Marine biological resources are abundant, and coral is a common organism in the ocean. It is a low-level invertebrate of the ocean, belonging to the phylum Coelenterata and the class Coralis. Coral mainly lives in tropical oceans and has a wide variety and distribution. There are over 6,100 species of coral worldwide and 719 species in China (Li T. T., 2010). Corals can be divided into Hexacorallia and Octocorallia (Xu, 2016). Corals are known as “sea flowers” and are a type of aquatic coelenterate. Their population is dendritic, branching and spreading like fans, with fine branches. Their surface contains many hydra bodies called anthozoan polyps. Their body is hemispherical in shape, with eight feathered tentacles on top. The tentacles have a mouth in the center, and the insect body can secrete limestone to form bones. White is better than snow; red is similar to blood; green is similar to jade, and yellow is similar to gold. Coral naturally grows in the sea, with strange shapes and unparalleled beauty (National Compilation of Chinese Herbal Medicine, 1996). The main compound of coral is calcium carbonate, which also contains a series of elements such as iron, manganese, copper, and strontium, as well as chitin and organic acids. Corals are commonly white, whereas gemstone-grade corals are red, pink, and orangey red, with a small amount of black and blue. The color of coral is due to its content of approximately 1% iron oxide and organic matter. With red as the top grade, red coral is as red as fire, known as the “fire tree” in ancient times. Its origin is in the deep sea of the Mediterranean and Atlantic oceans, and it is primarily used for jewelry, with the largest being used for carving figures, flowers, and birds, and other handicrafts (Wen, 2007). In India and Tibet of China, people use coral as a mascot for worship, often used to make Buddhist beads and decorate deities. In the West, coral is one of the three major organic gemstones, whereas in the East, coral symbolizes auspiciousness and happiness since ancient times. It also represents nobility and power and symbolizes happiness and eternity (Wen et al., 2007). The ancient Romans believed that coral played roles in disaster prevention, intelligence, hemostasis, and heat dissipation, which continued until this century (Hong, 2009).

Corals are distributed in the South China Sea, North China Sea, and East China Sea, among which the South China Sea is located in a tropical and subtropical zone and contains abundant coral biological resources. Since the 1980s, chemists have conducted in-depth research on corals in the South China Sea. At the beginning of the 20th century, the utilization of coral resources includes human bone substitutes, feed calcium filler, and a good source of calcium supply for the human body (Huang et al., 1997). With the rapid development of modern separation and identification methods and the increasing maturity of biotechnology, a large number of active substances have been isolated from marine organisms (Zhang G. et al., 2013), such as salicin with antibacterial activity and alkaloids with cytotoxic activity, which have been isolated from Sinularia suberosa on the side of the South China Sea (Qi et al., 2005). In addition, antitumor alkaloids have been obtained from Ellisella curvata on the side of the South China Sea (Zhang J. R., 2012). With the deepening of chemical research on natural products of soft coral and gorgonians^※, thousands of compounds with dozens of structural skeletons have been discovered, including steroids, terpenoids, nitrogen-containing compounds, long-chain fatty acids, and long-chain alcohols. The diverse structures, unique molecular frameworks, and significant pharmacological activities of coral secondary metabolites fully demonstrate their potential medicinal value (Zhang W. et al., 2006; Shao et al., 2009a).

In the late 1960s, scholars and others discovered prostaglandin precursors with unique structures and strong physiological activity from gorgonian^※, which further promoted coral chemistry research. The pharmacological activity of coral is also gradually being explored, which is primarily manifested in various aspects such as antitumor, anticancer, antioxidant, and anti-cardiovascular and in cerebrovascular system diseases. These pharmacological effects are mostly exerted by a single active substance extracted from coral bodies, while the bones of corals are mostly used as materials for bone transplantation and other applications (Wang et al., 2002b). Coral, as a medicinal material, has been recorded in detail in The Compendium of Materia Medica (1578 AD). It tastes sweet, and the property of the medicine is flat. It can improve eyesight, tranquilize the mind, and stop epilepsy. Coral is primarily used to treat corneal opacity. It also dissipates blood stasis. Coral powder can stop epistaxis. In the clinic, coral is also used in various compound preparations, such as Ershiwuwei Shanhu pills and Shanhu Qishiwei pills, which can restore nerve function and relieve pain. It is used in the treatment of albichoriasis, unconsciousness, body numbness, dizziness, brain pain, irregular blood pressure, headache, epilepsy, and various types of neuropathic pain. The Compendium of Materia Medica (1578 AD) records that corals are nontoxic, but according to literature reports, corals can release toxins, which are the second largest known deadly gas in the world, ultimately leading to toxic reactions such as muscle pain, four-limb weakness, and fainting. By contrast, in compound use, short-term use does not produce acute toxic reactions, but long-term use can cause damage to the liver, kidneys, and other organs.

In this review, we first conducted keyword searches on coral on academic websites such as PubMed, ScienceDirect, and CNKI and screened thousands of literature works related to medicine. Second, we conducted data mining to establish a database and finally extracted effective information for organization and analysis. This review discusses the use of coral in traditional medicine and its application in chemical composition, pharmacology, toxicology, and clinical research in the past two decades to provide important research data for the comprehensive development of marine biological resources, the discovery of drug lead compounds, the chemical ecological research of marine invertebrates, and the determination of organic synthetic chemical target compounds.

In recent years, Chinese scholars have made important contributions to the research of international marine natural products. In 1980, Su Jingyu first isolated two new types of diterpenoid dimers with double fourteen-membered cyclic carbon frameworks from soft corals (Xue, 2014). Weinheimer and Washecheck (1969) first discovered abundant and highly active prostaglandin-like compounds from gorgonians^※. These research results have aroused great interest in the study of coral chemical composition. After decades of research exploration and development, a large number of structurally novel and biologically active compounds have been discovered and determined from corals. Each type of compound contains many compounds with different structures, such as terpenoids, alkaloids, steroids, macrolides, quinones, polyethers, flavonoids, and peptides (Li R., 2012). The following sections provide an explanation of the chemical composition of corals based on different structural types.

Many structurally active unique secondary metabolites, such as terpenoids, steroids, ceramides, and prostaglandins, have been extracted from corals, and their significant pharmacological activities, such as cytotoxic and antiviral activities, have been widely noticed and studied by natural product chemists and other researchers. Meanwhile, the pharmacological activities of coral bone powder and various coral preparations in the cardiovascular system have been explored. This article focuses on their cytotoxic effects on a variety of tumor cells and cancer cells as well as their restorative effects on bone injury diseases and their biological activities, such as antioxidant, anti-inflammatory, analgesic, and antiviral activities, on tissues of the nervous system and respiratory system. Accumulating evidence suggests that they have significant therapeutic effects on diseases of the nervous system.

Many corals, such as animal corals, also known as soft corals, are very popular in aquariums (home or public) because of their appreciation value and low maintenance costs. The soft corals of genera Palythoa, Protopalythoa, Zoanthus, and Parazoanthus in the Zoanthidae family contain a highly toxic and potentially lethal compound, palytoxin (Hoffmann et al., 2008). Therefore, the toxic compound of coral is mainly palytoxin. Ciminiello et al. (2011) extracted palytoxin and 42-hydroxy palytoxin at levels up to 25–450 ng per kg of Zoanthid. Palytoxin is a potent vasoconstrictor, and its neurotoxicity and cardiotoxicity are primarily due to dysregulation of the transmembrane pump Na/K-ATP enzyme, which can lead to serious human disease, causing gastrointestinal symptoms, myalgia, muscle spasms, respiratory and cardiac problems, and even death (Wieringa et al., 2014). The toxin is heat-resistant, and conventional boiling inactivation operations are not effective against it. Reports of human exposure to palytoxin consumption have described significant morbidity and mortality (Sud et al., 2013).

Palytoxin exposure and the production of toxic compounds through corals are primarily associated with toxin poisoning from inhalation of toxin-dissolved water aerosols during cleaning, scrubbing, or eradication of corals in home/public aquariums. Thus, aquarium store staff and home aquarium hobbyists face a consequent elevated risk of exposure. The data we collected showed that people aged less than 80 years and children exposed to palytoxin nebulized from coral had immediate symptoms such as cough, dyspnea, chest pain, myalgia, tachycardia, and gastrointestinal symptoms, and in severe cases, acute reactions such as burning or stinging and erythema also occur. Coral injuries may also have complications such as foreign body reactions, bacterial infections, or local eczema reactions (Na et al., 2008). Examples of poisoning due to prolonged and unprotected exposure to corals have also been reported (Smith et al., 2003; Hoffmann et al., 2008). A patient who placed his right hand on a Zoanthid colony while cleaning a seawater aquarium at home developed myalgia, symptoms of general weakness in limbs, and, subsequently, signs of poisoning such as speech impairment, dull eyes, and fainting. The degree of poisoning is closely related to the contact time, contact distance, and contact method. Subsequently, corneal toxicity due to exposure to Zoanthid corals has been documented. Seven patients presented with corneal manifestations ranging from superficial punctate epithelial lesions to bilateral corneal melting and subsequent perforation, with some patients presenting with progressive corneal melting even requiring therapeutic penetrating corneal transplantation. Fortunately, more than half of these case reports show that short-term minor injuries are reversible with medication or emergency measures, with only a few disabilities or a significant reduction in quality of life due to sequelae (Chang et al., 2020).

In 2014, water extracts from water corals were first reported to contain a lethal nonpeptide neurotoxin (García-Arredondo et al., 2015). The investigators administered 5.3 µg protein/g body weight of the extract to mice intravenously, which caused violent convulsions and death in the range of 1 min and histopathological damage to the kidneys and lungs at doses below the LD₅₀ (LD₅₀ = 4.62 µg protein/g body weight). After incubation under heat denaturing conditions, this histopathological damage was completely eliminated. However, the denatured extracts maintained their lethal effect. Second, in the process of researching the anti-neurotoxic active ingredients of the side flat soft willow coral, it was found that water-insoluble parts of alkali extracts of S. suberosa can make the animal produce a whole body soft, heavy limb tremor, turn positive reflex disappear, and cause other reactions (Liao et al., 1992).

Coral is often used as medicine in combination. Ershiwuwei Shanhu pills and others are classic Tibetan remedies consisting coral preparations. In the acute toxicity test of Ershiwuwei Shanhu pills, there were no obvious acute toxic reactions, but in the subacute toxicity test, toxic damage to liver, kidney, and lung pathological sections was observed (Liu F. L. et al., 2016). Long-term doses of Ershiwuwei Shanhu pills lead to accumulation of copper, mercury, and lead in the internal organs of the rats, with few rats developing symptoms of the vegetative nervous system, such as increased salivary gland secretion (LI, 2011). It can cause toxic reactions, manifested in immune function, and liver, kidney, and lung tissues are affected and damaged to varying degrees. The main toxic target organs are the liver, kidney, and lung, and damage due to toxicity occurs in a dose-dependent manner (Liu F. L. et al., 2016). However, given the complexity of its compounds, specific toxic substances remain to be investigated.

Coral is an important marine biological resource, and species resources are extremely confusing and complex. In the Qing dynasty (1,616–1912 AD), red coral is a symbol of official status. In India and Tibet of China, people use coral as an auspicious object to worship Buddha, mostly to make Buddhist beads and decorate the statue of the deity in the temple (Hong, 2009). In ancient records, coral applications in medicine have also long been recorded, but only a few have pointed out that coral in medicine is a combination of coral species for the use of red coral. However, red coral has a broad range and many species, such as Corallium japonicum Kishinouye^※, Corallium secundum Dana^※, and Corallium elatius Ridley. Corallium japonicum Kishinouye^※ (trade name: Aka) is mostly used in compounding. Arca is expensive, but no reports have been retrieved on whether other red corals can be substituted. In addition, the corals studied in modern pharmaceutical research involve a total of 34 families and 99 genera of corals, dominated by the families Alcyoniidae, Nephtheidae, and Plexauridae^※. Coral species are confusing and complex, and sorting out their resource species not only helps us distinguish corals but also lays the foundation for developing new drugs and further research on corals.

Coral has a long history of medicinal value, which can remove corneal opacity, improve eyesight, tranquilize the mind, promote wound healing, and stop bleeding. Modern pharmacological studies have also gradually verified the medicinal value of coral and its mechanism of action. First, coral transplantation in the human body does not cause rejection; in coral, countless fine pores will gradually grow microscopic blood vessels and synthesize living cells of the bone. Numerous studies have reported that coral has become an alternative material to bone, and coral is often used in the fields of maxillofacial surgery and orthopedics (Guillemin et al., 1989; Zhu, 2001; Lai, 2017). Second, active ingredients such as terpenoids (diterpenes and sesquiterpenes) and steroids extracted from coral have evident pharmacological properties such as antiviral, antibacterial, antioxidant, and antimalarial activities. In addition, some of the active ingredients show not only good enzyme inhibition activity but also evident anticonvulsant, antiepileptic, and sedative–hypnotic effects in the nervous system; in the cardiovascular system, they show anti-tubular formation activity and proangiogenic activity as well as a certain amount–effect relationship. The antihypertensive, hypolipidemic (Chun et al., 2022), and antiulcer (Elshamy et al., 2017) activities have also been relevantly verified. Most of these chemical compounds were extracted from corals of Alcyoniidae and Gorgonidae^※, and the compounds extracted from a particular coral may have multiple uses. Therefore, the study of active ingredients in corals has become the cornerstone of subsequent pharmacological studies, and exploring the mechanism of action of active substances can be a research direction to provide a basis for the elucidation of pharmacological effects and the design of clinical experiments (Wang, 2015).

Coral has various pharmacological activities, among which cytotoxic, anti-inflammatory, and analgesic pharmacological effects are more prominent. A549, HL-60, MCF-7, colon cancer cells, K562, HeLa, and other tumor cells are research hotspots. Scholars have mostly evaluated the inhibitory and apoptotic effects of different concentrations of active ingredients on different cells by MTT assay and SRB method. Studies have also shown that cytotoxicity can be influenced by compound structure. For example, prostaglandins with hydroxyl groups have good inhibitory properties (Hurtado et al., 2020); sterols introduced with hydroxyl groups decrease the inhibitory potency against HeLa cell lines; and acetyl groups increase the cytotoxic activity. Pro-inflammatory enzymes, particularly iNOS for nitric oxide production and prostaglandin-producing COX-2, play a central role in inflammatory mechanisms (Wei et al., 2013). In addition, glial cells and elastin are also important components of the anti-inflammatory mechanism. At present, pharmacological experiments of coral have identified its active ingredients. However, most of the results of pharmacological studies are derived from cellular or animal models, and they do not fully prove their effectiveness, so more clinical trials are needed to confirm these findings (Zhang X. L. et al., 2015).

Clinically, coral is often processed into powder for punching or used directly to treat bone diseases, in addition to showing good therapeutic effects in the treatment of epilepsy, primary headache, migraine, cerebral infarction, hypertension, neurogenic cervical spondylosis, and lumbar myofasciitis. In the face of complex diseases, obtaining the desired effect of a single drug is difficult, so coral is often used in combination with other drugs to treat the disease, which has satisfactory results in clinical applications. At a certain efficacy, compound prescriptions containing coral exhibit the same effects as when coral used alone. However, given the large number of herbs contained in the compound, the role played by coral remains unclear; the effect may be weakened; the effect may be synergistically enhanced; or another effect may be stimulated. Moreover, the mechanism of action of coral remains unknown; thus, further research is needed.

Although coral toxicity is not included in the Pharmacopoeia of the People’s Republic of China, studies have found that coral toxicity is mostly found in marine ornamental soft corals of the Zoanthidae family. Palytoxin is the main toxic compound. Nonpeptide neurotoxins were extracted from water coral all of which have toxic effects on the skin, cornea, etc. Short-term minor injuries are reversible with medication or emergency measures, with only a few disabilities or a significant decrease in quality of life because of sequelae. No significant acute toxicity was observed in coral-related compound preparations, but if applied for a long time, toxicity to the liver, kidneys, lungs, and other internal organs can still occur in a dose-dependent manner. The toxicity of coral is not yet generalized because of the complexity and diversity of its species. Coral insects are toxic, but whether coral is toxic after calcification is yet to be studied because of the special nature of coral.

The organic compounds in corals are remarkably studied, whereas other compounds, such as trace elements, are less studied. Coral as mineral medicine should strengthen the exploration and development of other compounds, such as trace elements, to pave the way for improving its quality standards and research on the basis of medicinal substances. Toxicological studies have also come to the forefront. The limited clinical trials are not perfect in quality, but they still have some reference value, and more scientific and representative clinical trials are needed in the future. At present, coral is used in several different fields, such as medical and apparel (Zhang Q. Y., 2013), with more areas still under development. Its value in medical care is particularly significant, which needs more attention and extensive research.

Coral reefs are one of the most diverse ecosystems on Earth, sensitive and fragile marine ecosystems, and one of the most sensitive environmental indicators of global climate change (Huang et al., 2023). Coral reefs not only provide a place for many fish and marine invertebrates to lay eggs, reproduce, and avoid predators, but also have extremely high biodiversity. It also plays a crucial role in homeland security. At present, habitat loss, diseases, bleach accidents, and species invasion are the main causes of coral death (Ma et al., 2018). Antipatharia, Scleractinia, Helioporacea, Gorgonaceae, Tubiporidae, Corallium, Corallium elatius, Corallium japonicum, Corallium konjou, and Corallium secundum are officially listed as endangered. Fishing for any coral species may have some impact on the ecosystem, as coral reefs are a complex ecosystem that is interdependent on many other organisms. So wild acquisition is strictly prohibited for species that have already been listed as extinct in the wild, regionally extinct, and critically endangered. Strengthening the protection and management of rare and endangered wild plants of vulnerable, near-endangered, and non-endangered species by building dynamic monitoring databases and strictly implementing on-site conservation measures is essential to maintain ecological balance and biodiversity (Wang, 2023). The most fundamental thing is that the coral species (extinct in the wild, regionally extinct, critically endangered, and rare and endangered wild plants of vulnerable, near-endangered, and non-endangered species) included in the list have no distinction between beneficial and insignificant and should receive equal protection. Strict implementation of the Endangered Species Law should help them restore to their normal numbers.

It is worth noting that some corals are currently listed as endangered on CITES and IUCN lists, such as Antipatharia ^※, Tubiporidae ^※, Corallium elatius ^※, Corallium japonicum ^※, Corallium konjou ^※, and Corallium secundum ^※, ensuring that a balance between the sustainability of scientific research and the protection of endangered species is a complex but crucial task. The development and research on the effectiveness of coral is likely to lead to the indiscriminate capture of coral, thereby exacerbating the endangered situation of coral. Ethically speaking, the application and development of coral should be prohibited. This article mainly discusses the endangerment caused by coral medicinal use. Therefore, we encourage scientists to use new technologies and methods, such as remote sensors, remote sensing technology, and genetic analysis, to reduce interference with endangered species while providing more valuable data (Wang et al.). The most effective measure is to avoid and prohibit the use of coral. We call on scholars to devise strategies for replacing coral in treatments to alleviate and solve the problems of endangerment of corals. First, search for alternatives based on similar biological species relationships. Species that are closely related often have similar physiological structures, as well as their chemical composition and pharmacological activities (Tian et al., 2023). Naemorhedus goral and Saiga tatarica have similar chemical components such as proteins, peptides, and amino acids (Liu et al., 2018), and as a substitute, Naemorhedus goral has a better sedative effect (Jiang and Zhai, 2006). Therefore, soft corals, sea fans, and sea yellows with similar chemical components have become one of the ways to replace endangered corals. Second, search for alternatives based on similar pharmacological effects. On the one hand, coral is usually used as an orthopedic material for the treatment of bone diseases. Therefore, we can achieve the same therapeutic effect by using other composite materials such as composite resin, ceramic, rubber, organic glass resin, and metal alloy instead of coral. This measure can not only achieve the effect of treating diseases but also reduce the use of coral. On the other hand, based on the bioactive substances extracted from coral, search for other organisms contain similar bioactive substances. For example, the pharmacological activity of cetosane diterpenoids can be extracted from Boswellia carterii (Xu et al., 2023). Medicinal compounds such as terpenoids and other substances can be extracted from Croton tiglium and Panax notoginseng (Wei et al., 2022). In modern research, replacing bile powder of Rhinoceros unicornis with that of Bubalus bubalis and using other animal bile powder instead of that of Selenarctos thibetanus as medicine have alleviated the endangerment problem of animals to a certain extent (Bai et al., 2018; Chen et al., 2022; Ye et al., 2022). Third, search for alternatives based on artificial domestication and breeding. Artificial cultivation of coral has become a feasible method (Wang, 2020). The artificial breeding technology of coral can be divided into sexual reproduction and asexual reproduction and can be classified into in situ cultivation technology and off-site cultivation technology according to the cultivation environment. The South China Sea Institute of Oceanography, Chinese Academy of Sciences, has carried out experiments on coral sexual reproduction and coral larva cultivation and proliferation in Sanya Bay and Yongxing Island in Xisha, Hainan Province. At present, it has mastered the reproductive law and larva development process of species such as Acropora gemmifera ^※ and Platygyra sinensis (Yu et al., 2022)^※. Fourth, look for alternatives based on synthetic methods. The active ingredients with pharmacological activities can be directly synthesized by chemical synthesis and enzyme engineering technology. The development of artificial Moschus berezovskii can be described as a sword sharpened for decades, which has completely solved the problem of long-term shortage of Moschus berezovskii supply (Fu et al., 2023). Artificial Panthera tigris is similar to natural Panthera tigris in fingerprint, pharmacological and pharmacodynamic indexes, and clinical efficacy (Liu and Han, 2006). They are all used in a variety of Chinese patent medicines (Yan et al., 2023). Finally, find the alternative mode of biotechnology based on industrialization. The use of coral stem cells to cultivate medicinal parts and secrete metabolites is a biotechnology method that can meet the requirements of syngeneic and homogeneous substitutes. Animal stem cell research mainly focuses on the direct use of stem cells for disease treatment, repair of organ damage, and establishment of the drug screening platform (Shi, 2020). Taxus chinensis’s stem cells have been used to produce paclitaxel and its corresponding active substance (Lee et al., 2010), and Panax ginseng stem cells have been used to produce ginseng (Jang et al., 2023).

Although some developments have not been broken yet through due to incomplete research on the material foundation and mechanism of action, as well as immature artificial farming techniques, which have prevented the formation of large-scale farming, modern biotechnology and multi-omics detection methods have brought new avenues for the development and evaluation of animal drugs, using genomics, proteomics, transcriptomics, metabolomics, and other detection methods at the molecular and cellular levels. The balanced and comprehensive approaches such as implementing multidimensional and multi-level systematic evaluation at the animal level, establishing new approaches for alternative research, and providing support for the protection, development, and utilization of endangered medicinal animals help ensure the survival of endangered species while providing valuable knowledge for the scientific community (Chun et al.).

It is undeniable that effective scientific research can alleviate the problem of endangerment of species, but the decision to “protect” and/or “establish a recovery plan” does not depend only on science. At the same time, there is ambiguity among managers regarding governance issues, and the institutional management plan seems to have failed to address the vulnerability of endangered species. Therefore, a statutory plan should be established to fundamentally alert people. Unfortunately, only relatively few countries have enacted national legislation on endangered and threatened species. Internationally, the Endangered Species Act of 1973 is a legislative model. Its implementation has achieved significant results, and it is said that 90% of the species on the bill’s protected list have been restored (Teng and Zhang, 2022). So the government and relevant departments should strengthen regulations and policies to ensure that research on endangered coral species does not lead to abuse or overfishing, such as restrict or prohibit fishing and destructive activities and adopt sustainable fishing practices, including limiting fishing quantities, using selective fishing nets, and monitoring fishing activities, to protect marine ecosystems. Obviously, effective protection of endangered and threatened species in the ocean depends on appropriate legislation developed to protect them, and similarly, achieving the goals of these legislative tools depends on the political and social factors that affect their implementation. Since the 21st century, the debate between the protection of endangered species and economic benefits and ecological values has never stopped. Congress and the government always try to weaken the effectiveness of bills and tend to choose economic development. Opponents believe that some measures have harmed their own interests, and even more so, some are testing the “red line” for potential benefits. However, the public is more inclined to support the protection of endangered species, and the public support rate for the bill remains high. Obviously, the importance of protecting species is higher than economic growth and protecting private property, and maintaining biodiversity is a global cause (Jeffrey, 2016). Wildlife managers have a greater responsibility to ensure that their management actions reflect public values and attitudes. Third, the negative impact of social media comments on the public is very strong, which leads to significant differences in public beliefs in participating in endangered species management (Rodgers and Willcox, 2018). Some people, even with an urgent desire to protect endangered species, have low mobility. Therefore, it is important to raise awareness among the public, governments, and businesses about the importance of protecting coral reefs, encourage environmental action, and alleviate the pressure faced by these fragile ecosystems. In addition, with the development of industrialization and technology, the marine ecosystem is increasingly deteriorating, the ability to accommodate and rescue wildlife is weak, and habitats are gradually lost. Scientific research and monitoring are necessary. This includes ecosystem monitoring, which regularly monitors the health status of coral reef ecosystems and changes in environmental parameters such as temperature, salinity, and acidity, as well as research on coral diseases. Studying the pathogenesis of coral diseases will help develop prevention and control strategies (Yang, 2021). It is also necessary to reduce the flow of land pollution into the ocean, including agricultural and urban sewage discharge, as well as pollutants from rivers and streams (Gao, 2023; Zhu and Hu, 2023).

There is relatively little research on linking wildlife value orientations with attitudes toward T&E species and non-charismatic species, and even to a large extent, it has been overlooked (George et al., 2016). We encourage cooperation among scholars, conservation organizations, and governments to work together to achieve the common goals of scientific research and conservation (Lv et al., 2020; Zou and Jiang, 2023).

Coral is one of the marine species. The imminent extinction of coral reminds people to take immediate measures to protect endangered species and the ecological environment. The substitution principles are as follows: search for alternatives based on similar biological species relationships. Search for alternatives based on similar pharmacological effects. Search for alternatives based on artificial domestication and breeding. Look for alternatives based on synthetic methods. Search for the alternative mode of biotechnology based on industrialization. These principles should be applied to protect all organisms from natural sources and not restricted to corals. Among them, the alternative strategy of artificial domestication is one of the most fundamental and effective measures. For example, treatments using pearls, centipedes, and others should be supplemented and replaced by other resources to prevent their endangerment or even extinction. In addition, reducing pollution, which means taking measures to reduce marine pollution, especially plastic waste, agricultural and industrial emissions, oil pollution, and sustainable economic management methods including fisheries, tourism, and marine technology, can promote economic growth and create decent employment opportunities, thereby reducing people’s hunting of certain species, which is also one of the effective measures to protect ecosystems (Chinese and Foreign Experts and Scholars Talk Together on Marine Ecological Protection in the Process of Modernization, 2023). Protecting endangered species and protecting ecosystems is our mission and responsibility. These measures can balance the goal of protecting ecosystems and meeting human needs.

Recently, the signing of the High Seas Treaty in September 2023 and the Nagoya Protocol in October 2010 has pushed the protection of endangered species and ecological environmental issues onto the international stage, marking a significant shift in ecological governance from disorder to order. The Chinese government must strictly abide by the agreement, and in addition, it can educate the Chinese people, enterprises, and other relevant departments through media and policies to reduce and prohibit the use of coral. China’s participation should make good use of the platform for treaty and agreement consultations and be more proactive in clarifying the content and value of this theory to the international community, injecting new vitality into the protection of ecology and subsequent consultations. The feasibility of global action is low, and its effectiveness is difficult to assess and regulate. However, the ability of countries or regional international organizations to respond more quickly to environmental changes greatly contributes to the improvement of the marine environment. International treaties can not only regulate the behavior of contracting parties but also promote the practice of non-contracting parties. Conducting this work under international cooperation undoubtedly has the most legitimacy and credibility. This not only strengthens cooperation among countries and encourages them to jointly address high seas protection issues but also enhances people’s awareness of coral protection and ecosystem protection through universal participation. At the same time, these agreements also limit people’s indiscriminate killing of corals and causing damage to the environment, pointing the way for protecting the ecological environment. To a large extent, it is urgent to alert and call on people to protect corals and endangered species, but how to achieve from regional practice to universal participation is still a difficult implementation dilemma.

Warning: The coral species marked with "※" have been included in the rare species list of CITES and IUCN. We should respect life and nature. We should protect wild animals and create a safe home for them. In addition, we call on researchers to increase their attention and importance to the protection of endangered corals and to conduct limited and valuable coral-related research within the framework of domestic and foreign laws and regulations. We also call on non-researchers to refrain from illegally collecting and using endangered corals after reading this review article and to carry out collection and utilization activities within the framework of domestic and foreign laws and regulations.

Marine invertebrates, a rich potential source of drug precursors, have been a popular avenue for the international search for drugs or drug precursors in recent decades. In the last two decades, coral chemistry and pharmacology research has made some achievements and discovered some new compounds with unique structures and strong physiological activities, but the utilization of corals is limited to only a small number and species of families, such as Alcyoniidae, Nephtheidae, Plexauridae, and Gorgoniidae^※ . This article provides the first comprehensive account of six aspects of the medicinal history, species, chemical composition, pharmacological activity, toxicology, and clinical application of coral in China. Coral is a natural mineral medicine, and its active ingredients are mixed and difficult to extract and identify. At present, the effective compounds extracted from coral are terpenoids, steroids, and nitrogen-containing compounds, with sesquiterpenes and diterpenes being the main compounds of terpenoids. However, during extraction, extraction conditions, and the joint use of related techniques, such as ICP-MS and LC-MS, have not been reported. Exploring the best extraction of the active ingredients of coral is a breakthrough for future experiments. The pharmacological effects of most of the compounds isolated from coral have been developed. The pharmacological activities of terpenoids are relatively rich, including cytotoxicity, anti-inflammatory, antibacterial, and antiviral. Second, steroid compounds also play important roles in antitumor, anticancer, and anti-inflammatory activities. Finally, other compounds such as lipids and aromatic compounds play important roles in their pharmacological activities such as antioxidant and immunosuppressive effects. However, they mostly reside in superficial areas, which shows a long way to go in the study of the mechanism. In addition, scientists are encouraged to use new technologies and methods, such as remote sensors and gene analysis, to reduce interference with endangered species while providing more valuable data. Toxicological studies have shown that corals of the family Zoanthidae cause toxic reactions in people through contact and inhalation, but they can be treated with pharmacological relief. With regard to clinical application, coral is mostly used in combination with other drugs to treat diseases, with limited cases of coral alone, which may lead to the inability to prove the effectiveness of coral but is still informative. Pharmacological studies of coral are mostly about the monomer extracted from coral, whereas clinical studies are more about the compound prescription application of coral. Studies show that coral is often used as a substitute for orthopedic materials to treat diseases such as bone defects and bone hyperplasia. Compound preparations that contain coral are widely used in the treatment of neurological diseases such as migraine, primary headache, epilepsy, cerebral infarction, hypertension, and other cardiovascular and cerebrovascular diseases.

More extensive and in-depth research on the active ingredients of coral and its mechanism of action should be focused on deepening the understanding at genetic and molecular levels in the future to make it better applied in practice. In addition, whether the absorption, distribution, metabolism, and excretion as well as the blood concentration of coral change over time after administration in the body remains unclear. Coral is often used in the form of powder into the body, but whether coral powder can be taken orally as well as differences and similarities between its oral and external therapeutic effects remains unknown. Finally, diluted coral extracts have been derived as new drugs for the treatment of diseases. Therefore, the form of coral intake should not be limited to powder or as an orthopedic material. However, the development of its active ingredients is not a research strategy and prospect. It provides different ideas for the development of new drugs. We experienced pressure and challenge during the study of the clinical application of coral but offered us a good opportunity (Ai et al., 2006).