Convergent molecular nodes of curcumin and tanshinone IIA: A narrative review of their multidisease therapeutic scope and clinical challenges

A BSTRACT Traditional Chinese medicine (TCM) provides a holistic therapeutic framework with over 2000 years of clinical use; however, its molecular mechanisms remain incompletely defined. This narrative review, which is based on a systematic search of global and Chinese databases, evaluates preclinical and clinical evidence across seven disease categories: osteoporosis, Alzheimer’s disease, inflammatory bowel disease, cardiovascular disease (CVD), cancer, liver disease, and viral infections. Curcumin ( Curcuma longa ) and tanshinone IIA ( Salvia miltiorrhiza , TIIA) emerge as key bioactive compounds targeting shared pathological pathways, including nuclear factor kappa B-mediated inflammation, nuclear factor erythroid 2–related factor 2 (Nrf2)-related oxidative stress, and mitochondrial dysfunction, providing a unified mechanistic basis for TCM’s multidisease effects. Clinical evidence supports the adjunctive use of curcumin in ulcerative colitis, nonalcoholic fatty liver disease, and coronavirus disease 2019 and of TIIA in CVD. However, current studies are limited by small sample sizes and formulation heterogeneity. Poor oral bioavailability, potential toxicity, and regulatory challenges remain major barriers to clinical translation. Advancing TCM into evidence-based practice requires improved formulations, well-designed multicenter randomized controlled trials, and robust pharmacovigilance to ensure safety and efficacy.