Schisandra chinensis, a traditional Chinese materia medica, possesses unique pharmacological activities and extensive clinical application value. Its processing techniques have evolved and improved over thousands of years. In the traditional Chinese medicine system, the processing of Schisandra chinensis directly affects its efficacy and is closely related to quality control and medication safety. Currently, there are still deficiencies in the standardization of processing techniques, quality control of active components, and research on the component-efficacy relationship. This review summarizes the historical evolution and modern technological advancements in the processing of Schisandra chinensis. Integrating contemporary analytical techniques and pharmacological studies, it discusses the quality control methods for its main active components, the mechanisms by which different processing methods influence these components and their efficacy, as well as its applications in metabolic diseases, liver diseases, respiratory diseases, and neurological disorders. This paper aims to provide a reference for the standardization of processing techniques, the precision of quality control, and the modernization of clinical applications of Schisandra chinensis.