ANTIQUITY

Evidence suggests that Ayurveda, developed in India, is perhaps the earliest medical system. The Rig veda, the oldest document of human knowledge, written between 4500 and 1600 bce, mentions the use of medicinal plants in the treatment of humans and animals. The “Nakul Samhita,” written during the same period, was perhaps the first treatise on the treatment of animals with herbs. Chapters dealing with animal husbandry like “Management and Feeding” appear in ancient books like Skandh Puran, Devi Puran, Harit, and others. Palkapya (1000 bc) and Shalihotra (2350 bc) were famous veterinarians who specialized in the treatment of elephants and horses (Unknown, 2004). King Asoka (274-236 bc) engaged people to grow herbs for use in the treatment of sick and aged animals (Haas, 1992). Medicines that are mentioned in early Ayuvedic texts (200 bc–ad 200) of Charaka Samhita include ricinus, pepper, lily, and valerian.

Vasant Lad describes the basis for Ayurveda (“life science”) in a way that is reflected in the Tao of Chinese medicine and echoes the humors of Greek medicine:

In China, one of the oldest known and longest preserved Materia Medica was compiled in 3700 bc by a Chinese emperor named Shen Nong. Shen Nong (the Divine Farmer) is the legendary originator of Chinese herbal medicine. He is credited with tasting hundreds of herbs, selecting those that were suitable as remedies, and describing their properties. As a result of his efforts, numerous herbs became routinely used for healthcare, and knowledge was handed down by oral tradition for centuries. His book of medicinal herbs listed herbal Materia Medica for both humans and animals. It is interesting to note that it discussed the antifever properties of Artemesia annua (Chinese wormwood), which has now been shown to be extremely effective against malaria.

When these herbs were described in a formal manner, the book was named after Shen Nong, known today as the Shen Nong Ben Cao Jing (Herbal Classic of Shen Nong). The earliest mention of a text called Shen Nong Jing (Classic of Shen Nong) came from authors who lived during the period immediately following the fall of the Han Dynasty (220 ad), suggesting that it might have been compiled during the latter part of the Han Dynasty. It is thought that Shen Nong lived from 2737 bc to 2697 bc—nearly 5000 years ago; this is why it is common to hear that Chinese medicine has a history of 5000 years. However, we are able to access little information about how herbal medicines were used before the compilation of the Shen Nong herbal—about 1800 years ago.

The Shen Nong Ben Cao Jing describes for the first time the flavors (sour, salty, sweet, bitter, acrid/pungent), natures (cold, hot, warm, cool), functions, and indications for the herbs. Herbs were classified according to their efficacy and toxicity, and the terms sovereign (or king), minister, assistant, and envoy were described to define the function of an herb within a formula. According to the Ben Cao, “Medicinals should coordinate [with each other] in terms of yin and yang, like mother and child, or brothers…. to treat cold, one should use hot medicinals. To treat heat, one should use cold medicinals.” Shen Nong clearly tasted the herbs and fit their characteristics into the Tao, the philosophy that guided people’s understanding of their world. Herbs were tools that interacted with people to shift and balance their bodies back to health. An English language translation of the ancient Shen Nong Ben Cao Jing has been published (Yang, 1997).

The earliest Chinese medical practitioners treated both people and animals until the Zhou dynasty (1122-770 bc), when veterinary medicine became a separate branch of traditional Chinese medicine (Schoen, 1994), and in China, the first mention of diseases and treatments of horses appeared in writings of the Shang Dynasty (1766-1027 bc). One of the first texts in Chinese veterinary medicine was Bai Le’s Canon of Veterinary Medicine, written by Sun Yang in approximately 650 ad (Figure 4-1).

Figure 4-1 Administering liquid medicine with a bamboo bottle is an aspect of the old Chinese-Japanese art of horse healing, Ryoyaku-ba-ryn-benkai, as portrayed in Zisanshi (first edition, Kyoto [1759]; second edition, Yedo [1859]).

(From Dunlop RH, Williams DJ. Veterinary Medicine: An Illustrated History. St. Louis, Mo: Mosby; 1996.)

In Mesopotamia, the Sumerians used cuneiform written language from about 3500 bc. The earliest extant clay tablet from Sumeria dates from about 2100 bc; it contains 15 medical prescriptions and mentions 120 mineral drugs and 250 plant-derived medicines. These included asafetida, calamus, crocus, cannabis, castor, galbanum, glycyrrhiza, hellebore, mandragon, menthe, myrrh, opium, turpentine, styrax, and thyme. The largest surviving medical treatise is from about 1600 bc; it is entitled “Treatise of Medical Diagnoses and Prognoses.” Although the names of the medicines used then do not translate well, it is probable that milk, snakeskin, turtleshell, cassia, thyme, willow, fir, myrtle, and dates were also used (Janick, 2002). The Code of Hammurabi (circa 1780 bc), another famous document arising from Babylonian society, discussed treatments of animals, costs of treatments, and penalties for mistreatment and errors (Swabe, 1999).

The Edwin Smith Papyrus (found in Egypt and preserved at the New York Academy of Medicine) dates from 1700 bce. These scrolls include a surprisingly accurate description of the circulatory system, noting the central role of the heart and the existence of blood vessels throughout the body. They describe the use of herbs such as senna, honey, thyme, juniper, pomegranate root, henbane, flax, oakgall, pinetar, bayberry, ammi, alkanet, aloe, cedar, caraway, coriander, cyperus, elderberry, fennel, garlic, wild lettuce, myrrh, nasturtium, onion, peppermint, papyrus, poppy, saffron, watermelon, and wheat. The Ebers Papyrus (now in University Library at Leipzig) dates from about 1500 bc and contains more than 800 prescriptions. Some of these are very complicated, containing such ingredients as opium, hellebore, salts of lead and copper, and blood, excreta, and viscera of animals (Haas, 1999). Many more of the ancient scrolls were housed in the Library of Alexandria, which was destroyed by fire in 47 bce. However, early evidence of veterinary herbal medicine is found in ancient Egyptian parchments such as the Kahun Veterinary Papyrus (dating around 1900 bc) (Karasszon, 1998), on which cattle feature prominently.

Ancient Greek and Roman societies began developments in veterinary medicine in similar, yet slightly different directions compared with the Egyptians. The “Hippiatrika” is one of the first documents we see that relates to Roman practitioners and their study of horses (Walker, 1991). “Hippiatros” was a term used in Greece around 500 bc to refer to horse doctors (Swabe, 1999). The horse was central in Greek and Roman society because members of society depended on it for military and trade functions. Earlier on (between 383 bc and 322 bc), Aristotle, sometimes called “the Father of Veterinary Medicine,” became very influential in Greek society. Physiology, comparative anatomy, and pathology were a few of the specialized areas that Aristotle discussed in his writings. He compared animal and human anatomy and physiology and disease in writings such as Historia Animalium, De Partibus Animalium, De Generatione Animalium, and Problematicum (Karasszon, 1998). Another important influence on both veterinary and herbal medicine was Hippocrates (460-377 bc). He wrote Corpus Hippocraticum, in which he described more than 200 plants, and he is credited with the development of the humoral theory (Figure 4-2).

Figure 4-2 An illustration from the 14th century Hippiatrika manuscript showing treatment of distention in a horse. Much of the information on horse care found in the Hippiatrika came from the Greeks, and the use of oil and wine for medicinal purposes is frequently prescribed. Here, a clyster of wine, oil, soda salt, and sap from wild cucumber roots is being administered to relieve the distention. (Cod. G. 2233. Bibliothèque Nationale, Paris)

(From Dunlop RH, Williams DJ. Veterinary Medicine: An Illustrated History. St. Louis, Mo: Mosby; 1996.)

HUMORAL THEORY

The idea of the Four Humors became popular in Ancient Greece from about 400 bc. It probably originated in Indian Ayurvedic medicine, where it was picked up by travelers and taken to the Greek empire (which included the present-day countries of Greece, Egypt, Turkey, and Italy). However, it is attributed to Hippocrates. At this time, thinkers were beginning to explain events in the world around them in terms of natural phenomena rather than blaming the gods and spirits. They established that all things were made up of the four elements air, water, fire, and earth. These elements were also linked to the four seasons and to body fluids or “humors”—blood, phlegm, black bile, and yellow bile. Illness was thought to result when these humors lost their natural balance, and health could be restored by rebalancing the humors. This theory was very important because it encouraged doctors to look for natural causes of disease and to provide physical, rather than spiritual treatments.

The rise of rationalism meant that doctors were now observing patients and reasoning toward a logical cure, just as the Chinese had done. Hippocrates reasoned that medicine could be applied without ritual because disease was a natural phenomenon and not a supernatural event. He argued that some acute diseases were self-limiting and should not necessarily be treated, and that diet and exercise were vital in preventing and treating conditions of the human body. The humoral theory remained very influential for more than a thousand years and was not seriously challenged until the 15th century. It is interesting to note that it is related in many ways to the philosophical basis of Traditional Chinese Medicine and of many other traditional medical practices (Table 4-1).

TABLE 4-1

MEANWHILE IN JAPAN

Kampo (also written Kanpo) is based on Traditional Chinese Medicine and literally means “the Han Method,” referring to the herbal system of China that developed during the Han Dynasty. Cultural contact between China and Japan has occurred since ancient times. There is a story about a Chinese Emperor (reign: 221-210 bc) who is said to have sent emissaries by ship on the Eastern Sea to find the herb of immortality; it is suggested that they returned from Japan at the end of their mission with ganoderma (lingzhi; Japanese: reishi). Some Chinese medical works were introduced to Japan as early as the 4th or 5th Century ad, coming first by way of Korea, which had adopted Chinese medicine by that time. Historical records indicate that a Korean physician named Te Lai came to Japan in 459 ad, and that a Chinese Buddhist named Zhi Cong brought medical texts with him to Japan via Korea in 562 ad. It was during this period that the Chinese written language was adopted in Japan, which enabled people to learn from China about Buddhism, Confucianism, governmental organization, and the divination arts and opened the way for study of Chinese medicine. Kampo encompasses acupuncture and other components of Traditional Chinese Medicine but relies primarily on prescription of herb formulas. It differs today from the practice of Chinese herbal medicine in mainland China primarily in its reliance on a different basic collection of important herb formulas and a somewhat different group of primary herbs. Kampo medicine is widely practiced in Japan today (Dharmananda, 2004).

THE RISE OF ROME

A first century Roman (Lucius Junius Moderatus Columella) wrote 12 volumes of On Agriculture. Volume VI dealt with cattle, horses, and mules; volume VII with sheep, goats, pigs, and dogs; and volume VIII with poultry and fowl. In volume VI, we find reference to the use of garlic in cattle:

He also recommended for bloat in cattle a drench of wild myrtle and wine mixed with hot water. For ulceration of the lungs, he recommended administration of cabbage leaves baked in oil. He also recommended a seton (a foreign body, more recently of cloth, introduced into tissue to elicit drainage or form an open tract for drainage of a wound) of white hellebore through the ear and a daily mixture of leek juice, olive oil, and wine to “avert death of cattle” (Smithcors, 1957).

The decline of Ancient Greece corresponded with the rise of the Roman Empire, and many Greek scholars moved to Rome. Two Greek scholars working in Rome had an influence on herbal medicine. Dioscorides of Anazarbus (Pedianos Dioskurides) was a careful observer and naturalist, botanist, and skilled physician and is known today for the famous work De Materia Medica, published in the year 65 ad. This book listed more than 500 plants and was translated into many languages, including Persian, Hebrew, and Anglo-Saxon. The organization of Dioscorides’ work followed the pattern of one plant, one chapter. Following the description of the plants, some indications for use were described.

Dioscorides classified plant medicines according to the state of the plants themselves (with seasonal variations) and their effects on people—this was a drug affinity system (Riddle, 1985) that had little to do with mystical powers or cosmic relationships that would later characterize the alchemical herbology of Culpepper. It became the foremost classical source of modern botanical terminology and the leading pharmacologic text for the next 1600 years. An illuminated copy prepared in the year 512 is now housed in the Österreichische Nationalbibliothek.

The second Greek physician who had a lasting impact was Claudios Galenos (131-201 ad), who is generally referred to as Galen. He learned much about anatomy through his work treating professional gladiators. He developed an interest in anatomy and skills as a surgeon, and he dissected pigs, goats, and apes and applied what he found to the human body. He was strongly influenced by Hippocrates’ Four Humors and his theory was built on Hippocrates’ idea that the body was made up of four liquids—blood, phlegm, yellow bile, and black bile—and that imbalances in one of these humors might be treated with a substance that opposed that tendency. For instance, psoriasis is considered a hot and dry condition, so Galen would suggest that the patient drink cool liquids, eat cold foods, and use a cool, wet herb such as plantain. He wrote more than 500 books on medicine and developed a system of pharmacology and therapeutics. Galen’s humoral theory and Alexandrian Greek medicine shaped Islamic and European medicine for the next 1400 years. His books were used at medical schools until the Renaissance.

Other early Roman writers of note on the topic of veterinary medicine include Vegetius, author of Mulomedicina, a comprehensive equine veterinary text compiled from works of the previous authors Pelagonius, Chiron, and Apsyrtus (Mezzabotta, 1998).

THE DARK AGES

When Rome fell in 476 ad, Greek medicine was temporarily lost to Europe. Civilization as it was during the reign of Rome ceased to exist, and it took centuries for the level of Roman societal achievements in living standards, culture, architecture, and medical practice to be regained. When Galen’s ideas were rediscovered after Crusaders and Byzantine scholars returned to Europe, his system again became medical dogma for hundreds of years.

But first, Europe had to endure the Dark Ages, when medicine was characterized in two ways—the storage and adaptation of Greek knowledge by Christian monasteries, and folk medicine.

During the Dark Ages, Christian monasteries played a crucial role in preserving the knowledge of the ancients. Monks painstakingly copied classical texts, which were traded or passed on to other eminent individuals or institutions. Monks also cared for the sick and injured because there were very few physicians. So, monks not only preserved but also developed skills in the use of herbs and natural medicine. Each monastery maintained its own herbal garden and kept others up-to-date with advances in medical treatments.

The writings of the Dark Ages in Europe are largely lost to us, but some books from those times remain. Anglo-Saxon herbals were published from the 7th to the 11th centuries (Table 4-2). The medicine of this age incorporated many charms, in addition to the plants; Christian prayers probably replaced older pagan charms over time. The herbs that appeared most commonly included betony, vervain, peony, yarrow, mugwort, and waybroad (plantain). There are four known texts from the 10th century; these are now held by the British Museum and include Leech Book of Bald, Lacnunga, Herbarium of Apuleius (a translation from the 5th century), and a translation from Petronius’ Practica Petrocelli Salernitani entitled περι´ Διδαξε´ως (which means “about learning/instruction”).

TABLE 4-2 Examples of Anglo-Saxon Veterinary Medicine

One of the most interesting Middle European monastic personalities was German abbess Hildegard von Bingen (1098-1179). Remnants of Greek medicine were evident in her writings, which retained some of the old herb characteristics but introduced a new spiritualism that reflected her love of God and her Old Testament belief that everything in creation was made to serve man (Hozeski, 2001):

And:

Hildegard wrote Causeae et Curae and Physica, in which she described causes of diseases and their cures. She compiled the beginnings of a Germanic herbal knowledge and wrote widely on devotion, mysticism, and healing. She used the four-element and four-humor system, and her approach integrated body, mind, and spirit with specific prescriptions for herbs, diet, and gems. She also wrote Liber Simplicis Medicinae, in which she prescribed different herbs for cattle, goats, horses, pigs, and sheep (Haas, 2000). Currently, the writings of Hildegard are undergoing a revival in the German-speaking world.

Outside the monasteries, the wise women and traveling herbalists were using medicinal plants in ritual and magic. It was mainly these wise women who felt the brunt of the Inquisition, and many were burned as witches; because they relied on an oral tradition, their knowledge was widely lost. While Europe’s Dark Ages trundled on under the influence of Christianity, Spain became a center of botanical research. Among other bright lights, Arab culture and society in the Near East advanced medicine to new heights.

ARABIC MEDICINE

Rational approaches to medicine were developed to the highest level in the Middle East, where Avicenna lived from 980 to 1037 ad. He is the most famous and influential of the philosopher scientists of Islam and was born in Persia (now Iran). Abdullah Ibn Ahmad Ibn al-Baytar, as he was known in his land, was a botanist (he described more than 1400 medical herbs, comparing them with the descriptions of ancient authors) and pharmacist. He further codified Galen’s theory of using opposites to correct disease processes. His Canon of Medicine is one of the most influential medical books of all time. The Canon described the primary constituents of the human body as the elements—earth, air, fire, and water—that possess two qualities each. Earth is dry and cold, water is wet and cold, air is hot and moist, and fire is hot and dry. The humors are described as the primary body fluids that affect physiologic processes; they are themselves influenced by states of motion and rest. These humors include sanguineous (blood), serous (phlegm), bilious (choler or yellow bile), and atrabilious (melancholy, or black bile), which correspond with air, water, fire, and earth, respectively. Avicenna is credited with introducing astrology into medicine. Each humor possessed certain normal qualities and was associated with certain signs of the zodiac. Avicenna’s Canon was widely read by Europeans after it was translated into Latin in the 12th century. From 1500 to 1674, more than 60 editions were published in Europe. It was the standard text for university medical training until the 18th century.

In the 12th century, Ibn al-Wwam wrote “Kitab Al-Falaha,” a treatise on agriculture with a section on veterinary medicine. The 33rd chapter discusses diseases of the horse. Redness in the eye was said to be cured with rose water, blepharitis and conjunctivitis with centaury or saffron, mange in the ears or on the nose with saffron and sulphur, stomatitis with powder of pomegranate shells, headache with a linseed cataplasm, leeches in the mouth, nose, or throat with olive oil, and red urine with white pepper (Erk, 1960).