Editorial: Clinical evidence for and advances in translational research on the classic formulas of traditional Chinese medicine

Traditional Chinese medicine (TCM), one of the ancient healing practices with a history of more than 2,500 years and unique theories, has been making a great contribution to human healthcare. It includes Chinese herbal medicine, food therapy, acupuncture, moxibustion, massage (tuina), physical exercises, etc (Tang, et al., 2008), which is gaining increasingly popularity in other Asian and Western countries. Classic formula of TCM, with clear verifiable scientific literature on the traditional usage, is generally recognized as being from ancient medical books such as Treatise on Febrile Diseases (伤寒论, Shang Han Lun), Synopsis of the Golden Chamber (金匮要略, Jin Gui Yao Lue), etc. As TCM is also popular in Japan and Korea, classic formula of TCM is also widely used in traditional Japanese Kampo medicine and traditional Korean medicine. It possesses the characteristics of fixed components (generally greater than or equal to 2 herbs), clear curative effect with fewer adverse effects in clinical treatment. Classic formula of TCM has made a substantial contribution to the well-being including viral infection diseases, cardiovascular and cerebrovascular diseases, digestive disease, endocrine disease, tumors, etc.Currently, rigorous 'totality of the evidence' including chemical standardization, biological assays, experimental studies, and clinical trials of classic formula in TCM is gradually receiving attention from modern medicine. Several paradigms in clinical and translation researches of classic formula of TCM, including Tianma Gouteng decoction for hypertension (Zhang, et al., 2020), Qili qiangxin capsule (Shenfu decoction) for chronic heart failure (Li, et al., 2013), Tian qi jiang tang capsule (Yuye decoction) for impaired glucose tolerance (Lian, et al., 2014), Gegenqinlian decoction for T2DM (Xu, et al., 2015), Hemp Seed pill for functional constipation (Zhong, et al., 2018), Tong xie yao fang-based Chinese herbal medicine for irritable bowel syndrome (Bensoussan, et al., 1998), Maxingshigan decoction-Yinqiaosan for H1N1 influnza virus (Wang, et al., 2011), Maxingshigan decoction for COVID-19 (Hu, et al., 2021), PHY906 (Huangqin decoction) for chemotherapy-induced gastrointestinal toxicity (Lam, et al., 2010), and Shenfu injection for patients with return of spontaneous circulation after in-hospital cardiac arrest (Zhang, et al., 2017), etc., highlight the tremendous progress and advances in this field (as shown in Table 1). Furthermore, a great amount of clinical evidence provided some biological functions and potential mechanisms of classic formula of TCM. It suggests that classic formula of TCM could be considered an effective complementary and alternative approach in the future.Due to the challenge of 'improving investments, declining drug approval' in modern drug research and development, scientists have turned their attention to natural herbs and classic formula of TCM for promising drugs and candidates. Some derivatives from natural products have been widely used as cornerstones in Western medicine, including aspirin, digitalis, paclitaxel, etc. Recently, the natural herbs and classic formula of TCM-oriented new drug development model has achieved significant breakthroughs, including artemisinin and dihydroartemisinin for malaria (Tu, 2011), arsenic trioxide for acute promyelocytic leukemia (Soignet, et al., 1998), tripterygium glycosides for active rheumatoid arthritis (Lv, et al., 2015), red yeast rice for hyperlipidemia (Zhao, et al., 2004), berberine for hyperlipidemia and diabetes (Kong, et al., 2004;Zhang, et al., 2008), etc., which can avoid blind screening and reduce the cost and time required for drug development.Nevertheless, given the difficulty of retrieving original literature in Chinese, the poor methodological quality of original clinical trials including a high risk of bias, unclear reporting of outcome measures, lack of pre-registration in an international database, lack of high-level clinical recommendation evidence, and insufficient data reports on toxicology, pharmacological effects, and adverse effects, quite a few classic formulas of TCM have been regarded as a "mystery" to modern science. Accordingly, more clinical and experimental data are still warranted to verify their application value.Altogether, in this Research Topic, 43 papers were collected, out of which 8 papers were accepted for publication. The original research articles and reviews in this special issue covered a wide range of medical fields, including essential hypertension, contrast-induced nephropathy after percutaneous coronary interventional, hepatocellular carcinoma, lung cancer, doxorubicin-induced cardiotoxicity, DNCB-induced atopic dermatitis-like skin lesions, heat stroke, etc. The other two articles focused on heat stroke and the quality markers research of classic formulas of TCM.More and more evidence shows that classic formulas of TCM have important clinical value in the treatment of chronic diseases, infectious diseases, etc. These findings in this research topic significantly promoted the comprehension of the therapeutic efficacy and the potential protective mechanisms of classic formulas of TCM. In conclusion, this special issue explored the new clinical evidence and novel approaches in the application of classic formulas in treating various diseases, paving the evidence-based way.

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