In China, thrombocytopenia is generally defined as a total platelet count of less than 100*109/L in routine blood tests, and the diagnosis of thrombocytopenia should be determined not only by the results of one test, but also by multiple tests combined with microscopic examination and clinical manifestations. The diagnosis of idiopathic thrombocytopenia should be determined by combining multiple examinations with microscopic examination and clinical manifestations. Idiopathic thrombocytopenic purpura (also known as immune thrombocytopenic purpura, abbreviated as ITP, hereafter referred to as ITP) is one of the more common diseases of thrombocytopenia. At present, it is still an acquired bleeding disorder of unknown cause, clinically characterized by thrombocytopenia, normal or increased megakaryocytes in bone marrow, and unknown etiology. In clinical practice, I believe that the following aspects still deserve our vigilance: 1. The etiology of this disease is still unknown, and the main view is that the human body has produced anti-platelet autoantibodies, which destroy too many platelets and lead to thrombocytopenia; however, there are also new views that the inhibition of megakaryocyte hematopoiesis leads to reduced platelet production; the rise in platelet-related immunoglobulins leads to increased platelet clearance, etc. may also be one of the mechanisms leading to its pathogenesis. We should continue to research and explore, from the macroscopic point of view of Chinese medicine combined with the microscopic research of Western medicine, to find out the mechanism of its pathogenesis. 2. Diagnostic aspects. Attention should be paid to differentiate it from secondary thrombocytopenic purpura. Especially in patients with mild to moderate enlargement of the spleen, poor hormone therapy, and disease duration greater than 3 months, attention should be paid to differentiate from autoimmune diseases, myelodysplastic syndrome, atypical infections, etc. Bone marrow cytomorphology, bone marrow pathology, autoantibodies and infection-related indicators should be reviewed regularly (every 3 months) to exclude secondary thrombocytopenic purpura. I have treated 3 patients diagnosed with ITP with poor outcome, 2 of which were finally diagnosed with SLE and 1 with gastric mucosa-associated lymphocytic lymphoma, which warrants our vigilance. 3. In terms of treatment principles and goals. ITP is a benign disease, but its condition is prone to recurrence and the platelet count may fluctuate greatly, and some patients and their families may suffer from the decline of platelet count in clinical practice. The main risk of ITP is bleeding, and patients with acute severe thrombocytopenia may be at risk of life-threatening bleeding, such as intracranial or gastrointestinal bleeding. Therefore, the goal of treatment for ITP is to stop bleeding, not to raise the platelet count to “normal”. The focus should be on the presence or absence of combined bleeding and not on the platelet count. Patients with ITP who have a platelet count greater than 30*109/L and no clinical bleeding do not require special treatment. I have encountered many patients with ITP who used hormones on their own for a long period of time without following medical advice and subsequently had femoral head necrosis; I have also encountered patients with ITP whose platelets fluctuated between 30 and 50*109/L and who took small doses of oral hormone maintenance therapy on their own for a long period of time. We hope that patients and their families will fully communicate with their treating physicians to understand their treatment goals and treatment methods, assess the risks and benefits of treatment, and adjust the treatment plan under the guidance of physicians. 4. As for the status of TCM treatment. From the medical literature, it is clear that the efficacy of TCM in the treatment of ITP is positive. The combination of Chinese and Western medicine in the treatment of ITP is lower than the relapse rate of ITP treated by Western medicine alone, and the therapeutic efficacy is better, without obvious toxic side effects. Is it safe to say that the combination of Chinese and Western medicine should be preferred for the treatment of ITP? It should be noted that in today’s civilized society, which emphasizes the patient’s and family’s right to know about the disease and the right to choose the treatment, and in the Chinese medical environment, where the doctor-patient relationship is relatively tense, physicians are more likely to give diagnostic and therapeutic advice, and we cannot make treatment decisions for the patient in a preconceived way. In conclusion, the etiology of ITP is not yet clear, so the diagnosis should be made with caution, and the identification of secondary thrombocytopenia should be noted in patients with poor outcome and recurrent clinical disease; the clinical bleeding symptoms should be the main observation target, and the platelet count is for reference only; the combination of Chinese and Western medicine is more effective in the treatment of ITP, but the specific treatment plan should be made by patients and their families based on full communication with their primary care physicians. The decision should be made by the patient and his family based on full communication with his primary care physician. Of course, there are still questions to be answered about the treatment of ITP such as splenectomy, use of immunosuppressants, and application of combination chemotherapy, but it is believed that if doctors and patients communicate, trust each other, and work together, the difficult problems will be solved.