肝纤维化是肝脏内的慢性损伤修复反应，其本质为肝脏细胞外基质（extracellular matrix，ECM）的弥漫性过度沉积与异常分布。尽管病因治疗可延缓纤维化进展，但直接靶向纤维化过程的药物研发仍面临重大挑战，临床选择极为有限。中医药凭借多成分、多靶点、多通路的特点，在抗肝纤维化领域受到广泛关注，但相关研究仍以基础实验为主，系统性的机制整合与临床证据梳理尚不充分。通过概述肝纤维化的发病机制，重点阐述肝巨噬细胞极化、肝窦内皮细胞毛细血管化、肝星状细胞活化及ECM代谢失衡等机制；按类别归纳中药活性成分的抗肝纤维化作用规律，从炎症启动、代谢调节、肝纤维化执行3个层级整合信号通路的交互网络，探讨中药多成分协同调控的抗肝纤维化系统机制；并对多组学整合、单细胞测序、人工智能筛选及病因分型精准治疗等前沿技术驱动下的研究方向进行展望，为中药抗肝纤维化的机制阐释与临床转化提供思路。

Liver fibrosis is a chronic wound-healing response of the liver, essentially characterized by diffuse excessive deposition and abnormal distribution of the extracellular matrix (ECM). Although etiological therapy can slow fibrosis progression, drug development directly targeting the fibrotic process still faces substantial challenges, and clinical options remain extremely limited. Traditional Chinese medicine (TCM) has attracted extensive attention in the field of liver fibrosis research due to its multi-component, multi-target, and multi-pathway properties. However, current studies are still predominantly based on preclinical experiments, and systematic integration of mechanisms and sorting of clinical evidence are still inadequate. This review outlines the pathogenesis of liver fibrosis, with emphasis on the polarization of Kupffer cells, the capillarization of liver sinusoidal endothelial cells, the activation of hepatic stellate cells, and ECM metabolic imbalance. Antifibrotic effects of active components from herbs are summarized by chemical categories. Furthermore, the interactive network of signaling pathways is integrated from three hierarchical levels—the “inflammation initiation, metabolic regulation, and fibrotic progression”—to explore the systemic mechanisms underlying synergistic modulation by multiple components of TCM. Finally, the limitations of current research are identified, and future directions driven by cutting-edge technologies, including multi-omics integration, single-cell sequencing, artificial intelligence-based screening, and etiology-stratified precision therapy, are discussed. This review provides insights into mechanism interpretation and clinical translation of TCM against liver fibrosis.

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国家自然科学基金资助项目（82204656）；博士后科学基金特别资助（2024T170534）；山东省中医药科技项目（M20241725）；山东中医药大学中医药特色专项（KY2025T09）；山东省自然科学基金面上项目（ZR2026MS1262）