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Alisma Orientale: Ethnopharmacology, Phytochemistry and Pharmacology of an Important Traditional Chinese Medicine

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Alisma Orientale: Ethnopharmacology, Phytochemistry and Pharmacology of an Important Traditional Chinese Medicine The American Journal of Chinese Medicine, Vol. 44, No. 2, 227–251 © 2016 World Scientific Publishing Company Institute for Advanced Research in Asian Science and Medicine DOI: 10.1142/S0192415X16500142 Alisma orientale: Ethnopharmacology, Phytochemistry and Pharmacology of an Important Traditional Chinese Medicine Zhiheng Shu,*,† Jiang Pu,‡ Ling Chen,* Yuanbin Zhang,† Khalid Rahman,§ Luping Qin* and Chengjian Zheng* *Department of Pharmacognosy, School of Pharmacy Second Military Medical University, Shanghai 200433, P.R. China †School of Pharmacy, Ningxia Medical University Yinchuan 750004, P.R. China ‡Administrative Office, Changhai Hospital Second Military Medical University, Shanghai 200433, P.R. China §Faculty of Science, School of Biomolecular Sciences, Liverpool John Moores University, Byrom Street Liverpool L3 3AF, England, UK Published 1 April 2016 Abstract: Alisma orientale (Sam.) Juzep. (Alismataceae) is a traditional and famous Chinese medicinal herb. Its rhizomes, which possess versatile bioactivities, are commonly used to treat oliguria, edema, gonorrhea with turbid urine, leukorrhea, diarrhea and dizziness. Approxi- mately 120 compounds have been isolated from A. orientale. Terpenoids have been identified as A. orientale’s characteristic constituents, which include protostane triterpenoids and guaiane sesquiterpenoids. The traditional medical uses of A. orientale in TCM have been evaluated in modern pharmacological studies, which have shown that A. orientale and its active constituents Am. J. Chin. Med. 2016.44:227-251. Downloaded from www.worldscientific.com exhibit a wide range of bioactivities, such as diuretic, anti-urolithiatic, antinephritic, anti- by UNIVERSITY OF CALIFORNIA @ SAN DIEGO on 04/17/16. For personal use only. atherosclerotic, immunomodulatory, and hepatoprotective activities. The medicinal potential of A. orientale makes it an ideal candidate for new drug development. Further studies are still required to identify its bioactive constituents, and elucidate the structure–activity relationship and detailed mechanisms of action. Additionally, the use of the other medicinal parts of A. orientale may reduce resource waste and afford novel secondary metabolites. Keywords: Alisma orientale (Sam.) Juzep.; Ethnopharmacology; Phytochemistry; Pharma- cology; Terpenoids; Review. ⁄ Correspondence to: Dr. Chengjian Zheng and Dr. Luping Qin, Department of Pharmacognosy, School of Pharmacy, Second Military Medical University, 325 Guohe Road, Yangpu District, Shanghai 200433, China. Tel: (þ86) 21-8187-1305, E-mail: [email protected] (C. Zheng); Tel: (þ86) 21-8187-1309, E-mail: [email protected] (L. Qin) 227 228 Z. SHU et al. Introduction Alisma orientale (Sam.) Juzep. (Alismataceae) is a traditional, popular Chinese medicinal herb native to several Asian countries, including China, Korea, and Japan (Liu et al., 2010; Han et al., 2013; Lin, 2014). Alismatis rhizoma (AR) (also known as Ze Xie in Chinese and Takusha in Japanese), the dried stem tuber of A. orientale, can remove dampness and promote water metabolism, according to the theory of traditional Chinese medicine (TCM). AR has been used for centuries in China, Korea, and Japan for the treatment of various diseases, including oliguria, edema, gonorrhea with turbid urine, leukorrhea, diarrhea and dizziness (Yoneta et al., 2009; The State Pharmacopoeia Commission of P. R. China, 2010; Han et al., 2013). Recently, it was proven that A. orientale has therapeutic effects on hyperlipidemia (Dan et al., 2011), fatty liver disease (Liu et al., 2013), cancer (Huang et al., 2006), and obesity (Guo et al., 2009). A. orientale has been listed in the Pharmacopoeia of the People’s Republic of China since 1985. The components used in traditional medicine, the rhizomes, are commonly listed as an important ingredient in many TCM formulations, such as Long Dan Xie Gan Wan and Wu Ling San. Modern pharmacological studies have shown that A. orientale and its active compounds possess a wide range of bioactivities, including diuretic activities (Feng et al., 2014), anti-urolithiatic activities (Cao et al., 2003), anti-atherosclerotic activities (Xue et al., 2014), immunomodulatory activities (Matsuda et al., 1998), hepa- toprotective activities (Hong et al., 2006), antinephritic activities (Hattori et al., 1998). Most of these actions support the traditional medical uses of A. orientale in TCM. Due to its versatile traditional use and promising pharmacological actions, A. orientale has been the subject of many phytochemical studies. Since 1960, more than 120 com- pounds have been isolated from A. orientale and identified, including terpenoids, flavo- noids, polysaccharides, and other compounds. Terpenoids, including protostane triterpenoids, guaiane sesquiterpenoids and kaurane diterpenoids, are the characteristic constituents of this plant (Liu et al., 2010). Alisol B 23-acetate, a major protostane tri- terpenoid in A. orientale, exhibits potent bioactivity and is regarded as the official indicator for the quality control of this medicinal herb in the Pharmacopoeia of the People’s Am. J. Chin. Med. 2016.44:227-251. Downloaded from www.worldscientific.com Republic of China (The State Pharmacopoeia Commission of P. R. China, 2010). This paper aims to review the advances in the published ethnopharmacological, phy- by UNIVERSITY OF CALIFORNIA @ SAN DIEGO on 04/17/16. For personal use only. tochemical, pharmacological and toxicological profiles of A. orientale in the past decades so as to facilitate its further study and its use as a resource. Additionally, the potential for future investigations on this plant are also discussed. Ethnopharmacology A. orientale plays a very important role in TCM due to its versatile therapeutic properties. Dating back more than 1800 years, “Ming Yi Bie Lu”, a famous monograph of traditional Chinese medicine written in China during the Han dynasty, lists it as a “top grade” medicine. In this book, A. orientale is described as useful for the treatment of abdominal REVIEW ON ALISMA ORIENTALE (SAM.) JUZEP. 229 masses based on its good diuretic properties (Tao et al., 1986). Then, in “Ben Cao Gang Mu”, the most famous classical book of Chinese material medicine, this plant was recorded to be used for the treatment of wet-swelling, stranguria and to expel heat (Li, 2007). Due to its long-term traditional use and well known efficacy, A. orientale has been listed in the Chinese Pharmacopoeia since 1985 and its rhizome has been listed as a treatment for oliguria, edema, gonorrhea with turbid urine, leukorrhea, diarrhea, and dizziness (The State Pharmacopoeia Commission of P. R. China, 2010). It is commonly used as the main component of many famous TCM formulations, and it plays a vital role (Table 1). Among TCM prescriptions, “Liu Wei Di Huang Wan”, a very famous formula in TCM, is used to invigorate the kidney and nourish yin. “Long Dan Xie Gan Wan”, another famous pre- scription in TCM, has been applied to clear away liver heat and damp-heat. The rhizome of this plant is used as the effective agent in these formulations, after it is processed by bran, wine, salt, or dried by the fire, all of which may influence its clinical efficacy (Duan et al., 2004). A. orientale also has a long history of use as a folk remedy in Korea, where it is applied to inhibit hypersensitivity reactions (Lee et al., 2012) and to treat acute lung injury (Han et al., 2013). In Japan, A. orientale, also known as Takusha, is prescribed in many pre- parations in Kampo medicine, such as Hachimi-Jio-Gan, Saiei-to and Chorei-to (Liu et al., 2010). A. orientale is currently popular on the Japanese market and has been use to cure nephritis (Hattori et al., 1998), vertigo, and dizziness (Yoneta et al., 2009). With both medical and edible functions, A. orientale has been applied in many health care products, mixed with other medicines or with food, to treat obesity, reduce edema, and tonify the kidney and spleen. For instance, “Ze Xie Cu (vinegar)”, consists of A. orientale, fructus crataegiand sticky rice, and can be used to reduce phlegm, nourish the liver and reduce blood pressure. Another healthy beverage, “Ze Xie Tea”, which consists of A. orientale, Radix et Rhizoma Rhei and Semen Cassiae, can be used to lower lipids, promote water metabolism, reduce edema, and nourish the kidney and spleen (Yi et al., 2007). Phytochemistry Am. J. Chin. Med. 2016.44:227-251. Downloaded from www.worldscientific.com Since the 1960s, extensive phytochemical studies have been carried out on A. orientale in by UNIVERSITY OF CALIFORNIA @ SAN DIEGO on 04/17/16. For personal use only. China, Japan, Korea and other countries. Based on previous reports, terpenoids are con- sidered the main constituents of A. orientale, with protostane triterpenoids and guaiane sesquiterpenoids regarded as the characteristic compounds (Jiang et al., 2006). Protostane- type triterpenoids mainly include alisols A–I and their derivatives, while guaiane-type sesquiterpenoids include alismol, alismoxide, orientalols A–F and orentalols sulphate. A. orientale also contains small amounts of diterpenoids, flavanoids, alkaloids, asparagine, phytosterols, fatty acids and resins. As the rhizome was the component traditionally used in TCM, most investigations have just focused on the chemical constituents of the rhizomes. To date, approximately 122 chemical components have been isolated and identified (Table 2). The structures of the principal constituents, including triterpenoids, diterpenoids and sesquiterpenoids, are shown in Figs. 1 and
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