Integrating Western & Eastern Herbal Medicine
© 1995 by M. Salim Khan M.D. (M.A.) M.H. D.O. M.I.R.C.H. F.G.N.I.
The last two decades have seen a renaissance of alternative and complementary therapies throughout the world. There is a plethora of books and courses on different therapies.
However, when examined closely, most of these books are a mixture of ancient teachings taken out of context and mixed with some aspect of modern scientific discovery. There is an absence of integration and wholeness.
One of the hallmarks of natural medicine and health care was balance, wholeness and unity. Herbal medicine is the oldest and most widely used form of medicine in the world today. However, herbal medicine as practiced today, particularly in the West and especially in Britain and America suffers from a lack of consistent and comprehensive framework of paradigm.
This article is intended to explore ways that integration and unity can be realised, at various levels of our work, our organisations and ourselves.
The Current Situation
The Mesnavi of Jalal-ud-din Rumi, a classic of wisdom, contains a story called 'The disagreement as to the description and shape of the elephant'. It runs as follows:
"The elephant was in a dark house. Some people had brought it for exhibition. To see it, many people were going; every one, into that darkness and, as seeing it with the eye was impossible, each one was feeling it in the dark with the palm of his hand.
The hand of one fell on the trunk: he said, "This creature is like a water pipe". The hand of another touched its ear: to him it appeared to be like a fan. Another handled its leg and said, "I found the elephant shape to be like a pillar". Another lay his hand on the back - he said, “Truly this elephant is like a throne".
Similarly, when anyone heard a description of the elephant, he understood it only concerning the part that the reporter had touched. Because of the diverse place of view, their statements differed: one man entitled it 'Dal', another 'Alif'. If there had been a candle in each one's hand, the difference would have gone out of their words.
The eye of sense perception is only like the palm of the hand: the palm has not the power to reach the whole of the elephant."
The genius of Rumi has penetrated to the centre of the problem of knowledge. Each hand, as it were, fumbles over some part of the elephant, each proclaiming what they have discovered, and none is able to relate the part to the whole.
The invention of instruments that render the senses a thousand or more times more acute does not reduce the difficulties: if anything it increases them. Because of the minute examination one is unable to listen to what is being said at the other end of the elephant.
Even if it was possible to spare the time to study different disciplines or specialties, the search for knowledge has become so intense; so much data and observations have been accumulated, that no person can ever hope to know all that others have recorded.
The prospect of synthesizing so much data seems an impossible task. It would seem that the very existence of an elephant has been forgotten. Consequently, the efforts are solely upon compilation of vast catalogues of observation on the trunk, legs or the tail, depending on one's area of interest.
This is the unsatisfactory state in which the whole body of knowledge finds itself. It is equally true of medical science: medicine studies the human being, who is an indivisible whole of such enormous complexity that it is impossible to grasp the whole truth about him. Modern medical science, therefore, has taken him to pieces to study each piece separately.
The modern physician, called upon to deal with a sick human being, is confronted with a truly formidable task. What renders this task so difficult is that the physician is unaware of what a normal human being is, still less a sick one.
He has acquaintance with the organs of a human being and has an idea of how they work; but of the reality or nature of the human being himself, he is woefully ignorant.
Since the renaissance in European society, the fundamental conceptions of creation of life and the human being have developed on mechanistic and materialistic lines to the exclusion of any higher values.
In general, this view of the world has created fundamental problems, both technological and psychological, which have pushed him to the edge of an abyss.
F. Capra in his famous book ‘The Turning Point’ , says:"At the beginning of the last two decades of our century, we find ourselves in a state of profound, world-wide crisis. It is a complex, multi-dimensional crisis whose facets touch every aspects of our lives - our health and our livelihood, the quality of our environment and our social relationships, our economy, technology and politics. It is a crisis of intellectual, moral and spiritual dimensions of a scale and urgency unprecedented in recorded human history. For the first time we have to face the real threat of extinction of the human race and all life on this planet."
The Need for Integration
It in this context that herbal medicine can help to restore balance and order, specifically in health and well-being. Any comprehensive tradition of medicine has a network of interdependent ideas and practices through which the origin, understanding, treatment and prevention of illness and the maintenance of health are explained. Thus in reality there are close and intimately inseparable relations between the conception of a human being and health and disease.
When we examine herbal medicine it can be divided into the systems of the West, and the systems of the Orient/East. The Western systems of herbal medicine are: the naturopathic herbalists, the allopathic school, the planetary herbalists and physio-medicalism.
It is interesting to note that Samuel Thompson, a founder of physio-medicalism, wrote: "I found that all animal bodies were formed of four elements. The earth and water constitute the solid, and air and fire, or heat, are the cause of life and motion; that cold or lessening of power of heat is the cause of all disease. That to restore heat to its natural state was the only way that health could be produced, and that, after restoring the natural heat, by clearing the system of all obstructions and causing a natural perspiration, the stomach would digest the food taken into it, and the heat of nature be enabled to hold her supremacy."
The oriental systems can be divided into three main groups: Traditional Chinese Medicine (TCM), Traditional Indian Medicine (Ayurveda and Siddha) and Traditional Persian/Middle Eastern Medicine (Tibb).
The need for integration and unity, and the practice, of herbal medicine can be expressed at various levels:
- Individual, where integration and unity is an inherent human need.
- Professional: Where it is essential for: - clear communication; - the establishment of areas of agreement; - diagnostic purposes; - therapeutic purposes; - research and development; - legal protection.
The Transcultural Principles of Herbal Medicine
In order to establish clear unity we may explicitly agree to core principles that we share irrespective of our training or school. I call these transcultural principles. These are:
- Vis medicatrix naturae - the healing power of nature, which regulates, protects and heals.
- Energy - the chi of Chinese, the prana of Indian and the quwwah of Middle-Eastern Medicine.
- Wholeness and the unity of the individual.
- The micro-macro principle - that each being is a complete biological miniature universe.
The Integrated Perspective and Its Clinical Application
The transcultural principles provide us with a perspective that can be useful in clinical practice. Of course each tradition uses its own jargon to express this and Tibb is no exception.
The elements (arkaan) are the simple constituents of minerals, plants and animals. Throughout the classical civilisations of China, the Middle East, India and Greece, the concept of elements has been used to explain and understand nature's most complex processes, including health and disease.
Tibb as a living and dynamic tradition of Medicine and health care shares with classical societies the idea of elements. However, owing to its own unique historical and social contexts, it has its own particular emphasis, which will be the focus of this article.
The manifestation of existence by being is a result of polarisation of material prima into energy (quwwah). From the Tibbi perspective, the highest levels of organisation of the cosmos are concerned with complex energies.
This understanding of the universe also extends to other organisms including Human beings. This framework is developed by creating a spectrum for measuring the qualities of heat, cold, moisture and dryness.
These four primary qualities (khawas) are used as qualitative dimensions of measurement, hot and cold being active and moist and dry passive. This concept is further developed to yield four basic universal symbols of the primary elements.
The macrocosm, the cosmos and its miniature-human being - is the resultant interplay of these four elements which are united in unvarying patterns.
This understanding of qualities and the elements is an intricate and subtle idea that requires the transcending of gross materialism.
The elements can be perceived as components, dynamic qualities, primary forms or different phases of a cycle. However, in all these aspects, the elements represent dynamic aspects of the phenomena of life, originating from one creative source.
The Four Elements
Earth is an element normally situated at the centre of all existence. In its nature it is at rest and all other elements naturally tend towards it, however great a distance away they might be. This is because of its intrinsic weight. Earth is cold and dry. in the scheme of creation, it serves the purpose of rendering things firm, stable, lasting and heavy. It is by means of earthly element that other parts are fixed and held together into a compacted form. Thus it is because of earth that the outward form is maintained. The vibration rate of the earth is slow. It is passive and receptive in nature like the female principle in creation.
Water is a simple substance whose position in nature is exterior to the orbit of the Earth and interior to that of air. This is because of its relative density. It is cold and moist. The purpose of water in the scheme of creation lies in the fact that it lends itself to dispersion. Water provides, in the construction of things, the possibility of being moulded and shaped without permanency. Water being moist allows shapes to be readily fashioned. Water is the source of life as well as being essential to life.
Air is a simple substance, occupying the position above the sphere of water beneath that of fire. This is because of its relative lightness. Air is hot and moist. In nature, in the process of creation, its purpose is to rarefy and render things finer, lighter and more delicate.
Fire is a simple substance, occupying a position in nature higher than that of the other three elements. Fire is hot and dry, The part fire plays in the creation of things is that it matures, refines and intermingles with all things. Its penetrative power enables it to permeate the substance of air. It thus subdues the coldness of earth and water and enables their integration into various compounds.
The temperament is that dynamic quality that results from mutual action and interactions of the four primary qualities residing within the elements.
Temperament as defined above is the synthesis of physical, emotional, intellectual and spiritual aspects of an individual. It is a dynamic statuesque to each individual. Every being is endowed with the most suitable temperament for the purpose and conditions of its creation. Human beings possess the most suitable temperaments for the conditions of life.
Temperament is the inherent predisposition to respond and react along qualitatively predetermined characteristic patterns. Temperamental differences are the differences of response patterns to identical situations. Each individual reacts and responds according to an innate psycho-emotional pattern, which he shares with others as well as it being unique to himself.
The Origins of Temperament
The temperament of each individual is unique, due to inborn strengths and weaknesses of various forces. It is liable to temporary changes due to psycho-social factors such as emotions, occupation, food and ecological factors such as climate (see table three).
According to Tibb, each part of the human body has been assigned a characteristic temperament. Thus each specific organ has a hot, cold, moist or dry temperament suitable for its structural and functional requirements (see table four).
Akhlat is the biological application and extension of the elements. There are four primary fluids (al-aklaat al-arbah) sometimes referred to as daughters of the elements (banat al-arkan). There are two types of fluid: normal and abnormal. Normal fluids are capable of being assimilated and integrated into tissue or energy, whilst abnormal fluids are unsuitable for assimilation and can be a source of imbalance and ill-health.
There are four primary fluids in their normal state which are responsible for the physiological, morphological and energy requirements of the body. Food begins to be changed and modified as soon as it comes into contact with the lining of the mouth. Saliva also promotes digestion due to its innate activity. Within the stomach, digestion changes food into chyme, a juice-like fluid.
Chyme is absorbed through the stomach and small intestine into the liver. The liver works rapidly with the chyme, maturing it and converting it into the four primary fluids. The main characteristics of the primary fluids are given below.
Normal blood (dum) is connected to the element air, being hot and moist in nature. The associated organs are the lugs, blood and liver. Blood is active in childhood, spring and between three and nine in the morning. Normal blood is red, sweet and without smell. Blood possesses an attractive force. Its function is to provide nutrition to the organs and tissues. Abnormal blood can result from cold and heat, mixture with other fluids, dietary mismanagement or emotional imbalance.
Normal phlegm (bulghum) is sweet. Associated with the element water, and cold and moist in nature. It is dominant in old age, winter and during the night from 9pm to 3am. The related organs are the kidneys, the bladder and the brain, although it moves freely in the blood and joints. It possessed an expulsive force. Phlegm is different from the other fluids in that it can be converted into blood when necessary. It moistens the organs and joints to prevent dryness caused by excess friction and heat. There are several varieties of abnormal phlegm and their main causal factors are lack of heat, working in water for long periods, and an excess of phlegm-producing foods such as milk and cheese.
Normal bile (safra) is yellow bile, corresponding to the element fire, being hot and dry in nature. It is active in youth, summer and between 9am and 3pm. Bile is light in weight and yellow in colour. Bile is taken into the gall bladder and the blood. The heart and the gall bladder are the associated organs. The yellow bile that is taken into the blood makes the blood light and thin for easy passage through the capillaries. Yellow bile that enters the gall bladder serves that organ and activates the intestines and rectum for defecation by peristaltic movements. Abnormal yellow bile can be caused by its mixture with other fluids or because of a change of temperament. The causative factors can be excess heat, hot or sweet and greasy food.
Sauda - as the Arabic word indicates - is black bile and is the sediment of normal blood. Black bile corresponds to the element earth, being cold and dry in nature and possessing a retentive force. Its taste is midway between sweetness and astringency. Black bile is associated with middle age and autumn and is active between 3pm to 9pm daily. The associated organs are the spleen, stomach and bones. Black bile is taken from the liver into the spleen and the blood. The bile that enters the spleen is used by the spleen for nutrition and to purify the rest of the body of its excrementitious material, and part of it is sent to the stomach. It renders the stomach firm, active and induces hunger by its acidity. Abnormal black bile can be caused by excess heat or cold inefficiency of the spleen, dietary indiscretions such as food containing thick, dry ingredients, and negative emotional conditions. There are several varieties of abnormal black bile that are a source of ill health, particularly mental-emotional diseases.
From these basic characteristics of the primary fluids we can begin to understand the relationship between the various factors. This simple and clear relationship begins to form a coherent picture indicating how closely and intimately interwoven are the relationships between diet, seasons, health and well-being.
Assessment and Evaluation
Assessment of Temperament
The temperament (synthesis) of an individual is assessed against that of a balanced person under normal conditions. Since the skin, specifically the skin of the terminal phalanges is the most balanced, touch has been adopted as the most suitable means of assessment. However, in practice all five senses are used to arrive at a proper assessment. Practical clinical training and experience primes the practitioner to make professional judgements. The ten primary indicators for the assessment of innate temperament are:
- i. Physique.
- ii. Complexion.
- iii. Hair.
- iv. Muscularity and adiposity.
- v. Feel of the body.
- vi. Functional condition of the organs.
- vii. Excretions.
- viii. Receptivity of organs.
- ix. Sleep and wakefulness.
- x. Psychological aspects.
Principles Employed to Restore Balance
Having arrived at an assessment of the whole person's constitution and temperament as well as specific organs, we are now able to understand the qualitative nature of various interventions. Different interventions have their own energetic qualities too. In order to maintain or restore lost balance within an organ or the person as a whole, we need to match the intervention to the imbalance (see table five).
The principles behind treatment are: a) to conserve and maintain balance if the individual mizaj is in a state of equilibrium (this is achieved through the like or similar principle) and to restore balance when lost, through application to the contrary principle.
From this brief paper, it should be clear how almost all aspects of lifestyle and interventions - be they dietary, naturopathic, herbal or psychological - become amenable to systematic understanding. This understanding can be used with the patient to help him/her toward health and well-being. The universal idea and fact is that disease and disorder are, in reality, a manifestation of moving away, violation or deviation from natural laws.
Disclaimer: This information is provided for education and information purposes only. Please consult your healthcare professional for personal advice.