As herbalists, our understanding of body systems and their interplay with herbal medicine is in constant evolution, following the threads of emerging science, spiralling back through traditional viewpoints and landing immediately in our direct clinical experiences.
In recent years, our understanding of the dynamics of the adrenal response to the array of modern day stressors has timed perfectly with a new ease of availability of adaptogenic herbs, particularly from the Ayurvedic and traditional Chinese herbal pharmacopoeias. Before this, we really only had Glycyrrhiza glabra (licorice) to call upon as a reliable adrenal adaptogen, but we were often perturbed by its long list of contraindications and points of caution. So, the ‘new’ adrenal herbs have been very welcome additions to the apothecaries of modern western herbalists. Thanks to them, ‘stress’ – the original ‘condition’ that invariably brings the majority of our patients to us – is a cluster of symptoms we can treat more effectively than ever before.
Astragalus membranaceous (astragalus), Ocimum tenuiflorum (holy basil), Ganoderma lucidum (reiishi), Rhodiola rosea (rhodiola), Schisandra chinensis (schisandra) and many other adaptogenic medicines offer us far greater specificity in the support of adrenal function, and thus greater clinical outcomes in our practice. However, whilst we relish in this newfound information and the ease of reach of these tonic herbs, it is vital not to allow our valuable traditional nervines to be overshadowed and underutilised.
Adrenal glands immediately respond to stressors with the production hormones, while the nervous system responds with equal weight and more enduring consequences. Since true adrenal dysfunction is both rare and medically serious, it may be that we are overusing controversial terms like ‘adrenal burnout’ and ‘adrenal fatigue’. When an exhausted, anxious and depleted individual presents, we are more likely looking primarily at nervous system symptoms. Without due diligence, we may find ourselves neglecting the importance of nervines when we come to the time of formulation. We may need to begin thinking of these cases more as ‘nervous system burnout’ and broadening our focus beyond the adrenal glands. It’s important to remember that adaptogenic herbs and nervines are complementary but not interchangeable.
Interestingly, the two actions are not widely found operating simultaneously in many plants, with a few exceptions. From a holistic perspective, considering both nervous and adrenal systems and formulating accordingly is the true sweet spot of prescription in cases centred around stress. This means applying our nervines as specifically and enthusiastically as we apply our adaptogens.
Hans Selye, a prominent physiologist, created the theory that ‘stress’ is a threefold, in-built mechanism that occurs in response to any demand made on us; a protective defence. These demands are not ‘bad’ by necessity – we have all experienced the ‘stress’ responses of long-haul travel, new love, exciting relocation or a positive shift in employment firsthand.
Our physiology does not delineate between these stressors and more ‘negative’ influences. Our first response to a stressor is the alarm reaction known also as fight or flight. Next there is a resistance stage where the body attempts to physiologically recover to a superior level than the pre-stress state. Sometimes we can sustain the resistance stage beyond the point at which the stressful scenario abates, at which point we may have built a degree of biological resilience. But continued exposure to pressing demands eventually results in the exhaustion phase – the breakdown of the recovery stage.
In each stage of what Selye coined the general adaptation syndrome (GAS), the adrenal glands and both the parasympathetic and sympathetic nervous systems are engaged in complex ways. Most of what we experience symptomatically in relation to stress resides in the nervous system.
Terms like frazzled nerves and shell shock are both antiquated and medically inaccurate, but they serve as useful descriptors for the ways stress manifests in the body and mind as a result of nervous system involvement in GAS.
Some nervous system symptoms include:
- anxiety, restlessness and insomnia
- brain fog, poor memory and concentration
- depression and digestive problems
- exhaustion, lethargy and muscular tension
- mental overactivity and worrying.
When we come to selecting appropriate medicines, the nervine materia medica is generally organised into three groups:
1) Nervine trophorestoratives
Provide nutrition to nervous system tissues, usually in addition to either a relaxing or stimulating action.
Included in this group are:
- Avena sativa (oats): traditionally thought of as a nervous system ‘feeder’, oats are a nutritive herb high in specific nutrients required for optimal nervous system function. Oats are specific for nervous exhaustion and depletion, especially when linked with depression.
- Hypericum perforatum (St Johns wort): most commonly prescribed for its antidepressant action, this herb also works to restore function and reduce inflammation in nerve tissues. St Johns wort is specific where there is experience of physical pain associated with depression.
- Scutellaria lateriflora (skullcap): indicated specifically for nervous tension in association with anxiety. Skullcap is thought to revive and renew the central nervous system, hence its history in the treatment of seizures.
2) Relaxing nervines
Relieve constriction and contraction in nervous system tissues. Relaxing nervines are indicated for anxious, tense and restless patients, especially where there is digestive and musculoskeletal involvement and/or difficulty sleeping. Included in this group:
- Melissa officinalis (lemon balm): traditionally referred to as a ‘scholars herb’, lemon balm is specifically indicated as a relaxant in cases where there is a significant mental ‘load’, especially where digestive symptoms are also present.
- Lavandula officinalis (lavender): the popular ‘sleepytime’ remedy is also specific for headaches and musculoskeletal tension resulting from stress.
- Matricaria chamomilla (chamomile): with very broad application in cases of anxiety, depression and other symptoms of nervous tension, chamomile is also specific for digestive symptoms connected to stress.
- Passiflora incarnata (passionflower): as one of our gentlest hypnotic remedies, passionflower is specific for sleep disturbances and mild cardiovascular symptoms (e.g. tachycardia and blood pressure fluctuations) connected to nervous tension and stress.
- Eschscholzia californica (California poppy): as a stronger hypnotic and sedative medicine, California poppy is indicated in chronic insomnia and sleep disturbances connected with anxiety.
- Valeriana officinalis (valerian): known best for its immediate hypnotic and sedative actions, valerian can also be prescribed in lower doses where there is cramping and indigestion associated with stress.
3) Stimulating nervines
Are thought to increase vital energy to stagnant nervous system tissues. Stimulating nervines are indicated for exhausted patients with low energy and mild cognitive complaints. The most straightforward and fast-acting stimulating nervines from the plant kingdom are coffee and green tea, which have been known to be ‘prescribed’ with positive clinical outcomes. We can also include the following herbal medicines in this group:
- Rosmarinus officinalis (rosemary): traditionally prescribed to improve memory, 1-8 cineole, a component of the essential oil fraction of rosemary, has been clinically demonstrated to improve the efficiency and accuracy of cognitive tasks. Rosemary is also an effective circulatory stimulant and is specifically indicated for ‘cold’ patients.
- Turnera diffusa (damiana): specifically indicated where the libido and sexual performance are affected by the patient experience of depression, anxiety and tension.
When we revisit our nervine materia medica, we find that we have had a cabinet of very specific remedies for treating the stress all along. These medicines beautifully illustrate the unique and varied ways that we all experience and metabolise the demands of life, good and bad, within our nervous systems. As we move deeper still into the applications of the nervines, we may find ourselves prescribing them more and more often. Every patient, after all, needs at least one nervine.