Related Terms

• European herbs, European herbalism, formula, Galen, Galenic medicine, herbal products, herbal remedies, herbal tradition, herbalism, herbalist, Hippocrates, medical herbalist, medicinal herbs, medicinal plants, Native American herbs, naturopath, pharmocognosy, plant medicine, phytotherapy, simple, Traditional Western herbal medicine, Western herbs, Western herbalism.

Background

• Western herbal medicine involves using plants and plant material to create medicines to help prevent or treat various illnesses. These materials may use some or all parts of a plant, such as flowers, roots, fruits, leaves, and bark.

• This modality emphasizes the use of European and Native American herbs; however, herbs from other parts of the world are sometimes used as well.

• Traditional Western herbal medicine evolved mostly from the ancient Greeks, who were strongly influenced by Egyptian and Middle Eastern civilizations. Western herbal medicine also has roots in the indigenous practices of the British Isles and ancient Roman traditions. Well-known historical physicians including Hippocrates and Galen are thought to have used herbal medicine in their practices. The use of various herbal formulas is one of the oldest and possibly the most widespread form of medicine.

• Herbal remedies are used for many suggested purposes, such as improvement or general support of digestive, respiratory, circulatory, immune, endocrine, and nervous system processes. Herbs are also used to purportedly remove waste and toxins from bodily cells or topically to promote healing of the skin.

• Herbs of the Western herbal medicine tradition are the subject of increasing interest in the medical community. Research is currently being conducted in the use of medicinal herbs for various medical conditions. For instance, garlic has been researched as a potential treatment for high blood pressure. In some studies, the whole herb is given to a patient, whereas in other studies, isolated active chemicals, or constituents of a plant, may be extracted, purified, and administered to the patient. Herbal constituents may be concentrated to deliver standardized set doses and may also be synthesized in a lab. They may also have their chemical structure changed and patented. This wide variety of herbal formulations used in clinical, in vivo, and in vitro studies is an area of concern for accurate analysis of research and determination of clinical recommendations.

• While both the United States and Europe have a long history of practitioners who use Western herbal medicine, this form of treatment has not always been considered widely available or accepted. The use of herbal remedies in the United States and Western Europe experienced a strong resurgence in the late 1990s, which continues today.

Technique

• Western herbalism may be characterized by a person-centered approach with the practitioner focusing on the patient rather than the disease. For instance, the herbalist may be more likely than a conventional doctor to provide emotional support to the patient or to ask about how a condition is impacting the patient's quality of life.

• A consultation with a medical herbalist or naturopath usually begins with an interview that may take as long as one hour or even perhaps longer. During this meeting, the herbalist will assess the patient's condition. In this process, the practitioner asks the patient about their current injuries, symptoms, and medical problems. The practitioner may also ask questions about the health conditions of family members and lifestyle choices. Some medical herbalists are qualified to conduct a routine physical examination.

• The herbalist may then make an assessment of the vitality and constitution of the patient based on the information obtained from the case history. The choice of herbs in the prescription is based on this assessment. The prescription, rather than being based simply on the diagnosis of a disease or condition, is determined by an understanding of the significance of the signs and symptoms in that individual. Therapy is directed at the causes, rather than just the presenting symptoms.

• Prescriptions may vary significantly between individual patients who may be given an identical diagnosis in conventional Western medicine. Many herbalists also offer advice on lifestyle, especially nutrition. The practitioner usually works to create an environment of trust and personal healing in the relationship with the patient.

• Unlike other popular herbal systems of medicine, such as traditional Chinese medicine (TCM) or Ayurvedic medicine Western herbal medicine sometimes uses single herbs, rather than formulas of multiple herbs, to treat conditions. These herbs are known as "simples." However, herbs may also be given in combination with one another. When herbs are combined, they are known as a "formula."

• Practitioners may choose to use medicinal plants in fresh or dried form or as simple extracts, standardized extracts, teas, liquid extracts, and capsules. Herbal remedies are taken in many different ways, both internally and externally. Herbs may be infused (steeped) in water and drunk as a tea or dried and ground into capsules or tablets while others are applied topically to the skin as a cream, ointment, or poultice. Herbs may also be used in suppositories and douche formulations or may be added to warm bath water (usually wrapped in a muslin cloth or large tea bag and then added to the water).

• Follow-up appointments are often suggested. Throughout this process, the herbalist refines what treatment is given. For instance, the herbalist may change the simple or formula given to the patient, or they may recommend a lifestyle modification. Western herbal medicine aims to prescribe a remedy taking into account all aspects of the patient's condition and personal constitution, not just specific current symptoms. The goal of the herbal practitioner is to move the patient towards an overall state of wellness, rather than to simply treat one medical condition.

• Conventional Western medicine tends to control or treat the symptoms caused by a disease or syndrome. In contrast, Western herbal medicine aims to treat the underlying disorder that may be causing the symptoms. For this reason, conventional Western medicine may work faster to relieve the symptoms of one particular disease. Herbal therapies aim to enhance the body's ability to minimize the impact of the disease, and thus may take longer to produce noticeable results in the patient.

• Since herbal remedies attempt to treat the underlying condition or problem rather than symptoms, individuals who take natural remedies should not expect symptoms to disappear until the underlying physical problem has responded to the herbal treatment. Whereas symptom relief may be considered important in Western herbal medicine, discovery and treatment of potential bodily dysfunction causing symptoms is given equal importance in Western herbal medicine and is considered the primary goal of this modality.

• Popular herbs used in Western herbal medicine include: St. John's wort, gotu kola, Ginkgo biloba, bilberry, dandelion, echinacea, ephedra (ma huang), flaxseed oil, garlic, ginseng, green tea, horse chestnut, kava, melatonin, mistletoe, and saw palmetto. For more information on individual herbs, please visit the Natural Standard Herbs & Supplements Database.

Theory/Evidence

• Traditional knowledge of medicinal plant remedies have been preserved over thousands of years by oral tradition as well as written records.

• In North America, Western herbalism formulations also use plants traditionally used by various Native American tribes. Herbs with origins outside of North America and Europe have also been incorporated into this practice.

• Western herbalism relies on the potential synergistic and curative properties of plants to treat a particular symptom or disease or to enhance overall wellness. Western herbalism is also based upon pharmacognosy, the study of natural products, including the identification, extraction methods, and applications of specific plant constituents responsible for therapeutic actions. An example is digoxin, extracted from Digitalis leaf, which is used in the treatment of heart failure.

• Herbal remedies have been suggested as a primary or adjunct treatment for conditions including: emotional psychological disorders, such as depression; women's health issues including menstrual disorders and yeast infections; immune disorders such as rheumatoid arthritis and lupus; skin conditions, such as eczema; digestive disorders, such as irritable bowel syndrome; urinary conditions, such as cystitis; and other conditions including but not limited to insomnia, fatigue, and stroke rehabilitation. Many of these claimed uses may not be supported by well documented scientific studies.

• A study done in 2006 by Walker et al. assessed United States national usage patterns, reasons for use, and the perceived efficacy of herbal products and dietary supplements. In this secondary analysis of the complementary and alternative medicine (CAM) supplement to the 2002 National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics (NCHS), participants were asked whether they had used herbs for their own health and treatment of conditions. Supplement users were asked whether they had used any of 36 specific herbs or non-herbal dietary supplements (e.g. glucosamine, fish oil, bee pollen), how important the use of CAM treatment was to them, whether they had seen a CAM provider, and whether they had informed a conventional medical provider about the use of herbal or non-herbal dietary supplements. The results showed a total of 31,044 adults participated in the 2002 NHIS CAM survey; 632 were omitted from analyses due to incomplete information. In the study, 5,787 adults said they had used herbs or supplements during the previous 12 months, of which 57.3% said they used these products to treat specific conditions. Based on these responses, an estimated 38.2 million adults in the United States used herbs and supplements in 2002. More than half of all users said that herbs and natural products were important to their health and well-being. User rates were higher for women; adults aged 45 to 64 years (as compared to other age groups); those of mixed ethnicity followed by Asians, then Native Americans or Alaskan natives, whites, and African Americans; residents of the western United States; and college graduates. Only about 1/3 told a conventional health care provider about their herb or supplement use. The study concluded that herb and natural supplement use was widespread in the US adult population in 2002, despite the fact that few participants informed their conventional health care providers about such use.

• A 2005 study by Clement et al. stated that the unprecedented global increase in the use of herbal remedies is set to continue rapidly well into the foreseeable future, thus raising important public health concerns, especially relating to safety issues including adverse effects and herb-drug interactions. The study found that many conventional Western physicians are not aware of the potential risks and benefits of herbalism. The study authors proposed that an assessment of opinions about and knowledge of herbalism would identify appropriate intervention strategies to improve physician-patient communication in this area. This study conducted a cross-sectional survey using an interviewer-administered pilot tested de novo questionnaire at six public hospitals in Trinidad between May-July 2004. The questionnaire utilized weighed questions to quantify acceptance and knowledge of herbal remedies. The results showed that of 192 physicians interviewed, most (60.4%) believed that herbal remedies were beneficial to health. Respondents had relatively high acceptance levels and poor knowledge of herbal remedies. Seventy-eight physicians (40.6%) admitted having used herbs in the past, and 60 of these (76.9%) were satisfied with the outcome. Although 52 physicians (27.1%) recommended the use of herbs to their patients only 29 (15.1%) were able to identify at least one known herb-drug interaction. The study concluded that use of herbal remedies is relatively high in Trinidad, as throughout the world, and most patients self-medicate with or without the knowledge of their primary care physician. The authors stated that the scenario of high acceptance levels and poor knowledge of herbal medicine creates a situation that demands urgent intervention and recommended educational intervention to narrow the gap between acceptance and knowledge so that physicians would be adequately equipped to communicate with their patients on this modality. The authors also believe that integration of herbal medicine into the curriculum of medical schools and continuing education programs and the availability of reputable pharmacopoeias for referencing at public health institutions are useful instruments that can be used to close this gap and promote improved physician-patient communication.

Safety

• A qualified healthcare provider should be consulted before making decisions about therapies and/or health conditions.

• Products described as "natural" or "herbal" may have serious side effects or interactions with other herbs, supplements, drugs, foods or laboratory tests. While some commonly used herbal remedies are safe, it is best to obtain the advice of a well-trained practitioner before using any plant-based medication that is not well known, especially since herbals may interact with conventional drugs. Further, it is important to use herbal remedies correctly and follow the herbalist's or naturopath's instructions exactly.

• Patients who think they may be experiencing side effects from medications should contact their herbalist or naturopath, as well as their primary care physician.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. American Herbal Products Association (AHPA). www.ahpa.org.

2. Bruno LC. Herbal remedies, western. Gale Encyclopedia of Medicine. Gale Research, 1999.

3. Clement YN, Williams AF, Khan K, et al. A gap between acceptance and knowledge of herbal remedies by physicians: the need for educational intervention. BMC Complement Altern Med. 2005 Nov 18;5:20. View Abstract

4. Food and Drug Administration. www.fda.gov.

5. Kennedy J. Herb and supplement use in the US adult population. Clin Ther. 2005 Nov;27(11):1832-3. View Abstract

6. National Center for Complementary and Alternative Medicine (NCCAM). nccam.nih.gov.

7. Walker AF. Herbal medicine: the science of the art. Proc Nutr Soc. 2006 May;65(2):145-52. View Abstract