Making Medicine Part 5 of 5: Pressing and Filtering a Tincture

This is the fifth and last post in a series in which I am using the process of wild harvesting and making a fresh herb tincture of blue vervain (Verbena hastata) as an example to explain in detail the process of making herbal tinctures. In Part 1 of this series I discussed the process of harvesting blue vervain; in Part 2, preparing the herb for macerating; in Part 3, preparing the maceration; and in Part 4 I discussed some of the common equipment that is available for pressing and filtering the maceration. Now we're going to look at the actual process of pressing and filtering our maceration to prepare the tincture.

As I indicated in Part 4, this final stage in preparing our tincture can be either a single or two part process. The standard method is to pour the maceration into our press. Much of the fluid (also called the macerate) will flow through, but not all of it. Then we apply as much pressure as our press will easily allow to squeeze as much of the fluid as we can out of the herb material (also called the marc). The better the press, the more fluid that we can press out of the herb. This is not only more efficient because we will end up with a greater volume of tincture, but our tincture will tend to be a bit stronger because the fluid that is deep withing the tissues of the herb will tend to contain the highest concentration of its constituents. Having macerated the herb for at least three months will ensure that the herb tissues have softened sufficiently to make it more easier for our menstruum to penetrate into the tissues of the herb, extract its chemical constituents, and be pressed out when we apply pressure.

With this method, the fluid that flows from the press will contain herb particles that are small enough to pass through. The fluid must then be filtered. The standard method is to allow the tincture to flow into a filter in a funnel placed over a large beaker or other kind of receiving container, and allow gravity to draw the tincture through the filter. Beakers are the best container to use because they have a large opening, are graduated, have a spout that will make it easier to pour the tincture into our bottles, and better ones will be made of borosilicate glass which is more durable. Although the graduations on a beaker do not allow us to accurately measure the volume of our tincture, they give us an approximate volume which allows us to determine the size and number of bottles we will need to store it.

For this process we do not want to use a paper filter as these are too fine. We need to use a fairly coarse filter because we want to include the fine sediment and other thick components like latex in our tincture. This means that it is best to use a cloth filter. It is critical that our filter does not contain lots of chemicals that are typically found on fabrics these days. The best fabrics are unbleached organic cotton, hemp or another natural fibre or combination of fibres. Muslin or some other coarse weave is best as long as it isn't fuzzy like flannel. Otherwise cloth fibres might end up in our tincture. Even when using a relatively non-toxic fabric to make our filters, it is best to wash them a few times and rinse them very well. We don't want soap in our tinctures! Cloth filters will last many years. They need to be scrubbed (by rubbing the fabric against itself) and rinsed well after use. Although it is best to use soap the first time we wash them and rinse them very well, water alone is best after their initial use. Soap isn't necessary because tinctures are sterile. However, it is important that the filters be allowed to dry completely before storing them.

When using a potato ricer, the macerate (fluid) and herb material are poured into the ricer, which is held over the filter.

The liquid will flow through into the filter. An cone-shaped unbleached cotton coffee filter works well for this.

The herb material (marc) is then squeezed to get as much liquid out as possible. Once the macerate

has completely flowed through the filter we wring it out to get any remaining fluid out of it.

In terms of funnels, the best funnels have a design that has a spiral cut into them. This reduces the surface contact between the filter and the funnel and allows the fluid to flow out more quickly. These funnels are usually make of glass or polycarbonate (plastic #7). We don't want to use polycarbonate plastic because it contains toxic chemicals that will leach into our tincture. That leaves the glass ones. However, they are very expensive, easily broken, and only marginally speed up the filtering of tinctures that have sediment or latex. Tinctures that don't have these components tend to filter relatively quickly anyway. As a result, I recommend solid plastic funnels. They are inexpensive and easy to obtain. That being said, we only want to use funnels that are made of polyethylene or polypropylene (plastics #1, #2, #4 and #5) as these are not known to contain any chemicals that will leach into our tincture (so far). If the funnel doesn't clearly indicate which type of plastic it is, don't use it.

With a screw press, the receiving cylinders must be removed from the frame of the press in order to

be able to easily empty the contents of our macerating jar into them. It is also important that

the beaker be at a lower level to allow the tincture to flow into it.

The biggest disadvantage of this method of filtering is that it is very slow. In fact, if the tincture contains a lot of sediment and/or latex it can be extremely slow, even with a very coarse filter. This is undesirable because the longer our tincture is exposed to light and especially air, the greater the amount of degradation of its active constituents that will occur. As a result, I always use the second method of filtering the macerate and that is to make cloth filters that fit inside our pressing device. This allows the maceration to be pressed under pressure. It only slightly slows down the pressing process and the end result is a filtered tincture that can be bottled immediately. The reduction in time will significantly reduce the oxidation of the components of our tincture and therefore improve its quality and how long it can be stored before use. With this method it is not necessary to use a funnel unless we are using a potato ricer as our press. With a well designed screw press or hydraulic press the tincture can be directed directly from our press into the beaker.

With a potato ricer the cotton coffee filter is placed inside the ricer. It's still a good idea to use a funnel because the tincture

doesn't flow out of the ricer as neatly as through a hose and the funnel provides a wider area for it to drain into.

Here's the same set-up with a screw press. In this case it's necessary to make filters that fit the inner cylinder

of the screw press as cotton coffee filters are too small and not the right shape.

We pour the fluid into filter and then empty any of the remaining herb material into it as well. There will always be some residue in the jar, so I will pour some of the filtered tincture back into the jar to rinse the last of the herb material out of it. then we fold up the top of the filter so that when we apply pressure to it none of the unfiltered fluid will flow out of the top. With herbs that have a latex or are very mucilaginous, the filter will sometimes clog up preventing the fluid from draining efficiently. If this happens, it is important that there is no excess liquid on top of the herb material in the filter when we press it or it will not be possible to prevent it from flowing unfiltered out of the top of the filter. In this case I lift the filter part way out of the cylinder and rock it back and forth to speed up the rate at which the macerate flows through. Once the level of liquid is below the top of the herb material, it is OK to fold up the filter over top of it and press it. With a potato ricer we simply press it as hard as we can; with a screw press we tighten the screw as tight as we can; with an hydraulic press we pump it as much as we can.

Tightening the screw.

Here's the actual process using my hydraulic press: pouring the macerate and herbs from the jar into the cylinder.

Pumping the press.

With this method, once we finish pressing the herbs the filtering process is also complete and our tincture is ready! We need to get our tincture into bottles as quickly as possible in order to minimize oxidation. It is necessary to use narrow mouthed bottles because they have a smaller air space and it's easier to pour out of them. Once more we want to use amber glass bottles. The bottles I use are called amber metric rounds. The best lids are plastic phenolic caps with a cone-shaped polyethylene liner as these lids seal the best and polyethylene is one of the two kinds of plastic that are suitable for this purpose (the other being polypropylene).

50 ml, 100 ml and 250 ml amber metric rounds. The equivalent in the US is 2, 4 and 8 oz. bottles, which are slightly larger.

It is better to store our tincture in several smaller bottles rather than one large bottle. This will significantly increase the shelf life of our tincture. Every time we open up the bottle and use some of it we are exposing it to more oxygen and increasing the size of the air space in the bottle. The tincture in the bottle we are using will degrade much more rapidly than tincture in a full, unopened bottle. Since I tend to press half or one litre jars, I store my pressed tincture in multiple 250 ml bottles. If you are making smaller quantities for personal use, it is better to store your tincture in 100 ml bottles. Just like with our maceration, these bottles should be stored in the dark. Presumably, the last one we fill won't be completely full. We'll start by using that one and not start another until it is completely finished. In this way each bottle remains undisturbed until we need it. For most herbs, the tincture stored in the dark in an undisturbed full bottle will maintain its potency for about 6 months to a year. However, once we start opening it and using it it's best to use it up within 4-6 months. They don't go bad. They just lose their potency. The timing I have indicated is what is ideal. It doesn't mean you should throw out a tincture if you don't use it all within that time frame. However, I like to do things as ideal as possible, so I usually don't press any more of a specific tincture than I can use within 4-6 months.

Pouring the finished tincture into storage bottles. For demonstration purposes I broke with the tradition of these posts. I did not press
blue vervain herb tincture (Verbena hastata) because I had plenty on hand. Instead I pressed a half litre of blueweed herb tincture
(Echium vulgare) which is from the Borage family and has similar properties as common comfrey herb (Symphytum officinale).

It's important that we label our bottles of tincture. The label should include the name of the herb, the part of the herb used, the potency of the tincture, and the date it was pressed. I always use the same bottles for the same tincture because the bottle picks up the aroma and energy of the herb. You will note from the photo that I use green masking tape for labels because it is relatively water resistant, can be written upon and looks pretty good. Each time I press a tincture I cross out the old date on the bottle labels and write the new one until the label is full. Then I start a new one. This is an efficient way to label them because the same label can be used many times and a quick scan of the label gives me an accurate indication of how much I am using that tincture. This information is important when it's time to harvest that herb in terms of estimating how much I will need for the following year.

So, that finally wraps up this discussion of making tinctures! I hope that you have found it useful. As I promised way back when I posted the first installment of this series, since blue vervain was the common thread, especially in the first three posts, I am providing detailed information on the properties and uses of this herb that is based on my research and experience on the Herbal Resources page of the Living Earth website in the form of a pdf document that you can download (link to pdf file). Enjoy!

Thank you blue vervain!

Healing Bone Fractures, Part 5 of 5

This is the fifth in a series of posts in which I am documenting the process of treating a serious fracture of my right leg. In Part 1 I discussed the details behind the injury and the initial protocols that I used with the remedies I had available while I was still away. In Part 2 I provided a detailed account of the protocols that I implemented when I returned home. In the remainder of the posts I am providing an update on how things are progressing and any modifications that I have made to the protocols that I am using.

At this time I have to report that my leg is healing amazingly well. Since my last post I gradually increased the amount of weight I was carrying with my injured leg while still walking with crutches. On April 7th, about nine and a half weeks after my surgery, I walked without crutches for the first time! It kind of happened spontaneously while we were sitting around a fire. After that I increased the amount that I was walking without crutches each day. On April 10th I drove for the first time. I purchased a cane that day because I had to drive into Toronto on the evenings of the 11th and 12th and I knew I would be walking quite a bit. I thought I might need to use it for awhile, but except for those two evenings, I haven't used it since. On those two days I didn't use my crutches at all during the day except when I took my dogs for a walk in the woods. On the 13th I walked them for the first time without crutches and I have been crutch free ever since! This is pretty amazing given that the original prognosis was that I wouldn't be able to even begin to put weight on my leg until the middle to end of May. My healing process is about eight weeks ahead of schedule. Thank you plant people!

The "complications" that I discussed in my last post are pretty much resolved. I got rid of the remaining infection underneath one of the scabs on my incision. The astringed skin still isn't completely back to normal. It takes quite awhile for the skin to completely heal when the deeper dermal tissues get astringed, so am still applying things to this area at a minimum.

I had another x-ray this past week and the slightly darker area in my lower tibia below the bottom portion of the metal plate is still there, but not as dark as before. The surgeon can't explain it, but it isn't as noticeable as last time and, based on everything else, an infection in my bone has been pretty much ruled out. There is still a moderate amount of swelling around my ankle, although it is improving, but this is not due to infection. It turns out I have a pretty badly sprained ankle. This is typical with the kind of injury that I have. At this point my bone is doing fine and it is the sprain that is giving me the most difficulty. I still can only stretch my ankle about 80% of its normal range. It's a bit painful when I walk and it causes me to walk with a slight limp. However, I still refused the anti-inflammatories and ankle brace that the surgeon suggested. I've been doing some additional kinds of stretches with my ankle and in the last two days it has improved a fair bit. Today I had almost no limp even when I was walking my dogs. Tomorrow I have to teach a six and a half hour field workshop out in the woods. We'll see how well I hold up with that one! On Wednesday I'm off to Mexico for a week and a half, then I'm back for a day and off to Lake Superior for another week. This is part of my work, not a holiday. I am very grateful to be able to go as it was looking unlikely right after my injury. It will probably be awhile before I can run or carry a heavy pack, but otherwise my life is pretty much back to normal!

So here are the changes to the protocols that I have been using:

Systemic Herbal Formulation: In Part 4 of this series I provided the details of the third and fourth systemic formulations that I used. At about the nine week point the fourth formula ran out. The fifth version of the formulation contained wild bergamot herb (Monarda fistulosa) 20%, boneset herb (Eupatorium perfoliatum) 20%, common comfrey herb (Symphytum officinale) 18%, wood nettle herb (Laportea canadensis) 15%, maidenhair tree leaf (Ginkgo biloba) 15%, turmeric rhizome (Curcuma longa) 10%, and white pine leaf/twig (Pinus strobus) 2%. I added the wild bergamot because of the risk of infection in my tibia. It is an excellent herb for circulation and inflammation, but it is also an amazing antimicrobial. Yesterday I ran out of my fifth formulation and once more I made a slight change, substituting common burdock herb (Arctium minus) for boneset, and reintroducing stinging nettle herb (Urtica dioica) instead of wood nettle. Otherwise the formulation is the same. These changes were primarily implemented to prevent my body from getting too used to the formulation. I am continuing to take 6 ml three times per day on an empty stomach, 5-10 minutes before each meal.

Wild bergamot (Monarda fistulosa), my dear friend and colleague!

Herbal Sleep Formulation: I have been sleeping great, but probably not enough because most nights I have been working late. To support my healing process by making sure that I continue to get good sleep, I am still taking 0.75 mg of melatonin and an herbal sleep formulation when I go to bed. I have made additional adjustments to my sleep formulation so that my body doesn't get used to it and it continues to be somewhat coordinated (overlapping) with my daytime formulation. I have made two additional sleep formulations since my last post coinciding with the two most recent systemic formulations for my leg. The first one contained English lavender flowering spike (Lavandula angustifolia) 20%, wood nettle herb (Laportea canadensis) 20%, St. Johnswort herb (Hypericum perforatum) 20%, common comfrey herb (Symphytum officinale) 15%, hop strobilus (Humulus lupulus) 15%, wild bergamot herb (Monarda fistulosa) 9%, white pine leaf/twig (Pinus strobus) 1%. The most recent one that I prepared a couple of days ago contains English lavender 20%, stinging nettle 20%, St. Johnswort 20%, hop 20%, common comfrey 10%, wild bergamot 9%, white pine 1%. I am continuing to take 6 ml immediately before bed. Very rarely I've needed to take an additional 3 ml dose when I've woken up at the crack of dawn and had difficulty falling back asleep.

Homeopathic Remedies: I am continuing to take the same homeopathic remedies that I indicated I was using in Part 3.

Supplements: I am continuing to take the same supplements that I indicated in Part 2 except, as I mentioned in Part 4, I no longer need to take probiotics.

Topical Herbal Preparations: As I mentioned above, the infection underneath a scab that I discussed in Part 4 is gone, but the skin around my incision is still a bit astringed from doing too many poultices. As a result, I've had to cut back further on the topical preparations compared to what I was doing before. In spite of this, I have hardly any scar! Here's what I am currently doing:

• When I wake up I apply the liniment I am using (see Part 2) to my whole lower leg up to and including my knee, but not to the area of the incisions themselves. I actually ran out of the liniment and made a new batch. It has the same essential oils in roughly the same proportions, but I increased the potency to 3 drops per ml of base oil and the base oil is now 2/3 the infused oil I have been using and 1/3 castor bean oil (Ricinus communis). I made these changes because I was concerned about the possibility of an infection in my lower tibia. This has now been ruled out, but I am continuing to use the higher potency liniment to help address my sprained ankle. I do not apply anything to the area of my skin around the scar that is still somewhat astringed.
• In the evening before I go to bed I reapply the liniment as in the morning, but this time I apply castor oil to the astringed areas of my skin. This has been an interesting experiment because I haven't really used castor oil before. Nevertheless, I know a couple of people who have had great success treating bone fractures almost exclusively with castor oil packs. The castor oil is very drawing and it is accelerating the exfoliation of the dry scaly skin. However, it is also slightly astringent. Initially I tried applying it twice per day and it actually aggravated the astringed skin a bit. I've found once per day to be working much better. Once the astringed skin heals, I will go back to applying Monika's scar ointment to the area of the incision (see Part 4).

Castor bean oil (Ricinus communis) has many healing properties.
It can also help reduce infections deep in the tissues.

So there you have it! Needless to say, I'm very happy with how things are going. No matter how much we think we know, healing is still a very powerful and mysterious thing. It never ceases to amaze me, whether I'm experiencing it first hand or supporting other people with their healing process.

I'm going to be out of commission for the next few weeks as I will be off working in Mexico and then near Lake Superior. I will report on how my leg holds out when I get back ... and then maybe it will be time to write about something else. Enjoy the spring (or fall if you live in the deep south)!

Healing Bone Fractures, Part 4 of 5

This is the fourth in a series of posts in which I am documenting the process of treating a serious fracture of my right leg. In Part 1 I discussed the details behind the injury and the initial protocols that I used with the remedies I had available while I was still away. In Part 2 I provided a detailed account of the protocols that I implemented when I returned home. In the remainder of the posts I am providing an update on how things are progressing and any modifications that I have made to the protocols that I am using.

Overall, things have been going well, specifically with regard to the healing of my fractures. My leg is strong and I am well ahead of schedule. However, there have been a couple of unexpected complications relating to other aspects of my healing process which I will document below. I will begin with adjustments to the remedies and protocols that I am using.

Systemic Herbal Formulation: In Part 3 of this series I provided the details of the second systemic formulation that I began using about 3 weeks after my surgery. At about the 5 week point the second formulation ran out and once more I decided to make a slight change to the formula. While maintaining the focus on healing my bone fractures, I wanted to increase the emphasis on improving circulation to help further compensate for my lack of movement which was still resulting in a fair amount of blood pooling in my foot. At that time I only made a slight change, substituting rosemary (Rosmarinus officinalis) for wild ginger (Asarum canadense). I made additional changes at the 7 week point when I prepared my fourth formulation, replacing American plantain (Plantago rugelii) with maidenhair tree (Ginkgo biloba) and stinging nettle (Urtica dioica) with wood nettle (Laportea canadensis). The fourth version of the formulation contains wood nettle herb (Laportea canadensis) 20%, boneset herb (Eupatorium perfoliatum) 20%, common comfrey herb (Symphytum officinale) 20%, maidenhair tree leaf (Ginkgo biloba) 18%, turmeric rhizome (Curcuma longa) 10%, rosemary herb (Rosmarinus officinalis) 10%, and white pine leaf/twig (Pinus strobus) 2%. I am continuing to take 6 ml three times per day on an empty stomach, 5-10 minutes before each meal.

Wood nettle (Laportea canadensis) is rarely mentioned in the herbal literature.

Its properties are similar to stinging nettle (Urtica dioica) but a bit more diverse.

Herbal Sleep Formulation: My sleep has been very good since my last post four weeks ago. Beginning a few days after I posted Part 3, I was able to gradually start shifting slightly onto my right side, which made it easier for me to sleep. For the last two weeks I have been able to sleep completely on my right side without any discomfort. However, I still can't lie on my left side for more than 10-15 minutes before my leg starts to get uncomfortable as there is pressure directly on the plate and screws in my leg. It doesn't hurt, it just doesn't feel good. At this point I am sleeping mostly on my right side and shifting onto my back or left side for short periods a few times per night when my body starts to stiffen up. Because of the importance of getting good sleep to facilitate my healing process, I am still taking 0.75 mg of melatonin and an herbal sleep formulation when I go to bed. Due to the additional changes to my primary systemic formulation, once more I made a slight adjustment to the sleep formulation as well so that the two formulations remain well coordinated. It now contains English lavender flowering spike (Lavandula angustifolia) 20%, wood nettle herb (Laportea canadensis) 20%, St. Johnswort herb (Hypericum perforatum) 15%, German chamomile flowering top (Matricaria recutita) 15%, common comfrey herb (Symphytum officinale) 10%, hop strobilus (Humulus lupulus) 10%, turmeric rhizome (Curcuma longa) 9%, white pine leaf/twig (Pinus strobus) 1%. Once more this formula overlaps with and carries over some of the properties of my daytime formula while still maintaining its effectiveness as a sleep formula. Among other things, wood nettle is an excellent tranquilizer. I am continuing to take 6 ml immediately before bed and additional 3 ml doses through the night, as required. However, in the last three weeks I haven't had to take an additional dose more than once or twice per week.

Homeopathic Remedies: I am continuing to take the same homeopathic remedies that I indicated in Part 3.

Supplements: I am continuing to take the same supplements that I indicated in  Part 2 except that I no longer need to take the probiotics.

Topical Herbal Preparations: It is with regard to the application of topical preparations that I have had to make a couple of adjustments, partly because of some unforeseen complications.

The first change to the protocols that I implemented was at the suggestion of Monika Ghent. She recommended that I use a scar formulation instead of a generic ointment on my incisions. Since Monika has a lot more experience than I do working with topical herbal preparations for healing and cosmetic uses, as this is one of her areas of specialization, I had her make up the formulation for me (see below). About two weeks ago I started using it on the scars from my incisions twice per day.

About a week and a half ago (7.5 weeks since my surgery) is when things got a bit complicated. Firstly, I started to get a rash on my leg around the area of my incisions. At first I wasn't sure what was causing it. Since I hadn't been using the scar ointment for very long and it contains a number of ingredients that I have never used before, I considered the possibility that I was allergic to one of the ingredients in that formulation. I stopped using it for a few days but the rash got worse. That's when I realized what was going on. I had over-astringed my leg from poulticing too much!

Pot marigold (Calendula officinalis) is a very potent healing and antimicrobial herb. It is also very astringent.

I increased the proportion of this herb to boost the antimicrobial element of my poultice formulation

which may have contributed to the more rapid astringing of my skin.

Contrary to what you are likely to read in the herbal literature, all herbs are astringent. This is because the most common astringent constituents, such as organic acids and polyphenols, are found in all plants. Whenever we apply herbs in concentration to a localized area there is a danger of astringing the tissues too deeply so that the affect penetrates down into the deeper living tissue layers. It is even more of a concern for mucus membranes, but it can happen to our skin as well. This is one of several reasons why it is very important that a poultice is very mucilaginous, because this reduces the affect somewhat. I had been applying a poultice to my leg for about 5 weeks at that point, twice per day for 30 minutes to an hour. I knew that the astringency would be a concern eventually. However, my poultices were very mucilaginous. I was applying oil-based preparations such as liniments and ointments to my leg twice per day as well. The moisturizing action of the oil also helps to counteract the affects of the astringency to some degree. In addition, because my fractures were healing well and also to reduce the potential for excessive astringency, in the last two weeks that I was applying poultices I only did the afternoon poultice a couple of times per week. So, I was taken off guard when I got the rash. I didn't expect it to happen that quickly given everything that I was doing. That being said, once I realized what was going on I stopped applying the poultices.

The second complication was that there were two spots, one at the top of each incision, where very thick scabs had formed. Scabs have an important protective function and are often an important element of the healing process. However, scabs can actually interfere with healing and lead to the formation of more scar tissue if they persist for too long. If they are relatively thick, they also interfere with the ability of the herbal constituents to penetrate to the underlying tissues where they are needed. Finally, by trapping too much moisture, they can also lead to infection. That's what happened in my case. I got a mild infection under the scabs. As a result, I stopped using the ointments on the scabs because the oil base can also contribute to trapping moisture under the scabs. Instead, I began applying essential oils directly to the scabs. I am using marjoram (Origanum majorana) because it is very antimicrobial. I combine it 50/50 with English lavender (Lavandula angustifolia) essential oil. Although the lavender is not as antimicrobial as the marjoram, it is a good combination because lavender essential oil is very healing and not as harsh. It is one of the few essential oils that can be used neat (undiluted). Combining them reduces the harshness of the marjoram essential oil. Essential oils are appropriate for this application because they are very penetrating and they don't contain any water or fixed oil (lipid), so they won't add to or trap moisture under the scab. I have been using them for a bit more than a week now and the infection is gone from one of the spots and almost gone from the other.

English lavender (Lavandula angustifolia) has been part of many of my systemic and local formulations.

Now that I've explained the complications I've had to deal with, here is what the topical protocols I am using currently look like:

• When I wake up I apply the liniment I am using (see Part 2) to my whole lower leg up to and including my knee, but not to the area of the incisions themselves. I apply a 50/50 mixture of neat lavender and marjoram essential oils to the two areas where there was a bit of infection under the scabs. Then I apply Monika's scar ointment to the rest of the area of the incisions, and any remaining areas immediately adjacent where there is still a bit of the astringency rash to help heal and moisturize those tissues. Monika was kind enough to provide the ingredients of her scar formulation. It contains cocoa butter (Theobroma cacao), shea butter (Vitellaria paradoxa), castor oil (Ricinus communis), camellia oil (Camellia sinensis), argan oil (Argania spinosa), rosehip oil (Rosa rubiginosa), infused oil [St. Johnswort herb (Hypericum perforatum), pot marigold flower (Calendula officinalis), purple loosestrife herb (Lythrum salicaria), yarrow herb (Achillea millefolium) and American plantain herb (Plantago rugelii) in a base of olive oil (Olea europaea) and coconut oil (Cocos nucifera)], vitamin E (mixed tocopherols), vitamin D, English lavender (Lavandula angustifolia) essential oil, patchouli (Pogostemon cablin) essential oil, carrot (Daucus carota) essential oil, and Bach flower remedies [cherry plum (Prunus cerasifera), clematis (Clematis vitalba), impatiens (Impatiens glandulifera), rock rose (Helianthemum nummularium), star of Bethlehem (Ornithogalum umbellatum), crab apple (Malus sylvestris) and walnut (Juglans regia)].
• In the evening before I go to bed I more or less repeat the morning protocol except that I use the comfrey ointment instead of the liniment.

On March 20, which was one day short of 7 weeks since my surgery, I had an appointment to have the first x-rays done since they were last taken immediately after my surgery. My leg felt strong and, as I suspected, the healing of my fractures looked very good. I also didn't have any pain when the surgeon put pressure on my leg from various angles. As a result, I was given the OK to begin carrying some weight with my leg. The original prognosis was that I wouldn't be able to do so for 12-16 weeks. So, this is in about half the time originally expected.

Fortunately I have been working hard to maintain as much strength and flexibility in my leg by doing various exercises and stretches. Stretching the tendons and ligaments, especially in my foot, ankle and knee, is actually the most difficult part of the rehabilitation process. At that time I had managed to get about 80% of the movement in my knee and 60-70% in my ankle. It has been steadily improving since.

During the first week I put about half of my weight on my leg when standing still (therefore 1/4 of my total body weight) and 10-20% of my weight on my leg while walking. I have also spent much more time walking around. For instance over the last 2 weeks I have been walking my dogs in the back field and woods where I live every day.

During the second week, which is ending today, I have been standing normally (therefore carrying 1/2 of my full body weight) and have worked up to carrying about 40-50% of weight while walking. I don't want to put too much stress on my bones too fast, so I will continue to increase the weight gradually and work towards being off the crutches in another 2-3 weeks.

As you can see, much of the scar looks like it is many months or even years old. The scabs near the top

of each incision are the areas that got infected. The dry areas from the astringency

of the poultices are slightly visible, especially below the lower incision.

Except for a couple of minor issues that I mentioned above, my fracture is healing very well. However, when I saw the surgeon a couple of weeks ago, there was some potentially bad news as well. There was a shadow in the x-ray at the bottom of my tibia below the lowest part of the plate that could be an indication of an infection in my bone. The surgeon wasn't completely sure, especially since there were no other indicators: no pain, no abscessing. He will reassess it when I see him in 2 weeks for another x-ray. In the mean time, I am focusing my treatment on my bone fractures and incisions. At this point I don't know to what degree I should be concerned about the possibility of infection. It is still inconclusive. So far all I've done is ramp up the essential oil content of my liniment when I apply it around my ankle by adding a couple of drops of marjoram essential oil to the liniment that I apply to that area. My current systemic formulation is going to run out in a couple of days and I will probably add an antimicrobial herb to the next version. I hope that it was just an anomaly in my x-ray because infections in bone are difficult to treat, even with a combination of herbs and antibiotics. If there is an infection, it would have been introduced during the surgery, possibly when the screws were put into my bone in that area. According to standard procedure, all of the materials they used would have been disinfected and I was given intravenous antibiotics during the remaining time (about 16 hours) that I was in the hospital following my surgery. Unfortunately, there is always a risk of acquiring an infection when in a hospital and the risks are greater when we must undergo surgery. Infections acquired in hospitals are often the multiple antibiotic resistant kind. In truth, I held out until the last minute on approving the surgery, partly for this reason. However, it was clear that my fracture was too severe and the likelihood of it healing properly with just a cast was very low.

If it turns out that there is an infection, this will require another aggressive protocol. I'll know in a couple of weeks. In the mean time, my fractures are healing amazingly well and I hope to be walking without crutches very soon. For this I am very grateful! I will continue the updates in Part 5.

Applying a Poultice

This post is an tangent from my series on Healing Bone Fractures. In that series I have mentioned applying herbal poultices to my leg. I had considered including more details about applying a poultice in one of those posts but decided to do it separately so I can provide more details. I would like to thank my friend Elyse Portal who took some great photos while I was applying a poultice to my leg last weekend.

For the most part, a poultice is the most potent method of application of herbs to a localized area. This is because as the constituents of the herbs are absorbed into our tissues through the layer of moisture covering our skin, they are immediately replaced by more constituents from the herbs that diffuse into the layer of water. Also, the concentration of constituents is very high because the ratio of herb to liquid is very high. We are using a lot of herb and very little water.

We usually use dried herbs, but I often apply what I call a "survival poultice" if I get some kind of injury or bite when I'm wandering around in the fields and woods. In these circumstances I will find one or a few good healing herbs in my immediate area, chew them up and apply them where needed. I used to do this for my kids when they were small and we were on a hike or camping trip. You don't need to worry too much about bacteria in saliva because the antimicrobial properties of the herbs are very concentrated when applied this way and will take care of any risk of infection.

Here is the bowl of dried herbs I'm using for this particular poultice.

When using dried herbs, they should be coarsely ground. I usually rub them between my palms or use a mortar and pestle. We apply just enough boiled water to moisten them but so that they are not runny.

The herbs after moistening them with boiled water.

The purpose of the poultice I am preparing is to help heal the incisions from my surgery and to penetrate deeper into my leg to help heal my broken tibia (shinbone) as well. This poultice consists of 1 part common comfrey leaf (Symphytum officinale), 1 part stinging nettle leaf (Urtica dioica), 1 part purple loosestrife herb (Lythrum salicaria), 1 part pot marigold petals (Calendula officinalis), 1 part Canada goldenrod herb (Solidago canadensis) and 1/2 part whole flax seed (Linum usitatissimum). It is essential that a poultice is very mucilaginous. Comfrey is one of the few herbs that is mucilaginous enough that it doesn't require the addition of a more mucilaginous herb. However, since comfrey is only making up 20% of this formulation, it is necessary to add something to make it more slimy. My preference is to use a small amount of whole flax seed whenever I prepare a poultice. It will add the extra mucilage that we need and has important healing properties of its own. Never use ground flax seed. We just want the mucilage. We don't want to release the oil.

Getting ready to apply the poultice. At this point I had been poulticing the smaller incision on the right twice per day

for two weeks and the larger incision on the left for one week. There is clearly a difference between the two.

When applying a poultice I always put some gauze between the poultice and the skin. This serves two purposes: firstly, it ensures that small particles of herbs can't get into an open wound; secondly, it allows the poultice to be easily lifted off when finished without having to wipe bits of herb off the skin. This is important because when we remove the poultice we want any remaining herb infused liquid to dry on the skin. We use the minimum amount of layers of gauze to prevent bits of herb from getting through. The number of layers will depend on the thickness of the gauze.

Laying the gauze in preparation for the poultice.

When we apply the poultice we must completely cover an area a bit larger than the area we are working on with the moistened herbs and press down on them so that there is good contact with the skin. I usually apply it with a spoon and use the spoon to press the herbs once they are applied.

Beginning to apply the poultice...

...and finishing it off.

Under normal circumstances our skin is water-proof. In order to get the constituents of the herbs in our poultice to penetrate through our skin our skin must be hydrated to eliminate its water-proof characteristics. To accomplish this it is necessary for the entire area where we wish to apply the poultice to remain moist. We can't allow the skin to breathe. To accelerate this process it is also necessary that the poultice be applied as hot as we can tolerate and remain warm for the duration of the application. This process also takes time. The longer the poultice is in contact with our skin, the more hydrated our skin becomes and the better the penetration. I usually recommend a minimum of 30 minutes, but an hour or more is sometimes necessary, depending on the severity of the condition being treated. To facilitate the hydration of our skin it is best to wrap the poultice in plastic so that our skin remains in complete contact with herb infused liquid from our poultice and isn't able to breathe (no contact with air). Most types of plastic wrap are made of polyethylene which isn't known to leach any toxic chemicals. After wrapping the poultice I recommend pushing down on it once more to make sure there is good contact with the skin and no air spaces between the plastic and the herbs.

The poultice wrapped in plastic.

This whole process must be done as quickly as possible so that the herbs are still hot. Once the poultice has been wrapped in plastic it is necessary to cover it with a towel or something similar to help insulate it to keep it warm. If is going to be applied for a long period of time it may be necessary to apply a hot compress over the plastic. A cloth soaked in hot water that has been wrung out so that it isn't dripping will do. The cloth can be reheated periodically when it cools down. If the area where we need to apply the poultice isn't too large, a hot water bottle will also work and is more convenient than using a compress.

Covering the poultice with a couple of layers of towel.

Once we are done we can remove the poultice. For my leg, I have been applying a poultice for 45-60 minutes twice per day. When we use gauze the whole thing will lift off really easy.

The poultice has been uncovered and is ready to be removed.

When we remove the poultice the skin will be moist with herb infused liquid. We don't want to wipe this off. Let it dry completely before covering the area.

After removing the poultice we let the remaining liquid completely dry on the skin.

Notice the larger droplets of herb infused water.

Once the remaining herb infused water has dried completely the process is complete. We can bandage the area, if necessary, or cover it in some other way. We can also apply an ointment or liniment to the area, if appropriate, to further assist the healing process.

Which herbs we use, how often and how long we apply a poultice will depend on the situation, but the basic elements of applying a poultice will always be the same.

Healing Bone Fractures, Part 3 of 5

This is the third in a series of posts in which I am documenting the process of treating a serious fracture of my right leg. In Part 1 I discussed the details behind the injury and the initial protocols that I used with the remedies I had available while I was still away. In Part 2 I provided a detailed account of the protocols that I implemented when I returned home. In this post I am providing an update on how things are progressing four weeks after my surgery and any modifications that I have made to the protocols that I am using.

Systemic Herbal Formulation: On the fifth day after my surgery I was finally able to make a specific herbal formulation to treat my injury. I made up a 250 bottle, which lasts two weeks at the dose I am taking (for the details see Part 2). This formula ran out during the third week after my surgery. Although I was only taking it for two weeks and I could have just repeated the same formula, I decided to make a slight change to the formula. Since there is no evidence of nerve damage, I eliminated the St. Johnswort (Hypericum perforatum). I also substituted stinging nettle (Urtica dioica) for common horsetail (Equisetum arvense). The second version of the formulation contains turmeric rhizome (Curcuma longa) 18%, stinging nettle herb (Urtica dioica) 20%, boneset herb (Eupatorium perfoliatum) 20%, American plantain herb (Plantago rugelii) 20%, common comfrey herb (Symphytum officinale) 15%, wild ginger rhizome (Asarum canadense) 5%, white pine leaf/twig (Pinus strobus) 2%. I am continuing to take 6 ml three times per day on an empty stomach, 5-10 minutes before each meal.

St. Johnswort (Hypericum perforatum), topically, systemically and in homeopathic potencies,

is a very important herb for healing nerve damage.

Herbal Sleep Formulation: Due to the changes to my primary systemic formulation I made a slight adjustment to the sleep formulation as well so that the two formulations remain well coordinated. It now contains English lavender flowering spike (Lavandula angustifolia) 15%, St. Johnswort herb (Hypericum perforatum) 15%, catnip herb (Nepeta cataria) 15%, American plantain herb (Plantago rugelii) 15%, hop strobilus (Humulus lupulus) 15%, stinging nettle herb (Urtica dioica) 15%, turmeric rhizome (Curcuma longa) 9%, white pine leaf/twig (Pinus strobus) 1%. Once more this formula overlaps with and carries over some of the properties of my daytime formula while still maintaining its effectiveness as a sleep formula. Just as with plantain, it is rare for stinging nettle herb to be acknowledged as a sedative in the herbal literature. In fact, it is a very calming herb, especially when harvested a bit later in its life cycle when a some of the harvested portion includes the immature seeds. These are the most sedating part of the plant. I am continuing to take 6 ml immediately before bed and additional 3 ml doses through the night, as required.

More On Sleep: For reasons that I explained in Part 2, getting sufficient sleep has been a real challenge for me, even with the herbal sleep formula. By day 23 after my surgery I still had experienced only a slight improvement in my sleep, so I decided to go one step further and take melatonin as well. In the past I have found that clients with moderate to severe insomnia for whom an herbal sleep formula does not produce sufficient results usually respond well to the addition of a small amount of melatonin into the mix. Although I am not experiencing typical insomnia, my hope was that this will help me to sleep deeper and I won't wake up as much due to the discomfort and stiffness I have been experiencing as a result of having to lie on my back all night. I have to say, I was appalled at the poor selection of melatonin products even in a very well stocked health food store. Most of them had additional undesirable ingredients such as high doses of individual B vitamins or calcium. In addition, the doses of melatonin were way too high. Melatonin is a hormone and, although it is safe when used correctly, it is important to use only the minimum dose that will produce the desired results. The way I recommend people take it is to begin with a 0.5 mg dose for a few days. If that isn't strong enough I have them increase the dose in 0.5 mg increments (allowing a few days each time the dose is increased to determine its effectiveness) until they hit the ideal dose for them. One of the advantages of using melatonin in combination with a good herbal sedative is that they are mutually synergistic and, when taken concurrently with the herbs, the melatonin will usually produced the desired result at a very low dose. Although I did find a few products that had relatively low (1 mg) dose of melatonin, they all had other things in them that I didn't want to take. As a result, I ended up purchasing a 3 mg sublingual lozenge that I am able to cut into quarters so that each dose is approximately 0.75 mg. I take 0.75 mg of melatonin about 15 minutes before I go to bed and then take a 6 ml dose of my sleep formulation just before bed. When I wake up in the night and have difficulty falling back to sleep, if it seems that I won't have too much difficulty falling asleep I will take an additional 3 ml dose of the tincture. However, if it seems that I am going to have more difficulty, I will allow myself one more 0.75 mg dose of melatonin in addition to 3 ml of the tincture. If I wake up additional times through the night and have difficulty falling asleep I will only take the tincture. As it turns out, the first night I required two doses of melatonin but after that my sleep improved so much I only required one. I have found that I am waking up less often through the night and having less difficulty falling back to sleep when I wake up.

Homeopathics: On day 23 after my surgery, when I added the melatonin, I also diverged from the homeopathic protocols that I had intended to follow (as indicated in Part 2). I am continuing to take Symphytum 200C three times per day to support the healing of my bone. Since I was past the stage of the initial tissue trauma, I dropped the Arnica. As there seemed to be no major nerve damage, but there is a little bit of numbness of my skin along the major incision, I dropped the Hypericum 200C to one dose per day. To address the mild numbness I also kept Hypericum (St. Johnswort) in my sleep formulation even though I eliminated it from my daytime formulation. I also added Rhus 200C two doses per day. Rhus is for injuries or strains that stiffen up and feel worse when they are rested for periods of time, but feel better when we move around. These symptoms are typical for me whenever I have injuries or stiffness. I always feel better when I can move around and limber up. My hope was that the Rhus will help reduce the stiffness I am experiencing from lying on my back all night, since this stiffness is one of the things interfering with my sleep. It has helped somewhat and I have experienced a significant improvement in my sleep since adding the Rhus and melatonin to my protocols. It is my intention to continue taking these three homeopathic remedies in these doses for the next few weeks.

Eastern poison oak (Toxicodendron pubescens) was formerly classified as Rhus toxicodendron.

The names of homeopathic remedies are often based on obsolete botanical names

so as to maintain the continuity of the name with older homeopathic texts.

Topical Herbal Preparations: I have two incisions in my leg. A smaller one just below my knee and a larger one that runs down to my ankle which is the area where the plate was put in. On day 13 after my surgery all of the stitches in the smaller incision were removed, but the surgeon decided to remove only half of the stitches in my larger incision because the inflammation and edema were putting a lot of pressure on that area. He wanted me to come back in two more weeks to have the remainder of the stitches removed. On day 16 we began applying a poultice to the smaller incision from which all of the stitches had been removed (for more details about the poultice, see Part 2). We decided to use it as an opportunity to demonstrate how to apply a poultice during our Making Herbal Tinctures workshop. By day 18 it was apparent that the healing of the smaller incision was already much further along than the larger incision to which I was not yet able to apply a poultice because of the remaining stitches. I tried to get an appointment that week to see the surgeon and have the remaining stitches removed so that I could begin working on the longer incision, but there were no appointments available. As a result, I decided it was best if I removed the stitches before my appointment the following week. On day 23, herbalist (and my partner) Monika Ghent removed them for me in the morning. We allowed the holes to seal during the next few hours and began applying a poultice to the larger incision as well that night.

This photograph was taken of my leg just before we removed the remaining stitches from the larger incision.

Notice how much further along the healing is on the smaller incision which at this point I had been

poulticing for a week. The redness is in areas that were formerly covered by scabs.

Since then the protocol that I have been using is as follows:

• When I wake up I apply the liniment I am using (see Part 2) to my whole lower leg up to and including my knee, but not to the area of the incisions themselves. I apply an ointment to the incisions. The ointment is made from the same infused oil that I used as the base for my liniment (see Part 2) with a little bit of English lavender (Lavandula angustifolia) essential oil added to it (probably about 2 drops in each 25 ml jar). Both the infused oil and the ointment were made during our Herbal Field Studies field workshops.
• In the mid afternoon I apply a poultice to both incisions (for details see Part 2). I leave them on for 30-45 minutes and then remove them and allow the plant juices to dry on my leg. I do not apply anything else at that time.
• In the evening I apply a second poultice to both incisions. However, after I remove them and the plant juices dry on my leg I apply a comfrey (Symphytum officinale) ointment to my whole lower leg below the knee including the incisions. I had not prepared any comfrey ointment but fortunately my friend and fellow herbalist Rick DeSylva provided me with an jar of his excellent comfrey ointment.

This is what the protocols I am using look like at about 4 weeks after my surgery. There is no pain in my leg even when I touch the area where the incisions and fractures are. The surgeon was quite surprised at that. My leg feels strong and I am doing my best to stretch the tendons and ligaments in my ankle and knee so they don't tighten up too much while I'm not walking. There is some edema in my foot because I am spending a fair bit of time upright, which allows the blood and lymph to pool in my foot. This is has gone down somewhat but is still significant except when I wake up in the morning after I've been horizontal through the night. It is something I'm going to have to put up with until I start walking unless I want to spend the whole day sitting or lying with my leg raised, which is not an option.

I will continue provide updates on how things are progressing and any changes to my protocols in Part 4.

Healing Bone Fractures, Part 2 of 5

This is the second in a series of posts in which I am documenting the process of treating a serious fracture of my right leg. In Part 1 I discussed the details behind the injury and the initial protocols that I used with the remedies I had available while I was still away. In this post I am going to explain the protocol that I implemented when I returned home.

I returned home on evening of Sunday February 3rd, four days after my injury and three days after my surgery. On Monday we picked up some additional supplements that I needed and then on Tuesday I made up a couple of new formulations specifically formulated to address my injury. This is the protocol that I implemented at that time:

Homeopathics: I am taking Arnica 200C, Hypericum 200C and Symphytum 200C individually, four pellets per dose alternated throughout the day. The dosage of each remedy varies over time according to the following protocol:

• Week 1: Arnica 4 doses per day; Hypericum 4 doses per day; Symphytum 4 doses per day.
• Week 2: Arnica 3 doses per day; Hypericum 3 doses per day; Symphytum 3 doses per day.
• Week 3: Arnica 2 doses per day; Hypericum 2 doses per day; Symphytum 3 doses per day.
• Week 4: Arnica 1 dose per day; Hypericum 1 dose per day; Symphytum 3 doses per day.
• Week 5 and onwards (until my bones are completely healed): Symphytum 3 doses per day.

Herbs: I created three new formulations to address my specific needs:

• A systemic herbal formulation prepared from 1:5 fresh herb tinctures containing turmeric rhizome (Curcuma longa) 18%, common horsetail herb (Equisetum arvense) 15%, boneset herb (Eupatorium perfoliatum) 15%, St. Johnswort herb (Hypericum perforatum) 15%, American plantain herb (Plantago rugelii) 15%, common comfrey herb (Symphytum officinale) 15%, wild ginger rhizome (Asarum canadense) 5%, white pine leaf/twig (Pinus strobus) 2%. This formulation is a specific for healing damaged tissues and blood vessels, bone, and improving general circulation. Boneset and turmeric also have a significant tonic action on the liver which will help address any stress on my liver from the medications and other aspects of my hospital experience, as well as protect my liver from any toxicity from the pyrrolizidine alkaloids in the comfrey, which is the best herb I know for healing bones and well worth the very slight risk of toxicity. Given that the comfrey will not exceed the 15-20% range in any of the formulations that I use and will be combined with herbs that can mitigate its potential toxicity, the likelihood of any toxicity is almost nil. Boneset and horsetail are also specifics for healing bone tissue. This formulation is taken in 6 ml doses three times per day on an empty stomach, 5-10 minutes before each meal.

Boneset (Eupatorium perfoliatum) is an excellent healing herb that is very effective for the healing of bone tissue.

• A systemic herbal sleep formulation prepared from 1:5 fresh herb tinctures containing English lavender flowering spike (Lavandula angustifolia) 20%, St. Johnswort herb (Hypericum perforatum) 20%, catnip herb (Nepeta cataria) 20%, American plantain herb (Plantago rugelii) 15%, hop strobilus (Humulus lupulus) 15%, turmeric rhizome (Curcuma longa) 9%, white pine leaf/twig (Pinus strobus) 1%. The dosage of this formulation is 6 ml immediately before bed and additional 3 ml doses through the night, as required. Getting sufficient sleep is one of my greatest challenges. I tend to be a light sleeper. I sleep on my sides and wake up four or five times a night feeling a bit stiff and change my position, flipping from side to side and then falling back to sleep fairly quickly. With my broken leg I can only sleep on my back. This is difficult for me because as a general rule I can't sleep on my back, and it also doesn't allow me to shift my position sufficiently. By half way through the night my lower back is very stiff and sore. Most nights I'm only getting five to six hours sleep, and that's with the sleep formulation. Occasionally I get a bit more. Getting sufficient sleep is critical to the healing process, so I made this formulation to help me sleep better. Notice that it contains a few of the herbs that are in my daytime formulation. This is to help continue to support the healing process through the night. It is also important that the overlapping herbs contribute to the sleep formulation. You will find few, if any, references to plantain having sedative properties, but it does. As a general rule, whenever someone is taking more than one herbal formulation concurrently, it is usually preferable if there is some overlap between the herbs in the different formulations. As in this case, the overlapping herbs must contribute to the desired actions of both formulations.
• A topical liniment made up of a base containing 1:5 fresh herb infused oils of pot marigold flower head (Calendula officinalis), Canada goldenrod leaf (Solidago canadensis), wild bergamot herb (Monarda fistulosa), coltsfoot leaf (Tussilago farfara), St. Johnswort herb (Hypericum perforatum), northern white pine leaf (Pinus strobus) and American plantain herb (Plantago rugelii). This infuse oil was prepared last year. The herbs are in descending order based on proportion as I am not certain of the exact percentages. To the base oil I added the following essential oils at an overall potency of two drops per ml of base oil: rosemary leaf (Rosmarinus officinalis) 25%, English lavender flower (Lavandula angustifolia) 25%, black spruce leaf/twig (Picea mariana) 15%, marjoram herb (Origanum majorana) 10%, eastern hemlock leaf/twig (Tsuga canadensis) 10%, Roman chamomile flower head (Chamaemelum nobile) 5%, yarrow herb (Achillea millefolium) 5% and eastern white cedar (Thuja occidentalis) 5%. I apply this twice a day, immediately upon waking and just before bed, to the lower thigh, knee and half of the foot of my injured leg as my leg below my knee and half of my foot are covered by a tensor bandage. I also apply it to the hip, knee and ankle of my left leg, and my wrists, as these areas are being stressed in unusual ways due to using crutches.

In this photograph we have common plantain (Plantago major), an alien species that has naturalized throughout

North America, on the left, and American plantain (P. rugelii), our native species, on the right. Notice the

reddish colour at the base of the petioles (leaf stalks) of American plantain. Most people

(including herbalists) don't realize that these are two different species.

Two weeks after my surgery I went to the hospital to have my stitches removed. There was a lot of pressure on my stitches due to the edema in my leg that occurs whenever I am moving around in an upright position. The blood and lymph tends to pool in my leg because I am not using my leg to walk, which is necessary to efficiently pump the fluids out of my leg against the force of gravity. As a result, the doctor decided to leave every second stitch in my lower, longer incision for another two weeks. In the mean time, beginning a couple of days after I got my stitches out I started poulticing the shorter incision from which all of the stitches were removed. I am applying a poultice twice per day for 30-45 minutes. The primary herbs that I am using are common comfrey leaf (Symphytum officinale), stinging nettle leaf (Urtica dioica), pot marigold petals (Calendula officinalis), purple loosestrife herb (Lythrum salicaria), and a bit of whole flax seed (Linum usitatissimum) to increase the mucilage content. I use these herbs in roughly equal proportions (except for the flax seed) and each time add a sixth herb in a similar proportion. I have a lot of "ends" which are small quantities of herbs that are left over from when I harvest herbs to make tinctures. I dry these remainders and use them when the opportunity arises. This is one of those opportunities. Each time I make a poultice I use a different sixth herb. Some of the herbs that I have used so far include elecampane leaf (Inula helenium), wood nettle leaf (Laportea canadensis), Canada goldenrod herb (Solidago canadensis), blueweed herb (Echium vulgare), blue vervain herb (Verbena hastata), wormwood herb (Artemisia absinthium), yarrow herb (Achillea millefolium), yellow bedstraw herb (Galium verum) and pearly everlasting herb (Anaphalis margaritacea).

Supplements: I was able to obtain the additional supplements that I need over the course of the first week that I was back so that since about a week and a half after my injury I have been on the full complement of supplements that I need to help heal my leg. These supplements are very important whenever there is significant tissue damage, but they are particularly important for healing damaged bone, cartilage, tendons and ligaments, regardless of the cause of damage. I use a similar supplement regimen for the treatment of osteoarthritis and osteoporosis. Although there are a number of supplements available that are formulated for building bone tissue that contain some of these nutrients, I chose not to use any of them because I didn't like any of the formulations. All of them were missing important nutrients, had way too much calcium relative to the other ingredients, and most of them were compromised in some way by using cheaper, low quality ingredients such as magnesium oxide. As a result, I had to put this supplement regimen together using a fair number of products. Nevertheless, the importance of using all of these nutrients in the right balance can not be over emphasized. I have listed them here by nutrient instead of by which ones I am taking with each meal, as I did in the first post of this series, so that it is more clear what I am taking. All of these are taken with meals:

• Vitamin A: 3,500 IU with breakfast; 3,500 IU with dinner.
• Beta-carotene: 750 IU with breakfast; 750 IU with dinner.
• Vitamin C (calcium and magnesium ascorbate): 1,485 mg with breakfast; 1,360 mg with lunch; 1,485 mg with dinner.
• Vitamin D: 1,200 IU with breakfast; 1,000 IU with lunch; 1,400 IU with dinner.
• Vitamin E (mixed tocopherols, acetate): 115 IU with breakfast; 40 IU with lunch; 315 IU with dinner.
• Vitamin K: 60 mcg with breakfast; 80 mcg with dinner.
• Calcium (citrate, ascorbate, malate): 150 mg with breakfast; 135 mg with lunch; 450 mg with dinner.
• Magnesium (citrate, ascorbate, malate): 60 mg with breakfast; 60 mg with lunch; 260 mg with dinner.
• Zinc (citrate): 5 mg with breakfast; 25 mg with dinner.
• Silicon (aqueous horsetail extract): 4.7 mg with breakfast; 4.7 mg with lunch; 4.7 mg with dinner.
• Manganese (chelate, citrate): 0.5 mg with breakfast; 5.5 mg with dinner.
• Copper (citrate): 0.5 mg with breakfast; 1.5 mg with dinner.
• Boron (chelate): 350 mcg with breakfast; 350 mcg with dinner.
• Selenium (chelate): 50 mcg with breakfast; 150 mcg with dinner.
• Polyphenol complexes (flavonoids, anthocyanidins, proanthocyanidins and catechins from extracts of berries, citrus, grape seed and green tea): 325 mg with breakfast; 225 mg with lunch; 325 mg with dinner.
• Quercetin: 100 mg with breakfast; 100 mg with lunch; 100 mg with dinner.
• Lutein: 0.5 mg with breakfast; 0.5 mg with dinner.

Blueberries (Vaccinium spp.) are a very rich source of anthocyanins and flavonoids, including quercetin.

Some of these are ingredients from a multivitamin that I am taking with breakfast and dinner. It is a good quality low potency multi with an excellent trace mineral content. It does not contain iron. I did not list all of the ingredients of the multivitamin, only those that are important for bone repair. However, the full range of nutrients in the multi are important to support healing in general. Mostly what I haven't listed are the B vitamins and some of the other trace minerals. In addition, I am also taking omega-3 fatty acids in the form of organic flax seed oil, 2-3 teaspoons taken throughout the day mixed in food (but not heated).

In addition to the above supplements that I am taking with meals, I am also taking the following on an empty stomach three times per day 30 minutes before each meal:

• Methylsulfonylmethane (MSM) 400 mg.
• Glucosamine hydrochloride 300 mg.
• Betaine 80 mg.
• Hyaluronic acid 10 mg.

Probiotics: Another one of the challenges that I am dealing with is constipation. It started with fasting from food and water for 16 hours before my surgery and was further aggravated by the intravenous hydromorphone and three courses of intravenous antibiotics that I was given through the night after my surgery. However, the ongoing issue is that I am spending a lot more time sitting and can't walk or run, which is important for good bowel tone. I am addressing this by taking a high potency probiotic supplement that contains 25 billion active cells of a combination of eight active strains of bacteria. I take this first thing in the morning in a glass of warm water with a tablespoon of whole organic flax seed. My bowel movements gradually returned to normal during the first week that I took this and I am continuing to take it on an ongoing basis.

Lactobacillus rhamnosus: An important probiotic species.

Exercise: This is another of my major challenges. The surgeon wants me to spend most of my day sitting or laying with my injured leg raised. This is not an option. It's bad enough that the muscles in my right leg are getting weaker. I'm not going to sit around and let my whole body atrophy. Plus, I have clients and students that depend on me and lots of work to be done. My life has definitely slowed down and there are many things that are too difficult or impossible for me to do, but I'm not out of commission completely. I have sit stations all over my house where I work, eat and rest consisting of a padded chair to sit on and a second chair with a pillow on it that I can put my leg up on. I have found that there is a delicate balance between sitting and moving around upright. If I do either for too long, the edema in my lower right leg gets worse.

Aside from the exercise I get moving around on crutches, every morning before breakfast I do an upper body workout with light weights and lots of stretching. I'm also working my injured leg as best I can. Whenever I'm sitting for periods of time I periodically massage my thigh and knee. I also wiggle my toes a lot and gently stretch the tendons and ligaments in my ankle and knee. In addition, I'm doing my best to work out my right knee and hip as best I can without being able to walk. To maintain some level of strength in these joints I do leg lifts from my hip raising my whole leg, and from my knee raising my lower leg several times per day for a few minutes. I also "pump" my leg while I'm walking on crutches by raising my leg and bending my knee on one step and then lowering my leg on alternate steps. As before I also continue to do deep breathing exercises in which I "feel" the life force or qi energy flowing into and out of my leg.

Diet: My diet is pretty good in general. It is almost completely organic and I get a lot of variety. My only concern is getting a bit more good quality protein. I have been a vegetarian for 33 years. Contrary to what some people believe, it is very easy for vegetarians to consume sufficient protein. Nevertheless, a good supply of high quality protein is necessary to heal bone tissue. Rather than bump up some of the typical high protein vegetarian foods such as beans or nuts which are harder on the digestive system, I have decided to increase my protein somewhat by eating one or two organic, free-range eggs most days. I have to strike a balance here and not eat too many eggs because for me eggs tend to be constipating.

So there you have it! This is the regimen I am following at this time. It is very intensive. I probably spend about 10% of my waking hours engaged in some aspect of this healing protocol. However, that's not bad considering I am still working at about 60% capacity instead of laying around like the surgeon advised me to. Also, with the exception of the intravenous hydromorphone and three courses of intravenous antibiotics that I was given through the night immediately after my surgery, I did not fill the prescription for painkillers that the surgeon gave me and only had to take a single dose of acetaminophen about 24 hours after my surgery. When I had the stitches removed, the surgeon prescribed another course of antibiotics and some anti-inflammatories. I didn't fill those prescriptions either. My intent is not only to stay relatively functional through this process, but also to make sure that my bones heal well and are strong enough to allow me to continue doing what I've always done. I'm also hoping to be able to start putting some weight on my leg a fair bit earlier than the three to four months that the surgeon predicted.

Overall, I have to say that the biggest challenge for me has been not being able to walk the land. In my normal life, every day I take my dogs out for about an hour and a half and walk the trails through the fields and forest where I live. Aside from the obvious benefits of the exercise and fresh air for the dogs and myself, it provides me with an opportunity to deepen my ongoing relationship with the land; to observe what changes are taking place; to stop periodically at one or more of my favorite sit spots and just be. I'm also missing the winter. Last year was the warmest winter I can remember. There was pretty much no snow. This year we are having a somewhat more "normal" winter. I am missing walking through the snow; breathing the cold, crisp air; feeling the wind on my face; the calls of the chickadees, goldfinches and nuthatches. At best a couple of times a week when the conditions are good I can put the spiky snow things on the bottom of my crutches, go out and sit behind my house by our fire pit and gaze out over the landscape. I really do appreciate those moments.

"The Land" in winter.

Most of the details relating to the protocols that I am using have been covered in these first two parts of this series. From Part 3 of this series onwards I will discuss any changes that I make to these protocols and provide updates on how things are progressing.