The “Vital” Force

Vitalism has provided the foundation for medical thinking since the times of Hippocrates and Galen. The premise of Vitalism considers that living processes are animated by the Vital Force, which starts flowing at the moment of conception and ceases with death. This flow of vital energy in the body nourishes, heals, develops, and sustains the body. The flow of Vital Force is linked with the emotional experience of the being, wherein emotions have a direct effect on the body’s physiologic function and thoughts affect emotion. Thus, Vitalism embraces the interrelationships of mental, emotional, and physical experience; and holistic thinking about the human (and animal) body has served as the basis for almost all traditional systems of medicine (Holmes 1997).

How is Vitalism relevant to modern-day prescribing? Whether or not the Vital Force exists from a scientific perspective, the relative “vitality” of the patient is important in prescribing. Extremely debilitated patients should be prescribed a different formula than would be given to a robust animal with strong vitality, even though they may have the same diagnosis. An example may be seen in the treatment of constipation in a debilitated 15-year-old dog that might be treated with a formula containing butternut, a gentle laxative, versus a 5-year-old robust dog that might be given cascara (a stronger laxative) in the formula instead.

“Thus, this view of the pathology of disease does not militate against our cardinal principle, ‘that disease is an impairment of vitality’” (Scudder, 1874).

Guises of Vitalism and Elemental Knowledge still appear in Chinese, Indian (Ayurvedic), and Arabic traditional medicine today.

Traditional Chinese medicine

Traditional Chinese medicine (TCM) is based on the theories of Yin-Yang and the Five Elements, which have arisen from ancient Chinese observations of nature’s cycles and changes (Figure 19-1). These theories held that wood, fire, earth, metal, and water are the basic substances constituting the material world. These five basic substances were considered an indispensable part of daily life. Each of these elements represents a category of related functions (concordances) and qualities pertaining to direction, season, climatic conditions, color, taste, smell, yin and yang organs, body opening, body tissue, emotion, and human sound.

Figure 19-1 Five element concordances.

Humoral theory

Humoral theory (originally developed by Hippocrates) describes the concept that a balance of qualities exists within a patient that include his or her fundamental nature, physical characteristics, behavior, and physiology.

The four humors are perceived within the blood through each of the four Elements in turn (Figure 19-2):

Figure 19-2 The sanguine humor (blood) containing the choleric, melancholic, and phlegmatic humors.

Samuel Thomson (1769–1843) developed a system of practice that recalled elements of this theory. He thought that all diseases are brought about by a decrease or change in vital fluids—the humors—“either by taking cold or the loss of animal warmth.” He saw health as a balance within the body of four elements—earth, air, fire, and water. Accumulated wastes led to obstruction, lessening heat in the body and resulting in disease. With diffusion of heat throughout the body, the obstruction could be removed. Thomson saw fever and sweating as natural responses of the body designed to eliminate wastes via the skin. It was therefore logical to conclude that diaphoretics such as Capsicum would aid sweating during fever, thus assisting the innate healing power of the body (Griggs 1997).

Humor and Temperament:

Each humor has its own temperament in terms of hot, cold, wet, and dry and is traditionally ruled by different planets. The humors can be explained from both symbolic and biochemical viewpoints, and they can be used to parallel biochemical medicine. The symbolism of the Elements also helps to reveal the nature of the humors (Table 19-1).

TABLE 19-1 Humoral Relationships

The particular humoral composition of a patient was called temperament, from the Latin temperare, meaning “to mingle or mix in due proportion.” When the person was healthy, the balance or temper of the humors allowed the Vital Force to flow easily; this was accompanied by an inner clarity, peace, and harmony.

The temperament was often used as a starting point for evaluating health and disease and would serve as the basis of herbal prescribing. To determine temperament, herbalists would assess the color and shape of the body, as well as habits, personality, temperature, pulse, colors, odors, and consistency of excretions. For a representation of this in veterinary terms, see Table 19-1.

In disease, the harmonious temper is lost. When a particular humor dominates, this causes a characteristic “distemper.” The humor was identified by the symptoms produced, whether they were hot or cold, dry or moist. The common cold is classically a phlegmatic condition—a cold and moist disease. The therapeutic objective was to counteract the predominating humor and restore temper. For example, a fever is a hot and dry condition. It can be visualized as a fire burning within the patient—pyrexia, coming from the Greek pyr, meaning “fire.” The rise in body temperature and dehydration through perspiration illustrates its hot and dry nature. To counteract this fiery choleric condition, medicines of a cooling, moistening, and watery nature are needed—like willow (Salix alba).

In humoral terms, willow has an affinity with the cold, moist phlegmatic humor in the body. This is opposite to the hot and dry choleric humor, hence its particular reputation for treating fevers. It is interesting to note that willow is a source of salicylates that are used to treat fever—the fire of the fever is extinguished, restoring balance to the humors so that health returns.

The principles upon which humoral physiology are based are thus highly relevant to the perceptive skill of an herbalist. Even if the exact pathology is not known, we can use the energetic, elemental principles to guide us. If the patient is hot, one should use cooling herbs; if dry, moistening herbs should be used. There is no reason why humoral ideas cannot be juxtaposed alongside biochemical ideas. The potential benefit of using both is great.

Modern physiomedical prescribing

Physiomedical concepts have evolved into a step-by-step process for developing a formula. This method has been described by Bone and allows the herbalist to set treatment goals, prescribe efficiently, and monitor the progress of patients (Mills 2000, Bone, 1994, 1996). It is especially useful in treating patients who present with a wide range of clinical signs and symptoms. The basic principle is to write balanced prescriptions by setting short-term and long-term goals that are appropriate for the individual patient.

The steps involved in physiomedical prescribing are described in the following sections.

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