The use of herbal medicines by people with cancer: a qualitative study. Complement Altern Med. Hasan SS, Ahmed SI, Bukhari NI, Loon WC. Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics.

Complement Ther Clin Pract. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: an updated systematic review. Jang SH, Kim DI, Choi MS. BMC Complement Altern Med. Ke F, Yadav PK, Ju LZ. Herbal medicine in the treatment of ulcerative colitis.

Saudi J Gastroenterol. Kennedy DO, Haskell CF, Mauri PL, Scholey AB. Acute cognitive effects of standardised Ginkgo biloba extract complexed with phosphatidylserine. Hum Psychopharmacol. Knox J, Gaster B.

Dietary supplements for the prevention and treatment of coronary artery disease. J Altern Complement Med. Kraft K. Prev Med. Lovera J, Bagert B, Smoot K, et al.

Ginkgo biloba for the improvement of cognitive performance in multiple sclerosis: a randomized, placebo-controlled trial. Mult Scler. Luo H, Lu M, Pei X, Xia Z. Chinese herbal medicine for subacute thyroiditis: a systematic review of randomized controlled trials.

J Tradit Chin Med. Manheimer E, Wieland S, Kimbrough E, Cheng K, Berman BM. Evidence from the Cochrane Collaboration for traditional Chinese medicine therapies. Marcus DM. Therapy: Herbals and supplements for rheumatic diseases.

Nat Rev Rheumatol. Mendes E, Herdeiro MT, Pimentel F. The use of herbal medicine therapies by cancer patients. Act Med Port. Modi AA, Wright EC, Seeff LB. Complementary and alternative medicine CAM for the treatment of chronic hepatitis B and C: a review. Antivir Ther. Moquin B, Blackman MR, Mitty E, Flores S.

Complementary and alternative medicine CAM. Geriatr Nurs. Oktem M, Eroglu D, Karahan HB, Taskintuna N, Kuscu E, Zeyneloglu HB. Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. Adv Ther. Pham AQ, Kourlas H, Pham DQ.

Cinnamon supplementation in patients with type 2 diabetes mellitus. Roberts AT, Martin CK, Liu Z, et al. The safety and efficacy of a dietary herbal supplement and gallic acid for weight loss. J Med Food. Sarris J, Panossian A, Schweitzer I, Stough C, Scholey A.

Herbal medicine for depression, anxiety, and insomnia: a review of psychopharmacology and clinical evidence. Eur Neuropsychopharmacol. Schink M, Troger W, Dabidian A, et al. Mistletoe extract reduces the surgical suppression of natural killer cell activity in cancer patients.

a randomized phase III trial. Forsch Komplementarmed. Sheridan MJ, Cooper JN, Erario M, Cheifetz CE. Pistachio nut consumption and serum lipid levels.

J Am Coll Nutr. Shimazaki M, Martin JL. Do herbal agents have a place in the treatment of sleep problems in long-term care? J Am Med Dir Assoc.

Shrestha S, Freake HC, McGrane MM, Volek JS, Fernandez ML. A combination of psyllium and plant sterols alters lipoprotein metabolism in hypercholesterolemic subjects by modifying the intravascular processing of lipoproteins and increasing LDL uptake.

J Nutr. Sood A, Barton DL, Bauer BA, Loprinzi CL. A brief outline of the legislation in United States, Canada, and Europe is given in this section, and could be used to guide the legal aspects of the herbal medicine industry in other countries.

In the United States, under the Dietary Supplement Health and Education Act DSHEA of , any herb, botanical and natural concentrate, metabolite and constituent of extract, is classified as a dietary supplement. Dietary supplements do not need approval from the Food and Drug Administration FDA before they are marketed FDA Under DSHEA, herbal medicines, which are classified as dietary supplements, are presumed safe, and the FDA does not have the authority to require them to be approved for safety and efficacy before they enter the market, which is the case for drugs.

This means that the manufacturer of the herbal medicine is responsible for determining that the dietary supplements manufactured or distributed are indeed safe and that any representations or claims made about them are sustained by adequate evidence to show that they are not false or misleading.

Regarding contamination, the FDA has not issued any regulations addressing safe or unsafe levels of contaminants in dietary supplements but has set certain advisory levels in other foods FDA ; Gao A product being sold as an herbal supplement dietary supplement in the United States cannot suggest on its label or in any of its packaging that it can diagnose, treat, prevent, or cure a specific disease or condition without specific approval from the FDA.

A claim also cannot suggest an effect on an abnormal condition associated with a natural state or process, such as aging FDA ; Gao In Canada, herbal remedies must comply with the Natural Health Products Regulations Health Canada According to these regulations, all natural products require a product license before they can be sold in Canada.

In order to be granted a license, detailed information on the medicinal ingredients, source, potency, nonmedicinal ingredients, and recommended use needs to be furnished. Once a product has been granted a license, it will bear the license number and follow standard labeling requirements to ensure that consumers can make informed choices.

A site license is also needed for those who manufacture, pack, label, and import herbal medicines. In addition, GMPs must be employed to ensure product safety and quality.

This requires that appropriate standards and practices regarding the manufacture, storage, handling, and distribution of natural health products be met. The GMPs are designed to be outcome based, ensuring safe and high-quality products, while giving the flexibility to implement quality control systems appropriate to the product line and business.

Product license holders are required to monitor all adverse reactions associated with their product and report serious adverse reactions to the Canadian Department of Health.

The directive establishes that herbal medicines released on the market need authorization by the national regulatory authorities of each European country and that these products must have a recognized level of safety and efficacy Calapai The registration of herbal medicinal products needs sufficient evidence for the medicinal use of the product throughout a period of at least 30 years in the European Union EU , at least 15 years within the EU, and 15 years elsewhere for products from outside the EU.

With regard to the manufacturing of these products and their quality, products must fulfill the same requirements as applications for a marketing authorization. Information is based on the availability of modern science—based public monographs in the European Pharmacopeia and their equivalents developed by the pharmaceutical industry.

The standards put forward allow not only to define the quality of products but also to eliminate harmful compounds, adulteration, and contamination. Within the EU, a number of committees were set up to attempt and standardize the information and guidelines related to herbal medicines.

A variety of materials has been produced, such as monographs on herbs and preparations, guidelines on good agricultural and collection practice for starting materials of herbal origin, and guidelines on the standardization of applications and setting up pragmatic approaches for identification and quantitative determination of herbal preparations and their complex compositions Routledge ; Vlietinck, Pieters, and Apers Herbal medicine has been commonly used over the years for treatment and prevention of diseases and health promotion as well as for enhancement of the span and quality of life.

However, there is a lack of a systematic approach to assess their safety and effectiveness. The holistic approach to health care makes herbal medicine very attractive to many people, but it also makes scientific evaluation very challenging because so many factors must be taken into account.

Herbal medicines are in widespread use and although many believe herbal medicines are safe, they are often used in combination and are drawn from plant sources with their own variability in species, growing conditions, and biologically active constituents.

Herbal extracts may be contaminated, adulterated, and may contain toxic compounds. The quality control of herbal medicines has a direct impact on their safety and efficacy Ernst, Schmidt, and Wider ; Ribnicky et al.

But, there is little data on the composition and quality of most herbal medicines not only due to lack of adequate policies or government requirements but also due to a lack of adequate or accepted research methodology for evaluating traditional medicines WHO ; Kantor In addition, there is very little research on whole herbal mixtures because the drug approval process does not accommodate undifferentiated mixtures of natural chemicals.

To isolate each active ingredient from each herb would be immensely time-consuming at a high cost, making it not cost-effective for manufacturers Richter Another problem is that despite the popularity of botanical dietary and herbal supplements, some herbal products on the market are likely to be of low quality and suspect efficacy, even if the herb has been shown to have an effect in controlled studies using high-quality product.

There is a belief that herbs, as natural products, are inherently safe without side effects and that efficacy can be obtained over a wide range of doses. A major hypothetical advantage of botanicals over conventional single-component drugs is the presence of multiple active compounds that together can provide a potentiating effect that may not be achievable by any single compound.

This advantage presents a unique challenge for the separation and identification of active constituents. Compounds that are identified by activity-guided fractionation must be tested in appropriate animal models to confirm in vivo activity. Ideally, the composition of the total botanical extract must be standardized and free of any potential hazards, and plants should be grown specifically for the production of botanical extracts under controlled conditions and originate from a characterized and uniform genetic source with a taxonomic record of the genus, species, and cultivar or other additional identifiers.

Records should be maintained for the source of the seed, locations and conditions of cultivation, and exposure to possible chemical treatments such as pesticides. Because the environment can significantly affect phytochemical profiles and the efficacy of the botanical end product, botanical extracts can vary from year to year and may be significantly affected by temperature, drought, or flood as well as by geographic location.

Therefore, biochemical profiling must be used to ensure that a consistent material is used to produce a botanical. The concentration step can also be challenging, and the process to concentrate active compounds to a sufficient level can negatively affect their solubility and bioavailability.

Therefore, improving efficacy by increasing concentration can be counterproductive, and the use of solubilizers and bioenhancers needs to be considered just as for drugs Ribnicky et al. However, there are major challenges to achieving this.

Although in theory botanicals should be well characterized and herbal supplements should be produced to the same quality standards as drugs, the situation in practice is very different from that of a pure drug. Herbs contain multiple compounds, many of which may not be identified and often there is no identifier component, and chemical fingerprinting is in its early stages and is lacking for virtually all herbs see Chapter This makes standardization of botanicals difficult, although some can be produced to contain a standardized amount of a key component or class of components, such as ginsenosides for ginseng products or anthocyanins for bilberry products see Chapter 4 on bilberry and Chapter 8 on ginseng in this volume.

However, even when such key compounds have been identified and a standard content is agreed or suggested, there is no guarantee that individual commercial products will contain this.

Another interesting point to consider is that herbal materials for commercial products are collected from wild plant populations and cultivated medicinal plants.

The expanding herbal product market could drive overharvesting of plants and threaten biodiversity. Poorly managed collection and cultivation practices could lead to the extinction of endangered plant species and the destruction of natural resources.

It has been suggested that 15, of 50,—70, medicinal plant species are threatened with extinction Brower The efforts of the Botanic Gardens Conservation International are central to the preservation of both plant populations and knowledge on how to prepare and use herbs for medicinal purposes Brower ; Li and Vederas Research needs in the field of herbal medicines are huge, but are balanced by the potential health benefits and the enormous size of the market.

Research into the quality, safety, molecular effects, and clinical efficacy of the numerous herbs in common usage is needed. Newly emerging scientific techniques and approaches, many of which are mentioned in this book, provide the required testing platform for this.

Genomic testing and chemical fingerprinting techniques using hyphenated testing platforms are now available for definitive authentication and quality control of herbal products. They should be regulated to be used to safeguard consumers, but questions of efficacy will remain unless and until adequate amounts of scientific evidence accumulate from experimental and controlled human trials Giordano, Engebretson, and Garcia ; Evans ; Tilburt and Kaptchuk Evidence for the potential protective effects of selected herbs is generally based on experiments demonstrating a biological activity in a relevant in vitro bioassay or experiments using animal models.

In some cases, this is supported by both epidemiological studies and a limited number of intervention experiments in humans WHO In general, international research on traditional herbal medicines should be subject to the same ethical requirements as all research related to human subjects, with the information shared between different countries.

This should include collaborative partnership, social value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for the subjects Giordano, Engebretson, and Garcia ; Tilburt and Kaptchuk However, the logistics, time, and cost of performing large, controlled human studies on the clinical effectiveness of an herb are prohibitive, especially if the focus is on health promotion.

Therefore, there is an urgent need to develop new biomarkers that more clearly relate to health and disease outcomes. Predictor biomarkers and subtle but detectable signs of early cellular change that are mapped to the onset of specific diseases are needed.

Research is needed also to meet the challenges of identifying the active compounds in the plants, and there should be research-based evidence on whether whole herbs or extracted compounds are better.

The issue of herb—herb and herb—drug interactions is also an important one that requires increased awareness and study, as polypharmacy and polyherbacy are common Canter and Ernst ; Qato et al.

The use of new technologies, such as nanotechnology and novel emulsification methods, in the formulation of herbal products, will likely affect bioavailability and the efficacy of herbal components, and this also needs study. Smart screening methods and metabolic engineering offer exciting technologies for new natural product drug discovery.

Advances in rapid genetic sequencing, coupled with manipulation of biosynthetic pathways, may provide a vast resource for the future discovery of pharmaceutical agents Li and Vederas This can lead to reinvestigation of some agents that failed earlier trials and can be restudied and redesigned using new technologies to determine whether they can be modified for better efficacy and fewer side effects.

For example, maytansine isolated in the early s from the Ethiopian plant Maytenus serrata , looked promising in preclinical testing but was dropped in the early s from further study when it did not translate into efficacy in clinical trials; later, scientists isolated related compounds, ansamitocins, from a microbial source.

A derivative of maytansine, DM1, has been conjugated with a monoclonal antibody and is now in trials for prostate cancer Brower Plants, herbs, and ethnobotanicals have been used since the early days of humankind and are still used throughout the world for health promotion and treatment of disease.

Still, herbs, rather than drugs, are often used in health care. For some, herbal medicine is their preferred method of treatment. For others, herbs are used as adjunct therapy to conventional pharmaceuticals.

However, in many developing societies, traditional medicine of which herbal medicine is a core part is the only system of health care available or affordable. Regardless of the reason, those using herbal medicines should be assured that the products they are buying are safe and contain what they are supposed to, whether this is a particular herb or a particular amount of a specific herbal component.

Consumers should also be given science-based information on dosage, contraindications, and efficacy. To achieve this, global harmonization of legislation is needed to guide the responsible production and marketing of herbal medicines.

If sufficient scientific evidence of benefit is available for an herb, then such legislation should allow for this to be used appropriately to promote the use of that herb so that these benefits can be realized for the promotion of public health and the treatment of disease.

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Show details Benzie IFF, Wachtel-Galor S, editors. Search term. Chapter 1 Herbal Medicine An Introduction to Its History, Usage, Regulation, Current Trends, and Research Needs. I nternational D iversity and N ational P olicies The diversity among countries with the long history and holistic approach of herbal medicines makes evaluating and regulating them very challenging.

Q uality , S afety , and S cientific E vidence Herbal medicine has been commonly used over the years for treatment and prevention of diseases and health promotion as well as for enhancement of the span and quality of life.

RESEARCH NEEDS Research needs in the field of herbal medicines are huge, but are balanced by the potential health benefits and the enormous size of the market. Antioxidant effects of natural bioactive compounds. Curr Pharm Des. Barnes P. M, Bloom B, Nahin R. Complementary and alternative medicine use among adults and children: United States, CDC National Health Statistics Report pdf access date: 5 Nov.

Beckman K. B, Ames B. The free radical theory of ageing matures. Physiol Rev. Benzie I. F, Wachtel-Galor S. Biomarkers in long-term vegetarian diets. Adv Clin Chem. Vegetarian diets and public health: Biomarker and redox connections.

Antioxid Redox Signal. Bozzetti F. Nutritional issues in the care of the elderly patient. Crit Rev Oncol Hematol. Brower V. Back to nature: Extinction of medicinal plants threatens drug discovery.

J Natl Cancer Inst. Calapai G. Drug Saf. European legislation on herbal medicines: A look into the future; pp. Canter P. H, Ernst E. Herbal supplement use by persons aged over 50 years in Britain: Frequently used herbs, concomitant use of herbs, nutritional supplements and prescription drugs, rate of informing doctors and potential for negative interactions.

Drugs Aging. Ayurveda is an ancient healing system from India that uses a range of techniques to treat illness and encourage wellbeing. Bowen is a holistic remedial body technique that works on the soft connective tissue fascia of the body. Bowen therapy can be used to treat musculoskeletal or related neurological problems including acute sports injuries and chronic or organic conditions.

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Complementary and alternative care. Home Complementary and alternative care. Herbal medicine. Actions for this page Listen Print. Summary Read the full fact sheet. On this page. What is herbal medicine?

Active ingredients and herbal medicine Medicinal uses for specific herbs Do not self-diagnose ailments Special considerations for herbal medicine Where to get help. Active ingredients and herbal medicine Herbal medicines contain active ingredients. Medicinal uses for specific herbs Herbal medicine aims to return the body to a state of natural balance so that it can heal itself.

Some herbs that are commonly used in herbal medicine, and their traditional uses, include: Echinacea — to stimulate the immune system and aid the body in fighting infection. Used to treat ailments such as boils , fever and herpes. Dong quai dang gui — used for gynaecological complaints such as premenstrual tension , menopause symptoms and period pain.

Some studies indicate that dong quai can lower blood pressure. Garlic — used to reduce the risk of heart disease by lowering levels of blood fats and cholesterol a type of blood fat. The antibiotic and antiviral properties of garlic mean that it is also used to fight colds , sinusitis and other respiratory infections.

Ginger — many studies have shown ginger to be useful in treating nausea, including motion sickness and morning sickness. Ginkgo biloba — commonly used to treat poor blood circulation and tinnitus ringing in the ears. Ginseng — generally used to treat fatigue , for example during recovery from illness.

It is also used to reduce blood pressure and cholesterol levels, however overuse of ginseng has been associated with raised blood pressure. It is also used for anxiety and insomnia. Do not self-diagnose ailments It is very important that people do not self-diagnose any health conditions.

A Guide to Common Medicinal Herbs · Chamomile · Echinacea · Feverfew · Garlic · Ginger · Ginkgo · Ginseng · Goldenseal There are many herbal products and supplements that promise to treat a range of symptoms. However, talk to your family doctor before you begin Looking for natural remedies for pain, inflammation, or health concerns Examples of healing plants for which there is some evidence

Natural health remedies samples - Herbal remedies are plants used like a medicine. People use herbal remedies Here are some examples: Kava is an herb used for anxiety, insomnia A Guide to Common Medicinal Herbs · Chamomile · Echinacea · Feverfew · Garlic · Ginger · Ginkgo · Ginseng · Goldenseal There are many herbal products and supplements that promise to treat a range of symptoms. However, talk to your family doctor before you begin Looking for natural remedies for pain, inflammation, or health concerns Examples of healing plants for which there is some evidence

Many are secondary metabolites and include aromatic substances, most of which are phenols or their oxygen-substituted derivatives such as tannins Hartmann ; Jenke-Kodama, Müller, and Dittmann Many of these compounds have antioxidant properties see Chapter 2 on antioxidants in herbs and spices.

Ethnobotanicals are important for pharmacological research and drug development, not only when plant constituents are used directly as therapeutic agents, but also as starting materials for the synthesis of drugs or as models for pharmacologically active compounds Li and Vederas About years ago, the first pharmacologically active pure compound, morphine, was produced from opium extracted from seeds pods of the poppy Papaver somniferum.

This discovery showed that drugs from plants can be purified and administered in precise dosages regardless of the source or age of the material Rousseaux and Schachter ; Hartmann This approach was enhanced by the discovery of penicillin Li and Vederas With this continued trend, products from plants and natural sources such as fungi and marine microorganisms or analogs inspired by them have contributed greatly to the commercial drug preparations today.

Examples include antibiotics e. Between and , 13 drugs derived from natural products were approved in the United States.

Average life expectancy at birth has increased from around 41 years in the early s to approaching 80 years in many developed countries. Consequently, the percentage of elderly people 65 years and above in our populations is increasing.

The graying of our populations brings an increasing burden of chronic age-related disease and dependency. Aging is associated with a progressive decline in physiological function and an increased risk of pathological changes leading to cancer, cardiovascular disease, dementia, diabetes, osteoporosis, and so on.

Lifestyle factors such as nutrition or exercise play an important role in determining the quality and duration of healthy life and in the treatment of chronic diseases Bozzetti ; Benzie and Wachtel-Galor , It is most likely that there is no one cause of aging, and different theories of aging have been suggested over the years.

Genetic factors are undoubtedly important, but among all the metabolic theories of aging, the oxidative stress theory is the most generally supported theory Harman ; Beckman and Ames This theory postulates that aging is caused by accumulation of irreversible, oxidation-induced damage oxidative stress resulting from the interaction of reactive oxygen species with the DNA, lipid, and protein components of cells.

However, even if the aging process itself is found to be unrelated to oxidative stress, highly prevalent chronic age-related diseases all have increased oxidative stress Holmes, Bernstein, and Bernstein ; Beckman and Ames ; Finkel and Holbrook ; Rajah et al.

Antioxidants in herbs may contribute at least part of their reputed therapeutic effects Balsano and Alisi ; Tang and Halliwell Given the market value, potential toxicity and increasing consumer demand, particularly in the sick and elderly members of our populations, regulation of production and marketing of herbal supplements and medicines require attention.

In , the U. gov , last access: November 5, , and the European Scientific Cooperative on Phytotherapy ESCOP was founded in with the aim of advancing the scientific status and harmonization of phytomedicines at the European level www.

com , last access: November 5, This led to an increase in investment in the evaluation of herbal medicines. While this scale of investment is low compared to the total research and development expenses of the pharmaceutical industry, it nevertheless reflects genuine public, industry, and governmental interest in this area Li and Vederas With tremendous expansion in the interest in and use of traditional medicines worldwide, two main areas of concern arise that bring major challenges.

These are international diversity and national policies regarding the regulation of the production and use of herbs and other complementary medicines and their quality, safety, and scientific evidence in relation to health claims WHO ; Sahoo et al.

The diversity among countries with the long history and holistic approach of herbal medicines makes evaluating and regulating them very challenging. In addition, there are a great number of different herbs used. Legislative criteria to establish traditionally used herbal medicines as part of approved health care therapies faces several difficulties.

In a survey conducted across countries, WHO reported the following issues regarding herbal medicines: lack of research data, appropriate mechanisms for control of herbal medicines, education and training, expertise within the national health authorities and control agency, information sharing, safety monitoring, and methods to evaluate their safety and efficacy.

The support needed from different countries includes information sharing on regulatory issues, workshops on herbal medicines safety monitoring, general guidelines on research and evaluation of herbal medicines, provision of databases, herbal medicine regulation workshops, and international meetings.

National policies are the basis for defining the role of traditional medicines in national health care programs, ensuring that the necessary regulatory and legal mechanisms are established for promoting and maintaining good practice, assuring the authenticity, safety, and efficacy of traditional medicines and therapies, and providing equitable access to health care resources and their resource information WHO Another fundamental requirement is harmonization of the market for herbal medicines for industry, health professionals, and consumers Mahady Herbal medicines are generally sold as food supplements, but a common regulatory framework does not exist in different countries.

As a result, information on clinical indications for their use, efficacy, and safety are influenced by the traditional experience available in each place. A brief outline of the legislation in United States, Canada, and Europe is given in this section, and could be used to guide the legal aspects of the herbal medicine industry in other countries.

In the United States, under the Dietary Supplement Health and Education Act DSHEA of , any herb, botanical and natural concentrate, metabolite and constituent of extract, is classified as a dietary supplement.

Dietary supplements do not need approval from the Food and Drug Administration FDA before they are marketed FDA Under DSHEA, herbal medicines, which are classified as dietary supplements, are presumed safe, and the FDA does not have the authority to require them to be approved for safety and efficacy before they enter the market, which is the case for drugs.

This means that the manufacturer of the herbal medicine is responsible for determining that the dietary supplements manufactured or distributed are indeed safe and that any representations or claims made about them are sustained by adequate evidence to show that they are not false or misleading.

Regarding contamination, the FDA has not issued any regulations addressing safe or unsafe levels of contaminants in dietary supplements but has set certain advisory levels in other foods FDA ; Gao A product being sold as an herbal supplement dietary supplement in the United States cannot suggest on its label or in any of its packaging that it can diagnose, treat, prevent, or cure a specific disease or condition without specific approval from the FDA.

A claim also cannot suggest an effect on an abnormal condition associated with a natural state or process, such as aging FDA ; Gao In Canada, herbal remedies must comply with the Natural Health Products Regulations Health Canada According to these regulations, all natural products require a product license before they can be sold in Canada.

In order to be granted a license, detailed information on the medicinal ingredients, source, potency, nonmedicinal ingredients, and recommended use needs to be furnished. Once a product has been granted a license, it will bear the license number and follow standard labeling requirements to ensure that consumers can make informed choices.

A site license is also needed for those who manufacture, pack, label, and import herbal medicines. In addition, GMPs must be employed to ensure product safety and quality.

This requires that appropriate standards and practices regarding the manufacture, storage, handling, and distribution of natural health products be met. The GMPs are designed to be outcome based, ensuring safe and high-quality products, while giving the flexibility to implement quality control systems appropriate to the product line and business.

Product license holders are required to monitor all adverse reactions associated with their product and report serious adverse reactions to the Canadian Department of Health. The directive establishes that herbal medicines released on the market need authorization by the national regulatory authorities of each European country and that these products must have a recognized level of safety and efficacy Calapai The registration of herbal medicinal products needs sufficient evidence for the medicinal use of the product throughout a period of at least 30 years in the European Union EU , at least 15 years within the EU, and 15 years elsewhere for products from outside the EU.

With regard to the manufacturing of these products and their quality, products must fulfill the same requirements as applications for a marketing authorization. Information is based on the availability of modern science—based public monographs in the European Pharmacopeia and their equivalents developed by the pharmaceutical industry.

The standards put forward allow not only to define the quality of products but also to eliminate harmful compounds, adulteration, and contamination. Within the EU, a number of committees were set up to attempt and standardize the information and guidelines related to herbal medicines.

A variety of materials has been produced, such as monographs on herbs and preparations, guidelines on good agricultural and collection practice for starting materials of herbal origin, and guidelines on the standardization of applications and setting up pragmatic approaches for identification and quantitative determination of herbal preparations and their complex compositions Routledge ; Vlietinck, Pieters, and Apers Herbal medicine has been commonly used over the years for treatment and prevention of diseases and health promotion as well as for enhancement of the span and quality of life.

However, there is a lack of a systematic approach to assess their safety and effectiveness. The holistic approach to health care makes herbal medicine very attractive to many people, but it also makes scientific evaluation very challenging because so many factors must be taken into account.

Herbal medicines are in widespread use and although many believe herbal medicines are safe, they are often used in combination and are drawn from plant sources with their own variability in species, growing conditions, and biologically active constituents.

Herbal extracts may be contaminated, adulterated, and may contain toxic compounds. The quality control of herbal medicines has a direct impact on their safety and efficacy Ernst, Schmidt, and Wider ; Ribnicky et al.

But, there is little data on the composition and quality of most herbal medicines not only due to lack of adequate policies or government requirements but also due to a lack of adequate or accepted research methodology for evaluating traditional medicines WHO ; Kantor In addition, there is very little research on whole herbal mixtures because the drug approval process does not accommodate undifferentiated mixtures of natural chemicals.

To isolate each active ingredient from each herb would be immensely time-consuming at a high cost, making it not cost-effective for manufacturers Richter Another problem is that despite the popularity of botanical dietary and herbal supplements, some herbal products on the market are likely to be of low quality and suspect efficacy, even if the herb has been shown to have an effect in controlled studies using high-quality product.

There is a belief that herbs, as natural products, are inherently safe without side effects and that efficacy can be obtained over a wide range of doses.

A major hypothetical advantage of botanicals over conventional single-component drugs is the presence of multiple active compounds that together can provide a potentiating effect that may not be achievable by any single compound.

This advantage presents a unique challenge for the separation and identification of active constituents. Compounds that are identified by activity-guided fractionation must be tested in appropriate animal models to confirm in vivo activity.

Ideally, the composition of the total botanical extract must be standardized and free of any potential hazards, and plants should be grown specifically for the production of botanical extracts under controlled conditions and originate from a characterized and uniform genetic source with a taxonomic record of the genus, species, and cultivar or other additional identifiers.

Records should be maintained for the source of the seed, locations and conditions of cultivation, and exposure to possible chemical treatments such as pesticides. Because the environment can significantly affect phytochemical profiles and the efficacy of the botanical end product, botanical extracts can vary from year to year and may be significantly affected by temperature, drought, or flood as well as by geographic location.

Therefore, biochemical profiling must be used to ensure that a consistent material is used to produce a botanical. The concentration step can also be challenging, and the process to concentrate active compounds to a sufficient level can negatively affect their solubility and bioavailability.

Therefore, improving efficacy by increasing concentration can be counterproductive, and the use of solubilizers and bioenhancers needs to be considered just as for drugs Ribnicky et al. However, there are major challenges to achieving this. Although in theory botanicals should be well characterized and herbal supplements should be produced to the same quality standards as drugs, the situation in practice is very different from that of a pure drug.

Herbs contain multiple compounds, many of which may not be identified and often there is no identifier component, and chemical fingerprinting is in its early stages and is lacking for virtually all herbs see Chapter This makes standardization of botanicals difficult, although some can be produced to contain a standardized amount of a key component or class of components, such as ginsenosides for ginseng products or anthocyanins for bilberry products see Chapter 4 on bilberry and Chapter 8 on ginseng in this volume.

However, even when such key compounds have been identified and a standard content is agreed or suggested, there is no guarantee that individual commercial products will contain this. Another interesting point to consider is that herbal materials for commercial products are collected from wild plant populations and cultivated medicinal plants.

The expanding herbal product market could drive overharvesting of plants and threaten biodiversity. Poorly managed collection and cultivation practices could lead to the extinction of endangered plant species and the destruction of natural resources.

It has been suggested that 15, of 50,—70, medicinal plant species are threatened with extinction Brower The efforts of the Botanic Gardens Conservation International are central to the preservation of both plant populations and knowledge on how to prepare and use herbs for medicinal purposes Brower ; Li and Vederas Research needs in the field of herbal medicines are huge, but are balanced by the potential health benefits and the enormous size of the market.

Research into the quality, safety, molecular effects, and clinical efficacy of the numerous herbs in common usage is needed. Newly emerging scientific techniques and approaches, many of which are mentioned in this book, provide the required testing platform for this.

Genomic testing and chemical fingerprinting techniques using hyphenated testing platforms are now available for definitive authentication and quality control of herbal products. They should be regulated to be used to safeguard consumers, but questions of efficacy will remain unless and until adequate amounts of scientific evidence accumulate from experimental and controlled human trials Giordano, Engebretson, and Garcia ; Evans ; Tilburt and Kaptchuk Evidence for the potential protective effects of selected herbs is generally based on experiments demonstrating a biological activity in a relevant in vitro bioassay or experiments using animal models.

In some cases, this is supported by both epidemiological studies and a limited number of intervention experiments in humans WHO In general, international research on traditional herbal medicines should be subject to the same ethical requirements as all research related to human subjects, with the information shared between different countries.

This should include collaborative partnership, social value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for the subjects Giordano, Engebretson, and Garcia ; Tilburt and Kaptchuk However, the logistics, time, and cost of performing large, controlled human studies on the clinical effectiveness of an herb are prohibitive, especially if the focus is on health promotion.

Therefore, there is an urgent need to develop new biomarkers that more clearly relate to health and disease outcomes. Predictor biomarkers and subtle but detectable signs of early cellular change that are mapped to the onset of specific diseases are needed.

Research is needed also to meet the challenges of identifying the active compounds in the plants, and there should be research-based evidence on whether whole herbs or extracted compounds are better.

The issue of herb—herb and herb—drug interactions is also an important one that requires increased awareness and study, as polypharmacy and polyherbacy are common Canter and Ernst ; Qato et al. The use of new technologies, such as nanotechnology and novel emulsification methods, in the formulation of herbal products, will likely affect bioavailability and the efficacy of herbal components, and this also needs study.

Smart screening methods and metabolic engineering offer exciting technologies for new natural product drug discovery. Advances in rapid genetic sequencing, coupled with manipulation of biosynthetic pathways, may provide a vast resource for the future discovery of pharmaceutical agents Li and Vederas This can lead to reinvestigation of some agents that failed earlier trials and can be restudied and redesigned using new technologies to determine whether they can be modified for better efficacy and fewer side effects.

For example, maytansine isolated in the early s from the Ethiopian plant Maytenus serrata , looked promising in preclinical testing but was dropped in the early s from further study when it did not translate into efficacy in clinical trials; later, scientists isolated related compounds, ansamitocins, from a microbial source.

A derivative of maytansine, DM1, has been conjugated with a monoclonal antibody and is now in trials for prostate cancer Brower Plants, herbs, and ethnobotanicals have been used since the early days of humankind and are still used throughout the world for health promotion and treatment of disease.

Still, herbs, rather than drugs, are often used in health care. For some, herbal medicine is their preferred method of treatment. For others, herbs are used as adjunct therapy to conventional pharmaceuticals. However, in many developing societies, traditional medicine of which herbal medicine is a core part is the only system of health care available or affordable.

Regardless of the reason, those using herbal medicines should be assured that the products they are buying are safe and contain what they are supposed to, whether this is a particular herb or a particular amount of a specific herbal component. Consumers should also be given science-based information on dosage, contraindications, and efficacy.

To achieve this, global harmonization of legislation is needed to guide the responsible production and marketing of herbal medicines. If sufficient scientific evidence of benefit is available for an herb, then such legislation should allow for this to be used appropriately to promote the use of that herb so that these benefits can be realized for the promotion of public health and the treatment of disease.

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The calming powers of chamomile have been frequently studied, including a study that states chamomile is superior to taking a placebo when treating generalized anxiety disorder. There are two types of chamomile: German chamomile, an annual that thrives in the Midwest, and Roman chamomile, a perennial that attracts pollinators and smells like apples.

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Gingko Turmeric Evening primrose oil Flax seed Tea tree oil Echinacea Grapeseed extract Lavender Chamomile. We scoured through histories of herbal studies for you.

Was this helpful? Things to consider Long-term use may increase chance of thyroid and liver cancer , which has been seen in rats. It can interact with blood thinners.

Gingko seeds are poisonous if ingested. Side effects can include headache, upset stomach, dizziness, and allergic reaction. Gingko use needs to be discussed with your doctor because of numerous drug interactions. Share on Pinterest. Turmeric could be beneficial for: pain caused by inflammatory diseases, like arthritis preventing cancer stopping DNA mutations several skin diseases.

Things to consider When used as a supplement, people tend to take too much, so it can be difficult to trust the dosage and quality. Safety increases when ingested as an herb in cooking or tea. Long-term use can potentially cause stomach problems. Turmeric has low bioavailability. Consuming with pepper can help your body absorb more of its benefits.

Evening primrose oil. Evening primrose oil could be beneficial for: PMS mild skin conditions breast pain menopause inflammation diabetic neuropathy multiple sclerosis PCOS blood pressure. Things to consider interacts with some blood-clotting medications safety during pregnancy is uncertain may interfere with drug absorption during HIV treatment interacts with lithium for bipolar disorder long-term use may not be safe.

Flax seed. Flax seed could be beneficial for: decreasing obesity regulating blood pressure preventing colon cancer inflammation hot flashes. Things to consider Flax seed can affect estrogen production in women, especially if they have a history of cancer or are pregnant.

Tea tree oil. Things to consider Tea tree oil is poisonous if taken orally. Your skin could experience an allergic reaction. It may influence hormones. Echinacea could be beneficial for: colds immunity bronchitis upper respiratory infections. Originally from North America, it has long been used in Native American practices to treat a variety of ailments, including wounds, burns, toothaches, sore throat, and upset stomach 2.

Most parts of the plant, including the leaves, petals, and roots, can be used medicinally — though many people believe the roots have the strongest effect. Echinacea is usually taken as a tea or supplement but can also be applied topically. Though insufficient data exists to evaluate the long-term effects of this herb, short-term use is generally considered safe.

That said, side effects like nausea, stomach pain, and skin rash have occasionally been reported 4. You can find echinacea in most supermarkets and health food stores, though you can also buy it online.

Echinacea is a flowering plant frequently used to treat and prevent the common cold. Ginseng is a medicinal plant whose roots are usually steeped to make a tea or dried to make a powder. Several varieties exist, but the two most popular are the Asian and American types — Panax ginseng and Panax quinquefolius , respectively.

American ginseng is thought to cultivate relaxation, while Asian ginseng is considered more stimulating 5. Although ginseng has been used for centuries, modern research supporting its efficacy is lacking.

Several test-tube and animal studies suggest that its unique compounds, called ginsenosides, boast neuroprotective, anticancer, antidiabetes, and immune-supporting properties. Nonetheless, human research is needed 6. Potential side effects include headaches, poor sleep, and digestive issues 7.

Ginseng is available at most health food stores, as well as online. Ginseng is an herbal remedy frequently utilized in traditional Chinese medicine to boost immunity, brain function, and energy levels.

However, human studies are lacking. Ginkgo biloba, also known simply as ginkgo, is an herbal medicine derived from the maidenhair tree 8.

Native to China, ginkgo has been used in traditional Chinese medicine for thousands of years and remains a top-selling herbal supplement today. It contains a variety of potent antioxidants that are thought to provide several benefits 8. The seeds and leaves are traditionally used to make teas and tinctures, but most modern applications use leaf extract.

Some people also enjoy eating the raw fruit and toasted seeds. However, the seeds are mildly toxic and should only be eaten in small quantities, if at all. Ginkgo is said to treat a wide range of ailments, including heart disease, dementia, mental difficulties, and sexual dysfunction.

Yet, studies have not proven it effective for any of these conditions 9. You can shop for ginkgo online or at supplement shops. Gingko is traditionally used to treat numerous illnesses, including heart disease, dementia, and sexual dysfunction, but modern research has yet to prove its efficacy for any of these purposes.

Elderberry is an ancient herbal medicine typically made from the cooked fruit of the Sambucus nigra plant. It has long been used to relieve headaches, nerve pain, toothaches, colds, viral infections, and constipation Some people prefer to make their own syrup or tea by cooking elderberries with other ingredients, such as honey and ginger.

Test-tube studies demonstrate that its plant compounds have antioxidant, antimicrobial, and antiviral properties, but human research is lacking Short-term use is considered safe, but the unripe or raw fruit is toxic and may cause symptoms like nausea, vomiting, and diarrhea Elderberry is used to treat cold and flu symptoms, with some research suggesting that it may be at least mildly effective.

Its small, yellow flowers are commonly used to make teas, capsules, or extracts Its use can be traced back to ancient Greece, and SJW is still frequently prescribed by medical professionals in parts of Europe Historically, it was utilized to aid wound healing and alleviate insomnia, depression, and various kidney and lung diseases.

Many studies note that short-term use of SJW is as effective as some conventional antidepressants. SJW has relatively few side effects but may cause allergic reactions, dizziness, confusion, dry mouth, and increased light sensitivity It also interferes with numerous medications, including antidepressants, birth control, blood thinners, certain pain medications, and some types of cancer treatments Particular drug interactions could be fatal, so if you take any prescription medications, consult your healthcare provider prior to using SJW.

If you decide to try it out, SJW is available online and in numerous stores. Yet, you may need to practice caution or avoid it because it interferes with several conventional medicines.

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