Herbs: Hype or Hope?
Dr. Stephen Fulder
For many health professionals the use of herbs today is full of uncertainties and doubts. Why do we need herbs, surely modern drugs are far better and more effective? Are they not yesterday’s grandmother’s remedies, unreliable, unmeasurable and irrelevant in the face of modern pharmacology? Why take an herb when we can isolate and use its active component? Herbal medicine is indeed very ancient, and was used throughout history for every kind of disease, serious or trivial. In the west, herbal medicine from the Greek-Arab lineage was rational and formed the basis of modern therapeutics and modern drugs. However the herbs went out of fashion around a century ago, not because they were ineffective (they were never tested), but rather because they were a ‘soup’ in which precise dosages and content could not be established.
Today the picture has changed. Fuelled by concerns about drug side effects and the attraction of nature, herbs are used in virtually every household. There are tens of thousands of published research papers on herbs demonstrating that they do indeed have pharmacological and clinical activity. In addition, modern HPLC analysis and processes of standardization ensure that herbal extracts such as St. John’s Wort (היפריקום) have the same level of the main or supposed active ingredient in every batch and every dose. Therefore herbal extracts are no longer an unknown ‘soup’. And there is a growing body of understanding how and when to use herbs instead of, or in addition to conventional drugs.
Herbs contain small doses of a large number of active ingredients; drugs generally contain larger doses of a single active ingredient. For this reason herbs are milder than drugs, take longer to act, are safer, and are broader in their activity than drugs. In contrast to the ‘magic bullet’ of modern pharmacology, that hits specific targets, herbs scatter their action more softly, often encouraging normal function rather than attacking abnormality. Take the example of garlic. Historically it has been used as the main household antimicrobial herb. Its antiseptic and antibiotic activity in vitro is well established and the active ingredient, allicin, is as active as conventional antibiotics. However in garlic juice it is present at a concentration of a few percent. In practice this means that it would be suitable for chronic or repeated non-serious infections for example of Ear Nose and Throat, in which it would work slowly, safely and steadily, and may be appropriate where repeated doses of conventional antibiotics may not be necessary. In addition, garlic has other uses, proven in a number of clinical studies. It can gradually reduce blood pressure and lower blood fat and cholesterol to the same extent as fibrate drugs. It also has a significant anticlotting effect. A drug that is both an antibiotic and has such a broad action on the circulation would indeed seem strange, but in garlic it is clear that the family of sulphur-containing active ingredients can affect a number of physiological and pathological processes in the body. Garlic then would have a role where its safety and mildness and broad action are valuable.
Sometimes herbs seem too mild to be taken seriously. But this may be because their effects are not so visible, not that they do not work. They are below the radar screen of a modern medicine used to the concept of targeted and more powerful drugs. For example chamomile (בבונג) tea is one of the mildest of all herbs. Yet if a proper dose is taken to treat the inflammatory pain of monthly periods, it can have a remarkable effect. And for long-term use it is surely safer than non-steroid anti-inflammatory drugs. The herbs that are freely available in health shops and pharmacies for self-medication are all very mild and extremely safe. Their therapeutic index is way above that of virtually all known drugs. Some of them, such as ginger, mint, thyme (קורנית) fenugreek, חילבה)) fennel, (שומר) or rosemary double as foods, but have therapeutic effects when taken in specific ways and at specific dosages. This introduces the fascinating possibilities of the kitchen as the household pharmacy. However there are more powerful herbs such as Misteltoe, (דבקון לבן) or Artemisia (לענה), which are usually only available through professional herbalists.
Another advantage of herbs is that they can treat some health problems not addressed by modern medicine. Often this is because there is no clear diagnosable disease or condition, and therefore little on offer in conventional medicine. For example, Ginseng can treat exhaustion and weakness, Echinacea can enhance general immunity and resistance, milk thistle (גדילן מצוי) seeds can aid poor liver function and removal of toxins, vitex (סיח אברהם) can regularize the monthly cycle, centaury (דרדר הנגב) can stimulate inadequate digestion, elder flower (סמבוק) can hasten recovery from viral infections, and so on. Which drugs can do the same? There are also situations where drug treatment is inadequate and relatively symptomatic, whereas herbal treatment can be more successful because the approach is different, more related to the normalizing of functions, more holistic. An example would be the treatment of skin diseases such as eczema. Herbal medicine would prescribe internal herbs such as red clover, (תלתן לבן) which treat the cause, as well as herbs such as mallow (חוטמיתexternally to treat the itching and inflammation.
Herbs then are returning to common use in our society, much as they have been for all of human history. They can often be the answer where either the patient or the doctor is reluctant to use conventional drugs, particularly in many non-serious and common family health complaints where the risk of drug treatment may not be worth the benefit. They can be used alongside drug treatment, and in some cases can help to alleviate the side effects of medical treatment. The success of herbal treatment depends on our knowledge of when, what and how to use them. But they can be a very popular alternative that helps the patient to feel less of a patient.
מתוך איך להתמודד עם טיפול רפואי