Principles of herbal treatment

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3 Principles of herbal treatment

Chapter contents

First principles of traditional herbal treatment 

Approaches to using herbs 

Other healing strategies 

First principles of traditional herbal treatment

As any review of herbal traditions from around the world will confirm, the use of plants in medicine reflects the enormous diversity of local traditions, with much more variety than consistency. However, more consistent themes emerge in history, most clearly where local folk practices were systematised in the great written traditions, reviewed in Chapter 1.

When these traditions are examined closely, especially when they relate to human experience of illness and medicine, or to recurrent pharmaceutical forms (for example, tannin, resin, laxative, essential oil, acrid or bitter principle formulations rather than the individual remedies) and then translated into modern terminology, it is possible to identify recurrent features. These appear to encapsulate essential characteristics of the material, universal archetypes of the effects plants have on humans. They certainly reflect the therapeutic priorities of earlier ages (and should therefore be adapted before being applied to modern health needs). They are valuable, however, because they probably represent the roots of herbal therapeutics, those characteristics of the remedies that are the most reliable and potent. They also draw stark contrasts with the approaches that have emerged with the development of modern technological medicine. They are antidotes to the modern tendency to view herbs solely as milder versions of modern drugs. In essence, they should underpin any rational phytotherapy.

Note: Therapeutic insights are generally better absorbed from instruction and in practice rather than in the scientific literature and the following information arises from a breadth of sources. Notable among these is the bibliography at the end of the chapter listing authors who mostly were in contact with primary resources or leading teachers. The attempt is to distil rather than list scholastically.

Cleansing: detoxification and elimination

In much traditional practice there was an explicit or implicit assumption that, before healing could take place, noxious influences needed to be removed. In the earliest animistic traditions, pathogens could be literally demons and shamanistic practices emerged to drive them out. However, there was also a consistent, more mundane view of toxins and poisons: these needed to be removed by the body’s eliminatory functions. Disease was widely seen as a failure of elimination and the vomiting, diarrhoea, coughing, diaphoresis and diuresis of most acute diseases as evidence that the body was being driven to extraordinary eliminative measures. In Ayurvedic medicine the doshas were initially excretions and health their healthy presence; in Chinese medicine the development of chronic disease was a sign that acute eliminatory responses had failed in their primary task of keeping pathogens out and that penetration into the interior had occurred.

The task of the physician was equally clear: to support eliminatory functions as vigorously as possible compatible with the body’s vital reserves (eliminatory functions were mostly seen as taxing the body’s energies). In practice this meant robust ‘heroic’ treatments in acute disease, notably involving emetics, purgatives, powerful expectorants and, in fever management, diaphoretics. In chronic and debilitated conditions the aim was to use gentler treatments, peeling away toxic accumulations like the layers of an onion, always making sure that eliminatory measures, laxatives, diuretics, choleretics, expectorants and the more systemic lymphatics and alteratives were supported by adequate sustenance for the vital functions: rest, nourishment and the use of tonic remedies (see below).

Typically in traditional therapeutics, therefore, eliminatory measures were the first stage of treatment, to be followed increasingly by the following more adjustive and sustaining treatments.

Heating: moving the circulation

It was apparent to all humans that heat equated to vitality. The extreme absence of heat was the striking coldness of the corpse. When Samuel Thomson in North America built his therapeutics around the principle that disease was essentially a cold intrusion and that before all else remedies should heat the struggling body, he was only highlighting an almost universal instinct. In every tradition there is frequent use of heating remedies; the hot spices, or ‘pungent’ remedies, were the strongest for internal use, but there was always a raft of gentler warming remedies as well. Some were applied as aromatic digestives to failing ‘cold’ digestion, others as warming expectorants or mucolytics in treating the effects of cold and damp on the chest and respiratory system. There were warming tonics (yang tonics in traditional Chinese medicine) and a variety of remedies that brought heat to the head, reproductive system or kidneys.

All the above could be used, along with hot packs, hot baths, ‘sweat lodges’ or hot drinks in fever, which was the major indication for supportive heating. Heating remedies used in fever management are now called ‘diaphoretics’ as their main effect is to increase perspiration. Sweat was understood not only as a cooling agent but also as the prime eliminatory route in febrile disease; in this context, therefore, heating was an obvious cleansing strategy, as above.

Indications for the use of heating agents apart from fevers were easily understood. If the patient felt cold, as a whole or in the diseased part, or favoured hot food, hot drinks, hot packs or hot baths; if there was diminished vitality; if there was pallor (the nail bed or ‘quick’ was a particularly sensitive guide) or signs of cumulative cold-damp conditions like mucus or gravity-dependent oedema, then heating remedies were indicated. The fact that a headache or arthritic joint or abdominal swelling was relieved by a hot pack was as important in choosing the course of treatment as determining what pathological factor was involved.

When the focus of cold was clearly demarcated, then extreme heating, in the form of powerful ‘counter-irritation’, cayenne or mustard plasters, blistering croton oil or formic acid or stinging nettles, might be applied topically, with sometimes dramatic beneficial effects.

Heat in modern terms equates also to circulation: a rationale that includes improved tissue perfusion, oxygenation and metabolite removal can easily be made. A modern phytotherapist might avoid the more drastic topical heating agents and may have less need to manage fevers, but could still consider the role of heating agents in a prescription if these were indicated.

The major caution in modern times is that many patients are also debilitated, at least from the perspective of earlier, more robust times. Heating agents do not heat directly, but instead stimulate increased thermogenesis and circulatory activity. They thus require reserves of energy in the body. Someone weakened by chronic ill health may suffer if stimulated in this way. An assessment of vital reserves is essential in such treatment.

Cooling: stimulating digestion

Whereas heating was clearly ‘on the side of the angels’ in traditional healthcare, cooling was altogether a more thoughtful matter. It is, after all, perfectly possible to have hot spicy foods at every mealtime (especially in the tropics where they prompt gastric defences against enteric infections) but, with a few notable exceptions, cooling was confined to therapeutics. Cooling meant reducing vitality. The ultimate cold was death. In their simple restatement of fundamental principles, Samuel Thomson and his followers denied any prospect of cooling in healthcare and even saw something diabolical in it. Nevertheless, more considered views throughout history recognised that one can have too much, or inappropriate, heat. The obvious examples were hyperpyrexia in fevers, inflammatory diseases, hypersensitivity or allergic reactions, nervous agitation and, above all, pain. The respective treatments, febrifuges, anti-inflammatories, antiallergic remedies, sedatives, hypnotics (and narcotics) and analgesics, would all be classified as cooling in these terms. Indeed, some of the eliminatory treatments often applied for these purposes, especially the laxatives and cholagogues, were also seen as cooling. Reference to the Galenic classification (pp. 4–5) will put all this into context.

The classification of sedatives is illuminating. In former times, neurosis and anxiety, irritability and tension were aspects of heat. Children were hotter than adults and there was progressive constitutional cooling with age. Psychological explanations were not prominent and no one was told ‘it is all in the mind’. The Cartesian body–mind split had not occurred.

Clearly there was more likely to be care in prescription of cooling remedies. Although many popular treatments existed, it was more likely that professional expertise would be called for, especially in the treatment of severe pains and inflammations. Almost everything now prescribed by modern doctors would have been classified as cooling.

There was one striking exception to the cautions linking cooling to reduced vitality. As referred to in the Galenic classification, the gentlest category of cooling remedy (those ‘cold in the first degree’) did ‘qualify the heat of the stomach and cause digestion’. Digestion was widely seen as a cooling activity, marked of course by a shift of blood flow from the periphery to the core (so that excessive exercise after a big meal can lead to cramps).

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