TCM formulas and acupuncture show potential for radiation enteropathy in limited evidence

Radiation enteropathy (RE) is a debilitating complication following radiotherapy, with currently limited treatment options. Multi-target intervention strategies such as Traditional Chinese Medicine (TCM) botanical formulas and acupuncture have been investigated as potential complementary approaches for its management. This review systematically synthesizes the evidence on TCM botanical formulas (e.g., Modified Baitouweng Decoction, Xihuang Pill, TJ-14) and acupuncture for the treatment of RE. Existing studies suggest multiple mechanisms of action, including anti-inflammatory and antioxidant effects, regulation of apoptosis and proliferation, restoration of intestinal barrier integrity, and modulation of gut microbiota. Clinical studies have reported improvements in symptoms and reductions in inflammatory markers, while preclinical models have demonstrated protective effects against radiation-induced intestinal injury. However, the current body of evidence is generally constrained by methodological limitations. Many clinical studies have small sample sizes and lack rigorous designs (e.g., absence of randomized controls), while mechanistic research often provides limited causal inference and relies on models with questionable clinical relevance, resulting in a significant translational gap. Based on this appraisal, we critically evaluate the limitations of existing research and propose future directions. These include: (i) employing CRISPR-based microbiome editing to investigate causal mechanisms; (ii) developing pharmacokinetic-pharmacodynamic (PK-PD) models for dose individualization; and (iii) utilizing innovative trial designs such as Bayesian adaptive trials to bridge the gap between empirical practice and evidence-based medicine. Rigorous further investigation is essential to define the role of these TCM interventions within the integrative treatment strategy for RE.