Abstract
Introduction: Traditional plant medicines (TPMs) are plant-derived therapeutic products prepared and applied according to longstanding medical customs. Around the world they are widely used in primary and preventative health care. The World Health Organization (WHO) calls in its Traditional Medicine Strategy 2014–2023 for Member States to provide a regulatory framework so that the formal contribution of traditional therapeutics can be advanced in national systems of health care. Evidence of effectiveness and safety is paramount for the regulatory integration of TPMs; however, a presumed lack of such “evidence” is one obstacle for full integration. The consequential health policy question is how to systematically evaluate therapeutic claims relating to herbal remedies when the extant evidence is predominantly based on historical and contemporary clinical usage, i.e., is empiricist in nature. This paper introduces a new method along with several illustrative examples. Method: Our research design employs a longitudinal, comparative textual analysis of standard textbooks of the professional European medical literature from the early modern period (1588/1664) onwards to today. It then triangulated these intergenerationally documented clinical observations on two exemplars (Arnica and St. John’s Wort) with corresponding listings in multiple qualitative and quantitative sources. A Pragmatic Historical Assessment (PHA) tool was developed and tested as a method to systematically collate the large amount of pharmacological data recorded in these judiciously selected sources. The evidential validity of longstanding professional clinical knowledge could thus be compared with therapeutic indications approved in official and authoritative sources (pharmacopoeias, monographs) and with those supported by contemporary scientific research (randomised-controlled trials [RCTs], experimental research). Results: There was high congruency between therapeutic indications that are based on repeated empirical observations from professional patient care (empirical evidence), those approved in pharmacopoeias and monographs, and modern scientific evidence based on RCTs. The extensive herbal triangulation confirmed parallel records of all main therapeutic indications of the exemplars across all qualitative and quantitative sources over the past 400 years. Conclusions: Historical clinical medical textbooks and contemporary phytotherapeutic equivalents are the key repository of repeatedly evaluated therapeutic plant knowledge. The professional clinical literature proved to be a reliable and verifiable body of empirical evidence that harmonised with contemporary scientific assessments. The newly developed PHA tool provides a coding framework for the systematic collation and evaluation of empirical data on the effectiveness and safety of TPMs. It is suggested as a feasible and efficient tool to extend evidence typologies that substantiate therapeutic claims for TPMs as part of an evidence-based regulatory framework that formally integrates these medically and culturally important therapeutics.
References
1.
World Health Organization. WHO traditional medicine strategy 2014–2023. Geneva, Switzerland: World Health Organization; 2013.
2.
Saad B, Said O. Greco-Arab and Islamic herbal medicine: traditional system, ethics, safety, efficacy and regulatory issues. Hoboken (NY): John Wiley & Sons; 2011.
3.
Crellin JK. Social validation: an historian’s look at complementary/alternative medicine. Pharm Hist. 2001;31(3):43–51.
4.
Dobrow MJ, Goel V, Upshur R. Evidence-based health policy: context and utilisation. Soc Sci Med. 2004;58(1):207–17.
5.
European Parliament. Directive 2004/24/EC of the European Parliament and of the Council of 31 March 2004 amending, as regards traditional herbal medicinal products, Directive 2001/83/EC on the Community code relating to medicinal products for human use. Official Journal of the European Union. 2019. p. 85–90. Available from: https://ec.europa.eu/health//sites/health/files/files/eudralex/vol-1/dir_2004_24/dir_2004_24_en.pdf.
6.
Knöss W. Current regulatory environment of herbal medicinal products in the European Union. In: Cechinel Filho V, editor. Natural products as source of molecules with therapeutic potential. Basel, Schweiz: Springer Nature; 2018. p. 365–89.
7.
Evidence guidelines. Guidelines on the evidence required to support indications for listed complementary medicines. Version 3.0. Australian Government. Department of Health. 2019. Available from: https://www.tga.gov.au/sites/default/files/evidence-guidelines.pdf.
8.
Health Canada. Pathway for licensing natural health products used as traditional medicines. Version 1.0 2012. Available from: https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/legislation-guidelines/guidance-documents/pathway-licensing-traditional-medicines.html#a2.4.
9.
Teng L, Zu Q, Li G, Yu T, Job KM, Yang X, et al. Herbal medicines: challenges in the modern world. Part 3. China and Japan. Expert Rev Clin Pharmacol. 2016;9(9):1225–33.
10.
Swissmedic. Verordnung des Schweizerischen Heilmittelinstituts über die vereinfachte Zulassung und das Meldeverfahren von Komplementär- und Phytoarzneimitteln (Komplementär- und Phytoarzneimittelverordnung, KPAV). Swiss Agency for Therapeutic Products; 2018. Available from: https://www.swissmedic.ch/swissmedic/de/home/services/documents/phytoarzneimittel_hmv4.html.
11.
Legislation Direct. Ko Aotearoa tēnei: a report into claims concerning New Zealand law and policy affecting Māori culture and identity. Wellington, New Zealand: Te taumata tuatahi (Waitangi Tribunal report); 2011.
12.
Parker M. Two into one won’t go: conceptual, clinical, ethical and legal impedimenta to the convergence of CAM and orthodox medicine. Bioeth Inq. 2007;4(1):7–19. ):S.
13.
Daly J, Willis K, Small R, Green J, Welch N, Kealy M, et al. A hierarchy of evidence for assessing qualitative health research. J Clin Epidemiol. 2007;60(1):43–9.
14.
Howick J. Exposing the vanities-and a qualified defense-of mechanistic reasoning in health care decision making. Philos Sci. 2011;78(5):926–40.
15.
O’Donnell E, Atkinson JA, Freebairn L, Rychetnik L. Participatory simulation modelling to inform public health policy and practice: rethinking the evidence hierarchies. J Public Health Policy. 2017;38(2):203–15.
16.
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. Br Med J. 1996;312(7023):71–2.
17.
Sackett DL, Straus SE, Richardson WS, Rosenberg WMC, Haynes RB. Evidence-based medicine: how to practice and teach EBM. 2nd ed.Edinburgh, Scottland: Churchill Livingstone; 2000.
18.
Borck C. Medizinphilosophie zur Einführung. Hamburg, Deutschland: Junius Verlag; 2016.
19.
Clark-Grill M. Questionable gate-keeping: scientific evidence for complementary and alternative medicines (CAM): response to Malcolm Parker. Bioeth Inq. 2007;4(1):21–8.
20.
McCarthy J, Rose P, editors. Values-based health and social care: beyond evidence-based practice. Los Angeles (CA): Sage; 2010.
21.
Loke YK, Price D, Herxheimer A; Cochrane Adverse Effects Methods Group. Systematic reviews of adverse effects: framework for a structured approach. BMC Med Res Methodol. 2007;7(1):32.
22.
Rawlins MD. De testimonio: on the evidence for decisions about the use of therapeutic interventions. Lancet. 2008;8(6):579–88.
23.
Sanderson I. Is it “what works” that matters? Evaluation and evidence-based policy-making. Res Pap Educ. 2003;18(4):331–45.
24.
Freedland KE. Pilot trials in health-related behavioral intervention research: problems, solutions, and recommendations. Health Psychol. 2020;39(10):851–62.
25.
World Medical Association. The Declaration of Helsinki: ethical principles for medical reserach involving human subjects. Sixth revision. 2008.
26.
Batra S, Howick J. Empirical evidence against placebo controls. J Med Ethics. 2017;43(10):707–13.
27.
Rycroft-Malone J. The PARIHS framework: a framework for guiding the implementation of evidence-based practice. J Nurs Care Qual. 2004;19(4):297–304.
28.
Imrie R, Ramey DW. The evidence for evidence-based medicine. Complement Ther Med. 2000;8(2):123–6.
29.
Smith R. Where is the wisdom…? The poverty of medical evidence. Br Med J. 1991;303(6806):798–9.
30.
US Congress Office of Technology Assessment. The impact of randomized clinical trials on health care policy and medical practice. Washington (DC): US Congress, Office of Technology Assessment; 1983.
31.
US Congress Office of Technology Assessment. Assessing the efficacy and safety of medical technologies. Washington (DC): US Congress, Office of Technology Assessment; 1978.
32.
Coulter ID. Comparative effectiveness research: does the emperor have clothes. Altern Ther Health Med. 2011;17(2):8–15.
33.
Coulter ID, Khorsan R. Complementary alternative and integrative medicine: current challenges for outcomes measurement. In: Magnabosco JL, Manderscheid RW, editors. Outcomes measurement in the human services Cross-cutting issues and methods in the era of health reform. Washington (DC): NASW Press; 2011. p. 163–78.
34.
Kräuter SG, Geister R. Eine Kulturgeschichte der Arznei. Darmstadt, Deutschland: Wissenschaftliche Buchgesellschaft; 2004.
35.
Müller-Jahncke WD, Friedrich C. Geschichte der Arzneimitteltherapie. Stuttgart, Deutschland: Deutscher Apotheker Verlag; 1996.
36.
Balick MJ. Ethnobotany, drug development and biodiversity conservation: exploring the linkages. In: Ciba Foundation Symposium 185, editor. Ethnobotany and the search for new drugs. Chichester, England: John Wiley & Sons; 1994. p. 4–24.
37.
Cox PA. The ethnobotanical approach to drug discovery: strengths and limitations. In: Prance GT, Chadwick D, Marsh J, editors. Ethnobotany and the search for new drugs. Chichester, England: John Wiley & Sons; 1994. p. 25–41.
38.
Farnsworth NR. The role of ethnopharmacology in drug development. Ciba Found Symp. 1990;154:2–11; discussion 11–21.
39.
Farnsworth NR, editor. Ethnopharmacolgy and drug development. Chichester, England: John Wiley & Sons; 1994.
40.
Touwaide A. Therapeutic strategies: drugs. In: Grmek MD, Fantini B, Shugaar A, editors. Western medical thought from antiquity to the middle ages. Cambridge (MA): Harvard University Press; 1998. p. 259–73.
41.
Touwaide A. Healers and physicians in ancient and medieval mediterranean cultures. In: Yaniv Z, Bachrach U, editors. Handbook of medicinal plants. New York (NY): Food Products Press & The Haworth Medical Press; 2005. p. 155–73.
42.
Clair S. The challenges in regulating traditional plant medicines in the era of contemporary evidence-based health policy (Unpublished doctoral dissertation). Christchurch, New Zealand: University of Canterbury, Te Whare Wānanga o Waitaha; 2019.
43.
De Vos P. European materia medica in historical texts: longevity of a tradition and implications for future use. J Ethnopharmacol. 2010;132(1):28–47.
44.
Tobyn G, Denham A, Whitelegg M. The Western herbal tradition: 2000 years of medicinal plant knowledge. Edinburgh, Scottland: Churchill Livingstone Elsevier; 2011.
45.
List and brief technical explanation of various forms in which traditional knoweldge may be found [Internet]. 2010. Available from: https://www.wipo.int/meetings/en/doc_details.jsp?doc_id=147152.
46.
Anton R, Mathioudakis B, Pramono S, Sezik E, Sharma S. Traditional use of botanicals and botanical preparations. Eur Food Feed Law Rev. 2019;14:132.
47.
World Health Organization. The regional strategy for traditional medicine in the Western Pacific (2011–2020). Geneva, Switzerland: World Health Organization; 2012.
48.
Adams M, Berset C, Kessler M, Hamburger M. Medicinal herbs for the treatment of rheumatic disorders: a survey of European herbals from the 16th and 17th century. J Ethnopharmacol. 2009;121(3):343–59.
49.
Adams M, Gmünder F, Hamburger M. Plants traditionally used in age related brain disorders: a survey of ethnobotanical literature. J Ethnopharmacol. 2007;113(3):363–81.
50.
Adams M, Alther W, Kessler M, Kluge M, Hamburger M. Malaria in the renaissance: remedies from European herbals from the 16th and 17th century. J Ethnopharmacol. 2011;133(2):278–88.
51.
Adams M, Gschwind S, Zimmermann S, Kaiser M, Hamburger M. Renaissance remedies: antiplasmodial protostane triterpenoids from Alisma plantago-aquatica L. (Alismataceae). J Ethnopharmacol. 2011;135(1):43–7.
52.
Atanasov AG, Waltenberger B, Pferschy-Wenzig EM, Linder T, Wawrosch C, Uhrin P, et al. Discovery and resupply of pharmacologically active plant-derived natural products: a review. Biotechnol Adv. 2015;33(8):1582–614.
53.
Bladt S, Wagner H. From the Zulu medicine to the European phytomedicine Umckaloabo®. Phytomedicine. 2007;14(Suppl 6):2–4.
54.
Buss D, Butler MS, editors. Natural product chemistry for drug discovery. Cambridge, England: Royal Society of Chemistry; 2010.
55.
Butler MS. The role of natural product chemistry in drug discovery. J Nat Prod. 2004;67(12):2141–53.
56.
Cragg GM, Newman DJ, Snader KM. Natural products in drug discovery and development. J Nat Prod. 1997;60(1):52–60.
57.
Fabricant DS, Farnsworth NR. The value of plants used in traditional medicine for drug discovery. Environ Health Perspect. 2001;109(Suppl 1):69–75.
58.
Oubre AY, Carlson TJ, King SR, Reaven GM. From plant to patient: an ethnomedical approach to the identification of new drugs for the treatment of NIDDM. Diabetologia. 1997;40(5):614–7.
59.
Patwardhan B. Ethnopharmacology and drug discovery. J Ethnopharmacol. 2005;100(1–2):50–2.
60.
Buenz EJ, Bauer BA, Johnson HE, Tavana G, Beekman EM, Frank KL, et al. Searching historical herbal texts for potential new drugs. BMJ. 2006;333(7582):1314–5.
61.
Jütte R, Heinrich M, Helmstädter A, Langhorst J, Meng G, Niebling W, et al. Herbal medicinal products: evidence and tradition from a historical perspective. J Ethnopharmacol. 2017;207:220–5.
62.
Helmstädter A, Staiger C. Traditional use of medicinal agents: a valid source of evidence. Drug Discov Today. 2014;19(1):4–7.
63.
Schanz P. Weißdorn und Herzgespann. Medizinische Untersuchungen zur euro-päischen Tradition dieser Arzneipflanzen vom Mittelalter bis zur Gegenwart. In: Gross D, editor. Kassel, Deutschland: Kassel University Press; 2009.
64.
Kazemekaitis A. Änderungen des europäischen Bestandes an Arznei- und Heilpflanzen durch die Erweiterung der Europäischen Union: Einflussmöglichkeiten am Beispiel der baltischen Republik Litauen (Unpublished doctoral dissertation). Schweiz: Universität Zürich; 2010.
65.
Freyer M. Europäische Heilkräuterkunde. Ein Erfahrungsschatz aus Jahrtausenden. Würzburg, Deutschland: Königshausen & Neumann; 1998.
66.
Richter T. Melissa officinalis L.: ein Leitmotiv für 2000 Jahre Wissenschaftsgeschichte. Würzburg, Deutschland: Königshausen & Neumann; 1998.
67.
Mayer-Nicolai C. Vergleich der durch die historischen Autoren Hildegard von Bingen und Leonhart Fuchs pflanzlichen Arzneimitteln zugeschriebenen mit aktuellen anerkannten Indikationen (Unpublished doctoral dissertation). Würzburg, Deutschland: Julius-Maximus-Universität Würzburg; 2009.
68.
Mersi J. Ingwer (Zingiber officinale ROSCOE) und Galgant (Alpinia officinarum HANCE) in der Geschichte der europäischen Phytotherapie (Unpublished doctoral dissertation). Würzburg, Deutschland: Universität Würzburg; 2011.
69.
Notker Zorn B. Wirkung und Anwendung von Hyssopus officinalis L. - eine medizinhistorische Studie (Unpublished doctoral dissertation). Würzburg, Deutschland: Universität Würzburg; 2012.
70.
Verhoeven M. Stachys officinalis: eine grosse Arzneipflanze der traditionellen europäischen Medizin. Ihr historischer Stellenwert und ihre aktuelle Bewertung. Würzburg, Deutschland: Universität Würzburg; 2012.
71.
Leonti M, Verpoorte R. Traditional Mediterranean and European herbal medicines. J Ethnopharmacol. 2017;199:161–7.
72.
Jick TD. Mixing qualitative and quantitative methods: triangulation in action. In: Van Mannen J, editor. Qualitative methodology. Beverly Hills (LA): Sage; 1979. p. 602–11.
73.
Patton MQ. Qualitative research & evaluation methods: integrating theory and practice. Saint Paul (MN): SAGE Publications; 2014.
74.
Tabernaemontanus JT. New vollkommen Kräuter-Buch. Jetzt widerumb auffs newe übersehen vnd anderm vermehret durch Hieronymus Bauhin. 4th ed.Basel, Schweiz: König; 1664.
75.
Löseke JLL, Gmelin JF. Materia medica oder Abhandlung von den auserlesenen Arzneymitteln: nach derselben Ursprung, Güte, Bestandtheilen, Maße und Art zu wirken nebst Vorschriften wie dieselben aus der Apotheke zu verordnen sind. 6th ed.Berlin, Deutschland: Nicolai; 1790. Vol. 16; 584.
76.
Plenck JJ. Icones plantarum medicinalium. Wien, Österreich: Graeffer; 1788.
77.
Plenck JJ. Icones plantarum medicinalium. Wien, Österreich: Graeffer; 1789.
78.
Plenck JJ. Icones plantarum medicinalium. Wien, Österreich: Graeffer; 1790.
79.
Plenck JJ. Icones plantarum medicinalium. Wien, Österreich: Graeffer; 1791.
80.
Plenck JJ. Icones plantarum medicinalium. Wien, Österreich: Graeffer; 1792.
81.
Plenck JJ. Icones plantarum medicinalium. Wien, Österreich: Graeffer; 1794.
82.
Plenck JJ. Icones plantarum medicinalium. Wien, Österreich: Graeffer; 1803.
83.
Richter GA.Ausführliche Arzneimittellehre: Handbuch für praktische Aerzte. Berlin, Deutschland: Rücker; 1826. Vol. XXIV; 565. S. p.
84.
Richter GA.Ausführliche Arzneimittellehre: Handbuch für praktische Aerzte. Berlin, Deutschland: Rücker; 1827. Vol. XVI; 829. S. p.
85.
Richter GA.Ausführliche Arzneimittellehre: Handbuch für praktische Aerzte. Berlin, Deutschland: Rücker; 1828. Vol. X; 646. S. p.
86.
Richter GA.Ausführliche Arzneimittellehre: Handbuch für praktische Aerzte. Berlin, Deutschland: Rücker; 1829. Vol. VI; 650. S. p.
87.
Richter GA.Ausführliche Arzneimittellehre: Handbuch für praktische Aerzte. Berlin, Deutschland: Rücker; 1830. Vol. X; 844. S. p.
88.
Richter GA.Ausführliche Arzneimittellehre: Handbuch für praktische Aerzte. Suppl. Bd. Berlin, Deutschland: Rücker; 1832. Vol. XVIII; 654. S. p.
89.
Strumpf FL. Systematisches Handbuch der Arzneimittellehre. Berlin, Deutschland: Enslin; 1848.
90.
Strumpf FL. Systematisches Handbuch der Arzneimittellehre. Berlin, Deutschland: Enslin; 1855.
91.
Hager H. Handbuch der pharmaceutischen Praxis. Für Apotheker, Ärzte, Drogisten und Medicinalbeamte. Berlin, Deutschland: Springer; 1876.
92.
Hager H. Handbuch der pharmaceutischen Praxis. Für Apotheker, Ärzte, Drogisten und Medicinalbeamte. Berlin, Deutschland: Springer; 1878.
93.
Schulz H. Vorlesungen über Wirkung und Anwendung der deutschen Arzneipflanzen: Für Ärzte und Studierende. Leipzig, Deutschland: Thieme; 1919.
94.
Madaus G. Lehrbuch der biologischen Heilmittel. Abteilung 1: Heilpflanzen, Vol. 1. Leipzig, Deutschland: Georg Thieme; 1938.
95.
Madaus G. Lehrbuch der biologischen Heilmittel. Abteilung 1: Heilpflanzen, Vol. 2. Leipzig, Deutschland: Georg Thieme; 1938.
96.
Madaus G. Lehrbuch der biologischen Heilmittel. Abteilung 1: Heilpflanzen, Vol. 3. Leipzig, Deutschland: Georg Thieme; 1938.
97.
Kroeber L. Das neuzeitliche Kräuterbuch. Die Arnzeipflanzen Deutschlands in alter und neuer Betrachtung. Band I. 4th ed.Stuttgart, Deutschland: Hippokrates-Verlag; 1948.
98.
Kroeber L. Das neuzeitliche Kräuterbuch. Die Arnzeipflanzen Deutschlands in alter und neuer Betrachtung. Band II. 3rd ed.Stuttgart, Deutschland: Hippokrates-Verlag; 1947.
99.
Kroeber L. Das neuzeitliche Kräuterbuch. Die Arzneipflanzen Deutschlands in altern und neuer Betrachtung. Band III. 2nd ed.Stuttgart, Deutschland: Hippokrates-Verlag; 1949.
100.
Weiss RF. Lehrbuch der Phytotherapie. 3rd ed.Stuttgart, Deutschland: Hippokrates; 1974.
101.
Weiss RF. Lehrbuch der Phytotherapie. 6th revised and expanded ed.Stuttgart, Deutschland: Hippokrates; 1985.
102.
Saller R, Reichling J, Hellenbrecht D. Phytotherapie. Klinische, pharmakologische und pharmazeutische Grundlagen. Heidelberg, Deutschland: Haug-Verlag; 1995.
103.
Bäumler S. Heilpflanzenpraxis heute: Porträts, Rezepturen, Anwendung. München, Deutschland: Urban & Fischer; 2007.
104.
Bäumler S. Heilpflanzenpraxis heute: Rezepturen, Anwendung. 3rd ed.München, Deutschland: Elsevier, Urban & Fischer; 2021.
105.
Anton R, Serafini M, Delmulle L. Traditional knowledge for the assessment of health effects for botanicals: a framework for data collection. Eur Food Feed Law Rev. 2012;7(2):74–80.
106.
Shils E. Tradition. Chicago (IL): University Press; 1981.
107.
Helmstädter A, Staiger C. Traditionelle Anwendung: eine Betrachtung zu pflanzlichen Arzneimitteln aus pharmaziehistorischer Sicht [Traditional use: phytopharmaceuticals seen from a historical perspective]. Forsch Komplementmed. 2012;19(2):93–8.
108.
Europäisches Parlament. Richtlinie 2004/24/EG des Europäischen Parlaments und des Rates vom 31. März 2004 zur Änderung der Richtlinie 2001/83/EG zur Schaffung eines Gemeinschaftskodexes für Humanarzneimittel hinsichtlich traditioneller pflanzlicher Arzneimittel. Amtsblatt der Europäischen Union vom 30042004. L 136-85-902004.
109.
Heinrich M, Kufer J, Leonti M, Pardo-de-Santayana M. Ethnobotany and ethnopharmacology: interdisciplinary links with the historical sciences. J Ethnopharmacol. 2006;107(2):157–60.
110.
Will H. Vergleich der Indikationen des 'Kleinen Destillierbuches‘ des Chirurgen Hieronymus Brunschwig (Straβburg 1500) mit den nach derzeitigem wissenschaftlichem Erkenntnisstand belegten Indikationen (Unpublished doctoral dissertation). Würzburg, Deutschland: Julius-Maximilians-Universität Würzburg; 2009.
111.
Dal Cero M. Swiss medical flora: a result of knowledge transmission over the last two millennia (Unpublished doctoral dissertation). Zürich, Schweiz: Universität Zürich; 2016.
112.
Staub PO, Casu L, Leonti M. Back to the roots: a quantitative survey of herbal drugs in Dioscorides’ De Materia Medica (ex Matthioli, 1568). Phytomedicine. 2016;23(10):1043–52.
113.
Bofinger U. Das Kräuterbuch des Jakob Theodor Tabernaemontanus. Aspekte der Interpretation (Unpublished doctoral dissertation). Heidelberg, Deutschland: Universität Heidelberg; 2004.
114.
Friedrich C, Müller-Jahnke W-D, Schmitz R. Geschichte der Pharmazie. Von der Frühen Neuzeit bis zur Gegenwart. Eschborn, Deutschland: Bovi-Verlag; 2005.
115.
Bundesinstitut für Arzneimittel und Medizinprodukte. Liste der Monographien der E-Kommission (Phyto-Therapie), die im Bundesanzeiger veröffentlicht sind. Köln, Deutschland: Bundesanzeiger Verlegsgesellschaft; 2002.
116.
European Union monographs [Internet]. n.d. [cited 2018 Jun 15]. Available from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/general/general_content_001132.jsp&murl=menus/regulations/regulations.jsp&mid=WC0b01ac0580033809.
117.
World Health Organization. WHO monographs on selected medicinal plants volumes 1–4. Geneva: World Health Organization; 2006.
118.
European Scientific Cooperative on Phytotherapy. ESCOP monographs: the scientific foundation for herbal medicinal products. 2nd ed.Exeter, England: ESCOP; 2003.
119.
European Scientific Cooperative on Phytotherapy. ESCOP monographs: the scientific foundation for herbal medicinal products Suppl. 2nd ed.Exeter, England: ESCOP; 2009.
120.
Alphabetical list of ESCOP herbal monographs published online [Internet]. ESCOP. n.d. [cited 2022 Sep 1]. Available from: https://escop.com/online-consultation/.
121.
Hager ROM. Hagers Enzyklopädie der Arzneistoffe und Drogen. In: Blaschek W, Hilgenfeldt U, Holzgrabe U, Mörike K, Reichling J, Ruth P, editors. Berlin, Deutschland: Springer; 2016.
122.
Anton R, Serafini M, Delmulle L. The role of traditional knowledge in the safety assessment of botanical food supplements: requirements for manufacturers. Eur Food Feed L Rev. 2012:241–50.
123.
Abel G, Bos R, Bowen IH, Chandler RF, Corrigan D, Cubbin IJ, et al. Adverse effects of herbal drugs. Berlin, Deutschland: Springer; 2012.
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