Thrombocytopenic purpura is an autoimmune disease.
This disease also involves the spleen and often occurs in children and young adults.
The incidence in females is higher than in male. In TCM, the disease is categorized
as "ji niu" (subcutaneous hemorrhage) "fa ban" (purpura),
etc.
Main Points of Diagnosis
The disease can be divided into acute
type and chronic type according to the clinical manifestations and courses.
1.
Acute type of thrombocytopenic purpura is commonly found in adolescents. In most
cases, the patients have a previous history of viral infection. The onset of the
disease is sudden, manifested as chill, fever and obvious hemorrhage in skin and
mucosa. Chronic type of the disease is often seen in females. The onset is slow
with mild symptoms. There may appear alternation of attack and remission in a
certain period.
2. Physical examination of acute type reveals no particular
signs but infection and hemorrhage, while in chronic type which is recurrent in
attack, spelenomegaly may be the only finding.
3. Laboratory test: Blood test
shows a sharp reduction of platelet count in acute type, usually less than 20×109/L.
The bleeding time is prolonged associated with poor contraction of blood clot.
The picture of bone marrow in acute type shows an increased promegakaryocytes,
with smaller bodies and few granules inside the cells most of which are immature,
and there is no formation of platelets, while in chronic type, there is an increase
of megalocaryocytes, in which mature cells dominate in number, but granulae inside
are smaller in number, indicating their poor function of producing blood.
Differentiation
and Treatment of Common Syndromes
1. Bleeding due to Blood-Heat
Main symptoms
and Signs: Sudden onset with fever, purple and deep-colored purpuras which are
great in quantities and in stretches or epistaxis and hematuria with bright color,
flushed face, irritability, deep-red tongue with dry and yellowish fur, slippery
and rapid pulse.
Therapeutic Principle: clearing away pathogenic heat and
toxic materials, cooling blood to stop bleeding.
Recipe: Decoction of Buffalo
Horn and Rehmannia with additional ingredients.
buffalo horn
or buffalo
horn (decocted prior to others)
dried rehmannia root
red peony root
moutan
bark
scrophularia root
arnebia root
forsythia fruit
field thistle
All
the above ingredients, except buffalo horn which is to be mixed with the finished
decoction, are to be decocted in water for oral administration.
In addition
to the above ingredients, 15 grams of rubia root and 30 grams of hairy vein agrimony
should be prescribed for treating cases with profuse bleeding; 30 grams of gypsum
and 10 grams of anemarrhena rhizome for cases with thirst and fondness for cold
drink; 6 grams of rhubarb (decocted later) for cases with restlessness and constipation.
2. Hyperactivity of Fire due to Yin Deficiency
Main Symptoms and Signs:
More purpuras in purple and red color, especially in the low extremities and appearing
and fading at frequent internals, dizziness, tinnitus, hot sensation in the palms
and soles irritability, night sweat, bleeding from the gum, epistaxis, profuse
menstruation, red tongue with reduced saliva, thready and rapid pulse.
Therapeutic
Principle: Nourishing yin and removing pathogenic heat from blood to arrest bleeding.
Recipe: Modified Bolus for Replenishing Vital Essence.
dried rehmannia
root
prepared rehmannia root
tortoise plastron
anemarhena rhizome
phellodendron
bark
eclipta
glossy privet fruit
donkey-hide gelatin
moutan bark
wolfberry
bark
biota tops
All the above herbs are to be decocted in water for oral
administration.
3. Deficiency of the Spleen-Qi
Main Symptoms and Signs:
Pink purpuras which appear and fade from time to time, sallow complexion, lassitude
and listlessness, dizziness, palpitation, poor appetite, pale tongue with little
fur, weak pulse.
Therapeutic Principle: Reinforcing the spleen and tonifying
qi and guiding blood to go back to the vessels.
Recipe: Modified decoction
for Invigorating the Spleen and Nourishing the Heart.
astragalus root
codonopsis
root
white atractylodes rhizome
poria
Chinese angelica
white peony
root
longan aril
eclipta
donkey-hide gelatin
Chinese date
prepared
licorice root
All the above herbs are to be decocted in water for oral administration.
As for cases with persistent purpuras and splenomegaly, add 3 grams of notoginseng
powder (taken after being mixed with the finished decoction), 6 grams of prepared
aconite root are added for chronic cases marked with aversion to cold, cold limbs,
aching pain of the loins and loose stool.
Dr. Ming's TCM Medical Center,
Hua
Xi Xiao Yuan, Hutian Developing Area,
Huaihua city, Hunan province
China