Medical Herbalism

675 Pages · 2011 · 87.21 MB · English

  • Medical Herbalism






    author of The Complete Illustrated Holistic Herbal MEDICAL


    The Science and Practice

    of Herbal Medicine

    David Hoffmann, fnimh, a hg


    Heai„ .

    gAj Healing Arts Press

    One Park Street

    Rochester, Vermont 0S767


    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



    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



    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



    Part One



    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



    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


    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


    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


    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


    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


    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.

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