Traditional Chinese medicine in sepsis-associated PICS: potential immunometabolic mechanisms and translational...

Persistent inflammation, immunosuppression, and catabolism syndrome (PICS) has emerged as an important contributor to long-term morbidity among survivors of sepsis. This syndrome is characterized by sustained immune dysregulation, metabolic disturbances, and progressive skeletal muscle wasting, reflecting a failure of coordinated recovery following severe infection. Although advances in critical care have improved early survival, effective strategies targeting the complex immunometabolic alterations underlying PICS remain limited. Traditional Chinese medicine (TCM) has increasingly been investigated as an adjunctive approach in critical care. Randomized clinical studies have reported potential benefits of several Chinese herbal injections in patients with sepsis, particularly Xuebijing injection, which has been associated with improvements in short-term clinical outcomes and inflammatory markers. Experimental studies further suggest that bioactive compounds contained in herbal formulations may influence multiple biological processes relevant to immune regulation and metabolic homeostasis. However, most available evidence has been derived from studies conducted during the acute phase of sepsis rather than the prolonged recovery phase in which PICS develops. In addition, the absence of a standardized diagnostic definition for PICS, together with variability in biomarker thresholds, diagnostic timing, and outcome measures across studies, limits comparability and may introduce heterogeneity in patient selection. These factors constrain the interpretation and generalizability of current findings. Accordingly, the potential role of TCM in PICS should be interpreted with caution. Rather than providing definitive therapeutic recommendations, this review critically synthesizes the currently available evidence, identifies important knowledge gaps, and proposes a conceptual framework to guide future mechanistic and translational studies in post-sepsis recovery.