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Metabolic diseases (MetDs), characterized by metabolic dysregulation leading to abnormal blood glucose, lipid, and uric acid levels, frequently result in organ damage, functional impairment, and multiple complications. These conditions severely compromise quality of life and increase mortality risk, constituting a major global health burden. Icariin (ICA), a major bioactive compound derived from Epimedium species, has demonstrated substantial therapeutic potential in the management of MetD. Accumulating evidence indicates that ICA exerts beneficial effects by improving insulin resistance and modulating oxidative stress, fibrosis, inflammatory responses, and lipid metabolism. Through these mechanisms, ICA influences the pathogenesis and progression of diabetes mellitus, osteoporosis, metabolic dysfunction-associated steatotic liver disease, obesity, and various metabolic disorders. This review provides a comprehensive summary of recent advances in the application of ICA for the management of MetD, focusing on its molecular mechanisms, clinical applications, and research prospects. The aim is to establish a solid foundation for optimizing the therapeutic use of ICA in the management of MetDs.