The review organizes Alzheimer’s pathology into seven interconnected pillars: the amyloid-beta cascade, tau abnormalities, neuroinflammation, regulated cell death, synaptic plasticity impairment, gut microbiota-brain axis imbalance, and oxidative stress. Each pillar alone has been the target of major drug programs, and each alone has largely disappointed. The amyloid hypothesis, which dominated the field for decades, produced antibodies that clear plaques but deliver only modest clinical benefit, fueling debate about whether attacking one node of a network can ever halt a systems-level disease. The authors argue that this is precisely where TCM’s multi-component, multi-target character becomes an advantage rather than a liability, because a single herbal formula can modulate dozens of molecular nodes at once.

At the top of the review’s mechanistic hierarchy sit two molecular hubs: glycogen synthase kinase 3 beta, known as GSK-3β, and nuclear factor kappa-B, or NF-κB. GSK-3β is the principal kinase that tags tau proteins with phosphate groups, driving them to detach from microtubules and clump into the neurofibrillary tangles that correlate so tightly with cognitive decline. NF-κB, meanwhile, is the master switch of inflammation, sitting at the intersection of amyloid signaling and the activation of microglia, the brain’s immune cells. Because these two hubs link the protein-aggregation side of Alzheimer’s to its inflammatory side, the review positions them as the most strategically valuable targets in the entire network, and notes that many TCM compounds converge on them.

The evidence for this convergence is drawn from a striking range of plant-derived molecules. Tanshinone IIA, a diterpenoid from the root of Salvia miltiorrhiza, has been shown in APP/PS1 transgenic mice to regulate GSK-3β-related signaling and ameliorate memory impairment, while independently suppressing the RAGE/NF-κB inflammatory pathway in cell and animal models. Curcumin, the golden pigment of turmeric, inhibits the HMGB1-RAGE/TLR4-NF-κB cascade in the hippocampus of Alzheimer’s model mice and also activates AMPK, an energy-sensing kinase that guards metabolic and mitochondrial homeostasis. Hesperidin and its aglycone hesperetin, flavonoids from citrus peel, activate Akt/Nrf2 antioxidant signaling while dampening RAGE/NF-κB, effectively pushing the same network in two protective directions at once.

Inflammation receives particularly detailed treatment in the review. Microglial activation and the NLRP3 inflammasome, a molecular machine that triggers the inflammatory form of cell death called pyroptosis, have emerged as central amplifiers of neurodegeneration. Baicalin, a flavone from Scutellaria baicalensis, protects neurons by suppressing both NLRP3 inflammasomes and TLR4/NF-κB signaling, while resveratrol blocks Aβ-induced microglial activation through the TXNIP/TRX/NLRP3 pathway. Forsythoside B attenuates memory impairment by inhibiting NF-κB signaling, and the multi-herb formula Kai-Xin-San ameliorates Alzheimer’s-related neuropathology in APP/PS1 mice via the mitochondrial autophagy-NLRP3 inflammasome axis, with a related study implicating the SIRT3/NLRP3 pathway in its protection of mitochondrial function. The pattern is consistent: rather than blocking one cytokine, these compounds throttle the upstream switches that produce interleukin-6, interleukin-1 beta, and tumor necrosis factor alpha together.

Cell death itself is another domain where the review finds TCM acting across multiple modalities. Beyond apoptosis, Alzheimer’s brains show ferroptosis, an iron-dependent death driven by lipid peroxidation and loss of the antioxidant enzyme GPX4, as well as pyroptosis mediated by caspase-1 cleavage of gasdermin D, and necroptosis regulated by RIPK1 complexes. The PINK1/Parkin pathway, which tags damaged mitochondria for removal by mitophagy, is frequently defective in the disease, allowing dysfunctional mitochondria to accumulate and spew reactive oxygen species. Compounds such as the combination of beta-asarone and icariin have been reported to reverse cognitive deficits by promoting mitophagy, while galangin rescues amyloid-beta-induced mitophagy impairment in brain organoid models. By restoring cellular quality control rather than merely blocking death executioners, these interventions address death pathways upstream of the point of no return.

Synaptic failure, arguably the strongest correlate of cognitive decline, is governed by molecules such as brain-derived neurotrophic factor, or BDNF, and the postsynaptic scaffold protein PSD-95. Recent work shows that PSD-95 can physically protect synapses from beta-amyloid toxicity, and that multivalent tau/PSD-95 interactions can disrupt the postsynaptic density. On the TCM side, Suan-Zao-Ren Decoction ameliorates synaptic plasticity in APP/PS1 mice by inhibiting amyloid deposition and JAK2/STAT3 signaling, while the Chinese herbal compound Jinsiwei improves synaptic plasticity in a sporadic Alzheimer’s model induced by streptozotocin. Hesperidin has been shown to improve memory by enhancing neurogenesis, and sesame lignans elevate BDNF expression alongside anti-cholinesterase activity, suggesting that herbal compounds can rebuild synaptic architecture rather than simply slow its erosion.

Perhaps the most contemporary section of the review concerns the gut microbiota-brain axis. Germ-free studies have shown that amyloid pathology can be reduced in the absence of gut microbes, and that transferring a healthy microbiota into Alzheimer’s model animals reduces both amyloid and tau pathology. Gut-derived beta-amyloid itself has been proposed as a centerpiece of gut-brain communication in the disease, and gut microbiota have been shown to regulate Alzheimer’s pathologies through polyunsaturated fatty acid-associated neuroinflammation. TCM formulas appear well suited to this axis: Qifu Yin regulates intestinal microbiota in mice with memory impairment, and the classical formula Huang-Lian-Jie-Du Decoction acts on oxidative stress and the AMPK-SIRT1 pathway in Alzheimer’s rats, linking metabolic, redox, and microbial regulation in a single intervention.

The redox thread ties the whole network together. Oxidative stress has been proposed to occur prior to amyloid plaque formation and tau phosphorylation, with glutathione depletion and metal ion dysregulation as early events. The Nrf2/HO-1 pathway is the cell’s primary antioxidant defense, and multiple TCM molecules converge on it: rhynchophylline from the cat’s claw vine activates Nrf2-ARE signaling against amyloid-induced oxidative damage, platycodin D simultaneously suppresses TLR4/NF-κB and activates Nrf2/HO-1 in microglial cells, and Qifu-yin activates the Keap1/Nrf2/ARE axis to ameliorate synaptic injury in APP/PS1 mice. Meanwhile SIRT1, activated by resveratrol and targeted by tanshinone IIA in the context of endoplasmic reticulum stress, regulates both inflammation and mitochondrial biogenesis, positioning the AMPK-SIRT1-Nrf2 module as the metabolic and redox control center that TCM compounds repeatedly engage.

The review’s authors are careful to frame their synthesis as a direction rather than a verdict. Human clinical evidence remains thinner than the preclinical literature, although randomized controlled trials such as one testing the Huannao Yicong Formula against donepezil in mild-to-moderate Alzheimer’s patients and a pilot trial of Kami-guibi-tang for mild cognitive impairment point toward translational potential. Standardization of herbal preparations, identification of active constituents, and rigorous multi-center trials remain essential hurdles. Yet the conceptual contribution is clear and, to many researchers, compelling: by concurrently modulating GSK-3β and NF-κB hubs, the AMPK-SIRT1-Nrf2 metabolic core, PINK1/Parkin mitophagy, and the BDNF/PSD-95 synaptic machinery, traditional Chinese medicine establishes a synergistic therapeutic network that reduces amyloid deposition, attenuates tau hyperphosphorylation, and mitigates neuronal damage in ways that single-target drugs cannot replicate. As the search for effective Alzheimer’s therapies continues, the ancient pharmacopeia may prove to hold not a miracle cure, but a blueprint for treating a network disease as a network.

Subject of Research: Multi-target mechanisms of traditional Chinese medicine in Alzheimer's disease therapy

Article Title: Traditional Chinese medicine for Alzheimer’s disease: pathological mechanisms and multi-target interventions

Article References: Zhang, Y., Song, R., Wang, J., Chen, B., Sun, H., Ren, X., Ju, L., Feng, X., Wang, X., & Qin, G. (2026). Traditional Chinese medicine for Alzheimer’s disease: pathological mechanisms and multi-target interventions. 3 Biotech, 16(10), Article 449. https://doi.org/10.1007/s13205-026-05078-2

Image Credits: AI Generated

DOI: 10.1007/s13205-026-05078-2

Keywords: Alzheimer's disease, traditional Chinese medicine, amyloid-beta, tau hyperphosphorylation, neuroinflammation, GSK-3β, NF-κB, NLRP3 inflammasome, mitophagy, gut microbiota-brain axis, oxidative stress, synaptic plasticity