Objective To analyze the characteristics of tongue images and Chinese medical syndromes in primary Sj?gren''s syndrome （pSS） patients with hemocytopenia, and to study its related factors. Methods Totally 210 pSS patients in line with the inclusion criteria were enrolled from 243 patients who visited Department of Chinese Medical Rheumatism, China-Japan Friendship Hospital from December 2018 to May 2022. They were assigned to group A and B according the presence or absence of hemocytopenia. The differences in tongue images, Chinese medical syndromes, and immune inflammation indices were analyzed. Logistic regression analysis was used to analyze the factors associated with hemocytopenia in pSS patients. Results Totally 86 （40.95%）patients with hemocytopenia in group A and 124 （59.05%） patients without hemocytopenia in group B. pSS patients in group A commonly had cracked tongue, less tongue fluid, and white tongue coating. Pi-qi deficiency syndrome and Gan-Shen yin deficiency syndrome were more often seen. Compared with group B, pSS patients in group A had a higher proportion of less tongue fluid, thin tongue coating, and Pi-qi deficiency syndrome （P<0.05）. Logistic regression analysis showed that less tongue fluid [OR=2.197, 95%CI （1.128, 4.280）, P=0.021], Pi-qi deficiency syndrome [OR=2.861, 95%CI （1.340, 6.106）, P=0.007], positive anti-SSA antibody [OR=3.051, 95%CI （1.168, 7.966）, P=0.023], and decreased level of complement 3 （C3） [OR=2.992, 95%CI （1.404, 6.374）, P=0.005] were positively correlated with hemocytopenia in pSS patients. Conclusions Pi-qi deficiency syndrome and Gan-Shen yin deficiency syndrome were more often seen in pSS hemocytopenia patients. Less tongue fluid, Pi-qi deficiency syndrome, positive anti-SSA antibody, and lowered C3 were positively correlated with pSS patients with hemocytopenia.