herbal medicine herbal medicine herbal medicine (also called herbalism, phytomedicine or phytotherapy) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. with worldwide research into pharmacology, some herbal medicines have been translated into modern remedies, such as the anti-malarial group of drugs called artemisinin isolated from artemisia annua, a herb that was known in chinese medicine to treat fever. there is limited scientific evidence for the safety and efficacy of many plants used in 21st century herbalism, which generally does not provide standards for purity or dosage. the scope of herbal medicine sometimes include fungal and bee products, as well as minerals, shells and certain animal parts. this article is part of a series onalternative medicine general information alternative medicine history terminology alternative veterinary medicine quackery (health fraud) rise of modern medicine pseudoscience antiscience 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therapy traditional medicine african muti southern africa ayurveda dosha mvah balneotherapy brazilian bush medicine cambodian chinese blood stasis chinese herbology dit da gua sha gill plate trade meridian moxibustion pressure point qi san jiao tui na zang-fu chumash curandero faith healing hilot iranian jamu kambo japanese korean mien shiang mongolian prophetic medicine shamanism shiatsu siddha sri lankan thai massage tibetan unani vietnamese diagnoses adrenal fatigue aerotoxic syndrome candida hypersensitivity chronic lyme disease electromagnetic hypersensitivity heavy legs leaky gut syndrome multiple chemical sensitivity wilson's temperature syndrome an antique selection of herbal medicines paraherbalism describes alternative and pseudoscientific practices of using unrefined plant or animal extracts as unproven medicines or health-promoting agents. paraherbalism relies on the belief that preserving various substances from a given source with less processing is safer or more effective than manufactured products, a concept for which there is no evidence. history main articles: history of herbalism and materia medica a physician preparing an elixir, from an arabic version of dioscorides's pharmacopoeia, 1224 archaeological evidence indicates that the use of medicinal plants dates back to the paleolithic age, approximately 60,000 years ago. written evidence of herbal remedies dates back over 5,000 years to the sumerians, who compiled lists of plants. some ancient cultures wrote about plants and their medical uses in books called herbals. in ancient egypt, herbs are mentioned in egyptian medical papyri, depicted in tomb illustrations, or on rare occasions found in medical jars containing trace amounts of herbs. in ancient egypt, the ebers papyrus dates from about 1550 bc, and covers more than 700 compounds, mainly of plant origin. the earliest known greek herbals came from theophrastus of eresos who, in the 4th century bc, wrote in greek historia plantarum, from diocles of carystus who wrote during the 3rd century bc, and from krateuas who wrote in the 1st century bc. only a few fragments of these works have survived intact, but from what remains, scholars noted overlap with the egyptian herbals. seeds likely used for herbalism were found in archaeological sites of bronze age china dating from the shang dynasty (c. 1600 – c. 1046 bc). over a hundred of the 224 compounds mentioned in the huangdi neijing, an early chinese medical text, are herbs. herbs were also commonly used in the traditional medicine of ancient india, where the principal treatment for diseases was diet. de materia medica, originally written in greek by pedanius dioscorides (c. 40 – c. 90 ad) of anazarbus, cilicia, a physician and botanist, is one example of herbal writing used over centuries until the 1600s. modern herbal medicine the world health organization (who) estimates that 80 percent of the population of some asian and african countries presently use herbal medicine for some aspect of primary health care. some prescription drugs have a basis as herbal remedies, including artemisinin, digitalis, quinine and taxanes. regulatory review in 2015, the australian government's department of health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; herbalism was one of 17 topics evaluated for which no clear evidence of effectiveness was found. establishing guidelines to assess safety and efficacy of herbal products, the european medicines agency provided criteria in 2017 for evaluating and grading the quality of clinical research in preparing monographs about herbal products. in the united states, the national center for complementary and integrative health of the national institutes of health funds clinical trials on herbal compounds, provides fact sheets evaluating the safety, potential effectiveness and side effects of many plant sources, and maintains a registry of clinical research conducted on herbal products. according to cancer research uk as of 2015, "there is currently no strong evidence from studies in people that herbal remedies can treat, prevent or cure cancer". prevalence of use the use of herbal remedies is more prevalent in people with chronic diseases, such as cancer, diabetes, asthma, and end-stage kidney disease. multiple factors such as gender, age, ethnicity, education and social class are also shown to have association with prevalence of herbal remedies use. herbal preparations leaves of eucalyptus olida being packed into a steam distillation unit to gather its essential oil there are many forms in which herbs can be administered, the most common of which is a liquid consumed as a herbal tea or a (possibly diluted) plant extract. herbal teas, or tisanes, are the resultant liquid of extracting herbs into water, though they are made in a few different ways. infusions are hot water extracts of herbs, such as chamomile or mint, through steeping. decoctions are the long-term boiled extracts, usually of harder substances like roots or bark. maceration is the cold infusion of plants with high mucilage-content, such as sage or thyme. to make macerates, plants are chopped and added to cold water. they are then left to stand for 7 to 12 hours (depending on herb used). for most macerates, 10 hours is used. tinctures are alcoholic extracts of herbs, which are generally stronger than herbal teas. tinctures are usually obtained by combining pure ethanol (or a mixture of pure ethanol with water) with the herb. a completed tincture has an ethanol percentage of at least 25% (sometimes up to 90%). non-alcoholic tinctures can be made with glycerin but it is believed to be less absorbed by the body than alcohol based tinctures and has a shorter shelf life. herbal wine and elixirs are alcoholic extract of herbs, usually with an ethanol percentage of 12–38%. extracts include liquid extracts, dry extracts, and nebulisates. liquid extracts are liquids with a lower ethanol percentage than tinctures. they are usually made by vacuum distilling tinctures. dry extracts are extracts of plant material that are evaporated into a dry mass. they can then be further refined to a capsule or tablet. the exact composition of an herbal product is influenced by the method of extraction. a tea will be rich in polar components because water is a polar solvent. oil on the other hand is a non-polar solvent and it will absorb non-polar compounds. alcohol lies somewhere in between. a herb shop in the souk of marrakesh, morocco many herbs are applied topically to the skin in a variety of forms. essential oil extracts can be applied to the skin, usually diluted in a carrier oil. many essential oils can burn the skin or are simply too high dose used straight; diluting them in olive oil or another food grade oil such as almond oil can allow these to be used safely as a topical. salves, oils, balms, creams, and lotions are other forms of topical delivery mechanisms. most topical applications are oil extractions of herbs. taking a food grade oil and soaking herbs in it for anywhere from weeks to months allows certain phytochemicals to be extracted into the oil. this oil can then be made into salves, creams, lotions, or simply used as an oil for topical application. many massage oils, antibacterial salves, and wound healing compounds are made this way. inhalation, as in aromatherapy, can be used as a treatment. safety for partial list of herbs with known adverse effects, see list of herbs with known adverse effects. datura stramonium has been used in ayurveda for various treatments, but contains alkaloids, such as atropine and scopolamine, which may cause severe toxicity. consumption of herbs may cause adverse effects. furthermore, "adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal." proper double-blind clinical trials are needed to determine the safety and efficacy of each plant before medical use. although many consumers believe that herbal medicines are safe because they are natural, herbal medicines and synthetic drugs may interact, causing toxicity to the consumer. herbal remedies can also be dangerously contaminated, and herbal medicines without established efficacy, may unknowingly be used to replace prescription medicines. standardization of purity and dosage is not mandated in the united states, but even products made to the same specification may differ as a result of biochemical variations within a species of plant. plants have chemical defense mechanisms against predators that can have adverse or lethal effects on humans. examples of highly toxic herbs include poison hemlock and nightshade. they are not marketed to the public as herbs, because the risks are well known, partly due to a long and colorful history in europe, associated with "sorcery", "magic" and intrigue. although not frequent, adverse reactions have been reported for herbs in widespread use. on occasion serious untoward outcomes have been linked to herb consumption. a case of major potassium depletion has been attributed to chronic licorice ingestion, and consequently professional herbalists avoid the use of licorice where they recognize that this may be a risk. black cohosh has been implicated in a case of liver failure. few studies are available on the safety of herbs for pregnant women, and one study found that use of complementary and alternative medicines are associated with a 30% lower ongoing pregnancy and live birth rate during fertility treatment. examples of herbal treatments with likely cause-effect relationships with adverse events include aconite (which is often a legally restricted herb), ayurvedic remedies, broom, chaparral, chinese herb mixtures, comfrey, herbs containing certain flavonoids, germander, guar gum, liquorice root, and pennyroyal. examples of herbs that may have long-term adverse effects include ginseng, the endangered herb goldenseal, milk thistle, senna (against which herbalists generally advise and rarely use), aloe vera juice, buckthorn bark and berry, cascara sagrada bark, saw palmetto, valerian, kava (which is banned in the european union), st. john's wort, khat, betel nut, the restricted herb ephedra, and guarana. there is also concern with respect to the numerous well-established interactions of herbs and drugs. in consultation with a physician, usage of herbal remedies should be clarified, as some herbal remedies have the potential to cause adverse drug interactions when used in combination with various prescription and over-the-counter pharmaceuticals, just as a customer should inform a herbalist of their consumption of actual prescription and other medication. for example, dangerously low blood pressure may result from the combination of an herbal