## 4 Discussion  
The evaluation and assessment of the clinical trials developed a few basic questions necessary for any study such as \"what is the source/background of the herb?\", \"what is its phytochemicalial profile?\", \"what are the parts, dosage forms, and extraction solvents used?\", \"what is the asking information, dose used, and its clinical phase studied?\" All these questions are summarized briefly below. _Source and background data regarding the herb:_ Basic information relevant to the herb in terms of family, genus, species, folkloric use in cancer, geographical origin, and identification from authentic resources are very important. The plant may vary with regard to phytochemistry, which is subjected to differences in terms of place of origin, wherein altitude, temperature, stress, salinity, irrigation, etc. may affect the nature and quantity of active chemical present [110,111]. The majority of the trials were unable to explain the authentication process for the source of plant used and its background information. This may affect the quality of a clinical trial. _Plytochemical profile for the part used:_ The part of a plant may differ in the nature and amount of active chemicals when compared to other parts of the same plant; hence, there is a need for proper phytochemical profiling. These clinical trials used various parts of the plants such as leaves, roots, fruits, infusion, juice, and essential oils; however, the phytochemistry for the part of the plant used was missing in most of the studies [100]. _Final dosage form used and its preparation/extraction:_ A number of clinical trials used dosage forms (extract or dried powder in capsule/tablet, creams, gels, mouthwashes, liquid extract, pills, syrup, etc. ), however, the method of extraction or dosage form preparation was observed often. For a herbal product to be effective, appropriate extraction/processing is the basic step for success. The factors \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Quality of Trial Based on Assigned Scale** & **Frequency** & **Percent** & **Cumulative Percent (\%)** \\ \hline Very poor quality clinical trials & 27 & 36.99 & 36.99 \\ (6 and below, i.e., negative value) & 15 & 20.55 & 57.53 \\ (7–12) & 19 & 26.03 & 83.56 \\ (13–18) & 12 & 16.44 & 100.00 \\ \hline Total & 73 & 100.00 & \\ \hline \hline \end{tabular}
\end{table} 
Table 7: Final in-house scoring for the clinical trials. involved in extraction/drying/preparation of final dosage form (sunlight, temperature, solvent polarity and non-polarity, extraction time, pressure etc.) may either degrade or enhance the amount of an active ingredient or its activity thereof [112; 113; 114]. It is very crucial to investigate the effect of these factors upon the potential of an herbal dosage, but none of the clinical trial undertook such an investigation. _Choice of green solvent and extraction:_ Most of the extraction at present is performed using green solvents (water, ethanol, acetonitrile, etc.) due to dual properties of being eco- and human-friendly with less adverse effects. The infusion, juice, and fermentation products prepared in the reported clinical trials used alcohol-based solvents that are unhealthy, costly, and carry more adverse effects. Most of these solvents release toxic chemicals upon heating [115]. A need to shift to green extraction may be promoted. _Phase (0-V) selection:_ Although phase-0 is mandatory for sub-therapeutic dose and toxicity, often the phase-I studies are skipped for the herbs with proper ethnopharmacological/folklore data available at community level [116]. In such cases, phase-II studies are started without a prior phase-I study, and hence proper evidence is necessary for an herb to start with a clinical trial. _Masking of clinical study:_ Equally important, a clinical trial should be properly blinded with respect to the patient, care provider/administrator, and data assessor in order to avoid the risk of bias in the data [117; 118]. A number of clinical trials we reported do present the issue of improper blinding.