Clinical efficacy and mechanism of Bletilla striata and Chinese herbal compounds in treatment of peptic ulcer

Table 1 Bletilla striata-sovereign herbal compound formulations

Formula name	Composition	Source	Actions and indications
Bletilla striata Powder (Baiji San)	Bletilla striata, Ampelopsis japonica, Os Sepiae, Salvia chinensis, Scutellaria baicalensis, Os Draconis	Volume 290, Puji Fang (Universal Relief Manual), Ming Dynasty	Promotes tissue regeneration, alleviates pain, stops bleeding, closes ulcerations, and dispels pathogenic wind. Indicated for abscesses, boils, sores, and toxic-heat lesions[37]
Bletilla striata Ointment (Baiji Gao)	Bletilla striata, Alpinia officinarum, asphalt	Volume 314, Puji Fang (Universal Relief Manual), Ming Dynasty	Treats furuncles[37]
Baiji Pipa Wan	Bletilla striata, loquat leaf, lotus node	Classified Prescriptions from Standards for Diagnosis and Treatment, Vol 3, Ming Dynasty (Dai's formulas)	Treats hemoptysis[38]
Baiji Lianhua San	Bletilla striata, lotus stamen, Platycladus orientalis leaf, Adenophora stricta	Classified Prescriptions from Standards for Diagnosis and Treatment, Vol 3, Ming Dynasty (Dai's formulas)	Treats hemoptysis[38]
Baiji Xionghuang San	Bletilla striata, realgar	Volume 10, Dongtian Ao Zhi (Mysterious Revelations of the Heavenly Abode), Qing Dynasty	Treats neonatal skin lesions (tà pí chuāng) in infants, attributed to maternal excessive consumption of pungent, heat-inducing foods during pregnancy[39]
Baiji Tang	Bletilla striata, Rubia cordifolia, rehmannia, Moutan bark, Achyranthes bidentata, tangerine peel, Angelica sinensis tail	Ancient and Modern Comprehensive Medicine, Vol 2, Qing Dynasty	Sed for hematemesis due to internal injury[40]

Table 2 Clinical efficacy of Bletilla striata

Drug combination	Clinical application	Specific effects	Supporting research
Bletilla striata powder combined with esomeprazole or omeprazole	Treatment of peptic ulcer	Inhibits inflammation, promotes ulcer healing, and reduces recurrence	Combination with proton pump inhibitors significantly enhances therapeutic efficacy[19,20]
Combined with rhubarb	Treatment of burns and scalds	Promotes wound contraction and tissue regeneration, and accelerates healing	Synergistic use enhances heat-clearing, detoxification, swelling reduction, and analgesic effects[41]
Ointments and gels containing Bletilla striata	Treatment of skin injuries	Used for chapped skin, acne, and other skin conditions. Demonstrates whitening, anti-inflammatory effects, and serves as an effective wound dressing	Bletilla striata-based topical preparations exhibit significant therapeutic efficacy in dermatological applications[42-44]
Bletilla striata polysaccharide	Antitumor, gastroprotective, and hemostatic effects	Exhibits adjuvant effects against various tumor types, reduces gastric ulcer index, enhances healing rate, and demonstrates significant hemostatic efficacy for pulmonary, gastric, and traumatic bleeding	Bletilla striata polysaccharides show antitumor activity, gastroprotective effects, shortened coagulation time, and enhanced platelet aggregation[45-48]
Other active components	Protection against acute lung injury	Demonstrates significant protective effects against LPS-induced lung injury by reducing neutrophil infiltration and downregulating pro-inflammatory cytokine expression	Bioactive extract EFBS of Bletilla striata exhibits potent anti-inflammatory activity in acute lung injury models[49,50]
Combined with Coptis chinensis and borneol	Other applications	Clinically used in the treatment of herpes zoster, pressure ulcers, and related conditions	Combination therapy enhances anti-inflammatory and analgesic outcomes[51,52]

LPS: Lipopolysaccharide; EFBS: Esophageal foreign body.

Table 3 Clinical efficacy of Bletilla striata compound formulations

Ref.	Study focus	Herbal formula composition	Control group treatment	Research findings
Zhao et al[21]	Huoxue Yuyang Granule in treating gastric ulcers with stomach collateral blood stasis pattern	Bletilla striata, Dendrobium, Gynostemma pentaphyllum, Pseudostellaria heterophylla, Aucklandia lappa, Sepia esculenta, Corydalis yanhusuo, Gallus gallus domesticus, etc.	Ranitidine, hydrotalcite tablets	The treatment group exhibited significantly higher complete healing and total effectiveness rates than the control group, along with notable improvements in multiple clinical symptoms
Liu[22]	Treatment of peptic ulcers using Pseudo-ginseng Rhizoma Bletillae Powder combined with quadruple therapy	Bletilla striata, Panax notoginseng	Standard Western quadruple therapy	The integrated Chinese-Western treatment group achieved a higher total effectiveness rate, along with faster symptom resolution and ulcer healing, compared to the control group
Qin and Deng[23]	Treatment of peptic ulcer with Zhuang Yao Yuyang San	Ilex rotunda, Panax notoginseng, Taraxacum mongolicum, Bletilla striata, Astragalus membranaceus, Sepia esculenta, etc.	Omeprazole capsules, clarithromycin tablets, metronidazole tablets	The treatment group demonstrated a higher Helicobacter pylori eradication rate compared to the control group, with comparable ulcer healing efficacy
Li et al[24]	Use of Shugan Yuyang Decoction in managing gastric ulcers	Bletilla striata, stir-fried Bupleurum chinense, Paeonia lactiflora, Trogopterus dung, stir-fried Aurantii Fructus Immaturus, Angelica sinensis, etc.	Conventional Western medicine	The observation group showed a significantly higher overall effectiveness rate than the control group
Chen et al[25]	Clinical efficacy of traditional Chinese medicine for Helicobacter pylori-positive peptic ulcers	Bletilla striata, Bupleurum chinense, Paeonia lactiflora, Citrus reticulata, Pinellia ternata, Pseudostellaria heterophylla, Poria cocos, etc.	Anti-H. pylori agents and other conventional Western treatments	Bletilla striata forms a protective film over ulcers, reduces mucosal inflammation, improves microcirculation, accelerates mucosal repair, and promotes ulcer healing

Table 4 Mechanisms of Bletilla striata in peptic ulcer treatment

Mechanism of action	Specific manifestations	Research support
Anti-H. pylori activity	Inhibits the growth of H. pylori and reduces ulcer recurrence	Reduces H. pylori-associated ulcers[53]
Inhibition of inflammatory response	Downregulates pro-inflammatory cytokine secretion and alleviates gastric mucosal inflammation	Suppresses the inflammatory cascade and limits inflammatory cell infiltration[54]
Enhancement of mucosal blood flow	Decreases nitric oxide activity and endothelin-1 Levels in gastric tissue	Improves mucosal perfusion and promotes tissue repair[55]
Promotion of cell proliferation and repair	Upregulates EGF and EGF receptor expression	Stimulates gastric epithelial proliferation and maintains mucosal integrity[55]
Immune modulation	Regulates cytokine secretion balance	Enhances the gastric mucosa’s defense against inflammation[56]
Antioxidant effect	Increases superoxide dismutase activity and reduces malondialdehyde content	Enhances antioxidant defense and limits oxidative tissue damage[57,58]

H. pylori: Helicobacter pylori; EGF: Epidermal growth factor; SOD: Superoxide dismutase; MDA: Malondialdehyde.

Table 5 Mechanisms of Bletilla striata compound formulations and their active components in treating peptic ulcers

Ref.	Research content	Experimental model & grouping	Key findings
Wang et al[30]	Effects of Sanqi Baiji powder on blood stasis-type gastric ulcers in rats	A rat model of blood stasis-type gastric ulcer was established and divided into five groups: Control, model, low-dose Sanqi Baiji San, high-dose Sanqi Baiji San, and high-dose Sanqi Baiji San + PI3K activator (740Y-P)	Sanqi Baiji powder alleviates inflammation and oxidative stress by inhibiting the PI3K/AKT signaling pathway. It improves hemorheological parameters (e.g., blood viscosity) and gastric mucosal blood flow, thereby reducing gastric mucosal injury
Gong et al[31]	Effects of BSPs on gastric ulcer in rats	A gastric ulcer rat model was established and divided into a blank control, model, ranitidine hydrochloride group, and low-, medium-, and high-dose BSP groups	BSPs protect the gastric mucosa by downregulating JNK and p38 MAPK gene and protein expression, and by inhibiting abnormal secretion of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6)
Fang et al[32]	Therapeutic effects and mechanisms of Bletilla striata non-polysaccharide components in gastric ulcer	An ethanol-induced gastric ulcer mouse model was established and divided into blank control, model, Yunnan Baiyao, and high-, medium-, and low-dose Bletilla striata alcohol extract groups	Bletilla striata non-polysaccharide components exert synergistic therapeutic effects via multiple bioactive compounds, targets, and signaling pathways
Shi et al[33]	Anti-ulcer activity and mechanisms of Bletilla striata fibrous root ethanol extract in ethanol-induced ulcers	Ethanol-induced acute gastric ulcer rat models were divided into normal, model, positive control, and low-, medium-, and high-dose Bletilla striata fibrous root ethanol extract groups	The fibrous root extract reduces serum levels of IL-1β and other pro-inflammatory markers while increasing IL-10 and VEGF expression, thereby exhibiting protective effects against ethanol-induced gastric ulcers
Fan et al[34]	Protective effects of sodium alginate/BSP in situ gel on alcohol-induced ulcers	Rats were divided into blank control, omeprazole-treated positive control, BSP group, blank gel group, and BSP-loaded in situ gel group	The BSP-loaded in situ gel reduces tissue necrosis, mitigates inflammatory cell infiltration, preserves mucosal barrier integrity, modulates cytokine imbalance, and suppresses apoptosis related to inflammation. No significant adverse effects were observed, supporting its potential for peptic ulcer treatment

BSP: Bletilla striata polysaccharide; VEGF: Vascular endothelial growth factor; TNF-α: Tumor necrosis factor-alpha; IL-1β: Interleukin-1β; IL-6: Interleukin-6.