How Traditional Chinese Medicine May Help Improve Targeted Therapy for Lung Cancer

 Tiejun Tang

Lung cancer is one of the most common cancers worldwide. The most common type is non-small cell lung cancer (NSCLC).

In recent years, major progress has been made in the treatment of NSCLC through targeted therapy. These medicines are designed to block specific genetic changes that help cancer cells grow.

One of the most important targets is the epidermal growth factor receptor (EGFR) gene. Many patients with NSCLC have mutations in this gene. Drugs that block EGFR can slow the growth of cancer cells and significantly improve outcomes for these patients.

Common EGFR-targeted drugs include: Gefitinib, Erlotinib, Osimertinib

These medications have greatly improved treatment results. However, there are still important challenges.

Most patients eventually develop drug resistance, meaning the cancer begins to grow again despite treatment. This usually happens after 8–16 months of therapy ^[1]. In addition, some patients experience treatment-related side effects. Because of these limitations, researchers are exploring new strategies to improve treatment outcomes. One promising approach is the integration of Traditional Chinese Medicine (TCM) with modern targeted therapy.

Traditional Chinese Medicine has been used for thousands of years and includes treatments such as:

Chinese herbal medicine, Acupuncture, Dietary therapy, Lifestyle regulation.  Unlike many modern drugs that act on a single biological target, Chinese herbal formulas contain multiple active compounds that can influence several biological pathways at the same time.

Because of this multi-target effect, researchers believe that TCM may help:

• enhance the effectiveness of cancer treatments
• reduce treatment side effects
• support immune function
• improve overall quality of life

In recent years, increasing scientific research has begun to explore how TCM may work together with targeted cancer therapies ^[2,3].

How Chinese Herbal Medicine May Support Targeted Therapy

Researchers have identified several possible mechanisms through which Chinese herbal medicine may enhance the effects of EGFR-targeted therapy.

1. Improving the Sensitivity of Cancer Cells to Targeted Drugs

Some natural compounds appear to make cancer cells more sensitive to targeted therapy.

For example, studies have shown that shikonin, a compound derived from traditional medicinal plants, may enhance the anti-tumor effect of Gefitinib. Laboratory studies suggest that it works by blocking key cancer growth signals inside the cell ^[4].

2. Blocking Additional Cancer Growth Pathways

Cancer cells often use multiple signaling pathways to survive. Some herbal compounds may help block these pathways.

One well-known compound is curcumin, a natural substance found in turmeric. Research suggests that curcumin can:

• slow cancer cell growth
• promote cancer cell death
• reduce activation of EGFR signaling
• reduce certain digestive side effects associated with targeted therapy ^[5]

Another compound, Astragaloside IV, extracted from the traditional herb Astragalus (Huangqi), has also demonstrated anti-cancer activity in laboratory studies. It appears to slow the growth and spread of lung cancer cells and promote cancer cell death through specific cellular pathways ^[6].

A further natural compound, resveratrol, derived from Polygonum cuspidatum (Huzhang), has also shown anti-tumor effects in lung cancer cells by influencing proteins involved in cell survival and apoptosis ^[7].

3. Supporting the Immune System

Cancer develops within a complex biological environment known as the tumor microenvironment. This environment includes immune cells, signaling molecules, and surrounding tissues that interact with cancer cells.

Some Chinese herbal formulas may influence this environment and help regulate immune responses.

For example, a traditional formula known as Fei Liu Ping has been shown in experimental studies to affect immune regulation within tumors. Research suggests it may reduce certain immune cells that suppress anti-tumor immunity, potentially helping the body better fight cancer ^[8].

Clinical Evidence for Combining TCM with Targeted Therapy

In addition to laboratory research, several clinical studies have examined whether Chinese medicine can improve outcomes when used alongside EGFR-targeted therapy.

One large randomized clinical trial involving 354 patients with advanced lung adenocarcinoma compared two groups:

• patients receiving EGFR-targeted therapy plus Chinese herbal medicine
• patients receiving EGFR-targeted therapy plus placebo

The study found that patients who received herbal treatment experienced:

• longer progression-free survival (their cancer remained stable for longer)
• higher treatment response rates
• better quality of life
• fewer mild treatment-related side effects ^[9]

Another analysis combining 13 clinical trials involving 899 patients found that several Chinese herbal injections used together with EGFR-targeted therapy improved treatment response rates compared with targeted therapy alone ^[10].

These findings suggest that integrative approaches may provide additional benefits for some patients.

Why Integrative Medicine May Be Beneficial

Traditional Chinese Medicine takes a holistic approach to health, focusing on restoring balance within the body and strengthening the body's resistance to disease.

When used alongside modern cancer treatments, TCM may help:

• support the immune system
• improve treatment tolerance
• reduce side effects
• enhance overall wellbeing

However, it is important to emphasize that TCM should not replace standard cancer treatments. Instead, it may be used as a complementary therapy under professional supervision.

The Need for Further Research

Although current research is encouraging, more high-quality studies are still needed.

Future research should focus on:

• identifying the most effective herbal formulas
• understanding how herbal compounds interact with targeted drugs
• establishing optimal integrative treatment protocols
• confirming long-term safety and effectiveness

Large, well-designed clinical trials will help clarify the role of Traditional Chinese Medicine in modern cancer care.

Conclusion

Targeted therapies have significantly improved the treatment of non-small cell lung cancer, particularly for patients with EGFR mutations. At the same time, growing evidence suggests that Traditional Chinese Medicine may enhance the effectiveness of these treatments while improving patient wellbeing.

Integrating carefully selected Chinese medicine therapies with modern targeted treatments may represent a promising approach for improving outcomes in patients with lung cancer.

Patients interested in this approach should always consult qualified healthcare professionals experienced in both oncology and Traditional Chinese Medicine.

References

1. Absenger G. Resistance to epidermal growth factor receptor tyrosine kinase inhibitors in mutated non-small cell lung cancer. MEMO. 2019;12:128-135.
2. Tang M, Wang S, Zhao B, et al. Traditional Chinese Medicine prolongs progression-free survival in EGFR-TKI treated NSCLC patients. Med Sci Monit. 2019;25:8430-8437.
3. Wang Y, Wu G, Li R, et al. Chinese medicine combined with EGFR-TKIs prolongs survival in NSCLC patients with EGFR mutations. Front Public Health. 2021;9:677862.
4. Tang J, Ren Y, Zhao J, et al. Shikonin enhances sensitization of gefitinib against NSCLC via inhibition of PKM2/STAT3/cyclin D1 pathway. Life Sci. 2018;204:71-77.
5. Lee J, Lee Y, Chang G, et al. Curcumin induces EGFR degradation and enhances gefitinib therapy. PLoS One. 2011;6:e23756.
6. Jia S, Lv D, Zhang S, et al. Astragaloside IV inhibits NSCLC progression through Akt/GSK-3β/β-catenin pathway. Oncol Res. 2019;27:503-508.
7. Wright C, Iyer A, Yakisich J, et al. Anti-tumorigenic effects of resveratrol in lung cancer cells. Curr Cancer Drug Targets. 2017;17:669-680.
8. Wang Z, Li M, Bi L, et al. Traditional Chinese Medicine in regulating tumor microenvironment. Onco Targets Ther. 2024;17:313-325.
9. Jiao L, Xu J, Sun J, et al. Chinese herbal medicine combined with EGFR-TKI in advanced lung adenocarcinoma: randomized controlled trial. Front Pharmacol. 2019;10:732.
10. Yuan J, Yan M, Wu T, et al. Chinese herbal injections combined with EGFR-TKIs for NSCLC: systematic review and meta-analysis. Front Pharmacol. 2025;16:1670501.

Sphenopalatine Ganglion Acupuncture: A Specialized Acupuncture Technique for Nasal Disorders

 Tiejun Tang   

Many patients suffer from chronic nasal problems or recurrent headaches that do not respond well to medication alone. In recent years, a special acupuncture technique called sphenopalatine ganglion (SPG) acupuncture has attracted increasing attention because of its rapid and long-lasting effects in conditions such as allergic rhinitis, sinusitis, and migraine.

This article explains what SPG acupuncture is, what conditions it is used for, how it works, and what patients should know before receiving this treatment.

What is the sphenopalatine ganglion?

The sphenopalatine ganglion is a small but very important nerve structure located deep in the face, behind the nasal cavity. It acts as a key “relay station” connecting:

• The trigeminal nerve (related to facial sensation and pain)
• The facial nerve
• The autonomic nervous system (which controls blood vessels, glands, and secretions)

Because of these connections, the sphenopalatine ganglion plays a major role in:

• Nasal congestion and nasal discharge
• Facial and head pain
• Autonomic symptoms such as tearing, nasal swelling, and pressure

Who developed SPG acupuncture?

SPG acupuncture was developed in China in the 1960s by Professor Li Xinwu, an ENT doctor in Tongren hospital Beijing.

He discovered that carefully stimulating the area of the sphenopalatine ganglion with acupuncture could significantly relieve nasal symptoms, especially in patients with chronic or allergic rhinitis.

In China, this acupuncture point is sometimes referred to as “Xinwu Point”, and it has been practiced and studied for decades.

What conditions can SPG acupuncture help with?

SPG acupuncture is mainly used for conditions involving the nose, face, and head, especially when symptoms are severe or persistent.

Common indications include:

• Allergic rhinitis (hay fever)
• Chronic rhinitis and sinusitis
• Nasal congestion, runny nose, sneezing

How is SPG acupuncture performed?

SPG acupuncture is different from regular body acupuncture.

General procedure:

• The patient is usually in a seated or lying position.
• A long, sterile acupuncture needle is gently inserted through the side of the face or nasal region, following a precise anatomical pathway.
• The needle is directed toward the area near the sphenopalatine ganglion.

What might the patient feel?

During the treatment, patients may experience:

• A deep pressure or aching sensation
• Temporary nasal fullness
• Increased nasal discharge or tearing

These sensations usually last a short time and are considered a normal response.

⚠️ Because this is a deep and highly specialized technique, it should only be performed by well-trained and experienced practitioners.

What are the clinical effects?

Clinical studies and long-term clinical experience have shown that SPG acupuncture may:

• Quickly reduce nasal congestion
• Decrease sneezing and runny nose
• Improve breathing through the nose
• Reduce the frequency and intensity of headaches
• Improve quality of life in patients with chronic nasal conditions

A 2020 RCT study showed that: In treating persistent allergic rhinitis, the sphenopalatine ganglion acupuncture group had a significantly higher overall effective rate after 4 weeks compared to the conventional acupuncture group (≈ 69.7% vs 44.4%) ^[1].

How does SPG acupuncture work?

From a modern medical perspective:

SPG acupuncture may work by:

• Regulating the autonomic nervous system^[2]
• Reducing excessive parasympathetic activity that causes nasal swelling and secretion^[2]
• Modulating pain pathways related to the trigeminal nerve ^[3]
• Influencing inflammatory mediators and neuropeptides involved in headache and rhinitis^[3]

From a Traditional Chinese Medicine perspective:

In TCM theory, SPG acupuncture:

• Opens blocked pathways in the head and face
• Disperses pathogenic wind and clears heat
• Regulates Qi and Blood circulation in the nasal and facial region

These two explanations complement each other rather than conflict.

Is SPG acupuncture safe?

When performed correctly by trained professionals, SPG acupuncture is generally safe.

However, it is not suitable for everyone.

It may not be recommended for patients who:

• Have bleeding disorders
• Have active nasal infections
• Are extremely anxious or unable to cooperate
• Have severe nasal structural abnormalities

Minor side effects such as temporary discomfort or mild nasal bleeding may occur but are usually short-lived.

Conclusion:

SPG acupuncture is a specialized, targeted form of acupuncture that combines traditional knowledge with modern neuroanatomy.

For patients with stubborn nasal symptoms or certain types of headache, it can be an effective option—especially when conventional treatments provide limited relief.

If you are considering SPG acupuncture, always consult a qualified and experienced practitioner who can evaluate whether this technique is appropriate for your condition.

Reference:

1.     Jiao-Ping Mi. Efficacy of Acupuncture at the Sphenopalatine Ganglion in the Treatment of Persistent Allergic Rhinitis. Med Acupunct. 2020 Apr 1;32(2):90-98

2.     Kuiji Wang. Sphenopalatine Ganglion Acupuncture Improves Nasal Ventilation and Modulates Autonomic Nervous Activity in Healthy Volunteers: A Randomized Controlled Study. Sci Rep. 2016 Jul 18;6:29947. 

3.     Da Wen, Chunmei Li. Clinical studies on therapy of acupuncture on the sphenopalatine ganglion[J/OL]. Chinese Journal of Acupuncture and Moxibustion (Electronic Edition), 2022, 11(03): 113-115.

Mechanistic Effects of Acupuncture on Stem Cells

Tiejun Tang  

Stem cell therapy is a rapidly developing field in regenerative medicine. By harnessing the self-renewal and multi-lineage differentiation capacities of stem cells, this approach aims to repair or replace damaged cells, tissues, and organs, ultimately restoring physiological function. Although stem cell–based treatments have demonstrated promising therapeutic potential across a wide range of diseases, their clinical application remains limited by high costs, technical complexity, and safety concerns.
In recent years, increasing attention has been directed toward the effects of acupuncture on stem cell activity. Rather than relying on exogenous stem cell transplantation, acupuncture appears to regulate endogenous stem cells, thereby promoting tissue repair and functional recovery. Accumulating experimental and clinical evidence suggests that acupuncture can influence stem cell mobilization, proliferation, differentiation, homing, and survival through integrated neural, immune, endocrine, and microenvironmental mechanisms ^[1].
This article reviews current research on the mechanisms by which acupuncture modulates stem cell behavior, while also exploring these findings through the lens of traditional Chinese medicine (TCM). Methodological challenges, limitations, and future directions for research and clinical translation are also discussed.
Introduction
Stem cells play a central role in tissue regeneration and physiological homeostasis due to their capacity for self-renewal and differentiation into multiple cell lineages. Modern regenerative medicine has increasingly shifted its focus from exogenous stem cell transplantation toward strategies that activate and regulate endogenous stem cells ^[2].
Acupuncture, a core therapeutic modality of traditional Chinese medicine, has been widely used to treat disorders of the nervous, cardiovascular, musculoskeletal, and reproductive systems, many of which involve tissue injury and repair ^[3]. Growing evidence indicates that acupuncture can modulate stem cell behavior at both local and systemic levels. Unlike pharmacological or genetic interventions, acupuncture acts through biophysical stimulation, activating neurovascular, immune, and endocrine networks, thereby optimizing the stem cell microenvironment and enhancing intrinsic regenerative capacity ^[1].
Types of Stem Cells Influenced by Acupuncture
1. Mesenchymal Stem Cells (MSCs)
Mesenchymal stem cells derived from bone marrow, adipose tissue, and other mesenchymal sources are the most extensively studied stem cells in acupuncture research. Experimental studies demonstrate that acupuncture can increase MSC proliferation, enhance paracrine activity, and promote differentiation toward osteogenic, chondrogenic, angiogenic, and neurotrophic lineages ^[1,4].
2. Neural Stem/Progenitor Cells (NSCs)
In models of stroke, spinal cord injury, and neurodegenerative disease, acupuncture has been shown to activate endogenous neural stem or progenitor cells, particularly in the subventricular zone and hippocampal dentate gyrus. These effects are associated with enhanced neurogenesis, synaptic plasticity, and improved neurological function ^[5,6].
3. Hematopoietic Stem Cells (HSCs) and Endothelial Progenitor Cells (EPCs)
Acupuncture may facilitate the mobilization of hematopoietic stem cells and endothelial progenitor cells from the bone marrow into peripheral circulation, contributing to immune regulation, angiogenesis, and tissue repair ^[1,7].
Mechanisms by Which Acupuncture Modulates Stem Cells
1. Increasing Stem Cell Numbers
Both animal experiments and clinical studies indicate that acupuncture can significantly increase the number of circulating stem and progenitor cells. Electroacupuncture has been shown to elevate mesenchymal stem cell counts in peripheral blood, accompanied by increased levels of stromal cell-derived factor-1α (SDF-1α), which promotes stem cell migration and mobilization ^[4].
Acupuncture can also activate endogenous neural stem cells. When combined with stem cell transplantation, electroacupuncture demonstrates a synergistic effect, outperforming cell transplantation alone. This combined therapy enhances neurotrophic factor expression, promotes angiogenesis, inhibits apoptosis, and improves neurological recovery in cerebral ischemia models ^[5].
2. Improving the Survival of Transplanted Stem Cells
Both acupuncture and stem cell transplantation independently improve functional recovery after ischemic stroke. When used together, they significantly enhance the survival rate, homing efficiency, and functional differentiation of transplanted stem cells.
Transplanted stem cells primarily exert neuroprotective effects through paracrine signaling and immune regulation. Acupuncture, by contrast, improves the internal environment by stimulating endogenous neurogenesis, increasing cerebral blood flow, and upregulating anti-inflammatory cytokines such as interleukin-10 (IL-10) and transforming growth factor-β (TGF-β) ^[5].
3. Promoting Stem Cell Differentiation
In rat models of traumatic brain injury, acupuncture significantly increased the expression of nestin, neurofilament protein (NF-200), and glial fibrillary acidic protein (GFAP). These markers indicate enhanced proliferation and differentiation of neural stem cells into neurons and astrocytes, supporting functional neural repair ^[6]..
4. Enhancing Stem Cell Homing and Tissue Repair
Stem cell factor (SCF) plays a critical role in guiding stem cells to injured tissues. Studies of myocardial infarction demonstrate that electroacupuncture significantly increases SCF levels in both peripheral blood and myocardial tissue, promoting stem cell migration to ischemic regions and supporting myocardial regeneration. Early post-infarction acupuncture appears particularly effective in mobilizing endogenous stem cells and improving prognosis ^[7].
5. Regulating the Stem Cell Microenvironment
A key mechanism underlying the synergy between acupuncture and mesenchymal stem cell therapy is the regulation of the stem cell microenvironment. Acupuncture enhances growth factor secretion, upregulates SDF-1 expression in damaged tissues, and suppresses inflammatory signaling pathways. Both electroacupuncture and MSC therapy independently reduce NF-κB activation and decrease levels of inflammatory mediators such as IL-6 and TNF-α, creating conditions favorable for stem cell survival and tissue repair ^[8].
Discussion
From a traditional Chinese medicine perspective, stem cell activity may correspond to the concept of kidney essence (肾精), which governs growth, development, and regeneration^[9].  Acupuncture’s regulation of qi and blood aligns with modern concepts of energy metabolism, circulation, and cellular signaling, providing a conceptual bridge between traditional theory and contemporary stem cell biology.
Although current research employs in vivo injury models, in vitro stem cell culture with acupuncture-treated serum, and multi-omics approaches, challenges remain in acupoint specificity, dose–response relationships, and long-term stem cell tracking. Future studies should focus on standardized protocols, rigorous clinical trials, and integrative treatment strategies. As a low-risk and cost-effective intervention, acupuncture holds considerable promise for enhancing endogenous regeneration and supporting stem cell–based therapies.

 References

1. Hongyan Gao, Weijun Ding. Effect and mechanism of acupuncture on endogenous and exogenous stem cells in disease treatment: A therapeutic review.LifeSciences.Volume 331, 15 October 2023, 122031.
2. Ziwei Jiang et al. Bioactive Materials That Promote the Homing of Endogenous Mesenchymal Stem Cells to Improve Wound Healing. Int J Nanomedicine. 2024 Jul 30;19:7751–7773.
3. Xiaoer Liu et al. Acupuncture accelerates wound healing via CGRP-RAMP1-TSP1-mediated macrophage M2 polarization. Chin Med. 2025 Nov 18;20:192.
4. Lizhen Liu et al. Electro-Acupuncture Promotes Endogenous Multipotential Mesenchymal Stem Cell Mobilization into the Peripheral Blood. Cellular Physiology and Biochemistry (2016) 38 (4): 1605–1617. 
5. Huidong Jia et al.Combination of stem cell therapy and acupuncture to treat ischemic stroke: a prospective review. Stem Cell Res Ther. 2022 Mar 3;13:87
6. Yi-Min Zhang et al. Effect of acupuncture on proliferation and differentiation of neural stem cells in brain tissues of rats with traumatic brain injury. Chin J Integr Med. 2013 Feb;19(2):132-6.
7. Yuan C. Y. et al. Comparative Study on Effects of Electroacupuncture at Different Time Points on Myocardial Protection and Stem Cell Factor Expression in Rats With Myocardial Infarction, Chinese Journal of Information on Traditional Chinese Medicine. 2021; 28 (10) 70–74.
8. Wei-Gang Ma. Combining acupuncture and mesenchymal stem cell therapy offers promise as a treatment for inflammatory bowel disease.World J Stem Cells. 2025 Jul 26;17(7):105371.
9. Yan-Bo Ren et al. Shen-Jing as a Chinese Medicine Concept Might Be a Counterpart of Stem Cells in Regenerative Medicine. Chin J Integr Med. 2019 Jan;25(1):64-70.

World Osteoporosis Day — A Hidden Risk You Might Overlook

 Tiejun Tang

Today is World Osteoporosis Day. Osteoporosis is a global health issue, and with the increasing aging of the population, its incidence continues to rise. According to the International Osteoporosis Foundation (IOF), about 200 million people worldwide suffer from osteoporosis. Every three seconds, someone experiences a fracture due to osteoporosis.

There are many causes of osteoporosis. Advancing age, decreased estrogen levels in postmenopausal women, and vitamin D deficiency are well-known risk factors. However, I would like to draw attention to another often-overlooked cause of osteoporosis, hoping to raise awareness among both doctors and patients.

Over the past two years, I have seen several patients diagnosed with osteoporosis, one of whom even suffered a pathological lumbar fracture. The common factor among these patients was long-term use of proton pump inhibitors (PPIs), a class of Western medications used to suppress stomach acid.

Studies have shown that long-term PPI use may be associated with an increased risk of hip, spine, and overall fractures. This may be due to reduced calcium absorption or a direct effect of PPIs on bone cell function [1]. Research has reported that five commonly used PPIs in clinical practice have varying degrees of adverse effects leading to osteoporosis [2].

There are several possible mechanisms by which PPIs may induce osteoporosis. First, gastric acid plays an essential role in the ionization of dietary calcium, which is critical for calcium absorption. PPIs, by inhibiting gastric acid secretion, may interfere with this process, thereby impairing calcium absorption[3]. The second possible mechanism is that PPIs directly affect bone metabolism. Studies have found that omeprazole may increase bone resorption by upregulating osteoclast gene expression and promoting the release of calcium ions into the bloodstream, thus influencing bone cells [4].

To prevent PPI-induced osteoporosis, there are two possible strategies. One is to use H2 receptor antagonists as an alternative to PPIs, which may reduce the risk of osteoporosis, though long-term use may cause other side effects. Another approach is to use natural herbal medicines as substitutes for Western acid-suppressing drugs.

Traditional Chinese Medicine (TCM) has shown great potential in both the prevention and treatment of osteoporosis, with its multi-target and multi-pathway regulatory effects. Active compounds in Chinese herbs—such as flavonoids, polyphenols, saponins, and polysaccharides—can modulate key signaling pathways including Wnt/β-catenin and RANKL/OPG. These effects promote osteoblast differentiation, inhibit osteoclast activity, alleviate oxidative stress and inflammation, and improve gut microbiota imbalance, ultimately restoring bone microenvironment homeostasis [5].

In my previous blog posts, I have discussed the mechanisms by which Chinese herbalmedicine can prevent and treat vitamin D deficiency, as well as its therapeuticeffects on osteoarthritis. On this World Osteoporosis Day 2025, I would like to remind everyone be aware of PPI-induced osteoporosis—do not harm your bones in the process of protecting your stomach.

References

1. Saowanee N. et al. Proton pump inhibitors and risk of fracture: a systematic review and meta-analysis of observational studies. Am
   J Gastroenterol. 2011 Jul;106(7):1209-18.
2. Jingkai Di et al. Evaluating the risk of osteoporosis-related adverse events with proton pump inhibitors: a pharmacovigilance study. Front Pharmacol. 2025 Jul 11;16:1582908.
3. G. Graziani et al. Effect of gastric acid secretion on intestinal phosphate and calcium absorption in normal subjects. Nephrol Dial Transplant. 1995;10(8):1376-80.
4. Mohamed I. Zanaty et al. Effect of Omeprazole on Osteoblasts and Osteoclasts in vivo and in the in vitro Model Using Fish Scales. Biochemistry (Mosc). 2021 Oct;86(10):1192-1200.
5. Chaoqun Song et al. The role of active constituents in traditional Chinese medicine for primary osteoporosis: a mechanistic review. Front Endocrinol (Lausanne). 2025 Sep 16;16:1647984.

Is Eating Chili Peppers Good or Bad for Your Heart?

 Tiejun Tang

For centuries, chili peppers have added heat and flavor to cuisines around the world. But beyond the spice, scientists have been asking a fiery question: is chili good or bad for the human heart? Recent research suggests that moderate chili consumption might actually protect cardiovascular health — though not everyone agrees.

The Evidence for a Healthy Heart

Over the past decade, several large population studies have investigated the link between spicy foods and heart disease. One of the most influential was conducted in China, following nearly half a million adults for seven years. The researchers found that those who ate spicy food almost every day had a 14% lower risk of death compared with those who rarely did ^[1]. The reduction was particularly strong for deaths due to ischemic heart disease and stroke.

Similar results appeared in Italy’s Moli-sani study, which tracked over 22,000 adults for eight years. Regular chili eaters had a significantly lower risk of cardiovascular and all-cause mortality, even after accounting for other lifestyle factors such as smoking, body weight, and Mediterranean-diet adherence^[2].

When these and other studies were pooled together, meta-analyses confirmed the trend: frequent chili consumption was consistently linked to lower overall and heart-related death rates ^[3,4].

What Could Explain the Benefit?

Scientists believe the active compound capsaicin, which gives chili its heat, may help explain these effects. Capsaicin activates a receptor called TRPV1 in blood vessels and nerve endings. This can lead to vasodilation (wider blood vessels), improved blood flow, and lower inflammation ^[5].

Laboratory experiments and small human trials have shown that capsaicin may reduce cholesterol levels, improve blood vessel flexibility, and boost metabolism ^[6]. These effects could, in theory, lower cardiovascular risk over time.

But the Story Isn’t Entirely Sweet (or Spicy)

Not all findings are conclusive. Most of the strongest human studies are observational, meaning they can show an association but not prove that chili itself causes better heart health. People who eat more chili might also have other habits — such as more plant-based diets or higher physical activity — that contribute to their good outcomes.

In addition, excessive spicy food can cause stomach irritation, worsen acid reflux, or lead to discomfort in people with gastritis or ulcers. Very high doses of capsaicin, especially in supplement form, have been linked to rare cases of coronary vasospasm, a temporary narrowing of heart arteries ^[7]. Howeve, such effects are uncommon at normal dietary levels.

How Much Is Too Much?

So far, the evidence suggests that moderate chili consumption — a few times a week, as part of a balanced diet — is safe and may offer modest cardiovascular benefits. Those who enjoy spicy foods can continue to do so, provided it doesn’t cause gastrointestinal distress. On the other hand, taking high-dose capsaicin supplements for heart protection is not recommended until large, long-term clinical trials confirm clear benefits.

The Takeaway

The spice of life may indeed be good for your heart — in moderation. While scientists continue to study the exact effects of capsaicin, the best advice remains simple: eat a balanced diet rich in fruits, vegetables, and whole foods, and if you like your meals with a little kick, that’s probably just fine for your heart.

References

1. Lv J et al. Consumption of spicy foods and total and cause-specific mortality: a population-based cohort study. BMJ. 2015;351:h3942.
2. Bonaccio M et al. Chili pepper consumption and mortality in Italian adults (Moli-sani study). J Am Coll Cardiol. 2019;74(25):3139-3149.
3. Yamani N et al. Meta-analysis evaluating the impact of chili-pepper intake on all-cause and cardiovascular mortality: A systematic review. Ann Med Surg (Lond). 2021; 8;70:102774
4. Ofori-Asenso R et al. Association of Spicy Chilli Food Consumption With Cardiovascular and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies. Angiology. 2021;72(7):625-632.
5. Sreepadaarchana Munjuluri .Capsaicin and TRPV1 Channels in the Cardiovascular System: The Role of Inflammation. Cells. 2021 Dec 22;11(1):18.
6. Vijaya Juturu . Capsaicinoids Modulating Cardiometabolic Syndrome Risk Factors: Current Perspectives. J Nutr Metab. 2016 May 23;2016:4986937.
7. Ozgur Sogut . Acute myocardial infarction and coronary vasospasm associated with the ingestion of cayenne pepper pills in a 25-year-old male. Int J Emerg Med. 2012 Jan 20;5:5.

Is the Famous TCM Formula Angong Niuhuang Wan Effective or Ineffective?

 Tiejun Tang   

Recently, I came across a video on YouTube by a highly popular YouTuber celebrity, Mr. Wang, who claimed that the traditional Chinese patent medicine Angong Niuhuang Wan has no therapeutic benefit in treating acute stroke and performs no better than a placebo. Based on this, he concluded that this long-celebrated and expensive remedy is completely ineffective. Could it really be true that a classic formula used by traditional Chinese medicine (TCM) practitioners for hundreds of years is useless? This article aims to analyze and discuss this issue in detail.

 Source of the Controversy

Mr. Wang’s argument was based on a recently published study in the Chinese Medical Journal (English edition) ^[1]. The study included 117 patients from 17 hospitals across China — 57 in the Angong Niuhuang Wan treatment group and 60 in the placebo group. The conclusion stated that there was no significant difference in efficacy between the two groups. The research was conducted by the Peking Union Medical College Hospital, one of the most prestigious Western medical institutions in China, and published in a top-tier Chinese medical journal. Unsurprisingly, the findings quickly drew attention and spread widely across both mainstream and social media.

Angong Niuhuang Wan was formulated by Wu Jutong (1758-1836), a renowned physician of the Qing dynasty and an expert in the study of febrile diseases. The formula has the functions of clearing heat, resolving phlegm, detoxifying, and opening the orifices. It has been used for over 200 years to treat high fever with coma, stroke-induced unconsciousness, and convulsions in children. It is known as one of the “Three Cooling and Orifice-Opening Treasures” for treating stroke of the Close Symdrome in TCM. So, why did a formula with long-standing clinical efficacy fail to show benefit in a randomized, double-blind clinical trial?

 Clinical Research Evidence

A research team from the China Academy of Chinese Medical Sciences published a meta-analysis with a much larger sample size, reporting different conclusions ^[2]. The study included 28 randomized controlled trials (RCTs) with a total of 2,745 acute stroke patients (1,375 in the experimental group and 1,370 in the control group). The results showed that Angong Niuhuang Wan  significantly improved the overall effective rate, Glasgow Coma Scale (GCS) score, Mini-Mental State Examination (MMSE) score, Activities of Daily Living (ADL) score, and Barthel Index score. It also reduced the National Institutes of Health Stroke Scale (NIHSS) score and serum brain natriuretic peptide (BNP) levels. No serious adverse events were reported, indicating good safety.

 Experimental Research Evidence

Experimental studies have also provided insights into the mechanisms of Angong Niuhuang Wan.

One study established a cerebral ischemia–reperfusion injury (CIRI) model via middle cerebral artery occlusion and used acetylomics and proteomics to explore the neuroprotective effects of  Angong Niuhuang Pill (ANP). The results showed that ANP pretreatment significantly reduced neurological deficit scores and infarct volume, increased regional cerebral blood flow (rCBF), and decreased neuronal apoptosis. Further analysis revealed that ANP regulates autophagy at the transcriptional level via H4K16ac modification, promotes sirtuin 1 (SIRT1) accumulation, and modulates the SIRT1–H4K16ac axis to inhibit excessive autophagy, thereby exerting neuroprotective effects^[3].

Another study used network pharmacology to identify key active compounds in ANP and predict its potential pathways. Five bioactive equivalent combinatorial components (BECCs) were identified, which demonstrated comparable effects to ANP in improving motor recovery in zebrafish and reducing neurological deficits and infarct volume in MCAO mice, mainly through the PI3K/AKT signaling pathway^[4].

More recently, researchers applied ultra-high-performance liquid chromatography coupled with quadrupole-Orbitrap high-resolution mass spectrometry (UHPLC-Q-Exactive-Orbitrap-MS) to identify chemical constituents in ANP and its serum-absorbed components. Using network pharmacology and transcriptomic analysis, they found that 169 compounds were identified in total, 13 of which were detected in serum and interacted with 91 key targets. ANP significantly reduced serum TNF-α and IL-6 levels, as well as hypothalamic COX-2 and PGE2 levels. It upregulated NRF2 and KEAP1 expression while downregulating TLR4, IL-17A, p-P65/P65, TNF-α, and NLRP3. In LPS-induced RAW264.7 cells, ANP inhibited excessive secretion of inflammatory mediators (NO, IL-6, TNF-α), suppressed iNOS and CD86 expression, and enhanced NRF2 expression, thereby demonstrating strong anti-inflammatory and antioxidant effects^[5].

Discussion

Experimental studies have clearly demonstrated the multi-target mechanisms and material basis underlying the efficacy of Angong Niuhuang Wan. Why, then, do some clinical trials report conflicting results? What causes these discrepancies? And ultimately — is the medicine effective or not?

In my view, the key to evaluating the efficacy of a Chinese medicine lies in syndrome differentiation. No matter how famous or expensive a medicine is, if it is not prescribed according to the correct diagnosis (zheng), it will not be effective — and vice versa.

In TCM, stroke patients with impaired consciousness are classified under the category of Close Syndrome (闭证), which can be further divided into Heat Close syndrome  and Cold Close syndrome. For heat close syndrome, depending on whether heat or phlegm predominates, and whether convulsions are present, practitioners select different formulas. The “Three Cooling and Orifice-Opening Treasures” — Angong Niuhuang Wan, Zhibao Dan, and Zixue Dan— are used for heat closed syndrome, whereas Suhexiang Wan is used for cold close syndrome.

Western medicine researchers often administer Angong Niuhuang Wan to all stroke patients with coma, without distinguishing between heat and cold syndromes — which contradicts TCM principles. Wu Jutong would never have used a randomized double-blind method to treat patients; instead, he and generations of TCM practitioners after him applied individualized treatments according to syndrome differentiation, saving countless lives in the process. The enduring use of this formula for over 200 years is itself strong evidence of its clinical value.

Therefore, evaluating Chinese medicine efficacy using Western evidence-based criteria alone is inappropriate and misleading. TCM requires its own evaluation system — one that respects syndrome differentiation and the holistic principles of Chinese medicine. Only through research designed on these foundations can we truly assess the therapeutic effects of formulas like Angong Niuhuang Wan.

 References

1. Li S. Safety and efficacy of Angong Niuhuang Pills in patients with moderate-to-severe acute ischemic stroke (ANGONG TRIAL): A randomized double-blind placebo-controlled pilot clinical trial. Chin Med J (Engl). 2025 Mar 5;138(5):579–588.
2. Meng X. Effectiveness and safety of Angong Niuhuang Pill in treatment of acute stroke: A systematic review and meta-analysis.  J Tradit Chin Med. 2023 Aug;43(4):650–660.
3. Wang L.  Angong Niuhuang Pill pretreatment alleviates cerebral ischemia-reperfusion injury by inhibiting excessive autophagy through the SIRT1-H4K16ac axis.  J Ethnopharmacol. 2025 Jan 31;340:119214.
4. Zhang X. A newly discovered bioactive equivalence of combinatorial components of Angong Niuhuang Pill improves ischemic stroke via the PI3K/AKT axis.  J Ethnopharmacol. 2025 Mar 13;343:119453.
5. Gao F.  Explore the chemical components of Angong Niuhuang Pill and its potential mechanisms for fever treatment based on UHPLC-Q-Exactive Orbitrap HRMS, transcriptomics, and experiment verification.  J Ethnopharmacol. 2025 Sep 5;354:120542.

 

Traditional Chinese Medicine and Homocysteine Regulation

 Tiejun Tang

Introduction

Homocysteine (Hcy) is a sulfur-containing amino acid produced during methionine metabolism.  Under physiological conditions, Hcy is remethylated to methionine or trans-sulfurated to cysteine via folate- and vitamin B-dependent pathways ^[1]. When this balance is disrupted, plasma Hcy accumulates, leading to hyperhomocysteinemia (HHcy) ^[2]. Elevated Hcy is associated with endothelial dysfunction, oxidative stress, and inflammation, contributing to atherosclerosis, coronary artery disease, ischemic stroke, and vascular dementia ^[1,3]. Epidemiological data indicate that each 5 μmol/L increase in plasma Hcy raises cardiovascular event risk by approximately 20% ^[2].

Conventional therapy primarily involves folic acid and vitamins B6 and B12 supplementation to enhance Hcy clearance ^[3]. However, some patients respond poorly due to genetic factors such as MTHFR polymorphisms. Therefore, alternative or complementary strategies are under investigation.

 

Traditional Chinese Medicine (TCM), emphasizing holistic balance, circulation improvement, and organ support, has long been used for cardiovascular and cerebrovascular disorders ^[4]. Both classical herbal formulas and modern patent medicines have been shown to improve endothelial function, reduce oxidative stress, and support metabolic homeostasis ^[5]. Recent studies suggest that TCM may directly or indirectly influence Hcy metabolism, potentially complementing conventional therapies ^[6].

This review aims to (1) summarize mechanisms by which TCM influences Hcy metabolism, (2) highlight experimental and clinical evidence on single herbs, active compounds, and compound formulas, and (3) identify limitations and future research directions ^[4–6].

Mechanisms of Action of TCM in Homocysteine Regulation

1 Modulation of One-Carbon Metabolism

TCM interventions may support folate- and vitamin B-dependent one-carbon cycles ^[1,5]. Herbal extracts can upregulate enzymes such as methionine synthase and cystathionine β-synthase, promoting remethylation of Hcy to methionine or trans-sulfuration to cysteine.  Some compounds act as methyl donors, supporting DNA and protein methylation impaired in HHcy ^[5].

2 Antioxidant and Anti-inflammatory Effects

HHcy generates reactive oxygen species (ROS) and impairs nitric oxide (NO) bioavailability, causing endothelial dysfunction ^[2,3]. Herbs such as Salvia miltiorrhiza (Danshen) and Astragalus membranaceus (Huangqi) contain polyphenols and saponins that scavenge ROS, upregulate antioxidant enzymes like superoxide dismutase, and inhibit pro-inflammatory cytokines including TNF-α and IL-6 ^[5,6].

3 Improvement of Endothelial Function

TCM enhances eNOS activity, restores NO levels, and reduces endothelin-1 expression . Fufang Danshen preparations improve flow-mediated dilation in patients with elevated Hcy ^[4,5], reducing vascular injury and thrombotic risk.

4 Hepatorenal Protection and Metabolic Clearance

The liver and kidneys are central to Hcy metabolism. Herbs like Rehmannia glutinosa and Lycium barbarum demonstrate hepatoprotective and nephroprotective effects, indirectly supporting systemic Hcy clearance ^[6].

5 Epigenetic and Gene Expression Modulation

Hcy disrupts DNA methylation and gene expression, leading to endothelial apoptosis. Certain herbal compounds modulate epigenetic mechanisms, restoring methylation balance and protecting vascular endothelium ^[6].

Single Herbs and Active Compounds

1. Danshen (Salvia miltiorrhiza): Tanshinones and salvianolic acid B reduce oxidative stress, preserve NO, and modestly lower Hcy ^[5,6].

2. Huangqi (Astragalus membranaceus): Polysaccharides mitigate oxidative injury and inflammation; vascular protection evident ^[5,6].

3. Gegen (Pueraria lobata): Isoflavones lower Hcy in animal models and improve endothelial vasodilation ^[6].

4. Chuanxiong (Ligusticum chuanxiong) and Danggui (Angelica sinensis): Blood-activating herbs improve circulation ^[5].

5. Other herbs: Rehmannia glutinosa, Lycium barbarum, and polyphenols from tea, resveratrol, and garlic also show potential ^[5,6].

Herbal Formulas and Patent Medicines

1. Fufang Danshen preparations: Improve endothelial function and modestly lower Hcy ^[4,5].

2. Yiqi Huoxue formulas: Combine qi-tonifying and blood-activating herbs; reduce Hcy and improve angina, fatigue, and post-stroke outcomes ^[5].

3. Kidney- and spleen-tonifying formulas: Enhance hepatic and renal metabolism; partial Hcy reductions observed ^[6].

4. Acupuncture and integrative therapies: Electroacupuncture reduces serum Hcy in vascular dementia ^[6].

5. Emerging patent formulas: Combinations such as Huangqi, Danggui, Gardenia, and fermented teas target Hcy ^[6].

Clinical Studies

- Fufang Danshen: improved endothelial function and modest Hcy reduction ^[4,5].

- Yiqi Huoxue: beneficial for post-stroke and angina patients ^[5].

- Kidney/spleen tonifying formulas: improved organ function with partial Hcy reduction ^[6].

- Acupuncture: reduced serum Hcy in vascular dementia ^[6].

Conclusion

TCM provides a multifaceted approach to elevated Hcy, targeting metabolic pathways and vascular consequences. Single herbs like Danshen, Huangqi, and Gegen offer antioxidant and endothelial-protective effects. Compound formulas, including Fufang Danshen and Yiqi Huoxue prescriptions, provide synergistic benefits. Complementary therapies like acupuncture further enhance outcomes. Evidence is encouraging, but high-quality, large-scale trials are needed to validate efficacy and establish standardized protocols ^[4–6].

References

1. Huang, X. Effect of Fufang Danshen preparations on endothelial dysfunction associated with hyperhomocysteinemia. Chinese Journal of Integrative Medicine. 2020; 26(4), 289–296.
2. Zhang, L. Natural plant-derived compounds in the regulation of homocysteine: A review. Molecules. 2021; 26(11), 3081. https://doi.org/10.3390/molecules26113081
3. Wang, J. Huang Qi Decoction improves homocysteine-induced endothelial dysfunction. Evidence-Based Complementary and Alternative Medicine.2016; 7272694. https://doi.org/10.1155/2016/7272694
4. Li, Y. Electroacupuncture lowers serum homocysteine in patients with vascular dementia. International Journal of Clinical and Experimental Medicine.2020; 13(9), 6531–6538.
5. Chen, Q. Traditional Chinese medicine and vascular protection: Effects on homocysteine metabolism. Frontiers in Pharmacology.2022;  13, 874562. https://doi.org/10.3389/fphar.2022.874562
6. Liu, H. Isoflavones from Pueraria lobata reduce homocysteine and improve endothelial function in hyperhomocysteinemic models. Journal of Ethnopharmacology. 2021; 277, 114179. https://doi.org/10.1016/j.jep.2021.114179