<p>Diabetic microvascular complications are the most common and serious late-stage problems with diabetes patient, while existing antidiabetic treatments still have limited effects in preventing or reversing microvascular damage. Traditional Chinese Medicine (TCM) has been applied in clinical practice for centuries, showing excellent therapeutic effects in alleviating diabetic microvascular complications. Recently, the regulatory effects of gut microbiota, especially concepts such as the “gut-retina axis” and “gut-kidney axis” have been proposed and supported by accumulating experiment, which shows the importance of gut microbiota in microvascular injury. This review focuses on how TCM-gut microbiota interactions contribute to the prevention and treatment of diabetic microvascular complications, reviewing and organizing the latest evidence from experimental and clinical research. We further summarize current limitations in the field and discuss future direction to better uncover the mechanisms of TCM-microbiota interactions.</p>