The role of traditional Chinese medicine in addressing the challenges of Clostridial gas gangrene: A multifaceted approach

Abstract

Traditional Chinese Medicine (TCM) offers a promising alternative approach for managing gas gangrene caused by Clostridium species. Gas gangrene is a severe, rapidly progressing soft tissue infection, characterized by extensive necrosis, gas formation, and systemic toxicity. Conventional treatment involves antibiotics, surgical debridement, and hyperbaric oxygen therapy; however, challenges such as antibiotic resistance and incomplete tissue regeneration persist. TCM compounds exhibit potent antimicrobial activity against Clostridium species by targeting bacterial replication, toxin production, and virulence factors. Berberine, baicalin, and emodin disrupt bacterial cell membranes, inhibit enzyme activity, and reduce toxin synthesis. TCM also addresses the pathogenic effects of alpha and theta toxins, which are key drivers of tissue destruction in gas gangrene. Compounds, such as epigallocatechin gallate and baicalin, neutralize these toxins, preventing cell lysis and vascular damage. Furthermore, TCM exerts anti-inflammatory and immunomodulatory effects by regulating cytokine production and macrophage polarization to limit excessive inflammation and support bacterial clearance. Polysaccharides from Astragalus membranaceus and Ganoderma lucidum enhance phagocytosis and modulate T-cell responses, whereas flavonoids, such as luteolin, reduce oxidative stress. TCM also promotes wound healing and tissue regeneration through compounds, such as asiaticoside and salvianolic acid B, which stimulate angiogenesis, collagen synthesis, and fibroblast proliferation. These multifaceted mechanisms position TCM as a valuable adjunct or alternative to conventional antibiotics in addressing bacterial elimination, toxin neutralization, inflammation control, and tissue repair in gas gangrene management. Further research is needed to elucidate the clinical efficacy and safety of TCM in treating gas gangrene, and to develop standardized formulations for integration into modern medical practice.