j o u r n a l o f h e r b a l m e d i c i n e 3 ( 2 0 1 3 ) 120–122
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/hermed
Book review
Principles and Practice of Phytotherapy – Modern Herbal
Medicine. Bone, K and Mills, S. Churchill Livingstone Elsevier
(2013). 1051 pp., 2nd edition, Hardback, £71.99
When the first edition of this landmark book emerged
in 2000, it was the first of its kind to blend the fun-
damental concepts of traditional western herbal medicine
with evidence-based scientific research, together with clinical
approaches, safety and dosage aspects. It was unique in that it
was written by two authors with extensive clinical experience
in herbal medicine, which allowed them to critically evaluate
any research and to fully integrate this into a therapeutic base
for herbal medicine practice.
It became a core teaching book for the majority of English
speaking students enrolled on western herbal medicine and
naturopathic courses world-wide and served as a valuable
resource for herbal practitioners, naturopaths and academics
in the wider phytotherapeutic sphere.
Thirteen years later, this key text book has been updated,
revised and expanded to include more recent understand-
ings, breakthroughs and scientific evidence on medicinal
plants, pharmacology and disease states. However, all this
new knowledge has needed to be carefully evaluated for rel-
evance and significance to the practice of herbal medicine.
In the intervening years, as Mills himself says in the preface
“. . .There has certainly been much more academic study of
herbal medicines, and the available literature we have had
to process seems to have doubled in these intervening years!
However, the large and more rigorous studies that we hoped
for have not delivered strong messages of efficacy”.
The new edition is a hefty tome as only a text book should
be. For those of you not familiar with the original edition, the
text in the 2nd edition is arranged in the same way and is split
into 3 key parts: underlying principles and the knowledge base
of modern herbal medicine; plants as therapeutic agents in a
clinical setting and 50 detailed monographs (7 more than the
previous edition). The text is clearly laid out with subchap-
ters and useful indices (general, actions and a new conditions
index).
In addition, in this new edition, there are several useful
appendices, including: a glossary on herb actions; a list of toxic
herbs; potential herb–drug interactions and general prescrib-
ing guidelines with concurrent use of pharmaceutical drugs;
dosing in children and how to assess research papers on clin-
ical trials. Compared to the previous edition, there are several
contributing authors that helped with the updating of several
of the monographs. Also included near the beginning of this
edition are photographs of some of the 50 herbs included in
the monographs. On this point, the photographs are of poor
quality and only some of the herbs are included (32 out of
50). They do seem to have been included as an afterthought.
However the book is extremely well referenced throughout
and references are conveniently given at the end of each
section.
The first section (chapters 1–5), “Background and Strate-
gies” covers philosophy, pharmacology, therapeutics and
safety of western herbal medicine. The section on herbal
pharmacology (chapter 2) has been expanded to include
recent research on pharmacological synergy and the differ-
ence between synergy, polyvalency and additive effects. It also
covers the newly emerging theory of “intelligent mixtures”,
which could explain, in the case of many herbs, how their
complex make-up of pharmacologically weak secondary plant
metabolites (in the absence of a highly bio-active compound)
can exert potent pharmacological effects.
In chapter 4, “validating herbal therapeutics”, there is a
useful new section exploring the validity of the “narrative
evidence base” and the value of traditional evidence in mod-
ern herbalism. There is also a section on how to critically
assess the relevance of published clinical research on herbs.
An appendix further expands on this.
The second section (chapters 6–9) “Practical clinical guide-
lines” covers dosage, prescribing and a herbal therapeutic
approach to different pathologies and system dysfunctions.
In the chapter on dosage, the section on standardised extracts
has been expanded to discuss the issues involved, includ-
ing the difference between galenical, highly concentrated and
selective phytochemical extracts and the question of quality.
Both chapters 8 and 9 have been considerably expanded to
take in account recent research on herbs and a developing
knowledge of particular disease states.
Chapter 8 covers topical applications, fever, infectious dis-
eases, inflammatory and autoimmune diseases, fatigue and
debility and malignant disease. Each section gives a back-
ground to the disease state and general phytotherapeutic
guidelines. For instance in the section on Chronic Fatigue
Syndrome (CFS), there is an exploration of the historical
background to the disease and it also includes more recent evi-
dence of a link between Chronic Fatigue Syndrome and human
parvovirus (HPV), mycoplasma infection and gut dysfunction,
including a new illustrative case history. The section on Malig-
nancy now includes recent research on both the efficacy of
 j o u r n a l o f h e r b a l m e d i c i n e 3 ( 2 0 1 3 ) 120–122
herbs and the use of herbal treatment in combination with
conventional treatments and therapeutic strategies.
Chapter 9 covers system dysfunctions. Each section covers
pathophysiology, general phytotherapeutic principles, includ-
ing herb actions and their indications, followed by specific
conditions and illustrative case histories. For example, in the
section on Digestion, new research into its pathophysiology is
incorporated into the treatment strategies for irritable bowel
syndrome, although I notice the illustrative case history is
left unchanged from the previous edition. There is also a
new section on intestinal dysbiosis, where the understand-
ing of its role in health and disease has developed in the
intervening years between the two editions. However, I was
disappointed that no further developments were reported on
the related epithelial barrier integrity of the gut. There is con-
siderable new research in the field of gastroenterology and
immunology on the role of compromised permeability and
digestive and systemic health that could have been reflected
here.
In the cardiovascular section, new research into Gar-
lic, plant phenolics and hyperlipidaemia have been added,
together with a new section on the phytotherapeutic approach
to cardiovascular risk factors, chronic venous disorders, DVT,
hypotension syndrome and Buergers disease, including new
illustrative case histories.
In the respiratory section, there is a comprehensive new
account of asthma: its pathophysiology, aggravating and
sustaining factors and a therapeutic approach to this dis-
ease. Equally in the female reproductive system section,
the same approach to treatment has been used for uterine
fibroids and in the section on Joint diseases, osteoarthritis
and fibromyalgia have been included. It is good to see that
there is, in the new edition, a phytotherapeutic approach to
nervous system conditions, something that was lacking in
the first edition. The section on Skin has been completely
rewritten, covering strategic approaches and research evi-
dence for atopic eczema, urticaria, herpes infections and
acne.
There are two brand new sections, Male Reproductive
System (andropause, low male fertility, erectile dysfunc-
tion and BPH) and Endocrine disorders (adrenal depletion,
reactive dysglycaemia, functional endocrine deficiencies,
metabolic syndrome, type 2 diabetes, hyper and hypothy-
roidism).
For each condition, a general therapeutic approach is given.
It would be of value to have some of the more constitutional
concepts covered in chapter 3 (Principles of Herbal treat-
ment), reflected in the approaches. The case histories running
through these two chapters are useful for students in partic-
ular, to see the herbal approach demonstrated with example
formulas. However, the majority of the formulas are based on
1:2 tincture strengths and do not reflect the broad prescrib-
ing practices of many herbalists. The authors do acknowledge
this diversity in the dosage section, but perhaps this needs
to be reflected more in the case histories. There is also a
lack of consistency with the weekly dispensed quantities,
despite the author’s setting out requirements in the dosage
section.
Part 3 consists of the monographs, which encompass
over half of the page count, including a comprehensive
121
explanation of the monograph structure, invaluable to stu-
dents and those in the herbal industry alike. There is a very
useful section on general toxicology. The monograph structure
remains the same as the first edition, namely: synonyms; what
is it?; effects; traditional view; summary actions; can be used
for; may also be used for; other applications; preparations;
duration of use; summary assessment of safety; technical
data; toxicology and other safety data (including a new sec-
tion on safety in children); regulatory status. The monographs
critically evaluate both traditional and modern usage of each
herb from a therapeutic perspective.
The 44 monographs in the original edition have been
updated and expanded, with the loss of Citrus seed extract,
but with the addition of 7 new monographs, namely: Gotu
Kola, Willow bark, Bugleweed, Butchers broom, Boswellia,
Myrrh, Tribulus. As an example, in the Valerian monograph,
more recent research on sleep quality is presented and a
review of the use of Black Cohosh in breast cancer patients
with menopausal symptoms and the safety issues surround-
ing Black Cohosh is covered in its monograph. The new
monographs included reflect new quality research being pro-
duced. For instance the Boswellia monograph focuses on the
recent research into its use in the treatment of arthritis and
autoimmune disease. There is a strong scientific focus to the
monographs, but it is always presented with the best quality
research in mind.
As mentioned at the beginning of this review, there are
also several appendices at the end of the book. The “Glossary
on herb actions” will delight any student wading through the
quagmire of definitions and confusing terms. The appendix
on potential herb–drug interactions (HDIs) is useful and has
a section on general prescribing issues with drugs, including
drugs with a narrow therapeutic window and how HDIs are
monitored. Another appendix very usefully outlines dosage
rules for children. Herbal practitioners will be familiar with
both Dillings and Young’s formulations to calculate dosage in
children, but these do not work particularly well for children
under 2 years. New formulae based on paediatric pharma-
cological research are suggested. The last appendix covering
how to read clinical trial papers, mentioned previously, is
an extremely useful article for students, practitioners and
researchers alike, giving clear criteria for assessing and criti-
cally evaluating such research.
Some students may baulk at the price of this new edition,
but for a text book it offers considerable value for money. At
almost twice the page count of the previous edition, it reflects,
as Mills said at the beginning, an enormous increase in the
amount of research into medicinal plants. What Bone and
Mills have done is to sieve through the numerous trials and
concentrate on the ones that count in terms of quality and
relevance to students, herbal and naturopathic practitioners,
clinicians and academics. They have expanded the therapeu-
tic approach section for several pathological conditions. They
have managed to do this without losing that which should
remain integral to Western Herbal Medicine-valuing not only
new research, but also our traditional knowledge and thera-
peutic approach.
Dr Non Owen. originally trained as a microbiologist and
undertook further studies in molecular biology and genetics.
122 j o u r n a l o f h e r b a l m e d i c i n e 3 ( 2 0 1 3 ) 120–122

She studied Herbal Medicine at the School of Phytotherapy Non Owen ∗

where she qualified in 1998. Since then she has been a prac- Well Street Clinic, 46 Well Street, Rhuthun LL15 1AW,
ticing herbalist, clinical supervisor and lecturer on herbal United Kingdom
medicine programmes in the UK. She is currently module
∗ Tel.: +44 01824 750732.
leader for both Materia Medica and Herbal Therapeutics at
the University of East London. She practices in North Wales E-mail address: info@nonowenherbalist.co.uk
on the BSc Herbal Medicine Programme and also runs edu-
URL: http://www.nonowenherbalist.co.uk.
cational workshops on herbal medicine for the general public.
2210-8033/$ – see front matter
She is particularly interested in herbal therapeutic approaches
http://dx.doi.org/10.1016/j.hermed.2013.07.001
to endocrine immune dysfunction and its role in chronic dis-
Available online 4 September 2013
ease.