Osteopathic principles and philosophy suggest the use of osteopathic manipulative treatment (OMT) to restore, augment, or facilitate lymphatic fluid flow to maintain body fluid balance, and/or to stimulate immune system responses to aid in the recovery from illness and maintain normal body defense mechanisms. This review provides an osteopathic view of the role of the lymphatic system in health and disease, with an emphasis on the use of OMT to alleviate somatic dysfunctions (SD) that inhibit the optimum function of the lymphatic system. The current evidence base is reviewed for the use of OMT to assist in restoring or augmenting lymphatic system function to help patients recover from illness and maintain health and wellness. An overview is provided on how osteopathic principles and philosophy relative to the immune system are applied in practice. A literature search was conducted using databases such as Medline, PubMed, Ostmed-DR, and Scopus, focusing on osteopathic approaches to the lymphatic system. Keywords used included osteopathic manipulative medicine, OMT, and lymphatic manual treatment or therapy. Current osteopathic textbook information was also surveyed. There is support for the application of osteopathic principles and OMT for certain conditions that involve the lymphatic system. More prospective research is needed.