Medical Herbalism: The Science Principles and Practices Of Herbal Medicine

Book Preface

This is an exciting and very challenging time to be involved in herbal medicine. There is a growing openness to the insights of clinical herbalism from practitioners of other health care modalities, and a plethora of peer-reviewed work on herbs being published by the research community. Many new insights have been put forth, and many traditional ideas are being reassessed and either rejected or embraced anew.

Above all, this is a time of change for Western medicine, both holistic and orthodox. While herbs have a unique and valuable contribution to make, no clear con­text has yet been defined for Western holistic medicine. In such a rapidly evolving clinical and research milieu, a book of this sort can at best serve as a building block, a step on the road toward a more cohesive vision for the fu­ture of Western holistic healing.

With this book I have endeavored to lay a foundation for the skilled use of herbal medicine within a holistic practice by bringing together the modern scientific movement with traditional herbal practice. The book is intended for practitioners and students of medical herbal­ism, as well as practitioners of other modalities who are interested in the principles and practice of Western herbal medicine.
A cursory look at the contents reveals two distinct sections of the book.
Part 1 surveys the scientific underpinnings of medical herbalism, the chemistry and pharmacology that may help clarify the mechanisms of herbal activity and clinical efficacy. While this information may be unfamiliar and challenging for many herbalists, I feel it is important for traditional practitioners to have at least a rudimentary grasp of this subject as we move into the 21st century.
Part 2 deals with the practical therapeutics of the major body systems and the pathologies that affect them. It is based on my own 25 years of clinical experience, the experience and knowledge accrued by the Eclectic and Physiomedical physicians of the United States, and the practices developed by the National Institute of Medical Herbalists in the United Kingdom.

Despite the seeming dichotomy of these two major sections of the book, I have attempted throughout to marry biomedical theory with the clinical experience of the medical herbalist. As a clinician who began his own herbal practice in 1978, I have seen that ·western herbal medicine is based upon a body of knowledge and experi­ence that has as much clinical value as any other field of medicine. Thus the guidelines for protocol development given throughout the book are based firmly on this bedrock of Western herbalism. I have not rejected the clinical approaches of medical herbalism in favor of peer­reviewed research. Even acknowledging the wealth of research occurring, there is not yet enough clinically rel­evant material to justify changing tried-and-true ap­proaches, an issue that is explored throughout the book.

The focus of the medicinal plant research commu­nity, however, is rarely on the protocols used in herbal medicine, but instead on the plants themselves as sources of novel (and thus patentable) chemical structures. A dis­quieting trend in North American herbalism is the ten­dency to be influenced by the marketplace and herbal fashion. I have made a point of avoiding such hype in the treatment section of the book. The following statement, made by the 19th-century Eclectic physician John King in writing about Grindelia squarrosa, is as relevant today as it was 100 years ago:

The fact is, that many physicians have a great proneness to run after new remedies, especially when introduced under some pretentious name, and to place a marvelous credulity in the statements of interested parties, who are incapable of determining accurate conclusions as to the value of a remedy. 1 Herbalism is a fundamentally conserva6ve actlVlty, al­though I must say it is the only aspect of my life where any trace of conservative tendencies will be found!

OVERVIEW OF THE BOOK
PAR.Tl
Chapter 1
Places Western herbalism in a philosophical, therapeutic, ecological, and multicultural context. This chapter intro­duces the relationship between science and herbal medicine, looking at the scientific method and the lan­guage of research. A discussion of pharmacognosy is fol­lowed by a review of large-scale screening programs to as­sess the therapeutic potential of the world’s flora. The importance of the conservation of medicinal plants and the work of organizations such as United Plant Savers is discussed.
Chapter 2
Explores the diversity of medicinal plants through taxon­omy and the insights of the Linnaean system of nomen­clature-actually much more interesting than is often appreciated!
Chapters 3-8
Plant chemistry is the basis of the therapeutic uses of herbs. In these chapters, I discuss the nature of primary and secondary plant metabolites as a foundation for a re­view of the main categories of constituents considered to be of therapeutic importance. Each chapter includes an overview of structure, botanical distribution, and general­izations about pharmacology, followed by a discussion of representative molecules described in the herbal litera­ture. Important groups, such as sesquiterpene lactones, saponins, and flavonoids, are covered in depth.
Chapter 9
An introduction to the principles of pharmacology rele­vant to herbal medicine, covering the broad principles of pharmacokinetics and pharmacodynamics. Using herbal examples wherever possible, the chapter explores a range of pharmacological actions.
Chapter 10
An introduction to the basics of toxicology as they re­late to issues concerning the safety and toxicity of medic­inal plants. A discussion of contraindications and drug-herb interactions is followed by a review of toxic plant constituents.
Chapter 11
Explores the formulation and preparation of herbal medicines. The various pharmaceutical forms are dis­cussed, with examples from official pharmacopoeias as well as folk medicine.
PART2
Chapter 12
Presents a model of holistic herbal medicine that is ap­plied throughout the rest of the book, and describes the process of developing a protocol that addresses specific pathologies while supporting the unique individual invalved. The criteria for establishing dosage and formula­tion specifics are given, along with an outline of the struc­ture of the subsequent treatment chapters.
Chapters 13-24
The therapeutic approach to each body system is ex­plored in turn, focusing on prevention and wellness but also addressing a range of conditions that may be ap­proached herbally. Phytotherapeutic approaches to the health needs of the young and the elderly are also dis­cussed. The holistic context is always emphasized. ½7here lists or tables are given, the sequence of herbs reflects my opinion of relative importance.

I must emphasize that the suggested prescriptions are NOT to be considered “herbal formulae.” The impor­tance of their inclusion lies in the process of developing a treatment program that takes advantage of the strengths of herbalism in addressing individual needs, not simply pathologies. I have emphasized the application of the model and identification of any resulting patterns of rela­tionship between plant and pathology in an attempt to empower the reader as he or she faces clinical realities.
In practice, however, theory is often secondary to re­ality. The suggested prescriptions come from personal observation of many herbally treated cases. Any conclu­sions or ideas presented come from an interpretation of such observations and of the healing process in the peo­ple who have honored me by allowing me to work with them. In instances where I have no solid foundation in practice, I have referred to colleagues who do.
Chapter 25
A review of the main herbal actions with an exploration of the mechanisms underlying their activity (where known). The primary herbal examples are given, along with a dis­cussion of the other actions of these plants.
Chapter 26
An herbal materia medica, in the traditional sense, cover­ing 150 of the plants most commonly used in European and North American phytotherapy. A description of the structure used throughout these entries is presented at the beginning of the chapter. The traditional uses of the plant are covered, along with relevant research data.
Appendices

• Glossary of herbal, medical, and phytochemical terms.
• Meanings of some Latin binomials. Here translations can be found into English of the meanings of the Latin or Greek words used in botanical binomials.

• Translation lists of the common names of herbs to their Latin binomial and, similarly, the Latin binomial to the common name.
• Pharmacy terms. A listing of Latin pharmacy terms and their shorthand descriptors, which are often encoun­tered when reading older books on herbal medicine.
• Weight and measure conversion tables.
• Taxonomic classification of medicinal plants.
• Information sources and useful URLs. A brief guide to finding herbal information using modern biblio­graphic databases, emphasizing the relevance of Medline and MeSH terms. (The World Wide Web ad­dresses given were current as of]uly 2003 .)
• Bibliography. This select bibliography focuses on works relevant to the practice of Western herbalism. I have emphasized the writings of herbal clinicians who not only present relevant information, but also place it within the context of real clinical experience. References are given for phytochemistry, pharmacol­ogy, and toxicology. The suggested readings at the end of each chapter are not meant to be a comprehensive list of resources. Rather, they reflect my opinion of what is most relevant to the clinical experience.