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Fujikane A, Fujikane R, Hyuga S, Sechi Y, Hiyoshi T, Sakamoto A, Nishi A, Odaguchi H, Hiromatsu K, Goda Y, Ishino Y, Nabeshima S. Antiviral effect of alkaloids-free Ephedra Herb extract on respiratory syncytial virus infection. Front Pharmacol 2024; 15:1410470. [PMID: 39035985 PMCID: PMC11257991 DOI: 10.3389/fphar.2024.1410470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
Respiratory syncytial virus (RSV) is a major cause of respiratory tract infection in children. Despite decades of efforts, no effective therapies are available. We recently reported that extracts of Ephedra Herb and Cinnamon Bark interacted with the G attachment protein of RSV to inhibit infectivity. The present in vitro study aimed to investigate the antiviral effect of ephedrine alkaloids-free Ephedra Herb extract (EFE), which is characterized by free of harmful effects of ephedrine alkaloids in Ephedra Herb, on experimental RSV infection. Infection of RSV into A549 cells simultaneously with EFE resulted the significant reduction of RSV RNA, viral protein, and viral titers after the incubation of the cells. We found that RSV attachment to the cell surface was inhibited both in the presence of EFE and when RSV particles were pre-treated with EFE. We also found that EFE specifically interacted with the central conserved domain of RSV G protein by surface plasmon resonance, demonstrating that specific binding of G protein to the cellular receptor was inhibited by EFE. Another mechanism was found in which a higher concentration of EFE inhibited the viral load immediately after the viral entry into host cells, suggesting the inhibition of viral RNA replication. These results demonstrate that EFE worked against RSV infection through multiple antiviral mechanisms, a unique feature of this crude drug extract.
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Affiliation(s)
- Aya Fujikane
- Department of General Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryosuke Fujikane
- Department of Physiological Science and Molecular Biology, Fukuoka Dental College, Fukuoka, Japan
- Oral Medicine Research Center, Fukuoka Dental College, Fukuoka, Japan
| | - Sumiko Hyuga
- Oriental Medicine Research Center, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Yusuke Sechi
- Department of General Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tetsuya Hiyoshi
- Department of General Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Atsuhiko Sakamoto
- Department of General Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akinori Nishi
- TSUMURA Advanced Technology Research Laboratories, Tsumura & Co., Ibaraki, Japan
| | - Hiroshi Odaguchi
- Oriental Medicine Research Center, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Kenji Hiromatsu
- Department of Microbiology and Immunology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yukihiro Goda
- National Institute of Health Sciences, Kawasaki, Kanagawa, Japan
| | - Yoshizumi Ishino
- Department of Bioscience and Biotechnology, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeki Nabeshima
- Department of General Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Chroho M, Bailly C, Bouissane L. Ethnobotanical Uses and Pharmacological Activities of Moroccan Ephedra Species. PLANTA MEDICA 2024; 90:336-352. [PMID: 38423032 DOI: 10.1055/a-2269-2113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Ephedra species are among the most popular herbs used in traditional medicine for a long time. The ancient Chinese medical book "Treatise on Febrile Diseases" refers to the classic traditional Chinese medicine prescription Ge Gen decoction, which consists of seven herbs, including an Ephedra species. Ephedra species are utilized all over the world to treat symptoms of the common cold and coughs, and to combat major human diseases, such as asthma, cancers, diabetes, cardiovascular and digestive disorders, and microbial infections. This study aimed at identifying specific Ephedra species used traditionally in Morocco for therapeutic purposes. The plant parts, their preparation process, and the treated pathologies were identified and analyzed. The results revealed five ethnobotanically important species of Ephedra: Ephedra alata Decne, Ephedra altissima Desf., Ephedra distachya L., Ephedra fragilis Desf., and Ephedra nebrodensis Tineo. These species are used traditionally in Morocco for treating people with diabetes, cancer, rheumatism, cold and asthma, hypertension, influenza virus infection, and respiratory ailments. In addition, they are occasionally used as calefacient agents, to regulate weight, or for capillary care. Few studies have underlined the antibacterial and antioxidant activities of some of these Moroccan Ephedra species, but little information is available regarding the natural products at the origin of the bioactivities. Further phytochemical investigations and clinical data are encouraged to better support the use of these plants.
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Affiliation(s)
- Mounia Chroho
- Molecular Chemistry, Materials and Catalysis Laboratory, Faculty of Sciences and Technologies, Sultan Moulay Slimane University, Beni-Mellal, Morocco
| | - Christian Bailly
- OncoWitan, Scientific Consulting Office, Lille, France
- Institute of Pharmaceutical Chemistry Albert Lespagnol, Faculty of Pharmacy, University of Lille, France
| | - Latifa Bouissane
- Molecular Chemistry, Materials and Catalysis Laboratory, Faculty of Sciences and Technologies, Sultan Moulay Slimane University, Beni-Mellal, Morocco
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Antiviral Effect of Ephedrine Alkaloids-Free Ephedra Herb Extract against SARS-CoV-2 In Vitro. Microorganisms 2023; 11:microorganisms11020534. [PMID: 36838499 PMCID: PMC9964550 DOI: 10.3390/microorganisms11020534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
We report for the first time that ephedrine alkaloids-free Ephedra Herb extract (EFE) directly inhibits the replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and that the addition of EFE to the culture medium before viral infection reduces virus titers in the culture supernatant of SARS-CoV-2, including those of variant strains, by more than 99%, 24 h after infection. The addition of Ephedra Herb macromolecule condensed-tannin, which is the main active ingredient responsible for the anticancer, pain suppression, and anti-influenza effects of EFE, similarly suppressed virus production in the culture supernatant by 99% before infection and by more than 90% after infection. Since EFE does not have the side effects caused by ephedrine alkaloids, such as hypertension, palpitations, and insomnia, our results showed the potential of EFE as a safe therapeutic agent against coronavirus disease 2019.
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Goda Y. Regulatory science of natural products. J Nat Med 2022; 76:732-747. [PMID: 35870047 PMCID: PMC9307968 DOI: 10.1007/s11418-022-01639-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
Foods and pharmaceuticals play key roles in public health and welfare and ensuring that these products meet their quality assurance standards is a top priority in health and medical care. Quality assurance of natural products is essential in pharmaceutical sciences because the outset of a medicine is a natural, crude drug. Regulatory science underpins scientific regulations and is closely related to the quality assurance of foods and pharmaceuticals to ensure their safety and efficacy. During my time at the National Institute of Health Sciences, Japan, from 1986 to present, the regulatory science of natural products has been my main research focus. This review discusses 24 studies related to the regulatory science of natural food additives, 26 related to foods, 23 related to borderline products, 16 related to illicit psychotropic mushrooms, plants, and agents, and 57 related to herbal medicines. In later sections, the regulatory science for ethical Kampo products with new dosage forms and herbal medicines that use Kampo extracts as active pharmaceutical ingredients are discussed. My experience from the early twenty-first century in research projects on the bioequivalence of Kampo products and the development of ephedrine alkaloid-free Ephedra Herb extract demonstrate that regulatory science is crucial for developing new drugs.
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Affiliation(s)
- Yukihiro Goda
- National Institute of Health Sciences, 25-26 Tonomachi 3-chome, Kawasaki-ku, Kawasaki, 210-9501, Japan.
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Lee E, Yoon SH, Kim H, Kim YD, Leem J, Park J. Ephedrae Herba in combination with herbal medicine (Zhizichi decoction and Phellodendri Cortex) for weight reduction: a case series. Integr Med Res 2020; 9:100408. [PMID: 32405455 PMCID: PMC7210583 DOI: 10.1016/j.imr.2020.100408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 01/01/2023] Open
Abstract
Backgrounds Ephedrae Herba is widely used to treat obesity. There is a concern for adverse events (AEs) using it and we need to develop strategies to attenuate it without its effectiveness for weight-reducing potential. We investigated the effects of a combination of Ephedra Herba with Zhizichi decoction and Phellodendri Cortex (Anmyungambi (AMGB) decoction) in reducing the incidence of Ephedra Herba-related AEs. Methods We performed a retrospective chart review from a clinical case series of patients visiting the Jaonmi Korean Medicine Clinic (Seoul, Korea). The inclusion criteria was patients who were prescribed AMGB decoction, (containing Ephedrae Herba, Phellodendri Cortex, and Zhizichi decoction [Gardeniae Fructus, and Glycine Semen Preparata] in different proportions) for weight reduction. Exclusion of Phellodendri Cortex in the original AMGB preparation was allowed; conventional medications, acupuncture, and dietary supplements were not allowed. The primary outcome was absolute weight loss at the end of treatment. Results Twenty-seven patients (6 men and 21 women), aged 18–75 years (mean age, 42.6 ± 11.1 years) and the average treatment duration was 39.4 days. Absolute weight loss at the end of treatment was 4.49 ± 2.40 kg. Fifteen patients lost more than 5% weight (55.6%). Treatment >45 days resulted in significantly greater weight loss compared to treatment <30 days (p < 0.001). Not severe AEs were reported in 16 patients including constipation, fatigue, etc. Conclusion A combination of Ephedra Herba with Zhizichi decoction and Phellodendri Cortex may be a safe and effective treatment for weight reduction in obese and overweight patients.
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Affiliation(s)
- Eunji Lee
- Chung-Yeon Korean Medicine Hospital, Gwangju, Republic of Korea
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
| | - Sang-Hoon Yoon
- Chung-Yeon Korean Medicine Hospital, Gwangju, Republic of Korea
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
| | - Hyunho Kim
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
- Dongshin Korean Medicine Hospital, Seoul, Republic of Korea
| | - Young Doo Kim
- Jaonmi Korean Medicine Clinic, Seoul, Republic of Korea
| | - Jungtae Leem
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
- Dongshin Korean Medicine Hospital, Seoul, Republic of Korea
- Corresponding authors at: Dongshin Korean Medicine Hospital, 351, Omok-ro, Yangcheon-gu, Seoul 07999, Republic of Korea; Department of Oriental Pharmacology, Kyung Hee University, 26 Kyungheedae-ro, Hoegi-dong, Dongdaemun-gu, Seoul 02447, Republic of Korea.
| | - Jinbong Park
- Department of Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Corresponding authors at: Dongshin Korean Medicine Hospital, 351, Omok-ro, Yangcheon-gu, Seoul 07999, Republic of Korea; Department of Oriental Pharmacology, Kyung Hee University, 26 Kyungheedae-ro, Hoegi-dong, Dongdaemun-gu, Seoul 02447, Republic of Korea.
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Metabolite Profile Changes in Different Regions of Rat Brain Affected by Ephedra sinica. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:8358039. [PMID: 32419830 PMCID: PMC7201840 DOI: 10.1155/2020/8358039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/12/2020] [Accepted: 04/02/2020] [Indexed: 11/18/2022]
Abstract
Ephedra sinica Stapf (EP) has a long medication history dating back centuries in the world. There were some reports of adverse effects in the central nervous system (CNS) resulting from administration of a drug containing EP or ephedrine. Compared with alkaloid monomer compounds, the effects of EP on the CNS are usually neglected. It is necessary to explore CNS affection which is helpful to use EP rationally. However, the affection and the changes of substances by EP in the brain are still unknown because the effects of drug on the brain also exhibit different tendency and distribution and usually lead to diversity of metabolite alteration in different regions. In this study, metabolomics based on different brain regions was used to investigate the affection mechanism of EP in the CNS. The metabolites in 6 brain regions from a rat that underwent oral administration with EP for 14 days were determined by UPLC/Q-TOF-MS. Brain histological examinations showed that there were no obvious lesions in EP administration groups. Partial least square-discriminant analysis (PLS-DA) displayed that there were significant separations between control and EP administration groups. 7 CNS biomarkers were found and identified in different regions. 3 metabolic pathways were disturbed by EP, including amino acid metabolism, phospholipid metabolism, and amino sugar metabolism. Furthermore, all biomarkers were significantly changed in the cortex after administration. This study may be helpful to understand the affection mechanism of EP in the CNS and improve cognition of brain regional characteristics.
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Effect of Ephedra Herb on Erlotinib Resistance in c-Met-Overexpressing Non-Small-Cell Lung Cancer Cell Line, H1993, through Promotion of Endocytosis and Degradation of c-Met. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020. [DOI: 10.1155/2020/7184129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR-TKIs) are used to treat non-small-cell lung cancer (NSCLC), harboring an EGFR-activating mutation. However, acquired resistance to these treatments emerges after a few years. One of causes of resistance to EGFR-TKIs is a high level of c-Met amplification or c-Met protein overexpression/hyperactivation. Therefore, combination therapy with EGFR-TKIs and a c-Met inhibitor is thought to be effective treatment for patients with NSCLC resistance carrying c-Met amplification and/or protein hyperactivation. Ephedra Herb is a crude drug and is used in Japan as a component in many Kampo formulae. We previously reported that Ephedra Herb extract (EHE) inhibits HGF-induced phosphorylation of c-Met by preventing c-Met tyrosine kinase activity. Thus, we investigated the combination effect of EHE and erlotinib, an EGFR-TKI, on growth of H1993 cells, an erlotinib-resistant NSCLC cell line with overexpression of c-Met. The EHE and erlotinib combination proved to be effective in suppression of the growth of H1993 xenograft tumors and on inhibition of proliferation of H1993 cells, suggesting that EHE is effective in rescuing NSCLC cells from erlotinib resistance. Moreover, EHE not only inhibited the phosphorylation of c-Met, but also downregulated the expression of c-Met by facilitating clathrin-mediated endocytosis and lysosomal degradation of c-Met. EHE also promoted downregulation of the expression of EGFR and phosphorylation of EGFR. Ephedrine alkaloids-free Ephedra Herb extract (EFE) had the same effects as EHE, and the 40% MeOH fraction from EFE, which mainly contained the high-molecular mass condensed tannins, decreased the expression levels of c-Met, pMet, EGFR, and pEGFR to almost the same level as EFE. These results suggest that recovery from resistance to erlotinib by EHE is derived from the high-molecular mass condensed tannins and that EHE may be suitable for treatment of c-Met-overexpressing NSCLC with resistance to EGFR-TKIs.
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Yoshimura M, Amakura Y, Hyuga S, Hyuga M, Nakamori S, Maruyama T, Oshima N, Uchiyama N, Yang J, Oka H, Ito H, Kobayashi Y, Odaguchi H, Hakamatsuka T, Hanawa T, Goda Y. Quality Evaluation and Characterization of Fractions with Biological Activity from Ephedra Herb Extract and Ephedrine Alkaloids-Free Ephedra Herb Extract. Chem Pharm Bull (Tokyo) 2020; 68:140-149. [PMID: 32009081 DOI: 10.1248/cpb.c19-00761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previously, we reported that the c-Met inhibitory effect of Ephedra Herb extract (EHE) is derived from ingredients besides ephedrine alkaloids. Moreover, analgesic and anti-influenza activities of EHE and ephedrine alkaloids-free Ephedra Herb extract (EFE) have been reported recently. In this study, we examined the fractions containing c-Met kinase inhibitory activity from EHE and the fractions with analgesic and anti-influenza activities from EFE, and elucidated the structural characteristics of the active fractions. Significant c-Met kinase activity was observed in 30, 40, and 50% methanol (MeOH) eluate fractions obtained from water extract of EHE using Diaion HP-20 column chromatography. Similarly, 20 and 40% MeOH, and MeOH eluate fractions obtained from water extract of EFE were found to display analgesic and anti-influenza activities. Reversed phase-HPLC analysis of the active fractions commonly showed broad peaks characteristic of high-molecular mass condensed tannin. The active fractions were analyzed using 13C-NMR and decomposition reactions; the deduced structures of active components were high-molecular mass condensed tannins, which were mainly procyanidin B-type and partly procyanidin A-type, including pyrogallol- and catechol-type flavan 3-ols as extension and terminal units. HPLC and gel permeation chromatography (GPC) analyses estimated that the ratio of pyrogallol- and catechol-type was approximately 9 : 2, and the weight-average molecular weight based on the polystyrene standard was >45000. Furthermore, GPC-based analysis was proposed as the quality evaluation method for high-molecular mass condensed tannin in EHE and EFE.
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Affiliation(s)
| | | | - Sumiko Hyuga
- Oriental Medicine Research Center, Kitasato University
| | | | - Shunsuke Nakamori
- Department of Pharmacognosy, School of Pharmacy, Kitasato University
| | | | - Naohiro Oshima
- Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | | | | | - Hideki Oka
- Zeria Pharmaceutical Co., Ltd., Central Research Laboratories
| | - Hideyuki Ito
- Department of Nutritional Science, Faculty of Health and Welfare Sciences, Okayama Prefectural University
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Odaguchi H, Hyuga S, Sekine M, Nakamori S, Takemoto H, Huang X, Oshima N, Shimada N, Yang J, Amakura Y, Hyuga M, Uchiyama N, Kobayashi Y, Hakamatsuka T, Goda Y, Hanawa T. The Adverse Effects of Ephedra Herb and the Safety of Ephedrine Alkaloids-free Ephedra Herb Extract (EFE). YAKUGAKU ZASSHI 2019; 139:1417-1425. [DOI: 10.1248/yakushi.19-00122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Sumiko Hyuga
- Oriental Medicine Research Center, Kitasato University
| | - Mariko Sekine
- Oriental Medicine Research Center, Kitasato University
| | - Shunsuke Nakamori
- Oriental Medicine Research Center, Kitasato University
- School of Pharmacy, Kitasato University
| | - Hiroaki Takemoto
- Oriental Medicine Research Center, Kitasato University
- School of Pharmacy, Kitasato University
| | - Xuedan Huang
- Oriental Medicine Research Center, Kitasato University
- School of Pharmacy, Kitasato University
| | - Naohiro Oshima
- Tokyo University of Science Faculty of Pharmaceutical Sciences
| | | | | | - Yoshiaki Amakura
- Department of Pharmacognosy, College of Pharmaceutical Sciences, Matsuyama University
| | | | | | - Yoshinori Kobayashi
- Oriental Medicine Research Center, Kitasato University
- School of Pharmacy, Kitasato University
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Dai Y, Li Q, Tong J, Verpoorte R, Zhao SJ, Qin XM, Chen S. Quality marker identification based on standard decoction of differently processed materials of Ephedrae Herba. JOURNAL OF ETHNOPHARMACOLOGY 2019; 237:47-54. [PMID: 30898554 DOI: 10.1016/j.jep.2019.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/02/2019] [Accepted: 03/09/2019] [Indexed: 05/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The quality control of Traditional Chinese medicine (TCM) is a scientific problem and an industrial issue, which hampers the development of evidence based TCM. The concept of quality markers (Q-markers) is proposed and has been applied to the quality evaluation of TCM based on its clinical efficacy. However, more specific methods are needed to put this idea into practice. The standard decoction is a representative of decoction used in clinical practice and it can be used for the discovery of Q-markers related to the clinical efficacy of TCM. AIM OF THE STUDY In this study, a systemic strategy was established to discover Q-markers related to the clinical efficacy of TCM Ephedrae Herba (EH), dried stem of Ephedra sinica Stapf. The different processed materials of EH have different clinical applications, though originating from the same medicinal herb. MATERIALS AND METHODS The standard decoction of each of the processed materials was prepared and a 1HNMR metabolomics approach and total polysaccharide analysis were used to identify potential Q-markers related to the different clinical applications of EH. Correlation analysis was made of the measured biological activity and the holistic chemical profile. RESULTS The results showed that total polysaccharides and alkaloids were Q-markers for EH preparations. CONCLUSION This study demonstrates that the standard decoction is a reasonable research objective to explore chemical markers that correlate with the clinical efficacy of TCM.
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Affiliation(s)
- Yuntao Dai
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Qi Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiayu Tong
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Shanxi, China
| | - Robert Verpoorte
- Natural Products Laboratory, Institute of Biology, Leiden University, Sylviusweg 72, 2333BE, Leiden, the Netherlands
| | - Si-Jun Zhao
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Shanxi, China; Shanxi Institute for Food and Drug Control, Taiyuan, 030001, China
| | - Xue-Mei Qin
- Modern Research Center for Traditional Chinese Medicine, Shanxi University, Shanxi, China
| | - Shilin Chen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China.
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