There is no national licensure for botanical or herbal medicine, and there is no national or professional organization that regulates or accredits Western and Ayurvedic herbal medicine education. In 1996, the National Certification Commission for Acupuncture and Oriental Medicine developed a national certification written examination, which tests for entry-level capabilities in oriental herbal medicine. Passage of this examination allows practitioners to call themselves
Table 13.4 Botanicals: Potential for Interactions with Drugs
Anticoagulants Bilberry Chamomile Coenzyme Q-10 Danshen Dong quai Feverfew Garlic Ginger Ginkgo Ginseng Kava St. John’s wort Increased risk of bleeding (high dose) Increased risk of bleeding Decreased effectiveness Increased risk of bleeding Increased risk of bleeding Increased risk of bleeding Increased risk of bleeding Increased risk of bleeding Increased risk of bleeding Increased risk of bleeding Increased risk of bleeding Decreased effectiveness
Anticonvulsants Borage Decreased seizure threshold Comfrey Increased risk of phenobarbital toxicity Evening primrose oil Decreased seizure threshold Valerian Increased effects of barbiturates
St. John’s wort Yohimbine
Increased effect of monoamine oxidase inhibitors Increased risk of monoamine oxidase inhibitors Hypertension Monoamine oxidase inhibitors; increased blood pressure level Tricyclics—hypertension; selective serotonin reuptake inhibitors; increased serotonin levels
Data from O’Mathuna DP. Herb-drug interactions. Altern Med Alert 2003;6:37–43.
Table 13.5 Selected Risk Factors for Adverse Reactions or Drug Interactions with Botanicals
Radiation with or without chemotherapy
Taking sedatives/anxiolytics/central nervous system depressants, oral contraceptives, diuretics, monoamine oxidase inhibitors, antiretroviral drugs
Diplomats of Chinese Herbology (Dipl CH). The Commission’s website contains a searchable directory of certified practitioners (11).
Chiropractic Medicine Chiropractic medicine focuses on the relationship between structure (primarily the spine) and function, and how that relationship affects the preservation and restoration of health. It uses manipulative therapy as an integral tool. Chiropractors can legally do more than manipulate and align the spine, including taking a medical history, performing a physical examination, and ordering lab tests and x-rays to determine a diagnosis. The spectrum of chiropractors varies in terms of the conditions treated with manipulation. Although some practitioners limit their practice primarily to musculoskeletal problems, others claim to offer effective treatment for virtually any medical condition. They are referred to as doctors, which can be misleading to patients.
The most significant risk associated with chiropractic medicine is stroke. Vertebrobasilar accidents occur mainly after a cervical manipulation with a rotatory component. The average age of patients with a vertebrobasilar accident is 38 years. The frequency of serious adverse events varied from 1 stroke per 20,000 manipulations to 1.46 serious adverse events per 10 million manipulations and 2.68 deaths per 10 million manipulations (12). The true incidence of these risks is not known and more data are needed.
There is a national process for licensure for chiropractic medicine to which all 50 states adhere. Chiropractors must complete a 4-year chiropractic college program of study accredited by the Council on Chiropractic Education (CCE).
Massage therapy involves manipulation of the soft tissues of the body to normalize those tissues. A wide variety of approaches are available that include deep-tissue massage, Swedish massage, reﬂexology, Rolfing, and many others. A number of randomized controlled trials documented the value of massage therapy, particularly in pediatric conditions such as childhood asthma. Some studies show an increase in dopamine and serotonin, and an increase in natural killer cells and lymphocytes with regular massage therapy.