Traditional Chinese medicine believes that this disease falls under the categories of "hemorrhagic syndrome" and "skin eruptions" in TCM. It is caused by exposure to external pathogens or internal accumulation of toxic pathogens, which damage the blood vessels; or by excessive emotional stress leading to intense heat and fire, forcing blood to flow recklessly; or by dietary overexertion, which harms the heart and spleen, resulting in the inability to control qi and blood; or by prolonged illness causing qi stagnation and blood stasis, leading to blood not following its normal pathways and resulting in various hemorrhagic syndromes.

bubble_chart Modern Research

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune hemorrhagic syndrome, also known as primary thrombocytopenic purpura. The main symptoms of this disease are oral, visceral, and skin membrane hemorrhages. Clinically, it is divided into acute and chronic types: the acute type is more common in children, often presenting with large hematomas, hematuria, hematochezia, and even fatal intracranial hemorrhages; the chronic type is more common in adults, with a pronounced tendency to bleed.

This disease is caused by a disorder of the autoimmune function. Platelet antibodies can be detected in the serum of patients, which shorten the lifespan of platelets, reducing their survival time. Additionally, there is a maturation disorder of megakaryocytes in the bone marrow, leading to decreased platelet production. Furthermore, splenic factors and capillary defects also play a role in this disease.

[Diagnosis]

Symptoms: The acute type has a course of less than 6 months. It is more common in children, often preceded by a history of viral infections or upper respiratory infections, with a sudden onset and severe hemorrhagic symptoms. The chronic type has a course of more than 6 months, more common in women, rarely preceded by a history of infection, with a gradual onset, mainly presenting as recurrent skin ecchymoses, epistaxis, or hypermenorrhea.

Laboratory and other examinations: Decreased platelet count, often below 20×10⁹/L in acute ITP; prolonged bleeding time; positive capillary fragility test; poor clot retraction; chronic ITP often has platelet counts between 30~80×10⁹/L, with reduced numbers of megakaryocytes forming platelets in both types; platelet lifespan measurement is significantly shortened, often 1~3 days, sometimes only a few tens of minutes; most patients have increased platelet surface-associated IgG and PAC₃.

bubble_chart Pattern Analysis

1. Blood Heat Causing Bleeding︰The onset is sudden, with severe thirst, dysphoria, and restlessness. There is profuse skin purpura with purple-red patches, accompanied by epistaxis, gingival hemorrhage, bloody stool, hematuria, and hypermenorrhea in women. The throat and tongue are dry, with a preference for cold drinks, constipation, and scanty dark urine. The tongue is deep red with a yellow, rough coating, and the pulse is rapid. The treatment involves clearing heat and removing toxins, cooling the blood, and stopping bleeding. Modified Rhinoceros Horn and Rehmannia Decoction is used: Rhinoceros Horn powder 1g (to be taken separately, or substituted with buffalo horn 15g), Red Peony Root 10g, Moutan Bark 10g, Unprocessed Rehmannia Root 30g, Arnebia 10g, Scrophularia Root 15g, Gardenia Fruit 15g, raw Gypsum (to be decocted first) 30g, raw Rhubarb Rhizome 10g. Modifications: For severe skin purpura, add Sanqi 10g, Hairyvein Agrimonia Herb 15g, and Small Thistle 10g. For unconsciousness and delirious speech, Peaceful Palace Bovine Bezoar Pill or Miraculous Pill of Rhinoceros Horn may be added.
2. Yin Deficiency︰The onset is slow with a prolonged course. Subcutaneous ecchymoses vary in severity, mostly appearing as scattered patches with a red color. There may be epistaxis, gingival hemorrhage accompanied by dizziness, tinnitus, fatigue, restlessness, feverish sensation in the palms and soles, or tidal fever, night sweats, thirst without desire to drink. The tongue is red with no coating or a peeling coating, and the pulse is thin and rapid. The treatment principle is to nourish yin, reduce fire, cool blood, and calm the collaterals. Modified Anemarrhena, Phellodendron, and Rehmannia Decoction is used: Anemarrhena 10g, Phellodendron Bark 10g, Unprocessed Rehmannia Root 30g, Cornus 10g, Chinese Yam 10g, Moutan Bark 10g, Donkey-hide Gelatin (melted) 10g, Platycladus 15g, Glossy Privet Fruit 15g, Yerbadetajo Herb 15g. For significant gingival hemorrhage, add Dendrobium 20g and Gypsum 20g. For severe constipation, add Chinese Angelica 10g and Hemp Seed 10g.
3. Deficiency of Both Qi and Blood︰The onset is slow, with dull purple purpura scattered in appearance, recurring frequently and worsening with slight exertion. Menstruation is heavy in volume, pale in color, and prolonged. The patient appears listless with a dull complexion, experiencing dizziness and palpitations. There is mental fatigue, lack of strength, anorexia, abdominal distension and fullness, loose stools, or bloody stools. The tongue is pale with a thin white coating, and the pulse is thin and weak. Treatment involves tonifying the spleen and replenishing qi, nourishing blood, and calming the collaterals. Modified Returning to Spleen Decoction is used: Tangshen 15g, Astragalus Root 20g, Chinese Angelica 15g, Prepared Rehmannia Root 15g, Peony Root 10g, Poria 15g, stir-fried White Atractylodes Rhizome 15g, Donkey-hide Gelatin (melted) 12g, stir-fried Zizyphus Spinosa Seed 21g, Liquorice Root 6g, Chinese Date 5 pieces. For severe subcutaneous purpura, add Hairyvein Agrimonia Herb 15g and Sanqi 10g. For heavy menstruation, add Carbonized Windmill-Palm Petiole 10g, Hairyvein Agrimonia Herb 15g, and Carbonized Mugwort 10g. For abdominal distension, fullness, and loose stools, remove Donkey-hide Gelatin and Prepared Rehmannia Root, and add Psoralea 10g and Cassia Bark 10g.
4. Static Blood Obstruction︰Ecchymosis appears bluish-purple and dark, with epistaxis, hematemesis, bloody stool, and dark purple blood. Menstruation is accompanied by clots, hair is dry and yellowish without luster, complexion is dark and dull, eyelids are bluish-dark. The tongue texture is dark purple or with ecchymotic spots, and the pulse is wiry or thin and rough. The treatment principle is to dispel stasis to unblock collaterals and invigorate the blood to stop bleeding. Modified Peach Kernel, Carthamus, and Four-Ingredient Decoction is used: Peach Kernel 10g, Carthamus 6g, Chinese Angelica 10g, Sichuan Lovage Rhizome 6g, Prepared Rehmannia Root 15g, Red Peony Root 10g, Tian Sanqi powder (infused) 3g, India Madder Root 15g, Red Child 10g, Achyranthes Root 15g, Salvia 10g. For mental fatigue and shortness of breath, add Astragalus Root 20g, Heterophylly Falsestarwort Root 15g, and White Atractylodes Rhizome 10g. For chest and hypochondriac stuffiness and oppression, add Dried Tangerine Peel 10g and Curcuma Root 10g.