On the pros and cons of utilizing crude herbal preparations as opposed to purified active ingredients, with emphasis on the COVID pandemic

Abstract

It is well recognized that many plants contain substances with pharmacological activities, and there is a large body of traditional knowledge regarding their use in different clinical situations. Yet, most physicians in the Western world are reluctant to use herbal preparations, mostly because there are no large-scale randomized controlled trials to support their application. In this Opinion Paper, which is not intended to be a comprehensive review of herbal or traditional medicine, we challenge this approach and propose that herbal treatments should be added to our armamentarium, even if cautiously. This pertains particularly to situations in which there are no existing well-studied, safe, and effective evidence-based approaches; the known pharmacological properties of the plant or plants being used are relevant to the pathophysiology of the disease and the safety profile of the herbal preparation is well established. Specifically, due to our own experience, we focus on the treatment of patients with COVID with the plant _Artemisia_, based on _in vitro_ studies and small clinical trials, as an example of the approach we propose.