Abstract: The incidence of hyperlipidemia has continued to rise and shows a trend toward younger onset, making it an important issue in the prevention and treatment of metabolic diseases. In recent years, increasing attention has been paid to studies on traditional Chinese medicine intervention for hyperlipidemia through regulation of gut microbiota. Existing studies have shown that traditional Chinese medicine can improve dyslipidemia in hyperlipidemia, and its mechanisms may be associated with regulating the structure of gut microbiota, promoting the production of short-chain fatty acids, influencing bile acid metabolism, improving intestinal barrier function, and alleviating inflammatory responses. Overall, traditional Chinese medicine may exert its intervention effects by regulating the “gut microbiota-metabolite-host response” axis. This article reviews the research progress in the improvement of hyperlipidemia by traditional Chinese medicine through regulation of gut microbiota and its metabolites. This research direction has good application prospects and may provide a reference for subsequent studies on mechanisms of action and exploration of clinical translation.