Research progress of traditional Chinese medicine syndrome differentiation in prevention and treatment of hepatic encephalopathy

Introduction: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome caused by liver dysfunction and metabolic disturbances, presenting with consciousness disorders, behavioral abnormalities, and coma. Despite advances in modern medicine, effective prevention and management remain challenging. Traditional Chinese medicine (TCM) has shown promise in HE treatment through individualized syndrome differentiation and holistic therapeutic strategies. Methods: A comprehensive literature search was conducted in CNKI, Wanfang Data, PubMed, and Google Scholar for studies published from 2005 to 2025. Search terms included combinations of “hepatic encephalopathy,” “traditional Chinese medicine,” “syndrome differentiation,” and “mechanism of action.” After removing duplicates and screening titles, abstracts, and full texts, studies reporting TCM interventions, syndrome differentiation, or mechanisms of HE treatment were included. Results: Analysis revealed that TCM syndrome differentiation for HE predominantly involves phlegm-dampness, fire-toxin, liver-kidney deficiency, and qi-yin deficiency. Core therapeutic strategies include TCM compound decoctions, Chinese herbal enemas, and acupuncture. These interventions demonstrate efficacy in improving neurological symptoms, reducing inflammation and oxidative stress, and modulating gut microbiota. Discussion: TCM offers a holistic, multi-target, and multi-pathway approach for HE management. Syndrome differentiation provides a theoretical basis for personalized therapy, while recent mechanistic studies suggest TCM’s role in modulating the gut–liver–brain axis and neuroinflammation. Standardizing syndrome classifications and integrating multi-omics approaches may further enhance the precision and modernization of TCM-based HE therapies.