I have to admit that when I hefted Clinical Naturopathic Medicine by Leah Hechtman, ND, out of its delivery box, my first thoughts were along the lines of, “Whoa. This is a big book.” I know, not exactly my best example of penetrating insight. The book impresses with its 1,596 textbook-sized pages, and despite being bound in soft cover with a soothing and very natural picture of ginkgo leaves on the front cover, it is heavy and, frankly, rather commanding. However, its imposing girth gives way immediately to a genuinely delightful engrossment upon opening the book.
The book begins with a foreword written by Joseph Pizzorno, ND, who eloquently praises the work for its unrelenting focus on naturopathic medicine from both a philosophical framework and a scientific basis. He goes on to cite the key strength of Clinical Naturopathic Medicine as “practical guidance.” That is strong endorsement from the coauthor of the Textbook of Natural Medicine, arguably the most respected textbook on naturopathic medicine.
I decided to test Pizzorno's assertion that Clinical Naturopathic Medicine exemplifies practical guidance by applying some clinical queries. Before I describe these reading adventures, let me describe how the book is structured. It is composed of 4 parts with a section of appendices. Part 1 has 4 chapters that cover the principles of naturopathic medicine. Notable is the entire chapter devoted to herb/nutrient-drug interactions. Part 2, Naturopathic Treatments, consists of 2 chapters, one on nutritional medicine and the other on herbal medicine. Part 3 is called Body Systems and includes 11 chapters on key body systems. The last part is called The Lifecycle and includes 3 chapters on Fertility, Pregnancy, and Breastfeeding and Pediatrics. The appendices are a robust collection of dosage charts, nutrient requirement changes, examination tables, laboratory reference values, and an interactions guide. The structure of the book is certainly unique, and one could fairly claim, entirely naturopathic. Instead of being organized by disease or pathological process, the book is organized by body systems. This allows Hechtman to describe the physiology of the system and to provide an understanding of that system by naturopathic principles—both historical and modern. This is followed by a section she calls “investigations,” which outlines in surprising detail the various laboratory and other diagnostic assessments used to diagnose conditions affecting that system. This is followed by an overview of core naturopathic therapeutic applications and their general indications, as well as a multi-page table of potential drug/herb/supplement interactions and recommendations. It is only after these sections that the author delves into specific conditions within that system. Each condition is covered comprehensively from etiology, signs and symptoms, differential diagnosis, diagnostic work-up, and then therapeutic applications. The therapeutic application for each condition addresses specific dietary, lifestyle, supplemental nutrient, and herbal therapies. There is no doubt as to the comprehensiveness of this book. The organization and layout of each chapter leave hardly a pebble unturned.
Breadth, however, is only part of the equation of a good and practical textbook. Depth and, more specifically, reliable depth of the information presented is essential. I tested the depth of the information out in several ways. My first method was to randomly open the book and read a page to see how accurately and comprehensively the information was conveyed. After doing this several times, I was convinced that the information presented passed. As an example, in the Respiratory System chapter, under the topic of conjunctivitis, herbal medicines are presented. Eyebright (Euphrasia spp.) is one of the herbs highlighted on this page. The 2-paragraph description covers the historical uses of eyebright, the parts of the plant used, the active constituents, medicinal actions of the plant, and a summary of a clinical trial illustrating its effect for conjunctivitis. On the preceding page, the conclusion of diet and selected nutrients are presented for conjunctivitis. This bears mention, as there is a sample daily diet for conjunctivitis (as there is for all conditions covered). An excerpt from this diet is the following recommendation for lunch: “Open toasted sandwich made with stoneground, high-quality bread topped with tinned sardines in tomato sauce, sliced red onion, coriander, cucumber and alfalfa sprouts. Season with freshly ground pepper.” This is followed with an explanation as follows, “Energetically, cucumber, coriander and alfalfa are thought to be both cooling and alkaline foods, which help offset the heat of conjunctivitis. Sardines provide a good source of protein and essential fatty acids. Onion has a specific affinity for the respiratory system, being decongestant in nature.” Clearly, the provision of in-depth and holistic coverage is evident.
The organization and layout of each chapter leave hardly a pebble unturned.
Testing the book further, I looked up certain challenging conditions, like endometriosis, to see how the author addressed them. The treatise on endometriosis spans 24 pages. The condition is explained brilliantly from etiological and pathophysiological perspectives. The diagnostic section covers every angle of diagnosis succinctly. The therapeutic section addresses the seriousness of the condition and the role for integrative management, and then covers a variety of naturopathic treatments in sufficient detail to gauge their relative reliability and utility.
The book passed all the tests I threw its way. However, there are a couple areas in which the book falls short. The author occasionally presents information authoritatively, but without scientific verification—and this stands out in an otherwise well-evidenced text. Several of the sections in the topic of cancer exemplify this, such as the author's citing of thermography as “a useful and safer alternative to mammography” (p 391). Another example occurs within the therapeutic section, which includes therapies ostensibly to improve the health of the patient (as opposed to treating the tumor), but nonetheless, includes therapies whose efficacy is questionable at best. Notably, the 4 diets described in detail are the macrobiotic, Budwig, Gerson, and dietary restriction diets, despite the paucity of evidence to support these diets. Subsequent therapeutic information is presented more solidly in an evidence-based manner. Fortunately, the bulk of the therapeutic information covered in this voluminous book is presented in a scientifically sound (and referenced) manner. Most recommendations include the nature and type of evidence to support their use.
Another shortcoming is the lack of case management guidance. The therapies are presented as a smorgasbord of options without a clearly defined hierarchy or long-term management guidance. The author may have intentionally avoided case management guidelines in order to prevent the book from becoming a textbook of protocols that would be in direct contradiction to one of the core principles of naturopathy: treating each person individually. Additionally, the book is written for students and practitioners, who, with discerning minds, should be able to extract the information that seems most appropriate and indicated for the patient at hand.
Overall, I give this book a solid thumbs up. It is an exhaustive resource that fits the bill of being a practical resource of repute and utility. I will refer to it and fully expect my patient management to be better for it.
Clinical Naturopathic Medicine (Churchill Livingstone, 2011) by Leah Hechtman, ND, is available through
