Although surgery can be complicated and there are so many different types, there is one fundamental truth that prevails with all surgery: The better we heal, the less scar tissue we have. The less scar tissue we have, the better our tissue functions, whether it is an organ, a bone, or a muscle.

Of course, the more involved the surgery, the more resources are needed for the body to heal: nutrients need to be absorbed and taken to tissues, waste products and injured tissues need to be cleaned up. Healing starts the moment surgery begins (or before!) and involves a series of coordinated reactions and processes in the body. Because the majority of healing occurs within the first few weeks following surgery, it is important to plan ahead.

Herbs to Avoid Before Surgery

It is generally recommended to avoid the herbs listed below two weeks before surgery and for the first week after surgery. The herbs on this list can affect bleeding and bruising, cardiovascular function, blood sugar, and anesthesia or other drugs used during surgery. Remember, it is important to discuss all preoperative herbs and dietary supplements with your health care professional prior to any surgery or procedure.

Commonly taken herbs to avoid include: Ginkgo (Ginko biloba), Garlic (Allium sativum), Ginseng (Panax spp.), Ginger (Zingiber officinale), Dong Quai (Angelica sinensis), Ephedra (Ephedra spp.), Feverfew (Tanacetum parthenium), St. John’s Wort (Hypericum perforatum) and Kava (Piper methysticum).

Pre-surgery Preparation

Healing from surgery starts before we even go into the hospital. Some of the most important things we can do prior to surgery include getting moderate exercise and eating high nutrient whole foods. Although this article focuses on herbs, I can’t stress enough that diet is the single most important focus throughout the healing process.

Some of the most important nutrients to focus on include proteins, high-quality fats, Vitamins including C, D, A, and B Vitamins, and minerals including zinc and magnesium. Fermented foods, such as live sauerkraut, kombucha, and live yogurt, and probiotic supplements will aid in the digestive process, especially if antibiotics were part of the surgical protocol. A high-quality multivitamin can also be an excellent addition for some people.

One more excellent addition to any surgery recovery diet is bone broth. Bone broth is high in GAG’s (also called glycosaminoglycans), which helps repair connective tissue. GAGs are found in the linings of the digestive tract, mucus membranes, cartilage, and arteries.

The Healing Process

Healing...is not a science but the intuitive art of wooing nature. ~W.H. Auden, "The Art of Healing"

There are three general stages to healing post-surgery, including the inflammatory, proliferative, and remodeling phases.

1) The Inflammatory Phase

The Inflammatory Phase can last up to 5 days. The body’s first response to injury involves forming a localized blood clot to stop bleeding. This is called hemostasis. Once hemostasis is achieved the blood vessels dilate, bringing in extra nutrients, antibodies, and white blood cells. The white blood cells serve to fight infection (neutrophils) and clean and débride injured tissue (macrophages). This is when we generally feel the effects of inflammation including swelling, pain, heat, and redness. Rather than looking at short-term inflammation as a bad thing, we can see it as an essential step in the healing process.

Right Before and After Surgery

• Nutritive Tea Herbs: drinking nutritive teas helps add minerals and antioxidants necessary for healing. This can be a long-term support that can be started before surgery begins. Herbs: Nettles (Urtica dioica), Oat straw (Avena spp.), Chamomile (Matricaria chamomilla), Raspberry (Rubus spp.), Dandelion root and leaf (Taraxacum officinale), Yellow dock (Rumex crispus), Horsetail (Equisetum spp.), Hibiscus (Hibiscus sabdariffa), Rosehips (Rosa spp.)

• Essential Oils: sprinkle a couple of drops of Lavender or Orange essential oils on hospital sheets to clean the air and soothe and lift the spirits. I often find an added benefit that many nurses will spend more time in your room if you do this!

• Homeopathic Arnica: Homeopathic remedies don’t interact with medications and can be used safely both before and after surgery. I like to start using it 2 days before surgery and approximately 4 days after, or until pain upon movement is gone. Arnica can significantly reduce bruising and speed recovery from surgery. A homeopathic arnica salve or cream can be applied topically around the area, avoiding the incision.

• Flower Essences: I also really like Arnica flower essence for medical trauma in general, and for children specifically. The flower essence blend Rescue Remedy (and related products such as Soul Support by Alaskan Essences) can be helpful as well.

2) The Proliferative Phase

The Proliferative Phase lasts an average of two days to three weeks. The body starts building tissue and new blood vessels at the surgical site with specialized collagen-forming cells called fibroblasts. This new tissue, called granulation tissue, is usually pink or red in color. A pink color is a good indicator that the tissue is healing well and getting the oxygen and nutrients it needs. If the incision is red, pay close attention to possible infection or other healing issues.

• Continue: nutrient-dense diet, homeopathic arnica, and nutritive tea herbs

• Laxatives: encourage peristalsis and movement of the digestive system due to an either stimulating or bulking action, thereby initiating a bowel movement. Strong pain medications, such as opiates, cause constipation. I was recently speaking to a surgeon about a friend’s recovery and she expressed the opinion that she thought prescribing pain medication without laxatives was “malpractice”.

  • Stimulating laxatives: contain anthraquinones, which stimulate the vagus nerve and the defecation response in the body. Herbs: Coffee (Coffea arabica), Cascara sagrada (Rhamnus purshiana), Senna (Cassia angustifolia), Aloe (Aloe vera), Rhubarb (Rheum spp.), Yellow dock (Rumex crispus)

  • Bulking laxatives: add mass and water to the stool, aiding in the movement of food through the digestive system. Herbs: Pysllium (Plantago ovata), Flax (Linum usitatissimum), Fenugreek (Trigonella foenum-graecum), Slippery elm (Ulmus rubra), Marshmallow (Althea officinalis)

  • Lymphagogues: support the lymphatic organs and stimulate the activity of the lymphatic system. The lymph is crucial for cleaning up excess fluid at surgical areas, as well as providing immune support to those tissues. Herbs: Burdock (Arctium lappa), Calendula (Calendula officinalis), Cleavers (Galium aparine), Mullein (Verbascum thapsus), Ocotillo (Fouqueria splendens), Red clover (Trifolium pratense), Red root (Ceanothus spp.), Figwort (Scrophularia lanceolata)

  • Alteratives: are traditionally thought of as “blood cleansers”. I think of them as stimulating the eliminatory organs (which clean the blood) such as the liver, kidneys, lymph, skin, and digestive system. During surgery, we have more tissue injury. Using alteratives helps the body clean up. Herbs: Burdock (Arctium lappa), Cleavers (Galium aparine), Echinacea (Echinacea spp.), Figwort (Scrophularia lanceolata), Nettles (Urtica dioica), Oregon grape (Mahonia spp.), Goldenseal (Hydrastis canadensis), Red clover (Trifolium pratense), Yellow dock (Rumex crispus)

3) The Remodeling Phase

The Remodeling Phase also called the maturation phase, can last from 3 weeks to several years. The body replaces the collagen that was laid down during the proliferative phase with stronger collagen to support the structure and function of the tissue over the long term. Over time, cellular activity decreases and the number of blood vessels in the area decreases and recedes. This is a good time to work on longer-term healing and scar tissue reduction.

• Continue: nutrient-dense diet and nutritive tea herbs

• Once the stitches are removed (if you had them) and the incision is healed, herbs can be applied directly to the area. I find salves, poultices, and compresses particularly helpful (see recipes below).

• Vulnerary herbs: are used externally to promote healing of the skin (think incisions and wounds). These should be used once the incision is healed to reduce scar tissue and promote skin health. Herbs: Aloe (Aloe vera), Calendula (Calendula officinalis), Chickweed (Stellaria media), Cleavers (Galium aparine), Comfrey (Symphytum officinale), Fenugreek (Trigonella foenum-graecum), Plantain (Plantago ovata)

• Rubefacients: are applied topically to cause an increase of circulation to an area by causing capillary dilation. They can be helpful for pain, inflammation, sore joints, achy muscles, and tissue repair. Many of these herbs should be used in sparingly. Herbs: Cayenne (Capsicum annuum), Clove (Syzygium aromaticum), Garlic (Allium sativum), Ginger (Zingiber officinale), Horseradish (Armoracia rusticana), Mustard (Brassica spp.), Nettles, fresh (Urtica dioica), Poplar (Populus spp.), Rosemary (Rosmarinus officinalis), Wintergreen (Gaultheria procumbens)

• Astringents: are useful for pulling boggy or inflamed tissues back together. They usually contain tannins, which combine with proteins on the skin to help to tone, tighten, and protect the skin. By increasing tissue integrity, astringents can help prevent irritation and infection. Herbs: Agrimony (Agrimonia eupatoria), Bayberry (Myrica spp.), Blackberry (Rubus spp.), Cinnamon (Cinnamomum verum), Geranium (Geranium spp.), Meadowsweet (Filipendula ulmaria), Oak (Quercus spp.), Plantain (Plantago ovata), Raspberry (Rubus spp.), Rose (Rosa spp.), Rosemary (Rosmarinus officinalis), Sage (Salvia officinlais), Self heal (Prunella vulgaris), Uva ursi (Arctostaphylos uva-ursi), Witch hazel (Hamamelis spp.), Yarrow (Achilllea millefolium)

• Analgesics: help to relieve pain. Herbs: Willow (Salix spp.), Aspen (Populus tremuloides), Wintergreen (Gaultheria procumbens), Valerian (Valeriana spp.), Kava (Piper methysticum), Marijuana (Cannabis sativa), California poppy (Eschscholzia californica), Black Cohosh (Actea racemosa)

• Anti-inflammatories: help reduce inflammation by various methods, containing constituents such as salicylates, flavones, and chemical precursors to steroids. Herbs: German chamomile (Matricaria chamomilla), Licorice (Glycyrrhiza spp.), Meadowsweet (Filipendula ulmaria), Poplar (Populus spp.), Turmeric (Curcuma longa), Wild yam – cultivated only please (Dioscorea villosa), Willow (Salix spp.), Aspen (Populus tremuloides), St. John’s Wort (Hypericum perforatum), Ginger (Zingiber officinale), Wintergreen (Gaultheria procumbens), Birch (Betula spp.), Yucca (Yucca spp.), Bromelain (from pineapples, take on an empty stomach or it will act as a digestive enzyme)

• Hydrotherapy: is the use of water (hot, cold, steam, or ice) to promote tissue repair. I like to use hydrotherapy to aid circulation (bring nutrients and take away wastes) to repair areas of injury. If it feels too stimulating, or if it hurts, wait a few more days before using this method. How to:

  • Get two containers that will fit the body part where surgery occurred. One container can be a bathtub.

  • Fill one container with hot water (not too hot, but very warm). Herbal teas such as calendula (Calendula officinalis), yarrow (Achillea millifolium), ginger (Zingiber officinalis), and licorice (Glycyrrhiza spp.) can be added to the hot water. Fill the other container with very cold water.

  • Submerge your body part in the warm water for 3 minutes. Focus the water on the area where surgery occurred. For instance, if you had knee surgery, just submerge your foot and lower leg, up to your knee. Then switch to the cold water for 30 seconds. Repeat 3 times, always ending with the cold water.

  • Manual Treatments: in addition to lymphatic herbs (see above) to move the lymph, manual treatments can be added at this time. Dry brushing uses a natural soft bristle brush to stimulate both the skin and lymph flow. Always brush towards the heart, as the lymph empties into the cardiovascular system near the clavicle bones. Lymphatic massage is also wonderful during this time. As the remodeling phase progresses, deep massage can be done over the surgical area to help break up scar tissue.

Herbal Formulas:

Recovery Tea

• 2 parts Burdock (Arctium lappa)

• 2 parts Rose hips (Rosa spp.)

• 1 part Nettles (Urtica dioica)

• 1 part Raspberry (Rubus spp.)

• ½ part Hibiscus (Hibiscus sabdariffa)

• ½ part Rose petals (Rosa spp.)

• ½ part Spearmint (Mentha spicata)

This nutrient rich blend is designed to aid recovery from surgery but can also be used after exercise. Measure the herbs by weight. Put ½ ounce herbs by weight into a teapot or canning jar. Pour 1 cup of boiling water over the herbs and steep for ½-2 hours. Strain and enjoy 1-3 cups a day.

Sore Muscle Liniment

• 2 ounces Arnica (Arnica spp.) tincture

• 1 ounce St John’s wort (Hypericum perforatum) tincture

• 1 ounce Willow (Salix spp.) tincture

• 1 ounce Comfery (Symphytum officinale) tincture

Add all tinctures together and shake well. I like to put this formula in a glass spray bottle. This liniment can be used in the Remodeling Phase of recovery, as the person starts to become more active and get exercise. It is a great addition to any physical therapy regimen. Apply before and after exercise or with soreness, stiffness or pain. Do not apply to open wounds or abrasions. For external use only.

Scar Salve

• 2 ounces Calendula (Calendula officinalis) oil

• 2 ounces Comfrey (Symphytum officinale) oil

• 1 ounce Beeswax

• 10 drops Lavender (Lavandula officinalis) essential oil

• 10 drops Helichrysum (Helichrysum italicum) essential oil

• 5 drops Roman Chamomile (Chamaemelum nobile) essential oil

Melt your beeswax in a double boiler until it is liquid. Add calendula and comfrey oils. 
Stir well until beeswax and oil are incorporated and completely melted. Remove your pan from heat and add the essential oils. Pour into containers and let cool before using. Scar Salve is useful for skin injuries such as incisions, scrapes, cuts, bug bites, stings, infections, rashes, and burns. Apply to the area as needed. Once the scar is well healed, this salve can also be used to massage the area.

Skin Healing Poultice

• 1 Tablespoon powdered Marshmallow (Althea officinalis) root

• 1 Tablespoon powdered Calendula (Calendula officinalis) flower

• 1 Tablespoon powdered Plantain (Plantago ovata) leaf

• 2 - 3 Tablespoons hot water

• Add Aloe (Aloe vera) gel until you have a good consistency (similar to cooked oatmeal)

Put warm ingredients in a muslin cloth or cheesecloth and apply to the healed incision site for 20 minutes to a half hour. A hot water bottle can be placed over the top of the poultice to increase local circulation to the area.

Be well!

Because the majority of healing occurs within the first few weeks following surgery, remember to plan ahead. Herbs can be an amazing tool in the recovery and healing process!

© Elaine Sheff, Clinical Herbalist, RH (AHG)