Unlocking the therapeutic potential of traditional Chinese medicine in Crohn’s disease: from multi-target mechanisms to clinical promise

Abstract

Crohn’s disease (CD) is a chronic, relapsing inflammatory disorder of the gastrointestinal tract with an unclear etiology. Current Western therapies, including 5-aminosalicylates, corticosteroids, biologics, and immunomodulators, often fail to maintain sustained remission and are associated with significant adverse effects and high recurrence rates following drug withdrawal. Traditional Chinese medicine (TCM) has shown potential in alleviating CD symptoms through multi-target and multi-pathway mechanisms. Thus, this review aims to systematically summarize recent advances in understanding the mechanisms by which TCM intervenes in CD, focusing mainly on: regulating immune balance (including modulation of Th1/Th2, Th17/Treg, and M1/M2 macrophage polarization), attenuating inflammatory cascades (via NF-κB, MAPK, PI3K/AKT, and JAK/STAT pathways), reducing oxidative stress, regulating programmed cell death in intestinal epithelial cells (including apoptosis, pyroptosis, ferroptosis, and autophagic cell death), enhancing intestinal mucosal barrier integrity, and promoting restoration of intestinal microbial homeostasis. Furthermore, TCM combined with Western therapies may exert synergistic effects to improve clinical efficacy and reduce relapse risk. Future research could further integrate network pharmacology and multi-omics technologies to elucidate the molecular mechanisms of TCM more deeply, advancing precision therapeutics for CD.