Pathological mechanisms of inflammatory responses in atherosclerosis and the multi-target regulatory effects of traditional Chinese medicine.

Atherosclerosis (AS) is a vascular disease characterized by chronic inflammation and represents a major pathological basis for cardiovascular events such as myocardial infarction and ischemic stroke. During disease initiation and progression, endothelial dysfunction, lipid retention, sustained recruitment of immune cells, and aberrant activation of inflammatory signaling pathways interact to establish a self-perpetuating inflammatory microenvironment. This process is accompanied by dysregulation of inflammatory cytokine networks, persistent activation of key signaling pathways such as nuclear factor-κB (NF-κB) and mitogen-activated protein kinase (MAPK), increased oxidative stress, and enhanced thrombotic susceptibility, ultimately driving plaque formation, destabilization, and acute cardiovascular events. Given that these pathological mechanisms involve multiple cell types, interconnected signaling axes, and dynamic changes across different disease stages, single-target therapeutic strategies often show limited efficacy in long-term disease control. Traditional Chinese medicine (TCM), characterized by its multi-component, multi-target, and system-level regulatory properties, has attracted increasing attention for its potential to modulate inflammation-related pathological processes in atherosclerosis at multiple levels. Accumulating evidence indicates that TCM and its bioactive constituents can regulate inflammatory cytokine expression, inhibit NF-κB- and MAPK-mediated inflammatory signaling, alleviate oxidative stress, improve endothelial function, and reduce thrombotic susceptibility, thereby collectively attenuating chronic inflammatory burden and promoting plaque stability. This review focuses on inflammation-associated key pathological processes in atherosclerosis and systematically summarizes recent advances in the regulatory effects of TCM on inflammatory responses, signaling pathways, oxidative stress, and thrombosis. The aim is to provide mechanistic insights that may support integrated strategies for atherosclerosis prevention and treatment, as well as the modernization of TCM research.