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— updated 1998-01-19

A world history of herbology and medical herbalism: oppressed arts

A comparative history of medicine

American herbalists' realpolitik, essay #1. Find out how Hippocrates, whose philosophy of health mirrored that of ancient East Asia, was betrayed by the Western medical profession. Learn how herbal usage, philosophies, and religions of ancient civilizations and empires have affected modern herbal usage.

by Roger W. Wicke, Ph.D.

Subtopics on this page…

Copyright ©1995 by RMH-Publications Trust; all rights reserved.




The relevance of TCM's history to its role in modern health care

Within the past decade, Americans have consumed ever-increasing amounts of traditional Chinese herbs and formulas. Some of these consumers are under the care and guidance of practitioners who have received specific training in the use of Chinese herbal preparations. Many, however, receive haphazard advice from both health practitioners and lay people who have had no experience or training.

Whenever a culture attempts to assimilate alien ideas, social stresses are bound to occur, especially when such ideas threaten the hegemony of major economic and political interests. Mistakes are likely to arise while attempting to implement these ideas. In the case of Chinese herbal knowledge, its use by people unfamiliar with its rules and protocols invariably leads to mishaps: either the herbs or formulas fail to work as expected, or worse, side effects may result whenever herbs are used in contraindicated conditions. In the political and economic realms, government regulators unfamiliar with the unique characteristics of traditional Chinese medicine (TCM) may impose restrictions upon Chinese herbal practice that inhibit its effective application and suffocate its future development within our culture.

In examining the history of herbal traditions in each civilization or culture, we will benefit by keeping several questions in mind:

  • How does a culture's intellectual, philosophical, and spiritual climate affect the quality of health care and the ease with which effective but foreign methods of health care are assimilated?
  • During periods of cultural expansion and progress, which social policies are most effective in encouraging progress and improvement in health care methods?
  • During periods of cultural decay and collapse, which social policies are most effective in preserving medical and herbal knowledge for future generations?

The effectiveness of modern Chinese herbal practice suggests that we begin our search by understanding the history of herbal practice in China. "Chinese" herbs are grown and collected from all over the world. There is nothing magical about a "Chinese" herb; potent medicinal herbs can be found everywhere that plants grow. So what are the essential characteristics of Chinese herbal practice that distinguish it from European and other herbal traditions?

Precautions in understanding the development of Chinese herbal practice

•[1]• •[2]• •[3]•
Ancient Chinese herbalists were aware of the potential benefit of herbs, acupuncture, massage, and diet in maintaining and restoring health and in alleviating human suffering. They used only their own senses and perceptions to obtain information about the nature of a person's health imbalance and to make decisions of which technique or herbs to use. Microscopes had not been invented, x-ray machines were non-existent, and knowledge of chemistry was crude. Thus the way they described imbalances in health and the exact words they used to classify the various patterns of disharmony differed considerably from the modern scientific system. They did not recognize "influenza" because they did not have microscopes to deduce the association between a given set of symptoms and the presence of a particular influenza virus. However, they did have effective means to deal with the health consequences of influenza. The system they used to classify acute disharmonies allowed them to choose appropriate herbal formulas, diets, and acupuncture points for a given disharmony with great effectiveness.

Anytime we extract wisdom from the past and attempt to apply it in the present, we risk overlooking some crucial bit of insight considered obvious to people who lived in that time. This difficulty is of great concern to anthropologists and archaeologists. Frequently the scholar of ancient civilization superimposes his own world-view to explain the purpose of certain rituals, customs, or artifacts. When reason and science fail to explain their purpose, authorities often relegate these artifacts to the category of religious relics or superstition. Many translations of Chinese herbal texts fail to accurately convey the original meaning because the translators did not attempt to understand the entire social and physical context of the original text. Because of the disparity in philosophical perspective between the ancient Chinese and modern technological civilization, modern scholars frequently misinterpret important ideas as ancient superstition or religious dogma because they fail to accurately translate the underlying philosophy.

There is no one "authentic", "original", or "classical" version of traditional Chinese health science. Civilizations constantly change, and ancient China was no exception. The history of herbal practice in China reveals a continual process of observation, contemplation, formulation of theories, and testing of these theories in practice, as one would expect in a scientific tradition.

Herbal literature of ancient China

•[4]• •[5]•
During the Han Dynasty (206 B.C.–220 A.D.) herbalist-scholars recorded in written texts many of the basic ideas and principles of traditional Chinese herbal science and acupuncture and moxibustion (the application of heat by burning moxa) techniques. Although this text does not focus on acupuncture or moxibustion, many of the same principles apply to understanding the development of the Chinese herbal tradition. Yin and Yang, the Five Phases of Evolutive Change, acupuncture Meridian theory, and an herbal pharmacopoeia were part of the established knowledge and ideas of the time, and were recorded in The Yellow Emperor's Classic of Internal Medicine, written in the form of a discussion between the Yellow Emperor and his minister on the topic of health, rather than as an instructive text. Because of this, the translator must infer the proper context of the ideas being discussed. Imagine suddenly dropping in on a conversation between two nuclear physicists; only after listening for a while does one begin to form an idea of what they might be discussing. While The Yellow Emperor's Classic of Internal Medicine does not discuss herbs to any great extent, it is important in understanding the general philosophy of life and health current then.

Before the era of written knowledge in Chinese herbal practice, shamanic practices probably prevailed. There is a passing reference to this in The Yellow Emperor's Classic of Internal Medicine, where the Yellow Emperor asks his minister why incantations and spells no longer are as effective as they once were. His minister replies that because diseases have become more serious and persistent, stronger measures are now necessary. (The growth of civilization and urbanization invariably leads to the increased likelihood of epidemic disease.)

During the very early stages of Chinese civilization, shamans chose herbs more for their ability to encourage evil spirits to leave. As an example, for snake bites the shaman might have applied some part of an animal that is the snake's natural predator. Before one completely dismisses such logic, one should recall recent studies of the placebo effect. Even in today's health care techniques, whether surgery, Valium, antibiotics, or herbs, one should not underestimate its potential importance. Modern scientific method has gone to great lengths to filter out its effects on research results, which is a testament to its pervasive influence. The placebo effect or shamanic influence may come in many disguised forms that occasionally result in potent healing effects.

The Classic of the Materia Medica, written during the Han Dynasty, is the first organized description of individual herbs and their applications. This text deleted any reference to shamanic influences and described purely physical actions of herbs and their effects on the individual's sensations and symptoms. Ancient herbalists presumably obtained this information empirically, by simply giving the herb preparation to people and observing the effects. Later additions to herbal knowledge followed the style and format of the Classic, placing emphasis on taste, the herb's heating or cooling nature, which organs and meridians it primarily affects, dosage ranges, degree of toxicity, and overall effects of the herb on specific patterns of symptoms.

The Discussion of Illnesses Induced by Damage from Cold is one of the first major texts on herbal formulas for acute disharmonies (including what would be medically labeled influenza and upper respiratory infections). "Damage by Cold" describes these classes of health disharmony because of the observation that cold weather triggers many upper respiratory and other acute disharmonies. This theory explains how an acute imbalance disturbs the equilibrium of progressively deeper functional levels of the body. Correct herbal strategy for a particular acute disharmony depends upon the exact phase to which the disharmony has progressed. This theory can help us to understand why antibiotics may work well at only particular phases. A group of people may all be infected with the same bacterial organism; some of them may benefit by using antibiotics, yet others may worsen.

Just as in the history of European healing arts, alchemical practitioners influenced the practice of Chinese herbal science for a time. As in Europe, many of these practitioners poisoned themselves in their quest for transformation. Knowing about this influence is important, because even today certain versions of the materia medica contain references to heavy metals like mercury, lead, and arsenic. Occasionally one may encounter world travelers who claim that a great master in India, or some such place, prepared a special arsenic formulation for them and removed all toxic qualities with an arcane spiritual process. One may reserve a small area of the mind for this remote possibility, but preferably leave the risks to others more daring or foolish.

In the traditional Chinese health system, pulse and tongue analysis are the most important physical assessment methods for determining one's condition. These techniques were well established by the Han Dynasty, and were described in The Classic of the Pulse. Pulse technique differs from Western practice in that not only is the rate recorded, but the quality in each of three positions overlying the radial pulse on both left and right wrists, and each of three depths. The quality includes such characteristics as strength, width, regularity, pulse profile, and any other unusual tactile qualities. The tongue is inspected for the thickness and color of the tongue coating (fur) and the color and texture of the underlying tissue. Both tongue and pulse qualities are extremely sensitive indicators of ill health, and the practiced herbalist will usually be able to correlate abnormal deviations with the symptoms well before the imbalance results in clinically abnormal blood chemistry or x-rays. Gross deviations of pulse or tongue characteristics from normality usually indicate severe imbalances verifiable by medical evaluation.

After the Han Dynasty, the knowledge of herbal science continued to expand. Herbalists collected and studied plants from all of Asia, and incorporated effective herb species into the pharmacopoeia of China. By the 20th century, the pharmacopoeia included herbs from all over the world. For example, American ginseng (Panax quinquefolium) is a species native to North America. It is now cultivated predominantly in Wisconsin, and growers export most of it to China for use there! Some people have the notion that Chinese herbs are peculiar, exotic herbs grown only in China.. However, China has for centuries actively searched throughout the world for useful herbal plant species, and it is one of the first cultures to have a truly international perspective in its herbal practices. For a more thorough discussion of Chinese herbal texts of the most recent centuries, see Chinese Herbal Medicine: Materia Medica, edited by Bensky and Gamble.•[6]•

Traditional Chinese medicine reached its zenith during the 8th to 12th centuries A.D. In 1078 A.D. the Taiyiju ("Great Medical Authority") medical university was established; it sponsored publishing, scholarship, and rigorous training programs in traditional Chinese medicine. Invasion by the barbarian Mongols during the 12th and 13th centuries disrupted the Chinese culture and attention shifted away from scholarly pursuits toward survival issues. A reactionary trend set in, leading to a sense of urgency to preserve what knowledge had been gained. In the 1350's, the Mongols were expelled, and the warlord Hong Wu established the Ming Dynasty. The experience of Mongol rule left the Chinese preoccupied with defending and preserving what culture they had. Hong Wu established an authoritarian rule under which intellectual thought and personal initiative were stifled. The medical sciences, as well as scholarly pursuits in general, stagnated. Scholars at the Taiyiju increasingly engaged in highly theoretical speculations divorced from empirical evidence. Chinese culture had always been suspended between the two poles of Confucianism and Taoism, the former cultivating the speculative, contemplative nature of man and the latter emphasizing a mystical connection with nature through direct perception and awareness. During the Ming Dynasty, the medical profession retreated into introspection and contemplation under the influence of the Neo-Confucianist bureaucracy.

The only branch of Chinese medicine to withstand this speculative trend was pharmacology, which by then had become a well established discipline. During the following centuries of the Ming Dynasty, several herbalists became known for their compilations of pharmacopoeia. Among the best known of them, Li Shizhen compiled a pharmacopoiea over a 30-year period that described the clinical functions and applications of 1,892 remedies. He obtained this information on collecting trips throughout China and by evaluating the existing written knowledge of these remedies.

Chinese herbal health care has evolved into a sophisticated body of knowledge. Each century its practitioners built upon the old knowledge, rarely discarding theories and observations, but refining them and increasing their resolution and distinction of fine detail. Throughout the rise and decline of numerous dynasties, traditional Chinese health care enjoyed several thousands of years of predominance as the status quo system of health care.

Ayurvedic health care

•[7]• •[8]•
Ayurveda encompasses the traditional health care practices of India, including the use of herbs internally and externally, dietary guidelines tailored to individual constitutions and conditions, breathing exercises, and yoga. One cannot discuss traditional Chinese medicine without mentioning Ayurveda, because of their development in geographical proximity to each other, and their similarities in philosophy and technique. Like traditional Chinese health care, Ayurveda is also very ancient, originating several thousand years ago.

Both Ayurveda and TCM place great emphasis upon determining an individual's pattern of health imbalance, rather than choosing remedies to counteract single symptoms. Both systems classify symptom-sign patterns according to basic qualities. In ancient TCM theory, these basic qualities consisted of the Five Phases (or Five Elements) of Fire, Earth, Air (or Metal), Water, and Wood. The corresponding attributes (doshas) of Ayurveda consist of Vata (air or ether), Pitta (fire), and Kapha (water). In both systems, health results when each quality is present in the proper degree required by the individual's constitution, or hereditary makeup. In neither TCM nor Ayurveda was there a belief that these fundamental qualities were equivalent to physical elements, but rather these terms were used as metaphors. Western translators frequently stumble over these ideas, failing to see the value in these metaphors because of their cultural bias toward materialistic interpretations. Just as one can describe or recreate the colors of an object by various combinations of red, yellow, and blue, one can describe human behaviors and symptoms using various combinations of the Five Elements or Three Doshas.

The Ayurvedic system relies heavily on a differentiation of the Three Doshas to determine proper choice of herbal remedies and diet. The traditional Chinese system of health care begins with a comparable differentiation, but in practice, extends this process of differentiation to a greater degree of specificity. The Five Phases (or Five Elements) of TCM theory is a very ancient system of differentiation of qualities which Chinese physicians have found to be inadequate to represent the range and complexity of illnesses that are possible. Consequently, over a two thousand year period the Chinese developed more detailed theories and classification of categories of illness, such as the Eight Principal Patterns, the Fundamental Processes (Qi, Blood, Essence, Shen, and Fluids), Invasion by Pernicious Evils, Zang-Fu Organ Disharmonies, Illnesses Induced by Damage from Cold, and Virulent Heat Illnesses.

In theory, both Ayurveda and Chinese health care consider individual health practices, such as diet and special exercises, to be an important aspect of maintaining individual health. In practice today, Ayurvedic practitioners seem to emphasize this idea to a greater degree, whereas Chinese practitioners often take a more casual attitude toward the importance of diet and exercise.

Ayurvedic physicians generally pay greater attention to personality and mental attributes. The effects of herbs and foods on the mind and personality are considered important and these qualities are listed in the Ayurvedic pharmacopoeia. While Chinese physicians recognize the importance of mental and spiritual aspects, they often do not address these issues explicitly, and their methods of classifying illness rely more on physical symptoms and signs.

Ayurveda also yields insights into how the basic tastes (sweet, salty, sour, astringent, bitter, spicy, bland) affect the three doshas. Traditional Chinese theory recognizes the importance of taste, and both systems classify herbs and foods by their taste. However, Ayurveda explains the effects of each taste in a way that is easily understood, and is especially useful in teaching the proper combination of foods in cooking to match a given individual's body type, or constitution.

Health care in modern China

•[9]• •[10]•
After centuries of cultural disintegration, invasion by European colonialists, and warfare, the Neo-Confucianist trends of unearthly speculation and disdain of ordinary people's problems that had begun during the Ming Dynasty had become acute. Medical care for the population at large was non-existent, and epidemic diseases, unsanitary conditions, and malnutrition were rampant.

The 20th century brought a major upheaval in the Chinese health care system. Understandably concerned about the poor health of the population, in the 1930's the Chinese Nationalists attempted to eliminate traditional Chinese health care in an attempt to force adoption of Western medical methods, including vaccination, sanitation, and antibiotics. Most of the population, however, continued to secretly support their traditional health care system and maintained their skepticism of modern medical care. After the Communist takeover in 1949, the Communists also desired to bring China into the modern technological era, and this included Western-style scientific medicine. However, Mao Zedong realized that Western style health care systems would bankrupt China's fragile economy, and he restored traditional Chinese medicine as the primary health care system. Rightly recognizing that the decline in quality of health care was not due to an inherent lack of effectiveness of traditional Chinese health care, but to a centuries-long period of cultural decline, he promoted efforts to immediately restore and teach the traditional medical literature in medical schools. The few remaining highly skilled practitioners of TCM were called upon to train young doctors in their art.

Under the Communists it again became legal to practice acupuncture and to dispense traditional herbal preparations. However, the political establishment applied pressure on traditional practitioners to prove the effectiveness of these modalities using Western-style criteria; any technique was suspect that modern scientific methods couldn't validate using repeatable measurements. This would have been a laudable goal if only the scientific methods had been sophisticated enough to analyze complex systems of multiple variables, matching the complexity of the pattern recognition algorithms inherent in TCM analysis; most Western-style, single-variable scientific studies are too simplistic to probe the mechanisms of TCM techniques. In any case, the nature of the practice of traditional Chinese health care began to change over several decades. Not only was there pressure to validate TCM methods from a scientific viewpoint, there was a need to train thousands of paramedics to handle basic health care of the huge population throughout the country, including the large rural provinces.

All these factors combined to create pressure on the government to train many people quickly; thus there developed an effort to standardize and simplify many of the principles of traditional Chinese herbal science. Within the last decade, China has been opening up its hospitals to American students of acupuncture and Chinese herbology who wish to receive more training. Many of these students report being disappointed by the very basic level of instruction. On the positive side, students in China have been able to observe the application of basic techniques to severe life-threatening illnesses in China's hospitals; as a rule, U.S.-trained acupuncturist-herbalists intern in health care practices not affiliated with hospitals. Also to China's credit is that its efforts to train thousands of paramedics in traditional health care as well as basic modern health care and sanitation practices have paid off; reconstruction of the health care system has greatly improved the general level of health since 1949.

Herbal traditions of the Western world compared

•[11-21]•
It is a revealing exercise for Western students of TCM to compare the historical evolution of herbal science and practice in the West with that of China and Southeast Asia. Many of our cultural biases about the uses of herbs originate from cultural processes occurring 2000 years ago in the Middle East and Roman Empire.

The stages of development of health care traditions

Before analyzing the differences, it will be useful to outline certain similarities in the evolution of medical traditions, regardless of culture. Worldwide, the healing arts and medical knowledge have evolved through characteristic phases. To compare the level of sophistication of healing arts in various cultures, it is helpful to understand the nature of these evolutionary phases and the corresponding quality of health care. Roughly, these various phases are:

  1. traditional shamanic healing;
  2. institutionalized shamanic practice;
  3. urbanization and epidemics;
  4. discovery and use of sanitation, quarantining, potent medicines for treating infectious illnesses;
  5. recognition of side effects of potent medicines;
  6. development of a concept of human ecology: diet and environment;
  7. development of multifaceted herbal and medical strategies for resolving complex chronic illnesses.

The pattern of evolution through each of these phases may vary considerably among cultures, and retrogression to more atavistic phases may occur during periods of cultural decline and collapse. However, most cultures develop advances in health care as a response to crises arising from the characteristics of each historical period.

Shamanism

The earliest forms of intentional healing practices throughout the world have invariably been shamanic in nature. The shaman harnesses the beliefs of the sick person to assist the body's innate ability to heal itself. In scientific-technological periods of history, this effect becomes known condescendingly as the placebo effect. Yet regardless of the label given, the mind has potentially potent effects on processes of the physical body. When the minds of the shaman and the person to be healed focus together on a common belief system and cultural framework, they can work together for the common good and provide an effective healing influence over illness.

As the shaman begins to recognize his power over illness and over the minds of his tribe or people, the temptation often arises to use this power for ego enhancement, acquiring wealth, and exerting political and social control. As human societies transformed from hunter-gatherer tribes into nomadic animal herders and ultimately into farming societies, they became dependent upon fixed territories of land for their survival. Military-political power arose among individuals and groups most suited to lead armies into battle for defending territory. These military-political powers latched onto the pre-existing social power and influence of the shamans, and the shamanic traditions came under organized control and regulation. In ancient Mesopotamia, the powers of the shaman were divided among three specialized functionaries, each of which was regulated by the state, and each of which jealously scrutinized the others' actions so that the prescribed limits of action were never exceeded. The three types of practitioner (asu, or craftsman skilled in wound healing; ashipu, a specialist in incantations; and baru, or soothsayer) would all attend the patient together. The asu, besides tending to the patient's physical wounds and administering herbs and remedies, would tell the ashipu what he found so that the ashipu could mutter the proper incantations. The baru predicted the future course of the illness based upon omens and signs as they approached the patient's house, giving the other two useful insights into the patient's home and neighborhood environment, perhaps noting any unsanitary conditions, etc.

Many early peoples considered their herbalist-shamans to be gods. Shen Nong, to whom references date from 2699 B.C., was deified as a god and was worshipped by Chinese until Mao Zedong abolished religious worship in the 1950's. Thoth, Isis, Osiris and Imhotep were probably all healer-herbalists who were later considered by ancient Egyptians to be gods. In 2000 B.C., there is evidence that at least some Egyptian herbalists understood the physical effects of plants, separately from placebo effects and magical beliefs. After 1000 B.C., it is likely that the Egyptians borrowed much herbal knowledge from their Asiatic conquerors. The shaman-herbalist might have gained great advantage by understanding and acquiring knowledge about the physical effects of plant medicines, while continuing to publicly hold that mumbo-jumbo and special knowledge of incantations and appeals to deities were crucial ingredients of any healing ritual.

As agriculture became the predominant mode of survival in the Middle Eastern and Mediterranean regions, cities with large populations arose to promote trade of agricultural goods and of luxuries demanded by a growing cultured and leisure class. The efficiencies of the city for trade and commerce resulted in large concentrations of people and unsanitary conditions, eventually leading to severe epidemics. The shaman who relied upon incantations and placebo effects may have provided adequate relief before the era of urbanization, but the phenomenon of epidemics presented a new challenge. The ancient Greeks frequently suffered from respiratory illnesses, malaria, tuberculosis and measles; stronger remedies were sought, including heavy metals and toxic drugs. Herbalists experimented with many medicinal plants, as well as metallic drugs such as compounds of arsenic and lead, to determine their effectiveness in alleviating epidemic illnesses. Theophrastus, 372-285 B.C., studied over 500 medicinal plants, and is known as the first scientific botanist.

Ancient Greek medicine

Medicine in ancient Greece was never organized and practitioners were preoccupied with developing their effectiveness in order to make a living with their services. In contrast to prior periods during which the shamanic traditions were established, regulated, and entrenched in power, this period experienced one of the most rapid advances of medical knowledge known to history. In a period of only several centuries, the art of medicine evolved through six of the developmental phases of medical tradition: traditional and institutionalized shamanic healing, the age of epidemics, the age of sanitation and use of potent medications, the understanding of side effects, and the establishment of a philosophy of human ecology.

Historians have marveled at this sudden appearance of sophisticated medical practices in a historical era otherwise characterized by religious superstitions and shamanic practices. Rapid development of Greek medicine during this period is likely due to the active intellectual ferment created by the exchange of knowledge between local cultures, including that of the Egyptians, Phoenicians, Syrians, and Persians. Unlike many civilizations that had preceded Greece, the numerous contrasting philosophies and religions of Greece during the 5th century B.C. made it difficult for any one of them to gain hegemony over the others, precluding a priestly caste from exercising control over intellectual affairs. This created a laissez faire climate in which medical advances flourished, practitioners and scholars having been freed from both religious and secular regulation.

While ancient Greek physicians were relatively free from official regulation, constraints of the free market imposed another type of discipline. Many of a physician's clients were well educated in both popular philosophical theories and in practical arts and sciences, including medicine. A typical patient expected his physician to provide effective remedies and to explain the rationale for his choices, and would frequently engage him in probing debates about the relative merits of different therapies. The practice of medicine, unlike today, was a profession lacking in status, and the ancient Greek physician had no cloak of mystique, veil of religious authority, or elitist facade behind which to hide. If a patient was incurable, the physician was expected to recognize such a condition and refrain from providing futile treatments to such an individual. Such expectations by the public of their physicians did not succeed in weeding out all useless or harmful medical theories, but it did limit the practice of many noxious treatments, such as bleeding, violent purging, and ingestion of toxic heavy metal compounds, which were to become so popular in European medicine many centuries later.

Empiricism was king: does it work or not? Medical theories arose to explain and codify empirically observed patterns of illness; however, Greek physicians were wary of knowledge that did not lead to relatively immediate clinical benefits. Medical sciences such as anatomy and physiology required time-consuming exploration that yielded information for which immediate practical applications were rarely evident. During the Alexandrian period of Greece, as the center of learning shifted from Athens to Alexandria, Egypt, Greek physicians increasingly studied anatomy and physiology after observing advanced surgical techniques being performed by foreign doctors. Analytic methods in science and medicine require a great patience of the scientist in focusing upon minute aspects of the natural world and developing theories to explain these observations that in turn would help to predict other related phenomena; often the practical applications of such observations may not be evident until centuries later. Additionally, such narrow scope of scientific vision tended to diminish appreciation for ecological, whole-systems patterns of behavior. Thus, while the European tolerance for speculative theories frequently led to disastrous medical treatments, the data accumulated from such experiences eventually led to useful knowledge of the microcosm, though at the expense of an appreciation for macrocosmic or ecological phenomena. The clinician should appreciate the usefulness of both types of knowledge. Successfully controlling physiological variables such as blood pressure or reducing the proliferation of pathological organisms must not be achieved at the expense of an individual's overall health. Allopathic practitioners frequently violate this common-sense prohibition, whereas an ecologically-minded, whole-systems oriented clinician would not.

Hippocrates and the appreciation of human ecology

The development of a science of human ecology, which is rooted in the inductive methods of the Hippocratic empiricists, remains one of the great, yet unrecognized legacies of ancient Greek medicine. This evolution was probably influenced equally by the occurrence of epidemics and by experimentation with toxic drugs and heavy metal compounds. Some physicians eventually recognized the side effects, both immediate and long-term, caused by these drugs. Because long-term side effects may vary depending upon an individual's constitution, hereditary weaknesses, and environmental factors, and because correlating symptoms with events decades in the past requires patience and mental tenacity, the study of such side effects led to a sophisticated ecological understanding of the relationships between the human body, its various functions, and its external environment. Perceptive physicians also began to notice the correlation between lack of sanitation and epidemics. This is perhaps the most difficult stage of development in medical tradition, because it demands of practitioners a good memory, reasoning ability, and acute skills of observation.

According to Hippocrates, the Greek physician who developed the philosophy of human ecology during the 4th century B.C., "In medicine one must pay attention not to plausible theorizing but to experience and reason together." He was a keen observer who followed his own advice, and taught physicians to consider the influence of diet, water quality, climate, and social environment on illness. He urged treatment of the whole person, not just the symptoms, and to encourage the latent capacity of the body to heal itself. Hippocrates' emphasis upon observation and practical results reinforced the ideas of the empiricist school of philosophy, which held that theories about the nature of the world and the universe, mathematics, and philosophy should be subordinate to observable reality and should be used to help describe what we perceive with our senses.

Plato, a Greek philosopher and contemporary of Hippocrates, developed a world view opposed to the empiricist school of thought that was based upon pure reason, dissociated from any need to observe nature for verification of theory; material reality was mistrusted as a source of illusion, deception, and error.•[22]• Popular religious and philosophical notions at the time supported this mistrust of nature, believing that the remote heavens reflected God's perfection, but that the earth presented a picture of continual decay since the moment of its creation.

Several centuries later, as the Roman empire disintegrated and as the medical traditions of the region retrogressed into a state of shamanic barbarism, the Christian Church used Plato's philosophy, already popular in the region, as an ideological power base to promote superstitions among the masses while preserving for its elite an isolated life of the mind and the spirit, unconcerned with the squalor of the world. During the very period that the Western world was descending into madness and decay, the Chinese experienced a rapid flowering of their own medical traditions, following a similar path to that which Hippocrates had attempted to give to the future of European medicine. Instead, the medical traditions of Europe would experience over 1000 years of chaos, persecution, and religion-induced mania.

Ancient Roman medicine

As the Greek empire declined, Rome inherited its medical traditions and knowledge. Before the final decline of Rome, a number of physicians of Rome added considerably to the knowledge of herbs and medicine. As in ancient Greece, medicine in Rome was not organized and practitioners were often heads of families, slaves or foreigners. Warfare and continued urbanization created the stage for severe epidemics, motivating the building of public sewage disposal systems, fresh water supplies, and public baths to encourage improved personal hygiene. During the 1st and 2nd centuries A.D., worsening health conditions and epidemics resulted from contacts with the Orient, including smallpox, measles, mumps, and bubonic plague.

Dioscorides, a physician serving with the Roman army, wrote De Materia Medica, which described plants collected first hand from Italy, Spain, Greece, and Germany, including: almonds, aloes, aniseed, belladonna, chamomile, cardamom, catechu, cinnamon, colchicum, colocynth, coriander, crocus, dill, galls, gentian, ginger, hyoscamus, juniper, lavender, linseed, licorice, mallow, marjoram, mustard, myrrh, olive oil, pepper, peppermint, poppy, rhubarb, sesame, stramonium, thyme, tragacanth, and wormwood. For more than 13 centuries in Europe, it was a standard herbal reference.

Galen of Pergamon, a follower of Hippocrates, compiled much of the medical knowledge of the time and added to it his studies of anatomy and physiology (mostly of animals). In spite of his errors in describing certain anatomical and physiological phenomena, his writing created the foundation for medicine over 1500 years later in Europe.

Celsus, in the 1st century A.D., classified medicine into three parts: diet, pharmacy, and surgery. Treatment of infectious illnesses was by rest and dietary restrictions, and humoral imbalances were treated by bleeding, skin cupping and scarification (reminiscent of acupuncture and moxibustion of traditional Chinese medicine). Gastrointestinal purgatives were administered to keep the bowels cleansed of "corrupt humors".

The rise of Christianity and the return of shamanism

After the 3rd century A.D., as the Christian Church assumed the power vacuum created by the disintegration of the old Roman Empire, practice and research in medicine declined and was replaced by a belief in God's wrath as the cause of the frequent epidemics. In a period of only a few hundred years, the Roman Empire declined to a state of depravity and barbarism; philosophical and religious atavism often accompanies periods of disintegration in civilization•[23]•, and the decline of Rome is a classic example. The medical tradition reverted to the stage of institutionalized shamanism: early Christian medicine emphasized prayer, confession of sins, laying on of hands, exorcisms, and miracles through intervention of saints. In Byzantium, the older Graeco-Roman medical practice continued to some extent alongside the Christian practitioners. The Graeco-Roman traditional physicians often charged exorbitant fees; as their numbers declined, their increasing scarcity together with the relative effectiveness of their methods created an imbalance of low supply and high demand. Consequently, the Christians, who provided their services free within the church framework, often persecuted and harassed them. (This suggests one possible explanation for the constant warfare between the two groups even unto the present.)

During 1348-1350 A.D., bubonic plague hit Europe, killing over 25 million people. Bubonic plague epidemics recurred over the next several hundred years. After several experiences with epidemics, perceptive people recognized that rats were responsible for spreading the plague; communities in which domestic cats helped reduce the rat population experienced lower morbidity from plague. However, in a frenzy of zealousness behavior typical of the time, the Church destroyed cats because Church officials labelled them as the devil's helpers. Throughout Europe, Church henchmen burned and killed cats, as well as herbalists, having associated them both with witchcraft and paganism. This period was not favorable to the progress of either medicine or herbal knowledge. Herbalists were periodically persecuted, first by the Christian Church, and later by the medical societies that had been created by Church authority.

Many respected and ethical physicians, after having suffered persecution for simply practicing medicine as best they could, welcomed the offer of official protection and recognition from the Church and from secular authorities in the 12th century. With the blessing of the Pope, the monarchies of France and Italy monopolized medieval medical education and licensed the medical profession. However, this protection came at a price; formal university studies, which emphasized theory, rhetoric, and philosophical speculations, helped to elevate medicine to a higher status while subjugating it to scrutiny and control by political and religious authorities. Platonic and Aristotelian ideals were industriously applied to the task of building professional monopolies, and practical knowledge was discarded by the wayside. As in law and theology, practical skills were associated with a lower status; thus, surgery and pharmacy studies and were often excluded from the curriculum. The modern Western tendency to be awed by grandiose philosophical theories and themes can be traced to the medieval obsession with other-worldly affairs, which can be neither seen, nor felt, nor verified empirically. ("In medicine one must pay attention not to plausible theorizing but to experience and reason together.")

Medicine in Byzantium and Persia

While the European practice of medicine degenerated for over 1000 years, the focus of medical advancement shifted toward the Middle East. Byzantium, during the 5th to 8th centuries A.D., inherited the wealth of medical knowledge accumulated during the Greek and Roman eras. Even though Byzantium was wrought with religious strife, superstition, and general decadence as was the Roman empire preceding it, scholarly pursuits were protected to a greater degree than in barbarian-dominated Western Europe. The physician-scholar Oribasius wrote volumes of compilations of medical knowledge, noted his sources and quoted them accurately. While lacking in original thinking, his works are valued for their faithful transmission of knowledge which may have otherwise perished.

It was in Persia that the knowledge faithfully preserved by Byzantine scholars eventually flourished and developed into a more advanced system of medicine. Islamic physicians combined Graeco-Roman knowledge of medicine with Hindu and Islamic practices and continued the advancement of medicine in the spirit of Hippocrates. The Middle East during the Middle Ages continued to be a warring ground and a conduit for epidemic illnesses passing between Europe and the Orient; religious pilgrimages and trade aggravated the problem, ultimately retarding economic development in Europe and much of the Middle East. Islamic medical practitioners developed methods of treating these illnesses. The caliphs of Persia encouraged the collection and translation of Greek medical knowledge into Syriac language and later into Arabic. In Persia during the 9th century, formalized training was established for physicians, surgeons, bonesetters, and pharmacists. The Persian pharmacopoeia listed over 720 drugs, including medicinal plants of Greek, Hindu, and Persian origin.

The Renaissance and restoration of a European medical tradition

During and after the 12th century A.D., European scholars translated medical texts of Avicenna and other Islamic physicians from Arabic into Latin. In the 13th century, after almost one thousand years of neglect, physicians resumed studies of anatomy. However, the emphasis of anatomy and physiology and a focus on physical causes of illness led to the neglect of the Hippocratic philosophy in medicine and an emphasis on the use of drastic remedies to deal with these presumed causes. Physicians tended to ignore the numerous side-effects resulting from such drastic remedies. Hippocrates' philosophy of human ecology was but a faint memory in the minds of physicians, and in the 16th century, Philippus A. Theophrastus Bombastus von Hohenheim (known to commoners as Paracelsus) decisively rejected the ideas of Hippocrates and attempted to derive a new philosophy of medicine based on Christian dogma, Neoplatonic philosophy, and the correspondences between the microcosm and the macrocosm; this herculean task may have humbled Mr. von Hohenheim sufficiently to guide him toward observations of nature for ideas. Unfortunately, he placed emphasis on astrology and alchemy, rather than upon empirical observation. He believed that man functioned chemically and that illness could only be treated chemically, and he focused his theories on unseen chemical phenomena, rather than upon observable symptoms and clinical signs. While chemistry plays an undeniable role in human health, emphasis of the unseen over the immediately observable has blinded medicine to this day.

During the Renaissance period, numerous theories of health and medicine arose to attempt to remedy the failings of contemporary medical practice. Nicholas Culpeper compiled an eclectic variety of information on many herbs, incorporating a liberal dose of astrology, yet he ignored and deleted references to the "hot and cold" nature of remedies that is so important to traditional Chinese medicine.

In spite of persecution by institutions and by religious authorities, herbalists during recent centuries have attempted to reestablish the science of herbal medicine. Samuel Thompson, an uneducated but widely respected herbalist who acquired a knowledge of herbs through broad personal experience, influenced popular and professional opinion to such a degree that many doctors and herbalists began referring to themselves as Thompsonians; by so doing they distinguished themselves from the "Regular" physicians of 19th century America who used drastic, toxic, and often deadly remedies such as calomel and blood letting. Thompson's common sense approach led to a renewal of the empirical method in herbal medicine. However, in spite of the popularity of herbal doctors during the 19th century, powerful medical syndicates successfully quashed herbal traditions in America by the early 20th century. Meanwhile, many European countries including Germany, England, and France fostered the growth of herbal traditions.

In comparing the progress of Chinese medicine with that of European medicine, as the reader of history considers the follies of the European physicians and medical scientists, it is difficult to suppress an urge to write large the maxim of Hippocrates: "In medicine one must pay attention not to plausible theorizing but to experience and reason together." A thousand years of turmoil, cultural decay, and religious mania appears to have shaken the common sense out of the average European as well as Europe's physicians. Numerous creative physicians attempted to restore the logical foundation and philosophical vantage points lost during the disintegration of the Roman Empire, but most of these attempts suffered from an excess of religious speculation and philosophical theorizing, and a deficiency of attention to symptoms, clinical signs, and other empirical phenomena.

Where do we go from here?

An observer of modern medical care, even "holistic" health care, in the Occident will observe certain problematic thought patterns that can be traced back to confusion sown within the last 2000 years. In the process of reviewing the history of medical traditions in Europe and the Middle East, we have encountered the following tendencies:

  1. Conferring theoretical speculation a higher status than physical observation;
  2. Ignoring side effects of drastic medication in order to destroy a presumed cause of illness;
  3. Focusing on divine causes (karma, fate, punishment for sinfulness) of illness and ignoring ecological factors;
  4. Controlling and regulating the practice of health care for purposes of social control.

The alternative health fashion of waging search and destroy missions against "toxins" and an obsession with "cleansing", even when certain illnesses are characterized by deficiency disorders, traces back at least to the Essenes during the 1st century B.C., who developed numerous methods for purging the bowels as a way to purify the mind and the body. The idea that illness represents "evil" within the body in a cosmological-religious sense became a festering obsession itself, leading to centuries of horror and persecution. How much of modern obsession with regular bowel movements and constipation might have its roots in religious fanaticism? Martin Luther was said to have severe problems with constipation, to the point of not having a bowel movement for weeks at a time.

Perhaps the great cosmic lesson for the Western world is that God works through nature, and that when we try to theorize about God without paying attention to the nature of creation, with all its details, patterns, and ecological relationships, we will inevitably come to harm. Our role in creation is to observe carefully, pay attention always, and to harmonize with creation. Mental obsessions of any type, whether religious or scientific, tend to interfere with our ability to pay attention.

The tendency of bureaucratic and technological societies to control and regulate all aspects of human life and nature, at the same time that they have failed to pay attention to human ecological needs, has resulted in health care systems that function primarily as means of social control rather than as means of providing healing. Note that the period in which Hippocrates lived was characterized by lack of regulation of the medical profession, yet this period produced the most rapid advance of medical knowledge ever seen in that region of the world. The licensing of the medical profession in the 11th century A.D. by the Catholic Church served to shackle it to religious and political control and stifled its development for several more centuries. When bureaucrats claim to protect the public by licensing health care, they often create powerful monopolies that resist progress and change.

The fixation of modern medicine on physical causes of illness has led to a serious blindness regarding side effects. Overuse of antibiotics has created a massive problem of drug-resistant microbes. Drastic pharmaceutical and surgical remedies have left a trail of devastation, which is finally motivating the health care professions to restore the philosophy of human ecology to its rightful place. The philosophy of human ecology places greater emphasis upon understanding complex interactions of multiple variables rather then upon single causes; in any technological culture, most chronic diseases result from long-term stress and insult from multiple sources. After the disintegration of the Roman Empire, it has taken the Western world almost 2000 years of evolution to restore the same wisdom of perspective and world-view of Hippocrates. It is no accident that as we arrive at this recognition, we also recognize that traditional Chinese health care, which embodies principles of human ecology, has been patiently waiting for us to learn and to use at this phase in our culture's development.

From this survey of the advance and retreat of medical and general scientific knowledge throughout various historical eras, we should derive certain important lessons. History is more than a random sequence of events. Human nature repeats itself, and we should ask ourselves which of those attitudes and qualities of the past should we should hold up for emulation, and which should we avoid. Periods of cultural and intellectual expansion are typically characterized by opportunities for exchange of ideas between cultures and by an openness toward integrating these ideas with current theories of knowledge. The age of Hippocrates in ancient Greece, the golden age of Islamic medicine from the 7th to 11th centuries, and the golden age of Chinese medicine during the 1st millenia A.D. are all characteristic of these ideals.

The lessons that history shows to us during periods of general social decay and collapse are perhaps more difficult and unpleasant to examine; they are all the more important for their reminders of how centuries of knowledge can disappear unless certain individuals or institutions recognize both the steady decay of the existing civilization and take active steps to preserve knowledge for future generations. Byzantium and early Roman Catholic Europe are classic examples of two very different outcomes. Byzantine scholars preserved knowledge by compiling it for later use by Persian physicians. Early Catholic Europe was so preoccupied with religious infighting and theoretical speculation that the practical arts and sciences were left to disintegrate for over 1000 years. China during the last millenia took the course of Byzantium, and while the general practice of medicine deteriorated along with the general decline of Chinese civilization, medical knowledge was carefully compiled by the Taiyiju scholars during the 11th and 12th centuries. This knowledge would not experience a rennaissance until the Communists came to power in 1949. Ironically, during periods of social decline, medical knowledge appears to survive best when the practice of medicine is considered a second-class occupation lacking in prestige, which was the case in ancient Greece, Rome, Byzantium, and China. The ancient Egyptian and Babylonian empires elevated the practice of medicine to semi-divine status, attaching to it a cumbersome baggage of superstition, religious dogma, and pseudo-rationalisms meant to serve more political than therapeutic aims. The medieval Catholic Church likewise recognized its opportunity to consolidate power by bestowing official status upon physicians in return for regulating and controlling their every actions and ensuring political and religious correctness.

Today, the practice of medicine, being highly regulated and in control of pharmaceutical interests, has purchased its own status by agreeing to subordinate the therapeutic welfare of the patient to financial interests. Instead of superstition and religious dogma, the worship of mammon has supplanted the goal of health. Herbalists, being human, are also not immune from the temptations and weaknesses displayed by health care professionals throughout history. As traditional Chinese herbal practices are being introduced to America during a general state of social decline and collapse, the lessons of history suggest that to maximize the benefits to our culture, the following guidelines be followed:

  1. Both empirical and speculative (analytical) approaches should be encouraged in investigating and developing the Chinese herbal sciences, without encouraging either to dominate.
  2. Official regulations and actions should focus on preserving knowledge and establishing voluntary professional standards without establishing monopoly control.
  3. Foreign ideas and cultural exchange, especially with nations currently in a phase of cultural expansion, should be encouraged in order to prevent dogmatism, intellectual rigidity, and cultural stasis.
  4. Avoid elevating the social status of herbal health care, yet promote lay knowledge of it to firmly implant it as a tradition.

With regard to avoiding monopoly control, civilizations in a phase of decline are notoriously overrun with corruption, bribery and blackmail. The history of the early Catholic Church is a classic example of this. By avoiding monopoly control, corruption is minimized; promoting herbal knowledge among all levels of the society is one method for inhibiting monopoly control. The experience of the Chinese during the Nationalist rule illustrates the effectiveness of permeating all levels of society with a valuable traditional system of health care; in spite of regulatory ineptness, tyranny and general cultural decline, it will survive.

References

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