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Recent anthropological research has led to the astounding conclusion that traditional medicine has most probably a longer history than humanity itself: Our closes non-human animal relatives, the apes have demonstrated to use medicinal plants for the treatment of diseases.Moreover, human populations that settle in the same region as these ape populations use the same plants with very similar indications.The transfer of medicinal knowledge from animals to humans has been documented e.g. for the plant Vernonia amygdalina Del..Chimpanzees ( Pan troglodytes ) have been observed on numerous occasions to chew on its bitter pith as self-medication in case of parasitic nematode infections. Traditional healers of the WaTongwe people of the Mahale Mountains in Tanzania, where the use of V. amygdalina by Chimpanzees has also been observed, use this plant for intestinal parasites, diarrhoea,and stomach upset. Phytochemical research has demonstrated that sesquiterpene lactones in V .amygdalina possess anthelmintic, antiamoebic,antitumor, and antibiotic properties.
Current understanding thus hints at a long-term co-evolution between man and his food and medicinal plants, resulting in the adaption of human biology to pharmacologically active plant metabolites. The fact that already Neanderthals 50,000 years ago used yarrow( Achillea millefolium ) and camomile ( Matricaria chamomilla ) — two staple plants of European Phytotherapy still registered as medicinal plants in the European Pharmacopoeia — as well as poplar buds ( Populus spec.) [2–3] as medicine,demonstrates that contemporary practice of European Phytotherapy goes back to the dawn of man and the earliest native inhabitants of the European Continent.
In the 1950s, a 60,000 years old grave was discovered in Iraq. The dead were laid out in tufts of plants. A laboratory analysis showed that the heaps of plants consisted of more than 25 different medicinal plants, which are still used today. These included plantain (Plantago),yarrow (Achilea), mugwort (Arthemisia) and flakeflower (Centaurea). Even though this find does not provide clear evidence of such an early dating of herbal medicine, it is a first indication of the use of medicinal plants.
As humans and their closest ape relatives are able to learn successful behaviours, such successful systems of information become transferable from person to person. The accumulated body of learned knowledge that has been established within a population canbe referred to as the “tradition” or “culture” of the respective population. Through individual variation, innovation and learning from other populations on the one hand and empirical selection on the other hand, the basic principles of Darwinian evolution apply to the “culture”of a population in the same way as they apply to the genome. The process of the improvement and distribution of this knowledge can therefore be referred to as “cultural evolution”. As far as traditional medicine is concerned, the evolutionary pressure that drives this culturalevolution is the survival benefit for tribes with knowledge of effective treatments.
By 9000 BC, the cultural evolution of humans in Europe had resulted in the construction of the first archaeologically attested buildingsof mankind, of temples of Göbekli Tepe [4] .Although the archaeological evidence indicates that these first ritual places were still constructed by hunter gatherers, the development of agriculture follows soon afterwards, allowing the construction of the first permanently inhabited cities in Mesopotamia especially in ancient Sumer, where in the late 4 th millennium BC Sumerian Cuneiforms were developed,making Sumerian the first written language inthe world [5] .
Whereas previously, in the earliest phase of the cultural development of the anatomically modern humans, all cultural knowledge had to be passed down from the elder to the youngergeneration via direct personal instruction — as process that to this day forms the cultural basis all medical knowledge of contemporary hunter gatherer cultures but also of the so called “folk medicine” of civilized nations. The process of cultural evolution was now greatly enhanced by the written word, as written knowledge could be stored and transmitted without personal contact to its originators.
Even in the early Sumerian civilization,medicine had developed considerably. The Sumerian word for a medical doctor was “a zu” or “ia’-zu” and first medicinal herbs were listed in 4000 BC. Much of our knowledge of ancient Sumerian medical practices comes from cuneiform clay tablets, many of which are prescriptions for medicine [6] . One of the oldest known ancient Mesopotamian medical texts is a collection of 15 prescriptions, written in Sumerian, on a clay tablet, which dates from the Ur III period, or Sumerian Renaissance (2112–2004 BC). Common ingredients of these prescriptions were sodium chloride (salt),potassium nitrate (saltpeter), milk, snakeskin,turtle shell, cassia ( Senna alexandrina Mill.),myrtle ( Myrtus communis L.), asafoetida ( Ferula assa-foetida L.), thyme ( Thymus vulgaris L.), willow ( Salix purpurea L.),pear ( Pyrus communis L.), fig ( Ficus carica L.), fir [ Abies cilicica (Antoine & Kotschy) Carrière], and date ( Phoenix dactylifera L.) [7–8] .Most of these plants with almost 5,000 years of documented empirical knowledge of their therapeutic value are to this day commonly used in European Phytotherapy and found in many European Pharmacopoeias.
The knowledge of medicinal plants was also woven deeply into Sumerian mythology.In the epic mythic narrative known to modern scholars as “Enki and Ninhursag” the god Enki strives to “know the hearts” and the “destiny” of each of eight plants by ingesting them, names the body part that each plant is associated with, and creates the gods that are each associated with the respective body part.The mythical eight triplets of plant, human organ, and deity illustrate how pharmaceutical treatments of physical afflictions may have been formulated based on the symbolic attributes of plants, as well as the empirical observation of ameliorative effects. The myth —at the very least and in what is probably its most pragmatic reference — celebrates the collaborative production by Ninhursag and Enki of a pharmacopeia of herbal remedies.Their medical efficacy is ensured by the links that associate eight plants, eight pains, eight body parts, and eight deities in a homologous system partially underwritten by the proposal of etymological connections — even though none of these eight Sumerian plant names could be clearly identified as any specific species. All in all, the close similarity between the Sumerian myth of the creation of herbal medicine and the equivalent Chinese myth of Shen Nong is especially interesting: both the gods Enki and Shen Nong eat or taste plants and thereby determine their previously occult properties;both suffer sickness as a consequence; and both give rise by their efforts to a body of herballore that has eminently practical, medical use in their respective communities.
Sumerian civilization — which had largely been supplanted by Akkadians by the 19 th century BC — functioned as a model for numerous subsequent civilizations in the ancient Near East (like Akkadians, Hurrians,Assyrian, Hittites, Urartians, Persians, etc.),who copied and adapted the Cuneiform writing system as well as much of Sumer’s mythology,and cultural institutions including its knowledge of herbal medicine.
Amongst the other ancient civilizations of the Fertile Crescent, Egypt stands out as significantly more independent from Sumer than any other. Thus, whilst die idea of writing may have been transmitted to Egypt from Mesopotamia, the Hieroglyphs themselves,that first appeared almost in parallel with the first Cuneiforms in the 31 st century BC, are clearly an independent development and not an adaptation of the latter, in contrast to the writing systems of most other civilizations of the ancient Near East. In contrast to the Sumerian and the later Mesopotamian Traditional Medicines, the archaeological record of which is rather fragmentary, several volumes of ancient text books on Egyptian Medicine have survived. Amongst numerous surviving medicinal papyri, the Papyrus Ebers that has been dated to around the year 1550 BC is both the most extensive and also the one most concerned with herbal medicine, containing already 877 specific prescriptions of mixtures of herbal drugs for specific indications, in the same style as a typical European Phytotherapy prescription in our time. Common medicinal plants mentioned in these prescriptions are i.e. castor ( Ricinus communis L.), olive tree ( Olea europaea L.), pomegranate ( Punica granatum L.), myrrh [ Commiphora myrrha (T.Nees) Engl.], and frankincense ( Boswellia sacra Flück.). In many cases, the traditional indications of these plants are still the same as in European Phytotherapy today.
Together with neighbouring Israel, Egypt should function as the major transmitter of medical knowledge from the Bronze Age civilizations of the ancient Near East to the Mediterranean Iron Age civilizations of classical antiquity. Especially in the case of Israel, the amount of medicinal plants that were included in the Bible cannot be overstated.Although these plants are only rarely described in direct relation with their medical application —in a few cases like for example the “Balm of Gilead” [9] , the labdanum resin of Cistus creticus L., or poultice of figs ( Ficus carica L.) [10] their use for the treatment of wounds, boils and abscesses is directly mentioned [11] — their inclusion is of high symbolic importance as these plants became meaningful due to their healing power being reminiscent of the holy power of god. This analogy become even more meaningful when one remembers that the words“healing” and “holy” in English and most European languages are derived from the same linguistic root.
As far as their medical proficiency is concerned, the Greek and Roman civilizations of classical antiquity can largely be regarded as one. Both were heavily influenced by Egyptian medical practice and knowledge, which was easily accessible on the opposing coasts of the Mediterranean. The Greek historian Herodotus visited Egypt around 440 BC and wrote extensively of his observations of their medicinal practice [12] . In the 5 th century BC,Alcmaeon of Croton developed humoralism.This philosophical system which was further developed by Empedocles (c. 494–c. 434 BC) classifies not only the workings of the human body and the relevant medicines for its treatment, but also the surrounding world, thus linking Macro- and Micro-Cosmos. This system should remain on European Phytotherapy and all forms of Western Medicine not only for all major ancient physicians and philosophers but for the entire West until the 18 th century AD.
Hippocrates of Kos (c. 460–c. 370 BC) is often referred to as the “Father of Medicine” in recognition of his lasting contributions to the field as the founder of the Hippocratic School of Medicine. His school revolutionized medicine in ancient Greece and established medicine as an independent science and profession distinct from theurgy and philosophy. The Hippocratic Corpus (Latin: Corpus Hippocraticum), is a collection of around 60 early Ancient Greek medical works strongly associated with Hippocrates and his pupils. The Hippocratic Corpus became the foundation for which all future medical systems of the West would be built. A significant portion of the Corpus is made up of case histories that were supposed to function as model cases later doctors to base their own therapy on. It further contains theoretical and methodological reflections in the framework of humoralism, treaties on medical ethics and manners — the main guiding principle being “at least to do no harm”, and theories on the formation of urinary tract stones,amongst numerous other topics. Most famously,this work contains the “Hippocratic Oath”,which later found application around the world.
The Romans built extensively on the work of their Greek forbearers. Based on Greek concepts and thought systems, Roman scientists accumulated the knowledge from all parts of the vast Empire into extensive reference books that should remain the standard of the field for more than 1,500 years. Pedanius Dioscorides(c. 40–90 AD) was a Greek physician employed in the Roman army, who authored a 5-volume Greek encyclopedia about herbal medicine and related medicinal substances (a pharmacopeia) entitled “De Materia Medica”(Ancient Greek: Περὶ ὕλης ἰατρικῆς, On Medical Material). In all, about 600 plants are covered, along with some animals and mineral substances, and around 1000 medicines made from them. This work became the precursor to all modern pharmacopeias and formed the basis for European Phytotherapy drug therapy throughout the Middle Ages well into the 19 th century, suggesting that “the timelessness of Dioscorides” work resulted from an empirical tradition based on trial and error; that it worked for generation after generation despite social and cultural changes and changes in medical theory” [13] . Aelius Galenus (129 AD–c. 216 AD) was a physician and philosopher in the Roman Empire. Arguably the most accomplished of all medical researchers of antiquity, Galenus influenced the development of various scientific disciplines, including anatomy, physiology,pathology, pharmacology, and neurology, as well as philosophy and logic. Galenus’ main field of excellence, however, was surgery,and he accumulated a vast amount of clinical experience in the treatment of gladiators. Just as Dioscorides on the field of pharmacognosy,Galenus should remain the commonly accepted scientific standard for 1,500 years.
Table 3–2 Relationship of Humor to Temperament
After a long time of scientific, cultural, and military progress, the Roman Empire entered a state of perpetuated crises in the 4 th century AD.With all of the Mediterranean under Roman control and past conflicts with concurrent powers slipping from living memory in during the long “Pax Romana”, human desires for glory directed itself inwards and slowly against the cultural foundations of the empire itself.The “mos maiorum”, the “ancestral custom”that Roman social order hat been based upon as an axiom — not provable but not requiring any proof — more and more under scrutiny.The ability of the “mos maiorum” that had traditionally grown through cultural evolution to preserve and define a Roman identity even within changing circumstances permitted the expansionism of Rome from a city-state to a world power [14] . The preservation of the “mos maiorum”, however, depended on consensus and moderation among the ruling elite whose competition for power and status threatened it [15] . When larger parts of the Roman elite began to convert from their ancestral religion to Christianity in the late 300s, the Consul Quintus Aurelius Symmachus argued that Rome’s continued prosperity and stability depended on preserving the “mos maiorum”. This, however,was dismissed by his “modern” critics as blind adherence to a tradition as “the superstition of old grandpas” and inferior to the newly revealed truth of Christianity [16] .
By the late 5 th century, the Roman Empire had largely disintegrated. Western Europe had fallen to Germanic tribes from the North, who established new kingdoms that soon came to be defined by their specific amalgamate of Germanic and Roman culture, thus laying the foundation for the later development of the current nations of Europe. Whilst the southern half of the Empire should soon fall to invaders from Arabia, in the Greek speaking NorthEastern Portion of the Empire a continuous Roman government survived for more than 1,000 additional years. Commonly referred to as “Byzantine Empire” after its capitol city Byzantion, this state should serve as both a source for books, practical expertise in medicine, but also herbal raw materials as trade goods for many centuries to come. Latrosophia,“medical wisdom”, is a genre of Byzantine medical literature that comprises medical handbooks containing recipes or therapeutic advice, many of which were produced during this period [17] .
In the kingdoms of the West, the Catholic Church established itself as the major guardian of both the accumulated body of knowledge on the continent, which included most fields of science and medicine. In the scriptoriums of the monasteries, the medicinal works of Roman times were meticulously copied, serving as the foundation for the practice of Monk physicians in the hospitals that accompanied the monastery. This era and line of tradition of European Phytotherapy is therefore also referred to as “Monastery Medicine” [18] . In the year 800 AD, the Frankish king Charlemagne managed for the first time since 400 years to organize an imperial government that controlled a major portion of the continent. This Carolingian Empire is commonly considered the first phase in the history of the Holy Roman Empire, which lasted until 1806. It played a prominent role in the spread of both Christianity and Graeco-Roman based civilization to the north of Europe. The Carolingian monasteries gardens cultivated many medicinal plants from the Mediterranean that had previously not been found in the north, thus adapting these plants over generations to the colder climate.The surviving architectural plan of Saint Gall Monastery in Switzerland dating from 820–830 AD documents a dedicated cultivation area called “herbularius” for 16 species of medicinal plants. All plants listed in the plan are derived from the plant list of the “Capitulare de villis”,a royal decree of Charlemagne (c. 768–814) pertaining to the governance of his royal estates.This document contains a list of 73 herbaceous plant (mostly medical herbs) and 16 fruit trees,which were to be cultivated in all imperial estates. Many of these estates were located in the territory of present day Germany, to which many of these medicinal plants from the South —but also fruit trees like fig, almond, and sweet chestnut — were introduced for the first time.With the works of Dioscorides accessible in many monastery libraries, European Phytotherapy as it had developed in Rome had soon successfully been transplanted to the entire continent.
It must, however, be emphasized that the spread of Monastery Medicine northward through and beyond the Carolingian did not enter a vacuum. Through the Northern European woodlands, Germanic and Celtic traditional healers possessed a vast knowledge of the medical properties of the native flora but without a literary tradition, this knowledge could not a preserved and systematized in written form. After the establishment of Monastery Medicine, however, the stage was set for the integration of these plants into the therapeutic framework provided by Dioscorides and Galenus. One of the most prolific contributors to this process was St.Hildegard of Bingen OSB (1098–1179), a German Benedictine abbess, writer, composer,philosopher, Christian mystic, herbalist, and polymath. Her books Physica (Liber simplicis medicinae) and Causae et curae , published c.1160 AD, not only quotes Roman sources e.g.Dioskurides but also includes much previously only orally transmitted Germanic folk medicine,adapted to the style of Roman herbals and the principles of humoralism [18] . Many plants that are staples of European Phytotherapy today first entered the written tradition in St. Hildegard’s works, e.g. Calendula officinalis L. which is still used today in many skin ointments, and Arnica montana L., which is generally in use for its analgesic and anti-inflammatory effects.
In the subsequent centuries, European Phytotherapy remained largely set in the framework that had evolved in Monastery Medicine since the fall of the Roman Empire.However, as time went on, the practice of medicine shifted more and more from the monasteries to secular, commercial doctors who had studied medicine — largely with the same texts as the monks — at secular medicine schools and universities. The most influential of these schools was the Schola Medica Salernitana, the medical school of Salerno in Southern Italy. Founded in the 9 th century,the school, which was originally based in the dispensary of a local monastery, achieved itsgreatest celebrity between the 10 th and 13 th centuries,when it developed its own form of the Greek-Latin tradition supplemented by knowledge from Arabic and Jewish sources. Matthaeus Platearius,a professor at Salerno, wrote the Circa Instans (also known as The Book of Simple Medicines ), an alphabetically listed textbook of simple herbal prescriptions that was based on Dioscorides and describing the appearance, preparation,and uses of various drugs. His contemporary Constantinus “Africanus” (died before 1099) contributed immensely to the import of medical knowledge from Arabic sources into European Phytotherapy. Born in Tunisia where he received a profound education in the Arabic interpretation of Hippocratic Medicine,Constantinus later converted to Catholicism and became a professor at Salerno. Here he compiled a vast opus of textbooks, mostly composed of translations from Arabic sources such as Razes, Ibn Imran, Ibn Suleiman, and Ibn al-Jazzar. His textbooks remained in active use until 17 th century.
In Western civilization the transformation from the Middle Ages to the Early Modern period is typically defined by two events: 1) The invention of the printing press with movabletypes by Johannes Gutenberg in 1439 and 2) the discovery of the Americas by Christopher Columbus in 1492. Both events had major implication for the development of European Phytotherapy, as medical books could now be printed and ideas could thus spread much faster throughout the population. These ideas also included numerous medicinal plants that were introduced to Europe from the Americas..One of the first herbals that found mass market in print was the 1542 De historia stirpium commentarii insignes (Notable Commentaries on the History of Plants) by Leonhart Fuchs (1501–1566). In contrast to previous areas that printing press allow for the immediate translation of workinto the common German tongue as New Kreüterbuch . Just during Fuchs’lifetime the book went through 39 further printings in Dutch, French, and Spanish and 20 years after his death was translated into English.The work covers ca. 500 plants over 100 of which were firstdescriptions and has woodcut illustrations for almost all plants [19] . It set a new standard for accuracy and quality, as well as being the first known publication of plants from the Americas, such as chili pepper ( Capsicum annuum L.), pumpkin ( Cucurbita pepo L.),or marigold ( Tagetes erecta L./T. patula L.),all which were permanently integrated into European Phytotherapy
However, the Columbian exchange did not only bring new plants to Europe but also new diseases.Although the presence of syphilis in Europe before Columbus has been theorized, at least the emergence of the most virulent strain coincided with the aftermath of the discovery of the Americas and was perceived to be causally connected [20] . Often, the cure for the disease from across the sea was sought after in imported drugs from the New World as well. The German knight and religious reformer Ulrich von Hutten (1488–1523),who suffered from the syphilis of which he would later die for the final 15 years of his life, wrote the book De morbo Gallico in 1519, about his symptoms and his treatment with Guaiacum ( Guaiacum officinale L.).His text is regarded as one of the first patient narratives in the history of medicine [21] . Today, Guaiacum is a common ingredient in European Phytotherapy cold medicines.
The use of Guaiacum for syphilis therapy,however, was not without controversy. The Swiss alchemist, physician, and a philosopher Paracelsus (1494–1541) — born as Theophrastus von Hohenheim — was highly critical of its use and instead recommended mercury compounds derived from Alchemy, which he used with much success. He is credited as the “father of toxicology” [22] . His school of medical thought(Paracelsianism) that was continued by his pupils long after his death displayed a strong influence of Alchemy and a high respect for the herbal folk medicine of the common people that was unusual for university educated doctors of his time. Paracelsus thus, emphasized the value of experimental observation in combination with traditional knowledge. This duality of Paracelsus’ work, alchemical medicines based on minerals and often heavy metals on the one hand and herbal medicines from folk medicine with much emphasis on the distillation of pharmacologically active volatile oils on the other, should later lead to a major schism in the history of medicine in Europe.
After the works of Dioscorides and Galenus had stood for more than 1,000 years as the state of the art in medical practice, their position was seriously challenged during the Renaissance. In his 1628 book Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (Latin for “An Anatomical Exercise on the Motion of the Heart and Blood in Living Beings”) the English physician William Harvey(1578–1657) demonstrated the circulation of blood through the human body by the pumping action of the heart. His experimental evidence clearly disproved the views of the two ancient authors the new blood was constantly processed by the liver and waxed and waned through the arteries like the tides in the ocean. In the wake of the “Enlightenment”, a general crisis of belief in all European cultural traditions during the 17 th to 19 th centuries, this refutation of major basic assumptions of both Monastery Medicine and Alchemical Medicine called all traditional medicinal practice into question in the eyes of many contemporaries. The Enlightenment included a range of ideas centered on the “sovereignty of reason” and the“evidence of the senses” as the primary sources of knowledge [23] . This mindset gave way to vast variety of new forms of medicine —all based on the latest “scientific evidence”and “reasonable” theories about human physiology. However, as the latest “scientific evidence” and what seems “reasonable” were constantly changing, each decade brought a new “innovative” and “enlightened” school of medicine, that was a few decades later as quickly forgotten as it had emerged. European Phytotherapy was thus more and more replaced by diverse new forms of treatment that were not based on traditional knowledge but on purely theoretical speculation. Of the numerous medical systems developed in the Enlightenment, only chemical synthetic“scientific medicine” or “biomedicine” and Homöopathie have flourished to this day. The latter forms the basis and precursor of wide variety of today’s “alternative medicines” such as “anthroposophical medicine”. As “alternative medicines” are not based on traditional empirical knowledge but on a “philosophical interpretation” of disease and medication,they must not be confused with European Phytotherapy, which is based on the written traditional empirical medical knowledge alone.
The triumphs of “scientific medicine”or “biomedicine” over the past two centuries shall not be denigrated or denied. In contrast to infectious diseases — the non plus ultra success of scientific biomedicine — which scientific reductionism can easily be reduced to a singular cause — namely the causative microorganism —chronic conditions have no singular cause but are the result of a complex multitude of interconnected conditions and thus almost untreatable with the synthetic single compound drugs of scientific medicine. This has resulted in a renewed interest and popularity of European Phytotherapy in the population since the post war period.
The preservation of European Phytotherapy into the present era would, however, not have been possible without the engagement of many traditional practitioners who fought for the preservation of the European medical tradition in an age when governments and large parts of the public had grown hostile to ancestral customs that were dismissed by “modern”critics as blind adherence to tradition and pseudoscientific superstition, inferior to the new discovered truth of scientific materialism.
Amongst those who fought for the preservation of European Phytotherapy in the 19 th century Sebastian Kneipp (1821–1897) is clearly the most prominent. Kneipp was a Bavarian Catholic priest and is most commonly associated with the “Kneipp Cure” form of hydrotherapy. The importance of Hydrotherapy in Kneipp’s medical work should also not be overvalued, as this approach only formed the 1st of 5 “columns of health” the others being Exercise (promoting health of the body through physical training); Nutrition (a diet of whole grains, fruits, vegetables; explicitly including a however limited amount of meet); an Ordered Lifestyle (a health person needs a healthy mind,for Kneipp personally this meant traditional Catholic spirituality), and last but not least Phytotherapy (traditional botanical medicines was another of Kneipp’s fields of expertise).The integration of Catholic spirituality as well as the integration of a majority of its herbal drugs put the Kneipp school of European Phytotherapy thought into the direct line of tradition of earlier Monastery Medicine. As a Catholic priest Kneipp did not have a medical licence that a modernist government could have taken away. With the increasingly prominent success of his practice many university educated medical doctors joint his school of thought and lead to a much higher acceptance of European Phytotherapy in the medical community of German speaking Europe than in most other areas of the continent [24] .
This higher acceptance of European Phytotherapy in German universities later facilitated the scientific research into the pharmacological effects of its prescriptions and practices with the aim of both a general scientific understanding and further practical improvement of traditional practice [1] .
The fact that European Phytotherapy is today accepted in German and European law as one of three “particular therapeutic systems” — the other two being homeopathy and anthroposophical medicine [25] . According to AMG (German health law), these traditional medicinal products distinguish themselves from other medicinal products in that their efficacy is exclusively based on traditional use. Provided with this secure legal framework European Phytotherapy is in a good position to take a place amongst the great traditional medicine systems of mankind, just like Traditional Chinese Medicine on the opposing coastline of the Eurasian Continent.