Immune thrombocytopenia (ITP) 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 megakaryocytes, shortened platelet survival time, and the appearance of platelet membrane glycoprotein-specific autoantibodies. It is the most common form of thrombocytopenic purpura and is divided into primary and secondary forms. Primary forms are mostly autoimmune-mediated and secondary forms can be caused by a variety of factors. Primary thrombocytopenic purpura can be divided into acute type and chronic type. The acute type is common in children aged 2-9 years old and often has a history of upper respiratory tract infection, especially viral infection, 1-2 weeks before the onset of the disease. The onset of the disease is rapid, there may be fever, chills, sudden extensive skin and mucous membrane bleeding, even large petechiae and subcutaneous hematoma, platelet count below 20×10^9 may have visceral bleeding, such as vomiting blood, black stool, hemoptysis, drowning, vaginal bleeding, and even intracranial hemorrhage, as the main cause of death. The chronic form is common in adults and is more common in women. The onset of the disease is insidious, and the platelet count is often found to be reduced during physical examination. It may manifest as bleeding from the skin and mucous membranes, such as petechiae, petechiae, bleeding from the nasal mucosa and gums, and bleeding that does not stop easily after trauma. Chronic type can be aggravated if the disease is repeatedly infected with external evil, with extensive and serious bleeding of skin mucosa and even internal organs. 1.Etiology and pathogenesis Because it is mostly manifested as skin mucous membrane bleeding or visceral bleeding, it belongs to the category of “blood evidence”, “epistaxis”, or “hair spot” in Chinese medicine. Although blood evidence is mostly manifested as purpura and petechiae on the skin and mucous membrane, its occurrence is closely related to qi, blood, yin and yang, and internal organ lesions, and both external and internal injuries may trigger the disease. The evil poison is contained within: the external evil attack, contained in the poison is an important cause of the disease, acute type is such. Especially in children, because the couples are not dense and the surface guard is not solid, it is easy to suffer from external evil attack. “The children feel the external evil easily from the Yang to heat, the evil poison and the qi and blood fight, burn the blood, blood overflow outside the veins, stay in the skin, then the purpura. If the evil toxin is strong and the veins and ligaments are seriously damaged, large or multiple petechiae will be seen. If the evil toxin is contained inside, blood rises with the fire and goes up to the clear orifice, then you can see vomiting blood, epistaxis, moving heat to the lower jiao, burning the Yin ligament, then you can see blood in the stool, drowning blood, as “Danxi Hand Mirror – Hair Spot” says: “Hair spot, heat incandescence also.” Yin deficiency and fire: In Zhu Danxi’s “Pingzhi Huai Zui”, it is said, “The yang channel is real, the vagina is deficient, the yang channel is always spare, the vagina is always lacking, the yang is always surplus, the yin is always deficient. The birth of a person is also to 14 years and the menstruation, to 49 and the menstruation is broken, it can be seen that the Yin blood is difficult to become easy to lose. Yin is easy to lose, the evidence of the change of delusion in the upper, then epistaxis, decay solid in the outside, then deficiency labor, delusion back to the lower, then red stool.” Therefore, Yin deficiency and fire can often cause epistaxis and hair spots. Tang believes that Yin deficiency is mostly caused by a variety of factors such as emotion, diet and fatigue, resulting in internal injury to the internal organs and deficiency of stomach yin and kidney yin, resulting in Yin deficiency and fire exuberance, especially the deficiency of kidney essence is more important. Qi knot is blood condensation, Qi deficiency is blood off, Qi compulsion is blood away.” The qi mentioned here is the spleen. Tang believes that the spleen can produce blood as well as take in blood, but he believes that if the spleen and stomach are damaged by poor diet or are weak, especially in children, the spleen is often deficient, so there is a lack of source for the biochemistry of qi and blood, and the spleen tends to lose control of qi and blood. Stasis of Blood: Weakness of Spleen and Stomach or deficiency of Kidney Essence can cause deficiency of both Qi and Blood, Qi is the Commander of Blood, Qi deficiency will not be able to push Blood to run. Blood is the guard of qi, and less blood will lead to dispersion of qi. Therefore, qi stagnation does not work, and poor blood flow will lead to local blood stagnation, which will block the blood in the veins and make the blood not travel in the normal way and overflow outside the veins and see blood evidence. In addition to the large area and multiple parts of the purple paralysis, there are also other parts of the bleeding, the most common being the nasal chick and hard teeth, and in more serious cases, there is often internal bleeding, such as kidney bleeding, urinary and digestive bleeding, vomiting blood, stool blood, lung bleeding (hemoptysis), intracranial bleeding (epistaxis), etc. etc. The disease is dangerous, deteriorates rapidly, and can also die from bleeding (about 5%) At this time, the urgent treatment of its symptoms, clearing heat and detoxifying, cooling the blood to stop bleeding, is its priority, commonly used Rhizoma Dihuang Tang, San Huang Tang, Hu Zhan Tang and other additive application. The patient with thrombocytopenic violet palsy, after the acute bleeding period, enters the chronic phase, this period needs to be in addition to the chronic phase of patients with primary thrombocytopenic violet palsy, to Qi deficiency, spleen deficiency, kidney deficiency, blood addiction, to distinguish between different situations, treatment should be focused. In addition to recurrent episodes of thrombocytopenia, there is also weakness, lumbago, heartburn, bleeding in the eyes of the teeth. It is advisable to treat both the symptoms and the root cause. Nourish the spleen and blood, nourish the liver and kidney. The formula is based on the combination of Guei Spleen Tang, Liu Wei Di Huang Tang and Xi Gen San.