Ophiopogon (Ophiopogon japonicus): A Comprehensive Reference
1. Identity and Botanical Description
1.1 Taxonomy and Nomenclature
Ophiopogon japonicus (Thunb.) Ker-Gawl. is a herbaceous plant belonging to the genus Ophiopogon in the family Asparagaceae, which holds both medicinal and ornamental value. Common English names include dwarf lilyturf, mondograss, fountainplant, and monkeygrass; in Japanese it is known as ryū-no-hige ("dragon's beard") or ja-no-hige ("snake's beard"). In France it is called Muguet du Japon. The medicinal part is formally designated by multiple Latin pharmaceutical names, including Ophiopogonis Radix, Radix Ophiopogonis, and Tuber Ophiopogonis japonici. In traditional Chinese medicine, both the O. japonicus plants and tubers are known as mai men dong (Chinese: 麥門冬). In shortened everyday TCM usage the herb is frequently called simply maidong (麦冬).
1.2 Plant Morphology
The fountainplant is an evergreen, sod-forming perennial plant. The leaves are linear, 20–40 cm long. The flowers are white through pale lilac, borne in a short raceme on a 5- to 1-cm stem. The fruit is a blue berry, 5 mm in diameter. Underground, this species has large stolons with tuberous roots. Ophiopogon japonicus is also a popular ornamental plant in East Asia.
1.3 Geographic Distribution and Cultivation
O. japonicus is a perennial evergreen herb in the lily family and is mainly distributed in East, South, and South-east Asia, including China, Japan, Korea, and India. The species originates from Japan and Korea and is also grown in Vietnam and China, particularly in the provinces of Sichuan, Zhejiang, and Hubei. O. japonicus is mainly produced in Sichuan and Zhejiang provinces in China, where this plant is called Chuanmaidong or Zhemaidong respectively.
1.4 The Medicinal Part: Ophiopogonis Radix
Ophiopogonis Radix (Maidong in Chinese), the root of Ophiopogon japonicus (Thunb.) Ker-Gawl (Liliaceae), is a widely used traditional Chinese herb according to the Pharmacopoeia Commission of the People's Republic of China (2015). O. japonicus (Liliaceae) is indicated as the indigenous herbal origin of Maidong in the Chinese Pharmacopoeia (Pharmacopoeia Commission of PRC, 2015). As a traditional Chinese herbal drug, this plant is challenged by some adulterants, including 23 species and 3 varieties from the genera Ophiopogon and Liriope. Liriope muscari (Decne.) Bailey is clinically used as a substitute for O. japonicus in traditional Chinese herbal practice and is mainly distributed in Hubei and Fujian provinces in China.
1.5 Common Forms and Preparations
The Chinese pharmacopeia "Shennong Ben Cao Jing" lists O. japonicus as a superior medicinal herb. The drug is available in numerous forms. In traditional and contemporary Chinese medicine, the dried tuberous roots are used in water decoctions, concentrated granule extracts, and powders. O. japonicus is characterized by low fat content, high polysaccharide levels, high potassium, and high vitamin B2, making it a novel health food; it can be used to make teas that support hypoglycemic and antioxidant effects because of its high availability and safety. Ophiopogonis Radix is listed as an edible Chinese medicine by the Chinese Ministry of Public Health because of its efficiency, high availability, and safety. Outside East Asia, Ophiopogon root is increasingly sold as a stand-alone supplement or included in complex "lung support," "heart health," or "yin tonic" blends; labels may simply say Ophiopogon, Ophiopogon japonicus, Mai Men Dong, or dwarf lilyturf root. Modern pharmaceutical preparations derived from it include injectable solutions such as Shengmai injection and YiQiFuMai (YQFM) powder injection, both registered pharmaceutical products in China.
2. Traditional and Historical Use
2.1 Classical Chinese Medicine (China)
It is known that O. japonicus was first recorded in the Shen Nong's Herbal Classic and has been regarded as yin-tonifying medicine in the field of TCM. First documented in Shennong's Herbal Classic as a top-grade herb, it was noted for treating Qi stagnation, abdominal discomfort, and shortness of breath. The Compendium of Materia Medica further praised its ability to moisten the lungs, clear mental restlessness, and strengthen Yin.
According to the traditional Chinese medicine (TCM) principle, Ophiopogonis Radix nourishes the yin, promotes body fluid production, moistens the lung, eases the mind, and clears away heart fire. According to the 2015 edition of the Chinese Pharmacopoeia and Shen Nong's Herbal Classic, O. japonicus acts on the heart, lung, and stomach meridians, is slightly cool, and tastes sweet and lightly bitter; it has the function of nourishing yin and promoting fluid, moistening the lung and clearing the heart, and is mainly used for the treatment of lung dryness and cough, hematemesis, lung carbuncle, thirst quenching, dry throat and dry mouth, and constipation.
Classical TCM indications were systematized across key categories:
- Nourishing Lung Yin and stopping cough: chronic, hacking, dry cough from Lung Yin deficiency; cough with hard-to-clear mucus; and hemoptysis.
- Clearing stomach heat and nourishing stomach yin: dry mouth and tongue from stomach yin deficiency; treating indigestion due to overeating.
- Moistening the intestines: constipation from internal dryness with dry mouth and irritability.
2.2 Traditional Formulas Containing Ophiopogon
Ophiopogon rarely appears as a sole ingredient in classical prescriptions; it is characteristically combined with complementary herbs. Sheng-Mai-San (SMS) is a well-known TCM complex prescription composed of Panax ginseng C.A. Mey, Ophiopogon japonicus (Thunb.) Ker-Gawl., and Schisandra chinensis (Turcz.) Baill in a ratio of 1:3:1.5; SMS is used for the treatment of palpitations, lassitude, and shortness of breath, which are symptoms of effort angina in clinical practice. Sheng Mai San is a classical formula developed by the Jin Dynasty physician Zhang Yuansu.
Well-known combinations include Mai Men Dong Tang (Ophiopogon Decoction) for dry cough and lung–stomach yin deficiency; Sha Shen Mai Men Dong Tang for chronic dry throat and cough; and Sheng Mai San, where Ophiopogon root is paired with ginseng and Schisandra to support qi, yin, and heart function.
2.3 Use in Japan and Southeast Asia
Ophiopogonis Radix is widely used in local medicines of China, Japan, and some south-eastern Asian countries. The genera Ophiopogon and Liriope comprise a total of some 84 species and are indigenous to Asia, with many species having been traditionally used as medicines in China, with the common label 'maidong' or 'mai men dong' (for the tuberous roots), including Ophiopogon japonicus, together with Liriope spicata.
2.4 Food and Dietary Use
Modern research has verified that O. japonicus can be used either as a healthy food or a therapeutic agent for disease prevention and treatment. Its gentle, cooling nature makes it suitable for everyday use in teas and soups, and it has a long history as both a food and a medicine in China. Red ginseng and Ophiopogon japonicus are both traditional Chinese medicines; they have also been used as food in China for thousands of years.
3. Key Constituents and Active Compounds
3.1 Overview of Chemical Classes
Phytochemical studies have revealed various biologically active compounds, including steroidal saponins, homoisoflavonoids, and polysaccharides, which possess therapeutic effects against acute and chronic inflammation, diabetes, cardiovascular diseases, and other disorders. Modern pharmacological studies have confirmed that O. japonicus contains various chemical components, such as steroid saponins, flavonoids, polysaccharides, organic acids, and phenols, which were shown to exhibit various pharmacological activities, including anti-inflammatory, anti-diabetes, anti-oxidation, anti-tumor, neuroprotective, antiviral, and liver-protective effects. Other metabolites isolated from the tuberous roots, fibrous roots, and aerial parts of liriopogons include 19 organic acids, 26 phenols, 13 glycosides, and 20 other types of metabolites. Among the organic acids, vanillic acid has been found in O. japonicus, L. spicata, and L. muscari; oleanolic acid and palmitic acid have both been isolated from O. japonicus and L. muscari.
3.2 Steroidal Saponins (Ophiopogonins)
Literature investigation has shown that Ophiopogon japonicus contains many active compounds, such as Dwarf Lilyturf Tuber-13 (DT-13), Ophiopogon-B (OP-B), Ophiopogon-D (OP-D), Liriopesides-B (LP-B), Ruscogenin (RUS), and Ophiopogon-D′ (OP-D′). Ophiopogonin D (OP-D) is a rare C27 steroid glycoside isolated from the tuber of Ophiopogon japonicus. Ophiopogonin D is a steroid glycoside derived from Ophiopogon japonicus, which is widely used in cardiovascular diseases and inflammation.
A total of 30 compounds including steroidal saponins, homoisoflavonoids, allylbenzene, cholest, and cryptomeridiol have been screened or tentatively identified. Among them, three new steroidal saponins were found and tentatively characterized in O. japonicus.
3.3 Polysaccharides
Ophiopogon japonicus polysaccharides (OJPs), as one of the main active ingredients, are a kind of representative pharmacological bioactive macromolecule and are mainly composed of glucose (Glc) and fructose (Fru) with molecular weights between 2.48 and 325 kDa. A particularly well-studied fraction is MDG-1: MDG-1 is a water-soluble β-d-fructan with an average molecular weight of 3400 Da, including a backbone composed of Fruf (2→1) and a branch of Fruf (2→6), with Fruf (2→) per average 2.8 of main chain residues; MDG-1 also contains trace amounts of α-d-Glc. Another fraction, OJP1, has been characterized: OJP1 is a heteropolysaccharide with an average molecular weight of 35.2 kDa and consisting of arabinose, glucose, and galactose in a relative molar ratio of 1:16:8.
The systemic bioavailability of orally administered polysaccharides is restricted due to their high molecular weight and structural complexity, with most exerting bioactivity via gut microbial fermentation rather than direct intestinal absorption.
3.4 Homoisoflavonoids
Zhejiang Ophiopogon japonicus (ZOJ) is a specific variety with characteristic steroidal saponins and homoisoflavonoids, which are also the main pharmacodynamic constituents with clinical effects, including curing inflammation and cardiovascular diseases. Homoisoflavonoids constitute a structurally distinctive subclass of flavonoids found in high concentrations in O. japonicus and contribute significantly to its antioxidant and anti-inflammatory properties.
4. Mechanisms of Action
4.1 Cardiovascular Mechanisms
Ophiopogon japonicus polysaccharide promoted angiogenesis in myocardial ischemic tissue by activating SPHK/S1P/bFGF/AKT/ERK and eNOS/NO signaling pathways, which decreased the myocardial infarct size in rats with acute myocardial ischemia. In addition to clinical evidence, various experiments have confirmed that this drug has anti-arrhythmia effects, inhibition of platelet aggregation, reversal of myocardial ischemia, improvement of microcirculation, and other effects. Key active constituents of O. japonicus, including saponins and homoisoflavonoids, mitigate endothelial injury, suppress vascular smooth muscle cell (VSMC) proliferation, and prevent neutrophil adhesion.
4.2 Hypoglycemic Mechanisms
MDG-1 has been found to exhibit remarkable anti-diabetic activity through the InsR/IRS-1/PI3K/Akt/GSK-3/Glut-4 signaling pathway. MDG-1 increased monosaccharide and succinate content, improved intestinal environment, inhibited intestinal glucose absorption and hepatic glucose catabolism, and induced the secretion of GLP-1 from L cells. O. japonicus oligosaccharides (OJO) significantly elevated hepatic glucokinase activity, reduced phosphoenolpyruvate carboxykinase activity, increased glucagon-like peptide-1 levels, inhibited glucagon secretion, and enhanced insulin activity.
4.3 Anti-inflammatory Mechanisms
O. japonicus extract effectively inhibited leukocyte migration in response to inflammatory stimuli without altering prostaglandin levels; two bioactive compounds, ruscogenin and ophiopogonin D, were identified as key contributors.
4.4 Gut Microbiota Modulation
Emerging evidence indicates that OJPs modulate the composition and structural organization of the gut microbiota, thereby maintaining intestinal barrier integrity and enhancing both gastrointestinal and systemic homeostasis; moreover, OJPs and their metabolic derivatives engage in dynamic interactions with microbial communities, mediating cellular signaling cascades and endocrine regulation to elicit hypoglycemic effects.
5. Scientific Evidence by Area of Use
5.1 Cardiovascular Health
Animal/in vitro evidence: OJP1, extracted from the root of O. japonicus, was investigated for its cardioprotective effect on isoproterenol (ISO)-induced myocardial ischemia injury in rats; pretreatment with OJP1 (100, 200, and 300 mg/kg) significantly reduced ISO-induced ST-segment elevation and the heart index, attenuated the levels of marker enzymes (AST, LDH, CK, and CK-MB), and significantly enhanced the activities of ATPases; pretreatment with OJP1 also enhanced the activities of SOD, GPx, and CAT in serum and myocardium while decreasing MDA levels. Although the cardioprotective mechanisms of OJPs have been extensively elucidated through in vitro studies, their therapeutic potential remains insufficiently characterized in vivo due to the predominant use of standardized animal models; this limitation highlights the necessity for establishing more sophisticated and clinically relevant cardiovascular disease models.
Clinical evidence — Shengmai/Sheng Mai San: A Cochrane-registered systematic review (published in Cochrane Database of Systematic Reviews and updated through 2014) evaluated Shengmai — the formula containing Ophiopogon japonicus, ginseng, and schisandra — for chronic heart failure: A total of 14 RCTs (858 patients) were included; 11 trials compared Shengmai plus usual treatment with usual treatment alone, and three trials compared Shengmai with placebo. Improvement of NYHA functional classification was more common in patients taking Shengmai plus usual treatment than in those receiving usual treatment alone (RR 0.37; 95% CI 0.26 to 0.51; 10 trials, 672 participants; low quality evidence). Beneficial effects were also observed in exercise test, ejection fraction, and cardiac output outcomes. The three RCTs (106 patients) comparing Shengmai with placebo reported improvement in NYHA functional classification and in stroke volume.
A separate 2020 systematic review of Shengmai injection (SMI) for chronic heart failure reported: SMI is made from purified ginseng, Radix Ophiopogonis, and Schisandra chinensis; it has cardiotonic effects and is clinically used for the adjuvant treatment of chronic heart failure (CHF). However, its efficacy and safety are uncertain. Many TCM injections, including SMI, lack rigorous efficacy and safety evaluations due to early drug marketing policies; most RCTs have small sample sizes and inconsistent results. Currently available evidence indicates that SMI, as an adjuvant to basic Western medicine treatment, can improve the cardiac function of patients with CHF with good safety outcomes. The overall quality of this body of evidence is considered low to moderate by standard appraisal criteria.
Evidence strength: For Shengmai formulas in heart failure, positive signals exist from multiple RCTs, but these are rated low quality by the Cochrane assessment due to high risk of bias, small sample sizes, and lack of blinding. No robust double-blind, placebo-controlled trials isolating Ophiopogon japonicus alone in cardiovascular outcomes have been identified.
5.2 Diabetes and Metabolic Health
Animal evidence: MDG-1, a polysaccharide from O. japonicus, activates the PI3K/Akt signaling pathway and improves insulin sensitivity in a diabetic KKAy mouse model; in one study, KKAy mice were orally administered MDG-1 or rosiglitazone for 12 weeks. Results showed that MDG-1 (300 mg/kg) significantly decreased the levels of blood glucose, triglycerides, blood urea nitrogen, and albumin, and significantly inhibited the expression of transforming growth factor-beta 1 and connective tissue growth factor. MDG-1 could alleviate glomerular mesangial expansion and tubulointerstitial fibrosis in the diabetic mice; these data indicated that MDG-1 ameliorates renal disease in diabetic mice by reducing hyperglycemia, hyperinsulinemia, and hyperlipidemia, and by inhibiting intracellular signaling pathways.
Diabetic nephropathy — Ophiopogonin D: In a streptozotocin-induced diabetic nephropathy rat study, OP-D reversed decreased serum albumin and creatinine clearance, as well as increases in serum creatinine, blood urea nitrogen, TGF-β1, and kidney hypertrophy; STZ-induced oxidative damage and inflammatory response in diabetic kidney tissue were also reversed by OP-D treatment; these findings indicated that OP-D might possess the potential to be a therapeutic agent against diabetic nephropathy via inhibiting renal inflammation and oxidative stress.
Evidence strength: All current evidence for antidiabetic effects is from animal models and in vitro systems. No controlled human clinical trials specifically evaluating Ophiopogon japonicus extracts or isolated fractions (MDG-1, OJP1) for glycemic control in humans have been identified in the peer-reviewed literature as of this writing. The animal data is mechanistically compelling but cannot be extrapolated to clinical practice without human trial evidence.
5.3 Anticancer Properties
Extensive in vitro and in vivo studies have shown that O. japonicus and its active compounds exhibit potential anticancer effects in a variety of cancer cells in vitro and suppress tumor growth and metastasis without causing serious toxicity in vivo. There are rare clinical reports on the use of O. japonicus alone in cancer patients; as a complementary therapy, O. japonicus was one of the most frequently used herbs for patients with advanced nasopharyngeal carcinoma, and in traditional clinical applications, TCM prescriptions containing O. japonicus have been widely used for adjuvant treatment of cancers.
When exploring the anticancer activity of O. japonicus, additional attention should be paid to the pharmacokinetics and toxicity of O. japonicus and its active compounds, especially for human trials; in one pharmacokinetic study, after oral administration, DT-13 showed long-term absorption, extremely slow elimination, and a bioavailability of 5.51%.
Evidence strength: Anticancer evidence is preliminary and largely preclinical (cell lines, animal models). Controlled clinical trials of O. japonicus as an anticancer agent in humans are lacking.
5.4 Neuroprotection
Cardiovascular protective, anti-inflammatory, anti-diabetic, anti-oxidant, anti-cancer, neuroprotective, anti-viral, anti-acute myeloid leukemia, and hepatoprotective effects have been at the center of attention for liriopogon research, including O. japonicus. The neuroprotective effects of compounds from Ophiopogon japonicus seeds were evaluated in SH-SY5Y human neuroblastoma cells, demonstrating significant protection. Ophiopogon japonicus polysaccharides (OJPs) have been demonstrated to exhibit immunomodulatory, antioxidant, cardioprotective, cerebrovascular-protective, and hypoglycemic activities.
Evidence strength: Neuroprotective evidence is preliminary and based on cell-line studies and animal models only. No human clinical trials on neuroprotection have been identified.
5.5 Anti-inflammatory Activity
OJPs have a variety of biological activities, such as hypoglycemic, cardioprotective, immunomodulatory, improvement of obesity, and renal protective activity. Key active constituents of O. japonicus, including saponins and homoisoflavonoids, mitigate endothelial injury and support its traditional use in treating various inflammatory conditions.
Evidence strength: Anti-inflammatory mechanisms are well characterized in vitro and in animal models but have not been confirmed through independent human clinical trials targeting inflammation as a primary endpoint.
5.6 Immunomodulation
Emerging evidence suggests that OP-D possesses numerous pharmacological activities, including bone protection, cardiovascular protection, immune regulation, anti-cancer, anti-atherosclerosis, anti-inflammatory, and anti-NAFLD effects. Clinical pharmacy studies reveal that Shenmai injection is more effective when used to treat cardiovascular diseases such as coronary heart disease, viral myocarditis, and chronic pulmonary heart disease; it is often combined with chemotherapeutic drugs to increase their curative effects and improve the immune function of cancer patients. However, the immunomodulatory data in this context derives from the multi-herb Shenmai injection, not from O. japonicus in isolation.
6. Body Systems Associated with Ophiopogon
- Cardiovascular system: Studies on O. japonicus polysaccharide (OJP1) indicate its potential to protect against cardiovascular complications in diabetes and myocardial ischemia.
- Respiratory system: O. japonicus is widely used in traditional Chinese medicine for treating fever, cough, inflammation, epistaxis, constipation, respiratory disease, and gastrointestinal disorders.
- Endocrine/metabolic system: In TCM theory, O. japonicus has the functions of "moisturize dryness and promote the production of body fluid" and has been used to treat type 2 diabetes for centuries.
- Gastrointestinal system: Ophiopogon japonicus has been extensively utilized as both a dietary supplement and a therapeutic agent to enhance human health and manage chronic diseases, primarily through modulation of the gut microbiota and maintenance of intestinal homeostasis.
- Nervous system: Neuroprotective activity has been demonstrated in preclinical models, including cerebrovascular protection via polysaccharide fractions.
- Renal system: OJPs have a variety of biological activities, such as hypoglycemic, cardioprotective, immunomodulatory, improvement of obesity, and renal protective activity.
- Musculoskeletal system: Ophiopogonin D (OP-D) has been associated with bone protection in preclinical studies.
7. Dosage Forms and Reported Dosages
The following dosages reflect what has been reported in source texts and studies, not clinical recommendations:
- Traditional decoction: Typical decoction doses in East Asian practice are around 6–15 g of dried tuber per day, with granule concentrates often totaling 4–13.5 g per day.
- Animal study dosages (MDG-1 polysaccharide): MDG-1 was administered at 300 mg/kg in mouse studies, significantly decreasing blood glucose, triglycerides, blood urea nitrogen, and albumin levels.
- Animal study dosages (OJP1): Pretreatment with OJP1 at doses of 100, 200, and 300 mg/kg significantly reduced ISO-induced cardiac markers in rats.
- Pharmacokinetics of DT-13 (injectable): After intravenous injection of DT-13 at 1.0 mg/kg, the Tmax and t½ were found to be approximately 0.14 and 2.83 hours, respectively.
- Sheng-Mai-San extract in animal research: ESMS (728.0 mg/kg) significantly attenuated myocardial infarction-induced heart failure injury in animal models.
- Traditional food preparation: Dried slices in a coarse cut form are used at 6–12 g decocted in 500 ml water for 20 minutes, once or twice daily in some traditional systems.
No pharmacopoeial monograph from Western regulatory bodies (EMA, USP, or ESCOP) specifying a standardized dose for isolated O. japonicus preparations has been identified in the peer-reviewed or regulatory literature at this time. The Chinese Pharmacopoeia (2015) is the primary regulatory reference for this herb.
8. Safety Considerations and Known Interactions
8.1 General Safety Profile
From a toxicological perspective, Ophiopogon japonicus seems to be safe. Ophiopogonis Radix is listed as an edible Chinese medicine by the Chinese Ministry of Public Health because of its efficiency, high availability, and safety. Some problems with the quality of the pharmacological evidence stand out, including the application of excessive dose levels and methodological problems in study design.
8.2 Hemolytic Potential of Steroidal Saponin Fractions
A notable and specifically documented safety concern involves the steroidal saponin isomers. In vitro studies showed that only OP-D′ induced a hemolysis reaction, whereas in vivo, both OP-D and OP-D′ were found to cause hemolysis; the hemolytic effects of OP-D and OP-D′ were thought to be closely associated with disruptions in phospholipid metabolism. Previously published studies often focused on the therapeutic effects related to OP-D's antioxidant capacity but underestimated the cytotoxicity-related side effects of OP-D′, which may result in unpredictable risks; OP-D′ has a hemolytic side effect, and unexpectedly, this side effect also appeared with OP-D; although hemolysis effects for saponins are familiar to researchers, the hemolytic behavior of OP-D or OP-D′ and the interactions between these two isomers are unique. This concern is most relevant to injectable (intravenous) preparations rather than oral use.
8.3 Cardiotoxicity Consideration at High Concentrations
Ophiopogonin D, a steroidal saponin derived from Ophiopogon japonicus, presented toxic effects on cardiomyocytes in in vitro studies at certain concentrations. There are still many questions about OP-D that need to be discussed; in particular, the toxicity testing of OP-D in animals is currently insufficient.
8.4 Possible Adverse Effects
As the main component of Ophiopogon japonicus, OP-D may have side effects such as gastrointestinal reactions and allergic reactions similar to those observed with Ophiopogon japonicus itself.
8.5 Multi-Herb Interaction Context
Because O. japonicus is most frequently used in multi-herb formulas (Sheng Mai San, Shenmai injection, YQFM), clinical adverse events reported for these combinations cannot be definitively attributed to O. japonicus alone. Many TCM injections, including Shengmai injection, lack rigorous efficacy and safety evaluations due to early drug marketing policies in China.
8.6 Quality and Adulteration Issues
As a traditional Chinese herbal drug, this plant is challenged by some adulterants, including 23 species and 3 varieties from the genera Ophiopogon and Liriope. The risk of substitution with related but pharmacologically distinct species is a recognized issue in quality control.
8.7 Bioavailability Limitations
Structural modifications such as liposome modification, sulfation modification, and polyethylene glycol modification have improved the pharmacological activity and bioavailability of OJPs. After oral administration, DT-13 showed long-term absorption, extremely slow elimination, and a bioavailability of only 5.51% in pharmacokinetic research, suggesting that the active constituents of O. japonicus may be poorly absorbed when taken orally, which complicates direct translation of animal dosage data to human use.
9. Evidence Quality and Research Gaps
Some problems with the quality of the pharmacological evidence stand out, including the application of excessive dose levels and methodological problems in design; additionally, a reasonable link between local/traditional uses and pharmacological assessment is often vague or not reflected in the research text. Research on individual TCM herbs is growing but still limited by Western clinical trial standards. The most substantiated clinical evidence for formulas containing O. japonicus relates to cardiovascular outcomes via the Shengmai/Sheng Mai San preparations, but even this is rated low quality due to methodological limitations. Antidiabetic, neuroprotective, and anticancer evidence remains firmly in the preclinical stage as of 2024–2025.
References
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