To observe the clinical effect of Taohong Siwu decoction in the treatment of knee osteoarthritis, and explore its mechanism bysystems pharmacology.

A total of 60 patients with knee osteoarthritis admitted to Foshan Jianxiang Bone Injury Hospital from July 2023 to July 2024 were randomly enrolled, excluding those with poor compliance or comorbid severe cardiovascular and cerebrovascular diseases, rheumatic diseases, etc. They were randomly divided into treatment group and control group with 30 cases in each group. The treatment group was given Taohong Siwu decoction combined with extracorporeal shock wave therapy, while the control group was given oral celecoxib combined with extracorporeal shock wave therapy. Visual analogue scale (VAS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) of knee joint were followed up after one and two months of treatment. T test was employed to compare the therapeutic efficacy between the two groups. Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) was used to search and screen the active components and target of Taohong Siwu decoction. GeneCards and Online Mendelian Inheritance in Man (OMIM) Database were used to screen the targets of knee osteoarthritis disease. The intersection of the active component target of Taohong Siwu decoction and the target of knee osteoarthritis disease was selected by R software, and Venn diagram was drawn. The visualization network diagram of traditional Chinese medicine active ingredient-disease target was obtained by using the software of Cytoscape. Protein-protein interaction (PPI) of active ingredient disease target protein interaction was obtained through online string platform. Finally, gene ontology (Go) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were carried out, and then the obtained main active components were molecular docking with the core target protein, and the docking results were further visualized.

After one and two months of treatment, VAS score and WOMAC score of the two groups were lower than those before treatment, the differences were statistically significant (t=-3.24, -1.87, -5.69, -1.56, all P<0.05); compared with the control group, the VAS score and WOMAC score of the treatment group decreased more significantly after treatment, and the differences were statistically significant (t=-5.21, -6.41, -3.01, -3.69, all P<0.05). Forty compounds were screened from Taohong Siwu decoction, which could act on 120 therapeutic targets, such as serine/threonine kinase 1 (AKT1), Jun proto-oncogene (JUN), mitogen-activated protein kinase1 (MAPK1), and participate in the regulation of tumor necrosis factor, interleukin-17 and other signal pathways.

Taohong Siwu decoction can effectively relieve the symptoms of knee osteoarthritis, which may be related to the characteristics of multi-target and multi-channel regulation.