University Times

Herbal drugs have a place in the modern medical system. That was the conclusion of Michael Flannery, director of the Lloyd Library at the University of Cincinnati, during last month's C. F. Reynolds Medical History Society lecture. With a collection of more than 200,000 volumes, the Lloyd Library is "the largest library of pharmacognosy literature in the Western Hemisphere," according to the American Botanical Council.

Flannery also is the author of "John Uri Lloyd: The Great American Eclectic." Lloyd is generally acknowledged as one of the greatest and most versatile pharmacists American has ever produced. His "The Chemistry of Medicines" was one of the first texts of its kind when it was published in 1881 and was widely used for decades.

In his talk, "Why We Trust Mother Nature: The Emergence of American Botanical Medicine," Flannery said that growing public interest in over-the-counter herbal products promises to keep botanical medicine alive as a health care topic.

Over one-third of Americans use some form of alternative medicine, Lloyd said. Retail sales of over-the-counter herbal products is a $1.5 billion a year business and the pharmaceutical industry is taking note.

"Herbs have been and will be with us as therapeutic agents," Flannery said. "The herbal dark age from which are only recently emerging is not a product of a carefully engineered plot between the AMA and the drug industry. It is rather a result of a temporary and in some ways understandable myopium, a myopic fascination with the innovation of drug synthesis." Although botanical medicines were practically nonexistent in the United States by 1962, having given way to synthetics such as sulfa drugs and tetracycline, they have a very long record of success going back all of the way to the Egyptians.

The "Ebers Papyros" contains over 700 drugs and 800 formulas that were compiled about 1500 B.C., according to Flannery. Medicines recorded there come from plants, minerals and animals, but vegetable substances were predominant. From Egypt, the use of botanical medicines spread to the ancient Greeks, Romans and into Middle Ages. People of those periods used plants "in a variety of contexts for virtually every human ailment imaginable," Flannery noted.

The first theory on the use of botanical medicine was developed by Galen, a second century physician. Galen's theory was based on blood, phlegm, yellow bile and black bile, which he translated into four general qualities, hot, dry, cold and moist, and three categories of drugs. Simples, in Galen's system, were drugs that had one specific quality, such as a sleep inducer; composites were drugs with more than one quality, such as an antiseptic and pain reliever, while entities were drugs that failed to fit neatly in either of the other categories. "They were generally purges and poisons," Flannery said.

By the time Europeans arrived in the Americas, they possessed a long list of medicinal plants. They also began looking for new plants to use in medicine. The "Badinus" was the first manuscript to bring New World botanical medicine back to Europe in the 1550s. It was based on the work of an Aztec physician. However, Flannery pointed out, the "Badinus" disappeared, moving from one library to another, until it surfaced in the Vatican in 1929, so it had no effect on the way botanical medicines were used in Europe.

Herbal medicines from the New World did not make a mark on Europe until about 25 years later, in 1577, when a Spanish physician published "Joyful News Out of the New Found World." Using plants from the Americas, it promised cures for ailments that until then were incurable.

Although "Joyful News" promised miraculous cures, those cures remained hidden from the general public, locked away in the "official literatures" as it were, according to Flannery, until England's Nicholas Culpepper translated those medical works from the Latin and offered them to the public in 1600.

"Many an early American colonist, armed no doubt with his trusty Culpepper volume or volumes, actually introduced to this continent a number of medicinal species native to mother England," Flannery pointed out.

Culpepper's work helped European botanical medicine cross the Atlantic. However, according to Flannery, it would take American independence and a German to create a system of botanical medicine based on native American plants.

Johann David Schoepf came to American as a surgeon with Prussian mercenaries hired by the British to crush the American Revolution. After the war, Schoepf was given permission to remain in the country and study medicinal plants. In 1787, Schoepf published the first book-length catalogue of American medicinal plants. Benjamin Smith Barton, who taught medicine at the University of Pennsylvania, carried on Schoepf's work and published a book on American botany in 1798 and a second volume in 1804.

The first American phar-magpia published in 1820 contained 425 botanical substances, Flannery noted. By 1870, that total had reached 636.

"Being a 19th-century physician in America, or anywhere in Europe for that matter, meant much more than a familiarity with the literature and commentaries on plant products and medicine," Flannery said. "It meant a thorough knowledge of botany itself." The development of American botanical medicine helped to spur a popular uprising against the medical establishment's penchant to bleed, purge and heavily dose patients. People avoided physicians because such treatments often were worse that the ailments themselves.

Among the leaders of that uprising, according to Flannery, was Samuel Thomson. Born in New Hampshire in 1769, Thomson was the founder of Thomsonianism. He shunned formal education and believed anyone could practice medicine by following the system laid out in his "New Guide to Health; Or Botanic Family Physician," published in 1825.

Thomsonianism was followed by "physio-medicalism," which attempted to place botanical medicine on a more scientific basis; "homeopathy," which developed the theory of "like cures like" in which, for example, botanical drugs that cause nausea can be used to treat nausea; "eclecticism," which spurned all theories of medicine and adhered to a system of what worked best in clinical practice, and "naturopathy," which emphasized botanical remedies and lifestyle modifications in a holistic approach to health care.

"We know that these sects have either vanished or exist as mere shadows of their former shelves," Flannery said. "So the question needs to be asked what happened? In a nutshell, the germ theory in part did its work on these sects." Two other reasons botanical sects declined were advances in organic chemistry and new lab techniques that allowed scientists to synthesize the medicinal properties of plants.

"No longer was the medical community interested in whole plants as the basis for therapeutics," Flannery said. "New synthetic drugs and chemical alternatives to old vegetable products were transforming the healing arts." What the germ theory and advances in chemistry did to the Purple Cone Flower, which was first marketed in 1868 as Meyers Blood Purifier, is typical of what happened to botanical drugs in the United States after World War I. Although tests showed that it stimulated the body's immune system to fight disease, it was opposed by the American Medical Association because of its connection to the eclectics and faded from the scene.

"By 1962, it was about as obsolete as a drug could be in the United States," Flannery said, "even though research supporting its utility as an immuno stimulant was beginning to herald its renaissance in Europe." Today, according to Flan-nery, most plant medicines still are not used in the U.S., but are used extensively in western Europe, especially Great Britain, Germany and France. However, Flannery added, he is seeing the emergence of a new field, a multi-disciplinary field of study that is looking at plants for their medicinal values. "This new multi-disciplinary field is interested in shamanistic traditions and is willing to take those traditions and subject them to laboratory analysis and verification," Flannery said. "It is historically aware that ancient and medieval text may hold important clues to natural products of therapeutic value. The point of all this is that botanical medicine is not dead." Reference sources also are being published at an accelerated pace. Germany, in 1978, established Commission E to investigate about 1,400 herbal drugs from 700 different plant species. That has resulted in over 300 monographs on botanical medicine being published in German. Those monographs are being translated by the American Botanical Council and are due out this fall, according to Flannery.

In this country, the National Institutes of Health established the Office of Alternative Medicine in 1992, while Congress passed the Dietary Supplement Health and Education Act of 1994 in recognition of the fact that dietary supplements play an important role in public health. The act requires the Food and Drug Administration to submit proof that supplements cause damage before banning them. Flannery said this leaves supplements in a twilight zone of regulation.

"While it is an improvement on the traditional position, that is permit no claims whatsoever," Flannery noted, "its treatment of these products as dietary supplements seems to belay their therapeutic use. It also does nothing to promote further research."

–Mike Sajna