# Exploring the basis of Traditional Chinese Medicine in treating cardiovascular disease: insights into the microbiota-gut-heart axis

**Authors:** Xinxin Hou, Xiaoqi Guan, Xiaoyun Qin, Hai-dong Guo

PMC · DOI: 10.1186/s13020-026-01336-w · 2026-02-03

## TL;DR

This paper explores how Traditional Chinese Medicine affects cardiovascular disease through interactions with the gut microbiome, offering new insights for personalized treatments.

## Contribution

The paper provides a novel perspective on the microbiota-gut-heart axis in TCM for cardiovascular disease.

## Key findings

- Gut microbiota influences the bioavailability and efficacy of TCM.
- TCM can alter gut microbial composition and function, impacting cardiovascular health.
- Microbial metabolites are closely linked to the onset and progression of CVD.

## Abstract

Despite being widely used to treat cardiovascular disease (CVD), there are still limitations of Traditional Chinese Medicine (TCM) for their widespread use due to undetermined pharmacological mechanisms. The emerging area of “pharmacomicrobiology” facilitates the pursuing of the complex interactions between TCM and gut microbiome as the gut microbiota influences TCM bioavailability and efficacy, vice versa TCM affects the microbial composition and function. Furthermore, research over the past decades has proved that gut dysbiosis and diverse microbial metabolites intimately related to the onset and progression of CVD. Herein, we summarize latest understanding of the TCM–gut–heart axis in CVD, with an emphasis on describing microbial changes and the associated mechanisms in CVD, elaborating the role of gut microbiota in metabolizing TCM, and how TCM can be used to treat CVD through affecting the gut microbiota. We further highlight the challenges and future directions that target TCM–gut–heart axis in prospects for personalized medicine in CVD, thus to present novel insights for developing new therapeutic approaches.

## Linked entities

- **Diseases:** cardiovascular disease (MONDO:0004995)

## Full-text entities

- **Genes:** Nr1i2 (nuclear receptor subfamily 1, group I, member 2) [NCBI Gene 18171] {aka PXR, PXR.1, PXR.2, PXR1, SXR, mPXR}, Nr1h4 (nuclear receptor subfamily 1, group H, member 4) [NCBI Gene 20186] {aka Fxr, HRR1, RIP14, Rxrip14}, Nqo1 (NAD(P)H dehydrogenase, quinone 1) [NCBI Gene 18104] {aka Dia4, Dtd, Nmo-1, Nmo1, Nmor1, Ox-1}, Abca1 (ATP-binding cassette, sub-family A member 1) [NCBI Gene 11303] {aka ABC-1, Abc1}, TJP1 (tight junction protein 1) [NCBI Gene 7082] {aka ZO-1}, AGER (advanced glycosylation end-product specific receptor) [NCBI Gene 177] {aka RAGE, SCARJ1, sRAGE}, ADRA2B (adrenoceptor alpha 2B) [NCBI Gene 151] {aka ADRA2L1, ADRA2RL1, ADRARL1, ALPHA2BAR, FAME2, alpha-2BAR}, TLR4 (toll like receptor 4) [NCBI Gene 7099] {aka ARMD10, CD284, TLR-4, TOLL}, Il6 (interleukin 6) [NCBI Gene 16193] {aka Il-6}, Nfe2l2 (nuclear factor, erythroid derived 2, like 2) [NCBI Gene 18024] {aka Nrf2}, Ldlr (low density lipoprotein receptor) [NCBI Gene 16835] {aka Hlb301}, AHR (aryl hydrocarbon receptor) [NCBI Gene 196] {aka FVH3, RP85, bHLHe76}, APOE (apolipoprotein E) [NCBI Gene 348] {aka AD2, APO-E, ApoE4, LDLCQ5, LPG}, Smad3 (SMAD family member 3) [NCBI Gene 17127] {aka Madh3}, Cutc (cutC copper transporter) [NCBI Gene 66388] {aka 2310039I18Rik, CGI-32}, IGKV2D-29 (immunoglobulin kappa variable 2D-29) [NCBI Gene 28882] {aka A2a, A2c, IGKV2D29}, Gpbar1 (G protein-coupled bile acid receptor 1) [NCBI Gene 227289] {aka BG37, GPCR, GPR131, M-BAR, TGR5}, CMKLR2 (chemerin chemokine-like receptor 2) [NCBI Gene 2825] {aka GPR1}, Ahr (aryl-hydrocarbon receptor) [NCBI Gene 11622] {aka Ah, Ahh, Ahre, In, bHLHe76}, Ffar2 (free fatty acid receptor 2) [NCBI Gene 233079] {aka GPCR43, Gpr43}, Hcar2 (hydroxycarboxylic acid receptor 2) [NCBI Gene 80885] {aka Gpr109a, Gpr109b, HM74, Niacr1, PUMA-G, Pumag}, Nlrp3 (NLR family, pyrin domain containing 3) [NCBI Gene 216799] {aka AGTAVPRL, AII/AVP, Cias1, FCAS, FCU, MWS}, TNF (tumor necrosis factor) [NCBI Gene 7124] {aka DIF, IMD127, TNF-alpha, TNFA, TNFSF2, TNLG1F}, Tnf (tumor necrosis factor) [NCBI Gene 21926] {aka DIF, TNF-a, TNF-alpha, TNFSF2, TNFalpha, Tnfa}, Tlr4 (toll-like receptor 4) [NCBI Gene 21898] {aka Lps, Ly87, Ran/M1, Rasl2-8}
- **Diseases:** -segment elevation (MESH:D000072657), obese (MESH:D009765), NASH (MESH:D005235), endotoxemia (MESH:D019446), cardiac hypertrophy (MESH:D006332), mitochondrial dysfunction (MESH:D028361), hyperlipidemia (MESH:D006949), cardiac and cerebrovascular (MESH:D002561), thrombosis (MESH:D013927), preeclampsia (MESH:D011225), colitis (MESH:D003092), qi-yin deficiency syndrome (MESH:D016710), TCM (MESH:C562377), systemic (MESH:D015619), hypertension (MESH:D006973), type 2 diabetes (MESH:D003924), SCFA (MESH:C536560), cancer (MESH:D009369), vascular dilation (MESH:D002311), cardiac fibrosis (MESH:D005355), cholestasis (MESH:D002779), BSH (MESH:D013651), toxicity (MESH:D064420), insulin resistance (MESH:D007333), gastrointestinal damage (MESH:D005767), metabolic syndrome (MESH:D024821), AF (MESH:D001281), diabetes (MESH:D003920), ASCVD (MESH:D050197), intestinal damage (MESH:D007410), heart failure (MESH:D006333), injury (MESH:D014947), overweight (MESH:D050177), CVD (MESH:D002318), ischemia (MESH:D007511), CDCA (MESH:D011015), Dysbiosis (MESH:D064806), Cardiotoxicity (MESH:D066126), IR (MESH:D015427), acute myocardial infarction (MESH:D009203), cardiomyocyte hypertrophy (MESH:D006984), endothelial dysfunction (MESH:D014652), dyslipidemia (MESH:D050171), renal dysfunction (MESH:D007674), cardiac alterations (MESH:D006338), fatty liver diseases (MESH:D005234), TMAO (MESH:C536108), vascular calcification (MESH:D061205), atherosclerotic inflammation (MESH:D007249), metabolic diseases (MESH:D008659), myocardial damage (MESH:D009202)
- **Chemicals:** choline (MESH:D002794), cardiac glycoside (MESH:D002301), fructooligosaccharide (MESH:C116580), phenylalanine (MESH:D010649), lipid (MESH:D008055), butyrate (MESH:D002087), isocaproic acid (MESH:C034527), glutamic acid (MESH:D018698), DCA (MESH:D003840), propionate (MESH:D011422), CDCA (MESH:D002635), glucose (MESH:D005947), tryptophan (MESH:D014364), polyphenol (MESH:D059808), dihydroberberine (MESH:C039639), ICA (MESH:C012381), SJPs (-), Ginsenosides (MESH:D036145), l-methionine (MESH:D008715), UDCA (MESH:D014580), indole (MESH:C030374), L-carnitine (MESH:D002331), PAGln (MESH:C003089), PAA (MESH:C025136), isoproterenol (MESH:D007545), TMAO (MESH:C005855), 3,3-dimethyl-1-butanol (MESH:C007469), SCFAs (MESH:D005232), fat (MESH:D005223), DOX (MESH:D004317), geraniin (MESH:C024603), Fuzi (MESH:C575009), sterol (MESH:D013261), K (MESH:D011188), aconitine (MESH:D000157), Aspirin (MESH:D001241), acetate (MESH:D000085), TDCA (MESH:C024158), anthraquinones (MESH:D000880), Quercetin (MESH:D011794), Indoles (MESH:D007211), phosphatidylcholine (MESH:D010713), Oxyberberine (MESH:C103789), Glycosides (MESH:D006027), STZ (MESH:D013311), carbohydrate (MESH:D002241), Ginsenosides Rg1 (MESH:C035054), emodin (MESH:D004642), cholesterol (MESH:D002784), Berberine (MESH:D001599), digoxin (MESH:D004077), BA (MESH:D001647), LCA (MESH:D008095), flavonoids (MESH:D005419), isopentanoic acid (MESH:C008216), isoflavones (MESH:D007529), LPS (MESH:D008070), water (MESH:D014867), Alkaloids (MESH:D000470), TMA (MESH:C023336)
- **Species:** Clostridium sporogenes (species) [taxon 1509], Panax ginseng (Asiatic ginseng, species) [taxon 4054], Proteus (genus) [taxon 210425], Aspergillus usamii (species) [taxon 186680], Bacteria Latreille et al. 1825 (Bacteria stick insect, genus) [taxon 629395], Digitalis lanata (Grecian foxglove, species) [taxon 49450], Fusarium verticillioides (species) [taxon 117187], Staphylococcus aureus (species) [taxon 1280], Companilactobacillus paralimentarius (species) [taxon 83526], Eubacterium sp. A-44 (species) [taxon 394229], Phascolarctobacterium (genus) [taxon 33024], Roseburia (genus) [taxon 841], Faecalibacterium (genus) [taxon 216851], Akkermansia (genus) [taxon 239934], Prevotella (genus) [taxon 838], Aspergillus niger (species) [taxon 5061], Escherichia coli (E. coli, species) [taxon 562], Fusarium sacchari (species) [taxon 42676], Anaerococcus hydrogenalis (species) [taxon 33029], Rattus norvegicus (brown rat, species) [taxon 10116], Allobaculum (genus) [taxon 174708], Mus musculus (house mouse, species) [taxon 10090], Ruminococcus (genus) [taxon 1263], Homo sapiens (human, species) [taxon 9606], Faecalibaculum rodentium (species) [taxon 1702221], Sarocladium strictum (species) [taxon 5046], Staphylococcus xylosus (species) [taxon 1288], Oscillibacter (genus) [taxon 459786], Ligilactobacillus murinus (species) [taxon 1622], gut metagenome (species) [taxon 749906], Cladosporium cladosporioides (species) [taxon 29917], Lactiplantibacillus plantarum (species) [taxon 1590]

## Figures

3 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12870936/full.md

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Source: https://tomesphere.com/paper/PMC12870936