Herbal medicine: Types, uses, and safety

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Herbal medicines or supplements are natural compounds from plants&#; leaves, bark, roots, seeds, or flowers that people can use for medicinal purposes. They may offer therapeutic benefits when people use them as complementary medicine.

Herbal medicines contain active ingredients from natural plants. Their use dates back thousands of years, even before the invention of conventional medicine.

While many people prefer herbal medicines to some doctor-prescribed medications, others may use them in combination with prescription and nonprescription drugs.

This article outlines the different types of herbal medicines, their uses, safety precautions, and when to contact a doctor.

How to take herbal supplements

How a person takes herbal supplements depends on the form. They are available as tablets, capsules, teas, powders, extracts, and fresh or dried plants.

A person can take herbal supplements by:

• swallowing them as pills, powders, or tinctures
• applying them to the skin as gels and lotions
• adding them to bathwater
• drinking them as teas

Dosages for some herbal supplements may be challenging to get right. Many factors can affect the quality of herbal supplements, including the growing conditions, age, and preparation of the plant.

As a result, there is no standardized way to provide a correct dosage. If a person considers taking an herbal supplement, they should avoid self-prescribing and discuss it with a doctor first.

The doctor will ask questions about a person&#;s health condition and determine the best dosage for the desired pharmacological effect.

Because conventional medical doctors may not have received much education regarding herbal medicine, a person may instead want to consult a licensed naturopathic doctor, a licensed acupuncturist, or another qualified practitioner of herbal medicine.

Using herbal medicine safely

A person should talk with a doctor before taking herbal medicine. The National Center for Complementary and Integrative Health warns that supplements can increase or decrease the effects and side effects of prescription and OTC drugs. Doctors can advise people about drug interactions they need to be careful of.

Safe use of herbal medicine also includes:

• following label instructions carefully
• taking only the recommended dosage
• stopping taking an herbal supplement if it is ineffective

The United Kingdom&#;s National Health Service (NHS) notes that taking herbal medicine may not be suitable for a person if they are:

• pregnant
• breastfeeding
• taking other prescription or OTC medications
• over age 65
• under age 18
• having surgery

The NHS also notes that anyone taking herbal medicine should disclose it to their doctor before surgery. This is because some herbal medicines may interact with anesthesia drugs and affect blood pressure and blood clotting during and after surgery.

Frequently asked questions

Does the FDA approve herbal medicines?

No, the FDA does not approve herbal medicines. This is because the FDA does not consider herbal medicines drugs. Instead, it considers them dietary supplements for complementary therapy.

As a result, herbal medicines are not subject to the same testing, labeling, and manufacturing standards as traditional prescription and OTC medications. However, the FDA regulates herbal medicines to ensure that they meet specific criteria and that they are not dangerous for human consumption.

Is herbal medicine safe?

Not necessarily. The NHS warns that &#;natural&#; does not mean safe if a person uses a product without a doctor&#;s prescription.

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This is because some herbs can have adverse drug interactions with other medications. Some may also cause fatal side effects. A person should always check with a doctor before taking supplements if they have a health condition or are taking prescribed medication.

A person should discontinue using an herbal supplement and contact a doctor immediately if they experience any of the following symptoms:

• nausea
• dizziness
• headache
• swelling
• upset stomach
• breathing difficulty

They should also seek medical advice if they take an overdose of an herbal supplement.

If a person develops symptoms of a severe allergic reaction, they or other people around them should immediately call 911 or the local emergency number.

Outlook

According to a review published in American Family Physician, 40&#;60% of U.S. adults use dietary supplements, including herbal medicines, and 25% report taking herbal supplements with prescription medication.

The authors note that many people who use herbal supplements do not disclose it to their doctors. This affects the clinical assessment and safety of specific herbal supplement-drug interactions.

To help healthcare professionals better evaluate herbal supplement interactions in the body, a person should:

• disclose any herbal supplements they are using to their doctor
• document their symptoms
• stop using herbal supplements if symptoms do not improve
• avoid herbal supplement overdose
• report any worsening symptoms to their doctor

Summary

Herbal medicines or supplements are natural compounds made from plant parts. Manufacturers extract active ingredients from the plants&#; leaves, bark, roots, seeds, or flowers.

Herbal supplements are available in many forms, such as pills, teas, extracts, and powders. People use them to treat chronic conditions, including anxiety, sleep problems, and low libido.

Herbal supplements are not FDA-approved, and some natural products may be unsafe. Herbal supplements can cause adverse drug reactions, so a person must consult a doctor before taking them if they are also taking prescription medication.

1.1. HERBAL MEDICINE: A GROWING FIELD WITH A LONG TRADITION

Traditional medicine is &#;the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness&#; (World Health Organization, http://www.who.int/topics/traditional_medicine/en/). There are many different systems of traditional medicine, and the philosophy and practices of each are influenced by the prevailing conditions, environment, and geographic area within which it first evolved (WHO ), however, a common philosophy is a holistic approach to life, equilibrium of the mind, body, and the environment, and an emphasis on health rather than on disease. Generally, the focus is on the overall condition of the individual, rather than on the particular ailment or disease from which the patient is suffering, and the use of herbs is a core part of all systems of traditional medicine (Engebretson ; Conboy et al. ; Rishton ; Schmidt et al. ).

Traditional Chinese medicine (TCM) is an important example of how ancient and accumulated knowledge is applied in a holistic approach in present day health care. TCM has a history of more than years (Xutian, Zhang, and Louise ). The book The Devine Farmer&#;s Classic of Herbalism was compiled about years ago in China and is the oldest known herbal text in the world, though the accumulated and methodically collected information on herbs has been developed into various herbal pharmacopoeias and many monographs on individual herbs exist.

Diagnosis and treatment are based on a holistic view of the patient and the patient&#;s symptoms, expressed in terms of the balance of yin and yang. Yin represents the earth, cold, and femininity, whereas yang represents the sky, heat, and masculinity. The actions of yin and yang influence the interactions of the five elements composing the universe: metal, wood, water, fire, and earth. TCM practitioners seek to control the yin and yang levels through 12 meridians, which bring and channel energy (Qi) through the body. TCM is a growing practice around the world and is used for promoting health as well as for preventing and curing diseases. TCM encompasses a range of practices, but herbal medicine is a core part (Engebretson ; Nestler ; Schmidt et al. ; Xutian, Zhang, and Louise ). Three of the top-selling botanical products, namely Ginkgo biloba, Allium sativum (garlic), and Panax ginseng, can be traced back to origins in TCM and are today used to treat various diseases (Li, Jiang, and Chen ; Xutian, Zhang, and Louise ).

Over the past 100 years, the development and mass production of chemically synthesized drugs have revolutionized health care in most parts of the word. However, large sections of the population in developing countries still rely on traditional practitioners and herbal medicines for their primary care. In Africa up to 90% and in India 70% of the population depend on traditional medicine to help meet their health care needs. In China, traditional medicine accounts for around 40% of all health care delivered and more than 90% of general hospitals in China have units for traditional medicine (WHO ). However, use of traditional medicine is not limited to developing countries, and during the past two decades public interest in natural therapies has increased greatly in industrialized countries, with expanding use of ethnobotanicals. In the United States, in , about 38% of adults and 12% of children were using some form of traditional medicine (Ernst, Schmidt, and Wider ; Barnes, Bloom, and Nahin ). According to a survey by the National Center for Complementary and Alternative Medicine (Barnes, Bloom, and Nahin ), herbal therapy or the usage of natural products other than vitamins and minerals was the most commonly used alternative medicine (18.9%) when all use of prayer was excluded. A survey conducted in Hong Kong in reported that 40% of the subjects surveyed showed marked faith in TCM compared with Western medicine (Chan et al. ). In a survey of 21,923 adults in the United States, 12.8% took at least one herbal supplement (Harrison et al. ) and in another survey (Qato et al. ), 42% of respondents used dietary or nutritional supplements, with multivitamins and minerals most commonly used, followed by saw palmetto, flax, garlic, and Ginkgo, at the time of the interview.

The most common reasons for using traditional medicine are that it is more affordable, more closely corresponds to the patient&#;s ideology, allays concerns about the adverse effects of chemical (synthetic) medicines, satisfies a desire for more personalized health care, and allows greater public access to health information. The major use of herbal medicines is for health promotion and therapy for chronic, as opposed to life-threatening, conditions. However, usage of traditional remedies increases when conventional medicine is ineffective in the treatment of disease, such as in advanced cancer and in the face of new infectious diseases. Furthermore, traditional medicines are widely perceived as natural and safe, that is, not toxic. This is not necessarily true, especially when herbs are taken with prescription drugs, over-the-counter medications, or other herbs, as is very common (Canter and Ernst ; Qato et al. ; Loya, Gonzalez-Stuart, and Rivera ; Cohen and Ernst ).

Regardless of why an individual uses it, traditional medicine provides an important health care service whether people have physical or financial access to allopathic medicine, and it is a flourishing global commercial enterprise (Engebretson ; Conboy et al. ; Evans et al. ). In , expenditure associated with &#;alternative&#; therapy in the United States was estimated to be US$13.7 billion. This had doubled by the year , with herbal medicines growing faster than any other alternative therapy (Eisenberg et al. ). In Australia, Canada, and the United Kingdom, annual expenditure on traditional medicine is estimated to be US$80 million, US$1 billion, and US$2.3 billion, respectively. These figures reflect the incorporation of herbal and other forms of traditional medicine into many health care systems and its inclusion in the medical training of doctors in many parts of the developed world.

The total commercial value of the ethnobotanicals market cannot be ignored. For example, in , the total turnover of nonprescription-bound herbal medicines in pharmacies was equal to almost 30% of the total turnover of nonprescription-bound medicines in Germany, and in the United States, the annual retail sales of herbal products was estimated to be US$5.1 billion. In India, herbal medicine is a common practice, and about 960 plant species are used by the Indian herbal industry, of which 178 are of a high volume, exceeding 100 metric tons per year (Sahoo ). In China, the total value of herbal medicine manufactured in reached 17.6 billion Chinese yuan (approximately US$2.5 billion; Eisenberg et al. ; WHO ). This trend has continued, and annual revenues in Western Europe reached US$5 billion in - (De Smet ). In China, sales of herbal products totaled US$14 billion in , and revenue from herbal medicines in Brazil was US$160 million in (World Health Organization; http://www.who.int/topics/traditional_medicine/en/). It is estimated that the annual worldwide market for these products approached US$60 billion (Tilburt and Kaptchuk ).

Currently, herbs are applied to the treatment of chronic and acute conditions and various ailments and problems such as cardiovascular disease, prostate problems, depression, inflammation, and to boost the immune system, to name but a few. In China, in , traditional herbal medicines played a prominent role in the strategy to contain and treat severe acute respiratory syndrome (SARS), and in Africa, a traditional herbal medicine, the Africa flower, has been used for decades to treat wasting symptoms associated with HIV (De Smet ; Tilburt and Kaptchuk ). Herbal medicines are also very common in Europe, with Germany and France leading in over-the-counter sales among European countries, and in most developed countries, one can find essential oils, herbal extracts, or herbal teas being sold in pharmacies with conventional drugs.

Herbs and plants can be processed and can be taken in different ways and forms, and they include the whole herb, teas, syrup, essential oils, ointments, salves, rubs, capsules, and tablets that contain a ground or powdered form of a raw herb or its dried extract. Plants and herbs extract vary in the solvent used for extraction, temperature, and extraction time, and include alcoholic extracts (tinctures), vinegars (acetic acid extracts), hot water extract (tisanes), long-term boiled extract, usually roots or bark (decoctions), and cold infusion of plants (macerates). There is no standardization, and components of an herbal extract or a product are likely to vary significantly between batches and producers.

Plants are rich in a variety of compounds. Many are secondary metabolites and include aromatic substances, most of which are phenols or their oxygen-substituted derivatives such as tannins (Hartmann ; Jenke-Kodama, Müller, and Dittmann ). Many of these compounds have antioxidant properties (see Chapter 2 on antioxidants in herbs and spices). Ethnobotanicals are important for pharmacological research and drug development, not only when plant constituents are used directly as therapeutic agents, but also as starting materials for the synthesis of drugs or as models for pharmacologically active compounds (Li and Vederas ). About 200 years ago, the first pharmacologically active pure compound, morphine, was produced from opium extracted from seeds pods of the poppy Papaver somniferum. This discovery showed that drugs from plants can be purified and administered in precise dosages regardless of the source or age of the material (Rousseaux and Schachter ; Hartmann ). This approach was enhanced by the discovery of penicillin (Li and Vederas ). With this continued trend, products from plants and natural sources (such as fungi and marine microorganisms) or analogs inspired by them have contributed greatly to the commercial drug preparations today. Examples include antibiotics (e.g., penicillin, erythromycin); the cardiac stimulant digoxin from foxglove (Digitalis purpurea); salicylic acid, a precursor of aspirin, derived from willow bark (Salix spp.); reserpine, an antipsychotic and antihypertensive drug from Rauwolfia spp.; and antimalarials such as quinine from Cinchona bark and lipid-lowering agents (e.g., lovastatin) from a fungus (Rishton ; Schmidt et al. ; Li and Vederas ). Also, more than 60% of cancer therapeutics on the market or in testing are based on natural products. Of 177 drugs approved worldwide for treatment of cancer, more than 70% are based on natural products or mimetics, many of which are improved with combinatorial chemistry. Cancer therapeutics from plants include paclitaxel, isolated from the Pacific yew tree; camptothecin, derived from the Chinese &#;happy tree&#; Camptotheca acuminata and used to prepare irinotecan and topotecan; and combretastatin, derived from the South African bush willow (Brower ). It is also estimated that about 25% of the drugs prescribed worldwide are derived from plants, and 121 such active compounds are in use (Sahoo et al. ). Between and , 13 drugs derived from natural products were approved in the United States. More than 100 natural product-based drugs are in clinical studies (Li and Vederas ), and of the total 252 drugs in the World Health Organization&#;s (WHO) essential medicine list, 11% are exclusively of plant origin (Sahoo et al. ).

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