Background information
Western herbal medicine can be traced back to prominent physicians such as Paracelsus, Dioscorides, Hippocrates and Galen. The oldest surviving European herbal is the Anglo-Saxon text ‘The Leech Book of Bald’ which dates from the early 10th Century. Amongst the most popular herbs used at the time were vervain, mugwort and plaintain which were either taken as medicines or worn as amulets. The great European herbals of Gerard (1597) and Culpepper ((1653) described and illustrated plants so that ordinary people could find herbal medicines in the hedgerows and avoid expensive apothecaries. With increasing trade herb were imported from the East Indies and North America including yucca, nasturtium, nutmeg and tea. By the late nineteenth and early twentieth centuries ideas, practices and herbs were imported and exported from North America. The Eclectic and physiomedical herbal movements incorporated the herbal lore of the Native Americans, and many North American herbs, such as echinacea and saw palmetto are used in western herbal medicine in the UK.
Treatment
Medical Herbalists will take a detailed medical history, including current complaint and medications, allergies and family history but also diet and lifestyle. Physical examination may be necessary and blood pressure, pulse and urine and blood samples may be taken. Herbal therapy tends to be patient specific, with use of combinations of herbal extracts though manufactured products may be used. Where appropriate the practitioner may provide additional advice about other treatments such as osteopathy, counselling, massage etc, and also suggestions on changes to diet, exercise, and lifestyle. The response to the herbal treatment will be reviewed at regular intervals and the herbal composition will change to reflect physiological changes.
Some herbs used by herbalists, for example Echinacea, ginkgo, St Johns wort, are also sold as over-the-counter products in pharmacies and health food shops.
Side effects and interactions
As with any medicine, herbal medicine may have side effects. Those commonly reported are nausea, abdominal discomfort and diarrhoea. Herbs with potential for cardiac, renal and hepatic toxicity may be included in the materia medica but serious toxicity is rarely reported. As herbal combinations are often used, it may not be possible to associate an adverse effect with a specific herb.
The well documented interaction between St John’s wort (
Hypericum perforatum) and many orthodox medicines clearly demonstrates the potential for herb-drug interactions. Patients using any prescribed medicine should consult their general practitioner or other health provider before starting to use St John’s Wort. However there are few reliable herb-drug interaction studies on the majority of herbs used in the UK. Where herbal combinations are used it is more difficult to predict interactions as the final chemical composition of any prescription and its metabolism are not known. Health care providers should be aware of this, as closer monitoring may be required.
Regulation
At present in the UK there are no minimum training requirements for herbal practitioners. There are a number of professional organisations representing Medical herbalists, these include National Institute of Medical herbalists, College of Practitioners of Phytotherapy, Association of Master Herbalists, Unified Register of Herbal Practitioners. A system of statutory registration has been proposed and it is hoped that this will be introduced in the next few years.
Most of the herbal products available in the UK are unlicensed, with no evidence of quality, safety or efficacy. The EU Directive on Traditional Herbal Medicinal Products introduced a registration scheme for over-the-counter herbal medicines, suitable for use without the intervention of a medical practitioner. Registered products will meet standards of safety and quality and labelling will be improved.
Herbal medicines assessed by the Medicines & Healthcare products Regulatory Agency (MHRA) have a PL (product licence) or THR (Traditional Herbal Registration) number on the label. These products are accompanied by clear comprehensive information about the safe use of the product. However the quality of unlicensed herbal medicines is not assessed by the MHRA and information provided may be incomplete or unreliable.
Labelling Issues and Safety Concerns
Medical Herbalists commonly dispense infusions, decoctions, tinctures or oil infusions, though powders, tablets or capsules may be used. These are often sourced from manufacturers in the UK, Europe, US or Australia. Quality can vary, depending on the source. The practitioner should be willing to provide a full herbal ingredient list to the patient.