Abstract: Sepsis, characterized by high morbidity and mortality rates in the intensive care unit, poses a serious threat to human health. The gut plays a pivotal role in the development and progression of sepsis. Intestinal flora maintains the integrity of intestinal function through multiple mechanisms, and its imbalance can lead to intestinal dysfunction, thereby exacerbating sepsis. Recent studies have shown that traditional Chinese medicine (TCM) therapies exhibit unique advantages and significant efficacy in intervening in sepsis via regulation of intestinal flora. This paper reviews relevant domestic and international research literature, analyzes the pathological mechanisms linking intestinal flora and sepsis, and systematically summarizes the research outcomes of internal and external TCM treatments in intervening sepsis via regulation of intestinal flora. It aims to provide a theoretical basis and practical guidance for investigating pathological mechanisms and optimizing clinical management in critical conditions such as sepsis.