} >

Postmodern Herbalism

Principles and Practice of Phytotherapy

by Simon Mills and Kerry Bone

Principles and Practice of Phytotherapy (hereafter PPP) is a book that was waiting to be written. Simon Mills and Kerry Bone are both herbalists with long and distinguished careers in academic, technical, manufacturing, research and regulatory environments in Europe (Mills) and Australia (Bone). But above all it is their experience as clinical practitioners of herbal medicine that qualifies them for the job, and they have risen to the task in a virtuoso collaboration. Rather like the classic pairing of Goodman & Gilman (Pharmacology), "Mills & Bone" is set to become a standard reference work of western herbal medicine, and one whose publication will benefit students, educators, practitioners and allied healthcare professionals alike.

Overall, PPP is a defining statement of the field as well as a comprehensive guide to its subject matter. The text is a deftly woven fabric where pharmacokinetics jostles with chaos and complexity theory, traditional use is acknowledged as pharmacovigilance data rather than demeaned as anecdotal evidence, and the placebo effect becomes a healing principle rather than a tiresome source of error. The particular genius of the book is that it clearly articulates one of the unstated but foundational strengths of contemporary western herbal medicine - namely its ability to draw from several different and often apparently conflicting paradigms and integrate them into an effective clinical therapeutic based upon the use of medicinal plants that is wholly appropriate to the demands of contemporary healthcare. Although the book is subtitled Modern Herbal Medicine, it may be better described as postmodern herbal medicine. It goes well beyond the glib "best of both worlds" view (ie traditional wisdom plus modern science), a commonplace that always risked banalizing the subject. PPP systematically characterizes phytotherapy as a distinct and unique modality of clinical practice. Its multivalent coherence, which like all postmodernism recognizes the relative truth of and tensions between its diverse component tendencies, is emphatically distinct from the reductionist and disease model of modern mainstream biomedicine.

Summary of the Book
The book is arranged in three parts. The first section - Background and Strategies - sets the stage by briefly reviewing the main historical and theoretical features of different cultural views and systems of herbal medicine, and arrives at a tentative synthesis for a modern body-mind approach. It then covers pharmacological principles with a unique and important discussion of pharmacokinetics. An introduction to principal herbal therapeutic strategies is followed by a useful survey of the complex subject of validating herbal therapeutics; the section concludes with a chapter on safety, quality and interactions issues.

The second part - Practical Clinical Guides - is the clinical core of the book. After an analysis of different approaches to dosage, pharmacy and a restatement of the vitalist principles of treatment, the clinical material falls into two sections - pathological states, and body systems. Both these sections skillfully skate between paradigms - pathology here is not about diseases per se, but uses vitalistic and energetic principles with the consistent theme of supporting physiological systems and processes. Body systems likewise provide a conceptual basis for optimizing health rather than cataloging conditions. The areas covered in the first part include topical applications, fever, infection, auto-immune diseases, debility and malignancy, while the body systems section follows a more traditional classification. Mini case histories and example prescriptions and treatments are included throughout.

The third part - Materia Medica - consists of forty herb monographs, primarily of western botanicals but including a few herbal remedies from other parts of the world. These must be among the best succinct therapeutic monographs currently available anywhere, with a clear presentation of traditional views, as well as indications supported by clearly differentiated classes of evidence: pharmacology, clinical trials as well as empirical usage. Fully referenced with primary sources to enable the interested reader to pursue in depth study of each herb, these are emphatically clinical monographs, intended to guide and inform selection and use of the remedies. A good litmus test of monograph quality for the discerning is always the Echinacea piece, and it is gratifying to find here a sensible discussion of this familiar yet extraordinary herb that includes a critical stance toward the Commission E position on restrictions of use and contraindications of the herb from a clinical perspective. The book ends with a pair of useful indices of actions and conditions, in addition to the regular index.

Value to USA Readers
Whilst PPP will no doubt be useful to students in the several degree courses in western herbal medicine that now exist or are under development in Britain and Australia, the North American context is very different - and the publication of the book is in some respects a challenge to the pluralist culture of herbalism in the USA.

For stateside herbalists whose clinical practice draws from the abundance of rich antecedents in this country, including the different indigenous traditions as well as Eclectic, Thomsonian, Physiomedical and Naturopathic medicine, PPP may provide an interesting and provocative benchmark for comparison of clinical approaches.

More pointedly however, PPP clarifies the difference between herbal medicine as a primary therapeutic modality and the use of herbs as an adjunct or extension of dietary and nutritional approaches - a misconception of herbal medicine that has some currency in the USA, both within and outside herbalism. It also demarcates phytotherapy from the related trend in modern naturopathic medicine, whereby botanical agents tend to be one, often subordinate element in the multi-modality repertoire of the naturopathic physician.

PPP also serves to differentiate herbal medicine from the tendency, unfortunately endemic in the USA, whereby assorted journalists, career academics or self-promoting new age physicians, (who invariably share in common a lack of training in herbal medicine or clinical experience with herbs) publish their opinions on medicinal herbs, often supported by selected "studies" (of varying degrees of relevance from nil to secondary). Through their popular or pseudo-scientific publications they promote the fundamentally mistaken identification of such "scientific" data with knowledge of herbal medicine itself. Mysteriously, these ill informed pontifications appear to confer the status of "expert in herbal medicine" upon their authors, whom, emboldened by their new found expertise, publish tedious sequelae, contributing to the now minor industry of publishing herbal misinformation and myth propagation. In a sane world, PPP would stem the flow of publications from these panjandrums - but alas that is unlikely to happen.

PPP will give those involved in herbal education and course design a benchmark and a core model for content which could be developed and elaborated upon with appropriate local emphases and bioregional variations. For physicians and other healthcare professionals wanting to seriously understand the basics of herbal therapeutics, it is an ideal introduction, and herbalists can now refer their interested allopathic colleagues to PPP as a key resource alongside Rudolf Weiss's seminal Herbal Medicine - an invaluable work which for so long has served as a unique bridge between the two worlds of conventional and herbal medicine.

Minor Quibbles
Inevitably, there are some minor quibbles. The general layout is exceptionally clear and well organized but there is a striking lack of graphics, diagrams and especially plant pictures - a suprising economy from a publishing house with the reputation of Churchill Livingstone. Illustrations of plants are far more than decorative additions to herbal texts, they are an integral part of understanding botanical medicines - the form of a plant is an essential aspect of its archetypal nature. At least the monographs could have had accompanying photographs.

Some of the therapeutic approaches are overly cautious. The section on malignancy is a case in point, and while conservatism may arguably be prudent in a text of this kind, botanical medicines offer some unique tools for directly engaging the physiology and molecular biology of processes such as angiogenesis, cell proliferation, differentiation, and apoptosis as well as dealing with adjunctive treatment issues such as modulation of multidrug resistance and chemotherapy. The inexorable rise in incidence of cancer challenges amongst the general population is reflected in today's herbal practitioner caseload and will only become more so in future. Likewise, the discussion of chronic fatigue reflects the more conservative European attitudes toward CFIDS, often still described there as ME, and lacks coverage of different subsets within the CFIDS population for whom there are very specific indications such as the use of Glycyrhizza in individuals with neurally mediated hypotension.

The western body systems approach, unlike its humoral antecedents or Eastern counterparts is intrinsically limited by definition. As already mentioned the text is informed by an awareness of these limits, nonetheless a section on the immune system would have been appropriate. This is the key area where body system boundaries collapse and is also the point at which herbal medicines and their therapeutic possibilities are decisively superior to the pharmaceutical offerings of biomedicine.

In any brief Materia Medica, limitations of space inevitably will cause different readers to complain about oddball inclusions or missing favorites among the monographs. It may disappoint traditionalists to see familiar standards such as yarrow, calendula, sage and rosemary displaced by exotics, particularly when several of these have already been covered in Kerry Bone's book on Asian and Chinese herbs . Less understandable is the omission of the immune modulating mushrooms, among the most exciting and valuable agents in the modern Materia Medica.

What Next?
None of these criticisms detract in any major way from the overall value of PPP. Those familiar with the earlier publications and international conference presentations of the authors may recognize some of the material in the book; it is a text that summarizes over a decade of work in progress. One incidental criticism of PPP ironically arises precisely from the fact that it is a such a comprehensive and exhaustive work . Understandably then, it is not always the most exciting or inspiring read - vision and speculation necessarily take second place to the imperatives of the basic material.

Be that as it may, now that Mills & Bone have done such a good job of covering the basic ground, the only question left is - what next? In an earlier book, Simon Mills speculatively called for a new physiology appropriate to a modern herbal therapeutics, and pointed towards the phenomenology of Merleau-Ponty as a starting point. David Abram has eloquently developed one aspect of this challenge in his recent The Spell of the Sensuous, which relocates the (practitioner as a) subject in the global ecological system. In PPP, Mills' earlier vision remains sadly undeveloped except for a tantalizing hint at the end of section one about the impact of complexity and chaos theory on how we conceive not only physiology but herbal therapeutics and indeed natural systems as a whole. The authors point out that there is as yet no text that been written on this exciting subject - ideally that should be next. Apparently the authors have already planned a second volume. We shall have to wait and see.

The Herbal Bookworm • Herbal Hypotheses • Cancer & Herbal Medicine
What is Herbal Medicine • Herb/Drug Interactions
Plants of the Pacific NW • Consulting • Downloads • Herblog