Herbal Medicine
Herbal medicine uses plants for medicinal purposes. The term ‘herb’ includes leaves, stems, flowers, fruits, seeds, roots, rhizomes and bark, although in many traditions other naturally occurring substances including animal and mineral products are also used.
There can be little doubt that the use of plants for healing purposes is the most ancient form of medicine known. Men and women, led by instinct, taste, tradition and experience, used plants that were not part of their normal diet for healing purposes. The physical evidence for herbalism goes back some 60,000 years to a Neanderthal burial site uncovered in 1960 in the Middle East.
In China, Huang Di, the legendary Yellow Emperor, is credited with writing The Yellow Emperor’s Classic of Internal Medicine in about 400 BC which lists 12 herbal prescriptions. The authorship of China’s first Materia Medica (Shen Nong Ben Cao Jing) is credited to the mythical Shen Nong (‘divine father’), the Yellow Emperor’s predecessor.
The Egyptians are also renowned for the use of herbs, and official schools for herbalists existed in Egypt as early as 3000 BC. The Ebers Papyrus, written around 1500 BC and discovered in 1862, contains around 876 prescriptions made up of more than 500 different substances.
Many of the founders of the ancient Greek schools of medicine apparently owed their learning to the Egyptians. Hippocrates was tutored by Egyptian priest-doctors, and his writings mention over 250 medicinal plants.
A vast body of Greco-Roman knowledge of herbs was preserved and enlarged upon by the Arabs. This knowledge, much of which had been lost to Europe in the Dark Ages, was reintroduced to Europe when the Crusaders returned from the Middle East.
In India too, traditional medicine incorporated a large number of herbal remedies. The Indian Materia Medica, published in 1908, listed 2,982 medicinal plants.
During the eighteenth and nineteenth centuries, many Europeans emigrated to North America. These settlers discovered that the native American population was skilled at using the indigenous plants as medicines and they began to incorporate them into their own remedies. Many of these new herbal remedies from the Americas were also brought back to Europe.
Despite the popularity of herbalism in the West, by the beginning of the nineteenth century herbal medicine had begun to fall out of favour with the medical profession, which considered it to be unscientific and imprecise. In Britain, professional herbalism survived only through the establishment of the National Institute of Medical Herbalists in 1864, which is still flourishing today and is the oldest register of practising medical herbalists in the world.
HERBAL TRADITIONS
There are three main methods through which herbal medicines are prescribed: Chinese, Ayurvedic and Western.
Herbal medicines are an essential part of traditional Chinese medicine (TCM) and are prescribed according to an individualised diagnosis, much as one would prescribe particular acupuncture points. Ayurvedic herbs are prescribed according to the main underlying principles of Ayurvedic medicine, also on an individual basis. Western herbal prescriptions are individually formulated and usually involve a mixture of herbs.
Western herbal remedies are prepared solely from plant material, whereas traditional Chinese and Ayurvedic herbs may also use some animal and mineral substances. Chinese herbs are usually prepared as decoctions, which means that the herbal mixtures are boiled and the liquid is used medicinally. Ayurvedic and Western herbs are usually administered in tinctures (alcohol/water extracts). Many standard or patented traditional Chinese herbal products are available as pills, as are an increasing number of Western herbs.
Herbal preparations are available in health food shops and over the counter from pharmacies to treat a variety of quite specific medical problems (for instance, the use of St John’s wort in depression).
HOW DOES HERBAL MEDICINE DIFFER FROM CONVENTIONAL MEDICINE?
Many conventional drugs come from the purified extracts of herbs, and both herbal and conventional medicines work through the same biochemical and physiological pathways. However, herbalists claim that one of the great strengths of using the unrefined whole plant is that the active ingredient is present with a number of other naturally occurring plant chemicals. This can make the action of the active ingredient far safer, reducing the chance of unpleasant side effects. For example, the herb meadowsweet contains both an aspirin-like substance and a stomach-soothing compound that could, in theory, prevent te indigestion that aspirin can cause. These views are attractive, but as yet unproven.
Herbalists tend to use many herbs together. The combinations are largely based on clinical experience rather than rigorous science. It seems that conventional medicine is trying to decrease the number of drugs given to people, whereas in herbal medicine sometimes the opposite occurs.
As with many other forms of complementary medicine, the prescription of a specific herb or mixture of herbs is based not only on a conventional medical diagnosis but also on the traditional diagnostic system that underpins the herbal prescription. For instance, a herb may be prescribed to strengthen the kidney or liver or to dispel heat.
DOES HERBAL MEDICINE WORK?
Herbal medicines have been used widely for a large number of conditions over many thousands of years. Herbalists tend to treat chronic, benign conditions such as allergic disease (asthma and eczema), hormonal problems such as menopausal symptoms, premenstrual syndrome and painful, irregular or difficult periods, headaches (including migraine), irritable bowel syndrome and arthritis (both rheumatoid and osteoarthritis).
In practice, many herbalists combine their suggested herbal remedies with dietary recommendations and nutritional supplements. The aim of herbal medicine, particularly in these chronic, persistent complaints, is generally to improve well-being, and perhaps slow down or modify the natural history of an illness. Herbs can also be used to relieve depression or help sleep.
WHAT DOES THE TREATMENT INVOLVE?
Treatment by a herbalist will usually involve a detailed consultation to find out all your symptoms and your constitutional make-up. Herbs will then be prescribed based on the diagnosis made by the herbalist.
Treatment usually involves drinking a number of herbal extracts in teas or small amounts of alcohol that need to be taken at regular intervals, usually two to four times a day, over four to six weeks. The herbalist will usually review your clinical progress on a monthly basis. In general, you should begin to see some improvement in a long-term chronic problem within four to six months of taking herbal remedies.
IS IT SAFE?
The safety of herbal remedies has been the subject of much controversy. Herbal medicines must be produced using good manufacturing practice and must be free from adulteration. Medicines manufactured in the Westernised industrial nations or grown by herbalists themselves are almost certainly unadulterated.
Problems may occur with some patented medicines imported from Asia and the Far East, or sometimes with the pure herbal products, which may not be always as pure as one might expect and drugs (for example, steroids) have sometimes been detected. There are case reports of fatal events occurring when herbal products have been taken inappropriately. There was an outbreak of kidney disease after ‘Chinese herbs’ were prescribed by a slimming clinic in Belgium around 10 years ago, because the herbs had been unknowingly adulterated with a poisonous plant.
Herbs may also interact with conventional medicines. Some of the known interactions between herbal preparations and conventional drugs are described in the table. Always tell your herbal practitioner about all the conventional medicines that you are taking.
The National Institute of Medical Herbalists and the Register of Chinese Herbal Medicine take a very serious, and indeed very professional, view about the potential for adverse reactions with herbs. They have developed a system for reporting adverse reactions to herbs and these are being collated and recorded at the University of Exeter. The National Poisons Unit has also set up a database to record adverse herbal events.
You should be aware that taking a herbal remedy may cause an adverse reaction. If you think you are suffering from unexpected symptoms that may be produced by the herbal remedy you are taking, speak either with your own doctor or pharmacist (if the herbal remedy was self-prescribed) or with the herbal practitioner who prescribed the remedy.
WHOM SHOULD I SEE?
Herbalists work largely in their own small private practices, or in association with other complementary practitioners in clinics. Few herbalists work within the NHS.
There are two main organisations for herbalists: the National Institute of Medical Herbalists and the Register of Chinese Herbal Medicine. These bodies act as the regulatory and registering bodies in herbal medicine. Most herbalists in this country have taken a three- or four-year training course in herbal medicine and this has enabled them to pass an examination to become a member of the National Institute of Medical Herbalists. If they have skills in traditional Chinese herbalism, these have usually been added after their initial Western herbal training.
Some acupuncturists use traditional Chinese herbs as part of their practice. Their training is firmly grounded in traditional Chinese medicine, and combines herbal medicine and acupuncture in the same way as in the practice of Chinese-trained traditional Chinese doctors. There are a small number of medically qualified practitioners who are trained to prescribe herbal remedies.
If you are thinking of seeing a herbalist, he or she should be a member of the National Institute of Medical Herbalists or the Register of Chinese Herbal Medicine (see Useful addresses, page 102).
