The forkhead box protein 3 (FoxP3)/regulatory T cell (Treg) axis is a key regulatory network that maintains peripheral immune tolerance and immune homeostasis, and its functional imbalance is closely associated with immune-related diseases, including autoimmune diseases, cancer, and allergic diseases. Traditional Chinese medicine (TCM), with its characteristics of multi-components, multi-targets, and multi-pathways, shows unique advantages in regulating the FoxP3/Treg axis. This article systematically reviews the multidimensional mechanisms by which TCM and its active components regulate FoxP3 expression and Treg cell differentiation, stability, and immunosuppressive functions. These mechanisms include direct regulation of key signaling pathways and cytokine networks, indirect influence on the gut microbiota-immune axis, and mediation of FoxP3 epigenetic modifications. It also summarizes the characteristics of bidirectional regulation, treating different diseases with the same method and treating the same disease with different methods observed in immune regulation. This provides important reference for the precise and modern application of TCM in treatment of immune-related diseases.

peripheral immune tolerance  /  FoxP3  /  regulatory T cells  /  traditional Chinese medicine  /  immune regulation