Abstract: The human gut is inhabited by a large number and variety of microorganisms, which constitute the intestinal microecosystem with the intestinal environment where they reside. After oral administration, Chinese medicine undergoes metabolism by these intestinal microorganisms within the gastrointestinal tract. The resulting metabolites are absorbed into the bloodstream to produce pharmacological effects. This paper provides a comprehensive review of the characteristics and influencing factors related to the mediation of Traditional Chinese Medicine (TCM) metabolism by intestinal flora. Additionally, recent progress in the microbial-mediated metabolism of TCM components such as flavonoids, saponins, iridoids, and lignans is summarized. This serves as a foundation for understanding the connection between intestinal bacteria and the chemical structural alterations of TCM components. It also offers insight into the regulations and mechanisms governing the intestinal bacterial metabolism of TCM constituents.