Twenty-five-ingredient Pearl Pill

Twenty-five-ingredient Pearl Pill (Ershiwuwei Zhenzhu Wan) is a traditional Tibetan medicine (TTM) formulation first documented in the 8th-century classic text, the Four Medical Tantras. It is a multi-ingredient preparation composed of 25 distinct plant, animal, and mineral-derived substances, including pearl (margarita), pearl mother (margaritifera concha), nutmeg, saffron, and artificial musk. The formulation is widely used in China for the treatment of cerebrovascular and neurological disorders, particularly ischemic stroke, hemiplegia, facial paralysis, epilepsy, and vascular dementia. Preclinical studies suggest that it exerts neuroprotective, anti-inflammatory, and antioxidant effects, potentially by reducing the expression of inflammatory cytokines (such as TNF-alpha, IL-1beta, and IL-6), increasing superoxide dismutase (SOD) and catalase (CAT) activities, and inhibiting neuronal apoptosis through the upregulation of Bcl-2 and downregulation of caspase-3.