Advances in Traditional Chinese Medicine for Managing Diminished Ovarian Reserve: Mechanisms and Clinical Insights

Diminished Ovarian Reserve (DOR) is characterised by a decrease in the number and quality of oocytes, accompanied by biological markers such as a decrease in anti-Müllerian hormone (AMH), a decrease in the sinus follicle count (AFC), and an increase in follicle stimulating hormone (FSH). In response to the limitations of modern medical treatments, traditional Chinese medicine (TCM) has demonstrated unique advantages in the treatment of DOR. In this paper, we systematically reviewed the literature in the past decade to analyse the scientific content of TCM intervention in DOR from the dimensions of molecular mechanism and clinical application. It was found that single components (paeoniflorin, Epimedium glycosides, etc.), TCM pairs (Cuscuta chinensis-Sambucus nigra and Semencuspidatae-Epimedium), TCM combinations (Liuweidihuangwan, Haifuyuyuyuitang, Angelica sinensis-Paeonia lactiflora, etc.), and a variety of acupuncture therapies can improve the ovarian function through a multi-targeted modulation mechanism: ① regulating the signalling pathways, such as PI3K/AKT, to promote the development of the follicle; ②regulating the hypothalamic-pituitary-ovarian axis balance hormone levels; ③enhance anti-oxidative stress through Nrf2/HO-1/NLRP3 signalling; ④inhibit the expression of granulosa cell apoptosis-related factors (Bax/Caspase-3). Clinical data showed that TCM interventions significantly increased AMH levels, increased AFC and decreased FSH levels in patients. The study confirms that TCM exerts therapeutic advantages through multi-component synergistic effects, from improving the ovarian microenvironment, regulating reproductive endocrinology, delaying follicular atresia, etc. which provides a theoretical basis and practical reference for the integrated treatment of DOR. It is suggested that standardised clinical studies should be carried out to establish an evaluation system for the efficacy of TCM and to promote the development of precise treatment options.