Abstract: Objective To review the latest research findings on the regulation of the nuclear factor-kappa B (NF-κB) signaling pathway by traditional Chinese medicine (TCM) monomers and compound formulas in the treatment of sepsis induced acute lung injury (SALI), and to provide a reference for the prevention and treatment of SALI with TCM. Methods Literature on NF-κB, SALI, and the regulatory mechanisms of TCM that was published in 2015-2025 was retrieved from CNKI and PubMed databases. Such indicators as pathological damage to lung tissue, the wet-to-dry ratio, and inflammatory factors were observed before the data was analyzed. Results As a key inflammatory regulatory pathway, NF-κB was closely associated with the onset and progression of SALI when aberrantly activated. TCM monomers (such as baicalin and astragaloside Ⅳ) and compound formulas (such as Qingwen Baidu decoction) could reduce the release of pro-inflammatory cytokines, alleviate oxidative stress, regulate apoptosis and autophagy, and ameliorate SALI by regulating the NF-κB signaling pathway. However, current research was still facing such challenges as the lack of investigations into the mechanisms, large gaps between animal models and clinical applications, limited applicability of multi-omics technologies, and inadequate clinical translation. Conclusion TCM monomers and compound formulas have protective effects against SALI by regulating the NF-κB signaling pathway. However, more efforts should be devoted to studies on cross-talk between multiple pathways, optimization of modeling, promotion of multi-omics integration, and standardization of clinical research design in order to accelerate bidirectional bench-to-bedside translation of TCM in the treatment of SALI.

Key words: Sepsis-Induced Acute Lung Injury, NF-κB, Baicalin, Astragaloside Ⅳ, Qingwen Baidu Decoction