Signe Beebe More and more people are seeking integration between conventional medicine and other systems of medicine for themselves and their pets. Herbal medicine, also known as botanical medicine or ethnobotanicals, is the use of plants or plant derivatives that have a medicinal or therapeutic effect on the body. The entire plant, or a part of the plant may be used; herbal practitioners use flowers, berries, leaves, stems, and roots of plants that contain multiple active constituents to produce a therapeutic effect. A common philosophy underlying the development of all traditional herbal medicines is based on the restoration and maintenance of balance (homeostasis) between the body, the mind, and the environment, with an emphasis on promotion of health and preventative care. Herbal medicine is considered to be one of the most powerful systems of medicine, as many of our most potent and effective conventional drugs are obtained from plants, and so it is considered to be the basis for the modern-day pharmaceutical industry. It is estimated that approximately one-quarter of all drugs prescribed worldwide have their basis in traditional herbal medicines [1–3]. The earliest use of medicinal plants can be traced back to the Egyptians (Edwin Smith Papyrus, Ebers Papyrus), Greeks (Theophrastus/Enquiry into Plants, Hippocrates/The Medicine of Hippokrates, Dioscorides/De Materia Medica, Galen/De simplicium medicamentorum facultatibus libri XI), Arabic (School of Salerno, Formulary of Al Kindi and Samarquandi/Experiments of Cohpon), Chinese (Shen Nong Ben Cao Jing), Indians (Brihattrayee), and British (Herbarium Apuleius). The works by Galen and Disoscorides are considered to be the two of the most influential herbals as their repeated copying and dissemination shaped Mediterranean and European medicinal plant use until the eighteenth century [4–6]. Since this time traditional herbal systems were developed in the United States, Europe, Japan, India, Africa, the Middle East, Tibet, Central and South America, and many others. There is a significant overlap in herbs used in Eastern and Western herbal systems for instance ginger, fenugreek, turmeric are used by both, however the names are different due to the traditional system in which they evolved. Some herbalists and naturopaths often consider a single herb for preventative or mild health conditions. Ayurvedic and Western herbalists tend to use single herbs or build formulas comprised of a smaller number (1–4) of herbs whereas, Kampo and TCM (Traditional Chinese Medicine) practitioners prescribe classical herbal formulas containing a larger number (5 or more) of herbs. Complex herbal formulas composed of multiple herbs are typically used for more severe medical conditions. The common belief is that by combining different herbs into a formula, the therapeutic efficacy of the herbal medicine is improved through additive or synergistic effects, and other constituents help to improve bioavailability, neutralize any adverse effects of the others [7]. The most common botanical medical systems in use today that have evolved independently from or parallel with conventional medicine include Western Herbal Medicine (WHM), Traditional Chinese Herbal Medicine (TCHM), Ayurvedic herbal medicine (one of India’s traditional systems of medicine), and Kampo medicine (Japanese). Herbal medicine doctors of all systems of herbal medicine base their practice on years of historical traditional herbal medicine experience and documentation in combination with biomedical science and research. The term Western Herbal Medicine (WHM) is used to differentiate herbalism based on European-American traditional herbal medicine from other systems of herbal medicine such as Ayurveda, Unani, Kampo or Chinese. Western Herbal Medicine is also referred to as traditional Western herbalism, herbal or botanical medicine, and phytotherapy and is practiced in Australia, Canada, New Zealand, the United Kingdom, the United States, and Western Europe. Early Western herbal medicine traditions developed from the study of herbs used as medicine by indigenous people of that country [8]. In the US, the early schools of herbal practice were initially based on Native American herbalism from which the school of Thompsonian botanical study emanated and was soon followed by the development of Eclectic and Physiomedicalist schools [9]. Samuel Thompson (1769–1843) (Thompsonian medicine) was considered one of the first well documented physicians of the time from which emerged the “Eclectic” (from the Greek word eklego meaning to “choose or select”) and Physiomedicalist physicians of the late nineteenth century. The term eclectic was used to refer to those doctors that used whatever medical treatment they determined was beneficial to their patients and included herbal medicine, homeopathy and allopathic treatments. Eclectic physicians included Wooster Beach (1794–1868) and John Scudder (1829–1894). The Eclectic botanical system eventually gave way to the Physiomedicalist practice of botanical medicine that included Alva Curtis (1797–1881) and William Cook (1832–1899). It is important to remember that there was no official “school” of medicine during the eighteenth and early to mid-nineteenth centuries and most “doctors” were largely self-trained and treated patients in their homes. The American Medical Association (AMA) was established in 1847. All of the early botanical medicine schools were developed by doctors that were unhappy with the current medical treatments of the time. Disease in the eighteenth century was considered as an entity or a demon that required violent treatments in order to drive it out to cure the affected patient [10]. These early medical treatments provided the impetus for a more natural, less aggressive method of healing. These early American medical schools, founded on the philosophy of Physio-Medicalism substituted botanical medicines for allopathic medicines and treatments were based on the belief that every living system is governed and maintained by an inherent “vital force” that can be used to heal. This belief is common to all physiomedical practices, and is similar to the concept of Qi in TCHM. Disease or illness develops when there is a disruption or imbalance of this vital force. Physiomedical practice used herbal medication to restore vitality and return the body’s function to normal, to restore homeostasis, and eliminate obstructive conditions. The ability of the body to eliminate waste and toxins is of great importance to the physiomedicalist, as it is considered that the presence of pathogenic factors obstructs the vital function of the body. The philosophy and practices of physiomedicalism are the base from which modern clinical herbal medicine is developed. Between 1836 and 1911, thirteen physio-medical colleges were developed and the last finally closed at the end of the twentieth century. Today, the written records of the Eclectics/Physiomedicalism are stored in the Lloyd library in Cincinnati, Ohio, one of the greatest botanical libraries in the Western world [6]. One of the earliest herbal texts in Britain, Banckes’s Herbal, is considered the first herbal book published in English on the medicinal properties of herbs and was printed in 1525 [11, 12]. The author of this book is unknown, and the book was named after the publisher Richard Banckes. A digital scan of Banckes’s Herbal is available online at the US National Library. This was followed by the Grete Herball in 1526. Nicholas Culpepper (1616–1654) a seventeenth-century physician wrote the English Physician, also known as Culpeper’s Herbal, a comprehensive list of England’s medicinal herbs and is one of the most enduring herbal texts ever written and is still in use and available today [13]. The first comprehensive herbal in Germany was Gart der Gesundheit, written by Dr. Johann Wonnecke von Kaub (1430–1504) and contains 435 monographs and information from Buch der Natur (Book of Nature) by Konrad von Megenberg (1309–1374) and the Physica by Hildegard of Bingen (1098–1179) [14, 15]. Cranberry has been used for hundreds of years, especially cranberry juice, to prevent and treat the development of urinary tract infection (UTI) in humans. Cranberry is commonly used in the US by veterinary herbal practitioners for prevention and treatment of recurrent UTI in dogs. Chronic urinary tract infection (UTI) is the most common infectious disease in older women, causing poor quality of life and chronic infections are a leading cause of death and associated health expenditures. Multiple studies have been conducted on the active constituents found in cranberry responsible for its ability to prevent and treat UTI [16]. Evidence suggests that cranberries decrease the recurrence of urinary tract infections and can therefore decrease the chronic use of antimicrobials and resistance to them. A systematic review and analysis were done to evaluate and provide an update on the efficacy of cranberry (Vaccinium spp.) as an adjuvant therapy for the prevention of recurrent UTI’s in susceptible groups. This analysis included articles with data on the incidence of UTIs in susceptible populations using cranberry products. The meta-analysis included 23 trials with 3979 participants and reported that cranberry-based products significantly reduce the incidence of UTIs in susceptible populations [17]. A canine study was done to determine the effects of cranberry extract on the development of UTI in dogs and to determine adherence of Escherichia coli (E. coli) to Madin-Darby canine kidney (MDCK) cells [18]. Urinary tract infections in dogs are associated with poor immune defense mechanisms that allow pathogens to adhere, multiply, and persist within the urinary tract. Although other bacteria can infect the urinary tract, UTIs the most common uropathogen is Escherichia coli. The E. coli strains that cause UTIs have fimbriae that facilitate adhesion of bacteria to uroepithelial cells in the urinary tract the same as in human UTI’s. This study shows that oral administration of cranberry extract prevented development of UTI by P-fimbriated E. coli and adherence to MDCK cells, which may indicate it has benefit for preventing UTIs in dogs. Traditional Chinese Herbal Medicine (TCHM) has a history of more than 4,000 years, and according to legend and folklore, the Divine Husbandman’s Classic of the Materia Medica (Shen Nong Ben Cao Jing) was recorded around 250 CE (Common Era, formerly AD), the content is attributed to Shen Nong, a legendary healer thought to have lived over 2,000 years ago in China, and is the first and the oldest known herbal text in the world. This text contains information on 365 medicinal substances including details such as taste, thermal properties, dosages, and toxicity. This is the earliest record of Chinese herbal medicine, and much of its information still holds true today. Shen Nong is believed to have taught the ancient Chinese the practice of agriculture, and he dedicated his life to searching for herbal medicines to treat disease. It has been said that he traveled throughout ancient China, and personally collected and tasted each and every medicinal substance. To honor and commemorate his contributions to medicine, numerous authors and physicians compiled and published the Shen Nong Ben Cao Jing in his name. In addition to the Shen Nong Ben Cao Jing, the other seminal text on TCHM is the Huang Di Nei Jing (The Yellow Emperors Classic of Internal Medicine) [19
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Herbal Medicine – Origins and Major Systems of Herbal Therapy with Selected Evidence-based Interventions
Introduction
Major Systems of Traditional Botanical/Herbal Medicines
Western Herbal Medicine
Traditional Chinese Herbal Medicine
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