Herbal Medicine

What is Herbal Medicine?

 Use of whole plants in the promotion of
health and the treatment of disease.
 Primary medicine of over 80% of the
world's population
 Evidence of human use for more than 60
000 years e.g. pollens from yarrow,
marshmallow and ephedra found at the
burial site of a Neanderthal man in Iraq
 Herbal Approach
 Broader view of disease looking at the
underlying causes and individual
expression of disease not just the
presenting symptoms
 Prescription to restore homeostasis
 Promotion of optimal cellular nutrition
and elimination
 Herbal Medicine in the UK
 1 in 5 regularly use CAM - Herb no 1
 European market 2001 3.2 billion Euros
 Registered herbalists: ~ 650 Western,
550 Chinese, 150 Ayurvedic & 56 other
 Unregistered ~ Approximately 1000
 6 BSc NIMH accredited courses
 EHPA - Statutory Self Regulation
Is Herbal Medicine the same as
Homeopathy?
 No!
 Longer tradition - 60 000 years of use
 Different philosophy & approach
 Only plant based medicines
 Medicinal plants used in material doses
not in homeopathic potency
 Potential for herb-drug interactions
 The Herbal Consultation
 Client details including GP
 Comprehensive medical history
 Clinical examination & assessment
 Diagnosis & prognosis
 Discussion & advice
 Individualised prescription & dispensing
 Why Use Medicinal Plants?
 Whole plant medicines usually have a
more gentle and balanced effect
 Synergy within a plant & between plants
 Low cost
 Promote homeostatic mechanisms not
suppress the body’s efforts heal
 Safe and effective treatment option when
pharmaceuticals inappropriate
 Scope of Herbal Medicine
 Nutrition: food & nutrients e.g.
Coriander, Garlic, Nettle & Oats
 Maintenance of Health: systems
e.g.Dandelion, Garlic & Slippery Elm
 Treatment of Disease: acute & chronic
e.g. self-medication, over-the-
counter-products, medical herbalist &
other practitioners
 Herbal Medicines
 Herbal medicines prescribed according
to the needs of the individual patient
 Traceable products from unpolluted and
sustainable sources
 Versatility of herbal preparations e.g.
fresh, juice, tisane, tincture, syrup,
aromatic water, powder, capsule, tablet,
pessary, lotion, cream, ointment & oil
 Sources of Herbal
Medicines
 Cultivated and wild plants where appropriate
 A Medical Herbalist
 Herbal shop or other retail outlet e.g. Napiers 0131 553 7999
www.napierstheherbalists.com
 Avicenna 01570 471 000 avicenna@clara.co.uk
 Herbal Apothecary 0116 2602690 www.herbalapothecary.net
 The Organic Herb Trading Co. 01823 401205
www.organicherbtrading.com
 Phyto Products 01623 644334 www.phyto.co.uk
 Rutland Biodynamics Tel 01572 757440 www.rutlandbio.com
 Safety
 Few reports of adverse events following
the use of medicinal plants
 Plant misidentification, substitution,
adulteration and herb-drug interactions
 Improving quality control and labelling
 NIMH suspected adverse event reporting
scheme
 Awareness of herb-drug interactions
 Research
 In vitro analysis with chromatography
 RCT’s Serenoa repens, Carduus
marianus, Echinacea spp., Ginkgo
biloba, Cimicifuga racemosa, Hypericum
perforatum &Valeriana officinalis
 NIMH - herbal practice & clinical audit
 Laminitis Trust - Vitex agnus castus
 Further Reading
 Bartram T Encyclopedia of Herbal Medicine Grace Publishers 1995
 Bone K Clinical Applications of Ayurvedic and Chinese Herbs
Phytotherapy Press1996
 Bradley P R British Herbal Compendium Vol. 1 British Herbal Medicine
Association 1992
 British Herbal Medicine Association British Herbal Pharmacopoeia 1983
BHMA 1983
 British Herbal Medicine Association British Herbal Pharmacopoeia 1990
Volume 1 BHMA 1990
 Chevalier A The Encyclopedia of Medicinal Plants Dorling Kindersley
1996
 Evans W Trease and Evans’s Pharmacognosy W.B.Saunders Ltd 1996
 Further Reading Continued
 Grieve M A Modern Herbal Jonathon Cape Ltd. 1931
 Griggs B Green Pharmacy Jill Norman and Hobhouse Ltd. 1981
 Hoffman D The New Holistic Herbal Element Books Ltd. 1990
 Mills S & Bone K Principles and Practice of Phytotherapy Churchill
Livingstone 2000
 Newall CA, Anderson LA & Phillipson J D Herbal Medicines - A Guide
for Healthcare Professionals The Pharmaceutical Press 1996
 Ody P The Herb Society’s Complete Medicinal Herbal Dorling
Kindersley 1993
 Weiss R Herbal Medicine Beaconsfield Publishers Ltd 1988
Reasons for Taking Supplements
 Enhance well-being 33%
 Replenish/support body requirements 19%
 Preventative health 13%
 Stress and anxiety 10%


70% of survey rated quality of life as extremely
important

80% rated lack of side effects/safety as extremely
important
Demographics of
Herbal Supplement Use
 42% of the US population take vitamins; 27% take
a multivitamin *
 19% take herbal supplements *
 Used equally by men and women and age groups
 53% of individuals who use supplements take them
daily
 46% of individuals who use supplements purchase
them from a pharmacy
 * Sloan Survey, Patterns of Medication Use in the United States, 2004.
Demographics of
Herbal Supplement Use
 63% of people polled want to know more
about natural therapies
 56% want physicians to know more
 Over 50 population -- average 7+
supplements
 Someone turns 50 every 10 seconds
Phytotherapy

 Standardized vs
Nonstandardized

 Wildcrafted vs
Cultivated
Standardized
 Manufacturing
 Sourcing
screening for:
 Studies 
pesticides
 Structure 
heavy metals
 Standardization 
bacteria/fungi/etc.

 Substantiation

stability
Isolated Pharmaceutical Drugs
 Aspirin - White willow bark (Salix alba)
 Atropine - Belladonna (Atropa belladonna)
 Caffeine - Coffee shrub (Caffea arabica)
 Cephalosporin - Marine fungus (Cephalopsorium
acremonium)
 Cromolyn sodium - Khella (Amni visnagu)
 Isolated Pharmaceutical Drugs
 Cyclosporin - Cordyceps (Cordyceps sp.)
 Digoxin - Foxglove (Digitalis purpurea)
 Morphine - Opium poppy (Papaver somniferum)
 Scopolamine - Jimson weed (Datura sp.)
 Taxol - Pacific Yew (Taxus sp.)
 Theophylline - Tea shrub (Camelia sinensis)
 Vincristine - Periwinkle ( Vinca sp.)
European Use
 Commission E -- started by the Federal
Health Agency in Germany

developed over 200 monographs of herbs
 St. John’s wort vs. Prozac
 Ginkgo -- in top 5 prescribed drugs
 80% of herbs in Germany sold in
pharmacies
Labeling
 Product name (Latin and common)
 Plant part used
 Structure/function -- if warranted
 Total amount/dosage (i.e. 600mg)
 Total number of dosages in bottle
 Manufacturer name and address
Labeling
 Supplement facts

serving size

ingredient

amount in standardized dosage units

percentage DV

other ingredients -- excipients, etc.
Manufacturing: Dosage Forms
 Bulk dried herbs
 Teas
 Liquid extracts
 Alcohol-free extracts
 Tablets/capsules
 Standardized extracts
 Lipophilic sprays
 Creams and ointments, salves, patches
 Suppositories
Raw Materials
 Harvesting
 Drying
 Comminution (grinding)

conventional vs. cryogenic

problems with comminution
 Fresh plant vs. dried
Extraction
 Extraction
 Maceration -- solvents (ethanol, water, hexane,
methane, glycerin, polyethylene glycol, vinegar)
 Percolation
 CO2 extraction
 Countercurrent
 Other technology (spray drying, freeze-drying,
rotary evaporation)
Liquid Dosage Forms
 Tinctures (1:5 w/v or greater  Oils
dilution)
 Spirits/elixirs
 Liquid extracts (1:1 – 1:4
w/v)  Spray
 Glycerites  Succus
 Syrups
Teas
 Infusion (standard way to make teas by
pouring H2O over herb)

cold vs. hot
 Decoction (boiling; Chinese formulas)
 Examples: chamomile, lemon balm,
peppermint, Chinese formulas
Solid Dosage Forms
 Bulk encapsulation
 Freeze-dried
 Capsules/tablets
 Extended release

protect herb from stomach deactivation

protect stomach from irritation and nausea
Solid Dosage Forms
 Timed release

once daily dosing

increased patient compliance
 Lozenges
 Excipients -- hypoallergenic
 Useful Websites
 www.ejhm.co.uk European Journal of Herbal
Medicine
 www.euroherb.com European Herbal Practitioners
Association
 www.ex.ac.uk/phytonet/phytojournal European
Scientific Co-operative on Phytotherapy - Clinical
Trials in Phytotherapy: From Concept to Publication
 www.nimh.org.uk National Institute of Medical
Herbalists
 www.trusthomeopathy.org Faculty of Homeopathy
Methods of Preparation for Medicinal Uses

Drying: One of the most common forms for medicinal herbs, the
result should yield a completely brittle plant, with leaves flakey and
snappable roots
Infusion: Placing the fresh herb in either hot or cold water and
leaving for many hours. After prescribed time the liquid is drained
and the left over herb thrown away.
Salve: Grinding the fresh herb in high-proof alcohol, and then
squeezing result through thin cloth. With enough squeezing the oil of
the herb can be rendered.
Poultice: Like a salve with a heavy base (such as flax) a poultice
is used hot, placed between cloths, to reduce inflammation.
Tincture: Placing of either fresh or dried herbs into a large
quantity of high-proof alcohol. After several days, the liquid will take
on a green tinge and will contain all of the healthful constituents of
the herb.
 Herbs and their medicinal faculties were a part
of all ancient cultures. Used to cure illnesses, ward
off evil spirits and sanctify rituals, plants which
were discovered to have beneficial qualities were
treasured by early societies. An herb is technically
any non-woody plant, but can be more commonly
defined as any usable part of a plant. The practice
of herbology is the study of herbs, and the powers
that these herbs have. Before pills and shots, our
ancestors were dependent on their own ingenuity to
discover and then effectively use plants as
medicine.
 Mugwort (artemisia vulgaris)

Deemed the “mother of all herbs,”

mugwort was revered for its repelling
qualities: it would protect its user from
demonic possession and ward off evil
spirits. More mundanely, the plant is
supposed to cure headaches and sore
throats. A more common use, though,
was as a flavoring for beer before the
discovery of hops.
Like mistletoe, mugwort also
helps balance the nervous system, and
can be used to treat epilepsy and
hysteria.
Chamomile (anthemis nobilis)

The main quality of

chamomile which
bewitched early
Europeans was its
wonderful smell. Still
sold today as herbal
It is a completely
tea, chamomile has a
harmless sedative
long history as an
which can prevent
emollient. For
nightmares,
centuries the herb
hysteria, and
was used to help
delirium. Further
soothe the pains of
uses as are poultices
menstruation.
to relieve swelling
and inflammatory
pain.
 Nettle (urtica urens)

The stinging nettle, like the plantain, is a

hated weed throughout much of the world.
Known mainly for its burning properties, pain
caused by the plant can last for days after
contact. Armed with stinging hairs, both the
stem and leaves can cause extreme pain.

Medicinally, nettle is an effective arrester of bleeding,

and can also help alleviate lung ailments, such as
consumption. Ironically, a lotion made from nettle is an
effective healer of burns. In the Middle ages--before the
large-scale cultivation of cotton--nettle also served as a
fiborous base for cloth.
Ginger Ginger ( (Zingiber officinale)
 INDICATION(S)

HIV: nausea, vomiting, dyspepsia, flatulence
Other: antioxidant, anti-lipid agent, antiplatelet, motion
sickness
 TYPICAL DOSE

250mg- 1gram of powdered ginger rhizome/root 2hrs –
30mins prior

to needed effects
 SIDE EFFECTS

(Generally well tolerated) GI upset, flatulence, bloating (rare)
 POTENTIAL INTERACTIONS

Use less than 5 grams/day to minimize side effects

Acid inhibitors, anticoagulants, barbituates (additive), diabetes meds

(additive), hypertensives (↑/↓ BP),
Garlic Garlic ( allium sativum )

 INDICATION(S)

HIV: Anti-HIV activity, hyperlipidemia

Other: Hypertension, atherosclerosis, H.pylori, cancer, antifungal
 TYPICAL DOSE

600-900mg divided TID. Raw garlic contains active ingredient (allii

broken down to Æ allicin)
 SIDE EFFECTS

Breath odor, heartburn, flatulence, N/V/D
 POTENTIAL INTERACTIONS

Anticoagulants, antiplatelet agents, diabetes medications (additive)

fish oils
Echinacea (Coneflower)
Echinacea angustifolia/purpurea
 Standardized to 4% echinacosides (angustifolia) or
4% sesquiterpene esters (purpurea)
 Dosage: 250mg up to q.i.d. during cold/flu season
 Dosage: 250-500mg, 3 weeks on and 1 week off
(for prevention) --- conflicting evidence on use in
prevention, recent studies show no value in
prophalaxis
Echinacea
 Some studies not positive; may be due to
products used (species or plant part used,
non-standardized or low dosage), study
parameters
 Warnings: Should not take for prolonged
periods if compromised immunity/kidney
disorder
 Allergy daisy family
Echinacea (Coneflower)
Echinacea angustifolia/purpurea
 Stimulates alternate and complementary
pathways/activates white blood cells to
scavenge
 Accelerates wound healing/assists in
treatment of colds and flu
 Inhibits enzyme hyaluronidase/inhibits
breakdown of collagen matrix
Echinacea (Coneflower)
Echinacea angustifolia/purpurea
 Activates/increases white blood cell activity and cell-mediated
immunity (T lymphocytes/macrophages/ T killer cells)
 Increases tumor necrosis factor/ interleukin-1, facilitated by
macrophage activity
 May inhibit some cancer cell lines; antiproliferative

Chicca A, Adinolfi B, Martinotti E, Fogli S, Breschi MC, Pellati F, Benvenuti S, Nieri P. Cytotoxic effects of Echinacea
root hexanic extracts on human cancer cell lines. J Ethnopharmacol. 2006; [Epub ahead of print].
Echinacea Positive Studies
(selected)
 Schulten B, Bulitta M, et al., Efficacy of Echinacea purpurea in patients with a common
cold. A placebo-controlled, randomised, double-blind clinical trial.
Arzneimittelforschung. 2001;51(7):563-8.
 Rininger JA, Kickner S, et al., Immunopharmacological activity of Echinacea
preparations following simulated digestion on murine macrophages and human
peripheral blood mononuclear cells.J Leukoc Biol. 2000 Oct;68(4):503-10.
 Lindenmuth GF. The efficacy of echinacea compound herbal tea preparation on the
severity and duration of upper respiratory and flu symptoms: a randomized, double-blind
placebo-controlled study. J Altern Complement Med. 2000 Aug;6(4):327-34.
 Giles JT, Palat CT, et al., Evaluation of echinacea for treatment of the common cold.
Pharmacotherapy. 2000 Jun;20(6):690-7.
 Melchart D, Linde K, et al., Echinacea for preventing and treating the common cold.
Cochrane Database Syst Rev. 2000;(2):CD000530.
 Abrahams SG. Echinacea for the common cold. Ann Intern Med 2003;139(7):599.
 Goel V, Lovlin R, Chang C, et al. A proprietary extract from the echinacea plant
(Echinacea purpurea) enhances systemic immune response during a common cold.
Phytother Res 2005;19(8):689-694.
Esberitox®
 Combination of Wild indigo (Baptisia tinctoria), Echinacea, and
Thuja (Thuja occidentalis)
 Contains two types of echinacea (Echinacea pallida and
Echinacea purpurea)
 Improves cellular immunity
 Used for immune support during colds/flu
 Also used to support antibiotic use in bronchitis and other
infections; radiation induced leukopenia
 Used in Europe for over 70 years with positive clinical results;
over 30 clinical studies report benefits when using Esberitox®
 Adults and children over 12 years of age, chew 3 tablets, three
times daily. Ages 6-12, chew 2 tablets, three times daily.
Esberitox™
Selected Clinical Studies
 Naser B, Lund B, Henneicke-von Zepelin HH, Kohler G, Lehmacher W, Scaglione F. A randomized,
double-blind, placebo-controlled, clinical dose-response trial of an extract of Baptisia, Echinacea
and Thuja for the treatment of patients with common cold.
Phytomedicine. 2005 Nov;12(10):715-22.
 Wustenberg P, Henneicke-von Zepelin HH, Kohler G, Stammwitz U. Efficacy and mode of action of
an immunomodulator herbal preparation containing Echinacea, wild indigo, and white cedar.Adv
Ther. 1999 Jan-Feb;16(1):51-70.
 Hauke W, Kohler G, Henneicke-Von Zepelin HH, Freudenstein J. Esberitox N as supportive therapy
when providing standard antibiotic treatment in subjects with a severe bacterial infection (acute
exacerbation of chronic bronchitis). A multicentric, prospective, double-blind, placebo-controlled
study.
Chemotherapy. 2002 Dec;48(5):259-66.
 Hentschel C, Schnitker J, Kohnen R, Kohler G, Lindhauer I, Henneicke-von Zepelin HH.
[Phytotherapeutic drugs for the common cold. Results of a randomized controlled double-blind
study]. MMW Fortschr Med. 2000 Mar 2;142(9):46.
 Sartor KJ. [Efficacy of Esberitox in the treatment of radiation-induced leukopenia]
Ther Ggw. 1972 Aug;111(8):1147-50.
 Grape Seed
(Proanthocyanidins)
• Standardized to a procyanidolic value of
greater than 95% or at least 80%
proanthocyanidins or 95% polyphenols per
dose
• Dosage range: 25-100mg (standardized
extract) one to three times a day
• No known toxicity or adverse effects
 Grape Seed
(Proanthocyanidins)
• Free radical scavenger
• PCOs support collagen structures/inhibit
destruction of collagen by protecting 1-
antitrypsin (limiting breakdown of
collagen/elastin/ hyaluronic acid)
• Also directly inhibit damaging enzymes
• Neutralize lipid peroxidation
 Grape Seed
(Proanthocyanidins)
• RBCs penetrate into microcapillary
system/prevent fluids from leaking
• Strengthens the capillary walls and skin
• Inhibits release of histamine/
prostaglandins
 Grape Seed
(Proanthocyanidins)
Most Frequent Reported Uses:
• Antioxidant
• Allergies/ asthma
• Decrease platelet aggregation/ improves blood flow
• Improves capillary fragility and permeability
• Improves elastic fibers of collagen and elastin of
capillaries
• Improves microcirculation to the brain, heart, periphery
• Prevention of atherosclerosis
• Retinopathy/ macular degeneration
 Grape Seed
• Arterial or venous insufficiency/
intermittent claudication
• Preventative/ anti-aging effects
• Varicosities
Studies:
Castillo J, et al., Radioprotective Effects Against Chromosomal Damage Induced in Human
Lymphocytes by gamma-Rays as a Function of Polymerization Grade of Grape Seed
Extracts. J Med Food. 2001 Summer;4(2):117-123.
Bagchi D, Sen CK, et al., Molecular mechanisms of cardioprotection by a novel grape seed
proanthocyanidin extract. Mutat Res. 2003 Feb;523-524:87-97.
Natella F, Belelli F, et al., Grape seed proanthocyanidins prevent plasma postprandial
oxidative stress in humans. J Agric Food Chem. 2002 Dec 18;50(26):7720-5.
Busserolles J, Gueux E, Balasinska B, Piriou Y, Rock E, Rayssiguier Y, Mazur A. In vivo
antioxidant activity of procyanidin-rich extracts from grape seed and pine (Pinus
maritima) bark in rats. Int J Vitam Nutr Res. 2006;76(1):22-7.
Carini M, et al., Procyanidins from Vitis vinifera seeds inhibit the respiratory burst of
activated human neutrophils and lysosomal enzyme release.
Planta Med. 2001 Nov;67(8):714-7.