II. Epidemiology: United States
- Adults on Herbals and prescribed medication: 15 Million
- Adults alerting doctor of concurrent herbal use: 50%
- Americans spent $4 billion on Herbals in 1998
- Worldwide use: 4 billion people
- Most commonly used herbal products in the United States
- Echinacea
- St. John's Wort
- Ginkgo Biloba
- Garlic
- Saw Palmetto
- Ginseng
- Goldenseal
- Aloe
- Siberian Ginseng
- Valerian
III. Background
- Traditional medicine is basis for 80% world healthcare
- Most medications are synthesized from plant sources
- Plant Derivatives: 75% of modern medications
- Direct Extracts: 25% of modern medications
- Little efficacy data exists for Herbals
- Only 30-40 of 1200 herbs have evidence of benefit
- Prescribed medications by contrast must show benefit
- Modern drugs directly derived from plant sources
- Acetylsalicylic Acid (Aspirin) from willow bark
- Atropine from deadly nightshade plant
- Cantharidin from Blister beetle (for Wart Treatment)
- Colchicine from meadow saffron plant
- Cortisone from Mexican Discorea species
- Digitalis (Digoxin) from the foxglove plant
- Metformin from French Lilac
- Morphine and other Narcotics from the opium poppy
- Pilocarpine from the South American Jaborandi Tree
- Podophyllin or Podophyllum from mayapple plant
- Pyrethrins from chrysanthemums (for lice treatment)
- Quinine from yellow cinchona
- Reserpine from the snakeroot plant
- Scopolamine from Colombian Datura arborea tree
- Senna Laxatives from the senna plant
- Taxol from the yew tree
- Vincristine, Vinblastine from rosy periwinkle plant
- Yohimbine from black currant trees (Rubiaceae)
IV. Disadvantages: Related to herbal medication use
- No enforced labeling of efficacy
- No quality control regulation
- USP Verified Mark may be found on some products
- Adverse effects are not routinely labeled
- See below as well as specific herbal medications
- Some touted products (e.g. colloidal silver) have no significant benefit and carry great risk (see agyria)
- Serious Drug Interactions may exist
- St. John's Wort reduces Oral Contraceptive effectiveness
- American Ginseng decreases INR for patients on Warfarin
- No standardization of concentration and potency
- Many herbal preparations are mislabeled
- Some contain little if any active ingredient
- Toxin concentrations vary by part of the plant
- Toxins may concentrate in roots, stems, nuts and seeds
- Leaves tend to have lower toxin concentrations
- Preparations may contain contaminants
- Serious, permanent injury has occurred in epidemic outbreaks from contaminated products (e.g. L-Tryptophan)
- Pesticides
- Heavy Metals (often found in folk remedies)
- Arsenic
- Mercury
- Lead (see Lead-Containing Herbal Remedies)
- Cadmium
- Cyanide (home cooked Elderberry syrup)
- Prescription drugs illicitly placed in product
- Phenylbutazone
- Aminopyrine
- Prednisone
- Testosterone
- Diazepam
- Indomethacin
- Serious Drug Interactions may occur
- See Herbal Toxicity
- Goldenseal (high risk of interactions with multiple agents)
- St John's Wort (high risk of interactions with multiple agents)
- Ginkgo Biloba (increased bleeding risk with Warfarin)
- Milk Thistle (multiple interactions)
- Asian Ginseng (multiple interactions)
- Curcumin (decreases levels of many psychiatric medications)
- Many plants are highly poisonous (fatal at low dose)
- See Poisoning Causes in Children
- Deadly nightshade
- Hemlock
- Mistletoe
- Oleander (see Cardiac Glycoside Overdose)
- Daphne Berry
- Rosary Pea
- Jasmine
- Red sage
- Yew
V. History
- Do you use Alternative Medicines?
- Herbal Product?
- Herbal Supplement?
- Natural Remedy?
- What other prescribed or OTC Medications do you use?
- For how long have you used this herbal product?
- Do you have any allergies to plant products?
- Are you currently pregnant or Breast Feeding?
VI. Precautions: Pointers for patients purchasing herbal products
- Purchased products should be labeled appropriately
- Botanical name of herb
- Strength or concentration of active ingredient
- Batch or lot number
- Expiration date
- Name of manufacturer and contact information
- Avoid herbal products in pregnancy and Lactation
- Be particularly cautious in first trimester
- See adverse effects above or see specific herb
- Use herbal therapies with caution if Immunocompromised
- Herbal therapies may be contaminated with Microbes
- Use the lowest effective dose of a product
- Avoid prolonged use of any product
- Stop herbal therapies 2 weeks before elective surgery
- Avoid mixing herbal products
- Discuss herbal use with your physician
- Discuss potential Drug Interactions with physician
- Discuss adverse effects (see above)
- Reevaluate efficacy and safety on regular basis
- Avoid potentially sedating agents prior to driving or other activity requiring full concentration
- Relaxation drinks (e.g. Neuro Bliss, Just Chill, Marley's Mellow Mood)
- Contain Valerian Root, Kava xtract, GABA and Melatonin
- (2014) Presc Lett 21(1): 5
- Relaxation drinks (e.g. Neuro Bliss, Just Chill, Marley's Mellow Mood)
- Check manufacturer quality
- ConsumerLab.com
VII. References
- (2015) Presc Lett 22(12): 70
- Asher (2017) Am Fam Physician 96(2): 101-7 [PubMed]
- Borins (1998) Postgrad Med 104(1):91-100 [PubMed]
- Cupp (1999) Am Fam Physician 59(5):1239-44 [PubMed]
- Dipaola (1998) N Engl J Med 339(12):785-91 [PubMed]
- Eliason (1997) J Am Board Fam Prac 10:265-71 [PubMed]
- Ernst (1998) Am J Med 104:170 [PubMed]
- Ko (1998) N Engl J Med 339(12):847 [PubMed]
- Laliberte (1996) Can Med Assoc J 154(11):1689-92 [PubMed]
- Litovitz (1994) Am J Emerg Med 12:46-85 [PubMed]
- Mar (1999) West J Med 171:168-71 [PubMed]
- Rand (November, 1998) Modern Medicine 66:38-9
- Claudius, Behar and Nordt in Herbert (2020) EM:Rap 20(9): 5-7
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| Definition (PSY) | Treatments, health care practices, or culturally based healing traditions which are not generally used in conventional medical practice. |
| Definition (CSP) | diagnostic or therapeutic technique which is presently outside the field of conventional medical practice; for use as a 'tag' term index at 'T' emphasis level. |
| Concepts | Biomedical Occupation or Discipline (T091) |
| MSH | D000529 |
| English | Alternative Medicine, Medicine, Alternative, ALTERNATIVE MED, MED ALTERNATIVE, alternative medicines, alternative medicine, Alternative medicine, CAM, Alternative Therapy |
| Czech | alternativní lékařství, alternativní medicína |
| Portuguese | Medicina Alternativa |
| Spanish | Medicina Alternativa |
| German | Alternative Medizin, Medizin, alternative |
| Italian | Medicina alternativa |
| French | Médecine non conventionnelle, Médecine alternative |
| Croatian | ALTERNATIVNA MEDICINA |
| Norwegian | Alternativ medisin, Medisin, alternativ |
| Dutch | Geneeskunde, alternatieve |
Ontology: Phytotherapy (C0242388)
| Definition (NCI_NCI-GLOSS) | A type of medicine that uses roots, stems, leaves, flowers, or seeds of plants to improve health, prevent disease, and treat illness. |
| Definition (NCI) | Therapy based on plant-derived preparations which include the following: Individual herbs - Ginkgo biloba, Hypericum, Garlic, Ginseng, Echinacea, Saw palmetto, Urtica diocia (nettle), Kava kava, Hawthorne, Witch Hazel, Bilberry, Ginger, Aloe vera, Capsicum, Feverfew, Green tea, Tee Tree oil, Licorice root, Yohimbe, Valerian, Bee Pollen, Cat's Claw, Evening Primrose, Dong Quai, Fenugreek, Marshmallow, Psyllium, Turmeric. Combinations include: Padma 28, Hoxey, Essiac, Saw palmetto, Pygeum africanum. |
| Definition (MSH) | Use of plants or herbs to treat diseases or to alleviate pain. |
| Concepts | Therapeutic or Preventive Procedure (T061) |
| MSH | D008517 |
| SnomedCT | 414392008 |
| Japanese | フィトテラピー, ﾌｨﾄﾃﾗﾋﾟｰ, 植物療法, ハーブ療法 |
| Swedish | Fytoterapi |
| English | HERB THER, HERBAL THER, PHYTOTHER, Botanical Therapy, Phytotherapy or Herbalism, Herbal Medicine / Botanical Therapy, Phytotherapy, herb therapy, phytotherapies, herbal therapy, herb therapies, herbal therapies, herbs therapy, phytotherapy, Herb Therapy, Herbal Therapy, herbal medicine, Herbal therapy (regime/therapy), Herbal therapy, herbal medicine / botanical therapy |
| Czech | fytoterapie, Fytoterapie |
| Finnish | Yrttihoito |
| Italian | Terapia erboristica, Terapia con le erbe, Fitoterapia |
| Russian | TRAVY, TRAVOLECHENIE, FITOTERAPIIA, ТРАВОЛЕЧЕНИЕ, ТРАВЫ, ФИТОТЕРАПИЯ |
| French | Thérapie par les plantes, Thérapie végétale, Phytothérapie |
| Polish | Fitoterapia |
| Croatian | Not Translated[Phytotherapy] |
| Hungarian | Fitoterápia |
| Norwegian | Urteterapi, Fytoterapi |
| Portuguese | Terapia Herbária, Fitoterapia, Terapia de Ervas |
| Dutch | phytotherapie, Phytotherapie, Kruidentherapie |
| German | Phytotherapie, Kräutertherapie |
| Spanish | terapia herbaria (régimen/tratamiento), terapia herbaria, Fitoterapia, Terapia Herbaria |
Ontology: Chinese herbal medicine (C1273412)
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 393109002, 394060007, 395114000 |
| English | chinese herbal medicine, chinese herbal medicines, Chinese herbal medicine (regime/therapy), Chinese herbal medicine |
| Spanish | medicina china con hierbas (régimen/tratamiento), medicina china con hierbas |
Ontology: Natural Products (C1566558)
| Definition (NCI) | Any whole or part of a plant (including plant exudates), animal or microorganism that is unprocessed (raw material), or that has been processed, pulverized or extracted. Many of the natural products have some biological and/or pharmacological activity or are used for a specific purpose, not necessarily medicinal (food, aroma therapy, research and etc.). This class does not include any individual substance derived from plants/animals or other organisms with specific pharmacologic activity (See Drug, Natural Product). |
| Concepts | Biologically Active Substance (T123) |
| MSH | D001688 |
| English | Natural Product, naturals products, product natural, natural products, natural product, Natural Products, Products, Natural |
| Portuguese | Produtos Naturais |
| Spanish | Productos Naturales |
| French | Produits naturels, Substances naturelles |
| German | Naturprodukte |
| Czech | přírodní produkty |
| Italian | Prodotti naturali |
Ontology: Herbal medicine (product) (C2240391)
| Concepts | Pharmacologic Substance (T121) |
| SnomedCT | 349365008 |
| English | herbal medicines (medication), herbal medicines, Herbal medicine (product), Herbal medicine, Herbal medicine (substance) |
| Spanish | medicina herbal (producto), medicina herbal |
Ontology: Herbal interaction (C2938878)
| Concepts | Pathologic Function (T046) |
| English | Herbal interaction |
| Dutch | wisselwerking tussen kruiden |
| Spanish | Interacción de fitoterapia |
| Portuguese | Interacção de fitoterapia |
| Italian | Interazione da erbe medicinali |
| German | Wechselwirkung mit pflanzlichen Mitteln |
| French | Interaction de phytothérapie |
| Japanese | ﾊｰﾌﾞｿｳｺﾞｻﾖｳ, ハーブ相互作用 |
| Czech | Rostlinná interakce |
| Hungarian | Gyógynövény kölcsönhatás |
