The real Theriac - panacea, poisonous drug or quackery?

ETHNOPHARMACOLOGICAL RELEVANCE: Theriac is considered the most popular cure-all multi-ingredient medicine and has been used for more than two millennia. It has also been used as one of the most important anti-epidemic drugs up to the 19th c., treated as an emergency medicine in case of e.g. bubonic plague. AIM OF THE STUDY: Until now, no reliable information regarding the pharmacological effect of the treacle was available, including its possible toxic or narcotic properties. In order to change the state of knowledge in this matter we have selected the Theriac recipe that had been actually used for producing the treacle in 1630, which was confirmed by the official municipal documents of the time. METHODS: The recipe was written in Latin, with the use of pre-Linnean nomenclature and then apothecary common names, which required translation into the modern scientific language in order to get reliable pharmacological conclusions. The information from historical sources has been compiled with the pharmacological data concerning the most potent compounds, which for the first time made it possible to calculate the amounts of active compounds in the doses taken by then patients. RESULTS: Only two species included in Theriac can be harmful in humans: poppy and sea squill, but in both cases the calculated quantity of morphine and cardiac glycosides, respectively, were below toxic level. There are no indications, both from the historical and pharmacological point of view, for Theriac being toxic or narcotic in patients, when used as prescribed. CONCLUSIONS: As for now, the most probable is that the treacle owed its postulated efficacy in the main indications to the placebo effect. Still, the results should be further confirmed by reconstructing the actual Theriac and subjecting it to modern tests and analyses.

[Debate about the theriac in Arabic treatises]. / La thériaque en débat dans les traités arabes.

The Greek treatises about antidotes of Andromaque and Galen, have been the subject of various translations in Arabic language. Thus, numerous highly interested arab-muslim physicians discovered, used and then spread the formulae of the Great Theriac. Two attitudes can be distinguished at first: they either copied and used as before their literary sources or they adapted them by changing the proportions of the components which compose the electuary or by changing even some of them. These different approaches involve comments and criticisms and bring about the third attitude: a rich debate of ideas. The article proposes to recall through quotations of arab-muslim physicians the evolution of the matter.

[What was Montpellier's theriac]. / Ce que fut la thériaque de Montpellier.

The long-lasting fame of Montpellier's theriac does not come from the originality of its composition. In the Middle Ages, its formula followed Antidotarium Nicolai's while, in the modern period, it copied Galen's. This fame is explained by the reputation of the medical University, by the dynamism of its apothecaries and by the strength of Montpellier's trade networks.

[The theriac Diatessaron; oligopharmacy against polypharmacy]. / La thériaque Diatessaron Oligopharmacie contre polypharmacie.

The theriac of Andromachus was the symbol of polypharmacy and the theriac Diatessaron was a product of oligopharmacy. The four substances that entered in its composition were gentian roots, aritolochia roots, sweet bays and myrrh. The excipient, honey, was sometimes replaced by peppermint syrup. It was possible to add juniper berries extract. Symbolic interest of number four was confirmed by a reference to the four elements of Empedocles. The pharmacological activity, which was attributed to the diaressaron, was not very different from those of the great theriac. Since the end of 18th century, this theriac began to loose its prestige.

[At the origin of the theriac: the receipt of Andromachus]. / Aux origines de la thériaque: la recette d'Andromaque.

The Greek physician Galen of Pergamum (129-c. 210) has preserved in his two tracts De antidotis and De theriaca ad Pisonem the original recipe of the theriac under the name of Andromachus. Galen specifies that Andromachus was the first to add flesh of vipers in this pharmacological preparation. This paper intends to study the real originality of Andromachus compared with his predecessors and to examine in which sense he can really be considered as the inventor of the theriac.

[Theriac in modern period (XVIIth-XXth centuries)]. / La thériaque à l'époque moderne (XVIIe au XXe siècle).

After centuries of fluctuant usages, the theriac, this kind of universal drug to cure everything, was popular again starting from the XVIIth century and it will remain at the official french pharmacopea up to 1908. Viper was one of the key components, which was an opportunity for several authors to discuss about its real therapeutic value. Amont the tens of constituants of theriac, opium, in large quantities, was also an important part of this "électuaire". Its success was at the origin of many formulations (such as poors' theriac and celestial theriac), and falsifications, the most famous being the "Orvietan", driving pharmacists to produce it themselves. Counterfeiting being frequent, it became usual to prepare theriac publicly up to the french Revolution. Very much criticized, as a symbol of polypharmacy more and more rejected, theriac will progressively disappear during the XIXth century, sometime replaced nowadays by new universal drugs outside the pharmaceutical network.

[Theriacs in charity books, during the 17th and the 18th centuries]. / Les thériaques dans les ouvrages charitables aux XVIIe et XVIIIe siècles.

"Charity books" were books containing formulas of remedies, which were easy to prepare and not too expensive. Their purpose was to cure poor people who had not enough money to have access to official Medicine or who lived too far away from medicine doctors and apothecaries. They were then useful for charitable people such as country priests or charitable Ladies. Great Theriacs were very expensive and too difficult to prepare to be described in this kind of books for non-professional people. Simplified formulas were then proposed. They contained much less products and were quite cheaper. Some of these medicines are described in this article.

Foreign vs. local new horizons, and ancient dilemmas and strategies?

Capitalizing on the data presented in the three papers in this issue, the comments and conclusions here elaborate on the concept of transfer of knowledge in the field of materia medica and pharmacy. They evidence different mechanisms in three contexts, the Holy Roman Empire, the Western world and China, and trace the possible ancient roots of the phenomena under consideration. In so doing, they contextualize the processes under study in the three essays, and suggest also a possible new interpretation of the practice of science from the Late Middle Ages to the Scientific Revolution.

Bolatu's pharmacy theriac in early modern China.

In early modem China, natural history and medicine were shifting along with the boundaries of the empire. Naturalists struggled to cope with a pharmacy's worth of new and unfamiliar substances, texts, and terms, as plants, animals, and the drugs made from them travelled into China across land and sea. One crucial aspect of this phenomenon was the early modern exchange between Islamic and Chinese medicine. The history of theriac illustrates the importance of the recipe for the naturalization of foreign objects in early modem Chinese medicine. Theriac was a widely sought-after and hotly debated product in early modern European pharmacology and arrived into the Chinese medical canon via Arabic and Persian texts. The dialogue between language and material objects was critical to the Silk Road drug trade, and transliteration was ultimately a crucial technology used to translate drugs and texts about them in the early modern world.

Treating medieval plague: the wonderful virtues of theriac.

This paper examines one of the most popular remedies in medieval plague medicine, namely theriac, and explores possible reasons for its remarkable continuity in the late medieval and early modern medical tradition. Theriac, reputed as a universal antidote since ancient times, was a complex compound, composed of multiple ingredients, difficult to prepare, and subject to strict manufacturing and commercial controls. The paper centers on the therapeutic applications of theriac and on its relative pharmacologic efficacy in treating the symptoms of plague. The consistent use of theriac in plague medicine attests not only to the conservatism of medieval medical practice, but also to an underlying solidly founded rationale that combined humoral doctrine, empiric observation, and pharmacologic effect.