The molecular mechanisms involved in cardiac hypertrophy and the latest research progress in preventing and treating the disease with traditional chinese medicine (TCM) are reviewed. Cardiac hypertrophy is a major risk factor for heart failure, which may result from the dysregulation of multiple cellular factors and/or signaling pathways, such as the calcium signaling, AMPK, TLR4/NF-κB, MAPK, PI3K/Akt and oxidative stress-related signaling pathways. Pathological hypertrophy can be prevented or reversed by astragaloside A, gastrodin, ginsenoside, propolis and asiatic pennywort herb by regulating related pathways, thereby avoiding progression to heart failure.