Applications and challenges of traditional Chinese medicine in gastrointestinal disease treatment: A review

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.