Various pieces of slightly more in depth information about herbal medicine. Scroll down the page to see what is here.
More about a herbal consultation
When I see a patient, most of the time is taken up with talking, and usually the consultation ends with my prescribing and dispensing a herbal medication. With consultations lasting up to an hour there is an emphasis on my listening to the patient, and there is space both for hearing the whole of a complex medical history and for patients to unload any emotional burdens that might be associated with this. Herbalists try to balance their insights into the physical and emotional aspects of a patient's condition. Whilst not all consultations will require any physical examination, herbalists will often listen to heart or breath sounds, palpate an abdomen or examine a joint. Recording of a patient's blood pressure is often routine.
Herbalists are trained in orthodox medical science and use the same technical language as the medical professions. Although I may use the same labels in terms of pathology, my aim is to support normal physiology and aid the ways in which the body heals itself rather than to treat a named disease. Sometimes a patient is encouraged to see symptoms such as tiredness or fever as being part of their healing rather than just an aspect of their problem.
While a person may often want a medicine as a quick fix for an illness, their encounter with a herbalist may actually encourage them to place their symptoms and their recovery into a wider context. Patients are encouraged to observe patterns in their illness, and to note how current habits and diet affect their health. A relatively minor condition will be seen as a chance to avert more serious illness in the future by attention to diet, exercise and emotional needs in the present.
For me to formulate an effective remedy I have to both correctly diagnose the patient's condition and make enough of a connection with the patient to accertain which will be the most effective combination of herbs for that person.
Herbalists, as professionals, are more involved with, and more familiar with the sources of their medication than are homeopaths or orthodox doctors. Like many herbalists, I grow some of my own supplies, and find myself involved in political debate about cultivation, harvesting and conservation of medicinal plant species. Herbalists find themselves responsible for caring for plants as well as people. I sometimes enrol patients to collect some of their own medication, showing them pictures or examples of living plants and common "weeds" may be mentioned as sources for self help medication. In such ways consulting with a herbalist becomes a form of experiential ecology, and a possible way of re-establishing links with the natural environment that in itself is part of the healing process.
Holism
Herbal medicine is generally seen as being a form of holistic medicine, but what does this actually mean? Since holistic treatment is normally seen as being different from the treatment offered by orthodox doctors, let us consider a theoretical case and consider what is actually different in the treatment that might be offered by a herbalist and by a doctor.
A person with red inflamed skin on their arms, chest and face consults her doctor, who diagnoses "eczema". The doctor offers a mild corticosteroid cream and bath oil.
The same woman consults a herbalist who asks her about her symptoms and asks questions to find out about her health in general, and her life. The herbalist offers her a cream and a herbal mixture made from several plants explaining that the mixture to be taken internally is the important part of the remedy. The herbalist spends time listening to the woman and also stipulates some dietary rules.
"Holistic" is often taken to mean dealing with the underlying problems as well as the symptoms that are most easily apparent. In this example if the woman were to use the steroid cream from her doctor it may clear the problem quickly and be seen as the end of the story. If, however, the skin irritation is an expression of an inappropriate diet or stresses in the woman's life, then the problem may resume as soon as use of the cream stops. Indeed prolonged use of a steroid cream may lead to thin inflamed red skin!
The approach of the herbalist will take into account any stresses in the woman's life, and the medicine may well include herbs which support the function of the nervous system and which help to alleviate stress. The other herbs in the mixture will have the intention of healing from the inside out, so that new skin will grow through healthy. As well as specifying achievable goals in terms of dietary changes, the herbalist may suggest mental or physical exercises as seem appropriate.
The herbalist's choices of action are informed by several beliefs:
That the mind/body/emotions/spirit of a person are a continuum, that each aspect of a person's life and personality impinges on the others. That each of these aspects needs to be examined and addressed. A problem with hospital medicine is its tendency to discuss patients in terms of only one part of their body.
That the body has an ability to heal itself. As the body can heal itself from minor cuts and illnesses such as colds, so it can get over more chronic or serious problems. Herbal treatment is aimed at stimulating and supporting the body's tendency to return to a healthy balance.
Different people express disease differently, and remedies should be "person specific" rather than "disease specific". For example two partners may have an illness called flu. One may have a high temperature, aching joints, and congested nose. The other may not have the aching joints but have a bad sore throat. Each person may require a different herbal intervention.
In terms of the comparison made above between the approach of a doctor and a herbalist it should be pointed out that some doctors are, of course, more holistic than others. In terms of their interactions with social workers and housing departments etc they tend to have more social "clout" than alternative practitioners do. This means that they have more power to address some of the social problems that lie in the background to many illnesses, and at that level can be seen as the more holistic practitioners.
There are however other issues that dog the use of pharmaceutical medicine, and make its use less holistic than herbal alternatives. One such issue has already been mentioned above, namely the unwanted side effects of pharmaceutical drugs. Implicit in the use of modern medicines is the notion that they can't be very powerful unless they have strong side effects. Interestingly, many modern pharmaceutical drugs are based upon older botanical medicines. Aspirin was one of the first drugs to be synthesised artificially. Aspirin is a form of salicylic acid which occurs in willow bark and meadowsweet. Whilst in its pure form aspirin is associated with side effects including stomach irritation and in severe cases gastric bleeding, the herbs from which such chemicals were originally isolated do not. Herbs contain dozens of different organic compounds and they interact with each other mostly in such a way that the dangerous ones are made more safe. That this is so can be attributed to the wonders of Nature, the hand of God or Goddess, or fortuitous chance depending upon your worldview. The wayside weeds and plants which are the raw material for herbal medications are freely available to all, and as such have been, until recently, mostly unprofitable concerns for industry. Isolated components of plants can be synthesised and patented and profited from. Unfortunately the isolation of one plant compound from a herb nearly always increases the side effects associated with its use.
Inherent in the industrial production of pharmaceutical medicines are other problems also. Testing of modern drugs often involves vivisection, and the factories in which they are produced may be sources of environmental pollution. The industry has also been described as cynical in its offloading of those medicines discredited as being unsafe onto markets in the "third world". Modern medicine in general can be seen as overly hierarchical (and male dominated) and technological. As Oliver Sachs has said " We are overdeveloped in mechanical competence but lacking in biological intelligence, intuition and awareness, and it is this we need to regain not only in medicine but in all science." It is beyond the brief of this document to pursue these arguments to great depth, but it is important to consider the relative merits of orthodox and other medical systems in a wider context than just efficacy and safety.
A few words about over-the-counter herbs
The following information, about 3 popular over-the-counter herbs, is given as a way of illustrating the differences between using herbs in a holistic way or otherwise.
Saint John's Wort
Whilst medical herbalists may not have so much use for St John's Wort as a wound herb as they did in the past, it is still used a lot for inflammation and bleeding in the digestive tract. Its application to the nervous system is much wider than just for stress and depression. It is employed in neuralgias, and herbalists apply its anodyne qualities to treating shingles - internally as a tea or tincture and externally as oil. It also has regenerative effects on nervous tissue. Whilst nervous tissue normally recovers only very slowly from damage, lesions from operations and accidents may be helped in their healing by St John's Wort. Hypericum also has a mild tonic action on the liver.
The focus upon St John's Wort as the herb for depression not only diverts attention away from other herbs such as Lemon Balm but also assumes that depression is an illness that can be treated with a medicine. Whilst there are some depressive states that can be seen as a result of chemical imbalance in the body and which respond well to medication, herbal or pharmaceutical, most of us recognise that "depression" is to do with our interactions with the world around us. Whilst uplifting nervine herbs may be a source of support during hard times, they are not going to remake a broken marriage, remedy someone's poverty or redundancy from work or heal the pain of an abusive childhood. The attitude that says we can sort our lives out by taking a tablet is the one that stops us listening to the messages and the learning that illness can bring.
Standardisation
Another general issue about the marketing of herbs by the over - the counter (OTC) industry that is highlighted by St John's Wort is that of "standardisation". Whilst people and plants are variable in their makeup, industry requires a standardised product. It is reasonable, if buying a product, to want to know that what I buy this month is of the same quality as that I purchased before. The way that the OTC industry reassures us is to calibrate levels of certain chemical constituents of a herb and to make sure that these are maintained in its products. Usually one key active constituent is taken as the marker - in the case of St John's Wort this has been the red pigment, hypericin. The implication here is that hypericin is the essence of Hypericum, and that the anti-depressive activity of the plant is generated by this compound.
Chemists have determined what they think is the optimum level of hypericin that a plant sample should contain. As a crop of St John's Wort is processed its hypericin content is assessed. If the amount is too high then some is removed. If there is not enough then more hypericin is added. The label on the finished product will then proclaim "standardised for hypericin content" and will give a percentage figure to indicate its content.
In some ways this is a modern version of what the pharmaceutical industry has done with plants for over a hundred years - identifying the "active constituent" and taking it out to turn it into a drug. Only now it is taken out and then put back into a processed sample of the same plant. We have seen that extraction and synthesis of plant chemicals has led to an increase of potency but also of unwanted side effects. There is beginning to be a suspicion that a similar charge could be levelled at standardised extracts.
There is a humorous footnote to add here. There have been many clinical trials to assess the antidepressant activity of St John's Wort, most of them with standardised extracts. More recently a trial was done with St John's Wort which had had the hypericin removed. It was found to be efficacious in relieving depression!
Side Effects
Historically the main unwanted side effect that has been noted with the use of St John's Wort has been increased sensitivity to light. Some individuals using the plant may develop a skin reaction in strong sunshine. Actually this is an effect that has been noted in livestock far more frequently than in people and it is assumed that this reaction is relatively unusual in humans.
Near the beginning of the year 2000 the Medicines Control Agency in Britain published information concerning dangerous potential interactions between St John's Wort and pharmaceutical medication. These fell into two categories: 1 Some medicines that act on the central nervous system are potentiated 2 Some medicines that are cleared from the body by the liver are cleared more quickly than usual resulting in lower amounts of the medication in the bloodstream. Those medicines in the first category included Prozac and similar antidepressive drugs. Those in the second category included drugs used to treat epilepsy and clotting disorders, those used to stop the body rejecting transplants and the contraceptive pill.
Several points can be made about this. People taking herbal medication and orthodox medicines need to be aware that there are potential interactions between them. In the marketing of Hypericum's anti-depressive action its liver function enhancing effects have been neglected, but since many herbs act on the liver it is to be expected that more herb/drug interactions will come to light. It is recommended that people taking OTC herbal remedies inform their doctors of the fact. To be on the safe side, many doctors have reacted by advising people to cease taking St John's Wort, whereas monitoring blood levels of crucial drugs would be another course of action.
The effects of St John's Wort in lowering the effectiveness of the contraceptive pill are theoretical. Given the huge OTC sales of St John's Wort (�6 billion reported in 1999) and that more women purchase the herb than men, one would expect problems to be reported. It is, however, worth bearing in mind.
All reported actual and potential drug/herb interactions with St John's Wort all relate to standardised extracts. Medical herbalists tend to regard teas and tinctures as safer products.
It is also worth noting that problems with a particular herb or a sample of a particular herb still often result in an outcry against herbal medication in general, compared to problems with individual pharmaceutical drugs being perceived as just concerning that particular medication.
Echinacea
Echinacea has achieved immense popularity as an anti-infective remedy. Its use increases white blood cell count and activity, and also production of interferon, an anti-viral protein. This means that it is active against all sorts of infective illnesses. Traditionally its use was in suppurating skin conditions and it was seen as a heat clearing, detoxicant remedy applicable to inflammation and discharge as well as to infection.
Whereas a doctor might prescribe an antibiotic to treat a bacterial infection, a herbalist may use Echinacea. The intention of employing an antibiotic is to kill the organism responsible for the illness. Using a remedy such as Echinacea, which is seemingly much broader in its remit, actually allows the body to mediate its own specific response to a particular infective organism. This is a good example of the way in which herbal treatment supports the body's natural course of action rather than acting in its place.
It is the contention of many practising herbalists, however, that Echinacea is being very much overused.
We are only likely to catch an infective illness when our bodies are already feeling tired or stressed. We are exposed to all sorts of infective organisms all of the time but only go down with an illness when we are unable to fight it off. This means that when we do get an illness we need to get some rest, take time off from work and think about our diets. We also need to see if there are things we have been doing too much or too little of and see what generally in our lives needs readjusting to keep us well. It may well be that nervine herbs and a better diet are much more useful responses to an infection than dosing with Echinacea.
Echinacea is a very valuable remedy, but it is one that boosts our last line of defence when our bodies have already been weakened. Thus it can be seen that the mass consumption of Echinacea is perhaps the antithesis of holistic treatment.
It is also worth remembering that Echinacea is only one of a number of herbs useful in fighting infective illness. Traditionally herbs that support specific tissues were used for infections in that area - for example thyme for chest infections.
Milk Thistle
Traditionally the leaves have been used as food and the plant was used as a galactogogue. It had, however, fallen out of popular use until modern research showed the plant to be useful for treating a whole range of liver complaints. As well as stimulating bile flow, it is also useful in fatty liver, hepatitis and cirrhosis. Commercial extracts are often standardised for silymarin content - this being seen as the main active constituent. Silymarin acts on cell membranes in the liver helping to prevent damage from infective organisms and harmful chemicals (including pharmaceutical drugs). It is seen as a liver trophorestorative by herbalists, that is, a herb that helps restore an organ to an undamaged state. As such it is immensely valuable.
Whilst many people will benefit from the use of a herb which aids their liver, Milk thistle is probably most useful in complaints where professional supervision is needed. Many of the people who are buying Milk thistle supplements might be better off getting to know a little more about the lowly dandelion!
