Acute lung injury(ALI) is an inflammatory disease that can be triggered by various pathogenic factors both inside and outside the lungs. Its pathogenesis is complex, and clinical symptoms include hypoxemia, pulmonary infiltration, and pulmonary edema. With the deepening understanding of the overall treatment concept of diseases, the role of traditional Chinese medicine‘s multi-component, multi efficacy, multi target, and overall regulation in the prevention and treatment of ALI has gradually received widespread attention. This article systematically explains the mechanism by which traditional Chinese medicine affects ALI related signaling pathways by regulating gut microbiota and its metabolites. The results show that imbalance in the gut microenvironment can lead to an increase in inflammatory factors and affect NF-κB. The expression of key signaling pathways such as PI3K/AKT and NRF2/HO-1 is associated with the occurrence and development of ALI disease. The intervention of traditional Chinese medicine can significantly increase the abundance and diversity of gut microbiota, increase the proportion of Firmicutes/Bacteroidetes, improve the disturbance of ALI gut microbiota, affect signal transduction pathways, repair of lung epithelial cells, apoptosis, and autophagy factors, providing new research ideas for clinical prevention and treatment of ALI.