What is herbal medicine?
Herbal medicine, also called botanical medicine or phytomedicine, refers to
the use of any plant's seeds, berries, roots, leaves, bark, or flowers for
medicinal purposes. Long practiced outside of conventional medicine, herbalism
is becoming more mainstream as up-to-date analysis and research show their value
in the treatment and prevention of disease.
What is the history of herbal medicine?
Plants had been used for medicinal purposes long before recorded history. For
example, ancient Chinese and Egyptian papyrus writings describe medicinal plant
uses. Indigenous cultures (e.g., African and Native American) used herbs in
their healing rituals, while others developed traditional medical systems (e.g.,
Ayurveda and Traditional Chinese Medicine) in which herbal therapies were used
systematically. Scientists found that people is different parts of the globe
tended to use the same or similar plants for the same purposes.
In the early 19th century, when methods of chemical analysis first became
available, scientists began extracting and modifying the active ingredients from
plants. Later, chemists began making their own version of plant compounds,
beginning the transition from raw herbs to synthetic pharmaceuticals. Over time,
the use of herbal medicines declined in favor of pharmaceuticals.
Recently, the World Health Organization estimated that 80% of people
worldwide rely on herbal medicines for some aspect of their primary healthcare.
In the last twenty years in the United States, increasing public dissatisfaction
with the cost of prescription medications, combined with an interest in
returning to natural or organic remedies, has led to an increase in the use of
herbal medicines. In Germany, roughly 600 to 700 plant-based medicines are
available and are prescribed by approximately 70% of German physicians.
How do herbs work?
For most herbs, the specific ingredient that causes a therapeutic effect is
not known. Whole herbs contain many ingredients, and it is likely that they work
together to produce the desired medicinal effect. Many factors affect how
effective an herb will be. For example, the type of environment (climate, bugs,
soil quality) in which a plant grew will affect its components, as will how and
when it was harvested and processed.
How are herbs used?
For the reasons described in the previous section, herbalists prefer using
whole plants rather than extracting single components from them. Whole plant
extracts have many components. These components work together to produce
therapeutic effects and also to lessen the chances of side effects from any one
component. Several herbs are often used together to enhance effectiveness and
synergistic actions and to reduce toxicity. Herbalists must take many things
into account when prescribing herbs. For example, the species and variety of the
plant, the plant's habitat, how it was stored and processed, and whether or not
there are contaminants.
What happens during a visit to an herbalist?
When you visit an herbalist, the treatment goals are often more broad than
stopping a single complaint. Herbalists aim to correct imbalances, resolve
patterns of dysfunction, and treat the underlying cause of your complaint.
Specific symptoms may also be treated if necessary.
A session with an herbalist typically lasts one hour. You may be physically
examined and asked about your medical history and your general well-being (that
is, how well you sleep, what you eat, if you have a good appetite, good
digestion and elimination, how often you exercise, and what you do to relax).
The herbalist might recommend one or more herbs, dietary changes, and lifestyle
modifications. Because herbal medicines are slower acting than pharmaceuticals,
you might be asked to return for a follow-up in two to four weeks.
What is herbal medicine good for?
Herbalists treat many conditions such as asthma, eczema, premenstrual
syndrome, rheumatoid arthritis, migraine, menopausal symptoms, chronic fatigue,
and irritable bowel syndrome, among others. Herbal preparations are best taken
under the guidance of a trained professional. Be sure to consult with your
doctor or an herbalist before self-treating. Some common herbs and their uses
are discussed below. Please see our monographs on individual herbs for detailed
descriptions of uses as well as risks, side effects, and potential interactions.
- Ginkgo (Ginkgo biloba), particularly a standardized
extract known as EGb 761, appears to produce improvements in awareness,
judgment, and social function in people with Alzheimer's disease and dementia.
In a year-long study of 309 people with Alzheimer's disease, those taking EGb
761 consistently improved while those on placebo worsened.
- Kava kava (Piper methysticum) has become popular as a
treatment for anxiety, but recent reports have traced liver damage to enough
people who have used kava that the U.S. FDA has issued a warning regarding its
use and other countries, such as Germany and Canada, have taken kava off of the
- St. John's wort (Hypericum perforatum) is well known for
its antidepressant effects, and an analysis of 27 studies involving more than
2,000 people confirmed that the herb is an effective treatment for mild to
- Valerian (Valeriana officinalis) has had a long
tradition as a sleep-inducing agent, with the added benefit of producing no
hangover feeling the next day.
- Echinacea preparations (from Echinacea purpurea and other
Echinacea species) may bolster immunity. In a study of 160 volunteers with
flu-like symptoms, echinacea extract reduced both the frequency and severity of
Is there anything I should watch out for?
Used correctly, many herbs are considered safer than conventional
medications, but because they are unregulated, herbal products are often
mislabeled and may contain undeclared additives and adulterants. Some herbs are
associated with allergic reactions or interact with conventional drugs.
Self-prescribing herbal products will increase your risk, so it is important to
consult your doctor and an herbalist before taking herbal medicines. Some
examples of adverse reactions from certain popular herbs are described below.
- St. John's wort causes sensitivity to the sun's ultraviolet rays, and
may cause an allergic reaction, stomach upset, fatigue, and restlessness.
Studies show that St. John's wort also interferes with the effectiveness of many
drugs, including warfarin (a blood thinner), protease inhibitors for HIV,
possibly birth control pills, and many other medications. In addition, St.
John's wort must not be taken with anti-depressant medication. The Food and Drug
Administration (FDA) has issued a public health advisory concerning many of
- Kava kava and echinacea have both been linked to liver toxicity.
Again, kava has been taken off the market in several countries because of the
- Valerian may cause oversedation, and in some people it may even have
the unexpected effect of overstimulating instead of sedating.
- Feverfew (Tanacetum parthenium) may cause agitation.
- Bleeding time may be altered with the use of garlic, ginkgo, feverfew,
ginger (Zingiber officinale) and ginseng.
Who is using herbal medicine?
Nearly one-third of Americans use herbs and it is estimated that in 1998
alone $4 billion was spent on herbal products in this country. Unfortunately, a
recent study in the New England Journal of Medicine indicated that nearly
70% of individuals taking herbal medicines (the majority of which were well
educated and had a higher-than-average income) were reluctant to reveal their
use of complementary and alternative medicine to their doctors. Because herbal
medicines contain a combination of chemicals, each with a specific action, many
are capable of eliciting complex physiological
responses—some of which may create unwanted or
unexpected results when combined with conventional drugs. Be sure to consult
your doctor before trying any herbal products.
How is herbal medicine sold in stores?
The herbs available in most stores come in several different forms: teas,
syrups, oils, liquid extracts, tinctures, and dry extracts (pills or capsules).
Teas are simply dried herbs left to soak for a few minutes in boiling water.
Syrups, made from concentrated extracts and added to sweet-tasting preparations,
are frequently used for sore throats and coughs. Oils are extracted from plants
and often used as rubs for massage, either alone or as part of an ointment or
cream. Tinctures and liquid extracts are solvents (usually water, alcohol, or
glycerol) that contain the active ingredients of the herbs. Tinctures are
typically a 1:5 or 1:10 concentration, meaning that one part of the herbal
material is prepared with five to ten parts (by weight) of the liquid. Liquid
extracts are more concentrated than tinctures and are typically a 1:1
concentration. A dry extract form is the most concentrated form of an herbal
product (typically 2:1 to 8:1) and is sold as a tablet, capsule, or lozenge.
Currently, no organization or government body regulates the manufacture or
certifies the labeling of herbal preparations. This means you can't be sure that
the amount of the herb contained in the bottle, or even from dose to dose, is
the same as what is stated on the label. Some herbal preparations are
standardized, meaning that the preparation is guaranteed to contain a
specific amount of the active ingredients of the herb. However, it is still
important to ask companies that are making standardized herbal products the
basis for their product's guarantee. If consumers insist on an answer to this
question, manufacturers of these herbal products may begin to implement more
quality control processes, like microscopic, chemical, and biological analyses.
Again, it is important to consult your doctor or an expert in herbal medicine
for the recommended doses of any herbal products you are considering.
Are there experts in herbal medicine?
Herbalists, chiropractors, naturopathic physicians, and practitioners of
Traditional Chinese Medicine all use herbs to treat illness. Naturopathic
physicians believe that the body is continually striving for balance and that
natural therapies can be used to support this process. They are trained in
four-year, postgraduate institutions that combine courses in conventional
medical science (such as pathology, microbiology, pharmacology, and surgery)
with clinical training in herbal medicine, homeopathy, nutrition, and lifestyle
How can I find a qualified herbalist in my area?
For additional information, or to locate an experienced herbalist in your
area, contact the American Herbalists Guild (AHG) at P.O. Box 70, Roosevelt, UT
84066 (435-722-8434) or visit their web site at
To locate a licensed naturopath in your area, contact the American Association
of Naturopathic Physicians (AANP) at 601 Valley Street, Suite 105, Seattle, WA
98109 (206-298-0126) or visit their web site at
What is the future of herbal medicine?
Although a renaissance is occurring in herbal medicine in the United States,
the FDA still classifies herbs as dietary supplements and forbids manufacturers
to claim that their products are able to treat or prevent specific diseases. In
some countries in Europe, however, herbs are classified as drugs and are
regulated. The German Commission E, an expert medical panel, actively researches
their safety and effectiveness.
Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care.
Barrett B, Kiefer D, Rabago D. Assessing the risks and benefits of herbal
medicine: an overview of scientific evidence. Altern Ther Health Med.
Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded
Commission E Monographs. Newton, Mass: Integrative Medicine Communications;
Braunig B, Dorn G, Knick EM. Echinacea purpurea radix for
strengthening immune response in flu-like infections [in German]. Z
Brenner R, Azbel V, Madhusoodanan S, Pawlowska M. Comparison of an extract of
Hypericum (LI 160) and sertraline in the treatment of depression: a
double-blind, randomized pilot study. Clin Ther. 2000;22(4):411-419.
Chavez ML, Chavez PI. Herbal medicine. In: Novey DW, ed. Clinician's
Complete Reference to Complementary and Alternative Medicine. St. Louis, Mo:
Coon JT, Ernst E. Panax ginseng: a systematic review of adverse effects and
drug interactions. Drug Saf. 2002;25(5):323-344.
D'Epiro NW. An historical, regulatory, and medical use perspective on nine
common herbs. In: Micozzi MS, Bacchus AN, eds. The Physician's Guide to
Alternative Medicine. Atlanta, Ga: American Health Consultants;
Donath F, Quispe S, Diefenbach K, Maurer A, Fietze I, Roots I. Critical
evaluation of the effect of valerian extract on sleep structure and sleep
quality. Pharmacopsychiatry. 2000;33(2):47-53.
Egan CD. Addressing the use of herbal medicine in the primary care setting.
J Am Acad Nurse Pract. 2002;14(4):166-171.
Ernst E. Herbal medications for common ailments in the elderly. Drugs
Fugh-Berman A. Herb-drug interactions [Review]. Lancet.
Fugh-Berman A. Herbal supplements: indications, clinical concerns, and
safety. Nutr Today. 2002;37(30:122-124.
Fugh-Berman A, Ernst E. Herb-drug interactions: review and assessment of
report reliability. Br J Clin Pharmacol. 2001;52(5):587-595.
Le Bars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg AF. A
placebo-controlled, double-blind, randomized trial of an extract of Ginkgo
biloba for dementia. North American EGb Study Group. JAMA.
Linde K, Mulrow CD. St. John's wort for depression (Cochrane Review). In:
The Cochrane Library, Issue 3, 2000. Oxford: Update Software.
McIntyre M. A review of the benefits, adverse events, drug interactions, and
safety of St. John's wort (Hypericum perforatum): the implications with
regard to the regulation of herbal medicines. J Altern Complement Med.
Meserole L. Western herbalism. In: Micozzi MS, ed. Fundamentals of
Complementary and Alternative Medicine. New York, NY: Churchill Livingstone;
Miller LG. Herbal medicinals: selected clinical considerations focusing on
known or potential drug-herb interactions. Arch Intern Med.
Schoeneberger D. The influence of immune-stimulating effects of pressed juice
from Echinacea purpurea on the course and severity of colds [in
German]. Forum Immunologie. 1992;8:2-12.
Stedman C. Herbal hepatotoxicity. Semin Liver Dis.
Vickers A, Zollman C. Herbal medicine. BMJ.
Volz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety
disorders—a randomized placebo-controlled 25-week
outpatient trial. Pharmacopsychiatry. 1997;30(1):1-5.
Woelk H, Burkard G, Grunwald J. Benefits and risks of the Hypericum
extract LI 160: drug monitoring study with 3250 patients. J Geriatr
Psychiatry Neurol. 1994;7(suppl 1):S34-38.
Woelk H, Kapoula O, Lehrl S, et al. Treatment of anxiety patients. Kava
special extract WS 1490 in anxiety patients is comparable to the benzodiazepine
oxazepam, a double-blind study [in German]. Z Allgemeinmed.
Yarnell E, Abascal K, Greenfield RH, Romm A, Sudberg S. Credentialing of
practitioners of botanical medicine. Am J Med Qual.