Difficulties in the treatment of pediatric allergic purpura and its countermeasures
Allergic purpura is a capillary allergic disease. Due to its widespread capillary inflammation, it leads to skin purpura, gastrointestinal mucous membrane bleeding, joint swelling and pain, and even renal purpura involving the kidneys. In recent years, the disease is on the rise, especially in school-age children. Although the disease can partially heal itself, it is very easy to recur. The main reason for the persistence of allergic purpura is that it is difficult to subcutaneous purpura to subside, and it is also difficult to treat urinary occult blood and urinary protein after the kidneys are affected.
The following is the experience of more than ten years in the treatment of allergic purpura, especially the countermeasures for the above treatment difficulties.
Difficulties I. Treatment of recurrent urine protein and urine occult blood.
Renal involvement with lesions is the most common clinical feature of allergic purpura. Clinically, about 20%~100% of children have different degrees of renal damage, which can be manifested as microscopic or carnal hematuria, urine protein, acute nephritis syndrome, acute nephrotic syndrome and acute renal insufficiency.
The degree of renal involvement is an important factor in determining the prognosis of pediatric allergic purpura disease, so its recurrent urinary proteinuria occult blood becomes one of the difficulties in the treatment of this disease. The author believes that the treatment of this difficulty starts with the spleen and kidneys and focuses on deficiency, dampness and silt.
The spleen and the kidney are two important organs of the human body, one is the root of the innate and the other is the root of the acquired and both are directly related to the production and transformation of the body’s essence and absorption. If the spleen is deficient, the upper can’t raise the clear and disperse the essence, and if the kidney is deficient, the lower can’t warm the yang and transform the qi.
In addition, if the spleen is deficient, its function of ascending clear and descending turbid is malfunctioning, causing the essence of water and grain not to be fully utilized by the body through ascending clear, and the dregs not to be excreted through descending turbid.
If the kidney is deficient in its qihua, the function of regulating water channels will also be affected, the body’s water running to the lower jiao, in the kidney’s qihua transpiration effect of the clear through the three jiao up in the lungs, the transmission of the whole body turbid down to the injection is urine discharge position. Deficiency of the kidneys is not conducive to gasification and water channel function, it will affect the normal water metabolism of the body.
It is clear that spleen and kidney deficiency is the root cause of urinary occult blood and urine protein. In the treatment, the author takes the six words of tonifying deficiency, clearing heat and resolving stasis as the major treatment formula. Depending on the specific situation, they can be applied individually or in combination. The basic formula is “Kuangzheng and eliminate turbidity soup”; it consists of Radix et Rhizoma Ginseng, Atractylodes Macrocephalae, Radix Rehmanniae, Poria, Salviae Miltiorrhizae, Semen Cuscutae, Semen Gorgonii, Rhizoma Zedoariae, Phellodendron, Mucuna Pruriens, of which 50-80 grams of Yam, 10-50 grams of Poria and 10-25 grams of Mucuna Pruriens are used, Yam is sweet and flat in nature, and has the function of benefiting Qi and nourishing Yin. The efficacy of the essence of the spleen and kidneys, the drug is light and slow tonic but not dry, so although heavy use without the risk of fire
Poria taste sweet and light function of the spleen and water, the drug is calm and can drive away the evil can support the right, water without harming the right, heavy use of its water to drive away the evil, so that the poisonous heat of the evil from the urine and out, and wood fragrance pungent, rationalizing the qi and Tongli Sanjiao heavy use to make it increase the efficacy of lowering turbidity and drainage of toxins. If there is also toxic heat congestion plus clearing heat and detoxifying and cooling the blood such as raw earth, white foxglove, verbena, small thistle, panax notoginseng, red peony, etc.
If the disease persists for a long time, depleting the vital energy and damaging the spleen and kidneys, causing the evil to go before the evil has been wounded and the deficiency to intermingle with the real and the virtual, the evidence is latent blood, protein does not disappear, body fatigue, lumbar and knee weakness, etc. In this case, the treatment should be based on strengthening the spleen, benefiting the kidneys, replenishing the vital energy and nourishing the blood, as well as exorcising the evil and adding astringent products to stop the bleeding and consolidate the essence. The basic formula is often used in combination with tortoise shell and Agaricus blazei and the homemade four flavors of hemostatic soup (keel bone, oyster, cuttlebone and cyperus).
The second difficulty, the course of the disease is prolonged repeatedly difficult to heal
Although allergic purpura has a certain tendency to heal itself, but all the children with one-third of the disease have recurrent episodes that are difficult to heal and become another difficulty in the treatment of this disease.
How to prevent its recurrence becomes the focus of treatment of this disease, according to years of clinical experience in the treatment of the disease effective prevention of recurrence of pediatric allergic purpura can be considered from the following aspects.
Emphasis on the righteousness, exorcise the evil
The author divided the allergic purpura into three phases of treatment, the acute phase, the stable phase and the repair phase (recovery phase). In addition to the acute phase the smooth phase and the repair phase treatment should put the support of the righteousness in the first place. This can be seen from the basic formula for the treatment of occult blood proteinuria that almost one-half of the remedies to support the righteousness. In the Nei Jing, there is a statement that “where evil comes together, its qi must be deficient, but when positive qi is present, the evil cannot dry up”.
The main reason for this is that it is a good idea to take a look at the treatment of the disease. We know that allergic purpura is a kind of allergic disease, its pathogenesis is related to the immune mechanism, although there are many causes of allergic purpura, but the decrease of immune function of the affected children is an important internal cause of the disease. The most effective way to avoid recurrence is to help the immune system.
The reason for triggering allergic purpura includes bacterial infections, viruses, parasitic attacks and contact with allergy-prone chemicals, drugs, foods, etc. It is necessary to carefully find the cause and remove it completely.
In addition, the treatment of children with allergic purpura, avoiding the mouth is a very noteworthy problem. It is one of the important causes of recurrence, many doctors do not pay much attention to this problem, often only told not to eat seafood, or even nothing, in fact, there are many allergy-causing foods such as: mushrooms, tomatoes, mutton, chicken, eggs, etc. must be prohibited in the treatment.
Exercise to enhance physical fitness and improve immunity is also a way to avoid relapse, in addition to not strenuous exercise can be appropriate to participate in some sports activities. The winter and spring season is the high incidence of the disease try to avoid going to crowded places to reduce the chance of infection to reduce recurrence.
Difficult point three: skin purpura is difficult to fade
There are a lot of allergic purpura patients after treatment other symptoms are eliminated such as abdominal pain, arthralgia, large subcutaneous bleeding, angioedema and so on, but the skin bleeding point sometimes not a lot but repeatedly difficult to heal, so that the families of children are very distressed. The main reason for this situation is that these children are born with poor vascular elasticity and brittleness, so after treatment, although the clinical symptoms are eliminated, but still occasionally see bleeding spots.
According to the characteristics of long-standing disease into the complex, long-standing disease easy to stasis on the treatment of this type of children in the dialectical legislation based on the use of a large number of drugs to activate blood circulation and remove blood stasis every can achieve better results. Through the treatment of this disease in recent years, we found that two-thirds of the patients have a tendency to increase the platelet count, which is caused by allergic antibodies that produce metabolic antibodies and form a composite of antigen and antibody deposited on the wall of small blood vessels throughout the body, which then leads to the increase of capillary permeability and fragility. This is completely consistent with the evidence of blood stasis in Chinese medicine.
In addition, through clinical observation, the combination of Chinese medicine licorice and peony has obvious effect of improving the fragility of blood vessels and increasing the elasticity of blood vessels, the dosage of raw peony can be 30-50 grams, at the same time, we can also add raw hawthorn to remove blood stasis and eliminate lipid to clear the immune accumulation in blood vessels and complete the repair effect of blood vessels together with stasis medicine.
In conclusion, for the treatment of allergic purpura Chinese medicine still has its unique advantages, such as the ability to quickly improve the symptoms, shorten the course of the disease, reduce complications, etc. Although some of the treatment difficulties are still unsatisfactory, but I believe that soon by the joint efforts of the same people will gradually be solved.