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Gut microbiota-mediated regulation of lipid metabolism by single herbal medicines: a review focused on cold/hot properties

Summary

This review examines how traditional Chinese herbal medicines can help regulate lipid metabolism and lower cholesterol by changing the composition of bacteria in our gut. Different herbs have different properties – some are considered cooling and others warming – and these properties affect which gut bacteria they increase or decrease. The review found that herbal medicines work best when matched to a person’s body constitution, and provides a framework for choosing the right herb based on whether someone has a heat-type or cold-type condition.

Background

Single herbal medicines (SHMs) possess distinct advantages in regulating lipid metabolism through modulation of gut microbiota composition and function. Compared to herbal formulas, SHMs are characterized by traceable active components, clear pharmacological targets, and greater reproducibility. However, their intrinsic cold/hot properties must be considered to avoid disturbing the body’s holistic balance.

Objective

To systematically classify lipid-lowering SHMs according to their cold/hot properties and establish a medicinal properties-microbiota framework to guide personalized treatment strategies for hyperlipidemia. The review aims to provide a comprehensive assessment of how SHMs regulate lipid metabolism through gut microbiota modulation.

Results

SHMs improved lipid metabolism mainly by modulating gut microbial composition and metabolites including short-chain fatty acids (SCFAs), lipopolysaccharides (LPS), bile acids (BAs), and trimethylamine N-oxide (TMAO). Cold/cool-property SHMs targeted environmentally adaptive microbial taxa, warm/heat-property SHMs enriched Akkermansia muciniphila and promoted SCFA production, while neutral-property SHMs exerted broad-spectrum regulation to maintain microbial homeostasis.

Conclusion

SHMs regulate lipid metabolism through multiple microbiota-related pathways with effects closely associated with their cold/hot properties. Classification of SHMs according to the four natures provides a theoretical basis for personalized treatment and may guide safe and effective use for dyslipidemia treatment.
  • Published in:Chinese Medicine,
  • Study Type:Review,
  • Source: PMID: 41530857, DOI: 10.1186/s13020-025-01301-z
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