Traditional Chinese medicine interventions and mitochondrial communication in myocardial and cerebral ischemia: a critical review

Myocardial infarction and ischemic stroke share mitochondrial disturbances, but evidence that traditional Chinese medicine (TCM) interventions regulate mitochondrial communication rather than general mitochondrial injury remains uncertain. This critical review evaluates that distinction. A structured search of PubMed, Lens Scholarly Search, and CNKI from inception to 28 August 2026 identified 1,663 records; 29 reports (24 preclinical/mechanistic and 5 clinical or systematic-review reports) informed the focused evidence map. We organized the evidence across four levels: intramitochondrial coordination, communication among mitochondria, contacts between mitochondria and other organelles, and intercellular mitochondrial signaling. Selected formulations, botanical drugs, and plant metabolites were associated most consistently with calcium–redox balance, bioenergetics, mitochondrial dynamics, mitophagy, and immune-metabolic responses. However, most studies measured static proteins or downstream injury markers, used preventive dosing or poorly defined exposure, and did not test direct target engagement. Evidence for altered organelle contacts or transfer of intact mitochondria was sparse. Clinical studies of selected standardized commercial Chinese polyherbal preparations reported possible functional benefits, but product heterogeneity, trial limitations, and the absence of mitochondrial pharmacodynamic biomarkers preclude mechanistic attribution. We therefore distinguish communication-specific evidence from pathway association and appraise product identity, exposure plausibility, causal validation, methodological quality, and clinical relevance. Future studies should use taxonomically authenticated and chemically characterized preparations, clinically achievable dosing, dynamic communication-specific assays, causal perturbation, and prospectively defined mitochondrial biomarkers. Current evidence supports mitochondrial communication as a useful hypothesis-generating framework, but not yet as an established clinical mechanism of TCM in myocardial or cerebral ischemia.