An Introduction – written by Roy Upton
For multiple millennia, humans have relied on plant-based materials for all aspects of human existence including for food, fuel, our homes and clothing, and not the least, our medicines. Through hundreds of thousands of years of co-evolution, plants have developed protective mechanisms, secondary metabolites, to curtail predation and ensure the plant’s continued survival. In like fashion, humans have developed biological pathways and processes that allow us to consume numerous plants to our benefit.
Despite the technological advancements that gave rise to the development of modern medicines in the past few hundred years, herbal medicine remains the mainstay of medicine for most underdeveloped and developing nations. Similarly, recognition of the health potential both of botanical medicines and traditional healing systems, along with the many failures of conventional medicines and the paradigm by which they are used, has resulted in increased use of medicinal plants in most developed nations. The rapid and increasing rise in the worldwide use of herbal medicines in recent decades suggests botanical medicines, both traditional and modern, fulfill a therapeutic niche not adequately addressed in modern health care delivery systems. Since the introduction of COVID, botanical medicines specifically have exponentially grown in popularity in great part fueled by recognition of the importance of immune health and the complete lack of Western medical therapies to address this beyond vaccinations. At the same time, there is a propensity, predominantly in developed, but also developing nations, to research herbal medicines in the same manner as modern chemically characterized drugs. This trend is driven partly by a belief that the same regulatory requirements that are applied to modern pharmaceuticals should be applied to herbal medicines and partly by economics.
Safe and effective botanical medicine
The economics of the conventional and even medicinal plant market aside, central to the needs of a patient is to have a botanical medicine that is first safe and secondarily effective for its intended use. In turn, the safety and efficacy of a botanical medicine requires adherence to good agricultural and manufacturing practices that encompass proper harvesting or cultivation, processing, identity, purity, quality, and potency. Early herbalists devoted a great amount of time in the quality assessment of herbal drugs with specific emphasis placed on appropriate growing regions, harvest times, processing conditions, and the detection of inferior quality or adulterated materials. This was prior to the advent of chemistry and molecular techniques. Herbal quality assessment was based on what an herbalist could discern through her or his senses; predominantly as reflected in the growing habit, color, aroma, feel, and taste of the plant. Most every consumer can recognize an apple from an orange as well as discern its relative quality. Every chef knows the not-so-subtle difference between fresh and dry ginger. As chemical techniques developed, focus on the plant itself greatly diminished and the skills at discerning quality all but disappeared in Western herbal traditions and science, though has remained in more intact systems of Ayurveda and traditional Chinese medicine. Emphasis on quality shifted from the field to the laboratory; from human senses to mechanical methods of analysis; from the plant to isolated plant compounds.
Similarly, in the same time period, the use of herbal medicines was rapidly declining as use of chemical medicines was on the rise. In developed nations, the responsibility of herb quality passed from herbalists to medical doctors who became among the first teachers of materia medica, and then to pharmacognosists—pharmacists specializing in the development of drugs from natural products. Subsequently, this pharmacognostic knowledge was codified into national pharmacopoeias, which became the quality standard for drugs within national health care approval systems. Thus, modern drug approval systems, and subsequently, modern pharmacopoeias, were modeled for the needs of modern drugs not traditional herbal medicines or traditional healing systems.
In parallel, the economics of medicine changed with greater focus on research, specialization, technology, high cost drug approval processes, and a medical system more driven by research findings and profits than practitioner or patient need. This greatly influenced the way in which the practice of medicine and approval of medicinal agents evolved, including creating significant positive bias in pharmaceutical research and substantial negative bias against traditional medical practices overall and specifically herbal medicines.
Because of the importance traditional medical systems, as well as herbal medicines, play in world health the World Health Organization (WHO) reports that among the most salient benefits of both, are accessibility and affordability (WHO 1978; 2013). Applying the same regulatory models to traditional medicines as is applied to modern drugs negates these two advantages. WHO, however, does not explicitly recognize other very unique benefits of traditional medicines. Specifically in the United States (US), arguably among the most technologically advanced of countries, 58% of consumers who use traditional healing modalities, do so not for the treatment of disease, but rather to “prevent future illness from occurring or to maintain health and vitality” (Eisenberg et al. 1998). Similar findings were reported in a later survey of dietary supplement users in the US in which “preservation of health was by far the most predictive indicator for use of herbal products and dietary supplements” (Marinac et al. 2007) and in a similar survey in Australia (MacLennan et al. 2002). There is not a single western drug in the world designed to “maintain health and vitality” or “preserve health”.
Another unique characteristic of traditional healing systems, especially, Ayurveda, traditional Chinese medicine (TCM), Unani, Tibetan, etc., is the utilization of a completely different diagnostic system than is applied in the West. Traditional systems are meant to be applied to the individual needs of the patient. This allows for an understanding of health and pathology and subsequently the development of unique therapeutic strategies, thus broadening patient options. Additionally, amongst these healing traditions is an inherent belief of the relationship between human and environmental health, a belief completely integrated into the diagnostic construct of most herbal traditions, and completely ignored in modern medicine.
Traditional vs. conventional medicine strategies
These traditional healing strategies are in stark contrast to the prevalence of Western conventional medical strategies, which are predominantly focused on disease management more than the promotion or restoration of health. The specificity inherent in western medical therapies gives those therapies a targeted focus, often to the neglect of the general health status of the individual. Generally speaking, in western conventional medicine, if tissue or organ structures are not functioning properly the treatment is to basically attack them leading to the removal of tonsils (a first line of defense against infectious disease), gallbladders (integral to digestive and eliminative processes), cataracts; transplants of hearts, livers, and kidneys; radiation or poison (in cancers); or interfering with normal processes, such as pharmacological agents designed to either up regulate, down regulate, or otherwise completely obviate normal physiological processes. A good example of this is the widespread use of anti-inflammatories, inflammation actually reflecting a biological response of the body to an inflammatory mediator. Rather than seeking to identify and remove the inflammatory trigger, the conventional western medical strategy is to shut down, what ultimately is a healing response. From a natural health care perspective, such a strategy is the antithesis of what is needed to support human health. This does not mean there is no value in such a strategy. Militaristic search and destroy therapies such as these are uniquely suited for crisis intervention and emergency medicine. Severed limbs, acute poisonings, intractable severe pain, ruptured organs, etc. respond well to a militaristic approach; in contrast, pregnancy does not, a fact reflected in the appalling high rate of infant mortality in the US, whose system of medicine is almost completely militaristic. To have a medical system entirely based on militaristic therapies is inherently limited; a fact equally evidenced by the high rates of iatrogenesis, deaths due to pharmaceuticals, and chronic illness associated with modern health care systems. Perhaps of greatest consequence is that western medical strategies focus on the treatment of diseases not the treatment of people.
Thus, conventional and traditional healing practices represent two very different paradigms of medicine. Traditional healing practices offer a different paradigm and different therapeutic solutions than conventional medical care. This is precisely why traditional healing systems, and herbal medicines are growing in popularity. If the two systems can be harmonized there is a greater potential for healing than either system can deliver on its own. However, regulating chamomile tea, valerian root, and hawthorn berry syrup, with their hundreds of compounds, in the same way as Prilosec, Ambien, and artificial hearts, disregards the fact that each botanical medicine has several hundred years of historical use, has been in the public domain for those several hundred years, and threatens to undermine the potential herbal medicines possess. In contrast, a rigorous safety and efficacy evaluation is necessary for the chemicals used in modern drug development, as most have never been in human use. Whereas with botanicals that have been used for centuries, there is a reasonable basis based on human experience and, in many cases, formal scientific evaluation to assure there is a reasonable basis both for safety and efficacy, whereas in modern drug development, no basis at all for safety or efficacy exists, thus necessitating detailed scientific exploration of compounds that have never before existed prior to their being administered to humans; think broccoli and carrots for which no formal toxicology data exists.
The herbal medicine world is changing
Throughout much of the world herbal medicine is in transition from the collection and processing of crude herbal materials of varying strengths and potencies, such as are used as powders, teas, simple syrups, and extracts by local healers and communities to well characterized preparations made according to pharmacopoeial standards predominantly supplied through a highly regulated market. The former more crude preparations are characteristic of undeveloped and developing nations, while the latter are typical of developed nations. Each country is at a different point in its evolution regarding herbal medicine. A new paradigm that takes into consideration the unique characters of herbal medicines is needed with a focus on the quality and sourcing of raw material based on the myriad of constituents found in single herbs and formulas.
Ironically, and perhaps most saliently, practitioners of traditional healing systems are seldom part of traditional health care policy decisions. Rather, commercial interests by traditional medicine producers often drive national and international health care policies, frequently leading to a restriction in materia medica and impeded access to herbal drugs. Thus, it is questionable whether traditional herbal medicine will thrive, and in many cases, survive within national health care systems. If policy makers, regulatory bodies, medicinal plant researchers, and pharmacopoeias can once again place emphasis on the quality of the plant material itself rather than viewing herbal drugs as cocktails of chemicals to be pulled apart, isolated, and manipulated, there is a chance. Similarly, medicinal plant research should reorient itself to investigate the traditional use of herbal medicines within the traditional healing system from whence they came, investigating the physiological and pharmacological subtleties that give the medicine its unique healing quality, rather than simply looking at the application of herbal drugs for Western disease patterns. Truly honoring traditional healing systems and herbal medicines and maximizing their healing potential is an international challenge that minimally should be discussed as part of national and international health care policy if humankind is to continue to reap the benefits of medicinal plants based on the systems in which they were traditionally used.