EXPLORING HERBAL MEDICINE

Benjamin Franklin defined insanity as “doing the same thing over and over and expecting different results.” The desire of veterinarians to explore herbal medicine is therefore quite cogent, since it varies inversely with their tolerance for continuing disappointments in conventional treatment of chronic disease.

Despite the allure of possibly improved therapeutic outcomes, veterinarians are still aware that conventional medicine is the acknowledged standard of practice for their profession. The ample body of research into its methods offers some certainty about the anticipated therapeutic outcome, however unsatisfactory it may be. In no way, however, are these outcomes sufficient to justify a self-righteous stance that herbal medicine should not be pursued until conventional medicine validates it.

Individuals interested in herbal medicine may hesi-tate to explore it because its efficacy has not been demonstrated. There is no lack of anecdotal reports of success, but what is needed to sway the profession as a whole is unbiased clinical evidence. The dearth of clinical trials in herbal medicine is a product of the phase of development that veterinary herbal medicine is currently in. It is only from the field research that is currently ongoing in examination rooms around the world that testable hypotheses regarding herbal medicine will be developed. In the meantime, evidence of efficacy must be sought personally, the same way the field observations are being recorded, on an individual case-by-case basis.

Albert Einstein stated, “We can’t solve problems by using the same kind of thinking we used when we created them.” Pathophysiology and pharmacology thus seem an inadequate basis for prescribing herbal formulas, in that a complete pathophysiologic understanding of most chronic diseases still eludes us, leading to the current frustration with conventional medical efforts. Other methods of prescribing must be explored for maximum efficacy with the use of herbal medicine.

METAPHORIC MEDICINE

This is not the first time that humans have faced the prospect of treating serious diseases in the absence of definitive knowledge about them. The near-universal cultural taboos against human dissection resulted in a lack of definitive knowledge of the human body, forcing most societies to develop instead a schematic understanding of internal physiology and anatomy.

In their attempt to frame models of anatomy and physiology in more familiar terms, Chinese medicine practitioners chose to equate the internal environment of the human body with the external one. The choice seemed logical, in that humans resonate so much with their environment that it seems to invade and dominate them. Patients could “catch a cold,” or echo the same heat and desiccation of any desert that surrounded them. The internal landscape seemed subject to the same laws and phenomena of the external landscape.

The resultant climatic model seemed accurate enough to be validated almost daily by human experience, leaping over the wide gaps in medical knowledge. These same models are being explored today when, once again, we lack definitive knowledge of chronic disease, such that the best efforts of modern medicine are palliative at best.

It is surprising to note that other cultures took a similar approach to grappling with the mysteries of inner space. The close agreement among these medical systems is stunning and supports the validity of the metaphoric approach, however abstract it may be. Despite the fact that there is no evidence of significant cultural exchange between the citizens of ancient Greece and their contemporaries in China, congruencies between the two medical systems run the gamut from diagnosis to treatment. The importance of “phlegm” and its elaboration in the digestive tract as a major cause of disease; the existence of four obvious phases of life and the “climatic influences” that tend to dominate them; the use of pulse and tongue diagnosis in patient evaluation; the crucial importance of diet in preventing disorders; and even the medical application of specific herbs—all were salient features of both bodies of work. Even between ancient China and 19th century America, the indications of any globally distributed plant species were synonymous long before cultural exchange occurred.

Eventual information exchange served only to deepen the accord between traditions. When knowledge was shared freely between India and China, and between China and Japan, agreement about use of a multitude of plants and formulas became nearly universal. The translation, preservation, and assimilation of ancient Greek texts by Muslim nations during Europe’s Dark Ages likewise ensured the propagation and survival of some of mankind’s most important empirical advances, including the specific medicinal use of hundreds of herbs.

Each of these medical systems is thus a candidate for the veterinarian who is contemplating a different approach to prescribing herbs. Chinese medicine is, however, favored by many veterinary herbalists because resources available for study and reference are abundant, detailed, and sophisticated enough to warrant a place on a health professional’s bookshelf. Many of the most important of these references were originally published 2 millennia ago, but since the Chinese language has barely changed during that period, herbalists can read verbatim the notes of a physician such as Sun Si Miao of the 6th century and, through his characteristically detailed description of symptoms, determine exactly what condition was being treated. Recipes, indications, and dosing instructions were precise, allowing us to re-create and study in the 21st century the efficacy of these ancient approaches to disease.

Before an herbal therapy could be prescribed in Chinese medicine, it had to be understood in the same climatic frame of reference as the patient. This broad understanding of a plant’s climatic effect, together with knowledge of the region of the body where this effect is exerted, constitutes what many modern authors refer to as the “energetic” of an herb.

As a simple example, then, a therapy that is capable of relieving the superficial aches and chills associated with “catching a cold” had to be able to “expel cold pathogens invading the neck and back.” The diagnosis of the patient implies a general blueprint for an effective treatment. Of all potentially antimicrobial, immune-stimulating, or antiviral herbs, the only ones that would suffice in this instance are those that could be understood to be warming and to provide some sort of outward push to a pathogen that invades the periphery of the body. Perspiration following ingestion of a plant was considered tangible evidence of its outward push. Herbs most appropriate for our patient would thus include the spicy pungent diaphoretics, such as garlic. Although diaphoresis does not itself resolve a cold, it is an associated effect of plants with abundant volatile oil content, which, in turn, are often strongly antimicrobial.

Modern practitioners have the benefit of knowing both the pharmacologic makeup of herbs and their energetic. It is important, however, to consider the pharmacologic appropriateness of an herb as the last step. First, the practitioner must “suspend their disbelief” of metaphoric medical models and use them to rapidly remove from consideration a host of therapies, then home in quickly on just a few highly and generally appropriate candidates. Rather than being a fumbling process of guesswork (trial and error), metaphoric schemata allow the prescription of herbal medicines by even a novice herbalist to be specific, rapid, and incisive.

THE BEDROCK OF DISEASE

The process of prescribing Chinese herbs accurately begins with understanding the patient in metaphoric terms. Very frequently, the same general diagnosis would be rendered for most of the different diseases a patient might suffer over time. Like the land they live upon, humans and animals seem to be subject to the same repetitive sequence of climatic patterns.

The bedrock of a mountain provides a good metaphor by which an understanding of this consistent recurrent predisposition in a patient can be facilitated. Mountains often have a completely different appearance when viewed from neighboring valleys, yet the same bedrock creates both topographies. Likewise, a consistent general metaphoric predisposition in a patient can give rise to two seemingly unrelated illnesses. The idea of an enduring weakness that could “outcrop” any time if not mitigated is similar to the notion of constitutional predisposition embraced by homeopaths. It also corresponds roughly to genetic predisposition. Herbal therapies cannot, of course, change genetic makeup but can certainly play a role in deciding whether and to what extent genes are expressed, allowing outcroppings of the patient’s own particular bedrock to retreat to the interior.

Despite the resources expended in the development and mastery of tools of disease intervention such as acupuncture, herbal medicine, surgery, or gene therapy, the tie that binds most of the world’s medical systems together is the belief that nothing is more important than an ideal diet, exercise, adequate rest, and a healthy lifestyle in the treatment and prevention of disease. If these factors are not addressed, responses to treatment are often incomplete or are followed by another problem that materializes in the near future. Only preventive lifestyle measures are considered powerful enough in the long term to keep the bedrock of disease concealed.

The importance of prevention in furthering therapeutic outcomes makes Chinese medicine an extremely powerful tool; such measures are never ignored or eclipsed by the intricacies involved in diagnosing and treating a condition. Sooner or later, the Chinese medical clinician turns his or her attention to determining which specific lifestyle factors might have precipitated the illness; in some cases, the diagnosis itself hinges upon an identification of these factors. For example, if a patient experienced problems following overwork or overexercise, Kidney Qi deficiency would be far more likely to function as an underlying cause of illness than, say, a “pathologic excess” such as Damp Heat.

Lifestyle factors facilitate not only diagnosis but treatment; indeed, Chinese herbal medicine was originally itself a form of dietary therapy, with a few herbs added to enhance the therapeutic effectiveness of certain dishes. This practice is still common in China to this day with, for example, medicinal herbs such as Dang Gui root and White Peony root served routinely as tea or added to dishes served in restaurants.

Sometimes, no obvious lifestyle factors are suggested as the cause of an illness during questioning of the patient. Even then, however, Chinese medicine has a unique advantage over conventional medicine in that it is able to postulate and institute preventive diets long before conventional medicine eventually identifies and verifies them as effective.

This ability comes from a metaphoric approach to medicine, and it is one of the many reasons why Chinese medicine was not abandoned, even as definitive knowledge of the body was later acquired.

In general, once a metaphoric diagnosis has been validated by a response to an appropriate treatment, other modalities with the same effect are immediately suggested as suitable preventive measures. Thus, when a patient responds to anti-inflammatory drugs in conventional medicine, no particular preventive strategy is implicated. When, on the other hand, a patient with inflammation responds to a strategy that “drains damp and clears heat” (regardless whether a drug, herb, or surgery was the treatment), a “dampening and heating” diet, or one that is too calorically dense, is immediately suggested as a likely contributing cause.

Although these conclusions were drawn centuries ago by Chinese medical practitioners, it is only in the 20th century that, for example, overnutrition was identified by conventional medicine as a contributing factor to arthritis and pancreatitis. Such is the power of a metaphoric approach to medicine.

A corollary of the precept that one underlying predisposition governs all manifestations of illness in a patient is that every episode of illness and every clinical finding in each of those episodes is reflective of that one core disorder. Diagnosis is thus a process of triangulation, where all salient features of the history and all readily apparent physical features are analyzed until one common denominator is found—the one and only problem, or bedrock, that might underlie them all.

Technically, finding the common denominator behind as many clinical findings as possible is also the ideal of conventional medical diagnosis. For example, if a patient has polyuria, polydipsia, weight loss, hyperglycemia, and glycosuria, the best treatment is not a separate therapy for each of these findings, but rather, one that addresses the common denominator of diabetes mellitus at its core. To this extent, then, both conventional and Chinese medicines are equally “holistic”; they both attempt to understand and treat the whole patient. The main difference between them is the extent to which they can identify relationships between diverse symptoms and signs. The inability of conventional medical analysis to explain relationships between concomitant findings becomes a very important indicator to the practitioner that another system of medicine, one that can weave all salient features of a case into a single assessment, may be better suited to treating a given patient.

An interesting implication arises from the idea that a diagnosis involves finding the common denominator of divergent findings. In general, and in direct contrast to conventional medicine, the implication is that the more complicated a patient’s case is, the easier it is to diagnose. Conversely, when symptoms and signs are vague, general, and nondescript, any number of core disorders may conceivably have given rise to them. Diagnosis becomes much the same as a verdict in a courtroom—the fewer the witnesses and the more absent the physical evidence, the more it is possible that anybody could have committed the crime. In circumstances in which symptoms are vague or nondescript, meticulous attention to the physical nuances of the patient—pulse, complexion, even the timber of the voice—becomes all important in exposing the bedrock of disease at the patient’s core. Chinese medicine refers to this cataloging of the physical data of a patient as The Four Examinations.

THE FOUR EXAMINATIONS

Questioning

It has been said that a good history in conventional medicine will give the clinician the diagnosis of a patient 75% of the time. The same is also true of Chinese medicine, where Questioning—the first of the Four Examinations—will suggest a likely Chinese medical diagnosis if it is thorough enough. A thorough history in Chinese medicine includes approximately the same information as a complete history in conventional medicine. General areas of inquiry include the following:

• History of present illness

• Review of complaints in other systems

• Past medical history

• Prior treatments and response

• Diet and lifestyle

• Family history

• Appetite, thirst, and temperature preferences

• Sleep patterns

It is especially important during questioning that the practitioner should not settle for an interpretation offered by the client or the patient, but instead should seek out raw data and draw his or her own conclusions. For example, during an inquiry about complaints in other organ systems, the subject of behavior comes up. In response to the question, “How would you describe your dog’s personality?” An owner might reply, “He’s very dominant—very protective of me.” This is an interpretation and is not suitable in itself for interpretation from a Chinese medical perspective. An appropriate follow-up question would therefore be, “What is it about your dog’s behavior that makes you think he is dominant or protective?” If the owner replies that the dog tries to intimidate other strange dogs, or barks furiously when people come to the door, only to slink away if they enter, the dog is likely more fearful than protective.

Historical data can be interpreted according to a number of perspectives. One of the simplest and most useful methods used by the author is to decide whether the information gathered is most reflective of a Hot, Cold, Excess, Deficient, or Stasis syndrome, or some combination of these. Boxes 13-1 through 13-5 list typical historical and physical findings for each category, although a patient may have traits of more than one.

Veterian Key

Fastest Veterinary Medicine Insight Engine

13: Herbal Energetics: A Key to Efficacy in Herbal Medicine

EXPLORING HERBAL MEDICINE

METAPHORIC MEDICINE

THE BEDROCK OF DISEASE

THE FOUR EXAMINATIONS

Questioning

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Veterian Key

Fastest Veterinary Medicine Insight Engine

13: Herbal Energetics: A Key to Efficacy in Herbal Medicine

EXPLORING HERBAL MEDICINE

METAPHORIC MEDICINE

THE BEDROCK OF DISEASE

THE FOUR EXAMINATIONS

Questioning

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