Raw and processed Radix Polygoni Multiflori have been used in the prevention and treatment of nonalcoholic fatty liver disease (NAFLD), hyperlipidemia, and related diseases in Asian counties for centuries. The lipid regulation ability of raw and processed Poligoni Multiflori Radix were compared in high-fat diet fed rats in this research. Total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) in blood and liver tissue were all significantly higher in model rats. However, triglyceride (TG) contents increased only in liver tissue, not in the blood samples. The rats fed the high-fat diets were considered the model of type IIa hyperlipidemia and early-stage nonalcoholic fatty liver disease. Both Radix Polygoni Multiflori (RPM) and Radix Polygoni Multiflori Praeparata (RPMP) revealed TC-lowing effects, and middling doses of RPMP displayed the most significant TC-lowing effects, as indicated by blood samples. Neither RPM nor RPMP was found to reduce LDL-C in rats' blood. Nevertheless, RPM showed dose-dependent TC- and TG-lowing effects in the liver tissue samples. In conclusion, RPM showed more pronounced effects on lipid regulation in liver samples in the treatment of early-stage NAFLD. RPMP, however, displayed better effects in regulating lipids in circulating blood for the treatment of hyperlipidemia.