Ardisia gigantifolia stapf (Primulaceae): A review of ethnobotany, phytochemistry, pharmacology, clinical application, and toxicity

Ardisia gigantifolia Stapf, known as Zou-ma-tai (in Chinese), is a traditional folk medicine, which was commonly used by Dong, Jing, Li, Maonan, Miao, Mulam, Yao, and Zhuang people. The main use of A. gigantifolia is the treatment of rheumatoid arthritis, gouty arthritis, fractures, osteoproliferation, traumatic injuries, gynecological, and neurological diseases. Current studies have shown that the plant has various bioactive components, especially gigantifolinol, which has anti-tumor, anti-inflammatory, anti-tuberculosis, and neuroprotective activities. However, to date, few reviews have been made to summarize A. gigantifolia's related studies. This review aimed to summarize the traditional use, phytochemistry, pharmacology, clinical applications, and toxicity of A. gigantifolia, which expect to provide theoretical support for future utilization and highlight the further investigation of this vital plant. The information related to A. gigantifolia were collated by surveying the traditional medicine books, ethnomedicinal publications, and searching academic resource databases including Web of Science, SciFinder, Springer Link, Pub Med, Science Direct, CNKI, and CQVIP database. A. gigantifolia has been used as a traditional folk medicine for more than 400 years in China. Different parts of the plant, including the aerial part, root, rhizome, and leaf, are mainly used as herbal medicine to treat rheumatoid arthritis, traumatic injuries, gynecological, etc. Currently, 165 compounds have been identified from the plant, including triterpenes, phenolics, coumarins, quinones, volatile oil, and sterols, 137 of which were identified from the rhizome parts. Pharmacological research showed that A. gigantifolia has various bioactivities, such as anti-tumor, anti-inflammatory, anti-oxidant, anti-thrombus, anti-tuberculosis, cough expectorant, and neuroprotective activities. Clinical studies have shown that the plant has no toxic side effects. In vivo administration at the maximum dose was not lethal, indicating the plant's safety. To date, most bioactive compounds are identified from the rhizomes of A. gigantifolia, which pharmacological activity and clinical observational studies have validated the plant's traditional use as a treatment for rheumatoid arthritis. It would be helpful to verify the mechanism of some components in vivo, such as gigantifolinol. Moreover, the plant's triterpenoid saponins demonstrated valid anti-tumor effects, especially the AG4 and AG36 compounds, which were shown to have anti-breast cancer effects both in vitro and in vivo. Further research on these components, including molecular mechanisms and in vivo metabolic regulation, needs to be confirmed.