Neurological diseases have always been a major challenge in the field of medicine, and the role of macrophage polarization in them has attracted much attention in recent years. Macrophages have different polarization states, including M1 type and M2 type, which play a key role in the occurrence and development of neurological diseases. In neuroinflammation, M1-type macrophages may exacerbate damage, while M2-type macrophages contribute to tissue repair and nerve regeneration. Studies have found that the imbalance of macrophage polarization is closely related to a variety of neurological diseases, such as Alzheimer's disease, multiple sclerosis, and traumatic brain injury. In response to this phenomenon, some progress has been made in drug research, and new drugs are designed to regulate the polarization of macrophages to reduce inflammation and promote nerve repair. Some drugs regulate the polarization of macrophages by inhibiting specific signaling pathways, while others work by targeting cytokines or receptors. However, there are still many challenges in the current research, such as the safety and effectiveness of the drug, and the complexity of the mechanism of action. This paper summarizes the different polarization phenotypes and main functions of macrophages stimulated by different microenvironmental signals, and focuses on the role of macrophage polarization in nervous system diseases and clinical disease treatment strategies targeting macrophage polarization, which brings new hope for the treatment of nervous system diseases.