2 General Guidelines for Use of Herbal Medicines – Gastrointestinal diseases – Colds and flu – Liver and gallbladder diseases – Psychovegetative diseases – Circulatory problems and decreased mental performance – Sleep disorders – Diseases of the kidney and efferent urinary passages – Prostatic diseases – Diseases of the female genital tract – Varicose veins – Convalescent care – Prevention of degenerative diseases – Supportive (adjuvant) treatment – Severe diseases – Infectious diseases – Emergency medicine – Although recent reports highlight a few problems with herb–drug interactions such as St. John’s wort reducing plasma levels of antirejection and antiretroviral drugs, the overall chance of most herbal preparations interfering with the safety and efficacy of synthetic drugs is small, on the basis of actual human reports. Many published comments about herb–drug interactions in the literature and popular press involve theoretical interactions only. More work needs to be performed in this new area of research. – Herbal medicines have a wide therapeutic range (the gap between therapeutic and toxic doses is very large) and, thus, a superior risk-to-benefit ratio. A number of recent published studies involving thousands of patients show that patient reports of adverse effects are close to those reported for placebo. – Herbal medicines provide a high level of treatment safety. – When given a choice, patients with the conditions listed above tend to accept them more readily than synthetic drugs, thereby increasing compliance. – Herbal medicines facilitate the transition from acute short-term to chronic long-term treatment. – Herbal medicines can replace some of the conventional synthetic drugs used to treat patients with chronic diseases, such as chronic fatigue syndrome, and multiple morbidity syndromes. This is important because their synthetic counterparts often have considerable side effects. – Herbal medicines are often not potent enough to treat severe illnesses by themselves, except sometimes with a long-term course. – Diseases may be drawn out unnecessarily when self-prescribed herbal drugs are taken improperly. – The improper long-term use of certain herbal preparations, such as the pyrrolizidine alkaloid-containing herb comfrey, can lead to severe side effects. – The pharmacokinetic and pharmacodynamic responses of infants and small children to herbal remedies are different from those of adults. As a result, the therapeutic range of an herbal drug will also differ in children and adults. – These differences are attributable to the underdevelopment of organ structure and function in children and differences in receptor structures. – Drugs are retained longer in a child’s body owing to the lower rates of excretion and metabolism. – The treatment of pediatric patients with herbal medicinal preparations should be carried out under the supervision of a physician and/or other appropriately experienced health care provider, if the persons who take care of the child are not experienced in herbal medicine, or the disease is more serious or longer lasting. A herbal remedy suitable for use in children should be selected and administered at the lowest dose possible. – Generally, the herbal preparation should be administered according to the supplier’s recommendation. – For preparations without dose recommendation a formula for calculation of reduced dosages for children and infants based on body weight may be used: children’s dose = (adult dose/110) × (1.5 × weight in kg). – Infants: 5 drops or 1 to 2 droppersful of a tea, or 1 part of tincture (ca. 1: 5) diluted with 10 parts water, several times a day. – Children 1 to 5 years: 1 to 2 teaspoons of a tea infusion 3 to 5 times a day (or a liquid made by diluting 1 part of tincture with 10 parts of water). – Children 6 to 10 years: ¼ to ⅓ of the adult dose. – Children 11 to ca. 16 years: ½ of the adult dose. – Children over 16 years: Generally the adult dose, but used with greater caution. – It is important to start with the smallest dose for the first day and work up to a higher dose, if no adverse reactions are apparent. – Alcohol-free herbal preparations, such as flavored glycerites, are preferable for pediatric medicine. Liquid herbal remedies often contain alcohol as a preservative; the ethanol content must be indicated on the label.
2.1 Potentials and Limitations
Clinical Applications of Herbal Medicine
Primary indications
Indicated for adjuvant therapy only in
Advantages of herbal medcines
Disadvantages of herbal medicines
Self-Care Management
Owing to budget restrictions and the reduced number of drugs covered under many health insurance plans, the role of herbal self-treatment is increasing.
In self-care management, the responsibility for correct herb use and dosage lies with the patient.
As a result, side effects and interactions with other drugs are more likely to go unnoticed by these patients.
It is therefore imperative that all herbs and herbal remedies be accurately labeled with adequate instructions and warnings. Ideally, the patient will consult a qualified health care professional such as a physician trained in herbal medicine, trained herbalist, or naturopathic physician before initiating self-treatment with any herbal remedy. The advice of a physician should also be sought when herbal preparations are used together with pharmaceutical drugs, and obviously with severe ailments.
In North America, according to recent studies, most patients do not inform their physician about herbal use. This may be because most medical doctors are uninformed about some of the current research regarding the safety and efficacy of herbal preparations. This is not surprising, since they rarely receive training or continuing education in this area. Perceived disapproval from a physician may also play a role in this choice.
Role of the Physician
The physician should be informed of the use of herbal remedies to avoid unnecessary or excessive treatment and unwanted interactions with synthetic drugs (physician-supervised self-care management).
Since physicians should be able to advise patients about the limitations of self-care management, doctors must have a solid knowledge of herbal medicine. Patients often tend to be more responsive about informing physicians concerning herbal use when they feel the physician is knowledgeable and, as far as possible, unbiased.
Not all herbal medicinal products are safe and gentle. The improper long-term use of certain herbs can lead to serious side effects. Therefore, herbal remedies should not be used for extended periods without the supervision of a physician or other appropriately experienced health care provider.
2.2 Special Patient Groups
Preliminary Remarks
Owing to their low rate of side effects, the use of herbal remedies is increasing in certain patient groups, particularly in chronically ill children, pregnant and nursing mothers, and senior citizens.
Certain precautions may be observed when treating allergy sufferers and intensive-care patients with herbal remedies.
Infants and Children
Pharmacokinetics
Basic rules for treatment of pediatric patients
Practical dosage recommendations for administration of teas (or diluted tinctures) to pediatric patients
Administration: Teas, highly diluted alcoholic tinctures, and flavored liquid glycerites are preferably used with pediatric patients because they contain low doses of the active constituents.
Instant teas containing saccharose promote the formation of dental caries.
Value of herbal medicine: The rate of spontaneous healing is much higher in infants and children than in adults. This makes it more difficult to assess the effectiveness of herbal medicines in pediatric patients.
Geriatric Patients
Preliminary remarks:
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In Germany, many herbal remedies, even those that have been taken by pediatric patients for years without adverse effects, are labeled with statements such as “Owing to the lack of sufficient scientific data on the use of this preparation in children, it should not be used in children under 12 years of age”. Such statements are intended to indicate a residual risk. In this case, it is important to obtain the advice of a physician in selecting the proper remedy. On the other hand, remedies labeled with the statement “Children under 12 years of age should not take this preparation” are clearly contraindicated in pediatric patients. In North America, many preparations are not labeled with recommendations for pediatric use, which is why special children’s herbal products are increasingly popular. These are mild and pleasant-tasting.
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