Journal of Traditional Chinese Medicine ›› 2026, Vol. 46 ›› Issue (5): 1096-1105.DOI: 10.19852/j.cnki.jtcm.2026.05.004

• Original Articles • Previous Articles     Next Articles

Xiaoyao San (逍遥散) enhances the sensitivity of hepatocellular carcinoma to 5-fluorouracil via autophagy modulation

SONG Yulin1, YE Jinhua2, XIAO Jingyang2, FU Liang2, LI Yixiu2()   

  1. 1 Department of Orthopedics, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
    2 Department of Pharmacy, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
  • Received:2024-12-22 Accepted:2025-11-20 Online:2026-10-15 Published:2026-10-09
  • Contact: LI Yixiu, Department of Pharmacy, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China. 396112445@qq.com,Telephone: +86-15870634829
  • About author:

    SONG Yulin and YE Jinhua are co-first authors and contributed equally to this work

  • Supported by:
    Jiangxi Province Natural Science Foundation of China: Study on the Mechanism of Xiaoyao San Inhibiting Autophagy of Cancer Stem-like Cells to Reverse 5-Fu-induced Resistance in Hepatocellular Carcinoma(20212BAB206054)

Abstract:

OBJECTIVE: To evaluate the therapeutic potential of combining Xiaoyao San (XYS, 逍遥散) aqueous extract with 5-fluorouracil (5-FU) in chemoresistant hepatocellular carcinoma (HCC) cells.

METHODS: The effects of XYS on 5-FU-induced apoptosis and autophagy in Bel-7402/5-FU cell line were assessed using cell counting kit-8 (CCK8) assays, Western blotting, immunofluorescence, and transmission electron microscopy. A nude mouse xenograft model of human HCC was established to examine the in vivoeffects of XYS on tumor growth, as well as molecular alterations associated with apoptosis and autophagy. In addition, autophagy-related gene-5 (ATG5)-overexpressing and ATG5-silenced cell models were generated to further investigate the role of XYS in modulating 5-FU-induced apoptosis.

RESULTS: XYS enhanced the anti-proliferative effects of 5-FU and promoted apoptosis in chemoresistant HCC cells. These synergistic effects were further confirmed in vivo, where XYS potentiated the tumor-suppressive activity of 5-FU. Mechanistically, 5-FU treatment elevated basal autophagy, contributing to drug resistance, whereas XYS suppressed autophagy activation, thereby restoring sensitivity to 5-FU.

CONCLUSION: In HCC, 5-FU resistance appears to be mediated, at least in part, by drug-induced autophagy. XYS effectively inhibited autophagy and enhanced the chemosensitivity of HCC cells to 5-FU. These findings suggest that XYS may serve as a promising adjunctive therapy to improve the efficacy of 5-FU in treating HCC.

Key words: carcinoma, hepatocellular, fluorouracil, resistance, autophagy, Xiaoyao San

Cite this article

SONG Yulin, YE Jinhua, XIAO Jingyang, FU Liang, LI Yixiu. Xiaoyao San (逍遥散) enhances the sensitivity of hepatocellular carcinoma to 5-fluorouracil via autophagy modulation[J]. Journal of Traditional Chinese Medicine, 2026, 46(5): 1096-1105.