Herbal medicine

{{Short description|Study and use of medicinal properties of plants}} {{redirect|Phytomedicine|the journal|Phytomedicine (journal)}} {{Alternative medicine sidebar|fringe}} thumb|right|230px|A selection of antique herbal medicines '''Herbal medicine''' (also called '''herbalism''', '''phytomedicine''' or '''phytotherapy''') is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine.<ref name=swallow>{{cite journal | vauthors = | title = Hard to swallow | journal = Nature | volume = 448 | issue = 7150 | pages = 105–6 | date = July 2007 | pmid = 17625521 | doi = 10.1038/448106a | doi-access = free | bibcode = 2007Natur.448S.105. }}</ref> Scientific evidence for the effectiveness of many herbal treatments remains limited, prompting ongoing regulatory evaluation and research into their safety and efficacy. Standards for purity or dosage are generally not provided.<ref name=swallow/><ref name=Lack2016>{{cite book | vauthors = Lack CW, Rousseau J |title=Critical Thinking, Science, and Pseudoscience: Why We Can't Trust Our Brains |date=2016 |publisher=Springer Publishing Company |isbn=978-0-8261-9426-8 |pages=212–214 |url=https://books.google.com/books?id=Miy2CwAAQBAJ&pg=PA212 |language=en}}</ref> The scope of herbal medicine sometimes includes fungal and bee products, as well as minerals, shells and certain animal parts.<ref name="cruk-herbs"/>

'''Paraherbalism''' is the ''pseudoscientific'' use of plant or animal extracts as medicine, relying on unproven beliefs about the safety and effectiveness of minimally processed natural substances.

Herbal medicine has been used since at least the Paleolithic era, with written records from ancient Sumer, Egypt, Greece, China, and India documenting its development and application over millennia. Modern herbal medicine is widely used globally, especially in Asia and Africa. Traditional medicine systems involve long-standing, culturally-embedded practices using local herbs, animal products, and spiritual elements. These systems have influenced and contributed to modern pharmacology. Herbalists believe that plants, having evolved defenses against environmental stressors, produce beneficial phytochemicals, often extracted from roots or leaves, that can be used in medicine.

Sick animals often seek out and eat plants containing compounds like tannins and alkaloids to help purge parasites—a behavior observed by scientists and sometimes cited by indigenous healers as the source of their knowledge.

==History== {{main|History of herbalism|Materia medica}} [[File:Folio Materia Medica Dioscurides Met 13.152.6 (cropped).jpg|thumb|A physician preparing an elixir, from an Arabic version of Dioscorides's pharmacopoeia, 1224]] Archaeological evidence indicates that the use of medicinal plants dates back to the Paleolithic age, approximately 60,000 years ago. Written evidence of herbal remedies dates back over 5,000 years to the Sumerians, who compiled lists of plants. Some ancient cultures wrote about plants and their medical uses in books called ''herbals''. In ancient Egypt, herbs were mentioned in Egyptian medical papyri, depicted in tomb illustrations, or on rare occasions found in medical jars containing trace amounts of herbs.<ref name="aem">{{cite book | vauthors = Nunn J |title= Ancient Egyptian Medicine|chapter=Drugs of vegetable origin|url=https://books.google.com/books?id=WHfEnVU6z8IC&pg=PA151|year= 2002|volume= 113| pages= 57–68|publisher= University of Oklahoma Press|isbn= 978-0-8061-3504-5}}</ref> In ancient Egypt, the Ebers papyrus dates from about 1550&nbsp; BCE, and covers more than 700 compounds, mainly of plant origin.<ref>{{cite journal | vauthors = Atanasov AG, Waltenberger B, Pferschy-Wenzig EM, Linder T, Wawrosch C, Uhrin P, Temml V, Wang L, Schwaiger S, Heiss EH, Rollinger JM, Schuster D, Breuss JM, Bochkov V, Mihovilovic MD, Kopp B, Bauer R, Dirsch VM, Stuppner H | display-authors = 6 | title = Discovery and resupply of pharmacologically active plant-derived natural products: A review | journal = Biotechnology Advances | volume = 33 | issue = 8 | pages = 1582–1614 | date = December 2015 | pmid = 26281720 | pmc = 4748402 | doi = 10.1016/j.biotechadv.2015.08.001 }}</ref> The earliest known Greek herbals came from Theophrastus of Eresos who, in the 4th century BCE, wrote in Greek ''Historia Plantarum'', from Diocles of Carystus who wrote during the 3rd century BCE, and from Krateuas who wrote in the 1st century BCE. Only a few fragments of these works have survived intact, but from what remains, scholars have noted an overlap with the Egyptian herbals.<ref>{{cite book| vauthors = Robson B, Baek OK |title= The Engines of Hippocrates: From the Dawn of Medicine to Medical and Pharmaceutical Informatics|publisher= John Wiley & Sons|year= 2009|isbn= 978-0-470-28953-2|page= 50|url= https://books.google.com/books?id=DVA0QouwC4YC&pg=PA50}}</ref>

Seeds likely used for herbalism were found in archaeological sites of Bronze Age China dating from the Shang dynasty<ref>{{cite journal| vauthors = Hong F |title=History of Medicine in China |journal=McGill Journal of Medicine |year=2004 |volume=8 |issue=1 |page=7984 |url=http://www.medicine.mcgill.ca/MJM/issues/v08n01/crossroads/hong.pdf |archive-url=https://web.archive.org/web/20131201231218/http://www.medicine.mcgill.ca/MJM/issues/v08n01/crossroads/hong.pdf |archive-date=1 December 2013 }}</ref> ({{Circa|1600|1046 BCE}}). Over a hundred of the 224 compounds mentioned in the ''Huangdi Neijing'', an early Chinese medical text, are herbs.<ref name="Unsc">{{cite book| vauthors = Unschuld P |title= Huang Di Nei Jing: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text |url=https://books.google.com/books?id=N2ZdrPCbpNIC&pg=PR9 |year=2003 |publisher=University of California Press |isbn=978-0-520-92849-7|page= 286}}</ref> Herbs were also commonly used in the traditional medicine of ancient India, where the principal treatment for diseases was diet.<ref name="Acker">{{cite book | vauthors = Ackerknecht E |title=A Short History of Medicine|url=https://archive.org/details/shorthistoryofme00acke |url-access= registration|year=1982 |publisher=JHU Press |isbn= 978-0-8018-2726-6|page= [https://archive.org/details/shorthistoryofme00acke/page/39 39]}}</ref> ''De Materia Medica'', originally written in Greek by Pedanius Dioscorides ({{Circa|40|90 CE|lk=no}}) of Anazarbus, Cilicia, a physician and botanist, is one example of herbal writing used over centuries until the 1600s.<ref name="ct">{{cite book | title = The Classical Tradition | url = https://books.google.com/books?id=LbqF8z2bq3sC&pg=PA146 | year = 2010 | publisher = Harvard University Press | isbn = 978-0-674-03572-0 | page = 146 }}</ref>

==Modern herbal medicine== The World Health Organization (WHO) estimates that 80 percent of the population of some Asian and African countries presently uses herbal medicine for some aspect of primary health care.<ref name=who>{{cite web|url=https://www.who.int/mediacentre/factsheets/fs134/en/ |title=Traditional medicine |archive-url=https://web.archive.org/web/20080727053337/http://www.who.int/mediacentre/factsheets/fs134/en/ |archive-date=27 July 2008 }}</ref>

Some prescription drugs have a basis as herbal remedies,<ref name="Lamottke">{{citation |author=Kai Lamottke, Christophe Ripoll, Robert Walczak |title=The roots of innovation |date=2011 |periodical=European Biopharmaceutical Review |volume=15 |pages=52–56 https://www.researchgate.net/publication/260943788_The_Roots_of_Innovation}}<!-- auto-translated from German by Module:CS1 translator --></ref> including artemisinin,<ref>{{cite journal | vauthors = Su XZ, Miller LH | title = The discovery of artemisinin and the Nobel Prize in Physiology or Medicine | journal = Science China Life Sciences | volume = 58 | issue = 11 | pages = 1175–9 | date = November 2015 | pmid = 26481135 | pmc = 4966551 | doi = 10.1007/s11427-015-4948-7 }}</ref> digitalis, quinine and taxanes.

===Regulatory review===

In 2015, the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; herbalism was one of 17 topics evaluated for which no clear evidence of effectiveness was found.<ref name="aus17">{{cite web |year=2015 |title=Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance |url=http://www.health.gov.au/internet/main/publishing.nsf/content/0E9129B3574FCA53CA257BF0001ACD11/$File/Natural%20Therapies%20Overview%20Report%20Final%20with%20copyright%2011%20March.pdf |archive-url=https://web.archive.org/web/20160626024750/http://www.health.gov.au/internet/main/publishing.nsf/Content/0E9129B3574FCA53CA257BF0001ACD11/$File/Natural%20Therapies%20Overview%20Report%20Final%20with%20copyright%2011%20March.pdf |archive-date=26 June 2016 |access-date=12 December 2015 |publisher=Australian Government – Department of Health |vauthors=Baggoley C}}</ref> Establishing guidelines to assess the safety and efficacy of herbal products, the European Medicines Agency provided criteria in 2017 for evaluating and grading the quality of clinical research in preparing monographs about herbal products.<ref>{{cite web|url=http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/general/general_content_000830.jsp&mid=WC0b01ac0580033a9b|title=Assessment of clinical safety and efficacy in the preparation of Community herbal monographs for well-established and of Community herbal monographs/entries to the Community list for traditional herbal medicinal products/substances/preparations|publisher=European Medicines Agency|date=2017|access-date=25 February 2017|archive-date=26 February 2017|archive-url=https://web.archive.org/web/20170226050218/http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/general/general_content_000830.jsp&mid=WC0b01ac0580033a9b|url-status=live}}</ref> In the United States, the National Center for Complementary and Integrative Health of the National Institutes of Health funds clinical trials on herbal compounds, provides fact sheets evaluating the safety, potential effectiveness and side effects of many plant sources,<ref name="nccih">{{cite web|url=https://www.nccih.nih.gov/health/herbsataglance.htm|title=Herbs at a Glance|publisher=National Center for Complementary and Integrative Health, US National Institutes of Health|date=21 November 2016|access-date=24 February 2017|archive-date=30 March 2019|archive-url=https://web.archive.org/web/20190330204542/https://nccih.nih.gov/health/herbsataglance.htm|url-status=live}}</ref> and maintains a registry of clinical research conducted on herbal products.<ref>{{cite web|url=https://clinicaltrials.gov/search/open/term=herbal+medicine|title=Clinicaltrials.gov, a registry of studies on herbal medicine|publisher=Clinicaltrials.gov, US National Institutes of Health|date=2017|access-date=25 February 2017|archive-date=1 April 2019|archive-url=https://web.archive.org/web/20190401125849/https://clinicaltrials.gov/search/open/term=herbal+medicine|url-status=live}}</ref>

According to Cancer Research UK as of 2015, "there is currently no strong evidence from studies in people that herbal remedies can treat, prevent or cure cancer".<ref name="cruk-herbs">{{cite web |publisher=Cancer Research UK |url=https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/herbal-medicine |title=Herbal medicine |date=2 February 2015 |access-date=12 November 2018 |archive-date=29 May 2019 |archive-url=https://web.archive.org/web/20190529165631/https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/herbal-medicine |url-status=live }}</ref>

===Prevalence of use=== The use of herbal remedies is more prevalent in people with chronic diseases, such as cancer, diabetes, asthma, and end-stage kidney disease.<ref>{{cite journal | vauthors = Burstein HJ, Gelber S, Guadagnoli E, Weeks JC | title = Use of alternative medicine by women with early-stage breast cancer | journal = The New England Journal of Medicine | volume = 340 | issue = 22 | pages = 1733–9 | date = June 1999 | pmid = 10352166 | doi = 10.1056/NEJM199906033402206 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Egede LE, Ye X, Zheng D, Silverstein MD | title = The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes | journal = Diabetes Care | volume = 25 | issue = 2 | pages = 324–9 | date = February 2002 | pmid = 11815504 | doi = 10.2337/diacare.25.2.324 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Roozbeh J, Hashempur MH, Heydari M | title = Use of herbal remedies among patients undergoing hemodialysis | journal = Iranian Journal of Kidney Diseases | volume = 7 | issue = 6 | pages = 492–5 | date = November 2013 | pmid = 24241097 }}</ref> Multiple factors such as gender, age, ethnicity, education and social class are also shown to have associations with the prevalence of herbal remedy use.<ref>{{cite journal | vauthors = Bishop FL, Lewith GT | title = Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use | journal = Evidence-Based Complementary and Alternative Medicine | volume = 7 | issue = 1 | pages = 11–28 | date = March 2010 | pmid = 18955327 | pmc = 2816378 | doi = 10.1093/ecam/nen023 }}</ref>

===Herbal preparations=== [[File:Eucalyptus olida distillation1.JPG|thumb|right|Leaves of ''Eucalyptus olida'' being packed into a steam distillation unit to gather its essential oil]] There are many forms in which herbs can be administered, the most common of which is a liquid consumed as a herbal tea or a (possibly diluted) plant extract.<ref name="saad-2011-p80" />

Herbal teas, or tisanes, are the resultant liquid of extracting herbs into water, though they are made in a few different ways. Infusions are hot water extracts of herbs, such as chamomile or mint, through steeping. Decoctions are the long-term boiled extracts, usually of harder substances like roots or bark. Maceration is the cold infusion of plants with high mucilage-content, such as sage or thyme. To make macerates, plants are chopped and added to cold water. They are left to stand for 7 to 12 hours (depending on the herb used). For most macerates, 10 hours is used.<ref name=autogenerated1 />

Tinctures are alcoholic extracts of herbs, which are generally stronger than herbal teas.<ref>{{cite book| vauthors = Green J |title=The Herbal Medicine Maker's Handbook: A Home Manual|publisher=Chelsea Green Publishing|year=2000|isbn=978-0-89594-990-5|page=168|url=https://books.google.com/books?id=5nxKJ7SocEUC&pg=PT168}}</ref> Tinctures are usually obtained by combining <!--close to 100%-->pure ethanol (or a mixture of <!--100%(?)-->pure ethanol with water) with the herb. A completed tincture has an ethanol percentage of at least 25% (sometimes up to 90%).<ref name=autogenerated1>Groot Handboek Geneeskrachtige Planten by Geert Verhelst</ref> Non-alcoholic tinctures can be made with glycerin, but it is believed to be less absorbed by the body than alcohol based tinctures and has a shorter shelf life.<ref>{{cite book | vauthors = Romm A |title=Botanical Medicine for Women's Health |year=2010 |publisher=Churchill Livingstone |isbn=978-0-443-07277-2 |page=24}}</ref> Herbal wine and elixirs are alcoholic extracts of herbs, usually with an ethanol percentage of 12–38%.<ref name=autogenerated1 /> Extracts include liquid extracts, dry extracts, and nebulisates. Liquid extracts are liquids with a lower ethanol percentage than tinctures. They are usually made by vacuum distilling tinctures. Dry extracts are extracts of plant material that are evaporated into a dry mass. They can then be further refined to a capsule or tablet.<ref name=autogenerated1 />

The exact composition of a herbal product is influenced by the extraction method. A tea will be rich in polar components because water is a polar solvent. Oil, on the other hand, is a non-polar solvent and it will absorb non-polar compounds. Alcohol lies somewhere in between.<ref name="saad-2011-p80">{{cite book| vauthors = Saad B, Said O |title=Greco-Arab and Islamic Herbal Medicine: Traditional System, Ethics, Safety, Efficacy, and Regulatory Issues|publisher=John Wiley & Sons|year=2011|isbn=978-0-470-47421-1|page=80|url=https://books.google.com/books?id=-WQVF8nhKf4C&pg=PT80}}</ref>

[[File:Marrakech 103.JPG|thumb|left|A herb shop in the souk of Marrakesh, Morocco]] Many herbs are applied topically to the skin in a variety of forms. Essential oil extracts can be applied to the skin, usually diluted in a carrier oil. Many essential oils can burn the skin or are simply too high dose used straight; diluting them in olive oil or another food grade oil such as almond oil can allow these to be used safely as a topical. Salves, oils, balms, creams, and lotions are other forms of topical delivery mechanisms. Most topical applications are oil extractions of herbs. Taking a food-grade oil and soaking herbs in it for anywhere from weeks to months allows certain phytochemicals to be extracted into the oil. This oil can then be made into salves, creams, lotions, or simply used as an oil for topical application. Many massage oils, antibacterial salves, and wound healing compounds are made this way.<ref name=":0">{{Cite book|title=Northern Lore: A Field Guide to the Northern Mind-Body-Spirit| vauthors = Odinsson E |year=2010| publisher = Eoghan Odinsson |isbn=978-1-4528-5143-3}}</ref>

Inhalation, as in aromatherapy, can be used as a treatment.<ref>{{cite web |url= http://www.umm.edu/health/medical/altmed/treatment/aromatherapy |title=Aromatherapy |date=2017 |publisher=University of Maryland Medical Center |archive-url= https://web.archive.org/web/20171025095003/http://www.umm.edu/health/medical/altmed/treatment/aromatherapy |archive-date=25 October 2017 }}</ref><ref>{{cite journal | vauthors = Herz RS | title = Aromatherapy facts and fictions: a scientific analysis of olfactory effects on mood, physiology and behavior | journal = The International Journal of Neuroscience | volume = 119 | issue = 2 | pages = 263–90 | year = 2009 | pmid = 19125379 | doi = 10.1080/00207450802333953 | name-list-style = vanc | s2cid = 205422999 }}</ref><ref>{{cite journal | vauthors = Gilani AH, Shah AJ, Zubair A, Khalid S, Kiani J, Ahmed A, Rasheed M, Ahmad VU | display-authors = 6 | title = Chemical composition and mechanisms underlying the spasmolytic and bronchodilatory properties of the essential oil of Nepeta cataria L | journal = Journal of Ethnopharmacology | volume = 121 | issue = 3 | pages = 405–11 | date = January 2009 | pmid = 19041706 | doi = 10.1016/j.jep.2008.11.004 | name-list-style = vanc }}</ref> {{clear}}

===Safety=== {{For|a partial list of herbs with known adverse effects|List of herbs with known adverse effects}}

[[File:Datura stramonium - Köhler–s Medizinal-Pflanzen-051.jpg|thumb|right|''Datura stramonium'' has been used in Ayurveda for various treatments, but contains alkaloids, such as atropine and scopolamine, which may cause severe toxicity.<ref>{{cite journal | vauthors = Gaire BP, Subedi L | title = A review on the pharmacological and toxicological aspects of Datura stramonium L | journal = Journal of Integrative Medicine | volume = 11 | issue = 2 | pages = 73–9 | date = March 2013 | pmid = 23506688 | doi = 10.3736/jintegrmed2013016 }}</ref>]]

It is a popular misconception that herbal medicines are safe and side-effect free.<ref>{{cite book |vauthors=Kumar P, Nandave M, Kumar A, Nandave D |year=2024 |chapter= Herbovigilance|veditors=Nandave M, Kumar A |title=Pharmacovigilance Essentials |publisher=Springer | doi=10.1007/978-981-99-8949-2_12 |pages=243–267|isbn=978-981-99-8948-5 }}</ref> Consumption of herbs may cause adverse effects.<ref name="Talalay">{{cite journal | vauthors = Talalay P, Talalay P | title = The importance of using scientific principles in the development of medicinal agents from plants | journal = Academic Medicine | volume = 76 | issue = 3 | pages = 238–47 | date = March 2001 | pmid = 11242573 | doi = 10.1097/00001888-200103000-00010 | doi-access = free }}</ref> Furthermore, "adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal."<ref name="LewisME">{{cite journal | vauthors = Elvin-Lewis M | title = Should we be concerned about herbal remedies | journal = Journal of Ethnopharmacology | volume = 75 | issue = 2–3 | pages = 141–64 | date = May 2001 | pmid = 11297844 | doi = 10.1016/S0378-8741(00)00394-9 | name-list-style = vanc }}</ref> Proper double-blind clinical trials are needed to determine the safety and efficacy of each plant before medical use.<ref name="pmid17761132">{{cite journal | vauthors = Vickers AJ | title = Which botanicals or other unconventional anticancer agents should we take to clinical trial? | journal = Journal of the Society for Integrative Oncology | volume = 5 | issue = 3 | pages = 125–9 | year = 2007 | pmid = 17761132 | pmc = 2590766 | doi = <!-- none --> }}</ref>

Although many consumers believe that herbal medicines are safe because they are natural, herbal medicines and synthetic drugs may interact, causing toxicity to the consumer. Herbal remedies can also be dangerously contaminated, and herbal medicines without established efficacy, may unknowingly be used to replace prescription medicines.<ref name="pmid17913230">{{cite book| vauthors = Ernst E |chapter=Herbal Medicines: Balancing Benefits and Risks |title=Dietary Supplements and Health|volume=282|pages=154–67; discussion 167–72, 212–18 |year=2007|pmid=17913230|doi=10.1002/9780470319444.ch11|series=Novartis Foundation Symposia|isbn=978-0-470-31944-4}}</ref>

Standardization of purity and dosage is not mandated in the United States, but even products made to the same specification may differ as a result of biochemical variations within a species of plant. Plants have chemical defense mechanisms against predators that can have adverse or lethal effects on humans. Examples of highly toxic herbs include poison hemlock and nightshade.<ref>{{cite journal | vauthors = Müller JL | title = Love potions and the ointment of witches: historical aspects of the nightshade alkaloids | journal = Journal of Toxicology. Clinical Toxicology | volume = 36 | issue = 6 | pages = 617–27 | year = 1998 | pmid = 9776969 | doi = 10.3109/15563659809028060 }}</ref> They are not marketed to the public as herbs, because the risks are well known, partly due to a long and colorful history in Europe, associated with "sorcery", "magic" and intrigue.<ref>{{cite journal | vauthors = Lee MR | title = Solanaceae III: henbane, hags and Hawley Harvey Crippen | journal = The Journal of the Royal College of Physicians of Edinburgh | volume = 36 | issue = 4 | pages = 366–73 | date = December 2006 | doi = 10.1177/1478271520063604005 | pmid = 17526134 }}</ref>

Although not frequent, adverse reactions have been reported for herbs in widespread use.<ref>{{cite journal | vauthors = Pinn G | title = Adverse effects associated with herbal medicine | journal = Australian Family Physician | volume = 30 | issue = 11 | pages = 1070–5 | date = November 2001 | pmid = 11759460 }}</ref> On occasion serious untoward outcomes have been linked to herb consumption. A case of major potassium depletion has been attributed to chronic licorice ingestion,<ref>{{cite journal | vauthors = Lin SH, Yang SS, Chau T, Halperin ML | title = An unusual cause of hypokalemic paralysis: chronic licorice ingestion | journal = The American Journal of the Medical Sciences | volume = 325 | issue = 3 | pages = 153–6 | date = March 2003 | pmid = 12640291 | doi = 10.1097/00000441-200303000-00008 | s2cid = 35033559 }}</ref> and consequently professional herbalists avoid the use of licorice where they recognize that this may be a risk. Black cohosh has been implicated in a case of liver failure.<ref>{{cite journal | vauthors = Lynch CR, Folkers ME, Hutson WR | title = Fulminant hepatic failure associated with the use of black cohosh: a case report | journal = Liver Transplantation | volume = 12 | issue = 6 | pages = 989–92 | date = June 2006 | pmid = 16721764 | doi = 10.1002/lt.20778 | s2cid = 28255622 | doi-access = free }}</ref> Few studies are available on the safety of herbs for pregnant women,<ref>{{cite journal | vauthors = Born D, Barron ML | title = Herb use in pregnancy: what nurses should know | journal = MCN: The American Journal of Maternal/Child Nursing | volume = 30 | issue = 3 | pages = 201–6; quiz 207–8 | date = May–June 2005 | pmid = 15867682 | doi = 10.1097/00005721-200505000-00009 | s2cid = 35882289 }}</ref> and one study found that use of complementary and alternative medicines is associated with a 30% lower ongoing pregnancy and live birth rate during fertility treatment.<ref>{{cite journal | vauthors = Boivin J, Schmidt L | title = Use of complementary and alternative medicines associated with a 30% lower ongoing pregnancy/live birth rate during 12 months of fertility treatment | journal = Human Reproduction | volume = 24 | issue = 7 | pages = 1626–31 | date = July 2009 | pmid = 19359338 | doi = 10.1093/humrep/dep077 | name-list-style = vanc | doi-access = free }}</ref>

Examples of herbal treatments with likely cause-effect relationships with adverse events include aconite (which is often a legally restricted herb), Ayurvedic remedies, broom, chaparral, Chinese herb mixtures, comfrey, herbs containing certain flavonoids, germander, guar gum, liquorice root, and pennyroyal.<ref name ="ErnstE">{{cite journal | vauthors = Ernst E | title = Harmless herbs? A review of the recent literature | journal = The American Journal of Medicine | volume = 104 | issue = 2 | pages = 170–8 | date = February 1998 | pmid = 9528737 | doi = 10.1016/S0002-9343(97)00397-5 | name-list-style = vanc }}</ref> Examples of herbs that may have long-term adverse effects include ginseng, the endangered herb goldenseal, milk thistle, senna, aloe vera juice, buckthorn bark and berry, cascara sagrada bark, saw palmetto, valerian, kava (which is banned in the European Union), St. John's wort, khat, betel nut, the restricted herb ephedra, and guarana.<ref name="LewisME"/>

There is also concern with respect to the numerous well-established interactions of herbs and drugs.<ref name="LewisME"/><ref name="Izzo 2012 pp. 404–428">{{cite journal | vauthors = Izzo AA | title = Interactions between herbs and conventional drugs: overview of the clinical data | journal = Medical Principles and Practice | volume = 21 | issue = 5 | pages = 404–28 | date = 2012 | pmid = 22236736 | doi = 10.1159/000334488 | doi-access = free }}</ref> In consultation with a physician, usage of herbal remedies should be clarified, as some herbal remedies have the potential to cause adverse drug interactions when used in combination with various prescription and over-the-counter pharmaceuticals, just as a customer should inform a herbalist of their consumption of actual prescription and other medication.<ref name="NCCIH 2015">{{cite web | title=Herb-Drug Interactions | website=NCCIH | date=10 September 2015 | url=https://www.nccih.nih.gov/health/providers/digest/herb-drug-interactions | access-date=26 June 2019 | archive-date=26 June 2019 | archive-url=https://web.archive.org/web/20190626162518/https://nccih.nih.gov/health/providers/digest/herb-drug | url-status=live }}</ref><ref name="Kuhn 2002 pp. 22–32">{{cite journal | vauthors = Kuhn MA | title = Herbal remedies: drug-herb interactions | journal = Critical Care Nurse | volume = 22 | issue = 2 | pages = 22–8, 30, 32; quiz 34–5 | date = April 2002 | pmid = 11961942 | doi = 10.4037/ccn2002.22.2.22 }}</ref>

For example, dangerously low blood pressure may result from the combination of a herbal remedy that lowers blood pressure together with prescription medicine that has the same effect. Some herbs may amplify the effects of anticoagulants.<ref>{{cite journal | vauthors = Spolarich AE, Andrews L | title = An examination of the bleeding complications associated with herbal supplements, antiplatelet and anticoagulant medications | journal = Journal of Dental Hygiene | volume = 81 | issue = 3 | page = 67 | date = Summer 2007 | pmid = 17908423 | url = http://findarticles.com/p/articles/mi_hb6368/is_3_81/ai_n31843689/ | access-date = 28 December 2010 | archive-date = 12 October 2011 | archive-url = https://web.archive.org/web/20111012175719/http://findarticles.com/p/articles/mi_hb6368/is_3_81/ai_n31843689/ | url-status = live }}</ref> Certain herbs as well as common fruit interfere with cytochrome P450, an enzyme critical to much drug metabolism.<ref>{{cite journal | vauthors = Nekvindová J, Anzenbacher P | title = Interactions of food and dietary supplements with drug metabolising cytochrome P450 enzymes | journal = Ceska a Slovenska Farmacie | volume = 56 | issue = 4 | pages = 165–73 | date = July 2007 | pmid = 17969314 }}</ref>

In a 2018 study, the FDA identified active pharmaceutical additives in over 700 analyzed dietary supplements sold as "herbal", "natural" or "traditional".<ref>{{Cite web|url=https://www.npr.org/sections/health-shots/2018/10/12/656875443/no-wonder-it-works-so-well-there-may-be-viagra-in-that-herbal-supplement|vauthors=Cohen R|title=No Wonder It Works So Well: There May Be Viagra In That Herbal Supplement|website=NPR.org|language=en|date=12 October 2018|access-date=13 October 2018|archive-date=13 October 2018|archive-url=https://web.archive.org/web/20181013010847/https://www.npr.org/sections/health-shots/2018/10/12/656875443/no-wonder-it-works-so-well-there-may-be-viagra-in-that-herbal-supplement|url-status=live}}</ref> The undisclosed additives included "unapproved antidepressants and designer steroids", as well as prescription drugs, such as sildenafil or sibutramine.

===Labeling accuracy=== Researchers at the University of Adelaide found in 2014 that almost 20 percent of herbal remedies surveyed were not registered with the Therapeutic Goods Administration, despite this being a condition for their sale.<ref name="carroll">{{cite web|url=http://www.smh.com.au/national/health/herbal-medicines-study-raises-alarm-over-labelling-20140223-33aex.html|title=Herbal medicines: Study raises alarm over labelling|vauthors=Carroll L|publisher=The Sydney Morning Herald, Australia|date=24 February 2014|access-date=25 February 2017|archive-date=26 February 2017|archive-url=https://web.archive.org/web/20170226050056/http://www.smh.com.au/national/health/herbal-medicines-study-raises-alarm-over-labelling-20140223-33aex.html|url-status=live}}</ref> They also found that nearly 60 percent of products surveyed had ingredients that did not match what was on the label. Out of 121 products, only 15 had ingredients that matched their TGA listing and packaging.<ref name=carroll/>

In 2015, the New York Attorney General issued cease and desist letters to four major US retailers (GNC, Target, Walgreens, and Walmart) who were accused of selling herbal supplements that were mislabeled and potentially dangerous.<ref>{{cite news|vauthors=O'Connor A|title=New York Attorney General Targets Supplements at Major Retailers|url=http://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers/|access-date=3 February 2015|work=The New York Times|date=3 February 2015|archive-date=28 April 2019|archive-url=https://web.archive.org/web/20190428162113/https://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers/|url-status=live}}</ref><ref>{{cite news|vauthors=Kaplan S|title=GNC, Target, Wal-Mart, Walgreens accused of selling adulterated 'herbals'|url=https://www.washingtonpost.com/news/morning-mix/wp/2015/02/03/gnc-target-wal-mart-walgreens-accused-of-selling-fake-herbals/|access-date=3 February 2015|newspaper=The Washington Post|date=3 February 2015|archive-date=24 May 2019|archive-url=https://web.archive.org/web/20190524214941/https://www.washingtonpost.com/news/morning-mix/wp/2015/02/03/gnc-target-wal-mart-walgreens-accused-of-selling-fake-herbals/|url-status=live}}</ref> Twenty-four products were tested by DNA barcoding as part of the investigation, with all but five containing DNA that did not match the product labels.

===Practitioners of herbalism=== [[File:Picking of heads of Arnica montana.JPG|thumb|right|A herbalist gathers the flower heads of ''Arnica montana''.]]

In some countries, formalized training and minimum education standards exist for herbalists, although these are not necessarily uniform within or between countries. In Australia, for example, the self-regulated status of the profession (as of 2009) resulted in variable standards of training, and numerous loosely formed associations setting different educational standards.<ref name="lin">{{cite journal | vauthors = Lin V, McCabe P, Bensoussan A, Myers S, Cohen M, Hill S, Howse G | title = The practice and regulatory requirements of naturopathy and western herbal medicine in Australia | journal = Risk Management and Healthcare Policy | volume = 2 | pages = 21–33 | year = 2009 | pmid = 22312205 | pmc = 3270908 | doi = 10.2147/RMHP.S4652 | doi-access = free }}</ref> One 2009 review concluded that regulation of herbalists in Australia was needed to reduce the risk of interaction of herbal medicines with prescription drugs, to implement clinical guidelines and prescription of herbal products, and to assure self-regulation for protection of public health and safety.<ref name=lin/> In the United Kingdom, the training of herbalists is done by state-funded universities offering Bachelor of Science degrees in herbal medicine.<ref name="The National Institute of Medical Herbalists">{{cite web | title=Becoming a Herbalist | website=The National Institute of Medical Herbalists | url=https://www.nimh.org.uk/becoming-a-herbalist | access-date=26 June 2019 | archive-date=26 June 2019 | archive-url=https://web.archive.org/web/20190626164329/https://www.nimh.org.uk/becoming-a-herbalist | url-status=live }}</ref> In the United States, according to the American Herbalist Guild, "there is currently no licensing or certification for herbalists in any state that precludes the rights of anyone to use, dispense, or recommend herbs."<ref name="American Herbalist Guild">{{cite web | title=Legal and Regulatory FAQs | website=American Herbalist Guild | date=24 January 2014 | url=https://www.americanherbalistsguild.com/legal-and-regulatory-faqs | access-date=25 November 2020 | archive-date=24 November 2020 | archive-url=https://web.archive.org/web/20201124100420/https://www.americanherbalistsguild.com/legal-and-regulatory-faqs | url-status=live }}</ref> However, there are U.S. federal restrictions for marketing herbs as cures for medical conditions, or essentially practicing as an unlicensed physician.

===United States herbalism fraud=== Over the years 2017–2021, the US Food and Drug Administration (FDA) issued warning letters to numerous herbalism companies for illegally marketing products under "conditions that cause them to be drugs under section 201(g)(1) of the Act [21 U.S.C. § 321(g)(1)], because they are intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease and/or intended to affect the structure or any function of the body" when no such evidence existed.<ref name="fda-fraud">{{cite web |title=2017 Warning Letters – Health Fraud |url=https://www.fda.gov/consumers/health-fraud-scams/2017-warning-letters-health-fraud |publisher=US Food and Drug Administration |access-date=2 April 2021 |date=27 February 2017 |archive-date=9 May 2021 |archive-url=https://web.archive.org/web/20210509110850/https://www.fda.gov/consumers/health-fraud-scams/2017-warning-letters-health-fraud }}</ref><ref name="FDA2017">{{cite web | title=Warning Letter – Herbal Doctor Remedies | publisher=U.S. Food and Drug Administration | url=https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/herbal-doctor-remedies-515519-05252017 | vauthors=Porter Jr SE | date=25 May 2017 | access-date=25 November 2020 | archive-date=2 December 2020 | archive-url=https://web.archive.org/web/20201202212726/https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/herbal-doctor-remedies-515519-05252017 | url-status=live }}</ref><ref name="fda-covid">{{cite web |title=Fraudulent Coronavirus Disease 2019 (COVID-19) Products |url=https://www.fda.gov/consumers/health-fraud-scams/fraudulent-coronavirus-disease-2019-covid-19-products |publisher=US Food and Drug Administration |access-date=2 April 2021 |date=2 April 2021 |archive-date=5 March 2021 |archive-url=https://web.archive.org/web/20210305182557/https://www.fda.gov/consumers/health-fraud-scams/fraudulent-coronavirus-disease-2019-covid-19-products }}</ref> During the COVID-19 pandemic, the FDA and US Federal Trade Commission issued warnings to several hundred American companies for promoting false claims that herbal products could prevent or treat COVID-19 disease.<ref name=fda-covid/><ref name="bellamy">{{cite web |vauthors=Bellamy J |title=FDA and FTC issue more warning letters citing products and services making illegal COVID claims |url=https://sciencebasedmedicine.org/fda-and-ftc-issue-more-warning-letters-citing-products-and-services-making-illegal-covid-claims/ |publisher=Science-Based Medicine |access-date=2 April 2021 |date=19 November 2020 |archive-date=14 January 2021 |archive-url=https://web.archive.org/web/20210114200429/https://sciencebasedmedicine.org/fda-and-ftc-issue-more-warning-letters-citing-products-and-services-making-illegal-covid-claims/ |url-status=live}}</ref>

===Government regulations=== The World Health Organization (WHO), the specialized agency of the United Nations (UN) that is concerned with international public health, published ''Quality control methods for medicinal plant materials'' in 1998 to support WHO Member States in establishing quality standards and specifications for herbal materials, within the overall context of quality assurance and control of herbal medicines.<ref>{{cite web|url=http://apps.who.int/medicinedocs/documents/h1791e/h1791e.pdf|archive-url=https://web.archive.org/web/20140801100849/http://apps.who.int/medicinedocs/documents/h1791e/h1791e.pdf|archive-date=1 August 2014|title=WHO Quality Control Methods for Herbal Materials|date=2011|publisher=World Health Organization, Geneva, Switzerland}}</ref>

In the European Union (EU), herbal medicines are regulated under the Committee on Herbal Medicinal Products.<ref>{{cite web|url=http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/general/general_content_000208.jsp&mid=WC0b01ac05800240cf|title=Herbal medicinal products|date=2017|publisher=European Medicines Agency|access-date=25 February 2017|archive-date=15 March 2017|archive-url=https://web.archive.org/web/20170315200330/http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/general/general_content_000208.jsp&mid=WC0b01ac05800240cf|url-status=live}}</ref>

In the United States, herbal remedies are regulated dietary supplements by the Food and Drug Administration (FDA) under current good manufacturing practice (cGMP) policy for dietary supplements.<ref name="ods2011">{{cite web|url=https://ods.od.nih.gov/factsheets/BotanicalBackground-Consumer/|publisher=Office of Dietary Supplements, US National Institutes of Health|title=Botanical Dietary Supplements|date=June 2011|access-date=25 February 2017|archive-date=20 October 2018|archive-url=https://web.archive.org/web/20181020220552/http://ods.od.nih.gov/factsheets/BotanicalBackground-HealthProfessional/|url-status=live}}</ref> Manufacturers of products falling into this category are not required to prove the safety or efficacy of their product so long as they do not make 'medical' claims or imply uses other than as a 'dietary supplement', though the FDA may withdraw a product from sale should it prove harmful.<ref>{{Cite web|url=https://www.fda.gov/opacom/laws/dshea.html|title=US Dietary Supplement Health and Education Act of 1994|website=Food and Drug Administration|access-date=16 December 2019|archive-date=31 May 2009|archive-url=https://web.archive.org/web/20090531213336/http://www.fda.gov/opacom/laws/dshea.html}}</ref><ref>{{cite journal | vauthors = Goldman P | title = Herbal medicines today and the roots of modern pharmacology | journal = Annals of Internal Medicine | volume = 135 | issue = 8 Pt 1 | pages = 594–600 | date = October 2001 | pmid = 11601931 | doi = 10.7326/0003-4819-135-8_Part_1-200110160-00010 | s2cid = 35766876 }}</ref>

Canadian regulations are described by the Natural and Non-prescription Health Products Directorate which requires an eight-digit Natural Product Number or Homeopathic Medicine Number on the label of licensed herbal medicines or dietary supplements.<ref name="hc">{{cite web|url=http://www.hc-sc.gc.ca/dhp-mps/prodnatur/applications/licen-prod/lnhpd-bdpsnh-eng.php|title=Licensed Natural Health Products Database: What is it?|publisher=Health Canada|date=8 December 2016|access-date=25 February 2017|archive-date=4 June 2017|archive-url=https://web.archive.org/web/20170604083408/http://www.hc-sc.gc.ca/dhp-mps/prodnatur/applications/licen-prod/lnhpd-bdpsnh-eng.php|url-status=live}}</ref>

Some herbs, such as cannabis and coca, are outright banned in most countries though coca is legal in most of the South American countries where it is grown. The ''Cannabis'' plant is used as a herbal medicine, and as such is legal in some parts of the world. Since 2004, the sales of ephedra as a dietary supplement is prohibited in the United States by the FDA,<ref>[http://www.cfsan.fda.gov/~lrd/fpephed6.html FDA Issues Regulation Prohibiting Sale of Dietary Supplements Containing Ephedrine Alkaloids and Reiterates Its Advice That Consumers Stop Using These Products] {{webarchive|url=https://web.archive.org/web/20070915111213/http://www.cfsan.fda.gov/~lrd/fpephed6.html |date=15 September 2007 }}</ref> and subject to Schedule III restrictions in the United Kingdom.

===Scientific criticism=== Herbalism has been criticized as a potential "minefield" of unreliable product quality, safety hazards, and the potential for misleading health advice.<ref name=swallow/><ref name="quackwatch">{{cite web|url=https://quackwatch.org/related/herbs/|title=The Herbal Minefield|vauthors=Barrett S|author-link=Stephen Barrett|publisher=Quackwatch|date=23 November 2013|access-date=25 February 2017|archive-date=5 August 2020|archive-url=https://web.archive.org/web/20200805172021/https://quackwatch.org/related/herbs/|url-status=live}}</ref> Globally, there are no standards across various herbal products to authenticate their contents, safety or efficacy, and there is generally an absence of high-quality scientific research on product composition or effectiveness for anti-disease activity.<ref name=quackwatch/><ref>{{cite web|url=http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf?ua=1|publisher=World Health Organization|title=WHO Traditional Medicine Strategy, 2014–2023|page=41|date=2013|access-date=25 February 2017|archive-date=18 November 2017|archive-url=https://web.archive.org/web/20171118192156/http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf?ua=1|url-status=live}}</ref> Presumed claims of therapeutic benefit from herbal products, without rigorous evidence of efficacy and safety, receive skeptical views by scientists.<ref name=swallow/>

Unethical practices by some herbalists and manufacturers, which may include false advertising about health benefits on product labels or literature,<ref name=quackwatch/> and contamination or use of fillers during product preparation,<ref>{{cite journal | vauthors = Zhang J, Wider B, Shang H, Li X, Ernst E | title = Quality of herbal medicines: challenges and solutions | journal = Complementary Therapies in Medicine | volume = 20 | issue = 1–2 | pages = 100–6 | year = 2012 | pmid = 22305255 | doi = 10.1016/j.ctim.2011.09.004 }}</ref> may erode consumer confidence about services and products.<ref>{{cite journal | vauthors = Morris CA, Avorn J | title = Internet marketing of herbal products | journal = JAMA | volume = 290 | issue = 11 | pages = 1505–9 | date = September 2003 | pmid = 13129992 | doi = 10.1001/jama.290.11.1505 }}</ref><ref>{{cite journal | vauthors = Coghlan ML, Haile J, Houston J, Murray DC, White NE, Moolhuijzen P, Bellgard MI, Bunce M | display-authors = 6 | title = Deep sequencing of plant and animal DNA contained within traditional Chinese medicines reveals legality issues and health safety concerns | journal = PLOS Genetics | volume = 8 | issue = 4 | article-number = e1002657 | year = 2012 | pmid = 22511890 | pmc = 3325194 | doi = 10.1371/journal.pgen.1002657 | doi-access = free }}</ref>

==Paraherbalism== [[File:Cinchona officinalis 001.JPG|thumb|right|An example of a herbal medicine resource: the bark of the cinchona tree contains quinine, which today is a widely prescribed treatment for malaria. The unpurified bark is still used by some who cannot afford to purchase more expensive antimalarial drugs.]]

'''Paraherbalism''' is the pseudoscientific use of extracts of plant or animal origin as supposed medicines or health-promoting agents.<ref name=swallow/><ref name="tyler">{{Cite web |date=31 August 1999 |title=False Tenets of Paraherbalism |url=http://www.quackwatch.org/01QuackeryRelatedTopics/paraherbalism.html |url-status=live |archive-url=https://web.archive.org/web/20091111182115/http://www.quackwatch.org/01QuackeryRelatedTopics/paraherbalism.html |archive-date=11 November 2009 |access-date=29 October 2016 |publisher=Quackwatch |vauthors=Tyler VE}}</ref><ref name=quackwatch/> Phytotherapy differs from plant-derived medicines in standard pharmacology because it does not isolate and standardize the compounds from a given plant believed to be biologically active. It relies on the false belief that preserving the complexity of substances from a given plant with less processing is safer and potentially more effective, for which there is no evidence either condition applies.<ref name=tyler/>

Phytochemical researcher Varro Eugene Tyler described paraherbalism as "faulty or inferior herbalism based on pseudoscience", using scientific terminology but lacking scientific evidence for safety and efficacy. Tyler listed ten fallacies that distinguished herbalism from paraherbalism, including claims that there is a conspiracy to suppress safe and effective herbs, herbs cannot cause harm, whole herbs are more effective than molecules isolated from the plants, herbs are superior to drugs, the doctrine of signatures (the belief that the shape of the plant indicates its function) is valid, dilution of substances increases their potency (a doctrine of the pseudoscience of homeopathy), astrological alignments are significant, animal testing is not appropriate to indicate human effects, anecdotal evidence is an effective means of proving a substance works and herbs were created by God to cure disease. Tyler suggests that none of these beliefs have any basis in fact.<ref name="tyler" /><ref name = Tyler>{{cite book | vauthors = Tyler VE, Robbers JE | author-link = Varro Eugene Tyler | year = 1999 | title = Tyler's Herbs of Choice: The Therapeutic Use of Phytomedicinals | publisher = Routledge | pages = [https://books.google.com/books?id=4X4ly7nRDxwC&pg=PA6 6–8] | isbn = 978-0-7890-0159-7 }}</ref>

==Traditional systems== {{See also|Traditional medicine}} [[File:Xi'an traditionnal medecine market (18).JPG|thumb|right|Ready to drink macerated medicinal liquor with goji berry, tokay gecko, and ginseng, for sale at a traditional medicine market in Xi'an, China]]

===Africa=== {{Main|Traditional African medicine}} Up to 80% of the population in Africa uses traditional medicine as primary health care.<ref>{{cite web|url=https://www.who.int/mediacentre/factsheets/2003/fs134/en/|archive-url=https://web.archive.org/web/20030608090402/http://www.who.int/mediacentre/factsheets/2003/fs134/en/|archive-date=8 June 2003|title=Traditional medicine, Factsheet No. 134|publisher=World Health Organization|date=May 2003}}</ref>

===Americas=== Native Americans used about 2,500 of the approximately 20,000 plant species that are native to North America.<ref>{{Cite book| vauthors = Moerman DE |chapter=Ethnobotany in North America|editor=Selin, Helaine|editor-link=Helaine Selin|title=Encyclopaedia of the History of Science, Technology, and Medicine in Non-Western Cultures|publisher=Springer|year=1997|isbn=978-0-7923-4066-9|page=321|chapter-url=https://books.google.com/books?id=raKRY3KQspsC&pg=PA321}}</ref>

In Andean healing practices, the use of entheogens, in particular the San Pedro cactus (''Echinopsis pachanoi'') is still a vital component, and has been around for millennia.<ref>{{cite journal | vauthors = Bussmann RW, Sharon D | title = Traditional medicinal plant use in Northern Peru: tracking two thousand years of healing culture | journal = Journal of Ethnobiology and Ethnomedicine | volume = 2 | issue = 1 | page = 47 | date = November 2006 | pmid = 17090303 | pmc = 1637095 | doi = 10.1186/1746-4269-2-47 | doi-access = free }}</ref>

===Asia=== ====China==== Some researchers trained in both Western and traditional Chinese medicine have attempted to deconstruct ancient medical texts in the light of modern science. In 1972, Tu Youyou, a pharmaceutical chemist and Nobel Prize winner, extracted the anti-malarial drug artemisinin from sweet wormwood, a traditional Chinese treatment for intermittent fevers.<ref>{{cite journal | vauthors = Yuan D, Yang X, Guo JC | title = A great honor and a huge challenge for China: You-you TU getting the Nobel Prize in Physiology or Medicine | journal = Journal of Zhejiang University. Science. B | volume = 17 | issue = 5 | pages = 405–8 | date = May 2016 | pmid = 27143269 | pmc = 4868832 | doi = 10.1631/jzus.B1600094 }}</ref>

====India==== thumb|A platter of herbal medicines at Goa, India In India, Ayurvedic medicine has quite complex formulas with 30 or more ingredients, including a sizable number of ingredients that have undergone "alchemical processing", chosen to balance dosha.<ref>{{cite journal |vauthors=Kala CP |title=Preserving Ayurvedic herbal formulations by Vaidyas: The traditional healers of the Uttaranchal Himalaya region in India |journal=HerbalGram |year=2006 |volume=70 |pages=42–50 |url=http://cms.herbalgram.org/herbalgram/issue70/article2969.html |access-date=9 June 2020 |archive-date=18 February 2020 |archive-url=https://web.archive.org/web/20200218142556/http://cms.herbalgram.org/herbalgram/issue70/article2969.html |url-status=live }}</ref> In Ladakh, Lahul-Spiti, and Tibet, the Tibetan Medical System is prevalent, also called the "Amichi Medical System". Over 337 species of medicinal plants have been documented by C.P. Kala. Those are used by Amchis, the practitioners of this medical system.<ref>{{cite journal| vauthors = Kala CP |title=Health traditions of Buddhist community and role of amchis in trans-Himalayan region of India|journal=Current Science|year=2005|volume=89|issue=8|pages=1331–38}}</ref><ref>{{cite book| vauthors = Kala CP |title=Medicinal plants of Indian trans-Himalaya|year=2003|publisher=Bishen Singh Mahendra Pal Singh|location=Dehradun|page=200}}</ref> The Indian book, Vedas, mentions treatment of diseases with plants.<ref>{{cite journal | vauthors = Petrovska BB | title = Historical review of medicinal plants' usage | journal = Pharmacognosy Reviews | volume = 6 | issue = 11 | pages = 1–5 | date = January 2012 | pmid = 22654398 | pmc = 3358962 | doi = 10.4103/0973-7847.95849 | doi-access = free }}</ref>

====Indonesia==== [[File:Jamu.jpg|thumb|right|Different types of Indonesian jamu herbal medicines held in bottles]] In Indonesia, especially among the Javanese, the jamu traditional herbal medicine may have originated in the Mataram kingdom era, some 1300 years ago.<ref>{{cite news |vauthors=Wahono T |title=Jejak Mataram Kuno di Sindoro |trans-title=Traces of Ancient Mataram in Sindoro |url=https://edukasi.kompas.com/read/2012/02/21/06231614/jejak.mataram.kuno.di.sindoro |work=KOMPAS |date=21 February 2012 |language=id |access-date=9 June 2020 |archive-date=9 June 2020 |archive-url=https://web.archive.org/web/20200609114749/https://edukasi.kompas.com/read/2012/02/21/06231614/jejak.mataram.kuno.di.sindoro |url-status=live }}</ref> The bas-reliefs on Borobudur depict the image of people grinding herbs with stone mortar and pestle, a drink seller, a herbalist, and masseuse treating people.<ref name="Tribun1">{{cite news |title=Jamu dan Lulur, Rahasia Cantik Para Putri Keraton |date=21 May 2013 |newspaper=Tribun Jogja |url=http://jogja.tribunnews.com/2013/05/21/jamu-dan-lulur-rahasia-cantik-para-puteri-keraton |language=id |access-date=4 November 2015 |archive-date=3 April 2019 |archive-url=https://web.archive.org/web/20190403104425/http://jogja.tribunnews.com/2013/05/21/jamu-dan-lulur-rahasia-cantik-para-puteri-keraton |url-status=live }}</ref> The Madhawapura inscription from Majapahit period mentioned a specific profession of herb mixer and combiner (herbalist), called ''Acaraki''.<ref name="Tribun1"/> The book from Mataram dated from circa 1700 contains 3,000 entries of jamu herbal recipes, while Javanese classical literature Serat Centhini (1814) describes some jamu herbal concoction recipes.<ref name="Tribun1"/>

Though possibly influenced by Indian Ayurveda systems, the Indonesia archipelago holds numerous indigenous plants not found in India, including plants similar to those in Australia beyond the Wallace Line.<ref>{{Cite web |last=Society |first=National Geographic |date=2020-08-20 |title=Dividing Species: Wallace Line Map |url=http://www.nationalgeographic.org/maps/dividing-species-wallace-line-map/ |access-date=2022-05-04 |website=National Geographic Society |language=en |archive-date=7 May 2022 |archive-url=https://web.archive.org/web/20220507162627/https://www.nationalgeographic.org/maps/dividing-species-wallace-line-map/ |url-status=live }}</ref> Jamu practices may vary from region to region, and are often not recorded, especially in remote areas of the country.<ref>{{cite book | vauthors = Beers SJ |title=Jamu: The Ancient Indonesian Art of Herbal Healing |date=2001 |publisher=Periplus Editions (HK) Limited |isbn=978-962-593-503-4 }}{{page needed|date=June 2020}}</ref> Although primarily herbal, some Jamu materials are acquired from animals, such as honey, royal jelly, milk, and ''Ayam Kampung'' eggs.

==Beliefs==

Herbalists tend to use extracts from parts of plants, such as the roots or leaves,<ref name="vickers">{{cite journal | vauthors = Vickers A, Zollman C | title = ABC of complementary medicine: herbal medicine | journal = BMJ | volume = 319 | issue = 7216 | pages = 1050–3 | date = October 1999 | pmid = 10521203 | pmc = 1116847 | doi = 10.1136/bmj.319.7216.1050 }}</ref> believing that plants are subject to environmental pressures and therefore develop resistance to threats such as radiation, reactive oxygen species and microbial attack to survive, providing defensive phytochemicals of use in herbalism.<ref name=vickers/><ref>{{cite journal | vauthors = Grassmann J, Hippeli S, Elstner EF |title=Plant's defence and its benefits for animals and medicine: role of phenolics and terpenoids in avoiding oxygen stress |journal=Plant Physiology and Biochemistry |date=June 2002 |volume=40 |issue=6–8 |pages=471–478 |doi=10.1016/S0981-9428(02)01395-5 |bibcode=2002PlPB...40..471G }}</ref>

==Use of plants by animals== {{main|Zoopharmacognosy}}

Indigenous healers often claim to have learned by observing that sick animals change their food preferences to nibble at bitter herbs they would normally reject.<ref>{{cite journal | vauthors = Huffman MA | title = Animal self-medication and ethno-medicine: exploration and exploitation of the medicinal properties of plants | journal = The Proceedings of the Nutrition Society | volume = 62 | issue = 2 | pages = 371–81 | date = May 2003 | pmid = 14506884 | doi = 10.1079/pns2003257 | doi-access = free }}</ref> Field biologists have provided corroborating evidence based on observation of diverse species, such as chickens, sheep, butterflies, and chimpanzees. The habit of changing diet has been shown to be a physical means of purging intestinal parasites. Sick animals tend to forage plants rich in secondary metabolites, such as tannins and alkaloids.<ref>{{cite journal | vauthors = Hutchings MR, Athanasiadou S, Kyriazakis I, Gordon IJ | title = Can animals use foraging behaviour to combat parasites? | journal = The Proceedings of the Nutrition Society | volume = 62 | issue = 2 | pages = 361–70 | date = May 2003 | pmid = 14506883 | doi = 10.1079/pns2003243 | doi-access = free }}</ref>

== See also == * Chinese herbology * Ethnobotany * Ethnomedicine * Herbal * Medicinal fungi * List of plants used in herbalism * Thomsonianism, a popular 19th century movement * Traditional medicine * Traditional Knowledge Digital Library

== References == {{Reflist}}

== Further reading == {{Commons category|Herbalism}} * {{cite book| vauthors = Aronson JK |title=Meyler's Side Effects of Herbal Medicines|publisher=Elsevier|year=2008|isbn=978-0-08-093290-3|url=https://books.google.com/books?id=_hkSTiEsKvkC}} * {{cite book| vauthors = Braun L, Cohen M |year=2007|title=Herbs and Natural Supplements: An Evidence-Based Guide|publisher=Elsevier|isbn=978-0-7295-3796-4}}

{{History of botany}} {{Medicinal herbs & spices}} {{Traditional Medicine}} {{Dietary supplement}}

{{Authority control}} {{Use dmy dates|date=August 2021}}

Category:Herbalism Category:Botany Category:History of botany Category:Biologically based therapies Category:Dietary supplements Category:Alternative medicine