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¡Á109/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.
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