Traditional Chinese medicine and gastroenterology: exploring the interplay of the microbiome, immune system, and barrier function

Traditional Chinese Medicine (TCM) offers promising multi-target interventions for gastrointestinal disorders by modulating the complex tripartite interplay among the gut microbiome, immune system, and intestinal barrier function. This review examines the mechanistic foundations of TCM’s efficacy in gastroenterology, evaluating how herbal formulations such as berberine, ginseng saponins, and classical decoctions exert systems-level effects. We analyze evidence suggesting that TCM may restore microbial diversity, enriching beneficial taxa like Akkermansia muciniphila and short-chain fatty acid (SCFA) producers, while concurrently regulating mucosal immunity via T-cell modulation and cytokine suppression. Furthermore, these pathways converge to fortify epithelial integrity by upregulating tight junction proteins (Occludin, ZO-1, and claudins), effectively preventing antigen translocation. We discuss the bidirectional relationship between phytochemicals and gut microbiota, highlighting how microbial biotransformation generates bioactive secondary metabolites like SCFAs to maintain immune homeostasis. Finally, we outline future translational priorities, emphasizing large-scale randomized controlled trials, multi-omics approaches, and data-driven personalized protocols. Ultimately, this synthesis contextualizes an alternative integrative framework from single-target conventional pharmacology toward holistic, multi-target TCM strategies that overcome incomplete clinical symptom relief to effectively modulate multi-target mucosal and microbial signaling networks.