The fundamental principles which traditional herbal systems are based on are a collation of time-tested empirical observations and clinical experience. For example, in the Eastern Han period, a medical scientist of Traditional Chinese Medicine named Zhang Zhongjing (150 CE – 219 CE), wrote a sixteen-volume work entitled Discussion of Cold Induced Disorders (Shanghan Lun) including treatments for epidemics, fevers from cold, external heat disorders, jaundice, gynaecological conditions; this treatise set down a complete set of treatment principals based on clinical experience. Zhang Zhongjing’s theory and prescriptions are still of great practical value today and have been used to determine treatment approaches during the recent COVID-19 epidemic (1, 2). 

Off the back of these traditional medical systems, a great change in medical knowledge happened in the 1800s with the rapid progress in chemistry. The focus of medicine development changed from using whole herbs to extracting single isolated compounds and developing new to nature chemicals. Unsurprisingly, painkillers were naturally high on the list of medical endeavours. With morphine being the first isolated compound from Poppy (Papaver somniferum) in early the 1800s and Salicin acid for Aspirin from willow bark (Salix alba) a few decades later, the hunt for ‘silver bullet’ solutions has been actively pursued ever since. The discovery of antibiotics and painkillers (such as Non-Steroidal Anti-Inflammatory Drugs, NSAIDs) are drugs that have fundamentally changed healthcare, often for the better. However, this is not without consequences; burgeoning antibiotic resistance is the result of inappropriate and overuse of antibiotics leading to the evolution of Multi-Drug Resistant Bacteria, and NSAIDs are one of the leading causes of adverse drug events.

As the responsibility for drug quality passed from the apothecary herbalists to drug manufacturers, the herbal materia medica was largely replaced by a pharmacological approach that became codified into the national pharmacopoeias and health guidelines such as The British Pharmacopoeia and more recently The National Institute for Health and Care Excellence (NICE). Concurrently, the medical paradigm changed to prioritise research, specialization and high-cost drug approval processes; a medical system more driven by research findings and profits than practitioner or patient needs (3). 

In contrast to the recent arrival of pharmaceutical medicine, the medical theories of traditional herbalism, Ayurvedic and Chinese medicine remain intact, continue to evolve, and continue to be practised according to their historical foundational principles. And given the enhanced evidence base of herbs and herbal medicine, there is now the opportunity for the scientific community to review the benefits of the whole plant complex rather than solely viewing herbal drugs as cocktails of chemicals to be pulled apart, isolated, and manipulated – a process accompanied with high risks with the potential to lead to serious and fatal adverse drug reactions (ADRs); a meta-analysis of Lazarou et al. on the incidence of ADRs in hospital patients in the US, demonstrated overall 2,216,000 hospitalised patients had serious ADRs and 106,000 had fatal ADRs, making these iatrogenic deaths between the fourth and sixth leading cause of death in one year (4). These facts remind us to not lose sight of the benefits of whole plant therapeutics while analysing quality marker compounds and other research findings.