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.
