Herbal Antibiotics, 2nd edition: Natural Alternatives for Treating Drug-Resistant Bacteria

Herbal Antibiotics cover2012, 467 pages, softback, $24.95
review by Gregory Luckman

Recently, I wrote a review of Buhner’s Herbal Antivirals that appeared in the Spring 2020 issue of The Natural Farmer. Readers of that review may well have noticed that Herbal Antivirals was hardly a new book. Published in 2013, it was already seven years old. The 2nd edition of Herbal Antibiotics (hereinafter I will drop the 2nd edition specification) tops that: Published in 2012, a year before Herbal Antivirals, it is already eight years old. My justification for the earlier review was that a viral pandemic, now called COVID-19, was gathering force around the world at the time of submission of that review (end of January 2020), so it was appropriate to bring anew to readers’ attention a book that, among other topics, did in fact describe an herbal approach to treating a coronavirus, albeit an older coronavirus that caused an illness known as SARS.

So, what is my justification for reviewing Buhner’s 2012 Herbal Antibiotics at this time, given that my beginner status in herbal medicine has not changed? COVID-19 is due to a virus, not a bacterium. What does a book on herbal approaches to bacterial infections have to do with that? In response, I direct your attention to statements in a 2008 article in the CDC Journal, Emerging Infectious Diseases, titled “Deaths from Bacterial Pneumonia during 1918–19 Influenza Pandemic.” At one point in their article, the authors write,
“Care providers and experts of the day [1918-1919] in epidemiology, pathology, bacteriology, and infectious diseases clearly concurred that pneumonias from secondary bacterial infections caused most deaths during the pandemic.”

To be clear, no one doubts today that the original influenza of 1918-1919 was viral, not bacterial. So antibiotics would not have been effective against the original flu strain. But the concept of “secondary bacterial infection” suggests that although the original influenza could kill by itself, it was more often a “gateway” illness, weakening the immune system and enabling the deadly bacterial pneumonias. And influenza was not unique in this characteristic. Speaking of measles in nineteenth century England, Anne Hardy, in The Epidemic Streets writes:
“Mild in itself, it [measles] can assume a life-threatening form in certain circumstances, in ‘virgin-soil’ populations, and in the severely undernourished. It also predisposes sufferers to secondary bacterial infections, which may result in permanent hearing and respiratory injury. . . Bronchitis and broncho-pneumonia are damaging (and the latter often fatal) sequelae.”

It could be that coinfections are the norm rather than the exception in deadly diseases.

As I write this (end of April 2020) not enough is known about COVID-19 to say what role secondary bacterial infections might play in the disease’s lethality. However, the frequent use in the press of the phrases, “COVID-19 related” and “complications of COVID-19” make me suspicious. But for sure, until such time as secondary bacterial infections, especially those due to increasingly common antibiotic-resistant bacteria, can be ruled out as important contributors to COVID-19-related deaths, a look anew at a book that covers herbal treatments of resistant bacteria, fungi, and protists is, in my opinion, timely just as, in my opinion, the review of Herbal Antivirals was timely. In addition, the issue of antibiotic resistance is not just about the current pandemic. COVID-19 might go away, but as long as we have CAFOs and over-prescription of antibiotics, the problem of antibiotic-resistant bacteria will be with us and will likely only get worse.

One might reasonably regard Herbal Antibiotics and Herbal Antivirals as a two volume set, with Herbal Antibiotics being the first volume and therefore the volume tasked with the greater burden of providing an overview of the topics both books address. The two books not only have similar titles and have the same author and same publisher, they actually almost look alike with similar cover designs. They also have a similar organization. Consequently, I will skip many of the introductory observations for Herbal Antibiotics that are duplications of remarks I made for Herbal Antivirals and simply refer you to my earlier review in the Spring 2020 issue of The Natural Farmer. Many of my remarks in the earlier review really apply to both books.

I would like to start with three caveats, all of which apply to both books, but which I did not state before.

First, on the copyright page of both books is the disclaimer,

“This publication is intended to provide educational information for the reader on the covered subject. It is not intended to take the place of personalized medical counseling, diagnosis, and treatment from a trained health professional.”

Similarly, just as I am not a trained herbalist, I am also not a medical professional. My book review is for the information of readers only and it is not intended as medical advice.

The second caveat is perhaps anticipated by a paragraph written by Buhner himself in his discussion of echinacea in the chapter of Herbal Antibiotics entitled “The First Line of Defense: Strengthening the Immune System.” He writes,

“Echinacea is not an immune tonic; it is an immune stimulant. Continued immune stimulation in instances of immune depletion to avoid necessary rest or more healthy lifestyle choices will always result in a more severe illness than if the original colds and flus were allowed to progress. Echinacea should not be used if you are getting sick a lot and are only using echinacea to stave off illness without using the time gained to heal the immune system itself through deep healing and recuperation.”

And critical among healthy lifestyle choices, of course, is healthy nutrition. Despite silence on the issue by public health authorities, my personal view is that healthy nutrition is likely to be more important than frequent hand-washing, wearing masks in public, or so-called social distancing in dealing with the COVID-19 pandemic or with future pandemics. The point is that healthy nutrition and healthy living are the real first line of defense. Even the best of herbal remedies are supportive. I do not think that I need to dwell on this in a book review for readers of The Natural Farmer. But I can assure you that I do not mean to dismiss the primacy of nutrition and other lifestyle factors even though I do not discuss them in reviews of Buhner’s books. And, by the way, echinacea is not even among the most potent of the herbal remedies Buhner discusses.

The third caveat is that many medicinal herbs may well be borderline toxic and can be outright toxic if they are not used properly. This issue shows up in Buhner’s discussion of the berberine-containing plants in the chapter of Herbal Antibiotics entitled “Herbal Antibiotics: The Localized Nonsystemics,” to wit:
“There is a tendency, because of the berberine plants’ poor absorption across the intestinal mucosa, to increase the dose of the plants substantially to try to get more into the bloodstream. This is a very bad idea. Abdominal cramping, nervous tremors, and, most importantly, excessive drying of the mucous membranes will occur at high doses. Do not attempt to use these herbs as systemics.”

In other words, damage to the GI tract will occur long before a therapeutic dose of the berberine plants’ constituents is reached in the bloodstream. So the caveat is, there can be problems due to overdoses. Use herbal medicines with care, only in ways that long experience has shaped to provide an understanding of their appropriate use. Statements analogous to the above quote about the berberines occur for several of the plants mentioned in each book. The occurrence of such statements is a notable feature of both books: warnings on what not to do as well as guidance on what to do for the safe usage of herbal medicine.

In Herbal Antibiotics, the foreword to the first edition (1999) by James Duke, PhD. that is reprinted in the second edition, the preface to the second edition, the prologue (titled “Rise of the Superbugs”), and Chapter 1 (titled “The End of Antibiotics”) all function to provide an overview of what the world is facing with antibiotic resistance and emerging superbugs.

Chapter 2, “The Resistant Organisms, the Diseases They Cause, and How to Treat Them,” corresponds to Chapters 2 through 4 of Herbal Antivirals. It starts with ten more pages of overview of what the world is facing, then zooms in to enumerate the types of resistant organisms, divided into three main categories: Gram-positive bacteria, Gram-negative bacteria, and non-bacterial organisms.

Gram-positive bacteria are those whose stain in labs in the Gram stain retain a violet color and have a thick cell wall.

The five types of Gram-positive bacteria considered are, in alphabetical order, Clostridium difficile, Enterococcus species, Mycobacterium tuberculosis, Staphylococcus aureus, and Streptococcus species. The thirteen types of Gram-negative bacteria considered are, in alphabetical order: Acinetobacter baumannii, Campylobacter jejuni, pathogenic E. coli strains, Haemophilus influenzae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Proteus species, Pseudomonas aeruginosa, Salmonella species, Serratia marcescens, Shigella species, Stenotrophomonas maltophilia, and Vibrio cholerae. The non-bacterial organisms are Candida species, Plasmodium species (the causative agents of malaria), and Aspergillus species.

Wow! That’s quite a list. Many of the names are widely familiar to the public, especially as foodborne pathogens. Some of the pathogens that are not familiar are likely to be associated with hospital-acquired infections, relevant to the person in the hospital for COVID-19 or for anything else. For each of the twenty-one types of organisms, Chapter 2 provides proposed formulations, dosages, and frequencies of administration of specific herbal remedies. The majority of formulations seem to be tinctures, but there are also some infusions, decoctions, poultices, and essential oil preparations. This manner of presentation might be confusing to someone not familiar with herbal medicine who is reading the book through for the first time from start to finish. The designation, “formulation,” is cryptic to a beginner. One needs to know that the formulations are described in more detail only later in the book, in the sections on individual herbs.

Chapter 3, “About Herbal Antibiotics,” starts with an overview, but this time of medicinal herbs rather than of the emerging resistant organisms. The chapter is only ten pages long, but I believe it contains the essence of the difference in philosophy between Western medicine and the evolving outlook on medicine by much of the world outside of the United States and Western Europe. Much of the world, Buhner suggests, have realized that they cannot rely on a “pharmaceutical/technological medical model as their primary approach to health care.” This leads to research seriously looking for the best plants for any application and for the optimum preparation of those plants for maximum effectiveness. By contrast, in the U.S. researchers often (although not always) assume that an herbal approach is primitive and thus inferior, and present dismissive accounts of herbal medicine based on experiments that are sometimes superficial.

Chapters 4 through 7 of Herbal Antibiotics correspond to Chapters 5 and 6 of Herbal Antivirals, being organized around lists of herbs with specific properties and around specific uses of those herbs. Chapter 4, “Herbal Antibiotics: The Systemics,” discusses Buhner’s choice of five herb genera, a therapeutic subset of whose constituents can cross the intestinal membrane and circulate in the bloodstream throughout the body. This property is essential when treating resistant infections that are similarly spread throughout the body. The five herb genera are Cryptolepis, Sida, Alchornea, Bidens, and Artemisia. Cryptolepis, Sida and Alchornea all appear to be particularly broad-spectrum in their actions. Sida and Bidens are considered to be invasive species. By contrast, Alchornea is not readily available in the Western world. Buhner states, “Part of the point of listing this wonderful plant here is to stimulate suppliers to import it or for gardeners [or organic farmers? Don’t forget the organic farmers!] to begin planting it in the United States.

Chapter 5, “Herbal Antibiotics: The Localized Nonsystemics,” discusses Buhner’s choice of medicinals that contain constituents that one should assume cannot cross the intestinal membrane, but that can be very effective within the GI tract or for skin infections. These include the berberine-containing plants that Buhner refers to as the Berberines, the junipers, Usnea, and organic wildflower honey. Several of the Berberines are considered to be invasive.

Chapter 6, “Herbal Antibiotics: The Synergists,” covers plants which might have some anti-bacterial properties of their own, but whose primary action is to increase the effectiveness of other medicinal plants. They do this through several mechanisms that Buhner describes. He briefly mentions 19 different plants, many of which are common garden plants or culinary herbs. He then goes into more detail on three plants in particular: licorice, ginger, and black pepper/piperine.

The notion of synergy between plants seems to me to be an example of the notion of “as below, so above.” Pathogenic organisms are thought not to develop resistance to medicinal plants the way that such organisms develop resistance to antibiotics because the plants use many different secondary compounds, not just one “active ingredient.” It is harder for a pathogen to evolve around many different control mechanisms than around the control mechanism of one active ingredient. Synergy between two plants extends this notion, with two or more plants contributing complementary collections of secondary compounds.

Chapter 7, “The First Line of Defense: Strengthening the Immune System,” resembles Chapter 6 of Herbal Antivirals, except that there are eight herbs listed rather than three. They are, in alphabetical order, Ashwaganda, Astragalus, Boneset, Echinacea, Eleuthero, Red Root, Reishi, and Rhodiola.

The discussion of each of the herbs in Chapters 4 through 7 is extensive, including sections on which parts of the plant are used, preparation and dosage, side effects, herb-herb and herb-drug interactions, habitat and appearance, cultivation and collection, medical properties, commercial sources, plant chemistry, traditional uses, and finally, in smaller type font, a description of studies that Buhner found in the worldwide scientific literature. (OK, I did cut and paste most of this paragraph from my review of Herbal Antivirals. But there is a reason for this. The presentation of herbs in the two books is identical, and in both cases, seemingly encyclopedic.)

In Herbal Antivirals there is a twenty-one page appendix on herbal medicine making. Buhner openly states that the appendix is condensed from a more extensive discussion in Herbal Antibiotics, 2nd edition. Well, here it is: Chapter 8, “A Handbook of Herbal Medicine Making,” a forty-seven page discussion.

Some topics such as water infusions and decoctions, alcohol tinctures, and herbal medicine for children are copied almost verbatim into the Herbal Antivirals appendix. What is included in Herbal Antibiotics Chapter 8 that the appendix of Herbal Antivirals lacks is a discussion of harvesting and storing plants, a broader array of water extraction applications such as washes, steams, evaporative concentrates, and percolations; a broader array of alcohol or related substance extractions; oil infusions; salves; lotions; essential oils; and a section on using whole herbs.

In general, these extended topics leave me with the impression that the full Chapter 8 is more suited for the professional herbalist who is more likely to have occasion first to wildcraft or grow herbs and second to use them in a practice extending beyond her or his own family needs. The common topics are nevertheless enough to get the do-it-yourselfers started. For those who would prefer to buy rather than make their own, there is a resource list. As I stated in the earlier review, there are now additional suppliers, some of whom have recently been appearing as vendors at NOFA summer and winter conferences over the past year and a half.

The concerns I expressed about Herbal Antivirals in my earlier review apply as well to Herbal Antibiotics, and there is no need to repeat them here. In addition to those concerns, there is the obvious issue of the age of the books. The plant medicines have not changed, but new diseases are always emerging. COVID-19 is an obvious example. Figuring out an effective herbal approach to such new diseases can ultimately only be done by experience. In the interim, one has to fall back on broad spectrum herbal remedies or look to remedies used for diseases due to similar organisms. Developing a COVID-19 protocol by starting with the formulations for the older SARS is a case in point. I hope that someday someone will undertake an updating of Buhner’s impressive two volumes on herbal antibiotics and antivirals.

I would like to close with some comments on Buhner’s preference for and championing of invasives as medicinal plants. (This is the special issue of The Natural Farmer on invasives, isn’t it?) Buhner concludes his introductory remarks to Chapter 4, “Herbal Antibiotics: The Systemics,” with the words,
“While cryptolepis is sometimes hard to find, many of the other herbs in this section are not – at least in the wild. They are often widely distributed throughout the world; a number of them are considered invasive plants, which is a plus. Invasive plants – Earth’s way of insisting that we notice her medicines.”

My apologies here to Buhner and other advocates of Gaia and sacred plant medicine, but I personally look for a scientific (but not reductionist or linear) reason why something occurs. In this case, I ask, why are invasives so well represented among healing plants? My possibly simplistic reasoning is as follows: There are probably no two acres-worth of soil on the Earth that have exactly the same strains of microorganisms. Most microorganisms are beneficial to plants, but there are also many varieties that are pathogenic, and there are many strains of those pathogenic organisms. Plants have learned over millions of years to cope with pathogenic organisms in their environment, mostly through secondary chemical compounds that keep the pathogenics under control.

But the wider the range of a plant, and invasives by definition have a wide range, the greater the variety of strains of pathogenic organisms that the plant needs to control. To thrive over a wide range, a plant has to have secondary compounds that are sufficiently powerful and sufficiently broad spectrum in their actions that they can control all of those different strains of pathogens on whatever acre on whatever continent the plant finds itself.

Now, broad spectrum ability to control soil pathogens is no guarantee that a plant is invasive – ecologies are more complex than that. And a broad spectrum ability to control soil pathogens is no guarantee that a plant’s secondary compounds will also control organisms pathogenic to the human body. But I am just saying that we should not be surprised that invasive plants, with their ability to control many different strains of plant pathogens, are well represented among the plants with medicinal benefits for human beings.

Regardless of the validity of my reasoning on that issue, more dialog on the appropriate use of herbal medicine is needed, with Buhner’s books as valuable source material.