Fatty liver disease now ranks among the most common chronic liver conditions seen worldwide. What was once called non-alcoholic fatty liver disease has since been reclassified as metabolic dysfunction-associated steatotic liver disease (MASLD) — a renaming that better captures its tight connection to obesity, insulin resistance, type 2 diabetes, dyslipidaemia, and other cardiometabolic disturbances. MASLD spans a wide spectrum, ranging from uncomplicated hepatic steatosis at one end to metabolic dysfunction-associated steatohepatitis, advancing fibrosis, cirrhosis, and hepatocellular carcinoma at the other. Its underlying pathogenesis is driven by multiple interacting processes: insulin resistance, a greater influx of free fatty acids into the liver, heightened de novo lipogenesis, mitochondrial dysfunction, oxidative stress, endoplasmic-reticulum stress, inflammatory signaling, and disruptions along the gut-liver axis.While Ayurvedic classics do not describe a disease entity that maps precisely onto MASLD, the condition can reasonably be interpreted through concepts such as Agnimandya, Ama, Medovaha Srotodushti, Meda Dhatu Vriddhi, Santarpanajanya Vyadhi, and the progressive involvement of Kapha, Pitta, Rakta, and Vata. In its earliest form, steatosis appears to align mainly with Kapha-Meda accumulation, while the inflammatory phase that follows tends to draw in Pitta, Rakta, and Ama. The fibrotic changes seen in more advanced disease can be understood as chronic Srotorodha, ongoing tissue damage, and secondary Vata involvement.An Ayurvedic approach to management should center on Nidana Parivarjana, restoring Agni, clearing Ama and excess Meda, correcting the underlying metabolic disturbances, and protecting liver tissue. Depending on the patient's constitution and how advanced the disease is, this may involve dietary changes, physical activity, weight loss, adequate sleep, and selected Deepana-Pachana, Lekhana, Medohara, Srotoshodhana, and Rasayana interventions. Early clinical studies of certain Ayurvedic treatments have produced encouraging results, though this evidence base is still held back by small sample sizes, brief follow-up periods, inconsistent formulations, and outcome measures that are not standardized. For this reason, Ayurvedic care is best applied alongside proper metabolic assessment, fibrosis risk stratification, and sustained long-term clinical monitoring.