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“Herbal medicine workshop:

with case histories ”

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
Global origins of herbs used in UK
by herbal practitioners
❧ Native European Herbs
❧ 200 BC: trade between Europe, Middle
East, India and Asia: culinary spices
❧ ‘Discovery’ of Americas
❧ 1700 & 1800s European migrations:
Americas, Africa, Australia
❧ 1990s-present enhanced communication
between major herbal cultures
Finland 1999
Practice of Herbal Medicine and the
Law in the UK - historical perspective
1542: Act of Parliament protected herbalists from
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
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 doctors
❧ Professional 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, PCOS
❧ Fatigue conditions: fibromyalgia/ ME/ CFS
❧ Digestive problems: gastritis, constipation, indigestion
❧ Cardiovascular: 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 health
❧ Dietary advice and nutritional support
❧ Individualised herbal prescription
❧ No need to change orthodox medication
❧ Integrated strategy with modern medicine
The aim of nutrition and herbal

health and well-being through

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

Fruit and Tonic herbal Toxic

vegetables plants
LOW Phytochemical content/ physiological effect HIGH
Energy & fibre Culinary Potent
sources herbs herbal
and spices medicines
Examples of foods with evidence from
clinical trials of positive health benefit

❧Artichokes: high blood cholesterol

❧Bilberries: retinal disorders
❧Broccoli: cancer prevention
❧Cabbage: peptic ulcers
❧Cherries: gout
❧Cranberries: 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 ❧ Feb ‘97: (a) continue diet
with hot swollen (b) high potency A-Z multi,
hands and feet, CLO (omega 3), Vit C, E,
weak wrists Ca/Mg. (c) Rx: scullcap,
❧ Just changed her vitex, pokeweed, echinacea,
diet: high F&V, meadowsweet, guaiacum,
wholegrains, no devil’s claw/ 10 ml bid.
dairy products. ❧ March ‘97: swellings
Condition down.
improving ❧ May ‘97: doing well, hands
rapidly ‘wonderful’. Signed off.
Case study of acute osteoarthritis

Patient First visit Treatment Outcome

details Feb 01 (no OA drugs)

ML, male, Swollen L F&V↑ , Apr 01 swelling

Asian, knee with omega-3↑ down, pain
47 yrs, muscle Mg↑ , vit C&E↑bearable
non- spasm: May 01 no
smoker, 8 months, Devil's claw swelling, pain,
low pain 2 yrs, Meadowsweet asthma &
intake affecting Cramp bark h'aches much
F&V, job Willowbark less
omega-3 Headaches Juniper Jun 01 signed
Asthma Gumweed off
Case study of Menopausal symptoms

Patient First visit Treatment Outcome

details Nov 'O2
RA, 63 Stopped Ca+Mg↑ , Jan '03
yrs, non- HRT 6 vit/min↑
smoker, weeks Omega-3↑ Vitality much
diet low ago, some better. No hot
in Ca, hot flushes Black cohosh flushes. "Much
omega-3 and Scullcap better than HRT"
fatigue Chinese angelica
Goat's rue
Case study of CFS

Patient First visit Treatment Outcome

details June '00
AV, Low vitality, Mg↑ , vit/min↑ Dec '00 full-time
female, sore job, vitality better,
27 yrs, throats, ear St John's wort symptoms
non- aches, Astragalus improved
smoker, painful Thyme Feb '01 coping
low Ca wrists, Ashwagandha with job,
intake swollen Licorice managing gentle
otherwise glands, not exercise
diet fine worked for + herbs to aid June '01 new job
2 yrs sleep most symptoms
Effects of Grapeseed flavonoids on premenstrual
leg health
Mean 7-day premenstrual score

4 P < 0.05
* 2 months
4 months

Placebo Flavonoids

Christie et al. (2003) accepted for Phytomed

Effects of bromelain on knee health

70 *
* *
% Improvement

Pain Stiffness Physical 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 knee
❧ Design: 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
❧ 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
❧ UK herbal practice involves multi-intervention &
● dietary modification

● integration with modern medicine

❧ A wide range of chronic conditions may benefit from a

consultation with a herbal practitioner, including