Systematic Aggregation, Analysis, and Review of the Literature
Search Strategy
To prepare each Natural Medicines monograph, electronic searches are conducted in many databases, including AMED, CANCERLIT, CINAHL, CISCOM, the Cochrane Library, EMBASE, HerbMed, International Pharmaceutical Abstracts, Medline, and NAPRALERT. Search terms include the common name(s), scientific name(s), and all listed synonyms for each topic. Searches are conducted of additional journals (not indexed in common databases), and of bibliographies from selected secondary references. No restrictions are placed on language or quality of publications. Researchers in the field of complementary and alternative medicine (CAM) are consulted for access to additional references or ongoing research.

Selection Criteria
All literature is collected pertaining to efficacy in humans (regardless of study design, quality, or language), dosing, precautions, adverse effects, use in pregnancy/lactation, interactions, alteration of laboratory assays, and mechanism of action (in vitro, animal research, human data). Standardized inclusion/exclusion criteria are utilized for selection.

Data Analysis
Data extraction and analysis are performed by health care professionals conducting clinical work and/or research at academic centers, using standardized instruments that pertain to each monograph section (defining inclusion/exclusion criteria and analytic techniques, including validated measures of study quality). Data are verified by a second reviewer.

Review Process
Blinded review of monographs is conducted by multidisciplinary research-clinical faculty at major academic centers with expertise in epidemiology and biostatistics, pharmacology, toxicology, complementary and alternative medicine (CAM) research, and clinical practice. In cases of editorial disagreement, a three-member panel of the Editorial Board addresses conflicts, and consults experts when applicable. Authors of studies are contacted when clarification is required.

Update Process
Natural Medicines regularly monitors scientific literature and industry warnings. When clinically relevant new data emerge, best efforts are made to update content immediately. In addition, regular updates with renewed searches occur every 3-18 months, variable by topic.