Multi-target network modulation of Traditional Chinese Medicine in radiation enteropathy: mechanistic insights and therapeutic implications

Abstract Radiation enteropathy (RE) is a common and clinically significant complication of abdominal and pelvic radiotherapy, characterized by multifactorial pathological processes including oxidative DNA damage, epithelial barrier disruption, immune–inflammatory dysregulation, vascular injury, fibrosis, and gut microbiota dysbiosis. Despite its clinical burden, effective disease-modifying therapies remain limited. Traditional Chinese Medicine (TCM), widely used in the management of gastrointestinal disorders, has attracted increasing attention as a complementary approach for radiation-induced intestinal injury. Accumulating experimental evidence indicates that TCM formulas, herbal extracts, and bioactive phytochemicals may exert protective effects through coordinated regulation of interconnected pathological processes. Reported protective effects involve several interconnected pathological processes, but the supporting evidence remains uneven. Most studies use acute, single-dose animal models, and many mechanistic conclusions rely on pathway-marker changes rather than functional perturbation. This review therefore evaluates TCM interventions according to disease stage, intestinal site, irradiation design, and the strength of mechanistic support. Multi-target regulation is treated as an interpretive framework rather than a mechanism established for every intervention. Clinical evidence remains limited by small samples, heterogeneous preparations, inconsistent endpoints, and inadequate follow-up. Translation will require standardized products, clinically relevant fractionated and tumor-bearing models, exposure-relevant mechanistic validation, and rigorous trials that assess intestinal benefit without compromising tumor control.