St John's Wort: From Traditional Use to Biomedical Misuse

Hypericum perforatum        St John’s wort        The Fairy Herb

 

Traditional use

Since pre-Christian times in Europe, St John’s wort has been associated with magical attributes to ward off evil. Indeed the ancient Greeks called the plant hypericon, meaning ‘over an apparition’, alluding to the folkloric idea that a whiff of the plant’s balsamic, incence-like aroma would cause ghosts, devils, imps and thunderbolts to flee. After the advent of Christianity, pagan women of wicca, the witches, ironically would be added to the list of evil entities that could be repelled by this herb.¹⁻³
The herb has also always been associated with midsummer/solstice ceremonies and rituals. This is a time when the yellow flowers bloom and which, when crushed, turn blood red, a colour associated not only with wounds, but also with menstruation, fertility and childbirth. And midsummer is also a time when the magical attributes of St John’s wort were thought to be greatest.

The English name itself derives from its symbolic importance of being ceremoniously gathered on St John’s Eve, the 23rd of June, to celebrate the Feast of St John the Baptist, the anniversary of the birth of the beheaded Christian martyr, on 24th June.^2,3 The traditional date of his beheading is 29th August, the legendary date when the herb first shows its red spots.⁴ According to folklore, if a girl gathered the herb on midsummer’s eve with the dew still on it, she would marry within a year; and if a childless wife walked naked to pick it she would conceive within a year.¹

Thus, from earliest times St John’s wort has been used to treat the evil of pain. It has been drunk as an infusion, and also Incorporated into numerous unguents, balms and mixtures and topically applied, for the aches and pains of sprains and strains, rheumatism, gout, arthritis, fibrositis, sciatica, neuralgia, skin rashes, haemorrhoids, bruises and burns, and deep wounds, particularly those inflicted during sword fights. During the Middle Ages the healing red oil was used by the Crusading armies to sooth and heal their wounds.⁵ And, as Nicholas Culpeper wrote, in 1653: ‘The decoction of the herb and flowers…is [also] good for those that are bitten or stung by any venomous creature.⁶ 

Being associated with blood, it has also been used to regulate menstruation, and treat ovulation and menstrual pains. The herb’s power to ward off evil was also evident in its use as an infusion for the treatment of fevers, fainting fits, toothache, insomnia and disturbed sleep patterns, and nocturnal enuresis in children; for colic and ridding the bowels of worms; for bronchial catarrh, bronchitis and, in more recent times, for tuberculosis; and for internal bleeding, from the lungs, nose, bowels, stomach, bladder, and from the uterus after childbirth.


Note: St John's wort has never been traditionally used for depression per se.

Elemental Qualities

Taste: Bitter, astringent, pungent (balsamic)

Temperature and Effect: Cool, light and dry

Specific Patient Presentation/Condition

St John’s wort is specific for any patient who manifests the qualities of heat, fire, excess, agitation, and heaviness in his or her constitutional attributes or disease characteristics. It has an affinity, but is not limited, to those with the following attributes: 

· Hot physical nature: choleric characteristics 

· Tendency to fiery, or choleric, emotions of irritability and anger

· Warm skin with tendency to profuse and rancid-smelling sweat 

· High-pitched, sharp voice 

· When balanced, bold, goal-oriented, purposeful, powerful, inventive 

· When disturbed , reckless, vain, argumentative, critical, and dominating

· Hyperactive 

· Has a tendency to infections, inflammatory diseases and fevers 

· Strong, excess or full bodily processes and pathologies (the opposite of weak or deficient conditions)

Specific Physiological and Psychological Conditions

St John’s wort has an especial affinity to the nerves, calming down excessive nervous activity whether from pain induced by physical traumas, inflammatory conditions or psychological conditions. Such conditions were traditionally classified in European herbalism as aspects of yellow bile—the Choleric temperament. Hence it is indicated for people who experience excessive, or full-blown, anxiety, nervous tension or irritability. These people are angry units, and likely to be verbally or physically aggressive. In Ayurveda these conditions would indicate that the Pitta dosha is aggravated and, to a lesser extent, the Vata dosha.

Yes, these psychological conditions may well lead to exhaustion and/or depression, but St John’s wort is not for depression per se. It is too cold for all but Choleric, or Pitta depression. This type of depression is evident in people whose depression is expressed through aggression, often very violent, towards others. The gunfire massacres in the United States, at schools, university campuses or shopping centres, exemplify the extreme consequences of Pitta or Choleric depression.

Many other herbs have traditionally been used for depression: lemon balm (Melissa officinalis), rosemary (Rosmarinus officinalis), oat seed (Avena sativa), damiana (Turnera diffusa), vervain (Verbena officinalis), wild celery seeds (Apium graveolens), lady’s slipper (Cypripedium pubescens), and its Indian therapeutic equivalent, ashwagandha (Withania somnifera). Most of these herbs are humorally warm, and in the case of a cool herb like Vervain, is combined with warming herbs.

St John’s wort is a specific for nerve injuries to the extremities, sacral spine and coccyx (hence also for sciatica), as well as teeth and gums. It also has an affinity to the blood vessels and is indicated wherever there is internal or external haemorrhaging. Its affinity extends to the immune system, bolstering the body’s ability to rid itself of evil, inimical, microbiological forces. Thus it promotes the elimination of catabolic waste products.⁷ In this function it helps elimination from the lungs, bowels and urinary tract. Hence it has traditionally been used for such lung diseases as tuberculosis and bronchitis, and for such urinary afflictions as nocturnal enuresis and kidney inflammation.

And finally, St John’s wort also has an affinity to the female reproductive organs, for use in ovulation pains and menstrual pains, ovarian inflammation, irregular periods, infertility, and menopausal symptoms with accompanying psychological irritability and anger. As a gynaecological remedy it has a mild emmenagogue action (it stimulates blood flow to the reproductive organs).

In Summary

St John’s wort is definitely indicated if the patient presents with hot physical symptoms (fast pulse, warm and sweaty skin, red tongue, hyperventilating, etc), and also if, in consultation, the idea comes to mind that the patient is an angry individual who is likely to emotionally explode. Think of St John’s wort as a cool, calming, midsummer night’s remedy.

From Tradition to Biomedical Science

Not until the 1950s did St John’s wort attract any scientific attention. From the ’50s up until 1980 there were fewer than 30 scientific studies on St John’s wort, almost entirely by Eastern and Western European teams on the herb’s traditional antimicrobial and vermifuge actions. At that time countering infections was to the fore in biomedical thinking.

Then during the 1970s a new health phenomenon arose: the medical profession, together with Big Pharma, turned their attention to the rising tide of depression sweeping through populations of the developed nations.

Not once did anyone think to ask why the incidence of depression was rising; that perhaps the increasingly disconnected nature of modern life has the same impact on human beings as the disconnected nature of zoo life has on elephants or lions—after all, we all evolved in the wilds, both animals and us, as hunters and gatherers. Not a single psychological or social explanation was sought. Instead, the biomedical business mindset was that the problem lay inside the neurochemistry of patients and that a chemical fix, with patented drugs, was the solution.

Biomedical Mindset and Shenanigans

This mindset lay behind the first generation of anti-depressant drugs, meprobamate (the trade name was Miltown), which had entered the armamentarium of psychopharmacology in the 1950s. By 1987 yet another class of Big Pharma's psychotropic drugs, the selective serotonin reuptake inhibitors, hit the medical marketplace: fluoxetine, known by such brand names as Prozac, Rapiflux and Sarafem (the last is targeted at premenstrual women). And the aim? Besides making big profits for Big Pharma, the biomedical aim was to increase serotonin levels in depressed or anxious people's brains.

Tellingly, within four years of the FDA's approval of Prozac, the US FDA banned l-tryptophan, the essential amino acid that is the precursor to serotonin. Because of a corporate and governmental cover-up, the smoke-and-mirror spin was that the reason for banning the amino acid was that the Japanese-made tryptophan had, in 1989, killed 37 Americans, and permanently disabled 1,500 others from eosinophilia myalgia syndrome. But the underlying reason was that the manufacturer of the amino acid, the pharmaceutical company Showa Denko K.K., had switched to using a genetically engineered bacterium to produce the amino acid. Not once, however, has the FDA acknowledged that the tryptophan was made by a living genetically engineered organism. And Showa Denko K.K. destroyed all biological evidence and some potentially incriminating records of the manufacturing process.⁸ 

How Biomedicine Usurped St John's Wort

Given such a medical Zeitgeist, it's not surprising that scientific attention, underwritten by corporate greed, would turn towards identifying anti-depressant chemicals in plants.

Thus in 1984, the anti-depressant actions of St John’s wort first came to light: two German scientists conducted tests on six women, aged 55−65, with depressive symptoms, and found that a hypericine-standardised extract of the herb had an anti-depressant effect on them, reducing anxiety, anorexia and insomnia and feelings of worthlessness.⁹ Hypericine is one of the two known red-coloured chemicals in the herb.

Curiously, 13 years earlier, in 1971, The British Herbal Medicine Association—which had collaborated with representatives of the oldest organisation of herbal practitioners in the Western world, the National Institute of Medical Herbalists—had published the first edition of the British Herbal Pharmacopoeia. And in its monograph of Hypericum it states: 'Contra-indications: Depressive states.¹⁰

Notwithstanding the professional expertise underpinning this contra-indication, since 1994, when research began in earnest, there have been approximately 585 studies on St John’s wort’s so-called anti-depressant actions, and 1830 generally on the herb.¹¹

Many herbal practitioners today have also adopted the modern, non-holistic practice of incorporating St John’s wort into remedies for psychologically depressed patients. These practitioners have been seduced by biochemical explanations for the action of herbs; that certain chemicals, hypericine and more particularly hyperforin in the case of St John's wort, are the 'active constituents' or 'actives'; that the 'actives' provide the scientific (pharmacological) reason for why herbs work the way they do. Hyperforin has been identified as a serotonin reuptake inhibitor, exactly the same as Prozac.^12-14

Over the past 25 years the chemical explanation for the medicinal actions of herbs has increasingly become the paradigm of what I call biochemical herbalism—at the National Institute of Medical Herbalists many of us learned a user-friendly and holistic paradigm of herbalism called Physiomedicalism that focused on the physiological actions of herbs on tissues, organs and systems; but the reductionist, biochemical model is the new kid on the block, the new mindset of herbalism, and it is underwritten not by traditions but by scientists trained in biochemistry but with no clinical training or experience in herbalism.

And that is called ‘evidence-based’. In other words, there is an unwritten subtext to anything classifed as ‘evidence based’ that adds '...but not traditional knowledge' to the doublespeak, to which the gullible public are oblivious.

Many herbal publications, some written by herbalists with an educational background in biomedicine or chemistry, have reinforced this radicle departure from traditional usage. And many colleges of natural therapies are trying to legitimise their place within of the business world of biomedicine by adopting this paradigm.

In later posts I will further explore the academic obsession for explaining life and medicine within a biochemical paradigm, a paradigm that is reductionist in its focus, and disconnected from life in its attitude. Clearly the traditional explanation for a plant's medicinal actions—based in humoral medicine, and identified through the energetic dynamics of interactions between herbs and people—is being abandoned. The wise words of Albert Szent Györgyi, Hungarian physiologist and Nobel Prize winner in Physiology or Medicine in 1937, are warning enough about the biomedical path modern herbalism is taking: 'In every culture and in every medical tradition before ours, healing was accomplished by moving energy.¹⁵

Moreover, every medical tradition before modern medicine, had treated people, not diseases, and treated the root of a disease, not its stem as modern biomedicine does. Again, in later posts I will explore this biomedical disconnection too. But in this post, through the example of modern biomedical approach to St John’s wort, I hope you are able to see the modern trend of ‘evidence-based medicine’ usurping traditional herbal knowledge.

Today PubMed lists over 1900 studies on Hypericum perforatum. And as a sign of the corporate grab for herbal medicine, the United States Patent and Trademark Office lists 252 patents on products that incorporate Hypericum perforatum.

Complementary Herbs

The following are a sample of effective herbal combinations involving St John’s wort: 

· To reduce St John’s wort cold and dry nature, combine with Ginger and Liquorice. 

· For ovulation pains combine one part each of St John’s wort and Liquorice with two parts of False Unicorn root, and three parts of Wild yam. 

· For irregular menstrual cycle combine one part each of St John’s wort, Ginger, Liquorice, Chaste tree and False unicorn root, with two parts of Schisandra. 

· For arthritic pains combine one part of Guaiacum with two parts each of St John’s wort and Dandelion root, and four parts each of Cat’s claw and Hawthorn. 

· For depression with signs of heat, irritation, and/or anger combine one part each of St John’s wort and Dandelion root with two parts each of Schisandra and Withania. 

· For neuralgia, combine one part each of St John’s wort, Ginger and Liquorice with two parts each of Hawthorn, Turmeric and Withania. 

· For acute inflammation combine one part each of St John’s wort and Dandelion root with two parts each of Pau d’arco and Echinacea. 

Caution 

Given that many practitioners do use St John’s wort for depression, caution is recommended with patients who display coldness in any signs or symptoms, and who are erratic psychologically or physiologically. This includes people who are self-destructive, mentally disturbed, apathetic and/or suicidal. St John’s wort is likely to increase their psychological disturbances.

References

1. Baker M. Discovering the Folklore of Plants, Shire Publications Ltd, Aylesbury, Buckinghamshire, UK, 1981; p. 59. 
2. Stuart M (editor). The Encyclopedia of Herbs and Herbalism, Guild Publishing, London, UK, 1985; p. 204. 
3. Palsaiseul J. Grandmother’s Secrets, Penguin Books, Harmondsworth, Middlesex, UK, 1986; pp. 290−293. 
4. Wren RC and Wren RW (eds). Potter's New Cyclopaedia of Botanical Drugs and Preparations, Health Science Press, Hengiscote, Bradford, N Devon, UK, 1975; p. 289. 
5. Loewenfeld C and Back P. The Complete Book of Herbs and Spices, AH & AW Reed, Wellington, New Zealand, 1974; p. 221. 
6. Culpeper N. The Complete Herbal, 1653; reprinted in Wordsworth Editions Ltd, Ware, Hertfordshire, UK,1998; p. 140. 
7. Priest AW and Priest LR. Herbal Medication, LN Fowler & Co Ltd, London, UK, 1982; pp. 80, 81. 
8. Sleeman J. Cry for Health, Vol 1, Health: The Casualty of Modern Times, Dragon Lair Publishing, Mt Barker, SA, Australia; p. 236. 
9. Müldner H, Zöller M. ‘Antidepressive effect of a Hypericum extract standardized to an active hypericine complex. Biochemical and clinical studies.’ [In German]. Arzneimittelforschung, 1984; 34 (8): 918-20. 
10. British Herbal Medicine Association. British Herbal Pharmacopoeia, London, 1976; p. 117. 
11. Hübner WD, Lande S, Podzuweit H. ‘Hypericum treatment of mild depression with somatic symptoms.’ Journal of Geriatric Psychiatry and Neurology; 7 (1): S12−14. 
12. Cellarova E, Kimakova K, Daxnerova Z, and Martonfi P. 'Hypericum perforatum (St.John’s Wort): In vitro culture and the production of hypericin and other secondary metabolites.' In: Bajaj,.P.S.(ed), Biotechnology in Agriculture and Forestry, 33:261-275; Springer-verlag, Berlin/Heidelberg, 1995. 
13. Müller WE, Singer A, Wonnemann M, Hafner U, Rolli M, and Schäfer C. 'Hyperforin represents the neurotransmitter reuptake inhibiting constituent of hypericum extract.' Pharmacopsychiatry,31 Suppl 1:16;1998. 
14. Singer A, Wonnemann M, and Müller WE. 'Hyperforin, a major antidepressant constituent of St. John's Wort, inhibits serotonin uptake by elevating free intracellular Na+1.' Journal of Pharmacology and Experimental Therapeutics, 290(3):1363; 1999. 
15. Szent-Györgyi A. Introduction to a submolecular biology. Academic Press, New York, USA, 1960; p. 135.