Abstract
Currently, the use of Traditional Chinese Medicine (TCM) for healthy living in daily practice is widely accepted across the world. However, not much attention has been paid to the particular characteristics of TCM “pills”, one of the classic dosage forms in TCM. For a better understanding, this review was undertaken to provide a modern pharmaceutical overview of pills. Over many centuries, pills have been developed in different types (honeyed pill, water-honeyed pill, watered pill, pasted pill, waxed pill, concentrated pill, and dripping pill) to achieve varying intended TCM release patterns. It suggests that knowledge relating to the impact of binders and excipients on drug release from TCM pills can be traced back to before dissolution testing was invented. Therefore, although Pills may be considered as an ancient and outdated dosage form compared to current drug delivery systems, they have surprisingly modern pharmaceutical properties that is highlighted in this article. In addition, this review found that the quality control standards for TCM pill are globally substantially different. Hence, greater effort should be taken to establish an internationally harmonized and proper standard to safeguard the quality of this dosage form and to ensure the alignment with TCM use.
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References
Leung AY. Traditional toxicity documentation of Chinese Materia Medica—an overview. Toxicol Pathol. 2006;34:319–26.
Liu X, Wang Q, Song G, Zhang G, Ye Z, Williamson EM. The classification and application of toxic chinese materia medica. Phyther Res. 2014;28:334–47.
Luo N. The export of Chinese herbal medicine increased by more than 10% in 2018 [Internet]. China news Tradit. Chinese Med. 2019 [cited 2019 May 1]. Available from: http://www.cntcm.com.cn/2019-03/21/content_58300.htm
Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002–2012. Natl Health Stat Report. 2015;79:1–16.
Esmail N. Complementary and alternative medicine: use and public attitudes 1997, 2006, 2016 [Internet]. Fraser Inst. 2017 [cited 2019 May 2]. p. 1–87. Available from: https://www.fraserinstitute.org/studies/complementary-and-alternative-medicine-use-and-public-attitudes-1997-2006-and-2016
World Health Organization (WHO). WHO traditional medicine strategy 2014–2023 [Internet]. World Heal. Organ. 2013 [cited 2019 May 6]. p. 1–76. Available from: http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf?ua=1 (Accessed 09.09.2016).
Qi Z. The WHO traditional medicine strategy 2014–2023 [Internet]. Glob. Heal. Hist. Semin. Tradit. Med. Ayurveda. 2015 [cited 2019 May 6]. p. 1–28. Available from: https://www.who.int/global_health_histories/seminars/Dr_Zhangs_Presentation_GHHSeminar_86.pdf
Chen Y long, Zhao C, Zhang L, Li B, Wu C hong, Mu W, et al. Toward evidence-based chinese medicine: status quo, opportunities and challenges. Chin J Integr Med. 2018;
Lam WC, Lyu A, Bian Z. ICD-11: impact on traditional Chinese medicine and world healthcare systems. Pharmaceut Med. 2019.
Shang H, Zhang J, Yao C, Liu B, Gao X, Ren M, Cao H, Dai G, Weng W, Zhu S, Wang H, Xu H, Zhang B Qi-Shen-Yi-Qi dripping pills for the secondary prevention of myocardial infarction: a randomised clinical trial. Evidence-based Complement Altern Med 2013, 2013, 1, 9;
NCT01659580. Phase III Trial of Dantonic® (T89) capsule to prevent and treat stable angina. https://clinicaltrials.gov/show/nct01659580. 2012;
Zuo J, Park C, Doschak MR, Löbenberg R. Are the release characteristics of Erzhi pills in line with traditional Chinese medicine theory? A quantitative study. J Integr Med. 2020.
Yan SK, Zhang WD, Liu RH, Zhan YC. Chemical fingerprinting of Shexiang Baoxin pill and simultaneous determination of its major constituents by HPLC with evaporative light scattering detection and electrospray mass spectrometric detection. Chem Pharm Bull. 2006;54:1058–62.
Yan S, Yang Y, Wu Y, Liu R, Zhang W. Chemical fingerprinting and quantitative analysis of volatiles in Shexiang Baoxin pill by gas chromatography with flame ionization and mass spectrometric detection. J Anal Chem. 2009;64:149–55.
Duan S, Niu L, Yin T, Li L, Gao S, Yuan D, et al. A novel strategy for screening bioavailable quality markers of traditional Chinese medicine by integrating intestinal absorption and network pharmacology: application to Wu Ji Bai Feng pill. Phytomedicine. 2020;76:153226.
Liu H, Qiu F, Yang X, Zhao H, Bian B, Wang L. Pharmacokinetics of the Yougui pill in experimental autoimmune encephalomyelitis model rats and its pharmacological activity in vitro. Drug Des Devel Ther. 2019;13:2357–70.
Li JC, Shen XF, Meng XL, Zhang Y, Lai XR. Analgesic effect and mechanism of the three TCM-herbal drug-combination Tou Feng Yu pill on treatment of migraine. Phytomedicine. 2011;18:788–94.
Li H, Chu S, Zhao H, Liu D, Liu X, Qu X, et al. Effect of Zishen Jiangtang pill, a Chinese herbal product, on rats with diabetic osteoporosis. Evidence-Based Complement Altern Med. 2018;2018:1–10.
Sun H, Li TJ, Sun LN, Qiu Y, Huang BB, Yi B, et al. Inhibitory effect of traditional Chinese medicine Zi-Shen pill on benign prostatic hyperplasia in rats. J Ethnopharmacol. 2008;115:203–8.
Wang Q, Wang YR, Jia QY, Liu L, Xu CQ, Wang XY, et al. The efficacy of the traditional Chinese medicine Juanbi pill combined with methotrexate in active rheumatoid arthritis: study protocol for a randomized controlled trial. Trials. 2018;19:188.
Chen R, Wang J, Zhan R, Zhang L, Wang X. Integrated systems pharmacology, urinary metabonomics, and quantitative real-time PCR analysis to uncover targets and metabolic pathways of the you-gui pill in treating kidney-yang deficiency syndrome. Int J Mol Sci. 2019;20:3655.
Wan Y, Xu L, Liu Z, Yang M, Jiang X, Zhang Q, et al. Utilising network pharmacology to explore the underlying mechanism of Wumei pill in treating pancreatic neoplasms. BMC Complement Altern Med. 2019;19:158.
Li W, Zhang K, Liu Z, Liu L, Cheng Y, Yin J, et al. Effect of Zuogui pill and Yougui pill on osteoporosis: a randomized controlled trial. J Tradit Chinese Med. 2018;38:33–42.
Zhen G, Jing J, Dan X, Zheng L, Fengsen L, Qi S. A randomized controlled study of the Yi Qi Gu Biao pill in the treatment of frequent Exacerbator phenotype in chronic obstructive pulmonary disease (lung and spleen Qi deficiency syndrome). Evidence-based Complement Altern Med. 2017;2017:1–10.
Mestel R. The colorful history of pills can fill many a tablet [Internet]. Los Angeles Times. 2002 [cited 2019 Apr 7]. Available from: https://www.latimes.com/archives/la-xpm-2002-mar-25-he-booster25-story.html
Guo G, Chen T. On the strategic advantage of pills of traditional Chinese medicine\. China J Chinese Med. 2012;27:990–2.
Avis KE. Pharmaceutical dosage forms. Pharm Dos Forms. Rockville; 2018. p. 7425.
Zhang Z, Gao T, Fu C, Zhang J, Shi J, He Y, et al. Analysis on dosage form theory and current application situation of traditional Chinese medicine pill. Zhongguo Zhong Yao Za Zhi. 2017;42:2408–12.
Huang X. Study on the origin and application of Chinese pill. Clin J Tradit Chinese Med. 2018;30:1823–6.
Chinese Pharmacopeia commission. Pharmacopoeia of the People’s Republic of China. 2015th ed. Beijing; 2015.
Health Canada. Licensed Natural Health Products Database [Internet]. [cited 2020 Dec 20]. Available from: https://health-products.canada.ca/lnhpd-bdpsnh/search-recherche.do;jsessionid=95D41042326A0ACE3259ACD3DBD7D326
Yang Z, Wong CS, Yang C, Jiang ZH, Zhao Z, Liu L. Control release effects of binders used in pills of traditional Chinese medicine herbs. Chem Pharm Bull. 2006;54:188–95.
Jiang S, Ge W, Wu J, Shi T, Xu G, Ruan L. Study on the materiomic release kinetic profiles of Guanxin Suhe pill. Chinese Tradit Pat Med. 2011;33:809–13.
Lu B, Qiao C, Guo L. Comparison of release rate of berberine in Zuojin pill and Zuojin capsule. Lishizhen Med Mater Medica Res. 2010;21:3352–3.
Weng X, Shi S, Wu S, Guo F, Xiong Y. Comparative of dissolution and drug releasing characteristics of Liuwei Dihuang pills produced by different manufactures. Chinese J Exp Tradit Med Fromulae. 2015;21:44–8.
Chinese Pharmacopeia commission. <0108> Pills. Pharmacopoeia People’s Repub China. 2015th ed. Beijing; 2015. p. 13–14.
Liu Y. pills. In: Yang M, editor. Pharm Tradit Chinese med. 10th ed. Beijing: China Press of Traditional Chinese Medicine; 2016. p. 262–85.
Xu JM. Studies on the production technic of water honey pills. Zhong Yao Tong Bao. 1985;10:26–8.
Wang W, Chen J. Characteristics and application of dripping pills. J Pharm Pract. 2003;21:201–3.
Cheng B, Li XY, Liu KQ, Wang L, Wu WP, Xu H. Recommendations on the clinical use of compound danshen dripping pills. Chin Med J. 2017.
Fu Y, Yang L. Discussion on the reason of pill and powder becoming the main formulations in the Qin and Han dynasties. China J Tradit Chinese Med Pharm. 2014;29:829–31.
Peng W. Women’s body shape and disease in Han dynasty. Zhejiang Acad J. 2009;6:30–41.
Li X, Liu R. On “ pill, is sluggish”. Chinese Pharm. 2008;18:1917–9.
Zhu A. Summary of the development of pharmaceutics of traditional Chinese medicine. J Anhui TCM Coll. 2000;19:48–50.
Wang J, Di L, Shan J. Analysis of the drug release characteristics and mechanism of traditional Chinese medicine pills. Chinese Tradit Pat Med. 2012;34:723–6.
Uebbing L, Klumpp L, Webster GK, Löbenberg R. Justification of disintegration testing beyond current FDA criteria using in vitro and in silico models. Drug Des Devel Ther. 2017;11:1163–74.
Jiang M, Teng J, Peng Z. Comparative experimental study on the dissolution of Liqi Nantong capsules and pills. J Hunan Coll TCM. 2000;20:10–1.
Sha Q, Yuan Z, Gong Y. Comparison of the release rate of semen Strychni tablets and pills. Chinese Tradit Pat Med. 1986:6–8.
Jiang M, Lin X, Yang S, Zhao S, Wei X, Huang Y, et al. Evaluation of dosage form characteristics of Fuzi Lizhongwan based on dissolution behavior. Chinese J Exp Tradit Med Fromulae. 2019;25:15–22.
Liu J, Liang SX, Lu YF, Miao JW, Wu Q, Shi JS. Realgar and realgar-containing Liu-Shen-Wan are less acutely toxic than arsenite and arsenate. J Ethnopharmacol. 2011;134:26–31.
Liu J, Wei LX, Wang Q, Lu YF, Zhang F, Shi JZ, et al. A review of cinnabar (HgS) and/or realgar (As4S4)-containing traditional medicines. J Ethnopharmacol. 2018;210:340–50.
Huang K, Huo Q. Overview of Liushen pill modern clinical application. Chinese Tradit Pat Med. 2011;33:2132–7.
Du L, Wang D. Introduction analysis of toxic herbs and decoction pieces in Chinese pharmacopeia (2015 edition, part 1). China Pharm. 2017;28:4023–6.
Chen KK, Kovaříková A. Pharmacology and toxicology of toad venom. J Pharm Sci. 1967;56:1535–41.
Dasgupta A. Review of abnormal laboratory test results and toxic effects due to use of herbal medicines. Am J Clin Pathol. 2003;120:127–37.
HONG Z, CHAN K, YEUNG HW. Simultaneous determination of Bufadienolides in the traditional Chinese medicine preparation, Liu-Shen-Wan, by liquid chromatography. J Pharm Pharmacol. 1992;44:1023–6.
Wu J, Shao Y, Liu J, Chen G, Ho PC. The medicinal use of realgar (As4S4) and its recent development as an anticancer agent. J Ethnopharmacol. 2011;135:595–602.
Li Y, Shi S, Wu S, Guo F, Xiong Y. Study on materiomic release kinetics of toxic Xiaohuoluo pills. China J Tradit Chinese Med Pharm. 2014;29:3614–8.
Guo Z, Ling D, Zhang J, Ge W, Shi S. Materiomic release kinetics of Longdan Xiegan pill. Chinese Tradit Herb Drugs. 2010;41:1806–8.
Wang L. Thinking over clinical application of large-prescription pill of TCM. Shan Dong Zhong Yi Yao Za Zhi. 2004;23:131–3.
Wang GH, Lan R, De Zhen X, Zhang W, Xiang J, Cai DF. An-Gong-Niu-Huang Wan protects against cerebral ischemia induced apoptosis in rats: up-regulation of Bcl-2 and down-regulation of Bax and caspase-3. J Ethnopharmacol. 2014;154:156–62.
Chinese Pharmacopeia Commission. Angong Niuhuang Pills. Pharmacopoeia People’s Repub China. Beijing; 2015. p. 538.
Lu YF, Yan JW, Wu Q, Shi JZ, Liu J, Shi JS. Realgar- and cinnabar-containing an-Gong-Niu-Huang Wan (AGNH) is much less acutely toxic than sodium arsenite and mercuric chloride. Chem Biol Interact. 2011;189:134–40.
Pan H, Wang P, Wang N. Clinical application of Angong Niuhuang pill and its similar formula. J New Chinese Med. 2001;33:64–6.
Luo J, Xu H, Chen K. Systematic review of compound danshen dropping pill: a chinese patent medicine for acute myocardial infarction. Evidence-based Complement Altern Med. 2013;2013:1–15.
Ren L, Wang J, Feng L, Wang S, Li J. Efficacy of Suxiao Jiuxin pill on coronary heart disease: a meta-analysis of randomized controlled trials. Evidence-based Complement Altern Med. 2018;2018:1–12.
Smith B, editor. Solubility and dissolution. Remingt Educ Phys pharmacy. 1st ed. London; 2015. p. 31–50.
Li L. Classification of traditional Chinese medicine materials based on the unification of drug materials. Henan University of Traditional Chinese Medicine; 2016.
Ma Y, Wang J, Liu R, Chen T. Study on the effects of different proportions of pills on dissolution in vitro. World Sci Technol Tradit Chinese Med Mater Medica. 2019;21:1209–15.
Yang C, editor. Pharmaceutical botany. Shanghai: Shanghai Scientific & Technical Publishers; 1997.
Chen T, Kang B. Characteristic exploration of slow release preparations in traditional Chinese medicine pills. China Pharm. 2009;18:17–9.
Chinese Pharmacopeia Commission. Longdan Xiegan Pills. Pharmacopoeia People’s Repub China. Beijing; 2015. p. 1207–1208.
Ye Y, Chen Y, Weng X, Wu S, Shi S. Characteristics of materiome release kinetics and visual evaluation of different types of Liuwei Dihuang pills. Chinese Tradit Herb Drugs. 2017;48:4425–31.
Zhang J, Li Z, Shi S, Ge W, Wu S. Comparison of dissolution behaviors of different types of Guizhi Fuling pills. J Zhejiang Tradit Chinese Med. 2019;54:693–4.
Huo W, Li D, Zhu S. Effect of pill excipients stated in pharmaceutical technology of compendium of materia medica. China Pharm. 2010;21:3742–4.
Vist GE, Maughan RJ. Gastric emptying of ingested solutions in man: effect of beverage glucose concentration. Med Sci Sports Exerc. 1994;26:1269–73.
Zuo J, Gao Y, Almukainzi M, Löbenberg R. Investigation of the disintegration behavior of dietary supplements in different beverages. Dissolution Technol. 2013;20:6–9.
Ling D, Zhang J, Chen L, Lin M, Ge W, Gu J. Application of the theories of materiomic release kinetics to the evaluation of the sustained release kinetics and synchronicity of Yinqiaojiedu honeyed pills. Acta Pharm Sin. 2008;43:1140–11146.
Cao C. Discussion on the relationship between the dosage form of Chinese medicine and biopharmaceutics. Chinese Tradit Pat Med. 1981;3:41.
Lordi N. Sustained release dosage forms. In: Lachman L, Liverman H, Kanig J, editors. Theory Pract Ind pharm. 3rd ed. Bombay: Varghese Publishing House; 1990. p. 430–56.
Tang Y, Yuan G, Liu Y. Experimental study on drug release from traditional Chinese medicine waxed pills. Chinese Tradit Pat Med. 1987;8:1–3.
Liu Y. Theory of Chinese medicine pills in ancient literature of Chinese medicine. Lishizhen Med Mater Medica Res. 2011;22:260–1.
Yan L, Zhu J. Historical evolution of beeswax pill. Tianjin J Tradit Chinese Med. 2014;3:244–6.
Fan S, Chen J, Liu W, Zhao R. Comparison of disintegration and release between pan-system law and plastic law in manufacture of pills. Bull Chinese Mater Medica. 1987;12:30–2.
Chen X. Discussion on the factors affecting on disintegration of traditional Chinese medicine watered pills. Chinese Tradit Pat Med. 2002;24:227.
Pei Y, Ma Y. Study on influence factors of in vitro dissolution of pills of traditional Chinese medicine. China Heal Ind. 2016:193–5.
Lin X, Zhang L, Chen J, Chen L, Zheng B. Deproteinization of purple sweet potato polysaccharide. Chinese J Trop Crop. 2014;35:381–6.
Chinese Pharmacopeia commission. The Pharmacopoeia of the People’s Republic of China. 1990th ed. Beijing; 1990.
Disch L, Drewe J, Fricker G. Dissolution testing of herbal medicines: challenges and regulatory standards in Europe, the United States, Canada, and Asia. Dissolution Technol. 2017;24:6–12.
Government_of_Canada. Quality of Natural Health Products Guide. Government of Canada, Health Canada, Health Products and Food Branch, Natural Health Products Directorate [Internet]. 2013 [cited 2019 May 15]. p. 1–44. Available from: http://www.hc-sc.gc.ca/dhp-mps/prodnatur/legislation/docs/eq-paq-eng.php
The Ministry of Health Labour and Welfare. Monographs for preparations related to crude drugs. Japanese Pharmacopoeia. 17th ed. Tokyo: Society of Japanese Pharmacopoeia; 2016. p. 21–22.
Silva DA, Webster GK, Bou-Chacra N, Löbenberg R. The significance of disintegration testing in pharmaceutical development. Dissolution Technol. 2018;25:30–8.
Chinese Pharmacopeia Commission. <0921> Determination of Disintegration. Pharmacopoeia People’s Repub China. 2015th ed. Beijing; 2015. p. 138–140.
United States Pharmacopeial Convention. <701> Disintegration. United States Pharmacop Natl Formul USP 41-NF36. Rockville; 2018. p. 6455.
Davydova N. Disintegration and dissolution of dietary supplements. Pharmacopeial Forum. Rockville; 2010. p. 567.
The Ministry of Health Labour and Welfare. 6.09 Disintegration test. Japanese Pharmacopoeia. 17th ed. Tokyo: Society of Japanese Pharmacopoeia; 2016. p. 155–157.
Lou L, Wu S, Ge W, Shi S. Correlation between in vitro release and dissolution of Jinkui Shenqi pills. Chinese Tradit Pat Med. 2013;35:948–51.
European Medicines Agency. Reflection paper on markers used for quantitative and qualitative analysis of herbal medicinal products and traditional herbal medicinal products [Internet]. 2008 [cited 2019 May 17]. Available from: https://www.ema.europa.eu/en/documents/scientific-guideline/draft-reflection-paper-markers-used-quantitative-qualitative-analysis-herbal-medicinal-products_en.pdf
Waldmann S, Almukainzi M, Bou-Chacra NA, Amidon GL, Lee BJ, Feng J, et al. Provisional biopharmaceutical classification of some common herbs used in western medicine. Mol Pharm. 2012;9:815–22.
Lou Y, Shi T, Chen L, Ge W. Study on the materiomic release kinetic profiles of Wuzi Yanzong pills. Chinese Arch Tradit Chinese Med. 2011;29:1489–91.
Wu J, Li Z, Shi S, Ge W, Wu S. Characteristics of materiome release kinetics and visual evaluation of Guizhi Fuling pill. Zhejiang J Tradit Chinese Med. 2014;49:299–302.
Cranford SW, Buehler MJ. The materiome. Springer Ser Mater Sci. Springer, Dordrecht; 2012. p. 27–60.
Chen LB, Zhang JW, Gu JK, Ge WH. Principles of chemomic release/dissolution kinetics for Chinese materia medica in conventional dosage forms or drug delivery systems. Chinese Tradit Herb Drugs. 2008;39:641–4.
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The authors acknowledge the financial support by Mitacs, Canada (Mitacs Accelerate: IT13686), JRC Pharmaceuticals Inc. and the Drug Development and Innovation Center at the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta.
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Zuo, J., Park, C., Kung, J.Y.C. et al. Traditional Chinese Medicine “Pill”, an Ancient Dosage Form with Surprising Modern Pharmaceutical Characteristics. Pharm Res 38, 199–211 (2021). https://doi.org/10.1007/s11095-021-03007-x
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DOI: https://doi.org/10.1007/s11095-021-03007-x