Interactions between traditional chinese medicine and gut microbiota in chronic diseases

Introduction
The gut microbiota (GM) is a vast and dynamic community of microorganisms residing in the mammalian gastrointestinal tract. It plays a vital role in the absorption, digestion, metabolism, and distribution of food and drugs. Dysbiosis of GM is increasingly recognized as a key contributor to the development of intestinal disorders such as irritable bowel syndrome (IBS), Crohn's disease, and colorectal cancer. Moreover, GM communicates with distant organs through various axes, including the brain-gut, liver-gut, and lung-gut axes, thereby participating in the pathogenesis of systemic diseases such as Alzheimer's disease, non-alcoholic fatty liver disease, liver cancer, and lung cancer.
Methods
This review systematically examines the recent literature on the bidirectional interaction between traditional Chinese medicine (TCM) and GM, focusing on preclinical and clinical studies. Emphasis is placed on the mechanisms through which GM influences the pharmacokinetics and pharmacodynamics of TCM, including microbial enzymatic activities such as hydrolysis, redox reactions, and deacetylation.
Results
GM can significantly impact both the efficacy and toxicity of TCM by transforming its active ingredients. Conversely, TCM and its active compounds also modulate the composition and function of GM, contributing to the prevention and treatment of chronic diseases. Key chronic conditions covered in this review include gastrointestinal, neurological, hepatic, and pulmonary diseases.
Discussion
The interaction between TCM and GM represents a promising avenue for personalized medicine and targeted interventions for GM-related diseases. Understanding these complex interactions provides a theoretical basis for developing novel TCM-based strategies to prevent and treat chronic conditions through modulation of the gut microbiota.