Therapeutic strategies of traditional Chinese medicine for chronic heart failure: from active ingredients to herbal formulations

Abstract Chronic heart failure (CHF) remains a global health challenge with complex pathological mechanisms, including inflammation, oxidative stress, mitochondrial dysfunction, myocardial remodeling, ferroptosis, and autophagy. Despite some progress in modern medicine for the treatment of CHF, challenges remain, including insufficient therapeutic efficacy and significant side effects. In this context, traditional Chinese medicine (TCM), characterized by its multi-component, multi-target, and holistic regulatory properties, demonstrates potential advantages in the prevention and treatment of CHF. This paper summarizes the research progress of active ingredients from Chinese medicinal herbs, single herbs, and traditional Chinese herbal formulations in addressing key pathological mechanisms related to CHF. These mechanisms include inflammation and oxidative stress, mitochondrial quality and energy metabolism disorders, myocardial remodeling, ferroptosis, and autophagy abnormalities. A multi-target framework is constructed by linking active ingredients from Chinese medicinal herbs, the signaling pathways they regulate, and the corresponding pathological mechanisms involved in CHF. Further integrating the classification background of HFrEF, HFmrEF, and HFpEF, this paper analyzes the potential differential focal roles of TCM-related mechanisms across different heart failure subtypes and pathological processes, and discusses existing problems in current research in the aspects of evidence hierarchy, druggability of active components, quality control, and clinical translation, as well as other related fields. This paper aims to provide a reference for subsequent research on TCM-based prevention and treatment of CHF.