肌萎缩侧索硬化（amyotrophic lateral sclerosis，ALS）是一种致命的神经退行性疾病，其发病机制复杂且尚未完全阐明。近年来，肠-脑轴（gut-brain axis，GBA）失调被认为在ALS的发病和进展中扮演重要角色。肠道微生物群及其代谢产物、肠道屏障功能、免疫系统激活和神经炎症等，均可通过GBA与中枢神经系统进行双向通信，进而影响ALS的疾病进展。同时，多种中药活性成分在调控GBA功能、改善肠道微环境及减轻神经炎症方面展现出显著潜力。例如，小檗碱可通过激活自噬过程以清除TAR DNA结合蛋白（TAR DNA-binding protein 43，TDP-43）聚集；人参皂苷及其非皂苷成分Gintonin可通过抑制TLR4/LPA1信号通路调节神经炎症反应；川芎嗪衍生物——四甲基吡嗪硝酮（tetramethylpyrazine nitrone，TMPN）可增强PGC1-α（peroxisome proliferator-activated receptor gamma coactivator 1-α）介导的线粒体抗氧化功能；7，8-二羟基黄酮（7，8-dihydroxyflavone，7，8-DHF）前药R13可通过激活TrkB-AMPK信号通路改善神经元能量代谢。本文系统综述了GBA在ALS发病与发展过程中的作用机制，并重点探讨了中药通过调节GBA功能干预ALS的潜在机制和研究进展，以期为该疾病的治疗提供新的策略与思路。

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease, and its pathogenesis is complex and has not been fully elucidated. In recent years, the dysregulation of the gut-brain axis (GBA) is considered to play an important role in the pathogenesis and progression of ALS. Intestinal microbiota and their metabolites, intestinal barrier function, immune system activation, and neuroinflammation communicate bidirectionally with the central nervous system through GBA, thereby influencing the pathological process of ALS. Meanwhile, various active components of Chinese herbal medicine have shown significant potential in regulating GBA function, improving gut microenvironment, and alleviate neuroinflammation. For instance, berberine can activate autophagy to clear TAR DNA-binding protein 43 (TDP-43) aggregates; ginsenoside and its non-saponin component Gintonin can inhibit the TLR4-LPA1 signaling pathway to regulate neuroinflammatory responses; ligustrazine derivative tetramethylpyrazine nitrone (TMPN) can enhance the mitochondrial antioxidant function mediated by PGC1-α (peroxisome proliferator-activated receptor gamma coactivator 1-α); the 7,8-dihydroxyflavone (7,8-DHF) prodrug R13 can activate the TrkB-AMPK pathway to improve neuronal energy metabolism. This paper systematically reviews the mechanism of GBA in the pathogenesis and development of ALS, and focuses on discussing the potential mechanisms and research progress on Chinese herbal medicine interventions for ALS through the modulation of GBA function, aiming to provide new strategies and insights for ALS treatment.