Small interfering RNA (siRNA) is the initiator of RNA interference, which stimulates the silencing of complementary target mRNA. It is of great significance for gene regulation and disease treatment. It is used in viral infections, cancers, family genetic diseases and autoimmune diseases. As a new type of drug, siRNA is gradually being valued by researchers due to its high efficiency, strong specificity, and easy detection of therapeutic effects. siRNA used as a drug alone or co-delivered with anti-tumor drugs such as chemotherapy for cancer treatment shows greater application potential than traditional drugs. siRNA drugs have the advantages of designable targeting, convenient synthesis, instantaneous silencing, and strong target specificity. However, their delivery also faces obstacles that they are easily degraded in the blood circulation, cleared by the kidney, and difficult to break through the vascular endothelium/cell membrane/lysosome. Therefore, designing suitable nanocarriers to help siRNA successfully deliver into cells and play a role is an important goal for the development of siRNA drugs, and the amout of research in this area is also increasing year by year. The precise design of the nanocarrier material type, size, structure, surface modification, etc. are important factors for the successful delivery of siRNA drugs. At present, the design of siRNA drug nanocarriers mainly includes 4 strategies: loading siRNA drugs on the surface of nanocarriers, co-assembly of siRNA drugs and nanocarriers, nanocarriers encapsulating siRNA drugs, and siRNA self-assembly. At this stage, the use of nanocarriers to achieve siRNA drug delivery has made great progress. With the in-depth research and application development, the precise controlled preparation, precise targeted delivery and multifunctionalization of siRNA drug nanocarriers have achieved good results. However, there are still some problems that need to be overcome by researchers. For example, when siRNA drugs are used in the clinic, there are still problems such as inaccurate structure design of targeted drugs, serious off-target effects, difficulty in achieving endosome escape, and difficulties in large-scale preparation of nanocarriers. Because of this, only 3 siRNA drugs have been approved for marketing, namely Onpattro (Patisiran), Givlaari (Givosiran) and Oxlumo (Lumasiran) developed by Alnylam Pharmaceuticals. How to prepare siRNA drugs on a large scale is a major problem facing the clinical application of siRNA drugs, and it will become a research hotspot. At the same time, with the development of computer technology, combined with artificial intelligence, machine learning and other technologies, drug design with the aid of big data analysis is becoming a new research and development trend. Intelligent design and precise regulation of siRNA nanomedicine, and the design of multifunctional siRNA nanomedicine that integrates targeting, tracing, and co-delivery with other drugs to achieve synergy is also one of the future development directions of siRNA nanomedicine.