H
Herbal medicine/medical herbalism/phytotherapy
Description
Herbal medicine is the study and use of plants as medicines or food nutrients to restore and maintain good health. Western medical herbalists follow similar diagnostic procedures as orthodox doctors including history-taking, laboratory tests and X-rays necessary, examination and prescription of appropriate remedies. Treatment may consist of four elements: cleansing, detoxification and elimination, with expectorants, laxatives and diuretics; heating and aiding circulation with circulatory stimulants, peripheral vasodilators and aromatic digestives; cooling with bitters to stimulate digestion and febrifuges to reduce temperature; and tonification to nourish and repair with tonic herbs, often combined with convalescence, rest, exercise and diet.
Herbal remedies (defined in (2004/27/EC Article 1) are subject to the EU Traditional and Herbal Medicines Directive (2004/24/EC) and Medicinal Products for Human Use (2004/27/EC). The key difference between herbal remedies and orthodox medicine is that orthodox pharmacological drugs are prescribed as a single entity, whereas a herbal prescription will reflect the synergy of the chosen plant remedies and the range of symptoms being presented. In 1978, the German government established the Commission E to investigate and monitor the safety and effectiveness of herbal medicines and a collection of monographs was collated defining their ‘reasonable certainty’ about the safety and effectiveness of herbs, but while they provide valuable information, they should not be regarded as the definitive source on the subject.
Constituents of herbal remedies include:
Glycosides:
secondary plant metabolites which yield one or more sugars on hydrolysis, most commonly glucose.
Mucilages:
act as a demulcent, soothing and antiinflammatory agent; may also have incidental healing effects, mainly by trapping water to form a protective gel.
Eliminative:
encourages elimination from the body either as a laxative, diuretic, expectorant or diaphoretic.
Safety:
Many people believe that because herbs are natural, they are also safe – and safer than drugs. However, this is not necessarily so and practitioners and patients need to be aware of the potential dangers of mixing herbal remedies with orthodox medication or with other herbs which have similar properties. In addition to their intrinsic therapeutic actions herbal remedies may interfere with the liver’s cytochrome P450 enzyme system and its substrates resulting in increased levels of drugs metabolized by this system, for example: the tricyclic antidepressants, antipsychotics, benzodiazepines, oral hypoglycaemic agents, angiotensin 11 receptor antagonists, proton pump inhibitors, warfarin, non-steroidal antiinflammatories including aspirin, antihistamines. Many herbal remedies are known to have anticoagulant effects and patients should discontinue herbal medicine use at least 2 weeks prior to surgery or invasive procedures to avoid interactions with anaesthesia and other drugs and to prevent postoperative haemorrhage. Children, pregnant and lactating women should not use herbal remedies without expert advice. Herbal tinctures contain alcohol, therefore caution is needed if the patient is a recovering alcoholic, taking antabuse or metronidazole.
Selected herbal remedies
Agrimony (Agrimonia eupatoria) (also known as Church steeple, Liverwort, Stickwort)
Aloe vera (Aloe vera) (also known as Burn plant, Miracle plant)
Evidence:
Has been shown to have wound healing, hypoglycaemic, anticoagulant and antiinflammatory properties.
Safety:
Chronic oral use may result in electrolyte imbalance. Thought to increase the effects of cardiac glycosides and anti-arrhythmic drugs. Internal use contraindicated in renal and cardiac pathology. May increase risk of haemorrhage in patients with bleeding disorders or on anticoagulants, including aspirin and NSAIDs.
Angelica (Angelica sinensis) (also known as Dong quai)
Bearberry (Uva ursi)
Bilberry (Vaccinium myrtillus) (also known as Huckleberry, Whortleberry, Wineberry)
Safety:
Bilberry may increase the risk of bleeding in patients with bleeding disorders and potentiate the effects of anticoagulants, aspirin and non-steroidal antiinflammatory drugs. Avoid in pregnancy as there is insufficient information available on the teratogenic effects. As bilberry may have the potential to lower blood glucose, caution is needed in diabetic patients taking medication to control blood glucose levels.
Black cohosh (Cimicifuga racemosa) (also known as Black snakeroot, Baneberry, Bugwort, Cimicifuga, Phytoestrogen, Rattleweed, Sheng ma, squaw root)
Safety:
Avoid in pregnancy until term, as it may trigger uterine contractions. Black cohosh may increase risk of bleeding in patients with bleeding disorders or in those on anticoagulants including aspirin and non-steroidal antiinflammatories. May increase the effects of oestrogen supplements and should be avoided in those with hormone-sensitive conditions. There is some evidence to suggest that it may increase metastatic growth in women with breast cancer; caution should be used in women taking Tamoxifen. May be hepatotoxic in large doses or if taken concurrently with medication which has hepatotoxic side-effects. Care should be taken not to confuse black cohosh with blue cohosh (Caulophyllum thalictroides).
Blue cohosh (Caulophyllum thalictroides) (also known as Blue ginseng, Caulophyllum, Papoose root, Squaw root)
Boldo (Peumus boldus)
Traditional uses:
as a digestive and hepatobiliary remedy and for colds, gout, headache, menstrual pain.
Safety:
Boldo is contraindicated in CNS or respiratory disorders and should not be taken concurrently with sedation or with analgesics containing codeine. It may increase the risk of bleeding in patients with bleeding disorders or taking anticoagulants including aspirin and NSAIDs. Boldo has been shown to be hepatotoxic.
Borage (Borago officinalis) (also known as Starflower oil)
Traditional uses:
Borage seed oil is used for rheumatoid arthritis, atopic eczema, seborrhoeic dermatitis in babies and stress. It is particularly popular for premenstrual syndrome and has been used for attention deficit-hyperactivity disorder (ADHD), alcoholism, depression, reducing pyrexia and for preventing heart disease and stroke. Borage is also used as a cardiac tonic, sedative and to increase circulatory capacity and breast milk production.
![](https://clinicalpub.com/wp-content/uploads/2023/09/banner1.png)