Herb Rhizome (根茎 gēn jīng)

Chong Lou

Paris rhizome · 重楼

Paris polyphylla Smith var. yunnanensis (Franch.) Hand.-Mazz. / Paris polyphylla Smith var. chinensis (Franch.) Hara · Rhizoma Paridis

Also known as: Zao Xiu (蚤休), Qi Ye Yi Zhi Hua (七叶一枝花)

Chong Lou (Paris rhizome) plant

Images shown are for educational purposes only

Paris rhizome is a potent Heat-clearing herb used in Chinese medicine primarily for infections, abscesses, sore throat, snakebites, and traumatic injuries. It is one of the key ingredients in the famous Yunnan Baiyao formula. Because it carries slight toxicity, it should only be used under professional guidance and is not suitable for people without genuine Heat conditions, or during pregnancy.

Category Herbs that clear Heat and resolve Toxicity (清热解毒药)
Therapeutic focus Infection Support Sore Throat Relief Injury and Trauma Recovery Skin Health

TCM Properties

Temperature

Slightly Cool

Taste

Bitter (苦 kǔ)

Channels entered

Liver

Parts used

Rhizome (根茎 gēn jīng)

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What This Herb Does

Every herb has a specific set of actions — here's what Chong Lou does in the body, explained in both everyday and TCM terms

Therapeutic focus

In practical terms, Chong Lou is primarily used to support these areas of health:

Infection Support Sore Throat Relief Injury and Trauma Recovery Skin Health

TCM Actions

In TCM terminology, these are the specific therapeutic actions that Chong Lou performs to restore balance in the body:

Clears Heat and Resolves Toxicity Reduces Swelling and Alleviates Pain Settles Fright and Calms Convulsions

How these actions work

'Clears Heat and resolves toxins' means Chóng Lóu can neutralize the type of intense, localized Heat that TCM associates with infections and inflammatory swellings. Its bitter taste and slightly cool nature make it well suited for conditions where Heat-toxins accumulate, producing painful abscesses (boils, carbuncles), severe sore throat, or the angry red swelling from a venomous snakebite. This is its primary and most celebrated action. It can be taken internally as a decoction or applied externally by grinding the raw rhizome into a paste.

'Reduces swelling and relieves pain' refers to its ability to disperse the swelling and ease the pain that accompany traumatic injuries, insect bites, or toxic swellings. Whether the swelling comes from a fall, a blow, or accumulated Heat-toxins, Chóng Lóu helps bring it down. It is a key ingredient in Yunnan Baiyao and other trauma formulas precisely because of this capacity to address both inflammation and pain.

'Cools the Liver and arrests convulsions' describes how Chóng Lóu targets the Liver channel to calm internal Wind generated by extreme Heat. In TCM, when Heat flares in the Liver channel, particularly in young children, it can trigger high fever followed by convulsions, tremors, or spasms. Chóng Lóu's cooling action on the Liver quenches this Heat and stops the resulting Wind, making it useful for childhood febrile seizures.

Patterns Addressed

In TCM, symptoms cluster into recognizable patterns of disharmony. Chong Lou is used to help correct these specific patterns.

Why Chong Lou addresses this pattern

Toxic Heat is a pattern where pathogenic Heat concentrates and produces purulent, inflamed, painful lesions such as boils, carbuncles, and deep abscesses. Chóng Lóu is bitter and slightly cool, entering the Liver channel. Its bitter taste drains and descends Heat, while its cool nature directly counteracts the Heat-toxin accumulation. This makes it one of the most potent herbs for resolving localized Toxic Heat, especially in conditions like deep carbuncles, severe sore throat, and venomous bites where the toxin is intense and the swelling is pronounced.

A practitioner would look for one or more of these signs

Periappendiceal Abscess

Red, hot, painful swellings with pus

Sore Throat

Acute sore throat with swelling and difficulty swallowing

Snakebite

Venomous snakebite with local swelling and pain

Skin Infection

Boils, carbuncles, or infected skin lesions

Commonly Used For

These are conditions where Chong Lou is frequently used — but only when they arise from the specific patterns it addresses, not in all cases

Arises from: Toxic-Heat

TCM Interpretation

TCM understands skin abscesses and boils as the result of Toxic Heat congesting in a local area. When Heat-toxins accumulate under the skin, they 'cook' the flesh, producing redness, swelling, heat, and pain, and eventually pus. The Liver channel's role in smooth circulation means that when it is obstructed by Heat, swelling and toxin buildup worsen. The severity of the condition reflects the intensity of the Toxic Heat involved.

Why Chong Lou Helps

Chóng Lóu is one of the strongest Heat-toxin resolving herbs in the materia medica. Its bitter taste drains and breaks down the accumulated Heat-toxin, while its cool nature directly counteracts the inflammatory process. It enters the Liver channel, helping to restore smooth circulation to the affected area and reduce the congestion that sustains the abscess. It can be taken as a decoction internally and simultaneously applied as a ground powder paste externally, attacking the toxin from both directions. A folk saying preserved in the Ben Cao Gang Mu captures this reputation well, describing how Paris rhizome handles abscesses as easily as picking something up with one's hand.

Also commonly used for

Snakebite

Venomous snakebite, a classical primary indication

Lumps

Parotitis (mumps) with painful glandular swelling

Seizures

Childhood febrile convulsions

Appendicitis

Acute appendicitis as adjunct treatment

Mastitis

Acute breast inflammation with Heat-toxin signs

Cervicitis

Cervical erosion and inflammation

Shingles

Herpes zoster with burning pain, applied topically

Herb Properties

Every herb has an inherent temperature, taste, and affinity for specific channels — these properties determine how it interacts with the body

Temperature

Slightly Cool

Taste

Bitter (苦 kǔ)

Channels Entered

Liver

Parts Used

Rhizome (根茎 gēn jīng)

Dosage & Preparation

These are general dosage guidelines for Chong Lou — always follow your practitioner's recommendation, as dosages vary based on the formula and your individual condition

Standard dosage

3–9g

Maximum dosage

Generally do not exceed 9g in decoction. In some modern clinical cancer-adjuvant protocols, doses up to 15g have been used under close practitioner supervision, but this exceeds the standard Pharmacopoeia range and increases the risk of gastrointestinal side effects.

Dosage notes

The standard decoction dose is 3 to 9g. When taken as ground powder (研末), the dose is reduced to 1 to 3g per administration. For external use, an appropriate amount of powdered herb is mixed with vinegar or water and applied to the affected area, or fresh rhizome can be crushed and applied as a poultice. Lower doses (3 to 5g) are appropriate for sore throat and mild infections. Higher doses within the range (6 to 9g) are used for severe abscesses, snakebite, or as adjunctive cancer treatment. Because Chong Lou is bitter and cold with slight toxicity, prolonged use or doses at the upper end of the range should be monitored for digestive disturbance.

Preparation

No special decoction handling required. Chong Lou is simply sliced and decocted normally with other herbs. For external use, it is ground into powder and mixed with vinegar or water for topical application, or the fresh rhizome is crushed into a paste.

Processing Methods

In TCM, the same herb can be prepared in different ways to change its effects — here's how processing alters what Chong Lou does

Processing method

The raw rhizome is cleaned, soaked until softened, sliced into thin pieces, and sun-dried or oven-dried.

How it changes properties

Slicing does not significantly alter the herb's thermal nature or actions. It primarily increases the surface area to improve extraction efficiency during decoction. The core properties of bitter taste, slightly cool nature, and Liver channel entry remain unchanged.

When to use this form

This is the standard decoction-ready form used in clinical practice. Choose this form for any internal use via decoction.

Common Herb Pairs

These ingredients are traditionally combined with Chong Lou for enhanced therapeutic effect

Jin Yin Hua
Jin Yin Hua Chóng Lóu 6-9g : Jīn Yín Huā 15-30g

Chóng Lóu and Jīn Yín Huā (Honeysuckle flower) together create a powerful Heat-toxin resolving combination. Chóng Lóu is the stronger toxin-resolver that breaks down deep, intense Toxic Heat, while Jīn Yín Huā clears Heat broadly and vents it outward. Together, they address both surface and deep layers of Heat-toxin in infected swellings.

When to use: Severe boils, carbuncles, or deep skin abscesses with pronounced redness, swelling, heat, and pain. Also useful for acute sore throat with significant swelling.

Ban Bian Lian
Ban Bian Lian 1:1 (equal parts, fresh herbs mashed together for external use; decocted in equal amounts internally)

Chóng Lóu and Bàn Biān Lián (Lobelia) are the classical pair for venomous snakebite. Chóng Lóu resolves the intense local toxin and reduces swelling, while Bàn Biān Lián promotes urination to help the body expel the venom systemically and also clears Heat-toxins. Together, they address both the local toxin accumulation and the systemic poisoning.

When to use: Venomous snakebite with local swelling, pain, and spreading toxin. Both herbs are used internally and can also be mashed fresh for topical application to the bite site.

Lian Qiao
Lian Qiao Chóng Lóu 6-9g : Lián Qiào 10-15g

Chóng Lóu and Lián Qiào (Forsythia fruit) combine deep toxin resolution with the ability to clear Heat from the upper body and vent it outward. Lián Qiào is particularly good at dispersing clumped Heat-toxins and directing them to the exterior for clearance, while Chóng Lóu works deeper to break down stubborn toxic accumulations.

When to use: Heat-toxic sore throat, swollen lymph nodes (scrofula), or early-stage carbuncles before pus has fully formed.

Gou Teng
Gou Teng Chóng Lóu 6-9g : Gōu Téng 10-15g (added near end of decoction)

Chóng Lóu cools the Liver and clears Heat-toxins, while Gōu Téng (Uncaria stem with hooks) extinguishes Liver Wind and calms spasms. Together, they address the root cause (Liver Heat) and the manifestation (Wind-driven convulsions) simultaneously, providing a more complete approach to febrile seizures.

When to use: Childhood febrile convulsions with high fever, hand and foot spasms, and restlessness from Liver Heat generating internal Wind.

Comparable Ingredients

These ingredients have overlapping uses — here's how to tell them apart

Pu Gong Ying
Chong Lou vs Pu Gong Ying

Both Chóng Lóu and Pú Gōng Yīng (Dandelion) clear Heat-toxins and are used for abscesses and swellings. However, Chóng Lóu is significantly stronger for deep, intense Toxic Heat and is the go-to herb for venomous snakebite and convulsions. Pú Gōng Yīng is milder, non-toxic, safer for longer use, and has a particular affinity for breast abscesses and urinary tract infections. Choose Chóng Lóu for severe, acute toxic conditions; choose Pú Gōng Yīng for milder Heat-toxin patterns or when the patient's constitution is weaker.

Ban Zhi Lian
Chong Lou vs Ban Zhi Lian

Both herbs clear Heat-toxins and are used in modern practice for tumors and abscesses. Bàn Zhī Lián (Scutellaria barbata) is more commonly used in oncology support formulas and for clearing Damp-Heat, while Chóng Lóu is stronger for acute toxic swellings, traumatic injuries, and has the additional action of cooling the Liver to arrest convulsions. Chóng Lóu is slightly toxic and requires careful dosing; Bàn Zhī Lián is generally safer for extended use.

Quan Shen
Chong Lou vs Quan Shen

Chóng Lóu (Paris rhizome) and Quán Shēn (Bistort rhizome) look very similar in their raw form and were historically confused with each other. Both clear Heat-toxins. However, Chóng Lóu is slightly toxic and particularly effective for snakebite and childhood convulsions, while Quán Shēn is non-toxic and excels at treating Heat-toxin dysentery (bloody diarrhea). Their cross-sections differ visually: Chóng Lóu is yellowish-white inside, while Quán Shēn is brownish-red.

Identity & Adulterants

Related species and common adulterations to be aware of when sourcing Chong Lou

Chong Lou is one of the most frequently adulterated Chinese herbs due to its high market price and the scarcity of wild material. Common substitution issues include: 1. Cao He Che (草河车) confusion: The name Cao He Che has historically been used for both Chong Lou (Paris polyphylla) and Quan Shen/Bistort rhizome (Polygonum bistorta, 拳参). These are completely different plants from different families with different actions. Quan Shen lacks the steroidal saponins that give Chong Lou its anticancer and antitoxin properties. 2. Other Paris species: Due to the morphological similarity of Paris species, non-official species with thinner rhizomes or lower saponin content are sometimes mixed in. Only Paris polyphylla var. yunnanensis and var. chinensis are recognized in the Chinese Pharmacopoeia. 3. Quality substitution: Horny/gelatinous-textured rhizomes (角质重楼) are sometimes sold as the superior floury-textured type (粉质重楼). The floury type is easier to process and considered more potent. 4. Import materials of unclear botanical origin are increasingly common on the market.

Educational content — always consult a qualified healthcare provider or TCM practitioner before using any herb.

Toxicity Classification

Classical Chinese pharmacopoeia toxicity rating for Chong Lou

Slightly toxic

Chong Lou is classified as slightly toxic (有小毒) in the Chinese Pharmacopoeia. Its primary bioactive and potentially toxic compounds are steroidal saponins, including polyphyllin I, II, VI, VII (also called paris saponins). These saponins can cause gastrointestinal irritation at excessive doses. Symptoms of overdose include nausea, vomiting, abdominal pain, diarrhea, dizziness, headache, and pallor. In severe cases, respiratory difficulty and muscle spasms have been reported. Modern toxicity studies have also noted mild hepatotoxicity with prolonged or excessive use. At the standard dosage of 3 to 9g in decoction, the herb is considered safe. The saponins are partly broken down during decoction, which reduces their irritant effects compared to taking the raw powder.

Contraindications

Situations where Chong Lou should not be used or requires extra caution

Avoid

Pregnancy. Chong Lou is bitter and cold with slight toxicity, and classical texts explicitly list pregnancy as a contraindication. The herb's properties may adversely affect the fetus.

Avoid

Constitutional deficiency (体虚) without true Fire-Heat toxin. As a cold, bitter, toxin-clearing herb, Chong Lou can further damage the Spleen and Stomach in deficient patients. The Ben Jing Feng Yuan states that those with deficient original Qi (元气虚者) should not use it.

Avoid

Yin-type sores and abscesses (阴证外疡). These are cold, non-inflamed lesions where a cold-natured toxin-clearing herb would be inappropriate and could worsen the condition.

Caution

Heat injuring the nutritive Yin level with vomiting or nosebleed (热伤营阴吐衄血). The Ben Cao Hui Yan cautions against use in this pattern, as the bitter cold nature may further damage Yin fluids and Blood.

Caution

Spleen and Stomach deficiency cold. The bitter, cold nature of Chong Lou can aggravate digestive weakness, potentially causing nausea, vomiting, or diarrhea.

Caution

Overdosage. Due to its slight toxicity, exceeding the recommended dosage can cause nausea, vomiting, diarrhea, dizziness, headache, and in severe cases respiratory difficulty or muscle spasms.

Special Populations

Important considerations for pregnancy, breastfeeding, and pediatric use

Pregnancy

Contraindicated during pregnancy. Classical texts unanimously prohibit use in pregnant women (孕妇忌服). Chong Lou is bitter, cold, and slightly toxic, and its steroidal saponin content poses potential risks to fetal development. Paris polyphylla extracts have demonstrated cytotoxic activity in various cell studies, raising concerns about possible teratogenic or embryotoxic effects. No modern clinical safety data exists for use in pregnancy. Pregnant women should strictly avoid this herb in all forms, including topical application.

Breastfeeding

Not recommended during breastfeeding. Although no specific studies have evaluated transfer of Chong Lou's steroidal saponins into breast milk, its slight toxicity and potent bioactive compounds warrant caution. Saponins are known to have hemolytic properties and could potentially affect the infant through breast milk. Until safety data is available, nursing mothers should avoid this herb.

Children

Children should use Chong Lou with caution (儿童慎用). Due to its slight toxicity and bitter, cold nature, dosages for children must be significantly reduced from the adult range and should be strictly determined by a qualified practitioner based on the child's age and weight. Classically, Chong Lou was used in pediatric formulas for high fever with convulsions (小儿惊风), but always in carefully controlled amounts within multi-herb prescriptions. It should not be given to infants or very young children without expert guidance.

Drug Interactions

If you are taking pharmaceutical medications, be aware of these potential interactions with Chong Lou

Current in vitro research suggests that the main paris saponins (polyphyllin I, II, VI, VII) have low potential to inhibit major CYP and UGT drug-metabolizing enzymes, indicating a low likelihood of pharmacokinetic herb-drug interactions at standard doses.

However, due to the documented cytotoxic activity of Chong Lou's steroidal saponins, theoretical caution is warranted when combining with chemotherapy drugs, as additive or unpredictable interactions could occur. Patients undergoing chemotherapy should only use Chong Lou under the guidance of a practitioner experienced in integrative oncology.

No other well-documented pharmaceutical drug interactions have been established. Due to the herb's slight toxicity, concurrent use with other potentially hepatotoxic medications should be approached with care.

Dietary Advice

Foods and dietary considerations when taking Chong Lou

Avoid cold, raw, and greasy foods while taking Chong Lou, as these can impair digestion and compound the herb's cold nature, potentially causing nausea or stomach upset. Avoid alcohol during treatment, as it may increase the absorption of the saponin compounds and intensify side effects. Light, easily digestible foods are recommended.

Botanical Description

Physical characteristics and morphology of the Chong Lou source plant

Paris polyphylla is a slow-growing perennial herbaceous plant of the family Melanthiaceae (historically classified under Liliaceae), reaching approximately 50 cm in height. The rhizome is thick, fleshy, and creeping, brownish in colour, with a rough, knotted surface bearing fibrous roots at the nodes. A single erect, smooth, cylindrical stem rises from the rhizome, often tinged purplish-red at the base.

The most distinctive feature is a single whorl of 5 to 9 leaves (usually 7) arranged umbrella-like at the top of the stem, giving rise to the folk name "Seven Leaves, One Flower" (七叶一枝花). The leaves are narrow-ovate to oblanceolate, papery, 7 to 9 cm long. In summer, a single yellowish-green flower emerges on a stalk above the leaf whorl, with 5 to 6 leaf-like sepals and 5 to 6 slender, thread-like petals. The fruit is a capsule that splits open when ripe to reveal red seeds. The plant grows in shaded, moist understory habitats in forests and ravines at elevations of 600 to 3,100 metres.

Sourcing & Harvesting

Where Chong Lou is sourced, when it's harvested or collected, and how to assess quality

Harvesting season

Autumn, after the above-ground parts die back. The rhizome requires a minimum of 5 to 7 years of growth before it is thick enough for medicinal harvest.

Primary growing regions

Yunnan Province is considered the primary dao di (道地) region for Chong Lou, particularly the western, northwestern, and central areas of Yunnan, which produce the highest-quality material. Sichuan, Guizhou, Guangxi, Hubei, Hunan, Jiangxi, Zhejiang, and Fujian also produce significant quantities. The historical dao di region recorded in the Ben Cao Pin Hui Jing Yao was Chuzhou (滁州, in modern Anhui). Due to overexploitation of wild resources, Chong Lou is now increasingly cultivated, mainly in Yunnan and Sichuan. The species is classified as rare, endangered, and threatened (RET) due to habitat loss and overharvesting.

Quality indicators

Good quality Chong Lou rhizome is thick and heavy, firm and solid, with a nodular, flattened cylindrical shape. The outer surface should be yellowish-brown to greyish-brown with clearly visible coarse ring-like growth markings. The cross-section should be white to pale brownish, with a floury (starchy, powdery) texture rather than a horny or glassy appearance. Floury-textured rhizome (粉质重楼) is considered superior to the horny or gelatinous type (角质重楼/胶质重楼). The taste should be slightly bitter with a numbing sensation on the tongue. It should be free of excessive rootlets, mould, or insect damage. Larger, heavier individual pieces are graded higher.

Classical Texts

Key passages from the classical Chinese medical texts that describe Chong Lou and its therapeutic uses

Shen Nong Ben Cao Jing (《神农本草经》, Divine Farmer's Classic of Materia Medica)

Chong Lou was recorded under the name "Zao Xiu" (蚤休) in the lower grade (下品) of this earliest materia medica text. The original entry describes it as treating: "惊痫，摇头弄舌，热气在腹中，癫疾，痈肿，阴蚀，下三虫，去蛇毒。" ("Fright-epilepsy, head-shaking and tongue-wagging, heat-Qi in the abdomen, epileptic disease, abscesses and swellings, genital sores, expelling three types of parasites, and removing snake venom.")

Xin Xiu Ben Cao (《新修本草》, Newly Revised Materta Medica, Tang Dynasty)

Su Jing's Tang Dynasty pharmacopoeia first introduced the name "Chong Lou" as a synonym: "今谓重楼者是也。一名重台，南人名草甘遂，苗似王孙、鬼臼等，有二三层。根如肥大菖蒲，细肌脆白，醋摩疗痈肿，敷蛇毒，有效。" ("What is now called Chong Lou is this herb. Also named Chong Tai. Southerners call it Cao Gan Sui. The plant resembles Wang Sun and Gui Jiu, with two or three layers. The root is like a thick Calamus rhizome, fine-textured and crisp-white. Ground with vinegar it treats abscesses and swellings; applied to snake bites, it is effective.")

Ben Cao Hui Yan (《本草汇言》)

"热伤营阴吐衄血证忌用之。" ("Contraindicated in patterns of Heat damaging the nutritive-Yin level with vomiting blood or nosebleed.")

Ben Jing Feng Yuan (《本经逢原》)

"元气虚者禁用。" ("Prohibited for those with deficient original Qi.")

Historical Context

The history and evolution of Chong Lou's use in Chinese medicine over the centuries

Chong Lou has one of the longest recorded histories among Chinese medicinal herbs. It first appeared in the Shen Nong Ben Cao Jing (compiled during the Han Dynasty) under the name "Zao Xiu" (蚤休), classified in the lower grade (下品), indicating recognized medicinal potency balanced by slight toxicity. The name "Chong Lou" (重楼, meaning "layered tower" or "tiered pavilion") first appeared in the Tang Dynasty text Xin Xiu Ben Cao and refers to the plant's distinctive layered appearance, with whorled leaves stacked like the eaves of a pagoda. Over time, "Chong Lou" gradually replaced "Zao Xiu" as the standard name, becoming the official designation in modern pharmacopoeias.

The folk name "Qi Ye Yi Zhi Hua" (七叶一枝花, "Seven Leaves, One Flower") vividly describes the plant's unique morphology. Chong Lou gained enormous modern significance as a key ingredient in Yunnan Baiyao (云南白药), one of China's most famous proprietary medicines used for trauma and bleeding. This demand, combined with the plant's extremely slow growth (requiring at least 5 to 7 years before the rhizome is harvestable, and seeds that can remain dormant for years), has led to severe depletion of wild populations and driven prices to extraordinary heights, making it one of the most expensive Chinese herbs on the market.

Modern Research

4 published studies investigating the pharmacological effects or clinical outcomes of Chong Lou

1

Assessment of Paris Saponins on CYP and UGT Enzyme Inhibition (In Vitro Study, 2020)

Wang et al., Biomedicine & Pharmacotherapy, 2020, 123, 109748

This study evaluated whether the main saponin compounds in Paris polyphylla could cause drug interactions by inhibiting liver enzymes (CYP and UGT families). The results showed that paris saponin I, II, VII and polyphyllin VI had very low inhibitory potential, suggesting minimal risk of herb-drug interactions through these metabolic pathways.

PubMed
2

Cytotoxic Steroidal Saponins from Paris polyphylla var. chinensis (Phytochemical Study, 2024)

Guan LJ et al., Phytochemistry, 2024, 218, 113948

Researchers isolated new spirostanol saponins from Chong Lou rhizomes and tested them against several human cancer cell lines. One novel compound showed significant cytotoxic effects on glioma, cervical, liver, and pancreatic cancer cells, acting through the EGFR/PI3K/Akt/mTOR apoptosis pathway.

PubMed
3

Steroidal Saponins from Paris polyphylla and Cytotoxic Activities Against HL-60 Cells (Phytochemical Study, 2009)

Zhao Y, Kang LP, Liu YX et al., Planta Medica, 2009, 75(4), 356-363

Three new and ten known steroidal saponins were isolated from Chong Lou rhizomes. Several compounds showed potent cytotoxicity against human leukemia cells, with the study establishing that the spirostanol framework and terminal rhamnose sugar linkage are essential structural features for high anticancer activity.

PubMed
4

Cytotoxic Steroidal Saponins from Paris polyphylla var. yunnanensis Against Nasopharyngeal Carcinoma (Phytochemical Study, 2012)

Qin XJ et al., Phytochemistry, 2012, 80, 2-8

Eighteen steroidal saponins were isolated from Yunnan Chong Lou rhizomes. Seven compounds showed stronger cancer cell inhibition than the chemotherapy drug cisplatin against nasopharyngeal carcinoma cells. The most potent compound induced both apoptosis and cell cycle arrest.

PubMed

Research on individual TCM herbs is growing but still limited by Western clinical trial standards. These studies provide emerging evidence and should be considered alongside practitioner expertise.