Background <p>Gastrointestinal (GI) cancers remain a significant global health burden with high mortality rates. Chinese herbal medicine (CHM) has emerged as a complementary therapy, yet limited real-world evidence regarding its use and effectiveness in GI cancers.</p> Methods <p>This scoping review evaluated findings on CHM usage patterns and survival outcomes in GI cancer patients from studies using the Taiwan National Health Insurance Research Database, a uniquely data source covering 99.99% of the Taiwanese population. Five databases were searched for studies from January 1, 1997, to November 30, 2024. Information on exposures and outcomes were extracted, alongside study designs, patient characteristics, methodologies, and results.</p> Results <p>We identified seven studies focusing on liver (<i>n</i> = 3), gastric (<i>n</i> = 2), pancreatic (<i>n</i> = 1) and colon (<i>n</i> = 1) cancers. Of the 6 studies that evaluated usage patterns, Bai-Hua-She-She-Cao (Oldenlandia Diffusae Herba) and Dan-Shen (Salviae Miltiorrhizae Radix et Rhizoma) were the most frequently used herbs among Taiwanese GI cancer patients. Of the 6 studies that investigated survival, complementary CHM use was associated with lower mortality (adjusted HRs = 0.41–0.68) compared to conventional treatment only. Subgroup analyses showed longer durations of CHM use were associated with greater survival benefits. However, potential for confounding and bias tempers any conclusions.</p> Conclusion <p>This review underscores the potential role of CHM as a complementary treatment for improving survival in GI cancers in real-world settings. These findings will require future rigorously-designed multinational observational studies and trials to further identify the role of specific herbal treatment in contemporary oncological care to improve outcomes for people with GI cancer.</p>