What’s in traditional Chinese herbal medicine, and do its prescriptions work?

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The dried herbal products are arrayed on the floor and on floor-to-ceiling shelves." class="dmm-resize-img-full cq-dd-image lazy lazy-image" title="The main entrance of a shop selling traditional Chinese medicine, with a shopkeeper inside. The dried herbal products are arrayed on the floor and on floor-to-ceiling shelves."/> </picture> <div class="credit"> Credit: Edna Winti/Flickr </div> <div class="caption"> Shops selling traditional Chinese herbal medicine, such as this one in Vancouver, British Columbia, can be found all around the world. </div> </div> </div> </div> </div> <div class="text-left article-content"> <p><span class="text-first-letter">If you’ve ever walked into an apothecary for traditional Chinese medicine (TCM), it’s hard to ignore the tang of dried herbs that are arrayed on the floor, lining the counter, and stacked on floor-to-ceiling shelves. There’s a good chance any brew you buy won’t taste great either. Despite the smell and taste, many people around the world swear by TCM, using it to treat various ailments or as supplements to bolster general health.</span></p> </div> <div class="long-form-text-par-2 container responsivegrid"> <div id="container-2d8b8eceb1" class="cmp-container"> <div class="image"> <div class="image-component image-component-medium pull-right"> <img src="/content/dam/cen/static/images/dev/thumbnail-profiles/placeholder.jpg" data-src="https://s7d1.scene7.com/is/image/CENODS/10112-feature2-artemisinin?$responsive$&wid=300&qlt=90,0&resMode=sharp2" data-srcset="https://s7d1.scene7.com/is/image/CENODS/10112-feature2-artemisinin?$responsive$&wid=300&qlt=90,0&resMode=sharp2" alt="Chemical structure of artemisinin." class="dmm-resize-img-medium cq-dd-image lazy lazy-image" title="Chemical structure of artemisinin."/> </div> </div> </div> </div> <div class="text-left article-content"> <p>A large fraction of TCM ingredients come from plants, and the active compounds are their metabolites. Plants are amazing chemists—they can’t run from danger or environmental stressors, so they have no choice but to synthesize their way to survival. Their strategies include secreting bitter or toxic compounds to deter consumers in the wild. Occasionally, some of these chemicals are potent enough to treat human health conditions.</p> </div> <div class="text-left article-content"> <p>For as long as humans have been hunter-gatherers, our ancestors have foraged for plants to seek relief from their illnesses. Ancient China wasn’t the only civilization to tap into the vast medical potential of plants. What distinguishes TCM from other canons of herbal remedies is the early emergence of the written language in China, TCM experts say. <a href="https://www.nature.com/articles/nplants2017109" shape="rect" title="Demystifying traditional herbal medicine with modern approach I Nature Plants">The power of the written word</a> allowed historical medical scholars to record, compile, and share thousands of years of medicinal wisdom.</p> </div> <div class="long-form-text-par-4 container responsivegrid"> <div id="container-374c31f8e9" class="cmp-container"> <div class="speedBump"> <div class="recommended-multiple-item"> <p class="speedbump"> <a href="/biological-chemistry/genomics/Large-genomics-effort-yields-antiparasite/96/i45"> Related: Large genomics effort yields antiparasite targets </a> </p> </div> </div> </div> </div> <div class="text-left article-content"> <p>Today, traditional Chinese herbal medicine is adopted all around East and Southeast Asia and among their diasporas. In China, TCM is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114631/" shape="rect" title="Traditional Chinese medicine in the Chinese health care system - PMC">well integrated into the health-care system</a>; modern-day hospitals have entire wings dedicated to the practice. Herbs like ginseng and ginkgo are mainstay ingredients in household beauty products. Ancient TCM texts provide pharmaceutical companies with a treasure trove of promising would-be drugs to screen for. Nevertheless, TCM’s popularity is mainly confined to communities in or from the Far East. Outsiders are skeptical, arguing that because most TCM offerings haven’t gone through double-anonymized clinical trials, they may not be safe or effective.</p> </div> <div class="text-left article-content"> <p>“There is a tremendous cultural barrier,” says <a href="https://biology.mit.edu/profile/jing-ke-weng/" shape="rect" title="Jing-Ke Weng - MIT Department of Biology">Jing-Ke Weng, a Massachusetts Institute of Technology plant biologist</a> who studies how plants synthesize medically important molecules. “People will be reluctant to adopt something they don’t understand.”</p> </div> <div class="long-form-text-par-6 container responsivegrid"> <div id="container-235a3b3a1c" class="cmp-container"> <div class="inArticleRevealAds"> <style> .inArticleRevealAd1 { clear:both; padding : 20px 0px 20px 0px; } </style> <script> $(".inArticleRevealAds").removeClass("section"); </script> <div class="inArticleRevealAd1" id="div-gpt-ad-2894946-1"> <script> googletag.cmd.push(function() { googletag.display('div-gpt-ad-2894946-1'); }); </script> </div> </div> </div> </div> <div class="text-left article-content"> <p>The TCM label is a historical and cultural one; there is no unifying chemistry behind the diversity of TCM herbs. Some practitioners trained in TCM say the foundational principles are <a href="https://www.nlm.nih.gov/exhibition/chinesemedicine/yin_yang.html" shape="rect" title="Classics of Traditional Chinese Medicine: Yin and Yang">yin and yang</a>, which roughly translate to “darkness” and “light.” Although outsiders may think these concepts are unscientific, they embody homeostatic balance, says <a href="https://life-sci.hkust.edu.hk/team/karl-wah-keung-tsim/" shape="rect">Karl Tsim</a>, a molecular biologist at the Hong Kong University of Science and Technology who researches the genetic and chemical properties of TCM. He explains that yin points to the body’s immune defenses, while yang refers to the body’s metabolic levels, notions that allopathic doctors can recognize.</p> </div> <div class="text-left article-content"> <p>On occasion, a prescription from the TCM classics can make a splash on the global stage. Perhaps the most well-known TCM herbal ingredient that became a pharmaceutical is the antimalarial molecule <a href="https://cen.acs.org/articles/94/i1/Well-Known-Malaria-Drug-Artemisinin.html" shape="rect" title="Well-Known Malaria Drug Artemisinin Works By Attacking Multiple Parasite Proteins">artemisinin</a>, which is derived from <i>Artemisia annua</i>, or sweet wormwood. Its discovery is somewhat of a legend: In 1969, a Chinese herbalist named <a href="https://www.nobelprize.org/womenwhochangedscience/stories/tu-youyou" shape="rect" title="The Nobel Prize I Women who changed science I Tu Youyou">Tu Youyou</a> began combing through the yellowed pages of 1,600-year-old medical tomes for a cure for malaria.</p> </div> <div class="long-form-text-par-8 container responsivegrid"> <div id="container-833b72bcd0" class="cmp-container"> <div class="image"> <div class="image-component image-component-full pull-right"> <picture id="three"> <source media="(max-width: 480px)" srcset="https://s7d1.scene7.com/is/image/CENODS/10112-feature2-youyou?$responsive$&wid=400&qlt=90,0&resMode=sharp2"/> <source media="(max-width: 992px)" srcset="https://s7d1.scene7.com/is/image/CENODS/10112-feature2-youyou?$responsive$&wid=610&qlt=90,0&resMode=sharp2"/> <img src="/content/dam/cen/static/images/dev/thumbnail-profiles/placeholder.jpg" data-src="https://s7d1.scene7.com/is/image/CENODS/10112-feature2-youyou?$responsive$&wid=700&qlt=90,0&resMode=sharp2" data-srcset="https://s7d1.scene7.com/is/image/CENODS/10112-feature2-youyou?$responsive$&wid=700&qlt=90,0&resMode=sharp2" alt="Tu Youyou leaves the stage after receiving her 2015 Nobel Prize in Physiology or Medicine at the cerenomy in Sweden." class="dmm-resize-img-full cq-dd-image lazy lazy-image" title="Tu Youyou leaves the stage after receiving her 2015 Nobel Prize in Physiology or Medicine at the cerenomy in Sweden."/> </picture> <div class="credit"> Credit: Charles Hammarsten/Ibl Bildbyr/ZUMA Press/Newscom </div> <div class="caption"> Tu Youyou was one of the winners of the 2015 Nobel Prize in Physiology or Medicine. She was honored for her role in the discovery and development of the antimalarial compound artemisinin. </div> </div> </div> </div> </div> <div class="text-left article-content"> <p>At that time, outbreaks were sweeping through southern China and its neighbors. The disease hit the soldiers in the Vietnam War especially hard. Making matters worse was the fact that the malaria parasite had grown resistant to chloroquine, the standard treatment of that era. North Vietnam asked China for help, and the Chinese government launched Project 523. As the operation’s leader, Tu discovered frequent mentions of sweet wormwood in the recipes that treated malaria-like fevers. Her team isolated the active ingredient from sweet wormwood and developed a low-temperature extraction that preserved the molecule’s bioactivity. Tu even volunteered as the first human medical test subject for the compound. Her discovery saved millions of lives and earned her a share of the <a href="https://cen.acs.org/articles/93/i40/Nobel-Prize-Physiology-Medicine.html" shape="rect" title="Nobel Prize In Physiology Or Medicine">2015 Nobel Prize in Physiology or Medicine</a>.</p> </div> <div class="text-left article-content"> <p>Identifying the active agent in other TCM prescriptions will be equally, if not more, challenging. A typical TCM brew contains upward of 10 plant ingredients, and that translates to thousands of metabolites.</p> </div> <div class="text-left article-content"> <p>Weng’s lab at MIT is among those trying to untangle the medicinal secrets of herbal TCM by linking plants and their metabolites to the biological effects they induce in the body with the help of modern science.</p> </div> <div class="long-form-text-par-11 container responsivegrid"> <div id="container-2b959542fc" class="cmp-container"> <div class="speedBump"> <div class="recommended-multiple-item"> <p class="speedbump"> <a href="/articles/94/i48/Bitterness-wild-cucumber-melon-watermelon.html"> Related: Bitterness in wild cucumber, melon, and watermelon </a> </p> </div> </div> </div> </div> <div class="text-left article-content"> <p>For example, a standard experiment is to feed cells with a TCM herb, use RNA sequencing to analyze the cells’ gene expressions, and see which biological pathways have been upregulated or downregulated. Weng speculates that machine learning may one day enter the fray to help parse the mountains of metabolomic data.</p> </div> <div class="text-left article-content"> <p>The complexity of a formula could make herbal TCM remedies a good option for treating complex diseases that involve many targets and multiple biological processes going haywire. TCM is usually slow acting and has long-lasting effects, so it’s suitable for chronic or preventive use against conditions such as inflammation and cardiovascular diseases, Tsim says. In contrast, “Western” medicine often focuses on finding a silver bullet for acute diseases. These differences make Western medicine and TCM complementary, he adds.</p> </div> <div class="long-form-text-par-13 container responsivegrid"> <div id="container-3950a0dd1a" class="cmp-container"> <div class="image"> <div class="image-component image-component-full pull-left"> <picture id="three"> <source media="(max-width: 480px)" srcset="https://s7d1.scene7.com/is/image/CENODS/10112-feature2-herbs?$responsive$&wid=400&qlt=90,0&resMode=sharp2"/> <source media="(max-width: 992px)" srcset="https://s7d1.scene7.com/is/image/CENODS/10112-feature2-herbs?$responsive$&wid=610&qlt=90,0&resMode=sharp2"/> <img src="/content/dam/cen/static/images/dev/thumbnail-profiles/placeholder.jpg" data-src="https://s7d1.scene7.com/is/image/CENODS/10112-feature2-herbs?$responsive$&wid=700&qlt=90,0&resMode=sharp2" data-srcset="https://s7d1.scene7.com/is/image/CENODS/10112-feature2-herbs?$responsive$&wid=700&qlt=90,0&resMode=sharp2" alt="Chinese herb selection, a mortar and pestle, and chopsticks over a distressed-white-wood background." class="dmm-resize-img-full cq-dd-image lazy lazy-image" title="Chinese herb selection, a mortar and pestle, and chopsticks over a distressed-white-wood background."/> </picture> <div class="credit"> Credit: Shutterstock </div> <div class="caption"> Herbs are an important component of traditional Chinese medicine. </div> </div> </div> </div> </div> <div class="text-left article-content"> <p>One group is taking a botanical approach to tackle the thorny disease of cancer. Researchers from Yale University and the company <a href="https://yiviva.com/pipeline/" shape="rect" title="Pipeline - Yiviva">Yiviva</a> are developing what could be <a href="https://www.nfcr.org/blog/first-in-class-drug-candidate-developed-through-national-foundation-for-cancer-research-funding-commences-international-phase-iib-liver-cancer-clinical-trial/" shape="rect" title="World-First Phase II Clinical Trial for a Botanical Cancer Drug Candidate">the first herbal cancer drug</a>. Derived from a 1,800-year-old TCM prescription, the four-herb formula, YIV-906, <a href="https://www.nature.com/articles/srep09384" shape="rect" title="PHY906(KD018), an adjuvant based on a 1800-year-old Chinese medicine, enhanced the anti-tumor activity of Sorafenib by changing the tumor microenvironment I Scientific Reports">has demonstrated in preclinical and early clinical studies</a> that it can boost the efficacy of chemotherapy drugs and <a href="https://cen.acs.org/articles/88/i34/Herbal-Remedy-Counters-Chemos-Side.html" shape="rect">reduce their side effects</a>. The TCM-inspired oral formulation is currently being tested as an adjuvant in combination with other anticancer drugs in Phase 2 trials for liver-associated carcinoma.</p> </div> <div class="long-form-text-par-14 container responsivegrid"> <div id="container-9f784c43e8" class="cmp-container"> <div class="sponsoredContent"> <div class="article-sponsored-component full-width" id="long-article-nativo-1"> </div> </div> </div> </div> <div class="text-left article-content"> <p>With more herbs come more challenges for quality control and standardization of the ingredients, which are already problems that saddle everyday-use TCM herbs, Weng and Tsim say. These issues also threaten public trust for the broader adoption of TCM. It also doesn’t help that TCM’s bioactive molecules often come from endangered plants or once-common shrubs harvested to the brink of extinction.</p> </div> <div class="text-left article-content"> <p>To modernize TCM and prevent reliance on increasingly rare plants, Weng is turning to the manufacturing machinery of bacteria and yeast. He hopes that implanting herbs’ genes into these nonnative hosts will allow the active substances to be synthesized at scale in bioreactors. Such a tack “would be a major step forward to resolving the sourcing issue for these critically important medicinal molecules,” Weng says.</p> </div> <div class="text-left article-content"> <p>It could also solve another problem: the finickiness of plants as chemists. The molecules they churn out depend on regional terroir, just as the quality of wine from a vineyard does.</p> </div> <div class="long-form-text-par-17 container responsivegrid"> <div id="container-0252bd2889" class="cmp-container"> <div class="speedBump"> <div class="recommended-multiple-item"> <p class="speedbump"> <a href="/articles/94/i26/Novartis-MMV-extend-malaria-drug.html"> Related: Novartis, MMV extend malaria drug pact </a> </p> </div> </div> </div> </div> <div class="text-left article-content"> <p>With global temperatures on the rise, quality control of TCM will become even more of a nightmare in the future. Tsim and his collaborators are rushing to profile the chemicals in TCM herbs according to their source, geography, and growth conditions so they know how the active compounds in herbs might shift with time—and how to reproduce these compounds if the need for greenhouse cultivation ever arises.</p> </div> <div class="text-left article-content"> <p>Without these urgent efforts, the immense herbal knowledge amassed over millennia could be yet another casualty of climate change. “It’s not for us. It’s for the next generations,” Tsim says.</p> </div> <div class="long-form-text-par-19 container responsivegrid"> <div id="container-548fa4d2b8" class="cmp-container"> <div class="copyright"> <div class="article-copyright"> <div class="copyright-desc"> <div>Chemical & Engineering News</div> <div>ISSN 0009-2347</div> <div>Copyright © 2024 American Chemical Society</div> </div> </div> </div> <div class="relatedArticles"> <div class="grid-container"> <div class="article-recommended"> <h3 class="recommended-title">You might also like...</h3> <div class="grid-x grid-padding-x recommended-main"> <div class="large-3 medium-6 small-6 cell spaced-manage"> <div class="recommended-multiple-item"> <div class="recommended-wrap-img-eyebrow"> <div class="recommended-menu recommended-menu-img"> <a class="recommended-img" href="/biological-chemistry/genomics/Large-genomics-effort-yields-antiparasite/96/i45?sc=230901_cenymal_eng_slot1_cen"> <picture> <source media="(max-width: 992px)" 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What’s in traditional Chinese herbal medicine, and do its prescriptions work?