Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 21 appraisals
Journal of integrative medicine
Deep learning in traditional Chinese medicine
As an alternative medicine approach, traditional Chinese medicine (TCM) is mainly built on an ancient understanding of the world. In order to translate the promises of TCM into modern therapies, rigorous scientific techniques are applied, which generates big data from experiments, clinical practices and medical literature. Recently, deep learning (DL) has attracted the attention of TCM researchers due to its application in data mining. In this review, we summarized recent examples of DL application in the study of TCM, including medical image processing, medicinal substances investigation, data fusion and natural language processing. We find that DL methods have considerable potential to extract valuable information from TCM data, but high-quality TCM data are still needed for further development of DL techniques. Please cite this article as: Liu LP, Yang C, Cen SX, Suo TC. Deep learning in traditional Chinese medicine. J Integr Med. 2026; 24(4):471-480.
1 July 2026
Read appraisal →Medicine
Efficacy and safety of traditional Chinese medicine decoctions as an adjuvant treatment for rheumatoid arthritis: A systematic review and meta-analysis
BACKGROUND: To assess the effectiveness and safety of traditional Chinese medicine (TCM) decoctions as an additional therapy for rheumatoid arthritis (RA) via a systematic review and meta-analysis. METHODS: Databases including PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang were searched up to June 2024. Randomized controlled trials (RCTs) on TCM decoctions as adjunctive RA treatment were included. Primary outcomes were efficacy and safety. Effect sizes were measured using standardized mean difference, risk ratio, and 95% confidence intervals. Sensitivity and subgroup analyses were conducted to test result robustness and identify heterogeneity sources. Data were analyzed using RevMan 5.4 and Stata 15. In addition, the quality of evidence was assessed using grading of recommendations assessment, development and evaluation grading. RESULTS: Thirty-six RCTs with 6934 participants showed that TCM decoctions significantly improved overall efficacy versus control (risk ratio = 1.25, 95% confidence interval [1.21-1.29], P < .00001). They also reduced erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, swollen joint count, Disease Activity Score, and morning stiffness duration compared to placebo. Subgroup analysis suggested treatment duration, disease duration, and age may affect efficacy. Among them, the quality of evidence was high for Visual Analog Scale, and moderate for overall efficacy, C-reactive protein, Disease Activity Score, Traditional Chinese Medicine Symptom Score, and interleukin-1. CONCLUSION: TCM decoctions as adjunctive RA treatment significantly enhance efficacy. However, due to study limitations, further large-scale, multicenter RCTs are needed to confirm these findings.
28 June 2026
Read appraisal →Journal of ethnopharmacology
Revealing the temporal metabolic trajectory and potential pharmacodynamic substances of Da-Cheng-Qi Decoction in treating patients with acute pancreatitis: A serum metabolomics-based study
ETHNOPHARMACOLOGICAL RELEVANCE: Acute Pancreatitis (AP) is a pancreatic inflammatory disease lacking specific therapeutics. Da-Cheng-Qi Decoction (DCQD) has been proven to alleviate the severity and mortality of AP. However, its underlying mechanisms remain to be fully elucidated. AIM OF THE STUDY: This study aimed to explore DCQD's dynamic metabolic regulatory effects on AP patients and potential pharmacodynamic substances via serum metabolomics and serum pharmacochemistry analysis, with validation in animal models. MATERIALS AND METHODS: AP patients were randomized into conventional therapy (Con) and Con + DCQD groups. Fasting venous blood samples were collected at four time points (admission, 24 h/96 h post-admission, pre-discharge) for biochemical assays and UHPLC-Q-Exactive-Orbitrap-MS analysis. Metabolomics was used to screen AP-related biomarkers, evaluate the two regimens' reversal effects, and compare inter-group differences in metabolic recovery trajectories. Prototypes and metabolites of DCQD were identified, with potential pharmacodynamic substances screened via correlation analysis with AP biomarkers. L-arginine-induced SAP mouse model was used for validation. RESULTS: Serum amylase normalization and C-reactive protein decline were accelerated in Con + DCQD group. Both regimens reversed AP-related energy, amino acid, and lipid metabolic disorders. Adjuvant DCQD therapy accelerated inflammation alleviation and energy homeostasis restoration in early stage, and improved lipid metabolism more comprehensively in middle-to-late stage, with efficacy validated in SAP mice. Forty-eight and 35 blood-migrated components were identified in patients and mice, respectively, with 8 key pharmacodynamic substances screened. CONCLUSIONS: Integrating serum metabolomics and multi-time-point monitoring, this study delineated AP's metabolic recovery trajectory and clarified DCQD's efficacy and dynamic metabolic regulation, providing guidance for its clinical application.
12 June 2026
Read appraisal →Journal of ethnopharmacology
Exploring the molecular mechanism of Shenling baizhu formula in the treatment of ulcerative colitis via the cGMP-PKG signaling pathway
ETHNOPHARMACOLOGICAL RELEVANCE: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by symptoms such as persistent diarrhea. Shenlingbaizhu Formula (SLBZ), a classical Chinese herbal formula with centuries of clinical application, has long been used to treat such gastrointestinal disorders. This historical efficacy provides a strong ethnopharmacological rationale for investigating its therapeutic potential and underlying mechanisms in UC. AIM OF THE STUDY: To elucidate the molecular mechanism by which SLBZ ameliorates UC by restoring the intestinal barrier via the sGC-cGMP-PKG signaling pathway. MATERIALS AND METHODS: To systematically investigate the therapeutic effects of SLBZ on UC, we established a dextran sulfate sodium (DSS)-induced colitis model in 57BL/6 mice. Comprehensive evaluations were conducted to assess intestinal barrier function and elucidate underlying mechanisms, including histological analysis, immunofluorescence staining of tight junction proteins, 16S rDNA sequencing for gut microbiota profiling, transcriptomic analysis for gene expression patterns, and Western blot validation of key proteins. Furthermore, a multi-tiered experimental strategy was employed, integrating molecular modeling, machine learning algorithms, graph neural network (GNN) approaches and in vitro experiments using Caco-2 cell monolayers, to systematically validate the sGC-cGMP-PKG signaling pathway and identify bioactive compounds responsible for SLBZ's therapeutic effects. RESULTS: SLBZ treatment markedly alleviated UC symptoms in mice and restored intestinal barrier function through dual mechanisms: upregulation of tight junction proteins (ZO-1/Occludin) and modulation of gut microbiota composition. Transcriptomic analysis pinpointed the cGMP-PKG signaling pathway as a central therapeutic target. Through an integrated approach combining molecular docking, machine learning (random forest algorithm), and deep neural network analysis, we identified soluble guanylate cyclase (sGC) as the primary molecular target, with Choerospondin emerging as a key bioactive component. Mechanistic investigations demonstrated that SLBZ robustly activated the sGC-cGMP-PKG axis both in vivo (colon tissues) and in vitro (Caco-2 cells), culminating in significant suppression of intestinal epithelial apoptosis. CONCLUSION: SLBZ alleviates UC by activating the sGC-cGMP-PKG pathway to restore intestinal barrier function through tight junction upregulation and microbiota modulation. Our study both validates SLBZ's traditional use and identifies this pathway as a novel therapeutic target for UC.
12 June 2026
Read appraisal →Journal of ethnopharmacology
Insight of traditional Chinese medicine in treating pulmonary hypertension: Achievements from 2021 to 2025.
ETHNOPHARMACOLOGICAL RELEVANCE: Pulmonary hypertension (PH) significantly impairs patients' quality of life and imposes a substantial economic burden. Despite advances in pharmacotherapy, PH remains a life-threatening pulmonary vascular disease. Traditional Chinese Medicine (TCM), with its multi-target and multi-pathway mechanisms, has shown therapeutic potential for PH management. AIMS OF THE REVIEW: This review systematically summarizes TCM formulas, extracts, and active components, along with their pharmacological mechanisms, for the treatment of PH, and highlights the advantages of TCM in managing PH. MATERIALS AND METHODS: A systematic review of the literature on TCM for PH was conducted. The search included scientific publications from January 2021 to August 2025. Relevant articles were identified through comprehensive searches of PubMed, Web of Science, ScienceDirect, and Google Scholar. The search strategy combined keywords including "pulmonary hypertension", "pulmonary arterial hypertension", "Traditional Chinese Medicine", "Chinese herbal medicine", "herb", "formula", "extract", "active component", and "active ingredient". Retrieved publications were screened and analyzed using pre-defined inclusion and exclusion criteria to ensure relevance and methodological quality. RESULTS: This review synthesizes findings on TCM-based theory, experimental models, TCM formulas (both classical and novel), extracts (including ethanol/aqueous extracts, volatile oils, total flavonoids, saponins, and alkaloids), and active components (terpenoids, flavonoids, glycosides, and alkaloids) for the treatment of PH. Predominant models include monocrotaline-induced pulmonary arterial hypertension (PAH) in vivo and hypoxia-induced in vitro models using pulmonary artery smooth muscle cells (PASMCs). Mechanistic studies indicate that TCM target multiple signaling pathways, including NF-κB to alleviate inflammation, PI3K-AKT-mTOR signaling to mitigate oxidative stress, modulation of K+/Ca2+ channels to attenuate pulmonary vascular remodeling, the HIF-2α-Arg-NO signaling pathway to protect endothelial function, inhibition of the TGF-β1/Smad pathway to suppress endothelial-to-mesenchymal transition, and regulation of JAK2-STAT3 and p53-p21 pathways to inhibit abnormal proliferation, migration, apoptosis resistance, and phenotypic transformation. CONCLUSION: TCM, including formulas, extracts, and components exhibit significant therapeutic potential for PH, positioning TCM as a promising complementary strategy for managing this disease.
12 June 2026
Read appraisal →African journal of reproductive health
Effects of kegel training combined with acupoint application in preventing postpartum pelvic floor dysfunction: A randomized controlled trial
This study investigated the early preventive benefits of combining Kegel exercises with acupoint application at Qi Hai and Guan Yuan points for addressing postpartum pelvic floor dysfunction (PFD). A total of 110 first-time mothers were randomized into two groups: the prevention group, which received the combined intervention, and the control group, which practiced only Kegel exercises. The interventions followed a structured schedule during the postpartum period. At 42 days postpartum, the prevention group showed a notably lower rate of urinary leakage and improved outcomes in Type II pelvic floor muscle strength, ICI-Q-SF scores, and Hamilton Anxiety Scale results (all P<0.05). However, there were no significant differences between the groups in Type I muscle strength, vaginal dynamic pressure, PFDI-20 scores, or anatomical positioning of the bladder and cervix (P>0.05). The treatments were well-tolerated, with only two minor cases of redness and itching at application sites. We conclude that combining Kegel exercises with acupoint application at Qi Hai and Guan Yuan points may effectively reduce postpartum urinary incontinence, strengthen specific pelvic floor muscles, and improve emotional well-being. Cette étude a examiné les bénéfices préventifs précoces de la combinaison d'exercices de Kegel avec l'application d'acupression sur les points Qi Hai et Guan Yuan pour traiter la dysfonction du plancher pelvien (DPP) post-partum. Au total, 110 primipares ont été randomisées en deux groupes : le groupe prévention, recevant l'intervention combinée, et le groupe témoin, pratiquant uniquement les exercices de Kegel. Les interventions ont suivi un calendrier structuré pendant la période post-partum. À 42 jours post-partum, le groupe prévention a montré un taux de fuites urinaires nettement inférieur et de meilleurs résultats pour la force musculaire de type II du plancher pelvien, les scores ICI-Q-SF et les résultats à l'échelle d'anxiété de Hamilton (tous p<0,05). Cependant, aucune différence significative n'a été observée entre les groupes pour la force musculaire de type I, la pression dynamique vaginale, les scores PFDI-20 ou la position anatomique de la vessie et du col de l'utérus (p>0,05). Les traitements ont été bien tolérés, avec seulement deux cas mineurs de rougeurs et de démangeaisons aux sites d'application. En résumé, combiner les exercices de Kegel avec l'acupression sur les points Qi Hai et Guan Yuan pourrait réduire efficacement l'incontinence urinaire post-partum, renforcer des muscles spécifiques du plancher pelvien et améliorer le bien-être émotionnel.
31 May 2026
Read appraisal →Medicine
The clinical efficacy of Astragalus-containing Chinese patent medicines in the effective treatment of heart failure: A systematic review and network meta-analysis
BACKGROUND: The incidence of cardiovascular diseases, particularly heart failure, has been rising year by year. Traditional Chinese medicines containing Astragalus have been widely used in clinical research. However, there is no definitive research on the efficacy of proprietary Chinese medicines containing Astragalus. A network meta-analysis was conducted to investigate the efficacy and safety of oral traditional Chinese medicines containing Astragalus for the treatment of heart failure. METHODS: This study searched 6 databases for clinical randomized controlled trials involving the use of traditional Chinese herbal medicines containing Astragalus alone or in combination with other drugs, with a search period from the establishment of the databases to May 27, 2025. Using the Cochrane Quality Assessment Manual, we conducted a bias analysis of the included studies, and the extracted data were analyzed using network meta-analysis in Stata 18. RESULTS: A total of 18 studies were included, involving 1584 patients with heart failure, with 16 types of traditional Chinese medicines containing Astragalus. The network meta-analysis via Surface Under the Cumulative Ranking Curve analysis indicated that: Compared to using Western medicine (WM) alone, Astragalus Granule + WM ranked best for improving overall clinical efficacy rate; Qiangxin Capsule + WM was optimal for improving six-minute walk test; Astragalus Granule + WM showed the best efficacy for reducing B-type natriuretic peptide levels; Yanxing Decoction + WM ranked first for lowering N-terminal pro-B-type natriuretic peptide levels; Xinlishen Compound + WM was the optimal combination for improving left ventricular ejection fraction; Qili Qiangxin Capsule + WM performed best for reducing left ventricular end-diastolic diameter; Yangxin Tongmai II Prescription + WM exhibited the highest efficacy for decreasing Minnesota Heart Failure Quality of Life Questionnaire scores. CONCLUSIONS: Adding oral traditional Chinese medicine containing Astragalus to WM treatment can further improve the clinical efficacy of heart failure. However, due to the limited number and quality of the included studies in this research, the above conclusions still require further validation through well-designed randomized double-blind controlled trials.
31 May 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Utility of Acupuncture Therapy for Adult Chronic Daily Headache Prophylaxis: A Systematic Review and Meta-Analysis
BACKGROUND Chronic daily headache (CDH) management remains challenging due to limited efficacy of standard preventive pharmacotherapies. Acupuncture has shown promise in chronic headache management. This study evaluated its sustained prophylactic efficacy for CDH. MATERIAL AND METHODS Following PRISMA guidelines, we systematically searched PubMed, EMBASE, the Cochrane Library, CNKI, VIP, Sinomed, and Wanfang Data (inception to September 2025) for randomized controlled trials (RCTs) comparing acupuncture with other interventions for CDH. Primary outcomes included headache frequency, days, intensity, duration, and analgesic use; subgroup analyses covered treatment modality, CDH subtype, and duration. RESULTS Twenty-two RCTs (1449 patients) were included. Compared with control, acupuncture significantly reduced headache frequency (mean difference [MD], -0.32; P=0.001), headache days (MD, -0.72; P<0.00001), intensity (standardized mean difference [SMD], -0.63; P=0.001), duration (SMD, -1.18; P=0.0001), and analgesic use (MD, -0.52; P<0.00001) after the intervention. These benefits persisted during follow-up: headache days (standardized mean difference [SMD], -0.70; P<0.00001), intensity (SMD, -1.11; P=0.008), duration (SMD, -1.83; P=0.003), and analgesic use (SMD, -0.60; P=0.007) remained reduced; headache frequency showed a trend toward reduction (SMD, -0.47; P=0.05). Subgroup analyses revealed consistent efficacy across various CDH subtypes, including chronic migraine and chronic tension-type headache, treatment durations (4-12 weeks), and intervention strategies (acupuncture alone or combined with medication), indicating broad clinical applicability. CONCLUSIONS Acupuncture yields clinically meaningful, sustained improvements in CDH, supporting its role as an effective routine and adjunctive prophylaxis and broader application in this population.
25 May 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Wrist-Ankle Acupuncture on Postoperative Nausea and Vomiting Prophylaxis in High-Risk Female Patients: A Pragmatic, Randomized, Single-Blind, Sham-Controlled Trial
BACKGROUND: Postoperative nausea and vomiting (PONV) affects up to 80% of high-risk patients, compromising Enhanced Recovery After Surgery (ERAS) outcomes and prolonging hospitalization. This randomized controlled trial evaluated wrist-ankle acupuncture (WAA) efficacy for PONV prevention in high-risk female surgical patients. METHODS: This single-center, randomized, patient- and assessor-blinded, sham-controlled trial enrolled female patients (aged 18-60 years, ASA I-II) scheduled for elective surgery under general anesthesia with documented motion sickness or previous PONV. Participants received either WAA (sterile needles at four standardized acupoints, 30-minute retention) or sham acupuncture postoperatively. The primary outcome was 24-h PONV incidence using the Rhodes Index of Nausea, Vomiting, and Retching (R-INVR). RESULTS: Among 132 patients (median age 41 years), WAA significantly reduced 24-h PONV incidence versus sham (42.4% vs. 71.2%; RR 0.60, 95% CI 0.42-0.82; p = 0.002). Median R-INVR scores were lower with WAA [0 (0-5) vs. 8 (0-11); p < 0.001]. WAA patients reported significantly reduced nausea/vomiting at 30 min, 6 h, and 24 h (all p ≤ 0.006) and higher satisfaction scores (p < 0.001). Antiemetic use was comparable (9.1% vs. 16.7%; p = 0.299). No adverse events occurred. CONCLUSIONS: WAA significantly reduced PONV incidence and severity with sustained effects and improved satisfaction, offering a promising non-pharmacological prevention strategy.
21 May 2026
Read appraisal →Journal of ethnopharmacology
Moxibustion with Artemisia argyi H.Lév. & Vaniot in rheumatoid arthritis animal models: A meta-analysis linking clinical efficacy to inflammasome and cytokine signaling mechanisms
ETHNOPHARMACOLOGICAL RELEVANCE: Moxibustion, a traditional Chinese healing method, uses mugwort (Artemisia argyi H.Lév. & Vaniot) to apply heat to specific points, treating conditions like "Bi Zheng", which is akin to rheumatoid arthritis (RA). According to traditional theory, its therapeutic actions are attributed to warming the meridians and regulating the flow of Qi and blood. AIM OF THE STUDY: To quantitatively evaluate the therapeutic efficacy of moxibustion and to map its anti-arthritic mechanisms in animal models of RA. MATERIALS AND METHODS: The protocol was registered with PROSPERO (CRD42024503829) and reported according to PRISMA 2020. Eight databases were searched through 28 July 2025 for randomized controlled animal studies comparing moxibustion with the control in RA models. The primary outcome was arthritis severity, assessed by the arthritis index, paw volume, and histopathological score. Secondary endpoints included serum or tissue levels of pro-inflammatory cytokines (IL-1β, TNF-α, IL-6), immunomodulatory cytokines (IL-10, IL-4), and key signaling proteins (NF-κB, NLRP3, TLR4, MyD88). The SYRCLE tool was used to assess the risk of bias. RESULTS: Seventy-three studies were included. Meta-analysis showed that moxibustion significantly reduced arthritis severity (arthritis index: SMD -3.72, 95% CI -4.25 to -3.20; paw volume: SMD -4.59, 95% CI -5.54 to -3.63; histopathological score: SMD -2.24, 95% CI -2.80 to -1.67). Moxibustion also lowered the levels of pro-inflammatory cytokines: IL-1β (SMD -3.52, 95% CI -4.19 to -2.86), IL-6 (SMD -3.17, -4.17 to -2.16), and TNF-α (SMD -3.38, -3.97 to -2.79) and suppressed key signaling pathways, including NF-κB (SMD -2.29, 95% CI -3.20 to -1.37), NLRP3 (SMD -1.74, 95% CI -2.49 to -0.99), TLR4 (SMD -6.72, 95% CI -12.54 to -0.90), and MyD88 (SMD -9.16, 95% CI -15.28 to -3.04). CONCLUSION: This meta-analysis suggests that moxibustion alleviates arthritis severity and histopathological damage in RA animal models, potentially through modulating inflammatory networks and inhibiting key pathways such as NF-κB and NLRP3. These findings provide preclinical evidence supporting the rationale for future clinical investigation of moxibustion as a potential adjunct therapy for RA.
13 May 2026
Read appraisal →Journal of ethnopharmacology
Anti-inflammatory properties of Dendrobium: A systematic review of pharmacological mechanisms
ETHNOPHARMACOLOGICAL RELEVANCE: In Traditional Chinese Medicine (TCM), Dendrobium species have long been used to alleviate various inflammatory conditions, particularly those characterized by Yin deficiency with internal heat and stomach deficiency-heat, including impaired fluid production, stomach Qi dysfunction, and poor appetite. The inflammatory response is regulated by multiple signaling pathways that drive disease pathogenesis, making these pathways promising targets for anti-inflammatory therapy. Medicinal Dendrobium, enriched with anti-inflammatory bioactive constituents, exhibits substantial systemic anti-inflammatory activity. Its growing research interest stems from favorable properties such as low toxicity, broad therapeutic efficacy, and minimal risk of drug resistance. AIM OF THE STUDY: Medicinal Dendrobium and its bioactive constituents have demonstrated significant anti-inflammatory properties, underscoring their pharmacological potential. Nevertheless, substantial efforts remain an urgent priority to advance the translation of basic research findings into clinical applications. Therefore, pharmacological studies published within the past six years were systematically reviewed to elucidate the mechanisms by which Medicinal Dendrobium and its bioactive constituents modulate inflammatory processes, thereby evaluating their potential as multi-targeted natural anti-inflammatories. This will facilitate the translation of anti-inflammatory research on medicinal Dendrobium from basic research to clinical investigation, thereby laying a solid foundation for its eventual clinical application in managing inflammatory diseases. MATERIALS AND METHODS: A literature search and screening strictly followed the PRISMA 2020 guidelines and employed a predefined Boolean strategy. A comprehensive search was conducted across Web of Science, PubMed, Elsevier, ScienceDirect, Scopus, CNKI, Wanfang Data, Baidu Scholar, and Google Scholar. No language restrictions were applied; this review includes key findings from Chinese-language literature. The predefined keywords included "Dendrobium," "Shihu," "bioactive constituents," "anti-inflammatory," "cytokines," "signaling pathways," as well as their corresponding Chinese terms. Taxonomic validation was conducted using the World Flora Online (http://www.worldfloraonline.org) and the Medicinal Plant Names Services (http://mpns.kew.org) databases. RESULTS: Eight Medicinal Dendrobium species and their bioactive constituents-such as polysaccharides, alkaloids, flavonoids, bibenzyls, polyphenols and stilbenoids-exert anti-inflammatory effects by modulating multiple signaling cascades, including NF-κB, MAPK/NF-κB, TLR4/NF-κB, PI3K/AKT, Nrf2/HO-1, JAK/STAT, and AMPK/SIRT1 pathways, indicating their multi-target therapeutic potential for inflammatory diseases. This review further underscores the innovative role of Dendrobium in regulating these pathways and its potential for integration with conventional pharmacological treatments, supporting its synergistic use in precision medicine. CONCLUSIONS: Medicinal Dendrobium represents a promising ethnopharmacological resource, exhibiting broad-spectrum anti-inflammatory effects through multi-target, multi-pathway, and multi-organ mechanisms. To advance its modernization, therapeutic development, and clinical translation, future research should prioritize several key directions: establishing standardized quality control system and prioritizing the structures of core bioactive constituents; applying a multi-omics approach combined with artificial intelligence-assisted modeling, network pharmacology and advanced molecular imaging techniques to systematically map its systemic anti-inflammatory regulatory network; strengthening systematic pharmacokinetic and bioavailability studies; exploring precision and synergy delivery formulations; and conducting rigorous assessments of safety profiles and side-effect management. By focusing on these priorities, research can further elucidate the systemic anti-inflammatory mechanisms of medicinal Dendrobium, thereby bridging its traditional use with contemporary precision medicine, and supporting integrated interventions for complex inflammatory diseases.
12 May 2026
Read appraisal →Journal of ethnopharmacology
Long Gu (Os Draconis): Textual research, modern scientific evaluation, and quality control challenges.
ETHNOPHARMACOLOGICAL RELEVANCE: Long Gu (Os Draconis), a mineral medicine with over 2000 years of use in traditional Chinese medicine, is facing a critical juncture. Its identity has been clarified scientifically-from a mythologized "dragon bone" to a fossilized mammalian bioapatite-yet its sustainable clinical application is threatened by resource depletion, widespread domestic and international adulteration, and the lack of modern quality standards. AIM OF THE STUDY: This review aims to systematically analyze the evolution of Long Gu through historical materia medica, define its authentic characteristics using modern science, diagnose the root causes of its current market and regulatory crisis, and propose a robust, multi-dimensional framework for quality evaluation and sustainable sourcing. MATERIALS AND METHODS: A systematic review of Chinese materia medica literature from the Pre-Qin to Qing Dynasties was conducted. Historical textual research was integrated with evidence from modern mineralogy, paleontology, geochemistry, and pharmacology to validate traditional knowledge and establish scientific identification criteria. RESULTS: The understanding of Long Gu evolved from mythological origins to a scientific conclusion in the Ming Dynasty, with Li Shizhen correctly identifying it as fossilized ancient mammalian bones. Modern research confirms authentic "Wuhua Long Gu" from the Shanxi-Shaanxi region is primarily carbonated hydroxyapatite, characterized by high porosity (>35%), significant hygroscopicity, and a unique trace element profile (Zn, Sr). These properties underpin its advertised therapeutic effects. However, the market is now saturated with dangerous adulterants, including fluoride-rich dinosaur fossils and processed modern bones, due to resource exhaustion and inadequate pharmacopoeial standards focused solely on calcium content. CONCLUSION: The future of Long Gu depends on transcending outdated quality controls. Ensuring its efficacy and safety necessitates a paradigm shift to a comprehensive standard system that combines paleontological and geochronological origin verification, quantitative microstructural analysis, chemical fingerprinting of key components, and strict safety monitoring. Complementary research into biomimetic synthesis and accelerated mineralization is urgently needed to develop sustainable alternatives for this invaluable yet endangered medicinal resource.
12 May 2026
Read appraisal →Artificial intelligence in medicine
CL-MHAD: Contrastive Learning-based Multi-Hypergraph Aggregation and Diffusion model for prescription recommendation
Multiple syndrome-based prescription recommendations are significant for personalized diagnosis and treatment in Traditional Chinese Medicine (TCM). However, it remains a challenge to effectively extract and fuse multi-dimensional knowledge in herbs for accurate syndrome-based prescription recommendations. To address it, we propose CL-MHAD, a contrastive learning-based multi-hypergraph aggregation and diffusion model for prescription recommendation. Focusing on prescriptions, herbs, properties, and dosages, this model presents a multi-view hypergraph reconstruction mechanism, which employs a consistent Top-K neighbor strategy to generate affinity and feature matrices. Subsequently, a diffusion-enhanced method is proposed, utilizing multi-step propagation and weighted mapping to capture high-order relationships. Then, we propose a cross-view contrastive learning strategy to enhance discrimination and present a topology-aware random walk augmentation approach to alleviate data sparsity. An integrated loss function combining classification, contrastive, and augmentation losses is designed to optimize model performance. We evaluate CL-MHAD in a real-world clinical setting using Gastrointestinal Diseases (GID) as a case study. Extensive experiments, including comparative evaluations, ablation studies, and parameter sensitivity analyses, show that CL-MHAD achieves overall superior performance compared with representative baselines across multiple evaluation metrics. Specifically, the model achieves performance gains of 1.27% to 24.67% over representative baselines across all datasets. We further evaluate the model through dosage-syndrome interaction and data-sparsity robustness tests, with results demonstrating the effectiveness of our weighted fusion strategy and the model's superior stability. This study offers an effective solution and a promising paradigm for accurate syndrome-based prescription recommendations in TCM.
4 May 2026
Read appraisal →Journal of ethnopharmacology
A multicenter, placebo-controlled clinical trial and preliminary experimental study exploring the efficacy of modified Banxia Xiexin Decoction in the treatment of advanced colorectal cancer
ETHNOPHARMACOLOGICAL RELEVANCE: Recent studies in China have increasingly focused on the evidence-based evaluation of malignant tumors, including colorectal cancer (CRC), leveraging the unique properties of herbal medicine. This has led to notable progress in the development of novel therapies. Clinical observations indicate that the modified Banxia Xiexin Decoction (mBXD) exhibits significant anti-cancer effects. However, well-designed clinical trials and foundational research in this field remain insufficient. AIMS OF THE STUDY: This study aims to assess the clinical efficacy and safety of mBXD in the treatment of advanced CRC, alongside preliminary in vivo and in vitro verification of its anti-CRC effects. METHODS: A clinical trial was conducted from October 2020 to October 2024 across 12 hospitals in Southwest China. Eligible participants were randomly assigned to either the mBXD group or the placebo group. Both groups received standard chemotherapy combined with targeted therapy; the mBXD group received mBXD granules (Ready-to-use), while the placebo group received a placebo. Treatment lasted for six months (six cycles). The primary endpoint was progression-free survival (PFS), while secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and serum tumor markers. Efficacy was assessed every two cycles, with follow-ups conducted every three months after treatment completion until disease progression or death. This study is registered with the Chinese Clinical Trial (No. ChiCTR2100041643). Basic research included the establishment of a subcutaneous CT26 colon cancer model and the use of the HCT116 cell line, with mBXD interventions to monitor tumor growth and evaluate the viability, invasion, and migration of HCT116 cells. RESULTS: A total of 129 participants were enrolled. Compared to the placebo group, the mBXD group showed a 1.9-month and 2.8-month extension in PFS and OS, respectively, with a 17 % reduction in the risk of disease progression and a 15 % reduction in the risk of death (P = 0.341, 0.465). After two, four, and six cycles, the ORR and DCR in the mBXD group were 3.7-12.6 % and 1.2-18.5 % higher than those in the placebo group, respectively, with only the DCR after six cycles reaching statistical significance (P = 0.037). Moreover, serum levels of CEA and CA724 were significantly reduced in the mBXD group after four and six cycles (P ≤ 0.05). No severe adverse events were reported during the trial. Additionally, mBXD significantly inhibited subcutaneous tumor growth after 14 days of treatment (P < 0.05), and its drug-containing serum notably suppressed the viability, migration, and invasion of HCT116 cells. CONCLUSIONS: mBXD demonstrates clinical efficacy in prolonging PFS and OS, stabilizing tumor lesions, and reducing serum tumor marker levels in advanced CRC patients. The treatment is both safe and well-tolerated. Furthermore, mBXD significantly inhibits the growth of subcutaneous CT26 colon cancer and suppresses the viability, invasion, and migration of HCT116 cells.
28 Apr 2026
Read appraisal →Journal of ethnopharmacology
MAGED: Multimodal attentive graph learning with gene expression dynamics on knowledge graphs for TCM target prediction
ETHNOPHARMACOLOGICAL RELEVANCE: Plants used in traditional medicine have long provided valuable clues for drug discovery, yet systematically connecting their documented therapeutic effects with modern understanding of biological mechanisms remains a key scientific question. Bridging the gap between traditional knowledge, clinical symptom profiles, and contemporary molecular-level regulation is essential for advancing the study of herbal medicine. OBJECTIVES: This study aims to develop a multimodal graph attention learning framework, named MAGED, which integrates knowledge graphs with gene expression dynamics to improve the accuracy and interpretability of Herb-Target Interaction (HTI) prediction. METHODS: MAGED incorporates multi-source heterogeneous data, including traditional Chinese medicine (TCM) properties, hierarchical clinical symptom information, and molecular-level biological data, such as gene expression dynamics under drug intervention and causal biological networks. A multimodal fusion encoder is employed to embed herb attributes into efficacy-related feature vectors, which are then combined with functional representations (e.g., normalized enrichment scores) to form a unified contextualized representation. Additionally, a hierarchical graph attention network is designed to integrate macroscopic symptom-gene associations with microscopic regulatory pathways, thereby establishing a coherent inference chain from herbal effects to biological targets and phenotypic symptoms. RESULTS: Systematic experimental evaluations demonstrated that MAGED significantly outperforms existing baseline methods across multiple evaluation metrics, achieving a 59.8 % improvement in HR@10. The model also exhibited superior ranking and recall performance under cold-start scenarios. In a case study on Scutellaria baicalensis, 8 out of the top 10 predicted targets were supported by existing literature, with functional or direct interaction evidence, and some targets were further validated through molecular docking. CONCLUSION: MAGED provides an accurate and interpretable framework for predicting herb-target interactions, effectively integrating traditional knowledge with modern molecular evidence. This approach shows strong potential to facilitate the discovery of herbal mechanisms and the identification of novel therapeutic targets.
27 Apr 2026
Read appraisal →Journal of ethnopharmacology
Neuroprotective effects of Tongxinluo capsule in acute ischemic stroke: A systematic review and meta-analysis
ETHNOPHARMACOLOGICAL RELEVANCE: Tongxinluo capsule is widely used in patients with acute ischemic stroke (AIS), although the literature does not consistently agree on its efficacy and safety. AIM OF THE STUDY: We aimed to assess the efficacy and safety of Tongxinluo capsule for patients with AIS. MATERIALS AND METHODS: A systematic search of the databases PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang data, VIP Chinese Journal Service Platform, and SinoMed was conducted from their inception dates to January 2025. Randomized controlled trials (RCTs) that enrolled patients with AIS who receive Tongxinluo capsule and compared effects with placebo or as an add-on therapy to usual care were included. Literature screening, risk of bias assessment, and data extraction were independently conducted in duplicate. Fixed-effects or random-effects models were used to perform meta-analysis for pooling data from eligible studies. The primary outcome was long-term functional independence (defined as modified Rankin Scale [mRS] grade less than 2). Secondary outcomes included all-cause mortality, improvements in activities of daily living (measured with the Barthel Index [BI]), and neurological impairment (measured with the National Institutes of Health Stroke Scale [NIHSS]). Incidence of adverse events were identified as safety outcomes. RESULTS: We included 4842 patients with AIS from 12 RCTs (2422 [50.02 %] treated with Tongxinluo capsule) in the final analysis. Tongxinluo capsule treatment in AIS significantly improved the proportion of patients with mRS less than 2 (RR, 1.21; 95 % CI, 1.02 to 1.44), improved the change in BI score (MD, 11.47; 95 % CI, 10.34 to 12.60) and NIHSS score (MD, 3.48; 95 % CI, 2.87 to 4.09). No significant differences were detected in all-cause mortality (RR, 0.57; 95 % CI, 0.17 to 1.95), or the incidence of overall adverse events (RR, 1.01; 95 % CI, 0.91 to 1.12). CONCLUSION: Administration of Tongxinluo capsule for AIS demonstrated potential benefits in improving the long-term functional outcomes and activities of daily living, and relieving neurological impairment, without observing major safety concerns.
25 Apr 2026
Read appraisal →Journal of ethnopharmacology
Tianjing Zelan formula improves polycystic ovary syndrome by regulating steroid biosynthesis and arachidonic acid metabolism
ETHNOPHARMACOLOGICAL RELEVANCE: Polycystic ovary syndrome (PCOS) is a set of symptoms related to menstrual irregularities that can cause infertility in women of reproductive age. Unfortunately, there are currently no authorized treatment medications for PCOS. The Tianjing Zelan (TJZL) formula, a herbal formulation developed from the ancient Chinese medical classic Beiji Qianjin Yaofang in Tang Dynasty, is employed in the clinical management of menstrual irregularities and amenorrhea. However, its clinical characteristics and mechanism have not been systematically evaluated. AIM OF THE STUDY: To reveal the clinical characteristics and mechanisms of TJZL in treating PCOS. MATERIALS AND METHODS: A multicenter and single-arm clinical trial, and two PCOS models were used to evaluate the effectiveness of TJZL. The chemical constituents of TJZL were analyzed by UHPLC-QTOF-MS/MS. In addition, a combination of untargeted metabolomics and transcriptomics was used to reveal the complex therapeutic mechanisms of TJZL on PCOS. Subsequently, a metabolite-gene network analysis was performed to reveal potential differentially expressed genes associated with metabolites in PCOS patients. Key targets and pathways were further validated using quantitative real-time polymerase chain reaction (qRT-PCR), Western blot and immunohistochemistry in PCOS mice. Finally, molecular docking analysis was employed to explore the potential active ingredients of TJZL. RESULTS: Clinical trials provided evidence that TJZL significantly improved the menstrual cycle, sex hormone levels, and hyperandrogenic phenotypes, and reduced insulin resistance in PCOS patients. TJZL significantly improved the fertility, estrous cycle, ovarian morphology, sex hormone levels, and oral glucose tolerance in PCOS model. Transcriptomic and metabolomics results show that TJZL has a significant regulatory effect on metabolites and gene expression profiles in pathways such as steroid synthesis, arachidonic acid metabolism, and fatty acid metabolism. Utilizing metabolite-gene association analysis, We further verified that TJZL significantly improved the expression of genes and proteins related to the ovarian steroidogenesis and arachidonic acid metabolism pathways, including CYP17A1, CYP19A1, HSD17B3 and PTGS2. Furthermore, molecular docking results showed that berberine, rosmarinic acid and glycyrrhizinic acid in TJZL had strong affinity with PTGS2 in arachidonic acid metabolism, and hesperidin, naringin and liquiritin have strong affinity with CYP19A1 in steroid synthesis. CONCLUSION: TJZL exerts beneficial therapeutic effects on PCOS in both clinical and laboratory studies. TJZL improves PCOS by regulating multiple endogenous metabolites and correcting abnormal steroid synthesis and arachidonic acid metabolism in the ovaries. Our research provides a promising therapeutic agent for PCOS patients.
25 Apr 2026
Read appraisal →Medicine
Clinical study on the efficacy of electroacupuncture combined with pelvic floor muscle training for female stress urinary incontinence
BACKGROUND: To evaluate the clinical efficacy and synergistic effects of electroacupuncture (EA) combined with pelvic floor muscle training (PFMT) in the treatment of mild-to-moderate stress urinary incontinence (SUI) in women. METHODS: A single-blind (assessor-blinded), 2 × 2 factorial, randomized controlled trial was conducted. A total of 128 SUI patients were allocated to 4 groups: the EA group (sessions every other day, targeting acupoints including Guanyuan [RN4] and Shenshu [BL23]), PFMT group (3 daily sessions), combination group (EA + PFMT), and waitlist group. The intervention lasted for 4 weeks. The primary outcome was the change in 1-hour pad test leakage volume. Secondary outcomes included 72-hour urinary incontinence episodes and International Consultation on Incontinence Questionnaire-Short Form scores. Data were analyzed using intention-to-treat and factorial analysis of variance. RESULTS: The combination group showed the greatest reduction in leakage volume (6.17 g, 95% confidence interval [CI] = 5.89-6.44), significantly outperforming the EA group (4.53 g, 95% CI = 4.26-4.81), PFMT group (2.13 g, 95% CI = 1.85-2.41), and waitlist group (0.38 g, 95% CI = 0.11-0.66; all P < .001). Factorial analysis confirmed significant main effects for EA (mean difference = 5.35 g, 95% CI = 5.15-5.54) and PFMT (mean difference = 4.15 g, 95% CI = 3.95-4.34; both P < .001), but no interaction effect (P = .686). Secondary outcomes showed consistent improvements in incontinence episodes and International Consultation on Incontinence Questionnaire-Short Form scores. CONCLUSION: Combined EA and PFMT significantly alleviated SUI symptoms. Although no synergy was observed, the additive therapeutic effect provided clinical benefits, offering a promising nonsurgical alternative for SUI management.
20 Apr 2026
Read appraisal →Blood pressure
Acupuncture for primary hypertension: a systematic review and meta-analysis of randomised controlled trials
OBJECTIVE: This systematic review and meta-analysis evaluated the efficacy and safety of acupuncture for primary hypertension, based on randomised controlled trials (RCTs) published between 2015 and 2024. METHODS: We searched seven major databases for RCTs comparing acupuncture to control interventions. The primary outcomes were changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Meta-analyses utilised random-effects models, and the Cochrane Risk of Bias tool assessed study quality. RESULTS: Seven RCTs (n = 812) were included. Acupuncture was associated with lower SBP [mean differences (MD) = -6.73 mmHg, 95% confidence interval (CI): -8.84 to -4.62] and DBP (MD = -6.59 mmHg, 95% CI: -9.42 to -3.76). Heterogeneity was substantial for SBP (I2 = 73.3%) and considerable for DBP (I2 = 90.9%). Notably, the SBP analysis included seven studies, whereas the DBP analysis included six studies, and the similar absolute pooled reductions should be interpreted cautiously, given the small and not fully overlapping study sets. Exploratory subgroup analyses suggested blood pressure reductions across several acupuncture modalities, though each subgroup contained very few studies. Adverse-event reporting was limited and inconsistent across studies. Formal tests for publication bias were underpowered given the small number of included studies. CONCLUSIONS: Acupuncture may have blood pressure-lowering effects in patients with primary hypertension, but the evidence is limited by substantial heterogeneity, a small number of studies and considerable variation in intervention type and exposure. Larger, well-designed, multi-centre RCTs with standardised protocols and longer follow-up are needed to confirm these findings and establish optimal treatment parameters. High blood pressure (hypertension) is a major health concern worldwide. Acupuncture, a component of traditional Chinese medicine, has been used to manage blood pressure, but evidence of its effectiveness remains limited. This review examined seven recent randomised controlled trials involving 812 participants to assess whether acupuncture reduces blood pressure in people with primary hypertension. The findings suggest that acupuncture may reduce both systolic and diastolic blood pressure; however, the included studies were few and varied considerably in the type of acupuncture used, the number of treatment sessions (ranging from a single session to 60 sessions over 12 weeks) and the populations studied. Reported side effects were minor, such as temporary pain at the needle site, though safety reporting was incomplete. Therefore, while the results are encouraging, they are not definitive. Further large-scale, rigorously designed trials are needed before firm conclusions can be drawn about the role of acupuncture in hypertension management.
20 Apr 2026
Read appraisal →Journal of ethnopharmacology
Efficacy of Yuxintong capsule on cardiorespiratory fitness in patients with stable coronary heart disease: A multicentre, randomized, double-blind, placebo-controlled, parallel-group clinical trial
ETHNOPHARMACOLOGICAL RELEVANCE: Yuxintong capsule, a traditional Chinese patent medicine, has been widely used in the treatment of coronary heart disease (CHD). However, whether it can improve cardiopulmonary fitness (CRF) in patients with CHD remains unclear. AIM OF THE STUDY: To evaluate the efficacy and safety of Yuxintong capsule in CRF in patients with stable CHD. MATERIALS AND METHODS: A multicentre, randomized, double-blind, placebo-controlled, parallel-group trial was conducted in 13 hospitals in China from March 2021 to November 2021, and 404 patients with stable CHD were randomly assigned to receive either Yuxintong capsule and conventional Western medicine (Yuxintong group) or placebo and conventional Western medicine (placebo group) in a 1:1 ratio for 12 weeks (ChiCTR2000041293, December 23, 2020). The primary outcomes were peak oxygen uptake (VO2peak) and anaerobic threshold (AT). The secondary outcomes were metabolic equivalents (METs), duration and onset time of 1-mm ST-segment depression on electrocardiography (ECG), and 36-Item Short Form Health Survey (SF-36) scores. The main safety indicators included complete blood count, urinalysis, liver function, renal function, coagulation function, and 12-lead electrocardiogram. And adverse events were recorded throughout the trial. RESULTS: 369 patients, 187 in the Yuxintong group and 182 in the placebo group, were finally included for analysis. Compared with placebo group, 12-week treatment with Yuxintong showed an improvement in AT (0.98 ± 2.88 vs. 0.12 ± 2.79 mL kg-1·min-1; LSMD, 0.80 [95 % CI: 0.28 to 1.32]; P < 0.025), and general health (13.61 ± 15.13 vs. 8.29 ± 14.14; LSMD 5.30, [95 % CI: 2.33 to 8.31]; P < 0.05) and vitality scores (12.46 ± 11.32 vs. 6.01 ± 11.41; LSMD 6.43, [95 % CI: 4.13 to 8.31]; P < 0.05) on SF-36 scale. The other outcomes did not significantly differ between the two groups. The adverse events were similar between the two groups. CONCLUSIONS: Yuxintong capsule, as an adjunctive therapy to conventional treatment, improved AT, and general health and vitality scores on SF-36 scale in patients with stable CHD. However, the improvements in VO2peak, METs, and the duration and onset time of 1-mm ST-segment depression on ECG were not statistically significant.
6 Apr 2026
Read appraisal →Journal of ethnopharmacology
Efficacy and safety of Qiliqiangxin capsule as adjunctive therapy in heart failure with reduced ejection fraction: A systematic review and meta-analysis of randomized controlled trials
ETHNOPHARMACOLOGICAL RELEVANCE: The Qiliqiangxin (QLQX) capsule is a prominent traditional Chinese medicine formulation developed based on the collateral disease theory, specifically for the treatment of heart failure (HF). Its composition includes 11 medicinal botanicals, such as Huang Qi, Ren Shen, and Dan Shen, and is designed to tonify qi, activate blood circulation, and promote diuresis. Supported by over 20 years of extensive clinical application, modern pharmacological research, and stringent quality control, QLQX has been incorporated into the national heart failure guidelines in China. AIM OF THE STUDY: This study evaluates the efficacy and safety of QLQX as adjunctive therapy for heart failure with reduced ejection fraction (HFrEF). METHODS: We systematically searched seven databases until February 24, 2025, for randomized controlled trials (RCTs) evaluating QLQX in patients with HFrEF. Two independent researchers screened trials, extracted data, and assessed the risk of bias using the Cochrane RoB 2.0 tool. Meta-analyses were conducted for efficacy and safety outcomes, with evidence quality evaluated through the GRADE framework. RESULTS: Twenty-four RCTs (n = 5580) were included. Compared with conventional treatments (CTs) alone, QLQX adjunctive therapy significantly reduced the risk of cardiovascular death (RR = 0.82, 95 %CI [0.69, 0.96], P = 0.02), hospitalization for HF (RR = 0.78, 95 %CI [0.67, 0.91], P = 0.001), and composite cardiovascular events by 18 % (RR = 0.82, 95 %CI [0.73, 0.92], P = 0.0005), with evidence quality rated as moderate. QLQX significantly improved cardiac function parameters compared to controls: increased left ventricular ejection fraction (MD = 7.14, 95 % CI [6.75, 7.54], P < 0.05), reduced left ventricular end-diastolic diameter (MD = -5.25, 95 % CI [-5.75, -4.75], P < 0.05), improved NYHA class (RR = 1.19, 95 %CI [1.14, 1.25]), decreased NT-proBNP (SMD = -2.01, 95 %CI [-2.26, -1.95], P < 0.05), and increased 6-min walking distance (MD = 44.80, 95 %CI [42.37, 47.22], P < 0.05). CONCLUSION: QLQX adjunct therapy effectively reduces cardiovascular death and HF hospitalization while improving cardiac function in HFrEF, with favorable safety. Large-scale multicenter RCTs with extended follow-up are required to confirm long-term benefits and address existing study limitations.
6 Apr 2026
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