Plants and humans share many experiences. Humans are of course one species spread around the world with all individuals sharing essentially the same physiology and anatomy. However, even the myriad species of plants share more than they differ, with common mechanisms of primary metabolism and cell structure and many common strategies of regulation, reproduction and even defence. Although there are vast numbers of pharmacologically active ‘secondary’ metabolites in plants, they mostly classify into a small list of phytochemical groups (see Chapter 2). A review of human medical cultures shows that there are common themes that may arise from consistent experiences of consuming plants. When these themes are recast in the light of modern scientific enquiry one may glimpse therapeutic approaches that are radically different from those which underpin conventional medicine.

What also emerges again and again is that, contrary to modern prejudice, writers on medicine from the very earliest eras demonstrate a respect for rigorous observation and humane pragmatism that still may provide a valuable lesson for healthcare today. These sources are not to be dismissed lightly.

As it is now known that animals use plants for medicinal purposes,^1,2 it is unlikely that there was a time when humans did not use herbal remedies. There is prehistoric evidence of the use of medicinals from the USA³ and medicinal plant traces found at neolithic sites.⁴ There are also innumerable accounts of medicinal plants being used by small communities around the world, living wholly within the natural world and crafting their survival from the facilities around them.^5–7

Most of what is known about herbal use from recorded history is provided by early texts, often among the earliest of all known books. However, one overwhelming gap in this record is that, although in its original mode herbal medicine was centred in local communities and practised largely by women, this is barely reflected in contemporary accounts.⁸ After the demise of organised medicine with the collapse of the Roman empire, healthcare in Europe for most people was again provided at a very local level, probably including a mix of herbs and diet, together with faith and holy relics, as well as astrology, pagan incantation and ritual⁹ (the Inquisition permitting – millions of women were killed for practising ‘witchcraft’ across Europe from the 13th to the 18th centuries).¹⁰ Hildegarde von Bingen, one of the first prominent woman authorities in Europe, achieved particular renown through her medicinal text Physica. In it, she became the first woman publicly to discuss plants in relation to their medicinal properties.¹¹ She was, however, a solitary exception to the prevailing view that women were not in the forefront of academic, professional or literary efforts. Like her, however, most European writers of the time were from the monastic tradition, only moving into the popular arena around Chaucer’s time. By then well-organised medicinal gardens and practices were recorded in England by authors such as Henry Daniel, John Arderne, John Bray and Chaucer himself, all reflecting on current medicinal practice across Europe in the 14th century.¹² Where systems were apparent in these texts, they appear to have been derived from the Graeco-Roman tradition with varying amounts of astrology, especially in works by Culpeper and Gerard. It was only with the works of Paracelsus that scholarship began substantially to question the previous deference to Galen and medicine moved into the modern technological age, leaving folk practice way behind.

Such was the enormous variety of folk practices around the world that one must conclude that, while most rationales were based on empiricism, local shibboleths and traditions often acted as a brake on innovation. Nevertheless, there are likely to have been common features. A fascinating account of one remote group in Central America¹³ shows significant similarities between their and other humoral approaches around the world. It is also certain that where therapeutic systems did develop, they were based on popular practices.

The systematic development of medical ideas that started with the Hippocratic writings from the Greek island of Kos in the fifth and fourth centuries bc and climaxed in the work of Galen in the second century ad, laid the foundations for European medicine until the scientific era, and the framework for Islamic medicine until the present time. They were marked by almost modern standards of empiricism, logic and rigour.¹⁴

The Hippocratic writings,¹⁵ a complex series of treatises from a school rather than from one individual, were an astonishing event. In passages of renaissant illumination, they evidenced an enlightened tradition that invoked dietary, lifestyle, environmental and psychotherapeutic means to encouraging health. The Hippocratic tradition is generally associated with the concept of the natural healing power of life, the vis medicatrix naturae. In fact, most of the texts are pragmatic guides to maintaining health and to the practice of medicine, with some passages (e.g. The Art of Medicine) being undisguised paeans to the importance of physicians in healthcare!

There were herbs included in the Hippocratic canon, but it was a wider doctrine of whole healthcare that was being formulated. It was left to others to formulate the materia medicae of the day. The Greek Dioscorides in the first century ad rigorously collected information about 500 plants and remedies in tours with the Roman armies and collated them in his seminal Materia Medica.¹⁶

Galen is widely regarded as the pivotal Graeco-Roman authority in medicinal matters. He wrote extensively about his subject, setting out comprehensive principles of sometimes surprising topicality. For example, he proposed a research agenda for establishing the ‘powers’ of a remedy, based on the observance of eight conditions:

In further passages (most have never been translated into English) he shows clear evidence of modern logical thought in setting out a series of experiments to prove that the kidneys were the source of urine into the bladder.¹⁴

The fundamental principle in Galen’s work was that nature was an active dynamic force, and phenomena its expressed purpose. Treatments engaged these forces, either in the case of drugs through their own dynamic ‘qualities’, or in the case of foods by the qualities of their substance. In classifying the dynamic qualities of medicines, he refined the widely established view that they had ‘temperaments’ reflecting well-understood climatic influences.

In the Greek and Roman world the temperaments hot, cold, dampness and dryness were formed into paired combinations of the four elements that made up nature: earth, water, fire and air (heat is generated by fire and air, cold by earth and water and so on). The elements were associated with four fluids, ‘juices’ or humours in the body, respectively black bile, phlegm, yellow bile and blood (their more everyday manifestations were faeces, mucus, vomit and bleeding), with these being linked with personality types: the melancholic, phlegmatic, choleric and sanguine. As we will see elsewhere, the Old World had no problems in associating the most banal phenomenon with fundamental truths about human nature! Therapeutically the humours were the cornerstone and physicians moved to counteract excess (plethora) or deficiency (kenos) in any of them. For excess or toxic conditions ‘diasthetic’ remedies, sometimes alterants and eliminatives, were literally ‘antidotes’, primarily heating, cooling, drying and moistening accordingly, in degrees, with remedies in the ‘first degree’ milder than those in the third or fourth (which became increasingly dangerous). In deficiency conditions ‘physic’ remedies were replenishing, supportive or ‘plerotic’.

A widely noted quality of remedies was the effect they appeared to have on the mobilisation of body heat, especially in relation to fevers. His authoritative definitions of these pharmaceutical qualities were widely used throughout medieval Europe:

This is a clinically elaborate classification. Heating remedies start as at ‘equal heat with our bodies’ (i.e. normalising a healthy body temperature), increasing in stages to those that are so hot that they must only be ‘outwardly applied’ in counter-irritation and blistering strategies (see p. 39). Their primary function is to thin ‘offending humours’, or toxic accumulations, a process that may have been likened to the effect of warming congealed meat stock, so that they may be expelled by perspiration (in fever). This strategy was clear: fevers were a healthy response and such remedies supported this response ‘when nature cannot do it’. As they become stronger they are more forceful, till they actually ‘cause fevers’ and ‘cause inflammations’, taking over entirely from a failing constitution.

Cooling remedies are inherently more risky. The ultimate cold is the corpse. Nevertheless, they can be used to contain excessive vital responses such as pain, ‘choler’ and excessive eliminations (‘defluctions’). Intriguingly, at the gentlest such level, the effect is to ‘cause digestion’; the bitters (see p. 84) were included in this category, the attraction being that these cooled but did not depress, reducing heat by switching the physiology towards increased digestive activity (universally seen as cooling) and thus increased nourishment, a highly attractive tactic in many fevers. Also intriguing is the insight at the other end of the spectrum. Using powerful sedatives when all else fails and death is imminent (‘in extreme watchings’) is one of the less formally advisable clinical knacks from a more desperate age; it appears that the effect can be to wipe out the clamour of adversity at that stage of crisis so that new life might just flicker back. The works of the Graeco-Roman writers were most extensively remodelled by the medical writers of the Islamic era. Up to 100 authors on pharmaceutics and materia medica are identifiable in the Arabic bibliographies, most copying and adapting directly from Dioscorides and Galen. There were, however, notable developments, including the work of the Persians al-Majusi (Ali Abbas), ar-Rhazi (Rhazes) and Ibn-Sina (Avicenna), the Jew Maimonides and the Christian Hunayn ibn-Ishaq. However, not for the first time in reviews of classic texts (the Chinese canon is another example) there is a sense that much that was written was truly theoretical, with evidence of systematisation by rote, showing little regard for likely actual practices.¹⁷

Nevertheless, it is apparent that in Islamic pharmaceutics considerable respect was paid to the qualities of individual herbs (unlike the Chinese emphasis on formulations, these were seen as reflecting a secondary skill). Physicians were expected to understand intimately the nature of each remedy, its natural habitat, its specific energy pattern, actions, indications, specific relationships to the organs, duration of action, toxicity and contraindications, types of preparation, dosage, administration and antidotes.¹⁸

The Islamic medical tradition as Unani/Tibb has been maintained in its heartland until the present day and it also generated important benefits for the medicine of Europe. Montpellier and Salerno were among the first of the new medical centres of Europe. Rather than relying just on ancient texts, a new experimental culture led to reports of the tested effects of substances from identified plants. This advance was fostered by the foundation of universities and greatly aided by the later invention of the printing press, which also allowed wider dissemination of the classical texts.¹⁹

The traditions of medicine that developed in China from prehistoric times have survived as a major part of healthcare provision to the present day and through this extraordinary continuity constitute the most comprehensive clinical strategy for the use of herbal medicines anywhere.

This text is not the place for an exhaustive overview of Chinese medicine. There are effective texts available in English, notably the essential work by Unschuld,²⁰ other classic texts,^21,22 one very accessible introduction,²³ a rigorous yet practical review,²⁴ and a summary designed to help the Western practitioner.²⁵ What will be attempted here is the distillation of uniquely herbal strategies and concepts from the vast corpus of Chinese medicine. There is much to choose from. Over the last 2000 years a number of seminal texts and systems have been developed, each incorporating the developments of their predecessors. These were often very intricate systems, reflecting perhaps the priorities of scholarship and portent lore (much theorising at the early stages was for the Imperial court²⁶). At more than one stage, there appears to have been some difficulty in organising the empirical folk traditions into neat systems²⁰ and there is always a suspicion that realities may have been squeezed to justify the cosmology.

However, Chinese medicine was certainly not idle theorising. In one review of the medicine of early China,²⁷ it has been pointed out that among other ‘modern’ advances were the use of androgens and oestrogens (in placentas) to treat hypogonadism, the development of forensic medicine, the advocacy of hand washing to avoid infection and the association of hardening of the arteries with high salt intake. Qualifying examinations for physicians were conducted by the Chinese state as early as the first century ad and there was an elaborate system of medical ethics.

It is first important to emphasise that the Chinese world view has been fundamentally different from that in the West since the time of Aristotle. In Chinese thinking everything moves (the seminal classic, the I Ching, is translated as the ‘Book of Changes’). Events are automatically described by their transient qualities in relation to other events and are manifestations of energies in ways that the West understood only after Einstein.²⁸ The generic term for these energies is qi, but in the case of the living body there are many forms of varying density, from wei qi as the most rarefied on the body surface, manifest in acute defensive reactions like fever and colds, through ying qi, the nourishing qi flowing through the meridians, to xue or blood, the most substantial aspect of qi, manifest in many somatic events. Qi is also manifest in jing (essence) and the body fluids. The comparison with modern physics is even more apposite as qi is simultaneously energy, movement and fluid (reminiscent of attempts to define light as waves and/or particles).

Transience continues: thus, in what has become known as Traditional Chinese Medicine (TCM – in fact the mainstream tradition in China after the Communist Revolution of 1948 and the one most widely used by Western practitioners), the framework by which diseases are addressed is made up of four sets of polar opposites, the ‘eight conditions’.

Each pair denotes a spectrum of qualities onto which any illness can be placed; each implies that the aim of any therapeutic measure is to move extremes back towards a healthy mean. Although used as a diagnostic framework for acupuncture, it is widely agreed that TCM is primarily based on herbal therapeutics. Thus herbs are ascribed temperaments or tendencies accordingly: they may be Yin or Yang, tonic or dispersive, cooling or heating, eliminative or constructive. These manifestations are in turn aspects of fundamental properties of the remedies (see Table 1.1).

Table 1.1

In Chinese medicine there is little regard for anatomy and the main entities upon which pathogenic or therapeutic forces act are essentially functional and physiological. There are six pairs of functions, often confusingly translated in the West as ‘organs’. These, like all phenomena in the Chinese world, are ascribed to points on the five-phase cycle that further illuminate their qualities. The five phases (the frequently used term ‘five elements’ is clearly not appropriate here) are seasonal and cyclical transitions through which all the universe moves. They have a multitude of dynamic relationships with each other and an array of more or less consistent qualities. The five phases, their attributes and their relationship with the six pairs of functions are illustrated in Table 1.2.

Following the strictures of Porkert,²¹ words in this text which may be confused with their Western meanings are distinguished typographically (with capitals and italics though not, as he insisted, using completely new words altogether).

The five Tastes (Chinese pharmacology)

In days before laboratory investigations, taste was obviously a major arbiter of a plant’s quality and it is easily seen how an association with pharmacological activity could be made. In the case of Chinese medicine the taste became a pharmacological force in its own right.

Two of the Tastes are primarily yang and tend to disperse upwards in the body. They are the pungent and sweet Tastes (the latter is usually yoked with a sixth non-taste quality, referred to here as the bland Taste).

Three Tastes are primarily yin and tend to flow downwards in the body. They are the sour, bitter and salty Tastes.

The Tastes were assigned to the five phases and their functional manifestations in the body, as below. In turn, this came to mean that the normal role of each Function included being a vehicle for the activity of its own Taste and depended on acquiring a quantum, primarily from food or medicine.

While a moderate amount of each Taste is necessary for its corresponding Function, there are also wider effects arising from their consumption. The relationships are expressed in Figure 1.1. (For a review of the implications of the four-phase nature of the relationships and the peculiar position of the Spleen, see Mills.²⁵)

Figure 1.1 The five Tastes and their relationships.

Tonification

As well as being associated with one Function, each Taste is also seen to tonify, i.e. at moderate levels support, another Function.

Dispersing

Extra amounts of each Taste disperse excessive activity in the Function with which it is linked. This is straightforward except in the case of the Spleen, which is already tonified by sweet: it appears, therefore, to do a swap with the Heart.

Damaging

The effects of taking excessive amounts of any particular Taste follow a conventional destructive ko cycle pattern in the five-phase relationship.

A brief review of the properties of each Taste is instructive.

Salty

The taste of common salt and seafood, but is not well represented in the herbal materia medica. However, seaweeds are occasionally used in maritime cultures and in Japan. It is possible to classify the occasional remedy like celery seed in this category. In China, however, the main group of drugs classified as salty are animal tissues and the minerals.

The salty Taste is directed by the Spleen to the Kidneys. It is yin and tends to flow downwards in the body and particularly to the bones.

It is said to ‘moisten’ and ‘soften’ and salty remedies are used for ‘dry, hard’ pathologies, such as tumours, fibroses (e.g. liver cirrhosis), constipation and other abdominal swellings.

In moderation it tonifies the Heart, but damages it in excess. It is interesting to see how closely ancient observations tie in with current views on the influence of salt and electrolytes on the circulation.

Sour

This arises as the result of the stimulation of the sour taste buds by hydrogen ions. It is the taste of fruit acids, vinegar and tannins.

The sour Taste is directed by the Spleen to the Liver; it is yin and tends to move downwards in the body. It moves particularly to the muscle fibres (or ‘sinews’).

It is said to ‘absorb’ and ‘bind’ and is applied to discharges, excessive diuresis, incontinence, perspiration and premature ejaculation. Some of these indications recur in the discussion of the effect of tannins (see p. 35).

It disperses excess activity in the Liver and tonifies the Lungs. Among other roles, the latter is concerned with the maintenance of the body’s defences against external pathogens. The role of fruit as protection, particularly against respiratory infections, was thus apparently not a new discovery.

In excess it damages the Spleen. Excessive consumption of tannins interferes with assimilation of foods.

Bitter

This taste is mediated by bitter taste buds in the mouth which are stimulated by a number of chemical structures. It is thus a quality recognised by the Chinese, and others, as being intrinsic to herbal remedies.

It is directed by the Spleen to the Heart; it is yin and tends to flow downwards in the body. It moves particularly to xue (‘blood’). As the densest of the circulating energies in the body, xue is in effect the speculative force behind the more somatic events in the body. Compared to acupuncture, which is seen to primarily affect qi, the more rarefied circulating energy, the archetypal bitterness of herbal remedies is strongly associated with treating more substantial deep-seated clinical problems.

It is said to ‘sedate’, ‘dry’ and ‘harden’. The first reflects bitter’s cool temperament while ‘drying’ refers to bitter’s use in ‘damp-heat’ conditions (e.g. hepatitis); ‘harden’ may be better translated by the term ‘consolidate’ to express the effect of improving assimilation and nourishment.

It disperses excess in the Spleen. A modern manifestation of such a condition is the excessive consumption of sweet foods with the consequent possible disruptions in blood sugar levels. There is clinical experience of the benefits of bitter herbs in stabilising such disruptions.

It tonifies the Kidneys. As the repository of constitutional reserves, the Kidneys provide the greatest tonifying challenge, another example of the universal traditional reverence for bitters.

In excess it damages the Lungs. Excessive cooling suppresses vital defences.

Sweet

In a time when sugar was almost unknown, this was a far more subtle taste and was used to refer to the intrinsic sweetness of the rural diet: cereals, pulses, cooked root vegetables and those fruits suitable for drying and storing as winter food such as apricots, figs and prunes. In days when even honey was rare, the taste of extracted sugar would have been considered intrinsically excessive. In herbal remedies the sweet taste is exhibited particularly by the saponins, a chemical group often found in Chinese tonics and adaptogens.

The Spleen keeps the sweet Taste to itself; it is yang and tends to move upwards in the body, particularly to the soft tissues. Sweetness is nourishment: it is the quality of a simple agrarian diet and has its most potent metaphor in mother’s milk. It thus manifests in the soft tissues and in overall body shape.

It is said to ‘tonify’ and to ‘balance’. As well as being the obvious tonic influence, a good stable agrarian diet is the most effective way to promote homeostasis; many saponin-rich adaptogenic remedies have a similar clinical reputation.

It disperses excess in the Heart, including symptoms of anxiety and nervous tension.

In excess it damages the Kidneys, a terminal effect in Chinese medicine, resulting in premature ageing. The Chinese in effect predicted an enfeeblement of general vitality through excessive sweet consumption.

Pungent

Sometimes also called ‘acrid’, this is the taste of the hot spices: cayenne, ginger, mustard, the peppers, horseradish, raw onions and garlic (both the latter become sweet when cooked) and generally all the ‘heating’ herbal remedies. Unlike the other four tastes, the effect is not linked to any special taste bud but simply follows direct irritation of any exposed tissues and sensory nerve fibres. The association with the Metal phase may have followed inhaling the fumes given off from smelting.

It is directed by the Spleen to the Lungs; it is yang and tends to move upward, particularly to qi. The heating properties of the pungent Taste are always its dominant feature.

It is said to ‘move qi’, ‘disperse’, ‘activate the body fluids’, ‘cause expulsion from the Lungs’ and ‘open the pores’. It tends to be used therefore for superficial, external disease conditions, to counteract external pathogenic influences, especially Wind and Cold, and to mobilise stagnant body energies.

It disperses excess in the Lungs, notably that manifested by congested bronchial inflammations. It tonifies the Liver, the Function responsible for ensuring a balanced dispersal of all the body’s energies and activities, but in excess also damages the Liver.

Bland

Is a substance seen as having no character and without dynamic action in the body. It is not, therefore, a typical Taste and is not recognised in all classical texts. Where it is, it is said to slip through the body without hindrance or interaction. It moves straight through from the Spleen to the Bladder, i.e. the urinary system, and thus out of the body.

Its only effect, therefore, is that it is a diuretic. Many of the diuretics used in herbal medicine have a characteristic blandness of taste.

The written record of the traditional medicine of India is less accessible than that for China, with few English texts from India itself^29–31 and few notable, though exceptional, texts written in the West.^32,33 Nevertheless, it is clear that this tradition includes significant systematising of medical practices in one of the major cultures in history. Medicines were classified, for example, by their Tastes and therapeutic categories, as in Chinese medicine, and their effects on illnesses linked to constitutional types (doshas) and humours.

The doshas provide the primary orientation. The word derives from the same root as the English ‘dys-’ as in ‘dysfunction’: the dosha is essentially a fault in the healthy state of the body. Three doshas are fundamental, each being a condensation of pairs of the five elements, waste products produced when the body replenishes its elements. The doshas support the body only as long as they continually flow out of it, as proper eliminations of urine, faeces and sweat.

Kapha is a condensation of water and earth (the damp and dry elements of matter) and it projects itself into the production of lubricant fluids in the body. It is the stabilising influence in the body and generally concentrates in the thorax to contain rising vata; it is associated with mucus. Illnesses of excessive kapha are marked by symptoms of cold, damp and heaviness (e.g. catarrh, oedema, abdominal congestion) and are relieved by warming, drying, stimulating remedies such as the pungent spices, warming diaphoretics and expectorants, emetics, aromatic and bitter digestives, and carminatives and, to a lesser extent, perhaps combined with the above, diuretics, laxatives and astringents.

Pitta collects fire and water elements into the production of bile and is associated with digestive juices more generally; it is in charge of transformation and processing, and concentrates in the mid-abdomen. Illnesses of excessive or obstructed pitta are marked by biliary disturbances and may include symptoms of heat, damp and excessive activity (e.g. fever, inflammation, infection, blood toxicities, bleeding); they are relieved as appropriate, and perhaps in combination, by cooling, drying, nutritive or calming remedies such as the bitters, purgatives, sweet tonic remedies, astringents, cooling diaphoretics, alteratives and diuretics.

Vata arises from condensation of air and space and is the (often unstable) windy form of prana, linked to the functions of the respiratory system. It is in charge of all movement in the body and it concentrates in the lower abdomen to help lift kapha. Illnesses of the vata type, marked by cold, dryness and excessive (especially nervous) activity, are of two types. Deficient vata (e.g. emaciation and constitutional dehydration) is treated with sweet and nutritive tonics, bulking laxatives, demulcents and salty remedies. Accumulated or obstructed vata is a congestive version that may include abdominal distension and gas, constipation and rheumatic and arthritic conditions. This is treated with modest pungent herbs in the short term only, moderate warming diaphoretics, carminatives and antispasmodics and temporary laxatives. All vata conditions are indications for traditional Ayurvedic enema therapy.

In a bias that often recurs in herbal medicine texts, the Ayurvedic tradition also sees many conditions as combinations of the doshas with toxicity, ‘damp’ or ama. This is a kapha-like influence, being generally cold, slimy, heavy and dense, with phlegm and mucus, loss of taste and appetite, indigestion, depression and irritability as common symptoms, and may arise from emotional difficulties as well as physical reasons. It lies at the root of much chronic disease and immune disturbance. Where there is evidence of ama, improving eliminations is the first priority of treatment, a universal theme in herbal therapeutics. The prime herbal influences in the elimination of ama are the bitter and pungent herbs, often in that sequential order, perhaps after a fast. (This is exactly the strategy for the Galenic elimination of ‘damp’.) Sweet, salty and sour herbs can increase ama.

The treatment of ama is, however, complicated by its combinations with the doshas (in which case it has the suffix sama). Combined with kapha (kapha sama), it is marked by severe mucus conditions and is a clear indication for pungent with bitter herbs. Pitta sama is the classic Galenic damp-heat condition, with yellow tongue coating, urine and faeces, congestive anorexia, loss of thirst and biliousness. Bitter herbs lead the treatment, with modest amounts of pungent, as appropriate. Vata sama is associated with constipation, painful abdominal congestion and flatulence, anorexia and bad breath, and is treated with pungent herbs, warming aromatic digestives and carminatives combined with laxatives as required.

The majority of the early immigrants to North America were Europeans looking for a fresh chance in the vast spaces of the ‘New World’. Although there were new towns and cities, significant numbers lived remotely from any organised services, for example often hundreds of miles from a doctor (who was often poorly qualified). These were hardy self-reliant people who had to find all resources on their doorstep. They had to rediscover their self-sufficiency in health terms as well, combining their (imported) old European home remedies with native North American flora and a considerable amount of Indian lore as well. Their experience provides the modern reader with a unique precedent: the rediscovery of traditional herbal medicine by a modern population.

A new group of practitioners emerged, sometimes referred to now as ‘travelling medicine shows’, more often contemporarily as ‘white Indian doctors’, often peripatetic, exploiting their claimed skills and usually their own patent nostrums. Many were opportunists with little to contribute in a lasting way to the development of healthcare (although one 19th-century herbal tonic was to become, as Coca-Cola, the most massively consumed product of all time). Nevertheless, there were also true pioneers among this group; some passionately keen to develop a self-reliant healthcare system based on what they knew of plant remedies.

One ‘white Indian doctor’ went into print. Samuel Thomson (1769-1843) was brought up as a shepherd boy in New Hampshire and introduced to herbs by a ‘wise woman’, Mrs Benton, who was versed in Indian lore. He very quickly became adept, being called upon by neighbours in competition with what may have been particularly poor service from the local doctor.

Thomson was horrified by the remedies used in ‘regular physic’, these being dominated by toxic minerals based on mercury, arsenic, antimony and sulphur. He also saw that there was a fundamental difference in therapeutic approach. He saw the objective of the doctors as being to stop the disease at all costs. The main conditions of the day were febrile infections and the regular approach was to use mineral products and bloodletting to stifle the symptoms and bring the temperature down (this was before germ theory redefined the objective as eliminating pathogens). Thomson had ministered to patients almost killed by the combination of calomel (mercurous chloride), antimony, bloodletting and fever. In native Indian tradition (as seen in the sweat lodge), Thomson treated fevers in the opposite way, by maintaining and supporting them. He saw the fever as a sign of healthy resistance: it was possible for damage to follow if the fever got out of hand but the main risk was failure of the febrile defence. Thus Thomson used Capsicum (cayenne) as a powerful support to the febrile mechanism, along with a range of other remedies including Lobelia inflata (lobelia), Myrica cerifera (bayberry), Viburnum opulus (cramp bark) and Zanthoxylum (prickly ash) to modulate and support various aspects of the febrile response.

Thomson was sufficiently enthused by the distinction between his and the regular approaches that he learned to read and write so that he could pass on his message. He set out a principle that at once encapsulated this tradition and fired the public imagination. The book in which he propagated his views³⁵ was a runaway publishing success across the East and Mid-West and at the time it was calculated that over half the population of Ohio were adherents of Thomsonian medicine.

Thomson’s language was simple, even simplistic, and aimed at a God-fearing readership. However, he seemed to have touched a gut instinct that life and health are positive virtues, to be protected or recovered through personal self-sufficiency using the medicinal aids provided by the Maker. In one key passage he appears to have adopted some of the language of Graeco-Roman humoral medicine:

To a readership versed in the Book of Genesis, the fact that Earth and Water (or clay) were the stuff of life, the dry and wet principles respectively, would have been readily appreciated. For those spending all their lives in the open, Air would have been easily equated with its original meaning, wind, a persistent metaphor for movement. The important vital principle, of course, was Fire or heat, the obvious difference between a living body and a corpse, the universal metaphor for life.

Thomson’s message was simple. Heat is life. Disease and death are degrees of cold. Heating thus provides the fundamental principle of healing. Other measures, principally in improving eliminations and digestive performance, are often essential supports to this central measure. Cayenne is literally a life promoter.

In the case of fever this message was particularly appropriate in its radical emphasis. The battle lines between heat and cold are more clearly drawn. Thomson was of course essentially correct in his judgement: fevers are defence mechanisms and the symptoms of pyrexia, anorexia, nausea, vomiting, diarrhoea or convulsions are all side effects of this mobilisation, not to be confused with the underlying pathogen. Clinical experience is that a fever well fought, with a clear crisis and lysis, no hyperpyrexia and side effects prevented from causing collateral damage, can leave the body in a stronger position. Effective fever management can be a more helpful strategy than suppression.

The central point, of course, was that Thomson had articulated, with popular success, an essential feature of the herbal tradition: that the primary task was to support the body’s own recuperative efforts. Everything else was secondary. He also sounded the essential difference between that tradition and what had already become conventional medicine. The fact that his relationship with the medical establishment was almost entirely acrimonious only served to reinforce his position as a fundamentalist.

Thomson highlighted common naturopathic and traditional principles in his principles of medicine (note, for example, similarities with the principles of Ayurvedic diagnosis and treatment listed above³⁴). These included:³⁶

There are some obvious and striking parallels between the Thomsonian strategies and Ayurveda. From the Charaka Samhita Sutrasthana³⁰ 1.53 and 22.4 we find ‘The goal of Ayurveda is the equilibrium of the tissues’ and ‘One who knows how to reduce excess, nourish deficiency, dry, oleate (lubricate), sweat and astringe is a real Ayurvedic physician.’

Some of Thomson’s followers were less keen on his simplicities. Much to the old man’s disgust, several started developing variations on his teachings, recognising, for example, that there were conditions that could be diagnosed as excessive heat. There were different emphases on the need to control heat (in fact, circulation) and variations in the mechanisms for keeping the blood ‘clean’. In the second half of the 19th century, at the same time as osteopathy and chiropractic emerged, Thomsonian approaches inspired both eclecticism and physiomedicalism. Unlike these former, however, the medicinal therapies did not fare well. The main colleges of physiomedicalism and eclecticism, along with those of homeopathy, were ‘invited’ to come within the umbrella of established medical training in talks held with the American Medical Association (AMA) at the turn of the century. This was an inspired example of the establishment eliminating radicalism by accommodation, the most notable of which was for osteopathy (the modern American osteopathic physician is to all intents a conventional medical practitioner).

Three figures stand out in physiomedicalism: the intellectual offshoot of Thomsonian medicine. TJ Lyle produced a superb herbal materia medica,³⁷ concentrating on the observed influence of each remedy on the human being rather than listing its symptomatic indications. JM Thurston produced the last authoritative physiomedical text, posing operational definitions of the vital force, health and disease and the distinctions between functional symptoms and those arising from organic (‘trophic’) origins, and elaborating on the need to use only such remedies as supported vitality. He also, rather prematurely, sought to classify remedies in terms of the newly discovered autonomic nervous system, reasoning that in its vasomotor activity control could be exerted on local circulation and thus on all tissue functions, including digestion, elimination and hormonal and nervous activity.³⁸

Of the physiomedical theorists, WH Cook was particularly inspired. Like the others, Cook attempted to link the rapid new discoveries of medical science to traditional approaches. Through his arguments appears to run the theme that the living body is essentially a functional entity and that disease starts as a disturbance of normal functional rhythms, for example:

Like other physiomedicalists, Cook started with the principle that the ideal medicine should support recuperative functions, but added considerably to the view that thereafter they should have a gentle dynamism, helping to correct distorted functions, either ‘relaxing’ overstimulated tissues or functions, or ‘contracting’ those that are sluggish.

Thomsonian medicine and physiomedicalism both travelled to Britain to a welcome from the newly urbanised medical herbalists of the Industrial Revolution. Their approaches led to the birth of Anglo-American herbalism (which is largely reflected in this textbook) and formed the foundation of the oldest body of medical herbalism in the Western world, the National Institute of Medical Herbalists, established in 1864. Although the vigour of the American pioneers faded in the following century, their ideas at least survived on foreign shores while they singularly failed to do so after the AMA takeover at home.

Although the eclectics were a more intellectual and professional group than the Thomsonians, their system lacked an overall cohesive philosophy. Although they used their medicines in physical doses, their prescribing approach could be like homeopathy and many of their new remedies were adapted by homeopaths. However, their wealth of clinical experience was outstanding and they made substantial contributions to Anglo-American herbalism through the development of the materia medica. They introduced Echinacea and golden seal and discovered the immunostimulant action of the former (although they did not realise it at the time). Their innovations in pharmacy and chemical research on plants set the scene for modern phytochemistry. Some of their developments pre-empted modern drug medicine: in their development of ‘Specific Medications’ they rejected ‘inert’ plant material. The name of a leading eclectic figure John Uri Lloyd was preserved in the title of a major journal of plant research (Lloydia, now the Journal of Natural Products). The key eclectic texts are Ellingwood,⁴⁰King’s Dispensatory⁴¹ and Felter.⁴²King’s Dispensatory (especially later versions written by Felter and Lloyd) provides the best traditional use data in existence for Western herbal medicine. Ellingwood also contains a wealth of clinical experience. Felter has extensive information on materia medica, including dosage charts. Subsequent developments with specific medications (and the costs involved) disenchanted the English herbalists who realigned themselves strongly with the physiomedicalists.

Much of Western herbal therapeutics is imbued with the values of a healthcare tradition that arose in central Europe from the 18th century. Built on the philosophical foundations of Goethe and Schiller, a cultural view arose of health as a refinement, a separation of the pure from the greater impure.

The Goethian view achieved practical therapeutic form in Germany in the homeopathy of Samuel Hahnemann, the biochemic tissue salts of Schussler and, in the 20th century, the anthroposophical medicine that arose as one aspect of the holistic world view of Rudolph Steiner (and indirectly in the Flower remedies of Edward Bach in England). It also provided the founding principles of a variety of practices that have been grouped under the heading of naturopathy. The use of dietary changes (and in later years dietary supplements), hydrotherapy and a range of physical therapies in order to allow ‘nature cure’ has one of its strongest cultural roots in this tradition.

The European naturopathic tradition also developed Galenic concepts of heat and cold and notably (as a northern European phenomenon) that of damp. The concept of ‘catarrh’ and ‘mucus’ became a cornerstone of naturopathic treatment. Following the Graeco-Roman lead, many infectious and inflammatory diseases were seen as congestive toxicities to be warmed and dried. When germ theory established the role of bacteria in infections, these were seen as ‘saprophytes’ rather than pathogens; in other words, essentially beneficial cleansing organisms, like forest fungi breaking down dead wood, taking advantage of the catarrhal nutrients to effect extraordinary healing responses like inflammation and fever. As in all other foregoing traditions, herbal remedies were seen as important contributions to detoxifying damp conditions, although these were closely interwoven with dietary techniques in ways that have permeated much herbal practice in the West to this day.

The main impact of the Middle European tradition of herbal medicine was on dosage. Whereas the historical emphasis has always been on large ‘heroic’ doses of herbs, often single preparations for short-term use in acute diseases, the homeopathic initiative led to a general move towards smaller doses, often linked to the use of their ‘mother tinctures’ from fresh rather than dried plants. Some of today’s leading German phytomedicine companies were formed by homeopaths and have provided plant products over a mixed range of doses and potencies, with the herbal remedies having sometimes tiny material doses. In some European countries, notably The Netherlands, the public perception of herbal or phytomedicine is that it uses homeopathic remedies. The significance of this is that the German industry makes up the largest single part of the European herbal market and the overwhelming part of the herbal clinical research literature. Much of this literature relates to products supplied in much lower doses than those commonly used elsewhere in the world, with chaste tree and black cohosh representing good examples.

The clinical implications, and possible limitations, of low-dose phytotherapy are reviewed in Chapter 6 on dosage. Whatever the pharmacological doubts, however, one beneficial effect is that it marked the move from primitive drastic short-term medication for acute conditions to a therapy that could, and did, take its place in the modern mainstream in the treatment of chronic disorders. Remedies changed their role when so transformed (for example, hawthorn moved from a fever management treatment in high doses to a gentle cardiovascular modulator, valerian from an alterative to a mild sedative, garlic from an antiseptic to a treatment for high plasma cholesterol). It can be argued that the Western fascination with Chinese and Ayurvedic herbal medicine is for traditions that have yet to be adequately exposed to the clinical realities of illnesses of a modern developed society.

Several themes emerge from the previous reviews of traditional herbal therapeutic systems, as already touched on in the comparison of Ayurvedic and Thomsonian treatment strategies:

If modern herbal therapeutics is to be true to its traditions then it should be able to postulate modern versions of the above themes. Unfortunately, this language is lost among the modern population. Any postulates at this stage have to remain speculative and theoretical. They may form principles for the practitioner rather than an effective language for the patient.

It will also be difficult to arrive at acceptable modern versions of the humours. We no longer relish the language of body fluids and so lose the opportunity to create a modern metaphor that links both the bedpan and the spirit and our own personal experiences. At another level, however, modern systems analysis of body fluid dynamics may support the prospect for oceanic currents through the tissues rather than the mechanistic pipes and channels of Harvey,⁴³ so providing a possible rationale for meridianal movement. This is again not a substantial point.

There may still, however, be a future for a subjective physiology and pathology. Indeed, one of the concerns about the way modern medicine has developed is that its language has long left the patient behind. Doctors have become better and better at differentiating pityriasis alba from seborrhoeic eczema but are not as good at telling the patient what is wrong, especially if there is only superficial treatment available.

Again, there is a long way to go. However, there are few conceptual barriers to a new physiology that might become understood by anyone. Much of the theoretical ground has been broken in such disciplines as endocrinology and neuropeptide science, neurophysiology, immunology (and the radical North American hybrid of almost every human science: ‘psychoneuroimmunology’). In embryology and developmental biology, researchers regularly think in four dimensions and of models of transience that are rare in the other medical sciences. For some time biology has been taking mathematics, physics and computer sciences into its domain. As will be seen in the next section, the fascinating insights that have followed a better understanding of the behaviour of complex living systems have also begun to affect the biomedical model, at least slightly. All these disciplines are still highly arcane, barely comprehensible even to other biologists, let alone the general public. However, they do offer opportunities for a functional physiology based on the insights of many cultures over many centuries.

The traditional herbal therapeutic systems reviewed in preceding sections were all constructed using empirical insights, honed by generations of observers of the human condition. Even without instrumentation, they were able to draw clinical connections between observed body functions in health and disease. As outlined earlier, there was an assumption that a principle applying at one level applied equally across others; there was also much more interest in function than anatomical structure, malfunctions rather than pathologies. Principles were often established with the acquiescence and knowledge of the wider population, using the common language. They were often workaday and pragmatic, with only occasional efforts to construct elaborate theoretical systems. The vast number of local cultures means that there are considerable diversity and even contradictions in the detail. Nevertheless, fundamental principles about vital functions were widely agreed. We can see the basis of a traditional physiology.⁴⁴

All living organisms clearly:

Moreover, living organisms manifested these vital functions at every level of body, mind and spirit and in their social groups. In modern parlance, we would say equally at the cell, tissue, organ, body, psyche, society and wider ecosystem levels (the Gaia model develops similar principles). Importantly each of the vital processes above is a recognisable system that could be used to characterise a wide range of different functions. They lead to the thought that a systems analysis might be a fruitful language for the new physiology; that it is in the study of complex dynamic systems that the future may lie.

One of the serious drawbacks of the science inspired by Galileo and Newton and developed mainly in the 19th century is that it was never designed to understand wholes. Its strength is in reduction of complexities to their parts. While modern science is, therefore, unprecedented in understanding the constituents of life and nature and building new edifices and realities with the results, it has been poor in understanding or predicting the behaviour of life and nature itself.

It is difficult to put this right. Scientific tools have not been readily available to understand patterns. Nevertheless, the study of complex systems has been tackled by leading scientific minds since computers provided the tools. Traditionally, the study has been one of high mathematics as the permutations and calculus of relationships between entities are worked through. However, application of often relatively simple mathematical formulae or simple modelling has shown that surprising things can happen in apparently random arrays. Programmed with only two simple instructions, dots on the screen behave spontaneously like flocks of birds, and a simple mathematical formula creates myriad self-similar fractal patterns of astonishing natural beauty that closely resemble natural patterns and structures. New properties that are genuinely more than the sum of the parts emerge from simple constituents.

All this has enormous implications for those who wish that there was another way to observe life and health rigorously, and the reader is strongly recommended to read the excellent early introductory texts.^46–48

One of the most stunning proposals of complexity in the biological realm is the radical riposte to conventional views of the origin and, by inference, the mechanics of life. So far, the current view is that life formed once upon a time after the fortuitous combination of numbers of organic molecules in a primeval soup, perhaps aided by the odd burst of lightning. The first key stage in reproducible life was the formation of strands of ribonucleic acid (RNA) that could provide the mechanism for protein synthesis and eventually replication. A mathematical review of this scenario shows how astonishingly improbable it is that such events could have happened by chance, even in the billion years or so that were available for this leap. Visions of monkeys producing not one but many Shakespearean texts by random play with a typewriter come to mind.

However, it is a principle of organic chemistry that molecules interact, tending to catalyse each other’s transformations. If there are enough organic molecules together, catalytic loops may be closed (i.e. some catalysts are formed by transformations they themselves initiate), then the molecules in that loop become self-sustaining: they become an ‘autocatalytic set’. Their levels will be built up within their locale, they will ‘consume’ building block molecules and ‘excrete’ metabolites and they will colonise any other locales into which they spill. This is not only possible; it is inevitable if there is sufficient diversity of organic molecules in the medium. Self-organisation is shown to happen spontaneously, simply out of the mathematical permutations of the events. This is ‘order for free’, as the leading proponent of this scenario, Stuart Kauffman, puts it.⁴⁵ It implies that organised structures arise spontaneously all the time. It resonates with a much wider finding that complex systems tend to self-organisation as an essential property of their complexity.

But this order is not fixed. If it were, it could not grow, move or adapt. It would be dead. It is important that there be some adaptability in self-organisation. Science and mathematics are now very familiar with the phenomena of chaotic behaviour in natural systems. The patterns of clouds or sand dunes or flames, the flow of water down pipes, the weather, all are manifestations of the behaviour of particles acted upon by natural forces. Chaos in this sense is not random; its patterns are deterministic, not actually predictable overall but made up of elements which at any one point follow a predictable trajectory. Chaotic behaviour also creates moving zones of minimum energy or ‘attractors’ (a ‘point attractor’ is reached by a ball dropped into a bowl) which behave in characteristic ways: these are the ‘strange attractors’. The trajectories of activity to and from strange attractors mean that a small initial stimulus, if on the appropriate trajectory, could amplify to massive effects: the fabulous ‘butterfly wing effect’ where in theory a hurricane in the Gulf of Mexico could start with a butterfly flapping in the Amazon … or not.

Chaos, although sometimes manifest in familiar patterns (such as clouds), is not consistent with sustainable life and health. What appears to happen, however, in self-organised complex systems is that they spontaneously tend to a state just on the ‘edge of chaos’, a position where, in information theory terms, there is enough stability to store information, and enough fluidity to send it. It has been described as a ‘phase transition’ such as exists between the solid and fluid state of substances. Complexity therefore is seen as a state between fixed order and chaos, one to which complex systems seem gravitationally to revert. The cell sustains high potassium levels in a dissipative sea of sodium; the heart beats most effectively when it is neither too regular nor too sensitive but somewhere in between (and this behaviour may well be the inevitable dynamic effect of circulatory structures – the heart doesn’t beat, it resonates); an ant colony appears automatically to adjust its boundaries so that its density is always at optimum levels for effective ant-to-ant interactions; human civilisations consume chaotic phenomena and construct stable systems from them before eventually decaying through too much order or too much chaos.

Without going through the many fascinating arguments, it really does appear possible that the hovering of complex systems on the edge of order and chaos is itself an attractor, a state of lowest energy for such systems. And this is the punch line: health itself could be seen as a biological attractor, the state to which living systems revert, effortlessly!

The interest of the herbalist in a science of wholes, of qualities rather than quantities, is obvious. Unlike conventional pharmaceutical medicine, even the remedy is a complex and unquantifiable thing. On the other hand isolated drugs produce unpredictable side effects because real people are also unfathomably complex. There may after all be a principle to be elucidated that one way to treat complexity is with an appropriate complexity – perhaps on some principle of pattern recognition (e.g. diagnosis or anamnesis).

This cannot be a thorough review of the impact of complexity theory on therapeutics; indeed, such a text has not yet been written. However, the subject is beginning to generate vigorous debate in some quarters and taking all the discussions in this chapter together, as well as reviewing the section on the placebo effect (see p. 89) it is possible to make the following tentative therapeutic propositions:

Somewhere in this there is the basis of a truly rational therapeutic approach ideally suited to the use of herbal remedies.