类风湿性关节炎（rheumatoid arthritis，RA）是一种以慢性滑膜炎和进行性关节破坏为特征的自身免疫性疾病，现有临床治疗药物存在不良反应显著、易产生耐药性等临床局限。秦艽Gentianae Macrophyllae Radix作为传统祛风湿要药，在RA治疗中历史悠久且疗效确切。研究表明，秦艽中发挥抗RA作用的核心成分为环烯醚萜类、三萜类及黄酮类化合物，其中龙胆苦苷、獐牙菜苦苷、熊果酸、山柰酚等为关键活性单体成分，这些成分通过调控核因子-κB、Janus激酶/信号转导与转录激活因子、核因子-红细胞2相关因子2/血红素氧合酶1等核心信号通路，实现抗炎、调节免疫、抑制滑膜成纤维细胞异常增殖与侵袭、抗氧化、抑制血管新生、抗骨破坏与软骨保护的多维度药理作用。临床上，秦艽常与防己、桑寄生、独活等药物配伍组成复方（如蠲痹汤、复方芪芎颗粒），针对RA不同中医证型实现多成分、多靶点的网络协同增效。综述秦艽通过多机制、多途径的整体调节模式干预RA病理进程，展现出良好应用前景，以期为其药效物质基础及开发利用提供理论依据。

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic synovitis and progressive joint destruction. Current clinical therapy drugs are limited by significant adverse effects and the development of drug resistance. Qinjiao (Gentianae Macrophyllae Radix), a well-known herb for dispelling wind-dampness in traditional Chinese medicine, has been historically used to treat RA with confirmed efficacy. Phytochemical studies have identified iridoids, triterpenoids, and flavonoids as the primary anti-RA constituents, with gentiopicroside, swertiamarin, ursolic acid, and kaempferol serving as key active monomers. These compounds exert multifaceted pharmacological effects through modulation of core signaling pathways including nuclear factor--κB (NF-κB), Janus kinase (JAK)/signal transducer and activator of transcription (STAT), and nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1), leading to anti-inflammatory activity, immune regulation, inhibition of fibroblast-like synoviocyte (FLS) proliferation and invasion, antioxidant effects, suppression of angiogenesis, and protection against bone destruction and cartilage damage. In clinical practice, Qinjiao is commonly combined with other botanicals such as Fangji (Stephaniae Tetrandrae Radix), Sangjisheng (Taxilli Herba), and Duhuo (Angelicae Pubescentis Radix) in composite formulas (e.g., Juanbi Tang and Compound Qixiong Granules), achieving synergistic multi-component and multi-target effects tailored to different TCM syndromes of RA. This review summarizes the comprehensive regulatory mechanisms through which Qinjiao intervenes in RA pathogenesis via multiple pathways, highlighting its promising therapeutic potential and providing a theoretical basis for further investigation of its pharmacodynamic material basis and clinical development.

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河南省中医药科学研究专项（2025ZY3069）；国家中医药管理局第五批全国中医临床优秀人才研修选项目（国中医药人教函[2022]1号）；河南省中医药拔尖人才培养项目专项课题（2022YBJ23）；河南省首批中医药拔尖人才项目（豫中医科教[2018]25号）；河南省中医药重点学科建设项目（豫卫中医[2023]16号）