INTEGRATED MEDICINE: HERBS AND DRUGS
Ranvir Pahwa
Since time immemorial different medical systems have been integrated. Several
systems of Complementary and Alternative Medicine (CAM) integrate herbs and drugs
successfully. Herbs are pharmacologically active natural products and are often taken
with drugs. The chances of interactions are very likely. This article provides information about
the integration of herbs with drugs.
The modalities of modern medicine have resulted in several adverse and toxic side effects. Do we
practice "Do no harm" medicine? Ayurveda recommended this before any other system of medicine.
People are now detouring from modern medicine to find a safer system. Herbs and other CAM modalities
have made a comeback, along with many new sciences. Some of the reasons that prompted people to
look for alternatives are:
(a) Unwanted side effects of drugs
(b) Inability to manage chronic ailments
(c) Surgery was not always successful in improving health condition
(d) Several research studies have proven that CAM modalities are safe and effective
(e) Inclination toward self-healthcare; improvement in diet and lifestyle.
Patients are taking herbs along with drugs because herbs are safer and generally do not have toxic side
effects. There is a dilemma among practitioners as to whether integrated medicine is safe or not.
However, many physicians are cooperating with patients who use these modalities and an increasing
number of physicians want to learn about CAM.For many health problems patients prefer herbs because
they provide benefits that drugs do not, while for other health conditions patients depend on prescription
drugs as the only source of relief. Herbs and drugs can be taken together for certain health problems, but
caution should be exercised when integrating herbs and drugs, just as caution is required when taking
two or more drugs together. There is a lack of research on the interaction of drugs and herbs.
Understanding the pharmacology of drugs and herbs and the mechanisms by which their interactions
proceed can assist in predicting or allowing early recognition of drugherb interactions. It is a vast area but
certain issues and concerns must be addressed. The interactions of herbs and drugs can be categorized
as follows:
(a) Positive interactions: Herbs supporting drug functions
(b) Adverse drug interactions
(c) No interactions
Some common examples of herb-drug interactions are discussed below.
Anticoagulant effects: Butchers broom, feverfew, alfalfa, sweet clover, chamomile, cayenne, licorice,
dong quai, garlic, ginger, ginseng, gingko biloba, and kava kava show an anticoagulant effect. Dosage
adjustment and monitoring of coagulation time are needed when anticoagulant drugs are taken along with
these herbs.
Anticoagulants can also alter the transport of medicine due to low viscosity of the blood. This can hasten
the elimination time or increase the toxic effects of herbs and drugs on the organs and organ systems.
Cardiovascular effects: Hawthorn can be used in mild cardiac insufficiency, mild forms of bradycardial
arrythmias, and to regulate blood pressure. Arjuna, an Ayurvedic herb, has also been reported as good
for treating heart conditions. It is used as a cardiac tonic and for cardiac failure and dropsy. It also
relieves hypertension. Use caution when taking these herbs in conjunction with drugs for cardiac
conditions.
Ginseng may interfere with the action of digoxin. St. John’s wort may increase blood pressure and cause
confusion and drowsiness. Black cohosh may decrease blood pressure.
Diuretic effects: The following herbs possess diuretic action: berberis, corn silk, couch grass, dandelion,
horsetail, parsley, juniper berry, and uva-ursi. Dosages of diuretic drugs should be adjusted when these
herbs are taken. In addition to diuretic properties these herbs have other benefits for which patients are
inclined to take them. For example, parsley is nutritive, dandelion is a liver tonic, juniper berry and uvaursi are anti-infective, and corn silk helps treat incontinence.
Estrogenic activity: Use of estrogenic herbs such as black cohosh, dong quai, chaste berry, red clover,
and wild yam should be monitored in patients taking hormone replacement therapy drugs.
Anti-cold and Anti-cough medicines: Herbal and aromatic oils are sometimes incorporated into cold
and cough medicines. Recently the herb Echinacea has been incorporated into over-the-counter cough
syrup. Echinacea boosts the immune system and is reported to increase T- and B-lymphocytes. It may
have positive effects after chemotherapy also. Echinacea may show adverse effects in patients with
autoimmune disorders and it may negate the effects of immunosuppressants such as cyclosporine.
Miscellaneous:
(a) Patients undergoing surgery have possible risks if taking the herbs mentioned above that affect
coagulation time
and blood pressure. In addition, licorice may cause hypokalemia.
(b) Uva-ursi may interfere with the absorption of several alka loid drugs.
(c) Tannic acids in St. John’s wort and Saw Palmetto may inhibit iron absorption, undermining the
benefits of prescribed anemia drugs.
(d) Ginseng may cause headaches, tremulousness, and manic episodes if taken with the antidepressant
phenelzine sulfate.
(e) Milk thistle has been reported to reduce and prevent toxic side effects in the liver caused by drugs.
There are no reports of adverse interactions for many herbs, however caution should still be exercised.
Caution should also be exercised in prescribing herbs during pregnancy.
Other valuable suggestions:
(a) Do liver and/or kidney function tests before, during, and after the use of herbs to check for any toxicity.
(b) Herbal energetics: Western herbal formulas are not based on the energy principles of combining
herbs as inAyurvedic and Chinese medicine. Combining herbs without the knowledge of their energy can
lead to toxic side effects. Recently a formula for postmenopausal syndrome that contained all the
available estrogenic herbs caused severe diarrhea (personal communication).
(c) It is important to know that herbs can interact with other herbs in the same way that drugs can interact
with other drugs. The chance of interactions is enhanced by the purchase of over-the-counter products by
people who are not knowledgeable about herbs. Healthcare practitioners are responsible for finding better
and safer ways to integrate medicine and must exercise sound judgment in this area. We encourage
healthcare providers to expand their knowledge of herbs through education courses and thereby prevent
unintended interactions.
Healthcare practitioners are responsible for finding better and safer ways to integrate medicine and must
exercise sound judgment in this area. We encourage healthcare providers to expand their knowledge of
herbs through education courses and thereby prevent unintended interactions.
AAPI (USA), May/June:34-35, (2004)
Dr. Ranvir Pahwa is an Ayurveda Practitioner, Clinical Herbalist, Homeopath, Acupuncturist
(Body and Auricular), Holistic Nutritionist and Toxicologist. He is a consultant, natural medicine
practitioner, researcher, writer, and author and has presented seminars and lectures on various
alternative complementary medicine topics. He has written over 24 articles and research papers
and two books: (1) Home remedies from India, and (2) Healthy Cooking. He has about 32 years
of experience in Human health. He is a professional member of various natural medicine
associations across North America.
rpahwa@sasktel.net / ranvirp@gmail.com; www.rpsalthealthcentre.com