Myocardial injury is the pathological basis of many cardiomyopathies, such as viral myocarditis (VMC) and its sequelae. VMC is a localized or diffuse inflammatory lesion of the myocardium related to viral infection (Sagar et al., 2012). It is a typical inflammatory disease with a high incidence rate that often occurs in children and adolescents (Putschoegl and Auerbach, 2020). As a result of its long and varied severity course, lingering effects, slow and difficult recovery, and tendency to relapse or aggravate under the influence of fatigue and exogenous factors, most patients develop sequelae (Cao et al., 1997a). A large number of clinical observations have shown that patients with VMC sequelae have varying degrees of myocardial injury, manifested as palpitations, chest tightness, chest pain, and arrhythmia, accompanied by abnormal elevations in CK-MB, LDH, and cTnI (Cao, 1993; Cao et al., 1997a, 1998). There is no targeted vaccine or specific treatment method in modern medicine for the treatment of VMC and its sequelae, and antiviral drugs combined with myocardial cell nutrition are mostly used in clinical treatment at present. Although their effects are recognized, they have not been widely promoted in clinical practice (Cull et al., 2002; Daliento et al., 2003). In addition, some doctors believe that immunosuppressive therapy can be used (Daly et al., 1984). However, experimental studies have shown that some immunosuppressants not only have poor effects but also exacerbate the condition of experimental animal myocarditis (Herzum et al., 1991; Monrad et al., 1986).

Shen Bai formula (SBF) is a TCM formula, which has the effect of nourishing Qi, activating blood, dissipating phlegm, nourishing yin, clearing heat, nourishing the heart, and tranquilizing the spirit. According to TCM theory and more than 5000 cases of clinical treatment observation, SBF has a good effect of eliminating and improving the clinical symptoms, such as arrhythmia and myocardial injury, and preventing the development of VMC sequelae (Cao, 1993; Cao et al., 1997a, 1998). In addition, many experimental studies have shown that SBF can repair damaged cardiomyocytes and regulate related genes to reduce cardiomyocyte apoptosis (Cao et al., 2001; Guo et al., 2001; Zhang et al., 2005a, 2005b), reduce the expression of anti-ANT antibodies to prevent the development of autoimmune injury (Zhang et al., 2004), regulate immune function (Cao et al., 1997d), decrease the levels of inflammatory factors, SDH and LDH in serum, and improve the degree of myocardial injury and arrhythmia (Cao et al., 1992, 1997b, 1997c, 2002; Li and Qi, 2007; Zhou et al., 1995).

Energy consumption rate, respiratory entropy, intake and drinking, activity level, and other basic daily metabolic indicators of organic organisms directly reflect the survival status of the body. In recent years, with the progress of technology, several energy metabolic measurement systems have emerged (Jin et al., 2022; Seichter et al., 2021). Their emergence and application have greatly contributed to the pharmacological evaluation of drugs, and the obtained indicators macroscopically characterize the effect of drugs on life activity functions (Liu et al., 2022; Qing et al., 2020; Rahbani et al., 2021). Moreover, metabolomics method provides an effective analytical strategy in translational medicine, demonstrating promising potential in many fields like toxicology, nutrition, as well as natural product discovery that relies on advanced technology (Ren et al., 2023, Ren et al., 2023; Zhang et al., 2016). As a translational tool, metabolomics exhibits many advantages for the study of complex systems and has been widely used in TCM (Chu et al., 2016; Ren, J. et al., 2023; Wang et al., 2012). Therefore, integrating energy metabolism and metabolomics, a combination of macro and micro approaches, is conducive to comprehensively evaluate the effects of drugs on the body and elucidate the laws and mechanisms of drug action on diseases in complex systems.

SBF has a beneficial effect in treating myocardial injury. But the treatment mechanism and potential targets of SBF on myocardial injury are unclear. In present research, SBF was evaluated in rats for its overall biological impact on myocardial injury using energy metabolism and metabolomics. The search for potential endogenous myocardial injury biomarkers in rats was enhanced by serum metabolomics research and UPLC-Q-TOF-MS/MS method. A comparison was also made between biomarkers before and after SBF treatment for rats with myocardial injury to determine the targets and pathways involved, and validated through molecular docking technology. Correlations between pharmacological evaluation indicators, targets, and metabolic pathways demonstrated the biological significance of the testing results. Multivariate analysis method was applied to research the curative effect of SBF, along with serum metabolomics to determine the mechanism of action. These findings can help further understand and clarify the pharmacological mechanism of SBF.