With Reference to Research Design Matthew Wood Registered Herbalist (AHG)
6001 Sunnyfield Road, Minnetrista, Mn. 55364
Master of Science Degree (Herbal Medicine)
Submitted: January 2006
Scottish School of Herbal Medicine
University of Wales
[This edition has been slightly corrected due to feedback from my committee.]
This report is submitted in fulfillment of the requirements of the Scottish School of Herbal Medicine and the University of Wales for the award of MSc (Hons.) in Herbal Medicine. Abstract
Western herbalism – the practice of herbal medicine in modern, English-speaking areas – is in a period of change, when many new and old concepts are in competition for recognition. Biomedicine has proposed a strict interpretation of herbal research, in which the experience, tradition, and conceptual framework of Western herbalism is substantially ignored in favor of the biomedical ‘gold standards:’ double blind clinical trials and pharmacological studies. In this paper the author proposes that biomedical research methods are not the only appropriate method for the study of herbalism. Instead, Western herbalism, to be a scientific field in its own right, needs to develop its own conceptual foundation and from this its own methods of research. Towards this end the author examines questions of science, paradigms, holism, biomedicine, research, and knowledge-gathering in traditional herbalism and biomedical research design. This includes visionary and intuitive methods that have not included in conventional scientific work. The paper concludes that established methods of research in herbalism, biomedical models for research, and visionary and intuitive approaches can all contribute to a healthy herbal science. It also suggests that visionary and intuitive methods can improve the holistic element in Western herbalism. It suggests that a ‘confluence’ of results from different approaches may produce more certainty in herbal knowledge than strict adherence to a single or few methods. Of special interest is the unlooked for conclusion that ‘case series’ study should be developed to provide research that can benefit Western herbalism and improve its scientific foundation.
The author gratefully acknowledges the help of Clara NiiSka, MSc. (liberal studies), University of Minnesota, for her assistance in reading and criticizing the manuscript, Robert Schmidt, of Project Hindsight, in Cumberland, Maryland, a professional Greek translator and scholar of Greek science, for his insights in Greek science and ‘archealogical science,’ Frank H. Wood, professor emeritus of educational psychology, University of Minnesota, for his contributions regarding research, Midge Whitelegg, Ph.D., F.N.I.M.H., Department of Nursing, University of Central Lancashire, who provided several important articles and helpful comments, and Clair Teegarden, of Minnetonka, Minnesota, who provided assistance with Internet research.
Extensive public use of complementary and alternative medicine (CAM) (Eisenberg, Davis, Ettner, Appel, Wilkey, Van Rompay, and Kessler, 1998), sometimes also called holistic medicine, led to an examination of the movement by governments in Britain and America. Scientific research into the phenomenon was recommended (United Kingdom House of Lords Select Committee on Science and Technology, 2000; United States Department of Health and Human Services, 2002).
Response to government initiatives within the biomedical field has been diverse. Prominent American medical journals have suggested that CAM be investigated using conventional biomedical methods alone and that holistic professions be ignored and eliminated (Angell and Kassirer, 1998; DeAngelis and Fontanerosa, 2003). This corresponds to past experience in America, where holistic professions have been frequently persecuted and banned (Milton, 1996). A more conciliatory attitude in found in prominent British biomedical journals. Here the suggestion was made that complementary and alternative disciplines should engage in research to establish the reputation of their own professions (Haynes, 1999). These two thoughts – the threat of external take over and elimination of holistic professions, and the suggestion that holistic medicine increase its standing through conducting its own research – have led to the publication of the present paper.
Until the last two decades of the twentieth century, Western herbalism maintained its own conceptions and methods of research. These consisted primarily of empiricism (experience and observation), theory based on experience, and tradition based on experience (Crellin and Philpott, 1990).
Empiricism is considered a fundamental part of biomedical education and practice (Sackett, Richardson, Rosenberg, Haynes, 1997). Since empiricism is a fundamental tool of scientific and medical research (Carr, 1992; Kosso, 1992, Fugh-Berman, 1996), these methods cannot be considered unscientific. Yet, leading biomedical journals have proposed that the study of holistic medicine and herbalism be founded exclusively on biomedical research (pharmacology and randomized controlled trials), without reference to experience, theory, or tradition within holistic professions (Angell and Kassirer, 1998; DeAngelis and Fontanerosa, 2003; Leibovici, 1999).
The biomedical approach has been adopted by some herbalists and herbal writers (Mills and Bone, 2000). Others, however, have attempted to enlarge Western herbalism by introducing methods originating in traditional or subjective sources that include visionary and intuitive practices rejected by modern science (Cown, 1995, Buehner, 1996). Conflicting concepts of herbalism are apparent in the survey of contemporary Western herbal literature cited in section 4, ‘Modern Western Herbalism.’ Hence, the author concluds that basic assumptions in herbalism are not settled but subject to debate.
In order to discuss this debate within Western herbalism it is helpful to understand the nature of scientific change and debate at such periods. In 1962 Kuhn (1970) introduced the concept of the paradigm to describe scientific concepts and their ability to change in professional debate. The paradigm is a theory or assumption, or collection of them, which defines a field. He differentiated between ‘normal science,’ which proceeds from a concensus on theories and assumptions, and ‘scientific revolution,’ when adherents of different theories or paradigms contend with each other for recognition and dominance.
The present author, concluding above that Western herbal medicine is in such a period, applies Kuhn’s (1970) model to hebalism for two reasons. First, it may be beneficial for herbalists to understand and define the nature of the debate they are in. Second, it may facilitate discussion of specific theories, practices, and assumptions currently being considered for inclusion in Western herbalism. It is to be hoped that this application of the paradigmatic model will sharpen issues of debate while diminishing the sharpness of feeling often associated with professional debate.
The current paper attempts to provide basic materials for study and selection among different competing ideas. It is intended to support herbalists who want to be in charge of their own destiny by developing a profession based on theories, traditions, conceptions, research, and practices consciously examined, compared, and selected by themselves, rather than by a competing profession imposing standards upon them. It also attempts to define and reconcile so-called scientific and nonscientific approaches to knowledge, so that herbalists can select from the greatest possible diversity of methods, without having to limit their choices to narrow or rigid standards.
2. Review and Analysis
The contemporary practice of Western herbalism has not been widely studied in scientific research and literature. Only one extensive treatment of the subject has been undertaken by scientifically trained observers (Crellin and Philpott, 1990). They noted that previous studies by folklorists, anthropologists, sociologists, and pharmacologists focused on magical recipes and charms, the sociology of complementary and alternative medicine, its impact on the community, and the possible utility of traditional medicinal plants for modern pharmacology. By comparison, their study focused on the actual practice of herbal medicine in America.
Crellin and Philpott (1990) used an historical method to interpret Western herbalism. They adopted this approach because of the close historical relationship between herbalism and conventional medicine, and the diversity characteristic of herbal practitioners. This allowed them to catalogue, trace, and compare different practices and ideas within the field, and their relationship to conventional medicine. The initial study was limited to a single individual, Tommie Bass, a rural practitioner living in northwestern Georgia. They record his views, theories, experiences, and practices, then compare them with the larger herbal and medical tradition.
Crellin and Philpott (1990) isolated several important methods used to gather knowledge in traditional herbalism. The most significant of these are empiricism, theory, and tradition.
“Empiricism – observation and information gathered supposedly without theoretical presuppositions – is conspicuous in all areas of medicine. . . [and is] prominent in many current herbal practices” (Crellin and Philpott, 1990, 1:12).
“When the ‘rampant empiricism’ – as it is often called – in medicine at any time is examined closely, it is often seen to be sustained by theoretical or cultural notions” (Crellin and Philpott, 1990, 1:13).
“There is no doubt that theory has played a considerable role in the enlargement of the materia medica over time within both domestic and professional medicine” (Crellin and Philpott, 1990, 1:13).
The three theories most prominent in herbal medicine, according to Crellin and Philpott (1990), are:
(2) the relationship of taste to property, and
(3) the doctrine of signatures.
The first theory classifies herbal properties and disease symptoms into simple categories of excess or deficiency of basic states or substances like:
(1) temperature (hot, cold),
(2) impression (stimulating, relaxing, puckering or astringing, etc.)
The third relates:
(2) environmental niche, or
(3) physical properties of a plant
to its medicinal virtues (Crellin and Philpott, 1990).
Crellin and Philpott (1990) provide a comprehensive view of herbal history, from early American colonization until the late 1980s. The author found their observations in line with his own knowledge of the field. However, vast changes occurred in CAM in the decade following their examination, as biomedical and non-Western standards and ideas exerted an influence on Western herbal medicine. This situation is not even referred to by Crellin and Philpott (1990).
In order to describe the nature of the change within herbalism, the author has provided a short literary survey, characterizing herbal publications of the last two decades (section 4, ‘Modern Western Herbalism,’ p. 7).
Although this is a paper on science, the historical methods of Crellin and Philpott (1990) and Kuhn (1970) were selected to provide a context within which to study different scientific options available for research in Western herbal medicine. The subject has been so seldom examined by conventional academicians, that it was thought necessary to consult Crellin and Philpott (1990) to define past practices within the field. Thus, their input is largely restricted to section 2, ‘Review and Analysis.’ The paradigmatic method of Kuhn (1970), on the other hand, was adopted to classify and describe different assumptions or guiding ideas in herbalism, science, and medicine. Thus, it constitutes the prinicipal method used in this paper to discuss and characterize information of use to herbalists.
The concept of the paradigm was introduced by Kuhn (1970) to describe different suppositions and practices in various fields of science, especially in disciplines undergoing profound conceptual change. It was applied to modern holistic medicine almost from the first announcement of its existence (Yahn, 1979). The following year one researcher described seventeen distinct paradigms characteristic of holistic medicine (Gordan, cited by Goldstein, 1999).
Kuhn (1970) recognized two different usages of the term paradigm:
“On the one hand, it stands for the entire constellation of beliefs, values, techniques, and so on shared by the members of a given community. On the other, it denotes one sort of element in that constellation” (Kuhn, 1970, 175).
In this paper, ‘paradigm’ has been used in both senses. In section 7, ‘Paradigms and Holistic Medicine,’ (p. 14), the first of these two approaches is applied. It discusses major paradigms associated with the holistic movement in both popular and scientific discussion. Thus, it chronicles the ‘constellation’ of paradigms which characterizes holistic medicine. Section 8, ‘Paradigms and Herbal Research,’ (p. 18), adheres to the second definition. Here the attempt is made to arrive at the fundamental ‘elements’ from which such ‘constellations’ of belief and practice are derived.
Several terms used in this paper ought to be defined. English language herbalism is known to participants in the field as “Western herbalism” (Hoffmann, 2003, 1), in distinction to Chinese and Ayurvedic herbalism. This term has been adopted throughout this paper for the sake of clarity. The following terms also need definition:
Western medicine: medicine as it was practiced in the West up to the 1940s.
Biomedicine: modern medicine, no longer a ‘Western’ phenomenon.
Conventional medicine: both of the above.
Holistic medicine, unconventional medicine, and complementary and alternative medicine (CAM) are used interchangeably.
The author consulted his own library, Hennepin County Library, and the University of Minnesota Library for scientific and historical information on Western herbalism, Western medicine, biomedicine, the paradigmatic model, complementary and alternative medicine, and other subjects related to this paper. Recent research and editorials on these subjects in the most important English language professional medical journals were consulted to determine the characteristic attitudes towards these subjects in contemporary biomedical literature. Articles were located through research on the Internet using ‘Google scholar’ and keywords including ‘medicine’ and ‘paradigm’ in combination with ‘complementary,’ ‘alternative,’ and ‘holistic.’ The most often cited articles were selected. Searches under specific subjects were also pursued.
4. Modern Western Herbalism
The 1940s were a watershed for Western herbalism. The use of whole plant parts in medicine was superseded by the use of drugs made from isolated, synthesized molecules. The latter were described as the ‘active ingredients’ of plants, implying that the rest of the plant was inactive or less active. Herbal medicine was marginalized (Crellin and Philpott, 1990). Widespread persecution of folk healers and unconventional physicians was initiated in the United States including imprisonment and book burning, physicians were not allowed to practice homeopathy or herbalism without losing their licenses, and unlicensed practice by others was considered illegal in all but a few states (Milton, 1996). The present author has also argued that the practice of medicine itself changed, making it difficult for younger herbalists to understand how to apply the materia medica they inherited from the past (Wood, 2004). How did the profession deal with these changes?
A survey of contemporary herbal literature shows that many authors imported concepts into Western herbalism from other systems they deemed holistic. The Way of Herbs (Tierra, 1984) uses traditional Chinese medicine to classify Western herbs. The Yoga of Herbs (Lad and Frawley, 1989) uses Ayurvedic principles from India. The Traditional Healer (Chishti, 1989) follows the Greek/Arabic method. The Wise Woman Herbal Healing Wise (Weed, 1989) claimed to reflect the methods of traditional ‘wise women.’ Creating Your Herbal Profile (Hall, 1988) presented profiles of herbs resembling homeopathic constitutional types.
During the late 1990s, as biomedical interest in CAM and herbalism was on the increase, publications appear written both by herbalists and biomedicists attempting to explain the action of herbs according to biomedical standards. Publications reflecting this perspective include Phytotherapy (Mills and Bone, 2000) and PDR for Herbal Medicines (Fleming, 1998).
Herbal methodology based on early twentieth century medicine did not completely disappear. One of the most popular and influential texts of the past twenty five years has been The New Holistic Herbal (Hoffmann, 1992). Here herbs are applied to body systems (rather than specific lesions, as in modern biomedicine) and are classified by ‘action’ (astringent, bitter, demulcent, etc.) These methods are characteristic of the medical and herbal approach of the early twentieth century (Crellin and Philpott, 1990; Wood, 2004).
For many, the traditional method of herbal practice explained by Hoffmann was as exotic as Chinese or Ayurvedic medicine. In The Practice of Traditional Western Herbalism (Wood, 2004) the present author attempted to explain early twentieth century medicine for the modern herbal audience. He would point out that herbal education and practice was legally irradicated in America from about 1950 to 1975, during the period of persecution mentioned above (Milton, 1996), so that the traditional system of herbal medicine was not readily understood by younger Americans. It was maintained in isolated pockets, like Southern Appalachia, where Tommie Bass practiced (Crellin and Philpott, 1990). This may explain why all the above books based on Chinese, Ayurvedic, Greek/Arabic, or ‘wisewoman’ herbalism are written by Americans.
The above survey reveals polarities in the herbal field between holism and biomedicine, tradition and innovation. The author concludes that this diversity of opinion indicates that Western herbalism is in the phase Kuhn (1970) called ‘scientific revolution,’ when the supporters of different paradigms are in competition. The author suggests that this circumstance recommends herbalists to the study of the concept of the paradigm and its application within their field.
5. Paradigms and the Study of Science
Kuhn (1970) explains that the paradigm can be a law, theory, application of knowledge, or instrumentation – or several of these together – that supports a certain perspective. Paradigms can be theoretical or practical. Thus, the theory of general relativity represented a change in paradigm from previous, Newtonian physics. In the same fashion, the introduction of the microscope brought about a paradigmatic change by allowing an entirely new view of the world. Together or individually, paradigms
“provide models from which spring particular coherent traditions of scientific research” (Kuhn, 1970, 10).
Such traditions are often named by scientists and historians. Examples are Ptolemaic astronomy, Copernican astronomy, Aristotelian, Newtonian, and Einsteinian physics, corpuscular optics, and wave optics (Kuhn, 1970). Within Western herbalism the author notes such named traditions as Greek or Galenic medicine, physio-medicalism, and eclecticism.
When a paradigm has been accepted by a group of scholars and a discipline is organized around it, practitioners within the field no longer need to dispute fundamental assumptions. Work is now directed by a recognized conceptual structure and generally recognized definitions, resulting in a continuous development of interrelated information. Problems are identified and solved within the established paradigm. At this point the field usually generates its own societies, journals, and claims for recognition in higher educational facilities. This phase of activity Kuhn (1970, 35) calls “normal science.” The basic activity of normal science is defined as “puzzle-solving” (Kuhn., 1970, 35).
When a paradigm does not adequately explain study results or the nature of the world satisfactorily, alternate paradigms are suggested and attract different adherents. This leads to conflict within the field. During this period, ‘normal science’ is superseded by the phase called ‘scientific revolution.’ This is a period of uncertainty during which old paradigms are thrown into doubt and new ones generated (Kuhn, 1970).
When a new paradigm achieves recognition in its field, replacing an old one, Kuhn called the change a “paradigm shift” (Kuhn, 1970, 52). The introduction of cyber-technology in the 1990s is an example of a recent paradigm shift in science due to changes in instrumentation; in biomedicine it led to a new approach or paradigm called ‘evidence-based medicine’ (EBM), discussed in section 8.3, ‘Experimental Science,’ (p. 31).
During scientific revolution a field is fraught with uncertainties and unanswered questions. However, as new experience, research data, and instrumentation are acquired, guiding concepts become clarified and competing explanations are eliminated until a single or several complementary paradigms emerge which are able to adequately account for the observed data. This arrival is, for a scientific community, a “sign of maturity” (Kuhn, 1970, 11). A scientific culture that has reached this level of agreement has more authority than one still developing basic concepts (Milton, 1996).
Kuhn (1970) was skeptical about the objectivity of debate during periods of competition between different paradigms.
“This issue of paradigm choice can never be unequivocally settled by logic and experiment alone” (Kuhn, 1970, 94).
Paradigms are not derived from research; they direct research. Therefore,
“A debate about paradigm choice. . . is necessarily circular. Each group uses its own paradigm to argue in that paradigm’s defense” (Kuhn, 1970, 94).
This position has been controversial. Some critics take issue with the suggestion, as they perceive it, that science is a mere belief system (Vickers, 1996; Horgan, 1997). But science has never been based on certainty. It was always founded on theories, hypotheses, probabilities, and now – as Kuhn (1970) has shown – assumptions. Instead of rejecting the concept of the paradigm as a threat to the idea of objectivity in science, a more mature view would see that it “sharpens the burden” on science to
“allow for meaningful tests that genuinely put the theory at risk” (Kosso, 1992, 133).
Another controversial point is Kuhn’s (1970) argument that scientific models which have been cast aside in the development of science are still as scientific today as they were when they were accepted practice.
“Aristotle’s physics, understood on its own terms, was simply different from, rather than inferior to, Newtonian physics” (Kuhn, paraphrased by Horgan, 1997, 42).
Nor was Newton canceled out by Einstein:
“In so far as Newtonian theory was ever a truly scientific theory supported by valid evidence, it still is” (Kuhn, 1970, 99).
Kosso (1992, 131) considered Kuhn’s work to be “influential” and “high profile,” not only in historical discussion, but in the design of scientific research. However, he recognized that it was easy to misunderstand. The word ‘paradigm’ has entered into popular culture and become widely used in nonscientific settings. Kuhn himself described it as “hopelessly overused” and “out of control” (Kuhn, quoted by Horgan, 1997, 45).