Strobilanthes cusia (Nees) Kuntze, a multifunctional traditional Chinese medicinal plant, and its herbal medicines: A comprehensive review
Graphical abstract
Introduction
In Traditional Chinese Medicine (TCM), different parts of one plant can be processed into different medicines with different effects. Strobilanthes cusia (Nees) Kuntze (SCK, Malan) is such a traditional Chinese medicinal plant with a long medicinal history of about one thousand years. Through traditional crafts, SCK could be processed into three frequently-used herbal medicines. Its root and rhizome, Rhizoma et Radix Baphicacanthis Cusiae (RRBC), is an important common medicine, which is famous for its obvious effects on cold with fever, influenza, mumps, epidemic encephalitis B and some other infectious diseases. Its leaf and stem, Malanye (Southern Daqingye),1 is widely used as an antipyretic-alexipharmic drug in the folk. The processed product of its leaf and stem, Indigo Naturalis (IN, Qingdai), is a multiduty herbal medicine with great therapeutic effects on inflammations, dermatoses, scald and even hemorrhage. Multiple prescriptions of SCK's patent medicines have been inquired by the authors and those representative ones are listed together with their major components and clinical usage in Table 1.
Since 1970s, new curative effects of SCK have been discovered in succession. SCK's herbal medicines showed therapeutic effects on multiple diseases including ulcerative colitis (UC), nail psoriasis, infantile atopic dermatitis, and so on with mild side effects. Multiple pharmacological activities including anticancer, anti-inflammation, bacteriostasis and oxidation resistance have been demonstrated. Particularly, IN is closely concerned for its obvious effect against cancers and adverse reactions of chemotherapy. IN has been applied to clinical treatment of cancers, especially acute promyelocytic leukemia (APL). In addition, despite reports of adverse reactions, IN showed much less toxicity than most anticarcinogens. Alkaloids are considered as the main effective components of SCK. It has been proved in vitro and in vivo that tryptanthrin and indirubin in SCK can obviously suppress various types of cancers. Except for alkaloids, polysaccharides and glycosides of SCK have been discovered with multiple pharmacological activities. If the chemical and pharmacological research goes deeply, it will be hopeful for SCK to become an important raw material of specific drugs aimed at multiple diseases, especially cancers and dermatoses.
This is the first comprehensive review of herbal medicines of SCK. This review is aimed to summarize the traditional uses and modern studies of SCK and its herbal medicines. The emphasis is laid on chemical, pharmacological and textual studies. In addition, traditional processing, toxicity and quality control are also elucidated.
The prescriptions and major functions of patent medicine in Table 1 are obtained from Drug Intelligence Database (accessed in August 16th, 2019) and checked against CHP 2015 and ministerial standards of China.
Section snippets
Botany
Strobilanthes cusia (Nees) Kuntze is a perennial herb with erect stems. The plant can reach 0.5–1.5 m tall. Its drying blackish stem is branched and slightly lignified. Its young parts and inflorescences are covered with rust-colored squamiform hairs. Its leaves are ovoid, apex short acuminate, base cuneiform, serrated on the edge, papery and soft, 4–20 cm long and 2–9 cm wide. There is no hair and about 7–9 secondary veins on both sides of leaves. The length of petioles is from 1.5 to 2 cm.
Traditional names
In ancient China, plants containing blue pigments were collectively called “Lan” (蓝) and used to dye cloth. The Book of Songs says, “Lan picked from one morning to one night is not enough for one garment dyed”, depicting the scene that people picked “Lan” to dye cloth (Anonymous, 2002). As a nontoxic dyeing plant, SCK has been used so far in traditional clothes of ethnic minorities, such as Bai and Yao people of Yunnan Province, southwestern China (Fan et al., 2018a; Li et al., 2019b).
“Lan”
Glycosides
Multiple glycosides have been obtained from SCK and its herbal medicines.
There are 11 glycoalkaloids found in SCK. Above all, indican (1) in SCK is the precursor substance of indigo and indirubin, the main components of IN, (Yang et al., 2010). Three benzoheterocyclic glycoalkaloids including (2R)-2-O-β-D-glucopyranosyl-2H-1,4-benzoxazin-3(4H)-one (2) and (2R)-2-O-β-D-glucopyranosyl-4-hydroxy-1,4-benzoxazin-3-one (3) were found in RRBC (Wei et al., 2005). After that, Gu et al. isolated
Harvesting and processing of RRBC
RRBC is usually harvested in summer or autumn. The whole plants are digged up and rhizomes and roots are cut down, washed, and dried in the sun (National, 2015). Those stems and leaves are used as the raw materials of IN or dried and sold as Malanye. The quality of RRBC is related to some factors like harvesting season, growing time and baking temperature (Cao, 2015). It was found that RRBC harvested in summer showed higher contents of indigo and indirubin, while RRBC harvested in autumn was
Identification
There are three approved physiochemical identification (PI) methods of IN recorded in CHP 2015, including fire test, acid test and TLC. TLC is also the authoritative PI method of RRBC (National, 2015). With the development of instrumental analysis, more exact approaches have been excogitated. For IN, Zhi-ang Yao established a HPLC determination method of malachite green and crystal violet in fakes (Yao, 2011). It was also discovered that the acid-insoluble ash content of counterfeit IN was over
Treating leukemia
Since 1970s, IN has been discovered with therapeutic effects on cancers, especially leukemia and the active ingredient was considered to be indirubin at that time (Leukemia, 1977, 1979; Wu et al., 1978). It was illustrated that indirubin could induce apoptosis of leukemic cells and lengthen the lifetime of rats with lymphocytic leukemia L7212 (Huang, 1994). After that, Ai-dong Zou found IN's inhibition of HL-60 cells in vitro and tumor caused by NB4 cells in vivo (Zou, 2004). Cun Liu et al.
Pharmacokinetics
“Pharmacokinetics” is deemed closely related to “meridian tropism” of TCM. However, there are few pharmacokinetic studies on medicines of RRBC till now. Only a few pharmacokinetic studies of indirubin and tryptanthrin can be found.
Yu-feng Wei reported the pharmacokinetics of indirubin in rats (25 mg, i.g.). The result indicated that inditubin's distribution in rats was accorded with two compartment model (Wei, 2012). The main pharmacokinetic parameters: peak plasma concentration (Cmax
Toxicology and adverse reactions
So far, there has been no toxic ingredient found in IN and RRBC, and no recorded severe medical malpractice has been proved relevant to them. But sometimes there will be some side effects when IN and its preparations are used on patients in special physical or pathological conditions. In 1989, a Chinese physician recorded two cases of IN-induced contact dermatitis (Zhou, 1989). The two patients were both children and were given IN orally (Zhou, 1989). In 2006, two similar cases happening on
Future perspectives and conclusion
The present review collectively discussed the available scientific reports on chemical components, traditional usage, processing technology, pharmacological activities, pharmacokinetics, toxicity and quality control. Previous studies mostly focused on pharmaceutical effects and clinical applications of RRBC and IN. However, for clear statement of basic pharmacological principles and reasonable inference of research directions, the authors specifically reviewed the chemical compositions of
Funding
This research was supported by "Science and Technology Benefit People" Technical Research and Development Project of Chengdu Science and Technology Bureau (No. 2015-HM01-00401-SF) and "Xinglin Scholar" Scientific Research Promotion Plan for Disciplinary Talents of Chengdu University of Chengdu University of Traditional Chinese Medicine (No. QNXZ2018023, XSGG2019008).
Consent for publication
Written informed consent for publication was obtained from all participants.
Availability of data and material
Not applicable.
Ethics approval and consent to participate
Not applicable.
Declaration of competing interest
The authors declare that they have no competing interests.
Acknowledgements
We are indebted to our alma mater, Chengdu University of Traditional Chinese Medicine for provided convenience in the collection of documents. Thanks for all the help from everyone in our lab. Thanks Doctor Xin-xin Zhu (Xinyang University, China), Yan-jie Zhang (Xianggejia Indigo Naturalis Farmers' Cooperative of Shufeng Village, Xianyou Country, Fujian Province), Hong-xiong Lin (Tianwei Indigo Naturalis Agricultural Cooperative of Xianyou Country, Fujian Province) and Web of Flora Reipublicae
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