Disorders in energy metabolism are a critical factor contributing to cognitive dysfunction. Astrocytes, as key suppliers of energy substrates to neurons, engage in extensive energy metabolism activities in the brain under the coordination of various energy supply mechanisms to sustain normal cognitive function. Imbalances in astrocyte-neuron energy metabolism coupling lead to abnormal neuronal activity, thereby driving the pathogenesis and progression of Alzheimer"s disease (AD). Investigating the pathological mechanisms and therapeutic targets associated with AD from the perspective of energy metabolism is essential for future disease treatment and intervention. Traditional Chinese medicine (TCM), characterized by its multi-component and multi-target effects, has shown potential in regulating cerebral energy metabolism, suggesting that modulating brain energy metabolism may represent a significant pathway for TCM in ameliorating AD. This review systematically elucidates the mechanistic role of astrocyte-neuron bioenergetic coupling dysregulation in the pathogenesis and progression of AD, and critically evaluates recent advancements in therapeutic interventions mediated by TCM.