Honey is becoming accepted as a reputable and effective therapeutic agent by practitioners of conventional medicine, and by the general public. This has been a consequence of there being an increasing awareness of the good clinical results that are obtained, and of there being rational explanations for its therapeutic actions. Further establishing this recognition of honey as a medicine involves a combination of literature research and laboratory research to obtain evidence and explanations of the therapeutic effectiveness of honey, and educating medical practitioners and the general public about the results of this research. Increasingly the medical profession is requiring evidence-based decisions on therapeutic options.

There are many reports in the medical literature of honey being very effective as a dressing for wounds, burns and skin ulcers: inflammation, swelling and pain are quickly reduced, malodour is reduced, shedding of dead tissue is induced so surgical removal is unnecessary, healing occurs rapidly with minimal scarring and with no need for skin grafting, and infection is rapidly cleared. A moist environment is created which promotes the growth of new skin tissue. Although a moist environment also favours the growth of infecting bacteria, the antimicrobial properties of honey prevent infection. But unlike other antiseptics, honey is not harmful to tissues, and actually speeds up the growth of new tissue to heal the wound.

Most practitioners have not been aware that there is a marked variation in the potency of the antimicrobial activity of honey, due mainly to differences in the amount of hydrogen peroxide generated, but sometimes to additional antimicrobial components from specific plant sources. Honey from manuka (Leptospermum scoparium) has an exceptionally high level of plant-derived antibacterial activity. The most common wound-infecting species of bacteria, Staphylococcus aureus, has been found to be particularly sensitive to this. All of the common wound-infecting species of bacteria have been tested and found to be sensitive to both types of antibacterial activity in honey. Clearing bacterial infection from a wound is essential to allow the healing process to occur. Recent tests carried out in collaboration with the Central Public Health Laboratory in London, UK, on many strains of multi-antibiotic-resistant bacteria such as MRSA strains MRSA, VRE and Acinetobacter baumarii have shown that these bacteria have no resistance to honey. (These "superbugs" are a serious clinical problem as infections with them often cannot be treated at all with antibiotics.) All of the testing of sensitivity of wound-infecting species of bacteria that we have carried out has been done with honeys selected to have mid-range levels of antibacterial activity. These have been found to have ten to fifty times more activity than is needed to completely suppress the growth of the bacteria tested. Although this may suggest that therefore other less potent honeys would be suitable for use on wounds, it should be taken into account that honey gets diluted by serum exuding from wounds, and that the depth of penetration of an effective level of antibacterial activity depends on the strength of the activity on the surface.

The hydrogen peroxide generated in honey is responsible for some of the other therapeutic effects seen in wound treatment as well as for the antibacterial activity. It stimulates the growth of the cells responsible for replacing damaged tissue. Additionally it has an insulin-like effect on cells which would be expected to be beneficial to the healing process as application of insulin to wounds aids healing. It also stimulates the development of new blood vessels, a key first step in tissue regeneration. It serves as a messenger between the different types of cells involved in the immune response of the body to infection. It also activates protein-digesting enzymes in tissues which are involved in the healing process. Although hydrogen peroxide is generally an inflammatory substance, the enzymic generation in honey gives only low levels. Also, antioxidants in honey prevent the formation of free radicals which are responsible for this inflammatory effect. The antioxidants in honey are also the likely explanation of the anti-inflammatory action of honey.

The acidity of honey and its content of sugars and other nutrients are also important for the promotion of the healing process. Acidification of a wound prevents ammonia from bacterial metabolism being harmful to the body tissues. It also increases the release of oxygen from haemoglobin in the blood, oxygenation of the tissues being essential for growth of new tissue. Another important factor for growth of new tissue is a supply of nutrients, usually limited because of damage to the underlying circulation resulting from injury or infection. Honey will supply the cells with a wide range of vitamins, amino acids and minerals. It will also supply white blood cells with the glucose necessary for their "respiratory burst" to destroy bacteria. Further, it will supply nutrients to the cells by drawing serum out through the tissue by osmosis induced by the high sugar content of honey. This is what creates the moist environment for healing, preventing the deformity that would result if the re-growth were forced down by a dry scab forming on the surface. It also serves to create a film of liquid between the tissues and the dressing, which allows the dressing to be lifted off painlessly and without tearing off the recently re-grown cells. Another benefit is that it serves to reduce swelling in the surrounding inflamed tissue, and thus reduces a major cause of pain. The sugar content of honey also eliminates the unpleasant odour associated with major burns and skin ulcers, as the infecting bacteria use the sugar from the honey in preference to amino acids from the serum and dead cells, from which amines and sulphur compounds are produced.

Other traditional therapeutic uses of honey, for peptic ulcers, diarrhoea, eye infections, and throat infections, have also been researched to find evidence for their effectiveness. Clinical trials have been reported in which honey was found to be effective in the treatment of peptic ulcers and diarrhoea, and a clinical reports of the use of honey for the treatment of eye infections indicate that the treatment is effective. Laboratory research has been carried out that demonstrates that the bacteria that cause these infections are sensitive to the antibacterial action of honey.

In addition, laboratory research has been carried out to establish if there is a rational basis for trialing honey treatment of fungal infections of the skin, for protection of dental health, and treatment of mastitis in dairy cows and goats. In all of these it has been found that the microorganisms involved are sufficiently sensitive to the antimicrobial action of honey for a good therapeutic effect to be expected.

Clinical trials are currently being undertaken to measure the effectiveness of honey as a treatment for persistently non-healing wounds, for eczema, and for mastitis in dairy cattle.