herbal medicine research paper topics

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Perspective
• Published: 31 July 2017

Demystifying traditional herbal medicine with modern approach

• Fu-Shuang Li 1 &
• Jing-Ke Weng   ORCID: orcid.org/0000-0003-3059-0075 1 , 2  

Nature Plants volume  3 , Article number:  17109 ( 2017 ) Cite this article

7047 Accesses

261 Citations

115 Altmetric

Metrics details

Plants have long been recognized for their therapeutic properties. For centuries, indigenous cultures around the world have used traditional herbal medicine to treat a myriad of maladies. By contrast, the rise of the modern pharmaceutical industry in the past century has been based on exploiting individual active compounds with precise modes of action. This surge has yielded highly effective drugs that are widely used in the clinic, including many plant natural products and analogues derived from these products, but has fallen short of delivering effective cures for complex human diseases with complicated causes, such as cancer, diabetes, autoimmune disorders and degenerative diseases. While the plant kingdom continues to serve as an important source for chemical entities supporting drug discovery, the rich traditions of herbal medicine developed by trial and error on human subjects over thousands of years contain invaluable biomedical information just waiting to be uncovered using modern scientific approaches. Here we provide an evolutionary and historical perspective on why plants are of particular significance as medicines for humans. We highlight several plant natural products that are either in the clinic or currently under active research and clinical development, with particular emphasis on their mechanisms of action. Recent efforts in developing modern multi-herb prescriptions through rigorous molecular-level investigations and standardized clinical trials are also discussed. Emerging technologies, such as genomics and synthetic biology, are enabling new ways for discovering and utilizing the medicinal properties of plants. We are entering an exciting era where the ancient wisdom distilled into the world's traditional herbal medicines can be reinterpreted and exploited through the lens of modern science.

This is a preview of subscription content, access via your institution

Access options

Access Nature and 54 other Nature Portfolio journals

Get Nature+, our best-value online-access subscription

24,99 € / 30 days

cancel any time

Subscribe to this journal

Receive 12 digital issues and online access to articles

111,21 € per year

only 9,27 € per issue

Rent or buy this article

Prices vary by article type

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Associating 197 Chinese herbal medicine with drug targets and diseases using the similarity ensemble approach

Shuo Gu & Lu-hua Lai

Revealing the efficacy-toxicity relationship of Fuzi in treating rheumatoid arthritis by systems pharmacology

Wuwen Feng, Juan Liu, … Cheng Peng

Assessing the therapeutic potential and safety of traditional anti-obesity herbal blends in Palestine

Mohammed Hawash, Nidal Jaradat, … Yousra Hijazi Hawash

The Plant List (accessed 1 June 2017); http://www.theplantlist.org/

Weng, J.-K., Philippe, R. N. & Noel, J. P. The rise of chemodiversity in plants. Science 336 , 1660–1677 (2012).

Article   Google Scholar  

Hardy, K. et al . Neanderthal medics? Evidence for food, cooking, and medicinal plants entrapped in dental calculus. Naturwissenschaften 99 , 617–626 (2012).

Article   CAS   Google Scholar  

Lietava, J. Medicinal plants in a Middle Paleolithic grave Shanidar IV? J. Ethnopharmacol. 35 , 263–266 (1992).

Aboelsoud, N. H. Herbal medicine in ancient Egypt. J. Med. Plants Res. 4 , 82–86 (2010).

Google Scholar  

Yang, S. The Divine Farmer's Materia Medica: A Translation of the Shen Nong Ben Cao Jing (Blue Poppy Press, 1998).

Li, S. The Ben Cao Gang Mu: Chinese Edition (Univ. California Press, 2016).

Patridge, E., Gareiss, P., Kinch, M. S. & Hoyer, D. An analysis of FDA-approved drugs: natural products and their derivatives. Drug Discov. Today 21 , 204–207 (2015).

Wani, M. C., Taylor, H. L., Wall, M. E., Coggon, P. & McPhail, A. T. Plant antitumor agents. VI. The isolation and structure of taxol, a novel antileukemic and antitumor agent from Taxus brevifolia . J. Am. Chem. Soc. 93 , 2325–2327 (1971).

Neuss, N., Gorman, M., Svoboda, G. H., Maciak, G. & Beer, C. T. Vinca alkaloids. III. 1 Characterization of leurosine and vincaleukoblastine, new alkaloids from Vinca Rosea Linn. J. Am. Chem. Soc. 81 , 4754–4755 (1959).

Kiyohara, H., Matsumoto, T. & Yamada, H. Combination effects of herbs in a multi-herbal formula: expression of Juzen-taiho-to's immuno-modulatory activity on the intestinal immune system. eCAM 1 , 83–91 (2004).

PubMed   Google Scholar  

Phillipson, J. D. Phytochemistry and medicinal plants. Phytochemistry 56 , 237–243 (2001).

Courtwright, D. T. Forces of Habit: Drugs and the Making of the Modern World (Harvard Univ. Press, 2001).

Manglik, A. et al . Crystal structure of the micro-opioid receptor bound to a morphinan antagonist. Nature 485 , 321–326 (2012).

Huang, W. et al . Structural insights into μ-opioid receptor activation. Nature 524 , 315–321 (2015).

Vaughan, C. W., Ingram, S. L., Connor, M. A. & Christie, M. J. How opioids inhibit GABA-mediated neurotransmission. Nature 390 , 611–614 (1997).

Snyder, J. P., Nettles, J. H., Cornett, B., Downing, K. H. & Nogales, E. The binding conformation of Taxol in β-tubulin: a model based on electron crystallographic density. Proc. Natl Acad. Sci. USA 98 , 5312–5316 (2001).

Saville, M. W. et al . Treatment of HIV-associated Kaposi's sarcoma with paclitaxel. Lancet 346 , 26–28 (1995).

Gigant, B. et al . Structural basis for the regulation of tubulin by vinblastine. Nature 435 , 519–522 (2005).

Khoury, H. J. et al . Omacetaxine mepesuccinate in patients with advanced chronic myeloid leukemia with resistance or intolerance to tyrosine kinase inhibitors. Leuk. Lymphoma 56 , 120–127 (2015).

Garreau de Loubresse, N. et al . Structural basis for the inhibition of the eukaryotic ribosome. Nature 513 , 517–522 (2014).

Gandhi, V., Plunkett, W. & Cortes, J. E. Omacetaxine: a protein translation inhibitor for treatment of chronic myelogenous leukemia. Clin. Cancer Res. 20 , 1735–1740 (2014).

Gu, Y. et al . Small-molecule induction of phospho-eIF4E sumoylation and degradation via targeting its phosphorylated serine 209 residue. Oncotarget 6 , 15111–15121 (2015).

PubMed   PubMed Central   Google Scholar  

Staker, B. L. et al . The mechanism of topoisomerase I poisoning by a camptothecin analog. Proc. Natl Acad. Sci. USA 99 , 15387–15392 (2002).

Ulukan, H. & Swaan, P. W. Camptothecins. Drugs 62 , 2039–2057 (2002).

Damayanthi, Y. & Lown, J. W. Podophyllotoxins: current status and recent developments. Curr. Med. Chem. 5 , 205–252 (1998).

CAS   PubMed   Google Scholar  

Wu, C. C. et al . Structural basis of type II topoisomerase inhibition by the anticancer drug etoposide. Science 333 , 459–462 (2011).

Meng, Z. P. et al . Berbamine inhibits the growth of liver cancer cells and cancer-initiating cells by targeting Ca 2+ /calmodulin-dependent protein kinase II. Mol. Cancer Ther. 12 , 2067–2077 (2013).

Gu, Y. et al . CaMKII γ, a critical regulator of CML stem/progenitor cells, is a target of the natural product berbamine. Blood 120 , 4829–4839 (2012).

Dolma, S., Lessnick, S. L., Hahn, W. C. & Stockwell, B. R. Identification of genotype-selective antitumor agents using synthetic lethal chemical screening in engineered human tumor cells. Cancer Cell 3 , 285–296 (2003).

Stickel, S. A., Gomes, N. P., Frederick, B., Raben, D. & Su, T. T. Bouvardin is a radiation modulator with a novel mechanism of action. Radiat. Res. 184 , 392–403 (2015).

Zalacain, M., Zaera, E., Vazquez, D. & Jimenez, A. The mode of action of the antitumor drug bouvardin, an inhibitor of protein synthesis in eukaryotic cells. FEBS Lett. 148 , 95–97 (1982).

Wink, M. Medicinal plants: a source of anti-parasitic secondary metabolites. Molecules 17 , 12771–12791 (2012).

Tu, Y. The discovery of artemisinin (qinghaosu) and gifts from Chinese medicine. Nat. Med. 17 , 1217–1220 (2011).

Wang, J. et al . Haem-activated promiscuous targeting of artemisinin in Plasmodium falciparum . Nat. Commun. 6 , 10111 (2015).

Wu, Y. et al . Therapeutic effects of the artemisinin analog SM934 on lupus-prone MRL/ lpr mice via inhibition of TLR-triggered B-cell activation and plasma cell formation. Cell. Mol. Immunol. 13 , 379–390 (2016).

Li, J. et al . Artemisinins target GABAA receptor signaling and impair α cell identity. Cell 168 , 86–100 (2017).

Lai, H. C., Singh, N. P. & Sasaki, T. Development of artemisinin compounds for cancer treatment. Invest. New Drugs 31 , 230–246 (2013).

Samochocki, M. et al . Galantamine is an allosterically potentiating ligand of neuronal nicotinic but not of muscarinic acetylcholine receptors. J. Pharmacol. Exp. Ther. 305 , 1024–1036 (2003).

Raves, M. L. et al . Structure of acetylcholinesterase complexed with the nootropic alkaloid, (–)-huperzine A. Nat. Struct. Biol. 4 , 57–63 (1997).

Coleman, B. R. et al . [+]-Huperzine A treatment protects against N -methyl-d-aspartate-induced seizure/status epilepticus in rats. Chem. Biol. Interact. 175 , 387–395 (2008).

Wang, H. et al . Multiple conformations of phosphodiesterase-5: implications for enzyme function and drug development. J. Biol. Chem. 281 , 21469–21479 (2006).

Leung, D. Y. et al . Effect of anti-IgE therapy in patients with peanut allergy. N. Engl. J. Med. 348 , 986–993 (2003).

Srivastava, K. D. et al . The Chinese herbal medicine formula FAHF-2 completely blocks anaphylactic reactions in a murine model of peanut allergy. J. Allergy Clin. Immunol. 115 , 171–178 (2005).

Srivastava, K. D. et al . Food Allergy Herbal Formula-2 silences peanut-induced anaphylaxis for a prolonged posttreatment period via IFN-γ–producing CD8 + T cells. J . Allergy Clin. Immunol. 123 , 443–451 (2009).

Kattan, J. D. et al . Pharmacological and immunological effects of individual herbs in the Food Allergy Herbal Formula-2 (FAHF-2) on peanut allergy. Phytother. Res. 22 , 651–659 (2008).

Ehrlich, H. Food Allergies: Traditional Chinese Medicine, Western Science, and the Search for a Cure (Third Avenue Books, 2014).

Wen, M. C. et al . Efficacy and tolerability of anti-asthma herbal medicine intervention in adult patients with moderate-severe allergic asthma. J. Allergy Clin. Immunol. 116 , 517–524 (2005).

Srivastava, K., Sampson, H. A., Emala, C. W. Sr & Li, X. M. The anti-asthma herbal medicine ASHMI acutely inhibits airway smooth muscle contraction via prostaglandin E2 activation of EP2/EP4 receptors. Am. J. Physiol. Lung Cell Mol. Physiol. 305 , 1002–1010 (2013).

Srivastava, K. D., Sampson, H. A. & Li, X. The anti-asthma chinese herbal formula ASHMI provides more persistent benefits than dexamethasone in a murine asthma model. J. Allergy Clin. Immunol. 127 , AB261 (2011).

Yang, N. et al . The Sophora flavescens flavonoid compound trifolirhizin inhibits acetylcholine induced airway smooth muscle contraction. Phytochemistry 95 , 259–267 (2013).

Yang, N. et al . Glycyrrhiza uralensis flavonoids present in anti-asthma formula, ASHMI, inhibit memory Th2 responses in vitro and in vivo . Phytother. Res. 27 , 1381–1391 (2013).

Liu, C. et al . Ganoderic acid C1 isolated from the anti-asthma formula, ASHMI TM suppresses TNF-α production by mouse macrophages and peripheral blood mononuclear cells from asthma patients. Int. Immunopharmacol. 27 , 224–231 (2015).

Lam, W. et al . PHY906(KD018), an adjuvant based on a 1800-year-old Chinese medicine, enhanced the anti-tumor activity of Sorafenib by changing the tumor microenvironment. Sci. Rep. 5 , 9384 (2015).

Lam, W. et al . The four-herb Chinese medicine PHY906 reduces chemotherapy-induced gastrointestinal toxicity. Sci. Transl. Med. 2 , 45ra59 (2010).

Chan, K. et al . Good practice in reviewing and publishing studies on herbal medicine, with special emphasis on traditional Chinese medicine and Chinese materia medica . J. Ethnopharmacol. 140 , 469–475 (2012).

Luo, D. et al . Compound Danshen dripping pill for treating early diabetic retinopathy: a randomized, double-dummy, double-blind study. eCAM 2015 , 539185 (2015).

Avanzas, P. & Kaski, J. C. Pharmacological Treatment of Chronic Stable Angina Pectoris (Springer, 2015).

Book   Google Scholar  

Tagliaferri, M. A. et al . A phase IIb trial of coix seed injection for advanced pancreatic cancer. J. Clin. Oncol. 31 , e16023 (2013).

Liu, C., Hu, Y., Xu, L., Liu, C. & Liu, P. Effect of Fuzheng Huayu formula and its actions against liver fibrosis. Chi. Med. 4 , 12 (2009).

Szasz, T. Psychiatry and the control of dangerousness: on the apotropaic function of the term “mental illness”. J. Med. Ethics 29 , 227–230 (2003).

Liu, J., Lee, J., Salazar Hernandez, M. A., Mazitschek, R. & Ozcan, U. Treatment of obesity with celastrol. Cell 161 , 999–1011 (2015).

Lee, J. et al . Withaferin A is a leptin sensitizer with strong antidiabetic properties in mice. Nat. Med. 22 , 1023–1032 (2016).

Inokuma, Y. et al . X-ray analysis on the nanogram to microgram scale using porous complexes. Nature 495 , 461–466 (2013).

O’Connor, S. E. Engineering of secondary metabolism. Annu. Rev. Genet. 49 , 71–94 (2015).

Cook, D. et al . Lessons learned from the fate of AstraZeneca's drug pipeline: a five-dimensional framework. Nat. Rev. Drug. Discov. 13 , 419–431 (2014).

Download references

Author information

Authors and affiliations.

Whitehead Institute for Biomedical Research, 455 Main Street, Cambridge, 02142, Massachusetts, USA

Fu-Shuang Li & Jing-Ke Weng

Department of Biology, Massachusetts Institute of Technology, Cambridge, 02139, Massachusetts, USA

Jing-Ke Weng

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Jing-Ke Weng .

Ethics declarations

Competing interests.

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Li, FS., Weng, JK. Demystifying traditional herbal medicine with modern approach. Nature Plants 3 , 17109 (2017). https://doi.org/10.1038/nplants.2017.109

Download citation

Received : 11 January 2017

Accepted : 08 June 2017

Published : 31 July 2017

DOI : https://doi.org/10.1038/nplants.2017.109

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

This article is cited by

Recent advances in the potential effects of natural products from traditional chinese medicine against respiratory diseases targeting ferroptosis.

Chinese Medicine (2024)

Update on Brazilian essential oils with leishmanicidal activity

• Ingrid Borges Siqueira
• Yvanna Louise Di Christine Oliveira
• Silvio Santana Dolabella

Phytochemistry Reviews (2024)

An update on the bioactivities and health benefits of two plant-derived lignans, phyllanthin and hypophyllanthin

• Sylvester I. Omoruyi
• Joshua Delport
• Okobi E. Ekpo

Advances in Traditional Medicine (2024)

Cepharanthine analogs mining and genomes of Stephania accelerate anti-coronavirus drug discovery

• Shilin Chen

Nature Communications (2024)

Anti-Trypanosoma cruzi activity of Coptis rhizome extract and its constituents

• Yuki Tayama
• Shusaku Mizukami
• Kenji Hirayama

Tropical Medicine and Health (2023)

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Traditional herbal medicine: overview of research indexed in the scopus database

• Original Article
• Published: 28 October 2022
• Volume 23 , pages 1173–1183, ( 2023 )

Cite this article

• Hassan Hussein Musa 1 , 2 ,
• Taha Hussein Musa 2 , 3 ,
• Olayinka Oderinde   ORCID: orcid.org/0000-0002-2050-0948 4 ,
• Idris Hussein Musa 5 ,
• Omonike Olatokunbo Shonekan 6 ,
• Tosin Yinka Akintunde 7 &
• Abimbola Kofoworola Onasanya 8  

6889 Accesses

7 Citations

Explore all metrics

Traditional herbal medicine has been playing an essential role in primary health care globally. The aim of this work is to present an overview of traditional herbal medicine research productivity over the past years. The data was accessed from the Scopus database ( www.scopus.com ), while VOSviewer.Var1.6.6, Bibliometrix, and R studio were used for further analysis of the obtained data. The results showed that researches on traditional herbal medicine increased annually after 1990, followed by a corresponding increase in global citations during the period, with a total of 22,071 authors contributing to all the publications. Yiling Wang of Shanghai Institute of Drug Control, Shanghai, China was the most productive author (TNP = 303), while Journal of “Evidence-based Complementary and Alternative Medicine”, and “Journal of Ethnopharmacology” were the top ranked journals, respectively. Also, China, Japan, and India were found to be the top Corresponding Author's Countries for researches on traditional herbal medicine, as Beijing University of Chinese Medicine, China Academy of Chinese Medical Sciences and China Medical University were top affiliations. Moreover, National Natural Science Foundation of China, National Key Research and Development Program of China, Ministry of Science and Technology of the People's Republic of China, and Ministry of Science and Technology, Taiwan were top funding agencies, with more than 100 documents. The bibliometric research study has revealed an annual increasing trend in traditional herbal medicine, while also revealing that the topmost ranked authors and funding agencies were from Asia especially China.

Similar content being viewed by others

Evolving importance of anticancer research using herbal medicine: a scientometric analysis.

Tapasree Basu, Ajoy Mallik & Nripendranath Mandal

Rhodiola rosea: main features and its beneficial properties

Alessandra Durazzo, Massimo Lucarini, … Antonello Santini

Scientometric study of academic publications on antioxidative herbal medicines in type 2 diabetes mellitus

Ozra Tabatabaei-Malazy, Amir Ramezani, … Mohammad Abdollahi

Avoid common mistakes on your manuscript.

Introduction

Traditional herbal medicine (or alternative herbal medicine) has played an essential role as a source of primary health care for many, globally (Maroyi and Cheikhyoussef 2015 ), as it has maintained the health of majorly Africans and Asians for thousands of years with a unique medical system built based on empirical- and accumulated knowledge. It has been reported that ~ 70–80% of Africa’s emerging urban and rural population rely on traditional herbal medicine for health intervention (Hostettmann et al. 2000 ; Lee et al. 2019 ), and even at the moment, billions of people around the world are taking traditional herbal medicine daily in form of food, drugs or supplements (Aydin et al. 2016 ). Traditional herbal medicine have been reported to have been used to cure or prevent many diseases and ailments including gastroesophageal reflux disease (Dai et al. 2020 ), prevents postoperative recurrence of small hepatocellular carcinoma (Zhai et al. 2018 ), adjuvant for chemo- and radiotherapy for cancer (Qi et al. 2010 ), adjunctive therapy for nasopharyngeal cancer (Kim et al. 2015 ), resectable gastric cancer (Lee et al. 2018 ), treatment of viral infections, stress and anxiety as well as improve mental health during Covid-19 pandemic (Shahrajabian et al. 2021 ; Yu et al. 2020 ), just to mention a few. Therefore, sustainable management towards traditional herbal medicine, the reactions, and challenges in the monitoring and safety of plant resources are essential sources of new drugs development which are used in treating several diseases ranging from general body pain to complicated diseases in humans (Kutalek and Prinz 2005 ; Maroyi and Cheikhyoussef 2015 ).

Bibliometric analysis has been used in many fields including Covid-19 and mental health (Akintunde et al. 2021 ), gum arabic (Musa et al. 2021a ), neem (Onasanya et al. 2022 ) and in diseases such as sickle cell anemia (Musa et al. 2021b ), anticancer research using herbal medicine (Basu et al. 2017 ), herbal medicine for pain (Wang and Meng 2021 ), medical treatment of cardiovascular diseases (Huang et al. 2016 ), and natural products against cancer (Du and Tang 2014 ). The findings from these studies have helped researchers to explore new directions for future research while also playing a fundamental role in decision making regarding policy, in addition to identifying new perspectives on potential collaborations in these fields (Basu et al. 2017 ; Du and Tang 2014 ; Huang et al. 2016 ; Musa et al. 2021a , 2021b ; Wang and Meng 2021 ). However, there is yet any bibliometric analysis reportedly conducted to enhance the understanding of research hotspots, frontiers, and trends in the traditional herbal medicine indexed in the Scopus, as this will initaiate a focus on future researches and identify gaps, hence assist to explore current patterns and trends in literatures (Dol et al. 2021 ). Furthermore, using bibliometric analysis will enable researchers have a good grasp of the basic characteristics of the publications done over the years with empirical evidence on traditional medicine.

Therefore, in order to identify and further promote the growth and development of traditional herbal medicine, we used Bibliometric analysis to analyse all the published literatures therein. This technique can draw the primary bibliometric landscapes of the development of topics, highlighting the most active authors, influential countries or regions, topmost research interests in the fields and the hot topics covered over the past years, in addition to the international and national collaboration networks among authors, countries or regions. Hence, this paper aims to establish via analysis, the research productivity on the traditional herbal medicines indexed in the Scopus database, while assessing the research gaps by reviewing the published literatures.

Materials and methods

Sources of data.

A bibliographic data acquisition was carried out using the Scopus database ( https://www.scopus.com/ ) updated to March 2, 2022. Scopus is a world leading scientific database widely known for its extensive database of abstracts and citations which offers researchers the most comprehensive literature (covering all fields of natural sciences, medicine, social sciences and life sciences) retrieval.

Search strategy

We developed our search by examining related publications on traditional herbal medicine using the following query with the corresponding search approach based on:

TITLE ("traditional herbal medicine") OR TITLE ("Herbal medicine") OR TITLE ("herbal drug") OR TITLE ("Traditional Chinese medicine") OR TITLE ("Chinese medicine") OR TITLE ("Persian medicine") OR TITLE ("traditional Iranian medicine") OR TITLE ("Ayurveda") AND (EXCLUDE (PUBYEAR, 2022) OR EXCLUDE (PUBYEAR, english AND limit-to AND doctype)) AND (LIMIT TO (DOCTYPE, "ar")) AND (LIMIT-TO (LANGUAGE, "English")).

To ensure the high quality and academic nature of the literatures, only full research articles published in English were included. Initially, the search query returned 10,163 documents and the authors thereafter screened the titles of these articles for relevance. The total extracted docuemtns were harvested after retrieval and saved as Bib format, CSV format, and RIS format for further analysis using the bibliometric tool to run the frequency and generating, visualizing, and analyzing the maps. Two authors (THM and HHM) used bibliometric techniques to set a protocol to retrieve and collect reliable and relevant publications on traditional herbal medicine, as shown in Fig.  1 . More also, the research category and organisations which enhanced the research productivity over the years were manually retrieved, while the quality of publication was assessed by calculating author’s or journal’s H-index (Fassin and Rousseau 2019 ; Garfield et al. 2006 ). The Journals’ impact factor (IF) for the year 2020 was also considered for visualising analysis results by using two bibliometric visualization tools (Garfield et al. 2006 ).

The inclusion and exclusion process on traditional herbal medicine related-publications

Data analysis analysis

Bibliometric data were presented using descriptive mapping analysis via VOSviewer, while Var1.6.6 was used for developing, constructing and viewing the bibliometric maps analysis by the unit of co-occurrence analysis, co-citation and bibliographic coupling to examine the length (L) or total length strength (TLS) occurrences or reports between authors, keywords in the titles, abstracts, organizations and countries within the distributed clusters (van Eck and Waltman 2010 ). Also, bibliometrix and a R package were used to perform the comprehensive bibliometric science mapping analysis (Dervis 2019 ).

Basic characteristics of global publication analysis

In total, 10,163 articles met the criteria of articles published during year 1909 to 2021. It was observed that there was an annual increase in the number of publications after the year 1990 (Fig.  2 ). Of the 10,163 publications, an average of 15.09 citations per documents were found in 2552 Journals, which involved 22,071 authors with 2.34 Collaboration Index (CI) (Table 1 ).

Year-wise distribution of number of publications, 1905–2021

Analysis of 10 top highly-cited documents

The recognition of a document on traditional herbal medicine can be reflected by the number of times it is cited, as presented in Table 2 , on the descriptive analysis of the top 10 articles that have been published on the domain per citation during the years of investigation. An article titled “TCMSP: a database of systems pharmacology for drug discovery from herbal medicines” which was published in the Journal of Cheminformatics by Ru JL et al. (Ru et al. 2014 ) received the top-ranked cited article with 1346 citations and 149.5556 Total Citations Per Year. This was followed by the article “Some traditional herbal medicines, some mycotoxins, naphthalene and styrene, published with World Health Organization International Agency for Research On Cancer (WHO–IARC 2002 ) which received 774 citations and 36.8571 Total Citations Per Year (Table 2 ).

Journal analysis and quality of the publication

A total of 2552 journals were involved in the publication of traditional herbal medicine researches indexed in the Scopus database. The analysis revealed that the Journal of “Evidence-based Complementary and Alternative Medicine” was the topmost productive journal (h_index = 32, TNP = 401), followed by Journal of Ethnopharmacology (h_index = 57, TNP = 359) and then Chinese Journal of Integrative Medicine (h_index = 18, TNP = 253) as presented in Table 3 .

Evaluation of scientific research by geographical area

In the evaluation of the scientific output based on geographical area, it was found that ninety-four (94) Corresponding Author's Countries contributed to the traditional herbal medicine-based published works, out of which only the top 10 most productive countries were listed in Table 4 . People’s Republic of China was revealed to be the most productive (TNP = 4585), followed by the Japan (TNP = 730), India (TNP = 485), USA (TNP = 479) and Korea (TNP = 339), respectively. Meanwhile, the highly cited countries revealed that China is the topmost with reported 67,287 citations at an average citation of 14.675, followed by Japan with 14,372 citations at an average of 19.688 citations and then United States of America with 13,011 at an average of 27.163 citations, while Germany (3163 citations at an average of 27.991 citations) and Iran (1848 citations at an average of 9.625 citations) are coming from the rear back, on traditional herbal medicine-based researches published during the study period.

Authors productivity and co-authorship analysis

On the authors’ productivity, a total of 22,071 authors have been revealed to have contributed to traditional herbal medicine publications within the study period. The analysis of the top 10 authors shows that Yiling Wang from Shanghai Institute of Drug Control, Shanghai, China has the highest contribution with 303 published articles and an H_index of 39, followed by Zhang Y of Yunan University of Chinese Medicine College with 228 published documents and an H_index of 27, among other reported authors, as given in Table 5 .

Top subject areas and funding sponsors for research on traditional herbal medicine

In order to analyse the key subject areas in relation to traditional herbal medicine, most of published articles were indexed in field of Medicine (6005; 38.0%), Pharmacology, Toxicology and Pharmaceutics (2607; 16.5%), Biochemistry, Genetics and Molecular Biology (1885; 11.9%), Chemistry (1341; 8.5%), Agricultural and Biological Sciences (552; 3.5%), Nursing (343; 2.2%), Immunology and Microbiology (337; 2.1%), Chemical Engineering (320; 2.0%), Environmental Science (277; 1.8%), Health Professions (273; 1.7%), amongst other subject areas (Fig.  3 ). Moreover, majority of research fundings emanated form National Natural Science Foundation of China, National Key Research and Development Program of China, and Ministry of Science and Technology of the People's Republic of China. Furthermore, Beijing University of Chinese Medicine, China Academy of Chinese Medical Sciences, China Medical University, and Shanghai University of Traditional Chinese Medicine were amongst the top listed affiliations (Table 6 ).

Subject area on traditional herbal medicine

Co-occurrence analysis

The network visualization of co-occurrence indicates the frequency number of a keyword that appeared to determine the hot topics, while the color of each point on the map represents the density of the term over the past years, and the color represents the cluster. Also, the lines between the items represent the links. All Keywords (the minimum number of occurrences of keyword with over 300) were selected, as only 81 Keywords met the threshold and were included in the network analyses, which show different occurrences of the topic as organized into three (3) clusters with links and total link strength given between the keywords (L = 3118, TLS = 521,963), as shown in (Fig.  4 A).

A Co-occurrence of Keyword Plus analysis ( A ). B Co-author networks analysis among organizations C Co-author networks analysis among countries

Co-author networks analysis among authors, organizations, and countries or regions

Based on a threshold of 10, the minimum number of documents for an author was selected, yielding a total of 47 organizations (Fig.  4 B), which were thereafter organized into 5 distinct groups/clusters with links and total links strength (L = 77, TLS = 346), while countries were organized into 7 clusters with links and total links strength (L = 420, TLS = 2285), as shown in Fig.  4 C.

Bibliometrics has played a significant role in influencing policymaking as well as presenting a better understanding of scientific fields (Akintunde et al. 2021 ; Onasanya et al. 2022 ). The data for this study were retrieved from Scopus because the database provides different h_index ratings for authors who will need them to track citations and determine the impact of their publications (Musa et al. 2021c ). The total number of traditional herbal medicine related-publications has been increasing annually since the year 1990, as traditional herbal medicine has gained attractive attention due to easy accessibility, affordability, safety, promising efficacy, and being environmentally bening (Musa et al. 2021d ; Shahrajabian et al. 2019 ). Their essential roles in public health have led many people of different nationalities to rely on traditional herbal medicince (Soleymani and Shahrajabian 2018 ), as many herbs and plants included in several traditional systems have promising bioactive compounds for modern drug therapy (Shahrajabian et al. 2020 ) (Fig.  5 ).

Prisma flow diagram of the inclusion and exclusion process of the on traditional herbal medicine related-publications

The recognition of a document on traditional herbal medicine can be reflected by the number of times it is cited as presented in Scopus and other databases. “TCMSP: a database of systems pharmacology for drug discovery from herbal medicines” (Ru et al. 2014 ) and “Some Traditional Herbal Medicines, Some Mycotoxins, Naphthalene and Styrene” (WHO–IARC 2002 ) were reported to have being the most influential documents, with the highest number of total citations, as the research of J. Ru and coworkers (Ru et al. 2014 ) focussed on drug discovery from herbal medicines.

The analysis of journals based on h_index, total citations, number of documents, and Journal impact factors for the year 2021, revealed that Evidence-Based Complementary and Alternative Medicine, Journal of Ethnopharmacology and Chinese Journal of Integrative Medicine were the topmost ranked journals, based on their total number of publications, total citations and h_index, as these journals are more concentrated in traditional herbal medicines.

Also, the total number of traditional herbal medicine-focused publications generated 94 countries, with China, Japan, India and the USA being the topmost ranked countries in that order. This is in addition to the top 10 most productive authors coming only from China. This is of no coincidence as China is a reservoir of various high-valued medicinal plants, which have been used in the cosmetics, nutraceutical and pharmaceutical industries (Sun and Shahrajabian 2020 ). Increasing the research productivity in China is an indicator of the previous published reports that highlighted that herbal medicine is an essential part of traditional medicine which is part of Chinese culture. Moreso, traditional herbal medicine has been in practise in China for thousands of years (Fabricant and Farnsworth 2001 ). Due to the importance of traditional chinese herbal medicine in Chinese culture, Beijing University of Chinese Medicine and the Chinese Academy of Chinese Medical Sciences were the highest ranked in Organizations-enhanced traditional herbal medicine researches, as the top ten affiliations based on traditional herbal medicines were mainly Chinese domiciled, while the other developing countries are still lagging in conventional herbal medicine research productivity, although most developing countries depend on conventional herbal medicine to treat many diseases (Sen and Chakraborty 2017 ). The lagging in traditional herbal medicine-based researches in most developing countries could be attributed to fewer funding agencies that support scientific researches with grants. The results further revealed that the top ranking authors were Yiling Wang, Zhang Y, Yan-Da Li and Jong-Jing Wang, while Beijing University of Chinese Medicine, Chinese Academy of Chinese Medical Science, China Medical University and Shanghai University of Traditional Chinese Medicine, all based in China, were top ranking organizations. Furthermore, the cooperation networks facilitated by the creation of a database for storing a large portion of the data and their transformation into valuable information , has effectively contributed to the progress of the traditional medicine information system (Noraziah et al. 2011 ). Noteworthy, China’s Comprehensive Herbal Medicine Information System for Cancer has served as an appropriate information resource for traditional medicine researchers (Fang et al. 2005 ), while Web-based Decision Support System for Prescription in Herbal Medicine could play a significant role in controlling the quality of the herbal drugs prescriptions. Also, developed for consulting with the patients in the e-health system, e-health Record System in Australia has successfully assisted traditional medicine practitioners in the treatment management (Bjering et al. 2011 ). Although, there are some limitations as we have only included documents published in English language, while only one database, Scopus was used even though other databases such as Web of Sciences (WoS), Embase, PubMed, and Google scholar have also contributed extensively in the coverage of traditional herbal medicine researches.

Conclusions

The current study is the first bibliometric analysis of traditional herbal medicine scientific researches and publications. The study has shown an increasing publishing trend in recent years, in addition to identifying the global patterns of research, which serves as a tool in supporting the decisions and policies in traditional medicine. However, there is a need to increase research activities and international collaborations, particularly in developing countries as the present world system has been pushing for green and natural products rather than the synthetic ones.

Akintunde TY, Musa TH, Musa HH, Musa IH, Chen S, Ibrahim E, Tassang AE, Helmy MSEDM (2021) Bibliometric analysis of global scientific literature on effects of COVID-19 pandemic on mental health. Asian J Psychiatr 63:102753. https://doi.org/10.1016/j.ajp.2021.102753

Article   PubMed   PubMed Central   Google Scholar  

Aydin A, Aktay G, Yesilada E (2016) A guidance manual for the toxicity assessment of traditional herbal medicines. Nat Prod Commun 11:1763–1773. https://doi.org/10.1177/1934578x1601101131

Article   CAS   Google Scholar  

Basu T, Mallik A, Mandal N (2017) Evolving importance of anticancer research using herbal medicine: a scientometric analysis. Scientometrics. https://doi.org/10.1007/s11192-016-2223-8

Article   Google Scholar  

Bjering H, Ginige A, Maeder A, Bensoussan A (2011) Electronic medical record information system for patient consultations in chinese medicine. Stud Health Technol Inform 168:10–15. https://doi.org/10.3233/978-1-60750-791-8-10

Article   PubMed   Google Scholar  

Dai YK, Wu YB, Wen H, Li RL, Chen WJ, Tang C, Lu L, Hu L (2020) Different traditional herbal medicines for the treatment of gastroesophageal reflux disease in adults. Front Pharmacol. https://doi.org/10.3389/fphar.2020.00884

Dervis H (2019) Bibliometric analysis using bibliometrix an R package. J Scientometr Res. https://doi.org/10.5530/JSCIRES.8.3.32

Dol J, Campbell-Yeo M, Dennis C-L, Leahy-Warren P (2021) Bibliometric analysis of parental anxiety and postpartum depression across the perinatal period from 1920–2022: a protocol. medRxiv 10:1–12. https://doi.org/10.1101/2021.05.08.21256829

Du J, Tang XL (2014) Natural products against cancer: A comprehensive bibliometric study of the research projects, publications, patents and drugs. J Cancer Res Ther. https://doi.org/10.4103/0973-1482.139750

Fabricant DS, Farnsworth NR (2001) The value of plants used in traditional medicine for drug discovery. Environ Health Perspect 109:69–75. https://doi.org/10.1289/ehp.01109s169

Article   CAS   PubMed   PubMed Central   Google Scholar  

Fang X, Shao L, Zhang H, Wang S (2005) CHMIS-C: a comprehensive herbal medicine information system for cancer. J Med Chem 48:1481–1488. https://doi.org/10.1021/jm049838d

Article   CAS   PubMed   Google Scholar  

Fassin Y, Rousseau R (2019) The h Index of academic journals. Malaysian J Libr Inf Sci 24:41–53. https://doi.org/10.22452/mjlis.vol24no2.3

Garfield E, Paris SW, Stock WG (2006) HistCite TM : a software tool for informetric analysis of citation linkage. Information-wiss. und Prax.

Hostettmann K, Marston A, Ndjoko K, Wolfender J-L (2000) The potential of African plants as a source of drugs. Curr Org Chem 4:973–1010. https://doi.org/10.2174/1385272003375923

Huang Y, Deng Q, Zhang J, Sajid A, Shang X, Zhou M (2016) A bibliometric study on Chinese herbal medicine treatment of cardiovascular diseases. African J Tradit Complement Altern Med 13:33. https://doi.org/10.4314/ajtcam.v13i1.5

Kim W, Lee WB, Lee J, Min BI, Lee H, Cho SH (2015) Traditional herbal medicine as adjunctive therapy for nasopharyngeal cancer: A systematic review and meta-analysis. Integr Cancer Ther 14:212–220. https://doi.org/10.1177/1534735415572881

Kutalek R, Prinz A (2005) African medicinal plants. Handbook of medicinal plants. CRC Press, Boca Raton, pp 97–124. https://doi.org/10.1201/9781482278026-5

Chapter   Google Scholar  

Lee YK, Bae K, Yoo HS, Cho SH (2018) Benefit of adjuvant traditional herbal medicine with chemotherapy for resectable gastric cancer. Integr Cancer Ther 17:619–627. https://doi.org/10.1177/1534735417753542

Lee WY, Lee CY, Kim YS, Kim CE (2019) The methodological trends of traditional herbal medicine employing network pharmacology. Biomolecules. https://doi.org/10.3390/biom9080362

Maroyi, A., Cheikhyoussef, A., 2015. A comparative study of medicinal plants used in rural areas of Namibia and Zimbabwe. Indian J. Tradit. Knowl.

Musa HH, El-Sharief M, Musa IH, Musa TH, Akintunde TY (2021a) Global scientific research output on sickle cell disease: a comprehensive bibliometric analysis of web of science publication. Sci African 12:e00774. https://doi.org/10.1016/j.sciaf.2021.e00774

Musa HH, Musa TH, Musa IH, Musa IH (2021b) Global scientific research progress in mycetoma: a bibliometric analysis. Trans R Soc Trop Med Hyg. https://doi.org/10.1093/trstmh/trab072

Musa TH, Akintunde TY, Gatasi G, Ghimire U, Kawuki J, Musa HH (2021c) A bibliometric analysis of the 100 top-cited articles on global malnutrition indexed in Web of Science. J Public Health Emerg 5:36–36. https://doi.org/10.21037/jphe-21-38

Musa TH, Musa IH, Osman W, Campbell MC, Musa HH (2021d) A bibliometric analysis of global scientific research output on Gum Arabic. Bioact Carbohydr Diet Fibre 25:100254. https://doi.org/10.1016/j.bcdf.2020.100254

Noraziah A, Abdella AN, Hamid RA, Sidek RM, Omardin A (2011) Empirical study on medicinal herbs information system (MHIS) in Malaysia. African J Bus Manag 5:5292–5296. https://doi.org/10.5897/AJBM11.149

Onasanya AK, Akintunde TY, Oderinde OK, Shonekan OO, Bankole IS, Musa HH, Musa TH (2022) Research productivity and mapping on neem: a bibliometric analytical approach indexed in web of sciences. Trop J Nat Prod Res 6:123–132. https://doi.org/10.26538/tjnpr/v6i1.20

Qi F, Li A, Inagaki Y, Gao J, Li J, Kokudo N, Li XK, Tang W (2010) Chinese herbal medicines as adjuvant treatment during chemoor radio-therapy for cancer. Biosci Trends 4:297–307

PubMed   Google Scholar  

Ru J, Li P, Wang J, Zhou W, Li B, Huang C, Li P, Guo Z, Tao W, Yang Y, Xu X, Li Y, Wang Y, Yang L (2014) TCMSP: a database of systems pharmacology for drug discovery from herbal medicines. J Cheminform 6:13. https://doi.org/10.1186/1758-2946-6-13

Sen S, Chakraborty R (2017) Revival, modernization and integration of Indian traditional herbal medicine in clinical practice: Importance, challenges and future. J Tradit Complement Med 7:234–244. https://doi.org/10.1016/j.jtcme.2016.05.006

Shahrajabian MH, Sun W, Cheng Q (2019) A review of Ginseng species in different regions as a multipurpose herb in traditional Chinese medicine, modern herbology and pharmacological science. J Med Plants Res 13:213–226. https://doi.org/10.5897/JMPR2019.6731

Shahrajabian MH, Sun W, Cheng Q (2020) Traditional herbal medicine for the prevention and treatment of cold and flu in the autumn of 2020, overlapped With COVID-19. Nat Prod Commun 15:1934578X2095143. https://doi.org/10.1177/1934578X20951431

Shahrajabian MH, Sun W, Soleymani A, Cheng Q (2021) Traditional herbal medicines to overcome stress, anxiety and improve mental health in outbreaks of human coronaviruses. Phyther Res 35:1237–1247. https://doi.org/10.1002/ptr.6888

Soleymani A, Shahrajabian MH (2018) Changes in germination and seedling growth of different cultivars of cumin to drought stress. Cercet Agron Mold. https://doi.org/10.2478/cerce-2018-0008

Sun W, Shahrajabian MH (2020) Adaptation of acupuncture and traditional chinese herbal medicines models because of climate change. J Stress Physiol Biochem 16:85–90

Google Scholar  

van Eck NJ, Waltman L (2010) Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics. https://doi.org/10.1007/s11192-009-0146-3

Wang C, Meng Q (2021) Global research trends of herbal medicine for pain in three decades (1990–2019): a bibliometric analysis. J Pain Res. https://doi.org/10.2147/JPR.S311311

WHO-IARC (2002) Some Traditional herbal medicines, some mycotoxins, naphthalene and styrene, IARC monographs on the evaluation of carcinogenic risks to humans. Lyon

Yu S, Wang J, Shen H (2020) Network pharmacology-based analysis of the role of traditional Chinese herbal medicines in the treatment of COVID-19. Ann Palliat Med 9:437–446. https://doi.org/10.21037/apm.2020.03.27

Zhai XF, Liu XL, Shen F, Fan J, Ling CQ (2018) Traditional herbal medicine prevents postoperative recurrence of small hepatocellular carcinoma: a randomized controlled study. Cancer 124:2161–2168. https://doi.org/10.1002/cncr.30915

Download references

Acknowledgements

The authors acknowledge the support of the Biomedical Research Institute, Darfur College, Nyala, Sudan, while also appreciating the research innovation of The Organization of African Academic Doctors (OAAD), Nairobi, Kenya for enhancing research collaboration and innovations in Africa.

The research has received no internal or external funding for this work.

Author information

Authors and affiliations.

Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan

Hassan Hussein Musa

Biomedical Research Institute, Darfur University College, Nyala, Sudan

Hassan Hussein Musa & Taha Hussein Musa

Key Laboratory of Environmental Medicine Engineering, Department of Epidemiology and Health Statistics, School of Public Health, Ministry of Education, Southeast University, Nanjing, 210009, China

Taha Hussein Musa

Department of Chemical Sciences (Chemistry Unit), Faculty of Natural and Applied Sciences, Lead City University, Ibadan, Nigeria

Olayinka Oderinde

School of Medicine, Darfur University College, Nyala, Sudan

Idris Hussein Musa

Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Lagos, Lagos, Nigeria

Omonike Olatokunbo Shonekan

Department of Sociology, School of Public Administration, Hohai University, Nanjing, China

Tosin Yinka Akintunde

Forestry Research Institute of Nigeria (FRIN), Jericho, PMB 5054, Ibadan, Nigeria

Abimbola Kofoworola Onasanya

You can also search for this author in PubMed   Google Scholar

Corresponding authors

Correspondence to Hassan Hussein Musa or Olayinka Oderinde .

Ethics declarations

Ethical approval.

This article does not contain any studies involving animals performed by any of the authors. This article does not contain any studies involving human participants performed by any of the authors.

Conflict of interest

Hassan Hussein Musa has no conflict of interest. Taha Hussein Musa has no conflict of interest. Olayinka Oderinde has no conflict of interest. Idris Hussein Musa has no conflict of interest. Omonike Olatokunbo Shonekan has no conflict of interest. Tosin Yinka Akintunde has no conflict of interest. Abimbola Kofoworola Onasanya has no conflict of interest.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (XLSX 17 kb)

Rights and permissions.

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Musa, H.H., Musa, T.H., Oderinde, O. et al. Traditional herbal medicine: overview of research indexed in the scopus database. ADV TRADIT MED (ADTM) 23 , 1173–1183 (2023). https://doi.org/10.1007/s13596-022-00670-2

Download citation

Received : 15 April 2022

Accepted : 13 October 2022

Published : 28 October 2022

Issue Date : December 2023

DOI : https://doi.org/10.1007/s13596-022-00670-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Traditional herbal medicine
• Bibliometric analysis
• Research productivity
• Find a journal
• Publish with us
• Track your research

• Frontiers in Pharmacology
• Ethnopharmacology
• Research Topics

Herbal Remedies and Phytochemicals: Focus on Safety and Toxicological Evaluation

Total Downloads

Total Views and Downloads

About this Research Topic

The use of plants with medicinal properties evolved with man based on the fact that a sound health is essential for survival propelled by day-to-day activities. Man overtime identified useful plants and employed such in the treatment of diverse debilitating conditions. Such folkloric uses of plants were ...

Important Note : All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Topic Editors

Topic coordinators, recent articles, submission deadlines.

Submission closed.

Participating Journals

Total views.

• Demographics

No records found

total views article views downloads topic views

Top countries

Top referring sites, about frontiers research topics.

With their unique mixes of varied contributions from Original Research to Review Articles, Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area! Find out more on how to host your own Frontiers Research Topic or contribute to one as an author.

Herbal medicine today: clinical and research issues

Affiliation.

• 1 Center of Natural Medicine, S.Giuseppe Hospital, Empoli, Italy.
• PMID: 18227931
• PMCID: PMC2206236
• DOI: 10.1093/ecam/nem096

HERBAL MEDICINE IS THE USE OF MEDICINAL PLANTS FOR PREVENTION AND TREATMENT OF DISEASES: it ranges from traditional and popular medicines of every country to the use of standardized and tritated herbal extracts. Generally cultural rootedness enduring and widespread use in a Traditional Medical System may indicate safety, but not efficacy of treatments, especially in herbal medicine where tradition is almost completely based on remedies containing active principles at very low and ultra low concentrations, or relying on magical-energetic principles.In the age of globalization and of the so-called 'plate world', assessing the 'transferability' of treatments between different cultures is not a relevant goal for clinical research, while are the assessment of efficacy and safety that should be based on the regular patterns of mainstream clinical medicine.The other black box of herbal-based treatments is the lack of definite and complete information about the composition of extracts. Herbal derived remedies need a powerful and deep assessment of their pharmacological qualities and safety that actually can be realized by new biologic technologies like pharmacogenomic, metabolomic and microarray methology. Because of the large and growing use of natural derived substances in all over the world, it is not wise to rely also on the tradition or supposed millenarian beliefs; explanatory and pragmatic studies are useful and should be considered complementary in the acquisition of reliable data both for health caregiver and patients.

Keywords: evidence based medicince; explanatory trials; herbal medicine; mainstream medicine; phytotherapy; pragmatic trials; traditional medical system; traditional medicine.

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• For authors
• Browse by collection
• BMJ Journals More You are viewing from: Google Indexer

You are here

• Volume 8, Issue 10
• Effectiveness and safety of herbal medicines for induction of labour: a systematic review and meta-analysis
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• http://orcid.org/0000-0003-2490-0815 Collins Zamawe 1 ,
• http://orcid.org/0000-0002-6885-6716 Carina King 1 ,
• Hannah Maria Jennings 1 ,
• Chrispin Mandiwa 2 ,
• Edward Fottrell 1
• 1 Faculty of Population Health Sciences, Institute for Global Health , University College London , London , UK
• 2 School of Public Health, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , China
• Correspondence to Collins Zamawe; c.zamawe{at}ucl.ac.uk

Objective The use of herbal medicines for induction of labour (IOL) is common globally and yet its effects are not well understood. We assessed the efficacy and safety of herbal medicines for IOL.

Design Systematic review and meta-analysis of published literature.

Data sources We searched in MEDLINE, AMED and CINAHL in April 2017, updated in June 2018.

Eligibility criteria We considered experimental and non-experimental studies that compared relevant pregnancy outcomes between users and non-user of herbal medicines for IOL.

Data extraction and synthesis Data were extracted by two reviewers using a standardised form. A random-effects model was used to synthesise effects sizes and heterogeneity was explored through I 2 statistic. The risk of bias was assessed using ‘John Hopkins Nursing School Critical Appraisal Tool’ and ‘Cochrane Risk of Bias Tool’.

Results A total of 1421 papers were identified through the searches, but only 10 were retained after eligibility and risk of bias assessments. The users of herbal medicine for IOL were significantly more likely to give birth within 24 hours than non-users (Risk Ratio (RR) 4.48; 95% CI 1.75 to 11.44). No significant difference in the incidence of caesarean section (RR 1.19; 95% CI 0.76 to 1.86), assisted vaginal delivery (RR 0.73; 95% CI 0.47 to 1.14), haemorrhage (RR 0.84; 95% CI 0.44 to 1.60), meconium-stained liquor (RR 1.20; 95% CI 0.65 to 2.23) and admission to nursery (RR 1.08; 95% CI 0.49 to 2.38) was found between users and non-users of herbal medicines for IOL.

Conclusions The findings suggest that herbal medicines for IOL are effective, but there is inconclusive evidence of safety due to lack of good quality data. Thus, the use of herbal medicines for IOL should be avoided until safety issues are clarified. More studies are recommended to establish the safety of herbal medicines.

• herbal medicine
• induction of labour
• pregnancy outcomes
• complementary and alternative medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2018-022499

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Strengths and limitations of this study

Due to safety and ethical reasons, herbal medicines for pregnant women are rarely evaluated through randomised controlled/clinical trials (RCTs). Nonetheless, most of the reviews of herbal medicines during pregnancy are restricted to RCTs. The present review included non-experimental studies to assess a wider evidence base.

No restrictions were applied on the date of publication, location, study design and types of treatment (herbal medicine used).

There is lack of data on key outcomes (eg, maternal death and sepsis) and from low-income countries.

Some analyses did not have sufficient statistical power due to the inadequate number of studies and small sample sizes.

Introduction

Across the world, the use of unconventional or traditional medical therapies is very high. 1–4 These non-biomedical remedies are together referred to as complementary and alternative medicines (CAMs). WHO recognises the role of CAM of verified quality, safety and efficacy in ensuring universal access to healthcare. 5 As such, for the period between 2014 and 2023, WHO traditional medicine strategy focuses on harnessing the potential contribution of CAM in healthcare and promoting its safe and effective use. 5 Although this requires rigorous evidence on safety and efficacy of CAM, research in this area remains limited. 5 Herbal medicine or medicinal plant is one of the well-known CAM therapies that involve the use of plants or plant extracts for therapeutic motives. 6 As in the general population, the use of herbal medicines is common among pregnant women globally. 7–10 The estimated prevalence varies between regions and countries but ranges from 10% to 80%. 11 12 One of the common indications for herbal medicine use during pregnancy is prolonged labour or merely the desire to induce or augment labour for different reasons. 13 14 This practice is well documented and transcends cultural and generational boundaries. 14

From a medical perspective, induction of labour (IOL) changes the physiological processes associated with childbirth in ways that may increase the risk of adverse pregnancy outcomes such as neonatal mortality, fetal distress, premature birth, haemorrhage, uterine rupture and caesarean section. 15–17 Because of this, WHO recommends that labour should only be induced in health facilities with the capacity for continual monitoring and emergency obstetric care. 18 The emphasis on facility-based IOL and close monitoring of pregnant women demonstrates the risks associated with the procedure. Nonetheless, with herbal medicine-induced labour, monitoring of women is often out of the question due to self-prescription. 2 19 So, the use of herbal medicines for IOL is likely to be riskier and it is plausibly an important factor influencing adverse pregnancy outcomes in settings where its use is common.

In vitro studies have confirmed that some of the herbal medicines used during pregnancy have oxytocic properties. 13 20 For instance, a study in Nigeria found that several plants that are used to facilitate childbirth in the country significantly induced muscle cell contractility. 13 However, safety is the main concern as many of the herbal medicines are believed to be poisonous and may contribute to maternal and neonatal mortality as well as morbidity. 21 22 To date, there is mixed evidence from population-based studies regarding the efficacy and safety of herbal medicines for IOL 23–25 and yet available data have not been systematically evaluated and synthesised to provide the rigorous evidence necessary to inform decisions. Lack of high quality and consistent data on efficacy and safety of herbal medicines makes recommendations and regulations challenging. 5 Consequently, we conducted a systematic review to explore the effectiveness and safety of herbal medicines for IOL. This review is important to inform the development of guidelines relating to the use of herbal medicines among pregnant women.

This is a systematic review and meta-analysis of published literature on effectiveness and safety of herbal medicines for IOL. The reporting of the abstract (online supplementary file S1 ) and results (online supplementary file S2 ) are guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses . 26

Supplementary material 1

Supplementary material 2, data sources and searches.

We searched in MEDLINE, AMED and CINAHL from 13 February to 22 April 2017 and repeated this on 22 June 2018 using key terms such as herbal medicine, labour and pregnancy outcomes, which were modified in accordance with each database (online supplementary file S3 ). More papers were identified through scanning the reference list of studies found through the initial search as well as direct searches in the following journals: African Journals Online, Journal for Herbal Medicine, BMC Complementary and Alternative Medicine, Journal of Alternative and Complementary Medicine and Journal of Integrative Medicine.

Supplementary material 3

Inclusion/exclusion criteria.

The inclusion criteria were based on participant, intervention, control, outcomes and studies. We considered studies with pregnant or postpartum women as participants. The treatment or exposure was herbal medicines for induction or shortening of labour. For studies that did not explicitly indicate the reasons for use, the name of the medicine was used to determine if IOL was the possible motive. There was no restriction on dosage, but the route of administration was oral. The plants could be either processed or crude and used alone or alongside conventional medicines. An appropriate comparison group comprised either pregnant women who did not use the herbal medicine under consideration or used biomedical drugs exclusively. The maternal outcomes were haemorrhage, sepsis, caesarean section, uterine rupture, assisted vaginal delivery and maternal death; while the neonatal outcomes were stillbirth, premature birth, neonatal mortality, meconium-stained liquor (MSL)/fetal distress, birth defects and referral to neonatal intensive care unit (also known as nursery).

Due to ethical, safety  and methodological issues, pregnant women are often excluded from randomised controlled/clinical trials (RCTs) and herbal medicines may not be evaluated through RCTs. 27–29 Thus, observational studies are a common source of literature for efficacy and safety of herbal medicines in pregnancy. Accordingly, we considered both experimental and non-experimental study designs. In particular, the following study designs were eligible for inclusion: RCTs, quasi-experimental, cohort, case–control and cross-sectional. We only considered studies published in English or in other languages, but with a detailed English abstract. No restrictions were applied on the date of publication and study setting.

Data extraction

A data extraction form (online supplementary file S4 ) was developed specifically for this review based on templates developed by the Joanna Briggs Institute and the Cochrane Pregnancy and Childbirth Group. 30 31 The form included specific details about the study design, participants, setting, intervention/exposure, control and outcomes. Owing to the focus of our study (ie, efficacy and safety), ‘per protocol’ treatment effects were preferred in RCTs. 32 As none of the observational studies reported adjusted effect estimates, crude data were extracted and used in this review. Two reviewers—CZ and CM—separately extracted the data and any differences were resolved by discussion.

Supplementary material 4

Quality/risk of bias assessment.

Two different tools were used to assess the risk of bias in experimental and non-experimental studies that met the inclusion criteria. CZ and CM independently performed the risk of bias assessment and any disagreements were resolved by discussion. For experimental studies, Cochrane Risk of Bias tool for the RCTs 33 was used and the following domains were assessed: random sequence generation, allocation concealment, blinding of participants, blinding of outcome assessment, incomplete outcome data, selective reporting and other biases (online supplementary file S5 ). Only abstracts were available in English for two studies 25 34 and hence their risk of bias is largely unclear. The overall risk of bias for the other RCTs is low.

Supplementary material 5

The risk of bias for non-experimental studies was assessed using a standardised critical appraisal tool developed by ‘John Hopkins Nursing School’. 35 This tool divides the strength of research evidence into five levels based on the study design. The RCTs occupy the top level (level I) followed by quasi-experimental studies (level II) and other non-experimental studies (level III). The last two levels are for opinion-related papers either based on research evidence (level IV) or individual expertise (level V). The quality of evidence is further graded as high (A), good (B) and low quality or major flaws (C) depending on the risk of bias and scientific basis for the conclusions. Based on this tool, a list of 10 questions (or domains) was developed to guide the assessment (online supplementary file S6 ). Since the review used crude data, the need to control extraneous variables and whether this was done (if required) were key factors in determining the study grade. For instance, grade C was given to studies in which the treatment and control groups were not comparable and confounders were not adjusted for. Two studies 23 36 received a grade of C and were eventually excluded from the review.

Supplementary material 6

Data analysis.

Meta-analyses were performed to compare the onset of labour (effectiveness) and the incidence of adverse pregnancy outcomes (safety) between the users and non-users of herbal medicines for IOL. As variations were expected between studies due to the differences in setting, design and types of herbal medicines, a random-effects model was used to synthesise effects sizes of the studies. 37 Heterogeneity was explored through the I 2 statistic and meta-analysis was conducted regardless of the outcome as random-effects model accommodates statistical heterogeneity. 38 Subject to availability of the sufficient number of studies, subgroup analyses were conducted based on the type of treatment/exposure or study design to explain observed heterogeneity. Potential publication bias was assessed using Egger’s test since all analyses had less than 10 studies to use a funnel plot method. 39 40 Summary effects were measured using risk ratios (RRs) and all analyses were performed using Stata/SE V.13.1 software.

Patient and public involvement

As this was a review of existing literature, we did not involve any patient and the public in the design and conduct of the study. However, the development of the review question was informed by the experiences of pregnant women as observed in the literature.

Study selection process

Searches in the three databases returned a total of 1421 papers (CINAHL=420, AMED=279 and MEDLINE=723). After removal of duplicates (n=539), the titles and/or abstracts of 882 publications were screened and 802 studies were dropped at this stage for various reasons (see figure 1 ). Full-text articles were retrieved for 80 studies for further eligibility assessment and 71 of them failed to meet the inclusion criteria. Additional potential relevant papers (n=3) were identified through direct searches in journals and reference lists. Twelve papers were appraised in the final stage and two were excluded due to poor methodological quality (see online supplementary file S6 ). Thus, 10 studies were included in this review.

• Download figure
• Open in new tab
• Download powerpoint

A PRISMA flow diagram summarising the study selection process. IOL, induction of labour; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

An overview of the included studies

Online supplementary file S7 presents the characteristics of the studies, such as location, exposure, outcomes and ratings. In brief, of the 10 studies in the review, three were conducted in Iran, two in the USA and one each in South Africa, Israel, Thailand, Australia and Italy. In relation to the World Bank’s classification of countries by income, half of the studies were conducted in high-income countries and the other half in upper-middle-income countries (UMICs). No study from low-income countries (LICs) or lower-middle-income countries (LMICs) was included.

Supplementary material 7

Three types of exposures were reported by the studies. An Australian study was concerned with exposure to raspberry leaf. 41 This is one of the common herbal remedies used during pregnancy that is believed to prepare the uterus for childbirth and thereby effectively reduce the length of labour. 14 In this study, exposure was self-reported by the participants as they were given raspberry pills by the nurses to take at home. Eight studies examined exposure to castor oil. 25 34 42–47 The oil is derived from the castor plant’s bean and is widely thought to have oxytocic properties. 44 45 In all the studies, pregnant women consumed 60 mL of castor oil, but in one study 43 the treatment was repeated in women who did not deliver within 1 week after the first dose. One study 48 assessed general exposure to herbal medicines, but there are indications in the report that they were for IOL.

Five of the included studies are RCTs and the remaining five are non-experimental, including cohort (3), case–control (1) and quasi-experimental (1) designs. The following pregnancy outcomes were reported by the included studies: onset of labour within 24 hours, caesarean section, haemorrhage, neonatal referral to nursery care, MSL, assisted vaginal delivery, stillbirth, neonatal death, maternal death and uterus rupture.

Outcome 1: onset of labour within 24 hours

Eight studies explored the onset of labour within 24 hours after the use of herbal medicine for IOL. Castor oil was the exposure or intervention in all the studies. As shown in figure 2 , herbal medicine users were significantly more likely to give birth within 24 hours than non-users (RR 3.46; 95% CI 1.58 to 7.55). In the subgroup analysis by study design, similar results were observed among experimental studies, but there was no significant difference in onset of labour between users and non-users among the non-experimental studies (online supplementary file S8 ). Publication bias was not an issue (bias 3.23; 95% CI 0.48 to 5.97), but heterogeneity was significant (I 2 =90.2%, p≤0.001) and this was likely due to variations in study design and or setting.

Supplementary material 8

The use of herbal medicines for induction of labour and onset of labour. RR, risk ratio.

Outcome 2: incidence of caesarean section

The association between herbal medicine use and occurrence of caesarean section was examined by six studies. A meta-analysis ( figure 3 ) found no significant difference in the rate of caesarean section between the users and non-users of herbal medicines (RR 1.19; 95% CI 0.76 to 1.86). Similar results were observed in subgroup analysis by type of treatment (online supplementary file S9 ) and study design (online supplementary file S10 ), except that Mabina  et al 48 (eg, any exposure), found a significant difference in the incidence of caesarean section between the study groups. Both heterogeneity (I 2 =45.6%; p=0.102) and publication bias were not significant (Bias=−0.39; 95% CI −4.47 to 3.70).

Supplementary material 9

Supplementary material 10.

The use of herbal medicines for induction of labour and the incidence of caesarean section. RR, risk ratio.

Outcome 3: incidence of assisted vaginal delivery

In this review, assisted vaginal delivery was defined as the use of medical interventions such as forceps and or episiotomy to aid delivery. This outcome was reported by five studies and a meta-analysis ( figure 4 ) found no significant difference between the users and non-users of herbal medicines (RR 0.73; 95% CI 0.47 to 1.14). Heterogeneity was significant (I 2 =74.4%; p=0.004), but publication bias was not (Bias=−1.87; 95% CI −6.12 to 2.38). Subgroup analyses by type of treatment (online supplementary file S11 ) and study design (online supplementary file S12 ) did not substantially change the results.

Supplementary material 11

Supplementary material 12.

The use of herbal medicines for induction of labour and the incidence of assisted vaginal delivery. RR, risk ratio.

Outcome 4: incidence of haemorrhage

The occurrence of haemorrhage among users and non-users of herbal medicines for IOL was assessed by four studies and a meta-analysis ( figure 5 ) shows no significant difference between the two groups (RR 0.84; 95% CI 0.44 to 1.60). These results were consistent with those in subgroup analyses by type of treatment (online supplementary file S13 ) as well as study design (online supplementary file S14 ). Heterogeneity was almost non-existent (I 2 =0.0%; p=0.802) and publication bias was not significant (Bias 0.49; 95% CI −2.73 to 3.70).

Supplementary material 13

Supplementary material 14.

The use of herbal medicines for induction of labour and the incidence of haemorrhage. RR, risk ratio.

Outcome 5: incidence of MSL

The occurrence of MSL, a strong indicator of fetal distress, 49 was reported by five studies. Overall, there is no significant difference in the rate of MSL between users and non-users of herbal medicines (RR 1.20; 95% CI 0.65 to 2.23) ( figure 6 ). Comparable results were observed in subgroup analysis by type of treatment (online supplementary file S15 ). However, in subgroup analysis by study design, the experimental studies tended to favour treatment while the non-experimental inclined towards control, but both results were not statistically significant (online supplementary file S16 ). Publication bias was not significant (Bias=−2.38; 95% CI −6.76 to 2.00), but heterogeneity was high (I 2 =77.9%; p=0.001) probably due to variations across studies.

Supplementary material 15

Supplementary material 16.

The use of herbal medicines for induction of labour and the incidence of meconium-stained liquor. RR, risk ratio.

Outcome 6: neonates’ admission to nursery

Whether a newborn child is referred to neonatal intensive care unit (also known as nursery) or not is often used as an indicator for well-being. 41 This outcome was reported by three studies and none of them individually found a significant difference in admission to nursery between users and non-users of herbal medicines for IOL. A meta-analysis ( figure 7 ) found no significant difference between the two groups (RR 1.08; 95% CI 0.49 to 2.38). Both publication bias (bias=−1.51; 95% CI −7.66 to 4.64) and heterogeneity (I 2 =0.0%; p=0.482) were not significant. Subgroup analysis was not performed due to the inadequate number of studies.

The use of herbal medicines for induction of labour and neonatal admission to nursery. RR, risk ratio.

Other outcomes

The following outcomes were either reported by a single study or there was insufficient data and hence meta-analyses were not performed: maternal death, stillbirth and uterine rupture. A single study assessed maternal death and stillbirth outcomes among users (n=205) and non-users (n=407) of castor oil to induce labour. 43 No maternal death occurred in either group, but one case of stillbirth (0.3%) was reported in the control group. Uterine rupture was reported by two studies in relation to castor oil and only one case was reported among exposed women in one of the studies. 43 47 Overall, no study found a significant difference in any of the three outcomes between users and non-users of herbal medicines for IOL.

We have found that herbal medicines for IOL are effective and there is no concrete evidence of association with adverse outcomes. On efficacy, we have found that women who used the herbal medicines were significantly more likely to give birth within 24 hours than their counterparts who did not use. This corroborates many in vitro studies around the world that have shown that some herbal medicines effectively induce uterine contractions. 13 20 50 For instance, studies in Malawi and Nigeria have established that some medicinal plants commonly prescribed by traditional healers to induce childbirth have oxytocic properties. 13 20 Previous reviews, however, found insufficient evidence for the effectiveness of herbal medicines for IOL. 51 52 This contradiction could be as a result of the differences in inclusion criteria. Most of the related reviews excluded non-experimental studies, 51 52 which are a common source of efficacy data due to safety issues surrounding RCTs for herbal medicines or pregnant women. 27 28 53 Whereas this allowed us to assess a wider evidence base than the previous reviews, we are also mindful of the biases inherent in observational studies. Therefore, a definite conclusion about the efficacy of herbal remedies for IOL cannot be put forward based on the present review. 54–56

On safety, we did not find any statistically significant difference in the rate of haemorrhage, caesarean section, assisted vaginal delivery, referral to neonatal intensive care unit, MSL, maternal death, stillborn and uterine rupture between participants in treated and control groups. The implication is that herbal medicines for IOL may not be harmful to women or neonates. This observation is consistent with the results that have been reported by other reviews on a related topic. 51 52 Notwithstanding, caution must be exercised in the interpretation of this data because in some outcomes (eg, caesarean section) the difference in the number of cases between treated and control groups was very high. This was also noted by Boltman-Binkowski 51 in her review. Despite lack of statistical significance, she argues that a higher number of adverse outcomes among women who ingested castor oil implies that the link between the two cannot be entirely dismissed. The finding may also be inconclusive owing to lack of data on key outcomes, such as maternal death, sepsis and neonatal death.

The results of this review should be considered in the context of the following limitations and biases. First, although the baseline characteristics of the observational studies were similar across study groups, not all potential confounders were measured. Likewise, of the five RCTs in this review, three were unclear on selection, performance and detection biases while two had unclear attrition, reporting and other biases. Thus, the risk of bias may have been introduced as a result of these poor methodologies. In addition, some analyses lacked adequate statistical power because of small sample sizes or the insufficient number of studies. These issues strongly suggest that the outcomes of this review be treated with considerable caution.

Second, in almost all the studies, herbal remedies were provided at the health facility and pregnant women were somewhat monitored by clinical staff. In this way, many potential adverse events may have been averted or lessened. Nevertheless, this does not entirely represent the reality of the context in which herbal medicines are taken, and thus, the results of these studies may be misleading. In sub-Saharan Africa, for instance, herbal medicines are often taken outside the health facility without the knowledge and support of healthcare providers. 12 48 57 In such situations, the risk of adverse events could be higher than reported by these studies.

Lastly, all studies in this review are from higher and UMICs. No study from a low or LMIC was included. This probably suggests lack of studies on this subject in limited-resource settings. Hence, the findings of this review cannot be extrapolated beyond higher and UMICs. Since the issue of safety of herbal medicines in pregnancy relates to maternal as well as neonatal morbidity and mortality, 22 48 58–60 which are principally the problems of LIC, 61 62 high-quality studies that include a range of maternal morbidity and mortality outcomes in LIC are urgently needed. 22 63

Conclusions and implications

The evidence from this review suggests that herbal medicines for IOL are effective, but their safety among women and neonates require further exploration. Therefore, we would not recommend the use of these medicines until all the safety concerns are adequately addressed. In the meantime, larger safety and efficacy studies with sufficient statistical power and of high methodological quality should be conducted to improve the evidence base.

Acknowledgments

We are grateful to Tim Colbourn for his technical advice on meta-analysis.

• Kyomuhendo GB
• Maimbolwa MC ,
• Diwan V , et al
• Nordeng H , et al
• Westfall RE
• 5. ↵ World Health Organisation . WHO Traditional Medicine Strategy . Geneva 2014 .
• 6. ↵ World Health Organisation . Guidelines on Developing Consumer Information on Proper Use of Traditional, Complementary and Alternative Medicine . Geneva : World Health Organisation , 2004 .
• Al-Ramahi R ,
• Jaradat N ,
• Chuang CH ,
• Hsieh WS , et al
• Frawley J ,
• Steel A , et al
• Laelago T ,
• Yohannes T ,
• Ali-Shtayeh MS ,
• Jamous RM ,
• Mureyi DD ,
• Monera TG ,
• O’Brien M ,
• Koehbach J , et al
• McKenna LG ,
• Griffiths DL
• Guerra GV ,
• Cecatti JG ,
• Souza JP , et al
• 18. ↵ World Health Organization . WHO recommendations for Induction of Labour . Geneva 2011 .
• Nsabimana D , et al
• Bullough CH ,
• Furman KI ,
• Bullough CH
• Lamadah S ,
• Mohamed H ,
• Ouyang W , et al
• Abedzadeh M ,
• Sadat Z , et al
• Liberati A ,
• Altman DG ,
• Tetzlaff J , et al
• Saint-Victor DS ,
• Isaacs MB , et al
• Merkatz RB ,
• Sobel S , et al
• Parveen A ,
• Parveen B ,
• Parveen R , et al
• 30. ↵ Cochrane Pregnancy and Childbirth Group , 2017 . Author resources for NEW REVIEWS: The Cochrane Collaboration http://pregnancy.cochrane.org/author-resources-new-reviews ( accessed 12 May 2017 ).
• 31. ↵ The Joanna Briggs Institute . Joanna Briggs Institute Reviewers’ Manual . 2014 edn . South Australia : The Joanna Briggs Institute , 2014 .
• Higgins JP ,
• Gøtzsche PC , et al
• Pirdadeh Beiranvand S ,
• Lotfalizadeh M
• Parsons M ,
• Simpson M ,
• Borenstein M ,
• Hedges LV ,
• Higgins JP , et al
• Ioannidis JP ,
• Patsopoulos NA ,
• Rothstein HR
• Higgins JPT ,
• Davey Smith G ,
• Schneider M , et al
• Greenwood J , et al
• Pirdadeh S ,
• Lotfalizadeh M , et al
• Rijken MJ , et al
• Figueroa R ,
• Guillaume J , et al
• Hochner H ,
• Savitsky B , et al
• Pignatti L , et al
• Mabina MH ,
• Pitsoe SB ,
• Fleischer A ,
• Anyaegbunam A ,
• Guidetti D , et al
• Nikolajsen T ,
• Nielsen F ,
• Rasch V , et al
• Boltman-Binkowski H
• Kavanagh J ,
• Firenzuoli F ,
• Ab Rahman A ,
• Naing L , et al
• Wang JD , et al
• Cuzzolin L ,
• Francini-Pesenti F ,
• Verlato G , et al
• Ronsmans C ,
• 62. ↵ WHO, UNICEF, UNFPA . Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division . Geveva : World Health Organization , 2015 .

Twitter @czamawe

Contributors CZ, CK, HMJ and EF conceived the review. CZ and CM conducted the literature search, appraised the papers and extracted the data. CZ performed the analysis and drafted the manuscript. CK and EF commented on drafts and provided technical input at all stages. All authors have read and approved the final manuscript.

Funding Collins Zamawe is a Commonwealth Scholar supported by the UK Government (CSC-2016-795).

Competing interests None declared.

Patient consent Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

Data sharing statement All data used in this review can be accessed from the corresponding author.

Read the full text or download the PDF:

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List

Global Research Trends of Herbal Medicine for Pain in Three Decades (1990–2019): A Bibliometric Analysis

Chennan wang.

1 School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China

Qinggang Meng

2 System Complexity Research Center of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China

The aim of this study was to explore the global research trends of herbal medicine for pain from 1990 to 2019, using bibliometric methods, and explore international collaborations, intellectual structure, the evolution of active topics, emerging trends, and research frontiers.

Articles on herbal medicine for pain were retrieved from WoSCC. Two information visualization softwares including CiteSpace and HistCite were used to process bibliographic catalogs. Identification of international collaborations, intellectual structure, the evolution of active topics, emerging trends, and research frontiers were performed based on results from bibliometric analysis.

A total of 2986 original articles published between 1990 and 2019 were identified based on the inclusion criteria. The number of publications on herbal medicine for pain in WoSCC significantly increased. China ranked highest in the number of scientific outputs; however, articles with the highest citation rates were found to be from the United States. China–Japan reported the most active collaborations, whereas Kyung Hee University from South Korea was the most productive institution. Zhang Y was the most productive author, whereas research by Sherman KJ and Vane JR had the highest influence. Journal of Ethnopharmacology was the most active journal, whereas Integrative and Complementary Medicine was the most active research area. History of herbal medicine for pain research comprises three major phases of activities. The main points of focus of bibliometric analysis of herbal medicine for pain include “knee osteoarthritis”, “cancer”, “low back pain”, etc.. Moreover, research on mechanisms of action of herbal medicine for pain remains at the forefront of this field.

This paper provides a basis for future development of research on herbal medicine for pain, which may help researchers explore new directions for future research and identify new perspectives on potential collaborations in this field.

Introduction

Pain is a significant public health concern. The Centers for Disease Control and Prevention (CDC) reports that approximately 100 million Americans – more than the number affected by cardiovascular disease, diabetes, and cancer combined – suffer from common chronic pain conditions. 1 Studies report that the prevalence of chronic pain ranges between 11% and 40%. 2 According to the CDC, 50 million adults in the United States experience chronic daily pain, with 19.6 million adults experiencing high impact chronic pain that interferes with their daily life or work activities. 3 Chronic pain is linked to numerous physical and mental conditions and contributes to high health care costs and loss of productivity. 4 In the United States, the estimated cost for pain management ranges from $560 billion to $635 billion annually. 5 , 6 Opioids are commonly prescribed drugs for chronic pain, and in the United States, the most recent national data show a fourfold increase in opioid prescriptions in the early 2000s, accompanied by an increase in opioid-related overdose and misuse. 7 , 8 In 2018, opioids were implicated in 46,802 overdose deaths in the United States (69.5% of all drug overdose deaths). 9 Gastrointestinal discomfort is the most common side effect of nonsteroidal anti-inflammatory drugs, whereas cardiovascular anomalies are common side effects of COX-2 inhibitors and they have raised serious concerns. Therefore, inadequate assessment and pain management have become public health issues. 10

Phytocompounds, used in herbal medicine for pain reduction, have gained significant attention. Herbal medicine, which is rooted in indigenous medical practices, has accumulated a great number of refined drugs through many generations of valuable experience. Extensive research shows that most herbal medicines have been used to manage pain with minimal or no side effects. 11–15 A previous evaluation reported that lipoic acid, curcumin phytosome and piperine are effective complementary therapy for complimenting conventional treatments to achieve better efficacy in reducing neuropathic pain. 16 A prospective clinical trial suggested that a Chinese herbal decoction (Xiaozhi decoction) effectively relieves postoperative pain and reduces analgesic medication after hemorrhoidectomy. 17 Recent evidence suggests that the crude methanolic root extract of C. ficifolius showed anti-nociceptive and anti-inflammatory activities. 18 Another study reports that incarvillateine (INCA), derived from the Chinese herb Incarvillea sinensis , shows potent nonopioid antinociceptive action mediated predominantly through A3AR – adenosine 3 receptor action. 19

Bibliometrics is a quantitative analysis method that utilizes scientific literature to identify intellectual structures, active topics and emerging trends of a specific domain. 20 This study used a bibliometric approach to track the advances in collective knowledge of herbal medicine for pain management with promising results that present an objective and comprehensive overall picture of research outputs and identify new perspectives on potential collaborations in this field. In this study, existing achievements of herbal medicine for pain were explored. Studies related to herbal medicine for pain published from 1990 to 2019 were retrieved from the Web of Science Core Collection (WoSCC), using the topic search. CiteSpace 21–23 and HistCite 24 , 25 are information visualization softwares that are widely used to visualize and process bibliographic catalogs. Various types of indicators and multiple bibliometric methods were used to assess performance and other characteristics, including countries, institutions, authors, journals, research areas, references and keywords. In addition, bibliometric analysis was used for identification of international collaborations, intellectual structure, evolution of active topics, emerging trends, and research frontiers. To the best of our knowledge, this is the first study to conduct a comprehensive and systematic bibliometric analysis of herbal medicine for pain. The findings of this study provided a framework for the future development of research on herbal medicine for pain, which may help researchers explore new directions for future research and identify new perspectives on potential collaborations in this field.

Materials and Methods

Data collection.

Data on herbal medicine for pain were searched by topic using the search strategy: TS = ((herbal medicine OR traditional medicine OR herbal therapy OR herb therapy OR phytotherapy) AND (pain)). Studies published between 1990 and 2019 were retrieved to explore the global research trends in herbal medicine for pain. Results were restricted to studies published in English. After retrieval, only original articles were chosen for further investigation. A total of 2986 original articles were included. Data used in this study were lastly updated on December 31, 2020. Flow chart of the study retrieval strategy is presented in Figure 1 .

Flow chart of study retrieval and selection process.

Bibliometrics Methods and Analysis Tools

Historian’s description of the progress of science is limited by their own experience, memory, and adequacy of available documentation. Subjective judgment primarily determines the historical picture of development of events. 27 Traditional reviews are based on opinions of scholars, whereas bibliometric analysis focuses on finding qualitative changes in the quantity of references. 27 In this paper, bibliometric methods were used to explore existing achievements of herbal medicine for pain. CiteSpace (version 5.7 R2) 21–23 and HistCite (version 8.12.16) 24 , 25 softwares were used to assess bibliographic catalogs. Descriptive indicators (publications per year, research areas, journals and authors), qualitative indicators (bursts, betweenness centralities and citation scores) and relational indicators (collaborations of countries/regions and institutions) were used to assess bibliographic catalogs. Multiple bibliometric methods, such as co-citation analysis, co-occurrence analysis, and typical cluster analysis were performed to identify international collaborations, intellectual structure, evolution of active topics, emerging trends and research frontiers.

Results and Discussion

Analysis of publication outputs.

A total of 2986 original articles, which met the inclusion criteria, were included in this research. The articles were published in 1010 journals between 1990 and 2019 and comprised 112,788 references. After removing the duplicates, a total of 90,537 references were obtained. Total local citation score (TLCS) and total global citation score (TGCS) for all publications were 1503 and 51,112. The H-index was 80 with 17.12 average citations per item. The number of total publications and citations by year is shown in Figure 2 . The number of international scientific papers and citations on research on herbal medicine for pain from 1990 showed a gradual upward trend.

Number of total publications and citations by year.

International Collaborations of Countries/Regions

Analysis of international collaborations of countries/regions showed that a total of 113 countries/regions performed research in this field. Geographical distribution of publications on herbal medicine for pain research from countries/regions is presented in Figure 3 .

World map of countries/regions based on research on herbal medicine for pain.

Nearly half of the 2986 publications were from the top three countries. China had the highest number of publications (685, 22.9%), followed by the United States (584, 19.6%), and South Korea (260, 8.7%). Co-occurrence network analysis was used to describe the relationship among various items based on the relations among the network nodes that are involved in information or connections travel. The network was used to assess the significance and impact of a node by determining the citation and centrality. Betweenness centrality is identified within a network’s connectivity and represents the degree to which nodes stand between each other. International collaborations network between the most productive countries/regions is presented in Figure 4 . Analysis of the collaboration network showed that Germany (0.34), the United States (0.16), China (0.14), and England (0.14) played the most active role and maintained collaborations with the remaining countries. Collaboration between China and Japan ranked first, followed by Germany–England and US-China. South Korea (0.03) and Iran (0.01) had a large number of publications but showed a lack of international collaborations. Details on cooperation network between the top 10 countries/regions are shown in Table 1 .

Top 10 Countries/Regions with the Highest Number of Publications, Citation Score, and Centrality

Notes: Blue, green, orange and pink cells indicate the top three countries in each column.

Abbreviations: TP, total publications; TLCS, total local citation score; TGCS, total global citation score.

Collaboration network between countries/regions.

China ranked first in publication production, whereas the United States had the highest number of citations both in TLCS and TGCS ( Table 1 ). Despite England and Germany producing fewer publications, their total citation values were higher compared with several other high-producing countries, indicating that the publications were of high quality. The United States was second in number of outputs and value of centrality.

Distribution of Institutions

A total of 3488 institutions contributed to research in herbal medicine for pain reduction. The top 10 most productive and highest centrality institutions are shown in Table 2 . Kyung Hee University (70, 2.3%) from South Korea was the most productive institution, followed by China Academy of Chinese Medical Science (54, 1.8%) and Shanghai University of Traditional Chinese Medicine (51, 1.7%). Half of the top 10 most publishing institutions were from China. China institutions ranked first in terms of the total publications, indicating that Chinese scientists have explored this field more compared with researchers from other countries.

Top 10 Most Productive and Active Institutions

Abbreviations: Kyung Hee Univ, Kyung Hee University; China Acad Chinese Med Sci, China Academy of Chinese Medical Sciences; Shanghai Univ Tradit Chinese Med, Shanghai University of Traditional Chinese Medicine; Korea Inst Oriental Med, Korea Institute of Oriental Medicine; Univ Tehran Med Sci, Tehran University of Medical Sciences; Beijing Univ Chinese Med, Beijing University of Chinese Medicine; China Med Univ, China Medical University; Shahid Beheshti Univ Med Sci, Shahid Beheshti University of Medical Sciences; Chinese Acad Sci, Chinese Academy of Sciences; Univ Washington, University of Washington; Univ Florida, University of Florida; Univ Oulu, University of Oulu; Vanderbilt Univ, Vanderbilt University; Tech Univ Munich, Technical University of Munich; Karolinska Inst, Karolinska Institute; Kaiser Permanente Ctr Hlth Res, Kaiser Permanente Center for Health Research; Univ Milan, University of Milan; Univ Vermont, University of Vermont; Washington Univ, Washington University in St. Louis.

International collaborations among the most productive institutions are shown in Figure 5 . University of Florida (0.56), University of Oulu (0.49) and Vanderbilt University (0.46) were the top three universities based on centrality. Notably, only one institution from the United States was among the top 10 most productive institutions. However, 6 out of top 10 most collaborative institutions were from the United States, indicating that United States institutions support collaboration in this field.

Collaboration networks of the institutions.

Performance of Authors

A total of 12,653 authors contributed to 2986 articles on herbal medicine for pain. The top 10 most productive and cited authors are presented in Table 3 . Zhang Y was the most productive author, and contributed 24 articles, followed by Lee J (23), Lee JH (21) and Wang Y (21). However, the annual citation frequencies of the articles from these productive authors were not included. Sherman KJ (69) had the highest TLCS, indicating that he can be considered as the most important author in this field. However, research by Vane JR (684) had the highest global influence.

Top10 Most Productive and Cited Authors

Characteristics of Journals

Search results showed that research on herbal medicine for pain was published in 1011 journals. A dual-map overlay of journals that have published work related to herbal medicine for pain was generated by CiteSpace ( Figure 6 ). Dual-map overlays were designed by Chen and Leydesdorff to explore patterns of scientific citation. 28 The distribution of the base map of citing journals is shown on the left, representing the main disciplines (knowledge carriers) of herbal medicine for pain, and can be regarded as the application field ( Figure 6 ). The right of the dual-map is the base map of cited journals corresponding to the distribution of cited journals, which represents the main disciplines cited (knowledge sources) ( Figure 6 ). These can be regarded as the research basis of herbal medicine for pain.

Dual-map overlay of journals related to studies on herbal medicine for pain.

Literature on herbal medicine for pain research is mainly represented in three major regions ( Figure 6 ). The three regions include, region in yellow at the edge of the upper part with the label of veterinary/animal/science; the region in orange with the label of molecular/biology/immunology and the region in green with the label of medicine/medical/clinical. Major destination areas for citations with the biological origin include health/nursing/medicine, molecular/biology/genetics and environmental/toxicology/nutrition.

Top 10 most productive journals and research domains of each journal are listed in Table 4 . A total of 296 articles were published in the Journal of Ethnopharmacology (IF 3.69), followed by Evidence-Based Complementary and Alternative Medicine (IF 1.813) with 117 articles and Journal of Alternative and Complementary Medicine (IF 2.256) with 84 articles. Analysis of Journal Citation Reports (JCR) from the WoS website showed that 7 of the top 10 journals were associated with the research domain of Integrative and Complementary Medicine and were the most active in areas for research on herbal medicine for pain.

Top 10 Most Productive Journals and Research Domain of Each Journal

Note: *Data from the 2019 edition of Journal Citation Reports.

Evolution of Research Areas

Evolution of research areas reveals the variation trends of various domains over time indicating the history and future of herbal medicine for pain research. Research areas in this study were defined by categories from the WoS website. Research on herbal medicine for pain has significantly advanced in the past 30 years and is currently broadly distributed in multiple research areas. Growth trends of the top 10 research areas are presented in Figure 7 . The number of articles was very limited in every research area in the initial stage. Topics on General & Internal Medicine and Neurosciences Neurology were relatively prominent in the mid-1990s and show steady increase in number over the past two decades. However, Integrative and Complementary Medicine and Pharmacology & Pharmacy fields, which started in the mid-1990s, rapidly expanded at the end of the twentieth century and had an upsurge in the late 2000s. Over the past 20 years, the top two leading productive areas were occupied by Pharmacology & Pharmacy and Integrative and Complementary Medicine. At the beginning of the twenty-first century, the number of plant science publications began to increase, and declined slightly at the end of the 2000s, but has increased significantly in recent years. Research and Experimental Medicine area became obvious in the late 2000s and showed steady growth. Number of articles in Oncology and Health Care Sciences Services research has gradually increased. Chemistry and Biochemistry and Molecular Biology areas have significant increase in recent years, based on the number of published articles. However, they show slow growth rate in the number of articles in the past two decades.

Steam graph of the top 10 research areas.

Intellectual Structure

Structural and temporal dynamics can be identified by most active topical areas and cited references. 29 A co-citation network of references representing the evolution of the topics between 1990 and 2019 is shown in Figure 8 .

Characteristics of intellectual structure. ( A ) A network of co-cited references about research on herbal medicine for pain. ( B ) Cluster view of co-cited references from publications between 1990 and 2019.

History of research on herbal medicine for pain can be divided into three major phases of activities based on the overall structural and temporal dynamics of articles presented in Figure 8 , as follows:

• Phase I (1990–1999): the initial stage, during which research output on herbal medicine for pain increased slowly (as shown in Figure 2 ). The upper part of the network with links shown in purple, and corresponding co-citations made in the first 10 years of the period between 1990 and 2019 are shown in Figure 8A . The entire network was divided into several clusters. Each cluster is a group of closely coupled documents, representing a distinct specialty or a thematic concentration in the field. The labels from the clustering are shown in Figure 8B .
• Phase II (2000–2009): the stage of smooth growth, during which research output on herbal medicine for pain and citations increased at a steady rate. Figure 8A shows the central part of the network with links in orange, which are co-citations mostly made in the next 10 years, that is, the period between 2000 and 2009.
• Phase III (2010–2019): Figure 8A shows the lower part of the network with co-citation links in yellow, which implies that these co-citations were made in the most recent 10 years, that is, between 2010 and 2019. The period of development during which herbal medicine for pain research output increased rapidly. Recent developments are represented by this part of the network.

Common keywords and the most cited articles are regularly used to show the most significant logical areas of interest inside a particular subject of exploration. The top 10 most cited articles for each phase are listed in Table 5 , which also shows the main research themes in each phase. The main information is summarized based on the bibliometric results from HistCite.

The 10 Most Cited References in Each Phase

Phase I focused on the most cited references on the prevalence and patterns of use of herbal medicine 33 , 36 ( Table 5 ). The National Center for Complementary and Alternative Medicine (NCCAM) defines herbal medicine as an alternative, or complementary, prevention and treatment strategy. 60 A survey reported that 37% of 143 advanced cancer patients used complementary medications, and 39.6% of 197 complementary medications purchased were herbs. 35 Moreover, assessments of prevalence and extent of use of herbal medicine were conducted among patients with gastrointestinal disorders, chronic arthritis, cancer and congestive heart failure, where pain is a common comorbid condition. 31 , 32 , 35 , 39 Another major research theme in phase I was analgesic effect and mechanism of herbal medicine. 38 A study revealed that the anti-inflammatory and analgesic constituents from the roots of Angelica pubescens were related to peripheral inhibition of inflammatory substances and to the influence on the central nervous system. 30 Wei et al conducted a study to evaluate the effects of herbal medicine extracts of Duhuo (Radix Angelicae Pubescentis), Bai Jiang cao (Patriniae Herba cum Radice), Yan hu suo (Rhizoma Corydalis) and Sanqui (Panax Notoginseng) on a rat model of inflammatory hyperalgesia. The results supported that some herbal agents may provide an alternative approach to the treatment of persistent inflammatory pain and hyperalgesia. 37 Vaz’s study suggested that, despite that the mechanisms underlying the antinociception caused by extract of herbal medicine Catuama were still not completely understood, the herbal medicine Catuama may constitute a useful therapeutic agent for the treatment of clinical pain. 34 These findings indicated that herbal medicine was regarded as a complementary and alternative medicine for pain and appeared to be gaining popularity among patients with pain in the early stage of research.

Studies in Phase II were a continuation and extension of phase I research. For example, a survey conducted by Molassiotis et al explored the use of complementary and alternative medicine (CAM) in 956 cancer patients from 14 European countries. 48 Data results suggested that CAM was popular among cancer patients with 35.9% using some form of CAM, and herbal medicines and remedies were the most commonly used therapies. In addition, clinical research was another major research focus in Phase II. Chrubasik et al conducted a study to evaluate the effectiveness of Willow (Salix) bark extract for the treatment of low back pain. Clinical data from their research suggested that Willow bark extract may be a useful and safe treatment for low back pain. 41 Similar studies were conducted to examine the effect of ginger extract on patients with chronic pain due to osteoarthritis and to evaluate the effectiveness of leech therapy for symptomatic relief of osteoarthritis of the knee. 42 , 46 Another preliminary study revealed that the traditional herbal medicine, Shao-yao-gan-cao-tang, could prevent frequent and unendurable muscle cramps in patients undergoing hemodialysis. These studies demonstrated that scholars are placing significant attention on the clinical evidence of herbal medicine.

Analysis of the third stage (2010–2019) showed significant increase in the number of articles published. Therefore, the research topic was summarized based on the top 10 most cited publications in this stage. In Phase III, scholars became increasingly concerned about analgesic effect and mechanism of herbal medicine, particularly traditional medicine. Cnestis ferruginea is a shrub widely used in traditional African Medicine (TAM) for the treatment of various painful and inflammatory conditions. An experimental result showed that Cnestis ferruginea exerts its analgesic effect possibly mediated through peripheral and central mechanisms involving inhibition of release and actions of vasoactive substances and prostaglandins. 52 Salvia officinalis L. has been used as a traditional herbal medicine for gastric disturbances and inflammatory processes. An experiment reported that carnosol and ursolic acid/oleanolic acid contained in Salvia officinalis appears to contribute to the antinociceptive property of the extract, possibly through a modulatory influence on TRPA1-receptors. 55 The studies were also carried out in a traditional Chinese herbal medicine, Ge-gen and Sinomenium acutum, and well-known traditional Chinese medicine prescriptions, Shaoyao-Gancao Decoction (SGD) and Tou Feng Yu pill (TFY). 54 , 56 , 57 , 59 These findings provided additional pharmacological information and contributed to the further study. On the other hand, clinical evidence of herbal medicine for pain attained more attention. Two randomized controlled trials (RCT) were conducted to demonstrate clinical equivalence between herbal medicine and celecoxib (NSAID) for the treatment of knee osteoarthritis. The results of these studies supported that herbal formulations (especially GCSB-5 and SGCG) significantly reduced knee pain, and were comparable to Celecoxib in terms of the efficacy and safety for the treatment of osteoarthritis of knee joint. 53 , 58 Moreover, a prospective cohort study involving patients with low back and leg pain was carried out in Korea. After 24 weeks of integrative therapy (including herbal medicines), patients reported improvements in all outcome measures. 51

Hotspots and Research Frontiers

Burst patterns of keywords, that is, indexing terms, may reveal hotspots within a certain field in a certain period. The research fronts of the domain in each period can be detected through analysis of keywords with high burst rates. A stronger burst rate shows higher attention to the research topic and can effectively represent the research frontier in this period. The top 40 keywords with citation bursts are presented in Figure 9 .

Top 40 keywords with citation bursts related to herbal medicine for pain from 1990 to 2019.

Based on the meaning of the items, 40 keywords with citation bursts were classified into four categories. “Alternative medicine” was the major keyword with high strength in citation burst in phase I (1990–1999) period ( Figure 9 ). At the initial stage, the number of academic publications on herbal medicine for pain was rather scant and herbal medicine was recognized as the most common form of alternative medicine from its inception. Phase II (2000–2009) was an extension of phase I research and the most important keyword was “Asteraceae” belonging to the medicine category. Phase III (2010–2019) was a period of research domain transition from an embryonic stage to a fast-growing stage and varied widely in terms of keywords. Researchers originally focused on the mechanisms of action (such as “anti-inflammatory” and “antinociceptive”); however, keywords of pain-related diseases and disorders affecting high-attention have been considered since 2013. Keywords such as “knee osteoarthritis”, “cancer”, and “low back pain” are current citation bursts, indicating that they are research frontier diseases. Moreover, some keywords associated with the research on mechanisms of action, such as “inflammation”, “antioxidant” and “cytokine”, remain at the forefront of the herbal medicine for pain.

Substantial efforts have been invested in the search for alternative pain medications in the past few years. Research in the field of herbal medicine for pain has increased exponentially in the last decade; however, few bibliometric studies have been performed. This study sought to assess the global research trends of herbal medicine for pain from 1990 to 2019, using bibliometric methods. The findings of this study can be summarized as follows:

• China has the highest output, whereas publications from the United States are of the highest quality. China–Japan show the most active collaborations.
• Kyung Hee University from South Korea is the most productive institution. The total number of publications from Chinese institutions ranks first, whereas the United States institutions attach great importance to cooperation in this field.
• Zhang Y is the most productive author, whereas Sherman KJ and Vane JR have the greatest influence in the field.
• The most productive and cited source is the Journal of Ethnopharmacology , whereas Integrative and Complementary Medicine is the most active research area.
• Integrative and Complementary Medicine and Pharmacology Pharmacy are the two most broadly distributed areas in papers published in this particular field in recent 20 years. Plant Sciences, Chemistry, and Biochemistry Molecular Biology have shown a very high growth rate in recent years.
• The history of herbal medicine for pain research can be divided into three phases. In Phase I (1990–1999), the publications focused mainly on prevalence and patterns of use of herbal medicine, whereas in Phase II (2000–2009), researchers paid significant attention to clinical evidence of herbal medicine for pain. In Phase III (2010–2019), there is a growing interest in analgesic effect and mechanism of herbal medicine. Clinical research on herbal medicine for pain remains one of the most vibrant areas of investigation within the field.
• Keywords such as “knee osteoarthritis”, “cancer”, and “low back pain” are current citation bursts, indicating that they are research frontier diseases. Moreover, some keywords associated with the research on mechanisms of action, such as “inflammation”, “antioxidant” and “cytokine”, remain at the forefront of the herbal medicine for pain.

In this paper, we aimed to assess the global research trends of herbal medicine for pain from 1990 to 2019, using bibliometric methods, and explored international collaborations, intellectual structure, evolution of active topics, emerging trends, and research frontiers. This paper lays a framework for future development of research on herbal medicine for pain. This information will help researchers explore new directions for future research and identify new perspectives on potential collaborations in this field. In addition, these findings have implications for policymakers and funding agencies.

Authors declare no conflicts of interest in this work.

The Big List Of Beginner Herbalist Research Topics

Categories Beginner Guides , Herbalism

Please note that posts on this site may contain affiliate links

As 2020 approaches, my big goal for the coming year is to really immerse myself in herbalism. It’s something I am so passionate about that I am actually looking into taking courses for it and maybe doing it professionally.

The more I learn about any topic, though, the more I realize how hard it is to find the right words to learn more. Sometimes you just don’t know what you don’t know.

Herbalism as a topic is vast and the knowledge held within this topic is both wide and deep. It’s easy for a new person researching herbalism to drown in this knowledge without ever learning much at all!

To help not only myself but others that are considering becoming herbalists, I have compiled a list of topics and terms I want to learn more about this year. Because of how vast a topic herbalism is, this list cannot possibly cover everything we need to learn, but it’s a good place to start.

Without further ado, the beginner herbalism guide to research topics !

Things That Every Beginner Herbalist Should Research

• What are adaptogens?
• What are alteratives?
• What are aromatics?
• What are astringents?
• What are bitters?
• What are nervines?
• What are carminatives?
• What are diaphoretics?
• What are diuretics?
• What are emollients?
• What are expectorants?
• What are tonics?
• How do you use a compress?
• How do you use an essential oil?
• How do you use a decoction?
• How do you use an extract?
• How do you use an infusion?
• How do you use an infused oil?
• How do you use a liniment?
• How do you use a poultice?
• How do you use a salve?
• How do you use a syrup?
• Necessary and helpful tools for herbalists
• The history of herbalism
• Local, state, and federal laws of herbalism
• What plants are common in your area?
• What are the home remedies in your local area for certain ailments?
• The theories of Traditional Chinese Medicine
• The theories of Ayurvedic medicine
• The theories of plant spirit medicine
• The theories of Indigenous or Tribal Medicine
• The theories of Western herbalism
• The theories of the Eclectics
• Plant identification skills
• How to wildcraft ethically
• How to grow and harvest your own herbal remedies
• Dosages of specific plants for specific ailments
• Herbal nutrition
• How to use kitchen herbs as medicine
• Herbalism for preventative health
• How specific cultures use herbs
• How to understand scientific names of plants
• The use of fermentation in herbalism
• How to make a materia medica
• Herbal remedies as beauty products
• Herbal remedies for female issues
• Herbal remedies for male issues
• Herbal remedies for children
• Herbal remedies for the elderly
• What extraction medium is best for specific plants
• Where to find herbs locally, either in the wild or in stores
• Common herbalist vocabulary
• Language to avoid using as an herbalist

Where To Learn More About Herbalism

There are so many books and articles online about herbalism. Where does someone even start?

I compiled a list of books for herbalists some time ago. I’ve also been enjoying Llewellyn’s 2020 Herbal Almanac so far.

I am finding more and more as I research herbalism that Wikipedia is a surprisngly good place to begin research. The articles there give you direction when you feel like you may be at a research dead end. For that reason, I recommend looking through some Wikipedia articles about herbalism now and then.

Here are a few articles to start with:

• Eclectic medicine
• History of herbalism

Each topic you research will, without a doubt, lead you to 10 more. It’s important to understand and accept that you will never know everything about herbalism! Those who have come before us, like Rosemary Gladstar and David Hoffmann , don’t know everything either!

Herbalism is a craft that requires a community that you can turn to when you need more information. So my biggest piece of advice for any beginner herbalist reading this blog post right now is this: Make friends. Seek the advice of others. You are not competing with them, you are working with them to reveal the secrets of plants and heal those around you.

• Working With Hekate During The Full Moon

During the full moon, we call upon Hekate to assist us in clearing our past, releasing our fears, and opening ourselves to new possibilities. We ask her to help us gain clarity in our lives, to help us transform our inner worlds , and to allow us to move forward with courage and confidence.

It is said that Hekate helps us to overcome obstacles and challenges that stand in our way, and to achieve our goals. In addition to being a benevolent Goddess , she is also a fierce warrior. When we summon her, we invite her to help us take charge of our lives, to lead us into battle, and to fight for justice.

I am an eclectic witch - I've been practicing since 1974. As a student of the occult, working with astrology, tarot cards, runes, and numerology, I found that this was a very comprehensive and well written text on working with Hekate during the full moon. Highly recommended. - Gail Sager

Great read - a must have for anyone interested in working with the Goddess during the full moon! Highly recommended! - Luis Meyer

We earn a commission if you click this link and make a purchase at no additional cost to you.

• 20 Love Spells: From Love At First Sight To Break Up

Find the perfect magic spell for your every romantic need. From first meeting a lover to breaking up or getting married, the perfect spell is in this book!

• A Witch's Guide to Setting Goals and Achieving Them in the New Year

The New Year is a great time to start fresh, and what better way to do that than with some magical help? This witchy book will show you how to properly plan your new year's goals and when to cast them, using lunar phases, planetary hours, planetary days, and monthly correspondences.

This intermediate level guide includes:

• Goal setting tips
• How to use the lunar phases for goal setting (new moon, waxing moon, full moon, waning moon)
• How to use planetary days and hours for goal setting ( Sun, Moon, Mars, Mercury, Jupiter, Venus, Saturn)
• How to use monthly correspondences for goal setting
• How to mix all of these for explosively powerful magic
• Easy Simmer Pot Recipes for Financial Abundance Using Herbal Witchcraft

Are you ready to unleash the power of simmer pot spells in your life? In this guide, you'll learn everything you need to know about using these potent potions for wealth, abundance and success . From different recipes to ways of making them more powerful, this ebook will show you how to use simmer pots to create the life of your dreams. So what are you waiting for? Pick up a copy now and let the magic begin!

The different styles of simmer pots I will cover in this ebook are:

• Business Abundance Simmer Pot
• Good Luck Simmer Pot
• Life Of Luxury Simmer Pot
• Money Drawing Simmer Pot
• First Of The Month Prosperity Simmer Pot
• Unemployment Protection Simmer Pot
• Manifest Gifts Simmer Pot
• Full Moon Witchcraft: Traditions, Correspondences And Rituals For Beginners

Take your moon magic to the next level with Full Moon Witchcraft . In this book, you'll learn how to work with the powerful energy of the full moon to create positive change in your life. From choosing the right moon phase for your spellwork to understanding how the full moon influences you based on your natal moon sign, you'll be equipped with all the information you need to work successfully with this potent lunar force.

You'll also find tips and tricks for working with full moon energy for love, money, healing, and even hexes and curses. So whether you're a novice witch looking to take your first steps into magical practice or an experienced practitioner looking to deepen your understanding of this vital component of witchcraft, Full Moon Witchcraft has everything you need!

• Moon Sign Astrology: Your Emotions & Inner Self Revealed

Learn the deepest secrets of your moon sign in this comprehensive guide!

By understanding your moon sign, you can get a much deeper insight into yourself – both on an emotional level and in terms of your true inner desires. With this knowledge at hand, you'll be able to make more informed choices about all areas of life that impact you, from relationships to career paths.

In this guide, we'll cover everything you need to know about moon sign astrology – from the basics of each sign to how it affects your moods and emotions. We'll also explore what your unique moon sign means for your spiritual journey and witchcraft, and how you can use this information to create the life you've always wanted.

So whether you're just getting started with learning about astrology or you're a seasoned pro, this guide will give you the insights you need to understand your moon sign like never before .

• The Magic of Full Moon Tea: Recipes And Rituals

Indulge in the enchanting power of the full moon with "The Magic of Full Moon Tea: Recipes And Rituals" - the ultimate guide to brewing delicious and spiritually nourishing herbal teas.

This book will lead you on an unforgettable journey of full moon energy, teaching you how to select the right ingredients, master the art of tea-making, and create your very own personalized blends.

Immerse yourself in the magic of full moon tea ceremonies and discover how to incorporate them into your spiritual practice. Whether you're a tea lover or a seeker of spiritual growth, "The Magic of Full Moon Tea" is the perfect companion to help you unlock the secrets of the universe, one sip at a time.

• Beginner Witchcraft: 15 Candle Spells for Beginners

Discover the enchanting world of candle magic with "Beginner Witchcraft: 15 Candle Spells for Beginners," your ultimate guide to harnessing the power of fire, intention, and energy through the use of candles. In this comprehensive book, you'll learn the art of candle magick, an ancient practice rooted in the elemental power of fire and the symbolic meanings of colors. Whether you're new to witchcraft or an experienced practitioner looking to expand your knowledge, this guide has everything you need to embark on your magical journey with confidence.

• Lilith Spells: Tapping Into The Dark Divine Feminine And Feminist Activism

Delve into the mystical world of "Lilith Spells: Tapping Into The Dark Divine Feminine And Feminist Activism," a powerful grimoire that will guide you on a transformative journey through the realms of Lilith, the first wife of Adam, feminist icon, and demon goddess. Unearth the secrets of this enigmatic figure, who embodies the essence of feminine power, independence, and rebellion against patriarchal oppression. Includes 35 unique spells.

• Aphrodite Of Love And War: A Spell Book For Romantic Warfare

This comprehensive book delves into the dual energies of Aphrodite, empowering you to manifest your desires in matters of the heart and personal conflicts. Explore the depths of love and war magic as you learn advanced techniques such as sigil creation, candle magic, and divination to deepen your connection with Aphrodite and gain insight into romantic situations. Discover a diverse collection of spells that range from attraction and deepening connections to conflict resolution and protection. Embrace the dark aspects of love while honoring the nurturing and healing energies of Aphrodite, and learn to wield baneful magic with respect and caution. With its reader-friendly layout and comprehensive features, "Aphrodite of Love and War: A Spell Book for Romantic Warfare" is your ultimate companion on a transformative journey of self-discovery and empowerment.

• Pagan Prosperity: Aligning with Abundance through Earth-Based Practices

Unearth Your Wealth: Harness the Power of Saturn and the Earth Element for Abundant Prosperity

Have you ever wondered if the stars and the elements could unlock your true financial potential? If you're ready to embark on a transformative journey, our book "Unearth Your Wealth: Harness the Power of Saturn and the Earth Element for Abundant Prosperity" is the mystical guide you've been waiting for!

• Creating Moon Water During the Waning Moon

Unveil the power of the celestial bodies and explore a side of witchcraft often misunderstood and underused. "Creating Moon Water During the Waning Moon: Healing and Purification" is an all-inclusive guide that will transform your magical practice and daily life.

• Ascending Into Greatness: Unleashing Your Rising Sign's Potential

Dive into the pages of "Rising Signs Unveiled: Your Astrological Mask and Its Power" to decode the mystery that is YOU! This comprehensive guide uncovers the hidden depths of the twelve Rising Signs, from the trailblazing Aries to the dreamy Pisces, and everyone in between.

• Sea Witchcraft: A Guide to the Magical Wisdom of Water

Are you called to the mystic arts of the sea? Do you feel a deep connection to water and long to learn from the endless wisdom of the oceans? Then this comprehensive guide to sea witchcraft is for you.

Dark Divine Feminine: Lilith Spells Book

Thank you for submitting the form

Last Updated on February 23, 2023 by Emma Kyteler

Terms and Conditions - Privacy Policy

• Open access
• Published: 21 January 2020

Herbal medicines: a cross-sectional study to evaluate the prevalence and predictors of use among Jordanian adults

• Faris El-Dahiyat   ORCID: orcid.org/0000-0002-5264-8699 1 ,
• Mohamed Rashrash 2 ,
• Sawsan Abuhamdah 3 , 4 ,
• Rana Abu Farha 5 &
• Zaheer-Ud-Din Babar 6  

Journal of Pharmaceutical Policy and Practice volume  13 , Article number:  2 ( 2020 ) Cite this article

25k Accesses

35 Citations

1 Altmetric

Metrics details

Introduction

Understanding why adults resort to herbal medicine can help in planning interventions aimed at increasing awareness regarding herbal use. This study sought to investigate the prevalence and to determine factors for predicting the use of herbal medicine among Jordanian adults.

A cross-sectional study was conducted involving 378 older adults who were randomly selected from two different areas of Jordan. A questionnaire was used to gather data and validation criteria for validity and reliability of the content were tested by content and face validity in a panel of experts.

From a total of 500 invited participants, 378 completed the questionnaire. The prevalence of the use of of herbal products in this study was high at 80.2%. Herbal medicines use was not associated with any demographic factors other than age ( p  < 0.05). Moreover, the only associated health-related characteristic was the patient’s disease state including, notably, hypertension ( p  < 0.05). Reasons for not using herbal medicines as reported by nonusers included mainly a lack of belief in their efficacy (52.2%). Another two important reasons were that the individuals believed themselves to healthy and have no need for their use (31.3%) and the unavailability of enough information about the herbal medicines (29.7%). Finally, the most common side effects as reported by patients in this study were nausea and vomiting (9.3%), and, to a lesser extent, skin rash (2.1%).

There is a high rate of use of herbal medicines in Jordan, especially among hypertensive patients. Therefore, there is a need to establish effective herbal medicine policies and health education programs to discuss the benefits and risks of herbal medicine use, with the aim of maximizing patient-desired therapeutic outcomes.

Herbal medicines are substances one can eat or drink and may be vitamins, minerals, or herbs or parts of these substances. They can be defined as ‘plants or plant parts used for their scent, flavour, or therapeutic properties’ [ 1 ]. Herbal medicines are distinct from drugs wherein they are exempted from needing to meet premarketing safety and efficacy standards required for conventional drugs to adhere to [ 2 ]. The use of herbal medicines has increased remarkably throughout the world, with many people now using these products for the treatment of many health problems in health care practice across different countries [ 3 ].

People report using herbal medicine to meet a variety of health care needs, including disease prevention and to cure chronic illnesses such as dyslipidemia, hypertension, diabetes, cancer, and inflammatory bowel diseases [ 4 , 5 ].

The usage of herbal medicines in the world varies depending on location and the prevalence has increased recently. In the Arab world, similar rates have been found. About 80% of the population in Arab societies relies on herbal medicines for the prevention and treatment of illness [ 6 ]. For instance, in Egypt, 37% of the population reported using herbal medicines [ 7 ], while, in Saudi Arabia, a higher proportion of the population (73%) have used herbal medicines [ 8 ]. In Jordan, herbal medicine has maintained popularity as a result of historical, cultural, and psychosocial factors [ 9 ]. The most common reasons for using traditional herbal medicine are that it is inexpensive, more closely corresponds with the patient’s beliefs, avoids concerns about the adverse effects of chemical (synthetic) medicines, satisfies a need for more personalised health care, and allows for a greater public approach to health information [ 10 ].

It is hypothesised that as the use of herbal medicine increases among Jordanian adult populations so too do the occurrence of adverse effects and herbal drug interactions. Knowledge of the predictors of herbal use may help health care providers to identify patients at high risk who would be candidates for receiving additional guidance on the safe use of herbal medicines [ 11 ]. Such could further provide pathways for facilitating positive social changes by developing stricter governmental policies to ensure consumer safety and promote high-quality products and by driving the development of public awareness interventions about herbal use and related health risks.

The present study aimed to examine the prevalence and to identify factors predicting the use of herbal medicine among adults in Jordan. Understanding why adults resort to herbal medicine can help with planning interventions to increase awareness about herbal use. Such could also shed light on the importance of setting frameworks to regulate the entry into, distribution, and use of herbal medicine in the Jordanian market.

Study design, subjects, and setting

This was a cross-sectional study that was carried out in Jordan. Data collection period was from 10 March to 19 April 2017. During the study period, 500 Jordanian individuals were invited to participate in this study and to fill out an anonymous questionnaire designed to evaluate the nature of their herbal medicine use and to identify factors predicting their use of herbal medicine. Participants were Universities students and their family members. Universities staff and their family. The students were approached while participating in different classes. The study objectives were explained to them and they were informed that the study was to assess the knowledge and beliefs about the use of herbal medicine in Jordan.

Questionnaire deployment and data collection

Data collection was carried out using self-administered questionnaires that were developed by the researchers based on questions extracted from previous studies [ 12 , 13 ].

Content validity and face validity of the items questionnaire was evaluated in a panel of experts. Qualitative face validity was evaluated by asking the opinion of experts including a sample of the target group and 5 faculty members, assessed the questionnaire for appropriateness, complexity, attractiveness and relevance for the items. The items were edited and reworded based on their statements. Content validity was also evaluated by qualitative and quantitative methods. In the qualitative phase, we invited two expert panel to evaluate and discuss the essentiality of the questionnaire items, its wording and scaling, and its relevance. In quantitative method, content validity ratio (CVR) and content validity index (CVI) were tested for each item. If CVR was greater than the criterion of the Lawshe’s table [ 14 ] for each item, the item was weighed as essential; if not, it was omitted. According to the Lawshe table [ 14 ], an acceptable CVR value for 5 experts is 0.99.

The questionnaire was divided into four sections. The first section dealt with respondents’ acquisition, recommendations, and trust of currently available information on herbal medicines. The second part inquired about respondents’ attitudes towards herbal medicines The third part requested the health-related characteristics of study participants. The final section characterised the respondents’ demographics. The methods for response were organised differently, including using single-answer, multiple-answer (participants were allowed to choose more than one answer), and four-point Likert scale (i.e., 1 = strongly disagree, 2 = disagree, 3 = agree, and 4 = strongly agree) schemes.

Ethical considerations

This study was conducted following the guidelines outlined in the World Medical Association’s Declaration of Helsinki [ 15 ]. Ethical approval for conducting this study was obtained from the Institutional Review Board Committee at Applied Science Private University.

The participation of members of the Jordanian public was strictly voluntary. Informed consent of the participants was obtained prior to study inclusion and no personal data of the participants are reported. The anonymity of respondents was preserved in the study, as the names of participants were not included.

Sample-size calculation and sampling technique

A sample size calculation was performed using the following formula:

Where P is the anticipated prevalence of students’ knowledge, d is the desired precision, and z is the appropriate value from the normal distribution for the desired confidence.

Using a 95% confidence level (CI), 10% precision level, and 50% anticipated prevalence of inappropriate knowledge, a minimum sample size of 96 people was considered as accurately representative for the purpose of this study. In this study, we tried to approach 500 subjects to increase the generalizability of the study. A convenience sampling technique was employed to approach students based on their accessibility and proximity to the researcher.

Statistical analysis

All data were entered and analysed using SPSS© version 22 (IBM Corp., Armonk, NY, USA). Categorical variables were expressed as frequencies and percentages, while continuous variables were presented as means ± standard deviations (SDs). The chi-squared test was used to evaluate demographic and health-related characteristics associated with herbal medicines.

Multiple logistic regression analysis was used to identify attitude-related factors that best predicted the use of herbal medicines in the study population, using odds ratio (OR) values as a measure of association. A p -value of less than 0.05 was considered to be statistically significant.

The first draft of the questionnaire was formed through a grounded theory study and extensive literature review. The questionnaire was divided into four sections. The first section dealt with respondents’ acquisition, recommendations, and trust of currently available information on herbal medicines. The second part inquired about respondents’ attitudes towards herbal medicines. The third part requested the health-related characteristics of study participants. The final section characterised the respondents’ demographics.

In qualitative face validity, by consideration of the expert panel, four items were deleted due to content overlap. One item was also omitted due to complexity. In qualitative content validity, we changed two items according to the experts’ recommendations. In the quantitative stage, CVR of all the items was between 0.99, except for 4-items that had a CVR < 0.62 and therefore were deleted.

The CVI for each item scale was the proportion of experts who rated an item as 3 or 4 on a 4-point scale [ 16 ]. Clarity, simplicity, and relevancy of each item were scored in a four-point Likert scale (from 1: not relevant, not simple, and not clear to 4: very relevant, very simple, and very clear). Items with scores less than 0.7 were omitted. CVI of other items were between 0.8–1.

Construct validity of this questionnaire was evaluated by 378 respondents with mean age of 26.7 ± 5.60 years. Detailed demographic data of the study participants are as shown in Table  1 . A total of 378 respondents responded to the questionnaire and the majority of them reported using herbal medicine (80.8%). The main reason for the nonparticipation of the remaining students ( n  = 122) was a lack of interest in the subject of the study. About two-thirds of respondents were female (69.6%). The majority had either bachelor or college degrees of education (62.9%) and had an annual income of less than 1000 (68.3%).

Table  2 shows responses pertaining to health-related characteristics and the use of herbal medicines. More than three-quarters of the study sample admitted using herbal medicines. The majority of participants rated their health as either excellent or very good (71.4%) but no significant association between the provided health rating and the usage of herbal medicines was observed. About 80% of the study population did not report the presence of any chronic disease, and there was no association between the presence of chronic illness and the use of herbal medicine found. The most prevalent chronic diseases among the study subjects were hypertension followed by diabetes (9.5 and 5.6%, respectively), and there was a statistically significant association between the type of chronic illness and the admitted use of herbal medicines. More than half of the respondents were somewhat unfamiliar with herbal medicines (52.6%). Among those who used herbs, about one-third were using them only during certain seasons, and approximately half of them reported used herbal remedies followed by vitamins and minerals, respectively (48.9 and 21.7%). The main reasons for using the products were to treat disease and maintain health (44.8%). Approximately 22% of consumers experienced side effects from using herbal medicines including, most commonly, vomiting and nausea (9.3%).

Table  3 indicates that the majority of consumers obtained herbal medicines from herbalists followed by from a pharmacy (37.8 and 23.0%, respectively). Herbal medicine use was mainly recommended by family and friends (39.7%) followed by pharmacists (17.7%) and mass media (12.4%). Pharmacists and medical doctors were the individuals most trusted to provide accurate information on herbal medicines (24.6 and 23.3%, correspondingly).

Reported attitudes towards herbal medicines, as presented in Table  4 , revealed that the majority of respondents agreed with six statements and disagreed with two statements. The reported disagreements were with the statements if a herbal medicines is for sale to the public, I am confident that it is safe and herbal medicines are better for me than conventional medicines. The strongest agreement was with the statement herbal medicines can maintain and promote health followed by that the respondents desired to know more about the safety and efficacy of herbal medicines and about the possibility of the use of herbal medicines to treat illnesses (83.3, 79.6, and 77.8%, respectively).

Multivariate logistic regression analysis outcomes comparing who agreed and disagreed about certain statements regarding herbal medicine use are shown in Table  5 . The highest odds were found among people who agreed about the use of herbs to maintain health (OR: 3.9, 95% CI: 0.12–0.57), while the least significant odds were found among those who agreed with the statement a lot of the health claims made by the manufacturers of herbal medicines are unproven (OR: 0.515, 95% CI: 1.05–3.60). Other significant predictors were herbal medicines can be used to treat illness and if a herbal medicineis for sale to the public , I am confident that it is safe ( p  < 0.05).

The nonusers’ reasons for not using herbal medicines are shown in Table  6 . The highest percentage explained that they feel they are healthy and have no need for herbal medicines or they do not have enough information about herbal medicines. There was a significant association between the nonuse of herbal medicines and the mentioned reasons ( p  < 0.05).

The prevalence of herbal use in this study (80.2%) was the highest when compared with findings presented in other studies from Middle Eastern areas [ 5 , 17 , 18 ] and the United States [ 19 ]. The majority of previous studies reported a higher rate of use of herbal medicines among hypertensive patients [ 20 , 21 , 22 ]. In this study, the use of herbal medicines was not associated with any of the recorded demographic factors but age. Moreover, the only associated health-related characteristic was the patient’s disease state, including specifically hypertension. On the contrary, other studies showed an association with some demographic variables such as educational level or marital status as reported by Ibrahim et al. [ 17 ]. Another survey in Turkey showed a significant association with almost all demographic variables considered [ 21 ].

Our study’s findings were consistent with those of other studies, which reported a degree of independence between sociodemographic factors and the use of herbal medicines [ 23 ]. Any discrepancy might be attributed to different perspectives and definitions of herbal medicines among different populations due to variations in the recognition and valuation of herbal medicines as well as attitudes towards herbal medicines among different cultures.

An assortment of herbal medicines is known to be applicable in managing high blood pressure, which is supported by the findings of this study and other studies conducted in developing countries [ 21 , 24 ]. The low cost and acceptability of traditional herbal medicines in different cultures made users confident with adopting these products for both therapeutic and prevention reasons. Moreover, the use of herbal medicines has a historical context and is well-accepted in Islamic culture, further strengthening users’ acceptance of these products.

Reasons for not using herbal medicines are different as reported by nonusers, and no significant single reason for non usage was stated. However, the highest percentage of nonusers reported they did not believe in the efficacy of herbal medicines. Other important reasons were that the individuals felt healthy and had no need for its use and there was unavailability of adequate information about the herbal medicines. These findings might prompt manufacturers of these herbal products to disseminate more information and perform more outreach and education regarding their products.

The highest adopted products were herbal remedies, as about of half of our sample used these products, followed to a lesser extent by vitamins and minerals, and the total percentage represents less than one-quarter of our population. Our results indicated that older patients were the most frequent users of herbs, vitamins, and minerals. This can be explained by the fact that the older population has more ailments and health issues as compared with their younger counterparts and hence are likely looking for additional health and wellness support.

The reasons for the use of herbs as reported by the study population were mainly to treat diseases and to maintain health followed by preventing illness, which are logical findings in relation to the use of such herbal products. The use of herbal medicines was recommended by family and friends to the greatest extent and secondly by pharmacists, while physician recommendations were the most infrequent recommendations received. Consistently, other studies found nearly the same pattern where seekers do not ask medical advice and instead depend upon friends and family members for guidance [ 25 , 26 ].

The most common side effects as reported by patients in this study were nausea and vomiting and, to a lesser extent, skin rash, which is inconsistent with the findings of other studies that found other multiple side effects including mainly skin rash as the primary unwanted effect of traditional therapy [ 25 , 27 ]. Side effects and drug interactions are common among users of these herbal products, as they are users of other medications such as antihypertensive drugs; hence, health care professionals should be vigilant and educate patients regarding these issues. In addition, the lack of accurate or regulated dosing of these products is another major concern. All of these aspects represent potential sources of debate among health professionals about the risk–benefit ratio and effectiveness of these products.

Limitations

Study participant recruitment was done inside universities, so most of the study sample was from specific age groups spanning students’ ages. Another limitation was the convenience sampling method used in this study. Our findings may not be extrapolated to the broader population of Jordan or to those of other countries.

We found that the use of herbal medicines is common among the study population, including specifically hypertensive patients, in Jordan, and the same is true among other Middle East populations. Demographic characteristics are not significantly related to the use of herbal medicines. The only determinant of the use of these products is the presence of elevated blood pressure. Nausea and vomiting were the most common side effects reported by consumers of herbal medicines. It is worth knowing that herbal products are not risk-free and the risk of drug interactions is not currently well-studied, so further research in this area is warranted and health care professionals should suggest caution to patients where appropriate.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Mamtani R, Cheema S, MacRae B, Alrouh H, Lopez T, ElHajj M, Mahfoud Z. Herbal and nutritional supplement use among college students in Qatar/Consommation de complements nutritionnels et a base de plantes par des etudiants de l'enseignement superieur au Qatar. East Mediterr Health J. 2015;21:39.

Article   CAS   Google Scholar  

Klepser TB, Klepser ME. Unsafe and potentially safe herbal therapies. Am J Health Syst Pharm. 1999;56:125–38.

Ekor M. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Front Pharmacol. 2014;4:177.

Article   Google Scholar  

James PB, Taidy-Leigh L, Bah AJ, Kanu JS, Kangbai JB, Sevalie S. Prevalence and correlates of herbal medicine use among women seeking care for infertility in Freetown, Sierra Leone. Evid Based Complement Alternat Med. 2018;2018:9493807.

Awad A, Al-Shaye D. Public awareness, patterns of use and attitudes toward natural health products in Kuwait: a cross-sectional survey. BMC Complement Altern Med. 2014;14:105.

Cecilia NC, Al Washali A, Albishty AAAMM, Suriani I, Rosliza A. The use of herbal medicine in Arab countries: a review. Int J Public Health Clin Sci. 2017;4:1–14.

Google Scholar  

Saleh A, Atwa H, Ismail MA. Studying complementary and alternative practices in Bedouin community: family based study, North Sinai, Egypt. World Fam Med J. 2012;99:1–9.

Albadr BO, Alrukban M, Almajed J, Alotaibi K, Alangari A, Bawazir A, Aljasser A. Attitude of Saudi medical students towards complementary and alternative medicine. J Fam Community Med. 2018;25:120.

Wazaify M, Alawwa I, Yasein N, Al-Saleh A, Afifi FU. Complementary and alternative medicine (CAM) use among Jordanian patients with chronic diseases. Complement Ther Clin Pract. 2013;19:153–7.

Benzie IF, Wachtel-Galor S. Herbal medicine: biomolecular and clinical aspects: CRC press; 2011.

Book   Google Scholar  

Aziz Z, Tey N. Herbal medicines: prevalence and predictors of use among Malaysian adults. Complement Ther Med. 2009;17:44–50.

Sawalha AF, Sweileh WM, Sa’ed HZ, Jabi SW. Self-therapy practices among university students in Palestine: focus on herbal remedies. Complement Ther Med. 2008;16:343–9.

Al Saeedi M, El Zubier A, Bahnassi A, Al Dawood K. Patterns of belief and use of traditional remedies by diabetic patients in Mecca, Saudi Arabia; 2003.

Lawshe CH. A quantitative approach to content validity. Pers Psychol. 1975;28:563–75. https://doi.org/10.1111/j.1744-6570.1975.tb01393.x .

World Medical A. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4.

DeVon HA, Block ME, Moyle-Wright P, Ernst DM, Hayden SJ, Lazzara DJ, et al. A psychometric toolbox for testing validity and reliability. J Nurs Scholarsh. 2007;39(2):155–64.

Ibrahim IR, Hassali MA, Saleem F, Al Tukmagi HF, Dawood OT. Use of complementary and alternative medicines: a cross-sectional study among hypertensive patients in Iraq. J Pharm Health Serv Res. 2018;9:59–65.

AlBraik FA, Rutter PM, Brown D. A cross-sectional survey of herbal remedy taking by united Arab emirate (UAE) citizens in Abu Dhabi. Pharmacoepidemiol Drug Saf. 2008;17:725–32.

Rashrash M, Schommer JC, Brown LM. Prevalence and predictors of herbal medicine use among adults in the United States. J Patient Exp. 2017;4:108–13.

Eddouks M, Maghrani M, Lemhadri A, Ouahidi M-L, Jouad H. Ethnopharmacological survey of medicinal plants used for the treatment of diabetes mellitus, hypertension and cardiac diseases in the south-east region of Morocco (Tafilalet). J Ethnopharmacol. 2002;82:97–103.

Ali-Shtayeh MS, Jamous RM, Jamous RM, Salameh NM. Complementary and alternative medicine (CAM) use among hypertensive patients in Palestine. Complement Ther Clin Pract. 2013;19:256–63.

Hasan SS, Ahmed SI, Bukhari NI, Loon WCW. Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics. Complement Ther Clin Pract. 2009;15:152–7.

Amira OC, Okubadejo NU. Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria. BMC Complement Altern Med. 2007;7:30.

Valli G, Giardina EG. Benefits, adverse effects and drug interactions of herbal therapies with cardiovascular effects. J Am Coll Cardiol. 2002;39:1083–95.

Ibrahim IR, Hassali MA, Saleem F, Al Tukmagi HF. A qualitative insight on complementary and alternative medicines used by hypertensive patients. J Pharm Bioallied Sci. 2016;8:284–8.

Hughes GD, Aboyade OM, Clark BL, Puoane TR. The prevalence of traditional herbal medicine use among hypertensives living in South African communities. BMC Complement Altern Med. 2013;13:38.

Niggemann B, Gruber C. Side-effects of complementary and alternative medicine. Allergy. 2003;58:707–16.

Download references

Acknowledgements

The authors are extremely grateful to the survey participants who took the time to participate in the study. Without their participation and feedback, this study would not have been possible.

The authors received no specific funding for this work.

Author information

Authors and affiliations.

College of Pharmacy, Al-Ain University, Alain campus, Al-Ain, P. O Box 64141, United Arab Emirates

Faris El-Dahiyat

Department of Pharmaceutical and Administrative Sciences, School of Pharmacy, University of Charleston, Charleston, WV, USA

Mohamed Rashrash

College of Pharmacy, Al-Ain University, Abu Dhabi campus, Al-Ain, United Arab Emirates

Sawsan Abuhamdah

Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan

Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan

Rana Abu Farha

Department of Pharmacy, University of Huddersfield, Huddersfield, UK

Zaheer-Ud-Din Babar

You can also search for this author in PubMed   Google Scholar

Contributions

FD conceptualized the project with ZB. FD performed data collection, entry and analysis. MR contributed to data analysis and interpretation. FD, SA, MR, RA and ZUD contributed to manuscript development, The final version was approved by all authors.

Corresponding author

Correspondence to Faris El-Dahiyat .

Ethics declarations

Competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

El-Dahiyat, F., Rashrash, M., Abuhamdah, S. et al. Herbal medicines: a cross-sectional study to evaluate the prevalence and predictors of use among Jordanian adults. J of Pharm Policy and Pract 13 , 2 (2020). https://doi.org/10.1186/s40545-019-0200-3

Download citation

Received : 23 July 2019

Accepted : 29 December 2019

Published : 21 January 2020

DOI : https://doi.org/10.1186/s40545-019-0200-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Herbal medicines
• Risk factors

Journal of Pharmaceutical Policy and Practice

ISSN: 2052-3211

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]