Homeopathy Under Attack

In the last few years there has been a growing trend to discredit natural healing traditions. Always looking for a controversial subject to cash in on, the media has jumped in on this one with both feet. The primary target that has been in the crosshairs of all of this vitriol is homeopathy. Because the principles of homeopathy can not be explained by modern scientific theory it is an easy target. Although most of the skeptics will be satisfied if homeopathy is thoroughly discredited, the more extreme of the lot are hoping that they will be so successful making homeopathy look incredibly far fetched and ridiculous that it will be easy to extrapolate that sentiment to other systems of healing. In writing this post, I have no interest in debating with the skeptics because it is pointless. I'm putting this out there for those of you who are confused by all of the misinformation that has been propagated in the media. Hopefully it will help you to have a better understanding of the issues.

For my next post I was planning to write the second installment of my series on vaccinations, itself a very controversial subject these days. As we shall see, it is closely related to the homeopathy debate (or lack of it!). I had originally intended to steer clear of homeopathy because I have a limited amount of time for writing and there are other things I want to write about. I was hoping that with time people would just get bored of it and move on to something else. However, instead of fading away this issue has been building momentum and a couple of recent attacks that are relatively close to home grabbed my attention. Firstly, a group of scientists have attacked University of Toronto for proposing some good research on homeopathy. The chief researcher of the study, which is intended to examine homeopathy as a treatment for children with Attention Deficit Hyperactivity Disorder, is Heather Boon of the Department of Pharmacy. In proposing this study her credibility has also come under attack. I met Heather a few times quite awhile ago. I don't know her very well, but I am familiar with some of her work. She is someone who seems to me to be very committed to doing quality research on complementary and alternative medicine (CAM). The essence of the attack on Heather and U of T is that, although the proposed study is well-designed, since we already know that homeopathy doesn't work conducting this study is a waste of time and money.

That happened a few weeks ago. More recently the government of Ontario has come under attack for regulating homeopaths in this province. This has been in process since 2007 when the Homeopathy Act was tabled and finally came to completion a couple of weeks ago when the Act was passed. The provincial government is being condemned for legitimizing homeopathy.

Samuel Hahnemann, the founder of homeopathy.

This story begins at the end of the 18th century when purging, bleeding, high doses of mercury and poor hygiene were typical of the practices of mainstream medicine. At that time there was already a growing divide between the practices of orthodox medicine and more natural healing traditions, although there was a lot of grey in between. Enter Samuel Hahnemann. He was a medical doctor that wasn't happy with the practices of his time. He saw them as counter to the traditional healing principles that date back to Hippocrates and beyond. I'm not going to get into a detailed discussion of the principles of homeopathy because that would require a book, but what's important is that by the end of the 19th century the homeopaths were better organized and had better standards and hospitals throughout Europe and North America than their mainstream counterparts. As a result, they were perceived as a major threat by allopathic medical practitioners who used financial and political influence to gradually discredit or absorb most of the homeopaths. This was easier to do by the early 20th century because mainstream medical science was starting to mature and the public no longer perceived going to a doctor as such a scary prospect.

The influence of homeopathy may have been reduced but it never went away. In some parts of the world, such as India, it continued to flourish. Fast forward to the 1960s and we have the beginning of a renaissance of natural healing traditions that continues to this day. During this time homeopathy has prospered along with herbalism and many other natural healing modalities, and natural health products have become big business.

The growing popularity of natural healing has not been universally appreciated, as is always the case when money, influence and a clash of paradigms occurs. The four major antagonistic sectors are the pharmaceutical industry, medical doctors, pharmacists, medical researchers, and the associations that represent them. Although the growth of the natural health product industry has to some extent been at the expense of the profits of the pharmaceutical industry, the latter has chosen to adapt by diversifying. That primarily translates into buying up successful natural health products manufacturers.

Of course, not everyone who is a member of one of these groups is antagonistic to CAM. But many of them are. In spite of this, medical doctors and pharmacists are mostly too busy to care and pharmacists are happy to reap the profits of natural health product sales whether or not they believe in them. There are, however, a minority of extremists among the doctors and pharmacists who are very antagonistic to CAM.

The recent wave of attacks has to a significant extent been championed by medical researchers, supported by the professional skeptics who are always out their proselytizing. Although there is a definite clash of paradigms at the root of this, a big part of it is about money. In response to its growing popularity, many governments and universities have chosen to devote a small proportion of their research dollars to investigating CAM. For the most part this is a good thing because CAM research in the West is lagging way behind the research that is being done in Eastern countries such as China and India where traditional healing systems have continued to be appreciated.

The result of these changes is that it is now slightly more difficult for researchers who are doing mainstream medical research, many of whom are antagonistic to CAM, to get funding. As they see it, all of the research money rightfully belongs to them and it is being wasted funding research on what they see as pseudoscientific or completely unscientific healing modalities.

In laying out this background, what is not apparent is why the skeptics are particularly focusing on homeopathy. Basically it is this: in accordance with the principles of homeopathy, homeopathic remedies are subjected to a "potentization" process that involves diluting them in fixed ratios and shaking each dilution vigorously before diluting them again. Remedies are used at a variety of different dilutions, but they can potentially be diluted to the point where few, if any, of the molecules of the substance from which the remedy is derived are present. According to homeopathic theory and practice, the more times a remedy is subjected to this potentization process the more potent it becomes, even if on a chemical level it is becoming more dilute.

No one knows with absolute certainty how homeopathic remedies work.

From the perspective of the modern reductionistic, materialistic paradigm, this is absolute nonsense! How can something that has no molecular basis be more potent or have any therapeutic value at all? According to Hahnemann, the potentization process separates and intensifies the "vital force" or life force of the substance and it is this vital force that is primarily responsible for the therapeutic action of the remedy. More recently homeopaths, in an attempt to explain the actions of these remedies in more modern terms, have postulated mechanisms such as the transfer of this life force energy into the water in a way that alters the bonding angle or the electromagnetic field of water molecules, or possibly that they act within the realm of quantum mechanics. These are just hypotheses. The bottom line is that if homeopathic remedies work they operate in a way that can not currently be explained by the known laws of chemistry or physics. This is the crux of the matter.

The attack on homeopathy is fear-based. One of the unfortunate characteristics of human nature, at least how it is expressed in the modern world, is that when people invest a lot of energy into a belief system they (consciously or unconsciously) are afraid of alternative beliefs. Some people can just agree to disagree, but others are more zealous. Human history is full of examples of groups of people acting with violence against other groups of people who held different religious, political or other beliefs. Although scientists like to believe that they are beyond this and act on the basis of reason, the history of science says otherwise. The majority of scientists are dogmatists to varying degrees who do not question the reigning scientific paradigm of their era.

As anyone who has read a few of my posts knows, I'm actually a fan of science! However, for any field of inquiry to be useful we must recognize its limitations. Science, when practiced appropriately, is a very useful way to explore the world that we live in. However, it is only one of a number of different ways to explore the world. Each is legitimate within its field of reference and each has its strengths and limitations. Each also affects how we perceive the world. If we approach the world in a rationalistic, reductionistic, materialistic way, the world will appear to us as a rationalistic, reductionistic, materialistic place. This is one of the major mistakes that most scientists make. Objectivity is an illusion. The world will tend to appear in ways that conform to how we look at it. Even when it doesn't, we tend ignore, misinterpret or deny experiences that don't conform to our world view.

When science is done properly it is a beautiful thing. We approach the world as the big, beautiful, mysterious place that it is. We are humbled by it, knowing that it is infinitely bigger and more complex than we can every hope to comprehend with our rational mind. As soon as we fall into the trap that we have things figured out we are no longer doing science because our beliefs affect the kinds of questions that we ask and how we perceive and interpret the results. Our beliefs can even cause us to see things in the results that aren't there or to manipulate the results so that they conform to our expectations.

The mystery of Nature: the source of all healing!

Getting back to homeopathy, if we want to truly investigate it in a scientific way the first thing we need to do is separate the effect from the explanation of the effect. The most important thing to investigate is whether or not homeopathic remedies work. If we focus on the explanation, we risk throwing out the baby with the bathwater because if the explanation turns out to be false there is a tendency to assume that the effect is also false. As a healer, I subscribe to a particular paradigm because it is what best conforms to my experience and produces the best results. However, my goal is to heal. Healing is a beautiful and mysterious thing. It doesn't matter to me if my understanding of why what I do works is accurate. What matters most is that it helps people. Similarly, demonstrating whether or not homeopathic remedies work is the most important thing. If it turns out that they do, the appropriate response is not to reject the results because they don't conform to our theories, it is to re-examine our theories because clearly they are inadequate to explain our observations.

One of the major arguments against homeopathy is that it is not supported by research. In fact, one of the reasons that the attack on homeopathy has recently ramped up so intensely is because the Australian National Health and Medical Research Council (NHMRC) recently conducted a "review" of the available research on homeopathy and concluded that the research overwhelmingly demonstrates that homeopathic remedies do not work any better than a placebo. Although it is true that there aren't many good studies on homeopathy, this conclusion is not accurate for a number of reasons. Firstly, good quality human clinical studies are very expensive to conduct and, in general, it's difficult to get funding for studies on homeopathy. Consequently, there aren't very many studies out there on homeopathy and most of them aren't very good. Another issue is that homeopaths are not part of the mainstream research community. If they attempt to do studies, it is difficult for them to get sufficient funding and they, as a rule, don't have a lot of experience doing research. Conversely, most experienced researchers aren't interested in doing research on homeopathy, and even if they are, they don't understand homeopathy. This means that their research is likely to be conducted from a modern medical paradigm and is not accurately testing homeopathy the way it is actually practiced. Finally, many of the people who have done studies on homeopathy are really trying to disprove it. Thus their studies are significantly biased. The Australian NHMRC itself was also trying to disprove homeopathy, so their analysis is extremely suspect.

Personally, I can not speak to the quality of the studies on homeopathy out there because most of the people who are writing about them are biased one way or the other and I simply don't have time to review the actual studies myself. However, I am familiar with one study which illustrates my point. In the late 80s a French researcher, Jacques Benveniste, did a study which seemed to demonstrate the effectiveness of homeopathy. He submitted a paper to Nature magazine. Not surprisingly, they were skeptical of his findings. They told him that in order to publish it he would have to incorporate some additional controls in the study and also have it replicated at other labs. He made the suggested changes and his study was replicated by researchers at University of Toronto, University of Milano and Hebrew University. When he resubmitted the paper, Nature begrudgingly published it because they said that they would, but in an uncharacteristic move they also published an editorial attacking the study. They then sent a team of "experts" to examine Benveniste's methodology. This is completely unprecedented! They would never do this with researchers whose research conforms with the mainstream medical paradigm, even if the research was of a much poorer quality. In addition, none of the "experts" were actual researchers and only one of them was a scientist, but from a completely different field of study. Their sole intent was to discredit Benveniste. They had him repeatedly redo his experiment under more extreme controls even though the results remained consistent, until finally they got the results that they wanted and this is what was reported. From their perspective, that of Nature, and most of the scientific skeptics in the world, Benveniste's results were disproved and the positive results that he did get were due to some flaw in the design of the study that they were not able to determine. Benveniste later conducted even better designed studies and got consistent results but Nature refused to publish them. Shortly after, the French Institute of Health and Medical Research cut his funding after a routine evaluation of his lab. Although they acknowledged that his lab exceeded their standards, they cut his funding because he refused to stop doing research on microdoses.

Needless to say, the whole Benveniste affair has very little to do with real science and all of the characteristics of a witch hunt. Even some scientists who are skeptical of homeopathy have criticized the way it all went down.

When evaluating healing systems that are outside of the mainstream, "not supported by scientific evidence" is one of the common criticisms. What is interesting to me is how skeptics like to apply strict criteria to the evaluation of things that they don't believe in, but are willing to accept far lower standards for things that they support. For instance, many of the practices of modern medicine have little to no research backing them up and medical practitioners often continue to practice them even when the research clearly demonstrates that they are ineffective [see: http://www.scientificamerican.com/article/demand-better-health-care-book/ and http://well.blogs.nytimes.com/2009/04/02/the-ideology-of-health-care/?_r=0]. It is also quite common that things that initially seem to be backed up by research turn out to be false [see: http://www.huffingtonpost.com/alison-rose-levy/what-statins-transfats-and-gmos-tell-us-about-scientific-controversies_b_4385741.html and http://www.newyorker.com/magazine/2010/12/13/the-truth-wears-off]. To a large extent this is because of the biases of researchers, whether ideological or because the people conducting and funding the research have a vested interested in the results of the study [see: http://www.scientificamerican.com/article/trial-sans-error-how-pharma-funded-research-cherry-picks-positive-results/ and http://www.sciencedaily.com/releases/2015/04/150403073439.htm and http://www.sciencedaily.com/releases/2014/10/141021141746.htm and http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124].

Although there are many medical practitioners that genuinely want to find ways to help people who are sick or suffering, sadly, even those who are coming from a good place are largely barking up the wrong tree. Although mainstream medicine has made great progress when it comes to emergency interventions, it is largely unsuccessful when it comes to the treatment of chronic health conditions. In fact, it has actually contributed to the growing epidemic of chronic degenerative diseases, both as a result of its toxicity and side-effects [see my previous post The Vaccination Controversy, Part 1] and by promising magical cures that don't really work. This is because modern medicine is not really about healing. It is about palliative care - suppressing or neutralizing symptoms rather than understanding and addressing the underlying condition. A good example is the so-called "war on cancer". In spite of the billions of dollars that have been spent funding the cancer industry, with the exception of childhood leukemia a person's prognosis if they are diagnosed with some form of cancer is no better today than it was 60 years ago [see: http://blogs.scientificamerican.com/cross-check/2014/05/21/sorry-but-so-far-war-on-cancer-has-been-a-bust/]! Lots of new drugs have been developed and profits made, but the actual results speak for themselves.

Another comment that is interesting to me is that homeopathic remedies are "just placebos". They speak about placebos as if they are something to be written off, but the placebo effect is one of the most interesting things ever demonstrated by medical science. It is a demonstration of the healing power of the human mind! If anything, we should be doing a lot more research on the placebo effect. For one thing, so called "placebo controlled" studies aren't even properly designed to determine the magnitude of the placebo effect [see: http://www.sciencedaily.com/releases/2015/04/150413140906.htm]. Secondly, the placebo effect is a very powerful and important part of the healing process. It should be cultivated, not written off, because the beneficial affects of ALL treatments, conventional and natural, are partly due to the placebo effect [see: http://blogs.scientificamerican.com/cross-check/2013/03/12/psychiatrists-instead-of-being-embarrassed-by-placebo-effect-should-embrace-it-author-says/]. This is why it is a very dangerous thing to attempt to convince someone with a serious illness that they shouldn't follow a treatment that they really believe in. What this does is instill doubt and fear in people and it can significantly hinder the outcome of their treatment. Similarly, there is also a negative placebo effect. Just as a person's belief in the benefits of a treatment can significantly improve the effectiveness of the treatment, their disbelief in the benefits of a treatment can significantly hinder the effectiveness of the treatment. This is one of the reasons why there is usually no point attempting to convince someone to undergo a treatment that they don't believe in (the other reason is that they are less likely to properly follow instructions or continue the treatment long enough for it to be effective). As a practitioner, the best thing we can do is attempt to educate a person in as unbiased a way possible about the potential benefits and limitations of their treatment options and allow them to choose what they feel is best for them.

St. Johnswort (Hypericum perforatum) is an amazing herb for the treatment of nerve trauma and inflammation. For this purpose it works

both in crude form and in homeopathic potencies, but it works best when both are used concurrently.

Getting back to homeopathy, regardless of how difficult it is to understand from a scientific perspective, it is completely unrealistic to assume that the tens of thousands of practitioners that have prescribed homeopathic remedies and the millions of people who have used them over the last couple of centuries are completely deluded. I have used homeopathy for myself, my family and pets. Although it is not my primary modality, I sometimes recommend homeopathic remedies to my clients as well. I can say with absolute certainty that they work. Interestingly, they work even better for animals than humans because animals don't have any negative beliefs about them. Because of their lack of beliefs, when animals demonstrate positive results from homeopathic remedies it can not be attributed to the placebo effect.

It certainly wouldn't hurt to fund some good quality, unbiased human clinical studies that investigate homeopathy in the context of how it is actually used to put this issue to rest once and for all. Unfortunately, this is unlikely to convince most of the skeptics. They are too attached to their theories. How the world really works is secondary. If such studies were to be done, I have confidence that the results will be positive. Once it is clear that homeopathy does work, then we can attempt to figure out why. It may be that we do not have the right technology to figure that out at the moment, or that we will never be able to with absolute certainty. As far as I am concerned, that doesn't matter. What matters is that homeopathic remedies when used correctly have a tremendous potential to help people. Positive healing outcomes are the most important thing. Good theories and explanations are useful, but not necessary.

For those who have been patiently waiting, I will continue my series on vaccinations in my next post.

A Crazy Season in the Life of an Herbalist!

Well, it's been a long time since I sat down at my computer and put any energy into this neglected child. Since April 2nd to be exact! I've contemplated it a few times, but the truth is that it has been such an incredibly busy seven months there hasn't been any time for it. Harvesting season begins in early to mid April, depending on how quickly things thaw, and ends some time in November or December when the ground freezes and I can't dig any more. This has always been a busy time for me. During the most intensive periods of harvesting, which are mid May to the end of July and late October to mid November, it is often necessary for me to devote the better part of three days per week to harvesting herbs and preparing tinctures - and that is on top of everything else that I need to do. There has always been a bit of travelling that was necessary during this time as well. Mostly to teach workshops but hopefully there is time for a holiday at some point. However, in the last few years my work has expanded into some new realms that require me to travel a lot more than I am used to. This year my travelling began on April 28th and ended on November 5th. During that time I was away three weeks in May, two weeks in July, one week in August, two weeks in September, two weeks in October, and the first bit of November. All of it was work related except for a week holiday in early September. We actually had to cancel a planned road trip to Nova Scotia in mid August because it would have been too much on top of everything else.

The interesting thing is that I'm not particularly into travelling, so it's surprising that my life has taken a turn of this nature. I'd rather just stay put and deepen my relationship with the land where I live from season to season, year to year. Nevertheless, the work that I am doing that requires me to travel is amazing and expansive, and I know in my heart that it is an important part of my path. It was a busy half year but it was all amazing. The challenge has been finding time to harvest all of the herbs that I need and fit in all of my clients on the few weeks that I am here. As it was, there were a few herbs that I wasn't able to get. In my world, that means that I have to use them less to stretch the stock that I have. When I eventually run out I won't have those herbs available until three months after I harvest them next year (three months is the minimum amount of time that I macerate tinctures).

It was a busy workshop season: Discussing black elder (Sambucus nigra) at an Herbal Field Studies workshop in early July.

This year things were even more challenging because of the weather that we had. After a record breaking, bitter cold winter and late thaw, we had a very strange spring and summer. It was much cooler than normal but not in the usual way. We do typically get a cool summer about once per decade. But those summers are usually very cloudy and wet, with very little sunshine. This year it was cloudy and wet a lot of the time, but we didn't get the days (sometimes weeks) of constant rain that we usually get during this kind of summer. On the rainy days the rain was more intermittent. We also had very few thunder storms. On the positive side, most weeks we still got at least a few sunny days. This was very important from an herbalists perspective because during years when it is almost constantly cloudy and rainy, although herbs that like that kind of weather such as stinging nettle (Urtica dioica) and coltsfoot (Tussilago farfara) do very well, herbs that don't like it such as red clover (Trifolium pratense) and common St. Johnswort (Hypericum perforatum) do very poorly. For many herbs in the latter category it just isn't worth harvesting them as the quality of their medicine is very low. Fortunately, many plants can tolerate a range of habitats that get different amounts of sunlight. Therefore, it is possible to partially compensate for unusual weather conditions by harvesting them in different locations. During hot, dry years it is often possible to find healthy populations in the part of their range where they get less direct sunlight. In these areas they will experience less heat stress and the soil will be more moist. In cooler, wetter years we harvest them in the part of their range where they get the most sunlight. Here they will get as much sun as possible and the soil will be less wet. However, during extreme years even this doesn't work for some herbs and I have to pass on harvesting them and make up for it by using more of some of the other herbs that can be used as a substitute in various contexts. This is one of the reasons why it is necessary to work with a rich and diverse group of herbs. I also usually try to harvest enough herb to make a two year supply of tincture for herbs that this is manageable, meaning the ones that I use in small to moderate quantities. This is partly so that I don't have to harvest every herb every year, but also to build some resilience into my supply of tinctures. If for some reason I am not able to get some of the herbs that I need in a particular year, there will be more choices if I have to use substitutes.

Common St. Johnswort (Hypericum perforatum) doesn't like cool, cloudy, wet years.

In our area, from mid June to mid September we can usually count on at least a few weeks of hot, humid weather with temperatures of 30+ °C (86+ °F). This year we only got a couple of days of temperatures in the 30s in June and then another couple in July. As a result, although plants that like a fair bit of sun, such as wild mint (Mentha arvensis) and wild bergamot (Monarda fistulosa), and flower earlier in the season did fairly well with the amount of sun that we had in spite of lots of rain and cooler temperatures, some of the plants that need more heat and flower later, such as peppermint (Mentha x piperita) and spearmint (Mentha spicata), really suffered from the cumulative affects of the weather. In our area they didn't flower until early September and the quality was too poor to harvest.

Wild mint (Mentha arvensis) got enough sun and produced some good medicine this year.

Another thing that stood out this summer was the continuing decline of the local honey bee (Apis mellifera) population. Around my home there are many species of clover. They all came into flower in June: first red clover; then alsike clover (T. hybridum); then white clover (T. repens); then yellow sweet clover (Melilotus officinalis); then white sweet clover (M. alba). Honey bees love many flowers, but the clovers are among their favorites. Yet, during their peak flowering in June and July I didn't see a single honey bee. A few years ago these flowers were covered in them! There is a wild hive in the woods about 400 m from my house. This year it didn't become active until early July. As their numbers increased they gradually expanded their range, but I didn't see any within 100 m of my house until the Canada goldenrod (Solidago canadensis) was well into flower in mid July. Recent evidence suggests that a major factor in the collapse of the honey bee population in much of North America is the use of a group of pesticides that are nicotine derivatives called neonicotinoids. It's typical for us to look for simple, unidimensional solutions, but as with everything in life the cause is a lot more complicated than that and due to a combination of factors. In all likelihood the bees are being killed or weakened by the combined effects of neonicotinoids and other pesticides and, as a result, the weakened individuals are also becoming less resistant to various parasites. There are probably other environmental factors involved as well, but something needs to be done about it quickly and reducing the use of neonicotinoids is a good place to start.

The population of this colony of honey bees living in a crack in an old white pine (Pinus strobus) near my home

has been significantly reduced in the last few years

Needless to say, between the travelling and the weather conditions it was very difficult for me to get all of my harvesting done this year. There were a few plants I didn't have time to harvest and a few more that weren't good enough to harvest. This has continued up to the present. Unlike the spring and summer, September and October were warmer than usual. This had it's own challenges. For instance, I had to be away from October 24th to November 5th. I needed to harvest maidenhair tree leaves (Ginkgo biloba) before I left. I have found that the best time to harvest the leaves is in the fall when they are about midway between their transition from green to gold. In the region where I live this is usually around the third week of October. However, because of the warm weather, when I went to harvest them on October 21st they were only just beginning to turn. I knew I couldn't wait until I came back because by then they would have fallen, so I harvested them that day. They weren't perfect but they were good enough.

The maidenhair tree leaves (Ginkgo biloba) started turning gold late this year because of the warm fall.

Note the contrasting yellow and orange of the sugar maple trees (Acer saccharum) in the background.

When we returned from Mexico on November 5th the warm weather was still with us. Right away I had to get to work because the aerial parts of most of the herbaceous plants had already died back and it was time to start harvesting roots and rhizomes. We need to get them done before the ground freezes and we can't dig any more. There are also a few fruits that I need to harvest at this time of year, but they have to be harvested after a couple of good frosts, so they weren't ready yet. Things started out OK. We were getting highs of around 8-12 °C (46-54 °F) and lows of 4-7 °C (39-45 °F) and not too much rain. Perfect root harvesting weather! We got to work right away.

Here's Monika harvesting stinging nettle rhizome (Urtica dioica).

Then on November 11th the temperature went up to 18 °C (64 °F) and the next day it dropped below freezing! For a few days it wasn't so bad because the the daytime temperatures were staying above freezing. But by the end of the week temperatures had dropped to January levels. I still needed to harvest several herbs and was worried that the ground might freeze before I could do them all. The unseasonably cold temperatures weren't just a stress for us. Everybody was feeling it! On Sunday morning in my peripheral vision I caught a movement outside my kitchen window. I knew it wasn't a bird that should still be hanging around here at this time of year and sure enough there was a yellow-rumped warbler (Setophaga coronata) shivering in a tree just outside the window. That was November 16th. I have never seen any species of warbler around here later than mid October. He was probably migrating through from somewhere much further north. With the lingering warm weather he must have been taking his time. That choice could turn out to be fatal!

This is a yellow-rumped warbler (Setophaga coronata), but not the yellow-rumped warbler.

As if the cold temperatures weren't enough of a challenge, last Sunday night and all day Monday it snowed. Fortunately, we didn't get that much. I can't imagine what it must have been like a little south of us in Buffalo, New York where they got completely buried! That would have definitely been the end of the harvesting season for us.

It was incredibly beautiful in the woods on Monday afternoon. The first snow. It was perfectly still and silent, and everything was covered in a blanket of white. Monika and I would have preferred to have just gone for a nice walk. But, still racing against winter, instead we went out and harvested wild sarsaparilla rhizome (Aralia nudicaulis). This herb is a colonial species with a network of rhizomes that does not leave a recognizable stalk standing after it dies back. Below the snow and fallen leaves, the only way to identify it is by the crowns with the buds of next years growth that usually sit a bit higher than the surface of the soil. Finding them is easy, but only if you know exactly where they are growing! It's simply a matter of clearing away the snow and leaves, finding the buds, and following the rhizome from that point.

Harvesting wild sarsaparilla rhizome (Aralia nudicaulis) last weekend. Note the bud in the centre foreground.

Since Monday it has been even colder. The ground is starting to freeze, but fortunately hasn't yet completely because we got just enough snow to insulate the ground a bit. Yesterday I was able to get out and harvest high bush cranberry fruit (Viburnum opulus), which are ready now that the temperature has gone below freezing. There are a few good sized colonies of these shrubs on the property where I live. But for some reason none of them produced fruit this year. They all flowered. I can only assume that there was something about the conditions when they flowered that affected their ability to produce fruit. As a result, I had to hike a couple of kilometers into the back fields in order to find an area where there was a good supply of fruit.

High bush cranberry fruit (Viburnum opulus) can't be chopped on a cutting board because they are too juicy.

They need to be ground for a few seconds with a bit of menstruum. Great colour!

Starting today the temperature is going up again and we are supposed to get rain with the temperature peaking at around 13 °C (55 °F) by Monday before it starts dropping again. That will melt the snow and warm up the soil a bit and it looks like I will be able to harvest the last two herbs that I need to get: marshmallow root (Althaea officinalis) and wild ginger rhizome (Asarum canadense). After that harvesting season will be over for this year and I'll be using the time that I have been devoting to harvesting to converting classroom courses to online courses. This is something I don't have much time for during harvesting season. I'll also have more time to put up some more stuff on this blog. It won't be another six months until the next one!

Until next spring I can spend more of my time in nature just being with a lot less doing. I'm looking forward to that. I'm also putting out some good energy for my little winged friend and others like him that lingered too long. I hope they are able to make it to the warmer regions down south!

Harvesting Herbs: Dancing With Weather

OK, I'm back! I haven't posted anything since I returned from my back-to-back trips to Mexico and Lake Superior - and, yes, my leg is doing great! I'll provide more on that in a future post.

Unlike last year, during which the warm weather came very early in the spring and the spring and first half of summer were extremely hot and dry, so far this year it has been unusually cool and wet in the region where I live. This can have a significant influence on many plant species. Each plant has an ideal habitat that it prefers, including type of soil, moisture level, amount of sun, and climatic conditions. However, there will be a range of conditions in which it can do well and a wider range of conditions that it can tolerate. What these conditions are and how much variation it can tolerate will vary from plant to plant.

The plant life in my area can be pretty lush when there is lots of moisture like there is this year.

There is always a certain amount of climatic variation in any given region. The amount of variation in the Great Lakes region where I live is probably moderate compared to other regions. However, since around 1970 our climate has been noticeably changing - and the amount of change has been increasing with each successive decade. The kind of change is consistent with what we can expect given global trends: a progressive warming with greater extremes. This has had a noticeable impact on plant and animal species.

So, let's get back to the conditions this year. It is fortunate that, although it has been cooler and wetter, we have at least had one or two sunny days most weeks and even on some of the days that it has rained there have been sunny breaks at some point during the day. As a result, some plants that do very poorly if there has been very little sun are managing to stay relatively healthy.

Many plants that don't do well if there is too much rain and too little sunshine are still doing fairly well this year.

On the other hand, there are a few plants that are looking a bit stressed. This is particularly the case for plants, such as a few of the bedstraw (Galium) species, that grow in lower light areas that are relatively moist. Examples include cleavers (G. aparine) and rough bedstraw (G. asprellum). When there is as much rain as we have been getting this year, the typically moist areas where some of these species grow tend to be moist to the point where they are somewhat wet - and not all plants that grow in these areas necessarily like wet conditions.

Rough bedstraw (Galium asprellum) is finding many of the areas where it lives too wet this year.

As an herbalist that wild-harvests almost all of the medicines that I work with, years when it is very cloudy, rainy and cool can be challenging in a couple of ways. Firstly, most herbs need to be harvested on a sunny day and there needs to be at least one additional sunny day between the day they are harvested and the last rain. For some plants there needs to be two sunny days in between. This is because the plant tissues tend to otherwise be too wet and there are many important constituents, such the components of essential oils, that are produced in much lower quantities if there isn't much sunshine. If there are too few consistent periods of sufficient sunshine, there are also a lot fewer days when herbs can be harvested. If the timing of the sunnier periods doesn't line up with when the herbs are ready to be harvested, I may not get some herbs that year. Secondly, there are some plants, such as red clover (Trifolium pratense) and common St. Johnswort (Hypericum perforatum) that are significantly less potent during such conditions to the point where it isn't even worth harvesting them. In unusually wet (and dry!) years many plants will also be affected by mildew, making them unusable.

Red clover (Trifolium pratense) isn't happy when it's too cloudy and wet!

When the conditions are cooler, cloudier and/or wetter than usual, it is best to harvest herbs in the sunnier parts of their range where they will get maximum direct sun and the soil will be a little bit drier. In years when it is hotter, sunnier and/or drier than usual, it is best to harvest herbs in the shadier parts of their range where they are more protected from excessive sunshine and the soil will be more moist. This year, herbs such as stinging nettle (Urtica dioica), which can tolerate full sun but doesn't usually do well in it, is doing very well in more open areas.

Our native stinging nettle (Urtica dioica ssp. gracilis) is doing very well this year in more open areas.

I typically spend about one day per week harvesting the medicines from mid April to mid May; two days per week from mid May to mid June; three days per week from mid June to the end of July; two days per week in August; one day per week in September; I only harvest on two to three days in October; and then it's back up to two days per week in November. This means that during harvesting season I have to minimize the amount of days that I have a fixed schedule, such as clinic days and scheduled classes and workshops. Which days I need to harvest on depends on when the herbs reach the right stage in their life cycle for harvesting and, of course, the weather! During the peak harvesting season I do my best to allow four to five days per week when I have nothing in particular scheduled so that I can head out on a moments notice whenever the herbs and the weather align! Fortunately, a lot of the work that I do can be scheduled around my harvesting days.

This intensive harvesting schedule means that if I harvest almost all of the herbs I use and don't cut any corners to ensure that the medicines are harvested in a respectful and ecologically sustainable way, and are the highest quality possible, I can only harvest and prepare enough medicines to comfortably run clinics two days per week scheduling about five to seven clients per day. I could maybe do three days per week if I really push it, but I would rather not. These constraints are fine with me. Healing work is very intensive. If one gives oneself fully to the medicine it is very difficult to be completely present when seeing more than 15-20 clients per week. It is essential that any healer live a balanced life and look after their own health and well-being in order to be able to fully live the medicine and offer the most to those who need it.

In my practice I only run clinics one day per week. The rest of the time I do other related work such as teaching, writing, and dealing with the various responsibilities I have as a result of being on the board of directors of both our provincial and national herbalist associations. For almost two years a lot of my time has also been devoted to converting the content of courses to an online format. This will continue for a couple of years, but out of necessity it slows down during harvesting season. By nature I do best with diversity and flexibility. My work also requires that I spend regular time deepening my relationship with Nature and the medicines, whether I'm out there observing or just being.

In years where the weather conditions verge towards the extremes it can make harvesting difficult. For instance, of the sixteen herbs that I had intended to harvest this spring, I only managed to harvest ten of them. Fortunately, I didn't need as many herbs as usual. This is partly because I will often harvest enough to prepare a two year supply of tincture for herbs that I use in low to moderate quantities so that I don't have to harvest every herb that I use every year. For herbs that I use in larger quantities this isn't possible. Also, last year I used less of some of the spring herbs than usual.

 American black elder (Sambucus nigra ssp. canadensis) is right on schedule this year!

Another challenge associated with more extreme weather conditions is that it can significantly alter the life cycle of a plant. Although the timing of some species such as black elder (Sambucus nigra) and yarrow (Achillea millefolium) is pretty consistent from year to year, others can vary by as much as one to four weeks depending on the weather.

This year lance-leaved heal-all (Prunella vulgaris ssp. lanceolata) came into flower sixteen days later than last year.

Ultimately, all I can do is surrender! Herbalists have always had to learn to work with whatever Nature provides. Fortunately, I work with enough medicines that if I can't harvest a sufficient quantity (or any!) of a particular herb in any given year I usually have one or more herbs that are similar enough that I can use as a substitute. In the mean time, looking ahead at the coming weeks there is still lots of rain in the forecast. In terms of the rest of the harvesting season, I'll just have to wait and see how the summer is going to unfold. All I know for sure is it will be an adventure!

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.

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.