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 mRNA expression, but not protein levels in vivo ⁽¹¹⁾. It also upregulates p21 protein levels and downregulates MMP1 and multidrug resistance-1 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⁾.