The Principles and Practice of Phytotherapy: Modern Herbal Medicine by Simon Mills and Kerry Bone. Churchill Livingstone, 2000. Hardcover, 643 pp. ISBN 0-443-06016-9 $82.95 ABC Catalog #B441.

What a pleasure to read a book on the modern practice of herbal medicine, written by knowledgeable, experienced clinicians of phytotherapy. Not the least pleasure of this book is their literate, erudite, yet eminently readable style. The richness of this essential volume reflects the authors’ depth of clinical, research, and didactic credentials.

The Principles and Practice of Phytotherapy represents the first text in English to describe modern herbal medicine as it is actually practiced by well-trained practitioners of this profound therapeutic modality.

It is a timely addition to the burgeoning library of books on medical herbalism aimed at healthcare professionals. In fact, I would say it sets new standards for dialog between practitioners of various modalities, elucidating directions for education, boding well for the professionalization of phytotherapy in the U.S.

Mills and Bone have such impressive credentials in all aspects of phytotherapy that this review could simply consist of a tour of their achievements and contributions. The authors are both fellows of Britain’s National Institute of Medical Herbalists (NIMH). Simon Mills is the director of the Centre for Complementary Health Studies at the University of Exeter, the secretary of the European Scientific Cooperative on Phytotherapy (ESCOP), a past president of the NIMH, and a co-author of the British Herbal Pharmacopoeia. Kerry Bone is the principal of the Australian College of Phytotherapy, and has a deep interest in both clinical and laboratory research. He is the head of research and development at MediHerb, Australia’s largest manufacturer of herbal medicines. His writings regularly appear in professional journals around the English-speaking world. Both have been deeply involved in the maze of regulatory issues surrounding phytotherapy and natural products in Europe and Australia.

Who is the intended audience? In an ideal world this is a text for new clinicians and phytotherapy students, whether purely herbal, naturopathic, or orthodox. However, the 20th century history of repression of herbal education in North America makes this volume an essential book for all involved with herbal issues today. This includes clinicians, teachers, students, regulators, manufacturers, and journalists.

The first part of the book explores what they call Background and Strategies. The authors have eloquently described a number of different systems of herbal medicine from around the world and throughout history. This brief review cannot explore the philosophical and therapeutic importance of the authors’ ideas but the systems explored range from Graeco-Roman medicine, Traditional Chinese Medicine, Ayurveda, and 19th century North American systems such as the Eclectics. All this is integrated into identified common themes and even viewed from the perspective of Chaos theory.

A useful review of phytochemistry and herbal pharmacology follows, discussing the primary groups of constituents and their known activities. However, the authors are careful not to overwhelm readers with chemical details, noting that the activity of herbs is rarely due to a specific molecule, but to an intricate synergy of phytochemical complexity.

Principles of herbal treatment are articulated with the emphasis one would expect from phytotherapists so well grounded in holistic medicine. They provide clear acknowledgement that competent phytotherapy is more than simply the use of herbs; their use in a well-rounded, individualized program must also take into account diet and lifestyle, etc.

A brief, but invaluable, section discusses the validation of herbal therapeutics, explores research methodology, the strengths and limitations of the research paradigm, and looks at ways to assess herbal efficacy validly without compromising fundamental issues of herb integrity. A discussion of safety issues follows. Arguments concerning toxicity and adverse reactions are explored from, both the perspectives of toxicology and the experience of actually using the plants.

The second part of the book, addressing practical clinical issues, manifests the authors’ mastery of the field. The arcane complexities of ideas concerning dosage are sidestepped by a clear, concise and usable chapter on dosage and dosage forms in herbal medicine. A section titled "A systematic approach to herbal prescribing" addresses the challenging issue of applying herbal medicines in a holistic context. This section should be required reading for all U.S. herbalists. Their approach is not one of rote formulas, but to identify and then address individual needs for physiological enhancement or compensation. Thus, the importance of taking case history and its careful interpretation is emphasized. General herbal approaches to pathological states are explored, providing the rationale for the specifics that follow. The broad issues investigated are fever, infectious diseases, autoimmune diseases, debility, and malignant diseases. An interesting addition here is an exploration of topical herbal applications, their pharmacology, and indications.

The discussion of herbal approaches to system dysfunctions provides practical information, blending clinical experience of Western herbalism with insights from pharmacology in such a way as to guide the practitioner in individual protocol development. It is refreshing to see such herbal clinical guidelines presented in a style free from hype and the latest "miracle herbs." The material is free from dogma, emphasizing the strengths of phytotherapy while not glossing over the weaknesses. The authors clearly identify one of the unique strengths of phytotherapy as treating individual variability. They show how to support healthy functioning as well as facilitate recuperation and repair. After reviewing general health issues for the system, a selection of pathologies exemplify how to develop phytotherapeutic protocols. Throughout this section, care is taken to express any cautions to be taken into account, either due to the condition being treated or the herbs suggested.

Part three consists of an in-depth materia medica. However, if there is any criticism of this book, it is the relatively small number of herbs discussed — only 44. Each is presented in a well-structured, fully referenced way, blending traditional views with insights from phytochemistry, pharmacology, and clinical studies. This plethora of information may be the reason why only 44 were chosen. Not all of the herbs used in clinical phytotherapy have attracted the attention of the research community. It must be remembered that a lack of research does not mean a lack of efficacy, but a lack of funding! Each entry discusses the name and its synonyms, history and parts used, effects, traditional views about the herb, its actions, primary clinical uses, uses that might be extrapolated from any known pharmacology, dosage, preparations, duration of use, and safety data. An invaluably extensive, well-constructed index is included.

The Principles and Practice of Phytotherapy balances the respect and understanding of science with the respect and experience of tradition. It shows the authors’ profound grasp of their subject through a well-balanced blending of logical, controlled, perspectives of pharmacology with the variable realities of treating real people with real herbal medicine. Simon Mills and Kerry Bone are to be congratulated for this cutting edge contribution to health care in the 21st century.