From chemical composition to clinical application: the value of bile-based traditional Chinese medicines in the treatment of liver diseases.

Bile-based traditional Chinese medicines comprise a special category of medicinal materials that have distinct value in the treatment of liver diseases. Bile acids are the primary active components of bile-based TCMs. These components exert significant therapeutic effects by targeting key signaling pathways related to disease progression through bile acid receptors such as FXR and TGR5. Herein, we comprehensively review the chemical composition, pharmacological effects, and clinical applications of bile-based TCMs with a particular focus on their potential and recent research progress in the treatment of liver diseases. The bile acid components of bile-based TCMs have dual "Yin and Yang" effects in the treatment of liver diseases. They show therapeutic actions such as anti-inflammation, hepatoprotection and anti-fibrosis, and they may also promote disease through certain constituents like TCA and GCA. This dual nature creates a complex balance between benefit and risk. It highlights the mechanistic complexity of bile-based TCMs in treating liver diseases and presents new challenges for their precise clinical application. Future research needs to thoroughly analyze the composition and efficacy of bile-based TCMs, clarify their mechanisms of action and pharmacological effects, and explore component modification and combination therapies. This will provide a scientific basis and innovative ideas for precise application of bile-based TCMs and development of new, more effective and safer treatment options for patients with liver diseases.