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Herbal medicine (also herbalism) is the study of
pharmacognosy Pharmacognosy is the study of plants or other natural sources as a possible source of drug File:Aspirine macro shot.jpg, Uncoated aspirin Tablet (pharmacy), tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of ine ...
and the use of
medicinal plants upright=1.3, Medicinal plants Medicinal plants, also called medicinal herbs, have been discovered and used in traditional medicine practices since prehistoric times. Plants Plants are mainly multicellular organisms, predominantly photosy ...
, which are a basis of
traditional medicine Traditional medicine (also known as indigenous or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefIn folkloristics, folk belief or folk-belief is a broad genre of folklor ...

traditional medicine
. There is limited
scientific evidence Scientific evidence is evidence Evidence for a proposition is what supports this proposition. It is usually understood as an indication that the supported proposition is true. What role evidence plays and how it is conceived varies from field to ...
for the safety and efficacy of plants used in 21st century herbalism, which generally does not provide standards for purity or dosage. The scope of herbal medicine commonly includes
fungal A fungus (plural The plural (sometimes list of glossing abbreviations, abbreviated ), in many languages, is one of the values of the grammatical number, grammatical category of number. The plural of a noun typically denotes a quantity great ...

fungal
and
bee Bees are flying insect Insects or Insecta (from Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known ...
products, as well as
minerals In geology and mineralogy, a mineral or mineral species is, broadly speaking, a solid chemical compound with a fairly well-defined chemical composition and a specific crystal structure that occurs naturally in pure form.John P. Rafferty, ed. (20 ...
,
shells Shell may refer to: Architecture and design * Shell (structure), a thin structure **Concrete shell, a thin shell of concrete, usually with no interior columns or exterior buttresses **Thin-shell structure, **Oil company Science Biology * Seashell ...
and certain animal parts. Herbal medicine is also called phytomedicine or phytotherapy. Paraherbalism describes
alternative ''AlterNative: An International Journal of Indigenous Peoples'' (formerly ''AlterNative: An International Journal of Indigenous Scholarship'') is a quarterly peer-reviewed Peer review is the evaluation of work by one or more people with simi ...
and
pseudoscientific Pseudoscience consists of statements, belief A belief is an Attitude (psychology), attitude that something is the case, or that some proposition about the world is truth, true. In epistemology, philosophers use the term "belief" to refer to ...
practices of using unrefined plant or animal
extract An extract is a substance made by extracting a part of a raw material, often by using a solvent A solvent (from the Latin language, Latin ''wikt:solvo#Latin, solvō'', "loosen, untie, solve") is a substance that dissolves a solute, resulting ...

extract
s as unproven medicines or health-promoting agents. Paraherbalism relies on the belief that preserving various substances from a given source with less processing is safer or more effective than manufactured products, a concept for which there is no evidence.


History

Archaeological evidence indicates that the use of
medicinal plant upright=1.3, Medicinal plants Medicinal plants, also called medicinal herbs, have been discovered and used in traditional medicine practices since prehistoric times. Plants Plants are mainly multicellular organisms, predominantly photosy ...

medicinal plant
s dates back to the
Paleolithic The Paleolithic or Palaeolithic or Palæolithic (), also called the Old Stone Age, is a period in human prehistory distinguished by the original development of stone tools that covers  99% of the period of human technological prehistory. ...
age, approximately 60,000 years ago. Written evidence of herbal remedies dates back over 5,000 years to the
Sumer Sumer ()The name is from Akkadian '; Sumerian ''kig̃ir'', written and ,approximately "land of the civilized kings" or "native land". means "native, local", iĝir NATIVE (7x: Old Babylonian)from ''The Pennsylvania Sumerian Dictionary''). ...

Sumer
ians, who compiled lists of plants. Some ancient cultures wrote about plants and their medical uses in books called ''
herbal A herbal is a book containing the names and descriptions of plants, usually with information on their medicinal, tonic, culinary, toxic Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage a ...

herbal
s''. In ancient Egypt, herbs are mentioned in
Egyptian medical papyri Egyptian medical papyri are ancient Egypt Ancient Egypt was a civilization of Ancient history, ancient North Africa, concentrated along the lower reaches of the Nile, Nile River, situated in the place that is now the country Egypt. Ancient ...
, depicted in tomb illustrations, or on rare occasions found in medical jars containing trace amounts of herbs. In ancient Egypt, the
Ebers papyrus The Ebers Papyrus, also known as Papyrus Ebers, is an Egyptian medical papyrus of herbal knowledge dating to circa 1550 BC. Among the oldest and most important medical papyri of ancient Egypt Ancient Egypt was a civilization of Ancient ...
dates from about 1550 BC, and covers more than 700 compounds, mainly of plant origin. The earliest known
Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population is approximately 10.7 million as of 2018; Athens is ...
herbals came from
Theophrastus Theophrastus (; grc-gre, Θεόφραστος ''Theόphrastos''; c. 371c. 287 BC), a Greek native of Eresos in Lesbos,Gavin Hardy and Laurence Totelin, ''Ancient Botany'', Routledge, 2015, p. 8. was the successor to Aristotle in the Peripatet ...

Theophrastus
of Eresos who, in the 4th century BC, wrote in
Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population is approximately 10.7 million as of 2018; Athens is ...
'' Historia Plantarum'', from
Diocles of CarystusDiocles of Carystus (; el, Διοκλῆς ὁ Καρύστιος; la, Diocles Carystius; also known by the Latin name Diocles Medicus, i.e. "Diocles the physician"; c. 375 BC – c. 295 BC) was a well-regarded Greek Greek may refer to: Greece A ...
who wrote during the 3rd century BC, and from Krateuas who wrote in the 1st century BC. Only a few fragments of these works have survived intact, but from what remains, scholars noted overlap with the Egyptian herbals. Seeds likely used for herbalism were found in archaeological sites of
Bronze Age The Bronze Age is a prehistoric Periodization, period that was characterized by the use of bronze, in some areas proto-writing, and other early features of urban civilization. The Bronze Age is the second principal period of the Three-age syst ...
China dating from the
Shang dynasty The Shang dynasty (), also historically known as the Yin dynasty (), was a Chinese dynasty that ruled in the middle and lower Yellow River valley in the second millennium BC, succeeding the Xia dynasty and followed by the Zhou dynasty. ...

Shang dynasty
(c. 1600–1046 BC). Over a hundred of the 224 compounds mentioned in the ''
Huangdi Neijing ''Huangdi Neijing'' (), literally the ''Inner Canon of the Yellow Emperor'' or ''Esoteric Scripture of the Yellow Emperor'', is an ancient Chinese medical text that has been treated as the fundamental doctrinal source for Chinese medicine for mo ...
'', an early Chinese medical text, are herbs. Herbs were also commonly used in the
traditional medicine Traditional medicine (also known as indigenous or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefIn folkloristics, folk belief or folk-belief is a broad genre of folklor ...

traditional medicine
of ancient India, where the principal treatment for diseases was diet. ''
De Materia Medica (Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Latium. Through the power of the Roman Republic, ...
'', originally written in Greek by
Pedanius Dioscorides Pedanius Dioscorides ( grc-gre, Πεδάνιος Διοσκουρίδης, ; 40–90 AD) was a Greek physician, pharmacologist, botanist, and author of ''De materia medica'' (, On Medical Material) —a 5-volume Greek encyclopedia about herbal me ...
(c. 40–90 AD) of
Anazarbus 200px, Anazarbus West Gate Anazarbus ( grc, Ἀναζαρβός, medieval Ain Zarba; modern Anavarza; ar, عَيْنُ زَرْبَة) was an ancient Cilicia Cilicia (); el, Κιλικία, ''Kilikía''; Middle Persian: ''klkyʾy'' (''Kliki ...
,
Cilicia Cilicia (); el, Κιλικία, ''Kilikía''; Middle Persian: ''klkyʾy'' (''Klikiyā''), Parthian language, Parthian: ''kylkyʾ'' (''Kilikiyā''), tr, Kilikya). is a geo-cultural region in southern Turkey, extending inland from the northeastern ...
, a physician and botanist, is one example of herbal writing used over centuries until the 1600s.


Modern herbal medicine

The
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment ...
(WHO) estimates that 80 percent of the population of some Asian and African countries presently use herbal medicine for some aspect of primary health care. Some
prescription drug A prescription drug (also prescription medication or prescription medicine) is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The r ...
s have a basis as herbal remedies, including
artemisinin Artemisinin () and its semisynthetic derivatives are a group of drugs Uncoated tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and binders. Aspirin is a pharmaceutical drug A medicati ...

artemisinin
,
aspirin Aspirin, also known as acetylsalicylic acid (ASA), is a medication A medication (also referred to as medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, therapy, treat, or prev ...

aspirin
,
digitalis '' ''Digitalis'' ( or ) is a genus Genus (plural genera) is a taxonomic rank Taxonomy (general) is the practice and science of classification of things or concepts, including the principles that underlie such classification. The term may ...
, and
quinine Quinine is a medication used to treat malaria and babesiosis. This includes the treatment of malaria due to '' Plasmodium falciparum'' that is resistant to chloroquine when artesunate is not available. While sometimes used for restless legs ...

quinine
.


Regulatory review

In 2015, the
Australian Government's Department of Health Australians, colloquially referred to as "Aussies", are the citizens, nationality, nationals and individuals associated with the country of Australia. Between 1788 and the Second World War, the vast majority of settlers and immigrants came ...
published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by
health insurance Health insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance is risk among many individuals. By estimating the overall risk of health risk and healt ...
; herbalism was one of 17 topics evaluated for which no clear evidence of effectiveness was found. Establishing guidelines to assess safety and efficacy of herbal products, the
European Medicines Agency The European Medicines Agency (EMA) is an agency of the European Union (EU) in charge of the evaluation and supervision of medicinal products. Prior to 2004, it was known as the European Agency for the Evaluation of Medicinal Products or Euro ...
provided criteria in 2017 for evaluating and grading the quality of clinical research in preparing monographs about herbal products. In the United States, the
National Center for Complementary and Integrative Health The National Center for Complementary and Integrative Health (NCCIH) is a United States government agency which explores complementary and alternative medicine (CAM). It was initially created as the Office of Alternative Medicine (OAM), and ren ...
of the
National Institutes of Health The National Institutes of Health (NIH ) is the primary agency of the United States government The federal government of the United States (U.S. federal government) is the national government of the United States The United Sta ...
funds clinical trials on herbal compounds, provides fact sheets evaluating the safety, potential effectiveness and side effects of many plant sources, and maintains a registry of clinical research conducted on herbal products. According to
Cancer Research UK Cancer Research UK is a cancer research and awareness charity in the United Kingdom and Isle of Man, formed on 4 February 2002 by the merger of The Cancer Research Campaign and the Imperial Cancer Research Fund. As the world's largest independent ...
as of 2015, "there is currently no strong evidence from studies in people that herbal remedies can treat, prevent or cure cancer".


Prevalence of use

The use of herbal remedies is more prevalent in people with chronic diseases, such as cancer,
diabetes Diabetes mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased appeti ...
,
asthma Asthma is a chronic (medicine), long-term inflammation, inflammatory disease of the bronchi, airways of the lungs. It is characterized by variable and recurring symptoms, reversible Airway obstruction, airflow obstruction, and easily triggered b ...
and
end-stage kidney disease Chronic kidney disease (CKD) is a type of kidney disease The kidneys are two reddish-brown bean-shaped organs found in vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular eukary ...
. Multiple factors such as gender, age, ethnicity, education and social class are also shown to have association with prevalence of herbal remedies use.


Herbal preparations

There are many forms in which herbs can be administered, the most common of which is a liquid consumed as a herbal tea or a (possibly diluted) plant extract.
Herbal tea Herbal teas—less commonly called tisanes (UK and US , US also )—are beverages made from the infusion or decoction of herb In general use, herbs are plants with savory or aromatic properties that are used for flavoring and garnishing foo ...

Herbal tea
s, or tisanes, are the resultant liquid of extracting herbs into water, though they are made in a few different ways.
Infusion Infusion is the process of extracting chemical compounds or flavors from plant material in a solvent such as water, edible oil, oil or alcohol, by allowing the material to remain suspended in the solvent over time (a process often called steepin ...

Infusion
s are hot water extracts of herbs, such as
chamomile Chamomile (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. Currently, American English ...

chamomile
or
mint MiNT is Now TOS (MiNT) is a free software Free software (or libre software) is computer software Software is a collection of Instruction (computer science), instructions and data (computing), data that tell a computer how to work. This ...
, through
steeping Steeping is the soaking of an organic solid, such as leaves, in a liquid (usually water) to extract flavours or to soften it. The specific process of teas being prepared for drinking by leaving the leaves in heated water to release the flavour an ...
.
Decoction Decoction is a method of extraction by boiling herbal A herbal is a book containing the names and descriptions of plants, usually with information on their medicinal, tonic, culinary, toxic Toxicity is the degree to which a chemical substa ...
s are the long-term boiled extracts, usually of harder substances like roots or bark. Maceration is the cold infusion of plants with high
mucilage Mucilage is a thick, gluey substance produced by nearly all plant Plants are mainly multicellular organisms, predominantly photosynthetic Photosynthesis is a process used by plants and other organisms to Energy transformation, convert ...
-content, such as sage or
thyme Thyme () is the herb (dried aerial parts) of some members of the genus ''thymus (plant), Thymus'' of aromatic perennial evergreen herbs in the mint family Lamiaceae. Thymes are relatives of the oregano genus ''Origanum''. They have culinary, medic ...

thyme
. To make macerates, plants are chopped and added to cold water. They are then left to stand for 7 to 12 hours (depending on herb used). For most macerates, 10 hours is used.
Tincture A tincture is typically an extract of plant or animal material dissolution (chemistry), dissolved in ethanol (ethyl alcohol). Solvent concentrations of 25–60% are common, but may run as high as 90%.Groot Handboek Geneeskrachtige Planten by Gee ...
s are alcoholic extracts of herbs, which are generally stronger than herbal teas. Tinctures are usually obtained by combining 100% pure ethanol (or a mixture of 100% ethanol with water) with the herb. A completed tincture has an ethanol percentage of at least 25% (sometimes up to 90%).Groot Handboek Geneeskrachtige Planten by Geert Verhelst Non-alcoholic tinctures can be made with glycerin but it is believed to be less absorbed by the body than alcohol based tinctures and has a shorter shelf life. Herbal wine and
elixir An elixir is a sweet liquid used for medical purposes, to be taken orally and intended to cure one's illness. When used as a pharmaceutical preparation, an elixir contains at least one active ingredient designed to be taken orally. Etymology Th ...
s are alcoholic extract of herbs, usually with an ethanol percentage of 12–38%.
Extract An extract is a substance made by extracting a part of a raw material, often by using a solvent A solvent (from the Latin language, Latin ''wikt:solvo#Latin, solvō'', "loosen, untie, solve") is a substance that dissolves a solute, resulting ...

Extract
s include liquid extracts, dry extracts, and nebulisates. Liquid extracts are liquids with a lower ethanol percentage than tinctures. They are usually made by vacuum
distilling Distillation, or classical distillation, is the process of separation process, separating the components or substances from a liquid mixture by using selective boiling and condensation. Dry distillation is the heating of solid materials to produ ...
tinctures. Dry extracts are extracts of plant material that are into a dry mass. They can then be further refined to a capsule or tablet. The exact composition of an herbal product is influenced by the method of extraction. A tea will be rich in
polar Polar may refer to: Geography Polar may refer to: * Geographical pole, either of two fixed points on the surface of a rotating body or planet, at 90 degrees from the equator, based on the axis around which a body rotates *Polar climate, the clim ...
components because water is a
polar solvent A solvent (from the Latin language, Latin ''wikt:solvo#Latin, solvō'', "loosen, untie, solve") is a substance that dissolves a solute, resulting in a solution. A solvent is usually a liquid but can also be a solid, a gas, or a supercritical flui ...
. Oil on the other hand is a non-polar solvent and it will absorb non-polar compounds. Alcohol lies somewhere in between. Many herbs are applied topically to the skin in a variety of forms.
Essential oil An essential oil is a concentrated hydrophobic In chemistry Chemistry is the scientific discipline involved with Chemical element, elements and chemical compound, compounds composed of atoms, molecules and ions: their composition, s ...
extracts can be applied to the skin, usually diluted in a carrier oil. Many essential oils can burn the skin or are simply too high dose used straight; diluting them in olive oil or another food grade oil such as almond oil can allow these to be used safely as a topical.
Salve A salve is a medical ointment A topical medication is a medication A medication (also referred to as medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, therapy, treat, or p ...

Salve
s, oils, balms, creams and lotions are other forms of topical delivery mechanisms. Most topical applications are oil extractions of herbs. Taking a food grade oil and soaking herbs in it for anywhere from weeks to months allows certain phytochemicals to be extracted into the oil. This oil can then be made into salves, creams, lotions, or simply used as an oil for topical application. Many massage oils, antibacterial salves, and wound healing compounds are made this way.
Inhalation Inhalation happens when air or other gases enter the lungs. Inhalation of air Inhalation of air, as part of the cycle of breathing Breathing (or ventilation) is the process of moving air out and in the lungs to facilitate gas exchange w ...

Inhalation
, as in
aromatherapy Aromatherapy is a pseudoscience based on the usage of aromatic materials, including essential oils, and other aroma compounds, with claims for improving psychological or physical well-being. It is offered as a complementary therapy or as a form ...

aromatherapy
, can be used as a treatment.


Safety

Consumption of herbs may cause
adverse effect An adverse effect is an undesired harmful effect resulting from a Pharmaceutical drug, medication or other Surgery#Definitions, intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main o ...
s. Furthermore, "adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal." Proper double-blind clinical trials are needed to determine the safety and efficacy of each plant before medical use. Although many consumers believe that herbal medicines are safe because they are natural, herbal medicines and synthetic drugs may interact, causing toxicity to the consumer. Herbal remedies can also be dangerously contaminated, and herbal medicines without established efficacy, may unknowingly be used to replace prescription medicines. Standardization of purity and dosage is not mandated in the United States, but even products made to the same specification may differ as a result of biochemical variations within a species of plant. Plants have chemical defense mechanisms against predators that can have adverse or lethal effects on humans. Examples of highly toxic herbs include poison hemlock and nightshade. They are not marketed to the public as herbs, because the risks are well known, partly due to a long and colorful history in Europe, associated with "sorcery", "magic" and intrigue. Although not frequent, adverse reactions have been reported for herbs in widespread use. On occasion serious untoward outcomes have been linked to herb consumption. A case of major potassium depletion has been attributed to chronic licorice ingestion, and consequently professional herbalists avoid the use of licorice where they recognize that this may be a risk. Black cohosh has been implicated in a case of liver failure. Few studies are available on the safety of herbs for pregnant women, and one study found that use of complementary and alternative medicines are associated with a 30% lower ongoing pregnancy and live birth rate during fertility treatment. Examples of herbal treatments with likely cause-effect relationships with adverse events include aconite, which is often a legally restricted herb, ayurvedic remedies, broom, chaparral, Chinese herb mixtures, comfrey, herbs containing certain flavonoids, germander, guar gum, liquorice root, and pennyroyal. Examples of herbs that may have long-term adverse effects include ginseng, which is unpopular among herbalists for this reason, the endangered herb goldenseal, milk thistle, senna, against which herbalists generally advise and rarely use, aloe vera juice, buckthorn bark and berry, cascara sagrada bark, saw palmetto, valerian, kava, which is banned in the European Union, St. John's wort, khat, betel nut, the restricted herb ephedra, and guarana. There is also concern with respect to the numerous well-established interactions of herbs and drugs. In consultation with a physician, usage of herbal remedies should be clarified, as some herbal remedies have the potential to cause adverse drug interactions when used in combination with various prescription and
over-the-counter Over-the-counter (OTC) drugs are medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patient and managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment or Palliat ...
pharmaceuticals, just as a patient should inform a herbalist of their consumption of orthodox prescription and other medication. For example, dangerously low blood pressure may result from the combination of an herbal remedy that lowers blood pressure together with prescription medicine that has the same effect. Some herbs may amplify the effects of anticoagulants. Certain herbs as well as common fruit interfere with cytochrome P450, an enzyme critical to much drug metabolism. In a 2018 study, FDA identified active in over 700 of analyzed dietary supplements sold as "herbal", "natural" or "traditional". The undisclosed additives included "unapproved antidepressants and designer steroids", as well as
prescription drug A prescription drug (also prescription medication or prescription medicine) is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The r ...
s, such as
sildenafil Sildenafil, sold under the brand name Viagra among others, is a medication used to treat erectile dysfunction and pulmonary hypertension, pulmonary arterial hypertension. It is unclear if it is effective for treating sexual dysfunction in wo ...

sildenafil
or .


Labeling accuracy

A 2013 study found that one-third of herbal supplements sampled contained no trace of the herb listed on the label. The study found products adulterated with contaminants or fillers not listed on the label, including potential allergens such as soy, wheat, or black walnut. One bottle labeled as
St. John's wort ''Hypericum perforatum'', known as perforate St John's-wort, is a flowering plant The flowering plants, also known as Angiospermae (), or Magnoliophyta (), are the most diverse group of Embryophyte, land plants, with 64 Order(biology), orders ...
was found to actually contain '' Alexandrian senna'', a laxative. Researchers at the
University of Adelaide The University of Adelaide (informally Adelaide University) is a public university A public university or public college is a university or college that is in state ownership or receives significant Government spending, public funds through a ...

University of Adelaide
found in 2014 that almost 20 percent of herbal remedies surveyed were not registered with the Therapeutic Goods Administration, despite this being a condition for their sale. They also found that nearly 60 percent of products surveyed had ingredients that did not match what was on the label. Out of 121 products, only 15 had ingredients that matched their TGA listing and packaging. In 2015, the
New York Attorney General The Attorney General of New York is the chief legal officer of the U.S. state of New York and head of the Department of Law of the state government. The office has been in existence in some form since 1626, under the New Netherland, Dutch colon ...
issued
cease and desist A cease and desist letter is a document sent to an individual or business to stop allegedly illegal activity. The phrase "cease and desist" is a legal doublet, made up of two near-synonyms. The letter may warn that, if the recipient does not disc ...
letters to four major U.S. retailers ( GNC,
Target TARGET2 (Trans-European Automated Real-time Gross Settlement Express Transfer System) is the real-time gross settlement (RTGS) system for the Eurozone, and is available to non-Eurozone countries. It was developed by and is owned by the Eurosystem. ...
,
Walgreens Walgreen Company, d/b/a Walgreens, is an American company that operates as the second-largest Pharmacy (shop), pharmacy store chain in the United States behind CVS Health. It specializes in filling prescriptions, health and wellness products, health ...

Walgreens
, and
Walmart Walmart Inc. (; formerly Wal-Mart Stores, Inc.) is an American multinational retail corporation that operates a chain of hypermarkets, discount department stores, and grocery stores from the United States The United States of Americ ...

Walmart
) who were accused of selling herbal supplements that were mislabeled and potentially dangerous. Twenty-four products were tested by
DNA barcoding DNA barcoding is a method of species identification using a short section of DNA The structure of part of a DNA double helix Deoxyribonucleic acid (; DNA) is a molecule File:Pentacene on Ni(111) STM.jpg, A scanning tunneling microsco ...
as part of the investigation, with all but five containing DNA that did not match the product labels.


Practitioners of herbalism

In some countries, formalized training and minimum education standards exist for herbalists, although these are not necessarily uniform within or between countries. In Australia, for example, the self-regulated status of the profession (as of 2009) resulted in variable standards of training, and numerous loosely-formed associations setting different educational standards. One 2009 review concluded that regulation of herbalists in Australia was needed to reduce the risk of interaction of herbal medicines with
prescription drug A prescription drug (also prescription medication or prescription medicine) is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The r ...
s, to implement clinical guidelines and prescription of herbal products, and to assure self-regulation for protection of public health and safety. In the United Kingdom, the training of herbalists is done by state-funded universities offering Bachelor of Science degrees in herbal medicine. In the United States, according to the American Herbalist Guild, "there is currently no licensing or certification for herbalists in any state that precludes the rights of anyone to use, dispense, or recommend herbs." However, there are U.S. federal restrictions for marketing herbs as cures for medical conditions, or essentially practicing as an unlicensed physician.


United States herbalism fraud

Over the years 2017–21, the
U.S. Food and Drug Administration The United States of America (USA), commonly known as the United States (U.S. or US), or America, is a country primarily located in North America North America is a continent entirely within the Northern Hemisphere and almost all ...

U.S. Food and Drug Administration
(FDA) issued warning letters to numerous herbalism companies for illegally marketing products under "conditions that cause them to be drugs under section 201(g)(1) of the Act 1 U.S.C. § 321(g)(1) because they are intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease and/or intended to affect the structure or any function of the body" when no such evidence existed. During the
COVID-19 pandemic The COVID-19 pandemic is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identified from an outbreak in the Chinese city of ...

COVID-19 pandemic
, the FDA and U.S.
Federal Trade Commission The Federal Trade Commission (FTC) is an independent agency of the United States government Independent or Independents may refer to: Arts, entertainment, and media Artist groups * Independents (artist group)The Independents were a group of Mode ...

Federal Trade Commission
issued warnings to several hundred American companies for promoting false claims that herbal products could prevent or treat COVID-19 disease.


Government regulations

The
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment ...
(WHO), the specialized agency of the United Nations (UN) that is concerned with international public health, published ''Quality control methods for medicinal plant materials'' in 1998 to support WHO Member States in establishing quality standards and specifications for herbal materials, within the overall context of quality assurance and control of herbal medicines. In the
European Union The European Union (EU) is a political and economic union of Member state of the European Union, member states that are located primarily in Europe. Its members have a combined area of and an estimated total population of about 447million ...

European Union
(EU), herbal medicines are regulated under the
Committee on Herbal Medicinal ProductsThe Committee on Herbal Medicinal Products (HMPC), is the European Medicines Agency The European Medicines Agency (EMA) is an agency of the European Union (EU) in charge of the evaluation and supervision of medicinal products. Prior to 2004, i ...
. In the United States, herbal remedies are regulated
dietary supplements A dietary supplement is a manufactured product intended to supplement one's diet by taking a pill (pharmacy), pill, capsule (pharmacy), capsule, tablet (pharmacy), tablet, powder, or liquid. A supplement can provide nutrients either extra ...
by the
Food and Drug Administration The United States The United States of America (USA), commonly known as the United States (U.S. or US), or America, is a country Contiguous United States, primarily located in North America. It consists of 50 U.S. state, states, a Wash ...
(FDA) under
current good manufacturing practice Good manufacturing practices (GMP) are the practices required in order to conform to the guidelines recommended by agencies that control the authorization and licensing of the manufacture and sale of Food industry, food and Drink industry, beverage ...
(cGMP) policy for dietary supplements. Manufacturers of products falling into this category are not required to prove the safety or efficacy of their product so long as they do not make 'medical' claims or imply uses other than as a 'dietary supplement', though the FDA may withdraw a product from sale should it prove harmful. Canadian regulations are described by the Natural and Non-prescription Health Products Directorate which requires an eight-digit Natural Product Number or Homeopathic Medicine Number on the label of licensed herbal medicines or dietary supplements. Some herbs, such as
cannabis ''Cannabis'' () is a genus of flowering plants in the family Cannabaceae. The number of species within the genus is disputed. Three species may be recognized: ''Cannabis sativa'', ''Cannabis indica'', and ''Cannabis ruderalis''; ''C. ruderalis ...
and
coca Coca is any of the four cultivated plants in the family (biology), family Erythroxylaceae, native to western South America. Coca is known worldwide for its Psychoactive plant, psychoactive alkaloid, cocaine. The plant is grown as a cash crop in ...

coca
, are outright banned in most countries though coca is legal in most of the South American countries where it is grown. The is used as an herbal
medicine Medicine is the science Science (from the Latin word ''scientia'', meaning "knowledge") is a systematic enterprise that Scientific method, builds and Taxonomy (general), organizes knowledge in the form of Testability, testable explanations ...

medicine
, and as such is
legal Law is a system of rules created and law enforcement, enforced through social or governmental institutions to regulate behavior,Robertson, ''Crimes against humanity'', 90. with its precise definition a matter of longstanding debate. It has be ...
in some parts of the world. Since 2004, the sales of
ephedra , an alkaloid found in ephedra Ephedra is a medicinal preparation from the plant '' Ephedra sinica''. Several additional species belonging to the genus ''Ephedra (genus), Ephedra'' have traditionally been used for a variety of medicinal purposes, ...
as a dietary supplement is prohibited in the United States by the FDA, and subject to Schedule III restrictions in the United Kingdom.


Scientific criticism

Herbalism has been criticized as a potential "
minefield A land mine is an explosive device concealed under or on the ground and designed to destroy or disable enemy targets, ranging from combatants to vehicles and tanks, as they pass over or near it. Such a device is typically detonated automatical ...
" of unreliable product quality, safety hazards, and potential for misleading health advice. Globally, there are no standards across various herbal products to authenticate their contents, safety or efficacy, and there is generally an absence of high-quality scientific research on product composition or effectiveness for anti-disease activity. Presumed claims of therapeutic benefit from herbal products, without rigorous evidence of efficacy and safety, receive skeptical views by scientists. Unethical practices by some herbalists and manufacturers, which may include false advertising about health benefits on product labels or literature, and contamination or use of fillers during product preparation, may erode
consumer confidence Consumer confidence is an economic indicator that measures the degree of optimism that consumer A consumer is a person or a group who intends to order, orders, or uses purchased goods, products, or Service (economics), services primarily for pers ...
about services and products.


Paraherbalism

Paraherbalism is the
pseudoscientific Pseudoscience consists of statements, belief A belief is an Attitude (psychology), attitude that something is the case, or that some proposition about the world is truth, true. In epistemology, philosophers use the term "belief" to refer to ...
use of
extract An extract is a substance made by extracting a part of a raw material, often by using a solvent A solvent (from the Latin language, Latin ''wikt:solvo#Latin, solvō'', "loosen, untie, solve") is a substance that dissolves a solute, resulting ...

extract
s of plant or animal origin as supposed medicines or health-promoting agents. Phytotherapy differs from plant-derived medicines in standard
pharmacology Pharmacology is a branch of medicine, biology and pharmaceutical sciences concerned with drug or medication action, where a drug may be defined as any artificial, natural, or endogenous (from within the body) molecule which exerts a biochemical ...
because it does not isolate and standardize the compounds from a given plant believed to be biologically active. It relies on the false belief that preserving the complexity of substances from a given plant with less processing is safer and potentially more effective, for which there is no evidence either condition applies. Phytochemical researcher
Varro Eugene Tyler Varro Eugene Tyler (December 19, 1926 – August 22, 2001), of Auburn, Nebraska, was an American professor of pharmacognosy and philately, philatelist who specialized in the study of forged postage stamps and the forgers who created them. Academi ...
described paraherbalism as "faulty or inferior herbalism based on pseudoscience", using scientific terminology but lacking scientific evidence for safety and efficacy. Tyler listed ten
fallacies A fallacy is the use of invalid or otherwise faulty reason Reason is the capacity of consciously making sense of things, applying logic Logic (from Ancient Greek, Greek: grc, wikt:λογική, λογική, label=none, lit=possessed of ...
that distinguished herbalism from paraherbalism, including claims that there is a
conspiracy A conspiracy, also known as a plot, is a secret plan or agreement between persons (called conspirers or conspirators) for an unlawful or harmful purpose, such as murder or treason Treason is the crime of attacking a Sovereign state, state a ...
to suppress safe and effective herbs, herbs can not cause harm, that whole herbs are more effective than molecules isolated from the plants, herbs are superior to drugs, the
doctrine of signatures The doctrine of signatures, dating from the time of Dioscorides and Galen, states that herbs resembling various parts of the body can be used by herbalists to treat ailments of those body parts. A theological justification, as stated by botanist ...
(the belief that the shape of the plant indicates its function) is valid, dilution of substances increases their potency (a doctrine of the pseudoscience of
homeopathy Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine Medicine is the Art (skill), art, science, and Praxis (process) ...
), astrological alignments are significant, animal testing is not appropriate to indicate human effects,
anecdotal evidence Anecdotal evidence is evidence Evidence, broadly construed, is anything presented in support of an assertion, because evident things are undoubted. There are two kind of evidence: intellectual evidence (the obvious, the evident) and empirical ...
is an effective means of proving a substance works and herbs were created by God to cure disease. Tyler suggests that none of these beliefs have any basis in fact.


Traditional systems


Africa

Up to 80% of the population in Africa uses traditional medicine as primary health care.


Americas

Native Americans used about 2,500 of the approximately 20,000 plant species that are native to North America. In
Andean The Andes, Andes Mountains or Andean Mountains ( es, Cordillera de los Andes) are the longest continental mountain range in the world, forming a continuous highland along the western edge of South America South America is a continent e ...

Andean
healing practices, the use of
Entheogen Entheogens are psychoactive substances that induce alterations in perception, mood (psychology), mood, consciousness, cognition, or behavior for the purposes of engendering spiritual development or otherwiseRätsch, Christian, ''The Encyclope ...
s, in particular the San Pedro cactus (''
Echinopsis pachanoi ''Echinopsis pachanoi'' (syn. ''Trichocereus pachanoi'') — known as San Pedro cactus — is a fast-growing columnar cactus A cactus (plural cacti, cactuses, or less commonly, cactus) is a member of the plant Plants are mainly mul ...

Echinopsis pachanoi
'') is still a vital component, and has been around for millennia.


China

Some researchers trained in both Western and
traditional Chinese medicine Traditional Chinese medicine (TCM) is a branch of traditional medicine in China. It has been described as "fraught with pseudoscience", and the majority of its treatments as having no logical mechanism of action. TCM is said to be based on Com ...
have attempted to deconstruct ancient medical texts in the light of modern science. In 1972, Tu Youyou, a pharmaceutical chemist, extracted the anti-malarial drug
artemisinin Artemisinin () and its semisynthetic derivatives are a group of drugs Uncoated tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and binders. Aspirin is a pharmaceutical drug A medicati ...

artemisinin
from sweet wormwood, a
traditional Chinese A tradition is a belief A belief is an Attitude (psychology), attitude that something is the case, or that some proposition about the world is truth, true. In epistemology, philosophers use the term "belief" to refer to attitudes about the wo ...
treatment for intermittent fevers.


India

In India,
Ayurvedic medicine Ayurveda () is an alternative medicine system with historical roots in the Indian subcontinent. The theory and practice of Ayurveda is pseudoscientific. The Indian Medical Association (IMA) characterises the practice of modern medicine by A ...
has quite complex formulas with 30 or more ingredients, including a sizable number of ingredients that have undergone " alchemical processing", chosen to balance
dosha ''Dosha'' ( sa, दोषः, IAST The International Alphabet of Sanskrit Transliteration (IAST) is a transliteration scheme that allows the lossless romanisation of Brahmic family, Indic scripts as employed by Sanskrit and related Indic la ...
. In Ladakh, Lahul-Spiti and Tibet, the Tibetan Medical System is prevalent, also called the 'Amichi Medical System'. Over 337 species of
medicinal plant upright=1.3, Medicinal plants Medicinal plants, also called medicinal herbs, have been discovered and used in traditional medicine practices since prehistoric times. Plants Plants are mainly multicellular organisms, predominantly photosy ...

medicinal plant
s have been documented by C.P. Kala. Those are used by Amchis, the practitioners of this medical system. The Indian book, Vedas, mentions treatment of diseases with plants.


Indonesia

In
Indonesia Indonesia ( ), officially the Republic of Indonesia ( id, Republik Indonesia, links=yes ), is a country in Southeast Asia and Oceania between the Indian Ocean, Indian and Pacific Ocean, Pacific oceans. It consists of more than List of islands ...

Indonesia
, especially among the Javanese, the traditional herbal medicine may have originated in the
Mataram Kingdom The Medang Kingdom () or Mataram Kingdom () was a Javanese Hinduism, Hindu–Buddhism, Buddhist kingdom that flourished between the 8th and 11th centuries. It was based in Central Java, and later in East Java. Established by King Sri Sanjaya, S ...

Mataram Kingdom
era, some 1300 years ago. The
bas-relief Relief is a sculptural technique in which the sculpted elements remain attached to a solid background of the same material. The term ''wikt:relief, relief'' is from the Latin verb ''relevo'', to raise. To create a sculpture in relief is to give t ...
s on
Borobudur Borobudur, also transcribed Barabudur ( id, Candi Borobudur, jv, ꦕꦤ꧀ꦝꦶꦧꦫꦧꦸꦝꦸꦂ, Candhi Barabudhur) is a 7th-century Mahayana Mahāyāna (; "Great Vehicle") is a term for a broad group of Buddhist traditions, texts, phil ...

Borobudur
depict the image of people grinding herbs with stone
mortar and pestle Mortar and pestle is a set of two simple tool A tool is an object that can extend an individual's ability to modify features of the surrounding environment. Although many animals use simple tools, only human beings, whose use of stone tool ...

mortar and pestle
, a drink seller, an herbalist, and
masseuse Massage is the manipulation of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet, or a device. The purpose of massage is generally for the treatment of body stress or pain. A perso ...
treating people. The Madhawapura inscription from
Majapahit The Majapahit () was a Javanese Hindu Hindus () are persons who regard themselves as culturally, ethnically, or religiously adhering to aspects of Hinduism Hinduism () is an Indian religion and ''dharma'', or way of life. It i ...

Majapahit
period mentioned a specific profession of herbs mixer and combiner (herbalist), called ''Acaraki''. The book from Mataram dated from circa 1700 contains 3,000 entries of jamu herbal recipes, while Javanese classical literature
Serat Centhini ''Serat Centhini'' is a twelve volume compilation of Javanese tales and teachings, written in verse and published in 1814. The work was commissioned, directed and partially written by Crown Prince Mangkunegoro, later enthroned as Pakubuwono V of ...
(1814) describes some jamu herbal concoction recipes. Though possibly influenced by Indian
Ayurveda Ayurveda () is an alternative medicine system with historical roots in the Indian subcontinent. The theory and practice of Ayurveda is pseudoscience, pseudoscientific. The Indian Medical Association (IMA) characterises the practice of modern me ...

Ayurveda
systems, the Indonesia archipelago holds numerous indigenous plants not found in India, including plants similar to those in Australia beyond the
Wallace Line 250px, Wallace's Line delineates Australian and Southeast Asian fauna. The probable extent of land at the time of the last glacial maximum, when the sea level was more than lower than today, is shown in grey. The deep water of the Lombok Strait ...
. Jamu practices may vary from region to region, and are often not recorded, especially in remote areas of the country. Although primarily herbal, some Jamu materials are acquired from animals, such as
honey Honey is a sweet, viscous food substance made by honey bees A honey bee (also spelled honeybee) is a eusocial flying insect within the genus Genus (plural genera) is a taxonomic rank Taxonomy (general) is the practice and science o ...
,
royal jelly Image:Weiselzellen 68a.jpg, 300px, Developing queen larvae surrounded by royal jelly Royal jelly is a honey bee secretion that is used in the nutrition of larvae and adult Queen bee, queens. It is secreted from the glands in the Insect mouthparts# ...
, milk and '' Ayam Kampung''
eggs An egg is an organic vessel in which an embryo begins to develop. Egg or eggs may also refer to: Food * Egg as food Eggs are laid by female animals of many different species, including bird egg, birds, reptiles, amphibians, a few monotreme, ...

eggs
.


Beliefs

Herbalists tend to use extracts from parts of plants, such as the roots or leaves, believing that plants are subject to environmental pressures and therefore develop resistance to threats such as radiation,
reactive oxygen species Reactive oxygen species (ROS) are highly reactive Reactive may refer to: *Generally, capable of having a reaction (disambiguation) *An adjective abbreviation denoting a Bowling ball#Coverstock technology, bowling ball coverstock made of reactive ...
and microbial attack to survive, providing defensive
phytochemical Phytochemicals are chemical compound A chemical compound is a chemical substance composed of many identical molecules (or molecular entity, molecular entities) composed of atoms from more than one chemical element, element held together by che ...
s of use in herbalism.


Use of plants by animals

Indigenous healers often claim to have learned by observing that sick animals change their food preferences to nibble at bitter herbs they would normally reject. Field biologists have provided corroborating evidence based on observation of diverse species, such as chickens, sheep,
butterflies Butterflies are insects in the macrolepidopteran clade Rhopalocera from the Order (biology), order Lepidoptera, which also includes moths. Adult butterflies have large, often brightly coloured wings, and conspicuous, fluttering flight. The gr ...

butterflies
, and chimpanzees. The habit of changing diet has been shown to be a physical means of purging intestinal parasites. Sick animals tend to forage plants rich in
secondary metabolites proline Proline (symbol Pro or P) is an organic acid classed as a proteinogenic amino acid Proteinogenic amino acids are amino acids that are incorporated biosynthetically into proteins during translation (biology), translation. The word "prot ...
, such as
tannins Tannins (or tannoids) are a class of astringent, polyphenol Polyphenols () are a large family of naturally occurring organic compounds characterized by multiples of phenol units. They are abundant in plants and structurally diverse. Pol ...
and
alkaloids Alkaloids are a class of basic BASIC (Beginners' All-purpose Symbolic Instruction Code) is a family of General-purpose programming language, general-purpose, high-level programming languages whose design philosophy emphasizes ease of use. The ...

alkaloids
.


See also

*
Ayurveda Ayurveda () is an alternative medicine system with historical roots in the Indian subcontinent. The theory and practice of Ayurveda is pseudoscience, pseudoscientific. The Indian Medical Association (IMA) characterises the practice of modern me ...

Ayurveda
*
Chinese herbology Chinese herbology () is the theory of traditional Chinese herbal therapy, which accounts for the majority of treatments in traditional Chinese medicine (TCM). A ''Nature (journal), Nature'' editorial described TCM as "fraught with pseudoscience" ...
*
Ethnobotany at work in the Amazon (~1940s) Ethnobotany is the study of a region's plants and their practical uses through the traditional knowledge of a local culture and people. An ethnobotanist thus strives to document the local customs involving the practi ...
*
Ethnomedicine Ethnomedicine is a study or comparison of the traditional medicine Traditional medicine (also known as indigenous or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefIn f ...
*
Herbal A herbal is a book containing the names and descriptions of plants, usually with information on their medicinal, tonic, culinary, toxic Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage a ...

Herbal
* List of medicinal mushrooms * List of plants used in herbalism * Traditional Chinese Medicine * Traditional medicine


References


Further reading

* * {{Use dmy dates, date=August 2021 Herbalism, Botany History of botany Biologically-based therapies Dietary supplements Alternative medicine