Multitarget mechanisms and clinical integration of traditional Chinese medicine in cardiac rehabilitation: a narrative review

Cardiovascular diseases (CVD) are a major global public health burden. Annually in the United States, over one million patients undergo arduous cardiac rehabilitation (CR) after experiencing cardiovascular events such as myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass grafting, cardiac valve surgery, and heart transplantation. Although CR can reduce mortality, it fails to fully address residual risks, including chronic inflammation, autonomic dysfunction, and psychological disorders. Meanwhile, low patient participation and completion rates remain a major clinical challenge. Traditional Chinese medicine (TCM) shows multi-target cardioprotective effects that can effectively complement CR. This review focuses on the theoretical compatibility, multi-target mechanisms, and clinical application of TCM integrated with CR. Clinically, TCM effectively compensates for the limitations of conventional CR. Traditional Chinese exercise (TCE) acts as an optimal bridging therapy to facilitate safe rehabilitation initiation in deconditioned populations prior to standard aerobic training. The application of Chinese herbal medicine (CHM) in complex metabolic and psychological comorbidities refractory to conventional pharmacotherapy yields prominent advantages in CR. During inpatient and early outpatient rehabilitation, acupuncture and acupoint stimulation modulate autonomic function, relieving postoperative angina and myocardial ischemia without increasing cardiac burden. Despite promising prospects, inconsistent syndrome classification standards and inadequate high-grade evidence remain obstacles to its global clinical adoption. This review therefore elaborates on the theoretical rationale and clinical evidence to promote the integration of TCM-CR as a novel holistic regimen for CVD rehabilitation.