Phytotherapy in Paediatrics by Heinz Schilcher
Natural Healing for babies and Children by Aviva Jill Romm
Encyclopedia of Natural Healing for Children and Infants by Mary Bove
There are (at least) two things going on here. One is quite simply information about how herbs can be used in children’s healthcare. But when taken together these books pose a question that Bookworm readers may find more intriguing, which is nothing less dramatic than – whither western herbalism?
On the one hand, we have German phytotherapy represented by Professor Schilcher, eminent academic pharmacognoscist, industrial pharmacist, and member of Commission E since its inception in the early 60’s. On the other hand, Anglo-American herbalism, popularly presented by Mary Bove and Aviva Romm, the former a Naturopathic physician, midwife and British trained medical herbalist – the latter a professional midwife and experienced herbalist.
It is hard not see these two tendencies as antithetical, and despite the current rising crescendo of euro-monograph madness that has apparently seized sections of the herbal community and its media, there can be little doubt that the spectre of German phytotherapy as the means to salvation for western herbalism in the next century leaves many, including the Bookworm, disenchanted to say the least. For those readers currently labouring under the misconception that there is something inherently superior in the German model of phytotherapy, a comparative study of these texts may prove to be an enlightening, if uncomfortable, experience.
PUBLISHERS (ONCE AGAIN)
But first we might ask an obvious question – why is it that in the same year we suddenly have two almost indistinguishable Anglo-American offerings on herbs for kids from different publishers? Well of course this reflects the publishing industry’s continued cash crop attitude to the resurgence in herbalism and natural healing. Each publisher has to have their very own title on natural healing for kids, for women’s health, for pregnancy and childbirth, for elders etc. How many really good books can be written for the same niche market? Quality is blatantly subordinated to marketing strategies. After all, the gold standard in this particular terrain was set impeccably in 1992 by Anne McIntyre in her Herbal for Mother and Child (Element Books). One might question whether any additional work on the subject was necessary at all.
On the dismal topic of publishers, once again one has to complain at the extraordinary lack of finesse in typesetting, graphics and layout that seems to be an inevitable aspect of the current drive to cut costs to the bare minimum and rush out titles willy nilly. Neither American book has a single illustration, line or photo, and the visual monotony of the type matter is unrelieved – sometimes one longs for the sheer graphic excitement of the next issue of Wrench Grinders Manual Monthly……when will these people appreciate a single picture is worth a thousand words? Are all production departments staffed by pimply teenagers who think that typefaces are simply bundled software inside postscript output devices? Of the two houses, one could say Crossing has made a marginally neater job; at 250 pages Aviva Romm’s book is apparently shorter than Mary Bove’s at 300 pages – however its type measure is wider, the point size smaller and leading tighter making Ms Romm’s book in fact a more substantial as well as more attractive read – for two dollars more.
BOVE & ROMM
Superficially, the content of Dr Bove’s and Ms Romm’s books is almost identical. The titles are even confusingly alike. Both are built around the uninspired idea of an A-Z of common medical conditions arising in childhood. (in fact this format is worse than useless if you don’t know what you are looking for – as a worried parent with a sick child indeed may not – for example Roseola is under R – whereas it should be under F for Fever…) Both books begin with uncontentious introductory sections on the benefits of herbal medicine for children, and have notes on gathering herbs, basic preparation methods for remedies, a herbal first aid kit, and so on. This is the Anglo-American do-it-yourself paradigm in action. Of course the problem is that now every single herb book has its ‘how to gather, how to make, where to buy, useful herbs and first aid kit’ sections, the repetition becomes tediously predictable and generally uninspiring for the authors and the readers.
The essential difference in content between the two is that Aviva Romm has a large section on pregnancy and healthcare for the new-born and infant. This is her speciality, and indeed Ms Romm has also written a whole book on Natural Pregnancy, so in a way some of this material is redundant – or at least better covered elsewhere. Mary Bove reveals her naturopathic leanings beginning with two preliminary sections on Working with the Immune System and on Nutrition – these include a useful but regretfully small handful of recipes. Unlike Ms Romm, she also includes a lengthy Materia Medica section, with a paragraph on each of the herbs employed, listing actions, preparations and dosage, together with some recipes for specific preparations. An additional bonus in Ms Romm’s book is a section on demystifying physical examination of the child for the parent – inevitably this really suffers from the lack of diagrams and illustrations – and while it may be a little oversimplified it is nonetheless a useful idea.
Stylistically the two books are different. Given that both were written by qualified women natural healthcare practitioners who have many years experience with children, it is interesting to conjecture to what extent editorial constraints have influenced the stylistic presentation, but generally Mary Bove’s book is rather matter of fact in its feel, covering the bare bones of the physical conditions; it is almost terse, to the point of excessive brevity at times. Aviva Romm however, writes in a more intimate way. She communicates her love of plants throughout the book and is not afraid of the texture and complexity of the issues; she tends to speak from her own experience and directly addresses the experience of the parent. Needlessly, there is an ambient suggestion that Aviva Romm therefore must belong to the “Wise Woman” tendency, presumably on account of this experiential quality of writing. Not unsurprisingly, Susun Weed makes this claim herself – on the back cover notes. Since Dr Bove is clearly both wise and a woman, Ms Weed’s retrofitting recruitment campaign on behalf of Ms Romm appears puzzlingly unfair to Dr Bove. In any event, whatever the differences twixt Ms Romm and Dr Bove – they are emphatically on the same side when compared to Prof Schilcher.
The publisher of Phytotherapy in Paediatrics is Medpharm, who also publish Wichtl’s Herbal Drugs and Phytopharmaceuticals, and this book is produced in the same house style as Wichtl’s – in a clear easy to read two column format with austere but efficiently legible typesetting and layout. Translation from German to English is never a simple task, and the translator has generally done a good job – unfortunately the editor has let through a few howlers; my favourite being:
To prevent the tea separating into its components, up to 20% of the plant material with no or limited medicinal action which, however must be very hairy, is added to the mixture.
Collectors of eponymous medical syndromes will also be delighted with the hitherto obscure “Kratschmer’s reflex”, apparently an affliction of German children victims of the following unfortunate iatrogenic aetiology –
The wrong method of application, eg applying ointment containing menthol inside or immediately below the nostrils of infants can cause immediate collapse (Kratschmer reflex)
The graphics are curious – starting with a photograph of a teapot, (perhaps available on prescription as a medical appliance in Germany?) followed by a close-up of a commercial sample of non-medicinal grade chamomile flowers looking like used mattress stuffing. Ludicrously, there follows a murky photo of a TLC chromatogram of various unidentified commercial Hypericum preparations, purporting to show the different hypericin contents in the samples. Such variance in commercial product is of course real and a fascinating subject in its own right, but an unlabelled photo of a chromatogram tells us nothing per se – it is presumably included to emphasise the aura of “science” around the book but may as well be an amateur photograph of a UFO sighting for all it adds. Also included are a few illustrations of structural chemical formulae of herbal constituents (more science).
The book is emphatically NOT directed toward parents. And while Prof Schilcher’s credentials are listed as industrial and academic pharmacy and pharmacognosy – there is no indication that he is paediatrically or even medically qualified, he certainly is not a clinical herbalist – after all they do not exist as such in Germany. His intended audience are medically qualified paediatricians and pharmacists. The first paragraph of his introduction warns these legitimate custodians of scientific phytotherapy of their responsibility to
“distance themselves clearly from the lyrical indications given in popular and traditional medicine and obtain their information from the indications given in the Commission E monographs.. . .. physicians should only prescribe preparations of high pharmaceutical quality, preferably standardised products…..”
To aid the practitioner in this task, more than half the text is devoted to reproducing official monographs; 100 Commission E and 15 ESCOP monographs are included. The structure of Professor Schilcher’s text is far more sensible than the jumbled A-Z format of disorders used in the American books. He begins with herbs for topical application, and then considers herbs for internal use. Oddly, this second section mixes a systems approach (Respiratory, GI, Urogenital) with an actions approach (diaphoretics and analgesics). Also odd is the omission of all the major childhood infective illnesses, with the exception of Bordella pertussis. Presumably, either German children don’t get these infections, or they are only treated allopathically. There are no recommendations on nutrition, diet or psycho-social factors. Pure reductionism rules here. However the rigour with which some of the herbal information is discussed is certainly refreshing for the practicing herbalist, although the recommendations are invariably conservative and interestingly not without error in science either.
For example – Prof Schilcher recommends Comfrey root for topical application in children because he considers the benefits outweigh the risk of pyrrolizidine alkaloid toxicity. But he then suggests that the N-oxide level of PA’s is a relevant index of safety, but he omits to mention that the N-oxides are water soluble, and thus are quite simply excreted renally without metabolic interaction with hepatic cytP450 and thus no risk of hepatotoxicity whatsoever. As is often the way with those who bring their science into herbs from without, however well intentioned, they are ignorant of all the relevant variables. Thus it is that a comfrey leaf infusion made from the basal leaves has less hepatotoxicity than a cup of coffee. On the other hand Aviva Romm rather liberally advocates the use of comfrey root for both internal and external paediatric use, without once mentioning toxicity issues at all – not perhaps the wisest approach. Mary Bove neatly evades the toxicity issue by omitting all mention of comfrey – unfortunately throwing the baby out with the bath water.
Prof Schilcher is also concerned about the paediatric use of Valerian. He suggests that only valepotriate free and baldrinal free (baldrinals are a breakdown product of valepotriates, nothing to do with Blackadder) preparations of Valerian should be used. Despite the lack of contraindications or side effects noted even by Commission E, the fact that isolated valepotriate derived epoxides in one lab test caused alkylating cytotoxicity in some mouse cell lines, is sufficient cause for our Professor to suggest avoid using the whole herb drug. This is a bad case of what I call “Tylerism” after its founder Professor Varro Tyler, namely – the apparently authoritative declaration by a scientist lacking clinical training or herbal experience that a centuries old plant remedy should no longer be considered safe on the basis of laboratory tests using isolated chemical constituents of the herb on bacteria or rodents.
In fact none of our authors get near what is actually paediatrically of particular interest about valepotriates. It appears to be precisely valepotriate rich preparations from species such as V. edulis , V. walichii and V. sitchensis that are most effective in treating ADHD and related problems. There is no mention of these issues in Aviva Romm’s treatment of Valerian, or hyperactivity – and Mary Bove does not cover Valerian in her materia medica and gives it only cursory mention in her brief treatment of hyperactivity.
It might be instructive at this point to take a condition covered by all our authors and compare their recommendations. Since bed-wetting (nocturnal eneuresis) is a common problem of childhood, often met by practitioners and equally often refractory to treatment let’s look at that.
Mary Bove merely has two short and really rather uninspired paragraphs on the subject. She mentions the importance of lab tests to eliminate medical causes such as UTI’s or mechanical factors, and suggests that food allergies may be a cause. Otherwise she makes no herbal, nutritional or physical suggestions for therapeutics, and does not engage with the fact that psychological factors play a large part in the problem. Basically a poor show from Dr Bove.
Aviva Romm has three pages on eneuresis. Her approach is much more inclusive – she makes physical recommendations (kegel type exercises); she describes in detail a moxibustion procedure to “strengthen the kidneys”. This technique is used in several East Asian traditions – curiously this is the only place in the book where she mentions it. Her herbal recommendations include corn silk tea (she says preferably fresh – of course – dried cornsilk is inert) , to which Horsetail, Rosemary and Parsley can be added. Celery should be eaten, and finally she recommends a constitutional approach using Chinese herbal formulae – however suggesting somewhat blithely that this can be found in a book! She also talks about the need for counselling, and makes the rather rash assertion that if the bed wetter is a male child, the father son relationship will need healing. Boys too are likely to have bed wetting father. Are we to conclude that the opposite applies for girls? Sounds dangerously close to a dig at the Y chromosome. So – a mish mash of options, but at least they go some way to addressing the complexity of problem – therapeutically her use of herbs with marked diuretic action is questionable. Oddly, Ms Romm suggests “that medical intervention is rarely necessary because usually no physiological problem exists.” It is not clear upon which level she considers her herbal and physical protocols to be acting if physiology is excluded. She also omits to mention specifically that infective causes must be ruled out – in fact these are common enough, and even a succession of different micro-organisms may be cultured from an otherwise asymptomatic child’s urinary tract over a period of months.
Finally, Prof Schilcher who takes a conventional allopathic stance, gives some interesting herbal suggestions – Sweet sumach root (Rhus aromatica) Pumpkin seeds (Cucurbitae pepo seeds), Hypericum (in a proprietary formulation, of course) Kava (Piper methysticum) and Hop strobiles. To the reviewer at any rate these were at least the most sensible herbal suggestions of the three; however the use of mild anticholinergics such as Garryea and a specific such as Verbascum root (rather than leaf ) both have something to offer. The quality of the child’s sleep should be considered, and sometimes it may even be appropriate to add small quantities of Ephedra to “lighten” the depth of sleep. And no-one even mentioned treating the mother – often the first priority in these cases.
Where does all this lead us? As a practitioner recommending a book to moms interested in using herbs, I personally would not use Mary Bove’s text as it is frankly disappointing. Its redeeming feature is the inclusion of several nice recipes and preparations, but alas far too few. One hopes that her next offering is better, she is certainly more than capable of it. Aviva Romm’s book would be most useful as a general read, particularly for parents becoming interested in Natural Healing for the first time. She certainly has the most “holistic” approach – exemplified by her chapter on The Needs of the Whole Child. However, if Mary Bove does too little, Aviva Romm perhaps tries to do too much. An unforgivable omission from a children’s healthcare book is the topic of immunisation; the pros and cons as well as its likely effects on later health. Immunisation is not mentioned by Dr Bove despite her having a chapter on the Immune system; and it is likewise ignored by Ms Romm, for all her discussion of general health issues.
As an all round therapeutic handbook for parents my personal preference would still be for Anne MacIntyre’s older book, for its holistic approach, clearly arranged by systems and with a useful coverage of the major childhood infections; her consistent use of Bach Flower Essences throughout is an added bonus. I would supplement this with Leo Galland’s still excellent Superimmunity for Kids.
Prof Schilcher’s book really is a good buy for anyone contemplating the purchase of the Commission E or ESCOP monographs. One suspects that if more readers had earlier had the opportunity to preview the absurd conservatism and blinkered reductionism of the Commission E monographs – so usefully reproduced here at a cut price rate – that the complete edition of Commission E , at $189.00US dollars might not currently be occupying pole position in the Herbalgram best seller list, despite the endless promotional attempts to portray it to that magazine’s readers as the source of true herbal knowledge (perhaps it is not too late – The Commission E is not actually available at the time of writing – save money now!) For most practising herbalists, the herbal content of Prof Schilcher’s book will be familiar. For lay folk wanting to improve their general knowledge of herbs and herbalism, this slim volume would be an interesting addition to their library for as we have said it represents succinctly the model of German phytotherapy that some would have us believe is the path that most embodies the future of herbal medicine.
WHITHER WESTERN HERBALISM?
Returning finally to our original question – Phytotherapy in Paediatrics reveals that German phytotherapy includes the following less than desirable features…
- Intellectual copyrighting of plant medicine as proprietary brands.
- Insistence on standardised preparations based upon a reductionist view of herb action premised upon pharmacology of isolated active constituents.
- International (phyto)pharmaceutical corporate domination of herbal medicine manufacture.
- Maintenance of a elite/expert physician profession legally licensed to be the sole prescribers of herbal medicines.
- The reliance upon scientific “monographs” of herbs to provide a self-serving theoretical and legislative justification of its position.
- Preservation of the standard practice medical model, its mechanistic and reductionist view of human beings in health and sickness.
A bleak prospect, one might think, and one in which there is no place for such “lyrical”remarks as Aviva Romm’s exhortation to us:-
On a beautiful spring day you can easily gather the herbs for this tea. The activity of harvesting wild violets is so pleasant that I encourage you to venture outdoors with basket in hand every available afternoon
In the joyless and soulless world of the vision of German phytotherapy, we are left only with the bankrupt Cartesian paradigm of conventional medicine and its corporatist system of healing that is demonstrably flawed, historically redundant, but, thankfully perhaps, beyond even the healing power of herbs themselves.
Phytotherapy in Paediatrics, 1997, is published by Medpharm and distributed in the USA by Medicina Biologica, 2937 NE Flanders, Portland, OR, 97232. Paper,181pp., $35.00 US Dollars ISBN 3-88763-026-2
Professor Heinz Schilcher of the Institute of Pharmaceutical Biology at Berlin Independent University, has previously taught at Munich, Marberg and Tuebingen Universities. He has many years industrial experience and was a pharmacognosy memmber of Commission E in the Federal German Republic since its inception.
Natural Healing for Babies and Children, 1996, is published by The Crossing Press Inc, California. Paper, 247pp., $16.95 US Dollars ISBN 0-89594-786-2
Aviva Jill Romm is a certified midwife and herbalist trained in eastern and western health traditions, who has been practising since 1983. She lives with her husband and four children in Alpharetta, Georgia. She is the author of “The Natural Pregnancy Book” also from Crossing Press.
An Encyclopedia of Natural Healing for Children & 1996, Infants is published by Keats Publishing, Connecticut. Paper, 302pp., $14.95 US Dollars ISBN 0-87933-692-X
Mary Bove, ND, is a Naturopathic physician, licensed midwife and British trained herbalist who is a member of the National Institute of Medical Herbalists (UK). She is a former chair of Botanical Medicine at Bastyr University, and an internationally known lecturer on herbalism for women and children. SHe currently lives and practices in Brattleboro, Vermont.