Background: Mitochondrial biosynthesis regulated by the PGC-1α-NRF1-TFAM pathway is closely related to mitochondrial function and mitochondrial reactive oxygen generation, and is considered to be a new possible therapeutic target for the treatment of heart failure.Methods: Tongmai Yangxin Pills (TMYXP) is a Chinese patent medicine for the treatment of ischemic heart disease. It has the ability to scavenge oxygen free radicals and improve the antioxidant capacity of the heart muscle, thereby protecting cardiomyocytes, however, its mechanism is not well established. In this study, to investigate the mechanisms of TMYXP in cardiac protection, a rat model of cardiomyopathy was established by continuous isoproterenol (ISO) stimulation. Changes in the rat body weight, heart weight index (HWI), echocardiography, histological staining and biochemical indicators were examined.Results: Our results suggested that TMYXP reduced myocardial remodeling, inhibited deterioration of cardiac function, and delayed HF onset in rats with ISO-induced cardiomyopathy. Meanwhile, TMYXP markedly reduced ROS production, increased the levels of antioxidant enzymes, improved function of the mitochondrial respiratory chain, and promoted ATP production in myocardial tissues. In addition, TMYXP inhibited cytochrome C (Cyt C) release in mitochondria and caspase-3 activation in cytosol, thereby reducing the apoptosis of myocardial cells. Finally, TMYXP remarkably up-regulated the mRNA and protein expression levels of SIRT3, PGC-1α, NRF1 and TFAM in myocardial cells.Conclusions: Taken together, our results suggest that TMYXP regulates mitochondrial biosynthesis mediated enhancing the expression of SIRT3 and PGC-1α, thereby improving the cardiac function in rats with ISO-induced cardiomyopathy.