Lehrbuch phytotherapie

Lehrbuch Phytotherapie
V. Fintelmann; R. F. Weiss
Hippokrates Verlag Stuttgart 2009, 12. überarbeitete Auflage, 430 Seiten, gebunden, 134 Abbildungen, 7 Tabellen, € 89,95

Die aus uralten Traditionen überlieferten Therapieformen mit Pflanzen verdanken Ihre Modernisierung und Überarbeitung zu einer zeitgemäßen Phytotherapie in Deutschland auch dem lebenslangen, engagierten Handeln des Arztes und Pflanzenkenners Rudolf Fritz Weiss (1895 - 1992). Volker Fintelmann, der Autor der 12. Auflage des von Weiss bereits 1943 begründeten Lehrbuchs der Phytotherapie, hat bereits ab der 7. Auflage das Lebenswerk des großen Phytotherapeuten überarbeitet. Beide Mediziner schufen, ihrer festen Überzeugung als praktizierende Ärzte folgend, dieses Standardwerk einer ganzheitlichen Medizin auf der Grundlage der Phytotherapie. Sie erläutern den präventiven, adjuvanten und kurativen Einsatz von Pflanzen in der Heilkunde. Fintelmann, der die Phytotherapie mit naturwissenschaftlicher Methodik anwendet und als komplementäre Therapiemöglichkeit versteht, legt den Schwerpunkt auf Beobachtungen und praktische Heilerfolge am Menschen und nicht nur nicht auf die Phytochemie oder statistisch auswertbare Versuche.

Im Grundlagenteil geht es um Definition, Geschichte und Besonderheiten der Phytotherapie sowie um spezifische Aspekte der Rezepturen bei verschiedenen Therapieformen.
Im Praxisteil werden, nach Krankheitsbildern beziehungsweise Organen geordnet, die Heilpflanzen, ihre Pharmakologie, die Indikationen und Rezepturen mit Dosierungsanweisung sehr kenntnisreich aufgeführt. Es werden die Verdauungsorgane und der Stoffwechsel, Herz-Kreislauferkrankungen, die Atemorgane, Niere, Harnwege und Prostata, Rheumatische Erkrankungen und Gicht, Nervensystem und Psyche Hautkrankheiten, Frauenkrankheiten, Alterskrankheiten, Kinderkrankheiten und Onkologische Erkrankungen ausführlich behandelt. Im Zuge dieser Abhandlungen werden ca. 150 Heilpflanzen vorgestellt. Zu den Heilpflanzen gibt es meist ein neus Foto oder eine exakte Zeichnung.
Der Anhang ist eine praktische Kurzfassung. Alphabetisch, nach Beschwerde oder Diagnose sortiert, werden die Indikationen der Heilpflanzen zusammengestellt. Nützlich ist ebenfalls die Nachschlagemöglichkeit nach Pflanzennamen in der abschließenden Kurzcharakteristik und die Register der Arzneimittel oder Sachthemen.
Dieser Klassiker ist zu einem modernen und übersichtlichen Lehrbuch geworden und beinhaltet nun auch Fragen zur Selbstüberprüfung für Studierende. Die übersichtlichen Aufstellungen erleichtern die praktische Anwendung des kompakten Wissensgebietes der Phytotherapie und machen das "Lehrbuch Phytotherapie" zu einer wertvollen Hilfe für die Praxis.

Herbal Medicine: Revised and Expanded Edition
by Rudolf Weiss and V Fintelmann

Readers familiar with the Beaconsfield edition of R F Weiss's Herbal Medicine will likely be more than disappointed by Thieme's second English edition of the book. The original has been comprehensively revised, rewritten, and edited by Dr Volker Fintelmann, a former chairman of The German Commission E, and is now a very different work altogether.

For those unacquainted with Weiss's book, the following brief summary must suffice, at least for the present task of situating the Fintelmann revision.

Rudolf Fritz Weiss (1895-1992) qualified as an MD in 1922 . By 1937 he was the leading proponent of phytotherapy in German postgraduate medical curricula. The first edition of Lehrbuch der Phytotherapie was published in 1944. In 1961 Weiss retired from active clinical practice to devote himself full time to the development of phytotherapy. Lehrbuch distilled over 20 years of Weiss's clinical experience in its first edition (several years of which he was doctoring as a prisoner in Russian POW camps), and it subsequently matured through six editions over the next twenty years. The first English edition, Herbal Medicine, was rapidly acknowledged as a classic following the publication of a well crafted production by Beaconsfield Publishing in 1988 of Meuss's silky translation of the sixth (1985) German edition of the work. Incredibly, this had been edited by the author in his 90th year, and was thus to all intents and purposes the final statement of his life's work.

Weiss was a libertarian protagonist of herbal medicine within the orthodox medical community: he knew he was arguing for a herbal therapeutics that ultimately was neither philosophically nor practically containable within the dominant medical viewpoint whilst operating within that milieu. He therefore addressed the medical community - and set about defining herbal medicine for them, articulating its basic premises, criticizing its weaknesses, and promoting its strengths. In so doing he anticipated many of the major issues that continue to confront western herbal medicine today and was arguably the first real exponent of the now fashionable trend of "integrative medicine". The original book remains a valuable "crossover" tool for introducing herbal medicine to physicians today.

As a philosophical progressive and experienced clinician Weiss was not only an authority within herbal medicine but also an outstanding thinker about herbal medicine. In Herbal Medicine, he ranged effortlessly over philosophy, materia medica and therapeutics in a way that consistently expresses an understanding of the nature of plants as healing agents, and of phytotherapy as a specific modality of natural medicine whose unique characteristics derive from the nature of medicinal herbs. By any informed historical account, Weiss was a towering figure of herbal medicine in the second half of the twentieth century, comparable to the leading physiomedical and eclectic figures of the preceding era.

Dr Fintelmann on the other hand is obviously conservative and scientistic, holding a Commission E perspective, with its accompanying limited and narrow "evidence based approach" that ignores and even disparages traditional use and empirical experience. His philosophical position is hard to interpret precisely - his understanding of holistic seems to involve an appeal to recognize both "subjective and objective" aspects of health and disease - so theory is clearly not his strong point - and he frequently refers to Goethe, possibly indicating anthroposophical leanings. He displays no particular empathy for medicinal plants themselves and although he professes to be an advocate of phytomedicine, he nowhere reveals the intimate personal clinical knowledge of herbs that is the warp and weft of Weiss's work. He explicitly states that he considers Weiss to be in error on fundamental points, and has eliminated accounts of folkloric and traditional remedies from the text. Weiss's often lengthy clinical accounts of herbs have been cut entirely, or reduced to minimalist lists of the tedious "take this for that - because of this study" genre.

Space does not permit an exhaustive catalog of Fintelmann's violations of Weiss's text, but one or two examples will serve to illustrate.

Weiss's Chapter 1, What Is herbal medicine? - a seminal philosophical manifesto of modern western herbalism - has been completely replaced by Fintelmann's disjointed commentary which lapses at times into complete unintelligibility - although poor translation may be partly to blame for this. However one thing is clear, Fintelmann explicitly attacks and rejects Weiss's classification of herbal medicines into mild, intermediate and strong type remedies (it has to be said without any coherent justification whatsoever) and completely extirpates Weiss's lucid and valuable discussion of the challenges faced by orthodox physicians and medical education in developing a genuine and effective understanding of medicinal herbs.

Fintelmann's agenda becomes clearer in Chapter 2 - Proof Of The Efficacy Of Herbal Drugs - which Weiss had only added for the 6th edition. Aware that orthodox medicine would increasingly challenge the efficacy of herbal medicine, Weiss anticipated the problems of applying orthodox medical criteria to phytotherapy by discussing topics such as the limits of clinical trials, the nature of placebo, the importance of empiricism in herbal therapeutics and so on. Fintelmann removes all this and instead launches into a routine promotion of the Commission E as a standard, which simply acquiesces to the criteria of dominant medical model that Weiss had tried to preempt.

Weiss often included accounts of the use of folkloric and traditional remedies, understanding that they are used largely because they work! In his chapter on peptic ulcers for example, Weiss discusses the use of raw cabbage juice as a simple ulcer remedy, and indeed spends two pages on the topic. Fintelmann however, dismissively says the treatment of ulcers with cabbage and potato juice does not seem worthwhile from a modern point of view. These folk remedies are more or less outdated. (p.70)

Neither are Weiss's meticulous clinical observations and insights spared the Fintelmann axe. For example, Weiss's twenty page discussion of the cardiac glycosides is an outstanding example of modern herbal writing. It has completely gone. Fintelmann declares instead this is already standard knowledge for physicians. (p149), thereby directly equating plants with pharmaceuticals. The myopic arrogance of this position is highlighted by the recent research interest on the anti-metastatic activity of the cardiac glycosides, especially from Nerium (oleander), which makes clinical experience of their different specific glycoside effects, as detailed at length by Weiss, a subject of considerable importance.

The volume includes some additions, including a chapter on pediatrics. This is reminiscent of the tedious book by Prof. Schilcher (Phytotherapy in Paediatrics) and is of similarly limited usefulness. For example, one must assume that German children do not get ear infections. Or maybe that Drs. Fintelmann and Schilcher just feel able to write about things whether or not they have any practical knowledge of them. Current CDC statistics confirm, as every primary care practitioner knows, childhood otitis media is among the top ten reasons for all physician office visits across the board in the USA. One might expect at least a mention of the subject but the topic is nowhere to be found. What do these physicians actually do, one wonders?

The "revising" or "rewriting" of classic or historical texts is generally considered unnecessary and undesirable in academic circles, an uncivilized behavior reserved for the nether worlds of politburo despotism and political show trials, where its purpose is to overturn the ideological influence of the original work to legitimize some new hegemony. Unfortunately, whether intentional or not this seems to be precisely the process we are confronted with in evaluating these two books side by side.

Thieme, who are launching their complementary medicine line with this title, are a subsidiary of Hippokrates, who hold the original rights in Germany, and presumably whose profit motives placed exploitation of Weiss's name and book title over respect for his work. But the political agenda is clearly that of promotion of a medical-pharmaceutical-scientific model of herbalism designed and packaged for pharmacists and orthodox physicians. This is corroborated by Blumenthal's Foreword to the volume which makes the serially absurd argument firstly that Varro Tyler was deeply influenced by Weiss, and then that Fintelmann's volume is one of the foundational texts of German herbal medicine which we are apparently so fortunate to have available to us in English (along with Commission E of course).

On the subject of English, the poor quality of the translation has already been mentioned. In fact it is so bad it is funny at times. When a phrase such as "herbal baths" is rendered as "phytobalneology" one wonders if the Monty Python team perhaps had some involvement in the editorial process. Why a prestigious German international publishing house is content with such inferior translation is another question.

Thieme have managed to add insult to injury by distressingly "improving" the book's appearance, with vulgar graphics and crude typography using garish green (er...get it?) ink boxes, rules and headings everywhere which uncannily complement the insensitive purging of Weiss's finesse and intelligence from the text. Even the elegant line illustrations of the original have been replaced by poorly reproduced often out-of-focus color photographs. Curiously some of the old illustrations have been randomly reproduced at sub postage stamp size in the new "quick reference" section - to what end is unclear since they are all but invisible without use of a glass. All this is "improvement" strictly in the WalMart sense, especially when compared to the craftsmanship and quality of the original production.

Is there any redeeming value in the text on its own merits? Very little. Most of the useful content is a truncated version of the original. Herb professionals or scholars might wish to compare the two texts, in the same way that one might try and illuminate say Stalin's revision of Marxism by comparative study of textual sources. Unfortunately, Beaconsfield Publishers of the UK are apparently now contractually prevented from reprinting the original edition (to their credit they declined to publish the Fintelmann revision). Of their total print run of 13,000 copies through several impressions, some should still be in circulation amongst second hand book dealers; readers who do not own an original copy should try and find a used one as soon as possible.