the general method of preparing the inventive formulation is to put ground birch bark ( betula alba ) into an acidic solution , preferably an acetic acid solution , and allowing the birch bark to soak in the acidic solution for at least about 30 minutes . this step may optionally include any standard mechanical means of agitation . the concentration of acid in the solution is selected so that the final solution has a ph of between about 2 and about 5 . the solution is then filtered to remove visible particulates . optionally the birch bark / acid solution can be boiled for some or all of the soaking time . the formulation is then placed into bottles , pump spray bottles or pressurized aerosol containers . the preferred option is to place the formulation into pump spray bottles because this provides for a convenient , cost effective and efficacious means of topical application . it also avoids the problem of contamination if the formulation is stored in a regular bottle and avoids the extra cost and possible side effects of propellants that are necessary for a pressurized aerosol container . optionally the inventive formulation may be mixed with medically acceptable or cosmetically / pharmaceutically / physiologically acceptable carriers , excipients , diluents , adjuvants , vehicles , preservatives , antibiotics and mixtures thereof appropriate for the formation of emulsions , slurries , poultices , drenches , balms , salves , pomades , oils , jellies , foams , creams , solutions , shampoos , soaps , lotions , ointment , hydrogels , bath gels , shower gels , and gels . in a clean large stainless steel pot ( or large pyrex glass erlenmeyer flask ) between about 1 , 000 mg and about 10 , 000 mg ( preferably about 4000 to about 5000 mg ) of finely ground and dried betula alba bark ( mountain rose herbs in eugene , oreg . 97405 phone : 1 - 800 - 879 - 9337 ) is combined with distilled water and glacial acetic acid such that the proportion of acetic acid to water produces a ph in the range of about 3 . 0 to 4 . 0 with a total volume of liquid of about 400 mls . subsequent steps are described below . an alternative procedure is to mix 59 milliliters distilled white vinegar ( which is about 5 % acetic acid ) with finely ground and dried betula alba bark ( from mountain rose herbs ) in the weight range of between 1 , 000 mg and 10 , 000 mg ( preferably between about 4000 to about 5000 mg ). stir with a stainless steel whisk which is inserted into a stainless steel automatic stirring apparatus , and place on a heating element . stir until the liquid comes to a boil . distilled water in the amount of 355 mls is then added , stirring is continued and the contents brought back to a boil for no less than 30 minutes , but for no more than about one hour while the heat level was observed and adjusted to avoid boiling over of the liquid . the solution was removed from the heating element and the pot is covered with a clean stainless steel lid ( a clean glass stopper or clean paper towel may be substituted as a lid if a flask is used ) and allowed to sit undisturbed for at least 60 minutes . specifically , the initial extract of birch bark can be achieved by boiling and / or soaking in vinegar ( about 5 % acetic acid ) and then diluting the vinegar by the addition of water or in the alternative all of the boiling and / or soaking is done in the diluted vinegar . the contents of the flask was filtered such that printed material of arial bold characters with a font size 40 or smaller can be read through one inch depth of solution under the bottom of a clear glass beaker . two means of achieving this level of clarity have been utilized , though there are many other means well known in the art . one method is to filter through a filter funnel with three layers of filter paper of 5 micron of less pore size and repeating this filtration twice more with the filtered solution , through fresh 3 ply paper filters ( or an equivalent filtration medium ). the alternative is to perform three successive vacuum filtrations thorough membrane filters having a pore size of about 5 microns or less . optimal product color is a pale golden yellow and has a ph of about 3 to 4 . the solution is funneled into a glass bottle , labeled and assembled with fine mist aerosol pump , and then plastic shrink wrap was applied to protect the bottle from tampering and contamination . the packaged bottles is then subjected to gamma irradiation for a calculated period of time , dependent upon the weight of the solution , to achieve a specific calculate dose of irradiation delivered of at least about 30 kgy , but no more than about 50 kgy . over 700 patients have been treated with the inventive formulation while under the care of the inventor , a california licensed medical doctor , specialized in dermatology . the majority of patients were suffering with conditions which arose from , were impacted by or resulted in neurocutaneous malcircuitry , and which had failed standard medical treatments before receiving a topical application of the inventive solution . the only treatment failures were associated with ongoing inflammatory disorders such as an incarcerated femoral hernia , osteomyelitis , and bone fracture non - union . a more complete understanding of the present invention can be obtained by reference to the following specific examples . the examples are described solely for purposes of illustration and are not intended to limit the scope of the invention . the symptoms of patients suffering from conditions of neurocutaneous malcircuitry were mitigated by the inventive formulation as evidenced by the ratings of clinical patients regarding improvement of acute and chronic pain , as well as subject reports of normalization of function , sensation , numbness , and pruritus . medical conditions mitigated by the inventive formulation include normalization of signs , symptoms , functions , control , and / or conditions impacted by neural maltransmission and / or malcircuitry including , but not limited to , the following examples of the documented clinical effects on patients suffering from the clinical conditions listed below : 1 . normalization of muscle tone , range of motion , and muscular control ( resolution of inappropriate muscle contractions in cases of arthritis and radiculopathy complicated by clinical evidence of neurocutaneous malcircuitry ). 2 . reduction of abnormal involuntary somatic movement ( reduction of involuntary movement in cases of benign essential tremor , hemispasms , and tardive dyskinesia impacted by neurocutaneous malcircuitry ). 3 . reduction of abnormal autonomic activity ( reduction of flushing impacted by cytokine induced neurocutaneous malcircuitry of rosacea ). 4 . reduction of abnormal vascular flow ( resolution of burning feet syndrome hyperemia due to neurocutaneous malcircuitry of erythromelalgia ). 5 . reduction of abnormal inflammation ( reduction of redness , swelling and pain from carpet burn , spider bite , drug induced dermatitis , radiation dermatitis , hypersensitivity reactions types ii - iv , post surgical tissue changes , acne , seborrheic dermatitis ). 6 . reduction of hyperhidrosis ( resolution of sweaty macerated feet arising from neurocutaneous malcircuitry with sympathetic stimulation of erythromelalgia ). 7 . reduction of normal and abnormal bruising and swelling ( reduction of and hastened resolution of post traumatic and spontaneous bruising related to trauma , vascular stasis , liposuction , coumadin , and excision of skin cancers ). 8 . reduction of abnormal secretory and ductal dysfunction ( resolution of abnormal reflexive tearing sustained by facial trauma induced neurocutaneous malcircuitry ) 9 . normalization of bladder control and function ( complete resolution of neurogenic bladder associated with the neurocutaneous malcircuitry of erythromelalgia ) 10 . reduction of hyperesthesia , inflammation and pain escalation of normal acute , chronic pain , and from infection ( analgesia related to disruption of extraneous neural transmission and conduction of trigeminal neuralgia , post herpetic neuralgia , mrsa infection of skin , burn pain , injuries , arthritis ) one of the first patients treated with the formulation of the invention suffered from erythromelalgia , which is one of the conditions resulting from neurocutaneous malcircuitry . erythromelalgia results in radiating progressive pain associated with autonomic system dysregulation . the pain and neural malcircuitry of erythromelalgia typically extends to the feet , and this pain is refractory to all medical and surgical treatment modalities . typically the skin of the feet in erythromelalgia , is very inflamed , hot , and red in color , and is associated with severe recalcitrant pain . on may 16 , 2006 , an elderly white female , suffering with erythromelalgia , sought assistance from the treating physician and asked if there was anything that could be done to help her with her excruciating pain . historically , the patient had suffered from multiple rheumatologic and orthopedic problems , associated with chronic severe back pain . over many years , multiple spinal surgeries failed to correct her upper and lower back pain , and she became unable to walk normally or lift her arms over her head . she then developed a neurogenic bladder and became unable to void without manually pushing her bladder to obtain urinary flow . in 2001 , the patient began to suffer intense feet pain , associated with heat and color changes . the only relief that she could get was from standing in a tub of ice water , and this relief was only temporary . her erythromelalgia was refractory to additional neurosurgical efforts , pain medications , physical therapy and nerve blocks . when she was examined , the patient was unable to ambulate normally , dragging one leg as she walked and she ambulated with a very stooped posture . she also demonstrated that she could not lift her arms above her shoulders . the patient &# 39 ; s feet were very warm , sweaty and reddened in color bilaterally . after obtaining informed consent to participate in clinical case study research , the inventive formulation was applied to the most painful foot . it was observed that the redness of the foot disappeared within seconds . the patient exclaimed that the foot pain , as well as much of her lower back pain was immediately relieved by this application , even though the formulation had only been applied to that one foot . while observing her response to application of the inventive formulation to the one foot , the redness of the contra lateral foot immediately disappeared . the patient &# 39 ; s posture spontaneously straightened from the formerly hunched posture . the patient was now smiling and laughing excitedly . she reached down and touched her toes , demonstrating a range of motion that she had not experienced in years . the inventive formulation was then applied directly over the local orthopedic tenderness sites of the upper and lower back . the patient instantly raised her arms above her head , rejoiced and began to demonstrate restoration of full range of movement of the upper extremities . the patient ambulated normally from the clinic with erect and normal posture and was no longer dragging her leg . a few hours later that day , she called from her home to report that she was now able to spontaneously and normally empty her bladder , for the first time in many years . application of the inventive formulation to the skin regions associated with the patient &# 39 ; s neural malcircuitry resulted in spontaneous remission of her neurogenic bladder . the patient reported that she remained pain free with continued normalization of bladder and ambulatory functions on the following day . she was advised to continue to apply the inventive formulation twice daily , but she discontinued regular application of the inventive formulation after a few days because she was no longer symptomatic of her erythromelalgia . this patient remained free of her erythromelalgia and neurogenic bladder over five years later , and has sustained this improvement until this writing . she occasionally applies the inventive formulation to control the pain and stiffness of her chronic arthritis in her shoulders and spine . she still no longer requires a cane for ambulation . an elderly white male with an active herpes zoster infection was examined and found to be suffering from pain characterized as 15 / 10 on a pain scale of 1 - 10 . narcotics , steroids , capsaicin cream , and antiviral medication failed to relieve his pain . after obtaining informed consent for participation in clinical case study research , the inventive formulation was applied over the involved dermatome . pain relief was obtained upon application , and the patient was advised to apply the inventive formulation at home twice daily . the patient states that the inventive formulation provided the only successful pain relief during his zoster infection . application of the inventive formulation allowed the patient to finally be able to sleep at night , and the baseline pain gradually decreased with ongoing usage . after several weeks , the patient was free of zoster pain , and he discontinued application of the inventive formulation . he continued to maintain relief from the zoster pain during the subsequent two years , even without further application of the inventive formulation . this same patient later suffered from post operative orthopedic pain and stiffness in his shoulders . he was unable to obtain adequate relief with narcotics and other traditional medications . he characterized the pain as 8 / 10 when he tried to lift his right arm . within a minute of topical application of the inventive formulation , his pain was reduced to 2 / 10 , and he obtained greater range of motion . a middle aged white female was examined found to have constant and severe pruritus over the posterio - lateral bilateral arms . her diagnosis was brachioradial pruritus . she had suffered with this disorder for many years and her condition had been unsuccessfully treated with scabicide cream , steroids , and antihistamines . the only relief that she could obtain was to apply ice to her arms . although the pruritus was constant , her worst pruritus was at night , which disrupted her sleep . after obtaining informed consent to participate in clinical case study research , the inventive formulation was applied to the involved areas , and complete symptomatic relief of pruritus was obtained within minutes . she continued to apply the inventive formulation to the involved areas at home once daily , before bedtime . the pruritus episodes became less frequent . she discontinued daily application of the inventive formulation , using the product only when she became symptomatic . upon clinical follow up , a few months later , the patient estimated that frequency of the pruritus was reduced to only about twice a month . a 71 year old white female was examined on feb . 3 , 2010 with severe disfiguring facial drooping after receiving botox for right facial hemispasms ( severe twitching ). the patient was very unhappy with the disfiguring results of the botox treatment administered by her neurologist . her facial spasms returned 3 after her botox injection . on sep . 22 , 2011 , she was examined and found to have right eye eyelid , right cheek , right perioral , and right platysmal muscle twitching , which was very distracting when she tried to engage in communication . after obtaining informed consent to participate in clinical case study research , she was allowed to apply the inventive formulation to the involved facial regions . she was examined again on jan . 25 , 2011 with improvement of the intensity and frequency of the facial spasms . it was noted that light touch on a post auricular region of the neck resulted in reflexive spasms . in this case , intense pulsed light was applied this trigger point of reflexive spasms , with no benefit noted . the patient was advised to apply the inventive formulation to the involved region , including the trigger point , every four hours while awake . the next morning , the patient awoke with no spasms , and her result was sustained for the next four days , the patient was completely free of her facial hemispasms ; however , the patient discontinued use of the inventive formulation when the facial hemispasms disappeared . the hemispasms began to recur on the fifth day after the last application of the inventive formulation . upon resumption of daily application of the inventive formulation , the hemispasms were again diminished . a 30 year old white female was examined and complained of severe episodic genital region pain . the condition began during a long overseas flight to australia . she experienced extreme pain when sitting . the most painful tissue , at the posterior aspect of the vaginal extroitus , was observed to become very red , swollen and macerated during pain episodes . antidepressants , pain medications , and steroid creams were tried and proved unsuccessful in managing the pain . her condition became complicated by pruritus , possibly due to steroid - related dermatitis . even during pain free intervals , any manipulation of the involved region resulted in swelling and pain . the painful site was biopsied by her gynecologist , and histopathologic examination revealed no pathology . she was diagnosed with vulvodynia , but did not obtain effective treatment . the patient sought help from many medical specialists , only to be misdiagnosed as having a psychosomatic disorder . she was examined by the inventor several months before her scheduled wedding . upon examination , there was evidence of a prior biopsy scar at the vaginal extroitus . there was no exudate , sclerosis , or lymphadenopathy . given the history , the patient was diagnosed with vulvodynia related to angioedema complicated by steroid dermatitis . after obtaining informed consent to participate in clinical case study the inventive formulation was applied to the involved region . the patient obtained immediate symptomatic relief of pain after application of the inventive formulation . topical steroids were discontinued and the patient was instructed to apply the inventive formulation twice daily and as needed . she was also instructed to avoid long periods of sitting and to avoid long overseas air travel . her painful episodes became less frequent and less intense . her marriage was consummated in november of 2010 . although the inventive solution did not cure the tendency toward angioedema underlying her vulvodynia , the invention allowed her to enjoy comfortable sexual relations and provided effective symptomatic management of her condition . on feb . 14 , 2011 , a middle aged white female was examined and found have pain at a level of 4 - 5 out of 10 ( 10 being the worst pain ) of her neck related to plastic surgery procedures that had been performed within the prior few weeks . she also complained of 4 out of 10 pain in her right hip from arthritis , and 4 - 6 out of 10 pain from orthopedic surgery related to a fracture of her left foot . after obtaining informed consent to participate in clinical case study research , the inventive formulation was applied to the involved regions . the subject obtained complete relief of each of these pain conditions within a few minutes after topical application of the solution . she rated her pain as zero ( no pain ) within 5 minutes of each application . an elderly female developed a new onset itchy and painful eruption within her inferior breast folds which appeared following the eruption of a painful dermatitis on her neck . both eruptions were refractory to topical steroids prescribed by her primary care physician . the neck eruption was well demarcated to the area of 5 - fluorouracil cream application for actinic keratosis , consistent with drug induced dermatitis . the breast fold eruption was thought to be caused by severe yeast dermatitis with secondary bullous impetigo ; thus , empiric antibiotic and topical antifungal therapy was begun . bacterial cultures returned negative . this eruption failed to clear after empiric antimicrobial therapy . the eruption was biopsied . histological tissue examination demonstrated many eosinophils and a subepidermal split diagnostic of bullous pemphigoid . the bullous lesions and macerated psoriasiform patches were localized only to the region of the inferior breast folds , consistent with the vegetative form of bullous pemphigoid . the vegetative form of bullous pemphigoid has a predilection for the intertriginous areas of the skin . it is unclear whether the 5 - fluorouracil treatment may have precipitated this case of bullous pemphigoid . after obtaining informed consent to participate in clinical case study research , the inventive formulation was applied to both the neck and breast fold eruptions . the patient immediately obtained symptomatic relief of the pain and itchiness of both the neck and breast fold eruptions . she was advised to apply the solution twice daily at home . at her one week follow up , the inflammatory eruption of the neck had completely cleared and the breast fold pain and itchiness had ceased . the inflammation and induration of the breast fold eruption had also improved ; however , bullous lesions continued to erupt . once the histologic diagnosis of bullous pemphigoid was obtained , traditional treatment with tetracycline was begun , and the patient continued application of the inventive formulation twice daily . although the inventive formulation had not cleared all of the eruption associated with the bullous pemphigoid , she obtained complete symptomatic relief of the pain and itchiness with the inventive formulation . on nov . 2 , 2010 , a female college student was examined and found to have painful subcutaneous nodules of erythema nodosum which arose after resolution of mononucleosis . the nodules were distributed over the bilateral lower extremities and were very tender after she had been on her feet for a while . the pain and induration of the nodules were refractory to diphenhydramine and nsaid medication . after obtaining informed consent to participate in clinical case study research , the inventive formulation was applied to the involved regions . pain was immediately relieved and the nodules became softer and smaller in size within minutes . support stockings were recommended , along with daily application of the inventive formulation . the patient obtained excellent symptomatic management of her erythema nodosum . the condition was no longer apparent a few weeks later at clinical follow up . on apr . 29 , 2008 , a 74 year old white female was examined and found to have a very painful , swollen , fissured nose with copious exudate . the eruption began after application of imiquimod to the nose to treat actinic keratosis . a culture was performed . after informed consent to participate in clinical case research , the inventive formulation was applied to the entire nasal eruption . the patient experienced relief of pain and swelling upon application of the inventive formulation . she was advised to discontinue the imiquimod and to apply the inventive formulation to the nasal eruption twice daily . empiric antibiotic treatment was initiated . culture results returned positive for methicillin resistant staphylococcus aureus . the bacterial sensitivity demonstrated that the staphylococcus aureus was sensitive to the prescribed antibiotic . upon clinical follow up , on jun . 19 , 2008 , the infection had cleared and the nose was well healed without scarring , pain or discomfort . no recurrence of the actinic keratosis was evident upon later follow up of feb . 15 , 2011 . the cosmetic result was excellent as evidenced by smooth texture and normal coloration at the actinic keratosis treatment site . an elderly white female was examined for a skin condition . she mentioned that she was in severe pain from arthritis of the right shoulder . she reported that her other doctor diagnosed her with arthritis of the right shoulder . the shoulder pain was refractory to nsaid medications . the patient found physical therapy to be painful and of questionable benefit . she was not able to lift her right arm above her shoulder , and movement of the shoulder was very painful ( 9 + out of 10 on the pain scale ). after informed consent was obtained to participate in clinical case research , the inventive formulation was applied to the right shoulder . three months later , the patient returned for follow up on her skin condition and reported that she had obtained 100 % sustained pain relief and restoration of complete range of motion of the right shoulder since that one time office application of the inventive formulation . a young adult female sustained a laceration to the nasal side wall from a motor vehicle accident several years prior to clinical presentation . ever since the nasal laceration healed , a light touch to her nose ( which remained numb since the accident ) resulted in intense pain of her cheek , associated with reflexive tearing from her right eye ( and not her left ). after obtaining informed consent to participate in clinical case study research , the inventive formulation was applied to the involved regions . after topical application of the inventive formulation , the numbness , reflexive pain , and reflexive tearing were instantly extinguished and normal sensation was restored to her nose . upon clinical follow up , years later , there was no recurrence of the pain , numbness , or abnormal reflexive tearing . resolution of the extraneous neural conduction and transmission was sustained since that one single application of the inventive solution . an elderly white female when examiner was found to be suffering with excruciating pain of several days duration associated with an expanding and ulcerating lesion over the right medial thigh . she was afebrile . there was no purulent drainage , no crusting , and no honey colored exudate associated with the lesion . the pain was refractory to the antibiotics and traditional pain medications prescribed by her regular doctor . black widow spiders are common to the southern california region in which the patient lived . given the intensity of the pain and lack of evidence for infection , she was diagnosed with black widow spider bite . after obtaining informed consent to participate in clinical case study research , the inventive formulation was applied to the site of the lesion and pain relief was obtained within seconds . the patient applied the inventive solution twice daily for two to three weeks until the lesion was completely healed , and during this time the solution effectively managed her pain . the lesion promptly regressed and healed in response to the inventor &# 39 ; s formulation . there was no residual pain , numbness or paresthesia upon clinical follow up . although the preferred embodiments of the present invention have been disclosed for illustrative purposes , those skilled in the art will appreciate that various modification , additions and substitutions are possible , without departing from the scope and spirit of the invention .
a formulation and method of mitigation of symptoms of patients suffering from a neurocutaneous pain syndrome by topical application of the formulation . the formulation is obtained by steeping the bark of a tree from the genus betula in an aqueous acidified solution and then subsequent filtering , packaging and sterilization .