Herbal medicine

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The real medicinal valerian ( Valeriana officinalis ) has a long tradition as a medicinal product in herbal medicine.

The herbal medicine (or phytotherapy , even herbal medicine known) is the teaching of use of medicinal herbs as phytotherapeutics said drug . Phyto- pharmacy deals with the research and manufacture of phytotherapeutic agents .

Basics

Herbal medicine is one of the oldest medical therapies and is at home on all continents and in all cultures. Herbal medicine is based on herbal medicine ( phytopharmacognosy ), which provides knowledge of the various medicinal plants . Herbal medicine also contains parts of pharmacology , pharmaceutics and toxicology . Herbal medicine can therefore be assigned to the umbrella term pharmaceutical biology . The aim of herbal medicine is to research medicinal plants and their ingredients with regard to their therapeutic effects. The identification of old plant names should also be fundamental, so as not to overlook old empirical knowledge due to confusion and errors in the tradition.

In herbal medicine, only whole plants or parts of plants (flowers, leaves, seeds, bark, roots) are used, but no isolated individual substances. These raw materials, which are called drugs in pharmacy , are therapeutically used fresh or as an infusion or decoction (tea), juice, tincture , extract , powder, essential oil, etc. Since mixtures of substances always work, medicinal plants can have different effects or can be used for different clinical pictures. The effective ingredients of the medicinal plants are subject to natural fluctuations due to the climate, location and harvest time of the plant. The content of ingredients in preparations made from medicinal plants can also be influenced by storage and the manufacturing process. Therefore, the standardization of the starting materials and methods for drug production is very important. Phytopharmaceuticals contain defined quantities of the active ingredients and are of consistent quality and effectiveness.

Herbal medicine is partly based on traditional medicine . Experience, traditional knowledge and traditions play an important role. The effects of medicinal plants cannot always be scientifically proven. Modern herbal medicine follows the principles of scientifically based medicine in that it assumes a dose-effect relationship and defines similar clinical pictures.

The use of isolated individual substances ( biogenic medicinal substances ) is not part of herbal medicine . The use of individual substances, which are obtained by isolation or synthetically, and their derivatives is carried out with the aim of improving the effect and reducing side effects .

Herbal medicinal products in pharmaceutical law

In the states of the EU , finished herbal medicinal products must, like other finished medicinal products, be officially approved in accordance with the provisions of pharmaceutical law before they can be marketed . In addition, quality, effectiveness and harmlessness must be proven.

For an appropriate quality, the nature of the herbal drugs and other raw materials used, as well as the manufacturing conditions, must meet special standards. The pharmaceutical company can provide evidence of the effectiveness and harmlessness of a drug in the approval process either on the basis of pharmacological-toxic and clinical studies or, if the drug is "generally used in medicine", on the basis of other "scientific evidence" such as bibliographical material Data. At this point, standardized data collections support the compilation of the required information. With authorities of the elaborate Committee on Herbal Medicinal Products ( Committee for Herbal Medicinal Products, HMPC ) of the European Medicines Agency and the World Health Organization (WHO) corresponding monographs. In Germany, Commission E at what was then the Federal Health Office (BGA) had drawn up so-called processing monographs for the use of over three hundred drugs and drug preparations from 1978 with the entry into force of the new Drugs Act until 1994, which represent the state of scientific knowledge at the time. In addition, there are the material collections of associations such as the Phytopharmaka Cooperation and, at European level, the Euro monographs of the European Scientific Cooperative on Phytotherapy (ESCOP).

In addition to approval, a simplified procedure for certain phytopharmaceuticals is possible in the EU member states in the form of “registration as traditional medicinal products”, with proof of efficacy based on documented traditional experience. For this purpose, at least 30 years of experience - of which at least 15 years in an EU member state - must be proven for the herbal medicinal product. The traditional uses are compiled and published as a list by the EMEA's Herbal Medicines Committee. The registration as a traditional medicinal product takes into account the fact that in some countries there are a large number of herbal preparations that have a long tradition and a high level of safety, but whose effectiveness can only be proven with difficulty using clinical or bibliographical evidence. In Germany, traditionally registered medicinal products are labeled as follows: "The medicinal product is a traditional medicinal product that has been registered for the area of ​​application solely on the basis of long-term use" and "... the user should be advised if symptoms persist or if symptoms other than those in the package insert occur consult a doctor or other qualified person working in a health care profession ”.

Role of Herbal Medicine in Modern Society

Many modern herbal medicinal preparations or pure substances isolated from them have a long history of use as medicinal products - such as opium , acetylsalicylic acid , digitalis , quinine and others. The World Health Organization (WHO) estimates that currently 80% of the world population uses herbal medicine for some areas of basic medical care. For a large part of the world population, half of whom have to get by on less than (the equivalent of) US $ 2 a day, commercial drugs are very expensive. In herbal medicine, you can fall back on products from nature that cost less or nothing at all. In Germany, the share of over-the-counter phytopharmaceuticals and homeopathic medicines (for self-medication and medically prescribed) was 31 percent of sales with over-the-counter medicines in 2015. In 2015, sales of phytopharmaceuticals increased by 5.9 percent compared to the previous year.

Phytotherapy and its special forms

The term phytotherapy was coined internationally by Henri Leclerc (* 1870, † 1955), a French doctor who published the book Précis de Phytotherapy in 1922 . From 1931 Rudolf Fritz Weiss founded scientific herbal medicine in Germany.

Traditional phytotherapy in European countries

The traditional herbal medicine was until 1800 in Europe incontrovertible basis for all pharmacopoeia, but fell by the advent of science on a side track. With the development of science-oriented medicine since the early 19th century, however, herbal medicines have also increasingly been the subject of scientific analysis. The traditional herbal medicine is a therapy direction primarily on traditional experiences based ( traditional medicine ). Popular or traditional use can be justified differently depending on the country. There are an estimated 29,000 herbal health practitioners in the EU .

Rational phytotherapy

The rational Phytotherapy is based on the traditional European Phytotherapy, but rises beyond the claim that science alongside existing empirical material evaluation criteria to be used and the effectiveness of the plants contained and the preparations and combinations each based on studies proves to have. It is assumed that every extract that is contained in a rational phytopharmaceutical has been proven to contribute to clinical efficacy. In addition to the ingredients that contribute directly to the effect, phytopharmaceuticals contain other ingredients that can modify the effect of the active ingredients by z. B. affect their stability or bioavailability . In general, the entire extract (or the extract combination) and thus a multi-substance mixture is considered to be a medicinal substance. Here the rational phytotherapy differs from the therapy with synthetic active ingredients, which are administered as single substances to produce a healing effect. Rational phytotherapy claims to apply the same scientific methods to phytopharmaceuticals as to synthetic drugs. Evidence-based medicine is proclaimed as the authoritative standard of scientific medicine, which, according to David Sackett, represents "a conscientious, sensible and best possible use of the best external scientific knowledge currently available for the medical care of patients". In this sense, pharmacological and toxicological studies are just as much a part of rational phytotherapy as proof of efficacy in randomized , controlled double-blind studies according to the guidelines of Good Clinical Practice .

Japanese phytotherapy ( Kampō )

The name Kampō came up in Japan during the second half of the 19th century to delimit traditional medicine from the inflowing western medicine. Although it literally means something like 'Chinese procedures / recipes', 'Chinese direction', Japan developed numerous innovations as early as the Edo period and especially since the first half of the 20th century, which Japanese kampo medicine of of traditional Chinese medicine is clearly different. Some authors have included therapeutic procedures such as massage, acupuncture, and dietetics. In the meantime, however, the narrower version of 'Japanese phytotherapy' has established itself. When making a diagnosis, many representatives of Kampō medicine attach great importance to the abdominal diagnosis (palpation).

Traditional Chinese Medicine (TCM)

The Traditional Chinese Medicine (TCM) is used plants and their ingredients. For decades the medical effectiveness of Chinese herbal medicine or TCM has been researched in studies. In 2007, Swiss researchers carried out a meta-analysis of 136 studies on Chinese herbal medicine. Overall, only two percent of these studies were of good quality . Many studies were of poor methodological quality to allow reliable conclusions to be drawn. At the moment, it seems unclear whether Chinese herbal therapy does more good than harm. The study's authors therefore seriously agree that given the popularity of herbal medicine, more research is needed to determine its status, and that this proposal also applies to Chinese herbal medicine.

Ernst commented on the above study: “Chinese Herbal Medicine (CKM) is often touted as if its effectiveness was beyond question - 3000 years of history cannot be wrong! [...] Another very interesting finding concerns the individualized CKM. When a patient is treated with CKM, he almost always receives a mixture that is individually tailored to him according to the principles of TCM. Many believe that this approach cannot be verified with randomized studies. This is most certainly not true. What is correct, however, is the fact that very few studies exist that test the effectiveness of these individualized CKMs. In the present analysis only two such studies were found. Both do not show that this approach is effective [...] "

Ayurveda

Plants are also used for healing in the Indian Ayurveda tradition.

Methods of preparation

The release time plays a special role in all types of preparation , as certain substances are released from the plants depending on the time. When preparing as an infusion and decoction, it is also important that the plants soak or boil with the lid closed, as this process usually creates therapeutically particularly effective essential oils that are particularly volatile and would otherwise be lost. The preparation and dosage of appropriate preparations requires expert knowledge, there may be a risk of fatal poisoning.

The method of preparation depends on the ingredients or active ingredients that you want to extract from the plant parts (especially). The type of preparation can have a decisive influence on the effectiveness of one and the same plant species.

  • Infus : Plant parts are poured over with hot or boiling water and strained after a certain infusion time.
  • Decoction : parts of plants are boiled in water and then strained, especially in the case of roots or siliceous plants.
  • Macerate : Plant parts are poured with cold water and strained after a certain steeping time, for example in the case of plants that contain mucilage , as mucilage is sensitive to heat.
  • Mixed forms: parts of plants are poured with cold water, left to stand and then boiled (maceration decoction).
  • Percolate : Plant parts are seeped through by a menstruum ( solvent ), whereby the menstruum is continuously updated. Thesolvent equilibrium is preventedby the process of percolation . This enables the complete release of ingredients. The best-known example of a percolate is filter coffee.
  • Tincture : alcoholic extract
  • Mother tincture : Like the tincture, an alcoholic extract that is used in homeopathy as a starting point for the production of homeopathic potencies.
  • Oil extract : Synthetic or vegetable oils are used as extractants . The extraction can be carried out warm (up to 70 ° C) or cold (for external use or for the production of ointments).
  • Ointment : Plant extracts can be used to make ointments . Synthetic or natural raw materials are used (for example beeswax). If different phases are used (aqueous extracts, alcoholic extracts, oil extracts), an emulsifier must usually be added.
  • Gel : Gels can be made from aqueous or diluted alcoholic extracts, for example, with the help of gel formers ( e.g. xanthan gum ).

Systematization of the herbal ingredients

Phytochemical and pharmacological studies have revealed the chemical structure of many ingredients. Different groups can be summarized:

Herbalists in History

See also

literature

Rational phytotherapy

General reference works

  • Andreas Alberts, Peter Mullen: Psychoactive plants, fungi and animals. Franckh – Kosmos, Stuttgart 2000, ISBN 3-440-08403-5 .
  • Siegfried Bäumler: Medicinal plant practice today: portraits, recipes, application. Urban & Fischer at Elsevier, Munich 2010, ISBN 978-3-437-57271-5 .
  • Diether Ennet: BI Lexicon. Medicinal plants and drugs . VEB Bibliographisches Institut, Leipzig 1990, ISBN 3-323-00191-5 .
  • H.-P. Michael Freyer: Herbal Medicine . In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 1135-1141.
  • Ulrich Jürgen Heinz: The manual of modern herbal medicine. Hermann Bauer Verlag, Freiburg im Breisgau 1984, ISBN 3-7626-0276-X .
  • Volker Fintelmann , Rudolf Fritz Weiss , Kenny Kuchta: Textbook Phytotherapy. 13th edition. Haug-Verlag im Thieme-Verlag, Stuttgart 2016, ISBN 978-3-13-240015-3 .
  • Robert Jütte : History of Alternative Medicine. From folk medicine to today's unconventional therapies. CH Beck, Munich 1996, ISBN 3-406-40495-2 , pp. 164-178 ( herbal medicine ).
  • Karin Kraft : Checklist phytotherapy. Thieme, Stuttgart 2000, ISBN 3-13-124551-4 .
  • Johannes Gottfried Mayer , Bernhard Uehleke , Kilian Saum : The great book of monastic medicine . Zabert Sandmann, Munich 2013, ISBN 978-3-89883-343-1 .
  • Thomas Richter: Medicinal herb. In: Werner E. Gerabek et al. (Ed.): Enzyklopädie Medizingeschichte. 2005, pp. 545-533.
  • Heinz Schilcher (Ed.): Guide to phytotherapy . 5th edition. Urban & Fischer at Elsevier, Munich 2016, ISBN 978-3-437-55344-8 .
  • Hildebert Wagner, Markus Wiesenauer: Phytotherapy - Phytotherapeutics and herbal homeopathics. Stuttgart 1995.
  • Margret Wenigmann: Phytotherapy: medicinal plants, active ingredients, application. Munich 1999.
  • Max Wichtl (Ed.): Tea drugs and phytopharmaceuticals. Wissenschaftliche Verlagsgesellschaft, Stuttgart 2009, ISBN 978-3-8047-2369-6 .
    • New edition by Wolfgang Blaschek (Ed.): Wichtl - Teedrogen und Phytopharmaka. A guide for the practice. 6th edition. Wissenschaftliche Verlagsgesellschaft, Stuttgart 2016, ISBN 978-3-8047-3068-7 .
  • Richard Willfort: Health through medicinal herbs . Rudolf Trauner Verlag, Linz 1997, ISBN 3-85320-117-2 .

Web links

Individual evidence

  1. ^ Jörg Mildenberger: Anton Trutmann's Pharmacopoeia. Part 2: Dictionary. (= Würzburg medical historical research. Volume 56). Königshausen & Neumann, Würzburg 1997.
  2. ↑ European Medicines Agency: HMPC , Community monographs ( Memento from December 20, 2008 in the Internet Archive )
  3. ↑ List of the monographs of Commission E heilpflanze.de on the website www.heilpflanze-welt.de , viewed May 18, 2019.
  4. ^ Cooperation with phytopharmaceuticals: Scientific knowledge material koop-phyto.org
  5. ^ European Scientific Cooperative on Phytotherapy (ESCOP), Publications
  6. ↑ Directive 2001/83 / EC Article 16a; national implementation in Germany: § 39b AMG , national implementation in Austria: §§ 12, 12a AMG
  7. ↑ European Medicines Agency, HMPC, Community list ( Memento from December 20, 2008 in the Internet Archive )
  8. ↑ § 10 AMG
  9. ↑ The pharmaceutical market in Germany in figures for 2015. According to the Federal Association of Drug Manufacturers
  10. ^ Rudolf Fritz Weiss: Textbook of Phytotherapy. 6th edition. Hippokrates, Stuttgart 1985, ISBN 3-7773-0675-4 , p. 12.
  11. ↑ Rudolf Fritz Weiss: Now and then a little hawthorn. In: The time . September 7, 1985.
  12. ^ A b V. Schulz, R. Hansel: Rationale Phytotherapy. 5th edition. Springer, Berlin / Heidelberg 2004, p. 2.
  13. ↑ Popular use of indigenous medicinal plants. 2nd Edition. Berlin 1925.
  14. ↑ Johannes Arends: Popular names of medicines, drugs, medicinal herbs and chemicals. 16th edition. Heidelberg / New York 1971.
  15. ↑ K. von Ammon, M. Frei-Erb, F. Cardini, U. Daig, S. Dragan, G. Hegyi, P. Roberti di Sarsina, J. Sörensen, G. Lewith: Complementary and alternative medicine provision in Europe– first results approaching reality in an unclear field of practices. In: Researching complementary medicine (2006). Volume 19, Supplement 2, 2012, pp. 37-43, doi: 10.1159 / 000343129 . PMID 23883943 (Review).
  16. ↑ Onmeda.de: Phytotherapy , May 12, 2011.
  17. ^ V. Schulz, R. Hansel: Rationale Phytotherapie. 5th edition. Springer, Berlin / Heidelberg 2004, p. 5.
  18. ↑ a b V. Fintelmann, Rudolf Fritz Weiss: Textbook of Phytotherapy. 11th edition. Hippokrates, Stuttgart 2006, p. 7.
  19. ↑ A. Schapowal: Rational Phytotherapy: Antiallergic Effects of Butterbur Extract Ze 339 . Kilian, Marburg 2004, p. 10.
  20. ↑ Eberhard (2003), Reißenweber (2001).
  21. ↑ a b c A. Shang, K. Huwiler, L. Nartey, P. Jüni, M. Egger: Placebo-controlled trials of Chinese herbal medicine and conventional medicine - comparative study. In: Int. J. Epidemiol. 36 (5), Oct 2007, pp. 1086-1092. PMID 17602184
  22. ↑ K. Linde, G. ter Riet, M. Hondras, A. Vickers, R. Saller, D. Melchart: Systematic reviews of complementary therapies - an annotated bibliography. Part 2: Herbal medicine. In: BMC Complement Altern Med. 1, 2001, p. 5. PMID 11527508 .
  23. ^ MH Pittler, NC Abbot, EF Harkness, E. Ernst: Location bias in controlled clinical trials of complementary / alternative therapies. In: J Clin Epidemiol. 53, 2000, pp. 485-489. PMID 10812320 .
  24. ↑ C. Liu, RM Douglas: Chinese herbal medicines in the treatment of acute respiratory infections: a review of randomized and controlled clinical trials. In: Med J Aust. 169, 1998, pp. 579-582. PMID 9887898 . Full text ( January 9, 2010 memento in the Internet Archive ). Retrieved August 18, 2008.
  25. ^ A b N. C. Armstrong, E. Ernst: The treatment of eczema with Chinese herbs: a systematic review of randomized clinical trials. In: Br J Pharmacol . 48, 1999, pp. 262-264. PMID 10417508
  26. ^ E. Ernst: Herbal medicines: where is the evidence? In: BMJ . 321, 2000, pp. 395-396. PMID 10938031
  27. ^ E. Ernst: [Health insurances pay for untested procedures. Falsely conceived "patient friendliness"]. In: MMW Fortschr Med. 149 (8), Feb. 22, 2007, pp. 55-56. PMID 17615704
  28. ↑ Cf. for example Irmgard Müller: The herbal remedies in Hildegard von Bingen. Healing knowledge from monastery medicine. Salzburg 1982; New printing Herder, Freiburg im Breisgau / Basel / Vienna 1993; 2nd edition ibid 2008, ISBN 978-3-451-05945-2 .