Chronic idiopathic thrombocytopenic purpura (CITP) refers to patients with immune thrombocytopenia with a disease duration of 12 months or more. Most scholars believe that this disease is related to the immune dysfunction of the body, but the exact pathogenesis is not clear. Modern medical treatment for CITP includes adrenocorticosteroids, biological agents, Danazol, immunosuppressants, chemotherapeutic drugs or monoclonal antibodies, etc. Some patients have achieved certain clinical efficacy, but the effect of these drugs cannot last, the side effects are large and even serious complications occur, and the treatment is expensive and easy to relapse after cure, so it can not meet the clinical needs. In our department, we have achieved satisfactory results by using the “spleen and kidney method” to treat CITP from the spleen and kidney, and our experience is summarized as follows. 1. Theoretical basis for treating CITP from spleen and kidney Traditional medicine classifies CITP as “blood evidence” [1], with bleeding from skin, mucous membrane or internal organs as the main clinical manifestation, and various manifestations such as epistaxis, epistaxis, epistaxis, epistaxis, vomiting blood, vomiting blood, blood in stool, blood in urine, and leakage in the collapse can be seen. Common clinical patterns include: (1) deficiency of both qi and blood, (2) deficiency of spleen and kidney, (3) deficiency of liver and kidney, and (4) deficiency of both yin and yang. All of them are based on the deficiency of qi, blood, yin and yang, and all of them are closely related to spleen and kidney. (1) Theoretical basis for treating CITP from the spleen First of all, the spleen is the origin of the posterior, the source of Qi and blood biochemistry, the five organs and six bowels all rely on the spleen and stomach to transport the water and grain essence to feed, such as “Suwen Ping Ren Weather Theory” said: “People are based on water and grain, so people die without water and grain.” And the spleen is the master of blood, “difficult Jing” cloud “spleen is the master of blood, warm five organs”, spleen is sufficient, the blood is strong, restrain the blood flow in the veins, spleen deficiency, the control is weak, more bleeding disorders. Therefore, Tang Rongchuan said: “treatment of blood, must be the main treatment of the spleen”. Secondly, this disease has a long course and complex characteristics. Due to the long-standing disease, the patient often sees the deficiency of Qi, blood, yin and Yang in all five organs, and for this complicated situation, it is often appropriate to treat from the spleen. In this complex situation, it is often advisable to treat the spleen. The “Spiritual Pivot to the End”: “Both yin and yang are deficient. If this is the case, we can use sweet medicine.” This so-called sweet medicine is the medicine to nourish the spleen. On this basis, later generations further proposed the principle of “treating deficiency of Qi and blood in all five organs. Zhou Shenzai even pointed out that “all diseases that do not heal should be treated from the middle.” The importance of spleen tonification in the treatment of chronic diseases was emphasized. For example, Professor Lu Zhizheng [2], a famous contemporary doctor, made good use of the theory of spleen and stomach in treating difficult diseases, believing that the spleen and stomach are in the center as the pivot of qi rising and falling, connecting the four organs by transporting up and down, and regulating the spleen and stomach can stabilize the five organs, which is the fundamental method for treating complex diseases. Lu’s view elevates the treatment of the spleen to the fundamental method for treating all miscellaneous diseases. Third, CITP patients often have immune deficiencies, such as susceptibility to HP infection, while HP infection in turn can lead to the prolongation and recurrence of the disease, “where the evil comes together, its qi will be deficient”, suggesting the pathological state of CITP patients with deficient middle Jiao vital energy. Therefore, it is important to benefit the qi and strengthen the spleen in the clinical consultation. (2) The theoretical basis for the treatment of CITP from the kidney The “Health Treasure Book” says: “internal injury hair spots, spots like mosquito and flea bites, scar thin and slightly red, this lower yuan yin fire deficiency”, coupled with the fact that most CITP patients have a history of long-term use of hormones, animal experiments have confirmed that hormones are equivalent to strong warming Yang medicine, long-term application can feedback inhibit the hypothalamus-pituitary-adrenal cortex -The pituitary-adrenocortical axis function, after the withdrawal of hormones appears adrenocortical dysfunction, can lead to imbalance of the body’s yin and yang, so the treatment of CITP can not be without taking care of the lower yuan; “Ji Sheng Fang” proposed that the spleen should also be supplemented with kidney, “if the kidney is strong, Dantian fire through the upper steam spleen earth, spleen earth gentle, the central jiao autonomy. The Spleen and Earth are gentle and the Middle Jiao is autonomous.” Therefore, warming the kidney and filling the essence is used to treat the root of the problem. In addition, for CITP, which is prone to recurrent infection or has chronic foci of infection, tonifying the kidney to treat the root can also help to drive out the evil, as stated in Jing Yue Quan Shu, “To drive out the evil, it is not from the essence and blood, but can’t be reached by profit”. 2. Case presentation Yang, female, 33 years old, visited the clinic on March 25, 2011. Complaint: Recurrent subcutaneous bleeding from both lower extremities for more than 1 year, aggravated for 2 months. In March 2010, the patient had skin bleeding on both lower extremities with no obvious cause and no obvious itching. The leukocyte and red blood cell morphology was generally normal, and platelets were rare; bone penetration report: active proliferation, G=68%, E=17%, the proportion and morphology of granulocytes and red blood cells were generally normal, red blood cell morphology was normal, the proportion of lymphocytes and monocytes were normal. The total number of megakaryocytes in the whole film was 45, including 42 granular giants, 2 naked giants and 1 naked giant. The diagnosis of “ITP” was made with anti-double-stranded DNA antibody (-), anti-nuclear antibody (-), anti-cardiolipin antibody (-), and lupus index test (-), and the patient was given dexamethasone tablets 40mg d1-4 days orally, and after two weeks, he took the same dose orally for 3 courses. After stopping the hormone, PLT gradually dropped to about 10G/L. Western doctors suggested to use hormone again, but the patient refused to take it again and turned to Chinese medicine, and had taken traditional Chinese medicine (Comfrey, henbane, salvia, fangfeng, pu huang, antelope horn powder, Xianhecao, Chaihu, scutellaria, platelet root, etc.) for 5 months without any reduction in bleeding, and PLT was still below 20G/L. The patient has lived in Beijing for a long time and has not been exposed to obvious chemical pollutants or strong radiation. At the time of consultation, the patient’s symptoms were: weakness, sore throat, dry mouth, warmth, average appetite, thin stool, acceptable urine. Physical examination: red pharynx, hyperplasia of lymphatic follicles in the posterior pharyngeal wall, scattered bleeding spots in both lower extremities, not obstructed by touch, not fading by pressure, red tongue, thin white coating, sunken pulse. Blood count: WBC5.49G/L, HgB138g/L, PLT10G/L. Traditional Chinese medicine diagnosis: blood evidence (purpura), identified as spleen and kidney deficiency, deficiency fire on inflammation. Western medicine diagnosis: chronic immune thrombocytopenia. Treatment is to tonify the spleen and kidney and induce fire to return to the meridian. Prescription: Radix Rehmanniae 10g each, Radix Angelicae Sinensis 6g, Radix Paeoniae Alba 10g each, Radix Ginseng 30g, Radix Ginger 10g each, Radix Cinnamomum Cassiae 10g, Poria 10g, Rhizoma Atractylodis Macrocephalae 10g, Rhizoma Zedoariae 10g, Radix Danpi 10g, Radix Bupleurum Chinense 10g, Jujube 10, 14 doses. Second consultation on April 8, 2011: WBC4.49G/L, HgB135g/L, PLT8G/L, sore throat improved, but blood oozing from the gums, heavy menstrual flow, lingering for 10 days, light red blood, red tongue, thin white fur, sunken pulse. The diagnosis is that the spleen does not regulate the blood and the blood does not return to the menstrual flow. Treatment is to benefit Qi and regulate Blood. Prescription: Radix Astragali 90g, Radix Codonopsis Pilosulae 30g, Rhizoma Atractylodis Macrocephalae 10g, Radix Angelicae Sinensis 3g, Rhizoma Polygonati 3g, Rhizoma Polygonati 10g, Rhizoma Polygonati 10g, Rhizoma Longan 10g, Rhizoma Polygonati 20g, Rhizoma Fu Ling 30g, Radix Ginger 15g, Radix Ginger 10g, Jujube 10, Fructus Schisandrae 6g, Radix Glycyrrhiza Uralensis 10g, Poria 10g, Cornu Cervi Pantotrichum 10g, Radix Rehmanniae 20g, Dampi 10g, Rhizoma Zedoaria 10g, Rhizoma Lotus Root Char 10g Taken 14 doses. April 22, 2011: WBC5.51G/L, HgB142g/L, PLT6G/L, only a small amount of blood oozing from the gums, while the PLT is decreasing but not increasing, with a red tongue, thin white coating and weak pulse. The diagnosis is spleen-kidney Yang deficiency. Treatment is to tonify the spleen and benefit the kidney. Prescription: Radix Rehmanniae Praeparata 30g, Radix et Rhizoma Ginseng 30g, Cortex Phellodendron 10g, Rhizoma Atractylodis Macrocephalae 10g, Poria 10g, Radix Angelicae Sinensis 10g, Rhizoma Dioscorea Z 30g, Radix Danpi 10g, Radix Zeleniae 10g, Radix et Rhizoma Phellodendron 6g, Radix Ginger 10g, Radix Glycyrrhiza Uralensis 10g, Radix Platycodon grandis 6g, Radix Dates 10, Fructus Lycii 20g, Radix Rehmanniae Sinensis 30g, Radix et Rhizoma Ginseng 10g (decoction separately). On May 19, the fourth consultation, the patient only see cold pain in the abdomen, like warmth, like to press, to the period when the menstruation does not end, etc., the tongue light red, thin white moss, weak pulse. PLT18G / L. The patient showed that the lower yuan deficiency cold, spleen and kidney deficiency of the original, in the above to remove the yellow cypress plus with two to pill and mugwort, aromatic herb warming the uterus to regulate menstruation. After this method with the symptoms to add reduction. To August 10, 2011 (seven consultation), recheck PLT150G / L, all the evidence are removed, no significant discomfort. She was then given herbs to tonify the kidneys and strengthen the spleen to improve her condition. According to the current understanding of the pathogenesis of CITP in Western medicine, the use of hormones and immunosuppressants to inhibit antibody production and activate T-cell function in the treatment can achieve short-term results, but the PLT will drop again in most patients, so it cannot solve the fundamental problem. According to traditional Chinese medicine, bleeding disorders are mostly caused by evil heat drying the blood and forcing the blood to move delicately; or deficiency of spleen qi and failure of qi to take in blood; or deficiency of liver and kidney yin and inflammation of deficiency fire. In our long-term clinical practice, we have observed that the pathogenesis of CITP is mostly based on the deficiency of the spleen and kidneys, and treatment should be to benefit the spleen and kidneys. In this case, the patient had sore throat and dry mouth, and the former doctor thought that the real fire, so he used antelope horn powder, scutellaria baicalensis, panax quinquefolium and other heat-clearing products, and took many doses, but the effect was disappointing, obviously not the real fire. The patient had a history of high-dose hormone application, and he felt cold pain in the abdomen, which is a deficient body of the lower yuan. This fire is the true element is not enough to support, so the syncope and inflammation, the fire in the water should not be head-on, quickly extinguish it? The reason should help its remaining Yang, when the kidney key spleen, reconciliation of yin and Yang, submerged Yang to the lower as the method. In the Essence of Pinhui, it is said that Xuan Shen has the function of eliminating the swelling of the throat and dipping the rootless fire; in the Book of Living People, Xuan Shen is the sacred medicine for treating the dense air and rootless fire. The combination of Xuan Shen and Di Huang Tang can make the deficiency fire return to the lower yuan and return to its original position. Since the patient likes hot food and has less food and nourishment, this is the evidence of deficiency of middle yang, so dry and ginger are used to warm the spleen and stomach to help transport and digestion, which can help the patient to enhance food and drink, and can also transport the drugs to increase the effect of medicine. The patient’s throat is the gateway to the lung. The patient’s sore throat indicates that there is evil in the lung guard, therefore, Gui Zhi Tang is applied to expel evil externally and regulate yin and yang internally. At the time of the second consultation, the patient had heavy menstrual flow, which lasted for a long time, and epistaxis. From the Western medical point of view, excessive bleeding depletes the body of platelets and clotting factors. In this case, the principle of “treating the symptoms when urgent” should be adopted, and it is appropriate to stop the bleeding first. The patient’s blood color is light red regardless of menstruation or epistaxis, so it is because the spleen does not regulate blood. The formula is supplemented with Wu Wei Zi sour and sweet to astringent yin to stop bleeding, Lotus root charcoal and White fungus root to stop bleeding. At the same time, qi is lost with blood and both qi and blood are lost, so qi should be tonified and blood nourished at the same time. “The tangible blood cannot be generated quickly, the invisible qi should be fixed urgently”, “qi can generate blood”, so increase the dosage of Huang Qi. This diagnosis to save the emergency as the most important. The third diagnosis of body deficiency with cold, spleen and kidney deficiency has been revealed, but there is still gum bleeding, visible deficiency fire has not been exhausted, still forcing the Yin blood overflow, add the use of Phellodendron, Radix et Rhizoma. Zheng Qin’an said: Phellodendron endowed with the cold water of winter and into the kidney, yellow color and into the spleen, the spleen and kidney with Gu, Phellodendron and fire with the same gas and taste pungent, according to its cave house and recruiting, the same gas and seek, fire will fall. Combined with Huang Tang, which nourishes the kidney yin, and Radix Aconiti, which is a steep tonic for the yuan yin and yuan yang, the true qi can be latent and not go upward, while warming the middle jiao, the spleen and kidney are both nourished. The herb “Huiyin”: “The sapodilla is the main medicine of the Gate of Life, can enter its cave point and recruit it, lead the fire to the yuan, then the floating fire is extinguished”. The fourth diagnosis of the spleen and kidney deficiency cold symptoms are fully revealed, the method of tonifying the kidney and strengthening the spleen remains unchanged, at the same time the patient has a deficiency of the uterus, pay special attention to the application of the medicine to warm the uterus and regulate menstruation, otherwise the menstruation is more than, blood from the lower leakage, the previous work is lost. The person who treats blood is good at treating qi, and in the use of warm tonic-based Chinese medicine with the long-term application of Qing tonic Western ginseng. Ginseng, Radix et Rhizoma Ginseng and Radix et Rhizoma Polygoni are all effective in tonifying Qi. Ginseng has the strongest power to tonify Qi, but it is warm and dry in nature, which is easy to induce fire and move blood, so it is not suitable for this patient; Radix et Rhizoma Ginseng is not as strong as Ginseng and Radix et Rhizoma Polygoni, and the patient’s Qi deficiency is more, while Radix et Rhizoma Ginseng is not as strong; Radix et Rhizoma Polygoni is sweet, slightly bitter and cool in nature, which can tonify Qi and nourish Yin, clear heat and generate fluid. On the one hand, the patient was not confused by the “fire evidence”, such as sore throat and dry mouth, and focused on the return of true yang; on the other hand, the patient was treated at the root of the disease, and the spleen and kidney were tonified together.