OBJECTIVE: To observe the effects of modified Liuwei Dihuang decoction on fatigue and immune regulation of patients with thrombocytopenia of liver and kidney Yin deficiency type in hemodialysis. METHODS: A total of 200 cases of thrombocytopenia of liver and kidney Yin deficiency type in hemodialysis treated in the hospital from Feb. 2020 to Feb. 2022 were divided into the treatment group and control group via the random number table method. The treatment group ( n = 100) received conventional western medicine combined with modified Liuwei Dihuang decoction, while the control group (n = 100) received conventional western medicine. CD4 + and CD8 + of T lymphocytes and CD19 + of B lymphocytes, regulatory B cells ( Breg ), CD41 and CD61 of platelet membrane glycoproteins, transforming growth factor-β1 ( TGF-β1 ), interleukin-10 ( IL-10 ), interferon-γ ( IFN-γ ), thrombopoietin ( TPO) and platelet count ( PLT) before and after treatment were detected. Platelet accumulation (PCT) level was calculated, fatigue assessment instrument( FAI) score and traditional Chinese medicine syndrome score were measured. The clinical efficacy and incidence of adverse drug reactions were compared between two groups. RESULTS: After treatment, the levels of Breg and CD4 + in the treatment group were higher than those in the control group, while the levels of CD19 + and CD8 + were lower than those in the control group, with statistically significant differences (P<0. 05). After treatment, the levels of IFN-γ and TGF-β1 in the treatment group were lower than those in the control group, and the levels of IL-10 were higher than those in the control group, with statistically significant difference (P<0. 05). After treatment, the levels of PLT and PCT in the treatment group were higher than those in the control group, and the levels of TPO were lower than those in the control group, with statistically significant differences [ABSTRACT FROM AUTHOR]