What’s in the bottle? Prescriptions formulated by medical herbalists in a clinical trial of treatment during the menopause

This paper reports on the complex prescriptions designed by practitioners of western herbal medicine in a pilot randomised, waiting-list controlled trial carried out in primary care in the UK. Herbal practitioners recorded their prescriptions and advice contemporaneously during the pragmatic trial investigating 5 months of treatment for symptoms associated with the menopause. Treatment was modified so that the 35 participants received 141 prescriptions between them during the course of their treatment. These complex prescriptions were shown to contain varying combinations of a total of 80 herbs. Between 4 and 9 herbs were used in each prescription. The three most commonly prescribed herbs were Leonurus cardiaca, Cimicifuga racemosa and Salvia officinalis. Care included not only herbal prescriptions but also dietary and lifestyle advice and discussion of self care in an evolving therapeutic relationship. The care was individually reviewed and adjusted at each consultation over the course of treatment.

► Western herbal practitioners took a detailed clinical history in consultations.
► 80 herbs were included in complex prescriptions for 35 menopausal women over a 5 month period.
► The complex main prescriptions included 4-9 herbs, and were adjusted at 71% of the consultations.
► Discussion and advice on diet, fluid intake, emotional factors and exercise was noted at 53% of the consultations.
► Modelling the complex intervention would require consideration in planning a future clinical trial of herbal practice.