I displayed a passage from the apocryphal book of Ecclesiasticus, done in calligraphy, on the wall of one of my office examination rooms throughout my years in family practice. A portion of it reads:

“The Lord has created medicines from the earth, and a sensible man will not disparage them. Was it not a tree that sweetened water and so disclosed its properties?”

It is a clear reference to the use of plant substances such as herbs, berries, and barks for medicinal purposes. The words were penned by Jesus, son of Sirach, in the early part of the second century B.C. and published by his grandson in 132 B.C. They express the Jewish scholar’s high regard for medicinal herbs. His view is consistent with those held by virtually all societies prior to the mid-twentieth century.

Herbal remedies remain in wide use today, despite the rise in popularity of pharmaceutical medications over the latter half of the twentieth century. Worldwide, herbal formulations are used far more commonly than pharmaceutical agents in the battle against disease.

Herbal remedies tend to be viewed with disdain by most physicians in the United States. Such preparations, they argue, have not undergone double-blinded, placebo-controlled, crossover studies, which are widely used by the pharmaceutical industry to demonstrate safety and effectives of new agents and gain FDA approval of their release. This is not strictly true, however, as many herbals have done well when compared to placebos or prescription drugs in controlled medical trials.

Those who quickly dismiss herbal medications as “unscientific” have an extremely narrow view of what constitutes evidence. Centuries of common usage coupled by a clearly understood mechanism of action is, in itself, solid scientific evidence of a substance’s safety and effectiveness.

The experience of hundreds of thousands of users over many years actually provides a much more reliable track record of benefits and risks than highly touted medical studies that are typically done on small groups of people for a short period of time. It is not uncommon to see a double-blinded, placebo-controlled, crossover study that looks at as few as twenty or thirty subjects over a two or three month period. Widespread usage often reveals that the risks of a particular drug are much greater than suggested by its carefully controlled pre-marketing trials.

While I use and recommend herbal remedies when necessary, I do not consider them basic to good health. I do not view them as essential to well-being in the manner I view vitamins, minerals, essential fatty acids, essential amino acids and similar nutrients. I approach herbal formulations with respect, recognizing that in many instances I am using them to address symptoms rather than to correct underlying causes of disease. When possible, I discontinue herbal remedies when health has been restored.

It is not uncommon to find herbs promoted as safe “natural” alternatives to “synthetic” drugs. While herbal formulations are, in nearly all cases, safer than pharmaceuticals, it does not follow that they are universally safe and free of adverse effects.

Herbal remedies have been used in China and India for millennia. Traditional Chinese herbalists divide herbs into three categories: superior herbs, inferior herbs, and messenger herbs.

Given our penchant for potent medications capable of providing rapid symptomatic relief many in the United States might expect “superior” herbs to be the most potent in dealing with a particular health challenge. This is not the case, however. Chinese herbalists define superior herbs as substances that have little or no potential to cause adverse effects and that are safe for long-term consumption. Garlic is an example of a superior herb. It is often used as a seasoning, can be used daily over the course of one’s lifetime, and, outside of causing a distinctive body odor, does not cause any undesirable effects. Traditional Chinese herbal formulations are dominated by superior herbs.

Inferior herbs, on the other hand, are substances that are capable of conferring specific benefits, but which also have the potential to cause harm. St. John’s wort is an example of an inferior herb. While St. John’s wort has been used for centuries to treat depression and has been demonstrated to be beneficial in helping the body overcome viral infections it can cause side effects such as dry mouth, dizziness, diarrhea, nausea, increased sensitivity to sunlight, and fatigue. Skilled practitioners use inferior herbs sparingly.

Traditional Chinese herbalists rarely prescribe single herbs. They use combinations of herbs that are formulated to work synergistically to obtain the desired result. Messenger herbs are substances that tell the body how to respond to a particular blend. A knowledgeable herbalist can change the action of a formulation simply by changing the messenger herb while the blend of superior and inferior herbs remains the same.

When a single herb is used to address a health challenge it often must be taken at a dosage that causes adverse effects. Herbal combinations that are formulated with emphasis on superior herbs, selective use of inferior herbs, and with a clear understanding of the interaction of the superior, inferior and messenger herbs involved almost always provide greater benefits with a lower incidence of side effects.

Given the rising popularity of alternative approaches to disease many products are being brought to the United States market by individuals and companies that do not understand these time tested and proven principles of herbal formulation. I see many concoctions that appear to have been formulated on the premise that “more is always better”. This assumption is not only false, it can be dangerous.

I recently helped staff a booth at a Health Fair in Tulsa. Another booth at the fair was passing out samples of what they claimed to be the ultimate elixir for health. One of the ladies with whom I was working accepted a sample of the product and drank it. Within minutes she became violently ill, experiencing dizziness, weakness, and vomiting.

When she returned to our booth she told me about the incident. A review of the ingredients in the product confirmed that her reaction was not a coincidence. The formulation contained a long list of inferior herbs. It was obvious that no attempt had been made to balance the ingredients and that no thought had been given to the possibility that their interaction might produce undesirable results. Despite the potential for harm posed by imprudently mixing a large number of potent ingredients, the concoction was being promoted as the finest daily nutritional supplement available.

Herbal remedies can be very helpful when used appropriately, but they can be detrimental and even fatal when employed in an irresponsible and careless manner. As I discuss medicinal herbs bear in mind that optimum wellness results not from treating symptoms or conditions with herbs, but by identifying and correcting the root causes of disease whether they are structural, nutritional, energetic, emotional, or spiritual in nature.

For example, fatigue is a common symptom. Many conditions can cause fatigue. Vitamin and mineral deficiencies, anemias, hormonal deficiencies, sleep disorders, infections, and electromagnetic disturbances are only a few of the possibilities. Mental or spiritual burnout can also present with fatigue. A number of herbal preparations are promoted for their ability to enhance energy. While formulations containing substances such as Asian ginseng, guarana and caffeine can provide a quick energy boost, they do nothing to correct the factor or factors that are causing the fatigue. At times they accelerate the underlying energy drain and create a greater demand for their ongoing use.

Viewing herbs and herbal combinations as safer but still potentially hazardous alternatives to drugs in the management of health challenges will keep their use in proper perspective. Use superior herbs or herbal combinations in which superior herbs dominate whenever possible, and continue to seek ways to support the body’s healing ability so that an inferior herb or herbal remedy containing inferior herbs need not be continued indefinitely.

Recognize that many superior herbs are either foods or are commonly used in food preparation. Incorporating them into your diet is often a more cost effective way of obtaining their benefits than purchasing them as nutritional supplements.

An additional principle should be kept in mind when choosing to use medicinal herbs. That is the time honored principle of caveat emptor (buyer beware). While it is extremely important to purchase vitamin and mineral supplements from reputable manufacturers who use bioavailable ingredients and adhere to the highest manufacturing standards, it is critical to purchase herbal products only from sources in which you have absolute confidence. There are many reasons to do so.

The first reason to purchase herbs only through reliable sources is the need to assure that you are actually obtaining the herb or herbs that you are seeking. While this should be a given in our society, it is not. Analyses of products randomly selected from store shelves have repeatedly demonstrated that the contents the bottles contain are not always those listed on the outside.

A reputable manufacturer of herbal products will analyze all raw materials before encapsulating them or using them in herbal formulas. No license is required to gather and sell herbs. Anyone who desires may do so. If the person gathering what he or she believes is mullein but is actually selecting plantain, the desired benefit of the end product will not be achieved.

Herbs should also be tested for the presence of contaminants. Heavy minerals such as cadmium, mercury, and lead have been found in herbs from sources as diverse as India, China, Korea, & Brazil. Twelve cases of lead poisoning in adults from the use of herbal remedies were reported to the U.S. Centers for Disease Control between 2000 and 2003. It is impossible to know how many individuals have accumulated levels of lead that, while toxic, are not sufficient to cause overt symptoms of lead poisoning.

A further factor to be considered when considering herbal quality is the actual collection site. While some soils are high in heavy metals that become incorporated into plants grown in them, other soils are depleted of essential plant nutrients and are therefore incapable of producing herbs of optimum potency. It is imperative that manufacturers of herbal products know that their suppliers are adept at identifying and collecting specimens, that the plants have been grown in good soil, and that the herbs they are using are free of toxic substances. When the active substance within a herb is known, only specimens that contain a standardized amount that substance should be utilized.

Following these principles should allow you to obtain optimum benefits and minimize risks when using herbs. When used appropriately herbal remedies can be an important adjunct to your basic wellness regimen.