• TCM in der Behandlung des Kniegelenks (TCM in the Treatment of the Knee)
    Greten, HJ, ATOSnews 2009 Nr. 13
  • Objectifying specific and non-specific effects of acupuncture: A double-blinded, randomised trial in osteoarthritis of the knee
    Karner M, Brazkiewicz F, Remppis A, Fischer J, Gerlach O, Stremmel W, Subramanian SV, Greten HJ. Evid Based Complement Alternat Med, 2013, http;// (IF 4,774)
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    Introduction. Acupuncture was recently shown to be effective in the treatment of knee osteoarthritis. However, controversy persists whether the observed effects are specific to acupuncture or merely nonspecific consequences of needling. Therefore, the objective of this study is to determine the efficacy of different acupuncture treatment modalities. Materials and Methods. We compared between three different forms of acupuncture in a prospective randomised trial with a novel double-blinded study design. One-hundred and sixteen patients aged from 35 to 82 with osteoarthritis of the knee were enrolled in three study centres. Interventions were individualised classical/ modern semistandardised acupuncture and non-specific needling. Blinded outcome assessment comprised knee flexibility and changes in pain according to the WOMAC score. Results and Discussion. Improvement in knee flexibility was significantly higher after classical Chinese acupuncture (10.3 degrees; 95% CI 8.9 to 11.7) as compared to modern acupuncture (4.7 degrees; 3.6 to 5.8). All methods achieved pain relief, with a patient response rate of 48 percent for non-specific needling, 64 percent for modern acupuncture, and 73 percent for classical acupuncture. Conclusion. This trial establishes a novel study design enabling double blinding in acupuncture studies. The data suggest a specific effect of acupuncture in knee mobility and both non-specific and specific effects of needling in pain relief.

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  • Acute Effects of Acupuncture in Chronic Low Back Pain – A Preliminary, Prospective, Randomised, Controlled and Single Blinded Study
    Seca S, Master Thesis 2011, University of Porto, supervised by Greten HJ
  • Efeitos Agudos da Acupuntura na Dor Lombar Crónica Estudo Prospetivo, Randomizado, Controlado e Duplo Cego
    Duarte A, Master Thesis 2012, University of Porto, supervised by Greten HJ


  • Differential effect of Rhizoma coptidis and its main alkaloid compound berberine on TNF-alpha induced NFkappaB translocation in human keratinocytes.
    Enk R, Ehehalt R, Graham JE, Bierhaus A, Remppis A, Greten HJ.
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    The Chinese medicine Rhizoma coptidis (RC) is well established in the treatment of common dermatological disorders although the mechanism of its‘ anti-inflammatory effects have previously remained elusive. We stimulated an inflammatory state in human keratinocyte cultures using TNF-alpha in the presence of RC extract (RCE) and berberine, to identify the dose-dependent anti-inflammatory role of these compounds. Control data demonstrates significant translocation of NFkappaB into the nucleus after stimulation with TNF-alpha. This translocation can be inhibited, and hence anti-inflammatory effects inferred, by RCE but not by berberine. We conclude that in dermatological disorders berberine exerts its anti-inflammatory effects by inhibiting signal transduction pathways other than the NFkappaB dependent pathway, while the RCE complex acts partially by blocking the NFkappaB dependent pathway. Rhizoma coptidis extract therefore appears to be a potent inhibitor of TNF-alpha induced inflammation in dermatological conditions.

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  • Rhizoma Coptidis inhibits LPS-induced MCP-1/CCL2 production in murine macrophages via an AP-1 and NFkappaB-dependent pathway.
    Remppis A, Bea F, Greten HJ, Buttler A, Wang H, Zhou Q, Preusch MR, Enk R, Ehehalt R, Katus H, Blessing E.Mediators Inflamm. 2010;2010:194896. doi: 10.1155/2010/194896. Epub 2010 Jun 21.
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    The Chinese extract Rhizoma coptidis is well known for its anti-inflammatory, antioxidative, antiviral, and antimicrobial activity. The exact mechanisms of action are not fully understood.
    We examined the effect of the extract and its main compound, berberine, on LPS-induced inflammatory activity in a murine macrophage cell line. RAW 264.7 cells were stimulated with LPS and incubated with either Rhizoma coptidis extract or berberine. Activation of AP-1 and NFkappaB was analyzed in nuclear extracts, secretion of MCP-1/CCL2 was measured in supernatants.
    Incubation with Rhizoma coptidis and berberine strongly inhibited LPS-induced monocyte chemoattractant protein (MCP)-1 production in RAW cells. Activation of the transcription factors AP-1 and NFkappaB was inhibited by Rhizoma coptidis in a dose- and time-dependent fashion.
    Rhizoma coptidis extract inhibits LPS-induced MCP-1/CCL2 production in vitro via an AP-1 and NFkappaB-dependent pathway. Anti-inflammatory action of the extract is mediated mainly by its alkaloid compound berberine.

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  • The Chinese phytotherapy: oriental and western pathophysiological aspects and perspectives – the example of ephedrae decoctum
    Soares H, Master Thesis 2010, University of Porto, supervised by Greten HJ
  • Self-medication with nutritional supplements and herbal over-the-counter products
    Eichhorn T, Greten HJ, Efferth T. Nat. Prod. Bioprospect 2011, 1, 62-70
  • Quality Control for Medicinal Plants
    Efferth T, Greten HJ, Med Aromat Plants 2012, 1:7
  • The European directive on traditional herbal medicinal products: friend or foe for plant-based therapies?
    Efferth T, Greten HJ. JCIM 2012; 10(4):357-61; DOI: 10.3736/jcim20120401
  • Medicinal and Aromatic Plant Research in the 21st Century
    Efferth T, Greten HJ. Medicinal Aromatic Plants 2012. 1:2
  • Potential of ‚Omics‘ Technologies for Implementation in Research on Phytotherapeutical Toxicology
    Greten HJ, Efferth T in Shyur LF, Lau AS. Adv Bot Res. Recent Trends in Medicinal Plants Research. Elsevier, Amsterdam, 2012, Vol. 62
  • Animal plant warfare and secondary metabolite evolution
    Wöll S, Hee Kim SH, Greten HJ, Efferth T. Nat. Prod. Bioprospect. 2013, DOI 10.1007/s13659-013-0004-0
  • Mechanisms of Herb-Induced Nephotoxicity
    Allard T, Wenner T, Greten HJ, Efferth T. Curr Med Chem. 2013 Apr 12. PMID: 23597204
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    Herbal therapies gained much popularity among the general public, but compared to therapies approved by official authorities, toxicological studies are frequently not available for them. Hence, there may be inherent risks and the kidneys may be especially vulnerable to toxic effects. Herbs may induce nephrotoxicity by induction of apoptosis. High oxalate contents in Star fruit (Averrhoa carambola L.) may induce acute nephropathy. Triptolide from Thunder God Vine (Triperygium wilfordii Hook) is a diterpenoid epoxide with induces reactive oxygen species and nephrotubular apoptosis. Cranberry juice is discussed as promoter of kidney stone formation (nephrolithiasis). Abuse of guaifenesin from Roughbark (Guaicum officinale L.) increases stone formation. Aristolochia acids from Aristolochia fangchi Y.C.Wu ex L.D. Chow & S.M. Hwang causes the well-known aristolochic acid nephropathy and carcinogenesis by DNA adduct formation. Carboxyatractyloside from Impila (Callilepsis laureola DC.) inhibits mitochondrial ATP synthesis. Acute allergic interstitial nephritis was diagnosed after intake of Peruvian Cat’s claw (Uncaria tomentosa Willd. DC.). Whether or not Willow Bark (Salix alba L.) induces analgesic nephropathwy is a matter of discussion. Other herbal therapies are considered to affect the rennin-angiotensisn-aldosterone (RAA) system Ephedra sinica Stapf with its ingredient ephedrine. Devil’sx Claw (Harpagophytum procumbens DC. Ex Meisn.) and licorice (Glycyrrhiza glabra L.) may inhibit major renal transport processes needed for filtration, secretion, and absorption. Strategies to minimize nephrotoxicity include (1) quality control and standardization of herbal products, (2) research on the molecular modes of action to better understand pathophysiological mechanisms of herbal products as well as (3) clinical trials to demonstrate efficacy and safety.


  • Chinese Pharmacotherapy in Cancer and Inflammation: From Molecular Mechanisms to Rational Application
    Greten HJ. Scientific Approaches to Chinese Medicine, Heidelberg 2007, Heidelberg School Editions, ISBN 978-3-939087-08-3
  • Curcumin induces apoptosis in human neuroblastoma cells via inhibition of NFκB
    Freudlsperger C, Greten J, Schumacher U, Anticancer Research 28: 209-214 (2008)
  • Anti-Inflammatory and Anti-Cancer Activity of Boswellic Acids from Frankincense (Bosellia serrate Roxb. et Colebr, B. carterii Birdw.)
    Efferth T, Greten HJ. Forum on Immunopathological Diseases and Therapeutics. 2(4):303-313 (2011)
  • Effects of Scrophularia ningpoensis Hemsl. on inhibition of proliferation, apoptosis induction and NF-kB signaling of immortalized and cancer cell lines
    Shen X, Eichhorn T, Greten HJ, Thomas Efferth T. Pharmaceuticals 2012, 5, 189-208
  • Autophagy by Natural Products in Cancer Cells
    Efferth T, Greten HJ, Biochem Anal Biochem 2012. 1:8


  • Assessment of Qigong-Related effects by Infrared Thermography: A Case Study
    Matos LC, Gonçalves M, Machado J, Greten HJ. JCIM 2012; 10(6):663-666
  • Effects of Qigong on the Balance of Elderly People – A feasibility study
    Sousa L, Master Thesis 2012, University of Porto, supervised by Greten HJ


  • Qigong Therapy in Physiotherapists in Burnout – A Preliminary Study
    Saganha JP, Doenitz CA, Greten T, Efferth T, Greten HJ, 2012, JCIM 2012; 10(11): 1233-9
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    The study was carried out in order to evaluate the prevalence of burnout in physiotherapists, and to assess whether „White Ball“ Qigong exercises may be effective in burnout. This was aimed to provide preliminary data for the preparation and development of a larger study.
    Physiotherapists completed a demographic questionnaire and the Maslach Burnout Inventory (MBI) questionnaire. For the intervention and the control groups, the authors selected those physiotherapists with the highest levels of burnout on the most important subscale. The intervention group (eight physiotherapists) performed a specific qigong intervention as developed by the Heidelberg School of Chinese Medicine; the control group consisted of eight physiotherapists on a waiting list. At the end of a three-week period of treatment or waiting list, both groups repeated the MBI for the comparison of results.
    Of 106 physiotherapists (36 males and 70 females) assessed by the MBI, Emotional Exhaustion subscale was seen in 52 (49.1%), Depersonalization subscale in 36 (33.9%), and Burnout in the Personal Accomplishment subscale in 33 (31.2%), of whom 4 (3.8%) suffered to a severe degree and 29 (27.4%) moderately. Within the study group qigong lowered the mean values of Emotional Exhaustion subscale from 38.0 to 31.4, whereas in the control group the values rose from 33.9 to 37.9. The differences between the two groups were statistically significant (P=0.023). Qigong lowered the mean value of Depersonalization subscale from 10.8 to 6.8. In controls the value rose from 7.3 to 10.6. The difference between the two groups was statistically significant (P=0.013). The mean values of Personal Accomplishment subscale decreased in both groups: from 35.4 to 33.9 in the intervention group, and from 37.5 to 37.1 in the control group. The difference between the two groups was not statistically significant.
    The effects of „White Ball“ Qigong on burnout symptoms are measurable by the MBI. The results are compatible with the thesis that this type of qigong is an effective tool for the self-management of burnout. It is easy to integrate into a daily routine as it takes only 2×5 min per day. On the basis of this evaluation, a study design can now be developed on a larger scale with appropriate blinding, follow-up testing and adequate controls.

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  • Effects of qigong on performance – related anxiety and physiological stress functions in transverse flute music schoolchildren – A Feasibility Study –
    Sousa CM, Gonçalves M, Machado J, Efferth T, Greten T, Froeschen P, Greten HJ. JCIM 2012; 10(8):858-65
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    Based on individual cases of treatment, we were interested in whether the effects of a special kind of qigong, the „White Ball“ exercises, can be objectified by physically measurable parameters and psychological scores.
    We performed a preliminary prospective controlled interventional study with the waiting list design. In the qigong group eight children were included. They received specific qigong lessons of the „White Ball“ qigong over seven weeks, twice a week, for 30 min with a waiting list design and instructions to perform the same exercises at home daily. In the control group eight children were included in a waiting list design with no qigong instruction. Subjective perception of anxiety was measured by the Portuguese version of the Depression, Anxiety and Stress Scale adapted for children. In addition, salivary cortisol, heart rate variability, blood pressure, surface electromyography of the trapezius muscle and reaction time were measured at the beginning and the end of the study prior to the regular public auditions.
    In comparison to the changes in the control group, the qigong group scored significantly lower in heart rate. Otherwise the groups did not differ significantly; however, the effect size was large for salivary cortisol, surface electromyography of the trapezius muscle and blood pressure. There were relevant reductions of subjective perception of anxiety, salivary cortisol levels and heart rate.
    The heart rate of performing schoolchildren can be potentially reduced by „White Ball“ exercises. Based on a sample of 8/8, positive tendencies were also observed for anxiety and blood pressure. The next steps of objectifying possible qigong effects are to increase the sample size, to study young people in other situations arousing anxiety, to develop an appropriate control intervention, to solve the problem of blinding and double blinding, to find additional parameters that may be influenced by the „White Ball“ qigong, and to compare the qigong effects with other methods reducing anxiety such as more traditional biofeedback or systematic desensitization

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