Herb Rhizome (根茎 gēn jīng)

Quan Shen

Bistort rhizome · 拳参

Polygonum bistorta L. (syn. Bistorta officinalis Delarbre) · Rhizoma Bistortae

Also known as: Zi Shen (紫参), Cao He Che (草河车)

Quan Shen (Bistort rhizome) plant

Images shown are for educational purposes only

Quán Shēn (Bistort rhizome) is a cooling herb used primarily to clear infectious Heat and toxins from the body. It is especially valued for treating dysentery with bloody stools, bleeding conditions, skin infections, and mouth sores. Despite having 'shēn' (参) in its name, it is not a tonifying herb and belongs to the Heat-clearing category.

Category Heat-clearing herbs Herbs that clear Heat and resolve Toxicity (清热解毒药)
Therapeutic focus Digestive Health Immune Support Skin and Wound Care Respiratory Health

TCM Properties

Temperature

Cool

Taste

Bitter (苦 kǔ), Astringent (涩 sè)

Channels entered

Lungs, Liver, Large Intestine

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 Quan Shen does in the body, explained in both everyday and TCM terms

Therapeutic focus

In practical terms, Quan Shen is primarily used to support these areas of health:

Digestive Health Immune Support Skin and Wound Care Respiratory Health

TCM Actions

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

Clears Heat and Resolves Toxicity Cools the Blood and Stops Bleeding Disperses Swelling and Dissipates Nodules Calms the Spirit and Settles Fright Astringes the Intestines and Stops Diarrhea

How these actions work

'Clears Heat and resolves toxins' means Quán Shēn can address conditions where infectious or inflammatory Heat-toxin has accumulated in the body. Because it is cool in nature and bitter in taste, it excels at clearing Heat from the Lungs and Large Intestine. This makes it particularly useful for conditions like sore throat, mouth ulcers, skin abscesses (called yōng zhǒng in TCM), and scrofula (lymph node swellings). It is also applied externally as a wash or poultice for infected wounds and snakebite.

'Cools the Blood and stops bleeding' refers to its ability to address bleeding caused by Heat in the Blood. When Heat forces Blood out of the vessels, it can cause nosebleeds, vomiting blood, blood in the stool, or bleeding hemorrhoids. Quán Shēn's cool, astringent nature both clears the Heat driving the bleeding and helps constrict the blood vessels to stop it. Modern pharmacological research has confirmed its hemostatic (blood-stopping) properties.

'Reduces swelling and dissipates nodules' means it can help resolve painful swellings, abscesses, and lumps such as scrofula (a type of lymph node swelling historically common in TCM practice). It can be taken internally in decoction or applied topically as a crushed fresh poultice.

'Calms convulsions and settles fright' describes its traditional use for high fevers accompanied by seizures or muscle spasms, including childhood febrile convulsions and tetanus (called pò shāng fēng, or 'wound wind'). The cooling nature of the herb helps clear the Heat that is generating Wind internally and triggering these neurological symptoms.

'Astringes and stops diarrhea' relates to the herb's astringent taste, which gives it a binding, contracting quality. This makes it effective for treating dysentery (especially the type with blood and pus in the stool, called 'red dysentery') and hot diarrhea. Its tannin content contributes to this astringent, anti-diarrheal effect.

Patterns Addressed

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

Why Quan Shen addresses this pattern

Quán Shēn's cool nature and bitter, astringent taste make it well-suited for addressing Damp-Heat lodged in the Large Intestine. The bitter taste clears Heat and dries Dampness, while the astringent quality helps bind the intestines and stop the discharge of blood and pus. Its direct channel entry into the Large Intestine means it acts on this organ system specifically, clearing the Heat-toxin that drives the dysenteric process while its astringent tannins reduce the excessive intestinal secretion.

A practitioner would look for one or more of these signs

Dysentery

Especially red (bloody) dysentery with tenesmus

Diarrhea

Hot diarrhea with urgency and burning sensation

Abdominal Pain

Cramping abdominal pain with foul-smelling stools

Hemorrhoids

Bleeding hemorrhoids with Heat signs

Commonly Used For

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

Arises from: Large Intestine Dryness

TCM Interpretation

In TCM, dysentery (especially the form with blood and pus in the stool, known as 'red and white dysentery') is understood as Damp-Heat or Heat-toxin invading the Large Intestine. The Heat damages the intestinal lining and the blood vessels within it, causing bleeding and the discharge of pus-like material. The Dampness component creates the heavy, urgent, incomplete-feeling bowel movements (tenesmus). The condition reflects a battle between the body's righteous Qi and the invading pathogenic factors in the intestines.

Why Quan Shen Helps

Quán Shēn directly targets the Large Intestine channel where this pathology resides. Its cool nature clears the Heat driving the inflammation, while its bitter taste dries the pathological Dampness. Critically, the astringent quality (from its high tannin content) helps bind the intestines, reducing the excessive discharge and stopping the bleeding. Clinical studies using Quán Shēn tablets to treat bacterial dysentery in 80 cases reported a cure rate of approximately 89%, with symptoms like fever, bloody stools, and abdominal pain resolving within days.

Also commonly used for

Diarrhea

Acute infectious diarrhea with Heat signs

Sore Throat

Acute pharyngitis and tonsillitis

Skin Abscess

Applied topically as a poultice for infected wounds and abscesses

Nosebleeds

Nosebleeds from Blood Heat

Bronchitis

Chronic bronchitis with Lung Heat

Epilepsy

Febrile seizures and convulsions, traditionally including tetanus

Snakebite

Applied topically for venomous snakebite

Herb Properties

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

Temperature

Cool

Taste

Bitter (苦 kǔ), Astringent (涩 sè)

Channels Entered

Lungs Liver Large Intestine

Parts Used

Rhizome (根茎 gēn jīng)

Dosage & Preparation

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

Standard dosage

4.5-9g

Maximum dosage

Up to 30g in acute dysentery or severe Heat-toxin conditions, under practitioner supervision. Some clinical reports have used higher doses in decoction for specific infections, but standard practice keeps within 5-10g.

Dosage notes

Standard decoction dose is 4.5-9g for most indications including clearing Heat-toxin, stopping bleeding, and treating dysentery. For acute infections such as severe dysentery or intestinal inflammation, some practitioners use up to 15-30g. For external use (oral rinse for mouth sores, wash for skin lesions, or poultice for abscesses), use an appropriate amount in decoction for topical application. The herb can also be ground into powder for pill or powder preparations. Lower doses are appropriate for milder conditions or for patients with borderline Spleen-Stomach weakness.

Preparation

No special decoction handling required. Decoct normally with other herbs. For external use, prepare a stronger decoction for washing wounds, gargling for mouth sores, or making poultices. The rhizome can also be ground into fine powder for direct application to wounds or for making pills.

Processing Methods

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

Processing method

The raw rhizome is cleaned, briefly soaked to soften, sliced into thin pieces, and sun-dried.

How it changes properties

Slicing does not significantly alter the thermal nature or core properties. The primary purpose is to increase surface area for more effective decoction and standardize dosing. The cool, bitter, astringent nature is preserved.

When to use this form

This is the standard dispensing form used in decoctions. It is preferred over the whole uncut rhizome because the thin slices allow more complete extraction of active constituents during cooking.

Common Herb Pairs

These ingredients are traditionally combined with Quan Shen for enhanced therapeutic effect

Gan Cao
Gan Cao Quán Shēn 15g : Gān Cǎo 9g (approximately 5:3 by weight, following the classical Zǐ Shēn Tāng ratio)

Quán Shēn clears Heat-toxin and cools the Blood, while Gān Cǎo harmonizes the formula, protects the Stomach from the harsh bitterness, and adds its own mild toxin-resolving action. Together they form the classical Zǐ Shēn Tāng from the Jīn Guì Yào Lüè, used for diarrhea with lung pain.

When to use: When treating conditions where Heat-toxin affects both the Lungs and the intestines simultaneously, such as diarrhea or dysentery occurring alongside respiratory or chest discomfort.

Huang Qin
Huang Qin 1:1 (typically 9g each)

Both herbs clear Heat, but they target different areas. Quán Shēn's astringent quality stops diarrhea and bleeding in the Large Intestine, while Huáng Qín powerfully clears Damp-Heat from the intestines and dries Dampness. Together they provide a stronger, more comprehensive clearing of intestinal Damp-Heat than either herb alone.

When to use: For acute bacterial dysentery or enteritis with bloody, pus-filled stools, abdominal cramping, and fever.

Jin Yin Hua
Jin Yin Hua 1:1 (typically 9-15g each)

Jīn Yín Huā is one of the premier Heat-clearing, toxin-resolving herbs with broad antimicrobial properties. When paired with Quán Shēn, the toxin-resolving effect is amplified. Jīn Yín Huā disperses Wind-Heat at the exterior and upper body, while Quán Shēn adds astringency and Blood-cooling to the combination.

When to use: For skin abscesses, sore throat, upper respiratory infections, or any condition with significant Heat-toxin accumulation presenting with redness, swelling, and pain.

Ban Lan Gen
Ban Lan Gen 1:1 (typically 9-15g each)

Bǎn Lán Gēn is a powerful antiviral and antibacterial herb that clears Heat-toxin and cools the Blood. Combined with Quán Shēn, the pair addresses upper respiratory infections, tonsillitis, and pharyngitis more effectively, as both herbs enter the Lung channel and clear Heat-toxin from the throat region.

When to use: For acute tonsillitis, pharyngitis, or upper respiratory tract infections with sore throat and fever. This combination forms part of the modern formula 'Gǎn Mào Tuì Rè Chōng Jì' (Common Cold Fever-Reducing Granules).

Comparable Ingredients

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

Chong Lou
Quan Shen vs Chong Lou

Quán Shēn and Chóng Lóu (Paris rhizome) both clear Heat and resolve toxins, and their rhizomes look confusingly similar (they are often mixed up in the herbal trade). However, Chóng Lóu is more potent for reducing swelling and relieving pain from traumatic injury, and it has a stronger action to calm the Liver and extinguish Wind for convulsions. Quán Shēn is preferred when the primary issue is intestinal Damp-Heat with dysentery or enteritis, due to its stronger astringent and hemostatic properties in the intestines.

Di Yu
Quan Shen vs Di Yu

Both Quán Shēn and Dì Yú (Sanguisorba root) cool the Blood, stop bleeding, and have astringent properties. Both are used for bloody dysentery and hemorrhoid bleeding. However, Dì Yú is a stronger and more focused hemostatic herb specifically for lower body bleeding (bloody stool, hemorrhoids, uterine bleeding), while Quán Shēn has broader Heat-toxin clearing and anti-infective actions, including use for abscesses, sore throat, snakebite, and convulsions.

Ku Shen
Quan Shen vs Ku Shen

Both are bitter, cold herbs that clear Heat and dry Dampness, and neither is a tonifying 'shēn' despite having 'shēn' in the name. Kǔ Shēn (Sophora root) is more focused on clearing Damp-Heat from the skin (for eczema and itching) and the urinary tract (for painful urination), and it also kills parasites. Quán Shēn is preferred for dysentery, bleeding conditions, and Heat-toxin abscesses, and has stronger hemostatic properties.

Identity & Adulterants

Related species and common adulterations to be aware of when sourcing Quan Shen

Quan Shen has a long history of confusion with Chong Lou (重楼, Paris polyphylla rhizome). In the commercial herb trade, both have been called "Cao He Che" (草河车), leading to frequent mix-ups. The two can be distinguished by cross-section: Quan Shen has a reddish-brown cross-section with a ring of yellowish-white vascular bundle dots, while Chong Lou has a white to pale yellow, starchy cross-section. Quan Shen's exterior is purplish-black with dense ring markings; Chong Lou tends to be lighter in color with different surface texture. Additionally, other Polygonum section Bistorta species (such as Polygonum viviparum, Polygonum macrophyllum) may be used as regional substitutes with somewhat similar but not identical properties.

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

Toxicity Classification

Classical Chinese pharmacopoeia toxicity rating for Quan Shen

Slightly toxic

Quan Shen has very low toxicity. Animal studies showed that its extract (100% concentration) had an LD50 of 0.33 g per mouse via intraperitoneal injection, and rabbit studies at 0.2 g/kg showed no abnormalities after 30 days. A recent acute oral toxicity study in rats found the LD50 to be beyond 7 g/kg body weight, confirming a wide safety margin. The rhizome is rich in tannins (8.7-25%), which at high doses may cause gastrointestinal irritation, nausea, or constipation. At standard decoction doses (4.5-9g), no significant adverse effects have been reported. The herb's astringent nature means that excessive or prolonged use may impair digestion in those with weak Spleen and Stomach function.

Contraindications

Situations where Quan Shen should not be used or requires extra caution

Caution

Spleen and Stomach deficiency cold (脾胃虚寒): Quan Shen is bitter, astringent, and slightly cold in nature. People with constitutional coldness in the digestive system, presenting with chronic loose stools, poor appetite, or abdominal pain relieved by warmth, should avoid this herb as it may worsen these symptoms.

Caution

Absence of true Heat-toxin: This herb should not be used for conditions without genuine Heat or toxicity. Its cold and bitter nature can damage the Spleen and Stomach when there is no pathological Heat to clear.

Caution

Yin-type sores and abscesses (阴证外疡): Cold-natured, non-inflamed sores that lack redness, heat, or swelling are a contraindication. The classical caution states that Yin-type external sores should not be treated with this herb.

Caution

Pregnancy: Due to its cold nature and blood-moving properties, pregnant women should use this herb only under the guidance of a qualified practitioner.

Special Populations

Important considerations for pregnancy, breastfeeding, and pediatric use

Pregnancy

Use with caution during pregnancy. Quan Shen is slightly cold in nature with astringent and blood-cooling properties. While it is not in the traditionally listed pregnancy-prohibited herbs, its cold nature may theoretically affect the developing fetus if used excessively, and some classical sources note mild blood-moving effects. Use only under practitioner supervision when clinically necessary, at the lowest effective dose.

Breastfeeding

No specific studies exist on Quan Shen during breastfeeding. Given its slightly cold nature and high tannin content, it is advisable to use with caution during lactation. High tannin intake could theoretically cause digestive discomfort in the nursing infant if transferred through breast milk. Use only when clinically indicated and at standard doses, under practitioner guidance.

Children

Quan Shen has been used in pediatric settings, particularly for conditions such as pulmonary tuberculosis and respiratory infections, at reduced doses. Historical clinical reports mention children receiving proportionally reduced doses of the adult standard (approximately one-third to one-half for children over 6). Due to its cold nature and high tannin content, prolonged use in children should be avoided to prevent digestive upset. Always use under practitioner supervision.

Drug Interactions

If you are taking pharmaceutical medications, be aware of these potential interactions with Quan Shen

Iron supplements and iron-containing medications: Quan Shen is rich in tannins (8.7-25%), which can bind to iron and reduce its absorption. Separate administration by at least 2 hours.

Anticoagulant and antiplatelet drugs: While Quan Shen has hemostatic (blood-stopping) properties, it also contains compounds with potential anti-inflammatory effects on blood vessels. Theoretically, concurrent use with warfarin or similar medications could alter bleeding time unpredictably. Monitor closely if used together.

Alkaloid-containing medications: Tannins may precipitate alkaloids and reduce the bioavailability of alkaloid-based drugs. Avoid concurrent administration.

General note: Due to its high tannin content, Quan Shen may interfere with the absorption of various orally administered drugs. It is prudent to separate its administration from pharmaceutical medications by at least 1-2 hours.

Dietary Advice

Foods and dietary considerations when taking Quan Shen

Avoid cold, raw, and greasy foods while taking Quan Shen, as these may compound digestive strain from the herb's cold nature and high tannin content. Avoid strong tea, which also contains tannins and could increase astringent effects. A bland, easily digestible diet supports the herb's therapeutic action in treating dysentery and intestinal Heat conditions.

Botanical Description

Physical characteristics and morphology of the Quan Shen source plant

Quan Shen (Bistorta officinalis Raf., syn. Polygonum bistorta L.) is a perennial herbaceous plant in the Polygonaceae (buckwheat) family, growing 50 to 90 cm tall. The rhizome is thick, twisted, and curled like a fist (hence the name "fist root"), with a dark purplish-brown to blackish exterior. The stem is erect, unbranched, and bears broad lance-shaped or narrowly ovate basal leaves with pointed tips and truncate to slightly heart-shaped bases; the leaf margins are slightly rolled. Upper stem leaves are smaller and sessile with lance-shaped to linear blades. The plant produces dense, terminal spike-like racemes of small white or pale pink flowers from June to July, each flower with 5 petal-like tepals and 8 stamens. The fruit is a triangular brown achene, ripening August to September.

Quan Shen grows wild in moist, shady mountain slopes, alpine meadows, and forest margins across temperate regions of the Northern Hemisphere. It prefers cool climates, is both cold-hardy and drought-tolerant, and thrives in well-drained sandy loam or calcareous soils.

Sourcing & Harvesting

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

Harvesting season

Spring (before new shoots emerge) or autumn (when stems and leaves begin to wilt).

Primary growing regions

Quan Shen is widely distributed across northern and central China. Major producing regions include Hebei, Henan, Shanxi, Shaanxi, Shandong, Jiangsu, Hubei, Liaoning, Jilin, and Inner Mongolia. It also grows in Gansu, Ningxia, Anhui, Zhejiang, Hunan, and Xinjiang. Hebei and Shanxi are traditionally considered among the best sources. The plant also occurs in Russia, Central Asia, and parts of Europe and North America, where it grows in cool mountain meadows.

Quality indicators

Good quality Quan Shen rhizome is flattened cylindrical or curved in a shrimp-like shape, 6-13 cm long and 1-2.5 cm in diameter. The surface should be purplish-brown to purplish-black, rough, with dense prominent ring-like nodes and visible root scars. One side is slightly raised and the other flatter or slightly grooved. The texture should be hard and firm. On cross-section, the flesh should be light brownish-red to brownish-red, with yellowish-white vascular bundle dots arranged in a ring pattern. The herb should have minimal odor and a distinctly bitter, astringent taste. Avoid pieces that are soft, moldy, worm-eaten, or have a dark and mushy cross-section.

Classical Texts

Key passages from the classical Chinese medical texts that describe Quan Shen and its therapeutic uses

Shen Nong Ben Cao Jing (《神农本草经》, under the name Zi Shen 紫参)

Original: 紫参，味苦辛寒。主心腹积聚，寒热邪气。通九窍，利大小便。一名牡蒙。

Translation: "Zi Shen [Bistort], bitter and acrid, cold in nature. Governs accumulations and gatherings in the chest and abdomen, and cold-heat pathogenic Qi. Opens the nine orifices and promotes urination and bowel movements. Also called Mu Meng."

Ming Yi Bie Lu (《名医别录》)

Original: 紫参，微苦，无毒，主治肠胃大热，唾血、衄血、肠中聚血、痈肿诸疮。

Translation: "Zi Shen, slightly bitter, non-toxic. Treats great Heat in the intestines and stomach, blood in the saliva, nosebleed, blood accumulation in the intestines, and various sores and abscesses with swelling."

Ben Cao Tu Jing (《本草图经》, Song dynasty)

Original: 拳参，生淄州田野。叶如羊蹄，根似海虾，黑色。五月采。……捣末，淋渫肿气。

Translation: "Quan Shen grows in the fields of Zizhou. Its leaves resemble those of Rumex [sheep's sorrel], and its root looks like a sea shrimp, black in color. Collected in the fifth month. Pound into powder, wash and soak swellings."

Xin Xiu Ben Cao (《新修本草》, Tang dynasty)

Original: 紫参，叶似羊蹄，紫花青穗，皮紫黑，肉红白，肉浅皮深，所在有之。

Translation: "Zi Shen has leaves like sheep's sorrel, purple flowers on green-blue spikes; the bark is purple-black, the flesh is reddish-white, the flesh paler than the bark. Found everywhere."

Historical Context

The history and evolution of Quan Shen's use in Chinese medicine over the centuries

The name Quan Shen (拳参, "fist root") first appeared in the Song dynasty text Ben Cao Tu Jing (《本草图经》) by Su Song, who described it as growing in Zizhou with leaves like sheep's sorrel and a root resembling a black sea shrimp. However, the herb's medicinal use predates this name by over a thousand years. It was originally recorded as Zi Shen (紫参, "purple root") in the Shen Nong Ben Cao Jing (《神农本草经》), classified as a middle-grade herb. The name derives from its distinctive purplish-brown to purplish-black bark and reddish cross-section. Its many folk names reflect its uses and appearance: "shrimp root" (虾参) for its curled, shrimp-like shape; "sword-and-knife herb" (刀剪药, 刀枪药) for its traditional use in treating weapon wounds; and "red three-seven" (红三七) for its blood-stopping properties.

One of the most historically significant confusions in Chinese materia medica involves Quan Shen and Chong Lou (重楼, Paris polyphylla). Because both herbs have somewhat similar-looking rhizomes and overlapping folk names (both were called "Cao He Che" 草河车 in trade), they were frequently mixed up in historical texts and commercial markets. The confusion traces back to the Shen Nong Ben Cao Jing, where both Zi Shen and Wang Sun (王孙, a plant related to Chong Lou) shared the alias Mu Meng (牡蒙). Li Shizhen attempted to clarify: "The Mu Meng used in ancient formulas all referred to Zi Shen; the Mu Meng used by later practitioners was Wang Sun, not Zi Shen." Zhang Zhongjing's Jin Gui Yao Lue includes two formulas containing Zi Shen (Zi Shen Tang for dysentery with lung pain, and Ze Qi Tang for cough), which most modern scholars believe refer to this herb.

Modern Research

4 published studies investigating the pharmacological effects or clinical outcomes of Quan Shen

1

Anti-inflammatory activity of Polygonum bistorta, Guaiacum officinale and Hamamelis virginiana in rats (Animal study, 1994)

Duwiejua M, Zeitlin IJ, Waterman PG, Gray AI. J Pharm Pharmacol. 1994;46(4):286-290.

This preclinical study tested P. bistorta extract in rat models of inflammation. At doses of 100-400 mg/kg orally, the extract dose-dependently suppressed carrageenan-induced paw swelling and inhibited both acute and chronic phases of adjuvant-induced arthritis, confirming significant anti-inflammatory properties.

PubMed
2

Aqueous extract of Polygonum bistorta modulates proteostasis by ROS-induced ER stress in human hepatoma cells (In vitro study, 2017)

Lin YH, Wang YP, Lee HY, Tsai SW, Chen CJ, Liao CJ, Kuo CY, Lin JY. Scientific Reports. 2017;7:41578.

This laboratory study found that an aqueous extract of P. bistorta induced endoplasmic reticulum stress and apoptosis in human hepatoma (liver cancer) cells by generating reactive oxygen species (ROS) and disrupting protein homeostasis. The findings suggest a potential mechanism for the herb's traditionally observed anticancer effects.

PubMed
3

Pharmacology mechanism of Polygonum bistorta in treating ulcerative colitis based on network pharmacology (Network pharmacology and in vitro study, 2022)

Liu J, Liu S, Cao H, Shi B, Li Q, Shan J, Lin J, Yuan J. Evidence-Based Complementary and Alternative Medicine. 2022;2022:6461560.

Using network pharmacology, molecular docking, and cell experiments, this study identified that quercetin and other active compounds in P. bistorta may treat ulcerative colitis by downregulating the IL-17 signaling pathway. This provides modern evidence supporting the herb's classical use for dysentery and bloody stool.

4

Exploration of the anti-inflammatory potential of Polygonum bistorta L.: protection against LPS-induced acute lung injury in rats via NF-kB pathway inhibition (Animal study, 2025)

Published in Frontiers in Pharmacology, 2025.

This recent study evaluated P. bistorta root extract in a rat model of acute lung injury. The extract demonstrated significant lung-protective effects at doses of 100-500 mg/kg, reducing inflammation through inhibition of the NF-kB pathway. The acute oral toxicity study found LD50 beyond 7 g/kg, confirming a high safety margin.

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.