Atherosclerosis is a chronic inflammatory disease and a major global health concern. In recent years, traditional Chinese medicines (TCMs) have demonstrated multi-target therapeutic potential against atherosclerosis by modulating inflammatory responses, oxidative stress, lipid metabolism, and gut microbiota interactions. This review systematically evaluates (1) the anti-atherogenic mechanisms of key TCM herbs (e.g., Panax ginseng, Salvia miltiorrhiza ) and bioactive compounds (e.g., ginsenosides, tanshinones), (2) their synergistic effects in proprietary formulations, and (3) clinical evidence for cardiovascular protection. Notably, we highlight how TCM compounds like berberine and resveratrol target the gut-vascular axis by regulating microbiota-derived metabolites (e.g., TMAO) and improving endothelial function. While preclinical studies show promising results through Nrf2/HO-1 activation, NF-κB inhibition, and plaque stabilization, translational challenges persist, including the lack of standardization and microbiome-dependent efficacy variations. We conclude that integrating TCM's multi-component advantages with cutting-edge technologies such as bioinformatics, nanotechnology, and patient-specific multiomics including microbiome profiling could revolutionize atherosclerosis management, though rigorous clinical validation and standardization remain imperative
