View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Online Submissions: http://www.journaltcm.com J Tradit Chin Med 2015 June 15; 35(3): 355-360 [email protected] ISSN 0255-2922 © 2015 JTCM. All rights reserved. REVIEWTOPIC Review of the powder and decoction formulae in Traditional Chi- nese Medicine based on pharmacologically active substances and clinical evidence Liu Qihua, Wen Jin, Peng Zhiping, Liu Fenglin, Tong Xiaolin aa Liu Qihua, Wen Jin, Peng Zhiping, Tong Xiaolin, Depart- tions; Pharmacology; Medicine, Chinese traditional; ment of Pharmacy and Endocrinology, Guang'an men Hospi- Review tal, China Academy of Chinese Medical Sciences, Beijing 100053, China Liu Fenglin, Department of Medical, Harbin Emergency INTRODUCTION Center, Harbin 150020, China Supported by National Basic Research Program of China Most crude drugs used in Traditional Chinese Medi- (Dose-Effect Relationship Study of Classical famous Prescrip- cine (TCM) are natural products. Some come from en- tion, No. 2010CB530601), Beijing Science Society Project dangered species, which means their supply is very lim- (Common technology Demonstration and Research for Boil- ited and the supply of some crude drugs is constrained ing Powders of Chinese Materia Medica, No. by their exhaustibility. The use of power formulae is an Z121102001112010) effective way to conserve these crude drug resources. Correspondence to: Prof. Tong Xiaolin, Department of En- Study indicates that the use of powder formulae can docrinology, Guang'an men Hospital, China Academy of Chi- save up to two-thirds of each drug used compared with nese Medical Sciences, Beijing 100053, China. xiaolin- decoction formulae, while achieving identical therapeu- [email protected] tic efficacy. Cai et al 1 conducted a retrospective review Telephone: +86-10-60214943 on the dosages of 28 processed herbal medicines com- Accepted: June 8, 2014 monly used in powder and decoction formulae created by herbalists from the Song to the Qing Dynasty (AD 1644-1911). They found that for all 28 drugs, the dos- ages used in powder formulae were smaller than those Abstract in decoction formulae. For the same processed medi- Powder formulae are an indispensable part of pre- cine, the dosages in terms of powder were scription in Traditional Chinese Medicine. Powder 20.9%-41.9% those in decoction. The ratio of dosages formulae are characterized by good therapeutic ef- of the medicines used in powder to those in decoction formulae is 1 5 to 2 5. Therefore, research on tradi- ficacy and low dose used for their preparation. ∶ ∶ tional powder formulae could allow for further develop- Analysis of the therapeutic application and materi- ment of TCM therapeutics. al basis of pharmacological active substance in power formulae can enable the development of new powder formulae. This in turn can contribute HISTORY OF POWDER FORMULAE to reduction of wastage of drug material, relief of IN TCM shortage of herbal medicinal resources and sustain- Powder formulae in TCM consist of single or a few me- able development of Traditional Chinese Medicine. dicinal materials, and are the basis of dosage forms in both traditional and modern Chinese medicine. For ex- © 2015 JTCM. All rights reserved. ample, traditional honeyed pills, water pills, and con- temporary tablets in chunk or capsule form are all Key words: Powders; Decoctions; Drug prescrip- based on medicinal powders.2 As early as the Eastern JTCM | www. journaltcm. com 355 June 15, 2015 |Volume 35 | Issue 3 | Liu QH et al. / Review Han Dynasty (AD 25-220), the Treatise on Cold during the decoction process. Qingdai (Indigo Natura- Pathogenic Diseases and Synopsis of Golden Cham- lis) is a product formed by precipitation from water bers,3 compiled by Zhang Zhongjing, included more during processing, and nearly all constituents are insol- than 40 powder formulae. Powder formulae became uble in water. Bingpian (Borneolum Synthcticum) is the more popular by the Five Dynasties (AD 907-979) and crystal obtained from the distillate of sambong leaves, Song Dynasty (AD 960-1279), during which the use and is volatile and labile in heat. Luhui (Aloe) are the of powder formulae largely replaced that of decoction concentrated and dried extracts of leaf fluid. Addition- formulae. In the Shanghan Zongbing Lun,4 it was pro- ally, other herbal medicines that have volatile oils as posed that, "decoction formulae are prepared in pow- their main active constituents are suitable for powder der form for direct consumption." The herbalist Li Shi- formulation for infusion. This is because the volatile zhen of the Ming Dynasty (AD 1368-1644) compiled components are largely evaporated during the decoc- the compositions and indications of many medicinal tion process, which diminishes thery potency. Exam- formulae in the Compendium of Materia Medica.5 The ples of these drugs include strongly fragrant herbs such book put great emphasis on the use of powder formu- as Doukou (Fructus Amomi Rotundus), Sharen (Fructus lae, of which there are more than 3200 types. Amomi), Muxiang (Radix Aucklandiae), Jiangxiang (Lig- The powder formulae proposed by Zhang Zhongjing num Dalbergiae Odoriferae), Tanxiang (Lignum Santali are categorized as orally or externally administered Albi), Rougui (Cortex Cinnamomi Cassia), Dingxiang medication.6 Orally administered formulae are divided (Flos Syzygii Aromatici), Xiaohuixiang (Fructus Foenicu- into blended type and decocted one. External formulae li), and Hujiao (Fructus Piperis Nigri). Some herbal are divided into topical forms and suppositories. In medicines that contain coumarins with low water solu- powder formulae for blending, the drug powder is bility and small amounts of volatile components are mixed with different fluids according, which facilitates suitable for both decoction and powder formulae. oral administration. The fluids suggested by Zhang's However, powder formulae are more advantageous work include water, fermented vegetable infusion, than decoction formulae. Examples include Baizhu wine, porridge, chicken egg yolk, and medicated infu- (Rhizoma Atractylodis Macrocephalae), Cangzhu (Rhi- sion. In powder formulae for decoction, a suitable zoma Atractylodis Lanceae), Houpu (Cortex Magnoliae amount of drug powder is boiled with water before Officinalis), Foshou (Fructus Citri Sarcodactylis), Qiang- oral administration. This method proposed by Zhang huo (Rhizoma et Radix Notopterygii), Duhuo (Radix An- combines the advantages of both powder and decoc- gelicae Biserratae), Baizhi (Radix Angelicae Formosanae), tion formulae. Examples include decoction with Banx- Fangfeng (Radix Saposhnikoviae), Wuzhuyu (Fructus ia (Rhizoma Pinelliae), Ganjiang (Rhizoma Zingiberis) Evodiae Rutaecarpae), Chuanxiong (Rhizoma Chuanx- powder, Yiyiren (Semen Coicis), Fuzi (Radix Aconiti iong), and Jianghuang (Rhizoma Curcumae Longae). Lateralis Preparata), Baijiangcao (Herba Patriniae Sca- Naphthoquinones found in Zicao (Radix Lithospermi) biosaefoliae) powder. Topical powders are directly ap- possess hemostasis, anti-bacterial, anti-viral, and an- plied or rubbed on lesion sites. For example, the indica- ti-tumor effects, and are largely insoluble in water. tion for cowherb seed powder is for "spreading on mi- Danshen (Radix Salviae Miltiorrhizae) contains hydro- nor sores." For suppositories, the drug powder is philic phenolic acids and lipophilic phenanthrenequi- wrapped inside cotton and then plugged into the le- sion site. An example is the common Cnidium fruit nones. The phenanthrenequinone tanshinone has ther- powder used for treating genital coldness in women. apeutic effects on tumors, cardiovascular diseases, bac- terial infections, and inflammation.7 The choice of herbal medicines with both hydrophilic and lipophilic RESEARCH ON POWDER FORMULAE components for powder or decoction formulae de- BASED ON PHARMACOLOGICALLY pends on the clinical indication and the exact composi- tion of active ingredients. Some herbal medicines con- ACTIVE SUBSTANCES AND CLINICAL taining soluble active substances are also suitable for EVIDENCE powder formulae. Huanglian (Rhizoma Coptidis) con- tains water-soluble alkaloids, berberine, coptisine, pal- Herbal medicines matine, and jatrorrhizine. Sun et al 8 reported that Herbal medicines containing insoluble or sparingly sol- when Huanglian (Rhizoma Coptidis) powders were dis- uble active substances are not suitable or contraindicat- solved in gastric juice, then berberine and jatrorrhizine ed in decoctions. Instead, they are pulverized for medi- dissolution was about 50% higher that of its decoc- cal use. Examples include Hupo (Succinum), Ruxiang tion. Wei et al 9 found that oral administration of (Olibanum), Moyao (Myrrh), Anxixiang (Benzoinum), Huanglian (Rhizoma Coptidis) powder facilitates intesti- Suhexiang (Storax Liquidambaris Orientalis), Awei (Resi- nal absorption of not berberine but jatrorrhizine. Sanqi na Ferulae), and Xuejie (Sanguis Draconis). These medi- (Radix Notoginseng) contains water-soluble Panax no- cines have main active ingredients like resins and vola- toginseng saponins (PNS). Han et al 10 found that PNS tile oils. Resins are insoluble in water, and oils are lost is poorly absorbed in small intestine after oral adminis- JTCM | www. journaltcm. com 356 June 15, 2015 |Volume 35 | Issue 3 | Liu QH et al. / Review tration. Low membrane permeability may be a more in febrile disease with fluid retention, and edema important factor for dominating absorption extent.