This review discussed the gut microbiota and its metabolic products，summarized changes in the gut microbiota of patients with coronary microcirculatory disorder(CMD)，and clarified how intestinal barrier damage and bacterial translocation induced inflammatory and immune responses that exacerbated CMD.Changes in the gut microbiota affect various metabolic pathways，including those involving trimethylamine N-oxide(TMAO)，short-chain fatty acids(SCFA)，and bile acids(BA)，contributing to CMD.The review highlighted the association between dysbiosis of the gut microbiota and CMD，the regulatory effects of traditional Chinese medicine(TCM) on gut microbiota，and treatment protocols based on gut microbiota.The results suggest that TCM may influence inflammatory and immune responses by targeting and modulating gut microbiota and its metabolic products，such as TMAO，SCFA，and BA.This action may improve atherosclerosis，stabilize vulnerable plaques，enhance microvascular endothelial dysfunction，and intervene in risk factors for CMD，ultimately improving CMD.Using the internal-external relationship between the heart and small intestine as a starting point，the review delved into the critical role of TCM in regulating gut microecology during the onset and progression of CMD，aiming to provide new insights and strategies for the combined treatment of CMD through both Western medicine and TCM.