Natural compounds are increasingly gaining attention in modern pharmaceutical research due to their multiple therapeutic effects and low toxicity. Alisol B 23-acetate (AB23A), a naturally derived triterpenoid compound isolated from Alisma orientale(AO), exhibits a variety of pharmacological activities. It demonstrates significant therapeutic potential in the treatment of chronic atherosclerosis, anti-inflammatory responses, liver and kidney protection, as well as anticancer effects. Moreover, its low toxicity and high safety profile make it an attractive compound for researchers. This suggests that AB23A is a promising natural compound with substantial development potential. In this review, we systematically reviewed the extraction methods, pharmacokinetics, metabolism, pharmacology, and toxicity of AB23A. Additionally, the current research status of AB23A was comprehensively analyzed and summarized, providing valuable reference materials for further investigation and drug development.