Here, we show that berberine (BBR) nanoparticles (BBRNPs, ∼300 nm hydrodynamic diameter) are a promising sonosensitizer for cancer sonodynamic therapy (SDT). HeLa cells were cultured for in vitro investigation, and a HeLa xenograft tumor model was established with BALB/c nude mice (∼20 g, female) for in vivo study. Significant effects of BBRNP-mediated SDT were observed in both in vitro and in vivo experiments. Cell counting kit-8 (CCK-8) cell proliferation and cytotoxicity assays were performed to confirm if BBRNPs-SDT has cytotoxicity against HeLa cells in vitro. The mechanism for inhibition of tumor proliferation by BBRNPs-SDT was investigated via flow cytometry, photoluminescence spectroscopy, dynamic light scattering, scanning electron microscopy, ultrasonic contrast imaging, tumour pathological analysis, western blot and anatomical analysis. We identified two ongoing assumptive mechanisms. One is due to the tumor angioembolism effect, which blocks oxygen and nutrient supply in situ, leading to early-stage HeLa apoptosis. The other domino effect is due to ultrasonic energy-activated BBRNP cavitation and reactive oxygen species release, which leads to tumor vascular injury and finally induces HeLa apoptosis, resulting in tumour shrinkage. Both pathways synergistically helped with HeLa xenograft tumor supression. In conclusion, we posit that BBRNPs are a promising agent for tumor SDT.