The use of herbal medicines has been increasing worldwide. It is commonly used as a substitute or to complement allopathic medicines, as a supplement to diet and to prevent and treat diseases and conditions. Moreover, many patients perceive herbal remedies to be more efficacious than physician-prescribed allopathic medicines. However, scientific evidence is sparse and inconclusive. Furthermore, herbal products are not regulated as medications by national health agencies and there is a lack of standardization in formulation, quality control and labeling of the herbs. These issues pose considerable risk to public health and safety.
Traditional herbal medicine (THM) has centuries of anecdotal usage. Moreover, TCM practitioners use herbs to regulate general bodily changes rather than to treat specific disease symptoms. This is based on the concept of ‘pattern diagnosis’ which views disease as a complex interaction of various physiological systems in the body. The ‘endpoint’ of TCM treatment is to improve the pattern of imbalances which delay healing. This is achieved by a combination of herb therapy and acupuncture.
In a recent survey, 86% of patients reported using herbal remedies, with 35% reporting that they believe these to be more efficacious than physician-prescribed medication. However, there is little information on whether the perceived efficacy of herbs varies by age, gender, household income or education level. There is also little knowledge of the exact ingredients in each herbal remedy. Furthermore, it is known that some herbal remedies contain a variety of active compounds and may exert multiple therapeutic effects.
It is also important to note that the majority of patients surveyed did not disclose their herbal usage to their attending physicians. This may be due to the perception that their physician would not consider it an important issue or that they would be misdiagnosed. The survey also showed that a large number of patients did not believe that their physician would consider the use of herbal remedies as part of their medical treatment plan.
While randomized clinical trials are necessary to prove the efficacy of herbal medicines, these will be difficult to carry out quickly and will be subject to a multitude of limitations. Observational studies may be the best way to bridge this gap until more definitive and reliable scientific research is available. These can include classical cohort and case-control designs. In addition, new technologies such as ‘omics’ (genomics, proteomics and metabolomics) have the potential to provide valuable insights into the measurable effects of medicinal herbs. In the interim, it is essential that regulatory agencies establish measures to ensure that all herbal medicines are of suitable quality and safe for use.