Non-alcoholic fatty liver disease (NAFLD) is a liver disease caused by metabolic abnormalities. NAFLD causes structural damage, dysfunction of the liver and, in severe cases, multiple organ failure. At present, the global prevalence of NAFLD is on the rise, and there is an urgent need for safe and effective therapeutic drugs. The intestinal flora is a complex microbial ecosystem that interacts with various body tissues through an intricate network, and the metabolites it generates are closely related to NAFLD. The polysaccharides of traditional Chinese medicine have the potential to regulate inflammation, immune response and intestinal microbiota, which can improve NAFLD. This article reviewed the research progress of traditional Chinese medicine polysaccharides and intestinal flora in NAFLD, aiming to provide better therapeutic strategies for NAFLD.