The monthly musings of a Druid Herbalist living in New England.
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Communicating with Plants
Signatures of Plants – Learning Nature’s Alphabet
There are those who say they get messages from plants and that plants actually speak to them with a human voice, telling them the healing virtues of an herb. Others, (like me) get pictures in our minds that seem to be another form of direct communication from the plant world. Many other plant identification and communication systems have been devised over the millennia that do not rely on the written word.
Thousands of years ago the ancient Chinese developed a system of plant classification based on flavor, temperature and direction. Armed with this knowledge, an herbalist could identify which plants were most useful for a particular illness.
The Four Natures
Chinese herbalism divided herbs into warm, hot, cool and cold. A cooling or cold plant was suitable for a “Yang” (congested, full, toxic) hot disease, and a hot or warm herb was given for a “Yin” (dissipating energy, debilitated, chilly) cold disease. Some herbs were considered “neutral” and could be given for both cold and hot conditions.
The Five Flavors
Plants were also classified according to flavor; salty, spicy, sweet, sour and bitter.
Sour tasting herbs were known to stop secretions and contract tissue, and to promote digestion and liver function. Examples are; Lemon (Citrus limon), Rose hips (Rosa spp.), Hawthorn (Crataegus spp.) berries and Chinese Dogwood (Cornus officinalis).
Bitter tasting herbs were cooling, anti-inflammatory, anti-viral and helped to clear parasites from the body. They improved stomach function, cleaned the blood via the liver, cleared cholesterol from the venous system and helped the heart. Examples include; Goldenseal (Hydrastis Canadensis), Gentian (Gentiana lutea), Centaury (Centaurium umbellatum, Erythroea centaurium) and Mugwort (Artemisia vulgaris). (*note: Goldenseal is tonic to the system when taken as no more than one tenth part of a formula. Taken alone Goldenseal becomes an antibiotic and must be treated with caution as with any antibiotic. After a course of Goldenseal root take plain yoghurt, Sauerkraut, miso soup, raw apple cider, garlic or any probiotic supplement to restore intestinal flora.)
Sweet tasting herbs were building and nourishing. Foods and herbs that contained complex carbohydrates, proteins and sugars were found to be nutritive and building to the body. Examples are; Ginseng (Panax quinquefolium), Rehmannia root (R. glutinosa), Dates (Phoenix dactylifera) and Barley malt (Hordeum vulgare L.)
Spicy herbs and foods were found to be drying and warming to the body. They were useful for mucus congestion, arthritis, colds, flu, and menstrual cramps when taken internally; applied topically they relieved bruising and injuries. Examples are; Red Pepper (Capsicum annuum), Cinnamon (Cinnamomum verum, C. cassia), Ginger (Zingiber officinalis) and Prickly Ash (Zanthoxylum spp., clava-herculis and americanum).
Salty tasting herbs were found to be cooling and moistening to the body; because of the way they helped the organs to retain water. Seaweeds (Marine algae) are a good example of this kind of plant.
Bland tasting plants such as mushrooms were classified as mildly sweet and diuretic.
The Four Directions
Every substance in nature was understood to float, sink, and rise or descend, depending upon its inherent qualities. Seasons also seen to have these characteristics; summer has floating energy, fall descending energy, winter has sinking energy and spring has ascending energy.
Leaves and flowers have ascending energy, making them useful for acute, surface level diseases such as colds and flu. Barks, roots, seeds and berries have sinking energy and thus move deeper into the system to aid chronic conditions.
The Four Humors
Until the seventeenth century, European herbalists relied on the classification system of Galen and the four elements as understood by ancient Greece and Rome. In this system people were said to be divided into four “humors”; Earth, Air, Fire and Water. This system classified plants and people as hot, cold, dry or moist.
The sanguine or “Air” type person was hot and moist, cheerful with a ruddy complexion, but with a tendency to over indulge. They were prone to diseases of excess such as gout and diarrhea and had a tendency to develop inflammatory conditions. Cool and dry herbs such as Burdock (Arctium lappa) and Figwort (Scrophularia nodosa) helped to cleanse and restore these people.
The melancholic or “Earth” type was cold, dry and pale, and prone to constipation and depression. They could be visionaries but also suffered from mental or sexual disorders. Hot herbs such as Senna (Cassia acutifolia, C. angustifolia) and Hellebore (Veratrum album) were used restore balance to this type.
The phlegmatic or “Water” person was cold and moist and sometimes a little slow or dull. They tended towards congestion, mucus accumulation, and rheumatic conditions. Warming and drying herbs such as Thyme (Thymus vulgaris) and Hyssop (Hyssopus officinalis) were recommended for these disorders.
The choleric or “Fire” person was hot and dry, easily angered, and susceptible to liver disease, high blood pressure, rashes, fevers and sunburn. Cool, moist plants such as Rhubarb (Rheum palmatum), Violets (Viola spp.) and Dandelion (Taraxacum officinalis) were found to be helpful for them.
The Doctrine of Signatures
Centuries ago in Europe, in a time before most people could read, yet another system was developed to catalogue the language of plants called “The Doctrine of Signatures”. With this plant classification system in their head, an illiterate person with no access to a printed herbal could encounter a plant they had never seen before and divine its medicinal properties.
I have successfully used this system to understand the medicinal properties of a plant and its great fun to look the plant up later, and see if others have determined the same thing.
Once you have the basics down you can let your intuition lead you further, for example when I sat before a Cardinal Flower (Lobelia cardinalis) I thought immediately of a fire engine, of burning, redness, fever and sparks before the eyes. That seemed way too obvious and I didn’t think it could be so easy. Then I went and looked it up in Clarke’s Materia Medica and here was what I found;
“There is a proving of Lob. card. by S. D. R. Dubs, who took ten drops of the tincture in one dose. Dubs' symptoms have been confirmed by a second proving by Kopp (H. W., xxxi. 26). The acrid properties of the plant were immediately felt by Dubs, in burning in mouth and throat, which lasted a long time. Sticking and pricking sensation in various parts, especially left chest and left hypochondrium. Oppression of breathing. Headache at base of occiput < by motion and shaking head; stiffness in nape. Throbbing and weakness in lower limbs. Most of the effects lasted two weeks, and it was three weeks before the appetite returned. There was thirst for cold water, which > burning in tongue and fauces. Many symptoms occurred at 8 a.m. Sleepy but difficulty in sleeping. A lady to whom Cooper gave one dose of Lob. cd. had "flashes of light before eyes every day for a week." It seems, he says, to have an action distinct from that of other Lobelias, since a dose of it brought back pains which had been relieved by Lob. dort.”
(For those who may not be aware of how Homeopathy works, a dilute amount of the herb, mineral or other substance is taken until a “proving” or symptom picture results. The symptoms that appear in the “provings” are compared to those of a sick person and if properly matched, the person who takes the remedy will heal).
Here is an overview of some elements of The Doctrine of Signatures. Once you have these in your mind it’s easy to ferret out the properties of an unfamiliar herb.
The first thing is, get used to using all your senses to communicate with a plant; touch, sight, smell, and taste. Next, be aware that this system works only with wild plants growing in their natural habitat, or with “invasives” that have chosen, without human intervention, to incorporate a certain set of light and soil conditions. Non-native species that have been planted by humans do not give accurate readings!
Where is the plant growing, in sunlight or in shade? Plants that crave a lot of sun will generally bring dryness and heat into the body; Elecampane (Inula helenium), Sunflower (Helianthus annuus). Plants that thrive in the shade; Elderberry (Sambucus nigra, S. Canadensis), Peppermint (Mentha spp.) tend to be cooling.
Is the plant growing in a wet place or a dry place? Plants that thrive in damp areas will help with conditions such as rheumatism, fevers, colds, and coughs; Willow (Salix spp.), Mint (Mentha spp.), Vervain (Verbena hastata), Sweet Flag (Acorus calamus), Elderberry (Sambucus nigra, S. Canadensis), Boneset (Eupatorium perfoliatum), Jack-In-The-Pulpit (Arisaema triphyllum), Skunk Cabbage (Symplocarpus foetidus), Sundew (Drosera rotundifolia, D. anglica and D. linearis).
Plants that are used to dry up mucky soil will help dry mucous secretions; Sunflower (Helianthus annuus), Eucalyptus (Eucalyptus globulus).
Plants that grow in or around clear ponds and fast moving brooks tend to be diuretic; Horsetail (Equisetum hyemale), Bedstraw (Galium aparine), Mint (Mentha spp.), Alder (Alnus serrulata) and will help to clear the urinary tract of waste.
Plants that thrive in gravel and rock formations will help to clear stone-forming and catarrhal accumulations from the bronchial and alimentary systems; Bearberry (Arctostaphylos uva ursi), Horsetail (Equisetum hyemale), Peppergrass (Lepidium virginicum), Parsley (Carum petroselinum), Shepherd’s Purse (Capsella bursa-pastoris), Juniper (Juniper communis), Sassafras (Sassafras albidum, S. variifolium).
Does the plant grow in thin or disturbed soil? If thin soil it is a plant that likes to struggle and will bring grit and strength to the body.
Does the plant have hollow stems? If so it will help clean tubes in the human body such as the bronchi and alimentary tract; Comfrey (Symphytum officinale), Onion (Allium cepa), Garlic (Allium sativum, A. canadense), Thyme (Thymus serpyllum, T. vulgaris), Irish Moss (Chondrus crispus, Gigartina mamillosa).
Alone or in a Group
Is the plant growing alone or in a group? Solitary plants are telling you they are powerful and need to be treated with cautious respect. Plants that grow in masses such as Red Clover (Trifolium pratense) are more gentle in action or esculent.
Does the plant grow near people or as far away as it can manage? Plants that grow on your doorstep like Dandelion (Taraxacum officinale) and Plantain (Plantago major) can be used safely for a long time. Plants that grow in the deep woods; Goldenseal (Hydrastis Canadensis), Blue Cohosh (Caulophyllum thalictroides) have more specialized uses and should only be used for a short time period. Plants that grow in fields, the middle distance between house and forest, can be used for a while but only during special seasons or for a certain period of time; Yarrow (Achillea millefolium), SaintJohnswort (Hypericum perforatum).
The Signatures of Roots
Check out the roots. Are they deep or shallow, thick or thread-like? Plants with very thin, thread-like stems and roots are often skin healers, their roots imply the sewing up of lesions; Bedstraw or Cleavers (Galium aparine), Tormentil or Septfoil (Potentilla tormentilla), Cinquefoil (Potentilla reptans), Gold Thread (Coptis greenlandica).
Very fine and meshed roots are a signature for healers of the nervous system; Valerian (Valeriana officinalis), Lady’s Slipper (Cyprepedium calceolus, C. pubesceous).
Annuals have small thread-thin roots. These plants are mostly Fire and Air. They do not live longer than one year and lack strong Earth energy thus they are not grounding to the body and mind, however they will help to raise a person’s spirits, lighten their outlook and promote change. Their medicinal properties will be concentrated in the leaves and flowers.
Biennials are plants that grow over a two year life cycle. They have large fleshy roots that store energy to get them through the dark, cold winter. In their first year they have no flowers or seeds and their healing virtue is concentrated in their roots. In their second year the energy moves to the flowers or berries and ultimately the seeds, which is where their medicinal properties will be found; Carrots and Queen Anne’s Lace or Wild Carrot (Daucus carota), Beets (Beta vulgaris), Burdock (Arctium lappa), Parsnip (Pastinaca sativa), Salsify (Tragopogon spp.), Raspberry (Rubus ideaus). These plants tend to have sweet roots that are nutritive due to their high carbohydrate content.
Perennials are plants that come back every year. Some, such as deciduous trees, Reeds (Phragmites communis) and Comfrey (Symphytum officinale) may appear to die back in the winter. Conifers, of course, stay green all year. These plants have very large and deep roots and a more even energy distribution. Even in winter their twigs and roots will provide medicinal aid.
Understanding the structure of leaves can point to the uses of a plant. For example Liverwort (Hepatica ssp.), used to heal liver conditions, has a three lobed leaf, like the liver. Comfrey (Symphytum officinale) leaves have “cells” that look like human skin as seen under a magnifying glass and tiny hairs. It is one of the greatest skin healers and a healer of areas of the human body that have small hairs such as the nose, throat and intestines. Nervine plants tend to have a prominent vein in the leaf while plants that benefit circulation have raised veins.
Softness of the Leaves
Plants with very soft leaves will often ease pain in a diseased or injured area; Mallow (Malva rotundifolia), Hoarhound (Marrubium vulgare), Hollyhock (Althea rosea), Mullein (Verbascum Thapsus). (Mullein leaves were once used as a wound dressing).
Plants that help the eyes such as Eyebright (Euphrasia officinalis) look like an eye, while the seeds of Skullcap (Scutellaria spp.) resemble a cap or helmet, pointing to its use to help sleeplessness, headaches and nerve problems.
Plants with a sticky mucilaginous sap are great wound and itch healers; Aloe (Aloe spp.), Pine sap (Pinus spp.), Comfrey (Symphytum officinale) and if very juicy and wet (Aloe spp.) will help swell excretions and benefit the colon.
If a plant has thorns it is probably edible and evolved the thorns to protect itself; Raspberry (Rubus ideaus), Blackberry (Rubus spp.), Rose (Rosa spp.). Thorns are also a signature for sharp pain. Thorny plants relive pain not by sedating it but by striking at the root cause of it, for example Hawthorn (Crataegus spp.) which is a tonic for angina and all manner of heart conditions. Other such plants are Prickly Lettuce (Lactuca virosa, L. scariola), Motherwort (Leonurus cardiaca), Blessed Thistle (Cnicus benedictus), Raspberry (Rubus ideaus), which eases labor pains, and Strawberry (Fragraria spp.) and Blackberry (Rubus spp.), which contain malic and citric acids that break up formations that lead to kidney and gall stones.
If a plant is very dry and lacking in juice, such as Sage (Salvia officinalis) it will be good to dry up secretions such as catarrh and breast milk.
A plant that sticks to itself will cling to and removed hardened mucus; Sage (Salvia officinalis), Coltsfoot (Tussilago farfara), Hoarhound (Marrubium vulgare), Life Everlasting (Gnaphalium obtusifolium), Mallow (Malva rotundifolia).
Hairy plants relive “stitch in the side” types of pain; Nettles (Urtica dioica), Sumac (Rhus typhina), Mullein (Verbascum thapsus), Currant (Ribes spp.), Hops (Humulus lupulus), Sundew (Drosera rotundifolia, D. anglica and D. linearis).
Plants with long trailing root systems and vines that resemble veins and the nervous system of the body are often blood purifiers, nervines and antispasmodics; Sarsaparilla (Smilax spp.), Woodbine (Lonicera periclymenum), Licorice (Glycyrrhiza glabra), Bittersweet Nightshade (Solanum dulcamara), Grapes (Vitis vinifera), Hops (Humulus lupulus), Mints (Mentha spp.), Cinquefoil (Potentilla reptans), Dog Grass (Agropyron repens), Bearberry (Arctostaphylos uva-ursi).
Trees with bark that has openings and tears or “lenticels” are a signature for broken skin and thus skin healers; Birch (Betula spp.), Elder (Sambucus spp.), Cherry (Prunus spp.), Sumac (Rhus typhina).
Wart-like growths and galls such as growths on Sumac (Rhus typhina), and Oak Galls (Quercus spp.) contain tannins and gallic acid which is astringent and pulls together the edges of a wound.
Spotted leaves point to tumorous growths and pus sacks on infected lungs; SaintJohnswort (Hypericum perforatum), Lung Wort (Pulmonaria officinalis).
Plants that contain a lot of resin are often healers of moist lesions, cuts and ulcers; Balsam of Peru or Tolu Balsam (Myroxylon balsamum pereirae), Benzoin (Styrax spp.), Mastic (Pistacia lentiscus), Pine resin (Pinus spp.), Myrrh (Commiphora myrrha), Turpentine (from Pinus spp.), Aloe (Aloe spp.).
Lichens and molds are useful for skin conditions such as psoriasis which they resemble.
Mucilaginous plants will soothe the throat; Acacia (Acacia spp.), Tragacanth (Astragalus adscendens, A. gummifer, A. brachycalyx, and A. tragacanthus), Irish Moss (Chondrus crispus), Hollyhock (Alcea spp.), Slippery Elm (Ulmus rubra), Mallow (Malva rotundifolia), Lungwort (Pulmonaria officinalis), Flax-seed (Linum usitatissimum).
Plants that are highly aromatic are also disinfectant and deodorizing; Thyme (Thymus serpyllum, T. vulgaris), Rosemary (Rosmarinus officinalis), Lemon (Citrus limon), Juniper (Juniperus spp.). For bad breath and body odor; Marjoram (Origanum majorana), Mint (Mentha spp.), Rosemary (Rosmarinus officinalis), Anise (Pimpinella anisum). Other aromatics are antiseptic, germicidal and antibiotic; Tansy (Tanacetum vulgare), Pennyroyal (Mentha pulegium), Sage (Salvia officinalis), Savory (Satureja hortensis), Fennel (Foeniculum vulgare), Basil (Ocimum spp.).
A scull-like shape reveals a brain healer, for example Walnut (Juglans spp.) and Scullcap (Scutellaria laterifolia).
Plants with compact flower clusters can deal with an intense accumulation of pus in the throat and tonsils and are astringents for tonsillitis and sore throats; Sumac (Rhus typhina), Self-Heal (Prunella vulgaris), Hard-hack (Spiraea tomentosa).
Plants that sting (Ginger (Zingiber officinalis), Nettles (Urtica dioica), stimulate internal circulation of fluids.
Plants that stink; Stinking Arrach (Chenopodium olidum) are used for indolent, foul ulcers.
Plants with a groin-like shape; Mandrake (Mandragora officinarum), Poke Root (Phytolacca americana), Ginseng (Panax quinquefolium), Bryony (Bryonia dioica) are used to overcome sterility and sexual lethargy.
Color of the Root or Flower
The color red points to the blood and the plant is likely a blood purifier and or beneficial to the heart (Red Clover (Trifolium pratense), Burdock (Arctium lappa), Rose (Rosa spp.), Raspberry (Rubus ideaus), Bee Balm (Monarda fistulosa, M. punctata, M. menthifolia, M. didyma), Hawthorn (Crataegus spp.).
Yellow flowers are associated with the liver and gall, jaundice and yellow bile; Dandelion (Taraxacum officinale), Celandine (Chelidonium majus), Goldenseal (Hydrastis Canadensis), Barberry Root (Berberis vulgaris), Lemon (Citrus limon).
Blue and purple flowers point to a plant that will improve the complexion and which may also be a remedy for cyanosis; a blueness of the skin resulting from lack of oxygen in the blood and impaired arterial flow (Joe Pye Weed (Eupatorium purpureum), Red Clover (Trifolium pratense), Vervain (Verbena officinalis, V. hastata), Burdock (Arctium lappa), Gentian (Gentiana lutea), Chickory (Cichorium intybus).
The Taste of Plants
There is an old adage; “Bitter taste, sweet to the stomach, sweet taste, bitter to the stomach”.
Plants that are yellow and bitter (Dandelion (Taraxacum officinale)) benefit the liver while plants that are yellow and sweet Astragalus root (Astragalus membranicus),Elecampane ( Inula Helenium) are building to the stomach, spleen and pancreas.
Plants that are sour and taste like Lemons are telling you they have a lot of vitamin C.
Plants that taste like carrots have a lot of carotene or Vitamin A.
Lichens will taste of the minerals in the rock they are growing on.
Spinach actually tastes like iron ore.
Plants that taste like garlic contain sulphur and can help clear heavy metals out of the body.
Pain killing plants will deaden the lower lip when tasted.
The Energetics of Color
The Chakras are energy nodes that exist in specific areas of the body. Red flowering plants; (Wild Ginger (Asarum spp.) will help move energy to the second chakra, or sexual node of the body.
Orange flowered plants tend to spread cleansing energy over the whole body; Calendula (Calendula officinalis).
Yellow, Solar plants enhance the sense of personal power and the Self; Dandelion (Taraxacum officinale), Elecampane (Inula helenium).
Plants that are mostly green; Self-heal (Prunella vulgaris) are soothing to the eyes and to the entire bodily system.
Blue flowers such as Mint (Mentha spp.) point to the throat chakra and communication while indigo, dark blue and dark purple flowered plants enhance the Third Eye (Ajna in Sanskrit) and kill pain; Gentian (Gentiana lutea), Scullcap (Scutellaria laterifolia).
Violet plants are attuned to the Crown Chakra at the top of the skull, to the hormonal and nervous systems, pineal and pituitary glands; Scullcap (Scutellaria lateriflora). White blooming flowers; Boneset (Eupatorium perfoliatum), Comfrey (Symphytum officinale) point to bone healing.
The Signatures of Foods
Slice a carrot and you will find radiating spokes that look like the human eye. Carrots contain Vitamin A which is very beneficial to eye health.
Tomatoes are red and have four chambers, just like a human heart. Tomatoes, like all red fruits and vegetables according to Chinese medicine, benefit the Fire Element; the heart, blood and circulation.
Grapes hang in heart shaped clusters. Grapes are great blood and lymph cleansers and contain resveratrol which helps the heart.
Walnuts look like little brains, with left and right hemispheres and wrinkles that resemble the neo-cortex. Walnuts are known to improve brain function.
Kidney beans actually do benefit the kidneys.
Eggplants, Pears and Avocados are shaped like the female womb. It takes nine months to grow an avocado from seed to fruit and avocados balance hormones, help shed birth weight and prevent cervical cancers.
Figs hang in clusters of two and are filled with seeds. They increase the number and motility of sperm.
Sweet potatoes resemble the pancreas and can help balance the glycemic index. In Chinese medicine orange foods are said to benefit the Earth element and the pancreas.
Olives help the ovaries which they resemble in structure. Pomegranates, which are larger but also resemble the ovary filled with blood and eggs, are cleansing to the female reproductive tract.
Citrus fruits; grapefruits, oranges, and others, resemble mammary glands. They help move lymph in and out of the breasts.
Onion cells under the microscope look like human cells. They help to clear waste from cells and cause tears which clean the epithelial layers of the eyes.
What’s in a Name?
When you look at an herbal you will notice that a plant may have several common names. Pay attention to the folk names for herbs, because the old timers named them that way for a reason. Eyebright (Euphrasia officinalis) got its name because it helps the eyes. Liverwort (Peltigera Canina, Anemone hepatica) is called that because it helps the liver (“wort” is an old word for “herb”).
Mouthroot or Gold Thread (Coptis greenlandica) is good for ulcers and mouth sores. Heartsease (Pansy) leaves are a tonic for the heart. Kidneywort (Cotyledon umbilicus) helps with inflammation and stone in the Kidneys. Lungmoss (Lobaria pulmonaria) helps with pulmonary problems. Scullcap (Scutellaria laterifolia) is for headaches.
Other examples are Cough Herb (Tussilago farfara), Puke Weed (Lobelia inflata), Heal-all (Collinsonia Canadensis), Self-heal (Prunella vulgaris), Nose bleed (Achillea millefolium), Asthma Weed (Lobelia inflate), Colic Root (Dioscorea Villosa), Boneset (Eupatorium perfoliatum), Dysentery Bark (Simaruba Amara), Feverwort (Erythraea centaurium), Pilewort (Ranunculus ficaria), Scabwort (Inula Helenium), and many more. You get the idea.
A Note about Poisonous Plants
Nature in Her kindness has given us a signature for poisonous herbs; the color is maroon. For example the berries and stems of Poke Weed (Phytolacca americana), and the streaks of maroon found up and down the stems of Water Hemlock (Cicuta spp.) which is the herb that did in Socrates.
*This is a system that I teach my students in a yearly six month herbal intensive, October to April, in Western MA. Visit my website for a look at my books, DVDs and blog www.elleneverthopman.com
Bjerklie, David The Doctrine of Signatures Isn't Mother Nature amazing? TIME Magazine, Oct. 2003
Grieve, M., A Modern Herbal, Dover Publications Inc., New York, 1971
Harris, Ben Charles, The Compleat Herbal, Larchmont Books, New York, 1982
Tierra, Michael, Planetary Herbology, Lotus Press, Santa Fe, New Mexico, 1988
Clarke, John Henry, A Dictionary of Practical Materia Medica, Lobelia Cardinalis http://www.homeoint.org/clarke/l/lob_card.htm accessed 12/02/13
Herbal History http://herbwisdom.tripod.com/herb_history.html accessed 11/29/2013
Web MD, Liverwort http://www.webmd.com/vitamins-supplements/ingredientmono-37-Hep%C3%A1tica%20(LIVERWORT).aspx?activeIngredientId=37&activeIngredientName=Hep%C3%A1tica%20(LIVERWORT) accessed 12/05/2013
Wolfson P, Hoffmann DL., Altern Ther Health Med. 2003 Mar-Apr; 9(2):74-8, An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers, http://www.ncbi.nlm.nih.gov/pubmed/12652886 accessed 12/05/2013
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