Metabolic associated fatty liver disease(MAFLD) is closely related to intestinal flora disorders, and regulation of intestinal flora can improve MAFLD. Treating MAFLD by spleen and stomach is a classic method of traditional Chinese medicine with remarkable clinical effect. Regulating intestinal flora has become a new research approach for treating MAFLD by spleen and stomach. The authors elaborate the mechanism of spleen and stomach treatment of MAFLD from intestinal flora in order to provide a modern biological basis for spleen and stomach treatment of MAFLD.