The Tibetan Plateau (TP), the most massive elevated landform in the Northern Hemisphere, serves as a powerful atmospheric heat source that anchors the Asian monsoon system and profoundly influences East Asian climate patterns. Although extensive research has yielded fruitful results regarding the TP’s thermal anomalies and their climatic effects, a systematic review of its dynamic mechanisms in driving multi-scale precipitation and extreme events over the Middle and Lower reaches of the Yangtze River (MLYR) is still lacking. Centered on the “thermal forcing-circulation response-precipitation processes” framework, this paper systematically reviews the mechanisms by which the TP’s atmospheric heat source affects precipitation in the MLYR. The review first addresses methods for quantifying the TP heat source, highlighting their uncertainties and spatiotemporal characteristics. We then comprehensively elucidate the core physical mechanisms through which the TP heat influences key atmospheric circulation systems via two pathways: “background state modulation” and “direct thermal forcing.” At upper levels, the TP’s thermal forcing governs the intensity and position of the South Asian High (SAH) and the seasonal migration of the subtropical westerly jet. At mid-levels, it acts as a primary source of Rossby wave trains that remotely influence the Western Pacific Subtropical High (WPSH). At lower levels, the “Sensible Heat-driven Air Pump” (SHAP) effect reshapes the monsoonal flow and establishes critical water vapor transport channels. Subsequently, the review synthesizes how these multi-level circulation adjustments translate into specific precipitation patterns over the MLYR. Two distinct configurations for persistent heavy rainfall are identified: the PSAH type, characterized by robust vertical coupling between an eastward-extended SAH and a westward-extended WPSH sustained by the rainfall-related ascent anomaly, and the NSAH type, which features a westward-extended WPSH but with a westward-retreated SAH. Furthermore, we introduce a novel framework of “scenario-dependent roles” to describe the TP’s function in extreme events. Specifically, it acts as a “primary driver” under weak external forcing (e.g., neutral ENSO), a “synergistic amplifier” when phase-locked with favorable oceanic conditions, or a “passive modulator” when strong external forcings like La Niña dominate. Our synthesis reveals that the TP’s thermal forcing is not an isolated, static driver, but rather exhibits a complex synergistic interaction with large-scale background states, such as tropical sea surface temperatures. The combination of these multiple forcing factors ultimately determines the triggering and amplification of extreme precipitation events. Finally, future research priorities are outlined to bridge existing knowledge gaps. These include advancing from analyzing the heat source’s total intensity to disentangling the differential climatic impacts of its vertical profile; moving beyond correlation to quantitative attribution of the TP’s role in specific extreme events; and overcoming data scarcity by developing a benchmark heat source dataset through the fusion of multi-source data. Addressing these challenges is crucial for advancing scientific understanding and enhancing the predictive capability for precipitation variability and extremes in the MLYR.