Could a couple of drops of an herb tincture enable someone who underwent open heart surgery to feel her chest for the first time in four years? Could it help you mitigate and prevent back pain?

In our society, it’s easy to think that the most complex, advanced medicine is the best cure for any and all pain. And yet, a powerful tool for pain treatment could be an overlooked plant growing in your backyard. In this episode, Dr. Sanjiv Lakhia and his guest John Slattery of Desert Tortoise Botanicals dive into herbalism and its potential. 

Botanical medicine has held a key role in medicine since ancient times. Herbalists and indigenous people have preserved wisdom on medicinal plants and how to use them, and they are reviving awareness about botanical medicine.

“In the way that the nature of a plant resonates with the nature of an individual, it can allow for opening and release in their physical tissue as the consequence of where that resonance meets, such that a healing experience can be facilitated within their physical body,” says John. “That may sound a little bit metaphysical, and it is, but it's also observable.”

Listen to this episode of Back Talk Doc to learn all about botanical medicine and how it can help you treat back pain and other ailments. 

💡 Featured Expert 💡

Name: John Slattery 

What he does: John is a bioregional herbalist, forager, and author. Inspired by his desire to improve the accessibility of botanical medicine, he founded Desert Tortoise Botanicals, a company that sells products made from sustainably foraged herbs. 

Company: Desert Tortoise Botanicals

Discount Code: Back Talk Doc listeners are eligible to receive 10% off their first purchase from Desert Tortoise Botanicals. 

Words of wisdom: “Because the body and the mind are inextricably linked, the so-called placebo effect is actually extremely powerful, meaning that how we hold our mind in wave form within our body consolidates into particle form into the tissue.” 

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👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode The Vagus-Trigeminal-Pain Connection with Sharik Peck, PT.

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at CNSA.com.

And so that has come into create the foundation for what I call bioregional herbalism. And these were all Indigenous peoples from the Southwest US, all the way down into Brazil, when I traveled over 20 years ago, for over a year through the extent of the Americas.Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery & Spine Associates, where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.

Part of my podcast over the last year has been to bring to you guys all sorts of approaches to help with your back pain and your injury. And now that I'm a board certified specialist in integrated medicine, in addition to my board certification and physiatry, I'm really hoping over the next few months to bring some different ideas to help you look at when you're trying to address your symptoms. Pain in particular can be very challenging. Particularly when we discuss medication approaches, as many of you know, a lot of the medicines that we prescribe as physicians do carry with them some side effects and some difficulties during my integrated medicine fellowship. One of the things that I was really fascinated with studying was the field of herbalism or herbology or botanical medicine. And it really unlocked and opened up a door to a whole new universe of options potentially, that are worth having a conversation about.

Today, I'm very pleased to bring to you an interview with John Slattery and he is a founder of Desert Tortoise Botanicals. And we're going to have a nice conversation today about botanical medicine and maybe dive into some pearls and options that you may want to consider on your path to wellness. So John, welcome to the show.

Thank you, Sanjiv. Pleasure to be here with you.

Okay. So let me go ahead and introduce you to our listeners. John is a bioregional herbalist. He's dedicated to helping people develop deep and meaningful relationships with wild plants. His work has been widely influenced by Indigenous plant healers from throughout the Americas, herbalist Michael Moore, and most importantly, the plants and wild places of the Sonoran Desert, and the broader bioregion of the Southwest United States. He founded Desert Tortoise Botanicals, a bioregional herbal products company, in Tucson, Arizona in 2005, in order to bring his wild-harvested plant medicines to the people of the Southwest, and Desert Forager, a prickly pear focused forged foods company, in 2014. He founded the Sonoran Herbalist Apprenticeship Program in 2010, and John is a practicing herbalist, he's an educator, an author, and a forager. His first book, Southwest Foraging, was released in 2016 on Timber Press, and his second book Southwest Medicinal Plants was released in February of 2020.

In addition to studying the history of oaks and acorns across the world, and how this ties into the ancient, earth-based civilizations of the Northern hemisphere, some John's current passions include bringing the concepts and principles of bioregional herbalism to a wider audience, visiting ancient, sacred sites and studying the wisdom passed down from the ancient cultures who built or occupied these places. So you guys can find out more about his work at www.johnslattery.com. And of course, we'll link to that in the show notes, and follow him on Instagram @johnjslatteryherbalist, or his YouTube channel. So that's a really good introduction to some of the work that you've been doing. And I, of course, encountered your work during my fellowship training, where you had some wonderful videos that walked the physicians through herbal medicine, how you make tinctures and salves, and some of the principles that go into it. So why don't you start a little bit by informing people how you got into this line of work and this passion?

And I didn't necessarily have an idea to create this, but upon reflection, what I had been through, I realized that they were all teaching me about becoming a bioregional herbalist in the way that I've labeled it. But really, another simple way is developing relationship with plants as a person of the earth. So that has contributed tremendously into how I use herbs for medicine, and has helped create a perspective and cosmology, if you will, on how I apply herbs and look for imbalances within the individual.

One of the things I've noticed about individuals that I come across, who are into this space, is exactly what you just mentioned. There seems to be a story where the individual also not just learns about plants and what X plant can help for in terms of conditions, but the cultural aspect that goes with it, and use the word developing a relationship, is so different than traditional pharmaceutical medicine, which is very reductionist, also very useful and helpful for millions of people. But talk a little bit to people about, in your perspective, the difference between herbalism and pharmaceutical development. Give us a little contrast of how you see it.

Yeah, I think fundamentally, it's a leveraging of widely available assets that have been distilled down into a finer substance via technology. And then there's a bit of mystique that's wrapped around them. And I'm speaking of course of pharmaceuticals in this case, there's a mystique that's wrapped around them through the arcane language of the practitioners, that's unreachable by the vast majority of people that even take them for decades. And this has happened as a consequence of people losing touch and losing connection with the world around them because they can't recognize or identify a handful of plants from their yard that their ancestors would've taken on a regular basis as a food or a medicine that supported their function of their organs, or relieved simple ailments, or provided much needed nutrients. And so in the absence of all that, there's a place within the individual, now they're more susceptible to being placated by grandiose ideas that would promise to cure them.

And we both know that one of the leading causes of injury and death in this country is properly prescribed over-the-counter and prescription medications and procedures. So there's a tremendous amount of risk that is underplayed. And of course, the risk of herbs is sensationally, dramatically overplayed. More people arguably die of chronic illness due to what's in the center aisles at the grocery store than anyone is injured, even injured by herbal medicine. So I think there's a huge chasm between pharmaceutical medicine and herbal medicine in terms of safety, and accessibility to the average person who is uneducated at the level of institutional education, but unfortunately, has also lost education that they had through simple practices and life ways that were connected to the earth.

I recommend often both. I do a lot of prescription writing in the world of spine care and acute pain. Sometimes nothing's better than a prednisone burst pack. But I will tell you, I think this is an important conversation to have because people are seeking alternatives, whether their physicians are recommending them or not. And from an accessibility perspective, it's very easy to go online or go to your store and buy some sort of botanical product. And I think what needs to happen is increase education of both providers and the lay public about how to use them appropriately, which is why I'm thrilled to have you on today. The other thing that I think is a difference that I've at least observed, when you study cultural medicine, like, let's say, traditional Chinese medicine or Ayurveda, or even Western botanical medicine, it appears to me that the plants, when prescribed properly, or at least the formulas, within the formula or within the whole plant, there seems to be constituents that are just naturally there, that offset side effects, that we don't see when we isolate a chemical concentrate and prescribe it.

So for example, in a traditional Chinese medicine formula, there may be one or two key ingredients, let's say, to help with pain, but there may be also one or two herbs that help offset any nausea. So that the whole is greater than the individual in that respect. Do you observe that as well when you're putting together recommendations, or looking at different plans to help people out?

Yeah, that can certainly be a consideration in formulation. That's a reason to formulate, is to balance out the ingredients, to be able to deliver the particular medicine that an herb carries, yet mitigate a potential risk or threat, to use a word that is maybe a bit overstated there, but to minimize harm, to soften the formula. That's a way to look at formulation. I don't know how much of the formulation in commerce is oriented that way outside of maybe, yeah, traditional Chinese medicine, by and large, as you brought up. But there are many things that contribute to a formula, and another is what they call synergy, synergistic effects, which I think you might have been hinting on initially as you spoke, that it's more than the sum of its parts. And when you bring certain herbs together, they can amplify their individual effects. One of the things that I had set up to share with you relates to that idea. And there's a concept in Western medicine, of a diffusive, and a diffusive is an herb that helps move things out towards the surface.

And that could be witnessed as increased blood flow. So if someone is palpably cold, and then upon ingesting this diffusive as an individual herb, or part of a formula, now they develop warmth and blood flow. So with different types of pain conditions, that can be very useful. For me, it's more, as a vitalist, I like to see what's the underlying root cause of this pain. I want to hear the person's story, I want to understand what's happening in their life, or what was happening in their life leading up to the episodes of pain, what has continued to happen, oftentimes, as we speak somewhat casually about this, but also somewhat pointedly, it'll start to bubble up to the surface, what it is there for them that's really paining them. And so because the body and the mind are, I believe, inextricably linked, the so-called placebo effect is actually extremely powerful, meaning that how we hold our mind in way form within our body consolidates into particle form into the tissue.

And so whether it's fear or some sort of emotional injury, trauma from birth, throughout childhood, that will allow repeated pain to surface. And for me, with herbs, as an herbalist, what I've learned working with plants, so this is where I really draw a distinction between bioregional herbalism and herbalism, in that I'm not relating to bottles on a shelf or words on a page, primarily. A lot of my students, I introduce them to the plants, I don't even tell them what the name of the plant is, will meet the plant in C2, in its natural environment. Maybe even ingest some of it directly from the plant or a preparation that I've made, and they still don't tell them what that is. So their impression of it is their sensorial impression, all aspects of their being. So there's something that can be transmitted to each individual that is unique, but it relates to the nature of that plant. That's how I like to put it.

So sometimes, what I'm getting around to saying, trying to say somewhat concisely, it's a broad topic that I realize not many people are very acquainted, with this nature of plants. But in the way that a nature of a plant resonates with the nature of an individual, it can allow for opening and release in their physical tissue as the consequence of where that resonance meets, such that a healing experience can be facilitated within their physical body. That may sound a little bit metaphysical, and I think it is, but it's also observable. And it's something that people physically experience, from what I witness.

There's no doubt, the longer I'm in the field of dealing with people who have pain and injury, that there is a mind-body connection and correlation. And in fact, I had a conversation with Dr. David Schechter, where he has talked about and put together some materials on the mind-body connection. And he put together a 30-day journal workbook that people can basically process their emotions while they're going through treatment. And we'll link to that episode in the show notes as well, for those you who haven't heard it. But he's on a terrific job. And I think it speaks to what you're talking about. And I came across this as well in our fellowship training. One herb in particular, I think it was when we were talking about doing our cardiovascular module, when we talked about hawthorn. And one of our professors mentioned that this also can be, in addition to the medical benefits, a low dose can be used to help quote "open the heart" when people have grief. And those types of clinical pearls are just fascinating because we don't have those in traditional Western pharmacology, at least it's not spoken about directly.

So that part is very intriguing to a provider, that if there are tools that are safe and have clinical benefit and can treat the mind and body, as it's connected, I think that's definitely worth exploring.

I have a quick anecdotal story for you on that. So one of the things I do, as I mentioned, I'll take my students out and we will meet a plant. I have it often prearranged, sometimes we just stumble upon it, but in this case it was prearranged. And we were going to go sit with this plant, and I passed around the tincture. And I had an idea of its effects, but it's also learning for me because I see how they respond, and then as close to a double-blind study as I'm going to be able to do with herbs in this way. So they know nothing about it. In fact, this herb, I understand, through some research that was done in Southern California, it's our native chia, it has properties, has compounds that are similar to danshen, salvia miltiorrhiza, red Sage and China. Thousands of pages have been written on this book. Certain hospitals in China, you go in with acute myocardial infarction, they will give you injections of compounds of this plant.

And so apparently, there was a story in Southern California amongst the Kawaiisu or Kumeyaay Indians, that there was a plant that brought people back from the dead. And somehow, these researchers, I don't know this part of the story, managed to put together that it might be salvia columbariae, our native chia. And so they grew it and then made a preparation of the root and examined it. And they found these same encryption ones and tension ones present and preparation. So I read that and I said, "Okay, I want to try chia in this regard." And I made a tincture out of it from what I gathered in the wild, and there was an opportunity with my students. So I brought the tincture along. I said, "Just take two to five drops." So we sat in meditation with it, and it just so happened that one of my students, she was probably in her mid to late fifties at the time, and she had had open-heart surgery about three or four years prior.

And so she took the drops of the tincture. This is mostly done in quiet, sometimes I'll be giving them feedback as we go along to help guide them, but mostly done in quiet. And I could see at some point that after she had taken it, she started to get teary-eyed, and I could see her putting her hand in front of her chest. And then afterwards, I didn't lead it at all. I just said, "If you guys have anything to share, please let me know. What was it like for you?" And she started touching her chest again, and said, "I haven't felt anything in my chest since I had my surgery." So when you talk about the subtle effects of that gentle touch of the herb, it's resonance, it's nature. That's something that pharmaceuticals will never be able to do. It's not a biochemical. And I think that is a very eyeopening moment, I think, for an open-minded researcher.

Absolutely.

The fact that biochemical reactions is not the whole deal. And so if not, then what is? What else is happening? I think if we really look at that with open eyes, we look at tremendously more expensive possibilities about how we can heal or restore wholeness within ourselves.

Wow, thanks for sharing that. That's definitely, at least for me, it makes me say what's that all about? For some, it may be, "Oh, that sounds strange." But I think as we ask good questions will only expand our knowledge base. Having said that, let me pick your brain though and dive into some more options, considerations on the physical plane, so to speak. I have a couple of maybe typical cases that I encounter. And again, if you're listening, I'm bringing you John's expertise for informational purposes only. Definitely, before you take action, make sure you work with your healthcare provider on any treatment or anything that you come across on the internet or on a podcast. But let's go into some common things. So obviously, I am the Back Talk Doc, so I see a lot of people with back pain. And I like to break it down, pick your brain a little bit, and folks, you can take notes, but we'll put these in the show notes, as he gives us his thoughts.

They're basically two categories. And again, when we're talking about back pain, I'm talking about orthopedic related back pain, not back pain from an ominous condition and infection or something of that nature. But basically, acute back pain. The average middle-aged dad, who's lifting a box in his basement and strains his back on a Saturday, and shows up in the office on a Tuesday and can't stand up straight, and he's popping ibuprofen. And then the second category, which unfortunately is probably more prevalent in this society, it's just age-related, chronic, degenerative back pain. And that category in particular, John, we have a scarcity of good options for people, particularly from a medication perspective. I'd love to hear your thoughts. I know you have people who consult you for just different recommendations so...

Yeah, thanks for presenting it in that way, because as you know, back pain's a pretty wide gamut.

Yeah, for sure.

I'm happy to hear what's more of a challenge for you in your line of work. So I think, for what I understood about your first case, I'll say that gentle and slow I think is the best way to approach it, in my opinion. That's maybe not where people want to go sometimes, they want something quick and they want to get back to work. And I think that would be my greatest challenge in helping communicate to them that this is not something you may necessarily change overnight because even though they perceived it to have happened in a split second, it was cumulative.

Yep.

Right. So I would imagine you have all sorts of tools and tricks, so to speak, within your office, in a way, to coax the body back into a relaxed state. I created some salves based on what other herbalists had done, Michael Moore primarily, one of my main teachers and also what I could find in my local environment. So I have three basic salves that I use for pain and they've been so effective, by and large, that I haven't bothered experimenting with other things. But I basically have two that bring warmth, and one brings a greater degree of warmth than the other. So in other words, I'm looking to increase blood flow.

Okay.

And I see when someone is, like you said, living in a box, there's lack of movement. There's perpetual lack of movement in their body, so they're developing a cold condition in their body, they're not moving their musculature, their lymph system isn't moving, therefore, and any number of things could be contributing to that acute onset of pain. But I know that if I can bring more of fluidity into the area and warmth, they stand at better chance of not further injuring themself, or exacerbating that injury, that tissue that got, twisted, , just enough to where they're really noticing it, but it was like they were walking on a crumbling cliff edge likely up to that point anyway. Yeah, so I use two salves. One is my arnica muscle balm. Anrica is a traditional herb from Europe, but we have native species in North America, that along with St. John's Wort and Calendula and calendula, and to some extent, yarrow, was used for all sorts of injuries. Open-wound injuries, closed injuries, bruises, breaks, sprains, and so forth.

So I like arnica in its ability to help restore organization within the tissue, once there's been some twisting and breakage and disruption. And then the cayenne I add in there, so the cayenne can be bringing enhanced blood flow, in fact. If you put that salve on, and you're out in the sun and you're moving and you're sweating a little bit, it'll burn. So you have a counter-irritant effect that is not unlike the multitude of capsaicin ointments that are on the shelf.

Yeah.

I haven't often been expected that was going to resolve someone's pain, but I can't tell you how many times it did, at least for a certain time period. And now I have another salve that I make that is a little bit more for, I consider it colder, in that it numbs out acute sharp pain. And just coincidentally, I've had people I've given that to that they've continued their mechanical movements, that aggravated it and exacerbated it in the first place, the lifting of boxes at their work or whatever. But in this case that I'm thinking of, it was a carpal tunnel situation. And so they had a lot of tension around basically to the cervical spine. And I told them, even though they had pain in their wrist, I said, "Rub it around the cervical spine and you'll start to get relief." And sure enough, they did. And he said, "You know what? It's become less and less, even though I'm doing the same thing."

So there's a lot that we could say about there. I think in some regards, the herbs can help dispel the accumulated tension and pressure that's building onto the impinged tissues.

Talk a little bit about, maybe if you can expand on arnica a little bit. It's widely available in different formulas. Let's say, at CVS or Walgreens, you can go in and get a homeopathic arnica vial with little pellets. Traumeel is a well known, widely used topical ointment that's been out there for a while, and in fact, that company used to offer Traumeel solution that you could do injections with, and I would pair that some with lidocaine for trigger point shots and things. But I believe that's no longer available. But help us understand a little bit to your knowledge about how arnica works. Is it an anti-inflammatory?

Yeah, that's a little bit hard for me to say, to be honest. Frankly, I think it's all theory.

Okay.

And I don't really have a good theory that's formulated within my framework to speak clearly on that. But what Michael Moore, again, my primary teacher in herbalism, had stated years ago, is that it helps rearrange disorganized tissue. So if you twist an ankle and now you've got all kinds of interstitial fluid mingling with torn connective tissue, it helps resolve that really well. They would say pain on movement.

Okay.

Arnica is very good for pain on movement. In this case, where I combine it with cayenne and a few essential oils, it seems to do really well for sore back muscles.

Yeah, excellent.

And so I think that, here's back to your point previously about combining herbs in certain ways helps to expand the useful. I wouldn't rely so much on just arnica for back pain and arnica salve, but combining with the cayenne and the essential oils. Not to say if I just did cayenne and essential oils, it would do the same thing, I think the arnica does contribute, but I think it contributes a lot more once I've combined it with a relatively small amount of cayenne. About the homeopathic version of arnica, I've worked with that in the past. It's actually a dilution of what I would make in the field, of tincture of arnica or an oil infusion. Oil infusion is primarily what I use and that's for the salves. But the homeopathic is going to be, the philosophy is that it becomes more potentized as it becomes diluted, by 100, 1,000, 10,000, and so forth.

In my personal experience, I haven't witnessed a whole lot of benefit from the arnica homeopathics versus the so-called mother tincture or the mother oil, as it were. In fact, one anecdotal story I have is a neighbor had twisted her ankle and she was laid up for a couple days and I went to visit them. And she told me that she was taking arnica and I said, "Oh, okay. What, what kind of arnica?" And she showed me the pills, the little milk sugar tablets.

Yeah.

Homeopathic tablets. And I said, "Okay, I want you to try something." So when I make arnica oil, I press it out, after the herb has been sitting in the oil. And this is arnica that I gather from the mountains myself, I've never used anything else. And that's really hard to find in the marketplace. I'll come back, there's another comment I want to make about that. But when I press it out, I save the herb, I take the oil and then make the salve but I save the herb to use as a poultice because I find it so valuable. So I said, "Here, this has already been extracted, but I want you to try it out. And we'll warm it up in a steamer tray and then apply the herb directly to the skin with a cloth over it." And she was up and walking around that night after doing that treatment.

Wow.

Night and day compared to topical or internal homeopathics. And that's something that's already been extracted. So I have great deal of faith in arnica, topically, for injuries.

Okay. So let's pivot, let's say, that same individual we apply the salve and his back pain is better, but it develops into more of a nerve pain, maybe like a sciatic pain down the leg. You mentioned St. John's Wort, and I know there's some others. What's kind of, in your brain, your go-tos when someone's got some nerve pain? Whether it's down the leg or a carpal tunnel, shingles pain, those types of things. Those are very, very difficult for people to deal with.

Yeah. And fortunately, but unfortunately, I was one who dealt with sciatica in the past, such that I was completely bedridden for a week and had to crawl around. So I know what that type of sciatic pain is like. And that's actually when I've made my first tincture, almost 20 years ago, prickly poppy, Michael Moore wrote about prickly poppy. It's in the poppy family and it's a wild plant in our area, and I have it on my website. We used it also for menstrual pain. But it showed promise perhaps for people with sciatica. I took some of it internally and it didn't seem to help my sciatica at all. And there's other members of the poppy family or related families, California poppy. Actually, those are the two herbs prickly poppy and California poppy that are in my nerve sedating salve, which is something that I might use when there is a sharp, pointed pain that seems to be involving nerves.

That was the same salve that I gave to the friend who had the issue with the carpal tunnel. And then another herb that I might use, there's a lot more I can say about this herb, but I'm trying to be concise, but corydalis was once part of the poppy family. I feel like it has a greater breadth of how it helps an individual deal with pain. If the individual is willing to collaborate with their body through their mind, it's like the corydalis gives the mind an enhanced vehicle to permeate the pain, and to get around it or get underneath it, such that they do not perceive the pain anymore. It's an interesting thing that I've only witnessed with corydalis, but as I say, someone who's motivated or connected through their awareness of their body, and they have a more active participation with that pain, not just, "I just wanted to switch shut off," but they would be excited to gain this ally that could help them move through the pain more effectively as they try to do that themselves. And that's corydalis.

Yeah. One of my first podcast episodes, that interviewed a friend of mine, Dr. Alan Tillotson, he used to be, I believe, former President of the American Herbalist Guild. He's out in Delaware and has a great practice, where he deals with a lot of neurologic issues. And we did an episode just on neuropathy. And he had mentioned corydalis. And even to the context that some research showing potential similar efficacy as the traditional medicines like gabapentin or Neurontin and that it was being studied out in the West Coast, in the United States, at, I believe, Stanford, and looking at some of the properties of that plant. So I'm glad you mentioned that. Now, you're talking about, initially at least, you've mentioned a couple formulas that are salves. When should someone consider going to a tincture? And even more basic, can you just explain to people who don't even really know what that means, what a tincture is? And then how, as an herbalist, you're kind of organizing in your mind if someone should take something internally versus topically?

Yeah. So the simple question to answer is that a tincture is an hydroethanolic extraction of the plants, i.e., you take fresh or dry plants and then you add, generally speaking, water and alcohol, water and/or alcohol. Sorry, alcohol and/or water to extract the medicinal qualities of the plant because those two solvents are primarily used because they're the best solvents for what plants carry. And then given that it's alcohol, it's shelf stable, and it's relatively concentrated compared to a cup of tea. So it's easy to transport and take small amounts over an extended period of time, and not have to worry about it spoiling, which one would for a tea. So that's what a tincture is. And to some extent, what its benefits are, they can also be used topically of course. And then your next question was...

Just determining when someone should consider taking herbs internally, through the tincture, or topically, when you're having pain, or should you be doing both?

Yeah. I think in some cases, depending on what the pain is, I feel like some people I've dealt with, it's very, very rooted in a physical musculoskeletal area of the body, that a salve would be far more beneficial than the internal. And so if a salve works in that case, great. The one thing that I would say might be an exception to that is the juice of prickly pair fruit. Ande juice of prickly pair fruit has probably been the most consistently phenomenal, I will say that, internal pain, musculoskeletal pain remedy that I've used, when I didn't even expect that that was its main attribute initially. I was looking at it as a restorative to the metabolic function. But that gives an insight, in the Chinese system, where those two overlap, and it took a friend, an acupuncturist friend, to help me see this, that's of the liver yin tonic. So liver yin is intimately connected with metabolic function. And you could say lubricating of the sinuous. And so it has more to do with ligaments and tendons than it does muscle. So certainly articulations.

Yeah.

Of the spine and the entire skeletal system. So I've seen people recover from injuries and arthritic pain very, very quickly with small amounts of daily prickly pear fruit juice.

Do you have to be concerned about any glycemic response if you take that routinely?

Prior to a few weeks ago, would've I said no. But I have a client who supposedly has had a very, I couldn't recite it back to you, but a very rare and unusual internal procedure done. She's one of like two dozen people in the world, and she gets an immediate distinct drop in blood sugar, drop, she takes.

Oh, okay.

Yeah.

No, I'm just thinking about any concentrated juice, you worry a little bit about the sugar and, well, the fruit sugar, would it cause.

Prickly pear fruit and it's pad, have about the lowest insulinemic index of any food on the planet.

Wow.

Yeah. So that's something that I've made into a fruit juice concentrate. And that's what's given me the ability to experiment with this, with a lot of people. And I actually have a private client recently who his back pain he told me was completely gone after a few weeks of working together. There's we did do some internal herbs as well. But that was a major intervention that we made, was daily prickly pear juice. So why else may I want to give someone internal herbs for back pain? Could have to do with what I feel the source of the pain is. Of course, there's non-spinal back pain, it might have something to do with kidney function. So that would definitely warrant internal as well as topical use. I also look at things from a vitalist perspective, in that this is very basic hot, cold, moist or dry. And I've noticed this, year after year, where I live in the Sonoran Desert, which is predominantly dry, but then this time of year, we get a lot of the moisture and a lot of heat.

So people tend to develop what traditionally would be called rheumatism.

Yeah.

Where there's a lot of liquid, damp accumulation around the joints, could also be in the back, but tends to be more elbows, knees, wrists. And so giving internal herbs that would help clear the lymph and drain stagnant liver function, maybe diuretics even, all of those could be helpful to relieve pain. And maybe not the most common, but could be related to back pain. Another area where I've seen the internal use as well as topical become effective is upper back tension, can definitely have a strong, emotional, or least psychological component to it. And people preoccupied with thoughts and worries, or needing to perform at a certain level, whatever it may be, that it reads rigidity in the back that, at certain point in time, you can no longer sustain that and it's very painful. And so there's two herbs that I have in my repertoire that I think of one is lobelia and one is verbena.

And lobelia was a classic herb used by the doctors of the 19th century. In fact, there was a country doc, you could call him, that develops his practice around lobelia. Lobelia was the cornerstone of his practice, lobelia and cayenne, Samuel Thomson, in the early to mid 1800s. So that is essentially what lobelia does. It does more, but I might say primarily, it induces the parasympathetic. So when this person is overwrought with tension, stress, psychological stress, they're sympathetic stress response is up, lobelia can shift that into parasympathetic.

It seems like that should be a part of every prescription.

Right? Yeah. It's definitely a remedy, you might say, to the pitfalls of our culture.

Yeah, for sure.

Although that would probably be the last thing people want.

Right.

Because it's not going to necessarily help performance. But yeah, so that opens up a category or genre of herbs that I would say has probably grown substantially over the past decade, more so than any other category of herbs that I'm familiar with, and that would be nervines or nervines, however you like to say it.

Mm-hmm.

So yeah, there's more tonifying, more relaxing, many herbs do both. That's the confusing thing for people, and herbs are, I would say, intelligent, in that they can resonate and correspond to the needs of the body, such that when a relaxing effect is needed, then that's the effect that's brought forward. When a tonifying effect is needed, that's the effect that's brought forward. It's kind of built into the herb's nature to be able to facilitate movement towards center for the body. Going back to your original question about the difference between pharmaceuticals and herbs, that's definitely at the top of the list there.

Well, they're just more elegant. I mean, when I hear you talk in this language, and I've heard it before, and it's just a more elegant description of how things can work. All right, I want to be respectful of your time. I've one more category I wanted to get your thoughts on before we close.

Sure.

In traditional medicine, I mean, when people come in pain, our first thought is inflammation. So we're prescribing anti-inflammatory drugs, like over-the-counters, NSAIDs, non-steroidals, and prednisone. When I go through my coursework and my training and understanding of maybe some botanical options or alternatives, the classic ones discussed are turmeric or cumin, a fish oil supplementation, boswellia, ginger, these are the types of things that come up. But I haven't encountered anything, and I'm just going to put you on the spot, and you may not have an answer and that's okay, but is there anything in the herbal world that would be on par or similar to prednisone, maybe beyond licorice, maybe licorice is there. But there's so many people that could benefit from even short courses of prednisone, but can't take it because of their type 2 diabetes, or because it puts weight on, or raises their blood pressure. So I've always been on the hunt for a suitable alternative in that acute pain field, or just in general, just love to hear your thoughts on maybe your top two or three go-tos to reduce inflammation rapidly.

Yeah. As a vitalist, that's really hard for me to contend with.

Yeah, it's very reductionist.

Yeah, right. And so I'm going to challenge myself to speak on it from this perspective. So what I hear you saying, in part, in that question is that what you've witnessed is that many of these things that are listed don't really serve under certain circumstances, like the turmeric, the fish oils.

Correct, correct. I mean, I look at those as maybe good fertilizer for the body, but I need a weed killer, in the moment. So there are some times where I can do a higher dose of turmeric and someone can feel a therapeutic benefit within a week or two. But certainly, I don't observe that with fish oil supplementation, I don't observe that with ginger. The only one that I might see that does a pretty good job rapidly is boswellia. I've definitely seen some improvement with that in the short term. So I don't know if there's any others that I'm missing.

Yeah. Well, I think one thing that we're missing as a whole that would help restore people because we can't think that they've got a prednisone deficiency, right?

Correct, yep.

And I know you're not trying to claim that or operating from that perspective. But just to state the obvious, what are some of the traditional methods that were used that were in line with mobilizing the vital force within the individual? And unfortunately, there's so few of those practices that are integrated into the modern field, where I feel like that is, it maybe is not as immediate and is not so simple and quick, immediate is the same thing, but could coax the individual's vital force back into the area that is evidently screaming.

Right.

Screaming for their attention, whatever it may be, whether it's how they position themselves in the chair at home, and work, and to and from, or the lack of mobility, what they're eating, all of the above, how they processed whatever they feel coming up in their body, or absolutely don't feel for that matter. I realize that's not what the general customer is looking for or asking for when they come in with that severely sharp pain. But I think, unfortunately, someone like yourself, who's dedicated to helping people, is quickly painted into a corner, when the impacts on the individuals become so severe that there really isn't a finger to fit that hole in the dyke anymore. And I wonder if collectively, culturally, if we're not inching, encroaching on that space, where the effectiveness of this arsenal is weaning.

Yeah. No, that's great, and that's why I like an integrative approach. And as a DO, I feel really good that I can offer people treatments from both aspects. So yes, someone comes in, I can give them an injection, I can put out the fire, but then I can ask questions like, or at least make statements like, "Look, your nerve is pinched in your back because it doesn't have enough space. If you really pay attention, that's your body's way of saying you don't have enough space in your life. What do you need to let go of in this moment to not only create space in your back, but in your life as a whole? So we don't have this cycle through every three months."

Mm-hmm.

And I think sometimes we don't take the time to ask that in medicine, in our brief time we have with people, but maybe the answer to my own question is that some of the things you're talking about can help people achieve that balance and stay balanced over time, while some of the other tools in my toolbox can help them get back on track when they fall. But they certainly can't, in isolation, keep them on the right track. And I talk about that a lot with people, that I think at least in the world of orthopedics and musculoskeletal care, from a medical side, I kind of feel like I'm the bumper rails, like in the bowling alley when you have young kids and they put up those rails so the ball doesn't go in the gutter. It's like I can keep you out of the gutter, but I can't bowl the ball for you in the right direction. And maybe some of these other tools, particularly herbalism, can be something that people learn over time to integrate into their own lifestyle.

Certainly. And hydrotherapy would be the one that I would say, that could have the most profound effect for people. And it's just a matter of what you have access to. Ideally that would be in nature, and if somebody has hot and cold water, to go back and forth between that can be exceptionally feeling revitalizing. That's one of the things directly I was inferring.

Are you talking about hot-cold contrast baths?

Yes. And people can do that in the shower as well. It may not relieve an immediate, very sharp pain, but I think to pick up on what you said, you might be able to help someone take that edge off of a really sharp pain, and I think that's a great way to maintain enhance blood flow in your body, or to help reestablish proper blood flow in the body. And you do that with herbs and whatever else you're offering people in terms of exercises, and mind-body awareness, then that, I think, cumulatively, you could really start moving, like all the little [inaudible] moving the giant one by one. There's isn't one little [inaudible] trying to drag the giant by his toe.

Yeah, absolutely. All right. Well, before I let you go, one final question. And again, I'm putting you on the spot. I didn't give you all these questions ahead of time so...

No, it's great. I love it.

As a man of nature, someone who's really connected, can you share with listeners maybe one or two tips, habits that you have integrated into your life, to help you stay vital, stay healthy? Particularly over the last several years, where I think the mental-emotional burden across the world has, at least in my lifetime, obviously every generation has their challenges, but at least in my lifetime, I haven't seen anything like it. So what are some simple things that you think people who listen to this episode today can maybe start right away, or at least consider looking into?

Yeah, I appreciate that question. And yes, I concur. It's a been very challenging past year, year and a half, frankly, but where I find solace personally is my retreat to nature, and that can look differently, certainly for different people, but where I think there's tremendous benefit awaiting us is where we stop and listen, and we feel. We are a part of nature, nature is a part of us. We are coaxed into a very narrow area of existence, narrower and narrower, according to the apps on your phone, and whatever you're doing with technology throughout the day, through your work, in your vehicle, in your home, everything is "smart". And most people in urban environments have lost touch, almost entirely some, with the natural world around us. And what I found, years ago, when I used to take people out, first started taking groups of people out on walks, I realized I didn't need to do much, but just facilitate a journey.

And if the people were really there to experience what was there for them, they could experience more than I could ever create for them, that I could ever package up and offer them because it's their engagement with the natural world. So to wrap it up, I think being present in a way that inspires you, but maybe also challenges you, to go for a walk alone in nature and talk to the trees, talk to the ocean, talk to the prairie, wherever you're at. Give yourself an opportunity to let some thoughts off your chest, or simply feel what's out there for you. And if that's difficult for you, that's diagnostic. So it's diagnostic of lack of mobility in that aspect of your humanness, and that lack of mobility in that aspect of your humanness will spread out into other aspects. So when they say pick your weakness and focus on that, enhance your weaknesses to balance out with your strengths, there's a very clear sign that that's something for person, if they don't feel anything, or if they have a really difficult time trying to relate to nature, that's fantastic diagnostic information.

Oh, I love that. And the science nerd in me says there's also good scientific data that being out in nature positively affects your white blood cells, your immune system, culturally it's been called grounding, forest bathing. And if you don't believe what he's saying, all you got to do is spend a weekend at the beach. I mean, folks, I don't know anyone who doesn't love the beach. And for me, when I'm at the beach and in nature, in the ocean water, my entire nervous system is different. I feel it, I feel more connected. I just feel like a totally different person. And I love that tip. I think that is a tip, if you're listening, that costs you nothing, that you can start today, and reap the benefits right away. So thank you for sharing that.

On that note, I'm just going to share some quick words. There was something I pulled from a film in Ireland. And let me see if I have it here, I thought I had it close at hand, if you just give me a second.

You're already out in nature, we're recording this. I'm seeing John over video here and he's in his yard and he's got his, I don't know if that's a pear tree or what that is.

Pomegranates hanging behind me.

Oh, delicious. Love it.

Maybe you can see some of the grapes too.

Yeah.

Okay, so this is from a man named Patrick McCormack in the West of Ireland from a film called The Silver Branch. And it says, "I take a look at my home life at times, the dark areas, the vulnerable areas. When you walk on the rock, be in the woods or sit by a stream, you can talk to that stream, you can talk to the woods, and you can talk to the trees, and you can leave your foot on the earth. For me, it's to let nature work on you. I think that's the essence of how to be in the world. To find your place in the world is to let nature work on you, just to be and be part of, be part of the silver branch singing." That's what I wanted to share.

And thank you for sharing that, that's terrific.

To inspire everyone to let nature work on them.

Love it, final take home point. So thank you so much for your time today. I think we covered a lot of material. I really just wanted people, more than just getting an idea of a specific herb for a problem, is just to understand your passion for how we can have a relationship with nature, with plant medicine, and that it is a whole nother path to explore. I encourage you to look at the show notes and then, he does sell his products online and we'll have something in the show notes for people who are interested in looking at that, and links to that in the show notes as well. And they do work. I've ordered some of them myself. John, I also have, we didn't talk about it, but I purchased the salve you have for skin, cuts and bruises and irritation, and that stuff, it's like gold. Particularly when you have kids, it's awesome. It takes the tears away.

Yeah.

So definitely very, very high quality stuff. And I look forward to connecting with you further. I'm hopeful I can be out your way in 2023 and love to talk more.

Fantastic. Thanks so much for having me, Sanjiv.

Okay, thank you.

Thank you for listening to this episode of Back Talk Doc brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.