Mechanistic perspectives on traditional Chinese medicine in ischemic heart disease: Focus on M2 macrophage polarization

Ischemic heart disease (IHD) poses a substantial global burden. Immune responses are pivotal in IHD progression, while the limited efficacy of conventional anti-inflammatory drugs highlights the need for dynamic modulation of the cardiac immune microenvironment. As key orchestrators, M2 macrophages determine inflammation resolution and tissue repair through efferocytosis, fibrosis modulation, and metabolic reprogramming, thereby influencing ventricular remodeling and heart failure outcomes. This review delineates the dynamic transition of cardiac macrophages from homeostasis to ischemic injury, with a focused mechanistic examination of M2 polarization and function. The effects and mechanisms of traditional Chinese medicine (TCM) interventions on M2 macrophages in treating IHD are primarily centered on anti-inflammatory effects, fibrosis regulation, and metabolic reprogramming. Notably, some TCMs exhibit temporal, biphasic regulatory properties, potentially enabling balance across distinct disease stages. Future studies should deepen mechanistic insights into efferocytosis, establish dose-response relationships and safety thresholds for TCM interventions, and validate findings through high-quality clinical research.