Herbal Formularies for Health Professionals, Volume 3: Endocrinology by Jill Stansbury. White River Junction, VT: Chelsea Green Publishing; 2019. ISBN: 9781603588553. Softcover, 272 pages. $49.95.

This five-volume series on herbal formulations for professionals by Jill Stansbury, ND, is much needed. The lack of published works on this fundamental practice of natural medicine — formulating herbs into synergistic blends — has been a constant source of annoyance to me.

Stansbury has taken on the difficult task of writing about formulating in all areas, and she is to be congratulated for her Herculean effort.

I recommend this volume as a good introductory work on herbal formulation for people with endocrine and reproductive problems. The author clearly had to walk a tightrope between presenting information for people new to formulating (whether students or conventional health care providers who never learned herbal medicine) and those who already have a fair bit of knowledge. Some sidebars in the book are useful for creating individualized formulas, such as “Fine Tuning Menopausal Transition Formulas” on page 138. Overall, I feel confident having my beginning botanical medicine students at Bastyr University, Southwest College of Naturopathic Medicine, and National University of Health Sciences look at many of her base formulas as a starting point in formulation for individual cases.

I do have several concerns about this volume that unfortunately lessen its utility. First, there is a lack of recognition of other widely used ways to formulate. Stansbury’s simple formulas, most with five herbs or fewer and in equal parts, do not reflect more sophisticated systems such as Chinese or Ayurvedic formulation, let alone more complex Western herbal formulation. This is appropriate in a textbook for beginners, which I contend this book is, but will leave intermediate prescribers wanting. An area of weakness in this regard are her various formulas for cancers, which I believe overlook the full potential of herbal medicine.

Second, there is a problematic lack of consistency. Sometimes, conflicting information is presented in the materia medica, such as on page 21, where yarrow (Achillea millefolium, Asteraceae) is listed as both warming and cooling, and this confusion is not addressed in the description of the herb. Some recipes state to use equal parts in unspecified amounts, but others give specific (equal) amounts. In some formulas, she lists the herbs followed by the amounts and in others this is reversed with no obvious reason as to why.

Third, the process of determining how much medicine to supply to a patient is a crucial oversight. Many of her formulas, at the doses stated, will last only a brief time, which is difficult to justify when treating patients with chronic conditions. For example, her Tincture for Uterine Fibroids on page 151 calls for dispensing 32 mL of the formula (also odd, as this would overflow a standard 1-oz or 30-mL bottle) at a dose of 0.5–1 teaspoon three to four times daily. At the lowest end of this dose, 32 mL would only last for four days! Is the patient to then get a larger amount after taking this tiny amount to ensure tolerability, or get refills every four days (presumably not, given the incredible inconvenience)? No explanation is provided.

Fourth, though Stansbury rightly points out that traditional knowledge is the basis of much of herbal medicine, her failure to cite any of the herbal references to which she refers throughout the book is upsetting. Including a general bibliography of at least the major references she employed while writing this text would show respect to those who came before her. It would also allow the reader to verify if the sources are being cited correctly. Or, if she intended to say that the oral traditions of world herbal knowledge were a major base of her writings, then she should cite those people from whom she obtained this knowledge, including their permission to use it here.

Fifth, though she criticizes the current emphasis on isolated, “active” constituents and describes the problems with research on them, she focuses a good deal on these constituents and recommends isolated constituents as therapies surprisingly often. For some herbs, such as sweet wormwood (Artemisia annua, Asteraceae) or Oregon grape (Berberis aquifolium, Berberidaceae), which have a rich literature on the synergy among their constituents, she presents only the constituents artemisinin and berberine, respectively, in her materia medica discussions. Both isolated constituents are recommended as treatments either alone or with only one other ingredient, which seems to have nothing to do with herbal or traditional medicine. I advocate dropping these and other single constituents she recommends from consideration in the book, as such information is readily available in numerous other books and on the internet. She should focus solely on formulating with whole herbs and extracts, or, if she is going to recommend isolated constituents, at least reinforce the need to combine them with the whole plant for synergy.

Unfortunately, Stansbury squandered the opportunity to use the materia medica descriptions to highlight and clarify the actions of the herbs. Each herb should have its energetics listed (at least whether they are cooling or warming). She refers to these properties frequently in the book but does not mention them in many herb descriptions. A simple list of major and minor actions also would be helpful. The short narratives she provides are not easy to find for quick reference and not complete enough for serious study. They put too much emphasis on preclinical research on isolated constituents and on use of herbs for specific diseases, which is odd given her stated philosophy that these are not a good basis for formulation.

Jill Stansbury’s volume three is an acceptable text for use in a beginning herbal formulation class, but an experienced teacher will be needed to help guide students in using this tool. I would not recommend it as a standalone text or reference, but only in this particular teaching context.

Eric Yarnell, ND, RH(AHG), is an assistant clinical researcher and adjunct faculty member in the department of botanical medicine at Bastyr University. He is president of Heron Botanicals and CEO of Red Root Pharmaceuticals.