Abstract: Chemotherapy-induced nausea and vomiting (CINV) represents one of the most prevalent adverse reactions during cancer treatment. Its pathological mechanism is complex, involving multiple neurotransmitters and their biopathways, such as serotonin, substance P, and dopamine, along with their respective receptors. Existing chemical agents for CINV prophylaxis and management face challenges including limited efficacy, serious side effects, and high cost. In contrast, traditional Chinese medicine (TCM) holds considerable promise for CINV prevention and treatment, leveraging advantages such as multi-components, multi-targets, high safety, low side effects, and cost-effectiveness. The structural classes, mechanisms of action, structure-effect relationships, and clinical applications for currently available CINV drugs were systematically reviewed. Moreover, the recent research progress on TCM for preventing and treating CINV was also introduced It will provide significant references for the development of novel CINV therapeutics with sustained efficacy, high efficiency, and low cost.