Idiopathic Thrombocytopenic Purpura (ITP)

WESTERN MEDICINE: Thrombocytopenia in which no exogenous etiologic factor or underlying disease is apparent. The pathogenesis of ITP remains uncertain, but the salient features of the disorder can best be explained by the autoimmune hypothesis; i.e., the platelets are sensitized in vivo by autoantibodies and as a result are removed from the circulation at an accelerated rate by the spleen. The nature of the immunizing event is obscure, and platelet antibodies can seldom be demonstrated serologically.

SYMPTOMS AND SIGNS: includes bleeding into the skin (petechiae, ecchymoses) and mucosa (epistaxis; GI, GU, or vaginal bleeding), and slow protracted oozing following surgery or trauma. The physical findings are those of bleeding and the consequent anemia. 

ETIOLOGY AND PATHOLOGY: In Chinese medicine, it belongs to the "Bleeding Syndrome". The causative factors are as followings: 

  1. Spleen and stomach deficiency: Spleen and stomach work together to digest, transform and transport the food essence into Qi and blood; the spleen is also supposed to hold blood circulating Inside of vessels. So spleen and stomach deficiency easily causes bleeding and blood deficiency as well.
  2. Yin deficiency due to the body type or other reasons: Yin deficiency can easily lead to the interior fire flaming up and disturbing the blood circulation so as to cause bleeding. 
  3. Infections of exogenous pathogenic factors invade the body and disturb the blood circulation and lead to the bleeding. 

DIFFERENTIATIONS: 

1. Spleen and Stomach Deficiency Type:

Indications: Occasional appearances of petechiae, or ecchymoses in light red color, worse after overworking or in exhaustive state, dull and yellowish complexion, lower energy, dizziness, lassitude, poor appetite, or insomnia, spontaneous sweating. Pale tongue, slow and weak pulse. 

Treatment & Formulas: Tonify the Qi and blood by promoting the functions of spleen and stomach.

Products:

2. Excessive Fire due to Yin Deficiency:

Indications: Petechiae or ecchymoses in dark red or purplish color, mostly showing at lower legs, flushed complexion, lower fever, or tidal fever (fever at afternoon or evening), dizziness, night sweating. Red and dry tongue, scanty coating without moisture, wiry and thready pulse. 

Treatment & Formulas: Tonify the Yin to clear the deficient fire and stop bleeding. 

Products:

    • Zhi Po Ba Wei Wan (Anemarrhena, Phellodendron and Rehmannia Formula, Item No. 2123): This is the kidney Yin tonic, and has the function to clear the deficient fire as well. 
    • Si Sheng Wan (Rehmannia and Lotus Leaf Formula, Item No. 2058): This is a blood cooling formula. It can be combined with other formulas to strengthen the function of stopping bleeding. 

3. Blood Heat due to Infections:

Indications: Sudden onset of high fever, aversion to cold, skin bleeding, or epistaxis, or hematuria with bright red color, flushed complexion, restlessness, insomnia, irritability. Dark red tongue, dry yellowish coating, slippery and rapid pulse. 

Treatment & formulas: Clear the heat and cool blood to stop bleeding. 

Products:

    • Dang Gui Liu Huang Tang (Tang- kuei and Six Yellow Combination, Item No. 2231): It is strong formula for interior heat or blood heat.
    • Si Sheng Wan (Rehmannia and Lotus Leaf Formula, Item No. 2058): This is a blood cooling formula which can be combined with other formulas to stop bleeding due to the heat factor. 
    • Shi Wei Bai Du San (Bupleurum and Schizonepeta formula, Item No. 2017) or Jing Fang Bai Du San (Schizonepeta and Siler Formula, Item No. 2166): lt treats the bleeding with the wind heat or wind cold symptoms. 

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