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Ischemic stroke is one of the most severe vascular diseases in the central nervous system, with its pathogenesis involving acute cerebrovascular occlusion leading to local cerebral ischemia and hypoxia, triggering complex pathophysiological cascading reactions. Mitochondrial dysfunction serves as the critical pathological foundation of disease progression, primarily manifesting as significantly enhanced oxidative stress, cellular metabolic disorders, abnormal apoptotic signal activation, amplified inflammatory cascades, and mitochondrial dynamic imbalance. The molecular mechanisms of mitochondrial injury involve multiple key signaling pathways: mitochondrial electron transport chain dysfunction generating substantial reactive oxygen species, calcium overload disrupting mitochondrial membrane potential, and mitochondrial dynamic imbalance leading to fragmentation-fusion disequilibrium. Studies have confirmed that from single herbal active ingredients to compound preparations and even acupuncture and moxibustion, traditional Chinese medicine(TCM) demonstrates multidimensional and multilevel synergistic neuroprotective effects. Focusing on the epidemiological trend of ischemic stroke with a rising incidence, this study delves into mitochondrial dysfunction, the core molecular pathological mechanism of disease occurrence and progression. By systematically elaborating on the multi-target and multi-mechanism intervention strategies of TCM in the neurological protection domain, this study reveals the complex molecular network of mitochondrial damage and highlights the unique therapeutic advantages of TCM in regulating mitochondrial membrane potential, inhibiting oxidative stress, optimizing energy metabolism, and reducing cellular apoptosis. It explores a novel molecular target system for treating ischemic stroke, offering a new theoretical foundation for integrative medicine research.