Thursday, 22 January 2015

Southernwood And Yarrow

 "Artemisia abrotanum0" by Kurt Stüber [1] - part of Licensed under CC BY-SA 3.0 via Wikimedia Commons -

Two stories that come to mind about herbalism are the "southernwood" story and the "yarrow" story.  I expect there to be other similar ones.

Southernwood is a kind of wormwood found in the Med and like wormwood it kills worms and "brings on periods" (that's a euphemism). I have used it but it's nothing special. It has a couple of uses and is an entirely prosaic, lacklustre remedy which in no way stands out from the crowd.

However, there is a story about southernwood and a particular herbalist. A certain practitioner used to do the usual kind of consultation, taking a full medical history, listening to the patient, performing the necessary physical exams and so on. Then he would give the patient southernwood and they would get better.  It didn't matter what the health problem was. It would happen anyway. Presumably he even gave the herb when he wasn't supposed to.

"Achillea millefolium vallee-de-grace-amiens 80 22062007 1" by O. Pichard - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons -

Then there's the yarrow story, which is easier to pin down. When Coffin brought western herbalism back to Britain in Victorian times (an interesting story in itself which I will get round to one day), he encountered an old herbalist who, whatever the patient had, would recommend giving her yarrow, soaking a hot brick in a yarrow tea and sending them to bed, and hey presto, the patient would get better. Now, yarrow is not like wormwood because it seems to have more actions than any other herb. It's antiinflammatory, astringent, promotes sweating, and allegedly has a great long list of things it can do, although that list seems to me to be a lot shorter than the ones I attach to chamomile and marigold, both of which are incidentally in the daisy family like yarrow.  Therefore this story is slightly different to the other one because it involves the use of a herb which is a lot more versatile.

The first story is more about the herbalist and the second more about the herb, although also about the herbalist. The idea is that someone's health is likely to improve when they see a herbalist and that it isn't really about the herbs. Of course, I do think it's substantially about the herbs but also the lifestyle changes are as important, and I am not a particularly charismatic individual so I'm not sure if I could pull something like that off.  My self-doubt in that area might of course make that self-fulfilling.  What it's saying is that the ritual of seeing a healthcare practitioner and getting the attention and care, perhaps the respect, is a huge part of the process of healing.

Now consider research into herbal remedies.  There are various problems with the ecological validity of these studies which are too involved to go into here although they include things like the solvents used, the use of standardised extracts rather than whole plant extracts and various questions of quality control.  One thing they almost always exclude is the herbalist herself.  A double-blind study on herbal remedies published in a major medical journal does not generally involve the use of remedies by a professional herbalist with the use of a placebo by a control group, but the action of a possibly very low quality "active ingredient" set at a particular level, extracted by methods not used by the herbal industry and not given in the context of a consultation.  This considerably reduces the value of such studies.

When I read such studies, I usually see something like the results being quoted as ineffective or barely noticeable.  This contradicts my clinical experience.  I am aware that when I give a consultation and measure something like peak expiratory flow, blood pressure or peristalsis, something which is easily quantifiable, and then prescribe and dispense herbal remedies, the quantity measured will almost always change in a positive direction.  I'm not able to reconcile these observable objective facts with the claims of research papers which reach negative conclusions about the efficacy of the same remedies, except to note that they are not being given in the same context as I give them.

Therefore, the question I pose myself is this:  is there something about the consultation itself which has a therapeutic effect?  I don't see myself as a magician or anything special, so it may just be that being simply listened to by almost anyone is therapeutic.  

This is also the effect which people miss out on when they buy herbal remedies without a consultation.  It's also considered unethical for a herbalist to do this.  However, it's also not clear what I should do when a patient is clearly confident about her assessment of her own health, and I don't feel I am in a position to judge that she isn't competent, so I don't.

Hence herbalism, and I think other kinds of therapy, seem to be about more than they seem to be on the surface.  Clearly you have to be doing something when you practice a therapy, or the session wouldn't exist, but what you're actually doing appears to be about something other than it does superficially.  I don't know why that is.