From Pathophysiological Consensus to Integrative Potential: A Comprehensive Narrative Review of Traditional Chinese Medicine Interventions for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Future Directions

Abstract: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is the most prevalent chronic liver disease globally, with a worldwide prevalence over 30%. Its complex pathogenesis involves insulin resistance, lipid metabolism disorders, mitochondrial dysfunction, gut-liver axis imbalance, chronic inflammation and genetic susceptibility. Currently, no radical pharmacological treatment is clinically approved for MASLD, resulting in a huge unmet clinical demand. Traditional Chinese Medicine (TCM) presents unique strengths in multi-target regulation and long-term prognosis improvement for MASLD, yet fragmented mechanistic evidence and inconsistent syndrome differentiation criteria limit its international application. This narrative review systematically summarizes the latest epidemiological, pathophysiological and diagnostic progress of MASLD, and clarifies the internal correlation between TCM theories and modern pathological mechanisms. Relevant domestic and foreign literature published from 2015 to 2025 was retrieved and analyzed to compare the advantages and limitations of Western medicine and TCM interventions. Western medicine mainly adopts lifestyle intervention, targeted drugs and bariatric surgery, while TCM therapies including herbal formulas, active ingredients, acupuncture and moxibustion improve MASLD through regulating lipid metabolism, stabilizing intestinal microecology, inhibiting inflammation and modulating hepatocyte autophagy, with reliable clinical efficacy. Nevertheless, non-uniform quality standards and insufficient high-level clinical trials restrict the standardized development of TCM. In conclusion, TCM’s holistic and multi-target characteristics perfectly adapt to the multifactorial pathogenesis of MASLD. Future studies should combine multi-omics and precision medicine to unify TCM diagnostic and pharmaceutical standards and conduct high-quality multicenter trials, promoting the standardization and international popularization of TCM in MASLD management. Keywords: MASLD, epidemiology, pathophysiological mechanism, diagnosis, TCM, modern medical treatment