Traditional Chinese medicine modulates hypothalamic neuropeptides for appetite regulation: A comprehensive review

Obesity has emerged as a global health crisis, imposing substantial burdens on both individual well-being and socioeconomic development. The pathogenesis of obesity primarily stems from disrupted energy homeostasis, wherein the hypothalamus plays a pivotal role through its complex neuropeptide networks that regulate appetite and energy balance. Recent advances have highlighted the therapeutic potential of traditional Chinese medicine (TCM) in modulating hypothalamic appetite regulation. This comprehensive review systematically evaluates current evidence from PubMed and China National Knowledge Infrastructure databases, focusing on the mechanisms by which TCM interventions influence hypothalamic neuropeptide signaling pathways. Our analysis reveals that various TCM modalities, including bioactive compounds (e.g., berberine and, evodiamine), herbal formulations (e.g., Pingwei Powder, Fangji Huangqi Decoction), plant extracts (e.g., Cyclocarya paliurus aqueous extract), and Chinese patent medicines (e.g., Danzhi Jiangtang Capsules and Jingui Shenqi Pills), have significant effects on key appetite-regulating pathways. These effects are mediated through modulation of critical neuropeptide systems, particularly AgRP/NPY and POMC/CART neurons, as well as leptin signaling. These findings not only provide mechanistic insights into TCM's anti-obesity effects but also demonstrate the value of integrating traditional medicine with modern pharmacological approaches. The synergistic potential of TCM formulas, when combined with contemporary research methodologies, offers promising avenues for developing novel therapeutic strategies for obesity and related metabolic disorders.