title: Synergistic Effects of Chinese Herbal Medicine: A Comprehensive Review of Methodology and Current Research.
abstract: Traditional Chinese medicine (TCM) is an important part of primary health care in Asian countries that has utilized complex herbal formulations (consisting 2 or more medicinal herbs) for treating diseases over thousands of years. There seems to be a general assumption that the synergistic therapeutic effects of Chinese herbal medicine (CHM) derive from the complex interactions between the multiple bioactive components within the herbs and/or herbal formulations. However, evidence to support these synergistic effects remains weak and controversial due to several reasons, including the very complex nature of CHM, misconceptions about synergy and methodological challenges to study design. In this review, we clarify the definition of synergy, identify common errors in synergy research and describe current methodological approaches to test for synergistic interaction. We discuss the strengths and weaknesses of these models in the context of CHM and summarize the current status of synergy research in CHM. Despite the availability of some scientific data to support the synergistic effects of multi-herbal and/or herb-drug combinations, the level of evidence remains low, and the clinical relevancy of most of these findings is undetermined. There remain significant challenges in the development of suitable methods for synergistic studies of complex herbal combinations.
authors.affiliation: School of Science and Health, National Institute of Complementary Medicine, Western Sydney University Penrith, NSW, Australia.
authors.forename: Xian
authors.initials: X
authors.lastname: Zhou
authors.affiliation: School of Science and Health, National Institute of Complementary Medicine, Western Sydney University Penrith, NSW, Australia.
authors.forename: Sai Wang
authors.initials: SW
authors.lastname: Seto
authors.affiliation: School of Science and Health, National Institute of Complementary Medicine, Western Sydney University Penrith, NSW, Australia.
authors.forename: Dennis
authors.initials: D
authors.lastname: Chang
authors.affiliation: Faculty of Medicine, University of New South WalesSydney, NSW, Australia; School of Medicine, Western Sydney UniversityCampbelltown, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie UniversitySydney, NSW, Australia.
authors.forename: Hosen
authors.initials: H
authors.lastname: Kiat
authors.affiliation: School of Science and Health, National Institute of Complementary Medicine, Western Sydney UniversityPenrith, NSW, Australia; Faculty of Medicine, University of New South WalesSydney, NSW, Australia.
authors.forename: Valentina
authors.initials: V
authors.lastname: Razmovski-Naumovski
authors.affiliation: School of Science and Health, National Institute of Complementary Medicine, Western Sydney UniversityPenrith, NSW, Australia; School of Pharmacy and Biomolecular Sciences, Liverpool John Moores UniversityLiverpoor, UK; Faculty of Science, TCM Division, University of TechnologySydney, NSW, Australia.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Chan
authors.affiliation: School of Science and Health, National Institute of Complementary Medicine, Western Sydney University Penrith, NSW, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Bensoussan
keywords: Chinese herbal medicine; combination index; interaction; isobologram; synergy; system biology