Aplastic anemia （AA） is a hematological disorder caused by bone marrow hematopoietic failure due to multiple factors， and its pathogenesis is relatively complex， mainly involving the hematopoietic microenvironment and immune abnormalities. Based on the traditional Chinese medicine （TCM） theory of "essence and blood homology"， this paper explores the pathogenesis of AA from the perspectives of the balance between liver and kidney， spleen and kidney， and kidney

yin

and kidney

yang

. It considers "kidney deficiency and marrow exhaustion" as the fundamental pathogenesis. Treatment should be guided by the principle of "tonifying the kidney and replenishing the essence and marrow"， and， according to the clinical syndrome， should also include nourishing liver

yin

and strengthening spleen

qi

to balance kidney

yin

and kidney

yang

and regulate the functions of the

Zangfu organs

. This approach provides new insights and methods for the clinical diagnosis and treatment of AA with integrated TCM and Western medicine.