Abstract: Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by immune-mediated platelet destruction, resulting in thrombocytopenia and an increased risk of bleeding. First-line therapies, such as corticosteroids and intravenous immunoglobulin, can achieve short-term disease control but are limited by adverse effects, high relapse rate, and inadequate responses in a subset of patients. As a key non-pharmacological therapy in traditional Chinese medicine, acupuncture exerts holistic regulation and multi-target intervention. By modulating the neuro-endocrine-immune network and restoring immune homeostasis, acupuncture has emerged as a promising adjunctive treatment for ITP. At the innate immunity level, acupuncture regulates the activity of antigen-presenting cells, attenuates excessive activation, and suppresses pro-inflammatory responses, thereby mitigating aberrant autoantigen presentation. Within adaptive immunity, acupuncture contributes to immune balance by suppressing pathogenic antibody production in B cells and rebalancing T-cell subset homeostasis, characterized by suppression of effector T-cell hyperactivation and enhancement of regulatory T-cell function. This review summarizes recent evidence on acupuncture-mediated immunomodulation and ITP pathogenesis, delineating the cellular and molecular mechanisms through which acupuncture may restore immune homeostasis. By integrating fragmented findings, we aim to clarify the multi-cellular and multi-pathway synergistic effects underlying its therapeutic actions, thereby providing a mechanistic rationale for acupuncture as a complementary strategy and supporting the optimization of clinical management for ITP.