Acute lung injury（ALI）is a kind of respiratory disease with high mortality，which has attracted much attention in recent years. The plasticity of macrophages is regulated by chromatin epigenetics，which deter⁃mines the phenotypic changes of macrophages and plays an important role in the pathogenesis of ALI. In recent years，it has been found that some traditional Chinese medicine compound and active ingredients can prevent and treat ALI by regulating the activation of macrophages in a beneficial direction. In this review，the origin of the macrophages，the molecular mechanism of macrophage plasticity，ALI in macrophage plasticity，some traditional Chinese medicine compound and active ingredient by regulating macrophage polarization to reach the role of prevention and treatment of ALI were summarized，so as to clarify the molecular targets of macrophage plasticity，and provide new theoretical basis for clinical prevention and treatment of ALI.