Tourism in high-altitude areas and high-altitude outdoor activities have seen a significant increase, and health threats centered around high-altitude pulmonary edema and high-altitude pulmonary hypertension have become increasingly prominent. Hypoxia, as the primary pathogenic trigger, initiates a cascade linking inflammatory responses, oxidative stress, and vascular dysfunction, culminating in a vicious cycle of injury. Leveraging its unique advantages of holistic regulation and multi-targeted synergistic effects, Chinese Herbal Medicines (CHM) shows promising potential in preventing and treating pulmonary injury associated with high-altitude hypoxia. Through single herbs or compound formulations, CHM targets the HIF-1α pathway, scavenges reactive oxygen species, inhibits inflammatory cytokine release, protects the vascular endothelial barrier, and reverses abnormal vascular remodelling. This systematic review examines the core mechanisms by which high-altitude hypoxia causes acute and chronic pulmonary injury, and explores the action mechanisms of CHM in their prevention and treatment, aiming to provide a theoretical basis for the precise prevention and management of high-altitude hypoxia-related pulmonary diseases.