The clinical treatment of silicosis remains a major challenge. With the rapid advancement of research in traditional Chinese medicine, increasing evidence suggests that traditional Chinese medicine exerts a unique holistic regulatory effect in the prevention and treatment of silicosis. The mechanisms of treatment effects involve inhibition of inflammatory responses, suppression of epithelial-mesenchymal transition, regulation of macrophage polarization, inhibition of apoptosis and oxidative stress, modulation of immune responses, improvement of pulmonary microecology, regulation of ferroptosis, and interference with urinary metabolic pathways. These effects are mediated through multiple signaling pathways, including the transforming growth factor-β1/mothers against decapentaplegic homolog pathway, phosphatidylinositol 3-kinase/protein kinase B/nuclear factor-κB pathway, and Janus kinase/signal transducer and activator of transcription pathway. Compound traditional Chinese medicine formulations provide systemic regulatory effects, whereas monomeric components exhibit precise target specificity. Their combination may facilitate the modernization of traditional Chinese medicine. However, current studies on traditional Chinese medicine therapy for silicosis face several limitations, including the lack of standardized dosages and toxicological data in basic research, unclear mechanisms of action, insufficient clinical evidence and difficult to advance into clinical development, limited clinical sample sizes, short follow-up durations, and incomplete efficacy evaluation systems. Future research should focus on elucidating the mechanisms of action of traditional Chinese medicine in silicosis, conducting high-quality clinical trials, establishing integrative efficacy evaluation criteria for traditional Chinese medicine and Western medicine, and promoting the translational application of basic research findings to clinical practice.