Since its proposal in the 1980s, Task-Based Language Teaching (TBLT) has become a pivotal direction for global foreign language teaching reform due to its philosophy of emphasizing “learning by doing” and focusing on linguistic meaning and communicative functions. China’s basic education English curriculum reform has also incorporated TBLT into curriculum standards and advocated its implementation in classrooms. However, after more than two decades of localized practice, TBLT has encountered numerous dilemmas in Chinese classrooms: the coexistence of theoretical advocacy and practical deviation, as well as formal imitation and substantive alienation. This paper systematically sorts out the theoretical core of TBLT, deeply analyzes the practical constraints it faces in China such as large class sizes, examination pressure, and teachers’ professional competence, summarizes the specific manifestations of the dilemmas, combs through domestic scholars’ attempts at localized improvement, and explores the possible paths for the integration of TBLT with China’s examination system.