Gastrointestinal tumors are a significant cause of cancer-related mortality，with incidence rates increasing each year.Tumor-associated macrophages(TAM) are crucial components of the tumor immune microenvironment，playing a dual regulatory role in tumor progression.Traditional Chinese medicine(TCM) is widely applied in the comprehensive treatment of gastrointestinal tumors，demonstrating notable efficacy and advantages.Recent studies have shown that various active compounds from Chinese medicine，such as vitexin，astragaloside IV，and triptolide，as well as Chinese medicine formulas like Shuyu Pills，Yiyi Fuzi Baijiang Powder，and Zhizhen Formula，can regulate macrophage polarization-related signaling pathways，upregulate the expression of inducible nitric oxide synthase(iNOS)，tumor necrosis factor-alpha(TNF-α)，and interleukin-12(IL-12)，downregulate IL-10，transforming growth factor-beta(TGF-β)，and arginase 1(Arg-1)，induce M1/M2 macrophage polarization，enhance the phagocytic and cytotoxic abilities of macrophages，inhibit tumor angiogenesis，suppress tumor cell proliferation and invasion，and improve the efficacy of chemotherapy，targeted therapy，and immunotherapy，thereby exerting anti-gastrointestinal tumor effects.By summarizing recent literature on TCM regulation of TAM in the treatment of gastrointestinal tumors，this review explored the role of TAM in the disease process and the molecular mechanisms through which TCM targeted TAM to combat tumors，aiming to expand the application of TCM in the comprehensive treatment of gastrointestinal tumors，enhancing the effectiveness of integrated Western medicine and TCM approaches，and promoting the modernization of TCM.