[MUSIC] I'm delighted to interview Sharon Kotzer who is a medical herbalist, and a director of the Research and Development in Bara Enterprise factory, here in Israel. And Sharon, thank you for coming to this interview. And I would like to ask you about your approach to herbal medicine and let's just begin in definitions. What is really from your perspective, what is herbal medicine? And which part of the herb you use when you put use medications, herbal medications? >> Okay, herbal medicine is really the use of the whole herb. It doesn't mean that we use all the parts of the herb, but it means that we take all the ingredients there is in the herbs. It means that we don't extract only one ingredient, what we call active ingredient, but we take the full spectrum. It's quite many things together, coming in some kind of biological balance. And for every herbs, we use actually a different part. Sometime, different part from the same plant, with different properties or different action in the body. So sometime you use the roots, sometime only the cortex of the root, only the upper part of the root. Sometime you use the flowers, the seeds, the stems, the leaves, everything. And sometime we actually use the whole herb, everything going into the extract. >> And do you include in that animal part, as well, or minerals? >> Not so much in what we call western herbal medicine. We don't use it, at least not in the modern herbal medicine. We use only herbs in the Chinese medicine but also in the old European traditions, sometimes we used to have to add some other ingredients, something metal, salts, and sometime animal parts. But not anymore. >> So what's the basic difference between what you do as a medical herbalist and conventional medicine approach to herbs as medications, as drugs? >> The difference is actually very big. Sometime they say in western medicine that ,okay, still 25, 30, 35% of the medicines are based from botanical base. Okay, it is true, but they usually extract, always extract, only one active ingredient, and they take it out of the whole. It doesn't affect anymore, it doesn't influence the body as a full unit. It's only one specific ingredient, which is usually very, very strong, very often with some kind of side effects. The herbs are coming together, so that's the first thing. In herb, you can say rule number one, we use the whole thing. All the ingredients together, some of them are doing more than others. But the others ingredients they are usually make it less toxic or sometime even enhance the effect of the active ingredients. And sometime do some other things so herbs are very varied effect. That's first thing, and the second thing, we usually combine herbs together. So even if I treat something like pain, I don't only try to influence the pain reduction. I try to influence the inflammation and sometimes the conditions of the nervous system as a whole, because sometimes the person is very uptight. We usually work on different systems at the same time, and we don't target only one purpose, or one. [COUGH] We don't try to influence only one system of the body. But we try to do it something which is more a wide varied. >> Or holistic maybe. >> Yes, it is holistic actually, it's true. >> So you're less into the specific ingredient or specific herb but you're looking for an additive effect or synergistic effects between ingredients in one plant or between several plants. >> Yes, that's what we are doing. For example, pain, it always have a reason, okay? When you take drug to reduce the pain, usually they influence something very specific. Some receptor or some activity, physiological activity, in the body. But we try to see what is the reason for it? Maybe there is some contraction, or maybe there is some kind of dilation, or maybe there is some kind of overactivity. So we are doing the same thing. At the end, we want to reduce the pain, but we do it from different directions. And we enable the body better physiological activity actually. It's helps the body to help itself or to resolve the problem. >> So how do you establish the quality of the herbal product you produce here? What are the ways to establish that? >> Okay, this is excellent question. First of all, it's a traditional knowledge. Its starts from the traditional knowledge. We have traditional knowledge of so many years. Many, many generations of until maybe 100 years ago herbs was the drug of choice. Medicine is actually herbal medicine. It changed only 100, 200 years ago. So we know what the herbs are doing and we know what part to use. And we know how to extract it and we know how to use it. And we know how to combine it. That's the traditions tell us this, it's written. >> Like a basic literature, like a textbook. >> Textbook the western herbal medicine, Chinese herbal medicine, Arabic herbal medicine. We all have these kind of herbal medicine books, or materia medica, which it's very accurate. Today in the modern herbal medicine, we take this tradition, but we add the advantages that we have of the 21st century. We can know much better how to extract the ingredients in the best way to preserve them. And then we also have the pharmacological and clinical research, which shows what to use, how safe it is, for how long we can use it, how it's influenced the body exactly. So we know the safety and we know the efficacy even better than before, but it's all based on the tradition. >> So actually, I mean, in your factory, when you produce herbal products, or take several herbs and package them together. How do you know if it's a good quality? Do you have something like GMP, or another way to standardize the quality of product? >> Okay, we're living in a very exciting era or time for herbal medicine, because in a relatively accessible way, we can approach herbs from every corner of the world. And this is great, we can use these things which in the past we can only dream of. And we can pick it up in Jamaica, and two days after it's here, and things like that. At the same time, you also have a very difficult questions of quality. It'd have to be safe, it'd have to be a great herb. We have to recognize the herbal in a in the best way. And for that we used many, many, methods of analysis of, actually of modern analysis. >> Which kind? >> It's a modern herbal medicine and modern analysis. We used analysis for quality, so we can recognize that this is the accurate herb and it's accurate in quality. And we do it according to some kind of, we call it a chemical markers. They're not necessarily active ingredients but they're markers from different groups of biochemicals like or- polyphenols, that we recognize it with H, B, C, or different methods. And we know that if it's in this and this range, it's a high quality herb and we can purchase it. In addition we have analytics for safety. It means microbiology, heavy metals, residual of pesticides and thing like that. These all just, can not cross the borders of Israel. Everything have to be approved by the Ministry of Health. And at the end of the day we've had, it proves itself safe, first of all, and high quality in addition. So we know what we have is real. It's high quality and it's safe and we can start the process of extracting and combining and all the process until we have the final herbal medicine. >> So the final product, how does it look like? It's an ointment? It's an? What kind of products you have? >> What I use, or what we use here in Israel or in Bara herbs. It's usually or in a liquid form, it means extracts which are based in water. Water and ethanol, water and glycerin, this is a traditional thing. Sometimes syrups, it's based on sugar or some other additives. And at the same time we have herbs which are based on dry extract. Sometimes you take them in a powder, sometimes in capsules, in tablets, etc. We also use of course, ointments and oils. Steam inhalation and other things. But we use them less. The internal medicine is the first choice and the external come after. The internal medicine is usually liquid or in powders. Powders and capsules, or tablets are actually very similar to chemical drugs. It looks the same, different color sometime. >> What's the difference between Western herbal formula and Chinese herbal formula? >> Yeah, Chinese herbal medicine is based on classical formulations that you find in different books. Some of this formulation, this classical formulation existed for many many many generations, some of them maybe more than 1,000 or 2,000 years. And they are specific for some condition, and they are usually you take them or you give it after accurate diagnosis. Or you add or reduce or change it a bit, what the Chinese practitioner called modifications. So then it's very much specific, and that's what they train for, but they are based on, usually they are based on classical formulations. In Western herbal medicine, we don't have it all, we really build it from scratch. It means that when a patient come to me I diagnose and do all the necessary things and when I come to build the plan and the formulation for the person and for the condition, I really start to add herb by herb and create a new formulation which was never exist before. Sometimes it's really great because I have really 100% freedom to really diagnose what I feel is the right thing to do. And sometime it's complicated. Because when you have some kind of basic formulation and you know, okay, this is good for this condition. Let's just make little bit of change. In a way, it's easier to work, but it's a big difference. One method is working on something which is exist, and the other one we start from zero. >> So you may say that in Western herbal medicine, it's more patient tailored and less strict compared to the Chinese ancient knowledge? But there is a sense of modification and the chain is very formal as well. >> Yeah. >> But it's basically more free, or more free associated in herbal approach from the west. So typically how many herbs are included in a Chinese formula? >> Chinese formulas can be any number. Can be sometimes single herb or two herbs. But it's usually more than that. I would say, average of maybe eight or ten herbs. Which is quite a lot. Or Western herbal medicine it's usually maybe four, maybe five or six herbs. Which more or less half than the amount that we find in Chinese formulations. It's a big difference and I think you're right, there is a bit more freedom in a way in western herbal medicine. I don't say Chinese medicine is so rigid, but it is more rigid. It's more broken according to some regulations and rules how to do it and what to use. Yes it is true. >> Shawn along the years we had a lot of conversations in the ongoing dialogue about the specific formulas that we designed together. >> Yeah. >> Regarding fatigue for example. >> Yes. >> Of patients undergoing chemotherapy. And the other time I was the one that was very bothered let's say with the safety concerns. >> Yes >> Now how would I as Western clinician can work with the Chinese formula that include eight or ten herbs? In terms of herb drug interactions and so on. I mean are there specific safety concerns in Chinese herbal medicine, specifically in the oncology realm? >> This is different world today, because you combine the drugs, sometimes the chemical drugs, biological drugs with traditional medicine. That's something which didn't exist before. So we have to invent, and see how we work well together. And this is absolutely not easy thing to do. And the more herbs you put in the formulation, you might have more problems and yes, herbal medicine or herbs are very potent. They influence the body, they influence the liver, they influence the nervous system, they influence the circulation. They change something in the body chemistry. So theoretically it can change the absorption or the action of the chemical drug. It is difficult. In a way everyday we have more and more knowledge about it, there are some special website let you know all about them. And they're all the time trying to test and see how the herbs influence or not influence, safe or not safe. I don't think there are golden rules about it. I think you really have to check it properly. Now sometimes you can say, okay, this and this herbs might react or influence the action of specific drug. Okay, so you can say, I don't have a choice, I have to give it up. But I say, well, maybe it's too fast to say something like this, because sometime you have to see how much there is in the formulation. Maybe it's a very small amount. And then I don't say that it's not true that it can change something. But with this amount, it's actually the inference is very weak, and you actually say it's safe to do it. It very often has to do, how important the herbs are. If the person is in a very crucial stage in the chemical treatment, and he say, well, I cannot change anything now, and now it's life and death situation. You won't take any risk, but if it's more palliative care, it's a different story, so there are many consideration. And it's something that for myself, and also here in the company, we are considerate and check it all the time, it's not easy answer to it. >> So what are the leading herbs, in Chinese medicine, in terms of integrative oncology? >> Okay, I'm not a Chinese practitioner. But I would say, because if I was a Chinese practitioner, I would tell you, okay, this combination, it's going on, it's very complicated. And in Chinese medicine, it's always complicated. It's according to your condition, and your syndrome, and your symptoms, and it's never simple, okay? And this could be really big variation of very important herbs. But I would say still, the leading herbs, the herbs which are researched better. And the good thing is that the Chinese government invest a lot of money, of investing their traditional medicine, or their traditional herbs. So we have quite a bit of research on Chinese herbs, in regard to oncology. So I can say, yes, we have some herbs, that we know that they are very active in different conditions, and different influences in cancer treatment. So some of them is, of course, the Astragalus, which is very common now, and also in use in the West. We have different kind of medicinal fungus, or medicinal mushrooms. Like the reishi, or the maitake, and the shiitake, which are proved to be very active in different things. And of course, we have the ginseng, which is very interesting, to see how it influence. The ginger, the licorice, or the Glycyrrhiza, which is very interesting influence. And on some of these herbs, we have quite intensive research to show that, at least very interesting, and it's, in a way, proved the traditional knowledge. And there are different and different herbs, that we are dealing with them. So today, when I, as a Western practitioner, use Chinese herbs, I usually pick them according to how much is new research we have on each one of them. And then I combine them, with my understanding of the herbs. I do understand little bit about Chinese medicine, and Chinese philosophy, and I don't ignore it. So I do take care, if they influence in, [COUGH], the body, and I know if it's warming, or cooling, or what it does to the liver, according to tradition. But usually, when I use them, I base it on the new research. >> So what you do is Western interpretation- >> Yes, yeah. >> On the traditional Chinese medicine herbs? >> Yes, yes, for me, it comes naturally, because my way, it's Western thinking, so yes, I take the new interpretation. And as I said, I use the traditional knowledge in the background, it's also very important, and then I combine it with Western medicine. Some of the Mediterranean, some of the European, some of the American, some of the Ayurvedic. As I said, it's a very exciting time for herbal medicine, because we can use the whole thing. The knowledge is available, the translation is available. The herbs are available in high quality, and in a variation which is unimaginable, few generations ago. So we can combine them all together. I was trained as a Western herbalist, okay, a medical herbalist, or phytotherapist. And my teacher used to say, let's use the European and Mediterranean herbs first. And for a long time I said, great, I agree, let's use them like this. But I think it's impossible today, everything is so available. The knowledge is available, the research is available, so I combine them all together. If you see my typical formulation for constipation, you can see, this is from India, and this is from China, and this is from Israel. And this is from Lebanon, and this is from Iran, and this is from United States, and I combine them together. So I said, it's exciting time now for us. >> So as a medical herbalist, a Western medical herbalist, how do you perceive Ayurvedic medicine? What is unique, from your own perspective, regarding Ayurvedic medicine? >> Again, this is a different method, with a full system of diagnosis, and treatment, and rules of creating the formulation. And again, it's a great system, it's very effective. Also, what we call Ayurvedic medicine, it's not real. Because in Ayurvedic medicine, there are so many branches, and so many approaches, it's not one system. For me, I'm very attracted to it, I think it's great. They put lots of emphasis on taste, every herb, it's a combination of taste. And they combine together with some kind of foods which, based on taste and different methods of diagnosis. Which is, at least for me, it's very easy to understand when I diagnose. >> Well, what do you mean, taste? I mean, what's the unique aspect of taste in India, or in Ayurvedic medicine? >> Well we are some kind of feeling machine, okay? We have five senses, which are very intelligent senses, and the sense of taste is a very advanced sense and system. When we are talking about, if I explain to you about taste, we see that we are very limited. It's satly, it's sour, it's spicy, or it's sweet, etc. >> Sweet- >> But actually, it's not true, the taste, you can divide it into so many other variation of taste. And each one of them is a piece of information. Your taste buds on your tongue, mainly on the side of your tongues, are getting this chemical irritation, or chemical signal. And they're sending the signals to the brain, of course. And then the brain activates the immune system, the digestive system, the secretory system, the psychological system, the endocrine system accordingly. Mainly via the vagus, or the, [COUGH], parasympathetic nerves, but much more than that. So it's a signal to the body, sometimes a defense system. Okay, this taste is a bit strange, let's take care of what's going on there. And extreme things, we will throw up, we take it out. And sometimes, we excrete a bit more hydrochloric acid, to break it down. Sometimes speed up the metabolism, or speed up the peristaltic movement. Sometimes influence the liver or the immune system, to work accordingly. So the Old Indians somehow, also the Chinese, but also the Indians, find out, and they observe it, and say, whoa, it's very influential, and develop- >> And the taste. >> The taste influence the body in a very interesting way, and they develop a full system, how to use this taste. >> Together with a full system of how you diagnose you, or patients, according to specific character. The Kapha, the Pitta, the Vata, the air, the, [COUGH], the fire, the water, etc. So they diagnose person in a very specific way, and they give him specific herbs and specific dietary advice accordingly. It's not very difficult, it's very difficult when you go into very high standard of ideas, of course. But the basic of it is very beautiful, it's very nice, and I always like simple things. In a way, it's simple. So, based on your experience, which are the more prominent herbs regarding oncology that comes from medicine? >> First of all, of course, is the ashwagandha, it's the vitania or the Indian ginseng. Which of course is not accurate name because not from the ginseng family. But it's a great, what's really called rasayana herbs or what we call adaptogenic or chi tonics or these herbs which influence the whole system of the body in a kind of strengthening or empowering ability. It was always a very important ayurvedic herb, by the way grow naturally here in this room. And today we have lots of research on these herbs which show that it does very interesting things on oncology field, directly on the cancer, and of course the immune system and other important systems. Other herbs are the Curcuma, the turmeric, of course. Which is today we extract the curcumin out of it. But today is the most researched herbs in history, okay? So many research about the relation of curcumin in cancer. Not always you give it because sometime maybe it's interact with other drugs or does some things but it's certainly well researched. The ginger which is also very much in used in Chinese medicine but it also has a very interesting potential in oncology. And use some other very interesting herbs in relation to cancer. Directly or influencing on the immune system or influence, of course, on the nervous system in relation to stress conditions and some other. And the system, or other conditions which we are, if we treat it, we are certainly enable a better quality of life for the patients. >> So, what's the basic difference between tumeric or that you use as a spice in the Indian cuisine or the Arab cuisine as well, of course And what you produce here, in liposomes. Yes. In high tech medication. What's the difference between them? >> High tech traditional medicine? >> Yeah. >> The difference in relation to Curcumin or Curcuma longa is that the Curcumin which is the orange pigment of the Curcumin of the Curcuma. Is only around, maybe, 2% in the natural root. And, when you use it from childhood in a very high quantity and in India they estimate that they use it more than two or three grams a day, which is almost a tablespoon of cumcamin everyday. They don't use this amount in the West. Okay, but if you use it from a very young age it give you a protection. It certainly build up your immunity, protection for the digestive system, etc. But very often, what we see in the west is that people are coming already in a sick condition. In cancer or different problems. And when they are coming to give them one or two teaspoons of of the natural powder of the root, first of all, they very often won't be able to take it, and second It's not enough anymore, it's too late. Now you need to give them the. Now the is only 2% or 1% in the natural root. But it's 95 or 97% in the medicine, so it's whatever, 50, 100 times more potent, or more concentrated. So in a way it's became a drug. Now it's very potent, and it can give some kind of relief of some kind of activity in a medicinal way. Then we have a problem, curcumin on its own doesn't absorb very well in the body, what we called a poor bioavailability. Then we find some solution for it and in [INAUDIBLE] head we, the solution is as we say the liposome. We combine it in a special way, [INAUDIBLE] what we call phospholipid, we create some kind of new molecule. Which when it's absorbed in the body it's absorbed directly through the gut wall into the bloodstream and increase the [INAUDIBLE] availability for the absorption of the cucumine to the blood by hundreds and hundreds percent. And then see the full effect of the cucumine. Which is of course antiinflammatory and many other effects in the body. >> Let us consider the clinical scenario where you meet patients, patients with cancer, some of theme undergo chemotherapy or biological therapies, and how do you perceive your role as a medical herbalist? I mean what happens in the room when a patient comes? How is it different from other settings where patients are coming to and to an oncology ward and see integrative physicians. What is unique in your own clinical setting? >> I'm not sure it's so different than your clinic, Iran's clinic. Because I think your product is also integrative and it's holistic. So I'm not sure it's so different but I think it is different from oncology clinical. Because there you can see, okay, this is the solution for the problem. The person has this and this situation, let's say this and this tumor, and this is the solution. And if it's side effect, it's a very specific. When they come to see me, I see more things. I can see how the person is sleeping and if they are, how anxious or how depressed this person is and they're usually are when it comes to somebody one day tell you that you have cancer. It's a life-threatening problem. So it's always influenced you emotionally. I would look very much how it's influence your digestive system. Not only your bowel movements, I see everything. I see your flatulence. And I see a blood test to see if you have any, how much you absorb into your blood. Sometimes you eat a lot but you don't absorb so much. And I see many, I look, I observe to the whole person. And sometime, what you see at the end, the direction of the treatment which I decided for a specific person, you look at this and say, I don't see any anticancer helps in it, what did you do here? And as I explain to you, look, I work on the liver, because I see some toxic condition here. And I work very much to improve the sleep of the person, because when you don't sleep well, you lose your energy and, well, the Chinese already said thousands of years ago that if you don't sleep well, there's nothing we can do for you until you start to sleep better. So, let's first of all help you to sleep better, but naturally. It's a bit different than to take a sleeping drugs which influence your cycles of your dreaming, and cycle of the quality of your sleep. With herb it's a bit different, I don't do it only by herbs, I do it by other device, etc. And at the end they want to improve your quality of life and give you some advice so your body will function better, you will be able to deal better with your anti-cancer drugs that you usually take. Not from me, usually from your doctor. So we will be working, usually work together. But your system is much more alive. And sometimes yes, I give herbs, like they have some kind of anti-cancer activity according to some research. But I always do it humbly because I don't think we have enough research to say something that is so pronounced. >> So your therapeutic intention, is to consider two poles, let's say the one is anti-cancer, >> And the other one is to improve quality of life. >> Yes. >> You find yourself more oriented into the quality of life pole during this dialogue with a patient? >> I think it's a good question. I think it really depend on the patient, on the case, on the situation. Sometimes, yes, I'm more interested on the quality of life and some other problems I see in the system, which are not directly connect to cancer. Also, because, at the same time, the person is taking anti-cancer drugs. And I say, okay, that's what they're taking. He's taken care of this and my part is different. Sometimes, I combine, I do give some kind of anti-cancer activity herbs. And sometime I put almost only this kind of herbs. Why? All because the situation is very bad. Or because the person declined to take the chemotherapy or whatever it takes anymore. Sometime people are coming to me after the third, fourth, or the fifth cycles of the chemotherapy, and they say no more. They tried before, and they don't want to try it again. And they say, do whatever you can to help us and then I do what I can. I try to persuade them sometime still maybe try to do it, but sometime I got frustrated because that's what they ask. They won't take the drugs any more. >> So basically we're talking about a setting where the patient's approach is quite alternative in terms I wouldn't take chemotherapy anymore. I want your advice as an alternative. >> Yes. To that. >> Sometime the alternative, yes. A while ago came a young woman with a very progressed breast cancer and she doesn't want any chemical treatment. First time she was diagnosed, very bad, her doctor told her you have to take it soon as possible, it's life threatening and she told me no way, I won't take it, please help me. And she's still with us. It was, it started about a year ago. But the, you can call her alternative, I would be careful with this, she's just a special character. But sometimes. >> So your approach these kind of patients, I mean that comes from an alternative, let's say alternative health belief model. >> Okay, first of all I check their motive. And sometime I'm the person to persuade them go to your doctor and to your oncologist as soon as possible. Because my medicine is not proven enough. I will help you with everything I can. But you have to take the other medicines because they have much better proven concept behind them and this is life threatening I understand and I respect your motives but, and sometime I succeed. But sometime I listen to them and I start to have conversation and I see heir approach Is very focused. They know what they're doing, and nothing will change it. That is their decision, and of course then I respect them and I do whatever I can, okay? Some of them are not alternatives. They were there, they did, as I said, three, four, five cycles of chemotherapy or whatever they took, and radiation and everything, and it's return and return and return, and they say, never again, we don't want this horrible experience again. We understand the meaning of it, but this is our decision. I don't know if to call it alternative, they say, we don't want it anymore, we feel it, our body screaming not again. So, this is a different situation and so, yes, it's up to the patient. >> I would like to understand more of the approach of your clinical approach when you tailor a treatment to patients. And let us consider a patient with a let's say, breast cancer who is undergoing chemotherapy. And she's suffers, I mean, the leading quality of life concern is pain. >> Okay. >> And it might be a pain that relates and there be gastric pain because of the chemotherapy and maybe neuropathic pain because of the she is receiving. And it might be musculoskeletal pains that she had few years ago, and now during the chemotherapy it's coming back. How would you tailor a treatment to such a patient when pain is the leading concern? >> Okay. Okay, I will focus the answer, but still I give a bit wider than the first. I would divide it to three parts. Patients who are coming to me, before the chemical treatment. Sometime it's a very short time, sometime it's days before, but sometime not until it's sure what they really have. And it can take sometime weeks and sometime a little bit more. And during that time, I give them, of course, dietary advice, and I give them a kind of herbal tonics, immune support, metabolic or liver support. And I give it as much as possible in a way as a preparation for the chemical treatment and somehow to increase the strength of the body. Second stage is together with the chemical treatment. >> Concomitant with the chemotherapy? >> Yes, and that's what you said. For example, when they have some side effect of the treatment. For this part of the treatment, I call it a rolling treatment. Because it's roll around and it's all the time, it sometime person at the beginning will tell me I have some kind of gastric pain. And we do something and we solve it, or it's improved. But then they tell me that they cannot sleep at night, and after that they have some kind of tingling or some kind of neuropathy. So it's changing all the time, so I hear from them very often. Not necessarily see them, but I hear from them very often, maybe once a week or ten days. And if you follow the findings you see that I change the combination quite often. Sometimes it's for the digestive system, after this for sleeping. And my part at this stage is really to help them to deal with the chemical treatment, of course without to bother, or without to damage the chemical treatment. As much I know. And the third stages after the chemical treatment. In the past they used to say, let's do some kind of cleansing, and let's do some kind of strengthening of the system, and some immune kind of support and build up for few months. Today I say for years. Okay? Why? Because I mean the business now for many, many years, and sometime I see my patients return after five years or six years, or seven years with the same problem. Today we have more research about the preventative ability of herbs. What is the potential? So I said let's do it for longer, and longer, time. Some patients are taking this for long time. Some patients, after few months, they decide, or we decide together, they don't need it anymore. We follow them with some kind of adaptogenic or, in a way. System, or immune-boosting herbs for long period of time. Then I look on the herbs as a, in a way, you can call it, a specific immune food, nutritional kind of thing, for the immune system. And we know that we can do it for long time, it doesn't harm the immune system, it doesn't weaken it. For me, at least, my belief, that it's more effective than kind of multivitamins or similar. It's natural, it give some kind of support, of course, it's overloaded sometimes, antioxidants and many things like that. According to your specific question about the pain, pain or many other complication during chemotherapy, I don't look at them as cancer patients. I look at them, if a patient coming to me and say I have epigastric pain with heartburn or without heartburn, I give the herbs, which are soothe, kind of relax the pain. [COUGH] Balance the excretion of the hydrochloric acid and protect, give some kind of protection layer to the membranes in a way support and strength up the muscle tone of the diaphragm and protect the esophagus. >> What kind of herbs you would consider as pain relieving herbs? >> Yeah, we have wonderful herbs for this, some of them are very simple herbs. For example, chamomile, chamomile extract, alcoholic extract of Matricaria, of chamomile is much stronger than tea. Tea is great, but actually many of the ingredients need alcohol in order to extract them. It's a great herb for inflammation, and balance the acidity of the stomach, and increase the recovery of this inflamed or burned kind of the tissue. The other herb they use is Glycyrrhiza, it's a licorice, it's combined well with Matricaria. I give the natural sage of Israel, the saliva. Not in a big proportion but maybe 10, 20, 25% of the formulation and it's anti-inflammatory to increase healing of the damaged tissue. I give Melissa, okay, lemon balm, it's great for this purpose. And sometimes I use also some powder like slippery elm, the Ulmus fulva, which protect, give some kind of protection layer over damaged tissue so the acid cannot damage it so much. At the same time I can give small amount, even, of ginger. But usually from fresh ginger which increase kind of the healing, what happened with chemotherapy is the gut, the stomach became very weak, the tone is so weak it means that sometime it's increased or decreased. The balance of how much acid to produce, and the function is not very well-behaved. So sometimes little bit amount of ginger in the formulation, it in a way wake up the stomach. And even so, I wouldn't give it in big quantities, because it's hot and it can damage. In small quantities, sometime it does the trick. It's a great thing to give them. We also have treatment against nausea and some increase well-being. So it's good in many ways, but you have to be careful and know exactly how much to put and how to use them together. So I have so many things to give for pain and for heartburn, mainly of the upper digestive system. And the same thing I do for other things, so other pain in the body or different problems. But this is not pharmacology, this is the way I would use other people who come with the same problem without cancer. It's a different medicine, of course, the difference is I need to be very careful with the dosage because they are sometime very sensitive. I need to check out carefully if there is some interaction with the drugs they take, all of these things. This is the difference. But it's not the herb so much difference. It's not the approach. It's a bit more checking up, a bit more careful than usually. >> And if the woman that we're talking about, the patient, is coming with a debilitating pain from the cancer itself. And she receives morphine or other medications and still she suffers from pain. What would you recommend in terms of herbal medicine? I mean, are there specific herbs to consider to alleviate the pain, the cancer pain? We're not talking here about the side effects of chemotherapy like epigastic pain. But about the pain which originates from the cancer itself, the widespread cancer. >> Of course, we have herbs which are used specifically for pain. But most of them are illegal in Israel for medical herbalists. For example, opium poppy and marijuana, and other things which prove themselves as great painkillers, we don't use them. So, no, the answer is that we don't have really a great anti-pain drugs. Certainly not on the level of the things that they can get in the hospital. So when the pain is absolutely unbearable, herbal medicine is not for them. But herbal medicine is for them, but not as the solution for this problem. Herbs can help with pain, very much. Again, on the reason for the pain. What's behind it? For example, if the digestive system is very much contracted because of inflammation, or even because of some pressure from the tumor. So we can give spasmodics or anti-spasmodic herbs and sometimes they are doing very good effect. Sometime it's the same chamomile we talked before but we needed to make the very concentrated extract and we need to give it in a big quantity. Then it's not the same mild gentle sweet herbs which we take before nighttime or even children or babies can take it. But suddenly it's became almost a drug, very effective and very safe, but it's a drug, it's work like wonders. I can use it with 50% chamomile 50% valerian. Valerian we usually use, everybody know it's used for headaches and used anxieties and sometimes sleeping disorders, but it's a great antispasmodic herb. 50/50 in the same formulation, >> Alcoholic tinctures? >> Alcoholic tinctures, I think it's very effective together with the chamomile. It does wonders in contractions. Very fast reaction. You don't need to wait three or four days, it's sometimes it's happened in front of your eyes. Again, you can put the or the Salvia fruticosa, little bit of it, with other things. So, in that sense sometime you can do very impressive kind of support. But sometime it's just wrong. Sometimes the direct stimulation of the nervous system and the painkillers that we are allowed to use here in Israel, they're not as strong as drugs. Sometimes the problem is with constipation and you can- >> Absolutely, so we can help with the problem. >> More with induced constipation and then you can relieve. >> Then we can relieve the constipation and this is true and also the pain would be relieved, this is true. >> Maybe moving a little bit to talk with you about insomnia and anxiety In this population of patients with cancer, which are the herbs which are the leading herbs in terms of alleviating sleep problems and anxiety. Which are so common in this population of patients who anticipate chemotherapy, or during chemotherapy? >> Yes okay, that's interesting. First of all, very often the sleeping disorders which are certainly damaging to the whole system, they're not necessarily sleeping problems. Sometimes it's reflecting the anxieties or the mental stress during the day. You see it overnight, but actually you need to treat it during the day. You need to reduce the tension, reduce the fears, the contractions all day long, and then naturally the sleep will come. So that's what I usually do. Sometimes I give day formulation and sleeping formulation, sometimes it's the same formulation, okay? But in the daytime it will put them to sleep, but in the nighttime it will help them. So it depend, but the thing is that sleeping is natural tendency of human being of life. It's not something that we need to re-invent for the body, is something that we need to release. We need to free the body from the reason that stopped them because as I said, the fear of something else which bother this kind of natural tendency. It means, for my approach, that you don't need to use such a strong sleeping agent, herbal sleeping agent. It's not a matter of, let's try to find the strongest herb that put you to sleep, okay? For this, again, there are drugs which are working much faster and stronger than herbs. They really shut down some kind of mechanism in the body, and they force you to sleep. >> They can knock out- >> Knock you out completely, and you sleep. And sometime it's great, because it's better than not to sleep at all. But of course, the quality of the sleep is not very good, okay. With herbs, I would say the special things about herbs for this program is the gentleness, okay. And gentleness is a good word, not a bad word. Gentle is something the body take and say check, and say, it's not threatening on me, it's nice, it's reduced my tension a little bit and it's absorbed happily, it means no side effect. It means the body, it changed a little bit the body, it helps you a little bit, and then you add to it some kind of positive suggestion, or some kind of a meditation, or some kind of music. It's very recommended for cancer patients with sleeping problems. And you change your eating habits so your stomach won't bother you too much, and sometimes that's enough. The gentleness of herbs is a nice thing, now gentleness, let's not make a mistake, gentle is not weak. Gentle is very strong, but it's gentle. This level, we find many herbs. The valerian, we talked about before, sometimes people think valerian is a strong herb, no. You have to taste it, you have to try it. Valerian, high-quality valerian, is a very mild, is a very gentle herb. People are usually very happy, they almost smile when they take it, okay, most people. Again, the chamomile is a great thing, it's also a good combination. We have other things, we use the Melissa, and we use Scutellaria, and we use also the hops, the same thing that we put in the beer, but a little bit higher quantity. It's a bit bitter, but it's something that you take and almost instantly, you feel okay. >> Like a release. >> Like a release, almost instantly, it's working already on the nerve ending in the digestive system, and all that is in a different mode. And of course in combination between them. I don't eat any narcotic. And sometimes we use them in teas, when give teas I take care that the tea will be tasty. Because I think when people take something that is nice to them to drink before they go to sleep or something, then they will feel better with themselves and again, this natural tendency for sleep will come easier. And sometime I give it in tincture form or tablets or whatever, then it's extracted and it's stronger. It's already kind of stronger medicinal activity. And I see great effect, I also tell the people don't expect this not this is not stilnox this is working in a mild way. I prepare them to what it does, and I tell them look you have to prepare yourself for sleeping. Your sleeping environment have to be cleaner, okay? Wash yourself, eat better, meditate. >> Sleep hygiene, what we call. >> Sleep hygiene, which I think is a great word. I think it's a very important thing. And this is also make the patient more part of the treatment, okay? They do something, they don't only take medication as something maybe will heal them. They're a part of the process, and this is always very recommended. >> And if our patient that we consider during chemotherapy, her main complaint or concern is fatigue. And it might be a cancer related fatigue from the disease itself, it might be a chemotherapy related fatigue. As a side effect of chemotherapy, which herbs would you consider to use in this case regarding fatigue. >> Yeah, yeah. Well this is a great, I would say this is the most promising and interesting subject of herbal medicine today. Because herbs have the ability to increase the well-being of the body, and the general energy. This is really the group of herbs that we call adaptogens. >> What are adaptogens? >> Adaptogens are herbs which increase the wellbeing and the energy of the body. And they do it by direct influence on the immune system, on the nervous system, and mainly what we call the adrenal glands. So it means that the balance of the cortisol and other hormones that the adrenal glands produce. And by doing this it's recover in one hand the energy level of the body, or the resistance of the body, and at the same time, the immune reaction or the immune activity of the body. And this is great because there is no other medicine that targets the adrenal gland and the general strengthening and tonic effect on the whole body. This is really unique to herbal medicine and in a way, this is the way that herbs are coming to the front of the need, of the people of the 21st century. Cancer patients and others because we are dealing so often with fatigue in the population and of course with people have chronical disease and cancer. And this ability to recover, to help the body to recover from these things is very much in need. And herbs are very good in it, okay? I would mention first of all, of course the Chinese what we call, the Korean ginseng, the kind of herbs, according to traditional Chinese medicine, the Ren Shen. Which was always used to call the Caesar of all herbs, the king of all herbs because it has increased the well being of the person. In the past you used to say, every man above 50 should take this root, the root of this herb, because it increases well-being and general stamina and energy. Today we know how it does it, and it's very much a direct influence on the adrenaline gland, nervous system, immune system, circulation, etc. Other herbs as the indigenous sought, as the Withania somnifera, the ashwagandha, from the Ayurvedic medicine, the licorice, the glycyrrhiza, the rhodiola, the American ginseng, and more and more herbs that are doing very, very effective, and today even proven effect on increasing the well-being of the person. I use these herbs always with these cancer patients in different combination and sometime even in fixed combination that we made here in Davao. We make the kind of general adaptogenic formulation because it's so much in need. And of course, we can make some modication if necessary. So we always give it, because almost, as I said before, there's always some kind of depression or anxiety around but there is always some reduction of energy. So this is really important, of course. If we take in account what medication to take, if there is interaction. So there are times that we cannot give it sometimes, or some people, that it's not suitable for them. But generally, this is in a way the main pillar of the treatment, okay? [INAUDIBLE] are very important. I would like to ask you how you envision the future in terms of collaboration between integrated physicians, practitioners, herbalists? And how would you see the way we can collaborate, I mean, what's the practical meaning? Not only to talk about it, but to work together with patients. >> So first of all, I think the future is already present here, okay? We're already in the future. I think the future is a combination from both sides. It means that the medical establishment need what we call evidence-based medicine. Without this, they cannot do anything, and I appreciate that. So we try to research, more and more, the efficacy, the activity of the herbs, and of course the safety of the herbs. In medical standards, it's not easy, because when you use traditional herbal medicine, it means that you use many ingredients together something formulated. It's absolutely not easy for present research methods to know how to deal with this, but there are better and better ways to do it. So, today, you can read some well researched and you know how to respect a good research about herbs. And you say, well this is high standard. It was very difficult to get it 20 years ago. And today, you can get it more, and more, and more. So I think this is the future, from one hand. From the other hand, from the medical establishment, they need to understand that herbal medicine is different. It's what you call, polychemistry or polypharmacy. It means, many ingredients together and this is the way it works. It's different from singular ingredient drugs, and it targets the whole system, it's sometimes tailor-made medicine. So they need to appreciate this, they need to appreciate the efficacy and safety of it in different tools and to be open-minded for it. And also in that sense, I see a big difference in the last 20 years, because in the past it was absolutely nothing in between. I mean, they're in their world, we're in our world, and it's vague in the middle. And today, the amount of medical establishments, Research centers, here in Israel and the world contact us and contact me. And they want to understand more, and they want to research things together, and we're already doing many things. It's overwhelming, we absolutely cannot deal with all the people who are interest. And they all come from scientific backgrounds. And they understand, very much today, the fact that herbal medicine is not a single ingredient, it's not a single chemistry medicine, so you need to research in a different way. So we try to get together to see how to do it and it's fascinating time. That's the reason I'm saying the future is here. It means that if you want to accept herbal medicine as polypharmacy or polypharmacy medicine, polymedicine, you need to change your approach a bit, okay. The medical establishment, not was always there, have to be more acceptable. The meaning of holistic medicine exist. It's something real and even find a way to prove it. So some of the things already exist and some of them, at least there is open minded from both directions. Okay, so it's good for everybody. If in ten years' time, it's completely married with each other, I'm not sure, but the direction is very positive and very, very interesting. There is a lot of open mindness for herbal medicine from the medical establishment because it's a biochemistry proven medicine, okay. So it's many ingredients together, but still something can feel, you can measure, okay, let us improve our method of research. So there is open-mindedness from both sides and this is great. It's important for us, for people who come from traditional herbal medicine not to lose our way. It means not to become too scientific. We need to keep our tradition, it doesn't matter if it's Chinese, or Ayurvedic, or Western. We need to hold to it because it's very real. I have some example. Okay, it's not really so much to do with the quality of it. Today, there is a kind of a approach in nutrition to eat many meals a day, five or six. It's proven in some kind of research, which I look at this and I'm not very impressed from this research, that you lose weight if you eat six times a day. So many nutritionists today, give them six times a day, okay? The traditional way, the traditional recommendation and that's what I personally feel is absolutely right, is absolutely not to do it. It's the wrong thing to do. Usually it's three times a day. For example, you eat your breakfast, whatever you eat, doesn't matter at the moment, at 8 o'clock, and then your lunch time at 1 o'clock. And in between you have something like five hours. So your stomach and your duodenum or your small intestine will finish most of the job after maybe two and a half hours. And you have about two and a half hours to relax. Your stomach relaxes, slows down, cleans itself, prepares itself for this next meal. And then it's woke up again. If you eat six times a day, it's all the time doing something, create heats, creates whatever. It's not right. So this is an example of traditional medicine, which advises how to deal with the body. Listen to it. We need to keep to it, not going so much to the scientific and the proven, because. It's more than that. The full system is complicated things and the philosophical things behind the work is still very true, still very active. >> So do you see a scenario in the future where a traditional herbalist or a trained herbalist like yourself, medical herbalist would join the medical staff in oncology wards, go into the guarded fortress of conventional oncology, and be included in the team of integrated physicians, nurses TCM practitioners, Ayurvedic practitioners, and so on. Would you see a place for such inclusion of people that comes from herbal medicine? >> Absolutely, absolutely. >> How would it look like in practice? I mean when a clinical herbalist will join this team, how would it look like? I mean, how would you envision the role of herbalist with part of this integrative setting? >> I don't have a ready answer for it, okay? I think it's a big question. I think you are dealing with this everyday of your life. But I think herbal medicine can offer very specific advantages, and they should be first of all explained to the team, preferably with some kind of proven background, scientific background that, for example, helped to reduce tension, or increase the activity of the immune system, or helping with sleeping, etc, or pain. So, first of all, let's start from learning from each other, okay? Talking, explaining, and after that it's be more clear what is necessary. And after that it's a matter of discussion of the case. And, for example, if I was in a team like this and I would say, and they explain to me about a person, they say, okay, this is the problem now, that we don't really have specific help, and neuropathy, and sleeping disorder, and anxieties, and we don't want to give too many drugs, and what you can suggest? So I would say, okay, neuropathy, this is an option. And, of course, we can combine his Chinese medicine and other things that might help. And with this we can offer this, and we discuss what is right thing. And I think it can be part of the daily life in an oncology ward. Yes, I would think it's absolutely key. The situation at the moment is that they are coming to see me in a different world, okay? They're inbetween for example, between, they have one week off from chemotherapy, next week they have the next one, and they come to see me and I advise what I advise. I look what they are taking, they're oncology student, medical attention. Sometimes they see what I give, sometimes not. And we are in a way in a different world, the connection is the patient. It's not bad, but it can be much better, absolutely. >> So you envisioned the integration of integrity of therapies altogether. >> Absolutely, yes, I think that's what you are doing now? [LAUGH] >> Thank you very much for inviting me here and for your support and contribution in our course on herbal medicine. Thank you very much. >> Thank you, always a pleasure. 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