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Original Article | Open Access

Rheum palmatum L.–Prunus persica (L.) Batsch herb pair restores endometrial receptivity in adenomyosis

Meiling Wanga,b,c,1, Lin Dub,c,1, Xianyun Fub,c,d( ), Wenjie Shib,c, Yirong Sub,c, Lin Lib,c
The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People’s Hospital, Yichang 443000, China
College of Medicine and Health Sciences, China Three Gorges University, Yichang 443000, China
Hubei Key Laboratory of Tumor Microenvironment and Immunotherapy, China Three Gorges University, Yichang 443000, China
TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 61000, China

1 These authors have contributed equally to this work.

Peer review under responsibility of Beijing University of Chinese Medicine.

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Abstract

Objective

To investigate whether herbal pair Rheum palmatum L. (R. palmatum; Da Huang)–Prunus persica (L.) Batsch (P. persica; Tao Ren) (RP) can restore endometrial receptivity and mitigate adenomyosis (AM)-associated infertility by regulating dysregulated glycolytic metabolism.

Methods

An AM mouse model was established by pituitary transplantation. Mice receiving RP were divided into the low-dose (RP-L) and high-dose (RP-H) groups based on the RP dose administered. Pregnancy outcomes were assessed based on embryo implantation sites, progesterone levels, and levels of endometrial receptivity markers, including homeobox A10 (Hoxa10), leukemia inhibitory factor (LIF), and integrin beta 3 (Itgβ3). Molecular docking was used to analyze the interactions between the RP components and glycolytic enzymes.

Results

AM mice exhibited pathological features of infertility, including reduced implantation sites, suppressed progesterone (P < .001), and downregulated receptivity markers (Hoxa10 and Itgβ3, P < .01; LIF, P < .05), alongside glycolytic dysfunction characterized by depleted glucose (P = .003) and accumulated pyruvate/lactate (both P < .05). RP treatment reversed these defects, restoring embryo implantation (P = .001 for RP-L; P = .013 for RP-H) and upregulating Hoxa10 (P = .001), LIF (P = .04), and Itgβ3 (P = .004). Crucially, RP normalized glycolytic flux, increasing glucose (P = .046) while reducing pyruvate (P = .01) and lactate (P = .003). RP significantly reduced LDH activity in the RP-H group (P = .025) and PK activity in the RP-H (P < .001) and RP-L (P = .007) groups compared to the AM group, with greater suppression than that with gestrinone treatment (LDH, P = .023; PK, P = .003). Molecular docking confirmed strong binding (energy, <−5.0 kcal/mol) between RP components and LDHA/PKM2, primarily via hydrogen bonds. In vitro, RP rescued lactate-impaired trophoblast adhesion (P = .002).

Conclusion

RP ameliorated AM-associated infertility by regulating glycolytic metabolism and improving endometrial receptivity.

Keywords

Rheum palmatum L.Prunus persica (L.) BatschAdenomyosisGlycolysisEndometrial receptivity

References

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Journal of Traditional Chinese Medical Sciences
Volume 13 Issue 2,
April 2026
Pages 254-266
DOI: 10.1016/j.jtcms.2026.03.004

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Cite this article:
Wang M, Du L, Fu X, et al. Rheum palmatum L.–Prunus persica (L.) Batsch herb pair restores endometrial receptivity in adenomyosis. Journal of Traditional Chinese Medical Sciences, 2026, 13(2): 254-266. https://doi.org/10.1016/j.jtcms.2026.03.004

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Received: 05 October 2025
Revised: 11 March 2026
Accepted: 12 March 2026
Published: 18 March 2026
© 2026 Beijing University of Chinese Medicine.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).