Abstract: Traditional Chinese medicine (TCM) exerts unique therapeutic effects, while some unfavorable physicochemical properties limit its therapeutic potential. Exosomes are involved in cellular communication and may enhance the efficacy of TCM. The relationship between TCM and exosomes is supported by the connection between exosomes and the theory of “Qi, Xue and Ye” (one of the basic theories of TCM). Also, the functional resemblance between exosomes and Qi, which is less researched. We fill this gap by systematically summarizing exosomes from different sources with therapeutic effects and exploring the mechanisms and implications of exosomes in TCM treatment. TCM and exosomes undergo two-way communication, with TCM affecting exosomes and exosomes loading TCM monomers. The dual roles of exosomes as destructive agents in disease development are also emphasized; current obstacles and future scope of TCM–exosome therapeutic strategies are fully discussed. The objective of this review is to stimulate further investigation and create a new application of TCM.