<p>Aplastic anemia (AA) is a life-threatening blood disorder characterized by bone marrow failure and pancytopenia. Treatments such as immunosuppressive therapy (IST) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) have limitations, including poor long-term remission and donor shortages. Exosomes, nanosized extracellular vesicles, are promising drug delivery systems (DDS) due to their biocompatibility, targeted delivery, and capacity to penetrate biological barriers. Traditional Chinese medicine (TCM) regulates hematopoiesis and immunity but faces challenges with delivery. This review discusses exosomes loaded with TCM constituents (Exo-TCM) for AA, summarizing AA pathogenesis, exosome features, TCM potential, Exo-TCM preparation, and preclinical efficacy, and translational challenges, highlighting Exo-TCM as a novel therapeutic approach for AA.</p> Graphical Abstract <p></p>