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, Minnesota 55364
Master of Science Degree (Herbal Medicine)
Submitted: January 2006
University of Wales
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.
© Matthew Wood, 2006
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 competing for recognition. Biomedicine has proposed a strict interpretation of herbal research, in which the experience, tradition, and conceptual framework of Western herbalism is largely ignored in favor of clinical trials and pharmacological studies.
The author attempts to demonstrate that biomedical research methods are inadequate, both because the public is demanding more holism in medicine, and because the research undertaken may be flawed by professional bias, lack of background in the subject area, or inadequate design. The paper advocates that Western herbalists develop their own conceptual foundation and from this their own methods of research. It attempts to provide the tools necessary for this work, including discussion of science, biomedicine, paradigms, holism, traditional methods of knowledge-gathering used in herbalism, biomedical research models, and visionary and intuitive methods. It highlights case series study as an approach that especially should be developed.
It favors an holistic approach to the future development of Western herbalism.
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 Nature8. Paradigms and Herbalism
7.2. Self Healing
7.5. The Individual
8.1. Empiricism9. Discussion
8.1.1. Empirical Research: Taste8.2. Rational Science
8.1.2. Empirical Research: Animal Use
8.1.3. Empirical Research: Case Histories
8.2.1. Research on Theory8.3. Experimental Science
8.4. Visionary Science
8.4.1. Visionary Research8.5. Analogical Science
8.5.1. Analogical Research8.6. Authoritarian Science
The author gratefully acknowledges the help of Robert Schmidt, of Project Hindsight, in Cumberland, Maryland, a professional Greek translator and scholar of Greek science, Frank H. Wood, professor emeritus of educational psychology, University of Minnesota, and Clara NiiSka, MSc. (liberal studies), University of Minnesota, for their assistance in contributing ideas, reading, and criticizing the manuscript. Midge Whitelegg, Ph.D., F.N.I.M.H., Department of Nursing, University of Central Lancashire, provided several important articles and helpful comments. Clair Teegarden, of Minnetonka, Minnesota, provided assistance with Internet research and background material.
Extensive public use of complementary and alternative medicine (CAM), sometimes also called holistic medicine (Eisenberg, et al., 1998), led to an examination of the movement by governmental bodies. They recommended scientific research into the phenomenon (House of Lords Select Committee on Science and Technology, 2000; United States Department of Health and Human Services, 2002).
Prominent biomedical journals responded. They suggested that CAM be investigated using conventional biomedical methods alone (Angell, et al., 1998; Leibovici, 1999; DeAngelis, et al., 2003). However, holistic medicine presents a dilemma because it is founded upon fundamental assumptions about knowledge and medicine that are not usually tested in conventional research (Kollman, et al., 1999, 391:903). The biomedical response to this wrinkle in the experimental fabric has been largely to ignore the problem (Angell, et al., 1998, etc.) This would seem to defeat the purpose of the governmental recommendations. If holistic parameters are intentionally ignored in biomedical research, the latter cannot produce evidence that reflects complementary and alternative practice.
Prior to the 1990s, when government and biomedicine began to look into the holistic phenomenon, Western herbalism maintained its own conceptions and methods of research: empiricism, theory based on experience, and tradition based on experience (Crellin and Philpott, 1990). Empiricism (experience and observation) is a fundamental tool of scientific and medical research (Carr, 1992; Kosso, 1992, Fugh-Berman, 1996), so these methods cannot be considered unscientific.
Although empiricism is a fundamental part of biomedical education and practice (Sackett, et al., 1997), the leading biomedical journals cited above have proposed study of holistic medicine and herbalism without reference to the experience, theory, or tradition within these professions; instead they have already begun to impose upon them a research-driven approach which even they do not follow in practice.
At the same time, starting in the 1980s and extending to the present, many new ideas originating around the world, and in past practices of medicine and herbalism, were introduced into the literature of Western herbalists by authors seeking to enlarge the paradigmatic conceptions of the field (see section 4, "Modern Western Herbalism"). Many of these methods include practices that have been rejected by modern science, particularly the visionary and intuitive methods.
The present paper was designed to explore, compare, and define methods herbalists could use to gather knowledge, then to determine whether it was feasible to include them in herbal practice. The study concluded that this was possible and beneficial. However, the author was driven to additional conclusions he did not anticipate. He concluded that certain methods, particularly case series studies, were of greater importance than others. These recommendations will be given in the Conclusion section.
2. Review and Analysis
The contemporary practice of Western herbalism has been largely ignored 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 study Western herbalism. They adopted this 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 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 categories like temperature (hot, cold), humidity (damp, dry), and constituent (blood, phlegm, bile, etc.) The second relates
(1) taste (bitter, sweet, salty, pungent, acrid, sour) and
(2) impression (stimulating, relaxing, puckering or astringing, etc.)
to medicinal properties. The third relates the appearance, growth habit, coloration, environmental niche, or physical properties of a plant to its medicinal virtues.
Crellin and Philpott (1990) provide a comprehensive view of herbal history, from approximately the beginning of American settlement 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 this examination. As we have seen, biomedicine entered into a study of holistic medicine and has attempted to exert pressure upon CAM and herbalism. This situation is not even referred to in Crellin and Philpott (1990). Likewise, the introduction of new ideas into herbalism in the 1980s is hardly mentioned.
In order to describe the nature of the change within herbalism, the author has provided a short literary search, characterizing herbal publications of the last two decades (section 4, Modern Western Herbalism.")
A central idea characterizing both these debates -- that between biomedicine and herbalism, and that between an older and newer herbalism -- is the word 'paradigm.’
Hence, the paper uses this concept as an organizational and conceptual tool.
The concept of the paradigm was introduced in 1962 by Kuhn (1970) to describe different suppositions and practices in various fields of science, especially in relationship to scientific change. The paradigmatic approach 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). The term 'paradigm' has also been applied to the debate within herbalism (Whitelegg, 1992).
Biomedical writers have had various reactions to the paradigmatic argument. The current dissertation recognizes these perspectives and presents reasons why it would be beneficial for herbalists to study the historical and paradigmatic context of herbal medicine.
When the author took up the idea of designing a study which would benefit herbal medicine, he was dissatisfied by what he perceived to be the general lack of definition of basic conceptions in modern herbalism. A search of contemporary herbal literature (section 4, page 7) showed, on the one hand, introduction of unrelated theories from widely separated cultures by different authors, and on the other, a 'scientific herbalism' consisting almost entirely of research done by biomedicists, rather than herbalists. Consequently the author felt the need to define common assumptions underlying a diversity of traditions and methods in Western herbalism.
Unfortunately, a discussion of paradigms in Chinese and Ayurvedic herbalism could not be included here due to the constraints of space.
The paradigmatic method of Kuhn (1970) was adopted to classify and describe different methods of gathering knowledge in herbalism and medicine. Kuhn (1970) introduced the term to describe different scientific approaches and conceptions. He recognized two different usages:
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, the term paradigm has been used in both senses. The section on "Paradigms and Holistic Medicine" (page 13) follows the first of these two usages. The section entitled "Paradigms and Herbalism" (page 17) adheres to the second.
The latter section is organized around six fundamental paradigms, methods, or procedures which have been used gathering and organizing knowledge. This section examines how they have been used by Western herbalism and medicine, past and present. These six paradigms were arrived at through the following process.
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 been identified as an additional 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).
These may all be considered paradigms of science or knowledge-gathering and organization.
This tabulation adds two more paradigms -- revelation and authority. However, 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 based on analogical thinking, while revelations from gods are more frequently associated with visions and dreams. Hence, it has been necessary in the present paper to split revelation into the visionary and analogical paradigms.
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.
Several terms 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. Searches under specific subjects were also pursued. The most often cited articles were selected.
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 involving imprisonment, literal book burning, and prolonged prosecution in the courts (Milton, 1996). The present author also argues that the type of medicine with which the older herbal literature was associated became obsolete and was no longer understandable to the younger generation of herbalists appeared on the scene in gentler times -- the 1970s and '80s. Western herbalism still possessed a pharmacopoeia but lacked a system of application (Wood, 2004). What were these students of herbalism to do?
A survey of contemporary herbal literature shows that many 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 (Weed, 1989) claimed to reflect the methods of traditional "wise women." The Practice of Traditional Western Herbalism (Wood, 2004), by the author of this paper, purposed to resuscitate herbal conceptions associated with nineteenth and early twentieth century Western medicine.
While this movement was at work, another group attempted to explain the action of herbs according to modern scientific methods. Authors in this vein would include Phytotherapy (Mills and Bone, 2000) and PDR for Herbal Medicines (Medical Economics Company, 1998).
Some herbalists attempted to bring the older perspective into relationship with the new. One such author would be Hoffmann, The New Holistic Herbal (1992) and Herbal Medicine (2003). However, in the opinion of the present author, the herbal community today tends to divide into two camps, one seeking to establish Western herbalism on an alternative, holistic basis (using a diversity of sources), and the other attempting to adhere to biomedical standards.
If this opinion is correct, then Western herbalism would appear to be in the phase Kuhn (1970) called 'scientific revolution,' when different paradigms and their supporters are in competition. Such a situation would recommend herbalists to the study of the concept of the paradigm and paradigmatic change. The current paper attempts to provide the basic materials for such a study. It is intended to support herbalists who want to be in charge of their own destiny, by developing a profession based on paradigms consciously examined, compared, and selected by themselves, rather than by a competing profession imposing standards upon them.
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 -- which 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 would be Ptolemaic astronomy, Copernican astronomy, Aristotelian, Newtonian, and Einsteinian physics, corpuscular optics, and wave optics (Kuhn, 1970). Within Western herbalism the author would note 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 concept, resulting in a continuous development of interrelated information. Problems are 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 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 a different phase Kuhn (1970) called scientific revolution. This is a period of uncertainty during which old paradigms are thrown into doubt and new ones generated.
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 change in instrumentation; in biomedicine it created a new approach or paradigm called "evidence-based medicine" (see page 23).
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 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 interior 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).
Although the concept of the paradigm has been controversial, it has come to be widely accepted. 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. At the same time, the concept has been much overused, and the author would like to close this section by acknowledging that its use demands care. Kuhn himself described it as "hopelessly overused" and "out of control" (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. This is the direction in which they want herbalism to move.
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 Fontanaros, 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 latter date, Kollman and Vickers (1999), published a series of articles on complementary and alternative medicine in the BMJ which acknowledged the existence of the paradigmatic argument.
In a subsequent article in the BMJ, Leibovici (1999) addressed problems he thought were raised by Kollman and Vickers (1999). He addressed the question which therapies and methods in CAM should be subjected to testing and which should not. He admitted that the experimental method of biomedicine was not infallible, but subject to error, bias, and fraud. However, these difficulties may be countered, in some measure, because this method is backed up by what he called a "deep model” (Leibovici, 1999, 319:1631). He does not define what this is, 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 of 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).
Leibovici (1999) uses the concept of the 'deep model' or paradigm to purpose the same approach taken by other biomedical authors: ignore the paradigm of holistic medicine and investigate the contents based solely on the biomedical model. Leibovici (1999) does not actually enter into paradigmatic debate with the other side.
This article 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 "empirical" studies 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. 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.'
The 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 mix up empiricism with 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 experimentalism, 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 which are 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 which 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. 'Appropriate Clinical Trials for Herbal Medicine.'
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.
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. The most recent survey of US consumers indicated that there were more visits (629 million) to CAM practitioners in 1997 than to primary care physicians (Eisenberg, et al., 1998).
About a half dozen prominent concepts or paradigms characterize holistic medicine. Let us examine those most frequently cited, both by exponents and critics. 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 as a continuum, the concept of "energy," and vitalism.
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 (Haller, 1997).
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, educated readers, advances Lovelock's 'Gaia' hypothesis: natural healing is part of a balanced ecosystem. Buhner (2000) argues that pollution from the pharmaceutical industry is destroying the biosphere.
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. The homeopathic 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), originally alternative, but now incorporated into the hospice movement in conventional medicine.
"The positive role of spiritual or religious beliefs in the histories of almost every major alternative approach is difficult to deny" (Goldstein, 1999, 75). Holistic medicine appeals to many people who feel they are spiritual beings and need to make decisions which contribute 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.
Vitalism is the concept that the living body is animated by a spiritual or non-material 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
Biomedicine uses the randomized controlled trial to establish therapeutic methodology. This places the emphasis on the statistical mean rather than the individual person. Holistic medicine, on the other hand, places the emphasis on the individual. Each person is evaluated as unique and each practitioner is accepted as a unique person with skills differing from his or her peers, better in some ways and less in others. The subjective symptoms, attitude, problems, self-evaluation, and conditions of the patient are given greater weight. For many clients,
this is a source of great comfort (Goldstein, 1999, 45),
especially if they have not been listened to or treated as an individual in their biomedical experience. Frustratingly, even a holistic cure deemed successful by the client, or proven successful by biomedical testing, the case history is dismissed as "anecdotal medicine" because individual results are not considered to be statistically reliable (Fugh-Berman, 1996). Both the holistic practitioner and consumer may feel that their positive work goes unrecognized.
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. This paper will describe 'energetics' 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.' 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. This would include the four elements, the five elements, the four qualities of Aristotle, yin and yang, and the three doshas of India. This approach was utilized, even when it was not named, all the way down to the advent of modern biomedicine. 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 (Wood, 2004).
In the opinion of the author, energetic systems appear to be a characteristic device in many systems of traditional and holistic medicine. It is sometimes said that such systems lack a pathological system equivalent to modern biomedicine, and therefore they cannot be used for hints or advice about how to apply traditional remedies, methods, and herbs (Sampson, 2005). However, this argument appears to reflect a widespread indifference on the part of modern researchers to examining the pathological concepts of traditional people and holistic practitioners. The author suggests that the study of energetics should be required before the meaning and value of a given system is accessed by modern researchers.
8. Paradigms and Herbalism
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 which constitutes CAM has been derived from nature. By describing major characteristics of holistic medicine they serve a valid function, but this does not directly contribute to research.
To move to the question to research and the derivation of information from nature, the author suggests that the concept of the paradigm is still useful, but that it has to be utilized in a different fashion. Instead of applying paradigms descriptively, he suggests that they be used to define different methods used to develop knowledge and direct research.
In the Methods section of this paper (page 6) the author's intention to use six basic paradigms pertaining to scientific method was noted. The remainder of the present section will be devoted to an examination of these six different paradigms to determine:
(1) how they have been used in herbalism,
(2) how they are related to modern biomedical research methods, and
(3) how they can be used to design conventional or unconventional methods of
Through the study of the paradigms described in this section the author has come to agree with the assertions by Crellin and Philpott (1990) that the discovery of knowledge of plant properties in Western herbal medicine has been due to a combination of direct experience (empiricism), theories or guidelines (rationalism), and tradition (authority). The author will attempt to illustrate these assertions by reference to primary sources that have contributed to the development of Western 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 which was largely founded upon empirical methods. The 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 (Chadwick, 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 to altering the amounts and kinds of food on the sick to understand their effect (Chadwick, 1950).
The treatise argues against any standard which 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 (Chadwick, 1950, 17).
It also argues against any standard that is 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 (Chadwick, 1950, 21).
The earliest comprehensive writers on the properties of plant medicines, Dioscorides and Plinius (first century ACE), wre 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 ACE). These will be discussed under the next subsection, rationalism.
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 experience (Rosner, 1989, 346). This approach was still used by Salmon (1709) 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 which can 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 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 serve merely to provide eyewitness testimony and contain few facts that are educational.
The present author has noted that few students of Thomson (1825a) or Scudder (1985a) give more than the occasional case history in their works, though there are some exceptions. He suggests that it is likely this is because the two of them were in the midst of a 'paradigm shift' and needed to try to prove themselves, their ideas, and their remedies to their readers. Their students, on the other hand, were mostly in the period Kuhn (1970) called 'normal science,' and did not feel this need.
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, 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 continue to develop this pragmatic methodology, especially with regard to case histories.
These 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').
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 appraises the importance of the case history in empirical medicine:
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 EBM (Sackett, Richardson, Rosenberg, Haynes, 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 see by their discussion of research in section 6, 'Paradigms and Biomedicine.'
8.1.1. Empirical Research: Taste
Thomson's (1825a, 1825b) chief method of learning about plants was to taste them. This is the method he followed early in his practice when he adopted sumach 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' (Hoffman, 1983), but 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 having her young, 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 after-birth infection, leucorrhea, menorrhea, and vaginal hemorrhage is found in herbal literature (Menzies-Trull, 791, 2003; Medical Economics Company, 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:
Skin sallow, eyes sunken, pulse feeble and quick, temperature 100.5, 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] in an elderly man treated with Rhus aromatica (Goss, 1885). He also documented from his own practice cases of palliation or cure of diabetes mellitus type II 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 would like to point out that from the standpoint of holistic medicine (and traditional Western herbalism), the case series could be organized around an 'energetic' feature, such as excessive flux from any orifice. Thus, a case series for sumach could include hemorrhaging from the vagina, excessive urination, diarrhea, and excessive perspiration.
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. Tradition in Medicine specifically challenges the 'new' hypothesis of the 'four qualities' (hot, cold, damp, dry) and treatment by 'contrary' (hot to cold) which was 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 (Chadwick, 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 (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 (third century ACE) 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).
The author has observed that 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 (Clumston, 1987). The authors 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 provided by Nicholas Culpeper (1990, 376), in "A Key to Galen's Method of Physic." Herbs are defined 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 this organizational theme 'throws into order' the vast array of herbal terminology presently found in Western herbalism, allowing students to classify remedies with greater confidence. Mention has already been made of the Thomsonian or physio-medical system, which offered a rationale somewhat different from the Galenic.The study of these two methods would benefit most practitioners.
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 whole-heartedly 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 (see page 7). Hence, he would apply the arguments of Scheid (1996) to the study of Western herbalism.
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 (1709) 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 descriptions 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) (Carr, 1992, Fugh-Berman, 1996).
Clinical trials are the final and highest level of medical research. 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. The intervention must prove statistically 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. The results can actually only be measured as probabilities and are represented by the 'p value' (p=probability) showing that the result has a low likelihood of 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, 14).
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, Richardson, Rosenberg, Haynes, 1997, 2).
Evidence-based medicine (EBM)] is used as a standard for the study of complementary and alternative methods. Thus, we now see references to "evidence-based complementary and alternative medicine" and "evidence-based herbal medicine" (Guameri, 2005, n.p.). 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 -- see the biomedical journals quoted earlier.
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 pharmaceutical companies and huge financial stakes. 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:e124).
Ioannidis (2005) maintains that most research methods produce results so short of statistical significance, that the findings represent the opinions of the researchers, not 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 doctors are 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).
These figures stopped the author in his tracks: can a method which produces such carnage (and more, since injuries are not recorded) be considered a system of knowledge -- a science?
8.3.1. Pharmacological Research
A student might want to determine whether modern research on sumach verifies traditional herbal usage. The PDR for Herbal Medicine (Medical Economics Company, 1998) gives the following account of Rhus aromatica:
Tannins (8%)- phenolglycosides: 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 (Medical Economics Company, 1998, 1065).
Usage reflects traditional applications of sumach to prevent fluid loss. The once prominent use for diarrhea and dysentery is not noted, probably because of changes in public health.
Evidence-based medicine would encourage the student to make a further step to determine whether there have been additional pharmacological, clinical, or case studies. The present author checked through 'Google] scholar' for modern papers on sumach and found none.
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 a trained Chinese herbalist. All patients received an individualized assessment but not the individualized formula. Three trained Chinese herbalists were used in the study. 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 appears to work within the holistic paradigm of individualized treatment. It should be easy to set up other studies like this, but biomedicists have not often pursued this model. The author would like to suggest a reason why this kind of follow-up has not occurred. Rather than empowering biomedicine, it empowers other professions.
8.4. Visionary Science
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).
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 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 ACE) 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).
He 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 authors includes this as an excellent 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 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). Nor is the visionary experience unique among scientists:
Many scientists have described to me their own experiences resembling that of Kekule (Needleman, 1975, 106).
As mentioned in sections 7.1-7.3, empiricism, rationalism, and experimentation are largely used to provide a kind of 'proof' in herbalism or medicine through observation, experience, reasoning, isolation of facts, and demonstration. By 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 the 'proof' to be provided by the successful application of the insight in practice. As long as vision and dream are not used to provide proof, it seems to the author that there cannot be any opposition to their use either in conventional science or modern herbalism to enhance creativity.
8.4.1. Visionary Research
The only source describing systematic visionary research that the author of this paper could find in modern herbalism is Cowan (1995). The example below is followed by a case history illustrating its successful use:
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).
Cowan (1995) persistently interprets his plant visions to refer to psychological or spiritual states in his patients, although -- as is observable in this account -- the plant does not limit itself to that application. Traditionally, St. John's wort is used for wounds, especially those involving nerves (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 body were torn apart and needed 'cement.'
8.5. Analogical Science
The basic premise of the analogical approach is that there is significance in the resemblance, similarity, or analogy between two separate natural entities. This method forms a very definite tradition in European science, reaching a zenith in Imperial Rome, in the Hermetica, and again in the Renaissance, in Paracelsian 'natural magic' (Pagel, 1982).
Paracelsus (1493-1542) is generally considered to be the chief representative of this method of analysis. He developed special vocabulary to work with this approach. The external form, shape, or signature gives the clue to the hidden identity or essentia of an entity. Thus, every entity in nature has a primordial essence or archetype and the natural world as a whole corresponds to an archetypal world. The latter is the macrocosm (greater world), while the individual is the microcosm (lesser world). The essence or archetype is the source of the medicinal power that works upon the sick, not through mechanical force, but by similarity. Thus, healing is by 'like to like,' not 'hot to cold,' as in the Galenic method (Pagel, 1982).
Paracelsus called this system magia naturalis or 'natural magic' because the resemblance or similarity is not to be seen in the external, material form, but by an internal, 'magical' similarity. He rejects literal 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. An example of this method of thinking would involve the peony (Paeonia spp.), the flower bud of which looks like a cranium, complete with sutures. Peony has been used as far back as Galen as a remedy for the brain, e.g. for epilepsy in children. The author has used it for head injuries with reported improvement from subjects. Several of his friends and students have used it with reported success for convulsion or epilepsy in children. Ironically, this signature does not justify its most famous use, in Greek and Chinese medicine, as a menstrual remedy (Wood, 2004). However, following the analogical method, convulsion of one type (epilepsy) could be considered analogous to spasm of another (uterine).
The term 'magical' can be variously defined as enchanting, occult, irrational, etc. The sense in which Paracelsus uses it 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).
This gives rise to two separate magical principles, which Frazier called the "law of similarity" and the "law of contact or contagion, contagious magic" (Frazier, 1961, 5). The author would go a step further. 'Magic,' as defined both by Paracelsus and Frazier, implies a nonmaterial, non-causal explanation, experience, or (even) world. In this subsection the word will also be used in this context.
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. The English alchemist Thomas Vaughan describes it:
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).
Paracelsus has been credited by historians of science with advocating the direct observation of nature, which in the Renaissance was still a radical break from medieval scholasticism (Pagel, 1982). However, the author would hasten to add that Paracelsus was not recommending observation by the material senses alone, but by material and magical senses together! Taking the peony as an example, the author notes that the analogy between the peony flower bud and the cranium is magical because it does not involve a physical, causal relationship. However, the analogy between the use of peony for epilepsy and menstrual cramp is not necessarily magical, because a physical, causal explanation can be provided, i.e., both are neurological problems.
Frances Bacon (1561-1626) is remembered for his contributions to the reductionistic method of experimental science. However, he too advocated the use of similars and analogies to counteract the compartmentalistic tendencies of reductionistic thinking.
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 purposing a causal, physical relationship in his analogy. Furthermore, he differentiates his kind of analogy thinking from the
superstitious or curious similarities, such as are everywhere paraded by writers on natural magic (Bacon., 1994, 194).
He does not give an example, but he was presumably thinking of writers like Paracelsus. Bacon rejects the 'magical,' non-causal method of analogy, presenting one that is causal.
Yet, Bacon (1994) was influenced by natural magic (Rossi, 1968) and at times he wrote 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, curious, and magical excesses of the analogical method, 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 is invested with at least a faint aura of 'magic.'
Where does this come from? Early on in the writing of this paper, the author had to let the qualitative data speak for itself, and this caused him to separate the visionary and the analogical methods, despite a long tradition that had united them under the revelatory paradigm. Both methods appear to be revelatory. That is to say, they receive insight from beyond normal senses. However, the one receives revelation from a vision or dream, while the other receives it in an intellectual manner. The author suggests that the modus operandi behind the magical/analogical approach as the intuition. The certainty felt by Paracelsus, Vaughan, and Bacon in the 'Light of Nature' is described by Jung as a characteristic of this faculty:
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).
Not only does the intuition bequeath a sense of certainty, but the author notes that it is generally associated with making mental connections between things which were previously not evident. Thus, the intuition would naturally gravitate to similarities, analogies, and 'signatures.'
Paracelsus and Bacon (1994) were trying to practice a scientia intuitiva. A subsequent thinker who may be considered slightly more successful in this regard would be 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. Like Paracelsus, he advocated examination of both the objective and subjective elements of a thing. In order to fully understand something, Goethe felt it was necessary to allow the internal faculties to complete their analysis of the information and not to cut them off, as is the custom in conventional science (Whitelegg, 2003).
As a first step, Goethe advocated a detailed empirical observation of natural phenomena, analogous to the modern scientific concept of 'informed observation.' However, the observer was also to let their imagination and intuition play upon the phenomena. Goethe was convinced that this would spontaneously lead the mind to the inherent idea or primordial essence of the thing. He used traditional Platonic terms like idea (the appearance of a thing in the mind) and his own German creations, such as urphaenomenon (primal, archetypal, key, or essential phenomenon). The final step in the Goethean process involves comparison of imaginative and intuitive data by different people examining the same phenomena; Goethe was confident that the inherent theme of the thing would makes its presence known (Storl, 1990; Whitelegg, 2003).
From the Goethean perspective,
The proper Idea belonging to the phenomenon [is] as objective as is the phenomenon itself (Storl, 1990, 94).
This is the intuitive experience, as described by Jung (1976). The archetype of the thing is as real to the intuitive as a physical sensation.
The internal reality of the archetype cannot, of course, be substantiated by material observation. Thus, the archetypal rebuttal to Plato's idea was rendered long ago by Diogenes the Dog:
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 relationships and contextuality 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 methods (trials, double-blind, the p-value, etc.) to arrive at research conclusions, a mature view would allow intuitive investigation the use of well-defined methods to arrive at intuitive conclusions. As Whitelegg (2003) comments, the doctrine of signatures may have to be reassessed.
Magical and analogical 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 often tried to ignore signatures, but even today it has advocates (Harris, 1972; Wood, 2004, 2005).
8.5.1. Analogical Research
In the 1990s the author was first approached by clients diagnosed with Lyme disease. This is a deer-borne syphilis which is spread to humans through the bite of the tiny deer tick (Buhner, 2005). Without guidance from pharmacology or tradition, the author was forced on his own wits. He used an intuitive or analogical process to find a remedy that many people have found curative:
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, 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.
8.6. Authoritarian Science
When science is successful, it is authoritative. However, the use of authoritarianism in scientific argumentation, in lieu of factual evidence, is classified as a major scientific fallacy (Carr, 1992). The author thinks of science in a continuous tension between authority which is justified by previous research and authority that has slipped over the line into unjustifiable bias.
Milton (1996) collected instances in which science used its authority to oppose significant research. For five years after they began flying airplanes in broad daylight, in front of hundreds of witnesses, the Wright brothers were ignored by the media, government, and general public because contemporary scientists declared that heavier-than-air flight was impossible. More recently, Ornish developed dietary methods to prevent and treat heart disease which the American Heart Association refused to fund for research because they declared heart disease impossible to prevent or improve.
From extensive evidence of this sort, Milton (1996) concluded that a 'scientific taboo' towards innovative and unusual information, methods, and people was characteristic in most 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 spouting opinions outside their field, as 'experts.'
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 overthrow 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. This phenomenonof scientific growth through the "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 (yes, but now we've got it right) (Kosso, 1992, 3).
These examples suggest that authoritarianism should be viewed as a many faceted creature that can have both positive and negative influences upon science.
The importance of authority and its analogue, tradition, are apparent in Western herbalism. The author has often observed that the opinions of the ancient authors -- Hippocrates, Dioscorides, Plinius, and Galen -- are repeated continually down to the Renaissance period (with or without attribution). The Renaissance authors -- Gerard, Culpeper, and Parkinson -- quote them extensively. An early twentieth century source like Grieve (1994) mentions all of these people, and herself gets quoted by more recent authorities. It is not evident that there is any method to the accumulation of material.
During the current period, when Western herbalism appears to be in a period of uncertainty or 'scientific revolution,' the search for authority in the past is almost universal. Books by Western herbalists mentioned in this paper (on p. 6 or elsewhere), seek tradition and authority in many diverse sources including 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. The need to find a tradition to which to belong appears to be a strong force.
Tommie Bass, the old Georgia folk herbalist interviewed by Crellin and Philpott (1990) mistrusted practices that were 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, 85).
Unfortunately, this theme is not further developed by Crellin and Philpott (1990).
The author notes two major problems with tradition:
(1) uncritical accumulation of unsorted material, and
(2) ignorance of well established traditional knowledge.
In regard to the first point, the author suggests that herbalists examine traditional indications to determine is there is a logic behind their usage (Galenic, Thomsonian, Eclectic, or Pharmacological).
Regarding the second point, the author sees the danger in discarding traditional knowledge to be particularly of concern in regard to the introduction of products into the herbal marketplace based solely on modern scientific theory or testing, without reference to tradition or personal experience with the herb. The histories of two different plants illustrate the problem.
8.6.1. Biomedical Research and Herbal Tradition
Elder (Sambucus nigra) has long been used in European folk medicine for fevers, influenza, and respiratory conditions. A number of ingredients (cyanogenetic glucosides, flavonoids, cytokinens) suggest antifebrile and antiviral properties (Hoffman, 2001). 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, for which it has long been used.
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, Yarsano, Zlotnik, Manor, Regev, Schlesinger, and Mumcuoglu, 1995, 4:361).
In Sambucus a congruence 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. After years of research and widespread popularity in the marketplace, a recent exhaustive study published in the NEJM concluded that Echinacea angustifolia showed no clinically significant effect in rhinovirus infections (Tuner, Bauer, Woelkart, Hulsey, Gangemi, 2005). This was followed by an editorial in the same journal which 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. This usage is based on pharmacological speculation about the possible uses of its 'active constituents,' i.e., polysaccharide immunostimulants (Medical Economics Company, 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 and commercialism.
This raises an important question. If so-called CAM practitioners derive their information from modern biomedical sources, without reference to tradition, can they be considered complementary or alternative? In a sense, they are advocates of biomedical methods and findings.
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. This restrictive methodology has been shown to be 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 refers to herbal experience and tradition haphazardly and ignores the opinions and experiences of herbalists. Although clinical trial models have been designed and used which allow inclusion of holistic characteristics of herbal practice, these have 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. Thus, 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
revelatory methods, not commonly used in either biomedicine or traditional
This paper advocates that all 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. This is true of these methods. It is suggested, however, that modern herbalists may need to learn to interpret theories that made sense in the past but have not been sufficiently explained for a modern audience, such as Galenic and Thomsonian ideologies.
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, but this element is wrongly ignored by biomedicists. Hence, empirical study should especially be enlarged upon by herbalists. Herbalists need to 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 lately. 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 the other methods of knowledge-gathering; they draw a person into nature and 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 is accepts all people and all 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, and encourages a more holistic view of the medicinal agent. Rather than perceiving 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. More study needs to 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. From the foregoing methods the author can pull out 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 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 certainly 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 of its applications of plant medicines.
In contrast, the author finds that the biomedical model being applied to herbal medicine is designed in part to disempower herbalism and, used by itself, would seriously undermine the profession. Changes in the method necessary for unbiased and successful research are suggested. The author demonstrates that these methods have been successfully implemented.
These results addressed the questions the author set out to answer. However, he was driven to additional conclusions he did not anticipate. Specifically, he concluded that herbal medicine needs to develop some methods more than others. This conclusion pertains especially to the use of case series studies, a form of empirical research that not only satisfies scientific standards but provides herbalists with information useful in the clinic. Additionally, the author offers his observation, as an herbal teacher and writer, that case histories have illustrative value in the education of students. Thus, this method serves two important functions: scientific documentation of herbalism and improved training of herbal 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 also an 'observational belief' he has picked up while teaching in the herbal community. He is so convinced of this need that he has already published two works on the subject (Wood, 2004, 2005).
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.
The author also concludes that it would be a good idea for herbalists to incorporate biomedical, visionary, and analogical methods and paradigmatic concepts 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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