Osteoarthritis （OA） is also known as degenerative arthritis with prominent clinical manifestations of joint pain， joint swelling， and loss of mobility. With the aggravation of population aging in modern society， its incidence is increasing year by year worldwide， and it has become one of the main diseases that reduce the quality of life of middle-aged and elderly people and even lead to disability. Modern medical research on OA has shown that tumor necrosis factor-α （TNF-α） produced by activated macrophages and/or synoviocytes is the initiator of OA inflammatory response and can interact with multiple signal transduction pathways. It is considered to be one of the most important cytokines and inflammatory mediators that promote the degradation of cartilage matrix and the destruction of articular cartilage in the course of OA， and plays a key role in the course of OA. Under the guidance of the basic theories of traditional Chinese medicine （TCM）， Chinese medicine provides individualized treatment of OA following the principle of people-oriented， syndrome differentiation and treatment， and has the significant advantages of multiple targets， high efficacy， and low toxicity. In recent years， it has become a research hotspot to explore the specific mechanism of Chinese medicine and its active ingredients in the treatment of OA. This study described the role of TNF-α and its signal transduction pathways in the course of OA and reviewed the modern medical research advances in Chinese medicine acting on TNF-α and its signal transduction pathways in the treatment of OA， providing a certain reference basis for the clinical treatment of OA， basic research， and development of targeted drugs.