Patients undergoing maintenance hemodialysis (MHD) frequently experience various acute and long-term complications, which severely impact their quality of life and prognosis. Although modern medicine employs methods such as shortening dialysis duration, increasing dialysis frequency, and providing symptomatic support to prevent and treat MHD complications, the therapeutic benefits are limited. This limitation stems from the incomplete understanding of the underlying mechanisms of MHD complications and the lack of specific etiological therapies. Traditional Chinese Medicine (TCM), grounded in its holistic concept and treatment based on syndrome differentiation, demonstrates unique potential. It may contribute to establishing a syndrome differentiation system adapted to the pathophysiological characteristics of MHD patients. Based on this perspective, this article reviews the current research status on TCM syndrome characteristics of MHD patients and their complications. Starting with a sort out of existing evidence, it provides a critical analysis of the common limitations in this research field concerning syndrome differentiation standards, study design, methodology, and the verification of syndrome-efficacy correlations. Consequently, it proposes that future research on MHD patients and their complications should focus on: formulating MHD-specific syndrome differentiation criteria, conducting multicenter prospective cohort studies, promoting the in-depth integration of modern data science and systems biology methods, and strengthening the verification of interventional efficacy based on syndrome differentiation. These efforts aim to advance the construction of a standardized, objective, and dynamic TCM syndrome differentiation and treatment system for MHD complications, thereby providing a solid theoretical and evidence-based foundation for enhancing the clinical prevention and management of these complications.