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CC BY 4.0 · Chinese medicine and natural products 2025; 05(02): e73-e85
DOI: 10.1055/s-0045-1809610
Review Article

Factors Influencing the Efficacy of Chinese Medicinals

Qichao Liang
1   Department of Pharmacy, The Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
,
Yun Jiang
2   Department of Pharmacy, Zhengzhou Yihe Hospital, Zhengzhou, Henan, China
,
Liguo Liang
3   Emergency Department, Nanyang Hospital of Traditional Chinese Medicine, Nanyang, Henan, China
,
Hualong Liang
4   Traditional Chinese Medicine (Zhong Jing) College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
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Abstract

This paper thoroughly explores the multifaceted factors influencing the efficacy of Chinese medicinals and categorizes them into three main groups: medicinal related factors, patient related factors, and practitioner related factors. Regarding medicinal related factors, the place of origin, growing environment, harvesting time, storage conditions, quality control, dosage form selection, compatibility of medicinals, precise dosing, decoction methods, and administration routes all significantly impact efficacy. The place of origin determines the authenticity of medicinals, the growing environment affects their composition, harvesting time influences potency, improper storage leads to deterioration, quality control forms the foundation of efficacy, dosage forms and compatibility of medicinals affect absorption, dosing and decoction methods require precision, and administration routes should be tailored to individuals. Patient related factors include psychological state, individual differences, background, and disease condition. Psychological state affects treatment compliance, individual differences determine medicine responses, background influences patients' understanding of Chinese medicinals, and disease condition directly reflects efficacy. Practitioner related factors encompass theoretical knowledge, clinical experience, inherited practices, psychological state, and professional ethics. Theoretical knowledge guides medication use, clinical experience enhances efficacy, inherited practices influence prescribing styles, psychological state affects doctor–patient communication, and professional ethics ensure medical quality. These interrelated factors collectively influence the efficacy of Chinese medicinals, emphasizing the need for comprehensive consideration in clinical applications to achieve optimal therapeutic outcomes.


 

Keywords

Chinese medicinals - efficacy of Chinese medicinals - influencing factors - medicinal related factors - patient related factors - practitioner related factors - authentic medicinal materials

Introduction

Traditional Chinese medicine (TCM) is considered a complex science, with theories rooted in social sciences, applications grounded in natural sciences, and explanatory tools imbued with philosophical elements. It is a science with dual social and natural attributes, established under philosophical guidance. However, philosophy must involve rigorous deductive reasoning and logical argumentation. If it relies merely on analogies and metaphors, no matter how eloquently expressed, it cannot be called philosophy. The disconnection between metaphysical theories and practical applications is a weakness of TCM. While TCM theories are rich in philosophical speculation, their applications often cannot be calculated, replicated, or repeated. Thus, TCM often resorts to examples, analogies, and case studies, lacking deductive reasoning and logical argumentation, which deviates from its philosophical foundation and appears less rigorous.

The core reason for TCM's enduring vitality over millennia lies in its clinical efficacy. Ancient medical records describe effects such as “recovery upon finishing the decoction”, “improvement after one dose, cure after two”, and “effects as immediate as drumbeats”.[1] This demonstrates that Chinese medicinals can also exhibit rapid and pronounced effects. Ancient practitioners prescribed medicine with “no more than three doses per formula and no more than a few medicinals.”[2] The influencing factors of the efficacy of Chinese medicinals are not singular; they involve multiple aspects related to the medicine, the patient, and the practitioner.


 

Medicinal Factors

Chinese medicinals used under the guidance of TCM theory, characterized by the four natures (ascending, descending, floating, sinking), five flavors (sour, bitter, sweet, pungent, salty), four properties (cold, hot, warm, cool), six therapeutic effects (warming, clearing, astringing, dispersing, tonifying, purging), and meridian tropism. These theoretical frameworks constitute the essence of Chinese medicinals. Without these attributes, they would merely be minerals, plants, or animals, perhaps termed as “natural medicinals”, but certainly not what TCM defines as “Chinese medicinals”. Thus, Chinese medicinals possess a complex intrinsic nature, and their efficacy is influenced by multiple interrelated factors.

The Factor of Origin

The efficacy of Chinese medicinals is closely tied to the geographical origin, primarily manifested in the following aspects. First is the influence of natural conditions. The distribution and production of Chinese medicinals depend on specific natural factors such as soil, climate, sunlight, and biodiversity. These conditions vary across regions, affecting the growth of medicinals and the accumulation of active constituents. For example, the glycyrrhizin content in Gancao (Glycyrrhizae Radix et Rhizoma) can differ by more than fivefold depending on its origin, while the levels of puerarin and total flavonoids in Gegen (Puerariae Lobatae Radix) also vary significantly by region. The artemisinin content in Qinghao (Artemisiae Annuae Herba) varies dramatically from north to south, differing by five to six orders of magnitude.

Dao-di medicinals (authentic medicinal materials) refer to those produced in specific regions that exhibit superior quality, stable efficacy, and are more renowned compared to the same medicinals grown elsewhere. Through long-term use, observation, and comparison, ancient physicians discovered that even widely distributed medicinals varied in quality due to differences in natural conditions, gradually giving rise to the concept of Dao-di medicinals. Examples include the Four Huai medicinals of Huai Niuxi (Achyranthis Bidentatae Radix), Huai Shanyao (Dioscoreae Rhizoma), Huai Juhua (Chrysanthemi Flos), and Huai Dihuang (Rehmanniae Radix), and the Four Sichuan medicinals of Chuan Dahuang (Rhei Radix Et Rhizoma), Chuan Niuxi (Cyathulae Radix), Chuan Huanglian (Coptidis Rhizoma), and Chuan Beimu (Fritillariae Cirrhosae Bulbus), which are renowned for their distinct therapeutic advantages over counterparts from other regions.

Traditional cultivation techniques and methods also play a crucial role in the quality and efficacy of Chinese medicinals. Some medicinals require specific growing conditions, often developed and refined over generations of farming experience. In the research and development of new Chinese medicinals, the botanical origin and geographical source of Chinese medicinals are critical, as different species or varieties may contain varying levels of active or toxic compounds, which results in differences in pharmacological, toxicological effects, and clinical outcomes.


 

The Factor of Growth

According to TCM theory and modern research, the quality of Chinese medicinals is influenced by various factors, among which growth duration and growing environment are exceptionally important indicators. Different Chinese medicinals have varying optimal growth durations and environments, which directly affect the types and concentrations of compounds they contain, thereby influencing their quality and clinical efficacy.

The types and contents of secondary metabolites in Huanglian (Coptidis Rhizoma) vary significantly depending on its growth duration, with the highest total content of active components observed in 5-year-old plants. In cultivated Huangqin (Scutellariae Radix), the total content of active components such as baicalin gradually increases during the first 2 years but begins to decline after the third year. Additionally, the qualification rate of Renshen (Ginseng Radix et Rhizoma) varies considerably with growth duration, making growth duration a critical quality attribute. Mahuang (Ephedrae Herba) contains lower levels of ephedrine during spring sprouting, but the content rises significantly by autumn when it matures. Furthermore, environmental factors such as light, temperature, and humidity also impact the growth and synthesis of active components in Chinese medicinals. For example, Huanglian (Coptidis Rhizoma) grown in cool and moist environments exhibits higher berberine content and stronger efficacy. Strengthening scientific research on Chinese medicinals and exploring the relationship between growth duration, growth environment and efficacy for different Chinese medicinals are of great significance for improving the quality and clinical effectiveness.


 

The Factor of Harvesting

The timing, methods, and parts of harvesting have a direct impact on the quality and efficacy of Chinese medicinals. Improper harvesting time may result in insufficient active component content. For instance, Jinyinhua (Lonicerae Japonicae Flos) harvested during the bud stage contains the highest chlorogenic acid content, whereas delayed harvesting leads to the loss of active components and reduced efficacy. Harvesting methods also affect the quality of Chinese medicinals. Manual harvesting causes less damage and better preserves active components, while mechanical harvesting may break some medicinals and result in the loss of active ingredients. Additionally, different plant parts exhibit varying efficacies. For example, both the roots and stems of Danshen (Salviae Miltiorrhizae Radix Et Rhizoma) can be used medicinally, but the roots contain higher concentrations of active components and thus stronger efficacy. Advances in modern science and technology have provided more precise methods for studying the relationship between harvest timing and efficacy in Chinese medicinals.Chinese medicinals are derived from natural plants, animals, and minerals, and their growth, development, and accumulation of medicinal components are closely linked to seasonal and climatic factors. Selecting the appropriate harvesting season is key to ensuring the quality and efficacy. Chemical analyses and pharmacological experiments have confirmed that harvest timing significantly influences the chemical composition and efficacy of Chinese medicinals.

Roots and rhizomes are typically harvested in autumn or winter when the aboveground parts of the plant have withered, or in early spring before sprouting or just as shoots emerge. At these times, the content of active constituents is relatively high. Stems and woody parts are generally collected in autumn or winter when active constituents are richly accumulated and moisture content is low, facilitating drying and storage. Barks are mostly harvested in late spring and early summer when nutrients and sap in the bark are abundant, cambium cells divide rapidly, and the bark is easily separated from the wood, with wounds healing more readily. Leaves are usually gathered during the plant's vigorous growth period, before flowering or fruit maturation, when photosynthesis is active and active constituent levels are elevated. Different flowers have varying optimal harvest periods to ensure adequate content of active constituents and therapeutic effects. Fruits are mostly picked when naturally ripe or nearly ripe, while seeds are typically collected at fruit maturity. Insects are harvested according to their growth and developmental seasons, whereas vertebrates and shellfish are mostly captured in summer and autumn when the animals are thriving and the medicinal efficacy is optimal. Mineral-based Chinese medicinals have relatively simple harvesting requirements, with most being collectible year-round. Harvesting at the appropriate time ensures that active constituent levels reach their peak, thereby enhancing efficacy.


 

The Factor of Storage

The efficacy of Chinese medicinals is closely related to their storage conditions. Proper storage methods and durations maintain the quality and efficacy of medicinal materials, whereas inappropriate storage may reduce or even nullify their therapeutic effects. After harvesting, Chinese medicinals require appropriate sun-drying and air-drying to remove excess moisture, minimize mold and bacterial growth, and prevent loss of efficacy due to excessive water content. Light exposure may degrade active constituents in medicinal materials. Therefore, light-proof storage is essential, often using opaque containers or bags to minimize light contact. Different types of medicinal materials should be stored separately to prevent odor interference, preserve their original fragrance and efficacy, and avoid cross-contamination. Moisture prevention is crucial in storage. Hermetic sealing helps prevent moisture infiltration, thereby avoiding deterioration and mold growth. Medicinal materials should be stored at suitable temperatures to maintain stability and efficacy. Excessively high or low temperatures may adversely affect their therapeutic properties. With technological advancements, modern solutions such as modified atmosphere packaging, freeze-drying, nanoencapsulation, and intelligent storage systems have emerged. These technologies protect active constituents, extend shelf life, and ensure sustained efficacy in clinical applications.

The relationship between the efficacy of Chinese medicinals and storage time is complex, as different types of Chinese medicinals exhibit varying patterns of efficacy changes during storage. Some Chinese medicinals are considered better with age. After proper aging, their efficacy may become milder, more stable, or even enhanced. For example, Chenpi (Citri Reticulatae Pericarpium) has a strong and irritating odor, but after storage, its volatile oil content decreases while flavonoid compounds increase, reducing or eliminating toxicity and adverse reactions, thereby enhancing its medicinal value. Banxia (Pinelliae Rhizoma) has the effects of drying dampness, resolving phlegm, and stopping vomiting, but its raw form is highly toxic and can irritate the digestive tract mucosa. After prolonged storage, its harsh properties weaken, reducing toxicity and side effects. The famous formula Er Chen Decoction is named after Chenpi (Citri Reticulatae Pericarpium) and Banxia (Pinelliae Rhizoma; the two aged ingredients). Mahuang (Ephedrae Herba) has a strong odor when fresh and is highly potent, but after long-term storage, its properties become milder and more suitable for medicinal use. Danggui (Angelicae Sinensis Radix) and Baishao (Paeoniae Radix Alba) also become less irritating and more effective after proper aging, which is why most Chinese medicinals are considered to be “used aged and not fresh”.

However, for many Chinese medicinal materials, active ingredients degrade over time during storage, leading to reduced efficacy or even complete loss of effectiveness. Most herbal medicinals and those containing volatile components, such as Bohe (Menthae Haplocalycis Herba), Huoxiang (Pogostemonis Herba), and Zisu (Perillae), lose their aroma and active ingredients if stored too long, and thereby diminish their efficacy. Medicinals containing fatty oils or sticky sugars, such as Danggui (Angelicae Sinensis Radix) and Gouqi (Lycii Fructus), are prone to “oil seepage” (surface oiliness) after prolonged storage, resulting in loss of efficacy. Mineral-based medicinals like Longgu (Ossis Mastodi Fossilia), Lingcishi (Magnetitum), and Xiaoshi (Saltpeter), though chemically stable, may still lose efficacy if stored for too long, with a recommended shelf life of not more than 10 years.

Some medicinal materials have an optimal storage period, neither too fresh nor too aged. For example, Aiye (Artemisiae Argyi Folium) reaches its best medicinal state after about 3 years of aging. During this time, volatile oils and other components naturally oxidize and mellow, making the leaves gentler and more stable. This allows the heat from moxibustion to penetrate the skin more effectively, achieving better therapeutic results. The volatile oils in Aiye (Artemisiae Argyi Folium) are among its key active ingredients, providing antibacterial, antioxidant, antiasthmatic, and antitussive effects. However, these oils gradually diminish over time, especially after 3 years, significantly reducing efficacy. Flavonoids and polysaccharides are relatively stable but can still degrade due to environmental factors like humidity and high temperatures. Thus, the optimal storage time for mugwort leaves is around 3 years, when their active ingredients remain stable and their properties are mild.


 

The Factor of Dosage Form

Chinese medicinals have featured diverse and abundant dosage forms since ancient times. Zhongjing Zhang's formulas included pills, powders, pastes, pellets, suppositories, and topical medications. The understanding of dosage forms is reflected in sayings such as “Pills act slowly” and “Decoctions act swiftly”, indicating that decoctions work rapidly and have a sweeping effect, often used for acute or severe conditions, while pills act gently and are suitable for chronic or deficiency syndromes. The efficacy of Chinese medicinals is closely related to their dosage form, as different conditions require different forms, and different dosage forms affect the medicine absorption rate, bioavailability, duration of action, and therapeutic characteristics, thereby influencing efficacy.

Decoctions are characterized by rapid absorption and high bioavailability, allowing quick onset of therapeutic effects, making them suitable for urgent conditions requiring immediate results.

Pills are categorized into water pills, honey pills, paste pills, and wax pills based on preparation methods and excipients. Water pills dissolve easily and act relatively quickly; honey pills dissolve slowly, providing prolonged effects; paste and wax pills dissolve even more slowly, making them suitable for chronic diseases or patients requiring long-term medication.

Powders, being fine particles with a large surface area, are absorbed quickly and produce rapid effects, making them ideal for acute conditions. Although boiled powders are rarely used clinically today, they facilitate the dissolution of active ingredients, save time and medicinal materials, and offer excellent efficacy, which represents a dosage form that should be widely promoted in practice.

Wine-based preparations and tinctures contain ethanol, which enhances the absorption rate of certain medicines in the stomach, thereby improving bioavailability.

Capsules, due to their good water solubility, rupture easily in the stomach after ingestion, allowing the medicine to disperse and release quickly. They exhibit higher bioavailability than tablets and pills and are absorbed more rapidly.

Tablets require binders and are compressed during manufacturing, reducing the medicine's surface area. The disintegration rate in the stomach is the main factor affecting absorption, which results in a slower onset of action.

Dripping pills are formed by the contraction of the matrix in a cooling liquid, which ensures fast absorption and high bioavailability.

Dosage forms also influence medicine stability. For example, honey pills and paste pills can protect medicine components and reduce degradation during storage and transportation. The choice of dosage form also affects medicine safety; certain medicinals may exhibit increased adverse reaction rates when formulated as injections. In terms of dissolution of active ingredients and practical advantages, the order of efficacy for oral preparations is boiled powders > decoctions > paste preparations > water pills > honey pills > concentrated pills. For different administration routes, the order of absorption speed and bioavailability is intravenous > inhalation > intramuscular > subcutaneous > rectal or sublingual > oral > transdermal.

The selection of medicine dosage forms should comprehensively consider the patient's condition, constitution, and medicine properties to achieve optimal therapeutic outcomes.


 

The Factor of the Number of Chinese Medicinals

In the treatment of diseases with Chinese medicinals, single-medicinal prescriptions were predominant before the Western Han Dynasty. With the emergence of classical formulas during the Western Han Dynasty, the practice of combining multiple medicinals began. Whether in Formulas for Fifty-two Diseases (Wu Shi Er Bing Fang), Huangdi's Canon of Medicine (Huang Di Nei Jing), or Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun), most prescriptions consisted of three to five medicinals, occasionally six or seven, with very few exceeding seven ingredients. Botanical and animal-derived medicinals, especially plants, contain multiple components in a single medicinal. When combined and decocted, these components undergo decomposition, synthesis, and other reactions, generating even more compounds. Thus, the efficacy of Chinese medicinals is closely related to the number of ingredients in a prescription. In TCM theory, prescription formulation emphasizes the principles of sovereign, minister, assistant, and envoy, as well as the distinction between major and minor formulas. Different medicinal combinations can enhance or reduce efficacy, increase or decrease toxicity, or alter the direction of action, thus resulting in varied clinical outcomes.

The more medicinals in a prescription, the greater its complexity. Each additional medicinal changes the prescription's structural and quantitative composition, thereby altering its effects. Therefore, prescription design requires careful consideration of therapeutic goals, and more medicinals do not necessarily mean better results; rational combination is key to achieving optimal efficacy. The relationship between the efficacy and the number of Chinese medicinals is complex, involving medicinal compatibility, dosage, flavors, and meridian tropism. Personalized adjustments are necessary based on therapeutic goals and patient-specific factors. Clinicians should continually explore and optimize prescriptions in practice to ensure efficacy and safety. Rational medicinal selection and precise compatibility are crucial for enhancing the efficacy of Chinese medicinals.


 

The Factor of Dosage

The secret of Chinese medicinals lies in dosage. Many of Zhongjing Zhang's prescriptions share the same medicinals but differ slightly in dosage, resulting in distinct formulas for treating different conditions. The efficacy is closely tied to dosage, but larger doses do not always equate to better outcomes. The human body has its own selectivity; excess amounts may be excreted as waste without absorption.

The dose–effect relationship is central to studying the efficacy of Chinese medicinals. Appropriate dosage is critical for ensuring therapeutic effects. As the saying goes, “Without experiencing medicinal dizziness, the persistent illness cannot be eradicated”, highlighting the importance of dosage in efficacy. The four properties (cold, hot, warm, cool), five flavors (pungent, sweet, sour, bitter, salty), directional tendencies (ascending, descending, floating, sinking), meridian tropism, and organ-specific characteristics of Chinese medicinals all influence the dose–effect relationship. Pungent, sweet, warm, and hot medicinals are typically used in smaller doses, while sour, bitter, salty, cold, and cool medicinals are used in larger amounts. Medicinals with ascending and floating properties are prescribed in smaller quantities, whereas those with descending and sinking effects are given in larger doses. Research on the dose–effect relationship of Chinese medicinals and their formulas, based on clinical practice, reveals that this relationship not only shares common attributes with general pharmaceuticals but also exhibits distinct characteristics. These include usage rules rooted in holistic theory and nonlinear features arising from medicinal compatibility, which demonstrates the close connection between dosage and efficacy in Chinese medicinals.

Within formulas, the standard dosages of medicinal substances exhibit relative concentration and demonstrate certain functional trends. The same Chinese medicinal may manifest different therapeutic effects in different prescriptions depending on its dosage and compatibility relationships. The dose–effect relationship in Chinese medicinals is not a simple linear correlation. Based on the nature and properties, Chinese medicinals can be categorized into yin and yang types, with the dose–effect curves following normal distribution patterns. Highly pungent or hot yang Chinese medicinals and intensely bitter or cold yin medicinals are typically used in smaller quantities (appearing at both ends of the curve), while milder cool, warm, and neutral medicinals occupy the central peak area.

In clinical practice, dosage determination must account for the patient's age, constitution, disease duration, pathological progression, and the nature of the Chinese medicinals. Generally, elderly patients, children, and those with weak constitutions require smaller doses; chronic conditions warrant lower dosages than acute cases; severe illnesses necessitate larger quantities while mild conditions require smaller amounts.

Both the absolute dosage of individual medicinals and their proportional relationships within a formula significantly influence therapeutic outcomes. The relationship between efficacy and dosage is complex, where appropriate dosage selection and proportional combinations are crucial for optimizing therapeutic effects.

While authoritative references like the Chinese Pharmacopoeia provide recommended dosages for common Chinese medicinals, clinicians routinely make adjustments based on practical circumstances. Therapeutic enhancement may involve increasing or reducing the dosage of certain Chinese medicinals according to patient feedback.


 

The Factor of Decoction

The therapeutic efficacy of Chinese medicinals is closely related to decoction methods, duration, and equipment selection. Ancient physicians placed great emphasis on decoction techniques, which remain critically important for efficacy. Specific methods include sequential addition (predecoction or postdecoction), wrapped decoction, melting dissolution, and re-decoction after filtration, all designed to maximize active component extraction while preventing volatilization and ensuring proper integration. Modern standardized hospital decoction processes often disregard material properties, employing fixed-time simultaneous boiling of all ingredients, which contributes to diminished efficacy compared to historical practices. Even when patients prepare decoctions themselves, pharmacies frequently fail to provide proper decoction instructions.

Optimal decoction vessels include earthenware pots, enamelware, or stainless steel containers, while iron, copper, and aluminum utensils should be avoided due to potential chemical reactions with medicinal components.

Most Chinese medicine decoction pieces contain dust and impurities, requiring brief predecoction rinsing. Extraction efficiency correlates positively with surface area. Animal shells, minerals, and seashell materials should be ground into fine powder before decoction to improve solubility. Dried decoction pieces generally require approximately 30 minutes of presoaking to facilitate component extraction, though soaking duration should be adjusted according to material texture and seasonal temperature variations. Clean cold water (tap, well, or distilled) serves as the standard solvent, though certain conditions or medicinals may require special solvents as documented in classical texts (e.g., clear liquor, fermented rice water, or rainwater). The ideal water volume covers medicinals by about 1.7 cm, added all at once without subsequent supplementation during boiling.

There are distinctions between high heat and low heat when decocting. Generally, high heat is used first, followed by low heat—that is, starting with a strong fire and switching to gentle heat after boiling. Different formulas require different decoction durations. For example, exterior-releasing medicinals should be decocted for a shorter time, while tonifying medicinals require longer decoction. Most standard formulas are decocted twice, while tonifying formulas or those containing numerous ingredients may be decocted three times. Precious medicinal materials are melted separately before being combined. The extraction rate of active components is approximately 30% in the first decoction, 40% to 50% in the second, and 70% to 80% in the two combined decoctions. Therefore, each dose of medicine is best decocted twice.

Some medicinals require special decoction methods, such as predecoction, postdecoction, melting, direct infusion, separate medicine decoction, or wrapped decoction. These special methods must be carefully followed to ensure the dissolution of active components, enhance efficacy, and avoid adverse factors. Tonifying medicinals, mineral medicinals, and dense root or rhizome medicinals should be decocted for a longer time. After boiling in the first decoction, they should continue simmering for 40 to 50 mins; for the second, third, or even fourth decoction, 30 to 40 min after boiling is sufficient. The selection of guiding medicinals during decoction also influences medicinal efficacy.

The traditional classical decoction method involves removing the dregs and then decocting again. Except for special cases requiring predecoction or postdecoction, the liquids from two decoctions should be combined, boiled for another 5 to 10 min, and then divided into two portions for consumption. This ensures both the extraction of active components and a thorough integration of medicinal ingredients. Classical formulas, with fewer ingredients and proper decoction methods, can achieve the expected therapeutic effects.

In addition to accurate syndrome differentiation and precise medication, proper decoction methods are also a crucial factor. Correct decoction techniques provide quality assurance for clinical medication and directly impact the efficacy of Chinese medicinal decoctions.


 

The Factor of Administration

The efficacy of Chinese medicinals is closely related to administration methods, timing, and dosage. Proper administration can enhance therapeutic effects, reduce adverse reactions, and ensure treatment outcomes. The administration method varies depending on the disease condition, formulation type, and dosage. The administration methods described in Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun) are highly meticulous, requiring comprehensive consideration of factors such as timing, temperature, dosage, frequency, and postadministration precautions based on the patient's condition, constitution, and medicine properties to achieve optimal therapeutic results.[3] [4] Specific administration methods include single-dose administration (taking the entire dose at once), two-dose administration (dividing the dose into two portions), and three-dose administration (dividing the dose into three portions), short-interval administration (taking the medicine at shorter intervals), preemptive administration (taking the medicine before symptoms typically occur), and discontinuation after sweating (stopping the dose after sweating is induced). These methods are strictly tailored to the patient's condition.[5] [6] The timing of medication administration includes taking before meals, which is suitable for diseases below the diaphragm, such as abdominal fullness, lower back pain, dysuria, beriberi, or lower abdominal distension. Taking medicine before meals allows the medicine to better reach the gastrointestinal tract and exert its effects. Taking after meals is suitable for diseases above the diaphragm, such as headache, dizziness, or sore throat. Taking medicine after meals can reduce irritation to the gastric mucosa while allowing the medicine to remain in the stomach longer for better efficacy.Taking medicine on an empty stomach is suitable for anthelmintics and purgatives. When the stomach is empty, the medicine can quickly enter the intestines to take effect, enhancing their vermifugal or purgative effects.Scheduled administration is required for medications that need long-term use, such as formulas for treating chronic diseases or regulating the body, which should be taken at regular intervals to maintain stable medicine concentrations in the body.

The temperature of medication administration includes taking hot, which applies to most formulas such as Guizhi Decoction or Mahuang Decoction. Taking medicine hot helps better induce sweating and relieve exterior syndromes, and aids in dispelling cold pathogens from the body. Taking warm is suitable for spleen–stomach regulating or tonifying formulas such as Xiao Jianzhong Decoction or Lizhong Pill. Taking warm can avoid irritation to the gastric mucosa caused by excessive heat while facilitating medicine absorption. Taking cold is suitable for heat-clearing, detoxifying, or hemostatic formulas such as Baihu Decoction or Xijiao Dihuang Decoction. Taking cold can enhance the heat-clearing effects of medicine while reducing gastric irritation, especially for patients with heart disease, to avoid aggravating internal heat pathogens. Generally, decoction should be taken warm, especially for medicinals that may irritate the gastrointestinal tract; exterior-relieving medicinals and those for cold syndromes should be taken hot to enhance their effects, while antiemetic, detoxifying, and heat-clearing medicinals are best taken cold.

Dosage includes starting with small doses for potent medicinals or new patients, where the initial dose should be small and gradually increased after observing changes in the condition. For example, when treating cold-type abdominal pain with Dahuang Fuzi Decoction, the initial dose should be small and adjusted based on the patient's response. For Chinese medicinals requiring long-term use, the dosage can be gradually increased according to disease progression to achieve better therapeutic effects. For patients with severe conditions or weak constitutions, dosage should be adjusted based on specific circumstances, such as smaller doses for weaker patients and appropriately increased doses for more severe cases. Generally, the dosage of medicinal decoction for adults is about 150 mL per dose, taken two to three times daily; the dosage for children and infants should be appropriately reduced. For special circumstances, such as patients with vomiting, it may be necessary to take the medicine in small amounts multiple times. When taking Chinese medicine, follow the doctor's instructions and do not adjust the dosage or change the administration method on your own. If combining with Western medicine, take them at staggered times. Children, pregnant women, and the elderly should strictly follow medical advice.

Regarding administration frequency, most formulas require multiple daily doses, such as Guizhi Decoction taken three times daily to maintain stable medicine concentrations and better efficacy. For potent or emergency medicinals like Dachengqi Decoction, treating Yangming fu-organ syndrome, a single large dose is required for rapid effect. For milder formulas like Minor Qinglong Decoction, divided doses can be used to reduce gastric irritation while maintaining efficacy.

After taking Chinese medicinals with diaphoretic and exterior-relieving effects, patients should avoid wind and cold to prevent interference with the sweating effect and worsening of symptoms. After taking Guizhi Decoction, patients should keep warm to promote sweating. During medication, patients should avoid foods that conflict with the medicinals, such as raw, cold, greasy, or spicy foods when taking Baihu Decoction to prevent reduced efficacy. At the same time, attention should be paid to contraindications. During the course of taking Chinese medicine, consumption of spicy, greasy, raw, cold, or other irritating foods should be avoided to prevent interference with the medicine's efficacy. Additionally, certain foods should not be consumed simultaneously with the medicine, such as avoiding radish when taking tonic medicinals like Renshen (Ginseng Radix et Rhizoma), as radish may reduce the effects of tonics. After administration, patients should be closely monitored for reactions like sweating, diarrhea, or vomiting, with timely dose adjustments or formula changes based on the response.

Although modern people taking Chinese medicine are not required to follow the strict standards of Zhongjing Zhang's era, it is still necessary to comply with essential requirements to meet the basic efficacy criteria.

First is the timing of administration. The timing for taking Chinese medicine is usually determined based on the nature of the medicine and the treatment purpose. Tonics and purgatives are generally recommended to be taken on an empty stomach before meals to facilitate absorption; Chinese medicines for treating heart and lung diseases and other common illnesses are advised to be taken after meals to reduce gastrointestinal irritation. Sedative medicinals are suggested to be taken before bedtime. For certain specific conditions, such as malaria, the medicine may need to be taken 2 to 3 hours before an attack. For chronic diseases, it is recommended to take the medicine at fixed times to maintain stable medicine concentrations in the body.

Next is the method of administration. The methods for taking Chinese medicine include decoction, infusion, and external application. Decoction is the most common method, usually requiring the medicinals to be boiled for a certain period before consumption; infusion involves steeping the medicinals in boiling water before drinking; external application refers to applying the decoction to the affected area or using it for bathing.

When to stop taking the medicine usually depends on the type of disease, the kind of Chinese medicine, the patient's physical condition, and the doctor's guidance. For acute diseases, such as colds or fevers, Chinese medicine typically begins to show effects within 2 to 3 days. Chronic diseases may require a longer duration. If no efficacy is observed after continuous use for over a month, it may be necessary to reassess whether continuing the medication is appropriate.

Proper administration of Chinese medicinals requires comprehensive consideration of the medicine's properties, the patient's specific condition, and the doctor's recommendations to ensure the medicine achieves its maximum efficacy. If there are any doubts, consult a doctor promptly.


 

 

Patient-Related Factors

The Factor of Psychological State

The Records of the Grand Historian: Biographies of Bian Que and Cang Gong proposed “six incurable conditions”, three of which pertain to the patient's psychological state.[7] When patients are arrogant, willful, unreasonable, or even disrespectful and uncooperative toward physicians, effective treatment becomes difficult. Patients who excessively prioritize material possessions over their health, unwilling to invest time and effort, are similarly challenging to treat. Those who superstitiously believe in witchcraft while rejecting medical science and scientific treatment methods also present significant obstacles. Successful treatment requires active patient cooperation; otherwise, it is unlikely to achieve positive outcomes. The influence of a patient's psychological state on the efficacy of Chinese medicinals is profound and multifaceted. Psychological state not only affects medicine absorption and metabolism but also indirectly impacts therapeutic outcomes through physiological mechanisms such as the neuroendocrine and immune systems. A positive psychological state can significantly enhance the efficacy of Chinese medicinals by improving absorption, regulating the neuroendocrine system, strengthening immune function, and increasing treatment compliance. Conversely, negative psychological states may diminish TCM efficacy by suppressing immune function, increasing stress responses, and reducing treatment adherence. Therefore, during TCM treatment, attention to the patient's psychological state, combined with psychological counseling and intervention, is crucial for optimizing therapeutic outcomes.

Impact of psychological state on medicine absorption and metabolism. When patients maintain confidence and a positive attitude toward treatment, their stress responses diminish, potentially improving gastrointestinal motility and digestive function, thereby facilitating absorption and metabolism of Chinese medicinals. A favorable psychological state promotes gastrointestinal blood circulation, enhancing medicine solubility and absorption rates.

In contrast, negative emotions like anxiety and depression can disrupt gastrointestinal function, such as reducing gastric acid secretion and slowing intestinal peristalsis, which impairs absorption of Chinese medicine. Chronic negative emotions may also compromise liver metabolic function, affecting the metabolism and excretion of Chinese medicine compounds. Psychological state influences the efficacy of Chinese medicinals through the neuroendocrine system. Negative emotions such as anxiety and tension activate the hypothalamic–pituitary–adrenal (HPA) axis, trigger stress responses that increase cortisol and other stress hormone levels. These hormones suppress immune system function and reduce the body's responsiveness to medication, thereby weakening the efficacy of Chinese medicinals. A positive psychological state regulates the neuroendocrine system by lowering stress hormone levels, enhancing immune function, and promoting the release of neurotransmitters like endorphins. These substances not only alleviate pain but also boost the body's resistance, thereby improving the efficacy of Chinese medicinals.

The psychological state is closely related to the immune system, which plays a crucial role in the efficacy of Chinese medicinals. Chronic negative emotions such as anxiety and depression can suppress immune function, reduce the activity of white blood cells and lymphocytes, thereby impairing the immunomodulatory effects of Chinese medicinals. Medicinals like Huangqi (Astragali Radix) and Renshen (Ginseng Radix et Rhizoma) are known to enhance immune function, but their effects may be diminished if the patient is in a prolonged negative emotional state. Conversely, a positive psychological state can boost immune function and improve the body's disease resistance. An optimistic mindset promotes the proliferation and activity of immune cells, thus making the immunomodulatory effects of Chinese medicinals more pronounced.

A patient's psychological state also influences their adherence to treatment. When patients have confidence in their treatment, they are more likely to take medications on time and follow medical advice, ensuring the efficacy of Chinese medicinals. Good compliance maintains effective medicine concentrations in the body and enhances therapeutic outcomes. Negative emotions like anxiety and depression may lead to a loss of confidence in treatment or even abandonment of therapy, significantly reducing the effectiveness of Chinese medicinals.

Psychological state affects pain perception, thereby influencing the analgesic effects of Chinese medicinals. An optimistic attitude can lower pain thresholds and reduce pain sensitivity. Medicinals such as Yanhusuo (Corydalis Rhizoma) and Chuanxiong (Chuanxiong Rhizoma) have analgesic properties, and their effects are more pronounced when the patient is in a positive mental state. Conversely, emotions like anxiety and depression heighten pain perception, making patients more sensitive to pain and potentially weakening the analgesic effects of Chinese medicinals.

Psychological state significantly impacts the speed of recovery. A positive mindset enhances the body's self-repair mechanisms and accelerates the healing process. Optimism improves blood circulation and tissue regeneration, allowing Chinese medicinals to take effect more quickly. Negative emotions, on the other hand, inhibit the body's self-repair capacity and delay recovery. Chronic anxiety and depression place the body in a state of prolonged stress, and impair tissue repair and regeneration, which diminishes the efficacy of Chinese medicinals.


 

Individual Differences

The relationship between the efficacy of Chinese medicinals and individual patients is complex and intimate. TCM emphasizes syndrome differentiation and treatment, and tailors personalized therapeutic plans based on the patient's specific symptoms, constitution, environment, and other factors. This individualized approach not only reflects the scientific, superior, and personalized nature of TCM but has also been validated by long-term clinical practice.

The above mentioned “six incurable conditions”: patients with irregular lifestyles and uncontrolled diets who are overly picky about medications and food, making them unable to meet treatment requirements; patients with severe conditions, imbalanced yin and yang, dysfunctional organs, and bodies too weak to withstand treatment; and patients in extremely debilitated states who cannot take medications or endure treatment.

Modern medicine increasingly values individualized treatment, which incorporates aspects of syndrome differentiation and represents a key point of integration between TCM and Western medicine. Personalized treatment accounts for genetic differences, enabling a “tailor-made” approach to medication. This helps reduce the likelihood of adverse medicine reactions, minimizes the frequency and duration of dosage adjustments, and alleviates patient suffering and financial burdens.

Personalized TCM treatment also involves individualized dosage adjustments. There is a close relationship between the dosage of Chinese medicinals and the therapeutic effects. Correct dosages ensure efficacy, while inappropriate ones may lead to treatment failure or adverse reactions. Therefore, physicians must adjust dosages based on the patient's specific circumstances, such as constitution, age, and gender.


 

The Factor of Patient Background

The Yellow Emperor's Inner Classic (Huang Di Nei Jing) discusses how geographical location, climate, and lifestyle habits influence disease patterns and corresponding treatments, highlighting that patients' backgrounds affect the efficacy of Chinese medicinals.[8] Different regions' natural environments and lifestyles lead to distinct disease characteristics, which necessitate region-specific TCM approaches. In eastern coastal areas, residents consume more fish and salt, tend to have heat-prone constitutions, and are susceptible to skin ulcers. Stone needles are often used for treatment. In Western windy and sandy regions, diets are rich in fatty and sweet foods. While residents are physically robust, they are prone to internal organ diseases and require potent medications. For northern cold climates, dairy-rich diets lead to cold-related disorders like abdominal distension, which should be treated with warm-natured medicinals. In southern humid and hot zones, sour-flavored diets are common, and residents often suffer from musculoskeletal issues, which require microneedles. In central plains with mild climates, mixed diets and sedentary lifestyles contribute to conditions like atrophy and cold–heat disorders, so patients should be treated with dispersing and dredging medicinals.

For the selection of a treatment method, the disease nature, location, and patient specifics should be taken into consideration. It aims not only to treat existing conditions but also to prevent future ones. Combining medicine therapy with non-pharmacological methods optimizes outcomes. Flexible and multimodal exemplify TCM's holistic philosophy and syndrome-differentiation treatment.

Living standards directly affect patients' nutritional status and overall health conditions, which may influence their absorption and response to Chinese medicinals. Good nutritional status may help enhance the efficacy of the medicine, while malnutrition may reduce it. The climatic conditions of the natural environment significantly impact the efficacy of Chinese medicinals. The physiological functions and pathological states of people in cold regions may differ from those in warm regions. Cold environments may lead to poor circulation of qi and blood in the body, and for Chinese medicinals, treating such symptoms, the efficacy may be more pronounced. Additionally, humid environments may exacerbate rheumatic diseases. When treating such conditions with Chinese medicinals, prescriptions need to be adjusted according to the environment to enhance the dampness-removing effects. The social environment includes factors such as patients' life stress and work pace. People under long-term high-pressure conditions may experience suboptimal physical functions. When treating such patients with Chinese medicinals, psychological factors must be considered comprehensively, and liver-soothing and depression-relieving Chinese medicinals should be incorporated to improve efficacy. Good dietary habits contribute to the efficacy of Chinese medicinals. A light diet aids the absorption and metabolism of Chinese medicinals in the body, while greasy, spicy, or other irritating foods may reduce their efficacy.

Dietary customs in different regions may affect the efficacy of Chinese medicinals. Some regions prefer spicy foods, which may influence the absorption and metabolism of Chinese medicinals in the body. Lifestyle customs also impact the efficacy. For example, in regions where staying up late is common, the regulatory effects of Chinese medicinals may be affected.


 

The Factor of the Patient's Disease Condition

The relationship between the efficacy of Chinese medicinals and the type and severity of a patient's illness is one of the core issues in TCM research. The efficacy of Chinese medicinals is closely related to the diseases they treat and the stages of illness, as different diseases and stages may require different treatment methods and compatibility of Chinese medicinals. TCM emphasizes treatment based on syndrome differentiation, which involves tailoring personalized treatment plans based on the patient's specific condition.

The severity of the illness directly affects the efficacy of Chinese medicinals. Generally, mild to moderate illnesses may recover more quickly with Chinese medicinals treatment, while severe or critical illnesses may require longer treatment durations. For example, in the treatment of pediatric hearing loss, patients with mild to moderate hearing impairment may recover relatively quickly with Chinese medicinals, whereas those with severe or profound hearing loss may need prolonged treatment or even adjunctive therapies. The longer the course of the disease, the more complex the condition tends to become, which increases the difficulty of treatment. For chronic diseases such as chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD), Chinese medicinals can alleviate symptoms and slow disease progression to some extent. However, for patients with long disease courses and advanced conditions, the efficacy of Chinese medicinals may be relatively limited.

Syndrome differentiation and treatment in TCM is a dynamic process. Different patients or the same patient at different stages of the disease may exhibit varying syndrome patterns. If Chinese medicine prescriptions are not adjusted promptly in response to changes in the condition, efficacy may be compromised. For instance, during the treatment of certain diseases, a patient may transition from an excess syndrome in the early stage to a deficiency syndrome. If prescriptions targeting excess syndrome continue to be used, the therapeutic effect will be significantly diminished. Treatment strategies and efficacy also differ between acute and chronic phases. During the acute phase, the condition changes rapidly, and Chinese medicinals need to take effect quickly to control the illness. In the chronic phase, Chinese medicinals primarily focus on regulating the body, improving symptoms, and delaying disease progression.

In clinical practice, TCM's advantageous disease categories refer to conditions where TCM demonstrates relative superiority in terms of efficacy, safety, and patient compliance. For example, Chinese patent medicine may serve as alternatives or complements to Western medicine in treating viral colds or specific stages, subtypes, or symptoms, or they may enhance the effects or reduce the toxicity of Western medicine. To improve the clinical value of Chinese patent medicine, it is particularly important to develop clinical guidelines for its use in advantageous disease categories.


 

 

Practitioner-Related Factors

Theoretical Proficiency

First, the practitioner's theoretical proficiency has a crucial impact on the efficacy of Chinese medicinals. Insufficient theoretical knowledge may negatively affect treatment outcomes in multiple ways. Firstly, the theoretical gaps cause diagnostic error. The core of TCM diagnosis lies in syndrome differentiation and treatment. If a practitioner lacks a thorough understanding of foundational theories, such as yin-yang and the five elements, zang-fu organs and meridians, etiology and pathogenesis, they may not accurately identify the patient's syndrome pattern. For instance, mistaking yin deficiency with fire hyperactivity syndrome (characterized by feverish sensations in the palms, soles, and chest, tidal fever, night sweats, red tongue with scant coating, thin and rapid pulse) for an excess heat syndrome could lead to inappropriate use of cold, heat-clearing Chinese medicinals. This not only fails to alleviate symptoms but may also further deplete yin fluid and exacerbate the condition. Similarly, incomplete mastery of disease etiology, pathogenesis, and progression may lead to failure in predicting disease trend or prognosis. For chronic diseases, failure to recognize stage-specific pathological changes or syndrome transformation patterns can result in rigid treatment protocols and hinder the therapeutic efficacy.

Secondly, improper theoretical application compromises therapeutic effect. TCM formulas are designed based on theoretical principles. Practitioners with superficial theoretical understanding may select inappropriate formulas. For example, a patient with spleen–stomach deficiency might erroneously receive kidney-tonifying or blood-nourishing formulas due to the practitioner's unfamiliarity with spleen-strengthening principles, thus leading to misdirected treatment and poor outcomes. The compatibility of Chinese medicinals follows a unique theoretical framework, including mutual enhancement, mutual assistance, mutual restraint, mutual suppression, mutual antagonism, and incompatibility. Misapplication of these principles, such as combining incompatible medicinals like Gancao (Glycyrrhizae Radix et Rhizoma) with Haizao (Sargassum), Daji (Euphorbiae Radix), Yuanhua (Genkwa Flos), or Gansui (Kansui Radix), may trigger severe adverse reactions, undermine efficacy, or even endanger the patient's life. Each Chinese medicinal possesses specific properties, flavor, and meridian tropism. Ignoring these characteristics—for instance, prescribing excessive cold-natured medicinals to a cold-constitution patient—may damage yang qi, aggravate conditions like spleen–stomach cold deficiency, and diminish therapeutic effects.

Thirdly, obsolete theories hinders efficacy advancement. With advances in modern science and technologies, researches on Chinese medicinals continue to evolve, and yield new theories and findings. Practitioners who fail to update their knowledge miss opportunities to integrate modern discoveries into clinical practice. Contemporary pharmacological studies have identified immunomodulatory and antioxidant properties in certain Chinese medicinals. Unawareness of such research limits practitioners' ability to leverage these advantages when treating relevant conditions. Moreover, shifts in disease epidemiology, including emerging modern illnesses, demand updated theoretical approaches. Practitioners confined to classical TCM theories without engaging with modern disease concepts may struggle to address new health challenges effectively. For autoimmune disorders, reliance solely on traditional methods without incorporating modern medical theories and research findings of Chinese medicinals often yields unsatisfactory results.

Furthermore, inadequate theoretical explanations can affect patient compliance. If doctors fail to clearly explain TCM theories in an accessible manner, patients may find it difficult to understand the rationale behind the treatment, thereby leading to skepticism and reduced adherence. For patients requiring long-term medication, if doctors do not thoroughly explain the mechanism and process of the treatment, patients might discontinue the medication prematurely due to a lack of immediate visible results, which may result in treatment failure. Additionally, if doctors fail to clarify TCM theories-related precautions such as decoction method, administration timing, and dietary restrictions, patients may misuse the medicinals, and this will compromise efficacy. For instance, certain Chinese medicinals must be taken on an empty stomach; if this is not communicated, improper administration may lead to poor medicine absorption and diminished effectiveness.


 

The Factor of Clinical Experience

The efficacy of Chinese medicinals is closely tied to the clinical experience of the practitioner. TCM emphasizes syndrome differentiation and treatment, a core principle that requires doctors to tailor personalized treatment plans based on the patient's specific symptoms and physical constitution. Clinical experience plays a pivotal role in this process, as doctors rely on their practical expertise to accurately diagnose and treat diseases.

TCM emphasizes the principles of individualized treatment based on the individual constitution, seasonal changes and geographical localities. Even for the same disease, different patients may present with varying syndromes, which necessitates tailored treatment methods and prescriptions. With a history spanning thousands of years, TCM has accumulated a wealth of clinical experience, encompassing disease understanding, treatment selection, and Chinese medicinals compatibility and application. This experiential knowledge is a vital asset in the inheritance and advancement of TCM. Doctors with extensive clinical experience can more accurately differentiate syndromes and select appropriate TCM formulas and Chinese medicinals. By analyzing the patient's symptoms, signs and medical history, they can determine the syndrome type, etiology and pathogenesis, thereby devising a personalized treatment plan. For example, patients with the common cold may exhibit different syndromes such as wind-cold, wind-heat, summer-heat, or wind-dampness. Experienced doctors can precisely identify these syndromes and prescribe corresponding formulas, such as Mahuang Decoction or Guizhi Decoction for wind-cold, Sangju Drink or Yinqiao Powder for wind-heat, and Baihu Decoction for summer-heat, thereby enhancing the efficacy of Chinese medicinals treatment.

A doctor's clinical experience aids in the rational combination of Chinese medicinals and the adjustment of dosages. Chinese medicinals emphasizes the compatibility principle of monarch, minister, assistant, and envoy, where different Chinese medicinals synergize or counteract each other to achieve optimal therapeutic effects. Experienced doctors can flexibly adjust Chinese medicinals combinations and dosages based on the patient's specific condition to ensure the prescription better aligns with the illness. For example, when treating spleen and stomach deficiency accompanied by dampness, a doctor may add medicinals like Huoxiang (Pogostemonis Herba), Peilan (Eupatorii Herba) to the Si Jun Zi Decoction and adjust the dosage of each medicinal according to the patient's constitution and severity of the condition to enhance efficacy. Some Chinese medicinals possess certain toxicity or side effects, but TCM pharmacology employs various detoxification methods, such as rational compatibility and specialized processing. Doctors with extensive clinical experience are better equipped to master the proper use and precautions of the Chinese medicinals to minimize or avoid adverse reactions. For instance, Fuzi (Aconm Lateralis Radix Praeparaia) has cardiotonic effects but also some toxicity. Experienced doctors can effectively reduce its toxicity while preserving its therapeutic effects through proper combination and processing.

Through clinical practice, doctors continually summarize and evaluate the efficacy of Chinese medicinals, and accumulate experience that is then passed down. By observing and analyzing numerous clinical cases, they can identify the strengths and weaknesses of Chinese medicinals in treating certain diseases, which provides a basis for further research and application. Additionally, this experience helps younger doctors develop faster and raise the overall clinical proficiency of the TCM profession. A doctor's clinical experience serves as a vital source of innovation in TCM. In practice, doctors may modify traditional formulas or create new ones based on patients' unique needs or emerging clinical challenges. If these new formulations prove effective in clinical validation, they can further drive the development and innovation of TCM preparations.

The characteristics of TCM pharmacology determine that a doctor's clinical experience significantly impacts the efficacy of Chinese medicinals. Extensive clinical experience enhances the precision of syndrome differentiation and treatment, optimizes Chinese medicinals compatibility and dosage adjustment, ensures medication safety, promotes efficacy evaluation and experience transmission, and drives TCM innovation and development. Therefore, valuing and cultivating doctors' clinical experience is crucial for improving the efficacy of Chinese medicinals and advancing the inheritance and development of TCM.

With the advancement of modern science, research methods in TCM are also evolving. For example, evidence-based medicine provides more scientific evidence for the efficacy of Chinese medicinals. Emphasizing systematic reviews and clinical trials to validate the effectiveness of medical interventions, evidence-based medicine helps integrate TCM clinical experience with scientific evidence and improve the accuracy and reliability of TCM treatments.

Clinical research on TCM has also received support and promotion from national policies. In 2016, the Chinese government issued the white paper Traditional Chinese Medicine in China, which emphasized the unique role of TCM in maintaining and promoting people's health and proposed a series of policy measures to support the inheritance and development of TCM. These measures include strengthening TCM education and talent cultivation, promoting scientific research and technological innovation in TCM, and improving the quality and standards of TCM services.[10]


 

The Factor of Inheritance Practices

Due to the flexibility of TCM theory, many schools of thought have emerged. Theoretically, they can be categorized into schools such as the Medical Classics School and the Cold Damage School. Clinically, they include the School of Cold and Cool, School of Warming and Tonifying, and the School of Purgation. Geographically, there are schools like the Xin'an School, Lingnan School, and Jinling School. Inheritance practices, along with their medication habits and preferences, also significantly influence the efficacy of Chinese medicinals.

Although there are numerous TCM academic schools, there is currently a severe disconnect and fragmentation, with some even gradually disappearing or becoming extinct.[11] The unique therapies and experience of some schools have not been effectively passed down, which prevents their distinctive advantages from being fully utilized in clinical treatment. For example, certain characteristic therapies of the Jinling School, such as plum-blossom needle treatment for herpes zoster, are now known by very few practitioners and are even at risk of being lost. Differences among schools in theory, diagnosis, and treatment approaches, if not fully understood and integrated, can easily lead to limitations in clinical application. In the past, for the same bacterial infection, ten different TCM schools might have prescribed ten different formulas with vastly different Chinese medicinals and theoretical foundations. Today, however, prescriptions from various TCM hospitals tend to be quite similar, weakening the individualized treatment advantage of TCM.

With social development, traditional inheritance methods such as master-apprentice mentorship have been replaced by university education. The separation of medicine and pharmacy has left medical students with insufficient knowledge of pharmacology, while veteran herbalists are retiring or passing away, and this limits the transmission of skills like customized herbal processing. Traditional methods such as observing mentors in clinics, oral instruction, and case documentation have their limitations. For instance, cross-regional and cross-temporal inheritance is difficult to achieve, and the “inbreeding” of mentor-student relationships further amplifies the drawbacks of regional academic schools, which ultimately affects the clinical efficacy of TCM.

Different regions have developed distinct medication habits and processing techniques due to variations in natural resources, living customs, and cultural traditions, such as the Zhang and Jianchang schools in Jiangxi province. If clinical practice does not consider local medication habits, it may reduce patients' tolerance and compliance, thereby affecting treatment efficacy. Some patients or doctors have developed unreasonable medication habits, such as long-term use of Chinese medicinals, which may lead to excessive accumulation in the body, cause chronic toxicity, and impair liver and kidney function. Others blindly use Chinese medicinals as general tonics for health maintenance while ignoring its potential biases and toxicity.

Some patients or doctors blindly believe in and prefer certain schools, renowned physicians, or ancestral secret formulas, and apply these prescriptions directly without considering the patient's specific condition and individual differences. This may result in inappropriate treatment, failure to achieve the expected efficacy, or even worsen the illness. Some individuals overly adhere to traditional medication preferences and refuse to accept new findings and insights from modern TCM research, thus preventing them from fully utilizing modern technological advancements to enhance efficacy and reduce risks. Modern research has discovered that certain TCM components may interact with Western medicine, yet some fail to adequately consider these factors when combining medications, thereby affecting efficacy or increasing adverse reactions.


 

The Factor of Professional Competence

The efficacy of Chinese medicinals is closely tied to doctors' professional competence, which encompasses expertise, clinical experience, medical ethics, communication skills. These factors collectively influence treatment outcomes.

Issues in medical ethics negatively impact the efficacy of Chinese medicinals. For instance, some medical staff lack a sense of responsibility, and conduct cursory consultations, impatient examinations, inaccurate diagnoses or nonstandard treatments. This prevents precise prescription of herbal formulas tailored to the condition, and consequently reduces efficacy. Some doctors prescribe common Chinese medicinals based solely on symptoms without fully understanding the patient's condition or constitution, and lead to poor results. A few medical staff exhibit indifferent or rigid attitudes, disregard patients' feelings and needs, or even shirk responsibility. This breeds distrust toward doctors and institutions, lower patient compliance and thereby affecting efficacy. Additionally, mass-produced Chinese medicinals may contain extremely low active ingredients or suffer from mold or insect damage, which severely compromises quality.


 

 

Conclusion

The efficacy of Chinese medicinals is a core issue in TCM studies, which is comprehensively influenced by multiple factors from three main aspects: the Chinese medicinals themselves, the patient, and the practitioner. These factors intertwine to collectively determine the clinical effectiveness.

From the perspective of the medicine itself, every step—including origin, growth, harvesting, storage, quality, dosage form, number of ingredients, dosage, decoction, and administration—is indispensable. The origin determines the growing environment of medicinal materials and affects the accumulation of active components. Growth conditions such as sunlight and water are equally crucial. The timing, methods, and parts of harvesting directly impact the medicinal efficacy, while storage conditions influence the stability of the materials. Quality control forms the foundation for ensuring the safety and effectiveness of medicinal materials. The selection of dosage forms, number of ingredients, and dosages requires precise adjustment according to the condition. The processes of decoction and administration are particularly critical steps that affect medicine absorption and therapeutic effects.

Individual differences among patients cannot be overlooked. Psychological state significantly influences efficacy, with a positive and optimistic mindset helping to enhance immunity, while negative emotions like anxiety and depression may weaken the medicinal effects. Individual variations such as age, gender, and constitution determine patients' tolerance and response to medications. Patients' life backgrounds, including lifestyle and dietary habits, also exert long-term effects on their physical condition. Furthermore, patients' disease conditions, including disease type, course, severity, and comorbidities, are direct factors affecting the efficacy of Chinese medicinals.

Practitioners play a crucial role in TCM application. Theoretical knowledge forms the foundation of practitioners' competence, with solid TCM theoretical knowledge being the prerequisite for accurate syndrome differentiation and treatment. Clinical experience helps practitioners flexibly adjust prescriptions when facing complex conditions. While inheritance practices have their advantages, they need to be combined with continuous innovation in modern medicine. Practitioners' psychological state and professional ethics are equally important, as good psychological quality and a strong sense of responsibility ensure rigor and safety throughout the diagnosis and treatment process.

In summary, the efficacy of Chinese medicinals results from the combined effects of medicine quality, individual patient differences, and practitioners' professional competence. In clinical practice, only by comprehensively considering these factors can we fully leverage the therapeutic advantages of Chinese medicinals and provide patients with more precise and effective treatment plans. In the future, with continuous advancements in science and technology and interdisciplinary research, we can further optimize the efficacy of Chinese medicinals, promote the modernization of TCM, and make greater contributions to human health.


 

 

Conflict of Interest

The authors declare no conflict of interest.

CRediT Authorship Contribution Statement

Qichao Liang: Conceptualization, and writing -original draft. Yun Jiang: Formal analysis, and writing-review & editing. Liguo Liang: Investigation, and writing-review & editing. Hualong Liang: Validation, methodology,and writing-review & editing.



Address for correspondence

Hualong Liang
Department of Pharmacy, Henan University of Chinese Medicine
156 Jinshui East Road, Zhengzhou, Henan 450046
China   

Publication History

Received: 12 January 2025

Accepted: 15 March 2025

Article published online:
27 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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