It was a herb that inspired the development of the first of the NSAIDs. White willow (Salix alba) is a herb traditionally used for pain relief and reducing fever (3). It contains flavonoids, tannins and salicylates; with the salicylate salicin considered to be the key active constituent (4). The discovery of salicylates from white willow and meadowsweet (Filipendula ulmaria) and their pain-relieving activity led to the development of acetylsalicylic acid (aspirin). 

White willow extract has been found to inhibit COX enzymes, tumour necrosis factor-α (TNF-α) and NFκB (5), all of which are involved in inflammatory pathways. Much lower levels of salicylates are provided by effective therapeutic doses of white willow than are administered when taking aspirin, which means that fewer of the gastrointestinal side effects seen with aspirin are experienced (5).

It also suggests that constituents other than salicin are involved in the beneficial effect seen. Evidence suggests that white willow may be effective for treating lower back pain, and one study found that a standardised extract containing 120–210 mg of salicin was equivalent to the NSAID rofecoxib (6).

A study of 96 students with primary dysmenorrhoea (painful periods) found that 750 mg of mefenamic acid was less effective than 400mg of white willow (containing 240mg of salicin) at reducing pain, as measured using a visual analogue scale (7).

Turmeric (Curcuma longa) has been well researched for pain, particularly to treat knee osteoarthritis. It impacts on inflammatory markers interleukin-6 (IL-6) and TNF-α, and has been found to downregulate pain receptor expression (8); indicating a more complex mechanism of action than NSAIDs. 

A meta-review of turmeric systematic review found there to be moderate GRADE evidence for the use of turmeric to relieve pain and improve symptoms of osteoarthritis (8). GRADE is a tool to systematically assess the quality or certainty of evidence in clinical research. 

One study of 144 patients with knee osteoarthritis found that 1 g of a bioavailable turmeric extract was as effective as paracetamol at reducing pain over six weeks, while achieving greater decreases in inflammatory markers C-reactive protein (CRP) and TNF- α (9).

Another study of 367 patients showed that 1.5 g of turmeric extract was as effective as 1.2 g ibuprofen but with fewer gastrointestinal side effects when taken for four weeks by adults with knee osteoarthritis (10).

The measurement of inflammatory markers is one way to objectively determine whether an intervention is likely to be having an effect on the processes involved with pain and inflammation. So, the reduction of CRP and TNF-α by turmeric was a positive sign that it was having an impact on the cause of the pain, rather than providing a placebo effect or simply improving overall wellbeing.

Prostaglandins are short-acting signalling molecules that are involved in inflammatory responses. They are synthesised by COX enzymes and inhibiting their production by COX is a key mechanism of action of aspirin and NSAIDs. A study of 60 patients with knee osteoarthritis demonstrated that both NSAID naproxen and a supplement containing turmeric, ginger and black pepper inhibited prostaglandin E₂ (PGE₂) with no significant difference (11).

Fennel (Foeniculum vulgare) has also been proposed to alleviate pain by lowering prostaglandin levels. Two meta-analyses have both concluded that fennel oil or capsules is equivalent to conventional drug therapies such as the NSAID mefenamic acid at treating dysmenorrhoea (12,13).

The holistic and “nudge”-like approach of herbal medicine that aims to address health challenges over the long-term may not seem at first to be the most suitable way to address pain. The urgent feeling and discomfort experienced when we are in pain stimulates the desire for fast-acting solutions. 

A randomized-controlled trial in 88 healthy adults with acute musculoskeletal pain found that those who took 1g of a black seed oil (Nigella sativa), turmeric and frankincense (Boswellia serrata) extract had pain relief comparable to paracetamol within an average of one hour (14). 

There is also evidence that topically applied pain-relieving herbs like chilli (Capsicum spp.), rosemary (Salvia rosmarinus) and lavender (Lavandula angustifolia) can act quickly (15).

Due to the difficulties in achieving results when treating pain, multiple drugs are often combined to provide a more effective outcome. The addition of herbal anti-inflammatories to standard therapy may also be a good approach. 

A study of 140 patients with knee osteoarthritis found that 1 g of a curcuminoid complex combined with 100 mg of the NSAID diclofenac daily for 28 days was more effective than the diclofenac alone. Pain and quality of life were improved and the number of rescue analgesics needed for uncontrolled pain were lower in those taking the curcuminoid complex. There were also fewer adverse effects and less need for treatment of acid reflux with H2 blockers in the curcuminoid group (16).

In women with primary dysmenorrhoea, there is an increase in release of prostaglandins, particularly PGE₂. A standard treatment is the NSAID mefenamic acid. One study of 150 female students found that combining 250 mg of mefenamic acid with 500 mg of turmeric powder daily for five days around the start of menstruation led to significant reduction in pain compared with either treatment alone (17).  

Some herbs work via similar mechanisms to common pain-relieving medication such as NSAIDs. In many cases, they have been demonstrated to be as effective as standard painkillers, but with fewer side effects and, in some cases, they may mitigate the side effects produced by NSAIDs. This may be due to the complexity and synergy from multiple different phytochemicals in one herb.

Additionally, the holistic approach used in herbal medicine will aim to address the factors that have caused or are prolonging the increased inflammation in the first place and work towards fully resolving the underlying pathology.

1. NICE. How do analgesics work? Clinical Knowledge Summaries. 2025. Accessed March 25, 2026. https://cks.nice.org.uk/topics/analgesia-mild-to-moderate-pain/background-information/mode-of-action/
2. Gunaydin C, Bilge SS. Effects of nonsteroidal anti-inflammatory drugs at the molecular level. Eurasian J Med. 2018;50(2):116–121. https://doi.org/10.5152/eurasianjmed.2018.0010
3. Committee on Herbal Medicinal Products (HMPC). Final European Union herbal monograph on Salix [various species including S. purpurea L., S. daphnoides Vill., S. fragilis L.], cortex. European Medicines Agency; 2017. EMA/HMPC/80630/2016-Corr. Accessed April 23, 2026. https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-salix-various-species-including-s-purpurea-l-s-daphnoides-vill-s-fragilis-l-cortex_en.pdf
4. Matyjaszczyk E, Schumann R. Risk assessment of white willow (Salix alba) in food. EFSA J. 2018;16(Suppl 1):e16081. https://doi.org/10.2903/j.efsa.2018.e16081
5. Heinrich M, Barnes J, Prieto-Garcia JM, Gibbons S, Williamson EM. Fundamentals of Pharmacognosy and Phytotherapy. 4th ed. Elsevier; 2023.
6. Oltean H, Robbins C, van Tulder MW, Berman BM, Bombardier C, Gagnier JJ. Herbal medicine for low-back pain. Cochrane Database Syst Rev. 2014;2014(12):CD004504. https://doi.org/10.1002/14651858.CD004504.pub4
7. Raisi Dehkordi Z, Rafieian-Kopaei M, Hosseini-Baharanchi FS. A double-blind controlled crossover study to investigate the efficacy of salix extract on primary dysmenorrhea. Complement Ther Med. 2019;44:102–109. https://doi.org/10.1016/j.ctim.2019.04.002
8. Rolfe V, Mackonochie M, Mills S, MacLennan E. Turmeric/curcumin and health outcomes: a meta-review of systematic reviews. Eur J Integr Med. 2020;40:101252. https://doi.org/10.1016/j.eujim.2020.101252
9. Singhal S, Hasan N, Nirmal K, et al. Bioavailable turmeric extract for knee osteoarthritis: a randomized, non-inferiority trial versus paracetamol. Trials. 2021;22(1):105. https://doi.org/10.1186/s13063-021-05053-7
10. Kuptniratsaikul V, Dajpratham P, Taechaarpornkul W, et al. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clin Interv Aging. 2014;9:451–458. https://doi.org/10.2147/CIA.S58535
11. Heidari-Beni M, Moravejolahkami AR, Gorgian P, Askari G, Tarrahi MJ, Bahreini-Esfahani N. Herbal formulation “turmeric extract, black pepper, and ginger” versus naproxen for chronic knee osteoarthritis: a randomized, double-blind, controlled clinical trial. Phytother Res. 2020;34(8):2067–2073. https://doi.org/10.1002/ptr.6671
12. Lee HW, Ang L, Lee MS, Alimoradi Z, Kim E. Fennel for reducing pain in primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2020;12(11):3438. https://doi.org/10.3390/nu12113438
13. Shahrahmani H, Ghazanfarpour M, Shahrahmani N, Abdi F, Sewell RDE, Rafieian-Kopaei M. Effect of fennel on primary dysmenorrhea: a systematic review and meta-analysis. J Complement Integr Med. 2021;18(2):261–269. https://doi.org/10.1515/jcim-2019-0212
14. Rudrappa GH, Chakravarthi PT, Benny IR. Efficacy of high-dissolution turmeric-sesame formulation for pain relief in adult subjects with acute musculoskeletal pain compared to acetaminophen: a randomized controlled study. Medicine (Baltimore). 2020;99(28):e20373. https://doi.org/10.1097/MD.0000000000020373
15. Barnett H. Pain relief: 5 analgesic herbs for external application. Herbal Reality. 2023. Accessed April 23, 2026. https://www.herbalreality.com/health-lifestyle/mobility-fitness/5-herbs-instead-painkillers/
16. Shep D, Khanwelkar C, Gade P, Karad S. Efficacy and safety of combination of curcuminoid complex and diclofenac versus diclofenac in knee osteoarthritis: a randomized trial. Medicine (Baltimore). 2020;99(16):e19723. https://doi.org/10.1097/MD.0000000000019723
17. Hesami S, Kavianpour M, Rashidi Nooshabadi M, Yousefi M, Lalooha F, Khadem Haghighian H. Randomized, double-blind, placebo-controlled clinical trial studying the effects of turmeric in combination with mefenamic acid in patients with primary dysmenorrhoea. J Gynecol Obstet Hum Reprod. 2021;50(4):101840. https://doi.org/10.1016/j.jogoh.2020.101840

Historically, herbal dosing was developed through empirical trial, observation, experience and long-term use. Effective doses, preferred formulations and the knowledge of optimal remedies was passed through the generations (1).

Traditional texts often describe dosing in experiential terms, such as a glass or handful, or an amount tolerated. While these measures may appear imprecise from a modern or conventional perspective, they reflect a responsive approach to medicine — trial and error.

Doses were often adjusted according to the strength of the herb and individual’s response over time. Sometimes doses may have to be adjusted according to the strength and purity of a batch of herbs, as differences in harvesting, drying, storage and processing can impact the strength of the actives. The importance of feedback and adjustment of doses was a valuable part of traditional practice (2).

Plant and formulation factors 

The characteristics of the herb itself must be considered when determining an appropriate dose. Herbs differ widely in their strength, safety profile and therapeutic range; these differences directly inform how they should be used (3). Nutritive herbs such as nettle (Urtica dioica) or dandelion (Taraxacum officinale) are rich in minerals and phytochemicals which are often used in generous doses over extended periods of time for their vast medicinal benefits ranging from anti-inflammatory to blood tonic effects (4,5).

In contrast, aromatic and bitter herbs tend to act more immediately on digestion, circulation and the nervous system and may produce noticeable effects at relatively small doses. For example, peppermint (Mentha x piperita, M. arvensis) stimulates taste receptors and digestive reflexes; even modest amounts can have carminative effects and stimulate gut motility (6).

Similarly, aromatic nervines such as lavender (Lavandula angustifolia) or lemon balm (Melissa officinalis) can have calming effects at relatively low doses (7). Some herbs have a narrow safety profile therefore require great precision and clinical judgement when dosing. Lily of the valley (Convallaria majalis) a cardiotonic can be highly toxic even in small over-doses (8). Hence, careful dosing, appropriate training and awareness of contraindications is so important.

Today, for most people dosing from raw or unprocessed material may be confusing. Telling someone to take a pinch of a powdered herb can lead to significant dosing variability, as a pinch can range on average from 0.3 g to 0.6 g. This variability could lead to double the dose which could have adverse effects rather than a therapeutic benefit. Therefore, quantifying a pinch as a definitive value (e.g., “a pinch is 0.3 g”) makes dosing reproducible, and standardises the process.

When using leaves in preparations (i.e. add two leaves) this can also have inconsistent dosing effects. The variable size, condition and stage of maturity of the leaf can also impact the efficacy of dosing. Furthermore, dried and fresh material will have different effects; dried material may be more concentrated, and the composition of bioactive compounds may have changed (i.e., essential oils may evaporate during drying). All these factors can impact the effective dosing of herbals (2,9,10,11).

Even among commonly used herbs, factors such as duration of use, interactions and individual sensitivity must be considered. For these reasons, effective dosing relies on familiarity with both traditional dosages and contemporary safety data, allowing herbs to be used confidently and appropriately.

Individual factors 

Determining an appropriate dose always begins with the person. Age, gender, body composition, digestive capacity, liver and kidney function, comorbidities and individual sensitivity all influence how someone may respond. A healthy adult with good digestion may require and safely tolerate a higher therapeutic dose to achieve a clinical effect.

In contrast, an older or frail adult, a child, or someone with comorbidities may only tolerate lower doses and respond better when doses are gradually introduced and increased. Response to doses also varies depending on individuals’ experiences as some people may respond to very small doses, particularly with aromatic, bitter or nervine herbs; while others can tolerate larger doses before any clinical response is seen.

Effective dosing, therefore, relies not on standardised quantities alone, but on careful assessment of the individual’s capacity to receive, process and respond to herbal medicines (12).

The nature of the condition being treated is equally important when determining dose. Acute and relatively minor health conditions often respond best to higher or more frequent dosing over a short period of time, with the aim of supporting the body through a transient physiological challenge.

For example, in the early stages of an upper respiratory tract infection (i.e., cold/flu), herbs such as elderberry (Sambucus nigra) or echinacea (Echinacea purpurea) may be taken as tinctures or infusions regularly to support immune and inflammatory responses, soothing symptoms and reducing recovery time.

Acute musculoskeletal pain (i.e., sprain/strain or minor injury) may respond well to short-term internal use of anti-inflammatory herbs such as turmeric (Curcuma longa) alongside topical applications of arnica (Arnica montana) or rosemary (Salvia rosmarinus) (7,12).

On the other hand, chronic conditions usually require low to moderate doses taken consistently over a longer period. Chronic digestive disorders, hormonal imbalances or stress-related conditions often respond better to sustained doses that work gradually with underlying physiological patterns rather than attempting rapid relief of symptoms.

The use of ashwagandha (Withania somnifera) for reducing stress and anxiety can take up-to two weeks before a clinical effect is observed, as the adaptogen regulates cortisol and other hormones (13). When managing on-going or chronic conditions high doses may be poorly tolerated and unnecessary, therefore a “low and slow approach” would allow for cumulative effects and monitoring to take place (14).

Most conventional pharmaceutical medicines have standard formula and doses. There is a comprehensive pharmacopeia which makes production scalable and reproducible. Aspirin is an example of a synthetic medicine (originally isolated from willow (Salix alba)) whereby a single active compound (acetylsalicylic acid) was identified, and chemically synthesised (15).

The therapeutic effects are evidence based with randomised controlled trials (RCTs) to validate the efficacy. For most herbal medicines, there is often not a single isolated compound responsible for the therapeutic effects. Instead, herbal medicines are a complex mixture with many active constituents.

The mixture of compounds are known to work synergistically to have a therapeutic effect; hence, isolating a single compound would not be as therapeutically beneficial (16). For this reason, dosing is rarely about achieving a precise milligram quantity of one active ingredient. Instead, it involves establishing an effective therapeutic relationship between the plant, the preparation and the person taking it.

Finally, the form of preparation has a significant impact on dosing. Teas and decoctions favour water-soluble constituents and are often taken in larger volumes. Powders and capsules rely on digestion and absorption and may therefore require higher quantities to achieve an effect.

Tinctures are more concentrated and allow for flexible, incremental dosing. Herbal dosing tends to operate within broader therapeutic ranges than pharmaceutical drugs, allowing for a greater degree of flexibility and individualisation. The dose is shaped not only by pharmacology, but also by constitution, strength, sensitivity and condition treated (11).

In practice, standardising dosing of herbals is best approached using clearly defined therapeutic ranges rather than fixed doses. Replacing ambiguity in dosing by eyeballing, using a cupful or a few drops/leaves, by standard measures such as volumes for liquids (i.e., millilitre for tinctures) and weights for solids (i.e., gram for dried herbs), can improve dosing. Where reputable suppliers have preparations available with clear strength and doses these may be a preferred option to use. 

It is important to regularly review an individual’s response to herbals, and educate them of the signs of efficacy, intolerance and adverse effects so that dosing can be refined over time. One of the strengths of herbal medicine is that it is responsive. Signs that a dose may be too low include a lack of change to symptoms, after an appropriate trial period, or progress which prematurely stalls.

On the other hand, signs that a dose may be too high may include digestive discomfort, headache, nausea or exacerbation of symptoms. Hence, herbal dosing is a dynamic process. Ongoing observation, communication with practitioners and adjustments are integral to safe and effective herbal practice (17).

There is no single answer to the question of how much is enough when it comes to herbal dosing. Effective dosing emerges from the relationship between plant, preparation and individuals, informed by knowledge, use and experience of the person and practitioners.

1. Bhamra SK, Slater A, Howard C, Heinrich M, Johnson MRD. Health care professionals’ personal and professional views of herbal medicines in the United Kingdom. Phytotherapy Research. 2019;33(9):2360-2368. https://doi.org/10.1002/ptr.6418 
2. Kofi Busia. Herbal medicine dosage standardisation. Journal of herbal medicine. 2024;46:100889-100889. https://doi.org/10.1016/j.hermed.2024.100889 
3. Jürges G, Sahi V, Rios Rodriguez D, et al. Product authenticity versus globalisation—The Tulsi case. Aravanopoulos FA, ed. PLOS ONE. 2018;13(11):e0207763. https://doi.org/10.1371/journal.pone.0207763 
4. Devkota HP, Paudel KR, Khanal S, et al. Stinging Nettle (Urtica dioica L.): Nutritional Composition, Bioactive Compounds, and Food Functional Properties. Molecules. 2022;27(16):5219. https://doi.org/10.3390/molecules27165219 
5. Kania-Dobrowolska M, Baraniak J. Dandelion (Taraxacum officinale L.) as a Source of Biologically Active Compounds Supporting the Therapy of Co-Existing Diseases in Metabolic Syndrome. Foods. 2022;11(18):2858. https://doi.org/10.3390/foods11182858 
6. Hirata M, Fornari Laurindo L, Dogani Rodrigues V, et al. Investigating the Health Potential of Mentha Species Against Gastrointestinal Disorders—A Systematic Review of Clinical Evidence. Pharmaceuticals. 2025;18(5):693. https://doi.org/10.3390/ph18050693 
7. Chevallier A. Herbal Remedies. DK Pub.; 2007.
8. Currie GM, Wheat JM, Kiat H. Pharmacokinetic Considerations for Digoxin in Older People. The Open Cardiovascular Medicine Journal. 2011;5(1):130-135. https://doi.org/10.2174/1874192401105010130 
9. Nakra S, Tripathy S, Srivastav PP. Drying as a preservation strategy for medicinal plants: Physicochemical and functional outcomes for food and human health. Phytomedicine Plus. 2025;5(2):100762. https://doi.org/10.1016/j.phyplu.2025.100762 
10. Bhamra SK. Investigating the Use and Identity of Traditional Herbal Remedies amongst South Asian Communities Using Surveys and Biomolecular Techniques. Published thesis (PhD). 2016.
11. Wilde M. Doses and Measures. Napiers. Published August 3, 2021. Accessed January 14, 2026. https://napiers.net/blogs/news/doses-and-measures 
12. Tyson RJ, Park CC, Powell JR, et al. Precision Dosing Priority Criteria: Drug, Disease, and Patient Population Variables. Frontiers in Pharmacology. 2020;11. https://doi.org/10.3389/fphar.2020.00420 
13. Fuladi S, Emami SA, Mohammadpour AH, Karimani A, Manteghi AA, Sahebkar A. Assessment of Withania somnifera root extract efficacy in patients with generalized anxiety disorder: A randomized double-blind placebo-controlled trial. Current Clinical Pharmacology. 2020;15. https://doi.org/10.2174/1574884715666200413120413 
14. Frost R, Bhamra SK, Heinrich M. Herbal Products and Antidepressants: A Safe Combination or a Risky Mix? Phytotherapy Research. Published online January 13, 2026. https://doi.org/10.1002/ptr.70173 
15. Mahdi JG, Mahdi AJ, Mahdi AJ, Bowen ID. The Historical Analysis of Aspirin discovery, Its Relation to the Willow Tree and Antiproliferative and Anticancer Potential. Cell Proliferation. 2006;39(2):147-155. https://doi.org/10.1111/j.1365-2184.2006.00377.x 
16. Efferth T, Koch E. Complex Interactions between Phytochemicals. The Multi-Target Therapeutic Concept of Phytotherapy. Current Drug Targets. 2011;12(1):122-132. https://doi.org/10.2174/138945011793591626 
17. Bhamra SK. The revival of herbal medicines. Prescriber. 2024;35(6):13-16. https://doi.org/10.1002/psb.2157 

Coconut (Cocos nucifera) oil and sunflower (Helianthus annuus) seeds

The study explored whether coconut oil or sunflower seed oil massage could improve skin integrity in preterm infants. In these babies, the skin is thinner than those born at full gestation, and they have less brown adipose tissue and glycogen stored in subcutaneous fat layers.

This was a randomised controlled trial in a neonatal intensive care unit in Turkey. In the study, 66 preterm babies (34–37 weeks gestation) were randomised to three groups. All infants received routine intensive care unit care in an incubator maintained at 32–34 °C. The three groups were:

• Sunflower seed oil massage
• Coconut oil massage
• Control or no topical application

Measures were taken at three time points, at admission to the unit, at discharge from the unit and at one-month post-discharge as follows:

• Body weight
• Neonatal Skin Condition Score (records dryness, erythema, skin peeling), scores 3–9 with high scores reflecting poorer skin condition
• Revised Northampton Neonatal Skin Assessment Tool (nine parameters: gestational age, body weight, postnatal age, skin integrity, temperature control, mobility, nutrition status, skin appearance, and care level), scores give a low to high risk of skin complications

The coconut and sunflower oils were purchased from a company approved by the Ministry of Health. Batches of product (500 mL sunflower and 270 mL coconut oil) were placed in identical containers. The amount used was calculated based on the baby’s body weight. There were two topical applications per day as follows:

• The nurse/mother performed hand hygiene and ensured hands were not wet or cold.
• The oil was pre-tested on the baby’s wrist for allergic reactions.
• After a waiting time of two hours the oils were massaged into the back, chest, abdomen, arms, legs and hands and fingers for around three minutes.
• In the unit, oils were applied by the researcher. After discharge, the mother applied the oils for one month.

A power calculation estimated that a total of 84 infants would be required for the study. Consequently, 28 babies were randomised to each of the three groups with six lost to follow up in each group, resulting in n=22 infants per group.

Inclusion criteria were preterm infants born at 34–37 weeks; birth weight of 2 kg or more, length of stay in the unit seven days or more, skin damage on 5% or less of the body. Babies were excluded if they had a major abnormality or health condition, or if they already had received medication applied to the skin.

Overall, most infants were born by caesarean section and there were marginally more males than females. There were no differences between the sunflower, coconut or control groups with regards initial birth weight (around 2.4 kg), the time in the unit (around 9 days), numbers of babies with nappy rash, the gender split, or characteristics of the mother, such as age or numbers of previous births.

There was no change in birthweight between the groups at the time of discharge from the unit with each group on average gaining 2–3 g in weight from birth. At one-month post-discharge, the babies receiving sunflower seed and coconut massages gained significantly more weight compared to the control group, gaining around 4 g more. Across all groups, babies had put on around 1 kg from their birth weight at this time.

For the Neonatal Skin Condition Score (records dryness, erythema, skin peeling) the scores for the infant groups decreased over time with skin health improving. At one month post-discharge, the skin scores of babies receiving sunflower oil or coconut oil massage was significantly improved over the babies in the control group.

For the Northampton Neonatal Skin Assessment Tool, again, there were improvements in scores over time for all three groups. At time-point two when the infants were discharged from the unit, scores were significantly improved for the sunflower oil and coconut oil groups compared to the control group.

The study showed that using sunflower oil and coconut oil to massage preterm baby skin reduced the risk of skin complications at the time of discharge from an intensive care unit, and significantly improved skin health at one month after discharge from the unit. The oils significantly improved weight gain at one month after discharge, with infants gaining around 4 g more than the control group.

Coconut oil comprises mainly saturated fats with lauric acid (40–50%) and lower levels of myristic, palmitic, caprylic acid, linoleic acid and stearic acid. Sunflower oil is richer in linoleic acid, an omega-6 oil that is associated with protecting the skin barrier function. These oils can penetrate the skin barrier and improve barrier function, reduce inflammation, have antimicrobial effects, and they also contain polyphenols with antioxidant actions (2).

For pre-term infants, the skin is thinner and subcutaneous layers are not as well established compared to infants born at full gestation. They can experience infection, skin damage, and experience reduced touching and bonding opportunities with their parents. The oils offer the potential to improve skin health, and, as the present study shows, this is associated with weight gain which is an important sign of growth and development.

A limitation of the study is that the control group did not receive a massage oil, so it is not clear whether the benefits seen were due to the composition of the oils or the massaging and bonding effects. Also, once the babies were home, it was not possible to control for differing home environments, feeding and bathing routines. While the study by Tiryaki et al. provides clinically relevant insights into the use of topical oils in neonatal care, its limited sample size, potential lack of blinding, and short follow-up period constrain the strength and generalisability of its conclusions.

Caring for the skin of preterm infants born at 34–37 weeks gestation using sunflower seed oil or coconut oil benefited the health of their skin, and positively improved weight gain at one month after being discharged from an intensive care unit. Both oils were equally effective, although no chemical analysis was carried out on the products to determine the oil compositions.

Further research could explore the effects of the oils on premature babies born earlier (less than 34 weeks gestation), and also look at the weight gained and other outcomes like sleep for longer follow-up times.

Using coconut or sunflower seed oils to massage premature babies is a simple activity that can improve skin health and weight gain.

1. Tiryaki Ö, Zengin H, Çınar N, Karabay M, Caner İ, Güçlü E. Comparison of Coconut and Sunflower Seed Oils in Improving the Skin Integrity and Weight Gain of Infants in the Neonatal ICU. Adv Skin Wound Care. 2024 Nov-Dec 01;37(11&12):1-8.  https://doi.org/10.1097/ASW.0000000000000241 
2. Lin TK, Zhong L, Santiago JL. Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils. Int J Mol Sci. 2017 Dec 27;19(1):70. https://doi.org/10.3390/ijms19010070

Constituents are often described as water-soluble, alcohol-soluble, or oil-soluble. But solubility behaves more like a continuum. A constituent may be somewhere on the spectrum of sparingly to highly soluble in any given solvent. Rather than asking “is this constituent water-soluble?” the question becomes, “from this herbal matrix, how soluble is this constituent in water, at this temperature, and using this extraction method?”

This is why changing the solvent and extraction method can change the focus and function of a herbal medicine. A standard infusion emphasises constituents that dissolve readily in hot water. Are these the constituents (and associated actions) that we desire in a particular medicine? A tincture made with a given menstruum extracts a different spectrum of constituents from the same herb. Which constituents will we focus on when we adjust the ethanol percentage of the menstruum? An infused oil of that herb will capture yet a different spectrum of constituents, therefore featuring different actions and energetics than the infusion or tincture.

The main influence on solubility is polarity — a property arising from a molecule’s electron distribution. If this distribution is unbalanced (i.e., there is internal charge separation) we have a polar compound. If the distribution is perfectly balanced, we have a nonpolar molecule. And, as with solubility, polarity is a spectrum. Any phytochemical or solvent falls somewhere along the continuum.

The key to solubility is matching the polarity of the solvent to the polarity of the constituents we desire to extract. The old aphorism “like extracts like” applies: higher-polarity solvents (like water) focus on higher-polarity constituents, while lower-polarity solvents (like fixed oils) favour lower-polarity constituents.

Relative polarity of solvents

If you think of water as being 100% polar, then glycerin would be about 81% as polar as water. Pure ethanol would be about 65% as polar as water. These solvents are close enough that they will intermix with each other. Each of these solvents targets a particular group of constituents but there is overlap in what they will extract. Fixed oils and carbon dioxide (CO₂) extract lower-polarity constituents don’t easily mix with water, vinegar, glycerol or ethanol.

Solvent / menstruum	Relative polarity
Water	1.00
Vinegar (like water but also acidic)	~ 1
Glycerin (glycerol)	0.81
Ethanol (100%)	0.65
Olive and other fixed oils	~ 0
Carbon dioxide (CO₂)	~ 0

A tincture is made with a hydroethanolic solvent system (menstruum) containing both mid-polarity ethanol and high-polarity water. By adjusting the ethanol (EtOH) percentage, we are tuning the overall polarity of the menstruum. More EtOH in the menstruum → lower polarity; less EtOH → higher polarity. This is one reason tinctures are so versatile — by choosing the right EtOH–water ratio, we design the menstruum to selectively extract constituents by polarity matching. In other words, menstruum composition strongly influences the phytochemical profile of the resulting tincture (1,5).

Hydroethanolic solvents

“K” is one way to quantify polarity. Since water is highly polar and ethanol (EtOH) is moderately polar, mixing them together in different proportions will create a menstruum with a specific polarity. The higher the % EtOH, the lower the polarity of the hydroethanolic solvent system (menstruum). We tincture different herbs with different % EtOH to match the polarity of the constituents we want to extract from those herbs.

EtOH / Water	~ K	EtOH / Water	~ K
100% water	80	60% EtOH	47
10% EtOH / 90% H2O	74.5	70% EtOH	41.5
20% EtOH	69	80% EtOH	36
30% EtOH	63.5	90% EtOH	30.5
40% EtOH	58	95% EtOH	27.8
50% EtOH	52.5	100% EtOH	25

In herbal pharmacy, “yield” indicates the amount of finished tincture collected. But from a phytochemical perspective, “yield” usually refers to the concentration of a constituent in the product. A high constituent yield is often but not always better. For example, an extraction rich in astringent tannins may be more appropriate in some cases (surface inflammation, excessive secretion) and less appropriate in others (dry conditions, sensitive digestive mucosa). What matters is whether the preparation delivers the appropriate concentration of the desired spectrum of constituents for a particular therapeutic application.

Polarity is central, but several additional factors can influence the concentration of constituents in our extractions:

Temperature

Heat is a kind of kinetic energy that physically increases the extraction of most constituents. At the same time, some kinds of constituents are sensitive and will degrade with excessive heat. We learn to choose the optimal temperature for an extraction solvent, and to apply heat for the right period of time (e.g., infusion vs. decoction).

Time

Longer contact between solvent and herb generally enhances extraction up to a point, but the optimal time is influenced by factors including plant matrix, surface area, agitation, constituent class, and type of preparation.

Surface area

Chopping, grinding, or powdering increases surface area of the plant matrix, facilitating solvent–constituent contact and enhancing extraction. Very fine powders, however, can complicate filtration.

Agitation

Shaking or stirring increases kinetic jostling between solvent and constituents, usually accelerating extraction and constituent yield.

Pressure

Increasing pressure (e.g., in a tightly closed canning jar or electric pressure cooker) usually enhances extraction.

Plant matrix

Constituents may extract somewhat differently depending on how they are packaged within plant tissues. Delicate structures like flowers yield their constituents more readily than tough structures like seed coats or root barks. Cellular structure and co-constituents such as mucilages, tannins, and resins can also alter extractability.

Taken together, these variables should be considered as part of the extraction method; they help explain why preparations of the same herb in the same solvent can be noticeably different. The combination of botanical quality, solvent, and extraction method largely determines constituent yield and product quality.

Water

Water excels for higher-polarity constituents such as mucilages, polysaccharides, sugars, and some kinds of glycosides. It is the preferred solvent for making teas, infusions, and decoctions. Hot water almost always works better than cold water.

Hydroethanolic solvent systems (menstrua)

Lower % EtOH generally favours more polar compounds; higher % EtOH extracts lower-polarity constituents. Rather than a single “correct” percentage for each herb, it’s more accurate to think in ranges that can be adjusted to extract particular constituent families. Depending on your menstruum composition, you can create multiple different medicines from a single herb.

Glycerin and honey

Glycerin is a viscous and polar solvent, often used when alcohol is not desired. It can extract many water-soluble constituents along with a moderate concentration of aromatics, though it is generally less efficient than ethanol for lower-polarity constituents. However, its extraction spectrum can be increased considerably by employing heat, pressure, and agitation. As a solvent, honey behaves similarly to glycerin.

Vinegar

Vinegar is an acidic aqueous solvent. Acidity can change the solubility of certain constituents, particularly alkaloids, by shifting them into more water-soluble ionic forms (1,4). Traditional vinegars and oxymels (made by combining infused vinegars and honeys) offer versatile, alcohol-free alternatives to hydroethanolic tinctures or glycerites.

Fixed oils

Botanical oils such as olive, safflower, or coconut are both therapeutic substances and low-polarity solvents. Herb-infused oils feature low-polarity, lipophilic constituents including many terpenoids and some phenolics, making them valuable for topical preparations. Culinary preparations such as infused ghee or vinegar-and-oil salad dressings can also double as herbal products. Oils are generally unsuitable solvents for mineral salts and polar constituents including mucilages and glycosides.

Supercritical carbon dioxide

Supercritical carbon dioxide (CO₂) extraction is sometimes used for low-polarity constituents (e.g., gingerols from ginger (Zingiber officinale) curcuminoids from turmeric (Curcuma longa), cannabinoids from hemp (Cannabis sativa)). This modern method uses high-pressure, low-temperature conditions, with the advantage that CO₂ leaves no solvent residue in the finished product. CO₂ extracts are good at preserving the characteristic flavours and aromas of herbs. They are especially suitable for use in highly concentrated formulas delivered in capsules. (2)

Betalains are the vivid, water-soluble pigments responsible for red-violet and yellow-orange colours in plants such as beetroot (Beta vulgaris) and prickly pear (Opuntia ficus-indica) fruit, as well as edible greens including red orach (Atriplex hortensis var. rubra) and purslane (Portulaca oleracea). These medicinal food-herbs (and their betalains) have antioxidant, anti-inflammatory, and broad-spectrum bioprotective effects. (3)

Betalains are highly polar. This predicts several practical outcomes:

• They extract readily into water and other higher-polarity solvents such as lower % EtOH menstrua. Betalain extraction decreases as EtOH percentage increases.
• Glycerin and honey can be suitable solvents, especially when gently warmed to decrease their viscosity.
• Vinegar (which is mostly water) is a good solvent for betalains.
• Betalains are not lipophilic; they do not extract well into fixed oils.

As another example, echinacea (Echinacea spp.) contain several important groups of constituents — immunomodulating polysaccharides (IP), alkamides, and polyphenols including phenolic acids and flavonoid glycosides. Each group has a characteristic polarity range (4). IP are quite polar and most soluble in hot water; alkamides have moderate polarity and favour 50–60% EtOH menstrua; and the polyphenols are mid- to higher-polarity constituents that extract fairly well with both hot water and lower % EtOH. 

Since all these constituents are bioactive, which solvent is “best”? We could bypass this question by delivering a dose of the tincture in a water-based extract like an infusion or decoction!

1. Lee JE, Jayakody JTM, Kim JI, et al. The influence of solvent choice on the extraction of bioactive compounds from Asteraceae: a comparative review. Foods. 2024;13(19):3151. https://doi.org/10.3390/foods13193151 
2. Uwineza PA, Waśkiewicz A. Recent advances in supercritical fluid extraction of natural bioactive compounds from natural plant materials. Molecules. 2020;25(17):3847. https://doi.org/10.3390/molecules25173847 
3. Sadowska-Bartosz I, Bartosz G. Biological properties and applications of betalains. Molecules. 2021;26(9):2520. https://doi.org/10.3390/molecules26092520 
4. Petrova A, Ognyanov M, Petkova N, Denev P. Phytochemical characterization of purple coneflower roots (Echinacea purpurea (L.) Moench.) and their extracts. Molecules. 2023;28(9):3956. https://www.mdpi.com/1420-3049/28/9/3956 
5. Ganora L. Herbal Constituents: Foundations of Phytochemistry. 2nd ed. Louisville, CO: HerbalChem Press; 2021. https://www.herbalconstituents.com/book 

Ivy (Hedera helix)

The aim was to carry out a randomised placebo-controlled trial to explore the safety and efficacy of ivy leaf cough liquid for acute cough in adults.

Patients

N=181 patients with cough were randomly assigned to receive an ivy remedy or placebo across four clinical locations in Germany. Patients were aged 18–75 years, were male and female, and had acute cough 2–3 days prior to enrolling onto the study. Patients were excluded if they had asthma, chronic bronchitis or any other chronic lung disease amongst other criteria.

Treatment

Groups received a liquid with ivy leaf extract (35 mg EA 575® ivy leaves dry extract) or inert placebo three times per day for seven days. No further details on the nature of the placebo were given — i.e., was it a similar liquid in a similar bottle and packaging? During the course of treatment any other medications that influenced bronchitis or mucociliary clearance were not permitted.

Outcomes

For the main outcome, cough severity was measured by visual analogue scale (VAS, a 100 mm scale) over the treatment period of seven days. Measures were taken at daily visits to the clinic which took place on days 2–7 (visits 1–6). The area under the curve was calculated from this VAS data.

For secondary outcomes, cough severity was measured by Bronchitis Severity Score (BSS) and Verbal Category Descriptive score (VCD). A Global Efficacy Assessment (GEA) at V5 and V6 was carried out and two questions were asked on the efficacy of the treatment completed by patients and investigators.

The study examined the effects of a liquid cough remedy containing EA 575 a dried extract of ivy leaf (ratio of 5–7.5:1, ivy:extraction solvent); the remedy contained 35 mg EA 575 (manufactured by Prospan, Germany).

N=181 patients with cough were randomly assigned to receive ivy or placebo; some subjects were lost to follow-up and in all there were n=88 in the ivy group and n=90 in the placebo group who completed the study.

Regarding the ivy versus placebo groups, the mean ages, gender splits and other demographics like ethnicity and blood pressure were similar between the groups. The mean age was around 36 years and there were near equal splits of males and females across groups.

Cough severity VAS

The ivy cough liquid group saw a significant reduction in cough severity with the mean area under the curve (AUC) reduced compared to the placebo group (p <0.0001). Looking at the time-point data, the ivy cough liquid was a significant improvement at the first visit (V1) and persisted as better through to the end of the study.

Secondary outcomes

For the other secondary outcomes, the cough severity monitored by the BSS and VCD scores were similar between groups at baseline, but were significantly reduced in the ivy cough liquid group compared to placebo. Looking at the separate visits, the BSS (bronchitis severity) improved for the ivy liquid again by visit 1 and was consistently better through to the end of the study compared to the placebo.

For the global efficacy assessment (GEA), patients taking the ivy liquid rated the medication better than the placebo group, and rated themselves as generally feeling better.

Adverse events

Adverse events were recorded in some of the ivy liquid patients (n=9) and placebo patients (n=12). Mostly these were a single adverse event which included worsening cough or sinusitis. Compliance was good.

Ivy leaf extract is a remedy for chesty coughs, acting as an expectorant and dilating the bronchial vessels (2). This randomised, placebo-controlled trial of patients with acute cough showed that ivy leaf cough liquid taken three times a day for seven days reduced the severity of cough symptoms compared to an inactive placebo. The outcomes included a visual analogue scale and bronchitis severity scale; both showed improvements upon the first visit and for each subsequent visit compared to the placebo.

Symptoms of cough do ease by themselves, so the improvements seen at the early visits are a significant finding and would have equated to approximately day three onwards of the cough starting, given that patients entered the study after about two days of seeking help. The global assessment questions showed that the patients reviewed the ivy leaf cough liquid as effective, more so than the placebo liquid.

One limitation of the study was a lack of information regarding the placebo. Was it similar to the ivy product in taste, smell, labelling and packaging? The authors also reviewed whether there was a centre effect or any differences in outcome at the four locations; one location did not observe any significant differences but they suggest this would be normal within a spread of data across different clinics.

The mean age of participants was 36 years, and the authors looked at eight subjects separately who were aged 65–75 years, and the safety profile was similar to the groups overall. This is an important consideration to ensure that the ivy product was safe within a group who can be more vulnerable to coughs.

An ivy leaf remedy containing an extract relieved acute cough symptoms in adults compared to a placebo. The remedy given for seven days provided instant relief and was consistently effective throughout the study and better than the placebo. The liquid was well tolerated and safe.

1. Schaefer A, Kehr MS, Giannetti BM, Bulitta M, Staiger C. A randomized, controlled, double-blind, multi-center trial to evaluate the efficacy and safety of a liquid containing ivy leaves dry extract (EA 575^®) vs. placebo in the treatment of adults with acute cough. Pharmazie. 2016 Sep 1;71(9):504-509.  https://doi.org/10.1691/ph.2016.6712 
2. European Medicines Agency (2018). Ivy leaf Hederae helicis folium – herbal medicinal product. https://www.ema.europa.eu/en/medicines/herbal/hederae-helicis-folium 

Spirulina (Spirulina maxima, Spirulina platensis, Spirulina fusiformis and Spirulina pacifica)

The aim of this spirulina study was to carry out a systematic review and meta-analysis of randomised controlled trials (RCT) to evaluate the effects of spirulina supplementation on modulating risk factors of cardiovascular disease (CVD).

Using the PRISMA statement protocol for systematic reviews, broad searches of medical databases were carried out and did not exclude papers based on language or date of publication. Two authors independently applied inclusion and exclusion criteria to select papers for the review.

The inclusion criteria were RCTs that explored the effects of spirulina intake on:

• Lipid profiles — triglycerides (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C)
• Glycaemic indexes — fasting blood glucose (FBG), HbA1c, insulin, and homeostatic model assessment-insulin resistance (HOMA-IR)
• Blood pressure
• Anthropometric indexes — weight and body mass index (BMI)
• Inflammatory biomarkers — high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor alpha (TNF-α), and interleukin 6 (IL-6)

Study design included RCT with placebo or control groups. Other types of study design were excluded.

Two authors independently extracted data and evaluated study quality using the Cochrane Risk of Bias tool. The authors looked at publication bias and assessed the quality of evidence using the GRADE tool.

Most of the RCTs identified through searching used spirulina in capsule or tablet form. A few used a water or ethanol extract, and one used spirulina prepared as a sauce.

In the systematic review, 35 RCTs were identified, which examined n=1523 participants.

The duration of supplementation ranged between 2–16 weeks, and doses were 0.5 to 8 mg a day. Studies recruited patients with a range of metabolic conditions or were healthy participants, and were a mix of males and females. The mean age of participants was 21.5 to 76.7 years, and body mass index ranged from 22.6 to 40.7 kg/m².

Of the 35 studies, most had a low risk of bias, with nine moderate and five high risk.

Lipid profiles

Results of the meta-analyses showed that spirulina lowered TG, TC, LDL-C (p<0.001, 28 studies) and raised HDL-C (p<0.001, 28 studies) compared to placebos.

Glycaemic values

Spirulina reduced FBG (p<0.001, 19 studies), insulin (p<0.001, 9 studies) and HOMA-IR (p<0.05, 4 studies), but there was no change to HbA1c (p>0.05, 7 studies) compared to placebos.

Blood pressure and body anthropometry

Spirulina reduced systolic blood pressure (p<0.01, 9 studies) and diastolic blood pressure (p<0.001, 9 studies). It reduced body weight by weighted mean difference of 1.78 kg (p=0.01, 15 studies) and BMI reduced accordingly (p<0.01, 18 studies) compared to placebos.

Inflammatory markers

Spirulina reduced all three inflammatory markers tested, which were hs-CRP (p<0.01, 7 studies), TNF alpha (p<0.01, 8 studies) and IL-6 (p<0.001, 9 studies).

GRADE analysis

Of the 15 cardiovascular risk factors measured, LDL-C, FBG and HbA1c were calculated to have a lower certainty of outcome, with all other parameters moderate or high.

Sub-group analysis

With such a large-data set, the authors were able to complete multiple subgroup analyses and looked at the results according to study duration (<8 and ≥8 weeks), dosage (<2 and ≥2 g/day), BMI category (normal, obese, overweight) and age (<50 and ≥50 years). The finer detail is presented in the paper 

The analyses showed both TG and TC were reduced in both short and longer trial durations (<8 and ≥ 8 weeks) and a range of doses (<2 and ≥2 g/day). TG was reduced in individuals with normal and overweight BMI, whereas TC was also reduced in individuals with an obese BMI. Levels were reduced over all age ranges  (<50 and ≥50 years). Overall blood lipids were generally regulated to a similar extent regardless of study duration, dose, BMI category or age.

Glycaemic indices and anthropometric measures were more variable with a tendency to be more effective at lower doses (<2g/day) and over shorter study durations (<8 weeks). For inflammatory markers there was a more consistent picture with spirulina being more effective at lower doses and shorter study durations, and in healthy populations who were less than 50 years of age.

This article is a comprehensive systematic review and meta-analysis on the use of spirulina to regulate cardiovascular risk factors, and was carried out to a high standard.

Overall, 35 RCTs were analysed. Dietary spirulina supplementation significantly improved blood lipid profiles, glycaemic responses, anthropometric measures and inflammatory biomarkers in patients with cardiovascular disease and healthy individuals.

There was a pattern within the sub-group analysis that suggested spirulina was effective in regulating blood lipids regardless of study duration, dosage or patient BMI or age. For glycaemic factors, anthropometric measures and inflammatory biomarkers, there was a tendency for lower doses to be more effective over shorter duration studies.

The authors conducted a GRADE analysis which weighs up the certainty of evidence, and this includes looking at the heterogeneity of the meta-analyses (a measure of how variable studies are from one another). Often for herbal remedies where heterogeneity is high — different herbal preparations, doses, etc. — the GRADE analysis can suggest lower levels of certainty. In this study, however, overall, GRADE suggested 12 of the 15 outcomes measured were attributed to moderate or high-quality evidence.

The findings suggest that spirulina is a strong candidate for modifying cardiovascular risk factors. Spirulina species are nutrient-rich blue-green algae that comprise proteins, vitamins, omega-3 oils, and pigments, such as beta-carotene, carotenoids, phycocyanin. It displays anti-inflammatory and antioxidant potential in the lab and it is widely researched for its effects on the cardiovascular system.

One recent study looked at its effects on vascular ageing. Spirulina was grown in silicon-enriched media, and over a six-month period, participants with high blood pressure showed an 8% decrease in pressure and 13.5% increase in aortic pulse wave velocity — an indicator of reduced arterial stiffness (2).

Dietary supplementation with spirulina improved many lipid, glycaemic and inflammatory biomarkers that are risk factors of cardiovascular disease. Spirulina reduced the levels of inflammatory markers and improved glucose homeostasis. It improved blood pressure and reduced weight and body mass index in participants. Spirulina in capsule or tablet form could be used therapeutically to reduce cardiovascular disease risk. 

Further research is needed to understand whether the changes persist after spirulina supplementation has stopped, and which preparations, doses and durations are optimal. Sub-group analyses of patients versus healthy individuals would elucidate the therapeutic and preventive potential of spirulina.

1. Shiri H, Soleimani AA, Omidi Sarajar B, Talebi Taheri A, Esmaeili F, Nematollahi MH, Alizadeh Sani M. Spirulina’s impacts on cardiovascular health: Insights from a systematic meta-analysis of RCT. Complement Ther Med. 2025 Nov;94:103242. https://doi.org/10.1016/j.ctim.2025.103242 
2. Virsolvy A, Benmira AM, Allal S, Demattei C, Sutra T, Cristol JP, Jouy N, Richard S, Perez-Martin A. Benefits of Dietary Supplementation with Specific Silicon-Enriched Spirulina on Arterial Function in Healthy Elderly Individuals: A Randomized, Placebo-Controlled Trial. Nutrients. 2025 Feb 28;17(5):864. https://doi.org/10.3390/nu17050864

Mistletoe (Viscum album)

To complete a meta-analysis to evaluate the effects of mistletoe extract in cancer-related fatigue by including randomised controlled trials (RCT) and non-randomised studies (NRSI).

A systematic review and meta-analyses were completed as follows:

• The study protocol was registered with PROSPERO.
• Searches were made of electronic library databases and grey literature.
• There were no limitations based on language or date of publication.
• Study selection and data extraction were performed independently by two reviewers.
• Included studies were:
  • RCTs or NRSIs
  • With patients with cancer-related fatigue, which was either patient or clinician-diagnosed. 
  • With a control group that was a placebo, or active control that was standard treatment.
    
• Risk of bias in RCT was determined using the Cochrane Risk-of-Bias tool, and for NRSI was determined using the Risk of Bias in Non-randomized Studies of-Interventions (ROBINS-I) tool.
• Reviewers carried out sensitivity analyses and tests for publication bias.
• In a supplementary file, the authors published formula used to calculate missing means and standard deviations, required for the meta-analyses, and presented their search strategies and all other analyses.
• In this meta-analysis, to search for mistletoe in the published literature, the authors used the following PubMed keywords which included brand and company names: (“mistletoe” OR “viscum” OR “iscador” OR “iscucin” OR “abnobaviscum” OR “helixor” OR “lektinol” OR “isorel” OR “vysorel” OR “plenosol” OR “cefalektin”).

Aqueous mistletoe extracts are used in treatment and were injected subcutaneously two or three times a week.

Of 802 records that were screened, the final meta-analyses included 19 studies — 12 RCT and 7 NRSI. Nine of the trials were carried out in Germany, with the remainder in Switzerland, Serbia, Bulgaria, Russia, Ukraine, China, Italy, Israel and South Korea.

In 17 of the 19 studies, mistletoe was given as an adjuvant to conventional cancer treatments, and in two, there were no additional treatments being given. Fatigue was assessed in patients with breast cancer (11 studies), lung cancer (two studies), pancreatic cancer (two studies), and the remaining studies were mixed cancer types. Mistletoe was mostly injected subcutaneously with one study administration was intravenous.

Mistletoe was compared to a placebo in two studies alongside chemotherapy or standard care, or was compared to untreated groups also receiving chemotherapy or receiving standard care.

Study durations ranged from 6–208 weeks.

Measuring fatigue as an outcome

The primary outcome of many of the RCTs was to measure quality of life through a questionnaire, and fatigue was an item within this. Other studies measured fatigue as recorded by the clinician.

Meta-analysis of RCT and NRSI

A meta-analysis was created for 12 RCTs that compared mistletoe extract to placebo or control. Overall the pooled result shows a significant effect of mistletoe compared to controls (p=0.006). The heterogeneity was high, reflecting the differing patient populations and study designs.

An analysis of the risk of bias using the Cochrane tool was low risk in terms of randomisation to groups. However, as the studies were open-label due to the nature of the injections given, the risk of bias under the category “measurement of the outcome” was high.

In the NRSI, the result also favoured mistletoe (p=0.0008), and there was high heterogeneity. The risk of bias was high overall.

Adverse events

In one quarter of patients, the most regular adverse event was a reaction at the site of injection. A small number of patients recorded systemic adverse events like fever, flu symptoms, nausea or diarrhoea.

Other results

The sensitivity analysis and publication analysis showed that the results were robust. The supplementary information included the details of the sources of funding for these studies, which for the most part were manufacturers of the extracts.

Mistletoe therapy to support individuals with cancer has been used for over a century, and it is considered to be safe and to integrate well alongside chemotherapy and conventional treatments (2). Mistletoe is a semi-parasitic plant and gains nourishment from the host tree through penetrating the bark with a root-like structure. The immunogenic properties of the mistletoe depend on the host tree and, for example, will vary between oak and pine (2).

In the meta-analysis, mistletoe extract reduced cancer-related fatigue in RCTs and NRSIs of different types of cancer, although breast cancer was the main type investigated. The results of using mistletoe were significant versus placebo or control (untreated groups), and for the RCT and NRSI groups, the effect estimate was moderate.

The heterogeneity that represents the variability between studies was high, which reflects the different patient groups, study durations and differing types of mistletoe extract used across the study preparations. Furthermore, fatigue is not a clearly defined measure and was recorded in these studies in self-reported surveys or scales, or was recorded by the clinician.

Nethertheless, fatigue that includes mental tiredness and physical exhaustion is widely experienced by cancer patients. Presently, physical activity is recommended but is not possible for everyone, so alternative treatments are needed.

The meta-analysis does have limitations and the risk of bias is high due to the lack of placebo, lack of blinding due to the nature of the injections and subjective nature of assessing fatigue.

The meta-analyses suggest that mistletoe extract is an effective treatment for reducing symptoms of fatigue in patients undergoing chemotherapy for different types of cancer. Across the majority of studies, mistletoe was administered safely alongside standard chemotherapy treatment — with adverse events occurring with most prevalence at the site of the injection.

More randomised, placebo-controlled studies with clearer definitions of fatigue and standardised approaches to measuring it as a primary outcome would offer more accurate data. In addition to explorations of alternative, less invasive, routes of administration, further research into the immunogenic mechanisms of mistletoe and how it differs with host tree could refine preparations and therapeutic understanding.

1. Pelzer F, Loef M, Martin DD, Baumgartner S. Cancer-related fatigue in patients treated with mistletoe extracts: a systematic review and meta-analysis. Support Care Cancer. 2022 Aug;30(8):6405-6418. https://doi.org/10.1007/s00520-022-06921-x  
2. Thompson, E. (Date). Mistletoe Therapy in Integrative Oncology. https://ncim.org.uk/mistletoe-therapy-in-integrative-oncology

Research into medicinal plants can be broadly split into two approaches. The first focuses on traditional and ethnobotanical uses of plants, which includes studies looking at plant use in specific geographical areas. The second covers use of plants in drug discovery, mechanistic in vivo and in vitro studies, and clinical studies assessing the effectiveness of herbal medicines (1).

Common themes for herbal research over the last ten years include: 

• The benefits of herbs to treat obesity, cancer, cardiovascular disease and infectious diseases
• Conservation and sustainability
• The interplay between the gut microbiome and phytochemicals
• Polyphenols and cardiovascular or cognitive health
• The use of formulations such as nanotechnology to improve bioavailability and efficacy

While the use of plants for health is truly global, the majority of research into medicinal plants is carried out in China and India, followed by Iran, Brazil, USA, South Korea, and Pakistan (1,2). 

Government funding, as well as the acceptance of Traditional Chinese Medicine (TCM) within the Chinese healthcare system has contributed to the large amount of herbal research produced there. India has also emerged as a global leader, since the launch of The World Health Organization (WHO) Global Traditional Medicine Centre there in 2022. Supported by the Government of India, this has the aim of advancing herbal research and enabling the ability of member states to conduct research that can address evidence gaps in the safety and efficacy of traditional medicine. 

The WHO’s 10-year global traditional medicine strategy was published at the end of October 2025. One of its key aims is to “integrate safe and evidence-based traditional and complementary medicine services within national and local health systems as appropriate, particularly at the level of primary health care” (3). Its first strategic objective is to strengthen the evidence base for traditional, complementary and integrative medicine (TCIM) through innovative research and digital tools, while encouraging collaboration between scientists and traditional practitioners. The location of the research centre in India is likely to consolidate India as one of the main countries contributing to herbal research globally.

Non-communicable diseases, such as obesity, diabetes, cancer, chronic respiratory disease and cardiovascular disease are responsible for the vast majority of deaths globally and are due to a combination of genetic, environmental and behavioural factors (4). Due to the magnitude of the problem, they are a big focus for research in all areas, and this is no different for herbal research. In cardiovascular research, China is again a key contributor (5).

TCM has been found to effectively reduce hypertension and blood lipid levels, improve outcomes in patients with type 2 diabetes, and relieve angina or reduce cardiovascular events (6).

The COVID-19 pandemic was a stimulus for research into the antiviral properties of herbs, as people focused on improving their immunity and looked into the possibility of herbal remedies for a viral disease with no known treatment. There is no treatment or vaccine for most viruses, and this need has provided an opening for herbal remedies.

A review of trends in global antiviral herbal research identified some key TCM herbs to treat COVID-19. These included liquorice (Glycyrrhiza glabra), Japanese honeysuckle (Lonicera japonica), baikal skullcap (Scutellaria baicalensis), ma huang (Ephedra sinica), weeping forsythia (Forsythia suspensa), Korean mint (Agastache rugosa), astragalus (Astragalus membranaceus), and poria (Poria cocos) (7).

Other areas of interest identified in this review include herbs for hepatitis B and C, respiratory syncytial virus, HIV, herpes simplex virus and influenza, those that support the immune system and the mechanisms of action of specific phytochemicals such as quercetin, andrographolide, luteolin, artemisinin and kaempferol. Nanoparticle formulations and essential oils also show promise, as well as technologies such as network pharmacology and molecular docking studies to virtually screen active ingredients (7). 

Metabolomics is a branch of research that analyses the complete range of metabolites in a biological system. The chemical complexity of plants means that this type of research is useful when analysing both plants and their impact on the body. Chemical analytical techniques are used to produce a unique “fingerprint” of all the metabolites in a sample. Raman and infrared spectroscopy, and liquid chromatography-mass spectrometry have been used for years, but newer technologies, such as mass spectrometry imaging and ambient ionisation techniques are rapidly increasing the ways to analyse samples.

The newer techniques allow measurement and determination of the chemicals present in dried herbs or herbal capsules containing multiple different plants without the need to extract the chemicals first (8). This means that samples can be tested for adulteration and likely effectiveness rapidly and throughout the supply chain. Metabolomics can be used to assess adulteration and contamination in quality control, as well as investigating the mechanism of action and to identify biomarkers of efficacy.

Screening herbal samples, extracts and mixtures of herbs enables the identification of all the compounds present. This can then be combined with computational analysis to match the chemical structures of compounds in a herb with proteins that they are likely to bind to. The biological processes that mix of compounds is likely to impact on can be determined and the pharmacology of a herb can be predicted. This field of research is known as network pharmacology and is increasingly being used to identify or justify specific uses of herbs or herbal formulations.

Network pharmacology integrates large datasets of information from phytochemistry analysis and biological assays to predict how a herb or mixture of herbs might work in the body by connecting up the network of active constituents from the herb with potential targets in the body (9,10). The field of research developed in the early 2000s from a desire to explain how complex formulae in Chinese medicine could be having an effect in the body (9). This approach reflects a paradigm shift from viewing drugs as single-target molecules to recognising the synergistic complexity of herbal formulations. 

Another innovation has been the use of nanoparticle formulations to improve bioavailability and stability, while reducing toxicity (11). Nanoparticles were first discovered as a natural occurrence during the preparation of herbal products, such as decoctions. The natural formation of vesicles and particles when plants are traditionally prepared is thought to contribute to the synergy effect seen when a whole plant extract is more effective than the main bioactive phytochemical extracted from a plant (12). Artificial nanoparticle technology is now being used to improve the efficacy of single phytochemicals that are known to have targeted efficacy in vitro, but which aren’t very bioavailable — for example, curcuminoids from turmeric root. 

The dual pressures of climate change and increasing popularity of certain herbal medicines, has led to difficulties in sourcing some herbs, with increasing numbers being added to at-risk lists (13). A changing climate, and subsequent environmental conditions, alters the levels of active compounds in the plants (14). In response, organisations such as the American Botanical Council (ABC) have launched initiatives to share information about sustainability challenges and promote responsible sourcing.

A key barrier to herbal research, as with many types of research, is money. Who funds research and why helps to define the field. This is why most clinical trials are carried out on standardised and trademarked extracts of herbal preparations produced by supplement companies and manufacturers. This has been particularly true for turmeric (Curcuma longa) and ashwagandha (Withania somnifera). 

An interesting development this year has been the launch of a trademarked extract of shatavari (Asparagus racemosus) by Ixoreal, the company behind the ashwagandha extract KSM-66. Despite centuries of use in Ayurvedic medicine for women’s health, shatavari has been relatively under-researched to date. The BioActivEx research group at University of Exeter has addressed this gap with a series of clinical studies funded initially by Pukka Herbs, showing benefits for muscle strength in older women (15,16,17). Additional studies have been published on the use of shatavari for perimenpausal symptoms, alone (18,19) and in combination with ashwagandha (20), as well as for the traditional use to support breastfeeding (21).

The gut microbiome

In line with the general increasing awareness of the importance of the gut microbiome, there has also been a flurry of new herbal research into the interplay between the gut microbiota and phytochemicals. How herbs affect the microbiome and how the microbiome affects the metabolism and bioavailability of herbs are both topics that have received attention.

While 60% of the variation in drug metabolism between individuals is due to genetics, there is a significant contribution from the gut microbes. Bacteria in the gut play a part in how plant chemicals are broken down and absorbed into the body. This will consequently have an impact on the efficacy and the toxicity of a herb (22). The presence or absence of specific microbes in the gut is likely to contribute to why herbs are more effective for some people than others.  

Plant chemicals such as polyphenols are well documented to impact the gut microbiome. Some phytochemicals have a prebiotic effect, promoting the growth and survival of beneficial microbes, while others may have an antibacterial effect on less desirable species (23). 

Herbal medicines have the potential to contribute to some of the key challenges to improving health. It will take more coordinated efforts globally to ensure that the herbal research is meaningful and can impact as many people as possible.

1. Salmerón-Manzano E, Garrido-Cardenas JA, Manzano-Agugliaro F. Worldwide Research Trends on Medicinal Plants. Int J Environ Res Public Health. 2020;17(10):3376. Published 2020 May 12. https://doi.org/10.3390/ijerph17103376 
2. El Allaoui H, El Ahmadi K, El Abdouni A, Dira I, El Bastrioui M, Bouhrim M, Eto B, Shahat AA, Herqash RN, Haboubi K. Trends and Insights in Medicinal Plant Extract Research: A Ten-Year Bibliometric and Visualization Study. Horticulturae. 2024; 10(11):1163. https://doi.org/10.3390/horticulturae10111163
3. WHO. Global Traditional Medicine Strategy 2025-2034. 2025. https://iris.who.int/server/api/core/bitstreams/cf37a4ad-4d27-4244-a7ee-001de39841ee/content 
4. WHO. Noncommunicable diseases. Fact sheet. 2025b. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases 
5. Chen Y, Li WW, Bi SL, et al. Visualizing research trends and identifying hotspots of herbal components for treating cardiovascular diseases: A bibliometric analysis from 2000 to 2023. Medicine (Baltimore). 2024;103(6):e35047. https://doi.org/10.1097/MD.0000000000035047 
6. Hao P, Jiang F, Cheng J, Ma L, Zhang Y, Zhao Y. Traditional Chinese Medicine for Cardiovascular Disease: Evidence and Potential Mechanisms. J Am Coll Cardiol. 2017;69(24):2952-2966. https://doi.org/10.1016/j.jacc.2017.04.041 
7. Hu L, Wang C, Zhang Y. Hotspots and trends in global antiviral herbal basic research: A visualization analysis. Eur J Integrative Med 2024. 102419.
8. Alum EU, Manjula VS, Uti DE, et al. Metabolomics-Driven Standardization of Herbal Medicine: Advances, Applications, and Sustainability Considerations. Natural Product Communications. 2025;20(8). https://doi.org/10.1177/1934578X251367650
9. Yuan Z, Pan Y, Leng T, et al. Progress and Prospects of Research Ideas and Methods in the Network Pharmacology of Traditional Chinese Medicine. J Pharm Pharm Sci. 2022;25:218-226. doi:10.18433/jpps32911
10. Zhao L, Zhang H, Li N, et al. Network pharmacology, a promising approach to reveal the pharmacology mechanism of Chinese medicine formula. J Ethnopharmacol. 2023;309:116306. doi:10.1016/j.jep.2023.116306
11. Ai S, Li Y, Zheng H, et al. Collision of herbal medicine and nanotechnology: a bibliometric analysis of herbal nanoparticles from 2004 to 2023. J Nanobiotechnol 2024 22:140. https://doi.org/10.1186/s12951-024-02426- 
12. Li J, Zhang YL, Jin T, et al. Advanced Pharmaceutical Nanotechnologies Applied for Chinese Herbal Medicines. Adv Sci (Weinh). 2025;12(31):e00167. doi:10.1002/advs.202500167 
13. Mykhailenko O, Jalil B, McGaw LJ, Echeverría J, Takubessi M, Heinrich M. Climate change and the sustainable use of medicinal plants: a call for “new” research strategies. Front Pharmacol. 2025;15:1496792. Published 2025 Feb 3. doi:10.3389/fphar.2024.1496792
14. Alum EU. Climate change and its impact on the bioactive compound profile of medicinal plants: implications for global health. Plant Signal Behav. 2024;19(1):2419683. doi:10.1080/15592324.2024.2419683
15. Greed E, Pritchard J, Struszczak L, et al. Shatavari supplementation during eight weeks of resistance training increases training load, enhances skeletal muscle contractility and alters the skeletal muscle proteome in older women. Front Nutr. 2025;11:1498674. Published 2025 Jan 6. doi:10.3389/fnut.2024.1498674
16. O’Leary MF, Jackman SR, Sabou VR, et al. Shatavari Supplementation in Postmenopausal Women Improves Handgrip Strength and Increases Vastus lateralis Myosin Regulatory Light Chain Phosphorylation but Does Not Alter Markers of Bone Turnover. Nutrients. 2021;13(12):4282. Published 2021 Nov 27. doi:10.3390/nu13124282
17. O’Leary MF, Jackman SR, Bowtell JL. Shatavari supplementation in postmenopausal women alters the skeletal muscle proteome and pathways involved in training adaptation. Eur J Nutr. 2024;63(3):869-879. doi:10.1007/s00394-023-03310-w
18. Gudise VS, Dasari MP, Kuricheti SSK. Efficacy and Safety of Shatavari Root Extract for the Management of Menopausal Symptoms: A Double-Blind, Multicenter, Randomized Controlled Trial. Cureus. 2024;16(4):e57879. Published 2024 Apr 8. doi:10.7759/cureus.57879
19. Yadav P, Yadav S, Vedururu SS, Kumari G. A Standardized Asparagus Racemosus Root Extract Improves Hormonal Balance and Menstrual Health and Reduces Vasomotor Symptoms in Perimenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Study. J Am Nutr Assoc. 2025;44(8):754-764. doi:10.1080/27697061.2025.2510474
20. Pingali U, Nutalapati C, Wang Y. Ashwagandha and Shatavari Extracts Dose-Dependently Reduce Menopause Symptoms, Vascular Dysfunction, and Bone Resorption in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Study. J Menopausal Med. 2025;31(1):21-34. doi:10.6118/jmm.24025
21. Ajgaonkar A, Debnath T, Bhatnagar S, Debnath K, Langade J. Shatavari (Asparagus racemosus Willd) root extract for postpartum lactation: A randomised, double-blind, placebo-controlled study. J Obstet Gynaecol. 2025;45(1):2564168. doi:10.1080/01443615.2025.2564168
22. Lim DW, Wang JH. Gut Microbiome: The Interplay of an “Invisible Organ” with Herbal Medicine and Its Derived Compounds in Chronic Metabolic Disorders. Int J Environ Res Public Health. 2022;19(20):13076. Published 2022 Oct 11. doi:10.3390/ijerph192013076
23. Guan Y, Tang G, Li L, et al. Herbal medicine and gut microbiota: exploring untapped therapeutic potential in neurodegenerative disease management. Arch Pharm Res. 2024;47(2):146-164. doi:10.1007/s12272-023-01484-9

Camellia sinensis  prepared as liupao tea — a fermented dark tea rich in polyphenols

To evaluate the effects of Liupao tea of different ages on patients with metabolic syndrome in relation to biochemical markers, body weight, body composition and gut microbiota.

The study was randomised, double-blind and a longitudinal experimental design. Participants were aged between 18 and 70 years and diagnosed with metabolic syndrome according to Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2022 edition) (2). Exclusion criteria precluded the participation of anyone with chronic illnesses — such kidney, liver, blood or heart disease — or were taking any medications that affected their blood glucose, blood lipids or blood pressure, any pregnant or lactating women, any individuals with allergies to tea ingredients, anyone with restrictive dietary habits (such as the ketogenic diet) and anyone with severe mental illness or trauma.

Participants randomised to one of four groups:

• 1-year old fermented tea n=19
• 4-year old fermented n=19
• 7-year old fermented n=19
• 10-year old fermented n=19.

The following measures were taken:

• Visual Analogue Scale (VAS) to evaluate patient appetite — hunger, fullness, mood etc out of a total of 500 points
• Fasting venous blood following an overnight fast for fasting blood glucose, HbA1c, blood lipids, insulin, hepatic and muscle biomarkers
• Body composition via a bioelectrical impedance analyser — body weight, body fat mass, skeletal muscle mass, body fat percentage, lean body mass, visceral fat area
• Waist circumference
• Blood pressure
• Faecal DNA analysis and library construction for diversity analysis and taxonomic classification of gut microbiota

Participants consumed 6 g (one teabag) of Liupao tea per day for 90 days. Tea was brewed with 250 ml of boiling water in a teapot and steeped for up to 45 seconds before drinking. The tea was consumed 1–2 hours after breakfast or lunch and was finished before 3 pm.

A power calculation was used to determine group sizes and there were n=19 participants in each group. Participants were encouraged to engage with the study via an App. Five were lost to follow-up.

Fifty-two females and 19 males completed the study. With the five lost to follow up the final groups were: 1-year old tea (n=19), 4-year old tea (n=17), 7-year old tea (n=18) and 10-year old tea (n=17). There were no differences in any of the demographic measures between the groups. There was an equal split of whether people were regular tea drinkers or not.

Blood pressure

Systolic blood pressure significantly reduced in the 4-, 7- and 10-year tea groups, whilst diastolic pressure only reduced in the group drinking the 10-year tea (p<0.05).

Blood lipids and biomarkers

Total cholesterol reduced in the one-year aged tea group. HDL-C was elevated in the 4- and 7- year aged groups, and LDL-C was reduced across all of the groups compared to baseline (p<0.05).

Apolipoprotein A1 was significantly reduced in the teas that were 1-, 7- and 10-year aged, but apolipoprotein B did not change.

The teas had no significant effects on other parameters such as fasting blood glucose and liver health biomarkers.

Body composition

The teas significantly reduced average body weight with groups losing on average 1–2 kg over the 90 day trial. This corresponded with significant reductions in body fat mass, body fat percentage and visceral fat area. Body mass index and waist circumference decreased in the 4-, 7- and 10-year-aged groups (p < 0.05).

Participant appetite scores did not alter.

Faecal microbiota

Diversity

The seven-year-aged group exhibited an increase in the number of unique Amplicon Sequence Variants (ASVs) after intervention, whereas other groups showed a decrease. This suggests there were shifts in populations. The α-diversity of gut microbiota in the four groups revealed no significant differences before and after intervention across the age range of teas. So for the seven-year aged tea, there were different species apparent, but overall diversity did not change as presumably some species swapped in and out.

Phylum and genus level changes

For individual phyla, Firmicutes and Bacteroidota were dominant in the participants as a whole group. Following the tea intervention, the relative abundances of Firmicutes decreased in the 1-, 4- and 10-year-aged groups, while Bacteroidota abundance decreased in the one-, four- and seven-year-aged groups. 

At the genus level, the overall gut microbiota were comparable in structure across the four tea groups. The most abundant genus in all groups was Bacteroides followed by Prevotella 9 and Faecalibacterium. The changes observed included reductions in Stenotrophomonas and Rothia, and an elevation in Eubacterium hallii in the one-year aged tea group. Elevation of Allobaculum, Monoglobus, and Eubacterium ventriosum in the four-year aged tea group. Reduction in Holdemania in the seven-year aged tea group.

Microbial and metabolic correlations

Using Spearman’s correlation, there were associations between microbial changes and metabolic indicators in the different tea groups. Firstly, Akkermansia displayed a strong inverse relationship with body mass index in the one-year- and seven-year-aged groups. Subdoligranulum was significantly negatively correlated with both triglyceride and insulin levels in the one-year aged group. Other associated changes are also presented.

Liupao tea is a variety of dark tea of ancient origin prepared from the Camellia sinensis plant that grows specifically in Liu Pao in the Guangxi Province in China. The tea is fermented over several years which converts catechins into tea polysaccharides and notably the polyphenol theabrownin. Similar to Pu-erh tea, this tea is enjoyed because of its unique aroma and flavour. Theabrownin and other tea polyphenols have been extensively researched for their lipid-lowering, anti-inflammatory and pre-biotic properties. The present study explored whether differing durations of fermentation would affect metabolic and microbial parameters in participants with diagnosed metabolic syndrome.

The teas that were consumed for 90 days had blood pressure-lowering and lipid-modifying effects. The tea did not affect fasting blood glucose or insulin. The teas significantly reduced average body weight over the 90-day trial, with reductions in body fat including the visceral fat area. Overall, these changes were seen more for teas that were fermented and aged for 4, 7 and 10 years.

Other meta-analyses have shown that tea consumption (green and black analysed together) can reduce body weight, body mass index and modify lipid profiles favourably in patients with metabolic disease (3). For the Liupao tea, the suggested mechanisms related to the cholesterol-lowering properties of theabrownin which increases faecal excretion of bile acids and reduces lipogenesis.

Other mechanisms are purported to involve the gut microbiota. Using a faecal microbiota transplantation method in an animal model, Liupao tea extract improved the abundance and species diversity of microbiota including commensals Lactobacillus and Dubosiella; These changes were associated with weight loss and improved glucose and lipid metabolism (4). In the present study, there were no significant differences in microbial diversity but there were genus and species changes across the groups. Both Firmicutes and Bacteroidota genera declined in the 4, 7 and 10-year aged tea groups. Reducing the ratio between these genera reported to improve intestinal barrier function. Other changes included reductions in Stenotrophomonas which is an opportunistic pathogen.

In supplementary information, the total polyphenol composition of the teas was compared. Levels of theabrownin increased from year one, to four and seven, whilst the 10-year aged tea was similar to seven. The levels of soluble dietary fibre were highest in the 7- and 10-year aged teas, which could have also accounted for the microbial changes. Other compounds such as total flavonoids and caffeine were similar across the teas.

Liupao tea, particularly if well-aged, improved blood pressure and blood lipids in patients with metabolic syndrome. Positive changes in body weight and composition were observed, and there were changes in gut microbiota genera and species abundance rather than observable changes in diversity.

Liupao tea could provide a natural and simple approach to managing metabolic health. Future studies could explore longer timeframes for ingestion, determine which age of tea is the most optimal, and also to compare it to other forms of tea such as green and black. Further work could explore the relationships between gut microbiota composition and specific health outcomes.

1. Wang Y, Hu Q, Jiang Q, Jiang J, Li B, Ma D. A Randomized Double-Blind Trial of the Effect of Liupao Tea on Metabolic Parameters, Body Composition, and Gut Microbiota in Adults with Metabolic Syndrome. Nutrients. 2025; 17(14):2371. https://doi.org/10.3390/nu17142371 
2. Chinese Elderly Type 2 Diabetes Prevention and Treatment of Clinical Guidelines Writing Group; Geriatric Endocrinology and Metabolism Branch of Chinese Geriatric Society; Geriatric Endocrinology and Metabolism Branch of Chinese Geriatric Health Care Society; Geriatric Professional Committee of Beijing Medical Award Foundation; National Clinical Medical Research Center for Geriatric Diseases (PLA General Hospital). Clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in China (2022 edition). Zhonghua Nei Ke Za Zhi 2022, 61, 12–50. https://doi.org/10.3760/cma.j.cn112138-20211027-00751 
3. Xiao, T., Li, Y., Li, H., Wang, K., Huang, J., Liu, Z., & Zhu, M. (2024). Tea consumption in relation with metabolic syndrome and obesity: A systematic review and meta-analysis of randomized clinical trials. Food Bioscience, 61, 104322. https://doi.org/10.1016/j.fbio.2024.104322 
4. Zhou H, Wang X, She Z, Huang L, Wei H, Yang S, Wei Z, Chen H, Yang B, Hu Z, Feng X, Zhu P, Li Z, Shen J, Liu H, Dong H, Chen G, Zhang Q. Combining bioinformatics and multiomics strategies to investigate the key microbiota and active components of Liupao tea ameliorating hyperlipidemia. J Ethnopharmacol. 2024 Oct 28;333:118438. https://doi.org/10.1016/j.jep.2024.118438 

Cordyceps (Cordyceps sinensis)

To evaluate the effectiveness of a fermented cordyceps broth in patients with diagnosed primary insomnia, with the utilisation of an app to facilitate the running of the study. The trial was registered with the Chinese Clinical Trial Registry.

The study was a randomised, double-blind, placebo-controlled trial. 

The study utilised an app to record:

• The Pittsburgh Sleep Quality Index (PSQI) — a scale that includes:
  •  Sleep quality
  • Sleep onset latency
  • Sleep duration
  • Sleep efficiency
  • Sleep disturbances 
  • Daytime function

• Experiences of drinking the beverage and any adverse reactions
• A Self-Rating Anxiety Scale (SAS)

A fermented cordyceps beverage was compared to a placebo, which was similar in appearance, taste and packaging.
Participants received 150 ml bottles and consumed one per day (at any time of day) for six days with a one day break. The trial duration was 28 days. The fermentation process is designed to enhance cordycepin levels and the dosage was within safety parameters defined by preclinical research (2).

Ninety patients were recruited to two groups and received cordyceps or placebo, and two people were lost to follow up. They were 20–75 years of age and included males and females. Inclusion criteria was diagnosis of primary insomnia according to Chinese Classification — with insomnia being the sole symptom and occurring at least three times per week for one month. The PSQI score was >5 for participants and SAS anxiety score <50. Participants were required to not consume probiotics, antibiotics or caffeine for the 28 days of the study, and also abstain from taking sleeping pills from one month before the start.

Overall 88 participants completed the study and included n=59 females and n=29 males. The baseline demographic data was similar between the cordyceps and placebo groups.

The presented data compares t=0 with t=14 and t=28 days. Both groups displayed improvements in many sleep symptoms over time (time factor) and many of the effects were significant for the cordyceps group compared to the placebo (group factor). Figure 5 displays the changes seen over time.

Sleep scores at day 14 and day 28

Apart from sleep onset latency, participants receiving cordyceps had significantly greater reductions versus placebo for all other 6 PSQI scores — the total PSQI score, sleep quality, sleep duration, sleep efficiency, sleep disturbances and daytime function. All these improvements were still significant at day 28 and at this time point sleep onset latency had also significantly reduced (i.e. the time it takes to fall asleep).

Gender differences

The data was stratified by gender. Female participants receiving cordyceps compared to placebo experienced significant reductions in their total PSQI score, sleep quality, sleep duration, sleep onset latency and sleep efficiency, but not improvements in sleep disturbances and daytime function. Among male participants, significant improvements were seen in the total PSQI score, sleep quality and sleep duration; however, no significant group effect was observed for the other measures, including sleep onset latency and sleep efficiency.

Age differences

The data was stratified by age into younger participants (age 20–40 years), middle-aged (41–65 years) and older years (66 and over). There were the most participants in the younger group and numbers in the other two groups were low.

For the younger participants there were significant improvements in five of the scores for cordyceps versus placebo with the exception of sleep disturbances and daytime function (Figure 7 in the publication). 

For the middle-aged adults, there were no significant differences between the cordyceps and placebo groups. For the older group, there were improvements in the total PSQI score, sleep efficiency and sleep duration. 

Safety 

In terms of safety, three minor adverse events were reported in the cordyceps group, relating to increased bowel movements (unconfirmed whether related to treatment).

Cordyceps sinensis is widely used due to its nutritional and medicinal properties. It contains many bioactive components including cordycepin and adenosine. Fermentation techniques are employed to increase levels of bioactive components, and cordycepin is one that is well-researched due to its therapeutic effects.

The study compared the daily ingestion of a fermented cordyceps drink compared to placebo for 28 days. The cordyceps drink resulted in significant improvements in sleep status, which was consistent from day 14 to day 28, compared to the placebo. The authors also suggest that female participants experience more sleep improvements compared to males. Whether this is due to different stages in the oestrus cycle over the course of the study, or perhaps some of the participants were peri- or post- menopausal, is not known. By analysing age, younger participants experienced more consistent improvements to sleep, although the numbers of participants within the older age groups was low and the results were under-powered.

Other studies using electroencephalogram (EEGs) have found that the active compound cordycepin binds to adenosine receptors in the brain and reduces sleep-wake cycles and increases non rapid eye movement sleep — NREM — which is the phase of sleep most attributed to body repair and rest (2). In the present human study, the authors were unsuccessful in using smartwatches to gain further insight into the participant’s sleep-wake cycles. This would have provided useful information to combine with the App which recorded sleep subjectively through the Pittsburg tool.

The authors did not report the bioactive levels within their product. Cordyceps is a valuable nutritional and medicinal plant and is subject to overharvesting, so, in addition to sourcing from cultivated supplies, using fermentation processes to enhance the yield of valuable compounds is beneficial to minimise the harvest required.

A fermented cordyceps beverage significantly improved sleep outcomes in patients with primary insomnia. Future research could continue to explore benefits within specific groups or at different ages. Combining cordyceps with herbs also known to be sedative would also be an interesting approach.

1. Zhao, S., Wang, Z., Fan, X., Shu, X., Chen, Q., Zhou, Y., … & Wen, C. (2025). Effectiveness of fermentation broth of Cordyceps sinensis for primary insomnia: a randomized clinical trial with digital health tool. Frontiers in Neurology, 16, 1555010. https://doi.org/10.3389/fneur.2025.1555010 
2. Hu Z, Lee CI, Shah VK, Oh EH, Han JY, Bae JR, Lee K, Chong MS, Hong JT, Oh KW. Cordycepin Increases Nonrapid Eye Movement Sleep via Adenosine Receptors in Rats. Evid Based Complement Alternat Med. 2013;2013:840134. https://doi.org/10.1155/2013/840134 

• Chinese raisin tree (Hovenia dulcis)
• Kudzu root (Pueraria lobata)
• A glutathione yeast extract

To examine the effects of Chinese raisin tree (Hovenia dulcis) in combination with kudzu (Pueraria lobata) or a yeast extract on hangover symptoms in healthy participants. Blood alcohol levels and acetaldehyde were monitored as they are linked to symptom severity.

The trial was a randomized, double-blind, parallel-group and placebo-controlled design. Participants attended the laboratory for the first visit and were randomised to the following beverages: A placebo, Hovenia dulcis with Pueraria lobata (HDPB) or Hovenia dulcis with glutathione yeast extract (HDGB). The participants and researchers were both blinded.

There were four lab visits in total. Participants abstained from alcohol 24 hours before the visits and received the different beverages with a seven-day washout between visits. For each visit:

• Participants received an identical meal
• Participants received their placebo or herbal beverage two hours later
• After 30 minutes, they consumed a 40% proof whiskey (0.9 g/kg body weight) as two drinks over 30 minutes
• They abstained from further food for the rest of the day
• The following morning upon waking they completed a hangover symptom questionnaire.

The following were outcome measures:

• Adverse events were recorded.
• Acute hangover scale (AHS): Nine items relating to symptoms which were scored for severity on a scale of 0 (none) to 7 (incapacitating)
• Blood alcohol and acetaldehyde was analysed by gas chromatography–mass spectrometry (GC-MS) at regular intervals (up to 15 hours following alcohol intake)
• Physiological tests (safety assessment) included blood pressure, temperature, pulse, clinical blood tests
• Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) enzymes

Three 500 ml bottles of drink were prepared:

• H. dulcis fruit extract 0.731% (v/v) with P. lobata 0.1% (v/v) (HDPB)
• H. dulcis fruit extract 0.731% (v/v) with glutathione yeast extract 0.02% (w/v) GY) (HDGB)
• Placebo of 0.021% (w/v) caramel pigment powder and 0.11% (w/v) flavours.

There were other minor ingredients in the beverages and all were similar in appearance, taste, colour and packaging.

N=30 participants were recruited and were healthy males and females aged 19–40 years with a body mass index ranging from 18.5 to 25 kg/m². They were screened at the first visit to exclude a range of medical conditions, to be screened for pregnancy, and for inclusion they had to indicate that they had a history of experiencing hangover symptoms like headache, nausea and fatigue.

Of the n=30 participants enrolled, n=25 completed the study. There were 14 males and 11 females and no differences in baseline characteristics such as age.

For hangover symptoms, there was a statistically significant reduction in the hangover scale (AHS) for the gastrointestinal score 15 h after drinking alcohol in the HDPB group versus the placebo, but not between the HDGB group and placebo group.

There was no statistical significance in any of the other reported hangover symptoms like thirst, fatigue etc.; although, for the HDPB group, the scores were consistently lower than the placebo group. 

For blood alcohol levels, in the HDPB group the area under the curve was larger than in the placebo group suggesting that there was a larger volume of alcohol in the participants’ blood stream over the 15-hour study. The figure showing alcohol levels over time (Figure 3) is interpreted as suggesting that the % blood alcohol levels were lower up to half an hour following the drink for both herbal groups compared to placebo, and that the herbs were potentially slowing alcohol absorption. By six hours, the dynamics had changed.

The levels of blood acetaldehyde at six hours were significantly higher for the herbal beverage groups compared to the placebo suggesting that alcohol metabolism was increased in these groups. 

As a safety assessment, there were no significant differences in blood pressure or other physiological measures before and after the study or between groups. Similarly, there were no significant differences in the clinical blood measurements inferring that the herbal beverages were safe.

Overall, the herbal beverage containing Chinese raisin tree (H. dulcis) fruit extract and kudzu (P. lobata) (HDPB) significantly reduced participant gastrointestinal symptoms compared to placebo, and tended to reduce other hangover symptoms but these did not reach statistical significance.

By monitoring blood alcohol and metabolites the herbal beverage HDPB may slow alcohol absorption in the first few hours which is important as it allows the body to process the beverage and the individual may potentially feel less drunk. At six hours, there were significantly higher levels of blood acetaldehyde in the group consuming HDPB suggesting that the herbs may also increase also increase alcohol metabolism.

The herbal beverages were deemed safe to consume, as there were no adverse physiological or biochemical test data following consumption.

The key question is why did the Chinese raisin tree fruit extract and kudzu (HDPB) not ease the hangover symptoms and blood parameters more dramatically? It could be that the level of alcohol tested (two whisky drinks) was not enough to cause a severe hangover and therefore did not reveal a clearer relationship between symptoms and blood alcohol or acetaldehyde levels. The meal may also have buffered some of the effects of alcohol consumption. Although the physiological characteristics of the groups like body weight and body mass index were similar, there may have been other individual differences in liver enzymes that altered their ability to metabolise alcohol.

In an earlier study with the same research group, individuals who consumed around 2.4 g of Chinese raisin tree fruit extract with a shot of alcohol also saw reduced hangover symptoms over time and decreased levels of inflammatory mediators interleukin 6 and 10 (2). In the present study using 0.731% herbal extract within a 500 ml drink equates to around 3.6 g so should have been sufficient to see changes.

As the main ingredient, the chemical composition of Chinese raisin tree includes genistein and kaempferol, both flavonoids with anti-inflammatory effects. Kudzu root is also used to treat alcohol-related conditions. These herbs, therefore, show potential to relieve the effects of alcohol.

To conclude, a H. dulcis fruit extract beverage significantly improved gastrointestinal symptoms associated with hangover and was safe. More research is needed to investigate the herb individually and using a refined protocol to determine its effects on the symptoms and blood biochemistry following alcohol consumption. More importantly, studies could also look at herbs for alcohol de-addiction as well as treating the symptoms that its consumption elicits.

1. Lee KW, Xu G, Paik DH, Shim YY, Reaney MJT, Park I, Lee SH, Park JY, Park E, Lee SB, Kim IA, Hong JY, Kim YJ. Clinical Evaluation of Hovenia dulcis Extract Combinations for Effective Hangover Relief in Humans. Foods. 2024 Dec 12;13(24):4021. https://doi.org/10.3390/foods13244021  
2. Kim H, Kim YJ, Jeong HY, Kim JY, Choi EK, Chae SW, Kwon O. A standardized extract of the fruit of Hovenia dulcis alleviated alcohol-induced hangover in healthy subjects with heterozygous ALDH2: A randomized, controlled, crossover trial. J Ethnopharmacol. 2017 Sep 14;209:167-174. https://doi.org/10.1016/j.jep.2017.07.028  

Turmeric (Curcuma longa)

Turmeric is well-researched for its effectiveness in treating knee osteoarthritis. Studies often test a wide variety of turmeric preparations and measure different outcomes. The present research uses a network meta-analysis (NMA) approach to compare the effects of different turmeric therapies in patients with knee osteoarthritis.

A systematic review was carried out to identify relevant papers. Several electronic bibliographic databases were used, and search terms included common and botanical names for turmeric. The population included adults with diagnosed primary knee osteoarthritis. The intervention was turmeric compared to placebo or standard treatment. Outcomes of interest were improvement in joint function, pain or stiffness. Outcomes were measured using WOMAC or VAS, with the former being Western Ontario and McMaster Universities Osteoarthritis Index and the latter a Visual Analog Scale for pain.

Study selection and data extraction were carried out by two reviewers. There were no restrictions on the searches by date or language. The authors used the Cochrane Risk of Bias tool which looks for details like randomisation, allocation concealment to determine potential bias within studies. They used GRADE to rate the overall certainty of evidence.

The NMA approach provides a comparison of all available interventions and gives a ranking of their effectiveness. This was done by pooling the data from all of the studies and applying statistical tests to give an indirect result (2).

For analysing the results, the authors grouped turmeric interventions based on their characteristics. These were:

• CT: Curcuminoid extractions
• BE: Preparations with additives or nanoparticles to enhance bioavailability
• PLS: Polysaccharide-rich preparations

These were compared to active comparison drug (AC) or a placebo (P).

Seventeen randomised controlled studies on turmeric were included in the review, and most used commercially available products. One study compared two doses giving a total of 18 analyses.

In all, 17 randomised controlled studies were analysed. The risk of bias was low risk (six studies), some concern (seven studies) and high risk of bias (four studies).

Nine studies compared turmeric to placebo and eight compared turmeric to standard drugs including diclofenac, ibuprofen and acetaminophen. For the types of turmeric preparation used in the 18 analyses, these were bioavailability enhanced products (BE, n = 12), curcuminoid extracts (CT, n=4) and polysaccharide preparations (PLS, n=2).

Meta analyses of intervention versus placebo

A two-way meta-analysis was produced from the data. For WOMAC pain, seven studies (n=913) showed that BE significantly reduced pain compared to a placebo with a pooled mean difference of −2.47 (–3.25, −1.68). For WOMAC function, BE statistically significantly improved this outcome compared to placebo. For WOMAC stiffness, none of the interventions significantly improved outcomes versus placebo.

For pain determined using VAS, both BE and PLS significantly improved pain scores compared to placebo.
 

Network meta-analyses

Network analyses were prepared for the same WOMAC and VAS outcomes as above, and Figure 2 in the paper nicely illustrates how multiple interventions can be visualised at once. The figure shows the comparisons of the interventions to AC — standard treatment, or P — placebo. The thick lines reflect the larger numbers of randomised controlled trials which have been carried out for the BE intervention group.

WOMAC pain

For this measure of pain, seven studies were analysed and all interventions significantly reduced WOMAC pain compared to placebo, with no single intervention being significantly better than the other.

By ranking the results, the effectiveness of the interventions was CT + AC > AC > CT > BE > P. Figure 3 presents these results, for example the largest effect due to CT + AC compared to placebo, with a mean difference of −4.01 (−6.22, −1.80).

WOMAC function

Similar to WOMAC pain, all interventions significantly improved function compared to the placebo, with no single intervention being statistically significantly better than the other. The ranking was the same as above: CT + AC > AC > CT > BE > P. 

WOMAC stiffness

None of the interventions significantly improved stiffness compared to placebo.

VAS pain

For pain measured using a VAS scale, all interventions significantly improved VAS versus placebo. This time, two interventions were statistically significantly more effective – both BE + AC and CT + AC were more effective than either AC or BE alone.

Safety

The PLS group produced the highest percentage of adverse events which were mostly reported as miscellaneous. The BE preparation reported the highest incidence of gastrointestinal symptoms overall, around 6% of patients.

Other data

The authors presented other data to validate the network analysis including transitivity, which reflects variation in study characteristics that could include things like disease severity, baseline characteristics of patients, or how interventions were administered. The study did find that for baseline pain scores, there were differences between the groups. 

A network meta-analysis approach is ideal for herbal research where often a range of preparations exist, which is certainly the case for turmeric. The authors identified studies and categorised turmeric according to three main methods of preparation.

Starting with a standard meta-analysis, this indicated that BE significantly improved WOMAC pain and function, but not joint stiffness, compared to placebos. For VAS pain scores, both BE and PLS were the most effective treatments compared to placebos. The meta-analysis compares interventions to controls but not against each other. This suggests that the BE (bioavailability-enhanced) preparations are the most effective in improving osteoarthritis symptoms of pain and joint function, as indicated by different pain score scales.

The authors carried out a networked approach to rank the treatments against each other. This provides indirect evidence from which to draw further conclusions. The ranking showed that the combination of curcuminoid extract and active comparator treatment (CT+AC) were the most effective in improving WOMAC pain and WOMAC function compared to other interventions. For the VAS pain scores, the CT+AC and BE+AC groups were the most effective. These results suggest that turmeric products could be a useful adjunct treatment alongside standard therapies, including diclofenac, ibuprofen and acetaminophen. 

Turmeric’s active compounds, including curcuminoids and alpha-turmerone essential oils, are recognised for their anti-inflammatory qualities and ability to inhibit cytokines thereby attenuating pro-inflammatory pathways. Many of the papers analysed used preparations of turmeric designed to enhance absorption. However, research also suggests that turmeric may have important biological effects through altering the gut microbiota. In one such study, the influence on gut microbiota composition was comparable between whole turmeric rhizome and curcumin in tablet form (3). As the relationship between imbalances in the microbiota, chronic inflammation and immune dysfunction have been established (4), future research could  investigate the intricacies of turmeric’s potential as an anti-inflammatory treatment through its impact on gut microbiota composition.

Preparations of turmeric that enhance the bioavailability of curcumin were effective in reducing pain and improving function in patients with osteoarthritis of the knee, compared to a placebo. The network analysis suggested that combining a turmeric product with an active standard drug could also be useful in reducing pain and providing functional improvements to patients. The review also showed that turmeric was safe to use. 

Overall the systematic review was carried out to a high standard. The combination of meta-analysis and networked approach provides a richer insight into the benefits offered by turmeric as a treatment for osteoarthritis.

1. Wai HS, Pathomwichaiwat T, Suansanae T, Nathisuwan S, Rattanavipanon W. Effect of turmeric products on knee osteoarthritis: a systematic review and network meta-analysis. BMC Complement Med Ther. 2025 Jul 29;25(1):292. https://doi.org/10.1186/s12906-025-05045-z 
2. Chaimani A, Caldwell DM, Li T, Higgins, JP, Salanti G. Undertaking network meta‐analyses. 2019. Cochrane handbook for systematic reviews of interventions, 285-320. Available: https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-11 
3. Peterson CT, Vaughn AR, Sharma V, Chopra D, Mills PJ, Peterson SN, Sivamani RK. Effects of Turmeric and Curcumin Dietary Supplementation on Human Gut Microbiota: A Double-Blind, Randomized, Placebo-Controlled Pilot Study. J Evid Based Integr Med. 2018 Jan-Dec;23:2515690X18790725.  https://doi.org/10.1177/2515690X18790725 
4. Bolte, Laura A., et al. “Long-term dietary patterns are associated with pro-inflammatory and anti-inflammatory features of the gut microbiome.” Gut 70.7 (2021): 1287-1298. Available: https://gut.bmj.com/content/70/7/1287

German chamomile (Matricaria chamomilla) and Roman chamomile (Anthemis nobilis) – although the review searched for “chamomile” in general.

To conduct a systematic review and meta-analyses to explore the use of chamomile as an anti-inflammatory agent, particularly as an anti-inflammatory for oral health.

This study was conducted as a systematic review. Whilst the authors broadly searched for inflammation, the main area of focus was oral health.

For the search strategy the population was human adults, the intervention was any chamomile preparation, and the outcomes of interest were inflammation, pain severity, gingival bleeding and anti-microbial effects.

It is noted that the details of the search terms were not included in the methodology, so it is not clear how extensive these were and whether the authors searched using botanical names or common plant names, or whether the terms included active compounds, such as chamazulene.

The search was performed using only one electronic bibliographic database – PubMed. Two authors were involved in study screening and data extraction. They did not look at the risk of bias for included studies.

Chamomile was administered in a range of oral products. Chamomile oral gel, chamomile mouthwash or gargle, chamomile powder for cleaning teeth, topical gel and chamomile extract.

Topical gels and creams ranged from 1.3 to 3% chamomile (w/v), and mouthwashes ranged from 20% to 160% (w/v).

Eleven randomised controlled trials were included in the analysis. Nine of these looked at oral inflammation, one nasal inflammation and one skin inflammation.

The first meta-analysis pooled data from seven studies and looked at overall inflammation. There was no statistically significant improvement in inflammation from using chamomile compared to controls, with a pooled mean of −1.57 (95% CI: −4.05 to 0.91). These studies included oral, nasal and skin inflammation and a wide range of chamomile products, and the heterogeneity, which measures variability between studies, was high.

A second meta-analysis included four studies and explored pain severity; there was a significant improvement following the use of chamomile compared to controls with a pooled mean of −0.61 (95% CI: −0.76 to −0.46).  For these studies, the heterogeneity was low at 0%, with three trials on oral care and one on skin inflammation.

For gingival bleeding, although there was a trend toward improvement, the pooled effects showed no statistically significant reduction in bleeding following chamomile treatment compared to controls. For anti-microbial effects, there was a trend toward improvement which also was not statistically significant.

The next meta-analysis pooled data from the studies that just examined the oral cavity. There was no statistical improvement in mucosal inflammation as shown by pooling data from three studies, and these tests looked for ulcers, swelling and redness. However, a final meta-analysis on gingival inflammation pooled data from three studies and showed a statistically significant improvement in the Gingival Index (gum inflammation), with a pooled mean difference of -0.70 (95% CI: -1.25 to -0.15), and the heterogeneity was low.

The systematic review retrieved and analysed 11 studies that examined the effectiveness of chamomile in treating inflammatory skin and mucosal conditions, with chamomile made available in topical gels, creams, oral mouthwashes and powders.

Overall, chamomile was not effective as an anti-inflammatory treatment but it did relieve pain severity in studies that included skin and nasal inflammation, and oral care.

In focusing on oral care, there were no improvements in visible mucosal inflammation as indicated by ulceration and swelling in the mouth, but chamomile did specifically improve gingivitis inflammatory scores, but not gingival bleeding. 

Overall, the results for chamomile were mixed probably due to the array of different products and varying concentrations used, and the varying medical conditions looked at in the review.

Chamomile is well known for its anti-inflammatory properties and is used to treat skin irritations and gut disorders. Its effects are attributed to volatile oil compounds like chamazulene and alpha-bisabolol, and flavonoids including apigenin. Future research could benefit from the standardisation of products, such as apigenin-7-glucoside, as per European and U.S. pharmacopoeia recommendations. This would allow for a more accurate comparison of the effects of different products.

Accounting for the botanical species and parts of the plant used, as well as the method of preparation would futher benefit future work. One study that explored the effects of chamomile extracts from five different parts of the plant on human T cells found varying immunomodulatory activity dependent on the plant part and method of extraction (they used aqueous extracts of whole plant and root, ethanolic extract of flowers and root, and an ethanolic mother tincture). Aqueous root extract inhibited T cell migration, whereas both aqueous root and aqueous whole plant extracts reduced T cell activation. Whole plant extract and ethanolic flower extract significantly reduced interleukin-2 intracellular levels (2). This reaffirms the importance of recording the preparation and plant parts used.

Chamomile was effective in improving pain severity in a range of inflammatory conditions, and reduced gingivitis scores suggesting that its analgesic and anti-inflammatory properties could be of particular benefit as an anti-inflammatory for oral health. Overall, the analyses included a diverse set of studies including skin, nasal and oral inflammation, and there was no significant improvement in inflammation overall across all studies analysed.

It must be noted that this study lacks any record of the complete search strategy and the risk of bias was not discussed, precluding reliable interpretation of the results. Further research is needed to better understand chamomile’s anti-inflammatory potential, in particular its application in dentistry.

1. Valmy J, Greenfield S, Shindo S, Kawai T, Cervantes J, Hong BY. Anti-inflammatory effect of chamomile from randomized clinical trials: a systematic review and meta-analyses. Pharm Biol. 2025 Dec;63(1):490-502. doi: 10.1080/13880209.2025.2530995. Epub 2025 Jul 15. PMID: 40665590; PMCID: PMC12269088.
2. Lairikyengbam D, Wetterauer B, Schmiech M, Jahraus B, Kirchgessner H, Wetterauer P, Berschneider K, Beier V, Niesler B, Balta E, Samstag Y. Comparative analysis of whole plant, flower and root extracts of Chamomilla recutita L. and characteristic pure compounds reveals differential anti-inflammatory effects on human T cells. Front Immunol. 2024 Apr 24;15:1388962. doi: 10.3389/fimmu.2024.1388962. PMID: 38720895; PMCID: PMC11077421.

Ginseng (Panax ginseng)

The study explored whether red variety of ginseng could regulate alcohol metabolism and alter hangover symptoms in healthy men.

The trial was a randomised, cross-over design. Participants were randomised to groups to receive either a placebo drink (water) or a beverage containing red ginseng. It was not clear from the study methodology whether the study was blinded at all. The drinks were presented in similar packaging.

Volunteers attended three visits and on the first two visits they received either the placebo or ginseng. There was a two-week wash-out between the first and second visits. On the third visit, they completed surveys. On each test visits the participants:

• Abstained from drinking alcohol for three days prior to the visit
• Fasted for 12 hours prior to the visit
• Consumed 100 ml 40% blended scotch whisky and one piece of cheese
• They consumed either 100 ml water (placebo) or red ginseng drink within five minutes of the alcohol.

The following outcome measures were recorded, which included participant surveys and food diaries, plus laboratory tests.

• Hangover symptom questionnaire on the third visit (15 questions including symptoms such as headache, nausea and fatigue on a scale of 0 absent to 4 extremely severe)
• Daily food intake was measured using recall diaries over 24 hours
• Body weight and percentage body fat
• Blood pressure
• Blood samples at regular intervals up to four hours after consuming the alcohol test
• Serum lipids, blood haematology and serum creatinine was measured
• Basal metabolic rate and total energy expenditure was calculated

Plasma alcohol and acetaldehyde was measured at regular intervals, as was alcohol in exhaled air for up to four hours.

The 100 ml placebo drink was water. The red ginseng drink comprised 0.321 mg/mL red ginseng extract prepared by water extraction and made up to a 100 ml drink, thereby constituting a 32.1 mg dose.

The n=25 healthy male volunteers were 25–49 years of age with a body mass index of 18 to 29 kg/m². Exclusion criteria included anyone with a medical condition or who was on medication, or those with an allergy to ginseng.

There were n=13 participants in the placebo group and n=12 in the Ginseng group. All physiological and biochemical characteristics were within normal ranges. There were no statistically significant changes in food intake or energy expenditure over the course of the study. The statistics do not display the differences if any between the groups, just changes over time, so it cannot be determined whether the groups were matched in characteristics.

The overall hangover symptom score was significantly lower in the ginseng group compared to placebo. Several symptoms also improved following the ginseng drink and were statistically different from the placebo: the group were less tired, had fewer stomach aches, were less thirsty, and experienced better concentration and improved memory compared to the placebo. The other symptoms associated with hangovers did not change.

Plasma alcohol levels were significantly lower in the ginseng group at 30–60 minutes after whiskey consumption compared to the placebo group suggesting that alcohol absorption was slower. By 90 minutes, the groups were the same. The area under the curve was smaller and statistically significant (just at p=0.051) for the ginseng group.

The expired alcohol levels mirrored this being lower in the ginseng group up to 60 minutes after drinking the whiskey, and similar thereafter.

For plasma acetaldehyde, the levels were similar except for the two-hour time point where levels were higher in the Ginseng group, but were similar again at three and four hours.

The study showed that consuming a ginseng drink alongside alcohol consumption improved hangover symptoms of fatigue and stomach ache, and was associated with lower plasma alcohol concentrations up to 60 minutes after drinking. Similarly, levels of alcohol in expired breath also reduced over this time frame, and this was also represented by statistically smaller areas under the curve calculations. This suggests that the ginseng had delayed alcohol absorption which is a benefit as this gives the body more time to metabolise and reduces feelings of intoxication.

Other research (cited by the authors) has shown that ginseng can alter alcohol metabolism through regulating enzyme activity, but in the present study, there was no change in the levels of the metabolite acetaldehyde in the blood. This may have been due to the small number of participants or that the acetaldehyde test was not sensitive enough to detect any differences.

Participants in the ginseng group also experienced improved concentration and less fatigue. Panax ginseng contains a host of bioactive components including ginsenosides or ginseng saponins, along with essential oils and polyphenols (2). It is known for its ability to improve memory and cognitive deficit (2), and other studies have shown that consuming a ginseng extract for three weeks can reduce fatigue in healthy adults (3). The present study confirms the effects of ginseng in improving fatigue and memory.

To conclude, a ginseng extract in a 100 ml beverage improved several hangover symptoms and reduced plasma alcohol levels compared to a placebo.

1. Lee MH, Kwak JH, Jeon G, Lee JW, Seo JH, Lee HS, Lee JH. Red ginseng relieves the effects of alcohol consumption and hangover symptoms in healthy men: a randomized crossover study. Food Funct. 2014 Mar;5(3):528-34. https://doi.org/10.1039/c3fo60481k  
2. Wee JJ, Mee Park K, Chung AS. Biological Activities of Ginseng and Its Application to Human Health. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 8. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92776/ 
3. Lee YG, Hong W, Cho YM, Kwon JE, Yang DC, Kim H, Kang SC. Anti-fatigue effects of Korean Red Ginseng extract in healthy Japanese adults: A randomized, double-blind, placebo-controlled study. J Ginseng Res. 2025 May;49(3):237-247. https://doi.org/10.1016/j.jgr.2024.12.003 

Valerian root (Valeriana officinalis) and hops (Humulus lupulus)

To examine whether a valerian–hop supplement improved sleep, cognitive performance and psychological well-being, in healthy participants that occasionally experience sleep disturbances.

The study was a randomised, double‐blind and placebo‐controlled trial of a valerian–hop supplement versus placebo. Participants had a run-in phase of 21 days followed by a 21-day treatment phase.

Primary outcomes

This was a feasibility study to test the design, recruitment and adherence to the protocol.

Secondary outcomes

• Sleep parameters were measured using a Fitbit Charge 5 tracker (combining movement and polysomnography within its algorithm to determine sleep and wake cycles).
• Subjective psychological parameters of stress, tiredness, mood, motivation, sleep quality were assessed using a visual analog scale.
• Cognitive performance was assessed using an online task.
• Adverse events were recorded.

This was a commercial preparation (Redormin 500 or Ze 91019) comprising 500 mg of valerian root (Valeriana officinalis) extract and 120 mg of hops (Humulus lupulus) extract. The placebo was identical in appearance. Participants ingested valerian–hops supplement or placebo one hour before bed.

Participants were healthy males or females aged 18 to 65 years who experienced occasional sleep disturbances 1–2 nights per week. Participants produced a Pittsburgh sleep quality index (PSQI) score greater than 5 (out of 21) suggesting there were sleep difficulties overall — the index assessed seven components including sleep quality, sleep duration, disturbances and daytime functioning.

To be included in the study they also had to experience cognitive difficulties at least once a week for the prior month. Volunteers were excluded if they were diagnosed with insomnia or were taking prescription drugs for sleep or mood problems.

There were n=18 participants in the test group and n=22 analysed in the placebo group (one dropped out of the study).

There were no differences in the demographic characteristics between groups, with similar splits of male to female participants and similar average age of 36 years per group.

The valerian–hop supplement significantly enhanced sleep duration compared to the placebo with an average increase of 21.7 minutes per night during the 21-day treatment period. Other Fitbit values such as average time in bed also improved, as did the overall sleep score although this was by only a few points.

There were no significant treatment effects for cognitive performance, or the subjective psychological parameters like mood or stress, or heart rate (Table 2 in the publication).

In an analysis of the shortest night for each participant, the test supplement significantly increased sleep duration by on average 47 minutes, and this was associated with a longer period in bed. Again, there were no changes in cognitive or psychological parameters following the shortest night sleep.

There were small numbers of mild adverse events in both the placebo and treatment groups.

Many drugs prescribed to treat insomnia, like benzodiazepines, are known to impair attention and memory. Hence this feasibility study looked at the possibility of using a herbal supplement to improve sleep as well as cognitive ability and mood the following day. The feasibility aspects of the study were a success with a well-designed and delivered protocol.

The study used a valerian–hop supplement, both herbs well known for their sedative and hypnotic effects. On average, participants slept for 6 to 7 hours, and the herbal combination significantly improved sleep duration compared to the placebo. On the participant’s shortest night of sleep the supplement improved the duration up to 48 minutes, topping up an average night of sleep around 4 to 5 hours.

There were no associated improvements in mood or cognitive function even following the shortest night sleep. Participants were surveyed or given an online test between 5pm and 12pm each day, and it could be that impairment was experienced earlier on in the day. The authors did note that participants were not experiencing problems in the run in before the study, so perhaps were not experiencing severe enough symptoms to observe changes. It is also possible that the home-based psychological tests used were not sensitive enough.

Other studies have used validated questionnaires to monitor mood and anxiety etc; in one study 530 mg dried root of Valeriana officinalis given for one month improved sleep and also improved mood changes, although this study was in patients undergoing haemodialysis, a therapy known to impair sleep and cause anxiety (2). Fitbit trackers and similar devices are becoming more sophisticated in their assessment of sleep but are not perfect. The multi-sensor tracking combines motion sensors and photoplethysmographic data to quantify sleep – wake cycles. However, the data collection can be affected due to movement on the wrist or failing batteries during the night.

To conclude, a valerian–hop supplement improved sleep duration and time in bed in participants who experience occasional sleep problems. There were no improvements in daytime cognitive performance, mood or other psychological outcomes. Further research could explore participants with more severe sleep or cognitive disturbances, or use more sensitive psychological tests although this would be more challenging in a home setting.

1. Schicktanz N, Gerhards C, Schlitt T, Aerni A, Müggler E, de Quervain D, Papassotiropoulos A, Boonen G, Drewe J, Butterweck V. Effects of a Valerian-Hops Extract Combination (Ze 91019) on Sleep Duration and Daytime Cognitive and Psychological Parameters in Occasional Insomnia: A Randomized Controlled Feasibility Trial. Brain Behav. 2025 Jun;15(6):e70600. https://doi.org/10.1002/brb3.70600 
2. Tammadon MR, Nobahar M, Hydarinia-Naieni Z, Ebrahimian A, Ghorbani R, Vafaei AA. The Effects of Valerian on Sleep Quality, Depression, and State Anxiety in Hemodialysis Patients: A Randomized, Double-blind, Crossover Clinical Trial. Oman Med J. 2021 Mar 31;36(2):e255. https://doi.org/10.5001/omj.2021.56 

I entered the world of research because I often felt that the quality of research in herbal medicine was questionable by many. To dig in deep, during my Master’s degree, I conducted the quality assessment of the COVID-19 clinical trial using Ayurveda intervention and compared it to the COVID-19 clinical trial using non-Ayurveda intervention, including conventional medicine (majority).

We found out that there was a difference between Ayurveda and non-Ayurveda trials. Initially the results favoured Ayurveda trials, so we conducted a sub-group analysis. The subgroup analysis could not establish the difference in the quality between two groups. 

After the completion of my degree, we conducted a next stage study to assess the characteristics and reporting of traditional medicine including Ayurveda and traditional Chinese medicine and compared it with conventional medicine. We found out the traditional medicine trials were less likely to report the results than conventional medicine.

We have also conducted a pilot study on fibromyalgia participants who were offered group therapies and weekly one-to-one sessions of Ayurvedic lifestyle intervention and noticed a significant improvement in pain and quality of life. 

My next project will be around cancer, and we are still at the proposal stage.

Plants and fungi play a crucial role in both serious and non-serious health conditions. Because they are in their natural form, the human body is likely to adapt and respond to them more easily. It is very unfortunate that not enough scientific evidence is available to prove this point. While some does exist, definitely more is required. However, to give an idea, I can give an example of traditional medicine Ayurveda.

The 5000 year old classical textbook of Ayurveda talks about both curable and non-curable disease. From nausea and vomiting to cancer, you name the condition and you can find a co-relation in those books. In the management of every condition they talk about suitable herbs. The book even talks about emergency health conditions like poisoning. The number of trials conducted that demonostrate positive results regarding herbal efficacy during COVID-19 signifies that this area is worth exploring. So, I believe more robust scientific work is needed to validate the relevance of ancient wisdom in the modern world.

Coming from both backgrounds and while working with experts in research and experts in traditional or herbal medicine, I have noticed a disconnect between the experts in these two areas. A lack of comprehension between these two worlds has troubled me. There are only a few people who are or who choose to train in both the areas. I feel that basic training on both should be offered to see better results. However, this isn’t the biggest challenge, but a lack of funding.

Lack of funds in this area contributes to the majority of challenges. Neither it supports the ones who are already working in the system, nor tempting others who would join. Research in herbal medicine is majorly an individual interest and this approach according to me is not sustainable. 

The above challenge leads to another. I have talked to a few researchers in herbal medicine who stopped researching because they did not feel that their work attracted enough attention or appreciation. So, often they prefer to focus on their practice, which gives them more fulfilment. I believe most of the challenges can be faced if there comes a body which regulates the funds in this area as well.

As a practitioner, I feel lack of awareness is a challenge. However, it does not bother me since there are many who are aware and there are many who through their experience find a way to connect with this science. One thing that is not a challenge for me but for the client is finding the right practitioner. I have seen a few clients who almost lost their hope in herbal medicine before meeting me. I think more information should be given to the clients on how to choose the one who has the expertise to work with them.

The answer is both yes and no.

We know that the absence of evidence does not mean evidence of absence. So, I have seen both the segments. Ones who are intrigued by this area and wish to work to contribute in generating the evidence. While there are also some who are very much occupied by the conventional medicine parameters. They judge traditional medicine on the same parameter, which gives out a sense of bias.

According to me, different streams of medicines work on different modes of action. Hence, they should not be compared under the same parameters.

An integrative approach is the need of the hour. The concept has been introduced to us for quite some time. However, we are yet to see it flourishing in practice. Both conventional medicine and herbal medicine should work hand in hand. One can offer what the other requires. So, instead of fighting over evidence, more contribution is needed to work towards building the evidence.

I come from India, so herbs have been a chief part of our kitchen. It is very important to know the basic properties of the herbs you are using. This ancient kitchen wisdom has been transferred from generation to generation.

Unfortunately, there has been a gap or some misinformation in recent years in the name of modernisation, which have negatively interfered with regular household practices. Therefore, clearer information on the kitchen herbs or even herbs required for health conditions should be shared with the masses. Herbal Reality is already doing this good deed and I appreciate the work done in making this information accessible.

As a phytochemist, I work predominantly on the extraction, isolation and characterisation of natural bioactive compounds from plants. I use different methods of extraction to yield the highest possible quantities of biologically active (i.e. anti-oxidant, anti-inflammatory, antiproliferative) molecules.

In addition, I perform semi-synthetic synthesis reactions to functionalise the natural parent molecules in an attempt to increase their activity, such as introducing aromatic ring moieties.

Lastly, I carry out a series of biological assays to assess the novel derivatives’ bioactivity, for example, in cancer cell lines, and then prepare the hit molecules into nanoformulations to improve drug solubility and deliverability.

Natural compounds are structurally diverse and complex molecules, which means they can have multiple drug targets and an array of biological activities. This means that natural compounds and extracts can often have synergistic effects. In fact, around 70% of the worlds’ chemotherapeutic drugs are either based on a natural compound or a structurally similar analogue.

Nature provides scaffolds of these structurally complex molecules that have phenomenal activity in cancer cell lines and, in my opinion, were the backbone to chemotherapy research. We have also seen the importance and effectiveness of using natural products as an adjunct to standard chemotherapeutic drugs. So, it is of utmost importance that natural product research for cancer therapy continues. 

Natural product chemistry is certainly not always straightforward! Plants contain hundreds of molecules and extracting the one you want can be a complicated and time-consuming process, not to mention large quantities of solvents are usually required for the extraction and separating (chromatographic) processes.

In addition, for every kilo of dried plant material used, sometimes only a few grams (or even milligrams!) of the desired compound can be obtained, making the process arduous and tedious. 

Plants can definitely be misunderstood, perhaps because they have been less studied/explored with a scientific lens. However, I do believe the landscape is changing. I also believe that in a world that has been heavily influenced by industrialisation, herbal medicine can sometimes be viewed as an archaic and irrelevant practice.

I suppose some scientists believe that moving from natural drugs to synthetic pharmaceuticals is progress and that the only way is forward. But from what I see in the scientific community (at least in my small world!), many scientists are acknowledging the benefits of having both practices (herbal and pharma) as part of the medical system.

Herbal medicine has been (and continues to be in many developing countries) the primary healthcare system and foundation to medical care. The importance of herbal medicines to medicine is categorically and undeniably significant. In countries where allopathic medicine is too expensive or unavailable, herbal medicine is used and accepted by the population.

In addition to this, in more developed countries, a return to a more “natural” way of living has spiked the curiosity of the general population to enquire and use more herbal medicines, as they recognise the benefits of herbal medicines (including fewer adverse effects and synergistic properties) when compared to synthetic medicines.

As for the future, as long as we can safeguard and protect the natural fauna and flora of this planet, herbal medicines could provide the answers and solutions to many of the ailments of our current society.

Herbal medicines often have a better safety profile when compared to allopathic (that’s not to say that all natural products/plants are safe, since plants contain toxic compounds – it’s all about the dosage really!). However, this does mean that plants are fantastic to use against “everyday illness” such as common colds, flu and sore throat and, perhaps more importantly, herbal medicines are much more suitable for preventative healthcare, something that the allopathic medical system is not geared towards — modern medicine has been more focused on treatment rather than prevention.