Si-Wu-Tang facilitates ovarian function through improving ovarian microenvironment and angiogenesis in a mouse model of premature ovarian failure

J Ethnopharmacol. 2021 Nov 15;280:114431. doi: 10.1016/j.jep.2021.114431. Epub 2021 Jul 19.


Ethnopharmacological relevance: Premature ovarian failure (POF) is a severe illness, characterized by premature menopause with a markedly decrease in ovarian function, which leads to infertility. Si-Wu-Tang (SWT), also called "the first prescription of gynecology" by medical experts in China, is widely used as the basic formula in regulating the menstrual cycle and treating infertility. However, the potential effect and underlying mechanisms of action of SWT on the treatment of POF have not yet been elucidated.

Purpose: This study aimed to explore the therapeutic effect and underlying molecular mechanism of action of SWT on the treatment of POF in C57BL/6 mice.

Materials and methods: The main compounds of SWT were identified by high-performance liquid chromatography (HPLC). POF model groups were established by a single intraperitoneal injection of cyclophosphamide (Cy, 100 mg/kg). SWT or dehydroepiandrosterone (DHEA) were administered via oral gavage for 28 consecutive days. Ovarian function and pathological changes were evaluated by hormone levels, follicular development, and changes in angiogenesis. Furthermore, statistical analyses of fertility were also performed.

Results: Treatment with SWT significantly improved estrogen levels, the number of follicles, antioxidant defense, and microvascular formation in POF mice. Moreover, SWT significantly activated the Nrf2/HO-1 and STAT3/HIF-1α/VEGF signaling pathways to promote angiogenesis, resulting in a better fertility outcome when compared to the model group.

Conclusions: Our findings indicated that SWT protected ovarian function of Cy-induced POF mice by improving the antioxidant ability and promoting ovarian angiogenesis, thereby providing scientific evidence for the treatment of POF using SWT.

Keywords: Angiogenesis; Antioxidant activity; Nrf2/HO-1; Premature ovarian failure; STAT3/HIF-1α/VEGF; Si-Wu-Tang.

MeSH terms

  • Animals
  • Drugs, Chinese Herbal / pharmacology*
  • Estradiol
  • Estrous Cycle
  • Female
  • Follicle Stimulating Hormone
  • Gene Expression Regulation / drug effects
  • Hypoxia-Inducible Factor 1, alpha Subunit / genetics
  • Hypoxia-Inducible Factor 1, alpha Subunit / metabolism
  • Male
  • Mice
  • Mice, Inbred C57BL
  • Neovascularization, Physiologic / drug effects*
  • Ovary / blood supply
  • Ovary / drug effects*
  • Phytotherapy
  • Primary Ovarian Insufficiency / drug therapy*
  • Progesterone
  • STAT3 Transcription Factor / genetics
  • STAT3 Transcription Factor / metabolism
  • Vascular Endothelial Growth Factor A / genetics
  • Vascular Endothelial Growth Factor A / metabolism


  • Drugs, Chinese Herbal
  • Hif1a protein, mouse
  • Hypoxia-Inducible Factor 1, alpha Subunit
  • STAT3 Transcription Factor
  • Stat3 protein, mouse
  • Vascular Endothelial Growth Factor A
  • si-wu-tang
  • vascular endothelial growth factor A, mouse
  • Progesterone
  • Estradiol
  • Follicle Stimulating Hormone