Why do patients reach out for herbal medicinal products in the first place? What is the true potential of phytopharmaceuticals and where are their limitations? Phytopharmaceuticals are effective medicines with low incidence of side effects. They are becoming increasingly popular among the population and account for a significant part of the pharmaceutical market. In particular, herbal medicinal products play an increasingly important role in self-medication—the responsible act of utilizing prescription-free medication for the purpose of health maintenance and prevention of ill health.

Phytopharmaceuticals are medicines with active ingredients obtained exclusively from plants. In contrast to most synthetic chemical ingredients and isolated pure substances of biogenic origin, the active ingredient of herbal medicines is a multi-component mixture with high-quality demands. The advantage of this multi-component mixture is often precisely the fact that a number of substances with different mechanisms contribute to the desired overall effectiveness. Evidence of efficacy in clinical trials has shown that herbal medicinal products have the right to occupy a firm place in modern drug therapy. The authorization of herbal medicinal products is analogous to that of drugs with synthetic chemical or biological pure substances.

Herbal medicinal products are generally regarded as having a relatively low risk. Despite the fact that side effects and interactions cannot be excluded, a special feature of herbal medicines is that they usually have a lower rate of side effects than synthetic drugs. The use of phytopharmaceuticals rarely leads to adverse drug reactions. Therefore, herbal medicines are particularly suitable for children and patients with multiple diseases.

The earlier use of medicinal plants as teas, powdered medicines, or alcoholic extracts (tinctures, drops) is still common, especially in mood disorders. Thanks to intensive research and modern technology, today extracts can be concentrated and marketed as capsules, drops, or tablets, which contain the active ingredients of the plant.

Drugs that include individual substances isolated from plant extracts as well as homeopathic remedies based on plants, anthroposophic medicines (medicines of Hildegard medicine or Bach flower preparations), natural cosmetics, or dietary supplements are therefore not considered as herbal medicinal products.

Today, the perception of herbal medicinal products oscillates between enthusiastic acceptance and radical rejection. Unfortunately, supporters and opponents argue mostly on a fundamental level and they hardly differentiate. Therefore, it is the intent to present information in an objective, independent, and fair manner so that emotional arguments are replaced by correct factual arguments. Supporters and opponents also talk about some very different things, such as herbal medicinal products and dietary supplements (functional food, etc.), which are increasingly present on the market. However, dietary supplements are legally classified as foods and therefore only suitable for the maintenance of good health. Although dietary supplements may also be of plant origin, they are not medicines because they neither have to demonstrate pharmaceutical quality, pharmaceutical effects, and efficacy nor their safety (adverse effects, toxicity, etc.). In their appearance, dietary supplements are very similar to medicines. This causes a great danger for the patient: The dietary supplements are used by the patient in the form of self-medication but the critical evaluation (by the doctor, pharmacist, leaflet) is missing.

This direction currently represents a massive threat for phytopharmaceuticals. How can a patient recognize whether a drug is a medicine or not? Each drug is allocated an approval number according to the pharmaceutical legislation. Dietary supplements do not have this authorization number. Efficacy and safety can be expected only from medicines, as they must be tested. Given the confusing offers of the internet and drugstores, there is urgent need for consultation strategies and targeted information regarding the characteristics and marketing of dietary supplements and medicines.

It is equally important that doctors and pharmacists receive adequate and scientifically sound information about phytopharmaceuticals during their training to educate patients regarding the quality, safety, and efficacy of the herbal medicines. In addition, the patient should discuss self-medication with herbal drugs with the doctor and/or pharmacist to prevent possible secondary effects or interactions.

The rapidly growing demand for herbal medicinal products is accompanied by a high demand for information, which can only be met by intensive and systematic research. However, the current research funding situation does not appear to hold promise. Due to their low risk, almost all of the phytopharmaceuticals are non-prescription medicines and therefore not reimbursable through health insurance. Research of herbal medicines is becoming less attractive for the industry as well as for the university and this is not without repercussions on research funding. Despite funding problems, there is still interest in research results. It is likely that dietary supplements will take the place of herbal medicines on the market. However, there is little known about their quality and no confirmation of their safety. Currently, the Medicinal Plant Research is massively influenced by political and economic considerations. This situation requires every effort for the development of science-based phytopharmaceuticals, which has already shown significant progress in the last decades.

The results contained in this special issue show the importance of the research activity for the increase in quality and proof of effectiveness of herbal medicinal products.

In addition to a review article regarding the use of herbal antidepressants, anxiolytics, and drugs against dementiain the elderly and an update regarding effects and efficacy of St. John’s Worth - other contributions address the mechanism of action of plant substances in cancer cells.

Further articles deal with the important contribution of herbal medicines to drug safety as well as a literature review on the use of herbal medicines in pediatrics.

In a follow-up booklet the use of herbal medicinal products in Lower Urinary Tract Symptoms(LUTS), as well as in LUTS-caused Bening Prostatic Hyperplasia (BPH), motility modulation beyond Metoclopramide and Domperidone will be discussed. In addition, the problem of ethanol in herbal medicinal products for children will be presented.

We hope that this special issue will increase the understanding of the value and possible use of herbal medicinal products and we thank the authors for their contributions, which support the scientific progress of phytotherapy.

The editor is mostly grateful to the Editorial Board members of “Wiener medizinische Wochenschrift,” who invited me as a guest editor for this special issue on Herbal Medicinal Products and Phytotherapy.

I want to thank Mag. Dr. Ruxandra McKinnon for fruitful discussions and I also want to express the deepest gratitude to all the authors for their significant contributions.

FormalPara Conflict of interest

The author declares that there is no conflict of interest.