Advances in traditional Chinese medicine for the treatment of acute radiation-induced oral mucositis: A review from clinical efficacy to pharmacological and analytical insights

Acute radiation-induced oral mucositis (ROM) is a debilitating complication of radiotherapy for head and neck cancer. Despite advances in supportive care, current therapies remain suboptimal. Traditional Chinese Medicine (TCM), characterized by its multi-component, multi-target, and holistic approach, has demonstrated promising efficacy in preventing and alleviating ROM. For instance, a combined regimen of Zhuhuang Powder and Qingyan Mixture was shown to significantly reduce radiation-induced oral mucositis (ROM) incidence (treatment group vs. control group = 84.7% vs 92.9%), severe mucositis (Grade ≥ II: 29.2% vs 55.7%) and pain (VAS 3.1 vs 4.7), and delayed onset (23.27 vs 8.77 days) compared to routine care. This review summarized recent clinical and preclinical evidence on TCM interventions for acute ROM, focusing on commonly used herbal formulas (Sancao Yuyang Decoction, Jiandu Granule), single herbs, and active compounds. We highlighted modern analytical and pharmacological technologies, such as ultra-performance liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry (UPLC-QTOF-MS/MS), network pharmacology, metabolomics, pharmacokinetic profiling, and quality marker (Q-marker) identification in elucidating the chemical basis, mechanisms of action, and quality consistency of TCM products. Furthermore, we discussed challenges in standardization, safety, and integration into oncology care, and proposed future directions for evidence-based development of TCM as an adjuvant therapy in radiation oncology.