From Burdock to Blood Cleansers: Graeme Tobyn on the Power of Alteratives

Sebastian: I'm here with Graemee Tobyn today and really. Ah, good to see you, Graeme.

Graeme Tobyn: Yeah, and you, Sebastian. Great to be here.

Sebastian: I'll just give you, a quick introduction to our audience that you, got a background as a herbalist. I think you've been practicing for over 30 odd years or something.

Graeme Tobyn: Well, no, 26.

Sebastian: It was 26, yeah. but you've been working as an educator and author, and you currently, working at the University of Lancashire and, in the herbal medicine course and integrated medicine degree.

Graeme Tobyn: That's why I've been there 23 years.

Sebastian: 23 years. Great. It's a real treat for us to have you with us.

Graeme Tobyn: Well, yeah, thanks for inviting me along.

Sebastian: And so, in this series of, Herb cast, Graemee, we're talking about herbal actions and really looking at the different categories. How useful are they? What benefits do they have for herbalists to be able to use herbs in that way? And today we've chosen the potentially controversial category of alteratives to look at.

Graeme Tobyn: Yeah, I like controversy, but actually, you know, I'm just going to blow my trumpet a bit right now, because, we had a section on alteratives, under the monograph of Burdock in the western herbal tradition. and, David Hoffman, in his review of the western herbal tradition, said, that it was one of the, best things he had read on alternatives. So, that chapter on Burdock was actually the one that I edited. What Alison Denham, Midge Whiteleg and I did was we did our, historical research, or our sources research. And then, we singly edited different chapters. So Burdock was mine. So in that sense, you know, I'm very pleased to have been invited to speak about alternatives.

Sebastian: Graeme, this is the book. I was also looking at it this morning.

Graeme Tobyn: Yeah, that's right.

Sebastian: That's the first edition. That's got a great entry from you on Burdock and a bit of a discussion about alteratives.

Graeme Tobyn: Yeah, that's right. I mean, the other alteratives in the book are fumitory, goose grass, figwort and heartsease. So we're just naming some alteratives here. And I'll be naming other plant alteratives in a minute as well. And let's get our definition in early, shall we? Sebastian? So this is Albert and Lillian priest, from herbal medication. an alterative is a medicine that alters the process of nutrition, restoring in some unknown way the normal functions of an organ or of the system, re establishing healthy, nutritive processes. So that's a fundamental definition of alterative that we should take away. So that's referring of course to that sort of tropho restoration which was you know, part of that physiomedical treatment, strategy. But they also talk about how alteratives are used to detoxify. And we know that Other words like Depurative or blood cleanser are used. And But just let me say something else about the western herbal tradition as well because Obviously I'd already written the book on culpepper. So I was already immersing myself in that sort of hippocratic galenic tradition. And so when Mills and bones principles of Practice of phytotherapy come out. Comes out, ah. And they sort of say, Traditionally use those. Look, I've got this quote, about burdock. Burdock. Say mills and bone is one of the plant remedies traditionally used as alteratives. Traditionally used as alteratives. Now you see, that irritated me slightly because there is no category of alterative when you get back to Culpepper's time or even before then, as I show in the monograph on Burdock. So You know, that was.

Sebastian: When was it first used, Graemee? Then when was it first used?

Graeme Tobyn: It's first used in I think the early 19th century because.

Sebastian: It'S in king's american dispensator, isn't it? And all those Texts on. That's right.

Sebastian: Arrow and herbs like that I mentioned there.

Graeme Tobyn: So you see, I felt that, you know, that comment was not really looking at the whole tradition to say traditionally used as. And that was one spur for writing the western herbal tradition to sort of correct that m misapprehension about the tradition. of course in principles and practice of phytotherapy. The two alteratives that They include in their Small materia medica are ah. Echinacea and phytolacca. So those are two other alteratives, as recognized by priest and priest, for instance. But of course echinacea is then called an immunostimulant by then, by 2000. And ah. An anti inflammatory. And phytolacca is predominantly an anti inflammatory, but also a lymphatic and depurative. So Although they're avoiding the category alterative in principles and practice phytotherapy, they still want to describe phytolacca as deportative. So what I'm getting at here is that there's a whole play on words which, needs kind of deconstructing, but quite rightly. Mills and bone show, that such herbs are indicated in chronic condition, chronic tonsillitis and chronic sore throat. Are the, Ah, are the, presentations where they advise, on those herbs. Okay, fair enough. now another source, I love, I don't know about you, Sebastian Rudolph Weiss's herbal medicine. The first edition, of course, because the second edition, which I remember, Heinz Elstra was really, pleased to have this, you know, phytotherapy colleague from the continent, you know, producing this textbook that he was massively recommending. And it is a great book, the second edition, unfortunately, they tried to make it very scientific by building in all this, all this research, evidence, and they lost that, wealth. It sort of diluted the wealth of experience you get from reading Vice's clear opinions on herbs. that is evident, in the first edition. And he says the old notion of cleansing the blood is obsolete. we see it as a somewhat milder form of antidiscratic therapy that is not used when disease has definitely developed. But early on, when the subject experiences a general feeling of tiredness or weakness, it is more or less understood under the term prophylaxis or prevention. that is springtime cures watercress, dandelion, parsley and nettle. And ah, he loves his alder buckthorn, which we might go, oh, stimulant laxative, anthracrinome glycoside, you know. But he sees that as actually a rather mild herb that doesn't require correction with, carminatives. Although, he does like his blackthorn prunus spinosa, and other reducing teas with Senna, which I'll come to in a minute because they, you know, they're definitely our stimulant laxatives. So you're happy with that differentiation, aren't you, between alterative and laxative?

Sebastian: I mean, I'm personally comfortable with the term alterative, but I'm interested that we seem to have potentially some sort of herbalist complex. There's some sort of embarrassment going on potentially about it, as you see being justified in the last two bits of literature you refer to in a sense of slightly, because it got mixed up in blood cleansing and some of this language that could appear to be, unobservable, or immeasurable on some level. It became a sort of split in the, in the language because I've got a big background in ayurvedic and chinese medicine and rakta shodhana, or cleansing the blood, or clearing heat toxins from the blood. In chinese medicine. At, ABC of practice, I'm comfortable with the language. I'm fascinated in this discussion within particularly western context.

Graeme Tobyn: Yeah.

Sebastian: Of how we evolve that language and how we come to understand how herbs work. But in clinical practice, it seems that, ah, alteratives are alive and well and that is how they are applied by lots of herbalists in that sort of early stages of treatment. In a less. I know you just touched on Senna and Buckthorn and things like that. You know, we're much more gentle, it feels like in this sort of early stages approach.

Graeme Tobyn: Yes, that's a really good point because I want to take that up. You see, I believe that there's a retreat going on, a retreat from the use of stimulant laxatives. But I've still got some unfolding to do. so that was Weiss, who is a phytotherapist, a consultant doctor specializing in herbal medicine on the continent. if we turn to priest, and priest, which was published in 1982, there takes herbal medication, which I think nim now, sell copies of that. they talk about the alteratives influencing the qualitative state of the blood supply, cleansing the blood of impurities by affecting mechanisms of intermediate metabolism, thus nutrition and toxicity. And that's not far away from your eastern, categories, you know. why not? for priests and priests, there are three types of alteratives. There's the relaxing ones, the stimulating ones and the toning ones. And they act slowly, but we must imagine that the stimulating ones, are going to be, a bit more perky than that. So they say in chronic conditions, more stimulating ones are required. But at what speed? What is the dose for that? alterative reaction will necessarily be slow, and they say two to three years to secure a fundamental tissue change. Now, I can't imagine giving alteratives to a patient for two to three years, expecting them to come back each time as a minuscule adjustment is made to their condition. It's the kind of thing that might work if, you know, the patient is a lot better, but you still think that there's improvement to be made. And so you're doing repeat prescriptions over, a good year or so, using an alterative. so when you look at the eastern category, Sebastian, I mean, what's the time period for using those ones that clear, you know, heat toxicity in the.

Sebastian: Blood, I mean, at the stronger end of things you'd just be using for a few days. You would not be using it for long periods of time. But for general, should we say, you know, I don't know, skin inflammation or something like that, you know, you're going to want to see results pretty quickly because a, people are suffering and b, it's expensive or cost money and time and and c, you want to make sure you're using the right formula because you don't want to go on for too long. Just hoping that over time the tissues.

Graeme Tobyn: Will be clean so that inexperienced herbalists, or students will make, you know, let's just keep on with that and you know, that's a bit.

Sebastian: Of a balance, isn't it? Depends what's being poured in the top of the vase, depends what the client is, what factors are causing their system to become, yeah, purified should we say for that language, or imbalance. So, but you basically want to see results pretty quickly with these areas that I would call toxic, you know, or where you've got armour or congestion, bloating, sluggishness, etc. You want to see quick results. So not too long and I'm more of a higher dose end of things to get things going, I'd say, yeah, I think the descriptions in the literature you're reading, we were, I don't know if we're more robust. I think we're more robust to slightly stronger treatments. Perhaps that would be the nature of the day, from a natural medicine point of view. and pain and things like that were much more prevalent in a way we weren't so accustomed to painkillers and things. obviously this topic has risen again and again in history where there are these systems and these pathologies and people that aren't getting removed by natural healing processes and need some stronger intervention. And I like this catalytic effect that you get from the ultra range.

Graeme Tobyn: So that sort of two to three years. But at least the priests and priests qualify that they say eliminative action and functional regulation requires a near physiological dose, whatever that is, over a relatively short period. So that's what we're talking about there. But alterative action and tropho restoration requires a possibly very small dose on a long term basis. So they want to make those two distinctions between elimination of toxins and tropho restoration. So their alteratives in their tables, near the back of the book they have burdock as a general alterative that's also a diuretic and then most of the other alteratives are stimulating bladderac, blue flag, which are also diuretic, echinacea as the. Now an immunomodulator. and again, talking about language, I think we made a mistake there when we first categorized it as an immunostimulant. And then orthodoxy goes, oh, it must be contraindicated in autoimmune condition. See what the trouble that these labels get you into. wild indigo with antiseptic properties. poke root, something of a cathartic as well. They say, bear's foot as a lymphatic agent and blue flag, also as a cholagogue. And then the only tonic one they list is doc, which of course contains anthraquinoglycosides. But again, herbalist are used not to have to correct that, action with carbonitives. Ah, and then the only relaxing one in there is figwort.

Sebastian: Quite a robust list, I'd say.

Graeme Tobyn: Yeah, yeah, I mean, I think that's a good list, there, checking, Doctor William Cook's physio medical dispensatory from 1869 as well. you know, he will have other ones in there as well that are north american herbs. But he said that too often relaxing alteratives were used. So it seems priests and priests may have learned from that because most of theirs are actually stimulating alterations. Coming back to David Hoffman then, so, definitely a west, you know, a UK trained herbalist. he says the alterative action is not understood. It appears unclear. The concept of blood cleansing is meaningless. they work as eliminative agents or by stimulating digestion function or as immunomodulators. So once again we've got that physiomedical idea of they clear toxins or they somehow help nourishment. Here he's talking about digestive function, but nourishment of tissues or that immunomodulator simply to, as it were, put, echinacea into its new category. And Yeah, Matthew, wood, in his six tissue states, puts alteratives as, alongside bitters and laxatives. So we've got that as treatment for a tissue state of torpor. Torpor, flabby, weak, undernourished tissues with accumulation of toxins. So we've still got that idea of clearing toxins.

Sebastian: The idea of excess really is talking about sort of a buildup and accumulation of what fluids, wastes, visible signs of excess, really.

Graeme Tobyn: Yeah, that's right. That's right. yeah, so that's torpor. Okay, so we still got that same theme running through, haven't we? The question is just which ones to use and for how long and at what dose. but Bartram, go to Bartram's, encyclopedia m. An alterative action. And you know this one because we, we touched on it last time, an alterative action has been succeed, superseded by the term adaptogen. A substance that helps the body to adapt to a new strain or stress by stimulating the body's own defensive mechanism.

Sebastian: I mean, linguistics are funny, isn't it? The description sounds quite good, but calling it an adaptogen, of course, confuses it with a modern. The modern description of what we term, adaptogens and the, whole sort of adaptive response. But yeah, I was very surprised to read that and hear that.

Graeme Tobyn: Yeah, yeah. I mean, it's hard to get your head around that because I did check, there's a paper from 2018 on herbal supplements used in sports. you know, and so, they are using a whole range of herbs, including the ginsengs and so forth, tribulus, terrestris, caffeine, you know, ephedra, of course, that's banned. and so forth, kn and others. so, you know, but the evidence isn't strong that these massively make a difference to sports performance. But there is evidence they make, you know, a small difference in some studies or a moderate difference in some studies. So they're definitely adaptogens.

Sebastian: Graemee, you're meaning what we would call adaptogens.

Graeme Tobyn: Yeah.

Sebastian: So not the misnamed alteratives as adaptogens.

Graeme Tobyn: No, we're talking about adaptogens. So, you know, so it's hard to imagine the alteratives. It's hard to agree with Bartram.

Sebastian: Yeah.

Graeme Tobyn: The alternatives we've just listed from priest and priest can be used by sports, by athletes, you know, to increase their strength and resilience in performance. But what is interesting is, of course, that conventional science doesn't recognize the term adaptogen in the same way that it wouldn't recognize the term alterative. These are kind of meaningless. There's no meaning behind that, you know, whereas we know what a diuretic means. M. and of course, someone like Varro argued that actually herbal diuretics should be called aqua retics because, you know, they don't do the same as drug diuretics. So we're back to that sort of semantic play. But yeah, neither of us, can quite agree with Bartram no language.

Sebastian: Is, you know, it's this whole basis on the history of herbalism. You know, modern medicine finding their own path and herbalists growing out of and potentially, you know, adopting some of that language as a need to be accepted, which is often the case in cultures, isn't it, to be accepted into the fold. You often adopt the language of the sort of dominant culture in a way. And I think that gets us into all sorts of problems. When we call things even an anti inflammatory or this whole area, we're using medical terms which perhaps herbs don't work in that way.

Graeme Tobyn: Yeah, I'm coming to that. But I would say over the period that I've been in practice, ah, and since, so from 1990, the BMA pamphlets that came out called us in the early eighties, sort of like mumbo jumbo workers. And then in the nineties, how to work with cam practitioners for the benefit of patients. But actually in the last couple of decades, ranks have completely closed. Ah, and in british medicine four can practice, I think, although acupuncture's in there and of course the manipulative therapies, osteopathy and chiropractic got statutory regulated. but to herbal and homeopathy, herbal medicine, homeopathy closed ranks. And I think COVID has now made the COVID pandemic has made it even worse. where cam practitioners are now linked in research papers I've seen with anti vaxxers. but here's the point.

Sebastian: I understand, yeah. That is going on and it is, that's not appropriate at all. The level of professionalism and scientific, artistic application of health, healing and medicine is superior. It's a great level that herbalists are trained to. So there's no need for this division of camps. I think there's a lot that each side can offer.

Graeme Tobyn: Yeah, I mean, you know, to be honest, it's because we sell medicines and that gets in the way of pharmaceutical profits. I think that's what the difference is. But yeah, I totally agree with you. We've got a lot to offer. But that's why I want us to be clear about what we say our herbs do. And not to dwell on things because traditionally they, we're described as that. but I do think, you know, here's my question. Does cleansing the blood, you know, to using, you know, make a person more resilient? My experience of practice is that, you know, where you have you know, I've had patients like this way where you have a patient who's had an acute condition and then suddenly they're going downhill, they're not getting over it, they're getting fatigued that, you know, you've got. You've got glands coming up and going down, sort of temperature and then disappearing again. That is exactly the kind of condition where actually some stimulating alteratives should be used in the mix, it seems to me. And so if that actually then, And I can think of one patient where that simply brought her back to the acute condition which she then threw off and she was healthy. You see, we might say that, chronic fatigue syndrome, long COVID, is a kind of chronic condition because they've never actually managed to bring, up, fight the condition off and it's still with them. Is that something you would agree with?

Sebastian: It is. I think it's almost like there can be a veil, if you like, or a layer that can block the body, absorbing the nutrition, the energy, vitality that is needed to throw off diseases. And I think that often you do need to, you know, cleanse the ground before it can be nourished and flourish. And, you know, you can use all sorts of metaphors of gardening or cleaning wallpaper off the wall and painting it with a primer and then putting the color on. But you need to cleanse the system for it to be fully receptive. And I do think that is time tested and proven in lots of ways. How strong you go in and for how long for. I think that is the nuance of practice. Perhaps that's changed over time to be more gentle in this, modern era. but I think it's fundamental. And just going in with tonics and adaptogens because people are tired or run down, it's strictly the wrong approach. It may be appropriate, but it shouldn't be your only route.

Graeme Tobyn: Yeah, that's right. That's too early to give tonics. You have to cleanse the system first, as you say. That's absolutely right. And, you know, that I think, that's clearly, born out in the longer tradition. If we go back much earlier than physiomedicalism or, ah, thompsonian medicine. and so when we do go back, there might be these herbs that we now call alteratives, but they run alongside what we now call stimulant laxatives. And these, of course, are things like senna, rhubarb, rams. these are on the gentle end of laxative. Compared to some of the cathartics that were used say, in Culpeppers day. and so yeah, just to give you some examples then Arthur Barker students, ah, at ah, the school of herbal Medicine, ah, used to get the Arthur Barker award. I got the Arthur Barker award and then years later I got his book, the Herbal Pocket prescriber, 1938, many prescriptions. I remember talking to Michael McIntyre about this, you know, he agreed with my observation that many herbs contain syrup of Senna. This was from the national botanic pharmacopoeia in the UK that was produced by Nim to be taken, however, in sub laxative doses. so although Senna was in a lot of Barker's prescriptions, that was in a sub laxative dose. And so that immediately reminds me of Rudolph Weiss's reducing tea for obesity. He says a strong laxative, a good diuretic and an antidiscratic drug such as dandelion or parsley, plus a carminative for a few days or a week at most. Then a long break. Now that's an interesting therapeutic strategy, I think. Do you know of that in the east, that kind of quick burst of a laxative and an anti, you know, sort of an alterative really. Dandelion or a liver herb and a carminative and a diuretic. and then a gap, you know. Do you, do you know of that particular approach?

Sebastian: It definitely would be part of either people would do it seasonally or as a, you know, routine. A routine part of beginning a treatment. definitely where you might be saying stronger at first, warn the client to be prepared. It's a week of treatment and that they need to be, you know, nearer home and easy access to people, bathrooms and things and then go on to treat that way. But you'd probably carry on with some gentle depuratives in ayurvedamids and often you're mixing tonics with cleansing herbs at the same time. So it's often that approach is used to optimize digestion, ensure that there is cleansing going on and nourish. You might do them all at the same time.

Graeme Tobyn: Yeah. And I think Simon Mills has talked about that in one of his books as well. Out of the earth, I think. yeah, there's a really great book in the history of medicine called, the woman beneath the skin. I can't see it on my shelf immediately, but it is a very well known book and what it does is describe the practice of a german doctor around the year 1800. It's sort of like maybe 1810 or whatever, because there was a massive change in an understanding of the body. So we talk about anatomy and physiology leading, to changes in therapy in that early 19th century period. So that, Because in the woman beneath the skin, the doctor is talking about all these women that come in, they want amenagogues and they want laxatives. And this relates to an older idea which, you know, was around in Culpepper's day. Ah, and right back, you know, to greek medicine where life is about things coming into the body and then moving out of the body. It's a flowing in and out of life. and you take things into the body and you've got to make sure that the waste from those is properly excreted, you know. so emmenagogues is a way of cleansing the womb, as it were. It's not, you know, fair enough, they were used to bring on abortion. But the more therapeutic idea about ammenagogues is that idea of things coming into the body and things coming out of the body. and so the same with, you know, laxatives and so forth, but from the early 19th century, so, you know, and it's not long before in the 19th century, we're into the victorian period. And so that victorian continent is the new thing and we still have that today, you know, when you, you know, the doctor will go, well, you know, the, the bowel motions of a patient, you know, we don't inquire too much as long as it's, you know, at least once a week or something. Yeah. You know, whereas your, your sort of your, your naturopath cleansers want that to be after every meal, you know, that's 21 times a week. There's a big difference there. But know, and so that reflects, that reflects the difference. And So that's an interesting point. And then it's not long ago, since we were all using these kind of herbs. Anyway, I interviewed Nalda Gosling about 20 years ago and of course her father was Charlie Abbott, who was one of the a well known, herbalist in, in the thirties and forties. He was revered in his hometown of Lee in Lancashire. and she learnt the use of vomits from, from Charlie Abbott, you know, and she remembers him taking, patients into a side room where there was a sink and you know, the teas would be you know, some kind of carminative tea alternated with lobelia. because of course, lobelia became the herb to use for bringing on vomiting. and she described a case that, she had herself of a guy with chronic catarrh. And so she instigated this vomiting treatment and he brought up this whole bolus of phlegm. And it's that. That, you know, was the source of his chronic guitar. If you don't get that out, the chronic guitar will never be, Never be, relieved.

Sebastian: And what you're saying maybe, is that expectorants just wouldn't cut it. If we're just using expectant on its own, that would take it to another level.

Graeme Tobyn: Yeah. I mean, you know, in the. In the sort of culpepper terms, expectorants are hot and dry because they cut up the phlegm into smaller pieces. That can be, you know, brought up by the ciliary transportation mechanism, but a big load. You can't, you know.

Sebastian: Do you, think there's something, Graemee, I could just ask about this discussion of depuratives and alteratives that was tied up with the cultural view that the flesh is the seat of sin or, problems, shall we say. And that you always needed to cleanse the flesh. And that therefore some of these stronger treatments was, you know, particularly we talk about heroic treatments, sort of medicine's got a bad reputation for the 19 hundreds or whatever. But, Do you see something cultural coming in there? Because there's obviously a very physiological need. But there's also seems like there's a cultural pressure as well to be cleansed.

Graeme Tobyn: Yeah, that's a really good point, Sebastian. I mean, I know people who, they were part of a spiritual group. So it is sort of vaguely christian. But there was this. They regularly took, liver cleansers. And then they're trying to identify all these stones that they're getting out of the gall. And this is obsession. This is pathological. So I think there's a danger with this idea of sin that people are going to, are going to scourge the flesh, you know, because, of course, life, you know, these transcendental religions are all about life in the hereafter. And this is a world of suffering. Whereas, I'm sure you and I know that, Imagine, you know, there's no heaven. It's easy if you try, no hell below us, above us only sky. Imagine all the people living for today. You know, that's. Yeah, that's where I'm coming from. Yeah.

Sebastian: Yes, yes.

Sebastian: It's an interesting area to explore, though, isn't it? Because it is a big thing in our culture, detoxing and cleansing, obviously. dieting and just sort of an area to be caught conscious of as a practitioner. I think that there is a need to cleanse, but there's not a need to only cleanse, just as there is a need to not only tonify is that sort of.

Graeme Tobyn: That's right. It can get out of hand. You're absolutely right. Yeah.

Sebastian: I mean, calling for vomiting therapy and laxatives. Graemee.

Graeme Tobyn: the old hippocratic rule was that if the problem sat above the navel, you used vomit, and if it sat below the navel, you used cathartics or laxatives. I mean, I myself, I remember very, early, I might even have still been a herbal student. I did a weekend fast. I dug up doc root, boiled it up and drank that. It was disgusting and it didn't do much good. But I did do a three week bowel cleanse some years later. I don't know if you've ever done that. I, was taking these capsules of cascara, sagrada and chamomile, and I would increase the dose every day, until, you know, I was. It was just coming out. And then I think I pulled that back by one capsule. And then in the second week, I took apple pectin to sort of like, you know, supposedly cleanse the bowel. And then in the third week, you stopped the stimulant laxatives, but you moved on to a bitter, in this case, berberis aquifolium. After three weeks, I felt great, I must say. You know, and there was a clear limit to that. And I only ever did it once. but, you know, there are some benefits to all of that. I don't know if you've ever done that.

Sebastian: Oh, Graemee. I've done all sorts of cleansers and panchakarma and strong laxatives and all sorts of yogic treatments many, many times. And, I, find them very useful, particularly like a seasonal thing. For me, it's like a sort of rhythm and, following the cycles of nature in a way. And you can see when the green shoots come up in the spring, we mentioned, you know, nettles and the parsley and cleavers. I like following that cycle. So, not necessarily heroic levels, but I'll do something at home. I've done things therapeutically with doctors in India, and, I think it's an important part of rejuvenating your system is to give it a break for a while. And that this wisdom, under whatever language we call it, has really taught us lots to understand how to help ourselves and our fellow clients, and, family, etcetera. So I think it's just understanding the nuance of the herbs and their level of strength in relationship to the strength of the person is a crucial area.

Graeme Tobyn: yeah, that's so hippocrates said, medicines purge and age. and in fact, I discovered this only a couple of years ago, that, Avicenna actually pushed himself to death. He was ill and he kept on taking these. So when you look at culpepper's key to Galen and Hippocrates method of physic, there are very strict rules about using vomits, ah, ah, particularly, and of course, the doctors of his day, you know, well, some of those cathartics were very dangerous, if not used correctly. You know, as he points out in his translation of the pharmacopoeia, the.

Sebastian: Largest over the sale counter, of herbal medicine is still Senna and, cerebral and things like that. They're still the biggest, solutions people turn to. And, you can see there's a need in society for that cleansing. We live in a sort of excessive time of consumption, but also perhaps not understanding how metabolism works as well as you might if you've been brought up to learn some of those things. And I think herbalism teaches you how our metabolism works so brilliantly and how you can be empowered as an individual to take control of some of those natural functions.

Graeme Tobyn: Yeah, and of course, you'll find senner in the BNF, the, british national formula. But here's the point, Sebastian. you know, my impression is that western herbalists are using laxatives less and less, but still retain alteratives. And for me, that doesn't make sense. Alteratives should be what comes after the more dynamic cleanse that can be achieved with laxatives. So to drop stimulant laxatives, but to retain alteratives seems to me a retreat into. I don't want to cause too much trouble here, because I'm, Whereas in fact, there'll be lots of indications and, ah, as you say, it's a big seller here. you know, it's one of the big sellers in unani tib, medicine.

Sebastian: It seems that the public want it, but herbalists aren't using it from what we're saying, you know, it's very popular. If you go down to boots, you can buy your senna or whatever with your health food shop. So what's going on, do you think amongst us herbalists and teaching the way we're taught, is it a confidence thing? Is it the client or.

Graeme Tobyn: It's a confidence thing and it's not seeing it actually in practice, you know, in the training clinics or whatever, you know. And the same is going to be said about schedule 20 herbs. I know that the CPP, are now writing up their recent, ah, seminar on that and I'll be interested to see what they say. But there's, you know, that's a different category, of course, because, those are toxic in a different way. but there is this danger of retreat from anything that is really meaty, whereas that isn't the case in eastern medicine.

Sebastian: No, certainly not. And Iverda, you're definitely taught how to purge and cause a mesis and further cleanses sweating therapy as well. We mentioned that. so you're definitely taught that how much it's practiced over here. I'm not so sure. That might be done more culturally, but there's definitely a place for them. And you know, I laud you for raising the fact that we could be, we haven't got so much choice perhaps with the diuretics. So clearly the stimulant laxatives are a bit more obvious, but I suppose they call some cleansing of fluids naturally. Anyway, so you're that way.

Graeme Tobyn: Yeah, that's right. and so there is, you know, just to remind people that there's that older idea of life flowing in and out of the body and that circulation has, to be encouraged. So just moving on. Actions of herbal medicine. So contextualizing the cook rights, for instance, when a scrofulous case is connected with the torpor of the liver and great laxity of the general system. See that careful evaluation of the patient in sort of like tissue terms, it will not be sufficient to direct such lack relaxant of promoters of pseudoresis, that sweating and urination as ah, arctium and solastrus, which is false twitter sweet. I don't know that. but such hepatics and tonics as sarsaparilla and gentiana become necessary. So there's a, you know, cook, is showing that there's, you know, you have to differentiate between your alternatives. and alteratives is just one of the categories. In priest and priests there are stimulants, relaxants, astringents, alteratives, tonics, nervines. And the general category not really containing sedatives, which of course is a challenge for certain orientations within physiomedicalism, diuretics, diaphoretics, demulcents, organ and then organ remedies. Cook, in his physiomedical dispensary, has stimulants, cathartics, diaphoretics, diuretics, alteratives, emetics, emmenagogues and parturients, demulcents and escharotics. The point there is that in both those lists, apart from the antispasmodic, there are no antis, anti diabetic, anti inflammatory. And so it's a real shame that we've slotted into a sort of a, conventional medical idea that anti, that sounds like suppressive, when in fact we're supposed to be bringing things out, you know, and not suppressing.

Sebastian: So anti the anti movement. I'm with you. I don't think it gives a very clear descriptor of how a lot of plants are working in the system. Actually. They're not normally antioxidants.

Graeme Tobyn: No, that's right. That's right. If we go back to Culpepper's time, here's Culpepper's list. from, again is key to Galen and Hippocrates method of physic. emollient hardening, loosening, making thick and thin. That's the humours in the blood, opening the mouths of vessels. that's heat to push things through, which could be a circulatory stimulant. or in other organs. For instance, the cutting effect of alteratives, I think. Sorry. of expectorants, attenuating, drawing and discussing, repelling, burning. That's the escharotics, cleansing plasters, glutinative, suppurative, diuretic, amenagogue, lactagogue. Herbs to increase seed, herbs easing pain, herbs breeding, flesh, scarifying, resisting poisoning, purging. there's no anti there, you know. So, you know, if we're talking about language, we're increasingly using the wrong language in western herbal medicine to describe what the herbs do. And I imagine that's because we lack, a sort of, you know, a philosophical underpinning that gives us a clear set, of treatment strategies. so I've mentioned priest and priest, of course, and they didn't have, they didn't have, laxatives in there, or emetics. But I've also got here, Albert Priest's. What are they? study notes to accompany studies in physiomedicalism. Papers, one to five. These are dated 1959 to 1963. So these are pretty early on, you know, in terms of our modern, western herbal medicine. And the laxatives are in there. So between, you know, the early sixties and 1982, we seem to have lost something. You know, we've needed to.

Sebastian: Conform a bit more and to fit into a medical world is part of this complex, in a way that because we're marginalized, you need to speak the language of the dominant culture. And so therefore you adopt that style to fit in.

Graeme Tobyn: Yeah, yes, it probably isn't before 1982. It's actually the modern movement towards statutory regulation. And so we have to, we have to be scientific and fit in there and cozying up to conventional medicine. And there was a little bit of cozying up, but then the quack busters got in, and got rid of all the courses in higher education. Ah. And now we're aligned with anti vaxxers, in their view. so that's really what's happened there. And as the Walker report states, we're not practicing scientifically, but traditionally. So let's practice traditionally. Let's forget this whole, you know, cozying up to science up. We do need to understand the body, and our medicines, but we need. It has to be more than pharmacology, it has to be more than anatomy and physiology as, ah, delivered by conventional medicine. It has to be more than that.

Sebastian: You know, I think about being rooted in the plants and in the patient, in the person, isn't it? To really connect them. And that traditional language is already developed for us and that delivers in a, in a clinical setting. I think we need to be able to have conversation and dialogue with other, other traditions, other practitioners, don't we? So it is important to understand, as you're saying, how the body works, etcetera, of course. But I think we should be proud of our heritage and we should be confident in what the teachers of the past have guided us towards, basically. And I really, I've loved our chat, Graemee. I really support your view that we could be using more of these, you know, stronger class alteratives, should we call them, and rejuvenate, that whole alterative category as the leading light in herbal treatment that I really think it stands for.

Graeme Tobyn: Great. Yeah. Yeah. Amen.

Sebastian: Let's carry on the conversation. Thank you so much for your work, Graemee. You offer so much to herbalists and healers around the world, your insight historically and obviously teaching, the university. So please carry on the great work. We love hearing from you.

Graeme Tobyn: Well, thanks for having me on this podcast. Sebastian, great to see you again.