Abstract: Background: Pathological cardiac hypertrophy is currently regarded as a disorder mainly resulting from mitochondrial abnormalities such as the interconnected disturbances in oxidative stress, calcium balance, mitophagy and mitochondrial gene regulation. These disturbances form a positive feedback loop which leads to the progression of the disease. The conventional treatments mostly focus on one pathway while Traditional Chinese Medicine (TCM) shows broader therapeutic effects. Purpose: The aim of this study is to explore the mechanisms of mitochondrial dysfunction in cardiac hypertrophy and to make a comprehensive evaluation of the TCM interventions targeting mitochondrial regulation. Methods: A thorough literature review and synthesis will be performed. Results: It has been shown that mitochondrial dysfunction happens through interconnected systems including oxidative stress, calcium imbalances, defective mitophagy and mitochondrial transfer, as well as various genetic alterations in mitochondria. Some TCM drugs and formulations may influence multiple aspects of these systems, which might help maintain the normal homeostasis of mitochondria and reduce the hypertrophic changes. Conclusion: TCM offers a promising, integrated method to treat pathological cardiac hypertrophy by focusing on the interconnected mitochondrial dysfunction system. Progress in standardizing the formulations, confirming the mechanisms and targeted delivery to mitochondria will facilitate its use in clinical practice.