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.

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

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

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

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.

Evidence for the failings of relying strictly on a research- and profit-driven versus a practitioner driven medical system is no better demonstrated than in the health care statistics of the United States. In 1998, Schuster et al. reported that in almost all aspects of health care, the US is failing.

These failings encompass the spectrum of services from preventive, acute, and chronic care; from infants to the elderly; or the health care delivery system of a single city or the country overall. Patients are either not receiving the care they should be receiving or they are receiving inappropriate care that is related to both under treatment and over treatment, as well as the inappropriate use of pharmaceutical medications. Similar findings were reported by numerous other authors (e.g., McGlynn et al. 2003) and organizations over the past decades, demonstrating these patterns have not changed.

By all measures of individual and social health, America is ranked among the worst of all similarly developed nations (Shellard 2000; WHO 2000; Woolf and Aron 2013). In infant mortality, a general marker of overall societal health, the US ranks an appalling 31 (based on 2008 data; Heisler 2012) in the world behind virtually all similarly industrialized nations. In 2000, the WHO ranked the US a dismal 37^th in overall health care systems.

In a similar ranking by the Commonwealth Fund (2011), the US was far behind other nations in terms of healthy lives, quality, access, efficiency, and equity of health care delivery services and 19^th of 23 nations surveyed in healthy life expectancy at age 60 (Commonwealth Fund 2008).

Perhaps most importantly, the report noted a “strikingly consistent and pervasive pattern of higher mortality and inferior health in the US, beginning at birth”; that this pattern of poorer health was evident at all stages of life, from infancy to childhood, to adolescence to young adulthood, to middle and old age, and could not be explained by disparities in social demographics.

Those who could afford health care and were financially well off fared little better than those less fortunate. More unfortunate is that some of these findings have been reported for decades (such as the persistent high rates of infant mortality) and yet no meaningful change in the system occurs. The failings of the American system is similarly evidenced by the disproportionate negative impact COVID-19 has had on the American population, where more people have died per capita than any other nation.

Primary care pioneer Barbara Starfield (1932–2011), highlights that the majority of those countries with the best health statistics have a strong primary care infrastructure and that better outcomes are correlated with primary care services (Starfield 2000). Primary care providers can be described as ‘patient centric’. This in contrast to the predominant reliance on specialists in the US, which can be described as more ‘research centric’.

The WHO has a long history of recognizing traditional health care practitioners as primary health care providers, but many countries, like the US, lack acceptance or full integration of traditional healing practitioners into their national health care systems. The advantage of integrating traditional healing practices into a national health care system was highlighted by China’s full integration of traditional Chinese medical practices, and specific codification of herbal formulas for the treatment of SARS in 2003. When herbal medicines were integrated into the treatment of SARS, the death rate due to SARS dramatically declined (Chen and Nakamura 2004; Yang et al. 2020). Similar protocols and use of herbal medicine were fully integrated for various stages of COVID-19.

No improvements in health statistics can occur without a fundamental change in the philosophical basis by which health and healing is approached. As long as the militaristic approach of search and destroy is employed as the primary therapeutic paradigm, big guns represented in powerful pharmaceuticals and high tech interventions will continue to yield the extremely poor health statistics reflected in the American system.

Medical diagnostic technology that leads to a cascade of subsequent treatments is partly responsible for the relatively high rate of iatrogenesis in the US (Starfield 2000). Such diagnostics are predominantly research-driven and represent how lack of a patient-centered focus results in negative health outcomes. This is no more evidenced than in policies regarding prostate-specific antigen (PSA) screening and mammograms.

For almost two decades in the US, annual PSA screening was recommended for healthy men over 50 years of age despite the lack of robust scientific evidence for a benefit (see Albertsem 1996; Woolf 1994). Literally millions of men were screened annually at an annual cost of $447 million to America’s Medicare program alone (2009) (Ma et al. 2014). False positives and detection of slow growing (indolent) tumors resulted in aggressive surgical or radiation treatments that caused serious harm including urinary incontinence, erectile dysfunction, pain, infections, hospital readmission, and death (Moyer 2012).

It has only been more recently that a number of studies specifically looking at the benefit-risk assessment of routine PSA testing over the last 20 years determined that the moderate to high risks of PSA screening and the ensuing cascade of treatments as described by Starfield (2000) far outweighed the low to moderate benefits of PSA screening (Carter et al. 2013).

Annual screening resulted in high levels of false positives that led to unnecessary biopsies that carry a risk of bleeding, infection, pain, urinary symptoms, and hospitalization (Loeb et al. 2012; Nam et al. 2013). Because of this, PSAs are no longer recommended for most of the demographics for which it was previously used. Routine mammograms followed the same trajectory and were, and among many, remain, a research-driven and profit-motivated technology (Epstein et al. 2001).

While early detection with mammograms benefits a small subset of the population, the very act of compressing breasts between two plates and subjecting breast tissue to the cumulative DNA-damaging effects of radiation increases women’s risk of breast cancer; some estimates accounting for up to 20% of breast cancers in the US (Epstein et al. 2001 and references therein).

Despite mounting evidence of questionable benefit (see Miller et al. 2014) and substantial risk of mammograms, as of February 2014, 75% of American women reported having received a mammogram in the past year. In the United States alone, approximately 37 million mammograms are performed annually at a cost of approximately $100 per mammogram. It can be considered that routine PSA and mammography screening are almost identical in their over-diagnosis, over-treatment, marginal benefit, enormous cost, and substantial risk.

Such practices represent medicine at its worst and are a complete antithesis of the common medical dictum of Primum non nocere (first do no harm), often attributed to Hippocrates and still integral, in theory only, to modern medical ethics. More significantly, these examples of research-driven technologies represent an insidious aspect of the modern health care system as every major cancer association as well as local and national government agencies strongly supported the use of the aforementioned screening tools for the majority of the adult population despite a lack of clinical evidence of benefit and despite significant mechanistic and observed evidence for risk.

The negative impact of such research- and economic-driven policies is clear. However, more importantly, these are poignant examples of how much of what is considered technologically advanced medicine is not based in sound clinical science, but rather research-based science.

A primary criticism levied against herbal medicines, and other traditional healing practices, is their lack of scientific proof of efficacy based in modern pharmacological research. However, much of traditional herbal medicines and traditional healing practices in general, are precisely based on human clinical outcomes codified in human experience for hundreds or thousands years.

This is not to say that traditional healing knowledge is complete, safe, effective, and appropriate for all people all of the time, or does not have limitations and knowledge gaps. This merely reflects a different knowledge base that has been a consistently evolving foundation of human healing since the beginning of human existence, and at the very least, should be given the same respect, honor, and use as technologically advanced therapies that only have decades of largely experimental use.

Table 1: US Health care statistics compared to 13 other countries

Outcome	Ranking of 13 countries*
Average for all health indicators surveyed	12
Low birth-weight %	13
Neonatal and infant mortality	13
Years of potential life lost	13
Postneonatal mortality and life expectancy at one yr old for females	11
Postneonatal mortality and life expectancy at 1 yr old for males	12
Life expectancy at 15 years of age	10
Life expectancy at 40 years of age (males)	9
Life expectancy at 40 years of age (females)	10
Life expectancy at 65 years of age (females/males)	7
Life expectancy at 80 years of age (females/males)	3
Age adjusted mortality	10

Table 2:  Mortality due to iatrogenic causes in the US

Cause	Mortality
Deaths from unnecessary surgery	12,0001
Medication errors in hospitals	70001
Other hospital errors	44,000-98,0002
Deaths from infections contracted in hospitals (annually)	80,0001
Deaths from non-error, adverse effects of medications (annually)	106,0001

In addition to the philosophical differences between traditional and conventional medical practitioners and the economics that drive medical practice, is the problem of having a system that relies predominantly on pharmaceutical medications. There is no doubt that pharmaceuticals save lives, especially in acute crisis.

The advent of antibiotics, while solidifying a search and destroy militaristic philosophy as a primary approach in health care, was responsible for saving tens of millions of lives. Morphine, while representing an inherent split between whole plant-based medicines and active constituents, is an incredibly effective painkiller, that, due to its potential for diversion to opium and heroin, is no longer allowed in the public domain as a plant-based medicine as it once was.

And, the story of pharmaceutical development can easily be written to focus on the positive attributes modern drugs have contributed to human health (e.g. The Inside Story of Medicines) (Higby and Stroud 1997). But despite many great successes in the world of pharmaceuticals, ironically many of which were derived from plants (e.g., aspirin, morphine, and vinca alkaloids), there is a tremendous price that current and future societies pay for their effects.

Firstly, pharmaceutical medications are represented to the public and health care professionals as proven to be safe and effective according to scientific methods. This is not entirely true. In 2009, the pharmaceutical giant Pfizer, plead guilty to a felony charge and agreed to pay $2.3 billion in fines for fraudulently marketing select drugs.

This was the fourth fine levied against Pfizer for similar infractions since 2002 demonstrating that fraud within at least one pharmaceutical giant is a recurring theme. In recent decades, a large number of the most recognized pharmaceutical companies have paid similar fines, most for fraudulent marketing practices and some for violations of good manufacturing practices (GMPs). Such practices reflect relatively gross violations of federal law.

The research and development side of pharmaceutical development is much more nuanced and insidious as has been highlighted in recent writings such as Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare. This expose was written by Peter Gøtzsche, a co-founder of the highly prestigious independent evidenced-based Cochrane Collaboration. Another, The Truth About Drug Companies: How They Deceive Us and What To Do About It, was written by medical doctor Marcia Angell, former editor in chief of the New England Journal of Medicine.

Both works, written by long-term editors of arguably two of the most prestigious medical journals in the world provide clear and evidence-based examples of broad-based bias and fraud in the world of medical literature.

These authors demonstrate clearly that published clinical research is positively biased to the sponsoring companies, provide examples of gross fraud by medical writers claiming to conduct trials that were never conducted (reviewed in Gupta 2013), and report that negative findings are often not publicized, allowing for a drug to be released on the market with the mistaken belief that it has been scientifically demonstrated to be safe and effective.

The consequence of poor science and fraud in pharmaceutical drug development is significant. There are numerous examples of heavily marketed drugs that were removed from the market due to serious, sometimes fatal, adverse effects including Oraflex, Propulsid, Rezulin, and perhaps the crowning jewel of this collection, Vioxx, a widely prescribed arthritis drug that was withdrawn from the market after disclosures that the pharmaceutical manufacturer Merck, withheld information from patients and physicians about the potential for Vioxx to increase the risk of heart attacks and stroke.

Vioxx use resulted in between 88,000 and 140,000 cases of serious heart disease. Most significantly, cautions regarding the safety of Vioxx were put forth by epidemiologist David Graham, who at the time was the Associate Director of the Food and Drug Administration’s (FDA) Office of Drug Safety. In formal testimony given before the US Senate Committee on Finance, Dr. Graham provided poignant testimony stating that policies within FDA were insufficient to protect the public from drugs, which carry unacceptable risks, stating;

“I would argue that the FDA, as currently configured, is incapable of protecting America against another Vioxx. We are virtually defenseless… Finally, the scientific standards CDER [Center for Drug Evaluation and Research] applies to drug safety guarantee that unsafe and deadly drugs will remain on the US market.” (Graham 2004).

In a follow-up interview with Dr. Graham, Congressional representatives asked specifically what within FDA needed to be fixed, Dr. Graham replied:

“FDA is inherently biased in favor of the pharmaceutical industry. It views industry as its client, whose interests it must represent and advance. It views its primary mission as approving as many drugs it can, regardless of whether the drugs are safe or needed.” (Carozza 2005).

While such testimony can be viewed as representing only an individual opinion, similar findings were reflected in a US Government Accountability Office (GAO 2006) report that stated:

“FDA lacks a clear and effective process for making decisions about, and providing management oversight of, post market drug safety issues.”

The fallacies of the scientific validity of the US drug approval process is further promoted to the American public in equally infactual ways. In a 2013 article in the Journal of General Internal Medicine, authors Faerber and Kreling, reported that 60% of prescription drug ads and 80% of over the counter drug ads were found to be misleading or false.

The study found 43% of the claims in direct to consumer (DTC) drug ads were “objectively true” while 55% were “potentially misleading” and 2% were “false.” Most DTC prescription drug ads reportedly spend more time on benefits than negative side effects and 84% of regulatory letters sent by the FDA from 1997 to 2006 cited the companies producing those ads for minimizing risks and/or exaggerating effectiveness of drugs.

For example, one study found that although 19% of DTC ads mentioned lifestyle changes as an adjunct to medication, none mentioned them as an alternative to drug treatment (Frosch 2007). Thus, promoting a drug in consumer advertisements as the solution to a specific health problem, rather than emphasizing life-saving lifestyle changes, disincentivized viewers from making healthy lifestyle changes and fostered the belief such changes are ineffective or unnecessary (Shaw 2008).

DTC drug advertisement, which is illegal in most all countries with the exception of the US and New Zealand, rarely focuses on public health messages about diet, exercise, addictions, social issues, and other treatments that may be more cogent to wellness than pharmaceutical interventions (Almasi et al. 2006).

Healthy lifestyle modification can result in fundamental changes in an individual’s health status, is free of side effects, and free of cost. Unfortunately, such practices are very bad for business, which circles back to the economic aspect of American medicine, that it is a business. Unfortunately, what happens in America does not stay in America. The consequences of deceptive drug development and approval practices carries over to other nations.

The relevance of all this to traditional healing practices, especially herbal medicine, is two-fold

1. First is that research, economic, and regulatory agendas are heavily biased to pharmaceutical development based on research findings that are often flawed at best and fraudulent at worst, versus being patient centric and outcomes oriented.
2. Second, no single herbal medicine or collective of herbal medicines in the history of the world has resulted in the magnitude of public harm as drugs such as opioids, Vioxx or Rezulin or the collective of pharmaceutical drugs.

Yet, despite hundreds or thousands of years of clinical and empirical data with herbal medicines, their use is often restricted or limited based on claims of their “unknown dangers” simply because modes of action have not been fully articulated according to modern conventional drug standards.