PPerimenopausal depression （PMD） is a mental disorder that occurs in women before and after menopause. It has become a major public health problem posing a threat to the health of perimenopausal women due to its high incidence， low prevalence， low diagnostic rate， and recurrent episodes. The pathogenesis of PMD is complex and mainly involves the aging of the hypothalamic-pituitary-ovarian （HPO） axis， which leads to abnormal fluctuations in reproductive hormones， inflammation and cascade reactions， and oxidative stress. Currently， there are no specific pharmacological interventions for PMD. Traditional Chinese medicine （TCM）， as a treasure of motherland medicine， integrates thousands of years of TCM experience and wisdom and has the advantages of holistic regulation， low toxicity， and mild adverse reactions in the prevention and treatment of PMD. In recent years， more and more studies have been conducted on the active ingredients， extracts， and compound formulas of TCM for treating PMD via multi-components and multi-directions， achieving fruitful results. A large number of studies have shown that TCM treats PMD by reducing inflammation， inhibiting oxidation， and modulating monoamine neurotransmitter levels， which mainly involve NOD-like receptor thermal protein domain-associated protein 3 （NLRP3） inflammasome， nuclear factor E₂-related factor 2 （Nrf2）/hemeoxygenase-1 （HO-1）， brain-derived neurotrophic factor （BDNF）/tyrosine kinase receptor B （TrkB） and other signaling pathways. This article reviews the clinical and basic studies about TCM treatment of PMD to analyzes the pathogenesis of PMD and the therapeutic targets of TCM， aiming to provide basic theoretical support and new approaches for the TCM treatment of PMD.