Background: Angiogenesis is a key link in a variety of physiological and pathological processes and plays a crucial role in tissue repair, tumor growth and ischemic diseases. Ginsenosides, as the main active component of ginseng, have a unique ability to bidirectionally regulate angiogenesis, but the systematic mechanism of their action in different diseases has not been fully elucidated. Purpose: This article comprehensively reviews the bidirectional regulatory effects of ginsenosides on angiogenesis by regulating multiple signaling pathways, aiming to provide new therapeutic strategies for angiogenesis-related diseases and explore their application prospects in combination with biomaterials. Methods: Through systematic searches of databases such as PubMed, Web of Science, CNKI and Science Direct, the search keywords were "angiogenesis", "fibrosis", "myocardial infarction", "cerebral ischemia-reperfusion", "endometriosis", "bone repair", "retinopathy", "skin", "Ginsenosides", "ginseng" and other combinations of these key words. The search time is up to May 2025. The core target was analyzed by network pharmacology, combined with the experimental data inside and outside the body and the research on the biomaterial delivery system, to evaluate its mechanism of action. Results: Ginsenosides can regulate multiple signaling pathways such as PI3K/Akt/mTOR, HIF-1α/VEGF and MAPK/NF-κB, exerting anti-inflammatory, antioxidant, anti-apoptotic and bidirectional regulatory effects on angiogenesis. In addition, ginsenosides are combined with biomaterials to achieve targeted delivery and controlled release. It has demonstrated remarkable therapeutic effects and biosafety in the treatment of heart repair, cerebral ischemia, skin trauma, tumor treatment and diabetic retinopathy. Conclusions: Ginsenosides show broad prospects in the treatment of angiogenesis-related diseases by regulating angiogenesis through multiple targets and in both directions. In the future, it is necessary to further combine clinical research to verify its mechanism and optimize the drug delivery system to achieve precise treatment.