Organ fibrosis is an important pathological basis for the progression of many chronic diseases to the end stage. Its development is closely associated with chronic injury, inflammatory and immune responses, fibroblast activation, extracellular matrix (ECM) deposition, and tissue structural remodeling. Current antifibrotic therapies have limited efficacy, and advanced fibrosis remains difficult to reverse. Traditional Chinese medicine (TCM), characterized by multiple components and multiple targets, has been investigated as a potential approach for the prevention and treatment of organ fibrosis. This review summarizes recent progress in the use of TCM for organ fibrosis, including the pathological basis of fibrosis and TCM concepts of “root deficiency with branch excess” and “chronic illness entering the collaterals.” Particular attention is given to mechanisms involving transforming growth factor-β/Smad, nuclear factor-κB, and nuclear factor E2 related factor 2/heme oxygenase-1 signaling and to processes including inflammation, oxidative stress, ECM metabolism, cell phenotypic transition, autophagy, ferroptosis, cellular senescence, and metabolic reprogramming. The current research on representative TCM formulas, proprietary Chinese medicines, and active compounds for liver, pulmonary, renal, and myocardial fibrosis is also reviewed. Current studies on TCM antifibrosis still have limitations such as insufficiently clarified mechanisms of action, unclear pharmacodynamic material basis, and inadequate evidence of long-term efficacy and safety. Future studies should identify the major active components and molecular targets of TCM by integrating multi-omics, single-cell sequencing and other technologies, and evaluate long-term efficacy and safety in well-designed clinical trials, so as to provide evidence for the clinical application of TCM in the prevention and treatment of organ fibrosis.

traditional Chinese medicine  /  organ fibrosis  /  mechanisms of fibrosis  /  signaling pathways  /  multi-target regulation