Introduction Subinvolution of the postpartum uterus is a common puerperal complication. While Chinese herbal hot compress (CHHC) therapy has been widely applied to promote postpartum uterine involution, its underlying mechanisms remain unclear. Methods This study employed a longitudinal metabolomics approach based on UPLC-Q-TOF-MS to analyze serum samples collected from 168 patients with postpartum uterine subinvolution (CHHC group, n = 86; routine care group, n = 82) at baseline (T0), day 3 (T1), and day 7 (T2) of treatment. Results OPLS-DA analysis revealed that the metabolic profiles of the two groups were highly overlapping at T0 and gradually diverged as treatment progressed, with the most significant separation observed at T2. A total of 83 differential metabolites were identified based on the criteria of VIP 1.0, p 0.05, and |log₂(Fold Change)| 0.58, among which 21 core metabolites exhibited four distinct dynamic patterns: sustained increase, sustained decrease, rise-then-fall, and fall-then-rise. KEGG pathway enrichment analysis indicated that the differential metabolites were primarily associated with arachidonic acid metabolism, glycerophospholipid metabolism, amino acid metabolism, and the tricarboxylic acid cycle. Spearman correlation analysis identified four candidate biomarkers—LysoPC(18:1), arachidonic acid, L-tryptophan, and citric acid—and the combined model achieved an AUC of 0.913. Notably, both pathway enrichment and biomarker diagnostic performance showed progressive enhancement from T1 to T2. Discussion This study is the first to characterize the dynamic metabolic changes associated with the “warming meridians and activating blood” effects of CHHC therapy from a dynamic metabolomics perspective, providing preliminary molecular evidence for evaluating the efficacy of traditional Chinese medicine external therapies.
Yin et al. (Wed,) studied this question.