The good news is that dosing for dried herbs taken as such (for example by chewing or as a powder in a capsule or stirred into water), or in simple water-based preparations such as infusions and decoctions, are often remarkably consistent even across cultures (e.g. traditional Chinese and traditional Western).
The perplexing thing is that with other kinds of preparations, notably tinctures and other liquid extracts, dosing recommendations differ widely between authors and between schools of thought. And yet you will not meet a practitioner who does not claim good results.
What is happening here? Here are some possibilities which we ought to consider:
Many plants have a very wide therapeutic window.
Herbs work in different ways when prescribed at higher, lower or minute doses, however they work to the same end. For example, some practitioners believe that in small doses herbs nudge the body towards a healing response rather than taking over parts of its physiology, which happens with larger doses: the difference between a subtle suggestion and a command. Others believe that it is some “subtle energy” conveyed by the herb, rather than the chemicals it contains, that interacts with the body’s “energy” to produce a healing response. This, they say, explains its effectiveness when used in extremely tiny doses.
Practitioners’ perceptions and beliefs are subject to considerable biases and therefore are not reliable reflections of reality. The reality might be that in many cases the patient’s encounter with them and the associated treatment did not materially affect the course of the patient’s condition.
The patient’s encounter with them and the associated treatment did affect the course of the patient’s condition, but this was not due in any way to the kind of herb prescribed, its dose or the nature of its preparation. It was due to other factors in the context of the interaction which we shall call “non-specific factors” e.g. the patient liked the practitioner and perceived them to be trustworthy and competent, which engendered belief in the treatment prescribed.
More than one of these things are happening at the same time.
Number 5 is my best guess, with the proviso that with regard to number 2, I do not believe in “subtle energies” disembodied from the chemistry of life. But I would like to direct people’s attention to numbers 3 and 4, the importance of which I believe most practitioners vastly underestimate, and some even deny. As practitioners of a non-conventional system of medicine, there is a tendency to be defensive on these matters, which is understandable as it is a commonplace for sceptics to assume, “Well, it’s all placebo, isn’t it?” But non-specific effects along with patient and practitioner biases and are normal phenomena occurring every day in all branches of medicine, conventional and non-conventional, all over the world. Only if we admit their importance and attempt to account for them can we move to a more mature understanding of our discipline and our art as practitioners.
This review of classic texts indicates that medicinal plants such as Feverfew, Chickpea, Bindii (Tribulus terrestris), Grape leaves, Lithospermum officinale, Carum copticum, Matricaria recutita, Grape, Prunus spp, Ferula persica, Apium graveolens, Nigella sativa, Peucedanum officinalis, Allium sativum, Centaurea cyan, Brassica rapa, Armenica vulgaris, Cucumber, Atriplex hortensis, Cucurbita maxima, Zingiber zerumbet, Arnebia euchroma and Origanum majorana are the most important medicinal plants used in traditional Iranian medicine for the treatment of kidney stones.
Pirhadi M. and Shahsavari S. An Overview of the Most Important Me-dicinal Plants Used in Iranian Traditional Medicine for the Treatment of Kidney Stones: A mini-review article. Plant Bio-technol Persa 2021; 3(1): 01-4.
For the purposes of this article vitalism is that attitude that focuses on the quality and characteristics of vitality in the organism. Vitality is the potential for life and health. Only vitality heals.
The great ancient civilisations developed elemental-energetic models of existence that encompassed the cosmos, living beings, physiology, health, disease and medicines. The Chinese had and still have a five-element system, Ayurvedic medicine had and still has its five elements and three doshas, and Greek-Unani medicine had its four elements and four qualities. All these systems had several things in common, but above all it was their focus on vitality that characterised them and differentiated them from modern medicine.
The Greek system has remained in modified form in modern Western herbalism, referred to as “energetics”. Some practitioners refer to this system, others do not. I have never taken to this usage of the word “energetics”. In my view it is important to realise that the usage of terms such as energy / energetics / hot / heat / warming / heating / cold / cooling / dry / drying / damp / moist / moistening is often (not always) metaphorical rather than literal. They are rules of thumb, heuristics, and should not be made into dogmas. Contradictions, incongruences, and paradoxes are part and parcel of such heuristics, and frustrating misunderstandings come from taking this thing too literally. Heat, cold, moist, damp, wind do not exist as energies, they are labels for mind associations that we make. They are man-made, not nature-made! These are not energetic systems but symbolic systems.
Secondly, the kinds of interactions taking place when medicinal plant material entering the human body affects human physiology is more often than not informational rather than energetic.
Another point about the neo-classical so-called “energetic”system of some modern Western herbalism is that while it considers qualities (such as hot, cold, dry, moist) it almost completely overlooks something fundamental which really is energetic: the global energetic potential (potential for vitality) of the person, “energy level” for short.
Towards a Better Vitalistic Understanding
First of all let me say that I am claiming nothing new or original in anything that follows. I have written this for myself, for the sole purpose of clarifying a few things in my own mind.
Let me formulate four working principles:
Physiological energy is transformed in three major ways, as heat, movement or mass.
All ill-health begins with hyperfunction or hypofunction, whether you call it warming, cooling, drying, moistening, contracting, relaxing or whatever.
Energy level (vital potential) heavily influences how hyperfunction and hypofunction express (i.e. nature of symptoms, pathology)
Chances are you are greatly under-estimating the influence of the mind!
Heat, Movement and Mass
It seems to me that of the old-world models, the Ayurvedic three-dosha construct approximates most a proper energetic model, inasmuchas the three doshas of Pitta, Vata and Kapha partially reflect the three major expressions of physiological energy: heat, movement and mass respectively.
Heat: The production and maintenance of body heat or anything that promotes or facilitates this. I am thinking of thyroid hormone activity and a good supply of substrates for it, implying efficient metabolism and digestion. Heat must also escape, if there is not to be over-heating. There is a hot-cold continuum (or dimension). Perspiration is our natural cooling system, so this is considered along with heat on a hot-cold axis.
But we needn’t be too literal about this and thousands of years of collective experience and reflection suggest that a little figurative thinking adds rather than detracts from the effectiveness of the model. So things that feel hot, are conflated with the idea ‘heat’: things such as any kind of acute inflammation, burning pain like heartburn from gastro-oesophageal reflux, a burning sensation on urination due to infection or inflammation, or the burning quality of some neuropathic pain. And things which feel worse with heat (acute inflammation, some headaches, and so on) we shall also call ‘hot’.
The opposite of too hot is obviously too cold, and a normal physiological balance is found in the middle. As with heat, cold is either something which allows us to become cold (deficient heat generation) or something which feels cold or gets worse with cold.
Movement: Voluntary muscular activity as well as smooth muscle, cardiac, secretomotor and involuntary skeletal muscle activity (e.g. shivering). We can already begin to see that there is (inevitably) interaction between our basic categories of physiological energy transformation. Heat is a bi-product of movement, and heat produces movement. The opposite of movement is stillness, which can come about through lack of neuromuscular activity or excessive neuromuscular activity (spasm). (Here only the variant of energy levelcan provide a coherent theoretical differentiator between the two. In practice, it is easy to do: the one is soft/lax and the other hard/taut). Health lies in the middle.
Mass: Anabolic activity both normal (muscle building, fat deposition) and abnormal (e.g. tumours). I am thinking too of passive processes or processes of omission such as oedema (this being the result of a deficit in the “movement” department). We also include things that feel heavy, such has ‘heavy legs’ (e.g. fluid stagnation due to venous insufficiency), or a heavy feeling in the lower abdomen (e.g. associated with dysmenorrhoea or prolapse). The opposite of weight gain or mass increase is weight loss, atrophy or wasting. Again, health lies in the middle
I think of this trinity of heat, movement and mass as forming three contractile and projectile limbs supporting an ameboide shape called vitality. This form can change shape in a fluid sort of way, with shifts of its centre of gravity in any direction in three dimensional space, the dimensions of which being these three variables. Normal vitality is delimited within this space. If the amoeba extends in any direction beyond these limits for any length of time, ill health will ensue. Ill health can then be understood as increases or decreases of energy transformation. The latter can be categorised literally or figuratively as changes in “heat”, “movement” and “mass”. From now on to signal when these are not always literal categories I will capitalise them: Heat, Movement, Mass.
All of the herbs we use can be used on the bases of this scheme in an allopathic way, but a holistic, vitalistic allopathic way. Allopathic because we use opposites to effect a return to balance. Holistic, because we consider the whole organism. Vitalistic, because we are primarily concerned with the organism’s vital potential.
Cooling herbs are anti-inflammatory, antipyretic, demulcent, diaphoretic, peripheral vasodilators (cooling to the centre), tonic or mimetic to the parasympathetic nervous system, or subjectively cool like bitters.
Warming herbs are antirheumatics, aphrodisiacs, aromatic digestives, circulatory stimulants, metabolic stimulants, peripheral vasodilators (warming to the periphery) and rubefacients.
Peripheral circulatory stimulants and diaphoretics (many herbs are both) are a bit of a paradox. They take heat from the core out to the periphery, where is is dispersed by diaphoresis. They make you feel warm to begin with but they are actually cooling you down. The lesson is to use them cautiously and sparingly unless we are sure of efficient digestion and metabolism. Happily, many are also digestives!
Movers: Aphrodisiacs, cholagogues, circulatory stimulants, deobstruents, emetics, emmenagogues, expectorants, galactagogues, glandulars, lymphatics, mood enhancing nervines, stimulant laxatives, stimulating tonics, vasotonics, sympathetics or parasympathetics depending on which system we are considering.
I am in accord with certain authors of the Physiomedicalist and Eclectic movements when I say all illness begins with an increase or decrease in a physiological function. They used other terms: Heat/Cold, Excitation/Relaxation. I use hyper- and hypofunction. The idea is the same – imbalance along a physiological spectrum – but it is broader, a higher level definition.
Hyperfunction and hypofunction can affect the tendencies towards Heat, Movement or Mass. By and large (not always) these are active processes requiring energy expenditure, whereas their opposites are generally (not always) passive. Warming up is active, cooling down is passive (vasodilatation is smooth muscle relaxation). Movement is by definition active, inaction is passive. Mass is a bit more ambiguous. For instance energy is expended both to build up and to break down adipose, however overall there is a net gain in energy in the longer term economy of the organism, energy that may then be utilised by the body for activity, body heat production, or body maintenance activities. Fluid stagnation (Mass) is a passive process, while its dispersal (Movement) requires energy.
Harmonisers are that class of herbs which tend by their particular chemical composition, to bring balance to one or more of these dimensions, whether the initial state is hyper- or hypo-. An example is Hawthorn, which tends to normalise high or low blood pressure. Sometimes these plants are called “tonics”, sometimes “alteratives”, sometimes “adaptogens”; they may do all these things at once, they are only labels!
This is the forgotten variable in herbal medicine! But one of vital importance. Different people have different levels of what I will call vitality, a composite of potential for physical energy transformation, enthusiasm, hardiness and resilience.
One’s energy level influences how symptoms of hyper- or hypofunction manifest. For example, to speak in general terms hyperfunction will lead to depletion of resources and exhaustion in the low energy subject, but plethora (diseases of excess) in the high energy one. Hypofunction will lead to lethargy in both low and high energy subjects, but while in the former this will be characterised more by extreme fatigue, in the latter it will mean accumulation and deposition: lymphatic congestion, oedema, obesity, atherosclerosis, diabetes.
The hyper-/hypofunction continuum can be thought of as one of rate and excitability, while the “energy” continuum is one of stiffness/laxness. Health is balance in the interplay of these factors.
What makes the effect?
“The effect of medicinal plants is due to the chemicals contained in them, called active principles.”
This is the first sentence of a recently published literature review detailing the phytochemistry of some commonly used medicinal plants in Romania1.
Posing this as a philosophical proposition on an internet forum, I asked for people’s comments. One person asked an astute question: “Is chemistry a part of energetics?”
I am not among those who believe in subtle, vital energies, disembodied from the chemistry of life. I do not believe, for example (an example that has been expressed to me), that the interaction of a plant medicine with the person who takes it is influenced by the emotions of the grower or harvester of the plant. I believe, on a physical level, that chemistry is the most important, basic thing; and beyond that physics. And beyond physics we do not know, although we guess and make believe.
But there are some for whom so powerful is their wishful thinking that they perceive truths in their fantasies, and then make dogmas out of them, and this blinds them to the true awesomeness of the chemistry of life. Or, they think that since it is complex and mechanistic, therefore it is boring; they have no time for that, they have something better, more magical, called intuition, they kid themselves. Not that I think ill of intuition, it is just that one needs to be extremely self-aware to separate true intuition from make-believe, and people with such reliable self-awareness are in a small minority.
To me, on an equal level of importance as the physical is that of the psyche, and that too is truly awesome. Some will say this is Cartesian thinking, to speak of the physical and the psychological being “on the same level” as if considered as two things, but these people who say this paradoxically are only able to think in black and white! Things can be different but at the same time the same at a different level of thought. Otherwise all thoughts and words are futile.
The psychosocial aspect of the relationship between giver and given-to, and the attitudes and beliefs of the given-to are real game-changers, aspects almost wilfully ignored by many in the field of alternative/complementary medicine. What is my guesstimate of the influence of non-specific effects in the overall effectiveness of a plant medicine? Anywhere from 0 to 100% depending on all the variables that go on in real clinical practice. What is my guesstimate of the influence of so-called “subtle energies”? 0-5%. This allows for the possibility that I’m wrong about their non-existence, but even if that were so, by my guesstimation the aforementioned contextual and psycho-social effects would far outweigh the importance of nebulous “subtle energies”.
So, with the above proviso about psychology, I would broadly agree with the statement at the head of this section: chemistry is the mechanism by which an individual plant sample exerts a physiological effect. But organic chemistry, biochemistry, phytochemistry, phytopharmacology, human biology are frighteningly, awe-inspiringly complex. So we make our folk models which are practical and useful attempts to make sense out of a complexity we can by no means fully understand, indeed which are by no means fully understood, but which we are obliged to navigate. One of these is the tridosha model of Ayurveda, the model which I have found most useful of all and from which I have taken inspiration to develop in my own mind the Heat-Movement-Mass construct and the four principles outlined in the aforethe titlegoing paragraphs.
1 Paciana I, Butnariu M (2021) Highlighting the Compounds with Pharmacological Activity from Some Medicinal Plants from the Area of Romania. Med Aromat Plants (Los Angeles) 10: 370.
This review summarises ethnobotanical use, pharmacology, nutritional value, preclinical and clinical studies, toxicity, other uses and current research prospects of Juglans regia L. (Walnut).
Walnut leaf has been found to possess the following properties of potential clinical significance:
Antimicrobial, antifungal and anti-viral.
Antityrosinase (against skin hyperpigmentation).
Walnut bark shares some of these properties but in particular, it is anthelmintic.
Walnut fruit (the nut) is antidepressant, antitrigliceridaemic, hepatoprotective, anti-amyloidogenic improves motor and cognitive performance.
Nael Abu Taha and Mohammed A. Al-wadaan (2021) Significance and use of walnut, Juglans regia Linn: A review. Advanced Journal of Microbiology Research ISSN 2736-1756Vol. 15 (1), pp. 001-010, January, 2021.
This randomised double-blind placebo-controlled clinical trial showed a reduction in liver enzymes ALT and AST as well as serum triglycerides in subjects with nonalcoholic fatty liver disease who took 2 g Plantago major (Common Plantain) seed twice weekly for 12 weeks.