TABLE 1.
Changes in the intestinal flora and potential mechanisms.
| Intervention | Common composition/Type | Subjects | Changes in intestinal flora | Potential mechanism | Outcome | References |
|---|---|---|---|---|---|---|
| Formulas | Common composition | |||||
| Cangfu Daotan Decoction (CDD) | Atractylodes lan (Thunb.) DC. [Asteraceae; Atractylodis rhizoma], Cyperus rotundus L. [Cyperaceae; Cyperi rhizoma], Citrus × aurantium L. [Rutaceae; Aurantii fructus immaturus], Arisaema erubescens (Wall.) Schott [Araceae; Arisaematis rhizoma], Citrus × aurantium L. [Rutaceae; Aurantii fructus], Pinellia ternata (Thunb.) Makino [Araceae; Pinelliae rhizoma], Conioselinum anthriscoides ‘Chuanxiong’ [Apiaceae; Chuanxiong rhizoma], Poria cocos (Schw.) Wolf [Polyporaceae; Poria], Shenqu Purchased by Zhang et al. (2020) from Guangdong Biotechnology Co., Ltd | PCOS-IR patients | Lactobacillus and Bifidobacterium↑, Enterobacteriaceae↓ | - | The cycle ovulation rate and cycle pregnancy rate↑ | Zhang and Jiang, (2020) |
| Cangfu Daotan Decoction (CDD) | Atractylodes lancea (Thunb.) DC. [Asteraceae; Atractylodis rhizoma], Citrus × aurantium L. [Rutaceae; Aurantii fructus immaturus], Cyperus rotundus L. [Cyperaceae; Cyperi rhizoma], Arisaema erubescens (Wall.) Schott [Araceae; Arisaematis rhizoma], Prunus persica (L.) Batsch [Rosaceae; Persicae semen], Angelica sinensis (Oliv.) Diels [Apiaceae; Angelicae sinensis radix], Pinellia ternata (Thunb.) Makino [Araceae; Pinelliae rhizoma], Poria cocos (Schw.) Wolf [Polyporaceae; Poria], Zingiber officinale Roscoe [Zingiberaceae; zingiberis rhizoma recens], Citrus × aurantium L. [Rutaceae; Aurantii fructus], Shenqu, Glycyrrhiza glabra L. [Fabaceae; Glycyrrhizae radix et rhizoma] (12:8:10:12:8:15:10:15:5:10:12:8) Prepared by Jiang et al. (2020) according to China Pharmacopoeia | PCOS-IR patients | Lactobacillus and Bifidobacterium↑, Enterobacteriaceae↓ | 1. Inflammation: IL-17↓, TGF-β, IL-10↑; 2. Insulin resistance indicators: FBG, 2hPBG, FINS, HOMA-IR↓ | - | Jiang et al. (2020a) |
| Buzhong Yiqi Prescription (BYP) | Astragalus mongholicus Bunge [Fabaceae; Astragali radix], Poria cocos (Schw.) Wolf [Polyporaceae; Poria], Codonopsis pilosula (Franch.) Nannf. [Campanulaceae; Codonopsis radix], Atractylodes macrocephala Koidz. [Asteraceae; Atractylodis macrocephalae rhizoma], Actaea cimicifuga L. [Ranunculaceae; Cimicifugae rhizoma], Bupleurum chinense DC. [Apiaceae; Bupleuri radix], Citrus × aurantium L. [Rutaceae; Aurantii fructus immaturus], Angelica sinensis (Oliv.) Diels [Apiaceae; Angelicae sinensis radix], Acorus tatarinowii Schott [Araceae; Acorus tatarinowii rhizoma], Salvia miltiorrhiza Bunge [Lamiaceae; Salviae miltiorrhizae radix et rhizoma], Epimedium sagittatum (Siebold and Zucc.) Maxim. [Berberidaceae; Epimedii folium], Rehmannia glutinosa (Gaertn.) DC. [Orobanchaceae; Rehmanniae radix] (30:15:15:12:9:6:9:15:15:15:18:18) Prepared by Ni et al. (2021) according to China Pharmacopoeia | PCOS-IR patients | the phylum Spirochaetae and the genera [Eubacterium]_rectale_group, Escherichia-Shigella, and Fusicatenibacter↑, Megamonas↓ | 1. Insulin resistance indicators: HOMA-IR↓; 2. Fecal metabolites: palmitic, palmitoleic, eicosenoic, erucic, behenic, tetracosanoic, stearic acid and sphingosine 1-phosphate↑, taurocholic acid and xanthine↓ | DHEAS, T↓; the cycle ovula | Ni et al. (2021) |
| Guizhi Fuling Wan (GFW) | Neolitsea cassia (L.) Kosterm. [Lauraceae; Cinnamomi cortex], Poria cocos (Schw.) Wolf [Polyporaceae; Poria], Paeonia × suffruticosa Andrews [Paeoniaceae; Moutan cortex], Paeonia lactiflora Pall. [Paeoniaceae; Paeoniae radix rubra], Prunus persica (L.) Batsch [Rosaceae; Persicae semen] Purchased by Zhu et al. (2020) from Chengdu Jiuzhitang Jinding Pharmaceutical Co., Ltd | PCOS SD rats | Alloprevotella, Firmicutes, Ruminococcaceae UCG-003, and Lachnospiraceae UCG-008↑, Bacteroidetes, Proteobacteria↓ | 1. Inflammation: TNF-α↓; 2. Insulin resistance indicators: FPG, FINS and HOMA-IR↓ | - | Zhu et al. (2020) |
| Modified Banxia Xiexin Decoction (MBXD) | Pinellia ternata (Thunb.) Makino [Araceae; Pinelliae rhizoma], Scutellaria baicalensis Georgi [Lamiaceae; Scutellariae radix], Coptis chinensis Franch. [Ranunculaceae; Coptidis Rhizoma], Zingiber officinale Roscoe [Zingiberaceae; Zingiberis rhizoma recens], Codonopsis pilosula (Franch.) Nannf. [Campanulaceae; Codonopsis radix], Glycyrrhiza glabra L. [Fabaceae; Glycyrrhizae radix et rhizoma], Ziziphus jujuba Mill. [Rhamnaceae; Jujubae fructus], Epimedium sagittatum (Siebold and Zucc.) Maxim. [Berberidaceae; Epimedii folium], Lycium barbarum L. [Solanaceae; Lycii fructus] (9:20:10:9:12:12:9:15:30) Prepared by Zhao et al. (2022) according to China Pharmacopoeia | PCOS SD rats | phyla Verrucomicrobiota Proteobacteria and genera Akkermansia and Blautia↑, genus Clostridium_sensu_stricto_1, Firmicutes and Actinobacteriota↓ | 1. Inflammation: HS-CPR, IL-6 and TNF-α↓; 2. Insulin resistance indicators: HOMA-IR↓ | body weight↓ | Zhao et al. (2022) |
| Hashi Bushen Huatan Formula (HBHF) | Cuscuta chinensis Lam. [Convolvulaceae; Cuscutae semen], Ziheche, Poria cocos (Schw.) Wolf [Polyporaceae; Poria], Pueraria lobata (Willd.) Ohwi [Leguminosae; Pueraria Lobata Radix], Shinanye, Salvia miltiorrhiza Bunge [Lamiaceae; Salviae miltiorrhizae radix et rhizoma], Atractylodes lancea (Thunb.) DC. [Asteraceae; Atractylodis rhizoma], Gynochthodes officinalis (F.C.How) Razafim. and B.Bremer [Rubiaceae; Morindae officinalis radix], Rehmannia glutinosa (Gaertn.) DC. [Orobanchaceae; Rehmanniae radix], Epimedium sagittatum (Siebold and Zucc.) Maxim. [Berberidaceae; Epimedii folium], Gleditsia sinensis Lam. [Fabaceae; Gleditsiae spina], Lujiao, Gentiana scabra Bunge [Gentianaceae; Gentianae radix et rhizoma], Senna tora (L.) Roxb. [Fabaceae; Cassiae semen], Crataegus pinnatifida Bunge [Rosaceae; Crataegi fructus], Alisma plantago-aquatica subsp. orientale (Sam.) Sam. [Alismataceae; Alismatis rhizoma], Nelumbo nucifera Gaertn. [Nelumbonaceae; Nelumbinis folium], Plantago asiatica L. [Plantaginaceae; Plantaginis semen] (20:6:15:15:15:30:10:15:15:15:15:15:10:10:15:15:10:15) Prepared by Wu et al. (2022) according to China Pharmacopoeia | PCOS SD rats | - | 1. Inflammation: IL-1β↓; 2. Insulin resistance indicators: FINS, HOMA-IR↓, Adiponectin receptors in ovarian and adipose tissues ↑; 3. SCFAs: butyric acid↓, acetic acid and propionic acid↑ | - | Wu et al. (2022b) |
| Wang’s YiJing Decoction (WYD) | Dipsacus asper Wall. ex DC. [Caprifoliaceae; Dipsaci radix], Eucommia ulmoides Oliv. [Eucommiaceae; Eucommiae cortex], Viscum coloratum (Kom.) Nakai [Santalaceae; visci herba], Gynochthodes officinalis (F.C.How) Razafim. and B.Bremer [Rubiaceae; Morindae officinalis radix], Cuscuta chinensis Lam. [Convolvulaceae; Cuscutae semen], Pinellia ternata (Thunb.) Makino [Araceae; Pinelliae rhizoma], Citrus × aurantium L. [Rutaceae; Aurantii fructus immaturus], Poria cocos (Schw.) Wolf [Polyporaceae; Poria], Atractylodes macrocephala Koidz. [Asteraceae; Atractylodis macrocephalae rhizoma], Citrus × aurantium L. [Rutaceae; Aurantii fructus], Artemisia capillaris Thunb. [Asteraceae; Artemisiae scopariae herba], Bupleurum chinense DC. [Apiaceae; Bupleuri radix], Angelica sinensis (Oliv.) Diels [Apiaceae; Angelicae sinensis radix], Cyathula officinalis K.C.Kuan [Amaranthaceae; Cyathulae radix] (15:15:15:15:15:10:10:15:30:10:10:6:10:10) Prepared by Chang et al. (2022) according to China Pharmacopoeia | PCOS-IR patients | - | 1. Insulin resistance indicators: HOMA-IR↓; 2. Gut-brain axis: ghrelin, PYY, GLP-1↑; 3. SCFAs: SCFAs in fresh stool↑ | T, DHT, FAI, AMH, E2, LH, FSH and the bilateral ovarian volume↓, SHBG↑ | Chang et al. (2022) |
| Modified Huanglian Wendan Decoction (MHWD) | Coptis chinensis Franch. [Ranunculaceae; Coptidis Rhizoma], Scutellaria baicalensis Georgi [Lamiaceae; Scutellariae radix], Bambusa tuldoides Munro [Poaceae; Bambusae caulis in taenias], Citrus × aurantium L. [Rutaceae; Aurantii fructus immaturus], Poria cocos (Schw.) Wolf [Polyporaceae; Poria], Citrus × aurantium L. [Rutaceae; Aurantii fructus immaturus], Cyperus rotundus L. [Cyperaceae; Cyperi rhizoma], Pinellia ternata (Thunb.) Makino [Araceae; Pinelliae rhizoma], Salvia miltiorrhiza Bunge [Lamiaceae; Salviae miltiorrhizae radix et rhizoma], Angelica sinensis (Oliv.) Diels [Apiaceae; Angelicae sinensis radix], Cuscuta chinensis Lam. [Convolvulaceae; Cuscutae semen], Atractylodes macrocephala Koidz. [Asteraceae; Atractylodis macrocephalae rhizoma] (6:10:15:12:15:12:12:10:12:12:24:15) Prepared by Zhou et al. (2021) according to China Pharmaco poeia | PCOS-IR patients | Prevotella and Bifidobacterium↑, Bacteroides and Escherichia coli↓ | 1. Inflammation: IL-1, IL-6, TNF-α↓; 2. Insulin resistance indicators: FBG, FINS, HOMA-IR↓ | BMI, WHR↓; the recovery rate of menstrual and ovulation↑ | Zhou et al. (2021) |
| Shaoyao-Gancao Decoction (SGD) | Paeonia lactiflora Pall. [Paeoniaceae; Paeoniae radix alba], Glycyrrhiza glabra L. [Fabaceae; Glycyrrhizae radix et rhizoma] (1:1) Prepared by Chang et al. (2021) according to China Pharmacopoeia | PCOS SD rats | Firmicutes/Bacteroidetes ratio and Turicibacter↓, Akkermansia, Blautia, Bacteroides, Coprococcus and Butyricicoccus↑ | 1. Inflammation: LPS, IL-18, IL-1β, IL-6 and TNF-α↓; 2. Insulin resistance indicators: HOMA-IR↓; 3. Intestinal barrier: occluding and claudin-1↓; 4. Signaling pathway: TLR4/NF-κB↓ | T, LH↓, E2, FSH↑; cystic follicles↓, corpus luteum↑ | Chang et al. (2021) |
| Shaoyao-Gancao Decoction (SGD) | Paeonia lactiflora Pall. [Paeoniaceae; Paeoniae radix alba], Glycyrrhiza glabra L. [Fabaceae; Glycyrrhizae radix et rhizoma] (1:1) Prepared by Deng et al. (2021) according to China Pharmacopoeia | PCOS SD rats | Firmicutes, Firmicutes/Bacteroidetes ratio, Lactobacillus and Odoribacter↓, Bacteroidetes↑ | 1. Plasma metabolites: Leucine, glutamine, tryptophan, proline, uric acid, and adenosine↑, lauric, palmitic, linoleic acid and acetylcarnitine↓; 2. Signaling pathway: Linoleic acid metabolism, alanine, aspartate and glutamate metabolic pathways | T↓; Body weight and ovarian weight↓ | Deng et al. (2021) |
| Zhishen Huatan Formula (ZHF) | Bupleurum chinense DC. [Apiaceae; Bupleuri radix], Paeonia lactiflora Pall. [Paeoniaceae; Paeoniae radix alba], Angelica sinensis (Oliv.) Diels [Apiaceae; Angelicae sinensis radix], Cyperus rotundus L. [Cyperaceae; Cyperi rhizoma], Citrus × aurantium L. [Rutaceae; Aurantii fructus], Conioselinum anthriscoides ‘Chuanxiong’ [Apiaceae; Chuanxiong rhizoma], Glycyrrhiza glabra L. [Fabaceae; Glycyrrhizae radix et rhizoma], Atractylodes lancea (Thunb.) DC. [Asteraceae; Atractylodis rhizoma], Citrus × aurantium L. [Rutaceae; Aurantii fructus immaturus], Poria cocos (Schw.) Wolf [Polyporaceae; Poria], Pinellia ternata (Thunb.) Makino [Araceae; Pinelliae rhizoma], Coix lacryma-jobi var. Ma-yuen (Rom.Caill.) Stapf [Poaceae; Coicis semen], Scutellaria baicalensis Georgi [Lamiaceae; Scutellariae radix], Cullen corylifolium (L.) Medik. [Fabaceae; Psoraleae fructus], Zishiying (10:15:15:12:15:10:6:15:10:15:12:15:10:10:10) Prepared by Li et al. (2021) according to China Pharmacopoeia | PCOS-IR patients | Lactobacillus and Bifidobacteria↑, Enterobacteriaceae and Enterococci↓ | 1. Inflammation: CRP, IL-6 and TNF-α↓; 2. Insulin resistance indicators: FINS, FPG, HOMA-IR↓; 3. Intestinal barrier: DAO, D-lactic acid↓; 4. Lipid metabolism indicators: TC, TG↓, HDL-C↑ | - | Li et al. (2021) |
| Siwu Tang (SWT) | Angelica sinensis (Oliv.) Diels [Apiaceae; Angelicae sinensis radix], Conioselinum anthriscoides ‘Chuanxiong’ [Apiaceae; Chuanxiong rhizoma], Paeonia lactiflora Pall. [Paeoniaceae; Paeoniae radix alba], Rehmannia glutinosa (Gaertn.) DC. [Orobanchaceae; Pehmanniae radix praeparata] (1:1:1:1) Prepared by Zhu et al. (2022) according to China Pharmacopoeia | DOR SD rats | Firmicutes and Bacteroidetes↓ | 1. Signaling pathway: Carbohydrate transport and metabolism, Amino acid transport and metabolism | FSH, LH↓, E2, P↑ | Zhu et al. (2022) |
| Huayu Jiedu Prescription (HJP) | Sargentodoxa cuneata (Oliv.) Rehder and E.H.Wilson [Lardizabalaceae; Sargentodoxae caulis], Curcuma aromatica Salisb. [Zingiberaceae; Curcumae rhizoma], Typha angustifolia L. [Typhaceae; Typhae pollen], Boswellia sacra Flück. [Burseraceae; Olibanum], Commiphora myrrha (T.Nees) Engl. [Burseraceae; Myrrha, gummi-resina], Epimedium sagittatum (Siebold and Zucc.) Maxim. [Berberidaceae; Epimedii folium] (30:9:9:9:9:18) | EMs C57BL/6J mice | Proteobacteria, Verrucomicrobia, Parasutterella, Akkermansia and Allobaculum↓, Cyanobacteria, Lactobacillus, Lachnospiraceae_NK4A136_group↑ | 1. Inflammation: LPS↓; 2. Fecal metabolites: homoveratric acid, melilotoside C, physapubescin↑; 3. Signaling pathway: linoleic acid metabolism, Toll-like receptor | Vimentin, E-cadherin↓ | Zhao et al. (2021) |
| Shaofu Zhuyu Decoction (SZD) | Foeniculum vulgare Mill. [Apiaceae; Foeniculi amari fructus], Zingiber officinale Roscoe [Zingiberaceae; Zingiberis rhizoma recens], Corydalis yanhusuo (Y.H.Chou and Chun C.Hsu) W.T.Wang ex Z.Y.Su and C.Y.Wu [Papaveraceae; Corydalis rhizoma], Commiphora myrrha (T.Nees) Engl. [Burseraceae; Myrrha, gummi-resina], Angelica sinensis (Oliv.) Diels [Apiaceae; Angelicae sinensis radix], Conioselinum anthriscoides ‘Chuanxiong’ [Apiaceae; Chuanxiong rhizoma], Neolitsea cassia (L.) Kosterm. [Lauraceae; Cinnamomi cortex], Paeonia lactiflora Pall. [Paeoniaceae; Paeoniae radix rubra], Typha angustifolia L. [Typhaceae; Typhae pollen], Wulingzhi Prepared by Cao et al. (2020) according to China Pharmacopoeia | EMs SD rats | Firmicutes/Bacteroidetes ratio↓, Ruminococcaceae↑ | 1. Inflammation: COX-2↓; 2. Gut barrier | - | Cao et al. (2020) |
| Active ingredients | Type | |||||
| Berberine | Alkaloid | PCOS SD rats | Bacteroidetes, Proteobacteria, Actinobacteria, Verrucomicrobia, Bacteroides, Lactobacillus, Bifidobacterium and Sutterella↑, Firmicutes, Prevotella, Oscillospira, Oscillospira and Anaeroplasma↓; Gram-Negative and Potentially Pathogenic↓ | 1. Inflammation: LPS, IL-1β, INF-γ, TNF-α↓; 2. Insulin resistance indicators: HOMA-IR↓; 3. Signaling pathway: LPS/NF-κB↓ | LH, T, LH/FSH ratio and body weight↓ | Zhao et al. (2022) |
| Berberine | Alkaloid | PCOS SD rats | Firmicutes↓, Bacteroidetes↑ | 1. Insulin resistance indicators: HOMA-IR↓; 2. Metabolites: glutamine↑, unsaturated acids [CH = CH], and glucose↓ | T↓ | Shen et al. (2021) |
| Inulin | polysaccharide | PCOS C57BL/6J mice | Bifidobacterium↑, Parasutterella, Helicobacter and Proteobacteria↓ | 1. Inflammation: TNF-α, IL-6 and IL-17A↓ | T and body weight↓, E2↑ | Xue et al. (2019) |
| Inulin | polysaccharide | PCOS C57BL/6J mice | Lactobacillus, Bifidobacterium, Prevotellaceae and Akkermansia↑, Anaerotruncus↓ | 1. Inflammation: IL-6, TNF-α↓, IL-22↑; 2. Signaling pathway: bile acid biosynthesis | LH, T↓, FSH, E2, P, PRL↑ | Li et al. (2022) |
| Naringenin | flavonoid | PCOS SD rats | Gemella, Prevotell, Veillonella and Fusobacterium↓, the beneficial bacterial genera of Blautia, Helicobacter, Ruminococcus, Lactobacillus, Coprococcus, Parabacteroides, Faecalibacterium, Roseburia, Butyricicoccus, Streptococcus and Paraprevotella↑ | 1. Insulin resistance indicators: FBG, FINS, HOMA-IR and ISI↓; 2. Gut barrier: occludin, claudin-1↑; 3. Signaling pathway: SIRT1/PGC-1α↓, Carbohydrate metabolism, Amino acid metabolism, Lipid metabolism | LH, T, LH/FSH ratio and weight↓ | Wu et al. (2022a) |
| Fisetin | bioflavonoid | POI C57BL/6J mice | uncultured_bacterium_f_Lachnospiraceae↑, Akkermansia↓ | 1. Inflammation: CCR9/CXCR3/CD4 T-lymphocyte, IL-12↓; 2. Signaling pathway: carbohydrate and nucleotide metabolism↑, lipid and amino acid metabolism↓ | AMH↑ | Li et al. (2021) |