Metabolic syndrome (MetS) is a complex metabolic disorder characterized by central obesity, hyperglycemia, dyslipidemia, and hypertension. At its core, MetS involves dysfunction of multi-organ metabolic networks, whereas current single-target pharmacological strategies are insufficient to address its complexity. Based on the emerging recognition of the gut microbiota as a central hub of metabolic regulation, this study systematically reviews the mechanisms of disrupted inter-organ communication in MetS mediated through the gut-liver axis, gut-brain axis, gut-adipose axis, and gut-cardiovascular axis. Phytochemicals derived from traditional Chinese medicine can exert multi-target interventions on key pathological processes, including insulin resistance and chronic inflammation, through four interconnected mechanisms: remodeling gut microbial composition, regulating microbial metabolites, restoring intestinal barrier integrity, and modulating host signaling pathways. By synthesizing evidence on representative traditional Chinese medicines, this study further distills a shared “multi-component-microbiome-multi-target” framework of action. This framework provides a scientific basis for the development of a novel theoretical paradigm for the systemic management of MetS and highlights potential directions for future practice. Looking ahead, the integration of multi-omics approaches and computational modeling is expected to facilitate the exploration of precision nutrition interventions and drug development based on this framework.

metabolic syndrome  /  gut microbiota  /  multi-organ crosstalk  /  phytochemicals  /  gut-organ axis