Table 2.

Current limitations and candidate-specific research priorities for Mongolian medicine in sepsis.

Evidence gap	Why it matters	Mongolian medicine-specific priority	Candidate preparation(s)	Progression criterion
Disease-model directness	Endotoxin and non-sepsis injury do not reproduce infection, pathogen burden, or immune trajectories	Test delayed treatment in pneumonia-derived sepsis, CLP, or fecal peritonitis; measure pathogen burden, organ injury, immune state, and survival	Nagab-9; Hohgardi-9; Monflu; Rhaponticum extract; Daruqi	Reproducible benefit without impaired pathogen clearance or late immune suppression
Chemical and batch standardization	Variable materials and processing undermine reproducibility	Define authenticated ingredients, manufacturing process, quantitative markers, fingerprints, stability, and batch-acceptance limits	Daruqi; HHQG; Nagab-9; Hohgardi-9; Monflu/Lider-7	Comparable exposure and biological activity across independent batches
Experimental rigor	Incomplete reporting inflates uncertainty	Prespecify randomization, concealment, blinding, sample-size calculation, exclusions, dose rationale, and adverse events; follow ARRIVE	All animal candidates	Independent replication with transparent reporting and consistent primary outcomes
Myeloid and NET mechanisms	Reduced cytokines alone do not establish preserved host defense	Pair NET/myeloid phenotyping with bacterial killing, vascular injury, and survival	Nagab-9; HHQG; Xanthium fractions	Mechanistic effect persists in infection-based models without worse bacterial burden
Gut barrier and immunometabolism	Oral formulas may act through barrier or metabolic pathways, but direct evidence is absent	Use gut-origin sepsis, permeability, viable translocation, microbial metabolites, immune-cell metabolism, and organ cross-talk	Batri-7; Qiqirigan-8	Barrier or metabolic benefit is causally linked to improved infection-based outcomes
Pharmacokinetics and safety	Sepsis changes absorption, distribution, metabolism, excretion, and drug interactions	Measure exposure, tissue distribution, organ toxicity, and interactions with antimicrobials and critical-care drugs under septic conditions	Prioritized standardized formulas or fractions	Defined exposure-safety window and no clinically relevant interaction signal
Human translation	Broad efficacy trials would be premature and confounded by sepsis heterogeneity	Begin with human pharmacology/safety, then biomarker-enriched adjunctive trials with prespecified immune and clinical endpoints	Only candidates meeting the preceding criteria	Standardized product, mechanistic target engagement, acceptable safety, and credible responder definition