Complementary Medicine: Flower remedies and emotional problems

Flower remedies are popular, but too few trials have examined their efficacy, argues Professor Edzard Ernst

Remedies are produced by placing sun-exposed flowers into water
Remedies are produced by placing sun-exposed flowers into water

Flower remedies, often also called Bach flower remedies, or flower essences, are specially prepared, highly diluted plant infusions administered orally with a view to balancing physical and emotional disturbances.

They were invented by Dr Edward Bach, a microbiologist at the Royal London Homeopathic Hospital in the early part of the 20th century.

Inspired by both homoeopathy and psychoanalysis, Dr Bach developed a new system of medicine in which all human disease and suffering are rooted in emotional imbalances.

He identified 38 flower  remedies that he believed  could treat most illnesses. Numerous other flower remedies have since been added.

Flower remedies

According to proponents, flower remedies are not targeted at specific medical conditions, but at underlying emotional imbalances. Dr Bach was convinced that all disease and illness was the result of conflict between the soul and mind. Therefore these treatments might be employed as an adjunct for virtually all medical conditions. For instance, ‘rescue remedy’ (five-flower remedy) is promoted as a first aid for all sorts of emergency situations.

The original 38 remedies are divided into seven therapeutic groups according to various emotions (see box). Bach associated each of these emotions with flowers that would be used to treat the underlying imbalances.

Diluted remedies

The  remedies are produced by placing freshly picked, sun-exposed flowers into spring water; brandy is added later for preservation. Being highly diluted, the remedies work not through pharmacological action but, proponents claim, through their ‘energy’.

‘The vibration frequency of the Bach  flower concentrate corresponds with the negative collective human psychic conditions and helps to transform them.’

‘Bach flower remedies’ is a brand name, but there are other  flower  remedies on the market, produced along the lines of Dr Bach’s specifications. Prescription by specialised therapists is intuitive.

Therapists are rarely medically qualified and often use flower remedies in conjunction with other forms of complementary medicine.

In 2000, it was estimated that the UK Edward Bach Foundation, which sets standards for the use of flower  remedies and registers practitioners, had about 550 members. However, as registration is optional, the number of therapists practising in the UK could be substantially higher.  Flower remedies are sold OTC for self-medication. 

Specialist practitioner

Many users will not see a specialised practitioner. If they do, the encounter will include a detailed history with little or no physical examination. An expert from the UK Mount Vernon Bach Centre explained that Bach ‘dispenses completely with uncomfortable clinical examinations, basing his treatment on temperament alone’.

The therapist prescribes the remedy that is, according to their intuition, best suited for that individual. In many cases, one prescription constitutes a full treatment. For persistent complaints, several sessions may be recommended and the total cost may be substantial. 

Millions of people use  flower remedies and believe they work. Advocates do not seem to believe scientific proof of efficacy is necessary.

Proof of efficacy

Others insist, perhaps erroneously, that science cannot prove the efficacy of flower  remedies. There are numerous anecdotal reports about therapeutic successes, but few controlled clinical trials. Results are inconclusive, not least because of methodological weaknesses. Robust studies have failed to show effects beyond placebo.

Examination stress was measured in 100 students recruited to a randomised, placebo-controlled double blind trial. No differences in stress levels were noted in those using five-flower remedy compared with placebo.

A similar trial found 61 students responded positively to both rescue remedies and placebo, with no difference between the two. The authors concluded that Bach flower  remedies were an ‘effective placebo for test-anxiety, which do not have a specific effect’.

A review uncovered no further rigorous studies, but latest research shows that, for children with attention deficit disorder, flower remedies are no more effective than placebo.

Because flower remedies contain only low concentrations of pharmacologically active ingredients, apart from alcohol, there is little risk of adverse effects.  There is no reliable evidence suggesting flower remedies generate clinical effects that differ from placebo. Their risk– benefit balance is not positive.

Professor Ernst is director  of complementary  medicine,  Peninsula  Medical School, Universities of Exeter and Plymouth

Emotion groups

Dr Bach’s seven therapeutic groups:



Lack of interest in the present.


Over-concern for the welfare of others.




Balinski A. Use of Western Australian flower essences in the management of pain and stress in the hospital setting. Complement Ther Nurs Midwifery 1998; 4: 111–7.

Barnard J. Bach flower remedies: form and function. Great Barrington: Lindisfarne Press; 2004.

Scheffer M Von. Sonne, Wasser, Blüten – die Bach-Potenzierung. Erfahrungsheilkunde 1992; 41: 421–5.

Mills S, Budd S. Professional organisation of complementary and alternative medicine in the UK. 2000. A second report to the Department of Health. Exeter: Centre for Complementary Health Studies, Exeter: Centre for Complementary Health Studies; 2000.

Howard J. Complement Ther Nurs Midwifery 1998; 4: 148–9.

Remedy Research. Bach Centre Newsletter 1998; May (7): 11.

Armstrong N C, Ernst E. A randomized; double-blind; placebo-controlled trial of Bach Flower Remedy Perfusion 1999; 11: 440–6.

Walach H et al. Efficacy of Bach-flower remedies in test anxiety: a double-blind, placebo-controlled, randomized trial with partial crossover. J Anxiety Disord 2001; 15: 359–66.

Ernst E. Flower remedies: a systematic review of the clinical evidence. Wien Klin Wochenschr 2002; 114: 963–6.

Pintov S, Hochman M, Livne A, et al. Bach flower remedies used for attention deficit hyperactivity disorder in children — a prospective double blind controlled study. Eur J Paed Neurol 2005; 9: 395–8 .

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