Immunomodulatory potential of Mongolian medicine in sepsis: current evidence, challenges, and translational perspectives

Sepsis is a heterogeneous, time-dependent syndrome in which inflammatory injury, immune suppression, endothelial dysfunction, metabolic disturbance, and barrier failure may coexist. This narrative review evaluates whether current pharmacological evidence provides a defensible basis for investigating Traditional Mongolian Medicine as an adjunctive source of immunomodulatory candidates in sepsis. A concise account of sepsis immunopathology is used as an interpretive framework, after which evidence from named Mongolian formulas, extracts, medicinal materials, and isolated constituents is mapped according to ethnomedical specificity, model directness, and study-design limitations. Direct sepsis-specific evidence is scarce. Daruqi particles, HHQG, Hohgardi-9, Nagab-9, Monflu, Batri-7, Qiqirigan-8, and selected extracts have mainly been studied in lipopolysaccharide-induced acute lung injury, organ-injury, enteritis, inflammatory, or metabolic models. These studies suggest effects on NF-κB/MAPK signaling, myeloid-cell infiltration, neutrophil extracellular traps, redox regulation, and lipid metabolism, but generally do not assess polymicrobial infection, pathogen clearance, survival, late immunosuppression, or human immune endotypes. Widely distributed compounds such as quercetin, berberine, geniposide, and gallate are therefore treated only as non-specific constituent-level evidence of pharmacological plausibility. We propose candidate-specific priorities for chemical standardization, rigorous sepsis modeling, pharmacokinetic and safety evaluation, and biomarker-guided translation. The current literature supports an ethnopharmacology-informed research agenda, not therapeutic efficacy in sepsis.