Abstract：Objective：To investigate the clinical effects of Jianpi Qushi Xiaozhi Decoction in treating metabolicassociated fatty liver disease （MAFLD） of the spleen-deficiency and dampness-obstruction type and its effects on carbohydrate and lipid metabolism. Methods：A total of 60 patients diagnosed with MAFLD of the spleen-deficiency and dampness-obstruction type at Huizhou Hospital of Guangzhou University of Chinese Medicine from January 2023 to March 2024 were selected and randomly divided into a control group and an observation group by random number table method， each with 30 cases. Both groups received exercise and dietary guidance. The control group was treated with polyene phosphatidylcholine，while the observation group was additionally treated with Jianpi Qushi Xiaozhi Decoction based on the control group's treatment. The treatment duration was 12 weeks for both groups. Liver fat-controlled attenuation parameter （CAP） values，traditional Chinese medicine （TCM） syndrome scores，obesity indicators，and levels of blood lipid and glucose were compared between the two groups before and after treatment. Results： After treatment， the liver CAP values and TCM syndrome scores in both groups were decreased compared to those before treatment （P＜0.05）. The observation group had lower liver CAP values and traditional Chinese medicine syndrome scores than the control group （P＜0.05）. Serum triglyceride （TG） and low-density lipoprotein cholesterol （LDL-C） levels in both groups were declined compared to those before treatment，with the observation group showing lower levels of LDL-C than the control group （P＜0.05），comparison of TG levels between the two groups （P＞0.05）. There was no significant difference high-density lipoprotein cholesterol （HDL-C） levels compare with those before treatment and between the two groups （P＞0.05）. Body fat percentage in both groups were decreased compared to those before treatment （P＜0.05）， with the observation group having lower body fat percentage and body mass index （BMI） than the control group （P＜0.05）. Fasting insulin （FINS） levels and homeostasis model assessment of insulin resistance （HOMA-IR） values in both groups were decreased after treatment compared to those before treatment （P＜ 0.05），with the observation group showing lower FINS levels and HOMA-IR values than the control group （P＜0.05）. There was no significant difference in fasting blood glucose （FBG） levels compare with those before treatment and between the two groups （P＞0.05）. No significant adverse reactions were observed in either group during the study period. Conclusion： Jianpi Qushi Xiaozhi Decoction shows significant efficacy in treating MAFLD of the spleendeficiency and dampness-obstruction type. It can effectively reduce liver fat content， regulate carbohydrate and lipid metabolism，and reduce body weight.