Holistic herbal medicine treats each person as an individual, working with the whole plant to heal the whole person. The art of herbal medicine lies in this personalised approach where practitioners choose herbs for the person rather than simply for a particular ailment. Internationally renowned clinical herbalist and ethnobotanist David Winston echoes these sentiments when he says, “we don’t just give herbs to treat symptoms or diseases - we give herbs to people”. However, there is also a modern scientific understanding to this concept of individuality, particularly in the context of health and nutrition, known as “bio-individuality.” i ii

This notion of bio-individuality acknowledges the incredible diversity within our human population and recognises that each person's unique genetic makeup, metabolic processes, microbiome composition and constitutional type influence their response to medicines. Roger J. Williams first proposed this theory in 1956, noting that the variation in chemical composition and enzymatic activities between humans is so large that it's impossible to define a "normal" human. This observation has profound implications for medicine and nutrition, emphasising that interventions should be tailored to the individual. iii iv v vi

Traditional herbal medicine has long recognised that individuals respond differently to the same treatments. As the saying goes, "one man's meat is another man's poison," which explains why treatments that work for one person may not work for another. Consider two patients with osteoarthritis seeking herbal treatment. While both might receive a base formula containing anti-inflammatory herbs such as turmeric and devil's claw, their individual needs require customisation. The first patient, experiencing fatigue, benefits from the addition of adaptogenic herbs such as reishi. The second patient, struggling with sleep issues, responds better when passion flower is included to support restful sleep. By utilising synergistic herbal combinations, practitioners can create formulations that address multiple aspects of an individual's health, enhancing therapeutic effects while minimising side effects. Regular follow-ups allow for prescription adjustments based on individual responses, ensuring optimal outcomes. vii viii

Conventional medicine has only recently embraced similar principles, evolving from a "one size fits all" approach to precision medicine over the past 30 years. This shift was catalysed by the development of affordable DNA sequencing. The goal of precision medicine is to deliver the "five rights": the right patient, drug, time, dose and route based on individual health characteristics. The integration of advanced technologies like omics, biomarkers, artificial intelligence and digital wearables is revolutionising healthcare through personalised diagnostics and treatments. These technological advances are expected to transform traditional herbal medicine as well. Network pharmacology can provide insights into the relationships between botanical substances and biological systems, while genomic medicine allows for customising treatments according to individual genetic profiles. However, challenges such as data integration and privacy issues remain. ix x

Crafting bespoke liquid herbal formulas honours traditional herbal wisdom while paving the way for the future of precision herbal medicine. The convergence of traditional herbal wisdom with modern scientific understanding creates a powerful framework for addressing health challenges. While conventional medicine has only recently begun to embrace personalisation through technological means, herbal medicine has maintained this principle throughout its long history. As both approaches continue to develop, they may find increasing common ground in their recognition that effective healthcare must honour the unique characteristics of each individual. xi xii xiii

As our understanding of bio-individuality continues to evolve it promises to further enhance the efficacy and safety of herbal treatments through increasingly targeted and personalised care. By recognising and respecting each person's unique biological makeup, practitioners can provide more effective solutions to their patients' unique needs moving beyond the one-size-fits-all approach and embracing the rich complexity of human biochemical individuality.

References

i de la Forêt R. Alchemy of Herbs. Hay House:California. 2017 p.11

ii Popham S. Working with the Whole Person. c2014-2025 The School of Evolutionary Herbalism (updated 8 Nov 2023;accessed 24 Feb 2025). Available from https://www.evolutionaryherbalism.com/2023/11/08/working-with-the-whole-person/

iii Patterson AD, Turnbaugh PJ. Microbial determinants of biochemical individuality and their impact on toxicology and pharmacology. Cell Metab. 2014 Nov 4;20(5):761-768. doi: 10.1016/j.cmet.2014.07.002. Epub 2014 Aug 21. PMID: 25156450; PMCID: PMC4252706.

iv Gilani B, Cassagnol M. Biochemistry, Cytochrome P450. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557698/

v Lorenzo PM, Izquierdo AG, Rodriguez-Carnero G, Fernández-Pombo A, Iglesias A, Carreira MC, Tejera C, Bellido D, Martinez-Olmos MA, Leis R, Casanueva FF, Crujeiras AB. Epigenetic Effects of Healthy Foods and Lifestyle Habits from the Southern European Atlantic Diet Pattern: A Narrative Review. Adv Nutr. 2022 Oct 2;13(5):1725-1747. doi: 10.1093/advances/nmac038. PMID: 35421213; PMCID: PMC9526853.

vi Zhao Q, Chen Y, Huang W, Zhou H, Zhang W. Drug-microbiota interactions: an emerging priority for precision medicine. Signal Transduct Target Ther. 2023 Oct 9;8(1):386. doi: 10.1038/s41392-023-01619-w. PMID: 37806986; PMCID: PMC10560686.

vii Ali H, Ali D, Almutairi BO, Kumar G, Karga GA, Masi C, Sundramurthy VP. Synergistic Effect of Conventional Medicinal Herbs against Different Pharmacological Activity. Biomed Res Int. 2022 Jun 29;2022:7337261. doi: 10.1155/2022/7337261. Retraction in: Biomed Res Int. 2024 Jan 9;2024:9836173. doi: 10.1155/2024/9836173. PMID: 35813228; PMCID: PMC9259343.

viii The safety of complementary medicines. Highlighting Complementary Medicine Research. The National Institute of Complementary Medicine. University of Western Sydney. (accessed 25 Feb 2025). Available from

https://www.westernsydney.edu.au/__data/assets/pdf_file/0006/723273/Fact_sheet_safety_of_CM_3.pdf

ix Marques L, Costa B, Pereira M, Silva A, Santos J, Saldanha L, Silva I, Magalhães P, Schmidt S, Vale N. Advancing Precision Medicine: A Review of Innovative In Silico Approaches for Drug Development, Clinical Pharmacology and Personalized Healthcare. Pharmaceutics. 2024 Feb 27;16(3):332. doi: 10.3390/pharmaceutics16030332. PMID: 38543226; PMCID: PMC10975777.

x Babu BK. Revolutionizing Herbal Medicine: The Role of E-health Informatics and Network Pharmacology in Personalized Herbal Therapies. Int J Pharm Investigation [Internet]. 2024 Dec 5;15(1):219–27. Available from: http://dx.doi.org/10.5530/ijpi.20251754

xi Balkrishna A, Sharma N, Srivastava D, Kukreti A, Srivastava S, Arya V. Exploring the Safety, Efficacy, and Bioactivity of Herbal Medicines: Bridging Traditional Wisdom and Modern Science in Healthcare. Future Integrative Medicine. 2024;3(1):35-49. doi: 10.14218/FIM.2023.00086.

xii Ng JY, Cramer H, Lee MS, Moher D. Traditional, complementary, and integrative medicine and artificial intelligence: Novel opportunities in healthcare. Integr Med Res. 2024 Mar;13(1):101024. doi: 10.1016/j.imr.2024.101024. Epub 2024 Feb 9. PMID: 38384497; PMCID: PMC10879672.

xiii Cramer H. Artificial Intelligence, Complementary and Integrative Medicine: A Paradigm Shift in Health Care Delivery and Research? J Integr Complement Med. 2023 Mar;29(3):131-133. doi: 10.1089/jicm.2023.0040. PMID: 36920088.

xiv Johnson KB, Wei WQ, Weeraratne D, Frisse ME, Misulis K, Rhee K, Zhao J, Snowdon JL. Precision Medicine, AI, and the Future of Personalized Health Care. Clin Transl Sci. 2021 Jan;14(1):86-93. doi: 10.1111/cts.12884. Epub 2020 Oct 12. PMID: 32961010; PMCID: PMC7877825.

Herbal medicines are increasingly being used in long-term care (LTC) settings, yet there remains a significant gap in understanding how healthcare professionals (HCPs) apply these treatments. A scoping review published in February this year found that while herbal medicines are commonly administered alongside conventional medications, research on their professional use in LTC remains scarce. The study revealed that HCPs, including nurses and physicians, often lack clear guidelines for herbal medicine application, leading to inconsistent practices. Despite some promising findings, such as chamomile for insomnia and ginkgo for cognitive function, many studies produced mixed results. The review highlights the need for further research, standardised protocols and interdisciplinary collaboration to ensure the safe and effective integration of herbal treatments into elderly care.

The study analysed twelve research papers published between 2014 and 2023, focusing on the professional application of herbal medicine in LTC. Findings showed that herbal treatments are primarily used for four key conditions: cognitive decline, respiratory infections, urinary tract infections and insomnia. While some herbal medicines demonstrated positive effects, such as garlic and onion extracts reducing respiratory infections others, like cranberry for urinary tract infections, showed inconsistent efficacy. Fenugreek, used in Alzheimer’s patients, was found to improve memory, quality of life and selective oxidative stress markers, making it a promising candidate for further study. However, the review also noted that the roles of HCPs in administering these treatments were often not clearly defined, raising concerns about proper dosage, interactions with pharmaceuticals and overall patient safety. Furthermore, as polypharmacy becomes increasingly common in older adults, the risk of drug-herb interactions remains a critical issue.

The prevalence of concurrent use of prescription drugs and herbal medicinal products can be up to 88.3 % in the older population. With the rising demand for complementary therapies in elderly care it is crucial to equip healthcare professionals with the knowledge and tools to safely incorporate herbal medicines into treatment plans. The review calls for more rigorous clinical studies, better training for HCPs and clear regulatory guidelines to optimise the use of herbal medicines in LTC. As the interest in phytotherapy continues to grow, bridging the gap between traditional wisdom and modern medical practice will be essential in delivering safe, effective and holistic care to aging populations.

References

i Walter C, Berger S, Langegger D, Strobl A, Kutschar AP, Pitzer S, Nestler PN. Application and use of herbal medicines by healthcare professionals in long-term care: A scoping review. Geriatr Nurs. 2025 Feb 10;62(Pt B):165-174. doi: 10.1016/j.gerinurse.2025.01.034. Epub ahead of print. PMID: 39933306

Buchu is an evergreen, gland-dotted, fragrant shrub that grows up to two metres in height and is naturally distributed in the Western Cape Province of South Africa. The plants are extremely aromatic, filling the surrounding area with their scent. The aroma is reminiscent of blackcurrants, though some people detect a mixture of rosemary and peppermint. Buchu is said to be the only plant in the world that genetically produces diosphenol (also called buchu camphor), found in the plant’s essential oil and which is responsible for the characteristic blackcurrant scent and flavour of the plant. The generic name Agathosma means ‘good fragrance’ and, in manufacturing, the essential oil from buchu is used to give a fruit flavour (often blackcurrant) to foods. It is also used as a fragrance in perfumes and colognes. A buchu plant, if properly handled, has a lifespan of up to 100 years. In the wild, the plant is only harvested every second or third year to ensure that there is enough time to regrow and seed. Currently the Agricultural Research Council of South Africa, in collaboration with local farmers, has projects in place to monitor harvesting and ensure the protection of pure genetic strains of plants from which to propagate.

The modern use of buchu is as a urinary tract antiseptic and as an anti-inflammatory agent thereby reducing the inflammation seen in urinary tract infections and treating infections of the urethra and prostate. Traditionally buchu has been highly prized by the Khoisan (indigenous people of the western region of South Africa) for medicinal and spiritual purposes including for dance rituals, anointment, beautification and as perfume. It has remained one of the most popular herbal medicines in South Africa. The traditional use of buchu encompasses the treatment of kidney and urinary tract infections, the common cold, stomach ailments, rheumatism, gout and fever. Externally it was applied as an antiseptic wash to infected wounds and as a compress to relieve swelling, bruising and sprains.

When early Dutch settlers first came to the Cape in South Africa, they were struck by the pervasive and intoxicating smell of the buchu bush. Initially noted by the early settlers, knowledge and use of buchu spread to Europe and later to the United States. It is even said that a shipment of eight bales of buchu leaves were catalogued as on board the doomed Titanic. Buchu has been in compendiums since 1826 for its diuretic effects and use in the treatment of genitourinary tract infections, however, became obsolete in the 20th century due to the lack of scientific evidence for its efficacy and the advent of antibiotics and synthetic diuretics. Modern research includes mostly laboratory (in vitro) and animal (in vivo) studies which demonstrate a variety of effects including diuretic, antioxidant, anti-inflammatory, analgesic and antibacterial activity. These activities may be attributable to the irritant nature of the volatile oil and the flavonoid components. There is a lack of available human studies to justify the traditional indications.

References

Brendler T, Abdel-Tawab M. Buchu (Agathosma betulina and A. crenulata): Rightfully Forgotten or Underutilized? Front Pharmacol. 2022 Feb 7;13:813142. doi: 10.3389/fphar.2022.813142. PMID: 35197854; PMCID: PMC8859318.

ii Huisamen B (ed.) Medicinal Effects of Agathosma (Buchu) Extracts AOSIS, Cape Town 2019;xxi-xxi https://doi.org/10.4102/aosis.2019.BK84.00

iii Skosana B, Aboua G, du Plessis SS. Buchu – The Multi-Purpose Ethnomedicinally Important Specie and Its Benefits in the Reproductive System [Internet]. Antioxidant-Antidiabetic Agents and Human Health. InTech; 2014. Available from: http://dx.doi.org/10.5772/57233

iv Brendler T, Abdel-Tawab M. Buchu (Agathosma betulina and A. crenulata): Rightfully Forgotten or Underutilized? Front Pharmacol. 2022 Feb 7;13:813142. doi: 10.3389/fphar.2022.813142. PMID: 35197854; PMCID: PMC8859318.

v LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Buchu. [Updated 2023 Mar 3]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK589899/

vi Brendler T, Abdel-Tawab M. Buchu (Agathosma betulina and A. crenulata): Rightfully Forgotten or Underutilized? Front Pharmacol. 2022 Feb 7;13:813142. doi: 10.3389/fphar.2022.813142. PMID: 35197854; PMCID: PMC8859318.

Supplementing with astragalus was found to prevent a decline in kidney function 

A 2024 randomised controlled trial found that in patients with type 2 diabetes, stage 2 to 3 chronic kidney disease (CKD) and macroalbuminuria (also known as proteinuria), taking astragalus for 48 weeks further stabilised kidney function on top of standard care.

Astragalus is a herb that has been used in traditional Chinese medicine (TCM) for centuries. It has a strong reputation in TCM for providing support for the kidneys. In the clinical practice of TCM astragalus is mainly used to invigorate Qi. Astragalus may support kidney health by improving blood flow and laboratory markers of kidney function, such as measures of protein in the urine.

In this clinical trial 118 patients, with estimated glomerular filtration rate (eGFR) of 30-90 mL/min/1.73m and urinary albumin-to-creatinine ratio (UACR) of 300 to 5000 mg/g were randomly assigned to taking oral astragalus granules (15g of raw herb daily equivalent) or to continue standard care alone, with no placebo, for 48 weeks. Compared to the astragalus group, eGFR declined (worsened) in the control group (−3.9 mL/min/1.73 m2) and there was no difference for UACR. For secondary outcomes, there was a decrease in systolic blood pressure and liver enzymes in the astragalus group compared to the control group.

References

Chan KW, Kwong ASK, Tsui PN, Chan GCW, Choi WF, Yiu WH, Cheung SCY, Wong

MMY, Zhang ZJ, Tan KCB, Lao L, Lai KN, Tang SCW; READY and SCHEMATIC

research group. Add-on astragalus in type 2 diabetes and chronic kidney disease: A

multi-center, assessor-blind, randomized controlled trial. Phytomedicine. 2024 Jul

25;130:155457. doi: 10.1016/j.phymed.2024.155457. Epub 2024 Feb 28. PMID:

38810556.