Written by Marion Mackonochie
Herbal research has risen exponentially over the years and herbalists play a vital role. We explain herbal research is vital for our evolving practise.
There has been an increase in herbal research over the last 30 years. A search for the terms âherb OR herbal OR botanicalâ on PubMed in April 2022 brought up nearly 130,000 results and around 96% of those had been published in the last 30 years. Of those studies, nearly 3000 were systematic reviews or meta-analyses, which are considered the gold standard in evidence-based medicine. For a healing tradition that is centuries old, modern, formal scientific interest is really only just beginning.
Is there a benefit to herbal research?
The two main benefits of researching herbs and herbal medicine are to gain greater understanding of what, how and why something works, and to provide evidence that reassures other healthcare professionals and members of the public of the safety and efficacy of herbs. Gaining wider recognition and understanding of the power of herbs and herbal practice requires us to be able to connect the current scientific environment with what we know from traditional medicine. Choosing the best ways to research herbs, however, can be a challenge.
There are problems with the current methods of research in biomedicine, and not just for herbs. The tools currently used to support evidence-based medicine were designed to investigate the efficacy of single compounds and the research field assumed that there were such things as magic bullets for every disease. Clinical trial methods that were developed to measure the effects from single compounds will always be lacking as a method to investigate the complex and subtle effects of plants, or indeed, the effect of any medicine in a complex human interacting with a complex world. A clinical trial can tell you how a specific intervention might impact a population on average, but wonât necessarily have much to say about how a herbal consultation will impact on an individual.
There are encouraging examples of studies that have compared personalised treatment from a herbalist with control groups for conditions such as menopause, osteoarthritis, urinary tract infections and upper respiratory tract infections (1,2,3,4). In the majority of these studies, herbal practitioners were involved in the design or execution of the research. Historically, doctors have been involved in research into what works in their clinics, so perhaps this is something that herbalists should be considering.
Some practitioners or supporters of herbal medicine argue that viewing it via the biomedical lens is inappropriate or detracts from its meaning and that the traditional use of herbs over hundreds of years provides adequate evidence to justify their efficacy and safety. There will always be value in traditional and empirical knowledge that canât be âprovedâ by modern science. However, there are benefits from research that go beyond simply confirming what we think we already know.
Research can help us to confirm our instincts about how traditionally used herbs might be beneficial for modern diseases. We can extrapolate from our deep understanding of historical use and the characteristics of herbs to see how they might be beneficial for these more modern health problems. Research can confirm our suspicions about how certain herbs might be working.
Obesity and metabolic disorders are more of a problem now than a few hundred years ago and cinnamon is proving to be a valuable herb for addressing this (5,6). But, when we look to traditional knowledge, this is a relatively modern use. Many older herbals only mention cinnamon with reference to its use as a flavouring. Mary Seacole discusses using it to treat cholera in her autobiography of 1857 (7), and in 1931, M Grieve listed the uses of cinnamon as a carminative, astringent, stimulant and antiseptic for vomiting and diarrhoea (8). It is only in more modern times that its use to help regulate blood sugar levels has been documented. Since one of the first clinical studies looking at benefits of cinnamon for those with diabetes was published in 2003 (9), the majority of research now published about cinnamon focuses on this pressing area of importance. The stories of how plants are used evolves as human culture does. Traditional medicine is not static and should be reinventing itself as the world around us changes.
What does increased research into herbal medicine tell us about society?
Science research is a reflection of the important questions that society has. Scientists do not work in a vacuum, but get ideas about what to research from the world they see around themselves, as well as the people who will fund their work. Greater numbers of people researching the benefits of herbal medicine or simply the benefits of herbs and other plants reflects an increase in the feeling that nature got it right. Herbal medicine is associated with nature and gentleness â two values that many of those who seek to use it are aligned with.
The way that herbalism is practised, with a focus on empowerment and the responsibility of our clients to be aware of nutrition, lifestyle and how they can best manage their own health would certainly benefit modern healthcare systems that involve minimal contact time with a physician and pill prescriptions rather than advice. As research into herbal medicine grows and those who appreciate the benefits of herbalism are involved more in academic fields, knowledge can be transferred both ways. Herbalists are the best people to demonstrate the power of herbs, so we need to be involved in the scientific process that society has to investigate the world and add to knowledge.
Why things are changing?
The way that science is communicated is changing. The internet means that everyone can easily access the latest research findings, or discuss them in online forums with others. You can have an opinion on science whether you are a scientist or not. This will also have an impact on what science is carried out. Whether a research paper gets traction on social media is now a factor in how much it is cited and can have a positive impact on which areas get attention and funding. The popularity of herbal medicine with large sections of society will increase the likelihood that herbal research is interesting enough to be invested in.
Confidence in an area of science develops as a result of coherent approaches to research questions, standardised methods and consistent, reproducible results. The various approaches to herbal science by researchers from many different disciplines means that consensus has been harder to come by, but this is improving. For acceptance of herbal medicine by practitioners of modern biomedicine, an evidence base built on randomised clinical trials is needed. The World Health Organization has published guidance for clinical evaluation of herbal medicines, which is a good start (10).
The key factor needed for more well-designed research studies into how society can benefit most from herbs is funding. Without the money and power of the pharmaceutical industry, research carried out by herbalists working within universities or studies by companies who sell herbal products and have an interest in the field has been the main driver. Organisations, universities and private companies funding relevant and well-designed research is welcome and necessary, but for maximum impact, collaborations of researchers and herbalists working together will help this exciting, developing field of research.
References
- Green J, Denham A, Ingram J, Hawkey S, Greenwood R. Treatment of menopausal symptoms by qualified herbal practitioners: a prospective, randomized controlled trial. Fam Pract. 2007 Oct;24(5):468-74.
- Hamblin L, Laird A, Parkes E, Walker AF. Improved arthritic knee health in a pilot RCT of phytotherapy. J R Soc Promot Health. 2008 Sep;128(5):255-62.
- Flower A, Harman K, Lewith G, Moore M, Bishop FL, Stuart B, Lampert N. Standardised Chinese herbal treatment delivered by GPs compared with individualised treatment administered by practitioners of Chinese herbal medicine for women with recurrent urinary tract infections (RUTI): study protocol for a randomised controlled trial. Trials. 2016 Jul 27;17:358.
- Wong W, Lam CL, Fong DY. Treatment effectiveness of two Chinese herbal medicine formulae in upper respiratory tract infections–a randomized double-blind placebo-controlled trial. Fam Pract. 2012 Dec;29(6):643-52.
- Mousavi SM, Rahmani J, Kord-Varkaneh H, Sheikhi A, Larijani B, Esmaillzadeh A. Cinnamon supplementation positively affects obesity: A systematic review and dose-response meta-analysis of randomized controlled trials. Clin Nutr. 2020 Jan;39(1):123-133.
- Davis PA, Yokoyama W. Cinnamon intake lowers fasting blood glucose: meta-analysis. J Med Food. 2011 Sep;14(9):884-9.
- Seacole M. Wonderful Adventures of Mrs Seacole in Many Lands. 1857. James Blackwood.
- Grieve M. A Modern Herbal. 1978. Peregrine Books. Middlesex; England. P.202.
- Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003 Dec;26(12):3215-8.
- World Health Organization. General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine. Geneva: World Health Organization; 2000. WHO/EDM/TRM/2000.1.