Allergic purpura is a common capillary allergic hemorrhagic disease, whose main pathological basis is allergic capillaritis, with skin purpura, gastrointestinal mucosal bleeding, painful joint swelling and nephritis as the main clinical manifestations, and a few patients are also accompanied by angioneurotic edema. The symptoms of upper respiratory tract infection such as low fever, sore throat and general malaise are often present one to three weeks before the onset of the disease. The first symptoms are mainly papulopapular purpura with symmetrical distribution and varying sizes on the extremities and buttocks of the lower limbs in batches, which may be accompanied by urticaria or edema and erythema multiforme. In the course of the disease, there may be hemorrhagic enteritis or arthralgia, and in a few patients, abdominal pain or arthralgia may occur 2 weeks before the appearance of purpura, and severe cases may be accompanied by purpura nephritis and various neurological symptoms.
There is no unified name for allergic purpura in ancient Chinese medical books, according to its clinical manifestations, it is mostly classified as “purpura”, “grape disease”, “spotted rash”, “muscle The name of the disease is not yet unified in ancient Chinese medical texts. As Chao Yuanfang said in the Treatise on the Origin of Various Diseases: “The disease of spotted poison is the result of heat entering the stomach, and the stomach is the main muscle, its heat and poison accumulate in the stomach, and the poisonous gas fumigates the muscle, and the appearance is like the sting of a mosquito, and the face is red and spotted all over the body”. In recent years, the National Key Specialist Collaborative Group of Chinese Medicine Hematology of the State Administration of Traditional Chinese Medicine named it “purpura” according to its clinical characteristics.
Etiology and pathogenesis
The external cause of this disease, or feel the six evil spirits, or diet, or drug poison injury; internal cause is mostly endowment deficiency. If the blood from the meridian overflows the skin and mucous membrane and becomes purpura; if the dampness and heat are internal and injure the spleen and stomach, it can be seen as abdominal pain and blood in the stool; if the dampness and heat undermine the blood of the kidney and bladder or the heat is strong and injures the yin, if the yin deficiency is hot, then blood in the urine; if the long term disease causes the deficiency of the spleen and kidney, if the qi is not fixed, then the essence will leak out. In the course of the disease, the blood that leaves the meridian becomes stasis blood, “Blood of the meridian is clear blood, but clear blood is also stasis blood”.
Syndromic features
The clinical type of this disease varies, but most of them have skin purpura as the first manifestation. The skin purpura is red or purplish red, higher than the skin, does not fade when pressed, may be accompanied by itching, fever, bad wind, dry mouth, sore throat, etc., with dampness can be accompanied by heavy head and body tiredness, sticky mouth and bitterness, swollen and painful joints, etc.; damp-heat conjunctive evidence can be seen in the skin scattered purpura, accompanied by dullness, abdominal distension, abdominal pain, or sticky stool, or even blood in the stool; yin deficiency fire evidence purpura is light red, sometimes hidden, sometimes visible. The purpura is light red in color, sometimes faint, feeling soreness and weakness of the waist and knees, irritability of the heart, hot flashes and night sweats, dizziness, dry mouth and dry throat, etc.; the purpura is scattered with recurrent attacks, and will occur when exerted, and will not heal, light red in color, accompanied by less color, fatigue and shortness of breath, poor appetite, etc. The purpura of spleen and kidney yang deficiency is vague and scattered, or the purpura disappears, only the urine protein and occult blood continues to be difficult to disappear, and may be accompanied by white face, cold limbs, weakness of the waist and knees, or loose stools, or unhealthy urination, swollen face and limbs.
Identification and treatment
The first stage of allergic purpura, the evil is mainly, manifesting wind and blood heat or damp heat, so the treatment should be to remove wind and heat, cool the blood and nourish the luo, clear the damp heat. If the disease is prolonged, it can be seen as qi deficiency, yin deficiency, yang deficiency, etc. The treatment is to benefit qi, nourish yin and warm yang respectively. For those with blood stasis, the treatment should be based on activating blood circulation and removing blood stasis.
1. Wind-heat and blood-heat evidence
The main symptom: the condition is acute, widespread skin purpura, fused into patches, bright red or purple-red, higher than the skin surface, does not fade when pressed.
Concurrent symptoms: fever, bad wind, dry mouth, sore throat, itching.
Tongue and pulse: red tongue with yellow coating and floating pulse.
Treatment: Drain wind and clear heat, detoxify and cool the blood.
Prescription: Rhizoma Rhizoma Dihuang Tang with Yin Qiao San plus or minus.
Rhizoma Polygonati 20g first decoction, Rhizoma Dihuang 20g, Mudanpi 10g, Radix Paeoniae 10g
Forsythia 10g, Bulbus Fritillaria 20g, Peppermint 10g, followed by Comfrey 15g
Cicadelle 10g Cyperus 10g Rutabaga 15g Glycyrrhiza glabra 10g
Addition and subtraction: add Bai Xian Pi and Di Shen Zi for itchy skin; add Angelica sinensis, Bai Shao and Bai Zhi for obvious abdominal pain; add Sheng Shi Fa, Fang Qi and Sheng Cao Ren for swollen and painful joints; add Shan Dou Gen, Ban Lan Gen and Burdock for sore throat; add Xiao Thistle and Bai Mao Gen for blood in urine.
The formula elaborates: the beginning of allergic purpura is mostly this evidence. If you are in the right place, you can get rid of the evil and the disease will be cured. The formula replaces rhinoceros horn with bitter, salty and cold water hyacinth, which cools the blood, clears the heart and detoxifies the heat, so that the fire and heat are reduced and the poison is relieved. Goldenseal, forsythia, peppermint, pungent and cool to clear wind-heat in the upper jiao; cicada moth to disperse wind-heat and penetrate the rash; comfrey and cyperus to cool the blood and stop bleeding; rhizome to clear heat and generate fluid, and licorice to clear heat and detoxify, and to harmonize all the medicines. The combination of these herbs can clear the wind and heat, detoxify and cool the blood.
Chinese patent medicine treatment.
1.Didan cool blood granules: (Langfang Hospital of Traditional Chinese Medicine formula: raw Dihuang, peony bark, Zi Cao, Banlangen, Bai Xian Pi, Gentian Cao, Lonicerae, Lian Qiao, etc.) 15g/time, 3 times a day, taken orally.
2.Feng Feng Tong Sheng San: 6g/time, 2 times a day, taken orally. This formula is used with caution for deficient and pregnant women as the sweat and downward force is severe and may damage the fetal energy.
2.Dampness and heat accumulation evidence
Main symptoms: scattered purpura on the skin, dullness, abdominal distension and pain, stagnant stools.
Concurrent symptoms: head heavy, body tired, mouth sticky and bitter, or joint swelling and pain, or even blood in the stool.
Tongue and pulse: red tongue, yellowish greasy coating, slippery pulse.
Treatment: Clear damp-heat and cool blood to resolve blemishes.
Prescription: San Ren Tang with reduction.
Almond 10g, Coix Seed 30g, Cardamom 20g, Radix et Rhizoma 30g
Comfrey 15g, Tongcao 30g, Shiwei 30g, Sempervivum 10g
Slippery Rock 20g decoction, Zeilan 10g Licorice 10g Mullein 9g
Addition and subtraction: add Panax ginseng powder and Agaricus blazei for blood in the stool; add Artichoke and White foxglove for blood in the urine; add White peony and Angelica dahurica for abdominal pain and distension; add Mulberry branch, Fangqi and Lonicera japonica for joint pain.
Explanation of the formula: This evidence is damp-heat accumulation, so it is necessary to take into account both dampness and heat clearing. Bitter almonds, cardamom kernel and raw coix seeds are used to expel dampness by declaring the upper part of the body, clearing the middle part of the body and permeating the lower part of the body.
Chinese patent medicine treatment.
Lingze dispel dampness granules (Langfang Hospital of Traditional Chinese Medicine formula: Bai Xian Pi, Gardenia, Huang Lian, Poria, Ze Di, Fu Ling Pi, Zi Cao, Wei Ling Xian, etc.) 15g/time, 3 times a day, taken orally.
3.Yin deficiency fire evidence
Main symptom: purpura is light red in color, sometimes hidden and sometimes visible.
Concurrent symptoms: irritable heat in the five hearts, hot flashes and night sweats, dry mouth, soreness and weakness of the waist and knees.
Tongue and pulse: red tongue with little fluid, fine pulse.
Treatment: Nourishing Yin and lowering fire, cooling the blood and stopping bleeding.
Prescription: Zhi Bai Di Huang Tang with reduction.
Radix Rehmanniae 15g Radix Phellodendron 10g Radix Rehmanniae 20g Artemisiae 10g
Tianmen Dong 10g Dan Pi 10g Red Peony 10g Zhi Mu 10g
Ligustrum lucidum 15g Cicadelle 10g Comfrey 10g Licorice 10g
Addition and subtraction: Add Bai Xian Pi, Di Shen Zi and Xian He Cao to obvious purpura; add Shi Wei, Xiao Thistle, Bai Mao Root and Panax notoginseng powder to blood in urine; add Cornu Cervi Pantotrichum and Gorgon fruit to proteinuria.
Explanation of the formula: Zhi Mu and Huang Bai are the ruling herbs, which strengthen kidney yin and clear deficiency heat; Sheng Di Huang, Zhen Zhen Zi and Tian Men Dong nourish yin and clear heat and cool the blood; supplemented by Di Bone Bark and Artemisia annua to clear deficiency heat in the kidney meridian; Dan Pi, Red Peony and Zi Cao to cool the blood and disperse it; Cicada Jiao to dissipate heat and permeate the rash; Sheng Gan Cao to clear heat and detoxify and harmonize the herbs.
Traditional Chinese medicine treatment.
Zhi Bai Di Huang Wan: 6g/time, 3 times a day, taken orally.
4.Qi does not take in blood
Main symptoms: recurrent purpura, vague and scattered, pale red or light dark, with immediate onset in case of exertion, and persistent.
The main symptom: recurrent attacks of purpura, pale red or light dark, with prolonged attacks upon exertion.
Tongue and pulse: light fat tongue with tooth marks, thin white coating, sunken and weak pulse.
Treatment: Tonifying Qi and regulating Blood.
Prescription: Tonifying the middle and benefiting the qi, plus reduction.
Radix Codonopsis pilosulae 15g, Astragalus membranaceus 30g, Atractylodes macrocephala 15g, Poria cocos 10g
Radix Angelicae Sinensis 10g, Radix Paeoniae Alba 10g, Semen lotus 10g, Pericarpium Citri Reticulatae 6g
Radix Bupleurum 6g, cuttlebone 10g, roasted licorice 10g, celandine 20g
Addition and subtraction: for Qi deficiency, reuse Astragalus and change Radix Codonopsis to Ginseng; for loose stools, add Yam and Lentil; for blood in urine, add Rhizoma Polygonatum charantium and Artichoke; for proteinuria, reuse Astragalus and add Gorgonzola.
Together, they are effective in tonifying Qi and regulating Blood.
Traditional Chinese medicine treatment.
1.GuiQi Wan: 9g/time, 2 times a day, taken orally.
2.Tonic Zhong Yi Qi Pill: 6g/time, 2 times a day, orally.
5.Spleen and kidney Yang deficiency evidence
Main symptoms: purpura vaguely scattered, prolonged, or purpura disappeared, only the performance of urine protein and occult blood persistently difficult to eliminate.
The main symptom: the face is white, cold, the waist and knees are sore and weak, loose stools or clear grain, unfavorable urine, swollen face and limbs.
Tongue and pulse: light fat tongue with tooth marks, white coating, sunken and feeble pulse.
Treatment: Warming the kidney and strengthening the spleen, warming Yang and regulating Blood.
Prescription: Experimental formula: Shuangtao Tang plus or minus.
Radix mulberry cuttlebone 15g, cuttlebone 15g, Cornu Cervi Pantotrichum 15g, Rhizoma Polygonati 20g
Eucommia Ulmoides 15g, Motherwort 20g, Semen Cuscutae 10g, Little Thistle 10g
Astragalus membranaceus 30g Rhizoma Atractylodes Macrocephalae 10g Radix Epimedium Tenuiflorum 10g Radix Glycyrrhizae 10g
Addition and subtraction: add Pu Huang Char and Phellodendron Char in case of heavy blood in urine; add Gorgonian and Jin Zhen Zi in case of heavy proteinuria; add Poria, Ze Xie and Dabang Pi in case of swelling.
Explanation of the formula: In this formula, mulberry cuttlebone and sea cuttlebone are used to tonify the kidney and consolidate the blood to prevent the leakage of the essence; dulcimer, codonopsis and epimedium warm the kidney and yang; with dogwood to seek yang in yin; astragalus and atractylodes nourish the spleen, benefit the qi and regulate the blood; white foxglove char, motherwort and small thistle clear the lower jiao and stop the bleeding; roasted licorice harmonizes the medicines. The combination of all the herbs consolidates the spleen and kidney and prevents the leakage of essence.
Traditional Chinese medicine treatment.
Jin Kui Kidney Qi Pill: 6g/dose, taken orally twice a day.
Complications
1.Blood in the stool
Allergic purpura with severe pain around the umbilicus or lower abdomen, or with blood in the stool, is the abdominal type of allergic purpura, and a few severe patients can develop intestinal entrapment and necrosis. The pathogenesis is mostly due to heat toxicity or damp-heat in the stomach and intestines, and the heat evil forcing the blood to travel, among which the damp-heat is more common. In severe cases of blood in the stool, fasting with water, intravenous nutritional support, anti-allergy and hemostatic drugs should be given. For mild cases of bleeding in stool, fluid or semi-liquid diet can be given, and in addition to the above-mentioned identification and typing treatment, the formula Four Flavors Stopping Blood (the main ingredients are Baihe powder, Puhuang charcoal, Agaricus blazei, Panax notoginseng powder) and lotus root powder can be given to mix and serve, which can significantly reduce the symptoms of bleeding, and Agaricus blazei and lotus root powder contain a large number of gum components, which can protect the damage and produce muscle, relieve the pain.
2.Blood in urine
The blood in urine is one of the more persistent symptoms of allergic purpura, which is caused by heat accumulating in the lower jiao and burning the yin complex. The treatment for acute cases should be based on the identification and treatment of the symptoms with the addition of clearing and lipping products. For example, the white flower and snake tongue grass, small thistle, stone reed, white foxglove root, etc.. Among them, white foxglove root has the effect of cooling the blood and stopping bleeding, clearing heat and detoxifying the toxin, and is considered by the Classic to have the effect of “main strain injury and deficiency, tonifying the middle and benefiting the qi, removing blood stasis, closing the blood to cold and heat, and facilitating urination”. Shiwei is bitter, sweet and cold in nature, and has the effect of inducing diuresis and laxative, which is effective in treating gonorrhea and blood in urine. White Flowering Snake Tongue Herb and Small Thistle clear heat and cool the blood to stop bleeding. If the condition is prolonged and the repeated urination of occult blood does not heal, charcoal-based hemostatic drugs such as Phellodendron charcoal and Phellodendron charcoal are used to not only remove heat and cool the blood, but also avoid the disadvantages of cold blood clotting, and at the same time strengthen the astringent effect of hemostasis in accordance with the teaching that “blood stops when it sees black”.
3.Proteinuria
The common symptom of allergic purpura kidney type is not only blood in urine, but also urine protein which is hard to disappear, such as a large amount of protein in urine can lead to foam in urine and cloudy urine, so it can be expressed as “cloudy urine”. The etiology of the disease is mostly due to the deficiency of the root and the symptoms of the disease, with the root deficiency being the main cause. This deficiency is due to deficiency of kidney qi, kidney qi is not solid, can not hide the essence, the essence is leaking out, so it causes cloudy urine; the standard reality is heat and toxicity, blood stasis, dampness and so on. Therefore, both the symptoms and the root cause should be treated, on the basis of tonifying the kidneys and consolidating the body, taking into account the detoxification, removing blood stasis and dispelling dampness. Astragalus is often applied in large doses to strengthen the spleen to consolidate kidney qi, and at the same time, kidney tonic drugs such as dried lotus grass, chasteberry, cuscuta, shamrock, etc. are given to both spleen and kidney, and fixing drugs such as cuttlebone, mulberry cuttlebone, etc. The lesser adjuvant, Bupleurum, clears heat and detoxifies the toxin, the motherwort invigorates the blood and stops bleeding, and the corn sap induces diuresis and permeates dampness to eliminate swelling, together eliminating proteinuria.
Treatment of heart enlightenment
1.Clear heat and cool the blood, and do not forget to dispel wind
This disease has an acute onset, with external wind-heat symptoms, the initial purpura is bright red, accompanied by a red and swollen pharynx, runny nose, red tongue, yellow moss, pulse number and other wind-heat symptoms, for blood heat spots usually follow Ye Tiansh “into the blood is afraid of blood consumption and blood, it is necessary to cool the blood to disperse the blood” meaning, and should be accompanied by dispel wind heat, at this time dispel wind is heat, as if the house under the heat and The common dispel wind medicine such as wind, cicada molasses, etc.. The wind is not only in the wind of the medicine, both inside and outside the wind, but also can win the dampness and spleen, a drug can be used. The skin purpura is not healed for a long time can be reused in the formula Bai Xian Pi, Tribulus terrestris, etc.
2, strengthen the spleen and benefit the kidneys, focus on consolidation
The most lingering and difficult to heal allergic purpura is the kidney type that is purpura nephritis, often manifested as persistent proteinuria, hematuria, the heavy can develop into nephrotic syndrome, renal failure. Even if the purpura symptoms are all gone, urine protein and occult blood can be found in the urine test. The patient is often accompanied by tiredness and weakness, swelling, waist and knee pain and other symptoms of spleen and kidney deficiency. The treatment should not be a one-sided attack, and then hurt the vital energy. The treatment should be based on strengthening the spleen and kidney, and adding astringent and astringent products as appropriate. For clinical spleen spleen qi deficiency can not be fixed, commonly used in large doses of Astragalus 30-60g, spleen benefit qi fixation, kidney deficiency need to identify yin and yang, often treated with nourishing yin and clearing heat, benefitting the kidney and fixing sperm of yellow essence, chasteberry, dry lotus grass or benefitting the kidney and warming yang of dogwood, cuscuta, Epimedium and other drugs, benefitting sperm astringent fixed astringent products often reused mulberry cuttlebone, cuttlebone, gorgonian, etc. to improve the effectiveness of treatment.
3, stopping bleeding and eliminating blemishes, not leaving stagnation
Allergic purpura is characterized by purple spots on the skin and can be accompanied by bleeding symptoms such as blood in urine and blood in stool, the blood from the menstruum is blood stasis, and it becomes one of the pathological mechanisms for the disease to persist. Therefore, when stopping the bleeding and eliminating the blemishes, we should pay attention to not leaving stagnation. The initial bleeding is mostly caused by heat toxicity or damp-heat forcing the blood to move, in accordance with Ye Tianshi’s: “Entering the camp can penetrate the heat and turn the qi, entering the blood is afraid of consuming the blood and moving it, so it must cool the blood and disperse it”. The treatment is to cool the blood to stop bleeding, and pay attention to both cooling and dispersing, avoiding too bitter cold, to prevent retention of stasis, often choose to choose Buffalo horn, Antelope horn, Dampi, etc. The main reason for this is that it is a very good idea to use the same drugs to stop the bleeding. For those with deficiency of Yin and fire, the medicine can be used to cool the Blood and invigorate the Blood.
Regression and prognosis
More than 80% of patients with allergic purpura only have single organ involvement, symptoms last for several weeks, about 10-20% of patients relapse, less than 5% of patients become chronic. Most patients have spontaneous resolution of abdominal pain within 72 hours. A small number of patients have kidney damage, which is one of the more difficult diseases in clinical practice.
In terms of TCM evidence, if the wind-heat and blood-heat evidence is treated timely and the external evil is dispelled, the disease is easier to heal. For the spleen and stomach damp heat evidence, because the dampness is sticky, damp heat evil is difficult to get rid of suddenly, often recurrent attacks, lingering difficult to heal. If the disease is prolonged, resulting in a lack of qi and yin, deficiency of yin and yang, injury to the spleen and kidneys, combined with blood in the urine, urinary turbidity is often difficult to heal after a long time.
Diet
The common causes of allergic purpura are: infection with bacteria or virus; ingestion of fish, shrimp, crab, eggs, milk and other foreign proteins; other factors such as cold, pollen, insect bites, vaccination stimulation, etc. The first thing to do is to avoid possible allergens, avoid taking drugs that may cause allergy, disable various vaccines, control and prevent infections. Patients should eat a light diet and forbid animal protein foods such as meat, seafood, eggs and milk; stimulating foods such as raw onion, raw garlic, chili pepper and alcohol; convenient foods such as beverages and sweet snacks; and indigestible foods such as frozen foods and deep-fried withers. Next, pay attention to rest, avoid straining and keep warm, avoid mood swings, avoid irritability, anxiety and other bad emotions, prevent insect bites, etc.
Food therapy (if the patient is allergic to a component of the food therapy formula is prohibited).
1, double flower root soup: honeysuckle 30g, wild chrysanthemum 20g, root 30g, mint 10g, ice sugar, water decoction, served twice a day. It has the effect of clearing heat and detoxifying, cooling the blood and stopping bleeding. It is used for allergic purpura with wind and blood heat evidence.
2, cinnamon jujube astragalus soup: cinnamon meat 20g, jujube 10, astragalus 30g, the above three flavors with water decoction, daily l dose, divided into 2 times to take. It has the function of replenishing qi and regulating blood. Can be used for allergic purpura Qi does not take blood evidence.
3, barley red bean porridge: coix seeds 30g, red bean 30g, mung bean 20g, boil porridge for consumption, suitable for allergic purpura damp heat within the evidence.