Where low mood and melancholia has not reached the status of clinical depression, there are remedies derived from nature which offer natural approaches to lifting the spirits. In observing the cyclical patterns of nature, we can be afforded some comfort in the knowledge that as humans, we are a part of this cycle and feeling the need for rest and a turning inwards is a reflection of this rhythm.  At the very darkest, coldest, lifeless part of the year when many animals hibernate and are in a state of metabolic depression, studies have demonstrated neurobiological similarities to clinical depression, including changes in cortisol, neurotransmitters, metabolism and other biomarkers (3). Occurring at the same time, seeds and rootstocks are also at their most potent, conserving energy to use later for spring growth (4). 

Hibernating animals rest in the awareness that they will emerge with the next turn of the seasons. For many centuries humans have adapted to the cold, quiet darkness with a shared instinct to foster joy, connection and ritual such as the northern hemisphere midwinter festivals, Christmas, the Roman Saturnalia, Jewish Hannukah, Slavic Koliada, pagan Yule, Persian Yalda, or Asian Dongzhi, are all a call for celebration and community. Earlier in the season the Hindu festival Diwali symbolizes the victory of light over darkness and good over evil. Often the best way to beat the winter blues is in accepting the inherent cyclical nature of the world, and that  darkness has its role in the cycle as the precursor of light and life.

Being able to get out for a walk in nature, taking a moment to observe and be present with the plants, can be enormously enriching and mood enhancing, offering a subtle but profound healing opportunity. Nature can also be brought into the home— in Japan, small gardens are often found on doorsteps, balconies and small corners, bringing life to dense  urban landscapes. Tending a garden, even in pots, is a great source of serenity. The act of walking can also be significant as exercise is an efficient and rapid way to stimulate neurotransmitters including serotonin and dopamine which are responsible for uplifting mood  (5). 

In respecting the cycle of the seasons one is also in connection with the natural instinct to sleep and eat more. In Ayurveda winter is known as kapha time, time to build resources for the hungry gap in spring, when historically people would have worked hard to get the crops in and be left with limited food supplies. A gentle increase in body weight during winter is a normal physiological response to reduced activity, daylight and hormonal shifts, this often reverses itself in spring (6). Similarly, the need for extra sleep and change is impacted by lower light and colder temperatures (7).  

The following plants bring some of the comforting qualities of nature to support the body and mind during the winter period. Each is a powerful tool for lifting the spirits. The best approach is to get to know each herb as an individual first. Ideally, make a single preparation, perhaps a cup of strong tea or decoction, and build up towards a higher dose, the maximum from the range provided below. Taken in this form, at robust levels, benefits can be rapidly felt  and it is soon possible to work out which is most helpful. They can be experimented with to discover which ones resonate best with the body’s constitution. 

These herbs are not antidepressants in the conventional sense. Instead, in different ways they strengthen the constitution, offer a sense of calm and an ability to cope better, whilst also reducing inflammatory pressures on the brain.St John’s wort, widely thought of as a herbal antidepressant, is traditionally used as a tonic specific for the winter months to help bring in the light, offering a feeling of resilience (8). 

For more in depth information on these herbs, please see our herbal monographs. 

Brahmi (Bacopa monnieri)

A classic Ayurvedic brain tonic, and saponin-rich adaptogen, Brahmi appears to work in a number of ways to protect brain cells and improve cognitive functions, especially when these are challenged by long-term stresses, illnesses and ageing (9). It has been used to help recover from chronic fatigue and associated low energies. Brahmi is also calming and helps directly in anxiety and tension conditions, and in helping cope with stress (9,10).

The recommended dose is 2–6 grams of the dried leaf per day, either as  tea or, as popularly taken in India, several teaspoons of the fresh leaf juice (9). Dosages are meant as a guideline only, and it is recommended to consult a medical herbalist for safety considerations. 

Cinnamon (Cinnamomum verum)

This common spice offers an organoleptic treat, with good quality cinnamon stimulating the taste buds and warming the body. Cinnamon is particularly useful in facilitating recovery from illness or chronic fatigue, and especially for those who are particularly prone to feeling the cold (8) It helps restore a healthy appetite and reduce digestive problems such as sluggish digestion that can be associated with being run down. To increase the heating quality and stimulate more warmth, combine it with fresh ginger (Zingiber officinale) in a tea. Cinnamon can be combined with any of the other herbs on this list as a stimulating, warming remedy (9). 

Take a teaspoonful of freshly powdered cinnamon (Ceylon cinnamon has the most complex flavour profile), add 50 ml of boiling water, stir and steep for 5–10 minutes and sip. Feel the mix of spicy and sweet tones reverberating at the back of the mouth, with a slightly woody quality, followed by a warmth emanating from the chest chest. A slight bitterness can be experienced afterwards, with a profound sense of warmth moving throughout the entire body. 

The suggested dose of cinnamon powder is up to 8 grams per day (9).

Gotu kola (Centella asiatica)

This popular traditional Asia restorative tonic is revered in Asia for ‘opening the mind’, sometimes accompanying meditative practices as a tea. Taken in this way, gotu kola offers an initial bitter flavour, followed by an  aromatic sweetness. It has a particular effect in supporting cognitive function, including improving memory and concentration, especially when these are compromised by increased  stress (9,10).

The dose starts at 3 grams of dried leaf per day, titrating up to 30 grams, if the initial dosage has proved effective with no unwanted side effectsGotu kola is traditionally consumed as a tea (8–10). 

Rosemary (Salvia rosmarinus)

There is something inherently uplifting about the smell and taste of this common garden herb— it can be felt heading straight to the brain. Rosemary is an excellent tonic to raise spirits and boost recovery after illness or periods of low energy. Even inhaling the fresh leaf from a garden or window box will stimulate mental energy and the tea taken internally will expand on this effect. 

There is promising evidence that rosemary may reduce inflammatory pressures on the brain now implicated in many conditions associated with low mood and depression, including chronic fatigue syndrome, dementia as well as clinical depression. Further research indicates it can improve cognitive performance in the elderly adding to its reputation as a  brain tonic (11).

Taking rosemary as a tea can be overpowering, however very uplifting. The dose is up to 4 grams a day of the dried leaf (9).

St. John’s wort (Hypericum perforatum)

This is often described as the herbal antidepressant, however it has a much wider range of actions than its mood enhancing properties. The herb and flowers of St. John’s wort have been used in European traditions to relieve nervous tension and anxiety. Importantly, this calming effect is combined with underlying restorative benefits and the plant was also used as a convalescent treatment for melancholic conditions, depression and recovering from illness or trauma (8–10).

This makes St John’s wort ideal in situations where tension and exhaustion combine. Its most useful modern application is towards a programme of recovery from chronic fatigue conditions. It also has a long reputation as a support to those experiencing symptoms during the menopause (8,10).

Note that St John’s wort has been shown as an active inducer of drug metabolism, so it may reduce the activity and active life of many medicines. It is wise to avoid in conjunction with medications and consult a medical herbalist for further guidance (8–10).  it if there are any powerful treatments underway, where reducing the effect of a medicine may be critical.

St John’s wort can come in a variety of preparations, including powder, tincture and tea. It is recommended to combine the herb with others as a tea, for flavour considerations, however the easiest is to take it as a tincture. The traditional calming and tonic dose was the equivalent of 2 to 5 grams of the dried leaf and flowers per day (9). 

1. Heald A, Stedman M, Farman S, Ruzhdi N, Davies M, Taylor D. Seasonal Variation in Antidepressant Prescribing. The Primary Care Companion For CNS Disorders. 2021;23(2). https://doi.org/10.4088/pcc.20m02790 
2. Clery E, Morris S, Cooper C, Das-Munshi J, McManus S, Weich S. Mental health treatment and service use. Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England. Published online 2025.
3. Tsiouris JA. Metabolic depression in hibernation and major depression: An explanatory theory and an animal model of depression. Medical Hypotheses. 2005;65(5):829-840. https://doi.org/10.1016/j.mehy.2005.05.044 
4. Klupczyńska EA, Pawłowski TA. Regulation of Seed Dormancy and Germination Mechanisms in a Changing Environment. International Journal of Molecular Sciences. 2021;22(3):1357. https://doi.org/10.3390/ijms22031357 
5. Ren J, Xiao H. Exercise for Mental Well-Being: Exploring Neurobiological Advances and Intervention Effects in Depression. ProQuest. 2023;13(7):1505. https://doi.org/10.3390/life13071505 
6. Fahey MC, Klesges RC, Kocak M, Talcott GW, Krukowski RA. Seasonal fluctuations in weight and self-weighing behavior among adults in a behavioral weight loss intervention. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. Published online May 15, 2019. https://doi.org/10.1007/s40519-019-00707-7 
7. Honma K, Honma S, Kohsaka M, Fukuda N. Seasonal variation in the human circadian rhythm: dissociation between sleep and temperature rhythm. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 1992;262(5):R885-R891. https://doi.org/10.1152/ajpregu.1992.262.5.r885 
8. Hedley C, Shaw N. Plant Medicine. (Waddell G, ed.). Aeon Books; 2023.
9. Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013.
10. Mcintyre A. Complete Herbal Tutor : The Definitive Guide to the Principles and Practices of Herbal Medicine (Second Edition). Aeon Books Limited; 2019.
11. Rahbardar M, Hosseinzadeh H. Therapeutic effects of rosemary (Rosmarinus officinalis L.) and its active constituents on nervous system disorders. Therapeutic effects of rosemary (Rosmarinus officinalis L) and its active constituents on nervous system disorders. 2020;23(9). https://doi.org/10.22038/ijbms.2020.45269.10541 

Sleep is an altered state of consciousness where changes in the brain’s activity take place (3), and it is essential for human life.

Although sleep is in part for resting, it is also actually quite a busy time for the body and it requires a certain amount of energy to maintain good quality sleep. Sleep is the time for cellular repair and is where maintenance mechanisms are actioned and healing for the body occurs.

Normal sleep consists of two parts: non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. NREM is broken down into stages 1 -3, and stage 4 of sleep is where REM sleep takes place (4).

These four stages of sleep are thought to gradually merge (3, 5):

Stage 1

This is where the transition between wakefulness and sleep which is normally up to about 5 minutes in duration. During this stage the person may have fleeting thoughts and if they wake think they have not been sleeping. Many people struggle with this stage as it takes them a while to get to sleep.

Stage 2

Light sleep is the first stage of true sleep.  There may be fragments of dreams and the duration is around 10 – 60 minutes.

Stage 3

Moderately deep sleep, referred to as slow-wave (SWS) sleep.  During this stage the body temperature and blood pressure tend to decrease, this usually occurs around 20 minutes after falling asleep. This stage of sleep is thought to be critical to restorative sleep, allowing for growth and recovery of the body. Experts believe it also is vital for the immune system and other bodily processes (5).

Stage 4

The deepest level of sleep, REM sleep. Duration 10 – 60 minutes. The eyes may move rapidly (hence the name). Most vivid dreaming usually occurs during REM sleep.

Sleep ideally consists of a single block of three to five cycles of sleep stages, usually happening during the night (6).  Typically a person goes from stage 1 – 4 of sleep in less than an hour and during a typical night’s sleep of 7 – 8 hours there will be approximately 3 – 5 episodes of REM sleep as a person passes between NREM sleep and REM sleep, with REM sleep occurring approximately every 90 minutes.

A baby’s sleep consists of around 50% of REM sleep, whereas in adults it usually makes up about 25% of sleep.  Although it is not fully understood, this high level of REM sleep in infants suggests that it is important for the maturation of the brain. Neuronal activity is high in REM sleep, brain blood flow and oxygen use are equal to or higher in REM sleep than in intense mental or physical activity while awake (3), indicating that sufficient energy is required to actually be able to sleep well and access all the stages of sleep.

Sleep is in part a time when organising and housekeeping in the brain takes place and is thought to play a vital role in retention of new learning (7). This may be considered again in the context of new-born babies who need between 14 – 17 hours of sleep per day (2). This is because aside from supporting the growth which is taking place in their bodies, they are creating neural networks as they learn new information about the world. Sufficient sleep necessary to facilitate this.

Sufficient good quality sleep is necessary for physical and mental health, and for quality of life.  Sleep is known to be important for regulation of the nervous system, helps with overall resilience, immune system function, ability to deal with stress, mental and emotional health. It is vital for the maintenance of overall health and wellbeing.

Sleep deprivation disturbs the circadian physiology, exerting a negative impact on the brain and behavioural functions, and can cause neuroinflammation and oxidative stress (8). Long term, this can lead to neurodegenerative issues. Mental health issues such as depression have also been linked to neuroinflammation now. Circadian rhythms are natural changes in physiology over a 24-hour day-night period, particularly hormone levels which typically influence sleep and wake cycles and our ability to fall asleep easily at night.

There is an ever-increasing body of evidence to suggest that insufficient sleep contributes to a host of adverse medical and mental dysfunctions, such as unbalanced body systems, increased incidence of cardiovascular morbidity, increased chances of diabetes mellitus, obesity, issues with cognitive function, increased accidents, and depressive symptoms (1).

It is suggested that sleep plays a key role in the optimization of energy as during sleep energy reserves are redirected to processes such as maintenance of cells, anabolism (‘rebuilding’ and repair), immune function, and neural plasticity (6).

Neural plasticity refers to the capacity of the nervous system to modify itself both functionally and structurally in response to experience and injury. Ultimately it ensures the healthy development and function of the nervous system (9) which can also impact on memory.

A recent study has found that sleep also seems to play a role in facilitating the clearance of molecular waste products from the brain which accumulate during waking hours (10). The authors noted that sleep seems to increase the brain’s interstitial volume (meaning the space between the tissues), and that the impact of one night of complete sleep deprivation on the molecular clearance was not recouped in the following 2 -3 night’s sleep.

This potential build-up of molecular waste in the brain which may occur as a result of consistent sleep deprivation is of particular relevance when considering the development of neurodegenerative health conditions such as Alzheimer’s disease (10).

For adults, 7 – 9 hours of sleep per night are usually recommended (2). Although there is a lot of focus on the number of hours of sleep, and whilst this is important, it is also necessary to consider sleep quality and whether the time spent sleeping is actually restorative.

The smooth progression through the stages of the sleep cycle is necessary multiple times during a sleep period to ensure that the rest taken whilst sleeping is high-quality and actually restorative (5). An example of this is the suggestion that whilst sleep stages each have their unique qualities, it is also thought that the change between SWS in NREM sleep stage 3 and REM sleep stage 4 is actually important for memory (7).

It is clear to see that although sleep is in some ways a time of rest from our usual waking activities, there is actually still a lot of activity going on during sleep which can be thought of as the ‘behind the scenes’ housework to keep everything functioning well. This is particularly true for the nervous system, and this requires a certain amount of energy to maintain.

Insufficient sleep is a prominent problem in today’s modern 24-h society, with the increased usage of smart phones and electronic devices worsening this epidemic (1).

Problems with sleep are often caused by (2):

• Environmental issues: Night-time noise, screen light from phones, TVs and tablets, and light from the outside can trick your body into delaying sleep. Air pollution can also disrupt your sleeping patterns.
• Life events: You may feel distracted, stressed or worried about something going on in your life while you’re trying to go to sleep, which can affect your ability to relax.
• Thinking cycle: Anxious thoughts about not getting enough sleep can cause distress, which can prevent you from relaxing and falling asleep. This can become a vicious cycle. Also an overactive mind when going to sleep delays sleep latency.
• Lifestyle: Developing poor habits around sleep, such as not having a regular routine, can cause problems.
  • Not having a regular sleep-awake routine
  • Eating late at night
  • Consuming alcohol, nicotine or caffeine around bedtime
  • Vigorous exercise late at night
  • Using smart devices (phones, tablets etc.) before bed
  • Checking and responding to work emails outside of working hours

It’s common for most people to experience periods of poor sleep at some point in life, but short bouts of sleep problems don’t usually result in health problems. However, consistently poor sleep can begin to contribute to health issues, including being a symptom and cause of mental health problems (2).

‘Tired but wired’ is a phrase coined to explain when the nervous system is in overload (in sympathetic or ‘fight and flight’ mode) and it can become difficult to switch off. Although one may feel tired or even exhausted, falling asleep (known as ‘sleep latency’) and/or maintaining sleep can become difficult. This is partly because of higher than normal levels of the hormone cortisol tend to circulate the bloodstream when we are over-stressed.

When the body is functioning well, cortisol levels naturally dip at night as part of the circadian rhythm, easing us into a restful night’s sleep. Understanding this contextualises why and how living removed from the rhythms of nature can have an impact on our sleep.

In addition to this from a holistic perspective when the nervous system is depleted due to chronic stress, we are tired and really need sleep. There are often not actually enough energy resources available to achieve and maintain the good quality sleep we really need.  This can become a vicious cycle where the over-tiredness prevents sufficient sleep, and the lack of sleep exacerbates stress on the body and further inhibits the capacity to sleep well.

This is where herbs can really help to reset this cycle.  Herbs which are classed as nervous system tonics can be helpful in restoring the nervous system so that it becomes less frazzled, which can be considered energetically as providing ‘food’ to the nervous system so that it has the sufficient nourishment required to maintain sleep. 

Herbs which are classified as adaptogens can also be beneficial to help reset the stress response, allowing the nervous system to function well, and redress the natural balance of stress hormones throughout the sleep-waking cycle of the circadian rhythm. 

In addition to this, herbs classified as sedatives and hypnotics can assist with getting off to sleep (sleep latency), and often have additional benefits of helping with anxiety or nervousness which often accompany sleep issues. However, the primary goal with herbal support is always to rebalance the body by addressing the root cause of issues.

This means that the natural processes can be restored and systems can function in a healthy way. Therefore, herbs which act as hypnotics and sedatives are only recommended as short-term solutions while the body systems are further restored and regulated, and lifestyle factors are addressed so that a healthy sleep cycle can be re-established.

It is best to note when considering herbal support for sleep is that if there are underlying factors at the root of sleep issues then these must be addressed alongside taking herbs. In the case of long-term issues then the guidance of a herbalist is recommended to tailor a personalised treatment plan. You can find clinical herbalists on our “Where to find a herbalist” page.

Valerian (Valeriana officinalis)

Valerian is traditionally considered a convalescent tonic to calm the nervous system and enhance its function. Its name comes from the Latin valere – meaning “to be strong, powerful, healthy”, which explains why, although it is typically considered to be a hypnotic and sedative herb, it can in some people also be stimulating due to providing an increase in vital energy.

Despite this, it is often helpful in restoring the nervous system. Therefore even in cases where it is stimulating as a bedtime remedy, it can sometimes be beneficial to continue taking the herb to help restore the nervous system so that deeper more relaxed sleep can be accessed eventually.

Valerian is often helpful when there is difficulty getting to sleep or staying asleep. It is particularly helpful when this is accompanied by emotional stress, excitability, or a sense of irritability. This is because it not only provides the tonic support to rebuild the nervous system allowing deeper more nourishing sleep to be possible, but it also has a sedative effect so can also be beneficial in assisting with getting off to sleep.  Valerian is also a muscle relaxant so can be a great support where muscle tension is present along with sleep issues.

Ashwagandha (Withania somnifera)

This is a tonic for both the nervous system and for restoring sleep.  It is best thought of as when the body is too exhausted or worn out to be able to sustain good quality sleep, because sleeping also requires a certain amount of energy. When one becomes “tired and wired” the depth of good quality sleep can become difficult to sustain.  In these instances, ashwagandha helps on a deeper level than simply sedating or aiding falling asleep, it can be considered as laying a deep restorative foundation which provides a base from where better-quality sleep becomes possible, allowing the body to truly rest and restore. 

Occasionally because of this restorative effect ashwagandha can sometimes be felt as stimulating, in which case it can be taken during the daytime rather than at night, where it will still have a restorative effect which will over time nurture better quality sleep.  Ashwagandha is considered an adaptogenic herb, so it also improves the bodies resilience to stress, and helps to reset the balance of the stress response. This makes it particularly beneficial when frazzled nerves and being overly stressed is a factor in sleep issues.

St John’s wort (Hypericum perforatum)

This is a nervous system tonic which is traditionally used for insomnia, particularly when emotional stress, anxiety, or depression are also a factor.  Because of its restorative effect on the nervous system, St John’s wort can benefit the onset of sleep and staying asleep (insomnia which involves waking in the night and difficulty getting back off to sleep is common feature of depression).

Passionflower (Passiflora incarnata)

This is helpful in cases where sleep issues are accompanied by anxiety, excitability or irritability.  Traditionally it has been given as a tea by Native Americans for sedative and anxiolytic effects and continues today to be given for this and its hypnotic effect.

Passionflower can aid getting off to sleep, as well as staying asleep.  It is considered particularly beneficial where circular thinking is preventing sleep onset (for example, worrying and repetitive over thinking). Passionflower helps to switch off this thinking and so getting to sleep becomes easier. It is also a nervine so helps to relax the nervous system and assists the ability to stay asleep.

Vervain (Verbena officinalis)

This herb is not particularly sedative as such, but as more of a tonic for the nervous system it tends to relax the body, energetically bringing a sense of grounding.  This can allow a better quality of sleep which will be overall deeper and more nourishing, especially when combined with other herbs which have sedative or hypnotic qualities such as valerian or passionflower. Herbalists may consider it for people who feel they sleep lightly, wake easily, or simply do not feel well rested after sleep. The grounding effect allows the sleep to become deeper.

Hops (Humulus lupulus)

Hops can be helpful when there is difficulty getting off to sleep or in staying asleep.  It tends to be hypnotic and mildly sedative and is particularly helpful if sleep issues are accompanied by a sense of excitability or restlessness, and also for people who experience excessive libido.  It is also beneficial for people experiencing sleep issues associated with the menopause.  It is best avoided in depression due to its slightly depressive effect.

Chamomile (Matricaria recutita)

This is a well-known remedy for sleep and suitable for children due to its gentleness. However, it is traditionally said of chamomile that ‘gentleness should not be confused with weakness’.  Although gentle in nature due to its calming effect Chamomile can be a simple but beneficial sleep remedy. It can be taken as an evening drink to aid getting off to sleep, particularly when sleep issues are accompanied by a feeling of restlessness or mild anxiety.

Limeflower (Tilia spp.)

Popular in France where it is a common home remedy taken as a relaxing evening drink to aid getting off to sleep.  It is relaxing and helpful if anxiety accompanies sleeplessness.

Skullcap (Scutellaria laterflora)

This is a wonderful herb when sleep issues are due to emotional stress, or when excitability, irritability, or anxiety are present with sleep issues.  It is a tonic for the nervous system, and as with other nervous system tonics it helps to restore the ability to achieve good quality deep sleep. It is also sedative so aids getting off to sleep. Herbalists consider it to have an affinity with the head (from the name skullcap), and is helpful to stop worrying about things that you cannot do anything about.

Lemon balm (Melissa officinalis)

Helpful for promoting better sleep quality, a calming herb that blends well with chamomile and lime flower for a pleasant tasting evening beverage. It is also considered energetically helpful for nightmares, and irritability in children and the elderly.

Key components to healthy sleep are ensuring healthy sleep routines and where possible eliminating or managing stressors which may be contributing to a lack of sleep.

The following guidelines have been recommended by Mental Health UK (2) as tips for getting a good night’s sleep:

• Create a regular sleeping pattern of sleeping and waking
• Create a restful sleeping environment (dark, peaceful and a comfortable temperature)
• Assess your stressors from work (for example workload, commute, work environment and boundaries at work)
• Regular exercise releases stress from the body, and tires us out in a healthy way so we can slip into a deep regenerative sleep. Avoid vigorous exercise too close to bedtime when possible as this can keep you awake.
• Be mindful of food and drink consumption. Caffeine takes at least 5 hours to leave the body and massively disrupts sleep for most people, as does alcohol. A herbal tea in the evening from the plants mentioned above could be a wonderfully soothing alternative.
• A sleep diary can be helpful for seeing how much sleep you are actually getting, allowing you to analyse your patterns and take informed action.
• A wind down routine will help you to relax before bed and nurtures a good night’s rest. This can include a warm bath, some gentle yoga or a relaxing and quiet podcast or music. Its important to support the transition between the day’s chores and activities and rest.
• Write down your thoughts, especially if you tend to lie and think about all you have to do the next day. Simply writing these down allows us to release them and have a clearer mind so we can get to sleep more quickly. 
• Create and maintain good sleep hygiene by avoiding bright lights at bedtime and screens for at least 30 minutes to an hour before bed.

In addition, Yoga Nidra can be helpful for re-establishing healthy sleeping habits.  It is also referred to as ‘Yogic sleep’, and is a guided relaxation practice which accesses the space between the conscious and subconscious mind, aiding the release of physical and mental tension, and promoting deep relaxation.

It helps to re-establish balance in the body-mind complex, nourishing the nervous system, and can be a great aid for re-establishing the balance and energy resources necessary to access sufficient good quality sleep. Yoga Nidra can be practised during the daytime, or as part of a wind-down routine before going to bed at night.

1. Chattu VK, Manzar MD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare (Basel). 2018;7(1):1. doi:10.3390/healthcare7010001
2. Sleep and mental health. Mental Health UK website. https://mentalhealth-uk.org/help-and-information/sleep/. Accessed December 3, 2022.
3. Tortora, G, Derrickson, B. Principles of Anatomy and Physiology. Vol. 1. 13^th ed. Asia: John Wiley & Sons; 2011.
4. Patel AK, Reddy V, Shumway KR, et al. Physiology, Sleep Stages. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK526132/ Accessed December 8, 2022.
5. Stages of Sleep. Sleep Foundation Website. https://www.sleepfoundation.org/stages-of-sleep.  Accessed December 3, 2022.
6. Nollet M, Wisden W, Franks NP.Sleep deprivation and stress: a reciprocal relationship. Interface Focus. 2020;10:20190092. http://dx.doi.org/10.1098/rsfs.2019.0092. (Accessed 02.12.22).
7. Newbury, CR, Crowley R, Rastle K, & Tamminen J. Sleep deprivation and memory: Meta-analytic reviews of studies on sleep deprivation before and after learning. Psychological Bulletin. 2021;147(11):1215–1240. https://doi.org/10.1037/bul0000348.
8. Bishir M, Bhat A, Essa MM, Ekpo O, Ihunwo AO, Veeraraghavan VP, et al. Sleep Deprivation and Neurological Disorders. BioMed Research International. 2020;5764017. https://doi.org/10.1155/2020/5764017.
9. R, Bernhardi LE, Eugenín J. What Is Neural Plasticity?. Adv Exp Med Biol. 2017;1015:1-15. doi:10.1007/978-3-319-62817-2_1.
10. Eide PK, Vinje V, Pripp AH, Mardal KA, Ringstad G. Sleep deprivation impairs molecular clearance from the human brain. Brain. 2021;144:3: 863–874. https://doi.org/10.1093/brain/awaa443.

Arguably, one of the most interesting and useful qualities of essential oils is how they can have a direct impact on our nervous system, simply through inhaling them. Olfaction, or our sense of smell, is one of the lesser-understood senses and has the power to evoke moods or memories almost instantaneously when we inhale an evocative aroma (1).

When we inhale, essential oil molecules can pass through into our olfactory bulb, the organ that detects scents, and are then recognised by smell receptors.

The olfactory bulb is directly connected to the brain (2) and passes the aroma nerve impulse generated by the aromatic molecule, which is sent directly into our limbic system – the part of the brain that is associated with emotion and memory (3).

As such, essential oils can have a profound impact on our mood since the nerve impulses triggered by smells pass through the amygdala – the part of the brain associated with interpreting the “emotional significance” (4) of what is around us – as well as impacting the hypothalamus, which largely controls our endocrine (hormonal) system. The production of hormones is often influenced by what we inhale (5) and variations in hormone levels can have a significant effect on our mood, as well as the status of our nervous system (6).

When our sympathetic nervous system is activated, we are in ‘fight or flight’ or “hyperarousal” mode, and as such, cortisol (commonly known as the stress hormone, although we need it for various functions in the body) levels are typically high (7). This can prevent our parasympathetic nervous system from activating, which is responsible for helping us feel calm and relaxed.

The parasympathetic nervous system is sometimes described as putting the ‘brakes’ on the sympathetic nervous system (8), preventing or slowing its activation, and allowing our body to enter the ‘rest and digest’ mode needed for sound sleep.

So, if we are experiencing high levels of brain activity, lots of stimulation or anxiety before bed, this can significantly impact our body’s ability to regulate and produce the hormones necessary for sleep.

Research papers suggest that cortisol levels are higher in those experiencing insomnia (9), and others note that stress in particular inhibits slow-wave sleep (10) which is thought to be the most restorative form of sleep (11).

There are a number of approaches to promoting restful sleep, with tips for creating a bedtime routine, reserving the bedroom for rest, exercising and finding other ways to de-stress (12).

Whilst aromatherapy is not a cure for serious sleep disorders such as insomnia, it can play a part in the wider picture of developing healthy ‘sleep hygiene’ (13).

Since aromatherapy taps directly into the nervous system and can therefore cause the production or reduction of hormones in the brain and rest of the body, it is a useful tool in our arsenal for helping to create the right internal environment in the body which can allow sleep to come.

Aromatherapy in the context of sleep has a strong focus on reducing stress, promoting a calm, positive mood, and gently allowing the nervous system to re-regulate. This decreases the activity of the sympathetic nervous system, and allows the parasympathetic nervous system to naturally activate as the hormonal ‘barriers’ such as cortisol are allowed to decrease. It also focuses on creating a positive environment to allow the client to reframe their approach to sleep and relaxation.

Creating mood-aroma associations

Throughout our lives, we might have developed positive emotional associations with some aromas, and not with others. This phenomenon is due to the link with between and our limbic system. The good news is that we can harness this link to our advantage, creating a “smell-mood memory” (14), establishing (or reinforcing) positive associations between aroma and mood that help us feel rested and ready for sleep.

For example, if a client comes to see me for help addressing insomnia or broken sleep, over the course of our treatments, I will co-create a blend of essential oils with them, using oils which already have a strong, positive and calming emotional association for them, or are new, but that they find calming. Then, over time, they begin to associate with a calm, restful time and environment – their monthly massage treatment.

My favourite essential oils for treating sleep disorders are those that work to calm the nervous system whilst also relaxing the muscles. By regulating our breathing, slowing our heart rate and releasing tension from muscles, we can ‘tell’ our brain that it’s time to rest, and literally trigger the activation of our parasympathetic nervous system (15).

Inhalation, as well as topical application of essential oils, can be synergistic since inhalation is the most effective way to use aromatherapy for psychotherapeutic effect (16).

Below, you will find some information and recipes for aromatherapy blends to support you the get a good night’s sleep.

Therapeutic touch to calm the body

Massage itself is also a brilliant way to prepare the body for rest. Moderate pressure massage can generate a response from the parasympathetic nervous system (17), and therefore support the work of the aromatic oils which are applied to the body topically as part of a blend in a base oil, and then absorbed into the bloodstream, and inhaled by the client as they receive the massage treatment.

Creating a sleep blend of calming essential and carrier oils and applying it to your neck, shoulders and arms 30 minutes before sleep as part of a wider wind-down ritual is soothing for the nervous system on both levels.

Suggested blend for pre-sleep massage or bath oil (2% blend)

Ingredients

10ml carrier oil e.g. sunflower oil (Helianthus annuus)

10 drops (total) of ant-spasmodic, anti-inflammatory, anxiolytic and nervine essential oils, to include any of the following:

• German Chamomile Matricaria recutita (anti-inflammatory, nervine, sedative)
• Roman Chamomile Chamaemelum nobile (anti-inflammatory, nervine, sedative)
• Lavender Lavandula angustifolia (anti-inflammatory, analgesic, sedative, relaxant, hypotensive)
• Juniper Juniperus communis (antispasmodic, analgesic)
• Mandarin (Citrus reticulata (antidepressant, antispasmodic, sedative for central nervous system, relaxant)
• Marjoram Origanum majorana. (relaxant, hypotensive oil, musculoskeletal antispasmodic)

How to make a pre-sleep massage oil

Stir well to combine, and apply to the affected area using gentle massage, preferably on warm skin. This is particularly effective post-shower or bath.

Inhalation to soothe the mind

Perhaps the simplest and most effective way for generating an impact on our mood and emotions, inhalation is my preferred method of application for regulating sleep. I have found that for myself and my clients, using a diffuser or aromatherapy inhaler 30-60 minutes before sleep whilst maintaining a dimly-lit room for the same amount of time can help to create a contextual association between “down time”, the aroma, and feeling calm. By reinforcing this routine daily, you can help to cement an ‘odour response’ (18) and with time may find that sleep is improved.

Suggested Inhaler sleep blend

Using a diffuser, fill with water to the maximum fill line and add up to ten drops of the following essential oils. Diffuse for 30-60 minutes before sleep, in the bedroom.

• Tarragon* (Artemisia dracunculus): Antispasmodic, hypnotic, neuromuscular tonic
• Bergamot (Citrus bergamia): Calming, antispasmodic
• Clary sage* (Salvia sclarea): Calming, sedative, tonic
• Cypress (Cupressus sempervirens): Antispasmodic, balances sympathetic nervous system
• Geranium (Pelargonium graveolens): Anxiolytic, antispasmodic, anti-inflammatory
• Jasmine (Jasminum officinale): Sedative, calming, antispasmodic

*Caution: avoid in pregnancy

Sleep ointment recipe

Mmakes 1 ~60ml pot at a ~2% dilution

Ingredients

8g Beeswax (or soy wax)

50ml Carrier oil, e.g. herbal infused St John’s Wort (Hypericum perforatum) oil, or sweet almond (Prunus dulcis) oil

30 drops of total essential oil from the following list:

• Marjoram (Origanum majorana) – works to calm the nervous system whilst simultaneously relaxing muscle tissue
• Grapefruit (Citrus paradisii) – a “cooling, cleansing” (19) oil that clears the mind and helps ease feelings of frustration and tension.
• Valerian (Valeriana officinalis) – a sedative essential oil that helps relax the body and mind, and relieve stress
• Vetiver (Vetiveria zizanoides) – sedative, grounding, and calming

Orange Petitgrain Citrus arurantium amara (fol). – uplifting without being stimulating, antispasmodic and calming. Particularly useful for nervous exhaustion.

How to make a sleep oil

1. Use a bain-marie on a low heat to melt the carrier oils and wax together. Stir until completely melted and combined.
2. Take off the heat. Allow to cool to 50-60 degrees C.
3. Add up to 57 drops of essential oils, from those listed above.
4. Stir well to combine, pour into a 60ml sterilised tin and allow to cool.
5. When solid, the balm is ready to use. Use within 6 months.
6. Apply topically to the neck, shoulders and arms 30 minutes before bed, massaging gently.

The wider picture of sleep

These recipes and suggestions are designed by a clinical aromatherapist to help support you to integrate aromatherapy into your pre-sleep ritual. Whilst aromatherapy has been shown by studies to improve sleep quality (20) these blends are not designed to cure insomnia or other disorders, and are to be used as part of a holistic approach to promoting healthy sleep which might include addressing areas such as food, exercise, levels of stimulation, reducing stress and establishing a regular sleep routine.

1. Martin, I. (2007). Aromatherapy for Massage Practitioners (1st ed.). Lippincott Williams & Wilkins.
2. Martin, I. (2007). Aromatherapy for Massage Practitioners (1st ed.). Lippincott Williams & Wilkins.
3. Walsh, C. (2020, February 27). How scent, emotion, and memory are intertwined – and exploited. Harvard Gazette. https://news.harvard.edu/gazette/story/2020/02/how-scent-emotion-and-memory-are-intertwined-and-exploited/#:~:text=Smells%20are%20handled%20by%20the,related%20to%20emotion%20and%20memory.
4. Ramachandran, V. S., & Blakeslee, S. (1998). Phantoms in the brain: Probing the mysteries of the human mind. William Morrow.
5. Lobmaier, J. S., Fischbacher, U., Wirthmüller, U., & Knoch, D. (2018, September 12). The scent of attractiveness: Levels of reproductive hormones explain individual differences in women’s body odour. Proceedings of the Royal Society B: Biological Sciences. Retrieved December 1, 2022, from https://royalsocietypublishing.org/doi/10.1098/rspb.2018.1520
6. Harvard Health Publishing, Harvard Medical School. (2020, July 6). Understanding the stress response. Harvard Health. Retrieved December 1, 2022, from https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
7. American Psychological Association. (n.d.). Stress effects on the body. American Psychological Association. Retrieved December 1, 2022, from https://www.apa.org/topics/stress/body#:~:text=When%20the%20body%20is%20stressed%2C%20the%20SNS%20contributes%20to%20what,adrenalin%20(epinephrine)%20and%20cortisol.
8. Harvard Health Publishing, Harvard Medical School. (2020, July 6). Understanding the stress response. Harvard Health. Retrieved December 1, 2022, from https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
9. Roehr, T., & Roth, T. (2019, April 25). Hyperarousal in insomnia: Pre-sleep and diurnal cortisol levels in response to chronic zolpidem treatment. Sleep Medicine. Retrieved December 1, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S138994571930125X
10. Kim, E.-J., & Dimsdale, J. E. (2007). The effect of psychosocial stress on sleep: A review of polysomnographic evidence. Behavioral Sleep Medicine, 5(4), 256–278. https://doi.org/10.1080/15402000701557383
11. Dijk, D.-J. (2009, April 15). Regulation and functional correlates of slow wave sleep. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. Retrieved December 1, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824213/
12. Harvard Health Publishing, Harvard Medical School. (2021, September 30). 8 secrets to a good night’s sleep. Harvard Health. Retrieved December 1, 2022, from https://www.health.harvard.edu/newsletter_article/8-secrets-to-a-good-nights-sleep
13. Sleep Foundation. (2022, September 29). Sleep hygiene. Sleep Foundation. Retrieved December 1, 2022, from https://www.sleepfoundation.org/sleep-hygiene
14. Martin, I. (2007). Aromatherapy for Massage Practitioners (1st ed.). Lippincott Williams & Wilkins.
15. André, C. (2019, January 15). Proper breathing brings better health. Scientific American. Retrieved December 1, 2022, from https://www.scientificamerican.com/article/proper-breathing-brings-better-health/
16. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, p 15.
17. Diego, M. A., & Field, T. (2009). Moderate pressure massage elicits a parasympathetic nervous system response. International Journal of Neuroscience, 119(5), 630–638. https://doi.org/10.1080/00207450802329605
18. Herz, R. S. (2005, January 1). Odor-associative Learning and Emotion: Effects on Perception and Behavior. Academic.oup.com. Retrieved December 1, 2022, from https://academic.oup.com/chemse/article/30/suppl_1/i250/270391
19. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, pp 80.
20. Ko, L.-W., Su, C.-H., Yang, M.-H., Liu, S.-Y., & Su, T.-P. (2021, January 13). A pilot study on essential oil aroma stimulation for enhancing slow-wave EEG in Sleeping brain. Nature News. Retrieved December 1, 2022, from https://www.nature.com/articles/s41598-020-80171-x#:~:text=found%20that%20inhaling%20lavender%20aroma,whole%20brain%20during%20waking%20times.

• American Psychological Association. (n.d.). Stress effects on the body. American Psychological Association. Retrieved December 1, 2022, from https://www.apa.org/topics/stress/body#:~:text=When%20the%20body%20is%20stressed%2C%20the%20SNS%20contributes%20to%20what,adrenalin%20(epinephrine)%20and%20cortisol.
• André, C. (2019, January 15). Proper breathing brings better health. Scientific American. Retrieved December 1, 2022, from https://www.scientificamerican.com/article/proper-breathing-brings-better-health/
• Caddy, R. Essential oils in colour (2nd ed.). Amberwood Publishing. 1997
• Diego, M. A., & Field, T. (2009). Moderate pressure massage elicits a parasympathetic nervous system response. International Journal of Neuroscience, 119(5), 630–638. https://doi.org/10.1080/00207450802329605
• Dijk, D.-J. (2009, April 15). Regulation and functional correlates of slow wave sleep. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. Retrieved December 1, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824213/
• Harvard Health Publishing, Harvard Medical School. (2020, July 6). Understanding the stress response. Harvard Health. Retrieved December 1, 2022, from https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
• Harvard Health Publishing, Harvard Medical School. (2021, September 30). 8 secrets to a good night’s sleep. Harvard Health. Retrieved December 1, 2022, from https://www.health.harvard.edu/newsletter_article/8-secrets-to-a-good-nights-sleep
• Herz, R. S. (2005, January 1). Odor-associative Learning and Emotion: Effects on Perception and Behavior. Academic.oup.com. Retrieved December 1, 2022, from https://academic.oup.com/chemse/article/30/suppl_1/i250/270391
• Kim, E.-J., & Dimsdale, J. E. (2007). The effect of psychosocial stress on sleep: A review of polysomnographic evidence. Behavioral Sleep Medicine, 5(4), 256–278. https://doi.org/10.1080/15402000701557383
• Ko, L.-W., Su, C.-H., Yang, M.-H., Liu, S.-Y., & Su, T.-P. (2021, January 13). A pilot study on essential oil aroma stimulation for enhancing slow-wave EEG in Sleeping brain. Nature News. Retrieved December 1, 2022, from https://www.nature.com/articles/s41598-020-80171-x#:~:text=found%20that%20inhaling%20lavender%20aroma,whole%20brain%20during%20waking%20times.
• Lobmaier, J. S., Fischbacher, U., Wirthmüller, U., & Knoch, D. (2018, September 12). The scent of attractiveness: Levels of reproductive hormones explain individual differences in women’s body odour. Proceedings of the Royal Society B: Biological Sciences. Retrieved December 1, 2022, from https://royalsocietypublishing.org/doi/10.1098/rspb.2018.1520
• Martin, I. (2007). Aromatherapy for Massage Practitioners (1st ed.). Lippincott Williams & Wilkins.
• Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005
• Ramachandran, V. S., & Blakeslee, S. (1998). Phantoms in the brain: Probing the mysteries of the human mind. William Morrow.
• Roehr, T., & Roth, T. (2019, April 25). Hyperarousal in insomnia: Pre-sleep and diurnal cortisol levels in response to chronic zolpidem treatment. Sleep Medicine. Retrieved December 1, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S138994571930125X
• Sleep Foundation. (2022, September 29). Sleep hygiene. Sleep Foundation. Retrieved December 1, 2022, from https://www.sleepfoundation.org/sleep-hygiene
• Walsh, C. (2020, February 27). How scent, emotion, and memory are intertwined – and exploited. Harvard Gazette. Retrieved December 1, 2022, from https://news.harvard.edu/gazette/story/2020/02/how-scent-emotion-and-memory-are-intertwined-and-exploited/#:~:text=Smells%20are%20handled%20by%20the,related%20to%20emotion%20and%20memory.

It is difficult to point at one solid piece of data or theory as to why men are in the situation we find ourselves today.

In my work with men, I believe the underlying themes point towards a number of different reasons:

• Lack of purpose or meaning in life
• The addiction to short term gratification – Food, material positions, sex, gambling etc.
• Poor male mentoring influence – No father in the childhood home or strong, well rounded male figures in the patient’s life
• The glorification of violence, money and tyrannical power as a pursuit to meaning
• Trauma
• Adverse childhood events (2)
• A society that values academic pursuits instead of a well-rounded, meaningful spiritual pursuit towards discovering truth and purpose
• Poor boundaries and a lack of assertiveness
• Lacking healthy morals

In my clinic I work with mostly young men aged 20-35. Many are what I consider to be “lost”. Lacking meaningful careers, healthy relationships, filled with anxiety, depression and substance abuse.

The focus of understanding the male patient first comes with detailing physiological complaints but often turns into uncovering the life plan or life pattern that the individual is stagnant in, stuck in or struggling to break. It is therefore crucial to help the man see his body is deeply connected to what he surrounds himself with or ingests.

Poor dietary choices and substance misuse are critical to discuss as they often underpin a self-medication process that many men are sucked into in order to cope. This is linked to lacking internal resources and the lack of action on the areas of their life that need attention.

Younger male patients are often unaware of how their behaviours are intricately linked with short term gratification (3). Preferring to engage in behaviours that offer very short term relief through dopaminergic activity (drugs, food, gambling, pornography, spending excessive amounts of money etc). However, this can be a problem that affects men at any age.

Older men tend to live more meaningful lives in terms of family commitments, children and job/career. They are more dominant in manifesting a stronger sense of purpose, responsibility and meaning. But the juggling of such responsibilities can become overwhelming and as such promote a background feeling of instability that men can find difficult to comprehend.

This follows the theory of the ‘U-shaped happiness curve’ (4) which shows data from across the world pointing towards life satisfaction dropping in the age range of 40-50. These also happen to be the years with peak responsibilities when it comes to jobs, finances, children and hobbies. Exhaustion and stress become entrenched within the man who struggles with his demanding work/life balance. Selye’s general adaptation syndrome (5) provides key parts to how the stress response can become overloaded and middle-aged men living a manifested life are easily overburdened around this age.

The “mid-life crisis” plays into this phenomenon of men being unsatisfied in their mid-forties, and seeking other pursuits to alleviate the burden.

At all ages it would seem men have many areas of their life that they consciously or unconsciously do not speak about for reasons such as fear of judgement, ridicule or a general lack of awareness that they need attention.

Humans are innately gifted at using things in their environment to bring about a change. Abuse and/or misuse of foods, medicine and drugs will often feature in a male patient seeking help for mental health problems. It is an important subject to understand here in that the patient is merely seeking a change in their experience of reality by using foods and substances to cope with, change or repress a human sensation or emotion they are struggling to comprehend.

I find that substances play differing roles for men, mainly dependant upon age. Younger men tend to use substances in more social settings as a means to engage with the group. This is predominantly the “party” scene. Large gatherings of people help the individual find more meaning, but they often include substance abuse as a social dynamic.

Solitary substance use tends to be more Cannabis in the younger generation of men. Cannabis is often used for anxiety and insomnia in the home, with stimulants such as cocaine and amphetamine being more favoured when in a group setting. In this case the substances are not necessarily stress related, or due to such a lack of responsibilities, but more associated with escapism.

Substances easily creep in with older men to cope with the increasing demands of a responsible life filled with a mortgage, marriage and children. Excessive Coffee often features in the morning due to poor cortisol awakening response (6), sugary foods during the day due to glucose needs impacted by stress, and alcohol in the evening to switch off and sleep.

Whilst every man is unique in presentation the following protocol is one I use with the most success:

• Detailed analysis and discussion of childhood experiences, family life, living situation, diet, substance misuse and physiological complaints.
• Introduction of agreements surrounding action that needs to be worked upon to become more of the man they wish to be.
• Agreements on changing diet and reducing substance misuse.
• The withdrawal of substances needs to be aligned with the practitioner attempting to understand what the male patient is using them for (repression of emotions, escapism, social connection, physical pain etc).
• Herbal treatment should be initially aimed at balancing the autonomic nervous system, fortifying the man’s energy reserves and reducing inflammation. This is often done with tonics, adaptogens, relaxants and anxiolytics.
• Younger men in their 20’s tend to be needing help to manifest more of the life they want by accepting the meaningful pursuit of responsibility. Herbs that change blood dynamics are more helpful here to break internal stagnancy which will be reflected in their external reality.
• Older men over 40 tend to need more help with finding calm, peace and a restructuring of the overburdening of responsibilities. Herbs that help reduce inflammation and calm the nervous system tend to be more relevant in this age group.
• Subsequent treatment should be aimed at working alongside new found goals, visions or thoughts towards a particular challenge, block and project they find meaning in. Nootropics are useful here.
• In all stages of treatment the consultations should encourage a significant amount of time towards facilitating the man to understand his life is more within his control than what he initially realises. Talking therapy, coaching and herbs are supporting him to become more manifested as a well-rounded and balanced individual.
• Men are likely to hold onto emotions for fear of judgement. When information is shared or released it is to be celebrated and encouraged by operating through a safe container in which information is received, discussed openly and new perspectives offered. This encourages trust and recognition that the male patient learns is not just acceptable but needed to unburden himself of the psychological weight that carrying around shame, guilt, anger, fear and resentments can bring upon the body.
• Nootropics are more likely to produce desired affects once inflammation, autonomic nervous system function, gut health and blood pressure have all found a more regulatory nature. I find that giving nootropics too early into treatment will lack the desired outcome.
• As treatment progresses, remember that the practitioner will produce lasting change by focusing on the life plan resolution and transformation rather than the disease. If you focus solely on the disease and treat only at the physiological level of illness you may not induce the psyco-spiritual changes that assist men to learn how they can master more control of their internal and external reality.

The following herbs are ones I use continuously with my male patients.

Gotu kola (Hydrocotyle asiatica)

• Actions: Nootropic, anti-inflammatory, brain tonic, warming
• Used for: Balancing the autonomic nervous system (ANS). Prolonged stress will cause a dysregulation that is perpetuated even at rest. Gotu Kola help stabilise and module the ANS. Helpful for anxiety.

Tulsi (Ocimum sanctum)

• Actions: Lung tonic, antidepressant, aromatic, stress relieving, adaptogen
• Used for: Stagnation in mind and body. It is a highly aromatic herb that focuses on expelling mucus in the lungs and digestion. Perfect for supporting a male patient who is a chronic smoker and/or substance user addicted to behavioural patterns that have caused stagnation.

He shou wu (Polygonum multiflorum radix)

• Actions: Adaptogen, blood tonic, kidney tonic, alterative, rejuvenative, nervine
• Used for: Exhaustion and depletion associated with chronic stress. Pain and weakness in the lower back, knees and tendons. A tonic for the adrenals, liver and pancreas.

Maca root (Lepedium meyenii radix)

• Actions: Boosts fertility, rejuvenative, aphrodisiac, sexual tonic
• Used for: A native to the high Andean mountains of Peru. It was supposedly eaten by Inca warriors before going into battle as well as being given as a gift to newly married couples (7). Useful for men of any age who are exhausted, suffering with low libido and a general feeling they are severely lacking physiological power.

Damiana leaf (Turnera diffusa folia)

• Actions: Antidepressant, aphrodisiac, anxiolytic, relieving stress
• Used for: Improving decision making associated with fear of the unknown. Relaxing the mind and stimulating change.

Wu wei zi (Schisandra chinensis fructus)

• Actions: Adaptogen, aphrodisiac, nervine, astringent, antidepressant
• Used for: Originally used by Siberian hunters to improve eyesight, strength and resilience during challenging pursuits. Wu Wei Zi is an adaptogen that has affinity for improving the health of the liver and the vitality of the kidneys. I often use it with male patients who have a lot of repressed anger that needs to be expressed and integrated.

Borage (Borago officinalis)

• Actions: Adrenal tonic, anti-inflammatory, diuretic
• Used for: Improving adrenal vitality and regulation. A hyperactive fight or flight response will tax energy levels and Borage is often supportive of improving energy levels, giving the man more resources (energy) with which to take action to bring about further resolution and change.

Rosemary (Rosmarinus officinalis)

• Actions: Nootropic, antidepressant, stimulates circulation and improves blood flow
• Used for: Young male patients who are often lazy, lacking motivation and need to create momentum. Rosemary improves blood dynamics which are often stagnant in young men, reflecting a much needed change in behavioural patterns towards creating the life they want.

1. https://www.mentalhealth.org.uk
2. https://mft.nhs.uk/rmch/services/camhs/young-people/adverse-childhood-experiences-aces-and-attachment/
3. https://www.psychologytoday.com/gb/blog/the-modern-brain/201909/the-real-issue-instant-gratification
4. https://www.inc.com/jeff-haden/scientists-just-discovered-mid-life-crisis-peaks-at-age-47-heres-how-to-minimize-effect-of-happiness-curve.html
5. https://www.medicalnewstoday.com/articles/320172
6. Lovallo. W.R, Whitsett. T. L, al’Absi. M, Sung. B. H, Vincent. A. S, Wilson, M. F. (2005) Caffeine Stimulation of Cortisol Secretion Across the Waking Hours in Relation to Caffeine Intake Levels, Psychosomatic Medicine, 67(5): p. 734-739.
7. https://charli-cohen.com/maca-the-mysterious-superfood-and-hormone-balancer/

The term adaptogen was first used by scientist Nikolay Lazarev in 1947 to describe substances that can improve an organisms ‘non-specific’ resistance to stress (1). In 1968 the definition was elaborated by fellow Soviet pharmacologists Brekhman and Dardymov to mean a substance that (2)

• is non-toxic, and causes minimal disturbance to the organism
• is non-specific in pharmacological action, improving the organisms resistance to a broad range of stressors
• tend to have a ‘normalising’ effect on body systems – reducing excess, and raising deficiency

This reflected an attempt to provide scientific support for a common theme in holistic herbal medicine – restoring balance and supporting the body’s natural adaptive resilience.

Not surprisingly herbs with these reported adaptogenic properties remain an attractive prospect for herbalists and patients. As would be expected from such a broad action adaptogens are employed for a whole host of conditions. However, the main therapeutic focus is reducing the extent of the body’s stress response, and improving recovery. Relatedly they will be used to improve stamina and support people with chronic conditions, and improve concentration.

While the word adaptogen is a very recent term, it is not without precedent in the long history of herbal medicine – the preservation and adaptation of herbal uses on which much pharmacological investigation is based. Exploring the histories of the most well known adaptogens shows the connections between their classifications in a variety of herbal traditions and their reinterpretation as adaptogens in the twentieth century.

• Eleutherococcus senticosus (Rupr. & Maxim.) Maxim.
• Family: Araliaceae
• Synonym: Acanthopanax senticosus (Rupr. & Maxim.) Harms)

While commonly known as Siberian ginseng, it has a wider distribution, growing wild across Northeastern and Central China, North Korea, South Korea, Far Eastern Russia and Japan (3).

It grows as a shrub, reaching heights of around 5 to 8 feet, and its light brown stems are covered in prickly spines. Each palmate leaf consists of five leaflets of varying size. It favours the cool semi-shade of mixed mountainous forests.

It produces tiny white flowers in mid-summer, borne on umbels, that produce clusters of black fruits. It is mainly the rhizome with the roots that is used in herbal medicine.

Eleutherococcus senticosus was the main herb of interest to the early researchers on adaptogens in the Soviet Union, and apparently found favour as a replacement for another member of the Araliaceae plant family, Panax ginseng, when supplies were low. Dr. Brekham researched and promoted the herb for convalescents, aiding immunity after surgery and protecting well-being. The herb found favour amongst Soviet athletes as an endurance aid, who then shared its use at international events (4).

It has a long history of use in Traditional Chinese Medicine, first recorded in the Shennong Ben Cao Jing c.220 A.D., and is mainly employed today in a range of combination prescriptions for various conditions.

It is recommended for general invigoration of Qi, with a particular affinity for the kidneys and liver, supporting their effective functioning, which leads to improvements in the health of the musculoskeletal system (5). It was traditionally used by people living in the subarctic forest regions of Siberia to improve quality of life and protect against infections (6).

• Panax ginseng C.A. Mey.
• Family: Araliaceae

Commonly known as Korean ginseng, it is historically associated with the country due to the reputation of the quality of the rhizome that grows there, that is still widely exported and remains an important souvenir for Chinese tourists visiting South Korea. Though like the so-called Siberian ginseng it has a wider distribution than its name suggests – spreading wild across North-Eastern China, North Korea, South Korea, and some regions of Far Eastern Russia (7).

It has a similar appearance to its close relative, though without the very spiney stem and having yellowish to pink flowers on its umbels that produce red rather than black fruits. It shares a similar habitat.

Again, it is the rhizome which is used medicinally, which makes it more at risk of overharvesting and it is now mostly cultivated due to the loss of wild plants, though semi cultivated ‘wild’ ginseng fetches a premium on the market while allowing stocks to be replenished.

The genus name shares the same etymology as panacea, coming from the Ancient Greek pân meaning “all” and ákos meaning “cure”, named for its supposed reputation in Chinese and Korean medicine. Chinese botanist Shiu Ying Hu argued in her 1976 paper that this reputation was based on a misrepresentation of its use in Chinese medicine which was “very specific and restricted”.

This was because it was only prescribed for patients “who have the jo (“weak”) symptoms and who need the pu (“tonic”) remedies”, out of ten possible symptom groups with matching remedy types (8). And in Chinese materia medica texts it is generally recommended for the following conditions – lassitude and anorexia, shortness of breath and low voice, diabetes, insomnia and impotence, and for each condition there is a specific combination of other herbs used alongside ginseng (9).

Despite these specific understandings of prescribing in a clinical tradition, Panax ginseng has gained a reputation across the world, including in China and South Korea, as a general tonic and health supplement on its own, to support peak performance at work, in sport and in the bedroom. It is sold as powder, pills, dried root, infused in wine, cooked in soup and in teabags.

• Rhodiola rosea L.
• Family: Crassulaceae (10)

Both fresh and dried, the root has a rich earthy rose like aroma, hence the species name ‘rosea’ and the common names roseroot and rosewort. It is also known as arctic root due to its affinity for icy habitats, and goldenroot on account of its yellow flowers. It grows upright to around 70cm high, with a fleshy stem and leaves.

Swedish botanist Carl Linnaeus recommended it for “headaches, “hysteria”, hernias, discharges, and as an astringent”(11). Tracing the longer history of the use of roseroot is harder because little detailed work has been published in English as far as I’m aware.

For example, there is debate over whether or not Vikings used it for endurance during their long journeys, which seems likely considering the uses we know of today, but there are very little textual records from this period and only a few studies on the archaeobotanical record. However, the root is used today for a range of conditions across its wide distribution – Arctic and mountainous regions of Europe, Asia and North America, covering around 30 countries (12).

According to a review of traditional uses the Sámi people chew on root pieces during long journeys and use it for urinary infections, Inuit people use the root for infections, colds, fatigue, and toothache, and for mental and physical rejuvenation. Evenki people in North-Eastern Russia use it as a ‘universal’ medicine. Elsewhere it is commonly used for fatigue, strengthening the body, mental stamina, stress relief and as a tonic (13).

It has become popular in recent years in commercial preparations for its advertised adaptogenic properties. The plant is of conservation concern due to climate change and overharvesting for the herbal medicine trade in certain areas (14).

Other herbs most commonly referred to as adaptogens are:

• Astragalus (Astragalus mongholicus Bunge (syn. Astragalus membranaceus Fisch. ex Bunge))
• Ashwagandha (Withania somnifera (L.)
• Schisandra (Schisandra chinensis (Turcz.) Baill.)
• American ginseng (Panax quinquefolius L.).

Mills and Bone, in their widely referenced book Principles and Practice of Phytotherapy extend the definition of adaptogen to:

• Goji berry (Lycium spp.)
• Codonopsis (Codonopsis pilosula (Franch.) Nannf.)
• Echinacea (Echinacea spp.)
• Gingko (Gingko biloba L.)
• Gotu kola (Centella asiatica (L.) Urb.)
• Tribulus (Tribulus terrestris L.) (15)

In addition to these herbalist David Hoffman lists many more as adaptogens. Many of these are in the same family as the ginsengs discussed above:

• Wu jia pi (Eleutherococcus sessiliflorus (Rupr. & Maxim.) S.Y.Hu)
• Japanese angelica tree (Aralia elata (Miq.) Seem.)
• Manchurian aralia (Aralia elata var. glabrescens (Franch. & Sav.) Pojark)
• Sakhalin spikenard (Aralia cordata Thunb.)
• Asian devil’s club (Oplopanax elatus (Nakai) Nakai)

And in diverse plant families:

• Silk tree (Albizzia julibrissin Durazz)
• Chickpea (Cicer arietinum L.)
• Indian hoppea (Hoppae dichotoma  Willd.)
• Guduchi (Tinospora cordifolia (Willd.) Hook.f. & Thomson)
• Arogyappacha (Trichopus zeylanicus Gaertn.)
• Holy basil (Ocimum tenuiflorum L.)
• Hardy rubber tree (Eucommia ulmoides L.)
• Maral root (Leuzea carthamoides (Willd.) DC.)
• And one species of mushroom, also popular for supporting immunity: lingzhi or reishi (Ganoderma lingzhi (Sheng H. Wu, Y. Cao & Y.C. Dai))(16)

As would be expected all these herbs have a long tradition of use both in the regions they grow and through international trade, combine this with the general nature of their actions and you can see how they have been employed for more conditions than it is possible to account for here.

There are however common themes that emerge when connecting these traditions to their more recent classification as adaptogens – the use for fatigue, general debility, endurance, resilience, as a tonic a ‘universal’, for support of the body as a whole or for optimal function of specific organs or systems.

One of the scientists who defined the term adaptogen distinguished it from a herbal tonic in 1968, describing a tonic action as increasing work capacity and correcting weakness and lack of tone, and from a stimulant which provides a temporary increase in work capacity, followed by a decrease (17).

It should also be noted that when studying traditional medical systems the word ‘tonic’ is often simply a translation into English of words that could be understood quite differently within those cultures, that may be closer to or further from the definition of adaptogen.

Some biochemists have argued that the term adaptogen should not be used as it cannot be linked to a few clear ‘mechanisms of action’ based on isolated compounds, and that scientists should ignore “the fact that the word ‘adaptogen’ was ever invented. While others argue the effect is the same as that of a placebo (18).

The original definition of adaptogen was very clear on the non-specific action, and it is seen as a useful way to bridge different approaches to philosophies of healing.

Despite some scepticism, many researchers are still looking to test the adaptogenic theory, and have focused on many different specific actions to understand the possible effects of these herbs on the body. Some areas that the action is understood in biochemistry are as follows – more efficient use of glycogen, regulating metabolism, inhibiting stress hormones binding to receptors, relaxation of blood vessels, antioxidant activity, steroidal activity, immunostimulant, immunomodulatory, hepaprotective, and antifatigue activities (19).

In some cases, as with Panax ginseng, a herb can contain chemicals that have opposing actions that may explain the adaptogenic effect, for example both hypotensive and hypertensive effects (20).

And for randomised controlled trials the focus is normally on work capacity and endurance for exercise, oxygen consumption, heart rate, respiratory exchange rate, blood pressure, blood glucose, tests of cognitive performance, as well as more subjective measures of wellbeing.

The search for a or cure all is not new, the phrase panacea was used for many different species of plants across ancient Greek and Roman texts, that have been linked to the contemporary names lovage (Levisticum sp.), yarrow (Achillea sp.), centaury (Centaurium sp.), tarhan herb (Echinophora), and species of the genus Opopanax, known in English as ‘all heal’.

While the term ‘adaptogen’ is a very recent development in the history of herbal medicine it is not without precedent. It seems there has always been a desire for a general tonic that can provide support to the body’s own resilience, and it is based on real benefits that people have experienced from taking these herbs. While it is not surprising that the idea of a ‘cure all’ plant raises scepticism, when the use of a herb is understood within its specific context it generally becomes clear that different adaptogens will be used for different patients and different manifestations of conditions in clinical practice.

It has become popular among herbalists, probably because it covers the complexity of using plants as medicines while connecting to a pharmacological approach. The ‘non-specific’ action that is so frustrating to biochemical models that rely on isolation and reduction, holds within it an awareness of complexity and the unknown, and of the workings of the body as a whole that may be more than the sum of its parts. More research is still being done to understand how the specific pharmacological actions connect to the more general outcomes in patients, and there are many more herbs that may demonstrate adaptogenic properties that have had very little research on them.

1. Marina Davydov and A. D. Krikorian, ‘Eleutherococcus Senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an Adaptogen: A Closer Look’, Journal of Ethnopharmacology 72, no. 3 (1 October 2000): 345–93, https://doi.org/10.1016/S0378-8741(00)00181-1.
2. I I Brekhman and I V Dardymov, ‘New Substances of Plant Origin Which Increase Nonspecific Resistance’, Annual Review of Pharmacology 9, no. 1 (April 1969): 419–30, https://doi.org/10.1146/annurev.pa.09.040169.002223.
3. POWO, ‘POWO’, Database, Plants of the World Online. Facilitated by the Royal Botanic Gardens, Kew., 2022, https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:90431-1. Accessed 15/02/2022.
4. Tracy Lee Bleakney, ‘Deconstructing an Adaptogen: Eleutherococcus Senticosus’, Holistic Nursing Practice 22, no. 4 (August 2008): 220–24, https://doi.org/10.1097/01.HNP.0000326005.65310.7c.
5. Erich Stöger, Chinese Herbal Medicine: Materia Medica (Eastland Press, 2004).
6. Linzhang Huang et al., ‘ChemInform Abstract: Acanthopanax Senticosus: Review of Botany, Chemistry and Pharmacology’, Die Pharmazie 66 (1 February 2011): 83–97, https://doi.org/10.1691/ph.2011.0744.
7. POWO, ‘POWO’. https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:91472-1. Accessed 15/02/2022.
8. Shiu Ying Hu, ‘The Genus Panax (Ginseng) in Chinese Medicine’, Economic Botany 30, no. 1 (1976): 11–28.
9. Yao-Zu Xiang et al., ‘A Comparison of the Ancient Use of Ginseng in Traditional Chinese Medicine with Modern Pharmacological Experiments and Clinical Trials: USE OF GINSENG IN TCM AND CLINICAL TRIALS’, Phytotherapy Research 22, no. 7 (July 2008): 851–58, https://doi.org/10.1002/ptr.2384.
10. A. Panossian, G. Wikman, and J. Sarris, ‘Rosenroot (Rhodiola Rosea): Traditional Use, Chemical Composition, Pharmacology and Clinical Efficacy’, Phytomedicine 17, no. 7 (1 June 2010): 481–93, https://doi.org/10.1016/j.phymed.2010.02.002.
11. Carl von Linné, Materia Medica (Holmiae: Typis ac sumptibus Laurentii Salvii, 1749), https://www.biodiversitylibrary.org/bibliography/72911. Quoted in Panossian, Wikman, and Sarris, ‘Rosenroot (Rhodiola Rosea)’.
12. POWO, ‘POWO’, Database, Plants of the World Online. Facilitated by the Royal Botanic Gardens, Kew., 2022, https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:315148-2. Accessed 15/02/2022.
13. J.A. Brinckmann, A.B. Cunningham, and David E.V. Harter, ‘Running out of Time to Smell the Roseroots: Reviewing Threats and Trade in Wild Rhodiola Rosea L’, Journal of Ethnopharmacology 269 (April 2021): 113710, https://doi.org/10.1016/j.jep.2020.113710.
14. Brinckmann, Cunningham, and Harter.
15. S. Mills and K. Bone, ‘Principles and Practice of Phytotherapy. Modern Herbal Medicine.’, 2000, xx + 643 pp.
16. David Hoffmann, Medical Herbalism: The Science and Practice of Herbal Medicine (Inner Traditions / Bear & Co, 2003).
17. Committee on Herbal Medicinal Products (HMPC), ‘Reflection Paper on the Adaptogenic Concept’ (European Medicines Agency, May 2008), https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-adaptogenic-concept_en.pdf.
18. Davydov and Krikorian, ‘Eleutherococcus Senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an Adaptogen’.
19. David Winston and Steven Maimes, Adaptogens: Herbs for Strength, Stamina, and Stress Relief (Inner Traditions / Bear & Co, 2007); Mills and Bone, ‘Principles and Practice of Phytotherapy. Modern Herbal Medicine.’; Joanne Barnes, Linda A. Anderson, and J. D. Phillipson, Herbal Medicines, 3rd ed (London ; Grayslake, IL: Pharmaceutical Press, 2007).
20.  Barnes, Anderson, and Phillipson, Herbal Medicines. 333.

Adrenal glands, also known as suprarenal glands, are small, triangular-shaped organs on top of both kidneys. They produce hormones that help regulate metabolism, immunity, responses to stressors, fluid balance and blood pressure, and other essential functions. Importantly, there are two distinct parts: the adrenal cortex and the adrenal medulla.

The adrenal cortex is the outer region. It is divided into three zones, each responsible for producing specific hormones.

• Cortisol is a glucocorticoid hormone that plays many important roles in the body. It helps control the body’s use of fats, proteins and carbohydrates; suppresses inflammation; regulates blood pressure; increases blood sugar; and can also affect bone formation. This hormone also controls the sleep/wake cycle. It is released during times of stress to help the body get an energy boost and better handle an emergency situation so it also generates a sense of euphoria.
• Aldosterone is a mineralocorticoid hormone that plays a central role in regulating blood pressure, acidity and the key electrolytes sodium and potassium. It sends signals to the kidneys, resulting in them absorbing more sodium into the bloodstream and releasing potassium into the urine.
• DHEA and the androgens are weak precursor hormones that are converted by the ovaries and testes to augment their own production of oestrogens and testosterone. This link and overlap with the functions of the sex glands is significant (see below).

The adrenal medulla is located at the core of the gland. It is essentially an extension of the sympathetic nervous system and produces ‘fight-fright-flight hormones’ including adrenaline and noradrenaline. This is an almost instant response to alarming situations, especially where urgent extreme physical activity is important, and these hormones increase heart rate and the force of heart contractions, blood flow to the muscles and brain (though in other areas can constrict blood vessels so as to increase blood pressure). They also relax airway smooth muscles to increase breathing efficiency.

So an adrenal stress response has two parts. The immediate reaction to a threat is a flood of adrenaline and noradrenaline from the medulla. The first tissue to be affected by this is the adrenal cortex, which responds in its own way by producing a more sustained response to stress, mainly with cortisol. It is the combination of the two responses that constitutes our adaptation to stress.

Pathologies of the adrenal medulla (e.g. pheochromocytoma) are very rare. There are a number of also relatively rare diagnosable disruptions in function of the adrenal cortex, either primary to the gland or secondary to disorders of the pituitary or hypothalamus.

They include Cushing’s Syndrome, where the adrenals overperform (and can also be a feature of over-prescription of steroids), and Addison’s Disease, which is a severe condition of adrenal insufficiency marked by weight loss, poor appetite, nausea and vomiting, fatigue, darkening of skin and abdominal pain, and can be a feature of potentially fatal ‘adrenal crisis’. The concept of ‘adrenal fatigue’ is not included in the catalogue of medical disorders of the adrenal glands.

Modern clinical concepts of ‘stress’ can be traced back to a brief article written in 1936 by the Austro-Hungarian scientist Hans Selye (2). The article set out what appeared to be a three-phase pattern of nonspecific physiological responses to injury: the ‘general adaptation syndrome’: this is made up of 1) an initial alarm phase 2) a stage of accommodation, resistance or adaptation, leading eventually to 3) a stage of exhaustion and even death.

This was a radical and sometimes controversial idea: that many different diseases could have a common cause in the failure of adaptation to stressors, which as well as the physical, such as cold, hunger and infections, could also include emotional and psychological ‘stress’.

It suggested that the body had an exhaustible capacity for coping, that initially it responded to stressors with vitality, learned to manage them for a while, but if the stressors persisted became increasing fatigued.

For Selye steroid hormones lay at the heart of the body’s capacity to adapt to the stress of life: “not only sex,” he wrote in 1949, “but the development and metabolism of the entire body, as well as its resistance and adaptability to exposure and disease, are influenced by the steroid hormones of the gonads, the adrenal cortex and the placenta.”

Although the separate discovery of cortisone as a medicine for the relief of rheumatoid arthritis (which won a Nobel Prize in 1950) were made without reference to Selye’s work, it contributed to a new enthusiasm for the role of steroids and the adrenal cortex in health. It was the linking of the third phase of Selye’s General Adaptation Syndrome with the adrenals that generated the concept of ‘adrenal fatigue’.

However Selye was at least as interested in the wider endocrine system, actually the basis of his most authoritative published works. In particular he led the way in understanding what we now know as the ‘hypothalamic-pituitary-adrenal axis’ (HPA). It is this circuit of the three glands, each producing hormones that regulate and affect the other, that is the real determinant of our adaptation to stress.  A well-functioning HPA is an indicator of resilience and coping capacity. Taking into account the hypothalamus and pituitary, and their location as integral parts of the central nervous system, and noting the complex interplay of signals back and forth between the three players (3), is much more useful than focusing just on the ‘adrenals’

Chronic fatigue is one of the syndromes often linked with ‘adrenal fatigue’. A common feature of chronic fatigue syndrome (CFS) appears to be reduced hypothalamic activity with less corticotropin-releasing hormone (CRH); this directly reduces the pituitary’s production of adrenocorticotrophic hormone (ACTH), that in turn reduces adrenal cortex activity (4).

The consequences of underperformance of the HPA axis include disrupted sleep patterns (leading to a vicious cycle of increasing fatigue that exacerbates all CFS symptoms as well as ‘adrenal fatigue’) (5).

There are also pointers to the disruptive role of inflammatory cytokines on the HPA axis (6). This could certainly link adrenal performance to infections, post-viral conditions and chronic inflammation.

However even the HPA role in fatigue is complex and it would be misleading to confine the argument to this endocrine factor alone (7). It is important in making biomedical assessments to remember that there are always wider factors at play. We will return to the ideas of networks later.

A popular synonym for adrenal fatigue syndrome is ‘kidney depletion’, a term appropriated from Traditional Chinese Medicine. The notion is that somehow the kidneys are the body’s powerhouse and that their depletion is analogous to flattened batteries. Not surprisingly, this attribution is even more thoroughly mocked in scientific circles, so before this conversation loses connection with modern experience altogether it is worth taking a look at what the ‘kidney’ means in traditional Chinese thought. The most glaring point is that it means something very different from the modern kidneys!

A general distinction between traditional and modern medical concepts is that the first were induced from cumulative subjective experiences, rather than the dissective, deductive approach that is the foundation of the scientific method. (In the traditional Chinese view dissection was more lowly work, eg. of butchers deconstructing dead bodies, rather than the work of physicians understanding living beings.)

Thus what are assumed as fixed organs in scientific medicine are understood in Chinese tradition as functions (zang fu). In classic texts going back up to 3000 years – like the huang di nei jing su wen -The Yellow Emperors Classic of Internal Medicine (8,9) the Chinese Kidney (shen) is a functional entity (10)  that is best understood by reference to our widest experiences of the world.

So the Kidney (shen) is

• linked to the Water phase in the Chinese universal 5-phase cycle and mediates the qualities of water within the living being (sinking, cold, yielding and fluid, tending to stillness, deep and dark, hidden, latent, full of potential, dissolving, necessary for buoyancy/vitality);
• at once the most yin or substantive function in the body: the ‘root of life” (it stores the constitutional energy received from one’s parents), manifest in the deepest tissues: bone and the marrow (which in Chinese observations including the brain and spinal cord);
• but also as the ultimate receptor of inspired vital energy (qi) from the Lungs(fei) it is the source of both yin and yang, water and fire, in the living being, with its yang aspect (ming men huo) the source of body heat and power, the ruler of birth, reproduction and development, the source of our will, and of jing (the vital energy that fuels reproduction and our capacity for action).

One can observe shen as the feeling of fear (which stimulates it to most activity)

• in the health of hair on the head
• in the ears (and hearing)
• in the sound of moaning (or a sad dull voice)
• in sputum
• in the radial pulse: 3rd position on the left (also right) side
• in the bones, teeth, joints and marrow
• when upset as a black hue to the complexion and around the eyes
• in that activity which is supported by moderate levels of bitterness, damaged by excess sweetness and in excess is relieved by moderate saltiness.

So the Chinese Kidney is very much the body’s central resource and powerhouse, manifest in its deepest places and most fundamental functions, including reproduction, birth, and development. There was a certain fatalism about the concept: a large part of Kidney energy is a birthright, to be cultivated by healthy practices, rather than squandered though an excessive lifestyle, and diminution of Kidney energy was seen as mark of ageing itself.

In this context Kidney Deficiency could be seen as potentially terminal and there is no doubt that repleting these energies is the toughest challenge in traditional Chinese therapy.

Although these concepts seem wholly alien to modern medicine there is a fascinating potential correlation between the Chinese Kidney and modern observations, as well as a link to our ‘adrenal fatigue’ theme.

In the human embryo, starting around 4 weeks after conception when it is around a centimetre long, there emerge several important structures in the back of the abdomen. There are primitive and temporary kidney structures, including the mesonephros, which fades away before the final kidney, the metanephros, emerges.

Alongside there is an accumulation of cells that forms the genital (or gonadal) ridge.  This ridge develops eventually to form two sets of endocrine glands, the gonads (ovaries or testes) and the adrenal cortex – the only tissues in the adult body that produce steroid hormones.

It is tempting to see a correlation between the embryonic genital ridge and the Chinese Kidney. The experiences that generated the concept of shen are mediated physiologically by the glands that originate in that ridge, which similarly sustain potency and resilience as well as sex and reproduction.

It is a happy coincidence that the course of the genital ridge in the embryonic abdomen is close to the Kidney meridian in the adult. (I am indebted to Richard Cone, Johns Hopkins Emeritus Professor of Biophysics for sharing the conversation that inspired this insight).

Although not biomedically supported the term ‘adrenal fatigue’ does describe an experience that is not uncommon, and which can be very distressing and disabling, not least because it is poorly explained and there are no useful prescriptions to treat it. This review has picked out different ways to understand the condition, but physiological mechanisms remain elusive. In some ways adrenal fatigue overlaps with chronic fatigue syndrome (see Fatigue) and can be seen as one aspect of this equally challenging condition.

There is one similar but relatively well and authoritatively described syndrome: ‘Critical Illness-Related Corticosteroid Insufficiency (CIRCI)’ associated with severe illnesses. It includes a complex dysregulation of the HPA axis, the suppression of cortisol-metabolizing enzymes in the liver and kidney, leading to raised cortisol levels, and tissue resistance to glucocorticoids (11). Heightened inflammatory activity is identified as a major driver for these disruptions and there may be some overlap with the more chronic conditions we have been discussing here.

Rather than looking for particular biomedical (or psychological) causes of adrenal fatigue syndrome (or any other chronic fatigue pattern) perhaps a more effective approach is to view it as a system breakdown, a failure in the normal self-organising adaptive network of functions in the body. Here a healthy emergent self-organising network of functions becomes chaotically disruptive (12).

The advantage of such a perspective is that rather than chasing elusive single causes, the search is on for ways to reprogram (‘reboot’) the whole system and to identify factors driving the disruptions. For example it has been found that it is helpful to switch the narrative in the management of fibromyalgia from damage and pain to the idea that the body is ‘a very, very clever computer’ where fibromyalgia is caused by a software rather than a hardware problem, by the body adapting when people have to ‘keep going’ despite ‘stop signals’, such as pain and fatigue.

This provides a rationale for engaging in interventions to reprogram the body’s software (13). Taking the opportunity of herbal treatment sessions to construct a ‘rebooting’ programme in which herbs support a strategic reconstruction of coping performance remains one of the best approaches to ‘adrenal fatigue’.

There is ample evidence that syndromes like these involve disturbances in the HPA axis (14), but a wider and more consistent pattern, such as described in CIRCI above, is the increased evidence of inflammatory and immunological activity (15), especially when this also becomes neuroinflammation (16), and in depression also (17). There is some indicative evidence of the benefits of anti-inflammatory diets in managing fatigue syndromes generally (18).

Given the absence of useful pharmaceutical approaches to syndromes identified as adrenal fatigue (although one unintended potential benefit of using antidepressants is that they actually down-regulate inflammatory processes (19) there is plenty of opportunity to consider more wholistic herbal solutions that can emerge from traditional insights, and take into account adaptive network ideas.

Certainly a first aim must be to hunt down any possible sources of inflammation, as the most likely driver of the system breakdown. There may already be evidence of chronic inflammatory conditions but these themselves may not be the origin. It is always a good start to assume that inflammatory pressures start in the gut, with increasing evidence of microbiome involvement and there are other Insight pieces in Herbal Reality that pick up on these themes. Look for possibilities of stealth pathogens as causes of chronic inflammatory pressures, those that evade defences and prescriptions and which best be managed by upregulating immune defences.

Setting up a proper convalescence programme is almost always productive as it gives the patient the opportunity to learn how to get on top of the conditions that worsen the exhaustion, like managing sleep, rest, activity, and diet.

Herbal tonics are the obvious first call. They have been poorly defined, with different meanings in different contexts. In this text they refer to remedies that support healthy functions. On one hand remedies used as tonics overlap wholly with foods: different parts of the oat, wheat, barley, rye, asparagus and artichoke, for example, have been used as both foods and medicines. In modern times dietary supplements like evening primrose oil and grape seed have further blurred the distinction.

Other tonics are more dynamic, notably some of those used in Chinese medicine, particularly the yang tonics like fenugreek and eucommia and the qi tonics like Panax ginseng (Asiatic ginseng): these can become a bit stimulating in the very debilitated. A particular application of tonics is to encouraging sleep, lack of which is notoriously part of a fatigue vicious cycle. Tonics like valerian, St John’s wort and notably ashwagandha (see also below) can often help break that cycle by helping charge up the particular sleep batteries.

However by definition the most appropriate herbal approach to supporting adaptation is the ‘adaptogen’. In currently the most definitive review (20), Alexander Panossian and his illustrious co-authors define adaptogens as ‘a category of herbal medicinal and nutritional products promoting adaptability, resilience, and survival of living organisms in stress’.

They emphasise that the term is related to a physiological process—adaptation to environmental challenges, including diverse mechanisms of extracellular and intracellular interactions that fit in well with the network theory above. The paper reviews many adaptogen candidates starting with Schisandra chinensis which inspired the concept in the USSR in the 1950s, initially to improve attention and endurance among the Soviet Armed Forces and the new cosmonauts.

Other adaptogens quickly became official medicines in the USSR: Aralia elata, Eleutherococcus senticosus, Panax ginseng, Oplopanax elatus, Rhodiola rosea, and Rhaponticum carthamoides.

Key points of the adaptogenic concept are in line with basic principles of traditional Asian medical systems like TCM, Japanese Kampo, and Ayurveda, for instance, an assumption is that their tonics, restorative remedies or rasayanas share normalizing effects, irrespective of the nature of the disease.

Ayurvedic rasayanas that are considered as having adaptogenic properties include

• Amla (Emblica officinalis)
• Ashwagandha (Withania somnifera)
• Guduchi (Tinospora cordifolia)
• Haritaki (Terminalia chebula)
• Kalmegh (Andrographis paniculata)
• Pipul (Piper longum)
• Shatavari (Asparagus racemosus)
• Tulsi (Ocimum tenuiflorum. O. sanctum)
• Yasthimadhu (Glycyrrhiza glabra)

Among around a hundred remedies in total listed in the Panossian paper traditional Chinese tonics that particularly fit the adaptogenic definition include

• Bai shao (Paeonia lactiflora)
• Bai zhu (Atractyloides macrocephala)
• Chai hu (Bupleurum falcatum)
• Chuan xiong (Ligusticum wallichii)
• Dang gui (Angelica sinensis)
• Di huang (Rehmannia glutinosa)
• He shou Wu (Polygonum multiflorum)
• Huang qi (Astragalus membranaceus)
• Ren shen (Panax ginseng)
• Suan zao Ren (Zizyphus jujuba)
• Yuan zhi (Polygala tenuifolia)

There are also holistic tools and lifestyle choices which can ease adrenal fatigue. In this article on fatigue, under holistic solutions the knowledge is shared on how to care for oneself beyond herbal treatment. 

Morris G, Anderson G, Maes M. (2017) Hypothalamic-Pituitary-Adrenal Hypofunction in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) as a Consequence of Activated Immune-Inflammatory and Oxidative and Nitrosative Pathways. Mol Neurobiol. 54(9): 6806-6819.

Adrenaline (epinephrine) and noradrenaline (norepinephrine) are two hormones released in response to danger or exertion by the body’s sympathetic (‘fight-flight’) nervous system. Adrenaline is pumped into the bloodstream from the core of the adrenal glands.

A more sophisticated response is the release of noradrenaline from the ends of sympathetic nerve fibres where these attach themselves to other cells. Because the effect of noradrenaline is directly on the target tissue it is referred to as a ‘neurotransmitter’.

Neurotransmitter effects on cells and tissues are mediated by receptors: proteins that span the cell membrane and behave rather like ‘locks’ into which the neurotransmitter ‘keys’ fit. The receptors in this case are called ‘adrenergic receptors’ or adrenoreceptors and are set up so that when the noradrenaline is detected they activate chemical messengers within the cell and switch on various functions.

There are two groups of adrenoreceptors, alpha (α) and beta (β). They have broad ranges of effects around the body. However most medical interest is in their effects on the circulation.

• α₁ receptors lead to vasoconstriction (narrowing of the blood vessels) and stimulation of other visceral muscle. As these receptors predominate in the tissues the main action of noradrenaline is therefore to raise blood pressure.
• α₂ receptors counteract the α₁ receptors as an inbuilt control mechanism.
• β₁ receptors increase heart rate and stroke volume (ie the amount of blood pumped at each stroke), and also increase secretion of the hormone renin from the kidney; all these factors work together also to raise blood pressure.
• β₂ receptors are vasodilatory and are the predominant receptors in the coronary blood vessels. They tend to relax smooth muscle around the body, notably opening the airways, and slow down gut motility. β₂ receptors are the most sensitive to low levels of noradrenaline and so predominate in non-stressed situations.

These medicines block β receptors. They slow the heart, improve the conduction of electrical signals in the heart, relax blood vessels, and lower blood pressure.

More than a dozen beta blockers fall into three main groups.

• Nonselective: The earliest beta blockers, like propranolol, affect both β₁ and β₂ receptors. They should be used with caution, if at all, in smokers or people with asthma or other lung conditions because by blocking β₂ they can constrict the airways.
• Cardioselective: A number of beta blockers, including atenolol (Tenormin), bisoprolol (Cardicor or Emcor), and metoprolol (Toprol, Lopressor) were designed to block only β₁ receptors in heart cells. Since they don’t affect β₂ receptors in blood vessels and the lungs, cardioselective beta blockers are safer for people with lung disorders.
• Third-generation: Some β blockers such as Labetalol (Normodyne, Trandate) also block α receptors. This further helps relax blood vessels. Nebivolol (Bystolic) also stimulates the inner lining of blood vessels (the endothelium) to generate nitric oxide, which helps the vessels relax. Carvedilol (Coreg) does both.

Beta blockers may be used to treat:

• Angina: Chest pain caused by narrowing of the arteries supplying the heart
• Heart failure: Failure of the heart to pump enough blood around the body
• Atrial fibrillation: Irregular heartbeat
• Heart attack: An emergency where the blood supply to the heart is suddenly blocked
• High blood pressure: However now used when other hypotensive medicines have been tried, or in addition to them (see below).

Less commonly, beta blockers are used to prevent migraine, to treat an overactive thyroid (hyperthyroidism), or to manage anxiety.

Beta blockers are very widely prescribed with few or mild side effects, occasionally including feeling tired, dizziness or lightheadedness, cold fingers or toes, difficulties sleeping, nightmares or feeling sick. More rarely there may be shortness of breath with wheezing or a cough that gets worse on exercise.

However in spite of the theoretical case for blocking β₁ receptors, these agents have proven not to be as effective as hoped, and they are rarely prescribed alone for hypertension. There are also increasing doubts about the long-term value of beta-blockers.

A large study published in The Journal of the American Medical Association found that beta blockers did not prolong the lives of patients. The researchers followed almost 45,000 heart patients over three-and-a-half years and found that beta blockers did not reduce the risk of heart attacks, deaths from heart attacks, or stroke (1).

A separate study published in the same year found the same (2). It appears that any short term symptomatic benefits beta blockers provide do not translate into the long term.

There are now well-attested risks that beta blockers could contribute to dangerous stroke and heart attacks if given at too high a level when there is a risk of low blood pressure, e.g., immediately after surgery.

There are some medicines that may interfere with the way that beta blockers work:

• Other medicines for high blood pressure. The combination with beta blockers can sometimes lower your blood pressure too much. This may make you feel dizzy or faint
• Other medicines for an irregular heartbeat such as amiodarone or flecainide
• Other medicines that can lower your blood pressure. These include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or Parkinson’s disease medicines such as levodopa
• Medicines for asthma or chronic obstructive pulmonary disease (COPD)
• Medicines for diabetes, particularly insulin – beta blockers may make it more difficult to recognise the warning signs of low blood sugar
• Medicines to treat nose or sinus congestion, or other cold remedies (including those you can buy in the pharmacy)
• Medicines for allergies, such as ephedrine, noradrenaline or adrenaline
• Non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen. These medicines may increase your blood pressure, so it’s best to keep them to a minimum

There is no known herbal equivalent to beta-blocking activity. Moreover although there may be doubts about beta blockers, interfering in a prescription can be dangerous: the problem here could be a precarious cardiovascular condition with attendant risks of coronary attacks, stroke or thrombosis. Rather than take unilateral action it is important to talk with prescribers. Reducing or stopping beta blockers might be acceptable especially if they have been prescribed for broader stress-related symptoms. It may also be possible safely to complement their activity and even render their continued prescription less necessary.

The following plant remedies (including three consumed as foods) step up as ones to consider in this context.

Hawthorn (Crataegus spp.)

Hawthorn is probably closest to beta blockers in its effects, although its mechanisms are different, involving the combined vasodilatory effects of polyphenols (including for coronary circulation) and cardiac calming effects of procyanidins. This is a practitioners’ favourite for the management of heart and coronary symptoms, especially when associated with anxiety, tightness in the chest, and palpitations.

Mild angina, intermittent episodes of tachycardia (fast heartbeat), benign arrhythmia (irregular heartbeat), and high blood pressure are among the symptoms that appear to respond to this remedy. The flowers and berries have similar actions, but the berries are thought to be more useful in the lowering of blood pressure and the flowers at improving circulation to the peripheries. It combines well with motherwort for anxiety-related heart symptoms and, for more general tonic effects, with lime or linden flowers (see below).

Motherwort (Leonurus cardiac)

Motherwort is associated with calming anxiety symptoms, especially in the chest, with a focus on reducing tension in the diaphragm and is a great herbal accompaniment to breathing exercise. As its botanical name suggests there was an association with reducing palpitations, most often a direct symptom of tension in the diaphragm and ribcage (with the creation of a resonating chamber to amplify heartbeats).

Gotu kola (Centella asiatica)

A classic rejuvenative tonic (rasayana) from Ayurvedic tradition, gotu kola has particular reputation for protecting the nervous system from excess stress, trauma or illness. It also improves the integrity of blood vessel walls and thereby improves circulation to key tissues. These and other properties mean that this remedy can often feature in supporting conditions that might call for a beta blocker prescription.

Lemon balm (Melissa officinalis)

Lemon balm is a common garden herb that is a relaxant remedy that has been useful when stress affects the chest and heart, with symptoms like palpitations and hyperventilation. These in turn may be associated with diaphragm tension linked for example to acid reflux and hiatus hernia, where lemon balm’s other benefits on digestive problems may have additional relevance.

Ginkgo (Ginkgo biloba)

Ginkgo is a modern herbal remedy that has always been seen to improve peripheral circulatory problems including symptoms of atherosclerosis, and to reduce the risk of cardiovascular disease. The extract has also been shown to reduce impacts of stress, anxiety and depression. Note however that all the evidence for ginkgo is for a highly concentrated patented extract of the leaves and that there is no such evidence or tradition for the leaves themselves.

Limeflowers (Tilia spp.)

The flowering bracts of the lime or linden tree have long been used to calm the nerves and relax the blood vessels. It improves the peripheral circulation and helps to lower blood pressure.

Skullcap (Scutellaria lateriflora)

Skullcap is a relaxing remedy that has also been applied where stress and nervous tension are associated with palpitations and high blood pressure.

The following foods can be used to support the circulation as part of a long-term strategy for many conditions for which beta blockers are prescribed. There will be no problems in using these alongside any prescription.

Beetroot (Beta vulgaris)

A food item with significant benefits for the circulation, beetroot contains nitrates that are converted into vasodilatory nitric oxide in the body. Recent research has confirmed that this improves tissue blood flow and lowers blood pressure.

Green tea (Camellia sinensis)

Green tea is the most popular drink in the world also which has appreciable long-term benefits in protecting the circulation. A key part of its benefits are linked to its observed effects on improving the health and integrity of the lining of the blood vessels, the endothelium. It is at this surface that almost all inflammatory processes commence and ‘endothelial dysfunction’ has been implicated in a wide range of inflammatory diseases, cardiovascular problems, dementia and diabetes.

Bilberry (Vaccinium myrtillus)

Like its more common food relative blueberries, bilberries contain high levels of vasodilatory blue pigments (anthocyanidins) that have established benefits for fragility of the veins and peripheral circulation. It can be tried for poor peripheral circulation, including for complications of diabetes and high blood pressure.

Ayurvedic herbs include sarpagandha (Rauwolfia serpentina) and arjuna (Terminalia arjuna). TCM uses pattern treatments so formulations like Tian Ma Gou Teng Yin for Liver Yang Rising , and Long Dan Xie Gan Tang (Liver Fire) are very popular.

1. Bangalore S, Steg G, Deedwania P, et al. (2012) β-Blocker Use and Clinical Outcomes in Stable Outpatients With and Without Coronary Artery Disease. JAMA.  308(13): 1340–1349. doi:10.1001/jama.2012.12559
2. Zuckerman IH, Yin X, Rattinger GB, et al. (2012) Effect of exposure to evidence-based pharmacotherapy on outcomes after acute myocardial infarction in older adults. J Am Geriatr Soc. 60(10): 1854-61. doi: 10.1111/j.1532-5415.2012.04165.x.

It used to be common in France in the springtime to see families out for a weekend gathering limeflowers (tilleul) from the massive lime or linden trees in parks and countryside. One of the main reasons for this was to collect and dry enough of this calming family to see them through the year. It is especially suitable for children, for a wide range of common ailments and notably as a night time drink to help sleep. Children may welcome a touch of honey or other flavouring.

This is a favourite calming remedy from North America and is widely used by herbal practitioners for its ability to calm excitable, tense and nervous states.

If you can get the right species (there are a number of common substitutes for lateriflora so this is important to check) this is definitely one to add to the list of remedies to help reduce restlessness ahead of sleep.

Such relaxant remedies should ideally be for short-term use and should always support a wider ‘sleep hygiene’ regime (where bedtimes and the bedroom are tightly regulated) and used with any other measures to reduce stress and adrenal alertness at bedtime (a brisk dose of exercise in the late afternoon is a good way to diffuse the day’s adrenal-cortisol buildup).

They could also be used with remedies that have a more sustained benefit.

This is a remedy that crosses over from short- to long-term benefits. It was traditionally used to aid sleep during convalescence. The old reputation therefore was as a tonic (the name come from the Latin for strength) and although this may mean that for a few people it can be a stimulant, it also means that for most sleep patterns may be benefited long term.

The herbal approach to sustaining sleep takes a more enlightened approach. It sees sleep as a body affair to be supported rather than sedated. Traditional views of insomnia assumed that it was a condition of depletion, not just that lack of sleep wears you down, but that being worn down interferes with sleep.

A classic vicious circle. Thus the favoured approach of old was to use restorative remedies. We might think of these like charging the batteries that are needed to run an effective sleep, and be reminded that sleep is a busy housekeeping activity that needs ‘batteries’ to run it. Common European sleep tonics include oatflower and vervain (Verbena officinalis) and there are many from other traditions. Two classic examples of this genre of restorative sleep remedies are St John’s wort and ashwagandha.

This is a particularly useful sleep remedy from European tradition. Although associated in modern times with reducing depression it used to be another convalescent tonic, used to calm agitated states and support recovery, in part by supporting sleep. (The link with depression in not a conflict as insomnia associated with restlessness and alertness in the middle of the night is a classic feature of this problem.)

Perhaps the most striking example of a sleep tonic. This is one of the most popular strengthening remedies in south Asia, whose botanical name refers to its simultaneous reputation for aiding healing sleep. Ashwagandha features in many herbal practitioner formulations aimed to rebuild good sleep.

Pain, especially chronic pain, can be extremely debilitating. In 2016 the British Pain Society researched the population to find that more than two fifths of the UK population (around 28 million adults) live with pain that lasts for 3 months or longer. Overall, 14.3% had chronic pain that was either moderately or severely disabling (1). This problem is not just prevalent in the UK but is common globally.

Common treatments include opioids like codeine (or in extreme cases morphine), and NSAID’s like ibuprofen. The problem is that the long-term use of NSAID’s can lead gastrointestinal problems like stomach ulcers, and in some cases issues with kidneys and the liver. Opioids are also highly addictive and have caused a devastating opioid crisis leading the destruction of hundreds and thousands of lives (2). Furthermore opioids do not actually work very well for neuropathic pain (3).

What causes pain is multifaceted, and varies from person to person.  For example the cause can be inflammatory in nature as pain is one of the five symptoms of inflammation (along with heat, swelling, redness and loss of function). This is predominantly down to the immune system.

Neuropathic pain is caused by the nervous system, and flare ups are often spontaneous without stimulation. Neuropathic pain can feel like electric shocks, tingling, numbness, pins and needles, shooting, stabbing or burning pain. There is a neurotransmitter called substance P that acts as a nociceptor, meaning it detects pain. It is found in specific sensory nerves, predominantly in the brain and spinal cord and reacts to potentially damaging stimuli by causing pain. It is an important factor in both inflammatory and neuropathic pain.

There is also mental and emotional factors when it comes to how we experience pain. Though of course some events and conditions cause us to feel pain, in many cases (in particular chronic pain conditions) the way we perceive pain effects the severity. This is why some people use modalities such as hypnotherapy to deal with chronic pain conditions.

Thankfully there are solutions and a particularly useful one is the use of cannabidiol (CBD). This is a molecule from cannabis and hemp which are both in the Cannabaceae family. Both clinical studies and real-world evidence show that CBD can be helpful for pain issues ranging from dysmenorrhoea to multiple sclerosis.

Here we will briefly explain what the endocannabinoid system is and how it is involved with pain, as well as what CBD is.

The endocannabinoid system (ECS) was discovered in Israel around 30 years ago, which in science terms is very new (8). Different receptors such as CB1 and CB2 were discovered, as were the endocannabinoids that bind to them. Endocannabinoids are neurotransmitters that the body makes naturally, and they bind to endocannabinoid receptors.

These include anandamide, derived from the Sanskrit word for “bliss”. Anandamide binds to the CB1 receptor and when stimulated it gives us pleasurable feelings. Phytocannabinoids are plant derived compounds that also bind to our cannabinoid receptors. CBD is an example of this, as is THC  (there are many more phytocannabinoids too).

The endocannabinoid system’s  main function is to regulate the nervous and immune system, and to promote a state of balance and equilibrium (also known as homeostasis). This is why it is implicated in so many different illnesses and conditions. Both inflammation and the nervous system are frequently involved with pain.

Two of the main receptors in the ECS are the CB1 and CB2 receptors. There are CB1 receptors that “monitor” the passing on of pain signals from painful stimuli, and research shows these are heavily involved with the analgesic effects of CBD and THC (tetrahydrocannabinol- the psychoactive part of the plant) (4).

CB2 receptors are also present on the microglial nerve cells, which are specific immune cells for the nervous system that remove damaged nerves and infection. They are involved with inflammation. It is through this that CB2 has been shown to be important for reducing cytokine-mediated neuroinflammation which can be a very significant factor for pain (5). There are a whole plethora of ways that the ECS is involved with pain, and here we have explained just a couple.

Both anecdotal and clinical evidence has shown it has a therapeutic effect for an array of different things including issues with pain. CBD is a non-psychoactive part of the cannabis plant so does not make people “high”, which is partially why it is such a welcome medicine for many.

Pain signals are sent from one neuron to the other in a forward-facing direction. However, the endocannabinoid system’s signals fire in the opposite direction (a process called retrograde signalling). This means the endocannabinoid receptors are on the cell that are producing the pain signal. If we activate these receptors through phytocannabinoids like CBD or THC , it means less pain signals are released which is why CBD can be analgesic.

CBD is often used for pain associated with inflammation, exercise, joint pain, arthritis, period pain and sometimes even to help deal with pain from serious conditions like cancer pain.

One way that it is suggested that CBD affects pain is through the GPR3 receptor in the brain and spinal cord, which is involved with pain reception. It could also be due to serotonin stimulation, as well as working on the opioid receptors μ and δ for pain regulation.

Anti-inflammatory effects through inhibiting TNF-α cells are also another potential way of reducing pain. TNF-α is a signalling molecule used by the immune system to communicate the need for more white blood cells to relocate to a certain spot. Whilst this can be useful, it causes an inflammatory response which can lead to pain. New mechanisms of action continue to be proposed as more and more is being discovered about CBD’s pharmacology and the ECS (6).

One study assessed CBD’s impact on patients with issues from multiple sclerosis to spinal cord injuries. They were assessed for pain, muscle spasms, bladder control and tremors and CBD on its own was shown to be useful for pain in comparison to placebo (6).

Another study across eight weeks showed that 50 out of 94 patients (53.2%) were able to reduce their use of opioids for pain management, with 2 people eliminating the use of them completely (6). CBD was also associated with a reduction in a variety of inflammatory mediators such as nitric oxide, lipid peroxide, prostaglandin E_{2 ,}which is perhaps some of the ways it works for chronic pain (6).

CBD has even been shown to be effective when applied topically, and many people use it as a muscle rub and for arthritic pain. Transdermal CBD gel significantly reduced joint swelling and pain and reduced pro-inflammatory biomarkers in a study done on rats with arthritis (7).

There is much conflicting information online about CBD and doses. Clinical trials (scientific studies on people) often use significantly higher doses than what is suggested commercially. The amount everybody needs varies depending on the condition being treated, the height and weight of a patient as well as the potency of the product. This is further complicated by the fact that all of our bodies metabolise medicines at different rates.

Products vary greatly in strength and quality. For example, some products only state how many milligrams are in a bottle and not the percentage strength. The more the milligrams, the stronger the product so 50mg in a 100ml bottle will be much weaker than 500mg in a 10ml bottle.

Clinical trials usually use 300 to 600mg a day for anxiety, though doses as low as 15mg have been shown in acute doses to be effective for anxiety (11). For epilepsy doses of between of 200mg to 300mg have been shown to be useful (10). Dosages of up to 1500mg/day of CBD have been shown to be effective and well tolerated (9).

Our best advice is to start slow and build up until you find the perfect dose for you. There will be an element of trial and error, but potential side effects and toxicity are minimal and personalised medicine is best.

There are thousands of CBD products on the market and it can get overwhelming knowing which is best. Our advice is to go for something that has been lab tested (so they can guarantee there are medicinal levels of CBD in the product). Also go for a full spectrum extract which includes the other plant molecules instead of CBD isolated by itself.

This will boost the bioavailability and efficacy of the CBD, and also research now shows that other parts of the plant are useful medicinally instead of CBD alone. Organic is best, as products are usually made using CO2 extraction which unfortunately also concentrates pesticides in the oil as well. We recommend oil as fat helps CBD be absorbed into the body better.

Finally if you want it to work fast, then hold the drops under your tongue. This means they go straight into your blood stream, avoiding filtration through your gut and liver. This makes for speedy absorption and means you will get the most out of your product.

As with all plant medicines it is the complexity in molecules that optimise both safety in efficacy. The best CBD extracts include an array of phytocannabinoids such as CBDn, CBC, CBDVa, CBG, CBDa, CBC and CBGa. They also contain essential oil compounds and terpenes like myrcense, alpha and beta-pinene, linalool, terpinolene, humulene, carophyllene oxide and beta-carophyllene. 

Finally, it must be mentioned that pain is usually treated in a multi-dimensional way. Exercise, diet, therapy, heat, massage, acupuncture and mixed herb formulas are all tools used to treat pain holistically. CBD is not an exclusive cure and a herbalist would always recommend taking it as part of a multi-herb complex along with other classic pain relievers such as boswellia, turmeric, valerian, cramp bark and corydalis. Treatment will be personalised and catered to an individual, as what is causing pain will vary from person to person. This is why we always recommend seeing a herbalist, and you can find one in our resources section.

1. British Pain Society. The silent epidemic – chronic pain in the UK | News | British Pain Society. Britishpainsociety.org. https://www.britishpainsociety.org/mediacentre/news/the-silent-epidemic-chronic-pain-in-the-uk/. Published 2016. Accessed September 24 2021.
2. Mcgreal C. ‘A cartel shouldn’t get away with this’: anger at opioid settlements that exclude admission of wrongdoing. the Guardian. https://www.theguardian.com/us-news/2021/jul/25/opioids-manufacturers-buying-their-way-out-of-accountability-families. Published 2021. Accessed September 27, 2021.
3. Przewlocki R, Przewlocka B. Opioids in Neuropathic Pain. Curr Pharm Des. 2005;11(23):3013-3025. doi:10.2174/1381612054865055
4. Woodhams S, Sagar D, Burston J, Chapman V. Pain Control.; 2015:119-143.
5. Fine P, Rosenfeld M. The Endocannabinoid System, Cannabinoids, and Pain.
6. Urits I, Gress K, Charipova K et al. Use of cannabidiol (CBD) for the treatment of chronic pain. Best Practice & Research Clinical Anaesthesiology. 2020;34(3):463-477. doi:10.1016/j.bpa.2020.06.004
7. Hammell D, Zhang L, Ma F et al. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. European Journal of Pain. 2015;20(6):936-948. doi:10.1002/ejp.818
8. Hanuš L. Discovery and Isolation of Anandamide and Other Endocannabinoids. Chem
   Biodivers. 2007;4(8):1828-1841. doi:10.1002/cbdv.200790154
9. Bergamaschi MM, Queiroz RH, Zuardi AW, Crippa JA. 2011. Safety and side effects of cannabidiol, a cannabis sativa constituent. Curr Drug Saf. 6(4):237-49.
10. Devinsky O, Cilio MR, Cross H, Fernandez-Ruiz J, French J, et al. 2014. Cannabidiol: Pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia. 55(6):791-802.
11. Blessing E, Steenkamp M, Manzanares J, Marmar C. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015;12(4):825-836. doi:10.1007/s13311-015-0387-1

I hardly ever treat anyone without including some herbs for nourishing and supporting their nervous system. Any imbalance causes there to be stress in the system. From an Ayurvedic perspective, ‘stress’ can disturb the quality of vata that is responsible for smooth flow of information and regulation of our bio-rhythms, which can cascade impacting the other doshas, pitta  and kapha. This leads to chronic stress also being implicated in most degenerative diseases from heart disease to diabetes to cancer.

Vata is the quality associated with change, movement and lightness. All stress involves some change, and severe stress usually involves some form of ‘shock’ to the system. To find balance means you have to digest the shock and adapt to the stress. Along with basic breathing exercises and massage, plants are of course valuable stress managers. Herbalists will usually make a tailor-made prescription to suit each individual’s needs. Some of Ayurveda’s renowned plants are:

Ashwagandha

Withania somnifera’s potent nourishing and adaptogenic abilities to help us cope with stress makes it my favourite plant to prescribe for supporting resilience. I normally dose at 2–5 g/day as a powder (capsule or in some almond milk) or 10–25% of a liquid tincture prescription.

I use it whenever there is any sign of deficiency, coldness or weakness leading to tiredness or debility. This makes ashwagandha the herb of choice when there is any chronic imbalance that results in depletion and convalescence. Its grounding and stabilising effects help in insomnia, palpitations and anxiety.

Its nourishing properties help stabilise weight and enhance vitality. As one of Ayurveda’s premier rejuvenating rasayana plants, used to extend the quality and quantity of life, it gives deep and enduring energy to the immune, reproductive, structural and nervous systems. By helping to support thyroid, brain, pancreatic and heart function it brings strength to the organs responsible for the foundation of our health. At a cellular level ashwagandha enhances our Heat shock protein response to stress — meaning we can tolerate more stress for longer with less harm — as well as enhancing glutathione recovery, so essential for consistent cellular rejuvenation.

Brahmi

Bacopa monnieri is a wonderful cooling herb for the nervous system and mind. Named after ‘brahman’ or the ‘universal consciousness’, it is renowned for influencing the quality of consciousness and it balances all three dosha. Clinical studies have shown that Brahmi can help increase cognition, memory and concentration whilst also greatly improving anxiety. I normally dose it at 2–3 g/day as a powder or 10–15% of a liquid tincture prescription.

I use it whenever there is any signs of mental or emotional imbalance resulting in nervous anxiety or debility. I specifically think of using it whenever there is nervous depletion resulting from excess work or thinking leading to anxiety and brain fatigue. Its ability to bring mental clarity makes it useful when an emotional experience(s) is too difficult to digest and we can become stuck in a repetitive cycle of feelings potentially leading to depression.

Its impact of the 5-HTP and serotonin pathways are valuable here . Its effects on improving cognition, enhancing learning and memory as well as regenerating brain cells indicate its use in Alzheimer’s, ADHD and autism, but also in any form of mental illness from depression to eating disorders.

All of this helps bring vitality and energy back, which is also shown in its impacts on the thyroid. It is also a useful addition to formulas used to heal hot skin conditions from acne, eczema to psoriasis which if they aren’t caused by any nervous system imbalances can ceryainly cause them.

Gotu kola

Hydrocotyle asiatica’s greatest asset is its ability to penetrate deeply into the circulatory system and carry its consciousness enhancing properties into the brain. I give it at 3–10 g/day as a powder (or capsules) or 10–25% of a liquid tincture prescription.

Whenever a client needs relaxing in order to think clearly I will consider gotu kola. It relaxes the channels of circulation, allowing more blood to flow whether this is needed for nutrition or wound healing. Either way, it reduces the stress of ’trauma’ caused by a wound, shock, skin disease, inflammation or mental fog. As it balances all three dosha it removes the ‘shock’ of doshic imbalance.

Commonly used in Alzheimer’s, epilepsy, spasmodic disorders, skin inflammations associated with stress and joint inflammations. It is also used to help prevent deep vein thrombosis. By normalising the cell adhesion molecule function it enhances cellular communication and promotes cellular intelligence. Gotu kola is true food for the mind.

Tulsi

Ocimum tenuiflorum (syn. O. sanctum) or holy basil is one of my favourite nervines. Its light aromatic scent is wonderful for lifting the spirits and alleviating a tired mind, even mild depression. I include it in a mix as 2–6 g powder per day or as herbal tea or at 5–15% of a liquid tincture prescription. It is packed with essential oils that help to open the lungs, and relax tension.

Tulsi is very useful for headaches, allergic irritation, nervous digestion and when taken as a strong herbal infusion, the physical ache associated with ‘flu and colds. It has become considered as an adaptogen in some circles with its ursolic acid content showing potent cellular repair and cortisol regulating effects.

Vacha

Acorus calamus is used in both Ayurvedic and Chinese medicine for ‘opening the mind’ and bringing clarity whenever there is sluggishness and mental fog. Its pungent and bitter flavour helps it penetrate its healing potential deep into the mind.

This warming quality ‘cooks’  and scrapes accumulations that are obstructing clear thinking. Used at 1–3 g/day (powder) or 5–7.5% of a liquid tincture prescription. It has a strong acrid taste and so should be used at a low dose. And not just because of the dose. It contains B-asarone at various levels depending on the country of origin due to its chromosomal make up so just use short term at a low dose.

Vacha’s ability to aromatically awaken digestion and clear mucus from the body indicates it whenever there is ‘stuck’ behaviour leading to depression, speech impediments and emotional stagnation with a heavy kapha type or cold vata type person. Called vacha meaning ‘speech’ in Sanskrit, its traditional use speaks volumes for the insights our ancestors discovered about plants for such specific uses.

A 43 year old woman presented with anxiety, ‘butterflies’ and poor sleep following a bout of intense stress. Her appetite is good but her digestion has become erratic resulting in bloating, constipation and general abdominal discomfort. Whilst she isn’t usually an anxious person, she has been fixed in this place for a while can’t stop her mind dwelling on the issue and is anxious about its impact on her health and mood.

She is now regularly fatigued and has developed restless legs and the occasional palpitation at night. She has a fast, thin and thready pulse high in vata quality with a pale tongue with teeth marks. A recent healthcheck showed Blood pressure and thyroid levels were all fine with no other symptoms of note. Otherwise she has a good diet- bar a bit too much sugar and coffee. Diagnosis is vata imbalance with nervous system (majja dhatu) involved with vata. So we decided to calm vata, strengthen the nervous system and nourish digestion:

• Home made relaxing tea with chamomile, fennel seed, gotu kola, liquorice and ashwagandha
• Home self-massage with warm sesame oil with patchouli and boswellia
• Daily breathing practice of rhythmical breathing
• We had a full discussion on the importance of supporting the digestive system and ‘feeding the fire’ agreeing on a diet of less coffee and sugar and more warm foods including almonds, nutmeg, hemp seed oil, ghee, rice pudding and saffron. Ensuring the herbs and spices are visible and tasty in each meal.
• Tincture (but it could have been a powder mix) 1–2 tsp three times daily in warm water

Prescription

• Ashwagandha root 25
• Gotu kola leaf 15
• Brahmi leaf 15
• Tulsi leaf 10
• Vacha root 5
• Motherwort aerial parts 10
• Rose flower 5
• Fennel seed 5
• Liquorice root 5

Taken as 5 ml (1 tsp) three times daily before food in a little warm water

The ashwagandha, gotu kola, brahmi all help to settle anxiety and calm tension. Vacha’s moving pungency is a specific for enkindling digestion and opening consciousness, combining well with the tulsi. Gotu kola and brahmi help with repetitive thoughts. Motherwort, rose and ashwagandha are good for palpitations.

They are also excellent for healing emotional trauma with vata aggravation. The vacha and fennel strengthen and warm digestion and help to move the aggravated rising vata energy downwards. Sweet licorice builds endurance and combines very well with ashwagandha as a tonic to reduce vata anxiety.

After a couple of months, she felt more settled and her digestion was much more reliable. We moved onto just the herbal tea and some ashwagandha powder with the breathing and massage becoming integral parts of her regular routine.

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• Pointel JP, et al. Titrated extract of Centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs. https://doi.org/10.1177/000331978703800106
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• Sharma R et al: Efficacy of Bacopa monnieri in revitalizing intellectual functions in children; J Res Edu Indian Med pp 1-12, Jan-June 1987.
• Singh RH, Singh L: Studies on the anti-anxiety effect of the  Medhy Rasayan drug, Brahmi (Bacopa monniera Wettst.) – Part 1; J Res Ayur Siddha 1 pp 133-148, 1980.
• Stough C, Lloyd J, Clarke J, Downey LA, Hutchison CW, Rodgers T, Nathan PJ. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl). 2001 Aug;156(4):481-4. https://doi.org/10.1007/s002130100815

Books

• Caldecott T. Ayurveda: The Divine Science of Life. St. Louis, MO: Mosby Elsevier; 2006.
• Pole S. Ayurvedic Medicine: The Principles of Traditional Practice. London: Churchill Livingstone; 2006.
• Gogte VM. Ayurvedic Pharmacology and Therapeutic Uses of Medicinal Plants. Mumbai: Bhartiya Vidya Bhavan; 2000.
• Bhavamisra. Bhavaprakash Nighantu: Authentic Text with English Translation and Notes. Varanasi: Chaukhambha Orientalia; 2007.
• Sharma PC, Yelne MB, Dennis TJ. Database on Medicinal Plants Used in Ayurveda. New Delhi: Central Council for Research in Ayurveda & Siddha, Dept. of ISM & H, Ministry of Health & Family Welfare, Government of India; 2002.
• Williamson EM. Major Herbs of Ayurveda. London: Churchill Livingstone; 2002.
• Government of India, Ministry of Health and Family Welfare. The Ayurvedic Pharmacopoeia of India. New Delhi: Ministry of Health and Family Welfare, Dept. of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH); 1989.

The technique of Yoga Nidra is broken into several sections. Initially you rotate your awareness through the parts of the body to remove muscular tensions. Then you focus on your breath aiming to maintain unbroken awareness of a slow breathing pattern. Staying awake while you do this can be difficult and most people find that they will doze at this stage, if not before, especially if they are tired. If you can remain awake you can then go into the deeper parts of your being, developing awareness of mental images and other internal experiences that arise as your awareness becomes subtler. Yoga Nidra can be a deep meditative process.

So Yoga Nidra has two main phases of practice. The first is called the phase of relaxation and recuperation and the second is called the phase of meditation. In the phase of relaxation and recuperation relaxing the muscles and following the breath will remove tensions and exhaustion and enable better sleep. Once you have practiced this for a while and have restored your vitality you will effortlessly go into meditative states that are both empowering and life affirming, and that lead to better mental calm and strength.

For most of us leading busy lives we need Yoga Nidra as a tool to support health and energy. This is the foundation of a good life. A good night’s sleep enables us to engage with and get the most of life.

Modern research has shown that as we age our sleep architecture can be disturbed so that we have less deep cycles of sleep and wake up more often. Though it was once thought that older people needed less sleep it is now known that this is not true.

Regardless of age we all need around 7 to 8 hours of deep sleep per 24-hour cycle. Research has also shown that when healthy adults had a siesta during the day their quality of nighttime sleep improved. Not only did they sleep longer but their quantity and quality of deep sleep also improved. It seems that if you are more relaxed and rested during the day that you sleep better at night.

The ultimate aim of Yoga Nidra is to induce deep relaxation and recuperation of the body-mind that leads to greater self-awareness. As you learn to relax and to direct your attention deeper and deeper into yourself, you can discover who you are and all the great things that lie within you.

There is a great variety of videos and recordings for Yoga Nidra. We are happy to recommend taking a looking at the Yoga Nidra Network website. They offer guidance, resources and free Yoga Nidra recordings in different languages.