Roy Upton explores how traditional healing systems have developed in developing countries compared to the West.
At the heart of most all herbal medicine traditions is a relationship with earth and the natural world. This stems from the inalienable fact that humans are an extension of the natural world, are dependent upon the natural world for their survival, and that what affects the natural world affects human health (e.g., diet, pollution, etc.). This relationship also extends to cultures, some of whom for generations have either cultivated medicinal plant crops or harvested them from the wild, and forms the basis of countless economies worldwide. While over-harvesting of medicinal plants can have a negative environmental effects, cultivation or wild harvesting of medicinal plants when done according to Good Agriculture and Collection Practices (GACP), international standards for which exist (e.g., WHO 2003; AHPA, among others), creates incentives for land preservation and maintains and fosters environmental stewardship of natural resources, thus ensuring future supplies of medicinal plants. Overwhelmingly, development and loss of land is the primary reason for loss of biodiversity and species.
Juxtaposed against the largely positive environmental impact of medicinal plant trade is the largely negative environmental impact of pharmaceutical medications, which have significant consequences on both human and environmental health. There are two primary sources of pharmaceutical pollution; pharmaceutical production and the pollution generated therefrom through effluence and emissions, as well as the excretion of medications and their metabolites ingested by humans and farm animals. In the US, a report from the US Geological Survey detected pharmaceutical contaminants in 80% of 139 streams sampled. Contaminants included antibiotics, hypertensive medications, antidepressants, analgesics, reproductive hormones, and other prescription drugs that also affected municipal water (Glassmeyer et al. 2005; NRDC 2009). The most stark environmental impact of pharmaceuticals has been from endocrine disruptors, partially due to metabolites excreted in urine from oral contraceptive use. A 2007 study reported that 75% of male smallmouth bass in certain areas of the Potomac River basin (US) had ovarian tissue in their gonads resulting in a feminization of the fish (Blazer et al. 2007).
Other studies report similar negative effects directly associated with oral contraceptives delivered through municipal wastewaters affecting fish populations (e.g., Kidd et al. 2007). In another study, fish exposed to effluent from a cattle feedlot in the US state of Nebraska experienced reproductive abnormalities, including reduced testes size in male fish and a lower level of estrogen in female fish (Orlando et al. 2004). Other studies link such xenoestrogen exposure to testicular and breast cancer in humans (Wright-Walters and Volz 2007, and references therein). The US Geological Survey (Glassmeyer et al. 2005) reported finding nonprescription pharmaceuticals in more than 40% of the municipal water samples tested; prescription and nonantibiotic pharmaceuticals in more than 30% of samples. Moreover, the ubiquitous overuse of antibiotics, especially in farm animals, bioaccumulate in soil potentially giving rise to antibiotic resistance pathogens (NRDC 2009), that is already a serious international health care crisis.
Such events are not limited to the US. In Pakistan, the non-steroidal anti-inflammatory (NSAID) diclofenac was linked to widespread die off of vulture populations leading to the listing of three vulture species as endangered (Arnold et al. 2013, and references therein). Moreover, the same drug increases the risk of heart attack in humans (Kearney et al. 2006). A number of surveys in Germany report that 95% of the pharmaceuticals studied are not readily biodegradable; 15% are persistent in surface water, approximately 50% of veterinary pharmaceuticals studied are persistent in soil, and a large number of pharmaceutical substances and metabolites can be found in wastewater and surface water throughout Europe.
Standard long-term tests conducted with fish, daphnia, and algae as test organisms revealed effects at pharmaceutical concentrations of less than 1 mg/L, while one study described changes in aquatic organisms at much lower concentrations of less than 0.001 mg/L (EEA 2010). There currently exists little health risk assessment data regarding the potential adverse effects from chronic exposure to the myriad of pharmaceuticals that accumulate in the environment. From a traditional herbal medicine perspective, it is incongruent to have a healing system that, in addition to killing more people than cigarettes and alcohol from gross adverse effects, is so inherently toxic to the environment that it contributes greatly to human disease. Conversely, medicinal plants have co-evolved with the environment for millennia and such negative consequences do not exist in healthy ecosystems.
Spiritual wellbeing
Lastly, an often neglected or completely shunned aspect of modern traditional herbal medicine is the role medicinal plants can play in spiritual health. This is largely due to modern medicine’s attempt to be scientific, a paradigm that, when applied in a typical manner, tends to divorce human and material existence from any precept of spirit, whether spirit is defined from a creationist or evolutionary perspective, or from a perspective of humanity’s relationship with each other, and the relation of humans to the larger world or creation.
In many systems of traditional healing, spiritual well-being is the highest ideal to achieve. In a practical sense, this means an attainment of a sense of peace and harmony with self and one’s surrounding world. In Ayurveda, for example, significant emphasis is placed on mental and emotional well-being through the incorporation of meditative practices, prayer (puja), and therapies such as pancha karma and shirodara, designed to promote a long life of physical, mental, and emotional well-being. Numerous herbs figure into a variety of spiritual practices. In India, the herb tulsi (Ocimum sanctum) is highly revered and by some is considered the wife of god Vishnu (Vishnupriya). Tulsi is central in Tulsi Vivah, a ceremony marking the end of the monsoon season and beginning of the Hindu wedding season, the rites of which are described in Hindu scripture. Among some regions of India, households grow tulsi plants and perform ceremonies by circling the plant reciting mantra morning and evening. Also in India, the Hindi avatar Dhanvantari is depicted as Lord Vishnu with four hands, holding medical herbs in one hand and a pot containing a rejuvenating nectar called amrita in another. Dhanvantari is also considered the God of Ayurveda.
In Western herbal traditions stemming from ancient Greece, the botanical genus Asclepias (commonly known as milkweed) is named after Asclepias, the Greek God of medicine. Thus, in most all medical traditions, including those in the West, there was an innate relationship between physical and spiritual health that was connected through plant-based medicines.
In TCM, especially in Taoist practices, there was and continues to be great emphasis of aligning one’s life with the spiritual will of heaven. In the five phases (wu xing) theory of TCM, each of the five major organ systems is correlated with a spirit that both serves to guide one to one’s authentic self that can be cultivated through various physical and spiritual practices. In this regard, the use of herbs served to facilitate this cultivation. In TCM principles, the shen (spirit or mind) is housed in the heart; the hun (ethereal soul) in the liver; the po (corporeal soul) in the lungs; yi (intellect or ideation) in the spleen, and zhi (will) in the kidneys. In turn, the physical manifestations of each of these organ systems affects these various “spirits” (wu shen). According to Chinese medical philosophy, the hun governs one’s nature. It drives and has the ability to nourish one towards their destiny. When in disharmony, the hun wanders aimlessly or perhaps violently, and in either case, cannot direct one to their greater good or expression.
The yi or intellect represents our ability to discern ideas and experiences and to form intent; intent of thought and action. When in disharmony, the judgment of the yi is clouded or misguided. The po most closely reflects human instinct, our inner knowing despite having all the facts; our gut senses, and is inherently limited to expressing our greatest self in one lifetime. When in disharmony, the po can cause us to act on gross human desires without considering the larger consequences of such actions. The zhi or will, provides, or not, the motivation to accomplish and act on intent. When in disharmony, the ability to act according to what is in the best interest of the five spirits is impaired. Lastly the shen or mind (xin) is regarded as consciousness itself. On a physical level it is our level of peace of mind, while on a more esoteric level it governs our ability to mobilize all the other shen to their higher purposes, imparting benevolence, compassion, and love when healthy, and muddled or erratic thinking and lack of the aforementioned positive qualities when in disharmony. The shen, yi, po, zhi, and hun are said to be “housed” in the heart, spleen, lungs, kidneys, and liver, respectively and are therefore influenced either positively or negatively by the physical health or disease of these organ systems. As such, herbs and formula that support the health of these systems support the higher goals of spiritual self, compassion, and love for humanity for which humans are capable.
While some of these concepts may seem archaic and religious, possibly not worthy of inclusion in modern medical thought, in the context of human and social health, the attainment of mental, emotional, and social well-being is a central doctrine to most concepts of health as articulated by the WHO (1946) as:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Thus, any complete healing system must take into account how an individual can attain, or a practitioner can facilitate the attainment, of higher states of health and healing than simply the removal of symptoms. This is the highest ideal of traditional healing systems that has no foundation or construct in the current Western medical delivery system, pharmaceutical industry, or modern pharmacognosy. It is only through traditional healing systems that such a level of health and healing can even be considered. Whether one is willing to apply what many consider to be spiritual aspects of healing to modern medicine is a matter of choice. In a more material sense, the recognition of the role pharmacognosy plays in human health was succinctly stated by DiPasquale (1984):
“Pharmacognosy is the science of drugs that originate from living beings and are studied to help other living beings.”
Proposal for a new paradigm
The benefits obtainable through the proper use of herbal medicines are inherently different than those attained through standard use of pharmaceutical medications and Western disease care paradigms. Because of this, a different paradigm for ensuring the integrity of traditional herbal medicines is to apply scientific investigation in a way that fully honors the unique characteristics of traditional healing systems. First and foremost is, through human investigation, understanding the scientific basis of the theoretical healing principles of our varying healing traditions, pharmacologically, physiologically, and pathologically and with an emphasis on patient outcomes. All other experimentation is abstract and of limited utility. Second, and most importantly regarding herbal medicine, is intensive investigation of what constitutes a “quality” herbal medicine that would then drive the quality control guidelines and requirements of the supply chain so as to ensure appropriate quality of herbal medicines in a manner that is truly independent of commercial influence and has scientific integrity. Such investigation could include a myriad of testing parameters. First of these would be proper identification of starting plant populations followed by morphological and organoleptic profiling of botanicals growing in their natural habitat and then to codify these characters in pharmacopoeias, GACP guidance documents, and in regulation or practice, as was done historically.
Chemical profiling of the botanicals can allow for making determinations of optimal harvest times, drying, processing, extracting, and storage conditions. Morphological, organoleptic, and chemical characterization can also help determine what species of plants can be used interchangeably, again, in manner that was similarly done historically. In the world of medicinal plant research, focus can be given, not only to Western pharmacological mechanisms but to how those mechanisms correspond, or not, to traditional characteristics such as taste, smell, and sensation of the botanical; or to make a scientific determination of what it really means for an herb to be classified as a ‘yin tonic’ or to ‘pacify vata’. Clinical investigation could also look at the application of the traditional medicine within the context of the lifestyle recommendations that usually accompany such prescriptions, emphasizing the holistic approach typically employed by traditional healers versus the lack of emphasis regarding lifestyle changes that dominate in Western medical care.. Such investigation can open a world of therapeutic possibilities for health care that is greater than what either traditional or modern systems offer alone. Such inquiry could then more fully inform the practice of both paradigms of medicine, creating new opportunities for research and practitioner training, product development, and environmentally sustainable economies.
Conclusion
While developing countries continue to rely on traditional healing systems for their primary health care needs, there is an ever increasing recognition in developing countries of the value these traditional healing systems have in human health and as a part of modern health care systems. This is a phenomenon occurring internationally. Herbal medicines serve an integral role in traditional healing systems and there is a need to preserve, promote, and continue to develop the traditional knowledge base needed for ensuring the identity, purity, and quality of botanical ingredients. Pharmacopoeias play a key role in these processes. However, in most Western countries, pharmacopoeial monograph systems developed as chemistry was overtaking crude botanical medicine and drugs were evolving into pure, isolated, and then synthetic compounds, in contrast to the multiple compounds and broad array of pharmacological activities inherent in herbal medicines. Because of this, modern pharmacopoeias, and subsequently regulatory systems, attempt to characterize botanical medicines in the same way they do pharmaceutical medications. Lacking in this system is a realization that traditional herbal medicine systems have a distinct way of understanding their materia medica that is vastly different than western pharmacological approaches. Rather, over several millennia, knowledge of plant-based medicines evolved based on the properties inherent in the plant, that includes a plant’s chemistry, and is reflected in the flavor, smell, and qualities as ascertained through sensory evaluation. More importantly, in traditional; healing systems, botanicals are applied in a manner that is similarly distinctly different from the typical western model whose focus is on disease pathology and symptom suppression in contrast to the improvement of human health and the elimination of the underlying cause of disease. In traditional medical systems, herbs are used to promote health, vitality, and longevity, and treat disease, and ameliorate symptoms. In conventional western medical practice, there is a single focus on pathology and almost no emphasis on health. Whereas there are hundreds of botanical medicines that are used to promote health, there is not a single pharmaceutical medication designed to promote health and vitality.
Driving the popularity in traditional herbal medicine is a desire on the part of consumers to be healthier. Another significant factor are the many failings of modern medicine in dealing with many diseases, most specifically, chronic degenerative diseases for which pharmaceuticals offer only palliative care, as well as the significant dangers posed by pharmaceutical medications, which are widely recognized as one of the leading causes of preventable deaths. Yet a last, but little recognized driving factor for the popularity of herbal medicine is its potential for environmental sustainability. Preserving herbal medicine preserves cultural knowledge, cultural integrity, environmental integrity, and the integrity of human health. If herbal medicine is to survive and thrive for future generations it cannot simply be approached using the same models as those used for pharmaceutical medications. Similarly, pharmacopoeias and regulatory systems must evolve to take into consideration the unique philosophies and traditional systems in which herbal medicines are applied and not simply reduce herb quality assessment to a chemical test. Rather, all aspects of the source of medicinal ingredients from the field to the pharmacy must be taken into consideration as was done historically by herbalists and early pharmacognosists. If modern pharmacopoeias and regulatory systems can evolve to integrate traditional healing knowledge and practices, herbal medicine can thrive and reach its full potential in serving humanity. If not, it will continue to survive and be utilized by those who are more committed to the promotion of health and minimization of disease, but will continue to be marginalized in modernity that maintains the status quo of disease management to the detriment of individual and societal health.
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