Herbal medicines with judgement: Natural does not mean harmless

What it is

A medicinal plant can reach the counter in three very different forms: as an authorised herbal medicine, as a traditional herbal medicine (a simplified registration based on decades of use) or as a food supplement. The first two have quality, indication and dosage reviewed by the medicines agency; the supplement does not, and it may not claim to treat or prevent a disease.

The European reference is the set of monographs from the Committee on Herbal Medicinal Products (HMPC) of the European Medicines Agency. They separate "well-established use", backed by clinical trials, from "traditional use", which rests on accumulated experience and plausibility rather than trials. Knowing which box a plant is in is the first step to recommending it honestly.

Three questions before recommending a herbal product

In this order:

WHAT ARE THEY ALREADY TAKING? Plants interact too. St John's wort, for example, reduces the effect of anticoagulants, hormonal contraceptives and many other medicines.
WHO WILL TAKE IT? Pregnancy, breastfeeding and children are almost always "not recommended for lack of data". It is not a formality: not knowing whether something is safe is not the same as knowing it is.
WHICH PRODUCT IS IT? The same plant name can be a studied standardised extract or a powder of unknown quality. The evidence belongs to the specific extract, not to the plant in general.

At the counter

When to recommend it

Mild, self-limiting symptoms, with a product of known quality
When the person prefers a herbal option and there is no interaction or contraindication
As a complementary measure, explaining what to expect and how soon
With a clear time limit to come back if it does not help

When not to

Pregnancy, breastfeeding and young children without safety data for that plant
To replace a prescribed treatment or delay a necessary consultation
Alongside narrow-margin medicines (anticoagulants, antiepileptics, immunosuppressants) without checking the interaction
With red-flag symptoms, which do not belong at the counter

What to say at the counter. Always ask what else they take, including "natural" products they do not think of as medicines. And say out loud what to expect: a traditional herbal medicine relieves mild symptoms; it does not cure diseases.

Warnings

Important Natural does not mean free of interactions: St John's wort is the classic example and reduces the effect of many medicines, including oral anticoagulants.
Important A food supplement does not have to prove efficacy, and its quality is not reviewed by the medicines agency.
Caution Before surgery, the person should tell the medical team which herbal products they take: some increase the risk of bleeding.
Caution Adverse reactions to herbal products should also be reported to the national pharmacovigilance system.
Worth knowing Quality varies widely between products with the same plant on the label.

How to read a herbal product

Check the pack: a medicine carries a registration number; a food supplement does not.
Look at the plant part and the type of preparation: root, leaf, flower; dry extract, tincture, powdered herb.
Check the dose against the European monograph, not against the product's advertising.
Set a time limit: if there is no improvement in the expected time, the symptom needs a consultation.

Traditional herbal medicine vs food supplement

Aspect	Traditional herbal medicine	Food supplement
Who reviews it	The medicines agency	Food safety authority (notification)
Can it claim to treat a symptom	Yes, the authorised indication	No
Quality and dose	Reviewed and fixed	Set by the manufacturer
Leaflet listing interactions	Yes	Not mandatory
Basis of the indication	Documented traditional use	Permitted health claims

With the same plant on the label, the traditional herbal medicine offers reviewed quality and dose; the supplement does not necessarily.

Self-assessment

Three questions. When you check your answers you will see the explanation for each one.

What separates "traditional use" from "well-established use" in the European monographs? Traditional use rests on experience of use, not on clinical trials Traditional use is more effective They are the same thing under different names
A pregnant woman asks about a plant whose monograph says "not recommended for lack of data". What does that mean? It is banned because it is toxic It is not known whether it is safe, so it is not recommended It is safe because no problems have been described
What should you always ask before recommending a herbal product? What other medicines and products they take Their favourite brand Whether they prefer capsules or tea

Training content. It does not replace the summary of product characteristics or clinical judgement.

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