Ethnopharmacological insights into Symphytum officinale L.: traditional uses, phytochemical composition, therapeutic potential, and clinical-toxicological implications

preparations significantly outperform placebo in acute back pain, knee osteoarthritis, ankle sprains, and myalgia, while showing non-inferiority to diclofenac and an excellent safety profile. However, the presence of hepatotoxic PAs (intermedine and lycopsamine) strictly limits internal use. Topical application remains safe owing to minimal systemic absorption. By bridging historical wisdom with rigorous contemporary data and spotlighting PA-depletion strategies, this review offers a balanced framework for safe clinical application and future formulation optimization.