Abstract: Hepatocellular carcinoma (HCC) develops within a profoundly immunosuppressive tumor immune microenvironment (TIME), which limits the efficacy of immunotherapy. Polarization of tumor-associated macrophages (TAMs) toward a protumorigenic M2 phenotype is a major driver of immune escape. Ferroptosis—an iron-dependent, regulated cell death program—intersects with hepatic iron metabolism and immune regulation and thus offers promising points of therapeutic intervention. Here, we systematically delineate how TAM ferroptosis contributes to immune evasion in HCC and explore, under the Traditional Chinese Medicine (TCM) principle of “fortifying healthy qi and eliminating pathogens, ” the potential of heat-clearing and detoxifying, qi-tonifying, and blood-invigorating strategies to reverse immunosuppression via modulation of TAM ferroptosis. Precisely inducing ferroptosis in M2-like TAMs may selectively deplete immunosuppressive cells, rebalance the M1/M2 ratio, and enhance antitumor immunity. Leveraging TCM’s multi-target, synergistic actions enables bidirectional regulation of iron metabolism and TAM polarization, highlighting a systems-level capacity to remodel the TIME. Targeting TAM ferroptosis represents an innovative strategy for HCC immunotherapy; integrating TCM-based approaches may inform new combined regimens. The translational potential of this paradigm warrants validation through multi-omics profiling and well-designed clinical studies.