Primary dysmenorrhea (PD) is the most prevalent condition in clinical gynecology. It is characterized by backache, swelling, abdominal pain, or discomfort before or during menstruation without pelvic pathology in the reproductive system1. A report on its prevalence showed that 85.7% of students suffer from PD2. Low-dose oral contraceptives are the standard therapy, but their adverse side effects, such as deep vein thrombosis, have drawn increasing attention3. The prevalence of deep vein thrombosis among oral contraceptive users is >1 per 1,000 women, and the risk is highest during the first 6-12 months and in users older than 40 years4.
Long used in traditional Chinese medicine (TCM), Cyperi rhizoma (CR) is derived from the dried rhizome of the Cyperus rotundus L. of the Cyperaceae family. CR regulates menstrual disorders and relieves depression and pain5. CR is widely used in gynecology and is considered a general medicine to treat women's diseases6. CR processed with vinegar (CRV) is typically used clinically. Compared with CR, CRV shows enhanced regulation of menstruation and pain relief. Modern studies have shown that CR inhibits cyclooxygenase-2 (COX-2) and the subsequent synthesis of prostaglandins (PGs), thus achieving an anti-inflammatory effect. Meanwhile, CR exhibits an analgesic effect without side effects7, making CR a good choice for dysmenorrhea patients. However, the mechanism underlying the regulation of menstruation and provision of pain relief by CRV is unclear. CR research has mainly focused on changes in its active chemical components and pharmacologic activities, such as its anti-inflammatory, antidepressant, and analgesic effects8,9,10,11,12.
Although the ingredients of TCM are complex, they are absorbed into the blood and must reach a specific blood concentration to be effective13. The scope of screening the active ingredients of TCM can be narrowed by utilizing the strategy of constituent determination in the blood. Blindness can be avoided in studying the chemical components in vitro, and one-sidedness can be avoided in studying the individual constituents14. By comparing the compositions of CR and CRV in the blood, changes in the active ingredients of the processed CR can be detected effectively and quickly. Drug efficacy is the process by which a drug influences the body. Changes in the drug components due to the body's metabolic response, which may be related to the action mechanism of the drug, can be determined with metabonomics. Metabonomics aims to measure the overall and dynamic metabolic responses, which is consistent with determining the overall efficacy of traditional Chinese medicine15. Furthermore, metabolites are the final product of gene expression, which is most closely related to phenotypes16. Thus, metabonomics may be suitable for exploring the differences in the metabolic pathways between CR and CRV in the treatment of PD. Liquid chromatography-high-resolution tandem mass spectrometry (LC-MS/MS)-based untargeted metabolomics is characterized by high throughput, high sensitivity, and high resolution and can be used to measure many different small molecular components17,18. This method can simultaneously determine the endogenous metabolites and exogenous constituents absorbed into the blood. Metabonomics has been widely used in studies on TCM19, drug toxicology20, health management21, sports22, food23, and other fields.
In this study, the differences in the exogenous constituents absorbed into the blood and the endogenous metabolites were measured between CR-treated and CRV-treated dysmenorrhea model rats using LC-MS/MS-based untargeted metabolomics to reveal the mechanisms of the analgesic effects of CRV.