From Single Genes to Systemic Networks: Transcriptomic Insights into Traditional Chinese Medicine for Heart Failure

Heart failure (HF) represents the terminal stage of diverse cardiovascular pathologies and has emerged as a global public health crisis, characterized by increasing prevalence and persistently poor long-term prognosis. Although modern pharmacological therapies have advanced considerably, high rates of disease recurrence and recurrent hospitalizations continue to profoundly impair patients' quality of life. Traditional Chinese medicine (TCM) has been reported in preclinical and some clinical studies to offer potential benefits, particularly in enhancing cardiac function, alleviating clinical symptoms, and slowing disease progression. Numerous TCM compound formulations are commonly used in clinical practice in China and are gradually attracting international research attention. Nevertheless, the inherent complexity of TCM compositions, their multi-target mechanisms of action, and the lack of clarity regarding their molecular underpinnings remain substantial obstacles to broader acceptance within contemporary medicine. In recent years, driven by the rapid evolution of high-throughput sequencing technologies, transcriptomics has become a pivotal tool in TCM research, facilitating the exploration of disease mechanisms and drug targets. This narrative review synthesizes research progress on TCM interventions for HF from a transcriptomic perspective. It traces the development of major transcriptomic technologies, critically evaluates their respective strengths and limitations, and synthesizes current findings on how TCM modulates differentially expressed genes, signaling pathways, and cellular processes at multiple regulatory levels. Furthermore, it examines the potential therapeutic impact of TCM on key pathological pathways, including myocardial remodeling, energy metabolism dysregulation, and inflammatory responses. By identifying existing research gaps and outlining future directions, this review seeks to elucidate the mechanisms of TCM treatment for HF through modern scientific frameworks, thereby offering novel insights for addressing this challenging condition.