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Intestinal macrophages are essential players in intestinal inflammation and intestinal immune homeostasis. Intestinal macrophages have the ability to polarize into two distinct phenotypes based on various environmental signals. These phenotypes include the typically activated pro-inflammatory M1 phenotype and the alternatively activated anti-inflammatory M2 phenotype. Under normal circumstances, intestinal macrophages prevent inflammatory damage to the gut. However, when genetic and environmental factors influence the polarization of intestinal macrophages, it can lead to an imbalance in M1/M2 macrophage activation and subsequently an imbalance in the control of intestinal inflammation. It transforms physiological inflammation into pathological intestinal damage. In patients with ulcerative colitis-associated cancer (UC-CRC), intestinal inflammatory disorders are closely associated with intestinal M1/M2 macrophage polarization imbalance. Consequently, restoring the polarization equilibrium of M1/M2 macrophages might be an effective measure to prevent and treat UC-CRC. This paper aims to examine the clinical evidence of traditional Chinese medicine in the treatment of UC-CRC, the pivotal role of macrophage polarization in UC-CRC pathogenesis, and the potential mechanisms of traditional Chinese medicine in regulating macrophage polarization to treat UC-CRC. Our goal is to provide novel insights into the clinical practice, basic research, and drug development of UC-CRC. [ABSTRACT FROM AUTHOR]