The key finding
A comprehensive 2026 review spanning 25 years of research found that Traditional Chinese Medicine (TCM) formulas, particularly Peony-Glycyrrhiza Decoction, are linked to significant reductions in prolactin levels among people taking antipsychotic medications. Clinical analysis showed this herbal formula reduced prolactin by an average of 32.69 ng/mL (p < 0.00001) with favorable safety profiles. The review synthesized evidence from network pharmacology analyses, molecular studies, and clinical trials, revealing that these ancient remedies appear to work through multiple biological pathways including dopamine receptor modulation, epigenetic regulation, and gut-brain-pituitary axis restoration.
What the study looked like
This was a narrative review analyzing scientific literature published between January 2000 and December 2024 from four major databases: PubMed, CNKI (China National Knowledge Infrastructure), TCMSP (Traditional Chinese Medicine Systems Pharmacology), and HERB databases. Researchers examined network pharmacology analyses, molecular docking studies, experimental validations in laboratory settings, and clinical studies involving both individual herbs and complex TCM formulas. The review focused specifically on interventions for antipsychotic-induced hyperprolactinemia—abnormally high prolactin levels caused by psychiatric medications—a condition that can cause menstrual irregularities, unwanted breast milk production, sexual dysfunction, and infertility. The researchers evaluated how historical TCM formulas traditionally used for “liver constraint” patterns and menstrual problems might apply to this modern medication side effect.
Why researchers think this happened
The review authors propose that TCM formulas work through multiple complementary mechanisms rather than a single pathway. Network pharmacology analyses revealed convergent effects across different formulas on dopaminergic synapses (the communication points between dopamine-producing nerve cells), TGF-β signaling, and neuroactive ligand-receptor interactions. Specifically, the herbal compounds appear to upregulate DRD2 (dopamine D2 receptors, which antipsychotics block) and inhibit MAO (an enzyme that breaks down dopamine). Additionally, these formulas may work through epigenetic mechanisms by inhibiting DNMT enzymes and causing demethylation of the DRD2 promoter region—essentially “unlocking” genes that produce dopamine receptors. The researchers also found evidence for modulation of the gut microbiome and anti-inflammatory effects that may restore normal communication along the gut-brain-pituitary axis, as well as regulation of key signaling pathways including JAK2/STAT5, NF-κB, and PI3K/Akt that control hormone production and cell responses.
How to read this carefully
This is a narrative review synthesizing existing studies rather than a new clinical trial, meaning it depends on the quality and design of the original research papers. The clinical evidence cited comes primarily from studies conducted in populations already using TCM alongside conventional treatments, which may not generalize to all populations or healthcare contexts. Network pharmacology and molecular docking are computational prediction methods that suggest possible mechanisms but don’t prove those mechanisms occur in living humans. The review doesn’t specify sample sizes for individual clinical studies or detail potential publication bias (studies showing no effect are less likely to be published). Importantly, “linked to” reductions in prolactin levels doesn’t mean these formulas cure hyperprolactinemia or should replace standard medical care. Herb-drug interactions remain possible, and TCM formulas are complex mixtures whose active components, optimal dosing, and long-term safety profiles require further rigorous investigation through randomized controlled trials.
What this means for everyday life
For people taking antipsychotic medications who experience hormonal side effects like menstrual changes, breast tenderness, or sexual dysfunction, this review suggests that certain traditional herbal formulas may offer a complementary approach worth discussing with healthcare providers. The finding is particularly relevant given that elevated prolactin affects 40-90% of people on certain antipsychotics and can significantly impact quality of life and medication adherence. However, anyone considering TCM formulas should consult both their psychiatrist and a qualified herbalist, as interactions with psychiatric medications are possible and discontinuing antipsychotics without medical guidance can be dangerous. The research also highlights how ancient medical wisdom, when subjected to modern scientific methods like network pharmacology, can reveal potential multi-target approaches that work differently than single-molecule pharmaceuticals. This bridges a fascinating gap between centuries-old pattern-based healing traditions and contemporary molecular medicine, potentially opening new research directions for managing medication side effects through component synergy rather than isolated drugs.