I came upon herbal medicine and began studying it when I realised it can work well for my own problem, this was nerve pain. I have come to believe herbal medicines are far under appreciated and have been neglected. However, there are many types of nerve pain and this article can only provide some indications of what herbs may work, I also go into diet which is important.

Underlying causes, diet, and the immune system

I should first say, when approaching nerve pain, including disorders like peripheral neuropathy, small fiber neuropathy, fibromyalgia, sciatica, and carpal tunnel, the key is to always look for the underlying cause. For example, some people have a deficiency in B12 which is causing or aggravating their problem, others may have a trapped nerve and need physiotherapy or to see a chiropractor. Poor digestive health may be a contributor or underlying the nerve pain, so steps may be necessary to improve the health of the digestive system, the simplest way is changing the diet. I should also say, B vitamins are key to the health of the nervous system (Watanabe et al., 1994), so the diet should include B vitamins through good quality meats (grass fed or wild) or a B complex can be used. Remember vitamin B6 can be toxic in high doses so do research and be careful if taking this (Levine et al., 2002). Alpha lipoic acid, an anti-oxidant molecule, has been shown to improve certain kinds of neuropathic pain, therefore is worth considering (Ziegler et al., 1995).

Before we go into the nervine herbs, it is relevant to discuss immunomodulating herbs, immune dysregulation, and go further into diet. Certainly this has relevance in disorders like MS, however, in other neurological conditions inflammation and chronic nerve pain are actually intimately connected and we are increasingly appreciating chronic neuropathic pain as a neuroimmune disorder (Scholz and Woolfe, 2004). Although usual anti inflammatory drugs, like NSAIDs, are not effective at reducing neuroinflammation and neuropathic pain, herbs are more complex, and there is a huge range of different medicinal plants that have immune modulating activity.

Key tonic herbs for the immune system include reishi and ashwagandha, both also act on the nervous system to induce a state of calm (Groves, 2016). It is also important to change diet to remove pro-inflammatory foods and to eat more anti-inflammatory foods. A natural plant based Paleo type diet (removes grains, dairy, processed foods, and refined sugars) is a good option (Cordain, 2012). Although, I definitely prefer to avoid red meat as it is pro-inflammatory and pro-cancer and include legumes and chickpeas (Montonen et al., 2013). Small amounts of good quality seafood and white meat are sensible, but the emphasis is on vegetables and fruits. There is also evidence omega3 oils may be helpful in treating neuropathic pain. In one recent study, researchers found omega3 supplementation in mice helped assist in recovery from nerve injury (Gladman et al., 2012). It is best to find a good quality supplement with high strength EPA and DHA.

Many people with nerve pain also suffer with sleep issues. This is where good sleep habits can really help. Going to bed at the same time every day and getting up at the same time can help train the circadian clock (Roenneberg et al., 2007). Many of the nervine herbs mentioned below may improve sleep as they calm the nervous system. Getting good sleep will assist in the healing process. Also, some may find it useful to combine immunomodulating herbs with those that more specifically target the nervous system, induce a state of relaxation, may restore function, and also treat pain. These are the nervine tonic herbs, generally, the most important class of herbs for nerve pain.

The nervine tonics

Two key herbs from our Western herbal materia medica, that may restore the nerves and reduce pain, are St. John’s wort and prickly ash. St. John’s wort was used by the ancient Greeks to treat sciatica (Castleman, 2001). It’s popular use as an antidepressant is only a recent development, traditionally it was used internally to heal nerves and topically for burns and wounds. There is some scientific support of it’s ability to treat neuropathic pain in experimental models (Galeotti et al., 2010). St. John’s wort is perhaps the most important herb for nerve pain in our materia medica and it is best obtained in fresh tincture form with a very deep red colour. Not using a fresh tincture in this case I believe is a mistake.

Prickly ash is a circulatory stimulant and analgesic, Matthew Wood reports good success in treating nerve pain using a combination of prickly ash and St. John’s wort mixed in equal parts, and taken 1-3 times daily in small doses (around 5-10 combined in drops) (Wood, 2009). Other tonics for nerve pain from the European and North American system, other than St. John’s wort and prickly ash, include wood betony, blue vervain, and American skullcap that can be considered for inclusion into a formula (Groves, 2016).  However, my preferred two, are St. John’s wort and American skullcap.

Outside of the Western system, traditional regenerative herbs for renewing the nervous system from Ayurveda, known as the ‘medhya rasayana’ herbs, include gotu kola, calamus, and ashwagandha (Groves, 2016). Ashwagandha, is a powerhouse of a herb and a versatile rasayana (restorative) tonic, recent science suggests it can encourage new growth of nerves when they are damaged (Nakayama et al., 2007).

Other option is a mushroom called lion’s mane, it has started recently to be widely used as a nervine tonic by herbalists (Groves, 2016), and there is preliminary scientific evidence that it can regenerate nervous tissue and encourage release of nerve growth factor (Wong et al., 2011). Finally, cannabidiol, one of 2 primary medicinal components of cannabis, has recently emerged as a popular option for nerve and inflammatory pain. Human studies strongly support the use of CBD/THC cannabis extracts for neuropathic pain (Nurmikko et al., 2007).

Formulation notes

It can be useful in herbalism to consider the constitution and energetics as well as the plant’s action, for example, gotu kola is a cooling herb that is less suited for the vata constitution (cold, dry). Formulating it with ashwagandha (warming) makes a compound better suited for vata.

The herbs I have mentioned above are all constitutionally drying. Although this may not be an issue with some people, if taking drying herbs long term it may be better to formulate them with moistening herbs such as hawthorn, licorice, shatavari, or fresh milky oat seed. Long term intake of sufficient quantities of drying herbs in a person prone to dryness may result in dry skin and constipation. Also, several of the herbs below are much better in a fresh tincture form, i.e. made from non dried plant material.

Nerve pain pair (from Matthew Wood)

Fresh St. John’s wort (1 part) (warming, drying)
Prickly ash (1 part) (warming, drying)

Dose approx: 10-40 drops 2-3 times daily

Note: This formula is contraindicated with SSRIs, during pregnancy, and breastfeeding. St. John’s wort may decrease the effectiveness of pharmaceutical drugs.

Nerve pain pair II

These two are a good combination for the nerve pain.

Fresh St. John’s wort (1 part) (warming, drying)
Fresh American skullcap (1 part) (cooling, drying)

Dose approx: 20-60 drops 2-3 times daily
Note: This formula is contraindicated with SSRIs. St. John’s wort may decrease the effectiveness of pharmaceutical drugs.

Nervous system restorative formula

This is what I think I have had the most success with after many attempts. The fresh tincture of the American skullcap is pretty amazing for sleep.

Fresh St. John’s wort (1 part) (warming, drying)
Fresh American skullcap (1 part) (cooling, drying)
Ashwagandha KSM-66 (2-4, 400mg capsules per day)

Dose approx: 20-90 drops 2-3 times daily
Note: This formula is contra indicated with SSRIs. If on sedative medication be highly cautious regarding dose. St. John’s wort may decrease the effectiveness of pharmaceutical drugs.

Conclusions

The best approach to nerve pain is a holistic one that takes into account the underlying cause of the problem (if known) and other factors in ones lifestyle, especially diet and associated digestive health. The path back from serious nerve problems, or to manage them, takes time, patience, and willingness to troubleshoot. This article has given some herbs that could be used in the construction of a formula for nerve pain.

Note: If you are not fully comfortable with a DIY approach for your condition for any reason, please do not hesitate to contact a local professional herbalist for more tailored assistance.

References:

Bibel, Barbara. “Body into Balance: An Herbal Guide to Holistic Self-Care.” (2016): 117-117.

Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471.

Christopher, John R. Herbal home health care. Christopher Publications, 1976.

Cordain, Loren. AARP The Paleo Diet Revised: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. John Wiley & Sons, 2012.

Galeotti, Nicoletta, et al. “St. John’s Wort reduces neuropathic pain through a hypericin-mediated inhibition of the protein kinase C γ and ɛ activity.” Biochemical pharmacology 79.9 (2010): 1327-1336.

Gladman, Stacy J., et al. “Improved outcome after peripheral nerve injury in mice with increased levels of endogenous omega-3 polyunsaturated fatty acids.” Journal of Neuroscience 32.2 (2012): 563-571.

Groves, Maria. Body into Balance. Storey Publishing, 2016.

Levine, S., and A. Saltzman. “Pyridoxine (vitamin B6) toxicity: enhancement by uremia in rats.” Food and chemical toxicology 40.10 (2002): 1449-1451.

Montonen, Jukka, et al. “Consumption of red meat and whole-grain bread in relation to biomarkers of obesity, inflammation, glucose metabolism and oxidative stress.” European journal of nutrition 52.1 (2013): 337-345.

Nakayama, Natsuki, and Chihiro Tohda. “Withanoside IV improves hindlimb function by facilitating axonal growth and increase in peripheral nervous system myelin level after spinal cord injury.” Neuroscience research 58.2 (2007): 176-182.

Nurmikko, Turo J., et al. “Sativex successfully treats neuropathic pain characterised by allodynia: a randomised, double-blind, placebo-controlled clinical trial.” Pain 133.1 (2007): 210-220.

Roenneberg, Till, C. Jairaj Kumar, and Martha Merrow. “The human circadian clock entrains to sun time.” Current Biology 17.2 (2007): R44.

Scholz, Joachim, and Clifford J. Woolf. “The neuropathic pain triad: neurons, immune cells and glia.” Nature neuroscience 10.11 (2007): 1361.

Watanabe, Tetsuya, et al. “Ultra-high dose methylcobalamin promotes nerve regeneration in experimental acrylamide neuropathy.” Journal of the neurological sciences 122.2 (1994): 140-143.

Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.

Wong, Kah-Hui, et al. “Peripheral nerve regeneration following crush injury to rat peroneal nerve by aqueous extract of medicinal mushroom Hericium erinaceus (Bull.: Fr) Pers.(Aphyllophoromycetideae).” Evidence-based complementary and alternative medicine 2011 (2011).

Wood, Matthew. The Earthwise Herbal: A Complete Guide to New World Medicinal Plants. North Atlantic Books, 2009.

Ziegler, D., et al. “Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant α-lipoic acid.” Diabetologia 38.12 (1995): 1425-1433.