Traditional Chinese medicine for sepsis: advancing from evidence to innovative drug discovery

Ji, Yun; Song, Hongyun; Li, Libin

doi:10.1186/s13054-025-05441-4

Critical Care

Table 2 Representative examples of pharmacological effects and potential mechanisms of TCM ingredients on sepsis

From: Traditional Chinese medicine for sepsis: advancing from evidence to innovative drug discovery

Bioactive compounds	Representative herbs	Related TCM formulations	Key pathophysiological pathways	Potential mechanisms	Experimental models used	Ref
Polyphenols
Baicalein/Baicalin	Radix Scutellariae	Banxia Xiexin Decoction; Dachaihu Decoction; HuangLian JieDu Decoction; Modified Liangge Powder; Qingwen Baidu Decoction	Immune modulation; programmed cell death	Inhibiting MAPKs and NF-кB; activating Nrf2/HO-1 signaling pathway	Cell culture; rodent model	[47,48,49,50]
Curcumin	Rhizoma Curcumae	Hongyu Peizhen Formula; Shengjiang Powder	Immune modulation	Upregulating PPAR-γ; inhibiting NF-кB; inhibiting NLRP3 inflammasome	Cell culture, rodent model; human study	[51,52,53,54]
Kaempferol	Flos Carthami	Xuebijing Injection	Endothelial protection	Regulating SphK1/S1P/S1PR1/MLC2 signaling pathway	Cell culture; rodent model	[64, 65]
Salvianolic Acid B	Radix et Rhizoma Salviae Miltiorrhizae	Xuebijing Injection	Endothelial protection	Reducing platelet activation and aggregation; inhibiting platelet CD226 function	Rodent model	[66]
Alkaloids
Berberine	Rhizoma Coptidis	Banxia Xiexin Decoction; HuangLian JieDu Decoction; Jiawei Yiyi Fuzi Baijiang Powder; Qingwen Baidu Decoction	Immune modulation; mitochondrial function	Inhibiting NF-кB; activating SIRT1; inhibiting JAK2/STAT3; upregulating Notch1 signaling	Cell culture; rodent model	[55, 56, 68]
Matrine	Radix Sophorae Flavescentis	Not available	Immune modulation	Inhibiting NLRP3 inflammasome activation and pyroptosis via the PTPN2/JNK/SREBP2 pathway	Cell culture; rodent model	[57]
Saponins
Astragaloside IV	Radix Astragali	Astragalus Injection; Qiguiyin Granule; Tuoli Xiaodu Powder	Immune modulation; mitochondrial function; programmed cell death	Upregulating AMPK/SIRT1 pathway; inhibiting RhoA/NLRP3 inflammasome pathway; regulating NOX4/JNK/BAX pathway	Cell culture; rodent model	[63, 69, 72]
Ginsenoside Rb1 and Rg1	Radix et Rhizoma Ginseng	Banxia Xiexin Decoction; Pogejiuxin Decoction; Shenfu Injection; Shengmai Injection; Shenmai Injection; Tuoli Xiaodu Powder	Programmed cell death; endoplasmic reticulum stress	Reducing HO-1 expression; activating PI3K/AKT pathway	Cell culture; rodent model	[70, 71, 75, 76]
Paeoniflorin	Radix Paeoniae Rubra	Huanglian Jiedu Decoction; Qingwen Baidu Decoction; Tuoli Xiaodu Powder; Xuebijing Injection; Yantiao Formula	Endothelial protection; mitochondrial function	Inhibiting NF-кB; inhibiting IкB kinase activity; inhibiting NLRP3 inflammasome activation; prevent mitochondrial damage; activating SIRT1/FOXO1a/SOD2 pathway; activating RXRα signaling	Cell culture; rodent model	[58, 59, 67]
Others
Anthraquinone/Emodin	Radix et Rhizoma Rhei; Rhizoma Polygoni Cuspidati	Dachaihu Decoction; Dachengqi Decoction; Dahuang Fuzi Decoction; Hongyu Peizhen Formula; JinHong Formula; Modified Liangge Powder; Qiguiyin Granule; Shengjiang Powder; Yantiao Formula; Zengye Chengqi Decoction	Immune modulation; programmed cell death; pulmonary epithelial protection	Inhibiting NF-кB; inhibiting pyroptosis; upregulating AQP and TJ proteins expression	Cell culture; rodent model	[73, 74]
Biphenyl neolignane/Honokiol	Cortex Magnoliae Officinalis	Dachengqi Decoction	Immune modulation	Inhibiting NLRP3 inflammasome; inhibiting pyroptosis; decreasing SLC3A2 and intracellular leucine uptake; inhibiting mTORC1 signaling; activating Nrf2/HO-1 signaling pathway	Cell culture; rodent model	[60, 61]

AKT, protein kinase B; AMPK, AMP-activated protein kinase; AQP, aquaporin; BAX, B-cell lymphoma-2-associated X; FOXO1a, forkhead box protein O1a; HO-1, heme oxygenase-1; JAK2, janus kinase 2; JNK, c-Jun N-terminal kinase; MLC2, myosin light chain 2; mTORC1, mechanistic target of rapamycin complex 1; NF-κB, nuclear factor kappa B; NLRP3, nod-like receptor pyrin domain-containing 3; NOX4, NADPH oxidase 4; Nrf2, nuclear erythroid factor 2; SLC3A2, solute carrier family 3 member 2; TJ, tight junction; PI3K, phosphatidylinositol 3-kinase; PTPN2, protein tyrosine phosphatase non-receptor type 2; PPAR-γ, peroxisome proliferator-activated receptor γ; SIRT1, sirtuin 1; RhoA, Ras homolog family member A; RXRα, retinoid X receptor alpha; S1P, sphingosine-1-phosphate; SphK1, sphingosine kinase 1; S1PR1, sphingosine-1-phosphate receptor 1; SODS, superoxide dismutase 2; SREBP2, sterol regulatory element-binding protein 2; STAT3, signal transducer and activator of transcription 3

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