Keywords
Zhenwu Tang
Molecular docking
Viral myocarditis
Precision medicine
Submitted : 2026-02-17
Accepted : 2026-03-04
Published : 2026-03-19
Abstract
Background: Zhenwu Tang is a typical Chinese medicinal preparation for the treatment of viral myocarditis (VMC) with remarkable clinical efficacy in alleviating symptoms such as palpitations, chest tightness, and fatigue in some patients, and reducing the frequency of episodes. Nonetheless, the exact mechanism by which it acts remains unclear. This research employed network pharmacology to investigate the therapeutic impact of Zhenwu Tang’s relevant targets on VMC, along with molecular docking validation. Methods: The primary components of Zhenwu Tang and their respective targets were sourced from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and the UniProt database, GeneCards and the Online Mendelian Inheritance in Man (OMIM) databases were used to identify targets related to VMC. Disease Ontology (DO), Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were used to evaluate the common ‘Zhenwu Tang-VMC’ targets. Using Cytoscape software, the protein-protein interaction (PPI) network, ‘compound-target-pathway’ network, and ‘target-organ’ network were developed, and their network parameters were thoroughly examined. The interactions between core targets and active compounds were evaluated and validated by molecular docking. Results: A total of 93 targets of Zhenwu Tang active compounds and 2,243 VMC-related targets were screened, and 37 Zhenwu Tang-VMC common targets were obtained. DO analysis of these 37 common targets indicated that the “Zhenwu Tang-VMC” common targets showed high enrichment in respiratory system diseases. According to the molecular docking results, 60 VMC ligand-receptor pairs and 47 respiratory-associated VMC ligand-receptor pairs had binding energies lower than -7 kcal/mol. Conclusion: The present study suggests that Zhenwu Tang is a promising Chinese medicinal preparation for the treatment of viral myocarditis, especially respiratory-associated viral myocarditis. Our illustration of the particular molecular mechanism of Zhenwu Tang against VMC and its potent active compounds offers a theoretical foundation for further basic experimental validation, clinical translation, and application.
References
Spotts P, Zhou F, 2024, Myocarditis and Pericarditis. Primary Care: Clinics in Office Practice, 51(1): 111–24.
Olejniczak M, Schwartz M, Webber E, et al., 2019, Viral Myocarditis: Incidence, Diagnosis and Management. Journal of Cardiothoracic and Vascular Anesthesia, 34(prepublish): 1591–601.
Chinese Society of Cardiology of Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology, 2024, 2024 Chinese Guideline for the Diagnosis and Management of Fulminant Myocarditis in Adults. Chinese Journal of Cardiology. 52(1): 10–33.
Zhang Y, Zhu L, Li X, et al., 2023, M2 Macrophage Exosome-Derived lncRNA AK083884 Protects Mice from CVB3-Induced Viral Myocarditis through Regulating PKM2/HIF-1α Axis Mediated Metabolic Reprogramming of Macrophages. Redox biology, 2023(69): 103016.
Zhang Y, Fu Y, 2024, Research Progress on the Mechanism of Immune Response in the Progression of Inflammatory Cardiomyopathy. Department of Hyperbaric Oxygen, 33(3): 354–357.
Zhang X, Han B, 2023, Advances in the Study of miRNAs in Viral Myocarditis. Journal of Shandong First Medical University & Shandong Academy of Medical Sciences, 44(10): 779–784.
Zhou B, Qin Q, Fang Y, et al., 2024, Exosomes from Human Bone Marrow MSCs Alleviate PD-1/PD-L1 Inhibitor-Induced Myocardial Injury in Melanoma Mice by Regulating Macrophage Polarization and Pyroptosis. Life Sciences, 2024(358): 123108.
Daetwyler E, Wallrabenstein T, König D, et al., 2024, Corticosteroid-Resistant Immune-Related Adverse Events: A Systematic Review. Journal for Immunotherapy of Cancer, 12(1): e007409.
Yang B, Huang F, 2021, Discussion on Viral Myocarditis from the Perspective of ‘Heart Manifests on the Surface’ in Huangdi Neijing. Forum on Traditional Chinese Medicine, 36(5): 15–16.
Wu C, Yang H, 2018, Efficacy of Emodin in Children with Viral Myocarditis and its Effect on Serum Indexes. Clinical Medication Journal, 16(9): 39–42+7.
Yu B, Xu R, 2021, Meta-Analysis of the Therapeutic Efficacy of Puerarin Combined with Shen-Mai Injection in the Treatment of Viral Myocarditis in Children. China Modern Doctor, 59(36): 71–74.
Liu M, Li L, Xu H, et al., 2022, Research Progress of the Roles of Chinese Medicine in the Treatment of Viral Myocarditis and its Mechanism. Journal of Changchun University of Chinese Medicine, 38(9): 1049–1053.
Qiao S, Chen Y, Li K, et al., 2024, Research Progress on the Pharmacological Effects and Clinical Applications of Danshen Injection. Modern Drugs & Clinical, 39(11): 2977–2982.
Liu M, Lin Y, Xu H, et al., 2022, Combination of Sophora flavescens Alkaloids and Panax quinquefolium Saponins Modulates Different Stages of Experimental Autoimmune Myocarditis via the NF-κB and TGF-β1 Pathways. Experimental and Therapeutic Medicine, 24(3): 570.
Yao T, Han S, Huang F, et al., 2024, Historical Evolution and Clinical Application Patterns of the Classic Formula Zhenwu Tang. China Medical Herald, 21(2): 150–154+65.
Wang X, Chen Z, Wang X, et al., 2023, Mechanism of Action of Zhenwu Tang in Treating Heart Failure. Chinese Journal of Gerontology, 43(22): 5608–5611.
Cui J, 2024, Evaluation of Therapeutic Effect of Modified Zhenwu Potion on HF with Cold Stasis and Water Accumulation Type, thesis.
Zhang B, Shi J, 2018, Efficacy of Zhenwu Tang Combined with Western Medicine in Treating Heart Failure of Heart-Kidney Yang Deficiency Type and its Effect on Serum NT-proBNP and Hcy Levels. Global Traditional Chinese Medicine, 11(8): 1252–1255.
Yu X, Qin W, Cai H, et al., 2024, Analyzing the Molecular Mechanism of Xuefu Zhuyu Decoction in the Treatment of Pulmonary Hypertension with Network Pharmacology and Bioinformatics and Verifying Molecular Docking. Computers in Biology and Medicine, 2024(169): 107863.
Carsten T, Enrico A, Biykem B, et al., 2020, Myocarditis and Inflammatory Cardiomyopathy: Current Evidence and Future Directions. Nature Reviews Cardiology, 18(3): 169–193.
Won T, Song E, Kalinoski H, et al., 2024, Autoimmune Myocarditis, Old Dogs and New Tricks. Circulation Research, 134(12): 1767–1790.
Song W, Chen M, 2016, Treatment of ‘Water-Liver Disease’ from the Perspective of Zhenwu Tang Syndrome. Journal of Liaoning University of Traditional Chinese Medicine, 18(5): 187–189.
Xia Z, Chen Y, Cheng J, 2025, Research Progress on Zhenwu Tang Series Formulas and their Combined Application with Acupuncture. Chinese Folk Therapy, 33(9): 108–111.
Liu W, Li F, Su P, et al., 2024, Effects of Zhenwu Tang Combined with Modified Buxinqi Formula on the Efficacy of Patients with Chronic Heart Failure of Heart-Kidney Yang Deficiency Type and its Effects on Oxidative Stress Response and Vascular Endothelial Function. World Journal of Integrated Traditional and Western Medicine, 19(6): 1238–1242.
Liu J, Xu M, 2015, Experimental Study of Zhenwu Tang on Myocardial Ischemia Reperfusion Injury. Hunan Journal of Traditional Chinese Medicine, 31(6): 162–163+78.
Zhao Y, Gan R, Zhang X, et al., 2023, In vitro Experimental Study of Ershen Zhenwu Tang Regulating PI3K/AKT/mTOR Signaling Pathway to Inhibit Myocardial Fibrosis. Journal of Anhui University of Chinese Medicine, 42(3): 77–82.
Esfandiarei M, McManus B, 2008, Molecular Biology and Pathogenesis of Viral Myocarditis. Annual Review of Pathology: Mechanisms of Disease, 2008: 3.
Zeng C, Zhong P, Zhao Y, et al., 2015, Curcumin Protects Hearts from FFA-Induced Injury by Activating Nrf2 and Inactivating NF-κB Both In vitro and In vivo. Journal of Molecular and Cellular Cardiology, 2015(79): 1–12.
Mitra E, Seti B, Agripina S, et al., 2007, Coxsackievirus B3 Activates Nuclear Factor Kappa B Transcription Factor via a Phosphatidylinositol-3 Kinase/Protein Kinase B-Dependent Pathway to Improve Host Cell Viability. Cellular Microbiology, 9(10): 2358–2371.
Ming Z, Xi H, Mei Z, et al., 2012, Low-Dose Celecoxib Improves Coronary Function After Acute Myocardial Ischaemia in Rabbits. Clinical and Experimental Pharmacology & Physiology, 39(3): 233–240.
Roberts R, Logan H, Keung L, 2021, The Potential of Hsp90 in Targeting Pathological Pathways in Cardiac Diseases. Journal of Personalized Medicine, 11(12): 1373.
Hiroki A, Kang P, James H, et al., 2002, Direct Activation of Mitochondrial Apoptosis Machinery by c-Jun N-terminal Kinase in Adult Cardiac Myocytes. The Journal of Biological Chemistry, 277(12): 10244–10250.