Ischemic stroke is one of the most prevalent cerebrovascular diseases. The HIF-1α/ VEGF signaling pathway is as a crucial mediator of angiogenesis and has demonstrated bidirectional effects in ischemic stroke treatment through multifaceted mechanisms involving angiogenesis, neurogenesis, oxidative stress, the inflammatory response, and autophagy. Emerging evidence indicates that traditional Chinese medicine can exert 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. Here, we review the dual-phase regulatory mechanisms and functional characteristics of the HIF-1α/ VEGF signaling pathway in ischemic stroke pathogenesis and progression. Furthermore, we summarize recent advances in traditional Chinese medicine-based interventions that target this pathway to provide evidence-based theoretical support and clinical references that will help to