Plant Medicine in Practice: Using the Teachings of John Bastyr by William A. Mitchell Jr, ND. St. Louis, Missouri: Churchill Livingstone, 2003. 458 pp. ISBN 0-443-07238-8. $66.95.
As pointed out in the introduction to this work, the late John Bastyr, DC, ND, left no written works. Therefore, we have only his many students, such as William Mitchell, ND, to help pass along Dr. Bastyrs knowledge. Practitioners of botanical medicine have long desired more information about Dr. Bastyrs use of medicinal plants, and by proxy the use by naturopathic physicians of his era. As one of the co-founders of Bastyr University and a beloved mentor to many in the naturopathic profession, Dr. Mitchells contribution to the field of naturopathic medicine has been significant. Though his knowledge of botanical medicine is large and eclectic, as represented in Plant Medicine in Practice, the book suffers from several shortcomings. The reviewer does not wish to dishonor or otherwise belittle Dr. Mitchell in any way, but only to give his honest thoughts on this work.
The positive features of the book include its collection of interesting facts and the handling of many obscure and potentially toxic herbs, practically ignored in all other botanical literature. Additionally, the strong empirical nature of the book is refreshing amidst the too-often absurdly reductionist and hypocritical demand for evidence-based medicine, referring of course to one extremely narrow type of evidence, controlled clinical trials. The large number of herbs covered also stands out amidst the flurry of books rehashing the same 10-20 herbs that have been extracted, standardized, and researched in Europe.
Of particular importance is Mitchells willingness to mention both herbs that are routinely considered toxic, though of course all toxicity is dose-dependent, and herbs that are uncommon or even unknown to Mitchell. This is hugely important in helping maintain a vital, broad materia medica and to avoid the trap of overly narrowing and limiting the number and type of herbs available to practitioners. Additionally this approach opens our eyes to new potential in the plant and fungal kingdoms to further the health of our patients. These elements make Plant Medicine in Practice worth perusing by scholars of botanical medicine and serious herbal practitioners, but it is not suitable for the lay public or as an authoritative text on botanical medicine.
One of the major issues with the book is that a strong editorial hand was absent. The numerous misspellings of herb names and other words, pointless repetitions, improper sentence structure, and other grammatical and technical problems occur far too frequently. An accepted source for modern botanical nomenclature such as the American Herbal Product Associations Herbs of Commerce 2nd edition or other authoritative work was not the basis for the Latin nomenclature.
As for more technical shortcomings, the most significant failure may be the lack of systematically integrating new information throughout all of the entries. The mixing of empirical information from Mitchells practice, anecdotes about Dr. Bastyr, and tidbits of recent research is interesting at times, but his format fails to produce the stated goal that the book is about transmitting Dr. Bastyrs teachings. In that regard, the amount of Dr. Bastyrs input on a particular subject varies wildly from herb to herb and section to section.
There are several technical errors in the book that are troublesome, such as the continued attribution of anticoagulant activity to coumarin-containing herbs such as Melilotus alba (sweet clover). Dr. Mitchell writes:
Coumarin itself is not an anticoagulant but contains dicumarol, which inhibits hepatic synthesis of the vitamin K-dependent coagulation factors. Drugs based on coumadin are used as anticoagulants. A decoction or a tincture of this plant may be used to prevent unwanted clotting.
Coumarin does not contain dicoumarol; it dimerizes to it in the presence of microbial enzymes. Non-fermented herbs do not contain dicoumarol and are not anticoagulant. The drug CoumadinTM (a trademarked name for the synthetic brand of the drug warfarin [Bristol-Meyers-Squibb, New York, New York], which was synthesized based on dicoumarol) is used as an anticoagulant. There is no evidence that whole plants containing coumarin are anticoagulant. Coumarin by itself has been shown to have no effect on clotting in human clinical trials,1 a fact admitted by Mitchell in one sentence then contradicted two sentences later. A weak attempt is made to say that these herbs should not be used in serious cases, but this still does not clear up the fundamentally erroneous and confused attempt to explain coumarin-containing herbs. While the confusion of coumarin and CoumadinTM is hardly unique, the bottom line is Dr. Mitchell, as an expert clinician, should have provided clearer direction on this subject and others.
Another troubling feature of this book is the near total lack of information about toxicity. Of course, the majority of herbs are amazingly free of serious adverse effects and have minimal contraindications, but some can be quite dangerous. Dr. Mitchell is to be commended for continuing to discuss these herbs, unlike most authors in the field. However, it is lamentable that he did not provide sufficient information for their safe clinical application in most cases. A poor attempt is made to cover for this by giving general warnings about safety in some instances, but they are so improperly applied as to be thoroughly questionable. For example, Chenopodium ambrosioides (wormseed) is listed as toxic, and should be used with care while the arguably vastly more dangerous Digitalis purpurea (foxglove) has no such warning.*