers was a matched cohort study to compare mortality and cancer risk of modern sleeping drugs (short-acting benzodiazepine agonists such as zolpidem, zaleplon and eszopiclone) with controls and older hypnotics. Their results were both surprising and alarming. Participants (mean age 54 years) were 10,529 patients who received hypnotic prescriptions and 23,676 matched controls with no hypnotic prescriptions, followed for an average of 2.5 years between January 2002 and January 2007. Data were adjusted for age, gender, smoking, body mass index, ethnicity, marital status, alcohol use and prior cancer. Hazard ratios (HRs) for death were computed from Cox proportional hazards models controlled for risk factors and using up to 116 strata, which exactly matched cases and controls by 12 classes of co-morbidity (so that any confounding effect of a pre-existing health condition was controlled for). Patients prescribed any hypnotic had substantially elevated hazards of dying compared to those prescribed no hypnotics. For groups prescribed up to 18, 18-132, and greater than 132 doses/year, HRs (95% CI (confidence intervals)) were 3.60 (2.92-4.44), 4.43 (3.67-5.36) and 5.32 (4.50-6.30), respectively, demonstrating a dose-response association. HRs were elevated in separate analyses for several

common hypnotics, including zolpidem, temazepam, eszopiclone, zaleplon, other benzodiazepines, barbiturates and sedative antihistamines. Particularly disturbing was the finding that receiving hypnotic prescriptions was associated with a greater than threefold increased hazard of death, even when prescribed at less than 18 pills/year. This association held in separate analyses for several commonly used hypnotics and for newer shorter-acting drugs. While it should be stressed that cohort studies such as this one do not necessarily imply causality, it is possible that the use of hypnotic drugs is responsible for millions of early deaths worldwide each year. Certainly, in Kripke’s opinion the risks of the use of such drugs now outweigh the benefits: “The recommended doses objectively increase sleep, little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioural treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia”4. Clearly, it is time to seek safer alternatives to help patients improve their sleep. There are many promising candidates among medicinal plants, as outlined below. Matthew Walker explains in his book why insomnia drugs might result in premature death. First, we need to accept the premise that these drugs do not fully create a genuine state of sleep, with all the features of REM and NREM sleep. Instead, they create a state of sedation that mimics sleep. Hence the person who uses these drugs is in fact sleep deprived. A feature of anyone who is sleep deprived is that they are more prone to infections and road accidents, both significant causes of death. In contrast, there are preliminary data that herbs can actually support sleep architecture, meaning they might represent the best and safest pharmacological option to treat insomnia and promote natural healthconferring sleep.

Classification of Insomnia

The following basic differentiations are used to classify insomnia: • Difficulty falling asleep (sleep onset insomnia) • Awakening during the night and difficulty falling asleep (sleep maintenance insomnia). This is often a characteristic of the adrenally-depleted patient and those with fibromyalgia syndrome • Early morning awakening (sleep offset or terminal THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 41

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insomnia) that can be linked to depression or poor sleep quality. This is often classified as one aspect of sleep maintenance insomnia • A sense of not having enough sleep (nonrestorative sleep). This is often characteristic of chronic fatigue syndrome These different patterns of insomnia are treated differently when applying herbal therapy (see Table 1 below).

Key Herbs for Sleep: The Evidence and Clinical Application European Valerian Leathwood and Chauffard in the 1980s demonstrated that European Valerian extract improved sleep latency and quality (versus placebo), but only in poor or irregular sleepers5. Results from subsequent trials have been mixed, but overall do indicate a clear effect on subjective sleep quality6. Numerous earlier studies of European Valerian on its own or in combination with Hops, Passionflower and/or Lemon Balm have demonstrated improvements in sleep parameters in controlled clinical trials. The Committee on Herbal Medicine Products of the European Medicines Agency concluded “...that aqueous ethanolic extracts of Valerian Root have a clinical effect in sleep disturbances as assessed by subjective ratings as well as by means of validated psychometric scales and electroencephalography (EEG)-recordings... There is quite strong evidence from both clinical experience and sleep-EEG studies that the treatment effect increases during treatment over several weeks”7. Chaste Tree and Melatonin According to Dioscorides (De Materia Medica AD 40 to 80), when writing about Chaste Tree: “A weight of 1 drachma in wine makes the menses come on earlier, detaches the embryo, attracts the milk, goes to your head and brings sleep”8. The circadian rhythm of Melatonin secretion was measured in 20 healthy men aged 20-32 years following the intake of placebo or various doses of an extract of Chaste Tree for 14 days9. In an open, placebo-controlled study, the doses investigated were 120-480mg/day of the extract (corresponding to approximately 0.6g-2.4g of the dried berries per day). These were taken as divided doses at 8.00, 14.00 and 20.00 hours. The concentration of Melatonin in serum showed the typical nocturnal increase, beginning PAGE 42 | SPRING 2020 | THE NATURAL THERAPIST VOL35 NO.3

approximately one hour after the light was turned off. Administration of Chaste Tree caused a dosedependent increase of Melatonin secretion when compared to the placebo treatment, especially during the night. Total Melatonin output was approximately 60% higher in the group receiving Chaste Tree. The authors observed that the feeling of fatigue or the promotion of sleepiness observed by some patients taking Chaste Tree during the trial might be a result of the stimulation of endogenous Melatonin secretion. Indications for Chaste Tree should now include jet lag, sleep maintenance insomnia and disturbed day-night rhythm (as with shift workers). Based on that research, this has become one of my most important clinical uses of Chaste Tree in both men and women, for which it is highly effective, providing an adequate dose is used. For jet lag, higher doses are needed: up to 5g/day. It is also valuable in some cases of sleep onset insomnia. Zizyphus Seed and Insomnia The key Chinese herb for insomnia is Zizyphus Seed (Suan Zao Ren) or the spiny jujube. A recent systematic review of randomised controlled trials (RCTs) of Chinese Herbal Medicine for insomnia found Zizyphus Seed was the most used (in 190 of the 217 identified clinical trials)10. Another systematic review of Zizyphus Seed decoction on its own for primary insomnia found 12 clinical trials. The overall finding was Zizyphus Seed was more effective than benzodiazepines, but trial quality was noted to be poor11. St John’s Wort St John’s Wort (SJW) might also boost Melatonin. In an uncontrolled trial involving 13 healthy volunteers, a significant increase in the nocturnal Melatonin plasma concentration was observed after three weeks of administration of SJW12. Sleep disorders, as well as anxiety and depressive agitation, were reduced by SJW extract in 240 patients suffering from mild-to-moderate depression with anxiety in a six week RCT13. Kava Kava is not only the best herbal answer for anxiety, it also plays a very useful role in promoting healthy sleep with very little ‘hangover’ effect the next day

Member Article Spring 2020

from its use (although this can occur to a mild extent in some people). There is also clinical evidence to back this up. In a pilot RCT involving 12 healthy volunteers over four days, a placebo was taken for the first three days and followed the next day by three divided doses totalling either 150mg Kava extract (containing 105mg Kavalactones) or 300mg extract (containing 210mg Kavalactones)14. With Kava, the time to fall asleep and the light sleep phase were shortened, the deep sleep phase was lengthened, the duration of REM sleep was not influenced and the length of wakeful phases in sleep EEG recordings was decreased. A later double-blind, multicentre RCT assessed a Kava extract in sleep disturbances associated with anxiety disorders in 61 patients15. The dose of Kava extract used was 200mg/day (containing 140mg Kavalactones) over a period of four weeks. Statistically significant group differences were demonstrated in favour of the Kava group, as measured by the sleep questionnaire SF-B sub-scores ‘Quality of sleep’ and ‘Recuperative effect after sleep’ (p=0.007 and p=0.018, respectively). Superior therapeutic efficacy was also demonstrated for Kava extract over placebo by way of the Bf-S self-rating scale of wellbeing, the clinical global impression (CGI) and the Hamilton psychic anxiety sub-score (p=0.002). Passionflower In the first RCT of Passionflower for sleep (crossover design), 41 people found that a week of the tea (2g in one cup one hour before bed) was better than placebo (parsley tea) in terms of subjective sleep quality16. There was a significant improvement in sleep quality when taking the Passionflower (5.2% mean increase relative to placebo; p<0.01). No significant effects were found for the other parameters, although the participants had initially low levels of anxiety and only a small number had polysomnography recorded. In a later RCT in 110 patients diagnosed with insomnia according to the DSM-5, two weeks of Passionflower treatment significantly improved total sleep time, compared to the placebo17. Mexican Valerian This herb is a highly underestimated option for treating insomnia and anxiety. Often the most positive feedback from patients suffering from these disorders is after they have taken Mexican Valerian.

Valeriana edulis ssp. procera, commonly known as Mexican Valerian, is widely used in Mexican Traditional Medicine for insomnia and anxiety. A crossover RCT (n=20) compared Mexican Valerian with European Valerian at equal doses (450mg of dry extract) administered one hour before lights out in a sleep laboratory18. Mexican Valerian reduced the number of awaking episodes, while both herbal treatments increased REM sleep; this last parameter was better improved by European Valerian. Both herbs improved NREM sleep. Validated clinical tests also showed that both species reduced morning sleepiness and did not affect anterograde memory (loss of short-term memory). Chemical analysis of the hydroalcoholic extract of Mexican Valerian indicated that the extract contained 0.26% of dihydroisovaltrate as the main valepotriate, and that it did not contain valerenic acid, which is a key active ingredient in European Valerian. Hence, the two herbs are both phytochemically and therapeutically distinct, with Mexican Valerian containing much higher levels of valepotriates.

Summary

The differential use of herbs for the various clinical patterns of insomnia is summarised in Table 1. Worth noting is that tonic and adaptogenic herbs used throughout the day or before bed can help to break the vicious cycle of non-restorative sleep in stressed patients. Ashwagandha (Withania) can be a key herb for this. While Kava is still the mainstay for sleep onset insomnia, Mexican Valerian is a highly effective option and represents a useful alternative to European Valerian, with quite different phytochemistry. However, the most significant recent development is the effective use of Chaste Tree for sleep maintenance insomnia and related sleep disturbances. Table 1: Herbs and Insomnia Classification Summary Sleep onset problems • Valerian, Kava, Mexican Valerian, Passionflower, Zizyphus Seed, Corydalis, Chaste Tree, Californian Poppy, Chamomile, Magnolia, Lavender, Hops Sleep maintenance problems • St John’s Wort, Chaste Tree, Valerian, Kava, Licorice and/or Rehmannia, Magnolia Restorative sleep problems • Withania, Rhodiola, Korean Ginseng, Licorice, Rehmannia

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 43

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Member Article Spring 2020

Ashleigh Mythen

Naturopath Podcast - ‘It can’t be that friggin hard’

3 Things to Think About Before Beginning a Spring Cleanse As the flowers begin to bloom bringing in the warmer weather, an increase in social activities and daylight savings commence allowing us to be more active but also perhaps bringing to light some of the winter comfort eating and other not so healthy habits that many of us indulge in these colder months. I find that this is the perfect time to do a little ‘spring cleaning’. Although the body detoxifies daily, symptoms of fatigue, digestive sluggishness, or bad skin could indicate that there is a need to support and boost those elimination pathways. Many fantastic supplements are dedicated to this particular outcome. Here are 3 things to think about before beginning a Spring cleanse: 1. Know Your Why: • Knowing why we do anything in life is what Simon Sinek talks about in his book ‘Find Your Why’ as one of the most valuable ingredients in creating inspiration and fulfilment in the work you do. I believe that knowing your motivations behind your choices regarding health and wellbeing is just as, if not more important, in understanding our intentions for the career path we choose. • Uncomfortable and painful symptoms can be a catalyst for looking at different alternatives to how we are living our life. But knowing a deeper ‘why’ will be a domino effect that will help people be more compliant in sticking to programs and also be the thing that has the biggest and most long-lasting effect as it will help them have an anchor to cling to when at future health crossroads. What are your core values? What does health mean to you? • These are some questions that can help uncover the reason that will spark purpose and momentum but also will help be a guiding lighthouse, leading the way back to shore after periods of bad and unhealthy decisions. 2. Clean Space, Clean Mind: “It’s a very strange phenomenon, but when we reduce

what we own and essentially ‘detox’ our house, it has a detox effect on our bodies as well” - Marie Kondo • I believe there is a huge connection between how we keep the space we live in and the internal mental dialogue that lives in us. So, when beginning a cleanse, consider looking at what else could do with some ‘spring cleaning’? Maybe your wardrobe could do with a cull. Maybe going through things in your storage that you no longer need to store. • This process will not only help you to feel less stress as your home space becomes less cluttered, but it will also help to create a less stressful state internally as well. 3. The Support Network: • When embarking on a new venture, especially where health is concerned. This can create rifts and walls between us and our social life. Studies have demonstrated that social networks have proven to improve immune, endocrine, and cardiovascular systems1. • Often cleanses are dietary strict, which can be an incredibly stressful experience for patients when they must see friends and family who are eating the exact opposite to their recommended diet. • Giving patients that support and foundation by education and getting them to connect with their own ‘why’ and reason why they are starting on such a journey, will help people feel more empowered and stay on track amidst the challenges that will no doubt come their way. Doing a yearly cleanse is a fantastic way to keep the body in ‘tip-top’ condition alongside connecting with our reason and our why; as well as looking at our environment and how it affects us. It’s important to consider not just the nutrient pathway needs, but also the mental and environmental wellbeing which will then have a holistic effect on the person. For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles THE NATURAL THERAPIST VOL35 NO.3 | SPRING 2020 | PAGE 45

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