Native Healers. Anita Ralph
herb or single ‘active constituent’ research. This property is closely connected with the potential for herbal medicines to have properties beyond what can be described by solely looking at their compounds or pharmacology. A ‘greater than the sum of parts’ effect, known as synergy, is an example of a recognition of the dynamic nature of nature.
Examples of synergistic interactions would include the ability of one constituent to maximize the absorption of another constituent across the gut wall (pharmacokinetic synergy), or the multiple differing pathways by which the constituents of a plant exert their effects, coming together to provide broad based support for a system, and therefore resulting in better than expected outcomes (pharmacodynamic synergy).
This dynamic nature of nature can also be exemplified in the energetic approach of Ayurvedic and Traditional Chinese Medicine systems, and other traditions of the world. Many Western herbalists still consider this way of thinking as vital to the practice, some still refer to the humoral approach, the original ‘energetic’ approach of Western herbal medicine. We will revisit and expand this theme in later chapters.
A summary of the extra characteristics that herbalists recognise within plants:
Each characteristic has multiple potential layers of meaning.
| Stimulating | Relaxing |
| Sedating | Astringing/condensing |
| Trophic | Adaptogenic |
| Nervine | Vulnerary |
Key concepts of the approach of the Western medical herbalist
[Today, medical herbalists] critically evaluate both historical documentation and the latest empirical findings underpinning herbal prescribing.
—G. Tobyn, A. Denham and M. Whitelegg21
Modern Western medical herbalists (phytotherapists) value a detailed consultation and case history taking, allowing the person time to speak, to be heard, and time for the herbalist to ask about information concerning each and every body system, not just the current symptom or focus of primary diagnosis.
An emphasis is placed on the interconnectedness of all parts of our physiology, and the inherent vitality that can be suppressed in some people or some situations, and can therefore be supported and nourished with certain herbal interventions.
A timeline and chronology of events from wellness to un-wellness is mapped out, and areas of weakness, fragility or lack of function are identified. The aim is to direct focus and treatment to the perceived root causes, and to apply herbal medicines (and any other valued activity such as nutrition, exercise, lifestyle advice) to areas that need attention.
Each medicinal plant has multiple capacities, and so care in the selection of plants to suit the person and the situation is taken by the herbalist. Herbal therapy therefore may be, for example, ‘anti-inflammatory’, but also stimulating, relaxing or tonifying in nature. These actions may be attributed to plant compounds and our current pharmacological understanding of them, and also to traditional understanding or empirical sources from centuries of use.
Herbalists value a deep connection with the plants they enrol as medicines. Being a herbalist often results in a glorious life-long relationship with plants and nature.
Herbal therapy can be applied internally and/or externally and in a huge variety of forms—tea, tincture, capsule, syrup, pessary, ointment and so on, and thus individualised to the situation and/or to the patient and their requirements. We shall explore some home pharmacy recipes later in this book.
Evidence
One fairly common and misguided comment made concerning herbal medicine is the lack of research underpinning practice. Although there is undeniably a lack of well-structured quality human research specifically designed for the purpose of investigating whole plant remedies, it is untrue to say that there is no relevant research.
This is a misconception that we have striven to address where possible in the writing of this book. Research is out there; fragmented at times, but out there none the less. One aspect of this, however, is the thorny question of animal research. We do not believe that animal research involving the wilful harming of living creatures should be supported. This has in places led to us deliberately not quoting what could be seen by some as ‘relevant’ supportive research. We feel such research is profoundly in conflict with the spirit of a healing profession for which we both care deeply and strive to practice with integrity and love. The tenet of ‘do no harm’ should be adhered to at all times, and this includes all living creatures that come under the auspices of herbal medicine (which is to say—all living creatures).
What is evidence, particularly where any medicine is concerned? This often depends partly on whom the evidence is intended to inform. The research that produces evidence can be qualitative or quantitative, or even a mixture of the two.
The originators of the concept of evidence-based medicine defined it as:
The integration of best research evidence with clinical expertise and patient values.
—D. L. Sackett et al., 199622
There is a perceived hierarchy of evidence recognised today, that could be said to have developed because of its intrinsic link to the development and manufacture of drugs by companies looking for a market, and potential validation by government organisations. Any patient-centred intervention is likely to fall short of criteria designed to fit mono-chemical therapy applied to disease labels. A gradual realisation of the significance of more qualitative data, case reports and patient-centred medicine is growing within the medical community.
Levels of evidence include:
•Patients: often bring evidence in anecdotal form from previous cases that they have heard about that reflect their own.
•Clinicians: are interested in evidence that gives a probability of success or adverse effects, to guide their prescribing.
•Clinical researchers: want a comparison of one group against another with blinding and randomisation to eliminate placebo and nocebo effects. The randomised, placebo controlled trial (RCT's).
•Laboratory researchers: use experiments to identify causative factors and mechanism of action.
•Office-based researchers/clinical analysts: the highest regarded research currently for analysing clinical effectiveness is the meta-analysis and systematic reviews of groups of trials. This is the basis of government recommendations to clinicians. As we shall see, however, this is not always applied evenly.
Herbal medicine has been criticised for having a lack of RCT's, but, despite significant stumbling blocks such as lack of financial backing, some do exist. Conversely, despite a lack of RCT data showing efficacy for paracetamol (acetaminophen/tylenol) for clinical effectiveness for the pain of osteo-arthritis (OA), it continues to be the most prescribed medication by conventional UK practitioners for OA and is NHS funded.
Meta-analysis has been championed by the Cochrane review, but poorly designed trials on herbal medicines such as those on echinacea have produced results that suggest no clinical effectiveness. Concerns have been raised about the poor quality or quantity of plant material used in these RCT's.23
Lack of evidence for efficacy is not the same as evidence for lack of efficacy.
—S. E. Edwards et al.23
This short and seemingly simple statement belies a massive lack of understanding on the part of many people. If something has not been proved by accepted scientific methodology, this does not signify that it has actually been disproved. The confusion caused by the statement. ‘there is no scientific evidence for this’ or words to that effect are regularly taken as evidence of disproof. This misconception often lies at the heart of perfectly sound interventions being discarded or maligned.
It