And I have 10 responses….
Recently I got a mild rap on my knuckles from a senior herbalist about what I had been teaching students in Herbal Therapeutics. The particular problem seemed to be my approach to Tuberculosis [TB]. The reasoning went thus; TB is such a serious problem that we mustn’t give the students the impression that they can ‘treat’ it, and that the patient can use herbs instead of antibiotics.
This is a statement that I agree with.
My feathers were so ruffled that I got up at the crack of dawn the following day to re-read what I had written in the module guide. This is an extract from the TB section;
TB is a notifiable disease and any approach to treating TB would be in liaison with a GP and/or a consultant.
Reactivated TB can be very dangerous and can kill; google Paul Thorn’s experience with TB when 7 out of the 8 occupants on his ward died when exposed to the airborne bacterium due to a sputum test being carried out in the same side ward they were all on. He was the only survivor. Never advise patient with reactivated TB to come off antibiotics.
Therapeutically I concentrated on increasing the health and nutrition of those patients with latent TB who were not on any orthodox medication and including herbs in their mix that had a reptation for being ‘anti-TB’.
I think herbal students should be taught about serious conditions and what herbalists can do for patients suffering with serious conditions. Although I want students to be thoroughly aware of their limits of competence, I don’t want them to be frightened of trying to help patients with conditions such as TB, or MS, or Motor Neurone Disease, or COPD.
Why?
- The difference between treating a disease and supporting a patient
Herbalists are not claiming to cure TB, metastatic cancer, MS, or fulminant sepsis. But, in patients with these complex conditions, herbs can support physiology, comfort, function, and resilience. Herbs offer nutritional support during chronic illness, provide anxiolytics during frightening diagnostic processes, and can work with, not in competition to, orthodox medication.
- The fragility of medical supply chains
Modern healthcare can be astonishingly effective but structurally brittle: in the area where I live we have experienced shortages of basic medications such as amantadine at times. Where society uses single‑source pharmaceutical manufacturing and commercial supply chains, and also experience transport disruptions [not to mention geopolitical instability], it is a useful contribution to have something to use for a patient as a support instead of nothing. Herbal medicine is not a replacement but a parallel system that does not collapse when a factory in another country goes ‘offline’. I call this a sober risk-assessment….
- Clinical herbalists are trained to think in contingencies
Doctors are trained for a world where the system works, but herbalists are trained for a world where the system sometimes doesn’t. I argue that teaching students how to support seriously ill patients in low‑resource situations is not irresponsible; it is responsible. What can we do? Herbs can contribute to symptom relief, maintaining strength and appetite, support sleep, reduce anxiety, manage pain, help the body cope with prolonged stress… None of this is ‘treating TB’. It is teaching clinicians how to be useful if the ideal tools are unavailable, or before they are necessary.
- Historical precedent
Humans have always used plants to manage serious illness because they had no alternative. Even today, in many parts of the world, herbal medicine is the only accessible healthcare. Dismissing this knowledge as totally irrelevant is historically illiterate. The point is that herbalists understand how to work with physiology when pharmaceuticals are absent.
- An ethical dimension: clinicians should not be helpless
A clinician who can only function when the full apparatus of modern medicine is available is, in a sense, under‑skilled. Herbalists are ethically obliged to know how to help in constrained circumstances. This is simply acknowledging that patients deserve care even when the system is strained.
- Complexity requires multi‑modal support
Modern medicine excels at specific, targeted interventions. However, complex chronic conditions often require multi‑modal approaches: sleep, digestion, endocrine balance, stress physiology, inflammation patterns. Herbs are multi‑constituent and multi‑modal. Teaching students how to support complex physiology is good practice.
- The false binary of ‘dangerous or ineffective’
There is a common criticism that herbs are either too weak to matter, or too dangerous to use. This is logically incoherent. Herbs have pharmacology. Pharmacology implies both potential benefit and potential risk. The solution is training, not dismissal. Our students are being trained precisely so they can use herbs safely and effectively.
- Preparedness is not anti‑medical
Herbal medicine is not anti‑science, and it is not anti‑medicine. It is a discipline that teaches clinicians how to maintain therapeutic usefulness when the ideal tools are absent or incomplete. My aim is to train students to think clearly and clinically: given this patient, this presentation, and these pharmaceuticals, what can I do that is safe, physiologically coherent, and genuinely beneficial?
I also want them prepared for the real world of practice, where underlying disease processes are often confusing, contradictory, and complex. They need to understand rare but important conditions because they must recognise when something falls outside the scope of herbal care. For example, a phaeochromocytoma is an uncommon benign adrenal tumour; most herbalists will never see one. But persistent hypertension that resists normal treatment demands awareness of such possibilities so that the patient can be referred promptly to a GP.
Teaching this is not the same as encouraging students to treat adrenal tumours. That would be unethical. The point is to ensure they can recognise red flags, support patients safely, and collaborate appropriately with medical care.
- Patients with serious illness need more than disease‑targeting
Even when modern medicine is fully available, patients with serious illness often struggle with stuff like appetite loss, insomnia, anxiety, digestive disruption, fatigue, emotional overwhelm. Herbs can help with these dimensions. Teaching students to address the lived experience of complex illness is not irresponsible; it is humane.
- The deeper point: herbal medicine preserves agency
Herbal medicine gives patients and clinicians agency in situations where modern medicine can feel impersonal, rushed, or constrained. Agency itself affects physiology, even in complex conditions. Teaching students how to offer agency in such cases is not irresponsible, it can be clinically useful.
