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Abstract In this study, a simple one-step ionic liquid-based ultrasound-assisted dispersive liquid–liquid microextraction technique was coupled with high-performance liquid chromatography for the analysis of four pyrethroids in three kinds of traditional Chinese medicine oral liquid preparations: simotang oral liquid, kangbingdu oral liquid, and huaji oral liquid. The extraction parameters were examined to improve extraction efficiency. The optimum extraction conditions were 50 μL of 1-octyl-3-methylimidazolium hexafluorophosphate utilized as the extraction solvent and 800 μL of acetonitrile applied as the dispersive solvent. The extraction was assisted by ultrasonication for 8 min. The limits of detection for the four pyrethroids were within 0.007–0.024 mg L−1, and the limits of quantitation ranged between 0.023 and 0.080 mg L−1. The accuracy of the pyrethroid determination ranged from 80.1 to 106.4%. It was indicated that the proposed ionic liquid-based ultrasound-assisted dispersive liquid–liquid microextraction method had an easy operation and was accurate and environmentally friendly. This approach has potential for the analysis of pyrethroids in traditional Chinese medicine oral liquid preparations.