Why Medical Herbalism Belongs on Every Herbalist’s Shelf

Part One: Foundations of Herbal Medicine

Part one of this book focuses on principles and practices. Hoffman provides us with excellent information on the foundations of herbal medicine, based on the classification of plants, their chemistry, and the preparation of herbs according to their chemical properties. He discusses terminology and covers a wide range of topics, from quality standards to conservation and plant taxonomy. Additionally, he covers a variety of herbal medicine preparation types, including water extracts, tinctures, capsules, pills, and topical preparations. We also get an exploration of toxicology, contraindications, and safety considerations.

My favorite thing about part one of this book is the phytochemistry and pharmacology. This book was my introduction to phytochemistry, and I love the breakdown of the categories of chemicals and plants. Hoffman gives us some examples of chemicals and the herbs that contain those chemicals, as well as some mechanisms of action and what those chemicals do within the body. 

Do we need to know all about phytochemistry to be a good clinical herbalist? Not necessarily. Is it interesting? Definitely, I also think it can be beneficial if you find yourself in a position where you need to communicate with a doctor, primary care practitioner, or a client who is more scientifically inclined. You can use this type of knowledge to get into more of a “scientific,” medically-oriented mindset, and both know and sound like you know what you’re talking about. Understanding the chemistry of the herbs you’re working with can be an advantageous way to bring that information forward.

Medical Herbalism Part Two

Part two is where this book truly shines, so I’ll do my best to articulate what is included for you. In this section of the book, treatment approaches are organized by body systems. I appreciate how Hoffman breaks everything down by system and thoroughly explores each one.

However, one thing I wish Hoffman had included is a more in-depth discussion of anatomy and physiology. When I’m studying an organ system, its pathophysiology, materia medica, treatment and therapeutics, anatomy and physiology (A&P) fits in very nicely and is really helpful. This book is massive, and he probably didn’t have the space to include it. Obviously, we can obtain that information elsewhere, but he does discuss some of the main contributing factors to health complications in each organ system.

Let’s look at the section on digestive system disorders as an example:

There are almost 50 pages on this system alone. He begins with some of the basic foundational information for this organ system and then covers the primary actions for the system. He has a chart listing the main herbal actions to address the digestive system, along with some examples of herbs that you would use for each action. 

Demulcents: Comfrey (Symphytum officinale), Marshmallow (Althea officinalis), Slippery Elm (Ulmus rubra), and Licorice (Glycyrrhiza glabra).

Bitter Tonics: Wormwood (Artemisia absinthium), Gentian (Gentiana lutea), and Goldenseal (Hydrastis canadensis). He’s got an example of milder bitters with Yarrow (Achillea millefolium) and Chamomile (Matricaria recutita).

Astringents: Agrimony (Agrimonia eupatoria), Cranesbill (Geranium maculatum), Meadowsweet (Filipendula ulmaria), and Bayberry (Myrica cerifera). 

These herb lists aren’t exhaustive. Instead, they are examples of herbs that fall into a specific category of action for addressing a particular system, and herbs that do so very well. I love that he has already refined each list and narrowed things down for us, rather than presenting a list of all the demulcents. He’s essentially saying, ‘Here are the key digestive demulcents that you should consider.’ 

Next, Hoffman examines the disorders within the system. He provides textbook definitions, directly from medical dictionaries, of what each term means. For example, what is constipation? He defines constipation, discusses it, and explores contributing factors. He also explains what laxatives are and describes the various types, including bulk-forming agents, dietary fiber, and anthraquinone laxatives. 

He covers the appropriate and inappropriate use of laxatives, and then delves into the treatment, explaining the basic strategies to take towards treating a condition, and provides simple triplet formulas. 

Now, these simple formulas are one thing about this book that I appreciate, and it has taken me 18 years to fully understand the way he constructs his formulas. These are not complex formulas, and, at one point, I just didn’t get it. I thought, really? That’s it? Only three herbs? Why isn’t this a more complex formula? However, I now understand and appreciate the simplicity of these basic triplets and pairs. Hoffman provides more complex formulas, too, but they aren’t overly complex.

For example, regarding gastroesophageal reflux disease (GERD), Hoffman gives us the indicated actions: 

• Demulcents soothe and coat the tissues of the esophagus and insulate the mucosal lining against acidic gastric contents. 
• Anti-inflammatories reduce localized mucosal reactions. 
• Vulneraries aid the healing of ulcerations and lesions.
• Astringents lessen local bleeding and other exudations.
• Alteratives help the body deal with any systemic problems related to the disease. 
• Carminatives may be needed if there is a general disruption of the digestive process.
• Caution, bitters are contraindicated in the initial stages of treatment, as they stimulate the secretion of stomach acid as well as peristaltic activity.

Then he gives a prescription for GERD: 

• 2 parts Marshmallow (Althea officinalis)
• 1 part Calendula (Calendula officinalis)
• 1 part  Chamomile (Matricaria recutita)

Dosage: up to 5 ml of tincture TID (three times per day). Additionally, sipping the anti-inflammatory herb Chamomile slowly throughout the day can be beneficial. As an alternative, a cold infusion of Marshmallow root can be taken whenever needed. 

Then Hoffman describes the actions supplied by the GERD prescription, stating, “It has demulcent, lymphatic, vulnerary, astringent, anti-inflammatory, and carminative properties.” It has all the actions we want, and he lists the herbs that have those actions, and then the broader context of treatment. 

Then, he gives some other information that can be helpful to consider, such as:

Raise the head of the bed, avoid stooping and constricting pressure on the abdomen, avoid certain foods and beverages, decrease the size of portions at mealtime, lose weight, avoid alcohol, stop smoking, etc.

So what you get here is much more than “Use these herbs or this formula for GERD.” but a deeper understanding as to the rationale and thinking behind the approach. This is what ultimately makes you a better herbalist. On top of that, he gives broader therapeutics that make the approach much more holistic. He gives us the condition, how that condition is defined, and how you should consider treating it. He gives the actions you want your herbs to have, some specific remedies, and an example of a basic pair or triplet formula, and what that formula does. In some cases, he provides multiple options for formulas, which is helpful. This provides a logical framework for thinking through therapeutics. 

I’ve been using this book for a long time, and I’ve referenced a lot of Hoffman’s baseline triplets and used them as foundations for my formulas over and over again.

After the conditions sections, you have Phytotherapy in Children and Phytotherapy in the Elderly, which caps off the body system section in the book.

A Model of Holistic Herbal Medicine

At the beginning of the treatment section, Hoffman covers “A Model of Holistic Herbal Medicine,” where he breaks down the approach for classifying herbs, including the context for the classification in terms of herbal actions.

There is a little in David Hoffman’s approach that I don’t fully resonate with. I remember being in a lecture with him one time and he said, “I’m just a mechanic; something in your body is broken. I’m going to give you an herb to fix it.” He is mechanistic in his approach, in my opinion. He doesn’t include energetics—I don’t think that’s in his mindset or approach to using herbal medicine. That’s fine, but I like having energetics overlaid, for example, with diuretics: I would like to know which ones are warming and which ones are cooling so as to prevent any symptomatic aggravation.

He does provide some differentiation with expectorants, breaking down stimulating versus relaxing expectorants, which is useful. He breaks nervines down into categories: nervine tonics, relaxants, and stimulants. So, he does use the stimulant-relaxant-tonic framework, which is essentially a Physiomedicalist classification system.

Hoffman offers his approach for choosing remedies. He says that through a competent diagnostic procedure, you can identify the physiological processes to address and understand how to address them. Then, select actions appropriate to address the physiological and pathophysiological processes identified through diagnosis.

Then, select relevant herbs based on their range of primary and secondary actions, ensuring the best fit for the patient’s needs. This is a very similar approach I have used in prescribing herbs as well.

In some issues in the body, you’ll consider the primary actions that you want to have in your formula, and then you’ll consider some secondary actions that can be very useful. And then, in the listings of the herbs, later in the book, Hoffman delves into herbal actions, defining them in great detail. He gives you a list of herbs that have that action, along with secondary actions. 

For example, he gives a list of primary alterative herbs and then breaks them down by their secondary actions. 

For example:

Alteratives that are also antimicrobial: Buchu (Agathosma betulina), Garlic (Allium sativum), Wild Indigo (Baptisia tinctoria), Echinacea (Echinacea angustifolia/purpurea), Goldenseal (Hydrastis canadensis), Chaparral (Larrea tridentata), Poke Root (Phytolacca americana), etc. 

Alteratives with secondary actions that are bitter: Burdock root (Arctium lappa), Goldenseal (Hydrastis canadensis), Bogbean (Menyanthes trifoliata). 

Alteratives with secondary expectorant properties: Bloodroot (Sanguinaria canadensis), Red Clover (Trifolium pratense), or Mullein (Verbascum thapsus).

He provides the main action of the alteratives and then herbs that have this secondary action as well—this helps you get more specific. 

In his section called “Applying the Model,” he offers us the following for approaching the herb selection process: “The best way to approach the selection process is to follow a number of steps. This may seem a long and potentially tedious process when first starting out, but it becomes straightforward with practice.”

1. List the signs and symptoms for each problem. 
2. Interpret the processes behind the symptoms and the underlying pathology, and identify appropriate herbal actions to address them. 
3. Using the reference list in chapter 25 (the Herbal Actions chapter), find herbs that may be helpful, based on their primary and secondary actions. 
4. Identify body systems that would benefit from the use of tonic herbs and choose relevant tonics. 
5. Are there any biochemical considerations? These might be positive indications for certain plants or clear contraindications.
6. Integrate the conclusions drawn in the previous steps and develop a prescription(s). 
7. Identify other healing modalities and lifestyle issues that might support the action of the herbs. 

Number seven is significant. It wouldn’t be holistic if he didn’t mention that, in my opinion.

Herbal Actions

Hoffman is a very action-based herbalist, and anyone who has followed my work for a while knows that he has heavily influenced my approach. I’ve read through this whole book at least a couple of times. The action-based approach is central to my model. It was also central to the approach that we took when studying herbs at Bastyr. It was very much action-oriented, and that’s why I especially like the herbal actions chapter. 

Many books that cover actions provide only a brief paragraph description and don’t break it down in detail. I love the charts in Medical Herbalism, particularly those showing the secondary actions and the relative strength of the herbs. 

For example, Hoffman lists the relative strengths of alterative herbs—mild, strong, and very strong (use with care). In the very strong category, he has Blue Flag (Iris versicolor), Chaparral (Larrea tridentata), Poke Root (Phytolacca americana), Sassafras (Sassafras albidum), Stillingia (Stillingia sylvatica), and Bloodroot (Sanguinaria canadensis). 

Materia Medica

Next, Hoffman gets into Materia Medica, and his listings are excellent. I find the constituent section very useful. 

To give you a picture of what his materia medica listings are like: First, you have the Latin name, then the common name, family, the parts of the herb used, the constituents, the actions, and then the indications, which are the descriptions of what the herb is commonly used for. I find some of the indications sections somewhat lacking. They just don’t have quite as much detail as I like in a monograph, but that’s just because I think more is better. I prefer lengthy descriptions, but brief descriptions can also be effective when you’re in a pinch and you just need to know quickly what an herb does. 

Next, you’ll find safety considerations, and preparations and dosage. Those are typically based on the British Herbal Pharmacopoeia (BHP), but he usually has German Commission E as well. He’ll mention the United States Dispensatory, too, but because he’s British, I think, he uses the BHP mainly for his dosage recommendations. 

This book contains mostly European herbs. There are some North American herbs included as well, but please note that this is a Western Materia Medica. This book doesn’t offer anything on Āyurvedic or Chinese herbs.

Final Sections of Medical Herbalism

At the back of the book, there’s an excellent glossary. Many books lack a glossary, so it’s a nice, quick reference guide. 

Hoffman also gives us the meaning of some of the plant names, which is pretty cool. For example, it says Belladonna means ‘beautiful lady.’ Benedictus means well or agreeable, so this would be Cnicus Benedictus, which is Blessed Thistle. Betonica is the name in Pliny of a medicinal plant growing in the region of Spain called Vectones or Vettones. Betonica is Wood Betony (Betonica officinalis or Stachys betonica). 

Then, you have another appendix, which lists herbs by Latin and common name. In the next appendix, he lists pharmacy terms, which can also be very useful. For example, BID stands for bis in die, which means twice a day.

Finally, Hoffman lists weights and measures conversions and provides a list of herbal information sources where you can find more information.

Who Is This Book For?

This book was first published in 2003, so it’s over 20 years old at the time of this writing.

Does that mean it’s outdated? No. He does reference some scientific studies, and I’m sure there’s much more that could be added to those sections. 

I highly recommend that if you’re interested in a more medically-oriented textbook for clinical herbalism consider adding Medical Herbalism to your bookshelf. You should read it. Don’t just reference it. I know it’s common to get books like this, and it just ends up turning into a reference book.

Don’t treat Medical Herbalism like a reference book. Use it as a reference book for sure, but don’t treat it as one. Read it from start to finish. It will serve you well. This book has had a very positive impact on my practice of herbal medicine, and I want to say thank you to David Hoffman for writing it. This was probably quite the project, and I absolutely adore this book. 

I would recommend this book to anyone who wants to gain a deeper scientific understanding of herbs and how they can be used to treat people in a more conventional medical context. This is not a down-home, folk herbalism-style home remedy book. As the name implies, this is more a medical textbook, for how to think about and apply herbal medicine. 

So, that, my friends, is my review of David Hoffman’s Medical Herbalism. I hope you find it useful.