Tripterygium wilfordii

as a type of Tripterygium specie of Celastraceae genus

has a long history and has been widely applied in treating rheumatoid arthritis (RA). However

T. wilfordii has a high toxicity and serious side effects in humans

such as in reproductive system

immune system and digestive system

which restricts its clinical application. Therefore

it is essential to study its attenuation and synergistic effects. In this study

literatures for T. wilfordii and its preparations in treating RA in recent years were explored to develop its attenuation process

improve formulations and define the compatibility with compound traditional Chinese medicines and the combination with western medicines and acupuncture. There had been T. wilfordii processing methods since the ancient times

mainly including cleansing

sheep blood processing and heat processing;and there are many new processing methods

such as microwave heating and bi-directional solid fermentation techniques

in recent years. All of them can achieve the attenuation and synergistic effects. There are many kinds of T. wilfordii preparations.Specifically

oral drugs have a higher toxicology through intestinal absorption

while mucosal drugs had a lower toxicology. Therefore

improved formulations can effectively reduce the irritation time in gastrointestinal tracts and increase the absorption and bioavailability. Common formulations include suppository

sustained release tablet and pill. According to the study

the combination with Glycyrrhizae can accelerate the metabolic turnover of triptolide and reduce the toxicity of T. wilfordii

the combination with Paeonia sterniana Fletcher in Journ can reduce liver injury.Besides

the combination with western medicines and acupuncture can also achieve the attenuation and synergistic effects. In this study

the T. wilfordii processing methods for the attenuation and synergetic effects were summarized in the expectation of promoting the effective application of T. wilfordii in clinical application.