This was written about 15 years ago, when I was asked to participate in a series of debate forums with a physician and a pharmacist.

Part I: 

Herbal Medicine: Folklore or Science?

I’ve spent my adult life studying and working with herbs. As with the succession of women before me -since the most ancient origins of humankind- my education in plant medicine is substantially contemplative, experiential; outside of an institutional setting. My laboratory is the night kitchen, when my children are sleeping, and my classroom is the garden -the forests and the fields- where I become intimate with plants. I know herbs, roots, barks and seeds, how they look and taste and feel when fresh and vital. The properties we recognize with our senses are referred to as organaleptics, and this is our indigenous assessment system.  I believe this skill is crucial to being able to recognize the quality of dried plant materals, as well as prepared herbal remedies.

 

Additionally, I won’t deny a great affection for my library. My shelves are a treasure of old and new titles, spattered from use while working, battered from repeated re-readings of the poetic turns-of-phrase and the vitalist contemplations of herbalists from distant places and even more distant times. There are hefty, contemporary reference texts in the sciences of medicine, and many books by modern herbal teachers and friends. The community of herbalists is growing, but still accessible and welcoming.  

 

Today’s forum is titled, “Herbal Medicine: Science or Folklore?” The question itself begins with an assumption that’s common in modern Western societies: science or folkore.

I’ll begin with some help from Webster, and define “science” and “folklore.”

Science:

  1. Knowledge; knowledge of principles and causes.

  2. Accumulated and established knowledge, which has been systematized and formulated with reference to the discovery of general truths or the operation of general laws; knowledge classified and made available in work, life, or the search for truth; comprehensive, profound, or philosophical knowledge.

  3. Especially, such knowledge when it relates to the physical world and its phenomena, the nature, constitution, and forces of matter, the qualities and functions of living tissues, etc.; -- called also natural science, and physical science.

  4. Any branch or department of systematized knowledge considered as a distinct field of investigation or object of study; as, the science of astronomy, of chemistry, or of mind.

Folklore:

  1. The traditional beliefs, myths, tales, and practices of a people, often transmitted orally.

  2. The comparative study of folk knowledge and culture

The notion of either-or is an artificial dichotomy. The study and practice of herbal medicine is science and folklore; more accurately, I argue that many traditional systems of medicine- as practiced across the planet and spanning eras- meet the definitional criteria of science. Of course, this isn’t an original idea of mine. The recognition that folklore is the science of another culture has launched exciting new fields of study in the last few decades. We use names like ethnobotany and ethnopharmacy to describe the study and translation of the science of traditional plant-based medicine from other cultures.

Where, and when, does the use of herbs in healing begin? Because we know that many animals- including primates- use nature to heal themselves, we can fairly assume that we have always sought out plants to assist in healing. Wild Health: How Animals Keep Themselves Well and What We Can Learn From Them documents examples and describes current studies of animals self-medicating to manage injury, infection, parasites and biting insects. In fact, excavation of one of the most ancient archeological sites in the Western Hemisphere- in the high desert mountains of South America- has brought evidence of the use of some 20 plants that are known and used as medicinal resources among the indigenous people of that area to this day.    

A useful way to develop an appreciation for the potential of herbal remedies is to review the systems of healing that have emerged in various cultures through history. It is also valuable to note- contrary to popular, modern prejudice- that writers on medicine -from the very earliest eras and distant places- demonstrate a respect for rigorous observation, theory development and critical assessment. In fact, our contemporary understanding of scientific method originated in 1600, with the recognition that Aristotle’s deductive reasoning method applied beautifully to mathematics, but didn’t fare so well with investigation into the natural world. Current “scientific method” (otherwise known as inductive reasoning), is based upon observation, observation, experimentation (otherwise known as experience), observation, theory development and more observation. Without doubt, the practitioners of traditional healing systems used what we now call “scientific method,” much of which is carefully itemized and described in ancient texts.  

Most of what we know about the earliest healing systems is provided by medical texts, which are often among the most archaic books. One disappointing- but expected gap- is in regard to the place of women as healers. Throughout human history- and indeed today, in much of the world- women are the primary providers of health care in small communities, on a very intimate level.

Additionally, less is known about the practices of ancient cultures in which written language did not develop. As a result, the three main systems of medicine we can explore are the traditions of Europe (usually referred to as Western), India and China.

When we think of the origins of Western medicine, the Greeks- and Hippocrates- may first come to mind. In fact, the Hippocratic writings espoused an enlightened view of invoking dietary, lifestyle, environmental, and psychological means of encouraging health that is stunningly consistent with a contemporary ideal of health. In terms of the practice of herbalism in Europe and the Arabian world, the influence of the 2nd century physician Galen is the most influential. He wrote extensively about the “humors”- blood, phlegm, black bile and yellow bile- and classified herbs by their essential qualities: hot or cold, dry or damp. While the Galenic system is comprised of elaborate classifications of conditions, the primary function of herbs on illness can be described as eliminating toxic accumulations. According to Galenic medicine, it is the accumulation of toxins in the system that cause illness and retard the body’s ability to protect itself and to heal.

While the concept of humors sounds bizarre, the notion of toxic accumulation and the idea that a healthy system heals itself is currently making a bold reappearance. Since the Galenic system prevailed in Europe through the 18th century, spanning some 1,600 years- and is still the framework for Islamic medicine- we can thank its practitioners for the materia medica of Western herbal knowledge we enjoy today. These herbs are the foundation of our medicine cabinets, whether herbal or pharmaceutical.

Next, we move to the Indian system of Ayurveda, which is roughly translated as “knowledge of how to live.” In Ayurvedic medicine, illness is viewed as imbalance, with herbs, diet, meditation and exercise used to restore equilibrium. At the base of the practice is the theory of doshas, or dysfunctions. Three fundamental dosha constitutional types are identified, and herbs are classified according to their effect on each dosha. A primary feature of Ayurvedic medicine involves cleansing, with many varied methods used to elicit elimination.

It’s interesting to note the focus on the elimination of toxic accumulation, both in Western and Indian medicine. Is there anyone here who hasn’t noticed the pervasive numbers of “detox” remedies available? I daresay we’re rediscovering the importance of cleansing, although, I believe a more accurate understanding of the mechanism of action of the herbs is their function in support of the organs and systems of elimination.

Now, we’re going to keep the discussion of Chinese medicine as simple as possible. In fact, Chinese medicine developed from prehistoric times and continues to be the primary medical system in China to this day. It is arguably the most comprehensive and complex system of traditional medicine. It is important to understand that the Chinese worldview has been far removed from Western thought since the time of Aristotle. In Chinese thought, everything moves, and the flow of energy is at the base of life. (In the West, we had our first glimpses of Chinese energy concepts with the work of Einstein.) The framework by which diseases are categorized is composed of a system of four opposites, or eight conditions. The healing principles are divided into five elements, or tastes. Once again, illness is regarded as disharmony, so the task of the traditional Chinese healer is to restore harmony and balance, thus enabling the body’s natural healing mechanisms to function effectively.

It is very interesting to note the broad underpinnings of these three distinctive systems. When reduced to simple terms, there is a pervasive ancient belief in the necessity of eliminating toxic build-up and achieving balance, in order to allow the body to heal, and function as it is designed to do.  It really doesn’t sound foreign at all.       

Now, let’s switch gears and talk a little bit about terminology. When I was given a synopsis of today’s panel and subject matter, I was surprised by the language used to describe the topic to be covered later this morning, wherein a physician and pharmacist discuss “traditional” medicine’s growing acceptance of “alternative” medicine. It reminds me that even within this culture there are many sub-cultures. From my perspective, “traditional” medicine constitutes the use of herbs and healing practices by generations and generations of our ancestors. I use words like “contemporary Western medicine”, “modern medicine” and –probably most often- “conventional medicine” to describe the form of medicine these practitioners refer to as “traditional.”  

I regard the various systems of medicine as essentially complementary; The idea that one needs to “adhere” to- or be stuck to- one system or another is simply false. I had surgery in December. I went to Madison and found a professor in the field at the University and he did a beautiful job correcting a structural problem. No plant on earth could have corrected my problem. Still, I used herbs to encourage healing after the surgery, and my doctor was impressed with my unusual rate of healing and rapid reduction of inflammation. He feels that post-operative inflammation is a significant problem hindering healing, with little relief. That’s what we’re talking about when we use the term, “complementary medicine.”

Now, this little anecdote begs the question of how we arrived at this point, where conventional medicine and herbalism are distinct fields of study? Most people are aware that even today, the majority of medicines originated with natural sources- primarily plant, but sometimes animal as well. At the dawn of the era of the pharmaceutical industry, all drugs were derived from plants and animals. Now, some will argue that pharmaceuticals allow for the standardization of dosages, and that’s a valid argument. There are others who argue that standardizing dumbs-down the natural medicine by sacrificing the complex efficacy of the whole plant. That’s a valid argument as well. But that’s a discussion we’re going to explore in-depth next week. Today, I’m going to tell you how- one century ago- the study of herbal medicine was eliminated from medical education in the United States and Canada.  

In 1908, the American Medical Association- or AMA- wrote to the director of the Carnegie Foundation with the request that they participate in the AMA’s efforts to reform medical education. At the time, members of the AMA were frustrated by the lack of public confidence in the profession and were engaged in fierce debates with practitioners of other systems of study, such as eclectics, physiomedicals, oseopaths and homeopaths. Additionally, the demand for AMA doctors was low, due to a high turnout of doctors from medical schools. In fact, physician incomes were approximately on par with that of train mechanics.

The Carnegie Foundation agreed to collaborate, and documents prove that they deliberately concealed this fact from the public, in a stated effort to “appear impartial.” It was determined that the Carnegie Foundation would fund a complete investigation of all medical colleges in the United States and Canada, and would publish an assessment and recommendations. With the collusion between the AMA and Carnegie Foundation hidden, the report would carry the weight of an independent, disinterested body and would be widely distributed to the public.

The Carnegie Foundation worked hand-in-hand with the Rockefeller Institute for Medical Research. Both the Carnegie and Rockefeller families were heavily invested in the new industry of pharmaceutical companies, and much was to be gained through changing the face of medicine in the US and Canada. As a matter of fact, the investigation was charged to an unemployed, former school master, with absolutely no medical training. His name was Abraham Flexner, and he was the brother of the director of the Rockefeller Institute.

The Flexner Report, published in 1910, is widely considered to have initiated the most significant medical reform in the past 100, maybe 200 years. In it, Flexner claimed to have visited all 167 medical colleges in the US and Canada. (Recent investigation into his records indicate that it would have been virtually impossible for him to have visited all the schools according to the calendar he claims in his documents.) He was caustic in his use of language to describe the schools he recommended closing; his assessments were scathing, shocking and theatrical, clearly intended for public consumption. He recommended that 5 of the 7 “Negro” colleges be closed (explained that two should remain open, in order to allow Negroes to treat themselves, lest they spread infection to whites by contaminating a white doctor.) He also recommended that all 3 women’s medical colleges be closed.

True to the interest of the AMA, he disparaged all the dissenting sects, referring to them as “quacks” and “mercenaries.” Remembering that the public would see the report- which was widely quoted by the media- and regard it to be the work of a neutral expert, one can only imagine the depth of damage to individual practitioners of herbal systems of medicine and homeopathy.

True to the interests of the Rockefellers and Carnegies, he utterly destroyed the reputations of the proprietary schools, which were self-supporting and self-directing. The Rockefellers had long made effective use of philanthropy to further business: in the case of medical education, the Rockefellers contributed enormously to colleges which relied in donations for survival, with the caveat that herbal medicine be completely disregarded in favor of pharmaceuticals. Proprietary schools- which trained students in the use of herbs over industrial pharmaceuticals whenever possible- thus threatened the Rockefeller and Carnegie desire for a monopoly on medicine.  

The effect of the Flexner Report ripped though the medical community. Maligned schools were abandoned, with 25 closing virtually immediately, and many more in the following years. In 1900, there were a total of 167 medical colleges in the US and Canada; following publication of the report in 1910, the number fell to nearly half, with only 85 schools remaining. What racial and gender diversity in doctors existed prior to the report was practically wiped out in a manner of a few, short years.  

Further, Flexner recommended that the purpose of medical education be re-designed, with a greater orientation toward research and drug development and a reduced focus on community practice. Prior to the report, most professors were chosen from the local area, based upon recognition as superior practitioners. Following the report, professors were selected according to researching skills, with the “publish or perish” phenomena beginning with medical education, and now pervading all areas of higher education.

Finally, Flexner recommended that government become significantly involved in controlling medical education, and specific legislative action. This action resulted in the necessity of gaining a license to practice medicine based upon membership in the American Medical Association. Essentially, the government seized authority over the practice of medicine, then transferred that authority exclusively to one group of practitioners. Of course, it was then illegal for a doctor who was trained in an herbal tradition to practice; further, all AMA doctors attended medical schools that were beholden to Rockefeller and were strict adherents of the use of pharmaceuticals. This was the end of the widespread use of herbs in contemporary medicine in the US and Canada. It had absolutely nothing to do with science. It was a condition designed by those with money and power, in order to serve their own interests.

So- in the interest of health and science- it is truly exciting that the turn of this century has brought a renewed vitality and sincere interest in the use of herbal therapies on the part of the public, as well as health care practitioners.