Peony — the garden flower that calmed epilepsy?

Aim of the study: Paeoniae Radix has been used for leg discomfort such as restless legs syndrome. The aim of this review is to evaluate the efficacy and safety of herbal medicines containing Paeoniae Radix for restless legs syndrome.

Results: Twelve studies (n = 639) were included. Overall methodological quality was low. In the herbal group, meta-analysis showed statistically significant improvements in the total effective rate, the restless legs syndrome rating scale, and the Pittsburgh Sleep Quality Index compared with the non-herbal group. Herbal treatments were found to be relatively safe. Herbal medicines containing Paeoniae Radix might improve restless legs syndrome. However, we cannot draw firm conclusions because of limitations in the included studies.

Aim of the study: Paeoniae Radix Alba (PRA, called Baishao in China) is the dried root of Paeonia lactiflora Pall. In clinical practice, PRA has been used to treat cardiovascular disease, menstrual disorders, abdominal pain, diarrhea, and liver disease, among other conditions.

Results: This review provides a systematic summary of its traditional uses, geographical distribution and current cultivation situation, phytochemistry, pharmacokinetics, pharmacology, quality control, and toxicology. It also offers an in-depth discussion of gaps in current research on PRA, a topic not addressed in previous reviews, and puts forward its own views and solutions. More research is needed to understand how PRA works, as well as the relationships between its chemical components and their potential synergistic and antagonistic effects. In addition, a comprehensive assessment of medicinal quality should be carried out to understand the long-term toxicity in living organisms and the clinical efficacy of PRA, and to provide more information for developing new drugs and treatments for various diseases using PRA and its chemical components.

Aim of the study: The paper aims to provide a comprehensive review of the botanical characteristics and distribution, ethnopharmacology, phytochemistry, biosynthesis pathway, pharmacology, pharmacokinetics, and quality control of P. lactiflora, to provide new insights and scientific evidence for future research.

Results: P. lactiflora is an herb with a long history of use in medicine, food, and ornamental gardening, and has considerable value. Two hundred compounds have been identified in it, including terpenoids, flavonoids, polyphenols, organic acids, and others. Among these, paeoniflorin, a monoterpenoid glycoside, has several activities and is currently a focus of pharmacological research. Many pharmacological experiments support the anti-inflammatory, antioxidant, liver-protective, neuroprotective, antibacterial, antitumor, skin-disease-treating, and other effects of P. lactiflora. In addition, assessing the quality of P. lactiflora is essential for its safe use in humans. Its chemical components are diverse and have a wide range of activities. Modern pharmacological studies have provided reliable evidence for its traditional effects, such as suppressing liver yang, regulating menstruation, and relieving pain.

Aim of the study: Preclinical and clinical studies investigated whether PHY906 enhances the therapeutic effects of a broad range of anticancer drugs.

Results: Preclinical studies have shown that PHY906 enhances the therapeutic effects of a broad range of anticancer drugs. These findings were examined in clinical studies of colorectal, liver, and pancreatic cancers, with PHY906 used as an add-on to chemotherapy, and the results were promising: PHY906 could reduce chemotherapy-induced toxicity and/or increase the effectiveness of chemotherapy. Furthermore, PHY906 did not affect the pharmacokinetics of the chemotherapy drugs used. Preclinical studies have provided some information about how PHY906 works. A comprehensive platform, PhytomicsQC, which combines chemical and biological fingerprints with a new biostatistical method, was developed to assess the quality of different batches of PHY906. Over a ten-year period, the multiplex technology “PhytomicsQC” was used to show consistency between batches of PHY906.

Aim of the study: To assess the efficacy and safety of combining total glucoside of peony (TGP) and methotrexate (MTX) to treat rheumatoid arthritis (RA). Randomized controlled trial (RCT) data on the traditional Chinese active component TGP combined with MTX versus...

Results: In addition, adverse events were reported more often in the MTX-only group than in the TGP and MTX combination group (P = 0.0007). Our study shows that TGP combined with MTX is more effective than MTX alone for treating RA. However, the adverse effects of combining TGP and MTX need further assessment. Because the included trials were of poor methodological quality, well-designed, multicenter, large-scale RCTs are needed to reach a more definitive conclusion.

Aim of the study: Total glucosides of paeony (TGP) are commonly used to treat rheumatoid arthritis (RA) in China. However, clinical practice has not been adequately informed by evidence from properly conducted systematic reviews. This PRISMA-compliant systematic review aims to examine the effectiveness and safety of TGP for RA.

Results: Eight studies involving 1209 patients with active RA were included in this systematic review. In addition to traditional DMARD(s), TGP might benefit patients with RA by improving American College of Rheumatology (ACR) 20, ACR 50, and ACR70 response rates, and by reducing adverse effects, compared with no treatment. The overall methodological quality of the included studies and the quality of evidence for each outcome were limited. Current trials suggest that TGP may offer benefits for RA when used alongside traditional DMARD(s). Therefore, TGP may be a good choice as an add-on therapy for RA. However, given the limited methodological quality and strength of the evidence, high-quality RCTs are needed to support the use of TGP for RA.

Aim of the study: Although topical creams and other anti-aging products claim to reduce the appearance of aging and skin wrinkles, their effectiveness has not been critically analyzed in scientific literature. This systematic review critically evaluates evidence for the effectiveness of botanical treatments in reducing skin aging and wrinkles.

Results: All trials were of poor methodological quality. Adverse effects were often not reported. In summary, there is some weak evidence that several botanical extracts may reduce the appearance of skin aging, but no evidence that the effect lasts. Independent studies with larger, more diverse samples, longer treatment periods, and more rigorous designs are needed to confirm these preliminary findings.

Aim of the study: Moutan Cortex (MC), the dried root bark of Paeonia × suffruticosa Andrews, is used as both a medicinal and edible product and has liver-protective and anti-inflammatory properties. It is rich in bioactive polysaccharides. However, the role of a polysaccharide-rich preparation from Moutan Cortex (MC-Pa) in alleviating non-alcoholic fatty liver disease (NAFLD) has not been sufficiently studied.

Results: MC-Pa treatment substantially reduced liver fat accumulation, inflammation, and oxidative stress in MCD-fed mice and lowered serum ALT/AST levels. MC-Pa favorably changed the gut microbiota by reducing the Firmicutes/Bacteroidota ratio and increasing the abundance of Muribaculaceae and Akkermansia. In addition, MC-Pa regulated bile acid-related signaling, as shown by changes in the expression of hepatic FXR, CYP7A1, and TGR5. MC-Pa alleviates liver fat accumulation, inflammation, and oxidative stress in mice with MCD-induced NAFLD. These effects are associated with changes in gut microbiota and bile acid metabolism, potentially involving the FXR/CYP7A1-related signaling pathway.

Aim of the study: Knee osteoarthritis (KOA) is a common chronic degenerative joint disease, and degeneration of the articular cartilage is its main pathological feature. Paeoniflorin, a bioactive terpene glycoside isolated from Paeonia lactiflora, has shown a protective effect on chondrocytes, but its specific mechanism is not well understood.

Results: In vitro experiments showed that paeoniflorin markedly increased chondrocyte proliferation and reduced the rate of cell death. In vivo, paeoniflorin treatment significantly improved bone volume and structural measures of the subchondral bone in rats with KOA and helped repair cartilage damage. Combined transcriptomic and metabolomic analyses showed that paeoniflorin promoted mitochondrial balance by regulating DL-glyceraldehyde (DLG), thereby improving chondrocyte energy metabolism. Molecular docking, molecular dynamics simulations, and subsequent mechanistic studies indicated that paeoniflorin regulated the expression of genes related to mitochondrial dynamics by changing DLG levels, promoting mitochondrial fusion, and preventing excessive fission. Paeoniflorin effectively reduced cartilage degeneration in KOA by regulating the downstream metabolite DLG to promote mitochondrial balance.

Aim of the study: Endometriosis (EMs) is a chronic inflammatory disease often treated with therapies that promote blood circulation and resolve stasis. Anxiety and depression are common mental health conditions in patients with EMs. No medicines are available to treat EMs with anxiety or depression. Paeonia × suffruticosa Andrews leaves (PSL) have blood-activating and stasis-resolving effects and are commonly used to treat inflammation and gynecological conditions.

Results: PSL inhibited the growth of EMs lesions and reduced Ki67 expression in the lesions. PSL improved anxiety-like and depression-like behavior in mice with EMs. Furthermore, PSL treatment helped restore neuronal damage in the hippocampus and prefrontal cortex of the mice, in line with the behavioral changes. PSL reduced mRNA and protein expression of IL-1β, IL-6, TNF-α, and iNOS in the brain tissue of mice with EMs, and increased the expression of IL-4, CD163, and Arg-1. In addition, the inflammation-related JAK2/STAT3 signaling pathway was activated in the brains of mice with EMs and anxiety/depression. PSL reduced M1-type microglia and increased M2-type microglia by inhibiting activation of the JAK2/STAT3 pathway in the hippocampus and prefrontal cortex. PSL suppressed neuroinflammation through the JAK2/STAT3 pathway to treat EMs with anxiety/depression.