from the outset while in the latter, time and the patient will tell.
Traditional Humoral theories have taken this approach but as they were developed before microscopic techniques they relied almost entirely upon inference and apparent homologies: they were unable to see the detail behind the detail. If we are able to understand the degree to which human perception is dictated by scale, it should become easier to generate models which unite structure and function in a way that is less metaphorical and less likely to ascribe symptoms to cosmic meaning. The flowering of modern physiology derived from interconnected analyses permits us a glimpse below the surface phenomena.4 Old habits die hard, however, and it may seem more relevant to concentrate on the effects produced in the patient by “The heartache and the thousand natural shocks that flesh is heir to”5 rather than on her or his capacity to emerge into health.
The limitations of the model
This work inclines to observational description rather than scientific analysis but I hope that I shall at least be judged to have followed the three guiding principles: relevance of observation, coherence of argumentation and economy of interpretation (Occam's razor) in such a manner that the model is consistent with existing science and that it is capable of generating testable hypotheses.
The most cogent argument against ancient humoral theory (as it may be against psychoanalysis) deplores the range of interpretation available to explain the symptoms of a patient. Reliance on subjective inferences runs the risk of developing strategies that depend for their success too much upon chance. It does not help the patient for us to disavow modern mechanistic approaches until we find a way of accepting the limitations as much as the strengths of our own models as a route towards therapeutic efficacy. The extraordinary insights into biology made by systems theory, complexity theory and other models of self-organisation should not blind us to the difficulties of making them clinically useful.
There is, of course, a converse trouble with falling back on what might look like the solid ground of a naive reductionism that seeks a single explanation for a condition. It too is subject to flukes and placebos as well as failures. Where is the patient expected to go when the statutory strategy fails, or when the “condition”, though acknowledged as multifactorial, derives from an unknown cause? It is common to find as much naive reductionism in herbal and “alternative” medicine as it is in orthodox medicine, where the real object of treatment is the supposed condition, from which the grateful individual is hoped to emerge.
In the model I am formulating, the “condition” is seen more as a divergent state than an entity to be addressed. This divergence presupposes a trajectory towards which the patient might be redirected. Such a trajectory is not a static ideal but rather an unfolding potential that emerges from the endowment and natural history of the patient. Health is generated in and by time. Although this book is more concerned with health than hurt, the two will inevitably coexist: even the most robust will get something in the eye and as we learn we will fall over some of the time. The concept of Health as Poise is most certainly not a positivist ideal that suggests we ignore these hurts: we give them the local and timely attention as needed.
As with the synthesis of any scheme that has something in common with humoral medicine, it may be prone to the ill effects of formalism, functionalism and teleologism with an over-reliance on a mass of metaphor. I will try to provide a comprehensive model that is higher on functional analysis than metaphorical exhortation. A reasonable criticism of humoral systems from the modern perspective is that they tend to disregard one or more of the matrices6 that make up human life and replace it with a conceptual force or entity that is speculated to underpin existence, but which remains indefinable. While these entities may beguile and entertain us poetically, the matrices are facts of life in the sense that, for instance, our bones do live after us as might the genetic material they contain. By contrast, those concepts that we hope might explain these facts remain intangible. Apart from explanation, the construction of a model of what is observed helps us to abstract functions in order to predict future behaviour of the state to be modelled: how a disease will respond to intervention, in the case of medicine. I have tried to turn the problem around and describe ways of avoiding or reducing the illness so that the resultant state of health can be visualised.
Model of health in this current work
I am hoping to offer a naturalistic description of health which may, however, be formally defined. It bases itself upon adaptive capacity as an integrated biological concept and derives its form and function from circadian physiology. For health I have substituted the term Poise. Health is a word that sprawls through our culture, into the H in NHS on the one hand (which is quite properly dedicated to the management of ill health), to any commodity, from confectionery to yoghurt, or any lifestyle that is purported to promote it, on the other. During a recent heatwave, people enjoined to take special care were those suffering from “health conditions”. We all understood, of course, that conditions of ill health were meant, but the absurdities of this profligate use of the word abound. I aim to construct a model of health and integrate it with a scheme that assesses a person's loss of capacitance and then to restore it by the use of medicinal plants.
Despite the complexities and subtleties of human life, there may be during the analysis of a patient's health a glimpse of simple recurring themes. Simple adjustments to the trajectory may provide a window of opportunity for increasing capacitance or slowing its loss. The purpose of the model, then, is not intended as an explanation of phenomena but rather a device for integrating the physical world with the psychic, physiologic and sociolinguistic events seen in the clinic with the hope of helping the patient towards an increased capacity for Poise. I appreciate that at this stage, the term can mean very little. As they cajole you on the corporate telephone: “Bear with me” and I will come to that in a later section.
I have come to the subject with three drives: first, the clinical impulse and experience; second, an abiding love of astronomy with the solar and lunar effects upon human health, and third, the endobiogenic theories of Drs Christian Duraffourd and Jean-Claude Lapraz which I have closely observed and which have channelled my clinical experience for more than two decades.
Their model, previously the Neuroendocrine Theory of Terrain, renamed Endobiogenics, forestalled any criticism of a model that claimed to be scientific but was not quantifiable. Duraffourd and Lapraz were acutely aware of this limitation from the outset and it led them to the elaboration of the nested algorithms that constitute their Biology of Functions. I had only a handful of serious objections to endobiogenic theory, one of which was that qualitative terms were often missing when it seemed to me that they should play a vital part, especially in the practice of data collection from the patient. I believe my scheme is more comprehensive at least on this score and more, well, schematic. The employment of my approach in concert with a Biology of Functions could only be complementary and additive.
Meanwhile, it may help here to remove ourselves temporarily from generalisations and abstractions and to list quite simply the kinds of suffering we might be trying to address. These are chronic, largely subjective states rather than signs of infectious illness such as diarrhoea and vomiting, cough and breathing difficulties:
Common presentations of ill health
The patient may have arrived with a number of diagnoses attached. For some cultural reason, patients in Britain who seek out a herbalist are often at their last port of call whereas in some other parts of Europe, where urbanisation was not so precocious as here, medicinal plants might be their first. Television programmes about the natural world do not seem to penetrate this cultural bias against these most natural of remedies, even among gardeners. Some previous diagnoses may be important to the patient as hand luggage or they may have begun to question whether the label has outgrown its usefulness. Tact is called for, but if we are to question or even to disparage8 a previous label, we must be shown to have a more coherent response to the patient's troubles. There is nothing to be gained by disputation, even less so with a contrary person, so that the practitioner who offers a broad and comprehensive approach may, just by doing so, bring some peace and comfort: the mystery of