Abstract： Overactive bladder（OAB）is a bladder dysfunction characterized by urgency as the core symptom， severely affecting the quality of life and physical and mental health of patients. Chinese medicine theory posits that the pathogenesis of OAB is rooted in spleen and kidney deficiency， with bladder qi transformation dysfunction as the manifestation. Modern research confirms that gut microbiota（GM）dysbiosis is a significant factor in the development of OAB，with its functional characteristics having multidimensional mappings to Chinese medicine theory. Explaining GM function through the "spleen-stomach-small intestine" system provides microbiological evidence for treating OAB from the perspective of the spleen. Chinese medicine， with the core therapeutic principles of fortifying the spleen and nourishing the kidney，can reshape GM homeostasis through active components of Chinese herbs，compound formulas， and external treatments such as acupuncture and moxibustion and tuina. This approach can inhibit bladder inflammation， improve detrusor muscle activity，and enhance bladder dynamics，with fewer adverse reactions and higher compliance. In terms of pathomechanism，spleen deficiency and GM dysbiosis bidirectionally regulate the OAB process through the microbiota-gut-bladder axis. Chinese medicine can target GM regulation and repair neural control.