Volume 18,Issue 2,2026 Table of Contents

1 New draft: Elucidating complex efficacy of traditional Chinese medicine in combating respiratory viral diseases

Nanshan Zhong

2026, 18(2):225-225. DOI: https://doi.org/10.1016/j.chmed.2026.02.006

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2 Future prospects of antiviral research in traditional Chinese medicine

Kexin Wang a , b , Zifeng Yang a , b ,

2026, 18(2):226-230. DOI: https://doi.org/10.1016/j.chmed.2026.02.014

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Traditional Chinese medicine (TCM) has a long history of treating viral diseases through holistic approaches and multi-component formulations. In response to emerging global viral threats like coronavirus disease-2019 (COVID-19), TCM has demonstrated significant potential in both antiviral and immune-modulatory roles. This review summarizes the current state of TCM antiviral research, highlighting advances in identifying active components and elucidating their mechanisms, which include direct viral inhibition and immune regulation. Technological innovations, including artificial intelligence (AI)-driven drug discovery and advanced extraction methods, are accelerating the development of TCM antiviral products. However, challenges remain in standardization, mechanistic validation, and international regulatory acceptance. Looking ahead, research should prioritize systems pharmacology, the development of multi-dimensional evaluation models, standardized clinical trials, and global health integration. By addressing these challenges, TCM can play a vital role in worldwide antiviral strategies and public health.

3 Anti-influenza formula medicines based on warm disease theory of traditional Chinese medicine

Mengjie Xiao a , h , Tao Huang a , Shengle Qin b , Tianbo Zhang g , Runfeng Li c , Xin Zhao a , Luping Lin d , Zifeng Yang c , d , e , f ,

2026, 18(2):231-240. DOI: https://doi.org/10.1016/j.chmed.2026.02.008

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Warm disease, characterized primarily by fever, is caused by exogenous pathogenic factors, such as Influenza. Ancient medical books have documented treatment strategies, and many formulas and herbs have been identified as effective against influenza. Treatment on acute flu-induced pneumonia should consider suppressing viral replication and mitigating the tissue damage mediated by the immune system. Traditional Chinese medicines (TCMs) have superiority since their multi-ingredients and multi-targets. There are many formulas containing anti-influenza components and anti-inflammation components. TCM showed less resistance during application. Many formulas are common for clinic use like Lianhuaqingwen Capsule, Fufang Xiangru Liquid, and Shengjiang Powder. Their efficacy in viral elimination and inflammation regulation has been evaluated, leading to the identification of effective phytochemicals that elucidate their anti-flu mechanisms. This review introduces some Chinese patent medicines based on warm disease theory and reviews their current research process.

4 Integrated network pharmacology, transcriptomics and experimental validation to explore mechanisms of Wenyang Jiedu Granule on IAVinduced pneumonia

Shengle Qin a , b , Taoyu Chen a , b , Yutao Wang c , Hongxia Ke c , Jingyan Xin a , b , Wenlong He a , b , Yi Guo a , b , Zemiao Niu a , b , Qiaoli Hua a , b , Zifeng Yang c , Yuntao Liu a , b , Zhongde Zhang a , b

2026, 18(2):241-261. DOI: https://doi.org/10.1016/j.chmed.2026.02.004

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Objective: Wenyang Jiedu Granule (WYJD) is an effective traditional Chinese medicine (TCM) preparation that has been generally applied for treating respiratory infectious diseases. Clinical observations involving thousands of cases have demonstrated that WYJD could alleviate disease progression and improve symptoms in treating respiratory viral infections, including SARS-CoV-2 and influenza virus. However, the chemical basis and underlying mechanisms of WYJD against influenza A virus (IAV)-induced pneumonia remain to be elucidated. This study aimed to reveal the underlying mechanisms of WYJD in treating IAV-induced pneumonia by a combined strategy of network pharmacology, transcriptomics and experimental validation. Methods: The pneumonia model was established in BALB/c mice via infection with H1N1 IAV to evaluate the therapeutic effects of WYJD on IAV-induced pneumonia. Firstly, ultra-high performance liquid chromatography-quadrupole Exactive Orbitrap mass spectrometer/tandem mass spectrometer (UPLC-Q Exactive Orbitrap-MS/MS) was employed to analyze the main chemical components in WYJDcontaining serum. Subsequently, the effects of WYJD on IAV-induced pneumonia were assessed through pathological observation, plaque forming assay, biochemical analysis, Evans blue staining assay, and immunofluorescence assay. Mechanistically, an integrated approach of network pharmacology and transcriptomics was applied to explore the potential active components, targets and related pathways of WYJD against IAV-induced pneumonia. Fluorescence TUNEL assay, quantitative real-time PCR (qRTPCR) and Western blotting were utilized for experimental validation and mechanistic studies. Results: Using UPLC-Q Exactive Orbitrap-MS/MS, a total of 25 prototypes and 15 metabolites were identified in the serum of mice after WYJD administration. WYJD treatment showed protective effects on IAVinduced pneumonia by inhibiting inflammation and lung barrier damage in the IAV-induced pneumonia mice model. Network pharmacology combined with transcriptomics analysis indicated that WYJD exerted therapeutic effects against IAV-induced pneumonia mainly through the synergistic effects of 11 active components, which regulated ten critical signaling pathways via 86 targets. Further experimental validation demonstrated that WYJD could alleviate IAV-induced pneumonia via the IL-17 signaling pathway, Toll-like receptor 7 (TLR7)/Myeloid differentiation primary response dene 88 (MyD88)/mitogen-activated protein kinases (MAPKs)/activator protein 1 (AP-1) signaling pathway and apoptosis. Conclusion: This study revealed the main active components and mechanisms of WYJD against IAVinduced pneumonia through the IL-17 signaling pathway, TLR7/MyD88/MAPKs/AP-1 signaling pathway and apoptosis, which provides novel insights into the clinical application of WYJD in treating influenza and its complications.

5 Combined network pharmacology and biological verification to investigate anti-influenza A virus effect and potential mechanism of Pudilan Xiaoyan Oral Liquid

Hualing Li a , Wenlei Wang a , Zhihui Zheng a , Yuqian Zhang a , Danting Li b , Qin Su a , Hailin Wei a , Zehua Wang a , Rui Min a , Xinyue Zhang a , Zihan Chen a , Xiaoquan Wang c , Pinghu Zhang a , d

2026, 18(2):262-271. DOI: https://doi.org/10.1016/j.chmed.2025.04.004

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Objective: Influenza is a common respiratory disease affecting human health and life. Pudilan Xiaoyan Oral Liquid (PDL) has frequently been used to treat respiratory infections such as COVID-19, pharyngitis, and tonsillitis. However, its efficacy against influenza A virus (IAV) infection remains unclear. This study investigates the anti-IAV activity and potential mechanism of action of PDL. Methods: The in vitro anti-IAV activity was investigated in a virus-infected MDCK (Madin-Darby canine kidney) cell model. The in vivo protective effect on AIV infection was evaluated in a virus-infected mice model. qRT-PCR was performed to examine the anti-inflammatory effects of the PDL. A network pharmacology method was used to investigate the underlying mechanism of PDL against IAV. Western blotting was performed to confirm the antiviral mechanism of PDL against IAV. Results: Our findings indicated that PDL had a broad-spectrum anti-IAV effect in vitro and exhibited an excellent protective effect against IAV infection by significantly increasing the survival rate, extending the survival time, and reducing pathological lung tissue damage. Moreover, PDL effectively inhibited the mRNA expression of inflammatory factors in lung tissue. GO analysis revealed that the potential targets were primarily associated with defense response regulation, positive regulation of cytokine production, and positive regulation of responses to external stimulation. PPI analysis indicated that Sarcoma (SRC), signal transducer and activator of transcription 3 (STAT3), mitogen-activated protein kinase1 (MAPK1), phosphatidylinositol 3-kinase regulatory subunit alpha (PIK3R1), and epidermal growth factor receptor (EGFR) might be potential PDL targets against IAV infection. Mechanistically, inhibition of the Toll-like receptor 3 (TLR3)/myeloid differentiation primary response gene (88) (MyD88) signaling pathway to attenuate an excessive inflammatory response might be one of the primary mechanisms of PDL against IAV. Conclusion: PDL efficiently suppressed in vitro IAV replication and provided protection against lethal influenza virus infection in vivo. Network pharmacology analysis revealed that the key PDL targets against influenza might be highly associated with biological processes, such as regulation of defense responses, cytokine production, and the Toll-like receptor signaling pathway. Mechanistically, regulating the TLR3/MyD88 signaling pathway may be one of the primary mechanisms of PDL against influenza virus infection. These findings indicate that PDL could be a potential therapeutic option for the clinical treatment of influenza viral infections.

6 Retrospective cohort study on Shufeng Jiedu granules for SARS-CoV-2 infection: Real-world evidence from multicenter outpatient clinics in a predominantly caucasian population

Thomas Friedemann a , Uta Knierim a , b , , Zhang Wei c , d , Sven Schr?der a , b

2026, 18(2):272-281. DOI: https://doi.org/10.1016/j.chmed.2026.02.002

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Objective: Due to the lack of clinical evidence on the effectiveness and safety of Shufeng Jiedu (SFJD) Granules in Europe, it is unclear if SFJD can effectively and safely be used as an adjunct treatment for mild SARS-CoV-2 infection in a predominantly Caucasian outpatient population in Germany. Therefore, we conducted a retrospective cohort study to evaluate the real-world effectiveness and safety of SFJD compared to standard symptomatic care. Methods: This retrospective cohort study included adult patients (≥ 18 years) with mild SARS-CoV-2 infection symptoms treated between October 2021 and March 2023 across four outpatient clinics in Hamburg, Germany. Patients were allocated to either the SFJD group or a control group receiving standard symptomatic care. Clinical data, including symptom duration, intensity [measured by Visual Analogue Scale (VAS)], and adverse events, were analyzed. The primary endpoint was the time to total symptom alleviation (TTSA), defined as the first 24–hour period with all index symptoms rated VAS ≤ 1 and no temperature ≥ 37.0 °C. Secondary outcomes included symptom-specific duration and intensity. Data were verified by propensity score matching (PSM). Results: A total of 81 patients met inclusion criteria, with 38 patients assigned to the SFJD group and 43 patients assigned to the control group. Baseline characteristics were comparable between groups. The SFJD group showed a statistically significant different Time to Total Symptom Alleviation (TTSA) compared to controls [(5.76 ± 3.74) d and (11.50 ± 7.45) d, difference of 5.74 d, P < 0.001]. Symptomspecific improvement was most pronounced for rhinorrhea, fatigue, fever, and shortness of breath. Intensity scores were also lower in the SFJD group for multiple symptoms. No severe adverse events were observed. Gastrointestinal symptoms were equally distributed and not clearly attributable to treatment. 1:1 Nearest-neighbor PSM confirmed the TTSA results. Conclusion: SFJD Granules demonstrated beneficial effects in reducing the duration and intensity of mild SARS-CoV-2 infection symptoms in a real-world outpatient setting, without significant safety concerns. These findings support the potential of SFJD as an adjunctive therapy for early-stage COVID-19, especially in populations outside of East Asia. Prospective randomized trials are warranted to confirm these results.

7 Exploring possible mechanisms of antiviral effect of Shufeng Jiedu Capsule on viral pneumonia: A comprehensive analysis

Shan Cao a , Lei Bao a , Zihan Geng a , Yingli Xu a , Bo Pang a , Jingsheng Zhang a , Qiang Zhu b , Jun Pan b , Yaxin Wang a , Mengping Chen a , Yu Zhang a , Yanyan Bao a , Jing Sun a , Ronghua Zhao a , Xiaolan Cui a , Shanshan Guo a

2026, 18(2):282-293. DOI: https://doi.org/10.1016/j.chmed.2025.01.007

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Objective: Influenza A virus (IAV) is a major cause of respiratory tract infections. Shufeng Jiedu Capsule (SFJD) has a broad-spectrum antiviral effect, however, it is not clear whether SFJD acts by targeting the immune-inflammatory pathway. The aim of this study was to elucidate the therapeutic effect and the mechanism of antiviral action of SFJD in mice with influenza virus pneumonia. Methods: In this study, a mouse model of influenza virus pneumonia was used to evaluate the efficacy of SFJD in the treatment of influenza virus pneumonia. Next, the potential pathways of action by which SFJD exerts its antiviral effects were analysed in conjunction with network pharmacology and and untargeted metabolomics. Finally, in vivo experimental validation was conducted through protein immunoblotting, transmission electron microscopy, and immunofluorescence experiments. Results: SFJD significantly reduced lung index, lowered viral load, attenuated lung tissue lesions, modulated inflammatory metabolism in lung tissue, reduced macrophage inflammatory infiltration and protected lung epithelial cells in mice. The results of the network pharmacological analysis and metabolomics analysis suggested that SFJD might act through the Toll-like receptor 4(TLR4)/myeloid differentiation primary response protein 88(MyD88)/ TNF receptor associated factor (TRAF6)/nuclear factor kappa-B(NF-jB) signalling pathway. SFJD was able to down-regulate the expression of TLR4, MyD88, TRAF6, and NF-jB proteins in lung tissues. Conclusion: SFJD could effectively attenuate lung injury induced by influenza virus infection and provide a scientific basis for the protection of respiratory mucosal epithelial cells. SFJD could effectively alleviate lung injury by regulating the TLR4/MyD88/TRAF6/NF-jB signaling pathway, inhibiting the levels of TNFa, IL-6, which may be the key mechanism for its antiviral effects.

8 Yu-Ping-Feng-San mitigates development of emphysema and its exacerbation induced by influenza virus in mice

Lingzhu Deng a , , Yaorong Chen a , , Ruifeng Chen a , c , Shengle Qin a , Xiao Wu a , Shiyun Liang d , Tongmei Shi d , Xin Zhao e , Runfeng Li a , Zifeng Yang a , b , c , f

2026, 18(2):294-302. DOI: https://doi.org/10.1016/j.chmed.2023.12.002

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Objective: Yu-Ping-Feng-San (YPFS) has been found to significantly reduce exacerbation rate and the risk of a second exacerbation in patients with chronic obstructive pulmonary disease (COPD). However, the effect of YPFS on emphysema development and its exacerbation caused by influenza virus is still unclear. This study aims to investigate the protective effect of YPFS on the impaired lung function and increased inflammation that occurs during the development and exacerbation of emphysema. Methods: This study developed an emphysema mice model using porcine pancreatic elastase (PPE) and treated it with YPFS [1 950, 975, and 487.5 mg/(kg d)] once daily. On day 7 post-PPE challenge, peripheral leucocytes and inflammatory cells in lungs were analyzed, respectively. Pulmonary inflammatory mediators were determined. On day 28, invasive lung function and inflammatory mediators were measured. In addition, histopathological changes at both time points were assessed. We also developed an exacerbation of emphysema mouse model by intratracheally infected mice with influenza H1N1 virus on day 28. After infection, YPFS administration was discontinued, and the protective effect was determined by lung function, viral titer and cytokine levels in the lungs, and lung histopathological changes on day 5 postinfection. Results: The results demonstrated that 32 days of YPFS administration significantly improved lung function and reduced severity of emphysema in PPE-treated mice. It significantly reduced monocytes and neutrophils, while increased lymphocytes in peripheral blood. Additionally, YPFS inhibited the accumulation of alveolar macrophages and the expression of cytokines in mice treated with PPE. MMP-9, fibronectin, and VEGF, which are inflammatory mediators associated with airway remodeling, were also inhibited by YPFS. The results also demonstrated that YPFS prophylaxis prior to viral infection benefited mice treated with PPE and H1N1 as evidenced by decreased lung cytokine levels, lowered lung index, and improved lung histopathology. Conclusion: YPFS prevents the development of emphysema and its exacerbation induced by influenza virus in mice. Our finding provides scientific evidence for the prophylaxis application of YPFS in mitigating acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

9 Efficacy and safety of Toujie Quwen Granules in patients infected with SARS-CoV-2: A prospective cohort study of 156 cases

Qihua Xu a , Xinyue Zhang a , Sanqi Huang b , Linghua Li b , Feng Li b , Wei Liu c , Kunzhou Ling b , Jialong Guan b , Xinghua Tan b , Luping Lin b

2026, 18(2):303-311. DOI: https://doi.org/10.1016/j.chmed.2026.02.016

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Objective: Given traditional Chinese medicine (TCM)’s efficacy in influenza and severe acute respiratory syndrome (SARS), it was adopted clinically in the early stage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection outbreak in China. However, the therapeutic effects of Toujie Quwen (TJQW) Granules in treatment of (SARS-CoV-2) infection have not been fully elucidated. This study aimed to investigate the efficacy and safety of TJQW in patients infected with SARS CoV-2 and provide evidence for clinical practice of TCM. Methods: A cohort study was conducted on SARS-CoV-2 infection admitted between 20 January and 15 March 2020. Patients were divided into two cohorts based on their clinical medication plan: TJQW combined with Western medicine (TJQW + WM) group and Western medicine (WM) group. The WM group received conventional WM treatment (antibiotics, glucocorticoids, oxygen therapy, arbidol, chloroquine, lopinavir/ ritonavir, ambroxol hydrochloride), while the TJQW + WM group received TJQW in addition to WM (15 g/bag, two bags at a time, three times a day). The incidence of severe disease and chest computed tomography (CT) findings before and after treatment were compared between groups. Dynamic analysis was performed on white blood cell (WBC) count, lymphocyte count (LYM), lymphocyte percentage (LYM%), Krebs von den Lungen 6 (KL-6) and symptom scores within 15 d of enrolment. Results: Six cases in the TJQW + WM group progressed to severe disease, with an incidence of 7.89% (6/76), while 16 cases in the WM group progressed to severe disease, with an incidence of 20% (16/80, P = 0.025), and the difference was significant. The CT scores of the TJQW + WM group decreased continuously from day 6 of disease onset and were significantly lower than those of the WM group on days 12 and 15, with significant differences. On day 12 of the disease, the improvements in WBC and LYM in the TJQW + WM group were superior to those in the WM group, with significant differences. The KL-6 levels of the two groups were compared by fitting the data to a generalised linear model. After controlling for the effects of time from onset to detection, the KL-6 level of the TJQW + WM group was significantly lower than that of the WM group (t = 3.703, P < 0.01). Repeated measures analysis of variance was performed on the total score of major symptoms and showed insignificant differences (F = 0.031, P = 0.871). However, there was an interaction effect between treatment plan and treatment duration, with significant differences in the degree of change at each time point for the global scores (F = 6.502, P < 0.01). The TJQW + WM group showed a better improvement in symptoms and a reduction in the expression of inflammatory factors than the WM group. Conclusion: TJQW could effectively decrease the incidence of severe disease, reduce pulmonary inflammation and fibrosis, and alleviate clinical symptoms.

10 Advancement of Astragali Radix in anti-tumor: Active components and combination therapy

Jiaxin Jiang a , Min Li b , Qiwen Lu a , Gongjian Dai c , Qichen Zhan d , Jing Chen e , ? , Xuan Han a

2026, 18(2):312-328. DOI: https://doi.org/10.1016/j.chmed.2025.10.003

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Natural products continue to serve as indispensable sources for anti-tumor drug discovery, accounting for approximately 40% of United States Food and Drug Administration (U.S. FDA) FDA-approved anti-tumor agents despite advancements in biologic therapies. Among these natural products, Astragali Radix (AR, Huangqi in Chinese) has emerged as a particularly promising candidate for tumor treatment due to its well-documented anti-tumor properties. Contemporary research has identified three principal bioactive compounds responsible for these therapeutic effects: Astragalus polysaccharides, total Astragalus flavonoids, and astragalosides. These compounds demonstrate multimodal anti-tumor activity against five major malignancies, including lung, breast, liver, colorectal, and cervical cancers, through coordinated modulation of critical cellular processes including apoptosis induction, cell cycle arrest, and metastasis suppression. Critical studies have revealed that AR-based combination therapies can synergistically enhance conventional treatments (chemotherapy/radiotherapy). This is achieved by simultaneously addressing two critical challenges in tumor treatment: Reducing treatment-related toxicity and overcoming multidrug resistance through chemosensitization effects in vivo. This review synthesizes current knowledge on AR’s anti-tumor components, their molecular mechanisms, and therapeutic targets. It emphasizes the synergistic benefits of integrating AR with existing tumor treatments and proposes future research directions to advance its clinical translation. By bridging traditional herbal knowledge with modern scientific rigor, this work aims to accelerate the development of AR-based therapies as safer, more effective options for cancer patients.

11 Herbal remedies for hepatic diseases: A review of medicinal herbs in the treatment of liver disorders

Istuti Saraswat , Anjana Goel , Jyoti Gupta

2026, 18(2):329-342. DOI: https://doi.org/10.1016/j.chmed.2026.02.015

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Medicinal plants have been integral to human healthcare for centuries, offering a vast repository of bioactive compounds with therapeutic potential. This comprehensive review underscores the significance of medicinal herbs in maintaining hepatic homeostasis and addresses their efficacy in treating liver disorders, including cancer, hepatitis, cirrhosis, and liver failure. The exploration begins with an examination of the historical importance of medicinal plants in diverse traditional healing practices, emphasizing their contributions to human well-being. Subsequently, the review delves into the specific hepatoprotective properties of herbs, unravelling their potential to mitigate liver disorders, their versatile antiinflammatory, antioxidant, and anti-cancer attributes, along with their immunomodulatory and antioxidant effects, set the stage for understanding their roles in managing hepatitis and other liver disorders. Furthermore, the review discusses anti-fibrotic and hepatoprotective qualities, antioxidant-rich composition guarding against hepatotoxicity, and their anti-inflammatory and anti-cancerous actions relevant to liver disorders. Many medicinal plants, known for their hepatoprotective and anti-inflammatory properties, are explored for their potential therapeutic benefits in liver failure. Understanding the pivotal role of medicinal plants in liver health enriches our appreciation for traditional healing practices and lays the groundwork for developing novel therapeutic approaches for both human and veterinary liver health.

12 Genus Cucumis: Traditional uses, phytochemistry, pharmacology, clinical application, and toxicology

Hesham M. El-Sayed a , Engy A. Mahrous b , Dalia M. Rasheed a , Essam Abdel-Sattar b

2026, 18(2):343-376. DOI: https://doi.org/10.1016/j.chmed.2026.02.005

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The genus Cucumis L. (Cucurbitaceae), flourishes across temperate, tropical, and subtropical regions. Species within the genus have a long-standing history in traditional ethnomedicinal practices throughout Asia and Africa, addressing a wide spectrum of ailments, including gastrointestinal, metabolic, urogenital, hepatic, dermatological, cardiovascular, respiratory, inflammatory, and infectious disorders. Despite this extensive traditional use, the full therapeutic potential of Cucumis remains underexplored. This review comprehensively explores the traditional ethnomedicinal applications, phytochemical composition, pharmacological activities, clinical evidence, and toxicological profiles of Cucumis species. A systematic survey of internationally recognized scientific databases and authoritative repositories, including Web of Science, Scopus, PubMed, ScienceDirect, and Google Scholar, and revealed over 428 bioactive compounds spanning through diverse phytochemical classes. These classes include steroids, triterpenoids (predominantly cucurbitacins), flavonoids (particularly C,O-glycosylflavones), coumarins, other phenolics, and additional secondary metabolites. Collectively, these compounds demonstrate multifaceted bioactivities, encompassing anti-inflammatory, antihypertensive, anti-diabetic, anti-cancer, organ-protective, antimicrobial, and antiviral properties, as validated through in vitro, in vivo, and limited clinical studies. Nonetheless, the molecular mechanisms underpinning these pharmacological effects remain inadequately elucidated. By integrating traditional ethnomedicinal knowledge with contemporary research approaches, this review highlights the necessity of advancing scientific insight into the genus Cucumis and its bioactive constituents. Future research should focus on comprehensive phytochemical profiling, mechanistic elucidation, clinical evaluations, and rigorous toxicological assessments to ensure the safe and effective application of various Cucumis species in modern herbal medicine.

13 Research progress of polysaccharide detection methods in traditional Chinese medicine

Lanying Zhang a , c , Xinrui Wang a , c , Jingze Zhang c , Dailin Liu a , c , Gang Bai b

2026, 18(2):377-390. DOI: https://doi.org/10.1016/j.chmed.2026.02.009

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In recent years, with the advancement of analytical technology and the development of molecular biology, the research of traditional Chinese medicine (TCM) polysaccharides is becoming a new frontier and hot spot in life science research due to their effectiveness and non-toxicity. The quantitative determination of polysaccharides plays an extremely important role in the quality control of polysaccharide drugs. However, the structural complexities of natural polysaccharides present a major obstacle to their accurate quantification. The objective of this review is to provide a comprehensive guide for the accurate quantification of polysaccharides in TCM. In this paper, the quantitative methods of polysaccharides are divided into traditional quantitative methods and new methods, and summarized from the medicinal materials included in the Chinese Pharmacopoeia (2025 edition) and the relevant literature in the past ten years. The traditional methods for polysaccharide quantification include titration, colorimetry, high performance liquid chromatography (HPLC) and resonance light scattering (RLS). With the technological progress, new nondestructive testing methods such as near-infrared spectroscopy (NIR) and hyperspectral imaging (HSI) have gradually emerged. In addition, glycospectrometry, as another new method, can accurately quantify the structural characteristics and content of polysaccharides by combining positional enzyme digestion technology and HPLC. Moreover, this review elaborates on the principles and discusses the advantages and limitations of each method mentioned. This paper aims to provide a comprehensive reference for the accurate determination of polysaccharide content in TCM, enhance its practicability and precision, and promote its wider application in the quality control of TCM and Chinese patent medicine preparations.

14 Chemical composition, antitumor properties and underlying mechanism of Sophora flavescens flavonoids: A review

Zhongyuan Guo a , b , Gaoyue Dong c , Xiaoqian Liu b , Huimin Gao b , Liangmian Chen b , Hong Yang c , ? , Zhimin Wang a , b

2026, 18(2):391-404. DOI: https://doi.org/10.1016/j.chmed.2026.02.011

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Sophora flavescens is a widely used medicinal plant in traditional Chinese medicine, particularly known for its rich flavonoid content. Historically used in traditional medicine, this herb has been documented in the Shennong’s Classic of Materia Medica (Shennong Bencao Jing) for its effects in clearing heat, eliminating dampness, and serving as an anthelmintic and diuretic, for treating various conditions, including dysentery, jaundice, and skin diseases. Recent research on S. flavescens has expanded, particularly concerning its flavonoid compounds, which exhibit significant pharmacological activities, including antimicrobial, antioxidant, hepatoprotective, hypoglycemic, and antitumor effects. This review systematically summarizes the chemical constituents of S. flavescens, identifying over 130 flavonoid compounds, primarily isoprenylflavonoids, with a specific focus on their antitumor activities. Studies have shown that representative compounds, such as kurarinone and kushenol G, selectively exhibit cytotoxic effects against various cancer cell lines (e.g., HepG2, A549, MCF-7) while sparing normal cells. The antitumor mechanisms are primarily attributed to apoptosis induction, modulation of oxidative stress, and regulation of multiple signaling pathways, including the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway and the cyclic adenosine monophosphate/protein kinase A (cAMP/PKA) pathway. Furthermore, safety assessments indicate that while the overall toxicity of flavonoids from S. flavescens is relatively low, certain compounds may pose hepatotoxic risks at high doses, warranting further attention in clinical applications. This review aims to provide an in-depth analysis and discussion of the chemical diversity, antitumor efficacy, and mechanisms of action of S. flavescens flavonoids, establishing a theoretical foundation and research direction for the development of novel anticancer drugs.

15 Isoquinoline alkaloids in Coptis chinensis to treat Alzheimer’s disease through promoting growth of Bifidobacterium breve inhibiting abnormal autophagy using a novel AI high-content intelligent imaging system

Siqi Gu a , Wei Yin a , Minzhen Xie a , Chengbing He a , Yuntong Bian a , Lin Li a , Wanying Lu a , Qi Wang a , b

2026, 18(2):405-419. DOI: https://doi.org/10.1016/j.chmed.2026.02.003

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Objective: Coptis chinensis has been shown to increase beneficial intestinal bacteria and treat Alzheimer’s disease (AD). Bifidobacterium breve can effectively treat AD through the gut-brain axis. Therefore, this study aimed to study the joint effects of C. chinensis and B. breve in the treatment of AD. Methods: 16S rRNA was used to test the abundance of bacterial flora in APPswe/PS1DE9 mice after C. chinensis administration. To determine the efficacy of C. chinensis combined with B. breve on AD, pathological section staining, Barnes maze, Western blotting and ELISA were utilized to confirm the improvement of cognitive dysfunction in AD mice after administration. In order to elucidate the pharmacodynamic components of monomers in C. chinensis, network pharmacology was used to screen the components related to autophagy and confirm the pharmacodynamic effects by artificial intelligence (AI) high-content intelligent imaging. Results: The results of 16S rRNA sequencing indicated that C. chinensis could modulate the abundance of B. breve in AD mice. Pathological assessments, Barnes maze testing, and additional experiments have shown that C. chinensis combined with B. breve can improve the memory and learning ability of AD mice by reducing neuronal apoptosis and amyloid-b (Ab) peptide deposition. Network pharmacology combined with AI high-content intelligent imaging technology and Western blotting experiments demonstrated that magnoflorine, 13-methylberberine and palmatrubine in C. chinensis could exert neuroprotective effects in AD mice by up-regulating p62 protein expression while down-regulating Beclin-1 and microtubule-associated protein 1 light chain 3 II (LC3II) protein levels, thereby modulating autophagy-related pathways. Conclusion: C. chinensis can enhance the abundance of beneficial bacteria in the gut and ameliorate cognitive dysfunction in AD mice by interacting with B. breve. Moreover, magnoflorine, 13-methylberberine, and palmatrubine within C. chinensis can also mitigate excessive autophagy and oxidative stress in nerve cells.

16 Integrated network pharmacology and metabolomics to analyze the mechanism of Shaofu Zhuyu Decoction in treatment of dysmenorrhea of cold coagulation and blood stasis

Yilu Luo a , Zengguang Wu b , Ruifeng Ji a , Lingling Shen c , Xin He a , d , e

2026, 18(2):420-438. DOI: https://doi.org/10.1016/j.chmed.2025.02.002

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Objective: To study the mechanism of Shaofu Zhuyu Decoction (SFZYD) in treating primary dysmenorrhea (PD) with cold coagulation and blood stasis based on metabonomics and network pharmacology. Methods: The disease model of primary dysmenorrhea in rats with cold coagulation and blood stasis was established according to the previous research methods. The model of cold coagulation and blood stasis was built with ice water bath, and the model of PD was built with estradiol and oxytocin injection.The success of modeling was judged according to the physiological condition of rats, the change of body weight, the number of twisting and the change of uterine blood flow. UPLC-Q/TOF MS technique was used to identify the components and their main components in plasma in the Wenjing group (WJ, means warming channel), Huoxue group (HX, means activating blood), and Quanfang group (QF, means complete prescription) group, and a ‘‘compound-target-pathway” network was constructed by network pharmacology. Untargeted metabolomics studies were applied to screen out endogenous differential metabolites and analyze their related metabolic pathways. The analgesic effect, pathological morphology and inflammatory mediators were evaluated, and the pathway targets were verified. Results: A total of 93 chemical components and 22 components in plasma were identified. A total of 52 potential targets of SFZYD for primary dysmenorrhea were identified by network pharmacological analysis, and 12 endogenous differential metabolites and four related metabolic pathways were screened out by metabonomics. The possible targets and pathways of action of the components of SFZYD into blood were analyzed by network pharmacology, and the results showed that it can widely act on the proteins and pathways related to thrombosis, new angiogenesis, vasodilation, inflammatory immune response and central sedation. Body torsion test showed that drug administration could reduce the frequency of body twisting in dysmorrhea rats, ELISAs showed that SFZYD could inhibit the release of inflammatory factors TNF-a and IL-6. Western blotting showed that SFZYD could reduced the protein expression of COX-2, p-ERK2 in uterine tissue, inhibiting inflammatory cell infiltration and inflammatory factor expression. By down-regulating the expression of p-MLC protein in uterine tissue, the strong contraction of smooth muscle was inhibited, thus relieving dysmenorrhea. Conclusion: Based on the research idea of ‘‘disease-syndrome-prescription-medicine”combination, this study discussed the internal relationship of SFZYD’s drug property, functional taste and efficacy. The substance basis of ‘‘warm property and pungent taste” in the WJ group reflects pungent taste is dispersive and propulsive, the warm property can dispel cold, to help Yang promoting circulation of qi and dispersing accumulation of pathogen, dredging connection tissue, dispersing fluid and promoting circulation of blood. Thus, it has the effect of WJ dispelling cold, regulating the circulation of qi and alleviating pain. The substance basis of ‘‘warm property, pungent and bitter taste” in HX group reflects that pungent taste is dispersive and propulsive, bitter taste can resolve stasis, warm property can dispel cold. All result in some effects of blood circulation, promoting qi, repelling congestion and improving dysmenorrhea. This study revealed the multi-component, multi-target and multi-pathway integration mechanism of SFZYD in the treatment of PD with cold coagulation and blood stasis, which preliminarily clarify scientific connotations about property theory of pungent, bitter taste and warm property,efficacy and material basis, laid a foundation for further research on the mechanism of action of SFZYD in the treatment of PD.

17 A methodological approach for complex mixture aqueous solution analysis by ATR-FTIR spectroscopy

Lingyu Han a , Qun Zhou b , Hang Yin a , b , Suqin Sun b

2026, 18(2):439-451. DOI: https://doi.org/10.1016/j.chmed.2026.01.001

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Objective: To develop an in situ, nondestructive approach for simultaneously acquiring overall structural and intermolecular interaction information of multiple components in complex aqueous mixtures without sample separation. Methods: In this paper, attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) was utilized to detect and analyze the juice and decoction (clinical application forms) of different processed products of a traditional Chinese medicine (TCM)—Rehmanniae Radix (Dihuang in Chinese). By the analysis of IR and the second derivative IR (SD-IR) spectra, the spectral structure information of water, organic acid, stachyose, glucose, galactose, fructose, manninotriose, amino acid and protein in the mixture system was extracted through non separation fingerprint characteristic. Results: A large number of in situ dynamic tracked IR spectra, obtained by ATR-FTIR and TimeBase software, were used to excavate the changes of absorption peak intensity (structural analysis) and diffusion velocity (time resolution) in the process of liquid adsorption-diffusion. The results indicated the coexistence of free hydroxyl groups, intermolecular hydrogen bonds, and intramolecular hydrogen bonds, analyzed by two-dimensional correlation infrared spectroscopy (2DCOS-IR), confirming their complex and dynamic hydrogen-bonding network structures. Furthermore, spectral analysis revealed interactions among the various active components in the mixtures, providing a microstructural basis for interpreting their holistic effects. Conclusion: This study provided a theoretical basis for the efficacy and pharmacologic mechanism of different processed forms of TCM from the perspective of physical chemistry. Also, it discussed how to carry out nondestructive and in situ dynamic tracking of complex mixture aqueous solution system, and how to study the timeliness, synergy and interaction of samples.

18 Optimization of imperatorin extraction from Qianliexin Capsules using deep eutectic solvent

Cejia Liu a , Hezheng Bai b , Jianxiang Liu b , Xunyong Zhou c , Ning Liang b , Tao Shen a , Longshan Zhao b

2026, 18(2):452-460. DOI: https://doi.org/10.1016/j.chmed.2025.03.005

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Abstract:
Yuqing Meng a

19 Shuxuening injection for acute ischemic stroke: Efficacy and safety − a randomized, double-blind, placebo controlled, multi-center clinical trial

Ruihong Ma a , Xiaogang Li b , Xiaolei An c , Juntao Li d , Jianguo Zhu e , Temuqile f , Liping Zhan g , Peiyang Zhou h , Baolong Ren i , Baoai Wang j , Yuanyuan Sun a , Wei Xiao k , Meng Xu l

2026, 18(2):461-469. DOI: https://doi.org/10.1016/j.chmed.2024.12.004

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Objective: To evaluate the efficacy and safety of Shuxuening injection, a Chinese remedy from Ginkgo biloba, in treating patients with acute ischemic stroke (AIS). Methods: A randomized, double-blind, placebo-controlled, multi-center clinical trial was conducted from 21 November 2018 to 20 January 2022 in 31 participating research centers involving 446 patients with AIS. Patients received either a Shuxuening injection (experimental group) or a placebo (control group) alongside basic treatment (aspirin enteric-coated tablets). The primary efficacy endpoint was the percentage of patients with a modified Rankin scale (mRS) score ≤ 2 at 90-day post-stroke. The secondary efficacy endpoints were the changes in mRS, National Institute of Health stroke scale (NIHSS), and Barthel index (BI) scores, and the incidence of adverse events. Results: The percentage of patients with mRS scores ≤ 2 at 90-day post-stroke was significantly higher in the experimental than in the control (P < 0.05) group. The percentage of patients with scores ≤ 1 at 90- day post-stroke was higher in the experimental group (P < 0.05). The change value of NIHSS scores in the experimental group was higher at 10-day post-treatment and 90-day post-stroke (P < 0.05). The percentage of NIHSS score reduction ≥ 50% was higher in the experimental group at 90-day post-stroke (P < 0.05). The change value of BI score and percentage of BI score ≥ 75 were higher in the experimental group at 90-day post-stroke (P < 0.05). Safety profiles did not differ between the groups. Conclusion: Shuxuening injection effectively improves the functional outcome of patients, reduces disability rates, improves neurological deficits, enhances activities of daily living, and demonstrates good safety profiles.

20 Novel step-by-step strategy for evaluating treatment of traditional Chinese medicine injections for community-acquired pneumonia in adults

Tiantian Zhao b , c , Qi Liu b , Xiangjia Song a , Fei Liao a , Yeqing Zhang b , Ningning Zhao a

2026, 18(2):470-480. DOI: https://doi.org/10.1016/j.chmed.2026.02.007

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Objective: Community-acquired pneumonia (CAP) is a leading cause of death from infectious diseases in adults worldwide. Traditional Chinese medicine injections (TCMIs) are often used as complementary therapies. This study aimed to evaluate the efficacy and safety of TCMIs for the treatment of CAP. Methods: A step-by-step strategy was first designed including data collection, systematic review, Bayesian network meta-analysis (NMA), and assessment of the NMA. Eight databases were searched for relevant randomized clinical trials (RCTs) from their inception to December 31, 2022. The Cochrane risk-of-bias tool was used to assess the methodological quality and the risk of bias of the included RCTs. Bayesian NMA was performed by WinBUGS 14.0 and STATA 15.0. Finally, the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence for each outcome. Results: A total of 35 RCTs involving 4 291 participants were included. For clinical effectiveness rate, the Reduning Injection (RDN) combined with Western medicine (WM) was the most likely to be the best treatment (SUCRA = 0.919). And the top three TCMIs interventions were RDN + WM, Xiyanping Injection (XYP) + WM, Tanreqing injection (TRQ) + WM. For defervescence time, disappearance time of cough, and the disappearance time of lung rales, the XYP with WM was probably the best treatment (SUCRA = 0.822, 0.838, 0.816). Moreover, adverse drug reactions have been reported in 14 RCTs. Conclusion: The TCMIs can effectively relieve clinical symptoms and improve clinical efficiency than that of WM alone for adults with non-severe CAP. Step-by-step results firstly indicated that XYP with WM was superior treatment regimen to reduce defervescence time, disappearance time of cough and disappearance time of lung rales. For safety, the mild adverse drug reactions occurred during the entire course of therapy and were self-limiting, further confirming the favorable safety profile of the TCMIs.

21 Rhein/Fe3+ nanoassembly for triple-negative breast cancer treatment via a ferroptosis and immunogenic death

Shuntao Liang a , c , Licheng Gan a , d , Xiaomei Tao c , Fei Xia a , b , Qingchao Tu a , Linying Zhong a , Yuanfeng Fu a , Yinan Liu a , Yuqing Meng a , Qiaoli Shi a , Junzhe Zhang a , Jigang Wang a , d , ? , Chong Qiu a , b , ?

2026, 18(2):481-483. DOI: https://doi.org/10.1016/j.chmed.2026.02.012

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22 Biosynthetic pathway analysis of ginsenoiside Rh1 to notoginsenoside R2

Rubing Wang a , b , Yanan Zhang a , b , Huanyu Zhang a , b , Wenqi Yang a , b , Yaowu Su a , b , Hongyan Jing c , Juan Wang a , b , ? , Wenyuan Gao a , b , ?

2026, 18(2):484-486. DOI: https://doi.org/10.1016/j.chmed.2026.02.001

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23 Diverse alkaloids with anti-inflammatory activity discovered from Thalictrum baicalense

Jinyuan Yang a , Zhaojing Chen a , Jingjing Xue a , Yikun Ren a , Zhanlin Li a , Dahong Li?a , Yating Sun b , ? , Huiming Hua a

2026, 18(2):487-490. DOI: https://doi.org/10.1016/j.chmed.2026.02.013

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