by Roy Upton*, American Herbal Pharmacopoeia (bio at end of blog)
Establishing an authoritative record of the historical use of a botanical is critical to the development of the Monographs and Therapeutic Compendiums of the American Herbal Pharmacopoeia, especially in the USA where there is a very unhealthy distrust of anything herbal or knowledge gained through empiricism. As the work of AHP encompasses Western, Chinese, and Ayurvedic botanicals, in that order of priority, each presents its own challenges. The focus of this blog is to present some of the challenges we face and how we address these, from the perspective of a traditional herbal organization attempting to chronicle the authoritative historical medical use of plants but without the luxury of being academically trained historians.
AHP Goals with the Historical Record
AHP’s primary goal in establishing the history of use of a botanical is to hopefully show the consistency by which the botanical was historically and is currently used. For example, the sedative qualities of valerian root (Valeriana officinalis) have been reported since at least the sixth century and likely were known at least a few weeks before that. AHP’s goal is also to revisit uses of the botanical that may have been lost due to market pressures or other effects. For example, red clover (Trifolium pratense) is commonly used as an alterative for skin conditions and market pressures have emphasized its use in menopause, at least in North America. Andrea Mattioli in 1626 wrote that consuming the purple flowers can cause the menstrual cycle to be irregular but that the white clover can cause the menses to flow. This does not occur in many herbals describing the use of red clover but considering the phytoestrogen aspect of the plant, may be worthy of attention and may broaden our application of the botanical.
The situation in the USA may be a bit different from other countries as the split between Old World Britain and Europe and the establishment of the New World resulted in a severe break in the continuity of traditional herbal medicine knowledge. Early Americans were cut off from a cultural milieu that perhaps more strongly supported plant-based medicines, were separated from the literary herbal record, and then subsequently, to a great extent, our herbal traditions were subsumed by market pressures that both favored synthetics over botanicals, and later led to market popularity-based herbal indications. For example, echinacea (Echinacea spp.) was popularized for its use for cold symptoms that are characterized by thick, phlegmatic boggy mucous, whereas historically echinacea was used for hot infectious conditions (e.g. snakebites). In a survey of the most popular cold remedies used by the Eclectic physicians of the late 1800s, echinacea was not even included among herbs used for colds even though it was one of their most frequently relied upon medicines. Other examples of market driven indications of herbal medicine use include ginkgo (Ginkgo biloba) for memory, saw palmetto (Serenoa repens) for prostate enlargement, and cranberry (Vaccinium macrocarpon) for bladder infection, all of which lack any record of historical medical use for these indications.
Western Herbal Literature
Much of Western herbal medicine literature begins with the first century AD De Materia Medica of Dioscorides who clearly stands among the most authoritative writers on materia medica in the West
and upon which many subsequent pharmacopoeias and materia medicas over the next 1,500 years were subsequently based. If you have the luxury of being a Greek linguist and have access to the original text it may be fairly easy to know what Dioscorides recorded. Unfortunately most of us are not Greek scholars and do not have access to original texts. Even if we did, the plant descriptions are often sparse leaving questions of what botanical was being presented, a challenge compounded in subsequent renderings of his work. Reportedly, the oldest version of De Materia Medica is the sixth century Anicia Codex, which cannot be a truly integrous presentation as it contained commentary from Galen and Crateuas and reportedly was arranged differently than the original. We are forced to presume that at least some integrity of the original was preserved. Subsequent editions of De Materia Medica were translated from the original Greek to Aramaic, Arabic, and Latin and eventually to English. This begins to reveal some of the challenges of tracing the historical literature as every translation, rewrite, commentary, and new presentation has the possibility of introducing unoriginal text, errors, extrapolations, and inconsistencies. In subsequent commentary, there is also the potential for providing greater clarity of meaning, correcting mistakes, and expounding on the foundational work as part of a continually evolving tradition, but in either case the integrity of what is accessible to most modern English readers is limited to the scholarly integrity of those presenting the English-language versions. Because of this, we must have a certain amount of trust in the historical lineage of the text and commentaries as the originals are typically only accessible to academicians, not herbalists attempting to better understand the historical use of their medicines.
One of AHP’s most significant challenges is accepting the fact that De Materia Medica remained the most authoritative and foundational work upon which most other herbals were developed into the Renaissance herbals of Fuchs, Bock, Brunfels, Mattiolis, Tabernaemontanus, Parkinson, Salmon, Gerard, and others. However, considering this should also bring great pain as few of these medical authorities actually recorded their own experiences. Rather they parroted Dioscoridian knowledge almost verbatim or, in some cases, provided more detailed commentary on how a botanical was to be used but predominantly according to the indications presented by Dioscorides. There is little record of whether medical authorities after Dioscorides considered his information to be grounded in clinical experience. The Renaissance herbals are some of the most exquisitely developed herbals of any culture that preserves an important piece of the historical record but with relatively few original contributions to medical knowledge, in great part due to religious prohibition against anything but divine healing. Even Physica of Hildegard von Bingen, who may superficially be viewed as a mystic and monastic practitioner, borrows extensively from Dioscorides and it is difficult to know what reflected her personal experience, at least from the accessible English-language translations.
Weaving a Tapestry of Herbal History
In our attempts to present a broad picture of the historical use of an herbal medicine the ideal is to go to the source texts and whenever possible avoid secondary references. For the reasons mentioned, this is most challenging. The next best option is to go to what would be considered authoritative reviews of the originals. Mattioli, for example, is considered an authority on Dioscorides, but additionally integrated information from local herbal folk traditions. The beauty of Mattioli’s works, different than others presenting Dioscorides, is there is a clear delineation between the information conveyed by Dioscorides and Mattioli’s own commentary. China’s Li Shizhen, perhaps the greatest writer of materia medica of any culture, adopted the same style, maintaining the original text of earlier materia medicas written in black and adding his personal commentary in red text, which allows for an integrous chronicling of herbal knowledge. This practice continued in other Chinese materia medicas. Another writer on Dioscorides, Jacobus Theodorus (Tabernaemontanus 1525–1590) can also rightfully be considered an authority. Like Dioscorides, Tabernaemontanus maintained a lifelong career as a botanist, herbalist, and practicing physician. His posts as private physician to counts, lords, and bishops, and his association with the University of Heidelberg, undoubtedly gave him the greatest access to the extant medical literature. His Neuw Kreuterbuch (1588) was published only a few years before he died, which we might consider as reflecting the work of a very seasoned professional. Access to literature contributed greatly to Li Shizhen’s notoriety as the greatest compiler of materia medica in China. Li was able to cite more than 900 previous medical authorities, an accomplishment unequaled in any other culture, and like Tabernaemontanus, was a highly seasoned medical practitioner. The challenge for English-language readers is then to rely on English translations of works such as those of Mattiolis and Tabernaemontanus, which have never been done, or to read the material in their original Italian and German, respectively, which presents its own challenges.
In addition to attempting to access original or authoritative literature and reviews, even mistakes are part of the historical record and, it is often helpful to note such mistakes, or at least acknowledge when confusion exists in the literature. In a recent review of the literature on arnica (Arnica spp.) it is clear that throughout history arnica was often confused with the more toxic aconite (Aconitum spp.), both sharing the common name Doronicum. In some references, the plant is described sufficiently to know which of the species is being discussed. In other cases, no such clarity is provided, presenting another challenge, as not all writers and historians are herbalists and botanists who can accurately interpret botanical descriptions. The confusion between aconite and arnica appears to have ended with the assignment of the name Arnica montana in Species Plantarum of Linnaeus in 1753, thus ending a few hundred years of ambiguity and suggesting in this case that the most accurate accounting of the use of the botanical can be made after Linnaeus.
The Path Forward
For the greatest accuracy in chronicling the historical record, it is critical, not to simply parrot information that has been written by a supposed authority, but rather to qualify who said what when. The simple two words according to and then citing the reference allows for a clear historical, if not always completely clinically relevant, record to be compiled. In many cases there is relative agreement in the medicinal indications of what was stated in source texts as medical indications themselves are often less subject to interpretation than what species of plant was used. Noting the overall context of the herbal literature is much like referring to a botanical voucher in a herbarium collection or a retention sample in herbal product manufacturing. It allows a reader to access the original reference and determine the level of confidence there is in the information presented. Just as not all historical literature is completely accurate, not all vouchers in herbarium collections are accurately named. The last and perhaps most critical part of determining the true healing potential of a botanical is to consider the historical record and compare that with one’s own personal experience with the plant, the application of that plant in patients, and comparing the historical record and one’s own finding with the experience and findings of other contemporary practitioners. Having a personal relationship with the medicine helps tremendously in interpreting literature, especially in cases where physical descriptors of the plant (hot or cold in the first degree, stimulating, causes one to sneeze, etc.) are given as it is relatively easy to determine if those descriptors are consistent with the properties of the plant of the same name today.
Most modern predominantly English-language herbalists have the distinct disadvantage of not being able to translate classic Greek or Latin-language texts and may be limited to English language translations of many of the most seminal works of herbal medicine that form a substantial part of Western materia medica. Conversely, most modern predominantly English-language herbalists have the distinct advantage of having access to more herbal medicine literature in more languages and more English language translations than has ever been broadly available to any culture in history. Yesterday we would have had to sail around the world to access the tomes of the library of Alexandria or study with Ibn-Sina in Persia and sit for weeks or months copying only a fraction of the available works by hand. Today, we can sit in our living rooms and have almost instant access to downloadable original language works and translations making this the “Golden Age of Herbal Discovery.”
Beck, L.Y., (2017). Pedanius Dioscorides of Anazarbus: De materia medica (3rd ed). Translated by L.Y. Beck. Hildesheim: Olms.
du Pinet, A., (1572). Commentaires de M.P. Matthiolus sur les six livres de Pedacius Dioscoride Anazarbeen de la matière médicale. Translated by A. du Pinet. Lyon: Veuve de G. Cotier [online] Available at https://archive.org/details/gri_33125012606816 [Accessed 14 October 2017].
Fuchs, L., (1542). The great herbal of Leonhart Fuchs: De historia stirpium commentarii insignes, 1542. Translated by F. Meyer, E. Trueblood and J. Heller. Vol. 1 & 2. Reprint 1999. Stanford, CA: Stanford University Press.
Gunther, R.D., (1934). The Greek herbal of Dioscorides. Reprint 1959. New York: Hafner.
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Li, S.Z., (1593). Ben cao gang mu [compendium of materia medica]. Vol. 5. Reprint 2003. Beijing: Foreign Language Press.
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Osbaldeston, T.A. and Wood, R.P.A., (2000). De materia medica: Being an herbal with many other medicinal materials written in Greek in the first century of the common era. Johannesburg: Ibidis.
Staub, P.O., Casu, L. and Leonti, M., (2016). Back to the roots: A quantitative survey of herbal drugs in Dioscorides’ De Materia Medica (ex Matthioli, 1568). Phytomedicine, 23(10), pp.1043–1052.
Throop, P., (1998). Hildegard von Bingen’s Physica. Translated by P.Throop. Rochester, VT: Healing Arts Press.
Tobyn, G., Denham, A. and Whitelegg, M., (2011). The Western herbal tradition: 2000 Years of medicinal plant knowledge. Reprint 2016. London: Jessica Kingsley.
Upton, R. (ed)., (2017). Red clover flowering tops, aerial parts, and dry extracts. Monograph and therapeutic compendium. Scotts Valley, CA: American Herbal Pharmacopoeia.
*ROY UPTON BRIEF BIO
Roy Upton, RH, DipAyu is the founder, executive director, and editor of the American Herbal Pharmacopoeia (AHP). Roy is also co-founder and past president, of the American Herbalists Guild (AHG), and serves on botanical expert advisory committees of AOAC International, the American Botanical Council, NSF International, and the Lloyd Library and Museum. Roy has been working and practicing professionally as an herbalist since 1981. He is trained in Ayurvedic, Traditional Chinese, and Western herbal medicine and has also studied and worked extensively with Native American and Caribbean ethnobotanical traditions. As an integral part of his work as an herbalist, Roy spends a great deal of time defending the rights of people to access herbal medicines and to see herbal medicine integrated into the fabric of both our homes and health care systems.