Natural medicines have been widely investigated for Alzheimer's disease (AD), but the development of this field and the relationship between bibliometric themes and experimental evidence remain insufficiently characterized. This study aimed to map the research landscape and thematic evolution of natural medicine research for AD through bibliometric analysis and to further examine representative mechanistic evidence through a focused narrative synthesis. MethodsPublications in the Web of Science Core Collection from January 1, 2001, to April 28, 2025 were analyzed using VOSviewer and CiteSpace. Bibliometric findings were used to guide a focused narrative synthesis of original experimental studies. A total of 3316 publications involving 16,858 authors, 3594 institutions, and 106 countries or regions were identified, with China contributing the most publications. Research has shifted from acetylcholinesterase inhibition and antioxidant effects toward broader AD-related mechanisms, while computational approaches such as network pharmacology and molecular docking have become increasingly represented in this research field. Gut microbiota-related research has increased but remains an emerging direction rather than a dominant hotspot. Experimental studies of representative compounds, medicinal herbs, and formulae mainly involved Aβ and tau pathology, cholinergic dysfunction, oxidative stress, neuroinflammation, mitochondrial dysfunction, and autophagy. Clinical evidence varied substantially, with EGb 761 and Huperzine A being more extensively studied than many agents supported mainly by preclinical evidence. Computational approaches were increasingly used for hypothesis generation, but their predictions require experimental validation. Natural medicine research for AD has become increasingly mechanism-oriented and methodologically diverse. Future studies should strengthen experimental validation, improve standardization and pharmacokinetic characterization, and conduct adequately powered clinical trials to support translation of preclinical findings.
