Therapeutic modulation of the gut microbiota by traditional Chinese medicine in the management of cholestatic liver injury

Cholestatic liver injury (CLI) is a complex pathology characterized by impaired bile excretion and a lack of effective curative therapies. Emerging evidence indicates that the gut microbiota plays a critical role in the pathogenesis of CLI via the gut-liver axis. Specifically, gut dysbiosis disrupts bile acid homeostasis, triggers immune-mediated inflammation, exacerbates oxidative stress, and dysregulates multiple signaling pathways, thereby accelerating hepatic damage. Traditional Chinese Medicine (TCM) offers a distinct therapeutic advantage through its multi-component, multi-target mechanisms. Many studies have shown that TCM herbal extracts and some formulas can attenuate CLI by restructuring the gut microbiome. These interventions work by promoting beneficial bacterial proliferation, restoring intestinal barrier integrity, modulating bile acid receptors, and suppressing inflammation and fibrosis. This review synthesizes current mechanisms linking gut dysbiosis to CLI and evaluates recent advances in TCM-based strategies that target the gut microbiota, offering theoretical insights for novel clinical interventions.