肠道菌群失衡是炎症性肠病（inflammatory bowel disease，IBD）发生发展的关键因素之一。紊乱的肠道菌群通过破坏胆汁酸代谢稳态，加剧肠道炎症反应并削弱肠黏膜屏障功能，从而推动IBD病理进程。胆汁酸作为重要的微生物-宿主共代谢产物，其代谢异常如次级胆汁酸积累、毒性代谢物生成增加等，可激活促炎信号通路，并通过胆汁酸受体介导的调控网络失衡，进一步放大炎症级联反应，削弱对肠道免疫和屏障功能的保护作用，形成“菌群-代谢-免疫”恶性循环。中药因其多成分、多靶点、多通路的协同调控特性，通过重塑肠道菌群结构、调节胆汁酸代谢，恢复肠道免疫稳态，在IBD治疗中展现出独特优势。这些作用为IBD的精准干预提供了新靶点，也为整合肠道微生态与代谢调控的中西医结合治疗策略奠定了理论基础。基于此，系统阐释了肠道菌群-胆汁酸轴在IBD发病中的核心作用，并总结了中药通过多维度干预该轴机制的研究进展，为IBD的预防与治疗开拓新路径。

Imbalance of the intestinal microbiota is one of the key factors in the onset and progression of inflammatory bowel disease (IBD). The dysbiosis of intestinal microbiota accelerates the pathological process of IBD by disrupting the homeostasis of bile acids metabolism, exacerbating intestinal inflammatory responses and weakening the intestinal mucosal barrier function. As important microbial-host co-metabolites, abnormally metabolized bile acids, such as the accumulated secondary bile acids and elevated production of toxic metabolites, can activate pro-inflammatory signaling pathways. Furthermore, imbalance of bile acid receptor-mediated regulatory networks amplifies the inflammatory cascade reaction and diminishes the protective functions of intestinal immunity and barrier function, thereby forming a vicious cycle of “microbiota-metabolism-immunity”. With its multi-component, multi-target, and multi-pathway synergistic regulatory features, traditional Chinese medicine (TCM) demonstrates unique advantages in the treatment of IBD. It reshapes the structure of the intestinal microbiota, regulates bile acids metabolism, and restores intestinal immune homeostasis. These mechanisms provide new targets for precise intervention in IBD and establish a theoretical foundation for integrated TCM-Western medicine treatment strategies that combine intestinal microecology and metabolic regulation. Based on this, this review systematically explains the core role of the intestinal microbiota-bile acids axis in the pathogenesis of IBD and summarizes the research progress of TCM in multi-dimensional intervention targeting this axis, aiming to open new avenues for the prevention and treatment of IBD.

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深圳市“医疗卫生三名工程”项目(SZZYSM202106004); 深圳市宝安区科技创新局面上项目(2023JD255,2023JD264); 深圳市中医药学会立项科研项目(2024128F,2024129F); 深圳市宝安区中医药临床专项立项项目(2023ZYYLCZX-34); 深圳市科技创新局基础研究面上项目(JCYJ20250604184258076)