Metabolic associated fatty liver disease（MAFLD）is characterized by fatty deposits in the liver accompanied by obesity，type 2 diabetes mellitus or metabolic related diseases.It is a common liver disease，whose spectrum of disease is not only limited to liver diseases such as metabolic steatohepatitis，liver fibrosis，liver cirrhosis and hepatocellular carcinoma，but also often associated with extrahepatic complications，involving multiple systems，especially posing a serious threat to the female endocrine system.It is often combined with polycystic ovary syndrome（PCOS），which refers to MAFLD combined with PCOS.Although MAFLD combined with PCOSis considered a benign disease，as the condition progresses，it eventually develops into cirrhosis，and even leads to liver cancer，infertility and other diseases，seriously endangering women＇s health.The pathogenesis of MAFLD complicated with PCOSis not clear yet.The author’s tutor believes that the occurrence of MAFLD combined with PCOSis related to spleen，liver and kidney.Phlegm and dampness run through the development of MAFLD combined with PCOS.From a modern medical perspective，it is currently believed to be related to insulin resistance（IR）.IR is highly consistent with the theory of phlegm-dampness in TCM.Therefore，this article discussed the important role of IR in this disease from the point of phlegmdampness.For the disease located in spleen，the treatment is mainly warming Yang to dissipate Qi.For the disease located disease in liver，the treatment is soothing liver and dispelling dampness.For the disease located in kidney，the treatment is tonifying kidney and dispelling dampness.Based on the method of eliminating phlegm and removing dampness to regulate IR and improve MAFLD with PCOS，it opens up a new idea for the treatment of MAFLD with PCOS.