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.

Abstract

List of Contents

1. Introduction 

2. Review and Analysis

3. Methods

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

            7.3. Spirituality

            7.4. Vitalism

            7.5. The Individual

            7.6. Holism

            7.7. Energetics

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

9. Discussion

10. Conclusions

11. References

Acknowledgments

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.

1.  Introduction

            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.

2.  Review and Analysis

            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.

            The three theories most prominent in herbal medicine, according to Crellin and Philpott (1990), are:

                        (1) humoralism,

                        (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:

                        (1) appearance,

                        (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). 

3.  Methods

            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:

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:

            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. 

4.  Modern Western Herbalism

            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.

5.  Paradigms and the Study of Science

            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

            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,

            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

            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.

Nor was Newton canceled out by Einstein:

            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).          

6.  Paradigms and Biomedicine

            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:

            The Final Report of the White House Commission on Complementary and Alternative Medicine Policy quotes the above statement with approval, noting that

            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 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:

            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:

            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.

7.  Paradigms and Holistic Medicine

            The paradigmatic discussion advocated by holistic practitioners represents a response to problems perceived in conventional biomedicine by practitioners and the public alike.

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. 

7.1.  The Goodness of Nature

            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.

7.2.  Self Healing

            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.

7.3.  Spirituality

            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.

7.4.  Vitalism

            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).

7.5.  The Individual

            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).

7.6.  Holism

            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

            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.  

7.7.  Energetics

            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). 

8.  Paradigms and Herbal Research

            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. 

8.1.  Empirical Science

            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: 

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: 

            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

            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:

It also argues against any standard not easily understood by the general population:

            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:

            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.  

            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:

            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.

            Thomson developed his knowledge of materia medica largely by tasting plants to see what their action upon himself would be: 

            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: 

            The major health problem at the time was fever, so Thomson’s theories were largely developed by dealing with that condition.

            Thomson thus arrived at his method of treatment: 

            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.

            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. 

            The same author ranks the use of the case history in Chinese Medicine to obtain knowledge very highly:

            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).

8.1.1.  Empirical Research: Taste

            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. 

            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:

            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.

8.1.2.  Empirical Research: Animal Use

            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).

8.1.3.  Empirical Research: Case Histories

            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:

            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.

8.2.  Rational Science

            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:

            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:

            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:

            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:    

            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).

8.2.1.  Research on Theory

            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.                    

8.3.  Experimental Science

            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, 

            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:

            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:”

            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:

            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? 

8.3.1.  Pharmacological Research

            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:

            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.    

8.3.2.  Clinical Trials and Herbal Medicine

            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 t