Traditional Chinese Medicine in Hyperuricemia: Current Advances, Mechanistic Insights, and Clinical Challenges

The global prevalence of hyperuricemia is steadily increasing. This narrative review systematically summarizes the epidemiological characteristics, pathophysiological mechanisms and mainstream diagnostic approaches of hyperuricemia, with a focus on the theoretical basis, pharmacological mechanisms and clinical applications of Traditional Chinese Medicine (TCM) for its intervention. Accumulated studies have demonstrated that TCM can regulate serum uric acid (SUA) levels via multiple pathways, including inhibiting key enzymes involved in uric acid synthesis such as xanthine oxidase, modulating urate transporters, relieving inflammatory responses and regulating gut microbiota. Classic herbal formulas including Simiao San and Fangji Huangqi Tang can effectively reduce SUA levels and alleviate comorbidities associated with hyperuricemia. As a narrative review, this paper objectively analyzes the existing limitations in relevant research, such as inadequate sample sizes, potential bias, over-reliance on animal experiments and insufficient safety evaluations. It also discusses the advantages, disadvantages and controversies concerning combined TCM therapies. Furthermore, future research directions are proposed, covering clinical evidence grading, standardization of herbal preparations, precision diagnosis and treatment, as well as new drug development. This review aims to provide evidence-based references and innovative ideas for the comprehensive prevention and management of hyperuricemia.