Clinical efficacy and mechanisms of Astragalus membranaceus, active components, and herbal formulas for chronic atrophic gastritis

Table 1 Clinical efficacy of Astragalus-based compound formulations

Ref.	Research contents	Composition of the compound formulation	Control group regimen	Clinical efficacy
Yan et al[46]	Therapeutic efficacy of Huangqi Jianzhong Decoction in treating CAG	Astragalus membranaceus, Ramulus Cinnamomi, Radix Paeoniae Alba, Rhizoma Zingiberis Recens, Fructus Jujubae, Radix Glycyrrhizae	None	Amelioration of multiple symptoms in patients with chronic atrophic gastritis
Zhang et al[47]	Therapeutic efficacy of Huangqi Sijun Decoction in treating CAG	Astragalus membranaceus, Pseudostellariae Radix, Rhizoma Atractylodis Macrocephalae, Poria, Ramulus Cinnamomi, Taraxaci Herba, etc.	Omeprazole	Amelioration of clinical symptoms and serum markers in patients
Li[48]	Therapeutic efficacy of modified Huangqi Guizhi Decoction combined with Western medicine in treating CAG of the spleen-stomach deficiency pattern	Astragalus membranaceus, Ramulus Cinnamomi, Radix Paeoniae Alba, Codonopsis Radix, Rhizoma Atractylodis Macrocephalae, Radix Saposhnikoviae, Pericarpium Citri Reticulatae, Radix Glycyrrhizae, etc.	Teprenone and folic acid	Enhancement of immune function and amelioration of clinical symptoms in patients
Zheng et al[49]	Clinical efficacy of Jiawei Huangqi Renshen Decoction in treating CAG with qi deficiency and blood stasis syndrome	Astragalus membranaceus, Codonopsis Radix, Rhizoma Atractylodis Macrocephalae, Radix Ophiopogonis, Angelicae Sinensis Radix, Pericarpium Citri Reticulatae etc.	Teprenone and folic acid tablets	Amelioration of clinical symptoms and repair of the gastric mucosa
Tang[50]	Clinical efficacy and medication safety of Huangqi Yujin Decoction in treating CAG	Astragalus membranaceus, Curcumae Radix, Poria, Rhizoma Atractylodis Macrocephalae, Radix Glycyrrhizae, Radix Paeoniae Alba, Radix Bupleuri, Fructus Aurantii, Semen Raphani Tostum etc.	Weifuchun Tablets	Alleviation of symptoms and delay of the inflammation-to-cancer sequence
Lin[51]	Therapeutic efficacy of Huangqi Yiqi Decoction combined with Western medicine in treating CAG	Honey-fried Astragali Radix, Aurantii Fructus Immaturus, Magnoliae Officinalis Cortex, Hedyotidis Diffusae Herba, Taraxaci Herba, Curcumae Rhizoma, Codonopsis Radix etc.	Omeprazole, Colloidal Bismuth Subcitrate, and Amoxicillin	Combination with Western medicine can enhance therapeutic efficacy

CAG: Chronic atrophic gastritis.

Table 2 Mechanisms of action of Astragalus compound formulas in the treatment of chronic atrophic gastritis

Ref.	Research contents	Experimental model	Mechanism of action
Zhang et al[52]	Therapeutic efficacy of Astragalus membranaceus in CAG rats: Insights from Huangqi Jianzhong Decoction	CAG rat model (cecal contents analysis)	Astragalus membranaceus treats CAG by regulating gut microbiota
Xia et al[53]	Mechanisms of action of modified Huangqi Guizhi Decoction in the treatment of CAG	CAG rat model	Mitigation of gastric mucosal injury and inflammation and restoration of epithelial cell structure
Liu et al[54]	Therapeutic efficacy of Huangqi Jianzhong decoction in established CAG rats	Rat model of CAG	Inhibition of inflammation, and amelioration of immunity and oxidative stress
Yu et al[55]	Therapeutic effects and mechanisms of Huangqi Jianzhong Decoction on H. pylori infection-induced gastric mucosal injury in rats	H. pylori infection-induced rat model	Inhibition of inflammatory response and amelioration of H. pylori-induced gastric mucosal injury
Huang et al[56]	Potential mechanisms of Qiling Formula in intervening in CAG with intestinal metaplasia	Rat model of CAG with intestinal metaplasia	Inhibition of pro-inflammatory factor release and gastric mucosal epithelial cell apoptosis, and delay of the inflammation-to-cancer transformation

CAG: Chronic atrophic gastritis; H. pylori: Helicobacter pylori.

Table 3 Experimental studies and mechanisms of action of Astragalus and its active components in the chronic atrophic gastritis treatment

Research contents	Action targets	Outcomes	Ref.
Astragalus membranaceus	H. pylori vacuolating cytotoxin A	Inhibition of H. pylori activity	Wang et al[58]
	Inflammatory factors	Suppression of pro-inflammatory cytokines and immunomodulation	Liu et al[60]
	Th1/Th2 and Treg/Th17 immune axes	Enhancing immune tolerance	Chang et al[63]
	PI3K/Akt, Wnt/β-catenin, and Janus kinase-signal transducer and activator of transcription 3 pathways	Protecting the gastric mucosa	Liu et al[66]; Yan and Zhang[67]
	Acetobacter and Escherichia coli	Alleviating gut microbial metabolic disorders	Liu[71]; Liu et al[72]
Astragaloside IV	H. pylori urease and related genes (ureA, ureB)	Attenuating the colonization ability of H. pylori	Wang et al[59]
	CXCL5-CXCR2 axis and the NF-κB pathway	Anti-inflammatory effects and inhibition of inflammation-to-cancer transformation	Pei et al[64]; Tian et al[65]
	Thrombin/PAR-1, p53, and MAPK signaling pathways	Increasing gastric acid secretion and protecting the gastric mucosa	Shen et al[68]; Duan et al[69]
	Bifidobacterium and the Wnt3a/β-catenin signaling pathway	Regulation of serum metabolite levels and anti-tumor effects	Wen et al[73]
	Reactive oxygen species, serum nitric oxide, and inducible nitric oxide synthase	Antioxidant and anticancer effects and improvement of clinical efficacy in CAG	Xia et al[75]; Li et al[76]
Astragalus polysaccharides	NF-κB p65/MAPK signaling pathway	Enhancement of immunomodulatory effects	Feng et al[62]
	Epidermal growth factor receptor downstream effector proteins cyclooxygenase-2 and metalloproteinases-2	Protection of the gastric mucosa	Zhu et al[70]
Total astragalosides	Immune factors	Enhancement of immunomodulatory capacity	Zhang et al[61]

CAG: Chronic atrophic gastritis; H. pylori: Helicobacter pylori; PI3K: Phosphoinositide 3-kinases; Akt: Protein kinase B; NF-κB: Nuclear factor-κB; MAPK: Mitogen-activated protein kinases.