Medicinal plants, as medicinal materials and important drug components, have been used in traditional and folk medicine for ages. However, being sessile organisms, they are seriously affected by extreme environmental conditions and abiotic stresses such as salt, heavy metal, temperature, and water stresses. Medicinal plants usually produce specific secondary metabolites to survive such stresses, and these metabolites can often be used for treating human diseases. Recently, medicinal plants have been found to partner with endophytic fungi to form a long-term, stable, and win-win symbiotic relationship. Endophytic fungi can promote secondary metabolite accumulation in medicinal plants. The close relationship can improve host plant resistance to the abiotic stresses of soil salinity, drought, and extreme temperatures. Their symbiosis also sheds light on plant growth and active compound production. Here, we show that endophytic fungi can improve the host medicinal plant resistance to abiotic stress by regulating active compounds, reducing oxidative stress, and regulating the cell ion balance. We also identify the deficiencies and burning issues of available studies and present promising research topics for the future. This review provides guidance for endophytic fungi research to improve the ability of medicinal plants to resist abiotic stress. It also suggests ideas and methods for active compound accumulation in medicinal plants and medicinal material development during the response to abiotic stress.