Abstract:

Patients with polycystic ovary syndrome (PCOS) exhibit significant dysbiosis of the gut microbiome. At the bacterial level, the α-diversity is reduced, with the decreased abundance of beneficial genera such as Bifidobacterium and Akkermansia, and the increased enrichment of opportunistic pathogens including Bacteroides and Escherichia coli. At the fungal level, there is a reduction in abundance of Saccharomyces and an increase in abundance of Candida. Gut microbiota participate in the pathogenesis of PCOS through multiple pathways: the reduction of short-chain fatty acids (SCFA); bile acid metabolism disorders leading to impaired FXR/TGR5 signaling; the elevated branched-chain amino acids (BCAAs) activating mTORC1; the increased intestinal permeability allowing lipopolysaccharide (LPS) translocation into the circulation and triggering chronic low-grade inflammation; and the gut-brain axis dysregulation resulting in aberrant hormone secretion. Traditional Chinese Medicine (TCM) has demonstrated significant efficacy in improving PCOS symptoms through the regulation of gut microbiota. Formulations such as Guizhi Fuling Pill and Bushen Huazhuo Formula can modulate microbial community structure and ameliorate insulin resistance; Yulin Tongbu Formula and Wangshi Yijing Decoction can correct hormonal metabolic disturbances; and Shaoyao Gancao Decoction, Bailing Capsule, and Guishen Pill Jiawei can suppress inflammatory responses and restore intestinal barrier integrity. Future studies should continue to explore the specific mechanisms underlying the influence of gut microbiota on PCOS, systematically dissect the potential of TCM in targeting gut microbiota for PCOS therapy, and thus provide more robust scientific evidence for the prevention and treatment of PCOS.

Key words: Gastrointestinal microbiome, Polycystic ovary syndrome, Brain-gut axis, Traditional Chinese drugs, Therapy