In 1991, glacial melting in the Italian Alps exposed a corpse preserved deep in the ice, the naturally mummified body of a prehistoric man who had frozen to death around 3300 BC.
Dubbed the Iceman, he wore straw-lined leather shoes, leather clothing, a thick coat made from woven grass, and a bearskin cap. He carried a wooden bow, a leather quiver filled with stone-tipped arrows, a flint-bladed knife, a wood-handled ax with a copper blade, and a food pouch that still contained dried deer meat and a prune.
The Iceman’s pouch also contained two mysterious, walnut-sized cork-like lumps strung together on a leather thong, suggesting that they were of value. The lumps turned out to be bracket fungus (Piptoporus betulinus), mushrooms that grow in shelf-like plates on tree trunks. Bracket fungus contains agaric acid, a potent laxative, and an oily resin that is toxic to some bacteria and intestinal parasites.
Scientists studying the Iceman had no idea why he would have carried bracket fungus until, in 1998, a painstaking autopsy of his digestive tract turned up the eggs of an intestinal parasite (Trichuris trichiura).
It now appears that the Iceman knew he had a medical problem and was ingesting bracket fungus to treat his condition. Given its laxative and antiparasitic action, the fungus probably provided some benefit.
This discovery ranks as the world’s oldest documented example of the practice of medicine, and it suggests that prehistoric humanity was more medically sophisticated than previously believed. After all, the Iceman or someone he knew had diagnosed his malady correctly and had recommended a reasonably appropriate treatment—an herbal treatment—5,000 years ago.
What exactly is a healing herb? “Herb” comes from the Latin for “grass.” Technically, herbs are plants that wither each autumn, plants other than shrubs or trees. But many woody perennials are used in herbal healing: cinnamon, slippery elm, tea tree, and white willow, to name a few. To herbalists, “healing herbs” includes every plant with medicinal value.
Prehistoric sites show that Neanderthals used yarrow, marshmallow, and other herbs as early as 60,000 years ago. What attracted them to these plants?
Animals played a key role. Prehistoric humans were keen observers of their world. No doubt our ancestors noticed that when animals appeared ill, they sometimes ate plants they ordinarily ignored. Humans sampled these plants and in many cases noticed curious effects, among them: wakefulness, sleepiness, laxative action, and increased urination. The herbs that caused these effects were incorporated into prehistoric shamanism, and later into medicine.
Animal-inspired herbalism is still with us. The controversial herbal cancer therapy marketed in the 1940s by Harry Hoxsey was reportedly inspired by a cancer-stricken horse that ate unusual herbs (more on this later).
Early humans were also attracted to healing herbs’ aromas. They rubbed strong-smelling herbs on their bodies to repel insects and to hide their scent from animals they feared or hunted. They also adorned themselves with sweet-smelling herbs to please their mates.
Fragrant herbs were eventually incorporated into perfumes and embalming mixtures. Demand for them spurred ancient trade. During the Middle Ages, when Europeans believed that bathing was unhealthy and farm animals often shared human living quarters, homemakers spread aromatic “strewing herbs” to freshen the air. Herbalists still prepare scent baskets (potpourris) today, and the perfume industry still creates most of its fragrances from herbal essences.
But foul odors, not fragrant ones, were key to the development of herbal healing. Early humans used plants such as rosemary, thyme, dill, and virtually all of today’s culinary spices to mask the stench of rotting food, especially meats. Today, we use culinary herbs and spices only as flavor enhancers, but to prehistoric humanity, flavor enhancement was incidental to food preservation.
Prehistoric humanity had no refrigeration, and food spoiled quickly. Spoilage destroyed precious reserves, and early humans learned the hard way that eating rotten food caused illness and sometimes death. No doubt some prehistoric homemaker happened to lay some rotting food on a bed of mint, rosemary, sage, or some other aromatic herb, hoping the herb’s fragrance would mask the item’s stench. It did, and as a bonus, the food didn’t spoil as quickly.
Our ancestors began wrapping food, especially meats, in aromatic herbs to preserve them, which led to other astonishing discoveries. Those who ate preservative herbs along with the food suffered less illness—and the food tasted better.
Surely, our ancestors thought, aromatic herbs were magical. As time passed and magic was incorporated into religion, ancient civilizations came to view aromatic herbs as gifts from the gods, which is why many herbs figure prominently in ancient myths and religions.
Thanks to modern science, we know that the oils that give aromatic herbs their fragrance and flavor contain potent antimicrobial compounds that kill many food-spoiling, disease-causing microorganisms. In fact, rosemary and sage have food-preservative action comparable to that of the commercial preservatives BHA and BHT.
Our ancestors also most likely discovered many healing herbs by trial and error. They learned through experience that some plants healed, while others harmed. They had little control over their world. Average life expectancy was barely 30 years. Because their lives were so full of threatening, often fatal, surprises, anything that made life more predictable acquired an aura of magic and healing.
It’s no coincidence that shamans from prehistoric times down to the present day have relied heavily on herbs, such as ipecac, buckthorn, and wormwood, that cause vomiting, purging, and hallucinations. Any predictable effect was better than none, and the ability to induce vomiting, purging, or visions made shaman/herbalists appear to possess magic powers.
The allure of predictable action remained central to medicine for thousands of years. Herbs that induced vomiting (emetics) or had powerful laxative action were used routinely in medicine until the late 19th century.
Major effects made big impressions, but early humans also recognized herbs’ more subtle benefits. We’ll never know what possessed some ancient Chinese peasant to brew a tea from the small, ungainly stalks of ma huang (Chinese ephedra), but several thousand years ago, someone did. In the process, that person stumbled upon one of the world’s oldest medicines, a decongestant whose laboratory analog, pseudoephedrine, inspired the name of a popular cold/allergy product, Sudafed. (Over-the-counter Sudafed no longer contains pseudoephedrine.)
Similarly, we’ll never know how many roots ancient Asians dug up before they discovered ginger. Or why Native Americans had a hunch that black cohosh might be useful in gynecology. However, around the world ancient peoples dug, dried, chewed, pounded, rubbed, and boiled the plants around them—and discovered the vast majority of medicinal herbs still used today.
Botanical trial and error becomes even more remarkable considering that widely separated cultures independently arrived at similar uses for many healing herbs. There are four major herbal-medicine traditions: Chinese, Ayurvedic (India), European (including Egyptian), and Native American. The ancient spice trade introduced Asian herbs such as garlic, ginger, and cinnamon into Europe thousands of years ago. And a few ancient herbalists, notably the 1st-century Greek, Dioscorides, traveled extensively as a physician to Roman armies and absorbed the herbal wisdom of cultures throughout the ancient world.
Nonetheless, early Asian and European herbalists were largely isolated from one another. Until the 1st century AD, it took 2 years for spice traders to travel round-trip from Greece to India’s black pepper farms.
Despite today’s instant global communication, different healing systems still operate relatively independently. During the 1970s and early 1980s, ginkgo became an important medicine in France and Germany for aging-related ailments, with sales topping $500 million a year. Most U.S. medical school libraries stocked the German and French journals showing ginkgo’s remarkable effectiveness, yet American physicians virtually ignored ginkgo well into the 1990s. How connected could the ancient herbalists have been?
Even granting a nearly impossible level of herbal mingling between Asia and Europe, the land bridge between Asia and North America became the Bering Sea about 10,000 years ago. Until the 15th century, Old World cultures were almost entirely isolated from the Americas. Nonetheless, Old and New World herbalists used many herbs similarly.
• Angelica and licorice. Asians, Europeans, and Native Americans relied on these herbs as treatments for respiratory ailments.
• Hop and the mints. All ancient herbal traditions used these herbs as stomach soothers.
• Blackberry and raspberry. Around the world, they were used to treat diarrhea.
• Uva-ursi. Asians, Europeans, and Native Americans all discovered its diuretic properties.
• White willow. All four herbal healing traditions used it to treat pain and inflammation.
During the 19th century, chemists used “herbal convergence” to point them to plants whose extracts became the first pharmaceuticals. According to a report in the journal Science, about 75 percent of the pharmaceuticals derived from plants came to drug companies’ attention thanks to traditional herbal medicine.
Most medical histories chronicle great achievements by great men: Hippocrates, the father of medicine; Galen, Rome’s leading physician; William Harvey’s explanation of blood circulation; Edward Jenner’s inoculations against smallpox; Louis Pasteur’s Germ Theory; Alexander Fleming’s discovery of penicillin.
But from ancient times to the present day, a relatively small number of male physicians made the great discoveries and ministered to the rich and royal while an enormous number of unsung women herbalists took care of everyone else.
Women healers have gone by many names: midwives, wise women, green women, witches, old wives, and nurses. Most physicians have scoffed at women’s folk healing, and scientists often dismiss folk wisdom as “old wives’ tales.” But medically untrained women still provide much of the world’s primary care. Even in the United States, most people view physicians as the health care choice of last resort. The medical profession promotes the idea that family doctors are our primary providers, but studies show that before people call health professionals, about 90 percent consult a friend or family member. These informal heath advisers are overwhelmingly women.
Ancient physicians officially recognized women’s leading role in obstetrics and gynecology more than 2,000 years ago in the Hippocratic Oath, still recited by many graduating medical students today: “I will prescribe no . . . pessary [contraceptive device] to produce abortion.” Anti-abortion activists have seized on this statement as a condemnation of abortion. In fact, this declaration withdrew male doctors from gynecology and gave the field—including abortion, which has been widely practiced since ancient times—to midwives.
Whatever your opinion of abortion, throughout history women have consistently sought to control their fertility. After all, until about 150 years ago, childbirth was a leading cause of female death.
Midwives completely dominated obstetrics and gynecology until the late 19th century. They used many herbs to calm the womb, trigger menstruation, induce abortion, promote or dry up mothers’ milk, and treat infant colic and infectious diarrhea (still a leading cause of infant death in many nations). These were the daily concerns that female patients presented to their women healers.
Sometimes medically unschooled women herbalists introduced university-trained physicians to powerful medicines, for example, the heart drug digitalis from foxglove. But by and large, male physicians dismissed female folk healers as ignorant practitioners of medicine that was at best, inferior, and at worst, harmful.
Nonetheless, women herbalists have played a key—and largely undocumented—role in medical history. Just as herbs are the forgotten sources of many medicines, the “wise women” represent the forgotten healers whose thousands of years of collective experience taught us how to use herbs safely and effectively.
The wise women were particularly adept at contraception. Around 700 BC, an oracle sent Greek colonists to the coast of what is now Libya to found a colony, Cyrene. It was located in a dry, desolate, inhospitable place, but the colonists soon discovered a local plant that made them wealthy, silphion (in Latin, silphium), a species of fennel. Silphium was a remarkably effective contraceptive. When women ate it, they did not conceive. The herb quickly became the contraceptive of choice around the Mediterranean. Cyrenian coins depicted the plant, often held by a woman. Poets extolled its powers. Silphium became so popular that overharvesting eventually wiped it out.
Legend has it that around 3400 BC (the Iceman’s era) “the divine farmer,” mythical emperor-sage Shen Nung, invented agriculture and discovered that many plants have medicinal value. He tested herbs on himself and recorded their effects—and died after ingesting one that was poisonous.
Chinese herbalists credit Shen Nung as the author of China’s first great herb guide or “herbal,” the Pen Tsao Ching (Classic of Herbs), which listed 237 botanical prescriptions using dozens of herbs, including cannabis, ephedra, rhubarb, and opium poppy. However, most authorities agree that the Pen Tsao Ching was passed down orally for millennia until published in book form during the Han dynasty, around AD 100.
Chinese herbalists discovered many medicinal plants, notably ginseng, tea, sesame, garlic, and cinnamon. Starting around AD 500, it became customary for Chinese emperors to commission updates of Shen Nung’s herbal. Over the centuries, these became increasingly elaborate—and contradictory. By 1590, when Li Shih-Chen published his landmark 52-volume Pen Tsao Kang Mu (Catalogue of Medicinal Herbs), he included 1,094 medicinal plants and an astounding 11,000 herbal formulas.
Today, practitioners of Chinese herbalism still study Li’s work, but they have simplified his art, employing some 300 herbs, 150 of which are considered indispensable, among them: Chinese angelica (dang gui), burdock, chrysanthemum, cinnamon, dandelion, garlic, ginger, ginseng, hawthorn, licorice, lotus, mint, rhubarb, scullcap, senna, and tea.
European colonialists introduced Western medicine into China, dismissing Chinese herbalism and acupuncture as nonsense. The Chinese felt the same way about the “foreign devils’” medicine, and the two systems seemed irreconcilable.
But shortly after the establishment of the People’s Republic in 1949, the Chinese government decided that China’s huge, medically underserved population could benefit from combining the two systems. Today, throughout China, Western-trained physicians practice alongside traditional herbalists and acupuncturists. Chinese and Western physicians examine the same patients, confer with each other, and often coordinate their recommendations.
A turning point in American acceptance of Chinese medicine occurred in 1972, when Richard Nixon became the first president to visit China. During his visit, American reporters visited a hospital and watched astonished as a woman had abdominal surgery while fully conscious, her only anesthesia being some acupuncture needles in her earlobes and feet.
On the trip, influential New York Times columnist James Reston developed appendicitis and had surgery. Afterward, he tried acupuncture for postsurgical pain control. He was so pleased with the results that he wrote a testimonial column that helped open the United States to acupuncture and Chinese herbalism.
According to legend, around 1200 BC a poor Indian boy named Jivaka studied medicine under the great Punarvasu Atreya, founder of India’s first medical school at the University of Taxila in the Punjab. Having no money, the lad offered to become Atreya’s servant in exchange for training.
Seven years later, Jivaka asked his teacher when his studies would be completed. Instead of answering, Atreya challenged him to scour the countryside and collect plants that were medically useless. Jivaka searched for a month, only to return sullen and empty-handed. He told his mentor that he was unable to find a single plant without healing power. Atreya replied, “Go! You now have the knowledge to be a physician.”
Centered in the Indus Valley near the present India-Pakistan border, ancient Indian civilization was quite advanced. Excavations at Harappa and Mohenjo Daro dating to about 2500 BC have revealed municipal water and sewerage systems more advanced than the ones the Romans developed 2,000 years later.
Ancient Indians called their medicine Ayurveda, from two Sanskrit words: ayur, life, and veda, knowledge. Ayurvedic medicine developed from the Vedas, India’s four books of classic wisdom.
The oldest, the 4,500-year-old Rig Veda, is a collection of 1,028 Hindu hymns, recited orally from 2500 BC and written 1,000 years later. The Rig Veda contains detailed descriptions of eye surgery, limb amputation, and medicinal formulas using 67 herbs, including ginger, cinnamon, and senna. The 3,200-year-old Atharva Veda also discusses many healing herbs.
Around 700 BC (400 years before Hippocrates), Charaka, a University of Taxila professor, wrote Ayurvedic medicine’s first encyclopedia, the Charaka Samhita, listing 500 herbal formulas.
In 250 BC, India’s King Asoka converted to Buddhism and launched a 1,000-year golden age of Ayurvedic medicine. Asoka sent Buddhist monk-physicians around the country to heal the sick and convert them to Buddhism. As the centuries passed, pilgrims came from as far away as China and Persia to receive Ayurvedic treatment.
One favorite Ayurvedic herb was Rauwolfia serpentina. It’s the source of reserpine, a drug used in Western medicine for much of the 20th century to manage high blood pressure.
Ayurvedic healing influenced Arab medicine, which combined Greco-Roman, Middle Eastern, and Asian therapies. Arab physicians in turn introduced some Ayurvedic practices into Europe.
During the 19th century, the British introduced Western medicine into India, but a majority of Indians and Pakistanis still rely on Ayurvedic medicine or homeopathy, both of which prefer medicinal herbs to drugs.
During ancient times, what we know today as Iraq was home to a succession of peoples: the Sumerians, Assyrians, Babylonians, and Persians. The early Sumerians had no physicians. Sick people congregated in public squares, and passersby gave them advice.
As Sumerian culture developed, so did its medicine. In late Sumerian mythology, the gods give Sumeria’s original healer, Thrita, 10,000 healing herbs and the wisdom to use them. One of the world’s oldest surviving prescriptions is a Sumerian clay tablet from around 2100 BC that mentions myrrh, cypress, and opium poppy.
By 1000 BC, Assyrians could consult three types of healers: herbalists (internists), knife wielders (surgeons), and counselors (psychiatrists). Herbalists were the most numerous and prominent, in part because Assyria was strategically placed along the ancient Spice Road (also known as the Silk Route) from Asia to Egypt. Archeologists have unearthed an Assyrian pharmacy that stocked 230 herbs, including almond, anise, caraway, coriander, juniper, saffron, sesame, turmeric, and willow.
The Assyrians, and later the Babylonians and Persians, were enthusiastic spice traders. Valued for taste, food preservation, and healing, spices were in great demand and generated huge profits. When properly dried and stored, spices could travel great distances without spoiling. They didn’t have to be fed like cattle and slaves. And they took up little space, which meant they could be easily transported and hidden from thieves. No wonder that in Genesis 37:25, when Joseph’s jealous brothers sold him into slavery, he was purchased by “a caravan . . . with camels bearing gum, balm, and myrrh on their way to Egypt.”
In 1874, in the Valley of the Tombs near Luxor, the German Egyptologist Georg Ebers discovered the world’s oldest surviving medical text, a 65-foot papyrus dating from 1500 BC. The Ebers Papyrus listed 876 herbal formulas from more than 500 plants: aloe, caraway, cardamom, chamomile, cinnamon, coriander, fennel, fenugreek, garlic, gentian, ginger, juniper, mint, myrrh, onion, opium poppy, saffron, sage, sesame, and thyme. The Ebers Papyrus shows that ancient Egyptians used around one-third of the herbs in today’s Western herbal pharmacopoeia.
Some Ebers formulas strike the modern reader as bizarre, such as a shampoo made from a dog’s paw, decayed palm leaves, and a donkey hoof, all boiled in oil. Others sound surprisingly prescient—the recommendation to bandage moldy bread over wounds to prevent infection. Penicillin was originally derived from a mold.
In Egyptian mythology, Thoth, god of knowledge, created medicine. He also invented writing, the arts, and science. The most notable Egyptian physician was Imhotep, who was also the architect to Pharaoh Zoser (3000 BC). Imhotep is credited with designing the first pyramid, but as time passed, he was revered mostly as a healer. He became deified, and around 700 BC, Egypt’s medical school at Memphis and a nearby school for midwives were dedicated to him.
The Egyptians imported mountains of herbs for perfumes, embalming mixtures, and medicines. They also considered plants important spoils of war. In 1475 BC, when Pharaoh Thutmose III conquered what is now Syria, he demanded as tribute specimens of all Syrian plants not found in Egypt.
The Egyptians loved aromatic herbs. The ancient kingdom’s access to both the Mediterranean and Arabian seas allowed them to import aromatics from as far away as Spain and the Spice Islands (Indonesia).
But the Egyptians also loved two herbs that many other ancients considered foul-smelling—garlic and onion. The Egyptians believed that they prevented disease (a view supported by modern science). They ate so much garlic and onion that the Greek historian Herodotus called them “the stinking ones.” Both herbs were found in the tomb of King Tut.
The Egyptians also gave their slaves daily rations of garlic and onion to keep them strong and healthy. In 450 BC, Herodotus wrote of an inscription inside the Cheops Pyramid at Giza (built around 2900 BC) that said 1,600 talents of silver, enough to equip an army, had been spent on garlic and onions for its builders.
Once, a garlic shortage once forced the Egyptians to cut their slaves’ rations. The slaves became so incensed that they refused to work. If this story is true, it would be the world’s first documented strike.
Egyptian farmers could not satisfy the demand for garlic and onions, so the Egyptians turned to the Philistines, who lived in nearby Canaan (Israel). The Philistine city of Askelon, in Gaza, became a major garlic and onion trading center, for the Egyptians, Greeks, and Romans. The Romans favored the Philistines’ small green onions, calling them ascalonia after Askelon. The word evolved into escallon, and finally into our “scallion.”
Middle Eastern herbalists also used a great deal of opium to treat pain. Excavations of 3,000-year-old tombs in Israel have discovered pottery shaped like opium poppy pods and containing residues of opium, the narcotic still widely used today as codeine and morphine.
By about 500 BC, Egyptian herbalists were considered the finest in the Mediterranean, and rulers from Rome to Babylon recruited them as court physicians. Aspiring physicians—Rome’s Galen among them—went to Egypt to study with the medical masters of the Nile.
The early Greeks viewed illness as a divine curse and prayed to Apollo, god of medicine, for recovery. In Greek mythology, Apollo fathered a son, Aesculapius, a physician-god like Imhotep, who treated the sick helped by his daughters, Hygeia and Panacea. Hygeia, source of our word “hygiene,” touted healthy living, while Panacea, whose name means cure-all, treated disease.
When ill, early Greeks visited temples dedicated to Aesculapius where physician-priests treated them with baths, exercise, massage, fasting, prayer, herbs, counseling, and animal sacrifices. The program was similar to the regimens at many contemporary health spas, except for the sacrifices.
Snakes were sacred to Aesculapius, and they slithered freely around his temple grounds. One omen of imminent recovery was to have a snake lick a patient’s wounds. Snakes’ tongues thus became symbols of healing, and they remained ingredients in medicinal potions well into the Middle Ages. Aesculapius was often pictured carrying a staff with a snake wrapped around it. The snake-staff combination became the caduceus, the symbol of medicine.
Sons of Aesculapian priest-doctors often followed their fathers into the healing temples. On the island of Kos, off Turkey, one Aesculapian family produced Hippocrates (460–377 BC), the father of Western medicine. Hippocrates rebelled against Aesculapius, however, by secularizing Greek medicine. He believed that diseases came not from the gods but from natural causes: the environment, climate, and diet.
In the Iliad, Homer claimed that Greek medicine came from Egypt. Kos is located only a short voyage from the land of Imhotep. But Hippocrates clearly elaborated on Egyptian practices. From his seat under a plane tree (a type of sycamore), he was the first physician known to examine patients closely and use case studies in medical training, a method still employed in medical education today.
Hippocrates never wrote a word, but his students compiled the 72-volume Corpus Hippocraticum. It mentions 350 medicinal plants, including anise, burdock, clove, cinnamon, mint, rosemary, and thyme.
Hippocrates taught that health depends on a balance among the body’s four vital fluids, or “humors”: blood, phlegm, yellow bile, and black bile. Hippocrates’ Humoral Theory of illness remained a cornerstone of European medicine until the mid-19th century, when Pasteur’s Germ Theory supplanted it.
The humors were said to have four qualities: hot, cold, dry, and wet. Hippocrates prescribed warming herbs such as ginger for diseases that he believed were caused by cold and cooling herbs such as mint for ailments produced by heat. All classic Western herbals assigned Hippocratic qualities to healing herbs—warming, cooling, and so on—and listed the “foul humors” they supposedly relieved.
Aesculapian priests and later Greek physicians grew and gathered many herbs. They also bought medicinal plants from herbalists known as root gatherers or rhizomists. (In botany, a rhizome is an underground stem.) The rhizomists were peasant foragers who gathered medicinal plants and sold them in market towns.
Hippocrates had no women students, but many midwives were also rhizomists. Homer mentions one named Agamede, who was famous for her knowledge of herbs.
Shortly before Hippocrates’ death, the father of botany was born. Theophrastus (372–285 BC) was the author of Historia Plantarum (An Inquiry into Plants) and De Causis Plantarum (The Growth of Plants), which remained standard references for more than 1,000 years. Many of the 550 plants he discussed were used medicinally. Theophrastus operated a prominent herb shop in Athens. He and Aristotle were friends. When the seminal philosopher died, he bequeathed Theophrastus his garden.
The first medical botanist was the Turkish-born Greek Pedanius Dioscorides (AD 40–90), who served as a physician with Emperor Nero’s Roman legions traveling from Germany to Arabia. In AD 78, he published De Materia Medica (On Medicines), Europe’s first book on herbs. It discussed 600 plants, including aloe, anise, chamomile, cinnamon, dill, marjoram, poppy, rhubarb, and thyme.
As a military physician, Dioscorides focused on soldiers’ needs, particularly wound treatment. But De Materia Medica also included a great deal of herbal folk wisdom, proving that he learned from many herbalists during his travels.
De Materia Medica remained a standard medical text for 1,500 years. Virtually every herbal published through the 17th century referred to it. After the invention of the printing press in 1440, De Materia Medica was one of the first books published. The oldest copy in the United States, from 1547, resides in the Lloyd Library in Cincinnati (more on the Lloyd Library later).
It’s fitting that Rome’s legions produced a great herbalist, because part of their mission was to protect the Roman spice trade with Asia from barbarian predation. By the 1st century AD, the herb and spice trade was a cornerstone of Roman commerce. Roman demand for medicinal, culinary, and perfume herbs was almost insatiable.
Shortly before the publication of De Materia Medica, Greek merchants discovered the secret of the Indian Ocean’s shifting monsoon winds, which blew east toward India part of the year and west toward Egypt the rest. This insight allowed spice merchants to cut round-trips from Rome to India in half, from 2 years to 1. Faster transit meant cheaper herbs, such as the Roman favorite black pepper, whose price plummeted to the modern equivalent of around $100 per ounce. (I recently bought black peppercorns for $1 an ounce.)
While Dioscorides traveled the Empire, back in Rome, Caius Plinius Secundus, or Pliny the Elder (AD 23–79), was busy compiling ancient scientific knowledge into his 37-volume Historia Naturalis (Natural History). Volumes 12 through 19 dealt with botany, and 20 through 27 addressed herbal medicine. Pliny recommended some wild prescriptions—for colds, “kissing a mouse.” But many of his herbal recommendations were more plausible and guided physicians for centuries.
In August AD 79, Pliny heard that Mount Vesuvius near Pompeii was rumbling. He had to see it and traveled there. When the volcano exploded on August 24, Pliny was perched on a nearby hill, taking notes. He died of asphyxiation.
Fifty years later, Claudius Galenus, better known as Galen (AD 131–200), became Rome’s leading physician. Born into a wealthy family in Turkey, Galen studied medicine in Greece and Alexandria and then spent several years as a physician to gladiators. At age 30, he moved to Rome, and eventually he became the physician to Emperor Marcus Aurelius.
Galen was arrogant and dogmatic. He practiced a highly theoretical form of medicine that dominated European medical training for 1,500 years. At a time when midwife-herbalists relied on single herbs or formulas with a few ingredients, Galen practiced “polypharmacy,” which used complex combination of herbs, animal parts, and minerals to create concoctions called “galenicals.” Galen’s wealthy patients liked galenicals because they were expensive and therefore exclusive. As the centuries passed, Europe’s nobility came to favor costly galenicals, while the peasantry stuck with single herbs or simple formulas, which became known as “simples.”
Roman rhizomists—herbarii, in Latin—congregated around Capitoline Hill. They were a motley crew. Physicians accused them of mislabeling and adulterating their herbs. Pliny and Galen boycotted them, provided tips on detecting adulteration (variations in color, taste, aroma), and urged physicians to grow and gather their own medicinal plants.
Roman herbalists were as likely to be killers as healers. The Imperial court seethed with murderous intrigue. Among available assassination methods—knifing, “accidents,” and poisoning among them—the herbal approach was most popular.
Political notables were typically surrounded by bodyguards, making knifings and accidents difficult to arrange. Physical assault also involved risk of capture. Poisoning could be accomplished from a safe distance. Death occurred sometime after the deed, allowing for escape or alibi. And in an age before autopsy, when apparently healthy people often sickened and died suddenly, wily poisoners might never be suspected.
As a result, rulers throughout the Roman Empire became obsessed with herbal poisons and the development of antidotes, known in Latin as theriaca (in English, “theriacs”) from the Greek theriakon, meaning remedies for venom.
The ancient world’s most poison-paranoid ruler was Mithridates Eupator (120–66 BC), king of Pontus, on the Black Sea. Mithridates governed by terror and feared being poisoned. As a result, he delved into botany, believing that familiarity with both poisonous and medicinal plants was his best defense. His botanical expertise is commemorated in the genus name of the herb boneset, Eupatorium.
In addition to formulating dozens of theriacs, Mithridates supposedly ordered his court physician to concoct the ultimate herbal poison. The ancient king took increasing doses to develop a tolerance and make himself immune.
Then, in 66 BC, the Romans attacked. Facing capture and certain execution, Mithridates tried to poison himself. But according to legend, he’d become so tolerant that no poison could kill him. He ordered a slave to stab him to death. To this day, the word mithridatism means an acquired tolerance to poisons.
Roman nobility offered to pay enormous sums for any antidotes attributed to Mithridates. Needless to say, Rome’s unscrupulous herbarii were only too happy to peddle bogus mixtures as “Mithridates’ Theriac.”
A century after the unpoisonable king’s death, Emperor Nero was driven nearly insane by fear of poisoning, in part because he’d gained the throne by poisoning his stepbrother. Nero ordered his physician, Andromachus of Crete, to improve on Mithridates’ Theriac. Andromachus mixed 78 herbal, animal, and mineral ingredients—including opium, a lizard, and snake flesh (in homage to Aesculapius)—to create Andromachus’ Theriac.
Slave midwife-herbalists were highly valued as poisoners. They could often be placed as concubines in the bedrooms of their intended victims, beyond the reach of bodyguards and tasters, who sampled rulers’ food and drink before they ingested, just in case. A slave herbalist Locusta became famous for her poisoning skill. After one important murder, she received her freedom and a gift of land.
Not to be outdone by Andromachus, Galen wrote a book containing more than 100 theriac recipes. He also developed his own, Galene, a polypharmaceutical brew of 70 ingredients, including dozens of herbs, honey, wine, minerals, and animal parts that took 40 days to prepare.
When Rome fell, the barbarians seized not only Rome’s lands and wealth but also its vast stores of herbs and spices. During one attack, the barbarians demanded horses, money—and 3,000 pounds of black pepper.
Theriaca eventually evolved into the Elizabethan English word “treacle.” The Elizabethan peasantry used garlic as an all-purpose medicine and antidote, and it became known as “poor man’s treacle.”
As Rome collapsed, Arab civilization filled the intellectual vacuum. From AD 600 to 800, Islamic armies forged an empire stretching from Spain across Northern Africa to India. Unlike the barbarians who seized Roman Europe, the Arabs venerated Greco-Roman culture and learning. Along with the spoils of conquest, they sent tens of thousands of Greco-Roman books to Baghdad, for translation into Arabic.
Ibn-Sina, or Avicenna (AD 980–1037), was the era’s leading Arab physician. While still quite young, he cured an Arab prince of a serious illness, triggering great demand for his services. A follower of Galen, he wrote the Canon of Medicine, the West’s medical bible for 600 years. Book Two discussed healing herbs, including cinnamon, clove, nutmeg, myrrh, rhubarb, and senna.
The Arabs revered Galen but were not ruled by polypharmacy. They simplified Galen’s formulas and developed pharmacy as a field distinct from medicine. The first pharmacies appeared in Baghdad in the 9th century.
Arab pharmacists replaced galenicals with syrups, ointments, and tinctures (alcohol extracts). They were the first to distill pure alcohol, whose name derives from the Arabic al-kohl, or “quintessence.” Arab medicine also gave us the terms alkalai, from al-qali, “ashes,” and sugar, from sukkar, meaning “grain or pebble.”
From AD 800 until Christians recaptured it in the 1400s, Spain rivaled Baghdad as a center of Arab herbalism. One influential herbalist was Abul-Kasim Khalef ibn Abbas, in Spanish, Abulcasis (AD 936–1013). He wrote Liber Servitoris (The Book of Simples), an important source for later European herbals.
The other prominent herbalist was Ibn al-Baitar (AD 1197–1248), a botanist who collected 1,500 plants from Spain to Syria. He also wrote the most complete Arab herbal, the Corpus of Simples. It introduced 200 new healing herbs (and poisons), including tamarind, aconite, and nux vomica (strychnine).
After the fall of Rome, the Catholic Church dominated European medicine, reviving the pre-Hippocratic Greek belief that illness was a punishment from God and was treatable only by prayer and penance. But Catholic monks preserved Greco-Roman herbalism by copying their texts.
Among monastic orders, the Benedictines were the most avid herbalists. They adopted the Arab practice of making tinctures. They flavored wine with digestion-promoting herbs and created the forerunners of today’s liqueurs. One is still called Benedictine.
Charlemagne (AD 742–814) was so impressed by the Benedictines’ herb gardens that he ordered all of the monasteries in his vast realm to plant “physic gardens” to ensure an adequate supply of healing herbs. Charlemagne described herbs as “friends of the physician and cook.”
Around AD 820, the Benedictines designed their ideal monastery, known as the Plan of St. Gall. In one corner was an infirmary that included rooms for bathing, examinations, and bloodletting. It also featured a 1,000-square-foot physic garden that contained two dozen herbs, including: cumin, fennel, fenugreek, mint, pennyroyal, rose, rosemary, rue, sage, savory, and watercress.
In another corner was a kitchen garden that also contained many herbs, including dill, which was commonly mixed with salt water to preserve vegetables, particularly cucumbers, forerunners of today’s dill pickles.
The most notable Benedictine herbalist was Hildegard of Bingen (1098–1179), abbess of the Rupertsburg convent in the German Rhineland. Centuries before the Renaissance, Hildegard was a Renaissance woman, a nun, administrator, composer, writer, and herbalist. Her religious music is still performed today.
Hildegard claimed that visions of God commanded her to treat the sick and compile herbal formulas. Her book, Hildegard’s Medicine, combined Catholic mystical, German folk medicine, and her own extensive herbal experience. Hildegard’s favorite herbs included aloe, apple, basil, bay, blackberry, caraway, celery, clove, dill, fennel, garlic, hyssop, licorice, marjoram, myrrh, nettle, nutmeg, onion, oregano, parsley, raspberry, rosemary, rue, thyme, and watercress.
Hildegard’s herbal is unique. At a time when the few literate Europeans, mostly monks, were content to copy the Greeks, Romans, and Avicenna, she composed an original medical text based on her own clinical experience. What’s more, she was the only medieval woman who left any account of “wise woman” healing practices.
Today, much of Hildegard’s advice sounds silly. For poor vision, she advocated rubbing the eyes with a topaz soaked in wine. However, many of her recommendations were quite sensible. She advocated eating a balanced diet and brushing teeth with aloe and myrrh—both of which have antibacterial, decay-preventive properties.
While Hildegard relied on simples, complex galenicals continued to be valued by the nobility, who had access to galenically inclined physicians and the wealth to afford all the ingredients that Galen’s polypharmaceuticals required. The men who mixed medieval galenicals were the first alchemists.
Around the time that the Benedictines invented liqueur, Germanic Angles and Saxons were settling England. They brought European herbalism with them and learned how the native Celts and their priests, the Druids, used healing herbs.
Around AD 950, a nobleman named Bald persuaded England’s King Alfred to commission the first British herbal. The book combined Anglo-Saxon and Celtic herbalism with Greco-Roman and Arab practices. It was called the Leech Book of Bald. (Leech comes from laece, Anglo-Saxon for “doctor.”) It discussed 500 plants, including vervain and mistletoe, both sacred to the Druids. A surviving copy is on display at the British Museum.
With the Renaissance, European medicine took a secular turn. After the invention of printing, monks stopped copying ancient herbals, but continued to tend their physic gardens. One Austrian monk-gardener was Gregor Mendel. In 1868, he published Plant Hybridization, an account of his experiments with peas. It launched the science of genetics.
Hildegard of Bingen was lucky to have lived in the 12th century. Had she practiced herbalism from 1300 to 1650, she might have been burned as a witch.
It’s not clear what led to Europe’s 350 years of witch hunts. Feminists link the practice to the rise of secular medicine as a male-dominated profession. Others blame the hysteria on bubonic plague (the Black Death), which swept Europe in waves and killed much of its population.
Another theory holds that European rulers and the Catholic Church became alarmed by post–Black Plague population decline, which they blamed on contraceptive herbs touted by the wise women. The leading medieval contraceptive herbs were abortifacients, or in modern parlance “morning-after” plants. The most popular were pennyroyal, rue, and wormwood. Modern research shows that all three stimulate uterine contractions and abortion.
After 1300, witch hunts transformed folk herbalists’ image from wise women to evil witches. The witch hunts started in Germany and eventually spread throughout Europe. Accusations of “sexual intercourse with the Devil” were typically accompanied by testimony that the alleged witch practiced herbal medicine and made healing mixtures, cosmetics, love potions, aphrodisiacs, abortifacients, and poisons.
Accusations of poisoning were particularly damning. It’s possible that some women herbalists continued the Roman tradition of herbal assassination, but this was the era before the discovery of the dose-response relationship, the idea that the greater the dose, the greater the effect. Many so-called witches’ plants, poisonous in large amounts, caused no harm in therapeutic or cosmetic amounts. Nonetheless, the witch hunters considered them poisons.
One plant associated with witchcraft was “devil’s herb,” which could be lethal if ingested. But applied topically, it was a cosmetic. Eventually, the plant was renamed “beautiful woman,” or belladonna.
Another sorcerer’s herb was witch’s bells. Large amounts are poisonous, but small amounts stimulate the heart. After the witch-hunt era, the plant’s name was changed to foxglove, source of the heart drug digitalis.
Conviction of witchcraft meant death. At the height of the witch hunts, as many as 600 women a year—about two a day—were executed in parts of Germany. At Toulouse, France, 400 were put to death in a single day.
North America did not escape the hysteria. The Salem witch trials in Massachusetts (1692) resulted in 20 executions of women. Records suggest that they were wise women herbalists.
After the witch hunts, the saintly Hildegard was forgotten, replaced by the witches of Shakespeare’s Macbeth, whose bubbling cauldron contained mandrake, belladonna, and other herbs. Witches were also vilified in the stories that became today’s fairy tales. In Snow White, the evil queen-witch concocts an herbal poison, dips an apple into it, and slips it to Snow White, who falls into a coma, an echo of herbal poisoning dating back to the Romans.
The witch hunts failed to eradicate women’s herbalism, but they succeeded in driving it underground. More than a century after the last witch hunts, the “old woman” who helped popularize foxglove said that it was a “secret family recipe.” Her forebears had good reason to keep their use of witch’s bells a secret.
The fall of Rome devastated the spice trade. Arab merchants continued to import Asian herbs into Europe, but the commerce declined and prices soared. During the Middle Ages, a pound of ginger could buy a fat sheep. Black pepper was counted out corn by corn and used to pay rents, taxes, and dowries.
Then came the Crusades. From 1095 until 1291, European armies attempted to wrest the Holy Land from Islamic control. Militarily, they failed, but while in the Middle East, the Crusaders tasted Asian spices and returned home craving more.
The 1296 publication of Marco Polo’s travelogue heightened European fascination with Asian herbs. Polo’s father and uncle were merchants who set out from Venice to China in 1271, taking the 17-year-old Marco with them. The young Italian became a favorite of Kublai Kahn, and when he returned in 1295, his famous memoir was filled with mouthwatering accounts of Asia’s tantalizing spices.
The ancient Spice Routes slowly reopened. Around 1300, British spice dealers obtained a royal charter to become the Guild of Pepperers. They bought black pepper and other herbs from brokers in Venice, who traded with Arab importers. By 1400, Venice alone imported 2,500 tons of ginger and black pepper a year. European demand seemed limitless.
Then something terrible happened. During the 1400s, the Mongols, who supported trade with Europe, lost Western Asia to the Ottoman Turks, who closed the trade routes. In Venice and Genoa, cities enriched by the spice trade, Italian merchants grew desperate for new avenues to the East. If the world was round, as some claimed, it might be possible to sail west across the Atlantic to reach the Indies.
It was no coincidence that Christopher Columbus hailed from Genoa. He never reached the East Indies, but he returned from the New World with allspice and red pepper, known to Caribbean Indians as kian, or “cayenne.”
In 1498, when the Portuguese explorer Vasco da Gama succeeded in sailing around Africa to India, he stepped ashore in Calcutta saying, “We come in search of Christians and spices.”
The Portuguese and Dutch grabbed an early lead in exploration. They monopolized the sea route around Africa to India and the Spice Islands (Indonesia), as well as the trade in cinnamon, cloves, tea, and black pepper.
The Spanish concentrated on the New World and its gold. Sometimes they found the precious metal, sometimes other valuables. In 1519, Hernando Cortez watched as Mexico’s Aztec ruler, Montezuma, toasted his arrival by sipping from a golden goblet. Cortez coveted the goblet—but the herbal beverage that it contained, chocolatl or “chocolate,” eventually became more important than the Aztec’s gold.
In addition to chocolate, Spanish conquistadors returned home with corn, tobacco, potatoes, carrots, strawberries, lima beans, tomatoes, sarsaparilla, passionflower, and the most important new healer of all, cinchona (Jesuit or Peruvian bark). Cinchona was the first effective treatment for malaria (also known as ague, intermittent fever, and swamp fever), which had plagued the Mediterranean area and Europe since ancient times. Centuries later, cinchona became the source of the antimalarial drug quinine.
The Spanish may also have returned from the New World with something else: syphilis. A doctor in Seville claimed he’d treated Columbus’ crew in 1493. It’s possible that they became infected in Haiti. Or perhaps increased trade spread a disease that had existed for ages in isolated pockets around the Mediterranean.
In any event, an epidemic of unusually virulent syphilis swept through Europe in 1494, killing thousands. Europeans considered the disease an import from the New World and looked across the Atlantic for a cure. They focused on sarsaparilla, which was widely used until well into the 19th century. (The herb turned out to be ineffective.)
Another syphilis treatment was mercury. It played a key role in the schism that developed in the early 19th century between promercury “regular” physicians and antimercury herbal “Eclectics.”
Spain kept chocolate, cinchona, and other New World plants secret for years. Eventually, they were revealed in a book by Spanish physician-botanist Nicolas Monardes. The book became a huge bestseller. It was published in English in 1577, with the title Joyful Newes Out of the Newe Founde Worlde.
Twenty years after Joyful Newes, England played a minor role in world exploration. That changed in 1599, when the Dutch suddenly tripled the price of black pepper. England was outraged. Eighty London merchants pooled their capital and established the British East India Company, which began importing pepper and other herbs directly from India.
The English eventually took control of India and Ceylon (Sri Lanka). The East India Company also imported Chinese tea, which quickly became as English as the Union Jack.
The East India Company’s tea was very popular in England’s North American colonies. In 1773, when Parliament tried to tax it, New England tea lovers dumped several tons into Boston Harbor in protest. The Boston Tea Party helped ignite the American Revolution.
Around 1500, Italian mathematician Giambattista della Porta conceived the first new medical philosophy since Galen. Called the Doctrine of Signatures, it claimed that a plant’s physical appearance revealed its healing value. As British herbalist William Coles explained in his Art of Simpling (1656), God had not only “stamped upon plants . . . a distinct forme but also given them particular signatures whereby a Man may read the use of them.”
According to Coles, “Wall-nuts [walnuts] have the perfect signature of the Head. The outer husk represents the cranium or outward skin of the skull, whereon the hair groweth, and therefore those husks are exceedingly good for wounds in the head. The inner woody shell hath the Signature of the Skull . . . and the Kernel hath the very figure of the Brain. If the Kernel be bruised, moistened with wine, and laid upon the Head, it comforts the head and brain mightily.” Some herbals still suggest walnuts for headache.
The most vocal champion of the Doctrine of Signatures was Phillippus Aureolus Theophrastus Bombastus von Hohenheim (1493–1541), the son of a Swiss alchemist/physician. A brilliant, arrogant student of medicine, he lived up to his name, Bombastus, then changed it to Paracelsus (“greater than Celsus”), convinced that he was more brilliant than the Roman physician Celsus (53 BC–AD 7), then considered on a par with Galen.
In the 1520s, Paracelsus taught at the University of Basel in Switzerland. At a time when medical students studied only Hippocrates, Galen, Celsus, and Avicenna, Paracelsus publicly burned their books to symbolize his rejection of Galenic dogma. He also rejected the ancient Humoral Theory of illness for the Doctrine of Signatures.
Strange as it sounds today, the doctrine was based on experience with healing herbs. For instance, the stems of dandelion are hollow, allowing air to pass through them. Based on this characteristic, the doctrine declared dandelion a respiratory remedy.
The Doctrine of Signatures quickly became the new medical dogma. Bile has a yellowish tinge, and jaundice, a liver problem, turns the skin yellow. Under the doctrine, any yellow flower or root was considered a liver medicine. Similarly, any plant with long, snaking roots was used to treat snakebite. Plants with heart-shaped leaves were considered heart remedies. Juicy plants were used as diuretics and lactation promoters.
In addition to promoting the insurgent medical philosophy, Paracelsus further offended medical professionals by rejecting Latin for the vernacular, opening medicine to those unschooled in the language of the universities. He correctly predicted the discovery of “active principles” in plants and pioneered the chemical extraction of plant oils.
Paracelsus also discovered the dose-response relationship. “Is it a poison or not?” he wrote. “It depends only on the dose.” His insight came too late to save thousands of alleged witches executed in part for possession of alleged poisons, but it allowed Paracelsus to introduce small doses of many potentially toxic minerals into medicine: arsenic, sulphur, lead, antimony, and particularly mercury, not just to treat syphilis but also for other diseases. In time, physicians came to view mercury as a panacea.
In the 1450s when printing arrived, herbals proliferated and England’s university-trained physicians feared losing their medical monopoly. They lobbied their influential patients in the British Court to restrict the practice of medicine to them, outlawing it to “rogues, horse-gelders, rat catchers, idiots, and witches.”
In a 1511 decree, Henry VIII limited doctoring to university-trained physicians and barber-surgeons who’d completed apprenticeships. Anyone else had to pass a test administered in Latin. Of course, few folk herbalists could even read English let alone Latin. Some stopped practicing. Many became “green men and women,” latter-day rhizomists who supplied herbs to physicians and early pharmacists, or apothecaries, often while continuing to practice herbal healing on the sly.
In time, England’s herbalists rebelled against the suppression of folk medicine by publishing two anonymous herbals. Bancke’s Herball (1525), the first herbal printed in English, and The Grete Herball (1526), a combination of French and German references.
Henry VIII’s edict eventually led to a major shortage of doctors. In 1543, he rescinded it with the Herbalists’ Charter: “From henceforth, it shall be lawful for every . . . King’s subject, having knowledge and experience of . . . Herbs and Roots . . . to practice, use, and minister to any Sore, Wound, Swelling, or Disease any Herbs, Ointments, Baths, Pulsters (poultices) and Emplaisters (plasters), according to their Cunning, Experience, and Knowledge . . . without Suit, Vexation, Trouble, Penalty, or Loss of their Goods.”
The Herbalists’ Charter came just one year after German botanist Leonhard Fuchs (1501–1566) published De Historia Stirpium (On Plants), the first original book of medical botany since Dioscorides’ treatise 1,500 years earlier. Illustrated with woodcuts, it discussed 500 healing herbs, including 100 from the New World.
In 1546, the University of Padua in Italy planted the first academic botanical garden, which helped launch the science of botany. In time, most major universities and many physicians and apothecaries planted their own physic gardens.
William Turner, the father of British botany, published his New Herball in 1551. Subsequently, a London publisher commissioned Robert Priest to combine and translate French and German herbals into English, but Priest died before completing the project, and his translation disappeared.
Enter herbalist John Gerard (1545–1612), who established a noted physic garden in London’s Fetter Lane that contained 1,000 species, including England’s first potatoes. In 1586, Gerard was appointed curator of the College of Physicians’ Physic Garden, and soon after, became herbalist to King James I.
In 1597, Gerard published his Herball or Generall Historie of Plantes, in which he displayed the College of Physicians’ characteristic contempt for “overbold apothecaries, and foolish women.” However, Gerard apparently had nothing against plagiarism. He obliquely acknowledged the late Robert Priest, leading to accusations that he’d obtained Priest’s lost translation and published it as his own.
Gerard denied wrongdoing. His herbal contained considerable original material on herb gardening—but most authorities believe he stole Priest’s work.
John Parkinson (1567–1650) was another pioneering British herbalist. In 1640, he published Theatrum Botanicum (The Theater of Plants), subtitled The Universall and Complete Herball, an 1,800-page book that discussed 3,800 plants, grouped into families such as Hot Plants, Venomous Plants, and Strange, Outlandish Plants.
Parkinson’s classification system appears quaint today, but during the 17th century, herbalists struggled with organizing botanical medicines. Many scientists proposed systems, but none stuck until 1737 when Swedish naturalist Carl Linne, also known as Carolus Linnaeus (1707–1778), developed his Latin binomial genus-and-species system based on reproductive characteristics. After Darwin, scientists added evolutionary criteria, but to this day, plants and animals are still named using Linnaeus’ binomial formula—genus and species in Latin, for example, garlic is Allium sativum.
As university medicine slowly became more scientific, leading physicians stopped growing their own herbs. They turned instead to the increasing number of apothecaries, who used mortars and pestles to powder healing herbs. The mortar and pestle remain symbols of pharmacy today.
In 1673, London’s apothecaries established Britain’s finest medicinal herb garden, the 3.8-acre Chelsea Physic Garden, which still exists. Today, it contains 5,000 species of herbs from around the world. Located 2 miles west of Piccadilly Circus, it is open to the public.
Nicholas Culpeper was by far England’s most influential herbalist. His Complete Herbal and English Physician (1652) has remained in print ever since in more than 100 editions, a record of longevity only a handful of books can claim. A century after Culpeper’s death, literary lion Dr. Samuel Johnson wrote, “Culpeper . . . undoubtedly merits the gratitude of posterity.”
Culpeper was—and still is—loathed as well as loved. His herbalist contemporary, William Coles, denounced him as “a man ignorant of simples.” More than 250 years later, in The Old English Herbals (1922), Elinour Rohde wrote, “The infamous Nicholas Culpeper was a false prophet of herbalism . . . [author of] an absurd book.” Today, scientists scoff at Culpeper’s prescriptions and his devotion to astrology.
Egotistical and brash, Culpeper came of age during the English Civil War (1642–1648), which pitted King Charles I and the monarchist aristocracy against Oliver Cromwell and the Puritans. The Puritans won, abolished the monarchy, and executed Charles.
Culpeper came from an aristocratic family, but he fought for Cromwell. He took a musket ball in the chest, which left him in poor health for the rest of his life and spurred him to study medicine.
As an aristocrat, Culpeper attended Cambridge, where he fell in love and planned to elope. But on her way to meet him, Culpeper’s fiancée was killed when lightning struck her carriage. Beside himself with grief, Culpeper left Cambridge and became an apothecary’s apprentice, a trade considered far beneath anyone with a university education.
Culpeper was an anomaly. Trained at Cambridge, he could read Greek and Latin as well as Court physicians. But he resented the snobbery of former classmates who became doctors and disparaged apothecaries. Furthermore, as a Puritan, he was outraged that the monarchist College of Physicians ignored the medical needs of the largely Puritan lower classes. Culpeper’s solution was to become England’s medical Robin Hood.
In 1649, Culpeper translated the College of Physicians’ Latin manual, the Pharmacopoiea Londinensis, into English, calling it The London Dispensatory and Physical Directory. It gave those illiterate in Latin their first look at the 1,600 simples and 1,100 other formulas that constituted the state of the art in 17th-century British medicine. Culpeper’s audacity earned him physicians’ undying hatred. However, apothecaries, midwives, and the common people lionized him for giving them access to professional medical information.
Culpeper’s apothecary shop near London became wildly popular. He often treated the poor for free. The College of Physicians attacked him relentlessly, and in response, he became increasingly combative.
Culpeper wrote a series of essays in which he accused the physicians of greed for their high fees and stupidity for their outdated devotion to Galen and Avicenna: “[We have] a company of proud, domineering doctors whose wits were born 500 years before themselves. . . . College, College, thou art Diseased, and I will tell thee the Cause. The Cause is Mammon [greed]. The Cure: Fear God. Be Studious. Hate Covetousness. Regard the Poor.”
To make botanical medicine even more accessible, Culpeper published his own herbal in 1652. It gave equal weight to the official herbalism of the ancient masters and the homegrown folk wisdom of England’s country people, who adored him all the more.
Today, critics dismiss Culpeper because of his devotion to astrology. In his herbal, Mars owned garlic, lavender was under Mercury, and the sun claimed rosemary under the celestial Ram. But in Culpeper’s day, astrology was taught in all the universities, and the College of Physicians routinely factored it into diagnosis and treatment decisions. In fact, one reason the College hated Culpeper was that he accused them of making astrological errors.
Culpeper’s real problem was that he rarely met an herb he didn’t consider a panacea. He touted dozens of herbs “to heal all inward and outward hurts.” He called about a third of the herbs in his herbal sure cures for “the bites and stings of venomous creatures.” He also promoted scores of herbs to “bring down women’s courses” (promote menstruation/abortion), many more than midwives of that era recommended.
But Culpeper can be forgiven his errors and exaggerations. In the 1650s, very little was known about the body, and statements that appear gross misrepresentations today were not far-fetched back then.
Physicians call most medical problems “self-limiting,” that is, if you wait long enough, they go away. Take almost any herb for “inward or outward hurts,” and most clear up, with or without all the herbs Culpeper recommended. The same goes for attacks by “venomous creatures.” Few bites and stings are fatal. Left untreated, most eventually resolve.
Unfortunately, Culpeper’s promotion of every herb for every ill has haunted herbalism ever since. Well into the 1970s, some herbals touted Culpeper-style hyperbole as truth, providing easy—and legitimate—targets for attacks by herb skeptics. Nicholas Culpeper was a seminal figure in botanical medicine, but his herbal should be viewed as history and nothing more.
In 1767, 26-year-old William Withering had barely begun practicing medicine in Stafford, England, when he was called to treat 17-year-old Helena Cookes, who was bedridden with a lingering illness that prevented her favorite pastime, painting watercolors of wildflowers.
Like every other medical student, Withering had studied botany—and hated it. Still, he was taken with Miss Cookes. He gathered wildflowers for her to paint while in bed and 5 years later married her. Along the way, he developed a passion for medical botany.
“In 1775,” he wrote, “my opinion was asked concerning a recipe for the cure of dropsy [congestive heart failure]. I was told it had been a family secret of an old woman in Shropshire, who sometimes made cures after regular practitioners had failed.” The old woman’s recipe contained 20 herbs, but Withering quickly decided that the heart stimulator was foxglove. Withering began using foxglove himself and gained a reputation for treating the heart problem.
In 1776, Dr. Erasmus Darwin (Charles’ grandfather) asked Withering to treat a woman with dropsy. Withering gave her foxglove, and she improved. Darwin submitted a report to a British medical journal claiming that he himself had cured the woman with foxglove. He did not mention Withering.
Furious, Withering published his Account of the Foxglove and Its Medical Uses, summarizing his results in 163 cases. Foxglove was the original source of digitalis, a drug considered a state-of the-art treatment for congestive heart failure well into the 20th century.
Europeans considered Indians “ignorant savages”—except medically. Explorers and colonists were all too familiar with plagues and pestilence and marveled at the Indians’ good health. Not surprisingly, many became eager students of Indian herbal medicine.
Each tribe had its own medical mythology, but this Cherokee tale is typical. Long ago, humanity grew too numerous. Hunters killed so much game that the animals feared for their survival and decided to afflict humans with diseases to reduce hunting. But the plants decided that the animals had acted unfairly. The trees, shrubs, grasses, and flowers showed humanity how they could cure the diseases the animals had unleashed.
An early European devotee of Indian medicine was Jacques Cartier, the French explorer who discovered Canada’s St. Lawrence River. In 1536, he sailed to the site of present-day Quebec, where he and his crew dug in for the winter. Within a few months, 25 of his 100 men had died of “sailors’ disease” (scurvy), and most of the rest were gravely ill.
During the Age of Exploration, scurvy was a scourge. On his first voyage around Africa, Vasco da Gama lost two-thirds of his crew to it. During the 16th and 17th centuries, sailors sometimes encountered unmanned “ghost ships” adrift on the high seas, their entire crews killed by scurvy.
Fortunately for Cartier, an Indian gave the sickly explorers a tea brewed from yellow cedar bark and leaves. Everyone recovered. Later, the tea was shown to contain vitamin C, which prevents and cures scurvy.
In Boston, Puritan minister Cotton Mather (1663–1728) wrote that Indian healers produced “many truly stupendous cures.” And in the 1730s when John Wesley (1703–1791), founder of Methodism, visited America, he wrote that the Indians had “exceedingly few” diseases and that their medicines were “quick and generally infallible.” Many early American physicians touted their apprenticeships to Indian herbalists. Later, even ardent Indian haters in the U.S. Army marveled at the effectiveness of Indian wound treatments.
Of course, Indian healers also had critics, mostly university-trained physicians. Philadelphia doctor Benjamin Rush (1745–1813), a signer of the Declaration of Independence, declared, “We have no discoveries in the materia medica . . . from the Indians. It would be a reproach to our schools of physic if modern physicians were not more successful than Indians.”
Rush was mistaken. Indians introduced white settlers to many healing herbs: black cohosh, black haw, boneset, cascara sagrada, echinacea, chaparral, goldenseal, lobelia, Oregon grape, sarsaparilla, slippery elm, and witch hazel.
In their “kitchen gardens,” American colonists grew both culinary and medicinal herbs, including: balm, basil, caraway, chamomile, comfrey, dill, fennel, garlic, lavender, licorice, marjoram, mints, mustard, parsley, rosemary, rue, savory, saffron, sage, tarragon, and thyme.
Thomas Jefferson was a typical herb grower. His 1,000-square-foot garden at Monticello contained 26 herbs. As president, while negotiating the Louisiana Purchase from France, he went to great lengths to obtain some French tarragon for his garden.
Nurse/midwives also grew medicinal herbs. One was Martha Ballard (1735–1812) of Maine, who kept a diary that included her practice of herbal medicine. She used 52 herbs grown in the area around her home on the Kennebec River, northeast of Portland, including anise, balm, buckthorn, burdock, chamomile, catnip, comfrey, feverfew, hop, mullein, mustard, onion, pennyroyal, rhubarb, rue, sage, shepherd’s purse, and yarrow. She also purchased 24 imported herbs, among them aloe, licorice, myrrh, pepper, and senna.
Herbs were prized imports into colonial America. In addition to tea, black pepper was very popular. New England shipping magnate Elias Hasskett Derby, one of early America’s first homegrown millionaires, made much of his money importing black pepper from Sumatra.
Herbs were also a major colonial export. Furs, tobacco, and cotton generated the most money, but pound for pound, nothing beat ginseng root, the herb prized in Asia as the ultimate whole-body strengthener (tonic).
French Jesuits began shipping Canadian ginseng to China in the early 1700s, where it brought the then-astounding price of $5 a pound. By the 1740s, news of the unassuming ground cover’s value in the Orient spread south to the 13 colonies. Shipping agents bought roots for $1 a pound, more than the wholesale value of the rarest furs. Foragers scoured the countryside, and frontier scouts, surveyors, and trappers collected ginseng as a sideline to their other work.
By the 1770s, rapacious collection had wiped out ginseng east of the Appalachians, forcing collectors into the western wilderness. The search for ginseng played a key role in the exploration of western Pennsylvania, West Virginia, Kentucky, and Tennessee. One noted collector was Daniel Boone, who, according to one account, lost a cargo of ginseng when his boat capsized in the Ohio River.
The American Revolution gave the new nation not only its independence but also its first herbal, Materia Medica Americana (1787), by Johann David Schopf (1752–1800). Ironically, Dr. Schopf came to America to treat Hessian mercenaries who fought for the British. After the war, he stayed long enough to compile his book on medicinal plants.
America’s first resident medical botanist was Constantine Rafinesque (1784–1841) who arrived as a young man and studied the herbs of the Mississippi Valley with Native American healers. In 1819, Rafinesque became a professor of botany at a Kentucky college where he wrote Medical Flora (1828).
Rafinesque coined the term “eclectic” to describe the kind of medicine he championed, a combination of European, Asian, Indian, and slave herbalism. Shortly after his death, 19th-century America’s most scientific herbalists began calling themselves Eclectics.
Today, most Americans associate “Shaker” with high-quality furniture. But throughout the 19th century, the Shakers were better known for the high quality of their medicinal herbs.
An English Quaker, Ann Lee, founded the sect in Manchester, England, in the early 1770s. She believed in worshiping God with singing and dancing called shaking, hence the name Shaking Quakers, then Shakers. Not surprisingly, Lee was briefly imprisoned as a witch.
In 1774, Lee and eight Shakers arrived in New York and founded a community near Albany. The Shakers practiced strict pacifism as well as gender equality and segregation. Marriage and sex were banned. Member families were broken up. Meals were eaten in devotional silence.
Eventually, the Shakers established 24 communities, from Maine to Indiana to Florida. Eight lasted through World War I. One survives—Sabbathday Lake in New Gloucester, Maine.
Ann Lee’s motto was “Hands to work, hearts to God.” Her industrious followers launched the American medicinal herb industry in 1799, first collecting healing herbs from the wild, then growing them. The herb business prospered, and in 1824, the Sabbathday Lake community built a large herb shed for drying and processing. It still stands.
The Shakers sold their herbs through a nationally distributed catalog. The first (1831) was headlined: “Why send to Europe’s bloody shore for plants that grow by our own door?” It offered 142 herbs, roots, barks, and seeds, including angelica, basil, bayberry, belladonna, black and blue cohosh, boneset, cannabis (marijuana), catnip, chamomile, coltsfoot, comfrey, elecampane, gentian, hop, hyssop, jimson weed, juniper, lady’s slipper, licorice, lobelia, marshmallow, mullein, motherwort, nux vomica, opium poppy, pennyroyal, peppermint, rosemary, saffron, senna, slippery elm, valerian, walnut, white oak, and wild cherry. The Shakers also sold a few culinary “sweet” herbs: sage, marjoram, savory, and thyme.
Unlike Rome’s herbarii, the Shakers developed a reputation for honesty and herbal purity. In 1851, Rafinesque said that they had “the best medicinal gardens in the United States. They cultivate a great variety and sell them cheap, fresh, and genuine.”
Pacifism did not prevent the Shakers from selling medicinal herbs to the Union Army during the Civil War. They supplied much of the Union’s opium. After the war, the Shakers sold medicinal herbs directly to hospitals and the embryonic pharmaceutical industry.
The Shakers invented pills. Before pills, loose powdered herbs were packaged in envelopes, which were inconvenient to ship. Shaker craftsmen drilled holes in wood frames to create the first pill molds. The herbalists poured in measured amounts of powdered herbs, then hammered pegs into the holes to turn powders into the pellets we call pills.
When patent medicines became popular after the Civil War, the Shakers marketed several. Their top seller was Dr. Corbett’s Shaker Sarsaparilla Syrup, with sarsaparilla, dandelion, black cohosh, yellow dock, juniper, and other herbs. The Shakers touted it for a dozen conditions. Two other popular items were Pain King, with opium, and Tamar Laxative, with dried prunes and senna.
The Shaker herb business died after World War II, but the Sabbathday Lake community revived it in the 1960s. The community’s herb garden, herb shed, and museum are open to the public.
Early America’s leading herbalist was Samuel Thomson (1760–1843). Born in Alstead, New Hampshire, he studied with midwives and Indian healers. Around 1800, Thomson’s daughter became seriously ill. Unsure of his skills, he called a physician, who pronounced her incurable. Then, Thomson cured her with herbs and hot baths. Soon after, he declared himself a “doctor.”
Thomson detested the regular physicians of his day, who relied on bloodletting, violent laxatives (cathartics), and mercury. These treatments were called “heroic medicine,” but the heroism was entirely on the part of patients.
Consider George Washington. In 1799, the elderly but healthy father of our country developed a sore throat with a fever and chills. He probably had strep throat that likely would have cleared up with rest, hot liquids, and herbal antibiotics such as garlic and onion.
Instead, Washington’s heroic physicians bled him of four pints of blood, leaving him anemic and weak. Then they gave him cathartics and mercury. He was dead a day later.
Inspired by European herbalism and mineral baths and Indian herbalism and sweat lodges, Thomson developed a medical system based on herbs and hot baths. His favorite herb was lobelia or Indian tobacco, which in large amounts causes vomiting, hence its common name “puke weed.”
In 1809, Thomson was arrested for murder after allegedly administering a fatal dose of lobelia. But the prosecutor could not persuade jurors that lobelia was poisonous, and Thomson was acquitted.
Samuel Thomson may not have been the nation’s greatest herbalist, but he was our first medical marketing genius. In 1813, he obtained a patent for Thomson’s Improved System of Botanic Practice of Medicine, which allowed him to sell his Indian-inspired herbalism nationwide while still retaining ownership. Thomson sold “family rights” to his medical system for $20. Starting in 1822, he charged another $2 for his book, The New Guide to Health, or the Botanic Family Physician.
Thomson’s motto was “Every man his own physician,” but the vast majority of his “family rights” were purchased by women, many of whom welcomed the opportunity to add legitimacy to the word-of-mouth herbalism that they’d learned from their mothers and other women.
In 1839, at the height of his popularity, Thomson claimed 3 million adherents. This was an exaggeration, but Thomsonian herbalism was very popular. Thomson boasted that half of Ohio used his system. Detractors said it was only one-third.
Initially, Thomsonian herbalists used 65 herbs, all available from the Shakers. Then Thomson realized that he could boost his income by selling prepackaged herbal formulas. He organized his family members into Friendly Botanic Societies, cooperatives that bought his formulas and distributed them around the country. Because Thomson’s formulas were part of his patented medical system, they became known as “patent medicines.”
As time passed, patent medicines became a major industry. Some were quality products, but many were worthless concoctions of alcohol, opium, and cocaine sold by hucksters whose outrageous claims eventually spurred Congress to create the Food and Drug Administration (FDA).
After Thomson’s death in 1843, his medical system fell from fashion. But some practitioners preserved it. One was Dr. John Kellogg of Battle Creek, Michigan, who invented the nation’s first health food, the cornflake, and founded Kellogg’s cereal company. For the most part, though, Thomsonian medicine was replaced by homeopathy and Eclectic herbalism.
From 1830 through World War I, the main competition for regular American physicians came from homeopathy, the herbally inclined medical system created by a disillusioned German physician, Dr. Samuel Hahnemann (1755–1843). Trained in heroic medicine, Hahnemann decided that bloodletting, cathartics, and mercury did more harm than good.
Hahnemann did not reject all heroic treatments. He was impressed with several, among them, cinchona bark, the antimalarial, and inoculation with cowpox to prevent smallpox. In healthy people, both of these treatments produce low-level symptoms of the diseases that they are used to prevent. Hahnemann called the phenomenon homeopathy, from the Greek for “treatment by similars.”
Hahnemann tested hundreds of herbs and other substances on himself, carefully cataloging their effects. Eventually, he began using them to treat illnesses with similar symptoms. His approach was less drastic than heroic medicine’s. He enjoyed considerable success and attracted a large following.
Homeopathy came to the United States in the 1830s, quickly winning many supporters fed up with heroic medicine, including Mark Twain, Daniel Webster, and John D. Rockefeller. Homeopaths popularized several drugs still used today, including ergot derivatives for migraines and nitroglycerin for angina.
By the early 20th century, however, homeopathy fell from U.S. medical fashion. One reason was the decline of heroic medicine. As regular physicians stopped opening veins and using mercury, their critics had less to criticize. Another reason was the unrelenting hostility of the American Medical Association (AMA). Around 1900, an estimated 25 percent of regular physicians also prescribed some homeopathic medicines. Then the AMA decreed that any physician caught using homeopathy would be expelled from the organization.
But the major reason for homeopathy’s decline was its Law of Potentization, Hahnemann’s assertion that his medicines grew stronger as they became more dilute. The Law of Potentization violated Paracelsus’ dose-response relationship, a cornerstone of pharmacology. Critics charged that medicines homeopaths considered extremely powerful were so dilute that they did not contain even a single molecule of the active ingredient. As a result, American scientists dismissed homeopathy—and its largely herbal medicines—as nonsense. By the 1950s, American homeopathy was just about dead.
Homeopaths can’t explain the Law of Potentization, but they insist that more than 150 years of clinical experience show that it works. They have a point. In recent years, rigorous scientific trials have found that homeopathic medicines, most of them herbal, effectively treat colds, flu, hay fever, asthma, fibromyalgia, rheumatoid arthritis, and infectious diarrhea.
In 1991, nonhomeopathic Dutch epidemiologists published an analysis of 105 homeopathy studies from 1966 to 1990. Of the 105, 81 (77 percent) showed significant benefit. Only 24 (23 percent) showed none.
However, few of these studies were double-blind, meaning that researcher bias might have contaminated the results. So the Dutch investigators spotlighted the results of the 21 most rigorous trials. Fifteen (71 percent) showed significant benefit. While questions remain about how homeopathy works, the researchers concluded that “the evidence presented in this review would probably be sufficient for establishing homeopathy as a regular treatment for certain conditions.”
Since its founding, homeopathy has been popular in Europe. Today, the physician to the British royal family is a homeopath. Surveys show that many British, French, and German M.D.s prescribe some homeopathic medicines in their practices.
During the last 30 years, America has witnessed a modest homeopathic renaissance. Today, about 9 percent of U.S. doctors—some 5,000 M.D.s—incorporate homeopathic medicines into their practices. Several thousand other health professionals—dentists, podiatrists, veterinarians, nurses, and chiropractors—also use homeopathy.
A study by Harvard researchers suggested that more than 2.5 million Americans have tried homeopathy. Sales of homeopathic medicines now total more than $250 million a year, in part because major drugstore chains now carry them. What’s more, in recent years, many celebrities have gone public with their use of homeopathy: singer Tina Turner, and actors Cher, Jane Fonda, and Angelica Huston.
Despite the regular physicians’ reliance on bloodletting, cathartics, and mercury, most 19th-century medicines were herbal. In 1820, two-thirds of the treatments in the U.S. Pharmacopoeia, the official list of the nation’s drugs, were botanical. By 1880, the figure was almost three-quarters.
During the 1820s, a group of antiheroic practitioners—Thomsonians, Indian-trained herbalists, and disillusioned regulars—created the Reformed Medical Society to promote nonheroic, largely herbal healing. In 1830, the society met in New York to found a Reformed medical school. The reformers were mostly Easterners, but the East’s cities were strongholds of regular medicine.
The Reformers decided to locate their school on the free-thinking western frontier, then located at the Mississippi River. Thomsonian medicine was very popular in Ohio, so the reformers established their school in Cincinnati. They adopted Rafinesque’s term, eclectic, to describe their herb-based approach, which combined European, Asian, Indian, and slave herbalism. They called their school the Eclectic Medical Institute.
The institute was the nation’s first medical school to admit women, many of whom were Thomsonian herbalists interested in more training. In 1877, however, the Eclectics “yielded to prejudice,” according to Eclectic historian Henry Felter, and barred women.
The Eclectics were scientific herbalists. They experimented with herbs, performing chemical analyses to identify active constituents. They published their findings in scientific journals and were prominent in the early pharmaceutical industry.
The two most distinguished Eclectics were John King and John Uri Lloyd, both professors at the Eclectic medical school. King (1813–1893) was a botanical pharmacologist who introduced physicians to podophyllin, a plant resin still used today to treat warts. In 1855, he published the first edition of his King’s American Dispensatory, 19th-century America’s most comprehensive scientific herbal. The 18th edition (1898) is still in print.
Lloyd (1849–1936) began his career at age 14 as a Cincinnati pharmacist’s apprentice. He loved it and brought his brothers, Nelson Ashley Lloyd (1851–1925) and Curtis Gates Lloyd (1859–1926), into the field. Eventually, they established Lloyd Brothers Pharmacists, Inc.
John Lloyd specialized in plant chemistry and developed most of the company’s products. He was also one of the first presidents of the American Pharmaceutical Association (1887–1888).
Nelson Lloyd managed the business side of Lloyd Brothers. His other love was baseball. He owned the Cincinnati team that eventually became the Reds, and later, he invested in the New York Giants.
Curtis Lloyd specialized in mushrooms. He also managed the brothers’ large collection of botany books.
By 1864, the collection had outgrown the brothers’ homes, so they established the Lloyd Library. Today, the library houses the world’s largest private collection of botanical information: 300,000 books and pamphlets as well as 500 journals. For years, the Lloyd Library also published a botanical journal, Lloydia, now called the Journal of Natural Products. The Lloyd Library in Cincinnati is open to the public.
The years 1880 to 1900 marked the heyday of Eclectic medicine. But with the dawn of the 20th century, Eclectic medicine declined as herbal medicines were largely replaced by pharmaceuticals. The Eclectic Medical Institute graduated its last class in 1939, and American scientific herbalism faded and almost died.
But not quite. A handful of Eclectic-inspired physicians, who called themselves “naturopaths,” hung on, particularly in the Pacific Northwest. Among them was John Bastyr, N.D. (1912–1995), of Seattle. He was affiliated with the National College of Naturopathic Medicine in Portland, Oregon, the sole surviving medical school of Eclectic herbalism.
In 1978, a group of Bastyr’s former students founded the John Bastyr College of Naturopathic Medicine in Seattle, now Bastyr University in nearby Kenmore. In addition to the Portland and Washington schools, North America now boasts six other naturopathic medical schools:
• Bastyr University, San Diego, California
• Southwest College of Naturopathic Medicine, Scottsdale, Arizona
• Canadian College of Naturopathic Medicine, Etobicoke, Ontario
• Boucher Institute, Vancouver, British Columbia
• National University of Health Sciences, Chicago, Illinois
• College of Naturopathic Medicine, University of Bridgeport, Connecticut
Naturopaths are currently licensed to practice in 17 states: Alaska, Arizona, California, Colorado, Connecticut, Hawaii, Kansas, Maine, Maryland, Minnesota, Montana, New Hampshire, North Dakota, Oregon, Utah, Vermont, and Washington. The District of Columbia, Puerto Rico, and the U.S. Virgin Islands also license naturopaths as do five Canadian provinces: Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan. Elsewhere, naturopaths practice under other medical credentials, typically as acupuncturists, chiropractors, or clinical nutritionists.
Naturopathic schools require standard college premedical courses for admission. The first 2 years at Bastyr combine a mainstream medical education—anatomy, physiology, biochemistry, pathology, microbiology, pharmacology, public health, and physical examination and diagnosis—with courses on naturopathic philosophy, clinical nutrition, homeopathy, and Western, Chinese, and Ayurvedic herbal medicine.
Third- and fourth-year students apprentice with mentor naturopaths, often at Bastyr’s clinic in Seattle, which treats more than 25,000 patients a year. At first glance, the clinic looks like a mainstream medical facility. Closer examination reveals that its large in-house pharmacy stocks few pharmaceuticals, relying mostly on herbs, homeopathic medicines, and nutritional supplements.
Modern pharmacology dates from 1820, when a German chemist first synthesized an organic compound (urea) from inorganic chemicals. Early pharmacologists developed drugs largely by modifying compounds extracted from medicinal plants. They isolated morphine from opium poppy, aspirin from willow bark, caffeine from coffee, anesthetic menthol from peppermint, antimalarial quinine from cinchona, and decongestant ephedrine from Chinese ephedra, among many others.
After the Civil War, aspiring American doctors had two basic training choices: apprenticeship to practicing physicians or enrollment in medical schools in the United States or Germany. Compared with American programs, a German medical education was more extensive and scientifically rigorous, and the medical schools were affiliated with hospitals, allowing intensive clinical training.
German-trained American physicians scorned U.S. medical education and urged the nation’s medical schools to adopt the German model. In 1870, Harvard was among the first to do so, after university president Charles Eliot wrote, “The ignorance and incompetence of the average graduate of American medical schools . . . is horrible to contemplate.”
Three years later in 1873, a $7 million bequest led to the creation of a German-style medical school and hospital in Baltimore, Johns Hopkins University. When it opened in 1893, Hopkins took the unprecedented step of refusing to admit medical students without college degrees. Harvard quickly followed, making medical training a graduate program.
Other medical schools adopted the Harvard-Hopkins model, dropping botany in favor of pharmacology. Heroic treatment fell from fashion, but so did herbs, replaced by the drugs of the new pharmaceutical industry.
Laboratories and teaching hospitals were costly, so financing became critical. Well-endowed Harvard, Johns Hopkins, and other medical schools spent enormous sums on their facilities. More modestly endowed homeopathic and Eclectic schools could not keep up. As a result, doctors trained under the Harvard-Hopkins model were considered superior physicians, and state licensing boards began requiring the Harvard-Hopkins curriculum. Other medical schools saw enrollments shrink.
Then the influential Carnegie Foundation commissioned Abraham Flexner to survey the quality of the nation’s medical training. His 1910 report endorsed the Harvard–Hopkins model and dismissed all others. Carnegie and other wealthy foundations supported only Harvard-Hopkins schools. By 1940, every surviving U.S. medical school offered only graduate training on the Harvard-Hopkins model, and none provided training in herbal healing.
For American herbal healing, the 1920s though the 1960s were lost decades. U.S. medical schools ignored herbal medicines as the nation’s pharmacies replaced tinctures with pharmaceuticals.
But herbal healing didn’t die. It reverted to what it had been throughout history, folk medicine practiced mostly by women who grew and gathered their own herbs and prescribed them as classic herbals recommended.
A few diehards continued to promote herbal healing. Dr. Benedict Lust (1869–1945), the father of modern naturopathy, came to the United States from Germany in 1895. He opened the nation’s first health food store and established sanitariums in New Jersey and Florida that offered mineral baths and herbal medicines. His nephew, John Lust, penned an influential herbal, The Herb Book (1974), which is still in print.
In 1939, Jethro Kloss (1863–1946), a sanitarium manager and health food pioneer, published Back to Eden. Subtitled “A Story of the Restoration to Be Found in Herb, Root, and Bark,” the book helped preserve herbal approaches to healing.
In England, C. F. (Hilda) Leyel (?–1957) almost single-handedly revived British herbalism when she opened the first of her Culpeper shops in 1927. In 1940, she successfully lobbied Parliament not to repeat Henry VIII’s mistake of outlawing herbal medicine.
But the most flamboyant and controversial herbalist of the 20th century, was Harry Hoxsey (1901–1974), who loudly proclaimed that his herbal formula cured cancer. A former Appalachian coal miner, Hoxsey had no formal medical training. He attributed his Hoxsey Cancer Formula to his great-grandfather, who, he claimed, had witnessed a cancer-stricken horse recover after eating an odd combination of plants. Hoxsey started selling his family’s formula in the 1930s. By the 1950s, his Dallas clinic was the world’s largest privately owned cancer center, with branches in 17 states.
Hoxsey’s claims outraged Texas medical authorities, and during the 1930s, a Dallas prosecutor arrested him for fraud more than 100 times. The Hoxsey formula didn’t work for everyone, but the prosecutor could not find any patients who felt that they’d been defrauded. What’s more, Hoxsey presented hundreds who swore that his formula had cured their cancers.
The Texas courts ruled in favor of the cancer maverick. Then the prosecutor’s brother developed cancer and secretly took the Hoxsey formula. When he recovered, Hoxsey’s former prosecutor became his defense attorney.
Hoxsey was also attacked by the AMA. He fought back in court. When AMA officials conceded that the Hoxsey Formula had merit for treating skin cancer, Hoxsey became the first person ever to win a libel suit against the AMA. The FDA eventually closed Hoxsey’s clinics for violating federal drug-labeling regulations. His herbal ingredients were not FDA-approved cancer treatments.
Ironically, Hoxsey died of prostate cancer. He took his formula, but it didn’t work for him.
The Hoxsey formula is available today at the Bio-Medical Center in Tijuana, Mexico. Studies show that nine of the formula’s ingredients have antitumor action: barberry, buckthorn, burdock, cascara sagrada, red clover, licorice, poke, prickly ash, and bloodroot.
Starting in the 1960s, many Americans began thinking differently about health and healing. They invested their energy in illness prevention rather than treatment.
One step involved a retreat from salt as the nation’s main seasoning as research linked it to high blood pressure, heart disease, and stroke. Retiring their salt shakers, many Americans rediscovered culinary herbs and spices. Many also learned of herbs’ medical benefits. In 2000, U.S. medicinal herb sales topped $4 billion and by 2014, $6.4 billion.
Several trends fueled the herbal renaissance:
• Growing interest in self-care. Mainstream medicine can produce miracles, but it has also become impersonal and often prohibitively expensive. To save time and money and limit dependence on doctors, many Americans have turned to prevention and self-care. Healing herbs fit neatly into lifestyles focused on a plant-based diet, fitness, and stress management.
• Enthusiasm for alternative healing arts. Once denigrated, homeopathy, naturopathy, and Chinese and Ayurvedic medicine have become increasingly popular. They all make extensive use of herbal medicines.
• Backlash against advanced technology. The very wizardry of high technology has spurred a yearning for more down-to-earth medicines. When there’s a choice, many Americans prefer healing herbs to the drugs often derived from them.
• Environmental awareness. As climate change and rainforest destruction have become global issues, interest has grown in screening threatened plants for medicinal uses. The National Cancer Institute and governments around the world have launched testing programs, hoping to identify new therapeutic actions.
• Advocacy by the United Nations. A 1974 World Health Organization report concluded that adequate worldwide health care could not be achieved unless nonindustrialized nations were encouraged to nurture traditional herbal healing. Since then, the United Nations has encouraged the Chinese model of combining traditional and Western medicine.
• Increasing mainstream medical acceptance. From the 1960s through the 1980s, no mainstream medical schools taught courses on alternative medicine. Today, almost 100 do.
Unfortunately, the Food and Drug Administration (FDA), the agency that regulates medicinal herbs, has been glacially slow to embrace the herbal renaissance. Herb critics are quick to cry “hucksterism” when herb marketers position their products as dietary supplements with vague labeling. But this sorry saga is a direct result of FDA policies.
During the 19th century, patent medicines laced with alcohol, cocaine, and even heroin raised cries for national drug regulation. But it took The Jungle (1906), Upton Sinclair’s exposé of deplorable conditions in the meatpacking industry, to convince Congress to prohibit adulteration and mislabeling of foods and drugs.
Congress established the FDA in 1928, but the agency had more bark than bite. Then in 1937, a toxic ingredient in an antibiotic, elixir of sulfanilamide, killed 107 people. The following year, Congress passed the Food, Drug, and Cosmetic Act, which gave the FDA real regulatory power.
But the agency remained weak on enforcement until 1959, when 8,000 European babies were born with terrible birth defects because, when pregnant, their mothers had taken Thalidomide, an over-the-counter sedative. After the Thalidomide scandal, the FDA got tough on drug safety.
The agency declared that, before new drugs could be approved, their makers had to demonstrate safety and effectiveness in rigorous studies. These trials were very expensive—millions of dollars per drug in the 1960s and, by some estimates, $100 million today.
Those who marketed over-the-counter (OTC) pharmaceuticals screamed that the FDA had no right to require costly testing of drugs that had been used safely in many cases for centuries. So the agency appointed panels of physicians, pharmacists, and pharmacologists to review the safety and effectiveness of OTC ingredients. The panels wrote reports, monographs, that served as the basis for grandfathering approval of drugs judged safe and effective. The OTC Review Panel process ran from 1972 to 1985.
When the reviews began, more than 100 herbal medicines were listed as safe and effective in the U.S. Pharmacopoeia, the nation’s official drug reference, and deserved grandfathered approved as OTC medicines. Unfortunately, the OTC Review Panels did not review the medical literature. They only considered information submitted in support of ingredients the OTC manufacturers hoped to retain on pharmacy shelves.
By the end of the review process, hundreds of ingredients had been analyzed in monographs, including two dozen herbs, for example, the active constituents in most OTC laxatives (senna, psyllium seed, and cascara sagrada), and decongestants (peppermint oil, eucalyptus oil, and two compounds in Chinese ephedra).
But the approved herbs represented only a tiny fraction of the hundreds of botanical medicines known to be safe and effective. For example, before World War II, all U.S. pharmacies stocked valerian-based sleep aids. By the time of the OTC review process, drug companies had dropped valerian in favor of sedative antihistamines (diphenhydramine, Benadryl). As a result, no valerian products were presented to the OTC Review Panel, and none were approved. As a result, the panels ignored dozens of herbs.
Why didn’t medicinal herb companies present their products to the OTC Review Panels? Several reasons:
• During the review process, the 1970s and early 1980s, botanical medicine was just beginning to recover from its lowest ebb in U.S. history. The few surviving botanical medicine companies were, by and large, mom-and-pop enterprises run by herbalists whose marketing efforts consisted mainly of brewing medicinal teas for friends and selling them at local health food stores. Most had no idea that the OTC review process was even taking place, let alone how to participate. When they found out, it was too late.
• At the time, many herbalists rejected the word “drug.” Most saw their products as foods, not drugs, despite the fact that their teas and tinctures were used for pharmacological, not nutritive, purposes. A few herbalists tried to organize participation in the OTC review process, but their efforts largely fell on deaf ears.
• Finally, the OTC Review Panels appeared unsympathetic to herbs. They were composed of mainstream health professionals who were largely unfamiliar with botanicals. Except for the few herbs that were approved, the OTC Review Panels basically ignored medicinal plants.
In 1985, when the OTC review process ended, it was closed. Any drug or herb that was not already approved had to undergo the expensive and time-consuming tests that the FDA required of new drugs—even if the herbal drugs had been widely used for millennia.
Furthermore when a new drug wins FDA approval, its owner gets a patent, the exclusive right to market it for many years. But who would spend millions to prove that valerian is an effective sleep aid? It is, and many studies have confirmed its effectiveness and safety, but since no one can patent valerian, there’s no way to recoup the huge investment in approval trials.
FDA regulations have left healing herbs in limbo. Even if they’ve been used for thousands of years, to be approved as drugs they must be tested as brand-new compounds, which makes no sense economically because they can’t be patented. Thus, the vast majority of medicinal herbs are sold as dietary supplements, a designation several rungs down the regulatory ladder.
The catch is that dietary supplements cannot make medicinal claims, which is why product labels are vague about the herbs’ effects.
In 1994, Congress passed the Dietary Supplement Health and Education Act (DSHEA), which directed the FDA to consider petitions that would allow herbs (and vitamin and mineral supplements) to make medicinal claims. To date, a few claims have been approved, notably that soy protein lowers cholesterol. But the FDA has declined entreaties by the herb industry to reopen the OTC review process.
Germany treats medicinal herbs more rationally. Like the FDA, the German government requires pre-approval safety and efficacy testing for all newly synthesized pharmaceuticals. However, it does not hold herbs, which the Germans call traditional medicines, to quite so high a standard.
In 1978, drug regulators in the former West Germany convened an expert panel, Commission E, to study the extensive scientific literature on 650 herbs. In a process similar to the FDA’s OTC review, the Commission E published monographs that declared hundreds of herbs safe and effective for dozens of ailments. The commission also recommended dosages and warned of possible side effects.
German herb companies are allowed to make medicinal claims supported by Commission E monographs as long as they market unadulterated, properly labeled herbs and adhere to the commission’s dose recommendations. Currently, Commission E monographs represent the world’s most authoritative government-sponsored, expert information on medicinal herbs’ benefits, dosages, and side effects.
In this country, the National Institutes of Health’s Office of Complementary and Alternative Medicine (OCAM) has sponsored meetings of FDA officials and herbal medicine advocates. The dialogue has focused on the possibility of reopening the OTC review process along the lines of Commission E. Some FDA officials support the idea, but as this book goes to press, the agency has taken no action.
It would clearly serve the public interest for the FDA to embrace an herbal medicine regulatory model similar to Commission E. According to a national survey conducted for Prevention magazine, 49 percent of American adults have used at least one herbal medicine. Another 24 percent consider themselves regular users.
Without clear labeling to specify benefits, side effects, and dosage—labeling that the FDA currently prohibits for all but a few medicinal herbs—many Americans remain confused about how best to use herbal medicines.
A 2002 survey in the Journal of the American Medical Association showed that during a typical week, 14 percent of American adults used at least one medicinal herb (other than coffee or tea). Today, it’s 20 percent—some 50 million people—and 10 percent of American adults have had herbs suggested by health professionals. In addition, pet owners increasingly treat their animals with herbs, notably chlorella.
However, the news media continue to be biased against herbs. In 2008, Canadian researchers compared newspaper coverage of clinical trials involving pharmaceuticals and herbal medicines. “Compared with pharmaceuticals, newspaper coverage of herbal clinical trials was more negative. Media coverage is not providing the public with the information necessary to make informed medical decisions.”
But that’s slowly changing, at least in medical journals. Until the 1990s, mainstream medical journals usually vilified herbs. Today, leading journals—including the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine—are still quick to knock them, but now they also tout herbs’ benefits, in part because the families and friends of medical researchers and journal editors use herbs, and in part because herbal medicine research has exploded. In 1977, English-language medical journals published 739 studies of medicinal herbs. By 2007, journal articles totaled 6,364, almost nine times as many.
Compared with American physicians, English doctors are more supportive of herbal medicine. But in a 2010 survey of 1,157 British doctors:
• 47 percent admitted feeling poorly informed about medicinal herbs.
• 63 percent did not ask patients if they used herbs.
• 72 percent said the public has too much faith in botanical medicines.
• 76 percent said their colleagues knew little about herbs.
Compared with American physicians, Scandinavian doctors are more supportive of herbs. But in a 2013 survey of 1,642 Norwegian adults, 80 percent said they used botanical medicines, but only 20 percent mentioned it to their doctors. The top reason why? My doctor didn’t ask.
That’s why it’s so important for herbal medicine users to say so during doctor visits. Discussing your use of herbs helps reduce risk of possibly harmful herb-drug interactions, and it coaxes doctors to take herbal medicines more seriously, learn more about them, and—let’s hope—recommend them.
