Written by Sebastian Pole
There is a rise in complex chronic conditions, that single-molecule pharmaceuticals simply do not have the answer for. This article explores how and why herbal medicines can be here to help.
The rise of modern medicine and chronic illness
Despite the advances in modern medicine, hygiene and nutrition over the last 200 years, there are still high levels of non-communicable chronic diseases challenging health and life-satisfaction. And given the pressures on national budgets and healthcare systems, are there other approaches to health that could help alleviate some of this burden?
With an ever-growing evidence base, a trained community of professional clinical herbalists and a public eager for help, could it be herbal medicine that is a part of the solution and help fill some of the therapeutic gaps in current healthcare?
The herbal perspective
The fundamental principles which traditional herbal systems are based on are a collation of time-tested empirical observations and clinical experience. For example, in the Eastern Han period, a medical scientist of Traditional Chinese Medicine named Zhang Zhongjing (150 CE – 219 CE), wrote a sixteen-volume work entitled Discussion of Cold Induced Disorders (Shanghan Lun) including treatments for epidemics, fevers from cold, external heat disorders, jaundice, gynaecological conditions; this treatise set down a complete set of treatment principals based on clinical experience. Zhang Zhongjing’s theory and prescriptions are still of great practical value today and have been used to determine treatment approaches during the recent COVID-19 epidemic (1, 2).
Off the back of these traditional medical systems, a great change in medical knowledge happened in the 1800s with the rapid progress in chemistry. The focus of medicine development changed from using whole herbs to extracting single isolated compounds and developing new to nature chemicals. Unsurprisingly, painkillers were naturally high on the list of medical endeavours. With morphine being the first isolated compound from Poppy (Papaver somniferum) in early the 1800s and Salicin acid for Aspirin from willow bark (Salix alba) a few decades later, the hunt for ‘silver bullet’ solutions has been actively pursued ever since. The discovery of antibiotics and painkillers (such as Non-Steroidal Anti-Inflammatory Drugs, NSAIDs) are drugs that have fundamentally changed healthcare, often for the better. However, this is not without consequences; burgeoning antibiotic resistance is the result of inappropriate and overuse of antibiotics leading to the evolution of Multi-Drug Resistant Bacteria, and NSAIDs are one of the leading causes of adverse drug events.
As the responsibility for drug quality passed from the apothecary herbalists to drug manufacturers, the herbal materia medica was largely replaced by a pharmacological approach that became codified into the national pharmacopoeias and health guidelines such as The British Pharmacopoeia and more recently The National Institute for Health and Care Excellence (NICE). Concurrently, the medical paradigm changed to prioritise research, specialization and high-cost drug approval processes; a medical system more driven by research findings and profits than practitioner or patient needs (3).
In contrast to the recent arrival of pharmaceutical medicine, the medical theories of traditional herbalism, Ayurvedic and Chinese medicine remain intact, continue to evolve, and continue to be practised according to their historical foundational principles. And given the enhanced evidence base of herbs and herbal medicine, there is now the opportunity for the scientific community to review the benefits of the whole plant complex rather than solely viewing herbal drugs as cocktails of chemicals to be pulled apart, isolated, and manipulated – a process accompanied with high risks with the potential to lead to serious and fatal adverse drug reactions (ADRs); a meta-analysis of Lazarou et al. on the incidence of ADRs in hospital patients in the US, demonstrated overall 2,216,000 hospitalised patients had serious ADRs and 106,000 had fatal ADRs, making these iatrogenic deaths between the fourth and sixth leading cause of death in one year (4). These facts remind us to not lose sight of the benefits of whole plant therapeutics while analysing quality marker compounds and other research findings.
The evidence house of herbal medicine
‘Evidence Based Medicine’ is used to assess the efficacy of modern drugs and procedures as well as herbal remedies. Whether we agree to its suitability as the sole method for measuring herbal efficacy or not, modern Western Herbalism and Phytochemists use this scientific approach to treatments, utilising traditional knowledge supported by phytochemical insights and a solid research base.
As science grows in its ability to interpret complex data, we have the chance to find new ways to analyse the complex and multi-dimensional nature of herbal medicine, so that a greater understanding of how herbs work can be developed; the world of chromatography, spectrometry, infrared, DNA analysis, bioassays, metabolomics, network pharmacology, and mitochondrial analysis all lead us to deeper levels of understanding. These insights, coupled with expert clinical experience, are leading to greater confidence in the alternative and supportive role herbal medicine has to offer the current chronic disease epidemic. Read the fascinating article The evidence house of Herbal Medicine by herbalist and educator Danny O’Rawe.
How much chronic disease is there in the UK?
With 58% of people over 60 having long-term health issues and 14% of those over 40 diagnosed with a chronic illness, it is not surprising that more than half of GP appointments are taken for chronic conditions and 70% of hospital resources are used on inpatient treatments for chronic conditions. As health inequality increases, the lower one’s socio-economic status health justice becomes an issue for everyone in society to address (5).
The dominant disease-focused approach of modern healthcare lacks an integrated approach to well-rounded, empowered and preventative health, leaving too many in a spiral of chronic illness. Whilst causes may be varied, the increased use of Ultra-processed food is centrally implicated in the rise of chronic disease with obesity, diabetes, cognitive disorders, mobility disorders and cancers all related; UPFs now represent 50% of daily calorie intake in the UK (6,7).
The arthritis conundrum
Around 8 million people have osteoarthritis in the UK and 400,000 people have rheumatoid arthritis (the auto-immune variety), usually in people over 40, meaning around 1 in 8 people suffer with a musculoskeletal condition. The mainstay of treatments are anti-inflammatory NSAIDs and corticosteroids which can alleviate some symptoms, yet have unpredictable safety and efficacy results.
Arthritis is a hard-to-treat and stubborn condition resulting in pain and debility, costing around £10 billion per year in the UK. Given the validity of traditional approaches and that the mechanisms of action of many herbs work on the same pathways as arthritis medications, with a much better safety profile, is there a place for clinical herbalism in standard treatment?
Can herbal medicine help arthritis?
In order to determine whether a treatment should be used we need to consider benefit-harm ratios, efficacy, cost as well as biological plausibility. Given the risks from long-term NSAID and corticosteroid use, coupled with the limited benefits, we should consider alternatives (8).
As many of the plants used in traditional systems meet the criteria for potential use we should investigate their potential. And many researchers have; a recent meta-analysis of 23 trials using herbal interventions, ‘Herbal Medications for Treatment of Osteoarthritis and Rheumatoid Arthritis’, looked at Boswellia spp., Curcuma spp., Eremostachys laciniata, Eucommia ulmoides, Matricaria chamomilla, Paeonia lactiflora, Tripterygium wilfordii, Withania somnifera, and Zingiber officinale. The authors state, “The anti-arthritic mechanisms of herbs include inhibition of pro-inflammatory and pro-catabolic mediators such as cytokines, PGE2, MMPs, ROS, apoptotic proteins via signalling pathways (NF-κB, RANKL, and PI3K/Akt). These activities may contribute to improvement in OA and RA joint pain, inflammation, swelling, structure, and function, with minimal adverse effects.” (9). In an earlier study, Long and Ernst also concluded “The authors found promising evidence for the effective use of some herbal preparations in the treatment of osteoarthritis. In addition, evidence suggesting that some herbal preparations reduce consumption of non‐steroidal anti‐inflammatory drugs was found…. Conclusions. Some herbal medicines may offer a much‐needed alternative for patients with osteoarthritis” (10). Herbs such as frankincense (11), willow bark (12) and turmeric (13) have positive trial results.
This science validates the traditional herbal, Ayurvedic and Chinese approaches with their detailed differential diagnoses and pathological perspectives on arthritis. Read about the traditional herbal approaches to Arthritis and the Ayurvedic approach to arthritis.
When do we know it works?
Medicine, of whatever form, works when used in the right person at the right time at the right dose.
- Effectively remove the causes and the symptoms of suffering and disease
- Improves health and vitality
- Are safe with minimal or no side effects or risk of harm
- Are practical to use for the duration of the required time they take to be effective
- Are affordable for the individual and for society
As the British Medical Journal points out, unfortunately too much of today’s medicine fails these tests; failing to remove the cause, can be harmful in themselves, interact adversely with other drugs (or herbs and foods), and can be expensive (14).
And whilst no intervention for such chronic conditions will bring 100% relief, surely the evidence stacks up to give herbs a chance.
- Wang J.H. Historical Timeline of Chinese Medicine; Understanding the Past http://www.traditionalstudies.org/historical-timeline-of-chinese-medicine/
- Leung, Elaine Lai-Han et al. The Scientific Foundation of Chinese Herbal Medicine against COVID-19, Engineering, Volume 6, Issue 10, 2020, Pages 1099-1107, ISSN 2095-8099, https://doi.org/10.1016/j.eng.2020.08.009.
- Upton R.H. Traditional Herbal Medicine, Pharmacognosy, and Pharmacopoeial Standards: A Discussion at the Crossroads (2015) in Evidence-Based Validation of Herbal Medicine edited by Mukherjee. ISBN 987-0-12-800874-4. http://dx.doi.org/10.1016/B978-0-12-800874-4.00003-9.
- Lazarou J., Pomeranz B., Corey P.N. Incidence of adverse drug reactions in hospitalized patients: A metaanalysis of prospective studies. JAMA, 1998; 279: 1200–1205.
- Department of Health (2012). Report. Long-term conditions compendium of Information: 3rd edition
- Jardim MZ, Costa BVL, Pessoa MC, Duarte CK. Ultra-processed foods increase noncommunicable chronic disease risk. Nutr Res. 2021 Nov;95:19-34. Epub 2021 Sep 11.
- Soil Association, Ultra processed Foods: https://www.soilassociation.org/causes-campaigns/ultra-processed-foods/
- Ennis ZN, Dideriksen D, Vaegter HB, Handberg G, Pottegård A. Acetaminophen for Chronic Pain: A Systematic Review on Efficacy. Basic Clin Pharmacol Toxicol. 2016 Mar;118(3):184-9.Epub 2015 Dec 28.
- Lindler BN, Long KE, Taylor NA, Lei W. Use of Herbal Medications for Treatment of Osteoarthritis and Rheumatoid Arthritis. Medicines (Basel). 2020 Oct 28;7(11):67.
- L. Long, K. Soeken, E. Ernst, Herbal medicines for the treatment of osteoarthritis: a systematic review, Rheumatology, Volume 40, Issue 7, July 2001, Pages 779–793, https://doi.org/10.1093/rheumatology/40.7.779
- Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD002947. DOI: 10.1002/14651858.CD002947.pub2.
- Werner, G., & Scheithe, K. (2004). Willow bark extract (Assalix®) for chronic back pain and arthralgia, a post-authorization surveillance study. In Congress Phytopharmaka and Phytotherapy (pp. 26-28).
- Daily JW, Yang M, and Park S, Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials, Journal of Medicinal Food 2016 19:8, 717-729
- BMJ What conclusions has Clinical Evidence drawn about what works, what doesn’t based on randomised controlled trial evidence?