General Tinio order Lyrica Esam bhutanam prthivi rasha, prthivya apo raso-pam osadhayo rasa, osadhinam puruso rasah;
[The essence of all beings is Earth. The essence of the Earth is Water. The essence of Water is Plants. The Essence of Plants is the Human Being….]
Chandogya Upanishad, sixth century CE Vedic text
Healing in nature
Thus, are the philosophical underpinnings of human existence recorded in the Chandogya Upanishad, a Vedic text dating to the Brahmana period sometime before the sixth century CE that clearly articulates the dynamic relationship that exists between humans, plants, and the environment overall. Similarly, the philosophy of Vis Medicatrix Naturae (the healing power of nature), as set down by Hippocrates summarizes the basic principles of healing; namely that the body as a living biological organism is always trying to achieve a state of health and balance and that an observed malady is the body’s attempt to reestablish equilibrium (Grube 1954; Hiroshi 1998). This connection between human health and nature is a philosophical underpinning of many traditional healing systems worldwide (Payyappallimana 2010), but is a perspective most often overshadowed or completely lost in attempts to push herbal medicine into a level of acceptance in modernity. Ancient healers recognized the human organism was made of the same substances that existed in nature and thus is an extension of nature. Therefore, so it was reasoned, that healing was facilitated through nature and substances of nature; namely fresh air, pure water, sunshine, good nutrition, exercise, and herbal medicines, and, including in shamanistic or religious healing practices, invocation of ancestors, saints, spirits, and deities.
The practice of herbal medicine, historically followed two paths. The first of these was rooted in relative simplicity; an herbalist gathering plant medicines and attending to the needs of the sick in a system that can be defined as community-based health care. These were, and in many countries today, are, the folk healers, grandmothers and grandfathers learned in the use of medicinal plants. The second path was that of professional practitioners. In ancient times, some of these were among the most learned of their generation and are well represented from the 1st to 15th centuries CE in works such as De Materia Medica of Dioscorides and the Hippocratic Corpus of Hippocrates, both of Greece, the Charka Samhita of India, and the Shennong Bencao of China, followed a few centuries later by the Canon of Medicine byIbn Sīnā (Avicenna) of Persia and several centuries later by the Renaissance herbal writers such as Fuchs, Gerard, Mattiolis, Parkinsons, and Salmon, and the later Chinese authority Li Shizhen’s Bencao Gangmu, to name only a few. The use of herbs within these formal medical traditions was integrated with very sophisticated theories of anatomy, physiology, and pathology. Conversely, folk healing traditions predominantly represented an empirical use of herbs passed down through families, community knowledge, and fragments of the more formalized medical practice. While the humoral system of Hippocrates, Galen, and to a great degree, Avicenna, was the ancestor of today’s medical theories, today’s conventional Western medical practitioners have no relationship to these past theories, with a belief of the scientific superiority of current theories.
In contrast, the medical theories of Ayurvedic and Chinese herbal medicine remain intact, continue to evolve, and continue to be practiced according to their same historical foundational principles, and often with correlative understandings informed by western science. Inherent in both Ayurveda and traditional Chinese healing systems is the belief that humans are an extension of nature and therefore, the theoretical principles developed were inherently designed to mimic nature and facilitate healing by adhering to vitalistic principles reflected in nature. These principles include the tri-doshic and five element (wu xing) systems of Ayurvedic and TCM, respectively, both of which relate human anatomy, physiology, pathology and dietary and herbal therapies to, in Ayurveda, vata (air), pitta (fire), and kapha (water) (which themselves consist of earth, water, fire, wind, and ether); and in TCM huo (fire), tu (earth), jin (metal), shui (water), and mu (wood). In contrast, current western medical traditions possess no principles that inherently link human health with the living biological principles of nature, and only tangentially as an after thought, attempt to link health to behavior or lifestyle. Traditional healing systems inherently seek to bring human beings into a healthful balance with self in relation to their environment. In contrast, the focal point of Western medicine is symptom suppression, inhibiting the very healing response meant to restore homeostasis to the organism.
The vitalistic principle of traditional healing systems
Traditional healing systems are commonly regarded as vitalistic or holistic, while Western medical philosophy is often described as mechanistic, reductionist, or rationalistic (Coulter 1975). This latter rationalistic perspective is based on the perception that development of modern medical theory and drug development was founded on rational scientific principles, implying that traditional herbal medicine knowledge lacked a rational basis, a premise countered by noted medical historian John Riddle (Riddle 1997).
The belief in traditional healing systems that human health is an extension of environmental health and that it is the relationship between the two upon which health is dependent, is in stark contrast to the philosophical basis of modern anatomy and physiology. Harvey’s (1578–1657) articulation of the circulatory system in the 17th century provided fertile soil for new mechanistic theories that challenged old humoral theory. However, the concept of circulation was described in the foundational text of TCM, the Neijing and by Galen centuries before. Noted French physiologist Claude Bernard (1813–1878) posited that the human environment (milieu intérieur) was separate from the external environment. Others, such as the noted German physician Rudolf Virchow (1821–1902) stated the cell was the basic unit of the body that had to be studied in order to understand disease. Bloodletting and purging with Paracelsun-type mercury compounds, the primary medical therapies of the 18th and 19th centuries employed by allopaths, were being used with little documentation of their clinical effects (Riise 1997). While traditional health practitioners gave focus to the macrocosm of all that makes up an individual’s life and health status (constitution, diet, lifestyle, environment, physical activity, stress, sleep) (Risse 1997), modern medical research gave focus to the microcosm of cellular biology. The visualization of microbes with the advent of the microscope by Holland’s Anton Van Leeuwenhoek (1632–1723), Pasteur’s (1822–1895) confirmation of the potential pathogenicity of germs, and Fleming’s (born 1881) discovery of antibiotics, further concretized the material cause and cure of disease, which in turn solidified the reductionist, militaristic, search and destroy approach typical of western medicine today and completely ignored the intimate relationship between human and environmental health.
In both Ayurveda and TCM, as well as naturopathic medicine, patient therapies are very much individualized and have remained physician- and patient-centered, the practitioner predominantly making their assessment through observational means reflected in the eight methods of diagnosis of Ayurveda (astavidha pariksa) and four examinations (si zhen) of TCM. Similarly, the traditional health practitioner takes into consideration the cause of disease, which for chronic illnesses, is almost always due to unhealthy lifestyle practices, and then work to correct the underlying causative factors while providing therapeutic options to address both cause and symptoms, codified in TCM as biao and ben or treating the “root and branch”. This is in stark contrast to research-based Western medical practices, which develop “standards of care” for diseases, in contrast to individualized healing protocols for patients. Rather, western diagnostics is not guided by any understanding of the individual’s lifestyle that initially led to the disease state, but rather relies on mechanized diagnostic tests of specific biomarkers that reflect the end result of the disease process not the cause. This results in an almost exclusive focus on the symptom and an almost complete neglect of the cause. This perhaps represents the primary differentiation between traditional and conventional healing philosophies.
The primary schism between traditional and modern medicines
Prior to the 15th century, the majority of medicinal agents were plant-based. While numerous medicinal agents of mineral and animal origin were also used, the overwhelming majority of medicines, as reflected in the De Materia Medica of Dioscorides, were plants (Gunther 1934; Riddle 1985). In the 15th century, the Swiss-German physician Philippus Aureolus Theophrastus Bombastus von Hohenheim, otherwise known as Paracelsus (1493–1541), pioneered the use of concentrated and relatively pure (for the time) chemicals in medicine. Perhaps more importantly, Paracelsus challenged, what at the time, was a relatively strict adherence to the medical philosophies of ancient texts, including those of Galen, Avicenna, and others, books of whom he actually burned at the University of Basel, Switzerland on St. John’s Day in 1527. The earlier teachings of Galen posited there were four physiological humors (blood, phlegm, yellow bile, and black bile) originally taught by the Greek philosopher Pythagoras (570 BCE-495 BCE) and that when in balance, there was health. The humoral theory persisted as a prominent medical theory until the middle 1800s (Estes 1997). Paracelsus argued there were three humors; salt representing stability, sulfur representing combustibility, and mercury representing fluidity. While both theories are considered by today’s theories as archaic and inherently limited, this shift marked a significant divergence in medical thought that has great impact today. In contrast to the foundational principles of Galenic thought that were physiologically based, Paracelsus shifted medical thought by giving focus to the actions of drugs, in other words, a pharmacological basis of understanding medicine, which predominates today. Another seminal change credited to Paracelsus was that, while Galenists believed that a disease of a certain character or nature would be cured by a remedy possessing the opposite effect, a precept similarly espoused by the famed Chinese Tang Dynasty physician and alchemist Sun Simiao (581–682 CE), Paracelsus and his followers argued that “a poison in the body would be cured by a similar poison”. While contemporaries of Paracelsus felt the substances he was recommending were too toxic to be used safely, Paracelsus defended his position with his oft quoted:
“Alle Ding sind Gift, und nichts ohne Gift; allein die Dosis macht, daß ein Ding kein Gift ist.”
(“All things are poison, and nothing is without poison; only the dose permits something not to be poisonous.”)
His challenging of the medical authority of the day resulted in the banishment of Paracelsus from Basel and the revolutionary physician died at the young age of 48 (Borzelleca 2000). Never-the-less, the teachings and writings of Paracelsus took on many adherents and charted a path in medicine that was alternative to the current medical thinking of the day and can be characterized as the progenitor of the modern, chemically refined, and highly toxic pharmaceutical medicines of today.
Other seminal events in medical history charted the course that led to today’s medicine. In 1805, a German apothecary apprentice named Friedrich Wilhelm Adam Sertürner isolated what was to become the first pure, presumably “active” compound of a plant—the alkaloid morphine from the opium poppy (Papaver somniferum) (Kapoor 1997). With the isolation, of morphine, an alkaloid making up approximately 10% of the total alkaloids of the plant (Kapoor 1995), medical researchers suggested that the whole plant need not be used as a medicinal preparation but rather that one could extract an active constituent. Sertürner referred to his new compound as principium somniferum or “sleep making principle”, later naming it morphium, after Morpheus the Greek God of dreams or sleep (Booth 1996). Subsequent decades witnessed the isolation and eventual synthesization of pure compounds and the race for “active” constituents began changing medicine from whole plant-based to individual chemical-based entities. Whereas Serturner posited that the whole plant was no longer needed, the emergence of synthetic chemistry posited that the plant was not needed at all changing the nature of drug development that has persisted to the present day. Traditional herbalists wonder what effects the other 90% of compounds in poppy contribute to either the safety or efficacy of the drug, while traditional herbalists and WHO continue to regard the whole plant as representing the activity of a traditional medicine.
During the same time period, the medical and pharmacy professions were undergoing rapid changes. Originally, it was physicians, often referred to as “medical botanists”, who were the primary teachers of materia medica and founders of early pharmacopoeias. As the pharmacy profession evolved, pharmacists began assuming an oversight role on the quality control of medicines. Later, pharmacognosy evolved as a sub-discipline of pharmacy, initially with an emphasis in the quality of crude drug materials. In modern times, this focus changed to searching for compounds in plants that were candidates for modern drugs. Subsequently, physicians became the sole prescribers of medicines, pharmacists became the primary and formal dispensers of medicines, and pharmacists and pharmacognosists assumed the primary role of drug development and quality control, as represented in the development of early pharmacopoeias.
The switch from botanical- to chemical-based medicine is clearly evidenced in the evolution of the United States Pharmacopeia (USP), which in the first edition of 1820 included approximately 150 herbal drugs, or 50% of the total approximately 300 listed drugs at the time (USP 1820). By 1950, herbal drug monographs in the USP numbered approximately 50 of the more than 1100 preparation entries (a little more than 4%) (Boyle 1991; USP 1950). This lack of representation of herbal drugs is in sharp contrast to the almost exclusive inclusion of herbal medicines that comprised the Pharmacopoeia Augustana of 1564 (Husemann 1927).