Metabolic dysfunction-associated fatty liver disease (MAFLD) has the core pathological feature of liver lipid accumulation, which is closely associated with the factors such as lipid metabolism disorders, insulin resistance, and inflammation, and abnormal lipid accumulation can exacerbate these factors and further intensify lipid accumulation, thereby forming a vicious circle. Huanglian Wendan decoction has shown unique advantages in alleviating lipid accumulation associated with MAFLD, but its mechanism of action is relatively complex. With reference to the latest literature evidence, this article systematically summarizes the mechanism of action of Huanglian Wendan decoction in improving lipid accumulation by regulating lipid metabolism, ameliorating insulin resistance, and exerting an anti-inflammatory effect, as well as the pharmacological actions of related active components, in order to provide a theoretical basis for the clinical application of Huanglian Wendan decoction in the management of MAFLD.