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Herbal Medicine

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Rooted in folklore and thought to be oldest form of therapy, herbal medicine still has a lot to offer the modern patient

What is it?

Herbal medicine is a system of healthcare that can stand alone or as part of a more complex medical system. It is thought to be the oldest form of therapy practised.

Over the centuries local formularies have been developed to embrace the diversity of plant life across the globe. Herbalists regard people as essentially self-healing; the aim of the herbal remedies is to support the specific systems which are under stress. Emphasis is on wellness rather than curing ill-health.

Herbal treatment

Medical herbalists follow similar diagnostic procedure to medical doctors including: history taking, laboratory tests and X-rays where necessary.

There are four pillars of treatment:

  • Cleansing: detoxification elimination, by the use of expectorants, laxatives and diuretics;

  • Heating: moving the circulation by the use of circulatory stimulants, peripheral vasodilators and aromatic digestives;

  • Cooling: by the use of bitters to stimulate digestion, febrifuges to reduce temperature;

  • Tonification: supporting nourishment and repair by the use of tonic herbs such as adaptogens.

The above are used in conjunction with convalescence, rest, exercise, and diet.

Herbal remedies

Remedies can be administered as tablets, infusions, decoctions, and tinctures.

The key difference between herbal remedies and orthodox medicine is the fact that in orthodox medicine, drugs are prescribed as a single entity, whereas a herbal prescription will reflect the synergy of the chosen plant remedies and the range of presenting symptoms.

Herbs are classified by the four tendencies, in which plants are classified as:

  • Rising;

  • Floating;

  • Condensing;

  • Sinking.

This is in concert with the cycles of the moon and seasons.

Folklore determines that herbal remedies should be collected in relation to the time of day, time of the month and the seasons of the year. These early observations have now been shown to be correct, since plants do vary in their therapeutic potential at different times of the day or year.

Herbal remedies are further classified by their temperament - hot, cold, moist, dry and temperate - and according to their actions:

  • Warming remedies such as vasodilators and circulatory stimulants;

  • Cooling remedies such as relaxants and bitters (for allergies, inflammatory conditions and antitussives);

  • Diuretics;

  • Expectorants: including stimulating and warming expectorants, relaxing expectorants and antitussives;

  • Alteratives: for detoxification and cleansing, for example for skin conditions;

  • Tonic and hormonal remedies.

Evidence base

Herbal medicine is a complete medical system which has application across the whole clinical spectrum.

The evidence to support the use of herbal remedies is extensive. In general it has followed the reductionalist approach by analysing the herbs active ingredients for example the identification of hyperforin as the antidepressant component of hypericum extracts.

Herbalists would refute the idea of one constituent being used on its own and emphasise that most plants have hundreds of constituents all acting synergistically to create the therapeutic effect and welcome the move towards researching the effects of the whole plant.

In addition most herbalist would not prescribe just one remedy but use a compound of a number of herbs to address the totality of the patient.

Evidence supports the use of St John’s wort in the treatment of depression (Paulke, 2008; Carpenter et al, 2008), hyperactivity (Weber et al, 2008) and wound healing (Mukherjee and Suresh, 2000)


Public and governmental concerns about the safety of herbal medicines led to the Traditional Herbal Medicinal Products Directive produced by the European Union in March 2004 providing a framework for the control of herbal medicines (EU, 2004).

Many people perceive that because herbs are natural they are intrinsically safe. This is untrue and there are potential dangers in mixing herbal remedies with conventional medication.

In addition to their intrinsic therapeutic actions herbal remedies may interfere with the liver, resulting in increased levels of drugs metabolised by this system.

The drugs affected include:

  • Tricyclic antidepressants;

  • Antipsychotics;

  • Benzodiazepines;

  • Oral hypoglycaemic agents;

  • Angiotensin 11 receptor antagonists;

  • Proton pump inhibitors;

  • Warfarin;

  • NSAIDs including aspirin;

  • Antihistamines.

Children, pregnant and lactating women should not use over the counter products.


Herbalists have practised in England under a charter awarded by Henry VIII in 1542, known as the Herbalists’ Charter. This permitted them to practise their craft without interference from physicians. It is still in existence to this day, allowing herbalists or anyone claiming to have sufficient knowledge of herbs and without necessarily having any formal qualifications to prescribe a herbal remedy under English Common Law and more recently, Section 12 (1) of the Medicines Act of 1968.

The modern practice of Medical Herbalism is recognised under Section 12 (1) of the Medicines Act 1968, which is currently being reformed.

Training is monitored by the National Institute of Medical Herbalists (founded 1864). However, under the above charter and English Common Law anyone can practise as a herbalist without any formal qualification.


Carpenter, C. et al (2008) Hypericum and nurses: A comprehensive literature review on the efficacy of St John's wort in the treatment of depression. Journal of Holistic Nursing 18.

Mukherjee, P.K. et al (2000) The evaluation of wound-healing potential of Hypericum hookerianum leaf and stem extracts. Journal of Alternative and Complementary Medicine; 6: 1, 61-69.

Paulke, A. et al (2008) St John's wort flavonoids and their metabolites show antidepressant activity and accumulate in brain after multiple oral doses. Pharmazie; 63: 4, 296-302.

Weber, W. et al (2008) Hypericum perforatum (St John's wort) for attention-deficit/hyperactivity disorder in children and adolescents: a randomized controlled trial. Journal of the American Medical Associations; 299: 22, 2633-2641.

Directive 2004/24/EC of the European Parliament and of the Council, OJ 30.4.2004, L136/85–90. European Union.

Further reading

Barnes, J. et al (2002) Herbal Medicines. London: Pharmaceutical Press.

Basch, E., Ulbricht, C. 2005 Natural Standard Herb and Supplement Handbook. St Louis, MO: Mosby.

Fetrow, C., Avila, J. (2001) Professionals' Handbook of Complementary and Alternative Medicines (2nd ed). Philadelphia, PA: Springhouse.

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