An overview is given of the current position of medicinal herbs in general in relation to usage, market and production, types of pharmacological activity and how they differ from conventional drugs. The increasing importance of quality and manufactured products is also discussed. A more detailed consideration of these issues is given in relation to echinacea, valerian and St John's wort as these herbs are well studied, are market leaders and have widespread community usage.

Herbal medicine is used worldwide either as a sole treatment method or as part of a comprehensive treatment plan alongside orthodox methods of diagnosis and treatment. A survey reported that, in the USA, nearly one-sixth of women took at least one herbal product in 2000. Despite their widespread use, numerous reports show that the herbal products available to consumers are of variable quality. This disparity in quality of herbal preparations can be attributed to the fact that their production is complicated. To produce high-quality herbal products, attention must be paid to, among others, phytochemical variations due to plant breed, organ specificity, stages of growth, cultivation parameters, contamination by microbial and chemical agents, substitution, adulteration with synthetic drugs, heavy metal contamination, storage and extraction. This review focuses on organ specificity, seasonal variations, the effect of drying and storage, and the extraction of phytochemical constituents. Special emphasis is placed on the four most frequently used herbal products in the USA: echinacea, Ginkgo biloba, ginseng and St John's Wort.

We report a case of severe unilateral epistaxis requiring surgical arrest of bleeding, via endoscopic sphenopalatine artery ligation and anterior ethmoidal artery ligation. This followed recreational nasal insertion of St John's wort (Hypericum perforatum). Interactions between this substance and prescribed drugs have been described following oral ingestion. However, this unusual case highlights a further, worrying potential rhinological side effect of this substance.