Herbal Medicines and Dosage Forms...

I think that it is important to deal with dosage as far as it applies to herbal medicines in it's various forms.

It is true that the public may be led to believe that one can buy an herbal medicine over the counter (OTC) and follow the dosage as described on the container. This can not only be ineffective, but outright dangerous! How can that be if it's a natural, herbal preparation? Surely it has to be harmless? I hear these statements made far too often and it is sad, to say the least. No person knowledgeable in herbology would take a non-homeopathic strength tincture of Belladonna or Digitalis, for instance, unless they were suicidal and no longer wished to live. Yes, these two examples are very important herbal preparations, with very clearly defined clinical uses like heart failure, as is the case with Digitalis, but deadlier than the uninformed person on the street could ever imagine. It is for this reason that these medicines can only be taken under the very strict supervision of a licenced health care professional. Luckily, in South Africa and most countries, you cannot buy full strength tinctures of these two herbs over the counter, but there are other herbal preparations which you can buy over the counter, but which should really only be taken under supervision of a herbal practitioner who understands how they work and what dangers, side effects, contraindications etc. they may carry. I've also heard medical practitioners say to patients:"Oh, you don't need to worry if you take herbal medicines or supplements with such-and-such prescription drug. It won't do anything with the drugs I've prescribed - IT'S ONLY HERBS". This is absolutely dangerous! A good example is taking the herb St. John's Wort (Hypericum perforatum), which can be bought in supermarkets these days, while you are on a certain class of drug called a monoamine oxidase inhibitor. Please, just don't ever do it!

On the flip side, we have the opposite problem:
Usually, by law, herbal preparations, especially tinctures, have dosages that are far below the therapeutic dose. Most OTC tinctures are a 1:10 preparation, which is a very weak titration by clinical herbal medicine standards. Some of these preparations that I have come across have a dosage of 10 drops of tincture per dose, which is way below the therapeutic dose of most herbal medicines, which would normally be around the 5ml (or higher) mark for a preparation of this low strength. Therefore the suggested dose is sub-therapeutic and sub-clinical and may not bring about the desired effects. This is purposefully done by the manufacturer to protect the patient from overdosing. The patient then underdoses himself and his disease may progressively get worse. He is then convinced that herbal medicines are useless and loses faith in them. His disease may progress to a very dangerous stage. An herbologist would usually prescribe a stronger tincture and adjust the dose according to the underlying disease and other factors taken holistically. Moreover, one dose does not fit all as we are all of different constitution, weight, height, build, etc. and an adult dose may differ from one person to the next. Dosage for the young are even more of a problem and qualified herbalists use a specific formula to calculate it.

There are some patent herbal medicines with a fixed dose and these can be trusted because they have been subject to clinical trials and the dose has been scientifically determined. This is not the case with over the counter preparations, which differ in strength from one manufacturer to the next. A dispensing herbologist will be able to control the dose accurately as the medicinals he dispenses to you will be well known to him and will usually be of a much higher quality and strength than an over the counter preparation.

Finally, herbal medicines may be natural, but that does not mean that they are completely safe and without side effects and contraindications. They should still only be used under the supervision of a qualified herbal practitioner - especially if you are on other medications. Certain combinations of herbs with prescription drugs can be fatal! So be warned.

In conclusion, please consult with a qualified herbologist before just self-diagnosing and treating conditions with OTC herbal preparations.

Yours in Health,
J Jackson, DHerb. (cand), MHONERI(SA)