The progression of coronary atherosclerotic heart disease (CAD) is closely associated with the persistent activation of chronic low-grade inflammation and vascular endothelial dysfunction. Although percutaneous coronary intervention (PCI) can effectively improve myocardial ischemia, patients often exhibit elevated inflammatory burden, insufficient endothelial repair, and impaired microcirculatory perfusion postoperatively, thereby contributing to a sustained residual cardiovascular risk. In recent years, integrated traditional Chinese (TCM) and Western medicine therapy have demonstrated advantages in multi-targeted, systematic, and comprehensive regulation to interrupt the vicious cycle of inflammatory responses and endothelial damage. This article reviews the modern pathological mechanisms of chronic inflammation and endothelial dysfunction in coronary atherosclerotic heart disease and explores the underlying pathogenesis from a TCM perspective. Within this framework, this article summarizes the foundational and clinical research progress on anti-inflammatory and endothelial protective effects of TCM through regulating inflammatory signaling pathways, protecting the endothelial glycocalyx, improving blood flow shear stress, and modulating immune metabolism. Finally, this article analyzes the limitations of current research in terms of the quality of evidence, the objectification of syndromes, and the elucidation of the material basis for efficacy of Chinese herbal medicine, and outlines future directions for translational medicine research, with the aim of providing a basis for optimizing integrated TCM and Western medicine prevention and treatment strategies for CHD.