Hepatocellular carcinoma (HCC) is currently managed through an integrated framework that includes curative surgery or ablation, locoregional therapy, targeted therapy, immune-antiangiogenic combinations, and dual immunotherapy. Nevertheless, patients with intermediate- or advanced-stage disease continue to face recurrence, treatment resistance, declined hepatic functional reserve, and treatment-related toxicity. Chinese herbal medicines and their derived natural products have long been investigated as components of comprehensive HCC management; however, herbal materials or extracts, purified active compounds, and clinical products represent different evidence levels, and preclinical mechanisms cannot be directly extrapolated to patient benefit. This review follows an evidence chain of “herbal materials/extracts-active compounds-formulas/proprietary products-clinical evidence”. We summarize studies on Huaier, Sophorae Flavescentis Radix, Astragali Radix, Curcumae Longae Rhizoma, Paridis Rhizoma, Hedyotidis Herba, and Scutellariae Barbatae Herba, with emphasis on ferroptosis, cell-cycle regulation, apoptosis/autophagy, metabolic reprogramming, invasion and metastasis, and the tumor immune microenvironment. The interpretive boundaries of network pharmacology, molecular docking, safety, and herb-drug interactions were discussed. Most active compounds remain supported mainly by cellular or animal studies and are limited by experimental concentrations, uncertain human exposure, model relevance, and insufficient causal validation. Clinical-level evidence is concentrated in a few standardized products: Huaier granules are supported by relatively complete evidence from postoperative studies, whereas evidence for compound Kushen injection and Huachansu is constrained by trial quality, treatment context, and limited independent replication. Future research should move beyond pathway accumulation toward a closed chain of evidence linking reproducible composition, achievable human exposure, verifiable target engagement, a predefined clinical role, and patient-relevant outcomes.

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