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Interactive effect of air pollution and genetic risk of depression on processing speed by resting-state functional connectivity of occipitoparietal network

Air pollution, a reversible environmental factor, was significantly associated with the cognitive domains that are impaired in major depressive disorder (MDD), notably processing speed. Limited evidence explor...

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Adiposity and mortality among intensive care patients with COVID-19 and non-COVID-19 respiratory conditions: a cross-context comparison study in the UK

Adiposity shows opposing associations with mortality within COVID-19 versus non-COVID-19 respiratory conditions. We assessed the likely causality of adiposity for mortality among intensive care patients with C...

Sleep patterns, physical activity, genetic susceptibility, and incident rheumatoid arthritis: a prospective cohort study

Sleep and physical activity (PA) are thought to be interconnected with the development of rheumatoid arthritis (RA). However, the precise nature and extent of these relationships have yet to be fully quantifie...

Efficacy of respiratory support therapies during pulmonary rehabilitation exercise training in chronic obstructive pulmonary disease patients: a systematic review and network meta-analysis

Exercise training is fundamental in pulmonary rehabilitation (PR), but patients with chronic obstructive pulmonary disease (COPD) often struggle with exercise intolerance. Respiratory support during exercise i...

A systems serology approach to identifying key antibody correlates of protection from cerebral malaria in Malawian children

Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) proteins are expressed on the surface of infected erythrocytes, mediating parasite sequestration in the vasculature. PfEMP1 is a major target of prote...

The impact of an exercise and sport intervention on cognitive function and pain among forcibly displaced individuals at risk for PTSD: a secondary analysis of the SALEEM randomized controlled trial

In response to the global scope of forced displacement, international organizations highlight the need of scalable solutions to support individuals’ health and integration into host societies. Exposure to high...

Association of depressive symptoms with incidence and mortality rates of COVID-19 over 2 years among healthcare workers in 20 countries: multi-country serial cross-sectional study

Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the menta...

Replacement of sedentary behavior with various physical activities and the risk of all-cause and cause-specific mortality

Sedentary behavior (SB) has emerged as a significant health concern that deserves attention. This study aimed to examine the associations between prolonged sedentary behavior and the risk of all-cause and caus...

Evaluating the impact of extended dosing intervals on mRNA COVID-19 vaccine effectiveness in adolescents

Extending the dosing interval of a primary series of mRNA COVID-19 vaccination has been employed to reduce myocarditis risk in adolescents, but previous evaluation of impact on vaccine effectiveness (VE) is li...

Single-cell sequencing of the vermiform appendix during development identifies transcriptional relationships with appendicitis in preschool children

The development of the human vermiform appendix at the cellular level, as well as its function, is not well understood. Appendicitis in preschool children, although uncommon, is associated with a high perforat...

Between faces: childhood adversity is associated with reduced threat-safety discrimination during facial expression processing in adolescence

Childhood adversity has been associated with alterations in threat-related information processing, including heightened perceptual sensitivity and attention bias towards threatening facial expressions, as well...

Integration of clinical and blood parameters in risk prognostication for patients receiving immunochemotherapy for extensive stage small cell lung cancer: real-world data from two centers

Immune checkpoint inhibitors (ICIs) had modest advances in the treatment of extensive-stage small cell lung cancer (ES-SCLC) in clinical trials, but there is a lack of biomarkers for prognosis in clinical prac...

Global acute malnutrition is associated with geography, season and malaria incidence in the conflict-affected regions of Ouham and Ouham Pendé prefectures, Central African Republic

Ongoing conflict between multiple armed groups, including pastoralist herders in the Central African Republic (CAR) causes frequent population displacements, food insecurity and scarcity of healthcare services...

Helicobacter pylori seropositivity associates with hyperglycemia, but not obesity, in Danish children and adolescents

Helicobacter pylori colonizes the human stomach and may affect the inflammatory response, hormone production related to energy regulation, and gastrointestinal microbiota composition. Previous studies have explor...

Potential deprescribing indications for antidepressants between 2012 and 2019: repeated cross-sectional analysis in two Scottish health boards

Antidepressants have a pivotal role in the treatment of many psychiatric disorders, but there are concerns about long-term use and adverse effects. The objectives of this study were (1) to examine time trends ...

Development and validation of machine-learning models of diet management for hyperphenylalaninemia: a multicenter retrospective study

Assessing dietary phenylalanine (Phe) tolerance is crucial for managing hyperphenylalaninemia (HPA) in children. However, traditionally, adjusting the diet requires significant time from clinicians and parents...

IL-17A exacerbates corpus cavernosum fibrosis and neurogenic erectile dysfunction by inducing CSMC senescence via the mTORC2-ACACA pathway

Neurogenic erectile dysfunction, characterized by neurological repair disorders and progressive corpus cavernosum fibrosis (CCF), is an unbearable disease with limited treatment success. IL-17A exhibits a comp...

A deep learning model for differentiating paediatric intracranial germ cell tumour subtypes and predicting survival with MRI: a multicentre prospective study

The pretherapeutic differentiation of subtypes of primary intracranial germ cell tumours (iGCTs), including germinomas (GEs) and nongerminomatous germ cell tumours (NGGCTs), is essential for clinical practice ...

Addressing the credibility crisis in Mendelian randomization

Genome-wide association studies have enabled Mendelian randomization analyses to be performed at an industrial scale. Two-sample summary data Mendelian randomization analyses can be performed using publicly av...

Newborn DNA methylation age differentiates long-term weight trajectories: the Boston Birth Cohort

Gestational age (GEAA) estimated by newborn DNA methylation (GAmAge) is associated with maternal prenatal exposures and immediate birth outcomes. However, the association of GAmAge with long-term overweight or...

Trends in the healthiness and nutrient composition of packaged products sold by major food and beverage companies in New Zealand 2015 to 2019

Dietary risk factors are the leading cause of death globally and in New Zealand (NZ). Processed packaged foods are prevalent in the food supply and contribute excess amounts of sodium, saturated fat, and sugar...

Air pollution and risk of 32 health conditions: outcome-wide analyses in a population-based prospective cohort in Southwest China

Uncertainty remains about the long-term effects of air pollutants (AP) on multiple diseases, especially subtypes of cardiovascular disease (CVD). We aimed to assess the individual and joint associations of fin...

Has multimorbidity and frailty in adult hospital admissions changed over the last 15 years? A retrospective study of 107 million admissions in England

Few studies have quantified multimorbidity and frailty trends within hospital settings, with even fewer reporting how much is attributable to the ageing population and individual patient factors. Studies to da...

Cardiovascular health and cancer mortality: evidence from US NHANES and UK Biobank cohort studies

The American Heart Association recently introduced a novel cardiovascular health (CVH) metric, Life's Essential 8 (LE8), for health promotion. However, the relationship between LE8 and cancer mortality risk re...

Association of lifestyle with valvular heart disease progression and life expectancy among elderly people from different socioeconomic backgrounds

Current cardiovascular prevention strategies are based on studies that seldom include valvular heart disease (VHD). The role of modifiable lifestyle factors on VHD progression and life expectancy among the eld...

Effect of salt substitution on fracture—a secondary analysis of the Salt Substitute and Stroke Study (SSaSS)

Associations of dietary sodium and potassium intake with fracture risk are inconsistent and the effects of salt substitute on fracture incidence are unknown. We assessed the effect of salt substitute compared ...

Phase 1b study of first-line fuzuloparib combined with modified FOLFIRINOX followed by fuzuloparib maintenance monotherapy in pancreatic adenocarcinoma

Chemotherapy remains the standard first-line treatment for pancreatic adenocarcinoma, but with limited efficacy. We aimed to explore the feasibility of adding the PARP inhibitor fuzuloparib to mFOLFIRINOX in t...

The spatiotemporal associations between esophageal and gastric cancers provide evidence for its joint endoscopic screening in China: a population-based study

The spatiotemporal epidemiological evidence supporting joint endoscopic screening for esophageal cancer (EC) and gastric cancer (GC) remains limited. This study aims to identify combined high-risk regions for ...

Cancer incidence (2000–2020) among individuals under 35: an emerging sex disparity in oncology

Aggressive malignancies, such as pancreatic cancer, are increasingly impacting young, female populations. Our investigation centered on whether the observed trends in cancer incidence were unique to pancreatic...

Time-restricted eating with or without a low-carbohydrate diet improved myocardial status and thyroid function in individuals with metabolic syndrome: secondary analysis of a randomized clinical trial

Obesity and metabolic syndrome (MetS) have become urgent worldwide health problems, predisposing patients to unfavorable myocardial status and thyroid dysfunction. Low-carbohydrate diet (LCD) and time-restrict...

Hyperactivation of ATF4/TGF-β1 signaling contributes to the progressive cardiac fibrosis in Arrhythmogenic cardiomyopathy caused by DSG2 Variant

Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiomyopathy characterized with progressive cardiac fibrosis and heart failure. However, the exact mechanism driving the progression of cardiac fibrosis an...

New-onset obstructive airway disease following COVID-19: a multicenter retrospective cohort study

The study assessed the association between COVID-19 and new-onset obstructive airway diseases, including asthma, chronic obstructive pulmonary disease, and bronchiectasis among vaccinated individuals recoverin...

The association of psychological and trauma-related factors with biological and facial aging acceleration: evidence from the UK Biobank

Psychological and trauma-related factors are associated with many diseases and mortality. However, a comprehensive assessment of the association between psycho-trauma exposures and aging acceleration is curren...

Effects of fructan and gluten on gut microbiota in individuals with self-reported non-celiac gluten/wheat sensitivity—a randomised controlled crossover trial

Individuals with non-celiac gluten/wheat sensitivity (NCGWS) experience improvement in gastrointestinal symptoms following a gluten-free diet. Although previous results have indicated that fructo-oligosacchari...

A functional variant rs912304 for late-onset T1D risk contributes to islet dysfunction by regulating proinflammatory cytokine-responsive gene STXBP6 expression

Our previous genome‑wide association studies (GWAS) have suggested rs912304 in 14q12 as a suggestive risk variant for type 1 diabetes (T1D). However, the association between this risk region and T1D subgroups ...

Advances and counterpoints in type 2 diabetes. What is ready for translation into real-world practice, ahead of the guidelines

This review seeks to address major gaps and delays between our rapidly evolving body of knowledge on type 2 diabetes and its translation into real-world practice. Through updated and improved best practices in...

Sex disparity in the association between metabolic-anthropometric phenotypes and risk of obesity-related cancer: a prospective cohort study

Sex disparity between metabolic-obesity (defined by body mass index, BMI) phenotypes and obesity-related cancer (ORC) remains unknown. Considering BMI reflecting overall obesity but not fat distribution, we ai...

Integrating machine learning and artificial intelligence in life-course epidemiology: pathways to innovative public health solutions

The integration of machine learning (ML) and artificial intelligence (AI) techniques in life-course epidemiology offers remarkable opportunities to advance our understanding of the complex interplay between bi...

Cruciferous vegetables lower blood pressure in adults with mildly elevated blood pressure in a randomized, controlled, crossover trial: the VEgetableS for vaScular hEaLth (VESSEL) study

Higher cruciferous vegetable intake is associated with lower cardiovascular disease risk in observational studies. The pathways involved remain uncertain. We aimed to determine whether cruciferous vegetable in...

Radiogenomic profiling of global DNA methylation associated with molecular phenotypes and immune features in glioma

The radiogenomic analysis has provided valuable imaging biomarkers with biological insights for gliomas. The radiogenomic markers for molecular profile such as DNA methylation remain to be uncovered to assist ...

NLRC5 exerts anti-endometriosis effects through inhibiting ERβ-mediated inflammatory response

Endometriosis is well known as a chronic inflammatory disease. The development of endometriosis is heavily influenced by the estrogen receptor β (ERβ), while NOD-like receptors (NLRs) family CARD domain-contai...

Past trends and future projections of palliative care needs in Chile: analysis of routinely available death registry and population data

The number of people with palliative care needs is projected to increase globally. Chile has recently introduced legislation for universal access to palliative care services for patients with severe and termin...

Implementation of health-promoting retail initiatives in the Healthier Choices in Supermarkets Study—qualitative perspectives from a feasibility study

Improving food environments like supermarkets has the potential to affect customers’ health positively. Scholars suggest researchers and retailers collaborate closely on implementing and testing such health-pr...

Impact of a school-based water and hygiene intervention on child health and school attendance in Addis Ababa, Ethiopia: a cluster-randomised controlled trial

School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban...

Patient-reported outcome measures for medication treatment satisfaction: a systematic review of measure development and measurement properties

Medication Treatment Satisfaction (M-TS) from the patients’ perspective is important for comprehensively evaluating the effect of medicines. The extent to which current patient-reported outcome measures (PROMs...

Gender-affirming hormonal therapy induces a gender-concordant fecal metagenome transition in transgender individuals

Limited data exists regarding gender-specific microbial alterations during gender-affirming hormonal therapy (GAHT) in transgender individuals. This study aimed to investigate the nuanced impact of sex steroid...

Adulthood weight changes, body mass index in youth, genetic susceptibility and risk of atrial fibrillation: a population-based cohort study

Epidemiological evidence on weight change and atrial fibrillation (AF) remains limited and inconsistent. Previous studies on body mass index (BMI) in youth and AF rarely considered subsequent BMI. This study a...

Camrelizumab plus apatinib in patients with advanced or recurrent endometrial cancer after failure of at least one prior systemic therapy (CAP 04): a single-arm phase II trial

The combination of anti-programmed death 1 (PD-1) inhibitors and tyrosine kinase inhibitors is an effective treatment strategy in endometrial cancer. We aimed to explore the efficacy and safety of camrelizumab...

Pregnancy complications and autoimmune diseases in women: systematic review and meta-analysis

Pregnancy complications might lead to the development of autoimmune diseases in women. This review aims to summarise studies evaluating the association between pregnancy complications and the development of au...

No evidence that ACE2 or TMPRSS2 drive population disparity in COVID risks

Early in the SARS-CoV2 pandemic, in this journal, Hou et al. (BMC Med 18:216, 2020) interpreted public genotype data, run through functional prediction tools, as suggesting that members of particular human pop...

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Citation Impact 2023 Journal Impact Factor: 7.0 5-year Journal Impact Factor: 8.7 Source Normalized Impact per Paper (SNIP): 2.000 SCImago Journal Rank (SJR): 2.711 Speed 2023 Submission to first editorial decision (median days): 6 Submission to acceptance (median days): 145 Usage 2023 Downloads: 6,375,113 Altmetric mentions: 24,228

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At a glance: Research

Randomised controlled trials on radiation dose fractionation in breast cancer

Effectiveness of modified vaccinia Ankara-Bavarian Nordic vaccine against mpox infection

Effect of laughter exercise versus 0.1% sodium hyaluronic acid on ocular surface discomfort in dry eye disease

Suicide rates among physicians compared with the general population in studies from 20 countries

Comparative oral monotherapy of psychedelics and escitalopram for depressive symptoms

Research papers, measures of how well a vaccine works, long term exposure to road traffic noise and air pollution and risk of infertility in men and women, prostate cancer incidence and mortality in europe and implications for screening activities, developing clinical prediction models: a step-by-step guide, risk of dementia after initiation of sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors in adults aged 40-69 years with type 2 diabetes, clinical value of guideline recommended molecular targets and genome targeted cancer therapies: cross sectional study, reporting on data sharing: executive position of the equator network, intake of sugar sweetened beverages among children and adolescents in 185 countries between 1990 and 2018, decompression alone or with fusion for degenerative lumbar spondylolisthesis (nordsten-ds), estimating the economic effect of harm associated with high risk prescribing of oral non-steroidal anti-inflammatory drugs in england: population based cohort and economic modelling study, personal protective effect of wearing surgical face masks in public spaces on self-reported respiratory symptoms in adults, learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in china, intraosseous versus intravenous vascular access in upper extremity among adults with out-of-hospital cardiac arrest, covid-19 infection and vaccination during first trimester and risk of congenital anomalies, trends in long term vaping among adults in england, 2013-23, lee silverman voice treatment versus nhs speech and language therapy versus control for dysarthria in people with parkinson’s disease, effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes, reporting of surrogate endpoints in randomised controlled trial protocols (spirit-surrogate): extension checklist with explanation and elaboration, reporting of surrogate endpoints in randomised controlled trial reports (consort-surrogate): extension checklist with explanation and elaboration, trends in cardiovascular disease incidence among 22 million people in the uk over 20 years, colchicine in patients with acute ischaemic stroke or transient ischaemic attack, research news, covid-19: nearly 20% of patients receive psychiatric diagnosis within three months of covid, antibiotics are as good as surgery for appendicitis, study reports, black babies are less likely to die when cared for by black doctors, us study finds.

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Medical Research Paper Topics

This page provides a comprehensive list of medical research paper topics divided into 20 categories, each with 10 unique subjects. The categories span across various subfields, including anatomy and physiology, diseases, epidemiology, health and fitness, health disparities, healthcare, kinesiology, mental health, pharmacology, and veterinary medicine. Additionally, the page offers expert advice on choosing the right topic and crafting an impactful medical research paper. It also introduces iResearchNet’s writing services, which are designed to assist students in creating high-quality, custom medical research papers.

200 Medical Research Paper Topics:

Medical research is a vast and diverse field, offering a plethora of topics for students and researchers to explore. The choice of topic can significantly influence the direction of your research and the impact of your findings. Therefore, it’s crucial to choose a topic that not only interests you but also aligns with your academic and career goals. To assist you in this endeavor, we have compiled a comprehensive list of medical research paper topics, divided into 20 categories, each with 10 unique topics.

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1. Anatomy and Physiology:

The role of the lymphatic system in maintaining homeostasis.
The impact of aging on muscle function and structure.
The physiological effects of stress on the human body.
The role of the endocrine system in metabolism.
The impact of exercise on cardiovascular health.
The role of the nervous system in sensation and perception.
The physiological effects of sleep deprivation.
The role of the digestive system in nutrient absorption.
The impact of genetic factors on human physiology.
The role of the immune system in disease prevention.

2. Diseases:

The genetic and environmental factors contributing to the development of cancer.
The impact of lifestyle factors on the prevalence of heart disease.
The role of vaccination in the prevention of infectious diseases.
The challenges in the management and treatment of diabetes.
The impact of the human microbiome on disease development.
The role of inflammation in the pathogenesis of autoimmune diseases.
The challenges in the diagnosis and treatment of Alzheimer’s disease.
The impact of antibiotic resistance on the treatment of bacterial infections.
The role of genetic mutations in the development of rare diseases.
The impact of viral evolution on the spread of infectious diseases.

3. Epidemiology:

The impact of socioeconomic factors on the prevalence of infectious diseases.
The role of vaccination in the prevention of disease outbreaks.
The impact of climate change on the spread of vector-borne diseases.
The role of epidemiological studies in the development of public health policies.
The impact of population density on the spread of infectious diseases.
The role of epidemiology in the identification of risk factors for chronic diseases.
The impact of global travel on the spread of infectious diseases.
The role of epidemiological data in the management of disease outbreaks.
The impact of demographic factors on disease prevalence.
The role of epidemiology in the study of health disparities.

4. Health and Fitness:

The impact of physical activity on mental health.
The role of diet in the prevention of chronic diseases.
The impact of sedentary lifestyle on health.
The role of physical fitness in the prevention of heart disease.
The impact of obesity on health and lifespan.
The role of exercise in the management of stress.
The impact of nutrition on cognitive function.
The role of physical activity in the management of chronic diseases.
The impact of sleep on health and wellbeing.
The role of lifestyle interventions in the prevention of diabetes.

5. Health Disparities:

The impact of socioeconomic status on health outcomes.
The role of healthcare access in health disparities.
The impact of racial and ethnic disparities on health outcomes.
The role of social determinants of health in health disparities.
The impact of health literacy on health outcomes.
The role of cultural competence in reducing health disparities.
The impact of gender disparities on health outcomes.
The role of health policy in addressing health disparities.
The impact of environmental factors on health disparities.
The role of education in reducing health disparities.

6. Healthcare:

The impact of healthcare reform on patient outcomes.
The role of telemedicine in improving healthcare access.
The impact of health information technology on patient care.
The role of healthcare quality in patient satisfaction.
The impact of healthcare costs on health outcomes.
The role of healthcare leadership in improving patient care.
The impact of health insurance on healthcare access.
The role of healthcare innovation in improving patient outcomes.
The impact of healthcare policy on patient care.
The role of healthcare management in improving healthcare quality.

7. Kinesiology:

The impact of physical activity on muscle function.
The role of biomechanics in injury prevention.
The impact of exercise on cognitive function.
The role of kinesiology in the prevention of chronic diseases.
The impact of physical fitness on health outcomes.
The role of kinesiology in the management of sports injuries.
The impact of exercise physiology on athletic performance.
The role of kinesiology in the promotion of physical activity.
The impact of motor control on athletic performance.
The role of kinesiology in the study of human movement.

8. Mental Health:

The impact of stress on mental health.
The role of psychotherapy in the treatment of mental disorders.
The impact of mental illness on quality of life.
The role of mental health promotion in the prevention of mental disorders.
The impact of stigma on mental health outcomes.
The role of mental health services in the treatment of mental disorders.
The impact of mental health policy on mental health services.
The role of mental health literacy in the prevention of mental disorders.
The impact of mental health disparities on mental health outcomes.
The role of mental health research in improving mental health care.

9. Pharmacology:

The impact of drug interactions on patient safety.
The role of pharmacokinetics in drug development.
The impact of pharmacogenomics on personalized medicine.
The role of pharmacology in the treatment of diseases.
The impact of drug resistance on the treatment of infectious diseases.
The role of pharmacology in the management of pain.
The impact of drug abuse on public health.
The role of pharmacology in the prevention of drug interactions.
The impact of drug development on patient care.
The role of pharmacology in the study of drug action.

10. Veterinary Medicine:

The impact of zoonotic diseases on public health.
The role of veterinary medicine in the prevention of animal diseases.
The impact of veterinary medicine on food safety.
The role of veterinary medicine in the treatment of animal diseases.
The impact of veterinary public health on human health.
The role of veterinary medicine in the prevention of zoonotic diseases.
The impact of animal health on public health.
The role of veterinary medicine in the promotion of animal welfare.
The impact of veterinary medicine on animal behavior.
The role of veterinary medicine in the study of animal physiology.

11. Neurology:

The impact of neurodegenerative diseases on public health.
The role of neurology in the treatment of neurological disorders.
The impact of neurological research on patient care.
The role of neurology in the study of the nervous system.
The impact of neurological disorders on quality of life.
The role of neurology in the diagnosis of neurological disorders.
The impact of neurological diseases on mental health.
The role of neurology in the prevention of neurological diseases.
The impact of neurological disorders on cognitive function.
The role of neurology in the study of brain function.

12. Oncology:

The impact of cancer on public health.
The role of oncology in the treatment of cancer.
The impact of oncological research on patient care.
The role of oncology in the study of cancer.
The impact of cancer on quality of life.
The role of oncology in the diagnosis of cancer.
The impact of cancer on mental health.
The role of oncology in the prevention of cancer.
The impact of cancer on physical health.
The role of oncology in the study of cancer biology.

13. Cardiology:

The impact of heart disease on public health.
The role of cardiology in the treatment of heart disease.
The impact of cardiological research on patient care.
The role of cardiology in the study of the cardiovascular system.
The impact of heart disease on quality of life.
The role of cardiology in the diagnosis of heart disease.
The impact of heart disease on mental health.
The role of cardiology in the prevention of heart disease.
The impact of heart disease on physical health.
The role of cardiology in the study of heart function.

14. Endocrinology:

The impact of endocrine disorders on public health.
The role of endocrinology in the treatment of endocrine disorders.
The impact of endocrinological research on patient care.
The role of endocrinology in the study of the endocrine system.
The impact of endocrine disorders on quality of life.
The role of endocrinology in the diagnosis of endocrine disorders.
The impact of endocrine disorders on mental health.
The role of endocrinology in the prevention of endocrine disorders.
The impact of endocrine disorders on physical health.
The role of endocrinology in the study of hormone function.

15. Gastroenterology:

The impact of gastrointestinal disorders on public health.
The role of gastroenterology in the treatment of gastrointestinal disorders.
The impact of gastroenterological research on patient care.
The role of gastroenterology in the study of the gastrointestinal system.
The impact of gastrointestinal disorders on quality of life.
The role of gastroenterology in the diagnosis of gastrointestinal disorders.
The impact of gastrointestinal disorders on mental health.
The role of gastroenterology in the prevention of gastrointestinal disorders.
The impact of gastrointestinal disorders on physical health.
The role of gastroenterology in the study of digestive function.

16. Dermatology:

The impact of skin disorders on public health.
The role of dermatology in the treatment of skin disorders.
The impact of dermatological research on patient care.
The role of dermatology in the study of the skin.
The impact of skin disorders on quality of life.
The role of dermatology in the diagnosis of skin disorders.
The impact of skin disorders on mental health.
The role of dermatology in the prevention of skin disorders.
The impact of skin disorders on physical appearance.
The role of dermatology in the study of skin health.

17. Pulmonology:

The impact of respiratory disorders on public health.
The role of pulmonology in the treatment of respiratory disorders.
The impact of pulmonological research on patient care.
The role of pulmonology in the study of the respiratory system.
The impact of respiratory disorders on quality of life.
The role of pulmonology in the diagnosis of respiratory disorders.
The impact of respiratory disorders on mental health.
The role of pulmonology in the prevention of respiratory disorders.
The impact of respiratory disorders on physical health.
The role of pulmonology in the study of lung function.

18. Pediatrics:

The impact of childhood diseases on public health.
The role of pediatrics in the treatment of childhood diseases.
The impact of pediatric research on patient care.
The role of pediatrics in the study of childhood diseases.
The impact of childhood diseases on quality of life.
The role of pediatrics in the diagnosis of childhood diseases.
The impact of childhood diseases on mental health.
The role of pediatrics in the prevention of childhood diseases.
The impact of childhood diseases on physical health.
The role of pediatrics in the study of child health.

19. Geriatrics:

The impact of aging on public health.
The role of geriatrics in the treatment of age-related diseases.
The impact of geriatric research on patient care.
The role of geriatrics in the study of aging.
The impact of aging on quality of life.
The role of geriatrics in the diagnosis of age-related diseases.
The impact of aging on mental health.
The role of geriatrics in the prevention of age-related diseases.
The impact of aging on physical health.
The role of geriatrics in the study of the aging process.

20. Psychiatry:

The impact of mental disorders on public health.
The role of psychiatry in the treatment of mental disorders.
The impact of psychiatric research on patient care.
The role of psychiatry in the study of mental disorders.
The impact of mental disorders on quality of life.
The role of psychiatry in the diagnosis of mental disorders.
The impact of mental disorders on social interactions.
The role of psychiatry in the prevention of mental disorders.
The impact of mental disorders on physical health.
The role of psychiatry in the study of mental health.

The field of medical research is vast and diverse, offering a multitude of topics for exploration. The choice of a research topic is a critical step in the research process, and it can significantly influence the direction of your research and the impact of your findings. Therefore, it’s crucial to choose a topic that not only interests you but also aligns with your academic and career goals. This comprehensive list of medical research paper topics provides a starting point for your research journey. Remember, the best research topic is one that is original, manageable, and meaningful.

Introduction to Medical Research

Medical research is a broad and multifaceted field that encompasses a wide range of topics and disciplines. It is the backbone of modern healthcare and plays a crucial role in improving the quality of life for people around the world. Medical research is the driving force behind new discoveries, innovative treatments, and the development of policies that shape public health.

At its core, medical research seeks to understand the complexities of the human body, the diseases that afflict it, and the various external factors that influence health. It is a field that is constantly evolving, with new technologies and methodologies continually pushing the boundaries of what we know about health and disease.

One of the key aspects of medical research is its interdisciplinary nature. It draws upon a variety of fields, including biology, chemistry, physics, and even social sciences. This interdisciplinary approach allows for a more comprehensive understanding of health and disease, as it considers not only the biological aspects but also the social, environmental, and psychological factors that influence health.

For instance, research in anatomy and physiology delves into the structure and function of the human body, providing the foundation for understanding health and disease. Studies in diseases and epidemiology, on the other hand, focus on the patterns, causes, and effects of health and disease conditions in defined populations. Health and fitness research explores the impact of lifestyle choices on health, while health disparities research examines the inequalities in health outcomes and healthcare that exist among different population groups.

Research in healthcare and kinesiology often intersects, examining how healthcare services and physical activity can improve health outcomes. Mental health research is a rapidly growing field, addressing a wide range of mental health disorders and the impact they have on overall health. Pharmacology research is vital for the development of new drugs and therapies, while veterinary medicine research not only improves the health of animals but can also provide insights into human health through comparative medicine.

Choosing a topic for a medical research paper can be a daunting task given the breadth and depth of the field. However, it also offers a wealth of opportunities to delve into a topic that is not only interesting but can also contribute to the betterment of health and healthcare.

How to Choose Medical Research Paper Topics

Choosing a topic for your medical research paper is a critical step in your academic journey. The topic you select will guide your research direction, influence your motivation, and determine the depth of your understanding of the subject matter. Therefore, it’s essential to choose wisely and consider various factors before making a decision. Here are ten comprehensive tips to help you select the right medical research paper topic:

Identify Your Interests: The first step in choosing a research topic is to consider your interests within the field of medicine. Are you fascinated by neurology, passionate about public health, or intrigued by the complexities of surgery? Identifying your interests can help you narrow down potential topics. When you choose a topic you’re passionate about, the research process becomes less of a task and more of an exploration. You’ll find yourself more engaged, and the enthusiasm will reflect in the quality of your research.
Consider the Scope: The scope of your topic is an important factor to consider. A topic that’s too broad can make your research overwhelming, as you may have to sift through an enormous amount of information and struggle to cover all aspects within the constraints of your paper. On the other hand, a topic that’s too narrow might not provide enough material for a comprehensive study. Strive for a balance where your topic is specific enough to manage but broad enough to explore in depth.
Check for Resources: Before finalizing a topic, ensure there are sufficient resources available for your research. These resources could include books, scholarly articles, reputable online sources, and expert interviews. Conduct a preliminary literature review to gauge the availability of sources. A lack of resources can lead to a weak paper, while an abundance of resources can provide multiple perspectives and strengthen your research.
Relevance to Current Times: Choosing a topic that is relevant to current medical issues or ongoing research can make your paper more engaging and significant. It allows you to contribute to the existing body of knowledge and possibly influence future research or policy. Whether it’s a new treatment method, an emerging disease, or a controversial medical practice, current topics can spark interest and debate.
Consult with Your Instructor: Your instructor or advisor can be a valuable resource when choosing a topic. They can provide guidance, help you refine a broad topic, expand a narrow one, and provide feedback on your initial ideas. They can also point you towards resources or research areas you might not have considered.
Consider the Target Audience: Always keep your target audience in mind when choosing a research topic. The topic should be interesting and accessible to them. If you’re writing for a class, consider what you’ve already discussed and what themes your instructor has emphasized. If you’re writing for publication, consider the interests and level of expertise of the readers of the journal.
Practicality: Consider the practical aspects of your research. If your research involves primary data collection, consider the feasibility of the methods you plan to use. Do you have access to the necessary equipment or population? Is your study ethical and approved by an ethics committee? Practical considerations can significantly influence your choice of topic.
Originality: While it’s important to build upon existing research, strive to bring a unique perspective to your topic. This could involve studying a well-researched topic from a new angle, exploring a less-studied area of medical research, or proposing a new hypothesis. Originality can make your research stand out and contribute to the advancement of your field.
Alignment with Course Objectives: Your research topic should align with the objectives of your course or curriculum. This ensures that your research paper will not only be interesting but also academically beneficial. It can demonstrate your understanding ofthe course material and your ability to apply it in a real-world context.
Future Career Relevance: If you have a clear idea of your future career path, consider choosing a topic that could be beneficial in your professional life. This could mean researching a topic related to a field you’d like to specialize in, a current issue in your future profession, or a novel area of study that could give you a competitive edge in your career.

In addition to these tips, it’s also important to consider the timeline of your research. Some topics may require more time to research than others, especially if they involve complex experiments or hard-to-reach populations. Make sure you choose a topic that you can reasonably research and write about within your given timeframe.

Also, consider the potential impact of your research. While it’s not always possible to predict how influential a research paper will be, you can consider whether the topic has the potential to affect policy, influence clinical practice, or lead to new research questions. Choosing a topic with potential impact can be particularly important if you plan to pursue a career in academia or research.

Remember, choosing a research topic is not a decision to be taken lightly. It’s the foundation of your research paper and can significantly influence your enjoyment of the writing process, your grade, and even your future career. Take your time, consider your options, and choose a topic that you are passionate about, meets practical considerations, and has the potential to contribute to the field of medical science.

Finally, be flexible. Research is a dynamic process, and it’s okay to refine or even change your topic as you delve deeper into your research. The most important thing is to stay curious, open-minded, and dedicated to uncovering new knowledge. With the right topic, research can be a rewarding journey of discovery.

How to Write a Medical Research Paper

Writing a medical research paper is a comprehensive task that demands a profound understanding of the subject matter, a systematic approach, and a lucid writing style. This process can be quite daunting, especially for those who are new to it. However, with the right guidance and a well-structured plan, it can be a rewarding experience. Here are ten detailed tips to guide you through the process:

Understand the Assignment Thoroughly: The first step in writing a medical research paper is to fully comprehend the assignment. What is the specific question you’re being asked to address? What is the scope of the research paper? What are the formatting requirements? Are there any specific sources you need to use? Understanding the assignment in its entirety will help you focus your research and ensure you meet all the requirements. It’s crucial to clarify any doubts with your professor or advisor at this stage to avoid any misunderstandings later on.
Choose a Suitable Topic: If you have the freedom to choose your own topic, select one that genuinely interests you. Your passion for the subject will come through in your writing, making the process more enjoyable and less of a chore. Make sure the topic is relevant to your field of study and is something you can manage within the given timeframe and word limit. A well-chosen topic can make the difference between a paper that is a joy to research and write and one that is a burdensome chore.
Conduct Thorough Research: The next step is to conduct comprehensive research. Use reputable sources such as academic journals, textbooks, and government health websites to gather information. Make sure to use the most recent data and research available, as the medical field is constantly evolving and it’s important to stay up-to-date. Keep track of your sources as you go along for easy referencing later. This will also save you a lot of time when you are compiling your bibliography.
Create an Outline: An outline is a roadmap for your research paper. It should include an introduction, a body with several points or arguments, and a conclusion. Each point should be supported by evidence from your research. An outline will help structure your thoughts and ideas, making your writing process smoother and more organized. It also allows you to see the flow of your arguments and make sure that everything is in a logical order.
Write a Strong Thesis Statement: Your thesis statement is the backbone of your research paper. It should clearly state the main idea or argument of your paper. It should be concise, specific, and arguable. The thesis statement will guide your writing and keep your argument focused. Spend some time crafting a strong thesis statement. It’s worth the effort as it will give direction to your research and writing.
Start Writing: Once you have your outline and thesis statement, you can start writing. Begin with a draft. Don’t worry about making it perfect the first time around. Just get your ideas down on paper. You can revise and improve it later. Remember, writing is a process. It’s okay to have multiple drafts. The important thing is to start writing.
Use Clear, Concise Language: Medical research papers should be written in a clear, concise, and formal style. Avoid jargon and complex sentences. Make sure your ideas are expressed clearly and logically. Remember, your goal is to communicate your research and ideas, not to impress with big words or complex sentences.
Cite Your Sources: Always cite your sources. This gives credit to the original authors and allows readers to follow up on your research. Be sure to use the citation style required by your professor or the journal you are submitting to. Proper citation is not just about avoiding plagiarism. It also lends credibility to yourpaper and demonstrates the breadth of your research.
Revise and Edit: Once you’ve finished your draft, take the time to revise and edit. This is where you refine your arguments, clarify your thoughts, and polish your language. Look for any inconsistencies, grammatical errors, or areas that could be clarified or improved. Consider having a peer or mentor review your paper. They can provide valuable feedback and catch errors you might have missed. Remember, good writing is rewriting. Don’t be afraid to make changes, and don’t be discouraged if your first draft isn’t perfect.
Proofread: Finally, proofread your paper. Check for any spelling, grammar, or punctuation errors. Make sure all citations and references are correct. Proofreading is a crucial step in the writing process. Even the most well-researched and well-written paper can lose credibility if it’s full of errors. Consider using a proofreading tool or ask someone else to proofread your paper. A fresh pair of eyes can often catch mistakes you might have overlooked.

In addition to these tips, remember to take breaks during your writing process. Writing a medical research paper is a significant undertaking, and it’s important to avoid burnout. Take time to rest and refresh your mind. This will help you maintain your focus and energy levels.

Also, keep in mind that writing a research paper is not just about the end product. It’s also about the process. It’s an opportunity to learn more about a topic you’re interested in, to improve your research and writing skills, and to contribute to your field of study. Approach it with curiosity and enthusiasm, and you’ll find that writing a medical research paper can be a rewarding experience.

Writing a medical research paper is a systematic process that requires careful planning, thorough research, and meticulous writing. By following these tips, you can produce a paper that is informative, insightful, and contributes to your field of study. Remember, every writer faces challenges along the way, so don’t be discouraged if you encounter difficulties. With persistence and dedication, you can write a successful medical research paper.

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Front Pharmacol
PMC10569491

Current state of research on the clinical benefits of herbal medicines for non-life-threatening ailments

Sandra salm.

1 Institute of Pharmaceutical Biology, Goethe University, Frankfurt, Germany

2 Institute of General Practice, Goethe University, Frankfurt, Germany

Jochen Rutz

3 Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany

Marjan van den Akker

4 Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands

5 Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium

Roman A. Blaheta

Beatrice e. bachmeier.

Marilena Gilca , Carol Davila University of Medicine and Pharmacy, Romania

Associated Data

The original contributions presented in the study are included in the article/ Supplementary Material , further inquiries can be directed to the corresponding author.

Herbal medicines are becoming increasingly popular among patients because they are well tolerated and do not exert severe side effects. Nevertheless, they receive little consideration in therapeutic settings. The present article reviews the current state of research on the clinical benefits of herbal medicines on five indication groups, psychosomatic disorders, gynecological complaints, gastrointestinal disorders, urinary and upper respiratory tract infections. The study search was based on the database PubMed and concentrated on herbal medicines legally approved in Europe. After applying defined inclusion and exclusion criteria, 141 articles were selected: 59 for psychosomatic disorders (100% randomized controlled trials; RCTs), 20 for gynecological complaints (56% RCTs), 19 for gastrointestinal disorders (68% RCTs), 16 for urinary tract infections (UTI, 63% RCTs) and 24 for upper respiratory tract infections (URTI) (79% RCTs). For the majority of the studies, therapeutic benefits were evaluated by patient reported outcome measures (PROs). For psychosomatic disorders, gynecological complaints and URTI more than 80% of the study outcomes were positive, whereas the clinical benefit of herbal medicines for the treatment of UTI and gastrointestinal disorders was lower with 55%. The critical appraisal of the articles shows that there is a lack of high-quality studies and, with regard to gastrointestinal disorders, the clinical benefits of herbal medicines as a stand-alone form of therapy are unclear. According to the current state of knowledge, scientific evidence has still to be improved to allow integration of herbal medicines into guidelines and standard treatment regimens for the indications reviewed here. In addition to clinical data, real world data and outcome measures can add significant value to pave the way for herbal medicines into future therapeutic applications.

1 Introduction

Plant derived drugs have been used since humans have started treating physical and mental illnesses. They are part of Traditional Medicine in different cultures all over the world ( Yuan et al., 2016 ). Since then, medicine and treatment procedures have evolved and while in Traditional Medicine a holistic approach of life focusing on health and its maintenance was common philosophy, present Modern Medicine has a clear emphasis on unravelling the changes leading to disease and eradiating it ( Fries, 2019 ). Traditional medicine has a rigorous algorithm of identifying the root of the disease, which is based on traditional concepts, which, unfortunately, are considered obsolete nowadays, despite their practical longevity (e.g., acupuncture, ayurveda). The problem is that this traditional medical epistemology is not fully understood and science has limited tools to “translate” it into modern terms.

With the success of synthetic drugs along with the design of targeted therapies interfering specifically with the respective disease-related signaling pathways, herbal medicines have been eliminated from modern rational treatment strategies. The most important obstacles for the use in novel therapy strategies is that markers to measure clinical efficacy of herbal medicine have not been developed so far. Markers of efficacy of herbal drugs could also be useful to distinguish between patients who could benefit from a therapy with herbal medicines from those who will not. First preclinical studies already indicate that those markers or “signatures” (e.g., mRNA, miRNA) could be found in the future ( Bachmeier et al., 2007 ; Bachmeier et al., 2008 ; Bachmeier et al., 2009 ; Bachmeier et al., 2010 ; Killian et al., 2012 ; Kronski et al., 2014 ).

In the last years, more and more patients report on the perceived efficacy of herbal drugs and praise the absence of undesired side effects and the good tolerability.

The following section provides insights into the standard therapies of selected ailments for which herbal medicines may be a rational alternative.

1.1 Indications suitable for treatment with herbal medicines

Herbal medicines are in particular suitable for the treatment of non-life-threatening conditions for which knowledge from traditional use is available pointing to their clinical benefits in treating the respective ailment ( Wachtel-Galor and Benzie, 2011 ). This applies especially to psychosomatic disorders, gynecological complaints, and upper respiratory tract infections. However also for other diseases like gastrointestinal diseases, urinary tract infections herbal medicines have been clinically applied and—as we will show in this review—with some success.

Standard Care of psychosomatic disorders comprises the application of synthetic psychotropic drugs and psychotherapy ( Laux, 2021 ). Psychotropic drugs are used not only for the treatment of depressive disorders and anxiety, but also for sleep disorders, excitation and chronic pain ( Gründer and Benkert, 2012 ). However undesired adverse events having negative impact on quality of life can occur like, e.g., weight gain, sexual dysfunction, sedation, headache and tremor ( Grunze et al., 2017 ). In addition their use, in particular benzodiazepines, can lead to addiction and drug abuse ( Soyka and Mann, 2018 ) and interactions with other medication has to be taken into consideration especially in older multimorbid patients ( Burkhardt and Wehling, 2010 ). About 23% of all over 70-year-old people have psychosomatic disorders with about 40% requiring therapy ( Haupt and Vollmar, 2008 ). In this context herbal medicines represent an interesting alternative to avoid the above-mentioned problems with standard synthetic drugs. However, they do not belong to standard therapy-options and therefore are underrepresented in therapy-guidelines ( Bittel et al., 2022 ). Nevertheless they play an important role in self-medication of patients ( Stange, 2014 ) probably due to their favorable ratio between benefit and side-effects.

Gynecological complaints include, e.g., menopausal and premenstrual symptoms. According to the German medical guideline for post- and perimenopause, vasomotor symptoms of the peri- and post-menopause such as hot flushes and sweating should be treated with hormone therapy for menopause (hormone replacement therapy; HRT), if not contraindicated ( AWMF, 2020 ). The side effects of HRT include edema, joint pain, psychological symptoms or even thrombosis and breast cancer ( Maclennan et al., 2004 ). Herbal medicines, on the other hand, are characterized by a low risk of adverse events which increases patients’ adherence and in consequence prevents therapy discontinuations ( AWMF, 2020 ). Premenstrual syndrome (PMS) is characterized by recurring physical and psychological symptoms in the days before menstruation. There are currently no medical guidelines in German-speaking countries for the treatment of PMS. Systematic reviews on hormonal treatments (oral contraceptives, progesterone and estrogen) ( Ford et al., 2006 ; Lopez et al., 2007 ; Naheed et al., 2013 ; Kwan and Onwude, 2015 ) and acupuncture/acupressure ( Armour et al., 2018 ) point to ambiguous evidence. Treatment with serotonin reuptake inhibitors was shown to be effective but was associated with frequent side effects, e.g., nausea and asthenia ( Marjoribanks et al., 2013 ).

Gastrointestinal diseases include several conditions like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), liver disease (hepatitis), and functional dyspepsia (FD).

Beside dietary changes, stress management and psychotherapy, severe cases of IBS and IBD require additional medication to reduce inflammation or to slow down the intestinal irritations. However patients often complain about the side effects of medical treatment like, e.g., dizziness or weight gain (particularly caused by steroids), or undesired fatigue, headache, and/or tiredness associated with the intake of methotrexate ( Feagan et al., 1995 ). Common types of hepatitis are viral hepatitis B and C. Antiviral therapy represents the treatment of choice to fight the virus caused disease. However, poor tolerability and significant adverse effects that include, for example, headaches, dizziness, depression, and irritability often lead to treatment discontinuation, further decreasing response rates ( Cornberg et al., 2002 ). FD is a common gastrointestinal disorder treated by proton pump inhibitors (PPI) or H2 receptor antagonist, and/or treatment with tricyclic antidepressants or prokinetic agents. As in all cases, adverse side effects may occur ranging from dizziness to the development of diabetes mellitus type 2 ( Yuan et al., 2021 ).

Urinary tract infections (UTI) with estimated 150 million cases worldwide each year reflect the most common outpatient infections ( Zavala-Cerna et al., 2020 ). Women are more susceptible than men with a lifetime incidence of 50%–60%. Application of antibiotics represents the standard treatment regimen to overcome the infection. However, serious side effects, predominantly exerted on the digestive system, may outweigh the benefits of this drug class. Most importantly, routine use of antibiotics bears the risk to trigger the selection of resistant strains. Hence, avoiding antibiotic treatment of UTI has gained high priority among the urologic community ( Jung et al., 2023 ). Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) requires a medical therapy which aims to reduce the BPH-related complications. A range of synthetic drugs is available to treat this condition. However, these have a range of side effects, including postural hypotension, dizziness, asthenia, abnormal ejaculation, intraoperative floppy iris syndrome (α1-blocker), or decreased libido, gynecomastia, and erectile dysfunction (5α-reductase inhibitors) ( Cheng et al., 2020 ). Due to this, patients often discontinue treatment.

The most common acute upper respiratory infections include bronchitis, rhinosinusitis and common cold. Common cold or acute viral rhinosinusitis is triggered by a viral infection/inflammation of the nose and by definition has a duration up to 10 days. According to Jaume and co-workers ( Jaume et al., 2020 ) the recommended therapy (mainly symptomatic) contains of paracetamol, NSAIDs, second-generation antihistamines to reduce symptoms the first 2 days; nasal decongestants with small effect in nasal congestion in adults; combination of analgesics and nasal decongestants; ipratropium bromide for reducing rhinorrhea; probiotics; zinc when administered the first 24 h after the onset of symptoms; nasal saline irrigations; and some herbal medicines. About 5% of adults have an episode of acute bronchitis each year. An estimated 90% of these seek medical advice for the same ( Saust et al., 2018 ). Acute bronchitis is caused by infection of the large airways commonly due to viruses and is usually self-limiting. Bacterial infection is uncommon. Still, often antibiotics are prescribed, despite lacking effectiveness ( Tanner and Karen Roddis, 2018 ). Most medical guidelines advice a “wait-and-see” policy, the use of antihistamines and cough medicines is discouraged.

1.2 Objectives

In the last decade we experienced a renaissance of herbal medicines with a rising demand especially for the treatment of the before-mentioned indications. This implicates that there is an urgent need for a scientific progress towards a rational phytotherapy, which will combine the benefits of “Modern Medicine” with the “Traditional Knowledge” on the therapeutic benefits of herbal medicines.

In order to create a basis of knowledge to build upon novel interdisciplinary research ideas towards the establishment of herbal medicines into rational therapeutic strategies, we extracted information from clinical studies. Thereby we aimed to get an overview on.

- which herbal medicines have been studied so far for which ailment
- which outcomes have been studied
- what quality level (level of evidence) the published studies have

Answering these questions, we create a comprehensive critical picture of the current knowledge on clinical efficacy and benefits as well as on failures and possible adverse events. Based on the results of these studies we give recommendations for practitioners and patients.

2.1 Search strategy and selection of scientific reports

Information on the therapeutic use of herbal medicines in different ailments was collected from scientifically published articles by conducting a search in the database PubMed for each of the five indication groups according to the following inclusion and exclusion criteria.

2.1.1 Inclusion criteria

1. Herbal Medicine
a.Psychosomatic symptoms (depressive disorder, sleeping disorders/insomnia, anxiety, cognitive impairment)
b.Gynecological complaints (climactic symptoms, menstrual symptoms, premenstrual syndrome)
c.Gastrointestinal disorders/dyspepsia
d.Urinary tract infections
e.Upper respiratory tract infections
3. Clinical Trial
Exclusion criteria
a. Reports in languages other than German or English language
b. No full-text available
c. Study protocols
d. Traditional medicine (e.g., Traditional Chinese Medicine, Ayurveda, etc. ),
e. Aroma therapy
f. Dietary supplements
g. Self-made extracts and preparations
h. Adjuvant treatment with herbal medicine
i. Herbal medicines without market access in the EU
j. In vivo / in vitro studies (pre-clinical studies)
k. Homeopathy
l. Acupuncture/acupressure
m. Children and youth (under the age of 18 years)
n. Healthy volunteers
o. Primary preventive interventions (incl. Pre-post-operative complaints)
p. Predominant comorbidities
q. Case studies/case reports
r. Televised, internet-based or web-based trials

Reasons for exclusion criteria:

a, b: Authors should be able to read and understand the full text; c: clinical results should have been obtained from a study; d, e, f, g, h, i: selected in order to filter all available information on legally approved (in Europe in particular in Germany) herbal medicines or the respective standardized extract (HMPC Monographs of the European Medical Agency - EMA) only; j: preclinical evidence should be excluded; k, l: alternative naturopathic therapy forms should be excluded; m: children should be excluded due to different drug metabolism; n, o: healthy volunteers should be excluded in order to obtain information on clinical therapeutic benefits; p: predominant comorbidities should be excluded because they can affect the efficacy of the herbal drug in particular when co-administered with other drugs; q; clinical benefits from single cases are difficult to generalize; r: excluded for methodological reasons, e.g., data interpretation.

2.2 Data extraction and quality assessment of scientific reports

To get an overview on the characteristics of all included articles, a table was created for each indication group containing information on the publication, the study design, the population and treatment duration, the indication and the primary outcome, the herbal medicine and comparison treatment (comparator) as well as the results. Furthermore, we performed a quality assessment of the collected reports according to the following scoring method.

• 1 point for an observational study or a pre-post observational comparison
• 2 points for a clinical trial
• 3 points for a randomized controlled trial plus 1 additional point for blinding

Thereby, a score between 1 and 4 was obtained indicating the quality for all scientific reports; respectively publications with the highest level of evidence (RCT + blinded) had a scoring value of four points (see Figures 1 – 5 ).

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Numbers of studies and outcomes.

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3.1 Psychosomatic disorders

A search for publications with the terms “psychosomatic disorder” and “herbal medicine” yielded only 64 results. Therefore, the search was extended with more specific terms (see inclusion criteria) yielding in 4.440 hits for depressive disorder, 1.907 hits for sleeping disorders, 2.380 hits for anxiety and 1.374 hits for cognitive impairment including Alzheimer’s disease. After eliminating all publications according to the exclusion criteria 59 publications remained. Among those, 39 studies were related to depressive disorders, 4 to sleeping disorders, 6 to anxiety and 10 to cognitive impairment and Alzheimer’s disease (neurological disorders). Most of them were double blind randomized controlled trials (quality group 4). For the treatment of depressive disorders predominantly Hypericum perforatum L (St. John’s Wort; SJW) was used and only few studies examined the clinical benefits of Rhodiola rosea L (Rosewood). Valeriana officinalis L (Valerian Root) and Humulus lupulus L (Hops) extracts were preferred for the treatment of sleeping disorders, while for anxietyextracts of Lavandula angustifolia (Lavender) were studied. Extracts of Ginkgo biloba L (Maidenhair Tree) were used in clinical studies with patients having neurological disorders (cognitive impairment and Alzheimer’s disease). Supplementary Table S1 provides an overview of the studies, their characteristics and results (see also Figure 1 ).

3.1.1 Depressive disorders

The use of herbal medicines in depressive disorders is well examined and in particular the clinical benefits of SJW are well supported by clinical studies of high quality. All 37 selected studies on the use of SJW in depressive disorders ranging from mild to severe forms have been double-blind randomized controlled trials (quality group 4). Study duration was predominantly between 4 and 8 weeks and only few studies examined the effects for longer time periods of up to 6 months. The majority of the studies reported positive therapeutic effects concerning Hamilton depression rating scale (HAMD) as primary outcome parameter and only 5 of them ( Shelton et al., 2001 ; Davidson et al., 2002 ; Bjerkenstedt et al., 2005 ; Moreno et al., 2006 ; Rapaport et al., 2011 ) did not demonstrate superiority as compared to placebo or pre-post.

In six studies (published predominantly before the year 2000) comparing SJW with tricyclic anti-depressive drugs the clinical benefits of the herbal drug in respect to placebo or in pre-post comparison was at least equal to the synthetic drug no matter if it was imipramine ( Vorbach et al., 1994 ; Vorbach et al., 1997 ; Philipp et al., 1999 ; Woelk, 2000 ), maprotiline ( Harrer et al., 1994 ) or amitriptyline ( Wheatley, 1997 ). However, with regards to tolerability, SJW was clearly superior to any of the tricyclic antidepressants.

The more recent studies compared the efficacy of SJW with the selective serotonin reuptake inhibitors (SSRI) paroxetine, sertraline, citalopram and fluoxetine. In most of the 18 studies the therapeutic benefits of SJW were at least equal to those of the SSRIs ( Harrer et al., 1999 ; Berger et al., 2000 ; Brenner et al., 2000 ; Friede et al., 2001 ; van Gurp et al., 2002 ; Bjerkenstedt et al., 2005 ; Gastpar et al., 2005 ; Szegedi et al., 2005 ; Anghelescu et al., 2006 ; Gastpar et al., 2006 ; Sarris et al., 2012 ). In two studies SJW was even superior to fluoxetine ( Fava et al., 2005 ) or paroxetine ( Seifritz et al., 2016 ) in reducing depressive symptoms. In one study the responders of a previous study were included in a further RCT testing the efficacy of SJW against citalopram. Here the numbers of patients with relapse was lower in the SJW group as compared to citalopram ( Singer et al., 2011 ). The results of one study indicated that SJW was less efficacious than both fluoxetine and placebo, however in this study the group on SJW had the lowest remission rates ( Moreno et al., 2006 ). In two studies no statistical differences in HAMD scores between SJW, placebo and citalopram ( Rapaport et al., 2011 ) or sertraline ( Davidson et al., 2002 ) could be found with adverse effects in the SJW and the SSRI groups.

In most of the above-mentioned studies, comparing the efficacy of SJW to standard therapy, a placebo group was included. However, in 13 studies SJW was tested exclusively against placebo whereby two of these studies examined the efficacy of different dosages of SJW extract ( Laakmann et al., 1998 ; Kasper et al., 2006 ). In these studies, the higher concentrations had the better clinical benefits. In a continuation study of the effect of SJW in long term treatment a higher dosage (1,200 mg/d) was not superior to the lower one (600 mg/d) ( Kasper et al., 2007 ). Interestingly the higher dosages were still well tolerated although mild adverse events related to gastrointestinal disorders were observed in a small portion of the patients ( Kasper et al., 2006 ). In only one of our selected studies SJW was not effective in comparison to placebo for the treatment of major depression but safe and well tolerated ( Shelton et al., 2001 ). In all other studies SJW was superior to placebo no matter if given in low ( Laakmann et al., 1998 ; Lecrubier et al., 2002 ; Randlov et al., 2006 ), medium ( Kasper et al., 2006 ; Kasper et al., 2007 ; Mannel et al., 2010 ) or in high ( Hansgen et al., 1994 ; Harrer et al., 1994 ; Sommer and Harrer, 1994 ; Kalb et al., 2001 ; Uebelhack et al., 2004 ; Kasper et al., 2006 ; Kasper et al., 2007 ; Kasper et al., 2008 ) dosages.

For the efficacy of Rhodiola rosea in treatment of depressive disorders only few studies were performed so far. Therefore, a clear conclusion cannot be drawn, especially as the outcomes are not homogenous. While one study investigating the efficacy of R. rosea against placebo and the SSRI sertraline reported on a statistically not-significant inferiority of the herbal medicine ( Mao et al., 2015 ) another study demonstrated clinical benefits concerning the symptoms of depression, insomnia, emotional instability and somatization against placebo. In this study two dosages of R. rosea were tested and the higher dose (680 mg/d) showed even positive effects on self-esteem ( Darbinyan et al., 2007 ).

3.1.2 Sleeping disorder

Interestingly the search for qualitatively high clinical studies (according to our inclusion and exclusion criteria) revealed only few studies. The majority of them investigated the efficacy of valerian alone ( Donath et al., 2000 ) or in combination with hops ( Koetter et al., 2007 ) compared to placebo ( Donath et al., 2000 ; Koetter et al., 2007 ) or to oxazepam ( Dorn, 2000 ; Ziegler et al., 2002 ). All studies reported clinical benefits, however while the one research group reported that valerian alone was efficacious against insomnia ( Donath et al., 2000 ) the other group reported on clinical benefits only in combination with hops ( Koetter et al., 2007 ). Both study designs were placebo-controlled. In comparison to oxazepam valerian was not inferior and both therapy options improved sleep quality (SF-B) in a similar fashion ( Dorn, 2000 ; Ziegler et al., 2002 ).

3.1.3 Anxiety

Herbal Medicines with lavender extracts were clinically studied for the treatment of anxiety. Between 2010 and 2019 six qualitatively high studies performed in Germany, Austria and Switzerland reported on the beneficial effects of lavender against symptoms of anxiety with improvements on the Hamilton anxiety rating (HAMA) scale as primary outcome ( Kasper et al., 2010 ; Woelk and Schlafke, 2010 ; Kasper et al., 2014 ; Kasper et al., 2015 ; Kasper et al., 2016 ; Seifritz et al., 2019 ) and all studies used the same extract (WS1265). Four of the 6 studies were performed by the same group, however the study design differed. In these studies the efficacy of lavender was either compared to placebo ( Anghelescu et al., 2006 ; Kasper et al., 2010 ; Kasper et al., 2016 ; Seifritz et al., 2016 ) and/or to paroxetine ( Kasper et al., 2014 ) and lorazepam ( Woelk and Schlafke, 2010 ). Overall, the lavender preparation was regarded as efficacious and safe.

3.1.4 Neurological disorders (cognitive impairment and Alzheimer)

We selected 10 studies investigating the efficacy of ginkgo biloba extract in the treatment of cognitive impairment and Alzheimer’s Disease (AD) with 8 of them testing against placebo ( Le Bars et al., 1997 ; Le Bars et al., 2002 ; Le Bars, 2003 ; van Dongen et al., 2003 ; Schneider et al., 2005 ; Napryeyenko et al., 2007 ; Gavrilova et al., 2014 ; Gschwind et al., 2017 ), one against rivastigmine ( Nasab et al., 2012 ) and one against donepezil ( Mazza et al., 2006 ). In three of the studies two different ginkgo extracts did not show superiority over placebo regarding the primary outcome. In detail 5 of the studies showed that extracts of ginkgo biloba lead to a decrease in NPI composite score ( Gavrilova et al., 2014 ) improved significantly ADAS-Gog and GERRI ( Le Bars et al., 1997 ; Le Bars et al., 2002 ; Le Bars, 2003 ), or the SKT test battery ( Napryeyenko et al., 2007 ) as outcome parameters. In three studies ginkgo extracts did not show superiority over placebo regarding the primary outcome parameters ADAS-cog ( Schneider et al., 2005 ), gait analyses ( Gschwind et al., 2017 ) or SKT test-battery ( van Dongen et al., 2003 ), whereby in one of these studies the primary outcome parameter ADAS-cog also declined in the placebo group rendering the results of the study inconclusive ( Schneider et al., 2005 ). With respect to the AD conventional medication rivastigmine, ginkgo biloba extract was inferior regarding the primary outcome parameters MMSE and SKT test-battery ( Nasab et al., 2012 ). Finally one study in which gingko biloba was more efficacious than placebo and equal to the second generation cholinesterase inhibitor donepezil ( Mazza et al., 2006 ) was heavily criticized by two other groups ( Corrao et al., 2007 ; Korczyn, 2007 ), making it difficult to estimate if the use of ginkgo containing herbal medicines are justified for the treatment of mild to moderate AD.

3.2 Gynecological complaints

Of 383 search hits, 20 articles met the inclusion criteria. Eleven studies were related to menopausal symptoms and nine to PMS. Most were double-blind randomized controlled trials or observational studies ( Figure 2 ). The studies on menopausal symptoms reported mainly positive results and the results concerning PMS were exclusively positive ( Figure 2 ). The tested phytopharmaceuticals contained Cimicifuga racemosa (L.) (Black cohosh) (10 studies) and Salvia officinalis (Sage) (1 study) for the treatment of menopausal symptoms and Vitex agnus-castus L (VAC, Chaste tree) (8 studies) and SJW (1 study) for PMS. Supplementary Table S2 provides an overview of the study characteristics and results.

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3.2.1 Menopausal symptoms

In studies examining the clinical benefits of black cohosh for the treatment of menopausal symptoms, sample sizes ranged from n = 62 to n = 6,141. Treatment duration was between 12 weeks and 9 months. The herbal drug dosages ranged from 20 to 127.3 mg.

In comparison to HRT, the benefit-risk-balance points to significant non-inferiority and superiority of black cohosh ( Bai et al., 2007 ). In three other studies menopausal complaints improved overall, but differences between black cohosh and HRT were not significant ( Wuttke et al., 2003 ; Nappi et al., 2005 ; Friederichsen et al., 2020 ). The combination of black cohosh with SJW significantly reduced menopausal complaints and was superior to transdermal estradiol ( Briese et al., 2007 ). Independent of a high or low dose, menopausal complaints decreased significantly ( Liske et al., 2002 ; Drewe et al., 2013 ). Adverse events rates were lower in the low dose group ( Drewe et al., 2013 ) or similar to the high dose group ( Liske et al., 2002 ). Menopausal symptoms decreased significantly more for black cohosh compared to placebo ( Osmers et al., 2005 ). In another study with 62 participants, the difference between the symptom scores just approached significance ( Wuttke et al., 2003 ). Interestingly, this also applies to the comparison of conjugated estrogens and placebo. Adverse events rates did not differ significantly between black cohosh and placebo ( Wuttke et al., 2003 ; Osmers et al., 2005 ). Significant and clinically relevant reductions in menopausal symptoms ( Vermes et al., 2005 ) or higher quality of life ( Julia Molla et al., 2009 ) were observed after treatment with black cohosh compared to therapy start. Sage taken for 8 weeks significantly decreased the number of menopausal hot flushes from week to week ( Bommer et al., 2011 ). Observed treatment-related adverse events were mild and occurred in only one person. However, no comparison was made to another treatment or placebo.

3.2.2 Premenstrual syndrome

Eight studies dealt with the treatment of PMS with VAC. The sample sizes ranged from n = 43 to n = 1,634. Treatment duration was three cycles; Berger et al. (2000) added three subsequent cycles without treatment. The administered dosages ranged from 1.6 to 20 mg extract.

Results of studies comparing VAC with pyridoxine or placebo were similar. PMS symptom reduction was significantly more pronounced for VAC compared to pyridoxine ( Lauritzen et al., 1997 ) or placebo ( Schellenberg, 2001 ; Bachert et al., 2009 ; Barrett et al., 2010 ; Schellenberg et al., 2012 ). Rates of adverse events were similar between groups in each study ( Loch et al., 2000 ; Schellenberg, 2001 ; Barrett et al., 2010 ; Schellenberg et al., 2012 ). Schellenberg et al. (2012) compared a VAC reference dose to a lower and higher dose; the results were in favor for the reference dose compared to the low dose. No significant differences between the high and reference dose emerged. The number of participants with adverse events was slightly elevated for the high dose. In single-arm studies, symptoms of PMS significantly decreased after three cycles of VAC treatment ( Berger et al., 2000 ; Loch et al., 2000 ; Momoeda et al., 2014 ). Only mild PMS-like adverse events were observed. Berger et al. demonstrated a gradual symptom return after therapy completion ( Berger et al., 2000 ). PMS symptoms were significantly higher compared to the end of the treatment, but still 20% lower than at baseline.

A clinical study testing the efficacy of SJW in treating mild PMS ( Canning et al., 2010 ) demonstrated significant improvements in physical (e.g., food craving) and behavioral (e.g., confusion) symptoms compared to placebo. The effect on mood (e.g., irritability) and pain (e.g., cramps) was not significant.

3.3 Gastrointestinal disorders

A search for publications with the search terms “gastrointestinal disorder” and “herbal medicine” yielded a total of 19 results after applying the exclusion criteria. Of these, eight studies were related to hepatic disorders, three publications dealt with IBD, two studies focused on IBS, and six studies had been done on FD. Most of them were done in a double-blinded randomized controlled manner ( n = 12) ( Figure 3 ). Silybum marianum (L.) Gaertn (Silymarin, milk thistle) was used in patients suffering from a hepatic disease. Patients with IBD were treated with Artemisia absinthium L (wormwood) or Potentilla erecta (tormentil). The standardized extract STW 5 containing Iberis amara (bitter candytuft), Glycyrrhiza glabra L (Liquorice), Carum carvi L (caraway), Mentha × piperita (peppermint), Melissa officinalis L (lemon balm) , Matricaria chamomilla (chamomile) , Angelica archangelica (wild celery), Chelidonium majus (greater celandine) and milk thistle has been applied in IBS and FD. The same has been done with the standardized extract STW 5-II which in contrast to STW 5 is free of wild celery, greater celandine, and milk thistle. SJW has been used to treat patients suffering from IBS. A combination of the standardized extracts WS 1340 (peppermint oil) and WS 1520 (caraway oil) was used for patients with FD. Supplementary Table S3 and Figure 3 provide an overview of the study characteristics and results.

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3.3.1 Hepatic disease

Trials on steatohepatitis, cirrhosis and different kinds of hepatitis ( n = 18) included patient cohorts ranging from 14 to 200 participants, all of them aged >18 years. Patients were treated with silymarin orally or intravenously ( Pares et al., 1998 ; Tanamly et al., 2004 ; Ferenci et al., 2008 ; Hawke et al., 2010 ; Fried et al., 2012 ; Adeyemo et al., 2013 ; Fathalah et al., 2017 ; Tanwar et al., 2017 ) with dosages ranging from 280 to 2,100 mg/day or 5–20 mg/kg/day, respectively. Six studies compared the HM group to a placebo group ( Pares et al., 1998 ; Tanamly et al., 2004 ; Hawke et al., 2010 ; Fried et al., 2012 ; Adeyemo et al., 2013 ; Tanwar et al., 2017 ). Silymarin did not reduce virus titers and/or serum alanine transaminase (ALT) in patients with Hepatitis C and non-alcoholic Steatohepatitis C, compared to placebo ( Adeyemo et al., 2013 ). The same observation has been made by others ( Hawke et al., 2010 ). Furthermore, the integration of silymarin into a PEGylated (Peg)-interferon based regimen did not improve the outcome of HCV patients in terms of HCV RNA suppression and Enhanced Liver Fibrosis score performance ( Tanamly et al., 2004 ). There was also no effect of silymarin on HCV patients who were previously unsuccessfully treated with interferon (multicenter, double-blind, placebo-controlled trial) ( Fried et al., 2012 ). Although HCV-patients reported to “feel better” after 12 months of silymarin therapy in a further study, symptoms and quality of life (QOL) scores did not differ between the silymarin and the placebo group ( Tanamly et al., 2004 ). Treatment with silymarin was also well tolerated over a period of 2 years. However, the course of liver cirrhosis in this patient cohort has not been improved ( Pares et al., 1998 ). Contrasting these results, dose escalating studies on HCV cirrhotic patients revealed positive effects of silymarin or silibinin (also milk thistle), in a way that high-dosed silymarin (1,050 mg/day) improved QOL and biochemical parameters of chronic HCV-decompensated cirrhotic patients with no serious adverse events ( Ferenci et al., 2008 ; Fathalah et al., 2017 ) compared to low-dosed silymarin (420 mg/day). Notably, silibinin exerted a dose-dependent antiviral effect on Peg-interferon/ribavirin non-responders ( Ferenci et al., 2008 ; Fathalah et al., 2017 ).

3.3.2 Inflammatory bowel disease (IBD)

Between 2007 and 2009, three clinical trials on CD or IBD have been conducted, two in Germany (quality groups 1 and 2) and one in the United States (quality group 4) ( Huber et al., 2007 ; Omer et al., 2007 ; Krebs et al., 2010 ). Patients were treated with wormwood or tormentil for 3–10 weeks. A total of 30 patients were treated with wormwood or placebo ( Omer et al., 2007 ; Krebs et al., 2010 ). In this context, wormwood decreased tumor necrosis factor alpha levels and the CD activity index score, whilst scores for IBD questionnaire and Hamilton depression scale have been improved, compared to the controls ( Omer et al., 2007 ; Krebs et al., 2010 ). Daily intake of tormentil reduced clinical activity index scores in all patients, however, during the wash out phase scores increased again. Tormentil has been proven to be safe for ulcerative colitis patients in dosages up to 3,000 mg/day ( Huber et al., 2007 ).

3.3.3 Irritable bowel syndrome (IBS)

Symptoms of IBS were treated with STW 5 and STW 5-II or SJW (both studies were quality group 4) ( Madisch et al., 2004b ; Saito et al., 2010 ). The clinical trial carried out by Madisch et al. compared the effects of the treatment group with those of bitter candytuft mono-extract and placebo. STW 5 and STW 5-II (60 drops/day over 4 weeks) significantly reduced the total abdominal pain and the IBS score compared to placebo and bitter candytuft mono-extract ( Madisch et al., 2004b ). The study carried out by Saito and others investigated the clinical efficacy of SJW pointing to a lower effect as compared to placebo ( Saito et al., 2010 ).

3.3.4 Functional dyspepsia (FD)

Six studies on patients suffering from FD were performed, including treatment with either a WS 1520/WS 1340 combination ( n = 3) ( Madisch et al., 1999 ; Rich et al., 2017 ; Storr and Stracke, 2022 ) or with STW 5 ( von Arnim et al., 2007 ) and/or STW 5-II ( n = 3) ( Rösch et al., 2002 ; Madisch et al., 2004a ). WS 1340/WS 1520 was documented to be a “valuable” ( Storr and Stracke, 2022 ) or an “effective” therapeutic regimen ( Rich et al., 2017 ), as it relieved pain and improved disease-specific QOL, compared to placebo. The primary outcome of WS 1340/WS 1520 was also proven to be comparable to the prokinetic agent cisapride ( Madisch et al., 1999 ).

It is to be noted that the use of cisapride has meanwhile be restricted by the EMA due to the risk of potentially life-threatening cardiac arrhythmia [ https://www.ema.europa.eu/en/medicines/human/referrals/cisapride ].

Similar results have been presented in the STW 5 and STW 5-II trials. The gastrointestinal symptom score was significantly lowered when compared to the placebo group ( Madisch et al., 2004a ; von Arnim et al., 2007 ), with a therapeutic response comparable to cisapride ( Rösch et al., 2002 ).

3.4 Urinary tract infection (UTI) and lower urinary tract symptoms (LUTS)

Initial search on herbal drugs in urologic clinical trials pointed to 263 manuscripts published between 1983 and 2022. Narrowing the search to “herbal medicine” (HM) 18 relevant publications were identified. One publication was nearly identical to another one and, therefore, has not been taken care of in this chapter, one article only reviewed former trials (16 publications remaining). All of them were related to lower urinary tract infection (UTI), or acute uncomplicated cystitis, respectively. Four different HM have been applied, either compared to placebo or guideline-based treatment ( n = 12).

3.4.1 Urinary tract infections (UTI)

Several studies investigated the standardized herbal extract BNO 1045 which contains Centaurium erythraea Rafin, herba (Centaury); Levisticum officinale Koch, radix (Lovage); and Rosmarinus officinalis L., folium (Rosemary). In two studies, the clinical benefits of BNO 1045 in preventing UTI in high-risk women undergoing urodynamic studies (UDS) ( Miotla et al., 2018 ) or urogynecological surgeries ( Wawrysiuk et al., 2022 ) was evaluated. High-risk women were defined as: age over 70, elevated postvoid residual urine>100 mL, recurrent UTI, pelvic organ prolapse (POP) ≥II in POP-Q scale, and neurogenic bladder. No statistical differences in UTI incidence were found between patients receiving antibiotics or BNO 1045. No superiority of antibiotics over BNO 1045 has been confirmed as well in a subsequent prospective study on postoperative UTI after midurethral sling surgery (MUS) ( Rechberger et al., 2020 ). In another study, an herbal mixture based on D-mannose, Arctostaphylos uva-ursi, Betula pendula, and Berberis aristata was compared to BNO 1045 in reducing symptoms of UTI after MUS ( Rechberger et al., 2022 ). The rationale was based on the EAU 2022 guidelines which recommended D-mannose as prophylaxis of UTI. In this context, BNO 1045 was proven to be similar effective, compared to the herbal mixture. The use of BNO 1045 has been documented here to be a potential and valuable alternative to antibiotics for UTI prevention. All four trials have been carried out in the same institution involving the same main investigators which were (partially) associated with the manufacturer of BNO 1045.

A randomized, double-blind, multicenter Phase III clinical trials compared the efficacy and of BNO 1045 to antibiotics concerning symptoms and recurrence rates in women with uncomplicated UTI. Based on the endpoints “UTI-recurrence” and “additional antibiotics use”, BNO 1045 was proven to be non-inferior to antibiotic treatment ( Wagenlehner et al., 2018 ). In a retrospective cohort study, data from outpatients in Germany with at least one diagnosis of acute cystitis or UTI and a prescription of either BNO 1045 or standard antibiotics were analyzed ( Holler et al., 2021 ). Compared to antibiotics, BNO 1045 was associated with significantly fewer recurrence rates of UTI and with reduced additional antibiotic prescription. BNO 1045 was propagated to be an effective and safe symptomatic treatment option for acute cystitis or UTI.

In an open-labeled, randomized, controlled trail the effect of BNO 1045 to prevent recurrences of cystitis in younger women was evaluated ( Sabadash and Shulyak, 2017 ). All patients received an antibacterial therapy, the test group was additionally treated with BNO 1045. The integration of BNO 1045 prevented bacteriuria and recurrent cystitis episodes more frequently (primary outcome), compared to the control group without BNO 1045. This may indicate superiority of the combination therapy. However, interpretation of the results of the study is limited due to the lack of blinding on both sides - patients and physicians. A further study without any involvement of the manufacturer (no conflicts of interest noted) included younger women with acute uncomplicated cystitis. All patients received the same therapy, the nonsteroidal anti-inflammatory drug ketoprofen in combination with BNO 1045 ( Kulchavenya, 2018 ). Quite interestingly, although the majority of the patients responded well to the therapy, the investigators also observed patients who only slightly responded, or did not respond to treatment at all. The authors concluded that uncomplicated cystitis might be cured by BNO 1045 instead of antibiotics which may be required only in minor cases. Still, the data seems to be over-interpreted, since patients were treated with both ketoprofen and BNO 1045 which does not allow to conclude to one drug alone.

Aside from BNO 1045, further herbal medicines have been investigated in clinical studies. Tablets with a standardized herbal extract containing Armoraciae rusticanae radix (Horseradish root) (80 mg) and Tropaeoli majoris herba (Nasturtium) (200 mg) have been applied to patients suffering from chronically recurrent UTI symptoms, with the result that recurrent UTI symptoms were less, compared to the placebo group ( Albrecht et al., 2007 ). However, a subsequent trial failed to demonstrate non-inferiority of this extract to antibiotics due to a poor recruitment rate ( Stange et al., 2017 ). Actually, no respective clinical trials with sufficient statistical power are underway.

3.4.2 Lower urinary tract symptoms LUTS

Clinical studies have also been conducted with an herbal medicine containing the standardized extracts WS 1473 Sabal serrulata Schult.f (Sabal fruit) (160 mg) and WS1031 Urtica dioica L (Urtica root) (120 mg). All studies were related to the treatment of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). The study protocols (placebo-controlled, double-blind, multicentric) were similar in all trials with the International Prostate Symptom Score (I-PSS), quality of life index, uroflow and sonographic parameters as the outcome measures for treatment efficacy. In one study ( Lopatkin et al., 2005 ) patients were randomized to either the herbal medicine (WS 1473 and WS1031) (treatment group) or placebo (control group) while in another study patients received either WS 1473 and 1031 or the α1-adrenoceptor antagonist tamsulosin ( Engelmann et al., 2011 ). A further study was based on the previous mentioned study ( Lopatkin et al., 2005 ), whereby all patients were offered participation in a further 48-week follow-up with WS 1473/1031 ( Lopatkin et al., 2007 ). Independent on the study design, it was concluded that WS 1473/1031 is superior to the placebo, and not inferior to tamsulosin in the treatment of LUTS. In a later re-evaluation of the data sets, WS 1473/1031 was shown to significantly improve nocturnal voiding frequency compared to placebo, with similar effects compared to tamsulosin or the 5α-reductase inhibitor finasteride ( Oelke et al., 2014 ). No further studies have been enrolled since then. However, a database search in 2022 including 3,000 private practices in Germany revealed a significant association between WS 1473/1031 prescription and reduced incidence of urinary incontinence and urinary retention compared to tamsulosin and tamsulosin/dutasteride (5α-reductase blocker), as well as reduced incidence of erectile dysfunction compared to dutasteride ( Madersbacher et al., 2023 ). In all four studies the manufacturer of the extract was involved.

One observational study was investigating the effectiveness of a standardized herbal extract containing a combination of Cucurbita pepo L (Marrow), Rhus aromatica bark (Fragrant sumac), and hops, in women with overactive bladder ( Gauruder-Burmester et al., 2019 ). Of the 113 patients included, nearly the half (61 patients) used concomitant medications (e.g., antihypertensive, levothyroxine, lipid/cholesterol lowering agents, low dose ASS, NSAIDS) within the frame of a routine clinical setting. Considering the noninterventional character of this study, the herbal combination was demonstrated to improve overactive bladder symptoms and quality of life. A controlled study has not yet been initiated.

3.5 Upper respiratory tract infections (URTI)

The search on herbal medicines for the indication Upper Respiratory Infections revealed 24 publications.

The most common indications studied for the effectiveness of herbal medications were sinusitis, viral acute Rhisosinusitis (ARS) and common cold (N = 13), bronchitis (N = 8), and less frequently on acute cough (N = 2) and Acute lower and upper tract respiratory infections (N = 1) and chronic rhinosinusitis (N = 1). Most of them (N = 18) were double-blind randomized placebo-controlled trials, there were also randomized controlled trials that compared herbal medication to other herbal medication (N = 2) or to antibiotics (N = 1). Other study designs involved prospective cohorts (N = 3) and one retrospective cohort.

3.5.1 Sinusitis/common cold and chronic rhinosinusitis

Studies on treatment of acute sinusitis and acute rhinosinusitis used a follow-up period between 7 and 14 days, with the (adapted) Sinusitis Severity Score (SSS) (N = 2), the Major Symptom Score (MSS) (N = 4), the Total Symptom Score (N = 1) and facial pain relief (N = 1) as primary endpoints. All studies reported significantly improvement of the intervention group over the placebo or control group.

The treatment of acute sinusitis and acute rhinosinusitis with Eps 7630 (standardized root extract of Pelargonium sidoides DC (Pelargonium) was studied in two double blind randomised placebo controlled trials ( Bachert et al., 2009 ; Dejaco et al., 2019 ) and in one prospective ( Perić et al., 2020 ), randomized, open-label, non-inferiority study comparing study medication to Amoxicillin All three studies reported a significant superiority resp. Non-inferiority for Eps 7630. The use of the standardized herbal extract BNO 1016 ( Primulae flos (Primrose), Gentiana lutea Ruiz and Pav. Ex G.Don (Yellow gentian), Rumicis herba (Sorrel), Sambuci flos (Elderflower) and verbenae herba (Vervain) was tested in two randomised placebo controlled trials ( Jund et al., 2015 ), one of which was blinded ( Jund et al., 2015 ). Both studies showed stronger impact on the symptom score for BNO 1016 compared to placebo. One more study tested BNO 1016 in a multicenter, prospective, open-label study comparing its effect to intranasal fluticasone furoate, with patients in both groups showing improvement ( Passali et al., 2015 ). ELOM-080 (standardized herbal drug preparation containing specially destilled oils from Eucalyptus (Eucalypt) and Citrus ×sinensis (Sweet orange) and Myrtus (Myrtle) and Citrus limon (L.) Osbeck (Lemon oil)) was evaluated once in a double blind randomised placebo controlled trial ( Federspil et al., 1997 ) and once in a prospective, non-interventional parallel-group trial where the control group received BNO 1016 ( Gottschlich et al., 2018 ). In both studies BNO 1016 showed superior results.

The use of extracts containing Echinacea for the treatment of common cold was positively tested in two studies, reporting on total number of facial tissues used in three to 7 days after intervention start ( Naser et al., 2005 ) and on the Total Daily Symptom Scores (TDSS) after 7 days ( Goel et al., 2004 ). No statistically significant differences were observed between treatment groups for the total symptom score (SS) after 14 days. In two other studies testing capsules/pills containing Echinacea angustifolia root and Echinacea purpurea root and E. purpurea herb there was no statistically significant difference between the intervention and placebo group concerning severity and duration of self-reported symptoms ( Barrett et al., 2002 ) or global severity ( Barrett et al., 2010 ).

In a double blind randomised placebo controlled trial BNO 1016 was tested for the treatment of chronic rhinosinusitis. The results reveal that the herbal drug was not superior over placebo regarding the Major Symptom Score (MSS) in week 8 and week 12 ( Palm et al., 2017 ).

3.5.2 Bronchitis

For bronchitis, nine studies were included, of which six were double-blind randomized placebo-controlled trials, testing EPs 7630 (N = 5) ( Matthys et al., 2003 ; Chuchalin et al., 2005 ; Matthys and Heger, 2007 ; Matthys et al., 2010 ; Kähler et al., 2019 ) or ELOM-080 (N = 1) ( Gillissen et al., 2013 ). The prospective observational studies included a standardized syrup of Hedera helix L (Ivy leaves) (N = 1) ( Fazio et al., 2009 ), pills with ethanolic Ivy-leaves dry extracts (N = 1) ( Hecker et al., 2002 ) and EPs 7630 (N = 1) ( Matthys and Heger, 2007 ).

Using a follow-up period of 7 days to 4 weeks, all but one (double-blinded placebo controlled trial) ( Matthys et al., 2003 ) reported positive effects of the study medication on either Bronchitis Severity Scores, change of symptoms and coughing frequency.

3.5.3 Acute cough

The treatment of acute cough with EA-575 (standardized extract from H. helix L.) was tested against placebo in one double blind randomized placebo controlled trial and reported a significantly better improvement of cough severity (CS) assessed by Visual Analogue Scale (VAS) in the intervention group after 1 week as compared to placebo ( Schaefer et al., 2016 ).

3.5.4 Acute lower and upper tract respiratory infections

We included one retrospective cohort study comparing people with acute lower and upper tract respiratory infections who were prescribed a phytopharmaceutical to those who were not prescribed such drugs. They found that extract EPs 7630 (description see 3.5.1) (odds ratio (OR) 0.49 [95% CI: 0.43–0.57]) and thyme extract (OR 0.62 [0.49–0.76]) compared to no phytopharmaceutical prescription exhibited the strongest decrease in antibiotics prescriptions among patients treated by general practitioners ( Martin et al., 2020 ).

4 Discussion

The aim of this review is to depict the current evidence for the therapeutic efficacy of herbal medicines. Therefore, we conducted a literature search with defined inclusion and exclusion criteria in particular to select information from clinical studies with high levels of evidence and legally approved (in Europe) herbal medicines. Certainly, life-threatening disease are not suitable for the treatment with herbal medicines. This is the reason why we limited our perspective on psychosomatic disorders, gynecological complaints, gastrointestinal disorders and common infectious diseases of the urinary and the upper respiratory tract. Additionally, we concentrated on clinical trials with adult patients. It is to be emphasized that respective studies using herbal drugs have also been done in children with psychosomatic diseases ( Verlaet et al., 2017 ; Schloss et al., 2021 ), IBS ( Menon et al., 2023 ), gastrointestinal disorders ( Michael et al., 2022 ), UTIs ( Ching, 2022 ), and URIs ( Mancak Karakus et al., 2023 ) to mention only some examples.

The use of herbal medicines in the treatment of psychosomatic disorders is widespread and accordingly a high number of clinical studies was available for our analysis. In our literature search, the term “psychosomatic disorders” has been chosen. This term has not been clearly defined but is related to diseases which involve both physical and psychological illness. In other words, the respective symptoms are caused by mental processes and not directly by a physical disorder. The hits we got are based on this “terminology”. In contrast, the term “mental illnesses” which also includes psychological or behavioral manifestations is strictly defined as “health conditions with changes in emotion, thinking or behavior” ( Stein et al., 2021 ). However, even this definition is problematic, since there are concerns about specific conditions, the discrimination between independent biological entities or value-laden social constructs, and the defined indicators of dysfunction ( Stein et al., 2021 ). Independent on these concerns, we did not apply this search term. Therefore, we cannot exclude that (very few) articles have not been discovered with our search strategy.

For the treatment of depressive disorders, St. John’s wort is well-established and the studies we selected were predominantly positive regarding improvement of symptoms. Concurrently, SJW is well tolerated and in the majority of the studies at least equal to conventional medication like tricyclic anti-depressants and selective serotonin reuptake inhibitors, which exhibit in part notable adverse events impacting patients’ quality of life of ( Voican et al., 2014 ; Jakobsen et al., 2017 ).

In contrast evidence for insomnia and anxiety was thinner. It would be worthwhile to study the use of herbal drugs as alternative medication for the treatment of sleeping disorders, as for elderly people or long term use conventional hypnotics are not always the best option ( Wortelboer et al., 2002 ; Cheng et al., 2020 ). All the studies we included were using valerian root extract alone or in combination with Humulus lupulus extract and showed positive effects on sleep without notable side effects. The few studies we selected for anxiety demonstrated efficacy of lavender extract (Lavandula angustifolia) and also here we had a homogenous picture of good efficacy along with good tolerability.

Several years ago, consistent beneficial effects of Ginkgo biloba for patients with cerebral insufficiency were proven in a systematic review ( Kleijnen and Knipschild, 1992 ). However, the methodologic quality of many trials was considered to be poor. Moreover, the studies entailed a heterogeneous collection of target health problems, ranging from overt dementia to noncognitive manifestations of brain dysfunction, such as vertigo and tinnitus. More recently, the results of several new Ginkgo biloba trials have been published, most of them focusing on dementia, and showing positive effects. Probably the most talked about is the trial of the North American EGb Study Group, which was published in the JAMA in 1997 and showed a modest improvement of the cognitive performance and the social functioning of the demented patients involved ( Le Bars et al., 1997 ), which is well in line with the studies we have collected.

In addition, menopausal symptoms and premenstrual syndrome are suitable for treatment with herbal medicines. In the here collected studies, no overall negative effects were observed and adverse events did not occur more frequently than in the comparison groups. A consistent picture emerged when comparing herbal treatment with synthetic drugs or placebo: while herbal drugs and treatment with, e.g., HRT or pyridoxine showed equal efficacy, herbal treatment was in general superior to placebo administration, except for one study.

Effective treatment of menopausal symptoms with black cohosh is supported with multiple study designs. Regardless of the study quality, there are no contradictory results.

The evidence for the treatment of PMS with VAC initially appears similar to that of black cohosh for menopausal symptoms. However, the sample sizes have been insufficient and there was a complete lack of comparisons of VAC with other therapies. Also of interest are the hints on the importance of the dose and continuous administration. A higher dosage did not have a higher efficacy compared to the standard dosage, but slightly more participants experienced adverse events ( Momoeda et al., 2014 ). This suggests a preference for the standard dosage of VAC. Continuous use of VAC is recommended, as it has been shown that symptoms increase significantly, even if they are still lower than before therapy ( Bachert et al., 2009 ).

However, further research is needed for both gynecological indications. Only one study each on sage for menopausal symptoms and SJW for premenstrual symptoms was found ( Lauritzen et al., 1997 ; Lauritzen et al., 1997 ; Adeyemo et al., 2013 ). The trend-setting results point to positive effects which have to be confirmed.

For gastrointestinal disorders herbal drugs were, at least partially, shown to be similar efficacious as the standard treatment. Selected, non-toxic plant derived natural compounds may, therefore, replace synthesized drugs which are associated with undesired negative side effects and the therapeutic potential of the compounds may depend on both the plant extract and the type of disease to be treated. Indeed, SJW was not efficacious in treating IBS, whereas WS 1340/WS 1520 and STW 5 and STW 5-II showed efficacy in both IBS and FD. Considering the broad spectrum of gastrointestinal complaints, therapy of severe liver disease may require more effort than treatment of moderate dyspepsia and, hence, herbal medicine may not replace standard therapy.

As no standard therapy has so far been established for FD ( Madisch et al., 2018 ) and IBS ( Lacy et al., 2021 ) the design of clinical studies is difficult, making it impossible to compare the phytodrug group with a “reference” cohort, and to finally assess the value of the phytodrugs.

Particular attention should be given to STW 5 containing greater celandine which has been related to liver and biliary tract disorders ( Zielińska et al., 2018 ). Therefore, careful preclinical examination of potential toxic properties of a compound of question is necessary before starting clinical trials.

Overall, most of the studies were well designed (multicenter, double-blind, placebo-controlled trials) with large cohorts. Considering the low side effects and often significant improvements, it might be useful to conduct further studies to either gain more detailed information about herbal medicine or to transfer the knowledge to diseases with a similar cluster of symptoms, so that distinct ailments might particularly benefit from herbal medicine ( Chey et al., 2015 ).

With respect to urinary tract infections (UTI), herbal medicines have been proven to be similar effective as antibiotics. Undoubtedly, the data encourages further research on herbal medicines as alternatives to antibiotics in acute lower uncomplicated UTI ( Wagenlehner et al., 2018 ). The use of herbal medicines has also been considered to be a good and safe alternative to perioperative antibiotic prophylaxis ( Miotla et al., 2018 ). However, whether herbal medicines may reduce or even replace antibiotics in future guideline-based regimen requires more prospective studies conducted on large groups of participants ( Wawrysiuk et al., 2022 ).

It is important to note in this context that one study discriminated between HM responders and non-responders ( Kulchavenya, 2018 ). This phenomenon is highly important, since it indicates that the application of HM in general might be restricted to a subset of patients. Unfortunately, no ongoing trials have been enrolled in this matter, and none of the publications cited here discussed the problem of acquired or innate resistance, at least from a theoretical point of view.

LUTS caused by BPH was treated differently than UTI, since the complications of BPH, namely, urinary incontinence, polyuria, urinary retention, and erectile dysfunction, have to be targeted. The clinical trials published so far point to the benefit of herbal medicines in reducing BPH symptoms. However, it is not clear yet whether the integration of herbal medicines may allow to reduce or even to avoid the use of standard medical therapeutics in this case.

Overall, several clinical studies conducted in the last years document a beneficial role of herbal medicines in the treatment of UTI and LUTS.

Upper Respiratory Infections (URIs) are a frequent cause of troublesome symptoms, that might be appropriately treated with herbal medicine. Most studies included in this paper evaluated herbal medicines for the treatment of acute bronchitis or common cold and acute sinusitis or rhinosinusitis.

The majority of the studies we included for the treatment of acute bronchitis tested P. sidoides against placebo and reported a statistically significant decrease of bronchitis symptoms and/severity. This is in line with the results of a systematic review and meta-analysis ( Agbabiaka et al., 2008 ), although a more recent systematic review judged that the evidence was of low quality ( Timmer et al., 2013 ). Evidence for other herbal medicines in the treatment of acute bronchitis was scarce.

For the treatment of common cold we found some indications of effectiveness of P. sidoides , Eucalyptus, sweet orange, myrtle and lemon oil (ELOM-080) and for Gentianae radix, Primulae flos, Sambuci flos, Rumicis herba and verbenae herba (BNO 1016). A recent systematic review with network meta-analysis, showed very little solid evidence of herbal medicine versus placebo for common cold, with only P. sidoides and Andrographis paniculata showing a reliable decrease of symptoms. Better results were found for herbal medicine versus placebo concerning health related quality of life (HRQoL) (in particular Spicae aetheroleum ) and for symptoms (Cineole and P. sidoides ) ( Hoang et al., 2023 ). A further systematic review reported on the efficacy of P. sidoides (liquid and tablet preparation) for the treatment of acute bronchitis, showing a positive results with, however, low evidence quality ( Timmer et al., 2013 ).

Although herbal medicines are considered to be safe in principle, this might not always be the case. Some herbal compounds are suspected to be carcinogenic and/or hepatotoxic. Herbal products have also been shown to inhibit and/or induce drug-metabolizing enzymes ( Moreira et al., 2014 ). This has to be taken into account, since herbal medicines are often used in combination with conventional drugs. In this context, preparations with SJW may reduce the efficacy of chemotherapy and of anticoagulants but enhance the one of certain consciousness-lowering agents (e.g., sedative medicines, antidepressants) ( Nicolussi et al., 2020 ; Scholz et al., 2021 ). Due to potential liver toxicity of chelidonium majus, preparations containing more than 2.5 mg daily dose of whole chelidonium alkaloids had to be withdrawn, and for all preparations with lower daily doses, their instruction leaflet must include warnings on liver toxicity ( Rosien, 2019 ). Therefore, the drug’s safety must always be carefully investigated and guaranteed by the producers and the regulatory authorities.

The analysis of the outcomes in the selected disorders reflects that herbal medicines are most efficacious for the treatment of URTI ( Figure 5 ), followed by gynecological complaints ( Figure 2 ) and psychosomatic disorders ( Figure 1 ). For the treatment of urological diseases ( Figure 4 ) in particular UTI and LUTS, we could select only 16 studies according to our strict inclusion/exclusion criteria and therefore more studies of high quality have to be performed to gain a better insight into the efficacy of herbal drugs for these ailments. Gastrointestinal diseases hold a special position as only the added value of the phytodrugs to the conventional therapy was tested. In addition, the number of studies we selected was small ( Figure 3 ), making it difficult to judge the efficacy of herbal drugs for this indication.

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Object name is fphar-14-1234701-g004.jpg

This report on the current state of research on the clinical benefits of herbal medicines for non-life-threatening ailments has some limitations.

1. The literature search had to be restricted to Pubmed, because other relevant databases like e.g., EMBASE or CINAHL have not been accessible to the authors.
2. Further limitations are the small cohorts in some of the studies
3. Or that the results/outcomes of some studies have been re-analyzed from previous studies.
4. A general obstacle of data interpretation is that for some indications, in particular for gastrointestinal diseases, herbal medicines are predominantly co-administered with standard therapy, which makes it difficult to estimate the clinical benefit of the phytodrug alone.

5 Perspective

Our literature research gives insights into applied herbal medicines for selected indications, the study outcomes and their quality. Based on our results, we (the authors) provide an overview for patients and healthcare practitioners which extracts can be recommended for the treatment if which disorder/complaint ( Supplementary Table S1 ).

In this context we recommend in particular H. perforatum L. for depressive disorder, V. agnus castus L. for menstrual complaints, Cimicifica racemose (L.) for menopausal symptoms, a combination of I. amara L., M. chamomilla L., Mentha × piperita L., C. carvi L., G. glabra L. and M. officinalis L., for functional dyspepsia, a combination of C. erythraea , Levisticum officinale W.D.J.Koch and Rosmarinus officinalis L. for uncomlicated urinary tract infections, P. sidoides DC. for bronchitis and sinusitis and finally H. helix for cough ( Supplementary Table S1 ). These recommendations are based on studies with the highest levels of evidence (RCTs).

However, evidence for efficacy of herbal medicines is still not satisfying in order to integrate them in conventional medicine guidelines and standard treatment regimen, which is the reason why statutory health insurances do not reimburse the costs. In fact, herbal medicines are highly popular and accepted among patients, since their application is safe since they do not exert severe side-effects. Especially when conventional medical therapies fail due to undesired side effects having a negative impact on the quality of life, patients are willing to purchase herbal medicines at their own expense. Often doctors do not know about the self-medication activities of their patients and in consequence cannot monitor the treatment with herbal medicines and possible interactions with other drugs.

The discrepancy between available results from clinical research and the use of herbal medicines under everyday conditions shows that we need to perform more interdisciplinary research studies in the future in order to collect scientific sound evidence on their benefits. Clinical research can provide information on the efficacy of phytodrugs and the importance of genetic dispositions and metabolism as well as possible interactions with other medicines. For effectiveness under everyday conditions (from bedside to practice), methods of health services research are necessary. With the help of these, the outcomes of herbal medicines can be recorded from different perspectives, in particular those of the patients (patient-reported outcomes (PROs)). For longitudinal observations, analyses of health insurance and sales volume data are also relevant, using prescriptions and the over-the-counter sales to get a picture on the needs of the patients and the acceptance of phytotherapy by healthcare practitioners. In order to pave the way for the integration of herbal medicines into therapy guidelines and regimens, findings from clinical studies should be carefully evaluated for their transferability to everyday healthcare within the scope of health services research. This way could lead to novel rational efficacious therapy strategies with less side-effects and better compliance of the patients.

Data availability statement

Author contributions.

SS: Investigation, Formal analysis, Writing–Original Draft. JR: Investigation, Formal analysis, Writing–Original Draft, Visualization. MA: Methodology, Investigation, Formal analysis, Writing–Original Draft. RB: Investigation, Formal analysis, Writing–Original Draft. BB: Conceptualization, Methodology, Investigation, Formal analysis, Writing–Original Draft, Supervision. All authors contributed to the article and approved the submitted version.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fphar.2023.1234701/full#supplementary-material

	Age-Associated Memory Impairment
	Alzheimer’s Disease
	Alzheimer’s Disease Assessment Scale-Cognitive Subscale
	Alzheimer’s Disease Cooperative Study-Clinical Global Impression Of Change
	Adverse Drug Reaction
	Adverse Effects
	Alzheimer’s Disease Assessment Scale-Cognitive Subscale
	Alanine Transaminase
	Acute Rhisosinusitis
	Beck-Depressions-Inventar
	Complaint Inventory for symptoms of depression („Beschwerdeerfassungsbogen”)
	Von Zerssen’s Adjective Mood Scale
	Benign Prostatic Hyperplasia
	Bowel Symptome Score
	Bronchitis Symptom Score
	Clinical Activity Index
	Crohn’s Disease
	Crohn’s Disease Activity Index
	Control Group
	Clinical Global Impression
	Clinical Global Impression of Improvement
	Clinical Global Impression of Severity
	Cough Severity
	Dyspeptic Discomfort Score
	Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised
	Daily Symptom Report
	Enhanced Liver Fibrosis
	Epigastric Pain Syndrome
	European Medicines Agency
	Full Analysis Set
	Functional Dyspepsia
	Generalized Anxiety Disorder
	General Alzheimer’s Disease
	Global Assessment of Functioning
	Geriatric Evaluation by Relative’s Rating Instrument
	Gastrointestinal Symptom Score
	Global Patient’s Self-Assessment
	Hamilton Rating Scale for Anxiety
	Hamilton Rating Scale for Depression
	Herbal Medicine
	Health Related Quality of Life
	Hormone Replacement Therapy
	Viral Hepatitis C
	Viral Hepatitis B
	Inflammatory Bowel Disease
	Irritable Bowel Syndrome
	International consultation on incontinence modular questionnaire
	Inventory of Depressive Symptomatology- Clinician-Rated
	Inventory of Depressive Symptomatology- Self-Report
	International Prostate Symptom Score
	Inflammatory Bowel Disease
	Irritable Bowel Syndrome
	Intervention Group
	Kupperman Menopause Index
	Left Alzheimer’s Disease
	Lower Urinary Tract Infection
	Lower Urinary Tract Symptoms
	Montgomery-Asberg Depression Rating Scale
	Mild Cognitive Impairment
	Menopausal Hormone Therapy
	Moos‘ Menstrual Distress Questionnaire
	Mini-Mental State Examination
	Mean Opinion Score
	Menopausal Rating Score
	Major Symptom Score
	Mid-Urethral Sling
	Nuremberg Gerontopsychological Rating Scale for Activities of Daily Living
	Nuremberg Gerontopsychological Inventory
	Nepean Dyspepsia Index
	Neuropsychiatric Inventory
	non-steroidal anti-inflammatory drug
	Overactive Bladder
	Odds Ratio
	Postprandial Distress Syndrome
	Polyethylene glycol
	Pressure, Heaviness and Fullness
	Patient Health Questionnaire 9
	Premenstrual Syndrome
	Premenstrual Syndrome Diary
	Premenstrual Tension Syndrome
	Pelvic Organ Prolapse
	Proton Pump Inhibitors
	Patient-Reported Outcome
	Pittsburgh Sleep Quality Index
	Penn State Worry Questionnaire
	Psychiatry Educator
	Quality of Life
	Quality of Life Enjoyment and Satisfaction Questionnaire
	Right Alzheimer’s Disease
	Randomized Controlled Trials
	Self-Rating Anxiety Scale
	Symptom Check List- 58
	Short Form 36 Health Survey
	Sleep Questionnaire B
	german: Syndrom-Kurztest, Cognitive Test Battery
	Symptom Score
	Selective Serotonin Reuptake Inhibitors
	Sinusitis Severity Score
	Slow-Wave Sleep
	Total Daily Symptom Score
	Time In Bed
	Total Score of the mean number of Intensity-Rated Hot Flushes
	Total Symptom Score
	Urodynamic Studies
	Upper Respiratory Tract Infections
	Urinary Tract Infections
	Vascular Dementia
	Visual Analogue Scale
	Wellbeing Scale

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Undergraduate

Psychology Capstone

Field Experience
Careers in Psychology

The Psychology Capstone Experience is intended to provide the psychology student with an intensive exploration into an aspect (e.g., teaching, service, research) and area (e.g., clinical, developmental, behavior analysis, behavioral neuroscience) of psychology as a means for enhancing learning and integrating the knowledge and experiences acquired as a psychology major.

Experiential learning experiences are critically important for baccalaureate graduates of Psychology to be competitive for graduate or professional programs or to seek employment. One goal of the Capstone requirement is that the student will become well-rounded professionally.

The capstone must be completed within the 12 months prior to graduation.

There are 5 types of Psychology Capstone courses.

Teaching Practicum - PSYC 490A
Professional Field Experience Capstone - PSYC 491A
Behavior Analysis Field Experience Capstone – PSYC 486
Behavior Analysis Research Experience – PSYC 487
Independent Study (Research) - PSYC 495A, PSYC 498A, or PSYC 487: Research and PSYC 498A: Honors Thesis

Selecting a Capstone

Start with what you want to do after you graduate. Your capstone can be used to help you develop the valued skills necessary for that next step related to your career path.

Mental Health

Students interested in an applied area of mental health, like Counseling or Social Work, should prioritize a PSYC 491A capstone.

Research or Medicine

Students interested in careers involving research or medicine should plan on completing several semesters of research with a faculty member, culminating in a PSYC 495A, PSYC 498A, or PSYC 487 capstone.

Behavior Analysis

Students interested in careers in Behavior Analysis, and all those pursuing the undergraduate Certificate in Behavior Analysis should complete a PSYC 486 or PSYC 487 capstone.

Human Resources or Business

Students interested in careers in Human Resources or Business should consider a PSYC 491A capstone.

Students planning to pursue a career in education should complete with a PSYC 490A or PSYC 491A capstone.

Capstone Requirements

Students must have completed PSYC 204 – Research Methods and Analysis II and be in their last year of study before they will be allowed to register for a capstone experience.

Credits: Capstone courses are necessarily 3 credits. Each credit will equate to 3 hours a week of activity in Fall or Spring semesters. Therefore, students should expect to complete 9 hours of activity a week during their capstone semester. If a student is completing a capstone over the 12-week summer session, they should expect to spend at least 12 hours a week engaged in their capstone work.

Project: As a requirement of their Capstone Experience, students complete a capstone project. The nature of the project will vary based on the type of capstone. For example, a PSYC 491A capstone project might be a case study of a particular child or adult at your site. A PSYC 495A capstone project would be completing a research study under the supervision of their faculty supervisor. The project will culminate in a 10-page paper and presentation of a professional paper at the department Capstone Poster Session.

Poster: At the end of the fall and spring semesters, the Department of Psychology hosts a Capstone Poster Session. At this event, all students completing their capstone requirements will produce a professional poster, with the supervision of their supervising faculty, and have their poster evaluated by members of the Department of Psychology. This is one of the most exciting and fun events of the semester. Students in their earlier years are encouraged to attend this poster session. Some PSYC courses may offer extra credit for attending this event.

ACAT: Around mid-semester, all Capstone students must complete the ACAT, a standardized assessment of psychology content.

PSYC 490A: Teaching Capstone

Students completing the PSYC 490A capstone will be involved in proctoring, tutoring, and depending on the course, lecturing or leading in-class activities and discussions. Students will complete a research or equivalent study on issues related to teaching/pedagogy.

This capstone can benefit those students who want to develop their presentational skills, tutoring skills, and are interested in examining topics related to pedagogy, student success, or other topics.

To arrange a PSYC 490A experience, email course supervisors for PSYC 101, PSYC 241, PSYC 251, or another course 1) that you find interesting and 2) in which you earned an A. Find out if that faculty has GPA requirements for their Teaching Practicum students. Some students will reach out a year in advance to secure their spot as a Teaching Practicum student with a faculty. These opportunities can be limited. Once approved to set up a PSYC 490A, you and the faculty member fill out a contract and once this is done, you will send this contract to our Undergraduate Records Assistant. After that, you will be allowed to register for the course.

PSYC 491: Field Experience

Please review the PSYC 491 page for more information about field experience options.

Student completing the PSYC 491A capstone option will be expected to work at a site for 9 hours a week in Fall or Spring semesters or 12 hours a week if completed over the summer session. Sites can be related to treatment of addictions, persons with autism spectrum disorders or neurodivergence, human resources, psychological testing, and many other areas of interest to students. Students will also meet weekly with their PSYC 491A faculty and GTA to complete work on eCampus.

Most Psychology majors complete this capstone option. It is beneficial for allowing students to gain practical experiences and develop skills valued by employers and many graduate programs. This is a popular capstone choice for students considering careers in Counseling or Clinical Mental Health.

Plan this at least year in advance . Check the due dates for the application and related forms. The application is usually due by the 4 th week of the previous semester. The steps setting up a Professional Field Experience will also include having a background check completed before a student can register for credits.

PSYC 486: Behavior Analysis Field Experience

Like PSYC 491A, student completing the PSYC 486 capstone option will be expected to work at a site for 9 hours a week in Fall or Spring semesters or 12 hours a week if completed over the summer session. The difference is that the site will be specifically focus on applications of behavior analysis, allowing students to use the PSYC 486 course to meet the experiential requirements for the undergraduate Certificate in Behavior Analysis as well as the Psychology major capstone.

Contact Dr. Brennan Armshaw ( [email protected] ) well in advance of the semester in which you wish to enroll. Spaces in PSYC 487 are limited.

PSYC 495A, PSYC 498A, or PSYC 487: Research

Students completing a research capstone are typically completing advanced research training in a faculty research lab within the Department of Psychology. Students may have already developed foundational skills in that faculty research lab from previously completing PSYC 497 or PSYC 487 credits. Students may be involved in recruiting, collecting data or coding data, running additional analyses, and assisting in manuscript writing.

PSYC 495A is a research capstone. PSYC 498A is an Honor’s thesis. PSYC 487 involves research in behavior analysis.

Students will develop important research skills and may engage in professional experiences, such as presenting research at colloquia and professional meetings. Students will be working with graduate students and often enjoy important mentoring as they prepare for jobs or graduate programs after they graduate.

Contact faculty members whose research interests you (using the Faculty Directory or Research page as a resource) to learn more about that person’s specific requirements.

PSYC 498A: Honors Thesis

This program is distinct from the Honors College. Students do not need to be members of the Honors College to engage in this capstone option.

Completing a PSYC 498A Honors Thesis generally requires 2 semesters. During the first semester, students typically register for the non-capstone section of PSYC 498. Then during the second semester, students will register for the Capstone section of PSYC 498A. Faculty often require that the student work in their lab for PSYC 497 credit previously. PSYC 498 positions are primarily available in the fall and spring semesters. However, some faculty members will work with students completing a PSYC 498A Capstone Experience during the summer.

In this option, students create a 3-person Honors Thesis committee, usually made up of their supervising faculty member, a second faculty member from outside the lab, and a graduate student. Honors Thesis students develop their own study, propose the study to their Honors Thesis committee, carry out the study, write up their findings, and then defend their study to their committee at the conclusion. As with other capstone students, Honors Thesis students will write a research paper and present their poster at the Department of Psychology Senior Poster Session. Most Honors Thesis papers are “manuscript quality,” that is, the student and the faculty may plan to submit the paper to a professional journal.

With the experience of forming a committee, proposing and defending the research, presenting the research and perhaps seeking a publication, students completing this capstone option are developing skills and experiences that will allow them to be competitive at the highest levels.

Students interested in the PSYC 498A Honors Capstone Experience should discuss this with their research faculty supervisor and their major advisor. A completed and approved PSYC 498 Application, an overall GPA of 3.4 and a Psychology GPA of at least 3.5 are required to apply for the Honors Capstone. Related application and contract forms are provided by the student’s major advisor.

Setting up a Capstone course will require the approval of the application, completion of a contract (and any other related materials) and submitting form(s) to the Undergraduate Student Records Administrator, Vee Lewis ( [email protected] ). Vee Lewis will lift the departmental approval restriction to allow students to enroll in their experiential course.

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Current state of research on the clinical benefits of herbal medicines for non-life-threatening ailments

Jochen Rutz

Marjan van den Akker

Roman A. Blaheta

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1 Introduction

1.1 Indications suitable for treatment with herbal medicines