Ischemic stroke represents one of the most prevalent major chronic cerebrovascular diseases. The HIF-1α/VEGF signaling pathway serves as a crucial mediator of angiogenesis and has demonstrated bidirectional regulatory characteristics in ischemic stroke treatment through multifaceted mechanisms involving angiogenesis modulation, neurogenesis, oxidative stress regulation, inflammatory response control, and autophagy modulation. Emerging evidence indicates that traditional Chinese medicine exerts therapeutic effects on ischemic stroke by targeting the HIF-1α/VEGF pathway, effectively ameliorating oxidative stress, inflammatory reactions, cellular autophagy, and apoptosis while promoting vascular regeneration in ischemic regions. This review systematically elucidates the dual-phase regulatory mechanisms and functional characteristics of the HIF-1α/VEGF signaling pathway in ischemic stroke pathogenesis and progression. Furthermore, it comprehensively summarizes recent advancements in TCM-based interventions targeting this pathway, aiming to provide evidence-based theoretical support and clinical references for optimizing therapeutic strategies against this debilitating neurological disorder