Acute lung injury (ALI) has multiple causes and can easily progress to acute respiratory distress syndrome (ARDS) if not properly treated. Nuclear factor κB (NF-κB) is a key pathway in the treatment of ALI/ARDS. By exploring the relevance of NF-κB and the pathogenesis of this disease, it was found that this disease was mainly associated with inflammation, dysfunction of the endothelial barrier, oxidative stress, impaired clearance of alveolar fluid, and coagulation disorders. Traditional Chinese medicine (TCM) has the characteristics of multitargeting, multipathway effects, and high safety, which can directly or indirectly affect the treatment of ALI/ARDS. This article summarizes the mechanism and treatment strategies of TCM in recent years through intervention in the NF-κB-related signaling pathways for treating ALI/ARDS. It provides an overview from the perspectives of Chinese herbal monomers, TCM couplet medicines, TCM injections, Chinese herbal compounds, and Chinese herbal preparations, offering insights into the prevention and treatment of ALI/ARDS with TCM.