MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Here I am not writing about herbal medicine in general – parts of which are supported by some encouraging evidence (I will therefore post more than one ‘seven things to remember…’ article on this subject) – here I am writing about the risks and benefits of consulting a traditional herbal practitioner. Herbalists come in numerous guises depending what tradition they belong to: Chinese herbalist, traditional European herbalist, Ayurvedic practitioner, Kampo practitioner etc. If you consult such a therapist, you should be aware of the following issues.

  1. Worldwide, the treatment by traditional herbal practitioners is by far the most common form of herbal medicine; it is more common than to use specific, well-tested herbs to treat specific conventionally diagnosed conditions (an approach that might best be called ‘rational phytotherapy’).
  2. Herbalists often use their very own diagnostic methods (think, for instance, of ‘tongue and pulse diagnoses’ used by Chinese herbalists) and reject (or are untrained to use) conventional diagnostic methods. The traditional diagnostic techniques of herbalists have either not been validated at all or they have been tested and found to be not valid.
  3. Herbalists usually do not recognise conventional disease categories. Instead they arrive at a diagnosis according to their specific philosophy which has no grounding in reality (for instance, energy imbalance in traditional Chinese herbalism).
  4. Herbalists individualise their treatments, meaning that 10 patients suffering from depression, for instance, might receive 10 different, tailor-made prescriptions according to their individual characteristics (and none of the 10 patients might receive St John’s Wort, the only herbal remedy that actually is proven to work for depression).
  5. Typically, such prescriptions contain not one herbal ingredient, but are mixtures of many – up to 10 or 20 – herbs or herbal extracts.
  6. Even though the efficacy of the individualised herbal approach can, of course, be tested in rigorous trials, and even though about a dozen such studies are available today, there is currently no good evidence to show that it is effective.
  7. The risk of harm through these individualised herbal mixtures can be considerable: the more ingredients, the higher the likelihood that one of them has toxic effects or that one interacts with a prescription medicine. Essentially, this means that there is no good evidence that individualised herbal treatments as used by so many herbal practitioners across the globe generates more good than harm.

19 Responses to Seven things to remember before you consult a herbalist

  • You are too kind. You do not mention the variability in amount of active ingredient(s), even if the preparation is simple and appropriate. Nor do you mention side-effects; the only time I took St John’s Wort, I felt more miserable than at any other time in my life and had to keep reminding myself that it would pass.

    • see my next post

    • I wonder if you felt worse than the millions of people who have experienced…

      libido loss, anxiety, nausea, confusion, insomnia, discontinuation effects such as brain zaps, suicidal feelings, serotonin syndrome, or other various “side effects” to the totally “evidence based” SSRIs.

      • Far less than millions who experienced it all at once. And remember that e.g. suicidal feelings is a symptom of depression, so, if you did not have them before and got them after, maybe you had never been depressed but simply bored? On the other had, if you had them before and still has them after, then maybe the dose was wrong, it was not depression, or there was more psychology than biochemistry in it.

  • So I understand that you think herbalists should use diagnostic methods outside of their own system of medicine (#2), diagnose outside of their system of medicine (#3), refrain from tailoring the best treatment for the individual (#4), eliminate the support herbs that lessen side effects of the mother herb (#5), and disregard data gathered from many generations of trial, error, and experience (#6).
    .
    But #7 is curious. Why didn’t you write it like this: “Essentially, this means that there is no good evidence that individualised herbal treatments as used by so many herbal practitioners across the globe generates more harm than good.” Do you have data, or is this more speculation on your part?

      • “CONCLUSIONS: There is a sparsity of evidence regarding the effectiveness of individualised herbal medicine and no convincing evidence to support the use of individualised herbal medicine in any indication.”
        .
        So basically, speculation based on sparse evidence. Sure, why not?

        • no!
          in medicine, no convincing evidence means we don’t do it and we alert people to the fact that it is not evidence-based.
          this is not called SPECULATION but RESPONSIBLE BEHAVIOUR.
          (perhaps not easy to understand for you?)

          • Ah. No convincing evidence to me would mean “we don’t know”. And if we don’t know…that would put #7 in the realm of speculation. Easy enough to understand?

          • only if you live in the parallel universe of alternative medicine, it seems.

          • Where I live, ‘sparsity’ combined with ‘no convincing evidence’ would mean do more research. Then again, I would also prefer a treatment tailored to my condition, from someone practicing within their scope, using their own tools, and minimizing side effects. I know, it’s crazy…

        • If a surgeon is not sure operations X benefits patiens, does he need to continue doing operation untill sufficient (for whom) number of patients get crippled or die?
          And in case of individualised herbal treatments there is no reason to believe they can work. Yes, different people can react to the same drug differently (geneticists ar doing wonderful research) BUT IT IS ABSOLUTELY CLEAR THAT DIFFERENT SUBSTANCES INTERACT WITH EACH ATHER, AFFECT PHARMACOKINETICS AND PHARMACODYNAMICS OF OTHER SUBSTANCES. And every herb already is full of different substances, amounts and proportions of which may differ, because of the conditions respective plant has been growing in.

  • “Even though the efficacy of the individualised herbal approach can, of course, be tested in rigorous trials, and even though about a dozen such studies are available today, there is currently no good evidence to show that it is effective.” – I notice you referenced the 2007 review which found 3 trials – have more of individualised herbal medicine been published since? To date I know of only three or so Western herbal medicine trials. I’d like the references if you have them?

  • Are you still trying to suggest that how most of the world assists people with health problems (herbalism) is quackery? Are you suggesting that say…Tibetan or Brazillian villagers- should wait for a qualified evidence based medical practitioner to “help” them before offering herbs for common health problems?

    Breathtaking colonialist garbage…

  • This article was clearly written by someone who has no understanding of herbalism or energetics. The term “energetics” refers not to an actual flow of energy from the plants but to an action that the herb has. For example cayenne is hot, cucumber is cold, etc.. admittedly the theory of energetics is primitive but there is yet to be a better model. It works consistently & is easy to understand if you dig beyond the very utmost surface of the terms. Here is an example of how it works: someone has the flu & they are having chills, administer a small dose of cayenne to the individual & they will not have chills as often because cayenne increases the metabolic rate of the body thereby generating heat, it’s “energy” is hot.
    Again this does not refer to some mystical hot force in the plant, but to the effect it has on tissue states.

    This method is also NOT unscientific. Primitive but not unscientific. Using herbs like drugs (as in the St. John’s Wort example) is not what real herbalists do as a whole & in fact only very rarely utilize that mode as it is a modern conception & leads down the same path that allopathic medicine does, which is more problems. Allopathic medicine tries to manage the disease not the cause of the disease, of this there is no question. A real herbalist treats the SOURCE of the problem which does in fact tend to cure the disease. I find it a shame that doctors like you & the establishment in general is so myopic to the fact that the drug companies do not want herbal therapies because there is no profit in it & they infect your kind with a psychological cancer to the truth.

    • Your comment has reminded me of something that I studied decades ago:
      https://en.wikipedia.org/wiki/Traditional_Tibetan_medicine
      QUOTE [retrieved 2016-07-19]

      A key objective of the government of Tibet is to promote traditional Tibetan medicine among the other ethnic groups in China. Once an esoteric monastic secret, the Tibet University of Traditional Tibetan Medicine and the Qinghai University Medical School now offer courses in the practice. In addition, Tibetologists from Tibet have traveled to European countries such as Spain to lecture on the topic.[14]

      The Tibetan government-in-exile has also kept up the practise of Tibetan Medicine in India since 1961 when it re-established the Men-Tsee-Khang (the Tibetan Medical and Astrological Institute). It now has 48 branch clinics in India and Nepal.[15]

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