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Thrombocytopenic Purpura And Traditional Chinese Medicine In China

 

 

 

 

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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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