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Erzhi-tiangui granules (ETG) is a traditional Chinese medicine (TCM) herbal formula developed as a proprietary hospital preparation by the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. Based on the TCM principle of replenishing vital essence to tonify the kidney, the formula consists of ten herbal ingredients, including Ligustrum lucidum (Nv Zhen Zi), Eclipta prostrata (Han Lian Cao), Lycium barbarum (Gou Qi Zi), Cuscuta chinensis (Tu Si Zi), Rehmannia glutinosa (Shu Di Huang), Angelica sinensis (Dang Gui), Paeonia lactiflora (Bai Shao), Ligusticum striatum (Chuan Xiong), Cyperus rotundus (Xiang Fu), and Glycyrrhiza uralensis (Zhi Gan Cao). Erzhi-tiangui granules are primarily used to improve female fertility, optimize oocyte and embryo quality, and enhance in vitro fertilization (IVF) outcomes in women with diminished ovarian reserve (DOR), poor ovarian response (POR), or advanced maternal age. The therapeutic mechanism is associated with the downregulation of granulosa cell apoptosis and oxidative stress, potentially mediated by the upregulation of the long non-coding RNA NEAT1 and the Nrf2/HO-1 signaling pathway, leading to the subsequent modulation of apoptotic factors such as Bcl-2, Caspase-3, Bax, and FOXO3a.
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