Principles and Practice of Constitutional
Physiology for Herbalists
by Michael Moore
Herbalism is currently playing curate’s egg for the publishing industry, as hardly a week goes by without yet another new book on herbs or herbalism appearing on the burgeoning shelves of complementary medicine texts. Unfortunately, the majority of recently published popular volumes on the subject are drearily predictable, generally bereft of academic rigour, and sadly lacking in originality. In this context, Michael Moore’s slim text Principles and Practice of Constitutional Physiology for Herbalists is an unusual and refreshing exception.
Moore’s style is accessible as the book (which is published on the Internet.) Indeed, his idiosyncratic and entertaining approach is so engaging that it runs the risk of detracting from the significance of the work itself. A brief recap of the historical context may help locate its importance.
It is a commonplace that western herbal medicine currently lacks a coherent paradigm. In other words, there is no unifying basis that integrates its diverse components and disparate antecedents into a consistent wholistic and vitalistic view of materia medica, diagnosis, and therapeutics that systematically informs its current clinical practice.
This has not always been the case. The Graeco-Roman tradition that was the most significant ( textually recorded) antecedent of western herbalism had a vitalist outlook descended from a spiritual cosmology and a Naturalistic world view, which was in practice empiricist – but Galenic medicine became the tool of rationalism and ultimately the midwife of modern materialist orthodoxy. Vitalism became relegated to an outsider status, and its proponents anti-establishment radicals – as the lives and work of Paracelsus, Culpeper, Samuel Thomson and others illustrate.
EAST AND WEST
Chinese medicine on the other hand, has an unbroken vitalist tradition of thousands of years, arching back to even earlier East Asian antecedents. Asian medical systems exemplify how a seamless cosmology and view of nature, coupled to an energetic interpretation of health and illness, complemented by a materia medica based upon practical clinical results, unite to form a coherent therapeutics capable of adapting to contemporary conditions.
Several contemporary herbalists have pointed out how the Chinese and Graeco-Roman systems of medicine resemble each other more closely in their views of the human being in health and illness, than either of them resemble the reductionist model of modern technological medicine. This in turn has led to a variety of attempts by different authors versed in both traditions to reconstruct western herbalism via the energetic and constitutional insights of TCM; to `re-vitalise’ it.
Peter Holmes’recent reinterpretation of western materia medica (Energetics of Western Herbs Vol 1 and 2 ) stands out as the most rigorous and substantial attempt at an East-West synthesis. He also tackles the philosophical issues directly , and by the same token most eloquently reveals the inherent flaws of the project. A close reading of Holmes’ survey however, can only conclude the the different paradigms of East and West cannot be synthesised, integrated or even satisfactorily mapped onto one another precisely because they are different – culturally, socially, philosophically, historically and empirically different. The metaphors simply don’t mix – or to use a (British) gastronomic analogy you can’t get a decent fish and chips from a chinese take-out.
Principles and Practice of Constitutional Physiology for Herbalists begins with this same starting point, but takes entirely different course. Moore is unashamedly a WESTERN herbalist – and to fill the void made by lack of a constitutional and energetic paradigm he uses WESTERN physiology to create an organ system energetics. At a stroke – the entire problem of incongruence of different paradigms is avoided. However – this leads directly to a major problem.
Orthodox medical physiology is clearly not inherently vitalist. Quite the opposite. Physiology was the principal vehicle that enabled the rationalist orthodoxy of modern medicine to bury and finally deny its ancestry of humoral and elemental vitalism. How then can a western physiological approach be commensurate with the vitalist core of a wholistic herbalism?
PHYSIOLOGY AND VITALISM
The Physiomedicalist herbalists earlier attempted a solution to this conundrum by elaborating a wholistic physiology of the vital force. However, whatever the other merits of Cook, Thurston et al, they were inevitably limited by the infant physiology of their time, which knew nothing of the neuroendocrinology and immunology of the last quarter of a century. Physiomedicalism was ultimately reduced to applying the formulaic polarities (relax-contract, /stimulate-sedate) to the vital force which itself became located in a convoluted physiology of the autonomic nervous system.
More recently, Simon Mills, a leading representative of the modern british medical herbalist tradition poses another solution in his book Out of the Earth,. Mills too argues that a new physiology is required by herbalism – a physiology with feeling, rooted in a phenemenology that wholistically understands the human subject and their place in the natural universe. However Mills subscribes to a biological vitalism, born of systems theory, in which a vitalist whole arises that is more than the sum of its mechanical parts. Although influential in modern ecological theory, (eg the Gaia hypothesis) it does not enable Mills to satisfactorily complete the east-west synthesis. Rather like a latter day Galen he concretises the vital substance by appending lists of energetic qualities, such as taste and temperature to the otherwise now near meaningless descriptions of generic herb actions, such as diaphoretic, diuretic etc. His materia medica, like that of Holmes, results in a hybrid list of East-West energetic-orthodox attributes whilst offering often debatable categories of remedy classification into which remedies are almost arbitrarily allocated.
The materia medica of Principles and Practice of Constitutional Physiology for Herbalists takes a different approach. Moore, deeply influenced by the later Eclectic tradition, uses the Specific Indication of the remedy as the basis for classification. The essence of this approach, developed theoretically by Scudder but perhaps best exemplified in the eloquent remedy descriptions of Finley Ellingwood and Harvey Felter, is empiricist and vitalist, based entirely upon the primacy of clinical therapeutic experience of the given botanical. The detailed pattern of symptoms calls forth a unique remedy – precise and detailed observation of the individual patient are primary. Pharmacy and remedy preparation were considered crucial, almost invariably involving the use of fresh whole plant extracts administered as simples or “specific medications” (produced to exacting standards by John Uri Lloyd’s pharmacy) This amounts to modern restatement of hermetic vitalism, which was always based upon the specificity of the herbal remedy. Both homeopathy and eclecticsm, despite being at apparent odds with each other, owe a common debt to that earlier vitalism of unknowable essences – each acknowledging in their own way the arcana of the remedy.
As if by legerdemain, Moore has in fact taken the two underlying principles of eastern wholistic systems – the systemic disharmony approach to dysfunction, and the symptom pattern approach to the remedy – and by using western idioms for each, resolved the problems of uniting two incompatible paradigms.
The practical success of this synthesis depends then on the validity of his “constitutional” physiology and the accuracy of the symptom pictures, or specific indications, of the remedies – and the therapeutic implications of the approach – to which we can now turn.
Moore’s physiology is always fluent, sometimes flippant; genuine insights jostle with the odd oversight. Brevity and irreverent humour are given more weight than academic respectability and citation counts. This is knockabout physiology for practising clinical herbalists, not lab scientists or establishment medics. No reproductive physiologist could fail to wince at his summary of testicular function which nonetheless grasps the essential processes more accurately than does many an elementary medical textbook…..
This ebb and flow between the Leydig and Sertoli cells constitues the male equivalent of the oestrogen-progesterone ambivalence in women, and the balance of yin and yang in the testes maintains fertility, prostate health, and prevents testosterone overdominance in the body
The serious point for Moore is that since medical physiology is subservient to the model of Standard Practice Medicine; its picture of dysfunction – and by implication normal function- is skewed toward the twin headed goals of modern medicine – either pharmaceutical or procedural intervention in the disease mechanism.
Since neither herbs nor herbalists work in this way, a broader picture is needed, painted with a subtler pallette. Moore’s philosophical aside on the `liver as a metaphor’, demonstrates his physiology at its eloquent best, and reffirms the central importance of hepatic function well known to all herbalists. However, the brevity of Moore’s text (a marked contrast to his lecturing style) on the physiological explanations of constitutional types perhaps does disservice to the sophistication of the model and its clinical application. For readers otherwise unfamiliar with the extent of Moore’s grasp of his subject or without a developed appreciation of the limitations of orthodox medical physiology this is possibly an unfortunate aspect of the work.
After reviewing each physiological system, Moore then defines the patterns of deficiency or excess of the system, that can be used to select an appropriate tonic herbal remedy. This is the classic stuff of energetic therapies, and the deficiency-excess model is universal in these approaches. Humoral and elemental systems see each individual as “constitutionally configured”, inheriting varying proportions of each component, the imbalance of disease being corrected by restoring the individuals original or “constitutional” nature. Correction of underlying imbalance is an essential element in the treatment of subclinical and chronic conditions, and an important adjunct in the treatment of acute presentations and primary pathologies, where constitutional strategies are adjunctive to the primary or symptomatic treatments.
Much of the organ system analysis in Principles will be familiar to practising herbalists: for example the upper and lower GI tract deficiencies and excess patterns are seen daily in every herbal clinic and the use of bitters, astringents and mucilages to tone, astringe or sooth is normal practise. The virtue of Moore’s approach is that normal practice does not a priori include systematic constitutional considerations, and as his introductory case history of “the bartender” shows, can lead to clinical failure against all such pragmatically “normal” expectations. Moore’s contribution succeeds in formalising what has hitherto remained largely unarticulated by western herbalists as their accumulated “clinical experience of different types of patient” into a systematic and accessible approach. It is debatable however whether Moore has in fact created a true “constitutional” physiology.
IS IT REALLY CONSTITUTIONAL?
The typology of Principles is in fact a collection of possible patterns of disharmony rather than modern physiological versions of a classical consitutional typology. His characterisation of neurohumoral stress types as the adrenal, adrenocortical and thyroid stress patterns – which together with a consideration of fluid transport energetics provide a backdrop to the organ system imbalances – are the nearest that Moore comes to actually identifying constitutional types in the classical sense of the term. While these original formulations have the benefit of integrating neuroendocrinology into a `constitutional’ framework, they are not “types” in the “as above so below” sense of the wholistic vitalist systems in which there is an inherent correspondence between all levels of nature. Ultimately a western physiology – however skilfully it is manipulated- can never regenerate such a unitary vitalist approach. Moore has not thrown the vitalist baby out with the reductionist bathwater, but rather has given it a wet suit – and perhaps this is the best survival option to date.
The book contains eleven pages of herbal energetics charts, covering over three hundred and fifty herbs analysed in terms of their tonic action on each of the organ and stress pattern systems, graded as weak or strong, stimulant or suppressant. This materia medica is a result of Moore’s long experience with the floras of the desert, mountain and pacific west and south western United States, coupled with an extensive trawling and cross correlationof original sources of the later Eclectics, Felter and Lloyd, Ellingwood, King’s, Culbreth and others as well as homeopathic symptom pictures of botanicals from authors such as Boericke.
As indicated earlier, this is a Specific Indication approach, and his materia medica is published separately in that format – in Principles, however each remedy is given a specific energetics profile. Even if used on a “standalone” basis , the charts contain awealth of information enabling a practitioner to make subtle differentiation between remedies. A more useful summary of the principal herbs for correcting imbalances in each organ system and stress type is also included in the text, and this clearly enables the process of remedy selection to be related to clinical findings. European readers will be familiar with most of these shortlisted herbs, and able to substitute their own local equivalents.
There are some minor inconsistencies between the detailed charts and the lists of primary herbs and the discussion of organ system imbalances. For example the CNS is covered as a category in the charts, along with the two divisions of the autonomic system and the endocrine stress types, but this does not fully correspond to the categories of the organ system analysis.
A clinical case history questionnaire is designed to extract constitutional information, and sample forms are supplied with the text. These could do with more explanatory notation, but the point of the intake forms here is not to deduce a differential diagnosis in order to derive a general therapeutic strategy, but to compile a specific picture of the patterns of excess and deficiency imbalance in each systemthat will require tonic correction with a correspondingly specific remedy.
Uniquely, Principles is published on the internet, bypassing the conventional publishing industry, and is currently freely available to anyone with a PC and a modem. Moore, until recently a self confessed computer illiterate, now regularly uses the internet and digital publishing technology in his work and teaching. Here is an elder herbalist who takes a Powerbook and digital camera on field trips, not just a flora and flower press. Principles has been a long time in the making and some elements of it have appeared in print before – a work in progress. It is hopefully the pilot edition of a more complete and detailed book on the subject – the current version may have some rough edges, and bears the unmistakable imprint of the author’s personality – this should in no way deter practitioners of western medical herbalism from closely examining this important publication.