Herbalism

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Herbalism, also known as medicinal Botany (a neologism by Dr.K.Seshagirirao, University of Hyderabad, India), medical herbalism,herbal medicine, herbology, botanical medicine and phytotherapy, is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. The bioinformatics related to this subject could be referred to as MedBotanics (Seshagirirao).

Utilizing the healing properties of plants is an ancient practice. People in all continents have long used hundreds, if not thousands, of indigenous plants for treatment of various ailments dating back to prehistory. There is evidence that suggests Neanderthals living 60,000 years ago in present-day Iraq used plants for medicinal purposes (found at a burial site at Shanidar Cave, Iraq, in which a Neanderthal man was uncovered in 1960. He had been buried with eight species of plants) These plants are still widely used in ethnomedicine around the world.

The first generally accepted use of plants as healing agents was depicted in the cave paintings discovered in the Lascaux caves in France, which have been radiocarbon dated to between 13,000 - 25,000 BC.

Anthropologists theorize that over time, and with trial and error, a small base of knowledge would have been acquired within early tribal communities. As this knowledge base expanded over the generations, the specialized role of the herbalist emerged. The process would likely have occurred in varying manners within a wide diversity of cultures.

Plants have an almost limitless ability to synthesize aromatic substances, most of which are phenols or their oxygen-substituted derivatives such as tannins. Most are secondary metabolites, of which at least 12,000 have been isolated, a number estimated to be less than 10% of the total. In many cases, these substances (esp. alkaloids) serve as plant defense mechanisms against predation by microorganisms, insects, and herbivores. Many of the herbs and spices used by humans to season food yield useful medicinal compounds.

The use of and search for drugs and dietary supplements derived from plants have accelerated in recent years. Pharmacologists, microbiologists, botanists, and natural-products chemists are combing the Earth for phytochemicals and leads that could be developed for treatment of various diseases. In fact, approximately 25% of modern drugs used in the United States have been derived from plants.

The use of herbs to treat disease is almost universal among non-industrialized societies. A number of traditions came to dominate the practice of herbal medicine in the Western world at the end of the twentieth century:
 * The Western, based on Greek and Roman sources,
 * The Ayurvedic from India, and
 * Chinese herbal medicine (Chinese herbology).

Many of the pharmaceuticals currently available to Western physicians have a long history of use as herbal remedies, including opium, aspirin, digitalis, and quinine. The World Health Organization (WHO) estimates that80 percent of the world population, presently use herbal medicine for some aspect of primary health care. Herbal medicine is a major component in all traditional medicine systems and a common element in Ayurvedic, homeopathic, naturopathic, traditional Chinese medicine, and Native American Indian medicine. According to the WHO, 74% of 119 modern plant-derived pharmaceutical medicines are used in ways that correlated directly with their traditional uses. Major pharmaceutical companies are currently conducting extensive research on plant materials gathered from the rainforests and other places for possible new pharmaceuticals. →

Biological background
All plants produce chemical compounds as part of their normal metabolic activities. These can be split into primary metabolites, such as sugars and fats, found in all plants, and secondary metabolites found in a smaller range of plants, some only in a particular genus or species.

The autologous functions of secondary metabolites are varied. For example, as toxins to deter predation, or to attract insects for pollination. It is these secondary metabolites which can have therapeutic actions in humans and which can be refined to produce drugs. The word drug itself comes from the Sweedish word "druug", which means 'dried plant'. Some examples are inulin from the roots of dahlias, quinine from the cinchona, morphine and codeine from the poppy, and digoxin from the foxglove, and salicylic acid alpha-hydroxybenzoic acid, C6H4(OH)(COOH). S.A. led to the development of Aspirin, acetyl-salicylic acid, originally a trade name, patented by Bayer.

In 2004 the National Center for Complementary and Alternative Medicine began funding clinical trials into the effectiveness of herbal medicine.

Surveys of a scientific approach to herbal medicine can be found in the books Evidence-based herbal medicine, and Herbal and traditional medicine: molecular aspects of health.

Popularity
A survey released in May 2004 by the National Center for Complementary and Alternative Medicine focused on who used complementary and alternative medicines (CAM), what was used, and why it was used. The survey was limited to adults age 18 years and over during 2002 living in the United States. According to this survey, herbal therapy, or use of natural products other than vitamins and minerals, was the most commonly used CAM therapy (18.9%) when all use of prayer was excluded.

Herbal remedies are most common in Europe. In Germany, the term apothecary (Apotheke) is still used, and next to prescription drugs one can order essential oils, herbal extracts, or herbal teas. It is even seen as a preferred treatment over the unnecessary overuse of industrialized production of chemical medication.

In the United Kingdom, the training of medical herbalists is undertaken in private colleges. Recently, Bachelor of Science degrees in herbal medicine are offered at Universities such as University of East London, Middlesex University, University of Central Lancashire, University of Westminster and Napier University in Edinburgh.

At UCLAN the training of medical herbalists is extensive, and involves the study of anatomy, physiology, biochemistry, pathology, differential diagnosis etc. This enables the herbalist to be able to talk on equal terms with conventional medical practitioners. They learn about when they can treat, and when they should refer. They study the biochemistry of the body and the chemistry and structure of plants. Alongside this, they study traditional herbal medicine: Indications and Actions, and Energetics. They learn to recognise where conventional medical opinion diverges from traditional herbal medicine doctrine. They look at lots of different models for health care. A significant amount of self reflection is required (see http://www.uclan.ac.uk/courses/ug/bsc_hm.htm and http://www.medicalherbalist.eu). A medical herbalist is trained to view a situation from multiple perspectives in a non-dogmatic way.

Types of herbal medicines
Medicinal plants can be used by anyone, for example as part of a salad, an herbal tea or supplement, although some herbs considered dangerous are restricted from sale to the public. Sometimes such herbs are provided to professional herbalists by specialist companies. Many herbalists, both professional and amateur, often grow or wildcraft their own herbs. Many common weeds have medicinal properties (e.g. dandelion).

Medicinal herbs can be used in various forms:

Herbal teas
Main article: Tisane

There are two methods of making herbal teas, infusion and decoction. Infusion is steeping lighter parts of the plant (leaves, flowers, light stems) in boiled water for several minutes. Decoction is boiling tougher parts, such as roots or bark for a longer period of time. Herbal teas are often used as a home remedy, and as an alternative to tea and coffee.

Some popular herbal teas include borage, chamomile, dandelion, elderflower, hibiscus, nettle, and various species of mint. Each herb has unique medicinal properties, and a range of secondary effects; and this is linked to its use as a casual drink. For instance, Borage can be used medicinally (amongst other things) as an aid against depression; and it may be drunk more casually to lift the spirits. It was traditionally served as a pep drink for weary travellers. Secondary effects include use as an anti-inflammatory or balsam; and hormonal and metabolic regulation. Other herbs may have similar side-effects, but in different proportions and are used in different ways.

Mixing Herbs. To counteract the various complications and side-effects of an ailment, or to produce a more rounded taste, a number of herbs may be mixed, and formulas are the preferred method of giving herbs by professional herbalists. A well-known mixture used against a cold includes eucalyptus leaf, mint leaf (which contains Menthol) and juniper berry. Another is the age-old favourite "dandelion and burdock", from which the popular fizzy drink was derived.

Fresh or Dried? Many flower and leaf herbs lose volatile compounds within a few hours, as the juices and oils evaporate, the scent leaks away, and the chemicals change their form. Drying concentrates other compounds as water is removed. Most herbal traditions use dried material and the reported effects for each herb tend to be based upon dried herbs unless otherwise specified.

If you are using fresh herbs, you will need more of them, and the tea will have a somewhat different effect. Finely chop the leaf immediately before using it.

Generic Western Tea is usually the leaf of one specific plant, Camelia Sinensis, which grows mainly in India and China. It can be seen as just one of many herbal teas. It is a stimulant, and its main property is to increase alertness, along with a slightly sedative or calming effect. But unlike a fresh herbal tea, it may include artificial additives to enhance the taste and to preserve it in the shops. More expensive recipes include Darjeeling (from Darjeeling in India) and Earl Grey (which has bergamot added).

Infusion Methods. Some simple methods include - With all of these methods, let stand, covered, for at least 15 minutes to get medicinal benefits.
 * Drop the herb directly into the water, steep and drink, including the chopped leaves.
 * Use a tea strainer which fits over the top of a cup.
 * Use a tea strainer which can be lowered into a teapot.
 * Cut the top off a normal teabag and empty it; replace the contents with your herb; fold over the top and staple it closed - then use it as normal teabag.

Coffee
Coffee is prepared by roasting and then grinding up the ingredients, or sometimes by decoction. It is normally stored as a powder or as granules. This is dropped directly into the hot water. Some preparations dissolve completely, while others remain partly solid, giving the drink a gritty texture.
 * See the main Coffee article for more information on coffee.

Where the coffee remains gritty, it must be left to infuse before drinking. To avoid the gritty texture, a machine such as a coffee percolator or French press may be used.

Generic Western Coffee is the roasted seeds of either Coffea arabica or Coffea canephora. Its properties are similar to the generic tea plant Camelia Sinensis, but it has about twice as much caffeine, a richer, mellower taste, and different additives. The roasting process eliminates caffeine, and (like tea) the darker the coffee, the less caffeine it contains. When coffee is scarce, people often drink coffee substitutes.

Herbal teas include many of the coffee substitutes, and others; but they are used here for a wide range of properties, rather than merely to simulate the taste of coffee.

Herbal tinctures
Steeping a medicinal plant in alcohol extracts the alcohol-soluble principles into a liquid form that can be stored for long periods. Different concentrations of alcohol are used to extract different constituents of the plants. For example; resins require high alcohol content and sugars usually require low alcohol content for optimal extraction.

There are many schools of thought about tincture making. In the traditional view an herb is either steeped once (single maceration) or more than once. In a double maceration the mark (or used plant material) is removed and replaced by a new batch (using the same alcohol) thus increasing the strength of the tincture. Sometimes the mark is then ashed (burnt until ash) and added back in which increase the amount of some minerals in the tincture.

In the scientific model tincture strengths are measured by a ratio of herb to alcohol (1:5 and 1:2 are the most common where the 1:2 is the stronger tincture). Many tinctures use a combination of vegetable glycerine and alcohol to extract which changes the compounds that are extracted.

Herbalists often mix several herbal tinctures to form an individualized prescription for each patient.

Plant tinctures are also the basis for many homeopathic medicines. Herbal medicine and homeopathic medicine should not be confused with one another as they are very different. (see homeopathy)

Fluid extracts
Fluid extracts are stronger than herbal tinctures, and can be preserved with alcohol or glycerin. They are just highly concentrated tinctures, made by distilling off some of the alcohol used in the tincture process. The final result is a liquid plant compound that can be 40 times more potent than a tincture.

Note: glycerates are herbal extracts that use glycerin as the sole extractant. They are very different and often have completely different medicinal properties than alcohol extracts. Tinctures or fluid extracts that are alcohol free should have the alcohol removed after the extraction process and replaced with glycerin which then acts just as the preservative.

Solid extracts
Solid extracts are made from tinctures just like fluid extracts, but the entire solvent is separated from the plant compound, leaving a soft paste-like solid exract or a dry solid extract that is often as much as 400 times more potent than tinctures. Solid extracts can be diluted back to either fluid extracts or tinctures.

Many solid extracts are made in the way that apple butter is made, by simply cooking the plant material and water slowly over low heat until it forms a paste. Sometimes these are sold with a preservative added (glycerine is the most common), and sometimes they need to be refrigerated when they are opened (like apple butter).

Herbal poultices
Poultices are a solid, vegetable fat-based mixture used externally. They have the shortest life span of any herbal remedy and must be made fresh for every use.

Poultices can be made with water or just fresh ground herb. They are applied topically often in conjunction with a heat source (hot water bottle or heating pad). They are used mostly (but not exclusively) for a localized injury (sprains, strains, scrapes, burns, bruises or cuts). They are excellent for hiking injuries (where there are usually plants and not pharmacies), but can be used for many other things.

Powdered herbs and tablets
Herbs that are dried and (usually) certain parts are separated out then ground to a powder fine consistency. Powered matter can then be compressed or put in an empty capsule to form a tablet. Most tablets these days are made from some form of concentrated extract and not just plain herbal powders. This method is optimal for foul tasting herbs, highly concentrated forms and for travelling.

Powders are also used simply in their powdered form. Many Chinese medicine practitioners use powdered herbs as a base for making teas. Powdered herbs are also used topically as powders where dry skin is advantageous (some diaper rashes respond bettered to powdered herbs than ointments).

Herbal ointments
An ointment or salve is a semi-solid preparation made to be applied to the skin. Depending on the purpose for which it is designed and its method of preparation, the texture can vary from very greasy to a thick paste.

Most ointments use vegetable oils (olive and almond are common) in conjunction with a thickener like bees wax. The herbs are often extracted in the oils for months before they are ready to be made into an ointment. The herb is then removed from the oil and it is slowly heated with bees wax to form the desired consistency. Vitamin E and essential oils are often used to preserve the salve or ointment.

The simplest ointments use petroleum jelly as a base. In traditional ointments, a combination of carrier oils is used that helps them to be absorbed through the skin, plus hardening agents to create the desired texture.

Essential oils
Extraction of volatile liquid plant materials and other aromatic compounds from plants gives essential oils. These plant oils may be used internally in some forms of herbal medicine as well as in aromatherapy and generally for their perfume, although their medicinal use as a natural treatment (alternative medicine) has proved highly efficacious in the treatment of headache and muscle pain, joint pain and certain skin diseases

Herbal supplements
Herbal supplements tend to be commercial products in tablet or capsule form manufactured and marketed by the health food industry for sale in retail outlets to the general public, although there are some types that are sold only to healthcare practitioners for prescription.

Herbal supplements are often standardized to contain stated levels of active phytochemicals. Standardization can be done in a number of different ways. Many companies extract the supposedly active constituents and add them back into a base like rice fiber. This is no longer an herbal preparation as the whole herb is no longer present. Some companies follow the same procedure but add the extracted constituent to whole powdered herb. Some companies simply concentrate their whole herb until the desired constituent concentration is reached.

Many herbalists do not agree with the extraction/standardization of active ingredients, preferring instead to use the whole plant.

Examples of herbal medicine
There are hundreds of herbal remedies. An experienced practitioner can offer a comprehensive holistic approach to health. Examples of some commonly used herbal medicines:
 * Artichoke and several other plants reduced total serum cholesterol levels in preliminary studies.
 * Black cohosh and other plants that contain phytoestrogens (plant molecules with estrogen activity) have some benefits for treatment of symptoms resulting from menopause.
 * Echinacea extracts limit the length of colds in some clinical trials, although some studies have found it to have no effect at lower dosages than are normally given by herbalists.
 * Garlic lowers total cholesterol levels, mildly reduces blood pressure, reduces platelet aggregation, and has antibacterial properties. It also has strong anti-viral and anti-fungal properties.
 * Grapefruit seed extract as a natural antimicrobial has minimal effectiveness as an anti-bacterial, anti-parasitic, and anti-fungal herb.
 * Nigella sativa (Black cumin) is a general medicinal plant used for diverse ailments such as cough, pulmonary infections, asthma, influenza, allergy, hypertension and stomach ache. The seeds are considered carminative, stimulant, diuretic and galactogogue. It is often taken with honey. Seed powder or oil is externally applied for eruptions of skin.
 * Pawpaw used for insecticidal purposes (killing lice, worms), as well as cancer treatment and viral infections.
 * Peppermint tea for problems with the digestive tract, including irritable bowel syndrome and nausea.
 * Rauvolfia Serpentina, used extensively in India for sleeplessness, anxiety, and high blood pressure. The first proven allopathic medicine for high blood pressure was extracted from this herb.
 * St. John's wort, has yielded positive results, proving more effective than a placebo for the treatment of mild to moderate depression in some clinical trials.
 * Valerian root can be used to treat insomnia.
 * Lemon juice or apple cider vinegar can be used to treat acne.
 * Green tea can heal scars faster.
 * Lemon grass can lower cholesterol
 * Honey can be a solution for cholesterol.

Risks and benefits
A common misconception about herbalism and the use of "natural" products in general, is that "natural" equals safe. However many plants have chemical defence mechanisms against predators that can have adverse or lethal effects on humans. Examples are poison hemlock and nightshade, which can be deadly, although they are not sold as herbs. Herbs can also have undesirable side-effects just as pharmaceutical products can. These problems are exacerbated by lack of control over dosage and purity. Furthermore, if given in conjunction with drugs, there is danger of 'summation', where the herb and the drug have similar actions and add together to make an 'overdose'. In animals, there are other dangers. There may be residues in food from farm animals (e.g. eggs, milk, meat) or danger of 'doping' in competition animals. The latter may also apply to human athletes.

There is a danger that herbal remedies will be used in place of other medical treatments which have been scientifically tested for safety and efficacy, resulting in the development or worsening of a medical condition which could have been better prevented or treated. There is also a danger that an herbal remedy may itself cause harm which is unanticipated due to a lack of a full understanding of its composition and biochemical effects.

In the UK, the profession's governing bodies such as The College of Phytotherapy Practitioners and The National Institute of Medical Herbalists offer membership, education and certification. A qualified Herbalist will have studied for four years and passed exams in botanical and medical subjects. He or she will be expected to have the required knowledge to prescribe and dispense herbs tailored to the individual, taking into account their medical history and any other medication.

Effectiveness
As noted above, there have been scientific studies which show that certain plant products can cure or prevent certain diseases. The gold standard for pharmaceutical testing is repeated, large-scale, randomized, double-blind tests. Some plant products or pharmaceutical drugs derived from them are incorporated into mainstream medicine. To recoup the considerable costs of testing to the regulatory standards, the substances are patented by pharmaceutical companies and sold for high profit. Pharmaceutical firms argue that the regulations protect public safety. Cynics point out that they have a secondary effect of setting a high financial barrier to competition.

Most herbal traditions have accumulated knowledge without modern scientific controls to distinguish between the placebo effect, the body's natural ability to heal itself, and the actual benefits of the herbs themselves. Many herbs have shown positive results in in-vitro, animal model or small-scale clinical tests. The few randomized, double-blind tests that receive attention in mainstream medical publications are often questioned on methodological grounds or interpretation. Studies tend to carry more weight if they are performed in the same country as the medical scientists evaluating them. Likewise, studies published in wide circulation magazines such as JAMA receive more consideration than those published in specialized herbal journals. Fortunately there is now much scientific research into the action and effectiveness of herbal remedies and many are justifying their traditional use. High quality trials involving proper controls and double blind methods are being increasingly carried out, with many useful results. Herbalists tend to use parts of plants, such as the roots or leaves but not isolate particular phytochemicals. They argue that the synergy of the combined substances enhances the efficacy and dilutes toxicity. Western medicine on the other hand prefers single ingredients on the grounds that dosage can be more easily quantified. Dosage is in general an outstanding issue for herbal treatments: while most conventional medicines are heavily tested to determine the most effective and safest dosages (especially in relation to things like body weight, drug interactions, etc.), there are few established dosage standards for various herbal treatments on the market. Furthermore, herbal medicines taken in whole form cannot generally guarantee a consistent dosage or drug quality (since certain samples may contain more or less of a given active ingredient).

The issue of regulation is an area of continuing controversy in the EU and USA. On one end of the spectrum, some herbalists and consumers maintain that traditional remedies that have a long history of use do not require the level of safety testing as xenobiotics or single ingredients in an artificially concentrated form. On the other hand, others are in favor of legally enforced quality standards, safety testing and prescription by a qualified practitioner. Some professional herbalist organizations have made statements calling for a category of regulation for herbal products. Yet others agree with the need for more quality testing but believe it can be managed through reputation without government intervention. Clearly the full debate involves issues of politics, economics and the role of government that are beyond the scope of this article.

Name confusion
The common names of herbs (folk taxonomy) may not reflect differences in scientific taxonomy, and the same (or a very similar) common name might group together different plant species with different effects. For example, in 1993 in Belgium, in a formula created by medical doctors including someTCM herbs for weight loss, one herb (Stephania tetrandra) was swapped for another (Aristolochia fangchi) whose name in Chinese was extremely similar but which contained higher levels of a renal toxin, aristolochic acid; this quid pro quo resulted in 105 cases of kidney damage. Note that neither herb used in a TCMcontext would be used for weight loss or given for long periods of time. In Chinese medicine these herbs are used for certain forms of acute arthritis and edema.

Standards and quality control
The legal status of herbal ingredients varies by country. For example, Ayurvedic herbal products may contain levels of heavy metals that are considered unsafe in the U.S., but heavy metals are considered therapeutic in Ayurvedic medicine.

In the United States, most herbal remedies are regulated as dietary supplements. Many herbs for home use could also be grown in a small home garden.

In the UK, herbal remedies that are bought over the counter are regulated as supplements,as in the US. However, herbal remedies prescribed and dispensed by a qualified Medical Herbalist, after a personal consultation, are regulated as medicines. A Medical Herbalist can prescribe some herbs which are not available over the counter, covered by Schedule III of the Medicines Act, for example. Forthcoming changes to laws regulating Herbal products in the UK, are intended to ensure the quality of herbal products used. Most Medical Herbalists will be using herbal products from a supplier who already meets these standards.

Medical interaction
In consultation with a physician, usage of herbal remedies should be clarified, as some herbal remedies have the potential to cause adverse drug interactions when used in combination with various prescription and over-the-counter pharmaceuticals. Dangerously low blood pressure may result from the combination of an herbal remedy that lowers blood pressure together with prescription medicine that has the same effect. In particular, many herbs should be avoided during pregnancy. However, most herbal books alert the reader to necessary precautions.

Not all physicians may be familiar with the effects of different types of herbal medicine, but general practitioners should be able to refer patients to a specialist, or investigate the medical literature on their behalf. A qualified Medical Herbalist, however, will be familiar with most commonly used medical drugs and their modes of action and therefore will only prescribe herbal remedies which will not interfere with these.

Regulation

 * Website of the National Herbalists Association of Australia
 * National Institute of Medical Herbalists Website for one of the governing bodies in the United Kingdom
 * College of Phytotherapy Practitioners Website for one of the governing bodies in the United Kingdom
 * Website of the American Herbalists Guild
 * Website of the National Certification Commission for Acupuncture and Oriental Medicine

Neutral/Positive

 * Herb Research Foundation Research and educational foundation
 * Center for Complementary and Alternative Medicine (National Institutes of Health)
 * University of Minnesota's Center for Spirituality and Healing
 * The American Botanical Council Research and educational foundation
 * HerbMed Research and educational foundation
 * Medline All Herbs and Supplements
 * Herbs by name
 * Henriettesherbal.com By a practising herbalist and one of the oldest and largest herbal information sites on the net.
 * Natural Standard Evaluation of evidence from a mainstream point of view
 * Medicine Hunter By Chris Kilham, an ethnobotanist at the University of Massachusetts at Amherst
 * Australasian College of Health Sciences College specializing in online holistic health education
 * United Plant SaversNonprofit foundation to preserve native herbal plants and plant habitats
 * London Community Herbalists Network of herbalists in London, UK
 * Herbological.com Sharp analysis of current research and debate on herbal medicine and related matters.
 * An overview of medicinal plants from the Science Creative Quarterly

Criticism

 * New England Journal of Medicine editorial about the risks of alternative medicine
 * University of Maryland site about alternative medicine: uses, possible prescription drug interactions, and possible nutrient depletions
 * Herbal supplements not child's play - CNN news article
 * And the Good Herb Taketh Away
 * Herbal Mythology - By Steven Novella MD, President of the New England Skeptical Society
 * Selling Supplements - By Steven Novella MD, President of the New England Skeptical Society
 * Herbal side effects and warnings - researched by Personal Health Zone staff
 * Quackcast "Herbal Remedies", direct mp3 download - Critical overview of several herbal remedies by Mark Crislip MD