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The most fundamental gap remains the acute need for rigorously designed, large-sample, multicenter, placebo-controlled randomized controlled trials (RCTs) dedicated to evaluating the efficacy (using primary endpoints such as 6-minute walk distance [6MWD] and time to clinical worsening) and long-term safety profiles of specific TCM interventions (whether monocomponent agents or standardized complex formulas) within well-defined HPH populations, characterized by precise inclusion criteria reflecting underlying lung disease etiology and PH severity alongside standardized treatment protocols

These effects often appear within the first few days to weeks and may improve over time with medical supervision

doi:10.1073/pnas.1016184107

Development 136 , 41434153 (2009)