Conditions
Herbalists believe that herbal medicines can have a significant role to play in the treatment of the a wide range of conditions including:
In response to an independent review of submitted clinical evidence herbal practitioners may claim to treat the following specific conditions but this list should not be taken as complete by any means as absence of evidence is not evidence of absence.
- Skin disease, including eczema, psoriasis, acne, acne rosacea, urticaria.
- Gastrointestinal disorders, including acid indigestion, irritable bowel syndrome, chronic constipation, inflammatory bowel disease
- Gynaecological conditions, including premenstrual syndrome and dysmenorrhoea, endometriosis, infertility
- Chronic fatigue syndrome,
- Respiratory conditions, including asthma, bronchitis, and chronic coughs, rhinitis and sinusitis
- Arthritic conditions (e.g. osteoarthritis, gout and rheumatoid arthritis)
- Urinary conditions including chronic cystitis, urinary tract infections, kidney stones
- Psychological problems (e.g. depression, anxiety).
In response to an independent review of submitted clinical evidence herbal practitioners may claim to treat the following specific conditions but this list should not be taken as complete by any means as absence of evidence is not evidence of absence.
- functional dyspepsia
- irritable bowel syndrome
- premenstrual syndrome
- back pain
- osteoarthritis
- depression
- migraine
- some acute infections (common cold, rhinosinusitis, uncomplicated upper respiratory tract infections, type A and B influenza).
As explained elsewhere on this site, herbalists treat each person as an individual; each treatment is tailored to a patient’s specific needs at that time. This means that although two people may suffer from the same condition e.g. osteoarthritis or migraine, successful treatment will almost certainly require a different approach for each person.
That said, herbal medicine has the potential to ease a wide variety of common disorders and aliments. For centuries this has been generally accepted; indeed modern medicine has derived many of its most effective medicines (see below) from plants. But in recent times new rules have been adopted that limit discussion of the potential of herbal medicine to meet the health needs of society. These as a rule require that evidence for health claims should include the result of randomized controlled human trials.
That said, herbal medicine has the potential to ease a wide variety of common disorders and aliments. For centuries this has been generally accepted; indeed modern medicine has derived many of its most effective medicines (see below) from plants. But in recent times new rules have been adopted that limit discussion of the potential of herbal medicine to meet the health needs of society. These as a rule require that evidence for health claims should include the result of randomized controlled human trials.
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This may sound a sensible way forward but the cost of the so-called gold standard evidence, the double-blind randomised clinically controlled trial, is totally unaffordable when it comes to plant medicines that cannot be patented as they grow in fields and woods. Moreover, the whole edifice of evidence based medicine is open to question.
There appears an assumption that the majority of mainstream medical practice is firmly rooted in an established evidence base of clinical effectiveness. However, as an ongoing study published by the BMJ Journal Evidence Based Medicine demonstrates, this is not the case. Evidence Based Medicine selects around 3000 treatments that have been subject to research analysis and publishes the outcome in a pie chart is displayed below[1]. |
The Evidence-based Medicine Pyramid
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This chart shows that of the 3000 treatments only 11% are rated as beneficial, 24% likely to be beneficial, 7% as trade off between benefits and harms, 5% unlikely to be beneficial, 3% likely to be ineffective or harmful, and 50%, the largest proportion, as having unknown effectiveness. These figures suggest that most decisions about treatments within conventional medical practice still rest on the individual judgements of clinicians and patients.
There are increasing concerns among the scientific and medical community about the way that evidence based medicine is being employed because it may:
- Undervalue clinical expertise and experience presenting a theoretical rather than ‘real world’ approach to clinical practice.
- Ignore patients’ values and preferences
- Promote a cookbook approach to medicine in which a particular treatment is promoted for a specific condition regardless of the individual presentation of that condition or the individual needs of the person seeking treatment. Although doctors have historically made care decisions on the basis of their own knowledge and experience, they are under growing pressure to adhere to guidelines as a way to improve and standardize care.
- Favour research over clinical experience whereas both are a valid means of coming to a decision about treatment. In truth, there are few trials for which the evidence is incontrovertible.
- In the absence of evidence from randomized trials, there is a tendency for patients to experience ‘therapeutic nihilism’ that fails to provide practical help based on clinical experience or emotional support.
- Fail to provide a holistic approach - taking account of the overall needs, circumstances and lifestyle of patients. Clinical guidelines providing evidence based medicine are designed to meet the needs of ‘average’ patients yet few patients fit such a description. Randomized clinical trials, held to be the scientific gold standard, often under-represent or exclude certain groups, such as minorities, children, the elderly and people with several coexisting medical problems. It is questionable as to whether such evidence should be used as the basis for establishing broad treatment protocols.
Evidence for herbal medicine
Herbal medicine has been practised since prehistoric times. This extraordinary wealth of experience amounts to a vast knowledge base stretching back millennia. Today the contribution of plants to disease treatment and prevention remains impressive. At the start of 21st century, 11% of the 252 drugs considered as basic and essential by the World Health Organisation were exclusively of flowering plant origin.[2] Researchers also noted that, 80% of 122 plant derived drugs had a traditional medicine use identical or related to the current use by the pharmaceutical sector of the active elements of the plant.[3] It is in the light of this that the European Traditional Herbal Medicinal Products Directive (2004/24/EC) recognises the validity of long traditional herbal use allowing “the registration of herbal medicinal products without requiring particulars and documents on tests and trials on safety and efficacy, provided that there is sufficient evidence of the medicinal use of the product throughout a period of at least 30 years, including at least 15 years in the Community.”
There is a vast amount of research on herbal medicines published worldwide. As an example, Medline (Pubmed), shows over 50,000 citations for the search term “herbal” demonstrating the ongoing scientific interest in plant medicines. The mechanisms by which plant medicines achieve clinical effect are becoming increasingly clear. Scientific analysis reveals herbal medicines to contain a wide range of active constituents (e.g. polyphenols, saponins, alkaloids, tannins, essential oils, fatty acids, vitamins and trace elements) and it is through the agency of these naturally occurring compounds that herbal medicine takes effect. These constituents provide reliable plausibility for the use of plant medicines in helping to treat disease and maintain optimum health.
Published research demonstrates the potential of herbal medicines. Two examples are mentioned here:
Herbal medicine has been practised since prehistoric times. This extraordinary wealth of experience amounts to a vast knowledge base stretching back millennia. Today the contribution of plants to disease treatment and prevention remains impressive. At the start of 21st century, 11% of the 252 drugs considered as basic and essential by the World Health Organisation were exclusively of flowering plant origin.[2] Researchers also noted that, 80% of 122 plant derived drugs had a traditional medicine use identical or related to the current use by the pharmaceutical sector of the active elements of the plant.[3] It is in the light of this that the European Traditional Herbal Medicinal Products Directive (2004/24/EC) recognises the validity of long traditional herbal use allowing “the registration of herbal medicinal products without requiring particulars and documents on tests and trials on safety and efficacy, provided that there is sufficient evidence of the medicinal use of the product throughout a period of at least 30 years, including at least 15 years in the Community.”
There is a vast amount of research on herbal medicines published worldwide. As an example, Medline (Pubmed), shows over 50,000 citations for the search term “herbal” demonstrating the ongoing scientific interest in plant medicines. The mechanisms by which plant medicines achieve clinical effect are becoming increasingly clear. Scientific analysis reveals herbal medicines to contain a wide range of active constituents (e.g. polyphenols, saponins, alkaloids, tannins, essential oils, fatty acids, vitamins and trace elements) and it is through the agency of these naturally occurring compounds that herbal medicine takes effect. These constituents provide reliable plausibility for the use of plant medicines in helping to treat disease and maintain optimum health.
Published research demonstrates the potential of herbal medicines. Two examples are mentioned here:
- A recent (2017) meta-analysis (gathering together the overall results) of studies carried out on St John’s wort for depression reviewed 27 clinical trials with a total of 3808 patients, comparing the use of St John's wort and Prozac type antidepressants (SSRIs). The researchers found that St John’s wort has comparable efficacy and safety to SSRIs.[4]
- A meta-analysis of the herb echinacea demonstrated a markedly positive response concluding “Evidence indicates that echinacea potently lowers the risk of recurrent respiratory infections and complications thereof.”[5]
For further reading, the website Herbal Reality is building good information on conditions that herbalists are treating.
[1] http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html. Accessed 16/05/17
[2] Veeresham C. Natural products derived from plants as a source of drugs. J Adv Pharm Technol Res. 2012 Oct;3(4):200-1.
[3] Fabricant D S, Farnsworth N R. The value of plants used in traditional medicine for drug discovery.Environ Health Perspect. 2001 Mar; 109(Suppl 1): 69–75.
[4] Ng QX, Venkatanarayanan N, Ho CY. Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis. J Affect Disord. 2017 Jan 3;210:211-221.
[5] Schapowal A, Klein P, Johnston SL. Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials. Adv Ther. 2015 Mar;32(3):187-200.
[2] Veeresham C. Natural products derived from plants as a source of drugs. J Adv Pharm Technol Res. 2012 Oct;3(4):200-1.
[3] Fabricant D S, Farnsworth N R. The value of plants used in traditional medicine for drug discovery.Environ Health Perspect. 2001 Mar; 109(Suppl 1): 69–75.
[4] Ng QX, Venkatanarayanan N, Ho CY. Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis. J Affect Disord. 2017 Jan 3;210:211-221.
[5] Schapowal A, Klein P, Johnston SL. Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials. Adv Ther. 2015 Mar;32(3):187-200.