The ascending-descending and floating-sinking of traditional Chinese medicine (TCM) refers to the action tendency of the medicine in the human body, and is one of the core contents of the drugs properties theory of TCM. The emergence of the ascending-descending and floating-sinking theory of TCM is closely related to the ascending and descending of the zang-fu organs Qi movement. The ascending-descending and floating-sinking effects of drugs can be affected by various factors including four properties and five flavors, texture and weight, processing methods, compatibility application, and medicinal parts. This paper discussed the ascending-descending and floating-sinking theory of TCM from three aspects: the evolution the theory, the influencing factors, and the clinical application. The ascending-descending and floating-sinking theory of TCM is the guiding principles of clinical medication, which were proposed by physicians over the ages according to the four properties and five flavors of drugs and the physiopathological characteristics of the zang-fu organs. It is necessary to combine the theories of Qi, flavors, ascending-descending and floating-sinking, and channel tropism for understanding roles of drugs, in order to comprehensively and accurately understand the medicinal properties of TCM, and better guide the clinical medication.