There are many approaches to herbal medicine available in the marketplace. Traditional Chinese Medicine (TCM), Ayurveda and Western Herbalism are the more popular choices. In this article (part I) we’ll focus on homeopathy, naturopathy and traditional herbalism. While these approaches have some similarities, they also have differences both in the principles that guide them and to the extent they have re-established themselves in this country. TCM and Ayurveda evolved along with their respective civilizations. Homeopathy and Naturopathy were created as a reaction to the standard medical practice of the day. We’ll look at that more in part II. Understanding the differences and knowing a bit of history can help put the current marketplace into perspective and assist consumers in making choices.
Homeopathy was founded by Samuel Hahnemann (1755-1843) in Germany. He was a trained doctor who took issue with the extensive use of blood-letting, cathartics and blistering medicines that was the traditional treatment of that time. Through his own experimentation he developed the principles of homeopathy, which are:
- Like cures like – This principle relates to symptoms. Let’s say an herb is given to a healthy person and they experience shivers and a raise in body temperature as a result. The theory of “like cures like” then says that this same herb can be given to a sick person who is experiencing the same symptoms that the herb produced in a healthy person.
- Minimum dose – The least amount of medicine needed to cause a beneficial effect in the patient should be used. Most homeopathic medicines are diluted until there is no detectable trace of the medicine. It is believed that this reduces or eliminates side effects while still allowing the medicine to be effective. Needless to say, this is a very controversial principle of homeopathy.
- Single Remedy – Only one medicine is given at a time. This is to eliminate the potential for the interaction of multiple medicines given to a patient and allows the practitioner to more accurately track the progress of the patient.
- Patient/medicine totality – A long interview is conducted in order for the practitioner to collect as much detailed information as possible from the patient. The totality of patient symptoms is then matched to the symptom profile of the potential medicines to be used. This specific matching may mean that two patients with the same illness may receive different treatments.
In the U.S. there are no states that offer licensing for homeopathic practitioners. There are three states that do allow licensed medical and osteopathic doctors to practice homeopathy (DHt means they are certified by the American Board of Homeotherapeutics). In states that license naturopathic doctors, those practitioners sometimes include homeopathy in their treatment routine (DHANP means they are certified by the Homeopathic Academy of Naturopathic Physicians). In states where there is no licensing of homeopathic practitioners, anyone can call themselves a homeopath. There are people who are considered “lay” homeopaths. Often they take certain classes and they can gain the certification of Certified Classical Homeopath (CCH) from the Council of Homeopathic Certification. However, “certified” does not equal “licensed.” These practitioners will be limited in what they can do so that they wouldn’t be charged with practicing medicine without a license.
Because there is a range of types of homeopathic practitioners, a typical visit may vary from one to another. One thing they all should do is conduct a detailed interview with the patient about their health and their health issue. Those that are licensed to do so will conduct a physical exam and may order laboratory and diagnostic studies. The practitioner will monitor the progress of the patient and make any adjustments as needed. Treatments are meant to support the healing powers of the body.
Many homeopathic medicines come in small round pills that are made from plants and/or minerals and water and/or alcohol. Some medicines may contain lactose, so those with lactose intolerance will want to make that clear to the practitioner during the interview. The medicines come in various strengths or potencies usually denoted with a number and the letter “c,” such as 6c. The lower the number, the lower the potency.
There are some homeopathic drugs that are recognized by the FDA and sold over the counter. These can be identified in the information panel on the label. Under the “drug facts” heading is the list of active ingredients. Any homeopathic drug will be followed with an “HPUS.” There should also be a statement following the list of active ingredients that says, “This ingredient is included in the Homeopathic Pharmacopoeia of the United States (HPUS).” These drugs are regulated by the FDA but not to the same degree that pharmaceutical drugs are. In fact, the FDA recently revisited the regulation of these drugs to see if changes were warranted.
There is the Accreditation Commission on Homeopathic Education in North America that sets standards for homeopathic doctoral schools. This can be used as a resource for consumers who are researching a practitioner.
Naturopathy was introduced into the United States at the beginning of the 20th century. Benjamin (Benedict) Lust (1872-1945) is considered to be the “father of Naturopathy” although the decision to bring this practice forward came from a meeting of Kneipp practitioners (followers of Father Sebastian Kneipp). It was a combination of physiotherapy, nutritional therapy, psychology, homeopathy, herbal medicines and other therapies.
There are six principles for naturopathy. The following is the description of them from the American Association of Naturopathic Physicians.
- The Healing Power of Nature (Vis Medicatrix Naturae): Naturopathic medicine recognizes an inherent self-healing process in people that is ordered and intelligent. Naturopathic physicians act to identify and remove obstacles to healing and recovery, and to facilitate and augment this inherent self-healing process.
- Identify and Treat the Causes (Tolle Causam): The naturopathic physician seeks to identify and remove the underlying causes of illness rather than to merely eliminate or suppress symptoms.
- First Do No Harm (Primum Non Nocere): Naturopathic physicians follow three guidelines to avoid harming the patient: Utilize methods and medicinal substances which minimize the risk of harmful side effects, using the least force necessary to diagnose and treat; Avoid when possible the harmful suppression of symptoms; Acknowledge, respect, and work with individuals’ self-healing process.
- Doctor as Teacher (Docere): Naturopathic physicians educate their patients and encourage self-responsibility for health. They also recognize and employ the therapeutic potential of the doctor-patient relationship.
- Treat the Whole Person: Naturopathic physicians treat each patient by taking into account individual physical, mental, emotional, genetic, environmental, social, and other factors. Since total health also includes spiritual health, naturopathic physicians encourage individuals to pursue their personal spiritual development.
- Prevention: Naturopathic physicians emphasize the prevention of disease by assessing risk factors, heredity and susceptibility to disease, and by making appropriate interventions in partnership with their patients to prevent illness.
The initial visit to a naturopath includes a long interview to allow the practitioner to learn about the patient’s health issue, their lifestyle, and general physical, mental, emotional and spiritual health. In states where the naturopath is licensed to do so, they may order certain lab tests and perform a physical exam. From that point forward, the patient goes in regularly (one a month or so) to allow the practitioner to monitor the progress and make adjustments to the treatment as needed.
Treatments can include diet recommendations, supplements, herbal medicines, homeopathy, exercise, mental health recommendations, etc. In states where the naturopath is licensed to do so, they can perform minor surgery. Purpose of treatment is not just to relieve symptoms but to find and treat the cause of the health issue by supporting the body in healing and rebalancing itself. Each treatment is personalized to the individual. The patient is expected to take an active role in following the recommendations in trying to bring the whole body back into balance.
Naturopaths are licensed to practice in Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Hawaii, Kansas, Maine, Maryland, Minnesota, Montana, New Hampshire, North Dakota, Oregon, Utah, Vermont, and Washington. As with homeopaths, in states where naturopaths are not licensed, anyone can call themselves a naturopath regardless of training.
The American Association of Naturopathic Physicians (AANP) is a professional organization for naturopathic doctors (ND or NMD). They have a search function in order to find a ND in your area. There is the Council on Naturopathic Medical Education which is the accrediting agency recognized by the U.S. Secretary of Education. The Association of Accredited Naturopathic Colleges (AANMC) maintains a list of naturopathic colleges that have been accredited by the U.S. Secretary of Education. Consumers can use these resources when researching about naturopaths in their area.
Traditional herbalism has existed in the world as long as humans have. It is a common story that humans gained some of their understanding of what herbs to try by watching what other animals ate. It was the main medical treatment until alchemy came onto the scene in the 13th century, and has continued to some or another degree through present day. The World Health Organization estimates that 80% of people in the world use herbal medicine for at least part of their health care.
There are different degrees of herbalists from ones who are self-taught to those who apprentice with an experienced herbalist to those who study at an institution and receive clinical training. Practitioners of TCM, Ayurveda, homeopathy, naturopathy and any practice that uses plants and plant extract therapeutically are considered herbalists. Herbalists can range from someone’s grandmother to your medical doctor. Because of that, there isn’t an official collection of principles that all herbalists adhere to like with the homeopaths or the naturopaths. In general, herbalists have a love and respect for plants, the environment, and the relationship between plants and humans. Some herbalists believe in the spiritual life and power of plants. Herbalists use herbs to help support the body and its healing powers.
Herbalists are not licensed in the U.S. outside of TCM, homeopathy, naturopathy, etc. Therefore, they cannot perform physical exams, order lab tests, give injections, perform surgery, etc. unless they are otherwise licensed to do so (e.g. as a medical doctor, naturopathic doctor, etc.). Practicing herbalists must be aware of state regulations for medical practitioners in order to avoid being charged with practicing medicine without a license. Because herbalists are not licensed, anyone can call themselves an herbalist.
A visit to an herbalist can involve a lengthy interview with the individual about the health issue, general past and current health, lifestyle, diet and any other factors related to the health issue. Herbs are recommended and can come in all types of form – teas, raw herbs/capsules, tinctures, creams/ointments, etc. – along with instructions of how and when to take/use them. Dietary and other lifestyle changes may be recommended too.
The American Herbalists Guild is the professional organization for herbalists. They have a code of ethics that each member is expected to follow. They provide continued training resources for their members and help facilitate mentorships. A Registered Herbalist (RH) is one who has registered with this organization. In terms of educational institutions, there are many herbalism schools; some are online or correspondence courses. There doesn’t seem to be an accrediting agency for herbal education institutions that fall outside of the naturopathy/homeopathy world.
So What’s a Consumer to Do?
While a consumer’s first introduction to the therapeutic use of herbs may be supplements on a store shelf, there is a lot more to herbal medicine for consumers to consider. Knowing what the options are and understanding the principles of each practice can broaden the herbal consumer’s world.
In sorting through the options, it’s valuable to understand the difference between “licensed” (overseen by a regulatory body, typically a state government) and “certified” (usually provided by a professional organization which sets their own standards and oversees their own process.) If you are looking at adding a practitioner to your health care repertoire, take the time to check out the licensing requirements for your state, the school(s) the practitioner has attended and any other credentials they have. It will be up to you what level of training you are comfortable with in your potential practitioner.
Due to licensing limitations and the fact that many of these practices have been building or re-building their education and accrediting structures over the past few decades, the actual number of practitioners in a given area may be small. In addition, not all practitioners will belong to their professional organizations and there is no requirement for them to do so. If you do a search and don’t come up with any results, there may still be practitioners in your area. You’ll just need to do a little more digging.
If you do add a practitioner to your health care team, let your primary care physician (PCP) know (if you have one) along with any supplements, medicines, dietary or exercise changes, etc. that you are doing. Sometimes a consumer may be hesitant to let their PCP know for fear of a negative reaction. In my experience so far, it has been a mix of benign indifference and distant respect. As herbal medicine becomes more integrated into our health care and culture, that relationship may improve. That’s why having informed herbal consumers is important. Remember that you are a health care consumer as well as an herbal consumer. You have every right to make health care decisions for yourself, and you deserve doctors and practitioners who want to be in active partnership with you.
Links to Learn More
University of Maryland Medical Center website – Naturopathy
National Center for Complementary and Integrative Health website – Homeopathy
Dr. Weil’s website – Herbal Medicine
Consumer Healthcare Products Association website – FAQs about Homeopathic Medicine
U.S. Food and Drug Administration website – Complementary and Alternative Medicine Products and Their Regulation by the Food and Drug Administration