it is found that most of the polyherbal dosages are generally used in decoction state and so it could be predicted that in decoction there may some chemical interaction take place among the natural constituents existing in the component herbs which increases the modulatory effect. 

Dosages of individual herbs can be lower, reducing risk of unwanted effects.

A medicinal may have multiple active constituents. Active constituent in the poly -herbal combination act as synergistic manner. so best combination of poly-herbal combination provide higher activity against a disease. Also, poly-herbal formulation having multiple types of molecules against a disease/complication so different molecules cure a disease by different mechanism so provide a complete therapy against a disease condition.

@ B. Tiwari,

The combination of different herbs may increase the medicinal potential of a chemical substance of interest present in individual herbs. 

Some herbs reduce toxicity of other more potent herbs in the mixture, reduce side effects, remove or mask unpleasant taste, improve colour produce synergy, improve solubility and absorption and in tandem, they have multiple targets, not only treating the diseases but improving the general well-being of the person e.g. boosting the immunity, improving appetite, eliminating body weakness or lethargy. Some traditional healers i know of actually add many more herbs to disguise the real identity of their herbal formulation etc

No disease has just one single symptom. Also in the pathogenesis of a disease many different factors or at work. The common cold causes cough, headache, runny nose, nausea, fatigue...to name a few symptoms. Like wise, we need different medicines (plants)  to resolve the various signs and symptoms of a disease.The various plants in a polyherbal medicine may:

increase the effectivity and potency of the formulation,                                                           reduce unwanted effects,                                                                                                             make the formulation more palatable,                                                                                       increase its life-span.....

In fact, we can compare them to the various ingredients of a an allopathic drugs like the binders, the stabilizers..etc....But unlike, them all the herbs in a polyherbal formulation are active and have their own effect.

i do agree with all the above said by eminent personalities along with that i just want to add one more point that in a poly herbal combination of medicines some herbs are added to reduce symptoms some are added as bio inhansers and some are added to break what particular pathogenesis.

Poly herbal combinations are effective as single herbs. In Indian medicine Ayurveda, most of the classical preparations are poly herbals with a combination of three to thirty plants. These combinations are made for the accuracy and are combined in such a way that the formula is a balanced one. On or two plants in these combination will be active and the others will be having a supporting role. The supporting herbs will have different actions, as a catalyzer, will help in proper absorption and transportation, nullify the toxicity etc. Altogether if the combination is ideal then the result will be excellent, but one should know thoroughly about the plants and how to combine!

The problems with polyherbal interventions is that many of these substances are toxic/carcinogenic and interfere with proper pharmocodynamics and kinetics.  They should be avoided like the plague because many of them are as toxic as the plague.

I do agree with the hypothesis proposed by Sudarshan Upadhyay.

Most of the diseases have multi-factorial causation, drugs as a whole (against extract of a herb) acting on a number of targets simultaneously is likely to be more effective. Traditional formulations are multi-component, thus have special relevance in such cases. Ayurveda with its armamentarium can answer and provide promising results in many of such situations. Ayurvedic drugs are a big ray of hope and can play crucial role in restricting complications, and improving quality of life of the suffering population.

At the same point, i am annoyed to see the comments of Mr Barry Turner. Persons without having complete knowledge on the system cannot speak or raise such concerns.

Centre for Disease Control and Prevention (CDCP) warned that the world is staring at a post-antibiotic era when common infections will no longer have a cure. In addition, due to drastic changes in life style and increased pollution and industrialization, global population is affecting with various kinds of life style diseases. Unless addressed, the mortality and disease burden from these problems will continue to increase.

Do you have any answers for this alarming situation Mr Turner. How the modern system of medicine can combat this situation. Do you have any answer for this?

Contribution of herbal remedies in global health care cannot be ignored by any science for its qualitative strength and clues provided in the field of therapeutics. The World Health Organization is fully aware of the importance of such medicines and supports the use of medicinal plants and their products in healthcare.

I would certainly not ignore the contribution of herbs to medicine, something like half of our modern medicines originate in plants.  I too fully support their use but would prefer it if a more vigourous approach was taken to testing them for harmful side effects as well as for efficacy and risk-benefit.

There is a common misconception that herbal medicine is not dangerous and that because it is 'natural' it is risk free.  This is sometimes promoted by herbalists and it is entirely untrue.  If a herb has efficacious effects it also has side effects.  If it has no side effects it does not work.

One of the biggest dangers of herbal medicine is that patients often take them concomitantly with prescription medications.  This can be potentially fatal and all herbalists should be trained in modern pharmacology, as should doctors to avoid such accidents.

All drugs, both those from Big Pharma and those from the herb garden are toxins. they must be treated as such.

Thank you Mr Barry. Now, i do agree with you. A bit disturbed to see your comment on herbs, recommending them to avoid and labeling them as toxic as the plague. Nothing under the sky is safe. All things are to be used judiciously, if not all the substances will be toxic as that of plague. 

Basically the herbal medicine is not just a single chemical constituent as we always see in the regular pharmaceutical formulations, e.g. the USP and/or BP drugs as well as INN drugs too. Ayurveda is an ancient art of medicine and at the time of the invention of ayurvedic medicine and its treatment system there was only option - the plants from which the medicinal effects could be achieved. That is the main reason why in an ayurvedic or herbal formulation we have many plant constituents rather than that of a single molecule.

Yes, active molecules purified from herbs will often give side effects--BUT, crude extracts containing the active molecule rarely give side effects. This is because crude extracts contain the active molecule along with other molecules which may synergize or antagonize the active molecule. SO, this balance is chemically maintained in a crude extract. Indeed, there are many publications on medicinal properties of crude extracts. Boswellic acid (Active molecule for joint pain) is available as standardized guggulu extract. SO, why do people still purify active molecules--its mainly done to get patents. Crude extracts would be a better option in many cases.

Dear all, thank you so much for your valuable and kind suggestions. These valuable inputs supports the age old trusted use of polyherbal combinations in traditional systems of medicine.

Herbs have been used as medications since before humans adopted agriculture and all ancient civilisations have a tradition of herbal medicine.  The famous Otzi the Ice man, a 5,300 year old European had a herbal medicine kit with him when he died in the Alps at the start of the Chalcolithic period.

They are active because they contain chemicals with pharmacological properties and as such have therapeutic effects and adverse effects.  There is little evidence that adverse effects are avoided simply by using unprocessed extracts and herbal medicines even in unprocessed form can cause nasty side effects just the same as manufactured pharmaceutical products.

For B.Turner: One does need more evidence to prove that crude extracts are safe. This evidence is lacking because scientists rarely work on such extracts. The bias towards purified compounds is so great, that we rarely get funded/published when we work on crude extracts. Western Med  used digitalis extracts, and these maybe just as effective as the modern, expensive cardiac meds. ironically, there is talk of a "polypill" for heart disease now! So, one needs to do more research on crude extracts before condeming them..

The bias towards purified compounds is simply an economic one.  Apart from the difficulties in establishing patents on natural products the manufacture/growing of herbs in commercially marketable volume and the global distribution is not cost effective.  Sadly in a world with over 6.3 billion people in it and a global economy the herbal market must compete not only in terms of therapeutic effectiveness but economically too.  This is adequately demonstrated by the disproportionate cost of herbal medicines and the sometimes staggering fees charged by herbal practitioners.  

We need a total overhaul of the way we treat disease but that is unlikely when medicine is about profit.  Medical research is motivated by the grant money available and that is directly related to future profits. So, with no profit in crude extracts there will be little or no research into them.  Just like drug manufacture and distribution it is all about money first, patients second. 

Dear Dr. Turner,

It is good to highlight the point of possible side effects exerted by herbs used in combination.

I would like to know your views on this question.

Did the traditional healers assess the possible side effect of herbs prior to make any combination and prescribe the combination to patients? If not then why such combination existed since ancient times?

Dear Bhavesh

The ancient healers who used herbal medications will have known of the side effects and will have used the same basic model we do today to deal with the problem.  Risk/Benefit is the equation we use.  All drugs have risks even if some do not have benefits.  However the simple rule is that we uses a drug to benefit the patient and that we should not use it if that risk outweighs the benefit.

Chemotherapy drugs have many very bad adverse effects but they extend the lives of patients and in some cases save them outright.  We use the drugs knowing that they will cause harm because the good that they cause outweighs it.

There is no reason to suspect that ancient healers were unaware of this concept.

This paper is worth catching!

Adverse effects of herbal medicines: an overview of systematic reviews

Paul Posadzki, honorary university fellow⇓, Leala K Watson, information specialist and Edzard Ernst, emeritus professor

E. Ernst has been writing such papers for a long time. There can be adverse reactions when 2 drugs (modern and herbal; 2 modern drugs;  2herbal drugs) compete for the same CYP enzyme and/or drug transporter.  Surprisingly, we don't read about adverse effects when 2 modern drugs interact..the one example is caffeinated drinks and aspirin causing kidney toxicity. To be fair, you should also cite papers documenting adverse effects of modern medicine. 

Venil

All medication has adverse effects and I have already stated that so there is no question of fairness.  I have spent many years looking into the properties of the P450 enzymes and how one drug can block the metabolism of another.  That is why polypharmacy is a dangerous practice and why also taking herbal medicines concomitantly with those on prescription or even over the counter drugs is risky.

There are literally thousands of papers on CYP enzymes and adverse drug reactions so I would be spoilt for choice in recommending one. There are many thousand papers on the interactions of pharmaceutical products.  I would however recommend Anne Lee's book Adverse Drug Reactions (Pharmaceutical Press)  Another superb book is Dr Grace Jackson's Rethinking Psychiatric Drugs.  Which covers adverse reactions in meticulous detail. The seminal work by Professor David Healy The Creation of Psychopharmacology is a must read for all interested in adverse drug reactions.  

Martindale's Extra Pharmacopeia covers reactions between herbs and manufactured pharmaceuticals in great detail as does the British National Formulary,  The Maudsley Prescribing Guide and many other textbooks have very good charts on interactions and ADR's.  There is no shortage of material in the literature describing the toxicity of concomitant prescribing.    

All drugs including those described as Ayurvedic are toxic, that is how they work.  Ayurvedic medicine rather interestingly shares many of the characteristics of modern psychiatry.  A belief that illness is caused by 'imbalances' and simplistic observations that because a drug appears to 'work' that it vindicates the belief in it.  

Both of course are based on faith rather than scientific rigour.  

Thanks to Dr. B. Turner for pointing out these additional References. I will check them out.  Unfortunately, the perception is that modern medicine is safe and herbal medicine is not.  It will be hard to change this perception. It is this on-sided view that is tough to accept. 

Nothing could be further from my mind that modern medicine is safe and herbal medicine is not.  They are both hazardous and it is the control of those hazards that needs the closest attention. 

Thanks to Dr. B. Turner: I meant to say that there is a "general perception" amongst many in India and overseas, that herbal meds are prescribed by "quacks" . Many local doctors complain that their patients damage their kidneys with herbal meds that contain heavy metals--this is assumed, even though the docs never test any of these herbal meds in any way !  Interestingly, local doctors ignore/dismiss queries on side effects of modern meds. Some will even claim that "if you want any effect-you must accept the side-effect". As Dr. B. Turner says, there are hazards with all types of Meds, and very few have the knowledge or relevant evidence to make any claim. So, caution and let scientific rigour prevail !

we believe each pure drugs has side effects. in medicinal plants we have lots of components which reduce side effects and sometimes we have to add other materials such as minerals or plants to complete the main effect. Besides some times some synthetic material such as some essence aren't similar to natural kinds exactly, they are isomers (e.g.  L and D isomers). in our bodies they act differently.

The % and quantitative amount of the chemical constituents of individual raw drug comparatively less than compound formulation. If in the compound formulation similar chemical moieties combined give and good results   

The polyherbal formulations are mentioned in the classical texts of Ayurveda and being in use for centuries,so these are time tested .The working principle of these drugs os that they work synergistically.They as individual drugs will certainly benefit for that particular disease but when taken in that combination the ill effects are reduced and the dosage is also reduced. 

POLYHERBAL FORMULATION HAVE COMBINED EFFECT ON PARTICULAR DIESESE

Disease causing agent may develop resistant if a single plant can be used for the treatment of specific disease but in case of Polyherbal formulation there is less chance to develop resistant for disease. So that it can be effective for long time as we see that same ayurvedic formulations is used more than 1500 year back and also effective in current scenario. 

Polyherbal formulation has its own advantage to have upper hand in treatment.  Actualy if we see polyhebal in broader sense, it do management of disease apart from treatment. If we see ayurvedic formulation closly and criticaly, we will find special combination of constituent in formulation and prepared by seeing patient and disease to treat disease along with management of complecations or to prevent forther growth of complication due to that disease. Also polyherbal formulation do not cause drug resistance and can be used for long time. Polyherbal formulation have one very important advantage of having its tannins, polyphenols  etc that act as antioxident and free radcal scavenger that remove harmfull metabolite and toxins from the body giving increase immunity too. 

Other reason may be that synergistic effect of constituents over other viz piper sp. used in formulation act as bioenhancer along with boost activity of other constituent. Likewise several constituent in polyherbal formulation act as to treat disease, to add synergistic effect, to subside drug resistance, to improve pharmacodynamics and pharmacokinetics of major constituents, as excipients etc. 

That is why, seeing the value of polyherbal formulation GoI has drafted Gazette on Phytopharmaceutical to control and boost its market on data based evidence for herbal sector.

To my mind "polyherbal combinations" as the word indicate 'poly' means many. The herbal combination prepared from more than one herb. This may be due to the additive effect of all the used herbs or to balance the effect of one by others in terms of curative potential.

there is a synergistic effect of various constituents present in poly- herbal formulation. Using a combine therpy by our ancestors  the herbs antagonize the toxic effect of one another