Microfluidics enables precise manipulation of scarce Traditional Chinese Medicine (TCM) samples while accelerating analysis and enhancing sensitivity. Device-level structures explain these gains: staggered herringbone and serpentine mixers overcome low-Reynolds-number constraints to shorten diffusion distances and reduce incubation time; flow-focusing or T-junction droplet generators create one-droplet–one-reaction compartments that suppress cross-talk and support high-throughput screening; “Christmas-tree” gradient generators deliver quantitative dosing landscapes for mechanism-aware assays; micropillar/weir arrays and nanostructured capture surfaces raise surface-to-volume ratios and probe density, improving capture efficiency and limits of detection; porous-membrane, perfused organ-on-a-chip architectures recreate apical–basolateral transport and physiological shear, enabling metabolism-aware pharmacology and predictive toxicology; wax-patterned paper microfluidics (µPADs) use capillary networks for instrument-free metering in field settings; and lab-on-a-disc radial channels/valves exploit centrifugal pumping for parallelised workflows. Framed by key performance indicators—sensitivity (LOD/LOQ), reliability/reproducibility, time-to-result, throughput, sample volume, and sustainability/cost—this review synthesises how such structures translate into value across TCM quality/safety control, toxicology, pharmacology, screening, and delivery. Emphasis on structure–function relationships clarifies where microfluidics most effectively closes gaps between chemical fingerprints and biological potency and indicates practical routes for standardisation and deployment.