“I think I’ve accepted that the time has come to ask you for a prescription for antidepressants”, she said. “I never thought I’d be here; I’ve always managed but I’m in the depths of despair.” My heart went out to Penny, a private, thoughtful and generous woman who has been my patient for many years but who consults rarely.

Penny is in her early 80s now and was reeling in the aftermath of the death of her beloved daughter after caring for her overseas before she died from complications of cancer. Uprooted, unattached and disorientated, life no longer had meaning or any sense of purpose. “I knew one day the time would come, maybe this is it, the end of the line?”, she mused, more to herself. You may wonder how this story panned out.

If you work in primary care as I do you may know the likely path – perhaps a negotiation around a prescription, a referral to the local psychology service, ongoing attentive follow up, perhaps a resignation on all sides that this is how life will be. We have been there many times. But what if there is another way? What if we have what we need to do things differently, more imaginatively?

Before I share what happened next for Penny, let me tell you some other stories. Three ‘what if’ stories. First, how environmentalist Rob Hopkins co-founded Transition Town Totnes and the Transition Network.

He is the author of ‘From what is to what if: unleashing the power of the imagination to create the future we want (2019)’. Rob asked himself a ‘what if’ question when he founded Transition, a movement characterised by people self-organising to develop local projects which strengthen community resilience and reduce carbon emissions. It describes itself as a movement of real people coming together to reimagine and rebuild our world using ‘head, heart and hands’.

It began with two groups, in Kinsale in Ireland and Totnes in Devon, in 2006, growing to more than 1,300 initiatives across more than 50 countries. Initially focusing on concerns relating to climate change and peak oil, its remit has broadened to include groups working on food, energy, community relationships, engaging with the natural world, localising the economy, skill development and sharing. Writing in the Journal of Public Health, Rob suggests that Transition could help reduce the pressure on the NHS through reframing change, preventing disease, improving staff wellbeing and increasing local economic resilience (1,2).

Our second story is about Dr Michael Dixon, a GP in Cullompton, Devon. His numerous roles include National Clinical Lead for Social Prescribing, Medical Advisor to HRH the Prince of Wales and Chair of the College of Medicine. I heard about Michael as one of the growing number of GPs, who like Bromley-by-Bow’s Sir Sam Everington, had also asked himself a ‘what if’ question.

As a result, the green spaces around his practice are now used therapeutically and creatively for the benefit of patients and staff. Michael recalls: ‘No one had previously been in the medical profession in my family. I was keen to do a job that made a difference though my initial interest was more in the mind than the body.

My interest in complementary medicine developed after 10 years as a country doctor as I began to realise that there were so many gaps in what we could do for patients using only conventional medicine – for example patients with chronic tiredness, frequent infections, irritable bowel, premenstrual syndrome, depression, stress, back pain, neck pain and so many other conditions. It was frustrating to have such a limited range of options for treating conditions that I would see in surgery every day. It made my medicine more effective and colourful and restored my sense of self-worth as a doctor.’

The third ‘what if’ story, is my own, of a woman of mixed heritage, from everywhere and nowhere, a ‘mongrel’ as my father affectionately said. Since I first found my place in 1997 when I started working as a GP in Kentish Town, north London, I have witnessed a lot of change: progress through clinical advances and better technology certainly. But in stark contrast we find ourselves living in increasingly disconnected times, unmoored from a sense of place or belonging and exposed to bewildering arrays of consumerist choices that sometimes feel like no choice at all.

It seems we have lost a sense of who we are or what we should do; many people feel lonelier and more afraid. Like Michael, I see this expressed every day: in mental health problems, in the many chronic diseases born of our ‘modern’ lifestyles, addictions, persistent physical symptoms and chronic fatigue.

Sadly as a profession we may over-diagnose, and respond by supplying an expanding array of medications, unrealistic ‘magical’ cures or attempting to anaesthetise distress (3). Much is missing in the space humans now inhabit, whiplashed between extremes of passivity and constant unquestioning actions and reactions. No wonder we find solace where we can, getting lost in electronic worlds, overfed and undernourished, in bloated consumption whether of goods, gaming, gambling or chemical substances of one kind or another. If these ‘remedies’ are so good, why do so many people feel unhappy?

Can social prescribing be truly restorative? Perhaps help is at hand? Social prescribing is in vogue and huge hopes are being laid at the doors of the ‘growing army of social-prescribers’ tasked to help us on the frontline in primary care (4). But in primary care we are fatigued and sceptical, for we are used to empty promises. In reality though, is this sort of language helpful? Are we really in a battle, a fight with problems that needs fixing? Or might the notion of social prescribing act as an invitation to reflect, use our collective imagination and respond in other ways?

Change comes about at the margins. People in the centre are not going to be the big change makers. You’ve got to put yourself at the margins and be willing to risk in order to make change. But more importantly, you have got to approach differences with this notion that there is good in the other. That’s it. And if we can’t figure out how to do that – if there isn’t the crack in the middle where there’s some people on both sides who absolutely refuse to see the other as evil, this is going to continue.” – Frances Kissling, 2011

If it is to be used less like a traditional prescription, we have to be clear about the process of social prescribing and not focus only on its content. As an enthusiastic cook I see social prescribing’s content as the ingredients and the process as the recipe. And this recipe is just our starting point, for it’s when we cook together that we develop our skills.

So, when sipping from the cup of life, how do we want it to taste? What sort of an ingredient am I, are you: do we even know? And what part might we play in telling the story of cooking? All good recipes have been tried and tested, perhaps rooted in family and cultural history, but at the same time personalised so they become our own.

As an enthusiastic social prescription-maker, I have had to ask myself how to develop our own unique recipes for social prescribing. Perhaps we have to start by imagining what it would be like to be fully human and what we have lost along the way now that our social fabric is so threadbare. If we are to gather the yarn and start weaving together again we will need a safe base: places for integration and where we can reconnect to ourselves.

Places for re-embodying our minds, and understanding our thoughts and feelings so we can reconnect to each other, to our histories, to the world from which we have come. A place for embracing the wide mystery of our universe, so that we can hold life and its uncertainty with awe and wonder and not just fear.

This is not to say the journey will be easy. It will need courage, moral imagination (5,6) hospitality, humility, creativity and an openness to generous listening and adventurous civility in conversation. We need to hold our destination lightly, be open to possibilities, to change our minds at times, to develop the resilience and flexibility to negotiate the twists and turns that life inevitably holds.

We need to broaden our perspective, to look at what we are discarding and disregarding, moving from the linear to the circular. Nature can be our great teacher in this, the cycles of life, death and rebirth, the complexity of ecosystems, the fractals and patterns all around.

The Transition strapline is: ‘If we wait for governments, it’ll be too little, too late; if we act as individuals, it’ll be too little, but if we act as communities, it might be just enough, just in time.’ We need to move from a focus on ‘I’ to ‘we’ The African proverb reminds us: ‘If you want to go fast, go alone, if you want to go further, go together.’

My recipe for an NHS practice in transition

Nearly five years ago, we started a small project with big dreams. We called it The Listening Space. Inspired by the pioneers, Michael Dixon and Sam Everington, and with reference to the guiding principles of the Transition Network, we collaborated with patients, members of our local community and Transition Kentish Town. We crowd-funded, worked our own gift-economy, exchanging skills and time for food, good company and celebration.

We repurposed found objects and as we worked together to transform a large disused space in the courtyard of our urban general practice into a therapeutic garden, we found we had developed skills of many kinds, woven connections and made new relationships. We valued the journey, though we didn’t always know which way things would go, which can be anxiety provoking and threatening to those who like to have more concrete plans.

We decided to celebrate all the small gains along the way and not to be harsh about the things that have been less successful, seeing them instead as our good teachers. We are now so proud of our place of refuge and shelter, a place where we can free up our imaginations, a space where we can listen to what nature has to teach us.

And in opening up these possibilities, we have gained the confidence to generate new ideas, new branches from our roots. I am excited about the further possibilities opening up for our community in our latest collaboration with Jane Riddiford of Global Generation, expanding our reach by taking ‘story walks’ between the green spaces of north London.

A tree can be only as strong as the forest that surrounds it.” – Peter Wohlleben, 2016

When we started out, I felt like Penny – lost in a land without hope, burned out having been overburdened with mindless, misdirected work trapped within a system that increasingly cared for numbers rather than valuing care, in a climate of endless reorganisation, under relentless pressure from top-down initiatives.

I have found hope again by tending to the soil and working from the grassroots. I found myself ‘burning in’ to a more stable but energised place where my work regained coherence, meaning and purpose. The hours may be similar but the emphasis has shifted from the mechanistic pursuit of efficiency and outcomes, to a focus on real compassionate patient care. My joy has been restored.

In the greatest book ever written about general practice, A Fortunate Man (1967), John Berger (7) describes his friend John Sassall, a country doctor in the 1960s as ‘… a fortunate man because his work occupies and fulfils him; his work and his life are not separate’. Our project has grown, literally and figuratively. It expanded from our early gardening groups, into organised and impromptu gatherings and waiting room ‘crafternoons’, then came a poetry pharmacy and storywalking.

At the outbreak of the pandemic, galvanised by our knowledge of how to work as a good team, we were able to quickly set up a pop-up social kitchen, to feed staff and patients in need.

The role of the clinician has been to facilitate participation, to invite civility in conversation across diversity, to provide support and navigate difficulties when there is distress, or if inevitable tensions arise in group situations. Our social prescriber Jo, who facilitates and supports the various groups that have developed, acts as a true link-worker, a warm and welcoming connector between all of us in the practice. In this way our work can remain expansive.

We focus on working with our relationships and less transactionally, always aiming for more equal partnership with our patients, other community organisations, individuals and businesses. Through this participatory approach and by ensuring our activities are fun, inclusive and positive at their heart, we are growing the community we imagined, rather than building an army. As each participant finds their place we are learning to work supportively and to grow our resilience and ability to rise to the challenges we will all face.

We all, adults and children, have an obligation to daydream. We have an obligation to imagine. It is easy to pretend that nobody can change anything, that we are in a world in which society is huge and the individual is less than nothing: an atom in a wall, a grain of rice in a rice field. But the truth is, individuals change their world over and over, individuals make the future and they do it by imagining things can be different.” – Neil Gaiman, 2013

So, what of Penny? As I listened to her tale unfold and her self-diagnosis of depression, I gently suggested that perhaps in her situation, sadness was understandable. And sadness requires mainly gentle observant company and community. We talked of what once had nourished her, her love of nature, of gardening and of her teaching.

With our expanded outdoor ‘consulting room’ we were able to offer an alternative prescription. That evening, Penny and I met, wandered among the flowers, the herbs and the productive beds of The Listening Space. We spoke of other gardens, the power of nature to ground and to heal; and imagined together a different future path. Penny joined us the following day for a distanced, intergenerational gathering and walk between The Listening Space in Kentish Town and The Story Garden in King’s Cross.

I spoke to her in a follow-up appointment two weeks on from our more despairing conversation. ‘I can’t believe how different life looks. I didn’t think at this point in my life, there could be anything else. But I know where I am now and what I want to do with whatever time remains for me.’ Penny is now volunteering with us, a valued, worldly-wise elder in our community already sharing English conversational skills with those from other lands who are also growing roots in our re-generating and remembering community.

What if GP surgeries became catalysts for Transition? So how do we weave a stronger social fabric; how do we learn to mend, remake, grow it and sew it? I was fortunate enough to be in conversation with Rob and Michael as part of Rob’s podcast series ‘From What If to What Next’ (8), where we were given generous space to reimagine healthcare for the future and had carte blanche to suggest policies as ministers of the imagination. Perhaps you will listen and join us?

The system will collapse, if we refuse to buy what they are selling – their ideas, their version of history, their wars, their weapons, their notions of inevitability. Remember this, we be many, and they be few. They need us more than we need them. Another world is not only possible, she is on her way. On a quiet day, I can hear her breathing.” – Arundhati Roy, 2003

Penny is not my patient’s real name although she gave me full permission to share her story with you. She told me at our last meeting that she had spoken to her friends about what had happened to her and reported their collective wish to have care and treatment in practices like ours. Yet I do not believe we are all that unusual, though we have travelled into a less unfamiliar place.

Having explored the territory we are here to tell you about the wonderful view and invite you along. So I write this piece in ‘Penny’s’ honour and on behalf of all the future patients we may be better able to serve if only we free up our imaginations, let our compassionate, authentic human selves back into our work, knowing we too will find nourishment in the process. If we in general practice were to act as hubs and safe spaces for transition, what would our world be like?

1. Smith J, Hopkins R, Pencheon D. Could the Transition movement help solve the NHS’s problems?. https://academic.oup.com/jpubhealth/article/39/4/841/2631018. Published 2016. Accessed December 3, 2016.
2. Hopkins R. A healthy society is just as much about community as healthcare. The Guardian. Published 2014. Accessed August 17, 2022.
3. Heath I. Overdiagnosis: when good intentions meet vested interests–an essay by Iona Heath. BMJ. 2013;347(oct25 2):f6361-f6361. doi:10.1136/bmj.f6361
4. Support D. NHS England bids PCNs to hire ‘army’ of social prescribers. Pulse Today. https://www.pulsetoday.co.uk/news/workforce/nhs-england-bids-pcns-to-hire-army-of-social-prescribers/. Published 2022. Accessed August 17, 2022.
5. Sacks J, Sacks B. Morality: Restoring The Common Good In Divided Times. Hodder and Stoughton; 2020.
6. Novogratz J. Manifesto For A Moral Revolution.
7. Berger J, Mohr J. A Fortunate Man, The Story Of A Country Doctor. London: Penguin Press; 1967.
8. Myat J, Dixon M. From What If to What Next: Episode Four: What if doctors’ surgeries became catalysts for Transition?. SoundCloud. https://soundcloud.com/transition-culture/from-what-if-to-what-next-episode-four-what-if-doctors-surgeries-became-catalysts-for-transition. Published 2022. Accessed August 17, 2022.

Bibliography

1. Gaiman N. Neil Gaiman: Why our future depends on libraries, reading and daydreaming. the Guardian. https://www.theguardian.com/books/2013/oct/15/neil-gaiman-future-libraries-reading-daydreaming. Published 2022. Accessed August 17, 2022.
2. Heath I. Overdiagnosis: when good intentions meet vested interests–an essay by Iona Heath. BMJ. 2013;347(oct25 2):f6361-f6361. doi:10.1136/bmj.f6361
3. Hopkins R. From What Is To What If – Unleashing The Power Of Imagination To Create The Future We Want. Vermont: Chelsea Green Publishing; 2019.
4. Hopkins R. A healthy society is just as much about community as healthcare. the Guardian. https://www.theguardian.com/lifeandstyle/2014/jun/26/healthy-society-about-community-alongside-healthcare. Published 2014. Accessed August 17, 2022.
5. Kissling F. Frances Kissling — What Is Good in the Position of the Other. The On Being Project. https://onbeing.org/programs/frances-kissling-what-is-good-in-the-position-of-the-other-sep2018/. Published 2022. Accessed August 17, 2022.
6. Novogratz J. Manifesto For A Moral Revolution: Practices To Build A Better World. Henry Holt and Co; 2020.Rilke R. Letters To A Young Poet. Penguin; 2012.
7. Support D. NHS England bids PCNs to hire ‘army’ of social prescribers. Pulse Today. https://www.pulsetoday.co.uk/news/workforce/nhs-england-bids-pcns-to-hire-army-of-social-prescribers/. Published 2022. Accessed August 17, 2022.
8.  Wohlleben P, Flannery T, Billinghurst J. The Hidden Life Of Trees. Greystone Kids; 2016.

The two main benefits of researching herbs and herbal medicine are to gain greater understanding of what, how and why something works, and to provide evidence that reassures other healthcare professionals and members of the public of the safety and efficacy of herbs. Gaining wider recognition and understanding of the power of herbs and herbal practice requires us to be able to connect the current scientific environment with what we know from traditional medicine. Choosing the best ways to research herbs, however, can be a challenge.

There are problems with the current methods of research in biomedicine, and not just for herbs. The tools currently used to support evidence-based medicine were designed to investigate the efficacy of single compounds and the research field assumed that there were such things as magic bullets for every disease.

Clinical trial methods that were developed to measure the effects from single compounds will always be lacking as a method to investigate the complex and subtle effects of plants, or indeed, the effect of any medicine in a complex human interacting with a complex world.

A clinical trial can tell you how a specific intervention might impact a population on average, but won’t necessarily have much to say about how a herbal consultation will impact on an individual.

There are encouraging examples of studies that have compared personalised treatment from a herbalist with control groups for conditions such as menopause, osteoarthritis, urinary tract infections and upper respiratory tract infections (1,2,3,4). In the majority of these studies, herbal practitioners were involved in the design or execution of the research. Historically, doctors have been involved in research into what works in their clinics, so perhaps this is something that herbalists should be considering.

Some practitioners or supporters of herbal medicine argue that viewing it via the biomedical lens is inappropriate or detracts from its meaning and that the traditional use of herbs over hundreds of years provides adequate evidence to justify their efficacy and safety. There will always be value in traditional and empirical knowledge that can’t be “proved” by modern science. However, there are benefits from research that go beyond simply confirming what we think we already know.

Research can help us to confirm our instincts about how traditionally used herbs might be beneficial for modern diseases. We can extrapolate from our deep understanding of historical use and the characteristics of herbs to see how they might be beneficial for these more modern health problems. Research can confirm our suspicions about how certain herbs might be working.

Obesity and metabolic disorders are more of a problem now than a few hundred years ago and cinnamon is proving to be a valuable herb for addressing this (5,6). But, when we look to traditional knowledge, this is a relatively modern use. Many older herbals only mention cinnamon with reference to its use as a flavouring. Mary Seacole discusses using it to treat cholera in her autobiography of 1857 (7), and in 1931, M Grieve listed the uses of cinnamon as a carminative, astringent, stimulant and antiseptic for vomiting and diarrhoea (8).

It is only in more modern times that its use to help regulate blood sugar levels has been documented. Since one of the first clinical studies looking at benefits of cinnamon for those with diabetes was published in 2003 (9), the majority of research now published about cinnamon focuses on this pressing area of importance. The stories of how plants are used evolves as human culture does. Traditional medicine is not static and should be reinventing itself as the world around us changes.

Science research is a reflection of the important questions that society has. Scientists do not work in a vacuum, but get ideas about what to research from the world they see around themselves, as well as the people who will fund their work.

Greater numbers of people researching the benefits of herbal medicine or simply the benefits of herbs and other plants reflects an increase in the feeling that nature got it right. Herbal medicine is associated with nature and gentleness – two values that many of those who seek to use it are aligned with.

The way that herbalism is practised, with a focus on empowerment and the responsibility of our clients to be aware of nutrition, lifestyle and how they can best manage their own health would certainly benefit modern healthcare systems that involve minimal contact time with a physician and pill prescriptions rather than advice.

As research into herbal medicine grows and those who appreciate the benefits of herbalism are involved more in academic fields, knowledge can be transferred both ways.

Herbalists are the best people to demonstrate the power of herbs, so we need to be involved in the scientific process that society has to investigate the world and add to knowledge.

The way that science is communicated is changing. The internet means that everyone can easily access the latest research findings, or discuss them in online forums with others. You can have an opinion on science whether you are a scientist or not. This will also have an impact on what science is carried out.

Whether a research paper gets traction on social media is now a factor in how much it is cited and can have a positive impact on which areas get attention and funding. The popularity of herbal medicine with large sections of society will increase the likelihood that herbal research is interesting enough to be invested in.

Confidence in an area of science develops as a result of coherent approaches to research questions, standardised methods and consistent, reproducible results.

The various approaches to herbal science by researchers from many different disciplines means that consensus has been harder to come by, but this is improving. For acceptance of herbal medicine by practitioners of modern biomedicine, an evidence base built on randomised clinical trials is needed. The World Health Organization has published guidance for clinical evaluation of herbal medicines, which is a good start (10).

The key factor needed for more well-designed research studies into how society can benefit most from herbs is funding. Without the money and power of the pharmaceutical industry, research carried out by herbalists working within universities or studies by companies who sell herbal products and have an interest in the field has been the main driver. Organisations, universities and private companies funding relevant and well-designed research is welcome and necessary, but for maximum impact, collaborations of researchers and herbalists working together will help this exciting, developing field of research.

1. Green J, Denham A, Ingram J, Hawkey S, Greenwood R. Treatment of menopausal symptoms by qualified herbal practitioners: a prospective, randomized controlled trial. Fam Pract. 2007 Oct;24(5):468-74.
2. Hamblin L, Laird A, Parkes E, Walker AF. Improved arthritic knee health in a pilot RCT of phytotherapy. J R Soc Promot Health. 2008 Sep;128(5):255-62.
3. Flower A, Harman K, Lewith G, Moore M, Bishop FL, Stuart B, Lampert N. Standardised Chinese herbal treatment delivered by GPs compared with individualised treatment administered by practitioners of Chinese herbal medicine for women with recurrent urinary tract infections (RUTI): study protocol for a randomised controlled trial. Trials. 2016 Jul 27;17:358.
4. Wong W, Lam CL, Fong DY. Treatment effectiveness of two Chinese herbal medicine formulae in upper respiratory tract infections–a randomized double-blind placebo-controlled trial. Fam Pract. 2012 Dec;29(6):643-52.
5. Mousavi SM, Rahmani J, Kord-Varkaneh H, Sheikhi A, Larijani B, Esmaillzadeh A. Cinnamon supplementation positively affects obesity: A systematic review and dose-response meta-analysis of randomized controlled trials. Clin Nutr. 2020 Jan;39(1):123-133.
6. Davis PA, Yokoyama W. Cinnamon intake lowers fasting blood glucose: meta-analysis. J Med Food. 2011 Sep;14(9):884-9.
7. Seacole M. Wonderful Adventures of Mrs Seacole in Many Lands. 1857. James Blackwood.
8. Grieve M. A Modern Herbal. 1978. Peregrine Books. Middlesex; England. P.202.
9. Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003 Dec;26(12):3215-8.
10. World Health Organization. General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine. Geneva: World Health Organization; 2000. WHO/EDM/TRM/2000.1.

The Chelsea Physic Garden is the perfect representation of a Healing Garden. Smack bang in the middle of London, it’s the city’s oldest botanic garden. It was established by The Worshipful Society of Apothecaries of London in 1673, as an educational garden to train the apprentices in identification, cultivation, harvesting and making medicine.

Its favourable climate by the Thames river and wind-dissipating walls keep the environment perfect for growing over 4000 edible and medicinal species from ashwagandha to zanthozylum.

There are different themed areas within the garden, offering a ‘Historical walk’, ‘Edible plants’, ‘Medicinal plant s’ areas – including beds dedicated to Dioscorides (the Greek herbalist), an Officinalis bed of recognised medicinal species, traditional medicinal species of the British Isles. A must visit.

This is a gem of a garden tucked into the side of the Northumbrian shire. Established in 2007, inspired and run by two neuroscientists focusing research on how plants can improve memory, focus and attention.

Brimming with over 700 species of well-signed herbs, attractively laid out and filled with quirky corners. They also serve a delicious cup of herbal tea. Well worth the detour.

The inspiration of the Register of Chinese Medicine Chinese and the University of Bristol Botanic Garden, this is one of the best places in the world to immerse yourself in the diversity of Chinese herbs. Tucked into a corner of this fascinating garden you are transported to the healing potential of one of the longest medical traditions in the world.

With over 180 species used in Chinese Herbal medicine it is the largest collection in Europe where you can meet such favourites as the medicinal paeonias, polygonums and panax.

The Botanical gardens themselves are a delight of phlyogenic classification beds, a western herb garden – and even an Evolutionary garden. The tropical glass houses host a range of Ayurvedic herbs including ginger and turmeric too amongst the remarkable lotus house. Bristol Botanical Gardens are a veritable herbal feast.

Recently celebrating its 400^th Birthday, Oxford University established its own medicinal garden in 1621, making it the oldest Botanical Garden in the UK. Laid out in a formal design its brimming with taxonomic beds, a medicinal collection and glasshouses with various temperate zones. A long-standing centre of medicinal knowledge, botanical insight and art. A place to soak up some serious knowledge.

English Heritage has recreated the herb garden at Mount Grace priory established in 1397. Worth a visit to see what a monk’s life would have been like and their connection with growing medicinal herbs such as wood betony, clary sage and hyssop.

Nestled between the Scottish Highlands and the sea in the Black isle, sits this picture perfect herb nursery. Lovingly created since the late 1970s the nursery has a huge range of native, naturalised and international medicinal herbs.

A true classic of Botanical gardens. Established in 1759 it is entwined with early plant-hunting and the evolving science of Botany. With over 50,000 plants and 3 million herbarium samples, Kew is a definitive destination for all plant-lovers. A leading global centre of plant expertise, scientific enquiry and artistic inspiration – you need a whole day to explore the varied arboretums, beds and glass houses.

Just a few miles south of Edinburgh at the Secret Herb Garden, this serene garden holds a bounty of treats. With over 600 different species, including over 50 types of mint, you will be sure to find many of the most important medicinal herbs.

It’s a place to soak up both the beauty and the practical side of the plant world.

“Everybody had the same terrible, terrible fatigue. So I just told everybody about the ‘trial’ and everybody… and, and those who signed up… you know, just, just got better. Really, really quickly.” – JSP service user

The Jade Screen Project (JSP) offers immune-enhancing and anti-viral herbal formulae for people working in the NHS, care homes, and those providing essential support services, that might reduce the risk and potential severity of infection.

We want to step forward to help those who are on the front line at greater risk of infection from Covid-19, by offering free CHM. We want to give it for free because we feel they deserve this level of support, as they are putting their lives on the line.

The Jade Screen is taken from the name of an ancient formula, which was used to protect people from infection. The formula’s name was derived from the Feng Shui practice of placing a screen made of the jade stone in rooms to protect people from draughts, the reference to jade reflects value and strength, and screen indicates a barrier – together it is considered something both protective and precious to have around the home.

The Jade screen, both the formula and the metaphor of protection, is our inspiration to offer our support to people working in environments where there is an increased risk due to high viral load.

The Jade Screen Project (JSP) was set up in April 2020 by a small group of Chinese herbal medicine practitioners in response to the rapidly developing healthcare crisis caused by Covid-19, and its potentially devastating effect on frontline workers. The name of the project was derived from a famous 13^th century Chinese herbal formula designed to protect against infectious disease.

Our aims were to replicate findings in Hong Kong from the 2002-3 SARS epidemic and anecdotal reports from Wuhan, China, in 2020, that described the use of immune regulating and anti-viral herbal medicines in helping to protect healthcare workers from contracting disease.

Our second aim was to provide herbal support for people who had contracted the virus and were managing the disease at home, and our third objective was to use herbal medicine to promote recovery from the chronic symptoms of disease now known as ‘Long Covid’.

Setting up the project was exciting and exhausting. We conducted rapid reviews on all the English and Chinese language literature describing the treatment of Covid-19 and similar coronaviruses with Chinese herbal medicine (CHM). Most of the data described the treatment of acute disease and various protocols that had been tested or were biologically plausible as preventative interventions.

We quickly formulated this review into treatment guidelines and ran three training seminars to inform our herbal colleagues of our findings. Seminars were free and were conducted via Zoom. Over 100 herbal practitioners attended, 50 of whom then signed up to provide a network of herbalists prepared to treat frontline workers.

We now had a theoretical framework we could apply to treating Covid and a group of practitioners prepared to treat frontline workers free of charge. In parallel to these encouraging developments we approached Balance Healthcare Ltd, who agreed to provide heavily discounted herbs for the project.

We desperately needed funding to enable to project to become operational and this was generously provided in the form of two £5000 grants from the Earthsong Foundation. Chinese herbal medicine in the UK now had a portal which it could use to make a contribution to the fight against the pandemic.

We saw our first patient, a policeman with acute Covid symptoms, on May 1^st 2020, and we have now treated 230 frontline workers coming from an astonishing array of occupational backgrounds including surgeons, care workers, teachers, GPs, youth workers, nurses, mental health workers, pharmacists, train and bus drivers, and physiotherapists. Initially our treatments tended to focus on providing preventative herbal formulae with a smaller number of people presenting with acute disease.

Over time there has been an increasing emphasis on helping people with the debilitating chronic symptoms of Long Covid. In light of the recent introductions of the vaccine we decided that from January 2021 we should focus our limited resources on supporting people with acute disease and with Long Covid.

In addition to the generous support of Earthsong we have raised over £10,000 in donations from professional bodies and individuals who have want to help the project, or who have been the recipients of JSP treatments. This is fantastic but unfortunately it is not enough to enable us to continue providing free herbal care-especially to patients with Long Covid who require complex and expensive interventions to help restore them to good health and enable their return to work. We need to find new sources of funding to enable us to continue to provide herbal support to frontline workers who have risked their health to provide vital services that we all depend on.

We are a group of experienced practitioners and researchers of Chinese herbal medicine (CHM) who want to make a positive contribution during the current pandemic. We are committed to providing accessible, high quality, evidence-based care using herbal medicines.

We are very moved by the response from the CHM community, who have registered as JSP practitioners and are all offering their services free of charge.

As a measure of our offering the best service we can, we have elected to choose practitioners for our service who are registered members of their professional association, so we can be sure of the high standard of the treatment we are offering.

These practitioners have also undergone specialised training in Covid-19 infection management based on research from Chinese treatment protocols currently used in the pandemic.

We also carried out our own survey of experienced practitioners based in different countries to find out their own clinical CHM experience with patients who have been affected by COVID-19.

Chinese herbal medicine (CHM) is an ancient system of medicine developed and refined in China and other East Asian countries over the past 2000 years, using the active compounds available from hundreds of different plants. Although they are not refined and isolated as they are in modern drugs these plants enable what has been described as a polypharmacy that allows many compounds to operate together to generate a therapeutic effect.

CHM herbal formulas are normally between 10-15 different herbs containing plant extracts that have immune-regulating, anti-viral, and anti-inflammatory effects. These individualised formulas are worked out after the practitioner notes down the precise nature of the symptoms, as well as any underlying health conditions and medication being taken.

CHM has demonstrated a preventative effect in previous coronavirus epidemics – a large study from 2003 during the SARS outbreak in Hong Kong compared 1,063 healthcare workers taking CHM with 36,111 who did not, and found that those who did had a much lower infection rate.

CHM is part of an array of support and advice that a qualified herbalist can offer. Having seen the evidence from both our clinical practice and research into the benefits of herbal medicine, we feel strongly about stepping forward to support those who are putting their lives on the line, and helping them during this incredibly difficult and stressful time.

We have seen in our clinics the results of the support we offer our clients, and through researching treatment protocols used over centuries in response to pandemics, infectious respiratory diseases and rehabilitation from chronic illness, we strongly believe that our skills and experience will be useful for those right at the edge of the crisis. 

A final word on how we are evaluating the project. In April we submitted a research proposal on preventative care to St Thomas’s Hospital and over the summer we had discussions with the Department of Primary Care in Southampton University about a research project treating patients with Long Covid.

Sadly, for reasons that to be frank escape me, neither project was considered to be worth developing. In the absence of formal academic support we have used MYMOP (a validated patient centred outcomes measure) to assess the results of our interventions and we have also conducted a number of in-depth interviews with JSP patients to explore their experience of the project.

We are currently conducting a service evaluation to look at all aspects of what we do that will hopefully result in quantitative and qualitative data being written up and published. We hope that this might provide a rigorous rationale to persuade funders and professional researchers to investigate the project.

There are studies on the front page of the Jade Screen Project website, for those interested in the science behind CHM being able to supress viral replication, and inhibition of the SARS protein entering the cell’s receptor sites, which is how the virus enters the cells. There are also studies showing how herbs may have anti-inflammatory and immunoregulatory effects by reducing cytokine levels and enhancing immune mechanisms.

Several studies have confirmed the ability of mushrooms in general to increase the effectiveness of both our innate and adaptive immune response to a range of pathogens, including viruses. Reishi has a strong anti-inflammatory activity, as well as the quality to curb viral replication. Covid-19 enters cells via angiotensin-converting receptors, which the triperpenes and proteins from Reishi have been shown to block.

Herbs such as Patchouli and Japanese Knot Weed are considered to have anti-inflammatory and immune-protective qualities, that are amongst a wide range of herbs available to herbalists. These three herbs in particular are very useful in our formulae, where we call them by their Chinese names of Ling Zhi, Huo Xiang and Hu Zhang.

“Good luck with the project and everything. I hope that would be great to see it more in the mainstream and helping more and more people because I know it can do that now.” – JSP service user

In the meantime we soldier on, making a small but meaningful contribution in the fight against Covid-19. My experience, and that of my colleagues, is that CHM can help manage acute disease and significantly speed up recovery from Long Covid. I hope we can find a way to continue and develop the support we provide to frontline workers and to extend it to the growing numbers of people who have been laid low by this disease.

We’re not asking the people on the frontline to pay for either the herbs, or the consultations, as we feel they deserve our support and have put their lives on the line for all of us.

All donations we receive will go towards paying for their herbs. Our time, research and consultations are being gifted as a token of our thanks for their courageous work. We are hopeful that our support will help to protect those who are in such a perilous situation.

All the money donated via our donation pages goes directly to paying for the herbs, which have been provided at a generous discount, allowing your money to go even further.

All admin costs are covered by internally generated donations, meaning all our fundraising from the public can go directly to covering the cost of the herbs.

Please help us to support those who really deserve it! If you can’t support us financially, please do share our page on Facebook and Instagram, and let your friends know, especially if they are working on the front-line and you feel they would benefit from our support.

All donations that were received by the Jade Screen Project went towards funding herbal medicine for our frontline workers.