Mingjing Granule

What It Is

• Mingjing Granule (often abbreviated “MG” or “Mingjing granule”) is a compound herbal formula in traditional Chinese medicine (TCM), manufactured as granules (concentrated, dried herbal extracts) for convenient dosing.
• In TCM theory, it is categorized under formulas for “cooling blood” and “removing blood stasis” (i.e., improving microcirculation, reducing stagnation).
• In practice, its investigated medical use is as an adjunctive therapy (i.e. supplement) in people with neovascular (wet) age-related macular degeneration (nAMD) — particularly in China.
• The formula is made up of eight botanical herbs (the precise herbs and proportions are given in some pharmacological studies) and the granules are produced by boiling, concentrating, drying, and combining with excipients so as to deliver a fixed “dose” equivalent to a certain amount of raw herb.
• The clinical trial design is to give Mingjing Granule in addition to standard anti-VEGF (vascular endothelial growth factor) therapy (e.g. intravitreal injections) to see if outcomes improve.

In short: it is not a simple “single herb,” but a multi-herbal formulation (in granule form) being studied for eye disease (specifically nAMD) as a complementary therapy.

How It Works

Because it's a complex herbal mixture, the mechanisms are multiple (and in many respects experimental or hypothetical). Based on published pharmacologic and animal studies, here is what is currently understood or proposed:

Anti-fibrosis / anti–fibrovascular membrane formation

• In an animal (rat) model of subretinal fibrovascular membrane (a pathologic feature in advanced nAMD), MG inhibited growth of the membrane when used with anti-VEGF therapy, more so than anti-VEGF alone. Frontiers
• The proposed mechanism includes suppression of macrophage activation (reduced markers like F4/80) and glial cell activation (markers like Iba-1, GFAP), which are involved in inflammation, tissue remodeling, and scarring. search.bvsalud.org
• It may inhibit processes in the local microenvironment that encourage vascular proliferation and fibrosis.

Modulation of VEGF / PEDF balance

• Some in vitro experiments show that MG (or its components) can downregulate VEGF expression and upregulate PEDF (pigment epithelium-derived factor), which is anti-angiogenic. Frontiers
• This helps shift the balance away from new abnormal blood vessel growth (a key driver in wet AMD) and toward stabilizing or inhibiting further angiogenesis.

Protection of retinal pigment epithelium (RPE) / cell survival

• In lab cell experiments, MG extracts have been shown to protect against light-induced apoptosis (cell death) in human RPE cells. Frontiers
• By protecting RPE, the formula might help preserve the health of that layer, which is critical in maintaining retinal structure and function.

Anti-inflammatory, hemostatic, immune modulatory effects

• Some active metabolites in MG are thought to exert anti-inflammatory effects, reduce oxidative stress, modulate immune cell activity, and affect microvascular blood flow (i.e. “cooling blood & removing stasis” in TCM-language). Frontiers
• Such effects could reduce secondary injury, leakage, or chronic inflammation that worsens the retinal lesions.

Synergy with anti-VEGF therapy

• The idea is that while anti-VEGF therapy addresses the growth factor driver of new vessels, the herbal formula might act on supportive or parallel pathways (fibrosis, inflammation, cellular protection), thereby enhancing efficacy, reducing required injection frequency, or slowing progression. BioMed Central

It must be emphasized: much of this is preclinical (animal, in vitro) or from small scale clinical observations. The precise bioactive constituents, pharmacokinetics, and human clinical efficacy remain under investigation.

Why It’s Important

The interest in Mingjing Granule arises from several unmet needs in the management of neovascular AMD and the limitations of current therapies:

Limitations of anti-VEGF monotherapy

• Anti-VEGF injections are standard care (e.g. ranibizumab, aflibercept), and they often yield good results. But challenges persist:
• Some patients respond suboptimally or lose response over time.
• Many patients still develop macular fibrosis or scarring, which leads to irreversible vision loss even if the neovascular activity is suppressed.
• Frequent injections (monthly or bimonthly) impose logistical, financial, and safety burdens (risk of complications from repeated intraocular injections). BioMed Central

Potential to reduce injection burden

• If MG can act as an adjunct to either stabilize lesion progression or reduce recurrence, it might reduce the number of required injections, easing burden on patients and healthcare systems. BioMed Central

Enhancement of outcomes

• The hope is that combining MG and anti-VEGF could lead to better outcomes in terms of visual acuity, retinal thickness, lesion size, or slower progression. The randomized controlled trial (RCT) being planned is designed to test exactly that. BioMed Central

Broader pathway targeting

• Because AMD pathogenesis is multifactorial (oxidative stress, inflammation, fibrosis, vascular leakage, immune dysregulation), a multi-component herbal formula may help “cover” complementary mechanisms that anti-VEGF does not fully address.

Cultural / integrative medicine interest

• In China (and among practitioners of TCM elsewhere), there is interest in integrative approaches that combine conventional modern therapy with herbal formulas aligned with traditional theory. Mingjing Granule represents one candidate for such integrative ophthalmologic therapy. Academia

Research and evidence development

• The ongoing and planned trials (double-blind, placebo-controlled) help generate rigorous evidence about the safety, efficacy, and applicability of MG. For example, a trial is registered to test MG in combination with ranibizumab in nAMD patients. MedPath

Thus, the importance lies in its potential to augment, complement, or refine existing therapies — not replace them (at least not based on current evidence).

Considerations (Cautions, Limitations, Unknowns)

Because Mingjing Granule is still under investigation, many caveats apply. These are crucial to keep in mind:

Lack of high-quality clinical evidence (so far)

• While some small-scale clinical reports and observational data exist, there is not yet robust, large-scale, high-quality RCT evidence confirming its efficacy or safety in humans.
• The ongoing RCTs are (or will be) key to establishing its role. BioMed Central

Herbal variability and quality control

• As with any multi-herb product, the consistency of source herbs, extraction methods, purity, contamination (heavy metals, pesticides, adulterants) is a concern.
• The granule manufacturing process may add excipients (starches, binders) whose impact (e.g. in diabetics) must be considered.
• The dose equivalence (how much raw herb equivalent is delivered) needs standardization.

Pharmacokinetics, absorption, interactions unknown

• We lack clear data on how the active compounds are absorbed, distributed, metabolized, and excreted in humans.
• Potential interactions with other medications (especially systemic drugs) are not well characterized. For instance, herbs that modulate inflammation or blood flow might interact with anticoagulants, anti-inflammatory drugs, etc.
• Because it’s given systemically (by ingestion), systemic effects (beyond the eye) are possible.

Safety / adverse effects

• So far, trials propose to monitor liver, renal, hematologic, ECG parameters. The protocol mentions “indexes of safety include blood, urine, liver function, renal function, ECG.” BioMed Central
• But a full safety profile (especially for long-term use, in diverse populations, in people with comorbidities) is not yet established.
• Herbal formulas may carry risks of allergic reactions, herb–drug interactions, idiosyncratic toxicity, etc.

Patient selection / TCM syndrome matching

• In the trial protocols, inclusion criteria include TCM syndrome differentiation (e.g. “yin deficiency and blood stasis”) — meaning that, in TCM practice, not all AMD patients may be considered suitable candidates. MedPath
• Thus applicability may be limited to those whose TCM diagnosis matches the intended pattern.

Regulatory / approval status

• It is unlikely to be approved or regulated as a standard medical therapy (e.g. via drug regulatory agencies) outside of China (or in jurisdictions unfamiliar with herbal medicines) unless and until strong clinical evidence emerges.
• Clinical use is, for now, largely experimental or supplementary.

Cost, burden, adherence

• Adding an extra therapy (oral herbal granules) requires patient adherence. If the regimen is complex or burdensome, compliance may suffer.
• The cost of herbal treatment and monitoring may also add to overall disease management expense.

Generalizability and external validity

• The bulk of existing research is in Chinese populations; whether similar results would hold in other ethnicities, dietary or environmental contexts, or in settings with different baseline care is unclear.

Placebo / bias control

• In herbal medicine research, designing placebos that match taste, smell, appearance is challenging; ensuring blinding is nontrivial.
• The ongoing RCTs attempt to address that, but until results are in, one must remain cautious of early positive reports that may reflect publication bias or small-scale effects.

Not a substitute for standard therapy

• Because anti-VEGF therapy has strong evidence, MG is being used as add-on (not replacement). Patients must not substitute it for proven treatments.
• Delaying or replacing anti-VEGF therapy in hopes of herbal benefit would be risky.