Call for Standardizing Uncaria rhynchophylla as the Sole Origin of Uncariae Ramulus cum Uncis

Favourable word-of-mouth, customer satisfaction and trust are essential elements for strengthening customer brand loyalty to gain a sustainable advantage in a competitive market. However, there is a relative scarcity of research on the impact of word-of-mouth and customer satisfaction on brand loyalty through the mediated role of brand trust in the herbal medicine market. Consequently, this research aimed to assess the impact of word-of-mouth and customer satisfaction on loyalty through the mediating role of trust in the herbal medicine market. A survey questionnaire was utilised to obtain empirical data from a sample of 265 customers through systematic sampling strategy. Covariance-based structural equation modelling was employed to examine the hypotheses formulated to achieve the aim of the study. The research established that positive word-of-mouth, satisfaction, and trust significantly impact loyalty in the herbal medicine market. More importantly, the research indicated that the customers` trust partially mediated the impact of word-of-mouth and customer satisfaction on loyalty in the herbal medicine market. Hence, this research contributes to advancing the extant brand management literature by establishing the intervening role of trust in the relationship between word-of-mouth, satisfaction and loyalty in the herbal medicine market. This research further provides a reference point to encourage the practitioners to develop and track the customers` word-of-mouth, satisfaction and brand trust to enhance loyalty in the industry.

A Response to Massimo Bonucci’s Editorial: COVID-19 Outbreak: How to Use Current Knowledge to Better Treat Positive Patients

The quality control over traditional Chinese medicine (TCM) preparations has long been an important issue on the international development road of TCMs. Because of the complexity of TCM ingredients, preparation production and its quality control become a big difficulty. How to produce TCM preparations with preparation quality stability and controllability is the key problem in urgent need of solution in current TCM preparation field. The author thought that according to the characteristics of TCM preparation process, the multidimensional dynamic quality control model in the production process might become one of methods for solving quality controllability of TCM preparations. Therefore, we proposed the study through of the multi-dimensional structure quality control based on TCM material basis component structure. The study aims to control over the stability of TCM preparation quality during the whole process of dynamic changes (the component analysis monitoring on intermediates during the process of production, herbal source, intermediate production to preparation products). Xiaoaiping injection was taken as the example to expound the multidimensional quality control process of Xiaoaiping injection, in the hope of providing new ideas for the quality control over modern TCM preparations.

Volume, value and floristic diversity of Gabon׳s medicinal plant markets

The quality assessment and control of traditional Chinese medicines (TCM) has received a great deal of attention worldwide with its tremendous increasing use. Chromatographic fingerprinting is thought to be a good approach for this task and has been used for the quality assessment and control of many herbal medicines. However, there are only a few reports on the quality control of TCM preparation by chromatographic fingerprinting. In the present work, gas chromatography-mass spectrometry (GC-MS) combined with chemometric methods were used for the chromatographic fingerprint analysis and characterization of Shengui hair-growth tincture (SGHGT), which is a complex TCM prescription made from 9 herbs. Thirteen "common peaks" were identified by MS and a comparison of retention indices. The software "The Traditional Chinese Medicine Quality Control System 1.0" (TCMQCS, developed by Research Center of Modernization of Chinese Herbal Medicine, Central South University) was used to evaluate the similarities. Principal component analysis (PCA) was used for the classification of 23 batches of SGHGT samples provided by Hunan Fusheng Hairgrowth Pharmaceutical Factory. The 23 batches of samples made in different years had similar GC-MS fingerprints. Four clusters were obtained from PCA treatment according to their production year. The proposed method was validated in precision and repeatability through the calculation of relative retention times and relative peak areas of the 13 common compounds to the reference compound eugenol. The result indicated that the method is feasible and applicable for the quality control of SGHGT. SUPPORTING INFORMATION available online at http://www.thieme-connect.de/ejournals/toc/plantamedica.

Half of the 2015 Nobel Prize in Physiology or Medicine was awarded to Chinese scientist Youyou Tu in recognition of her pioneering work on the antimalarial artemisinin, extracted from Artemisia annua, a traditional Chinese herbal remedy used to treat fever. This is clearly a great encouragement for scientists who engage traditional medicine research. As Youyou Tu stated in her Nobel Prize awarding lecture, artemisinin is a gift from traditional Chinese medicine (TCM) to the world, this definitely will generate great interest in not only TCM but also other traditional medicine systems from other parts of the world, including Europe, Africa, India, Americas, etc. Though the Nobel Prize selection committee did not confess that the prize is to award traditional Chinese medicine, rather a new drug discovery inspired from TCM, this is indeed the exciting and encouraging event for Chinese TCM scientists. In my opinion, it is meaningless to dispute if artemisinin is still belonging to TCMor westernmedicine. Any contribution or new discovery derived from TCM to benefit for the human health should be recognized and respected. TCM needs to be developed and modernized. Any standpoint that developed or modernized TCM does not belong to TCM may drastically hinder the TCM modernization and integration with modern medicine process, or even deepen the gap between TCM and modern medicine. Evidence-based medicine is the future of TCM by means of modern biomedicine advances and novel approaches. In the past 20 years, TCM has undergone rapid development period evidenced by a number of achievements including the geometric growth of TCM research papers, booming TCM industry, TCM new drug research and development, etc. However, TCM is still facing grand challenges in the future development. Shortage of modern scientific evidence for safety, effectiveness, quality and mode of action should be emphasized and dealt with solutions. TCM experienced-based feature should be turned into evidence-based and science-based one. Following several aspects are suggested for the future modern TCM research: a) TCM-based new drug discovery. TCM is still a non-fully explored treasure house for new drug discovery and development. According to TCM resource survey, there are over 12000 TCM species, among which majority are herbs. Apart from artemisinin and its derivatives, a number of single chemical entity drugs have been developed and successfully marketed, such as arsenic trioxide, ginsenoside Rg3, bifendate, β-elemene, indirubin, etc. It is anticipated that more new drugs could be discovered from this vast TCM resource with modern drug discovery technology and methodology. b) Research on the holistic TCM quality control. The current quality control approach is more focused on a single marker or a few marker determinations, which follows the western drug quality control model and hence, could not really monitor the quality of TCM products. Systemic and comprehensive quality control method should be developed for the TCM crude drugs, prepared slices and finished products, especially for those multiple-ingredient herbal products. c) Research on TCM processing. All TCM crude drugs should be processed in different extent before they can be used either for decoction or for herbal production. TCM processing method is mainly based on the traditional knowledge or experience. Mechanism of processing either for the purpose of enhancing efficacy or eliminating toxicity should be thoroughly investigated and clarified. d) TCM efficacy and safety research. During the development of TCM, greater attention needs to be paid to the integrated evaluation of the effectiveness and safety based on TCM theory and modern scientific research. New evaluation methodology fit for TCM complex feature should be developed with international collaborations. Globally recognized evaluation criteria should be constructed. Other TCM research focuses include pharmacokinetics, geo-authenticity, active principles and giant data library. It is firmly believed that TCM will contribute more than ever to the human health along with the rapid advances of biomedicine science and eventually developed into an evidence-based medicine system.

Validity of traditional Chinese medicine (TCM) is oppugned very often because of the bugs of quality, effectiveness, and repeatability. Standardization of TCMs is one way to make a change. How to realize standardization of TCMs and with what measures to shape the quality control system, is provoking much debate in the TCM field. Genetic and chemical profiling were comparatively performed on Alstonia scholaris in China through amplified fragment length polymorphism (AFLP) analysis and alkaloid high performance liquid chromatography (HPLC) scanning, aiming to evaluate the attributes of chemical and DNA fingerprinting as applicable tools for quality control of TCMs and explore theoretic strategy of TCM standardization. Each individual of A. schlolaris displayed a unique AFLP or HPLC profile, indicating well individual-distinguishing ability of the two techniques. Patterns of variance structure disclosed by the HPLC and AFLP profiling were similar, and more than 50% of alkaloid loci were kept constant across any single population, suggesting a genetic basis of the alkaloid secondary metabolism in the plant and justifying DNA fingerprinting as a qualified identifier for quality control of the TCM. Compared to the alkaloid HPLC scanning, the AFLP analysis produced much more loci with lower polymorphic loci percentage, suggesting that AFLP can be more statistically informative and with moderate sensitivity. In passing, a strategy pursuing genetically identical TCMs by popularizing plantation of selected germplasm of medicinal plants was suggested for TCM standardization. Key words: Traditional Chinese Medicine (TCM), standardization, Alstonia scholaris, alkaloid scanning, genetic profiling.  

Lonicera japonica flos (LJF), the dried flower buds of L. japonica Thunb., have been used in traditional Chinese herbal medicine for thousands of years. Recent studies have reported that LJF has many medicinal properties because of its antioxidative, hypoglycemic, hypolipidemic, anti-allergic, anti-inflammatory, and antibacterial effects. LJF is widely used in China in foods and healthcare products, and is contained in more than 30% of current traditional Chinese medicine prescriptions. Because of this, many Chinese villages cultivate LJF instead of traditional crops due to its high commercial value in the herbal medicine market. Since 2005, the flower buds of L. japonica are the only original LJF parts considered according to the Chinese Pharmacopoeia of the People’s Republic of China. However, for historical and commercial reasons, some closely related species of Lonicera Linn. continue to be mislabeled and used as LJF. Currently, there are hundreds of commercial varieties of LJF on the market and it is difficult to choose fine LJF varieties to cultivate. In this study, a total of 21 varieties labeled as LJF on the market were planted in the Hailuogou area. In order to choose the optimum variety, internal transcribed spacer (ITS) sequence alignment analysis was used to test whether the 21 varieties were genuine LJF or not. Cluster analysis of active components based on the content of chlorogenic acid and luteoloside in flower buds, stems and leaves was used to evaluate the quality of the varieties. Results demonstrated that four of the varieties were L. macranthoides Hand.-Mazz., while the other 17 varieties were L. japonica, and genuine LJF. The ITS sequence analysis was proven to be highly effective in identifying LJF and Lonicerae flos. Among the 17 L. japonica varieties, the amounts of chlorogenic acid and luteoloside in flower buds, stems and leaves were significantly different. Based on the cluster analysis method, the variety H11 was observed to have the highest level of active components, and is therefore recommended for large-scale planting in the Hailuogou area.

The chloroplast genomes of the five Crataegus species were shown to have a conserved genome structure. Complete chloroplast genome sequences were more suitable than highly variable regions for the identification and phylogenetic analysis of Crataegus species. Hawthorn, which is commonly used as a traditional Chinese medicine, is one of the most popular sour fruits and has high economic value. Crataegus pinnatifida var. pinnatifida and C. pinnatifida var. major are frequently adulterated with other Crataegus species on the herbal medicine market. However, most Crataegus plants are difficult to identify using traditional morphological methods. Here, we compared five Crataegus chloroplast (CP) genomes comprising two newly sequenced (i.e., C. pinnatifida var. pinnatifida and C. pinnatifida var. major) and three previously published CP genomes. The CP genomes of the five Crataegus species had a conserved genome structure, gene content and codon usage. The total length of the CP genomes was 159,654-159,865bp. A total of 129-130 genes, including 84-85 protein-coding genes, 37 tRNA genes and 8 rRNA genes, were annotated. Bioinformatics analysis revealed 96-103 simple sequence repeats (SSRs) and 48-70 long repeats in the five CP genomes. Combining the results of mVISTA and nucleotide diversity, five highly variable regions were screened for species identification and relationship studies. Maximum likelihood trees were constructed on the basis of complete CP genome sequences and highly variable regions. The results showed that the former had higher discriminatory power for Crataegus species, indicating that the complete CP genome could be used as a super-barcode to accurately authenticate the five Crataegus species.

Introduction and purpose: This study aimed to discuss herbal supplement usage in population and possible harmful effects with a strong emphasis on the kidneys health. Materials and methods: A literature search was conducted in the PubMed MEADLINE database of medical publications using the following keywords: herbal nephropathy, aristolochic nephropathy, herbal supplementation, Chinese traditional medicine Results: Despite the widespread use of herbs among the general public, awareness of possible side effects appears to be negligible. The herbal medicine market is often unregulated, moreover, there are problems with correct identification of the plant, variable cultivation, its processing and the lack of accurate information about its biological activity. Possible side effects include frequent contamination of preparations with heavy metals, other substances such as hormones, aflatoxins or pesticides. In addition, herbs can directly affect the metabolism of drugs taken for specific medical indications. They are able to change the level of their absorption, metabolism in the liver and secretion. The kidneys are a special organ exposed to the harmful effects of herbs due to their high blood flow, resorption from the renal tubules and high metabolic activity. Among kidney damage, aristolochic nephropathy is the one worth mentioning, induced by the herb Aristolochia fangchi and causing a rapidly progressing kidney disease, largely ending up with the need for dialysis or kidney transplantation. Conclusion: The use of herbs as medical substances carries dangers. They should be prevented through proper education of the society, appropriate legal regulations and doctors' awareness of their occurrence.

See related article, pages 1973–1979. The lack of effective and widely applicable pharmacological treatments for ischemic stroke patients may explain a growing interest in traditional medicines, for which extensive observational and anecdotal experience has accumulated over the past thousand years. The World Health Organization (WHO) defines traditional medicine as “health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being”.1 Unlike Western medicine, which focuses on disease, traditional medicine takes the approach that the body provides external clues to an internal imbalance that can be addressed by interventions such as herbs and acupuncture (holistic treatment approach).2 According to a 2003 WHO report,1 traditional medicine is very popular in all developing countries, and its use is rapidly increasing in industrialized countries. For example, traditional herbal preparations account for 30% to 50% of the total medicinal consumption in China. In Europe, North America and other industrialized regions, over 50% of the population have used traditional medicine at least once. The global market for herbal medicines currently stands at over US $60 billion annually and is growing steadily.1 In recent years, several reviews have been published on the effect and potential benefits of traditional Eastern medicine in stroke.3–7 It has been suggested that some herbal medicines, or their products, may improve microcirculation in the brain,4,8 protect against ischemic reperfusion injury,8,9 possess neuroprotective properties3,4 and inhibit apoptosis,10 thus justifying their use in ischemic stroke patients. However, unlike industrially manufactured pharmacological drugs used in Western medicine, the active (potent) components of herbal medicines often have not been specified and measured precisely, although there have been recent attempts to regulate dosages and use of …

Development of direct infusion quadrupole mass spectrometry database and intelligent identification system for 100 root herbs.

To evaluate the present development and status of quality control for intensive care unit (ICU) in Sichuan Provincial traditional Chinese medicine (TCM) hospitals including integrated traditional Chinese and western medicine hospitals and ethnic hospitals, and to provide practical references for improving the service quality of ICU. Supervisory Group of Sichuan Provincial Critical Care Medicine Quality Control Center of TCM was established in September 2018. From September 8th to 17th, 2018, according to the Scoring Criteria of Quality Control and Supervision Project of TCM for Critical Care Medicine, a 10-day quality control professional guidance was hand out to TCM hospitals with independent ICU in Sichuan Province. The service level of different aspects of hospital quality control was evaluated and ranked from equipment and resource support, medical team, service capacity and level, ward quality, completion of critical care core indicators, completion of quality control of TCM, development of new technologies, diagnosis and treatment schemes for dominant diseases. There were 52 TCM hospitals across the province that had an ICU. Thirty-three hospitals were third-class (63.5%), while the rest 19 hospitals were second-class (36.5%). Province-level, city-level and county-level hospitals were accounted for 9.6% (5/52), 38.5% (20/52), and 51.9% (27/52), respectively. Average bed ratio of ICU was 1.8%. Doctor-bed and guard-bed ratios were 0.71:1 and 2.0:1, respectively. The average annual admission rate of patients and the average daily admission rate of beds were higher, which were basically 1%. Ward quality was high; the incidence of nosocomial infection was controlled below 10%. Compliance rate of septic shock bundle treatment was high. The incidences of ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) were 0.45%, 0.22%, and 0.30%, respectively. Participation rate of TCM was about 83.4%. Average number of new technologies was about 4.4. Average number of disease schemes was about 2.62. ICU of Sichuan Provincial TCM hospitals reaches the standard level in service capacity and level, ward quality, critical medicine quality control, and participation rate of TCM treatment. Improvements are required for other prospects, including department scale, medical personnel allocation, new technical development, diagnosis and treatment schemes of dominant diseases.

ShenKang injection is traditional Chinese medicine used to treat chronic renal failure in China. It is a compound preparation that consists of four herbs: Rhubarb, Salvia miltiorrhiza, Safflower and Radix Astragali. We developed an ultra high pressure liquid chromatography coupled with Q Exactive hybrid quadrupole-orbitrap high resolution accurate mass spectrometry tandem mass spectrometry method to analyze its chemical compositions, and a total of 90 compounds were identified from ShenKang injection. Among them, 19 major compounds were unambiguously detected by comparing with reference standards. Meanwhile, 13 representative compounds selected as quality control markers were simultaneously quantified in ShenKang injection samples. Chromatographic separation was accomplished on a Waters ACQUITY HPLC® HSS C18 column using gradient elution. The method was validated with respect to linearity, sensitivity, accuracy and precision, reproducibility and stability. And the validated method was successfully applied for simultaneous determination of 13 bioactive compounds in ShenKang injection from ten batches of samples by liquid chromatography with mass spectrometry. The results were analyzed by principal components analysis method, and three compounds had a significant relationship with the quality control of ShenKang injection. This research established a rapid and reliable method for the integrating quality control, including qualitation and quantification of ShenKang injection.

BackgroundTibetan medicine (TM) and traditional Chinese medicine (TCM) are two independent traditional medical systems. Due to geographical factors, the development of Tibetan medicinal theory is relatively independent, but there are still many shared-use medicines in TM and TCM. However, a thorough and comparative study on those medicines is still absent. This study listed shared-use medicines by TM and TCM and analyzed the similarities and dissimilarities of these two medical systems. This paper also aimed to understand mutual influences like the shared history of TM and TCM and to roughly outline the exchanging process between them.MethodsShared-use medicines in TM and TCM were listed alphabetically. Information on the scientific name, material name, medicinal parts, and medical efficacy were extracted from publications. Shared-use medicines were grouped according to medicinal properties and medicinal parts used by TM and TCM. The historical origin and current status of clinical prescriptions of shared-use medicines were analyzed.ResultsA total of 136 shared-use medicines in TM and TCM were listed. Shared-use medicines that were used for a similar purpose in TM and TCM accounted for 14% of the total, while those used for different purposes accounted for 49% of the total, with some of the latter being commonly used in TCM. Shared-use medicinal herbs that originated from both Tibetan and Han regions accounted for 49% of the total, and those that were imported from South Asia and Southeast Asia were frequently observed in TM.ConclusionOwing to its unique geographical location and cultural diversity, the Tibetan region played a role as a development cradle for various traditional medicinal theories and knowledge. Medicinal knowledge was exchanged between TM and TCM during their parallel independent growth. Shared-use medicines in TM and TCM were mostly determined by flora similarity and medicinal trade, and they marked significant differences in their medicinal properties. However, medicines that were used for similar purposes in TM and TCM presented obvious commercial medicinal characteristic as well as the same chemical profile. The Tibetan region not only provided medicinal usage knowledge of TCM, but also served as a supply of medicinal resources attributing to “high altitude” locations.