In management of metabolic syndrome, the traditional Chinese medicine (TCM) is an excellent representative in alternative and complementary medicines with a complete theory system and substantial herb remedies. In this article, basic principle of TCM is introduced and 22 traditional Chinese herbs are reviewed for their potential activities in the treatment of metabolic syndrome. Three herbs, ginseng, rhizoma coptidis (berberine, the major active compound) and bitter melon, were discussed in detail on their therapeutic potentials. Ginseng extracts made from root, rootlet, berry and leaf of Panax quinquefolium (American ginseng) and Panax ginseng (Asian ginseng), are proved for anti-hyperglycemia, insulin sensitization, islet protection, anti-obesity and anti-oxidation in many model systems. Energy expenditure is enhanced by ginseng through thermogenesis. Ginseng-specific saponins (ginsenosides) are considered as the major bioactive compounds for the metabolic activities of ginseng. Berberine from rhizoma coptidis is an oral hypoglycemic agent. It also has anti-obesity and anti-dyslipidemia activities. The action mechanism is related to inhibition of mitochondrial function, stimulation of glycolysis, activation of AMPK pathway, suppression of adipogenesis and induction of low-density lipoprotein (LDL) receptor expression. Bitter melon or bitter gourd (Momordica charantia) is able to reduce blood glucose and lipids in both normal and diabetic animals. It may also protect β cells, enhance insulin sensitivity and reduce oxidative stress. Although evidence from animals and humans consistently supports the therapeutic activities of ginseng, berberine and bitter melon, multi-center large-scale clinical trials have not been conducted to evaluate the efficacy and safety of these herbal medicines.Metabolic syndrome characterized by insulin resistance has become a health thread worldwide in the past 20 years (1). In survey of 8,814 people in USA, prevalence of metabolic syndrome was over 40% in people of 60-69 year old (2). In the other geographic areas in the world including Europe and Asia, the prevalence of metabolic syndrome has been increasing dramatically (1). Metabolic syndrome and associated diseases have been one of major burdens in health care system in many industrialized countries.The concept of metabolic syndrome was generated by Kylin in 1923, who described a cluster of medical conditions, such as hypertension, hyperglycemia and gout (3). The concept did not attract much attention until Dr. Gerald Reaven introduced the syndrome X in 1988 (4), which is similar to the metabolic syndrome. In 1999, WHO (World Health Organization) and EGIR (European Group for the Study of Insulin Resistance) released their diagnostic criteria for the metabolic syndrome, respectively (5;6). Now, there are at least 6 sets of diagnostic criteria for the syndrome from different organizations over the world (1;7). The primary contents of diagnostic criteria are similar among these organizations. They are hyperglycemia, insulin r...