Written by Simon Mills
What to expect from herbal consultations and treatments
Herbs are the most accessible self care remedies, and for anyone wanting to look after themselves and their families we introduce many on Herbal Reality. However, they are also what physicians have used, and even today around the globe many thousands of doctors and other practitioners still regularly prescribe herbs to their patients. Herbs are very well suited to expert personalised health care, and were the basis of all systems of medicine until modern times. Indeed the classic traditional systems were largely framed by the innate qualities of plant medicines. A herbal practitioner identifies your signs and symptoms and then, following from a detailed conversation with you, clusters them into identifiable patterns. This then leads to a treatment plan and a selection of specific herbs and other life-style advice to form a treatment journey ahead.
Anyone who finds that their healthcare situation is more complex or challenging for self care may find consulting a well-trained herbal practitioner very productive. In the hour or so of a first session it is very encouraging how a careful herb-based treatment plan can break through health logjams.
So where to start?
There is no one type of herbal specialist. Due to a wide variety of national regulations different titles and approaches to herbal practice will be used around the world. In most countries of the world herbalism is the default local community option. However industrialised countries have lost much of that connection, and have often restricted healthcare delivery to registered medical practitioners. Signposts are needed in these countries and the following is a partial guide. Note that when the practitioner does not include ‘herbal’ in the title this may be for legal reasons (prescribing herbs as medicines is restricted to doctors in many parts of the world): one can check whether they provide substantial herbal treatment when making enquiries.
- United Kingdom and Ireland – ‘herbal practitioners’, ‘medical herbalists’, traditional Chinese medicine and Ayurvedic practitioners, ‘phytotherapists’.
- USA – nutritional therapists, herbalists, naturopaths (depending on the State); chiropractors often provide herbal support.
- Australia, New Zealand, Canada – naturopaths, herbalists, medical herbalists, nutritional therapists.
- Europe – across most of the continent herbal medicine is restricted to doctors and pharmacists and is referred to as ‘phytotherapy’; in some German states Heilpraktikers provide an alternative that usually includes phytotherapy; herboristas practise a form of nutritional therapy in Italy, and there are a few similar exemptions elsewhere.
In the UK ancient Common Law rights to consult the practitioners of one’s choice have not been eclipsed by prescriptive state laws as in Europe and the USA, and to a certain extent this is also true in Ireland, Australia, New Zealand and Canada. The UK provides a particularly diverse range of opportunities. Here there are many different traditions and schools of practice, and also a wide range of techniques. However, there are four dominant cultures of herbal practice.
- ‘Western’ herbal medicine combines approaches inherited from the ancient Greeks and Romans (‘Galenic medicine’) with folk practices from around Europe and also from North America. It tends also to adopt the language and some of the approaches of conventional medicine and can usually provide complementary treatment options for modern disease conditions in terms that fit relatively well with the conventional language about health. These practitioners are most likely to provide liquid prescriptions, as individual mixes of tinctures and liquid extracts, along with herbal teas and syrups.
- Traditional Chinese Medicine (TCM) practitioners apply principles drawn from thousands of years of practice and classical texts in China. Various interpretations are applied, although most reflect the harmonisation that followed the formal adoption of TCM after the founding of the Peoples Republic of China in 1949. TCM has a very clear system of assessing physical and mental health using a dynamic system of energetic principles. It often applies well-established and sophisticated herbal formulae though also maintains a tradition of using individualised blends. Pulse and tongue are most often integral to practitioner assessments.
- Ayurveda distils thousands of years of practice and lifestyle in India and is much broader than the prescription of medicines. Although suffering particularly from cultural overshadowing through the 400 years of the British Raj, its roots are very deep indeed and it has flowered strongly, increasingly finding its voice separate from the language of the west. Ayurvedic herbal remedies have also emerged as exciting potential contributions to modern health care needs and we focus on some on Herbal Reality.
- Unani medicine is named from the Arabic for ‘Greek’ and is a thousand-year old revival of Galenic medicine widely practised across the Islamic world, and supported by many university medical schools. Galen was a Graeco-Roman physician of the 2nd century who gave his name to a medicine comparable to that emerging at the same time in India and China. In true Galenic tradition, Islamic medicine is notable for its regard for the specific quality of individual medicines as contributions to prescription blends. In western countries this option is most often provided within Islamic communities rather than into the mainstream.
To find out more where to look for herbal practitioners it is wise to start with their professional associations. These will require standards of education and training, and provide professional codes of practice, insurance cover and other reassurances for patients. You can learn how to find a herbalist here in Herbal Reality.
Common theme I – Sharing stories
A visit to a herbal practitioner is usually very different from a conventional medical consultation (although in Europe some conventional physicians do prescribe ‘phytomedicines’ in their usual practice).
The most obvious difference is that the herbal practitioner usually has no prior case notes to refer to and will want to build a treatment plan from scratch. So a first consultation often takes a good time, usually at least an hour. This allows the personal story to emerge, so that what might start as arthritis or indigestion, turns into an individual journey with unique causes and characteristics. The technical medical name for this process is anamnesis (from the Greek for ‘opening memory’) and this has been contrasted with the usual doctor’s role of diagnosis (Greek for ‘distinguish’): it can simply be summarised as sharing stories.
Story sharing is fundamental to the herbal approach. Although symptom relief is the priority, the way plants best work is to mobilise healthy body functions rather than attack the end results of disease. Rather than focus on the diagnosis of the symptoms, the work of the practitioner is to assess the internal disturbances that lead to them. This will also include learning more of the person’s circumstances, lifestyle and environment, to understand some of the external pressures. However, “herbs do not change the weather” and rather are applied to support the individual’s internal responses to the outer world.
The practitioner will be interested in
- the illness story: learning how the problems unfolded, whether perhaps there are primary events that started the train and which deserve focus; and
- the bedrock: understanding how this particular body jumps when it is pushed. The constitutional assessment is a core feature of traditional systems, recognising that different constitutions account for different reactions to problems.
The aim will be to integrate the constitutional tendencies with the course of events to work out where to apply the herbs most productively, to change the way the body performs. In TCM they call this ‘addressing the root and the branch’.
Herbal medicines have sometimes been thought of as performance enhancers rather than ‘fixers’. They can ‘nudge’ healing functions, improve coping in the face of adversities, and calm disruptions. Using them entails a different sort of conversation with the patient, one that takes time, and effectively draws the story out. An excellent description of the ideal consultation is as a shared ‘healing presence’.
The different languages that practitioners adopt to make assessments are usually derived from various traditional approaches; they can seem confusing. However, all have in common deep roots in the fundamental principles and language of nature.
Common theme II – Out of nature
To understand the origins and power of herbal medicine one needs to step back in time. Before modern scientific measurements and investigations, humans had only their senses and wits to survive. Hunters needed to read all the signs, the terrain, the wind direction, the marks in the ground. Sailors depended for their lives and livelihoods on understanding the seasons, weather, the tides, and like hunters the behaviour of their catch. Farmers would learn to read all the signals for optimum planting and cropping.
Physicians did likewise. For them the body was a microcosm of the rest of the universe, subject to the same climatic and seasonal influences; looking for causes of disease entailed all the primal skills of the hunter. Wise women and the other first herbal healers needed to learn how to read the body’s behaviour in responding to adversities. Early medicine depended on sharp observations of nature. The ancient classic texts of medicine wrote them down.
Modern smart commentators often mock references to hot and cold, damp and dry, yin and yang, the doshas, ‘elements’ and other descriptors from traditional medicine. What they ignore is the real wisdom these terms distil, the valuable insights into the way the human organism behaves as a being in nature, manifesting patterns like any river, sea, field or forest. They confuse the modern science of quantities with the earliest science of qualities: the ability to make sense of and survive our natural environment. As it happens modern science can find useful rationales for these old ideas and the scope for a reconciliation is very promising.
Common theme III – The plants
Beneath all the vast diversity of languages and approaches to the use of healing plants there is an obvious point: there is only one species involved, Homo sapiens. There is an other less obvious point, but as important: the impact of plants on humans is also remarkably constant, around the world and through history.
In our Insight article about herbal evidence we look at classic ways in which plant constituents act on the body, ways that were understood before history, described fully in various classic texts around the world, and reinforced by modern science.
If we dig beneath the thousands of medicinal plants we can find common features, mostly detected by our ancestors through taste, smell and other senses. Those with mucilages are soothing and healing, with resins antiseptic, with aromatic volatile oils settling, with bitters stimulating digestion, with hot spices stimulating circulation, and so on. There is a powerful tool chest of remedies to support healing in the body that we can all share.
Common theme IV – Mind, Body, Spirit
The most common medical view today is that mind and body are separate, mental is different from physical, consciousness is something outside the body. This dualism was first clearly articulated by Rene Descartes (and is referred to as ‘Cartesian’ in his memory) but has origins also in religious traditions of a separate perhaps eternal soul.
In a fundamental sense the work of the original physicians, from wise women through the practitioners of classic traditions of medicine, has been based on an opposite view that there is no real separation between bodily, mental and spiritual functions. Most traditions of medicine see the world in energetic terms, in which the body, mind and spirit are different manifestations of the same being.
Some practitioners do work in a specific religious context, deferring to a higher and separate force, but in industrialised societies these are a minority. For most herbal practitioners all elements of a person’s story are relevant to understanding how to help that person get better. Although herbs are usually seen to move at a physical or physiological level, they can affect the person at any level.
Helping the body to help itself
Consulting a herbal practitioner is different from a visit to a conventional doctor because the work is different. Herbalism applies the characteristics of plant medicines to do what they do best: to help the body do its normal job of maintaining health.
Symptoms are seen as signs that the body is not coping as it should and that it needs help. Herbalists are therefore more interested in understanding how the body performs and where it is slipping up than in diagnosing or fixing a disease. This means a different sort of enquiry: rather than list or measure what has gone wrong they prefer to assess and support what should go right, and apply the plants because they nudge corrective functions in that individual.
The early human insights into medicine based on plants gave us tools that we can use to gently and powerfully nudge ourselves to better health.