The concept of treating disease before its onset in TCM has advantages in the diagnosis and treatment of precancerous lesions，while the management of pancreatic precancerous lesions faces challenges in both diagnosis and treatment.The strategies for the diagnosis and treatment of pancreatic precancerous lesions are not perfected and warrant further exploration.Disease differentiation and treatment outperforms syndrome differentiation and treatment for the asymptomatic patients.This paper reviews the progress in TCM research on pancreatic precancerous lesions，clarifies the significance of disease differentiation and treatment for pancreatic precancerous lesions，proposes a five-step disease differetiation and treatment approach：judging the disease location in the liver or spleen，the disease nature being steady or changing，the syndrome being accumulation or aggregation，the disease mechanism of pathogen excess or healthy qi deficiency，and the disease tendency of progression or remission.This review aims to provide new ideas for the clinical prevention and treatment of pancreatic precancerous lesions and to serve as a reference for establishing a precise differentiation and treatment system for this disease.