Xin Xiong, Yingqi Xiong, Songjiang Liu
Gastric cancer remains one of the most common malignant tumors worldwide and is associated with a high disease burden. Its treatment is still challenged by multidrug resistance, an immunosuppressive tumor microenvironment, and suboptimal postoperative recovery. Traditional Chinese Medicine (TCM) has shown potential in the prevention, treatment, and rehabilitation of gastric cancer. Herein, this review aims to discuss the basic theory, clinical practice, technical progress, epidemiological research, controversies and challenges, and future prospects of TCM in gastric cancer treatment. Literature from the past five years was retrieved from PubMed and China National Knowledge Infrastructure (CNKI) using English and Chinese search terms related to gastric cancer, TCM, Chinese herbal medicine, integrated traditional Chinese and Western medicine, clinical outcomes, mechanisms, network pharmacology, metabolomics, immunotherapy, chemotherapy resistance, postoperative recovery, and translational research. Experimental studies, clinical studies, cohort studies, randomized trials, meta-analyses, guideline-related studies, and technical studies were considered only if they were relevant to the scope of this narrative review. Based on these, we discuss how TCM may exert potential anti-gastric cancer effects through the regulation of apoptotic pathways, modulation of signaling networks, and improvement of immune function. Currently, clinical studies indicate that TCM combined with chemotherapy may prolong survival in patients with advanced gastric cancer, while perioperative interventions such as transcutaneous electrical acupoint stimulation and herbal formulations may alleviate postoperative pain, promote gastrointestinal recovery, and regulate inflammatory responses. Technological advances such as network pharmacology, metabolomics, and nano-preparation technologies have been used to help clarify the molecular mechanisms of TCM and improve drug delivery efficiency. In addition, observational and real-world evidence suggest that TCM use is associated with survival-related outcomes, patient acceptance, and regional differences in clinical application patterns. Despite these findings, challenges remain, including insufficient high-quality clinical evidence, lack of standardization in syndrome differentiation and efficacy evaluation, and the need for more rigorous safety assessment. Overall, TCM may serve as a complementary component of integrated gastric cancer management, particularly in supportive care, postoperative recovery, and treatment tolerance, but its clinical value remains dependent on the quality of supporting evidence. Future studies should use standardized protocols, rigorous clinical designs, reproducible quality-control systems, and appropriate safety assessment to define its role within modern precision oncology.