Medical Herbalism: The Science and Practice of Herbal Medicine

675 Pages·2003·87.21 MB·English

by  David Hoffmann

MEDICAL
HERBALISM
THE SCIENCE AND PRACTICE
OF HERBAL MEDICINE
DAVID HOFFMANN, FNIMH, AHG
author of The Complete Illustrated Holistic Herbal
MEDICAL
HERBALISM
MEDICAL HERBALISM
The Science and Practice
of Herbal Medicine
David Hoffmann, fnimh, a hg
G
Heai„ .
gAj
Healing Arts Press
One Park Street
Rochester, Vermont 0S767
www.InnerTraditions.com
Healing Arts Press is a division of Inner Traditions International
Copyright © 2003 David Hoffmann
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or me-
chanical, including photocopying, recording, or by any information storage and retrieval system, without permission
in writing from the publisher.
Note to the reader: This book is intended as an informational guide. The remedies, approaches, and techniques described herein
are meant to supplement, and not to be a substitute for, professional medical care or treatment. They should not be used to treat a
serious ailment without prior consultation with a qualified health care professional.
Library of Congress Cataloging-in-Publication Data
Hoffmann, David, 1951-
Medical herbalism : the science and practice of herbal medicine / David Hoffmann,
p. ; cm.
Includes bibliographical references and index.
ISBN-978-089281749-8 (hardcover)
1. Herbs—Therapeutic use. 2. Medicinal plants.
[DNLM: 1. Phytotherapy—methods. 2. Holistic Health. 3. Plants,
Medicinal. WB 925 H711m 2003] I. Title.
RM666.H33H6444 2003
615'.321—dc22
2003017536
Printed in India
10 9 8 7 6
Text design and layout by Priscilla Baker
A Traian as display typefaces
This book was typeset in Janson, with Agenda a
DEDICATION
For Lois Stopple,
What can I say, after 600 odd pages (odd pages indeed), I'm tongue tied! You have healed me heart and soul, with
the celebration of life and joy that you are. This book may have been written by me, but it was midwifed by you.
Sweet blossom come on under the willow
We can have high times if you'll abide
We can discover the wonders of nature
Rolling in the rushes down by the riverside
She's got everything delightful
She's got everything I need
A breeze in the pines in the summer night moonlight
Crazy in the sunlight, yes, indeed
—THE GRATEFUL DEAD (WHO ELSE ...)
ACKNOWLEDGMENTS
My deepest appreciation to Cheri Quincy, DO, for the continuing encouragement and support. Thank you for
your confidence in me, even when I couldn't even spell the word!
It is with love and gratitude that I acknowledge my friends and colleagues in the North American commu-
nity of herbalists for making this escapee from Thatchers' Britain so welcome. The ideas in this book have been
gestating over the years in discussions with many, many herbalists. The U.S. herb world is blessed with an at-
mosphere of openness and mutual support that is unique and deeply nurturing. We can thank Rosemary Gladstar
for so very much . . .
There is so much I could say to each of you, so I'm copping out and simply "naming names." No special order,
I love you all: Cascade Anderson-Geller, Paul Bergner, Jane Bothwell, Mark Blumenthal, Don Brown, Ryan
Drum, Rosemary Gladstar, Mindy Green, Christopher Hobbs, Tori Hudson, Feather Jones, Gail Julian, Kathi
Keville, Tierona Low Dog, David LaLucerne, Rob McCaleb (and everyone at the Herb Research Foundation),
Anne Mclntyre, Terence McKenna, Bill Mitchel, Pam Montgomery, Rob Montgomery, Michael Moore, 7 Song,
Ric Scalzo, Ed Smith, Sara Smith, Paul Stamets, Jill Stansbury, Autumn Summers, Jonathan Treasure, Gail
Ulhrich, Roy Upton, Marty Wall, David Winston, Linda Wolf, Tom Wolf, Matthew Wood, Dusty Yeo.
This book is much better than it deserves to be because of the superlative guidance of herbalist/editor ex-
troadinaire Evelyn Leigh. Thank you for being so knowledgeable, insightful, literate, and understanding of this
aging deadhead. You made the process pleasant, rewarding (or is that rewording?), and even entertaining.
To Jeanie Levitan, the first editor to give me her toothbrush! All authors should hope to be blessed with
guidance from someone with your erudition and warmth. To Jamaica Burns for editorial help above and beyond
the call of duty. Sorry about the obscure Chinese citations.
I want to thank the many groups of students I have had the honor of working with over the years. You all
know who you are. In case you've forgotten, you went to one (or more!) of the following institutions: the
California School of Herbal Studies, the Rocky Mountain Center of Botanical Studies, Bastyr University,
National College of Naturopathic Medicine, California Institute of Integral Studies, and the National College
of Phytotherapy.
Sonoma County reference librarians have been a great help during the writing of this book. What would we
do without libraries?
To Sasha Shulgin, Grant Morrison, Hakim Bey, Jerry Garcia, and Ozric Tentacles for the help with sanity
maintenance (and furtherance . . .).
CONTENTS
c^V,
Introduction
Part One
INTRODUCTION TO PRINCIPLES
AND PRACTICES
1. Herbs, Holism, and Science 6
Science and Phytotherapy, 17 • Pharmacognosy and Ways to Assess Herb
Quality, 19 • The Conservation of Medicinal Plants, 26
2. Classification of Medicinal Plants 30
The Linnaean System of Classification, 32 • Derivation of Botanical Names, 33
3. An Introduction to Phytochemistry 36
Primary and Secondary Plant Metabolites, 37* Commonly Used Terms and
Concepts, 40
4. Carbohydrates 41
Monosaccharides, 42 • Polysaccharides, 43 • Glycoproteins, 47 • Glycosides, 48
• Gums and Mucilages, SO
5. Lipids 54
Fatty Acids, 54 • Lipids Containing Glycerol, 58
6. Terpenes 62
Monoterpenes, 62 • Iridoids, 66 • Sesquiterpenes, 67 • Sesquiterpene
Lactones, 69 • Diterpenoids, 71 • Saponins, 74 • Triterpenoid Saponins, 79
• Cardenolides and Bufadienolides, 83 • Phytosterols, 83 •
Nortriterpenoids, 84 • Plant Exudates, 85 • Resins, 85 • Oleoresins, 86 •
Balsams, 87 • Gum Resins, 87
7. Polyphenols 90
Simple Phenols and Phenolic Acids, 92 • Phenylpropanoids and Cinnamic
Acids, 94 • Coumarins, 95 • Quinones, 96 • Xanthones, 99 • Stilbenoids, 99
• Flavonoids, 100 • Flavones and Flavonols, 101 • Isoflavonoids, 106 •
Flavanones, 107 • Dihydrochalcones, 107 • Biflavonoids, 108 • Lignans and
Neolignans, 112 • Tannins, 114
8. Alkaloids 120
Pyrrolidine and Piperidine Alkaloids, 122 • Tropane Alkaloids, 122 •
Pyrrolizidine Alkaloids, 123 • Purine Alkaloids, 124 • Isoquinoline Alkaloids,
125 • Indole Alkaloids, 127 • Ergot Alkaloids, 127 • |3-carboline Alkaloids, 128
• Quinoline Alkaloids, 130 • Quinolizidine Alkaloids, 130 • Diterpenoid
Alkaloids, 130 • Steroid Alkaloids, 131 • Miscellaneous Alkaloids, 131
9. Pharmacology 134
Pharmacodynamics, 135 • Phytoestrogens, 142 • Pharmacokinetics, 144 •
Immunomodulators, 152 • Inflammation and Anti-Inflammatory Agents, 154
• Cancer and Plant Constituents, 159 • Antiviral Agents, 164 • Antioxidants
and Free Radical Scavengers, 165 • Cardiac Glycosides, 168 • Nonsteroidal
Cardioactive Plant Constituents, 169 • Cholesterol and Lipid-Lowering
Activity, 170 • Hypertension and Hypotensive Agents, 171 • Platelet
Function and Cardiovascular Disease, 173 • Herbs and the Liver, 175 •
Hypoglycemic Agents, 178
10. Toxicity, Contraindications, and Safety 186
Evaluating Causality in Adverse Events, 187 • Toxicology, 192 • Oxalic Acid,
198 • Terpenes, 199 • Glycosides, 199 • Polyphenols, 200 • Alkaloids, 202
• Polypeptides, 205 • Lectins, 206 • Photosensitivity, 209
11. The Formulation and Preparation of Herbal Medicines 216
Herbal Medicines, 216 • Infusions, 219 • Decoctions, 221 • Tinctures
(Tincturae), 223 • Fluid Extracts (Fluid Extracta), 224 • Syrups, Elixirs, and
Emulsions (Emulsiones), 225 • Juices (Succi), Linctuses (Lincti), Mucilages,
and Oxymels, 226 • Waters (Aqua), 227 • Capsules, Pills, and Tablets, 227 •
Lozenges (Trochisci) and Pastilles (Pastilli), 228 • Baths (Balneotherapy), 228
• Douches and Enemas, 229 • Ointments and Suppositories, 230 •
Liniments, 231 • Gargles (Gargarisma) and Mouthwashes, 231 • Inhalants
(Vapors) and Spray Solutions (Nebulae), 231 • Oils, 232 • Compresses and
Poultices, 232 • Incompatibility , 232
Part Two
TREATMENT APPROACHES
BY BODY SYSTEM
12. A Model of Holistic Herbal Medicine 236
Phytotherapeutic Selection Criteria, 237 • Dosage and Formulation Criteria,
252 • Outline of Treatment Chapters, 256
13. The Digestive System 258
Flatulence, 262 • Constipation, 263 • Laxatives, 264 •
Diarrhea, 266 • Aphthous Ulcers, 267 • Periodontal Disease, 268 •
Esophagitis and Gastroesophageal Reflux, 269 • Gastritis, 271 • Peptic
Ulcers, 272 • Hiatus Hernia, 274 • Functional Dyspepsia or "Indigestion,"
275 • Irritable Bowel Syndrome, 276 • Inflammatory Bowel Disease, 279 •
Ulcerative Colitis, 279 • Diverticulitis, 280 'Jaundice, 283 • Chronic
Hepatitis, 283 • Viral Hepatitis, 285 • Cirrhosis, 286 • Cholecystitis, 287 •
Cholelithiasis, 288 • Hemorrhoids, 289
14. The Cardiovascular System 291
Tonics for the Cardiovascular System, 292 • Cholesterol, 300 •
Hypertension, 302 • Arteriosclerosis, 307 • Congestive Heart Failure, 309 •
Angina Pectoris, 310 • Peripheral Arterial Occlusive Disease, 311 • Varicose
Veins, 312
15. The Respiratory System 316
Coughs, 322 • Acute Bronchitis, 323 • Chronic Bronchitis, 326 • Pertussis,
329 • Asthma, 330 • Emphysema, 334 • The Common Cold, 336 •
Influenza, 338 • Hay Fever, 339 • Sinusitis, 340 • Laryngitis, 341 •
Tonsillitis, 342
16. The Nervous System 344
Managing Stress: An Overview, 349 • Depression, 354 • Insomnia, 355 •
Withdrawal from Benzodiazepines, 361 • Anorexia Nervosa, 363 •
Headache, 364 • Migraine, 367 • Neuritis, 371 • Tinnitus, 372 • Motion
Sickness, 373 • Shingles, 373
17. The Urinary System 375
Frequency, 377 • Dysuria, 378 • Hematuria, 378 • Edema, 379 • Cystitis,
379 • Urinary Calculus, 381
18. The Reproductive System 384
Emmenagogues, 385 • Amenorrhea, 386 • Dysmenorrhea, 387 •
Premenstrual Syndrome, 388 • Menopause, 391 • Pregnancy, 393 • Herbs to
Avoid During Pregnancy, 394 • Uterine Fibroids, 403 • Endometriosis, 404 •
Fibrocystic Breast Disease , 405 • Benign Prostatic Hypertrophy, 406
19. The Musculoskeletal System 408
External Applications for Musculoskeletal Problems, 416 • Myalgia, 417 •
Osteoarthritis, 418 • Rheumatoid Arthritis, 421 • Osteoporosis, 424 •
Gout, 426 • Bursitis and Tendinitis, 427 • Restless Leg Syndrome, 428
20. The Skin 430
Herbs for Topical Application, 431 • Eczema and Dermatitis, 432 •
Psoriasis, 435 • Acne, 438
21. The Immune System 441
General Support Protocols, 446 • Detoxification, 446 • Postoperative
Recovery, 448 • General Guidelines for Treating Infection, 451 •
Vaginitis, 452 • Prostatitis, 454 • Boils, 455 • Fungal Skin Infection, 455 •
Cancer, 456
22. The Endocrine System 461
Hypothyroidism, 461 • Hyperthyroidism, 462 • Diabetes Mellitus, 463 •
The Adrenal Glands, 465
23. Phytotherapy and the Elderly 467
Toning and Nurturing Health in Elders, 468 • Prevention and Treatment of
Disease in Elders, 469
24. Phytotherapy and Children 473
Measles, 474 • Mumps, 474 • Colic, 475 • Constipation, 476 •
Diarrhea, 477 • Indigestion, 477 • Nausea, 478 • Otitis Media, 478 •
Attention Deficit Disorder, 479 • Diaper Rash, 480 • Cradle Cap, 481 •
Impetigo, 481
25. Herbal Actions 483
Adaptogen, 483 • Alterative, 484 • Anticatarrhal, 485 • Anti-Inflammatory, 487
• Antimicrobial, 491 • Antirheumatic, 493 • Antispasmodic, 494 •
Astringent, 496 • Bitter, 498 • Cardiac Remedies, 501 • Carminative, 502 •
Cholagogue, 503 • Demulcent, 505 • Diuretic, 506 • Emmenagogue, 509 •
Expectorant, 511 • Hepatic, 513 • Hypnotic, 515 • Hypotensive, 516 •
Nervine, 517 • Stimulant, 519
26. Materia Medica 522
APPENDICES
1. Glossary 604
2. Selected Examples of Binomial Meanings 622
3. Herbs by Latin and Common Names 626
4. Pharmacy Terms 636
5. Weight and Measure Conversion 638
6. Herbal Information Sources 639
7. Taxonomy Hierarchy 646
Bibliography 652
Index 655
INTRODUCTION
T
his is an exciting and very challenging time to be herbal practice in 1978, I have seen that Western herbal
involved in herbal medicine. There is a growing medicine is based upon a body of knowledge and experi-
openness to the insights of clinical herbalism ence that has as much clinical value as any other field of
from practitioners of other health care modalities, and a medicine. Thus the guidelines for protocol development
plethora of peer-reviewed work on herbs being published given throughout the book are based firmly on this
by the research community. Many new insights have been bedrock of Western herbalism. I have not rejected the
put forth, and many traditional ideas are being reassessed clinical approaches of medical herbalism in favor of peer-
and either rejected or embraced anew. reviewed research. Even acknowledging the wealth of
Above all, this is a time of change for Western research occurring, there is not yet enough clinically rel-
medicine, both holistic and orthodox. While herbs have a evant material to justify changing tried-and-true ap-
proaches, an issue that is explored throughout the book.
unique and valuable contribution to make, no clear con-
text has yet been defined for Western holistic medicine. The focus of the medicinal plant research commu-
In such a rapidly evolving clinical and research milieu, a nity, however, is rarely on the protocols used in herbal
book of this sort can at best serve as a building block, a medicine, but instead on the plants themselves as sources
step on the road toward a more cohesive vision for the fu- of novel (and thus patentable) chemical structures. A dis-
ture of Western holistic healing. quieting trend in North American herbalism is the ten-
With this book I have endeavored to lay a foundation dency to be influenced by the marketplace and herbal
for the skilled use of herbal medicine within a holistic fashion. I have made a point of avoiding such hype in the
practice by bringing together the modern scientific treatment section of the book. The following statement,
movement with traditional herbal practice. The book is made by the 19th-century Eclectic physician John King in
writing about Grindelia squarrosa, is as relevant today as it
intended for practitioners and students of medical herbal-
was 100 years ago:
ism, as well as practitioners of other modalities who are
interested in the principles and practice of Western
The fact is, that many physicians have a great proneness
herbal medicine.
to run after new remedies, especially when introduced
A cursory look at the contents reveals two distinct
under some pretentious name, and to place a marvelous
sections of the book.
credulity in the statements of interested parties, who are
Part 1 surveys the scientific underpinnings of medical
incapable of determining accurate conclusions as to the
herbalism, the chemistry and pharmacology that may
value of a remedy.1
help clarify the mechanisms of herbal activity and clinical
Herbalism is a fundamentally conservative activity, al-
efficacy. While this information may be unfamiliar and
though I must say it is the only aspect of my life where
challenging for many herbalists, I feel it is important for
any trace of conservative tendencies will be found!
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
OVERVIEW OF THE BOOK
major body systems and the pathologies that affect them.
PART 1
It is based on my own 25 years of clinical experience, the
experience and knowledge accrued by the Eclectic and Chapter 1
Physiomedical physicians of the United States, and the Places Western herbalism in a philosophical, therapeutic,
practices developed by the National Institute of Medical ecological, and multicultural context. This chapter intro-
Herbalists in the United Kingdom. duces the relationship between science and herbal
Despite the seeming dichotomy of these two major medicine, looking at the scientific method and the lan-
sections of the book, I have attempted throughout to guage of research. A discussion of pharmacognosy is fol-
marry biomedical theory with the clinical experience of lowed by a review of large-scale screening programs to as-
the medical herbalist. As a clinician who began his own sess the therapeutic potential of the world's flora. The
1
2 INTRODUCTION
importance of the conservation of medicinal plants and volved. The criteria for establishing dosage and formula-
the work of organizations such as United Plant Savers is tion specifics are given, along with an outline of the struc-
discussed. ture of the subsequent treatment chapters.
Chapter 2 Chapters 13-24
Explores the diversity of medicinal plants through taxon- The therapeutic approach to each body system is ex-
omy and the insights of the Linnaean system of nomen- plored in turn, focusing on prevention and wellness but
clature—actually much more interesting than is often also addressing a range of conditions that may be ap-
appreciated! proached herbally. Phytotherapeutic approaches to the
health needs of the young and the elderly are also dis-
Chapters 3-8
cussed. The holistic context is always emphasized. Where
Plant chemistry is the basis of the therapeutic uses of lists or tables are given, the sequence of herbs reflects my
herbs. In these chapters, I discuss the nature of primary opinion of relative importance.
and secondary plant metabolites as a foundation for a re- I must emphasize that the suggested prescriptions are
view of the main categories of constituents considered to NOT to be considered "herbal formulae." The impor-
be of therapeutic importance. Each chapter includes an tance of their inclusion lies in the process of developing a
overview of structure, botanical distribution, and general- treatment program that takes advantage of the strengths
izations about pharmacology, followed by a discussion of of herbalism in addressing individual needs, not simply
representative molecules described in the herbal litera- pathologies. I have emphasized the application of the
ture. Important groups, such as sesquiterpene lactones, model and identification of any resulting patterns of rela-
saponins, and flavonoids, are covered in depth. tionship between plant and pathology in an attempt to
empower the reader as he or she faces clinical realities.
Chapter 9
In practice, however, theory is often secondary to re-
An introduction to the principles of pharmacology rele- ality. The suggested prescriptions come from personal
vant to herbal medicine, covering the broad principles of observation of many herbally treated cases. Any conclu-
pharmacokinetics and pharmacodynamics. Using herbal sions or ideas presented come from an interpretation of
examples wherever possible, the chapter explores a range such observations and of the healing process in the peo-
of pharmacological actions. ple who have honored me by allowing me to work with
them. In instances where I have no solid foundation in
Chapter 10 practice, I have referred to colleagues who do.
An introduction to the basics of toxicology as they re-
Chapter 25
late to issues concerning the safety and toxicity of medic-
inal plants. A discussion of contraindications and A review of the main herbal actions with an exploration of
drug-herb interactions is followed by a review of toxic the mechanisms underlying their activity (where known).
plant constituents. The primary herbal examples are given, along with a dis-
cussion of the other actions of these plants.
Chapter 11
Chapter 26
Explores the formulation and preparation of herbal
medicines. The various pharmaceutical forms are dis- An herbal materia medica, in the traditional sense, cover-
cussed, with examples from official pharmacopoeias as ing 150 of the plants most commonly used in European
well as folk medicine. 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
PART 2 plant are covered, along with relevant research data.
Chapter 12
Appendices
Presents a model of holistic herbal medicine that is ap-
• Glossary of herbal, medical, and phytochemical terms.
plied throughout the rest of the book, and describes the
• Meanings of some Latin binomials. Here translations
process of developing a protocol that addresses specific
can be found into English of the meanings of the Latin
pathologies while supporting the unique individual in-
or Greek words used in botanical binomials.