The global health burden of sepsis is immense, characterized by significant loss of life and high healthcare costs. Traditional Chinese medicine (TCM), with its over two millennia of clinical practice in China, has gained attention as a potential adjunctive approach for sepsis. Here, we evaluated TCM applications in sepsis management, highlighting both potential benefits and methodological limitations of existing clinical evidence. Although various TCM preparations have been evaluated for sepsis treatment, the vast majority lack robust clinical evidence. Xuebijing Injection represents a rare example that has demonstrated efficacy in a large-scale, multicenter, randomized, double-blind, placebo-controlled trial. In contrast, the evidence supporting other preparations such as Shenfu and Shenmai Injections comes primarily from smaller, single-center studies with significant methodological limitations. There is a clear need for more high-quality, multicenter randomized controlled trials to rigorously evaluate these potentially beneficial but currently insufficiently validated TCM preparations. The pharmacological effects and underlying mechanisms of some bioactive compounds derived from TCM medications have been elucidated, shedding light on the potential of TCM-based anti-sepsis drug discovery. We underscore the importance of continued research to better integrate TCM with modern sepsis management, paving the way for the development of evidence-based TCM treatments for this challenging condition.