Chinese materia medica used in medicinal diets

Author’s Accepted Manuscript Chinese Materia Medica Used in Medicinal Diets Fang Tan, Yalin Chen, Xiaolei Tan, Yunyun Ma, Yong Peng

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To appear in: Journal of Ethnopharmacology Received date: 15 January 2017 Revised date: 11 May 2017 Accepted date: 11 May 2017 Cite this article as: Fang Tan, Yalin Chen, Xiaolei Tan, Yunyun Ma and Yong Peng, Chinese Materia Medica Used in Medicinal Diets, Journal of Ethnopharmacology, http://dx.doi.org/10.1016/j.jep.2017.05.021 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Chinese Materia Medica Used in Medicinal Diets Fang Tana, b, Yalin Chena, b, Xiaolei Tana, b, Yunyun Maa, b, Yong Penga, b* a

Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union

Medical College, Beijing 100193, China b

Key Laboratory of Bioactive Substance and Resources Utilization of Chinese Herbal Medicines,

Ministry of Education, Beijing 100193, China

Authors’ e-mails Fang Tan: [email protected] Yalin Chen: [email protected] Xiaolei Tan: [email protected] Yunyun Ma: [email protected] Yong Peng: [email protected] E-mail: [email protected]

Corresponding author at: Yong Peng Institute of Medicinal Plant Development (IMPLAD), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100193, P.R. China. Tel: +86-10-57833166; Fax: +86-10-57833166.

Abstract Ethnopharmacological relevance: Medicinal diets have a history of more than 2000 years. Locally referred to as yaoshan (Chinese: 药膳), a medicinal diet is understood in China as a dietary product that combines herbs and food with the purpose of preventing and treating diseases or improving health under the guidance of traditional Chinese medicine theory. Medicinal diets are used in Chinese people’s daily life and in specialized restaurants. Hundreds of Chinese materia medica (CMM) are used in medicinal diets; however, a comprehensive evaluation of medicinal diets is lacking.

Aims of the study: This is an exploratory study that aims to identify the CMM that are most frequently used in medicinal diets and to provide an updated view of the current situation of medicinal diets in China. Materials and methods: A field study of 1221 people in 32 Chinese provinces was conducted over a period of approximately 6 months and included various types of interviews as well as a written questionnaire. Two approaches were used to analyse the data collected in the survey: (1) estimating the frequency of CMM consumed in daily diets; and (2) collecting CMM used in medicinal diet restaurants. Complementary information on the selected CMM was obtained from relevant databases, including PubMed, Google Scholar, Baidu Scholar, CNKI, and Web of Science. Results: Ten CMM were reported as commonly used by more than 50% of the participants. Among these 10 species, most medicinally used parts were seeds and fruits. Pharmacological data from the literature revealed that these species are associated with a wide spectrum of biological properties, including antitumour (80%), antioxidant (50%), anti-diabetic (40%), antilipemic (40%), anti-aging (40%), antimicrobial (40%) and cardioprotective (40%) activities. Our survey shows that most medicinal diet restaurants are located in the eastern part of China, with the greatest numbers being found in Beijing and Guangzhou. Only Dioscoreae Rhizoma, Lycii Fructus, Chrysanthemi Flos and Longan Arillus were frequently consumed both in daily diets and at medicinal diet restaurants. Some of the similarities shared by these 4 species include an extensive history of use (>2000 years); a sweet flavour; and antioxidant, antidiabetic, antilipemic and cardioprotective effects. Conclusions: The 10 most commonly consumed CMM possess various biological effects that are currently target the most frequent health problems for the majority of the population. The development of medicinal diet restaurants has certain regional restrictions and is

associated with the local climate environment and dietary culture. The data revealed by this study provided useful information for commercial exploitation of medicinal diets and their components and serve as a basis for further studies on various aspects of medicinal diets.

Graphical abstract

Keywords: Medicinal diets; traditional Chinese medicine; Chinese materia medica; medicinal diet restaurants Chemical compounds mentioned in this article: Triterpenoids (PubChem CID: 71597391); Betaine (PubChem CID: 247); Coumarin (PubChem CID: 323); Chlorogenic acid (PubChem CID: 1794427)

1. Introduction Many herbal medicines are traditionally used as both nutritional and pharmacological ingredients with health promoting properties (Etkin and Ross, 1982; Totelin, 2015). The food-medicine continuum has been well-illustrated (Jennings et al., 2015; Towns and van Andel, 2016). In China, the recognition that certain foods possess properties of interest for maintaining wellbeing and/or providing curative treatment goes back to ancient times. In the context of dietetics, medicinal diets have a history of more than 2000 years since the Han Dynasty in China; these diets are constituted by components of the Chinese materia medica (CMM), which combine the characteristics of food and medicine (Tan and Deng, 2005). A medicinal diet is currently defined in China as a dietary product that combines herbs and food with the purpose of preventing and treating diseases or improving health under the guidance of traditional Chinese medicine theory (Ma, 2009). The earliest record of medicinal diet recipes appeared in Huang Di Nei Jing (Han Dynasty, circa B.C. 100). Recipes, diet therapy theories and herbal ingredients were later documented in different well-known medical reference books, including Jin Gui Yao Lue Fang Lun (Han Dynasty, approximately A.D. 200), Bei Ji Qian Jin Yao Fang (Tang Dynasty, A.D. 652), Tai Ping Sheng Hui Fang (Song Dynasty, A.D. 992), Yin Shan Zheng Yao (Yuan Dynasty, A.D. 1330), and Sui Xi Ju Yin Shi Pu (Qing Dynasty, A.D. 1861). A few classic recipes found in these books are still in use, such as Mutton soup with Angelicae Sinensis Radix and Zingiberis Rhizoma Recens (Jin Gui Yao Lue Fang Lun), Asparagi Radix pancakes and Armeniacae Semen Amarum porridge (Tai Ping Sheng Hui Fang). In 2002, the Ministry of Health adopted the “Dual Use for Food and Medicine List” (87 species) and the “Health Food Availability List” (114 species) to define the raw materials permitted in medicinal diets. In 2014, the National Health and Family

Planning Commission revised the “Dual Use for Food and Medicine List”, which now includes 101 species. However, although more than 200 species are officially accepted as components of medicinal diets, no systematic investigation of either medicinal diet components or their effects has been conducted. The aims of this study were to identify the CMM most frequently used in medicinal diets and to provide an updated view of the current situation of medicinal diets in China.

2. Materials and methods The project was approved by Doctoral Program of Institute of Medicinal Plant Development (IMPLAD) on October10, 2013. 2.1. Data collection 2.1.1. CMM in daily diets Field work was conducted from November 2013 to May 2014 and comprised 1221 interviews performed in villages, towns, and cities. These interviews were conducted by students from Beijing University of Chinese Medicine and Peking Union Medical College, whose hometowns are in different regions of China. After receiving uniform training, the students gave out the questionnaires during winter holidays as a means to get data from different regions in China. The questionnaire (Appendix A) included a brief explanation of the purpose of the study, the socioeconomic characterization of the participants and questions on utilization frequency of the 95 CMM. Before applying the questionnaire, the project was fully detailed and the potential responder assured that he/she could refuse to participate or quit at any time. The 95 species were selected based on the following two lists: (1) the law on medicinal diets known as the “Dual Use for Food and Medicine List” and (2) a dataset consisting of species named more than 100 times in the 7700 medicinal diet recipes listed in the Chinese Medicinal Diets Dictionary (Wang, 2002). For convenience, the species were grouped into six categories: fruits, seeds, flowers, rhizomes, leaves/whole herbs, and others. The herbs were used as part of the daily diets, such as in tea, drinks, snacks or meals. The participants were asked to rate each herb as (5) always used, (4) frequently used, (3) used, (2) rarely used, or (1) never used.

2.1.2. Medicinal diet restaurants CMM that are frequently and currently used in restaurants specializing in medicinal diets (medicinal diet restaurants) were recorded. Medicinal diet restaurants were selected by interviewing key informants and by conducting an internet search (http://www.dianping.com/). Out of nearly 200 medicinal diet restaurants identified on the internet, only 32 restaurants with specific location information, operating history, customer evaluation and medicinal diet specialties were included in this study. Restaurants that were visited were fully informed about the project and its purposes and were free to refuse to participate. Out of the 32 restaurants visited, none refused. 2.2. Date analysis The frequency of CMM use was calculated as the percentage of participants that rated a given CMM as 5, 4 or 3. An analysis of the frequency with which each CMM was used was conducted using SPSS Version 19.0.

3. Results 3.1. CMM in daily diets The demographic characteristics of the participants are presented in Table 1. The cohort was 46.1% male and 53.9% female. Most of the responders were 21-30 years old (68.7%). It was observed that 45.6% of the participants were enrolled in university, and 33.2% of this group were enrolled in graduate school. Most people who participated in this study were well-educated, primarily consisting of the friends, relatives or neighbours of interviewers. The age and educational level may reflect the selection bias of the student who carried on the interviews. This is also a limitation of this study. Figure 1 shows the distribution of participants. Most participants were from North China (28.8%), Central China (25.9%) and East China (21.0%), with fewer hailing from Northwest China (9.3%), Northeast China (8.0%), Southwest China (5.2%) and South China (1.8%). Hunan, Shanxi, Hebei and Shandong provinces each had more than 100 responses collected. Figure 2 shows the frequency of use for the 95 CMM (Appendix B) listed in the

questionnaires. Only 10 CMM were reported as commonly used (always used [5], frequently used [4] or used [3]) by more than 50% of the participants. Table 2 details the 10 most commonly used CMM in daily diets and provides basic chemical and pharmacological information for each species. Figure 3 shows the number of species reported by more than 50% of the participants in each region in China. The relatively small number of species cited as commonly used may reflect the fact that different species are used in different regions in China. For instance, in analysing the 316 questionnaires from Central China, the data show that 11 species were cited by more than 50% of this subgroup. Along with the 10 most commonly used species throughout the entire country, Nelumbinis Semen is also frequently consumed in Central China. This may correspond to the abundance of Nelumbinis Semen in the Dongting Lake, which is located in this area. Analysing the 114 questionnaires from Northwest China, the data show that only 7 species were cited by more than 50% of this subgroup, excluding Longan Arillus, Dioscoreae Rhizoma and Chrysanthemi Flos. These 3 species are not medicinal materials produced in this region, which has an underdeveloped economy and inconvenient traffic. Thus, it is relatively difficult for people in Northwest China to acquire these 3 species. In analysing the 63 questionnaires from Southwest China, the data show that 20 species were cited by more than 50% of this subgroup. In this region, the CMM resources are abundant, and many people consume the local herbs as food and medicine. 3.2. CMM in medicinal diet restaurants Thirty-two restaurants located in 12 provinces were studied. Beijing and Guangzhou had the highest number of medicinal diet restaurants, and we found that most medicinal diet restaurants are located in the eastern part of China. In addition, there were often more restaurants in the capital cities of the provinces than in other cities, which may be because medicinal diet restaurants are middle-to-high end restaurants, and the eastern part of China is more developed; therefore, people in this region can spend more on healthy eating. After searching, a total of 60 CMM were recorded at the 32 restaurants, with at least 3 restaurants offering 23 CMM. Figure 4 shows the distribution of the visited restaurants in column A and the CMM provided

in column B.

4. Discussion 4.1. Ten most commonly used CMM in daily diets Many Chinese people incorporate medicinal diets into their daily routine to promote their health and adjust their constitution, such as Jujubae Fructus tea to replenish blood and Chrysanthemi Flos tea to combat overheating. Sometimes, medicinal diets can also be used to cure minor ailments, such as drinking Zingiberis Rhizoma Recens tea to treat a cold (Wang, 2012) or eating rock sugar-steamed pears to cure a cough (Shen and Zhang, 1997). Furthermore, medicinal diets are also used for rehabilitation after a severe illness, such as black-bone chicken soup after surgery and mutton soup with Angelicae Sinensis Radix and Zingiberis Rhizoma Recens after childbirth (Tan et al., 2010b). In China, men and women of all ages use some aspects of medicinal diets in their daily lives. We identified the 10 most commonly used CMM in daily diets, among which the majority of the medicinally used parts are seeds and fruits, with fewer roots, bulbs, flowers and animal products. We also found that these species were consumed in different ways, such as in herbal teas, soups, snacks and condiments. Among the 10 most used species, 60% contain polysaccharides, which have been shown to possess antilipemic, antitumour, antioxidant, antidiabetic and immunomodulatory effects (Li et al., 2013b; Ma and Li, 2015; Shen et al., 2011b; Xu et al., 2012; Zhao et al., 2013). Amino acids (60%), flavonoids (30%), volatile oils (30%), saponins (20%), alkaloids (20%) and phenolic compounds (10%) were also widely distributed among the top species reported. It has been well accepted that plants are the most critical source of exogenous antioxidants for humans, and phenolic compounds are known to play a significant role as antioxidants. Natural antioxidants maintain the balance of redox activity in the body and promote overall health (Li et al., 2008; Siti et al., 2015; Tan et al., 2010a). The data show that these species possess a wide spectrum of biological properties, including antitumour (80%), antioxidant (50%), antidiabetic (40%), antilipemic (40%), anti-aging (40%), antimicrobial (40%) and cardioprotective (40%) activities.

4.2. Different CMM are consumed in different regions The data show that Jujubae Fructus is the most frequently used CMM in Central China, North China, Northeast China, Northwest China and East China. This widespread use may be associated with the abundance, good taste, convenient methods of ingestion, established history and multiple effects. Jujubae Fructus has been developed into more than 120 types of products (Chen et al., 2015). With more than 2000 years of historic consumption and evidence of its multiple effects, such as supplementing qi, nourishing blood and soothing the nerves, Jujubae Fructus is widely enjoyed by the Chinese population. A well-known Chinese proverb states “If you eat three Jujubae Fructus every day, you do not need to look for a doctor.” In Southwest China, Zanthoxyli Pericarpium is the most consumed species. Because the weather of Southwest China is damp and warm, the people there tend to eat more spicy and fragrant food to dispel the dampness. With its pungent, fragrant and spicy taste, Zanthoxyli Pericarpium can not only mask the smell of fish and mutton in dishes but also promote digestion and dispel dampness from the body. It plays a great therapeutic effect for the local people. Chrysanthemi Flos is most frequently consumed in South China where the habit of “eating Chrysanthemi Flos” is highly popular. In this region, the climate is very damp and hot (Zhou, 2007), and Chrysanthemi Flos is believed to be beneficial for the local people due to its refreshing, detoxifying, heat-clearing, liver-clearing and vision-improving effects. Furthermore, herbal tea has a long history and is still widely enjoyed in South China, and Chrysanthemi Flos is commonly used as an important raw material of herbal teas in South China. 4.3. Medicinal diet restaurants are associated with the climate environment and dietary culture Medicinal diet restaurants are mostly sought after by elderly people who are more concerned about their health issues. The wealthy population constitute other segment of frequent customers because these restaurants are significantly more expensive and medicinal diets are considered vogue. The development of medicinal diet restaurants has certain regional restrictions and is associated with the local climate environment

and dietary culture. For example, Guangdong province has the most intense medicinal dietary culture in China. The climate of Guangdong is wet and hot, and people there frequently sweat and are commonly deficient in yin. To acclimatize to the region, Cantonese people gradually developed herbal tea which could clear heat, eliminate dampness and nourish yin. The earliest record of Guangdong herbal tea was written in Ling Nan Wei Sheng Fang more than 700 years ago. Over time, herbal tea has become a symbol of the Guangdong medicinal diet culture and been recognized as a nationally intangible cultural heritage. Another symbol of the Guangdong medicinal diet culture is slow-cooked soup. By using a clay pot, earthen pot or casserole dish as a vessel, slow-cooked soups maintain the characteristics of the traditional Chinese medicine prescription decoctions, retain the original flavour of the foods and dissolve the effective ingredients of the herbs. The type of slow-cooked soups changes with the shifts in the seasons. There is an idiom in Guangdong stating “I would rather eat with no dishes, but cannot eat without soup.” Herbal tea and slow-cooked soup helped the Cantonese population adapt to the damp and hot weather (Ding et al., 2008; Liu et al., 2015) and have gradually become integrated into the local people’s daily life as well as into medicinal diet restaurants. 4.4. CMM used in medicinal diet restaurants We collected information regarding the CMM used in medicinal diet restaurants and found that Gastrodiae Rhizoma was the CMM most commonly used. We investigated 32 restaurants, 8 of which offered Gastrodiae Rhizoma with steamed mandarin fish, stewed squab and pig feet, among other dishes. These dishes are considered beneficial for those experiencing dizziness, headaches and/or rheumatism because Gastrodiae Rhizoma is thought to extinguish wind, stop spasms, dispel wind, unblock the meridian and activate collaterals according to traditional Chinese medicine theory. The use of Dioscoreae Rhizoma was cited by 7 different restaurants in varying dishes. With its functions of tonifying qi, nourishing yin, and tonifying the spleen, lung and kidney, these dishes are suitable for individuals presenting with spleen qi deficiency syndromes with anorexia as well as lung qi deficiency with coughing. Angelicae Sinensis Radix appeared in 6 different restaurants, being offered

with stewed lamb, salty chicken, lamb and palmatum. Angelicae Sinensis Radix has the functions of tonifying the liver and kidney, nourishing blood and activating blood circulation. This herb is suitable for individuals with blood deficiency. Ginseng Radix et Rhizoma was offered in dishes at 6 different restaurants. With its long history of usage, Ginseng Radix et Rhizoma has multiple described functions, which include reinforcing original qi, promoting the generation of body fluid to alleviate thirst, inducing tranquilization of the mind and improving the intelligence. 4.5. CMM in daily diets and medicinal diet restaurants Only Dioscoreae Rhizoma, Lycii Fructus, Chrysanthemi Flos and Longan Arillus were found in daily diets as well as in medicinal diet restaurants. These 4 species have been used for more than 2000 years in China. Their safety has been established over time. They all have a sweet flavour. According to traditional Chinese medicine theory, sweet flavours always function to nourish and moderate. These 4 species all contain polysaccharides and vitamins, which indicates that they possess not only medicinal properties but also nutritional value. Additionally, they all exert antioxidant, antidiabetic, antilipemic, and cardioprotective functions. Some species were observed in medicinal diet restaurants but were not used very often in daily diets, which may be associated with a relatively expensive cost and/or the difficulties in using these herbs to prepare delicious homemade dishes. Some species are used frequently in daily diets but are absent from medicinal diet restaurants. One possible reason is that species that are used in restaurant kitchens as condiments but were not mentioned on the menu were not included in the analysis. It is common practice for medicinal diet restaurants to name dishes with the specific CMM in order to attract consumers. Another possible reason is that some species are commonly eaten as snacks, fruits or sweets in daily life but are not very common in restaurant-prepared dishes. 4.6. Toxicity of CMM Some species used in medicinal diets have been reported to cause allergic or adverse reactions. For instance, Zanthoxyli Pericarpium is used to alleviate pain and increase appetite. However, it may cause allergic reactions in some individuals, with itching of the oropharyngeal mucosa; swelling of the tongue, lips and face; cramping

in the stomach; vomiting; diarrhoea; breathing problems; and even anaphylactic shock (Li et al., 2009). Ganoderma used for its functions as immune regulation, antitumour, antiviral, anticoagulant and other pharmacological effects, has been used as a traditional tonic CMM in China (Yang, 2012). Ganoderma injection was reported to cause allergic reactions. It was suggested to be used only orally (Da et al.,1981) and injections are no longer available. It has also been recognized that large dosages and/or long-term consumption of Aloe or Cassiae Semen could cause diarrhoea and acute renal failure due to the presence of anthraquinones. Therefore, consumption of these species requires caution, especially by pregnant woman (Lin, 2012; Zhou and Li, 2009). Armeniacae Semen Amarum and Persicae Semen contain amygdalin, which may generate prussic acid via hydrolysis. Small dosages of prussic acid are believed to calm the respiratory centre and relieve cough, but larger doses can act as a poison and paralyze the medullary respiratory centre. Their consumption is regulated to be less than 20 g per day (Du et al., 2013; Zhou, 2001). Ginkgo Semen contains ginkgolic acids, hydroginkgolic acid and hydroginkgolinic acid, which are destroyed by cooking. However, eating a large amount of raw or undercooked Ginkgo Semen can easily cause food poisoning; therefore, it must be consumed after cooking, and less than 30 g per day for adults (Hu et al., 2006). Polygoni Multiflori Radix was widely reported to cause liver adverse reaction. However, studies showed that high doses of Polygoni Multiflori Radix could cause liver injury in normal animals, but instead liver protection in chronic liver injury animal models. The use of Polygoni Multiflori Radix should be closely monitored and specifically determined for different individuals (Pang et al., 2015; Yu et al., 2010). 4.7. Limitations This study presents several limitations. As a result of the strategy selected to reach different regions throughout China, most of the interviews were conducted with participants between 20-30 years old and enrolled in university or graduate school, a subpopulation that is significantly different from the country’s overall demographics. Although the daily diet results could change with a different distribution of participants, the data show that the use of CMM in daily diets is well established

among young people and therefore is likely to continue as a common habit. The data also indicate some loss of knowledge given that only 10 out of 95 species were identified as commonly used. When collecting data about CMM used in medicinal diet restaurants, we could only review menus; the kitchens were not open to guests. For this reason, some CMM commonly used as condiments may have been omitted from our results. Despite these limitations, this is one of the first studies to investigate the CMM used in medicinal diets, and the results provided valuable insights into the current situation in China and summarized the regularities of CMM used in medicinal diets. Medicinal diets are common and thriving, and we will continue to investigate them.

5. Conclusions This paper is one of the first studies focusing on the CMM used in medicinal diets. The 10 most commonly consumed CMM in daily diets were identified as Jujubae Fructus, Mel, Zingiberis Rhizoma Recens, Dioscoreae Rhizoma, Crataegi Fructus, Lycii Fructus, Zanthoxyli Pericarpium, Chrysanthemi Flos, Sesami Semem Nigrum and Longan Arillus. These CMM possess various biological effects that target the most frequent health problems currently occurring in the majority of the population (Wang, 2014). Twenty-three CMM were found to be offered by more than 3 medicinal diet restaurants. And only Dioscoreae Rhizoma, Lycii Fructus, Chrysanthemi Flos and Longan Arillus were found to be commonly used both in daily diets and medicinal diet restaurants. Some of the similarities shared by these 4 species include an extensive history of use, a sweet flavour, and antioxidant, anti-diabetic, antilipemic and cardioprotective effects. Medicinal diets combine herbs and food together in a reasonable manner based on traditional Chinese medicine theory. The appropriate compatibility of CMM, culinary principles, and flavour are all considered when creating these dishes. Medicinal diets have a great advantage in ameliorating chronic diseases (Xu, 2016), and the future of the medicinal diet industry has great potential. It is necessary to study ancient herbal remedies to assess the medicinal diet recipes that have been used for hundreds of

years and are still eaten today. In addition, chemical and pharmacological experiments should be performed on the recipes to explore the mechanisms of their medicinal effects. If a recipe is proven to be effective, then steps should be taken to industrialize and popularize the product. There is an urgent need to establish relevant industry standards, develop criteria regarding raw materials and the production process, and set up a regulatory system for licensed medicinal diet chefs who have knowledge of traditional Chinese medicine and nutrition as well as the ability to cook with these principles in mind. Establishing uniform standards and promoting new medicinal diets are important aspects in the industrialization of medicinal diets. This paper provided useful information for commercial exploitation of medicinal diets and served as the basis for further studies on various aspects of medicinal diets.

Authors’ contributions Fang Tan designed the study, collected and analysed data and wrote the manuscript. Yalin Chen, Xiaolei Tan and Yunyun Ma collected and analysed data and revised the manuscript. Yong Peng designed the study, supervised experimental procedures and revised the manuscript.

Acknowledgements This work was supported by a grant (81373923) from the Chinese National Natural Science Foundation. The authors thank Prof. Roberto Regensteiner and Prof. Elaine Elisabetsky from the Universidade Federal do Rio Grande do Sul for helping with the manuscript. We thank Prof. Yanze Liu from the Institute of Medicinal Plant Development for providing helpful comments. We also thank Mr. Hongxiang Li and Mr. Dongfang Zhang from the Institute of Medicinal Plant Development for editing the figures. Gratitude is also given to all the interviewers from Beijing University of Chinese Medicine and Peking Union Medical College. We also thank all the participants who unreservedly shared their knowledge of medicinal diets with us.

Appendix A Table A.1 Questions in the written questionnaire. 1 Purpose of the study 2 Date and address of interview 3 Name and hometown of the participant 4 Age and sex of the participant 5 Telephone and address of the participant 6 Educational level of the participant 7 Income of the participant 8 Health condition of the participant 9 How much do you know about medicinal diets? 10 Why do you care about medicinal diets? 11 Who do you think needs to ingest medicinal diets? Questions on the utilization frequency of the 95 CMM (rate each herb as (5) always used, (4) frequently used, (3) used, (2) rarely used, or (1) never 12 used). For convenience, the species were grouped into six categories: fruits, seeds, flowers, rhizomes, leaves/total herb, and others.

Appendix B Table A.2 Names of the 95 CMM in the written questionnaire. N CMM Vernacular Actions of CMM * o. name Tonify the middle 1 Jujubae Fructus Dazao

2

Mel

Fengmi

3

Zingiberis Rhizoma Recens

Shengjiang

4

Rhizoma Dioscoreae

Shanyao

5

Crataegi Fructus

Shanzha

6

Lycii Fructus

Gouqizi

7

Zanthoxyli Pericarpium

Huajiao

8

Chrysanthemi

Juhua

energizer and tonify qi, nourish blood and tranquilize the mind Tonify the middle energizer, moisten dryness, relieve pain, and remove toxin; topical application: promote tissue regeneration and wound healing Release the exterior and dissipate cold, warm the middle energizer to check vomiting, resolve phlegm and suppress cough, and reduce toxin from fishery products Regulate qi and relieve pain, remove toxin and disperse swelling Promote digestion and invigorate the stomach, move qi and dissipate stasis, resolve turbidity and lower lipid levels

Nourish the liver and kidney; replenish essence to improve vision Warm the middle energizer and relieve pain; kill worms to relieve itching

Disperse wind and clear

Scientific name Ziziphus jujuba Mill.

Apis cerana Fabricius Apis mellifera Linnaeus

Zingiber officinale Roscoe

Dioscorea oppositifolia L. Crataegus pinnatifida var. major N.E.Br.

Crataegus pinnatifida Bunge Lycium barbarum L. Zanthoxylum schinifolium Siebold & Zucc. Zanthoxylum bungeanum Maxim. Chrysanthemum

Flos

9

Sesami Semem Nigrum

Heizhima

1 0

Longan Arillus

Longyanro u

1 1

Anisi Stellati Fructus

Bajiaohuixi ang

1 2

Nelumbinis Semen

Lianzi

1 3 1 4

Lonicerae japonicae Flos Citri Reticulatae Pericarpium

Jinyinhua

1 5

Coicis Semen

Yiyiren

1 6

Foeniculi Fructus

Xiaohuixia ng

1 7

Mume Fructus

Wumei

1 8

Ziziphi Spinosae Fructus

Suanzao

1 9

Laminariae Thallus

Kunbu

Chenpi

heat, pacify the liver to improve vision, and remove toxin Tonify the liver and kidney, replenish essence and blood, and moisten the intestines Tonify and replenish the heart and spleen, nourish blood and tranquilize the mind Warm yang and dissipate cold; regulate qi to relieve pain Tonify the spleen to check diarrhoea, check vaginal discharge, tonify the kidney to astringe essence, and nourish the heart to tranquilize the mind Clear heat and remove toxin; disperse wind-heat Regulate qi and fortify the spleen, dry dampness and resolve phlegm Promote urination to drain dampness, fortify the spleen to check diarrhoea, relieve impediment, expel pus, remove toxin and dissipate binds Dissipate cold and relieve pain; regulate qi to harmonize the stomach Constrain the lung, astringe the intestines, engender fluid, quiet ascaris Calm the heart to tranquilize the mind, check sweating, and engender fluid Resolve phlegm, soften hardness and dissipate

morifolium Ramat.

Sesamum indicum L.

Dimocarpus Longan Lour.

Illicium verum Hook. f. Nelumbo nucifera Gaertn.

Lonicera japonica Thunb. Citrus reticulata Blanco Coix lacryma-jobi L. var. ma-yuen (Rom. Caill.) Stapf

Foeniculum vulgare Mill. Prunus mume (Siebold) Siebold & Zucc. Ziziphus jujuba var. spinosa (Bunge) Hu ex H. F. Chow Laminaria japonica Aresch.

binds, and promote urination to alleviate oedema

Ecklonia Thallus 2 0

Chaenomelis Fructus

Mugua

2 1

Lilii Bulbus

Baihe

2 2

Menthae haplocalycis Herba

Bohe

2 3

Vignae Semen

Chixiaodou

2 4

Armeniacae Semen Amarum

Tianxingre n

2 5

Glycyrrhizae Radix et Rhizoma

Gancao

Relax sinews and activate collaterals, harmonize the stomach and resolve dampness Nourish yin and moisten the lung; clear the heart to tranquilize the mind

Disperse wind-heat, clear and sooth head and eyes, soothe the throat, promote eruption, and soothe the liver to move qi Promote urination to alleviate oedema, remove toxins and expel pus

Direct qi downward to suppress cough and relieve panting and moisten the intestines to relax the bowels

Tonify the spleen and tonify qi, clear heat and remove toxin, dispel phlegm to suppress cough, relax spasm and relieve pain, and moderate drug actions

Ecklonia kurome Okam. Chaenomeles speciosa (Sweet) Nakai Lilium lancifolium Thunb. Lilium brownii var. viridulum Baker Lilium pumilum Delile Mentha haplocalyx Briq.

Vigna umbeuata (Thunb.) Ohwi & H.Ohashi Vigna angularis (Willd.) Ohwi & H.Ohashi Prunus armeniaca var. ansu Maxim.

Prunus armeniaca L. Glycyrrhiza uralensis Fisch．

Glycyrrhiza inflata Batalin Glycyrrhiza glabra

2 6

Asini Corii Colla

Ejiao

2 7

Persicae Semen

Taoren

2 8

Cinnamomi Cortex

Rougui

2 9

Mori Fructus

Sangshen

3 0

Piperis Fructus

Hujiao

3 1

Sterculiae Lychnophorae Semen

Pangdahai

3 2

Angelicae Sinensis Radix

Danggui

3 3

Sophorae Flos

Huaihua

3 4

Hordei Fructus Germinatus

Maiya

3

Canavaliae Semen

Daodou

Nourish blood and replenish yin, moisten dryness, and stanch bleeding Activate blood to eliminate stasis, moisten the intestines to relax the bowels, suppress cough and relieve panting

Tonify fire and assist yang, conduct fire back to its origin, dissipate cold and relieve pain, and warm and unblock the meridian Replenish yin and nourish blood, engender fluid and moisten dryness Warm the middle energizer to dissipate cold, direct qi downward, and resolve phlegm Clear heat and moisten the lung, soothe the throat to restore the voice, and moisten the intestines to relax the bowels Nourish blood and activate blood, regulate menstruation and relieve pain, and moisten the intestines to relax the bowels Cool the blood to stanch bleeding; clear the liver and purge fire Move qi and promote digestion, fortify the spleen and increase the appetite, lactifuge and relieve distention Warm the middle

L． Equus asinus L.

Prunus persica (L.) Batsch

Prunus davidiana (CarriŠre) Franch. Cinnamomum cassia (L.) J. Presl

Morus alba L.

Piper nigrum L.

Sterculia lychnophora Hance

Angelica sinensis (Oliv.) Diels

Sophora japonica L.

Hordeum vulgare L.

Canavalia gladiata

5

3 6

Cassiae Semen

Juemingzi

3 7

Perillae Folium

Zisu

3 8

Houttuyniae Herba

Yuxingcao

3 9

Siraitiae Fructus

Luohanguo

4 0

Ginkgo Semen

Baiguo

4 1

Portulacae Herba

Machixian

4 2

Codonopsis Radix

Dangshen

4 3

Armeniacae Semen Amarum

Kuxingren

energizer, direct qi downward, and relieve hiccups Clear heat and improve vision; moisten the intestines to relax the bowels Release the exterior and dissipate cold, move qi and harmonize the stomach Clear heat and remove toxin, disperse abscesses and expel pus, disinhibit urine and relieve stranguria Clear heat and moisten the lung, soothe the throat to restore the voice, and lubricate intestines to relax the bowels Constrain the lung to check wheezing, check vaginal discharge, and reduce urination Clear heat and remove toxin, cool the blood to stanch bleeding, and check dysentery Fortify the spleen and replenish the lung; nourish blood and engender fluid

Direct qi downward to suppress cough and relieve panting; moisten the intestines to relax the bowels

(Jacq.) DC.

Cassia obtusifolia (L.) H. S. Irwin & Barneby Cassia tora L. Perilla frutescens (L.) Britton Houttuynia cordata Thunb.

Siraitia grosvenorii (Swingle) C. Jeffrey ex A. M. Lu & Zhi Y. Zhang Ginkgo biloba L.

Portulaca oleracea L.

Codonopsis pilosula (Franch.) Nannf. Codonopsis pilosula var. modesta (Nannf.) L. D. Shen Codonopsis tangshen Oliv. Prunus armeniaca var. ansu Maxim.

Prunus sibirica L. Prunus mandshurica (Maxim.) Koehne

4 4

Platycodonis Radix

Jiegeng

4 5

Ziziphi Spinosae Semen

Suanzaoren

4 6

Poria

Fulin

4 7

Astragali Radix

Huangqi

4 8

Taraxaci Herba

Pugongyin g

4 9

Lablab Semen Album

Baibiandou

5 0

Puerariae lobatae Radix

Gegen

Diffuse the lung, soothe the throat, dispel phlegm, and expel pus Nourish the heart and tonify the liver, calm the heart to tranquilize the mind, check sweating, and engender fluid Promote urination to drain dampness, fortify the spleen, and calm the heart Tonify qi and upraise yang, secure the exterior to check sweating, promote urination to alleviate oedema, engender fluid and nourish blood, move stagnation to relieve impediment, expel toxin and expel pus, promote wound healing and promote tissue regeneration

Clear heat and remove toxins, disperse swelling and dissipate binds, disinhibit urine and relieve stranguria

Fortify the spleen and resolve dampness, harmonize the middle and remove summer heat Release the flesh and reduce fever, engender fluid to quench thirst, promote eruption, upraise

Prunus armeniaca L. Platycodon grandiflorus (Jacq.) A. DC. Ziziphus jujuba var. spinosa (Bunge) Hu ex H. F. Chow

Poria cocos (Schw.) Wolf Astragalus membranaceus var. mongholicus (Bunge) P. K. Hsiao

Astragalus membranaceus (Fisch.) Bunge Taraxacum mongolicum Hand. -Mazz.

Taraxacum borealisinense Kitam. Dolichos lablab L.

Pueraria montana var. lobata (Willd.) Sanjappa & Pradeep

the middle qi to check diarrhoea, unblock the meridian and activate collaterals, and remove wine toxin

5 1

Nelumbinis Folium

Heye

5 2

Pogostemonis Herba

Guanguoxi ang

5 3

Ginseng Radix et Rhizoma

Renshen

5 4

Polygonati odorati Rhizoma

Yuzhu

5 5

Lonicerae Flos

Shanyinhua

5

Hippophae

Shaji

Clear summer heat and resolve dampness, upraise the clear yang, and cool the blood to stanch bleeding Resolve turbidity with aromatic medicinal use, harmonize the middle and check vomiting, and release the exterior and summer heat

Greatly tonify the original qi, resume pulse and secure collapse, tonify the spleen and replenish the kidney, engender fluid and nourish blood, tranquilize the mind and replenish wisdom Nourish yin and moisten dryness; engender fluid to quench thirst Clear heat and remove toxin; disperse wind heat

Tonify the spleen to

Pueraria montana var. chinensis (Ohwi) Sanjappa & Pradeep Nelumbo nucifera Gaertn.

Pogostemon cablin (Blanco) Benth.

Agastache rugosus (Fisch. & C.A. Mey.) Kuntze. Panax ginseng C. A. Mey.

Polygonatum odoratum (Mill.) Druce Lonicera macranthoides Hand. -Mazz. Lonicera hypoglauca Miq. Lonicera confusa DC. Lonicera macrantha (D.Don) Spreng. Hippophae

6

Fructus

5 7

Sojae Semen Praeparatum

Dandouchi

5 8

Caryophylli Flos

Dingxiang

5 9

Gardeniae Fructus

Zhizi

6 0

Canarii Fructus

Qingguo

6 1

Salviae miltiorrhizae Radix et Rhizoma

Danshen

6 2

Ophiopogonis Radix

Maidong

6 3

Perillae Fructus

Zisuzi

6 4

Citri Sarcodactylis Foshou Fructus

6 5

Mori Folium

Sangye

promote digestion, suppress cough and dispel phlegm, and activate blood to dissipate stasis Release the exterior pattern, relieve vexation, and disperse depressed heat Warm the middle energizer and downbeat counterflow, tonify the kidney and assist yang Purge fire to relieve vexation, clear heat and drain dampness, cool the blood to remove toxin; Topical application: disperse swelling and relieve pain Clear heat and remove toxin, soothe the throat, and engender fluid Activate blood and eliminate stasis, unblock the meridian to relieve pain, clear the heart and relieve vexation, cool the blood and disperse abscesses Nourish yin and engender fluid, moisten the lung and clear the heart Direct qi downward and resolve phlegm, suppress cough and relieve panting, and moisten the intestines to relax the bowels Soothe the liver and regulate qi, harmonize the stomach and relieve pain, dry dampness and resolve phlegm Disperse wind heat, clear heat and moisten dryness,

rhamnoides L.

Glycine max (L.) Merr.

Syzygium aromaticu m (L.) Merr. & L. M. Perry Gardenia jasminoides J. Ellis

Canarium album Raeusch. Salvia miltiorrhiza Bunge

Ophiopogon japonicus (Thunb.) Ker Gawl. Perilla frutescens (L.) Britton

Citrus medica L.

Morus alba L.

6 6

Euryales Semen

Qianshi

6 7

Rubi Fructus

Fupenzi

6 8

Citri Exocarpium Rubrum

Juhong

6 9

Angelicae Dahuricae Radix

Baizhi

7 0

Galli Gigerii Endothelium Corneum

Jineijin

7 1

Rehmanniae Radix

Dihuang

7 2

Alpiniae Officinarum Rhizoma Amomi Fructus

Gaoliangjia ng

7 3

Sharen

and clear the liver to improve vision Tonify the kidney and secure essence, tonify spleen to check diarrhoea, and dispel dampness to check vaginal discharge Tonify the kidney, secure essence to reduce urination, and nourish the liver to improve vision Regulate qi and soothe the middle, dry dampness and resolve phlegm Release the exterior and dissipate cold, dispel wind and relieve pain, open nose orifices, dry dampness and check vaginal discharge, disperse swelling and expel pus

Euryale ferox Salisb.

Rubus chingii Hu

Citrus reticulata Blanco Angelica dahurica (Hoffm.) Benth. & Hook.f. ex Franch. & Sav.

Angelica dahurica var. formosana (Boissieu) Yen Invigorate the stomach to Callus gallus promote digestion, astringe domesticus Brisson essence and check seminal emission, relieve stranguria, and expel stones Fresh Rehmanniae Radix: clear heat and engender fluid, cool the blood, and stanch bleeding. Unprocessed Rehmanniae Radix: clear heat and cool the blood, nourish yin and engender fluid Warm the stomach to check vomiting, dissipate cold and relieve pain Resolve dampness to increase the appetite, warm the spleen to check

Rehmannia glutinosa (Gaertn.) DC.

Alpinia officinarum Hance Amomum villosum Lour.

diarrhoea, and regulate qi to prevent miscarriage

7 4

Phragmitis Rhizoma

Lugen

7 5

Lophatheri Herba

Danzhuye

7 6

Polygonati Rhizoma

Huangjing

7 7 7 8

Cannabis Fructus

Huomaren

Allii Macrostemonis Bulbus

Xiebai

7 9

Myristicae Semen

Roudoukou

8 0

Imperatae Rhizoma

Baimaogen

8 1

Corni Fructus

Shanzhuyu

8

Cichorii Herba

Juju

Clear heat and purge fire, engender fluid to quench thirst, relieve vexation, check vomiting, and disinhibit urine Clear heat and purge fire, relieve vexation and quench thirst, disinhibit urine and relieve stranguria Tonify qi and nourish yin, fortify the spleen, moisten the lung, and tonify the kidney

Moisten the intestines to relax the bowels Unblock yang and dissipate binds; move qi to remove stagnation

Warm the middle energizer and move qi; astringe the intestines to check diarrhoea Cool the blood to stanch bleeding, clear heat and disinhibit urine Tonify and nourish the kidney and liver; astringe to secure collapse Clear the liver and

Amomum villosum var. xanthioides (Wall. ex Baker) T. L. Wu & S. J. Chen Amomum longiligulare T. L. Wu Phragmites communis Trin.

Lophatherum gracile Brongn.

Polygonatum kingianum Collett & Hemsl. Polygonatum sibiricum Redouté Polygonatum cyrtonema Hua Cannabis sativa L. Allium macrostemon Bunge Allium chinense G. Don Myristica fragrans Houtt.

Imperata cylindrica var. major (Nees) C. E. Hubb. Cornus officinalis Siebold & Zucc. Cichorium

2

8 3

Atractylodis Macrocephalae Rhizoma

Baizhu

8 4

Torreyae Semen

Feizi

8 5

Raphani Semen

Laifuzi

8 6

Citri Fructus

Xiangyuan

8 7

Eucommiae Cortex

Duzhong

8 8

Phyllanthi Fructus

Yuganzi

8 9

Aconm Lateralis Radix Praeparaia

Fuzi

9 0

Chuanxiong Rhizoma

Chuanxion g

9 1

Citri Aurantii Flos

Daidaihua

disinhibit the gallbladder, invigorate the stomach to promote digestion, disinhibit urine and disperse swelling Fortify the spleen and replenish qi, dry dampness and induce diuresis, cheek sweating, and prevent miscarriage Kill worms and eliminate accumulation, moisten the lung to suppress cough, and moisten dryness to relax the bowels Promote digestion, relieve distention, direct qi downward and resolve phlegm Soothe the liver and regulate qi, soothe the middle, and resolve phlegm

Tonify the liver and the kidney, strengthen sinews and bones, and prevent miscarriage Clear heat and cool the blood, promote digestion and invigorate the stomach, engender fluid and suppress cough Restore yang to save from collapse, tonify fire and assist yang, dissipate cold and relieve pain Activate blood and move qi; dispel wind to relieve pain Regulate qi and fortify the spleen, promote digestion and invigorate the

glandulosum Boiss. & A. Huet Cichorium intybus L. Atractylodes macrocephala Koidz.

Torreya grandis Fortune ex Lindl.

Raphanus sativus L.

Citrus medica L.

Citrus wilsonii Yu.Tanaka Eucommia ulmoides Oliv.

Phyllanthus emblica L.

Aconitum carmichaelii Debeaux Ligusticum striatum DC. Citrus aurantium L.

9 2

9 3

9 4

Dendrobii Caulis

Cistanches Herba

Moslae Herba

Shihu

Roucongro ng

Xiangru

stomach, dry dampness and resolve phlegm Boost the stomach and engender fluid, nourish yin and clear heat

Tonify the kidney yang, replenish essence and blood, and moisten the intestines to relax the bowels

Dendrobium nobile Lindl Dendrobium chrysotoxum Lindl. Dendrobium fimbriatum Hook. Cistanche deserticoLa Y. C. Ma

Cistanche tubulosa (Schenk)Wight Promote sweating to Mosla chinensis release the exterior pattern, Maxim. resolve dampness and harmonize the middle

9 5

Cirsii Herba

Xiaoji

Cool the blood to stanch bleeding, dissipate stasis, remove toxin and disperse abscesses

* According to Chinese Pharmacopoeia (2010)

Mosla chinensis Maxim. Cirsium setosum (Willd.) Besser ex M. Bieb.

Appendix C Table A.3 Latin botanical names for the CMM mentioned in this article. No.

CMM

Latin botanical names

1

Aloe

Aloe barbadensis Mill. Aloe ferox Mill.

2

Angelicae Sinensis Radix

Angelica sinensis (Oliv.) Diels

3

Arctii Fructus

Arctium lappa L.

4

Armeniacae Semen Amarum

Prunus armeniaca var. ansu Maxim. Prunus sibirica L. Prunus mandshurica (Maxim.) Koehne Prunus armeniaca L.

5

Asparagi Radix

Asparagus cochinchinensis (Lour.) Merr.

6

Astragali Radix

Astragalus membranaceus var. mongholicus (Bunge) P. K. Hsiao Astragalus membranaceus (Fisch.) Bunge

7

Cassiae Semen

Senna obtusifolia (L.) H. S. Irwin & Barneby Cassia tora L.

8

Chrysanthemi Flos

Chrysanthemum morifolium Ramat.

9

Cistanches Herba

Cistanche deserticola Y. C. Ma Cistanche tubulosa (Schenk) Wight

10

Citri Reticulatae Pericarpium

Citrus reticulata Blanco

11

Coicis Semen

Coix lacryma-jobi var. ma-yuen (Rom. Caill.) Stapf

12

Crataegi Fructus

Crataegus pinnatifida var. major N.E.Br. Crataegus pinnatifida Bunge

13

Dioscoreae Rhizoma

Dioscorea oppositifolia L.

14

Ganoderma

Ganoderma lucidum (Leyss. ex Fr.) Karst. Ganoderma sinense Zhao, Xu & Zhang

15

Gastrodiae Rhizoma

Gastrodia elata Blume

16

Ginkgo Semen

Ginkgo biloba L.

17

Ginseng Radix et Rhizoma

Panax ginseng C. A. Mey.

18

Houttuyniae Herba

Houttuynia cordata Thunb.

19

Juglandis Semen

Juglans regia L.

20

Jujubae Fructus

Ziziphus jujuba Mill.

21

Lilii Bulbus

Lilium lancifolium Thunb. Lilium brownii var. viridulum Baker Lilium pumilum Delile

22

Longan Arillus

Dimocarpus longan Lour.

23

Lycii Fructus

Lycium barbarum L.

24

Nelumbinis Semen

Nelumbo nucifera Gaertn.

25

Panacis Quinquefolii Radix

Panax quinquefolius L.

26

Perillae Folium

Perilla frutescens (L.) Britton

27

Persicae Semen

Prunus persica (L.) Batsch

Prunus davidiana (CarriŠre) Franch. 28

Polygoni Multiflori Radix

Polygonum multiflorum Thunb.

29

Polygonati Rhizoma

Polygonatum kingianum Collett & Hemsl. Polygonatum cyrtonema Hua Polygonatum sibiricum F. Delaroche

30

Poria

Poria cocos (Schw.) Wolf

31

Sesami Semem Nigrum

Sesamum indicum L.

32

Zanthoxyli Pericarpium

Zanthoxylum schinifolium Siebold & Zucc. Zanthoxylum bungeanum Maxim.

33

Zingiberis Rhizoma Recens

Zingiber officinale Roscoe

References Chen, P., Deng, C.Y., 2014. Study and application on Sesamum indicum L. (black sesame). J. Mod. Med. Health 30, 541-543. Chen, X., Li, Y.J., Yang, Q., Chen, Y., Wang, Y.J., Weng, X.G., Li, Q., Zhu, X.X., Wang, X.C., 2015. Advance in modern research and development of Ziziphus Jujuba. World Sci. Technol. -Mod. Tradit. Chin. Med. Mater. Med. 17, 687-691. Chen, X., Wang, Y.X., Zheng, L.Y., He, X.H., Han, N.Y., Liu, Y.G., 2010. Simultaneous determination of rutin and jujuboside B in Ziziphus jujuba by HPLC. China Pharm. 21, 247-248. Cui, J.J., Li, Q., Jin, Q.Z., Feng, T., 2009. Study progress of ginger and its extract: a brief review. J. Shanghai Inst. Technol. Nat. Sci. 9, 229-234. Da, L.Q., Zhou R.K., Liu J. Y., 1981. Study on the allergy test and method of Ganoderma lucidum injection. Shaanxi Med. J. 10, 54-56. Ding, J.L., Guo, J., Pu, S.H., Hu, X.G., 2008. Discussion on culture and industrial development of medicinal diets in Lingnan area. Guangdong Sci. 13, 97-100. Dong, L., Ma, X.Y., He, Z.M., Wang, F., Fu, Y., Ma, X.Q., 2010. Comparison on the polysaccharide content of Lycium barbarum L. From different regions and collection period in Ningxia. Ningxia Med. J. 32, 323-324. Dong, X.L., Zhang, W.C., Ren, S., Li, B., Li, R.F., Li, X.B., Li, G.L., 2014. Determination of chlorogenic acid in chrysanthemum ultrafine powder by HPLC. Anhui Chem. Ind. 40, 74-75, 81. Du, H.W., Zhang, A.H., Zhao, X.L., 2013. Research progress on toxicity and detoxification of Armeniacae Semen Amarum. Heilongjiang J. Tradit. Chin. Med. 43, 58-59. Etkin, N.L., Ross, P.J., 1982. Food as medicine and medicine as food. An adaptive framework for the interpretation of plant utilization among the Hausa of northern Nigeria. Soc. Sci. Med. 16, 1559-1573. Gu, X.Z., Li, X.D., Zhong, Y.Y., Mao, S.J., 2007. Modern research and application of honey. Chin. J. Exp. Tradit. Med. Formulae 21, 70-72.

Han, Q.J., Ma, H.F., 2013. Study on Zizyphus Jujuba Mill polysaccharides extraction technique by microwave extraction method. J. Anhui Agric. Sci. 41, 2250-2251. Hu, G.Q., Feng, Q.X., Xu, R.X., 2006. Clinical analysis of 25 cases of acute poisoning of Ginkgo semen. J. Clin. Emerg. 7, 133-134. Jennings, H.M., Merrell, J., Thompson, J.L., Heinrich, M., 2015. Food or medicine? The food–medicine interface in households in Sylhet. J. Ethnopharmacol. 167, 97-104. Ji, L.P., Xu, J.A., Guo, C.J., 2011. Effects of lycium on liver cellular ultrastructure and antioxidant activity of rats under tolerance training. J. Biomed. Eng. 28, 501-505. Kong, D.P., Qian, D.W., Guo, S., Duan, J.A., 2011. Determination of nucleosides compounds in nine tonic traditional Chinese medicines of fruit and seeds. Chin. J. Exp. Tradit. Med. Formulae 17, 98-101. Li, H., Cheng, X., Yin, J., Wang, R. Q., Zhang, H. Y., 2009. Clinical features of Pericarpium Zanthoxyli allergy analysis and of its allergy component. Chin. J. Allergy Clin. Immunol. 3, 184-189. Li, J., Ou, Q., Zhang, T., Bai, D.F., Yang, J., 2006. Effect of Lycium barbarum polysaccharides on expression of DNA repairase 8-oxoguanine gene in liver of aging model rats induced by D-galactose. Chin. J. Clin. Rehabil. 10, 102-104. Li, L.Y., Li, C., Nie, S.P., 2013a. Chemical components, biological functions and applications of Sesamum indicum L. (black sesame). Acad. Period. Farm Prod. Process. 21, 58-62. Li, L., Wang, Y.F., Liang, Y., Yang, X.Q., 2008. A survey research on healthy function and antioxidant activity of natural antioxidants. J. Tea 34, 70-74. Li, P.W., Zhang, J.Y., Tong, Y., Yin, P.H., Wang, X.L., 2012. Study on extraction process of polysaccharides in chrysanthemum. J. Anhui Agric. Sci. 40, 3586-3587. Li, X.B., Chen, Y. L., Zhan, J. P., Xie, Z.L., Shen, X.J., Li, R.Q., 2013b. Influence of Lycium barbarum polysaccharide on blood glucose and immune function of diabetic rats. Chin. Gen. Pract. 16, 3208-3210.

Liang, H., Zhao, L., Yang, J., Zhou, X.L., Wang, C.J., Zhou, X.L., 2014. Research process on chemical constituents and pharmacological activities of Pericarpium zanthoxyli. West China J. Pharm. Sci. 29, 91-94. Liang, Y.L., Yan, G.F., Shu, K.X., Zhang, K., Huang, Y., 2007. Study of anti-oxidant effects of extracts of Dioscorea Opposita Thunb. Food Res. Dev. 28, 1-3. Lin, L.Z., Harnly, J.M., 2010. Identification of the phenolic components of chrysanthemum flower (Chrysanthemum morifolium Ramat). Food Chem. 120, 319-326. Lin, Y., 2012. Research on the pharmacological development of aloe. Tradit. Chin. Med. 1, 30-36. Liu, D.Y., Sun, Y., Gu, Y.F., Chen, H.L., Zhao, M., Jing, D.J., 2009. Effects of jujube polysaccharide on erythrocyte immunologic function of mice. Chin. J. Tradit. Med. Sci. Technol. 16, 202-203. Liu, H.L., Shi, W.C., Qu, W.L., 2015. Discussion on origin and development of health maintenance culture in Lingnan area. China J. Tradit. Chin. Med. Pharm. 30, 3372-3374. Ma, J.X., 2009. Chinese Traditional Medicine Scientific Diet. People's Medical Publishing House, Beijing. Ma, W.P., Li, H., Ye, L.Q., Chen, M., Zhang, S., 2007. Changes of the main carotenoids pigment contents during the drying processes at different harvest stage in Lycium barbarum L. Fruits. Sci. Agric. Sin. 40, 1492-1497. Ma, Y.L., Li, H., 2015. Clinic effect of ginseng polysaccharide combined with radiation therapy in nasopharyngeal carcinoma patients. J. Mod. Oncol. 23, 1511-1514. Meng, F.Y., Ning, Y.L., Qi, J., He, Z., Jie, J., Lin, J.J., Huang, Y.J., Li, F.S., Li, X.H., 2014. Structure and antitumor and immunomodulatory activities of a water-soluble polysaccharide from Dimocarpus longan pulp. Int. J. Mol. Sci. 15, 5140-5162. Miao, M.S., Miao, Y.Y., Sun, Y.H., 2006. Effect of fructus jujubae polysaccharide on hemogram indexes and activity of ATPase in erythrocyte of rats with blood

deficiency. Chin. J. Clin. Rehabil. 10, 97-99. Nong, X.X., Li, M., 1989. Pharmacologic effects of an extract of Arillus longan (Lour.) Steud. and Gecko. China J. Chin. Mater. Med. 14, 365-7, 383. Pang, J. Y., Bai, Z. F., Niu, M., Tu, C., Ma, Z. J., Zhao, Y. L., Zhao, K.J., You, Y., Wang, J.B., Xiao, X.H., 2015. The toxic and protective effects of Polygonum multiflorum on normal and liver injured rats based on the symptom-based prescription theory. Acta Pharm. Sin. 50, 973-979. Shen, G.Z., Guo, Q., He, Z.P., 2011a. Spectrophotometric determination of total flavonoids in jujube. Studies Trace Elements Health 28, 26-27. Shen, L.H., Wang, J.S., Li, W., Zhang, D.H., Zhu, T.C., 2011b. Research and application of plant polysaccharide. Chin. Agric. Sci. Bull. 27, 349-352. Shen, X., Tang, Y., Yang, R., Yu, L., Fang, T., Duan, J.A., 2009. The protective effect of Zizyphus jujube fruit on carbon tetrachloride-induced hepatic injury in mice by anti-oxidative activities. J. Ethnopharmacol. 122, 555-560. Shen, Z.Y., Zhang, S.Q., 1997. Medicinal diet therapy to treat cough for children. J. Chin. Med. Mater. 20, 266-267. Siti, H.N., Kamisah, Y., Kamsiah, J., 2015. The role of oxidative stress, antioxidants and vascular inflammation in cardiovascular disease (a review). Vascul. Pharmacol. 71, 40-56. Sun, Y., Mei, L.F., 2013. Study Progress of Dioscorea opposita. Asia-Pac. Tradit. Med. 9, 50-51. Tan, D.Q., Deng, B.X., 2005. Brief introduction of medicinal diets and food therapy. Hunan J. Tradit. Chin. Med. 67. Tan, H.B., Wang, G.X., Zhang, H.C., Sun, C.L., Wang, L.H., 2016. Nutritional ingredients and functional activities of honey. J. Bee 36, 12-15. Tan, P.X., Ye, T., Liu, X.X., He, J.H., 2010a. Research advances in antioxidant composition of botanical extracts and their action mechanisms. J. Food Sci. 31, 288-292. Tan, S.Y., Qin, L.Y., Lu, L.B., Li, T.T., Zhou, N.N., 2010b. Clinical application of

mutton soup with Angelicae Sinensis Radix and Zingiberis Rhizoma Recens. Chin. J. Ethnomed. Ethnopharm. 19, 170. Totelin, L., 2015. When foods become remedies in ancient Greece: the curious case of garlic and other substances. J. Ethnopharmacol. 167, 30–37. Towns, A.M., van Andel, T.V., 2016. Wild plants, pregnancy, and the food-medicine continuum in the southern regions of Ghana and Benin. J. Ethnopharmacol. 179, 375-382. Tripathi, M., Pandey, M.B., Jha, R.N., Pandey, V.B., Tripathi, P.N., Singh, J.P., 2001. Cyclopeptide alkaloids from Zizyphus jujuba. Fitoterapia 72, 507-510. Wang, C.Q., Wang, R.B., Zhang, Y.H., 2014a. Chemical constituents and pharmacological activities of chrysanthemi flos. J. Changchun Univ. Tradit. Chin. Med. 30, 28-30. Wang, G., Du, S.M., Xiao, M.S., Ye, L., Chen, L., Liu, Y.X., Yuan, S.H., 2007. Extraction, isolation and determination of the polysacchrides from Dioscorea opposita. Chin. J. Hosp. Pharm. 27, 1414-1416. Wang, L.D., 2014. Exploration of strategies for chronic disease prevention and control and relevant system construction in China. Eng. Sci. 16, 22-30. Wang, L., Luo, H.X., Ju, R.H., Li, S.R., 2014b. Research process on the nutrition, antioxidant and toxic and harmful substance in honey. Food Ind. 10, 227-230. Wang, S., 2012. Using medicinal diet to treat colds. China’s Naturop. 20, 75-76. Wang, Y., Zhao, R.X., Bai, B., Liu, A.L., Liu, X.H., 2008. Analysis of fatty acids from Dioscorea opposita Thunb. J. Xinxiang Med. Coll. 25, 112-113. Wang, Z.Y., 2002. Chinese Medicinal Diet Dictionary. Press of Dalian, Dalian, China. Wu, H., Guo, H., Zhao, R., 2006. Effect of Lycium Barbarum polysaccharide on the improvement of antioxidant ability and DNA damage in NIDDM Rats. Yakugaku Zasshi J. Pharm. Soc. Jpn 126, 365-371. Wu, S.J., Li, Q.J., Xiao, X.F., Li, M., Yang, X.R., Lv, T., 2010. Research process on chemical constituents and pharmacological activities of hawthorn. Drug Eval. Res. 33, 316-319. Xu, F.X., 2016. Analysis on the nutrition state in the intervention of nutrition

consultation:135 cases of chronic diseases. World J. Integr. Tradit. West. Med. 11,1556-1159. Xu, X. J., Liu, Z.F., Huo, N.R., Zhao, Y., Tian, X., Lei, T.T., 2012. In vitro anti-oxidation capacity and immunomodulatory efficacy in mice of yam polysaccharide. J. Chin. Cereals Oils Assoc. 27, 42-46. Yang, J.S., 2012. Research progress of chemical compositions and pharmacological effects of ganoderma lucidum. Chin. Arch. Tradit. Chin. Med. 30, 906-907. Yin, X.W., Wang, L., 2010. Effects of Fructus lycii on anti-anoxia and anti-fatigue for mice. J. Agric. Sci. 31, 40-43. Yu, B.B., Yan, X.S., Sun, D.D., 2015. Research progress in pharmacological activities and mechanism of hawthorn. Cent. South Pharm. 7, 745-748. Yu, J., Xie, J., Zhao, R.H., Cai, S.Q., Chen, Z., 2010. Advances in studies on liver adverse reaction of Polygonum multiflorum. Chin. Tradit. Herb. Drugs, 41, 1206-1210. Yuan, Y.F., Zhen, H.S., Ou, X.H., 2006. Determination of vitamin C content in Ziziphus Jujuba by spectrophotometry. J. Anhui Tradit. Chin. Med. Coll. 25, 40-42. Zhang, F.F., Ma, Y.J., Sun, G.J., Miao, M., Yang, L.G., Wang, S.K., Xie, J.J., 2008. Studies on the optimum extraction technology for volatile oil in Chrysanthemum. Lishizhen Med. Mater. Med. Res. 19, 834-836. Zhang, H., Jiang, L., Ye, S., Ye, Y., Ren, F., 2010. Systematic evaluation of antioxidant capacities of the ethanolic extract of different tissues of jujube (Ziziphus jujuba Mill.) from China. Food Chem. Toxicol. 48, 1461-1465. Zhang, Z., Wu, M.D., 2006. Protective effect of jujube dates polysaccharide on chemical liver injury in mice and anti-fatigue effect. J. Nanjing Agric. Univ. 29, 94-97. Zhao, J. L., Gao, H. M., Yu, H.S., 2013. Effects of Lycium barbarum polysaccharides on lipid metabolism and oxygen free radicals in hyperlipidemic rats. Chin. J. Exp. Tradit. Med. Formulae 19, 241-243. Zhao, R., Li, Q.W., Li, J., Zhang, T., 2009. Protective effect of Lycium barbarum polysaccharide 4 on kidneys in streptozotocin-induced diabetic rats. Can. J.

Physiol. Pharmacol. 87, 711-719. Zhao, R., Li, Q., Xiao, B., 2005. Effect of Lycium barbarum polysaccharide on the improvement of insulin resistance in NIDDM rats. Yakugaku Zasshi J. Pharm. Soc. Jpn 125, 981-988. Zhao, X.L., 2012. Research process in chemical constituents, biological activities and exploration utilization of Pericarpium zanthoxyli. China Condiment 37, 1-, 5. Zhao, X.X., 2008. Bioactive components of Pericarpium and its application research. J. Changchun Univ. Nat. Sci. 18, 108-110. Zhen, L.X., Fang, Z.H., Wu, H.L., Xu, L., Jiang, Z.Z., 2007. Determination of betaine in lycium Chinese by HPLC. Anhui Med. Pharm. J. 11, 703-704. Zhou, H.H., 2001. Brief analysis of toxic and nontoxic theory of traditional Chinese Medicine. Lishizhen Med. Mater. Med. Res. 12, 840-841. Zhou, X.W., Wang, J., Duan, H., Gu, N., Liu, H.Y., Zeng, X.X., 2011. Extraction, purification and antioxidant activity in vitro of protein fractions from Dioscorea opposita Thunb. cv. Tiegun. Food Sci. 32, 31-35. Zhou, Y., 2007. The phenomenon of antipyretic tea and Guangdong traditional culture. J. Wuyi Univ. Soc. Sci. Ed. 9, 7-11. Zhou, Y.Y., Li, J.S., 2009. Analysis of the potential safety risk of semen cassiae-containing health foods. Food Sci. Technol. 34, 295-297.

Table 1 Demographic characteristics of the participants (n=1221). Factor Gender Age

Categories Male Female ≤ 20 21-30 31-40 41-50 51-60 ≥61

Educational level

Income (yuan)

Secondary school High school University Graduate school ≤ 2000

2001-4000 4001-6000 6001-8000 ≥8001

% 46.1 53.9 10.8 68.7 8.7 5.5 4.2 2.1 8.8 12.4 45.6 33.2 50.0 28.3 12.4 5.3 4.0

Table 2 The 10 most commonly used Chinese materia medica in daily diets. CMM

Vern

Scientific

Famil

Plan

Characteristic

Phytochemical

Pharmacologica

acula

name

y

t

medicinal dish

data

l properties

r

part

nam

(s)

e

used

Jujuba

Daza

Ziziphus

Rhamn

Ripe

Jujubae Fructus

Polysaccharides

Hepatoprotective

e

o

jujuba Mill.

aceae

fruit

and Nelumbinis

(Han and Ma,

(Shen et al.,

Semen soup

2013),

2009),

triterpenoids,

antioxidant

saponins (Chen et

(Zhang et al.,

al., 2010),

2010),

alkaloids

antifatigue

(Tripathi et al.,

(Zhang and Wu,

2001), flavonoids

2006),

(Shen et al.,

antitumour,

2011a),

immunomodulat

nucleosides

or (Liu et al.,

(Kong et al.,

2009),

2011), vitamins

hematopoietic

(Yuan et al.,

system effects

2006), proteins,

(Miao et al.,

amino acids

2006)

Saccharides,

Hepatoprotective

Fructus

Mel

Feng

Apis cerana

mi

Fabricius

Apidae

Hon ey

Mel and lemon tea

proteins, organic

,

Apis mellifera

acids, vitamins,

cardioprotectiv

Linnaeus

amino acids (Gu

e,

et al., 2007),

anti-inflammat

polyphenols

ory,

(Tan et al.,

antimicrobial

2016)

(Gu et al., 2007), antioxidant (Wang et al., 2014b)

Zingib

Shen

Zingiber

Zingib

Fres

Mutton soup with

Volatile oils,

Antioxidant,

eris

gjian

officinale

eracea

h

Angelicae

gingerol,

antilipemic,

Rhizo

g

Roscoe

e

rhiz

Sinensis Radix

diarylheptanoids

anti-inflammator

ma

ome

and Zingiberis

(Cui et al., 2009)

y, antitumour,

Recens

and

Rhizoma Recens

root

anti-diabetic (Cui et al., 2009)

Diosco

Shan

Dioscorea

Diosco

Rhiz

Pork sparerib

Polysaccharides

Antioxidant

reae

yao

oppositifolia

reaceae

ome

soup with

(Wang et al.,

(Liang et al.,

Dioscoreae

2007), proteins

2007),

Rhizoma

(Zhou et al.,

antidiabetic,

2011), fatty acids

antilipemic,

(Wang et al.,

gastrointestinal

2008)

effects,

Rhizo

L.

ma

anti-aging, antitumour, immunomodulat or, hepatoprotective (Sun and Mei, 2013) Cratae

Shan

Crataegus

Rosace

Ripe

Mume Fructus

Flavonoids,

Promote

gi

zha

pinnatifida

ae

fruit

and Crataegi

triterpenoids,

digestion, reduce

Fructus juice

organic acids,

blood pressure,

amino acids (Wu

(Wu et al.,

et al., 2010)

2010),

Fructus

var.major N.E.Br．

Crataegus

antilipemic,

pinnatifida

antitumour,

Bunge

immunomodulat or, antioxidant (Yu et al., 2015)

Lycii

Gouq

Lycium

Solana

Ripe

Lycii Fructus and

Polysaccharides

Antioxidant (Wu

Fructus

izi

barbarum L.

ceae

fruit

white fungus

(Dong et al.,

et al., 2006),

soup

2010), vitamins

anti-aging (Li et

(Ma et al., 2007),

al., 2006),

betaine (Zhen et

anti-fatigue (Yin

al., 2007), amino

and Wang,

acids

2010), antilipemic, antidiabetic (Zhao et al., 2005), antitumour, hepatoprotective (Ji et al., 2011), hematopoietic system effects, reproductive effects (Zhao et al., 2009)

Zantho

Huaji

Zanthoxylum

Rutace

Ripe

Fried chicken

Volatile oils,

Antioxidant,

xyli

ao

schinifolium

ae

fruit

with Zanthoxyli

alkaloids, amides,

antitumour,

peel

Pericarpium

coumarins,

analgesia,

Pericar

Siebold &

pium

Zucc.

lignans,

antimicrobial,

Zanthoxylum

triterpenoids,

insecticidal

bungeanum

(Liang et al.,

( Liang et al.,

Maxim.

2014; Zhao,

2014),

2012), amino

hepatoprotective

acids, proteins,

(Zhao, 2012)

(Zhao, 2008) Chrysa

Juhu

Chrysanthemu

Compo

Capi

Chrysanthemi

Volatile oils

Anti-inflammato

nthemi

a

m morifolium

sitae

tulu

Flos and Lycii

(Zhang et al.,

ry,

m

Fructus tea

2008), flavonoids

antimicrobial,

(Lin and Harnly,

antiviral,

2010),

antioxidant,

chlorogenic acid

antitumour,

(Dong et al.,

cardioprotective

2014),

(Wang et al.,

polysaccharides

2014a)

Flos

Ramat.

(Li et al., 2012), amino acids Sesami

Heiz

Sesamum

Pedalia

Ripe

Glutinous rice

Oils and fats,

Antioxidant,

Semem

hima

indicum L.

ceae

seed

balls filled with

proteins, lignans,

anti-aging,

Nigru

Sesami Semem

pigments,

antimicrobial,

m

Nigrum

vitamins,

antitumour, (Li

minerals (Chen

et al., 2013a),

and Deng, 2014;

hepatoprotective

Li et al., 2013a)

, immunomodulat or, cardioprotective, reduce blood pressure (Chen and Deng, 2014)

Longa

Long

Dimocarpus

Sapin

n

yanro

Longan Lour.

Arillus

u

Aril

Longan Arillus

Polysaccharides

Anti-hypoxia,

dacea

and Jujubae

(Meng et al.,

body

e

Fructus tea

2014), vitamins,

temperature

amino acids

regulation (Nong and Li, 1989), antitumour, immunomodulat ory (Meng et al., 2014)

Fig. 1. Distribution of participants.

Fig. 2. Use frequency for the 95 CMM listed in the questionnaire.

Fig. 3. Number of species reported by more than 50% of the participants from each region in China.

Fig. 4. Distribution and CMM use of the visited medicinal diet restaurants.

Fig. 1. Distribution of participants.

100.0

Frequency/%

80.0 60.0 40.0 20.0 0.0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 No. of diffrent CMM

Fig. 2. Use frequency for the 95 CMM listed in the questionnaire.

Number of species

Southwest China South China Central China East China North China

Northeast China Northwest China 0

5

10

15

20

25

Fig. 3. Number of species reported by more than 50% of the participants from each region in China.

Report frequency / times

B

Fig. 4. Distribution and CMM use of the visited medicinal diet restaurants.