Researching the history of western herbal medicine

Earlier this year, I attended a couple of seminars on researching the history of western herbal medicine, organised by Middlesex University. They were both fascinating events, which brought together classical and medieval historians, medical herbalists and other academic and independent researchers to share their different perspectives on the history of western herbal medicine.

Although there were many points of common interest, there were some major differences in outlook between the herbalists and the historians. Herbal medicine often relies heavily on the historical and traditional uses of herbs as a justification for their modern day use. To the historians present, this seemed to be anathema: an unjustifiable use of historical detail out of its appropriate context. I heard several people make comments about how they would never have started researching in this area if they had thought that anyone would be dredging their work to find modern day application.

In one respect, this is of course a fair criticism. It is all too easy to miss the modern assumptions that we overlay onto interpretation of historical data. But to a herbalist, this works both ways, as hidden information may be dismissed and ignored as folklore if we do not look for the practical applications. One example is the use of incantations during the making of remedies – whilst this undoubtedly will have had a magical ritual element (in itself an effective way of evoking so-called ‘placebo’ responses –  a topic which I must revisit in future), it also serves as a useful way to measure time in a world before wristwatches!

One presentation at the first seminar came from Alison Denham and Midge Whitelegg  on Deciphering Dioscorides,  based on material from their forthcoming book (co-authored with Graeme Tobyn) ‘The Western Herbal Tradition: 2000 years of medicinal plant knowledge’. They have been researching the ways in which a group of medicinal herbs have been used from Dioscorides to the present day, looking at a range of key sources, including Greek, Roman and Renaissance texts. Such research is essential for herbalists to be able to evaluate the credibility of modern claims that depend on historical uses.

For example, it is fair to say that the use of a herb consistently for similar indications throughout recorded history is highly suggestive of that herb’s effectiveness for such uses. (Although it must be remembered that treatments such as bleeding and ingestion of mercurials also have long histories of use for indications where they are anything but helpful.) On the converse, a use that has no traditional history behind it will need considerable research before it can be accepted into current practice.

Another presentation came from the Research officer at the Wellcome library. I was amazed and thrilled to discover that they have been working hard to digitise their unrivalled collection of 17th century domestic recipe manuscripts. These books are now searchable by keywords as well as subjects. An amazing resource.

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Research into art and science

So, I always imagine that I will have time free in the summer to get on with lots of ongoing projects. In semester time, I blithely pictured myself updating this blog weekly, in between long afternoons of lazing around in the garden, occasionally doing a spot of weeding. Sadly, it never happens like that.

Back in reality, my only chance to update the blog is when, like now, I’m on a train. This time, I’m coming back from the final summer school at the Scottish School of Herbal medicine, where I was attending some of their Research methods classes. I came away with lots of problems to mull over.

For example…like many herbal practitioners, I consider my practice to be part art, part science. In herbal medicine, there is usually a multitude of choices of herb for any one patient. If greater blood flow to the skin seems desirable, there is reasonable scientific evidence to back up the prescription  of Capsicum minimum or Zingiber officinale, or maybe Tilia spp., or any number of others. The art comes into the choice of which one. Some of the reasons why I might pick one, rather than another, are easily explained and could be formalised – the soothing relaxing actions of Tilia spp. are clearly going to be more appropriate for an anxious stressed patient, whereas the stimulating effects of Capsicum will be better for others. But some reasons are less clear-cut.

For example, certain herbs, such as Rosa spp. (Rose) or the Crataegus spp. (Hawthorn), have strong symbolic value, and may be chosen for this. This would usually be considered a placebo effect, as for any medicinal treatment that works via an alteration in the way that the mind and body interact. But if you accept that mind and body are inextricably interlinked, as is suggested by both traditional medicine and by the newer sciences of psychoneuroimmunoendocrinology, then to call a treatment a placebo is roughly as useless and meaningless as calling a disease psychosomatic. You do not need to believe that the ‘spirit of Rose’ comes over in an ethanolic extract to appreciate that connecting with such powerful symbolism on a regular basis whilst taking medicine might facilitate a different attitude to your body. And that the better chosen the symbol, the more powerful the ‘placebo’ effect. (Please note that I am not suggesting that this is the only, or even a major, route by which herbal medicines exert  their effects).,

However, an approach that includes such artistic and intuitive aspects does not lend itself to codification and generalisation in a way that can be easily researched and used to inform the practice of others. One of the fine and noble purposes of medical research is to find out what works and enable others to use it. For herbalists, this requires methods of research that allow for the art as well as the science. Qualitative methods used by social scientists may enable an approach to exploring the art, and standard quantitative methods can survey the science. Herbalists need to find a blend of both.

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Tree studies

There were some fantastic tree studies this year.

This is part of Emma's fantastic painting summarising her work on an oak tree.

Sarah and Kerri with their work.

Sam and Nicky with their tree studies on Elderflower.

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pharmacy on wednesday mornings

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Intro to HM

The level 1 students have now finished all their plant family seminars. These have been great this year with some fantastic use of the wikis, well done all of you.  The high point has to be the Apiaceae soup,  what an amazing idea!

Apologies for the poor quality of the photos – I’m just getting to grips with the camera on this phone.

Group work on case studies in Lamiaceae week

Sam and Emma with their Solanaceae table

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Conversations with Skeptics

I recently discovered that there was a group called ‘Sheffield Skeptics in the Pub’ meeting regularly at the pub down the road from my practice. They describe a Skeptic as follows:

“A skeptic is one who prefers beliefs and conclusions that are reliable and valid to ones that are comforting or convenient, and therefore rigorously and openly applies the methods of science and reason to all empirical claims, especially their own.

A skeptic provisionally proportions acceptance of any claim to valid logic and a fair and thorough assessment of available evidence, and studies the pitfalls of human reason and the mechanisms of deception so as to avoid being deceived by others or themselves.

Skepticism values method over any particular conclusion.”

They sound really nice on their website, but I’m not sure if they’ll like me just as much. I’d guess that as a complementary therapist, I’m quite high on their list of idiotic morons. Nevertheless, I’ve been tentatively wondering about wandering along one week. So this has focused my attention on what exactly it is that I think we do. Why do herbs work and how could I explain it to the lovely Skeptics?

One argument, and one that would perhaps be accessible to my Skeptics (towards whom I am already feeling an affectionate interest), starts by looking at the botanical role of secondary metabolites. Anyone who has completed Phytochemistry with me at level 2 will be familiar with this one. Most plants produce a variety of compounds that serve a biological role akin to the human immune system (Bennet and Wallsgrove, 1994) preventing infection, deterring herbivores, etc. It is straightforward to make a logical case from here to their use for similar or related purposes in humans.

So, for example, tree resins such as Myrrh are produced to seal an area of damage to the bark. Now, any area of damage will be at higher risk of infection. So, logically enough, Myrrh resin contains constituents with powerful antiseptic effects (Hanuša et al., 2005) that will reduce the risk of infection in this damaged area. As these have to work against a wide range of potential pathogens, the antiseptic effect will be relatively non-specific. It would therefore be more surprising if they didn’t work against some human pathogens, than that they do.

But, that’s kind of a cop-out – I don’t feel it really gets to the heart of the issue. One bigger issue for me, is that a herbalist, like other complementary therapists, believes in asking why any given patient is ill, and thinks that it might be possible to find something of an answer for an individual case. And that answer may help to unravel the illness and lead to an effective treatment.

But then, how can we possibly validate our ideas of how to find an answer to the question that an illness poses, and how can we argue that herbs, in particular, would be effective in treatment? Plenty to discuss there in future postings.

Incidentally, if you are a Sheffield Skeptic in a Pub yourself, I’ve not got my nerve up yet. But I’ll be along one day. Remind me not to drink too much beer before we start.

Reference List

Bennet, R.N. and Wallsgrove, R.M. (1994) Secondary metabolites in plant defence mechanisms. New Phytologist, 127(4), pp. 617–633.

Hanuša, L.O., Řezankab, T., Dembitskya, V.M., and Moussaieff, A. (2005) Myrrh: Commiphora chemistry. Biomedical Papers, 149(1), pp. 3–28.

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