St John’s Wort herbal tincture
St John’s Wort
Whilst medical herbalists may not have so much use for St John’s Wort as a wound herb as they did in the past, it is still used a lot for inflammation and bleeding in the digestive tract. Its application to the nervous system is much wider than just for stress and depression. It is employed in neuralgias, and herbalists apply its anodyne qualities to treating shingles – internally as a tea or tincture and externally as oil. It also has regenerative effects on nervous tissue. Whilst nervous tissue normally recovers only very slowly from damage, lesions from operations and accidents may be helped in their healing by St John’s Wort. Hypericum also has a mild tonic action on the liver.
The focus upon St John’s Wort as the herb for depression not only diverts attention away from other herbs such as Lemon Balm but also assumes that depression is an illness that can be treated with a medicine. Whilst there are some depressive states that can be seen as a result of chemical imbalance in the body and which respond well to medication, herbal or pharmaceutical, most of us recognise that “depression” is to do with our interactions with the world around us. Whilst uplifting nervine herbs may be a source of support during hard times, they are not going to remake a broken marriage, remedy someone’s poverty or redundancy from work or heal the pain of an abusive childhood. The attitude that says we can sort our lives out by taking a tablet is the one that stops us listening to the messages and the learning that illness can bring.
Another general issue about the marketing of herbs by the over – the counter (OTC) industry that is highlighted by St John’s Wort is that of “standardisation”. Whilst people and plants are variable in their makeup, industry requires a standardised product. It is reasonable, if buying a product, to want to know that what I buy this month is of the same quality as that I purchased before. The way that the OTC industry reassures us is to calibrate levels of certain chemical constituents of a herb and to make sure that these are maintained in its products. Usually one key active constituent is taken as the marker – in the case of St John’s Wort this has been the red pigment, hypericin. The implication here is that hypericin is the essence of Hypericum, and that the anti-depressive activity of the plant is generated by this compound.
Chemists have determined what they think is the optimum level of hypericin that a plant sample should contain. As a crop of St John’s Wort is processed its hypericin content is assessed. If the amount is too high then some is removed. If there is not enough then more hypericin is added. The label on the finished product will then proclaim “standardised for hypericin content” and will give a percentage figure to indicate its content.
In some ways this is a modern version of what the pharmaceutical industry has done with plants for over a hundred years – identifying the “active constituent” and taking it out to turn it into a drug. Only now it is taken out and then put back into a processed sample of the same plant. We have seen that extraction and synthesis of plant chemicals has led to an increase of potency but also of unwanted side effects. There is beginning to be a suspicion that a similar charge could be levelled at standardised extracts.
There is a humorous footnote to add here. There have been many clinical trials to assess the antidepressant activity of St John’s Wort, most of them with standardised extracts. More recently a trial was done with St John’s Wort which had had the hypericin removed. It was found to be efficacious in relieving depression!
Historically the main unwanted side effect that has been noted with the use of St John’s Wort has been increased sensitivity to light. Some individuals using the plant may develop a skin reaction in strong sunshine. Actually this is an effect that has been noted in livestock far more frequently than in people and it is assumed that this reaction is relatively unusual in humans.
Near the beginning of the year 2000 the Medicines Control Agency in Britain published information concerning dangerous potential interactions between St John’s Wort and pharmaceutical medication. These fell into two categories: 1. Some medicines that act on the central nervous system are potentiated 2. Some medicines that are cleared from the body by the liver are cleared more quickly than usual resulting in lower amounts of the medication in the bloodstream. Those medicines in the first category included Prozac and similar antidepressive drugs. Those in the second category included drugs used to treat epilepsy and clotting disorders, those used to stop the body rejecting transplants and the contraceptive pill.
Several points can be made about this. People taking herbal medication and orthodox medicines need to be aware that there are potential interactions between them. In the marketing of Hypericum’s anti-depressive action its liver function enhancing effects have been neglected, but since many herbs act on the liver it is to be expected that more herb/drug interactions will come to light. It is recommended that people taking OTC herbal remedies inform their doctors of the fact. To be on the safe side, many doctors have reacted by advising people to cease taking St John’s Wort, whereas monitoring blood levels of crucial drugs would be another course of action.
The effects of St John’s Wort in lowering the effectiveness of the contraceptive pill are theoretical. Given the huge OTC sales of St John’s Wort (£6 billion reported in 1999) and that more women purchase the herb than men, one would expect problems to be reported. It is, however, worth bearing in mind.
All reported actual and potential drug/herb interactions with St John’s Wort all relate to standardised extracts. Medical herbalists tend to regard teas and tinctures as safer products.
It is also worth noting that problems with a particular herb or a sample of a particular herb still often result in an outcry against herbal medication in general, compared to problems with individual pharmaceutical drugs being perceived as just concerning that particular medication.
with thanks and acknowledgements to fellow medical herbalist Bendle in Sheffield
© Bendle MNIMH
You can order St John’s Tincture