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Making sense of herbal remedies

Herbal medicine uses plant extracts, in many forms, to promote good health and to treat ill health. This booklet offers an introduction to Western herbal medicine, gives information about basic self-help and describes some of the herbs used. It also tells you how to find a herbal practitioner and offers sources of further help.

The booklet does not cover Chinese herbal medicine. (See Making sense of traditional Chinese medicine.)

Copyright note: As Mind no longer produces this booklet in printed format both individuals and organisations are welcome to print and photocopy the information on this web page. Organisations are free to distribute it to service users and colleagues, but must ensure they always use the latest version, as available on the website, at the time of distribution.For more information see Mind's copyright guidelines.

Why do people choose herbal medicines?
In what way can a herbalist help me?
What happens during a consultation?
How do I find a good herbalist?
How is it best to use herbs?
How should I take herbal remedies?
How do I shop for them?
Is it safe to treat myself or my family using herbs?
Do herbs have side-effects?
Which herbs are used for mental and emotional health?
Herbs that have been used for mental health
Damiana
Ginkgo biloba
Lavender
Lemon balm
Peppermint
St John's Wort
Valerian
References
Useful organisations
Further reading

Why do people choose herbal medicines?

People try herbal remedies for all sorts of reasons: because they hear from others that it has worked, because they feel it's natural and believe it's likely to have fewer side effects, or because they prefer its holistic approach. People also like the idea of having more control over their own treatment. Others turn to herbal remedies because conventional medicine has lnot worked for them, or because they want to relieve the side effects caused by the prescription medication they need to take.

The popularity of herbal medicines has increased with the increase in availability of them over the counter. Also on the increase is the number of qualified practitioners and those choosing plant medicines, in their many forms.

Herbal medicines are often used to treat health problems that are short-lived (acute) or firmly established (chronic), as part of a holistic approach to health. In other words, when looking at the person as a whole, and working out whether there are underlying medical, emotional or lifestyle factors that may be having some influence on the outbreak of symptoms. (See 'Useful organisations' and 'Further reading' for more information.)

In what way can a herbalist help me?

Herbalists see people of all ages, who are trying to cope with short- or long-term problems. People often ask for help when they haven't been able to find relief from long-standing problems, or when they are taking prescription drugs, which have unwelcome side effects. Often, herbal remedies can help reduce these. Medical herbalists also see many children with common and ongoing conditions, such as eczema, asthma and problems sleeping or with digestion.

Herbalists treat symptoms affecting many systems of the body. Frequently, people have a batch of symptoms that can all be addressed by a trained practitioner. The same person could have a problem with their kidneys (recurrent cystitis), digestive system (irritable bowel syndrome or diverticulitis), heart and circulation (high blood-pressure), gynaecological problems (period pains or menopausal problems), nervous system (insomnia or nerve pain) and joints (arthritis).

What happens during a consultation?

Herbalists want to tackle the underlying causes of ill-health, as well as to relieve the symptoms that brought you to see them in the first place. So, a first consultation will take between an hour and an hour-and-a-half. It will cover, in detail, aspects of your medical, dietary, and emotional history and lifestyle, as well as getting a good account of your current state of health. He or she may do a physical examination, if that's necessary, and will usually check your blood pressure. This is especially useful if you haven't been to see your GP for a long time. It's also important for a herbalist to decide whether you should see your doctor, or whether a different system of health-care could be helpful.

Herbalists don't dispense standard remedies for symptoms. Following a consultation, a herbalist may prescribe herbs for a period of two to three weeks. After this time, the prescription will be reviewed, depending on what the outcome has been.

Remedies can take time to work or may work quickly, depending on the symptom and health picture. A qualified herbalist will give you an indication of timescales in which to expect changes and improvements to your symptoms, and how this will be evaluated.

How do I find a good herbalist?

To be confident about someone treating you, you should check whether they are qualified members of a recognised, professional body, and find out details of their training and experience. For instance, members of the National Institute of Medical Herbalists (established in 1864) have undergone a rigorous, four-year training, including subjects such as Western medical sciences, pharmacy, nutrition, the therapeutic actions of plants, and therapeutics. They have a strict code of ethics and full professional insurance. The letter MNIMH or FNIMH after the name indicate that someone is a member of the Institute.

Most herbalists have a sliding scale of fees, which they can apply according to whether you are working or on a reduced income. Unfortunately, not everyone can afford herbal medicine. Many GPs are open to the idea of herbal remedies (some are even practising herbalists themselves). Although they have general guidelines for referring patients to complementary practitioners, they don't have standard criteria for doing so. In some areas, herbalists work within GP practice settings, alongside other health professionals who may work with complementary or conventional medicine.

How is it best to use herbs?

It's important to recognise, first of all, that herbs don't have a specific and limited purpose, in the way that conventional medicines do. Each person should have their individual needs identified, so that herbs prescribed specially for him or her, at the time, can address these. For example, not only are there different types of depression, but they can also vary in intensity. A person may go through a depression that is altogether different from their experience of depression on a previous occasion. It may also involve a whole range of physical symptoms - lethargy, stomach problems (constipation and diarrhoea) and headaches, to name just a few - that are individual to that person. A herbalist will take into consideration the whole picture of someone's symptoms, and use an individually tailored combination of plants to address those symtoms and to restore health. Combining two or more herbs can enhance the individual effects of each one. This is known as synergism. Herbs for the nervous system fall into a number of categories. They can be used to strengthen a system, to relax or sedate a system, or to stimulate it.

How should I take herbal remedies?

At home, the easiest way is to make a tea or 'infusion', by leaving the plant material in boiling water for 5-10 minutes, before straining and drinking it. Herbal remedies come in many other forms, however. They can be bought over the counter as:

fresh herbs (such as, garlic cloves or peppermint leaves)
capsules or tablets (powdered herbs)
extracts (a concentrated form that comes as liquid tinctures, solid pills or capsules)
tea
in foods
as essential oils (for external use)
as creams and ointments (for applying to the skin).

The potency and quality of all of these vary widely. The herbs need additives to make them into extracts, which come in a range of strengths. Tinctures are more readily absorbed and solid extracts (pills or capsules) are the most concentrated and perhaps the best value.

Some products are (or contain) 'standardised extract'. This means that the manufacturer guarantees that the product contains a certain amount of a particular ingredient, so that you know how much (by weight) of that ingredient is in each day's dose. Different manufacturers produce remedies in different strengths and to different qualities. Prices will vary, and may not necessarily reflect the quality of the product.

Herbalists themselves prefer to use herbs in their natural state, or as close to it as possible, with nothing added and nothing taken away. They prefer this 'full spectrum' to standardised extracts because they feel that preparations with added or boosted components influence the effectiveness and safety of plants, for no good reason.

How do I shop for them?

Remedies are now available in health food shops, chemists and supermarkets, and directly from herbalists. Supplements can be useful, but it's always better to get an individual prescription rather than just guessing which herbs to use.

Many are available via the internet. If you buy from a website, it is very important to make sure that you are buying from a well-established and reputable supplier. Some UK websites show a quality mark for Good Manufacturing Practice which guarantees that their products are consistent and meet quality standards.

When buying herbs,

Choose remedies carefully - do a bit of research before you buy anything, and compare manufacturers as well as different forms of the herb. Don't choose on the basis of price alone.
Buy your herbs from a reputable supplier to ensure high quality.
Check the expiry date.
Choose single herbs, not combinations. (Remember that herbs act synergistically.)
Check the recommended dosage - different manufacturers have different recommendations.
Always read and follow the instructions on the label, carefully.

Many of the herbs available are user-friendly and have clear instructions. If you are self-prescribing but are unsure what to buy, contact a herbalist for advice.

Is it safe to treat myself or my family using herbs?

Most people can safely treat themselves for problems that are normally fairly short-lived, but for any long-standing condition, or one that doesn't go away, you should consult a qualified herbalist, and make sure that another form of treatment isn't also necessary. With self-diagnosis, it's important to know if and when to consult a doctor.

If your child is under five or has a tendency to allergies, seek help from a qualified practitioner. Otherwise, using herbs for children is relatively straightforward. When giving children herbs, mix them in yogurt with a little honey or dilute fruit juice, to help them.

For safe and accurate treatment, follow these guidelines:

Don't overuse products. Use the minimum dosage for all herbs, if you are self-prescribing.
Be aware of any side effects you experience. If a herb doesn't suit you, stop using it.
The more severe the problem, the more cautious you should be about self-treatment, as a general rule.
Don't use herbal remedies if you are trying to have a baby, or if you are already pregnant or breastfeeding, without first consulting a qualified herbalist.
Never use herbs for babies or small children without seeking professional advice.
Don't take herbs alongside other prescribed drugs without consulting a qualified herbalist, because some herbs may strengthen the effects of drugs or make others less effective. With consultation, it may be possible to reduce your conventional medication.
Don't make the mistake of switching from your existing pharmaceutical drug to a herbal remedy without consultation. Herbs are medicines that work in complex and subtle ways and won't always have exactly the same effect.
If you have long-standing health problems, see a herbalist who can work with you in a holistic and effective way to treat the underlying causes and achieve the best outcome.
If you have a short-lived condition and the symptoms aren't getting better within a few days, get professional advice.

Do herbs have side-effects?

A herb, like any other chemical compound, may have side effects. Being 'natural' doesn't make something automatically safe. But, on the whole, the side effects seem to be much milder and more infrequent than for pharmaceutical drugs. Most of the herbs that may have side effects in high doses aren't readily available to buy over the counter. Where problems have been reported, this seems to have been caused by very poor-quality products or by extreme misuse.

Sometimes, people do take the wrong remedy for the wrong reason - mistakenly believing, perhaps, that taking a higher dose will make it work better. Not only might they do themselves harm, they also miss out on the real benefits of the remedy. That's why it's vital to know what you're taking and why you're taking it.

Which herbs are used for mental and emotional health?

Practitioners approaching mental or emotional problems frequently choose from a class of herbs that includes those known as the nervous trophorestoratives. In other words, these are herbs that feed and nourish a system. Herbs usually have a primary action, but may also have additional influences. It's therefore important to use herbs that synergise, or enhance each other's activities. Such herbs may include St John's wort, lemon balm, damiana, passionflower, hops, and valerian (see below).

Herbalists need to take care that the herbs they use do not over-stimulate an individual. In the short-term, the herbalist may use additional prescriptions of regular doses of herbs throughout the day to regulate sleep or alleviate panic attacks, for instance. This will go on until the main prescription begins to make an impact. The time-scale will depend on the choice of treatment and individual needs.

Scientific research on St John's wort and valerian has confirmed good results in treating, variously, depression, anxiety, insomnia, and memory problems. It has also provided much more information about side effects that might be associated with them.

There are other herbs traditionally used for emotional problems:

for anxiety and stress: passionflower, reishi (a mushroom) and hops
for memory problems: sage, huperzine and peony
for sleep: chamomile, lemon balm and passionflower

St John's wort has been successful as a safe treatment for many people who have mild or moderate depression. But this has fuelled a mistaken idea that a particular herb can 'fix' a particular problem, and that all people need do is go and buy a bottle. This contradicts the core principles of herbal medicine, and creates false expectations. It's important to remember that what works for one person may not work for another, in just the same way that someone may try several conventional antidepressants before finding one that works.

Note: The herb kava kava, which used to be recommended for anxiety and stress, has been banned in the UK since 2003 because of an association with severe liver disease. It is an offence to buy or sell kava kava in the UK.

Herbs that have been used for mental health

Although there have been tests on many herbs, there is often no conclusive information about what side effects may occur and how likely they are. However, in comparison to the majority of pharmaceuticals, herbs are well tolerated. It's worth remembering that herbal remedies have been used safely for a very long time.

Damiana

A herb, Damiana Turnera diffusa. ( Plant family: Turneraceae.) Comes as a leaf, powder, capsule, tincture or fluid extract.

What's it used for?
A tonic herb to strengthen the reproductive and nervous systems. For mild to moderate depression and anxiety associated with fatigue. Also for lack of sexual desire.

Possible side effects
No reported side effects.

Caution
Turnera can be very stimulating, so, if you are self-prescribing, use the minimum dosage.

Ginkgo biloba

Extract from a Chinese tree. (Plant family: Ginkgoaceae.) Comes as tablets, liquid or tea.

What's it used for?
Memory and other age-related mental effects. Can be helpful for depression, and when an antidepressant reduces interest in sex. Ginkgo has a powerful influence on the circulatory system, and research has been undertaken into how it affects Alzheimer's disease and dementia.

Possible side effects
Rare. Stomach upset, headache, allergic skin reactions, or slight dizziness, on occasion.

Lavender

A herb, Lavendula officinalis. (Plant family: Labiatae.) Available as a tea, essential oil and in some over-the-counter preparations.

What's it used for?
A safe herb, generally used to influence the nervous system, digestive system, circulation and skin. Aids sluggish digestion and sleep, and relieves tension headaches. Also used by herbalists to help people with mild to moderate depression, and to ease pain.

Possible side effects
No reported side effects.

Lemon balm

A herb, Melissa officinalis. (Plant family: Labiatae.) Available as a tea and essential oil.

What's it used for?
Anxiety, irritability, insomnia, headaches and period pains.

Possible side effects
No reported side effects.

Peppermint

Mentha piperita. (Plant family: Labiatae.) Comes as herb, powder, capsule, essential oil, tincture and fluid extract.

What's it used for?
Commonly used by sufferers of irritable bowel syndrome. Useful for those who experience nausea due to emotional disruption, for digestive spasm and pain, mild diarrhoea, headaches and migraine.

Caution
Do not use medicinally in children under five. Do not use during pregnancy or when breastfeeding.

St John's wort

A herb, Hypericum perforatum. (Plant family: Guttiferae.) Comes as tablets, capsules, liquid, tea, tincture, ointment and oil.

What's it used for?
Depression. Clinical trials confirm its benefits for treating mild depression. May also be helpful for anxiety, sleep problems and seasonal affective disorder (SAD). It can influence the nervous system, the body's defences (the immune system) and the glands, and can be used, internally and externally, for a wide range of symptoms. Herbalists may use St John's wort to influence a number of health problems, including nerve damage, menopausal symptoms and viral infections.

Possible side effects
Mild nausea, headaches, sleepiness, dry mouth, constipation, itchiness, restlessness, dizziness, mania (in manic depression). Increases the skin's sensitivity to sun. Has been shown in scientific trials to have fewer side effects than prescribed antidepressants.

Caution
Do not use it if you are taking medication (including the contraceptive pill) without seeking professional advice. May thin the blood. The Medicines and Healthcare products Regulatory Agency suggests it should not be used with drugs such as Warfarin, anticonvulsants and antidepressants.

Valerian

A common plant, Valeriana officinalis. (Plant family: Valerianaceae.) Comes in capsules, pills, liquid extracts, tinctures, infusions, and tea.

What's it used for?
Anxiety and stress. It may be helpful for depression and for sleep problems. Herbalists may use valerian in combination with other herbs for pain management and to influence a whole range of health problems that may be exacerbated by disruption of the nervous system.

Possible side effects
Mild headaches, feeling sick, nervousness, palpitations, grogginess on waking. Long-term use at large doses may increase the range and severity of side effects.

References

'A combination of plant extracts in the treatment of outpatients with adjustment disorder with anxious mood' M. Bourin, T. Bougerol, B. Guitton (Fundamental and clinical pharmacology 1997, 11)
The complete floral healer A. McIntyre (Gaia 1996)
'Critical evaluation of the effects of valerian extract on sleep structure and sleep quality' F. Donath, S. Quisipe et al. (Pharmacopsychiatry
'Double blind study of a valerian preparation' O. Lindahl, L. Lindwall (Pharmacology biochemistry and behavior April 1998)
'Effects of a fixed valerian-hop extract' A. Fussel, A. Wolf, A Brattistrom, (European journal of medical research September 2000)
'The effects of valerian, propranolol and their combination on activation, performance and mood in healthy volunteers under stress conditions' R. Kohnen, W. D. Oswald (Pharmacopsychiatry 1988, 21)
Herbs for the mind J. R. T. Davidson, K. M. Connor (The Guilford Press 2000)
Herbal first aid A. Chevalier (Amberwood Publishing 1993)
Herbal remedies - a beginners: guide to making effective remedies in the kitchen C. Hedley, N. Shaw (Paragon 1997)
The new holistic herbal D. Hoffman (Element 1991) November 2000)

Useful Organisations

The British Holistic Medical Association
tel: 01278 722000
web: www.bhma.org
Promotes a holistic approach to healthcare

Institute for Complementary and Natural Medicine
tel. 020 7922 7980, web: www.i-c-m.org.uk
Maintains a register of practitioners

The Medicines and Healthcare products Regulatory Agency (MHRA)
tel. 020 7084 2000 web: www.mhra.gov.uk
Provides information on the safety of using herbal medicines and on the licensing of herbal medicines in the UK. Report adverse effects of herbal medicines at http://yellowcard.mhra.gov.uk

The National Institute of Medical Herbalists (NIMH)
tel. 01392 426 022
web: www.nimh.org.uk
For a list of practitioners