Pharmacy College, Chengdu University of Traditional Chinese Medicine, State Key Laboratory of Characteristic Chinese Drug Resources in Southwest China, The Ministry of Education Key Laboratory of Standardization of Chinese Herbal Medicine, Chengdu 611137, China.
Key Laboratory of Coarse Cereal Processing, Ministry of Agriculture Rural Affairs, College of Pharmacy and Biological Engineering, Chengdu University, Chengdu, 610106, China.
J Ethnopharmacol. 2020 Aug 10;258:112913. doi: 10.1016/j.jep.2020.112913. Epub 2020 May 1.
Paeoniae Radix Alba (PRA, called baishao in China), the root of Paeonia lactiflora Pall., has shown a rich medicinal value for more than 2000 years. PRA is used in local medicine and traditional medicine for autoimmune diseases associated with inflammation. At present, total glucosides of paeony (TGP), the main active ingredient of PRA, has been developed into a preparation for the treatment of autoimmune diseases, as TGP exhibits the effect of regulating immunity, anti-inflammatory, and analgesic effects.
TGP was developed and applied to inflammation-related autoimmune diseases in modern clinical practice. Based on its application in traditional prescriptions, this article reviews PRA's botany and phytochemistry (including its extraction process and quality control), and discusses the clinical application and pharmacological research of TGP as an anti-inflammatory drug from the perspective of ethnopharmacology. Additionally, we review modern pharmacological and molecular-target research on TGP and discuss the mechanisms of TGP in treating autoimmune diseases. Through a systematic literature review, we also highlight the clinical efficacy of TGP in the treatment of immune diseases, and provide a reference for the continued scientific development and quality control of TGP so that its wider application and clinical value can be fully realized.
Literature search was conducted through the Web of Science, Baidu Scholar, ScienceDirect, PubMed, CNKI, and WanFang DATA using the keywords "Total glucosides of paeony", "Paeonia lactiflora Pall. ", "Paeonia veitchii Lynch", "Paeoniae Radix Alba or white peony", "Paeoniae Radix Rubra or red peony", "Paeoniflorin", "Albiflorin", "Autoimmune diseases", and their combinations. In addition, information was collected from relevant textbooks, reviews, and documents.
Approximately 15 compounds have been identified in TGP, of which paeoniflorin and albiflorin are the most common constituents. In recent years, studies have found that TGP and its main chemical components are effective in the treatment of autoimmune diseases, such as rheumatoid arthritis, psoriasis, oral lichen planus, and Sjogren's syndrome. TGP has a variety of pharmacological effects related to PRA traditional effects, including anti-organ-damage, anti-inflammatory, analgesic, antioxidant, cardiovascular, and nervous-system protection. Previously published reports on TGP treatment of autoimmune diseases have shown that TGP regulates intracellular pathways, such as the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), mitogen-activated protein kinase (MAPK), and phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathways. However, there is no standardized preparation method for TGP, and there is insufficient quality control of formulations. Many related pharmacological studies have not tested TGP components, and the validity of such pharmacological results requires further verification.
Modern pharmacological research on TGP is based on the traditional usage of PRA, and its folk medicinal value in the treatment of autoimmune diseases has now been verified. In particular, TGP has been developed into a formulation used clinically for the treatment of autoimmune diseases. The combination of TGP capsules and chemicals to treat autoimmune diseases has the effect of increasing efficacy and reducing toxicity. Based on further research on its preparation, quality control, and mechanisms of action, TGP is expected to eventually play a greater role in the treatment of autoimmune diseases.
白芍（Paeoniae Radix Alba，在中国称为白芍）是芍药属植物的根，已有 2000 多年的丰富药用价值。白芍在当地药物和传统医学中用于治疗与炎症相关的自身免疫性疾病。目前，白芍总苷（TGP），白芍的主要活性成分，已被开发为治疗自身免疫性疾病的制剂，因为 TGP 具有调节免疫、抗炎和镇痛作用。
TGP 在现代临床实践中被开发并应用于与炎症相关的自身免疫性疾病。基于其在传统方剂中的应用，本文从民族药理学的角度综述了白芍的植物学和植物化学（包括其提取过程和质量控制），并讨论了 TGP 作为抗炎药的临床应用和药理学研究。此外，我们还综述了 TGP 的现代药理和分子靶标研究，并讨论了 TGP 治疗自身免疫性疾病的机制。通过系统的文献综述，我们还强调了 TGP 在治疗免疫性疾病方面的临床疗效，为 TGP 的持续科学发展和质量控制提供了参考，以充分实现其更广泛的应用和临床价值。
通过 Web of Science、百度学术、ScienceDirect、PubMed、CNKI 和万方数据等数据库，使用“白芍总苷”、“芍药”、“川赤芍”、“白芍或白芍药”、“赤芍或红芍药”、“芍药苷”、“氧化芍药苷”、“自身免疫性疾病”等关键词进行文献检索，并收集相关教材、综述和文献中的信息。
TGP 中已鉴定出约 15 种化合物，其中芍药苷和氧化芍药苷是最常见的成分。近年来，研究发现 TGP 及其主要化学成分在治疗类风湿关节炎、银屑病、口腔扁平苔藓和干燥综合征等自身免疫性疾病方面具有疗效。TGP 具有多种与白芍传统功效相关的药理作用，包括抗器官损伤、抗炎、镇痛、抗氧化、心血管和神经系统保护。以前关于 TGP 治疗自身免疫性疾病的报告表明，TGP 调节核因子 kappa-轻链增强子的 B 细胞（NF-κB）、丝裂原活化蛋白激酶（MAPK）和磷脂酰肌醇 3-激酶/蛋白激酶 B（PI3K/Akt）信号通路等细胞内途径。然而，TGP 没有标准化的制备方法，制剂的质量控制也不足。许多相关的药理研究没有测试 TGP 的成分，因此这些药理结果的有效性需要进一步验证。
TGP 的现代药理学研究基于白芍的传统用途，其在治疗自身免疫性疾病方面的民间药用价值现已得到验证。特别是 TGP 已被开发成一种用于治疗自身免疫性疾病的制剂。TGP 胶囊与化学药物联合治疗自身免疫性疾病具有增效减毒的作用。基于对其制剂、质量控制和作用机制的进一步研究，TGP 有望在治疗自身免疫性疾病方面发挥更大的作用。
