Objective To systematically review the overall landscape of research on hepatotoxicity associated with traditional Chinese medicine (TCM) using bibliometric methods, identify key research areas and emerging trends, and conduct a multidimensional analysis encompassing material basis, mechanisms of action, research methodologies, toxicity reduction strategies, and clinical evaluation, thereby providing reference for TCM safety research and rational application. Methods Chinese and English literature on hepatotoxicity of TCM was retrieved from the China National Knowledge Infrastructure (CNKI) and Web of Science (WOS) databases. The search period spans from January 1982 to July 2025. The CiteSpace bibliometric tool was employed to analyze the temporal distribution of published studies, core authors, key research institutions, high-frequency keywords, and emerging terms, thereby revealing research frontiers and hotspots in this field. Results A total of 552 Chinese-language articles were identified from the CNKI database, while 181 English-language articles were retrieved from the WOS database. The authors with the highest number of publications in both Chinese and English literature are Xiao Xiaohe and Wang Jiabo. The research institutions with the highest number of publications in both Chinese and English literature are Beijing University of Chinese Medicine and Shanghai University of Traditional Chinese Medicine. Bibliometric analysis indicates a steady annual increase in publications on TCM-induced hepatotoxicity. Research hotspots primarily focus on high-risk herbs (e.g., Polygonum multiflorum, Rheum officinale, Tripterygium wilfordii), toxic constituents (e.g., anthraquinones and pyrrolizidine alkaloids), and their molecular mechanisms. Further analysis revealed that research on hepatotoxicity caused by TCM has progressively established a systematic research chain spanning from fundamental mechanism analysis to clinical safety evaluation. Regarding material basis and mechanisms of action, research have focused on high-risk herbs and their active components, revealing multi-pathway synergistic mechanisms of liver injury mediated by metabolic activation, oxidative stress, immune inflammation, and apoptosis. Regarding research methodologies, research have evolved from traditional animal experiments and pathological observations to multidisciplinary approaches including cellular and molecular biology, systems toxicology, network pharmacology, and emerging organoids and liver-on-a-chip technologies. Regarding toxicity reduction strategies, a systematic toxicity reduction system has been established through the approaches of herbal processing, rational combination, formulation optimization, and personalized interventions guided by pharmacogenomics. Regarding clinical evaluation, the continuous refinement of case reporting, causality determination systems, and real-world studies has propelled TCM safety research toward evidence-based and international standards. Conclusion Current research on hepatotoxicity of TCM demonstrates a scientific progression from qualitative descriptions to quantitative analysis, and from empirical judgments to evidence-based conclusions. Future studies should deepen the elucidation of material bases and action mechanisms while strengthening the application of emerging technologies and big data mining. This will enhance the TCM safety evaluation system, providing support for rational TCM use and its modernization.

safety of traditional Chinese medicine  /  hepatotoxicity  /  bibliometrics  /  clinical evaluation  /  toxicity reduction strategies