Herbalism

For millennia, herbs were the major source of medicinal drugs. In Iraq, archaeologists unearthed medicinal plants buried 60,000 years ago alongside the dead. The Chinese used camphor and ginseng as early as 2700 B.C., the Egyptians favored aloe and opium in 1500 B.C., and the Incas and Aztecs used cocoa leaves and sarsaparilla in 700 B.C. Even today, in most countries, herbs remain among the most widely prescribed agents.

In the United States, traditional herbal remedies fell into disfavor as the pharmaceutical industry, with its synthetic "wonder drugs" such as the penicillin and polio vaccines, boomed during the 20th century. Americans preferred clinically proven drugs that could be identified, purified and patented. Herbal remedies became synonymous with quack treatments by much of the public and medical establishment.

Today the American attitude is changing once again. Bottles of St. John's Wort, echinacea and ginkgo biloba fly off the shelves of health food stores and supermarkets to the tune of $3 billion a year. A survey by Whole Food magazine showed a nearly 60 percent increase in the sales of herbal products in 1996. A 1998 poll by Landmark Healthcare, Inc. showed 17 percent of respondents had used herbal remedies and three out of four said they likely would try them in the future.

Do herbs work?

Do herbs work or is all that money going down the drain? The answers are: Many do and probably not, but only time will tell for sure. In more than 26 blinded and controlled studies, St. John's Wort was found comparable with standard drugs in treating mild-to-moderate depression. Additional research is being done. St. John's Wort also is being investigated for use against other disorders.

The mainstreaming of herbs

It's odd that the United States turned against herbs because many modern drugs owe their origins to medicinal plants. Some 25 percent of prescription drugs and 60 percent of over-the-counter drugs are obtained from natural products. Morphine comes from the opium poppy. Digitoxin, used to stimulate the heart and regulate its rhythm, comes from foxglove. Autumn crocus gives us colchicine, an anti-inflammatory drug used to treat gout, and belladonna provides atropine, a heart stimulant and treatment for Parkinson's disease. The cancer drug vincristine comes from periwinkles. Researchers continue to examine the components of plants in their search for new medicines.

Ten popular herbs: What do they do? Are they safe?

Black Cohosh

• Natural alternative to hormone replacement therapy in menopause

• Some evidence says it might benefit other gynecological complaints such as premenstrual syndrome, dysmenorrhea and uterine fibroids

• No serious side effects have been reported

Echinacea

• May stimulate immune system



• Used for colds and flu



• Not recommended for patients with tuberculosis, HIV or other autoimmune disorders, or allergies to sunflowers; not to be taken for more than eight weeks

Garlic

• May work against bacteria, fungal infections, inflammation and blood clots

• Used for lowering cholesterol and blood pressure

• Might increase effect of regular high blood pressure and anticoagulant (anti-clotting) drugs such as aspirin or warfarin, can lower blood sugar in diabetics; causes stomach upset

Ginger

• May prevent nausea

• Used to prevent and treat nausea and motion sickness

• May prolong bleeding time; not recommended for use after surgery, during pregnancy or in patients on anticoagulant drugs or with history of gallstones

Ginkgo biloba

• May expand blood vessels, inhibit clot formation and scavenge free radicals

• Used for tinnitis (ringing in the ears), varicose veins, dementia and dizziness; improves memory

• Might cause stomach problems, headache or skin rashes; large doses can cause diarrhea, restlessness, nausea and vomiting

Ginseng

• May stimulate the central nervous system; may have some effects of estrogen

• Used for relieving fatigue and stress and enhancing endurance

• Might decrease effect of the diuretic furosemide; estrogenic effects can lead to vaginal bleeding and breast nodules; not recommended for pregnant or nursing women and patients with emphysema, fibrocystic breasts, high blood pressure or cardiac arrhythmia

Goldenseal

• May work as an astringent working against microbial infections and inflammation; also may stimulate central nervous system

• Used in bacterial, fungal, gastrointestinal and eye infections

• Not recommended for pregnant women or diabetic patients

Kava kava

• May suppress anxiety and the central nervous system; may work as a local anesthetic

• Used for relieving mild anxiety and sleeplessness

• Increases effect of alcohol and other substances that depress the central nervous system; prolonged use leads to flaky, yellowing skin and impaired vision (stopping use reverses these effects); not recommended for pregnant or nursing women or patients with biologically caused depression

St. John's Wort

• May work against depression; may have some antiviral activity

• Used for mild-to-moderate depression

• Should not be taken with regular antidepressant drugs; might cause sensitivity to sunlight and stomach/intestinal upset

Saw palmetto

• May inhibit male hormones; may have some effects on estrogen; may be anti-inflammatory

• Used to relieve urinary problems caused by benign prostate hyperplasia

• Might reduce serum levels of PSA (prostate-specific antigen), a marker used for diagnosing prostate cancer; might cause stomach/intestinal upset or mild headache

Valerian

• May inhibit certain neurotransmitters; may relax muscles and may stop spasms

• Used for improving sleep and reducing mild anxiety

• Not for use for acute insomnia because it might take several weeks for it to work; might add to effects of other drugs that depress the central nervous system; might cause morning drowsiness, and headache, excitability and uneasiness after long-term use

Safety concerns

In the United States, herbal products are sold as "dietary supplements" and, as a result, are not subject to any scrutiny by the Food and Drug Administration. Proof of their safety and efficacy are not required. In fact, the government hasn't established a standard of quality for herbal products. The best bet might be to buy European herbal products, which must adhere to strict guidelines. The guidelines not only standardize the herbal extracts according to chemical or biochemical markers, but they also set limits on contaminants and require that the ingredients be stable over time.

In any case, it's important to check purchases, use and doses of these products with qualified professionals such as pharmacists and herbalists and to discuss potential side effects. Because some herbs interact with regular drugs, it also is important to inform your medical doctor about all supplements you're taking.

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External Sources Adapted with permission from DerMarderosian AH, Kratz AM. Alternative Healthcare. In: Gennaro AR, Chase GD, Medwick T et al, eds. Remington: The Science and Practice of Pharmacy. 19th ed. Easton, Pennsylvania: Mack Publishing Company; 1995:829-840. Adapted with permission from DerMarderosian AH. The Medicinal Role of Selected Herbal Products. In: Herbal Supplements: A Didactic Approach for Today's Pharmacists. Bioscience Communications, 1998.

This article was reviewed April 2004, by Dennis C. Policastro, M.D., FACP, FACEP, Residency Program Director, Internal Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA.

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