Herbs for cleansing: The Alteratives, with Graeme Tobyn

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.