Hananja Brice-Ytsma (MNIMH, MSc, DipED, DipTh)

Module Leader, Link Tutor

Archway Clinic of Herbal Medicine

Archway Campus

Highgate Hill

London N19 5LW

Herbal Medicine, Past and Present, for Women’s Health

http://creativecommons.org/licenses/by-nc-nd/2.0/uk/

Introduction

The focus of this essay is the historical socio-political context of orthodox

medicine and herbal medicine for women and by women. Herbal medicine has an
important place in the majority of people’s health throughout history and
throughout the world (Halberstein 2005). The historical socio-political context of
medicine will aid our understanding of the role that biomedicine and herbal
medicine have played in women’s health, in the 20th Century. Emerging interest in
herbal medicine and complementary medicine (Patersons 1997) requires a model of
health to enable much-needed research to be carried out, reflecting the proper
true practice in herbal medicine. An honest research model is required to suit the
practice of herbal medicine as well as, and satisfying, the rigors of science.

Historical perspective

Herbal medicine has been practised in many continents for thousands of years
(Griggs 1981). It used to be the main form of medicine, and still is today over
the entire world, where the majority of the world’s population uses herbal
medicine (Akerele 1993). Pre-industrial England saw relatively few official
medical practitioners in existence and they only served the social elite (Saks
1992). Most of the population could not afford the official medicine, had they
been able to, they would often have preferred not to use it because the treatments
offered were rather drastic, such as purging, blood letting and cauterising, which
often left the patient more ill after treatment (Hughes 1943). When people were
unwell they tended to go to wise women, who were the main providers of health care
pre-industrialisation (Oakley 1992). Healthcare was part of the women’s role in
the upper and the lower classes (Clark 1968), they did have knowledge of herbs
used for different conditions (Hughes 1943). They had no formal training and did
not get any economic rewards but treated more out of religious or neighbourly duty
(Hurt-Mead 1938).

Care of children and women in childbirth were an important part of the female
healing role and when a women was in labour, women in the neighbourhood would
attend, so that they could learn and increase their understanding in midwifery
(Clark 1968). Practising wise women / midwives were generally respectable and
enjoyed high status among the people they served (Clark 1968). The practice of
women’s medicine continued as an oral tradition (Griggs1981). The Royal College of
Physicians was set up in 1518 in the city of London (Saks 1992) and the Church
strictly controlled the early profesionalisation of medicine. It was considered
that if a woman dared to cure without having studied she was a witch and must die
(Hurt-Mead 1938), yet women were barred from the universities (Hughes 1943).
Suppression of women healers followed directly from the association between church
doctrine and university trained medical men, as well as the ruling classes (Griggs
1999). Over the following centuries the popular status and authority of the female
healer was gradually eroded. A midwife was liable to be accused of being a witch
(Parinder 1958), by the male dominated medieval church. The medieval wise women
would have administered abortive herbs to women carrying unwanted babies, this was
taboo in the church (Hughes 1943).

Further, in the seventeenth century, the learned professions monopolised learning

by using Greek and Latin, the languages used by the university-educated clergy,
physicians and lawyers (Poynter 1962). This made it inaccessible to women (Webster
1975) and further distanced them from the legitimate medical practise of the day.
Throughout history medical theory had been restricted to the work of Galen written
in AD130-200 (Saks 1992). Women practised empirically, using trial and error. Male
medicine was theological, ‘antiempirical’ and acceptable to the Church (Oakley
1992). Medicine was practised by the official doctors for many centuries using
Galen as their basic textbook as taught in the universities (Saks 1992). The way
it was practised remained the same for many hundreds of years (Griggs 1981). Both
the mainstream and unofficial medical practise used herbs.

The difference between licensed practitioners and the rest was essentially the
fact that they were accredited members of organised professional groups with the
legal authority to exclude others. It was this social power which distinguished
them form the unlicensed. It is the social mechanism that leads to certain kinds
of healing being regarded as legitimate or orthodox and others not. Such
mechanisms may be shaped to a great extent by external factors that have little to
do with the knowledge employed, or the proven effectiveness of the treatments
concerned. In the middle of the nineteenth century, those who held that there were
specific drugs for specific diseases were called ‘quacks’; a century later the
herbal practitioners were called ‘quacks’ (Griggs1981). In the seventeenth century
the herbalists accused the early ‘Chymists’ of using poisonous concoctions and in
this century (Griggs 1981), it is herbal medicine that is being queried as a
possible danger to the general public. 130 years ago, it was scientific medicine
that was seen as irrational and irresponsible (Rosenberg 1977). Orthodox medicine
achieved state registration with substantial powers of self-government in 1858
(Saks 1992). All other professions, such as midwives, dentists and nurses, were
subject to medical control and, in effect, were licensed as secondary
practitioners (Saks 1992). Doctors were thus given power over the patient and all
other auxiliary or paramedical professions (such as nurses or pharmacists), part
protection from the consequences of possible incompetence, and a virtual monopoly
over health care decisions (Saks 1992). During the first half of the twentieth
century complementary medicine was all but outlawed in this country. A doctor
could be struck off the medical register for sending a patient to a practitioner
who was not medically qualified (Griggs 1981). Modern medicine as it is today has
only dominated medical practice for the last 150 years. Mainstream medicine in
this day and age, if it is to be fully credible in the context of widely differing
cultures, the globalisation of knowledge and its accessibility through the world
wide web, where falsities easily spread, needs to encompass the socio-historical
context of what it has grown out of. Some prejudices of the past may have been
carried forward into the present day setting and will therefore need to be
reviewed. Certain aspects of medical knowledge and practise of the past may be
found to have been rejected wrongly, through prejudice rather than by scientific
elimination. The development of the NHS offered orthodox treatment free, whereas
before that, people chose to pay for an orthodox practitioner or other
practitioners. People, naturally, choose to have their treatment for free and in
so doing limit the possible therapies.

Medicine in Britain today

Orthodox medicine has been linked with modern, scientific ways of thinking. The
result is that, in people’s minds, alternative medicine has been linked with
unscientific thinking (Fulder 1996); equating scientific with effective medicine
and anything else with a non-effective form of medicine (Fulder 1996). This
bilateral distinction has not allowed much differentiation between alternative
therapies. Medicine has developed into this century where, still, the majority of
consultants are men and only very few women achieve this level, even in
gynaecology (Weader Kelly 1995). People are becoming disillusioned with the
present system (Fulder 1996) and question the autonomy of the medical profession.
More women visit their GP and are concerned about their health as is the same is
the case with the medical herbalist; more women than men attend as patients (Green
1999). With the HRT scare, an increasing number of women are looking towards
herbal medicine to help them with menopausal symptoms. The increasing hazard of
modern drugs contributes to the trend away from conventional medicine (Siahpush
1999). It has been estimated that two out of every five patients taking prescribed
drugs are likely to suffer from the side effects of these drugs and some drugs
produce dependence (Shitara and Sugiyama 2006). Over the centuries, improvement in
people’s health has been brought about by improved standards of nutrition and
sanitation (Dubos 1959) rather than as a consequence of new drugs. Antibiotics,
steroids, continuous improvement with surgery, have led to dramatic improvement in
conditions that were previously impossible or difficult to treat. Serious
infection could now lead to survival and normal health, where herbal treatment
would not have been able to provide and answer, such as in Tuberculosis, Syphilis,
and other conditions. Surgeries such as appendectomy, cholecystectomy have rescued
lives where no other treatment would have lead to survival. However some of
today’s diseases are the result of behaviour and environmental changes associated
with industrialisation (McKeown 1983). A past director of the World Health
Organisation (WHO) said that most of the world’s medical schools prepare doctors
for a medical practice that is blind to anything but disease and the technology
for dealing with it (Mahler 1977). The attempt to diagnose and treat one illness
may produce another, be it through side effects or iatrogenesis. ( Mahler 1977).
The resources directed into health are increasing steadily, yet life span remains
unchanged and we are getting sicker. In the last 20 years there has been a 300%
increase in health expenditure and a 50% increase in the percentage of the Gross
Domestic Product spent on health (Fulder 1996). Yet there is an increase of a
third of the population suffering from long-term illness and a 64% increase in
incapacity or days of certified illness (Fulder 1996). Today patients, women, and
carers are becoming active participants in their form of care and self-help groups
are empowering patients (Saks 1992). There has been an increase in the use of
different complementary therapies, and more GPs recommend or endorse the use of
complementary therapies (Paterson 1997). These changes are happening, partly due
to the buying-in of services, which have to be cost-effective (Fulder 1996). This
could lead to a reduction in the use of expensive drugs and in hospital bills
(Kincheloe 1997). Self-help groups present a challenge to the traditional
paternalistic and professional power base (Saks 1992). The sufferer or carer
becomes an active participant and, with alternative systems of healing, this cuts
across the orthodox doctor-patient relationship. These groups can be seen as
opposing bureaucratic and hierarchical authority structures. They have been
compared to the women’s movement, which intentionally opposed the typical
authority structures of patriarchal society. Their strength lies in empowering its
members (Saks 1992).

Looking at health

Herbal tradition has remained the cornerstone of medicine (Halberstein 2005). Some
of the most effective drugs have their basis in herbal medicine and about 25% of
the present day pharmacopoeia originate from the herbal world (Halberstein 2005).
In Shropshire in 1775, there was a secret remedy for dropsy, used by a local
healer, that led to the discovery of the use of foxglove, for the treatment of
heart failure (Weiss 1960). Research led to the use of the isolated constituent
and present day medicine of Digoxin. The development of aspirin from the willow
bark, quinine from the cinchona tree, and opium derived from opium poppy has led
to the discovery of drugs that led to important results (Halberstein 2005).

Where complementary medicine and orthodox medicine divide, is in the way they look
at health; in the complementary field it is restoration to health, rather than the
removal of sickness that is fundamental (St George 1995). The WHO stresses the
importance of the state of physical and mental well being (Mahler 1977). Modern
medicine defines health as absence of symptoms. Orthodox thinking is based on the
model from Descartes’ thesis, treating the body and mind as separate entities,
treatment is based on rational and objective observation without subjective
influence. The body is conceived of as a machine (Nettleton 1995). Clinical signs
are presented to the doctor objectively, and are not connected to the patient’s
own experience. The cause of the disease could be narrowed down to one specific
agent such as a germ, or a lack of a particular hormone. It has no place for
multi-factorial effects of the broader social environment such as nutrition and
stress. (Nettleton 1995).

With the desire to understand the processes within the body, specialisations
developed, such as gynaecology and obstetrics in women’s health. The understanding
of the body as a machine (Nettleton 1995) allows it to be dissected, and
individual tools used, such as individual chemical components, to be able to fix
the machine. To achieve this, one effective constituent of a plant is sought, or
one chemical assuming that other constituents are irrelevant. This leads to
isolating the active substances in the herbs, rather then having to cope with
hundreds of other constituents that make more difficult an understanding of how
the medicine works.

Research

The pinnacle of clinical research is Randomised Controlled Trials (RCT), however

by 1994 these constituted only 16% of the published trials in leading medical
journals (St George 1994). RCT, research is reductionist and objective, trying to
break down reality into manageable pieces. The emphasis is on standardisation,
isolation, control, classification, quantification, and randomisation. Within this
system there is an attempt to gain maximum control by stripping the therapy down
to a single intervention. This will enable researchers to have minimal other
influences on the condition studied, and enables them to draw the conclusion on
the effects of one particular chemical on the condition.

Current research aspects illustrate the masculine, dominating, quantitative

medical technology approach, in contrast with the female contribution which
includes mystical, qualitative, intuitive and natural approaches (Aakster 1986,
lecture notes Fox-Strangeways 2005). However there are certain limits to RCTs. RCT
have not always been large enough to pick up adverse effects or outcomes. On
occasions, drugs have had to be withdrawn, despite extensive RCT. For example the
drug Opren in the 1980’s was withdrawn; despite trials, the drugs led to 3000
deaths and side effects (Robertson 1995). Or the trials are undertaken for too
short a period. RCT can have difficulty in assessing prevention of rare events,
such as sudden infant death syndrome as related to the position a baby sleeps in.
RCT cannot always reveal problems with medication when used long term, e.g. the
contraceptive pill, where the problem did not arise until decades later (Robertson
1995). By using RCT, treating the person as a whole person is not possible and
classifying does not allow for the uniqueness of the patient (Aakster 1986).
Surrogate endpoints are often used in preference to clinical outcome measures.
With RCT research there can be no variables in treatment. With herbal medicine,
treatment is highly individual, assessing different body systems and for the same
condition in different people, the same herbs would not be used. Significant
lifestyle advice is discussed per patient. RCTs of individual herbs, although of
use, do not reflect treatment as would have been provided by a medical herbalist,
therefore the therapy under question has not been truly evaluated. RCT generally
offers an indication of the efficacy of an intervention rather than its
effectiveness in everyday practice and provides evidence of what can be achieved
in the most favourable circumstances (Black 1996). Analysis of only predefined
‘objective endpoints’ may lead to exclusion of important qualitative aspects of
the intervention and publication bias.

Within the context of wholeness, RCT are of limited value. The effects of herbal
medicines are the outcome of complex interacting variables, by eliminating the
variables in RCT however, a major part of the treatment is taken away.

RCTs have contributed towards the recognising of herbal medicine as a valuable

alternative in the case of Black Cohosh to HRT (Wuttke et al 2003) and Agnus
Castus (Wuttke et al 2003) in women’s health. Research is needed to help in the
clarification and development and professionalisation of the therapies. Proper
investigation is needed. Without it neither conventional nor complementary
medicine would exist beyond the folk remedy level. However there are difficulties
in scientifically exploring systems of treatment that do not obey constructed
scientific principles.

Complementary medicine involves individualised diagnosis and treatment of

patients, an emphasis on maximising the body’s inherent healing ability, the
treatment of the whole person by addressing their physical, mental and spiritual
attributes, rather than focusing on a specific pathogenic process as emphasised in
western medicine. At the centre is the patient, and not the disease. (Whitelegg
1995). So the alternative approach is ‘holistic’ rather than ‘reductive’, and the
person is treated as a whole (Whitelegg 1995). Despite this emphasis on
multimodality treatment regiments, most research investigating traditional systems
of medicine have examined only one, or perhaps two, interventions taken from a
whole treatment system. Empowering the patient to reflect on what contributed to
the disease process and correct aspects that are feasible, and encourage healthy
living, such as lifestyle, exercise, socialising and relaxing. Treatment involves
the patient who is not just passively present. There is a need to no longer see a
disease as a technical problem, but in essence as a human problem and research
should reflect this. One needs to acknowledge uncertainty and subjectivity in
medicine, which to orthodox medicine is inferior (Whitelegg 1995). However, to the
complementary health system, personal evaluation is central; nature is a force,
with which one works rather than fights against.

An alternative paradigm (see appendix) is needed to provide a human-centred

science in which patient self-assessment is valued, other knowledge accepted and
uncertainty and ignorance admitted (Whitelegg 1995). Acknowledging female
contribution that may include mystical, qualitative, intuitive and natural
approaches (Aakster 1986, lecture notes Fox-Strangway 2005) would also produce a
more total scientific analysis. Investigators are either faced with designing a
trial of a single intervention which contributes towards the credibility of
individual herbs, but does not accurately reflect true clinical practice, or
undertaking a multifaceted intervention trial that is complicated to design and
implement.

Different studies that could be used

- Single intervention approaches to treat a conventionally diagnosed disease, as

has been done with St Johns Wort for depression, Black Cohosh for menopause, and
Agnus Castus in hyperpolactinaemia is possible. These have been done as RCTs, and
continue to be a valuable contribution towards the understanding of herbal
medicine.

- One could treat a specific disease, in which investigation of a whole system of

medicine is investigated, so that both diagnosis and treatment can be
individualised. The system as a whole is used instead of a single form of
treatment. The system could be evaluated at the end of a trial through a validated
measure of the condition, as the Hamilton scale for depression (Hamilton 1960),
and Menopausal Rating Scale for menopause (Hilditch 1996).

- Comparative outcomes approaches examine the results in selected groups of

patients of the entire therapy performed by the therapist, compared with
conventional treatment by a doctor.

- Observational studies help with evaluation of rare adverse effects and are a
viable research option when randomisation might be unethical or unacceptable.

- Person centred approaches should include the patient’s ownership of their

treatment experience (Whittlegg 1995). It has been recognised that patients can
make a reliable assessment of their symptoms, everyday limitations and functional
impairment, provided they are asked relevant questions in a standard form, such as
Measure Yourself Medical Outcome Profile (MYMOP) (Patterson 1996).

Conclusion

The history of medicine has shown a male dominated system, where women healers
were dismissed as irrelevant. The distinction between orthodox and herbal medicine
depends on particular circumstances of different societies. It is fashioned by
factors, which include the nature of medical technology, the forms of organisation
of medical practice and more general social values. A healer is likely to be very
different if they think of the body as a machine. Many women choose herbal
medicine for their healthcare, and good research needs to evaluate safety and
effectiveness. Although there is some limited value in RCTs in herbal medicine,
this does not reflect a true evaluation of herbal medicine as it is practiced
today. Studies need to be done which reflect herbal medicine as practiced, with
measurements allowing for the assessment of the benefit to the patient.

http://creativecommons.org/licenses/by-nc-nd/2.0/uk/
References

Akerele O 1993 Summary of WHO guidelines for the assesment of herbal medicine.
Herbalgram 28:13-6

Black N. 1996 BMJ 1996;312:1215-1218

Chamberlain M. 1968 The Old Wife, Pregnancy and Birth Control. (London)

Clark A, 1968 Working Life of women in the seventeenth Century (London: Frank
Cass, 1968)

R.Dubos 1959 Mirage of health : René Dubos. World Perspectives, Vol. XXII. New
York, Harper and Brothers

Fox-Strangeways P. 2005 Lecture notes; Holism, Science and Women: the case of
Complementary /Alternative therapies.

Fulder S.1996 The Handbook Of Alternative and Complementary Medicine, Oxford

University Press

Ferguson M. 1980 The Aquarium conspiracy Pallidon, London p.270

Griggs 1981 Green Pharmacy; a history of herbal medicine.Jill Norman and Hobhouse
Ltd. London

Green et al 1999 Gender, psychosocial factors and the use of medical services: a
longitudinal analysis. Social Sciences and Medicine 48;10:1363-1372

Halberstein R 2005 Medicinal Plants: Historical and Cross-Cultural Usage Patterns.

Ann Epidemiology 15:686-699

Hamilton M 1960 A rating scale for depression. Jounal of neurology, Neurosurgery,

Psychiatry 23 :56-62

Hilditch JR et al 1996 A menopause-specific quality of life questionnaire:

development and psychometric properties, Maturitas 24: 161–175.

Hughes M.J. Women Healers in Medieval Life and Literature (Morningside Heights,
NY, 1943)

Hurt-Mead K.C. 1938, A history of women in medicine (London)

Joyce C 1994 Placebo and complementary medicine. The Lancet344,1279-81

Kincheloe 1997 Herbal medicine can reduce costs in HMO. Herbalgram 41;49

Lancet (1841) ‘State of the Medical Profession’ 655-6

Litovitz T.L. et al 1990. 1989 annual report of the American Association of Poison
Control Centers national data collection system. Emergency Medicine 8,394

Mahler H. 1977 Editorial. WHO Chronicle, 31,60-62).

McCaleb R.S. 1992 Food ingredient safety evaluations. Food and Drug Law Journal
47,657-63
McKeown T.(1983)‘A Basis for Health Strategies: A Classification of Disease’
British Medical Journal august 1983; 287

Mintel Ltd 1993 Alternative medicine; Mintel Market Intelligence report, Mintel,
Long Lane London.

Montgomery J 2005 Lecture, Diseases in the Seven Ages of women.

Nettleton,S 1995 The Sociology of Health and Illness, Cambridge: Polity Press

Oakley A. 1992 The wise women and the doctor in alternative medicine in Britain,
(Oxford university press 1992)

Parinder G., Witchcraft: European and African (London: Faber. 1958)

Paterson C 1997 Complementary practitioners as part of the primary health care

team: consulting patterns, patients characteristics and patient outcomes. Family
Practice 14:347-354

Patersons C 1996 Measuring outcomes in primary care: a patient generated measure,

MYMOP, compared with the SF-36. BMJ 312:1016-1020.

Paterson C et al 1996 Measure Yourself Concerns and Wellbeing (MYCaW): An

individualised questionnaire for evaluating outcome in cancer support care that
includes complementary therapies,Complementary Therapies in Medicine

Poynter F. 1962 , ‘Nicholas Culpeper and his books’, Journal of the History of
Medicine 17 (1962), 152-67

Robertson M 1995 The European Journal of Herbal Medicine 1;3:31-35

Rosenberg C. 1977 The therapeutic revolution: medicine, meaning and social change
in the nineteenth century. Perspectives in Biology and Medicine, 20, 485-506

Siahpush 1999 Post modern attitudes about health: a population-based exploratory

study. Complementary therapies in medicine7:3;164-169

Saks M, 1992 Alternative medicine in Britain. Oxford university Press

Savage and Hutchings 1987 Poisoned by herbs. British Medical Journal 295, 1650-1

Y. Shitara and Y. Sugiyama 2006, Pharmacokinetic and pharmacodynamic alterations

of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors: Drug–drug
interactions and interindividual differences in transporter and metabolic enzyme
functions , Pharmacology & Therapeutics

StGeorge D 1995 Research and development in herbal medicine; Biomedical research

or new paradigm. European Journal of Herbal Medicine Vol1;1:38-40

StGeorge D. 1994 Research into complementary medicine; going beyond the limits of
clinical trials. Advances, 10,59-61

The Independent 1992 9 September Chemical Marketing Reporter.

Valussi M 2001 Biochemical research methods and Herbalism, The European Journal of
Herbal Medicine.Special Issue 25-32

Weader Kelly 1995 Gender influences on earnings of obstetricians and

gynaecologists, Obstetrics & Gynaecology 86;1:112-118

Webster 1975 The Great Instauration: Science, Medicine and Reform, 1626-1660
(London: Duckworth, 1975)

Wegener T 2003 Proposals to enhance the quality of ovservational cohort studies.

Phytomedicine; International Journal of Phytotherapy and Phytopharmacology
10;8:700-708

Weiss R 1960 Lehrbuch der Phytotherapy, Hippokrates Verlag

Whitelegg M1995 An Alternative Science for Herbal Medicine. The European Journal
of Herbal medicine2;1:36-39

Wuttke et all 2003 Chaste tree (Vitex agnus castus) – pharmacology and clinical
indications. Phytomedicine 10:348-357

Wuttke et al 2003 The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in
a double-blind placebo-controlled study: effects on menopause symptoms and bone
markers. Maturitas 44 Suppl. 1 S67-S77