influence emotions. The IN-DO-OUT principle has as much influence on the emotional/ mental level as it does on the physical.

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1 influence emotions. The IN-DO-OUT principle has as much influence on the emotional/ mental level as it does on the physical. Botanical medicine is uniquely suitable for treatment of digestive tract issues. Throughout most of the history of humans, food has been our medicine. From the hunter/gathering periods to early society, herbs have played a big role in digestive health. In indigenous nomadic lifestyles, we still see wild botanical being a significant proportion of the diet. Early physicians like Hippocrates, Galen, and Pliny, up to modern Mediterranean cooking use herbs and spices like Thyme, Rosemary, Oregano, garlic and onions all as an important part of the diet. We find that herbal uses for the digestive tract are not only through absorption and metabolism of a large range of pant chemicals, but from direct action on the tissue of the gut. Much of todays digestive issues are due to simple abuse. Festival Food (India) When dealing with diet there are many do s and don ts. At first it is easy to get fanatical about certain foods. Even though strictness is often indicated, fanatical attitudes can cause health problems e.g. eating disorders. Many modern foods (like sugar) should not be eaten on a regular basis. It is what you eat on a regular day to day basis that is important, not the odd special festival food, as we know our ancestors often ate special foods at festival times. These days most of society eats these special festival foods way too often; sometimes several times a day. Guilt about the odd digression in diet can often cause problems as well. Macro-biotic diet philosophy allows 1/8 (12.5%) of diet as fun foods. Other philosophies suggest once a week or once a month as being more appropriate. That said, if the diet completely restricts a food because of allergies or problems such as Candida infection or diabetes then of course the food has to be complete avoided. The most common place for us to start any program related to the digestive tract is with some form of cleanse, like the 12-day Herbal D-tox. We will talk about this in much more detail later; suffice it to say it is a good starting point. Many students that have graduated from the Wild Rose Clinical Herbalist diploma program come back to us years later and say this is the most important lesson to pay attention to as by far the major set of problems they run into in their clinical practice have a strong component of digestive health. 4

2 Part One: Physiology of Digestion In this section we are going to review material you have already taken in the Anatomy and Physiology course. If any of the material doesn t seem familiar, please refer to your Anatomy and Physiology course or review it in your textbook for that course. The digestive system is comprised of a series of organs that participate in the breakdown and absorption of nutrients and accessory nutrients from our diet that are used to supply the body with energy and most of the nutrient molecules used to maintain structure of the body. The digestive tract or gastrointestinal tract (GIT) is a tube or canal up to nine meters (30 feet) long that is continuous with the integumentary system, and thus is not only comprised of similar tissues, but maintains similar functions to 5

3 protect us from the plethora of micro-organisms that are contained within it. Associated with this tract are a number of accessory digestive organs that secrete various substances into the lumen or opening of the digestive tract. Here they denature and break down the food we consume into tiny particles that can be absorbed across the lining of the digestive tract, into the blood and lymphatic systems for further processing. Overall the digestive tract participates in a variety of activities that include: mastication or chewing by the mouth; the secretion of digestive substances; the mixing and propulsion of the digesting food through the tract; the absorption of these nutrient particles into the body; and the elimination of substances that cannot be digested or are regarded as waste products. The process of digestion is comprised of two primary components: mechanical digestion, in which the food is broken down by mechanical activities such as chewing by the mouth and the churning of organs like the stomach; and chemical digestion, in which the food is denatured and broken down into smaller and smaller particles by chemical means. Histology and structure of the digestive tract 6

4 There are several layers of tissue that make up the digestive tract, some of which vary depending upon what area of the tract we are talking about. The deepest layer of the GIT is the mucosa, a lining of epithelial tissue, areolar connective tissue and a layer of smooth muscle fibers. Just above the mucosal epithelium is the lamina propria, a layer of areolar connective tissue that contains blood vessels as well as specialized lymphatic vessels called mucosaassociated lymphatic tissues (MALT) that play a key role in maintaining the integrity of the digestive tract against microbes that try to penetrate into the body. Laying above this is the muscularis mucosae, a thin layer of smooth muscle cells that cause the digestive tract to be arranged in a series of tiny folds, gently moving to increase the absorptive surface of the GIT. Superficial to the mucosa is the submucosa, a layer of areolar connective tissue that binds the mucosa to the underlying tissue, houses blood and lymphatic vessels that converge from the lamina propria, and contains an extensive network of neurons called the submucosal plexus. This plexus contains both sensory and motor neurons from the ANS that form what is called the enteric nervous system (ENS), sometimes referred to as the second brain, or the brain of the gut. The ENS contains enteric neurons, sympathetic and parasympathetic postganglionic neurons, and parasympathetic ganglia. Lying superior to the submucosa is the muscularis, which regulates the movement of ingested food through the GIT. In certain areas such as the mouth, throat and anus this area contains skeletal muscle fibers, which allow these areas to be under our (mostly) conscious control. The other areas of the muscularis however are comprised of smooth muscle fibers arranged in two layers: an inner layer of circular fibers and an outer layer of longitudinal fibers. Lying between these layers in the mysenteric plexus, is another branch of the ENS that functions to regulate muscular contraction. The most external layer of the GIT is the serosa, a serous membrane composed of areolar connective tissue and simple squamous epithelium (mesothelium). 7

5 Words to remember or review Many of the following images are taken from you Anatomy and Physiology textbook (to keep it consistent). Mouth or buccal cavity: cheeks, lips or labia, orbicularis oris muscle, hard palate, soft palate, oropharynx, nasopharynx, uvula, palatopharangeal arch, fauces, pharynx, palantine tonsils, lingual tonsils Salivary glands, parotid glands, masseter muscle, parotid ducts, submandibular glands, ligual frenulum, sublingual glands are located above the submandibular glands, their sublingual ducts opening into the anterior floor of the oral cavity. Associated with these major salivary glands are a number of smaller minor salivary glands that line the cheek, lips, palate and tongue. Saliva, 99.5% water, slightly acidic ions, mucus, lysozymes, immunoglobulin A, salivary amylase, lingual lipase, ml of saliva on a daily basis. Tongue: papillae, fungiform papillae, circumvallate papillae, Foliate papillae, lingual glands, lingual lipase Teeth: alveolar processes of the mandible and maxillae, gingivae, periodontal ligaments, crown, neck, roots, enamel, dentin, pulp, mastication, bolus 8

6 Pharynx: internal nares, larynx anteriorly, swallowing or deglutition, epiglottis, trachea Esophagus: posteriorly to the trachea, esophageal hiatus, upper esophageal sphincter (UES), lower esophageal sphincter (LES) 9

7 Stomach: J-shaped enlargement, four parts: the cardia, the fundus, the body, the pylorus, pyloric sphincter, rugae, gastric pits, gastric glands, mucous cells, parietal cells secrete intrinsic factor and also hydrochloric acid, chief cells secrete pepsinogen and gastric lipase, gastric juice secreted is about ml daily, G cells that release hormones, chime, peristaltic motions called mixing waves gastric digestion: three phases (cephalic phase, gastric phase, intestinal phase), Secretin acts to decrease gastric secretions, whereas cholecystokinnin inhibit gastric emptying, protein denaturation pancreas: head, body, tail, epithelial cells called acini, pancreatic juice, pancreatic islets (islets of Langerhans), pancreatic duct, hepatopancreatic ampulla (ampulla of Vater), accessory duct, pancreatic juice secreted is1200 and 1500 ml daily (water, salts, sodium bicarbonate, and several enzymes), pancreatic amylase (polysaccharides into di/trisaccharides), trypsinogen (which is converted into trypsin by enterokinase for proteins), chymotypsinogen (catalyzed into chymotrypsin by trypsin, breaking down proteins), procarboxypeptidase into carboxypeptidase by trypsin, pancreatic lipase (triglycerides that have been emulsified), ribonuclease (breaks down RNA), deoxyribonuclease ( breaks down DNA), trypsin inhibitor (deactivates trypsin if accidentally released) 10

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12 Liver: 1.4 kg in the average adult, inferior to the diaphragm, occupying most of the right hypochondriac and part of the epigastric regions of the abdominopelvic cavity, gall bladder, two lobes (larger right lobe, and smaller left lobe), divided by the falciform ligament, lobules (six-sided consists of specialized hepatocytes), arranged around a central vein, sinusoids, stellate reticuloendothelial (Kupffer) cells, bile canaliculi, hepatocytes, bile ducts, portal triad, left and right hepatic ducts, common bile duct. Bile: yellowish-brown to greenish-brown liquid manufactured by the hepatocytes, produce about ml on a daily basis, Its ph is about , and consists of water, bile acids, bile salts, cholesterol, lecithin, bile pigments and several ions, bile salts, which are comprised mostly of sodium and potassium salts of cholic and chenodeooxycholic acid, emulsification of fat, bilirubin (heme portion of hemoglobin), stercobilin, characteristic brown color of the feces small intestine: primary absorptive surface for digested food particles, 3 meters long, villi and microvilli, duodenum (25 cm, receives the acidic chime, secretions of the liver pancreas and gall bladder), jejunum (1 m long), ileum (2 m long), ileocecal sphincter, villi (lamina propria, a venule, a capillary bed, and a lymphatic lacteal), Paneth cells (lysozymes), Peyer s patches, duodenal (Brunner s) glands, up to 90%, are absorbed within the small intestine 15

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