Complete Guide to Herbal Medicines

First Chapter

From Chapter 1: Understanding and Using Herbal Medicines

Most people are familiar with herbs as foods — for example, basil and oregano in sauces, parsley as a garnish. However, for thousands of years many cultures around the world have used herbs and plants not just to eat but to treat illness. Archaeological evidence shows that even prehistoric man used plants to heal. Today, the World Health Orgamization estimates that 80ő of the world's population uses some form of herbal medicine.

Many of the drugs now prescribed come from plants that ancient cultures used medicinally. (The word drug comes from the Old Dutch word drogge, meaning "to dry," because pharmacists, doctors, and ancient healers often dried plants to use as medicines.) About one-fourth of all conventional pharmaceuticals — including roughly 120 of the most commonly prescribed modem drugs — contain at least one active ingredient derived from plants. The rest are chemically synthesized. (See Common drugs made from plants.)

Common drugs made from plants

Many drugs in common use today have botanical origins. Here's a selected list.

* Aspirin (salicylic acid) — from white willow bark and meadow sweet plant
* Atropine, used to treat irregular heartbeat — from belladonna leaves
* Colchicine, used for gout — from autumn crocus
* Digoxin (Lanoxin), the most widely prescribed heart medication — from foxglove, a poisonous plant
* Ephedrine, used to widen or relax the airways — from the ephedra plant
* Morphine and codeine, potent narcotics — from the opium poppy Paclitaxel Taxol), used to treat metastatic ovarian cancer — from the yew tree
* Quinine, a drug for malaria — from cinchona bark
* Vinblastine (Velban) and vincristine (Oncovin), anticancer drugs — from periwinkle

Potentially dangerous herbs

Herbs can harm as well as heal. The herbs below may pose special risks.
* Bloodroot, promoted as an expectorant purgative, stimulant and plaque and cavity preventer, is used in such a range of doses that it can be dangerous. It has caused death when used to induce vomiting.
* Chan su, a topical aphrodisiac also known as stone, love stone, and rockhard, has been fatal when mistakenly ingested.
* Chaparral tea, claimed to be an antioxidant and pain reliever, has caused liver failure, necessitating liver transplantation.
* Coltsfoot, used for respiratory problem has caused liver problems.
* Comfrey, used to promote wound healing (and formerly to relieve ulcers of the bowel, stomach, liver, and gallbladder), has caused liver problems and cancer.
* Indian herbal tonics can lead to lead poisoning.
* Jin bu huan, an ancient Chinese sedative and analgesic, contains morphine-like substances and has caused hepatitis.
* Kambucha tea, made from mushroom cultures and used as a cure-all, has caused death from a blood acid disorder.
* Lobelia, used to treat respiratory congestion, has led to respiratory paralysis and death.
* Ma huang, or ephedra, an ingredient in many diet pills, can cause psychotic behavior, seizures, irregular heartbeats, heart attack, stroke, and death. It's also sold under such names as Herbal Ecstasy, Cloud 9, and Ultimate Xphoria to induce a 'high' associated with illegal drugs.
* Pennyroyal, used to induce menstruation and treat colds, fevers, and the flu, has caused liver failure, kidney failure, coma, and death.
* Sassafras, used as a diuretic and a treatment for skin disorders and rheumatism, has caused liver damage. It has also been linked to narcotic poisoning and miscarriage. The Food and Drug Administration has banned sassafras volatile oil and the component safrole as food additives and flavor enhancers.
* Yohimbe bark, used as an aphrodisiac and hallucinogen, has caused psychotic behavior.

Misleading claims
The herbs below have been misrepresented as cures for serious illnesses.
* Mistletoe has been falsely touted as a cure for cancer.
* Pau d'Arco tea has been falsely touted as a cure for cancer and AIDS.

Some herbs and plants have value not just for their active ingredients but for other substances they contain, such as:

* minerals

* vitamins

* volatile oils (used in aromatherapy)

* glycosides (sugar derivatives)

* allkaloids (bitter organic bases containing nitrogen)

* bioflavonoids (colorless substances that help maintain collagen and blood vessels).

In the United States, many traditional health care providers lack knowledge about herbal remedies, and their patients may be reluctant to reveal their use of such remedies. But renewed interest in all forms of alternative medicine has led consumers, health care providers, and drug researchers to reexamine herbal remedies. Medicinal herbs have been touted in magazines, books, and television shows, sometimes with advocates making amazing claims for their benefits.

Unfortunately, herbs don't have magical or mystical properties. Like all drugs, they must be taken in the right doses for the right length of time-and for the right purpose — to produce a benefit. While some herbs are safe and effective, others can cause lasting harm and even death. (See Potentially dangerous herbs.)

Still other herbs are neither harmful nor effective.

History of herbal medicine

Herbal medicine, also called phytotherapy or phytomedicine, has been practiced since the beginning of recorded history. Specific remedies have been handed down from generation to generation.

In ancient times, medicinal plants were chosen for their color or the shape of their leaves. For example, heart-shaped leaves were used for heart problems, while plants with red flowers were used to treat bleeding disorders. This primitive approach is called the Doctrine of Signatures. Practitioners determined the best use for each plant by trial and error.

The formal study of herbs, called herbology, dates back to the ancient cultures of the Middle East, Greece, China, and India. These cultures revered the power of nature and developed herbal remedies based on the plants found in their home environments. Written evidence of the medicinal use of herbs has been found on Mesopotamian clay tablets and ancient Egyptian papyrus.

The first known compilation of herbal remedies was ordered by the king of Sumeria around 2000 B.C. and included 250 medicinal substances, including garlic. Ancient Greece and Rome produced their own compilations, including De Materia Medica, written in the I 1st century A.D. Of the 950 medicinal products described in this work, 600 come from plants and the rest from animal or mineral sources.

The Arabs added their own discoveries to the Greco-Roman texts, resulting in a compilation of more than 2,000 substances. Eventually, this work was reintroduced to Europe by Christian doctors traveling with the Crusaders. Herbal therapy is also a major component of India's Ayurvedic medicine, traditional Chinese medicine, Native American medicine, homeopathy, and naturopathy.

In the United States, herbal remedies handed down from European settlers and learned from Native Americans were a mainstay of medical care until the early 1900s. The rise of technology and the biomedical approach to health care eventually led to the decline of herbal medicine.

The herbal revival that we're seeing today has several causes:

* general disillusionment with modern medicine

* the high cost and side effects of prescription drugs

* widespread availability of herbal medicines

* the belief that natural remedies are superior to manmade drugs.

Regulating herbal medicine

In the 19th century, many fake remedies were sold to gullible, desperate Americans. The federal government finally took action against disreputable purveyors of phony remedies by passing the Food and Drug Act of 1906. This law addressed problems of mislabeling and adulteration of plant remedies — but not safety and effectiveness.

Today, herbal remedies remain largely unregulated. The Food and Drug Administration (FDA) regulates herbal products only as dietary supplements, not drugs. This means that the FDA can recall herbal products that are shown to be harmful, but manufacturers aren't required to provide information about their products' contents or side effects or to prove their safety or efficacy. They need only provide "reasonable assurance" that the product contains no harmful ingredients.

What's more, although manufacturers can't claim a particular product cures or prevents a specific disease, they can make any other claim about the supposed benefits without providing supporting evidence. They need only add the following disclaimer: "This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease."

In essence, herbal remedies in the United States are sold on a buyer-beware basis. This highlights the importance of learning everything you can about any herbal products you plan to use.

European standards

In Europe, where millions of people use herbal and homeopathic remedies, governments and the scientific community are much more open to natural remedies, especially those with a long history of use. In Great Britain and France, traditional medicines that have been used for years with no serious side effects are approved for use under the "doctrine of reasonable certainty" when scientific evidence is lacking.

The European Economic Community has established guidelines that standardize the quality, dosage, and production of herbal remedies. These guidelines are based on the World Health Organization's Guidelines for the Assessment of Herbal Medicines, a 1991 publication that addressed concerns about the safety and effectiveness of herbal medicines.

Therapeutic uses of herbs

A plant's leaves, flowers, stems, berries, seeds, fruit, bark, roots, or any other part may be used for medicinal purposes. Most herbal remedies are used to treat minor health problems, such as nausea, colds, cough, flu, headache, aches and pains, stomach and intestinal disorders (such as constipation and diarrhea), menstrual cramps, insomnia, skin disorders, and dandruff.

Some herbalists have reported success in treating certain chronic conditions, including peptic ulcers, inflammation of the colon, rheumatoid arthritis, high blood pressure, and respiratory problems. Some use herbal remedies for illnesses usually treated only with prescription drugs, such as heart failure.

However, if you have a serious disorder and are considering an herbal remedy, don't discontinue ongoing medical treatment. Also be sure to tell your health care practitioner about any prescribed drugs you're taking, because these may interact with herbal remedies. (See Taking herbal remedies safely, pages 6 and 7.)

Research on herbal remedies

Numerous studies on herbal remedies have been done in Europe and Asia. European studies have shown benefits from such herbs as ginkgo, bilberry extract, and milk thistle in treating various chronic disorders. Chinese researchers have extensively studied many herbs, such as ginseng, fresh ginger rhizome, foxglove, licorice root, and wild chrysanthemum. Indian researchers using modem scientific methods have recently studied various Ayurvedic, herbs, including Indian gooseberry and turmeric.

Taking herbal remedies safely

Many people take for granted the safety of the drugs and foods they buy. But unlike drugs, herbal remedies aren't reviewed by any government agency for quality, dosage, safety, or efficacy. If you're thinking about taking an herb, know that the vast majority of botanical products sold in the United States haven't been scientifically tested. Their alleged benefits are based largely on word-of-mouth.

How herbal products are regulated
The Food and Drug Administration regulates herbal products as food supplements, not drugs. The labels on these products don't tell you about their ingredients, risks, side effects, or possible harmful interactions with other substances. Nor do they guarantee that the herb is in a form your body can absorb or that the recommended dosage has been tested on animals or humans.
Also, herbal products may contain ingredients other than those indicated on the label. For example, Siberian ginseng capsules were found to contain a weed full of male hormone-like chemicals. What's more, the amount of active ingredient in an herb varies from brand to brand and possibly from bottle to bottle within a particular brand.
To help prevent problems caused by herbal medicine, follow these guidelines.

General precautions
* Check with your health care practitioner before using any herbal product especially if you're taking a prescription drug. Tell your practitioner about all drugs you're taking, including nonprescription medications and vitamins. Many herbal remedies can interact with other drugs.
* Make sure your health care practitioner is aware of your medical history, including allergies.
* When taking an herb, follow the instructions exactly. If you take too much of an herb or take it inappropriately, you may get no benefit from taking it — or put yourself at risk for potentially dangerous side effects.
* Never ignore symptoms you're experiencing. Contact your health care practitioner if you experience side effects of an herbal agent or if you have other health concerns that would normally require medical attention.
* Be sure to call your health care practitioner if you experience abdominal cramping, abnormal bleeding or bruising, changes in your pulse or heart rhythm; vision changes, dizziness or fainting; hair loss; hallucinations, inability to concentrate or other mental changes, hives, itching, rash, or other allergic symptoms, appetite loss, or dramatic weight loss.
* Don't use herbal agents to delay seeking more appropriate therapy. Keep in mind that herbs aren't necessarily a substitute for proven medical therapy.
* If you're a parent or other caregiver, consider each of the preceding precautions before giving herbal medicines to a child or an elderly debilitated person.
* Discontinue herbs at least 2 weeks before before surgery. They can interfere with anesthesia and cause heart and blood vessel problems.

When to avoid herbs
* Avoid herbal preparations if you're pregnant or breast-feeding. Most herbs' effects on the fetus are unknown. If you're a woman of childbearing age, use birth control when taking herbs.
* Don't use herbs for serious or potentially serious medical conditions, such as heart disease or bleeding disorders.
* Never let other people take your herbs or other medicine. Store herbal agents out of reach of children and pets.
* If you have questions about the herb you're taking, seek advice from a qualified health care provider. If your practitioner isn't knowledgeable about herbs, ask for a referral to someone who is.

Buying herbal products
* Be wary of products that promise to cure specific health problems.
* Read labels carefully when buying herbal products. Check for the term standardized on the label. Standardized means that the dose of medicine in each tablet or capsule in that package is the same. Also make sure the label states specific percentages, amounts, and strengths of active ingredients.
* Avoid herbal "cocktails" that contain more than one ingredient. Experts know little about the effects of combining herbs.
* Buy your herbs from reputable companies. Avoid products sold through magazines, brochures, the broadcast media, or the Internet.
* Consider buying organically grown herbs. Some people believe herbs that grow naturally in the wild are subject to contamination from pesticides, polluted water, and automobile exhaust fumes.
* Remember that the clerk at the health food store is a salesperson, not a trained health care practitioner.

The United States lags behind other countries in herbal medicine research for several reasons. Until the Office of Alternative Medicine (OAM) was established in 1992, such research lacked federal support. Also, pharmaceutical companies have no financial incentive to develop herb-based drugs because botanical products can't be patented. That means the companies could never recoup their research investment.

The inherent difficulty in studying herbs according to Western pharmaceutical standards has posed another obstacle to herbal research. Western standards favor isolating a single active ingredient. However, herbs may contain several active ingredients that work together to produce a specific effect.

Although large gaps remain in research, many clinical trials of herbs used as medication are currently underway. Since 1995, the OAM has collected more than 60,000 research citations on complementary and alternative health care practices, including 2,500 clinical trials that have been compiled in a computer database system.

Forms of herbal preparations

Herbs come in various forms, depending on their medicinal purpose and the body system involved. You can buy herbs individually or in mixtures formulated for specific conditions. Herbs may be prepared as tinctures or extracts, capsules or tablets, lozenges, teas, juices, vapor treatments, or bath products. Some herbs are applied topically with a poultice or compress. Others are rubbed into the skin as an oil, an ointment, or a salve.

Tinctures and extracts

An herb placed in alcohol or liquid glycerin is called a tincture or an extract. (Tinctures contain more alcohol than extracts.) Alcohol draws out the herb's active properties, concentrating them and helping to preserve them. Alcohol is cheap, is easily absorbed by the body, and allows the herb's full taste to come through. Alcohol-based tinctures and extracts have an indefinite shelf life.

Liquid glycerin extracts, called glycerites, are an alternative to alcohol extracts and preferred by some people. Most glycerites taste sweet and feel warm on the tongue. They're processed by the body as fat, not sugar — important to diabetics and others who must limit sugar intake.

Glycerin extracts have certain drawbacks. Taking more than 1 ounce (30 milliliters) of glycerin can have a laxative effect. Also, glycerin isn't an efficient solvent for some herbs that contain resins and gums. Such herbs need alcohol for extraction.

Extracts should contain at least 60% glycerin with 40% water to ensure preservation. Glycerin-based extracts have shorter shelf-lives than alcohol-based extracts. An extract that contains citric acid can last for more than 2 years if stored properly.

Tinctures or extracts may be taken as drops in a tea, diluted in spring water, used in a compress, or applied during body massage. If the tincture's alcohol content is a concern — for example, if the remedy is meant for a child — a few drops may be placed in one-quarter cup (60 milliliters) of very hot water and left to stand for 5 minutes. As the tincture stands, most of the alcohol evaporates and the mixture becomes cool enough to drink.

To make an herbal tincture, a glass bottle or jar is filled with herbal parts (cut fresh herbs or crumbled dry herbs), pure spirits, such as vodka, are added, and the container is sealed and placed in a warm area (70° to 80° F [21° to 26.6° C]) for 2 weeks. The mixture should be shaken daily. After 2 weeks, the herbs can be strained out and the residue squeezed out.

Extracts are made with alcohol or water to bring out the herb's essence. (The product label should indicate which base was used.) Extracts have the same advantages and disadvantages as tinctures but are more concentrated and therefore more cost-effective. Because of their strong herbal taste, they're usually diluted in juice or water.

Capsules and tablets

Capsules and tablets contain the ground or powdered form of the raw herb. They are easier to transport and typically are tasteless. The capsule or tablet should be made within 24 hours of milling the herb because herbs degrade quickly.

The best products use fresh herbs, which should be indicated on the label. Capsules can be a hard gel or soft gel made of animal or vegetable gelatin. Most people find capsules easier to swallow than tablets.

Both capsules and tablets may contain a large amount of filler, such as soy or millet powder. Filler makes the herb hard to identify in the powdered form, and an herb of poorer quality may be substituted without your knowledge. Tablets also may contain a binder, such as magnesium stearate or dicalcium. phosphate, which in turn may contain lead. Binders help the herb absorb water and break down more readily for easy absorption in the body.

Capsules or tablets can be swallowed whole, as indicated, or can be mixed with a spoonful of cream-style cereal or applesauce. They also may be dissolved in sweet fruit juice.

Lozenges

Herbal lozenges are nutrient-rich, naturally sweetened preparations that dissolve in the mouth. They come in various formulas, such as cough suppressant, decongestant, or cold-fighting. Most lozenges are boosted with natural vitamin C. The horehound lozenge, one type that has become popular, is used to relieve coughs and minor throat irritation.

Lozenges should be taken as directed by a health care practitioner or herbalist. For self-treatment, follow the directions on the package.

Teas

Herbal teas can be made from most herbs. Teas are used for a wide range of purposes, with formulations aimed at specific conditions or desired effects.

Usually, you prepare the tea by infusion or decoction. Decoction is preferred for denser plant materials, such as roots or bark. To prepare an infusion, let the dried herb steep in hot water for 3 to 5 minutes. To make a decoction, put the herb in a rolling boil of water for 15 to 20 minutes. You may steep teas in a muslin or conventional tea bag or tea ball or use them in their loose form for their fragrant, aromatic flavor.

Some teas taste bitter because they contain alkaloids (for example, goldenseal root) or highly astringent tannins (for example, oak bark). You may want to add honey to sweeten the tea, but don't give honey to a child younger than 18 months because of the risk of infant botulism.

For an infant, you may mix the tea with breast milk or formula and then put it into a bottle, an eyedropper, or an empty syringe (without a needle) and gently squirt the tea into the infant's mouth. Caution: If you're breast-feeding and taking an adult dose of an herbal remedy, keep in mind that the herb may pass through your breast milk to your child. Also remember that, as with any drug, you must use care when deciding whether to give these medicines to an infant or a child.

The Chinese teach that the heat of the water and the taste of the herb enhance its effectiveness. Steeping an herb in hot water draws out its therapeutic essence. With dried herbs, you'll probably want to use 2 heaping tablespoons of herb for every cup of tea, unless the product label directs otherwise. Place the dried herbs in a china or glass teapot or cup (plastic or metal containers aren't suitable for steeping). Immerse in 8 ounces (237 milliliters) of freshly boiled water for each cup and cover.

When using leaf or flower herbs, steep for 5 to 10 minutes. With roots or bark, simmer or boil for 10 minutes, and then steep for 5 minutes longer. After steeping, strain the tea and let it cool to a comfortable temperature before drinking. If you're going to place a tincture or extract in the tea, let the cup of hot water sit for 5 minutes so the alcohol will evaporate. You can drink herbal teas hot, cold, or iced, depending on the purpose and instructions.

When using fresh herbs, remember that three parts of a fresh herb generally equal one part of a dried herb. Bark, root, seeds, and resins must be powdered (to break down the cell walls) before they're added to water. Seeds should be slightly bruised to release the volatile oils. You may infuse an aromatic herb in a pot with a tight lid to reduce the loss of volatile oil through evaporation. Because roots, wood, bark, nuts, and certain seeds are tough, they should be boiled in water to release their properties.

Juices

Juices are made by washing fresh herbs under cold running water, cutting them with scissors into suitable pieces, and running them through a juice extractor until they turn into a liquid. Usually, herbal juices are taken by placing a few drops in tea or spring water. They also may be applied externally by dabbing them on the affected body part.

Ideally, you should drink fresh juices immediately after extraction. However, you also may store them in a small glass bottle, corked tightly, and refrigerate for several days to minimize breakdown of ingredients.

Vapor and inhalation treatments

Many herbalists recommend herbal vapor and inhalation treatments for respiratory and sinus conditions. The treatment helps open congested sinuses and lung passages, promote mucus discharge, and ease breathing.

One inhalation method requires a sink and an herbal oil. Fill the sink with very hot water and add 2 to 5 drops of the herbal oil. Let the hot water trickle into the sink to keep the water steaming. As the mixture becomes diluted, you may need to add a few more drops of the herbal oil. Then inhale the steam for 5 minutes.

Another method involves heating a large, wide pot of water, adding a handful of dried or fresh herbs, and bringing the pot to a boil. After the herbs have simmered for 5 minutes, remove the pot from the heat and place it on a trivet to cool slightly. (If you're using an aromatic oil, first heat the water to just short of boiling and then remove it from the heat.) With the pot on a trivet, add 4 to 5 drops of the oil. Then drape a towel over your head to form a tent and lean over the pot, inhaling the steam for 5 minutes. Remember, though — if the vapor is too hot, it can burn your nasal passages.

Herbal baths

An herb that's in a soluble agent, such as baking soda or aloe gel, may be dissolved in hot bath water. An herb in an oatmeal-type preparation may be finely-milled or whirled it into a powder in a blender. You may also bag fresh or dried herbs in a square of cheesecloth or place them in a washcloth and tie the cloth securely. The goal is maximum release of the herbal essence without having parts of the herb floating in the bath water. Full baths require about 6 ounces (170 grams) of dried or fresh herbs.

As the tub fills with water, place the bagged herbs under a forceful stream of comfortably hot water, and then drag them through the bath water to better distribute the herbal essence. Squeezing the bag releases a rich stream of essence that you can direct to the affected body part. You may also gently rub the bag over itching skin. Caution: Herbs with pointy or rough edges may be too irritating to use this way.

You can also add an herbal infusion to bath water. To make the infusion, soak 6 tablespoons (57 grams) of dried or fresh herbs overnight in 3 cups (710 milliliters) of hot water. The next morning, pour the strained infusion directly into the bath water.

Poultices and compresses

A poultice is a moist paste made from crushed herbs that's applied directly to the affected area, or wrapped in cloth to keep it in place and then applied. Poultices are useful for treating bruises, wounds, and abscesses.

Use only fresh herbs for poultices. One preparation method involves wrapping the herbs in a clean white cloth (such as gauze, linen, cotton, or muslin), folding the cloth several times, and crushing the herbs to a pulp with a rolling pin. (Pulping the herb directly onto the poultice cloth helps retain its juices and makes the poultice more effective.) Then expose the pulp and apply it to the affected area. To trap the herbal juices and hold them in place, wrap the entire area with a woolen cloth or towel. This type of poultice can remain in place overnight.

You can also prepare the herbs by placing them in a steamer, colander, strainer, or sieve over a pot of rapidly boiling water and allowing the steam to penetrate and wilt the herbs. After 5 minutes, spread the softened, warmed herbs on a clean white cloth (such as loosely woven cheesecloth) and apply the cloth to the affected area. To help retain the heat, wrap the poultice with a woolen cloth or towel. You can leave this type of poultice on for 20 minutes or overnight if you find the wrap comforting and soothing.

Compresses are effective for bleeding, bruises, muscle cramps, and headaches. They may be hot or cold, depending on the herb and the purpose for using it. To make a compress soak a soft cloth in a strong herbal tea, a tincture or glycerite, an oil, or aromatic water. Then wring it out and apply it to the affected area. You may use a bandage or plastic wrap to hold the compress in place.

Oils, ointments, salves, and rubs

Herbal oils usually are expressed from the peels of lemons, oranges, or other citrus fruits. Because they may irritate the skin, they're commonly diluted in fatty oils or water before being topically applied. Essential oils are used in massage and aromatherapy. They may be diluted to prevent skin irritation.

To make an herbal oil, wash fresh herbs and let them dry overnight. Then slice the herbs (or crumble them if you're using dry herbs), place them in a glass bottle or jar, and cover them with about I inch (2.5 cm) of fight virgin olive oil, almond oil, or sunflower oil. Cover the container tightly and let it stand in a warm area, such as on a stove or in the sunshine, for 2 weeks. Strain the oil before use.

Herbal ointments, salves, and rubs are applied topically for a variety of conditions. Examples include:

* calendula ointment for broken skin and wounds

* goldenseal applied to infections, rashes, and skin irritations

* aloe vera gel for minor burns

* heat-producing herbs for muscle aches and strains.

Commercial varieties of ointments, salves, and rubs usually are more appealing than homemade concoctions.

You can make an ointment in a ceramic or glass double boiler by heating 2 ounces (60 milliliters) of vegetable lanolin or beeswax until it liquefies. Once the lanolin or wax melts, add 80 to 120 drops of tincture and mix the compound together. Then pour the formula into a glass container and refrigerate it until it hardens. You can substitute a strong herbal tea made from fresh or dried herbs for a store-bought tincture.

Visiting an herbalist

If you decide to visit an herbalist, expect to start with an evaluation, including a review of your medical history. The herbalist may check your pulse and tongue to assess you and may perform a more thorough physical examination. Some herbalists assess the iris, a technique known as iridology, to aid diagnosis. This procedure involves correlating minute markings on the iris with specific parts of the body.

Most herbalists also ask if you're taking prescription or nonprescription drugs to avoid an interaction with an herb or to prevent a cumulative effect. For example, St. John's wort, an herb used as antidepressant, shouldn't be taken with a prescription antidepressant. If you're a female, the herbalist will ask if you're pregnant or breastfeeding because certain herbs can cause miscarriage, harm the fetus, or pass to the infant in breast milk, causing side effects.

After the evaluation, the herbalist may suggest individual herbs or herbal combinations to treat a particular condition. Medicinal plants may be combined to increase their therapeutic effect, alter the individual actions of each herb, or minimize or negate toxic effects of stronger herbs. An herbal combination, or compound, may make the remedy more effective. (Me art of herbal compounding has been practiced for over 5,000 years and is the basis of today's herbal practice.)

Herbal dosages

No dosages for herbal remedies have been established. Manufacturers' guidelines must be adjusted to each person based on such factors as age, weight, and whether he or she is using other herbs or drugs.

Keep in mind that herbal remedies take time to work. The length of therapy depends on the specific herb, whether youre using it as a therapy (to relieve symptoms), a tonic (to build strength), or both. If you're using an herb for therapy, you may need to take it only for a brief period — typically, 1 to 4 weeks. If you're using an herbal remedy as a tonic, expect to take it for a longer period — usually 4 to 6 months or longer. For example, hawthorn, a tonic for the heart and blood vessels, is most effective when used for 6 to 12 consecutive months.

As with other drugs, be sure to take the herb at the appropriate times of the day. Some herbs are more effective when taken in the morning; others, in the evening.

Also, some herbs work best if used with a resting cycle. For example, an herbalist might recommend that you take an herb for 6 days followed by I day off, 6 weeks on and I week off, 6 months on and 1 month off, or a similar pattern. According to advocates of the resting cycle, each period of rest from the herb treatment allows its effect to become integrated into the body. If the desired effect doesn't appear in the specified time or if side effects develop, the dosage or herb may be changed.

Avoiding problems

Although their overall risk to public health appears to be low, some traditional herbal remedies have been associated with potentially serious side effects. For example, ma huang, an ingredient in numerous diet pills, contains the same active ingredient that's in the chodilator ephedrine and can cause irregular heartbeats, seizures, and death. A few other herbs have also been linked to death and other complications.

To promote safer and more effective therapy, follow these guidelines:

* Before you start the herbal regimen, make sure you understand the potential risks involved in self-treatment. These include misdiagnosing your ailment, taking the wrong herb, worsening your condition by delaying conventional treatment, taking an herb that counteracts or interacts with prescribed medical treatment, and aggravating other disorders.

* Familiarize yourself with the herb's actions and side effects before you start taking it. Possible symptoms of sensitivity or side effects include headache, upset stomach, and a rash. Also, some people are predisposed to react to particular herbs. For example, if you're feeling depressed, taking certain herbs used to treat insomnia may heighten your depression. This warning may appear on the herbal remedy package, but the lack of federal regulation means there's no guarantee that remedies will carry adequate warnings.

* Discontinue the herb if you develop a side effect, such as headache, an upset stomach, or a rash.

* If you respond favorably but too intensely to an herb, decrease the dosage or stop taking it altogether. For example, if you're taking a laxative herb to treat constipation, stop taking it if you experience diarrhea.

* If you experience side effects, you may be taking the herb too often or continuing therapy for too long. Sometimes symptoms stem from an incorrect dosage. For instance, eating large amounts of black licorice on a daily basis can lead to high blood pressure.

Copyright © 2000 by Springhouse Corporation