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How are herbs and herbology related?

Do they really serve a purpose?

A herbalist is:

(1) A person whose life is dedicated to the economic or medicinal uses of plants;

(2) One skilled in the harvesting and collection of medicinal plants;

(3) Traditional Chinese herbalist: one who is trained or skilled in the dispensing of herbal prescriptions; traditional Chinese herb doctor. Similarly, traditional Ayurvedic herbalist: one who is trained or skilled in the dispensing of herbal prescriptions in the Ayurvedic tradition;

(4) One trained or skilled in the therapeutic use of medicinal plants;

(5) One who is skilled in the preparation/manufacture of dried and/or liquid herbal products who possesses a pharmacognostic, formulary and/or clinical understanding of the products being prepared/manufactured.

Herbalists must learn many skills, including the windcrafting or cultivation of herbs, diagnosis and treatment of conditions or dispensing herbal medication, and preparations of herbal medications. Education of herbalists varies considerably in different areas of the world. Lay herbalists and traditional indigenous medicine people generally rely upon apprenticeship and recognition from their communities in lieu of formal schooling.

In some countries formalized training and minimum education standards exist, although these are not necessarily uniform within or between countries. For example, in Australia the currently self-regulated status of the profession (as of April 2008) results in different associations setting different educational standards, and subsequently recognizing an educational institution or course of training.

The World Health Organization (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 in order 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 (EU), herbal medicines are now regulated under the European Directive on Traditional Herbal Medicinal Products. In the United States, herbal remedies are regulated dietary supplements by the Food and Drug Administration under current good manufacturing practice (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 don’t make ‘medical’ claims or imply being other than for ‘dietary supplement’ use, though the FDA may withdraw a product from sale should it prove harmful.

The National Nutritional Foods Association, the industry’s largest trade association, has run a program since 2002, examining the products and factory conditions of member companies, giving them the right to display the GMP (Good Manufacturing Practices) seal of approval on their products.

Some herbs, such as cannabis and coca, are outright banned in most countries though coca is legal in most of the South American countries where it is grown. The Cannabis plant is used as an herbal medicine, and as such is legal in some parts of the world. Since 2004, the sales of ephedra as a dietary supplement is prohibited in the United States by the Food and Drug Administration, and subject to Schedule III restrictions in the United Kingdom.

Some researchers trained in both western and traditional Chinese medicine have attempted to deconstruct ancient medical texts in the light of modern science. One idea is that the yin-yang balance, at least with regard to herbs, corresponds to the pro-oxidant and anti-oxidant balance. This interpretation is supported by several investigations of the ORAC ratings of various yin and yang herbs.

In India, Ayurvedic medicine has quite complex formulas with 30 or more ingredients, including a sizable number of ingredients that have undergone “alchemical processing”, chosen to balance “Vata”, “Pitta” or “Kapha”.

In Ladakh, Lahul-Spiti and Tibet, the Tibetan Medical System is prevalent, also called the ‘Amichi Medical System’. Over 337 species of medicinal plants have been documented by C.P. Kala. Those are used by Amchis, the practitioners of this medical system.

Ayurveda is Sanskrit, but Sanskrit was not generally used as a mother tongue and hence its medicines are mostly taken from Siddha and other local traditions.  “The Chinese and Western medical models are like two frames of reference in which identical phenomena are studied. Neither frame of reference provides an unobstructed view of health and illness. Each is incomplete and in need of refinement.” Specifically, the traditional Chinese medical model could effect change on the recognized, and expected, phenomena of detachment to patients as people and estrangement unique to the clinical and impersonal relationships between patient and physician of the Western school of medicine.

Four approaches to the use of plants as medicine include:

(1) The magical/shamanic—Almost all societies, with the exception of cultures influenced by Western-style industrialization, recognize this kind of use. The practitioner is regarded as endowed with gifts or powers that allow him/her to use herbs in a way that is hidden from the average person, and the herbs are said to affect the spirit or soul of the person;

(2) The energetic—This approach includes the major systems of Traditional Chinese Medicine, Ayurveda, and Unani. Herbs are regarded as having actions in terms of their energies and affecting the energies of the body. The practitioner may have extensive training, and ideally be sensitive to energy, but need not have supernatural powers;

(3) The functional dynamic—This approach was used by early physiomedical practitioners, whose doctrine forms the basis of contemporary practice in the UK. Herbs have a functional action, which is not necessarily linked to a physical compound, although often to a physiological function, but there is no explicit recourse to concepts involving energy;

(4) The chemical—Modern practitioners – called Phytotherapists – attempt to explain herb actions in terms of their chemical constituents. It is generally assumed that the specific combination of secondary metabolites in the plant are responsible for the activity claimed or demonstrated, a concept called synergy.

Herbalists tend to use extracts from parts of plants, such as the roots or leaves but not isolate particular phytochemicals. Pharmaceutical medicine prefers single ingredients on the grounds that dosage can be more easily quantified. It is also possible to patent single compounds, and therefore generate income. Herbalists often reject the notion of a single active ingredient, arguing that the different phytochemicals present in many herbs will interact to enhance the therapeutic effects of the herb and dilute toxicity.   Furthermore, they argue that a single ingredient may contribute to multiple effects. Herbalists deny that herbal synergism can be duplicated with synthetic chemicals.   They argue that phytochemical interactions and trace components may alter the drug response in ways that cannot currently be replicated with a combination of a few potentially active ingredients. Pharmaceutical researchers recognize the concept of drug synergism but note that clinical trials may be used to investigate the efficacy of a particular herbal preparation, provided the formulation of that herb is consistent.

In specific cases the claims of synergy and multi-functionality have been supported by science. The open question is how widely both can be generalized. Herbalists would argue that cases of synergy can be widely generalized, on the basis of their interpretation of evolutionary history, not necessarily shared by the pharmaceutical community. Plants are subject to similar selection pressures as humans and therefore they must develop resistance to threats such as radiation, reactive oxygen species and microbial attack in order to survive.   Optimal chemical defenses have been selected for and have thus developed over millions of years. Human diseases are multifactorial and may be treated by consuming the chemical defenses that they believe to be present in herbs. Bacteria, inflammation, nutrition and ROS (reactive oxygen species) may all play a role in arterial disease. Herbalists claim a single herb may simultaneously address several of these factors. Likewise a factor such as ROS may underlie more than one condition. In short herbalists view their field as the study of a web of relationships rather than a quest for single cause and a single cure for a single condition.

In selecting herbal treatments herbalists may use forms of information that are not applicable to pharmacists. Because herbs can moonlight as vegetables, teas or spices they have a huge consumer base and large-scale epidemiological studies become feasible. Ethnobotanical studies are another source of information. For example, when indigenous peoples from geographically dispersed areas use closely related herbs for the same purpose that is taken as supporting evidence for its efficacy.   Herbalists contend that historical medical records and herbals are underutilized resources.   They favor the use of convergent information in assessing the medical value of plants. An example would be when in-vitro activity is consistent with traditional use.

Kathy Kiefer

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