Primary immune thrombocytopenia (ITP), originally known as idiopathic thrombocytopenic purpura, is a common hematologic disorder that can occur in adults and children, and is characterized by persistent thrombocytopenia with varying degrees of bleeding. It is now recognized that most of the cases have no bleeding or only a small amount of bleeding, conventional first-line treatment is not effective for these patients or they need to rely on high doses of hormones to stabilize in a safe range, while some new drugs in clinical use, such as CD20 monoclonal antibody (Merova) or TPO receptor agonists, cannot be widely promoted because of their high cost, and the course of the disease is prolonged and treatment is difficult, and about 20%-25% of them eventually turn into chronic ITP (chronicimmune thrombocytosis). chronicimmune thrombocytopenia, CITP) or refractory ITP (refractory immune thrombocytopenia, RITP). This disease belongs to the category of “blood evidence”, “epistaxis”, “grape disease” and “hair spot” in Chinese medicine, and is mostly caused by external sensation and It is usually caused by external and internal injuries, resulting in internal heat and toxicity, forcing the blood to travel; or liver stagnation and heat, resulting in loss of blood storage; or kidney yin deficiency and deficiency of fire; or heart and spleen strain and damage, resulting in failure of qi to take in blood. Jing Yue Quan Shu Blood evidence: “Blood is Yin essence, should not move, but moving is disease; Ying Qi, not easy to lose, but loss is disease. The blood is not suitable for movement, but it is a disease; Ying Qi is not easy to lose, but it is a disease. The blood is mostly due to fire, and the fire is strong enough to force the blood to move; the loss is mostly due to gas, and the gas is injured so that the blood does not exist”, “The blood is moved by fire but gas”. The “Golden Guide to Miscellaneous Diseases” systematically describes deficiency labor: “Deficiency is the deficiency of yin and yang, qi and blood, Ying and Wei, spirit, bone marrow and fluid; loss is the external skin, veins, tendons and bones, and the internal lung, heart, spleen, liver and kidney. Into labor is said to be deficient for a long time, stay unhealed, and into five labor, seven injuries, six extreme also.” In the clinical treatment of patients, the acute stage of bleeding symptoms are often heavy, when the dialectical treatment mostly highlights “fire” and “qi”, but whether “fire” or “In the chronic stage, the symptoms of deficiency are more prominent, and the pathological mechanism can be considered as “deficiency labor” in the diagnosis and treatment, and the treatment focuses on the tonicity of the five viscera; therefore, in the process of disease diagnosis and treatment, it all revolves around the deficiency and actuality of the five viscera. Therefore, in the process of identifying and treating the disease, we focus on the deficiency and actuality of the five organs. The spleen is the main organ of transportation and transformation, and is the source of Qi and blood biochemistry. Qi and blood are the basic substances that constitute and maintain the vital activities of the human body, and normal transportation and transformation of the spleen and stomach is the guarantee for maintaining the abundance of Qi and blood. As it is said, “The spleen is the main organ of the blood, and the movement of the blood depends on the spleen. The spleen is the middle earth and is responsible for transporting water and grain; the spleen has the function of regulating blood so that blood runs in the veins and does not overflow; if the spleen is deficient, the blood is not able to circulate; if the qi does not take in the blood, the blood does not return to the meridian; if it overflows upward, epistaxis and epistaxis are seen; if it floods the skin, purpura is seen; if it seeps downward, blood in the urine and blood in the stool. Ling Shu meridians and veins: “people begin to be born, first into the essence, the essence into the brain marrow, bone for the stem, veins for the camp, …… blood gas is line.” It can be seen that the formation of blood and qi begins with the essence, and “the kidneys store the essence”. The “Suwen five run the great theory” cloud: “kidneys produce bone marrow”, it can be seen that the blood begins with the essence, and the kidneys hide the essence of the five viscera and six bowels, the main bone marrow. The Su Wen Sheng Qi Tong Tian Lun (The Treatise on the Life and Health of the People) states: “The bone marrow is strong, and the blood and Qi are all from it”, reflecting that the blood production function of the essence and marrow to produce blood mainly depends on the functional state of the kidney, and the yang energy in the kidney is the driving force of blood biochemistry, which shows that the deficiency of the internal organs, especially the kidney deficiency is the key. “Insufficient kidney essence is no source of biochemistry, insufficient kidney yin is a deficiency of internal fire, burning the ligaments and veins, deficiency of yang in the kidneys is a weakness in the promotion of the internal organs and failure of the organs. The chronic phase of the disease is either due to the toxic side effects of long-term drug treatment or due to recurrent attacks, resulting in damage to the functions of the internal organs, imbalance of yin and yang, deficiency of qi and blood, especially in the spleen and kidney qi deficiency, because qi is yang, qi deficiency over time leads to deficiency of spleen and kidney yang, warming and warming, low function of the internal organs, the inability to produce qi and blood, and the lack of power to regulate and bleeding; or there is a deficiency of kidney yin, water does not contain wood, liver and kidney yin deficiency, deficiency fire burns the ligaments and see bleeding. The liver is capable of harboring the visible blood and draining the invisible qi. The liver is responsible for the storage and regulation of blood. The blood supply, blood distribution and regulation of all organs and tissues of the body are related to the liver, and the excess is hidden and the deficient is replenished. The liver is responsible for draining and regulating qi, keeping the body’s qi in and out of the body. The functions of the internal organs cannot be separated from the movement and changes of qi, and the circulation of qi and blood and the distribution of essence must be realized through the up and down of qi. The liver is not draining, the qi becomes fire; the liver is hyperactive, the phase fire is delusional; the liver is deficient in blood collection; all can lead to bleeding symptoms. The heart is the official of the sovereign, the heart is the master of the blood vessels, promoting blood flow to nourish the whole body, the spleen is the master of transportation and transformation, the source of Qi and blood biochemistry, the master of the blood, wrapping and protecting the blood to travel through the meridians, irrigating the internal organs, external moistening the limbs and bones, flowing around and nourishing the whole body, neither overflowing outside the veins, nor stagnating and stagnating, the relationship between the heart and the spleen is mainly manifested in the mutual use of blood generation and the mutual synergy of blood flow, if exertion and If the heart and spleen are damaged by exertion and excessive worry, the heart and spleen will easily become deficient in qi and blood, causing the heart and spleen to lose its function as the master of blood and blood control, resulting in the blood not working in the normal way and overflowing out of the veins. The lung is responsible for the propagation of the body’s qi, and the exterior of the skin and hair; deficiency of the lung’s body’s qi and the lack of consolidation of the muscle surface can easily lead to the invasion of external evil; if it enters the interior and turns into heat, the blood heat will travel uncontrollably. This is especially common in patients who have been using glucocorticoids and other immunosuppressive drugs for a long time, and who are weak and susceptible to external sensation, which is often the main triggering factor for the aggravation or recurrence of clinical disease. The treatment of immune thrombocytopenia in Chinese medicine can be divided into acute phase and chronic phase according to the clinical characteristics, with different symptom complaints, different treatment principles, and different focus on the internal organs. Patients in the acute phase may have newly appeared bleeding symptoms, or may have mild bleeding with sudden aggravation of symptoms, and treatment is based on strengthening hemostasis and reducing bleeding symptoms. The bleeding evidence is attributed to gas and fire, and divided into the real and virtual ends; at the same time can not be separated from the heart, liver, spleen, lungs, kidneys five organs. The “fire” must be divided into real fire and false fire, real fire is mostly blamed on the liver, false fire is mostly asked about the kidneys. The actual fire is mostly seen as cyanotic spots or plaques all over the body, especially in the chest and abdomen, or accompanied by nasal bleeding, gum bleeding, fever, thirst, red tongue and thick coating. The treatment is to clear liver fire, drain liver heat, and use drugs that clear heat and cool blood to stop bleeding. The formula is Rhizoma Dihuang Tang with addition and subtraction: Buffalo horn instead of rhinoceros horn, raw earth, peony bark, red peony, big green leaf, dandelion, etc.; if the stomach fire is mixed with inflammation and burns the ligaments, see epistaxis, add scutellaria, gypsum and asclepias; if the heart fire is mixed with hyperactivity, see irritability, add Huang Lian, gardenia and forsythia. The deficiency evidence is mostly due to repeated use of hormones or long-term use of hormones, which depletes yin and fluid over time, with skin bruising and spotting, often with gingival and nasal bleeding, irritability and thirst, redness of the cheek and hot flashes or heat in the hands and feet, red tongue with little coating and fine pulse. Treatment is to nourish kidney yin, lower deficiency fire, and use drugs that nourish yin, nourish blood and stop bleeding. The main treatment is to nourish yin, nourish blood and stop bleeding. Take Six-flavored Dihuang Pill plus or minus, Sheng Di, Dan Pi, Turtle Board, Turtle Nail, Xuan Shen, Zhi Mu, Huang Bai, Zhen Zhen Zi and Dry Lotus Grass. “Qi injury” is mainly based on deficiency evidence, Qi is the commander of blood, Qi deficiency is the inability to regulate blood, blood overflow outside the complex, see bleeding symptoms, the spleen is the middle earth, the main transport of water and grain; spleen has the function of regulating blood, so that blood runs in the veins, and does not overflow, spleen qi deficiency is the inability to take blood, blood does not return to the meridian, overflow on the epistaxis, pan in the muscle surface see purpura, so “The patient mostly sees tiredness and weakness, little food and lazy speech, thin pulse and light tongue, and a deficiency of spleen qi, Sun Simiao said: “Rong qi is deficient and dispersed, blood is also wrong.” It can be seen that this type of spleen qi deficiency as the root, the treatment should be to strengthen the spleen and benefit the qi, unify the blood and return to the meridian method, the formula is selected from the spleen of the spleen soup plus or minus, astragalus, atractylodes, poria, dang ginseng, angelica, farmer’s mace, dragon bone, oyster, roasted licorice, etc.. In the selection of drugs to stop bleeding, focus on stopping bleeding without leaving stasis, can be used Xi Cao, lotus leaf, lotus root, Xian He Cao, etc. Patients in this stage are mostly triggered by various infections, mostly respiratory tract infections such as colds that reduce platelets and aggravate clinical symptoms, so the clinical evidence can be based on the identification and treatment, with appropriate addition of antiviral effect of heat-clearing herbs, which is more effective. Patients with ITP in chronic stage have lingering disease, and the bleeding symptoms are not heavy. The main clinical manifestations of patients are weakness, yellow face, dry mouth, heat in the hands and feet, soreness and weakness of the waist and knees, and other symptoms of deficiency, accompanied by vague purple spots on the skin, or epistaxis and other minor bleeding symptoms, so the treatment should be based on the identification of the five organs, focusing on the spleen and kidneys, not forgetting to regulate the liver, and taking into account the heart and lungs, in order to reduce the causes, prevent bleeding, and promote platelet production. Patients with fatigue, dizziness, pale or yellowish complexion, lack of desire to eat and drink, pale tongue and weak pulse; because qi is the commander of blood, if qi moves, blood moves; if qi stops, blood stops; qi and blood depend on each other as if yin and yang are mutually maintained; if qi moves abnormally, blood will not return to menstruation and will overflow; we should adopt the method of strengthening the spleen and benefiting qi, nourishing blood and stopping bleeding, with the formula of Bazhen Tang plus or minus; if there is little qi and lazy speech, restlessness of the mind and restlessness of sleep at night, we can adopt the treatment of tonifying the heart and spleen, nourishing the heart and calming the mind. If the patient is lazy with little qi, has a restless mind and sleepless nights, the treatment can be based on the principle of tonifying the heart and spleen, nourishing the heart and tranquilizing the mind. Patients with hair loss, teeth shaking, waist and knee impotence, deficiency of fire on the inflammation of the heart, thirst, redness of the cheeks, or heat in the hands and feet, are suffering from deficiency of kidney essence, and the clinical method is to nourish the kidney and fill the marrow. In the treatment of this disease, Gui Fen Di Huang Wan combined with Gui Lu Er Xian Gum is added and reduced to treat the deficiency of spleen and kidney yang. Patients in the chronic stage have a long duration of illness, or long-term use of immunosuppressants, such as glucocorticoids, and are prone to external infection, mostly respiratory tract infections, treatment can take into account the supplementation of the lung and spleen qi, regulate the glory and health, solidify the exterior of the surface and have a defense, solidify the interior and have a basis for the interior, “the righteousness of the qi exists within, the evil cannot dry up”, with the traditional formula Yu Ping Feng San as the formula, can often achieve certain results. We can often achieve certain therapeutic effects. At the same time, we pay attention to regulating the liver in the treatment process, i.e., either soothing the liver and regulating the qi, or nourishing the blood and softening the liver, so that the qi can rise and fall normally, so that it can be tonified without stagnation, so as to prevent depression from turning into heat, or injuring yin or helping fire, which may aggravate the bleeding symptoms. In summary, the spleen is the pivot, strengthening the spleen is important, the spleen is the central organ, regulating the qi and blood around the body, communicating up and down, is the pivot; the kidney is the root, the kidney is deficient for a long time, there is no way to nourish the internal organs around the body, the qi and blood can not be biochemical, forming a vicious circle; the root is in the kidney, and treat the spleen, is the correct treatment; the liver is the messenger, regulating the liver to increase the effectiveness, the liver is the messenger, communicating the qi around the body, so that the organs are organized, biochemical and normal, the smooth regulation of the qi is inseparable from the draining function of the liver. Without the draining of the liver, the spleen and kidneys cannot complete their physiological functions and produce qi, blood and kidney essence without the normal rise and fall of qi. The normal physiological function of the liver requires the nourishment of kidney water, the moistening of blood, the restraint of lung gold, and the bearing of spleen earth to achieve the coordination of the five organs, the secrecy of yin and yang, and the harmony of qi and blood. In recent years, there is more and more evidence that ITP is a heterogeneous disease, and its pathogenesis includes both disorders of humoral immunity and dysregulation of cellular immunity. Studies have shown that dysregulation of the Th1/Th2 cell balance is associated with the development of ITP and that patients with chronic ITP have a dysregulated Th1/Th2 ratio; patients with severe ITP and patients with positive anti-platelet glycoprotein antibodies have significantly lower numbers of CD4+ T-cell subsets with immunomodulatory functions-CD4+CD25+ T-regulatory cells (Treg) in peripheral blood, and patients in remission or splenectomy have significantly lower numbers of CD4+CD25+ T-regulatory cells. The number of CD4+CD25+ Treg was significantly higher in patients in remission or splenectomy. In addition, studies on platelet production showed that most ITP patients had a normal or decreased platelet “turnover rate”, suggesting a deficiency in platelet production as part of the pathogenesis of ITP, which was supported by morphological studies of bone marrow. Although the number of megakaryocytes is normal or increased in ITP patients, the classification is predominantly pre-platelet-producing, and their ability to produce platelets is significantly lower, especially in C/RITP. With the progress of research on platelet production in the pathogenesis of ITP, the promotion of platelet production is gradually being considered as one of the directions of treatment for C/RITP. This disease has an immune imbalance, with both active antibodies and immunodeficiency, as well as low production capacity, which is lacking in immunosuppressive treatment. A large number of clinical and basic experimental studies suggest that the kidney, spleen and the immune function of the body are related, and drugs that strengthen the spleen and tonify the kidney have the ability to adjust the immune function and improve the immune deficiency. “Essence and blood have the same origin” and “essence and blood mutually transform”, and the Nei Jing emphasizes that “those who are deficient in form are warmed with qi; those who are deficient in essence are tonified with taste.” It is suggested that Chinese medicine kidney tonics, especially those with the effect of filling the marrow, have the effect of promoting bone marrow hematopoiesis. Modern pharmacological effects suggest that kidney tonics act on the pituitary-adrenal system and can enhance adrenocortical function or have adrenocortical hormone-like effects without the side effects of hormones. Therefore, the systemic nature of herbal treatment is more in line with the current pathogenesis of the disease, and the safety of herbal treatment also reduces the complications associated with conventional treatment, thus corroborating the efficacy of Chinese medicine in the treatment of primary thrombocytopenia and the future of its clinical application. In conclusion, the conventional use of drugs for this disease has different degrees of toxic side effects or cannot be promoted due to the high cost. Chinese medicine treatment can achieve a better therapeutic effect by formulating different treatment goals at different stages of the disease according to the symptoms and complaints, and focusing on different five organs during dialectical treatment. Therefore, following the theory of TCM, making full use of the advanced technology of modern science, finding the entry point of combining TCM and Chinese medicine, carrying out clinical and experimental research on combining TCM and Chinese medicine in the treatment of ITP, and giving full play to the respective advantages of TCM and Chinese medicine will become the main goal at present.