bubble_chart Concept

Purplish macula, abbreviated as "purplish macula" or "purple spots," refers to the appearance of punctate or patchy purple changes on the skin, lying flat on the skin and not palpable when touched, collectively referred to as purplish macula.

This condition has various names in classical medical texts. During the Qin and Han dynasties, it was collectively called "衄"; during the Sui and Tang dynasties, it was known as "斑毒," and during the Ming and Qing dynasties, it was referred to as "purplish macula." Based on disease cause and mechanism of disease, it can be divided into two major categories: "yang macula" and "yin macula"; depending on the location of the disease and color differences, it also has different names. For example, Waike Zhengzong mentions "blue purplish macula" and "purpura"; Yizong Jinjian includes the term "swollen legs with suppurative gingivitis"; Yilin Gaicuo lists "purple marks" and "blue marks," among others.

bubble_chart Pattern Analysis

1. Blood Heat Causing Bleeding︰It belongs to the category of "yang macula," commonly seen in adolescents, with sudden onset. Purpura appears unpredictably, often symmetrically on the extensor surfaces of both lower legs, sometimes accompanied by grade I itching, non-blanching upon pressure, and occasionally grade I elevation above the skin surface, resembling foxtail millet grains, elm-seed-sized to coin-sized lesions, or even merging into patches. The lesions typically disappear in about two to three weeks but often recur in batches. Associated symptoms include fever, restlessness, sore throat, thirst, fatigue, a red tongue with thin yellow coating, and a slippery-rapid or thin-rapid pulse. In severe cases, widespread cyanotic purpura patches may appear, with cyanotic swelling of the legs, gum erosion, and persistent bleeding. The condition is often triggered by consuming allergenic or wind-inducing foods such as fish, shrimp, milk, eggs, etc., in individuals with inherent intolerance or pre-existing blood aspect heat accumulation. When blood heat is excessive and combined with wind pathogen, the wind and blood heat contend, forcing blood to recklessly extravasate, leading to blood stasis and aggregation, resulting in purpura. The key diagnostic points are: sudden onset, purpura predominantly on both shins, slightly elevated above the skin surface, mild subjective itching, non-blanching upon pressure, appearing in batches, and more common in adolescents. Associated symptoms include sore throat, thirst, restlessness, a deep red tongue with thin yellow coating, and other signs of blood heat pattern. Treatment involves clearing heat and cooling blood, activating blood circulation to resolve macules, with the formula Cooling Blood Five Roots Decoction. If the condition is due to accumulated heat in the Yangming forcing blood to extravasate, pathogenic heat may damage the collaterals, causing blood to escape from the vessels, manifesting as widespread cyanotic purpura patches, cyanotic swelling of the lower limbs, gum erosion, and persistent bleeding. In such cases, urgent treatment involves clearing the stomach and removing toxins, cooling blood and resolving macules, with the formula Macule-Dissipating Indigo Decoction.
2. Dampness-heat︰It belongs to the category of "yang macula" and is commonly seen in young women. It often appears on both lower legs or thighs, presenting as purple or purplish-red. It is accompanied by plum-pit-sized hard nodules that are painful to touch, with possible grade I swelling around them. The nodules usually leave no traces after subsiding. Symptoms may also include joint pain, heavy and sluggish limbs, difficulty in flexion and extension, a sticky sensation in the mouth, and unsmooth bowel movements. In women, there may be sticky, foul-smelling leukorrhea. The tongue is red with a yellow, greasy coating, and the pulse is slippery and rapid. This condition is caused by dampness-heat obstructing the collaterals, leading to poor circulation of qi and blood. Nodules the size of plum pits may be observed, with newly formed ones appearing red and causing burning pain, while prolonged stagnation may result in blue-purple patches. The treatment focuses on invigorating the blood to unblock the collaterals, with the Tongluo Huoxue Decoction being the recommended formula.
3. Spleen Failing to Control Blood︰It belongs to the category of "yin macula." The course of the disease is prolonged and recurrent, with purplish-dark and flat skin lesions. Accompanied by a complexion that is shallow yellow or pale and lusterless, poor appetite, fatigue, shortness of breath, and reluctance to speak. It may also include symptoms such as epistaxis, bloody stool, and in women, menorrhagia and metrostaxis. The tongue is pale and lusterless, and the pulse manifestation is thin and weak, especially at the guan pulse. The primary cause is insufficiency of spleen qi, where qi deficiency fails to control, leading to the spleen's inability to govern blood. When blood fails to follow meridian tropism, it spills outward, forming macules. Factors such as overstrain, excessive contemplation, prolonged illness, or physical weakness can all serve as triggers. Clinical manifestations include a lusterless complexion, shortness of breath, fatigue, poor appetite, anorexia, a pale tongue, and a thin pulse. Treatment should focus on tonifying the spleen and replenishing qi, guiding blood back to meridian tropism. The recommended formula is Returning to Spleen Decoction.
4. Spleen-kidney Yang Deficiency︰It belongs to the category of "yin macula." Purpura recurs frequently, mostly on both lower limbs, appearing the size of a elm coin or foxtail millet grain, pale in color and not merging with each other. Accompanied by cold limbs and aversion to cold, loose stools, diarrhea before dawn, shallow yellow complexion, cold extremities, dull abdominal pain that prefers warmth and pressure, normal sense of taste, and clear, copious urine. Symptoms often worsen due to cold or fatigue. The tongue texture is pale, and the pulse is deep and thin. Spleen-kidney yang deficiency, with fire failing to generate earth, leads to impaired transportation and transformation, losing its ability to control and retain, resulting in blood extravasation forming macules. Yang deficiency fails to warm the body, hence fear of cold and cold limbs; spleen yang deficiency leads to impaired digestion, hence undigested food in stools; kidney yang deficiency results in water failing to transform into qi, and spleen yang deficiency means earth cannot control water, hence edema; yang deficiency leads to shortage of qi, reluctance to speak, mental fatigue, a pale tongue, and a thin pulse. Treatment should focus on warming yang and fortifying the spleen, supplementing fire to generate earth. The prescription options include Fourteen-Ingredient Center-Fortifying Decoction or Aconite Middle-Regulating Pill with modifications.
5. Static Blood︰Commonly seen in conditions such as "purple-black patches," "purple marks," or "blue birthmarks," the symptoms typically appear from childhood or adolescence, with a family history, progressing slowly and presenting as purple, purplish-brown, or bluish-purple patches. There are usually no systemic symptoms, and the skin lesions have a smooth surface. They can occur on the chest, back, waist, abdomen, limbs, cheeks, temples, forehead, or {|###|}eyelid{|###|}. The {|###|}purpura{|###|} may be hairy or hairless, and the {|###|}tongue texture{|###|} may show ecchymosis, with a choppy pulse or normal tongue and pulse. {|###|}Purpura{|###|} often begins at birth or after adolescence without obvious triggers. As stated in Yilin Gaicuo, Volume 1: "The face appears as if bruised, with purple patches or the entire face turning purple, all caused by {|###|}blood stasis{|###|}... Conditions like purpura, purple marks, and blue birthmarks have lacked effective treatments since ancient times due to unknown origins." Treatment should focus on {|###|}invigorating blood and resolving stasis{|###|}, dredging meridians, and unblocking collaterals. The recommended formula is Orifice-Openning Blood-Activating Decoction.
6. Cold Congealing and Blood Stasis︰It belongs to the category of "yin macula." Purpura commonly occurs on the face, nose, auricle, and the back of the hands and feet, predominantly in young women. It worsens in winter and improves in summer. The tongue texture is pale with ecchymosis, and the pulse is deep, thin, and slow. It may also manifest as purpura. The key points of pattern identification are: purpura frequently appears on the hands, feet, face, auricle, and other areas, worsens in cold weather, and improves with warmth. In addition to purpura, localized pain is often present. Treatment should focus on {|###|}warming the meridians and dissipating cold, invigorating blood and resolving stasis{|###|}, with the formula Angelica Cold-Extremities Decoction modified as needed.

Purplish macula is one of the common symptoms of skin rashes. In summary, it can be categorized into two main types: "yang macula" and "yin macula." The treatment often employs the method of invigorating blood and resolving stasis to achieve results. The treatment for yang macula primarily focuses on cooling blood, clearing heat, draining dampness, and dispelling stasis. For yin macula, the treatment often involves warming the kidneys, warming the spleen, tonifying qi, and controlling blood, supplemented by resolving stasis. When static blood obstructs purplish macula, different methods of invigorating blood and resolving stasis can be selected based on the mechanism of disease caused by static blood obstruction.

bubble_chart Documentation

1. Yizong Jinjian．Waike Xinfa Key Points: "In the army, those who suffer from swollen legs and greenish lumps will inevitably develop ulcerative gingivitis above; those who suffer from ulcerative gingivitis with putrid blood will inevitably develop greenish legs below; the two conditions arise from each other. Tracing the origin, it is all due to the blazing yang fire above and the stagnation of pudendal coldness below, resulting in the failure of yin-yang to communicate between the upper and lower parts, each becoming cold or hot, and each coagulating to produce this syndrome."