In an attempt to make this clearer, here is an explanation of what these different categories are.
Herbal remedies
Herbal remedies are preparations made from the whole plant, or whole parts of the plant. They are also called herbal medicine or herbal supplements. They invariably contain a mixture of ingredients, some of which may be pharmacologically active. They are most often sold as dietary supplements that do not need to prove their efficacy, safety or quality. Thus, their variety is very wide, with both good and poor quality products. Calls for regulation or further studies are regularly made (by consumer associations in particular) without being followed up with much effect.
Herbal remedies are mainly used by consumers to treat minor symptoms themselves, most of which would otherwise disappear on their own. Doctors rarely use them (except in some countries such as Germany) but, more importantly, traditional herbalists have a totally different approach depending on the treatment.
The majority of herbal remedies have not been scientifically tested. But some have been analyzed, standardized and subjected to clinical trials. Perhaps the most studied example is St. John's wort (Hypericum perforatum). We know that this herbal antidepressant contains several pharmacologically active ingredients that have been standardized into good quality products, and tested for efficacy and safety in approximately fifty clinical studies and several post-marketing surveillance studies.
The results have left little doubt as to the efficacy of St. John's Wort against mild to moderate depression. It is also relatively safe as long as it is not taken with other medications.
When taken with other medications, St. John's Wort can strongly interact to such an extent that it can decrease the blood plasma levels of different drugs11 which, of course, can have serious consequences. Thus, the example of St. John's Wort is, in a sense, a good demonstration that herbal remedies can do as much good as harm. In other words, some herbal medicines are compounded pharmacological treatments and are biologically plausible.
Many other herbal remedies have not been studied, so nothing can be said about their benefit/risk profile. Even well-studied examples such as St. John's wort should be approached with skepticism: the few good quality products are drowned out by supplements of poor quality and questionable content. Thus, the market for herbal remedies is polluted by products that contain few or no herbal ingredients, mixed with prescribed medicines or contaminated with heavy metals.
Synthetic drugs derived from plants - Herbal remedies
Many modern medicines (aspirin, morphine, tamoxifen, vincristine, etc.) were originally derived from phytotherapeutic materials. In fact, many people have wondered why we could not extract and synthesize the active ingredients from well-studied herbal products such as St. John's wort, and produce simple ingredients from this plant. This would have the advantage of solving several problems inherent in herbal products, such as standardization.
While this approach, aimed at creating pure compounds, occasionally works, it does not work in other examples. One reason could be that herbal products tend to have not one but a multitude of active ingredients. Thus, extracting just one could reduce the pharmacological activity of the plant extract.
Isolated ingredients derived from plant extracts can obviously no longer be considered herbal remedies because, by definition, herbal remedies are based on the whole plant. Nevertheless, such medicines are reminders that many plants contain molecules that are pharmacologically active, and can therefore have both beneficial and harmful effects on health.
Herbal remedies - Traditional phytotherapy
Remedies derived from plants
If a patient consulted a Chinese, Indian, Japanese or European herbalist, he or she would be diagnosed and treated according to obsolete and unproven diagnostic principles and pathophysiology. Treatment will be individualized according to the characteristics of each patient, and based on complex mixtures of several homemade plant extracts. This means that ten patients suffering from depression could receive ten different, individualized potions, none of which could contain St. John's Wort, the only proven natural antidepressant. In other words, the biological plausibility of herbal medicine is questionable.
Traditional phytotherapy is thus dramatically different from the phytotherapeutic remedies described above. Scientifically testing its value can be complex, but is undoubtedly possible. Few rigorous studies with this approach are currently available, and those that have been published do not confirm the notion that traditional herbal medicine is effective8.
Nor can we be sure of its safety. Since homemade traditional herbal potions may contain a significant number of active ingredients, their potential toxicity, plant-drug interactions, contamination, etc. can be considerable.
Homeopathic herbal remedies
The public often confuses homeopathy with herbal remedies. This error usually occurs because many homeopathic remedies are produced from "mother tinctures", which are based on plant extracts. Thus, they may have the same names (or almost the same names) as herbal remedies. The difference is that homeopathic remedies are very strongly diluted and therefore contain no active ingredients at all. This is why homeopathy has no biological plausibility.
Arnica is a good example. It is used as a herbal cream and as a homeopathic remedy. Because it is toxic, Arnica should not be taken orally. Being highly diluted, homeopathic arnica is both non-toxic and totally ineffective.
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Bach Flower Remedies
These products are often very popular for self-medication. They are made by putting freshly cut flowers in spring water. Bach flower remedies are therefore derived from plants and are often confused with phytotherapy products. After the flowers have soaked for a while, the water is mixed with alcohol and sold at a high price as "Bach Flower Remedies".
Bach Flower Remedies were invented by an English doctor, Edward Bach, who used to work as a homeopath. His remedies, however, have little to do with popular homeopathy, except that, like homeopathy, they have no biological credibility, nor have they been proven to be effective for any medical condition.
Anthroposophic remedies
Rudolf Steiner developed his anthroposophical remedies about a century ago. They are produced according to protocols identical to those for homeopathic products. In contrast to homeopathy, however, anthroposophical treatments do not follow the principle of "like heals like".
Since anthroposophic remedies are based on plants, they are also often confused with herbal remedies. The best-known example is Iscador, a fermented mistletoe preparation which is a very popular product against cancer. There are many studies on this product, the results of which have generally shown that it is not an effective therapy.
Conclusion
Several scientific articles on herbal remedies have concluded that more research is needed in this area. Between 1999 and 2007, the National Institutes of Health (NIH) spent $1.9 billion on dietary supplements14. Not all of this money has been invested wisely.7 More research is certainly not much use because what is most lacking are good quality studies on the likelihood of beneficial aspects of certain herbal products. Finally, advertising matracages extolling the merits of alleged herbal treatments for joint pain, or other intellectual stimuli, are worth no more than a cuckoo's fart.
References :1- Buettner, C., K.J. Mukamal, P. Gardiner, et al. 2009. Herbal supplement use and blood lead levels of United States adults. Journal of General Internal Medicine 24(11): 1175-82.2- Cohen, P.A. 2009. American roulette: Contaminated dietary supplements. New England Journal of Medicine 361(16): 1523-25.3- Ernst, E. 2008. Anthroposophic medicine: A critical analysis [in German]. MMW Fortschritte der Medizin 150(Suppl. 1):1-6.4 ---. 2010. Bach flower remedies: A systematic review of randomised clinical trials. Swiss Medical Weekly 140: w13079.5- Ernst, E., M.H. Pittler, 1998. Efficacy of homeopathic arnica: A systematic review of placebo-controlled clinical trials. Archives of Surgery 133(11): 1187-90.6- Ernst, E., M.H. Pittler, B. Wider, et al. 2006. The Desktop Guide to Complementary and Alternative Medicine, 2nd ed. Edinburgh: Elsevier Mosby.7- Ernst, E., S.K. Hung, Y. Clement. 2011. NCCAM-funded RCTs of herbal medicines: An important critical assessment. Perfusion 24(3) 89-102.8- Guo, R., P.H. Canter, E. Ernst. 2007. A systematic review of randomised clinical trials of individualised herbal medicine in any indication. Postgraduate Medical Journal 83(984): 633-37.9- Hawkes, N. 2010. A spanner in the herbal works. BMJ 339: b5441.10- Horneber, M.A., G. Bueschel, R. Huber, et al. 2008. Mistletoe therapy in oncology. Cochrane Database Systems Review 16(2): CD003297.11- Izzo, A.A., E. Ernst. 2001. Interactions between herbal medicines and prescribed drugs: A systematic review. Drugs 15: 2163-75.12- Marcus, D.M., A.P. Grollman. 2002. Botanical medicines: The need for new regulations. New England Journal of Medicine 347(25): 2073-76.13- Miller, G.M., R. Stripp. 2007. A study of western pharmaceuticals contained within samples of Chinese herbal/patent medicines collected from New York City's Chinatown. Legal Medicine 9(5): 258-64.14- Regan, K.S., E.A. Wambogo, C.J. Haggans. 2011. NIH and USDA funding of dietary supplement research, 1999-2007. Journal of Nutrition 141(1):1-3.15- Schulz, V., R. Hänsel. 2003. Rational phytotherapie: A physician's guide to herbal medicine, 5th ed. Berlin: Springer-Verlag.16- Sievenpiper, J.L., J.T. Arnason, E. Vidgen, et al. 2004. A systematic quantitative analysis of the literature of the high variability in ginseng (Panax spp.): Should ginseng be trusted in diabetes? Diabetes Care 27(3): 839-40.17- U.S. Government Accountability Office. 2009. Dietary Supplements: FDA Should Take Further Actions to Improve Oversight and Consumer Understanding. United States Accountability Office, January: Report to Congressional Requesters. GAO-09-250.18- ---. 2010. Herbal Dietary Supplements: Examples of Deceptive or Questionable Marketing Practices and Potentially Dangerous Advice. United States Government Accountability Office, May 26: Testimony Before the Special Commitee on Aging, U.S. Senate. GAO-10-662T.
