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This is the final in the series of 13 articles looking at current herbal therapy. It reviews those plants with clinical and scientific evaluation sufficient to consider adoption into orthodox medicine. Surprisingly some commonly used herbs, such as the purple coneflower (Echinacea purpura), valerian and ginseng, do not as yet pass the test, but others such as St John's wort, ginkgo, saw palmetto now have sufficient clinical studies to consider orthodox use. With the huge interest in herbal treatment it is likely that other plants will join the list following adequate clinical evaluation.

Medical journals are now publishing case reports of adverse reactions to herbal therapy. With increasing use, and more importantly, increasing awareness of potential hazardous effects, these reports are liable to increase in frequency. It is also increasingly realised that herbs and drugs can interact in the same way that drug/drug interactions occur. This is particularly hazardous for the patient if the treating doctor is not aware of the herbal prescription. This article reviews the published material and highlights areas of major concern. Most of the serious adverse events reported relate to problems of product quality or adulteration.

Musculoskeletal symptoms are common and traditional family remedies are available in most households to reduce pain and inflammation. Most of these have only anecdotal evidence and have not stood up to scientific scrutiny. However, some effective treatments such as aspirin have borne the test of time. With adequate trials more effective herbal therapies may be confirmed, but currently such popular treatments as devils claw and nettles have yet to have confirmation of benefit. Although not herbal, cartilage derivatives are also currently popular alternative medicines and have increasing evidence of beneficial effect.

This ninth article in the series looks at the management of respiratory conditions, a traditional indication for herbs. Many symptomatic managements remain part of our treatment today, sometimes with remarkably little evidence of effect. The explosion in incidence of asthma has, as in any chronic condition, provided a new area where alternative treatment is increasingly considered by patients. Treatments have been even less well researched than in other areas of herbal medicine, and the potential for abuse and toxicity remains a concern.

This eighth article in the series looks at the current role of plant therapy in infection. Plant chemicals are useful for infection control and, until the advent of antibiotics (many themselves of natural origin) were the only remedies available. The current role of plants in this area could be summarised as treating minor acute infections, topical therapy for skin or wound infections and perhaps a supportive role in chronic infection. With increasing resistance of bacteria, viruses and malaria to standard therapy, alternative treatments are being re-explored with some urgency.

Over the years cancer has been more complicated by 'wonder cures' than perhaps any other condition. Remedies such as laetril, shark cartilage, high dose vitamins and many alternative medical practices have been used with little evidence of improvement and sometimes worsened outcome. It is disconcerting that attempts to scientifically discredit these treatments sometimes result in the development of conspiracy theories. However, some plants do contain anticancer agents, the vinca alkaloids (derived from the Madagascar periwinkle) and paclitaxel (derived from the pacific yew tree) are examples of success stories. Extensive screening of tens of thousands of plants has unfortunately revealed only a handful of potential cancer cures. An evidence based approach to alternative treatment in malignancy is appropriate and this seventh article in this series reviews the evidence.

This fifth article in the series looks at the long tradition of using herbal treatment for managing complications during pregnancy and with the menstrual cycle. Despite widespread use there has been surprisingly little research into the outcomes or the potential risks of using herbal therapies during pregnancy. Similarly phytoestrogens have become one of the fashionable areas of herbal treatment, although with remarkably little evidence of benefit. Studies have been carried out to assess their effectiveness in cardiovascular disease and osteoporosis but not their effect on irregularities of menstruation. Current herbal treatment in this area comes from traditional use, laboratory work and a lack of adequate clinical trials make it impossible to suggest which remedies may be of benefit.

This is the fourth in a series of articles discussing herbal therapies. This month looks at the herbal basis of gastrointestinal tract therapies. Disorders of digestion and bowel movement have troubled mankind throughout recorded time, providing a steady workload for herbal and orthodox practitioners. Most of these problems are mild and many herbs are used to treat the resulting minor symptoms with varying degrees of success.

This is the third article in this series. It covers a range of metabolic problems, some new and some old, in which herbal medicine has been traditionally suggested to have a place or where pharmaceuticals have herbal derivations. With the current 'epidemic' of diabetes and hyperlipidaemia, many patients are tempted by the media to consider herbal remedies. There is great concern that proven effective remedies may be ignored to the detriment of our patients' health.