Primary liver cancer belongs to the categories of “accumulation”, “jaundice”, “bulging” and “dysmenorrhea” in Chinese medicine. It is a common malignant tumor with insidious onset, high malignancy, rapid progression, aggressiveness, easy metastasis and poor prognosis. At present, surgical resection is still the most reliable means to cure hepatocellular carcinoma, but more than 80% of hepatocellular carcinoma is in advanced stage when clearly diagnosed and cannot be surgically resected. Moreover, the recurrence rate of liver cancer after surgery is very high (43.5% for tumor less than 5cm and 61.5% for tumor greater than 5cm). Discriminatory treatment is the core of the theory of Chinese medicine in preventing and treating liver cancer, which is the essence of treatment. The evidence pattern of primary liver cancer changes continuously with the development of the disease process. The first four types of evidence of Qi stagnation, blood stasis, Qi deficiency and Yin deficiency are in the top four throughout the disease course. With the development of the disease process, the combination of evidence becomes more and more significant and the disease mechanism becomes more and more complicated. Chinese herbal medicines commonly used to prevent and treat hepatocellular carcinoma include cat’s ginseng, stone ginseng, August zha, flat wood, white flowered snake tongue herb, half branch lotus, poria, atractylodes, astragalus, angelica and licorice. Commonly used classical formulas include Consistent Decoction, Prosperity San, Yin Chen Artemisia Tang, Gentian Diarrhea Liver Soup, Chai Hu Dredging the Liver, Si Jun Zi Tang, Xiang Sha Six Jun Zi Tang, and Diaphragmatic Expulsion of Blood Stasis Soup. The comprehensive treatment of advanced liver cancer has been widely recognized by academic circles for improving the efficacy. The planned combination of TCM with surgical treatment, radiotherapy and chemotherapy can significantly inhibit tumor growth, reduce adverse effects, prevent tumor recurrence after surgery and improve long-term efficacy. Basic experimental research on the mechanism of action of TCM in the treatment of primary liver cancer shows that TCM has the effects of blocking precancerous lesions of primary liver cancer, inhibiting cancer cell proliferation, inducing cancer cell apoptosis and inhibiting oncogene expression. Currently, the commonly used methods to prevent recurrence of hepatocellular carcinoma after surgery include transcatheter arterial chemoembolization (interventional therapy) and Chinese medicine treatment. Because of the side effects, the efficacy of interventional therapy to prevent postoperative recurrence of small hepatocellular carcinoma has yet to be improved. As the postoperative tumor load of small hepatocellular carcinoma is extremely low, TCM may have more advantages than interventional treatment in preventing recurrence due to its relatively low toxic side effects and more comprehensive mechanism of action.