This paper provides a comprehensive review of medical hyperspectral imaging (MHSI), an emerging imaging modality with significant potential for noninvasive disease diagnosis and surgical guidance. MHSI acquires a three-dimensional dataset called a hypercube, which includes two spatial dimensions and one spectral dimension. The review covers the mechanisms of HSI, its current development status, and its applications in various medical fields. Key topics include tissue optics, which explains how light interacts with biological tissues, and the hardware and systems of MHSI, detailing the acquisition modes, spectral ranges, measurement modes, dispersive devices, detector arrays, and combinations with other techniques. The paper also discusses image analysis methods, such as preprocessing, feature extraction, and classification, emphasizing the importance of these techniques in extracting diagnostic information from hyperspectral datasets. Finally, the review highlights the achievements and future challenges in the field of MHSI.This paper provides a comprehensive review of medical hyperspectral imaging (MHSI), an emerging imaging modality with significant potential for noninvasive disease diagnosis and surgical guidance. MHSI acquires a three-dimensional dataset called a hypercube, which includes two spatial dimensions and one spectral dimension. The review covers the mechanisms of HSI, its current development status, and its applications in various medical fields. Key topics include tissue optics, which explains how light interacts with biological tissues, and the hardware and systems of MHSI, detailing the acquisition modes, spectral ranges, measurement modes, dispersive devices, detector arrays, and combinations with other techniques. The paper also discusses image analysis methods, such as preprocessing, feature extraction, and classification, emphasizing the importance of these techniques in extracting diagnostic information from hyperspectral datasets. Finally, the review highlights the achievements and future challenges in the field of MHSI.