MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

I have often pointed out that, in contrast to ‘rational phytotherapy’, traditional herbalism of various types (e. g. Western, Chinese, Kampo, etc.) – characterised by the prescription of an individualised mixture of herbs by a herbalist – is likely to do more harm than good. This recent paper provides new and interesting information about the phenomenon.

Specifically, it explores the prevalence with which Australian Western herbalists treat menstrual problems and their related treatment, experiences, perceptions, and inter-referral practices with other health practitioners. Members of the Practitioner Research and Collaboration Initiative practice-based research network identifying as Western Herbalists (WHs) completed a specifically developed, online questionnaire.

Western Herbalists regularly treat menstrual problems, perceiving high, though differential, levels of effectiveness. For menstrual problems, WHs predominantly prescribe individualised formulas including core herbs, such as Vitex agnus-castus (VAC), and problem-specific herbs. Estimated clients’ weekly cost (median = $25.00) and treatment duration (median = 4-6 months) covering this Western herbal medicine treatment appears relatively low. Urban-based women are more likely than those rurally based to have used conventional treatment for their menstrual problems before consulting WHs. Only 19% of WHs indicated direct contact by conventional medical practitioners regarding treatment of clients’ menstrual problems despite 42% indicating clients’ conventional practitioners recommended consultation with WH.

The authors concluded that Western herbal medicine may be a substantially prevalent, cost-effective treatment option amongst women with menstrual problems. A detailed examination of the behaviour of women with menstrual problems who seek and use Western herbal medicine warrants attention to ensure this healthcare option is safe, effective, and appropriately co-ordinated within women’s wider healthcare use.

Apart from the fact, that I don’t see how the researchers could possibly draw conclusions about the cost-effectiveness of Western herbalism, I feel that this survey requires further comments.

There is no reason to assume that individualised herbalism is effective and plenty of reason to fear that it might cause harm (the larger the amount of herbal ingredients in one prescription, the higher the chances for toxicity and interactions). The only systematic review on the subject concluded that 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.

Moreover, VAC (the ‘core herb’ for menstrual problems) is hardly a herb that is solidly supported by evidence either. A systematic review concluded that, although meta-analysis shows a large pooled effect of VAC in placebo-controlled trials, the high risk of bias, high heterogeneity, and risk of publication bias of the included studies preclude a definitive conclusion. The pooled treatment effects should be viewed as merely explorative and, at best, overestimating the real treatment effect of VAC for premenstrual syndrome symptoms. There is a clear need for high-quality trials of appropriate size examining the effect of standardized extracts of VAC in comparison to placebo, selective serotonin reuptake inhibitors, and oral contraceptives to establish relative efficacy.

And finally, VAC is by no means free of adverse effects; our review concluded that frequent adverse events include nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus and erythematous rash. No drug interactions were reported. Use of VAC should be avoided during pregnancy or lactation. Theoretically, VAC might also interfere with dopaminergic antagonists.

So, to me, this survey suggests that the practice of Western herbalists is:

  1. not evidence-based;
  2. potentially harmful;
  3. and costly.

In a nutshell: IT IS BEST AVOIDED.

7 Responses to Individualised (traditional) herbalism: best avoided, in my view

  • Good day to you, Dr. Ernst!

    I think that you have cherry-picked a paper in order to condemn a natural therapy, i.e. herbalism, which may not work in every instance with every illness, but which works effectively nonetheless. Type in “Herbs” at http://www.nutritionfacts.org for research papers to this effect.

    I use herbal mixtures in certain instances when a doctor would prescribe a Western medicine, and they may take as little as 15 minutes to deal with the (minor) problem.

    It would be easy to use the same strategy you have used of choosing an instance where a Western medicine does not work and then state at the end as you have above: “In a nutshell: IT (i.e. Western Medicine) IS BEST AVOIDED.”

    The more you go after every kind of natural medicine, the more you run the danger of being seen as a corporate defender of Big Pharma.

    I think I hear the thunderous roar of your now upset supporters approaching, so I’ll leave quickly now.

    My warmest regards,

    Peter

    • please show us the trials of individualised herbal therapy that support what you are stating.
      I linked my post to the evidence that I am quoting, so please do the same, if you think I cherry-picked.

    • I cited 3 systematic reviews; FYI these are papers based on the totality of the evidence; and you accuse me of ‘choosing an instance’ – makes no sense at all.

    • and they [herbal mixtures] may take as little as 15 minutes to deal with the (minor) problem.

      The only plant-derived substance that I know of that takes effect within 15 minutes of ingestion is ethanol – although I doubt that sobriety comes under your definition of ‘a minor problem’.
      Unless, of course, you’re talking about this all too common problem of hyperpecuniosis, something that alternative practitioners are always on the lookout for. In that case, providing the patient with a herbal remedy from your own apothecary may have an even faster effect, particularly on the leathery structure known as ‘the wallet’.

  • Peter:
    Logical fallacies:
    (i) Red herring: There is no such thing as ‘Western medicine’ – only medicine (drugs in this context) which have been demonstrated to work by plausible reproducible scientific methods.
    Those which do not meet this criterion are not ‘medicine’ by definition.

    (ii) Straw man: ‘Big Pharma’. Some firms which use pharmacological methods may be crooks and frauds, and many are deserving of critique (which they receive from many doctors and commentators) – but modern firms have moved on from anachronistic methodologies, embraced science and advanced the development of drugs with as many beneficial effects, and as few side-effects as possible.

    None of ‘us’ defend bad practice.
    ‘Big Quacka’ offers no reputable practice at all.

    (iii) False dichotomy:
    Of course herbs have effects – they contain powerful compounds from which modern preparations have been derived – but the question is not black and white, but is: “To what extent does the preparation in question contain known compounds of known effects (beneficial or harmful)?”
    ‘Herbal preparations’ have yet to answer this question – which is why they are not medicines.

    (iv) False belief that there exists in the immanent universe ‘vital forces’ which, though unidentified, have an effect on the health of living things.

    More work needed Peter.
    It is a tough road I acknowledge, but worth it as the alternative is, well, alternative.

  • On a day when there is serious debate in the UK at the highest levels as to how quickly the law can be changed to allow medical cannabis to help those with epilepsy where this *might* be the most appropriate treatment, this article- saying nothing in particular apart from predictably AVOID!- seems rather outdated & totally out of touch with the incredible possibilities that herbal medicine *might* provide.

    • are you sure you have understood it?
      had the epileptic boy fallen into the hands of a traditional herbalist, he could well be dead by now.

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