Dr Ann Walker Senior Lecturer in Human Nutrition

Hugh Sinclair Unit of Human Nutrition

The University of Reading, UK

Member of the National Institute of Medical Herbalists

Member of the College of Practitioners of Phytotherapy

“Herbal medicine workshop:with case histories ”

Global origins of herbs used in UK by herbal practitioners

Native European Herbs200 BC: trade between Europe, Middle

East, India and Asia: culinary spices‘Discovery’ of Americas1700 & 1800s European migrations:

Americas, Africa, Australia1990s-present enhanced communication

between major herbal culturesFinland 1999

Practice of Herbal Medicine and the Law in the UK - historical perspective

1542: Act of Parliament protected herbalists from prosecution

1968: The Medicines Act: provision for the prescription and supply of herbal medicine by medical herbalists according to “his judgement as to the needs of a particular person who consults him”

2000 onwards: Discussions led by Department of Health on development of a register of herbal practitioners

2004: Statutory Self Regulation (SSR)

Current status of medical herbalism

University Degree courses (4 year): East London, Middlesex, Lancaster, Wales, Westminster

Training elements: Biochemistry, botany, anatomy, physiology, pathology,

differential diagnosis, pharmacology, clinical examination, materia medica, therapeutics, dermatology, geriatrics, ethics, psychiatry, laboratory diagnostics, clinical practice

Two year programme for medical doctorsProfessional bodies (insurance, CPD etc):

National Institute of Medical Herbalists (ca 400 members) College of Practitioners of Phytotherapy (ca 120 members)

Examples of conditions which can benefit from treatment by a herbal practitioner

Inflammatory conditions: eczema, psoriasis, OA, RA, migraine, bronchitis, catarrh, sinusitus, hayfever, inflammatory bowel disease, peripheral neuropathy

Hormonal problems: menopausal, PMS, PCOSFatigue conditions: fibromyalgia/ ME/ CFSDigestive problems: gastritis, constipation, indigestionCardiovascular: arrhythmia, claudication,

hyperlipidaemia, hypertension

Tripartite approach to treatment

Diet modification Diet enhancement Herbal medicine

Consultation with a herbal practitioner

Length of consultation: typically 1 hour for 1st consultation, 30 mins for follow-up

Holistic approach to healthDietary advice and nutritional supportIndividualised herbal prescriptionNo need to change orthodox medicationIntegrated strategy with modern medicine

The aim of nutrition and herbal medicine:

health and well-being through HOMEOSTASIS

Maintenance or re-establishment of the composition of the internal environment of the body within

narrow limits, consistent with the optimal function of the body’s cells

Phytochemical spectrum of plants

Energy & fibresources

Phytochemical content/ physiological effect

Fruit and vegetables

Culinary herbs

and spices

Tonic herbal medicines

Potentherbal

medicines

Toxic plants

LOW HIGH

Examples of foods with evidence from clinical trials of positive health benefit

Artichokes: high blood cholesterol Bilberries: retinal disordersBroccoli: cancer preventionCabbage: peptic ulcersCherries: goutCranberries: cystitis

Examples of herbs with substantial clinical evidence of efficacy

Gingko : memory loss

Saw palmetto : enlarged prostate (BPH)

St John’s wort : mild depression

Valerian : insomnia

How are prescriptions of herbs dispensed in practice?

Most commonly: Liquid medicine comprising a mixture of 3-7

herbal tinctures (in aqueous alcohol) individually prescribed for each patient

Occasionally: Teas (again, mixtures of herbs especially mixed

for the individual) Powdered herb capsules Herb extract tablets (concentrated form)

Finland 1999

Case study SD: rheumatoid arthritis

29 yr old woman with hot swollen hands and feet, weak wrists

Just changed her diet: high F&V, wholegrains, no dairy products. Condition improving rapidly

Feb ‘97: (a) continue diet (b) high potency A-Z multi, CLO (omega 3), Vit C, E, Ca/Mg. (c) Rx: scullcap, vitex, pokeweed, echinacea, meadowsweet, guaiacum, devil’s claw/ 10 ml bid.

March ‘97: swellings down.

May ‘97: doing well, hands ‘wonderful’. Signed off.

Case study of acute osteoarthritis

Patientdetails

First visit Feb 01

Treatment(no OA drugs)

Outcome

ML, male,Asian,47 yrs,non-smoker,lowintakeF&V,omega-3

Swollen Lknee withmusclespasm:8 months,pain 2 yrs,affectingjobHeadachesAsthma

F&V ,omega-3Mg , vit C&E

Devil's clawMeadowsweetCramp barkWillowbarkJuniperGumweed

Apr 01 swellingdown, painbearableMay 01 noswelling, pain,asthma &h'aches muchlessJun 01 signedoff

Case study of Menopausal symptoms

Patientdetails

First visit Nov 'O2

Treatment Outcome

RA, 63yrs, non-smoker,diet lowin Ca,omega-3

StoppedHRT 6weeksago, somehot flushesandfatigue

Ca+Mg ,vit/minOmega-3

Black cohoshScullcapChinese angelicaMotherwortGoat's rue

Jan '03

Vitality muchbetter. No hotflushes. "Muchbetter than HRT"

Case study of CFS

Patientdetails

First visit June '00

Treatment Outcome

AV,female,27 yrs,non-smoker,low Caintakeotherwisediet fine

Low vitality,sorethroats, earaches,painfulwrists,swollenglands, notworked for2 yrs

Mg , vit/min

St John's wortAstragalusThymeAshwagandhaLicorice

+ herbs to aidsleep

Dec '00 full-timejob, vitality better,symptomsimprovedFeb '01 copingwith job,managing gentleexerciseJune '01 new jobmost symptomsgone

Effects of Grapeseed flavonoids on premenstrual leg health

0

1

2

3

4

5

6

Placebo Flavonoids

Baseline2 months4 months

Me

an

7-d

ay p

rem

enst

rua

l sco

re

P < 0.05

*

Christie et al. (2003) accepted for Phytomed

Effects of bromelain on knee health

0

10

20

30

40

50

60

70

% I

mp

rovem

en

t

Pain Stiffness PhysicalFunction

Total Score

1 tablet 2 tablets

**

*

Walker et al. (2002) Phytomed 9, 681-686.

Battersea-OA pilot study

Subjects: 20 men and women with OA of the kneeDesign: double-blind randomised intervention with a

mixture of herbs as tinctures individually prescribed from a limited list of herbs by a practitioner or placebo

Intervention: Half of prescriptions to be substituted with placebo tincture by a dispenser privy to randomisation. All subjects to receive dietary advice and nutrient supplements (vitamins, minerals, omega-3) throughout study of 10 weeks

Outcome: WOMAC questionnaire, C-reactive protein, well-being questionnaire

Conclusions

Herbal treatment from a registered medical herbalist is aimed at normalising homeostasis

Herbs are rich sources of phytochemicals, also found in fruit and vegetables

There is increasing evidence of efficacy of herbal medicineUK herbal practice involves multi-intervention & includes:

dietary modification integration with modern medicine

A wide range of chronic conditions may benefit from a consultation with a herbal practitioner, including inflammatory, fatigue and hormonal problems