The Chinese herbal prescription Baicao Fuyanqing suppository treats vulvovaginal candidiasis by inhibiting Candida albicans infection and restoring vaginal metabolic balance

Vulvovaginal candidiasis (VVC) is a disease primarily caused by Candida albicans (C. albicans) infection of the vaginal mucosa. The Chinese herbal compound preparation Baicao Fuyanqing suppository (BCFYQS) is widely used in clinical practice to treat VVC, but its active ingredients and mechanism of action remain unclear. Therefore, we systematically investigated the efficacy and mechanism of BCFYQS in treating VVC by integrating chemical composition analysis, in vitro and in vivo anti- C. albicans infection efficacy experiments, metabolomics, spatial mass spectrometry imaging, network pharmacology, molecular docking, and Western blot validation. Our research reveals that BCFYQS, containing multiple active components such as alkaloids, flavonoids, and glycosides with antifungal and anti-inflammatory properties, disrupted metabolic pathways in C. albicans including the TCA cycle, glyoxylate and dicarboxylate metabolism, and amino acid metabolism, thereby inhibiting the activity of C. albicans. Furthermore, BCFYQS effectively inhibited C. albicans infection and damage to vaginal mucosa both in vivo and in vitro, thereby preserving vaginal mucosal integrity. Its 27 key bioactive components restored vaginal metabolic balance by suppressing the PLA2 activity, which downregulated metabolites (arachidonic acid, leukotriene B4, prostaglandin G1, glycerophosphocholine, and lysoPC (18:2/0:0), etc.) closely associated with arachidonic acid and glycerophospholipid metabolism, achieving therapeutic effects against VVC. Overall, this study explores the anti- C. albicans activity of BCFYQS and identifies its key bioactive components and mechanisms of action in treating VVC. It provides scientific evidence for its clinical application and offers a new, safe, and effective treatment option for VVC.