Objective: To explore the efficacy of TCM Sandplay on the psychological and behavioral symptoms of preschool children with ASD. Methods: Sixty children with ASD were randomly divided into two groups, each with 30 people. The control group adopted comprehensive intervention strategies such as structured education; the experimental group received TCM Sandplay intervention on top of the control group. Both groups used the Autism Behavioral Assessment Scale (ABC) to score before, 2 months after, and 4 months after intervention. In addition, the experimental group also used the TCM sand tray five element analysis method to score the sand tray works before, 2 months after, and 4 months after intervention. Results: There was a significant difference in the total number of sand tray space toys between the experimental group before and after intervention (P<0.05), and the number of sand tray space toys increased after intervention. There was also a significant difference in the traffic of the sand tray space before and after intervention in the experimental group (P<0.05), with the traffic of the sand tray space strengthened after intervention. Within the two groups, there were significant differences in the total scores and scores of various aspects such as sensation, interaction, movement, language, and self-care before and after intervention (P<0.05). Between the two groups, there were no significant differences in the scores of sensation, movement, and self-care 2 months after intervention (P>0.05), but there were significant differences in the scores of interaction and speech (P<0.05), and the experimental group’s scores were lower than the control group’s. At 4 months after intervention, there were significant differences in the total scores and scores of various aspects for both groups (P<0.05), and the total score of the experimental group was lower than that of the control group. Conclusion: TCM sandplay can significantly improve the psychological and behavioral symptoms of preschool children with ASD.