Efficient theranostic systems can realize better outcomes in disease treatment because of precise diagnosis and the concomitant effective therapy. Aggregation-induced emission luminogens (AIEgens) are a unique type of organic emitters with intriguing photophysical properties in the aggregate state. Among the AIEgens studied for biomedical applications, so far, metal-based AIE systems have shown great potential in theranostics due to the enhanced multimodal bioimaging ability and therapeutic effect. This research field has been growing rapidly, and many rationally designed systems with promising activities to cancer and other diseases have been reported recently. In this review, we summarized the recent progress of metal-based AIE materials in bioimaging and biological theranostics, and deciphered the pertinent design strategies. We hope that this review can offer new insights into the development of this growing field.