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Polypharmacy

The philosophy behind the basis of herbal medicine

Polypharmacy is the use of more than one ingredient in a medicine. Modern medicine does not in the main use polypharmacy as most drugs contain a single active ingredient. Herbalists will maintain that it is this single element philosophy which is responsible for many of the side effects and adverse reactions common in modern medicine. Polypharmacy by contrast is the very essence of herbal medicine philosophy where combinations of plants are used, each having different compounds as well as individual properties. It is this combination of complex compounds within each plant which complement and balance the effects of another. Mary Boughton of Dorwest Herbs explains.

Herbal medicine throughout the world has almost without exception meant the combining of two or more herbs, with some formulations containing more than a dozen different plants. However, even single plant medicines are considered by herbalists to be polypharmacy. The basis for this is that a single plant may contain hundreds of different chemical compounds, no plant or other living thing could survive if it were composed of a single chemical entity.

Modern medicine by contrast is either produced by development of a synthetic chemical ingredient or by identifying and extracting a specific active compound from a plant and then producing it synthetically to obtain a 'pure' form of the entity which has the desired pharmacological effect. In herbal medicine it is accepted that, even if a specific compound is identified and its action understood, it is the effect of the other supporting or modifying compounds present in the whole plant which complement the therapeutic action and minimise side effects and adverse reactions in herbal medicines. Therefore an isolated chemical compound would never be considered herbal medicine.

The British Herbal Pharmacopeia contains monographs of medicinal herbs in modern use in medicines today and we can see that many of these have similar pharmacological effects, indications and uses, so why is it necessary to include several in one product?

Polypharmacy again is the answer
Although several plants will have similar therapeutic effects the chemical compounds in each one will be different and it is this diversity that is the very strength of herbal medicine. In simple terms, one compound has an effect and another, either within the same or a different plant, will have a supporting effect which might for example balance any side effects or increase absorbtion into the system.

There is, of course, a correlation between polypharmacy and food. Every food that is consumed consists of many and complex chemical compounds and no-on would put forward a sound argument in support of foods being taken as single chemical entities. Complex foods are nutritious, health giving and totally beneficial. Nutritionists advocate a varied balanced diet for good health both in animals and people. A comparable situation exists with herbal medicine and it is this very use of combination products which are not at variance with nature that explains why herbal medicines maintain all round health and are effective safe treatment for many problems.

This comparison with food is very relevant as the other important factor in herbal medicines is that like foods they are based on organic plant materials, which are more readily assimilated into the system than inorganic compounds. It is for this reason that although the individual quantities of elements, such as minerals, in an organically based product may be very small, they are more readily absorbed and able to be used by the body than a much larger quantity of the same mineral that has been derived inorganically. An example of this is calcium - nearly all of the calcium obtained from milk or cheese is able to be used by the body whereas only a fraction of an inorganic calcium, such as the commonly available calcium carbonate is absorbed with the remainder being excreted. Calcium is also only absorbed efficiently when Vitamin D is present which is the reason for most supplements having this added to the product. Thus it is irrelevant to make a direct correlation between the quantities of any particular ingredient in an inorganic form and the quantity occuring naturally from an organic base. It is the amount that is able to be used that is important.

Polypharmacy is therefore the basis of herbal medicine philosophy and explains why this form of medicine depends on complex chemical compounds that naturally occur and perhaps why it is this very combination that makes it a safe form of treatment for animals and people alike. 

If it is natural it must be good?
In these days of green consumerism and environmental awareness, anything natural has come to be perceived as good and by implication safe for people, animals and the environment.

But how many times does one hear someone make the mistake of assuming that because something is natural it must be good and also be safe ? It is of course a common fallacy but one which is widely held. Many of the most toxic and dangerous substances known to man are natural but most would agree that they are not what we would generally accept as safe. Arsenic and lead from the mineral kingdom and yew berries, death cap mushrooms and foxgloves from the plant world are all natural but also all good examples of this. However, many more common substances are very toxic when taken to excess; alcohol, coffee and even water will kill if large enough quantities are consumed.

So are all herbs and herbal medicine safe?
The correct definition of a herb is a plant whose leaves are more aromatic than its flowers, although nowadays all plants which are used medicinally are commonly referred to as herbs and the general supposition is that they are all safe. Certainly those available for general sale are accepted as having a low toxicity whereas others such as digitalis or opium poppy are very strictly controlled under the poisons regulations. Every medicine is evaluated in reference to its "risk/benefit" ratio, thus those drugs with a high risk of toxicity or side effects must also have proved evidence of an expected high benefit to the user in order for the risk to be acceptable. All herbal medicines licensed for general sale for animal treatment are generally used for chronic or non-life threatening conditions. They will have a low risk of side effects or adverse reactions, but they will be just as effective although their benefits are generally more moderate in effect as they work in harmony with the whole system. 

Nevertheless it is important that any medication given to an animal, natural or otherwise, is appropriate for it and this usually means that it must have been formulated for that specific animal and have withstood the test of time - a very long time in the case of herbal medicine which has been used for centuries by all civilizations. Some people will unthinkingly give their animals medicines or supplements that were formulated, manufactured and tested for treating people without giving proper thought to the possible consequences. They believe that "if it's pure enough for me it must be the best possible for my dog or cat". This of course is a totally false and potentially dangerous belief and one that can have dire consequences. The commonest and most widely used human medicine, aspirin, is fatal for example if given to a cat. Yet many people continue to give human medicines and supplements to their animals convinced that they are giving them the best, when commonsense should tell them that people have a much bigger body mass and longer life span than most domestic animals and that their digestive systems and metabolism are entirely different. Unfortunately some manufacturers who are inexperienced in canine nutrition and treatments actually perpetuate this myth by using this 'human quality' tag to endorse their products.

To return to the 'natural' theme, it is definitely true to say that the herbal medicines that you can buy for your dog are safe to use, have minimal side effects and are effective in their actions. The product would not have obtained a licence if the data supporting it was unable to prove all of these things. Nevertheless, it is worth bearing in mind that anything that you give to your dog or cat should have been formulated especially for them, manufactured by a reputable company, and given in the recommended quantities. Of course some human medicines and supplements can be given to other species but this should only be done on veterinary advice or under veterinary supervision.

There are under 30 licensed herbal veterinary medicines in the UK and these are manufactured by just a few companies, who have been specialising in herbal medicines for many years. The major manufacturers have advisory services either by telephone or through their stands at major Championship shows so that product information, assistance and advice on the use of these medicines is always available from trained and experienced personnel.

To sum up - not everything that is natural is by definition safe, but the herbal medicines available in this country for dogs and cats are extremely safe with almost no recorded side effects and most can be given in conjunction with orthodox treatment if necessary. Many herbal medicines use quite common herbs and plants, often using extracts of the individual herbs in order to obtain the correct strength for a small animal in a single tablet. The majority of herbal supplements which are available will have been carefully formulated and produced for dogs by experienced manufacturers and these are also excellent to maintain general health when they are given in the correct quantities.

So by using your commonsense and being discerning in your choice, you can safely use all the herbal medicines available for dogs today. These together with quality supplements will make an important contribution to your dog's condition and well-being. They give the benefit of the oldest form of treatment, and one upon which all modern medicine has been based. It may be natural but in this case it is also safe !

How do herbal medicines work? Should they be called alternative?
As with many seemingly straightforward questions, there is more than just a simple answer to this often asked question. The easy response is that herbal medicines work in exactly the same way as modern medicines, but rather than being regarded as an alternative form of treatment they are complementary and can and should be used alongside the advances made in modern drug therapies. To understand why they still have relevant use today requires a longer explanation as well as a little history and background information.

For some reason many people confuse herbal with homeopathic medicine and some presume that they are the same, so we should start with an explanation of the difference. Homeopathic medicines are derived from a much wider range of ingredients than herbal medicines - using material of animal, vegetable and mineral origin. Minute dilutions of the active ingredient are used, which if they were introduced into the system at their full strength would actually cause symptoms similar to that from which the patient is suffering. However, when administered in these infinitesimal amounts they actually work in the opposite way and relieve the symptoms. This is where the homeopathic philosopy of 'like cures like' originates.

By contrast herbal medicine works in the same way as modern medicines, that is that herbs contain elements which have a direct psyiological effects on the body.  Virtually all medicines were originally based on herbs and plants. Herbal medicine has a long and well documented history. Until about the turn of the century these were almost the only medicines available, with the birth of 'modern' medicine being generally accepted with the discovery of modern antibiotics.

Nowadays, a great many of the medicines used by doctors and vets are still derived from plant material or are a synthetic copy of them. The plant is either purified to obtain a standard dose or more commonly the element in the plant that causes the active effect is isolated and then produced in a laboratory. The best example of this is aspirin which was originally derived from White Willow Bark but is now produced artificially to ensure a standardised strength and to satisfy the enormous demand. There are many similar examples of drugs from plant origins now being produced synthetically.

However, the effectiveness and administration of medicines made directly from plant material depends on many factors - it is obviously essential to be able to correctly identify the correct species of plant not only while it is growing but also in its dried form before it is incorporated into a medicine. Many herbs have a similar appearance when dried and therefore reliable ways of identifying them have had to be developed. The country in which the plant was grown, the soil and fertilisers used as well as the way it was harvested, dried and stored will all effect the final medicine in which it is used.

Therefore, when technology was able to produce drugs artificially by copying or mimicking the elements found in plants, it became unfashionable to use the raw plant material which was considered unreliable. The advantages of using a synthetically produced drug are obvious - firstly it eliminates any variation that may be in different batches of plants, it removes the possibility of contamination during the harvesting and drying processes, enables accurate administration of the dose and is extremely cheap to produce.  During this century continued and expensive research continues to produce the single element drugs which are now as commonplace as the plant derived drugs.

Unfortunately, with the advent of these artificially produced drugs came the increased incidences of adverse reactions and side-effects, something which had hitherto been relatively rare. Nevertheless because many of these drugs are used for acute life-threatening conditions the 'risk-benefit' ratio makes them acceptable to the medical profession, whereas for the less critical and chronic problems these risks are not always so acceptable.

It is here that the difference between herbal and allopathic medicine really lies. The whole philosophy of herbal medicine is that by using the whole plant, and often a combination of plants, the patient is taking a mixture of thousands of naturally occurring complex elements which are contained in each plant. It is the presence of all these elements which complement and balance the effect of each other, and this results in the extremely low incidence of adverse reactions and side-effects in herbal medicines compared with single element drug therapies. As the actions of the individual herbs has been well documented over hundreds and sometimes thousands of years they risk of long-term side effects are also negligible.

The action of herbs may sometimes be slower than the modern drugs that we have all become accustomed to using, but the advantage of fewer side-effects and of using a holistic medicine which works in a more natural way with the body makes this form of medicine very useful and the increasingly the preferred one for the treatment of many conditions, particularly the chronic and non-life threatening diseases.

There is a misconception among both the medical profession and the public that those who advocate the wider use of herbal medicine completely disregard the advances in modern medicine and will use herbal medicines as an alternative form of treatment regardless of the disease or condition. This is obviously a nonsense - nobody would presume to ignore the need for sugical operations when required or to dismiss the plethora of modern drugs that are regularly and effectively used for conditions where no botanically produced alternative is available. However, herbal medicine has its place alongside modern medicine for the treatment and prevention of many chronic conditions. Many doctors and vets are now recognising this and are becoming more and more reluctant to prescribe drugs for problems where a more gentle but just as effective treatment is available and the risk of side-effects therefore reduced.

It is also sometimes said that the results obtained from herbal medicines are psychosomatic, another misconception - herbs are widely used for treating animals all over the world and no psychosomatic effect can be responsible for the results, making the treatment of animals a particularly valuable source of clinical data and information on herbal treatments.

Of course, it is because the side-effects are minimal and instances of adverse reactions are few that herbal medicines are also regarded by some as always being safe to take. While this is broadly true for most commonly available herbs, it must be remembered that they are proper medicines and as such should be treated with respect. Anything taken to excess or inappropriately can be detrimental and therefore it is sensible to use the same precautions when using herbal medicines as any other form of medical treatment by always using medicines manufactured to the highest standards and wherever possible those licensed by the appropriate government regulatory authority.

Because herbal medicine is still regarded as being old-fashioned it is wrongly assumed that no advances have been made. However, in the same way that modern medicine has progressed over the years, herbal medicines too have been the subject of much on-going research. More is known about how they work, methods of accurate testing have been standardised and the quality and safety of modern herbal medicine is now greater than it has ever been in its long and illustrious history. The licensing system for all medicines ensures that the same standards of quality and safety are applied to herbal medicines as any other medicine, with the important exception that herbal medicine manufacturers are not required to undertake any animal testing procedures on their products and this is something that is reassuring for the many people who are concerned about the animal testing methods used to establish safety standards for modern drugs.

With the advent of the British Herbal Pharmacopoeia for identification purposes and the strict quality and safety procedures used today herbal medicines are more than ever appropriate for use alongside modern medicine and in the future will be more widely available as a first choice for the treatment of a whole range of common conditions.

Most clients nowadays appreciate the limitations but are willing to use a gentler form of medicine if it is appropriate and available. The veterinary practice is surely the place to regain the wealth of natural medicines which have been ignored to general practice in the last fifty years. There may only be a small number of these licensed herbal medicines but they have a relevant place and provide an additional method of treatment for both the client and the professional alike.

Many more veterinary surgeons now refer animals with chronic conditions for treatment with herbal medicines and although the results achieved are often slower than with stronger drugs, they are effective, rarely cause adverse reactions or show any recorded long term side-effects. Perhaps it is time that the veterinary profession considered becoming more knowledgeable about botanic medicines and use them in practice where appropriate ?

Herbal medicines are mainly used for chronic and non life threatening conditions whereas many drugs are developed specifically to treat critical and/or serious diseases. To make this direct comparison therefore is similar to trying to make a comparison between surgery and physiotherapy - surgery would be essential for appendicitis for example, whereas physiotherapy would be totally ineffective. It therefore depends on the condition and the severity of it as to which form of medicine is appropriate to be used to treat any given condition.

The subject of herbal medicine, particularly that used for animals, is a very complex one and I do not know how much you already know about it, but perhaps the following general information will be helpful to you.

There are no veterinary surgeons in the UK who use herbal medicines exclusively, although many homeopathic veterinary surgeons also use herbal treatments. Nowadays there are a growing number of the more orthodox veterinary practitioners using herbal medicines in conjunction with other treatments. This seems the most acceptable and sensible way for herbal medicine to be used - as another form of treatment to be used when appropriate for the condition presented. Veterinary herbal medicines are licensed in the UK by the VMD (Veterinary Medicines Directorate) which is a government agency associated with MAFF. There are only 26 herbal veterinary medicines which are licensed in the UK, the remainder of 'herbal' products being sold as food supplements and not to treat medical conditions.

We manufacture and supply a veterinary herbal medicine which contains both Damiana and Kola and we can therefore give you the following answers to your questions regarding this particular medicine.

  1. The species of the two herbs used are: Damiana [dried leaves and stems] (Turnera diffusa), Kola [dried cotyledons] (Cola nitida or Cola acuminata).
  2. The indications for this medicine are - "A traditional herbal remedy for the symptomatic relief of problems associated with lack of alertness and stamina in dogs  and cats. An aid to vitality for stud males and also racing and working dogs."
  3. It is not common practice to assess one medicine's efficacy by comparison to another so we are unable to answer this question. Clinical trials are not required to be carried out on herbal medicines as the efficacy of the product in proved by traditional use supported by bibliographic evidence.
  4. The most common advantage of herbal medicine over conventional medicines is the very low (usually neglible) incidence of adverse reactions (side-effects). However, they also generally have a slower or less dramatic effect than drug based therapies.
  5. There is no such thing as an 'animal herbalist'. Only veterinary surgeons may treat animals that are not their own. Many veterinary surgeons use herbal medicines in conjunction with, or as an alternative to, orthodox treatments. However, most herbal medicines are sold to individual animal owners as 'over the counter' (OTC) medicines.

by Mary Boughton of Dorwest Herbs

Member of NOAH’s Companion Animal Sub-group

and the British Herbal Medicine Association's Veterinary Committee