Abstract Cholestasis can be seen in many acute and chronic liver diseases. If not intervened in time, persistent cholestasis can further progress to liver fibrosis, liver cirrhosis, liver failure, and even death. The pathogenesis of cholestasis is complex, and there is currently a lack of effective therapeutic drugs. Bile acids(BAs), the main component of bile, are synthesized from cholesterol in the liver as primary bile acids. After entering the intestine through the enterohepatic circulation, they are reshaped into secondary bile acids by gut microbiota. BAs can directly or indirectly affect the composition and function of gut microbiota, which in turn can regulate the synthesis and metabolism of BAs. The interaction between BAs and gut microbiota plays an important role in the pathogenesis and treatment of cholestasis. This review elucidates the bidirectional regulatory mechanisms between BAs and gut microbiota and their roles in the pathogenesis and treatment of cholestasis, aiming to provide insights and references for basic research and clinical practice related to cholestasis-associated diseases.

Metabolic-associated fatty liver disease （MAFLD） is a manifestation of multi-system metabolic dysfunction that affects the liver. Its disease spectrum not only includes fatty liver hepatitis， liver fibrosis， cirrhosis， liver malignancies， and other liver diseases but also includes extrahepatic diseases such as type 2 diabetes， atherosclerosis diseases， and chronic kidney disease. It is the most common chronic liver disease worldwide， with a complex pathogenesis and a lack of effective pharmacological treatments. With the improvement of people's living standards and the acceleration of the aging process， the incidence of MAFLD may continue to increase in the future， and its occurrence， development， prevention， and treatment have received widespread attention. Recent studies have shown that abnormal composition and proportion of gut microbiota can affect the changes in gut microbiota-derived metabolites. Metabolic disorders of bile acids and choline can further exacerbate gut microbiota imbalance， leading to a vicious cycle that destroys intestinal barrier function， increases intestinal permeability， and allows lipopolysaccharides， bacteria， viruses， and other substances to enter the liver through the ''gut-liver axis''. This process promotes liver inflammation and lipid deposition. Factors such as gut microbiota shift， regulation of host energy absorption， glucose and lipid metabolism， and inflammatory response interact to participate in the occurrence and development of MAFLD. Traditional Chinese medicine regulates the structure and function of gut microbiota through multiple targets， promoting the growth of beneficial bacteria， inhibiting the formation of harmful bacteria， restoring the balance of gut microbiota， improving intestinal mucosal barrier function， inhibiting liver inflammation and lipid degeneration， and influencing liver metabolism and immune response. This ultimately contributes to the prevention and treatment of MAFLD. This article systematically reviewed the mechanism of traditional Chinese medicine （TCM） treatment of MAFLD targeting gut microbiota through a literature search， aiming to provide ideas and references for TCM treatment of MAFLD.