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Overview of herbal medicine and dietary supplements

Robert B Saper, MD, MPH
Section Editor
Joann G Elmore, MD, MPH
Deputy Editor
Howard Libman, MD, FACP


Plants have been used for medicinal purposes for thousands of years. All major cultures, including Native American, European, South American, Asian, and African cultures, have used botanicals for healing purposes. As an example, saw palmetto was used for urinary symptoms in men from Egypt in the 15th century BCE [1]. Hippocrates documented the use of St. John's wort for mood ailments in the 5th century BCE [2]. The Inner Classic of the Yellow Emperor around 100 BCE describes complex traditional Chinese herbs [3]. Herbal medicines flourished in Europe in the 17th century, then showed a decline with the Scientific Revolution. European immigrants brought to North America their own herbal medicine traditions as well as acquiring many from Native Americans. Two-thirds of entries in the first edition of the United States Pharmacopoeia (USP) published in 1820 were botanical substances [2]. After about 1920, standardized pharmaceutical drugs increasingly replaced herbal therapies in the United States. Synthetic drugs were found to have larger pharmacologic effects and greater profitability [2].

Over 120 conventionally used pharmaceuticals are derived from plant species (table 1) [2,4].

In the United States, in response to increased public interest and use of complementary and alternative medicines, Congress established the National Institutes of Health (NIH) Office of Alternative Medicine (OAM) in 1992. The NIH Office of Dietary Supplements was created in 1994 to conduct and coordinate research in herbs and supplements. In 1998, the NIH OAM was upgraded to the National Center for Complementary and Integrative Health (NCCIH). NCCIH has prioritized evaluating mechanisms, efficacy, and safety of botanical medicines through basic science studies, clinical research, and the establishment of dedicated botanical research centers [5].

A list of commonly used herbs and supplements is provided below with links to more information about use, efficacy, and safety elsewhere in UpToDate and from the US National Library of Medicine (NLM) and the European Medicines Agency (EMA) websites. General concerns about quality and safety are reviewed below. (See 'Commonly used herbs and supplements' below and 'Quality and efficacy' below and 'Safety' below.)

Several specific herbs and supplements are discussed in detail elsewhere. A partial list follows. (See "Vitamin supplementation in disease prevention" and "Complementary and alternative remedies for rheumatic disorders" and "Complementary and alternative therapies for cancer" and "Complementary and alternative therapies for allergic rhinitis and conjunctivitis" and "Complementary and alternative treatments for anxiety symptoms and disorders: Herbs and medications".)

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Literature review current through: Nov 2017. | This topic last updated: Dec 04, 2017.
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