Summary: Functional dyspepsia represents a significant clinical challenge due to its high prevalence, chronic and persistent symptom pattern, and limited efficacy of available treatment options. The complexity of its pathophysiological mechanisms reduces the effectiveness of monotherapy justifying the need for a multimodal therapeutic approach. STW 5-II is among the best-studied multi-component herbal medicines used in the treatment of functional dyspepsia. It is a modified formulation with a simplified and milder composition, providing a more targeted effect on dyspeptic symptoms and bloating, as well as improved tolerability in patients with gastrointestinal hypersensitivity. Its mechanisms of action are multifactorial and involve modulation of key pathophysiological components of functional dyspepsia, including impaired gastric motility, visceral hypersensitivity, microinflammation, increased intestinal permeability, alterations in gut microbiota, and dysregulation of the gut-brain axis. The synergistic interaction of the herbal constituents enhances the overall therapeutic effect. Experimental and clinical data confirm its beneficial impact on the reduction of dyspeptic symptoms, such as postprandial fullness, early satiety, and epigastric pain, as well as improvement in gas tolerance. The efficacy of STW 5-II has been demonstrated in randomized clinical trials and meta-analyses. According to the current guidelines, within the Rome V criteria framework, this preparation may be considered a first-line treatment option for both subtypes of functional dyspepsia.