An Exploration of the Conceptual Foundations of Western Herbalism and Biomedicine
With Reference to Research Design
Matthew Wood, Registered Herbalist (AHG)
6001 Sunnyfield Road, Minnetrista, Mn. 55364
Master of Science Degree (Herbal Medicine)
Submitted: January 2006
Scottish School of Herbal Medicine
University of Wales
[This edition has been slightly corrected due to feedback from my committee.]
This report is submitted in fulfillment of the requirements of the Scottish School of Herbal Medicine and the University of Wales for the award of MSc (Hons.) in Herbal Medicine.
Western herbalism the practice of herbal medicine in modern, English-speaking areas is in a period of change, when many new and old concepts are in competition for recognition. Biomedicine has proposed a strict interpretation of herbal research, in which the experience, tradition, and conceptual framework of Western herbalism is substantially ignored in favor of the biomedical ‘gold standards:’ double blind clinical trials and pharmacological studies. In this paper the author proposes that biomedical research methods are not the only appropriate method for the study of herbalism. Instead, Western herbalism, to be a scientific field in its own right, needs to develop its own conceptual foundation and from this its own methods of research. Towards this end the author examines questions of science, paradigms, holism, biomedicine, research, and knowledge-gathering in traditional herbalism and biomedical research design. This includes visionary and intuitive methods that have not included in conventional scientific work. The paper concludes that established methods of research in herbalism, biomedical models for research, and visionary and intuitive approaches can all contribute to a healthy herbal science. It also suggests that visionary and intuitive methods can improve the holistic element in Western herbalism. It suggests that a ‘confluence’ of results from different approaches may produce more certainty in herbal knowledge than strict adherence to a single or few methods. Of special interest is the unlooked for conclusion that ‘case series’ study should be developed to provide research that can benefit Western herbalism and improve its scientific foundation.
List of Contents
2. Review and Analysis
4. Modern Western Herbalism
5. Paradigms and the Study of Science
6. Paradigms and Biomedicine
7. Paradigms and Holistic Medicine
7.1. The Goodness of Nature
7.2. Self Healing
7.5. The Individual
8. Paradigms and Herbalism
8.1. Empirical Science
8.1.1. Empirical Research: Taste
8.1.2. Empirical Research: Animal Use
8.1.3. Empirical Research: Case Histories
8.2. Rational Science
8.2.1. Research on Theory
8.3. Experimental Science
8.3.1. Pharmacological Research
8.3.2. Clinical Trials and Herbal Medicine
8.4. Visionary Science
8.4.1. Visionary Research
8.5. Analogical Science
8.5.1. Analogical Research
8.6. Authoritarian Science
8.6.1. Biomedical Research and Herbal Tradition
The author gratefully acknowledges the help of Clara NiiSka, MSc. (liberal studies), University of Minnesota, for her assistance in reading and criticizing the manuscript, Robert Schmidt, of Project Hindsight, in Cumberland, Maryland, a professional Greek translator and scholar of Greek science, for his insights in Greek science and ‘archealogical science,’ Frank H. Wood, professor emeritus of educational psychology, University of Minnesota, for his contributions regarding research, Midge Whitelegg, Ph.D., F.N.I.M.H., Department of Nursing, University of Central Lancashire, who provided several important articles and helpful comments, and Clair Teegarden, of Minnetonka, Minnesota, who provided assistance with Internet research.
Extensive public use of complementary and alternative medicine (CAM) (Eisenberg, Davis, Ettner, Appel, Wilkey, Van Rompay, and Kessler, 1998), sometimes also called holistic medicine, led to an examination of the movement by governments in Britain and America. Scientific research into the phenomenon was recommended (United Kingdom House of Lords Select Committee on Science and Technology, 2000; United States Department of Health and Human Services, 2002).
Response to government initiatives within the biomedical field has been diverse. Prominent American medical journals have suggested that CAM be investigated using conventional biomedical methods alone and that holistic professions be ignored and eliminated (Angell and Kassirer, 1998; DeAngelis and Fontanerosa, 2003). This corresponds to past experience in America, where holistic professions have been frequently persecuted and banned (Milton, 1996). A more conciliatory attitude in found in prominent British biomedical journals. Here the suggestion was made that complementary and alternative disciplines should engage in research to establish the reputation of their own professions (Haynes, 1999). These two thoughts the threat of external take over and elimination of holistic professions, and the suggestion that holistic medicine increase its standing through conducting its own research have led to the publication of the present paper.
Until the last two decades of the twentieth century, Western herbalism maintained its own conceptions and methods of research. These consisted primarily of empiricism (experience and observation), theory based on experience, and tradition based on experience (Crellin and Philpott, 1990).
Empiricism is considered a fundamental part of biomedical education and practice (Sackett, Richardson, Rosenberg, Haynes, 1997). Since empiricism is a fundamental tool of scientific and medical research (Carr, 1992; Kosso, 1992, Fugh-Berman, 1996), these methods cannot be considered unscientific. Yet, leading biomedical journals have proposed that the study of holistic medicine and herbalism be founded exclusively on biomedical research (pharmacology and randomized controlled trials), without reference to experience, theory, or tradition within holistic professions (Angell and Kassirer, 1998; DeAngelis and Fontanerosa, 2003; Leibovici, 1999).
The biomedical approach has been adopted by some herbalists and herbal writers (Mills and Bone, 2000). Others, however, have attempted to enlarge Western herbalism by introducing methods originating in traditional or subjective sources that include visionary and intuitive practices rejected by modern science (Cown, 1995, Buehner, 1996). Conflicting concepts of herbalism are apparent in the survey of contemporary Western herbal literature cited in section 4, ‘Modern Western Herbalism.’ Hence, the author concluds that basic assumptions in herbalism are not settled but subject to debate.
In order to discuss this debate within Western herbalism it is helpful to understand the nature of scientific change and debate at such periods. In 1962 Kuhn (1970) introduced the concept of the paradigm to describe scientific concepts and their ability to change in professional debate. The paradigm is a theory or assumption, or collection of them, which defines a field. He differentiated between ‘normal science,’ which proceeds from a concensus on theories and assumptions, and ‘scientific revolution,’ when adherents of different theories or paradigms contend with each other for recognition and dominance.
The present author, concluding above that Western herbal medicine is in such a period, applies Kuhn’s (1970) model to hebalism for two reasons. First, it may be beneficial for herbalists to understand and define the nature of the debate they are in. Second, it may facilitate discussion of specific theories, practices, and assumptions currently being considered for inclusion in Western herbalism. It is to be hoped that this application of the paradigmatic model will sharpen issues of debate while diminishing the sharpness of feeling often associated with professional debate.
The current paper attempts to provide basic materials for study and selection among different competing ideas. It is intended to support herbalists who want to be in charge of their own destiny by developing a profession based on theories, traditions, conceptions, research, and practices consciously examined, compared, and selected by themselves, rather than by a competing profession imposing standards upon them. It also attempts to define and reconcile so-called scientific and nonscientific approaches to knowledge, so that herbalists can select from the greatest possible diversity of methods, without having to limit their choices to narrow or rigid standards.
The contemporary practice of Western herbalism has not been widely studied in scientific research and literature. Only one extensive treatment of the subject has been undertaken by scientifically trained observers (Crellin and Philpott, 1990). They noted that previous studies by folklorists, anthropologists, sociologists, and pharmacologists focused on magical recipes and charms, the sociology of complementary and alternative medicine, its impact on the community, and the possible utility of traditional medicinal plants for modern pharmacology. By comparison, their study focused on the actual practice of herbal medicine in America.
Crellin and Philpott (1990) used an historical method to interpret Western herbalism. They adopted this approach because of the close historical relationship between herbalism and conventional medicine, and the diversity characteristic of herbal practitioners. This allowed them to catalogue, trace, and compare different practices and ideas within the field, and their relationship to conventional medicine. The initial study was limited to a single individual, Tommie Bass, a rural practitioner living in northwestern Georgia. They record his views, theories, experiences, and practices, then compare them with the larger herbal and medical tradition.
Crellin and Philpott (1990) isolated several important methods used to gather knowledge in traditional herbalism. The most significant of these are empiricism, theory, and tradition.
“Empiricism observation and information gathered supposedly without theoretical presuppositions is conspicuous in all areas of medicine. . . [and is] prominent in many current herbal practices” (Crellin and Philpott, 1990, 1:12).
“When the ‘rampant empiricism’ as it is often called in medicine at any time is examined closely, it is often seen to be sustained by theoretical or cultural notions” (Crellin and Philpott, 1990, 1:13).
“There is no doubt that theory has played a considerable role in the enlargement of the materia medica over time within both domestic and professional medicine” (Crellin and Philpott, 1990, 1:13).
The three theories most prominent in herbal medicine, according to Crellin and Philpott (1990), are:
(2) the relationship of taste to property, and
(3) the doctrine of signatures.
The first theory classifies herbal properties and disease symptoms into simple categories of excess or deficiency of basic states or substances like:
(1) temperature (hot, cold),
(2) humidity (damp, dry),
(3) tension (constriction and relaxation), and
(4) constituent (blood, phlegm, bile, etc.)
The second relates medicinal properties to:
(1) taste (bitter, sweet, salty, pungent, acrid, sour) and,
(2) impression (stimulating, relaxing, puckering or astringing, etc.)
The third relates:
(2) environmental niche, or
(3) physical properties of a plant
to its medicinal virtues (Crellin and Philpott, 1990).
Crellin and Philpott (1990) provide a comprehensive view of herbal history, from early American colonization until the late 1980s. The author found their observations in line with his own knowledge of the field. However, vast changes occurred in CAM in the decade following their examination, as biomedical and non-Western standards and ideas exerted an influence on Western herbal medicine. This situation is not even referred to by Crellin and Philpott (1990).
In order to describe the nature of the change within herbalism, the author has provided a short literary survey, characterizing herbal publications of the last two decades (section 4, ‘Modern Western Herbalism,’ p. 7).
Although this is a paper on science, the historical methods of Crellin and Philpott (1990) and Kuhn (1970) were selected to provide a context within which to study different scientific options available for research in Western herbal medicine. The subject has been so seldom examined by conventional academicians, that it was thought necessary to consult Crellin and Philpott (1990) to define past practices within the field. Thus, their input is largely restricted to section 2, ‘Review and Analysis.’ The paradigmatic method of Kuhn (1970), on the other hand, was adopted to classify and describe different assumptions or guiding ideas in herbalism, science, and medicine. Thus, it constitutes the prinicipal method used in this paper to discuss and characterize information of use to herbalists.
The concept of the paradigm was introduced by Kuhn (1970) to describe different suppositions and practices in various fields of science, especially in disciplines undergoing profound conceptual change. It was applied to modern holistic medicine almost from the first announcement of its existence (Yahn, 1979). The following year one researcher described seventeen distinct paradigms characteristic of holistic medicine (Gordan, cited by Goldstein, 1999).
Kuhn (1970) recognized two different usages of the term paradigm:
“On the one hand, it stands for the entire constellation of beliefs, values, techniques, and so on shared by the members of a given community. On the other, it denotes one sort of element in that constellation” (Kuhn, 1970, 175).
In this paper, ‘paradigm’ has been used in both senses. In section 7, ‘Paradigms and Holistic Medicine,’ (p. 14), the first of these two approaches is applied. It discusses major paradigms associated with the holistic movement in both popular and scientific discussion. Thus, it chronicles the ‘constellation’ of paradigms which characterizes holistic medicine. Section 8, ‘Paradigms and Herbal Research,’ (p. 18), adheres to the second definition. Here the attempt is made to arrive at the fundamental ‘elements’ from which such ‘constellations’ of belief and practice are derived.
Several terms used in this paper ought to be defined. English language herbalism is known to participants in the field as “Western herbalism” (Hoffmann, 2003, 1), in distinction to Chinese and Ayurvedic herbalism. This term has been adopted throughout this paper for the sake of clarity. The following terms also need definition:
Western medicine: medicine as it was practiced in the West up to the 1940s.
Biomedicine: modern medicine, no longer a ‘Western’ phenomenon.
Conventional medicine: both of the above.
Holistic medicine, unconventional medicine, and complementary and alternative medicine (CAM) are used interchangeably.
The author consulted his own library, Hennepin County Library, and the University of Minnesota Library for scientific and historical information on Western herbalism, Western medicine, biomedicine, the paradigmatic model, complementary and alternative medicine, and other subjects related to this paper. Recent research and editorials on these subjects in the most important English language professional medical journals were consulted to determine the characteristic attitudes towards these subjects in contemporary biomedical literature. Articles were located through research on the Internet using ‘Google scholar’ and keywords including ‘medicine’ and ‘paradigm’ in combination with ‘complementary,’ ‘alternative,’ and ‘holistic.’ The most often cited articles were selected. Searches under specific subjects were also pursued.
The 1940s were a watershed for Western herbalism. The use of whole plant parts in medicine was superseded by the use of drugs made from isolated, synthesized molecules. The latter were described as the ‘active ingredients’ of plants, implying that the rest of the plant was inactive or less active. Herbal medicine was marginalized (Crellin and Philpott, 1990). Widespread persecution of folk healers and unconventional physicians was initiated in the United States including imprisonment and book burning, physicians were not allowed to practice homeopathy or herbalism without losing their licenses, and unlicensed practice by others was considered illegal in all but a few states (Milton, 1996). The present author has also argued that the practice of medicine itself changed, making it difficult for younger herbalists to understand how to apply the materia medica they inherited from the past (Wood, 2004). How did the profession deal with these changes?
A survey of contemporary herbal literature shows that many authors imported concepts into Western herbalism from other systems they deemed holistic. The Way of Herbs (Tierra, 1984) uses traditional Chinese medicine to classify Western herbs. The Yoga of Herbs (Lad and Frawley, 1989) uses Ayurvedic principles from India. The Traditional Healer (Chishti, 1989) follows the Greek/Arabic method. The Wise Woman Herbal Healing Wise (Weed, 1989) claimed to reflect the methods of traditional ‘wise women.’ Creating Your Herbal Profile (Hall, 1988) presented profiles of herbs resembling homeopathic constitutional types.
During the late 1990s, as biomedical interest in CAM and herbalism was on the increase, publications appear written both by herbalists and biomedicists attempting to explain the action of herbs according to biomedical standards. Publications reflecting this perspective include Phytotherapy (Mills and Bone, 2000) and PDR for Herbal Medicines (Fleming, 1998).
Herbal methodology based on early twentieth century medicine did not completely disappear. One of the most popular and influential texts of the past twenty five years has been The New Holistic Herbal (Hoffmann, 1992). Here herbs are applied to body systems (rather than specific lesions, as in modern biomedicine) and are classified by ‘action’ (astringent, bitter, demulcent, etc.) These methods are characteristic of the medical and herbal approach of the early twentieth century (Crellin and Philpott, 1990; Wood, 2004).
For many, the traditional method of herbal practice explained by Hoffmann was as exotic as Chinese or Ayurvedic medicine. In The Practice of Traditional Western Herbalism (Wood, 2004) the present author attempted to explain early twentieth century medicine for the modern herbal audience. He would point out that herbal education and practice was legally irradicated in America from about 1950 to 1975, during the period of persecution mentioned above (Milton, 1996), so that the traditional system of herbal medicine was not readily understood by younger Americans. It was maintained in isolated pockets, like Southern Appalachia, where Tommie Bass practiced (Crellin and Philpott, 1990). This may explain why all the above books based on Chinese, Ayurvedic, Greek/Arabic, or ‘wisewoman’ herbalism are written by Americans.
The above survey reveals polarities in the herbal field between holism and biomedicine, tradition and innovation. The author concludes that this diversity of opinion indicates that Western herbalism is in the phase Kuhn (1970) called ‘scientific revolution,’ when the supporters of different paradigms are in competition. The author suggests that this circumstance recommends herbalists to the study of the concept of the paradigm and its application within their field.
Kuhn (1970) explains that the paradigm can be a law, theory, application of knowledge, or instrumentation or several of these together that supports a certain perspective. Paradigms can be theoretical or practical. Thus, the theory of general relativity represented a change in paradigm from previous, Newtonian physics. In the same fashion, the introduction of the microscope brought about a paradigmatic change by allowing an entirely new view of the world. Together or individually, paradigms
“provide models from which spring particular coherent traditions of scientific research” (Kuhn, 1970, 10).
Such traditions are often named by scientists and historians. Examples are Ptolemaic astronomy, Copernican astronomy, Aristotelian, Newtonian, and Einsteinian physics, corpuscular optics, and wave optics (Kuhn, 1970). Within Western herbalism the author notes such named traditions as Greek or Galenic medicine, physio-medicalism, and eclecticism.
When a paradigm has been accepted by a group of scholars and a discipline is organized around it, practitioners within the field no longer need to dispute fundamental assumptions. Work is now directed by a recognized conceptual structure and generally recognized definitions, resulting in a continuous development of interrelated information. Problems are identified and solved within the established paradigm. At this point the field usually generates its own societies, journals, and claims for recognition in higher educational facilities. This phase of activity Kuhn (1970, 35) calls “normal science.” The basic activity of normal science is defined as “puzzle-solving” (Kuhn., 1970, 35).
When a paradigm does not adequately explain study results or the nature of the world satisfactorily, alternate paradigms are suggested and attract different adherents. This leads to conflict within the field. During this period, ‘normal science’ is superseded by the phase called ‘scientific revolution.’ This is a period of uncertainty during which old paradigms are thrown into doubt and new ones generated (Kuhn, 1970).
When a new paradigm achieves recognition in its field, replacing an old one, Kuhn called the change a “paradigm shift” (Kuhn, 1970, 52). The introduction of cyber-technology in the 1990s is an example of a recent paradigm shift in science due to changes in instrumentation; in biomedicine it led to a new approach or paradigm called ‘evidence-based medicine’ (EBM), discussed in section 8.3, ‘Experimental Science,’ (p. 31).
During scientific revolution a field is fraught with uncertainties and unanswered questions. However, as new experience, research data, and instrumentation are acquired, guiding concepts become clarified and competing explanations are eliminated until a single or several complementary paradigms emerge which are able to adequately account for the observed data. This arrival is, for a scientific community, a “sign of maturity” (Kuhn, 1970, 11). A scientific culture that has reached this level of agreement has more authority than one still developing basic concepts (Milton, 1996).
Kuhn (1970) was skeptical about the objectivity of debate during periods of competition between different paradigms.
“This issue of paradigm choice can never be unequivocally settled by logic and experiment alone” (Kuhn, 1970, 94).
Paradigms are not derived from research; they direct research. Therefore,
“A debate about paradigm choice. . . is necessarily circular. Each group uses its own paradigm to argue in that paradigm’s defense” (Kuhn, 1970, 94).
This position has been controversial. Some critics take issue with the suggestion, as they perceive it, that science is a mere belief system (Vickers, 1996; Horgan, 1997). But science has never been based on certainty. It was always founded on theories, hypotheses, probabilities, and now as Kuhn (1970) has shown assumptions. Instead of rejecting the concept of the paradigm as a threat to the idea of objectivity in science, a more mature view would see that it “sharpens the burden” on science to
“allow for meaningful tests that genuinely put the theory at risk” (Kosso, 1992, 133).
Another controversial point is Kuhn’s (1970) argument that scientific models which have been cast aside in the development of science are still as scientific today as they were when they were accepted practice.
“Aristotle’s physics, understood on its own terms, was simply different from, rather than inferior to, Newtonian physics” (Kuhn, paraphrased by Horgan, 1997, 42).
Nor was Newton canceled out by Einstein:
“In so far as Newtonian theory was ever a truly scientific theory supported by valid evidence, it still is” (Kuhn, 1970, 99).
Kosso (1992, 131) considered Kuhn’s work to be “influential” and “high profile,” not only in historical discussion, but in the design of scientific research. However, he recognized that it was easy to misunderstand. The word ‘paradigm’ has entered into popular culture and become widely used in nonscientific settings. Kuhn himself described it as “hopelessly overused” and “out of control” (Kuhn, quoted by Horgan, 1997, 45).
Most professional journals in biomedicine have rejected discussion of CAM theories, concepts, and paradigms. They advocate study of CAM products, practices, and therapies using the biomedical perspective or paradigm alone. For example, in 1998 the editors of NEJM expressed the following opinion:
“There cannot be two kinds of medicine conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted” (Angell and Kassirer, 1998, 339:841).
The Final Report of the White House Commission on Complementary and Alternative Medicine Policy quotes the above statement with approval, noting that
“many of the commissioners agree with the editors” (United States Department of Health and Human Services, 2002, 6).
The editors of JAMA proposed that dietary supplements (including herbs) should be tested according to the biomedical model, regulated as drugs if they are shown to be biologically active, and removed from the marketplace if not (DeAngelis and Fontanarosa, 2003).
Only the 6th Report of the House of Lords Select Committee on Science and Technology (2000) does not follow this line, but advocates both quantitative and qualitative studies of complementary and alternative medicine.
Vickers (1996) developed arguments against the use of paradigms in the study of conventional and unconventional medicine. Some are general objections to Kuhn. Others refer to the debate between CAM and biomedicine. However, writing at a later date, Kollman and Vickers (1999), published a series of articles on complementary and alternative medicine in the BMJ acknowledging the existence of the paradigmatic argument.
In a subsequent article in the BMJ, Leibovici (1999) addressed a problem raised by the introduction of CAM: which therapies and methods should be subjected to biomedical testing and which should not? He suggested that any therapy that did not fit the “deep model” of science should be ignored (Leibovici, 1999, 319:1631). He does not define a ‘deep model,’ but the context suggests that it is the basic paradigm of modern science, i.e., the rational, material world view in which phenomenon have objective explanations. This contrasts with the paradigm he attributed to holistic medicine:
“The deep model of alternative medicine is anthropocentric magic. The explanations of the practitioners of alternative medicine are giving our patients a set of magical rules to control the physical world, rules that have the human as the fulcrum. They are saying that herbs are beneficial and can do no harm, a substance that causes complaints similar to those observed in a patient will cure them if diluted to an infinitesimal concentration, ‘we will adjust your Qi force’; these are phenomena that work only on the living human, and not on any other component of the physical world” (Leibovici, 1999, 319:1631).
The author cannot detect a difference between Leibovici’s (1999) ‘deep model’ and a ‘paradigm.’ It appears, therefore, that Leibovici (1999) uses a paradigmatic argument to arrive at the same methodology suggested by other biomedical authors: ignore the paradigm of holistic medicine and investigate the contents based solely on a biomedical model.
Leibovici (1999) does not enter into debate about ‘deep models’ with those whose ‘deep model’ he challenges. The same tendency is seen in the previous biomedical writers. They feel at liberty to ignore the arguments of those they challenge. In the United Kingdom, practitioners of systems not in agreement with the ‘deep model’ of science would still be able to practice, since the law protects unlicensed practitioners, but in the United States there are no such Federal safeguards. In the past, adherents of systems medicine has chosen to ignore have been outlawed (Milton, 1998). Clearly, this is the intent of the NEJM and JAMA editorials, which completely ignore holistic professions and beliefs.
Leibovici (1999) is followed by a commentary written by one of the editors of the BMJ. In “A warning to complementary medicine practitioners: get empirical or else,” Haynes (1999, 319:1633) threatens CAM practitioners with the prospect that their methods and tools will be taken over by conventional physicians if they do not do research themselves and develop their profession in the same manner conventional medicine has done. Going a step further, Haynes recommends that CAM practitioners throw ‘deep models’ out the window:
“Deep models are for snobs, oppressors, and wishful thinkers. The flat earth, phlogiston, bleeding, cupping, oppression of women, the Aryan Race what are these but ‘deep theories’?” (Haynes, 1999, 319:1634).
This rather strong language carries the implication, at least to the ear of the present author, that average people cannot or should not think for themselves. Haynes seems to say that only scientists have the right to have a ‘deep model’ and they and their model should not be questioned by ordinary people, who will make mistakes of a childish, naive, or catastrophic nature. The author is concerned that the thinking nonscientist might conclude from such statements that scientists, by attempting to limit discussion of their field, take on the role of ‘snobs, oppressors, and wishful thinkers.’ On the other hand, Haynes is the only author who actually suggests an outlet by which CAM practitioners can develop a profession research.
The present author feels it is necessary to point out what he considers to be poor definition of several terms in the articles by Leibovici (1999) and Haynes (1999). Both these authors show a tendency to confuse empiricism and experimentation. Leibovici (1999, 319:1631) refers to the “epitome” of “empiricism” as the “randomized controlled trial.” Haynes (1999, 319:1633) threatens alternative practitioners to “get empirical,” then describes “empiricism” as experimental research. Like many modern scientific authors, these two do not differentiate between empiricism and experimentation, yet these are entirely different scientific methods. Empiricism refers to observation and experience yielding unsorted data, while experimentation refers to designed experiments yielding statistically significant information (Carr, 1992; Kosso, 1992).
Advocates of complementary and alternative medicine frequently argue that it is not possible to test their approach by conventional standards because the reductionism inherent in the biomedical model eliminates variables intrinsic to holistic practice (Goldstein, 1999). This difficulty has also been recognized by biomedical writers:
“Responses to [CAM] treatment are unpredictable and individual, and treatment is usually not standardized. Designing appropriate controls for some complementary therapies. . . is difficult, as is blinding patients to treatment allocation. Allowing for the role of the therapeutic relationship also creates problems” (Kollman and Vickers, 1999, 319:903).
However, research models have been developed that do take into account the important holistic paradigms so easily removed by reductionism. An example of one will be given in subsection 8.3.2, ‘Clinical Trials and Herbal Medicine,’ (p. 33).
The author concludes that biomedical research, to the extent it is directed by the methods advocated by authors and editorialists in major American biomedical journals, is not attempting to expand biomedical hegemony to include CAM products and methods while disempowering competing professions and their paradigms. This is in line with established legislation in the United States, which makes it illegal for both medical doctors and lay people to practice herbalism and homeopathy in almost all states, but protects the sale of the products (Milton, 1996). In Britain, on the other hand, where such practices enjoy legal status, the editoral tone is slightly more accomodating.
The paradigmatic discussion advocated by holistic practitioners represents a response to problems perceived in conventional biomedicine by practitioners and the public alike.
“Taken altogether, the core beliefs of alternative medicine, regardless of their origins hundreds or thousands of years ago in faraway cultures, provide a current ‘response’ to the well founded, highly rational critiques of biomedicine” (Goldstein, 1999, 70).
Ignoring paradigmatic debate sidesteps widespread criticism. If these paradigms were being advanced by cranks with no public following they would be irrelevant, but complementary and alternative medicine enjoys enormous popularity. A recent survey of US consumers indicated that there were more visits (629 million) to CAM practitioners in 1997 than to primary care physicians (386 million) (Eisenberg, et al., 1998).
About a half dozen prominent paradigms are frequently cited, both by exponents and critics, as characteristic of holistic medicine. Kaptchuk and Eisenberg (1998) mention nature, vitalism, science, and spirituality. Kollman and Vickers (1999) list holism, the self healing ability of the body, spirituality, and the treatment of the individual. Goldstein (1999) mentions holism, the mind/body/spirit model, health and illness on a continuum, the concept of ‘energy,’ and vitalism. The present paper arbitrarily describes the following seven: the goodness of nature, self healing, spirituality, vitalism, the individual, holism, and energetics.
Differences in approach to nature constitute paradigmatic choices. Belief in the innate goodness of nature is almost universal in holistic medicine and has been marked as such by most researchers and advocates (Goldstein, 1999). In Western herbalism plants are generally looked upon as representatives of the innate goodness of nature. This tradition goes back at least to Samuel Thomson, who popularized herbal medicine in pioneer America in the early nineteenth century as an alternative to toxic mineral medicines and bloodletting (Thomson, 1825a).
Different perspectives have been used to explain the goodness of nature. Kloss, a Seventh Day Adventist, entitled his famous herbal Back to Eden (1962), giving his argument a Biblical dimension. Hoffmann (1992), appealing to a modern readership, advances Lovelock’s ‘Gaia’ hypothesis: natural healing is part of a balanced ecosystem.
The self healing ability of the organism is recognized by both conventional and unconventional medicine. CAM places a high regard on the constructive, health-maintaining and self-healing capacity of the body. Disease is sometimes considered by CAM practitioners to be the result of not living and eating in harmony with nature. Even further, there is sometimes an emphasis on the positive aspects of disease. Blessed by Illness (Mees, 1983), argued in favor of the strengthening effects of childhood diseases well before this concept appeared in conventional immunology. Homeopathy developed a positive view of disease symptoms, which are looked upon as the healthy response of the sick organism. In homeopathy, the remedy sometimes temporarily intensifies the symptoms in order to strengthen the curative response of the organism and allow it to triumph over the disease (Panos and Heimlich, 1980). In naturopathy, diet and exercise are used to strengthen the organism to overcome disease (Lindlahr, 1919). Even death is treated as a natural outcome, as seen in the work of Elizabeth Kubler-Ross (1974), at one time ‘alternative,’ but now incorporated into the hospice movement in conventional medicine.
Goldstein (1999) emphasizes that holistic medicine appeals to many people who feel they need to make decisions contributing to their spiritual, as well as their physical, well-being. This may draw them away from conventional medicine, which directs its effects mainly towards the condition of the physical body. Materialism is a dominant characteristic of modern science and medicine that differentiates it from holistic movements.
“The positive role of spiritual or religious beliefs in the histories of almost every major alternative approach is difficult to deny” (Goldstein, 1999, 75).
Vitalism is the concept that the living body is animated by a spiritual or nonmaterial agency that marks the true difference between life and death. This is a characteristic belief of the holistic health movement. Thus, traditional Chinese medicine calls the life force in the body qi, while Ayurveda calls it prana, and homeopathy calls it the dynamis or vital force (Kaptchuk and Eisenberg, 1998).
Herbalism sometimes shares this view. Samuel Thomson’s followers felt that conventional medication was directed against the vital force, towards the suppression of the self-healing capacity of the organism, which they felt herbs supported (Thurston, 1900). However, another prominent group of botanical physicians in the nineteenth century, the eclectics, were more empirically ruthless and eschewed theories in general, including vitalism. Thus, their “vitalism,” if we may call it such, was purely experiential. Life was not a concept, but an experience to be achieved through examination of the living body, in health and disease (Scudder, 1985a).
Holistic medicine places more emphasis on the individual than biomedicine. Each client is evaluated as unique and each practitioner is accepted as a unique person with skills differing from his or her peers. The subjective symptoms, attitude, problems, self-evaluation, and conditions of the patient are given greater weight than in biomedical case taking. Treatment strategy is usually designed individually, on a case by case basis. For many clients this increased attention is a source of comfort which might itself have curative or psychological value (Goldstein, 1999).
Holism could be considered the fundamental concept behind holistic medicine, since it has been adopted by practitioners to distinguish themselves from conventional medicine (Yahn, 1979). Holism studies the whole, while conventional medicine studies the parts. The latter approach is called reductionism. A medical textbook defines reductionism as
“the exploring of details, and the details of details, until all the smallest bits of the structure, or the smallest parts of the mechanism are exposed to scrutiny. . . . Instead of reaching for the whole truth, the scientist examines small, defined, and clearly separable phenomena” (Wyngaarden and Smith, 1985, 5).
In holistic medicine both the organism and the disease are frequently looked upon as whole and complete entities and analysis begins from this perspective, rather than from the parts or details (Goldstein, 1999). The description of the whole nature of an entity demands its own vocabulary. This has often been called ‘energetics’ in modern holistic practice. Energetics is described below for those not familiar with the concept.
Many holistic disciplines not only recognize life energy, qi, or vital force, but describe this force as creating identifiable ‘energy patterns.’ Thus, the ‘energy’ of a person may be tight or loose, or the disease may be hot or cold. This subject is called ‘energetics’ by many holistic practitioners. A title reflecting this concept is The Energetics of Western Herbs by Peter Holmes (1997).
Virtually all major systems of traditional medicine, including Greek, Ayurvedic, and Chinese use some system of energetics. The four elements of Greek medicine, the four qualities of Aristotle, yin and yang, and the five elements and three doshas of India are examples of ‘energetic’ systems of description. Western medicine and herbalism, as practiced in the nineteenth and early twentieth centuries, utilized terms such as irritation, excitation, relaxation, constriction, contraction, depression, etc., to describe general ‘tissue states’ or pathological patterns in the organism (Scudder, 1985a; Thurston, 1900).
Because energetics are not used in biomedicine, their importance in traditional and holistic practice is sometimes missed. For instance, Crellin and Philpott (1990) describe the herbs used by Tommie Bass but do not mention his diagnostic or pathological conceptions. I asked his life-long friend and student, Darryl Patton, how Bass visualized disease. He responded that his teacher used the characteristic diagnostic system of southern Appalachian folk medicine based on the blood (‘bad blood,’ ‘sweet blood,’ ‘high blood,’ ‘low blood,’ etc.) and other folk medical considerations (Patton, 2006).
Vickers (1996) notes that complementary and alternative authors frequently focus on paradigmatic questions rather than research. He detected an inverse correlation between discussion of paradigms and the production of useful research. The above enumeration of complementary and alternative paradigms tends to confirm Vickers (1996), for none of them address the issue of research or the way in which the information that constitutes CAM has been derived from nature. By describing major characteristics of holistic medicine they serve an important function, but this does not directly contribute to research. However, this does not mean that research cannot be based upon paradigmatic constructs. Founding research which included the characteristic paradigms of holistic medicine would represent a positive response to the challenge laid down by Haynes (1999).
The above paradigms may be used as starting points for holistic and herbal research. However, the author is of the opinion that it is more important to first define basic kinds of scientific research, before setting off on an examination of specific holistic paradigms. For this, the paradigmatic model is also available.
Kuhn (1977) demonstrated that even within a single scientific field different kinds of science could be identified. He differentiated the mathematical (or rational) approach from the experimental. He did not define them as paradigms, but they have been widely viewed as such (Eamon, 1994). Empiricism has also been identified as a paradigm (Ginzburg, cited by Eamon, 1994).
A pre-Kuhnian author listed a total of five “methods and procedures” for constructing systems of knowledge:
“revelation, authority, reason, experience, and experimentation” (Clagett, 1955, 4).
This tabulation adds two more methods for gathering and organizing knowledge revelation and authority. It would seem reasonable also to apply the Kuhnian label ‘paradigm’ to these procedures.
The present author found it necessary to separate revelation into two separate categories. The concept of ‘revelatory’ science was used by Festugiere (Eamon, 1994) to explain the approach to knowledge associated with the Hermetic literature (c. third century ACE). These documents are largely presented as revelations, mostly from the god of knowledge, Hermes. The actual method of analysis used in the Hermetica has, however, been characterized as “sympathies and antipathies” (Eamon, 1994, 18). This method is not based on revelations from gods, visions, or dreams, but is analytical (see section 8.5, ‘Analogical Science, p. 38). The author suggests that it reflects an ‘analogical’ method. Hence, the revelatory paradigm has been split, in this paper, into the visionary and analogical approaches.
This gives a total of six primary scientific methods, procedures, or paradigms:
empiricism, rationalism, experimentation, the visionary and analogical methods, and authoritarianism.
This collection is not intended to be viewed as a comprehensive and exhaustive typology of science, but as a practical model for a qualitative study of medicine and herbalism.
Observation and experience are recognized as essential methods of knowledge-gathering in science and medicine (Carr, 1992; Kosso, 1992; Fugh-Berman, 1996). The unsorted information brought together through empiricism constitutes a ‘collection,’ rather than a ‘system.’ This has led to debate about whether empiricism can be considered a science, i.e., a ‘system of knowledge.’ Kuhn (1970) did not think it qualified:
“Though this sort of fact-collecting has been essential to the origin of many significant sciences, anyone who examines, for example, Pliny’s encyclopedic writings or the Baconian natural histories of the seventeenth century will discover that it produces a morass” (Kuhn, 1970, 16).
However, more recent historians of science have concluded that empiricism by itself does constitute a scientific paradigm (Ginzburg, cited by Eamon, 1994). The question is rather technical and for the purpose of this paper empiricism will be considered a scientific paradigm.
The Hippocratic physicians represent a school of medicine largely founded upon empirical methods. Their writings on epidemics and aphorisms are collections of unsorted observations and experiences, such as Kuhn (1970) describes. Whether or not this material forms a ‘morass,’ it educated physicians for more than two thousand years (Cumston, 1987).
Empiricism is derived from the Greek word for experience. The development of this method was the standard for which Hippocratic physicians strove:
“In the Hippocratic corpus, experience (peire) is the mark of the man who knows. It is synonymous with competence, and always carries a positive connotation” (Jouanna, 1999, 257).
Because of their empirical approach, the Hippocratic physicians were attacked by contemporaries who did not consider such efforts to be scientific. One Hippocratic treatise, Tradition in Medicine, responded to this charge by arguing
“Medicine has for long possessed the qualities necessary to make a science. These are original observations and a known method” (Hippocrates, 1950, 13).
The ‘original observations’ pertain to health, illness, and diet. They are enlarged by a ‘known method’ what would be called ‘trial and error’ experiment. Tradition in Medicine refers, for example, to altering the amounts and kinds of food on the sick to understand their effect (Hippocrates, 1950).
The treatise argues against any standard that is not empirical:
“One aims at some criterion as to what constitutes a correct diet, but there is no standard by reference to which accuracy may be achieved; physical sensation is the only guide” (Hippocrates, 1950, 17).
It also argues against any standard not easily understood by the general population:
“If anyone departs from what is popular knowledge and does not make himself intelligible to his audience, he is not being practical” (Hippocrates, 1950, 21).
The earliest comprehensive writers on the properties of plant medicines, Dioscorides and Plinius (first century CE), were largely empirical, though Ritter (1985) discovered a pharmacological order in Dioscorides that was not noticed by his readers. At a latter date, various theories for predicting the effects of herbs based on temperature (hot/cold), humidity (damp/dry), taste, organ affinity, etc., were introduced, mostly by Galen (third century CE). These will be discussed under the next subsection, 8.2, ‘Rational Science,’ (p. 27).
Empirical and rational methods were sometimes maintained alongside each other. Moses Maimonides (twelfth century) divided discussion of materia medica into two sections, one based on Galen’s theories of medicinal activity (taste, quality, organ affinity, etc.), the other on ‘specific’ indications derived from clinical experience (Rosner, 1989, 346). This dual classification was still used by Salmon (1710) in his English Herbal.
Western herbalism in the nineteenth and early twentieth centuries was largely the product of a combination of empirical experience, traditional indications carried down from the ancient literature of European medicine, and new theories, practices, and remedies introduced from America (Webb, 1916). The two most influential schools of the period were physio-medicalism, derived largely from the teachings of Samuel Thomson, and eclecticism, of which the leading thinker was John Scudder (Haller, 1997).
Scudder (1827-93) advocated a doctrine of relatively pure empiricism. He says the use of medicines is based largely on tradition and experience in all schools:
“In ordinary practice, whether it be Old School or Eclectic, there is no principle or law of cure. Remedies are not given because they are opposed to or agree with disease action, but simply because they have previously been used with reputed good success. It is, in fact, pure empiricism” (Scudder, 1985b, 23).
For Scudder, life is not a principle or theory, but a condition to be observed with the senses. Likewise, disease is not a name or concept, but a disturbed expression of life to be sensed by the physician.
“The first lesson in pathology we want to learn is, that disease is wrong life. The first lesson in diagnosis is, that this wrong life finds a distinct and uniform expression in the outward manifestations of life, cognizable by our senses. The first lesson in therapeutics is. . . to know the relation between the drug and the. . . disease expression” (Scudder, 1985b, 15-16).
Scudder’s whole system is based almost entirely on experience. He describes symptoms of ‘wrong life’ rather than disease names, in a graphic manner that he anticipates will resonate with the experiences of his readers:
“What is the color of health, as shown from the blood? It is rosy, a light shade of carmine and lake, and is clear, transparent, and offers no darkness, or admixture with blue, purple, or brown. As the finger is pressed upon the surface, or pressed over it, toward the heart, the rosy color is removed, leaving the structures clear and transparent, and the color comes back quickly when the pressure ceases” (Scudder, 1985a, 77).
Scudder (1985b) uses case histories to demonstrate his approach. He gives 18 cases under ague or intermittent fever [malaria or influenza with periodic chills], 18 under remittent fever [malaria or influenza with chills at odd intervals], 8 cases of continued fever [septicemia], 4 cases of small pox, 6 of measles, 7 under rheumatism, 4 under infantile pneumonia, 4 cases of infantile cholera, and 2 of dysentery. Very seldom does he use the same two remedies in a row; he is trying to show how a variety of remedies can be suited to different presentations of the same disease or symptom picture.
Samuel Thomson (1769-1843), a self-taught New Hampshire farmer who popularized herbal medicine in the early United States, is generally considered to be the single most influential figure in the history of nineteenth and early twentieth century Western herbal medicine (Webb, 1916; Haller, 1997). He developed a materia medica and theory of herbal treatment based on experience.
“Dr. Thomson began his practice as it were from accident, with no other view than an honest endeavor to be useful to his fellow creatures; and had nothing to guide him but his own experience” (Thomson, 1825a, 8).
Thomson developed his knowledge of materia medica largely by tasting plants to see what their action upon himself would be:
“I have adopted a rule to ascertain what is good for canker [mucus coatings], which I have found very useful. . . . chew some of the article, and if it causes the saliva to flow freely and leaves the mouth clean and moist, it is good; but on the other hand, if it dries up the juices, and leaves the mouth rough and dry, it is bad and should be avoided” (Thomson, 1825b, 55).
Notice how Thomson (1825b) adopted a rule, based upon his experience. Unlike Scudder (1985a), he is concerned throughout his work to discover rules and theories for practice:
“After I had come to the determination to make a business of the medical practice, I found it necessary to fix upon some system, or plan for my future government in the treatment of disease; for what I had done had been as it were from accident and the necessity arising out of the particular cases that came under my care, without any fixed plan” (Thomson, 1825a, 14).
The major health problem at the time was fever, so Thomson’s theories were largely developed by dealing with that condition.
“I found that fever was a disturbed state of the heat, or more properly, that it was caused by the efforts which nature makes to throw off disease, and therefore ought to be aided in its cause, and treated as a friend; and not as an enemy, as is the practice of the physicians. . . . All fevers proceed from the same cause, differing only in the symptoms; and may be managed. . . with much less trouble than is generally considered” (Thomson, 1825a, 15).
Thomson thus arrived at his method of treatment:
“My general plan of treatment has been in all cases of disease, to cleanse the stomach by giving No. 1 [Lobelia inflata], and produce as great an internal heat as I could, by giving No. 2 [Capsicum spp.], and when necessary made use of steaming [steam bath], in which I have always found great benefit, especially in fevers; after this, I gave No. 3 [Myrica cerifera], to clear off the canker” (Thomson, 1825a, 15).
Thomson (1825a) also gives many case histories scattered throughout the text. However, these mostly serve an autobiographical purpose, illustrating how he learned something, or describing his hard usage at the hands of physicians and ungrateful patients, or some remarkable cure. In some instances, not enough information is given to consider the case history illustrative of any medical lesson. At the end he gives a group of case histories certified by witnesses. These provide eyewitness testimony and contain few facts that are educational.
Another area in which empiricism enters deeply into herbal medicine is the derivation of herb uses from tasting plants. This takes two forms: sensing the taste and sensing the action. Thomson, above, provides an example of an herbalist tasting a plant to determine its action. The relationship of the taste of herbs has long been considered empirical evidence of their properties. There is a long, but forgotten history of this in Western herbalism (Crellin and Philpott, 1990); it is also characteristic of Chinese herbalism (Bensky and Gamble, 1986), and Ayurveda (Lad and Frawley, 1989). The author has observed several herbalists teaching the properties of herbs by having their students taste them.
This author concludes that these methods case histories, descriptions of clinical experience, and the tasting of plants are widely but sporadically used in Western herbal medicine. He suggests that modern herbalists develop this pragmatic methodology particularly in regard to case history documentation.
Case histories are not considered without value in biomedicine. The single case history is often dismissed as “anecdotal medicine,” but a series of cases (five being the minimum) is called a “case series” and is considered to be the basis for further investigation (Fugh-Berman, 1996, 8). There are scientific standards for making and reporting observations, and keeping them as independent of bias and theory as possible.
“Insofar as this activity is to contribute to science it should be more fully put as ‘observational claim’ or ‘observational belief’” (Kosso, 1992, 190).
Taken individually or together, the empiricism of Hippocrates, Thomson, and Scudder bear some resemblance to the approach of another traditional system, Chinese medicine (abbreviated ‘CM,’ or ‘TCM’). Here too the case history is important.
“If we examine, for instance, CM’s vast literary corpus, we find that a significant part consists of case histories (yian). An even larger part. . . cannot be assigned to any definite genre, but contain a heterogeneous mix of commentary, theory, prescriptions, case histories, philosophy, and so on” (Scheid, 1996, 10).
The same author ranks the use of the case history in Chinese Medicine to obtain knowledge very highly:
“If the double blind trial is the gold standard of biomedical research, than [sic] the single-case studies (SCS) are the research paradigm of CM” (Scheid, 1996, 11).
Scheid (1996) likens the practice of Chinese medicine to the practice of law, because it argues from case law, experience, and judgment. In the eyes of the present author, this is an equally useful metaphor for Western herbalism. Indeed, the incorporation of modern scientific evidence and research into jurisprudence, without destroying the traditional empirical foundation of the legal system, might be considered an ideal model for the incorporation of biomedical research into the originally empirical and traditional methodology of herbal medicine.
It should also be acknowledged that empiricism is an important component of modern medical practice, even within evidence-based medicine (Sackett, et al., 1997). Lown (1996) argues that it has become undervalued. Ironically, while biomedicists allow empiricism within their own practice, they do not generally extend the same standard to CAM and herbal practitioners, as we saw by their discussion of research in section 6, ‘Paradigms and Biomedicine,’ (p. 10).
Sir John Hill, in the mid-eighteenth century, attempted to establish some order by which the medicinal properties of plants might be rationally known. He suggested the use of taste.
“To give an instance in the marshmallow. It is known to work by urine, and to be good against the gravel. We will suppose no more known concerning this kind. A person desirous of extending this useful knowledge, finds that by the taste of the root, which is insipid, and its mucilaginous quality, he might have guessed this to be its virtue from what he before knew of medicine” (Hill, 1789, 396).
Hill also explains that plants that are similar in appearance are not only probably akin, but likely have similar properties. Thus, the common mallow and hollyhock resemble marshmallow in the construction of their flowers, and their tastes confirm similar uses (Hill, 1789, 396).
Although self-taught, taste was also Thomson’s (1825a, 1825b) chief method of learning about plants. This is the method he followed early in his practice when he adopted sumach (species not given) to help him in a serious epidemic:
“The first of my knowledge that it was good for canker was when at Onion River in 1807, attending the dysentery; being in want of something to clear the stomach and bowels in that complaint, found that the bark, leaves or berries answered the purpose extremely well, and have made much use of it ever since” (Thomson, 1825b, 57).
Thomson (1825b, 55) went on to classify sumach under a category he rather unimaginatively called “No. 3.” The plants listed under this heading are generally what herbalists or physicians call ‘astringents’ (Menzies-Trull, 2003), but the self-taught Thomson (1825b) was not familiar with this term.
It is often noted in books about herbalism that humans learned about plants from watching animals use them (Crellin and Philpott, 1990). However, actual examples of this are seldom found in the literature. The author offers the following example.
Paul Red Elk (2005, personal communication), was raised by his grandfather and grandmother, traditional Lakota Indian herbalists on Rosebud Reservation, in western South Dakota. He explained that sumach (Rhus aromatica, R. typhina) is an ‘elk’ or ‘deer’ medicine because it is used by the deer. It was observed that the female deer, after giving birth, would eat sumach leaves and lick her vagina. This led the Lakotas to believe that sumach helps “cleanse” the female parts.
The use of sumach for afterbirth infection, leucorrhea, menorrhagia, and vaginal hemorrhage is found in modern herbal literature (Menzies-Trull, 2003; Fleming, 1998).
In 1879, Dr. J. T. McClanahan introduced sumach (Rhus aromatica) as a remedy for diabetes mellitus what we would now call ‘type II.’ Here is his account of the condition in an elderly woman:
“Skin sallow, eyes sunken, pulse feeble and quick, temperature 100.5º, loss of flesh, slight cough, and sometimes night-sweats, appetite variable, sometimes ravenous and sometimes not so good; thirst, more or less, all the time; bowels sometimes constipated and sometimes the contrary condition was present; there was also a general sense of lassitude and languor. The history of the case revealed the fact that several months previously her attention was first attracted by frequent calls to urinate, and that she was compelled to get up at night to void large quantities of urine; this condition of things had been steadily increasing, until she was compelled to abandon her ordinary household duties. Under the usual tests the urine revealed a large saccharine deposit, specific gravity 1031” (McClanahan, quoted by Fyfe, 1909, 696).
Dr. McClanahan left a tincture of Rhus aromatica, ten drops every four hours. At the end of a week her husband reported that the urine was diminished and she was greatly improved, except for a pain and soreness across the kidneys. McClanahan gave a blistering plaster over the kidneys as a stimulant. At the end of four months the patient was in decent health (McClanahan, cited by Fyfe, 1909).
The author located another case of diabetes mellitus [type II] treated with Rhus aromatica (Goss, 1885). He also documented from his own practice cases of palliation or improvement of diabetes mellitus type II symptoms with Rhus typhina, and several cases of improvement of diabetes insipidus (Wood, 2004).
From the biomedical standpoint, to comprise a ‘case series’ the author would need to collect five case histories, and these would need to illustrate a biomedical conception (Fugh-Berman, 1996). However, the author feels that it is important to point out that, from the standpoint of holistic medicine, a case series could be organized around an ‘energetic’ feature. Thus, a case series for sumach could include various symptoms of fluid loss, since it is widely classified as an astringent and traditionally used to treat various kinds of fluid loss (Fyfe, 1909). Thus, hemorrhaging from the vagina, excessive urination, diarrhea, and excessive perspiration all could be used in a case series relating to sumach.
The use of rational theories to structure medical practice is ancient. The Hippocratic writers lived during a period of transition in science from empiricism to rationalism and theory. The Hippocratic treatise Tradition in Medicine specifically challenges the ‘new’ hypothesis of the ‘four qualities’ (hot, cold, damp, dry) and treatment by ‘contrary’ (hot to cold) then entering Greek medicine:
“They would suppose that there is some principle harmful to man; heat or cold, wetness or dryness, and that the right way to bring about cures is to correct cold with warmth, or dryness with moisture and so on. . . the remedy lies in the application of the opposite principle according to the hypothesis” (Hippocrates, 1950, 19).
The four ‘qualities’ had been introduced into the natural sciences by Aristotle. He defines them, not as physical sensations or entities, but as general principles operating in nature:
“Hot is that which associates things of the same kind. . . while cold. . . associates homogeneous and heterogeneous things alike. Fluid is that which, being readily adaptable in shape, is not determinable by any limit of its own, while dry is that which is readily determinable by its own limit, but readily adaptable in shape” (Aristotle, quoted by Mure, 1964, 73).
The present author interprets this to mean that cold conjoins substances together that have nothing in common (like water, a bug, and dirt in an ice cube), while heat separates them (water becomes vapor, the bug and dirt become ash). Dry is that which gives shape, while damp is that which lacks shape, but can be contained by shape. From the Aristotelian perspective, water is damp when it is liquid and dry when it is ice! This explains why the ‘qualities’ do not always make sense, in modern terms, when they were applied in the old literature.
From Galen onwards, the four qualities were the major classification system used to describe constitutions, pathological changes in patients (too hot, too cold, etc.), the properties of medicines (cooling, warming), and the method by which medicines worked (hot to cold, etc.) (Cumston, 1987). The ‘qualities’ comprise a major part of the ‘energetic’ system of Greek medicine (Holmes, 1999).
Many of the descriptive terms used to classify herbs in modern Western herbal literature were originally arranged into categories by Galen, but that the organizational theme was lost when Galenic medicine was rejected several hundred years ago (Cumston, 1987). The author suggests that modern herbalists study this system to reclaim an organizational perspective and enlarge their vocabulary for description of herb activities.
An excellent overview of the Galenic method for using herbs was written in 1652 by Nicholas Culpeper. This brief account, entitled “A Key to Galen’s Method of Physic” (Culpeper, 1990, 376) defines herbs under three major classes:
(1). Temperatures, the four qualities and four degrees.
(2). Appropriations, or organ affinities of the herbs.
(3). Properties (softening, hardening, purging, loosening, contracting or binding or drawing, dispersing, repelling, cleansing, agglutinative, preserving, nourishing, and diuretic).
The author believes that these simple themes will help sort out the vast array of herbal terminology presently found in Western herbalism, the logic for which was often forgotten when Galen’s system was dropped by seventeenth century medicine. The author also recommends study of the Thomsonian or physio-medical system, which offered a rationale somewhat different from the Galenic.
In addition to recommending case histories as the traditional research tool of Chinese medicine, Scheid (1996) recommends “conceptual” research:
“Rather than being guided by dominant biomedical ideologies, we need to build networks with anthropologists, historians of medicine, sinologists, philosophers, sociologists of knowledge, etc., to further our understanding of CM practice” (Scheid, 1996, 12).
The present author wholeheartedly agrees with this recommendation. He has observed that most modern Western herbalists have little understanding of traditional theories of Western herbalism. This would explain the introduction of so many alternative theories into herbal literature, noted in section 4, ‘Modern Western Herbalism,’ (p. 7). Hence, he suggests the arguments of Scheid (1996) can be fruitfully applied to the study of Western herbalism.
A final point should be noted regarding the theoretical approach to medicine. Rationalism can yield many different interpretations, theories, and explanations for a single phenomenon. Reise (1953) demonstrated that historical Western medicine had generated over a dozen different theories of disease. Therefore, one no medical system can claim that it is the only rational approach (Reise, 1953).
Sumach (Rhus coriaria) was used in traditional European herbalism (Gerard, 1975). Suppose a person wanted to determine if the traditional European uses resemble the American applications for Rhus aromatica, R. typhina, R. glabra, etc.
According to Gerard (1975), Galen classified sumach as cold in the second degree, dry in the third, and binding. The ‘degrees’ do not refer to increasing intensity of temperature or humidity, but to the type of action. William Salmon (1710) offers a good description of these technical terms. Cold in the second degree means that the remedy treats fever, but does not relax the mind (third degree), or cause unconsciousness or death (fourth degree). On the other hand, it can be used to cool on a hot summer day (first degree). Dry in the third degree means that the plant treats diarrhea and dysentery, but not fluid loss with cachexia, or consumption. The term ‘binding’ refers to stopping diarrhea or dysentery.
These terms accurately describe the use of the American sumachs for one of their most common applications: diarrhea or dysentery (Thomson, 1825b). Fluid loss with fever (McClanahan, quoted by Fyfe, 1909) is also described. In North America it is not uncommon to make a sour ‘lemonade’ during the hot, humid summer months with sumach berries (Harris, 1976). Thus, the actions of the European and American sumachs seem to be quite similar.
Carr (1992) outlines three basic laws of experimental research. First, the problem to be studied must be clearly formulated in words. Second, the problem must be one that will yield useful empirical data that can be identified and collected. Whenever possible, that data should be numerical, so that idiosyncrasies and peculiarities can be factored out statistically. Third, the events to be tested and collected must be accessible to other observers, so that the results can be checked.
Today medical experimentation includes such methods as survey (interviewing people on whom no intervention has been made), retrospective studies (study of past events), prospective studies (subjects or populations are followed into the future), pharmacological research into constituents of plants and other medicinal substances, animal trials, in vitro laboratory tests with bacteria and viruses, and clinical trials (people are subjected to experimental intervention) (Fugh-Berman, 1996).
Clinical trials are the final and highest level of medical research (Fugh-Berman, 1996). Trials can be conducted at varying levels of sophistication. In a controlled trial one group receives the intervention and one does not. In a placebo-controlled trial the group that does not receive the intervention receives a placebo. This helps to eliminate bias and equalizes the curative effects of ‘treatment.’ The intervention must be statistically proven more powerful than placebo, which produces positive responses in one third of recipients! In a randomized trial people are placed into two (or more) groups randomly, to prevent bias on the part of the experimenters. In a double-blind study neither the subjects nor the observers know which group is which. In order to produce statistically significant results the sample size or groups measured must be large enough to minimize the possibility that the results are due to chance. It is customary to measure the results as probabilities. The ‘p value’ (p=probability) shows the likelihood of the results being caused by chance. Thus,
“The gold standard for medical research is a prospective, randomized, double-blind, placebo-controlled trial with a sample size large enough to produce a p value of <.05 or lower” (Fugh-Berman, 1996, 14).
However, due to the expense involved in setting up research, many conventional and alternative studies come nowhere near ‘the gold standard’ (Fugh-Berman, 1996).
A change in the use of the experimental method in medicine occurred in the 1990s, when the cyber revolution allowed the collection and dissemination of massive amounts of data in minimal time. As the number of experiments grew it became increasingly hard for the average clinical physician to keep up with fast moving developments. Critics claimed that medical prescriptions were often based on advertising by self-interested drug companies. New computer technology made the accumulation and digestion of massive amounts of information feasible. By the 1980s the new paradigm had been envisioned; it was called “evidence-based medicine” (EBM). The publication of a digest of results from randomized controlled trials occurred in 1991. These changes made it possible to base medical practice on the most recent research data supplied by experimentation (Davidoff, Haynes, Sackett, Smith, 1995).
While EBM suggested that medicine could be practiced on a more scientific basis, it still acknowledged a place for clinical empiricism. A textbook on EBM notes:
“Good doctors use both individual clinical expertise and the best available external evidence and neither alone is enough” (Sackett, et al., 1997, 2).
EBM is used as a standard for the study of complementary and alternative methods. Thus, we now see references to ‘evidence-based herbalism’ (Ernst, 2002). Although biomedicine allows the use of clinical expertise in association with EBM in the practice of medicine, it seldom allows admission into evidence of the clinical experience of CAM practitioners vide the biomedical journals quoted in section 6, ‘Paradigms and Biomedicine,’ (p. 10).
Some very important criticisms of the application of the experimental method in medicine have appeared recently. Angell (2004), a former editor of the NEJM (cited elsewhere as co-author of an editorial demanding that nutritional supplements and herbs be tested like drugs), attributes poor quality studies and outright fraud to the corruptive influence of companies with huge financial stakes in the lucrative pharmaceutical industry. More serious methodological errors are suggested by Ioannidis, a faculty member of Tufts University, in an article with the controversial title, “Why Most Published Research Findings Are False:”
“Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias” (Ioannidis, 2005, 2(8):e124).
Ioannidis (2005) maintains that most research methods produce results so short of statistical significance, that the findings represent the opinions of the researchers, rather than reliable data. Add to this Angell’s contention that pharmaceutical companies are intentionally falsifying results and the picture is even murkier. She comes to a similar conclusion:
“Too often, all we have is bias and hype” (Angell, 2004, 114).
These problems may be contributing to the mortality and injury now becoming endemic in medical practice. Studies show that in 1999 doctors were the third leading cause of death in America 250,000 people a year, including over 100,000 from the negative effects of drugs that were properly prescribed and 12,000 from unnecessary surgery (Starfield, 2000).
The author asks: can a method producing such carnage be considered a system of knowledge a science?
Few herbalists will ever do research on pharmacological constituents, but a student might want to determine whether modern research on sumach verifies traditional herbal usage. The PDR for Herbal Medicine (Fleming, 1998) gives the following account of Rhus aromatica:
“Tannins (8%)- phenol glycosides: orcinol-beta-D-glucoside-volatile oil (0.01-0.07%); very complex in mixture, with, including among others delta-cadinene, camphene, Delta3-carene, beta-elemene, farnesyl acetone, alpha and beta-pinine, fatty acids.
“Triterpenes: including among others oleanolic aldehyde.
“Sterols: including among others beta-sitosterol.
“Sweet Sumach has an effect on the smooth muscles, causing changes in muscle tone and increased frequency of contraction. The plant also has antimicrobial and antiviral effects.
“INDICATIONS AND USAGE
“Irritable bladder, urinary incontinence. Universal use in treating kidney and bladder ailments, hemorrhage of the womb.
“Uses have not been proven through clinical studies or sufficient case documentary” (Fleming, 1998, 1065).
The high percentage of tannins alone explain the traditional applications of sumach as an astringent to prevent fluid loss. The complexity of these tannins might account for the wide applicability of sumach in many types of fluid loss.
Evidence-based medicine would encourage the student to take a further step to determine whether there have been additional pharmacological, clinical, or case studies. The present author checked through ‘Google scholar’ (keywords ‘sumach’ and ‘sumac’) for more recent papers on sumach and found no major increase in medical information.
A study in Australia looked at the treatment of patients with irritable bowel syndrome using Chinese herbal medicine (‘CHM’). Researchers set up a double blind randomized controlled trial with three groups, one treated by placebo, one with a single Chinese herbal formula, and one in which patients were given a formula individualized for them by one of three trained Chinese herbalists. All patients received an individualized assessment but not the individualized formula. Results were positive:
“Compared with patients in the placebo group, patients in the active treatment groups (standard and individualized CHM) had significant improvement in bowel symptom scores as rated by patients (P=.03) and by gastroenterologists (P=.002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P=.03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement” (Bensoussan, Talley, Hing, Menzies, Guso, Ngu, 1998, 280(18):1589).
This study attempts to work within the holistic paradigm of individualized treatment. The authors intentionally utilized the services of three herbalists, each with different training and background, since that is normative practice in CHM. Consequently, this study may be recommended as an example upon which to design research of herbalism and CAM. However, biomedicists have not largely pursued the opportunity. The author suggests that this is because such studies empower another profession (in this case, Chinese herbalists), rather than biomedicists. Milton (1996) collected many examples of research suppressed for professional self-protection.
The use of visions and dreams to derive information about the natural world was (and still is) an accepted method in indigenous America. Seeking a vision or dream which gives a person’s life meaning is called a ‘vision quest.’ When Lakota medicine man Wallace Black Elk was asked how he learned about the powers of different plants he replied:
“Through a vision quest. It takes years. If you want to carry the power, you make your commitment” (Weiss and Weiss, 1992, 35).
An Anishinabe Ojibwe elder speaking to a folklorist in the upper peninsula of Michigan in 1951 described the use of dream in traditional Indian society. He likened the process to going to school. Children were asked to relate their dreams to their elders. At large yearly sociopolitical gatherings, dreamers were queried by experts in the community to see what meaning their dreams had for the individual or the community. The elder likened the process to when
“a lawyer goes before the bar” (Dorson, 1951, 32).
Note the use of ‘peer review’ (so important in science) to evaluate the significance of dreams.
The visionary approach is widely used in contemporary Amazonia, where Indian cultures are comparatively intact. It is also used by South American mestizo practitioners. Ethnobotanists and pharmacologists working in Amazonia have been shocked that illiterate herbalists exhibit an understanding of complex pharmacological relationships. When asked how they learned about these phenomena, Indian and mestizo practitioners explained that the plants told them in dreams, visions, or hallucinations (Narby, 1998).
In 1984 Luna documented this practice among mestizo vegetalistas (mixed-blood herbalists):
“The spirits, who are sometimes called doctorcitos (little doctors) or abuelos (grandfathers) present themselves during the visions and during the dreams. They show how to diagnose the illness, what plants to use and how, the proper use of tobacco smoke, how to suck out the illness or restore the spirit to a patient, how the shamans defend themselves, what to eat, and, most important, teach them icaros, magic songs or shamanic melodies which are the main tools of shamanic practices” (Luna, quoted by Narby and Huxley, 2004, 229).
One ayahuasquero (shaman) commented that because vegetalistas learn directly from the plants, it is thought that vegetalismo (herbalism) is more powerful than la medicina destudio (biomedicine), since the latter is reputedly learned only from books. Another explained that the information comes directly from God:
“In nature, there is God, and God talks to us in our visions. When an ayahuasquero drinks his plant brew, the spirits present themselves to him and explain everything” (Narby, 1998, 24).
The use of vision and dream in ancient European science and medicine is not as frequently encountered as it is in Indian America. However, Pliny (c. 50 CE) acknowledged this method of discovery of herbal properties:
“We are for some of them beholden to mere chance and fortune: and for others (to say a truth) to the immediate revelation from God” (Turner, 1992, 225).
Pliny cites an example of the latter:
“It fortuned of late, that a soldier, one of the guard about the Praetorium, was bitten with a mad dog, and his mother saw a vision in her sleep, giving (as it were) direction unto her for to send the root unto her son for to drink, of an eglantine or wild rose (called cynorrhodon) which the day before she had espied growing in a hortyard, where she took pleasure to behold it. This occurrent fell out in Lacetania, the nearest part unto us of Spain. Now, as God would, when the soldier beforesaid upon his hurt received by the dog, was ready to fall into that symptom of hydrophobia, and began to fear water; there came a letter from his mother, advertising him to obey the will of God, and to do according to that which was revealed unto her by the vision. Whereupon he drank the root of the said sweet briar or eglantine, and not only recovered himself beyond all men’s expectations: but also afterwards as many as in that case took the like receipt, found the same remedy” (Turner, 1992, 224).
The author submits this as an illustration of the visionary process, but admits that it is of little practical value. The assertion that wild rose cures rabies would probably be impossible to test and few herbalists today would ever have need to use it!
The use of the revelatory paradigm is not unknown in modern Western herbalism. One influential American herbalist, the late William LeSassier, derived a complete system of herbal formulation from a vision:
“My first wife and I had just had a terrible fight. After a while I fell back on the bed. . . all of a sudden I was glued to the bed and a golden light, like the sun, but a golden triangle came down. Out stepped a clothed figure dressed in many shades of green. Said he was Pythagorus. Hands me this book. It was full of diagrams and formulas. . . nine fold formulations. My wife kept on going, I just wrote it down. Up to that time I was really stumped. It allowed me to make formulas. I wasn’t even on drugs. Since then I’ve never had any doubt about. . . compounding” (LeSassier, 2001, n.p.)
Several contemporary herbalists teach students how to communicate with plants to gain information (Cowan, 1995; Buhner, 1996). Both of these authors associate their methods with American Indian practices or teachers.
The use of the visionary faculty to obtain insight is not completely unrecorded within the annals of conventional science. The chemist Friedrich August Kekule actively used the hypnogogic state (visions seen just before falling asleep or waking up) to help him understand chemistry. Here is his description of how he came to understand the chemical structure of benzene:
“I turned my chair to the fire and dozed. Again the atoms were gamboling before my eyes. The smaller groups kept modestly in the background. My mental eye, rendered more acute by visions of this kind, could now distinguish larger structures, of manifold conformations; long rows, sometimes more closely fitted together, all twining and twisting in snakelike motion. But look! What was that? One of the snakes had seized hold of its own tail, and the form whirled mockingly before my eyes. As if by a flash of lightning I awoke” (quoted by Koestler, 1964, 118).
Kekule’s visionary state resembles descriptions by Amazonian Indians learning pharmacology under the influence of hallucinogens. They too frequently saw writhing snakes forming structures similar to complex organic molecules (Narby, 1998).
The visionary experience is not unique among scientists:
“Many scientists have described to me their own experiences resembling that of Kekule” (Needleman, 2003, 106).
As mentioned in subsections 8.1 to 8.3, the empirical, rational, and experimental paradigms are largely used to provide a kind of ‘proof’ in science through observation, reasoning, isolation of variables, and demonstration. In comparison, it does not appear that the above visionaries and dreamers used their experiences for ‘proof,’ but rather for insight, the solution of problems, and inspiration. Most of them considered ‘proof’ to be provided by the successful application of the revelation in practice. As long as vision and dream are not used to provide proof, it seems to the author that there cannot be any reasonable opposition to their use either in conventional science or modern herbalism to enhance creativity.
The only source describing systematic visionary research in the contemporary herbal field that the author could find was Cowan (1995). The following is an example of his work:
“My dream of St. Johnswort was short and simple. A disembodied voice told me, ‘I will bind together that which has been rent asunder.’ Since that time I have used it as cement for fractured souls. It works wonders in cases of soul loss, husband/wife imbalance [an energetic imbalance within a person], possession, and other situations” (Cowan, 1995, 126).
After recounting this dream, Cowan (1995) cites a case history illustrating the successful application of the dream.
According to his book, Cowan (1995) persistently interprets his plant visions to refer to psychological or spiritual states in his patients, although as is observable in the above account the plant does not limit itself to that application. Traditionally, St. John’s wort is used for wounds, especially those involving nerves (Fyfe, 1909; Hoffmann, 2003). The present author was struck, however, by his own experience of the appropriateness of the above ‘statement’ by St. John’s wort. This is the first herb he would use if a part of the physical body were torn or severed and needed ‘cement.’
This approach is characterized by the use of ‘similars and analogies’ (Eamon, 1994; Kuhn, 1977). In other words, meaning is derived from the resemblance between two natural entities that are similar or analogous in appearance, growth habit, or other physical traits. This technique can be employed in various ways. Some thinkers (such as Francis Bacon), describe analogies that have a rational, causal relationship. The present author refers to this as the ‘analogical’ approach. Others (such as Paracelsus), seek out similarities in which there is no rational or causal relationship. Paracelsus called his approach magia naturalis or ‘natural magic’ (Pagel, 1982). The author has followed him, referring to non-causal similarity as the ‘magical’ approach. The author suggests that these two methods are not entirely unrelated to each other but lie on a continuum.
Previous authors, perhaps thinking that ‘similars and analogies’ only occur in the imagination, lumped the analogical/magical method together with the visionary approach. However, the present author believes that the analogical and magical procedures are a form of intuitive thinking, and that it is important to differentiate between this and the visionary paradigm.
The magical approach forms a very definite tradition in European science, reaching a zenith in the Hermetic literature of Imperial Rome, and again in the Renaissance literature of Paracelsian natural magic (Pagel, 1982).
Paracelsus (1493-1542) is generally considered to be the chief representative of the use of similars and analogies (Pagel, 1982). He developed special vocabulary to express his conceptions. Accordingly, the physical form, shape, appearance, growth habit, color, texture, etc., of a stone, plant, animal, or human, yields a signature or sign that points to its hidden identity, essential nature, archetype, or essence. The disease also has a characteristic signature demonstrating its nature. Every natural entity has its own essence or archetype and therefore the natural world as a whole is the outward expression through signatures of an entire and complete archetypal world. The latter is called the macrocosm (greater world), while the individual or the human race is a microcosm (lesser world) (Pagel, 1982).
For Paracelsus, the curative properties of the plant are found in the similarity of the healing agent to a person, organ, or symptom. Thus, his healing credo is ‘like treats like’ (similia similibus curantur), opposed to the Galenic ‘hot to cold’ (Pagel, 1982). Here is an example of the Paracelsian method:
“Behold the Satyrion root, is it not formed like the male privy parts? No one can deny this. Accordingly magic discovered it and revealed that it can restore a man’s virility and passion” (Paracelsus, 1958, 122).
The rhizome of Cypripedium spp. (satyrion, lady’s slipper), which suggests the appearance of a testicle, is not used at present due to environmental concerns. However, its reputation as a remedy for sexual dysfunction of a nervous or psychological character (in both sexes) survived into modern times (Fyfe, 1909).
Paracelsus not only claims that magic discovers the signatures, essences, and similarities which heal, but rejects literal, physical, or causal resemblance as a basis for similarity:
“Not the brain of a cow, not the brain of a swine to the brain of a man, but the brain in the external world [macrocosm] to man’s brain [microcosm]” (Paracelsus, quoted by Wood, 2005, 23).
In other words, a plant that looks like a brain would be medicine for the brain of a human being, but the brain of a cow would not. For example, peony (Paeonia spp.) is used to treat the brain because the flower bud looks like a cranium (Harris, 1976).
The sense in which Paracelsus uses the term ‘magic’ is in agreement with the definition offered by Frazier in The Golden Bough:
“Analysis shows that magic rests everywhere on two fundamental principles: first, that like produces like, effect resembling cause; second, that things which have once been in contact continue ever afterwards to act on each other”(Frazier, 1961, 5).
From this definition can be derived two separate magical principles, which Frazier called the “law of similarity” and the “law of contact” or “contagious magic” (Frazier, 1961, 5). ‘Magic,’ as defined both by Paracelsus (1958) and Frazier (1961), implies a nonmaterial, non-causal explanation, experience, or world. In this paper the word ‘magic’ will be used to describe non-causal relationships due to similarity, or a world view based on that principle. It will not be used in a vague, ill-defined fashion to represent ‘enchantment,’ ‘mystery,’ or ‘irrational,’ unless noted.
Although the Paracelsian essences are hidden, they shine forth through the signatures, like a metaphorical light. This may have inspired the Paracelsian image of the “light of nature” (Pagel, 1982, 55), one of the most elegant concepts of natural magic. In 1652 the English alchemist Thomas Vaughan wrote:
“The Light of Nature. . . is the Secret Candle of God, which He hath tinned in the elements: it burns and is not seen, for it shines in a dark place. Every natural body is a kind of black lantern; it carries this Candle within it, but the light appears not: it is eclipsed with the grossness of the matter” (Vaughan, 1968, 266).
Frances Bacon (1561-1626) is remembered for his contributions to the reductionistic method of experimental science (Henry, 2002). However, he too advocated the use of similars and analogies to counteract the tendency of experimental thinking to result in a fragmentary view of nature:
“Our labor must be entirely redirected to investigating and noting the similarities and analogies of things, both in whole things and in their parts. For it is they that unify Nature and are the origin and foundations of the sciences” (Bacon, 1994, 194).
Here is an example of Bacon’s (1994) analogical method:
“That remarkable structure by which the sexes differ (at least in land animals) appears simply to follow from one being external and the other internal; that is to say, the greater heat in the male pushes the genitalia to the outside, while in females the heat is too faint to enable it to do this, with the result that they are contained within” (Bacon, 1994, 193).
The reader will observe that Bacon (1994) is proposing a causal, physical relationship in his analogy. He differentiates his kind of analogy from the
“superstitious or curious similarities, such as are everywhere paraded by writers on natural magic” (Bacon., 1994, 194).
Probably he has in mind someone like Paracelsus, the founder of natural magic.
Although Bacon (1994) rejects the ‘magical,’ non-causal use of analogy, he was influenced by natural magic (Henry, 2002) and at times he writes like a natural magician:
“Truth should be sought, not in the felicity of any particular age, which is a variable thing, but in the light of Nature and experience, which is eternal” (Bacon, 1994, 63).
If Bacon (1994) did not believe in the superstitious and curious excesses of the analogical approach, then what was he thinking when he described the light of Nature as the source of truth and eternity independent of variability and experience? The author suggests that even the most restrained use of the analogical method may be invested with a faint trace of ‘magic.’
The author suggests that the modus operandi behind the analogical/magical approach is the intuition. The certainty felt by Paracelsus, Vaughan, and Bacon in this method is described by Jung (1976) as a characteristic of the intuition:
“Intuitive knowledge possesses an intrinsic certainty and conviction, which enabled Spinoza (and Bergson) to uphold the scientia intuitiva as the highest form of knowledge. Intuition shares this quality with sensation. . . whose certainty rests on its physical foundations” (Jung, 1976, 453).
The intuition is frequently associated with the capacity to make mental connections between things or ideas previously not evident (Jung, 1976).
A subsequent thinker who advocated an intuitive approach to science was J. W. Goethe (1749-1832). His ‘scientific method’ was largely ignored in the nineteenth century, but has been resuscitated and today enjoys a modest following under the name “Goethean science” (Whitelegg, 2003, 311).
Goethe felt that empirical observation and rational analysis were incomplete. He advocated examination of both the external and internal impressions a thing made upon the observer. Goethe felt it was necessary to allow the internal faculties to complete their analysis of a phenomena, and not to cut them off, as he felt was customary in conventional science (Whitelegg, 2003).
The first step in Goethe’s process is a detailed empirical observation of the phenomena, analogous to the modern scientific concept of ‘informed observation.’ After finishing this, the observers are to let their imagination and intuition play upon the phenomena. Goethe was convinced that the mind would naturally gravitate towards the inherent idea or urphaenomenon (primordial nature) of a thing. The final step in the Goethean process involves comparison of imaginative and intuitive data by different people examining the same subject. The expectation is that different people will have similar subjective reactions to it (Storl, 1990; Whitelegg, 2003).
The word ‘subjective’ is used with some hesitance by the author. From the Goethean perspective,
“The proper Idea belonging to the phenomenon [is] as objective as is the phenomenon itself” (Storl, 1990, 94).
Here again we see the tendency of the intuitive experience to yield results of a ‘certainty,’ as described by Jung (1976). The essence of the thing can be as real to the intuitive as a physical sensation (Jung, 1976).
The intuitive reality of the archetype cannot, of course, be substantiated by material observation. When Plato introduced the concept of the idea (the ancestor of Goethe’s idea), Diogenes the Dog offered the retort:
“I’ve seen Plato’s cups and table, but not his cupness and tableness” (Davenport, 1979, 57).
This kind of criticism does not, in the author’s mind, negate the intuitive approach. It still may be of value in establishing relationship and context not evident in a purely physical examination. The author would further suggest that such distinctive concepts as ‘ideas,’ ‘archetypes,’ and ‘signatures’ be looked upon as ‘tools’ of the intuitive approach, rather than as real or unreal entities. Just as scientific experimentation uses tools (trials, double-blind, the p-value, etc.) to arrive at research conclusions, a mature view would allow intuitive investigation the use of its own well-defined methods to arrive at intuitive conclusions. As Whitelegg (2003, 320) comments, the doctrine of signatures may have to be “reassessed.”
Analogical and magical approaches have had an extensive influence on herbalism and pre-modern science. The use of the doctrine of signatures in traditional herbalism is nearly ubiquitous (Crellin and Philpott, 1990). Modern herbalists, following the cue of scientists, have tried to ignore signatures, but even today it has advocates (Harris, 1972; Wood, 2004, 2005).
In the 1990s the author was first approached by clients diagnosed with Lyme disease. This is a deer-borne syphilis spread to humans through the bite of the tiny deer tick (Buhner, 2005). Lacking guidance from pharmacology or tradition, the author was forced to use his wits. He employed tradition, analogy, and the doctrine of signatures to find a remedy.
The author reasoned that a remedy for Lyme ought to be good for the muscles and joints, which Lyme destroys. Teasel (Dipsacus japonica) is used for injured muscles and joints in Chinese herbalism (Bensky and Gamble, 1986). The author already had good experience using Dipsacus sylvestris (naturalized in his area) for these problems. Teasel is also discussed in the same source as a support for the ‘jing’ or essence, which the author understood to be a sort of ‘genetic blueprint’ particularly susceptible to attack by syphilis. He also knew, from conversations with American Indians, that thistles like teasel are often considered ‘elk medicines.’ These indications appealed to his intuition and induced him to try Dipsacus sylvestris (naturalized in his area) for Lyme disease.
Today the use of teasel for Lyme is widespread. A Google search under the words “teasel” and “Lyme” yielded 95,700 hits on December 21, 2005.
The success of science has contributed to its credibility and authority in society (Kosso, 1992). However, the use of authoritarianism in scientific argumentation, in lieu of factual evidence, is classified as a major scientific fallacy (Carr, 1992). The authority granted by society, plus the misuse of authoritarian argumentation has often produced very unscientific science (Milton, 1996). The latter has collected many interesting examples. For instance, for five years after the Wright brothers began flying airplanes in broad daylight, in front of hundreds of witnesses, they were ignored by the media, government, and general public because contemporary scientists declared that heavier-than-air flight was impossible. In the 1990s Ornish developed dietary and lifestyle methods to prevent and treat heart disease but the American Heart Association refused to fund his research because they declared heart disease impossible to prevent or treat.
From extensive evidence, Milton (1996) concluded that a ‘scientific taboo’ towards innovative and unusual information, methods, and people was characteristic in many fields:
“The taboo reaction draws a circle around a subject and places it ‘out of bounds’ to any form of rational analysis or investigation. . . . This form of scientific taboo is best seen in the prohibition against investigating any form of electromagnetic field associated with living organisms, when there is actually very substantial physical evidence for such a field” (Milton, 1996, 84).
This provides an explanation for why biomedicists refuse to study CAM paradigms, persons, and experiences. To engage in conversation grants the opponent authority. As Milton (1996) demonstrates in several instances, professionals in one field, feeling threatened by developments in another, attempt to suppress the work to guard their own turf. This is true even when the other field is relatively unrelated to their own. Airplanes were invented by bicycle mechanics, not scientists. Furthermore, media and the public tend to view scientists, even when expressing opinions outside their field, as ‘experts’ (Milton, 1996).
The misuse of authority in science has often been commented upon. What is surprising is that authoritarianism can play a creative role in the evolution of science. This is particularly the case during periods of scientific revolution, when new perspectives challenge entrenched authority. The scientific revolution of the Renaissance was deeply inspired by the idea that scientists were recovering the ‘lost knowledge’ of ancient authorities, when in fact they were often misinterpreting them to develop important new ideas. It is possible that scientific revolution would be too intimidating for some of its proponents if they did not think they were reestablishing sound practices from the past. The phenomenon of scientific growth through supposed ‘recovery of ancient wisdom,’ often resulting in profound misinterpretations which, nonetheless, significantly advance science, has been described as “archeological science” (Schmidt, 2005, personal communication).
The reverse also may to be true. Some find authority in the ‘latest’ research developments. This is the supposition behind evidence-based medicine (Sackett, et al., 1997). However, it is also possible to place too much authority in the ‘latest’ developments. When they are greeted uncritically, there can be
“an arrogance of the present” (Kosso, 1992, 3).
These examples suggest that authoritarianism should be viewed as a many faceted complex that can have both positive and negative influences upon science.
When the authority of the past extends unbroken to the present (and need not be recovered), the author would describe it a as tradition. The importance of authority and its analogue, tradition, are apparent in Western herbalism. The ancient authors Hippocrates, Dioscorides, Plinius, and Galen are cited by Renaissance authors (Gerard, 1975; Culpeper, 1990; Salmon, 1710), who are in turn cited by twentieth century writers (Grieve, 1994, Harris, 1976).
The twentieth century saw a break in herbal tradition. This is indicated, the author suggests, by the large number of publications cited in this paper seeking tradition and authority from a variety of sources physio-medicalism, eclecticism, traditional Chinese medicine, Ayurveda, Greek medicine, biomedicine, American Indians, witches burned at the stake, wise women, a vision of Pythagorus, nature, etc.
Ironically, in seeking authority outside Western herbalism, innovative authors were rejecting an established tradition. Tommie Bass, the old Georgia folk herbalist interviewed by Crellin and Philpott (1990), mistrusted practices not grounded in tradition.
“Bass is unappreciative of the many practitioners who have become part of the present-day wholistic [sic] movement without a clear lineage from the past” (Crellin and Philpott, 1990, 1:85).
The author concludes that both the adherence of the older herbalist to his inherited tradition, and the search for tradition among younger herbalists, indicate that tradition is an important criteria for validity in herbal medicine.
The author points to a possible danger from discarding traditional knowledge. The introduction of herbal products into the marketplace, based solely on scientific theory or research, without reference to tradition or experience, may be a formula for failure. The research histories of two different plants illustrate this problem.
Elder (Sambucus nigra) has long been used in European folk medicine for fevers, influenza, and respiratory conditions (Grieve, 1994). A number of constituents (cyanogenetic glucosides, flavonoids, cytokinens) suggest antifebrile and antiviral properties (Hoffman, 2003). In a study in 1995, Sambucol (a standardized elderberry extract) showed positive results in inhibiting the growth of ten different strains of influenza virus. Clinical trials demonstrated that it lessened the length of recuperation and discomfort from influenza.
“A significant improvement of the symptoms, including fever, was seen in 93.3% of the cases in the SAM [Sambucol]-treated group within 2 days, whereas in the control group 91.7% of the patients shows an improvement within 6 days (p < 0.001)” (Zakay-Rones, Varsano, Zlotnik, Manor, Regev, Schlesinger, and Mumcuoglu, 1995, 4:361).
In this research the confluence of tradition and modern pharmacology can be observed. Conversely, ignoring the historical, empirical, and paradigmatic context of a plant or therapy could led to disappointment. An example of this is demonstrated in research on echinacea. In 2004, the largest pediatric study ever conducted to date concluded that echinacea showed no benefit in the treatment of upper respiratory tract symptoms in children. One of the participants in this study was Bastyr University, a naturopathic (holistic) medical school (Dubik, 2004). The following year an exhaustive study published in the NEJM concluded that echinacea showed no clinically significant effect in rhinovirus infections (Turner, Bauer, Woelkart, Thomas, Gangemi, 2005). This was followed by an editorial in the same journal that stated,
“Tracing the evolution of views about the benefits of echinacea from the traditions of indigenous populations to modern claims, one finds little rationale for studying the effects of this herbal remedy on colds” (Sampson, 2005, 353:337).
Sampson is correct: echinacea was not traditionally used for head colds (Fyfe, 1909). This usage is based on pharmacological speculation about the possible uses of its ‘active constituents,’ i.e., polysaccharide immunostimulants (Fleming, 1998). If scientists had placed a higher value on traditional reports about echinacea, perhaps its use on apparently specious grounds might have been avoided.
Ironically, Sampson (2005) takes these high profile findings as evidence that CAM is bogus and the study of herbal remedies a waste of resources. Yet, according to his own statement, traditional medicine had nothing to do with this debacle. Who, then, is responsible?
The present author suggests it would be more appropriate to consider the role of commercial interests who have marketed echinacea. Angell (2004) refers to the corruptive influence of commerce in the drug industry. CAM practitioners and advocates who have recommended echinacea for head colds may have been misled, not by traditional or empirical herbalism, but by speculation fanned by commercialism.
This raises an important question. If so-called CAM practitioners derive their information from modern biomedical sources, without reference to tradition or holism, are they advocates of biomedicine or complementary and alternative medicine?
This paper is about the knowledge-gathering methods available to the herbalist. Scientifically oriented biomedical writers have attempted to enforce a strict methodology on the study of herbal medicines, allowing only pharmacological study and clinical trials while frequently ignoring or disallowing into evidence herbal experience, tradition, and holistic paradigms. It has been suggested that this restrictive methodology is inappropriate for several important reasons, and should be rejected by the herbal community.
Although biomedicine recognizes the need for empiricism in its own practice, it rejects empiricism in the study and use of herbs. It haphazardly refers to herbal experience and tradition and ignores the opinions and experiences of herbalists. Although a clinical trial model has been designed and used allowing inclusion of holistic characteristics of herbal practice, this model has been little used. The author suggests that this may be due to professional bias. Serious problems with biomedical research have been raised by Ionnides and Angell. Consequently, the author advocates that herbalists should not limit themselves to the biomedical model, but should retain traditional methods of knowledge-gathering, and oppose biomedical manipulation of their field.
This paper has researched and defined three basic classes of knowledge-gathering used in herbal medicine:
traditional methods of herbalism,
biomedical methods, and
This paper advocates that all these methods be used in modern Western herbalism.
The traditional methods were described by Crellin and Philpott (1990) and confirmed in the present study. They are:
rationalism or theory
tradition based on empiricism and theory
The present author suggests that these methods have carried herbalism along in the past, and are relatively scientific, even from a conventional perspective, since they are primarily dependent on experience and observation. As Kuhn (1970) maintains, older methods of science are not canceled out by newer methods, but remain scientific. Empirical knowledge is not canceled out by experimental research. However, the author suggests that herbalists need to develop deeper knowledge of modern scientific use of empirical data. They would also need to learn to interpret theories used to organize herbal knowledge in the past but have not been sufficiently explained for a modern audience, such as the Galenic and Thomsonian methods.
The biomedical methods are sufficiently described by sources explaining scientific procedure (Carr, 1992; Kosso, 1992; Fugh-Berman, 1996):
Science and herbalism are in relative agreement about the use of empiricism, though this element appears to be wrongly ignored by biomedicists in the study of herbalism. It need not be abandoned by herbalists. However, herbalists should learn more about scientific standards of evidence in empirical and observational research. Greater attention should be placed on the development of case series.
The revelatory methods have been routinely rejected by modern science and medicine. They have also been largely ignored by herbal medicine up to last quarter of the twentieth century, probably because herbalism was closely conjoined with conventional science and medicine until recently. However, it was shown that these methods (vision and intuition) are capable of constructive use. The latter, via the doctrine of signatures, has long played a recognized (or unrecognized, underground?) role in herbalism. It can be acknowledged today with the return to a more holistic, intuitive view of nature. Intuition can be developed through the Goethean method.
It should be noted that empiricism, vision, and intuition are more ‘participatory’ than other methods of knowledge-gathering; they draw a person into nature and can increase the sense of connectedness to the natural world (Cajete, 2000). Hence, the use of these methods should be considered to strengthen the natural and holistic elements in herbalism. By embracing different methods of perceiving and interacting with the natural world herbalism makes itself more professionally holistic it can accept different people and different methods of human intelligence, both in practitioners and in clientele.
The use of ‘participatory’ methods also brings herbalism into a closer relationship with the plant, encouraging a more holistic experience of medicinal agents. Rather than viewing medicinal plants as bags of chemical constituents to be broken up and reductionistically studied, herbalists may retain a view of them as whole beings, valuable in their wholeness. The author suggests that more study could be made of the differences between the use of constituent parts and the whole herb.
There is an additional reason to embrace the use of all possible methods of herbal knowledge-gathering: to improve certainty in the understanding and application of herbs. Among the foregoing methods the author can discern at least three different standards for relative levels of certainty in the use of medicinal substances.
The first of these is the scientific method, based upon the use of the ‘gold standard’ for biomedical research, the double blind clinical trial. This is advocated by leading biomedical journals, yet the evidence so far produced by this method is not encouraging. Controversy swirls around echinacea, critics have identified major flaws and biases in biomedical trial methods, commercialism may be interfering in drug and herbal studies, and biomedical bias against other professions may be influencing research. Expense is an increasing consideration. We may not be in an era when this methodology can produce its best results.
The second method of certainty is empirical: ‘it works.’ Greater efforts could be made by herbalists to incorporate positive results in the form of case series studies. These may be arranged both according to biomedical and holistic/energetic standards.
The third method of certainty is the intuitive: ‘it makes sense.’ Bias against this approach has led to its being ignored by conventional science on the premise that the intuitive faculty is subjective. However, the intuition has great potential and is commonly used for knowledge-gathering in social settings. If it can be carefully integrated with the scientific method, as is suggested by Goethean science, then it should be embraced by science and herbalism.
A fourth method emphasizes the importance of using more than one approach: the confluence of similar results from several different methods would be a source of certainty not available from the restrictive use of a single method. A science based on ‘confluent research’ (do we have here a new paradigm?) could have strength and depth.
This paper has examined various methods of knowledge-gathering available to the herbalist. The author concludes that all these methods can be used responsibly, and that their development within Western herbalism can contribute to a profession conceptually stronger, holistically founded, and more certain in its application of plant medicines. He suggests that the ‘confluence’ of several approaches would provide better evidence for use of herbs than the employment of one or two methods alone.
In addition, the author finds that the application of the biomedical model to herbal medicine as a sole methodology is inappropriate. He suggests that this approach is in part designed to disempower herbalism. Changes in the method necessary for unbiased and successful research are suggested. The author demonstrates that these methods have already been successfully implemented.
These results address the questions the author set out to answer. However, he was driven to additional conclusions he did not anticipate. Specifically, he concluded that some methods of research would be more fruitful for herbalism than others. This finding pertains especially to the use of the case series method, a form of empirical research that not only satisfies scientific standards but provides herbalists with information useful in the clinic. The author offers his observational belief, as an herbal teacher and writer, that case histories are a powerful tool in the education of students.
The present study was not designed to establish this result and it was not anticipated by the author. The three “Categories for Research Proposal” listed in the Research Guidelines Handbook for BSc/MSc Students & Tutors (2003, 8) issued by the Scottish School of Herbal Medicine do not directly allude to this method, though mention is made of case history research. The author suggests that the School (and other bodies) consider encouraging this method specifically. Initial work would be required to establish criteria for case series studies.
The second area in which study is recommended is historical reclamation of theories of practice used in Western herbalism. The author takes the recent explosion of herbal literature on Chinese, Ayurvedic, and other forms of herbal medicine as evidence that Western herbalists are searching for a theory of practice. This is another observational belief he has picked up while teaching in the herbal community.
In reaching these unanticipated conclusions, the author acknowledges the influence of Scheid’s (1996) paper on research design in Chinese medicine. His comments are suggestive of the unanticipated conclusions reached above. However, note that Scheid (1996) supports study of single case histories, while the present author is advancing the use of case series studies consisting of five or more case histories.
The author also concludes that it would be a good idea for herbalists to incorporate biomedical, visionary, and analogical methods, as well as paradigmatic research, into Western herbalism. He believes this would contribute to the maintenance and development of an effective, broad-minded, holistic profession with a healthy, ‘participatory’ relationship to nature.
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