Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is a complex chronic inflammatory disease. In recent years, the gut microbiota dysbiosis has been considered an important factor in the pathogenesis of IBD. Traditional Chinese medicine has gradually attracted attention due to its multi-component and multi-target properties, becoming a new strategy for regulating gut microbiota to treat IBD. Based on gut microbiota, this review discusses the pathogenesis of IBD and the intervention effects of traditional Chinese medicine. Firstly, we elaborate on the common pathogenic mechanisms of IBD, including immune system disorders, intestinal barrier disruption, and environmental genetic factors, and analyze the pathways through which gut microbiota participates in the development of IBD. Guided by gut microbiota, we summarize the mechanisms of traditional Chinese medicine against IBD. Specifically, traditional Chinese medicine can reshape gut microbiota composition, restore intestinal barrier function and regulate the levels of diverse metabolites, thereby modulating inflammatory signaling pathways and alleviating immune imbalance. This review aims to systematically elaborate the pathogenesis of IBD from the perspective of gut microbiota, emphasizing the unique advantages of traditional Chinese medicine as a special treatment strategy, such as multi-target intervention, synergistic enhancement, and overall regulation. It also summarizes the treatment of IBD by regulating gut microbiota with traditional Chinese medicine from a more comprehensive and objective perspective, and provides a novel insight for future research on IBD treatment.

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