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Compatibility Art of Traditional Chinese Medicine from the Perspective Of Journal of Ethnopharmacology 143 (2012) 412–423 Contents lists available at SciVerse ScienceDirect Journal of Ethnopharmacology journal homepage: www.elsevier.com/locate/jep Review Compatibility art of traditional Chinese medicine: From the perspective of herb pairs Shengpeng Wang a,b, Yangyang Hu a,b, Wen Tan a,b,XuWuc, Ruie Chen a,b, Jiliang Cao d, Meiwan Chen a,b,n, Yitao Wang a,b,n a State Key Laboratory of Quality Research in Chinese Medicine, (University of Macau) Macau SAR 999078, China b Institute of Chinese Medical Sciences, University of Macau, Macau SAR 999078, China c Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China d Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100193, China article info abstract Article history: Ethnopharmacological relevance: Over the past decades, research of traditional Chinese medicine (TCM) Received 11 April 2012 mainly focused on developing potential candidates from Chinese medicinal herbs, while the wisdom of Received in revised form applying these traditional herbs has not been paid as much attention as it deserves. As is well-known, 22 July 2012 multi-herb therapy is one of the most important characteristics of TCM, but the modernization drive of Accepted 23 July 2012 this conventional wisdom has faced many obstacles due to its unimaginable complexity. Herb pairs, the Available online 1 August 2012 most fundamental and the simplest form of multi-herb formulae, are a centralized representative of Keywords: Chinese herbal compatibility. In light of their simplicity and the basic characteristics of complex Traditional Chinese medicine formulae, herb pairs are of great importance in the studies of herb compatibility. Herb pairs Materials and methods: A systematic search of herb pair related research was carried out using multiple Compatibility online literature databases, books and monographs published in the past 20 years. Herb formulae Results: A comprehensive introduction to the compatibility of TCM, the position of herb pairs in TCM and the progresses of several famous herb pairs were provided in this review. Furthermore, the clinical study and the future research trends of herb pairs were also discussed. Conclusions: Herb pairs have played, and may continue to play a key role in full investigation of general herb compatibility for their indispensable position in TCM. Much more research is needed for the standardization, safety evaluation, and mechanism exploration of herb pairs. & 2012 Elsevier Ireland Ltd. All rights reserved. Contents 1. Introduction ......................................................................................................413 2. Herb compatibility and CHM. .......................................................................................413 2.1. Herb compatibility is a better choice ............................................................................413 2.2. Herb compatibility is a necessary choice .........................................................................414 2.3. The incompatibility of CHM....................................................................................414 3. The role of herb pairs in TCM . .......................................................................................415 4. Important herb pairs and their scientific rationale........................................................................416 4.1. Zuojin Wan. ..............................................................................................416 4.2. Danqi Fang . ..............................................................................................416 4.3. Dangguibuxue Decoction . .....................................................................................417 5. Clinical study of herb pairs . .......................................................................................417 Abbreviations: ADME, absorption, distribution, metabolism and excretion; APL, acute promyelocytic leukemia; CHM, Chinese herbal medicine; CYP2E1, Cytochrome P450 2E1; dl-THP, dl-tetrahydropalmatine; HIF1a, hypoxia-inducible factor-1alpha; HUVECs, human umbilical vascular endothelial cells; NSCLC, non-small cell lung cancer; PML-RARa, promyelocytic leukemia retinoic acid receptor a; RRLC, rapid resolution liquid chromatography; SERCA2a, sarco/endoplasmic reticulum ATPase 2a; SFDA, the State Food and Drug Administration; TCM, Traditional Chinese medicine; UPLC-Q-TOF/MS, ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry; VEGF, vascular endothelial growth factor n Corresponding authors at: Institute of Chinese Medical Sciences, University of Macau, Av. Padre Tomas Pereira S.J., Taipa, Macau 999078, China. Tel.: þ853 83974873. E-mail addresses: [email protected] (M. Chen), [email protected] (Y. Wang). 0378-8741/$ - see front matter & 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jep.2012.07.033 S. Wang et al. / Journal of Ethnopharmacology 143 (2012) 412–423 413 6. Conclusions and perspective . ......................................................................................419 Acknowledgments . ...............................................................................................420 References .......................................................................................................420 1. Introduction prescriptions in a flexible way to face the multiple needs of patients. In the procedure of forming a prescription, herb pairs For a long period of time, medical scientists have realized that are always used as the basic units. Actually, although most of the the pathogenesis and progression of diseases are so complicated recorded formulae involve more than two herbs, the interaction that the therapeutic effect of a single drug may be modest and and mutual influence within these formulae can be further ana- hampered by various side effects or resistances in clinic (Keith lyzed and subdivided into several herb pairs (Zhang, 2008). et al., 2005; Zhao et al., 2010). Meanwhile, the pharmaceutical The exact molecular mechanisms of herb pairs are extremely industry has begun to face the challenge of ‘‘more investments, complicated and are still not well elucidated. However, many fewer drugs’’ in drug development (Ruffolo, 2006), which drives famous herb pairs, such as Danggui Buxue Decoction (Astragali many researchers’ attention to the synergistic effects of natural Radix and Angelicae sinensis Radix) and Zuojin Wan (Coptis medicines. Interestingly, to reach the goal of better curative Rhizoma and Euodiae Fructus), have been well studied, and some efficacies and fewer side effects, multi-herb therapy as an essen- possible modes of actions have been hypothesized (Ung et al., tial component of traditional medicine systems has been utilized 2007; Yuan and Lin, 2000). The synergistic effects of herb pairs for thousands of years in China and other countries. In traditional can be achieved by using a pair of herbs with ingredients of Chinese medicine (TCM), drug compatibility has shown its sig- similar therapeutic actions or arising from the potentiation of nificance in long-term clinical practices and many inspiring pharmacokinetic profile, for example one ingredient enhances the experiences have been accumulated. As the marrow of traditional therapeutic effect of another active ingredient by regulating its Chinese culture, TCM has accumulated more than 100, 000 absorption, distribution, metabolism and excretion (ADME) formulae over the past 2000 years (Qiu, 2007), which is quite (Gilbert and Alves, 2003; Ung et al., 2007). Moreover, many different from other traditional herbal therapies across the world. ingredients of herbs are inactive individually but become active It is the essence of syndrome differentiation based on TCM in combination, called coalistic combinations, which are quite theories and this feature has made multi-herb prescription the common in herb pairs (Greco et al., 1995; Kawashima et al., most important characteristic of TCM. Due to its unique philoso- 2004). Peculiarly, recently a holistic systems biology approach has phy and treatment pattern, TCM was identified as one of the been widely applied to address many of the problems encoun- advanced medical sciences until the late 17th century (Yi and tered in TCM research (Buriani et al., 2012; Wang et al., 2009a), Chang, 2004). Until now, Chinese herbal formulae have been and this approach may help to elucidate the mechanism of herb widely explored and their effectiveness are gradually proved by pairs. The mystery of some herb pairs are gradually revealing, in vivo studies and clinical trials in modern times (Chen et al., thus the elucidated mechanism could be applied to more complex 2011; Guo et al., 2012; Lam et al., 2010). In spite of the wide use formulae. Therefore, the study of herb pairs may act as the of herb formulae in ethnopharmacology and in modern pharma- foundation and a pointcut in the investigation of the herb ceuticals, the exact mechanism of most of them is yet to be compatibility. In this review, we offered a comprehensive intro- explored. duction to the compatibility of CHM, the position of herb pairs in In TCM theory, compatibility refers to the combination of two or TCM and the progress of several famous herb pairs. Further, the more herbs based on the clinical settings and the properties of clinical trial and the future research trends of herb pairs were also
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