review

George Smith continues his series on complementary and alternative medicines

Herbs in Medicine Photo: PA nvestigation into the use of herbs in medicine therapeutics, traditional medicines were mostly is a vast subject. Even the descriptions used - . More than 1,500 herbalists practise in the phytotherapy, , herbalism, UK at present. KEY POINTS traditional and natural medicines - are erbal medicines I confusing, meaning different things to different Origins H contain substances of people. Herbal reference books may add to this From the earliest times, whether by accident, plant origin and in general confusion by including natural products such as through inspiration or in desperation, plants have not are available as over-the- vitamins, minerals and diet supplements, which are only provided food, cosmetics and embalming counter products, not essentially foods, but can be therapeutic in some cases ointments, but also a plethora of easily available of deficiencies and disease. Herbal medicines contain remedies for the maladies of mankind. The use of subject to close regulation. substances of plant origin where all or part of the plant treatments based on plants developed across the Whilst many valuable drugs is used to produce an infusion, medicine, tablet or world, usually with strong religious associations. have been identified, application. Herbal pharmacopoeias may include Traditional Chinese Herbal Medicine is based on purified, evaluated for hundreds of remedies, from aloe vera, through garlic, Taoism and the principle of balancing chi, the risk/benefit and eventually ginkgo biloba and to ziziphus jujuba. universal life force or ; Ayurvedic Indian synthesised from plants, the A significant number of plants and herbs originally medicine has strong Hindu associations involving provided natural sources for extremely valuable drugs chakras (energy centres); North American Indian effectiveness of most herbal that have now been identified, purified, evaluated for was practised by Shamans and medicines is still unproven 1 risk/benefit and eventually synthesised. These linked to spiritism. South American civilisations (the and concerns about toxicity include digitalis (foxglove), aspirin (willow bark), Mayas, Aztecs and Incas) had closely interrelated and drug interactions are morphine (poppy), quinine (cinchona bark) and herbal medicine and religious traditions. English real. In addition the history antibiotics such as penicillin. herbal medicine, certainly when practised by of the origins and present Culpeper, the modem pioneer of Western herbalism, Definitions had strong astrological connections. practices of the many Herbal remedies can conveniently be described as Archaeological findings of have varieties of herbal medicine over-the-counter products, not subject to close been found in ancient Iraqi burial sites but the first indicate that they are rooted regulation and obtainable from pharmacies and health written pharmacopoeia occurs in the Egyptian Ebers in and still associated with food stores without specific diagnosis or prescription Papyrus c 1500 BC. The Indian Vedas (poems also c non-Christian belief systems. from a health professional. Around five million people 1500 BC) listed plants with medicinal actions. 2 in the UK use these products regularly. Christian doctors should be Although the early use of herbal preparations was Herbalism (herbal medicine) as an alternative often associated with the mystical and magical, cautious about herbs both medical therapy is defined as the use of plants or Hippocrates (460-377 BC) appears to have from a Christian and substances derived from them, in treating disease, attempted a more scientific approach. (130- medical perspective. usually by medical herbalists without an orthodox 200 AD), physician to the Emperor Aurelius, medical qualification. Before the relatively recent recommended herbal preparations to balance the application of into diagnosis and four humours of the body.

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A Doctrine of Signatures evolved which suggested products interfere with the accuracy of diagnostic tests Photo: PA that the medicinal value of certain herbs was divinely and 64 drugs and food supplements require signalled by their resemblance to the conditions or therapeutic monitoring, generally unavailable to non- organs they treated. Pilewort was used because its medically qualified herbalists. 8 knobbly tubers resembled haemorrhoids. Similarly, A recent article in the British Journal of General the spotted pattern of Pulmonaria was suggestive of Practice emphasised these safety concerns, particularly lung tissue and so was used for respiratory problems. 3 in relation to reactions between anticoagulants and The popularity of herbalists and herbal medicines herbal preparations. 9 Whilst there is some evidence continued to wax and wane in conflict with orthodox that St John’s Wort (hypericum) is reasonably effective medicine. Nicholas Culpeper (1616-1654), described in mild to moderate depression, there are increasing Bibliography as an astrologer/physician, rebelled against the concerns about its safety, particularly in UK, Japan and Chevallier A. Encyclopaedia horrific medical practices of his day such as purging Canada. It has now been banned in France. 10 of Medicinal Plants. London: and blood letting. He fought for the acceptance of The results of a five-year survey by the Medical Dorling Kindersley, 2001 Culpeper N. Culpeper’s natural herbal medicines but emphasised astrological Toxicology Unit at Guy’s & St Thomas’ Hospitals Complete Herbal. London: influences that he believed controlled them. 4 highlighted possible links between many herbal Parkgate Books, 1997 Culpeper produced his first pharmacopoeia or Herbal products and adverse reactions. Earlier this year the Ernst E. Complementary in 1652. The National Institute of Medical World Health Organisation issued a warning against Medicine. Oxford: Herbalists (NIMH) was formed in 1864, an attempt the unregulated and often unsafe use of alternative Butterworth Heineman, 1996 to regulate British herbalists and their medicines. medicines including herbal medicines and food Ernst E. Desktop Guide to Over the next 150 years scientific research and supplements. 11 Complementary & Alternative development moved rapidly, leading to more exact Medicine. London: Mosby, knowledge of therapeutics and evidence based Christian checklist 2001 Jellin J. Natural Medicines

Photo: PA medicine. There are now university courses in Can it be recommended with integrity? phytotherapy, leading to a BSc in herbal medicine. So far, investigation into the vast majority of these Comprehensive Database. Stockton: USA Yet there is still a wide gap between herbalism and products has produced little evidence for their efficacy Therapeutic Research Faculty, orthodox therapeutics. but has raised many safety concerns. 2003 What are its roots? O’Mathuna D & Larimore W. Medical checklist : The History of the origins and present practices of the Does it work? Christian Handbook. This is extremely difficult to assess. Whilst many many varieties of herbal medicine indicate that they Michigan: Zondervan active chemical constituents can be identified, are rooted in and still associated with non-Christian Publishing House, 2001 standardisation of unrefined medicines from plants is belief systems. Wooley B. The Herbalist. complicated, making scientific evaluation and clinical London: Harper Collins, 2004 Are there spiritual dangers? trials difficult. Little reliable scientific information Belief in the healing properties of plants, part of exists although reference books are available to advise References God’s creation, is naturally attractive to Christians but on efficacy and safety. The powerful placebo effect 1. Chevallier A. Encyclopaedia we must not ignore experience and reason. A must always be considered. of Medicinal Plants. London: scientifically evaluated active ingredient of a plant is There have been attempts to perform scientific Dorling Kindersley, surely safer than the unrefined original preparation. investigations into some popular herbal products. The 2001:34,40,49 Whilst plants in themselves have no specific 2. Ibid:19 Desktop Guide to Complementary and Alternative Medicine spiritual influence, the religious beliefs of the 3. Ibid:18 reviewed investigations into 44 such products but did practitioner (particularly Traditional Chinese 4. Wooley B. The Herbalist. not find any convincing evidence of efficacy. For London: Harper Collins, Medicine, Ayurvedic Medicine and New Age example, the popular evening primrose oil ‘…has not 2004:170 therapists) can be spiritually harmful. been established as an efficacious treatment for any 5. Ernst E. Desktop Guide to Biblical references to herbs and spices almost condition’. 5 There is little evidence of significant Complementary & Alternative exclusively relate to their use in food preparation, Medicine. London: Mosby, benefit from echinacea. 6 Another 60 medicinal herbs anointing and embalming rather than their healing 2001:105 are listed where there is insufficient evidence to make properties. 6. Ibid:104 useful assessments. Recent investigation by the 7. Steuer-Vogt M. Viscum National Cancer Institute showed no evidence to Conclusion album is not a useful adjunct support the suggested beneficial effect of viscum alba in cancer therapy. Focus on Although many herbal preparations contain (mistletoe) for cancer. 7 Alternative & Complementary therapeutically active ingredients, these are too Therapies 2004; Vol 9 (1):17 Is it safe? variable to be used with confidence, and harmful 8. Ernst E. Op cit:185-191 side effects are well documented. From a medical 9. Smith L et al. Co-lngestion of It is commonly believed that all herbal medicines standpoint, the use of herbal medicine does not, in Herbal Medicines & Warfarin. and natural substances used as remedies must general, reach the high standards of clinical British Journal of General inherently be safe. Brief references, however, as to the Practice 2004; 154:439-441 excellence now required. From a Christian toxicity of some plants (for example, Deadly 10. Jellin J. Natural Medicines perspective, the roots of the therapy and the Nightshade, certain fungi and berries) show this to be Comprehensive Database. therapist’s belief system also raise serious concerns. a fallacy. Interactions with other drugs can also be Stockton: USA Therapeutic Research Faculty, 2003:1229 harmful: 78 herbal products may react with heart 11. WHO warns on alternative medication, 58 with anti-coagulants, 35 with diabetic George Smith is a Dermatologist and former GP in medicines. Health Watch medication and 9 with oral contraceptives. Some Berkshire 2004; July(54):1

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