We explore how formulations and medicine making of traditional medicine in the west has changed over time.
Traditional medicine in the west did things rather differently. If we go back to Galen the acknowledged authority from Roman times, we see that in his world view the ‘power’ of the individual medicine (or ‘drug’) was foremost. Galen set out what was in effect a ‘research agenda’ for ‘proving’ these powers, based on eight conditions:
1. the drug must be of good unadulterated quality;
2. the illness must be simple, not complex;
3. the illness must be appropriate to the action of the drug;
4. the drug must be more powerful than the illness;
5. one should make careful note of the course of illness and treatment;
6. one must ensure that the effect of the drug is the same for everybody at every time;
7. one must see that the effect of the drug is specific for human beings;
8. one must distinguish the effect of drugs (working by their qualities) from foods (working by their substance).
In effect the physician’s role was to ‘prove’ the individual effect of each drug by direct experience. The fundamental principle in Galen’s work was that nature was an active dynamic force. Treatments engaged these forces, either in the case of drugs through their own dynamic ‘qualities’, or in the case of foods by the qualities of their substance. In classifying the dynamic qualities of medicines, Galen refined the widely established view that they had ‘temperaments’ reflecting well-understood climatic influences: hot, cold, dampness and dryness, each formed of paired combinations of the four elements that made up nature: earth, water, fire and air (heat is generated by fire and air, cold by earth and water and so on).
The elements were associated with four fluids or ‘humours’ in the body, black bile, phlegm, yellow bile and blood, with their associated personality types, the melancholic, phlegmatic, choleric and sanguine. The humours were the cornerstone of therapy and physicians moved to counteract excess (plethora) or deficiency (kenos) in any of them. For excess or toxic conditions remedies were antidota, primarily heating, cooling, drying and moistening as necessary, in degrees, with remedies in the ‘first degree’ milder than those in the third or fourth (which became increasingly dangerous). In deficiency conditions physic remedies were replenishing or supportive.
Galenic principles
This focus on the quality of each remedy was elaborated in the second flowering of Galenic medicine in the 9th-11th centuries, still widely practised throughout the Islamic world as Unani/Tibb (‘unani’ is the Arabic word for Greek). Islamic medicine also pays more respect to the qualities of individual herbs than to formulations, Physicians are expected to understand intimately the nature of each remedy, its natural habitat, its specific energy pattern, actions, indications, specific relationships to the organs, duration of action, toxicity and contraindications, types of preparation, dosage, administration and antidotes.
Interestingly the settler traditions of North America in the 19th century rediscovered Galenic principles themselves. The pioneer Samuel Thomson credited his espousal of heating remedies in fever management not only to native American traditions like the sweat lodge and use of cayenne, but to earlier Greek-Roman concepts. In his widely popular 1835 book ‘New guide to health; or the botanic family physician’ Thomson also espoused vitalistic principles similar to those of Ayurveda and also naturopathy.
- Health follows from obeying natural laws
- Disease is an obstruction or diminution of vital energy
- Disease is caused by violation of natural laws such as:
- hereditary (violation by forefathers)
- lack or excess of exercise
- sudden temperature changes
- wrong diet and over-eating
- poisons and pollutants
- injury
- Symptoms, such as fever, are due to the effect of the disease and are not the disease itself
- Disease has only one basic type of cure – to remove obstructions or restore vital energy using substances that act in harmony with natural laws and the vital energy
- In doing so one or more of the following effects should be accomplished:
- relaxation
- contraction
- stimulation
- soothing
- nourishing
- neutralisation
However neither Thomson, nor his more sophisticated successors in the North American Eclectic and Physiomedical traditions, developed substantial formulation protocols. They did develop deep insights into the vital actions of each herb and so produced the most elaborate materia medicas of the modern age, but like Galen and the Islamic physicians before them clearly kept their focus on the individual remedy. There are formulae in all their books, but it seems these were less important than their role in eastern classic texts.
So discussing Western herbal formulation is much more difficult than the relatively clear descriptions in Chinese and Ayurvedic medicine. Over the course of the last few centuries, largely due to the meteoric rise of allopathic medicine along with various forms of discrimination against Herbal Medicine, much of the traditional language has morphed into modern scientific terminology. The closing of Eclectic schools in America in the early 20th Century, and the removal of Physiomedicalism from herbal education in the UK in the late 1970s, shut the doors on the more formal inclusion of vitalism in herbal training. In the face of various legal threats to practice and coupled with the pressure to ‘modernise’ the profession and promote ‘phytotherapy’ as the modus operandi, much of the framework and language of vitalistic thinking has been obscured.
In spite of its modern appearance phytotherapy can still be seen as the end of a cultural line through western history. The benefits of the phytotherapeutic approach to our understanding as herbalists are of course priceless, however an innate lure to the naturalistic means this cultural void has been filled by a somewhat disconnected approach to herbal pharmacology; some phytochemistry, some science, part Galenical, part Physiomedicalist, part Thomsonian, part Eclectic and probably ‘part’ a few other things depending on the herbalist’s training and experience.
This over-emphasis on molecular herbalism risks leading western practitioners away from differential prescription based on a comprehensively clear set of principles. How do we decide on using Melissa or Scutellaria or Taraxacum or Arctium in a clearly logical and vitalistic manner without a common diagnostic framework that is appropriate to how herbs work? In modern times we have been forced down the anti-inflammatory, antispasmodic, generally-anti route and in doing so diminished our collective autonomy. Do we borrow from Asian traditions, tap into our Celtic past, use our intuition, or justify it all based on 1 out of the 1000s of the chemicals in the plant?
On a more positive note however, if Western practitioners follow the Galenic ideal they formulate from scratch with each patient, starting with a clean sheet of paper and building up an individual blend from a deep insight into the personality of each remedy and their assessment of the needs to the patient in front of them.
A modern approach
There has been much work by eminent herbalists and schools to develop the principles of our herbal traditions into a more cohesive form; Michael Tierra, Anne McIntyre, Graeme Tobyn, Thomas Garran, Jim McDonald to just mention a few have all written useful work integrating different modalities of Western, Ayurvedic, Chinese traditions. Whether its using the Eclectic’s focus on tissue states (hot-cold/wet-dry/tense-relaxed), or re-birthing Galenical energetics, even some education on the levels of strength of each herb a la Culpepper, there is reflection across the community as to how we answer this cultural question about our identity in a world dominated by a primarily reductionist approach. We would do well to hold close Hippocrates’s advice that “Its more important to understand what sort of person has a disease than what disease a person has.”
That being said, the inherent functionality of the plants, and the very practical approach taken by the Western herbal tradition, means a wealth of information about each species is known. Out of all the herbal traditions, Western Herbal Medicine has perhaps most successfully coupled historical knowledge with phyto- and biochemical approaches, leading to a respected place in many communities and some healthcare systems. Although some may debate whether the use of a single plant solely based on a disease name is really ‘herbal medicine’, nonetheless, in Germany for example, phytomedicine is widely dispensed alongside allopathic medicines. And the vast increase in high quality research made possible because of this understanding of phyto- and biochemistry is taking the profession to new heights of interaction with the forefront of medicine.
Generally speaking, like its Galenic, Islamic and North American precedents, modern Western Herbal Medicine categorises therapeutic groups of plants by effects on physiology. Often these ‘actions’ are related not only to the system they influence (e.g. expectorants, nervines) but also the class of phytochemical constituents they contain (e.g mucilages, tannins). Whilst the contribution of Western herbalism to understanding how plants work cannot be underestimated – and new research into the interaction of herbs and the microbiome is revealing startling new insights – this action orientated approach is useful for categorising herbs but it takes you away from seeing the quality with which that activity may work. What a herb ‘does’ is not who that herb ‘is’. To understand ‘how’ a herb initiates change in a given person you need to understand the character of the person and the herb; Valerian (Valeriana officinalis) and Skullcap (Scutellaria lateriflora) are two very different type of nervines and only knowledge of the traditional uses and doses, the guidance of a good teacher, knowing the vitalistic qualities and direct experience can really help to differentiate.
As the fortunate recipients of the wisdom of our ancestors, much of the differential selection of the best herbs for certain conditions has already been done. Of course, all herbs have more than one ‘action’ and experience has distilled these into their main activity (often described as primary and secondary actions). Further to the active nature of the herb, herbs are designated effective differentiators; Aromatic, Astringent, Bitters, Demulcents, Relaxants, Stimulants. So you can have aromatic nervines, bitter nervines etc. Today, secondary activities are often medicalised terms; anti-bacterial, anti-inflammatory etc.
Excellent summaries by Simon Mills & Kerry Bone, David Hoffman, Jill Stansbury are worth exploring further. Also take a look at the References and Biography further down.
Western herbal formula review
Taking Ulcerative Colitis as an example and drawing from David Hoffman’s Medical Herbalism text as an example of a formula for IBS:
- Bayberry (Myrica cerifera) – 2 parts
- Mugwort (Artemisia vulgaris) – 1 part
- Chamomile (Matricaria recutica) – 1 part
- Wild Yam (Dioscorea villosa) – 1 part
- Peppermint (Mentha piperita) – 1 part
- Valerian (Valeriana officinalis) – 1 part
5ml of a tincture 3x/day. A carminative tea also prescribed.
| Action | Herb | Function |
|---|---|---|
| Astringent | Bayberry (Myrica cerifera) | Stops diarrhoea, reduces mucus |
| Bitter | Mugwort (Artemisia vulgaris), Chamomile (Matricaria recutica) | Stimulates digestive secretions |
| Anti-inflammatory | Wild Yam (Dioscorea villosa), Chamomile (Matricaria recutica) | Reduce localised inflammation |
| Carminative | Chamomile (Matricaria recutica), Peppermint (Mentha piperita) | Smooth transition of gas |
| Anti-spasmodic | Wild Yam (Dioscorea villosa), Chamomile (Matricaria recutica), Peppermint (Mentha piperita) | Stop cramping |
| Vulnerary | Chamomile (Matricaria recutica) | Stops bleeding, damage to intestinal lining |
| Nervine | Valerian (Valeriana officinalis) | Treats underlying stress and stress from diarrhoea |
Western herbal medicine classifications
Adaptogens are strengthening herbs that help us adapt to stress by interacting with the endocrine system. They help normalise metabolism and nourish the tissues. Examples include Licorice (Glycyrrhiza glabra), Ashwagandha root (Withania somnifera), Rhodiola root (Rhodiola rosea) and Ginseng root (Panax ginseng)
Alteratives are herbs that ‘alter’ the condition in a tissue by eliminating metabolic waste via the liver, large intestine, lungs, lymphatic system, skin and kidneys. Examples include Burdock root (Arctium lappa), Dandelion root (Taraxacum officinalis), Cleavers (Galium aparine), Poke (Phytolacca decandra) and Nettle leaf (Urtica dioica).
Amphoterics are herbs that bring balance to different organs, tissues and systems by regulating hyper and hypo functioning. Amphoterics create harmony. Examples include Licorice root (Glycyrrhiza glabra), Oatstraw flowering tops (Avena sativa), Hawthorn berry (Crataegus oxycanthoides).
Analgesic: These are medications that are applied internally or externally to reduce pain, Many of them work by depressing the functions of the central nervous system, Examples of effective analgesics include Jamaican Dogwood (Piscidia erythrina), Pasqueflower (Anenome pulsatilla), California Poppy (Eschscholzia californica), Corydalis (Corydalis yanghusuo) and Wild Lettuce (Lactuca virosa). Topically, Aconite (Aconitum napellus) and Cayenne (Capsicum minimum) are powerful anodynes.
Antimicrobials are herbs that interfere with the proliferation and life-cycle of microbes; bacteria, fungi, and viruses. Examples include Thyme leaf (Thymus vulgaris), Echinacea (Echinacea species), Elderberry (Sambucus nigra).
Aphrodisiac herbs are those that nourish, build and stimulate sexual desire and potency. Examples include Saffron (Crocus sativa) and Ashwagandha root (Withania somnifera).
Astringents: This group of herbs contain tannins that act to precipitate proteins and draw tissues together, tightening and toning them to reduce secretions and discharge. Astringents also tend to stop bleeding and can act on tissues with which there is no direct contact. Examples include Raspberry leaf (Rubus ideaus), Lady’s Mantle leaf (Alchemilla vulgaris), Agrimony leaf (Agrimonia eupatoria), Shepherd’s Purse leaf (Capsella bursa-pastoris), Witch Hazel leaf (Hamamelis virginiana) and Yarrow leaf (Achillea millefolium).
Bitters stimulate digestion by enhancing digestive secretion and peristaltic movements of the gut. They act via a reflex from the taste buds to the brain then through the vagus nerve to whole digestive system. Often these herbs are combined with warming digestives to balance the cold nature of bitters. Examples include Artichoke leaf (Cynara scolymus), Gentian root (Gentiana lutea), Wormwood leaf (Artemisia absinthium), Oregon Grape root (Mahonia aquifolium), Goldenseal root (Hydrastis canadensis)
Cardiotonics: These are herbs that bring order and strength to the cardiovascular system. speed up or slow down the heart as needed. Examples include Hawthorn berry and leaf (Crataegus oxycanthoides), Motherwort leaf (Leonurus cardiaca), Lily of the Valley leaf (Convalleria majalis), Garlic bulb (Allium sativum), Lime flower (Tilia platyphyllos), Mistletoe leaf and berry (Viscum album).
Carminative herbs are high in essential oils and help ease digestion by relieving gas, spasms and cramps. Examples include Aniseed (Pimpinella anisum), Fennel seed (Foeniculum vulgare) and Peppermint leaf (Mentha piperita).
Cholagogues and choleretics: Cholagogues promote the production of bile in the liver. A cholereticis a type of cholagogue that promotes the release of bile from the gall bladder into the duodenum. Cholagogues have an alterative and laxative effect. Cholagogues are contra-indicated if there is acute liver failure, obstructive jaundice, painful gallstones or cholecystitis. Examples include Celandine leaf (Chelidonium majus), Barberry root (Berberis vulgaris), Dandelion root and leaf (Taraxacum officinalis root), and Blue Flag root (Iris versicolor).
Demulcents are soothing mucilaginous and silky herbs that can be taken internally to soothe and protect damaged or inflamed tissue. Examples include Slippery elm bark (Ulmus rubra), Marshmallow root (Althea officinalis) and Limeflower (Tilia cordata).
Diaphoretics are herbs that cause sweating by increasing circulation in the periphary of the body. Usually used to help to relieve fevers some examples are Yarrow aerial parts (Achillea millefolium), Elder flowers (Sambucus niger), Ginger root (Zingiber officinalis).
Diuretics are herbs that stimulate the flow of urine, and help remove fluids from the body. Common examples are Dandelion leaf (Taraxacum officinalis), Burdock root (Arctium lappa) and Corn silk (Zea mays).
Emmenagogues are herbs that stimulate and promote menstruation. Examples include Marigold flowers (Calendula officinalis) and Chaste Tree fruits (Vitex agnus-castus), Turmeric root (Curcuma longa).
Expectorants are herbs that assist the body in expelling mucus from the upper respiratory tract. Examples include Licorice root (Glycyrrhiza glabra), Elecampane root (Inula helenium) and Thyme leaf (Thymus vulgaris).
Galactagogues are herbs that encourage the flow of breastmilk. Examples include Fennel seed (Foeniculum vulgare), Celery seed (Apium graveolens) and Shatavari root (Asparagus racemosus).
Hepatics are herbs that generally support liver function by decongesting as well as supporting bile flow. Examples include Dandelion root (Taraxacum officinalis), Yellowdock root (Rumex crispus), Turmeric root (Curcuma longa).
Hypnotics and sedatives: These are medications that promote a deep and relaxing sleep. They may work through muscle relaxant properties, through the action of volatile oils on the limbic system, or through the presence of alkaloids that affect the central nervous system. Chamomile flowers (Matricaria recutita), Lime flower (Tilia platyphyllos), Lemon balm leaf (Melissa officinalis), Wood Betony aerial parts (Stachys betonica), Skullcap leaf (Scutelleria lateriflora), Wild Lettuce leaf (Lactuca virosa), Passionflower aerial parts (Passiflora incarnata), Ashwagandha root (Withania somnifera) Valerian root (Valeriana officinalis), Corydalis root (Corydalis yanhusuo), California Poppy aerial parts (Eschscholzia californica).
Hypolipidemics: These herbs mildly reduce serum lipids, including triglycerides and cholesterol. Examples include Hawthorn berry and leaf (Crataegus oxycanthoides), Turmeric root (Curcuma longa), Guggulu resin (Commiphora mukul), Garlic bulb (Allium sativum), and Cayenne fruit (Capsicum annuum).
Hypotensives: These herbs act to reduce a high blood pressure by relaxing muscles or through a calming effect upon the central nervous system. Examples include Hawthorn berry and leaf (Crataegus oxycanthoides), Garlic bulb (Allium sativum), Lime flower (Tilia platyphyllos), Cramp bark (Viburnum opulus), Valerian root (Valeriana officinalis), Motherwort leaf (Leonorus cardiaca) and Mistletoe leaf and berry (Viscum album).
Immunomodulants: These herbs restore balance to a dysfunctional immune system. These are often used in chronic autoimmunity. such as Crohn’s and multiple sclerosis. Many immunomodulants are adaptogens, and vice versa. Examples include Reishi mushroom (Ganoderma lucidum), Astragalus root (Astragalus membranaceus), Licorice root (Glycyrrhiza glabra), Siberian Ginseng root (Eleuthrococcus senticosus), Ashwagandha root (Withania somnifera) and Cordyceps (Cordyceps sinensis).
Immunostimulants: These herbs stimulate the immune system protecting against infection, including non-specific mechanisms, and the specific mechanisms of humoral and cell-mediated immunity. Many immunostimulants are antimicrobials and vice versa, and are used in both acute and chronic infection. Examples include Echinacea root and leaf (Echinacea spp.), Garlic bulb (Allium sativum), Myrrh resin (Commiphora myrrha), Thyme (Thymus vulgaris, Andrographis leaf (Andrographis paniculata),) and Wild Indigo (Baptisia tinctoria).
Laxative herbs are those that stimulate or promote bowel movements. There are different types of herbs; gentle aperients, like Dandelion root (taraxacum officinalis), that have a mild effect; bulk-forming laxatives, like Flaxseed (Linum usitatissimum), that increase the water and bulk of the stool; stimulant laxatives is Senna leaf (Senna alexandria) that invigorate the muscles of the lower bowel to create a stronger motion.
Nervines are herbs that soothe the nervous system and have a calming effect on the emotions. Examples include Oatstraw flowering tops (Avena sativa), passionflower (Passiflora incarnata), Lavender (Lavandula officinalis), St. John’s Wort (Hypericum perforatum), Rosemary leaf (Rosmarinus officinalis), and Gotu Kola leaf (Centella asiatica).
Rubefacients: When applied externally these herbs cause a mild local irritation and draw blood to the area through capillary dilation. Rubefacients are used to enhance blood supply to localized areas to remove congestion and promote healing. Examples include Cayenne fruit (Capsicum minimum), Mustard seed (Brassica spp.), Ginger root (Zingiber officinalis), and Peppermint leaf (Mentha piperita oil)
Sialogogues: These are medications that stimulate production of saliva to treat dry mouth, poor digestion, receding gums and infection including Prickly Ash bark (Zanthoxylum americanum), Echinacea root (Echinacea spp) and Spilanthes flower (Spilanthes acmella).
Tonics is a slightly controversial term as it seems to apply to herbs that bring tone to an organ or tissue. It is also used to refer to herbs that help the whole system to function better acting as general energy boosters. Examples of herbs that bvring tone to the tissues are the astringent Goldenseal (Hydrastis canadensis) and Ground Ivy (Glechoma hederacea). Those that bring energy are Cacao (Theobroma cacao), Oatstraw flowering tops (Avena sativa) and Ashwagandha root (Withania somnifera).
Vulneraries: These are wound-healing herbs used internally and externally. Astringent herbs such as Witch Hazel (Hamamelis virginiana) and Shepherd’s Purse leaf (Capsella bursa-pastoris) directly stop bleeding and promote the formation of an eschar (scab). Mucilaginous herbs such as Plantain leaf (Plantago lanceolata) and Selfheal leaf (Prunella vulgaris) soothe inflammation. Some vulneraries are used internally to speed tissue healing, including Marigold flower (Calendula officinalis), Plantain leaf (Plantago lanceolata), Selfheal leaf (Prunella vulgaris), and Marshmallow root (Althaea officinalis).
Quality and Pharmacopoeias
And Western Herbalists and phytochemists have taken the chemical insights to whole new levels of expertise, allowing for deeply scientific view of the inner workings of how the herbs behave in and act on the body. This has led to a specific understanding of how some species work, greater safety and improved quality standards. The Monographs in The British Pharmacopoeia (and Indian, Chinese, European, USA etc) list the levels of marker compounds denoting medicinal grade. A pharmacopoeia (a word from the Greek for ‘knowing medicines’) is an official reference text containing a collection of standards to assure the quality of the medicines you can get from a doctor or pharmacy. Many herbs are used as medicines and their medicinal standards are published in the pharmacopoeias:
| Herb name | Food grade ISO 6571/1984 | European Pharamocopoeia |
|---|---|---|
| Chamomile flowers | Min. 0.2% essential oil | 0.4% essential oil Apigenin min. 0.25% |
| Fennel seed (sweet) | Min. 1% essential oil | Min. 2% essential oil (specifying that 80% of this must be anethole with a maximum of 10% estragole and 7.5% fenchone) |
| Peppermint leaf | Min. 0.6% essential oil | Cut leaf min. 0.9% essential oil Whole leaf min. 1.2% essential oil |
The attention to safety with regards contaminants (microbiological, heavy metals, pesticides, pollutants, extraneous materials) as well as quality in terms of upper and lower limits of important compounds) has brought the practice of clinical herbalism into the highest standard of safe and effective healthcare.
Prescribing Regulations
Please note that there are specific dispensary standards for blending herbs for individual use that must be followed by practitioners in the UK as a part of our commitment to safe and effective practice through self-regulation. Please refer to your Practitioner Association for the specifics.
References and bibliography
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