Abstract: Nonalcoholic fatty liver disease (NAFLD) is a global public health challenge with complex pathogenesis and limited clinical treatment options. Traditional Chinese Medicine (TCM), guided by the TCM theories, has demonstrated significant advantages in treating such complex liver diseases. There is extensive and close communication between liver and intestine, and existing studies have shown that gut microbiota dysbiosis plays a pivotal role in the progression of NAFLD and other liver diseases, which aligns with the TCM concept of “spleen and stomach” theory. Studying the mechanism of TCM from the perspective of the “gut-liver axis” is crucial for elucidating its multi-component, multi-target characteristics, and can also provide important theoretical reference for the clinical drug development of NAFLD. The review summarizes the research progress of TCM in the prevention and treatment of NAFLD based on the “gut-liver axis”.