Tian Xian

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Tian Xian

Common Names

  • Tian-Xian Liquid
  • Tien Hsien
  • Tien-Hsien Liquid

For Patients & Caregivers

How It Works

Tian Xian showed anticancer effects in laboratory studies and in animal models. Clinical data are needed to confirm such effects.

Tian Xian is an herbal extract used in traditional medicine and consists of the following herbs: Cordyceps sinensis (Dong Chong Xia Cao), Astragulus membranaceus (Huang Qi), Ganoderma lucidum (Ling Zhi), Panax ginseng (Ren Shen), Atractylodes macrocephalae (Bai Zhu), Dioscorea batatas (Shan Yao), Codnopsis pilosula (Dang Shen), Pogostemon cablin (Huo Xiang), Lycium barbarum (Gou Qi Zi), Pteria margaritifera (Pearl Powder), Ligustrum lucidum Ait (Nu Zhen Zi), and Radix glycyrrhizae (Licorice). Ingredients may vary depending on manufacturers.

Promoters of Tian Xian claim that it has immunomodulating and anticancer effects. Laboratory studies show that it can increase the number of immune cells upon stimulation with antigens, and also has anticancer effects. A small study in breast cancer patients suggests that it may improve quality of life and alleviate side effects associated with chemotherapy. Larger controlled trials are needed to confirm these effects and to determine safety.

Purported Uses
  • Immunomodulation A laboratory study showed that Tian Xian increased the number of immune cells when stimulated with specific antigens.
  • Cancer Treatment Lab studies show that Tian Xian has anticancer properties. A small study in breast cancer patients suggests that it may improve quality of life and alleviate chemotherapy side effects, but larger studies are needed to confirm effects and ensure safety.
Do Not Take If
  • You have hypersensitivity to any of the constituents. In addition, please see individual monographs for more drug interactions: Cordyceps, Astragulus, Reishi mushroom, Asian ginseng, Lycium, Ligustrum lucidum, and Licorice.
  • You are taking cytochrome P450 substrate drugs: Tian Xian may affect how these drugs are metabolized.
  • You are receiving chemotherapy: Tian Xian may alter the effects of conventional therapies.
Side Effects
  •  A case of unexplained splenic cyst: In a 55-year-old breast cancer patient after receiving Tian Xian liquid.
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For Healthcare Professionals

Clinical Summary

Tian Xian is an extract of Chinese medicinal herbs used for cancer treatment in traditional medicine. Ingredients may vary depending on manufacturers but usually include ginseng and astragalus as the main components. Proponents claim that the anticancer effects of this extract are due to the immunomodulating properties of its constituents.

In vitro and animal studies demonstrated that Tian Xian has immunomodulating (1) (3) and anticancer (4) (5) (6) (7) (8) (13) effects. In a small randomized controlled trial, Tian Xian liquid significantly improved QOL, decreased chemotherapy side effects, and demonstrated immunomodulating effects on lymphocytes in patients with refractory metastatic breast cancer. Larger studies are needed to confirm safety and efficacy (9).

No serious adverse effects have been reported from the use of Tian Xian liquid. However, patients should use caution because some of the herbs in Tian Xian may interact with prescription drugs due to cytochrome P450 3A4 induction (10). Future studies are needed to determine the extent to which this herbal remedy may either positively or negatively alter conventional anticancer therapy.

Purported Uses
  • Cancer treatment
  • Immunomodulation
Mechanism of Action

A number of ingredients in Tian Xian, including Cordyceps sinensis (Dong Chong Xia Cao), Astragulus membranaceus (Huang Qi), Ganoderma lucidum (Ling Zhi, reishi mushroom), Panax ginseng (Ren Shen), Atractylodes macrocephalae (Bai Zhu), Dioscorea batatas (Shan Yao), Codnopsis pilosula (Dang Shen), Pogostemon cablin (Huo Xiang), Lycium barbarum (Gou Qi Zi), Pteria margaritifera (Pearl Powder), Ligustrum lucidum (Nu Zhen Zi), and Radix glycyrrhizae (Licorice) (2)  have various characteristics and activities.

Tian Xian liquid increased proliferation of antigen-stimulated peripheral blood mononuclear cells and T cells isolated from patients with recurrent aphthous ulcers, likely via increased cytotoxic activity of NK cells, increased phagocytic activity of macrophages, anti-inflammatory effects, and immunopotentiation by the active constituents (1).

In vitro and in vivo studies indicate that Tian Xian activates human pregnane X receptor (PXR), which is involved in the hepatic uptake, metabolism, and elimination of toxic compounds; and alters the strength of PXR protein / transcriptional cofactor protein interactions (10). In humanized PXR mice, Tian Xian increased hepatic CYP3A11 expression and induced CYP3A4 expression, suggesting that combining it with conventional chemotherapeutic agents may be contraindicated (10). In models of human colorectal cancer, Tian Xian inhibits proliferation via the mitochondrial apoptotic pathway (8), downregulates matrix metalloproteinase-2 (MMP2) and MMP7 mRNA expression, and increases vascular endothelial growth factor (VEGF) mRNA expression, but not protein levels in vivo (11). It also upregulates p21 protein levels and downregulates MMP1 and multidrug resistance-1 (MDR1) protein levels (12). Suppression of gene expression and tumorigenicity of cancer stem-like hepatoma cells, as well as synergy with doxorubicin also occur through inhibition of multiple oncogenic signaling pathways (7).

Contraindications
  • Hypersensitivity to any of the components.
Adverse Reactions
  •  A case of unexplained splenic cyst: In a 55-year-old breast cancer patient after receiving Tian Xian liquid (14).
Herb-Drug Interactions
References
  1. Sun A, et al. Immunomodulating effects of “tien-hsien liquid” on peripheral blood mononuclear cells and T-lymphocytes from patients with recurrent aphthous ulcerations. Am J Chin Med 2004; 32(2):221-34.
  2. Product web site. http://www.tianxian.com. Accessed October 30,2019.
  3. Sun A, Chia JS, Wang WB, Chiang CP. “Tien-Hsien liquid” can modulate antigen-stimulated cytokine production by T-cells isolated from patients with recurrent aphthous ulcerations. Am J Chin Med 2005;33(4):559-71.
  4. Sun A, Chia JS, Chiang CP, et al. The chinese herbal medicine Tien-Hsien liquid inhibits cell growth and induces apoptosis in a wide variety of human cancer cells. J Altern Complement Med 2005;11(2):245-56.
  5. Yao CJ, Yang CM, Chuang SE, et al. Targeting PML-RAR{alpha} and Oncogenic Signaling Pathways by Chinese Herbal Mixture Tien-Hsien Liquid in Acute Promyelocytic Leukemia NB4 Cells. Evid Based Complement Alternat Med. 2009 Nov 23. [Epub ahead of print]
  6. Chia JS, Du JL, Hsu WB, et al. Inhibition of metastasis, angiogenesis, and tumor growth by Chinese herbal cocktail Tien-Hsien Liquid. BMC Cancer. 2010 Apr 30;10:175.
  7. Yao CJ, Yeh CT, Lee LM, et al. Elimination of cancer stem-like “side population” cells in hepatoma cell lines by chinese herbal mixture “tien-hsien liquid”. Evid Based Complement Alternat Med. 2012;2012:617085.
  8. Liu Q, Tong Y, Sze SC, et al. Tian Xian Liquid (TXL) induces apoptosis in HT-29 colon cancer cell in vitro and inhibits tumor growth in vivo. Chin Med. 2010;5:25.
  9. Kuo WH, Yao CA, Lin CH, et al. Safety and Efficacy of Tien-Hsien Liquid Practical in Patients with Refractory Metastatic Breast Cancer: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Phase IIa Trial. Evid Based Complement Alternat Med. 2012;2012:803239.
  10. Lichti-Kaiser K, Staudinger JL. The traditional Chinese herbal remedy tian xian activates pregnane X receptor and induces CYP3A gene expression in hepatocytes. Drug Metab Dispos. Aug 2008;36(8):1538-1545.
  11. Chu ES, Sze SC, Cheung HP, et al. Differential effects of anti-metastatic mechanism of Tian-Xian liquid (TXL) and its bioactive fractions on human colorectal cancer models. J Ethnopharmacol. Sep 1 2011;137(1):403-413.
  12. Sze SC, Wong KL, Liu WK, et al. Regulation of p21, MMP-1, and MDR-1 expression in human colon carcinoma HT29 cells by Tian Xian liquid, a chinese medicinal formula, in vitro and in vivo. Integr Cancer Ther. Mar 2011;10(1):58-69.
  13. Leigh AB, Cheung HP, Lin LZ, et al. Comprehensive and Holistic Analysis of HT-29 Colorectal Cancer Cells and Tumor-Bearing Nude Mouse Model: Interactions Among Fractions Derived From the Chinese Medicine Formula Tian Xian Liquid in Effects on Human Colorectal Carcinoma. Integr Cancer Ther. 2017 Sep;16(3):339-350.
  14. Chaiyasit K, Wiwanitkit V. Unexplained splenic cyst in a patient with breast cancer after receiving Tian Xian Liquid. Indian J Cancer. 2014 Oct-Dec;51(4):417.
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