Systematic Review

H J Hamre et al. (2023) · Systematic reviews

This systematic review examined six earlier meta-analyses (statistical pooling studies) of placebo-controlled randomized trials of homeopathy for any health condition in humans, asking whether homeopathy shows an effect beyond placebo. Homeopathy is built on drug provings (recording symptoms in healthy people), the principle that a substance causing a symptom pattern is used to treat a similar one, and potentization, which means serial dilution with vigorous shaking. Because the six meta-analyses, published between 1997 and 2017, used different methods and reached different conclusions, the authors reviewed them together under a published protocol and judged their risk of bias and the certainty of the overall evidence. The authors searched eight databases plus a private collection and contacted experts, identifying 16 reports covering six meta-analyses, with searches running to December 2020 and an update to April 2023. Two reviewers screened and extracted data independently. The meta-analyses together covered 310 trials or trial comparisons (182 distinct trials published between 1943 and 2014), most often on respiratory conditions such as allergic rhinitis and influenza. Each meta-analysis was rated for risk of bias with ROBIS, and the combined evidence was graded with a GRADE-based approach. All five meta-analyses with reported pooled estimates found a significant effect favouring homeopathy across all trials, for example an odds ratio of 2.45 (95% CI 2.05-2.93) across 89 trials in the 1997 analysis and a standardized mean difference of 0.33 (0.21-0.44) across 54 non-individualised trials in 2017. When only high-quality trials were kept, three of four analyses stayed significant, but the 2017 analysis did not (SMD 0.18, -0.09 to 0.46, 3 trials). Only 6-29% of trials met each analysis's high-quality criteria. Three analyses showed significant heterogeneity and funnel plot asymmetry, a pattern that can signal publication or small-study bias; individualised homeopathy showed neither. Two analyses that combined quality and trial-size restrictions found no significant difference from placebo. Three meta-analyses were rated low and three high risk of bias. The authors rated evidence certainty as high for individualised homeopathy and moderate for the other categories. The authors conclude that the data do not support the hypothesis of no difference from placebo and that placebo-controlled evidence gives no justification for regulatory action against homeopathy. The review only covers trials already in six meta-analyses, so trials after 2011 (individualised) and 2014 (non-individualised) are missing. It also reports no indication-specific results, and its use of GRADE tested whether any effect exists rather than how large it is. The authors recommend updating the individualised homeopathy analysis and studying specific non-individualised treatments for specific conditions.

María Magdalena Vaccarezza et al. (2026) · PloS one

This systematic review with meta-analysis pooled 17 randomized controlled trials of ketogenic diet therapies (KDTs) for drug-resistant epilepsy, meaning epilepsy that keeps causing seizures after two or three appropriately chosen antiseizure medications have failed. About 30% of people with epilepsy fall into this group. KDTs are high-fat, low-carbohydrate, adequate-protein diets that shift the body toward burning fat and producing ketone bodies, which are fat-derived fuel molecules that may calm brain activity and support neuron energy metabolism. Several forms exist: the classical ketogenic diet, the medium-chain triglyceride (MCT) diet, the modified Atkins diet with unrestricted protein, and the low glycemic index treatment. A 2020 Cochrane review left the evidence uncertain, and this update added newer trials. Eleven trials enrolled children and six enrolled adolescents and adults, with follow-up of up to 24 months. In nearly all trials, a ketogenic diet was compared with usual care, most often an added medication. The authors searched four databases in February 2024 and again in June 2025, screened 1,193 unique records in duplicate, and pooled results as relative risks (RR) using random-effects models. Study bias was rated with the Cochrane RoB 2 tool, and confidence in each result was graded from high to very low using GRADE. In children, a 50% or greater drop in seizures was far more likely with KDT (RR 4.06, meaning roughly four times the likelihood; 49.7% versus 12.2%, or 37 more children per 100). A 90% or greater drop was borderline (RR 1.74, 95% CI 1.00 to 3.03). Adverse events were similar to usual care (RR 1.03), and dropout was not significantly different (RR 1.64, 95% CI 0.88 to 3.07). In adolescents and adults, 50% or greater seizure reduction was also more likely (RR 7.73, which translates to 16 more per 100), with moderate certainty. Near-complete seizure control (RR 13.00, with a very wide interval of 0.74 to 226.98), side effects and dropout could not be judged because of very low certainty. Reported side effects were mainly gastrointestinal and resolved when the diet stopped. Quality of life findings were mixed: one infant trial found small differences favoring medication in temperament and peer relationships, while parents in another trial reported improved alertness and sleep. The authors interpret the findings as a clinically meaningful benefit for moderate seizure reduction, strongest in children. Certainty was limited by the impossibility of blinding a diet, small event counts and high heterogeneity for some outcomes. Most trials came from high-income countries, which may limit generalizability, and publication bias could not be excluded. No trial reported hospitalizations, status epilepticus or survival. The authors call for better evidence on safety, adherence, cognition and quality of life.

Sophia Tsokkou et al. (2026) · International journal of molecular sciences

This systematic review pulled together seven randomized controlled trials to ask whether vitamin D, vitamin C, and vitamin E supplements affect endometriosis, a long-term inflammatory condition in which tissue like the uterine lining grows outside the uterus and affects roughly 1 in 10 women of reproductive age. Common symptoms include painful periods (dysmenorrhea), chronic pelvic pain, pain during intercourse (dyspareunia), and difficulty conceiving. The vitamins were chosen because vitamin D helps regulate immune signaling, while vitamins C and E act as antioxidants that neutralize reactive oxygen species (unstable molecules that damage cells and add to inflammation). Both processes are central to how endometriosis develops and causes pain. The authors registered their protocol in PROSPERO and searched PubMed, Scopus, and ScienceDirect, screening 5,639 records down to seven eligible trials. Two reviewers screened independently, and trial quality was graded with the Jadad scale and the Cochrane RoB 2 tool. The trials varied widely: vitamin D doses ranged from 2000 IU daily to 50,000 IU weekly, vitamin C and E doses from 343 mg and 84 mg to 1000 mg and 800 IU daily, and treatment lasted from about 8 weeks to 6 months. Because of this variation, results were described narratively rather than pooled. High-dose vitamin D (50,000 IU every two weeks) cut pelvic pain scores by 1.12 points (95% CI -2.1 to -0.09; p = 0.03) and lowered hs-CRP, an inflammation marker, by 0.64 mg/L. A weekly 50,000 IU regimen lowered active β-catenin (a signaling protein linked to lesion invasion) in endometrial tissue. Lower daily doses did not clearly beat placebo, since both groups improved by similar amounts. Vitamin C plus E for eight weeks reduced oxidative stress markers, and one trial reported pain drops of 43% for daily pelvic pain, 37% for painful periods, and 24% for painful intercourse. Pregnancy rates did not rise in the trial that measured them. Side effects were generally minor, mostly occasional digestive upset. Three trials were rated low risk of bias and four had some concerns. The authors describe vitamins as a possible well-tolerated adjunct for pain and oxidative stress, though not for fertility. The evidence base is small, with only seven trials, English-language inclusion only, very different dosing across studies, and no trial using a publicly available preregistered protocol. Few trials checked participants' baseline vitamin levels, so it remains unclear whether any benefit depends on deficiency. The authors call for larger multicenter trials with standardized doses, longer follow-up, and fertility and lesion outcomes.

Tatiana Leite Müller et al. (2026) · International journal of biometeorology

This systematic review of nine studies with 465 adults looked at climatotherapy, the therapeutic use of climate and natural settings, for musculoskeletal and rheumatologic disorders such as osteoarthritis, rheumatoid arthritis, fibromyalgia and ankylosing spondylitis. The settings were the Dead Sea (very salty water, low humidity, distinctive solar radiation and air pressure about 5% above sea level) and coastal sites using thalassotherapy, which means bathing and exercising in seawater, sometimes with marine mud, sun exposure and sea air. Because these programs vary widely, the authors wanted to gather what trials say about pain, physical function, quality of life and safety. The reviewers searched three databases through September 2025 and included eight randomized trials and one non-randomized study from 1995 to 2011, mostly in Israel. Participants were aged 18 to 65 and stayed at a spa or coast for 10 days up to 12 weeks. Comparison groups used freshwater pools, usual care, pool exercise or the same program in Norway. Pain was usually rated on a 0 to 100 visual analog scale, and quality of life was measured with questionnaires such as the SF-36. Most studies reported short-term improvements in pain, stiffness, function and quality of life, mainly within groups. Only two studies could be pooled for pain, giving an inconclusive overall result (SMD -0.47, 95% CI -5.47 to 4.53; an interval too wide to show benefit or no benefit). Split by condition, osteoarthritis showed a large effect (SMD -1.01, meaning pain fell by roughly one standard deviation more than with comparison) while fibromyalgia showed a small non-significant one (SMD -0.18, p = 0.158). In fibromyalgia, single-study estimates showed fewer tender points (SMD -0.50, p = 0.0047) and better physical quality of life (SF-36 physical score 0.36, p = 0.0391), but mood scores (p = 0.5968) and overall fibromyalgia impact (p = 0.0612) did not change significantly. No serious adverse events were reported, though only one study recorded adverse events explicitly. The evidence has important limits: trials were small and published between 1995 and 2011, participants and therapists could not be blinded, safety was inconsistently recorded, and several programs combined many components, so the effect of the climate itself is hard to separate. Only one trial analyzed all participants as randomized, and the pooled estimate rests on two studies. Certainty was judged low. The authors suggest climatotherapy may be a complementary option, particularly for osteoarthritis, and call for multicenter randomized trials with standard outcome sets and systematic safety reporting.

Rita Chiaramonte et al. (2026) · The Journal of manual & manipulative therapy

This systematic review of 18 randomized controlled trials explored whether hands-on treatment eases pain and improves jaw movement in adults with temporomandibular disorders (TMD). TMD is a group of conditions affecting the jaw joint, the chewing muscles and nearby tissues, and it is estimated to affect about 31% of adults. Its subtypes include muscle pain (myalgia), disc displacement (the cushioning disc slips out of position, sometimes locking the jaw) and joint pain. Manual therapy covers thrust manipulation, soft-tissue release, massage and intra-oral techniques, delivered by physiotherapists, chiropractors, osteopaths, dentists and physicians. The review asked which techniques help most and whether results differ by profession. Researchers searched four databases through March 2025 and screened 561 records, keeping 18 trials of adults with a clinical TMD diagnosis. Trials compared manual therapy with sham treatment, no treatment, splints, medication, exercise or education. Pain was rated on the visual analogue or numeric rating scale (0 to 10), and maximum mouth opening was measured in millimetres. Risk of bias was checked with the Cochrane tool and certainty with GRADE. Because the trials differed so widely in technique, dose, comparator and follow-up, results were summarized in words rather than pooled statistically. Most trials reported short-term pain reduction and wider mouth opening, but certainty was low to moderate for pain and low for mouth opening. High-velocity low-amplitude (HVLA) thrusts made up 56% of interventions and fascial manipulation with myofascial release made up 37.5%. Dry needling plus upper neck HVLA beat splint therapy, diclofenac and joint mobilization at three months (p < 0.001), and intra-oral therapy kept benefits for one year in chronic jaw-muscle pain. Upper thoracic HVLA showed no significant effect (p > 0.05), and jog manipulation gained only 6.86 mm of mouth opening at first visit with no later group difference. Massage and fascial manipulation by physiotherapists were linked to relief of jaw-muscle symptoms, while chiropractic, osteopathic and dental trials also reported gains. Physiotherapy trials were the most numerous, which the authors attribute to publication volume rather than superior effectiveness. The authors describe manual therapy as associated with short-term benefit and treat professional comparisons as descriptive, since profession was tangled with setting, technique and country. Limitations include small samples, short follow-up, mixed diagnoses, English-only searching and no meta-analysis. Safety findings were not reported in pooled form, and the evidence mostly covers weeks to months rather than years. The authors call for larger trials with longer follow-up and standardized protocols, and they state that manual therapy is best delivered by trained, licensed professionals.

Qiaoyun Liu et al. (2026) · Frontiers in endocrinology

This systematic review and meta-analysis of 56 randomized controlled trials (4,605 participants) examined whether herbal formulae containing Smilax glabra, known in Chinese as Tufuling, help people with acute gout. Gout is a painful inflammatory arthritis caused by uric acid crystals depositing in joints. In traditional Chinese medicine, many acute flares are classed as dampness-heat accumulation, a pattern defined by red, swollen, hot, painful joints and dark urine, and treated by clearing heat and resolving dampness. The authors also used computer-based network pharmacology to predict which plant compounds and proteins might explain the effects. All 56 trials took place in China and enrolled adults, with ages ranging from 18 to 80 years, diagnosed with gout and the dampness-heat pattern. Participants received a Tufuling-containing herbal formula, sometimes with external applications or acupuncture, either alone or added to standard drugs such as NSAIDs, colchicine, allopurinol or benzbromarone, for 14 days or less. Comparison groups received the standard drugs alone. Pain was measured on a 10-point visual analog scale, and blood uric acid, C-reactive protein and erythrocyte sedimentation rate (inflammation markers) were also tracked. Herbal formulae added to standard drugs reduced pain by 0.94 points on the 10-point scale (a modest but statistically significant gain across 17 trials), raised the chance of a treatment response by 15% (risk ratio 1.15), and lowered blood uric acid by 57 micromoles per litre. Herbal formulae alone did not beat standard drugs for pain (a 0.33-point difference, not significant) but did lower uric acid. Adverse events, mostly stomach and intestinal complaints, totalled 73 in herbal groups versus 161 in comparison groups, all mild to moderate. Certainty of evidence was rated low to moderate, and heterogeneity was very high for pain (I² = 93.2%). Network analysis predicted 49 gout-related protein targets for Tufuling, centred on PTGS2, IL1B, PPARG and TP53 (proteins governing inflammation and metabolism), and docking suggested diosgenin binds PTGS2 strongly (-11.6 kcal/mol). The authors suggest Tufuling-based formulae may be a useful adjunct in acute gout, but the evidence carries clear limits. Most trials lacked blinding and trial registration, all came from China, treatment lasted at most 14 days, a quarter of trials did not report adverse events, and only four reported follow-up. The findings do not extend to chronic gout or other traditional patterns, and the network predictions are untested hypotheses. The authors call for larger, rigorous trials with longer follow-up and laboratory validation of the predicted targets.

Ana Luiza Cabrera Martimbianco et al. (2020) · Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia

This systematic review of five randomized controlled trials (279 women) examined whether Tribulus terrestris, a creeping herb used as a natural sexual stimulant, improves female sexual dysfunction (FSD) and what safety data exist. All participants had hypoactive sexual desire disorder (HSDD, persistently low sexual desire that causes distress) or loss of libido. Tribulus extracts contain protodioscin, a steroidal saponin (plant compound with hormone-like structure) proposed to increase luteinizing hormone, the pituitary hormone that stimulates androgen production. The review cites estimates that 30 to 50% of women experience FSD during their lifetime, and notes that the effects of Tribulus had not been established. Reviewers searched six databases and trial registries up to February 2019 for trials comparing Tribulus with placebo or another treatment. The trials took place in Brazil (four) and Iran (one) and enrolled 172 postmenopausal women (43 to 65) and 107 premenopausal women (18 to 44). Four trials gave 250 mg by mouth three times daily for 90 to 120 days; one gave a syrup twice daily for 30 days. Sexual function was measured with the Female Sexual Function Index (FSFI, scored 2 to 36) and the Sexual Quotient Female Version (SQ-F, scored 0 to 100); higher scores mean better function. Differences between trials prevented pooling results. One trial in 67 premenopausal women found a higher FSFI total score after one month on Tribulus (mean difference 4.39 points; 95% CI 2.90 to 5.88, a statistically reliable gain), driven by arousal, lubrication, orgasm and satisfaction rather than desire or pain. Two other FSFI trials at three months found no significant difference (p = 0.19 and p = 0.44). In 60 postmenopausal women, SQ-F scores rose by 16.40 points (95% CI 7.67 to 25.13) at three months. Testosterone rose in premenopausal women (mean difference 6.60; 95% CI 0.27 to 12.93) but not in postmenopausal women (2.50; 95% CI -1.79 to 6.79, a range that includes no effect). Only one trial reported adverse events: none serious, and one case of abdominal cramps. No trial measured quality of life. The authors rate the certainty of the evidence as very low, meaning future studies are likely to change the estimates. Trials were small, selection methods were unclear, and two trials lost 20% and 37.5% of participants. The authors state that current evidence does not support routine clinical use and call for more well-designed randomized trials in pre- and postmenopausal women. They note the main limitation was that only one of the contacted trial authors supplied additional data, and that this is the first systematic review of Tribulus for FSD.

José de Oliveira Vilar Neto et al. (2025) · Nutrients

This systematic review of 10 clinical studies (483 men in total) examined whether Tribulus terrestris supplements improve erectile dysfunction (ED, difficulty achieving or keeping an erection) and testosterone levels. Tribulus is a plant used for centuries in India and China as a sexual stimulant. Its steroidal saponins (plant compounds with hormone-like structure) are proposed to raise testosterone and to boost nitric oxide, a molecule that relaxes blood vessels and supports erections, though the authors note the mechanism is not fully understood. The review asked whether the evidence supports either claim, and it looked at men with and without low testosterone. Researchers searched 13 databases for studies in which men took Tribulus on its own, without other supplements or drugs. Ten studies qualified: nine clinical trials and one study without a control group, conducted in Egypt, Bulgaria, Brazil, Australia, India, China and Spain. Participants were aged 16 to 70: healthy men, men with ED (some also with low testosterone), and men with low sperm counts or unexplained infertility. Doses ran from 400 mg to 12 g per day for 4 weeks to 3 months. Study quality was graded with the Jadad scale, a 5-point checklist of randomization, blinding and dropouts. Three of the five studies that measured erectile function found improvement, and all three enrolled men with ED. One trial using 500 mg daily for 3 months raised International Index of Erectile Function (IIEF-5) scores against placebo, with significance already at 4 weeks (p = 0.0119) and stronger by the end (p < 0.0001). Eight of ten studies found no significant testosterone change, and those men did not have low testosterone at the start. Two studies in men with low testosterone found rises of about 58 to 71 ng/dL (27 to 33%), a small increase in clinical terms (roughly from 215 to 273 and 213 to 284 ng/dL), and both scored poorly for methodological quality (Jadad 2 and 0). None of the studies reported side effects, and lipid and liver tests showed no impairment. The authors conclude that evidence for improved erectile function at 400 to 750 mg per day is of low level and that no solid evidence shows Tribulus raises testosterone. Half of the studies had a high risk of bias, samples were small, saponin content varied between products, and no meta-analysis was possible. The authors state that Tribulus is not a substitute for first-line treatment of severe ED and call for well-controlled randomized trials to define dose and duration, including trials in men with low testosterone.

Aneesh Basheer et al. (2022) · Interactive journal of medical research

This systematic review pooled the human clinical trial evidence on Bacopa monnieri (Brahmi), a plant long used in Ayurvedic medicine and studied in animal models for its potential to protect brain cells, to ask whether it actually helps people with Alzheimer's disease or the memory decline that often precedes it (mild cognitive impairment). The comparison point was donepezil, the standard prescription drug for Alzheimer's, which modestly eases symptoms but does not slow the underlying disease. The review searched five major databases and trial registries through January 2021 and found only 5 trials, involving a total of roughly 200-plus participants, that directly tested Bacopa in people already diagnosed with Alzheimer's or mild cognitive impairment (most prior Bacopa research had studied healthy adults instead). The trials varied widely in dose, length (2 to 12 months), and whether Bacopa was given alone or mixed with other herbs and nutrients, so the researchers could not statistically combine the results and instead described each trial's findings individually. Study quality was assessed using the Cochrane risk-of-bias tool and graded overall with the GRADE system. The five trials told an inconsistent story. The largest head-to-head comparison against donepezil found no difference between the two through nine months, with donepezil only pulling ahead at the one-year mark in a trial that had to stop early due to poor participant recruitment (34 of a planned 48). Two other trials reported improvement, but Bacopa was just one ingredient in a multi-herb blend in both, so the benefit cannot be pinned on Bacopa specifically. A fourth trial had questionable methods, including dropping 15 participants from the analysis after the fact without explanation. None of the five trials reported serious safety concerns with Bacopa. Overall, the reviewers found no solid evidence that Bacopa monnieri outperforms placebo or donepezil for Alzheimer's disease or mild cognitive impairment, rating the certainty of the existing evidence as very low. This does not mean Bacopa definitely does not help, only that the trials done so far are too few, too small, and too inconsistent to say either way. The authors call for larger, well-designed trials testing Bacopa on its own before any conclusion about its use in dementia can be drawn.

Galib Ruknuddin et al. (2026) · JMIR research protocols

This paper is not a study of a treatment — it is a detailed, PROSPERO-registered plan (protocol) for a future systematic review that will evaluate India's AYUSH traditional medicine systems (Ayurveda, yoga and naturopathy, Unani, Siddha, Sowa Rigpa/Tibetan medicine, and homeopathy — governing prevention and personalized care) for managing prediabetes and type 2 diabetes. Diabetes affects roughly 537 million people worldwide, a number expected to more than double by 2050, and India alone had over 74 million cases in 2021 — with about half going undiagnosed — making a clear-eyed evidence review of its traditional treatment options a genuine public-health priority. Once underway, two independent researchers will search major databases (PubMed, Scopus, Web of Science, Embase) plus AYUSH-specific sources, screening for studies conducted in India that test any of these six systems — whether used alone or alongside standard diabetes care — measuring outcomes like blood sugar levels (fasting and after meals), long-term blood sugar control (HbA1c), and insulin resistance, alongside safety data. As of this publication, there are no results to report (the review had not yet started; database searching was planned for September 2025). What the protocol does establish is exactly how quality will be judged: each study will be scored with standard tools (from the NIH, and the Cochrane risk-of-bias tool for randomized trials) and then sorted into a visual "evidence map" — graded green, yellow, or red by the World Health Organization's A/B/C evidence-quality scale — showing at a glance where each traditional system has strong support and where the gaps are. The completed review and its findings are expected around December 2026, with publication in early 2027. For now, the practical takeaway is that this protocol tells us what will be studied and how carefully, not what was found. Until the finished evidence map is published, none of the six systems named here has established evidence for diabetes management; the protocol itself states upfront limitations even for the eventual review: English-language sources only, India-based studies only, and no pooled statistical meta-analysis planned.

Janmejaya Samal (2015) · Journal of intercultural ethnopharmacology

This systematic review pooled published research on using Ayurveda, India's traditional medical system, alongside standard drugs for pulmonary tuberculosis (PTB) — a bacterial lung infection that remains one of India's leading causes of death. The review searched PubMed through April 2015 and found six studies worth including: four human trials testing Ayurvedic herbal formulas as add-ons to standard anti-TB drugs (ATDs), and two lab studies testing plant extracts directly against the TB bacterium. In Ayurveda, PTB is traditionally understood as Rajayakshma, a wasting condition tied to depleted bodily tissues (dhatu) and vital reserve (ojas) — explaining why many of the formulas studied are rejuvenative "Rasayana" tonics rather than antibiotics. The four clinical trials enrolled 30 to 133 PTB patients each, all in India, and ran from 28 days to 6-8 months. Participants took Ayurvedic formulas — a nine-herb Rasayana capsule, a liquid tonic called Bhringarajasava, Ashwagandha with Chyawanprash, or a hepatoprotective blend called Liv-600 — alongside their prescribed drug regimen (DOTS). Researchers tracked symptoms like cough and fever, body weight, X-ray changes, drug blood levels, and liver enzymes. The two lab studies tested leaf and plant extracts against TB bacteria in culture, measuring the lowest concentration that stopped bacterial growth. Across the trials, Ayurvedic add-ons consistently eased symptoms and supported weight gain more than standard treatment alone (p<0.001 in the largest trial). One striking finding: Ashwagandha plus Chyawanprash raised blood levels of two key TB drugs, isoniazid and pyrazinamide, by 7-10% (meaning the body absorbed more of the medicine that actually kills the bacteria) — potentially valuable given rising drug resistance. The hepatoprotective blend showed no harmful rise in liver enzymes, suggesting it may guard against the liver damage these drugs can cause. In the lab, extracts from four of five tested legumes completely stopped bacterial growth at a low concentration (50 micrograms per milliliter), and extracts from five other plants inhibited even drug-resistant TB strains by up to 95%. These findings position Ayurvedic formulas as promising supportive care — easing symptoms, protecting the liver, and possibly boosting drug absorption — rather than replacements for standard TB treatment, which no study tested. The evidence base is thin: only six studies total, all small, mostly from India, with just one describing blinding and none pooling results statistically. The authors call for properly designed clinical trials of the lab-active plants, especially against multidrug-resistant TB. The evidence reviewed concerns Ayurvedic preparations as adjuncts to prescribed drug therapy; none of it addresses their use instead of it.

Ali Shields et al. (2023) · JAMA dermatology

Many people with acne turn to over-the-counter vitamins, minerals, herbal extracts, and probiotics hoping for a gentler alternative to prescription treatments -- but how well do these actually work? This systematic review pooled 42 randomized trials (3,346 participants total) testing oral nutraceuticals for acne, following a pre-registered research protocol and searching four major databases through January 2023. The interventions ranged from zinc and vitamins to green tea extract, fenugreek, probiotics, fish oil, and a traditional Korean herbal formula, giving a rare side-by-side look at how these popular supplements stack up against placebo. Reviewers independently screened thousands of records down to 42 qualifying randomized trials and rated each one's quality using a standard bias-assessment tool. Most trials (27 of 42) were rated poor quality, 11 fair, and only 4 good -- a reminder that supplement research overall is thinner than for prescription acne treatments. Outcomes tracked included clinician-rated improvement, lesion counts, patient-reported satisfaction, and side effects. Results varied widely by supplement. Zinc, the most-studied option, worked in only about half its trials and caused the most stomach-related side effects of anything tested, though higher doses (600 mg/day) tended to work better than lower ones. Vitamin D (1,000 IU/day) meaningfully reduced inflamed acne lesions in people who were vitamin D-deficient. Green tea extract cut inflammatory lesion counts but did not improve people's reported quality of life. Probiotics -- especially certain Lactobacillus strains -- showed the most consistently positive results across several small trials and were well tolerated. Omega-3 and omega-6 fatty acids reduced both inflamed and non-inflamed lesions after about 10 weeks. Pantothenic acid (vitamin B5) helped, but only at a dose far above typical nutritional intake. Fenugreek seed extract underperformed compared with an antibiotic in one small study. Four options -- vitamin D, green tea extract, probiotics, and the herbal formula cheongsangbangpoong-tang -- had the strongest (though still limited) supporting evidence. Vitamin D and omega-3/6 fatty acids carried the lowest risk in these trials, since their effective doses are close to normal nutritional intake, while zinc showed mixed results and a higher side-effect rate. Overall, most of this evidence comes from small, lower-quality trials; none of these supplements was tested as a replacement for proven acne treatments — the trials studied them as possible add-ons.

Aliasghar Manouchehri et al. (2023) · JBRA assisted reproduction

Polycystic ovary syndrome (PCOS) is one of the most common hormone-related conditions affecting women of reproductive age, estimated to affect 4-25% of women depending on how it is diagnosed (14.6% in Iran). Beyond irregular periods and fertility struggles, PCOS often comes with insulin resistance, weight gain, acne, excess hair growth, and long-term metabolic risk. Because standard medications can carry side effects, researchers have looked to medicinal plants as gentler options. This review pulls together what is known about nine herbs -- from aloe vera to flax -- and how each is thought to act on the hormonal and metabolic disruptions behind PCOS. Unlike a systematic review with a registered search protocol, this is a narrative synthesis: the authors describe the proposed mechanism of each of nine plants -- aloe vera, chamomile, chaste tree, cinnamon, ginseng, stachys, fennel, liquorice, and flax -- based mainly on animal and laboratory studies rather than human clinical trials. Each plant's key active compound and hypothesized mechanism of action are summarized in a comparison table, covering effects on hormone levels, ovarian tissue, insulin sensitivity, and inflammation. Each herb is proposed to work differently. Cinnamon appears to improve insulin sensitivity and lower blood sugar and lipids by affecting insulin-receptor signaling. Chaste tree and fennel are proposed to shift the balance of reproductive hormones (chaste tree lowering testosterone, fennel raising progesterone and thickening the uterine lining). Flax's lignans are linked to lower androgen levels and less excess hair growth (hirsutism), while stachys is proposed to ease abnormal uterine bleeding by damping estrogen receptor activity. Chamomile and aloe vera are described as supportive of ovarian tissue and follicle development, and ginseng and liquorice are framed around broader immune and metabolic support. Importantly, the review does not report clinical trial results, statistics, or human outcome data for any of these plants -- the mechanisms described come mainly from animal models and lab studies, not from testing in women with PCOS. The authors see herbal medicine as a promising, low-side-effect complement to PCOS care, working mainly through immune support and cycle regulation rather than direct hormone replacement -- but they are careful to say more research time is needed. Because this is a synthesis of mostly preclinical and mechanistic findings, none of these nine plants can be considered proven PCOS treatments; each is better read as a lead for future controlled human trials than as an established remedy to try in place of medical care.

Katarzyna Janda et al. (2020) · Nutrients

This systematic review pooled nine randomised clinical trials to ask whether passionflower (Passiflora incarnata) helps with anxiety, sleep and related neuropsychiatric symptoms. Passionflower is a perennial climbing vine whose aerial parts, flowers and fruit are used medicinally, and whose activity is attributed to flavonoids such as apigenin and luteolin and to flavonoid glycosides including vitexin and isovitexin. The European Medicines Agency recognised it as a medicinal product in a 2014 herbal monograph. The review frames the problem as stress — the body's response to physical and psychological stressors, which becomes pathological when prolonged and can impair concentration and memory. The authors searched PubMed, Embase and ClinicalTrials.gov to October 2019 and screened 417 records down to nine trials run between 2017 and 2019, five of them in Iran. Participants were all adults, between 16 and 128 per trial, and eight of the nine trials enrolled healthy volunteers rather than diagnosed patients. Preparations varied widely — drops, tablets, syrup, a standardised extract and herbal tea — over periods from a single day to 30 days. Anxiety was measured with instruments including the State-Trait Anxiety Inventory and the Corah Dental Anxiety Scale, sedation with the Ramsey scale, and sleep with polysomnography. Most trials found reduced anxiety, though the benefit was smaller in people whose anxiety was mild to begin with. In generalised anxiety disorder, 45 drops daily for 28 days matched oxazepam without impairing work performance. Before surgery, 500 mg tablets lowered anxiety more than oxazepam, and a 700 mg per 5 mL syrup given 30 minutes before spinal anaesthesia reduced anxiety with haemodynamics unchanged. Compared with midazolam before wisdom-tooth extraction, 260 mg gave similar calming with markedly less somnolence (50% versus 82.5%) and no amnesia at all, against 20% on midazolam — although more participants would still choose midazolam again (52% versus 27.5%), which the authors attribute to that same amnesia preventing negative memories. Herbal tea drunk nightly for a week improved self-reported sleep quality by 5.2% over placebo. No adverse effects, memory loss or collapse of psychometric function were reported anywhere in the review. The practical reading is that passionflower performs comparably to two established sedatives for procedural anxiety, with a different side-effect profile — less somnolence, no amnesia — which may matter where alertness is wanted afterwards. The evidence is genuinely limited, though: nine small trials, too heterogeneous to pool statistically, three of them rated low quality, and most never recorded which part of the plant was used. Its anxiolytic action is thought to work through the GABA system. Larger trials across more varied populations are needed before firm dosing guidance is possible.

Saylee Deshmukh et al. (2025) · Frontiers in pharmacology

This systematic review and meta-analysis examined whether Ayurvedic treatments — herbs, traditional formulations, and purification procedures — can genuinely lower blood pressure in essential hypertension, the symptomless condition that drives much of the world's heart disease and stroke. Researchers screened over 22,000 records from six databases, including India's AYUSH Research Portal, and included 44 studies, with ten randomized controlled trials (524 participants) providing data strong enough to pool statistically. The interventions ranged widely: single herbs like Arjuna (Terminalia arjuna, Ayurveda's principal heart remedy), Rudraksha seed powder, and Eclipta alba extract; polyherbal and herbomineral formulations; and Panchakarma purification procedures such as therapeutic purgation. Treatment durations ran from 10 days to a full year. The meta-analysis compared Ayurveda against two benchmarks — placebo and standard blood-pressure drugs — using Cochrane methods with formal risk-of-bias assessment. The pooled answer was no significant difference either way. Versus placebo, systolic pressure fell a non-significant 2.63 mmHg (95% CI −6.04 to 0.79, p=0.13); versus standard drugs the gap was essentially zero (−0.22 mmHg, p=0.47) — Ayurveda neither beat the drugs nor clearly lost to them. Heterogeneity was extreme (I² up to 98%), meaning the trials disagreed sharply: two of three placebo-controlled and five of eight drug-controlled trials individually favored Ayurveda, while others favored the comparator. Uncontrolled before-after studies showed large drops of 16–29 mmHg, but those designs cannot separate treatment effects from regression to the mean. No adverse events were reported where safety was tracked. The honest takeaway on Ayurvedic care for high blood pressure: the tradition's safety record in these studies was good and some individual trials are promising, but pooled controlled evidence does not yet show blood-pressure reductions beyond placebo or medication. Given the risks of unmanaged hypertension, the review's own conclusion is that the evidence does not yet justify Ayurvedic approaches standing in for proven treatment.

Jinglan Mu et al. (2020) · The Cochrane database of systematic reviews

Does acupuncture help chronic low back pain? A Cochrane systematic review — the reference standard for evidence synthesis in medicine — pooled 33 randomized controlled trials with 8,270 adults whose low back pain had lasted more than three months without an identifiable cause, and the answer depends entirely on what acupuncture is compared against. The trials, conducted across Europe, Asia, and the Americas, compared real acupuncture with three alternatives: sham needling (needles placed superficially or away from true acupuncture points), no treatment at all, and usual medical care such as medication and physiotherapy. Pain was measured on 0–100 scales, function with validated back-specific questionnaires like the Hannover Functional Ability Questionnaire, and the review graded how trustworthy each pooled result was using the GRADE framework. Against no treatment, acupuncture delivered a 20-point pain reduction (95% CI 16–25 — well past the roughly 15 points patients can actually feel) along with clear functional improvement. Against usual care, pain improved by about 10 points and physical quality of life rose measurably (4.2 points on the SF-12), though mental well-being did not change. Against sham needling, however, the advantage shrank to 9 points — a real but sub-clinical difference — and back function did not separate at all. Side effects were minor and no more frequent than with sham: needle-site pain, bruising, occasional bleeding, with no serious harms attributed to treatment. For the many people living with chronic low back pain, this review supports acupuncture as genuinely better than doing nothing and a reasonable, safe addition to routine care — while being honest that much of the measured benefit may ride on components shared with sham treatment, such as expectation, focused attention, and the treatment ritual itself. Trial quality was mixed, seven German studies contributed two-thirds of all participants, and the authors conclude the choice should ultimately weigh availability, cost, and personal preference.

Bernie Garrett et al. (2021) · Nursing open

This 2021 rapid evidence assessment examined ten years of research on Therapeutic Touch (TT), one of the most widely practiced energy healing methods in nursing. TT practitioners hold their hands near — but not on — a patient's body, aiming to sense and rebalance the human biofield (a proposed energy field surrounding the body, related to concepts like qi and prana in traditional systems). Developed in 1972 within nursing, TT is still taught in nursing schools today, so two researchers set out to answer a direct question: how well does the recent evidence actually hold up? The reviewers screened seven research databases for every clinical TT study published between January 2009 and March 2020, following PRISMA systematic-review guidelines. From 3,290 records they identified 21 qualifying studies — 15 randomized controlled trials among them — covering 1,302 patients from premature infants to adults in their 90s, in settings from cancer care to post-surgical recovery. Each study was scored for evidence quality and risk of bias using standard appraisal tools. On the surface the results look remarkable: 18 of 21 studies reported benefits — less pain, less anxiety, better sleep, reduced nausea. But quality told a different story. Over 70% of the studies scored the minimum possible evidence rating, and only 4 of 21 had a low risk of bias — and those four stronger studies all found no difference between TT and control treatments (meaning the positive results came almost entirely from the weakest research). No study reported any adverse effects, so safety was not a concern. The review's picture of TT: it appears safe and many participants find it relaxing, but there is currently no high-quality evidence it works better than placebo or other relaxation approaches, and sessions can cost around $120/hour. The reviewers recommend that research first validate whether the biofield can be reliably detected and measured — foundational work that biofield science is actively pursuing — before more clinical trials are run.

Sonia Zadro et al. (2022) · Frontiers in psychology

This study aimed to evaluate the effectiveness of Reiki over placebo in treating mental health symptoms, particularly focusing on anxiety, stress, and depression. Given the increasing prevalence of mental health disorders and the economic burden they impose, understanding the efficacy of Reiki could provide a safe and cost-effective treatment option. The findings suggest that Reiki may offer therapeutic benefits, although the overall evidence remains inconclusive due to the limited number of studies and concerns about bias. The study design was a systematic review of randomized controlled trials (RCTs), including a total of 14 studies with participants aged 18 years or older, both healthy and those with mental health conditions. The intervention tested was hands-on Reiki, where practitioners used specific hand positions either touching or near the participants' bodies. Outcomes were measured using standardized mental health outcome measures, including anxiety, depression, and stress, utilizing validated questionnaires and scales. The duration and frequency of Reiki sessions varied across studies, with specific details not provided. Results indicated that Reiki significantly reduced state anxiety in knee replacement patients (p = 0.004, d = 0.93) and caregiver stress levels (p < 0.001, d = 2.3). Additionally, state and trait anxiety in fibromyalgia patients were significantly reduced after four sessions (p = 0.005 and p = 0.003, respectively). However, no significant differences were found in anxiety or depression for participants with normal mental health scores (anxiety p = 0.295; depression p = 0.102). Participants frequently reported feelings of relaxation and reduced stress levels after Reiki sessions, and no adverse effects were reported in any of the studies. The authors concluded that Reiki shows a moderate to high therapeutic effect on mental health symptoms compared to placebo, suggesting it could be integrated into treatment plans for patients experiencing anxiety, stress, and depression. However, the study is limited by the small number of studies, potential biases, and confounding variables affecting outcomes. Future research should focus on well-controlled double-blind experiments to isolate the mechanisms of Reiki and confirm its efficacy, particularly regarding dose-response relationships and long-term effects.

Manasa Belal et al. (2023) · Global advances in integrative medicine and health

This systematic review synthesizes data from studies on perceptions of subtle pranic energy and the effects of biofield therapies, aiming to enhance understanding of their physical and emotional impacts. The research is significant as it bridges traditional healing practices with modern scientific inquiry, potentially benefiting integrative medicine. The study design involved a systematic review of qualitative and mixed-method research, analyzing nineteen relevant studies published between 1990 and 2022. The sample size varied across studies, focusing on individuals who reported experiences with subtle pranic energy. The intervention tested was not a specific treatment but included various biofield practices such as Reiki, Qigong, and Pranic Healing, with outcomes measured through qualitative interviews and surveys assessing physical, mental, and emotional changes. No specific duration or frequency was detailed as this was a review of existing studies. The meta-synthesis revealed significant experiences of pranic energy during biofield therapies, with participants reporting sensations of energy, including temperature variations and positive physical and psychological effects. Primary outcomes indicated that participants experienced awareness of pranic energy sensations, with no specific statistics provided. Secondary outcomes showed improvements in emotional well-being and physical comfort, although cognitive awareness during therapy did not demonstrate significant change. Qualitative findings highlighted participant-reported outcomes such as increased awareness of energy presence, physical sensations like warmth and tingling, and improved emotional well-being. Importantly, no adverse events were reported during the studies reviewed. The findings suggest that individuals across diverse demographics can benefit from biofield therapies, which may enhance mental and physical well-being. Practitioners could consider incorporating these therapies into their practices to improve patient outcomes. However, the study's limitations include a lack of rigorous empirical data to support personal reports of benefits and insufficient exploration of the mechanisms behind the reported sensations. Future research should focus on investigating these mechanisms and the relationships between different experiential themes to substantiate the therapeutic applications of biofield practices.