Liver cirrhosis is a leading cause of death from liver-related diseases accompanied by a variety of complications; however, hepatic fibrosis, an inevitable stage of cirrhosis, is possible to be reversed and cured. Hepatic stellate cells (HSCs) are the primary cells that secrete extracellular matrix in the liver and play a dominant role in the pathogenesis of hepatic fibrosis. Effective therapeutic approaches for reversing hepatic fibrosis aim at inhibiting the activation of HSCs and inducing their inactivation or death. This review highlights the mechanism by which traditional Chinese medicine (TCM) regulates the activity of HSCs and exerts antifibrotic effects, providing insights and prospects for the treatment of hepatic fibrosis with TCM. Hepatic stellate cells (HSCs) are the primary cells that secrete extracellular matrix (ECM) in the liver and play a dominant role in the pathogenesis of hepatic fibrosis. Effective therapeutic approaches for reversing hepatic fibrosis aim at inhibiting the activation of HSCs and inducing their inactivation or death. This review highlights the mechanism by which traditional Chinese medicine (TCM) regulates the activity of HSCs and exerts antifibrotic effects, providing insights and prospects for the treatment of hepatic fibrosis with TCM. TGF-beta, transforming growth factor-beta; Smads, small mothers against decapentaplegics; PI3K, phosphoinositide 3-kinase; Akt, protein kinase B; MAPK, mitogen-activated protein kinase; NF-kappa B, nuclear factor kappa-B.Highlights image HSCs play a dominant role in the pathogenesis of hepatic fibrosis. TCM can inhibit HSCs activation and promote HSCs death through multiple pathways, which actively exploits the unique therapeutic advantages.