Tincture: Concentrated liquid made with water, alcohol, and herbs. Vunerary: Herb to promote wound healing. Fields of Study

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1 Herbology Fields of Study Medicine; nutrition; naturopathy; biochemistry; botany; pharmacy; physiology. Summary Herbology is the study of plants for use in the prevention and treatment of health conditions and disease. Herbs have been used throughout history for medicinal purposes. Herbology is an essential part of traditional Chinese medicine and has been incorporated into Western naturopathy. Growing interest in natural remedies in North America has increased the popularity of training programs in herbology. Although some cultures have used herbal treatments for thousands of years, their efficacy and quality have been questioned, and some people have called for stricter regulation of herbal products. Key Terms and Concepts Adaptogen: Herb that treats physical and emotional stress. Alterative: Herb that restores normal bodily function. Astringent: Tannin containing herb used for contraction of tissues. Bitter: Digestive herb. Carminative: Herb for relief of gas. Cathartic: Laxative herb. Cholagogue/Choleretic: Herb to increase bile production. Decoction: Tea made from the fibrous part of plants. Demulcent: Mucilaginous herb that treats mucous membranes. Diaphoretci: Herb to promote perspiration. Emmenagogue: Herb to stimulate menstruation. Extract: Concentrated liquid made from herbs. Galactagogue: Herb with sugar and nonsugar composition. Hepatic: Quality of supporting liver function. Herbalist: Practitioner trained in the medicinal use of plants. Infusion: Herbal tea made from the soft parts of plants such as flowers and leaves. Tincture: Concentrated liquid made with water, alcohol, and herbs. Vunerary: Herb to promote wound healing. Definition and Basic Principles Herbology, also known as phytotherapy, is the study of plants and plant extracts for medicinal use. Herbology is an integral part of Chinese traditional medicine, folk medicine, and naturopathic medicine. Herbology is often used by practitioners who also favor alternative medical treatments such as acupuncture. An herbalist is a person who specializes in the use of plants and plant extracts for the prevention and treatment of diseases and conditions. Some herbalists also use naturally occurring nonplant products such as minerals and animal products. Herbology is based on the knowledge that phytochemicals (chemical substances within plants) have pharmaceutical properties. Many herbal remedies are based on traditional practices, and many scientific studies have been done to verify the properties of herbal products. In 1978, the German Commission E, a governmental regulatory agency, was formed to evaluate the safety and efficacy of herbs available for general use. The commission produced 380 monographs. Although the commission is no longer in existence, the monographs are available in The Complete German Commission E Monographs published by the American Botanical Council in These monographs are one of the most thorough collections of scientific data on the subject of herbology. Since the commission was disbanded, numerous scientific studies have been published by other groups regarding the effectiveness of various herbs in the treatment and prevention of disease. As of 2010, herbalists were not required to be licensed in the United States and Canada. Training programs in herbology are available through a number of organizations. The American Herbalists Guild was founded in 1989 to serve as an educational organization for herbalists in the United States. The American Botanical Council is a nonprofit organization that was founded in 1988 to provide information to herbalists and consumers. Herbal remedies are not regulated by the U.S. Food and Drug Administration (FDA) and are not 959

2 Herbology Applied Science investigated by the FDA unless there are reports of adverse reactions. A similar situation exists in Canada. As more and more herbal products have become available, reports of adverse reactions due to product misuse or product contaminants have been increasing. The National Center for Complementary and Alternative Medicine (NCCAM), a branch of the National Institutes of Health (NIH), takes a scientific approach. It provides research-based information on the safety and efficacy of herbs and offers training in herbology. A wide variety of medical practitioners uses herbology. In addition to traditional herbalists, medical herbalists, natural healers, holistic medical doctors, naturopaths, and practitioners of alternative medicine (such as traditional Chinese medicine) use herbs. In a practice called complementary medicine, some conventional doctors and other medical professionals treat patients using herbology and other alternative therapies in addition to conventional Western medicine. According to the National Institutes of Health, in 2007, more than 38 percent of adults in the United States reported using complementary or alternative medicine, including herbs. Background and History Plants and plant extracts have been used in the prevention and treatment of medical conditions for many centuries. Ancient Egyptians used opium, garlic, and other plants, and the Old Testament includes references to the use of herbs. The use of herbology has been an integral part of traditional Chinese medicine for more than a thousand years. Many pharmaceutical products are derived from plants. A well-known example is digitalis, which is derived from the foxglove plant and is used in the treatment of heart conditions. Another example is morphine, which was originally extracted from poppies. Aspirin is derived from salicin, which is present in the bark and leaves of the willow tree. As herbal remedies have become more popular, the manufacture and sale of herbal products including combinations of herbs in tablet or extract forms has increased. Many products are readily available at health food stores and pharmacies. Although the practice of herbology relies on traditional knowledge, a number of efforts have been made to verify the efficacy and safety of herbal remedies. The most well-known source for scientific information about herbs is the monographs produced by the German Commission E. The National Center for Complementary and Alternative Medicine also provides information on and training in herbology. How It Works Herbalists use herbal remedies made from plants. These remedies are based on the knowledge that phytochemicals have pharmacologic properties. These phytochemicals can be brought out by preparing the plant material in a variety of ways, depending on the remedy. Herbal medicines are often prepared as a tea, which is properly called an infusion or decoction. A decoction is typically made by placing the stems, roots, or bark of a specific plant in water, and boiling the water until the volume is reduced. Infusions are made by steeping plant parts in hot or cold water. Infusions are usually made from the softer parts of plants such as the flowers or leaves. Decoctions and infusions extract water-soluble phytochemicals. Herbal remedies may also be prepared as a tincture or extract. Tinctures are made by macerating the plant material in water and alcohol. The ratios of plant material, water, and alcohol will vary depending on the herbal remedy and dosages. Extracts will usually be more concentrated. For some extracts, glycerin is used as a solvent. Tablets, lozenges, and dried herbs are also available. Some herbal products can also be found in creams or ointments. Commercially available products are not regulated by the FDA, and the contents of some products have differed from the product label. Others have been contaminated with other herbs, metals, or pesticides. To ensure safety, NCCAM suggests that patients become informed about the herbal product, discuss it with their primary care physician, read the label carefully, and remember that natural does not always mean safe. Consumers and practitioners should be aware that herbal products can cause adverse reactions or result in negative outcomes for a number of reasons. First, consumers or herbalists may not recognize the seriousness of a medical condition, which might require more aggressive medical treatment than herbs can provide. Second, problems can arise from allergic reactions, misidentification of herbal products, intentional or unintentional contamination of herbal products with heavy metals or other harmful substances, or mistakes in the dosage. Third, herbs and conventional medications may interact and exacerbate an existing 960

3 Applied Science Herbology condition. Finally, unsubstantiated herbal remedies may be totally ineffective and allow a condition to remain basically untreated. Herbology is practiced in different ways according to the philosophy of treatment. Some dosage recommendations are derived from herbal traditions such as traditional Ayurvedic or Chinese medicine. Many books are available on the subject of herbal remedies, and some commercially available products will have recommended dosages on the label. Although there are no standards for training in herbology, training programs are available through NCCAM and other organizations. Applications and Products Traditional Chinese Medicine. Herbology involves the use of plants and plant extracts in the treatment and prevention of disease. The application of herbal remedies may depend on the medical tradition followed by the herbalist. For example, a herbalist following traditional Chinese medicine may recommend herbs to restore a person s body to a balanced state, based on an examination of aspects such as yin and yang, as well as qi (chi) and blood. Yin and yang are opposite aspects, defined as light and dark, hot and cold, and moist and dry, respectively. Qi is often described as energy, or a dynamic essence. Blood, transformed from the essence of food, is important as well. Chinese medicine also determines treatment according to the five elements--wood, fire, earth, metal, and water--which correspond to specific organs, senses, and bodily functions. Chinese herbal products range from specific foods such as wheat or grapes to combinations of herbs in a tablet or a tea. Western Herbology. Some Western herbalists subdivide herbal remedies according to the organs or systems affected or the action of the herb. Herbal actions fall into several categories. Adaptogens are herbs used to treat emotional and physical stress. Tonics provide energy. Vulnerary herbs promote healing, and nervines work on the nervous system. Astringents contract tissues. Diaphoretics promote perspiration, and febrifuge is used to treat a fever. Alterative herbs restore normal function and may be further divided into hepatic, digestive, or antimicrobial. The gallbladder can be treated with a cholagogue or choleritic to promote secretion of bile. Bitters and carminative herbs are used to support digestion. Purgative and carthartic herbs are used for a laxative effect, and stomachic is an agent to promote appetite. Demulcents are mucilaginous agents that sooth mucous membranes. Menstrual flow is enhanced by emmenagogues. Phytoestrogens enhance the estrogen system. Galactagogues promote lactation. Applications. Herbology is used in a number of settings. Herbalists may be solo practitioners or may work in a health food store. Nutritionists or conventional physicians may incorporate herbology in their practices. Herbal remedies are readily available in pharmacies, and many pharmacists will have some knowledge about the benefits and dosing of herbal remedies. Herbal remedies are often used along with other forms of alternative medicine such as yoga, acupuncture, and meditation. Impact on Industry Herbal products, used by more than 38 percent of Americans and millions of people worldwide, have become big business. Billions of dollars of herbal products are sold each year. According to some estimates, Americans spent more than $20 billion on vitamins, herbs, and other supplements in Health Canada reports that more than 71 percent of Canadians regularly take natural health products. Suppliers of herbal products range from small companies that specialize in a few products to major companies, including some major pharmaceutical companies. The growth in sales of herbs and supplements slowed after deaths were linked to the supplement ephedra, which was banned in However, herbal products continue to generate large revenues. Organizations. Herbology organizations range from governmental agencies designed to educate consumers to associations made up of people in the industry. The National Center for Complementary and Alternative Medicine, part of the NIH, provides research-based information to consumers as well as training in herbology. The American Botanical Council provides information about herbal medicine to consumers and herbalists. The American Herbal Products Association represents growers, importers, manufacturers, marketers, and corporations in the herbal industry. The American Herbalists Guild represents herbalists specializing in the medicinal use of plants. Governmental Regulation. According to the Dietary Supplement Health and Education Act of 1994, companies marketing supplements in the United States cannot make specific therapeutic claims about 961

4 Herbology Applied Science their products. Companies can make nutritional claims if they include a disclaimer that the claims have not been evaluated by the FDA. Reports of adverse reactions from herbal products are investigated by the FDA. In Canada, supplements can be treated as either foods or drugs. Supplements regulated as prescription drugs have a drug identification number (DIN) that appears on the product label. The National Health Products Regulations, which came into effect in January 1, 2004, defined natural health products as over-the-counter drugs. Those evaluated by Health Canada are given a natural product number (NPN). Government Research. Research on herbal products has been conducted by governmental agencies such as the German Commission E and Canada s Natural Health Products Research Program ( ). National Center for Complementary and Alternative Medicine funds a number of research programs and, in cooperation with the NIH s Office of Dietary Supplements, runs the Botanical Research Centers Program. Thousands of scientific articles have been published on herbal products and peer-reviewed articles are available through NIH s National Library of Medicine. Fascinating Facts About Herbology Herbs have been used as medicine for thousands of years. Perhaps the most expensive herb is saffron, which costs between $500 and $1,000 per pound. Some herbalists recommend saffron for memory enhancement and antiaging. Garlic is both a common remedy and a common ingredient in foods. The ancient Greeks and Romans used garlic to ward off disease. Garlic, which may reduce cholesterol, has been used to prevent heart disease, cancer, colds, and the flu. It is considered both a vegetable and a herb and is a member of the onion family. Garlic has been used as a natural mosquito repellent and was once believed to ward off vampires. Red clover has been reported to have magical powers, including the ability to protect against witchcraft and evil spirits. Four-leaf variants have been used as lucky charms. A flavenoid called quercetin present in apples may protect the brain, lending support for the adage An apple a day keeps the doctor away. It can be challenging to study herbal remedies because of large variations in the practice of herbology, including variable dosing and the practice of using a mixture of herbs. Another problem is the placebo effect. In blind studies, up to 30 percent of those taking placebos (a substance that resembles the product but does not have the active ingredient) report benefits. In addition, some researchers feel that those who take herbs are more likely to have a healthier lifestyle than those who do not take herbal products. Researchers have produced conflicting reports about a number of products, including St. John s wort, which has been used to treat depression. Later data seem to indicate that St. John s wort may not be effective and can have serious drug interactions. The efficacy of ginkgo biloba, a common herb taken to combat memory loss, has also been called into question. Industry and Business. Herbology involves a variety of sectors, both small and large. Herbology practices range from individuals working solo to those who are part of a larger alternative group practice. Herbal products are commonly sold in health food stores that specialize in the sales of herbs and supplements. These stores may be mom-and-pop establishments or branches of large corporate chains. Herbal products are also sold by several direct-sales companies. The industry also contains companies that grow, import, manufacture, and distribute herbal products. This segment of the industry includes large and small companies dedicated to herbal and other supplements as well as major pharmaceutical companies with an herbal product line. The distribution and sales of these herbal products in small and large retail chain stores generate billions of dollars in revenue every year. Careers and Course Work For those wishing to become a practicing herbalist, programs are readily available in the United States and Canada. Herbology training usually involves studying botany, herbal medicine, and the history and philosophy of herbal medicine, and receiving specialized training in the use of herbs in pregnancy and childhood. The Association of Accredited Naturopathic Medical Colleges consists of seven North American schools that provide naturopathic training. These schools offer a variety of programs leading to a degree or certificate, including a bachelor of science in herbal sciences, a certificate in Chinese herbal medicine, and a doctor 962

5 Applied Science Herbology of naturopathic medicine degree. The requirements for entry and completion of these programs vary depending on the chosen degree. These naturopathic programs are built around the six fundamental principles of healing: the body has an inherent ability to create, maintain, and restore health (the healing power of nature), the physician should not interfere with this healing power (first do no harm), the cause of an illness must be identified for its treatment, the physician should heal the whole person, the physician should educate and encourage the patient, and the physician should help the patient achieve health through preventative medicine. There are also a variety of online programs available for training in herbology. For careers in the business side of herbology, business training or industry experience may be helpful. Researchers in herbology often have advanced degrees in related fields such as biochemistry, botany, chemistry, or physiology. Grants are available through the National Center for Complementary and Alternative Medicine for additional training in herbology. Social Context and Future Prospects The use of plants and plant extracts for therapeutic treatment and prevention of disease will continue to be practiced worldwide. With the development of government organizations, degree programs, and medical school courses in alternative medicine, it is likely that someday mainstream medicine will incorporate the study of herbology. Consumer interest in herbal products continues to increase and to spur growth in the herbal industry. As the number of herbal products expands and more and more people use them, governments are likely to increase oversight of these products to ensure consumer safety and prevent fraudulent practices. The FDA may introduce licensing or other measures to control the production and use of herbal products. Continued research into herbal remedies is likely to lead to improved understanding of the benefits of herbs as well as possible side effects and interactions. The phytochemicals responsible for the herbal effects will probably lead to the development of conventional pharmaceuticals as well. Ellen E. Anderson Penno, M.D., M.S., F.R.C.S.C., A.B.O. Further Reading Blumenthol, Mark, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin, Tex.: American Botanical Council, Still considered a valuable resource for sciencebased information about herbs for therapeutic use. Boon, Heather, and Michael Smith. Fifty-five Most Common Medicinal Herbs. 2d ed. Toronto: Robert Rose, A detailed description of the fifty most commonly used herbs. Includes an introduction with information about herbal preparations and legislation of herbal products. Hurley, Dan. Natural Causes: Death, Lies, and Politics in America s Vitamin and Herbal Supplement Industry. New York: Broadway Books, Hurley criticizes the supplements industry for its excesses and discusses the politics behind regulatory decisions. PDR for Nonprescription Drugs, Dietary Supplements, and Herbs. 30th ed. Montvale, N.J.: Thomson Healthcare, The physician s desk reference provides information on dietary supplements and herbs. Tierra, Michael. The Way of Chinese Herbs. New York: Pocket Books, A very thorough compendium of Chinese herbal remedies with descriptions, including the philosophy of treatment underlying the Chinese herbal tradition. Web Sites American Botanical Council American Herbalists Guild American Herbal Products Association Health Canada Natural Health Products Herb Research Foundation National Center for Complementary and Alternative Medicine, NIH Office of Dietary Supplements, NIH See also: Horticulture; Pharmacology. 963