The Earthwise Herbal Repertory Read online

  Homeopathic repertories separate remedies based primarily on symptoms—not on disease names, or a physiological understanding of what is going on in the interior of the organism, nor even on an energetic or constitutional understanding of symptom patterns. In the oldest method, introduced by Baron Clemens Maria Franz von Boenninghausen, symptoms were broken down into location (region, not organ), sensation (burning, boring, itching, etc.), concomitants (symptoms occurring simultaneously), and modalities (aggravations and ameliorations). In many cases, looking up the main symptoms under location, sensation, concomitants, and modality pointed to only one choice of medicine. In others, it led to a few remedies, which (with further research) could be narrowed down to one.

  The History and Use of the Herbal Repertory

  Symptoms are of supreme importance in homeopathy, which largely ignores the pathological background behind them. They are of secondary significance in herbalism, and they are not used in the same way. Since they rarely describe physiological processes, symptoms in homeopathy are given without context. In herbalism, on the other hand, symptoms are almost always associated with their pathophysiological context: they refer to an organ, system, or function. This being the case, a repertory for herbalism has to be founded on a different set of variables.

  The major traditions of herbal medicine in the old world are “humoral,” or based on the idea of underlying fluids or “energies” controlling physiological function. This is true of Traditional Chinese Medicine, Ayurveda, Greek medicine, Scudder’s specific medicine, physiomedicalism, and some American Indian practices. Therefore we find nearly universal agreement on basic principles; almost all herbalists tend to approach the organism from three or four primary directions.

  Sometimes, the approach is (1) symptomatic. This is especially true when an herb is associated with a clear-cut, unique symptom. For instance, the ancient Greek physician Galen recorded the use of plantain (Plantago major) for “painless swelling of the tongue.” It isn’t for painful swelling, and it isn’t for undifferentiated swelling, and it isn’t for “the tongue” as such; there is a precise specificity in Galen’s description.

  A second method used by the herbalist is to determine the (2) “energetic pattern” or, in Greek medicine, the quality (whether hot, cold, damp, or dry). Galen specifies that plantain reduces an excess of “phlegm humor,” or damp quality. This helps us know that plantain is for a swollen tongue caused by dampness. Also, phlegm may be present; the tongue is probably moist and possibly coated.

  A third method used in herbal medicine is identifying (3) organ affinity. This was originally based on the “doctrine of signatures”: the plant looks like the organ it treats. Later, this approach was based on increasing anatomical experience. The Greeks called this category “appropriation”—indicating that the herb was “appropriated” by a specific organ. Plantain has long been associated with the tongue because of its shape. The name used for plantain by Galen translates as “sheep’s tongue.”

  A fourth method defines the (4) “action” of the remedy: plantain is astringent and mucilaginous, and therefore both drying and moistening, as well as contractive. This plant contains constituents that act oppositely: astringents are drying, while mucilage is moistening.

  Galen tells of a patient with a painful, swollen tongue who refused to use plantain because he thought of it as a common weed that could not possibly have curative value. Later the patient had a dream about a sheep choking on its tongue. He then took the remedy with success, and apologized to Galen. This case history was described by the twelfth-century Spanish Arabic physician Ibn Zuhr, who confirms that both he and his father used the herb many times with success for this condition. (See Henry Azar’s The Sage of Seville.)

  Nicholas Culpeper’s essay, “A Key to Galen’s Method of Physick,” found in most editions of Culpeper’s Complete Herbal, describes the basic logic of herbal medicine as it was passed down to him from the ancient Greeks: first determine (1) the “temperature” (energetics), then (2) the “appropriation,” or seat of the disease in the tissues, organs, or systems of the body, and then (3) the “action” required to alleviate the problem.

  For the Greeks, the action was usually something like thinning, thickening, raising, or lowering. Today, actions describe energetic effects (stimulant, refrigerant, or relaxant, for example), organ affinities (stomachic, pulmonary, etc.), and functions (diuretic, emmenagogue, adaptogen, etc.), so they include the energetics and the organ affinities in one poorly defined, catch-all scheme.

  To these three foundations of case-taking, I always add a fourth consideration: (4) the specific indication. This is used in traditional medicine, as we see from the example taken from Galen, but it was not thoroughly developed until the time of Scudder. Therefore, it does not appear in Culpeper’s essay. Specific indications are extremely important because they are the most exact indicators for a remedy.

  A fifth element—(5) taste—came to my attention as I was finishing this manuscript, so it is not well-developed in the repertory. Many skillful herbalists use taste as a guide to analyze the properties of a plant. They assess the pathophysiology of a case something like this: does the tissue need more tone (think astringent), stimulation (think pungent), cleansing (think bitter)? Then they start tasting their herbal supplies or running through their mental inventory of herbs and tastes. In this way the tastes act as a switchboard between the condition and the remedy. We can appreciate this as a simple, natural way of repertorizing each case.

  I have watched herbalists practice in this way. Chinese and Ayurvedic medicine both classify by taste. This was one of the methods of the American Indian practitioners. Pioneers who watched them carefully noticed that they frequently looked over a case, then went into the woods and started tasting plants. The early nineteenth-century herbalist Samuel Thomson also practiced this way. See Virgil Vogel’s American Indian Medicine (1970) and Thomson’s Narrative accompanying his Botanic Guide (1835) for accounts of these practices.

  If we weave these considerations together—energetics, organ affinity, actions, specific indications, and taste—they form an overarching organizational theme. I try to follow this model while taking a case history, and it is also the method used in the construction of this repertory.

  Some will suggest that scientific documentation is needed to support these basic elements of the repertory. The problem, however, with research-driven information is that it is not useful until it has been proven in a clinical setting, and not all scientific information about herbs has been clearly proven in terms that are specific enough for our purposes. There is certainly room for future research in this area.

  Now let’s look at the five factors that help us choose the best remedy.

  Energetics or Tissue States

  The modern biomedical approach is reductionist: identify the smallest possible constituent peculiar to the disease. The holistic approach, by contrast, places the emphasis on broad patterns of dysfunction. This was the only option for premodern people, of course, as they lacked the technology to be reductionist. Does this mean they were incompetent, or that healing wasn’t possible in their day and age? Modern biomedicine acts as if this were true, but healing works with the materials at hand. Using the naked eye, sound questions, and informed fingers, premodern medicine studied disease, medicines, and therapy in an effective if different fashion. These methods are still the ones we use today in herbal medicine because herbs are better suited to holistic processes, not fragmentary bits of process isolated by reductionism. They are themselves “whole processes” suiting to dealing with specific environmental imbalances—the “niches” in which they live.

  Reductionism isolates an exact tissue lesion. This is defined by identifiable changes in the molecular structure of the tissue. The drug is then defined by molecular structure and how this modifies the molecular structure of the lesion. The results are legally definable in a courtroom. Holism, by contrast, looks for the “whole process” and the “whol
e person.” These can only be described in terms of general tissue changes.

  Holistic analysis of “general tissue changes” requires a specialized vocabulary. Throughout the world, such changes have been described as variations of the effects of “fire” and “water.” Thus, we have “yang and yin” in Chinese herbalism, and “hot/cold, damp/dry” in ancient Greek medicine. A few additional values such as “wind” in TCM, or tension and relaxation in Greek practice, fill out the picture. Such terms describe about a half-dozen primal tissue changes in the body. I follow the method of the physiomedicalists (Cook 1869; Thurston 1900; Priest and Priest, 1983), who recognized four to six “tissue states.”

  The first thing we look for is the temperature or quality of tissues (hot, cold, damp, or dry), and the two tissue states (tense or relaxed), as described in ancient Greek medicine. These correspond to the sixfold-diagnostic method outlined by Thurston, the source for Priest and Priest’s approach.

  Heat

  Excitation, irritation, overstimulation

  Cold

  Depression, understimulation

  Dryness

  Atrophy

  Dampness

  Torpor, stagnation

  Tension

  Tension, constriction, “wind” (TCM)

  Relaxation

  Relaxation

  Relaxation keeps pores open, allowing for a continuous flux of fluids through tissues. Relaxation could thus also be considered “flowing dampness,” as opposed to the “damp stagnation” of torpor, where the fluids build up because they are not flowing. Both would be considered a form of dampness in Greek or Chinese medicine; however, for simplicity, I usually identify torpor or stagnation with dampness, and relaxation with—well, relaxation.

  There are also analogies to Ayurvedic medicine: the element of fire = heat; air = dryness; water = dampness; earth = cold; space = wind or tension (lack of space causes tension). Dampness is split into two categories—water and oil. The subdivisions of “excess” and “deficiency” are also used in all of these schools.

  Ayurveda provides us with the three great categories of vata (air and wind), pitta (fire and oil), and kapha (water and earth). From a clinical standpoint, these three constitutional types are especially useful because they correlate with thin, medium, and thick types, respectively. People tend to fall sick according to these three variables. The thin vata people get dry and nervous, the thick kapha people under-exercise, overeat, and gain weight, while the medium pitta people get overheated. In the words of Brent Davis, DC, “Everybody either dries up, burns up, or melts.”

  There is a good correlation between the Ayurvedic elements and six major tissue states:

  Fire

  Excitation

  Earth

  Depression

  Air

  Atrophy

  Oil

  Stagnation

  Space

  Tension

  Water

  Relaxation

  Organ Affinity

  The ancients did not have a good understanding of anatomy or physiology, but from the location of the symptom and the impairment of function, along with a superficial knowledge of anatomy, they deduced the basic functions of organs and systems, and the remedies that suited them. This knowledge was greatly refined in the nineteenth century, when the organ was directly examined by palpation or dissection. This was a period when doctors could really visualize what was going on inside the organism.

  Knowledge of the organ affinities of herbal and homeopathic remedies was developed by the English homeopath Dr. James Compton Burnett (1849-1900). He used herbs in material doses (containing actual plant substances) as well as homeopathic (extremely diluted), and his writings were influential in herbal as well as homeopathic circles. For instance, he was the first to introduce red root (Ceanothus americanus) into modern usage. Late in life, Scudder picked up this thread and wrote a series of articles arranging the eclectic materia medica by organ affinity, published posthumously in The Eclectic Medical Journal. The influence of these schools upon each other in the nineteenth century was continuous and important in the development of plant-knowledge.

  In Diseases of the Liver, Burnett (1895, 3) observes, “the organ in the organism does indeed possess not only autonomy but hegemony, i.e., the organ is an independent state in itself and in and on the organism exerts an important [and, he might have added, an independent] influence.” In consequence, “both a plus and a minus [an excess or deficiency] of a given organ results in diseases of the organism.” In his informal style, he writes, “this idea has swam more or less before my mind for many years … and its importance in my daily work increases with time.”

  The corresponding idea in herbal medicine is “trophorestorative,” introduced by J. M. Thurston (1900). In the nineteenth century, it was more common for practitioners to describe spheres of function (or “trophisms”) such as. . . . In the nineteenth century, it was more common for practitioners to describe spheres of function such as respiration, circulation, digestion, metabolism, elimination, nervous system, and locomotion. These were sometimes associated with the corresponding anatomical structures, and sometimes not. I have not used this term since Thurston tied it to the atrophic tissue state, which I thought was too narrow a definition.

  In modern times, the immune, lymphatic, and endocrine systems would be included among the major organ systems and functions. More recently some, including myself, would include the extracellular matrix (ECM).

  Altogether, we end up with about a dozen major body systems, or “spheres of activity.” Listed by function and organ or system, these are:

  Extracellular Matrix (includes Cells and the Fluids surrounding them)

  Respiration (Lungs, Respiratory Tract)

  Circulation (Cardiovascular System)

  Digestion (Gastrointestinal System)

  Assimilation (Lymphatics, Portal Vein)

  Metabolism (including Liver, Gall bladder)

  Elimination (Colon, Skin, Lungs, Kidneys)

  Locomotion, (Muscular and Skeletal Systems)

  Nervous, Central and Autonomic Nervous Systems

  Endocrine System (Endocrine Cascade, Pancreas)

  Lymph/Immune System (Spleen, Thymus, Bone Marrow, etc.)

  Reproduction (Female and Male)

  As we age, systems and organs naturally wear out, or may become overused and inflamed. One may be overworked to compensate for another that is worn out. Because of this, always look for organ compensation. Disease often starts in the organ system, which is why it is natural to base herbal teaching, practice, and repertory-making on organs, systems, and tissues.

  Actions

  In my experience, the energetics and organ affinities, plus the specific indications, are the necessary basis (three-legged stool) of a thorough case history. Culpeper also includes the category of “action.”

  Today the term “herbal action” would include everything: energetics (stimulants, sedatives, relaxants, astringents, mucilages, aromatics, etc.), organ affinities (stomachic, hepatic, diuretic, diaphoretic, laxative, etc.), the actions recognized by Culpeper (thinning, thickening, separating, conjoining, lifting, lowering, closing, opening, etc.), plus newly identified actions (antimicrobial, adaptogenic, etc.). I have included a few but not many actions in the repertory.

  Specific Indications

  The eclectics considered experience, or empiricism, to be an innate aspect of medical practice and an important plank upon which they constructed their medical knowledge. Scudder used this approach in the development of his system of specific medicine. Knowledge of specific indications and medicines were developed through experience, not experiment, as in the homeopathic provings or the biomedical randomized clinical trials (RCTs). Although modern herbalism now sometimes benefits from RCTs, the individual herbalist usually relies upon his or her experience. Herbalism as a whole is therefore more empirical than biomedicine.

  The specific indication is a symptom complex or pattern that poin
ts to both a specific pathology and a specific remedy. These associations were discovered through clinical experience. The practitioner observed a symptom pattern that seemed to be characteristic in many different presentations. It possessed both detail and uniqueness, so that it could be noticed again in similar presentations in the sick. No matter what the name of the disease, the specific indication appeared again and again and was characteristic of a common pathophysiological expression. It could be defined as a characteristic pathology summed up in a precise symptom complex.

  The next step involved finding a remedy for the specific indication. Scudder says that here the practitioner had to draw on his own clinical experience or established literature. Eventually a remedy was found that was specific to the indication. This was the “specific medicine.” Sometimes, of course, learning occurred in the opposite direction: the practitioner understood the characteristic or specific symptoms treated by a medicine, and then began to see the pattern in the sick.

  Let’s study specificity through an example. Yarrow (Achillea millefolium) is indicated by several very specific signs in the tongue—a carmine-red color, a pointed tip, a blue tinge in the center, a little dryness in the middle, and dampness towards the sides. I have used this indication scores of times—so many that I long ago gave up believing there is another herb suited to this precise but not uncommon presentation. When this symptom shows itself, even if only partially developed, yarrow always helps effect a cure.