Research Progress on Traditional Chinese Medicine in Regulating Inflammatory Pathways of the Gut–Kidney Axis in Diabetic Kidney Disease

Diabetic kidney disease (DKD) is a major microvascular complication of diabetes, and recent evidence highlights the gut-kidney axis as a critical target in its prevention and treatment. Traditional Chinese Medicine (TCM) has demonstrated its unique advantages in regulating this axis through multi-target and multi-pathway mechanisms. This review summarizes research progress on TCM interventions that modulate the inflammatory pathways of the gut-kidney axis in DKD. Literature from recent years was collected from PubMed, Web of Science, and CNKI, with a particular focus on studies investigating the roles of TCM monomers and formulas in microbiota regulation, intestinal barrier protection, and inflammatory signaling. TCM compounds such as resveratrol, astragalus polysaccharides (APS), and ginsenosides, as well as classical formulas including Yi-Shen-Hua-Shi Granule, Tangshen Formula, and Huangkui Capsule (HKC), were found to restore gut microbial balance, increase short-chain fatty acid production, and inhibit key inflammatory pathways like NF-κB, NLRP3, JAK/STAT, and TGF-β1/Smad. These effects collectively alleviate oxidative stress, suppress renal inflammation and fibrosis, and improve metabolic and immune homeostasis. The findings suggest that TCM can effectively intervene in DKD progression by targeting gut-derived inflammation and immune dysregulation, and thereby provides a theoretical and experimental basis for integrative DKD therapy centered on gut-kidney axis modulation.