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Herbal medicine: buy one, get two free

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In recent years, herbal medicine seems to have gone from strength to strength. However, not one but three types of herbal medicine exist—and we are confusing them at our peril.

The first form of herbal medicine is perhaps best called phytotherapy. It is the scientific face of herbalism and the area where reasonably good data are available.1 In phytotherapy, we accept that one extract of St John’s wort (Hypericum perforatum), for example, contains a multitude of pharmacologically active ingredients. Thus isolating one of them is often not the way forward. Instead, the whole extract is viewed as a single entity which can be standardised and clinically tested for one defined clinical condition. If all tests turn out to be positive, and the extract (for example. St John’s wort) does demonstrably generate more good than harm (for example, alleviates symptoms without unacceptable risks), it can be used for one clearly defined condition (for example, mild to moderate depression). Phytotherapy thus closely follows the principles of pharmacotherapy. Like all drug treatment, phytotherapy requires knowledge and skills—for example, making a diagnosis and identifying the treatment that best suits the patient. Therefore it should be practised by clinicians with adequate experience. In some countries, such as Germany, many doctors have integrated phytotherapy into …

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