Complex Herbs–Complete Medicines: A Merger of Eclectic & Naturopathic Visions of Botanical Medicine. Francis Brinker, N.D. Sandy, OR: Eclectic Medical Publications; 2004. 428 pp, paperback. ISBN 1-888483-12-1. $24.95.

So many years ago that it feels like another lifetime, I took courses in pharmacology and pharmacognosy while attending the University of Wisconsin pharmacy school. My class, which graduated in 1972, was the last of an era, as the pharmacognosy requirement was dropped for the incoming first year class.

I was fascinated by the idea that drugs could be derived from plants. The science of pharmacognosy looked at the natural origins of drugs. The science of pharmacology looked at how those isolated constituents we called drugs interacted with the body. Somewhere in that milieu it became apparent to me that isolated chemicals used to treat symptoms did not really address illness in a way that was effective and safe. Plants in all their complexity seemed to be better suited for dealing with the complexity of the human body, helping to restore the balance known as health.

It was through the disciplines of pharmacognosy and pharmacology that I found my calling to herbs. These sciences take the complexity of plants and reduce them to isolated chemicals. Ahh! – reductionism! My instincts brought me full circle back to the benefits of the whole plant complex.

Now Francis Brinker, a formally trained naturopathic physician who focuses on herbal research, has written a book that neatly establishes a scientifically unscientific reconstruction of the value of “Complex Herbs—Complete Medicines” (which happens to be the title of the book). I don’t mean to imply that this treatise is unscientific. Rather, I believe that Dr. Brinker has made the science of plant medicines understandable for anyone caring to learn. Many lively discussions these days pit science against nature as if they were exact opposites. Gratefully, Dr. Brinker realizes that the nature of science is complex and that the frequently reductionist nature of scientists is not natural.

Most scientists and the vast majority of the public at large don’t understand herbal products. Brinker knows that “Botanicals are now perceived more as drugs than foods, and many believe that they should be manufactured and regulated as such. The status of herbal products now is comparable to Frankenstein being established as the standard of what constitutes a legitimate human.”

This book is a step forward in explaining to herbalists and herbal enthusiasts the differences among different dosage forms and the comparative values and shortcomings of the myriad of products in the herbal marketplace today. This in turn can help them to better educate the health-seeking public in its quest for the potion that will cure their ailments.

In Part One of the book, Brinker discusses how to choose the most appropriate herb product. He looks at issues of complexity and synergy, as well as considerations affecting quality of products. He also gives a good explanation of the many different dosage forms, traditional and modern, and their comparative benefits, drawbacks, and differences, which allow the reader to better understand how the method of preparation can affect the outcome of treatment. He also gives an excellent explanation of standardization, its rationale, and its shortcomings. Unfortunately, many health consumers assume that standardized potency also means standardized outcome. However, since most herbal products are “standardized” to chemical markers and not necessarily to herbal activity, all standardization achieves is a surety of batch-to-batch conformity that meets a minimum of laboratory standards. Brinker’s use of a quote by Steven Dentali, PhD, a pharmacognosist and currently Vice-president of Scientific and Technical Affairs at the American Herbal Products Association, is appropriate: “There is no biological reason why a standardized extract would make a better herb. If it was necessary, we wouldn’t be using these herbs already. … It is foolish to think that one group of compounds will entirely account for an herb’s activity. Even inactive compounds play a role in an herb by affecting the distribution and absorption of the active components. When you place an herb in a different medium, you change its effects.” Standardization is pharmacologic, not therapeutic.

It’s interesting to note Brinker’s extensive use of the writings of the great eclectic pharmacist John Uri Lloyd, who embodies the bridge between the reductionist science of plant chemistry and the natural complexity of whole plant preparations. Lloyd believed that the best medicines—“specific medicines” as defined for the Eclectics by John Scudder—were made from fresh, whole, medicinal plants and were prepared as liquid extracts to preserve “an energetic matrix, constantly transforming itself according to the vital demands of the cells and their functions.”

This concept of “an energetic matrix,” or herbal energetics, is perhaps the area where natural arguments and scientific arguments come closest to being one. Brinker says it well in the section of the book entitled “Modern Roads to the Future”:

The truism of the vis medicina naturae, the healing power of nature, is that right relationships are hardwired into living systems in ways and by means that we must appreciate and acknowledge even when we don’t understand the full mechanisms or implications. In spite of many scientific advances, we still lack the means to adequately assess and effectively explain the inherent significance of many components residing in plants that impact health. Life, after all, is a mystery to be lived, not merely a problem to be solved. To achieve full health we must be guided by more than limited scientific knowledge.

Dr. Brinker does an admirable job of helping the reader understand this mystery.

Part Two of the book, “Changing Perceptions and Preferences—Popular Herbs in American Traditions,” looks at nine herbs that are widely used in America. Brinker notes that “the nine herbs covered here demonstrate the diversity of potential choices for each herb depending on the intended use, documented evidence, and preferred form. This limited number of herbs is used simply as an illustration of the immense differences in applications for any single herb and how the perceptions of its use have changed, and in some cases remained the same, over time.”

The nine herbs included are as follows: Classic Native American Herbs—goldenseal (Hydrastis canadensis), Echinacea angustifolia, and cranberry (Vaccinium macrocarpon); American Herbs Acclaimed Across the Atlantic—black cohosh (Actacea racemosa syn. Cimicifuga racemosa), Echinacea purpurea, and saw palmetto (Serenoa repens); and Immigrant Herbs Transplanted to America—kava (Piper methysticum), St. John’s wort (Hypericum perforatum), and milk thistle (Silybum marianum).

Saw palmetto is an herb I take myself for prostate health. Most of us are familiar with the liposterolic extract standardized to 70-95% free fatty acids and taken at a dose of 160 mg twice daily. Brinker gives us “the rest of the story.” The whole fruit has been the primary historical dosage form and dosages in the range of 200 mg to 4 grams of the whole fruit and up to 12 ml daily of various extracts. It was widely used for prostatitis and prostate enlargement, but it had many other applications, including immune enhancement, anti-inflammatory, toning an enlarged uterus, improving digestion, and relieving irritation of mucous membranes, thus making it useful for asthma, colds, and bronchitis. (Note: None of these historical and empirical uses have been confirmed by scientific research.)

Dr. Brinker notes the relative lack of adverse effects such as erectile dysfunction in 1.1% (vs. 0.7% for placebo) and gastrointestinal effects in 1.3% of extract users (vs. 0.9% for placebo) in a 1996 review of 18 clinical trials. That is, the side effects observed are comparable to those that occurred in the placebo group. He also notes a potential drug interaction: inhibition of binding of alpha-1-adrenoceptors by antagonists tamsulosin and prazosin (in test tube studies done by Goepel and others in 1999), which could theoretically reduce the effects of these and related drugs, but for which no documented evidence exists.

The book is easy to read and understand, striving not to be too pedantic. I highly recommend it as a good teaching tool for beginning herbalists and enthusiasts as well as a good refresher and resource for veterans of the herbal world.

—David La Luzerne, RPh Green Earth Natural Medicine Madison, WIHerbman50@earthlink.net