Primary liver cancer is one of the most common malignant tumors in China and has been a major threat to human health. With advances in the basic and clinical research on primary liver cancer in recent years, the diagnosis and treatment methods for primary liver cancer have been constantly enriched. Traditional Chinese medicine (TCM) has played an important role in the diagnosis and treatment of primary liver cancer, but there is still a lack of standardized guidelines for syndrome differentiation-based treatment and response evaluation criteria. In order to further standardize the TCM diagnosis and treatment of primary liver cancer, the drafting group developed this guideline through literature review, expert interviews, questionnaire surveys, and consensus meetings based on the requirements of TCM standardization and related technical guidance documents, so as to provide a reference for clinicians. This guideline has been approved by China Association of Chinese Medicine, with the standard number of T/CACM1575—2024.