Adhesive intestinal obstruction (AIO) represents a common postoperative complication, particularly following abdominal surgery, with reported incidence rates varying between 50 and 80%. Traditional Chinese Medicine (TCM) has proven clinically effective in managing AIO, offering diverse therapeutic approaches that facilitate multi-pathway and multi-target treatment. Clinical evidence consistently supports the favorable safety profile of Traditional Chinese Medicine (TCM). Nevertheless, several critical challenges remain to be addressed, including its complex multi-component nature, insufficiently elucidated mechanisms of action, lack of precise dosage standards, inconsistencies in decoction preparation methods, inconvenient administration procedures, and a paucity of large-scale, multicenter clinical trials with robust evidence. These barriers hinder the widespread adoption and clinical integration of TCM. Moving forward, large-scale, multicenter studies are essential to further investigate the safety and efficacy of TCM. Moreover, reforms in its administration methods and deeper exploration of its mechanisms in AIO treatment are crucial.