Abstract
Single herbal medicines (SHMs) possess distinct advantages in regulating lipid metabolism, particularly through modulating the composition and function of the gut microbiota. Compared with herbal formulas, SHMs are characterized by traceable active components, clear pharmacological targets, and greater reproducibility. However, their intrinsic cold/hot properties must not be overlooked, as inappropriate or prolonged use may disturb the body's holistic balance and pose health risks. Therefore, it is essential to systematically classify lipid-lowering SHMs according to their cold/hot properties and establish a "medicinal properties-microbiota" framework to guide personalized treatment strategies for hyperlipidemia. We searched PubMed, Web of Science, EMBASE, the Cochrane Library, the Chinese Biomedical Literature Database, and CNKI for studies published up to August 2025. Studies reporting lipid-lowering effects of SHMs through gut microbiota regulation were screened and analyzed. Fifty-seven SHMs were included, comprising 24 cold/cool-property, 20 warm/heat-property, and 13 neutral-property medicines. These SHMs improved lipid metabolism mainly by modulating the gut microbial composition and metabolites such as short-chain fatty acids (SCFAs), lipopolysaccharides (LPS), bile acids (BAs), and trimethylamine N-oxide (TMAO). Shared microbiota changes included a reduced Firmicutes/Bacteroidetes ratio and increased abundance of Akkermansia, Lactobacillus, Ruminococcaceae, and Clostridium. A new pattern has been identified: cold/cool-property SHMs mainly targeted environmentally adaptive microbial taxa, warm/heat-property SHMs enriched Akkermansia muciniphila and promoted SCFA production, whereas neutral-property SHMs exerted broad-spectrum regulation to maintain microbial homeostasis. In summary, SHMs regulate lipid metabolism through multiple microbiota-related pathways, and the effects are closely associated with their cold/hot properties. The classification of SHMs according to the four natures provides a theoretical basis for personalized treatment and may guide the safe and effective use of SHMs for the treatment of dyslipidemia.