Yet consumers who buy high street herbal remedies risk organ damage, interactions with prescription medicines and other health problems, experts have warned. In two serious incidents women taking black cohosh to relieve menopause symptoms suffered severe liver damage. One was so badly affected she needed a liver transplant.



At least 14 other cases of liver problems linked to the herbal remedy have been reported in the UK and there have been similar incidents in the United States, Germany, Sweden and Australia.



Despite previous warnings about the potential dangers of black cohosh, a member of the buttercup family, the products involved in the recent cases were sold as food supplements which are not subject to the same stringent controls and safety checks as herbal medicines.



Alan Henness, director of campaign group The Nightingale Collaboration, claims this puts lives in danger.



New rules which came into effect last April are designed to protect consumers from unregulated alternative remedies but a cursory check of any high street health shop reveals hundreds of medicinal herbs, such as echinacea, ginkgo biloba and agnus castus are still being sold as food or dietary supplements.



Richard Woodfield, group head of herbal medicines at the Medicines and Healthcare products Regulatory Agency (MHRA), which polices the industry, says: "Some companies appear to be evading the requirements by presenting their products as herbal food supplements.



"We recognise that as an issue and have been taking action."



HE ADDS that this is a laborious process as products are assessed on a case by case basis. European courts have also muddied the water by ruling that at low doses some herbal products can be sold as foods while at a higher dose they should be considered medicines.



Peter Bradley, chairman of the British Herbal Medicine Association, says: "There is a lack of clarity on which products ought to be classified food supplements. Clearly anything which makes a medicinal claim is medicinal."



High street health chain Holland & Barrett is the most recent to fall foul of these rules. In January it was ordered to recall a blend of black cohosh and agnus castus called Flash Fighters which it was selling as a food supplement.



A spokesman for the chain confirmed: "The MHRA stated the product's name implied it could be used to treat 'hot flushes'." He added that the store is undergoing the process of having Flash Fighters reclassified under the Traditional Herbal Medicine Registration Scheme (THR).



Regulators in Ireland have resolved the problem by producing a "positive list" of herbs which have not traditionally been eaten as foods and should not be sold as food supplements."



Mr Bradley would like to see similar controls here. "It does need clarity," he says. "I believe there is a good deal to be said for a positive list setting out which herbs are medicinal and which can also be sold as food supplements." The MHRA estimates that one in three of us has used a herbal remedy at some time.



Professor Edzard Ernst, world's first professor of complementary medicine, warns: "The notion that natural equals safe can be dangerously misleading."



So how can consumers protect themselves? RICHARD Woodfield says: "If you want to take a herbal medicine make sure that you buy one made to assured standards, identifiable by the THR number and logo."



This means the product is licensed and is made to pharmaceutical standards, meets strict guidelines for safety and quality, contains a consistent dose and includes information on any potential drug interactions or adverse reactions.



All carry a THR number and are easily recognisable by having braille on the pack and come with an information leaflet on possible drug interactions and side effects.



However the Nightingale Collaboration, which challenges questionable health claims, believes the THR scheme does not go far enough.



Alan Henness says: "The THR scheme does help to ensure herbal products are manufactured correctly and that appropriate instructions are given to purchasers but it says nothing about whether the products actually do what is claimed."



Instead medicinal claims are based on evidence of "traditional use" although in some cases there are also studies which suggest some efficacy. The guide on the right is based on published studies from the US National Institutes of Health (NIH), the US governmentbacked National Center for Complementary and Alternative Medicine (nccam.nih.gov) and alerts issued by the MHRA.



Always tell your doctor and pharmacist if you are using any alternative remedies.

