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Principles of Health: Anxiety and Stress

Herbal Medicine

by EBSCO Review Board

Overview

Along with massage therapy, herbal treatment is one of the most ancient forms of medicine. By the time written history began, herbal medicine was already being used all over the world.

There are several surviving schools of herbal medicine. Two of the most complex systems are Ayurveda (the traditional herbal medicine of India) and traditional Chinese herbal medicine (TCHM). Both Ayurveda and TCHM make use of combinations of herbs. However, the herbal tradition in the West focuses more on individual herbs, sometimes known as simples. This is the form of herbology discussed here.

History of Herbal Medicine

Originally, herbal medicine in Europe was primarily a woman’s art. The classic image of witches boiling herbs in a cauldron stems to a large extent from this period. Beginning in about the thirteenth century, graduates of men-only medical schools and members of barber-surgeon guilds began to displace the traditional woman village herbalists. Ultimately, much of the original lore was lost. So-called traditional herbal compendiums, such as Culpeper’s Complete Herbal, are actually of fairly recent vintage.

Another major change took place in the nine-teenth century, when chemistry had advanced far enough to allow extraction of active ingredients from herbs. The old French word for herb, drogue, became the name for chemical drugs. Subsequently, these chemical extracts displaced herbs as the standard of care. Several forces led to the predominance of chemicals over herbs, but one of the most important of these forces remains a major issue today: the problem of reproducibility.

Herbal Medicine’s Greatest Problem: Reproducibility

In purchasing drugs, consumers generally know exactly what they are purchasing. Drugs are single chemicals that can be measured and quantified down to their molecular structure. Thus, a tablet of extra-strength Tylenol, for example, contains 500 milligrams of acetaminophen, regardless of where or when one buys it. Although it contains a vitamin, not a drug, the same is true of a vitamin C tablet, provided that it is correctly labeled.

An herbal medicine platter (photo courtesy of Joegoauk Goa)

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Herbs, however, are living organisms comprising thousands of ingredients, and the proportions of all these ingredients may differ dramatically between two plants. Numerous influences can affect the nature of a given crop. Whether it was grown at the top or the bottom of a hill, what the weather was like, what time of year it was picked, what other plants lived nearby, or what kind of soil predominated are a few of the factors that can affect an herb’s chemical makeup.

This presents a problem for people who wish to use herbs medicinally, as opposed to, say, those who wish to use it for taste or fragrance. Due to variation, it is difficult to know whether one batch of an herb is equivalent in effectiveness to another.

The desire to overcome this problem provided the main initial motivation for finding the active principles of herbs and purifying them into single-chemical drugs. However, by now, most of the common herbs that possess an identifiable active ingredient have long since turned into drugs. Today’s popular herbs do not contain any known, single, active ingredients. For this reason, there is no simple way to determine the effectiveness of a given herbal batch.

This difficulty can be partially overcome by a method called herbal standardization. In this process, manufacturers make an extract of the whole herb and boil off the liquid until the concentration of some ingredient reaches a certain percentage. Contrary to popular belief, this ingredient is not usually the active ingredient; it is merely a tag or handle used for standardization purposes.

The extract is then made into tablets or capsules or bottled as a liquid, with the concentration of the tag ingredient listed on the label. This method is far from perfect, because two products with the same concentration of tag ingredients may still differ widely in other unlisted or even unidentified active constituents. Nonetheless, this form of partial standardization allows a certain amount of reproducibility. For this reason, it is recommended that when possible, one should use standardized herbal extracts. Even better, one should use the very same products that were tested in double-blind studies.

Effectiveness of Herbs

There is no doubt that herbs can be effective treatments in principle, if for no other reason than that through the 1970s, most drugs used in medicine came from herbs. Many of today’s medicinal herbs have been studied in meaningful double-blind, placebo-controlled trials that provide a rational basis for believing them effective. Some of the best sub-stantiated include ginkgo biloba for Alzheimer’s disease, St. John’s wort for mild to moderate depression, and saw palmetto for benign prostatic hypertrophy.

However, even the best-documented herbs have less supporting evidence than the majority of drugs for one simple reason: An herb cannot be patented; therefore, no single company has the financial incentive to invest millions of dollars in research when another company can market the product after it is proved to work. In addition, the problem of reproducibility always makes it difficult or impossible to know whether the batch of herbs a person is buying is as effective as the one tested in published studies.

The traditional uses of herbs are discussed here, but one should note that such uses are not reliable indicators of an herb’s effectiveness. For many reasons, it simply is not possible to accurately evaluate the effectiveness of a medical treatment without performing double-blind, placebo-controlled studies, and many herbs lack these.

Safety Issues

There is a common belief that herbs are by nature safer and gentler than drugs. However, there is no rational justification for this belief. An herb is simply a plant that contains one or more drugs, and it is just as prone to side effects as any medicine, especially when taken in doses high enough to cause significant benefits.

Nonetheless, the majority of the most popular medicinal herbs are at least fairly safe. The biggest concern in practice tends to involve interactions with medications. Many herbs are known to interact with drugs, and as research into this area expands, more such interactions will be discovered.

References

1 

Bratman, S., and A. Girman, editors. Mosby’s Handbook of Herbs and Supplements and Their Therapeutic Uses. Mosby, 2003.

2 

Dhanani, N. M., T. J. Caruso, and A. J. Carinci. “Complementary and Alternative Medicine for Pain.” Current Pain and Headache Reports, 10 Nov. 2010.

3 

Pan, S. Y., et al. “New Perspectives on Innovative Drug Discovery.” Journal of Pharmacy and Pharmaceutical Sciences, vol. 13, 2010, pp. 450–71.

4 

Schulz, V., R. Hansel, and V. Tyler. Rational Phytotherapy: A Physician’s Guide to Herbal Medicine. 4th ed., Springer, 2001.

5 

Zhang, X., et al. “Chinese Medicinal Herbs for the Common Cold.” Cochrane Database of Systematic Reviews, 2007, CD004782, EBSCO DynaMed Systematic Literature Surveillance, www.ebscohost.com/dynamed.

Citation Types

Type
Format
MLA 9th
Board, EBSCO Review. "Herbal Medicine." Principles of Health: Anxiety and Stress, edited by Lindsey L. Wilner & Megan E. Shaal, Salem Press, 2020. Salem Online, online.salempress.com/articleDetails.do?articleName=POHAnxiety_0099.
APA 7th
Board, E. R. (2020). Herbal Medicine. In L. L. Wilner & M. E. Shaal (Eds.), Principles of Health: Anxiety and Stress. Salem Press. online.salempress.com.
CMOS 17th
Board, EBSCO Review. "Herbal Medicine." Edited by Lindsey L. Wilner & Megan E. Shaal. Principles of Health: Anxiety and Stress. Hackensack: Salem Press, 2020. Accessed October 22, 2025. online.salempress.com.