Medicinal plants have shaped healthcare throughout history and continue to underpin modern medicine today. Examples of some of the most important drugs originate from plants, including:

• Pacific yew (Taxus brevifolia), the source of the anticancer drug taxol
• Sweet Annie (Artemisia annua), which yielded artemisinin for malaria treatment
• Opium poppy (Papaver somniferum), the origin of morphine
• Autumn crocus (Colchicum autumnale), used to treat gout and inflammatory conditions

Beyond these well-known examples, many other medicinal plant species remain underexplored, representing valuable potential for future therapeutic discoveries.

Medicinal plants also play a vital ecological and social role. They support biodiversity, pollinators, and soil health (1-3), and form the backbone of traditional healthcare systems and local economies—particularly in rural and Indigenous communities (4). Knowledge passed down through generations has guided the use of plants, such as snowdrop species (Galanthus spp.), inspiring neurological treatments, and Chinese angelica (Angelica sinensis), which remains central to traditional Chinese medicine (5,6). Protecting medicinal plants, therefore, means protecting health, culture, and livelihoods — now and for generations to come.

Despite their importance, medicinal plants are increasingly at risk. Specifically, our analysis reveals clear and consistent patterns in how medicinal plants are responding to climate change. Drawing on a scoping review of 367 medicinal plant species, we found that the most common predicted impact is the loss of suitable habitat, affecting 131 species, largely driven by changes in precipitation patterns and elevation.

Range shifts were observed in 97 species, with many plants moving toward higher altitudes and latitudes. In comparison, 73 species showed an increase in suitable habitat—suggesting that climate change may create new opportunities for a limited number of plants (Figure 1) (7).

These distributional changes have direct implications for the pharmaceutical and cosmetic industries, with knock-on effects throughout herbal value chains. Many of the most studied medicinal plants — whether cultivated or wild-harvested — are susceptible to climate-driven changes in temperature and rainfall. This includes species such as jatamansi (Nardostachys jatamansi), chonglou (Paris polyphylla), chuan bei mu (Fritillaria cirrhosa), and ma huang (Ephedra sinica). As a result, regions once considered reliable sources may become less productive or unsuitable, leading to reduced yields, supply disruptions, and increased uncertainty in sourcing raw plant materials. At the same time, the loss of vulnerable species limits opportunities to discover new therapeutic agents, narrowing the future potential of plant-based innovation.

Climate-driven shifts also pose significant challenges for geographical indications (GIs), including traditional concepts such as Daodi and European notions of provenance and terroir, which link product quality to specific ecological and cultural conditions. As climates change, the environmental foundations that give these regions their distinctive phytochemical profiles may no longer hold. Established GI zones may therefore need to adapt, relocate, or be redefined — raising important questions about quality standards, authenticity, and regulation (8).

Global warming may significantly alter the production of bioactive metabolites and marker compounds in medicinal and aromatic plants by increasing potential evapotranspiration due to elevated temperatures, which in turn accelerates soil drying (9). The resulting changes in phytochemical profiles are highly variable and depend on the plant species, the specific type of compounds, as well as the intensity and duration of drought stress (10).

Moderate drought often enhances the accumulation of various secondary metabolites, especially those with antioxidant properties. This is attributed to the induction of mild oxidative stress, which triggers the biosynthesis of protective compounds such as phenolics and flavonoids to scavenge reactive oxygen species (ROS) (11). When drought becomes prolonged and severe, plant metabolic processes are significantly disrupted (12). This contrasting pattern was evident in several species reviewed. For example, under water deficit conditions, both balangu (Lallemantia royleana) and Persian lilac (Melia azedarach) exhibited increased phenolic and flavonoid content (13,14).

However, in broadleaved lavender (Lavandula latifolia), drought conditions resulted in decreased levels of specific metabolites such as coumaric and salvianic acids (15).

As a major contributor to climate change, elevated CO₂ and temperature exhibit mixed results; in certain cases, they can enhance the production of some compounds while suppressing others, due to complex carbon allocation and temperature sensitivities (81). High temperatures alone reduce the levels of several secondary metabolites, likely due to metabolic shifts that favour survival over defence (16).

Changes in precipitation also influence metabolite levels, with reduced rainfall often linked to a decline in compound diversity, particularly in drought-sensitive species (17). In addition, temperature stress elevates volatile organic compounds, suggesting an upregulation of stress signaling or defense responses (18). 

These fluctuations in secondary bioactive metabolite and marker compound profiles could impact the potential risks and benefits of medicinal plants. Increased levels of certain compounds could enhance antioxidant, anti-inflammatory, or antimicrobial activity, while a decline in key bioactive may compromise the potential effectiveness of traditional and plant-derived preparations (19,20).

Similarly, the pharmaceutical and cosmetic industries face significant challenges. Drought, for instance, alters the synthesis of essential oils, phenolic compounds, and flavonoids, key compounds in skincare, personal, and healthcare products. Changes in the levels of bioactive metabolites or marker compounds, such as linalool, linalyl acetate, α-pinene, and borneol in lavender (21) or camphor and linalool in basil (Ocimum basilicum), as well as various compounds in rosemary (Salvia rosmarinus), due to drought, and/or heat stress, could explain these biochemical shifts (22,23).

These phytochemical shifts (including changes in the levels of bioactive metabolites or marker compounds) can affect the quality (including the safety and efficacy of plant-derived medical products) and sensory properties of cosmetic and healthcare products (21).

Overall, climate-driven changes in bioactive metabolites raise important questions about quality, safety, and consistency. While some plants may benefit from moderate stress, others may lose critical properties. At present, simple predictions are not possible, highlighting the need for longer-term and comparative research.

Climate change is increasingly undermining both biodiversity and the traditional healthcare systems that depend on medicinal plants. For instance, in the Central Himalayas, rising temperatures and shifting rainfall have advanced flowering and fruiting times by several weeks, disrupting culturally rooted harvesting practices and reducing the availability and effectiveness of key medicinal species. Traditional healers report growing reliance on substitute plants, which are often significantly less effective (24).

Similar patterns are emerging in northern Thailand, where medicinal plants used by Karen communities — particularly in women’s reproductive healthcare — are projected to lose much of their suitable habitat in the coming decades (25). Comparable challenges are faced by the Shan people and forest-dependent communities near the Chunati Wildlife Sanctuary, where limited access to formal healthcare increases reliance on traditional medicine (26).

As climate change alters the distribution, timing, and potency of medicinal plants, the resilience of these community-based healthcare systems is coming under increasing strain.

Safeguarding medicinal plants in a changing climate requires coordinated action across policy, conservation, industry, and communities: 

• Climate-resilient cultivation and agroforestry: Diversified cultivation systems and agroforestry can reduce pressure on wild populations while strengthening ecosystem resilience, but wider adoption will require investment and integration into land-use planning.
• Genetic conservation and species management: Seed banks, tissue culture, and germplasm conservation offer critical insurance against loss, but must be paired with fair benefit-sharing and livelihood support.
• Community-led and participatory conservation: Recognising Traditional Ecological Knowledge and supporting local stewardship has proven more effective than top-down approaches.
• Stronger policy frameworks and incentives: Clear regulation and economic incentives — such as Payments for Ecosystem Services — can reduce illegal harvesting while supporting sustainable trade.
• Research, training, and capacity building: Knowledge gaps remain across many medicinal-plant-producing regions. Long-term monitoring, targeted funding, and specialist training are essential to translate research into meaningful action.

Medicinal plants are a shared global resource, but their future depends on the choices we make today. Climate change has transformed sustainability from an environmental concern into a health, cultural, and economic imperative. By supporting responsible sourcing, sustainable cultivation, and informed policy, we can help ensure that medicinal plants continue to support the well-being and health of people and planet.  

Protecting medicinal plants today safeguards healing possibilities that cannot be recovered once lost.”

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7. Takubessi MI, Jalil B, Heinrich M. The impact of climate change on medicinal plants and natural products: a scoping review. Front Pharmacol. 2025;16:1697581. https://doi.org/10.3389/fphar.2025.1697581 
8. Brinckmann JA. Geographical indications for medicinal plants: globalization, climate change, quality and market implications for geo-authentic botanicals. World J Tradit Chin Med. 2015;1(1):16-23. https://doi.org/10.15806/j.issn.2311-8571.2014.0020 
9. Trenberth KE, Dai A, van der Schrier G, et al. Global warming and changes in drought. Nat Clim Chang. 2014;4(1):17-22. https://doi.org/10.1038/nclimate2067 
10. Tan U, Gören HK. Comprehensive evaluation of drought stress on medicinal plants: a meta-analysis. PeerJ. 2024;12:e17801. https://doi.org/10.7717/peerj.17801 
11. Ai Q, Dai A, Han M, Yang L, Liu C. Moderate drought stress interferes with the physiological state and promotes the accumulation of isoflavone in reproductive Iris domestica rhizomes. Agronomy. 2024;14(8):1730. https://doi.org/10.3390/agronomy14081730 
12. Li T, Tiiva P, Rinnan Å, Julkunen-Tiitto R, Michelsen A, Rinnan R. Long-term effects of elevated CO2, nighttime warming and drought on plant secondary metabolites in a temperate heath ecosystem. Ann Bot. 2020;125(7):1065-1075. https://doi.org/10.1093/aob/mcaa037 
13. Omidi H, Shams H, Seif Sahandi M, Rajabian T. Balangu (Lallemantia sp.) growth and physiology under field drought conditions affecting plant medicinal content. Plant Physiol Biochem. 2018;130:641-646. https://doi.org/10.1016/j.plaphy.2018.07.033 
14. Dias MC, Pinto DCGA, Costa M, Araújo M, Santos C, Silva AMS. Phytochemical and antioxidant profile of the medicinal plant Melia azedarach subjected to water deficit conditions. Int J Mol Sci. 2022;23(21):13611. https://doi.org/10.3390/ijms232113611 
15. Cáceres-Cevallos GJ, Albacete-Moreno AA, Ferreres F, Gil-Izquierdo Á, Jordán MJ. Evaluation of the physiological parameters in Lavandula latifolia Medik. under water deficit for preselection of elite drought-resistant plants. Ind Crops Prod. 2023;199:116742. https://doi.org/10.1016/j.indcrop.2023.116742 
16. Li ZG. Mechanisms of plant adaptation and tolerance to heat stress. In: Hasanuzzaman M, ed. Plant Ecophysiology and Adaptation under Climate Change: Mechanisms and Perspectives II: Mechanisms of Adaptation and Stress Amelioration. Springer; 2020:39-59. https://doi.org/10.1007/978-981-15-2172-0_3 
17. Prinsloo G, Nogemane N. The effects of season and water availability on chemical composition, secondary metabolites and biological activity in plants. Phytochem Rev. 2018;17(4):889-902. https://doi.org/10.1007/s11101-018-9567-z 
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21. Jalil B, Heinrich M. Pharmaceutical quality of herbal medicinal products and dietary supplements—a case study with oral solid formulations containing Lavandula species. Eur J Pharm Sci. 2025;208:107042. https://doi.org/10.1016/j.ejps.2025.107042 
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Baobab is often described as the “tree of life”, reflecting its ecological and nutritional importance across sub-Saharan Africa. The fruit pulp — now widely exported as a powdered supplement — is rich in vitamin C, calcium, potassium and soluble fibre. Traditionally, it has been used for digestive disturbances, febrile illness and convalescence.

From a phytotherapeutic perspective, baobab provides antioxidant polyphenols and prebiotic pectins, supporting gut integrity and immune resilience. In Western practice, it is best understood as a gentle nutritive and demulcent food-medicine rather than a high-impact pharmacological agent.

The supply chain for baobab involves many tens of thousands of low income rural harvesters in Africa. Because it grows in very dry areas, these harvesters are often heavily constrained in terms of the livelihood opportunities available to them. The income they earn from baobab fruit sales is incredibly important to their overall welfare, and many of the harvesters describe baobab sales as their biggest single source of cash income during the year. 

Encouragingly, harvesting the fruit is non-destructive; trees are not felled, and the fruit are collected from the ground once they have ripened and fallen from the trees. In many regions, baobabs are communally managed under customary governance systems. Increasing export demand raises questions about equitable trade and long-term ecological monitoring. These questions are being addressed in a co-ordinated and collaborative way by the African Baobab Alliance, an association of baobab harvesters from across Africa. 

Pelargonium sidoides is one of the few African herbs firmly established in European phytomedicine. Standardised root extracts are widely used for acute bronchitis and upper respiratory tract infections, supported by clinical trials suggesting antimicrobial and immunomodulatory activity. In Germany, it forms the basis of the herbal bronchitis remedy “Umckaloabo”.

The tubers contain tannins, including proanthocyanidins, alongside phenolic acids, coumarins and phenylpropanoid derivatives. Compounds such as umckalin and related coumarin glycosides are thought to contribute to its activity.

Traditionally, however, the plant was primarily used for diarrhoea and dysentery, as well as general debility following gastrointestinal infection.

The medicinal part is the root, which presents sustainability challenges. Wild harvesting is inherently destructive. In response, some South African producers have adopted the FairWild standard, providing greater assurance of ecological monitoring and fair payment for harvesters. For practitioners, pelargonium illustrates the importance of asking where and how herbs are sourced — especially when demand increases beyond local use and export markets expand rapidly.

Artemisia afra, or African wormwood, is widely used across eastern and southern Africa for fevers, respiratory infections, digestive complaints, malaria, intestinal worms and several other ailments. Unlike Artemisia annua, it does not contain artemisinin, yet it demonstrates antimicrobial, anti-inflammatory, and aromatic bitter properties consistent with its traditional applications.

This is a highly aromatic plant. A common practice is to insert fresh leaves into the nostrils to clear blocked nasal passages. Boiling the leaves in water and inhaling the steam will have a similar effect (with perhaps less nasal irritation!). The plant is also often consumed as an infusion or decoction of the leaves, typically sweetened with honey to mask the naturally bitter taste. 

There are an astonishing variety of volatile secondary metabolites in A. afra, including 1,8 cineole, alpha-thujone, beta-thujone, camphor and borneol. These metabolites exhibit biological activity against many different micro-organisms, which accounts for its broad spectrum use as a herbal remedy.

During the COVID-19 pandemic, artemisia-based preparations became the subject of intense public discussion in parts of Africa. This highlighted an enduring tension: how traditional medicines are evaluated, validated, and sometimes dismissed within global biomedical discourse.

Hoodia gordonii, native to the Kalahari Desert, was traditionally used by San communities to suppress hunger during long hunting trips. In the late twentieth century, appetite-suppressant compounds isolated from the plant attracted commercial interest.

H. gordonii contains more than 20 different glycosides based on 12-hydroxypregnane. The major steroid glycoside is called hoodigside, but the appetite suppressant compound is an oxypregnane steroidal glycoside known as P57. The plant also shows anti-diabetic effect and improved gastric acid secretion damage. Traditional medicinal uses include as a treatment for haemorrhoids, tuberculosis, diabetes, indigestion, hypertension and stomach ache. 

Patenting and licensing agreements led to negotiations over benefit-sharing, and the case became emblematic in discussions of biopiracy and the Convention on Biological Diversity. Although agreements were eventually reached, anticipated financial returns were modest and commercial enthusiasm waned.

Hoodia remains a cautionary example. Traditional knowledge can be translated into global markets in ways that inadequately compensate its originators. Legal compliance under frameworks such as the Nagoya Protocol is a minimum standard; ethical practice may require deeper partnership, transparency and long-term community benefit beyond simple royalty agreements.

Kigelia africana is instantly recognisable by its large, pendulous fruits. Across many African traditions, fruit, bark and leaves are used both topically and internally for fungal infections, wounds, inflammatory skin conditions and other complaints.

In Western markets, kigelia appears primarily in cosmetic formulations marketed for skin toning and anti-ageing. While this draws loosely on traditional topical uses, it represents a reframing of the plant from community medicine to cosmeceutical ingredient.

Phytochemical studies identify iridoids, including specioside, alongside naphthoquinones, flavonoids and phenolic compounds with demonstrated antimicrobial and anti-inflammatory activity in vitro. Some cytotoxic effects have also been explored, though clinical relevance remains preliminary.

For herbal practitioners, kigelia is better understood as a topical antimicrobial and vulnerary rather than a cosmetic novelty. Sustainability considerations depend on which plant part is harvested; fruit collection is generally less destructive than bark removal. As demand grows, sourcing transparency becomes essential to prevent overexploitation.

Hypoxis hemerocallidea is a perennial geophyte native to southern Africa. The medicinally used part is the corm. In traditional practice, particularly within Nguni healing systems, it has been used for urinary disorders, benign prostatic hypertrophy, inflammatory conditions and as a general immune tonic.

International attention grew during the HIV/AIDS epidemic, when extracts containing hypoxoside — converted in the gut to rooperol — demonstrated antioxidant and anti-inflammatory activity in laboratory studies. This led to its promotion as an immune-supportive supplement.

However, clinical evidence remains mixed, and claims have sometimes outpaced data. Practitioners should approach bold therapeutic assertions cautiously and consider potential herb–drug interactions, particularly in clients taking antiretroviral therapies or other immunomodulating medicines.

Sustainability is a significant concern. Harvesting the corm is destructive, and rising demand in the 1990s and 2000s led to overharvesting in parts of South Africa. As a slow-growing species, recovery is limited without cultivation and careful management.

As global demand for medicinal plants increases, certification schemes have emerged to address sustainability and equity. The FairWild Standard is specifically designed for wild-collected species.

Unlike organic certification, which focuses on cultivation practices, FairWild addresses ecological assessment, sustainable harvest levels, legal compliance, traceability and fair working conditions. For root-harvested species such as Pelargonium and Hypoxis, it requires population monitoring, quotas and regeneration planning. For fruit-bearing species such as baobab, it helps ensure commercial demand does not undermine community access or ecosystem function.

For practitioners and consumers in the UK, FairWild certification offers greater transparency, independent auditing of sustainability claims, assurance of fair compensation and evidence of ecological monitoring. While certification is not a panacea, where available it provides a meaningful mechanism for aligning herbal practice with conservation and social justice principles.

To acknowledge African medicinal herbs is to recognise the communities who have safeguarded them, the landscapes that sustain them and the histories that shape their movement into global markets. Protection requires ecological care, equitable economics and intellectual respect.

Herbal medicine often describes itself as holistic. In a globalised world, holism must extend beyond the individual patient to include ecosystems and source communities. When we prescribe herbal medicines, we participate in an international web of relationships. It is incumbent upon us as herbalists to ensure that participation is respectful, equitable, ecologically sustainable and genuinely reciprocal.

It was a herb that inspired the development of the first of the NSAIDs. White willow (Salix alba) is a herb traditionally used for pain relief and reducing fever (3). It contains flavonoids, tannins and salicylates; with the salicylate salicin considered to be the key active constituent (4). The discovery of salicylates from white willow and meadowsweet (Filipendula ulmaria) and their pain-relieving activity led to the development of acetylsalicylic acid (aspirin). 

White willow extract has been found to inhibit COX enzymes, tumour necrosis factor-α (TNF-α) and NFκB (5), all of which are involved in inflammatory pathways. Much lower levels of salicylates are provided by effective therapeutic doses of white willow than are administered when taking aspirin, which means that fewer of the gastrointestinal side effects seen with aspirin are experienced (5).

It also suggests that constituents other than salicin are involved in the beneficial effect seen. Evidence suggests that white willow may be effective for treating lower back pain, and one study found that a standardised extract containing 120–210 mg of salicin was equivalent to the NSAID rofecoxib (6).

A study of 96 students with primary dysmenorrhoea (painful periods) found that 750 mg of mefenamic acid was less effective than 400mg of white willow (containing 240mg of salicin) at reducing pain, as measured using a visual analogue scale (7).

Turmeric (Curcuma longa) has been well researched for pain, particularly to treat knee osteoarthritis. It impacts on inflammatory markers interleukin-6 (IL-6) and TNF-α, and has been found to downregulate pain receptor expression (8); indicating a more complex mechanism of action than NSAIDs. 

A meta-review of turmeric systematic review found there to be moderate GRADE evidence for the use of turmeric to relieve pain and improve symptoms of osteoarthritis (8). GRADE is a tool to systematically assess the quality or certainty of evidence in clinical research. 

One study of 144 patients with knee osteoarthritis found that 1 g of a bioavailable turmeric extract was as effective as paracetamol at reducing pain over six weeks, while achieving greater decreases in inflammatory markers C-reactive protein (CRP) and TNF- α (9).

Another study of 367 patients showed that 1.5 g of turmeric extract was as effective as 1.2 g ibuprofen but with fewer gastrointestinal side effects when taken for four weeks by adults with knee osteoarthritis (10).

The measurement of inflammatory markers is one way to objectively determine whether an intervention is likely to be having an effect on the processes involved with pain and inflammation. So, the reduction of CRP and TNF-α by turmeric was a positive sign that it was having an impact on the cause of the pain, rather than providing a placebo effect or simply improving overall wellbeing.

Prostaglandins are short-acting signalling molecules that are involved in inflammatory responses. They are synthesised by COX enzymes and inhibiting their production by COX is a key mechanism of action of aspirin and NSAIDs. A study of 60 patients with knee osteoarthritis demonstrated that both NSAID naproxen and a supplement containing turmeric, ginger and black pepper inhibited prostaglandin E₂ (PGE₂) with no significant difference (11).

Fennel (Foeniculum vulgare) has also been proposed to alleviate pain by lowering prostaglandin levels. Two meta-analyses have both concluded that fennel oil or capsules is equivalent to conventional drug therapies such as the NSAID mefenamic acid at treating dysmenorrhoea (12,13).

The holistic and “nudge”-like approach of herbal medicine that aims to address health challenges over the long-term may not seem at first to be the most suitable way to address pain. The urgent feeling and discomfort experienced when we are in pain stimulates the desire for fast-acting solutions. 

A randomized-controlled trial in 88 healthy adults with acute musculoskeletal pain found that those who took 1g of a black seed oil (Nigella sativa), turmeric and frankincense (Boswellia serrata) extract had pain relief comparable to paracetamol within an average of one hour (14). 

There is also evidence that topically applied pain-relieving herbs like chilli (Capsicum spp.), rosemary (Salvia rosmarinus) and lavender (Lavandula angustifolia) can act quickly (15).

Due to the difficulties in achieving results when treating pain, multiple drugs are often combined to provide a more effective outcome. The addition of herbal anti-inflammatories to standard therapy may also be a good approach. 

A study of 140 patients with knee osteoarthritis found that 1 g of a curcuminoid complex combined with 100 mg of the NSAID diclofenac daily for 28 days was more effective than the diclofenac alone. Pain and quality of life were improved and the number of rescue analgesics needed for uncontrolled pain were lower in those taking the curcuminoid complex. There were also fewer adverse effects and less need for treatment of acid reflux with H2 blockers in the curcuminoid group (16).

In women with primary dysmenorrhoea, there is an increase in release of prostaglandins, particularly PGE₂. A standard treatment is the NSAID mefenamic acid. One study of 150 female students found that combining 250 mg of mefenamic acid with 500 mg of turmeric powder daily for five days around the start of menstruation led to significant reduction in pain compared with either treatment alone (17).  

Some herbs work via similar mechanisms to common pain-relieving medication such as NSAIDs. In many cases, they have been demonstrated to be as effective as standard painkillers, but with fewer side effects and, in some cases, they may mitigate the side effects produced by NSAIDs. This may be due to the complexity and synergy from multiple different phytochemicals in one herb.

Additionally, the holistic approach used in herbal medicine will aim to address the factors that have caused or are prolonging the increased inflammation in the first place and work towards fully resolving the underlying pathology.

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12. Lee HW, Ang L, Lee MS, Alimoradi Z, Kim E. Fennel for reducing pain in primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2020;12(11):3438. https://doi.org/10.3390/nu12113438
13. Shahrahmani H, Ghazanfarpour M, Shahrahmani N, Abdi F, Sewell RDE, Rafieian-Kopaei M. Effect of fennel on primary dysmenorrhea: a systematic review and meta-analysis. J Complement Integr Med. 2021;18(2):261–269. https://doi.org/10.1515/jcim-2019-0212
14. Rudrappa GH, Chakravarthi PT, Benny IR. Efficacy of high-dissolution turmeric-sesame formulation for pain relief in adult subjects with acute musculoskeletal pain compared to acetaminophen: a randomized controlled study. Medicine (Baltimore). 2020;99(28):e20373. https://doi.org/10.1097/MD.0000000000020373
15. Barnett H. Pain relief: 5 analgesic herbs for external application. Herbal Reality. 2023. Accessed April 23, 2026. https://www.herbalreality.com/health-lifestyle/mobility-fitness/5-herbs-instead-painkillers/
16. Shep D, Khanwelkar C, Gade P, Karad S. Efficacy and safety of combination of curcuminoid complex and diclofenac versus diclofenac in knee osteoarthritis: a randomized trial. Medicine (Baltimore). 2020;99(16):e19723. https://doi.org/10.1097/MD.0000000000019723
17. Hesami S, Kavianpour M, Rashidi Nooshabadi M, Yousefi M, Lalooha F, Khadem Haghighian H. Randomized, double-blind, placebo-controlled clinical trial studying the effects of turmeric in combination with mefenamic acid in patients with primary dysmenorrhoea. J Gynecol Obstet Hum Reprod. 2021;50(4):101840. https://doi.org/10.1016/j.jogoh.2020.101840

• 1200 ml 45% strength alcohol (vodka is most commonly used)
• 1 kg dried herb (divided into three equal batches of 333 g each)

• 2–3 litre glass kilner jar 
• Muslin cloth 
• Funnel 
• Amber glass storage bottles

1. Place the 333 g of dried herb material in the jar 
2. Pour 1200 ml over the herb 
3. Ensure the herb is fully submerged 
4. Seal and label the jar 
5. Leave to macerate for between 3–4 weeks 
6. Stir or shake the jar regularly 
7. After four weeks, strain the maceration through muslin into a bowl
8. Squeeze the muslin to extract as much liquid as possible 
9. Measure out the second batch of 333 g herb material 
10. Pour the retained alcohol extraction from the first tincture over the dried herb
11. Macerate for another 3–4 weeks 
12. Repeat the previous steps once more for the third batch. 

Once the tincture has been pressed, bottle into glass (preferably amber) jars and keep out of direct sunlight in a cool place. As the alcohol is at 45%, this will act as a preservative, however it is always recommended to check the tincture for signs of mould before consuming. 

Medicinal benefits of each ingredient (this is probably where we can really write a lot of content with references to other pages and herbs)

This percentage alcohol will extract both water soluble and alcohol soluble compounds, offering a broad-spectrum tincture. Some of the compounds extracted include: 

• Tannins 
• Polysaccharides 
• Mucilage 
• Minerals 
• Phenolic acids 
• Flavonoids
• Glycosdies 
• Alkaloids 
• Bitters 
• Coumarins 
• Saponins 

If, as a home herbalist, you only have access to commercial alcohol, the easiest option is to use 40% vodka or brandy. Vodka is a popular choice as it has a neutral flavour and is widely available.

Fresh plant material contains a higher water content than dried material, and so will reduce the overall percentage of the final extraction. In order to extract the same compounds from the plant, an alcohol percentage of 60–80% is recommended. If this is not accessible, drying the plant before tincturing will yield the same results. 

Fresh plants not only contain more water, but natural sugars and microorganisms on the plant’s surface. This can create a more favourable environment for bacterial growth unless the alcohol percentage is adjusted. If using standard 40% vodka, the final tincture may drop to below 30% if using plant material. An extraction lower than 30% risks bacterial growth, whilst anything 40% and above is suitable for long term storage (1,2).

1. Easley T, Horne SH. The Modern Herbal Dispensatory: A Medicine-Making Guide. North Atlantic Books; 2016.
2. Ganora L. Herbal Constituents : Foundations of Phytochemistry : A Holistic Approach for Students and Practitioners of Botanical Medicine. Herbalchem Press; 2021.

Since ancient times, this resin has been valued for its medicinal properties, with the Sumerians using it for the treatment of tooth infection and intestinal worms as far back as 1100 BC (2). In the bible it is famously mentioned as one of the three gifts the wise men brought to the birth of Jesus.

In ancient Egypt, it was used as an ingredient in embalming fluid, in the Middle East its use included the treatment of wounds and to fight infections, and in Ayurvedic medicine, myrrh has long been used to treat problems such as gingivitis, mouth ulcers, and pharyngitis (3). Today, it is still commonly used as an analgesic, antiseptic, astringent, anthelmintic, carminative, emmenagogue, and as an expectorant (2).

Further to its value as medicine, myrhh has a long history of use as an incense and perfume. The world’s oldest perfume factory, dating back over 4,000 years to 1850 BCE, was discovered in Pyrgos-Mavroraki, Cyprus, by Italian archaeologists in 2003–2004. This massive Bronze Age industrial site featured dozens of stills, mixing bowls, and funnel bottles. Scents were created using various ingredients, including lavender, rosemary, pine, coriander, and myrrh. 

Today myrrh can be commonly found in incense, cosmetic products, perfumes, mouthwashes and toothpastes, soaps and shampoos, aromatherapy products and as a flavouring agent in beverages, candy, baked goods, chewing gum, gelatins, frozen desserts, puddings, soft drinks, and meat products all over the world (4). This shows that while perhaps myrrh is not seen in the same way as it was thousands of years ago, it is still a highly valued commodity. 

There are over 200 different species of myrrh, though Commiphora myrrha is the most commonly used species worldwide. Guggul (Commiphora wightii) is the more commonly used species of myrrh in the Ayurvedic tradition.

And Opoponax (Commiphora guidotti) is very commonly used in the perfume industry, and has a much sweeter aroma than C. myrrha. Balm of Gilead (Commiphora gileadensis) is, just like myrrh mentioned in the Bible, and has a history of use in Christian, Jewish and Muslim traditions where it was used as a medicine.

Most of the myrrh (C. myrrha) used today comes from the regions of Somalia and Ethiopia, with about 90% percent of the world’s myrrh supply coming from Somali trees (1).

Similar to frankincense, myrrh used to be harvested by semi-normadic pastoralist clans, who followed traditional rules around the harvest process, which would allow the continued co-existence with these trees. However, instability in recent Somali history, has increased levels of poverty, corruption and war, creating circumstances  in which unsustainable harvesting practices arise more readily and the continuity of traditional ecological knowledge is threatened (1).

Additionally, dryland areas in Kenya, Ethiopia and Somalia are experiencing increased overgrazing from livestock, leading to increased damage and subsequent deforestation in those areas. Overgrazing, harvest of firewood, deforestation, forest fires and climate change are currently the biggest threats to those ecosystems, advancing the process of desertification (5). 

In 2018, a gold rush emerged in parts of Somalia, leading to the uprooting of centuries-old trees in the search of gold. Some of the people digging had previously been part of semi-nomadic pastoralist communities, but because of ever-changing climate conditions, decided to give up their peripatetic lifestyles. Now, many live settled in the mountains, wishing they could return to their nomadic lives. The gold rush also brought more violence to the region, increasing instability, as competition over access to newly discovered resources intensified(6). 

Yet, some nearby communities still exist in close harmony with these trees, maintaining systems of stewardship in which knowledge of sustainable harvest practices is passed down through generations (6). Usually these people live in remote areas, and are not well connected to other villages or the outside world. As such, the resin is sold on to middlemen who hold a lot of power in terms of the price for the resin. All of which, gives little power and resource to wild harvesters themselves. Tappers and graders tend to see a fraction of the price on the market, with $10 /kg.

Approximately 30% of the price margin goes to the people tapping, the other approximately 70% to the urban merchants, selling on the resin (7). Additionally, it is estimated that 60% of the myrrh sold goes through illegal channels (7). The often opaque and complex nature of global supply chains, combined with the remote locations where myrrh trees grow and the resin harvested, makes transparency very difficult to achieve.

Myrrh resin, as well as other tree resins and gums, also represents an increasingly important source of income for these local communities, supporting livelihood diversification and risk management strategies (7). In response to these challenges, several companies and organisations that have committed themselves to more equitable practices and have obtained FairWild certification for their myrrh resins. 

FairWild is a certification body, which combines social and ecological factors and specialises in certifying wild-harvested products — a market with very difficult parameters, as every plant and every ecosystem brings its own requirements, which need to be taken into account when assessing the sustainability of its trade. One company that has gained the FairWild certification for their resins is IHSAN Resins Society Limited.

Made up of farmers, farm laborers unions and local traders of gums and resins harvested from the Horn of Africa region, this society brings together farmers and local traders, and reduces the negative impacts that middlemen often have. It is a supplier of a variety of types and grades of resins — including frankincense, myrrh, opoponax and gum arabic — and has been FairWild certified since 2023 (8,9).

Several other companies, such as Nagaad Resins and Gums, Kobac General Trading and other myrrh traders are also FairWild certified and supply these resins from these regions (7). As is often the case, when an opportunity is created for the people involved in the growing and harvesting of medicinal plants are able to organise and communicate with one another about their needs and challenges, they are better positioned to secure fairer compensation for their labour. This in turn creates more spaciousness to discuss, refine and implement sustainable harvest practices. 

Myrrh, as well as frankincense, grows in climates that are very challenging to life. Not just for the trees, but also for the people living alongside them, facing hot climates, droughts, and little fertile soil for permanent agriculture. Despite this, people and trees have lived alongside each other in these areas for thousands of years, and the tree resin, perhaps one of the most ancient things to be traded across continents, remains an important resource to humans all over the world. 

Now is a crucial time to pay attention to the trade of myrrh and the conditions that make it possible for us to use it whilst living so far away from the source of this resin. Currently, C. myrrha is not officially classified as globally endangered nor threatened (10). However, it is facing challenges in multiple, interconnected ways.

The harsh environments in which it grows are amongst the least able to buffer the impact of climate change and are already experiencing increased levels of drought. In regions where water is already so sparse, shifts in rainfall can determine whether ecosystems persist or not. These environmental pressures also contribute to broader socio-political instability, such as the change in land use. 

While the social sustainability of myrrh production remains uncertain on a larger scale, local community projects, particularly those working together with certification schemes such as FairWild, offer promise. These approaches can both sustain the ecological resource while also offering fairer pay and improved living conditions for those involved in the stewardship of the trees and the harvest of the resin. 

At a time of such global interconnectedness, supporting local communities who are maintaining sustainable relationships with these species is important now more than ever, not only for their livelihoods but for the continued availability of this incredibly valued natural resource. 

1. Small E. Frankincense and myrrh — imperilled divine symbols of religion’s duty to conserve biodiversity. Biodiversity. 2017;18(4):219-234. https://doi.org/10.1080/14888386.2017.1370390
2. Batiha GE, Wasef L, Teibo JO, et al. Commiphora myrrh: a phytochemical and pharmacological update. Naunyn Schmiedebergs Arch Pharmacol. 2023;396(3):405-420. https://doi.org/10.1007/s00210-022-02325-0
3. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. American Botanical Council; 2000.
4. Engels G, Brinckmann J. Myrrh Commiphora myrrha family: Burseraceae. HerbalGram. 2012;(93):1-4.
5. Hassan BA, Glover EK, Luukkanen O, et al. The role of Boswellia and Commiphora species in rural livelihood security and climate change adaptation in the Horn of Africa: case study of north-eastern Kenya. Int J Soc For. 2011;4:86-112.
6. Harper M. The Somali gold rush endangering frankincense and myrrh. BBC News. January 2023. https://www.bbc.com/news/world-africa-64162379
7. Gizaw AW, Pretzsch J, Kassa H, Teketay D. Socio-ecological significance of collection and marketing of ancient forest commodities: the case of myrrh and opoponax in the dryland areas of southeastern Ethiopia. Paper presented at: Tropentag; September 17-19, 2014; Prague, Czech Republic.
8. FairWild Foundation. Myrrh. Accessed April 15, 2026. https://www.fairwild.org/ingredients/myrrh
9. Ihsan Resins Society. About. Accessed April 15, 2026. https://www.irsociety.ltd/about/
10. Royal Botanic Gardens Kew. Commiphora myrrha (T.Nees) Engl. Plants of the World Online. First published in A.L.P.P. de Candolle & A.C.P. de Candolle, Monogr. Phan. 4: 10 (1883). Accessed February 28, 2026. https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:127741-1

North and South Sudan combined cover a vast area on the continent of Africa. Together, both countries sit on diverse land covered with over 3137 flowering plants recorded (2). Influenced by Islamic and Arabic cultures, especially in North Sudan, 90% of both North and South Sudan rely heavily on herbal medicines as their primary healthcare.

The majority of North and South Sudanese populations are reported to use medicinal plants most commonly for cough and colds, joint pains and gastrointestinal discomforts (3). About 48 medicinal plant species used in this region are in the Fabaceae family most are applied for their antibacterial, antifungal, antimalaria, antimutagenic, antioxidant, immunomodulant, and anti-inflammatory properties (2). 

Neem (Azadirachta indica) 

Commonly known as shajarat al-neem in the North Sudanese vernacular, or margosa tree, belongs to the Melilaceae family and is well-known for its bioactive antiparasitic, antibacterial, antimalarial, anti-inflammatory, neuroprotective, antinociceptive and acaricidal properties. 

Plant preparation of neem: Commonly seeds, roots, and leaves of A. indica are prepared in remedies. Roots and leaves are decocted as an anti-venom for snake bites and scorpion bites as well as for gastrointestinal spasms. The leaves are infused to address malaria, fever, jaundice, and helminthiasis. Powdered leaves are often used topically for skin blemishes and orally to increase appetite (2). 

Hibiscus (Hibiscus sabdariffa)

Also known as karkadeh or angara, in the vernacular hibiscus is classified in the Malvaceae family mostly found in South Sudan, also known as roselle in English. The plant possesses antioxidants, antispasmodic, and antimicrobial properties.

Plant preparation of hibiscus: H. sabdariffa sepals are predominantly steeped in long hot and cold infusions for uterine relaxation, hypertension, fevers, colds and flu, as well as a synergist herb in antimalaria formulations (1,2)^. Seeds are commonly found in about 60% of oils used for skin and hair products.

In Botswana, South Africa, Namibia and Zimbabwe the use of plant medicine is very popular in urban areas. About 72% of black South Africans use medicinal plants as their healthcare modality (4). Most South Africans seek to use traditional African medicine for physical and spiritual health reasons. There is strong belief in the healing methods of traditional African medicine within this region; not only does it provide primary healthcare but spiritual protection for the community at large.

Devil’s claw (Harpagophytum procumbens)

Common plant used across Southern Africa. Popularly known in Materia Medica as devil’s claw, in Setswana, knowledge keepers call it sengaparile. H. procumbens belongs to the Pedaliaceae family. 

Plant preparation of devil’s claw: Leaves, tubers, and fruit parts of H. procumbens are used; the tuber is the most popular form of preparation, however caution as the need for harvesting protection and plant medicinal quality is essential to note. It takes about four years for the tuber to mature and grow into the potent medicine sought (5).

Often, tubers are harvested before full maturity. H. procumbens is listed under CITES Appendix II, meaning the international trade of the plant is monitored and regulated owing to threats that it faces from overharvesting and loss of habitat (6). National legislation is also in place, requiring permits for harvest and export (7).

The fruit is hung outside the door of houses and used for spiritual protection. While the intact tuber is a well-known analgesic for back pain, headaches, and joint aches, the crushed powder is prepared for the treatment of skin cancer, or as a vulnerary, for toothaches and even prepared as a tincture to be used as a tonic. The leaves are often powdered for stomach ailments (5).

Cancer bush (Sutherlandia frutescens)

Known as unwele in isiZulu and isiXhosa, the common name, cancer bush, hints at its reputation in the treatment of cancer within indigenous communities (8). Known for its immunomodulatory, antioxidant, anti-inflammatory, antidiabetic, neuroprotective, and antimicrobial activities, it is predominantly used in indigenous communities as an antidepressant. Zulu warriors drank it after wars, and grieving widows still drink it today during mourning (8). 

Plant preparation of cancer bush: Aerial parts of S. frutescens are frequently used, including stems, leaves, flowers, and pods. However, roots and leaves are more commonly combined to make infusions and decoctions. Decoctions of leaves are mostly applied as a skin remedy or eye wash. Clinical research shows that leave infusions have been shown to inhibit HIV-1 reverse transcriptase enzyme (8,9).

S. frutescens is an anti-inflammatory, immunomodulant and appetite stimulant, actively recommended to support diseases such as HIV and cancer as well as opportunistic infections. Used in medicinal teas for fevers, stems and leaves infusions are prepared for cancer, HIV, diabetes, kidney and liver diseases, rheumatism and stomach conditions. It is also applied as a tonic to release stress, as a depurative to detox blood and heal wounds. Topically, the herb is applied for the treatment of haemorrhoids, urinary tract infections, and gonorrhea (9).

Kenya, Ethiopia and Tanzania have preserved popular practices in traditional African medicine where ancestral ways of prayer, divination and strong relationship with land translate into the practice of traditional African medicine therapy. Kenya alone has over 7000 identified species of medicinal plants to boast (10).

In Western Kenya, a community within the Cherangani Hills, of the Pokot nation, apply the use of medicinal plants mostly from the Asteraceae family. Root parts and decoction methods are the most dominant forms of preparation (10).

Bush plum (Carissa spinarum)

Colloquially known as Lokotetwo by the Pokot of Kenya and Mugariga in Swahili of Northern Tanzania. Part of the Apocynaceae family, the plant is used in both regions for several ailments. It is known to have anthelmintic, anti-inflammatory, anti-arthritic, anticonvulsant, hepatoprotective, antidiabetic, antimicrobial, antioxidant, antimutagenic, and antiquorum activities (11). 

Plant preparation of bush plum: In Ethiopia C. spinarum is used as a repellent of the evil eye known as buda an Amharic word. The root is fumigated and at times mixed with water, inhaled or drank to rid of the spiritual entities. It is also worn as a talisman around the neck for further protection (11).

Amongst the Pokot, the root is an important remedy used to heal several ailments. It is decocted for malaria, chest pains, epilepsy, diarrhoea, breast cancer, arthritis, gonorrhea, coughs and infertility in men. The leaves are burned as a mosquito repellent, infused and drank as an antivenom for snake bites, eye cataracts, gastric cancers, sickle cell anemia, diabetes as well as asthma (11,12).

East African greenheart (Warburgia spp.) is a popular East African plant. In some Kenyan and even Tanzanian vernacular it is called msokonoi derived from the Maa language Osokonoi. Belonging to the Canallaceae family and commonly known as East African greenheart or pepper bark tree, the medicine of this plant is an important anti-inflammatory, antimalarial, antimicrobial, antioxidant, diuretic, and cytotoxic.

Plant preparation: The bark of Warburgia is the most used part for oral or topical preparations. Often combined with other herbs, it is powdered as a snuff for headache relief, smoked to relieve coughs, prepared to make an anti-inflammatory ointment for sexually transmitted infections and urinogenital inflammation (13).

The bark can also be chewed to make ointments or pastes and used as an anal suppository or swallowed as juice. Used for gastrointestinal issues and post-partum discharge, it is an excellent vulnerary component when the bark is prepared as a decoction (14,15).  Other parts used include roots, leaves, and stalks, which are decocted or infused. 

Warburgia ugandensis faces serious sustainability pressures across East Africa, driven primarily by the over-harvesting of its stem bark, compounded by timber extraction. The species is listed as Vulnerable on the IUCN Red List of Threatened Species (16). Listed under a CITES Appendix, an export permit is required for any international trade in parts of the tree (17). Cultivation and sustainable harvesting practices of this plant are needed to secure its future.  

In Kebbi, Kwara and Sokoto states of Nigeria 131 plants were researched for viral diseases (18). The majority of West Africans including Nigerians, Ghanaians and Senegalese seek herbal remedies for spiritual and physical health. For healthcare, traditional African medicine is predominantly sought for viral infections, malaria, fevers, hypertension, cancer, blood sugar regulation and sickle cell anemia (19).

Roots, bark, leaf, seeds, and fruit are commonly prepared for viral diseases in this region, in the form of decoctions, concoctions, infusions, and ointments for topical use. 

African oil palm (Elaeis guineensis)

Known as igi ope in Yoruba, this plant belongs to the Arecaceae family and is an extremely important plant within the cultural context of the Yoruba people and their cosmologies. It is viewed as a spiritual ally and was once the currency of Yoruba trading nations. A symbol of life and prosperity, the seeds, leaves, oils and roots of igi ope will be found symbiotic in Yoruba festivals and ceremonies today. 

Plant preparation of African oil palm: Roots consist of analgesic properties. Decocted roots of E. guineensis are commonly used for hepatitis, meningitis, Lassa fever, yellow fever, and poliomyelitis (19). Palm hearts are used in the treatment of gonorrhea, menorrhagia, perinatal abdominal pain, as a laxative, diuretic, and antiemetic. The oil is often added to black soap blends, for skin and spiritual health, such as Dudu Osun soap. Its oil is a main ingredient in herbal ointments to apply in the treatment of leg swellings such as the parasitic infestation of Filaria (18,19).

Moringa (Moringa oleifera) 

Moringa has become a very popular plant worldwide, marketed as a global super food. In many Nigerian states M. oleifera is one of the most ubiquitous herbs used in traditional African medicine.  Known as ewe igbale in Yoruba, it is drumstick tree or tree of life in the Materia Medica. A panacea plant, M. oleifera can be used as a general support for almost any illness. It possesses antioxidant, anticarcinogenic, anti-inflammatory, antispasmodic, diuretic, antiulcer, antibacterial, antifungal, vulnerary, and antinociceptive active properties.

Plant preparation of moringa: Applied for its use for yellow fever; leaves are decocted to prepare a strong tea. Additionally, as an important nutraceutical and medicinal plant, even for children, it is added to food and decocted in teas for fever, ear infections, diabetes mellitus, managing sickle cell anemia, and hypertension (20,21). While the leaf is commonly used, seeds, roots, and flowers are also prepared. The root bark demonstrates analgesic, alexiteric, anthelminthic, properties often recommended for heart complaints, eye diseases, inflammation, and dyspepsia. With increasing prevalence of diabetes mellitus this plant is well sought out in Nigeria (21). 

Mental illness in Goma city, Congo is prolific amid displacement and war today. In a recent study approximately 63% of the population reported to be affected by anxiety, 37% psychosis, and 30% depression (12). Many people rely on and trust deeply in knowledge keepers of traditional African medicine, especially at a time like this. Thirty plant species have been identified to support people with mental health which is statistically rising due to political conflict (12).

Most plants used in Goma for mental health belong to the Asteraceae, Lamiaceae, and Solanaceae families. Research points out that Asteraceae plants contain a plethora of psychopharmacological constituents and, Lamiaceae and Solanaceae tend to have neurotrophic, anxiolytic and antidepressant properties (12). 

Tassel flower (Emilia coccinea)

Often used in formulations for depression, tassel flower belongs to the Asteraceae family and is locally known in Lingala as bitekuteo flower. Studies show its beneficial properties as anti-inflammatory, antioxidant, and antimicrobial.

Plant preparation of tassel flower: E. coccinea aerial infusions are used for fever and convulsions, and demonstrate insulin sensitive properties in clinical studies (22). Additionally, it is used as a neuroprotective for cognitive and mental health disorders (12). Cognitive health due to its anti-cholinergic activities, would be the reasons for its success in traditional African medicine use for mental health in Goma, Congo (23). It contains pyrrolidine alkaloids and as a result should be used with care.

Desert candle (Euphorbia abyssinica)

Plants from other plant families are well used for mental illnesses in Goma, such as Euphorbia abyssinica which is an example from the Euphorbiaceae family.  Often used for anxiety; its Swahili name is mtungutungii and its common name candelabra or desert candle.

Plant preparation of desert candle: Latex found in the roots of E. abyssinica is used as an antimicrobial as well as anti-malarial. A traditional recipe including a butter base oil is blended with the latex of the roots and applied against Plasmodium berghei, and various other skin infections (24). Decocted stems and roots are also used to treat anxiety, colic in children, and treat venereal diseases as well as gastrointestinal disturbances (12).

Traditional African medicine encompasses so many plants, cultures, preparations, and practices to discuss. What remains true across the continent of Africa is that accessibility, cultural relevance, trust, and ancestral relationship to traditional African medicineare the backbone of its success.

The assessment process of illness of the physical and spiritual are not so different — the intersection between these realms is where the practitioner meets the patient to employ herbal remedies, divine, and heal (25). Traditional African medicine could benefit from modern research to support education initiatives and policies that promote ethical harvesting practices and mitigate sustainability and adulteration risks, which are increasingly common in urbanised Africa.

This article offers a sample exploration of traditional African medicine as a prominent practice across the continent of Africa, and explores how diverse traditional African medicine preparation methods of plant medicines meet the healthcare needs of communities. Across Africa, plant medicine as an integrative and integral means of healthcare requires protection and preservation of land, wild herb populations and indigenous knowledge for a sustainable future for herbalism that can support the health of generations to come.

1. Karar MGE, Kuhnert N. Herbal Drugs from Sudan: Traditional Uses and Phytoconstituents. Pharmacogn Rev. 2017;11(22):83-103. doi:10.4103/phrev.phrev_15_15
2. Khalid H, Abdalla WE, Abdelgadir H, Opatz T, Efferth T. Gems from traditional north-African medicine: medicinal and aromatic plants from Sudan. Nat Prod Bioprospect. 2012;2(3):92-103. Published 2012 Apr 17. https://doi.org/10.1007/s13659-012-0015-2 
3. Mohamed R, Mohamed R, Dafalla R, Ahmed A, Abdeldaim A. The prevalence of herbal medicine among Sudanese adults: a cross-sectional study 2021. BMC Complement Med Ther. 2024;24(1):308. Published 2024 Aug 14. https://doi.org/10.1186/s12906-024-04584-1 
4. Dlamini NS, Darong GG, Nkwanyana NM. South African women’s use of African traditional medicine during pregnancy: A scoping review. Afr J Reprod Health. 2023;27(11):91-98. https://doi.org/10.29063/ajrh2023/v27i11.10 
5. Ncube SF, Ndagurwa HGT, Mundy PJ, Sibanda S, Dlodlo M. Ethnobotanical knowledge and use-value of Harpagophytum (Devil’s claw) in Matabeleland, Zimbabwe. South African Journal of Botany. 2022;144:134-144. https://doi.org/10.1016/j.sajb.2021.08.015
6. Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). Proposal for Amendment of Appendices I and II: Inclusion of Harpagophytum procumbens in Appendix II (Prop. 11.60). Geneva: CITES Secretariat; 2000. Available at: https://cites.org/sites/default/files/eng/cop/11/prop/60.pdf
7. Strohbach M, Cole D. Population Dynamics and Sustainable Harvesting of the Medicinal Plant Harpagophytum procumbens in Namibia. Results of the R+D Project 800 86 005. BfN-Skripten 203. Bonn: Bundesamt für Naturschutz (BfN); 2007.
8. Aboyade OM, Styger G, Gibson D, Hughes G. Sutherlandia frutescens: The Meeting of Science and Traditional Knowledge. Journal of Alternative and Complementary Medicine. 2014;20(2):71-76. https://doi.org/10.1089/acm.2012.0343
9. Ndjoubi KO, Sharma R, Hussein AA. Phytochemistry, Ethnopharmacology, and Pharmacology of . PubMed. 2025;14(14). https://doi.org/10.3390/plants14142086
10. Mbuni YM, Wang S, Mwangi BN, Mbari NJ, Musili PM, Walter NO, Hu G, Zhou Y, Wang Q. Medicinal Plants and Their Traditional Uses in Local Communities around Cherangani Hills, Western Kenya. Plants. 2020; 9(3):331. https://doi.org/10.3390/plants9030331 
11. Smyth C, Sheridan H. Carissa spinarumL.: A Case Study in Ethnobotany and Bioprospecting Research. IntechOpen eBooks. Published online July 12, 2022. https://doi.org/10.5772/intechopen.104665
12. Sharma N, Kumar V, Gupta N, Shekhar P, Kaur PS. Traditional Importance, Phytochemistry, Pharmacology, and Toxicological Attributes of the Promising Medicinal Herb Carissa spinarum L. Separations. 2023;10(3):158. https://doi.org/10.3390/separations10030158 
13. Maroyi A. The genus Warburgia: A review of its traditional uses and pharmacology. Pharmaceutical Biology. 2013;52(3):378-391. https://doi.org/10.3109/13880209.2013.837935
14. Abdelfattah MAO, Dmirieh M, Ben Bakrim W, et al. Antioxidant and anti-aging effects of Warburgia salutaris bark aqueous extract: Evidences from in silico, in vitro and in vivo studies. Journal of Ethnopharmacology. 2022;292:115187. https://doi.org/10.1016/j.jep.2022.115187
15. Mollel LK, Munishi LK, Giliba RA. Assessing the Ethnobotanical Uses, Harvesting Practices, and Conservation Awareness of Warburgia ugandensis in Northern Tanzania. Open Journal of Ecology. 2024;14(12):924-937. https://doi.org/10.4236/oje.2024.1412054
16. International Union for Conservation of Nature. Warburgia ugandensis subsp. longifolia. The IUCN Red List of Threatened Species. Published 2024. Accessed April 10, 2026. https://www.iucnredlist.org
17. Convention on International Trade in Endangered Species of Wild Fauna and Flora. Appendices I, II and III. Published 2024. Accessed April 10, 2026. https://cites.org/eng/app/appendices.php 
18. Abubakar IB, Kankara SS, Malami I, et al. Traditional medicinal plants used for treating emerging and re-emerging viral diseases in northern Nigeria. European Journal of Integrative Medicine. 2022;49:102094. https://doi.org/10.1016/j.eujim.2021.102094
19. Oreagba IA, Oshikoya KA, Amachree M. Herbal medicine use among urban residents in Lagos, Nigeria. BMC Complementary and Alternative Medicine. 2011;11(1). https://doi.org/10.1186/1472-6882-11-117 
20. Adejumo OE, Kolapo AL, Folarin AO. Moringa oleifera Lam. (Moringaceae) grown in Nigeria: In vitro antisickling activity on deoxygenated erythrocyte cells. Journal of Pharmacy & Bioallied Sciences. 2012;4(2):118-122. https://doi.org/10.4103/0975-7406.94812
21. Pareek A, Pant M, Gupta MM, et al. Moringa oleifera: An Updated Comprehensive Review of Its Pharmacological Activities, Ethnomedicinal, Phytopharmaceutical Formulation, Clinical, Phytochemical, and Toxicological Aspects. International Journal of Molecular Sciences. 2023;24(3):2098. https://doi.org/10.3390/ijms24032098 
22. Poualeu Kamani S, Kamgaing Waguia J, Miaffo D, et al. Efficacy of Emilia coccinea aqueous extract on inhibition of α-amylase enzyme activity and insulin resistance in dexamethasone treated-rats. Metabolism Open. 2022;15:100193. https://doi.org/10.1016/j.metop.2022.100193 
23. Foyet HS, Abaïssou HH, Wado E, Acha EA, Alin C. Emilia coccinae (SIMS) G Extract improves memory impairment, cholinergic dysfunction, and oxidative stress damage in scopolamine-treated rats. BMC Complement Altern Med. 2015;15:333. Published 2015 Sep 23. https://doi.org/10.1186/s12906-015-0864-4 
24. Muluye AB, Desta AG, Abate SK, Dano GT. Anti-malarial activity of the root extract of Euphorbia abyssinica (Euphorbiaceae) against Plasmodium berghei infection in mice. Malar J. 2019;18(1):261. Published 2019 Jul 30. https://doi.org/10.1186/s12936-019-2887-7 
25. Ozioma EOJ, Nwamaka Chinwe OA. Herbal Medicines in African Traditional Medicine. IntechOpen; 2019. https://www.intechopen.com/chapters/64851

At its core, AI today is merely a powerful tool for augmentation. It is most definitely not intelligent in the true sense of the word unlike many erroneous assumptions. While it is incredible at performing certain tasks, it can fool people into believing it is something that it is not, and this is because they do not understand its foundation and nature.

“At its core, AI today is merely a powerful tool for augmentation.”

The most advanced models still fail miserably in aspects such as nuance, authentic lived experience and human intuition because they do not have the intelligence, context and the organs or senses of perception that we have. As of March 2026, it is apparent that AI as we know it is reaching its technological and developmental limits as discussed further below. 

AI has no conscience, no morality, and no clinical discernment. It is a tool like a hammer and not a living thing. One does not use a hammer to tend to a delicate seedling, just as one should not use a sophisticated predictive text engine to understand and improve the complex health issues of a patient.

However, the undeniable fact is that an individual actively resisting or dismissing their engagement with AI while still using the internet is akin to declaring they are not engaging with the automobile industry because they don’t drive, yet they still participate in society. The food they buy, the mail they receive, the fuel that heats their home and any public or personal transport they use all rely on the deeply ingrained petrochemical infrastructure. Likewise, AI is already systematically integrated into the internet, and increasingly into the workflows of businesses. This includes search engines, mailboxes, website hosts, autocorrection and many other services. It is unavoidable.

On the opposite spectrum, overreliance or uninformed use of this new technology can be dangerous, perhaps even more so than its dismissal. Just as driving a car requires training, a licence, and an understanding of the rules of the road to navigate safely, successfully utilising AI in a clinical setting requires some level of AI knowledge and understanding.

This is why the EU has already implemented the EU AI ACT 2024, enforced since February 2025 in European countries which includes mandatory AI literacy for professionals using AI. This particularly affects healthcare, where any AI system used for health-related activities or assessment is considered “High Risk”. This deeply implicates herbalists and other CAM practitioners operating in Ireland or within the EU (1). 

In addition, with patients increasingly turning to “Dr. AI” for quick fixes and diagnosing themselves, practitioners can no longer afford to sit on the sidelines and ignore the pathologies and dangers that come from AI misuse, in particular for mental health or flawed health advice. Practitioners that strive to understand or learn to “drive” these complex models effectively, or at least have the “theory”, cannot only streamline their clinics, but to more importantly protect their patients and professional integrity.

In the EU, AI literacy is no longer an option in healthcare, it is a requirement by law and the UK may follow suit soon with the introduction of the UK AI Bill due to be implemented by 2027.

Both the Medical Council (Ireland) and the GMC (UK) are actively addressing AI use for health and within clinical settings. They insist that AI should augment, not replace clinical judgment and that ultimately the practitioner is responsible for the use of any AI advice (2,3). With regulated health sectors complying, it is vitally important for the self-regulated sectors to follow suit in order to show their ability to self regulate.

We must first dispel a common myth: large language models (LLMs) like ChatGPT, Claude, and Gemini are commonly referred to as AI, AI chatbots, GPAI (general purpose AI) or narrow AI and are not “true AI” otherwise known as artificial general intelligence (AGI). They are, essentially, no more than highly sophisticated multimodal predictive text engines. In other words, an LLM is trained on vast amounts of data from the internet and literature to predict the most statistically likely next word in a sequence, note in a song, pixel in an image and frame in a video.

When it is asked a question, it is not looking up the answer in a database, it is calculating what words usually follow the words in the prompt and what is the most agreeable way of doing so. While an incredible asset for specific tasks, the misunderstanding of this fundamental mechanic underlies the most significant clinical dangers practitioners face today.

In fact, a recent study, along with a mounting body of evidence, suggests that LLMs as they are now, including the most advanced models as of the beginning of 2026, are mathematically reaching their limits and that it is unlikely that AI will significantly develop intelligence this year or any time soon.

No matter how much information is being fed into the AI models, no matter how large the data centre hosting them is, the architecture they are built on will not address the underlying pathologies and errors nor improve their ability to predict or understand context. They are not becoming sentient nor are they near to achieving human intelligence or judgment without a major technological breakthrough and a complete restructuring of their digital synapses (4).

The human analogy

Another way of putting it is to use an analogy of the human brain. The architecture of an LLM can be understood as a disconnected prefrontal cortex functioning without the cerebellum, limbic system and broader nervous system that belong to a whole aware being.

This isolated part of the brain, whose role is to govern executive functions, is structurally incapable of developing into a fully cognitive intelligence. Without the functional equivalents of the cerebellum and limbic system, these models will remain “narrow” and disconnected from full cognitive potential, regardless of the volume of data or computational power fed into them. This illustrates the fundamental limitation we have reached with current LLMs, thus the synonym: narrow AI.

Because AI models are designed to generate plausible sounding text rather than to verify truth, they exhibit specific “pathologies” that can be highly dangerous in a healthcare setting. While companies behind AI models are attempting to mitigate these fundamental flaws, they cannot entirely be eradicated. In fact, improving on how an LLM responds may simply make it more difficult for the person reviewing its output to spot the pathologies, yet these errors persist even on the most advanced models.

Hallucinations (the confident liar)

LLM models are notorious for hallucinating, inventing facts, fabricating botanical actions and contraindications, or generating entirely fake peer reviewed references (5). Because the output is designed to sound authoritative, confident and is grammatically perfect, it is incredibly easy to be fooled. If an LLM is asked to cite a paper on the efficacy of Hypericum perforatum for a specific niche condition, it may simply invent a title, authors, and a DOI link that lead to nowhere. Relying on AI for patient care or professional writing without thoroughly reviewing the output is a direct threat to clinical safety. AI responses cannot be accepted at face value.

Sycophancy (the yes man)

AI models are generally programmed to be helpful, polite, and to please the user. In fact, those who have used the popular model, ChatGPT, will have encountered a prompt for them to “choose the best answer”, which further influences how the model responds. This creates a dangerous phenomenon called sycophancy, where the AI will actively agree with the user’s biases or leading questions which is especially dangerous in a medical setting (6).

If a patient or practitioner inputs a deeply flawed premise, for example, “Tell me why taking high doses of essential oils internally is the best way to cure gut issues”, the AI may validate that dangerous premise and build an argument to support it, rather than offering objective clinical pushback. The chances for sycophancy become more apparent the longer the “conversation” (or context in AI terms), which can often make it more difficult to spot, despite the safety measures AI companies are putting in place. In other words, AI can bypass the safety guards if the context “makes sense” for it to do so.

Regurgitation and model collapse

It is vital to understand what these models are trained on. A significant percentage of the training data for major LLMs comes from Wikipedia, Reddit, Quora, and YouTube transcripts. When patients or practitioners ask general AI models for herbal advice, they are often receiving a regurgitation of internet websites and forums, many of which may have mis- or disinformation. More disturbingly, the popular ChatGPT referenced 47.5% Wikipedia in its responses during a study, which in turn is now being used to write Wikipedia articles in a disturbing positive feedback loop (7,8). 

Furthermore, as AI generates a larger share of online content, newer models are increasingly trained on this ‘AI slop’, which is low-quality synthetic data. This feedback loop leads to the homogenisation of information and a significant loss in performance and accuracy. Over time, this can trigger ‘model collapse’,’ a state where the model’s output becomes a distorted caricature of reality, forcing developers to perform massive, costly resets using strictly curated, human-generated datasets (9). 

“AI psychosis” and mental health risks

A deeply concerning emerging theme in psychiatric literature is AI psychosis or Chatbot psychosis. Some argue that it’s not a new phenomenon as other mediums (books, radio or television) have also caused psychosis in individuals during their emergence (10). Others suggest that there is a growing concern that these convincing AI bots may reinforce cognitive instability, blur reality boundaries and disrupt self-regulation due to their close resemblance to human speech (11). 

In any case, practitioner awareness of the potential convincing delusions of AI chatbots can protect their patients from harm. Notably by educating them on what LLMs are, what they are not and how their predictive algorithms are designed by nature to be great at confidently convincing and affirming our prompts.

Fake AI literature: AI written herbals

It has also become apparent that AI is being used to author misleading and dangerous herbal literature. There was a letter from David Winston circulating in January 2026 warning that “82% of new herb books listed on Amazon for the year 2025 are AI generated”. Rosemary Gladstar had received an email from British publisher Oliver Rathbone indicating this finding (12,13).

More alarming yet, notable herbalist authors such as Simon Mills have already been prey to fake AI herbals attributed to, or using, their names. These fake AI books are using genuine names to increase authority, making it even more dangerous for both herbalists and public scouring the internet for authentic books. While most publishers will remove such books upon request, the danger is the fact that they get published in the first place.

Biases found in general LLMs

The author performs periodic benchmarks to assess the aforementioned flaws as well as biases found in the responses of the major LLMs. While many of them have improved in their logic, the nuances found in each of their answers is something that isn’t often discussed. The Irish Medical Council itself warns against “hidden biases” in AI systems (2).

This is highly relevant for herbal medicine, where AI models may struggle to interpret the nuances of traditional diagnostics such as functional frameworks and heuristics, or tongue and pulse diagnosis. These models can also exhibit bias toward specific modalities, as demonstrated in the author’s December 2025 AI benchmark.

For example, while ChatGPT and Claude ‘red flagged’ physiomedicalist terms in favour of biomedical terminology, Google’s Gemini and China’s DeepSeek were more respectful of diverse traditions, even elaborating on the legitimacy of these systems for health assessment (14). 

This disparity highlights the need for the herbalist sector to adequately be equipped to educate the public, their patients as well as advocating and funding inclusive tools, which remains a challenge for those working with non-standardised models (e.g., there is little to no availability for naturopathic-specific LLMs trained on unbiased, domain appropriate data).

The era of voluntary guidance regarding digital tools in healthcare is over. The legislative landscape has shifted dramatically over the years and has moved towards strict legal obligation, especially with the rise of AI.

UK GDPR closely mirrors European standards, and the direction of travel is clear — ignorance of digital privacy is no longer a valid legal defence (15).

Health data is special category data and requires special care

This brings us to one of the most critical vulnerabilities for modern practitioners in the UK and EU, especially for those who would call themselves “technophobes” — the use of “free” digital services. If a practitioner is using free email addresses to communicate with their clients, such as “@gmail.com”, “@hotmail.com”, or even “@protonmail.com”, they most likely do not have a Data Processing Agreement (DPA) in place as required by law. The same applies to free versions of AI tools. Even some premium services may not offer a DPA if they are not specifically designed for business or healthcare use.

Under GDPR Article 28 [and UK-GDPR], a data controller (the practitioner) is strictly required to have a legally binding contract, known as a data processing agreement or addendum (DPA), with all their data processors (web designers, hosts, email providers, AI services, cloud storage, or practice management software). This ensures that personal data is adequately stored, encrypted, and processed on the user’s behalf. Special category data such as health information has even more strict requirements (16,17).

Without valid DPAs, practitioners are strictly liable for privacy violations, not the data processor or service provider. A DPA is a legally binding contract that ensures the tech vendor handles data compliantly and, crucially, guarantees they will not process and sell user data or use it to train AI models. The author has already recommended that professional associations and organisations advise their members that using personal, free email and internet services lacking a DPA represents a severe regulatory and ethical risk. ICO (UK) or the DPC (Ireland) can request a warrant and seize digital assets during an audit such as a personal email inbox if it is implicated in a breach of data.

As data controllers, practitioners are ultimately liable for their clients’ personal data. Whether it is as simple as a contact form on a website, an email from a patient with their name (or worse, blood work results), or a web designer with access to patient user information via an administrative web panel, using a non-compliant internet service means companies can scan and use this data freely. 

Inherently, “free” services are not free. Input user data is given to these companies in exchange for their service. While some companies offer DPAs as part of their terms of service for professional bundles, others require manual activation (e.g., Google Workspace requires a manual signature of their Cloud DPA and HIPAA compliance settings within the Admin Panel). Practitioners are strongly advised to verify they have adequate DPAs with all digital services used to communicate and store patient data.

Note: To confuse the matter, the UK’s primary data protection legislation is the Data Protection Act 2018, which is also abbreviated as “DPA”. While this law works alongside the UK GDPR to enforce the standards discussed in this section, it is a piece of legislation and should not be confused with the Data Processing Agreement (or Addendum) contract required for compliance — i.e. A service advertising that it is “DPA compliant” is the same as saying it is “GDPR compliant” but does not mean that it automatically implements the required legally binding contract.

AI is here to stay, and when used ethically and securely, it can alleviate the administrative burden many practitioners face, speed up workflow as well as be an incredible research assistant. In fact, considering it purely an “assistant” is key to knowing what tools to use and when to use them.

AI can instead be imagined as an intern that is incredible at grammar and can compile existing work or research that has been reviewed and validated, but will still make some mistakes when piecing things together. AI won’t do flawless research, but can compile, adjust, abbreviate or elaborate whatever information it is given. There are brilliant AI tools available that isolate and mitigate some of the deep flaws of AI, making it an incredible tool to boost productivity, research and workflow (allowing for more time to spend outside with the plants). But it requires a certain level of AI literacy, understanding and diligence.

Red light: What to avoid (high risk)

• Diagnostics, formulations and dosages: Use of general AI for final diagnostics without validating the given information with genuine sources, or for any formulation, dosage, or safety profile of a prescription is strongly advised against. The practitioner holds the liability, and basing clinical decisions on AI suggestions has no legal or ethical defence.
• Blind referencing: AI generated script or citation can’t be trusted, so it is always worth clicking the link and reading the primary source — to review, validate and check every piece of information that is given. Some primary sources may be written by AI, so checking the authority of the website is important (e.g. Is the source from Wikipedia, a personal blog or a genuine research paper on an authoritative website?)
• Inputting raw patient data or personal proprietary data: Identifiable patient data is not safe to enter into a public chatbot, nor is any proprietary, unpublished work; not unless the AI service offers a Data Protection Agreement/Addendum. Most “free” services use prompts and data to train AI and some paid services may not have the necessary legal requirements in place.

Warning: As of March 2026, individual paid tiers such as ChatGPT Plus or ChatGPT Pro plans do not offer a Data Processing Agreement (DPA); they are therefore not GDPR compliant for processing patient data. To obtain a DPA from OpenAI, their ChatGPT Team or Enterprise plans must be used, which are costly. Alternatively, business grade services like Gemini for Workspace (by Google) include a DPA that ensures  input data is not used to train their models, making it a viable option for handling identifiable information. Verifying whether a DPA is available, active and signed can be found via specific account settings before uploading sensitive data. Otherwise, the service provider can be contacted by email, if in doubt.

Green light: What to do (low risk, high reward)

• Brainstorming and drafting: AI can be used to overcome writer’s block or aid in structuring a paragraph or section in a document. It is also excellent for drafting general patient handouts, writing newsletter outlines, or structuring an educational talk based on information and resources already acquired.
• Tone adjustments: AI can rewrite a complex, jargon-heavy email or handout into simpler, more compassionate language for a patient, using one’s own input and information.
• Research assistance and grammar review: Appropriate AI tools may be used to review, draft or compile existing information and data sets into an output adapted to desired needs, saving time and effort. This still will require careful review and manual adjustments.

Not all AI tools are created equal. Moving beyond the standard chatbot means utilising specialised tools that circumvent common multilingual and classification failures:

• For research: Instead of asking ChatGPT or any general AIs for medical studies, use tools like Consensus or Elicit. These AI-enhanced search engines only pull data from peer reviewed scientific journals, drastically reducing the risk of hallucinations.
• For private and health data analysis: For AI to analyse clinical notes or summarise complex blood work, there is a “walled garden” tool. These tools are called retrieval augmented generation (RAG) systems where AI assists the user by purely using the user trusted PDFs, literature, sources and documents. NotebookLM Plus, for instance, is an available service that never trains AI models and is also DPA compliant when used as part of “Google Workspace”. The AI will only search, synthesise and reference the documents provided, and it does not use data given by the user to train its foundational models. The DPA compliant version can be used, for example, to assess the blood work of a patient directly without worrying about censoring their identifiable data by inputting trusted books, presentations and literature alongside their results or to assist in structuring or summarising patient notes and individualised handouts. As a contracted data processor, they would be fully liable for a breach of a practitioner’s patient’s data, so long as they have a DPA in place.

There are countless other tools and systems available, and a core component of AI literacy is the discernment of which platforms are suitable for specific tasks. The above section is not intended to be an exhaustive list of rules, nor is it a complete directory of AI tools, but rather a foundational framework for safe clinical practice.

We are currently navigating a profound and complicated transition, comparable to the rise of the internet itself. The goal of AI literacy is not to turn herbalists into software engineers, but to ensure that emerging technologies are used to safeguard patients, their privacy and to preserve the integrity of our profession.

AI is brilliant at parsing massive datasets, organising administrative chaos, and synthesising clear and concise text. But it cannot feel a pulse, read the subtle shifts in a patient’s body language, or understand the complex energetics of a living plant interacting with a living human being.

AI organises information but the practitioner provides it. AI will never replace healthcare professionals. But professionals who understand AI, who know its pitfalls, and who wield it with ethics in mind will inevitably get ahead of those who do not and will be appropriately equipped to safeguard the patients who may overuse the technology.

Future development of AI technologies specifically curated for herbalists is not as far reaching as we might think. The primary roadblock is financial, as basic AI hosting servers can cost from one hundred to several hundred pounds a month. However, if resources are pooled within the herbalist community as a collective, and authors are willing to contribute their books and research to the cause, training and hosting a dedicated herbalist AI model is highly feasible. 

By building AI systems based strictly on authentic medical and herbal literature, the profession could create a secure ecosystem of knowledge untainted by the biases and limitations of conventionally trained general LLMs. While it would not be a flawless approach, it would ultimately be the safest method for integrating AI into herbal medicine and would bypass the requirement to rely on the proprietary “big tech” models currently dominating the market or systems solely orientated towards the biomedical model.

NotebookLM was used to assist in compiling the background research. Gemini for Workspace was utilised to aid the author in structuring the manuscript and refining the grammar. The final document was thoroughly reviewed, manually adjusted, and verified by the author.

1. European Union. (2024). Chapter 1 Article 4 AI literacy. Regulation (EU) 2024/1689 (Artificial Intelligence Act). Official Journal of the European Union, L series. [Accessed 25 January 2026] https://eur-lex.europa.eu/eli/reg/2024/1689/oj/eng#art_4 
2. Medical Council (Ireland). (n.d.). Medical Council (Ireland) Statement on AI. [Accessed 25 January 2026] https://www.medicalcouncil.ie/public-information/artificial-intelligence-in-medicine/medical-council-position-statement-on-artificial-intelligence.html 
3. General Medical Council (GMC). (n.d.). GMC (UK) Research on AI in Medicine. [Accessed 25 January 2026] https://www.gmc-uk.org/professional-standards/learning-materials/artificial-intelligence-and-innovative-technologies 
4. Sikka, V., & Sikka, V. (2025). Hallucination Stations: On Some Basic Limitations of Transformer Based Language Models. ArXiv, abs/2507.07505. https://doi.org/10.48550/arxiv.2507.07505 
5. Rumale Vishwanath, P., Tiwari, S., Naik, T. G., Gupta, S., Thai, D. N., Zhao, W., Kwon, S., Ardulov, V., Tarabishy, K., McCallum, A., & Salloum, W. (2024, June 29). Faithfulness hallucination detection in healthcare AI. OpenReview. [Accessed 22 January 2026] https://openreview.net/forum?id=6eMIzKFOpJ 
6. Chen, S., Gao, M., Sasse, K., & Topaz, M. (2025). When helpfulness backfires: LLMs and the risk of false medical information due to sycophantic behavior. npj Digital Medicine, 8(1), Article 605. [Accessed Sunday 25 January 2026] https://doi.org/10.1038/s41746-025-02008-z 
7. Lafferty, N. (2025, June 5). AI platform citation patterns: How ChatGPT, Google AI Overviews, and Perplexity source information. Try Profound. [Accessed Sunday 25 January 2026] https://www.tryprofound.com/blog/ai-platform-citation-patterns 
8. Tangermann, V. (2025, May 23). Terrifying survey claims ChatGPT has overtaken Wikipedia. Futurism. [Accessed Wednesday 4th March 2026] https://futurism.com/survey-chatgpt-overtaken-wikipedia 
9. Shi, L., Wu, M., Zhang, H., Zhang, Z., Tao, M., & Qu, Q. (2025). A Closer Look at Model Collapse: From a Generalization-to-Memorization Perspective. ArXiv, abs/2509.16499. https://doi.org/10.48550/arXiv.2509.16499 
10. Carlbring, P., & Andersson, G. (2025). Commentary: AI psychosis is not a new threat: Lessons from media induced delusions. Internet Interventions, 42, Article 100882. [Accessed Wednesday 4th March 2026] https://doi.org/10.1016/j.invent.2025.100882 
11. Morrin, H., Nicholls, L., Levin, M., Yiend, J., Iyengar, U., DelGuidice, F., … Pollak, T. (2025, July 11). Delusions by design? How everyday AIs might be fuelling psychosis (and what can be done about it). [Accessed 22 January 2026] https://doi.org/10.31234/osf.io/cmy7n_v5 
12. Tarita, T. (2025, November 4). Amazon’s bestselling herbal guides are overrun by fake authors and AI. ZME Science. https://www.zmescience.com/tech/amazons-bestselling-herbal-guides-are-overrun-by-fake-authors-and-ai/ 
13. National Forum for Herbalists. (2026). I’ve noticed many members asking about regulatory updates for 2026. Here is a summary of what to expect for the [Status update]. Facebook. [Accessed 26 January 2026] https://www.facebook.com/groups/NFHERB/posts/25584812314449057/ 
14. Ó hErodáin, L. (2026) AI in Herbal Medicine: Benchmarking Safety & Clinical Nuance. [Accessed 4 March 2026] https://celticfoxherbal.com/wp-content/uploads/2026/02/AI-Benchmark-results-Dec-2025.pdf 
15. The Medical Defence Union (The MDU). (2024). Introduction to data protection for independent practitioners. [Accessed 25 January 2026] https://www.themdu.com/guidance-and-advice/guides/introduction-to-the-gdpr-for-independent-practitioners 
16. Harper James. (2024, January 30). The controller to processor agreement: A GDPR guide. [Accessed 25 January 2026] https://harperjames.co.uk/article/controller-to-processor-agreement/ 
17. Ambit Compliance. (2024). Is your data processing agreement worth the paper it’s written on? [Accessed Sunday 25 January 2026] https://www.ambitcompliance.ie/blog/is-your-data-processing-agreement-worth-the-paper-its-written-on

One of the most persistent challenges is the overharvesting of herbs from wild populations. Many species, such as goldenseal (Hydrastis canadensis) and various orchids used in traditional medicine, have experienced dramatic population declines due to market pressure, while more common species, such as dandelion root (Taraxacum officinale) and raspberry leaf (Rubus idaeus), have faced recent availability constraints.

To mitigate risks related to supply insecurity, contaminants (pyrrolizidine alkaloids), and limited traceability, many operations in Albania, Poland, and Ukraine have begun supplementing wild-harvested material with sustainably cultivated stock, improving both environmental outcomes and stock availability.

The impact of climate change on herbal crops is ongoing. Fluctuating precipitation patterns, increasing drought frequency, heat stress, and extreme weather events have disrupted growing cycles and reduced yields. Habitat fragmentation has further undermined the ability of wild plant populations to adapt to these stresses. Research on cowslips (Primula elatior) has shown that fragmented habitats impair their evolutionary capacity to tolerate drought, thereby reducing resilience under warming climate conditions (2).

In response, herbal supply chains are increasingly diversifying sourcing regions and, where possible, selecting and breeding varieties better suited to local conditions. One example is the development of new basil (Ocimum basilicum) varieties, bred to maintain both yield and phytochemical richness under water-stress conditions (3).

Additional initiatives include increased investment in solar drying infrastructure and replacing fossil fuels with biomass for hot-air dryers. Herb drying has been shown to be one of the most carbon heavy operations in the supply chain and these measures are helping reduce carbon footprints while improving resilience to energy and climate-related disruptions.

The rural-to-urban migration in the herbal sector leads to the loss of traditional knowledge and reduced labour availability for both cultivation and wild harvesting. This trend places both supply continuity and sustainability at risk. Experienced harvesters who understand when, where, and how to collect plants sustainably are retiring or leaving for urban employment, while younger generations show declining engagement with these practices.

During engagements with rural communities in 2024 and 2025, several key drivers of migration were identified:

1. Income and job security: Unpredictable weather, fluctuating crop prices, and insecure sales channels make herb cultivation and wild collection high-risk and low-reward activities. Seasonal harvesting also leads to inconsistent income, often requiring collectors to supplement earnings with other work.
2. Image and self-respect: Wild herb collection is not always perceived as a successful or prestigious career path.
3. Access barriers: Knowledge of herb cultivation and collection is often transmitted generationally; those without family exposure face steep learning curves.
4. Work–life balance: Cultivation and wild harvesting rarely follow a standard 9-to-5 schedule. Younger generations tend to prioritise flexibility and personal time more than previous generations.
5. Policy and certification complexity: Permits, licensing, and certification requirements can be administratively burdensome, often favouring large, established operations over small entrants and individual harvesters.

Adequate Quality Control is critical in the herbal industry. Contamination with pesticides, heavy metals, pyrrolizidine alkaloids, tropane alkaloids, adulterants, or fillers remains common. Studies indicate that approximately 27% of commercial herbal products contain adulterants or are entirely substituted with incorrect species (4). While not always intentional, such issues may stem from insufficient plant identification knowledge or inadequate Quality Control within the supply chain.

The same study reported particularly high rates of adulteration in Brazil (68%), followed by Taiwan (32%), India (31%), the United States (29%), Malaysia (24%), Japan (23%), South Korea (23%), Thailand (20%), and China (19%) (4). Findings such as these emphasize the importance of robust Quality Control systems and accurate botanical identification.

While traditional macroscopic evaluation, complemented by chromatographic methods form the foundation of botanical identification, molecular techniques, including DNA barcoding, are available and becoming invaluable tools for ensuring authenticity throughout the supply chain.

The Sustainable Herbs Initiative (SHI) emerged as an important platform for coordinated action across the herbal sector. This coalition of producers, brands, scientists, and herbalists is developing best practices for wild harvesting, traceability, carbon-emissions tracking, and inclusive governance models that recognise nature as a stakeholder in supply-chain decision-making.

One of the most significant recent developments has been the establishment of the Scope 3 Herbal Foot printing Group, led by SHI. Through this pre-competitive collaboration, companies are working collectively to measure and reduce greenhouse-gas emissions across herbal supply chains, reflecting a notable shift in strategic thinking within the industry.

Economic sustainability is central to responsible herb sourcing. Certification schemes such as Fair for Life, FairWild, Fair Trade, and Organic require fair compensation, safe working conditions, and meaningful community engagement. These frameworks help ensure that communities benefit socially and economically from the plant resources they steward, moving beyond extractive models toward shared prosperity.

However, small-scale producers and processors often struggle to afford certification costs, limiting access to premium markets and reinforcing structural inequalities. In this context, group certification schemes continue to play a critical role in securing market access for smallholder organic growers. In 2025 there were over 1.1 million farmers registered under the Participatory Guarantee System (PGS) in India.

In 2024, FairWild implemented its Standard 3.0, expanding eligibility to a broader range of operators, from small-scale harvesters to global traders. While the number of FairWild-certified brands has remained relatively stable, adoption of the standard among operators and traders has increased substantially. This has amplified the standard’s impact and expanded the availability of FairWild-certified botanical ingredients (5).

The introduction of US import tariffs in 2025 had significant and multifaceted impacts on global MAP trade, affecting supply chains, pricing, industry profitability, and access to key botanical ingredients. To mitigate these effects, many US companies have sought alternative suppliers, raised shelf prices, or absorbed increased costs, often at the expense of reduced margins.

Trade and industry associations are actively lobbying for tariff exemptions for MAPs that are essential to the US herbal industry but cannot be commercially cultivated domestically. At present, only a limited number of botanical components are exempt from these tariffs.

For brands and operators in the herbal industry:

• Invest in the selection and breeding of MAP varieties suited to changing climatic conditions without compromising yield or active constituents.
• Diversify botanical sourcing geographically and supplement wild-harvested material with cultivated stock under organic or other sustainability certifications that support restorative ecology.
• Adopt tools and approaches to ensure species authenticity, safety and efficacy of herbal products. 
• Invest in community partnerships by working with local harvesters and cooperatives to secure fair wages and long-term resource stewardship.

For regulators and policymakers:

• Strengthen harvesting regulations by establishing science-based quotas, habitat protections, and effective enforcement mechanisms.
• Support access to certification by lowering barriers for small suppliers through funding and technical assistance.

For consumers:

• Choose certified products by seeking credible sustainability and Fair Trade certifications.
• Support transparent brands that disclose sourcing practices and demonstrate long-term commitments to ecological stewardship.

1. Herbal Medicinal Products Market Size & Share Analysis – Growth Trends and Forecast (2025 – 2030) Source: https://www.mordorintelligence.com/industry-reports/herbal-medicinal-products-market?utm_source=chatgpt.com 
2. Van Daele, F., Honnay O., Janssens S., De Korthttps Hanne. Habitat fragmentation affects climate adaptation in a forest herb. https://arxiv.org/abs/2303.15712v3
3. Rahimi, M., Mortazavi, M., Mianabadi, A. et al. Evaluation of basil (Ocimum basilicum) accessions under different drought conditions based on yield and physio-biochemical traits. BMC Plant Biol 23, 523 (2023). https://doi.org/10.1186/s12870-023-04554-8
4. Ichim MC. The DNA-Based Authentication of Commercial Herbal Products Reveals Their Globally Widespread Adulteration. Front Pharmacol. 2019 Oct 24; 10:1227. https://doi.org/10.3389/fphar.2019.01227 
5. FairWild Impact report 2024: https://www.fairwild.org/our-impact 

Historically, herbal dosing was developed through empirical trial, observation, experience and long-term use. Effective doses, preferred formulations and the knowledge of optimal remedies was passed through the generations (1).

Traditional texts often describe dosing in experiential terms, such as a glass or handful, or an amount tolerated. While these measures may appear imprecise from a modern or conventional perspective, they reflect a responsive approach to medicine — trial and error.

Doses were often adjusted according to the strength of the herb and individual’s response over time. Sometimes doses may have to be adjusted according to the strength and purity of a batch of herbs, as differences in harvesting, drying, storage and processing can impact the strength of the actives. The importance of feedback and adjustment of doses was a valuable part of traditional practice (2).

Plant and formulation factors 

The characteristics of the herb itself must be considered when determining an appropriate dose. Herbs differ widely in their strength, safety profile and therapeutic range; these differences directly inform how they should be used (3). Nutritive herbs such as nettle (Urtica dioica) or dandelion (Taraxacum officinale) are rich in minerals and phytochemicals which are often used in generous doses over extended periods of time for their vast medicinal benefits ranging from anti-inflammatory to blood tonic effects (4,5).

In contrast, aromatic and bitter herbs tend to act more immediately on digestion, circulation and the nervous system and may produce noticeable effects at relatively small doses. For example, peppermint (Mentha x piperita, M. arvensis) stimulates taste receptors and digestive reflexes; even modest amounts can have carminative effects and stimulate gut motility (6).

Similarly, aromatic nervines such as lavender (Lavandula angustifolia) or lemon balm (Melissa officinalis) can have calming effects at relatively low doses (7). Some herbs have a narrow safety profile therefore require great precision and clinical judgement when dosing. Lily of the valley (Convallaria majalis) a cardiotonic can be highly toxic even in small over-doses (8). Hence, careful dosing, appropriate training and awareness of contraindications is so important.

Today, for most people dosing from raw or unprocessed material may be confusing. Telling someone to take a pinch of a powdered herb can lead to significant dosing variability, as a pinch can range on average from 0.3 g to 0.6 g. This variability could lead to double the dose which could have adverse effects rather than a therapeutic benefit. Therefore, quantifying a pinch as a definitive value (e.g., “a pinch is 0.3 g”) makes dosing reproducible, and standardises the process.

When using leaves in preparations (i.e. add two leaves) this can also have inconsistent dosing effects. The variable size, condition and stage of maturity of the leaf can also impact the efficacy of dosing. Furthermore, dried and fresh material will have different effects; dried material may be more concentrated, and the composition of bioactive compounds may have changed (i.e., essential oils may evaporate during drying). All these factors can impact the effective dosing of herbals (2,9,10,11).

Even among commonly used herbs, factors such as duration of use, interactions and individual sensitivity must be considered. For these reasons, effective dosing relies on familiarity with both traditional dosages and contemporary safety data, allowing herbs to be used confidently and appropriately.

Individual factors 

Determining an appropriate dose always begins with the person. Age, gender, body composition, digestive capacity, liver and kidney function, comorbidities and individual sensitivity all influence how someone may respond. A healthy adult with good digestion may require and safely tolerate a higher therapeutic dose to achieve a clinical effect.

In contrast, an older or frail adult, a child, or someone with comorbidities may only tolerate lower doses and respond better when doses are gradually introduced and increased. Response to doses also varies depending on individuals’ experiences as some people may respond to very small doses, particularly with aromatic, bitter or nervine herbs; while others can tolerate larger doses before any clinical response is seen.

Effective dosing, therefore, relies not on standardised quantities alone, but on careful assessment of the individual’s capacity to receive, process and respond to herbal medicines (12).

The nature of the condition being treated is equally important when determining dose. Acute and relatively minor health conditions often respond best to higher or more frequent dosing over a short period of time, with the aim of supporting the body through a transient physiological challenge.

For example, in the early stages of an upper respiratory tract infection (i.e., cold/flu), herbs such as elderberry (Sambucus nigra) or echinacea (Echinacea purpurea) may be taken as tinctures or infusions regularly to support immune and inflammatory responses, soothing symptoms and reducing recovery time.

Acute musculoskeletal pain (i.e., sprain/strain or minor injury) may respond well to short-term internal use of anti-inflammatory herbs such as turmeric (Curcuma longa) alongside topical applications of arnica (Arnica montana) or rosemary (Salvia rosmarinus) (7,12).

On the other hand, chronic conditions usually require low to moderate doses taken consistently over a longer period. Chronic digestive disorders, hormonal imbalances or stress-related conditions often respond better to sustained doses that work gradually with underlying physiological patterns rather than attempting rapid relief of symptoms.

The use of ashwagandha (Withania somnifera) for reducing stress and anxiety can take up-to two weeks before a clinical effect is observed, as the adaptogen regulates cortisol and other hormones (13). When managing on-going or chronic conditions high doses may be poorly tolerated and unnecessary, therefore a “low and slow approach” would allow for cumulative effects and monitoring to take place (14).

Most conventional pharmaceutical medicines have standard formula and doses. There is a comprehensive pharmacopeia which makes production scalable and reproducible. Aspirin is an example of a synthetic medicine (originally isolated from willow (Salix alba)) whereby a single active compound (acetylsalicylic acid) was identified, and chemically synthesised (15).

The therapeutic effects are evidence based with randomised controlled trials (RCTs) to validate the efficacy. For most herbal medicines, there is often not a single isolated compound responsible for the therapeutic effects. Instead, herbal medicines are a complex mixture with many active constituents.

The mixture of compounds are known to work synergistically to have a therapeutic effect; hence, isolating a single compound would not be as therapeutically beneficial (16). For this reason, dosing is rarely about achieving a precise milligram quantity of one active ingredient. Instead, it involves establishing an effective therapeutic relationship between the plant, the preparation and the person taking it.

Finally, the form of preparation has a significant impact on dosing. Teas and decoctions favour water-soluble constituents and are often taken in larger volumes. Powders and capsules rely on digestion and absorption and may therefore require higher quantities to achieve an effect.

Tinctures are more concentrated and allow for flexible, incremental dosing. Herbal dosing tends to operate within broader therapeutic ranges than pharmaceutical drugs, allowing for a greater degree of flexibility and individualisation. The dose is shaped not only by pharmacology, but also by constitution, strength, sensitivity and condition treated (11).

In practice, standardising dosing of herbals is best approached using clearly defined therapeutic ranges rather than fixed doses. Replacing ambiguity in dosing by eyeballing, using a cupful or a few drops/leaves, by standard measures such as volumes for liquids (i.e., millilitre for tinctures) and weights for solids (i.e., gram for dried herbs), can improve dosing. Where reputable suppliers have preparations available with clear strength and doses these may be a preferred option to use. 

It is important to regularly review an individual’s response to herbals, and educate them of the signs of efficacy, intolerance and adverse effects so that dosing can be refined over time. One of the strengths of herbal medicine is that it is responsive. Signs that a dose may be too low include a lack of change to symptoms, after an appropriate trial period, or progress which prematurely stalls.

On the other hand, signs that a dose may be too high may include digestive discomfort, headache, nausea or exacerbation of symptoms. Hence, herbal dosing is a dynamic process. Ongoing observation, communication with practitioners and adjustments are integral to safe and effective herbal practice (17).

There is no single answer to the question of how much is enough when it comes to herbal dosing. Effective dosing emerges from the relationship between plant, preparation and individuals, informed by knowledge, use and experience of the person and practitioners.

1. Bhamra SK, Slater A, Howard C, Heinrich M, Johnson MRD. Health care professionals’ personal and professional views of herbal medicines in the United Kingdom. Phytotherapy Research. 2019;33(9):2360-2368. https://doi.org/10.1002/ptr.6418 
2. Kofi Busia. Herbal medicine dosage standardisation. Journal of herbal medicine. 2024;46:100889-100889. https://doi.org/10.1016/j.hermed.2024.100889 
3. Jürges G, Sahi V, Rios Rodriguez D, et al. Product authenticity versus globalisation—The Tulsi case. Aravanopoulos FA, ed. PLOS ONE. 2018;13(11):e0207763. https://doi.org/10.1371/journal.pone.0207763 
4. Devkota HP, Paudel KR, Khanal S, et al. Stinging Nettle (Urtica dioica L.): Nutritional Composition, Bioactive Compounds, and Food Functional Properties. Molecules. 2022;27(16):5219. https://doi.org/10.3390/molecules27165219 
5. Kania-Dobrowolska M, Baraniak J. Dandelion (Taraxacum officinale L.) as a Source of Biologically Active Compounds Supporting the Therapy of Co-Existing Diseases in Metabolic Syndrome. Foods. 2022;11(18):2858. https://doi.org/10.3390/foods11182858 
6. Hirata M, Fornari Laurindo L, Dogani Rodrigues V, et al. Investigating the Health Potential of Mentha Species Against Gastrointestinal Disorders—A Systematic Review of Clinical Evidence. Pharmaceuticals. 2025;18(5):693. https://doi.org/10.3390/ph18050693 
7. Chevallier A. Herbal Remedies. DK Pub.; 2007.
8. Currie GM, Wheat JM, Kiat H. Pharmacokinetic Considerations for Digoxin in Older People. The Open Cardiovascular Medicine Journal. 2011;5(1):130-135. https://doi.org/10.2174/1874192401105010130 
9. Nakra S, Tripathy S, Srivastav PP. Drying as a preservation strategy for medicinal plants: Physicochemical and functional outcomes for food and human health. Phytomedicine Plus. 2025;5(2):100762. https://doi.org/10.1016/j.phyplu.2025.100762 
10. Bhamra SK. Investigating the Use and Identity of Traditional Herbal Remedies amongst South Asian Communities Using Surveys and Biomolecular Techniques. Published thesis (PhD). 2016.
11. Wilde M. Doses and Measures. Napiers. Published August 3, 2021. Accessed January 14, 2026. https://napiers.net/blogs/news/doses-and-measures 
12. Tyson RJ, Park CC, Powell JR, et al. Precision Dosing Priority Criteria: Drug, Disease, and Patient Population Variables. Frontiers in Pharmacology. 2020;11. https://doi.org/10.3389/fphar.2020.00420 
13. Fuladi S, Emami SA, Mohammadpour AH, Karimani A, Manteghi AA, Sahebkar A. Assessment of Withania somnifera root extract efficacy in patients with generalized anxiety disorder: A randomized double-blind placebo-controlled trial. Current Clinical Pharmacology. 2020;15. https://doi.org/10.2174/1574884715666200413120413 
14. Frost R, Bhamra SK, Heinrich M. Herbal Products and Antidepressants: A Safe Combination or a Risky Mix? Phytotherapy Research. Published online January 13, 2026. https://doi.org/10.1002/ptr.70173 
15. Mahdi JG, Mahdi AJ, Mahdi AJ, Bowen ID. The Historical Analysis of Aspirin discovery, Its Relation to the Willow Tree and Antiproliferative and Anticancer Potential. Cell Proliferation. 2006;39(2):147-155. https://doi.org/10.1111/j.1365-2184.2006.00377.x 
16. Efferth T, Koch E. Complex Interactions between Phytochemicals. The Multi-Target Therapeutic Concept of Phytotherapy. Current Drug Targets. 2011;12(1):122-132. https://doi.org/10.2174/138945011793591626 
17. Bhamra SK. The revival of herbal medicines. Prescriber. 2024;35(6):13-16. https://doi.org/10.1002/psb.2157 

Coconut (Cocos nucifera) oil and sunflower (Helianthus annuus) seeds

The study explored whether coconut oil or sunflower seed oil massage could improve skin integrity in preterm infants. In these babies, the skin is thinner than those born at full gestation, and they have less brown adipose tissue and glycogen stored in subcutaneous fat layers.

This was a randomised controlled trial in a neonatal intensive care unit in Turkey. In the study, 66 preterm babies (34–37 weeks gestation) were randomised to three groups. All infants received routine intensive care unit care in an incubator maintained at 32–34 °C. The three groups were:

• Sunflower seed oil massage
• Coconut oil massage
• Control or no topical application

Measures were taken at three time points, at admission to the unit, at discharge from the unit and at one-month post-discharge as follows:

• Body weight
• Neonatal Skin Condition Score (records dryness, erythema, skin peeling), scores 3–9 with high scores reflecting poorer skin condition
• Revised Northampton Neonatal Skin Assessment Tool (nine parameters: gestational age, body weight, postnatal age, skin integrity, temperature control, mobility, nutrition status, skin appearance, and care level), scores give a low to high risk of skin complications

The coconut and sunflower oils were purchased from a company approved by the Ministry of Health. Batches of product (500 mL sunflower and 270 mL coconut oil) were placed in identical containers. The amount used was calculated based on the baby’s body weight. There were two topical applications per day as follows:

• The nurse/mother performed hand hygiene and ensured hands were not wet or cold.
• The oil was pre-tested on the baby’s wrist for allergic reactions.
• After a waiting time of two hours the oils were massaged into the back, chest, abdomen, arms, legs and hands and fingers for around three minutes.
• In the unit, oils were applied by the researcher. After discharge, the mother applied the oils for one month.

A power calculation estimated that a total of 84 infants would be required for the study. Consequently, 28 babies were randomised to each of the three groups with six lost to follow up in each group, resulting in n=22 infants per group.

Inclusion criteria were preterm infants born at 34–37 weeks; birth weight of 2 kg or more, length of stay in the unit seven days or more, skin damage on 5% or less of the body. Babies were excluded if they had a major abnormality or health condition, or if they already had received medication applied to the skin.

Overall, most infants were born by caesarean section and there were marginally more males than females. There were no differences between the sunflower, coconut or control groups with regards initial birth weight (around 2.4 kg), the time in the unit (around 9 days), numbers of babies with nappy rash, the gender split, or characteristics of the mother, such as age or numbers of previous births.

There was no change in birthweight between the groups at the time of discharge from the unit with each group on average gaining 2–3 g in weight from birth. At one-month post-discharge, the babies receiving sunflower seed and coconut massages gained significantly more weight compared to the control group, gaining around 4 g more. Across all groups, babies had put on around 1 kg from their birth weight at this time.

For the Neonatal Skin Condition Score (records dryness, erythema, skin peeling) the scores for the infant groups decreased over time with skin health improving. At one month post-discharge, the skin scores of babies receiving sunflower oil or coconut oil massage was significantly improved over the babies in the control group.

For the Northampton Neonatal Skin Assessment Tool, again, there were improvements in scores over time for all three groups. At time-point two when the infants were discharged from the unit, scores were significantly improved for the sunflower oil and coconut oil groups compared to the control group.

The study showed that using sunflower oil and coconut oil to massage preterm baby skin reduced the risk of skin complications at the time of discharge from an intensive care unit, and significantly improved skin health at one month after discharge from the unit. The oils significantly improved weight gain at one month after discharge, with infants gaining around 4 g more than the control group.

Coconut oil comprises mainly saturated fats with lauric acid (40–50%) and lower levels of myristic, palmitic, caprylic acid, linoleic acid and stearic acid. Sunflower oil is richer in linoleic acid, an omega-6 oil that is associated with protecting the skin barrier function. These oils can penetrate the skin barrier and improve barrier function, reduce inflammation, have antimicrobial effects, and they also contain polyphenols with antioxidant actions (2).

For pre-term infants, the skin is thinner and subcutaneous layers are not as well established compared to infants born at full gestation. They can experience infection, skin damage, and experience reduced touching and bonding opportunities with their parents. The oils offer the potential to improve skin health, and, as the present study shows, this is associated with weight gain which is an important sign of growth and development.

A limitation of the study is that the control group did not receive a massage oil, so it is not clear whether the benefits seen were due to the composition of the oils or the massaging and bonding effects. Also, once the babies were home, it was not possible to control for differing home environments, feeding and bathing routines. While the study by Tiryaki et al. provides clinically relevant insights into the use of topical oils in neonatal care, its limited sample size, potential lack of blinding, and short follow-up period constrain the strength and generalisability of its conclusions.

Caring for the skin of preterm infants born at 34–37 weeks gestation using sunflower seed oil or coconut oil benefited the health of their skin, and positively improved weight gain at one month after being discharged from an intensive care unit. Both oils were equally effective, although no chemical analysis was carried out on the products to determine the oil compositions.

Further research could explore the effects of the oils on premature babies born earlier (less than 34 weeks gestation), and also look at the weight gained and other outcomes like sleep for longer follow-up times.

Using coconut or sunflower seed oils to massage premature babies is a simple activity that can improve skin health and weight gain.

1. Tiryaki Ö, Zengin H, Çınar N, Karabay M, Caner İ, Güçlü E. Comparison of Coconut and Sunflower Seed Oils in Improving the Skin Integrity and Weight Gain of Infants in the Neonatal ICU. Adv Skin Wound Care. 2024 Nov-Dec 01;37(11&12):1-8.  https://doi.org/10.1097/ASW.0000000000000241 
2. Lin TK, Zhong L, Santiago JL. Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils. Int J Mol Sci. 2017 Dec 27;19(1):70. https://doi.org/10.3390/ijms19010070

Constituents are often described as water-soluble, alcohol-soluble, or oil-soluble. But solubility behaves more like a continuum. A constituent may be somewhere on the spectrum of sparingly to highly soluble in any given solvent. Rather than asking “is this constituent water-soluble?” the question becomes, “from this herbal matrix, how soluble is this constituent in water, at this temperature, and using this extraction method?”

This is why changing the solvent and extraction method can change the focus and function of a herbal medicine. A standard infusion emphasises constituents that dissolve readily in hot water. Are these the constituents (and associated actions) that we desire in a particular medicine? A tincture made with a given menstruum extracts a different spectrum of constituents from the same herb. Which constituents will we focus on when we adjust the ethanol percentage of the menstruum? An infused oil of that herb will capture yet a different spectrum of constituents, therefore featuring different actions and energetics than the infusion or tincture.

The main influence on solubility is polarity — a property arising from a molecule’s electron distribution. If this distribution is unbalanced (i.e., there is internal charge separation) we have a polar compound. If the distribution is perfectly balanced, we have a nonpolar molecule. And, as with solubility, polarity is a spectrum. Any phytochemical or solvent falls somewhere along the continuum.

The key to solubility is matching the polarity of the solvent to the polarity of the constituents we desire to extract. The old aphorism “like extracts like” applies: higher-polarity solvents (like water) focus on higher-polarity constituents, while lower-polarity solvents (like fixed oils) favour lower-polarity constituents.

Relative polarity of solvents

If you think of water as being 100% polar, then glycerin would be about 81% as polar as water. Pure ethanol would be about 65% as polar as water. These solvents are close enough that they will intermix with each other. Each of these solvents targets a particular group of constituents but there is overlap in what they will extract. Fixed oils and carbon dioxide (CO₂) extract lower-polarity constituents don’t easily mix with water, vinegar, glycerol or ethanol.

Solvent / menstruum	Relative polarity
Water	1.00
Vinegar (like water but also acidic)	~ 1
Glycerin (glycerol)	0.81
Ethanol (100%)	0.65
Olive and other fixed oils	~ 0
Carbon dioxide (CO₂)	~ 0

A tincture is made with a hydroethanolic solvent system (menstruum) containing both mid-polarity ethanol and high-polarity water. By adjusting the ethanol (EtOH) percentage, we are tuning the overall polarity of the menstruum. More EtOH in the menstruum → lower polarity; less EtOH → higher polarity. This is one reason tinctures are so versatile — by choosing the right EtOH–water ratio, we design the menstruum to selectively extract constituents by polarity matching. In other words, menstruum composition strongly influences the phytochemical profile of the resulting tincture (1,5).

Hydroethanolic solvents

“K” is one way to quantify polarity. Since water is highly polar and ethanol (EtOH) is moderately polar, mixing them together in different proportions will create a menstruum with a specific polarity. The higher the % EtOH, the lower the polarity of the hydroethanolic solvent system (menstruum). We tincture different herbs with different % EtOH to match the polarity of the constituents we want to extract from those herbs.

EtOH / Water	~ K	EtOH / Water	~ K
100% water	80	60% EtOH	47
10% EtOH / 90% H2O	74.5	70% EtOH	41.5
20% EtOH	69	80% EtOH	36
30% EtOH	63.5	90% EtOH	30.5
40% EtOH	58	95% EtOH	27.8
50% EtOH	52.5	100% EtOH	25

In herbal pharmacy, “yield” indicates the amount of finished tincture collected. But from a phytochemical perspective, “yield” usually refers to the concentration of a constituent in the product. A high constituent yield is often but not always better. For example, an extraction rich in astringent tannins may be more appropriate in some cases (surface inflammation, excessive secretion) and less appropriate in others (dry conditions, sensitive digestive mucosa). What matters is whether the preparation delivers the appropriate concentration of the desired spectrum of constituents for a particular therapeutic application.

Polarity is central, but several additional factors can influence the concentration of constituents in our extractions:

Temperature

Heat is a kind of kinetic energy that physically increases the extraction of most constituents. At the same time, some kinds of constituents are sensitive and will degrade with excessive heat. We learn to choose the optimal temperature for an extraction solvent, and to apply heat for the right period of time (e.g., infusion vs. decoction).

Time

Longer contact between solvent and herb generally enhances extraction up to a point, but the optimal time is influenced by factors including plant matrix, surface area, agitation, constituent class, and type of preparation.

Surface area

Chopping, grinding, or powdering increases surface area of the plant matrix, facilitating solvent–constituent contact and enhancing extraction. Very fine powders, however, can complicate filtration.

Agitation

Shaking or stirring increases kinetic jostling between solvent and constituents, usually accelerating extraction and constituent yield.

Pressure

Increasing pressure (e.g., in a tightly closed canning jar or electric pressure cooker) usually enhances extraction.

Plant matrix

Constituents may extract somewhat differently depending on how they are packaged within plant tissues. Delicate structures like flowers yield their constituents more readily than tough structures like seed coats or root barks. Cellular structure and co-constituents such as mucilages, tannins, and resins can also alter extractability.

Taken together, these variables should be considered as part of the extraction method; they help explain why preparations of the same herb in the same solvent can be noticeably different. The combination of botanical quality, solvent, and extraction method largely determines constituent yield and product quality.

Water

Water excels for higher-polarity constituents such as mucilages, polysaccharides, sugars, and some kinds of glycosides. It is the preferred solvent for making teas, infusions, and decoctions. Hot water almost always works better than cold water.

Hydroethanolic solvent systems (menstrua)

Lower % EtOH generally favours more polar compounds; higher % EtOH extracts lower-polarity constituents. Rather than a single “correct” percentage for each herb, it’s more accurate to think in ranges that can be adjusted to extract particular constituent families. Depending on your menstruum composition, you can create multiple different medicines from a single herb.

Glycerin and honey

Glycerin is a viscous and polar solvent, often used when alcohol is not desired. It can extract many water-soluble constituents along with a moderate concentration of aromatics, though it is generally less efficient than ethanol for lower-polarity constituents. However, its extraction spectrum can be increased considerably by employing heat, pressure, and agitation. As a solvent, honey behaves similarly to glycerin.

Vinegar

Vinegar is an acidic aqueous solvent. Acidity can change the solubility of certain constituents, particularly alkaloids, by shifting them into more water-soluble ionic forms (1,4). Traditional vinegars and oxymels (made by combining infused vinegars and honeys) offer versatile, alcohol-free alternatives to hydroethanolic tinctures or glycerites.

Fixed oils

Botanical oils such as olive, safflower, or coconut are both therapeutic substances and low-polarity solvents. Herb-infused oils feature low-polarity, lipophilic constituents including many terpenoids and some phenolics, making them valuable for topical preparations. Culinary preparations such as infused ghee or vinegar-and-oil salad dressings can also double as herbal products. Oils are generally unsuitable solvents for mineral salts and polar constituents including mucilages and glycosides.

Supercritical carbon dioxide

Supercritical carbon dioxide (CO₂) extraction is sometimes used for low-polarity constituents (e.g., gingerols from ginger (Zingiber officinale) curcuminoids from turmeric (Curcuma longa), cannabinoids from hemp (Cannabis sativa)). This modern method uses high-pressure, low-temperature conditions, with the advantage that CO₂ leaves no solvent residue in the finished product. CO₂ extracts are good at preserving the characteristic flavours and aromas of herbs. They are especially suitable for use in highly concentrated formulas delivered in capsules. (2)

Betalains are the vivid, water-soluble pigments responsible for red-violet and yellow-orange colours in plants such as beetroot (Beta vulgaris) and prickly pear (Opuntia ficus-indica) fruit, as well as edible greens including red orach (Atriplex hortensis var. rubra) and purslane (Portulaca oleracea). These medicinal food-herbs (and their betalains) have antioxidant, anti-inflammatory, and broad-spectrum bioprotective effects. (3)

Betalains are highly polar. This predicts several practical outcomes:

• They extract readily into water and other higher-polarity solvents such as lower % EtOH menstrua. Betalain extraction decreases as EtOH percentage increases.
• Glycerin and honey can be suitable solvents, especially when gently warmed to decrease their viscosity.
• Vinegar (which is mostly water) is a good solvent for betalains.
• Betalains are not lipophilic; they do not extract well into fixed oils.

As another example, echinacea (Echinacea spp.) contain several important groups of constituents — immunomodulating polysaccharides (IP), alkamides, and polyphenols including phenolic acids and flavonoid glycosides. Each group has a characteristic polarity range (4). IP are quite polar and most soluble in hot water; alkamides have moderate polarity and favour 50–60% EtOH menstrua; and the polyphenols are mid- to higher-polarity constituents that extract fairly well with both hot water and lower % EtOH. 

Since all these constituents are bioactive, which solvent is “best”? We could bypass this question by delivering a dose of the tincture in a water-based extract like an infusion or decoction!

1. Lee JE, Jayakody JTM, Kim JI, et al. The influence of solvent choice on the extraction of bioactive compounds from Asteraceae: a comparative review. Foods. 2024;13(19):3151. https://doi.org/10.3390/foods13193151 
2. Uwineza PA, Waśkiewicz A. Recent advances in supercritical fluid extraction of natural bioactive compounds from natural plant materials. Molecules. 2020;25(17):3847. https://doi.org/10.3390/molecules25173847 
3. Sadowska-Bartosz I, Bartosz G. Biological properties and applications of betalains. Molecules. 2021;26(9):2520. https://doi.org/10.3390/molecules26092520 
4. Petrova A, Ognyanov M, Petkova N, Denev P. Phytochemical characterization of purple coneflower roots (Echinacea purpurea (L.) Moench.) and their extracts. Molecules. 2023;28(9):3956. https://www.mdpi.com/1420-3049/28/9/3956 
5. Ganora L. Herbal Constituents: Foundations of Phytochemistry. 2nd ed. Louisville, CO: HerbalChem Press; 2021. https://www.herbalconstituents.com/book 

• 250 g fresh plant material 
• 750 ml filtered or spring water (enough to cover the plant material)

• Large pot with a tight fitting domed lid 
• Heat proof bowl with a 600 ml capacity 
• Trivet or ramekin 
• 1 kg ice cubes 
• Sterile glass bottle

1. Chop the rose petals. 
2. Place in the pot and cover with the filtered water (do not overfill so the plant is flooded).
3. Place the trivet on top of the plant material and water like a platform (this is to raise the collection bowl so it is collecting steam, not boiling water).
4. Place the collection bowl on top of the trivet. 
5. Place the lid on the pot upside down, so the steam runs down the inside of the lid and into the bowl. 
6. Place ice into the domed lid. 
7. Bring the mixture to a gentle simmer. Be careful to avoid vigorous boiling as it will reduce the aroma of the water. 
8. Continue until most water has evaporated and condensed into the bowl.*
9. Once the water has been evaporated, carefully remove the glass bowl and retain the water inside it— this is the aromatic water. 
10. Bottle in sterile bottles, label and keep in the fridge. 

* If the lid is too small to hold all the ice, it may require regular topping up to ensure it stays cold. 

Aromatic waters should be stored in the fridge and consumed within one month. They can also last for up to six months if they remain unopened. 

Floral waters should be discarded if there are any noticeable signs of decay such as cloudiness, a musty or sour smell, visible mould or gas/bubbles in the water.

Hydrosols can be used medicinally, and offer a safe, alcohol-free alternative for those who are not able to take alcohol. They can be safely used in children at the correct dose.

Can I consume a hydrosol internally?

Yes, hydrosols can be consumed internally; however, it is advisable to consume them within three months if they have been kept in the fridge. It is advisable to check the liquid for any signs of decay or mould and should be discarded if any are visible. 

Are hydrosols safe for children?

Hydrosols can be safe and effective for children internally, however their safety depends on the herb used. Some examples which are commonly considered safe include rose, chamomile (Matricaria chamomilla), lemon balm (Melissa officinalis) and lavender (Lavandula angustifolia). 

Āyurveda is a 5000-year-old all-encompassing system of medicine and philosophical guide to aligned living. It is both a system of curative medicine and preventative health through diet, lifestyle, rituals, ethical living, herbs and more. Ayurveda considers good health as far more than the absence of disease. To thrive with optimal health, we need to cast the net much wider.

How vibrant and alive do you really feel in the body, how calm and focused do you feel in the mind, how settled do you feel in your emotions and how nurtured do you feel from your social network and environments? All these elements contribute to our well-being.

Immunity is often only really considered during illness yett the immune system is constantly working in the background, maintaining health throughout life, bringing balance, homeostasis, healing wounds, and resisting invading pathogens. Immunity is the front-line defence of physical existence. 

In modern science, immunity refers to the system that protects the body from illness and infections that are caused by foreign invaders (pathogens), such as bacteria, viruses, fungi and toxins that cause disease in the body.

Bala, ojas and the three dimensions of strength
How the body responds to infectious conditions is deeply influenced by our underlying health or what is known as our bala (inner strength). Sage Vāgbhaṭa explains that bala sustains life, supports endurance, and determines resistance to disease, however the depletion leads to vulnerability (1). In Ayurveda, immunity is understood through three pillars of strength (bala):

• Hereditary (sahaja bala) — our innate immunity and strength we are born with
• Seasonal (kālaja bala) — immunity influenced seasons, stage of life, time
• Established (yuktikṛta bala) — acquired immunity developed through diet and lifestyle and self-care 

While we may not have total control over our encounters with infections or diseases, we have the power to navigate how our body responds. Through conscious choices in diet and lifestyle, we can build our immune resilience. This adaptive immune resilience is known as vyādhi-kṣhamatva’and it has two fundamental aims:  

• To maintain resistance to disease by building strength (bala)
• To enhance our capacity to adapt, recover and rebuild ojas after illness 

In other words, as mentioned in Charaka Saṃhitā scripture (2)Vyādhi-kṣamatva is both the art of preventing the onset of disease and of reducing disease severity once it has manifested. Immunity in Ayurveda is not merely about fighting disease, but about sustaining strong healthy body tissues from within that subsequently preserves vitality (ojas) (3) and supports long-term resilience (bala).

The purpose of immunity is to help us maintain balance in a world that is constantly changing. Today, immune challenges show up as infections, allergies, intolerances, autoimmune patterns, hormonal imbalance, and sensitivity to stress — all signs that the system is struggling to adapt.

Building strength (bala) and vitality (ojas) happens gradually over time and our task is to support our immunity through daily choices in diet, routine, rest, and how we relate to stress. When bala and ojas are strong, the immune system responds well, neither overreacting nor underperforming, but constantly adjusting to restore equilibrium.

From an Ayurvedic perspective immunity becomes compromised by a gradual wearing down of the body’s ability to adapt and self-regulate. The gradual loss of resilience reflects how well digestion (agni), doṣic balance and the body channels have been functioning over time. As these elements become strained, bala declines, and the formation of ojas is compromised. Some key factors that weaken immunity over time include:

• Improper diet, poor gut microbiome and ongoing digestive issues such as irregular or weak agni (visamāgni/mandagni) — disturbing how the body tissues get nourished.
• Nervous system dysregulation caused by excessive vāta, ongoing stress, negative mindset and emotions
• Lack of recovery time after an illness prevents the immunity from being fully recharged.
• Ongoing misalignment to daily and season rhythms including poor quality and lack of sleep, irregular eating patterns, lack of or excessive exertion.
• Excessive or prolonged cleansing or long-term stimulating / suppressive medications.

75–80% of immunity is formed in the gut, so it’s only as strong as agni (digestive fire). We are what we digest, and healthy ojas formation is the result of the healthy nourishment of the body tissues.

Through the Ayurvedic pathological lens immunity weakens when:

• Agni (digestive and metabolic fire) becomes impaired
• Āma (metabolic waste) accumulates
• Doṣas (vāta, pitta, kapha), the body’s functional intelligence becomes chronically aggravated
• Dhātus (tissues) are under-nourished, reducing ojas (the subtle essence of immunity and vitality)

Ayurveda aims to rebalance us at the root level. There are no short cuts to long-lasting wellness. The focus is to restore the doṣas to equilibrium, clear toxins from deep within and rebuild strength in every body tissue, rejuvenating the body at a cellular level.

The two-stage process of restoring mind-body-emotional balance.

1. Langhana – Lightening and cleansing therapies, including palliative measures and purification practices such as fasting, pañcakarma, to reduce excess, clear toxins and restore balance.
2. Rasāyana – Rejuvenation therapy focused on rebuilding strength in the tissues after cleansing. This includes supportive ahāra and vihara – wholesome diet, proper daily routines, good conduct and medicines when necessary.

Ayurvedic immune support through rasāyana

Rasāyana (rejuvenation therapy) focuses on protecting and rebuilding ojas. Through supportive diet, lifestyle adjustments, and targeted tonics, rasāyana helps restore strength, resilience, and long-term wellbeing, especially during periods of depletion or vulnerability.

In Ayurveda, herbs and home remedies are selected according to their energetic qualities — taste (rasa), potency (vīrya), action, and post-digestive effect (vipāka) — and the way they influence the doṣas, body tissues, channels, senses, and mind. This is the same principle applied to food, reinforcing the Ayurvedic view that food itself is medicine.

Immune-supportive herbs are traditionally used to build yuktikṛta bala, support digestion, clear metabolic waste, and nourish ojas. Classical formulations such as the Ayurvedic elixir Chyawanprāsha is valued for its holistic rejuvenating qualities.  Sitopalādi, Tālisādi are valued for their respiratory-supporting qualities. Single herbs such as tulsi (Ocimum sanctum), guduchi (Tinospora cordifolia), amalakī (Emblica officinalis), turmeric (Curcuma longa), garlic (Allium sativum), ginger (Zingiber officinale), shatavari (Asparagus racemosus), and ashwagandha (Withania somnifera) are commonly used to support resilience, digestion, vitality, and stress adaptation.

How herbs are taken is equally imperative. Traditional carriers (anupāna) such as milk, ghee, water and honey help guide the action and absorption of herbs to specific tissues. Rasāyana herbs are always personalised and used consciously, since herbal remedies work gently with a cumulative and nourishing approach to immune health as opposed to the quick fixes, we have become accustomed to. 

Actively cultivating yuktikṛta bala, begins with the first pillar of life in Ayurveda: satmya āhāra, a diet that is suitable for one’s constitution, digestive capacity, and current state of balance.

The body is shaped by what we are able to digest and assimilate making seasonal, local, whole foods the most supportive. Home-cooked, freshly prepared warm meals and slower cooking methods are becoming rare, yet they are the foundations for digestive and immune health. Our modern pace and reliance on processed foods weaken digestion (agni), contributing to rising food intolerances and gut imbalance. Stale, leftover, and heavily processed foods contain little vital energy (prāna) and do not support the formation of ojas.

Meals such as soups, stews, and gently spiced dishes provide grounding, easily absorbed nourishment for our immunity. A balanced immune-supporting diet may include wholesome grains and legumes, eggs or ethically sourced meats where appropriate, seasonal fruits and vegetables, nuts and seeds, and healthy fats such as ghee.

The connection between digestive health and immune resilience makes prebiotics and probiotics a vital part of the dietary mix. Traditional foods such as takra (spiced buttermilk) and fermented vegetables help support gut flora.

Eating consciously, in appropriate portions, and avoiding excess are just as important as food quality. Diets rich in vitamin C, zinc, healing spices, and warming teas gently kindle agni and support long-term resilience.

Building strength (bala)

Certain foods are traditionally known to build strength and resilience (rasāyana), including milk, ghee, green gram, figs, dates, and almonds. These are best supported with digestive spices and ingredients such as ginger, cumin, lemon, takra, and fresh seasonal fruits.

Movement, rest, and rhythm

Balanced exercise (vyayāma) is key to maintaining and build strength (bala), yet ensuring ojas is not depleted. Too little movement can lead to stagnation; excess can deplete strength. Regular conscious movement such as walking, yoga, strength training, massage, or breath-led practices support immunity, lymphatic flow, and the movement of prāna (life force energy). Just like the ebb and flow of life, it is equally important knowing when to rest and recover. 

Mind, breath, and emotional balance

Ayurvedic wellness is complete only when the mind, senses and emotions are cared for alongside the body. Chronic stress, mental overload, and emotional strain can erode bala. Practices such as conscious breathing, meditation, mudras, mantras, prayer, time in nature, and grounding routines help regulate the nervous system and restore balance. Traditional therapies like shiro-abhyanga (head massage) and shirodhāra (oil pouring on the 3^rd eye), along with medhya rasāyana, further support mental clarity and resilience when needed.

1. Vāgbhaṭa. Aṣṭāṅga Hṛdaya. Sūtrasthāna 11.1–2. Translated by Murthy KRS. Varanasi, India: Chowkhamba Krishnadas Academy; 2008.
2. Agniveśa, Charaka. Charaka Saṃhitā. Sūtrasthāna, Chapter 28, verse 7. In: Sharma RK, Dash B, trans. Charaka Saṃhitā (Text with English Translation). Vol 1. Varanasi, India: Chowkhamba Sanskrit Series Office; 2014.
3. Agniveśa, Charaka. Charaka Saṃhitā. Sūtrasthāna, Chapter 28, verse 7. In: Sharma RK, Dash B, trans. Charaka Saṃhitā (Text with English Translation). Vol 1. Varanasi, India: Chowkhamba Sanskrit Series Office; 2014.

In 2013, the German Federal Institute for Risk Assessment (BfR) published a risk assessment of botanicals that recommended prohibiting ashwagandha from use in food supplements, due to concerns about effects on the endocrine system and its safety in pregnancy (2). A lack of consensus about how to proceed led to no change.

However, in 2019, the Danish Food and Drug Administration suggested they also had concerns due to traditional use of ashwagandha as an abortifacient, as well as effects on sex and thyroid hormones. In 2020, Polish authorities limited the intake of ashwagandha to 3 g daily. In 2023, Denmark banned the use of ashwagandha in food supplements, with Dutch, French, German and Swedish authorities advising people against its use (2). 

In the UK, ashwagandha has not been accepted as a medicine under the traditional herbal medicinal products framework, but has not been banned, and its history of use in India could be used to support an application. Whether it can be used in foods and supplements in the future will depend on the outcome of the FSA consultation (2).

Multiple clinical trials and systematic reviews have concluded that the side effects from taking ashwagandha are minimal (7,8). Many of the clinical studies that have been published in the past have only assessed the effects of taking ashwagandha for 8–12 weeks, which doesn’t reflect the long-term use that is sometimes advised.

A recent 12-month multi-centre clinical study in 191 men and women was conducted to assess safety over a longer period of time (7). There were 18 mild adverse events of nausea, digestive upset and headache, none of which required an intervention. Liver, renal and thyroid function were all found to be unaffected. Cortisol was reduced, testosterone increased and self-reported quality of life was significantly improved; all of which are outcomes considered to be beneficial effects (7). 

The repeated demonstration of the safety of ashwagandha in clinical trials has not reassured regulatory authorities, however, and concerns have remained.

Concerns about ashwagandha’s safety in pregnancy surprised herbalists, as most traditional texts make no mention of this. In 2013, the BfR raised concerns that ashwagandha had abortifacient effects based on a World Health Organisation monograph for ashwagandha, which itself referenced an American Herbal Pharmacopoeia (AHP) monograph (4). However, the AHP monograph has been misrepresented. The original text is as follows:

“There are conflicting reports regarding the use of ashwagandha in pregnancy. Large but undefined doses have been reported to possess abortifacient activity. Of several ayurvedic practitioners consulted, none reported having observed an abortifacient activity clinically. Conversely, ashwagandha has, traditionally and in modern ayurvedic practice, been used to prevent miscarriage and stabilize the fetus.”

Concerns that the WHO monograph has distorted information from other sources has been shared by other authors and the AHP published a press report to respond to the claims (9,10). 

A detailed review of pharmacokinetics and toxicity studies of ashwagandha found no cause for concern from in vitro, in vivo and ethnobotanical sources (9). This is supported by preclinical and clinical evidence from the Ministry of AYUSH in India that demonstrates no toxicity to mother or foetus when pregnant women use ashwagandha root (10). As with any other herb, more research is needed to have complete certainty of ashwagandha safety.

Withanolides and withanosides are rapidly absorbed into the systemic circulation within 1 and 1.5 hours and withanolides are present for between 6 and 15 hours. Some withanolides are able to cross the blood-brain barrier, while others (such as withanoside IV and withanoside V) do not. The impact of ashwagandha phytochemicals on cytochrome P450 enzymes is not clear. Some studies show no impact, while others have found that CYP2B6 is inhibited and CYP3A4 is induced (9). It is likely that there are differences between individuals.

A safe dose of 2 g/kg has been found in animal studies and animal studies generally show low or no toxicity, unless high-alkaloid extracts are used (3). Williamson and Brendler conclude that ashwagandha “is an unusually safe herb” (3).

The complexity of plants and humans makes predicting the effects of consumption of herbs challenging. The presence of certain phytochemicals can prevent or enhance the absorption of others in the body. Ronen et al. described how they validated the use of AI to predict toxicity based both on published literature and on molecular structure of the phytochemicals in ashwagandha (6).

Out of 1396 publications mentioning ashwagandha 97% did not highlight any toxicity concerns; those that did refer to toxicity were mostly discussing cytotoxicity in the context of cancerous cells. There were nine articles that included concerns of liver toxicity and one mention of an adverse effect on thyroid activity (6). AI analysis of the structure of phytochemicals in ashwagandha found that all of those present in the roots of the plant were predicted to have low liver, reproductive and hormone toxicity, with only two of the phytochemicals found in the leaves of the plant being predicted to have liver toxicity (6).

It has always been challenging to confidently reassure regulatory authorities about the safety of herbs. The perspective of the herbalist who focuses on therapeutic benefits clashes with that of the regulator who disregards benefits and focuses on minimising risks. Ethics prevents us from conducting randomised controlled trials in pregnant individuals and herbs should always be prescribed cautiously in pregnancy, but it is important for experts to highlight when traditional understanding has been misrepresented.

Ashwagandha has a long history of traditional use and demonstrated clinical safety. More modern techniques may help to convince those who remain wary of herb safety.

1. Mills, S. Threats to ashwagandha safety: How do we respond to new reports of liver damage? Herbal Reality 2024. Threats to ashwagandha safety: How do we respond to new reports of liver damage? | Safety | Herbal Reality
2. Brendler T, Al-Mondhiry R, Lang L, Marles R, Tallon M, Raghu A. Ashwagandha: Is It Safe? Part 1: A Regulatory Review. Phytother Res. 2025 Dec 19. https://doi.org/10.1002/ptr.70151 
3. Williamson EM, Brendler T. Ashwagandha: Is It Safe? Part 2: A Preclinical Evidence Review. Phytother Res. 2025 Sep 18. https://doi.org/10.1002/ptr.70090 
4. Brendler T. Is Ashwagandha an Abortifacient? Phytother Res. 2025 Dec 26. https://doi.org/10.1002/ptr.70150
5. Li L, Zhang X, Hao J, Tian X, Zhu Y, Yang Y, Qiu B, Wen J. Evaluating the Safety of Ashwagandha as a Food Additive: A Focus on Reproductive, Thyroid, and Immune System Effects. Phytother Res. 2025 Dec 26. https://doi.org/10.1002/ptr.70157 
6. Ronen Y, Ebert C, Tamim-Yecheskel BC, Zev S, Kantor O, Arbel HB. Comprehensive safety evaluation of Withania somnifera (Ashwagandha): an AI-driven meta-analysis and quantitative structure-activity relationship based toxicity assessment. Front Nutr. 2025 Nov 24;12:1658265. https://doi.org/10.3389/fnut.2025.1658265 
7. Salve J, Kale S, Prajapati BL, Sparavigna A, Savant M, Ademola J, Langade D. Safety of 12-Months Administration of Ashwagandha (Withania somnifera) Standardized Root Extract in Healthy Adults: A Prospective, Observational Study. Phytother Res. 2025 Oct 8. https://doi.org/10.1002/ptr.70096 
8. Sharma E, Ganu G, Kshirsagar K, Shah A, Mahale U, Mehta A, Nair S. An open-label, single dose, safety and pharmacokinetic study of Withania somnifera root extract in healthy volunteers. Drug Metab Pers Ther. 2025 Feb 19;40(1):23-34. https://doi.org/10.1515/dmpt-2024-0089 
9. Tallon MJ, Koturbash I, Blum JL. A Systematic and Ethnobotanical Review of Ashwagandha’s (Withania somnifera) Teratogenic and Abortifacient Potentials. Phytother Res. Published online August 31, 2025. https://doi.org/10.1002/ptr.70079 
10. Upton, R. Press Release: AHP Responds to Claims of Ashwagandha Abortifacient Effects. 2024. American Herbal Pharmacopoiea. Press-Release-Ashwagandha-Abortifacient-Assessment_06-24-2024.pdf

Native to the coastal regions of Southern California and Baja California, Mexico, white sage thrives in the sun-drenched, rocky soils of coastal sage scrub habitats. Its perennial nature and aromatic leaves have made it a mainstay for Indigenous communities, who cherish it for its ceremonial, medicinal, and culinary uses. Despite its abundance in certain areas, white sage faces mounting threats that could jeopardise its long-term survival and the integrity of the ecosystems it supports. Let’s delve into the key conservation challenges confronting white sage today.

Habitat loss and environmental threats

White sage faces a double jeopardy: not only is it overharvested, but it’s also losing ground to urban development and environmental stressors. Nearly half of its natural range has been destroyed to make way for cities, roads, and agriculture. The remaining habitats are under siege from climate change, invasive species, and altered fire regimes.

Projections are grim. Combined threats could shrink suitable white sage habitat by up to 66% by the end of the century. This loss reverberates beyond the ecological sphere, disrupting the cultural practices of Indigenous peoples who rely on white sage for ceremonies and healing. The plant’s decline represents both an environmental crisis and an erosion of cultural heritage.

Pollination ecology and hybridisation

White sage is a linchpin in its native ecosystem, supporting a diverse community of pollinators. Bees, especially those in the genera Bombus (bumblebees) and Xylocopa (carpenter bees), are its primary pollinators, ensuring the reproduction and resilience of local populations. In coastal sage scrub communities, Salvia apiana often stands as a dominant species, anchoring biodiversity. The health of pollinator populations is crucial; declines in bees due to pesticides, habitat loss, and disease further complicate conservation efforts.

Environmental changes

Human-driven changes are reshaping white sage’s world. Increased fire frequency — sometimes a result of careless human activity — destroys established plants and disrupts regeneration cycles. Invasive species like Echium candicans outcompete native sage for space and resources, further hindering its growth and reproduction.

At the same time, the decline of pollinators, especially bees, is a growing concern. These creatures are essential for white sage’s reproduction, and their disappearance could spell disaster for the species. The interplay of these factors underscores the fragility of white sage’s native range and the urgent need for conservation action.

Cultural appropriation and misuse

Perhaps the most contentious aspect of white sage’s contemporary story is its widespread use in wellness and spiritual practices — often divorced from its deep Indigenous roots. The burning of white sage to “cleanse energy” or “purify spaces” has become a staple of New Age rituals, yoga studios, and online wellness influencers. Yet, this appropriation frequently ignores the plant’s sacred significance and the traditions of the communities that have stewarded it for centuries.

This disconnect between traditional use and commercial exploitation diminishes the spiritual value of white sage and fuels irresponsible consumption. When consumers are unaware of the plant’s origins and importance, they may unwittingly contribute to unsustainable harvesting and the erosion of cultural knowledge.

Commercialisation and overexploitation

The commercialisation of white sage has reached unprecedented levels. Today, it’s easy to find bundles of white sage for sale on e-commerce sites and in big box stores across the United States. However, the supply chain is fraught: there are only a handful of farms cultivating white sage for the market, and most products are still wild-harvested.

Poaching, or illegal harvesting, has plagued the plant for years. In California and Baja Mexico, authorities have confiscated hundreds of pounds of illegally collected Salvia apiana, sometimes during the plant’s most vulnerable blooming season. Poachers often take entire plants or strip large quantities from single locations, preventing regrowth and devastating local populations. Law enforcement rarely catches perpetrators, and wild populations have suffered steep declines.

Commercial exploitation and illicit trade

The meteoric rise in the popularity of Salvia apiana in spiritual and wellness circles has triggered a dramatic increase in commercial harvesting. Each year, tens of thousands of pounds of wild white sage are stripped from the hillsides of California and Mexico to supply markets in the United States and abroad. This large-scale removal destabilises native ecosystems and puts immense pressure on the species, which is not currently listed as endangered but is certainly at risk (1).

Recent efforts to shed light on the unregulated white sage trade have revealed troubling patterns. For example, arrests in the Etiwanda Preserve — a protected area between Los Angeles and Palm Springs — spurred investigations by organisations such as United Plant Savers and the California Native Plant Society. Their work, along with documentaries like Saging the World, highlights the ecological and cultural consequences of unchecked harvesting (1,2,3).

At the heart of the issue is a shadowy network sometimes referred to as the “white sage mafia”. These groups exploit vulnerable individuals, recruiting them to harvest wild white sage for profit. Ironically, although the herb is relatively easy to cultivate, most commercially available sage is wild harvested because cultivation costs are higher. To counter this, United Plant Savers urge consumers and sellers to demand proof of cultivation, thereby supporting sustainable practices and reducing pressure on wild populations (2). Or grow your own, Plant Savers sells white sage seed, it can be expensive because the seeds are so small and are hand harvested, but germination rates are high.

International trade and supply chain concerns

The reach of white sage extends far beyond North America. Online marketplaces offer hundreds of white sage products, some vendors requiring bulk orders of 100 bundles or more. Reports indicate that a single seller may move tens of thousands of pounds of Salvia apiana in a year.

This global trade raises thorny questions about sustainability and cultural respect. For Native American tribes, the smoke from white sage is spiritually potent — a medium for blessings and prayers. Its commercialisation by non-Indigenous groups not only threatens wild populations but also appropriates sacred traditions.

Western spiritual movements have driven international demand since the 1980s, with a recent study from the Netherlands showing a strong preference for white sage among smudge stick users. Many consumers are drawn by the plant’s association with Native American spiritualism, deepening the market’s reach (2).

Yet, there are glaring gaps in our understanding of the global supply chain. On major e-commerce platforms, several Chinese companies offer bulk white sage, but sourcing and buyer information remain opaque. No comprehensive tracking system exists for international sales, leaving researchers and advocates in the dark about the true scale of the trade. Essential oil derived from Salvia apiana is also a popular scent for candles and other products.

For Indigenous peoples such as the Cahuilla, Diegueno, Luiseno, Mahuna, Chumash, Tongva, and Serrano, white sage is an indispensable part of life. Its seeds are edible, its leaves used as a spice, and its medicinal properties harnessed to calm nerves, treat colds, and act as a diuretic. The spiritual dimension is paramount; for the Chumash, tending to the spirit is integral to healing the body, and white sage plays a key role in maintaining spiritual wellbeing.

Since the 1980s, white sage has been embraced by a variety of cultures and spiritual movements. Burning sage leaves for ceremonial fumigation has grown popular far beyond Indigenous communities, with New Age, Neopagan, and Wiccan groups driving demand for smudge sticks and related products.

Although Salvia apiana is not formally classified as endangered, its conservation status is precarious. Intense commercial demand and environmental pressures have led to misconceptions and unsustainable harvesting. Legal collection is strictly regulated, permitted only on private land with proper permissions or from certified sustainable sources. Unfortunately, lax enforcement and unclear regulations have allowed habitat degradation to continue.

Amid these challenges, hope springs from grassroots efforts and community-based conservation. Local environmental organisations, Indigenous groups, and conservationists are leading the charge, focusing on cultivation, habitat restoration, and education. Protected areas like the North Etiwanda Preserve provide a haven for native species and ceremonial access for Indigenous peoples, while home cultivation and community stewardship promote biodiversity.

To reduce pressure on wild populations, advocates encourage consumers to choose sustainably sourced or home-grown white sage. Educational campaigns — such as Saging the World — seek to inform the public about responsible sourcing and the importance of respecting Indigenous practices (3).

The central message is clear: plants are not mere resources, but relationships. By viewing Salvia apiana through this lens, we can support both ecological resilience and the preservation of traditional knowledge. United Plant Savers has submitted white sage for Red Listing status to bring more international attention. Plants in trade have very little protection, so it’s up to us to ask important questions and take a stand.

The success of ongoing initiatives depends on collective action, the integration of traditional ecological knowledge, and the amplification of Indigenous voices. By working together, stakeholders can ensure that Salvia apiana — and the cultural practices intertwined with it — survive and thrive for generations to come. White sage’s plight is a microcosm of broader tensions between commerce, culture, and conservation. As demand continues to rise, so too does the responsibility to safeguard its future.

Through informed choices, respect for tradition, and active stewardship, we can honor the legacy of white sage and help it flourish in the wild and in the hearts of those who cherish it. Whether you burn a smudge stick or simply admire its silvery leaves on a hillside, remember: the story of white sage is one of resilience, community, and the enduring power of nature and tradition.

1. California Native Plant Society. White Sage Protection. California Native Plant Society. Accessed February 13, 2026. https://www.cnps.org/conservation/white-sage 
2. Geertsma IP, Zandstra BE, Stefanki A, van Andel TR. Commercialized “smudge sticks” used as incense in the Netherlands: an inventory of plants and trends behind a New Age fashion. Plants. 2024;13(3003):1–15.
3. Saging the World [film]. Directed by David Bryant, Rose Ramirez, and Deborah Small; produced by Rose Ramirez, Deborah Small, and California Native Plant Society. 2022. Available at: https://www.youtube.com/watch?v=_V7NoB1UPU8 Accessed February 13, 2026.

• 3 large garlic bulbs
• 500 g raw, organic, unpasteurised honey

1. Peel the cloves and slightly crush or bruise each clove but do not cut or mince. 
2. Place the garlic into a 750 ml kilner jar.  
3. Pour the honey over the garlic, making sure all the garlic is fully submerged. 
4. Leave 2–3 cm of space at the top. 
5. Stir gently to remove all air bubbles. 
6. Ensure no garlic is exposed above the honey. There is the option to use a fermentation weight, or a small saucer to ensure all the garlic is fully submerged. 
7. Allow to ferment for between 4–6 weeks. 

Take one teaspoon of the honey at the first sign of symptoms. For a more potent dose, include a garlic clove in the spoonful. 

Honey has a demulcent action, and therefore this remedy can be used to soothe sore throats and coughs. 

Avoid in infants under one year old.

Storing the honey at room temperature will allow the gentle fermentation to occur, whereas cooler temperatures will limit fermentation.

Garlic (Allium sativum): A broad spectrum antimicrobial herb, expressing antibacterial, antiviral and antifungal properties, including against gram positive, gram negative and some antibiotic resistant strains in vitro (5,6).

Garlic also provides considerable cardiovascular support, and research shows it can reduce both systolic and diastolic blood pressure, helping to support those with hypertension (7,8). Many of its medicinal actions result from levels of alliin and allicin, the latter of which is released upon breaking a clove, whilst the former is stable in intact garlic (9).

What other herbs can I add to fermented honey?

Additional herbs such as thyme (Thymus vulgaris), rosemary (Rosmarinus officinalis) or ginger (Zingiber officinale) can be added for additional antibacterial and antiviral actions. The ginger has its own natural sugars and water content and so, will increase fermentation activity slightly and more bubbles may be noticeable, however it will still be self limiting (3). 

How do I know if my garlic honey ferment has gone off?

Normal signs of fermentation include smelling sweet, garlicky or slightly savoury; gentle bubbling and garlic darkening or softening. The honey will also naturally become thinner over time. If there are any signs of mould (white, green, black or blue); the garlic is exposed above the honey with mould growth or there is a rotten smell then discard the ferment on the compost (3,4). 

Can garlic honey cause botulism?

The risk is extremely low as honey is acidic and has a high sugar concentration. No extra water is added to the ferment. Follow the precautions mentioned above to minimise the risk including submerging the garlic and not adding water (3). 

1. Eteraf-Oskouei T, Najafi M. Traditional and Modern Uses of Natural Honey in Human Diseases: A Review. Iranian Journal of Basic Medical Sciences. 2013;16(6):731. https://pmc.ncbi.nlm.nih.gov/articles/PMC3758027/ 
2. Palma-Morales M, Huertas JR, Rodríguez-Pérez C. A Comprehensive Review of the Effect of Honey on Human Health. A Comprehensive Review of the Effect of Honey on Human Health. 2023;15(13):3056-3056. https://doi.org/10.3390/nu15133056 
3. Katz SE. The Art of Fermentation : An In-Depth Exploration of Essential Concepts and Processes from around the World. Chelsea Green Pub; 2012.
4. Redzepi R, Zilber D, Sung E, Troxler P. The Noma Guide to Fermentation. New York Artisan; 2018.
5. Li G, Ma X, Deng L, et al. Fresh Garlic Extract Enhances the Antimicrobial Activities of Antibiotics on Resistant Strains in Vitro. Jundishapur Journal of Microbiology. 2015;8(5). https://doi.org/10.5812/jjm.14814 
6. Mcintyre A. The Complete Herbal Tutor : The Definitive Guide to the Principles and Practices of Herbal Medicine. Aeon; 2019.
7. Wang HP, Yang J, Qin LQ, Yang XJ. Effect of Garlic on Blood Pressure: A Meta-Analysis. The Journal of Clinical Hypertension. 2015;17(3):223-231. https://doi.org/10.1111/jch.12473 
8. Ried K. Garlic Lowers Blood Pressure in Hypertensive Individuals, Regulates Serum Cholesterol, and Stimulates Immunity: An Updated Meta-analysis and Review. The Journal of Nutrition. 2016;146(2):389S396S. https://doi.org/10.3945/jn.114.202192 
9. Amagase H. Clarifying the Real Bioactive Constituents of Garlic. The Journal of Nutrition. 2006;136(3):716S725S. https://doi.org/10.1093/jn/136.3.716s 

Where low mood and melancholia has not reached the status of clinical depression, there are remedies derived from nature which offer natural approaches to lifting the spirits. In observing the cyclical patterns of nature, we can be afforded some comfort in the knowledge that as humans, we are a part of this cycle and feeling the need for rest and a turning inwards is a reflection of this rhythm.  At the very darkest, coldest, lifeless part of the year when many animals hibernate and are in a state of metabolic depression, studies have demonstrated neurobiological similarities to clinical depression, including changes in cortisol, neurotransmitters, metabolism and other biomarkers (3). Occurring at the same time, seeds and rootstocks are also at their most potent, conserving energy to use later for spring growth (4). 

Hibernating animals rest in the awareness that they will emerge with the next turn of the seasons. For many centuries humans have adapted to the cold, quiet darkness with a shared instinct to foster joy, connection and ritual such as the northern hemisphere midwinter festivals, Christmas, the Roman Saturnalia, Jewish Hannukah, Slavic Koliada, pagan Yule, Persian Yalda, or Asian Dongzhi, are all a call for celebration and community. Earlier in the season the Hindu festival Diwali symbolizes the victory of light over darkness and good over evil. Often the best way to beat the winter blues is in accepting the inherent cyclical nature of the world, and that  darkness has its role in the cycle as the precursor of light and life.

Being able to get out for a walk in nature, taking a moment to observe and be present with the plants, can be enormously enriching and mood enhancing, offering a subtle but profound healing opportunity. Nature can also be brought into the home— in Japan, small gardens are often found on doorsteps, balconies and small corners, bringing life to dense  urban landscapes. Tending a garden, even in pots, is a great source of serenity. The act of walking can also be significant as exercise is an efficient and rapid way to stimulate neurotransmitters including serotonin and dopamine which are responsible for uplifting mood  (5). 

In respecting the cycle of the seasons one is also in connection with the natural instinct to sleep and eat more. In Ayurveda winter is known as kapha time, time to build resources for the hungry gap in spring, when historically people would have worked hard to get the crops in and be left with limited food supplies. A gentle increase in body weight during winter is a normal physiological response to reduced activity, daylight and hormonal shifts, this often reverses itself in spring (6). Similarly, the need for extra sleep and change is impacted by lower light and colder temperatures (7).  

The following plants bring some of the comforting qualities of nature to support the body and mind during the winter period. Each is a powerful tool for lifting the spirits. The best approach is to get to know each herb as an individual first. Ideally, make a single preparation, perhaps a cup of strong tea or decoction, and build up towards a higher dose, the maximum from the range provided below. Taken in this form, at robust levels, benefits can be rapidly felt  and it is soon possible to work out which is most helpful. They can be experimented with to discover which ones resonate best with the body’s constitution. 

These herbs are not antidepressants in the conventional sense. Instead, in different ways they strengthen the constitution, offer a sense of calm and an ability to cope better, whilst also reducing inflammatory pressures on the brain.St John’s wort, widely thought of as a herbal antidepressant, is traditionally used as a tonic specific for the winter months to help bring in the light, offering a feeling of resilience (8). 

For more in depth information on these herbs, please see our herbal monographs. 

Brahmi (Bacopa monnieri)

A classic Ayurvedic brain tonic, and saponin-rich adaptogen, Brahmi appears to work in a number of ways to protect brain cells and improve cognitive functions, especially when these are challenged by long-term stresses, illnesses and ageing (9). It has been used to help recover from chronic fatigue and associated low energies. Brahmi is also calming and helps directly in anxiety and tension conditions, and in helping cope with stress (9,10).

The recommended dose is 2–6 grams of the dried leaf per day, either as  tea or, as popularly taken in India, several teaspoons of the fresh leaf juice (9). Dosages are meant as a guideline only, and it is recommended to consult a medical herbalist for safety considerations. 

Cinnamon (Cinnamomum verum)

This common spice offers an organoleptic treat, with good quality cinnamon stimulating the taste buds and warming the body. Cinnamon is particularly useful in facilitating recovery from illness or chronic fatigue, and especially for those who are particularly prone to feeling the cold (8) It helps restore a healthy appetite and reduce digestive problems such as sluggish digestion that can be associated with being run down. To increase the heating quality and stimulate more warmth, combine it with fresh ginger (Zingiber officinale) in a tea. Cinnamon can be combined with any of the other herbs on this list as a stimulating, warming remedy (9). 

Take a teaspoonful of freshly powdered cinnamon (Ceylon cinnamon has the most complex flavour profile), add 50 ml of boiling water, stir and steep for 5–10 minutes and sip. Feel the mix of spicy and sweet tones reverberating at the back of the mouth, with a slightly woody quality, followed by a warmth emanating from the chest chest. A slight bitterness can be experienced afterwards, with a profound sense of warmth moving throughout the entire body. 

The suggested dose of cinnamon powder is up to 8 grams per day (9).

Gotu kola (Centella asiatica)

This popular traditional Asia restorative tonic is revered in Asia for ‘opening the mind’, sometimes accompanying meditative practices as a tea. Taken in this way, gotu kola offers an initial bitter flavour, followed by an  aromatic sweetness. It has a particular effect in supporting cognitive function, including improving memory and concentration, especially when these are compromised by increased  stress (9,10).

The dose starts at 3 grams of dried leaf per day, titrating up to 30 grams, if the initial dosage has proved effective with no unwanted side effectsGotu kola is traditionally consumed as a tea (8–10). 

Rosemary (Salvia rosmarinus)

There is something inherently uplifting about the smell and taste of this common garden herb— it can be felt heading straight to the brain. Rosemary is an excellent tonic to raise spirits and boost recovery after illness or periods of low energy. Even inhaling the fresh leaf from a garden or window box will stimulate mental energy and the tea taken internally will expand on this effect. 

There is promising evidence that rosemary may reduce inflammatory pressures on the brain now implicated in many conditions associated with low mood and depression, including chronic fatigue syndrome, dementia as well as clinical depression. Further research indicates it can improve cognitive performance in the elderly adding to its reputation as a  brain tonic (11).

Taking rosemary as a tea can be overpowering, however very uplifting. The dose is up to 4 grams a day of the dried leaf (9).

St. John’s wort (Hypericum perforatum)

This is often described as the herbal antidepressant, however it has a much wider range of actions than its mood enhancing properties. The herb and flowers of St. John’s wort have been used in European traditions to relieve nervous tension and anxiety. Importantly, this calming effect is combined with underlying restorative benefits and the plant was also used as a convalescent treatment for melancholic conditions, depression and recovering from illness or trauma (8–10).

This makes St John’s wort ideal in situations where tension and exhaustion combine. Its most useful modern application is towards a programme of recovery from chronic fatigue conditions. It also has a long reputation as a support to those experiencing symptoms during the menopause (8,10).

Note that St John’s wort has been shown as an active inducer of drug metabolism, so it may reduce the activity and active life of many medicines. It is wise to avoid in conjunction with medications and consult a medical herbalist for further guidance (8–10).  it if there are any powerful treatments underway, where reducing the effect of a medicine may be critical.

St John’s wort can come in a variety of preparations, including powder, tincture and tea. It is recommended to combine the herb with others as a tea, for flavour considerations, however the easiest is to take it as a tincture. The traditional calming and tonic dose was the equivalent of 2 to 5 grams of the dried leaf and flowers per day (9). 

1. Heald A, Stedman M, Farman S, Ruzhdi N, Davies M, Taylor D. Seasonal Variation in Antidepressant Prescribing. The Primary Care Companion For CNS Disorders. 2021;23(2). https://doi.org/10.4088/pcc.20m02790 
2. Clery E, Morris S, Cooper C, Das-Munshi J, McManus S, Weich S. Mental health treatment and service use. Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England. Published online 2025.
3. Tsiouris JA. Metabolic depression in hibernation and major depression: An explanatory theory and an animal model of depression. Medical Hypotheses. 2005;65(5):829-840. https://doi.org/10.1016/j.mehy.2005.05.044 
4. Klupczyńska EA, Pawłowski TA. Regulation of Seed Dormancy and Germination Mechanisms in a Changing Environment. International Journal of Molecular Sciences. 2021;22(3):1357. https://doi.org/10.3390/ijms22031357 
5. Ren J, Xiao H. Exercise for Mental Well-Being: Exploring Neurobiological Advances and Intervention Effects in Depression. ProQuest. 2023;13(7):1505. https://doi.org/10.3390/life13071505 
6. Fahey MC, Klesges RC, Kocak M, Talcott GW, Krukowski RA. Seasonal fluctuations in weight and self-weighing behavior among adults in a behavioral weight loss intervention. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. Published online May 15, 2019. https://doi.org/10.1007/s40519-019-00707-7 
7. Honma K, Honma S, Kohsaka M, Fukuda N. Seasonal variation in the human circadian rhythm: dissociation between sleep and temperature rhythm. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 1992;262(5):R885-R891. https://doi.org/10.1152/ajpregu.1992.262.5.r885 
8. Hedley C, Shaw N. Plant Medicine. (Waddell G, ed.). Aeon Books; 2023.
9. Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013.
10. Mcintyre A. Complete Herbal Tutor : The Definitive Guide to the Principles and Practices of Herbal Medicine (Second Edition). Aeon Books Limited; 2019.
11. Rahbardar M, Hosseinzadeh H. Therapeutic effects of rosemary (Rosmarinus officinalis L.) and its active constituents on nervous system disorders. Therapeutic effects of rosemary (Rosmarinus officinalis L) and its active constituents on nervous system disorders. 2020;23(9). https://doi.org/10.22038/ijbms.2020.45269.10541 

Indigenous and traditional cultures

The most underrepresented of herbal medicine traditions in terms of national recognition among world cultures are indigenous traditions, and they are the most robust from the perspective of traditional integrity. These are represented by traditional African, Amazonian, South American, select North American herbal traditions, and other traditional herbalists whose primary regulatory pressures are based on who can successfully provide herbal health to their communities. The majority of traditional herbalists practice in rural areas, but for some, work also spills over into cities.

Botanicas are an example urban herbal workplace as herbal shops with histories tracing back to the ancient Aztec traditions that emerged as sanctuaries for Hispanic-Americans looking either for culturally-oriented healing practices or as alternatives where access to dominant health care services is limited (1). While there are efforts to bring regulations to traditional healers worldwide, true traditional herbal healers remain an integral part of communities and derive their legitimacy from community trust, not government oversight. At the same time, these healers follow well-established standards of training, ethics, and cultural restrictions rooted in their own traditions. 

In some African traditions, training is meticulous and requires several months to years depending on the ability of the student to learn (2). Traditionally, Ayurveda was learned through the Guru-Shishya Parampara/Gurukula system of education in which the student lived with the family of the teacher, sometimes for many years and remained devoted to that teacher throughout their life. They were expected to be steeped in the classic literal knowledge base of the vedas, samhitas, and nighantus, including the memorisation of hundreds of mantra and slokas that conveyed, not only the knowledge of anatomy, physiology, pathology, and treatment protocols, but mantra and invocations between student and teacher, teacher and student, harvesting of the plants, making of the medicines, and much more (3).

In China, in addition to having a similar apprenticeship model as in India, herbalists needed an intimate knowledge of the best sources of herbal medicine (dao di yao cai — “authentic regional medicinal materials”) (4). This concept refers to the understanding that the therapeutic quality and potency of a medicinal plant depend not only on its species, but also on the geographical origin, soil composition, climate, and traditional processing techniques associated with that region (4). 

In some indigenous North American traditions, grandmothers would not allow their students to pick an herb before they were 16 years old, because if they picked a herb for medicine without having the maturity to be in relationship with the plant it could foul the medicine. In most traditional cultures, it was the teacher who decided when the apprentice or student was ready to practice and the community subsequently accepted that individual as the next generation healer. From then, the new healer either succeeded or did not, based on her or his ability to offer their patients effective medicine. Conversely, traditionally across cultures, every household had family members who possessed greater or lesser degrees of folkloric knowledge to deal with everyday ills and spills, yet they would not specifically self-identify as being a healer or herbalist.

Herbs as supplements

While traditional and indigenous herbal practices continue to operate largely outside formal regulatory frameworks, the globalisation and commercialisation of medicinal plants has necessitated new approaches to oversight. As botanicals entered retail and international markets, regulators sought mechanisms to ensure consumer safety and quality without imposing the full evidentiary requirements of pharmaceutical approval. 

The US was the first country to adopt this formal regulatory model, which categorises botanicals as a subcategory of foods rather than therapeutic agents. This governs the trade of herbs that are in the public domain, without the need for pre-authorisation or formal toxicological studies due to precedent of historic use in the same manner as conventional foods are allowed without formal testing. In most countries, supplements are allowed to display ‘soft’ claims in herbal product packaging — such as “aids sleep” or “supports digestion”.

Herbal supplements, however, cannot be marketed for the prevention or treatment of any specified disease and must be manufactured with varying good manufacturing practices, among other regulatory requirements. Numerous countries including the US, members of the European Union (EU), and Japan, among others, regulate a variety of natural products as supplements. In this framework, herbs transition from a culturally governed, community-based practice to a commercially regulated domain, enabling broader public access while maintaining safety standards and acknowledging historical use.

Examples of herbs as supplements and the claims they are able to make under this regulation include St John’s wort (Hypericum perforatum) — “supports mood”, echinacea (Echinacea purpurea) — “supports immunity” , and milk thistle (Silybum marianum) — “supports liver health”.

Herbs as traditional medicines

In many countries, regulators recognised that certain herbal products had a long-standing history of safe and effective use. To accommodate this, frameworks were developed to formally acknowledge traditional medicines, which exist throughout Asia, Europe, and India. Ingredients used in traditional medicines must be safe for their intended use, must be documented as having been in the public domain for a material length of time, and are recognised for their traditional use. Traditional medicine products can be marketed as traditional medicines with specific claims depending on the extent of documentation supporting the claim, and varying models for assessing safety, efficacy, and product registration exist. 

In most of these countries, traditional medicines must be made according to traditional principles, with some countries (e.g., Japan) conforming strictly with exacting recipes (Kampo formulas), while others (e.g., China) allow for formula modification of individual patients. Canada maintains a unique regulatory framework of Natural Health Product that is much like the traditional medicine model. Similarly, Australia’s Therapeutic Goods Act 1989 governs complementary medicines under the Therapeutic Goods Administration (TGA), allowing herbal and vitamin products to be listed on the Australian Register of Therapeutic Goods (ARTG) when supported by traditional or low-risk evidence.

In most cases, the botanical ingredients used in traditional medicine products must comply with pharmacopoeial standards of the respective country, as well meet numerous other regulations (e.g., mandatory adverse effects reporting) (5). Until their exit from the EU, the UK was similarly beginning to implement the traditional medicine protocols of the EU. However, the UK also maintains their own Human Medicines Regulations (2012) specifically for products, while separate provisions exist in Ireland and elsewhere.

Examples of herbs under traditional medicines regulation in the UK include A. Vogel Echinaforce, containing echinacea (Echinacea purpurea), which under THR is permitted to state that it is “to relieve the symptoms of cold and flu-type infections”and Weleda’s Arnica Spray, containing arnica (Arnica montana) indicating its use “​​for the relief of minor sports injuries, bruises, muscular pain, stiffness and sprains”(5).

The same herb can be regulated differently depending on formulation, intended use, and presentation. In the US, valerian (Valeriana officinalis) sold as a dietary supplement may claim to “support relaxation” under food law. In the UK, a standardised extract marketed for “mild sleep disturbances” is regulated as a traditional herbal medicine under the THMPD, as in Canada under the Natural Health Products it may be labelled as “for relief of occasional sleeplessness (insomnia)”(6). So, intended use and presentation determine classification, which in turn defines allowable claims.

Botanical drugs

Some plant-derived products demonstrate sufficient evidence of safety and efficacy to qualify as therapeutic agents. Regulatory authorities, notably in the US, introduced a botanical drug approval process by which a drug of botanical origin, or some derivation of a plant or plant molecule, can attain formal drug approval by undergoing rigorous testing and approval similar to conventional pharmaceuticals (7). Examples of botanical drugs include Veregen, a topical FDA-approved treatment for genital warts derived from green tea (Camellia sinensis); Fulyzaq, a dragon’s blood tree (Croton lechleri) derivative approved by the FDA for non-infectious diarrhoea in HIV patient populations; and Qutenza, a topical chilli (Capsicum annum) preparation approved by the EMA for neuropathic pain and neuralgia (8,9).

Unlike the US, which maintains a distinct botanical drug category for plant-derived products supported by clinical evidence, the UK technically provides a similar pathway through full marketing authorisation. However, in practice, very few herbal products pursue this route due to the high financial demands and extensive clinical trial data requirements. Consequently, the UK market is dominated by two main categories: Herbs marketed as food supplements, and traditional herbal medicines registered under the Traditional Herbal Registration (THR) scheme. Thus, while a botanical drug pathway exists in principle, it is largely unused, meaning that the UK effectively operates with only two widely accessed regulatory categories.

Further to this, there is an idiosyncratic regulation in the UK permitting herbalists to prescribe unlicensed herbal remedies as magisterial prescriptions after a one-to-one consultation. However, there is no statutory or legally recognised definition of what constitutes a herbalist.

Different countries display varying degrees of acceptance of botanical medicines by health professionals and regulators. Generally speaking, Asia, India, and select countries in Africa, are strongly supportive of botanical medicine, while US regulatory and medical professionals are, generally, antagonistic towards botanical products. Canada and members of the EU can be described as moderately supportive of botanical medicine initiatives. However, Canada and the EU preferentially display a greater level of acceptance for Western herbs, and generally lack approval for most non-Western botanicals (e.g., Ayurvedic or Chinese medicines).

In the EU, this is in part owing to the requirement that herbal products must demonstrate a minimum of 30 years of medicinal use, including at least 15 years within the EU, to qualify for simplified registration — a requirement often less attainable for non-Western botanicals (10). Moreover, whereas quality control standards for multi-ingredient formulas are present in the respective pharmacopoeias of China and India, the European Pharmacopoeia, US Pharmacopeia, and others, have no entries for formulas outside of Western herbal traditions, and even Western herbal combinations are rarely included. This reflects a bias for single herb preparations over multi-ingredient formulations.

In the majority of countries, the trade of herbal products are overseen by the national regulatory authorities. The cost of approval of a traditional herbal medicine varies widely and is not clearly disclosed in the literature. but estimates range from more than $100,000 in England to $300,000,000 in the US, creating substantial barriers to market entry for new herbal medicine products (11). 

Market entry as a supplement is much less costly, generally only consisting of general business costs, while in some countries (e.g., Ghana) the government actively supports the safety and quality assessment of traditional medicines for traditional herbal medicine knowledge holders specifically to facilitate the availability of herbal products to consumers (12).

In most countries, individual herbalists are exempt from industry-mandated good manufacturing practices (GMPs), though the US Food and Drug Administration maintains the authority to require individual practitioners to meet the same GMPs as commercial manufacturers though to date, they have not imposed this requirement.

The World Health Organization (WHO) has supported the integration of traditional medicine practices including herbal medicines as integral to human health care for decades and have developed numerous works to advance traditional medicine globally. In 2023, WHO’s Gujarat Declaration proclaimed to all nations of the world that traditional medicine knowledge and the integration of traditional practices with modern medicine is critical to human health (13). This has created a directive for all countries to embrace traditional medicine knowledge, including botanical medicine.

While WHO can support these efforts, it is ultimately the responsibility of respective countries to implement WHO recommendations, and different countries do this to greater or lesser degrees with countries such as Bhutan, China, Ghana, India, Malaysia, and Turkey, to name a few, making great strides in advancing herbal medicine as a viable public healthcare option.

1. Tucker AO, Jules J. 2019. Aztec Botany, Agriculture, Trade, and Medicine: Flora of the Voynich Codex, Springer International Publishing, pp. 13-24, https://doi.org/10.1007/978-3-030-19377-5_2  
2. Mokgob MG. 2014. Understanding traditional African healing. Afr J Phys Health  Sep;20(Suppl 2):24-34.
3. Sihag J, Jain R. 2024. Enlightening the Principles of Traditional Learning Methods through Ayurveda. Journal of Ayurveda and Integrated Medical Sciences 9(1): 207-210.
4. Zhao ZZ, Guo P, Brand E. 2012. The formation of daodi medicinal materials. Journal of Ethnopharmacology 140: 476-481.
5. UK Government. Currently Approved Traditional Herbal Registrations (THRs) — granted to 06-08-2024. London, UK; 2024. Accessed October 2025. https://assets.publishing.service.gov.uk/media/66be02d13effd5b79ba49153/THRs_granted_to_06-08-2024_14-08-2024_final.pdf
6. Health Canada. Valerian Labelling Standard. Guidance: Valerian (Valeriana officinalis). Accessed October 14, 2025. https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/applications-submissions/guidance-documents/nonprescription-drugs-labelling-standards/valerian.html
7. Picking D. 2017. The Global Regulatory Framework for Medicinal Plants. Pharmacognosy, Fundamentals, Applications and Strategies: 663-675.
8. U.S. Food and Drug Administration. What is a botanical drug? Updated Jan 7, 2025. Accessed October 13, 2025. https://www.fda.gov/about-fda/cder-offices-and-divisions/what-botanical-drug
9. European Medicines Agency. Qutenza: EPAR – Product Information. Updated May 15, 2009. Accessed October 13, 2025. https://www.ema.europa.eu/en/medicines/human/EPAR/qutenza
10. European Medicines Agency. Herbal medicinal products. Published August 15, 2007. Accessed October 10, 2025. https://www.ema.europa.eu/en/human-regulatory-overview/herbal-medicinal-products
11. Medicines and Healthcare products Regulatory Agency (MHRA). Traditional Herbal Registration Scheme: Fees. London, UK; 2024. Accessed October 16, 2025. https://www.gov.uk/government/publications/traditional-herbal-registration-scheme-fees
12. Donor 2025, personal communication to AHP.
13. [WHO] World Health Organization. 2023. Gujarat Declaration. Traditional Medicine Global Summit. August 2023, Gujarat, India

Ivy (Hedera helix)

The aim was to carry out a randomised placebo-controlled trial to explore the safety and efficacy of ivy leaf cough liquid for acute cough in adults.

Patients

N=181 patients with cough were randomly assigned to receive an ivy remedy or placebo across four clinical locations in Germany. Patients were aged 18–75 years, were male and female, and had acute cough 2–3 days prior to enrolling onto the study. Patients were excluded if they had asthma, chronic bronchitis or any other chronic lung disease amongst other criteria.

Treatment

Groups received a liquid with ivy leaf extract (35 mg EA 575® ivy leaves dry extract) or inert placebo three times per day for seven days. No further details on the nature of the placebo were given — i.e., was it a similar liquid in a similar bottle and packaging? During the course of treatment any other medications that influenced bronchitis or mucociliary clearance were not permitted.

Outcomes

For the main outcome, cough severity was measured by visual analogue scale (VAS, a 100 mm scale) over the treatment period of seven days. Measures were taken at daily visits to the clinic which took place on days 2–7 (visits 1–6). The area under the curve was calculated from this VAS data.

For secondary outcomes, cough severity was measured by Bronchitis Severity Score (BSS) and Verbal Category Descriptive score (VCD). A Global Efficacy Assessment (GEA) at V5 and V6 was carried out and two questions were asked on the efficacy of the treatment completed by patients and investigators.

The study examined the effects of a liquid cough remedy containing EA 575 a dried extract of ivy leaf (ratio of 5–7.5:1, ivy:extraction solvent); the remedy contained 35 mg EA 575 (manufactured by Prospan, Germany).

N=181 patients with cough were randomly assigned to receive ivy or placebo; some subjects were lost to follow-up and in all there were n=88 in the ivy group and n=90 in the placebo group who completed the study.

Regarding the ivy versus placebo groups, the mean ages, gender splits and other demographics like ethnicity and blood pressure were similar between the groups. The mean age was around 36 years and there were near equal splits of males and females across groups.

Cough severity VAS

The ivy cough liquid group saw a significant reduction in cough severity with the mean area under the curve (AUC) reduced compared to the placebo group (p <0.0001). Looking at the time-point data, the ivy cough liquid was a significant improvement at the first visit (V1) and persisted as better through to the end of the study.

Secondary outcomes

For the other secondary outcomes, the cough severity monitored by the BSS and VCD scores were similar between groups at baseline, but were significantly reduced in the ivy cough liquid group compared to placebo. Looking at the separate visits, the BSS (bronchitis severity) improved for the ivy liquid again by visit 1 and was consistently better through to the end of the study compared to the placebo.

For the global efficacy assessment (GEA), patients taking the ivy liquid rated the medication better than the placebo group, and rated themselves as generally feeling better.

Adverse events

Adverse events were recorded in some of the ivy liquid patients (n=9) and placebo patients (n=12). Mostly these were a single adverse event which included worsening cough or sinusitis. Compliance was good.

Ivy leaf extract is a remedy for chesty coughs, acting as an expectorant and dilating the bronchial vessels (2). This randomised, placebo-controlled trial of patients with acute cough showed that ivy leaf cough liquid taken three times a day for seven days reduced the severity of cough symptoms compared to an inactive placebo. The outcomes included a visual analogue scale and bronchitis severity scale; both showed improvements upon the first visit and for each subsequent visit compared to the placebo.

Symptoms of cough do ease by themselves, so the improvements seen at the early visits are a significant finding and would have equated to approximately day three onwards of the cough starting, given that patients entered the study after about two days of seeking help. The global assessment questions showed that the patients reviewed the ivy leaf cough liquid as effective, more so than the placebo liquid.

One limitation of the study was a lack of information regarding the placebo. Was it similar to the ivy product in taste, smell, labelling and packaging? The authors also reviewed whether there was a centre effect or any differences in outcome at the four locations; one location did not observe any significant differences but they suggest this would be normal within a spread of data across different clinics.

The mean age of participants was 36 years, and the authors looked at eight subjects separately who were aged 65–75 years, and the safety profile was similar to the groups overall. This is an important consideration to ensure that the ivy product was safe within a group who can be more vulnerable to coughs.

An ivy leaf remedy containing an extract relieved acute cough symptoms in adults compared to a placebo. The remedy given for seven days provided instant relief and was consistently effective throughout the study and better than the placebo. The liquid was well tolerated and safe.

1. Schaefer A, Kehr MS, Giannetti BM, Bulitta M, Staiger C. A randomized, controlled, double-blind, multi-center trial to evaluate the efficacy and safety of a liquid containing ivy leaves dry extract (EA 575^®) vs. placebo in the treatment of adults with acute cough. Pharmazie. 2016 Sep 1;71(9):504-509.  https://doi.org/10.1691/ph.2016.6712 
2. European Medicines Agency (2018). Ivy leaf Hederae helicis folium – herbal medicinal product. https://www.ema.europa.eu/en/medicines/herbal/hederae-helicis-folium 

• 10 g turkey tail mushroom 
• 10 g reishi 
• 10 g artist’s conk 
• 10 g birch polypore 
• 20 g fresh ginger
• 1 tbsp dried orange peel 
• 10 green cardamom pods 
• 2 cinnamon sticks 
• 8 cloves 
• 3 star anise 
• 2 tsp black pepper
• Pinch nutmeg 
• 500 ml local organic raw honey (use agave as an alternative for vegan diets)
• 1 litre filtered water 
• Muslin cloth

1. Combine all of the mushrooms in a saucepan and cover with one litre of water. 
2. Bring to a boil then turn down the heat to a gentle simmer. 
3. Simmer gently for 1.5–2 hours on a low heat, making sure to top up with extra water if needed. 
4. There will, ideally be between 600–700 ml of liquid remaining. 
5. Add all the remaining ingredients aside from the honey back into the decoction. 
6. Simmer gently for another 10–15 minutes, being careful that the mixture doesn’t boil. 
7. Allow to cool slightly, then strain the mixture through fine muslin. 
8. There should be roughly 500 ml mixture remaining. 
9. Add in 500 ml honey and stir gently to dissolve. Taste the mixture, and add more honey if desired. 
10. Pour into sterilised glass jars, label and store in the fridge. 

• Add 30 ml (two tablespoons) to a cup of black tea and milk. 
• Add 50 ml to a cup of milk and gently mix for a cup of mushroom chai.

The more honey added, the longer the syrup will last. A 1:1 honey to liquid ratio will last roughly one month in the fridge.

Turkey tail

Found growing wild in the UK, turkey tail is a medicinal mushroom which is most renowned for its effect on supporting immune function. The polysaccharides — PSP and PSK stimulate NK (natural killer) cells, T cells, B cells and macrophages, indicating its support for both innate and adaptive immunity (3). 

Reishi

The polysaccharides and beta-glucans in reishi stimulate key immune cells including macrophages, NK cells, T and B lymphocytes. They also modulate inflammatory cytokines, acting as an immunomodulator (4). 

Birch polypore

Birch polypore has antimicrobial, anti-inflammatory and immunomodulatory effects. The beta glucans, similarly to reishi, also act to stimulate key immune cells including macrophages and NK cells in turn increasing phagocytosis and thus helping to fight infection and inflammation (5). 

Artists conk

A well known remedy in traditional folk medicine, the artist’s conk is a distant relative of reishi and exhibits many similar actions on the immune system (2). It has been shown in modern research to have antibacterial, anti-inflammatory and antioxidant actions (6,7). 

Ginger

A warming, pungent circulatory stimulant, ginger is a key herb for supporting the immune system due to its antibacterial, antiviral and anti-inflammatory actions. It helps to increase absorption, settle the digestive system and expel mucus from the lungs (1,8). 

Nutmeg

Most well renowned for its stimulating, supportive effect on the brain, nutmeg can be applied to promote circulation to the brain and easy anxiety. It can also be used to support digestive function, as well as be applied as a decongestant and antimicrobial for coughs and colds (8). 

Cinnamon

Cinnamon is an aromatic bark which is used as a warming circulatory stimulant and immune support. Rich in volatile oils, this herb is powerfully antimicrobial, antiviral and antifungal, helping to clear infections, reduce fever and dry mucus (8). 

Cardamom

Cardamom is a spicy aromatic used to warm, invigorate and support digestive function. The volatile oils also offer antimicrobial actions, specifically against gram-negative bacteria and fungi (8,9). 

Cloves

A powerful antimicrobial, clove has been used in traditional medicine for its antibacterial and antifungal properties (8). 

Star anise

Containing the constituent shikimic acid, star anise is well known to possess powerful antiviral properties against a range of different viruses. Its warming and aromatic compounds also help to support digestive function, and in the treatment of respiratory infections (1). 

Black pepper

Adecongestant, expectorant and digestive stimulant herb, black pepper is a popular spice which offers energising, stimulating and warming properties to support the digestive, immune and respiratory systems (8). 

Is it safe to forage mushrooms?

Safely foraging for mushrooms is a skill that requires guidance and takes time to develop. Whilst the mushrooms listed in this recipe are relatively distinctive in the wild, it is advised to ensure 100% positive identification before consuming any mushroom that has been foraged. 

Is it illegal to consume turkey tail in the UK?

As of 2025, turkey tail is now classified as a novel food. This means it is illegal to commercially distribute (including for free) any product containing turkey tail to the public. This legislation does not require individuals to obtain authorisation for foraging, possessing or privately consuming turkey tail. Medical herbalists can still legally prescribe and dispense this as a medicine for their patients (10). 

How do I sustainably forage turkey tail?

Turkey tail is distinct from other mushrooms as it grows year round in the UK, with an increase in fruiting bodies in the autumn and winter. It typically grows on dead wood including oak, beech, birch, sycamore or hazel. Once the spores have entered the wood, it can take between 1–2 years before fruiting bodies are produced. When foraging, only collect turkey tail from dead logs, and aim to take no more than 20% of the fruiting bodies from that log. Using a basket or net bag allows the spores to keep spreading even after they have been foraged (11).

1. Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013.
2. Hobbs C. Medicinal Mushrooms : An Exploration of Tradition, Healing, and Culture. Botanica Press; 2003.
3. Saleh MH, Rashedi I, Keating A. Immunomodulatory Properties of Coriolus versicolor: The Role of Polysaccharopeptide. Frontiers in Immunology. 2017;8. https://doi.org/10.3389/fimmu.2017.01087 
4. Saha TK, Mariom, Rahman T, Moniruzzaman M, Min T, Hossain Z. Immuno-physiological effects of dietary reishi mushroom powder as a source of beta-glucan on Rohu, Labeo rohita challenged with Aeromonas veronii. Scientific Reports. 2023;13(1). https://doi.org/10.1038/s41598-023-41557-9 
5. Grunewald F, Steinborn C, Huber R, et al. Effects of Birch Polypore Mushroom, Piptoporus betulinus (Agaricomycetes), the “Iceman’s Fungus”, on Human Immune Cells. International Journal of Medicinal Mushrooms. 2018;20(12):1135-1147. https://doi.org/10.1615/intjmedmushrooms.2018029154 
6. Cheng M, Zhang L, Wang J, et al. The Artist’s Conk Medicinal Mushroom Ganoderma applanatum (Agaricomycetes): A Mycological, Mycochemical, and Pharmacological Values: A Review. International journal of medicinal mushrooms. 2024;26(7):13-66. https://doi.org/10.1615/intjmedmushrooms.2024053900 
7. Rijia A, Krishnamoorthi R, Rasmi M, Mahalingam PU, Kim K. Comprehensive Analysis of Bioactive Compounds in Wild Ganoderma applanatum Mushroom from Kerala, South India: Insights into Dietary Nutritional, Mineral, Antimicrobial, and Antioxidant Activities. Pharmaceuticals. 2024;17(4):509-509. https://doi.org/10.3390/ph17040509 
8. Mcintyre A. Complete Herbal Tutor : The Definitive Guide to the Principles and Practices of Herbal Medicine (Second Edition). Aeon Books Limited; 2019.
9. Abdullah, Asghar A, Butt MS, Shahid M, Huang Q. Evaluating the antimicrobial potential of green cardamom essential oil focusing on quorum sensing inhibition of Chromobacterium violaceum. Journal of Food Science and Technology. 2017;54(8):2306-2315. https://doi.org/10.1007/s13197-017-2668-7 
10. Food Standards Agency. Novel foods authorisation guidance. Food Standards Agency. Published 2025. https://www.food.gov.uk/business-guidance/regulated-products/novel-foods-guidance 
11. Wild Food Uk. Turkeytail. Wild Food UK. Published January 12, 2022. Accessed January 5, 2026. https://www.wildfooduk.com/mushroom-guide/turkey-tail/ 

Traditionally, herbal supplements were purchased from local health food shops or high-street retailers, where trained staff might answer questions or guide customers toward reputable brands. Today, however, more people are buying supplements online, often from marketplaces offering thousands of products with little or no meaningful governance.

The convenience and sheer range of options have undoubtedly contributed to rising consumption, but they also introduce significant risks. One of the core issues is that the internet provides access to products that may not be subject to the same controls as those sold in stores. As a result, the quality, purity, and even identity of these products can vary widely. This is not to say that all online products are inferior — many excellent, well-established brands operate online — but consumers may assume that all supplements are equivalent, when in reality the variability is substantial.

Further complicating matters is the growing problem of counterfeit products, where consumers believe they are purchasing a reputable brand but are unknowingly buying falsified goods (3).

In response to quality concerns surrounding herbal medicines specifically, the UK adopted the Traditional Herbal Medicinal Products Directive (THMPD) in 2011. This directive established a licensing scheme designed to ensure the quality and safety of herbal medicines based on documented traditional use.

Products registered under this scheme are assessed according to standards similar to those applied to pharmaceuticals, giving consumers confidence in their identity, purity, and safety. Importantly, the directive grants companies’ permission to make medicinal claims — such as that it ‘aids digestion’, ‘promotes sleep’ or ‘relieves fatigue’ — provided these claims are grounded in long-standing traditional use. Any product on the UK market that makes such claims must hold a Traditional Herbal Registration (THR) in order to be legally sold (4).

Food supplements, however, fall under a different regulatory category. Although quality standards exist, the requirements are considerably less rigorous than those prescribed for THR-registered herbal medicines. Enforcement is also far weaker: products found to be adulterated, contaminated, or improperly labelled may remain available online for months, and sometimes reappear even after removal. This patchy oversight creates an environment where poor-quality products can circulate freely, often without consequence.

Research conducted at the UCL School of Pharmacy and the University of Westminster has shed light on the scale of the problem, uncovering numerous issues with supplement quality across a range of popular herbal products. These issues include poor extraction methods resulting in low concentrations of key active compounds, high levels of pesticides, contamination with aflatoxins, and deliberate adulteration intended to reduce production costs and inflate potency claims.

Ginkgo

For example, analysis of ginkgo (Ginkgo biloba) supplements revealed that many products contained added rutin — a cheap flavonoid (as it is abundant in low cost plant sources) — used to artificially boost total flavonoid levels. This allows manufacturers to claim, misleadingly, that their product contains the minimum 24% flavonoids expected of standardised ginkgo extracts.

Some products even included plant species with similar chemical profiles, added as cheaper substitutes for G. biloba. In one particularly concerning case, a product marketed as ginkgo contained none of the plant at all, but instead consisted solely of 5-hydroxytryptophan, a naturally occurring compound with reported antidepressant effects (5).

Rhodiola

A similar problem arose with rhodiola (Rhodiola rosea), a plant long valued in traditional medicine for its adaptogenic properties. Testing revealed that many products either contained or were partially substituted with Rhodiola crenulata, a related species native to China (6). Although chemically similar, R. crenulata lacks rosavin, the compound most strongly associated with the recognised therapeutic effects of R. rosea. Because R. rosea commands a higher price on the global market, substituting or mixing it with R. crenulata provides an economic incentive for manufacturers seeking to reduce costs. While the presence or absence of rosavin can be used to distinguish between the species, the increasing practice of blending the two makes accurate identification more challenging.

St John’s wort

In the case of St John’s wort (Hypericum perforatum), product quality was again highly inconsistent. Many supplements purchased through UK-based websites — but originating from the United States — contained food dyes added to mimic the ultraviolet absorbance of hypericin, one of the plant’s principal active compounds (7).

By absorbing UV light at the same wavelength as hypericin, these dyes allowed manufacturers to create the illusion of higher potency. This type of adulteration not only misleads consumers but also deceives analysts relying on basic UV assays, unless more sophisticated analytical methods are used.

Ashwagandha

Ashwagandha (Withania somnifera) also displayed significant quality variation. Its chemical composition differed markedly from product to product, largely due to differences in extraction methods. Traditional extraction techniques in Asia typically use water, whereas many Western manufacturers use alcohol, altering the phytochemical profile of the final extract. Additional issues included poor labelling, poor tablet disintegration, and, in two cases, contamination with aflatoxins (8).

Although ashwagandha has been banned in Denmark due to concerns about liver toxicity, it is unclear whether these adverse reactions reflect the herb itself or contaminants such as aflatoxins. Another possibility is that non-traditional extraction methods may produce more lipophilic compounds capable of crossing cell membranes more readily, thereby altering the herb’s safety profile

The effectiveness of any herbal product is inherently tied to its quality. Yet the average consumer may struggle to distinguish a high-quality herbal supplement from a poor one. One strategy is to buy products that are certified organic, which ensures that the ingredients are grown without synthetic pesticides and according to strict guidelines.

However, organic certification alone cannot guarantee appropriate manufacturing processes or freedom from adulteration later in the supply chain. Still, companies that invest in organic certification may be less likely to cut corners elsewhere, simply because they are already committed to meeting demanding production standards.

Another pragmatic approach is to choose well-known brands that are also available in major high-street shops, rather than unfamiliar brands sold exclusively online. Products that have undergone the additional scrutiny required to appear in retail stores may, on average, be more reliable than those available only through online marketplaces with little vetting.

Medical herbalists can offer valuable guidance on where to purchase herbs from, and may also suggest alternative preparations — such as teas, tinctures, and glycerites — which are less subject to adulteration than supplements (owing to the herbs being powdered and concealed).

Not only do many herbalists offer products that they have foraged, grown and/or prepared themselves, they will have experience with products from various suppliers and brands. As such, with insight into which products are the highest quality, medical herbalists are a reliable resource to find safe and efficacious herbal medicines. Explore our resources pages to find a herbalist.

International sourcing further complicates quality assurance. While many countries have robust regulatory frameworks for herbal products, the capacity of authorities to enforce these regulations varies widely. Online marketplaces, in particular, offer a loophole through which products can be sold into markets where they might not meet local standards. It is not uncommon for products removed from an online platform due to illegal labelling or identified quality problems to reappear months later, sometimes under slightly altered branding or via a different seller.

In the UK, some degree of industry self-regulation exists. Several organisations offer membership to companies that demonstrate appropriate governance standards and a commitment to producing safe, legally compliant products. These associations — such as the Proprietary Association of Great Britain (PAGB) (9), the Health Food Manufacturers’ Association (HFMA) (10), and the Council for Responsible Nutrition UK (CRN-UK) (11) — enforce strict membership criteria.

While they do not manage day-to-day operations or monitor internal quality systems, they provide an additional layer of accountability. When a product is made by a company affiliated with one of these bodies, consumers can have greater confidence in its authenticity, accuracy of labelling, and legal compliance.

Ultimately, responsibility for regulating food supplements in the UK falls to the Food Standards Agency (FSA), whose mission is to ensure that all food products — including supplements — are safe and of appropriate quality (12). Given the enormous size of the supplement market, the FSA increasingly depends on consumers and industry professionals to report concerns. Its confidential reporting systems allow individuals to notify authorities about mislabelling, substitution, contamination, or other forms of food crime without revealing their identity.

In conclusion, the food supplement market is characterised by a high degree of variability. A higher price does not necessarily indicate higher quality, and two products claiming to contain the same herb may differ dramatically in composition, potency, and safety.

Quality problems range from low concentrations of active ingredients to species substitution, adulteration, pesticide contamination, and the presence of harmful toxins. Therefore, whenever questioning whether a medicinal plant is good, bad, or ineffective, the only meaningful answer is: Which product?

1. Grand View Research. UK Dietary Supplements Market Size, Share & Trends Analysis Report, 2025‑2033. Market report. Accessed January 11, 2026. https://www.grandviewresearch.com/industry-analysis/uk-dietary-supplements-market-report
2. Health Food Manufacturers’ Association (HFMA). Health of the Nation Survey 2021. Published 2021. Accessed January 11, 2026. https://hfma.co.uk/wp-content/uploads/2021/03/hfm_health-of-the-nation_17.pdf
3. Intellectual Property Office. The Effect of Counterfeit Goods. Published 2024. Accessed January 11, 2026. https://www.gov.uk/government/publications/meta-counterfeit-and-piracy-campaign/the-effect-of-counterfeit-goods
4. Medicines and Healthcare products Regulatory Agency (MHRA). Herbal Medicines Granted a Traditional Herbal Registration (THR). Published 2025. Accessed January 11, 2026. https://www.gov.uk/government/publications/herbal-medicines-granted-a-traditional-herbal-registration-thr
5. Booker A, Frommenwiler D, Reich E, Horsfield S, Heinrich M. Adulteration and poor quality of Ginkgo biloba supplements. J Herb Med. 2016;6(2):79‑87. https://doi.org/10.1016/j.hermed.2016.04.003
6. Booker A, Jalil B, Frommenwiler D, et al. The authenticity and quality of Rhodiola rosea products. Phytomedicine. 2016;23(7):754‑762. https://doi.org/10.1016/j.phymed.2015.10.006
7. Booker A, Agapouda A, Frommenwiler DA, Scotti F, Reich E, Heinrich M. St John’s wort (Hypericum perforatum) products: an assessment of their authenticity and quality. Phytomedicine. 2018;40:158‑164. https://doi.org/10.1016/j.phymed.2017.12.012.
8. Kartbayeva E, Seitimova G, Khondkar P, et al. Withania somnifera (Ashwagandha): product quality and implications for consumer safety. Presented at: Joint Symposium on Chinese Medicine, Natural Products, Free Radical Research & Traditional and Complementary Medicine; October 23‑25, 2025; Taichung, Taiwan.
9. Proprietary Association of Great Britain (PAGB). PAGB. Accessed January 11, 2026. https://www.pagb.co.uk/
10. Health Food Manufacturers’ Association (HFMA). HFMA. Accessed January 11, 2026. https://hfma.co.uk/
11. Council for Responsible Nutrition UK (CRN‑UK). CRN‑UK. Accessed January 11, 2026. https://crnuk.org/
12. Food Standards Agency (FSA). Food Standards Agency. Accessed January 11, 2026. https://www.food.gov.uk/

At the heart of the library is the Duke Ethnobotanical Archives (DEA), located at the welcome centre (1). This archive distinguishes itself by featuring materials on flora from around the world, including Duke’s alphabetised ethnobotanical files. These resources offer a thorough overview of global ethnobotanical research and studies, enriching the library’s offerings. 

Jim Duke was a brilliant, dedicated, and humble botanist whose love of plants and people inspired thousands of scientists and herbal enthusiasts. He authored hundreds of articles and three dozen books, compiled botanical data for his “Nature’s Farmacy” database. He was a big supporter of United Plant Savers and loved coming to the sanctuary and teaching.  Born in Birmingham, Alabama, in 1929, Duke earned his undergraduate and doctoral degrees at the University of North Carolina, then pursued postgraduate work in St. Louis, where he developed his lifelong interest in neotropical ethnobotany.

Duke’s career included significant work at the Missouri Botanical Garden, the USDA, and Battelle Memorial Institute, focusing on crop diversification and medicinal plants. He led USDA’s Medicinal Plant Laboratory and Economic Botany Laboratory, supported cancer research, and later established the Green Farmacy Garden at his home in Maryland. Duke retired from USDA in 1995 but remained active, receiving accolades such as the ACEER Legacy Award and being profiled by The New York Times. We are honored to have his library and archives at our Welcome Center at the sanctuary.

The research library is further enhanced by several unique and significant collections. The John Staba collection provides early pharmacy textbooks, presenting historical perspectives on herbal medicine. Stephen Buhner’s collection invites philosophical reflection on plant wisdom, while our most significant donation has been David Winston’s extensive collection covers a wide range of eclectic medical traditions and modern herbal practices.

Cascade Anderson Gellar’s collection is the most recent donation and brings a focus on folk traditions and herbal knowledge from the Northwest and Central America, deepening the library’s diversity and scope. We have kept the library organised and searchable by the individuals who have created the collections, we see their stories just as important as the books themselves.

As the library started to grow, we had the opportunity to purchase the historic Brick House Apothecary, located in Pomeroy, about ten miles from the sanctuary. Pomeroy is a beautiful town that overlooks the mighty Ohio River. The Brick House has several rooms we can rent out to visitors or to host visiting scholars and artists. This is also where we have expanded the library collections.

The entire catalog, containing over 4,000 volumes, is searchable online through the United Plant Savers website. Members are encouraged to visit, explore, and immerse themselves in the rich information available, opening doors to new insights and traditions in the field of herbal medicine.

Expanding public access and the Duke Archives

United Plant Savers is dedicated to increasing public access to our sanctuary by providing lodging options and sharing the medicinal knowledge cherished by the community. The welcome centre has the largest collection of Jim Duke’s prolific herbal writings and Peggy Duke’s botanical drawings, along with their notes, slides, files, and herbarium. This central location preserves and showcases their extensive research, making it accessible to all.

Located at the centre, the Duke Library is curated in custom red oak bookshelves with locking glass doors, with additional materials stored in filing cabinets below. Plans are underway to catalog the slide collection, which features plants from the Amazon, Costa Rica, Appalachia, Maine, and other places. A small herbarium collection from Jim Duke and plants from the Sanctuary in Ohio is being curated as well. Looking ahead, we are planning a teaching garden and aim to announce ethnobotanical fellowship research opportunities. 

United Plant Savers was founded at the International Herb Symposium, which was also founded by Rosemary Gladstar and United Plant Savers is now the organiser. We have curated the classes taught at the International Herb Symposium over the years, which is now at the International Herb Symposium Learning Center.  It’s a wonderful resource to explore classes that can be purchased individually or in bundles.

International Herb Symposium and eclectic history

Last year, the International Herb Symposium took place in Cincinnati, Ohio, with a central focus on the history of the eclectics. Hosting the event in Cincinnati created a unique opportunity for collaboration with the Lloyd Library, an iconic institution known for its extensive medicinal book collections. This partnership highlighted the rich heritage of the eclectics and American herbalism, while also drawing attention to the often-overlooked aspects of conservation and social ethics from this influential period.

Library excursions and regional connections

The Lloyd Library and the United Plant Savers centre together offer a meaningful excursion into the heart of Appalachia, providing participants and visitors with direct access to the region’s deep-rooted traditions in medicinal plants and herbal practice.

Online resources and the magic of physical libraries

In addition to these physical centers, United Plant Savers actively supports resources like the World Herb Library, an online repository of scanned herbal books, and the Biodiversity Heritage Library, which provides free access to older herbal texts now in the public domain. While these online resources have made a wealth of information readily available, there remains something truly magical about being present in a library, physically holding a book that unexpectedly captures your interest.

Balancing online learning and hands-on experience

In our current era of online learning, it is important to maintain a balance between accessing digital knowledge and engaging directly with medicinal plants. Supporting gardens and centres that cultivate and preserve plant diversity is essential to sustaining the traditions and innovations of herbal medicine.

“If you have a garden and a library, you have everything you need.” ― Cicero

1. Duke Ethnobotanical Library. United Plant Savers. Published April 2, 2025. Accessed January 12, 2026. https://unitedplantsavers.org/dukearchives/

In the last few months of 2025 in the UK, there was a newspaper article warning of the dangers of herbal supplements and a spate of blog and social media posts outraged about the Food Standards Agency (FSA) preventing sales of certain medicinal mushroom products. These events highlight the challenges associated with navigating the complex regulatory environment around herbal and fungal products and the tension between empowering people to have the freedom to access products while ensuring that the public are safe.

In December 2025, there were several social media posts and blogs about the banning of certain medicinal mushrooms from the UK market. A manufacturer was asked by the FSA to remove turkey tail (Trametes versicolor) mushrooms and cordyceps (Cordyceps militaris) mushrooms from their website. This is not the first time a producer has been caught out in the last few years, and the Advertising Standards Authority (ASA) wrote an article to provide guidance for companies wanting to use medicinal mushrooms in 2024 (1).

Turkey tail is a beautiful stripey fungus that grows across multiple parts of the globe and is thought to have benefits for the immune system (2). Its traditional use is best documented from China and Japan, but despite being a UK native fungus, there isn’t any documented traditional use of it in the UK. Modern research has focused on its use as an adjuvant to cancer chemotherapy (3). 

Cordyceps militaris is a species of cordyceps that has gained popularity as an alternative for Cordyceps sinensis (4). Cordyceps sinensis has become harder to find in the wild due to overharvesting in its native China and Tibet. The militaris species has become popular more recently, as its short lifecycle lends itself well to being cultivated for commercial purposes on grain substrate (4). This relative novelty is likely to be why it has been flagged as of unknown safety (Cordyceps sinensis is acceptable in food supplements), despite some evidence of its low toxicity (5). 

In the UK, over-the-counter herbal and mushroom supplements are sold as food supplements, which means that they are regulated by the FSA. The FSA aims to ensure that any items that are sold as food or food supplements are guaranteed to cause no harm. Whether a product has a health benefit is not considered. Since Brexit, the UK largely uses the European Food Standards Agency (EFSA) criteria for managing food legislation (6). This is simply because it was co-created with the UK and building legislation up from scratch would involve a huge amount of work. 

This separation of food from medicine in legislation is historical and practical — to preclude inaccurate, misleading, or completely unfounded claims, such as drinking bicarbonate of soda daily will cure cancer, or lemon juice will melt belly fat. However, it does mean that supplement companies who research the evidence for their herbal products and carefully formulate a capsule that they believe will provide benefit, can’t claim the type of benefit that would be considered medicinal. In the same way that a medicine can only be used to treat conditions where there is substantial evidence that it has a therapeutic effect. 

It is important to remember that when herbalists prescribe and dispense herbs, they are considered medicine. When herbs are sold in a shop or a market without a consultation, they are considered food supplements, even if they are identical to what a herbalist would prescribe after a consultation. 

When a supplement company is banned from selling something that isn’t really a food, or from making a claim that implies it is a medicine, it isn’t the same as preventing the public from accessing natural medicines. Medicinal herbs and mushrooms are still available to forage and purchase — over-the-counter for those that have been proven to be safe to use without medical advice or monitoring, or via a herbalist following a consultation  as part of a bespoke prescription for those with restrictions. This ensures safe access to foods and medicines, which, on the whole, is a system that works well. 

At least every few years there is a dramatic and sensationalist newspaper article about the dangers of herbal supplements. They comment on a handful of reports or a single account of people developing signs of liver harm.

Some common culprits include turmeric, green tea extracts and ashwagandha. Often, when a negative effect happens, the person affected has taken a high-dose concentrated extract of the herb. Though, this isn’t always the case. Sometimes a reasonable dose of herb has caused a reaction. 

It is very hard to attribute effects like raised liver enzymes to a specific medicine, food or herb. So, in many situations, there’s no certainty about what has caused the negative reaction. 

Idiosyncratic (unpredictable) drug-induced liver injuries (DILIs) are rare, but can be very serious (7). They likely result from a combination of complex interactions between multiple metabolic pathways that are unique to the individual involved and can involve reactive metabolic products, increases in reactive oxidative species, accumulated toxic metabolites or immune cascades being triggered (7). 

The drugs that most commonly cause DILI vary from country to country, with the most common culprits in the UK being antimicrobials and non-steroidal anti-inflammatories (7). In China, traditional Chinese medicine (TCM) is responsible for a majority of cases (7). In the US, antimicrobials and herbal dietary supplements are recorded as being responsible (7); it has been estimated that 20% of DILI in the US involve botanical dietary supplements, potentially alongside pharmaceutical drugs (8). Whether these differences in reported incidents are genuinely due to differing reactions in certain countries, or the different ways that adverse events are treated and reported is impossible to know.

The global herbal supplement industry is worth nearly US$8000 million (9). While most companies start out with lofty intentions to improve lives and have a positive impact on health, their overall purpose of selling products means that they always need more customers. Herbal products are not universally suitable for everyone; but  without advice or clinical guidance an individual can purchase herbal preparations online not knowing whether it is appropriate for them, potential reactions to expect, or what might be cause for concern.

Negative effects can and do very occasionally occur when a herbalist prescribes a herb for an individual. Yet, medical herbalists are trained to be aware of possible side effects and can advise their clients to anticipate potential outcomes. With regular check-ins with a herbalist, changes can be monitored and a prescription adjusted if the collaborative team of herbalist and client suspect that something isn’t right.

Resources such as the Our Health Directory from the College of Medicine, herbalist-led foundation courses in herbal self-care, and reliable information from the American Botanical Council and Herbal Reality are essential for people to feel empowered to look after themselves and their families. However, there will always be limits to what can be managed without professional clinical training.

The skill, knowledge and experience of medical herbalists are a rich resource to be respected and trusted. Taking herbs and medicinal mushrooms under the guidance of  a trained, supported and insured herbalist offers a safer means to explore these medicines, than to buy a product off the shelf that has been marketed via social media. 

1. Advertising Standards Authority. Shroom for Improvement? Navigating the advertising rules for functional mushrooms. 2024. https://www.asa.org.uk/news/shroom-for-improvement-navigating-the-advertising-rules-for-functional-mushrooms.html
2. Herbal Reality. Turkey Tail monograph. 2023. https://www.herbalreality.com/herb/turkey-tail/
3. Habtemariam S. Trametes versicolor (Synn. Coriolus versicolor) Polysaccharides in Cancer Therapy: Targets and Efficacy. Biomedicines. 2020;8(5):135. Published 2020 May 25. https://doi.org/10.3390/biomedicines8050135 
4. Behrens, J. The Sustainability of Cordyceps. 2024. https://www.herbalreality.com/herbalism/sustainability-social-welfare/species-specific-sustainability/the-sustainability-of-cordyceps/
5. Chrysostomou PP, Freeman E, Murphy MM, Chaudhary A, Siddiqui N, Daoust J. A toxicological assessment of Ganoderma lucidum and Cordyceps militaris mushroom powders. Front Toxicol. 2024;6:1469348. Published 2024 Oct 30. https://doi.org/10.3389/ftox.2024.1469348 
6. Verkerk, R. Navigating the regulatory landscape: An essential update for UK and EU herbal practitioners. 2025. https://www.herbalreality.com/herbalism/quality/navigating-the-regulatory-landscape-an-essential-update-for-uk-and-eu-herbal-practitioners/
7. Andrade RJ, Chalasani N, Björnsson ES, et al. Drug-induced liver injury. Nat Rev Dis Primers. 2019;5(1):58. Published 2019 Aug 22. https://doi.org/10.1038/s41572-019-0105-0 
8. Koturbash I, Yeager RP, Mitchell CA, et al. Botanical-induced toxicity: Liver injury and botanical-drug interactions. A report on a society of Toxicology Annual Meeting symposium. Regul Toxicol Pharmacol. 2024;153:105708. https://doi.org/10.1016/j.yrtph.2024.105708 
9. Global Market Statistics. Herbal Supplements Market Overview. 2025. https://www.globalmarketstatistics.com/market-reports/herbal-supplements-market-14939x 

Saw palmetto (Serenoa repens) is a low-growing, shrubby palm native to the southeastern United States. The stem of saw palmetto is usually very short, and produces several stalks from which divided, fan-shaped leaves appear. These can span up to a meter across and may be composed of 18–30 segments. The leaf stems (petioles) have fine, sharp spines or teeth along the edges — giving the species its common name, saw palmetto. Clusters of white fragrant flowers, which grow on stalks give way to berries, which turn from green to orange to a purplish-black colour when ripe (1).

Saw palmetto grows as an undergrowth in forests, and on coastal sand shrubby areas. It’s an incredibly resilient plant, thriving on nutrient poor, acidic soils and being well adapted to fire disturbance. After fire, the plant grows rapidly, resprouting from root crowns and rhizomes. Periodic fires every five years seem to be beneficial to flowering and fruiting. However, being exposed to fire periodically, also helps to keep populations at bay, as without fire Serenoa repens soon completely dominates other plant species (2). Traditionally, fire was implemented by indigenous people to keep plant populations healthy but also in balance with other plant species (2).

Saw palmetto is native to the southeastern United States — Alabama, Florida, Georgia, Louisiana, Mississippi, South Carolina, which means, globally speaking, it has a fairly small natural habitat (1). In those areas, it can form unbroken plant populations that stretch for many miles (2). Seeds tend to have a very low germination rate, and the main way of reproduction seems to be mostly vegetatively via woody rhizomes lying on or just below the soil surface. Plants grow very slowly, but they can become very old, individual stems reaching 500 to 700 years of age, and some clonal patches are estimated to be around 5000 years old.

Saw palmetto is considered a keystone species — a species on which many other species in the ecosystem rely — as more than 100 bird species, 27 mammals, 25 amphibians, 61 reptiles, and countless insects use it as food and/or cover, including endangered species of bears and panthers (4). The flowers are an important source of pollen for insects, with over 300 different species of insects visiting the flowers (5).

By indigenous people, this plant was cherished as well and used in various ways. The berries were eaten as a food and used as medicine (6), the stalks were used to gain fibres for basketry, and the leaves used as thatch and for bedding material (2,6). In Florida, saw almetto is very common, covering vast areas of land, to the point that it used to be considered a pest by land developers and farmers, and pesticide use was encouraged to manage it (3).

Westerners started using and selling saw palmetto as medicine in the late 19th century, when it soon became popular. In the 1890s 250 tonnes of the berries were being used to make extracts (3). However, since herbal medicine lost popularity in the 19th and 20th centuries, trade with saw palmetto didn’t see another burst until the 1970s, when herbal medicine had a resurgence of interest.

Until the late 20th century, saw palmetto was mainly conceived as a pest species, to be eradicated with the use of machinery and herbicides to free the land for agricultural or land developmental uses (7). But with increasing interest in saw palmetto berries as a medicine, particularly from European countries, and increased research, providing evidence for its use, demand for the berry soon rocketed. Until then, harvest and sales of palmetto berries happened mostly under the radar. The harvest was mostly done by migrant farm workers who received a few cents per pound. But as the demand went up, so did the prices and harvesters could get as much as 3.00$ per pound. This led to land owners and the state of Florida to show more interest and soon harvesters needed the land owners permission to harvest the berries from plants growing on their land (8).

Landowners hired crew leaders, who in turn would employ harvest crews to do the actual harvest. Landowners would typically receive $0.44–0.46/kg, with $0.15-0.17/kg going to the pickers and $0.07/kg going to the crewleaders. For landowners this represents a lucrative business, potentially creating more yearly income than from cattle, which the land would normally be used for (7). In the following years, the demand remained high, although supply tends to fluctuate, as fruiting seems to follow a boom and bust pattern, some years bringing much higher yields than other years. And fruiting success is generally fairly low for saw palmetto.

Additionally, extreme weather events, especially large amounts of rain, can severely impact maturation and harvest rates (10). In 2010 worldwide sales of saw palmetto supplements were approximately US $700 million, with the United States accounting for US $200 million alone — showing the high demand for this crop.

Since the boom of saw palmetto, more and more voices have spoken out to regulate the saw palmetto trade, as nature conservationists highlight that the berry is a vital food source for wild animals. In 2018 the Endangered Plant Advisory Council of the Florida Department of Agriculture and Consumer Services added saw palmetto to Florida’s “commercially exploited plant list”. As a result of this, a “Native Plant Harvesting Permit” is now required on top of the land owner’s permit to be able to harvest saw palmetto fruits.

From July 2024, the illegal harvest or possession of saw palmetto berries is treated as a third degree felony, punishable by up to five years of prison. Since then, several instances of saw palmetto theft have been reported (11,12,13). One of these included approximately 768 kg of berries worth $3,309 (13). A question that remains open is how the increasingly abundant and restrictive regulations affect the already marginalised harvesters of saw palmetto.

Florida has one of the largest farming communities of the United States with over 100,000 farm workers (14). Two thirds are seasonal workers and one third migrants, all generally earning a marginal income. And the “contracting” system, by which a work force is contracted to work on farms via middle men (crew leaders) can make it very difficult to take action against abuse within the work force.

The Coalition of Immokalee Workers (CIW), a worker-based human rights organisation internationally recognised for its achievements in the fields of social responsibility, human trafficking, and gender-based violence at work has recorded several cases of gross abuse of human rights between 1997–2010, where workers were forced to work against their will, sometimes through threats, by retaining their passports or the use of physical violence (15). Other cases illustrate very demanding working conditions, 12 hour working days, six days a week, for as little as 20$ a week (15).

While no cases are specifically known regarding the harvesters of saw palmetto, as there is little transparency within the saw palmetto trade, it is impossible to positively exclude the likelihood of these conditions for harvesters. Saw palmetto harvest is hard work, partly due to the intense heat during the harvest months, but the plant itself makes harvest difficult. Thickets of saw palmetto stands can be too thick to penetrate, and the teeth on the stalks can rip clothing and cause wounds, and venomous snakes can hide between plants. Death of saw palmetto harvesters due to snake bites has been mentioned in the literature (16).

Overall Serenoa repens is considered as ‘apparently secure G4’. Populations in Mississippi and Florida are secure, while in South Carolina they are deemed ‘vulnerable’ and in Louisiana ‘critically imperiled’. Georgia and Alabama have not been assessed at this time (17).

The American Botanical Council raises concerns regarding its future sustainability. The greatest threats to saw palmetto today are habitat loss due to land change use — i.e. land being turned into agricultural land for crops, or converted to urban land. It is perhaps noteworthy that not all regulations seem to make sense in this regard. While berry harvest is seen as a threat to wildlife, land conversion to agricultural or urban land, doesn’t seem to be considered with the same vigor, even though arguably it presents a greater threat — though perhaps a better economical bargain. Climate change is a challenge for berry crops, as severe rainfall can cause fungal infections that affect the berries. It also represents long-term challenges as sea-level rises are predicted to affect the local coastal areas, one of the main habitats for saw palmetto (16).

However, other climate change effects are predicted to extend saw palmetto’s natural habitat inland, potentially increasing its habitat (18). This highlights the complexity of climate change, and how challenging it can be to accurately predict long-term impact. Some saw palmetto clone patches are said to be 8.000 years old, showing just how resistant they can be (19).

However, the land changes brought about due to human activity might yet prove more damaging — as with the Amazon rainforest, which has survived at least 50 million years of various climate changes, yet may fall due to the impact of fairly recent human activity on the land.

Perhaps saw palmetto shows a contrasting affair, where economical interest offers some level of protection of natural resources, but whether this is enough is unclear. A lack of transparency and sustainability incentives means that those involved in harvest are at risk of exploitation and further marginalisation.

With a plant that is in such high demand, there is great potential for development; either to expand an already extractive mindset, or to provide a fair system that benefits local wildlife, wild harvesters and everyone involved in the supply chain. There are projects out there that demonstrate that wild harvesting can be done in such a way, prioritising fairness, people and the planet, whilst retaining economic viability.

1. Royal Botanical Gardens, Kew. Serenoa repens – saw palmetto. Accessed November 24, 2025. https://www.kew.org/plants/saw-palmetto Kew Gardens
2. Anderson MK, Oakes T. Plant Guide for Saw Palmetto (Serenoa repens). USDA-Natural Resources Conservation Service, National Plant Data Team; 2012: Davis, CA.
3. Foster S. Saw palmetto in commerce — Part 1: Revelations from European contact to 1990. Sustainable Herbs Initiative. 2019. Sustainable Herbs Initiative
4. Maehr DS, Layne JN. Florida’s all-purpose plant, the saw palmetto. The Palmetto. 1996;16(4):6-10, 15, 21. suncoast.fnpschapters.org
5. Deyrup M, Deyrup L. The Diversity of Insects Visiting Flowers of Saw Palmetto (Arecaceae). Florida Entomologist. 2012;95(3):711-730. https://doi.org/10.1653/024.095.0322
6. American Botanical Council. Saw palmetto berry. In: Expanded Commission E Monographs. Accessed November 25, 2025. https://www.herbalgram.org/resources/expanded-commission-e-monographs/saw-palmetto-berry/
7. Carrington ME, Mullahey JJ, Krewer G, Boland B, Affolter J. Saw palmetto (Serenoa repens): an emerging forest resource in the southeastern United States. South. J. Appl. For. 2000;24(3):129-134. ResearchGate
8. Foster S. Saw palmetto sustainability — change in 140 years of commerce and conservation: 1879-2019. Sustainable Herbs Initiative. 2019. Sustainable Herbs Initiative
9. Carrington ME, Mullahey JJ. Effects of burning season and frequency on saw palmetto (Serenoa repens) flowering and fruiting. For. Ecol. Manag. 2006;230:69-78. faculty.nelson.wisc.edu
10. Gafner S, Baggett S. Adulteration of saw palmetto (Serenoa repens). Version 3. Botanical Adulterants Prevention Bulletin. 2018.
11. Farrow H. What are saw palmetto berries, and why would someone steal 800 pounds of them? Tampa Bay Times. August 28, 2024. 
12. Gay N. Florida saw palmetto berry bust leads to 11 arrests and seizure of 6,000-pound bounty: MCSO. FOX 13 Tampa Bay. Published August 13, 2025. Accessed December 14, 2025. https://www.fox13news.com/news/florida-saw-palmetto-berry-bust-leads-11-arrests-seizure-6000-pound-bounty-mcso
13. Franklin O. Martin County detectives arrest 10 men on charges involving theft of palmetto berries. Treasure Coast. Published 2025. Accessed December 14, 2025. https://eu.tcpalm.com/story/news/crime/martin-county/2025/08/13/detectives-arrest-11-related-to-illegal-palmetto-berry-harvesting/85642986007/
14. Rural Neighborhoods. Florida’s farm workers. Accessed November 26, 2025. https://www.ruralneighborhoods.org/what-we-do/farm-workers/floridas-farm-workers/
15. Coalition of Immokalee Workers. Slavery in the Fields and the Food We Eat. Accessed November 26, 2025. https://ciw-online.org/wp-content/uploads/12SlaveryintheFields.pdf
16. Foster S. The historical interplay of plant biology, trade, and human interactions with saw palmetto. HerbalGram. 2021-22;123:36-67. GlobeNewswire
17. NatureServe Explorer. Serenoa repens – saw palmetto. Accessed November 26, 2025. https://explorer.natureserve.org/Taxon/ELEMENT_GLOBAL.2.139448/Serenoa_repens
18. Butler CJ, Larson M. Climate change winners and losers: The effects of climate change on five palm species in the Southeastern United States. Ecol Evol. 2020;10(19):10408-10425. Published 2020 Sep 1. https://doi.org/10.1002/ece3.6697 
19. Ancient Saw Palmettos in the Heart of Florida – United Plant Savers. United Plant Savers. Published January 7, 2019. https://unitedplantsavers.org/ancient-saw-palmettos-in-the-heart-of-florida/ 

Spirulina (Spirulina maxima, Spirulina platensis, Spirulina fusiformis and Spirulina pacifica)

The aim of this spirulina study was to carry out a systematic review and meta-analysis of randomised controlled trials (RCT) to evaluate the effects of spirulina supplementation on modulating risk factors of cardiovascular disease (CVD).

Using the PRISMA statement protocol for systematic reviews, broad searches of medical databases were carried out and did not exclude papers based on language or date of publication. Two authors independently applied inclusion and exclusion criteria to select papers for the review.

The inclusion criteria were RCTs that explored the effects of spirulina intake on:

• Lipid profiles — triglycerides (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C)
• Glycaemic indexes — fasting blood glucose (FBG), HbA1c, insulin, and homeostatic model assessment-insulin resistance (HOMA-IR)
• Blood pressure
• Anthropometric indexes — weight and body mass index (BMI)
• Inflammatory biomarkers — high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor alpha (TNF-α), and interleukin 6 (IL-6)

Study design included RCT with placebo or control groups. Other types of study design were excluded.

Two authors independently extracted data and evaluated study quality using the Cochrane Risk of Bias tool. The authors looked at publication bias and assessed the quality of evidence using the GRADE tool.

Most of the RCTs identified through searching used spirulina in capsule or tablet form. A few used a water or ethanol extract, and one used spirulina prepared as a sauce.

In the systematic review, 35 RCTs were identified, which examined n=1523 participants.

The duration of supplementation ranged between 2–16 weeks, and doses were 0.5 to 8 mg a day. Studies recruited patients with a range of metabolic conditions or were healthy participants, and were a mix of males and females. The mean age of participants was 21.5 to 76.7 years, and body mass index ranged from 22.6 to 40.7 kg/m².

Of the 35 studies, most had a low risk of bias, with nine moderate and five high risk.

Lipid profiles

Results of the meta-analyses showed that spirulina lowered TG, TC, LDL-C (p<0.001, 28 studies) and raised HDL-C (p<0.001, 28 studies) compared to placebos.

Glycaemic values

Spirulina reduced FBG (p<0.001, 19 studies), insulin (p<0.001, 9 studies) and HOMA-IR (p<0.05, 4 studies), but there was no change to HbA1c (p>0.05, 7 studies) compared to placebos.

Blood pressure and body anthropometry

Spirulina reduced systolic blood pressure (p<0.01, 9 studies) and diastolic blood pressure (p<0.001, 9 studies). It reduced body weight by weighted mean difference of 1.78 kg (p=0.01, 15 studies) and BMI reduced accordingly (p<0.01, 18 studies) compared to placebos.

Inflammatory markers

Spirulina reduced all three inflammatory markers tested, which were hs-CRP (p<0.01, 7 studies), TNF alpha (p<0.01, 8 studies) and IL-6 (p<0.001, 9 studies).

GRADE analysis

Of the 15 cardiovascular risk factors measured, LDL-C, FBG and HbA1c were calculated to have a lower certainty of outcome, with all other parameters moderate or high.

Sub-group analysis

With such a large-data set, the authors were able to complete multiple subgroup analyses and looked at the results according to study duration (<8 and ≥8 weeks), dosage (<2 and ≥2 g/day), BMI category (normal, obese, overweight) and age (<50 and ≥50 years). The finer detail is presented in the paper 

The analyses showed both TG and TC were reduced in both short and longer trial durations (<8 and ≥ 8 weeks) and a range of doses (<2 and ≥2 g/day). TG was reduced in individuals with normal and overweight BMI, whereas TC was also reduced in individuals with an obese BMI. Levels were reduced over all age ranges  (<50 and ≥50 years). Overall blood lipids were generally regulated to a similar extent regardless of study duration, dose, BMI category or age.

Glycaemic indices and anthropometric measures were more variable with a tendency to be more effective at lower doses (<2g/day) and over shorter study durations (<8 weeks). For inflammatory markers there was a more consistent picture with spirulina being more effective at lower doses and shorter study durations, and in healthy populations who were less than 50 years of age.

This article is a comprehensive systematic review and meta-analysis on the use of spirulina to regulate cardiovascular risk factors, and was carried out to a high standard.

Overall, 35 RCTs were analysed. Dietary spirulina supplementation significantly improved blood lipid profiles, glycaemic responses, anthropometric measures and inflammatory biomarkers in patients with cardiovascular disease and healthy individuals.

There was a pattern within the sub-group analysis that suggested spirulina was effective in regulating blood lipids regardless of study duration, dosage or patient BMI or age. For glycaemic factors, anthropometric measures and inflammatory biomarkers, there was a tendency for lower doses to be more effective over shorter duration studies.

The authors conducted a GRADE analysis which weighs up the certainty of evidence, and this includes looking at the heterogeneity of the meta-analyses (a measure of how variable studies are from one another). Often for herbal remedies where heterogeneity is high — different herbal preparations, doses, etc. — the GRADE analysis can suggest lower levels of certainty. In this study, however, overall, GRADE suggested 12 of the 15 outcomes measured were attributed to moderate or high-quality evidence.

The findings suggest that spirulina is a strong candidate for modifying cardiovascular risk factors. Spirulina species are nutrient-rich blue-green algae that comprise proteins, vitamins, omega-3 oils, and pigments, such as beta-carotene, carotenoids, phycocyanin. It displays anti-inflammatory and antioxidant potential in the lab and it is widely researched for its effects on the cardiovascular system.

One recent study looked at its effects on vascular ageing. Spirulina was grown in silicon-enriched media, and over a six-month period, participants with high blood pressure showed an 8% decrease in pressure and 13.5% increase in aortic pulse wave velocity — an indicator of reduced arterial stiffness (2).

Dietary supplementation with spirulina improved many lipid, glycaemic and inflammatory biomarkers that are risk factors of cardiovascular disease. Spirulina reduced the levels of inflammatory markers and improved glucose homeostasis. It improved blood pressure and reduced weight and body mass index in participants. Spirulina in capsule or tablet form could be used therapeutically to reduce cardiovascular disease risk. 

Further research is needed to understand whether the changes persist after spirulina supplementation has stopped, and which preparations, doses and durations are optimal. Sub-group analyses of patients versus healthy individuals would elucidate the therapeutic and preventive potential of spirulina.

1. Shiri H, Soleimani AA, Omidi Sarajar B, Talebi Taheri A, Esmaeili F, Nematollahi MH, Alizadeh Sani M. Spirulina’s impacts on cardiovascular health: Insights from a systematic meta-analysis of RCT. Complement Ther Med. 2025 Nov;94:103242. https://doi.org/10.1016/j.ctim.2025.103242 
2. Virsolvy A, Benmira AM, Allal S, Demattei C, Sutra T, Cristol JP, Jouy N, Richard S, Perez-Martin A. Benefits of Dietary Supplementation with Specific Silicon-Enriched Spirulina on Arterial Function in Healthy Elderly Individuals: A Randomized, Placebo-Controlled Trial. Nutrients. 2025 Feb 28;17(5):864. https://doi.org/10.3390/nu17050864

Mistletoe (Viscum album)

To complete a meta-analysis to evaluate the effects of mistletoe extract in cancer-related fatigue by including randomised controlled trials (RCT) and non-randomised studies (NRSI).

A systematic review and meta-analyses were completed as follows:

• The study protocol was registered with PROSPERO.
• Searches were made of electronic library databases and grey literature.
• There were no limitations based on language or date of publication.
• Study selection and data extraction were performed independently by two reviewers.
• Included studies were:
  • RCTs or NRSIs
  • With patients with cancer-related fatigue, which was either patient or clinician-diagnosed. 
  • With a control group that was a placebo, or active control that was standard treatment.
    
• Risk of bias in RCT was determined using the Cochrane Risk-of-Bias tool, and for NRSI was determined using the Risk of Bias in Non-randomized Studies of-Interventions (ROBINS-I) tool.
• Reviewers carried out sensitivity analyses and tests for publication bias.
• In a supplementary file, the authors published formula used to calculate missing means and standard deviations, required for the meta-analyses, and presented their search strategies and all other analyses.
• In this meta-analysis, to search for mistletoe in the published literature, the authors used the following PubMed keywords which included brand and company names: (“mistletoe” OR “viscum” OR “iscador” OR “iscucin” OR “abnobaviscum” OR “helixor” OR “lektinol” OR “isorel” OR “vysorel” OR “plenosol” OR “cefalektin”).

Aqueous mistletoe extracts are used in treatment and were injected subcutaneously two or three times a week.

Of 802 records that were screened, the final meta-analyses included 19 studies — 12 RCT and 7 NRSI. Nine of the trials were carried out in Germany, with the remainder in Switzerland, Serbia, Bulgaria, Russia, Ukraine, China, Italy, Israel and South Korea.

In 17 of the 19 studies, mistletoe was given as an adjuvant to conventional cancer treatments, and in two, there were no additional treatments being given. Fatigue was assessed in patients with breast cancer (11 studies), lung cancer (two studies), pancreatic cancer (two studies), and the remaining studies were mixed cancer types. Mistletoe was mostly injected subcutaneously with one study administration was intravenous.

Mistletoe was compared to a placebo in two studies alongside chemotherapy or standard care, or was compared to untreated groups also receiving chemotherapy or receiving standard care.

Study durations ranged from 6–208 weeks.

Measuring fatigue as an outcome

The primary outcome of many of the RCTs was to measure quality of life through a questionnaire, and fatigue was an item within this. Other studies measured fatigue as recorded by the clinician.

Meta-analysis of RCT and NRSI

A meta-analysis was created for 12 RCTs that compared mistletoe extract to placebo or control. Overall the pooled result shows a significant effect of mistletoe compared to controls (p=0.006). The heterogeneity was high, reflecting the differing patient populations and study designs.

An analysis of the risk of bias using the Cochrane tool was low risk in terms of randomisation to groups. However, as the studies were open-label due to the nature of the injections given, the risk of bias under the category “measurement of the outcome” was high.

In the NRSI, the result also favoured mistletoe (p=0.0008), and there was high heterogeneity. The risk of bias was high overall.

Adverse events

In one quarter of patients, the most regular adverse event was a reaction at the site of injection. A small number of patients recorded systemic adverse events like fever, flu symptoms, nausea or diarrhoea.

Other results

The sensitivity analysis and publication analysis showed that the results were robust. The supplementary information included the details of the sources of funding for these studies, which for the most part were manufacturers of the extracts.

Mistletoe therapy to support individuals with cancer has been used for over a century, and it is considered to be safe and to integrate well alongside chemotherapy and conventional treatments (2). Mistletoe is a semi-parasitic plant and gains nourishment from the host tree through penetrating the bark with a root-like structure. The immunogenic properties of the mistletoe depend on the host tree and, for example, will vary between oak and pine (2).

In the meta-analysis, mistletoe extract reduced cancer-related fatigue in RCTs and NRSIs of different types of cancer, although breast cancer was the main type investigated. The results of using mistletoe were significant versus placebo or control (untreated groups), and for the RCT and NRSI groups, the effect estimate was moderate.

The heterogeneity that represents the variability between studies was high, which reflects the different patient groups, study durations and differing types of mistletoe extract used across the study preparations. Furthermore, fatigue is not a clearly defined measure and was recorded in these studies in self-reported surveys or scales, or was recorded by the clinician.

Nethertheless, fatigue that includes mental tiredness and physical exhaustion is widely experienced by cancer patients. Presently, physical activity is recommended but is not possible for everyone, so alternative treatments are needed.

The meta-analysis does have limitations and the risk of bias is high due to the lack of placebo, lack of blinding due to the nature of the injections and subjective nature of assessing fatigue.

The meta-analyses suggest that mistletoe extract is an effective treatment for reducing symptoms of fatigue in patients undergoing chemotherapy for different types of cancer. Across the majority of studies, mistletoe was administered safely alongside standard chemotherapy treatment — with adverse events occurring with most prevalence at the site of the injection.

More randomised, placebo-controlled studies with clearer definitions of fatigue and standardised approaches to measuring it as a primary outcome would offer more accurate data. In addition to explorations of alternative, less invasive, routes of administration, further research into the immunogenic mechanisms of mistletoe and how it differs with host tree could refine preparations and therapeutic understanding.

1. Pelzer F, Loef M, Martin DD, Baumgartner S. Cancer-related fatigue in patients treated with mistletoe extracts: a systematic review and meta-analysis. Support Care Cancer. 2022 Aug;30(8):6405-6418. https://doi.org/10.1007/s00520-022-06921-x  
2. Thompson, E. (Date). Mistletoe Therapy in Integrative Oncology. https://ncim.org.uk/mistletoe-therapy-in-integrative-oncology

Research into medicinal plants can be broadly split into two approaches. The first focuses on traditional and ethnobotanical uses of plants, which includes studies looking at plant use in specific geographical areas. The second covers use of plants in drug discovery, mechanistic in vivo and in vitro studies, and clinical studies assessing the effectiveness of herbal medicines (1).

Common themes for herbal research over the last ten years include: 

• The benefits of herbs to treat obesity, cancer, cardiovascular disease and infectious diseases
• Conservation and sustainability
• The interplay between the gut microbiome and phytochemicals
• Polyphenols and cardiovascular or cognitive health
• The use of formulations such as nanotechnology to improve bioavailability and efficacy

While the use of plants for health is truly global, the majority of research into medicinal plants is carried out in China and India, followed by Iran, Brazil, USA, South Korea, and Pakistan (1,2). 

Government funding, as well as the acceptance of Traditional Chinese Medicine (TCM) within the Chinese healthcare system has contributed to the large amount of herbal research produced there. India has also emerged as a global leader, since the launch of The World Health Organization (WHO) Global Traditional Medicine Centre there in 2022. Supported by the Government of India, this has the aim of advancing herbal research and enabling the ability of member states to conduct research that can address evidence gaps in the safety and efficacy of traditional medicine. 

The WHO’s 10-year global traditional medicine strategy was published at the end of October 2025. One of its key aims is to “integrate safe and evidence-based traditional and complementary medicine services within national and local health systems as appropriate, particularly at the level of primary health care” (3). Its first strategic objective is to strengthen the evidence base for traditional, complementary and integrative medicine (TCIM) through innovative research and digital tools, while encouraging collaboration between scientists and traditional practitioners. The location of the research centre in India is likely to consolidate India as one of the main countries contributing to herbal research globally.

Non-communicable diseases, such as obesity, diabetes, cancer, chronic respiratory disease and cardiovascular disease are responsible for the vast majority of deaths globally and are due to a combination of genetic, environmental and behavioural factors (4). Due to the magnitude of the problem, they are a big focus for research in all areas, and this is no different for herbal research. In cardiovascular research, China is again a key contributor (5).

TCM has been found to effectively reduce hypertension and blood lipid levels, improve outcomes in patients with type 2 diabetes, and relieve angina or reduce cardiovascular events (6).

The COVID-19 pandemic was a stimulus for research into the antiviral properties of herbs, as people focused on improving their immunity and looked into the possibility of herbal remedies for a viral disease with no known treatment. There is no treatment or vaccine for most viruses, and this need has provided an opening for herbal remedies.

A review of trends in global antiviral herbal research identified some key TCM herbs to treat COVID-19. These included liquorice (Glycyrrhiza glabra), Japanese honeysuckle (Lonicera japonica), baikal skullcap (Scutellaria baicalensis), ma huang (Ephedra sinica), weeping forsythia (Forsythia suspensa), Korean mint (Agastache rugosa), astragalus (Astragalus membranaceus), and poria (Poria cocos) (7).

Other areas of interest identified in this review include herbs for hepatitis B and C, respiratory syncytial virus, HIV, herpes simplex virus and influenza, those that support the immune system and the mechanisms of action of specific phytochemicals such as quercetin, andrographolide, luteolin, artemisinin and kaempferol. Nanoparticle formulations and essential oils also show promise, as well as technologies such as network pharmacology and molecular docking studies to virtually screen active ingredients (7). 

Metabolomics is a branch of research that analyses the complete range of metabolites in a biological system. The chemical complexity of plants means that this type of research is useful when analysing both plants and their impact on the body. Chemical analytical techniques are used to produce a unique “fingerprint” of all the metabolites in a sample. Raman and infrared spectroscopy, and liquid chromatography-mass spectrometry have been used for years, but newer technologies, such as mass spectrometry imaging and ambient ionisation techniques are rapidly increasing the ways to analyse samples.

The newer techniques allow measurement and determination of the chemicals present in dried herbs or herbal capsules containing multiple different plants without the need to extract the chemicals first (8). This means that samples can be tested for adulteration and likely effectiveness rapidly and throughout the supply chain. Metabolomics can be used to assess adulteration and contamination in quality control, as well as investigating the mechanism of action and to identify biomarkers of efficacy.

Screening herbal samples, extracts and mixtures of herbs enables the identification of all the compounds present. This can then be combined with computational analysis to match the chemical structures of compounds in a herb with proteins that they are likely to bind to. The biological processes that mix of compounds is likely to impact on can be determined and the pharmacology of a herb can be predicted. This field of research is known as network pharmacology and is increasingly being used to identify or justify specific uses of herbs or herbal formulations.

Network pharmacology integrates large datasets of information from phytochemistry analysis and biological assays to predict how a herb or mixture of herbs might work in the body by connecting up the network of active constituents from the herb with potential targets in the body (9,10). The field of research developed in the early 2000s from a desire to explain how complex formulae in Chinese medicine could be having an effect in the body (9). This approach reflects a paradigm shift from viewing drugs as single-target molecules to recognising the synergistic complexity of herbal formulations. 

Another innovation has been the use of nanoparticle formulations to improve bioavailability and stability, while reducing toxicity (11). Nanoparticles were first discovered as a natural occurrence during the preparation of herbal products, such as decoctions. The natural formation of vesicles and particles when plants are traditionally prepared is thought to contribute to the synergy effect seen when a whole plant extract is more effective than the main bioactive phytochemical extracted from a plant (12). Artificial nanoparticle technology is now being used to improve the efficacy of single phytochemicals that are known to have targeted efficacy in vitro, but which aren’t very bioavailable — for example, curcuminoids from turmeric root. 

The dual pressures of climate change and increasing popularity of certain herbal medicines, has led to difficulties in sourcing some herbs, with increasing numbers being added to at-risk lists (13). A changing climate, and subsequent environmental conditions, alters the levels of active compounds in the plants (14). In response, organisations such as the American Botanical Council (ABC) have launched initiatives to share information about sustainability challenges and promote responsible sourcing.

A key barrier to herbal research, as with many types of research, is money. Who funds research and why helps to define the field. This is why most clinical trials are carried out on standardised and trademarked extracts of herbal preparations produced by supplement companies and manufacturers. This has been particularly true for turmeric (Curcuma longa) and ashwagandha (Withania somnifera). 

An interesting development this year has been the launch of a trademarked extract of shatavari (Asparagus racemosus) by Ixoreal, the company behind the ashwagandha extract KSM-66. Despite centuries of use in Ayurvedic medicine for women’s health, shatavari has been relatively under-researched to date. The BioActivEx research group at University of Exeter has addressed this gap with a series of clinical studies funded initially by Pukka Herbs, showing benefits for muscle strength in older women (15,16,17). Additional studies have been published on the use of shatavari for perimenpausal symptoms, alone (18,19) and in combination with ashwagandha (20), as well as for the traditional use to support breastfeeding (21).

The gut microbiome

In line with the general increasing awareness of the importance of the gut microbiome, there has also been a flurry of new herbal research into the interplay between the gut microbiota and phytochemicals. How herbs affect the microbiome and how the microbiome affects the metabolism and bioavailability of herbs are both topics that have received attention.

While 60% of the variation in drug metabolism between individuals is due to genetics, there is a significant contribution from the gut microbes. Bacteria in the gut play a part in how plant chemicals are broken down and absorbed into the body. This will consequently have an impact on the efficacy and the toxicity of a herb (22). The presence or absence of specific microbes in the gut is likely to contribute to why herbs are more effective for some people than others.  

Plant chemicals such as polyphenols are well documented to impact the gut microbiome. Some phytochemicals have a prebiotic effect, promoting the growth and survival of beneficial microbes, while others may have an antibacterial effect on less desirable species (23). 

Herbal medicines have the potential to contribute to some of the key challenges to improving health. It will take more coordinated efforts globally to ensure that the herbal research is meaningful and can impact as many people as possible.

1. Salmerón-Manzano E, Garrido-Cardenas JA, Manzano-Agugliaro F. Worldwide Research Trends on Medicinal Plants. Int J Environ Res Public Health. 2020;17(10):3376. Published 2020 May 12. https://doi.org/10.3390/ijerph17103376 
2. El Allaoui H, El Ahmadi K, El Abdouni A, Dira I, El Bastrioui M, Bouhrim M, Eto B, Shahat AA, Herqash RN, Haboubi K. Trends and Insights in Medicinal Plant Extract Research: A Ten-Year Bibliometric and Visualization Study. Horticulturae. 2024; 10(11):1163. https://doi.org/10.3390/horticulturae10111163
3. WHO. Global Traditional Medicine Strategy 2025-2034. 2025. https://iris.who.int/server/api/core/bitstreams/cf37a4ad-4d27-4244-a7ee-001de39841ee/content 
4. WHO. Noncommunicable diseases. Fact sheet. 2025b. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases 
5. Chen Y, Li WW, Bi SL, et al. Visualizing research trends and identifying hotspots of herbal components for treating cardiovascular diseases: A bibliometric analysis from 2000 to 2023. Medicine (Baltimore). 2024;103(6):e35047. https://doi.org/10.1097/MD.0000000000035047 
6. Hao P, Jiang F, Cheng J, Ma L, Zhang Y, Zhao Y. Traditional Chinese Medicine for Cardiovascular Disease: Evidence and Potential Mechanisms. J Am Coll Cardiol. 2017;69(24):2952-2966. https://doi.org/10.1016/j.jacc.2017.04.041 
7. Hu L, Wang C, Zhang Y. Hotspots and trends in global antiviral herbal basic research: A visualization analysis. Eur J Integrative Med 2024. 102419.
8. Alum EU, Manjula VS, Uti DE, et al. Metabolomics-Driven Standardization of Herbal Medicine: Advances, Applications, and Sustainability Considerations. Natural Product Communications. 2025;20(8). https://doi.org/10.1177/1934578X251367650
9. Yuan Z, Pan Y, Leng T, et al. Progress and Prospects of Research Ideas and Methods in the Network Pharmacology of Traditional Chinese Medicine. J Pharm Pharm Sci. 2022;25:218-226. doi:10.18433/jpps32911
10. Zhao L, Zhang H, Li N, et al. Network pharmacology, a promising approach to reveal the pharmacology mechanism of Chinese medicine formula. J Ethnopharmacol. 2023;309:116306. doi:10.1016/j.jep.2023.116306
11. Ai S, Li Y, Zheng H, et al. Collision of herbal medicine and nanotechnology: a bibliometric analysis of herbal nanoparticles from 2004 to 2023. J Nanobiotechnol 2024 22:140. https://doi.org/10.1186/s12951-024-02426- 
12. Li J, Zhang YL, Jin T, et al. Advanced Pharmaceutical Nanotechnologies Applied for Chinese Herbal Medicines. Adv Sci (Weinh). 2025;12(31):e00167. doi:10.1002/advs.202500167 
13. Mykhailenko O, Jalil B, McGaw LJ, Echeverría J, Takubessi M, Heinrich M. Climate change and the sustainable use of medicinal plants: a call for “new” research strategies. Front Pharmacol. 2025;15:1496792. Published 2025 Feb 3. doi:10.3389/fphar.2024.1496792
14. Alum EU. Climate change and its impact on the bioactive compound profile of medicinal plants: implications for global health. Plant Signal Behav. 2024;19(1):2419683. doi:10.1080/15592324.2024.2419683
15. Greed E, Pritchard J, Struszczak L, et al. Shatavari supplementation during eight weeks of resistance training increases training load, enhances skeletal muscle contractility and alters the skeletal muscle proteome in older women. Front Nutr. 2025;11:1498674. Published 2025 Jan 6. doi:10.3389/fnut.2024.1498674
16. O’Leary MF, Jackman SR, Sabou VR, et al. Shatavari Supplementation in Postmenopausal Women Improves Handgrip Strength and Increases Vastus lateralis Myosin Regulatory Light Chain Phosphorylation but Does Not Alter Markers of Bone Turnover. Nutrients. 2021;13(12):4282. Published 2021 Nov 27. doi:10.3390/nu13124282
17. O’Leary MF, Jackman SR, Bowtell JL. Shatavari supplementation in postmenopausal women alters the skeletal muscle proteome and pathways involved in training adaptation. Eur J Nutr. 2024;63(3):869-879. doi:10.1007/s00394-023-03310-w
18. Gudise VS, Dasari MP, Kuricheti SSK. Efficacy and Safety of Shatavari Root Extract for the Management of Menopausal Symptoms: A Double-Blind, Multicenter, Randomized Controlled Trial. Cureus. 2024;16(4):e57879. Published 2024 Apr 8. doi:10.7759/cureus.57879
19. Yadav P, Yadav S, Vedururu SS, Kumari G. A Standardized Asparagus Racemosus Root Extract Improves Hormonal Balance and Menstrual Health and Reduces Vasomotor Symptoms in Perimenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Study. J Am Nutr Assoc. 2025;44(8):754-764. doi:10.1080/27697061.2025.2510474
20. Pingali U, Nutalapati C, Wang Y. Ashwagandha and Shatavari Extracts Dose-Dependently Reduce Menopause Symptoms, Vascular Dysfunction, and Bone Resorption in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Study. J Menopausal Med. 2025;31(1):21-34. doi:10.6118/jmm.24025
21. Ajgaonkar A, Debnath T, Bhatnagar S, Debnath K, Langade J. Shatavari (Asparagus racemosus Willd) root extract for postpartum lactation: A randomised, double-blind, placebo-controlled study. J Obstet Gynaecol. 2025;45(1):2564168. doi:10.1080/01443615.2025.2564168
22. Lim DW, Wang JH. Gut Microbiome: The Interplay of an “Invisible Organ” with Herbal Medicine and Its Derived Compounds in Chronic Metabolic Disorders. Int J Environ Res Public Health. 2022;19(20):13076. Published 2022 Oct 11. doi:10.3390/ijerph192013076
23. Guan Y, Tang G, Li L, et al. Herbal medicine and gut microbiota: exploring untapped therapeutic potential in neurodegenerative disease management. Arch Pharm Res. 2024;47(2):146-164. doi:10.1007/s12272-023-01484-9

• 20 g dried elderberries 
• 10 g dried marshmallow root 
• 5 g dried or fresh ginger root 
• 3 g dried thyme 
• 60 ml local raw honey 
• 60 ml gelatin (or substitute for agar at same volume)
• 350 ml filtered water 
• Silicon moulds or baking paper 
• Dusting of marshmallow root powder

• Combine the herbal ingredients and the water into a saucepan and simmer gently for 15–20 minutes. 
• The liquid will have reduced slightly to roughly 250 ml. Strain the mixture. 
• Add the honey and gelatin/ agar and stir until dissolved. 
• Place 5–10 ml (1–2 tsp) per lozenge into silicone moulds or gently drop onto baking paper. 
• Leave to cool and set. Placing them in the fridge can accelerate this process. 
• Dust the lozenges with marshmallow root powder to prevent them sticking together. 
• Once the lozenges have set, store them in an airtight container in the fridge. 
• The lozenges can be used at the first sign of a tickly throat, as well as throughout the day to soothe coughs, colds and sore throats. 

Lozenges should be stored out of direct sunlight, in a cool, dark place (ideally in the fridge to extend the shelf life). 

They will last for up to six months if stored in the fridge, or three months in a cupboard. Check before using and discard them if they show signs of mould or decay.

• Elderberry is a potent antioxidant, rich in anthocyanins with an additional antiviral effect. Elderberry inhibits viral replication and increases the production of antibodies whilst also modulating pro-inflammatory cytokines to help protect and recover from viral infections (3).
• Marshmallow is rich in mucilage which is anti-inflammatory and offers protective and soothing effects on mucous membranes in the throat and respiratory system. It forms a protective layer which helps to calm irritation and the cough reflex (4).
• Thyme is rich in volatile oils, thyme also has antispasmodic actions specific to the bronchial tubes, helping to relieve coughs, bronchitis and upper respiratory tract infections. It is also an expectorant and helps to reduce mucus, whilst also exhibiting antiviral properties (2,5). 
• As a warming expectorant, ginger helps to break down mucus and reduce coughs and colds. It also has antimicrobial activity, helping to protect against bacteria and viruses and accelerate recovery from an infection (2,6).

What herbs can you use for herbal cough lozenges?

In addition to the elderberry, marshmallow, thyme and ginger, other herbs that could be included are liquorice, cinnamon or rosemary. 

Are herbal cough lozenges suitable for children?

They can be used by the whole family including children, but beware of the choking hazard with small children.

1. Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013.
2. Mcintyre A. Complete Herbal Tutor : The Definitive Guide to the Principles and Practices of Herbal Medicine (Second Edition). Aeon Books Limited; 2019.
3. Torabian G, Valtchev P, Adil Q, Dehghani F. Anti-influenza activity of elderberry (Sambucus nigra). Journal of Functional Foods. 2019;54:353-360. https://doi.org/10.1016/j.jff.2019.01.031 
4. Fink C, Schmidt M, Kraft K. Marshmallow Root Extract for the Treatment of Irritative Cough: Two Surveys on Users’ View on Effectiveness and Tolerability. Complementary Medicine Research. 2018;25(5):299-305. https://doi.org/10.1159/000489560 
5. Dauth S, Schäfer SMG, Klippstein M, et al. Effect of thyme-ivy syrup on antiviral immune response in patients with mild COVID-19: a prospective, open-label, randomized pilot study. Frontiers in Medicine. 2025;12. https://doi.org/10.3389/fmed.2025.1672794 
6. Ayustaningwarno F, Anjani G, Mutiara Ayu A, Fogliano V. A critical review of Ginger’s (Zingiber officinale) antioxidant, anti-inflammatory, and immunomodulatory activities. Frontiers in Nutrition. 2024;11. https://doi.org/10.3389/fnut.2024.1364836 

• 250 g powdered or finely chopped medicinal mushrooms
• 500 ml of 45% vodka or organic food grade ethanol 
• 500 ml filtered water

• Two 1.5 l kilner jars 
• Muslin 
• Funnel 
• Amber storage bottles

• Place the 250 g dried mushrooms in the glass jar and cover with 500 ml alcohol, ensuring all plant material is submerged. 
• Seal the jar and leave in a cool, dark place to macerate for four weeks. Stir the mixture regularly and top up with more alcohol if necessary. 
• Strain the mixture through muslin. This can be repeated a couple of times for a clearer mixture with fewer particles. 
• Reserve the strained alcohol extract and the mushroom marc for the following steps. 
• Place the strained mushroom marc into a saucepan along with a litre of water. If there is extra dried mushroom material, it can be added in this step to make a stronger decoction. 
• Simmer gently for 2–3 hours, making sure the mixture does not boil. 
• The mixture should reduce down to roughly 500 ml. 
• Strain and allow the decoction to cool. 
• Combine both the alcohol extract (500 ml) and the decoction (500 ml) to make a litre of 1:2 22.5% alcohol. 
• To ensure the shelf life and stability, add a further 125 ml of alcohol to bring the finished mixture to 25%. 
• Pour the finished mixture into amber glass jars, label and store in a cool dark place. 

For dosage, see our individual mushroom monographs for suggested daily quantities and to check for any associated cautions and contraindications before consumption.

Reishi

Reishi (Ganoderma lucidum) is a well renowned mushroom has been used in China for thousands of years to promote health and longevity. Reishi has broad spectrum benefits for immunological, cardiovascular and nervous system conditions. It has a neuroprotective action and helps to reduce the risk of neurodegenerative diseases; as well as being an immunomodulator, reishi helps to support allergies and reduce inflammation (2). 

Turkey tail

Turkey tail (Trametes versicolor) is a powerful immunomodulator whose actions are attributed to the presence of polysaccharide-krestin (PSK) and polysaccharide-peptide (PSP). It has wide ranging actions on the immune system, helping to fight viral and bacterial infections including human papillomavirus (HPV) and Herpes simplex virus (HSV) (3). Turkey tail is used as an adjunct therapy in cancer treatment in Japan as a result of its immune supportive effects (2). 

Lion’s mane

Lion’s mane (Hericium erinaceus) is used to support the brain and nervous system. It has been shown to increase the production of nerve growth factor (NGF), helping to stimulate the production of nerve cells (2). It helps to stimulate the process of myelination, which is key in the transmission of electrical nerve impulses. It is a neuroprotective which helps to support cognitive function and reduce the risk of neurodegenerative diseases (4). 

This tincture should keep for up to a year and half if it’s kept in a cool place out of direct sunlight. It should be checked regularly for signs of mould or decay and discarded if any is found.

Can you use fresh mushrooms for this tincture recipe?

In order to ensure the correct water and alcohol content of the alcohol extraction, and ensure shelf life, it is best to use dried mushrooms. Freshly picked or foraged mushrooms can be dried in a dehydrator or on a low heat in the oven then powdered in a nutribullet. 

What alternative species can you use for mushroom tincture?

This recipe can be used for all species of medicinal mushroom. If you have multiple different species of mushroom, you can also combine all of them to make a mixed mushroom dual extraction tincture. Safety note: If you are foraging for medicinal mushrooms, it is essential to ensure correct identification of the mushroom before tincturing. 

Can you use whole mushrooms for tincture?

This recipe is most effective when the mushrooms are in the smallest possible particle size giving a larger surface area for extraction. This can be done by chopping very finely, or using a blender to create a powder.

Ethnobotany is highly interdisciplinary and weaves together perspectives from botany, anthropology, ecology, medicine and history to understand plant and human interactions. It has a particular focus on traditional knowledge and uses of plants within specific cultures and regions. Through ethnobotany we learn how people use plants for a variety of uses — from shelter to food, ceremony, clothing, medicine, art and ritual.

Ethnobotany is also not just limited to understanding indigenous peoples knowledge, but how people from everywhere use and interact with plants (including in cities and amongst global diaspora).  For example, the paper Cross-cultural adaptation in urban ethnobotany: The Colombian folk pharmacopoeia in London investigates which plants the Colombian diaspora in London use, and how these uses have changed after migration (2). Ethnobotany also largely works with people from afro-descendant communities, traditional societies and local communities. 

Other fields of ethnobiology include ethnomycology (the study of people and fungi), ethnozoologists (people and animals) and ethnoecologists (people and their environment/ecosystem), amongst others.

The field of ethnobiology that focuses on medicines is called ethnopharmacology. 

“Ethnopharmacology is a multidisciplinary field of inquiry investigating the anthropological rationale and the pharmacological basis of the medicinal use of plants, animals, fungi, micro-organisms, and minerals by human cultures” (3).

Drawing on pharmacology, anthropology, biology, phytochemistry and pharmacognosy, ethnopharmacology researches all things surrounding herbal medicines. This spans from different medical systems and philosophies, to harvesting practices and preparation methods, ethnopharmacology archives and expands on traditional knowledge by researching it from different perspectives. 

In ethnopharmacology, ‘folk medicine’ is not limited to the kitchen or the premises of traditional preparation, but is also investigated in the lab, and plant specimens taken to the herbarium.

One could argue that herbalism is ethnobotany in action — the use of plants as medicine. Much of our herbal knowledge — particularly in the West — has come from an ethnobotanical exploration of our own native practices, and adoption and incorporation of those from afar. 

A Western example is echinacea (Echinacea spp.) — an immune boosting plant in Europe and was brought from America in 1952. Swiss herbalist Alfred Vogel spent several weeks with the Sioux people on the Pine Ridge reservation in South Dakota, where he met a medicine man called Ben Black Elk from the Lakota Ogala tribe. Black Elk shared knowledge on the traditional use of echinacea for coughs, wounds, infections and snakebites and generously gave Alfred Vogel seeds to bring back home. Now echinacea is one of the most popular herbs used in Europe. 

Ethnobotany also unveils the diverse ways that people from different cultures use the same species in herbalism. The same plants grow across different countries and regions, yet, how the people from these places use and prepare the plants often differ. This highlights alternative benefits of the phytochemistry of the plants, new leads for scientific research, and the diversity of approaches to work with these medicines. 

In Northern Europe, bay leaves (Laurus nobilis) are used for digestive disorders and wound healing. However, in Greece, bay leaves are used for metabolic health for example diabetes and cholesterol. In Cyprus, people put bay leaves in their cupboards to keep insects and cockroaches out, and interestingly phytochemical analysis of bay leaves show that the compounds in them have insect repellent activity (4). This is exemplary of how scientific insight can enrich traditional knowledge, here, supporting a means to reduce chemical use with pesticides. 

People from different parts of the world often also use the same plant for the same actions or conditions. It could be argued that the repetition of use of a plant across cultures strengthens the evidence that a plant is useful, and therefore warrants further investigation and scientific enquiry.

Another invaluable part of ethnobotany is traditional ecological knowledge (TEK). Ecologist Fikret Berkes defined TEK as “a cumulative and dynamic body of knowledge, practices, and beliefs that evolves through adaptive processes, which are shared across generations through cultural transmissions”. TEK is an accumulation of all of the observational knowledge gathered over years, on all species that reside within a community and most importantly, how the humans living there interact with them. TEK includes practices, skills and understandings of how to work with the environment in a way that is sustainable and facilitates an enduring and thriving species population.

TEK also includes growing, foraging and harvesting techniques, as well as adaptive mechanisms to deal with a changing environment; though, it must be noted that sometimes maladaptations do happen, and practices can in some cases be damaging. When describing TEK, herbalist Jonas Brab said the practices are “usually based on a holistic worldview, where humans are part of a living community and where everything has repercussions that have to be considered” (5).  

This knowledge is particularly crucial for the protection and longevity of herbal medicines now, as there has never before been so much interest in herbal medicines commercially. With people seeking alternative medicines and more natural ways of living, there has been an enormous increase in sales of supplements and medicinal plants and fungi these past few years. The global herbal medicine market was estimated at $70.57 billion in 2023 and is projected to reach $328.72 billion by 2030 (6). Many medicinal plants now endangered and facing extinction in the wild include popular herbs like rhodiola (Rhodiola rosea), cordyceps (Ophiocordyceps sinensis), chaga (Inonotus obliquus) and liquorice (Glycyrrhiza glabra). Read about species specific sustainability issues.  

Not only is this a major loss for all, but most importantly for the people who have stewarded this land and the herbs, and who depend on them for medicines. A well-known example of this is with the popularisation of the psychoactive brew ayahuasca, traditionally made from plants in the Amazon amongst a diverse array of traditional communities within the jungle. Now because of ‘spiritual tourism’, the vines have been exploited, and in many places it is very difficult or not possible for the local people to have access to the plants, which are so integral to their spiritual practices, ceremonies and rites of passage (6). The same thing happens with the medicinal herbs in popular supplements. 

Ethnobiology, ethnoecology and TEK offer us the opportunity to listen to and learn from people who know how to sustain and nurture thriving ecosystems. Collaboration and genuine partnership allow us to co-create systems with mutual benefits and equitable sharing where all species can thrive.  As stated in the Fungi Foundations Ethnomycology Ethical Guidelines 2025, “The knowledge underlying the resource management practices of the world’s Indigenous Peoples, Afro-descendant communities, traditional societies and local communities is directly tied to the maintenance of biological diversity” (8).

Whilst ethnobiology holds much value and gives hope for the world, it has a deeply problematic history. The indigenous peoples, local communities, farmers, and Afro-descendant groups who are commonly involved with ethnobiology projects have faced deep historical injustices, marginalisation and oppression. Ethnobiology has been used to exploit these communities many times, and with the founder of ethnobotany John William Harshberger in 1895 describing it as “the study of the plants used by primitive and aboriginal peoples”. The term “economic botany” has often been used in place of ethnobotany, indicating the highly capitalistic and often extractive ways these tools have been used. 

Now, there is a strong cultural shift and work being conducted to decolonise these practices. Any positives that these collaborations and the pursuit of ethnobiology may have, will only bloom if the value systems and practices are inherently different to the past. As stated in the Fundamentals of Pharmacognosy and Phytotherapy, “The ‘Western’ use of such information has come under much scrutiny, and the national and indigenous rights of this knowledge has been acknowledged by most academic and industrial researchers” (7). Initiatives like the Convention of Biological Diversity (CBD) and The Nagoya Protocol have been created to prevent repetition of the past and ensure equitable benefit sharing. 

The Fungi Foundation has created Ethnomycology Ethical Guidelines, where they have outlined critical principles for the future of ethnobiology. They stated that “Ethnomycology thrives when it is carried out in dialogue with communities, under principles of reciprocity, mutual respect, and co-production of knowledge (8).”

The principles in the guidelines include: 

• Principle of self-determination, prior rights and responsibilities 
• Principle of respect to Pachamama (nature or mother earth) and her rights 
• Principle of historical justice and respect for Indigenous Peoples and local communities 
• Principle of reciprocity, mutual Benefit and equitable sharing
• Principle of conservation of flora, fauna and fungi 
• Principle of respect to the elders and knowledge keepers
• Principle of acknowledgement and due credit 
• Principle of educated prior informed consent 
• Principle of support for social and indigenous projects 

Globally there is a deep shift in our collective relationship to nature, and this is in large part from listening to the stewards of the land, as well as deep disenfranchisement with the current system. In 2008 the Constitution of Ecuador. recognised the rights of Nature or Pachamama as a legal entity with the right to exist and be protected, reflecting indigenous and ecological principles embedded in the national legal framework.

“Nature or Pachamama, where life is reproduced and takes place, has the right to integral respect for its existence and the maintenance and regeneration of its vital cycles, structure, functions, and evolutionary processes. Every person, community, people, or nationality may demand the public authority to fulfill the rights of nature. To apply and interpret these rights, the principles established in the Constitution shall be observed, as appropriate. The State will incentivize natural and legal persons, as well as collectives, to protect nature and promote respect for all the elements that form an ecosystem” (10).

Whilst herbalism and ethnopharmacology are very important for the evolution of our healthcare systems, there is no doubt that ethnobiology can offer support for a lot more than just medicine. In fact, many would argue that it is remiss not to include indigenous-led value systems at the centre of our new way of being. Respect, reciprocity and harmony with nature are fundamental if we are to create an antidote to the troubles we face — thankfully, we have many people and species we can learn from. 

1. Wcmc. Championing Indigenous Peoples’ stewardship of biodiversity – UNEP-WCMC. UNEP-WCMC. https://www.unep-wcmc.org/en/news/championing-indigenous-peoples-stewardship-of-biodiversity
2. Ceuterick M, Vandebroek I, Torry B, Pieroni A. Cross-cultural adaptation in urban ethnobotany: The Colombian folk pharmacopoeia in London. Journal of Ethnopharmacology. 2008;120(3). https://doi.org/10.1016/j.jep.2008.09.004 
3. Leonti M, Casu L. Traditional medicines and globalization: current and future perspectives in ethnopharmacology. Frontiers in Pharmacology. 2013;4. https://doi.org/10.3389/fphar.2013.00092 
4. Jemâa JMB, Tersim N, Toudert KT, Khouja ML. Insecticidal activities of essential oils from leaves of Laurus nobilis L. from Tunisia, Algeria and Morocco, and comparative chemical composition. Journal of Stored Products Research. 48:97-104. https://doi.org/10.1016/j.jspr.2011.10.003 
5. Braab J. The relevance of traditional ecological knowledge for modern herbal medicine | History | Herbal Reality. Herbal Reality. https://www.herbalreality.com/herbalism/history/relevance-of-traditional-ecological-knowledge-for-modern-herbal-medicine/ Published August 28, 2024.
6. Herbal Medicine Market Size, Share & Growth Report, 2030. https://www.grandviewresearch.com/industry-analysis/herbal-medicine-market-report 
7. Heinrich M, Barnes J, Gibbons S, Williamson E. Fundamentals of Pharmacognosy and Phytotherapy. 2nd ed. Elsevier; 2012. http://cms.herbalgram.org/heg/volume9/files/Fundamentals_FM.pdf 
8. Ethnomycology Ethical Guidelines | Fungi Foundation. https://www.ffungi.org/campaign/ethnomycology-ethical-guidelines 
9. Oregon State University, College of Forestry. What is TEK? | Traditional Ecological Knowledge Lab. Published 2022. https://tek.forestry.oregonstate.edu/what-tek 
10. Ecuador: 2008 Constitution in English. https://pdba.georgetown.edu/Constitutions/Ecuador/english08.html

• Ethnomycology Ethical Guidelines- Fungi Foundation 2025
• EthicalGuidelines_English_2025.pdf 
• Ethnopharmacologic Search for Psychoactive Drugs- ESPD55- McKenna Academy
• Championing Indigenous Peoples’ stewardship of biodiversity – UNEP-WCMC

Camellia sinensis  prepared as liupao tea — a fermented dark tea rich in polyphenols

To evaluate the effects of Liupao tea of different ages on patients with metabolic syndrome in relation to biochemical markers, body weight, body composition and gut microbiota.

The study was randomised, double-blind and a longitudinal experimental design. Participants were aged between 18 and 70 years and diagnosed with metabolic syndrome according to Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2022 edition) (2). Exclusion criteria precluded the participation of anyone with chronic illnesses — such kidney, liver, blood or heart disease — or were taking any medications that affected their blood glucose, blood lipids or blood pressure, any pregnant or lactating women, any individuals with allergies to tea ingredients, anyone with restrictive dietary habits (such as the ketogenic diet) and anyone with severe mental illness or trauma.

Participants randomised to one of four groups:

• 1-year old fermented tea n=19
• 4-year old fermented n=19
• 7-year old fermented n=19
• 10-year old fermented n=19.

The following measures were taken:

• Visual Analogue Scale (VAS) to evaluate patient appetite — hunger, fullness, mood etc out of a total of 500 points
• Fasting venous blood following an overnight fast for fasting blood glucose, HbA1c, blood lipids, insulin, hepatic and muscle biomarkers
• Body composition via a bioelectrical impedance analyser — body weight, body fat mass, skeletal muscle mass, body fat percentage, lean body mass, visceral fat area
• Waist circumference
• Blood pressure
• Faecal DNA analysis and library construction for diversity analysis and taxonomic classification of gut microbiota

Participants consumed 6 g (one teabag) of Liupao tea per day for 90 days. Tea was brewed with 250 ml of boiling water in a teapot and steeped for up to 45 seconds before drinking. The tea was consumed 1–2 hours after breakfast or lunch and was finished before 3 pm.

A power calculation was used to determine group sizes and there were n=19 participants in each group. Participants were encouraged to engage with the study via an App. Five were lost to follow-up.

Fifty-two females and 19 males completed the study. With the five lost to follow up the final groups were: 1-year old tea (n=19), 4-year old tea (n=17), 7-year old tea (n=18) and 10-year old tea (n=17). There were no differences in any of the demographic measures between the groups. There was an equal split of whether people were regular tea drinkers or not.

Blood pressure

Systolic blood pressure significantly reduced in the 4-, 7- and 10-year tea groups, whilst diastolic pressure only reduced in the group drinking the 10-year tea (p<0.05).

Blood lipids and biomarkers

Total cholesterol reduced in the one-year aged tea group. HDL-C was elevated in the 4- and 7- year aged groups, and LDL-C was reduced across all of the groups compared to baseline (p<0.05).

Apolipoprotein A1 was significantly reduced in the teas that were 1-, 7- and 10-year aged, but apolipoprotein B did not change.

The teas had no significant effects on other parameters such as fasting blood glucose and liver health biomarkers.

Body composition

The teas significantly reduced average body weight with groups losing on average 1–2 kg over the 90 day trial. This corresponded with significant reductions in body fat mass, body fat percentage and visceral fat area. Body mass index and waist circumference decreased in the 4-, 7- and 10-year-aged groups (p < 0.05).

Participant appetite scores did not alter.

Faecal microbiota

Diversity

The seven-year-aged group exhibited an increase in the number of unique Amplicon Sequence Variants (ASVs) after intervention, whereas other groups showed a decrease. This suggests there were shifts in populations. The α-diversity of gut microbiota in the four groups revealed no significant differences before and after intervention across the age range of teas. So for the seven-year aged tea, there were different species apparent, but overall diversity did not change as presumably some species swapped in and out.

Phylum and genus level changes

For individual phyla, Firmicutes and Bacteroidota were dominant in the participants as a whole group. Following the tea intervention, the relative abundances of Firmicutes decreased in the 1-, 4- and 10-year-aged groups, while Bacteroidota abundance decreased in the one-, four- and seven-year-aged groups. 

At the genus level, the overall gut microbiota were comparable in structure across the four tea groups. The most abundant genus in all groups was Bacteroides followed by Prevotella 9 and Faecalibacterium. The changes observed included reductions in Stenotrophomonas and Rothia, and an elevation in Eubacterium hallii in the one-year aged tea group. Elevation of Allobaculum, Monoglobus, and Eubacterium ventriosum in the four-year aged tea group. Reduction in Holdemania in the seven-year aged tea group.

Microbial and metabolic correlations

Using Spearman’s correlation, there were associations between microbial changes and metabolic indicators in the different tea groups. Firstly, Akkermansia displayed a strong inverse relationship with body mass index in the one-year- and seven-year-aged groups. Subdoligranulum was significantly negatively correlated with both triglyceride and insulin levels in the one-year aged group. Other associated changes are also presented.

Liupao tea is a variety of dark tea of ancient origin prepared from the Camellia sinensis plant that grows specifically in Liu Pao in the Guangxi Province in China. The tea is fermented over several years which converts catechins into tea polysaccharides and notably the polyphenol theabrownin. Similar to Pu-erh tea, this tea is enjoyed because of its unique aroma and flavour. Theabrownin and other tea polyphenols have been extensively researched for their lipid-lowering, anti-inflammatory and pre-biotic properties. The present study explored whether differing durations of fermentation would affect metabolic and microbial parameters in participants with diagnosed metabolic syndrome.

The teas that were consumed for 90 days had blood pressure-lowering and lipid-modifying effects. The tea did not affect fasting blood glucose or insulin. The teas significantly reduced average body weight over the 90-day trial, with reductions in body fat including the visceral fat area. Overall, these changes were seen more for teas that were fermented and aged for 4, 7 and 10 years.

Other meta-analyses have shown that tea consumption (green and black analysed together) can reduce body weight, body mass index and modify lipid profiles favourably in patients with metabolic disease (3). For the Liupao tea, the suggested mechanisms related to the cholesterol-lowering properties of theabrownin which increases faecal excretion of bile acids and reduces lipogenesis.

Other mechanisms are purported to involve the gut microbiota. Using a faecal microbiota transplantation method in an animal model, Liupao tea extract improved the abundance and species diversity of microbiota including commensals Lactobacillus and Dubosiella; These changes were associated with weight loss and improved glucose and lipid metabolism (4). In the present study, there were no significant differences in microbial diversity but there were genus and species changes across the groups. Both Firmicutes and Bacteroidota genera declined in the 4, 7 and 10-year aged tea groups. Reducing the ratio between these genera reported to improve intestinal barrier function. Other changes included reductions in Stenotrophomonas which is an opportunistic pathogen.

In supplementary information, the total polyphenol composition of the teas was compared. Levels of theabrownin increased from year one, to four and seven, whilst the 10-year aged tea was similar to seven. The levels of soluble dietary fibre were highest in the 7- and 10-year aged teas, which could have also accounted for the microbial changes. Other compounds such as total flavonoids and caffeine were similar across the teas.

Liupao tea, particularly if well-aged, improved blood pressure and blood lipids in patients with metabolic syndrome. Positive changes in body weight and composition were observed, and there were changes in gut microbiota genera and species abundance rather than observable changes in diversity.

Liupao tea could provide a natural and simple approach to managing metabolic health. Future studies could explore longer timeframes for ingestion, determine which age of tea is the most optimal, and also to compare it to other forms of tea such as green and black. Further work could explore the relationships between gut microbiota composition and specific health outcomes.

1. Wang Y, Hu Q, Jiang Q, Jiang J, Li B, Ma D. A Randomized Double-Blind Trial of the Effect of Liupao Tea on Metabolic Parameters, Body Composition, and Gut Microbiota in Adults with Metabolic Syndrome. Nutrients. 2025; 17(14):2371. https://doi.org/10.3390/nu17142371 
2. Chinese Elderly Type 2 Diabetes Prevention and Treatment of Clinical Guidelines Writing Group; Geriatric Endocrinology and Metabolism Branch of Chinese Geriatric Society; Geriatric Endocrinology and Metabolism Branch of Chinese Geriatric Health Care Society; Geriatric Professional Committee of Beijing Medical Award Foundation; National Clinical Medical Research Center for Geriatric Diseases (PLA General Hospital). Clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in China (2022 edition). Zhonghua Nei Ke Za Zhi 2022, 61, 12–50. https://doi.org/10.3760/cma.j.cn112138-20211027-00751 
3. Xiao, T., Li, Y., Li, H., Wang, K., Huang, J., Liu, Z., & Zhu, M. (2024). Tea consumption in relation with metabolic syndrome and obesity: A systematic review and meta-analysis of randomized clinical trials. Food Bioscience, 61, 104322. https://doi.org/10.1016/j.fbio.2024.104322 
4. Zhou H, Wang X, She Z, Huang L, Wei H, Yang S, Wei Z, Chen H, Yang B, Hu Z, Feng X, Zhu P, Li Z, Shen J, Liu H, Dong H, Chen G, Zhang Q. Combining bioinformatics and multiomics strategies to investigate the key microbiota and active components of Liupao tea ameliorating hyperlipidemia. J Ethnopharmacol. 2024 Oct 28;333:118438. https://doi.org/10.1016/j.jep.2024.118438 

Cordyceps (Cordyceps sinensis)

To evaluate the effectiveness of a fermented cordyceps broth in patients with diagnosed primary insomnia, with the utilisation of an app to facilitate the running of the study. The trial was registered with the Chinese Clinical Trial Registry.

The study was a randomised, double-blind, placebo-controlled trial. 

The study utilised an app to record:

• The Pittsburgh Sleep Quality Index (PSQI) — a scale that includes:
  •  Sleep quality
  • Sleep onset latency
  • Sleep duration
  • Sleep efficiency
  • Sleep disturbances 
  • Daytime function

• Experiences of drinking the beverage and any adverse reactions
• A Self-Rating Anxiety Scale (SAS)

A fermented cordyceps beverage was compared to a placebo, which was similar in appearance, taste and packaging.
Participants received 150 ml bottles and consumed one per day (at any time of day) for six days with a one day break. The trial duration was 28 days. The fermentation process is designed to enhance cordycepin levels and the dosage was within safety parameters defined by preclinical research (2).

Ninety patients were recruited to two groups and received cordyceps or placebo, and two people were lost to follow up. They were 20–75 years of age and included males and females. Inclusion criteria was diagnosis of primary insomnia according to Chinese Classification — with insomnia being the sole symptom and occurring at least three times per week for one month. The PSQI score was >5 for participants and SAS anxiety score <50. Participants were required to not consume probiotics, antibiotics or caffeine for the 28 days of the study, and also abstain from taking sleeping pills from one month before the start.

Overall 88 participants completed the study and included n=59 females and n=29 males. The baseline demographic data was similar between the cordyceps and placebo groups.

The presented data compares t=0 with t=14 and t=28 days. Both groups displayed improvements in many sleep symptoms over time (time factor) and many of the effects were significant for the cordyceps group compared to the placebo (group factor). Figure 5 displays the changes seen over time.

Sleep scores at day 14 and day 28

Apart from sleep onset latency, participants receiving cordyceps had significantly greater reductions versus placebo for all other 6 PSQI scores — the total PSQI score, sleep quality, sleep duration, sleep efficiency, sleep disturbances and daytime function. All these improvements were still significant at day 28 and at this time point sleep onset latency had also significantly reduced (i.e. the time it takes to fall asleep).

Gender differences

The data was stratified by gender. Female participants receiving cordyceps compared to placebo experienced significant reductions in their total PSQI score, sleep quality, sleep duration, sleep onset latency and sleep efficiency, but not improvements in sleep disturbances and daytime function. Among male participants, significant improvements were seen in the total PSQI score, sleep quality and sleep duration; however, no significant group effect was observed for the other measures, including sleep onset latency and sleep efficiency.

Age differences

The data was stratified by age into younger participants (age 20–40 years), middle-aged (41–65 years) and older years (66 and over). There were the most participants in the younger group and numbers in the other two groups were low.

For the younger participants there were significant improvements in five of the scores for cordyceps versus placebo with the exception of sleep disturbances and daytime function (Figure 7 in the publication). 

For the middle-aged adults, there were no significant differences between the cordyceps and placebo groups. For the older group, there were improvements in the total PSQI score, sleep efficiency and sleep duration. 

Safety 

In terms of safety, three minor adverse events were reported in the cordyceps group, relating to increased bowel movements (unconfirmed whether related to treatment).

Cordyceps sinensis is widely used due to its nutritional and medicinal properties. It contains many bioactive components including cordycepin and adenosine. Fermentation techniques are employed to increase levels of bioactive components, and cordycepin is one that is well-researched due to its therapeutic effects.

The study compared the daily ingestion of a fermented cordyceps drink compared to placebo for 28 days. The cordyceps drink resulted in significant improvements in sleep status, which was consistent from day 14 to day 28, compared to the placebo. The authors also suggest that female participants experience more sleep improvements compared to males. Whether this is due to different stages in the oestrus cycle over the course of the study, or perhaps some of the participants were peri- or post- menopausal, is not known. By analysing age, younger participants experienced more consistent improvements to sleep, although the numbers of participants within the older age groups was low and the results were under-powered.

Other studies using electroencephalogram (EEGs) have found that the active compound cordycepin binds to adenosine receptors in the brain and reduces sleep-wake cycles and increases non rapid eye movement sleep — NREM — which is the phase of sleep most attributed to body repair and rest (2). In the present human study, the authors were unsuccessful in using smartwatches to gain further insight into the participant’s sleep-wake cycles. This would have provided useful information to combine with the App which recorded sleep subjectively through the Pittsburg tool.

The authors did not report the bioactive levels within their product. Cordyceps is a valuable nutritional and medicinal plant and is subject to overharvesting, so, in addition to sourcing from cultivated supplies, using fermentation processes to enhance the yield of valuable compounds is beneficial to minimise the harvest required.

A fermented cordyceps beverage significantly improved sleep outcomes in patients with primary insomnia. Future research could continue to explore benefits within specific groups or at different ages. Combining cordyceps with herbs also known to be sedative would also be an interesting approach.

1. Zhao, S., Wang, Z., Fan, X., Shu, X., Chen, Q., Zhou, Y., … & Wen, C. (2025). Effectiveness of fermentation broth of Cordyceps sinensis for primary insomnia: a randomized clinical trial with digital health tool. Frontiers in Neurology, 16, 1555010. https://doi.org/10.3389/fneur.2025.1555010 
2. Hu Z, Lee CI, Shah VK, Oh EH, Han JY, Bae JR, Lee K, Chong MS, Hong JT, Oh KW. Cordycepin Increases Nonrapid Eye Movement Sleep via Adenosine Receptors in Rats. Evid Based Complement Alternat Med. 2013;2013:840134. https://doi.org/10.1155/2013/840134 

The medicinal legacy also included knowledge of the classical humoral system of the Greeks, which spread into the wider population. We have glimpses of Roman medicine even from a Celtic temple of healing at Lydney where one of several stone stamps used to label eye ointments was found (3).  These gave the name of the Roman oculist (eye doctor) and of the salve, including ingredients, such as frankincense (Boswellia sacra), quince (Cydonia oblonga), myrrh (Commiphora molmol), opium poppy (Papaver somniferum), fennel or saffron (Crocus sativus) (4). The Roman trade routes covered the known world, and spices as well as more exotic herbs were sold in shops that appeared in the towns that became Roman civitas. Recent archaeology has added greatly to our knowledge of the integration of Romano British life (5).

We have knowledge of medical recipes from the collection of Scribonius largus, a surgeon who spent time along Hadrian’s Wall in the first century (6). Having made a number of these in historical workshops, there are some surprising inclusions of ingredients that are backed by modern research; one being  The most surprising pine nuts ground with rose petals and poppy seeds to treat an ulcerated kidney. We have made this recipe several times and I was intrigued and followed up on why the pine nuts. Modern research I found supported it (7). 

Similar recipes appear in Celsus De Medecina written in Rome at the same period (8). Lastly, herbs continued to grow near the Roman forts as we find mentions of herbalists still gathering them centuries later from along the wall.

The legacy of Roman introductions of herbs, vegetables and trees is possibly the only Italian influence most people are aware of. There is so much more. Christianity also came with followers among the multicultural Roman army, but the real influence of the Church of Rome begins with the conversion of King Aethelbert of Kent in 597 CE. The first monastery was built in the following year and a school established in 670 CE in Canterbury.

There is evidence from some of the later pupils that medicine was one of the subjects taught there (9). Although the Church subsequently put care of the soul before care of the body in disease, there was ecclesiastical copying and exchange of medical manuscripts and exotic herbs during the Anglo-Saxon period. As a consequence, we find references to Roman and Greek sources being consulted in the Leechbooks (10).

In 1095, a long-established teaching hospital with an already high reputation in the busy port of Salerno, Italy, became the base hospital for crusaders. Some men returned home to England with prescriptions, and new herbal knowledge. Others with a taste for oranges experienced at Jaffa, also sugar and Asian spices, which were then increasingly imported often on Venetian galleys into Southampton (11). 

Many years ago, I visited Salerno, where among other English students, Gilbertus Anglicus, mentioned in Chaucer,’s Canterbury Tales, trained as a physician (12). There, in the museum, is a manuscript, copies of which were kept in Cathedral libraries in England, the Antidotarium of Nicolai. Salerno is associated with the translations of Greek, Jewish and Arabic medical texts by Constantine the African, a monk at the nearby Abbey of Montecassino in the 11^th century. 

Following his work, it was to be Avicenna’s interpretation of Galen that would be taught to physicians in the Universities of Europe (8). The Medieval Health Handbook, the Tacuinem Sanitatis, is adorned with vivid Italian illustrations. The original manuscript is thought to have been translated into Latin based on the work of an Arabian physician, Ibn Botlan who lived in the 11^th century. There are several copies held in different European countries. 

The brightly coloured illustrations accompany the slightly adapted Arabic Tacquim or tables of humoral advice. Fennel is listed as warm and dry, as useful for eyesight, milk and urine flow, and flatulence. Cautions are given  of danger from slow digestion, which is remedied by chewing slowly and informed that fennel is suited to be eaten in winter — for those who are old, or have cold temperaments. This pattern of advice is followed for herbs, such as sage (Salvia officinalis), marjoram (Origanum majorana), mandrake (Mandragora officinarum), dill (Antheum graveolens), garlic (Allium sativum) and elecampane (Inula helenium). The illustration of mandrake inevitably includes a dog, supporting the caution that it was not safe for a person to dig the plant out of the soil, a dog must be used. Other illustrated features included foods — such as eggs, wheat, dates, pasta, olive oil and meats — clothing fibres, activities, people chatting and expressing strong emotions s, as well as environmental influences — the winds from south, east, west or north (13).

Advice on how to live a healthy life was brought back to England also by pilgrims and in the time of Elizabeth I, her godson, Sir John Harington translated the Regimen Sanitatis   into English (14). His love of fun shows brilliantly in the playful poetic presentation of the different humoral types of person and medicinal properties of foods and herbs. It is an excellent aid to herbal students learning healthy living in the humoral system. 

Avicenna’s interpretation of Galen was used in Continental Universities. This also informed the training of English and Irish physicians as there seems to have been little enthusiasm for the subject of medicine at Oxford, where in 1303 there was one master with a handful of students (9). More went to Montpellier, Padua or Bologna. In Italy, where there had already been close ties to Arabic ways when the first official European formulary, the Florentine Nuovo Receptario Composito of 1498, was compiled (15). This was by a committee of physicians who co-operated with apothecaries in Florence in producing this work, as they both belonged to the same guild, the arte dei medici e speziali. Many Italian states followed (15).^. 

Italian regulation of medicine then was far more developed than the confused multiplicity of practices and freedoms in England. Henry VIII came to the throne in 1509. He was very interested in medicine and formulated his own herbal recipes to treat his chronic leg condition. One of his physicians, Thomas Linacre had graduated in Padua and been impressed by the control exercised by the Collegium of Physicians and training of apothecaries, who took examinations set at Salerno in order to practice. Although Henry VIII signed the letters patent, Thomas Linacre has been seen as the real founder of the Royal College of Physicians (9).

The London Pharmacopoeia was still a century away, but again the trail of inspiration has taken us back to Florence. The power of physicians to repress unlearned practitioners and examine stocks of apothecaries and druggists relates to herbs, yet Thomas Linacre and others learned of herbs from Dioscorides Materia Medica. Their physical contact with plants was limited to their dried state in the apothecary shop. Luca Ghini, who had previously taught practical medicine at Bologna, promoted the idea of a separate lectureship of materia medica. 

Invited by Cosimo I, grand duke of Tuscany to Pisa, he was appointed to teach and demonstrate medicinal simples in 1539. At Pisa he founded the first botanic garden there for direct observation and perfected the hortus siccus of pressed, dried specimens of plants as a teaching aid (16).

The hortus siccus was later known as the herbarium, an aid to plant identification which I teach herbal students today at the School of Herbal Medicine in pharmacognosy class. I also take them annually to the herbarium founded in 1621 at the University of Oxford, to see early samples of herbs from the botanical garden. Some are still with fresh colours, from the hills around Bologna, capturing how the Italian herbal influence lives on. 

1. Alcock JP. Food in Roman Britain. Tempus; 2001.
2. Bowman AK. Life and Letters on the Roman Frontier. The British Museum Press; 2003.
3. Wilson R. A Guide to the Roman Remains in Britain. Constable; 2002.
4. Scullard HH. Roman Britain Outpost of the Empire. Thames and Hudson; 1979.
5. Bedoyere G. Roman Britain A New History. Revised edition. Thames & Hudson; 2013.
6. Bernhold JM, editor. Scribonii Largi Compositiones Medicamentorum. Scholar Select; originally 1786.
7. Takala R, Ramji DP, Choy E. The Beneficial Effects of Pine Nuts and Its Major Fatty Acid, Pinolenic Acid, on Inflammation and Metabolic Perturbations in Inflammatory Disorders. Int J Mol Sci. 2023;24(2):1171. Published 2023 Jan 6. https://doi.org/10.3390/ijms24021171 
8. Spencer WG, translator. Celsus De Medecina II Books V-VI. Harvard University Press; 1989.
9. Stapley C. A History of Plant Medicine. Ancient Greeks to the Modern Day. Aeon Books; 2024.
10. Pollington S. Leechcraft. Anglo Saxon Books; 2000.
11. Labarge MW. A Baronial Household of the Thirteenth Century. Eyre & Spottiswoode; 1965.
12. Chaucer’s Canterbury Tales. Penguin Classics; 1975.
13. Arano LC, editor. The Medieval Health Handbook. Tacuinem Sanitates. George Braziller; 1976.
14. Harington SJ. The School of Salernum. Regimen Sanitatis Salerni. Edizioni Saturnia Roma; 1957.
15. Nuovo Receptario Composto Dal Famossisimo Chollegio Degli Eximii Doctori Della Arte. Firenze. Facsimile. Gyan Books (distributor).
16. Bellorini C. The World of Plants in Renaissance Tuscany. Routledge; 2016.

Aotearoa New Zealand (NZ) has a devoted and dedicated group of medical herbalists through the New Zealand Association of Medical Herbalists (NZAMH), an organisation which has been in existence since the 1930s. 

As with many countries, the Aotearoa NZ health system is under strain with growing demands from an increasing and aging population, an aging medical workforce and a preference for urban rather than rural practice. In some parts of the country, patients may sometimes wait several weeks to get an appointment with a general practitioner (GP) (1).

Given the above, and the many benefits that plant medicine can have on human health, the NZAMH has for many years been seeking some form of statutory regulation to facilitate increased public access to practitioner expertise and reduce pressure on other areas of the health workforce. In Aotearoa NZ, this entails becoming a registered health profession under the Health Practitioners Competence Assurance Act (HPCAA). Initial attempts by the NZAMH looked promising, with a letter of acceptance to proceed to the next stage received from the then Minister of Health in 2007. Subsequent changes of Government and ongoing reviews of the Act however, have further delayed this process. 

While a growing number of New Zealanders are consulting with medical herbalists and naturopaths for a range of chronic and acute health problems, generally there is no state funding support towards the treatment costs. However, Aotearoa NZ has a unique injury-based system – the Accident Compensation Corporation (ACC), a scheme which provides financial and health service support to all New Zealanders after injury, including certain natural medicine modalities (2).

NZAMH has persistently promoted the benefits of practitioner-provided herbal medicine, and its ability to foster a more prevention focused healthcare system, thus saving healthcare costs overall. It has had some wins with insurance company recognition, and supported the establishment of herbal clinics where some of its members work with those experiencing substance use or mental health disorders. 

Before the arrival of Europeans, Aotearoa NZ Māori used a variety of native plants in their healing practices. Sadly, this was largely suppressed following European colonisation, as was the Māori language and many other aspects of a rich indigenous culture. 

Traditional knowledge lived on, however, through the oral tradition of many elders (kaumātua, and kuia — wise elderly men and women, respectively), the observations and subsequent texts of early botanists and European migrants, and the dependency also of early Europeans on native plants and indigenous knowledge for many healthcare needs. A herbal pioneer in colonial Aotearoa NZ was Mother Mary Joseph Aubert, a French nun who migrated there in the late 19^th century. Having studied botany and chemistry, she learned the properties of Aotearoa’s NZ native plants applying knowledge learned from Māori women and healers. She went on to manufacture and sell liquid herbal combinations (3,4). 

During World War II, the Māori battalion, which fought throughout the Middle East and Europe, had native plants such as koromiko (Hebe salicifolia) to help with diarrhoea, or kumerahou (Pomaderris kumeraho) for chest infections, sent from home. Such was the reputation and esteem of Māori medicine that remedies were sought and valued on the other side of the globe to Aotearoa NZ in the midst of war (5).

In recent decades, traditional Māori medicine (Rongoa Māori), as well as the Māori language and culture itself, has undergone an impressive revival in Aotearoa. Rongoa Māori medicine is a holistic form of healing, making use not only of the medicinal plants of Aotearoa, but also of various forms of massage and spiritual healing. Several rural communities have rongoa Māori healing centres near hospitals and there are moves towards more collaborative care (6,7) . In recognition of the value and importance of traditional medicine, Rongoa Māori treatments are now available for rehabilitation and certain other conditions through the ACC (2).   

Western medical herbalists have also increasingly incorporated native plants into their materia medica, and many of these have been made available to herbal practitioners for the past 40 years as tinctures or liquid extracts. These are generally used in the Western way, most commonly as ingredients in liquid formulations and products for both internal and topical use.

The unique healing properties and other benefits of certain native plants in Aotearoa NZ, are also recognised and utilised by elements of the natural health product industry in Aotearoa NZ. Several of these, such as mānuka (Leptospermum scoparium), kānuka (Kunzea ericoides), kawakawa (Piper excelsum) and horopito (Pseudowintera colorata), are ingredients in commercial products used for common health conditions, and their use is increasingly being supported by scientific publications including a growing number of clinical trials. Mānuka honey and mānuka oil have both become highly sought after in global markets, for their antimicrobial and many other healing properties (8,9).

Regulations in Aotearoa NZ are in a desperate need of an update, to not only better recognise the large skillset of trained practitioners, but also to better regulate herbal products. Medical herbalists are largely unregulated but are impacted by the 1981 Medicines Act, which regulates all medicines in the country. This Act was briefly replaced by the Therapeutic Products Act 2023 but then repealed in 2024 after a change in Government (10). The 2023 Act was the first to specifically address natural health products and start to define and better acknowledge Natural Health product practitioners. 

While herbal medicine itself is not well regulated in New Zealand, education is government recognised for a degree level programme. The Bachelor of Natural Medicine taught through the South Pacific College of Natural Medicine (SPCNM) receives Government funding and students have access to loans and allowances. The education environment in herbal medicine and naturopathy has changed greatly in recent years — in the 2000s there were six colleges throughout the country, but this has now reduced to one. South Pacific College is based in Auckland and has been in existence since 1967. It is well regarded with the highest category awarded by the NZ Qualifications Authority, indicating excellent teaching and organisation. The College boasts an on-site medicinal herb garden which is used both in teaching and community classes. 

Herbal education has changed over the years, not only with fewer providers delivering, but also in the development of stronger curricula, educating practitioners with a robust understanding of evidence-based practice. The complexity of health problems requires practitioners to have a more detailed understanding of subjects, such as differential diagnosis and herb-drug interactions. 

For those wanting to see a qualified medical herbalist, it is recommended to look for a member of the NZAMH — registered members are listed on the website. South Pacific College also runs a community clinic, Paua Clinic, from their premises in Ellerslie, Auckland. During the academic year, the public can consult with a senior student supervised by an experienced practitioner, at very reasonable rates. 

Apart from herbal practitioners, there is a flourishing and growing natural health product industry in Aotearoa NZ, with hundreds of small, medium and large businesses operating in this sector. Industry is represented by Natural Health Products NZ, formed in 2002. As successively bigger annual summits and industry wide surveys show, the natural health products sector has grown steadily to contribute more than $1.5 billion annually to the Aotearoa NZ economy (11). 

Medicinal cannabis has also become more popular in recent years, with a number of companies now cultivating and producing products in that area, although consumer access is still somewhat limited, due to the regulatory environment.

Aotearoa New Zealand is a significant producer of food and beverages and exports of these make up a large percentage of its economy and GDP. With changing consumer preferences and a need for the country to further diversify its current agriculture-based economy to become less dependent on animal-based products, the natural health industry and herbal medicines are gaining ground and being more recognised as future export earners. The diverse geography and unique features of the Aotearoa NZ environment, including different microclimates, make it ideal to cultivate numerous species. A range of species — such as echinacea (Echinacea spp.), ginkgo (Ginkgo biloba), green tea (Camellia sinensis), barley grass (Hordeum vulgare), saffron (Crocus sativus) and ginseng (Panax ginseng) — are already being cultivated, for export as well as grown for the local market. 

With ongoing unsettled times owing to geopolitical events and the increasing impacts of climate change and extreme weather events, many consider Aotearoa NZ as an ideal country to grow and supply medicinal plants as well as food and beverages, to both domestic and export markets. Extending the number of species and increasing supply volumes grown locally, are seen by industry advocates as important priorities (12).   Field trials are underway involving cultivation of several species of Asian, European and American plants. These are aimed at optimising agronomy, production efficiency and reliability, and quality. 

With a population of only 5.4 million, and a land mass the same as that of the UK, Aotearoa NZ has many vibrant rural communities, and a strong network of farmers and scientists, that have historically enabled it to adapt relatively quickly to geopolitical events or changes in trading relationships. These qualities, combined with the growing interest and use of indigenous species, and outstanding and committed education providers, practitioners and industry advocates, mean that herbal medicine is very much alive and well in Aotearoa New Zealand!

1. Medical Council of New Zealand. Workforce Survey Report 2024. Wellington, NZ: Medical Council of New Zealand; 2024.
2. ACC. Accessing ACC’s Rongoā Māori Service. Auckland, New Zealand: ACC; 2025. Accessed October 9, 2025. https://www.acc.co.nz/im-injured/what-we-cover/using-rongoa-maori-services
3. Museum of New Zealand Te Papa Tongarewa. Mother Aubert’s medicines. Collections Online. Accessed October 9, 2025. https://collections.tepapa.govt.nz/topic/2077.
4. Munro J. The story of Suzanne Aubert. Auckland, New Zealand; Auckland University Press; 1996.
5. Brooker SG, Cambie RC, Cooper RC. New Zealand Medicinal Plants. Published by Reed Books, Auckland, 1987. 
6. Healthpoint. Te Houtaewa Māori Charitable Trust — ACC-registered Rongoā Māori. Auckland, New Zealand: Healthpoint; 2025. Accessed October 13, 2025. https://www.healthpoint.co.nz/community-health-and-social-services/acc-registered-rongoa-maori/te-houtaewa-maori-charitable-trust/.
7. Stephens M, Eason, C, Mead A, Chu A, McGowan PR, Rasmussen P, Foster M. He Huarahi Hou: exploring the genesis of a unique approach and design of a regional pharmacopoeia. AlgerNative: An International Journal of Indigenous Peoples. 2025. 1-13. https://doi.org/10.1177/11771801251356030 
8. Mathew C, Tesfaye W, Rasmussen P, Peterson GM, Bartholomaeus A, Sharma M, Thomas J. Mānuka Oil-A Review of Antimicrobial and Other Medicinal Properties. Pharmaceuticals (Basel). 2020 Oct 26;13(11):343.
9. Rasmussen PL, Honey as a medicine: Special properties of mānuka honey. Pharmacy Today, 1 Oct 2024; ISBN 1170-1927. The Health Media Ltd, Auckland. 
10. Ministry of Health. Regulating medicines, medical devices and natural health products. Wellington, New Zealand: Ministry of Health; last updated April 14, 2025.
11. Natural Health Products New Zealand. www.naturalhealthproducts.nz.
12. Rasmussen PL, ‘Why New Zealand Grown Herbs are Best’. www.herbblurb.com. June 21, 2019.

Founded in 2009 by a small group of professionally trained medical herbalists, the HHRN aims to promote further research through its blogs, seminars and study groups. It continues to be run today by a small voluntary group of medical herbalists and humanities researchers. In 2024 we celebrated our 15^th anniversary, quite an achievement and we are looking ahead to the next decade. The group’s mission is to promote a scholarly approach to understanding historic herb uses and practices by bringing together interdisciplinary practices actively involved in using and applying herbal knowledge around the globe.

Published research 

For the 5th anniversary of the network in 2014, founding members Anne Stobart and Susan Francia co-edited Critical Approaches to the History of Western Herbal Medicine (see Figure 2)​. The text is now freely available online via Bloomsbury Press​ and is an excellent starting point for anyone interested in researching herbal history.

In addition to this landmark publication, the group regularly publishes blogs authored by researchers from a variety of disciplines: Curator John Hunnex recently wrote about The Botanical Collections of the Natural History Museum and botanical artist, ​Christina Hart-Davis shared stories of painting her favourite herbs in the context of their history and traditional uses as discussed in her latest book, The Herbal Year​. 

The top two of our most visited blog posts over time are both about herbal remedies in Old English early medieval medical manuscripts — The Nine Herbs Charm: Plants, Poisons and Poetry and Medieval herbal manuscripts. ​Philologists in the early 20th century denigrated the value of these remedies and subsequently labelled them as charms. On reading these texts aided with the experience of a contemporary herbalist, it becomes apparent that they are wound healing remedies with prayer intention introduced during the remedy making process and application to the patient. Herbalists reading these texts will find a familiarity, a homecoming reminiscent of a healing tradition that has been passed down for millennia.

​Among the many blog posts that include recipes with botanical ingredients is Claire Burridge’s article on incense in early medieval medical recipes — it seems it was not only the sensory benefits of incense (derived from the tree resin and scented woods) that were purposed, but also mixed with antidotes to be given to asthmatics in drinks according to Dioscorides​. And, if you are interested in the Early Modern period, Anne Stobart’s Handy guide to deciphering 17th century domestic recipes includes an index to handwriting styles, methods of interpretation, spellings and abbreviations.​

Research interest

It may, therefore, come as no surprise that there is a breadth of research interest across the network. Academics, herbalists and students of herbal medicine and herbal history engage with the HHRN across disciplines such as classical and ancient medicine, 17th century domestic medicine, historiography, manuscripts, critical editions and formulations.​
​
From an herbal practitioner’s perspective, it is comforting to know the skills taught in practitioner training schools and colleges today are rooted in traditional practices and that many of those practices haven’t changed for thousands of years. 

Seminars

Seminars have been a key way to reach out to existing and new researchers​. There have been 10 seminars since the group’s foundation in 2009. Different perspectives have been platformed in each case — starting with appraising methods and sources in the first seminar in 2010, exploring the relationship with pharmacology in 2011, outlining the association with gardens in 2013, uncovering illustration as a means of identification at Kew in 2014 and considering the role of herbs and herbal medicine in trade routes at Wellcome in 2015. In 2017, we focused on the preservation of herbs at the Birmingham Botanic Garden, and in Bath in 2019, our last in-person seminar before the pandemic, we explored botanical knowledge and discovery. ​

COVID gave us the opportunity of conducting our seminars online, increasing the group’s global reach​ and the first of these discussed the theme of cough and lung disease in 2021 featuring Anne Van Arsdall, Valerie Thomas and Frances Watkins (Treasurer of the HHRN).  In 2022 we observed the transition of herbal medicine cultures with a range of speakers  including Diana Luft, Julian Barker, Siobhán Barrett and Professor Toine Pieters.​ And most recently, we explored Evolving Traditions: Influences on Western Herbal Practice in 2025 (See Figure 3) with an array of speakers from diverse disciplines and our best ever event with over 133 attendees.​

Workshops

We have previously also offered small study groups or practical workshops for up to 30 delegates. The last one was held in London in 2019 with Joe Nasr, founder of Avicenna. He discussed distilled and spiritous waters in early Arabic medicine following Avicenna’s 10th century innovation of the ‘worm’ to advance the development of distillation.  On the same day Christina Stapley discussed considerations for interpreting stillroom recipes and comparisons made between distilling practice by the apothecary versus methods followed in stillrooms. Details of past events can be found on the HHRN website.

Working groups

Following on from the online seminar in May 2021 Anne Van Arsdall and Frances Watkins discussed how best we could collaborate and explore the tacit knowledge required for making herbal remedies and this developed into them participating in a Decoding Remedies workshop at Sheffield University in October 2023. ​This resulted in a paper titled: Tacit knowledge behind the words in early medical texts: A collaboration to decode the remedies, which has been accepted for a forthcoming publication. The paper discusses several remedies from Harley MS 585.

Resources

In addition to publishing blog posts and creating seminars, the HHRN maintains a resource list on the website providing a handy guide to herbal history. Communication between academics, herbal practitioners and students of herbal medicine is encouraged through our Hist-Herb-Med JiscMail. It is an invaluable resource for locating knowledge of manuscripts, historical uses of medicinal plants, plant names (always a hot topic) and of course, the art and skill of making and taking herbal medicines.​

​If you are actively involved in research, please consider joining the HHRN mailing list. Join to be part of sharing the dialogues helping researchers better understand the enormous variety of skills we have as herbal practitioners and makers of herbal medicines — using traditional skills and knowledge passed down from our teachers.

The HHRN bulletin is emailed after each new blog post is published on the website and includes news of forthcoming seminars and herbal history events. Currently, we have over 700 subscribers and moving forward, we would be delighted to hear from anyone interested in working with the team to edit future blogs and/or write the bulletins which are published 4–6 times per year.​

Following on from the Decoding Remedies workshop, a Heritage Remedies Working Group was established by HHRN, and we’d like to hear from you if you would like to be involved. Our aim is to support herbal practitioners willing to share their tacit knowledge in collaborating with historians and philologists as to what is meant by the terse instructions often found in medical manuscripts describing recipes and remedies. ​ 

In addition to the blog posts, seminars and workshops planned in the future, the group aims to become a hub for herbal history research. With a growing social media presence (Instagram, X and Facebook) it is hoped that we will garner more attention nationally and internationally. A recent appearance at the Power of Plants festival organised by the National Institute for Medical Herbalists (NIMH) generated a considerable amount of interest.  ​

To join our network, please visit the contact us page on our website

There are three broad types of contaminants, these are physical, chemical and biological. 

Physical contaminants include items such as:

• Wood
• Glass
• Stones
• Insects

Herbal supply chains are susceptible to these contaminants, although certain parts of the supply chain may be more vulnerable. For example, when storing the herbs, if facilities are in a poor condition then this may lead to a higher likelihood of pest infestations resulting in the contamination of herbs with insects. 

Chemical contaminates would include substances like: 

• Acrylamides
• Heavy metals 
• Polycyclic aromatic hydrocarbons (PAHs) 
• Mineral oils 

These can occur as a result of environmental factors as well as processing activities. 

Lastly, biological contaminants are from microorganisms, such as:

• Viruses 
• Bacteria 
• Moulds
• Microbe metabolites mycotoxins

Their occurrences are often a result of poor hygiene practices in the growing and processing of the herb that then causes these harmful microorganisms to develop. Other biological contaminants include those from naturally occurring toxins in plants which can occur when weeds are co-harvested with the herb. Some well-known toxins include pyrrolizidine and tropane alkaloids.

In various herb growing regions across the world, the risk from environmental contamination through soil, air and water is an ever-growing concern. External pressures from climate change, consumer demand and industrialisation all play a role in increasing the likelihood of the presence of these environmental contaminants. 

Climate change will only increase the frequency of these issues — for example, flooding that results in pesticide contamination through contaminated water sources. Increasing consumer demand may lead to constraints in supply which leads to sourcing herbs from regions with known environmental contamination risks. The encroachment of heavy industry in herb growing regions in fast developing countries like India and China can lead to pollution by contaminants such as heavy metals, typically through the soil. There has of late been a concerted effort in some countries to address these issues, but unfortunately the legacy of heavy industrial activities can remain in the soil for some time (3).

Along with the risk of contamination from anthropogenic sources, like heavy industry, the topography and geology of where the herbs are grown can also play a part. For example, herbs that are grown in low lying areas may be prone to flooding from contaminated water sources. The geology is also important as certain rocks e.g. cinnabar, may lead to high levels of mercury in the herbs grown where those rocks are present. Certain herbs can also naturally accumulate heavy metals, some well-known examples include St John’s wort (Hypericum perforatum) and brahmi (Bacopa monnieri) (3,4). Among the 54 heavy metals in nature the most relevant contaminants in herbal medicines are:

• Mercury (Hg)
• Lead (Pb)
• Cadmium (Cd)
• Arsenic (As) (5)

To minimise the risk from environmental contaminants in herbal supply chains an important first step is to check whether the site is suitable for growing herbs. Avoiding agricultural land in heavily industrial areas and if wild collecting, avoiding places that are close to urban infrastructure, such as roads and factories, will help minimise the risk of environmental contamination. As the sources of environmental contaminants are complex and varied, managing these risks can be difficult.

By purchasing herbs from suppliers that have short integrated supply chains, the risk from environmental contaminants will be lower as these suppliers have direct insight or influence over the environmental contamination risks within their supply chain. This contrasts with herbs that are traded in open markets that typically involve longer complex supply chains where there is limited understanding of the contamination risks at origin.

Mycotoxins are a group of over 400 secondary metabolites that develop from fungal moulds when the right environmental conditions arise. These substances are toxic and carcinogenic and can been found in herbal materials (6). Aflatoxin and ochratoxin A are the two most well-known mycotoxin hazards in herb supply and develop from fungi such as Aspergillus and Penicillium. The occurrence of these toxins in herbs such as ginger (Zingiber officinale), liquorice (Glycyrrhiza spp.) and turmeric (Curcuma longa) is well documented. Mycotoxins are usually found in hot and humid climatic regions and as a lot of medicinal herbs are grown in these regions, mycotoxin contamination is a concern. They can directly contaminate herbal plants and their parts during pre- and post-harvest processing, transportation, and storage of herbal medicines (7).

Climate change poses a significant threat to medicinal plants that are particularly susceptible to changes in environmental conditions. The likelihood of contamination increases as the conditions change and become more unpredictable. Certain biological contaminants like mycotoxins are of particular concern as the environment plays a key role in the formation of these toxins and their increasing prevalence due to climate change is well documented.

Research has shown that the effects of climate change such as elevated carbon dioxide levels, environmental temperature rise and the interchange of extreme droughts with extreme rainfalls have a significant impact on mould growth and mycotoxin occurrence (8). As these extreme conditions become more widespread globally, the incidence of mycotoxin contamination and its severity will increase in many herb growing regions even regions that were previously at low risk. 

Herbs are grown in a wide variety of different regions with the infrastructure and access to technology varying considerably. Managing contamination risks in these diverse herbal supply chains is challenging. By using good agricultural and manufacturing practices we can apply common principles to processing activities in different herb growing regions. These practices minimise the risk of contaminants in processing and reduce the risk of contamination from environmental sources. 

Drying herbs is a key activity in most herbal supply chains and is a route where contamination can occur. Herbs are often air dried in many countries which means that herbs can be exposed to infestation by insects, birds, rodents and pests, as well as dust and dirt (9).

Formation of microorganisms during the drying process is also a well-documented issue. If there is inadequate air circulation during drying and there is high humidity the formation of microorganisms will be more likely to occur. By harvesting herbs at the right time (e.g. avoid harvesting in wet conditions), drying in hygienic conditions and ensuring good air circulation the risk of these microorganisms forming will be minimised. 

To reduce the risks of microorganism forming, industrial drying processes are sometimes employed as they can dry the herb quicker than traditional drying techniques (9). However, contamination risks still remain from substances such as PAHs, which form when combustible materials such as wood and oil are used in these processes (10). For example, an oil generator may contaminate the herbal material that you are drying, if it is not adequately ventilated.

Another activity where there is a risk of contamination is when transporting the herb from the field to the processing facility, as the herbs can come into contact with a wide variety of potential contamination sources. An example of this is when mineral oils leach from the vehicles used to transport the herb or from the sacks that they are collected in, which result in the contamination of the herbs.

Through the strict application of good agricultural and manufacturing practices risks from processing contaminants can be controlled. It is important to continually improve these practices as new threats and opportunities emerge. 

Although medicinal herbs are often sourced from around the world, there are still many that can be grown in the UK. If you are growing your own herbs or foraging for them in the wild you still need to be aware that many contaminants found in herbal supply chains will also occur in the UK. However, there will be differences in the types of contaminants found and the severity of the contamination, as environmental conditions are different. 

Also, when growing or foraging your own herbs you have an advantage in that you are able to observe the quality of the herbs directly and can take steps to avoid contamination issues. This is in direct contrast to purchasing herbs where you are reliant on the practices of others within the supply chain to control contamination risks.

Some simple steps to follow when foraging in the wild would include avoiding the collection of herbs from industrial sites, developed land and busy roadsides verges where pesticides will often be applied. Scorched or yellow leaves are a good indicator that pesticides were used. Other signs to watch out for when foraging are bruised leaves or signs of mould on the herb — avoid collecting from these plants.

If growing your own herbs, selecting a good location that is away from obvious contamination risks is essential. Avoid growing near buildings that are in a poor state of repair such as peeling paints which could lead to chemical contaminants. The use of clean water sources when irrigating is critical; so, avoid grey water, which is a pathogen contamination risk. Taking these steps will help to minimise the risk of contaminants when growing or foraging herbs in the UK.

Herbal supply chains face both current and emergent global as well as regional contamination risks. Keeping yourself educated about these contamination risks is important so that you know what to watch out for when purchasing herbs from your supplier. Insights about these risks could come from your herbal network, scientific publications or non-profit organisations like the American Botanical Council, which produce bulletins on herbal quality issues. Wherever practical, purchasing herbs with shorter supply chains helps to avoid the inherent risks in purchasing from long complex supply chains. 

Some simple steps which you could take could include purchasing from suppliers who hold third party accreditation (like GMPs) or food safety accreditation (like BRC) or specific herb industry initiatives like the BHMA HPSS scheme. Asking your suppliers about the origin of the herbs, testing reports for contaminants and details of how they manage quality within their supply chain will enable you to assess whether the supplier is taking proactive steps to manage these risks. If suppliers are unable to provide this it will generally be a good indicator that you may need to look elsewhere.

By knowing more about the origin of your herbs and the contamination risks within these supply chains it will help ensure that you make informed decisions about the quality of the herbs that you purchase.

1. Tripathy, V., Basak, BB., Varghese, TS., T.S. Saha, A. Residues and contaminants in medicinal herbs – A review, Phytochemistry Letters, 2015, Volume 14, 67-78. https://doi.org/10.1016/j.phytol.2015.09.003.
2. Eissa, F., Zidan, N. E.-H. A., & Sebaei, A. S. Contamination of herbs and spices: A 23-year EU RASFF notifications analysis. Journal of Food Safety, 2024, 44 (3). https://doi.org/10.1111/jfs.13131
3. Heinrich, M., Scotti, F., Booker, A., Fitzgerald, M., Kum, KY., Löbel, K. Unblocking High-Value Botanical Value Chains: Is There a Role for Blockchain Systems? Front. Pharmacol. 2019, Volume 10.
   https://doi.org/10.3389/fphar.2019.00396
4. Koorimannil, H., Abdussalalm, A., Chandra, R., Nabessa, S. Bioaccumilation of Heavy metals in Bacopa monnieri (L) Pennell growing under different habitat. International Journal of Ecology and development. 2010, 15.
5. Zuo, T., Li, YL., Wang, Y., Guo, YS., Shen, MR., Yu, JD Li, J., Jin, HY., Wei, F., Ma, SC. Distribution, speciation, bioavailability, risk assessment, and limit standards of heavy metals in Chinese herbal medicines, Pharmacological Research – Modern Chinese Medicine, 2023, 6. https://doi.org/10.1016/j.prmcm.2023.100218
6. Ałtyn I, Twarużek M. Mycotoxin Contamination Concerns of Herbs and Medicinal Plants. Toxins (Basel). 2020, 12(3), 182. https://doi.org/10.3390/toxins12030182
7. Opuni KFM, Kretchy JP, Agyabeng K, Boadu JA, Adanu T, Ankamah S, Appiah A, Amoah GB, Baidoo M, Kretchy IA. Contamination of herbal medicinal products in low-and-middle-income countries: A systematic review. Heliyon. 2023, 9(9). https://doi.org/10.1016/j.heliyon.2023.e19370
8. Kos J, Anić M, Radić B, Zadravec M, Janić Hajnal E, Pleadin J. Climate Change -A Global Threat Resulting in Increasing Mycotoxin Occurrence. Foods. 2023, 12(14), 2704. https://doi.org/10.3390/foods12142704
9. Singh, A., Moradiya, P., Jenish, P. Drying techniques in medicinal and aromatic plants and its impact on, Futuristic Trends in Agriculture Engineering & Food Sciences 2024, 3(9). https://www.doi.org/10.58532/V3BIAG9P3CH6
10. Reflection paper on Polycyclic Aromatic Hydrocarbons (PAH) in herbal medicinal products/ traditional herbal medicinal products (EMA/HMPC/300551/ 2015) of 31 May 2016. https://www.ema.europa.eu/en/polycyclic-aromatic-hydrocarbons-herbal-medicinal-products-traditional-herbal-medicinal-products-scientific-guideline#current-version-9120 Accessed 29th August 2025.
    

• Chinese raisin tree (Hovenia dulcis)
• Kudzu root (Pueraria lobata)
• A glutathione yeast extract

To examine the effects of Chinese raisin tree (Hovenia dulcis) in combination with kudzu (Pueraria lobata) or a yeast extract on hangover symptoms in healthy participants. Blood alcohol levels and acetaldehyde were monitored as they are linked to symptom severity.

The trial was a randomized, double-blind, parallel-group and placebo-controlled design. Participants attended the laboratory for the first visit and were randomised to the following beverages: A placebo, Hovenia dulcis with Pueraria lobata (HDPB) or Hovenia dulcis with glutathione yeast extract (HDGB). The participants and researchers were both blinded.

There were four lab visits in total. Participants abstained from alcohol 24 hours before the visits and received the different beverages with a seven-day washout between visits. For each visit:

• Participants received an identical meal
• Participants received their placebo or herbal beverage two hours later
• After 30 minutes, they consumed a 40% proof whiskey (0.9 g/kg body weight) as two drinks over 30 minutes
• They abstained from further food for the rest of the day
• The following morning upon waking they completed a hangover symptom questionnaire.

The following were outcome measures:

• Adverse events were recorded.
• Acute hangover scale (AHS): Nine items relating to symptoms which were scored for severity on a scale of 0 (none) to 7 (incapacitating)
• Blood alcohol and acetaldehyde was analysed by gas chromatography–mass spectrometry (GC-MS) at regular intervals (up to 15 hours following alcohol intake)
• Physiological tests (safety assessment) included blood pressure, temperature, pulse, clinical blood tests
• Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) enzymes

Three 500 ml bottles of drink were prepared:

• H. dulcis fruit extract 0.731% (v/v) with P. lobata 0.1% (v/v) (HDPB)
• H. dulcis fruit extract 0.731% (v/v) with glutathione yeast extract 0.02% (w/v) GY) (HDGB)
• Placebo of 0.021% (w/v) caramel pigment powder and 0.11% (w/v) flavours.

There were other minor ingredients in the beverages and all were similar in appearance, taste, colour and packaging.

N=30 participants were recruited and were healthy males and females aged 19–40 years with a body mass index ranging from 18.5 to 25 kg/m². They were screened at the first visit to exclude a range of medical conditions, to be screened for pregnancy, and for inclusion they had to indicate that they had a history of experiencing hangover symptoms like headache, nausea and fatigue.

Of the n=30 participants enrolled, n=25 completed the study. There were 14 males and 11 females and no differences in baseline characteristics such as age.

For hangover symptoms, there was a statistically significant reduction in the hangover scale (AHS) for the gastrointestinal score 15 h after drinking alcohol in the HDPB group versus the placebo, but not between the HDGB group and placebo group.

There was no statistical significance in any of the other reported hangover symptoms like thirst, fatigue etc.; although, for the HDPB group, the scores were consistently lower than the placebo group. 

For blood alcohol levels, in the HDPB group the area under the curve was larger than in the placebo group suggesting that there was a larger volume of alcohol in the participants’ blood stream over the 15-hour study. The figure showing alcohol levels over time (Figure 3) is interpreted as suggesting that the % blood alcohol levels were lower up to half an hour following the drink for both herbal groups compared to placebo, and that the herbs were potentially slowing alcohol absorption. By six hours, the dynamics had changed.

The levels of blood acetaldehyde at six hours were significantly higher for the herbal beverage groups compared to the placebo suggesting that alcohol metabolism was increased in these groups. 

As a safety assessment, there were no significant differences in blood pressure or other physiological measures before and after the study or between groups. Similarly, there were no significant differences in the clinical blood measurements inferring that the herbal beverages were safe.

Overall, the herbal beverage containing Chinese raisin tree (H. dulcis) fruit extract and kudzu (P. lobata) (HDPB) significantly reduced participant gastrointestinal symptoms compared to placebo, and tended to reduce other hangover symptoms but these did not reach statistical significance.

By monitoring blood alcohol and metabolites the herbal beverage HDPB may slow alcohol absorption in the first few hours which is important as it allows the body to process the beverage and the individual may potentially feel less drunk. At six hours, there were significantly higher levels of blood acetaldehyde in the group consuming HDPB suggesting that the herbs may also increase also increase alcohol metabolism.

The herbal beverages were deemed safe to consume, as there were no adverse physiological or biochemical test data following consumption.

The key question is why did the Chinese raisin tree fruit extract and kudzu (HDPB) not ease the hangover symptoms and blood parameters more dramatically? It could be that the level of alcohol tested (two whisky drinks) was not enough to cause a severe hangover and therefore did not reveal a clearer relationship between symptoms and blood alcohol or acetaldehyde levels. The meal may also have buffered some of the effects of alcohol consumption. Although the physiological characteristics of the groups like body weight and body mass index were similar, there may have been other individual differences in liver enzymes that altered their ability to metabolise alcohol.

In an earlier study with the same research group, individuals who consumed around 2.4 g of Chinese raisin tree fruit extract with a shot of alcohol also saw reduced hangover symptoms over time and decreased levels of inflammatory mediators interleukin 6 and 10 (2). In the present study using 0.731% herbal extract within a 500 ml drink equates to around 3.6 g so should have been sufficient to see changes.

As the main ingredient, the chemical composition of Chinese raisin tree includes genistein and kaempferol, both flavonoids with anti-inflammatory effects. Kudzu root is also used to treat alcohol-related conditions. These herbs, therefore, show potential to relieve the effects of alcohol.

To conclude, a H. dulcis fruit extract beverage significantly improved gastrointestinal symptoms associated with hangover and was safe. More research is needed to investigate the herb individually and using a refined protocol to determine its effects on the symptoms and blood biochemistry following alcohol consumption. More importantly, studies could also look at herbs for alcohol de-addiction as well as treating the symptoms that its consumption elicits.

1. Lee KW, Xu G, Paik DH, Shim YY, Reaney MJT, Park I, Lee SH, Park JY, Park E, Lee SB, Kim IA, Hong JY, Kim YJ. Clinical Evaluation of Hovenia dulcis Extract Combinations for Effective Hangover Relief in Humans. Foods. 2024 Dec 12;13(24):4021. https://doi.org/10.3390/foods13244021  
2. Kim H, Kim YJ, Jeong HY, Kim JY, Choi EK, Chae SW, Kwon O. A standardized extract of the fruit of Hovenia dulcis alleviated alcohol-induced hangover in healthy subjects with heterozygous ALDH2: A randomized, controlled, crossover trial. J Ethnopharmacol. 2017 Sep 14;209:167-174. https://doi.org/10.1016/j.jep.2017.07.028  

Turmeric (Curcuma longa)

Turmeric is well-researched for its effectiveness in treating knee osteoarthritis. Studies often test a wide variety of turmeric preparations and measure different outcomes. The present research uses a network meta-analysis (NMA) approach to compare the effects of different turmeric therapies in patients with knee osteoarthritis.

A systematic review was carried out to identify relevant papers. Several electronic bibliographic databases were used, and search terms included common and botanical names for turmeric. The population included adults with diagnosed primary knee osteoarthritis. The intervention was turmeric compared to placebo or standard treatment. Outcomes of interest were improvement in joint function, pain or stiffness. Outcomes were measured using WOMAC or VAS, with the former being Western Ontario and McMaster Universities Osteoarthritis Index and the latter a Visual Analog Scale for pain.

Study selection and data extraction were carried out by two reviewers. There were no restrictions on the searches by date or language. The authors used the Cochrane Risk of Bias tool which looks for details like randomisation, allocation concealment to determine potential bias within studies. They used GRADE to rate the overall certainty of evidence.

The NMA approach provides a comparison of all available interventions and gives a ranking of their effectiveness. This was done by pooling the data from all of the studies and applying statistical tests to give an indirect result (2).

For analysing the results, the authors grouped turmeric interventions based on their characteristics. These were:

• CT: Curcuminoid extractions
• BE: Preparations with additives or nanoparticles to enhance bioavailability
• PLS: Polysaccharide-rich preparations

These were compared to active comparison drug (AC) or a placebo (P).

Seventeen randomised controlled studies on turmeric were included in the review, and most used commercially available products. One study compared two doses giving a total of 18 analyses.

In all, 17 randomised controlled studies were analysed. The risk of bias was low risk (six studies), some concern (seven studies) and high risk of bias (four studies).

Nine studies compared turmeric to placebo and eight compared turmeric to standard drugs including diclofenac, ibuprofen and acetaminophen. For the types of turmeric preparation used in the 18 analyses, these were bioavailability enhanced products (BE, n = 12), curcuminoid extracts (CT, n=4) and polysaccharide preparations (PLS, n=2).

Meta analyses of intervention versus placebo

A two-way meta-analysis was produced from the data. For WOMAC pain, seven studies (n=913) showed that BE significantly reduced pain compared to a placebo with a pooled mean difference of −2.47 (–3.25, −1.68). For WOMAC function, BE statistically significantly improved this outcome compared to placebo. For WOMAC stiffness, none of the interventions significantly improved outcomes versus placebo.

For pain determined using VAS, both BE and PLS significantly improved pain scores compared to placebo.
 

Network meta-analyses

Network analyses were prepared for the same WOMAC and VAS outcomes as above, and Figure 2 in the paper nicely illustrates how multiple interventions can be visualised at once. The figure shows the comparisons of the interventions to AC — standard treatment, or P — placebo. The thick lines reflect the larger numbers of randomised controlled trials which have been carried out for the BE intervention group.

WOMAC pain

For this measure of pain, seven studies were analysed and all interventions significantly reduced WOMAC pain compared to placebo, with no single intervention being significantly better than the other.

By ranking the results, the effectiveness of the interventions was CT + AC > AC > CT > BE > P. Figure 3 presents these results, for example the largest effect due to CT + AC compared to placebo, with a mean difference of −4.01 (−6.22, −1.80).

WOMAC function

Similar to WOMAC pain, all interventions significantly improved function compared to the placebo, with no single intervention being statistically significantly better than the other. The ranking was the same as above: CT + AC > AC > CT > BE > P. 

WOMAC stiffness

None of the interventions significantly improved stiffness compared to placebo.

VAS pain

For pain measured using a VAS scale, all interventions significantly improved VAS versus placebo. This time, two interventions were statistically significantly more effective – both BE + AC and CT + AC were more effective than either AC or BE alone.

Safety

The PLS group produced the highest percentage of adverse events which were mostly reported as miscellaneous. The BE preparation reported the highest incidence of gastrointestinal symptoms overall, around 6% of patients.

Other data

The authors presented other data to validate the network analysis including transitivity, which reflects variation in study characteristics that could include things like disease severity, baseline characteristics of patients, or how interventions were administered. The study did find that for baseline pain scores, there were differences between the groups. 

A network meta-analysis approach is ideal for herbal research where often a range of preparations exist, which is certainly the case for turmeric. The authors identified studies and categorised turmeric according to three main methods of preparation.

Starting with a standard meta-analysis, this indicated that BE significantly improved WOMAC pain and function, but not joint stiffness, compared to placebos. For VAS pain scores, both BE and PLS were the most effective treatments compared to placebos. The meta-analysis compares interventions to controls but not against each other. This suggests that the BE (bioavailability-enhanced) preparations are the most effective in improving osteoarthritis symptoms of pain and joint function, as indicated by different pain score scales.

The authors carried out a networked approach to rank the treatments against each other. This provides indirect evidence from which to draw further conclusions. The ranking showed that the combination of curcuminoid extract and active comparator treatment (CT+AC) were the most effective in improving WOMAC pain and WOMAC function compared to other interventions. For the VAS pain scores, the CT+AC and BE+AC groups were the most effective. These results suggest that turmeric products could be a useful adjunct treatment alongside standard therapies, including diclofenac, ibuprofen and acetaminophen. 

Turmeric’s active compounds, including curcuminoids and alpha-turmerone essential oils, are recognised for their anti-inflammatory qualities and ability to inhibit cytokines thereby attenuating pro-inflammatory pathways. Many of the papers analysed used preparations of turmeric designed to enhance absorption. However, research also suggests that turmeric may have important biological effects through altering the gut microbiota. In one such study, the influence on gut microbiota composition was comparable between whole turmeric rhizome and curcumin in tablet form (3). As the relationship between imbalances in the microbiota, chronic inflammation and immune dysfunction have been established (4), future research could  investigate the intricacies of turmeric’s potential as an anti-inflammatory treatment through its impact on gut microbiota composition.

Preparations of turmeric that enhance the bioavailability of curcumin were effective in reducing pain and improving function in patients with osteoarthritis of the knee, compared to a placebo. The network analysis suggested that combining a turmeric product with an active standard drug could also be useful in reducing pain and providing functional improvements to patients. The review also showed that turmeric was safe to use. 

Overall the systematic review was carried out to a high standard. The combination of meta-analysis and networked approach provides a richer insight into the benefits offered by turmeric as a treatment for osteoarthritis.

1. Wai HS, Pathomwichaiwat T, Suansanae T, Nathisuwan S, Rattanavipanon W. Effect of turmeric products on knee osteoarthritis: a systematic review and network meta-analysis. BMC Complement Med Ther. 2025 Jul 29;25(1):292. https://doi.org/10.1186/s12906-025-05045-z 
2. Chaimani A, Caldwell DM, Li T, Higgins, JP, Salanti G. Undertaking network meta‐analyses. 2019. Cochrane handbook for systematic reviews of interventions, 285-320. Available: https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-11 
3. Peterson CT, Vaughn AR, Sharma V, Chopra D, Mills PJ, Peterson SN, Sivamani RK. Effects of Turmeric and Curcumin Dietary Supplementation on Human Gut Microbiota: A Double-Blind, Randomized, Placebo-Controlled Pilot Study. J Evid Based Integr Med. 2018 Jan-Dec;23:2515690X18790725.  https://doi.org/10.1177/2515690X18790725 
4. Bolte, Laura A., et al. “Long-term dietary patterns are associated with pro-inflammatory and anti-inflammatory features of the gut microbiome.” Gut 70.7 (2021): 1287-1298. Available: https://gut.bmj.com/content/70/7/1287

• 25 g bitter orange (Citrus aurantium) peel 
• 25 g angelica (Angelica archangelica) root 
• 12.5 g gentian (Gentiana lutea) root 
• 12.5 g dandelion (Taraxacum officinale) root 
• 12.5 g cardamom (Elettaria cardamomum) pods
• 12.5 g fennel (Foeniculum vulgare) seeds 
• 300 ml 45% ethanol (vodka is also effective)

• Sterilised mason jar
• 100 ml dropper bottle 
• 500 ml amber glass bottle

1. Place the dried herbs in a herb or spice blender and blend until they are finely ground. 
2. Cover the herbs with the alcohol and seal. 
3. Leave the herbs for 3–4 weeks to macerate. 
4. Strain the mixture through a fine muslin cloth and retain the liquid. 
5. Fill the 100 ml dropper bottle and retain the rest of the mix to refill the dropper bottle once it’s run out.  
6. Take one pipette before meals to stimulate digestion. 

The mixture should be stored in a cool, dark place, ideally in an amber glass bottle to prevent photodegradation (damage from light). 

The smaller mixture can be kept in the 100 ml dropper bottle, so it can be easily portable and taken throughout the day.

• Bitter orange peel increases the secretion of gastric fluid, including gastric enzymes and stomach acid. In traditional Chinese medicine (TCM), bitter orange peel is known to alleviate qi stagnation in the digestive tract, helping to relieve bloating, discomfort or heaviness (3).
• Angelica is a warming, stimulating and aromatic bitter which is also a sialagogue (stimulates the production of saliva). It contains high levels of bitter compounds as well as volatile oils which help to stimulate appetite and digestion as well as relieve irritation in the gastrointestinal tract (4). 
• Gentian is a traditional bitter remedy known for its cooling action on the gastrointestinal tract. It is a digestive tonic which helps to stimulate bile production, helping with nutrient assimilation and appetite stimulation (4).
• Dandelion root is a gentle but effective bitter remedy with additional mucilaginous compounds. Dandelion also contains inulin which supports digestion through its prebiotic effect. Additionally, it is a liver tonic, helping to improve hepatic function and elimination (4).
• Cardamom is a warming aromatic herb rich in volatile oils which reduces inflammation in the gastrointestinal tract, stimulates digestive enzymes and reduces mucus formation (4).
• Fennel is a well-renowned digestive tonic, fennel contains multiple aromatic compounds which help to facilitate digestion, stimulate appetite and assist with the digestion of fats. It is also an antispasmodic and can help to relieve bloating, flatulence and abdominal cramps (4). 

What can I use instead of alcohol?

This recipe can also be made using organic vinegar instead of alcohol for those who wish to avoid alcohol. 

When is the best time to take digestive bitters?

The ideal time to take digestive bitters is just prior to a meal for stimulation of digestive function; however, they can also be used post mealtimes to aid digestion and reduce bloating and flatulence. 

1. Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013.
2. Hundt M, Basit H, John S. Physiology, Bile Secretion. Nih.gov. Published 2022. https://www.ncbi.nlm.nih.gov/books/NBK470209/ 
3. Bensky D, Gamble A, Kaptchuk D. Chinese Herbal Medicine : Materia Medica. Eastland; 1993.
4. Mcintyre A. Complete Herbal Tutor : The Definitive Guide to the Principles and Practices of Herbal Medicine (Second Edition). Aeon Books Limited; 2019.

“Creation is the expression of cosmic consciousness. It is a journey of energy into matter. The five great elements are uniquely expressed in both mankind and plants.” (1)

According to Vedic science, all matter is composed of five elements, known as the panchamahabhutas, which range from the finest to the grossest: space / ether, air, fire, water, and earth. This may seem simplistic, but it is a sophisticated way to classify all matter found on earth as they refer more to states of matter than elements as we may know them. Every individual is a microcosm of nature and, as such, contains all five elements. Let us explore each of them (2).  

Space / ether (akash)

Space / ether (akash) is ever humbly present as emptiness, allowing movement and communication as the other elements interact. Space is where life can take place, it is a place of potential, pure all-encompassing consciousness. In the human body we find it in the mouth, nose, digestive tract, uterus, lungs and abdomen. Its qualities are light, smooth, subtle and clear. Its actions are to give porosity or hollowness and lightness. It is associated with sound and the sense of hearing.

Air (vayu)

Air (vayu) is responsible for all movement. Where there is matter, there is motion, the constant motion of the planets, the change of the seasons and the spinning of electrons.  In the human body, this air principle is found in the nervous system, respiration, ingestion, elimination and feeding every cell with oxygen. Its qualities include being light, cold, rough, dry, subtle and clear. Its actions are to produce dryness, lightness, roughness, clarity, weakness and looseness (creating separation or division). It is also responsible for the sense of touch.

Fire (agni)

Fire (agni) is the radiant energy responsible for transformation. On a daily basis we see fire transforming water to steam and food from raw to cooked. In our bodies, fire is found in maintaining body temperature, transformation, digestion, absorption and assimilation of thoughts as well as food. Its qualities include being light, hot, sharp, subtle, dry and clear. Its actions are to heat, digest (transform) and give complexion and colour. It is associated with the sense of vision and the eye.

Water (jala)

Water (jala) binds everything together, the universal cohesive solvent. In the human body it makes up around 70% of our body mass and is found in plasma, intercellular fluid, urine, sweat and saliva. Approximately 70% of the earth is covered with water, a representation of the human body being a microcosm of the macrocosm. Water is oily, cold, soft, heavy, mobile and dense. Its actions are to moisten, lubricate, secrete, soften and give pleasantness. It is responsible for the sense of taste.

Earth (prithvi)

Earth (prithvi) gives stability, structure, strength and stamina. We see it in the form of bones, teeth and skin. We nourish ourselves with foods from the earth and the body returns to earthly matter. It is heavy, dense, stable and clear.  Its action is to help grow and accumulate mass, heaviness and stability.  It is responsible for the sense of smell and the nose.

Whether we’re talking about individual people, herbs, nutrition, lifestyle activities or even the weather, all things can be described in terms of these elements. We can assimilate herbs, minerals, food and fluids because these substances are made of the same elements found in our own underlying make-up. Using this idea, we can start to understand what herbs might support a particular person. For example, a person predominant in the fire element has a tendency to overheat, and should minimise use of heating herbs (e.g. black pepper and ginger), spicy foods and other sources of heat, such as excessive sunbathing and saunas. However, all of these will support a person predominant in air and ether, both cold by nature. 

“Just as the moon, sun and air support the body of this world by functions like releasing of strength, withdrawing of strength and initiating all actions respectively, similarly kapha, pitta and vata support this human body”. (3)

Ayurveda defines three dynamic pathophysiological entities as the basis for all body functions. Tridosha comprises two words: tri and dosha. Here, tri means a group of three basic elements (vata, pitta, and kapha) and dosha means ‘that which is capable of vitiation’. When vata, pitta, and kapha are vitiated (aggravated or imbalanced) they produce disease; when they are in equilibrium, they maintain balance and harmony in the body. 

Vata dosha 

That which carries smell (i.e. which has movement) (4).

Vata dosha is composed of ether and air, sharing qualities familiar to both elements: cold, light, rough, mobile, subtle and dry (5) The primary site of vata is the colon. It also resides in the bladder, thighs, ears, bones and the sense of touch. The root va means ‘to spread’ and it is responsible for all movements in the body; the flow of breath and blood, elimination of wastes, expression of speech, it moves the diaphragm, muscles and limbs, regulates the nervous system and stimulates the function of the intellect. It is like a current of electricity, responsible for regulating all electrical impulses in the body-mind. It is the messenger. In fact, without vata the other dosha are inert. At the cellular level, vata dosha may be associated with signaling pathways that regulate cell growth, differentiation, and cell death. Vata dosha also governs movements of cells, molecules, nutrients, and waste.

Pitta dosha 

That which heats, burns or warms up (4).  

Pitta dosha is made up of fire and water. This seemingly contradictory combination of fire and water is actually complementary. Pitta exists as water or oil in the body, thus pre-serving the tissues from the destructive aspect of fire. It is light, hot, sharp, oily, odorous and liquid (5) Its primary function is transformation being the force of metabolic activity associated with the endocrine function, hormone levels, digestion, body temperature, visual perception, hunger, thirst and skin quality. Mentally, it plays a role in understanding and in digesting sensory impressions. It resides in the eyes, blood, sweat glands, the small intestine, stomach and lymph. Its primary site is in the small intestine. Pitta dosha is responsible for processes bringing about change, such as digestion, metabolism, energy production, and maintenance of immunity. At the cellular level, it may be associated with the activity of enzymes, growth factors, hormones, and the reactions required for homeostasis and the maintenance of basal metabolism.

Kapha dosha 

That which embraces, adheres, or keeps together (4).

Kapha dosha is a combination of earth and water elements. As the water element is contained within the earthen structures of the tissues and skin, the dry earth is moistened by the reviving water element. It is slow, heavy, cool, dense, soft, greasy, unctuous, sticky, cloudy, liquid and sweet. Kapha holds the body together. It is cohesive, gives shape and form, aids growth and development, lubricates and protects, and facilitates the senses of smell and taste. It relates to phlegm in the body. It resides in the chest, throat, head, pancreas, stomach, lymph, fat, nose and tongue. Its primary site is the stomach.  It acts to form and maintain body mass, shape, and flexibility. At the cellular level, anabolic processes and the coordination of gene and protein function may be associated with kapha dosha.

According to Ayurveda, we are born with a unique and individual combination of the three doshas, known as our prakruti.  This is called our constitution (or mind–body type) and defines the ways our bodies and minds naturally function and respond. It is important to note that we all have all three doshas, it is just that we are born with ‘blueprints’ of a certain combination of them. Charaka, an ancient sage of Ayurveda, states that prakruti is determined by the doshic predominance of the following at conception (6): Sperm and ovum; seasons (as they have an effect on sperm and ovum); condition of the uterus; diet and lifestyle of expectant mother. For example, if your parents were both mainly pitta dosha but you were conceived during a period of change, stress and uncertainty, the chances are that both vata and pitta will be strongly represented in your constitution. 

Yet, how are doshas related to our DNA? One can think of prakruti as akin to genotype. The science of genetics is evolving rapidly but broadly our DNA doesn’t change (unless exposed to certain toxins or radiation). Similarly, our constitution (or prakruti) doesn’t change as both are set when we are conceived. There have been some studies looking for genomic variations between people who are vata, pitta and kapha dosha, which have found significant differences between people with different dominant doshas irrespective of their ancestry (7).

There is also growing research to support our understanding of how our doshic constitution impacts physiological factors, for example in how we sleep (8). The emerging field of Ayurgenomics integrates concepts such as prakriti, with modern genetics research. It correlates the combination of doshas with the expression of specific genes and physiological characteristics. It also helps to interpret Ayurveda as an ancient science of epigenetics that assesses the current state of the doshas and uses specific personalized diet and lifestyle recommendations to improve a patient’s health (9,10)

A vata constitution (more ether / space and air elements)

A vata constitution has a changing nature with fluctuation, irregular appetite, thirst and bowel movements, variable energy levels and irregular menstrual cycles. These individuals are more endowed with movement; active eyes, fast speech, quick bodily movements and are always on the go. The mind is also agile, creative, lively and enthusiastic. There is a desire for change and routines are often a struggle. Things are picked up quickly but more often forgotten in the long term. They have more dryness and roughness in the body; dry, rough skin, lips and hair, cracking joints. 

They’re more likely to be constipated and have wind. They are also colder; often have cold hands and feet and strongly dislike cold and wind, prefer warm environments, food and drinks. They will also be light; with a slender body and thin muscles finding it hard to put on weight.  Sleep is also light and sometimes elusive. Those with a vata constitution will be more likely to suffer from constipation, gas and insomnia when not in balance. The mind when out of balance tends towards anxiety, fearfulness and insecurity.

A pitta constitution (more fire and water elements)

These individuals tend to be hot / warm, sweat easily and have preference for cooling environments, food and drink, with strong thirst. They have both lightness and liquidity due to the combination of water and fire, with moderate builds and energy. There is moderation regarding their sleep, with a tendency to require six to eight hours to wake feeling rested. They have a strong digestive fire, well able to digest food, information and experiences.  If they go long without food, they’ll get irritable.  They have easy, regular, looser bowel movements, and can gain or lose weight as required. Physically, they have more red or yellowish tones regarding, skin, hair, lips and teeth. They also have a degree of oiliness, with relatively soft skin and soft, flexible joints. Hair is prone to early greying or balding, and skin irritation and burning. They have a mental intensity, being focused, driven, goal-oriented, competitive, intelligent and persevering. The eyes have a penetrating gaze and their speech is organised, sharp and clear.  Decision-making, organisation, discipline and routine come easily. They are more likely to have an odour, tend towards inflammation, hypertension and hypersensitivity when out of balance. Mentally, they may have a tendency to  being more angry, aggressive or argumentative.

A kapha constitution (more water and earth elements)

Such constitutions tend to be solid, heavy and firm, with naturally broad frames and large, well-padded joints. They gain weight easily and find it hard to shift. Their eyes are large and pleasant, lips, nose and teeth are also large. They have colder bodies, so tend not to like cold, wet weather. Sleep is heavy, eight hours is often needed, with some difficulty waking. They have thick, moist skin and abundant hair. They tend to be smooth with higher levels of oiliness in both skin and hair, with well lubricated joints. Speech and movements are slow and deliberate.  Their energy levels are steady, and they tend to have good stamina.  The slow quality is also seen in the digestion and bowel movements, with lower thirst and weaker appetite. There is a natural resilience in the face of stress, with an inner sense of stability and contentment.  Sometimes it takes a while to grasp new things but once they are remembered, they are there for life. When out of balance they tend to have excess mucus, congestion and water retention, along with lethargy and withdrawal.

Dual-dosha and tridoshic constitutions  

Ayurveda recognizes seven types of constitution, based on the different combinations of the doshas. The vata, pitta and kapha mono constitutions have been described above. It appears that people today predominantly have two main dosha. For example, a pitta–kapha or kapha-pitta constitution would have a combination of kapha’s heavy, firm oiliness and pitta’s fire and intensity, with both sharing oiliness in common. A vata pitta or pitta vata constitution manifests as a combination of vata’s airy, dry nature, along with pitta’s fire and intensity, with both doshas sharing lightness in common. With a vata kapha or kapha vata constitution, kapha gives strength and stability and helps balance vata’s light inherent instability. However, they share the quality of coldness in common, so are aided by warming herbs, diet and lifestyle suggestions. Finally, some people are blessed with a tridoshic constitution, or an equal balance of all three doshas. This is the strongest constitution as it’s the easiest to keep in balance and manage.  

Understanding one’s doshic constitution (and that of one’s clients) is a useful tool in getting to know oneself better. To be successful, we need the influence of vata to come up with ideas, creatively and enthusiastically; the influence of pitta provides the ambition, determination and drive to see these ideas through to completion; finally, the steady, sustaining influence of kapha keeps it all going on a day-to-day level.  Self-knowledge fosters self-acceptance, and by making subtle changes to diet, lifestyle, how we work and relate to others, the doshas can be brought back into a more balanced state with profound effects. In this way, doshas can be a ‘lens’ through which we look at the world. However, one must also heed the following:

“When you begin to solely identify with your body type, and worse yet, with your conditions, you lose sight of your marvellous gift of humanity. The Sanskrit word “dosha” from which the body types are derived actually means “fault.” In identifying or typecasting yourself solely as a pitta, or vata, or kapha person, or becoming fanatical about choices that support each type, you are limiting your true self and infinite joy to the mere mundane. You are more than bodily fluids, tissues, and diseased conditions. You are the ever generating, ever changing infinite consciousness. It is wise to remember that you are a whole entity with body, mind, and spirit, each with your own incredible karma” (11)

There are some useful online questionnaires which can help explore the doshas,  but it’s important to note these are in no way definitive and one may get different answers using different doshic questionnaires. It can get confusing as one may be ticking boxes covering both constitution (prakruti) and state of imbalance (vikruti). It is best to focus on answering the questions for when you felt most balanced — perhaps as a young adult — to find one’s constitution. Such approaches are best used as a spring board to a deeper exploration of doshic constitution with a qualified Ayurvedic Practitioner. There are also encouraging attempts to quantify the doshas in a reliable self-assessment questionnaire, so they can be readily applied in clinical studies to control for such differences in the same way sex, age, height and weight are routinely used (12). 

“A person having equilibrium of dosha, agni (fires), dhatu (tissues), mala (wastes) and kriya (processes/actions), and a person who is possessed by spiritual, sensual and mental happiness is called a healthy person.” (3)

The doshas are in dynamic equilibrium and the optimal function of each dosha and normal interactions between them are essential for good health. Accordingly, individuals with balanced doshas are less susceptible to disease than individuals with disturbed doshas. An abnormal dosha can be inhibited, excessive, or vitiated with the type and nature of disease primarily determined by which dosha is affected. This imbalanced state is known as vikruti. In fact, the definition of dosha is: “the actual intrinsic factors which become excited and imbalanced, either conferring a predisposition to or actually causing morbidities are called as the dosha.”(13). These are some of the signs and symptoms of an increase in each of the doshas, offering helpful indicators as to which dosha has become most out of balance and offering a pathway to restore health (14):

• Increased vata dosha: Black, red-brown discolouration of the body (hyperpigmentation), astringent taste in mouth, emaciation, desire for warm things, bloating, constipation, weakness, weakness, insomnia, excessive talking, giddiness, and loss of confidence.
• Increased pitta dosha: Yellow, green, red colour (seen in stool, urine, eyes, or skin for example, along with sour, bitter taste; hunger, thirst, burning sensations, insomnia, increase sweat and desire for cool things
• Increased kapha dosha: White discolouration (such as skin, stool), sweet and salty taste, weak digestion, excess salvia, feelings of coldness, flabbiness, breathlessness, cough, nausea, oedema, and excessive sleep. 

How do doshas get out of balance?

A key law in Ayurveda is the law of similarity and dissimilarity which states that ‘like increases like’.  So, if foods predominant in air and space such as astringent and bitter raw leafy vegetables are eaten, this will increase those two elements in the body, which correlates to an increase in vata. Conversely, if oily, sweet foods, predominant in earth and water are eaten, vata will decrease but kapha will increase. Eating excess chillies (high in fire element) will increase the fire element in our bodies, correlating to an increase in pitta; something immediately perceivable. Looking beyond nutrition, this law also explains why vata dosha (with cold, dry, mobile qualities) is aggravated in autumn, a cold breeze and excess travel / movement.

Pitta dosha (hot, liquid qualities) in summer, by excess intellectual work and saunas. Kapha dosha (cold, heavy, stable, damp qualities) in winter, with day time naps and not moving enough. It is important to be aware of our dosha as it is only when they are in their natural balanced state (our constitutional state, our prakruti) that we remain in health. It is most often our primary dosha(s) that will tend to go out of balance when our lives aren’t as measured as they should be. For example, the person with a kapha constitution eating lots of kapha-increasing foods and having kapha-increasing lifestyle factors, could end up with a kapha imbalance, with water retention, weight gain and mental lethargy.

According to the above law, kapha can be reduced by substances with opposing qualities such as warmth, dryness and lightness, so dryer grains such as barley instead of wheat, plenty of movement and some dry skin brushing. Vata dosha with warm, oily, nourishing foods, warm oil massage, plenty of rest and grounding activities. Pitta dosha with cool, slightly drying substances and calming lifestyle activities.

Ways to dysregulate vata	Ways to dysregulate pitta	Ways to dysregulate kapha
• Excess spicy, bitter, astringent food • Cold, raw, frozen food • Lack of food / fasting • Lack of routine or sleep • Cold, dry climate • Air conditioning • Excess worries, travel, movement • Use of stimulants and caffeine • High impact sports or adrenaline rush activities	• Excess spicy, salty, sour foods • Excess caffeine, alcohol • Frustration and anger • Overly heating forms of exercise • Exercise in midday heat • A hot climate • Work in hot environment / near fire • Regular use of steam baths and saunas • Competition	• Excess sweet, sour, salty taste • Heavy, sweet, greasy food  • Overeating  • Daytime sleep and sedentary lifestyle • Too little worries • A cool, damp climate • Bottling up feelings • Avoiding intellectual challenges • Use of sedatives
Bring vata into balance with warmth, nourishment, oil, grounding and routine	Bring pitta into balance with cooling, calming, moderation	Bring kapha into balance with lightness, dryness, warmth, and activity
• Warm, cooked, nourishing foods like soups, stews, whole grains, and healthy oils (ghee, sesame, olive oil) • Favour sweet, sour, and salty tastes • Maintain a regular daily schedule for meals, sleep, and activities • Practice calming yoga, meditation, and self-massage with warm oils • Enjoy warm oil massage • Wear warm clothes and avoid cold, windy environments	• Consume cooling foods like basmati rice, legumes, leafy greens, coconut water, and sweet fruits • Avoid spicy, fried, or overly salty foods • Favour cool environments, avoid excessive heat, and limit overexertion/ competition • Engage in gentle yoga, meditation, and cooling breathwork such as Sheetali pranayama • Enjoy coconut oil massage with cooling rose and sandalwood	• Favor light, warm, and dry foods such as steamed vegetables, barley, legumes, and spices like ginger and turmeric • Avoid heavy, oily, sweet, and cold foods • Engage in vigorous exercise and stimulating activities to energize the body and mind • Wake early, avoid daytime naps, and embrace social interaction and mental stimulation • Use dry brushing or massage techniques without oil to invigorate circulation

Applying the dosha to times of day, year, life and geography

The classical Ayurvedic texts are clear on the fact it is not just human beings who are subjected to categorisation by the dosha. As the whole universe is made up of the five elements, so all things are made up of the doshas and the concepts can be applied more broadly. This can offer useful insights for the herbal practitioner.

Times of day

Morning is kapha time — we are sleepy and can feel sluggish, and the earth is damp and covered in dew; midday is pitta time, as the fiery sun is at its peak and digestive fire is also at its strongest; afternoon is considered vata time, things are winding down and energy can lower. The second half of the day follows a similar pattern, with kapha domination 6 pm to 10 pm, pitta 10 pm to 2 am, and then vata 2am to 6am. So, consistently waking at 2.30 am, can indicate a vata imbalance is behind the sleeplessness.

Being too wired to go to bed until 1am, or else going to bed at 10pm but waking between  12 and 1.30am may indicate increased pitta is responsible. This insight also explains why Ayurveda suggests eating the largest meal between 10am and 2pm, as pitta dosha peaks at this time which governs the digestive fire.

Times of year

Spring is considered kapha time with its increase in water element leading to new growth and potential. Summer is considered pitta time with its heat. Autumn is considered vata time with its cold, dry windy weather and the leaves drying out on the trees. Many people notice a seasonal pattern to their symptoms flaring up and subsiding, which often make good sense with a doshic insight. For example, spring often sees an overflow of kapha dosha with spring colds and hayfever, late summer and early autumn are a common time for heat related skin issues to flare up such as psoriasis and rashes.

Life stages

Kapha dosha is responsible for the growth of children (who are soft, loving and cuddly) to physical maturity (0–16 years); pitta dosha is responsible for the maintenance of the body in its maturity (16–55 years) when we must be organised, focussing on careers and family life.  Elderhood is vata time, when we are full of wisdom and life’s experiences, as the space element increases in the mind. Individuals are especially vulnerable to dosha-related issues at this time, for example, there is a need for children to minimise mucus-forming foods (e.g. ice cream, orange juice and yoghurt) as they are at a kapha stage of life when excess kapha foods can cause coughs and colds. Conversely, in old age, when vata can aggravate, we need lots of warming food and warm oil massage to counter vata’s tendency to dryness and stiffness.

Geographical locations

A cool, dry, open, desert-like plain, breezy place or a mountain top can be considered places where vata dominates. A hot, steamy rainforest would be considered a pitta place. A damp, cool marshy place, rich in vegetation, would be considered a very kapha place. An air-conditioned building would also be viewed as a place that could potentially aggravate vata due to its cold, dry qualities. This insight may help explain why someone’s symptoms get aggravated or clear up completely when they change locations or working conditions. 

Understanding the doshas deeply enriches the practice of herbal medicine by providing a personalised, systemic diagnosis and treatment framework as follows:

Understanding doshic constitution (prakriti) and imbalance (vikruti)

As has been outlined, Ayurveda’s foundational concept of the three doshas defines an individual’s physiological and psychological makeup, and what health issues they are most prone to, as each dosha governs unique bodily functions and mental tendencies. Understanding a person’s dominant dosha(s) and imbalances supports precise diagnosis and personalised herbal interventions based on Ayurvedic pathophysiology. 

• A vata constitution is associated with erratic digestion and energy levels. Ginger and fennel are ideal digestives, along with a mild laxative if dryness has led to constipation.  Their naturally restless nature benefits from tonic, adaptogenic herbs such as ashwagandha and brahmi. Over the age of 55, vata starts to naturally increase so herbs to reduce stiffness in the body are helpful, such as boswellia. Herbs can be taken with warm water, milk, or almond milk and raw honey to enhance the effect (known as anupan in Ayurveda).
• A pitta constitution is prone to inflammation, irritability and excess acidity, so requires herbs to cool and calm, especially an overactive digestive fire (or agni). Amla is especially good for this with its sweet, cooling nature, along with aloe vera, shatavari, coriander, fennel, turmeric and liquorice. Herbs can be taken with warm water, milk or aloe vera juice.
• A kapha constitution is often associated with lethargy and congestion, requiring herbs to invigorate, supporting a slower digestion and metabolism. Ginger, black pepper and turmeric offer metabolic stimulation and reduce dampness. Trikatu (‘three spices’) is a wonderfully warming and pungent classic Ayurvedic blend ideal for this dosha. It dries mucous secretions and excess phlegm whilst also rejuvenating the lungs. Tulsi is also recommended if additional lung support and mucus reduction is required.

Understanding herbal energetics according to dosha

This approach empowers practitioners to harness each herb’s unique dosha-specific properties — nourishing and warming vata, cooling and calming pitta, stimulating and warming kapha — to restore doshic balance and optimising therapeutic success. 

Ashwagandha acts as an ‘adaptogen’ helping us adapt to stress and the fatigue and depletion that can often follow. Its warming, oily, and nourishing qualities especially counterbalance vata’s cold, dry, and mobile nature. For individuals with predominant or aggravated vata dosha, who may experience anxiety, nervousness, insomnia, or fatigue, ashwagandha supports calmness, stabilizes the nervous system and promotes vitality. With predominant or aggravated pitta dosha, its warming nature should be carefully moderated to avoid exacerbating heat-related symptoms. For increased kapha, Ashwagandha’s warming quality is of great benefit, but its oily quality may need dose adjustment to prevent heaviness or lethargy.

Shatavari is a renowned tonic for the female reproductive system, which also has a strong anti-inflammatory effect, particularly within the reproductive and the digestive systems. It is unusual in nourishing each of the body’s tissues. Its sweet taste and oily, heavy properties helps to soothe the dry, cold, and light qualities of vata. It acts as a gentle stabilizer that promotes calmness and vitality in restless vata constitutions or those with aggravated vata. With its naturally cooling and bitter-sweet taste, it pacifies the heat and inflammation associated with pitta. It balances hormonal fluctuations and soothes digestive discomfort such as acidity. However, it’s sweet taste and heavy, nourishing nature can increase kapha if taken excessively. It can be combined with warming herbs like ginger or cinnamon to balance its effects.

Gotu kola is a tridoshic herb (balancing each dosha) by grounding vata, tonifying pitta, and reducing kapha. It is the perfect herb to support a healthy mind, promote concentration, memory, and intelligence. It is calming and nourishing with aggravated vata, soothing the nervous system and relieving anxiety and restlessness often associated with vata imbalance. Gotu Kola’s sweet, bitter and astringent tastes all pacify pitta’s fiery nature, helping to reduce systemic heat and feeling hot ‘under the collar’. Additionally, its cooling action promotes skin health by calming irritated or inflamed skin conditions common with pitta imbalances. Its bitter, astringent tastes and light, dry qualities help reduce excess kapha by improving circulation and stimulating metabolism. It supports cleansing processes, enhances blood flow, and can aid in weight management. The herb also rejuvenates and uplifts energy with lethargy associated with aggravated kapha by rejuvenating the nervous system.

Tulsi is prized for its adaptogenic effects, bringing mental clarity whilst also calming any nervous tension. It steadies the adrenal hormonal stress response allowing you to cope better under pressure. It is seen to be mainly vata and kapha reducing with the potential to increase pitta when used in excess. In vata types, careful dosing is also required since tulsi can be a little drying or stimulating, potentially increasing vata if misused. In pitta-dominant individuals prone to inflammation, acidity, and irritability, tulsi’s heating effect may increase heat in their system too much. For kapha constitutions struggling with congestion or sluggishness, tulsi’s invigorating properties are ideal in aiding metabolism and digestion of mucus with its dry, light, heating properties.

Turmeric has potent anti-inflammatory properties and efficacy in treating digestive and immune conditions. It is seen as balancing for all three doshas due to its combination of qualities, acting on each of the body’s tissues recognised by Ayurveda. Vata constitution benefit from turmeric’s heating nature, but excessive use may aggravate due to its dry, light qualities unless balanced with oils for example. For pitta constitutions, with tendencies to internal heat and inflammation, turmeric’s bitter and astringent tastes aid digestion and reduces inflammation but it should be prescribed carefully due to its heating effects. In kapha constitution one can have less concerns as its pungent, bitter and astringent tastes, along with dry, light qualities and heating effect is the ideal combination to balance kapha,  stimulating metabolism and clearing mucus or stagnation, promoting vitality.

Triphala is such a widely used and useful formula as each of its ingredients specifically balances each of the doshas: Amla primarily pacifies pitta dosha due to its cooling action, along with sour, bitter astringent taste. It supports digestion, detoxification, and rejuvenation, combating excess heat and inflammation associated with pitta. Bibhitaki balances kapha dosha, due to its dry, light and heating qualities that help reduce mucus, promote detoxification, and support respiratory and metabolic functions related to kapha. Haritaki balances vata dosha with its heating nature and sweet post digestive effect. It aids in regulating the nervous system and digestive tract, supporting elimination, and calming the erratic qualities of vata. Because each fruit targets a different dosha, their combination provides a powerful synergistic effect that helps maintain digestive health, supports regular bowel movements, enhances immunity and promotes detoxification without disrupting doshic equilibrium. Its tridoshic nature makes it a cornerstone of Ayurvedic herbal therapy, explaining its widespread use and efficacy in Ayurveda.

Complementing lifestyle and diet suggestions 

Beyond the herbal prescription, understanding doshas can also guide some appropriate dietary and lifestyle recommendations (as outlined in the table above). In summary, a vata individual is advised to consume warm, moist, grounding foods and adopt calming routines. A pitta individual benefits from cool, non-spicy diets and stress-reduction practices to prevent overheating. For kapha types, more stimulating activities balances their natural heaviness and aids detoxification.

Daily and seasonal adjustments

The dynamic fluctuation of doshas with times of day, life, seasons and environment may inform both diagnosis and treatment. For example, during the cold and dry autumn season when vata is naturally higher, treatments aim to pacify vata‘s qualities (dryness, coolness, roughness). A herbal ashwagandha oil with its warming and stabilizing energetics would be ideal. Aloe vera is prized for its cooling, bitter, and moistening qualities, which help balance pitta dosha that tends to increase during summer months. Excess pitta, associated with heat and inflammation, can cause skin irritation, digestive disturbances, and inflammatory conditions and aloe vera’s cooling nature soothes these imbalances effectively.

Looking at how doshas predominate different times of the day, we’ve outlined how 6–10 am is a kapha time of day characterised by heaviness, stability, and moisture. Morning intake of kapha-pacifying herbs such as ginger, turmeric, or triphala can stimulate digestion and clear accumulated toxins. Pitta, governing digestion, peaks around midday when agni is strongest. So, this is a beneficial time to take herbs that stimulate digestion and that enhance assimilation like ginger, cumin or coriander. 

Understanding the doshic constitution and imbalances offers unique insight to guide herb selection by matching herbal energetics to individual doshic imbalances and constitutional needs. It supports holistic healing by addressing the root imbalances reflected in unique physical, mental, and emotional patterns. It helps anticipate and mitigate potential aggravations of dosha imbalances (e.g., overheating pitta with too much turmeric).

It also allows for the adjustment of formulations, doses, and complementary lifestyle or dietary recommendations to optimize effect and reduce side effects. Overall, it supports transforming herbal medicine from uniform protocols into personalised, integrative therapies that respect and work with the body’s intrinsic nature, alongside seasonal and even geographical considerations.

1. Pole S. Ayurvedic Medicine: The Principles of Traditional Practice. 2nd ed. Churchill Livingstone; 2013. Foreword.
2. Vāgbhaṭa. Astanga Samgraha, Sutra Sthana 17/4-8. (Classical Ayurvedic text; date unknown, traditionally ca. 7th century CE).
3. Suśruta. Sushruta Samhita, Sutra Sthana 21/8. (Classical Ayurvedic text; traditionally ca. 1000 BCE–500 CE).
4. Suśruta. Sushruta Samhita, Sutra Sthana 21/5. (Classical Ayurvedic text; traditionally ca. 1000 BCE–500 CE).
5. Vāgbhaṭa. Astanga Hridaya, Sutra Sthana 1/11. (Classical Ayurvedic text; traditionally ca. 6th century CE).
6. Caraka. Charaka Samhita, Vimana Sthana 8/95. (Classical Ayurvedic text; traditionally ca. 1000 BCE–200 CE).
7. Sharma H, Wallace RK. Ayurveda and epigenetics. Medicina. 2020;56(12):687. https://doi.org/10.3390/medicina56120687 
8. Telles S, Pathak S, Kumar A, Mishra P, Balkrishna A. Ayurvedic doshas as predictors of sleep quality. Med Sci Monit. 2015;21:1421-1427. https://doi.org/10.12659/msm.893302 
9. Wallace RK. Ayurgenomics and modern medicine. Medicina. 2020;56(12):661. https://doi.org/10.3390/medicina56120661 
10. Prasher B, Gibson G, Mukerji M. Genomic insights into ayurvedic and western approaches to personalized medicine. J Genet. 2016;95(1):209-228. https://doi.org/10.1007/s12041-015-0607-9 
11. Tiwari M. Women’s Power to Heal Through Inner Medicine. New York: Mother Om Media; 2007. p.47.
12. Edwards MT, Streiner DL. Development of a reliable dosha self-assessment questionnaire. Explore. 2022;18(5):573-578. https://doi.org/10.1016/j.explore.2021.09.003 
13. Dwarkanath C. Introduction to Kayachikitsa. 3rd ed. Varanasi: Chaukhambha Orientalia; 1996. p.20.
14. Vāgbhaṭa. Astanga Hridaya, Sutra Sthana 11/5-7. (Classical Ayurvedic text; traditionally ca. 6th century CE).

German chamomile (Matricaria chamomilla) and Roman chamomile (Anthemis nobilis) – although the review searched for “chamomile” in general.

To conduct a systematic review and meta-analyses to explore the use of chamomile as an anti-inflammatory agent, particularly as an anti-inflammatory for oral health.

This study was conducted as a systematic review. Whilst the authors broadly searched for inflammation, the main area of focus was oral health.

For the search strategy the population was human adults, the intervention was any chamomile preparation, and the outcomes of interest were inflammation, pain severity, gingival bleeding and anti-microbial effects.

It is noted that the details of the search terms were not included in the methodology, so it is not clear how extensive these were and whether the authors searched using botanical names or common plant names, or whether the terms included active compounds, such as chamazulene.

The search was performed using only one electronic bibliographic database – PubMed. Two authors were involved in study screening and data extraction. They did not look at the risk of bias for included studies.

Chamomile was administered in a range of oral products. Chamomile oral gel, chamomile mouthwash or gargle, chamomile powder for cleaning teeth, topical gel and chamomile extract.

Topical gels and creams ranged from 1.3 to 3% chamomile (w/v), and mouthwashes ranged from 20% to 160% (w/v).

Eleven randomised controlled trials were included in the analysis. Nine of these looked at oral inflammation, one nasal inflammation and one skin inflammation.

The first meta-analysis pooled data from seven studies and looked at overall inflammation. There was no statistically significant improvement in inflammation from using chamomile compared to controls, with a pooled mean of −1.57 (95% CI: −4.05 to 0.91). These studies included oral, nasal and skin inflammation and a wide range of chamomile products, and the heterogeneity, which measures variability between studies, was high.

A second meta-analysis included four studies and explored pain severity; there was a significant improvement following the use of chamomile compared to controls with a pooled mean of −0.61 (95% CI: −0.76 to −0.46).  For these studies, the heterogeneity was low at 0%, with three trials on oral care and one on skin inflammation.

For gingival bleeding, although there was a trend toward improvement, the pooled effects showed no statistically significant reduction in bleeding following chamomile treatment compared to controls. For anti-microbial effects, there was a trend toward improvement which also was not statistically significant.

The next meta-analysis pooled data from the studies that just examined the oral cavity. There was no statistical improvement in mucosal inflammation as shown by pooling data from three studies, and these tests looked for ulcers, swelling and redness. However, a final meta-analysis on gingival inflammation pooled data from three studies and showed a statistically significant improvement in the Gingival Index (gum inflammation), with a pooled mean difference of -0.70 (95% CI: -1.25 to -0.15), and the heterogeneity was low.

The systematic review retrieved and analysed 11 studies that examined the effectiveness of chamomile in treating inflammatory skin and mucosal conditions, with chamomile made available in topical gels, creams, oral mouthwashes and powders.

Overall, chamomile was not effective as an anti-inflammatory treatment but it did relieve pain severity in studies that included skin and nasal inflammation, and oral care.

In focusing on oral care, there were no improvements in visible mucosal inflammation as indicated by ulceration and swelling in the mouth, but chamomile did specifically improve gingivitis inflammatory scores, but not gingival bleeding. 

Overall, the results for chamomile were mixed probably due to the array of different products and varying concentrations used, and the varying medical conditions looked at in the review.

Chamomile is well known for its anti-inflammatory properties and is used to treat skin irritations and gut disorders. Its effects are attributed to volatile oil compounds like chamazulene and alpha-bisabolol, and flavonoids including apigenin. Future research could benefit from the standardisation of products, such as apigenin-7-glucoside, as per European and U.S. pharmacopoeia recommendations. This would allow for a more accurate comparison of the effects of different products.

Accounting for the botanical species and parts of the plant used, as well as the method of preparation would futher benefit future work. One study that explored the effects of chamomile extracts from five different parts of the plant on human T cells found varying immunomodulatory activity dependent on the plant part and method of extraction (they used aqueous extracts of whole plant and root, ethanolic extract of flowers and root, and an ethanolic mother tincture). Aqueous root extract inhibited T cell migration, whereas both aqueous root and aqueous whole plant extracts reduced T cell activation. Whole plant extract and ethanolic flower extract significantly reduced interleukin-2 intracellular levels (2). This reaffirms the importance of recording the preparation and plant parts used.

Chamomile was effective in improving pain severity in a range of inflammatory conditions, and reduced gingivitis scores suggesting that its analgesic and anti-inflammatory properties could be of particular benefit as an anti-inflammatory for oral health. Overall, the analyses included a diverse set of studies including skin, nasal and oral inflammation, and there was no significant improvement in inflammation overall across all studies analysed.

It must be noted that this study lacks any record of the complete search strategy and the risk of bias was not discussed, precluding reliable interpretation of the results. Further research is needed to better understand chamomile’s anti-inflammatory potential, in particular its application in dentistry.

1. Valmy J, Greenfield S, Shindo S, Kawai T, Cervantes J, Hong BY. Anti-inflammatory effect of chamomile from randomized clinical trials: a systematic review and meta-analyses. Pharm Biol. 2025 Dec;63(1):490-502. doi: 10.1080/13880209.2025.2530995. Epub 2025 Jul 15. PMID: 40665590; PMCID: PMC12269088.
2. Lairikyengbam D, Wetterauer B, Schmiech M, Jahraus B, Kirchgessner H, Wetterauer P, Berschneider K, Beier V, Niesler B, Balta E, Samstag Y. Comparative analysis of whole plant, flower and root extracts of Chamomilla recutita L. and characteristic pure compounds reveals differential anti-inflammatory effects on human T cells. Front Immunol. 2024 Apr 24;15:1388962. doi: 10.3389/fimmu.2024.1388962. PMID: 38720895; PMCID: PMC11077421.

Ginseng (Panax ginseng)

The study explored whether red variety of ginseng could regulate alcohol metabolism and alter hangover symptoms in healthy men.

The trial was a randomised, cross-over design. Participants were randomised to groups to receive either a placebo drink (water) or a beverage containing red ginseng. It was not clear from the study methodology whether the study was blinded at all. The drinks were presented in similar packaging.

Volunteers attended three visits and on the first two visits they received either the placebo or ginseng. There was a two-week wash-out between the first and second visits. On the third visit, they completed surveys. On each test visits the participants:

• Abstained from drinking alcohol for three days prior to the visit
• Fasted for 12 hours prior to the visit
• Consumed 100 ml 40% blended scotch whisky and one piece of cheese
• They consumed either 100 ml water (placebo) or red ginseng drink within five minutes of the alcohol.

The following outcome measures were recorded, which included participant surveys and food diaries, plus laboratory tests.

• Hangover symptom questionnaire on the third visit (15 questions including symptoms such as headache, nausea and fatigue on a scale of 0 absent to 4 extremely severe)
• Daily food intake was measured using recall diaries over 24 hours
• Body weight and percentage body fat
• Blood pressure
• Blood samples at regular intervals up to four hours after consuming the alcohol test
• Serum lipids, blood haematology and serum creatinine was measured
• Basal metabolic rate and total energy expenditure was calculated

Plasma alcohol and acetaldehyde was measured at regular intervals, as was alcohol in exhaled air for up to four hours.

The 100 ml placebo drink was water. The red ginseng drink comprised 0.321 mg/mL red ginseng extract prepared by water extraction and made up to a 100 ml drink, thereby constituting a 32.1 mg dose.

The n=25 healthy male volunteers were 25–49 years of age with a body mass index of 18 to 29 kg/m². Exclusion criteria included anyone with a medical condition or who was on medication, or those with an allergy to ginseng.

There were n=13 participants in the placebo group and n=12 in the Ginseng group. All physiological and biochemical characteristics were within normal ranges. There were no statistically significant changes in food intake or energy expenditure over the course of the study. The statistics do not display the differences if any between the groups, just changes over time, so it cannot be determined whether the groups were matched in characteristics.

The overall hangover symptom score was significantly lower in the ginseng group compared to placebo. Several symptoms also improved following the ginseng drink and were statistically different from the placebo: the group were less tired, had fewer stomach aches, were less thirsty, and experienced better concentration and improved memory compared to the placebo. The other symptoms associated with hangovers did not change.

Plasma alcohol levels were significantly lower in the ginseng group at 30–60 minutes after whiskey consumption compared to the placebo group suggesting that alcohol absorption was slower. By 90 minutes, the groups were the same. The area under the curve was smaller and statistically significant (just at p=0.051) for the ginseng group.

The expired alcohol levels mirrored this being lower in the ginseng group up to 60 minutes after drinking the whiskey, and similar thereafter.

For plasma acetaldehyde, the levels were similar except for the two-hour time point where levels were higher in the Ginseng group, but were similar again at three and four hours.

The study showed that consuming a ginseng drink alongside alcohol consumption improved hangover symptoms of fatigue and stomach ache, and was associated with lower plasma alcohol concentrations up to 60 minutes after drinking. Similarly, levels of alcohol in expired breath also reduced over this time frame, and this was also represented by statistically smaller areas under the curve calculations. This suggests that the ginseng had delayed alcohol absorption which is a benefit as this gives the body more time to metabolise and reduces feelings of intoxication.

Other research (cited by the authors) has shown that ginseng can alter alcohol metabolism through regulating enzyme activity, but in the present study, there was no change in the levels of the metabolite acetaldehyde in the blood. This may have been due to the small number of participants or that the acetaldehyde test was not sensitive enough to detect any differences.

Participants in the ginseng group also experienced improved concentration and less fatigue. Panax ginseng contains a host of bioactive components including ginsenosides or ginseng saponins, along with essential oils and polyphenols (2). It is known for its ability to improve memory and cognitive deficit (2), and other studies have shown that consuming a ginseng extract for three weeks can reduce fatigue in healthy adults (3). The present study confirms the effects of ginseng in improving fatigue and memory.

To conclude, a ginseng extract in a 100 ml beverage improved several hangover symptoms and reduced plasma alcohol levels compared to a placebo.

1. Lee MH, Kwak JH, Jeon G, Lee JW, Seo JH, Lee HS, Lee JH. Red ginseng relieves the effects of alcohol consumption and hangover symptoms in healthy men: a randomized crossover study. Food Funct. 2014 Mar;5(3):528-34. https://doi.org/10.1039/c3fo60481k  
2. Wee JJ, Mee Park K, Chung AS. Biological Activities of Ginseng and Its Application to Human Health. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 8. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92776/ 
3. Lee YG, Hong W, Cho YM, Kwon JE, Yang DC, Kim H, Kang SC. Anti-fatigue effects of Korean Red Ginseng extract in healthy Japanese adults: A randomized, double-blind, placebo-controlled study. J Ginseng Res. 2025 May;49(3):237-247. https://doi.org/10.1016/j.jgr.2024.12.003 

When seeking a replacement solution, consider herbs with:

• A similar action profile
• A related phytochemical profile
• Comparable taste, qualities and energetics
• Corresponding traditional uses
• Local origins
• More sustainable plant parts used

Considerations when substituting different plant parts of endangered herbs

It is always worth reflecting on the impact of harvesting different plant parts:

• Barks: Removal of barks can kill trees. Taking many years to regenerate, they should be either coppiced or removed in a rotation.
• Resins: Tapping the resin of plants can drain nutritive reserves and weaken defences.
• Roots: Digging roots can remove the whole plant, reducing the potential for future growth and damaging population densities.
• Flowers: Prevents the formation of seeds and furthering of genetic diversity.
• Seeds: Harvesting can prevent the spread of genetic diversity and reduce local populations.
• Fruits: Harvesting reduces the potential for spreading the seed.

Substitutes rarely produce identical effects; sometimes it may just be one aspect of a plant’s therapeutics that can be replicated by another; at other times two herbs may be needed to meet the same qualities as the original choice.

Goldenseal (Hydrastis canadensis) is a herb that finding a replacement for is advisable because

• its wild populations are threatened and it is CITES listed 
• it has a long growing cycle making availability limited 
• due to ‘a’ and ‘b’, it is very expensive

Goldenseal is a herb native to North America, that has a long history of use by indigenous peoples and remains a highly valued herb in Western herbalism today, owing to the following qualities:

Goldenseal actions

• Anti-inflammatory
• Antimicrobial
• Bitter
• Cholagogue and choleretic
• Emmenagogue
• Hepatic
• Stomachic
• Vulnerary

Body systems support

Goldenseal supports different body systems, including

• Digestion
• Skin
• Reproductive system

Goldenseal energetics

• Bitter
• Astringent
• Cooling
• Toning

Goldenseal phytochemistry

• Isoquinoline alkaloids (2.5–6%) — hydrastine (minimum 2%)
• Berberine (minimum 2.5%)
• Canadine
• Berberastine
• Chlorogenic acid
• Volatile oil
• Resin
• Lipids
• Sterol and flavonoids (1)

Goldenseal substitution options 

Any bitter herb, such as andrographis or artichoke leaf, may be initially considered as a replacement, which would often suffice on its own due to the inherent cooling, drying and broad-spectrum antimicrobial effects of bitters in general. Bitter herbs containing berberine, such as barberry (Berberis vulgaris) or Oregon grape root (Berberis aquifolium), are all the better — though, of course, as roots (rootbarks, no less) these also face sustainability issues.

Other berberine-containing species, such as huang lian (Coptis chinensis) and daruharidra (Berberis aristata) also face sustainability threats in China and the Himalayas and are not recommended replacements. The efficacy of berberine in promoting weight loss and improving glucose metabolism has incited interest in the herb as a natural alternative to GLP-1 receptor agonists, such as Ozempic and Wegovy, despite producing a less significant effect, which is only leading to higher demand for berberine (2,3). And whilst berberine can be made synthetically, its a complex process rendering it costly and with safety risks (4).

To ensure the mucous membrane toning effects of goldenseal, combine the most appropriate bitter herb with an astringent herb, such as meadowsweet (Filipendula ulmaria) for the digestive system, calendula (Calendula off.) for the skin, and yarrow (Achillea millefolium) for the reproductive system — or any companion herbs with an affinity for the affected system. If it’s a specific digestive antimicrobial then garlic (Allium sativum) would be especially appropriate, if more astringency is required, consider combining with triphala, or if the issue is dermatological, alteratives are particularly useful.

Some herbs are much easier to substitute than others. Just as goldenseal is relatively easy to replace, so are slippery elm (Ulmus spp.) and gentian (Gentiana lutea); many herbs share their demulcent, nutritive or bitter digestive effects. However, herbs such as boswellia (Boswellia serrata), cordyceps (Ophiocordyceps sinensis), saw palmetto (Serenoa repens) or rhodiola (Rhodiola rosea) are more difficult to replicate as their actions and compounds are so specific.

Near equivalence can be achieved, but it will always be a compromise. Fortunately, this does not have to negatively impact clinical outcomes, as there are many approaches to creating a therapeutic strategy and personalised treatment that can initiate the healing response.

For a quick look guide through the Herbal Reality library of monographs, use the ‘herbal actions’ filter to view all of the herbs with a shared function — anti-inflammatory, analgesic, circulatory stimulant, or uterine tonic, for example.

Below are some suggested substitutions for replicating some aspects of our most challenged wild herbs. The following herbs are critically endangered.

Endangered herb	Replacement
Devil’s claw	Turmeric, willow, meadowsweet
False unicorn	Vitex agnus castus, motherwort, lady’s mantle, raspberry leaf
Goldenseal	Barberry, garlic, triphala
Jatamansi	Valerian, cramp bark, brahmi, skullcap
Kutki	Andrographis, barberry
Myrrh (Guggul)	Calendula 90% extracted tincture
Pasqueflower	Valerian, wood betony, ashwagandha, lady’s mantle
Rhodiola	Ashwagandha, brahmi, skullcap, tulsi, lion’s mane

Here are also some suggested replacements for other endangered herbs whose populations are currently under threat.

Endangered herb	Replacement
Albizia	St John’s wort, lavender, melissa
Arjuna	Hawthorn, motherwort, yarrow
Arnica	Daisy, calendula, St, John’s wort
Asafoetida	Garlic, ransoms (wild garlic)
Atractylodes	Liquorice, angelica, astragalus,
Baical skullcap	Barberry, oregon grape root
Bibhitaki	Meadowsweet
Black cohosh	Vitex agnus-castus, motherwort, ashwagandha
Black root	Chelidonium, rhubarb root
Boswellia	Turmeric, ginger
Cat’s claw	Astragalus, echinacea, reishi
Chaga	Reishi, turkey tail
Codonopsis	Siberian ginseng, nettle, rehmannia, cinnamon, astragalus
Corydalis	St. John’s wort, feverfew, turmeric
Echinacea	Garlic, thyme, astragalus
Eyebright	Chamomile, chrysanthemum, sage, self-heal
Gentian	Andrographis, artichoke, wormwood, dandelion
Ginseng	Siberian ginseng, ashwagandha, jiaogulan
Jamaican dogwood	St. John’s wort, valerian, cramp bark
Manjistha	Burdock root, yarrow, turmeric
Marshmallow	Liquorice, linseed, mullein, plantain
Mistletoe	Hawthorn, motherwort, yarrow, cramp bark
Red sage	Hawthorn, turmeric, yarrow
Saw palmetto	Nettle root
Schisandra	Milk thistle, rosemary
Senna	Cascara sagrada, rhubarb root, yellow dock
Siberian ginseng	Ashwaganda, nettle seed, liquorice, astragalus
Slippery elm	Marshmallow, plantain, linseed, mullein

Sadly, many of the potential substitutes are also threatened, so it is of utmost importance to know the source, ensuring sustainable cultivation or wild-harvesting that carries a third party certification, establishing that good practice has taken place.

Other resources to explore include:

• United Plant Savers have developed some useful lists and tools for assessing Sustainable status of herbs that is worth a look.
• Access the IUCN Red List
• Access the CITES list

Before choosing which herbs to use and purchase, important questions to ask are:

• Where is this species / herb / product grown?
• Is there any environmental certification — e.g. Organic?
• Is there any social certification — e.g. Fairtrade?
• Is the herb from the wild? If so, is it certified — e.g. by FairWild?
• Is there a mention of quality standards? If not, why not?!

Of course, some of these recommendations are just suggestions, and herbalists must use their own expertise and specific clinical needs in selecting replacements for endangered herbs. This is a work-in-progress so do please share any of your insights or recommendations further to these listed above.

1. Fisher C. Materia Medica of Western Herbs. London: Aeon Books; 2018.
2. Ilyas Z, Perna S, Al-Thawadi S, et al. The effect of Berberine on weight loss in order to prevent obesity: A systematic review. Biomed Pharmacother. 2020;127:110137. https://doi.org/10.1016/j.biopha.2020.110137 
3. Araj-Khodaei M, Ayati MH, Azizi Zeinalhajlou A, et al. Berberine-induced glucagon-like peptide-1 and its mechanism for controlling type 2 diabetes mellitus: a comprehensive pathway review. Arch Physiol Biochem. 2024;130(6):678-685. https://doi.org/10.1080/13813455.2023.2258559 
4. Meher AK, Zarouri A, & Kumar M. Rethinking Synthetic Berberine in Nutraceuticals: Nitrosamine Risks, Regulatory Oversight, and Safer Alternatives. Preprints. 2025. https://doi.org/10.20944/preprints202508.1171.v1 

• 120 g elderberries
• 120 g rosehips 
• 120 g blackberries
• 15 g grated fresh ginger
• 2 cinnamon sticks 
• 300 – 400 g raw organic local honey (this can be substituted for agave for vegan diets)
• 1500 ml filtered water

1. Pick the elderberries off using a fork and discard any stems. 
2. Combine all the ingredients aside from the honey in a large saucepan
3. Bring the mixture to the boil, then reduce the heat to low, cover and simmer for between 40–50 minutes. By this point the liquid should have reduced by half. 
4. Remove the mixture from the heat and cool slightly. 
5. Strain the liquid through a fine muslin cloth and place back into the saucepan. 
6. Stir the honey through once the mixture is still warm but not hot. 
7. Pour the mixture into sterilised glass bottles or jars.

Store the bottled mixture in the fridge and use within six weeks.

Elderberry (Sambucus nigra)

The flavonoids and anthocyanins in elderberry contribute to its antioxidant, anti-inflammatory, antiviral and immunomodulatory actions. Elderberry stimulates cytokines, macrophage activity and dendritic cells to stimulate the immune response, making it effective in treating infections (1). It is also a powerful antiviral as it blocks viral glycoproteins (including hemagglutinin on influenza viruses) preventing replication and limiting the spread of the virus (2). 

Rosehip (Rosa canina)

Rosehips contain one of the highest vitamin C levels of any fruit or vegetable. Rosehips have been shown to stimulate the production of lymphocytes and generation of antibodies, which helps to support the immune response (3). Rosehips also modulate immunity by inhibiting inflammatory mediators, which in cases of allergic rhinitis, asthma, coughs and colds, helps to alleviate associated respiratory symptoms (4). 

Blackberry (Rubus fruticosus)

Blackberries are another rich source of antioxidants and anthocyanins which help to reduce inflammation and oxidative stress. Blackberries have also shown to exhibit antimicrobial actions in vitro against multiple strains of bacteria (5). 

Ginger (Zingiber officinale)

Ginger is a warming expectorant, so brings warmth to the body and reduces mucus and congestion. Ginger also has antiviral and antibacterial properties and is effective in fighting infection (6). 

Cinnamon (Cinnamomum verum)

Cinnamon is another warming herb, helping to increase circulation and bring warmth in cases of colds, fevers or flus. Cinnamon has also been shown to inhibit viral replication with a specific effect on respiratory viruses including influenza and SARS-CoV-2 (7). It can also help to reduce excess mucus and provide relief from symptoms of respiratory infections (7). 

What herbs can you use for a herbal syrup?

There are a variety of other ingredients which can also be included in this recipe, many of which may be growing in the wild including turkey tail mushroom (Trametes versicolor) for its immunostimulatory effects; mullein (Verbascum thapsus) as a respiratory tonic or thyme (Thymus vulgaris) to increase the expectorant and antiviral properties. 

What can you use instead of honey in a syrup?

Honey can be substituted for agave or maple syrups to accommodate for vegan diets, or alternatively sugar can be used; however, as sugar is typically refined (undergone processing), natural syrups are preferable.

How can you extend the shelf life of herbal syrup?

The sugar content of syrups defines how long it will keep. To keep the sugar content down, this syrup has a relatively short shelf life, as its sugar to water to ratio is 1:2. Increasing the honey content to anything up to 1500 g (a ratio of 2:1) can increase how long a bottle or jar will last before it is first opened to around six months.

Most of us are already likely to be familiar with the qualities and names of these four Humours:

• Air: Sanguine or blood humour — hot and wet
• Fire: Choleric humour — hot and dry
• Earth: Melancholic humour — cold and dry
• Water: Phlegmatic humour — cold and wet

Perhaps the first guiding concept of humoral theory that we have not retained in the Western biomedical model is the role of cycles in health and disease.

In all ancient medical systems and traditions, rhythm and cycles are understood as the core expression of life, and the loss of cycle is associated with sickness and ill health.

We frequently find the ancient concept of dynamic cosmic change and repetitive cycles expressed through the symbol of a circle; it has no beginning, no end, it is in continual motion. It also corresponds to the world around us; the circular and cyclical nature of the sun and moon, the circle and cycle of the continual dance of day and night, the cycle of the four seasons coming, going and returning, the circle and cycle of being born from the earth and returning to the earth at death.

The humours themselves are bodily manifestations of the phases of movement in this cycle, a movement we see reflected in the seasonal cycle; winter — cold and wet, through spring — hot and wet, to summer — hot and dry, and back again through autumn — cold and dry. This humoral cycle is seen in the life cycle with spring being birth and youth, summer adulthood, autumn middle age, and winter old age and death. 

The activity of the humours in the body is likened to the seasonal changes that make up the annual cycle of growth and regeneration in the world around us. If the seasonal temperaments are in balance and there is a year without extreme heat and drought, or without extreme cold and wet flooding the land; everything grows well, and there will be a plentiful harvest. 

Similarly, if the humours are well balanced like good seasons, the vitality of the body is nourished. This living vitality then manifests in the body as healthy and strong ‘spirits’. Loss of health arises when one aspect of the cycle becomes excessive and overwhelms the body. 

A fever may be likened to a heat wave in the summer, which although can be made easier by finding a cool breezy place offering instant respite, it will only properly resolve when the balancing coolness of autumn arrives. 

When treating a fever, we must first address the excess temperature by using cooling strategies, such as swabbing with a tepid cloth and giving antipyretics, such as willow (Salix alba). But, we also need to find a way to move things on to the next cooler phase, for instance using sweat inducing and immune stimulating diaphoretics (traditional cleansing cathartic herbs) such as vervain (Verbena officinalis) or elder (Sambucus nigra). This is like moving the fever cycle from being stuck in summer heat into the cooler days of autumn. 

It is then important to consider what excess humour initially overwhelmed the system and lead to the depletion of the vital spirit and its innate heat, as it is this heat that confers protection against any ‘invasion of poisons’ (infection and fevers).

When the underlying temperamental balance is lost, the most powerful way of bringing the balance back is through using sympathetic supportive strategies, even if we have to initially respond with countering ‘antipathetic’ interventions to address the immediate imbalance.

Sympathetic supportive strategies consist of:

• Restoring and nourishing weakened tissues and organs ensuring that their temperament is returned to normal.
• Supporting any weakened ‘spirits’, including the organs that they reside in — the heart, the head, the liver, the reproductive organs.
• Using constitutional medicines that help to balance the individual’s dominant humour, or effects of their stage of life.

Even today when we ask someone if they are in ‘good spirits’, or if they are feeling ‘dispirited’ we are continuing the use of these ancient humoral concepts in our language.

In humoral physiology there are four spirits which arise in the body.

• The vital spirit resides in the heart and consists of the innate heat and radical moisture. It activates all the bodily functions, gives the body its vitality, and protects it from infection.
• The natural spirit resides in the liver, it enables digestion and the dispersal of the humours in healthy blood.
• The animal spirit resides in the head, corresponds to the element ether, and initiates motivation, movement, and sensory perception.
• The procreative spirit resides in the testes, ovaries and womb. It arises as desire and provides the ability to conceive and procreate.

As the loss of correct temperament is the main underlying cause of sickness, we need to look at its main possible causes.

1. Life stage
2. Constitution
3. External influences

Lifecycle 

Each stage of life is dominated by a particular humour, during each phase it is more likely that a loss of temperament will be caused by the dominant humour of that stage becoming an overwhelming influence: 

• Youth: Sanguine / air 
• Adulthood: Choler / fire 
• Middle age: Melancholic / earth 
• Old age: Phlegm / water

Individual constitution 

Each person is born with a constitutional temperament, and this remains the same throughout life. We can quickly recognise the dominant temperament of some people, in others it may be a bit more subtle. We automatically recognise ‘warm’ people and ‘hot’ fiery people, as well as those who are ‘cool and chilled’, or perhaps even ‘cold’.

Determining a person’s constitution is important, as the temperament that dominates is always most likely to be the underlying cause of an imbalance for any individual. Having this temperament as a dominant influence in our bodies makes it always most likely to be the one which will become excessive.

Sanguine / air constitution 

We all know the energetic, explorative, creative, embracing but slightly flighty types, the ones who can’t stay still for too long, who being similar to an energetic youngster have an exuberant sanguine/air temperament.

Choleric / fire constitution

These are those with a strong personal drive, focus, high motivation, and often low tolerance of failure and a short temper, this typifies the time of our lives when we are working toward goals as adults and corresponds to the choleric/ fire temperament. 

Melancholic / earth constitution

We expect these types to be more introverted, solitary and studious, also reliable and trustworthy, often going deeply into ideas, but often prone to getting a bit stuck. This corresponds to middle age, when we slow down, become steadier and more anchored in our lives. This more grounded energy is the melancholic/earth temperament.

Phlegmatic / water constitution

Like the water element that rules them, phlegmatics are more likely to accommodate and flow with others, being more tolerant, but also a bit dreamy, and prone to getting overwhelmed. This corresponds to becoming an elder, with the wisdom of age making one more tolerant, and being able to let go of fixed ideas and attitudes. This softer gentler energy corresponds to the phlegmatic/water temperament.

Each of these four temperaments may manifest in combination with another, one still being the dominant aspect and one being secondary. 

External factors affecting the temperament

In humoral medicine, there is a recognition that external factors have a very important influence on health and disease. These are seen as influences that arise from outside of the body rather than from its own nature, thus they are named the ‘six non-naturals.’ 

Air

The natural temperament of air is cold and moist like the lungs. When hot it may irritate the naturally damp lungs and blood, and when too cold and moist it may add to excess moisture causing putrefaction and infection. Each constitution is balanced by air of the opposite temperament — cool air for hot people, etc. Purity of air is of utmost importance.

Diet

Foods all have an intrinsic heat or cold, and each of the different constitutions are challenged or benefitted by them. In summer, the digestive heat is more dispersed due to the summer heat, and in winter, digestive heat is concentrated in the body. This corresponds to us eating more lightly in the summer with a preponderance for cooling foods such as lettuce, chicory and cucumber. Hotter people have stronger digestive heat and better digestion than cool phlegmatics, who benefit from always adding warming herbs, spices and pepper to their food.

Exercise and rest

Exercise activates innate heat and energises the body. The heat of excess exercise damages the body, and lack of exercise leads to stagnation and congestion.

Sleep and wakefulness

Sleep is brought on by the rising upwards of a sweet calming restoring vapour from the heart to the head. It has a moistening and refreshing effect on the brain and the nerves. During sleep the innate heat settles in the liver completing digestion and the production of the humours. Insomnia dissipates the spirits and dries the brain.

Retention and evacuation

The body has a retentive faculty associated with the Earth element and the spleen, and an expulsive faculty associated with the Water element, the bowels and bladder. If either faculty is lowered through disease, an excess of the retentive melancholic humour, or inadequate innate heat or moisture to activate the expulsive faculty then blockage occurs. This kind of congestion can lead to melancholic vapours rising up from the spleen effecting the heart, stomach and head.

Perturbations of the mind and emotions

The maintenance of a calm state throughout the body and mind is beneficial to health. Reducing stress and releasing extreme emotions through cathartic activities is very helpful.  Singing, dancing, and expressing emotions in a healthy way are all considered very important, especially to the health of the vital spirit. Activities that promote joyfulness and practicing kindness are as important as any other measure we may take to maintain health.