Underlying mechanisms of Traditional Chinese Medicine in treating metabolic dysfunction-associated steatohepatitis: evidences from preclinical and clinical studies

Abstract

Ethnopharmacological relevance: Traditional Chinese Medicine (TCM) has been employed for thousands of years as an effective treatment for liver diseases. In recent years, it has gained widespread use in the management of metabolic dysfunction-associated steatohepatitis (MASH).

Aim of the study: This article reviews the application of TCM in treating MASH, examining its pathogenesis, current treatment strategies, and preclinical (in vitro and in vivo) and clinical studies of TCM on MASH, with the aim to provide TCM-based solutions for MASH treatment.

Materials and methods: Literature on preclinical TCM studies for MASH, published between 2021 and 2025, was primarily sourced from databases such as PubMed, Google Scholar, Web of Science, and ScienceDirect®. Clinical studies on TCM-based improvements in MASH, conducted between 2019 and 2024, were systematically searched in databases including PubMed, Cochrane Library, Web of Science, CNKI, and WanFang.

Results: 77 preclinical studies indicated that TCM could alleviate MASH by mitigating inflammation, correcting metabolic disorders, ameliorating oxidative stress, apoptosis, and fibrosis, as well as regulating intestinal flora. Moreover, 32 clinical studies demonstrated that integrated TCM and Western medicine approaches were more effective in improving the overall course of MASH, liver function, blood lipid levels, and TCM syndrome scores compared to Western medicine alone.

Conclusion: TCM can improve MASH through multiple targets and pathways, and has shown significant advantages in clinical studies. These findings suggest a promising future for TCM in treating MASH.

Keywords: Clinical study; Inflammation; Intestinal flora; Metabolic disorders; Metabolic dysfunction-associated steatohepatitis; Preclinical study; Traditional Chinese medicine.