A comprehensive review on Jiao-tai-wan: Traditional application, pharmacokinetics, and therapeutic mechanisms in multiple disorders.

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Original abstract

<h4>Ethnopharmacological relevance</h4>Jiao-tai-wan (JTW) is a renowned traditional Chinese medicine (TCM) compound formula documented in Han Shi Yi Tong in the Ming dynasty of China. It is composed of Coptidis Rhizoma (CR) and Cinnamomi Cortex (CC) in a ratio of 10:1, and employed to alleviate the heart-kidney disharmony syndrome according to the TCM theory. At present, JTW has been extensively utilized for the treatment of multiple diseases.<h4>Aim of the review</h4>This review aims to summarize current research progress on the traditional applications, bioactive components and their pharmacokinetic characteristics, as well as the pharmacological mechanisms of JTW in multiple disorders, in order to provide full-scale comprehending of JTW.<h4>Methods</h4>A systematic literature search was conducted using multiple well-recognized databases, namely PubMed, Web of Science, ScienceDirect, and China National Knowledge Infrastructure. Several keywords were adopted to search the literatures related to JTW, such as Jiaotaiwan, Jiaotai pill, and Jiao-tai-wan.<h4>Results</h4>The diverse alkaloids derived from CR and essential oil from CC in JTW can be absorbed into the bloodstream, peripheral tissues, and brain. These components constitute the material basis for the neuroprotective and metabolic regulatory effects of JTW. Notably, CC significantly influences the pharmacokinetic properties of coptis alkaloids within JTW. Clinical trials and preclinical studies have demonstrated that JTW can ameliorate multiple conditions including insomnia, depression, cognitive impairment, Parkinson's disease, type 2 diabetes mellitus (T2DM), and polycystic ovary syndrome (PCOS). The neuroprotective effects of JTW are primarily attributed to its regulation on neurotransmitter, inflammation of gut-brain-axis, synaptic plasticity, microglia activation, and circadian rhythm. Furthermore, JTW promotes T2DM remission by upregulating AMPK pathway and insulin signaling, and restoring gut microbiota balance. For PCOS management, JTW modulates mitochondrial dynamic and cholesterol import, thereby improving clinical outcomes.<h4>Conclusion</h4>JTW serves as a promising alternative therapy for multiple nervous system diseases and metabolic disorders owing to its diverse pharmacological activities, although its clinical translation remains to be established. Further research is urgently necessary to utilize integrated systems biology approaches (such as proteomics, metabolomics, and transcriptomics) for elucidating the intricate mechanisms of JTW and uncovering the biological basis that underlies the synergistic effects of CR and CC within JTW.

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