Theoretical Basis and Mechanisms of Traditional Chinese Medicine for the Prevention and Treatment of Chronic Endometritis: An Immune Microenvironment Perspective

Abstract

Chronic endometritis (CE) is an insidious inflammatory disorder characterized by focal plasma-cell infiltration of the endometrium and is closely associated with adverse reproductive outcomes, including infertility, recurrent implantation failure, and recurrent pregnancy loss. From the perspective of the immune microenvironment, this review systematically examines the pathogenesis of CE and the theoretical basis and potential pathways of traditional Chinese medicine (TCM) intervention. It first describes the composition and homeostatic features of the normal endometrial immune microenvironment and then analyzes persistent inflammation and impaired tissue repair in CE arising from pathogen recognition, plasma-cell infiltration, dysregulation of immune-cell subsets, disruption of cytokine networks, and aberrant activation of the TLR4/NF-κB/NLRP3 signaling pathway. In TCM theory, CE may be classified under such categories as leukorrheal disease, abdominal pain in women, and infertility. Its core pathogenesis involves the dynamic evolution of dampness, heat, blood stasis, and deficiency: damp-heat pathogenic factors initially invade the uterus; prolonged disease leads to qi stagnation and blood stasis; and chronicity eventually results in spleen and kidney deficiency, producing a pattern of root deficiency with branch excess and a complex mixture of deficiency and excess. Treatment should therefore follow a stage-based approach: clearing heat and draining dampness when damp-heat predominates, invigorating blood and unblocking the collaterals when stasis is prominent, warming the channels and dispelling cold when cold-dampness congeals, and supplementing qi, strengthening the spleen, and tonifying the kidney when spleen-kidney deficiency is present. TCM may exert therapeutic effects by modulating inflammatory-mediator release, improving local microcirculation, promoting endometrial repair, and restoring immune homeostasis. However, current evidence is derived mainly from symptom scores, serum biomarkers, and animal experiments, and high-quality clinical validation of local immune phenotypes in CE tissue remains lacking. This review emphasizes that TCM syndromes should not be assigned simple, fixed correspondences with specific immune pathways; such associations should be treated as research hypotheses rather than established conclusions. Integrated Chinese and Western medicine should be based on standardized diagnosis and anti-infective therapy, with TCM serving as a component of syndrome-differentiated intervention and recovery management. Validation through standardized syndrome assessment, local tissue testing, and prospective studies is needed to advance more targeted integrated diagnostic and therapeutic strategies for CE.