The objective of this systematic review and meta-analysis was to determine whether there exists sufficient scientific evidence that Chinese herbal medicine (CHM) can be an effective treatment for immune-mediated thrombocytopenia (ITP). Literature was obtained through PubMed, Library & Information Resources Network, Google Scholar, Science Direct, and China National Knowledge Infrastructure, using keywords “purpura, thrombocytopenic, idiopathic”, “medicine, Chinese traditional”, and “veterinary medicine”. The studies that qualified for meta-analysis were controlled trials reporting outcomes with at least one of the following endpoints: effective rate, platelet count (PLT), adverse reactions, immune function indicators. A total of 174 articles were reviewed with 89 qualified studies undergoing meta-analysis. Study results indicated that CHM, either alone or combined with conventional Western medicine (CWM) had significantly better outcomes compared to CWM alone in terms of overall effective rate, post-treatment PLT, and incidence of side effects (all p<0.0001). Additionally, studies with classic CHM formulas (Gui Pi Tang, Liang Xue Hua Yu Tang), used alone or integrated with CWM, demonstrated significantly better outcomes when compared to CWM on overall effective rate and post-treatment PLT (all p<0.01). This systematic review and meta-analysis provide evidence that CHM, alone or combined with CWM for treating ITP, has significant advantages over CWM alone, including improved clinical outcomes, enhanced immune regulation, and fewer adverse reactions. These results are noteworthy for veterinarians. Due to limitations in quality of some studies and a scarcity of veterinary clinical trials, this systematic review and meta-analysis highlights the need for more rigorous randomized double-blind controlled trials, especially in veterinary patients.