Latin: Hypericum perforatum

WHAT IT DOES: St.  John's wort is bitter and astringent in taste and cooling in action.  It elevates the mood, soothes the nerves, aids the liver in detoxification, and strengthens immunity.  

RATING: Silver, due to action on other medications

SAFETY ISSUES: Do not use if pregnant.  Use cautiously with anxiety.  May potentiate MAO inhibitors.  High doses may lead to photosensitivity.  Do not take with protease inhibitors (used for HIV and AIDS) or cyclosporine.  Because this herb can potentiate liver detoxification causing quicker drug clearance, use cautiously with all pharmaceutical drugs, including birth control pills.

STARTING DOSAGE:
• Crude herb: two to four grams per day
• Standardized extract pills containing 300 mg.  of hypericin: one pill three times per day
∑ 1:2 tincture: 25-35 drops three times per day

St.  John's wort is a nervine stimulant useful in treating neuralgia, depression, and irritability due to menopausal changes.  It is prescribed throughout the world as a mild anti-depressant, sold seven times more frequently for that purpose than Prozac, and it has an impressive safety profile (Ernst et al., 1998).  Long-term use can improve sleep quality, and it is helpful in easing minor nerve-related pains such as sciatica and neuritis.

Originally, one of the compounds in St.  John's wort, hypericin, was thought to be the "active ingredient." This turned out to be false, though it can still be used as a marker to measure the strength of a particular batch.  Another chemical called hyperforin is now considered to be the important marker compound.  Scientists have determined a method to assure that the fragile active compound (hyperforin) in St.  John’s wort is preserved and stable in the finished product.  From an energetic standpoint, the bitter and astringent tastes of St.  John’s wort stimulates the nerves, while the cooling effect reduces irritation and inflammation, and the red color nourishes the heart.
 
I use St.  John’s wort whenever I see a patient with mild depression or depressed immunity due to mental causes, and especially if they have a viral illness or signs of nervous irritation.  I find it useful for chronic hepatitis, not only for its anti-viral qualities, but to help lift the black cloud that appears when patients are told they have an incurable illness that will lead to cirrhosis and liver cancer in ten or twenty years.  In one case, a patient of mine with hepatitis C compounded by depression had this lift within a few days of beginning treatment with St.  John’s wort.

Hypericin and pseudohypericin are anti-viral, so St.  John's wort can be used externally when brewed as a tea to dab onto herpes sores (though I prefer to use Earl Grey teabags).  St.  John's wort also contain several other anti-viral, anti-bacterial and anti-inflammatory phytochemicals, including xanthones, phloroglucinol derivatives, and flavonols.  (Nahrstedt et al., 1997).  

Because St.  John's wort is able to induce a liver detoxification enzyme (CYP3A4), it can lower drug and toxin levels in the blood.  This is positive in most cases, and may accound for why it clears the mind.  However, in the case of drugs where maintaining blood levels is critical, such as in organ rejection drugs, the same effect can be deadly.  Dr.  Duke points out that broccoli, brussel sprouts and tobacco also induce similar liver detoxification of drugs.

One point I would like to make is that the documented liver detoxification actions and resultant improvent in mental clarity produced by this herb--called blood purification in classic herbal medicine-- should be given greater weight in our clinical understanding. Thought about in this way, how this herb works is made more clear.

Research Highlights

• The anti-depressant activity of St.  John's wort has been shown in a number of studies to act on three major biochemical pathways, inhibiting the synaptic re-uptake system for serotonin, norepinephrine and dopamine with rough equality of action.  It is the only antidepressant than can act in this way (Nathan, 1999).

• A controlled human clinical study showed St.  John's wort effective in reducing symptoms of depression, anxiety and sleep disturbance ((Muldner and Zoller, 1984).

tables summarizing scientific trials of St. Johns wort for depression

click tab on left to see references