Chapter 13 Complementary and Alternative medicine
In addition to rational phytotherapy, which is a science-based, empirical approach to the use of medicinal plants in the treatment and prevention of disease, in developed countries there are other healthcare approaches involving the use of plants. The most popular of these non-conventional approaches are discussed in this chapter (Box 13.1 and 13.2).
Medical herbalism
Modern herbalism
• A patient’s psychological and emotional wellbeing, as well as physical health, is considered, resulting in the claim that a holistic therapy is offered.
• Herbalists select herbs on an individual basis for each patient (in line with the holistic approach), thus it is likely that even patients with the same physical symptoms will receive different combinations of herbs.
• Herbalists also aim to identify the underlying cause (e.g. stress) of a patient’s illness and to consider this in the treatment plan.
• Herbs are used to stimulate the body’s healing capacity, to ‘strengthen’ bodily systems and to ‘correct’ disturbed body functions rather than to treat presenting symptoms directly.
• Herbs may be used, for example, with the aim of ‘eliminating toxins’ or ‘stimulating’ the circulation. The intention is to provide long-term relief from the particular condition.
Importantly, different constituents of a medicinal plant are seen as acting together in some (undefined) way that has beneficial effects. For example, the constituents may have additive effects, or interact to produce an effect greater than the total contribution of each individual constituent (known as ‘synergy’), or the effects of one constituent reduce the likelihood of adverse effects due to another constituent. Similarly, it is also believed that some combinations of different herbs interact in a beneficial way. There is some experimental (but little clinical) evidence that such interactions occur, although it cannot be assumed that this is the case for all herbs or for all combinations of herbs. Synergy is discussed in detail in Chapter 11.
Herbalists’ prescriptions
A first consultation with a herbalist may last for an hour or more, during which the herbalist will explore the detailed history of the illness. Generally, a combination of several different herbs (usually four to six) is used in the treatment of a particular patient. Some examples of such combinations are given in Table 13.1, although there are no ‘typical’ prescriptions for specific conditions; as stated above, even patients with the same condition are likely to receive different prescriptions. Sometimes, a single herb may be given, for example, Vitex agnus-castus (chasteberry) for premenstrual syndrome and dysmenorrhoea. Each patient’s treatment is reviewed regularly and is likely to be changed depending on whether or not there has been a response.
Table 13.1 Examples of herbal prescriptions
Plant | Plant part |
---|---|
Menopausal symptoms | |
Cimicifuga racemosa (black cohosh) | Roots, rhizome |
Leonorus cardiaca (motherwort) | Aerial parts |
Hypericum perforatum (St John’s wort) | Aerial parts |
Alchemilla vulgaris (Lady’s mantle) | Aerial parts |
Stress | |
Passiflora incarnata (passion flower) | Aerial parts |
Valeriana officinalis (valerian) | Root |
Verbena officinalis (vervain) | Aerial parts |
Leonorus cardiaca (motherwort) | Aerial parts |
Comparison of herbalism with rational phytotherapy
Herbalism contrasts with rational phytotherapy in several ways (Table 13.2). Importantly, the herbalist’s approach has not been evaluated in controlled clinical trials, whereas there are numerous controlled clinical trials of specific phytotherapeutic preparations. Another important difference is that, although many of the same medicinal plants are used in each of the two approaches, the formulations of those herbs are often very different. For example, St John’s wort (Hypericum perforatum L.) is used in both rational phytotherapy and by herbalists. However, in rational phytotherapy, the preparations used are likely to be extracts of H. perforatum herb (leaves and tops) standardized on hypericin content and formulated as tablets. By contrast, herbalists are likely to use a tincture of H. perforatum herb that is not standardized on its content of any particular constituent.
Table 13.2 Comparison of herbalism and rational phytotherapy
Herbalism | Rational phytotherapy |
---|---|
Assumes that synergy or additive effects occur between herbal constituents or between herbs Holistic (individualistic) prescribing of herbs Preparations mainly formulated as tinctures Mainly uses combinations of herbs Some opposition towards tight standardization of preparations Not scientifically evaluated | Seeks evidence that synergy or additive effects occur between herbal constituents or between herbs Not holistic; uses symptom- or condition-based prescribing Preparations mainly formulated as tablets and capsules Single-herb products used mainly Aims at using standardized extracts of plants or plant parts Science-based approach |
Homoeopathy
History
1. A substance which, used in large doses, causes a symptom(s) in a healthy person can be used to treat that symptom(s) in a person who is ill. For example, Coffea, a remedy prepared from the coffee bean (a constituent, caffeine, is a central nervous system stimulant) would be used to treat insomnia. This is the so-called ‘like cures like’ concept (in Latin, similia similibus curentur).
2. The minimal dose of the substance should be used in order to prevent toxicity. Initially, Hahnemann used high doses of substances, but this often led to toxic effects. Subsequently, substances were diluted in a stepwise manner and subjected to vigorous shaking (‘succussion’) at each step. This process is called potentization. It is claimed that the more dilute the remedy, the more potent it is. This completely opposes current scientific knowledge.
3. Only a single remedy or substance should be used in a patient at any one time.
Modern homoeopathy
In addition to the key principles of homoeopathy outlined above, homoeopaths also claim:
• illness results from the body’s inability to cope with challenging factors such as poor diet and adverse environmental conditions
• the signs and symptoms of disease represent the body’s attempt to restore order
• homoeopathic remedies work by stimulating the body’s own healing activity (the ‘vital force’) rather than by acting directly on the disease process
• the ‘vital force’ is expressed differently in each individual, so treatment must be chosen on an individual basis and thus needs to be holistic
Homoeopathic remedies
• Homoeopathic remedies are (mostly) highly dilute whereas herbal medicines are used at material strengths. However, since homeopathic preparations are first extracted from, for example, plant material and then diluted, there is a borderline group including mother tinctures and lower potencies (i.e. less diluted) which still may contain biomedically relevant amounts of active ingredients.
• Many homoeopathic remedies (around 65%) originate from plants, whereas by definition all herbal medicines originate from plants (for examples of plant-based homeopathic preparations see Table 13.3).
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