Energy metabolism disorders are a critical factor contributing to cognitive dysfunction. Astrocytes,as key suppliers of energy substrates to neurons, help to sustain normal cognitive function via their extensive energy metabolism activities in the brain, coordinated by various energy supply mechanisms. Imbalances in astrocyte-neuron energy metabolism coupling lead to abnormal neuronal activity, thereby driving the pathogenesis and progression of Alzheimer’s disease (AD). It is therefore essential to investigate the pathological mechanisms and therapeutic targets associated with AD from the perspective of energy metabolism to support the future development of AD treatments and interventions. Traditional Chinese medicine (TCM), characterized by multi-component and multi-target effects, has shown potential efficacy for regulating cerebral energy metabolism, suggesting that modulating brain energy metabolism may represent a significant pathway by which TCM might ameliorate AD. This review systematically elucidates the mechanistic role of the dysregulation of astrocyte-neuron bioenergetic coupling in the pathogenesis and progression of AD, and critically evaluates recent advancements in therapeutic interventions mediated by TCM.