| Medical Herbalism: Clinical Articles and Case Studies |
Musculoskeletal - Arthritis case
by Cascade anderson Geller
Medical Herbalism 1(1):8-9
Each issue of Medical Herbalism will feature a case study, with commentary by expert herbalists from around the country. See accompanying commentaries. We welcome submissions of cases, and we also welcome reader comments on the cases. The following case study is from notes in a class taught by Cascade Anderson-Geller, a traditional herbalist, and instructor in botanical medicine at National College of Naturopathic Medicine.
Patient
Female, 40 years old, single. Communications specialist with high stress job. Overweight: 160 lbs at 5’4" Lives alone, but has close relationship with boyfriend. Eats out often — at least 2 meals a day. Diet is very rich. Feels run down and looks fatigued. Severe pain in shoulders, hands and hips for 9 months. Diagnosed with rheumatoid arthritis; also fibrocystic breast disease, Class I pap smear with yeast infection and extensive inflammation.
Medications
12-15 aspirin a day.
Treatment goals
Treat Arthritis. Assist in losing weight.
Initial visit
Patient advised to select three of the following initially, and add three a month.
1. 1 qt. of water daily: keep pitcher at desk.
2. Decrease coffee: have water before and after each cup.
3. Decrease wine to three times weekly.
4. Dark green fresh leafy vegetables daily.
5. 3-4 additional fresh vegetables daily. (suggested daily salad bar to replace 1 meal out)
6. brewers yeast: 1 tbs 5 times weekly
7.
Decrease nightshades: Potatoes, peppers, tomatoes, eggplant.
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8. Multi-vitamin/mineral supplement daily.
9. 2 grams vitamin C daily.
10. Keep herbal beverage teas (nutritive) at work.
11. Sauna twice weekly.
12 Use peanut oil in cooking; also rub on.
13. Walking 1/2 hour daily 5 days weekly.
Follow up: 6 Weeks
Attacks: experienced pain twice, but was less severe. Only took aspirin (8-12) at time of attacks. Weight: 153 pounds (lost 7 lbs. total) Walked: 1 hr. daily Vitamins: daily Coffee: Reduced to 2 cups daily Water: Keeps at desk. Still not drinking enough. Wine: decreased greatly Salads: daily Prescription: continue as above.
Follow up: 9 weeks
Attacks: 1 long attack: took only 3 aspirin 3 times a day for 2 days. Weight 148 lbs. (Total loss: 12 lbs) brewer’s yeast: takes several days weekly. Doesn’t like. Bath: Soaking in hot tub during attack, with foam pad at bottom of tub. Outlook: very hopeful and excited with results. Feeling much more energy. Enjoying compliments and encouragement from friends. Improved color and appearance. Prescription: Cottonwood Bud (Populus trichocarpa) tincture (Anti-inflammatory, with salicylates as metabolic end products); Stinging Nettle (Urtica dioica). Equal parts of tincture. Dose: 15 drops 3 times daily.
Follow up: 14 weeks
Attacks: Only 2 slight attacks. Took 1 motrin tab. Weight: 143 lbs (lost 17 lbs total) Outlook: Still feeling positive. Somewhat discouraged with slowing of weight loss. Diet diary still shows a fairly high caloric intake. Prescription: Same as above. Gave two refill bottles, one for home and one for work. Also added a 1 oz bottle of Valerian (Valeriana sitchensis) (sedative, pain} tincture. Dose: 10-25 drops midmorning for tension at work.
Follow up: 18 weeks
Attacks: none Weight: 141 lbs. (total weight loss 19 lbs) Outlook: Felt generally better all month. Herbs: Doesn’t think valerian is effective. Advised to use a higher dose.
Follow up: 24 weeks
Attacks:
1 slight attack in one hand only. No medications taken. Weight: 138 lbs
(total weight loss 22 lbs) Outlook: Positive for arthritis; discouraged
with weight loss. Prescription: Cottonwood bud (Populus trich.)
(anti-inflammatory); Willow Bark (Salix spp.) (anti-inflammatory,
action similar to Cottonwood); Burdock (Arctium lappa) (alterative).
Equal parts of tincture. Dose: 15 drops three times daily. Refilled Valerian
tincture
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Follow up: 28 weeks
Attacks: none Weight: 135 lbs. (Total loss 25 lbs.) Prescription: Same.
Silena Heron, N.D.
(notes from a telephone interview)
This is a wonderful case, and what I have to say is not really criticism. There are many ways to approach a case and have a good result.
I would have done my first follow up earlier, at about 3 weeks, and again at six weeks. I would also have given a formula for pain immediately, to be used as needed. I would also give much larger doses, say 1/2-3/4 tsp. three times a day. (I usually like to prescribe in mls rather than drops.) I would also have given nettles in a large dose early on. I ‘d also consider some kind of linement, perhaps Gaultheria procumbens (wintergreen). In this particular case, considering the whole picture, I would consider prescribing Verbena off. (vervain) — it is a nerve tonic, alterative, and galactagogue with some affinity for the female reproductive tract. For the midmorning tension at work, I would want to know what she had for breakfast. Did she have coffee in the morning? Whay was she tense then? I agree with the treatment here to start low with valerian and increase the dose later — it is possible to get idiosyncratic effects with any nervine in some people.
Silena Heron ND, is on the clinical faculty of Bastyr College in Seattle Washington. She was a practicing herbalist before becoming a naturopathic physician. She is also owner of Botanical Pharmaceuticals, a company selling tinctures, in Bainbridge Island, Washington.
Amanda McQuade Crawford, BA, MNIMH
excerpts edited for brevity
... I tend to treat the worst symptoms first, not necessarily in reverse order of their appearance. I find that patients with arthritis are most likely to continue with a long herbal treatment only when they experience a marked improvement first. Also if less allopathic painkillers are needed early, the right herbs can start the much-needed re-tread on the stomach and liver.
...
I try to schedule the first three visits or so at two-week intervals, to
keep the patients on track, and spend a lot of initial time listening to
patients’ needs. I offer supportive counseling around issues of friction,
both emotional and psychological. I may ask patients where their lives
are characterized by “surfaces grinding together.” This image is usually
followed by a light of recognition and insight on the faces of the patient.
I follow their lead on how deeply they want to go into this.
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... I also encourage corrective musculoskeletal manipulation as needed [this case was a chiropractic patient].
... I use large amounts of nervine relaxants, antispasmodics, and anti-inflammatories early in the case. My doses are high by current American standards: 1-2 tsp. herb mixture per cup of tea, 3-5 times a day, or 1-2 tsp. tincture diluted in 1 cup water 3 times a day. ... I sometimes give an external salve of Capsicum (Cayenne), Lobelia and Gaultheria (Wintergreen), which brings heat to cold, stiff joints.
For later treatment, as formulas change over several weeks, I might add Urtica (Stinging Nettle), Calendula (Marigold), or Humulus (Hops).
...Commonly, my arthritis patients take herbs 1 to 2 years.
The diagnosis of rheumatoid arthritis would lead me to use immune-normalizing alteratives within the context outlined above. The fibrocystic breast disease especially leads me to think of a caffeine-free diet and aromatherapy massage.
The yeast infection might be cleared without recourse to antifungals or even cleansing herb douches.
The extensive inflammation and Class I pap smear would concern me if these did not improve over the course of primary arthritis treatment. ... In the absence of a yeast infection, daily massage with vulnerary plant oils can bring results of a pap smear back to normal within a matter of months.
The fundamental restoration of health which underlies herbal treatment for arthritis may put these complications right in time without specific treatment.
Amanda McQuade Crawford, BA, MNIMH, practices herbal medicine at the Santa Rosa Medical Group, in Santa Rosa, California. She received her Diploma of Phytotherapy from the School of Herbal Medicine, Tunbridge Wells, Kent, England. She is a director of the California School of Herbal Studies in Sonoma County, CA. For more information, contact the School of Herbal Medicine, Box 39, Forestville, CA 95436.
Wade Boyle, N.D.
Edited
It
is easy to second-guess a failed case, but difficult to critique one, such
as this, which concludes with such excellent results.On the basis of the
information given, I agree with all the measures instituted. There are,
however, two things I would have done differently implementing the treatments.
First, I would not have held out my two best players (Populus and Urtica)
until the arthritis game had been more or less won by other members of
the therapeutic team. There was little need for them after two month’s
treatment had reduced the need for aspirin by (according to my calculations)
over ninety percent. Second, in a relatively young patient (forty years)
with a relatively recent disease (nine months) who is unusually motivated,
I would have made all the dietary and lifestyle changes right at the start.
Although this might have caused the patient some detoxification discomfort,
it may also have speeded up the resolution of the arthritis. Contrary to
the expectations I held when I first started practice, I find that most
patients are equal to stiff lifestyle challenges. Lacking further information
such ... whether or not the valerian worked at higher doses, what the basis
was for the diagnosis of rheumatoid arthritis, and how much wine, coffee,
and water the patient was consuming prior to treatment, I will make but
two other observations: First, I was amazed at the patient’s unhappiness
with the rate of weight loss, which seemed ideal to me, and wondered if
her expectations had been adequately addressed at the start of therapy.
Let me conclude by saying that this critique is strictly an academic exercise.
When a case comes to such an outstanding conclusion, all measures taken
must be deemed well-indicated and well executed.
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Wade Boyle, N.D. has a busy medical practice incorporating herbal medicine. He is author of The Herb Doctors, a history of early American herbalists and Eclectic doctors, and co-author of Naturopathic Hydrotherapy, both available from Buckeye Press, East Palestine, Ohio.
Comment on Hydrotherapy
P. Bergner
The patient reported at the ninth week sitting in a hot bath during a painful attack. Simple immersion in bath water has profound physiological effects which are relevant to the treatment of arthritis. Best effects are gained by immersion for 1-2 hours to a depth of about 3 feet.
1. O’Hare JP et al. “Observations on the effects of immersion in Bath spa water.” British Medical Journal. v.291 21-28 Dec 1985. p 1747-51.
2. O’Hare, JP et al. “Water immersion in rheumatoid arthritis.” British Journal of Rheumatology. 1984. 23 p117
3.
Grahme R et al. “The diuretic and natriuretic effect of water immersion
– a possible rationale for balneotherapy." Ann. Rheum. Dis. 1978,
37, 567
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