Sanguisorba

Sanguisorba: Botanical Identity, Traditional Use, Phytochemistry, Pharmacology, and Clinical Evidence

1. Botanical Identity and Nomenclature

Sanguisorba is a genus of perennial herbaceous plants belonging to the family Rosaceae. The genus comprises nearly 148 species, distributed widely across the temperate and subtropical regions of the Northern Hemisphere. Of these, two species dominate both traditional use and modern scientific investigation: Sanguisorba officinalis L. (great burnet, or Di-Yu in Chinese) and Sanguisorba minor Scop. (salad burnet or small burnet).

The genus name Sanguisorba derives from the Latin sanguis (blood) and sorbere (to absorb), reflecting its longstanding application as a hemostatic agent. The genus includes approximately 148 species and subspecies belonging to the Rosaceae family, distributed mainly in East Asia and southern Europe; the most widespread species is Sanguisorba officinalis L.

Sanguisorba officinalis reaches a height of 30–120 cm and is characterized by pinnate leaves with a serrated margin, sturdy and spindle-shaped roots, as well as dark red flowers; its generative stage lasts from August to November. S. officinalis is also referred to as Zi-Yu in South Korea and Japan, Di-Yu in China, and Burnet in the Western nations.

The medicinal plant drug material is known by the Latin drug names Sanguisorbae Radix (the root) and Sanguisorbae Herba (the aerial parts). Sanguisorbae Radix is the dried root of Sanguisorba officinalis L. or Sanguisorba officinalis var. longifolia (Bertol.) T.T.Yu and C.L.Li according to the documentation in the Chinese Pharmacopoeia, and has been used as Traditional Chinese Medicine (TCM). After washing the plants, the fibrous roots are discarded and the remaining plant is whole-dried or slice-dried for later use in TCM; similar documentation is available in the Polish Pharmacopoeia, according to which the underground parts of plants (rhizomes and roots) are known for their healing properties.

Sanguisorba minor Scop., as an edible wild plant, is a common ingredient of the Mediterranean diet, and its young shoots and leaves are often mixed with traditional vegetables and consumed as salad. Sanguisorba minor Scop. (also referred to as small or salad burnet) is a drought-tolerant species that exhibits extremely high drought resistance.

1.1 Common Preparations and Dosage Forms

The roots (Sanguisorbae radix) and the aerial parts of the plant (Sanguisorbae herba) are used as botanical drugs; traditional medicine uses the root of S. officinalis to heal wounds, cool blood, clear heat, and soothe snake bites. In practice, preparations include:

• Dried root (whole or sliced): The plants are uprooted and collected immediately after germination in spring or after withering in autumn; after washing, the fibrous roots are discarded and the remaining plant is whole-dried or slice-dried for later use in TCM.
• Decoctions: Aqueous preparations of the dried root for oral or topical use, a mainstay of classical Chinese and Korean practice.
• Standardized tablet (Diyushengbai Tablet / DYT): Diyushengbai tablet (DYT) is used to prevent and treat leukopenia caused by various reasons; its main active ingredient is Sanguisorbae Radix, recorded in the Chinese Pharmacopoeia as the dry roots of Sanguisorba officinalis L. or Sanguisorba officinalis L. var. longifolia (Bert.) Yü et Li.
• Ethanolic extracts: Prepared in 40–70% aqueous ethanol for both topical skin applications and systemic research uses.
• Essential oil: Isolated from the aerial parts by steam distillation and analysed by GC-MS.
• Cosmetic and dietary supplement preparations: The rich contents and biological effects of S. officinalis and S. minor facilitate these applications in dietary supplements and cosmetics.

2. Traditional and Historical Use

2.1 Traditional Chinese Medicine (TCM)

The plant of Sanguisorba officinalis L. (SO), also known as Diyu in Chinese, a widely used herb medicine in East Asia, has been prescribed clinically for more than 2,000 years in China. Sanguisorbae Radix has a long history of medicinal use, which was first recorded in Shen Nong's Herbal Classic: "Bitter taste and slightly cold in nature, it has a marked effect in treating women with spasms and cramps during childbirth, various debilitating diseases, and collateral diseases."

Since ancient times, Sanguisorba officinalis has been recognized as a medicinal plant; according to traditional Chinese medicine theory, the taste of S. officinalis is cold, bitter, and sour, and it enters the liver, lung, kidney, and large intestine channels; the treatment of bloody stools was documented in the Compendium of Materia Medica (Ben Cao Gang Mu); S. officinalis has been used as a clinically effective remedy for burns, hematemesis, melena, intestinal infections, bloody stools, and dermatitis for centuries.

The roots of S. officinalis have been used as an important astringent medicine in Eastern Asian countries over many thousands of years. It is used widely in Asia for the treatment of inflammatory and metabolic diseases including diarrhea, chronic intestinal infections, duodenal ulcers, bleeding and diabetes.

2.2 Korean and Japanese Traditional Medicine

In Korea, great burnet root is used to regenerate the skin and alleviate inflammation, while the whole plant is used to treat hemorrhoids and female diseases. The plant is known as Zi-Yu in both South Korea and Japan, where it holds a documented place in traditional herbal pharmacopeias.

2.3 European Folk Medicine

The medicinal properties of Sanguisorba species have been known since the 16th century and have been used in traditional folk medicine ever since. The aerial parts of this plant are also used to treat many diseases in Armenia. In Poland, the species has been sufficiently recognized that similar documentation is available in the Polish Pharmacopoeia, according to which the underground parts of plants (rhizomes and roots) are known for their healing properties.

2.4 Mediterranean Food Use

Sanguisorba minor Scop., as an edible wild plant, is a common ingredient of the Mediterranean diet, and its young shoots and leaves are often mixed with traditional vegetables and consumed as salad. This culinary tradition extends across parts of Italy, Greece, and the wider Mediterranean basin, making S. minor one of the few medicinal herbs in this genus that also serves as a regular food plant.

3. Phytochemistry: Key Constituents and Active Compounds

Over 270 chemical constituents have been identified in the plants of genus Sanguisorba, including flavonoids, triterpenoids, steroids, lignans, and organic acids. The principal biologically relevant compound classes are detailed below.

3.1 Tannins

Sanguisorba tannins are the major active ingredients in Sanguisorba officinalis L. (Rosaceae), one of the most popular herbal medicines in China, widely prescribed for hemostasis. The predominant tannins belong to the hydrolysable class — specifically ellagitannins and gallotannins.

• Sanguiin H-6: Sanguiin H-6 is a dimeric ellagitannin that can be found in S. officinalis. Sanguiins, as one of the subgroups of polyphenolic ellagitannins, exhibit various pharmacological activities due to having different chemical structures.
• 1,4,6-Tri-O-galloyl-β-D-glucopyranose (TGG): The tannin compound TGG, isolated from S. officinalis, has been shown to inhibit Wnt/β-catenin signaling pathway and induce apoptosis in colorectal cancer cells; the aims of associated studies were to discover its active compound and molecular mechanism against colorectal cancer.

A variety of chemical constituents, including tannins, triterpenoids, flavonoids, anthraquinones, and steroids, were isolated from S. officinalis L., and pharmacological studies on its hemostatic and anti-inflammatory properties have been reported.

3.2 Triterpenoid Saponins (Ziyuglycosides)

The triterpenoid saponins, particularly ziyuglycosides, are among the most studied bioactive monomers of S. officinalis.

• Ziyuglycoside I (ZY-I): Ziyuglycoside II is one of the major active compounds of Sanguisorba officinalis L., which has a wide range of clinical applications including hemostasis, antibiosis, anti-inflammation and anti-oxidation. Ziyuglycoside I (the related saponin) is particularly important: Ziyuglycoside I is one of the main active ingredients in the Sanguisorba officinalis white tablet and is clinically proven to reduce leukopenia; Sanguisorba officinalis white tablet has been clinically used for the treatment of leukopenia caused by continuous application of radiotherapy and chemotherapy in cancer for over 10 years.
• Ziyuglycoside II: Ziyuglycoside II is a triterpenoid saponin that can be found in S. officinalis. Studies investigated the effect of ziyuglycoside II on the growth of human breast carcinoma MDA-MB-435 cells; results showed that ziyuglycoside II could significantly inhibit the growth of MDA-MB-435 cells through blocking cell cycle progression at G0/G1 and S phase, as well as via inducing cell apoptosis; accumulation of reactive oxygen species (ROS) was observed in the progression of cell cycle arrest, which was associated with the increased expression of cell cycle regulating factors, p53 and p21.

The ingredient compounds of S. officinalis, such as ziyuglycosides I, ziyuglycosides II, sanguiin H-6, ellagic acid, and quercetin, have been reported for various pharmacological actions, including antiallergic, anti-inflammatory, anti-obesity, and anticancer effects.

3.3 Flavonoids

Flavonoids, including quercetin and its glycosides, constitute another major category. Quercetin is noted within the spectrum of S. officinalis constituents for its established antioxidant and anti-inflammatory activities. To date, more than 270 compounds have been isolated and identified from the species belonging to genus Sanguisorba.

3.4 Other Phenolic Compounds

The anti-inflammatory effects of extracts and isolated compounds were investigated by measuring the production of pro-inflammatory cytokines IL-12 p40, IL-6 and TNF-α in LPS-stimulated bone marrow-derived dendritic cells; certain compounds (including phenolics and monoterpenoids) revealed promising anti-inflammatory effects, suggesting that phenolic compounds and monoterpenoids from S. officinalis could be potential candidates for anti-inflammatory treatments.

3.5 Tannin Metabolites

For in vivo pharmacokinetic assessment (animal study), rats administered a single dose of 150 mg/kg of Sanguisorba tannins yielded 12 metabolites in urine, 6 metabolites in feces, and 8 metabolites in bile, while metabolites were barely found in plasma and tissues; for in vitro assessment, 100 μM Sanguisorba tannins were incubated with rat liver microsomes, liver cytosol, and feces, after which nine metabolites were found in intestinal microbiota and five metabolites were found in liver microsomes and liver cytosol. This metabolic profile has implications for understanding bioavailability and systemic effects.

4. Mechanisms of Action

4.1 Hemostatic Mechanisms

Among the seven terpene glycosides assayed for hemostatic activities with a Goat Anti-Human α2-plasmin inhibitor ELISA kit, ziyu-glycoside I (5) showed the strongest hemostatic activity. The classical hemostatic action is consistent with the astringent properties attributed to the high tannin content, which promotes protein precipitation in damaged tissue and supports platelet aggregation pathways.

4.2 Anti-Inflammatory Mechanisms

The underlying mechanism involved in the pharmacological actions of the active constituents is mainly related to p38 MAPK signaling. In the context of specific signaling pathways, S. officinalis has been found to exert its therapeutic effects on hepatocellular carcinoma through interfering in cancer cell proliferation and survival via the EGFR/MAPK and EGFR/PI3K/AKT/NFκB signaling pathways. More broadly, the reduction of pro-inflammatory cytokines such as IL-12 p40, IL-6 and TNF-α has been demonstrated in LPS-stimulated cell models.

4.3 Hematopoietic Mechanisms

Total saponins and their characteristic constituents, Ziyuglycoside I and Ziyuglycoside II, can inhibit apoptosis of TF-1 cells caused by cytokine deprivation and promote survival of mouse bone marrow nuclear cells through focal adhesion kinase (FAK) and extracellular signal-regulated kinase 1/2 (Erk1/2) activation in vitro; in addition, they can down-regulate macrophage inflammatory protein 2 (MIP-2), platelet factor 4 (PF4), and P-selectin secretion.

4.4 Anticancer Mechanisms

Triterpenoids and tannins isolated from the roots of S. officinalis have shown promising antitumor effects in several cancer research models. Ziyuglycoside I (ZY-I) from S. officinalis roots is reported to induce mitochondria-dependent apoptosis in human retinoblastoma WERI-RB-1 cells by activating P53 in a concentration-dependent manner. Prior results demonstrated that the aqueous extract of great burnet showed strong inhibition against proliferation of colorectal cancer (CRC) cells (HCT116, RKO) and Wnt/β-catenin signaling pathway.

The sanguiin compound SH-11 acts as a powerful antioxidant that significantly reduces glutamate-induced accumulation of reactive oxygen species and calcium ion influx in mouse clonal hippocampal HT22 cells; apoptotic cells exhibit effective neuroprotective activity via glutamate-induced phosphorylation of mitogen-activated protein kinases, including the extracellular signal-related kinases 1/2, c-Jun N-terminal kinase, and p38, and this activity was decreased significantly by SH-11.

4.5 Antidiabetic Mechanisms

The ethyl acetate layer in the alcohol extract of the roots of S. tenuifolia was found to be rich in triterpenes, which could inhibit plasma glucose levels in diabetic rats induced by alloxan; these triterpenoids have been reported to demonstrate inhibitory activity against α-glucosidase.

5. Scientific Evidence by Area of Use

5.1 Hematopoiesis and Leukopenia (Strongest Clinical Evidence Base)

This area carries the most clinically relevant human evidence for any application of Sanguisorba.

Sanguisorba officinalis white tablet has been clinically used for the treatment of leukopenia caused by continuous application of radiotherapy and chemotherapy in cancer for over 10 years. Diyushengbai Tablet (DST), a Chinese patent medicine made from raw material of Sanguisorba officinalis L., has been used to cure leukopenia caused by various radiotherapy and chemotherapy in clinical settings for more than 20 years and has shown significant efficacy; Ziyuglycoside I (ZgI), the main saponin from Sanguisorba officinalis L., has been proved to be the primarily active ingredient of leukogenic action of DST.

A 2022 systematic review and meta-analysis published in Frontiers in Pharmacology (Xu et al., 2022) is the most comprehensive synthesis of clinical evidence. This study systematically evaluated the efficacy and safety of Diyushengbai tablet (DYT) in preventing and treating leukopenia caused by radiotherapy and chemotherapy; a meta-analysis was performed to systematically analyze the therapeutic effects of DYT. A comprehensive literature search of electronic databases including PubMed, The Cochrane Library, CNKI, CBM, Wanfang, and VIP was performed through November 2021; the bias risk evaluation criteria developed by the Cochrane collaborative organization were used to evaluate the literature quality of the included studies. The pooled analysis found a statistically significant effect on white blood cell count recovery (mean difference = 1.20, 95% CI: 0.77–1.62, p < 0.00001).

Preclinical confirmation of mechanism was provided by an earlier study: total saponins from S. officinalis L. were evaluated for their hematopoietic effect on myelosuppressive mice induced by cyclophosphamide and by 60Co-γ-irradiation, confirming the therapeutic effect.

Previous studies have shown that ZgI can remarkably increase the levels of white blood cells (WBCs) and platelets in leukopenia mice induced by cyclophosphamide and can also relieve its bone marrow depression.

Limitations: There were previous meta-analyses estimating the clinical efficacy of DYT; one study took 8 studies into account with clinical outcomes involving only the WBC suppression rate, while another included 12 studies with outcomes of myelosuppression rate, WBC count, and the amount of G-CSF; the limited number of literatures may have had a negative impact on the reliability of the results. Data from large-scale, randomized, double-blind, multi-center trials are needed to confirm the efficacy and safety of the clinical use of traditional Chinese medicine; these clinical trials should use standardized efficacy indicators and should include an assessment of adverse events.

5.2 Anti-Inflammatory Activity (Primarily Preclinical)

Sanguisorba officinalis (known as Di Yu in Chinese), a member of the Rosaceae family, exhibits a wide range of pharmacological activities, such as hemostatic, anti-inflammatory, anti-allergy, anti-bacterial, antioxidant, hypoglycemic, neuroprotective, and anticancer effects.

S. officinalis uses its anti-inflammatory effect to treat airway inflammation (for example, bronchial asthma), contact and specific dermatitis, nephritis, and colitis. Evidence for anti-inflammatory activity derives predominantly from in vitro and animal models. In one study, the production of pro-inflammatory cytokines IL-12 p40, IL-6 and TNF-α was measured in LPS-stimulated bone marrow-derived dendritic cells, and certain phenolic and monoterpenoid compounds from S. officinalis revealed promising anti-inflammatory effects.

Regarding inflammatory bowel disease, a study using S. officinalis ethyl acetate extract found that it has been demonstrated to have antioxidant, anti-inflammatory, antiviral, antifungal, hemostatic, and anticancer properties in recent pharmacological studies. Evidence strength: preliminary to moderate; data are largely in vitro and animal-based, with no large randomized controlled trials in humans reported for isolated anti-inflammatory endpoints.

5.3 Anticancer Activity (Preclinical Only)

According to preliminary reports, S. officinalis possesses a variety of pharmacological effects, such as anticancer, antibacterial, antiviral, anti-inflammatory, anti-oxidant, and hemostatic effects. Research has confirmed the antitumor potential of this plant in human gastric carcinoma, human prostate cancer, and breast cancer.

For colorectal cancer specifically, prior results proved that the aqueous extract of great burnet showed strong inhibition against proliferation of CRC cells (HCT116, RKO) and Wnt/β-catenin signaling pathway. S. officinalis has also been shown to synergistically enhance 5-fluorouracil cytotoxicity in CRC cell lines (RKO and HCT116) by activating a reactive oxygen species-mediated and mitochondria caspase-dependent apoptotic pathway.

Evidence strength: exclusively preclinical (in vitro and animal); no randomized controlled trials in human cancer populations have been identified using Sanguisorba as a primary antitumor intervention. The clinical role remains limited to the supportive management of treatment-related leukopenia.

5.4 Antidiabetic / Metabolic Effects (Predominantly Preclinical)

In China, Sanguisorba tenuifolia Fisch. ex Link is used commonly for treating diabetes. Son et al. (2015) indicated the potential of great burnet roots as a source of metabolites with antidiabetic effects due to, among others, lowering the level of glucose, insulin, and glycated hemoglobin in the blood; the authors also confirmed the protective effect of these metabolites on the kidneys and liver in patients with type 2 diabetes.

Owing to its promising properties, this species is used in the treatment of various diseases, including influenza virus infection, inflammation, Alzheimer's disease, type 2 diabetes, and leukopenia caused by bone marrow suppression.

Evidence strength: largely preclinical; the Son et al. (2015) study referenced above is one of the few involving human subjects for metabolic parameters, though it requires replication in larger, adequately powered randomized trials. α-glucosidase inhibition and glycemic biomarker reduction have been shown in animal and limited clinical observations but not yet confirmed in large-scale RCTs.

5.5 Antimicrobial Activity (In Vitro)

S. officinalis, a traditional Chinese medicine clinically used for hemostasis and treatment of diarrhea, has various pharmacological activities; in vitro antimicrobial activity was used for the preliminary evaluation of S. officinalis against Helicobacter pylori, a pathogen for which antibiotic-based therapies are increasingly challenged by resistance to multiple commonly used antibiotics.

Sanguisorba officinalis L. and Sanguisorba minor Scop. are classified as medicinal plants because of hemostatic, antibacterial, antitumor, antioxidant, and antiviral activities. Antibacterial testing demonstrated activity against both Gram-positive (S. aureus, B. cereus) and Gram-negative (E. coli, P. aeruginosa) organisms in experimental settings. The leaf extract had relatively strong antibacterial activity against S. aureus (inhibition zone 15.5 mm), while E. coli was most sensitive to root and flower extracts; great burnet extracts showed the strongest activity against P. aeruginosa (inhibition zone, depending on dry extract content, 12.3–23.7 mm).

Evidence strength: in vitro only; no human clinical trials for antimicrobial applications have been identified.

5.6 Neuroprotection (Preclinical)

The sanguiin compound SH-11 acts as a powerful antioxidant that significantly reduces glutamate-induced accumulation of reactive oxygen species and calcium ion influx in mouse clonal hippocampal HT22 cells; apoptotic cells exhibit effective neuroprotective activity via glutamate-induced phosphorylation of mitogen-activated protein kinases, and this activity was decreased significantly by SH-11. Animal studies with S. minor in cognitive models have also been reported: a 2022 study published in Metabolic Brain Disease evaluated the effect of Sanguisorba minor on scopolamine-induced memory loss in rats, examining involvement of oxidative stress and acetylcholinesterase.

Evidence strength: animal and in vitro only; no human clinical trials for neurological conditions have been identified.

5.7 Exercise Performance (Preclinical Animal Model)

A study examining the water-extracted roots of Sanguisorba officinalis L. found that oral administration reduced the activities of lactate dehydrogenase A (LDHA) in in vitro enzyme assay myoblast C2C12 cells and murine muscle tissue; physical performance measured by a treadmill test was improved in the S. officinalis-administrated group; analysis of mouse serum and tissues showed significant changes in lactate levels. Evidence strength: animal only; no controlled human trials have been reported.

5.8 Topical / Dermatological Use

In Korea, great burnet root is used to regenerate the skin and alleviate inflammation, while the whole plant is used to treat hemorrhoids and female diseases. A 2024 study in Frontiers in Pharmacology subjected extract in 70% v/v ethanol to HPLC analysis for the content of selected phenolic acids and an ex vivo skin permeation study, demonstrating that active phenolic compounds can penetrate ex vivo skin — a prerequisite for topical efficacy.

6. Body Systems and Health Areas

Based on the compiled evidence, Sanguisorba has been studied or applied in the following body systems:

• Hematopoietic / Immune system: Clinical practice in China in the past few decades has confirmed that the extract of S. officinalis increases the number of white blood cells and reduces the bone marrow toxicity caused by antitumor treatments.
• Gastrointestinal system: The roots of S. officinalis have been traditionally used to treat diarrhea, chronic intestinal inflammation, duodenal ulcers, and bleeding hemorrhoids.
• Hemostatic / Cardiovascular system: Sanguisorba tannins are widely prescribed for hemostasis.
• Metabolic system (blood glucose): Preclinical evidence supports α-glucosidase inhibition and improvement of glycemic markers.
• Oncology (supportive care): Clinical use of DYT for chemotherapy/radiotherapy-induced leukopenia is documented across multiple clinical studies.
• Nervous system: Neuroprotective effects demonstrated in glutamate toxicity and scopolamine-induced amnesia models (animal).
• Dermatological / Integumentary: Topical use for burns, scalds, eczema, and wound healing is historically documented, and ex vivo permeation studies support the plausibility of dermal delivery.
• Antimicrobial (infection): Activity against H. pylori and other pathogens demonstrated in vitro.

7. Dosage Forms and Dosages Reported in Studies

The following dosages appear in peer-reviewed sources; no clinical dosage recommendations are extrapolated beyond what sources state.

• Diyushengbai Tablet (DYT): Diyushengbai Tablet, a Chinese patent medicine made from raw material of Sanguisorba officinalis L., has been used to cure leukopenia caused by various radiotherapy and chemotherapy in clinic for more than 20 years. The tablet is a standardized oral form used in clinical settings in China.
• Total saponins (animal study): Total saponins from S. officinalis L. were evaluated in myelosuppressive mice induced by cyclophosphamide and 60Co-γ-irradiation for 13 days.
• Tannins (animal pharmacokinetic study): Rats were administered a single dose of 150 mg/kg of Sanguisorba tannins.
• S. minor hydroalcoholic extract (preclinical toxicology): In the acute toxicity test, a single oral dose of 300, 2,000, and 3,000 mg/kg of SE was given to mice; oral administration of SE at 100, 200, and 400 mg/kg for 4 weeks was performed to evaluate subacute toxicity.
• Tannins (in vitro): 100 μM Sanguisorba tannins were incubated with rat liver microsomes, liver cytosol, and feces.
• Ethanolic extracts (topical/skin permeation): Antioxidant activity and total polyphenol content of extracts prepared in 70% and 40% aqueous ethanol solution (dry extract content 50–500 g/L) from the aerial parts of S. officinalis were evaluated; the extract in 70% v/v ethanol (dry extract content: 500 g/L) was subjected to HPLC analysis for the content of selected phenolic acids and an ex vivo skin permeation study.

No single internationally standardized human dosing protocol for Sanguisorba as a dietary supplement has been established in the reviewed literature. The Chinese Pharmacopoeia provides monograph guidance for clinical use of Sanguisorbae Radix in TCM practice, but specific doses vary by preparation and indication.

8. Safety Considerations

8.1 Overall Safety Profile

So far, there have been limited reports on the toxicity caused by the different species of Sanguisorba in humans, and the major safety concern related to these species has been confined to the veterinary field; to date, no harmful components, such as alkaloids, have been reported in S. minor and S. officinalis. Egorova et al. (2018) investigated the medicinal products of S. officinalis (rhizome and root) for the presence of heavy metals and other ecotoxic substances and reported no toxicity, thereby providing evidence for the safety and non-toxicity of S. officinalis.

8.2 Acute and Subacute Toxicology (S. minor)

The first dedicated preclinical toxicology assessment of S. minor hydroalcoholic extract was published in Journal of Complementary and Integrative Medicine (2021). The no-observed-adverse-effect level (NOAEL) of the extract was up to 2,000 mg/kg; the LD50 of the prepared extract was over 3,000 mg/kg; the rats exposed to the extract did not show any marked change in body weight; the extract at used doses did not affect neuromuscular coordination; according to hematological, biochemical, and histological examinations, no significant treatment-related adverse effect of the extract was observed, even at 400 mg/kg; only 48-hour exposure to 400 μg/mL of SE reduced the viability of PC12 cells (in vitro); the findings revealed that this plant could be well-tolerated, regarded safe, and used as herbal medicine.

8.3 Evidence Limitations and Call for Formal Safety Data

Data from large-scale, randomized, double-blind, multi-center trials are needed to confirm the efficacy and safety of the clinical use of traditional Chinese medicine; these clinical trials should use standardized efficacy indicators and should include an assessment of adverse events. The existing body of safety data consists predominantly of preclinical animal studies and a limited number of observational clinical reports. Formal evaluation of pharmacokinetic interactions with co-administered pharmaceutical agents, dosing thresholds, and long-term safety in human populations is currently lacking in the published literature reviewed.

8.4 Evidence Quality Summary

Despite its promising potential, limited clinical data and standardization issues present challenges for its integration into modern medicine. The compound class with the highest translational advancement is the triterpenoid saponins (principally Ziyuglycoside I), which underpin the clinically applied Diyushengbai Tablet formulation in China. For all other investigated applications — including anticancer, neuroprotective, antidiabetic, and antimicrobial — the evidence base remains at the in vitro and animal stages, requiring well-designed randomized controlled trials before efficacy in humans can be confirmed.

References

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