The active ingredients of natural herbs have been extracted to act on different targets in the body to exert multiple effects. However, traditional oral administration and intravenous injection of herbal medicines are also susceptible to many side effects. Transdermal drug delivery by microneedles can overcome the shortcomings of these traditional drug delivery systems. The active ingredients of natural herbs can be delivered to the dermis or the connective tissue layer by five types of microneedles: solid, hollow, coated, dissolving, and hydrogel. Subsequently, the herbal ingredients are delivered to different target points of the body through body circulation to exert their effects. In this study, we classified the microneedles that can deliver the active ingredients of natural herbs and summarized their advantages and disadvantages as well as their preparation methods and applications, to guide the development and clinical applications of other herbal transdermal microneedles.