Human Health and its Maintenance with the Aid of Medicinal Plants. Julian Barker

nothing for those who escape the narrowness of the definition. In fairness to McLaren, who spoke as a psychiatrist,⁴⁴ he criticised the originator of the model (George Engels, also a psychiatrist) as presenting a model which could not lay claim to the scientific method, but accepted that it had merits in its ethical approach. Herbal medicine does not make claims on the insurance sector. As its practice is banned, limited or otherwise constrained in many parts of the world, the ideas in this book can hardly be seen as a threat to the pharmaceutical or medical industries. There are no ports or shores for a contemporary Mayflower to head for, so it befits us to develop explanatory models to help us envision the way we can best help alleviate the illness of our patients, whether or not it stems from disease, and help them towards greater health.

      I take a break from these latter remarks lest it seem that herbal medicine is besieged for its lack of science (or that I have forgotten the invention of the paragraph). I assume that no practitioner of medicine would disparage the scientific method. Good scientists do not apply it to questions that they consider better answered by other means. The psychosocial model has been addressed in different modes and at all times by narrative and dramatic arts, music and architecture and by visual means, figurative or otherwise. Good medical doctors have always known this, but the discovery of antibiotics has led to some unkindness towards patients who are difficult to treat. At the heart of the ubiquitous use and abuse of powerful pharmaceuticals in the treatment of functional conditions lies a kind of mental laziness and an obsession with applying the scientific method to complex problems that are beyond its province. Punctilious search for evidence may seem punitive outside a laboratory, or a criminal court. No doubt this is an unintended consequence of the idealism behind the provision of affordable treatment for all, but the power over the practice of medicine exerted by the state and the power over the state exerted by economic interests has somewhat placed other approaches under siege. People who are ill need to be looked after irrespective of the medication or other intervention offered them. They need also to be freely communicated with in an individualised manner without condescension or rudeness: it is easy to patronise or infantilise those who are not overtly paying for services at the time, to describe their predicament only in generalised terms or even to refuse items or modes of information or communication that would be normal and to be expected in other transactions. Besides, the healing power of kindness is inestimable.

Where do we draw the line and with what do we draw it?

      Physiology is a description of processes while pathology is a description of the malfunction of those processes. The line is not so easy to draw: the body resolves local damage to tissue, or conflict with microorganisms principally by the natural process of inflammation, essential to normal functioning. Medicine as a theatre where inflammatory and other processes are pushed back to normality is a necessary and universal social undertaking. If not abused by power, its operations are benign and involve a great many people in cooperative and life–enhancing altruism. We can see a clear distinction, however, between managing someone whose vital functions are broken and helping someone manage. This margin drawn between remedial medicine with all its inevitable generalisations and a medicine that seeks a more adaptive state within the terrain will not help the patient if it creates any separation in his sense of self. Nor will the practitioner of terrain medicine do so well without the benefits of scientific testing, and should be grateful when investigations are helpful.

      To peddle remedies without knowing the recipient well (or even at all) is, putting it most charitably, to make a generalisation based upon commercial considerations. (Orthodox pharmacists know this and are prompted by social concern and are part of a medical enterprise; the same cannot be said for internet traffickers.) The distinction between an effective remedy and a bogus one is clearer to make when one is marketing it as a commodity. The commodification of health is ancient but in modern consumer society, the medication becomes pivotal in the nominal association between disease entity and its remedy.

      The freely engaged consultation changes the whole approach to medication. It sets in place a social contract based upon goodwill and Hippocratic maxims with the hope only of a good outcome for both parties: providing help and hope to one and a fee and the reward of reputation and esteem to the other. I do not wish to imply that the consultation permits and even sanctifies the administration of ineffective remedies but that, as herbalists prescribe personalised complex mixtures, these do not easily submit to testing of results in the way needed and demanded of pharmaceuticals. They do, however, admit to generalisable concepts, to clearly defined intentions: to modify the present ecological states of an individual with respect to their evolution. We should, it goes without saying, draw a line that excludes treatment strategies containing counterfactual elements or defy facts that science says can reliably be known. We are all in the position in this miraculous life of acting effectively in the unknowable but that does not give any honourable practitioner a passport into arbitrary nonsense. Many of the plants used by herbalists show promising, reproducible properties when examined and have led an anecdotal life for many centuries, millennia in some cases. The whole of phytochemistry is coherent and plausible. Indeed, to take a view that plants have no physiological effects and therefore potential medicinal benefits is an implausible belief showing an unscientific amount of prejudice. We draw lines with our beliefs and recruit those facts that suit us to endorse those beliefs and discount those that might show a bias in a different direction to the one we wish to pursue. The act of separation—between sheep and goats, as it were—is always rhetorical even if the facts themselves were unearthed by the scientific method.

      To summarise my attempts to draw the line I would say that disordered physiology very commonly leads to illnesses which are not themselves signs of disease and that pathological disease, the other way around, inevitably does lead to disordered physiology. The principal exception to this concerns infectious diseases where the individualised approach has a subordinate place in their management, especially in epidemics. Herbal remedies may be palliative and even helpful in sustaining the person who is ill from infectious disease and help the terrain mediate its course but have little if any influence on the infective agent. Aside from the incalculable benefits of antibiotics, anaesthesia and some of the newer disease–modifying agents, modern medicine should face its limitations, which means we all should face them lest hubris force itself upon us. The line drawn between cure and failure is most arbitrary when palliation or the induction of remission is all that is hoped for, even when the classification of the patient's condition is not in doubt.

      From an epidemiological vantage point, while the statistical method is needed for treating populations, the individualised approach defies analysis. Even then, the use of rigorous historical analyses takes almost as long as history to evaluate and to develop hypotheses, and these are too dependent on inference to fully satisfy the scientific method.⁴⁵ The line drawn between History and Science, each depending upon different notions of evidence, is a territorial one. While the patient's history may be all important for the holistic herbal practitioner, that bias does not constitute a refusal to recognise the powerful analytical tools provided by reductionism. Conversely, those epidemiologists who postulate that the evolution of disease is unique to each individual have grappled with limitations in statistical methods in their search for an expression of the uniqueness of an individual's evolution and response.⁴⁶

      From a clinical perspective, the individualised approach starts from the common-sense view that humans are primarily expressive, and will always return to this primary signifier. Loss of function turns to the technical capacity of the patient, thence—and this is the purpose of the assessment—to the biological source of any loss of function or fall in well-being. The critical position taken here hinges on the clinician not drawing a line: just as the matrices are interdependent, the evolution of the psychic and physical, social and emotional states constitute the loss of poise. These two phases are interlocked with the biological in the way figured by the Manx triskelion. Whichever leg seems uppermost, a simple rotation will engage the other two. This interdependence cannot be fragmented: no change in any of these states can occur without a concomitant shift in all the matrices, at every level, distributed across a wide range of tissues.

      Only when this open space is revealed in its three aspects—expressive, technical and biological—can the clinician assess whether some degree of specialisation may be required, though there is also a duty (quite aside