Herbal Medicine:

Navigating the Cultural Amalgam
By Kristin Whitfield

Navigating the world of herbal medicine can be a daunting task. With herbs of North America, traditional Chinese herbal medicine, Ayurvedic herbs and Japanese Kampo to choose from, which approach should you try? With various types of herbal practitioners, health food stores, drugstores, grocery stores and e-pharmacies selling herbal remedies, from whom should you buy? With articles in magazines, internet information, recommendations from friends, and suggestions from allopathic as well as complementary and alternative medical practitioners all readily available, the average consumer has a lot of information to wade through before making a safe and beneficial foray into the world of herbs.

As a prelude, let's consider the nature and history of herbal medicine: The art of herbal medicine has been practiced for millennia in every corner of the world. Early healers, such as American Indian shamans, African medicine men and Taoist priests, developed a knowledge of the flora and fauna in their environments and used natural substances to exorcise various evils (disease) from their patients. Over hundreds of years of empirical use and evaluation, the most effective of these remedies became established in the cultural lore.

As societies commingled over time, so did their herbal traditions. The Muslim materia medica preserved and built upon the Greco-Roman herbal tradition, while incorporating remedies discovered in the exploration of Asia. During the Middle Ages, Christian doctors traveling with the Crusaders reintroduced this herbal lore to Europe, and trade in herbs became a vast international commerce. Herbs played an important role in Ayurvedic medicine, which developed from ancient schools of thought in India. Over years of trading with its neighbors, China incorporated herbs from India, Southeast Asia, the Middle East and even the Americas into its already rich pharmacopoeia. Japan adopted and simplified the Chinese materia medica to develop its Kampo tradition.

As America became a melting pot for various ethnicities and religions, it inherited a rich melange of herbal medicinal approaches. The first settlers arriving from Western Europe actually brought their most important medicinal plants to begin their new colonial herb gardens. Through contact with Native Americans and experimentation, medicinal plants indigenous to North America were added to this imported pharmacopoeia to comprise the "eclectic" school of herbs which became the basis for naturopathic medicine. As immigration from all over the world continued, Chinese, Ayurvedic, Japanese Kampo and other herbal traditions were integrated into American culture. Well into the 20th century, most of the pharmacopoeia used by modern medical doctors came from native lore. Many drugs such as aspirin, digitalis, and strychnine are of herbal origin, and a number of prescription drugs currently being dispensed have at least one active ingredient derived from plant material.

All these herbal systems are similar in that they identify various medicinal properties in the leaves, stem, bark and roots of the plant. For instance (in a simplified way), some herbs are cooling, some are warming, some are drying and some are moistening. These medicinal effects can be delivered in the form of teas, tinctures, tablets or capsules. Of importance to all these herbal practices is the idea of synergism ­ that the medicinal strength of the whole herb is greater than the sum of its isolated chemically active constituents. This synergistic quality of the herb (or combination of herbs as in the case of Chinese Medicine) helps the body gently balance and heal itself without the side effects common to modern drugs made from larger dosages of selected active ingredients.

The various traditions are different in that each uses plants indigenous to the geography of cultural origin. Each also has a specific assessment process which aids in selecting the ideal herb or combination of herbs for each individual patient. Well-regarded herbal practitioners are rigorously schooled in assessing and treating the whole person, as well as in the specific actions of the herbs which are part of their particular materia medica. Choosing the right combination of herbs for any one individual is truly a learned "art," which is why self-treating is often problematic.

Historically, herbal medicine was the only internal medicine and it treated everything. While no one can deny the value of such advances as antibiotics and surgery, we also know that the overuse and incorrect use of antibiotics has bred resistant strains of bacteria, that some surgeries are unnecessary or unsuccessful, and that modern drugs are accompanied by sometimes devastating side effects. Herbal medicine can be effective with minimal side effects for the treatment of a wide range of ailments, such as the common cold and influenza, allergies, asthma, arthritis, digestive complaints, headaches and insomnia, depression and anxiety, kidney and urinary tract infections, gynecological problems including infertility, and skin diseases.

Which herbal tradition is best? This is a matter of personal choice. If you are a student of yoga and meditation or are intrigued by Buddhism, Ayurvedic medicine may be the ticket. If you are already seeing an acupuncturist, or are interested in Taoism, you might resonate more with the idea of a specialized Chinese herbal prescription (usually a synergistic combination of 8 to 20 herbs individualized to work for the particular patient). Or perhaps you may be more comfortable with herbs native to North America (most often used as single herbs or in small combinations). Selecting a tradition may ultimately be based on your choice of an herbal practitioner.

How can you evaluate practitioners? Although not required in Massachusetts, there is national board certification for practitioners of Chinese herbal medicine through the National Certification Commission for Acupuncture and Oriental Medicine [NCCAOM]. Log onto its website at http://nccaom.org to locate the board-certified practitioner nearest you. Licensed acupuncturists in Massachusetts may dispense herbs only if they have completed 500 hours of class/clinical time in the study of herbs. Finding a reputable herbalist in the other traditions is a bit more challenging, since there is no similar certification process. Personal recommendations from friends are a good place to start. Then do your own investigation into the extent of the practitioner's knowledge of the herbs themselves, as well as training in assessment and treatment. Above all, remember that you are entering into a therapeutic relationship with the practitioner you choose. Ideally he or she should be a caring healer who is capable of deep understanding and compassion, and with whom you feel a strong personal connection.

How can you decide which herbs or approach will be most beneficial? Remember that the gift of herbal medicine is that it treats the whole person. To take advantage of this, herbal practitioners are schooled in assessing your total health picture, creating a treatment plan and recommending the appropriate herbs. With follow-up, the combination and dosages can be adjusted to your unique needs. The disadvantage of over-the-counter shopping is not being able to benefit from this total and individualized approach.

Where can you find quality products? Most practitioners have their own supply of herbs which they know to be free of toxic heavy metals, pesticides or endangered species. Some Western herbalists actually grow and process many of their own herbal medicinals to ensure this quality. Because the same plant grown in different soil under different conditions can have different properties, it is important to be sure of where and how the herbs have been grown. Concentrations must be consistent so that dosing can be controlled and outcomes predicted. Knowing these variations exist, the wise consumer can ask the practitioner about the suppliers he uses and why.

The purity of the herbs in packaged products available over the counter is harder to ensure. Concentrations and dosages vary, so "buyer beware." Reputable health food stores generally carry reliable herbal supplements. Check the labels and don't be afraid to ask whether the products are heavy metal and pesticide-free. Watch out for herbal products designed and marketed by various "nutriceutical" companies which isolate the active constituents of the plants, thereby eliminating synergy and accentuating side effects.

How safe is herbal medicine? For years, health food stores have been providing herbal products to the general public in dosages designed for maintenance of general health and well-being. Taken as directed, these "tonic" doses are probably safe and hopefully helpful. As in all cases of self-medicating with over-the-counter preparations, overdosing can cause serious side effects. No one can dispute that a baby aspirin a day has been proven to be helpful to general circulatory maintenance; however, an entire bottle of adult strength aspirin ingested at the same time can be fatal. Herbal supplements should be treated with the same respect.

Larger, therapeutic doses of herbs, i.e. herbal "medicine," should be obtained only through a reputable herbal practitioner, who will assess and treat the whole body, consider possible herb/drug interactions, and monitor the effectiveness of the treatment. Consulting a practitioner is especially important if you are also taking a long list of Western medications, or if you are pregnant, pediatric, or elderly.

Herbal medicine is unsafe only when it is abused, as when herbs are taken for the wrong reason and/or in elevated dosages. The risk of harm from overdose is amplified when the active constituents are isolated, removing the balancing effects of the total plant synergy. Case in point, ma huang, or ephedra, traditionally used by herbalists for acute respiratory conditions: Herbalists use a very small amount of the plant in its totality, and most often in conjunction with other complementary herbs. However, when the active ingredient was isolated in a nutritional supplement and taken in large doses along with other stimulants for weight loss and heightened athletic performance, it caused a number of fatalities. Clearly this is not the art of herbal medicine, but rather the all-too-common search for the "quick fix."

What is the future of this ancient art in the face of modern science? In China, Western medicine and traditional Chinese medicine are practiced in an integrated way in the same hospitals. Australia and Western Europe long ago embraced their herbal tradition, carefully monitor it and make herbal medicine safely available to the public. Let us hope that in this country, we too can find a way to truly integrate herbs with current medicine, and preserve this venerable art for the health of future generations.

©2004 Kristin Whitfield all rights reserved.