Drug Guide

Herbal Drugs

By Anthony McDaniel, M.D.

Herbalism is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. Herbalism is also known as botanical medicine, medical herbalism, herbal medicine, herbology, and phytotherapy. The scope of herbal medicine is sometimes extended to include fungal and bee products, as well as minerals, shells and certain animal parts. Pharmacognosy is the study of medicines derived from natural sources. Traditional use of medicines is recognized as a way to learn about potential future medicines. In 2001, researchers identified 122 compounds used in mainstream medicine which were derived from "ethnomedical" plant sources; 80% of these compounds were used in the same or related manner as the traditional ethnomedical use.

Many plants synthesize substances that are useful to the maintenance of health in humans and other animals. These include aromatic substances, most of which are phenols or their oxygen-substituted derivatives such as tannins. Many are secondary metabolites, of which at least 12,000 have been isolated — a number estimated to be less than 10% of the total. In many cases, substances such as alkaloids serve as plant defense mechanisms against predation by microorganisms, insects, and herbivores. Many of the herbs and spices used by humans to season food yield useful medicinal compounds. Similarly to prescription drugs, a number of herbs are thought to be likely to cause adverse effects. Furthermore, "adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal. Although such Adverse Drug Events are minuscule compared with the 20% of GP visitations said to be due to ADRs of conventional drugs. or the 6-7% of hospital admissions due to ADRs. Well manufactured herbal products have far fewer ADRs and/or side effects generally than many drugs.

The highest standard for pharmaceutical testing is repeated, small-scale, randomized, double-blind tests. In 2002 the U.S. National Center for Complementary and Alternative Medicine of the National Institutes of Health began funding clinical trials into the effectiveness of herbal medicine. In a 2010 survey of 1000 plants, 356 had clinical trials published evaluating their "pharmacological activities and therapeutic applications" while 12% of the plants, although available in the Western market, had "no substantial studies" of their properties.

Many herbs have shown positive results in-vitro, animal model or small-scale clinical tests but many studies on herbal treatments have also found negative results. The quality of the trials on herbal remedies is highly variable and many trials of herbal treatments have been found to be of poor quality, with many trials lacking an intention to treat analysis or a comment on whether blinding was successful. The few randomized, double-blind tests that receive attention in medical publications are often questioned on methodological grounds or interpretation. Likewise, studies published in peer-reviewed medical journals such as Journal of the American Medical Association receive more consideration than those published in specialized herbal journals.

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