phytotherapy
phytotherapy, the use of plant-derived medications in the treatment and prevention of disease. Phytotherapy is a science-based medical practice and thus is distinguished from other, more traditional approaches, such as medical herbalism, which relies on an empirical appreciation of medicinal herbs and which is often linked to traditional knowledge. An herbalist’s approach generally has not been evaluated in controlled clinical trials or in rigorous biomedical studies, whereas numerous trials and pharmacological studies of specific phytotherapeutic preparations exist. The interpretation and acceptance of such evidence for phytotherapeutic practices varies. In some countries, it is considered sufficient to license phytotherapeutic products as medicines, whereas in other countries, phytotherapy is viewed as a form of traditional medicine.
There are a number of phytotherapeutic preparations in use. Examples include preparations derived from the leaves of ginkgo (Ginkgo biloba), which are used to treat a range of minor cognitive disorders and certain other disorders of the central nervous system; the aerial parts of St. John’s wort (St. Johnswort; Hypericum perforatum), which typically are used in the treatment of mild to moderate forms of depression; the aerial parts and roots of Echinacea angustifolia (and other species of Echinacea), which are used in the treatment and prevention of the common cold and other respiratory conditions; and parts of African devil’s claw (Harpagophytum procumbens), the root of which is used to treat chronic lower back pain.
History of phytotherapy
The concept of phytotherapy originated with French physician Henri Leclerc, who first used the term in 1913 and who published various editions of the Précis de phytothérapie (“Handbook of Phytotherapy”), the first in 1922. Phytotherapy entered the English language with its common definition in 1934, having been introduced by Eric Frederick William Powell, who was an English practitioner of herbalism and homeopathy. The English term, however, did not gain wider recognition until much later.
In 1960 German herbalist and physician Rudolf Fritz Weiss published Lehrbuch der Phytotherapie (1960; Herbal Medicine), which became the definitive German textbook on the topic. The work initially had been published in a different format in 1944 under the name Die Pflanzenheilkunde in der Ärztlichen Praxis (“Plant-Based Curative Science in Medical Practice”). Both Leclerc’s and Weiss’s approaches shared a strong focus on what later came to be described as evidence-based medicine.
Another important landmark in the history of phytotherapy was the emergence in 1987 of the journal Phytotherapy Research, edited by British pharmacognosist Fred Evans. In 1997 the book Rational Phytotherapy was published under the stewardship of American pharmacognosist Varro Tyler. The work was an English translation of the German book Rationale Phytotherapie: Ratgeber für die Ärztliche Praxis (3rd ed., 1996), written by Volker Schulz and Rudolf Hänsel.
The regulatory maze
The terminology of the various forms of treatment associated with herbal substances remains confusing. While many consider herbal medicines with a well-defined use profile (one based on scientific and medical evidence) as phytotherapeutic products, others consider such products to be food supplements. The latter implies that medicines based on herbal substances are unproven therapies, and in some countries they are treated that way. In the United States, for example, all herbal-based products are classified as dietary supplements. To complicate matters, herbalism is sometimes also referred to as phytotherapy, and both herbalism and phytotherapy are sometimes described as herbal medicine. Likewise, preparations used in phytotherapy and in herbalism may be referred to as herbal medicines or phytomedicines.
The confusion between phytotherapy and herbalism is also reflected in a complex regulatory situation, where assessments of what can or cannot be designated a medicine differ vastly. The differences often are the result of variations in legal frameworks that have been implemented by countries or regions, such as the European Union. For places that have laws or regulations for herbal products, specific requirements for quality assurance exist. The requirements are intended to provide a relatively high level of security to consumers by regulating the quality of the product through the supply and value chain, from the collection or wild crafting (harvesting from nature) of plants to the manufacture and promotion of the final product. The products used in phytotherapy generally are produced industrially by using routine procedures, which differs from herbalism. Thus, for phytotherapy, there is a limited difference between the batches of product sold on the market by an individual company. The composition of the same phytotherapeutic product, however, may differ from one company to the next.
Standardization
A commonly used but often poorly defined concept in phytotherapy is standardization, which is the requirement of having a minimum amount of one or several active compounds or groups of compounds in the plant extract. Often a range from a minimum to a maximum amount is given. In the field of phytotherapy, standardization applies only to extracts and by definition only to those where the active constituents are fully characterized. For example, an extract containing a certain percentage of compound class X (e.g., flavonoids) must contain one specific compound of the group (e.g., the flavonoid rutin). The quantification often is carried out by using chromatography-based techniques (e.g., gas chromatography or high-performance liquid chromatography), capillary electrophoresis, atomic absorption spectroscopy, or mass spectrometry.
Standardization is intended to ensure a reproducible composition of known active constituents. For example, St. John’s wort (H. perforatum) is used in both phytotherapy and herbalism. In the former, the preparations often are industrially produced extracts from the leaves and plant tops that have been standardized according to hypericin and hyperforin content (or sometimes one or the other). These two substances are known to be relevant for their pharmacological effects. The extract is generally formulated as tablets or capsules. By contrast, herbalists are likely to use a tincture of H. perforatum herb that is not standardized on its content of any particular constituent.
Phytotherapy and national health care systems
The practice of phytotherapy differs widely throughout the world. In some countries, such as South Korea and Japan, proven phytotherapy products are integrated into health insurance coverage. Other countries, including China, India, and Nepal, offer wide health care coverage for herbal medicines, which fall under traditional medicine services. In most other parts of the world, however, such products are not integrated into health care or health insurance programs. They are, rather, much more a patient’s private choice, and they often are sold as over-the-counter (OTC) products, though these products may be recommended or prescribed by a wide range of health care practitioners, including general practitioners and naturopathic doctors.
Since phytotherapy is a system of medical practice that is based on scientific or medical evidence, its products are pharmacologically active medicines, similar to conventional pharmaceutical drugs. Thus, phytotherapy cannot be subsumed under complementary and alternative medicine (CAM), which generally is linked to different philosophical principles.
Michael Heinrich