Research Progress on TCM Theory and Modern Pharmacology of Ophiopogonis Radix-Schisandrae Chinensis Fructus Herb Pair in Intervening Heart Failure With Preserved Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) is characterized by impaired diastolic reserve and a heterogeneous pathophysiological network involving chronic low-grade inflammation, oxidative stress, myocardial fibrosis, endothelial dysfunction, and metabolic remodeling. This narrative review critically evaluates the traditional Chinese medicine (TCM) compatibility rationale, pharmacological evidence, and translational evidence for the Ophiopogonis Radix–Schisandrae Chinensis Fructus herb pair in HFpEF. PubMed, Web of Science, Embase, and CNKI were searched from database inception through December 2025, and the available evidence was narratively synthesized according to study type, relevance to HFpEF, and whether the herb pair itself was directly evaluated. Evidence from single-herb and constituent studies suggests potentially complementary effects on myocardial energy metabolism, oxidative stress, inflammatory signaling, fibrosis, endothelial function, and cardiomyocyte survival. However, most pharmacological evidence is derived from non-HFpEF models, single-herb experiments, or network pharmacology predictions, while direct in vitro or in vivo validation using combined decoctions, co-extracts, or co-administration of Ophiopogonis Radix and Schisandrae Chinensis Fructus remains scarce. Clinical evidence is also indirect and derives mainly from multi-herb formulas or Chinese patent medicines; therefore, it cannot establish the efficacy of the herb pair itself. Furthermore, the existing clinical literature is limited by heterogeneous interventions and outcomes, variable methodological quality, and insufficient long-term HFpEF-specific endpoints. Overall, the Ophiopogonis Radix–Schisandrae Chinensis Fructus herb pair has a plausible multi-target rationale for intervention in HFpEF, but pharmacological synergy and clinical effectiveness have not yet been established. Further studies using HFpEF-specific experimental models, standardized combined preparations, pharmacokinetic evaluation, and well-designed multicenter randomized controlled trials are needed to determine its mechanistic interactions and clinical value.