The quality and yield of Chinese medicinal materials are profoundly shaped by soil health. This paper synthesizes evidence on how soil physical, chemical and biological attributes jointly govern the productivity of medicinal crops. Literature shows that deteriorated physical traits (e.g., compaction, declining porosity), impaired chemical conditions (pH drift, organic-matter depletion, skewed N-P-K availability) and degraded biological features (lower enzyme activities, altered soil-fauna assemblages, inhibited root growth, microbial imbalance) all curtail plant performance, reduce the accumulation of bio-active constituents and aggravate pest and disease pressure, thereby threatening the sustainability of the Chinese-medicine sector. For bulk root-and-rhizome crops, maintaining a loose, aerated and stable crumb structure, keeping pH between 5.0 and 7.0, matching organic-matter levels to species-specific demands, sustaining a nematode Shannon index ≥ 2.5, and establishing a microbiome dominated by bacteria with abundant actinobacteria, high fungal diversity and a rich complement of beneficial taxa—together with a balanced soil-fauna community—can improve soil architecture, accelerate nutrient release, alleviate replant problems and enhance both disease resistance and medicinal quality.