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Thrombocytopenic
purpura is an autoimmune disease. This disease also involves the spleen and
often occurs in children and young adults. The incidence in females is higher
than in male. In TCM, the disease is categorized as "ji niu"
(subcutaneous hemorrhage) "fa ban" (purpura), etc.
Main Points of
Diagnosis
The disease can be divided
into acute type and chronic type according to the clinical manifestations and
courses.
1. Acute type of
thrombocytopenic purpura is commonly found in adolescents. In most cases, the
patients have a previous history of viral infection. The onset of the disease is
sudden, manifested as chill, fever and obvious hemorrhage in skin and mucosa.
Chronic type of the disease is often seen in females. The onset is slow with
mild symptoms. There may appear alternation of attack and remission in a certain
period.
2. Physical examination of
acute type reveals no particular signs but infection and hemorrhage, while in
chronic type which is recurrent in attack, spelenomegaly may be the only
finding.
3. Laboratory test: Blood
test shows a sharp reduction of platelet count in acute type, usually less than
20¡Á109/L. The bleeding time is prolonged associated with poor
contraction of blood clot.
The picture of bone marrow
in acute type shows an increased promegakaryocytes, with smaller bodies and few
granules inside the cells most of which are immature, and there is no formation
of platelets, while in chronic type, there is an increase of megalocaryocytes,
in which mature cells dominate in number, but granulae inside are smaller in
number, indicating their poor function of producing blood.
Differentiation and
Treatment of Common Syndromes
1. Bleeding due to
Blood-Heat
Main symptoms and Signs:
Sudden onset with fever, purple and deep-colored purpuras which are great in
quantities and in stretches or epistaxis and hematuria with bright color,
flushed face, irritability, deep-red tongue with dry and yellowish fur, slippery
and rapid pulse.
Therapeutic Principle:
clearing away pathogenic heat and toxic materials, cooling blood to stop
bleeding.
Recipe: Decoction of Buffalo
Horn and Rehmannia with additional ingredients.
buffalo horn
or buffalo horn (decocted
prior to others)
dried rehmannia root
red peony root
moutan bark
scrophularia root
arnebia root
forsythia fruit
field thistle
All the above ingredients, except
buffalo horn which is to be mixed with the finished decoction, are to be
decocted in water for oral administration.
In addition to the above
ingredients, 15 grams of rubia root and 30 grams of hairy vein agrimony should
be prescribed for treating cases with profuse bleeding; 30 grams of gypsum and
10 grams of anemarrhena rhizome for cases with thirst and fondness for cold
drink; 6 grams of rhubarb (decocted later) for cases with restlessness and
constipation.
2. Hyperactivity of Fire
due to Yin Deficiency
Main Symptoms and Signs:
More purpuras in purple and red color, especially in the low extremities and
appearing and fading at frequent internals, dizziness, tinnitus, hot sensation
in the palms and soles irritability, night sweat, bleeding from the gum,
epistaxis, profuse menstruation, red tongue with reduced saliva, thready and
rapid pulse.
Therapeutic Principle:
Nourishing yin and removing pathogenic heat from blood to arrest bleeding.
Recipe: Modified Bolus for
Replenishing Vital Essence.
dried rehmannia root
prepared rehmannia root
tortoise plastron
anemarhena rhizome
phellodendron bark
eclipta
glossy privet fruit
donkey-hide gelatin
moutan bark
wolfberry bark
biota tops
All the above herbs are to
be decocted in water for oral administration.
3. Deficiency of the
Spleen-Qi
Main Symptoms and Signs:
Pink purpuras which appear and fade from time to time, sallow complexion,
lassitude and listlessness, dizziness, palpitation, poor appetite, pale tongue
with little fur, weak pulse.
Therapeutic Principle:
Reinforcing the spleen and tonifying qi and guiding blood to go back to the
vessels.
Recipe: Modified decoction
for Invigorating the Spleen and Nourishing the Heart.
astragalus root
codonopsis
root
white atractylodes rhizome
poria
Chinese angelica
white peony root
longan aril
eclipta
donkey-hide gelatin
Chinese date
prepared licorice root
All the above herbs are to
be decocted in water for oral administration.
As for cases with
persistent purpuras and splenomegaly, add 3 grams of notoginseng powder (taken
after being mixed with the finished decoction), 6 grams of prepared aconite root
are added for chronic cases marked with aversion to cold, cold limbs, aching
pain of the loins and loose stool.
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