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DiDang Decoction (DDD) is a classical Traditional Chinese Medicine (TCM) formula, originally documented in the Shanghan Lun, used for treating conditions associated with blood stasis, such as atherosclerosis (AS) and hyperlipidemia (HLP). It is a multi-component preparation typically consisting of rhubarb (Rheum palmatum), peach kernel (Prunus persica), leeches (Hirudo nipponica), and gadfly (Tabanus bivittatus). Modern pharmacological research indicates that DDD exerts its therapeutic effects through multiple targets and pathways, notably the HIF-1 signaling pathway. It has been shown to reduce lipid accumulation, attenuate mitochondrial damage, and decrease reactive oxygen species (ROS) levels. Molecularly, DDD up-regulates the expression of HIF-1α, Glutathione Peroxidase 4 (GPX4), and the anti-apoptotic protein Bcl-2, while down-regulating the pro-apoptotic protein Bax, thereby inhibiting ferroptosis and apoptosis in relevant cell types.
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