Herbal Remedies: The Natural

Approach to Combating Stress

NATALIE PAVLOVICH, PhD, RN, DiHt

Nurses working in high-pressure situations encounter an inordinate degree

of work-related stress in addition to the daily stress experienced in evelyday
living. A current trend in health care is to utilize natural substances to
decrease stress. This article provides an overview of stress and its impact on
health. Common herbal remedies, as well as other helpful aids for decreasing
stress and promoting health, are identified and discussed. A f e w guidelines
are offered for those who are considering the use of herbs in alleviating the
prevailing symptoms of stress. Generally speaking, therapeutic herbs are, for
the most part, safe and effective and result in general good health. A f e w
exceptions and warnings are noted.
9 1999 by American Society of PeriAnesthesia Nurses.

S THE NEW millennium approaches, it comes EXPERIENCING STRESS

A with advancements in computer technology,
diversity in life events, and drastic changes in
health care. All of these have produced increased
stress in all aspects of our lives. To deal with stress,
people have tried various coping strategies includ-
ing positive thinking, social support, assertive
behavior, stress management, and medications.
Drugs, though, often have undesirable side effects.
For various reasons, these ways of handling stress
have been slow in bringing about the desired
changes in reducing the stress that people experi-
ence on a daily basis. Consequently, many individu-
als have turned to complementary health modali-
ties. One popular category of natural remedies is
the use of herbs for alleviating stress. The first part
of this article will provide a brief overview of
stress, including its effects on one's total being. The
second part will describe the common herbal
remedies as well as other helpful herbs that are used
in decreasing stress and ultimately, in promoting
health. Last, a few general practical guide-
lines are discussed for those considering the use of
herbs.
Natalie Pavlovich, PhD, RN, DiHt, is a Professor at Du-
quesne University, School of Nursing, Pittsburgh, PA.
Address correspondence to Natalie Pavlovich, PhD, RN,
DiHt, Box 96002, Pittsburgh, PA 15226.
9 1999 by American Society of PeriAnesthesia Nurses.
1089-9472/99/1403-0003503. 00/0
Nurses are engaged in all aspects of patient care.
This combination of environmental work condi-
tions produces constant stress with very little
respite for the nurses. Psychologists define stress as
an anxious feeling experienced by individuals in
response to circumstances and events, called stress-
ors, that threaten them and tax their coping abili-
ties. 1-4 Stress permeates one's life in whatever
context it exists--home, school, work, travel, and
social relationships.
Since the 1950s, several psychological perspec-
tives have been identified that assist in under-
standing stress. The following factors have
also been explored: biological, cognitive, sociocul-
tural, environmental, and personality factors.
The biological factors in stress were discovered
by Hans Selye, 1,4 who showed that the body's
response to stress was a general adaptation syn-
drome. In the cognitive approach, life events are
evaluated according to whether they are challeng-
ing, threatening, or harmful within the context of
the situation. In the sociocultural realm, stress has
been related to socioeconomic status, gender, and
culture, then the person determines how to effec-
tively cope with the stressor. In everyday life,
environmental factors such as conflict, frustration,
overload, burnout, daily hassles, and life events are
faced.
Research results have shown how personality

134 Journal of PeriAnesthesia Nursing, Vol 14, No 3 (June), 1999: pp 134-138

HERBAL REMEDIES
characteristics influence our responses to stress,
namely, the Type A and Type B personality pat-
terns. The Type A person is described as hard-
working (at times, a workaholic), extremely com-
petitive, impatient, and, at times, hostile. These
characteristics typically have been related to the
incidence of cardiovascular problems. The Type B
individual views life and experiences in an easy-
going way. This person is relaxed, enjoys whatever
he or she is doing, and balances life with work, rest,
and recreational activities.
To deal with stress, individuals have tried Vari-
ous coping strategies that include social support,
assertive behavior, stress management, meditation,
positive thinking, biofeedback, yoga, relaxation
techniques, and certain medications that have be-
come popular during the past several decades. At
the same time, concerns have surfaced about the
undesirable side effects of prescription drugs. An-
other approach to coping with stress has been
complementary health modalities (ie, massage,
homeopathic medicines, and herbal remedies). In
the last few years, the use of these modalities has
been increasingly popular in the United States
because of their effectiveness, low cost, and lower
potential for harmful side effects than the tradi-
tional medical approaches.
in America today, the
rediscovery of the healing
power of plants has made its
mark,
HERBAL REMEDIES
Traditionally, herbs have been used as medicine
throughout the evolution of humanity beginning
with the Egyptian, Greek, and Roman civilizations,
extending through the Middle Ages, and enter-
ing modern day civilization. Consequently,
herbalism is considered the oldest complementary
therapy. Throughout their long history, herbs be-
came categorized as folk medicine in various
cultures. Therefore, herbal remedies are quite popu-
lar throughout the world. In America today, the
rediscovery of the healing power of plants has
made its mark. s
In the United States, herbal remedies have
become popular since the mid-1960s. Although
135
they are usually taken for a specific condition or
symptom, the herbs support and aid the whole
body. The symptoms experienced by an individual
are viewed as signs of distress or adjustment. In
herbology, the remedy aims to remove the cause of
the problem; in so doing, the distressing symptoms
then begin to fade away. A recent survey showed
that one third of all respondents took herbs. 5,6 The
two major reasons identified for using these natural
products were to promote one's well-being and to
maintain general health.
In my health care practice, I have discovered that
people take natural products, including herbal
remedies, for additional reasons. A major one is the
fear of possible side effects of prescription drugs. In
addition, prescription drugs are quite expensive,
and are frequently taken for an extended period of
time according to the directions of the medical
physician. Frequently though, the prescriptive medi-
cations do not seem to alleviate the symptoms or
ailments. Yet, on the other hand, the consumer will
note imbalances occurring within his or her body,
which, over time, may inhibit and compromise the
immune system or other bodily structures and
organs. Simply said, there is often very little relief
for conditions or symptoms. On the other hand,
some people simply do not like to take chemicals
because of the effects on the body and/or mind.
These people, many times, prefer natural sub-
stances.
COMMON HERBAL REMEDIES FOR STRESS
Herbs have been used for stress because of their
ability to act on the nervous system or to induce
states of relaxation and tranquility. Other herbs
relax tense muscles, ease stress-related headaches,
soothe an upset stomach, or encourage restful
sleep. Consequently, many of these remedies help
with several symptoms related to stress including
fatigue, insomnia, anxiety, and nervousness. Sev-
eral commonly used herbal stress relaxants are
described. For each herb mentioned, the common
name as well as the botanical name, which consists
of at least two names is listed, with the first
representing the genus and the second the species. 7
The identification is followed by a brief description
of the herb's properties and actions.
Astragalus (Astragalus officinalis)
This remedy, frequently referred to as Huang Qi,
is known for its immune property and is, therefore,
138
effective in activating, protecting, and supporting
the immune system, helping in the adrenal gland
function, and providing overall energy to combat
fatigue. One precaution is that this herb should not
be taken in the presence of a fever.
American Ginseng (Panax quinquefolium)
This herb is helpful in alleviating fatigue. It is
interesting to note that side effects are rare with
American ginseng. However, there have been some
reports of insomnia and allergic symptoms while
taking the herb. If these reactions are experienced,
stop taking the herb.
Asian Ginseng--Korean, Chinese (Panax ginseng)
This remedy helps in states of exhaustion. It is
considered more powerful and stimulating than
American ginseng. Three precautions are suggested
when taking this herb. (1) Avoid taking too close to
bedtime, because it is much more stimulating than
the American ginseng; (2) avoid taking it with
coffee; and (3) avoid taking it if you have high
blood pressure.
herbal remedies are relatively
safe a n d effective.
Siberian Ginseng (Eleutherococcus senticosus)
This herbal therapeutic agent, also known as
Eleuthero, helps the body adapt to physical, mental,
and emotional stress. It also stimulates the immune
system and, thereby increases body energy and
vitality to combat fatigue. This ginseng is more
powerful than Asian ginseng; therefore, use it with
care. With this herb, the two major precautions are
(1) avoid taking it too close to bedtime, because it
is much more stimulating than the American gin-
seng; and (2) avoid taking if you have hypoglyce-
mia, high blood pressure, or any type of heart
condition. (NOTE: Herbal remedies are relatively
safe and effective. However, if certain herbs are
taken along with prescription medications, the
results can be dangerous because of the interaction
of the herbal remedy with the prescribed drug.)
Recently, the American Medical Association (AMA)
conducted several studies on various herbal rem-
edies. The AMA reported that ginseng should not
be used with the following: (1) drugs such as
warfarin, heparin, aspirin, and other nonsteroidal
NATALIE PAVLOVICH
anti-inflammatory drugs because it can inhibit
clotting; and (2) estrogens or corticosteroids be-
cause ginseng may increase the side effects of those
drugs. Diabetics should not use any ginseng be-
cause it can affect the blood glucose levels. Last,
ginseng "may cause headache, tremulousness, and
manic episodes in patients treated with phenelzine
sulfate. ''8
Kava Kava (Piper methysticum)
This herb, known as "kava," is famous for its
calming properties. It is effective in reducing
anxiety, fatigue, stress-related disorders, nervous-
ness, and insomnia because of its relaxing effect on
the central nervous system, and enhancing well-
being without compromising alertness. It induces
physical and mental relaxation as a result of its
calming and relaxing effects. An advantage of this
remedy is that it does not lose its effectiveness over
time. One precaution is noted--this herb can cause
drowsiness. If this occurs, its use should be discon-
tinued or the dosage reduced. (NOTE: In the
previously mentioned AMA studies on herbal rem-
edies, results showed that kava should not be used
with the tranquilizer alprazolam because it may
result in a coma. s)
Passion Flower (Passiflora incamata)
This herb, often referred to as "maypop," is a
gentle sedative that helps anxiety, insomnia, ner-
vous tensions, nervous headaches, and stress-
related disorders because of its effect on the
sympathic nervous system. One warning is that
women should not use this herb in high doses
during pregnancy.
Skullcap (Scutellaria lateriflora)
This herb helps with insomnia, anxiety, fatigue,
nervous disorders, and stress headache because of
its calming and relaxing effect on the central
nervous system.
Valerian (Valeriana officinalis)
This remedy is considered a potent herbal against
anxiety, nervous irritability, fatigue, emotional
stress, and insomnia (mild) because of its most
useful calming and relaxing effect. Because of its
water soluble characteristic, it is considered the
best among herbalists. Furthermore, the herbal is
HERBAL REMEDIES
not habit-forming and does not produce a hangover.
According to the US Food and Drug Administra-
tion, this remedy is recognized as safe and is
approved for use. (NOTE: Differences in research
findings on this herb exist in the literature. Re-
search 9 involving studies of this herb in both
clinical and laboratory settings have provided scien-
tific evidence that this specific remedy is effective.)
Recently, it has been reported that AMA research
findings on valerian showed that "it should not be
used with barbiturates such as thiopental and
pentobarbital because it can cause excessive seda-
tion."8
OTHER HELPFUL HERBS FOR STRESS
In addition to the common herbs mentioned,
there are several other herbal remedies that are
helpful in decreasing symptoms and signs of stress.
Chamomile (Matricaria chamomilla or recutita)
This herb has been a traditional helper with
everyday tension, stress, anxiety, mild nervousness,
and insomnia. It is also effective with conditions
that are caused by stress such as diarrhea, indiges-
tion, and nervous problems of the stomach. Essen-
tially, it is a very soothing, relaxing herb for any
irritating condition. The individual is advised not to
use this herb for long periods of time because this
may lead to ragweed allergy. Similarly, this herb
should not be used by those who are allergic to
ragweed. Otherwise, research findings indicate that
this herb is effective. 9
Lemon Balm (Melissa officinalis)
This remedy is known for its soothing property
and acts to promote relaxation, ease nervous ten-
sion, relieve stress-related digestive problems, and
alleviate insomnia as a result of its gentle, relaxing
nature. It is used by drinking a cup of this herb
before going to bed. Research results 9 have shown
that this herb, too, is effective.
St John's Wort (Hypericum perforatum)
This herb acts to relieve anxiety, everyday stress,
insomnia, and tension headaches. It must be
cautioned that when taken internally in large
amounts, it can cause heightened sun sensitivity,
especially in fair-skinned people. This remedy also
interferes with the absorption of iron and other
minerals. According to scientific evidence, 9
137
findings have shown this herbal remedy to be
effective.
Vervain (Verbena offficinalis)
This remedy promotes a tranquilizing effect,
easing everyday tensions and stress because of its
strengthening effect on the nervous system.
NEW COMBINATION FOR STRESS
Recently, a new preparation for alleviation of
stress has been patented in Germany. This remedy
contains active ingredients from ginger (Zingiber
officinalis) and gingko (Ginkgo biloba) for the
various anxiety states. It is known as the anxiolytic
ginger/ginkgo combination. 10
GUIDELINES FOR USING HERBAL REMEDIES
For the most part, herbal therapy has been
effective in alleviating symptoms and various con-
ditions including stress. However, on occasion, the
news media reports a "negative" story about a
remedy. In examining the story, a few causative
factors may have been involved in the harvesting of
the herbal plant, the processing of the remedy, or
perhaps in the packaging. Currently, most herbal
remedies are sold without the US Food and Drug
Administration approval. Because herbs in the US
are treated under dietary supplements, there are a
few tips to follow.
1. Carefully read the label on the specific
herb. Pay attention to what is said and
any warnings on the label. Note where the
product is made (What country? What state?).
Look for herbs made by reputable, well-
known herbal companies. Also note the ingre-
dients and their amounts in addition to
the cost of the product. A cheaper product
of a particular herb may provide a smaller
dosage.
2. Be aware that there are health risks with
some herbal remedies. These risks may be
indirect, direct, or cause adverse effects. Look
for warnings and precautions. Read available
literature on the particular herbal remedy,
too.
3. Purchase products that are dated. Pay
attention to the expiration date.
138
4. A v o i d t a k i n g herbs every day. That is
not the i n t e n t o f h e r b a l therapy. Herbs
are taken o n l y w h e n n e e d e d b y the individ-
ual; in other words, they are for short-term
usage.
5. B e w a r e w h e n t a k i n g h e r b s w i t h p r e s c r i p -
t i o n d r u g s . If y o u are taking prescription
drugs, y o u need to discuss this with the
medical physician. S o m e herbs should not b e
m i x e d with alcohol because of the strong
REFERENCES
1. Kassin S: Psychology (ed 2). Upper Saddle River, NJ,
Prentice Hall, 1998, p 699
2. Lahey B: Psychology: An Introduction (ed 6). New York,
NY, McGraw-Hill, 1998, p 434
3. Wade C, Tavris C: Psychology (ed 5). Reading, MA,
Addison-Wesley, 1997, p 545
4. Zimbardo P, Weber A: Psychology (ed 2). Reading MA,
Addison-Wesley Longman, 1997, p 333
5. Greenwalk J: Herbal healing. Time, Vol 152, November
23, 1998, pp 58-67
SUGGESTED READINGS
Hoffmann D: The Herbal Handbook: A User's Guide to
Medical Herbalism. Rochester, VT, Healing Arts, 1998
Kernion M: Going Natural With Herbs. Pleasant Grove,
UT, Woodland, 1998
Kroeger H: Heal Your Life With Home Remedies and
Herbs. Carlsbad, CA, Hay House, 1998
Kroeger H: Healing With Herbs A-Z. Carlsbad, CA, Hay
House, 1998
NATALIE PAVLOVICH
synergistic effect. Other herbs require that the
p e r s o n drink plenty of fluids.
SUMMARY
Herbal remedies, for the most part, are consid-
ered helpful in alleviating the s y m p t o m s that are
experienced from stressful lifestyles resulting from
work, home, and family situations. Therapeutic
herbal agents are usually quite safe and beneficial.
Precautions should be taken with any remedy.
6. Natural Pharmacy--The Monthly News Magazine for the
Retail Pharmacist: NewsWlre. Vol 2, No 12, December 1998, p 4
7. Blumenthal M: Name that herb! Understanding botanical
nomenclature. Natural Pharmacy 2:20, 1998
8. Miller L: Bad mixes--some herbal remedies can be
dangerous when used with prescription drugs. The Pittsburgh
Post Gazette, December 1:G2 1998
9. Gottlieb B (ed): New Choices in Natural Healing. Em-
maus, PA, Rodale Press, 1995, pp 58-59
10. Dean K: Plant Patents. HerbalGram, No 43, 1998, p 25
Landis R: Herbal Defense: Positioning Yourself to Tri-
umph Over Illness and Aging. New York, NY, Warner Books,
1997
Murray M: The Healing Power of Herbs. Rocklin, CA,
Prima Health, 1995
Shaw N: Herbal Medicine: A Step-By Step Guide. Boston,
MA, Element Books, 1998