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I have seen many articles making the rounds lately that discuss the "active chemical constituents" of herbal medicines and whole foods. And why not? This is how we create and analyze western pharmaceuticals, and how we describe their mechanisms of action. Curing Chemophobia: Do Not Buy Alternative Medicine by Michelle M. Francl takes this method of distillation a step further by using it to compare ancient herbal medicine with modern western medicine. (Read her article to get the nuances of her opinion, and I'll summarize my understanding of it here.)
Ms. Francl compares one molecule of methotrexate, a western pharmaceutical that can treat arthritis, with a molecule of quercetin, present in the Chinese formula Four Marvels Powder (Si Miao Wan), which can also treat arthritis. She asserts that each of these toxic molecules can have a litany of adverse effects on the body, but at least methotrexate has been studied (by western science) and dosed with precision. Why should we place more trust the more benign-sounding substance, especially because we do not know its exact dosage, and because it is not in our western medical canon?
Francl's analysis is based on the assumption that breaking down these two medical systems into isolated constituents is an accurate or equitable way to compare them. But quercetin does not equal Four Marvels Powder, just as antioxidants do no equal blueberries. This modern metonymy is not poetic. It is an expression of our limited perspective. Maybe it is even a symptom of not feeling whole. In any case, I am calling into question this popular method of analysis.
I agree, of course, that dosage and precedent are crucial. I agree that nearly all known phenomena have a chemical correspondence. (I am excluding quantum weirdness, and leaving an openness for mystery.) I also want to emphasize that I love western science for what it can offer. Western medicine can be straight-up miraculous. Without it, I'd be blind for certain (thank you, scleral buckle, cryopexy, and general anesthesia), and perhaps dead from asthma or anaphylaxis (thank you albuterol; thank you epinephrine).
However, I disagree that subjecting a science borne of holism to the rigors of reductionist Cartesian philosophy, so recent in the grand scheme of things, is a fair means of weighing the two medical traditions against one another. Ms. Francl describes herself as equitable skeptic and pragmatist. I would like to offer some ways to help us all be more equitable and practical in the ways we discuss and compare holistic and modern medicine. (The right doctor can make these two terms interchangeable.) Let's widen our lens out beyond the confines of the modern western mythology of scientism, a term coined by Liu Ming to describe our religious adherence to a mentality which disproves itself continuously as we measure and deduce each newest "truth."
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We can draw a molecule of quercetin, which is found in Four Marvels Powder, but this tells us little to nothing about the formula. Breaking down an herbal formula into its "active chemicals" only displays our tendency to reduce and isolate. In the context of herbal medicine, this approach just does't make sense. Singled-out and de-contextualized, yes, quercetin and achyranthine can be damaging to the body when ingested. Western medicine tends to want to extract such compounds from their symbiotic environments to create very potent substances. Don't get me wrong, these substances can be just what the doctor ordered, as it were.
But don't mis-extrapolate this technology to denounce the ingredients of Four Marvels Powder. They are NOT quercetin, berberine, and achyranthine; they are phellodendron tree bark (huang bai), atractylodes root (cang zhu), and ox knee root (huai niu xi). If you google any of these, you will see pictures of beautiful plants before you. These are dried and decocted by traditional recipes that have thousands of years of research behind them, on willing human participants. When purely-sourced and skillfully blended, these whole substances are synergistically formulated to bring out the best in each other, like old friends. There is no such thing as an inactive ingredient when we are dealing with whole beings. Every "single" "part" plays a vital role. This is what it means to be whole.
Methotrexate was created in a laboratory in the 1940s by a man studying chemical responses in isolation, tested on non-human animals that were deliberately given cancer. He believed that by blocking folic acid absorption, he could prevent cancer cells from spreading. (This mechanism is also what makes methotrexate the "abortion pill.") So, you can see the difference in approach. He studied chemicals, cells, discrete things on unwilling participants with nonhuman physiology fewer than 100 years ago. This is a new way.
I myself feel that science is absolutely capable of reflecting and respecting living reality. Fortunately for adherents of western science, we don't have to convert to a foreign (i.e., Daoist) or indigenous way of being to embrace a holistic way of participating in phenomena. We have General Systems Theory! Rediscovered and refined by Ludwig von Bertalanffy in the 1930s, systems thinking describes open systems (like bioregions), as alive and self-regulatory, comprised of whole parts. Any terms that try to touch on the implications of animate interdependence is bound to distance us from the dynamic warmth it describes. Systems thinking can be applied to any discipline, including medicine. (I recently spoke with a research analyst who told me that systems thinking is changing the field of data analysis.)
My ubergeeky friend Erin Vang, the "Principle Pragmatist" of her software firm, introduced me to Michelle Francl's article and asked for a response, which you are reading now. She then offered a wonderful example of real-world systems thinking: "Western nutritionism demonized eggs because of the high cholesterol content of yolks, only to learn at least a decade later that the cholesterol was not generally problematic when the yolks were consumed at the same time as--oh, gosh, who could have seen THIS coming?!--egg whites."
Lastly, I want to address Francl's emphasis on the naming of things. I myself love the art of naming, and believe that a name can bestow great power or simply reflect the nature of phenomena when accurately done. Francl and many others suggest that a medicine's name can affect our perception and willingness to consume it. Chinese herbal products and formulations tend to have more innocuous-sounding names, therefore some people can wrongly consider them to be inherently safer as a general rule.
She explains that if western drugs had pleasant, pronounceable names, we would (and do) feel safer using them. This is why we take "Celexa" for depression, rather than "Citalopram Hydrobromide." However, changing the name of methotrexate to "spirit of feathers" (Greek meth: spirits; Greek pterin: feathers) as the author suggests, does not change its origin story, or, in my opinion, reflect its nature. The names of the natural plant substances found in Four Marvels Powder undoubtedly used to vary by region, and reflect their respective natures. This clear relationship between signifier and signified can still often be found in the Chinese characters or, for non-Chinese speakers, in the pin yin. For example, phellodendron bark, or "huang bai," simply means "yellow fir [bark]."
In the end, I jibe more with tree bark than I do with methotrexate, and not because of their names. There is a classical Chinese maxim that says something like, "If you wait until a person is sick to treat [her], you are not a very good physician." I argue that our interconnectedness with such an imbalanced world makes us all more susceptible to illness today. Perhaps in this time, we may also require more potent medicines. Fortunately, I have not been in a position in which methotrexate or Four Marvels Powder are appropriate treatments. Honestly, I am not sure what I would do if I or my daughter had an illness serious enough to warrant strong medical measures, but I might use either treatment if the proper context arose.
