Integrating "Yang transforming Qi and Yin constituting the body" with immune regulation: an evidence synthesis of multidimensional traditional chinese medicine therapy for immune thrombocytopenia

Immune thrombocytopenia (ITP) is an acquired autoimmune hemorrhagic disorder with a substantial incidence globally across all age groups. Its pathogenesis involves the accelerated immune-mediated platelet destruction and impaired platelet production due to dysfunctional megakaryocyte maturation interactively. ITP is primarily treated by glucocorticoids and intravenous immunoglobulin in Western medicine conventionally. However, these therapies exhibit several limitations such as corticosteroid dependency, increased risk of infection, treatment resistance, and frequent relapse, despite its obvious efficacy in rapidly elevating platelet counts. In contrast, traditional Chinese medicine (TCM) attributes the pathogenesis of ITP (under "blood syndrome" or "purpura disease") to an imbalance in the fundamental TCM principle of "Yang transforming Qi and Yin constituting the body". By targeting both pathological platelet destruction and insufficient platelet production, TCM exerts multidimensional therapeutic effects in ITP, with clearly elucidated mechanisms demonstrated by active components from single herbs and compound formulations. The integration of TCM with Western medicine has shown promise in enhancing the therapeutic outcomes of the latter therapy while mitigating their side effects. Accordingly, the present study intends to systematically review the mechanisms of TCM in ITP, summarize recent research advances, analyze current challenges, and propose future research directions. This work is expected to provide potential foundation for further investigation and clinical application of TCM in ITP.