Herbal bitters in routine integrative care: a real-world prescription database study from a Swiss hospital

In traditional medicine, natural remedies are often used based on empirical observation and experimental knowledge. Even today, the prescription of phytotherapeutics at major centers for integrative medicine, such as Klinik Arlesheim (KLA) in Switzerland, frequently reflects physician experience rather than a purely guideline-based approach. Therefore, prescribing patterns may offer valuable insights into the clinical logic and cultural framework behind the use of specific remedies. This study examines the use of bitter herbal preparations at KLA as a case example of how routine health data can support hypothesis generation and provide insight into therapeutic culture. This real-world data study involved the analysis of KLA’s prescription database between 2018 and 2019. A total of 301,821 prescriptions were screened, focusing on 66,038 prescriptions containing 34 predefined natural bitter remedies. The analysis was narrowed to 10 frequently used mono- and multi-herbal bitter preparations. Indications, forms of administration and prescribing clinical departments were analysed descriptively. A total of 10,660 prescriptions of bitter preparations were identified. Bitter preparations were most frequently prescribed in psychiatry and oncology particularly for patients experiencing anxiety, stress and stress-related nausea. This pattern diverges from their traditional gastrointestinal use and may reflect evolving clinical applications in integrative care. The study also demonstrates the potential of structured clinical data to surface novel patterns and research hypotheses. The prescribing patterns of bitter substances observed in this study highlight underexplored areas of integrative care, particularly in psychosomatic and oncological contexts. These findings underscore the value of structured, practice-based data as a window into lived therapeutic traditions. Future research should examine both the clinical effects and efficacy as well as the cultural dimensions of phytotherapeutic use, including the unconventional administration of herbal bitters.