Abstract: Background/Objectives: Metabolic dysfunction–associated steatotic liver disease (MASLD) and its progressive inflammatory/fibrotic form, metabolic dysfunction–associated steatohepatitis (MASH), represent a growing global health burden. Theis progression driven by complex, interconnected mechanisms involving metabolic dysregulation, chronic inflammation, oxidative stress, and progressive fibrosis. Despite advances in understanding disease pathophysiology, effective pharmacological therapies remain limited. Pentacyclic triterpenes, a structurally diverse class of natural compounds widely distributed in nature, have attracted increasing attention due to their broad biological activities and ability to modulate multiple molecular pathways implicated in chronic liver disease development. This review aims to provide a mechanistic overview of the potential role of pentacyclic triterpenes in MASLD and MASH. Methods: A comprehensive review of the literature was conducted using major scientific databases (Pubmed, Scielo, Web of Science) to identify experimental studies investigating pentacyclic triterpenes in the context of metabolic liver diseases. The selected studies were analyzed according to triterpene structural classification, reported bioactivities, molecular targets, and experimental evidence from in vitro and in vivo models of MASLD/MASH or specific processes involved in the disease progression. Results: Pentacyclic triterpenes, specially ursolic acid, oleanolic acid and glycyrrhizin, exhibit pleiotropic hepatoprotective effects, including regulation of lipid metabolism, attenuation of oxidative and endoplasmic reticulum stress, suppression of pro-inflammatory signaling, inhibition of inflammasome activation, and reduction of hepatic stellate cell activation and extracellular matrix deposition. These effects are mediated through modulation of key signaling pathways such as AMPK, NF-κB, NLRP3, TGF-β, FXR, MAPK, and related metabolic and inflammatory cascades. Preclinical evidence consistently demonstrates improvements in steatosis, inflammation, and fibrosis across multiple experimental models. Conclusions: By integrating mechanistic and biological evidence, this review highlights pentacyclic triterpenes as potent multitarget modulators of MASH. However, a transition from preclinical models to well-designed clinical trials is essential to validate their safety and efficacy in humans.