Lifestyle and Diet for a Cold or Flu: An Asian Medicine View, Part 1

Lifestyle and Diet for a Cold or Flu: An Asian Medicine View, Part 1

In preventing a cold or flu an important place to begin is to make sure to wear the appropriate clothing for your environment. It is important to have clothing layers on hand if you live in an environment where the temperature fluctuates often. There is a higher likelihood of catching a cold on a windy day, especially when there is a combination of wind, cold, and/or damp weather. A simple solution is to wear scarves to protect you against the wind. It is also important to sleep enough, in particular when feeling vulnerable, or if prone to sickness. Be sure to close all windows at night before sleeping to prevent dampness from entering your house and body. It is essential to manage stress and not push yourself if already feeling vulnerable to catching a cold or flu.
Treat any cold/ flu thoroughly, so that it does not repeat. This means stay home and rest until your sickness is completely gone. It is helpful to drink warm tea and/or take a warm bath. It is important to consume appropriate foods and herbal remedies that will help to speed up your recovery time. If preventative measures are taken at the onset of an illness, the sickness can be prevented from becoming full-blown. If prone to re-occurring colds/flu taking preventative measures can assist in stopping the cycle of reoccurrence. Acupuncture and/or herbal medicine is taken 1-2 months and/or 1 season ahead of time can prevent reoccurring colds/flu. Also, acupuncture and herbal medicine can be utilized in all phases of a cold or flu to speed up the healing process. It is best to seek the help of a practitioner to receive the most appropriate treatment for a speedy recovery.

…To be continued in Part 2:

written by:

Yasmin Spencer LAc, DAOM, Dipl. OM
427 F Street, Eureka, CA 95501
(707)616-6880

Home

 

Bibliography

  • Haas, Elson M.,  “Staying Healthy with the Seasons,” Celestial Arts (Pub), 2003
  • Five Branches University education

Lifestyle and Diet for a Cold or Flu: An Asian Medicine View, Part 2

Lifestyle and Diet for a Cold or Flu: An Asian Medicine View, Part 2

 

Consuming an appropriate diet is essential in quickly resolving an illness. It is beneficial to sweat out a sickness, especially during its initial onset. It is also beneficial to strengthen the body’s Qi (energy) as a sickness preventative. It is important to avoid dairy, wheat, and sugar, as well as cold/ raw/ and/or frozen foods. If exposed to wind, rain, and/or cold: consume hot spicy soup to help sweat out the potential sickness (this can also can be done during the initial onset of a cold). Another technique that can get rid of sickness right away is to drink a lot of warm to hot temperature water and then to go to sleep early during the initial onset.

Chicken soup is a European folk remedy for colds and flu. The Chinese medicine perspective on why chicken soup is so effective is as follows: the hot soup helps to sweat out sickness, onions or garlic can be added to helps clear sickness from the lungs, and the chicken strengthens bodies qi, aka. builds the body’s strength to fight against the sickness.

Garlic oil stimulates the immune system and is considered an herbal antibiotic. It also has antibacterial and anti-fungal properties. Garlic can be used for prevention, as well as for an acute cold. Garlic oil can be added to an already cooked meal. In order to preserve its healing properties, it is important to not cook the garlic oil. Consuming the garlic in the form of oil helps it to have medicinal strength without being too hot for the digestive system. Rosemary, oregano, and/or thyme can be added to the garlic oil to strengthen its healing properties & to enhance its flavor. To make garlic oil: chop the garlic finely, fill a jar with the garlic (and rosemary, thyme, or oregano if you wish) 1/2-3/4 full, cover the garlic with olive oil by 1-2 inches and leave some room at the top of the jar. Let the garlic sit in the sun (a window sill also works fine) for 5-7 days. Shake the jar daily. It is normal for it to bubble. Then strain out the garlic and throw it away. The oil (uncooked) can be added to your meals daily! The healing properties of the garlic are then infused into the oil.

The following are some foods that are preventative, or for a weak person who has a cold, or flu: Conjee, which is a rice soup, strengthens the body against sickness, post sickness, and supports a weak person who has a cold/ flu. Root vegetables strengthen a weak person whether they are sick or not. White foods (such as baked pears, onions, garlic, etc) strengthen the lungs. Warm moist foods strengthen the digestive fire, aka. strengthens the immunity. A cold bodied person can benefit from taking a bath in and/ or drinking ginger tea as a preventative measure.

**note: Immune stimulants, such as garlic and ginger, should be taken in moderation or avoided by individuals with autoimmune disorders.

written by:

Yasmin Spencer LAc, DAOM, Dipl. OM
427 F Street, Eureka, CA 95501
(707)616-6880

Home

 

Bibliography

  • Haas, Elson M.,  “Staying Healthy with the Seasons,” Celestial Arts (Pub), 2003
  • Five Branches University education

Reoccurring Colds, Chronic Bronchitis and How Acupuncture and Herbal Medicine Can Help, Part 1

Reoccurring Colds, Chronic Bronchitis 

and How Acupuncture and Herbal Medicine Can Help, Part 1

There are many reasons that the lungs become susceptible to sickness. The lungs often become weak due to damage caused by a serious illness, especially if the illness was never completely resolved. Many people report that they were rarely sick until they got one bad cold or flu, and now they are sick often. This is because the integrity of the lung tissue was compromised through the illness-causing a person to be prone to reoccurring sickness. A Chinese medicine view is that the “Qi” of the lungs and the “Wei Qi” defense was damaged, causing the lungs to be vulnerable to external pathogens. There can also be lung weakness in individuals who have or have had asthma, had a serious illness when young, exposure to toxic environmental pollutants or molds that damaged the lungs or have a constitutional lung weakness through their family line. If a person has a tendency to get frequent colds/flu and they also have poor diet and lifestyle habits, it will further increase the possibility of ongoing, or prolonged illnesses (esp. during the cold season).

Another reason for lung weakness that is often overlooked stems from the grief that is unexpressed or over-expressed. In Asian medicine, the lungs and grief are seen as interconnected. The lungs are weakened by excessive grief that is unexpressed and held in the body, as well as by grief that is prolonged and over-expressed. It is important that emotions such as grief are expressed to an appropriate extent, so that this emotion does not become stuck in the body, or become an overdeveloped pathway. On the flip side, as recognized and worked within Five Elements acupuncture, an individual with a constitutional lung weakness can have a propensity towards excessive or deficient grief, hopelessness, and/ or weeping. Often times the individual with lung weakness will demonstrate a concave chest, to varying degrees. Opening the chest through breathwork, walking up steep hills, doing regular chest opening exercises, as well as finding supportive avenues to work with grief, can be helpful in reestablishing the health of the lungs.

 

…To be continued in Part 2:

 

 

Yasmin Spencer LAc, DAOM, Dipl. OM

427 F Street, Eureka, CA 95501

(707)616-6880

Home

 

 

Bibliography

  •  Five Branches University masters degree (MTCM) and doctorate degree (DAOM) course work

Reoccurring Colds, Chronic Bronchitis and How Acupuncture and Herbal Medicine Can Help, Part 2

Reoccurring Colds, Chronic Bronchitis 

and How Acupuncture and Herbal Medicine Can Help, Part 2

Chronic bronchitis, which is a tenacious cough with phlegm that is deeply-seated in the lungs (at times with concurrent infection), can also be caused by lung weakness due to the reasons mentioned in Part 1.  More often, however, this sort of cough is due to inappropriate diet, lifestyle, and/or treatment of a cold or flu. It is important to avoid raw or cold foods/drink, as well as to avoid dairy, wheat, and sugar when sick.  These foods create more phlegm and can prolong sickness. If the individual already has a cough with a lot of phlegm and they consume these foods, it can potentially create more dampness that further lodges the phlegm into the lungs.  Smoking while sick can also deepen phlegm into the lungs, damage the lung tissue, and make a person prone to reoccurring sickness. Sleeping outside (which is an issue with homeless individuals) and leaving a window open while sleeping (especially when living close to the ocean where dampness rolls in at night) can cause a person to be prone to a cold with increased dampness and/or phlegm and can also make bronchitis worse and harder to remedy. This is because the body is especially vulnerable to the environment while sleeping and dampness can easily enter the body.  If an individual has tenacious and thick phlegm, it will be difficult to resolve without treatment with acupuncture and/or herbal medicine.  If this sort of phlegm is not resolved, reoccurring and/or prolonged sickness is more likely to occur.

If an individual is susceptible to reoccurring colds and flus or has chronic bronchitis, it is important to consult a practitioner of acupuncture or herbal medicine, rather than attempt to treat the condition on their own. The treatment that is custom fit to the individual’s unique condition will have the best results.  Acupuncture and herbal medicine are able to support a person’s unique constitution and treat a combinations of signs and symptoms, such as: strengthens lung weakness, treats colds/flu, treats lung weakness with reoccurring sickness, treats lung weakness with a tendency towards phlegm and/or a deep cough, prevents and can end the cycle of reoccurring sickness, speeds up the healing time of an illness, and more. These treatments can have a longstanding benefit on the overall health and function of the lungs. It is, of course, very important that there is compliance with the appropriate diet and lifestyle as recommended to support the effectiveness of treatment.

 

Yasmin Spencer LAc, DAOM, Dipl. OM
427 F Street, Eureka, CA 95501
(707)616-6880

 

 

Bibliography

  •  Five Branches University masters degree (MTCM) and doctorate degree (DAOM) course work

Preparing for Spring with the Help of Asian Medicine, Part 1

  Preparing for Spring with the Help of Asian Medicine

 

A Five Element View:

In preparing for spring, it is important to begin with, an understanding of how each season affects every other.  Our sense of balance, as we go into the spring, is intricately connected to whether or not we took the time to rest in the winter (restore, be still, and go inward).  Spring is associated with new growth and expansion–the time when the seeds begin to sprout and push upward to the sun with force.  Likewise, there may be escalated agitation in individuals as the springtime inspires the urge to move forward and grow after the encapsulation of winter.  New growth is dependent upon the rejuvenation of our deeper sources that occurred in the winter.  Spring is associated with the liver in Chinese Medicine and with the emotion anger.  The liver energy, when balanced, smooths our emotional energy.  The autumn is the time of letting go.  If a person was not able to let go of outmoded beliefs or emotions in the fall it can show up in the springs as congestion.  This may be expressed as emotional outbursts, increased agitation, or emotional stagnation.   The growth that occurs in the spring effects summer and late summer in the same way that a plant grows and produces fruits, flowers, and seed.  Likewise, a person is able to bring the budding energies that arise in the spring to their full potential by living in harmony with the seasons.

Spring Lifestyle:

The energy of spring is expansive and outward moving.  It is time to start exercising and sweating more.  Begin cooking and eating lighter meals.  In wintertime, we would tend to bake our food to more deeply warm our bodies.  In the spring steaming and stir-frying are more appropriate.  It is beneficial to eat more leafy greens (kale, dandelion, collards, mint).    The sour flavor incorporated into the diet will help to balance the liver energy.  Try to be conscious to include good oils into your meals (flax oil, sesame oil, olive oil).  It is best to add these oils to already cooked food to preserve quality.  Eat what is locally grown and in season, as much as possible.  It is important to be emotionally calm when eating, as well as to breathe deeply and thoroughly chewing our food.  Drink lots of fluids (lemon can be added to water).  The spring is a great time of year to receive bodywork or acupuncture, in order to facilitate the body in opening and relaxing.

Do your best to avoid toxicity in your foods and environment.  Some things to avoid are chemicals, drugs and alcohol; as well as refined sugars, processed foods, caffeine, large portions of meat, greasy and rich foods.  Avoid stress!  All of these are toxicities that can impact and congest the liver.

…To be continued in Part 2:

 Written by:

Yasmin Spencer LAc, DAOM, Dipl. OM
427 F Street, Eureka, CA 95501
(707)616-6880

 

 

 

Bibliography

  • Pitchford, Paul,  “Healing with Whole Foods,” North Atlanta Books (Pub), 2002
  • Haas, Elson M.,  “Staying Healthy with the Seasons,” Celestial Arts (Pub), 2003
  • Five Branches University education

Preparing for Spring with the Help of Asian Medicine, Part 2

Preparing for Spring with the Help of Asian Medicine, Part 2

…Continuation of Part 1:

Liver Patterns:

When the liver energy is in balance we can make decisions and follow through with our creative visions.  This is a great time of year to begin new projects.  When the liver energy is deficient we may lack the ability to make decisions or follow through with them.  On the contrary, when this energy is excessive we may become “workaholics,” so determined to accomplish our goals that we neglect our needs or our relationships.

Physically, this is a time to assess the health of our nails, tendons, and eyes.  Nails should be strong and smooth with good color; not brittle or grooved.  Tendons should be supple, flexible and strong.  The eyes should be clear and bright, without yellow or red in the whites.  Emotionally we can assess our health by witnessing if we can healthily express our emotions, especially anger.

Spring Treatment:

When spring arises, if you begin to feel out of balance, it may be a good time to seek a Chinese Medicine treatment.  A person may experience a variety of symptoms, such as foggy thinking or forgetfulness; tendon tightness; blurry, red, or dry eyes; lethargy; dry skin, skin itch, or rash.  Also, a person can have rib-side pain (especially after eating while emotional), abdomen distention, diarrhea, or constipation.  Emotionally the imbalance can often come as outbursts of anger or increased frustration.

Through harmonizing with the energy of spring we begin to feel energized, light and open.  With tendons supple and strong we can move easily through our day. With eyes clear and bright we can appreciate the beauty of spring.  Enjoy your health and clarity this spring!

 Written by:

Yasmin Spencer LAc, DAOM, Dipl. OM
427 F Street, Eureka, CA 95501
(707)616-6880

 

 

Bibliography

  • Pitchford, Paul,  “Healing with Whole Foods,” North Atlanta Books (Pub), 2002
  • Haas, Elson M.,  “Staying Healthy with the Seasons,” Celestial Arts (Pub), 2003
  • Five Branches University education

Support Your Seasonal Allergies with Acupuncture and Herbal Medicine

Support Your Seasonal Allergies with Acupuncture & Herbal Medicine

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The Asian medicine view of allergies is related to a syndrome called Wei Qi deficiency. The Wei Qi is seen as the most superficial Qi of the body that acts as a barricade between the individual and their environment. When the Wei qi defenses are sufficient a person will have a resistance to external pathogens, preventing common colds and also assisting with allergies. When these defenses are normal a person will not be affected by irritants in the air, such as pollen, dust mites, cat or dog hair, etc. Therefore, if an individual suffers from allergies, it is of key importance to strengthen their Wei qi. There can be other underlying syndromes and deficiencies that cause a person to be prone to allergies that are more specific to an individual, but in general, the strength of the Wei Qi plays a key role in an allergic presentation.
It is very helpful to begin the treatments with acupuncture and herbal medicine a season ahead of time. These treatments are also helpful during an acute onset and are important for individuals who have allergies all year round, so it is perfectly acceptable to begin treatments during the acute onset. However, if it is the summer and you usually have allergies in the fall or it is the fall and you usually have allergies in the spring, don’t wait until the season that your allergies begin to start treatment. If you treat your allergies the season beforehand, there is the possibility of preventing the occurrence of allergies for that year. This, of course, depends on the severity as well as the length of time that a person has had allergies. It may take longer than 1 cycle of preventative treatments for individuals with severe allergies to obtain the desired results. It is easier to prevent the occurrence of allergies than it is to treat in the acute stage. The unchecked acute onset of allergies can create further weakness in the Wei Qi and cause local tissue damage, creating a vicious cycle that makes a person prone to prolonged and reoccur attacks. Acupuncture and herbal medicine are wonderful and strong preventative treatments.
A Western herbal medicine that is a wonderful ally for seasonal allergies is Nettles in the extract, fluid extract, and freeze-dried forms. This herb can be taken both as a preventative and during the acute phases of allergies. Some individuals have also found benefit from consuming Wild Flower Honey as a seasonal allergy preventative. If you have any adverse reaction to Nettles or Wild Flower Honey, and/or feel worse after taking, then please avoid these substances. Nettles and honey are nourishing, supportive and safe, so adverse reactions are very rare. Also consuming warm cooked foods and avoiding raw/cold/and frozen foods will help to build and support immunity. In addition, doing a neti pot or other nasal rinse can help to minimize and/or prevent allergies. In general, it is best to add 1/2 teaspoon of salt and 1/4 teaspoon of baking soda (NOT powder) to 1 cup of pre-boiled water. The baking soda is added to protect the tissues from the salt’s abrasive effect on the tissues. If you are sensitive to the salt, you can add additional baking soda (not too much). Do the nasal flush when the water is still warm, but not too hot. If it feels comfortable to keep your finger in the water, then it is probably the right temperature. It is important that the water not be too hot, so as not to damage the tissues. The water should also not be cold or room temperature, because it will not effectively cleanse the nasal passages. The goal, when doing this flush, is for the water to go in one nostril and out the other one. Be sure to change the angle of your head if the water runs down the back of your throat, etc. If your nasal passages are already clogged, do not do a nasal rinse. If doing the nasal flush doesn’t feel good or flows down the back of your throat, it is probably best to ask a health care practitioner for assistance on how to apply correctly. The nasal rinse is a wonderful tool but is not for everyone.
Another key component to minimizing and or preventing the onset of allergies is to identify which allergen aggravates you. Many peoples allergies are aggravated by certain flowers and trees (such as Acacia, as seen in the picture, has yellow flowers that are a common allergen when blooming). If you are aware that there is more pollen in the air on certain days or that a potential allergen is beginning to bloom, it can be essential to take preventative measures by avoiding exposure. It can be very helpful to close bedroom windows, so that the pollen doesn’t blow into your room, onto your bed and pillow. Also, a protective cloth can be placed on the bed or furniture if windows must be left open. On days of exposure, washing your face or taking a shower immediately upon coming inside can help to minimize the allergic response. This is also key for other types of allergies, such as cats or dogs.

 

written by:

Yasmin Spencer LAc, DAOM, Dipl. OM
427 F Street, Eureka, CA 95501
(707)616-6880

 

Bibliography

  • Five Branches University education

Menopausal Support with Acupuncture and Herbal Medicine

Menopausal Support with Acupuncture and Herbal Medicine

Although other traditional Chinese medicine syndromes can be overlapped, in general women during menopause will have a pattern called Yin deficiency.  The hormonal changes that occur during menopause can cause a group of very uncomfortable symptoms for women, such as hot flashes, night sweats, emotional fluctuations, and more.  These symptoms are caused by the decrease of estrogen and represent a loss of fluids in the body, as called Yin deficiency in Asian medicine. Acupuncture and herbs are great support for the transition into menopause. These interventions can help to support the Yin of the body, aid in balancing the hormones and thus smooth out the intensity of symptoms. It is best to see a trained acupuncturist and herbalist, as each individual’s presentation is different and certain regiments may not be appropriate for everyone.

When working to support the bodies Yin, other key aspects to consider is the diet: avoiding spicy hot foods, alcohol, ginger, chocolate, and coffee are very important dietary regiments. If menopausal symptoms are under control then these foods can be consumed in moderation, as long as it does not exacerbate the symptoms. I suggest being especially careful with spicy foods because it causes sweating and depletes the Yin (fluids) of the body. If the menopausal symptoms are full-blown it is strongly discouraged to consume these foods, because they will aggravate the symptoms. As with any dietary regiment, you can experiment for yourself by avoiding the substance for at least 2 weeks, then try eating or drinking the prohibited food/drink to see if your symptoms are exacerbated.

Primrose Oil is considered a hormone balancer that many women use as support through menopause. A Western herb that is a great ally to women is Vitex, also called Chaste Berry. Vitex is a wonderful herb for women in all phases of their life, as it supports hormonal balancing. It can also be wonderfully beneficial and nourishing to consume herbs that are rich in vitamins and minerals, such as Nettles and Red Raspberry Leaf (another known ally to women). If consuming Primrose Oil, Vitex, Nettles, or Red Raspberry Leaf causes any adverse reactions, stop taking it immediately. All of these substances are very safe and gentle and rarely have negative side effects.

 

written by:

Yasmin Spencer LAc, DAOM, Dipl. OM
427 F Street, Eureka, CA 95501
(707)616-6880

 

Bibliography

  • Five Branches University education

St. John’s Wort- Herb/Drug Interaction, Part 1

St. John’s Wort- Herb/Drug Interaction, Part 1

Although St. John’s Wort is not a Chinese herbal medicine, it is an important Western herbal medicine to be educated about.  This herb is of particular importance due to its popularity and because it is easily purchased over the counter in health food and herb stores throughout the US.  St. John’s Wort is used for mild depression.  Since it is effective herbal prescription, it is very popular.  St. John’s Wort is often self-medicated, without first seeking the advice of a health care practitioner.

            St. John’s Wort usually takes about 1 month before it has a therapeutic effect St. John's Wortfor the individual.  Although St. John’s Wort is for mild depression and has slow onset, the power of its biochemical constituents should not be underestimated when used in combination with Western medication!  As written in a journal by the American Academy of Family Physicians in 2008, “St. John’s Wort is the supplement that has the most documented interactions with drugs.” According to an NIH article, from Department of Experimental Pharmacology, in 2009: “Hyperforin, which is believed to contribute to the antidepressant action of St John’s wort, is also strongly suspected to be responsible for most of the described interactions.”

 

…To Be Continued in Part 2

 

Written by,

Yasmin Spencer LAc, DAOM, Dipl. OM
427 F Street, Eureka, CA 95501
(707)616-6880

 

 

Bibliography

  • Paula Gardiner, MD, MPH, Russel Phillips, MD, Allen F. Shaughnessy, PharmD, January 1, 2008. American Academy of Family Physicians.  “Herbal and Dietary Supplement-Drug Interactions in Patients with Chronic Illness.”  Retrieved from:  http://www.aafp.org/afp/2008/0101/p73.html
  • Borrelli F, Izzo AA.  December 11, 2009.  National Institute of Health- Department of Experimental Pharmacology, University of Naples Federico II.  “Herb-drug interactions with St John’s Wort (Hypericum perforatum): an update on clinical observations.”  Retrieved from:  http://www.ncbi.nlm.nih.gov/pubmed/19859815

St. John’s Wort- Herb/Drug Interactions, Part 2

St. John’s Wort- Herb/Drug Interactions, Part 2

 

I highly recommend St. John’s Wort for patients with mild depression who wish to utilize Western herbal medicine alone. However useful this herb is on its own, it is not to be used in combination with Western pharmaceutical medication without first consulting with the individual’s doctor. In addition, if it is approved for use alongside Western medicine, it should still be monitored carefully. St. John’s Wort should never be used at the same time as an SSRI’s, specifically because the combination can potentially cause Seratonin Syndrome. According to the American Family Physicians, in an article written April 1, 2005, “Serotonin syndrome is caused by a systemic excess of serotonin and is defined when at least three of the following signs and symptoms are present: mental status changes, diaphoresis, myoclonus, hyperreflexia, diarrhea, fever, tremor, incoordination, seizures, tachycardia, and QT interval prolongation.”

Due to a large amount of research done about Seratonin Syndrome, this contraindication is well known. However, there has been additional research that indicates that St. John’s Wort also has herb/drug interactions with other medications as well. According to an article published in the University of Maryland, St John’s Wort should not be taken with the following medications, without first discussing it with your doctor, “Antidepressants- tricyclic antidepressants, SSRIs, and MAOIs, Antihistamines, Dextromethorphan, Digoxin, Drugs that suppress the immune system, Drugs to fight HIV, Birth control pills, Reserpine, Sedatives, Theophylline, Triptans, Warfarin.” In addition, the article goes on to state, “Because St. John’s Wort is broken down by certain liver enzymes, it may interact with other drugs that are broken down by the same enzymes. Those drugs may include Antifungal drugs…, Some calcium channel blockers (taken to lower blood pressure), Statins (drugs are taken to lower cholesterol).”

In conclusion, St. John’s Wort is an important herb to be aware of, so as to guard against potential drug-herb interactions. St. John’s Wort should be used with caution, if used at all, with Western herbal medicines. In addition, it would be best to also use it carefully, if at all, in combination with Chinese herbal medicines. A person should be monitored carefully when taking both St. John’s Wort and Chinese Herbal Medicines simultaneously.

Written by,

Yasmin Spencer LAc, DAOM, Dipl. OM
427 F Street, Eureka, CA 95501
(707)616-6880

 

 

 

Bibliography

  • Paula Gardiner, MD, MPH, Russel Phillips, MD, Allen F. Shaughnessy, PharmD, January 1, 2008. American Academy of Family Physicians.  “Herbal and Dietary Supplement-Drug Interactions in Patients with Chronic Illness.”  Retrieved from:  http://www.aafp.org/afp/2008/0101/p73.html
  • Borrelli F, Izzo AA.  December 11, 2009.  National Institute of Health- Department of Experimental Pharmacology, University of Naples Federico II.  “Herb-drug interactions with St John’s Wort (Hypericum perforatum): an update on clinical observations.”  Retrieved from:  http://www.ncbi.nlm.nih.gov/pubmed/19859815