Abstract: Compared with normal cells, tumor cells exhibit unique metabolic characteristics. The therapeutic strategies formulated based on the energy metabolic features of tumors aim to block the energy and material supply of tumor cells at the source, remodel the immunosuppressive tumor microenvironment (TME), and create favorable conditions for immune cell infiltration and function. In recent years, Chinese herbal medicine-derived extracellular vesicles have attracted attention due to their unique metabolic regulatory capabilities and targeting properties. These extracellular vesicles can not only precisely deliver multi-component active molecules but also reprogram the metabolic processes in the tumor microenvironment, reverse immunosuppressive conditions, and thereby enhance antitumor immune responses. This review systematically summarizes the metabolic regulatory mechanisms of TCM-derived vesicles and their synergistic effects in immunotherapy, and looks forward to their clinical transformation potential and future research directions.