Idiopathic thrombocytopenic purpura (ITP), also known as primary immune thrombocytopenic purpura, is a group of bleeding disorders caused by immune-mediated excessive platelet destruction, characterized by extensive skin mucosal and visceral bleeding, thrombocytopenia, impaired maturation of bone marrow megakaryocyte development, shortened platelet survival time and the appearance of platelet membrane glycoprotein-specific autoantibodies, which are the most common bleeding disorders It is the most common bleeding disorder. According to the clinical manifestations, the disease can be divided into acute and chronic forms, with the acute form being more common in children and the chronic form in adults. Because the disease mainly manifests as bleeding from different parts of the body, it belongs to the categories of “blood evidence”, “hair spot”, “grape disease” and “epistaxis” in Chinese medicine. “Epistaxis” and other categories. At present, the State Administration of Traditional Chinese Medicine Key Specialties Collaborative Group of Traditional Chinese Medicine Hematology has named it “purpura”.
Etiology and pathogenesis
This disease is mainly caused by external evil, diet, emotion, exertion and long term illness. The disease is mainly caused by external evil, diet, emotion, strain and long term illness. The general external evil is mostly the evil of dryness and heat. The I Ching says: “The one who dries everything is indifferent to fire”. The dry heat of external sensation may correspond to the accumulated heat in the stomach and the same gas, and the accumulated heat in Yangming is getting heavier, or because of depression and anger injury to the liver, the liver and gallbladder fire, the poison of fire and heat is getting worse, depression but not hair, all can stay in the meridians, hurt the blood, overflow in the skin and develop epistaxis. Cover blood as if the ground of water also, the nature of the static, fire disturbance then blood moving, the more the fire and the more the blood is moving, so the blood to fire and delusional line, the so-called “fire not depressed can not spot”. The first disease is more heat and poisonous, for the actual evidence, long delayed but not cured, more turned to deficiency evidence. The disease may be caused by poor diet, injury to the spleen and stomach, resulting in deficiency of the spleen and stomach, loss of its function of control, blood overflowing outside the veins and bleeding, or excessive labor and fatigue and injury to the vital energy, or after a long illness, the internal organs are damaged, deficiency of qi, blood, yin and yang and the onset of disease. If the kidney yin is insufficient, the deficiency fire will move inside, forcing the blood to move and bleeding. If Yang Qi is depleted, Qi deficiency does not take in, and blood does not follow the meridians, bleeding can also occur. Blood stasis may be caused by Qi deficiency, or Qi stagnation, or bleeding. The main pathogenic mechanism is blood-heat, Qi deficiency and blood stasis. Blood-heat is also divided into deficiency and reality, while blood stasis is not pure. In mild cases, purple spots appear on the skin; in severe cases, internal organs and cranio-cerebral hemorrhage are complicated.
Symptomatological features
In mild cases or chronic cases, the disease may only show thrombocytopenia in laboratory tests without obvious bleeding manifestations; in most patients, the main manifestations are petechiae, epistaxis, oral blisters, etc. In severe cases, the disease may be accompanied by vomiting blood, blood in stool or cranial hemorrhage and other acute and critical illnesses. The clinical evidence is often divided into four types of treatment according to the pathogenesis: blood-heat delusion, liver and gallbladder fire, yin deficiency and fire, and qi not regulating blood. In the case of blood-heat delusion, the onset of bleeding is rapid and severe, with large amounts of bright red, subcutaneous purpura, or petechiae in patches, frequent epistaxis, blood oozing from the gums, blood blisters on the oral mucosa and tongue, often accompanied by fever, dry mouth, sore throat, yellow and red urine, and dry stools; in the case of liver and gallbladder fire, it may be due to external evil attack, depression in Shao Yang, or due to emotional disorders, qi stagnation, and qi depression turning into fire. The symptoms include purpura of the skin, epistaxis of the teeth and nose, bitterness of the mouth, dryness of the throat, stuffiness in the chest, impatience and irritability, or with cold and heat, yellow urine, etc. The symptoms include purpura scattered, sometimes faint, purple-red color, epistaxis of the teeth and nose, irritability of the five hearts, night sleep and night sweating, dizziness, soreness of the waist and knees, excessive menstruation in women, etc. The symptoms include lack of color or atrophy, recurrent epistaxis, pale red blood, fatigue, shortness of breath, and weakness. The symptoms include a dull or yellowish complexion, recurrent epistaxis, pale red blood, fatigue, shortness of breath, and spontaneous sweating.
Diagnosis and treatment
The treatment of this disease should be based on the basic pathogenesis, combined with the evidence of deficiency and actuality, the related internal organs and the urgency of bleeding. It can be summarized into three principles: treating fire, treating qi and treating blood. Treating fire: for real fire, it is appropriate to clear heat and remove fire; for deficiency fire, it is appropriate to nourish Yin and clear heat. Treatment of qi: in the case of actual qi, the treatment is to clear heat from the liver and gallbladder; in the case of deficiency of qi, the treatment is to strengthen the spleen and benefit the qi. Treatment of blood: according to the etiology of bleeding, appropriate use of cool blood to stop bleeding, astringent to stop bleeding, and stasis to stop bleeding.
1. Blood-heat delusion
Main symptoms: Acute onset, severe bleeding, large amount and bright red, purpura under the skin, or petechiae in patches, frequent epistaxis, blood oozing from the gums, blood blisters on the oral mucosa and tongue surface.
Concurrent symptoms: fever, dry mouth, sore throat, yellow and red urine, dry stool.
Tongue and pulse: red tongue, thin yellow coating, floating or slippery pulse.
Treatment: Clearing away heat and fire, cooling the blood and stopping bleeding.
Prescription: Rhizoma Rhizoma Dihuang Tang with Yin Qiao San plus or minus.
30g of water hyacinth or 1.0g of antelope horn powder for decoction. 15g of Radix Rehmanniae Praeparata, 10g of Salviae Miltiorrhizae.
Radix Paeoniae 10g Yinhua 15g Lianxiao 10g Banlangen 20g
Raw rhubarb 6g Comfrey 15g Temperate bamboo leaf 6g Panax notoginseng powder 2,0g, flushed
Add and subtract: for epistaxis, add Scutellaria baicalensis, Radix Bupleurum, and Ochraceae to clear heat from the lung and induce blood flow downward; for epistaxis, add Sheng Shi Fa, Huang Lian, and Zhi Mu to clear heat from the stomach; for blood in the stool, add Sophora japonica and Di Yu; for blood in urine, add Xiaoxi thistle and Lotus root to clear heat and diuresis to stop bleeding.
Description of prescription: This evidence is mostly seen in patients with acute onset of disease, often due to external heat inducing real fire, and the clinical evidence of hemorrhage is caused by the fire in full bloom moving blood and burning the veins and collaterals, but mostly seen in the evidence of epistaxis of the teeth and nose, petechiae of the skin and blood blisters in the mouth, etc. Therefore, we follow Wu Jutong’s “Wenzhi Zhuandian”, “For blood overflowing from above, Rhizoma Rhizoma Dihuang Tang combined with Yin Qiao San is the mainstay. This formula is based on the meaning of Wu Jutong’s “Wenzhi Zhuandihuang Tang and Yin Qiao San”. The formula is based on the following principles: (1) the blood is cooled and the blood is drained; (2) the blood is cooled and the blood is drained; (3) the blood is cooled and the blood is drained; (4) the blood is drained and the blood is drained; (5) the blood is drained and the blood is drained; (6) the blood is drained and the blood is drained; (7) the blood is drained and the blood is drained.
Chinese patent medicine treatment.
1, antelope Huang Liang blood granules: (Langfang Hospital of Traditional Chinese Medicine formula: antelope horn powder, dandruff, raw earth yellow, chasteberry, white peony, asparagus, maitong, scutellaria, platelet root, licorice) 10g / time, 3 times a day, orally, or as prescribed by the doctor.
2, Jiangnan rolled cypress tablets: 5-6 tablets / time, 3 times a day, orally.
3, platelet capsule: 4 capsules / time, 3 times a day, orally.
2, liver and gallbladder fire evidence
Main symptoms: purpura of the skin, epistaxis of the teeth and nose, bitter mouth and dry throat, irritability, yellow urine.
Complications: or with cold and heat, chest fullness.
Tongue and pulse: red tongue, yellow coating, string or slippery pulse.
Treatment: Drain the liver and clear heat, cool the blood and stop bleeding.
Prescription: Chai Hu and Mucuna pruriens with addition and subtraction.
Radix Bupleurum 10g, Radix Scutellariae 12g, Radix Mucuna Pruriens 10g, Radix Artemisiae 15g
Radix Rehmanniae 15g Sempervivum 20g Verbena 15g Radix Bupleurum 30g
Gentiana 10g Glycyrrhiza 6g
Addition and subtraction: If liver fire offends the stomach and the heart is agitated with vomiting, add Hanxia to harmonize the stomach and subdue the rebellion; add Citrus aurantium and Yu Jin if the Qi stagnation is heavy; add Sha Shen and Mai Dong if liver fire burns the fluid; add Sheng Longmu and Ephedra root if night sweating is obvious.
Explanation of the formula: In this formula, Chai Hu dredges the liver and clears heat, resolving Shao Yang; Scutellaria baicalensis and Gentiana gentiana clear the liver and diarrhea; Mucuna pruriens and Artemisia annua enter the liver and gallbladder meridian, and together with Chai Hu, they can dredge the wind and clear heat; Xie Cao and Xian He Cao stop bleeding; Verbena officinalis clears heat and detoxifies, activates blood circulation and disperses stasis; Bai Mao Root clears water and heat, cools the blood and stops bleeding, causing heat to come out of the lower jiao. The combination of all these medicines can clear heat from the liver and cool the blood to stop bleeding.
Traditional Chinese medicine treatment.
1.Chai Huang Blood Granules: (Langfang TCM Hospital formula: Chai Hu, Rhubarb, Scutellaria, Mucuna Pruriens, Semen, Verbascum, Antelope horn powder, Shi Wei, Panax notoginseng, Xian He Cao, Mudanpi, Xi Cao, Red Peony) 12g/time, 3 times a day, orally, or as prescribed by the doctor.
2.Gah Wei Yi Yao Wan: 6g/time, 2 times a day, taken orally.
3.Yin deficiency and fire evidence
Main symptoms: purpura scattered in, sometimes hidden, purple-red color, bleeding from teeth, epistaxis or excessive menstruation in women.
Concurrent symptoms: irritable heat in the five hearts, night sleep and night sweating, dizziness, soreness and weakness of the waist and knees.
Tongue and pulse signs: light dry tongue with little fluid or red tongue with little moss and fine pulse.
Treatment: Nourishing Yin and clearing heat, cooling the blood to stop bleeding.
Prescription: Zhi Bai Di Huang Tang with Xie Gen San, plus or minus.
Zhi Mu 12g, Huang Bai 10g, Radix Rehmanniae 20g, Dan Pi 12g
Radix et Rhizoma Ligustrum 15g, Radix Araliaceae 15g, Radix Macrocephala 15g, Radix asparagus 15g.
Cyperus rotundus 15g Cyperus rotundus 10g Phellodendron spp. 10g
Add and subtract: If this evidence is associated with liver qi discomfort and qi stagnation turning into fire, adopt the method of nourishing yin and clearing liver heat, which can be treated with the basic formula of zhi kidney and liver clearing heat (witness the treatment of heart enlightenment); if bleeding is serious, add white foxglove root, lotus root and earth rhubarb to strengthen the function of stopping bleeding; if yin is deficient and yang is hyperactive, add calcined dragon mud and tortoise shell to nourish yin and submerge yang; if tidal fever is obvious, add ground bones, artemisia and white wormwood to clear deficiency heat; if stasis is trapped, add angelica and red peony.
Explanation of the formula: The formula uses Zhi Mu and Huang Bai to clear heat and lower fire, and clear the deficiency heat of the kidney meridian; Sheng Di Huang and Dan Pi to nourish Yin and cool the blood; Mai Dong and Tian Dong to nourish Yin and lower fire; Female Zhen Zi and Dried Lotus Grass to nourish the liver and kidney; Xi Cao to cross the heart and kidney water and fire, nourish blood, resolve blood stasis and stop bleeding; Xian He Cao and Phellodendron Leaf to cool the blood and stop bleeding. The combination of all the drugs plays a role in nourishing Yin and clearing heat, cooling the blood and stopping bleeding.
Chinese patent medicine treatment.
1.Chai Lian Sheng Blood Granules: (Langfang Hospital of Traditional Chinese Medicine formula: Dihuang, Lady’s Maidenhair, Dry Lotus Grass, Antelope’s Horn Powder, Chai Hu, Mucuna Pruriens, Scutellaria Baicalensis, Verbascum, Xianhe Cao, Xie Cao, Peony Bark, Stone Reed, Semen) 12g / time, 3 times a day, or as prescribed by the doctor, taken orally.
2, Zhi Bai Di Huang Wan: 9g / time, 2 times a day, orally; combined with Jiangnan Rolled Cypress tablets: 5-6 tablets / time, 3 times a day, orally.
4, Qi does not take in blood evidence
Main symptom: Long-standing illness with recurrent epistaxis and epistaxis of the nose and teeth, with light red blood color.
Complications: lack of color or atrophy, fatigue, shortness of breath, and spontaneous sweating.
Tongue and pulse: light and fat tongue with tooth marks, thin coating, sunken or weak pulse.
Treatment: Strengthening the spleen and benefiting Qi, regulating blood to stop bleeding.
Prescription: Gui Spleen Tang with addition and subtraction.
Radix Codonopsis pilosulae 15g, Astragalus membranaceus 30g, Rhizoma Atractylodes Macrocephalae 10g, Fructus Longan 10g
Mullein 6g Poria 10g Agaricus 10g melted Semen Hesperus 30g
Yam 10g Blood Yu Char 10g Roasted Licorice 10g Panax Ginseng Powder 2,0g Flushing
Addition and subtraction: If palpitations are obvious, add Yuan Zhi and Wu Wei Zi; if menstruation is dripping, add Chuan Jian Char, Palm Char, etc.; if Qi deficiency is mixed with stasis, add Chicken Blood Vine, Pu Huang Char, etc.
Explanation of the formula: This symptom is commonly seen in chronic patients, which requires long treatment period and slow onset of effect. The formula uses Radix et Rhizoma Ginseng and Radix Astragali to nourish Qi, strengthen the spleen and regulate blood; Longan flesh to nourish blood and harmonize the camp; Poria, Atractylodes and Rhizoma Polygonati to strengthen the spleen and help transport; Agaricus to nourish blood and stop bleeding; Mu Xiang to regulate the middle and guide stagnation, so as to nourish but not nourish; Xianhe Cao to nourish deficiency and astringent to stop bleeding; Blood Yu Char to stop bleeding; Panax notoginseng powder to resolve blood stasis and stop bleeding, so that blood stops without leaving stasis; roasted licorice to strengthen the spleen and stomach and harmonize all medicines. The combination of these herbs can benefit Qi, strengthen the spleen, regulate blood and stop bleeding.
Chinese patent medicine treatment.
1.Chai Shu Sheng Blood Granules: (Langfang Hospital of Traditional Chinese Medicine formula: Chai Hu, Astragalus, Atractylodes, Radix Codonopsis, Scutellaria, Mucuna Pruriens, Semen, Senna, Verbascum, Panax ginseng, Mudanpi, Shi Wei) 12g/time, 3 times a day, taken orally, or as prescribed by the doctor.
2.Ginseng Ginseng and Spleen Pill: small honey pill 9g/time, 2 times a day, orally.
3.YiXiSheng capsule: 4 capsules/time, 2 times a day, orally.
Complications
1.Bleeding
Bleeding is the main symptom of the disease, treatment should be based on the principle of treating the symptoms of the disease in an emergency and treating the root of the disease in a slow manner, based on evidence-based treatment, to strengthen the treatment of hemostasis in the acute stage of bleeding with large volume and urgency, so as to prevent the loss of Qi with blood. This is the main key to cure the disease, reduce complications and shorten the course of the disease. The clinic should strictly grasp the disease mechanism, correctly administer the treatment, and adjust it in combination with different bleeding parts. For epistaxis: the nose is the lung orifice, treatment should be based on the identification of the symptoms with the addition of Scutellaria baicalensis, Baimao root and Lotus root; for congestion of lung fire, use Diarrhea Lung San; for liver fire, use Gentian and Liver Diarrhea Tang. Blood oozing from the gums: although the teeth belong to the kidney, the full mouth belongs to the stomach, and the gums are surrounded by the stomach meridians, so epistaxis is always seen as a result of inflammation of the stomach fire and blood moving with the fire. For vomiting blood and blood in stool: vomiting blood is mostly in the stomach, treated with diarrhea of the heart and clearing the stomach, accompanied by lowering the qi, so that the qi is smooth and the vomiting stops, then the blood does not run off. The formula Four Flavors Stopping Blood (Bai He Powder, San Qi Powder, Agaricus Root Pearl, Pu Huang Char) with rhubarb charcoal is finely ground, add 30g of lotus root powder and 200ml of water, boil it into a paste, 10g each time, and take it orally 3 times a day to treat hematological gastrointestinal bleeding, which is also effective. Blood in urine: Blood in urine is caused by heat in the bladder. Treatment is based on the identification and treatment of thistle, dry lotus grass, raw ground yu, white foxglove root and panax ginseng powder. Vaginal bleeding: Most of the bleeding is due to deficiency of the spleen or deficiency of qi in prolonged illness, so that the blood has no place to return to. Intracranial hemorrhage: It is an acute and dangerous symptom of the disease, and is also the main cause of death in this disease. The early stage of hemorrhage before coma can be added with Angong Niuhuang Wan, and the later stage is treated according to the closed or decompensated evidence of Chinese medicine.
2.Glucocorticoid side effects
Modern medicine takes glucocorticoids as the first choice for the treatment of this disease, and it needs to be applied in large quantities for a long time, which is mostly accompanied by weakness, easy externality, five heartburn, night sweating, burning sensation in the stomach and epigastrium, acid reflux, edema and other symptoms, or even bone pain, lumbago and femoral head necrosis due to calcium loss. Weakness and susceptibility to external sensation are mostly due to glucocorticoid-induced immune deficiency, i.e., the deficiency of positive qi and the failure of the external guard in Chinese medicine. For edema, add Poria, Daggerbelly, etc. to promote water and dampness; for bone disease, add Eucommia, Niubizi, Tonic Bone Paper, Dragon Bone, Oyster, etc. to nourish the liver and kidney and strengthen the tendons and bones.
The heart of the treatment
1.Beware of the disease mechanism, it is advisable to identify the deficiency and the urgency
The basic pathogenesis of this disease is blood-heat delusion, yin deficiency and fire and deficiency of qi and blood in the internal organs, so clearing heat and detoxification, nourishing yin and cooling blood, and tonifying qi and regulating blood are the main treatment for this disease. The three should be focused according to different conditions and strict attention should be paid to grasp the disease mechanism. This disease is clinically divided into deficiency, actual, slow, and acute, the actual is mostly acute ITP or the first attack, with heat and toxicity trapped in the blood or Yangming stomach heat is predominant, the deficiency is mostly chronic ITP, with spleen qi weakness, lack of power to regulate and yin deficiency and fire, forced blood delusion, with kidney yang deficiency or blood stasis and other changes, and more mixed deficiency and reality, the pathogenesis is more and more complex. For treatment, the main treatment for real fire is to clear heat and detoxify the toxin, supplemented by cooling the blood to stop bleeding; for deficiency fire, the main treatment is to nourish yin and clear heat, supplemented by cooling the blood to stop bleeding; for deficiency, the main treatment is to nourish the spleen and benefit the qi, regulating the blood to stop bleeding. If the bleeding is too much and the condition is critical, the principle of treating the symptoms in an emergency and treating the root cause in a slow manner should be followed, first stopping the bleeding and treating the symptoms, then when the condition is stable and the purpura is reduced, the treatment will be turned to supporting the root cause. The disease is difficult to treat persistent disease, is the original deficiency and the standard real, or real more deficiency less, or deficiency more real less, should be according to the standard deficiency and real urgency, weigh the priorities, successive priorities in order, not to commit the precept of deficiency real.
2.Stop bleeding and prevent retention of blood stasis
This disease is dominated by various kinds of bleeding. “In case of heat and blood stasis, it is advisable to add red peony, dandruff, Radix et Rhizoma, Panax notoginseng, Panax notoginseng, etc. on the basis of evidence to activate blood circulation and eliminate stasis; in case of Qi deficiency and blood stasis in prolonged illness, if the blood is purple in color and there are signs of stagnation, Pu Huang char, Radix et Rhizoma notoginseng, Dandruff char, Danshen, Radix et Rhizoma notoginseng, Panax notoginseng powder, etc. should be used to make the blood stasis go, then the blood vessels will be opened, and the blood will return to the normal path and the blood will stop. The blood will return to the normal path and the bleeding will stop.
Some patients may have weakness, shortness of breath, and other signs of qi deficiency; and the long-term use of hormones leads to internal heat of yin deficiency, manifesting as heat in the heart and night sweats; repeated bleeding may cause nervousness, fearing that the bleeding is life-threatening, or the liver may be injured due to emotional disorders, depression and anger, which leads to liver qi discomfort and fire, or liver fire moves blood and further aggravates bleeding. The symptoms of bleeding may be aggravated by burning kidney water, or by Yin deficiency and internal heat. The main pathogenesis is heat in the liver meridian and yin deficiency in the liver and kidney, so the principle of treating from the liver and regulating qi is proposed. In the case of actual fire in the liver and gallbladder, the formula Chai Hu Mu Thiang Tang is given to clear heat from the liver and cool the blood to stop bleeding. If the liver is deficient in qi and the yin deficiency is high in fire, we use the method of nourishing yin and clearing liver heat, and give the basic formula of zhi kidney and liver clearing heat. For Qi deficiency, add Astragalus and Radix Codonopsis. In this formula, Radix Bupleurum, Scutellaria Baicalensis and Antelope horn powder are used to clear heat from the liver; Radix et Rhizoma Polygonati, Radix et Rhizoma Polygonati and Radix et Rhizoma Dioscoreae nourish the liver and kidneys; Radix et Rhizoma Cyperus, Radix et Rhizoma Polygonati and Radix et Rhizoma Danpi cool the blood and stop bleeding; and Radix et Rhizoma Polygonati and Radix et Rhizoma Aconite strengthen the function of nourishing blood and stopping bleeding.
Dietary regimen
The acute bleeding of the disease is serious, to enter light and easy to digest food, with gastrointestinal bleeding fasting. The usual use of ice borax, tin type of san in 500ml of saline, daily before and after meals rinse mouth to keep the mouth clean and can prevent infection. Chronic patients should also eat a light diet, eat more fresh vegetables and foods containing high collagen, prohibit spicy and stimulating taste. The actual fact is that you will be able to get a lot more than just a few of these.
The food therapy principle of purpura disease can be formulated according to its pathology key and main pathological links. The food therapy for acute type can follow the principle of clearing heat and cooling blood; chronic type can benefit qi and nourish blood, warm yang and nourish kidney food composition.
Food therapy formula.
1, two fresh drink: fresh white mullein (chopped) 150g, fresh lotus root (sliced) 200g, boil the juice for tea to drink frequently, 1 dose a day, serve until the heat subsides spot elimination, for blood heat delusion.
2, five fresh juice: fresh raw earth, fresh thatch root, fresh lotus root, fresh watermelon skin, fresh pear 30g each, add water decoction to get juice for tea, drink frequently, 1 dose daily, suitable for those with Yin deficiency fire.
3, jujube porridge: 15g of jujube, 100g of round-grained rice, add water and cook porridge, take 1 dose each morning and evening daily. Long service can be effective, suitable for those who do not take in blood.
4, general treatment formula: the following prescriptions, because of the wide range of application, generally do not need to identify the evidence, especially for patients to choose their own, so called general treatment formula.
① beans and dates ice sugar soup: 100g white lentils, 20 red dates, ice sugar 50g, add water and stew into soup soup that is ready, eat 1 dose each morning and evening.
② peanut turtle date pot: peanut (with clothes) 50g, red dates 10, turtle meat 120g, into the sand pot, stewed over moderate heat until cooked, 1 dose daily.