State-of-the-Art Review on Botanical Hybrid Preparations in Phytomedicine and Phytotherapy Research: Background and Perspectives

Abstract

Background: Despite some evidence supporting the synergy concept, the commonly known assumption that combinations of several herbs in one formulation can have better efficacy due to additive or synergistic effects has yet to be unambiguously and explicitly studied. Study aim: The study aimed to reveal the molecular interactions in situ of host cells in response to botanical hybrid preparations (BHP) intervention and justify the benefits of implementing BHP in clinical practice. Results: This prospective literature review provides the results of recent clinical and network pharmacology studies of BHP of Rhodiola rosea L. (Arctic root) with other plants, including Withania somnifera (L.) Dunal (ashwagandha), (Camellia sinensis (L.) Kuntze (green tea), Eleutherococcus senticosus (Rupr. and Maxim.) Maxim. (eleuthero), Schisandra chinensis (Turcz.) Baill. (schisandra), Leuzea carthamoides (Willd.) DC., caffeine, Cordyceps militaris L., Ginkgo biloba L.(ginkgo), Actaea racemosa L. (black cohosh), Crocus sativus L. (saffron), and L-carnosine. Conclusions: The most important finding from network pharmacology studies of BHP was the evidence supporting the synergistic interaction of BHP ingredients, revealing unexpected new pharmacological activities unique and specific to the new BHP. Some studies show the superior efficacy of BHP compared to mono-drugs. At the same time, some a priori-designed combinations can fail, presumably due to antagonistic interactions and crosstalk between molecular targets within the molecular networks involved in the cellular and overall response of organisms to the intervention. Network pharmacology studies help predict the results of studies aimed at discovering new indications and unpredicted adverse events.

Synergy of botanical drug extracts from Dracaena cochinchinensis stemwood and Ardisia elliptica fruit in multifunctional effects on neuroprotection and anti-inflammation

“…While the present study provides valuable evidence of active phytochemicals within the BHP of DCS and AEF in cellular responses, there is a need to unravel the underlying mechanisms of action for the synergistic interaction between multiple components of this BHP. The application of network pharmacology in BHP can provide comprehensive insights into complex interactions between multiple active phytochemicals and their targets of action, which can support and further elucidate the synergistic interaction of BHP compositions ( Panossian et al, 2024 ).…”

“…In the notion of combined therapies, the combination of two or more botanical drugs supposes that a botanical hybrid preparation (BHP), a fixed botanical drug combination with specific chemical composition, can achieve greater activity through synergistic effects arising from distinct mechanisms ( Panossian et al, 2024 ). The synergistic interaction between multiple botanical drugs offers several benefits over monotherapy, such as increased therapeutic efficacy, lower required dosage with equivalent efficacy, and reduced toxicity and/or adverse effects ( Che, et al, 2013 ; Panossian et al, 2024 ). Among BHP, combining of two botanical drugs are the most fundamental and straightforward form of drug development ( Zhou, et al, 2016 ).…”

Evidence of synergistic mechanisms of hepatoprotective botanical herbal preparation of Pueraria montana var. lobata and Schisandra sphenanthera

“…As a key feature of Chinese medicine, BHP enhances the efficacy through synergistic effect ( Panossian et al, 2024 ). Our results suggested that the BHP PM-SS is superior to PM or SS alone in ALI.…”

Reporting characteristics and quality of randomized controlled trial protocols in traditional Chinese medicine: a cross-sectional study

“…The inclusion criteria were the following: i) The interventions were limited to CHMF, acupuncture, and moxibustion. According to the CONSORT-2017-CHMF ( Gagnier et al, 2006a ; Gagnier et al, 2006b ; Cheng et al, 2017 ), the CHMF dosage form included decoctions, granules, powders, and botanical hybrid preparations ( Panossian et al, 2024 ). The administration routes of CHMF were oral and external.…”