Evidence-Based Phytotherapy in Europe: Where Do We Stand?

Abstract

Medicinal plants represent the oldest source of pharmacotherapy used by mankind. A considerable number of traditional systems of medicine (folk medicine) have emerged over the last millennia under different cultural conditions. Even nowadays, the majority of people in less developed countries have to rely on herbal remedies as primary health care. Based on scientific and technical progress, the options to produce high quality herbal medicinal products have been largely improved in the last decades. The acceptance of phytotherapy as a "natural and mild alternative" to synthetic drugs is very high within the general public in developed countries and, from a global perspective, sales figures of herbal medicines are constantly rising. However, we still face many issues in this field. In contrast to the popularity of herbal medicinal products, physicians and their respective societies often have a very critical view of them. Besides dogmatic obstacles, this is based on the frequently missing clinical trials that clearly demonstrate their efficacy and/or safety. This perspective discusses the reasons and implications of the lack of scientific evidence and also of the wrong understanding of the principles of rational phytotherapy.

Immunosuppressive Activity of Artemisia argyi Extract and Isolated Compounds

“…This suggests that the A. argyi extract likely contains compounds affecting signaling on a more upstream target than the compounds isolated thus far. Our findings corroborate the notion of a multitarget effect of herbal extracts possibly resulting in pharmacological synergism (Fürst and Zündorf, 2015;Colalto, 2018). The study also demonstrates that the established cell-based screening platform approach is a powerful tool for identifying and characterizing potential immunosuppressive leads from natural product sources.…”

What phytotherapy needs: Evidence‐based guidelines for better clinical practice

“…For herbal medicinal products, traditional use may guarantee efficacy, but scientific data on safety and mechanisms of action useful to clinical practice (Claeson, ; Cravotto, Boffa, Genzini, & Garella, ; Turner, ) are available for very few medicinal plants. An interesting article by Fürst and Zündorf on “Evidence‐Based Phytotherapy in Europe” outlined the state of the art of herbal medicinal products, focusing on the quality and safety of these products, scientific evidence, and the regulatory system (Fürst & Zündorf, ). The authors gave a clear report and analysis of a number of problems arising here.…”

“…The clinical investigation of plant extracts is often difficult in view of the high heterogeneity of the mixtures examined, but also as a result of bias regarding numbers of patients, duration of treatment, and other similar things. The authors concluded by outlining the strange discrepancy between the wide availability of these products and the frequently poor scientific information (Fürst & Zündorf, ). In a similar vein, the review of Izzo et al noted that a high number of systematic reviews had been published on the clinical efficacy of herbal extracts but warned that the reported evidence is often weakened by poor methodology and thus unreliable clinical analysis.…”

“…Modern scientific research has confirmed the importance of these molecules and the ability of extracts to work in synergy with all components, focusing on improving efficacy and safety of their use in patient care. In parallel, production quality control has led to the discovery of new molecules and standardised extracts, so allowing a wide repertoire of medicinal‐plant‐based medications to be built up ( Fürst & Zündorf, ). Whereas modern pharmacology began with the study of traditional medicinal plants, going on to study individual molecules and standardised extracts, modern pharmacognosy concentrates on improving research and discovering new properties of an increasingly large number of medicinal plants.…”

Viability of Human Gingival Fibroblast (FGH) Treated with Ethanolic "Aroeira" Extract (Myracrodruon urundeuva Allemão)

“…The phytotherapeutics are standardized vegetable preparations that consist of a complex mixture of plant-based substances that are adequately prepared and prescribed in compliance with applicable legislation (Bettega et al 2011;Oliveira 2014, Fürst andZündorf 2015). Phytotherapeutic compounds, in general, can be used in a variety of formula such as capsules, tablets, gels, ointments, aqueous solutions, and infusions, such as tea (Francisco 2010).…”