Herbal MedicineRudolf Fritz Weiss

MD

Translated from the Sixth German Editionof Lehrbuch der Phytotherapie

by A. R. Meuss, FIL, MITI

AB ARCANUM, GOTHENBURG, SWEDENBEACONSFIELD PUBLISHERS LTD, BEACONSFIELD, ENGLAND ENGLAND

Chapter 1

What is Herbal Medicine?

Herbal medicine, or phytotherapy, is thescience of using herbal remedies to treat thesick. It therefore covers everything frommedicinal plants with powerful actions, such asDigitalis and Belladonna, to those with verygentle action, such as chamomile, mint andmany others. It should be noted that ‘verygentle’ action, when referring to chamomile ormint, does not mean they are more or lessineffective, but rather that one would notexpect these plants to produce instant andpowerful effects like those seen, for instance,after an injection of digitalis or strophanthin.‘Gentle’ action also means that these ‘simple’medicinal plants do not as a rule have anyappreciable toxic effects, and may thereforebe safely taken over an extended period oftime.

Gentle and PowerfulPhytopharmaceuticals

A clear distinction exists between gentle ormite phytopharmaceuticals on the one hand,and powerful or forte phytopharmaceuticalson the other. Between them lies a wide trans-itional field, i.e. the many medicinal plantswith actions somewhere between ‘gentle’ and‘powerful’- Liquiritia, Arnica and Khella, tomention just a few. These might also bereferred to as ‘intermediate’ phytopharma-ceuticals.

The situation is the same for phytothera-peutic agents as it is for chemotherapeuticones. With these we have a similarly widespectrum from gentle and largely non-toxicdrugs such as calcium carbonate, or evenaspirin, to the modern cytostatics with their

very powerful actions. Here too the majorityof drugs are in the middle. Like everywhereelse, life swings between two poles.

It is wrong, or at least one-sided, to thinkonly of gentle phytopharmaceuticals whenspeaking of phytopharmaceuticals, and to be-little them, if not in words, then at least inone’s thoughts. It is nevertheless true, withmost gentle phytopharmaceuticals, that thereis no standardized active principle that solelyor largely determines the drug action. Thegentle pharmaceuticals in particular demon-strate that with plant remedies one very oftenhas a comprehensive complex of active prin-ciples, with individual components interactingwith others, so that only the complex as awhole will produce the therapeutic action.One might speak of a bio-pharmaceutical. Thediagram overleaf will help to illustrate this.

Where Did the TermPhytotherapy Originate?

The term was introduced by the Frenchphysician Henri Leclerc (1870-1955). He hadpublished numerous essays on the use ofmedicinal plants, most of them in La PresseMedicale, a leading French medical journal.These essays were outstanding for their style,and superb examples of the art of presenting asubject. He summed up his life-time experi-ence in Pr&s de Phytothkrapie, a concisework that has since become a classic. Leclerc’slife and work were described in lively terms inan obituary which appeared in La PresseMedicale on 14 May 1955.

Herbal medicine has come a long way sincethe days of the ancient ‘herbalism’. The study

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Herbal Medicine

Herbal Drugs (Medicinal Plants)

Gentlee.g. chamomile, hawthornComplex of naturalprinciplese.g. chamomile extract,

hawthorn extract

Powerful

e.g. belladonna, digitalisIsolated naturalprinciplese . g . atropine ,

digitoxin

Gentle

hawthorn

Gentlechamomilepeppermint

Gentlevalerian

Midfield of numerous transitionse.g. arnica, pheasant’s eye, liquorice

Herbal Medicines for Heart Diseases

Powerful

digitalis

Midfieldlily-of-the-valley

Herbal Medicines for Gastrointestinal Diseases

Powerful

belladonna(atropine)

Midfieldliquorice

Herbal Medicines for Nervous Diseases

Midfieldhypericum

Powerful

opium,melissa morphine

of the use of medicinal plants is now ascientific subject, a field of medicine in thesame way as chemotherapy, hydrotherapy,electrotherapy and others. Knowledge ofmedicinal plants and their uses has beenrecorded from antiquity - by Imhotep, thepriest-physician of ancient Egypt who devisedthe Step Pyramid of Sakkara, by Galen,personal physician to the Roman emperorMarcus Aurelius, and later by Paracelsus, theAbbess Hildegard of Bingen, and the authorsof the great herbals of medieval times, right tothe present day.

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The rise of chemistry, the development ofnumerous synthetic chemical drugs, and thepossibilities opened up by experimentalpharmacology have caused herbal knowledgeto be neglected. A new climate was created bymethods evolved on the basis of modemphysiology, concerned predominantly witheffects that were measurable under experi-mental conditions. In this framework it wasdifficult to know what to do with the medicinalplants. Chemical compounds could always beexactly analyzed giving results in parts byweight of so and so many milligrams, etc. In

phytotherapy this method on the wholeapplies only to medicinal plants with powerfulactions - great difficulties arise in otheraspects of the work, particularly with many ofthe plants with gentle actions.

Native Substance versusPure Substance

It therefore became the aim to produce theactive principles of all medicinal plants as faras possible as pure substances, which couldthen be investigated in the same way asclearly-definable chemical compounds. A newtrend developed where such native substanceswere looked for, designating them phyto-pharmaceuticals. As a result it becamepossible to elucidate the mode of action ofmany of the old medicinal plants, and therecan be no doubt that this brought majoradvances in phytotherapy. This new approachwhich allowed the subject to become open toscientific investigation. At the same time, thefield of phytochemistry had greatly expanded.It proved possible to isolate a remarkablenumber of plant principles, and then to estab-lish their chemical formulae. This in turn lentfresh impetus to herbal medicine, and wasgreatly helped by the fact that new methodshad become available for the manufacture ofstandardized herbal pharmaceuticals. Thepharmaceutical industry has made a majorcontribution in this field.

Yet there are reservations when it comes tothe proposal that one can elucidate the modeof action of every medicinal plant by preparingand analyzing its active principles in pureform. There has been a tendency to disregardany medicinal plant that did not fit easily intothe new design concept of phytopharma-ceuticals, writing them off as being of doubtfuluse. In many such cases we simply have not yetfound the correct method of determining themode of action. Considerable scope remainsfor research in this area.

First attempts have already been made todevelop a particular discipline of phyto-

What is Herbal Medicine?

pharmacology. Its function is to developmethods of assessing the total complex of aplant’s medicinal actions, establishingadequate significance for such whole-plantactions. This would represent a great stepforward. It calls for very different ways ofthinking - moving away from seeking andisolating pure principles, learning instead totake medicinal plants for what they are: acomplete product of nature, with innumerableindividual constituents, active principles andother substances that may also make a signi-ficant contribution to the total medicinalaction. It should then also become possible toassess the many herbal elixirs and extractswhich continue to be so popular with thepublic. Most of them are made from ten,twenty or even more different medicinalplants, and many are based on old apothe-caries’ formulations. Until now it has not beenpossible to get an objective assessment ofthese multi-herb mixtures, however much theymay have been recommended on the basis ofpractical experience.

The Role of Empiricism

Even where it is not possible to demonstrateactivity in the principles, for the reason thatthe medical action is due to the total combina-tion of constituents, empirical data should notbe brushed aside. We need the two poles,experimental research on the one hand andproperly conceived empiricism on the other,to make up the whole spectrum of scientificphytotherapy.

Terminology

The term phytotherapy has come to be inter-nationally accepted for herbal medicine, beingclear and unmistakable. As already stated, itwas introduced into French medical literatureby Leclerc, and was then also adopted inGermany to describe the use of medicinalherbs in the treatment of the sick.

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Herbal Medicine

Phytochemists, pharmacists and pharma-cologists are trained to consider the propertiesand actions of isolated medicinal principlestraditionally referred to as ‘pharmaca’ (sin-gular ‘pharmacon’). It was logical for them torefer to a plant drug as a phytopharmacon.The terms ‘phytotherapeutic agent’ and‘phytopharmacon’ therefore mean the same,simply taking another point of view.

The field of chemical synthesis made tre-mendous advances after the second world war.The result was that ‘simple’ herbal drugs cameto be largely forgotten and considered old-fashioned. Only a limited number of pureprinciples extracted from medicinal plants stillheld their own, among them digitalis, pro-duced from fox-gloves. This was possiblebecause the same methods could be used inanalyzing and processing them as with syn-thetic drugs.

The large field of plant drugs, their medi-cinal use based on long-standing experience inempirical medicine, more or less fell by thewayside. These drugs, Leclerc’s phyto-therapeutic agents, now came to be used onlyin popular medicine. Hardly any mention wasmade of them in medical schools.

Yet they survived and have begun to enjoyan important revival. One reason was that theconstituents and active principles of medicinalplants were being isolated and identified inplant chemistry. The data produced by thesechemists confirmed the empirical uses andcould no longer be overlooked. Plant drugswere gaining scientific recognition.

Such recognition was also required for theready-made preparations offered by manu-facturers. To gain ‘scientific’ recognition, theterm ‘phytopharmacon’ was given preferenceover the term ‘phytotherapeutic agent’, usedby the Continental European medical profes-sion. The result has been an unnecessary con-fusion of terms. It grew even worse when theterm ‘phytopharmacotherapy’ was introducedin place of ‘phytotherapy’.

As already stated, ‘phytotherapy’ is a well-defined and easily accepted term. It is our taskto make it come to life.

One interesting definition has been given byProfessor H. E. Bock: ‘Herbal medicine,either using whole plants or isolated plantprinciples, is called phytotherapy. It presentsitself as a gift of nature, with a cosmicnaturalness that makes it the obvious choicefor a first-treatment approach. Generationshave made use of it, gained experience, andcherished it, like a historical treasure, as asource for therapy.’

Objections to Phytotherapy

Bock also referred to a number of problemsfrequently encountered in the evaluation ofherbal medicine, above all the vast and oftenhighly imaginative range of indications.Modern scientific herbal medicine wasemphatically against this. Nothing has donemore to prevent recognition than the whole-sale transmission of indications derived fromthe old herbalist tradition, often still broughtbefore the public in articles and lectures withno scientific foundation at all. This also appliesto many recent semi-scientific or popularbooks on herbal medicine.

The same thoughts were expressed by Vogelconcerning the special nature of plant drugs(D&c/r Apoth Ztg 1979; 119:2029-2033). Heput particular emphasis on the differentstandards to be applied when assessing thevalue and efficacy of plant drugs. Whilst it wasnecessary to investigate the efficacy of plantdrugs with the methods of scientific medicine,we should also not forget the following:‘Demonstration of medicinal actions shouldnot be based on rigid schemes, but be inaccord with the characteristic mode of actionof the drug concerned. Where methods basedon exact science are not yet available, medicalobservation and experience, including thesubjective statements of the patient, have tobe given equal validity with controlled clinicaltrials.’ The basic stance of rational therapy isuntenable because it rests exclusively on theprinciples of materialistic thought. ‘Applied tothe problems of medicine and pharmaco-

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What is Herbal Medicine?

therapy this means: man being a comple-mentary being of body and soul, the subjectivestatements of the patient concerning drugactions are just as valid as laboratory para-meters. Instead of double blind trials, it mightbe better to adhere to the rule attributed toAbraham Lincoln - you can fool all thepeople some of the time, and some of thepeople all the time, but you cannot fool all thepeople all the time. Applied to pharma-cotherapy this means that when a drug hasbeen used for a long time, is demanded bypatients and prescribed by doctors, its actionhas to be considered established, even withoutdouble blind trials.’

Practical Phytotherapy

To determine the rightful place of herbalmedicine in modem medicine, the above maybe summarized once more. Pharmacists andpharmacologists are trained to work withmedicinal agents, i.e. with pharmaceuticalproducts or drugs. If the product is a plantone, it is natural to refer to it as a plant drug orphytopharmaceutical. Medical practitionerson the other hand are concerned with therapy.If they are making use of a medicinal plant,they think in terms of ‘phytotherapy’. If weuse the term phytopharmaceutical or the termphytotherapy it is basically the same thing seenfrom another point of view.

There has been much discussion as towhether pure principles obtained frommedicinal plants should also be includedamong the phytopharmaceuticals or phyto-therapeutic agents, examples being digitoxin,a glycoside obtained from Digitalis, and atro-pine, an alkaloid from solanaceous plants.Some felt these were drugs ranking equal withsynthetic chemical products. Others pointedout that in the strictest sense these supposedly‘pure’ substances were not entirely free fromresidues of other constituents of the originalplant drug. The commission responsible forstandards applying to phytopharmaceuticals atthe Federal Ministry in Berlin concluded that

these pure principles obtained from medicinalplants should be considered phytopharma-ceutical products, They were aware that therecan be no clear line of distinction betweenthem and purely synthetic drugs, but agreedthat a compromise had to be reached.

Treatment with medicinal plants, phyto-therapy, can be used in all fields of medicine,although there are differentiations. As a rulethe practitioner will prescribe gentle phyto-pharmaceuticals. These are effective in acuteconditions, but are also worth considering forlong-term therapy, for instance with manymetabolic disorders, chronic heart disease andrheumatic conditions. Hospital doctors willmostly have to use phytopharmaceuticals withfast, powerful actions, such as strophanthin,atropine or morphine. The risks are twofold inthis case. In the first place, there is a tempta-tion to suggest to the GP that the patientshould continue on these powerful drugs,forgetting that conditions are different ingeneral practice and that a GP often has tolimit his prescribing to gentle drugs - indeed,these are perfectly adequate for long-termtreatment. The second point is that hospitaldoctors often have no real knowledge of gentledrugs and therefore tend to underrate them.They will often regard them as placebos, eventhough they are not. This results in thesituation where young doctors face difficultieswhen they finish their hospital training andenter into general practice, difficulties theyoften do not know how to cope with. They firsthave to find their way into the differentapproach required in general practice, and thisincludes relearning about phytotherapeuticagents.

To stress the point, so as to avoid anymisunderstanding - scientific phytotherapystands between two poles. One is orthodoxmedicine with its two branches of pharma-cology and clinical practice. Both want torecognize only those phytotherapeutic agentsthat fit into their particular spheres and whichcan be statistically confirmed by increasinglysophisticated methods. Clinical practice,particularly in hospitals, gives preference to

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Herbal Medicine

fast-acting powerful drugs and therefore onlyhas use for the powerful drugs.

The other pole represents the needs ofgeneral practice, where there is a call not onlyfor powerful phytopharmaceuticals but alsofor medicinal plants that have less toxicactions. Long-term therapy can be used ingeneral practice, though this does give rise tothe problem of assessing extended courses oftreatment. In general practice one also findsthe point of transition to the large field ofnature cure, where powerful drugs with toxiceffects are never used. From there it is only ashort step to ‘outsider’ medicine, where themedicinal plants are frequently only used as avehicle for the individual’s particular methods.

Scientific phytotherapy as presented in thisbook is therefore the middle way between thetwo extremes. Anyone working in this fieldwill be pleased if new active principles arefound in medicinal plants and prepared in pureform. It often makes them easier to use inpractice, as well as providing the theoreticalbackground for much that has to date onlybeen known empirically. Yet it would bewrong to present this as the only goal ofphytotherapy. It is equally important to findmethods that will permit an objective assess-ment of the combined active principles inmany medicinal plants. In this respect we areonly at the beginning, and reference will bemade to interesting prospects for some of theplants described in this book.

New Medical Aspects toPhytotherapy

It should again be stressed that phytotherapyis an independent scientific discipline whichaccordingly requires specific approaches totheory and practice. It is still in the process ofdevelopment, and as for any scientific disci-pline, cannot be otherwise. Certain specifictasks are already emerging. In the first place, itis important that physicians once againdevelop a special, almost ‘personal’ relation-ship to the medicinal plants they prescribe,

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very much as it was in the past. It is this whichgives herbal medicine special validity in theeyes of our patients. Repeated polls carriedout by independent institutes have shown thatthe great majority of patients continue to hold‘medicines made from plants’ in high esteem,despite all the progress medicine has made inother fields. More than 50% of those includedin the polls stated that in case of illness theywould prefer a plant-based medicament. Onlyabout 20% said that a chemical drug, a‘medicament produced by chemical synthesis’,seemed to them to offer better prospects. It isevident that medicinal plants are seen as beingcloser to nature, compared to syntheticchemical drugs, and thus closer to people. TheBerlin pharmacist Heuber said that modernmedicine has fallen too much under the spellof chemistry. American authors have warnedthat medicine is running the risk of building anew Tower of Babel, where people fromdifferent disciplines are no longer able tounderstand each other. Phytotherapy is able totake the middle line, making sure that medicalpractitioners do not move too far away fromthe foundations of their work as physicians.

Phytotherapy in PostgraduateTraining

Postgraduate training must continuouslypresent the potential of phytotherapeuticagents. It is important not to limit this toproprietaries, which is sometimes done with-out even mentioning the plant derivation.Physicians are often given the name of thepure principle and are hardly aware that it is ofplant origin. Another aspect is that physiciansshould be able to make up their own formula-tions, plant drugs being particularly suitablefor this. Finally, the aim must be to link everyproprietary product and every formulationwith a definite concept of the plant on which itis based, not only as regards its actions, butalso its appearance and the part used, whetherleaf, flower or root, and so on. Where achemical product has its structural formula,

the medicinal plant has a specific image, andknowledge is required of the plant drug and itsuses.

It is also necessary for medical students tolearn more about plant drugs in their pre-clinical as well as clinical years. Knowledge ofmedicinal plants should be conveyed as part ofpreclinical studies, particularly since ournative plants, ranging from digitalis and bella-donna, as powerful drugs, to chamomile,peppermint, melissa and many others of thegentle drugs, will later play an important rolein their practice. This is no less important thantheoretical knowledge. During the clinicalyears, information should be given not only ondigitalis, belladonna and other powerful drugswhich are essential in serious and acute condi-tions, but also on medicinal plants with gentleaction, with full discussion of recent researchfindings relating to them. This would be thefunction of outpatient clinical teaching, whereone sees more of the chronic cases that are themain field for gentle herbal drugs. Theproblem is that a major precondition is lack-ing: our teaching staff have themselves learnedpractically nothing of this in their training andare therefore unable to pass on such know-ledge. The solution will be to provide teachingappointments in practical herbal medicine,similar to the way it is now done in ‘generalmedicine’. There is no need for large newinstitutes, as happened in the case of psycho-somatic medicine. What matters is that a startis made, particularly since such teachingappointments require only minimal finance.Herbal medicine has in the meantime becomea separate field of knowledge, research andteaching, and can no longer be ignored. Itrequires specific knowledge and specialtraining, and this cannot be done as a sidelinein medical training.

already been said. Unfortunately, however,there are still many problems in this respect.New herbals are constantly being published,even atlases of medicinal plants with hand-some illustrations in colour where the textcontains little or nothing of the discoveriesmade in scientific phytotherapy. Old, long out-of-date indications are repeated, often embel-lished, listing all the things the plant issupposed to be good for and doubtless leadingto hopes that cannot be fulfilled. This return toa past which we thought was long sinceovercome makes it very difficult for phyto-therapy to make progress in its fight forrecognition as a scientific discipline.

It must also be stressed that phytotherapy isnot homoeopathy, though it is often confusedwith it or mentioned in the same breath. Thisis not intended as a criticism of homoeopathy.Homoeopathy makes use of plant materials infundamentally different ways from those ofphytotherapy. The latter has taken some ideasfrom homoeopathy, particularly since thatdiscipline has traditionally made use of awhole number of plants which are notgenerally in medical use. Some of these havebeen introduced into mainstream medicine,Crataegus for example. Others - the over-whelming majority - have not. It is possiblethat new avenues may open up for phyto-therapy if research is done into more of theplant-based remedies used in homoeopathy.We do use homoeopathic mother tinctures inphytotherapy on occasion, but this is nothingmore than making use of a sound method forpreparing certain plant remedies which cannotbe effectively prescribed in another form. Ithas nothing to do with homoeopathy as such,and will only be necessary in exceptionalcases, since we now have an excellent range ofpurely phytotherapeutic products.

Phytotherapy is Not Homoeopathy Phytoprevention

It is also important to know what phyto- Preventive medicine is gaining increasingtherapy is not. Everything necessary to distin- importance. It is in the nature of these thingsguish it from non-scientific herbalism has that there is no clear demarcation between

What is Herbal Medicine?

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prophylactic and early treatment measures. Alarge number of medicinal plants have provedvery useful in this field, so that we may speakof specific phytoprevention. Many gentledrugs, with the gentle action that makes themso suitable for long-term use, are ideal for this,like Crataegus for degenerative diseases of theheart. For the same reason, phytotherapy is noless important for convalescence and rehabi-litation. Plant drugs will be used particularlywhen treatment started in hospital is conti-nued in everyday life. When work is resumedone has the benefit of these drugs to maintainand support the function of an organ, evenwhen it has sustained lasting damage.Chamomile is a point in case for longstandinggastric complaints, mint for gallbladderdisease, dandelion for rheumatic complaints,and many more. Details are given in therelevant sections.

Side EffectsIt is generally assumed by the public, and alsoby some medical practitioners, that plantdrugs are harmless and therefore preferable.Put in such general terms this clearly is nottrue. The view is based on the assumption thatall phytotherapeutic agents are drugs withgentle action. Yet even these cannot always besaid to have no side effects. German andAmerican doctors, for example, recognize acondition known as ‘laxative colon’. Thisconsists in electrolyte imbalance produced bylong-term abuse of laxatives which aregenerally considered harmless. In severe casesthe condition may cause exhaustion and symp-toms resembling paralysis. Liquorice, orSuccus Liquiritiae , can produce oedema,bradycardia and hypertension if taken forsome time. Raw potato juice contains solanineand may therefore have side effects similar tothose of atropine - enlarged pupils, forinstance, and visual disturbances. Many otherplants have a similar potential.

Powerful herbal drugs can obviously behighly dangerous, like any other drug.Digitalis, Belladonna and Colchicum are

Herbal Medicine

examples. Yet they are all typical phyto-pharmaceuticals. It is necessary to know theindividual plants, their potential actions andhence their indications. Phytotherapy is nodifferent in this respect from pharmacotherapyin general: knowledge alone will preventfailure and ensure success.

The old dispute as to whether fresh plants,whole plant drugs or isolated principles arebetter, and should thus be given preference,has become irrelevant. We now know thatthere is no generally applicable answer. Thereare clear indications in many (though not all)cases, that the total complex of constituentswhich the fresh plant or whole plant drugpresents, in a well-balanced composition,offers definite advantages for the patient.Experimental research on the other hand givespreference to isolated principles.

New Discoveries ConcerningGentle DrugsProfessor Haensel has made a particular studyof phytopharmaceuticals. He defines ‘gentlephytopharmaceuticals’ as follows: ‘These arenatural products per se or drugs presented intheir natural state that have a wide therapeuticrange, no major toxic side effects, particularlywhere morphological changes are concerned.As a rule they do not produce remarkableeffects instantly, but prove effective only withprolonged use.’

He considers ‘time’ a major factor in theaction of gentle drugs. They will often only actafter a considerable latent period, due to thesummation of gentle actions. This must betaken note of, since it is easy to be deceived.The same also applies with many syntheticchemotherapeutic agents, gold therapy forinstance, or chloroquine phosphate in thetreatment of rheumatoid arthritis.

The time factor has not been fully taken intoaccount until now. Haensel points out thateven gentle drugs given over long periods canproduce side effects in pharmacological trials,by regulative action on pathological processes.This again refutes the common allegation that

What is Herbal Medicine?

a substance which has no toxic effects can alsohave no therapeutic effect. He says: ‘Quite afew of the gentle phytopharmaceuticals areconsidered to have practically no effectbecause they are investigated with methodsdesigned for substances with acute and power-ful actions. An example is valerian, whichunlike the barbiturates does not cause centralnervous depression. Its sedative action, whichcan be demonstrated by encephalography (W.Mueller-Limroth, 1976) has a differentmechanism of action from that of a lowbarbiturate dose. Gentle drugs produce noremarkable undesirable side effects, even iftaken in overdose and for extended periods.They clearly do not depress vital nervousfunctions, nor do they produce noticeablemorphological changes. Gentle drugs are thuseffective medicinal agents with no undesirableside effects. Here at least, we come intoconflict with orthodox medicine.’

The thesis that there is no effective actionwithout undesirable side effects has alwaysbeen based on somatic drug actions which canbe assessed by the methods of experimentalpharmacology. The real reason why the

efficacy of gentle phytopharmaceuticals hasnot yet been exactly demonstrated is purelyone of methodology, due particularly to thecomplexities introduced by the time element.Professor Haensel illustrates his views withtwo tables which are so informative that wereproduce them below.

Recognition by UniversityTeachersA number of respected university teachershave taken a positive attitude to phytotherapy.Professor F. H. Kemper of Muenster Univer-sity gave a lecture in Karlsruhe in which hespoke of the high rank to be accorded to plantdrugs. In his view, there were no first, secondor third-class plant drugs, but only phyto-therapeutic agents as such. Thousands of yearsof practical therapeutic experience - ‘realexperience’ as Professor Martini had calledit - were the equal in scientific terms of theexperimental pharmacological ‘experience’ onwhich the use of modern synthetic drugs wasbased. Pharmacological experiments also hadtheir limits.

Professor L. Demling of Erlangen Univer-

Differentiation of Drugs by Duration of Action (after Haensel)

Therapeutic Effects Undesired Side Effects

Immediate Long-term(after months

or years)

Acute toxicity Chronic toxicity

Examples of ‘Gentle Pharmaceuticals’ in Relation to Powerful Drugs (after Haensel)

Anti-inflammatoryAntispasmodicAnalepticSedativeSympathomimetic

Gentle Powerfulazulene, flavonoids cortisonechamomile, fennel, peppermint atropine, papaverinecamphor coramine, lobelinehops, kavaine , valerian barbituratecrataegus adrenaline, isoprenaline

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Herbal Medicine

sity Hospital has written as follows: ‘Manythings that had been firmly established inempirical medicine, but which for a long timesurvived only due to those interested in naturecure, are now, in the light of modem methodsof investigation, showing themselves to beeffective medicaments. Examples of these areonion and garlic for thrombotic processes andhyperglycaemia, carminatives for spasmsaffecting gastrointestinal sphincters, andalcohol as a stomachic to stimulate appetite.The limits set to information obtainable fromanimal experiments, and the fact that theresults of trials made on humans also do notapply worldwide, suggest that one should becautious about dividing therapeutic measuresinto those that are effective and those that arenot. New aspects are always arising, andmanifestly effective drugs should not bebrushed aside merely because no animalexperiments have been done.’

Professor R. Hegenauer of Leiden Univer-sity has stated: ‘The extensive experience inEurope and elsewhere of the therapeutic useof medicinal plants must inevitably lead totheir critical examination. The term ‘popularmedicine’ (though often used derogatively byorthodox doctors) is in no way synonymouswith humbug, charlatanism and quackery, butgives expression to knowledge gained andpassed on through many generations, relatingto the drugs available before the turn of thecentury. It is one of the functions of modernscience to unearth this treasure, now partlyburied under superstition and mystical con-cepts, and learn to give it its rightful value.This will only be possible if the pharmacologyof isolated principles is developed as well asthe pharmacological evaluation of compoundpreparations, which is what fresh plants, plantdrugs and plant-based preparations really are.Excellent pharmaceutical agents such aschamomile, valerian root, bloodroot and per-haps also fresh plantain leaves, all exclusivelyproduced with solar energy, are disregardedby a pharmacology geared to isolated prin-ciples, because they are not really accessibleby its methods. Slightly amended, the motto

which Leon Eisenberg (1977) placed at thehead of his article on drug research alsoapplies to our field: ‘Impeding crude drugresearch, no less than performing it, hasethical consequences. Not to act is to act.’ Aslong as no serious attempt is made to developappropriate methods for assessing the thera-peutic actions of whole medicinal plants and ofpreparations made from them, any refusal toaccept them as therapeutic agents may beregarded as unscientific. This attitude alsogoes against the highest dictum of medicalp r a c t i c e - Salus aegroti suprema lex. I tdeprives the physician of existing means forhelping mankind.

Phytotherapy in Modern Medicine

It is necessary to define the role whichmedicinal plants have to play in modernmedicine. The easiest way may be to look backat similar situations in the past and see howthey apply today. About 3,000 years ago,Asclepios of Thessaly, one of the great men ofancient medicine, gave the following sequencefor the use of therapeutic agents: ‘First theword - Then the plant - Lastly the knife’.

This needs some modification today, for wecannot do without the major chemothera-peutic agents in the armamentarium. I suggestthe following: ‘First the word - Then the plantdrug - Next the major synthetic chemothera-peutic agent - And finally the knife’.

We also see the position which medicinalplants should hold in modern medicine: beforethe major chemotherapeutic agents, andindeed before surgery, in any case in their ownposition and in their own right. The sequencealso establishes the degree of seriousness anddanger of the different interventions, being aprogression from the least invasive to the mostinvasive.

Some may feel that hydrotherapy anddietetics have been omitted. Asclepios did notgive them special mention. Part of the reasonmay be that herbal baths, widely used even inantiquity, were considered to be part of the‘plant’ aspect. Diet also includes plant

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products, and we will not go far wrong if weconsider these two methods of the ‘plant’aspect of therapy.

On the other hand it is important to em-phasize that the ‘word’ has been put as the firststep in medical practice. The ‘word’ is apsychological remedy, addressing first of allthe soul, through which it has importanthealing effects right into the physical sphere.Modem psychosomatic medicine has madethis clear again. The ‘word’, spoken in theright way, is a force of much greater powerand penetration than a materialistic world hasbeen prepared to accept. If there is a dialoguebetween physician and patient, and at thesame time a plant medicament is given, it isthe ideal method of healing, and all that isneeded in the majority of cases. This appliesparticularly to the many cases seen in generalpractice. Specialists could also profitablyremember this basic fact, brought to mindagain by phychosomatic medicine.

The medicinal plant thus takes us into aregion where we touch on the limits ofscientific and medical knowledge. Some timeago, I took up a concept presented by Lin-naeus, the Swedish botanist and physician,when he spoke of a Philosophia botanica.Occupying oneself with the plant world canlead us to philosophical insights and reflec-tions that touch on the ‘final questions’. Thestudy of plant life teaches us to see man as partof Nature, subject to her laws. The more wetry and control Nature, instead of using ourreason to find our rightful place within her, thesooner we become aware that we have gonebeyond a limit. When General Moltke wentinto retirement, someone asked him what heintended to do, having lived such an activelife. His reply, ‘Plant another tree’, speaks of aman who was aware of his place withinNature. To watch a plant grow according toinherent laws, developing flower and fruit, is atruly great experience, always new. We needto keep this ‘naive’ approach, so that we seethe harmony of the whole in one of its parts.We should also always remember that a plant,and therefore the raw material for investi-

What is Herbal Medicine?

gation and application in this field, is livingmatter, organic substance, subject to its ownlaws and therefore more difficult to analyzeand process than minerals and chemicalproducts.

There can be no ‘back to nature’ in the waythat Rousseau saw it. We have to use thewhole armamentarium of modern medicine,but must not allow ourselves to be ruled bytechnology. The aim should be to find amiddle way, to develop a materia medica thatincludes everything new as well as everythingthat has proved its value in the past, criticallyselected with a view to its usefulness formankind. Phytotherapeutic agents occupyconsiderable space in this. The first essential,however, is proper knowledge of the plantdrugs. They have the advantage over syntheticdrugs that their origin, the plant itself, is therebefore our eyes, very much like the structuralformula that a chemist would be using.

Phytotherapy should work with modernchemistry and its application in clinical prac-tice, not against it, and the two fields cancomplement one another if understoodproperly. If we consistently apply thisapproach in our research and teaching, phyto-therapy will achieve the recognition that isrightfully due to such a large field of medicaltherapy.

ReferencesBock, H. E.: Physikal. Med. u. Rehab. 21111 (1980)1-2; Demling, ~5.: Fortschr. Med. 94 (1976) 1193;Hansel, R.: Physikal. Med. u. Rehab. 18 (1977)283-292; -: Dtsch. Apoth. Ztg. 117 (1977)1672-1679; Hegnauer, R.: Planta medica. 34 (1978)1-25; Kemper, F. H.: Festschrift Fa. Dr. WilmarSchvube, Karlsruhe, 1975; Kirnbel, K. H.: Mtinch.med. Wschr. 122 (1980) 112-118; Vogel, G.: Dtsch.Apoth. Ztg. 119/50 (1979) 2029-2033; Weiss, R. F.:Hippokrates 46 (1975) 143- 157; -: Dtsch. Arztebl. 73(1976) 521-524; -: Modeme Pflanzenheilkunde.Kneipp VerL WGishofen, 1976; -: Z. f. angew. Phy-tother. 2 (1981) 9-13.

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