- Neurology and Research, Klinik Arlesheim, 4144 Arlesheim, Switzerland
- Institute of Integrative Medicine, Chair for Theory of Medicine, Integrative and Anthroposophic Medicine, Witten/Herdecke University, 58313 Herdecke, Germany
- Accepted 3 July 2015, Available online 11 August 2015
Highlights
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- It is a challenge to obtain reliable data on medicinal plant use from practitioners.
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- A model is presented on how useful data on the efficacy of botanicals can be obtained.
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- The “Vademecum of Anthroposophical Medicines” successfully addresses many challenges.
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- A continuous, multilingual collection of experiences in a community of practitioners
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- Assistance to new practitioners and data for research and government registration
Abstract
Objective
This paper addresses the challenge on how to obtain information from practitioners with experience in using medicinal plants.
Background
Collecting
information on medicinal uses of plants is very challenging; since
botanical remedies are used within the context of multiple differing
medical systems, practitioners differ in training from Western
physicians and scientists, and active ingredients of botanicals vary
with preparation method, growth, and harvest conditions.
Design/methods
A
model on how useful data on safety and efficacy can be obtained from
botanical practitioners is presented, based on methods developed by the
association of anthroposophic physicians in Europe, a system of
integrative medicine which includes the use of botanicals and is
practiced mostly by medical doctors.
Results
Decades
of experience by hundreds of practitioners are summarized and made
accessible in a manual, which alphabetically lists the most commonly
used botanicals and describes the most successful therapeutic
experiences which could be confirmed by several of the contributing
practitioners.
Conclusions/relevance
This
approach of continuous, multilingual systematic collection of
successful therapeutic experiences within a community of practitioners
with similar goals and a common therapeutic framework can be used not
only for the training of successful future botanical practitioners, but
also for helping to identify promising botanicals for scientific
research and to further their development, and could support their
official registration with governing bodies in countries of their use.
This article is part of a Special Issue entitled “Botanicals for Epilepsy”.
Keywords
- Botanical;
- Epilepsy;
- Integrative medicine;
- Ethnobotany;
- Data collection;
- Practitioner
1. Introduction
Botanicals
have been used for millennia to treat medical conditions including
epilepsy. While botanicals offer promise as potentially effective,
comparably well tolerated, and relatively easily available additions to
the current choice of anticonvulsants, it is very challenging to obtain
reliable information on the medical use of botanicals [1] especially in regard to their relative effectiveness [2].
There are many reasons for this, including the following issues.
- Indications/diagnoses. Botanicals are commonly used within a framework of a specific medical system, such as Chinese medicine, Ayurvedic medicine, Kampo, indigenous medical systems in Africa and Latin America, or anthroposophic medicine, which, similar to homeopathy, may have some roots in medieval alchemical traditions in Europe. As a result of this context, medical indications or uses of botanicals may not necessarily be described in the form of diagnoses of Western conventional medicine, but in phenomenological terms (e.g., [3]) or in terms of concepts which are intrinsic to the framework of the specific medical system. As a result, indications may end up in general terms, such as “gastrointestinal disorders”, “dermatological disorders”, “mental disorders” which include epilepsy, and so on (e.g., [3]).
- Training/background. Practitioners with experience in the use and effectiveness of botanicals are trained in their respective medical system, not necessarily in the system of Western conventional medicine. As a result, it may be difficult for them to express their experiences in terms which are understandable to Western physicians and scientists. In addition, a motivation for doing so may not necessarily be present, since their medical systems are in themselves complete. In turn, Western physicians and scientists may not have direct experience with the therapeutic effects of botanicals and, because of different training, may have difficulty understanding the context of the medical system in which they are used. As a result, there is a lack of uniformity of data on medicinal plant uses [1], making it difficult to share information across cultures and medical systems.
- Botanical preparations. Worldwide, countless botanicals and mixture preparations of them are in use, far more than conventional Western medications. It is an enormous challenge to bring order into this wealth of possible preparations. Moreover, ingredients and effectiveness of each botanical depend on the conditions of where it was grown, when and how it was harvested, and how extraction and preparation were done [4]. Reports of effectiveness, therefore, should ideally include not only the dosage and duration of use, but also the composition of the preparation, growth, harvest, and methods of preparation.
The
need and interest to find out medicinal uses of plants have developed
into the field of ethnobotany as a scientific discipline. Here,
typically, a geographic and cultural region is chosen; information is
gathered by conducting semistructured interviews directly with
practitioners (e.g., [5], [6], [7] and [8]) and/or by using structured questionnaires (e.g., [3], [9] and [10]).
Reliability
of the data may be analyzed by determining an informant consensus
factor (FIC, the degree to which all informants agreed with each other)
and by determining a fidelity level (FL) to describe the uniqueness of a
particular species for the treatment of a specific indication or
diagnosis [9].
An
additional source of information may be historical written works on the
use of botanicals (examples specifically for epilepsy are in [11], [12] and [13]).
Some ethnobotanical surveys are focused on specific medical diagnoses [14], [15] and [16], and recently, a survey with a specific focus on epilepsy [17] and a study of historical works describing medicinal plant use in epilepsy [18] have been conducted.
Initial
information on the effectiveness of botanicals may be obtained in
animal studies, which has given rise to the field of ethnopharmacology.
Due to the existence of pharmacological screening methods, the
indication of epilepsy is suitable for this approach, and several
studies have been published recently [19], [20], [21] and [22] (see the review in this special section by Sucher [23]). Similar screening methods are also employed by the NIH anticonvulsant screening program [24].
However, as we know from clinical studies, drugs which are effective in
animal models are not necessarily useful in clinical practice (e.g.,
retigabine, [25] and [26]),
so ethnopharmacological screening cannot replace the very valuable
clinical observations of experienced practitioners, providing us with
information on which botanicals are likely to be most effective for a
specific condition such as epilepsy.
2. Methods
In
the following, a model will be presented on how detailed information on
medical uses of botanicals was obtained in a specific setting of
experienced practitioners. Medical physicians practicing anthroposophic
medicine have developed a dynamic collection of their therapeutic
experiences with botanicals, termed “Vademecum of Anthroposophic
Medicines” [27] as described further below.
Anthroposophic medicine [28] and [29]
is a comprehensive system of integrative medicine which was founded in
the 1920s in Switzerland and Germany in exchanges between medical
physicians and a modern contemplative, Rudolf Steiner. Similar to
homeopathy, it may have roots in the medieval European tradition of
Alchemy as with the famous contemplative and physician Paracelsus [30],
professor of medicine at Basel, Switzerland in the 1500s.
Anthroposophic medicine is practiced by medical physicians around the
world and in specifically dedicated, acute care hospitals in Germany,
Switzerland, and Sweden, which blend it with conventional Western
medicine.
The “Vademecum of Anthroposophic Medicines” [27]
as a model of collecting information from practitioners has addressed
the challenges mentioned above to some extent. This is a collection of
experiences between colleagues within a single medical system which
facilitates reciprocal understanding and communication. Furthermore, the
practitioners contributing their experiences are all medical
physicians, which facilitates communication including conventional
medical diagnoses. Information on botanical preparations is provided or
can be obtained from the corresponding manufacturers.
