Category Archives: herbal medicine

Harnessing Heat in Greco-Roman and Islamicate Medicine

By Aileen R Das

Associated and sometimes identified with the life-giving (or vital) principle, heat occupied a central place in ancient Greek, and subsequently Roman and medieval Islamicate, theories about the human body and its care. The medical literature surviving from classical Greece shows that early doctors’ understanding of human physiology was greatly informed by philosophical speculations about the basic constituents of the world. Heraclitus of Ephesus (fl. 500 BCE) appears to be the first natural philosopher to give fire a primary role in the cosmos; according to him, everything originates from fire, which undergoes various changes to become the materials that we see around us. His now fragmentary writings do not discuss medical or biological themes, but later ‘Pre-Socratics’ – a modern term that describes Heraclitus and other thinkers before or roughly contemporary with Socrates – such as Empedocles (495–435 BCE) did explain how this element affected the body. Both a physician and a philosopher, Empedocles of Akragas is the progenitor of the four element theory, according to which earth, water, fire, and air are the building blocks of the universe, and he asserted that heat was responsible for sexual differentiation. In his philosophical poem On Nature, Empedocles remarks, ‘For in its warmer part the womb brings forth males, and that is why men are dark, more manly, and shaggy’ (fr. 67).

The authors of the Hippocratic corpus developed several of their therapies in light of the notion that an innate heat sustains essential processes in the body such as growth and digestion. The intensity of this heat supposedly varied not only according to sex – with men being warmer than women – but also from person to person. Thus, when deciding on a course of treatment, the doctor had to make sure that they did not excessively increase or reduce the natural heat of their patients. Dietary regimens were the mainstay of Hippocratic therapeutics, for doctors working in this tradition assigned to food a range of properties (cooling, warming, drying, and moistening, to name just a few) that could influence the condition of the body. For example, the Hippocratic treatise Regimen II recommends that the herb coriander, which is described as being ‘hot and astringent’, be eaten to combat heartburn and to induce sleep.

None of the Hippocratic writers offer an overarching theory of the powers of nutriment and other natural substances. Rather, centuries later the physician Galen (d. c. 217 CE) of Pergamum, who drew on the Hippocratics, their philosophical precursors, and earlier pharmacological writers, formulated a system that ranked the properties of plants, minerals, and animal products. The dividing line between what counted as a drug as opposed to a food was blurry in the ancient (as well as medieval) world, so Galen elaborates his theory in both his dietetic and pharmacological works. On the Powers and Mixtures of Simple Drugs, which lists several hundred one-ingredient drugs, offers the most comprehensive account; it relates that all substances possess a mixture of active (hot or cold) or passive qualities (wet or dry) in four varying degrees of intensity, with the first degree being weak and the fourth strongest. For example, in the entry on the chaste-tree (vitex agnus-castus), Galen reports that the leaves and seeds of this Mediterranean plant is warm and dry to the third degree. By learning the properties and strengths of a range of materia medica, the doctor can select the appropriate remedy that will match their patient’s imbalance. Regarding the power of the chaste-tree, Galen recommends that the seeds be used to dissolve wind in the stomach and to relieve uterine pain, but he cautions that they are so warming that they can cause a headache. Thus, to avoid this affect, he advises that they be ingested with sweetmeats or other dessert items.

While Galen’s theory of the potency of natural substances was extremely influential throughout antiquity and the middle ages, later medical thinkers looked to redress his failure to explain how a doctor (or pharmacist) calculates the right proportion of ingredients in a multi-ingredient (that is ‘compound’) drug to achieve the desired potency. The Muslim philosopher Abū Yaʿqūb ibn Ishāq al-Kindī (c. 801–66), who was not a doctor himself but had sponsored the Arabic translations of Greek medical works, developed a complex arithmetical theory to quantify the strength of a drug that contained varying degrees of warmth, for instance. According to it, a substance’s intensity increases with an increase in degree according to the double ratio. Thus, if one takes a ‘temperate’ drug that has equal parts of warmth and coldness and doubles the parts of warmth, the drug will be hot in the first degree; if the parts of warmth are quadrupled, then the drug is hot in the second degree and so on. With these proportions in mind, the practitioner can weigh out the simple ingredients of the compound drug to obtain the intended strength. Al-Kindī’s solution to the gap in Galen’s pharmacology was popular not only among medieval Islamicate but also European doctors, who read it through a 12th-century Latin translation.

Fetch Me at Pearl Nest Street: Rhubarb Pills as Panacea in Qing China

He Bian

In the late eighteenth century, American ginseng opened up a new niche market in Qing China. At the same time, Chinese rhubarb (dahuang) roots, harvested from the northwest regions of the empire, were transported by Chinese traders all the way to the southeast coast and sold off to foreign customers in Canton (Figure 1). Part of these transactions took place in the Ryukyu Kingdom (present-day Okinawa Islands), a vassal state of the Qing but also an important node of global trade that crisscrossed the West Pacific. At some point in 1789, the Qing court issued an edict to the Ryukyu king that explicitly forbade him from selling rhubarb to Russians, with whom the Qing was then engaging in an all-out trade war. Rhubarb featured prominently in the Qing strategy because they believed that Europeans imported so much of this drug that they could not live a day without it.[1]

Figure 1. Chinese or Turkish rhubarb (Rheum palmatum): flowering and fruiting stem with leaf. Coloured zincograph after M. A. Burnett, c. 1842. Credit: Wellcome Collection, https://wellcomecollection.org/works/cvty3qqk
Figure 1. Chinese or Turkish rhubarb (Rheum palmatum): flowering and fruiting stem with leaf. Coloured zincograph after M. A. Burnett, c. 1842. Credit: Wellcome Collection, https://wellcomecollection.org/works/cvty3qqk

Yet is it really true that pharmacological visions in early modern China and Europe were so different that they could not possibly reach a consensus over rhubarb’s properties ? Classical Chinese pharmaceutical literature listed rhubarb as a drug with a “very cold” nature, and generations of physicians were taught not to use the cold drug in curing cold-natured diseases. This suggested that Russians (and other Westerners, as seen in this post on rhubarb in early modern England) had different bodies than the Qing Chinese, as they depended on rhubarb as an all-round cure. Pharmacological theories, in other words, engendered a vision of difference that seemed insurmountable.

During my recent reading of Qing medical recipe books, however, I discovered that rhubarb in fact functioned as nothing short of a panacea for Qing Chinese. This is evident in the text Bianyong liangfang (Excellent Recipes for Expedient Use), which appeared in the Jiaqing reign (1796-1820). Compact (only 2-juan in length) and very nicely printed (with carved woodblocks), it arranges pills, powders, tinctures, and decoctions by symptom. The book has about 120 pages, and most recipes are merely a few lines in length. What surprised me was that one very long recipe at the end of the text takes up the entirety of 13 pages. The remedy in question, mi shou Qingning wan (Secretly transmitted pill of purity and tranquility), calls for “several dozen pounds” of good quality rhubarb roots as the principal ingredient. Rubbed clean and steeped in rice water, the rhubarb was sliced, sun-dried, processed with “ash-less good rice liquor” for three days, and then put through a lengthy, elaborate protocol of fifteen rounds of steaming. Each steam involved a different set of herbs. Finally, makers took the resultant rhubarb paste, mixed it with “yellow ox milk” (using cooked honey as substitute if there was no milk), boy’s urine, ginger juice, and rolled it into tiny pills. The recipe listed hundreds of common illnesses that could be treated with this pill, ranging from headache and hemorrhage to gynecological disorders.

Figure 2. Luo Benli ed. Bian yong liang fang. Vol. 2b, p. 50b. c. 1796-1820. Princeton University Library. Downloadable PDF available at http://pudl.princeton.edu/objects/fn107159v
Figure 2. Luo Benli ed. Bian yong liang fang. Vol. 2b, p. 50b. c. 1796-1820. Princeton University Library. Downloadable PDF available at http://pudl.princeton.edu/objects/fn107159v

I have tried to look up this recipe in earlier Chinese medical texts, and my preliminary findings suggest that it probably came into existence no earlier than the seventeenth century. It became wildly popular in the eighteenth century, and recipe books serve as evidence of its widespread consumption. On the last page of Bianyong liangfang (Figure 2), the compiler, Luo Benli, announced that he had a batch of rhubarb pills prepared during his tenure in Guizhou – a southwestern province of China – and that, in case of emergency, readers could “call upon my house on Pearl Nest Street” and look for the “residence of Mr. Luo of the Ministry of Defense (bingbu Luo zhai).” Pearl Nest Street (zhuchaojie), a neighborhood in Qing Beijing not far from the Forbidden City, featured prime real estate. As a military official who had served in the frontier provinces, Luo was less bound by medical norms of the day and possessed the financial and political capital to manufacture elaborate pills like these. Was there, in other words, a sub-culture of health and medication championed by military elites such as Luo, which stood distinct from classical prescriptions?

One last word about this recipe that hints at a hidden connection between different cultural realms in early modern China: Sun Xingyan (1753-1818), a prominent scholar who combed through medieval sources for fragments of ancient texts, published the same recipe for Pill of Purity and Tranquility in his scholarly series. The inclusion of this Qing text alongside ancient monographs so bewildered modern bibliographers that they mistakenly attributed the recipe’s author to a seventh-century figure. In fact, Sun Xingyan made it clear that it was a contemporary remedy and provided an elaborate scholarly argument to defend rhubarb’s all-around efficacy to cure both hot and cold-natured illnesses. He also suggested that “vulgar physicians” despised the pill because if everyone had access to this remedy then their businesses would be lost. Therefore it does appear that, when it comes to rhubarb, Qing Chinese scholars and military commanders were no less enthusiastic than what they imagined about the Russians.

 

[1] I recommend this excellent essay by Chang Che-Chia (translated by Penelope Barrett) for more on this curious episode.

Recipes and the Senses: An Introduction

By Hannah Newton

Lubin Baugin, Still-life with Chessboard (The Five Senses) (1630). Wikimedia.

 

Our enjoyment of food depends not just on how it tastes and smells, but also on what it looks, feels, and sounds like. Crispness, for instance, is perceived when we hear a ‘snap’ as the food breaks between our teeth. This relatively new understanding of gastronomic experience explains the recent explosion of recipe books designed to entice all five senses. In fact, a ‘sensorial revolution’ is taking place across most fields of history. This month’s thematic series, edited by Hannah Newton and Elaine Leong, gives a flavour of what might be gained by applying such an approach to the history of recipes; there are 7 contributions, spanning several disciplines, chronologies, and regions, from ancient Rome to eighteenth-century England. To put the posts in context, this introduction provides some background on sensory history.

Approaches

There are many ways to do sensory history. Perhaps the most influential has been the ‘grand narrative’ approach: scholars such as Marshall McLuhan and Walter Ong claimed that a ‘major sensory transition’ took place between medieval and modern times in the way the senses were ranked. In medieval Europe, societies privileged the ‘lower senses’ of touch and taste, but with the march of modernity the ‘nobler’ senses of sight and hearing came to the fore. Although this scholarship has been heavily criticised – not least for its disparaging attitude towards medieval people – the question of change over time rightly remains fundamental to sensory history. Yan Liu’s post in this series is a good example: he shows how the use of the spice saffron in China has been transformed since medieval times, from an antidote against evil powers to a flavour enhancer in cooking.

Another approach to sensory history involves focusing on a particular sensory organ, or a context directly linked to that sense. Examples include Stuart Clark’s Vanities of the Eye (2007), which explores anatomical and philosophical understandings of vision, and Holly Duggan’s Ephemeral History of Perfume, which uses scent as a window into cultural attitudes to smell.  One downside to the single-sense approach is that in daily life we perceive the world through all our senses, not just one, and the senses themselves influence one another. Several of the contributions to this series demonstrate these interactions nicely: Barbara Di Gennaro Splendore  reveals that the 17th-century apothecary ‘knew substances through “his whole person”’, and William Tullett makes similar observations about 18th-century perfumers.

A third way to study the senses is the ‘sensescape’ approach. This is where scholars take a particular environment or activity, and analyse the multiple sensations that were perceived within it. Bloomsbury’s six-volume series, Cultural History of the Senses, showcases some of the most popular sensescapes, which include the marketplace, street, and church. Donna Bilak’s post is an example of this approach: she uncovers the intriguing sensations reported in the iatrochemical laboratory of the 17th century New England puritan Gershom Bulkeley, which included ‘urinous’ flavours. What Bilak, and many of our other contributors reveal, is that people from the past consciously mobilised their senses when going about their everyday work, whether as a medical practitioner, perfumer, or chef.

Challenges

One of the biggest obstacles to doing sensory history relates to evidence: most sensory stimuli are ephemeral, leaving no direct historical trace, which means we have to rely on written descriptions or images to access past sensory experience. Unfortunately, this is far from straightforward, due to the difficulties people encountered when putting sensory experiences into words. Peter Charles Hoffer labels this the lemon problem: ‘I can taste a lemon and savour the immediate experience, but can I find words to convey to another person exactly what that sensation was?’

To meet these challenges, exciting new techniques have been devised by historians to recreate past sensations, which involve the use of ‘immersive technology’, such as artificial smells and tastes. By activating our own senses, the intention is to ‘replicate sensation in a world we have (almost) lost’. Historians of science and food deploy similar techniques, re-enacting past experiments (e.g. or making foodstuffs (e.g. here and here), to reach a closer understanding of contemporary worldviews. Tillmann Taape and Erica Rowan, two of our contributors, are both engaged in this sort of innovative work. Admittedly such approaches do attract sceptics. For instance, Mark Smith warns that while it is possible to reproduce a particular sensation from history, the way we ‘consume’ that sensation may be different from the way it was experienced at the time. Indeed, an experience of a sensation may even change over a person’s own lifetime, as Hannah Newton’s post reveals: for early modern patients, what they would normally perceive as pleasant tastes – such as sweet cordials – were found during illness to be disgusting, owing to the effects of noxious humours on the taste-buds.

Despite the challenges involved, our contributors are optimistic about applying a sensory approach to the study of recipes. So long as we accept that sensory perceptions are culturally contingent, there is no reason why it is not possible to glimpse how past societies understood and experienced sensations.

 

Following Valerian: New Name, Old Idea

Katherine Foxhall

In late August, 1781, Sir Charles Blagden, physician, Francophile, army surgeon and Fellow (later to be Secretary) of the Royal Society of London received a letter from his friend, Thomas Curtis. Curtis was concerned about the health of his son, who for more than a decade had suffered a ‘very peculiar kind of head ach’ with ‘a dizziness, or partial vision’, and which recently seemed to coincide with the fortnightly full or changed moon. Curtis had sought the opinions of plenty of doctors, but their prescriptions had failed. Blagden responded swiftly. He proposed that the young man was suffering from what the French called migraine. Blagden was not convinced that the moon’s phases were causing Curtis’ illness, but if the young man’s disease returned on 12 September 1781 (the date of the next full moon), Blagden instructed that the young Mr Curtis should have twelve ounces of blood taken a week later, and then to trial valerian ‘in considerable doses’, increasing the dose until his stomach could bear no more.

'Valerian'. Credit: Wellcome Collection: https://wellcomecollection.org/works/rw9eqv2m.
‘Valerian’. Credit: Wellcome Collection: https://wellcomecollection.org/works/rw9eqv2m.

Having long been known as an anticonvulsant, by the middle of the eighteenth century the herb Valerian had become something of a fashionable prescription for treating migraine. The distinguished physician Richard Mead, author of the famous Treatise concerning the influence of the sun and moon upon human bodies (1748) recommended frequent use of valerian root for periodic diseases of the head ‘pulverized before it shoot out its stalk’.[1] This seems to have prompted the Scottish physician John Fordyce to try it for his own hemicrania. Finding it of very great benefit, he recommended taking drachm doses of valerian three or four times a day in his essay De Hemicrania (1765). Erasmus Darwin included both bleeding and valerian in Zoonomia as treatments for the symptoms of hemicrania, and physicians throughout the nineteenth century would continue to recommend the herb. Such influential texts explain why Blagden turned to valerian for his young patient’s periodic ailment, but it struck me that this had not been one of the herbs that I had come across during the many months I had spent researching the Wellcome Library’s collection of recipe books for seventeenth century migraine remedies, though Nicholas Culpeper talked of valerian’s warming properties, and recommended the root for headache, diseases of the eyes, wounds splinters and thorns. I forgot about Curtis, and moved on. Then, by accident, I discovered that the valerian family also contains a plant called spikenard, and the penny dropped. Like valerian root, spikenard has an earthy musky odour, and a similar effect on the body – having sedative and relaxing properties. Suddenly, valerian didn’t appear to be an eighteenth-century story, but an episode in a longer history, which I’ve written about here before.

But the story goes back even further. The dispensatory of the Nestorian physician and pharmacologist Sābūr ibn Sahl, from southwestern Iran, is one of the earliest pharmacopeia written in Arabic. Dating from the ninth century CE, it provides important evidence of medieval Eastern Arabic medical practice. In Chapter Four of the dispensatory instructions set out the preparation of nard oil, an expensive essential oil with sedative properties used to treat hemicrania, among other things. This was an expensive recipe requiring a large investment to collect over twenty herbal ingredients (including cyprus, laurel, elecampane, citronella, myrtle leaves, wild caraway, forget-me-not, sweet marjoram, stalkless roses, fresh myrtle-water, myrrh and grape ivy), and prepare them with different liquids in three stages taking several days. The third stage took Indian spikenard (the ingredient that gave ‘nard oil’ its name), pounded together with cloves, storax, nutmeg, added to fresh water, balm oil and the strained oil from the previous two stages. Then the whole concoction should be boiled until the water had disappeared, before being bottled, stored and used as required.

Remedies for 'Mygreyn' in a Fifteenth century leechbook. Credit: Wellcome Collection MS.MSL.136: https://wellcomelibrary.org/item/b19295467#?c=0&m=0&s=0&cv=192&z=0.0194%2C0.2362%2C0.8409%2C0.673.
Remedies for ‘Mygreyn’ in a Fifteenth century leechbook. Credit: Wellcome Collection MS.MSL.136: https://wellcomelibrary.org/item/b19295467#?c=0&m=0&s=0&cv=192&z=0.0194%2C0.2362%2C0.8409%2C0.673.

Several centuries later, we find a mid fifteenth-century English ‘leechbook’ contained a recipe for migraine attributed to ‘Galen the good philosopher’ that required several of these same ingredients: nutmeg, ginger, cloves, a pennyweight of ‘spiknard’, anise, elecampane, liquorice, and sugar. By the sixteenth century, spikenard was appearing in print. In 1526, the anonymously published A New Book of Medecynes gave a recipe for migraine, postume and dropsy requiring ‘iiii peny weyght of the rote of Pyllatory of Spayne / a half peny weyght of Spygnarde’, ground together and boiled in good vinegar. The compilers of recipe books (including this blog’s favourite Mrs Corlyon) adapted these remedies to local conditions, substituting herbs of similarly warm, dry and aromatic qualities (such as sage and rosemary) that they could more easily obtain or grow. Following translations is notoriously hard, as Sietske Fransen’s post shows, but spikenard and valerian have weaved their way through more than a thousand years of migraine history. Does it work? Perhaps. It certainly has sedative properties, so today it’s more commonly used for insomnia.

[1] Richard Mead, A Treatise concerning the influence of the sun and moon upon Human Bodies and the Diseases thereby produced trans. Richard Stack (London: J. Brindley, 1748), 84-6

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Katherine Foxhall is Lecturer in Modern History at University of Leicester. Her new book, a history of migraine, will be published by Johns Hopkins University Press in 2019.