There is an increasing interest in the health risks related to the use of herbal remedies. Although most consumers think that phytomedicines are safe and without side effects, interactions between complementary alternative and conventional medicines are being described. The aim of this clinical case report is to highlight the importance of the safe use of herbal remedies by providing a clinical interaction study between pharmaceutical medicines and herbal medicinal products. The case of a patient self-medicated with Valeriana officinalis L. and Passiflora incarnata L. while he was on lorazepam treatment is described. Handshaking, dizziness, throbbing and muscular fatigue were reported within the 32 h before clinical diagnosis. The analysis of family medical history ruled out essential tremor, Parkinson's disease, Wilson's disease and other symptom-related pathologies. His medical history revealed a generalized anxiety disorder and medicinal plant consumption but no neurological disorder. Appropriate physical examination was carried out. An additive or synergistic effect is suspected to have produced these symptoms. The active principles of Valerian and passionflower might increase the inhibitory activity of benzodiazepines binding to the GABA receptors, causing severe secondary effects. Due to the increase in herbal product self-medication, the use of herbal remedies should be registered while taking the personal clinical history. Multidisciplinary teams should be created to raise studies on medicinal plants with impact on medical praxis.

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BackgroundFish-based therapeutics is fundamentally based on a dietary use, but these vertebrates have also been employed in the treatment of infectious and parasitic diseases, during pregnancy, childbirth and postpartum and to deal with diseases of the different systems.MethodsAn overview of the ethnomedical and historical Spanish literature has been carried out. Automated searches in the most important national and international databases have been performed. All related works have been thorough examined.ResultsWe examine the historical use of 54 medicinal fish species, 48 marine and six from inland waters. As useful, in Ancient times 39 species have been recorded (of which only 21 have been collected in subsequent periods), seven in the Middle Ages, 18 in Modern times and 17 in the contemporary period. Anguilla anguilla, Engraulis encrasicolus or Scyliorhinus canicula are species that have survived over time as an ingredient in Spanish folk remedies. Most remedies used in the last century and currently are empirical remedies based on the humorism theory and the principle of contraria contrariis curantur (74%), and the rest (26%) are magical type remedies that complete the popular therapeutic arsenal.ConclusionsIn the last century we find a progressive decrease in the number of fish species used in ethnomedicine. Only seven taxa have been documented as surviving therapeutic resources since centuries ago. The existence of a dynamic Spanish ethnomedicine has also been detected which has managed to generate new therapeutic resources in recent times. It is important to validate the remedies by ethnopharmacology and evidence-based medicine. In order to recover as much data as possible, it will be necessary to draw up an inventory of ethnoichthyological uses.

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