5.3.1 Traditions in Western Herbal Medicine
by Peter Mackenzie-Cook, DBTh, FETC.
This Article is taken from The Herbalist, newsletter of the Canadian Herbal Research Society. COPYRIGHT June 1989.
Thanks to Jonathan Treasure for sending this one over.
The Development of Theory in North America
Introduction: To one trained as a medical herbalist in Britain, it is a curious fact that herbal medicine, as it seems to be most widely known in Canada and the U.S., has been so little influenced by the great systems of herbal thought which once flourished here. Only remnants of these systems can now be found in the writings of Kloss, Christopher, Shook and others whose primary sources appear to be the European and native North American folk traditions.
These folk traditions are very valuable medical resources in their own right; a fact which has been recognized and supported by the World Health Organization (1978). It has also been recognized and increasingly exploited by the pharmaceutical industry. Folk medicine however, is also important as a rich source for the periodic historical development of major systems of traditional medicine. Examples of the development of two such systems in North America will be discussed here, together with some of the more important theoretical and practical contributions to herbal medicine which these systems generated.
Early American Folk Medicine: Eleanor Sinclair Rohdes (1922) has written very eloquently of the hardships faced by early American settlers in their efforts to cultivate the familiar medicinal plants of England and Europe. In many cases it seems these efforts failed completely and the pioneers were forced to supplement their folk medicine traditions with lore relating to indigenous plants obtained from the native people. To the extent that any special knowledge would have been likely, then as now, to remain a closely kept secret by the native medicine societies, it is probable that the native plant-lore passed onto these settlers was a matter of common knowledge amongst the native people. In fact, it may be said that a distinguishing feature of any folk tradition is that the lore contained in that tradition is, or has once been, common knowledge.
Another distinguishing feature of folk medicine, regardless of its historical or ethnic origin, is that the indications for the use of individual remedies are always given in terms which refer to specific symptoms or illnesses. Thus, comfrey (Symphytum officinale) is said to be useful in healing fractures, while white horehound (Marrubium vulgare) is recommended for cough. Typically, such lore has been handed down from generation to generation, often for hundreds if not thousands of years. Each new generation learns at first hand the look and 'feel' of particular symptoms and illnesses. They learn which plants may be used to treat these illnesses, and the best methods for collecting, preserving and administering them. Such a tradition is entirely dependant upon repeated experience and observation; usually only minor changes can be detected in these traditions over relatively long periods of time.
Thomsonianism: The popular medicine of all peoples however, has always given rise to, and been counterbalanced by a more specialized type of knowledge, acquired by individuals who have devoted their entire lives to the study and practice of healing. As resource persons, these individuals have served their communities by providing access to that specialized knowledge in circumstances where the more common folklore was insufficient to meet the needs of the moment.
A very popular figure in early American medicine, who managed to combine native and settler folklore with a more specialized approach, was Samuel Thomson (1769-1843). Thomson came from a farming family and evidently learned some of the 'root and herb' practice at an early age. Later, he seems to have become an avid reader of medical literature and was particularly impressed with the Hippocratic writings.
Probably as a consequence of his regard for Hippocrates, Thomson believed that medicine should be based exclusively upon observation. The formulation of theories, he felt, prevented ordinary people from taking responsibility for the care of their own health, and that theories obscured the simplicity and made a needless mystery of medicine.
Thomson himself however, after 'long observation and practical results', borrowed theory from Hippocrates and used it as a basis to explain the 'why and how' of his own medical system. According to this theory, disease was the result of a decrease or derangement of the vital fluids, brought about by a loss of animal heat. The resulting symptoms were interpreted as efforts of the Vital Force to rid itself of the toxic encumbrances thus generated. Essentially, treatment was aimed at restoring vital energy and removing disease-generated obstructions. In specific terms, Thomson believed that in restoring vital heat by means of steam baths and cayenne (Capsicum annum), toxins which obstructed health would be thrown into the stomach where they could be eliminated by emetics such as Lobelia inflata (Griggs, 1981).
This simple theory constituted a dramatic departure from pure folk medicine in that it recognized and sought to treat an underlying, fundamental cause of illness. Moreover, in perceiving symptoms as an expression of the organism's defensive efforts, this theory implied that the treatment of symptoms and illnesses, per se, might actually hinder the healing process. It is interesting to note that Thomson believed this theory was quite complete and needed no further refinement or extension. Nevertheless, despite his vehement opposition, Thomsonianism became a potent influence on the development to two major streams of thought within American herbalism.
Eclecticism: The earliest of these was 'Eclecticism', founded by a man who had originally apprenticed to an old German non-Thomsonian herbalist, and who later qualified as a 'regular' medical doctor. Although the founder of this system, Wooster Beach (1794-1868), had been horrified by the 'regular' medicine of his day, and fervently wished for radical reform, Thomsonianism had impressed him negatively in two ways. First, Beach was keenly aware of the bitter antagonism which Thomson had roused in the regular medical profession. As a result he decided to attempt reform (unsuccessfully as it turned out) from within, rather than as another medical 'outsider'. Secondly, Beach was disgusted by Thomson's evident arrogance in thinking that no further learning could possibly enhance the practice of herbal medicine.
Beach was well acquainted with the developments then taking place in such fields as chemistry, physiology, pathology and even botany. He was also quick to realize that this new thinking might have a valuable role to play in botanic practice, and began to move in this direction with the creation, in 1829, of his own school of 'Reformed Medicine'.
In terms of the study of medicinal plants, Beach's orientation resulted in the development and proliferation of an entirely new style. Eclectic monographs on individual herbs became more formal and typically included notes on the plant's chemistry, toxicology, physiological and therapeutic actions, as well as appropriate forms of preparation and dosage (e.g. King, 1900). Later Eclectic physicians became increasingly interested in obtaining preparations which represented the entire chemistry of the original plant as closely as possible. Although this preoccupation had near-disastrous consequences in at least one instance (Griggs 1981a), in general their research supported and developed the fundamental position of the value of using whole plant preparations rather than isolated extracts of a particular plant constituent (Lloyd, 1910).
Eclecticism was also a major contributor to herbal medicine in other areas. Beach himself, for instance, realized the fundamental importance of the blood and circulatory system in maintaining health, and began to develop herbal methods for 'equalizing the circulation'. Several valuable techniques used in the modern herbal treatment of fevers are probable directly attributable to Beach's work.
A later physician by the name of W.H. Cook (1879) expanded on this work in his correlation of the functions of the nervous and circulatory systems. Cook also developed a concept which related illness to deviations in trophic (i.e. structural) and/or functional tone. According to this view, disease consisted of excessive or diminished tone in organs, or in the functions of those organs. Corresponding herbal approaches to the correction of these kinds of imbalance were also eventually developed (Priest & Priest, 1982).
Another major development fostered by Eclecticism, was the clinical emphasis placed on treating a group or pattern of symptoms, usually with small doses of only one so-called 'specific' remedy. As the pattern of symptoms changed with the progress of disease, a new and more currently appropriate remedy would be indicated (Felter, 1922; Lloyd 1927).
Perhaps significantly, this approach was and is still fundamental to the practice of homeopathic medicine, which was rapidly becoming the most popular of all medical systems in the U.S. during the mid-19th century (Coulter, 1973). In fact Hahnemann (1810), the founder of homeopathy, had already written at some length concerning the relative merits of prescribing for what he called the 'Totality of symptoms', versus the treatment of individual symptoms or named diseases. The use of small doses of a single remedy was also an established fundamental tenet of homeopathy (e.g. Kent 1900).
Prescribing for patterns of symptoms had also been typical in traditional Chinese medicine for many generations. Clear examples of the fluidity of prescribing in accord with changes in symptom patterns may be found in the Chinese classic, 'Shang Han Lun' (Hsu & Peacher, 1981). However, although the use of a single remedy is an established technique within Chinese medicine under certain circumstances, Chinese herbal prescribing more often involves the use of formulae (e.g. Bensky & Gamble, 1986).
Physiomedicalism: The second major stream of thought in American herbal medicine, which arose directly out of the Thomsonian movement, was 'Physiomedicalism'. Although not so heavily influenced by the developing sciences as Eclecticism, the originator of this 'neo-Thomsonian' movement, Alva Curtis, felt, like Beach, that Thomson's resistance to theoretical development was a mistake.
Above all, Curtis wanted to open a school based upon Thomsonian principles, but encouraging a freer atmosphere for broader intellectual enquiry and learning. In 1835, despite Thomson's opposition, Curtis realized his ambition and opened the 'Botanico-medical School and Infirmary' at Columbus, Ohio. As evidence that he was not alone in his thinking, during that same year, a colleague opened the 'Southern Botanico-Medical School' in Georgia (Griggs 1981b).
Ultimately this new system of herbal medicine retained much of what had been accepted as fundamental in the Thomsonian theory. Thus, organic function was thought of as the aggregate expression of Vital Force, acting through cellular metabolism to maintain the functional integrity of the entire organism. Illness was seen as a disordered response at the cellular level, brought about by internally or externally generated toxic obstructions. Essentially, treatment remained a matter of supporting the efforts of the Vital Force, and of eliminating the toxic encumbrances which hindered those efforts.
A significant departure form Thomsonian thinking however, came with the recognition that some symptoms represented positive, eliminate and reconstructive efforts of the Vital Force, while others resulted from physical impediments to those efforts. If treatment was to be directed to the underlying cause of illness, therefore, symptoms which expressed a purely functional disorder had to be distinguished clinically from those produced by organic changes in cells and tissues.
Eventually it was also realized that the organism was capable of establishing a compensatory equilibrium in which toxic encumbrance would be tolerated to a degree, in order to maintain a relative functional integrity. This was a major step forward in understanding and had important implications for herbal therapeutics. Certain symptomatic crises which had been observed, particularly in the context of treatment with herbal alteratives and eliminatives, could now be explained and avoided.
Another significant development in Physiomedical thinking was stimulated through the work of W.H. Cook (see above). If health could be understood as the unimpeded and balanced function of all cells and tissues, then it was clear that the blood and circulatory system played a vital role in maintaining health, both in terms of nutrient delivery, and of waste and toxin transport to eliminative organs.
Cook had shown that, in addition to the quality of the blood itself, the chronic relative contraction or relaxation of tissues and particularly arterioles and capillary beds could also have serious consequences. Cellular function, and eventually cellular structure, could be strongly influenced by a relative excess or deficiency of blood and tissue fluid. Further, as understanding of human physiology increased it became obvious that hyperaemia in one part of the body would necessarily imply a relative ischaemia elsewhere.
The implications of this thinking for herbal medicine were threefold. Firstly, herbs which acted to increase or decrease tone in the three primary divisions of the circulatory system (arterial, capillary and venous) had to be distinguished. Secondly, the general, portal and pulmonary aspects of circulation had to be considered in treatment, as did the distinction between visceral and somatic components. Thirdly, the circulation to particular organs and tissues had to be taken into account, not only to support or modify the related functions, but also to restore normal trophic conditions, where possible.
The achievement of these goals became much more accessible following the work of J.M. Thurston (1900), which stressed the regulatory importance of the autonomic nervous system. Thurston made many important contributions to Physiomedical thought in the areas of diagnosis, prognosis, treatment and, perhaps especially, in the area of herbal pharmacy. A number of aspects of his work, and of Physiomedicalism in general, have been described by Priest & Priest (1982a).
Even by the close of the 19th century, Physiomedicalism could be described as a system which emphasized the role of herbal remedies in supporting Vital Force, balancing the circulation to various tissues, modifying and enhancing body functions, restoring optimum trophic or structural conditions, and in eliminating toxic encumbrances (Mills, 1985).
Unfortunately, the publication of the Flexnor report in 1910 and the subsequent forced closure of the 'irregular' medical schools put an end to any further developments of the kind described here in American herbal medicine (Cody, 1985; Gort, 1986).
Conclusion: Curiously, despite the slightly more open attitudes which prevailed in Canada (e.g. the government regulation of naturopathy on Ontario, 1925; Govt., 1986), neither the Eclectics nor the Physiomedicalists seem to have moved north across the border. In fact both systems, together with a version of Thomsonianism, had been taken to England where they were eventually integrated into one system of professional herbal medicine, regulated by law and still taught in the U.K.
In Canada and the U.S. however, only traces remain of these once influential and effective systems. The Dominion Herbal College in British Columbia for instance, has referred in its course notes to the need for 'equalizing the circulation' (1969). References can also be found in these notes and elsewhere to 'relaxing' or 'stimulating' herbs (i.e. plants capable of increasing or decreasing functional tone). The importance of supporting vital force and of eliminating accumulated toxins is also still widely recognized and practised. Nevertheless, there are probably few today however, who can apply physiomedical principles in distinguishing for instance, those lung, bowel and kidney conditionsrespectively requiring relaxing or stimulating expectorants, laxatives and diuretics.
Due principally to repressive legislation, herbalists in North America must once again rely heavily on folk traditions as their major source of learning and inspiration. It should be noted here that much of the
valuable herbal lore once utilized widely by native North Americans is now known by only a small handful of native elders (PC. 1988). It is very fortunate therefore, that Canadian and American herbalists have preserved some of this knowledge in their own practices.
Folk medicine traditions are virtually impossible to legislate against directly, and even in the recent Ontario government recommendations, treatment of oneself and one's family had been specifically exempted from prosecution under the proposed legislation (HPLR, 1989). Direct legislation however, was not the only factor contributing to the decimation of native culture and the virtual loss of their traditional healing knowledge.
The proposals tabled in the Ontario legislature will almost certainly impose or support severe restrictions on the cultivation and/or sale of medicinal plants, should they be passed into law. Furthermore, such legislation will definitely prevent or seriously delay the free development and re-emergence of a professionally oriented system of herbal medicine in Ontario.
Consequently, those who choose to make use of this 'valuable medical resource' (W.H.O., 1975a), will be forced to rely on their own experience and to gather and use only wild plants. This assumes however, that environmental policies in Ontario and the rest of North America will not poison even this source in the very near future.
- Bensky, D., Gamble, A. (Compl. & Ed.) Chinese Herbal Medicine Materia Medica; Eastland Press; Seattle, 1986.
- Cody, G. 'History of Naturopathic Medicine', in A Textbook of Naturopathic Medicine, Pizzorno, J.E.; Murray, M.J.; John Bastyr College Pulos, Seattle, 1985.
- Cook, W.H. The Science and Practice of Medicine; 1879 - quoted in Priest & Priest, ibid.
- Coulter, H. Divided Legacy: a history of the schism in medical thought Vol. 111. McGrath Pub. Co., Washington, D.C., 1973.
- Dominion Herbal College, Home Study Notes, 1969.
- Felter, H.W. The Eclectic Materia Medica, Pharmacology and Therapeutics, Scudder, Cincinnati, 1922.
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- Hahnemann, S. Organon of Medicine. 1810; 6th Ed. Trans. Hahnemann Foundation; Victor Gollancz Ltd.; London, 1983.
- HPLR, Striking a New Balance: a Blueprint for the Regulation of Ontario's Health Professions', Government of Ontario. 1989.
- Hsu, H.; Peacher W.G.(D) (Trans. & Ed.) Shang Han Lun; Oriental Healing Arts Institute; Los Angeles, 1981.
- Kent, J.T. Lectures on Homoeopathic Philosophy: 4th Indian Reprint, B. Jain Publishers; New Delhi, 1977.
- Kings's American Dispensatory; Felter & Lloyd, 1900; Reprinted by National College of Naturopathic Medicine; Portland (undated).
- Lloyd, J.U. Fragments from an Autobiography, a paper read at the 63rd meeting of the Ohio Eclectic Medical Assoc., Arkon, May, 1927; Eclectic Medical Journal, 1927.
- The Eclectic Alkaloids. LLB no. 12, Pharmacy Series 2, P41; 1910.
- Mills, S. The Dictionary of Modern Herbalism; Thorsons Pub. Gp.; Wellingbourgh, New York, 1985.
- Personal Communication, Art Solomon and other Ojibwa Elders; Native Elders Conference, Trent Univ., Peterborough, 1988.
- Priest, A.W.; Priest, L.R. Herbal Medication, a clinical and dispensary handbook; Fowler & Co. Ltd.; London, 1982.
- Rohde, A.C. The Old English Herbals, 1922; 3rd Ed. Rohde, E.S.; Minerva Press Ltd; London, 1974.
- World Health Organization The Promotion of Traditional Medicine; Technical Report Series No. 622; Geneva, 1978.
- W.H.O. Document EB/57/21, Training and Utilization of Traditional Healers and Their Collaboration with Health Care Delivery Systems; Nov. 1975.