Gastrointestinal (GI) diseases are common multifactorial disorders involving chronic inflammation, epithelial barrier disruption, immune dysregulation, gut microbiota imbalance, and abnormalities in motility and gut–brain interactions. Conventional pharmacotherapies (e.g., antibiotics, acid suppressants, and immunomodulators) relieve symptoms; however, they often act on single pathways and have limitations regarding long-term remission, tolerability, and safety. This review summarizes the pathogenesis and epidemiology of GI diseases and outlines the current clinical status of traditional Chinese medicine (TCM) in the treatment of these diseases. A total of 143 single herbs and more than 200 formulas from the Pharmacopoeia of the People's Republic of China and authoritative standards, primarily used for regulating the spleen and stomach, soothing the liver and regulating qi, and clearing heat and detoxifying, are collated. Drawing on modern experimental and clinical evidence, we describe how TCM-based interventions may modulate key pathological processes, including inflammation, mucosal barrier injury, microbiota dysbiosis, and motility disturbances, and summarize clinical findings in functional GI disorders, inflammatory bowel disease, chronic atrophic gastritis, and post-stroke GI dysfunction. Finally, we highlight major challenges and future directions, including improving the methodological rigor of randomized trials, establishing standardized diagnostic and evaluation systems, strengthening pharmaceutical standardization and long-term safety monitoring, and developing mechanism- and biomarker-guided integrative treatment strategies to support a more evidence-based role for TCM in GI disease management.
Funding
This work was supported by the National Natural Science Foundation of China (82404835, 82474050), the Guangdong Basic and Applied Basic Research Foundation (2024A1515011699, 2022A1515110682), Guangzhou Basic and Applied Basic Research Foundation (2024A04J3398), and supported by the Fundamental Research Funds for the Central Universities (21625214).
CRediT authorship contribution statement
Aijing Li: Conceptualization, investigation, data curation, and writing ‒ original draft. Liufang Hu: Investigation, writing ‒ review & editing, and project administration. Liangliang He: Supervision, conceptualization; writing ‒ review & editing, and project administration. Ping Yu: Conceptualization, investigation, and writing ‒ review & editing.
Conflict of interest statement
All authors declared that there is no conflict of interest.
Appendix A. Supplementary data
Supplementary data to this article can be found online at
https://doi.org/10.1016/j.jtcms.2026.03.001.
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