Mitochondrial autophagy is an important mechanism for maintaining cellular homeostasis, closely related to the occurrence and development of cerebral ischemic injury, and is an important way of neuronal death. In recent years, a large number of experimental studies have confirmed that traditional Chinese medicine has a significant effect on treating cerebral ischemic injury. Its advantages of multi-target, multi pathway, low toxicity and high efficiency have become an important component of the treatment of cerebral ischemic injury. Traditional Chinese medicine formulas and monomeric active ingredients such as Xiaoxuming Tang, Zishen Huoxue Formula, flavonoids, alkaloids, etc. can regulate mitochondrial autophagy related signaling pathways and targets, inhibit neuronal autophagic death, alleviate pathological damage to brain tissue, and exert neuroprotective effects. This article analyzes the molecular mechanism of traditional Chinese medicine regulating mitochondrial autophagy in the treatment of cerebral ischemic injury from four aspects: an overview of mitochondrial autophagy, related signaling pathways, its relationship with cerebral ischemic injury, and the regulatory effects of traditional Chinese medicine. The aim is to provide ideas and references for future basic research and clinical treatment.