Ischemic heart disease (IHD) is the cardiovascular disease with the highest morbidity and mortality worldwide. Mitochondrial dysfunction is its core pathological mechanism, and the dynamic balance between mitochondrial fusion and fission (mitochondrial dynamics) directly regulates energy metabolism and cell fate of cardiomyocytes during ischemia-hypoxia and reperfusion. With the advantages of multi-target and multi-pathway effects, active ingredients of traditional Chinese medicine can precisely regulate the expression and activity of key mitochondrial dynamics proteins such as dynamin-related protein 1, mitofusin 2, and optic atrophy 1, effectively maintain mitochondrial network homeostasis, alleviate myocardial ischemia-reperfusion injury, and exert significant cardioprotective effects. This paper systematically elaborates the regulatory mechanism of mitochondrial dynamics in the occurrence and development of IHD, focuses on reviewing the research progress of saponins, phenolic acids, alkaloids and other active ingredients of traditional Chinese medicine in preventing and treating IHD by regulating mitochondrial dynamics, and reveals novel mechanisms combined with cutting-edge technologies such as single-cell transcriptomics, while exploring the synergistic relationships among mitochondrial dynamics, mitophagy, and biogenesis. It aims to provide a solid theoretical basis and innovative research ideas for the treatment of IHD by targeting mitochondrial dynamics with traditional Chinese medicine.

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