From "Monarch, Minister, Assistant, and Envoy" to "Microbial Dialogue": A Review of Novel Mechanisms by Which Chinese Herb Pairs Improve Metabolic Diseases Through Gut Microbiota Metabolic Regulation.

Metabolic diseases, including obesity, Type 2 diabetes, and nonalcoholic fatty liver disease, have become a severe global health burden, and their pathogenesis is closely associated with gut microbiota dysbiosis. As the core unit of traditional Chinese medicine (TCM) compatibility theory, Chinese herb pairs possess unique advantages in metabolic regulation due to their multicomponent and multitarget characteristics. Recent studies have confirmed that herb pairs can improve host metabolic homeostasis by reshaping gut microbial community structure, regulating microbial metabolites (e.g., short-chain fatty acids, bile acids, and tryptophan metabolites), and repairing intestinal barrier function. This review systematically summarizes the latest research progress regarding the intervention of Chinese herb pairs in metabolic diseases by modulating the gut microbiota metabolic network, provides an in-depth analysis of their action mechanisms based on the "microbiota-gut-organ axis," and discusses the current research challenges and future translational directions.