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Review Article | DOI: https://doi.org/10.31579/2690-1919/557
Consultant Paediatrician National Health Service UK and Chairman of the Advisory Board, International Organisation of Integrated Health Practitioners
*Corresponding Author: Rajeev Gupta, Consultant Paediatrician National Health Service UK and Chairman of the Advisory Board, International Organisation of Integrated Health Practitioners.
Citation: Rajeev Gupta, (2025), Integrating Alternative and Complementary Medicine to Address Chronic Disease Gaps in Modern Medicine, J Clinical Research and Reports, 20(3); DOI:10.31579/2690-1919/557
Copyright: © 2025, Rajeev Gupta. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 24 June 2025 | Accepted: 07 July 2025 | Published: 21 July 2025
Keywords: alternative and complementary medicine; chronic diseases; traditional chinese medicine
Chronic diseases pose a significant global health burden, often characterized by incomplete remission, high recurrence, and polypharmacy-related complications. Despite advances in diagnostics and acute care, modern medicine faces limitations in addressing chronic, multifactorial conditions such as fibromyalgia, irritable bowel syndrome, diabetes, and depression. These limitations contribute to patient dissatisfaction, escalating costs, and persistent disability. Conventional care models often emphasize disease silos and symptomatic control rather than systems biology and whole-person approaches. In contrast, alternative and complementary medicine (CAM) offers individualized, preventive, and integrative models of care that align more closely with chronic disease complexity. CAM systems such as Ayurveda, Traditional Chinese Medicine (TCM), yoga, acupuncture, homeopathy, and chiropractic are based on restoring physiological balance, enhancing self-healing, and minimizing side effects. Evidence suggests that combining biomedical and CAM approaches may improve outcomes in chronic diseases, reduce healthcare utilization, and increase patient empowerment. Recent health policy shifts in the UK, USA, and India have begun to explore integrated care frameworks in primary and tertiary care. These models have demonstrated encouraging results in terms of patient satisfaction and symptom relief. This article explores the scientific rationale, mechanisms of action, and clinical outcomes supporting the integration of CAM into mainstream chronic disease care.
Modern medicine has transformed global health by advancing surgical techniques, pharmaceuticals, and emergency care. Its triumphs in controlling infectious diseases and improving trauma outcomes are undeniable. However, for long-term, lifestyle-driven illnesses like diabetes, hypertension, autoimmune disorders, and chronic pain syndromes, its efficacy is often partial or unsatisfactory. Chronic diseases are responsible for over 70% of global deaths, with increasing prevalence due to aging populations, sedentary lifestyles, and environmental factors [1]. Biomedical models often prioritize acute symptom management and rely on pharmacological interventions, which may not fully address underlying causes or patient individuality. Patients with conditions such as fibromyalgia, irritable bowel syndrome (IBS), or chronic fatigue syndrome frequently report frustration with conventional care due to limited relief and drug side effects. Moreover, the growing phenomenon of "medical pluralism" suggests that patients are increasingly seeking complementary approaches alongside biomedical treatments [2]. This calls for a re-evaluation of rigid boundaries between conventional and traditional healing systems. Integrative healthcare—a system combining the best of both worlds—has the potential to address this unmet need. This article critically examines how CAM modalities can scientifically and therapeutically complement modern medicine to create a more effective chronic disease management framework.
Gaps in Modern Medicine for Chronic Diseases
Chronic diseases often have multifactorial origins involving genetic predisposition, psychosocial stressors, metabolic imbalances, and environmental exposures. Modern medicine, with its reductionist orientation, tends to isolate disease processes into organ-specific dysfunctions, overlooking systemic interactions and mind-body connections. For example, in IBS, functional gastrointestinal symptoms are frequently attributed to stress and gut-brain axis disruption, yet biomedical treatment rarely addresses underlying emotional or neuroendocrine factors [3]. Similarly, in fibromyalgia, treatment may rely on selective serotonin reuptake inhibitors (SSRIs), pregabalin, or NSAIDs, none of which offer long-term resolution and often cause undesirable effects such as fatigue or cognitive dulling [4]. The management of type 2 diabetes often focuses on glycaemic control through oral hypoglycaemics or insulin, while neglecting psychological resilience, dietary behaviour, and metabolic syndrome context. Polypharmacy, particularly in elderly populations, introduces new risks including falls, confusion, drug-drug interactions, and kidney injury [5]. These clinical shortcomings are compounded by a lack of emphasis on prevention and personalized care. Furthermore, time constraints in conventional settings limit the depth of patient-provider communication and hinder holistic assessments. This leaves many patients feeling unseen and unsupported, prompting them to explore CAM modalities. Bridging these gaps requires a broader medical paradigm—one that integrates physiological, emotional, nutritional, and lifestyle factors through evidence-based complementary strategies.
CAM Disciplines and Their Potential in Chronic Disease Care
Ayurveda
Ayurveda, a 5,000-year-old Indian system of medicine, conceptualizes health as a state of equilibrium among three doshas—Vata, Pitta, and Kapha—governing physiological and psychological functions. Chronic disease is seen as a manifestation of doshic imbalance, weakened digestion (Agni), and toxin accumulation (Ama). Ayurveda emphasizes early diagnosis, personalized treatments, detoxification (Panchakarma), rejuvenation (Rasayana), and lifestyle correction. Several Ayurvedic herbs such as Tinospora cordifolia, Emblica officinalis, and Withania somnifera have shown immunomodulatory, adaptogenic, and anti-inflammatory properties. Randomized trials have demonstrated significant reductions in fasting blood glucose and HbA1c in type 2 diabetes patients using Ayurvedic regimens [6]. In osteoarthritis, combinations of guggulu, shallaki, and turmeric have yielded improvements in joint pain and mobility. Ayurvedic mental health therapies such as Shirodhara (forehead oil stream) and Brahmi-based formulations have been used in anxiety and cognitive decline. Ayurveda also incorporates daily and seasonal regimens (Dinacharya and Ritucharya), aligning the body with natural rhythms—a principle overlooked in modern medicine. Moreover, the integration of Ayurveda in hospital settings is gaining traction, particularly in India, Sri Lanka, and Germany. Its incorporation in chronic care pathways may reduce medication burden, improve quality of life, and provide cost-effective solutions.
Yoga Therapy
Yoga, derived from the Sanskrit root Yuj (to unite), offers a comprehensive system of physical, mental, and spiritual practices for maintaining health and managing disease. Unlike isolated exercise routines, yoga combines breath regulation (pranayama), physical postures (asanas), mindfulness (dhyana), and ethical principles (yamas/niyamas). Evidence from randomized controlled trials shows that yoga improves heart rate variability, reduces cortisol levels, and enhances parasympathetic activity [7]. In hypertension, yoga significantly lowers systolic and diastolic pressure, sometimes rivalling antihypertensive drugs [8]. In type 2 diabetes, yoga improves insulin sensitivity, weight loss, and lipid profiles. Yoga therapy has shown significant benefits in chronic back pain, depression, anxiety disorders, and cancer-related fatigue. Neuroimaging studies reveal increased gray matter in regions associated with emotional regulation and attention in long-term practitioners. Importantly, yoga promotes body awareness and interoception—skills critical for chronic illness self-management. Yoga’s non-invasive nature, adaptability, and minimal cost make it ideal for large-scale implementation in public health. Integrating yoga into primary care settings through certified therapists can empower patients and reduce dependence on medication. As a lifestyle medicine tool, yoga offers systemic benefits unmatched by any single pharmacological agent.
Acupuncture and Traditional Chinese Medicine (TCM)
Traditional Chinese Medicine (TCM) views health as the harmonious flow of Qi (life energy) through meridians, with disease resulting from stagnation or imbalance. Acupuncture, a key modality of TCM, involves inserting fine needles at specific points to regulate Qi and restore balance. Neurophysiological studies show that acupuncture stimulates A-delta and C-fibers, triggering the release of endorphins, serotonin, and other neuromodulators [9]. Functional MRI confirms activation of pain-inhibitory centers during acupuncture sessions. Systematic reviews support its efficacy in chronic low back pain, migraine, osteoarthritis, and tension-type headaches [10]. TCM herbal formulations such as Liu Wei Di Huang Wan and Jin Gui Shen Qi Wan have shown promise in metabolic and inflammatory diseases. TCM also includes practices like cupping, moxibustion, and Qigong, each contributing to chronic disease care. Unlike modern medicine, TCM emphasizes pattern differentiation, where two individuals with the same disease may receive different treatments based on their unique constitution. This aligns with modern ideas of personalized medicine. Integrating TCM into allopathic settings requires training, regulation, and outcome measurement, but early models have shown promise. The inclusion of acupuncture in many pain clinics and cancer centers worldwide reflects growing institutional acceptance.
Homeopathy and Chiropractic
Homeopathy operates on the principle of “like cures like,” where highly diluted substances are used to stimulate the body’s self-healing mechanisms. Though often debated, well-designed trials and meta-analyses suggest benefits in allergic rhinitis, rheumatoid arthritis, and irritable bowel syndrome [11]. Homeopathy’s strength lies in its individualized prescription, holistic case-taking, and safety profile. Simultaneously, chiropractic care addresses structural and neuromuscular causes of chronic pain. Spinal adjustments restore vertebral alignment, relieve nerve compression, and improve biomechanical function. Studies show that chiropractic interventions reduce pain and improve function in patients with chronic low back pain and neck dysfunction [12]. Both modalities emphasize patient education and preventive care. Though more research is needed, their inclusion in integrative clinics offers non-pharmacological options that resonate with patients. Professional regulation and adherence to evidence-based practices can help these disciplines gain wider medical acceptance.
Biophysiological and Biochemical Mechanisms of CAM in Chronic Diseases
CAM therapies operate through diverse physiological, biochemical, and neuroendocrine mechanisms that have been increasingly elucidated through modern research. Yoga and meditation, for example, are known to enhance parasympathetic activity, reduce cortisol levels, and normalize inflammatory cytokines such as IL-6 and TNF-α [13]. They improve vagal tone and stimulate the release of gamma-aminobutyric acid (GABA), which has anxiolytic effects and is often deficient in chronic pain and mood disorders. Acupuncture modulates the central nervous system by activating endogenous opioids, including beta-endorphins, enkephalins, and dynorphins, thereby reducing pain perception and enhancing emotional resilience [14]. Herbal remedies from Ayurveda and TCM contain active phytochemicals such as curcumin, withanolides, and ginsenosides that have documented antioxidant, anti-inflammatory, and immunomodulatory effects [15]. These compounds act on nuclear factor kappa B (NF-κB) pathways, PPAR-γ receptors, and other cellular signalling cascades. Homeopathic preparations, though highly diluted, are hypothesized to exert effects via nano-structured water memory or hormesis-like adaptive responses, though this remains an area of ongoing investigation. Chiropractic adjustments influence spinal reflexes, reduce mechanical stress, and enhance proprioceptive input, thereby normalizing muscle tone and improving neuromuscular coordination. Neuroimaging studies demonstrate changes in thalamic and cortical connectivity post-CAM interventions, supporting central modulation hypotheses. Thus, CAM modalities affect multiple systems—neurological, immune, endocrine, and musculoskeletal—offering comprehensive therapeutic benefits beyond what single-target pharmaceuticals can achieve. This systems-level approach aligns well with the multifactorial nature of chronic diseases.
| Chronic Disease | Scientific Basis of CAM Modalities | Synergy for Better Patient Care |
| Type 2 Diabetes | Ayurveda: glucose-regulating herbs; Yoga: improved insulin sensitivity; Acupuncture: modulates beta-cell function. | Combined effect improves glycemic control, lowers medication need, and enhances metabolic resilience. |
| Hypertension | Yoga: parasympathetic activation; Ayurveda: Rauwolfia-based herbs; Acupuncture: vasodilation and autonomic balance. | Multimodal approaches reduce BP more effectively, manage stress, and improve long-term outcomes. |
| Chronic Pain (e.g., Fibromyalgia) | Acupuncture: endorphin release; Yoga: cortisol reduction; Chiropractic: musculoskeletal realignment; Ayurveda: anti-inflammatory herbs. | CAM reduces pain, improves function, and lowers drug dependency with better emotional support. |
| Depression & Anxiety | Yoga & Meditation: increased GABA, serotonin modulation; Ayurveda: adaptogens like Ashwagandha; Acupuncture: limbic system regulation. | Targets multiple pathways (HPA axis, neurotransmitters) enhancing mood and reducing relapse. |
| Osteoarthritis | Ayurveda: Boswellia, guggulu for inflammation; Chiropractic: joint alignment; Acupuncture: cartilage protection, pain reduction. | Combining mechanical, biochemical, and energetic approaches leads to superior pain relief and joint function. |
| Irritable Bowel Syndrome (IBS) | Ayurveda: digestive fire (Agni) modulation; Acupuncture: gut-brain axis; Homeopathy: gut motility regulation; Yoga: vagal tone enhancement. | Improved gut motility, microbiota balance, and psychological well-being reduce symptoms more effectively. |
| Chronic Fatigue Syndrome (CFS) | Homeopathy: energy regulation; Yoga: mitochondrial biogenesis; Ayurveda: Rasayana for fatigue recovery; Acupuncture: neurohormonal support. | Enhanced cellular energy, immune function, and psychological support yield better outcomes. |
| Asthma | Ayurveda: Tulsi, Licorice; Yoga: breathwork for bronchial tone; Acupuncture: bronchial inflammation reduction. | Reduction in inflammatory episodes, improved breathing, and stress handling without steroids. |
| Autoimmune Diseases (e.g., RA) | Ayurveda: detox, immune balance; Yoga: cytokine regulation; Acupuncture: reduced autoimmune flares. | Balanced immune modulation, stress reduction, and inflammatory control with fewer immunosuppressants. |
| Cardiovascular Disease | Yoga: HRV improvement; Ayurveda: Arjuna, garlic; Acupuncture: reduced inflammation, improved endothelial function. | Holistic cardiac care with improved lifestyle, vascular health, and emotional resilience. |
Table -1 CAM Integration for Chronic Diseases
Clinical Integration Models and Health System Innovations
Integrating CAM into mainstream medical settings requires robust clinical frameworks, standardized protocols, and interdisciplinary collaboration. Several countries have pioneered integrative medicine models within hospitals and community care. In the UK, some NHS hospitals offer acupuncture, reflexology, and yoga through pain clinics or mental health services, especially for patients with limited response to conventional treatments. The US Veterans Health Administration (VHA) has launched the Whole Health initiative, incorporating acupuncture, mindfulness, chiropractic, and nutrition into chronic pain and PTSD care with notable improvements in patient-reported outcomes [16]. In India, the Ministry of AYUSH has facilitated co-located integrative clinics in district hospitals, where patients receive both biomedical and Ayurvedic assessments. Academic institutions such as Harvard, UCSF, and Duke University have established integrative medicine centres offering evidence-based CAM modalities alongside conventional care. These clinics employ outcome measurement tools like PROMIS, SF-36, and patient activation measures to track progress and ensure accountability.
Reimbursement models are evolving, with insurers beginning to cover selected CAM services under value-based care contracts. Digital health platforms are also integrating CAM tools, such as guided yoga videos and virtual Ayurveda consultations, expanding accessibility. Training programs for healthcare providers in integrative approaches are gaining popularity, fostering mutual understanding and collaboration. Despite these advancements, scalability remains a challenge due to variable regulation, provider availability, and funding. Nonetheless, these models demonstrate the viability of integration and provide a roadmap for system-wide adoption.
Barriers to Integration and Future Directions
While the case for integration is strong, several barriers hinder widespread adoption. One major challenge is the lack of uniform regulation and standardization across CAM disciplines, resulting in variable practitioner competence and public trust. Many CAM modalities are still viewed with scepticism by conventional practitioners due to perceived lack of evidence, even though a growing body of high-quality trials supports their use. Furthermore, medical curricula rarely include CAM education, leading to knowledge gaps and communication barriers between providers. Reimbursement remains inconsistent, especially in low-resource settings where out-of-pocket costs limit access to CAM services. Ethical concerns arise around unproven claims or interactions with biomedical treatments, underscoring the need for integrative governance frameworks. Research funding for CAM remains disproportionately low compared to pharmaceuticals, limiting the development of large-scale, multi-centre trials. Patient safety, while generally favourable, must be assured through regulatory oversight, quality assurance of herbal formulations, and professional licensure. Interprofessional collaboration between CAM and biomedical practitioners requires structured dialogue, shared protocols, and mutual respect. Looking forward, digital tools, artificial intelligence, and big data analytics can help monitor CAM outcomes and personalize integrative treatments. Strategic inclusion of CAM in global health policies, especially for chronic disease prevention, could revolutionize care delivery and align with WHO’s vision of universal health coverage. Empowering patients through integrative education and choice is vital to the healthcare models of the future.
Chronic diseases represent the most pressing challenge to 21st-century healthcare systems, characterized by complexity, chronicity, and resistance to reductionist medical interventions. While modern medicine excels in diagnostics, acute care, and targeted pharmacology, it often neglects the lifestyle, environmental, psychological, and energetic dimensions of chronic disease. CAM disciplines—including Ayurveda, yoga, acupuncture, TCM, homeopathy, and chiropractic—offer a rich array of personalized, non-invasive, and preventive interventions. When combined with evidence-based biomedical care, they have the potential to improve outcomes, reduce side effects, and enhance patient satisfaction. Integration is not a rejection of modern medicine but a strategic augmentation of its limitations. This article has outlined the scientific rationale, mechanisms, clinical models, and barriers to integration. The way forward lies in mutual respect, research collaboration, professional regulation, and patient-centred innovation. Global health systems must evolve from a fragmented, disease-centric model to one that embraces complexity, nurtures resilience, and prioritizes holistic well-being. Integrative medicine offers a powerful framework to meet these goals—one that honours both ancient wisdom and modern science.
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I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
