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.
Buchu (Barosma betulina)
Burdock (Arctium lappa)
Traditional uses:
as a diuretic, laxative, antiinflammatory, for skin conditions such as eczema and as an antibiotic.
Principal constituents:
inulin, glycosides, flavonoids, tannin, volatile oil, mucilage, pectin and sugars.
Safety:
Avoid concomitant use with drugs and other herbs with diuretic properties which may potentiate the effects. Burdock has been known to be contaminated by atropine in commercial form. Burdock may increase the risk of bleeding in patients with bleeding disorders or taking anticoagulants. Caution in hormone sensitive conditions including HRT. May cause allergic reactions in those allergic to chrysanthemums, marigolds and daisies.
Butcher’s broom (Ruscus aculeatus) (also known as Sweet broom)
Calamus (Acorus calamus) (also known as Sweet flag, Flagroot, Kalmus, Sweet grass)
Calendula (Calendula officinalis, Marigold)
Celery (Apium graveolens)
Traditional uses:
Celery has a long history of treatment for gout, headache, weight loss and poor appetite. It is also used as a sedative, mild diuretic, urinary antiseptic, digestive aid, menstrual stimulant, to reduce lactation and for purifying the blood.
Principal constituents:
volatile oil, bergapten, flavonoids, furano-coumarins, high in minerals including sodium.
Centaury (Centaurium erythraea)
Safety:
Caution regarding concurrent medication, herbs and supplements with similar therapeutic action, in particular, herbs with diuretic properties which may potentiate effect. Caution regarding concurrent sedation, including analgesics containing codeine. Contraindicated for patients with peptic ulcers.
Chamomile (German) (Matricaria recutita)
Safety:
German chamomile may increase bleeding in patients with bleeding disorders or taking anticoagulants; it 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, proton pump inhibitors, oral hypoglycaemic agents, angiotensin 11 receptor antagonists and antihistamines. It may have some mild oestrogenic activity, therefore caution with hormone replacement therapy and avoid concomitant use with tamoxifen. German chamomile should not be confused with Roman chamomile which has different constituents.
Coltsfoot (Tussilago farfara) (also known as Coughwort, Horsehoof)
Comfrey (Symphytum officinale) (also known as Knitbone, Boneset)
Couch grass (Agropyron repens) (also known as Wheat grass, Dog grass)
Cramp bark (Viburnum opulus) (also known as European cranberry bush, Guelder rose, High bush cranberry, Snowball bush)
Dandelion (Taraxacum officinale) (also known as Lion’s tooth, Fairy clock)
Devil’s claw (Harpagophytum procumbens) (also known as Grapple plant, Wood spider)
Drosera (Drosera rotundifolia) (also known as Sundew)
Echinacea (Echinacea augustifolia) (also known as Cone flower)
Principal constituents:
alkaloids, carbohydrates, glycosides, terpen-oids, glycol-proteins, essential oils.
Safety:
As with all herbal remedies, echinacea should only be taken as required and should not be taken for longer than three months at a time; it is inappropriate for people to self-medicate in the long term. Side-effects include nausea, vomiting, abdominal pain, diarrhoea, allergic reactions including a burning sensation and tingling and numbness of the tongue, headache, dizziness, insomnia, disorientation and anaphylaxis.
Elecampane (Inula helenium) (also known as Horse heal, Scabwort)
Ephedra (Ephedraceae) (also known as Ma huang, Natural ecstasy)
Principal constituents:
ephedrine, methyl ephedrine and noreph-edrine, volatile oil, tannins, flavonoids.
Safety:
Ephedra is a cardiac stimulant and may interfere with the action of cardiac glycosides, may cause tachycardia, cardiac arrhythmias and cardiomyopathy. It may decrease the effectiveness of anti-hypertensive and anti-diabetic therapy. Caution with caffeine-containing drinks. Contraindicated in patients on monoamine oxidase inhibitors.
Fenugreek (Trigonella foenum-graecum)
Principal constituents:
steroidal saponins, mucilages, volatile oils, alkaloids, coumarins and lipids.
Safety:
Side-effects include diarrhoea, heartburn and abdominal discomfort, allergic and anaphylactic reactions; large doses may cause hypoglycaemia. People who are allergic to soy beans, chick-peas, peanuts and green peas may be more at risk of allergic reaction due to cross-reactivity. It is considered unsafe in children and should be avoided by pregnant women, except as a culinary additive, as the neonate may be born with an unusual body odour similar to maple syrup urine disease. There have been isolated reports of loss of consciousness in children who have consumed the tea. There is a moderate theoretical risk of interaction with anticoagulant and antiplatelet drugs, as well as with diabetic medication.
Feverfew (Tanacetum parthenium) (also known as Bachelor’s buttons, Featherwort, Midsummer daisy)
Flax (Linum usitatissimum) (also known as Linseed, Flaxseed)
Traditional uses:
as a laxative for chronic constipation, disorders of the colon, irritable bowel syndrome and externally as a poultice for local areas of inflammation.
Principal constituents:
unsaturated fatty acids, soluble fibre, lino-lenic, linoleic and oleic acids.
Safety:
Contraindicated in patients with or at risk of prostate cancer and those with suspected or actual paralytic ileus. Side-effects are similar to other preparations used for gastrointestinal conditions, including diarrhoea, bloating abdominal and flatulence. Anaphylactic shock has been reported.
Garlic (Allium sativum)
Ginger (Zingiber officinale)
Safety:
Caution regarding the increased risk of bleeding in patients with bleeding disorders or taking anticoagulants including aspirin and non-steroidal antiinflammatories. Prolonged continual use of more than 1 g/day for 3 weeks or more should be discouraged and patients who use ginger, particularly pregnant women requiring its anti-emetic properties, should have their clotting factors assessed. Patients with any cardiovascular pathology should avoid ginger, which may also diminish the effect of anti-hypertensive therapy. Side-effects include heartburn and hot flushes.
Ginkgo biloba (Ginkgo biloba)
Ginseng (Ginseng eleutherococcus) (Siberian ginseng)
Safety:
Extreme caution in any cardiac pathology. Contraindicated in psychiatric illness, particularly mania, schizophrenia, nervous tension and hyperactivity. Caution in perimenopausal women and people under 40 years of age. It should not be taken with stimulants including coffee, nor with antipsychotic drugs; contraindicated with monoamine oxidase inhibitors. Do not confuse with Asian/Chinese ginseng.
Goldenseal (Hydrastis canadensis) (also known as Eye balm, Eye root)
Safety:
Possible emmenagogic and oxytocic effects make it theoretically unsafe in pregnancy, especially as berberine crosses the placenta and may be teratogenic. Contraindicated in neonates – berberine may cause kernicterus, via the breast milk. High doses/prolonged use may cause nausea, constipation, delirium, convulsions, paralysis, cardiac compromise, death. Vaginal douching with goldenseal may cause mucosal irritation and ulceration. Avoid in cardiovascular disease, hypertension, irritable bowel syndrome, Crohn’s disease, ulcerative colitis. Possible interaction with anti-hypertensives, anticoagulants, barbiturates, sedatives, antacids.
Hawthorn (Crataegus laevigata) (also known as Mayflower)
Hops (Humulus lupulus)
Principal constituents:
volatile oil, bitter resin complex, tannins, asparagine, oestrogenic substances.
Safety:
Caution with concurrent sedation and analgesics containing codeine. Contraindicated in individuals suffering from depression. May interfere with tricyclic antidepressants, antipsychotics, benzodiazepines, oral hypoglycaemic agents, angiotensin II receptor antagonists, proton pump inhibitors, warfarin, non-steroidal antiinflammatories including aspirin, antihistamines and thyroid therapy. Caution in hormone sensitive conditions including women taking hormone replacement. May induce hyperglycaemia in diabetics and hypoglycaemia in non-diabetics.
Horse chestnut (Aesculus hippocastanum)
Traditional uses:
to reduce vasodilatation, antiinflammatory, used for varicose veins, haemorrhoids and phlebitis.
Evidence:
Studies suggest antiinflammatory, hypoglycaemic, anti-oedema and venous toning properties.
Safety:
Caution regarding concurrent medication, herbs and supplements with similar therapeutic. May increase risk of bleeding in patients with bleeding disorders or taking anticoagulants including aspirin and NSAIDs. Avoid in pregnancy, inflammatory bowel and haemorrhagic conditions, hepato-renal disorders and in those with a latex allergy. Avoid in diabetics. Saponin content may affect protein binding of some drugs. May cause gastric irritation, muscle twitching, paralysis, coma. Aesculin in raw seeds and bark may cause toxicity – European Union preparations are standardized for adults; avoid in children.
