Herbal supplements are a $13 billion business, and herbalists need no license

Key takeaways

• In the U.S., herbs are usually sold as dietary supplements, and the FDA has no authority to check them for safety or effectiveness before they go on sale¹.
• In a 2012 national survey, 17.7% of U.S. adults used natural products other than vitamins and minerals, more than any other complementary health approach².
• The U.S. has no license for herbalists, though the American Herbalists Guild’s Registered Herbalist status asks for about 800 hours of study plus about 400 hours of clinical practice⁴⁵.
• At eight U.S. centers that track drug-caused liver injury, herbs and other supplements rose from 7% to 20% of cases between 2004 and 2013¹².
• Before you start any herb, know the plant, the part, the preparation and the dose, and check it against every medicine you take¹¹⁵.

The top-selling herbal supplement in America’s mainstream stores isn’t a rare root from a distant rainforest. It’s psyllium, the seed husk in many fiber powders. In 2024 it led that sales channel for the third year in a row, with about $290 million in sales³.

Altogether, Americans spent $13.23 billion on herbal supplements in 2024, up 5.4% from $12.55 billion in 2023³. That estimate comes from the American Botanical Council, an industry-supported nonprofit, using data from two market research firms³. Read it as an industry figure.

Federal survey data point the same way. In the 2012 National Health Interview Survey, 17.7% of U.S. adults used dietary supplements other than vitamins and minerals, a group that includes herbs². That made these products the most common complementary health approach, ahead of deep breathing, yoga and meditation².

Now the surprise: anyone can call themselves an herbalist. The American Herbalists Guild (AHG), a professional group for clinical herbalists, says the U.S. has no license and no legal recognition for them⁴.

No state or federal agency recognizes school titles such as “Master Herbalist” or “Certified Herbalist”⁴.

So the herbs are everywhere, and the guardrails are thin. Knowing what herbalism is, who practices it and how products are regulated is the first step toward using plants well.

This article opens our series on herbs and home remedies. Companion articles trace medicinal plants through history, compare traditional uses with clinical evidence, and explain how teas, tinctures, extracts and topicals differ.

Herbalism means using plants as medicine, from a cup of tea to a clinic

Herbalism is the practice of using plants, or preparations made from them, to support health or ease illness. It can be as simple as a cup of chamomile at bedtime. It can be as involved as a custom blend from a trained practitioner who has taken your full health history.

The National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, notes that herbal supplements are also called botanicals. Under federal law, they are a type of dietary supplement: a product taken by mouth, labeled as a supplement and containing one or more herbs¹.

Three details turn a vague “herb” into something you can judge.

• The plant. Common names can fool you. Black cohosh and blue cohosh sound like cousins, yet they are different plants with very different risks¹⁴.
• The part. Roots, leaves, flowers, seeds and bark hold different compounds. Black cohosh products, for example, use the root or the rhizome, an underground stem¹⁴.
• The preparation. A tea, an alcohol tincture and a capsule of concentrated extract can deliver very different amounts. NCCIH warns that the product on a store shelf may not match the one researchers tested¹.

Four living traditions, each with its own roots

Herbalism is a family of traditions, each with its own teachers, texts and ways of matching plants to people.

Western herbalism grew out of European folk practice and the herbal books of Greek, Roman, Arabic and medieval writers, later blended with North American plant knowledge. Our companion article on medicinal plants throughout history traces that long story. In the U.S. today, its professional side includes clinical herbalists and groups such as the AHG⁴.

Traditional Chinese medicine (TCM) has developed over thousands of years, according to NCCIH, and its practitioners use herbal products alongside acupuncture and other methods¹⁰. In the U.S., Chinese herbal skills are often part of acupuncture licensing. In 2023, 15 states required passing the national certification board’s Chinese herbology exam to get a license⁸.

Ayurveda, from India, is one of the world’s oldest medical systems, NCCIH says⁹. Its remedies come mainly from plants, but some include animal products, metals or minerals⁹. NCCIH estimates that about 240,000 American adults use Ayurvedic medicine, and no U.S. state requires its practitioners to hold a license⁹.

Indigenous plant knowledge belongs to many distinct nations and communities, each with its own plants, ceremonies and rules about who may share what. Some of it is sacred or meant only for community members. The respectful path is to learn only what is freely offered and to credit the people who hold it. Our articles on traditional knowledge and on telling cultural health stories truthfully cover consent, credit and benefit-sharing.

Folk and family herbalism is where most people first meet herbs: the ginger tea, the garden mint, the remedy a grandparent swore by. It deserves respect, and it deserves the same safety checks as anything you buy.

For the philosophies behind these systems, such as doshas and qi, see our article on old healing philosophies.

Who’s who: titles that sound official and titles that are

Because the word “herbalist” is unregulated, the person across the counter could have years of supervised training or a weekend course. This table sorts the titles you are most likely to see.

Title you may see	What stands behind it	Government license?
“Herbalist,” “Master Herbalist,” “Certified Herbalist”	Whatever a school or person decides; no state or federal agency recognizes these titles4	No
AHG Registered Herbalist (RH)	About 800 hours of herbal education and about 400 hours of clinical practice, including 100 supervised or mentored5; a scored application with case histories and references6	No; a professional credential
Licensed naturopathic doctor (ND or NMD)	A four-year graduate program accredited by the Council on Naturopathic Medical Education, plus national board exams; herbs are a common treatment7	Yes, in states that license them; rules vary7
Acupuncturist with Chinese herbology credentials	National certification exams; 15 states required the Chinese herbology exam for licensure in 20238	Yes, where states regulate acupuncture8
Ayurvedic practitioner	Training varies widely; little U.S. regulation of practice or schools9	No state license9

The RH application is more than a fee. Applicants submit three case histories from their own practice and two letters of recommendation. Three to five members of an admissions committee that includes 11 Registered Herbalists score each one⁶. When we checked in October 2026, AHG said submissions were paused while it updates the process⁶.

Naturopathy is a separate profession, though herbs are part of it. NCCIH says the profession more than doubled from 2000 to 2016, to an estimated 5,000 licensed practitioners⁷. Traditional naturopaths trained in programs without that accreditation can’t be licensed⁷.

Our article on how state licensing works explains what a license does and doesn’t promise.

In the U.S., herbs are sold as supplements, not tested drugs

Most herbal products in American stores are dietary supplements. The FDA has no authority to check them for safety and effectiveness before they go on sale, and their manufacturing rules are looser than those for prescription or over-the-counter drugs¹. Our articles on supplement label claims and on the history of natural health movements explain the law behind this system.

That doesn’t make every product poor. It means the burden of checking falls more heavily on you and the people advising you.

Europe takes a different route. Since a 2004 directive, many herbal medicines there can be sold through a simplified “traditional use” registration. The product must show at least 30 years of medicinal use, including at least 15 years in the European Union¹¹.

Notice what that registration does and doesn’t require. Companies must supply a full quality dossier, follow good manufacturing practice and track side effects¹¹. But they don’t have to run clinical trials on safety and effectiveness, as long as safety data are sufficient and the benefit is plausible from long use¹¹. The European Medicines Agency’s herbal committee also writes official monographs on individual herbs¹¹.

In other words, even Europe’s stricter system treats “traditional” and “proven” as different categories. The U.S. also has an FDA pathway for plant-based prescription drugs, which our article on plant-derived medicines describes.

What the evidence shows for a few well-known claims

Herbs don’t share one verdict. Each plant, part and preparation has its own record, and many have never been well tested. Here is how several claims rate on our four-level scale.

Claim	Evidence level	What the research shows
Some herbs change how prescription drugs work	Strong evidence	St. John’s wort speeds up enzymes and a gut “pump” that clear many drugs, with documented interactions15
Black cohosh extract eases menopause hot flashes	Promising but early	A 2023 review of 22 studies found possible benefit for overall symptoms and hot flashes, but not mood14
Chinese herbal products for the conditions studied	Not enough evidence	Many studies have been poor quality, so no firm conclusions can be drawn10
A remedy backed only by long use	Not enough evidence	Europe registers such products without new trials, a sign that tradition and proof are separate11
Ginkgo taken with the blood thinner warfarin	Evidence says no, or unsafe	Linked to a higher risk of major bleeding15
Blue cohosh used to bring on labor	Evidence says no, or unsafe	Tied to life-threatening complications in newborns, including seizures14

Our upcoming article on traditional uses versus clinical evidence looks at this gap in more depth.

The safety basics: liver, interactions, look-alikes, pregnancy and children

Liver injury. The Drug-Induced Liver Injury Network, a group of eight U.S. referral centers, studied 839 patients enrolled from 2004 to 2013¹². Herbs and other supplements accounted for 7% of its liver injury cases at the start and 20% by the end¹². Supplements other than bodybuilding products led to death or a liver transplant in 13% of those cases, compared with 3% for conventional medicines¹². The lead author cautioned that the network’s patients don’t show a national trend¹².

NIH’s free LiverTox database, run by the National Institute of Diabetes and Digestive and Kidney Diseases, covers liver injury from medicines and selected herbs and supplements¹³. Its entries include ashwagandha, black cohosh, comfrey, green tea and kava¹³.

Interactions. St. John’s wort has documented interactions with birth control pills, the blood thinner warfarin, the heart drug digoxin and the transplant drug cyclosporine¹⁵. In one study of healthy adults, goldenseal lowered blood levels of the diabetes drug metformin by about 25%¹⁵. Our article on telling your doctor about supplements explains why the conversation matters.

Wrong plants and hidden ingredients. Some black cohosh products have contained the wrong herb or undisclosed mixtures¹⁴. NCCIH reports that some TCM products have contained undeclared drugs such as warfarin, heavy metals or incorrect herbs that caused organ damage¹⁰. Some products sold for weight loss, sexual improvement and bodybuilding have been found to hide prescription drugs¹. Our article on supplement contamination covers testing and recalls.

Pregnancy, breastfeeding and children. Many supplements have never been tested in pregnant women, nursing mothers or children¹. Black cohosh may not be safe during pregnancy or breastfeeding¹⁴. Goldenseal shouldn’t be used then or given to infants, because its compound berberine can cause or worsen jaundice in newborns¹⁵.

When to get help. Call your clinician promptly if any of these apply:

• You notice dark urine or unusual tiredness while taking an herb¹⁴, or yellowing skin or eyes, called jaundice, which showed up in the network’s bodybuilding-supplement cases¹².
• You take warfarin, digoxin, cyclosporine or birth control pills, all with documented St. John’s wort interactions, and want to add any herb¹⁵.
• You are pregnant, nursing, or thinking about giving an herb to a child¹.
• You have surgery coming up, since some supplements pose risks around surgery¹.

Questions to ask, and a safe-start checklist

Use these questions with an herbalist, a naturopath, an acupuncturist or a store clerk. A good practitioner will welcome them.

Seven questions to ask before you buy or book

1. What training do you have, and who reviewed it? Ask for hours of study and supervised practice, and compare them with the AHG’s benchmark of roughly 800 and 400⁵.
2. Are you licensed in this state, and for what?
3. Which plant species, which part and which preparation are you recommending, and at what dose?
4. Which parts of this advice rest on tradition, and which on studies in people?
5. How will we know if it’s working, and when will we stop if it isn’t?
6. How does this fit with my medicines, and will you share your plan with my doctor?
7. Do you sell the products you recommend, and how do you check that each batch is the right plant and free of contaminants?

A safe-start checklist

• Start one herb at a time, so you know what caused any change.
• Choose a product that names the species and plant part.
• Write down the product, lot number, dose and start date.
• Ask a pharmacist to check it against your prescriptions.
• Look up the herb on NCCIH’s fact sheets and in LiverTox¹³.
• Skip herbs during pregnancy and nursing, and for children, unless a clinician who knows herbs agrees¹.
• Set a check-in date to decide whether it’s helping.
• Bring the bottle to every medical visit.

Respecting plants means taking their power seriously

If you turn to herbs, you probably already believe plants are powerful. That belief is well founded, and it cuts both ways. A plant strong enough to ease a symptom is strong enough to change how a prescription works or to strain a liver.

Respect for herbal traditions also means honoring their own standards. Skilled herbalists in every tradition care about the right plant, the right part, the right preparation and the right person. Those are the same questions modern safety science asks.

You don’t have to choose between tradition and evidence. Use tradition to decide what’s worth trying, evidence to decide what’s worth keeping, and your clinicians as partners along the way.

Questions readers ask

The bottom line

Herbalism is one of humanity’s oldest ways of caring for the body, practiced today in kitchens, shops and clinics across many traditions. In the U.S., though, herbalists aren’t licensed and herbal supplements don’t need FDA review before sale.

That makes you the first line of quality control. Ask who is advising you and what training they have. Know the exact plant, part, preparation and dose, check it against your medicines, and take extra care in pregnancy and with children. Respecting plants means respecting their strength.

Related reading

• The Iceman carried a fungus, and America’s first drug list was two-thirds plants
• How to judge a cup of herbal tea, which is gentle but not automatically harmless
• What happens when you don’t tell your doctor about supplements
• What gets into supplements that isn’t on the label
• Plants gave us Taxol and digoxin, yet the herb isn’t the drug

Sources

1. National Center for Complementary and Integrative Health. “Using Dietary Supplements Wisely.” NIH, last updated January 2019, accessed October 2026. nccih.nih.gov
2. National Center for Complementary and Integrative Health. “10 Most Common Complementary Health Approaches Among Adults, 2012” (from Clarke TC et al., National Health Statistics Reports No. 79, 2015). NIH, accessed October 2026. nccih.nih.gov
3. SupplySide Supplement Journal. “ABC report shows herbal supplement sales topped $13 billion in 2024” (reporting the American Botanical Council’s 2024 Herb Market Report; ABC is industry-supported). 2025. supplysidesj.com
4. American Herbalists Guild. “Herbal Education FAQs.” AHG, accessed October 2026. americanherbalistsguild.com
5. American Herbalists Guild. “AHG Suggested Education Guidelines.” AHG, accessed October 2026. americanherbalistsguild.com
6. American Herbalists Guild. “Become a Registered Herbalist: How to Apply.” AHG, accessed October 2026. americanherbalistsguild.com
7. National Center for Complementary and Integrative Health. “Naturopathy.” NIH, last updated April 2025. nccih.nih.gov
8. National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM; renamed the National Certification Board for Acupuncture and Herbal Medicine, NCBAHM, in January 2026). “NCCAOM 2023 Annual Report,” state licensure page. Accessed October 2026. ncbahm.org
9. National Center for Complementary and Integrative Health. “Ayurvedic Medicine: In Depth.” NIH, last updated January 2019. nccih.nih.gov
10. National Center for Complementary and Integrative Health. “Traditional Chinese Medicine: What You Need To Know.” NIH, last updated April 2019. nccih.nih.gov
11. European Medicines Agency. “Herbal medicinal products” (regulatory overview). EMA, accessed October 2026. ema.europa.eu
12. Wiley and Hepatology. “Liver Injury Caused by Herbals, Dietary Supplements Rises in Study Population” (on Navarro VJ et al., “Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network,” Hepatology, 2014). News release, September 3, 2014. investors.wiley.com
13. National Institute of Diabetes and Digestive and Kidney Diseases. “LiverTox: Clinical and Research Information on Drug-Induced Liver Injury.” NIH, National Library of Medicine Bookshelf, 2012–present. ncbi.nlm.nih.gov
14. National Center for Complementary and Integrative Health. “Black Cohosh: Usefulness and Safety.” NIH, last updated November 2024. nccih.nih.gov
15. National Center for Complementary and Integrative Health. “Herb-Drug Interactions: What the Science Says.” NCCIH Clinical Digest, December 2024. nccih.nih.gov