(IMMUNE), (IDIOPATHETIC) THROMBOCYTOPENIC PURPURA

Clinical Manifestations
  • Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets.
    Platelets stick together (clot) to seal small cuts or breaks on blood vessel walls and stop bleeding.
    There are two types of ITP. Acute ITP is a short-term illness that mainly affects children and often occurs after a viral infection. Most children get well quickly without any treatment. Adults who have ITP most often have chronic (long-lasting) ITP. Symptoms can vary a great deal, and some adults who have mild ITP don't need treatment.
    In most cases, an autoimmune response is believed to cause ITP. Normally your immune system helps your body fight off infections and diseases. But if you have ITP, your immune system attacks and destroys its own platelets. The reason why this happens isn't known. ITP can't be passed from one person to another.
    ITP can affect children and adults of all ages. Women are 2 to 3 times more likely than men to get chronic ITP.
    People who have ITP may have signs of bleeding, such as bruises (purpura) that appear for no reason or tiny red dots (petechiae) that are visible on the skin.
    Bleeding in ITP also occurs in the form of nosebleeds, bleeding gums, menstrual bleeding that's heavier than usual, or other bleeding that's hard to stop. Bleeding in the brain as a result of ITP is very rare, but it can be life threatening when it occurs.
  • Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder. In TTP, blood clots form in small blood vessels throughout the body. The clots can limit or block the flow of oxygen-rich blood to the body's organs, such as the brain, kidneys, and heart. As a result, serious health problems can develop.
    The increased clotting that occurs in TTP also uses up platelets in the blood. Platelets are blood cell fragments that help form blood clots. These cell fragments stick together to seal small cuts and breaks on blood vessel walls and stop bleeding.
    With fewer platelets available in the blood, bleeding problems can occur. People who have TTP may bleed inside their bodies, underneath the skin, or from the surface of the skin. When cut or injured, they also may bleed longer than normal.
    "Thrombotic" refers to the blood clots that form. "Thrombocytopenic" means the blood has a lower than normal number of platelets. "Purpura" refers to purple bruises caused by bleeding under the skin.
    Bleeding under the skin also can cause tiny red or purple dots on the skin. These pinpoint-sized dots are called petechiae. Petechiae may look like a rash.
    Manifestations:
    Bleeding into the skin or mucus membranes
    Confusion
    Fatigue
    Weakness
    Fever
    Headache
    Pale skin color or yellowish skin color
    Shortness of breath
    Tachycardia (over 100 beats per minute)
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • High fever, worse at night
  • Insomnia
  • Irritability
  • Mild thirst with no desire to drink
  • Mental disturbance
  • Speech disturbance
  • Red, dry, painful rashes
  • T: Deep red
  • C: Little or None
  • P: Thready and rapid
Treatment Principle
  • Reduce Heat in the Ying
  • Detoxify
Herb Formulas
Points
Clinical Manifestations
  • High fever
  • Confusion of mind
  • Delirium
  • Mania
  • Dark yellow urine
  • Excessive skin rashes all over body
  • Hemorrhage:
    Hematemesis
    Hemoptysis
    Epistaxis
    Hemafecia
    Hematuria
  • T: Deep red, dry or Purple red
    C: None
    P: Rapid or Thready and rapid or Thready and feeble
Treatment Principle
  • Cool the Blood
  • Dispel Heat and Toxins from the Xue Stage
  • Promote Blood Circulation
Herb Formulas
Points
Clinical Manifestations
  • Intermittent pale or light purple purpura with insidious onset
  • Purpura comes and goes and is scattered in location
  • Symptoms worse with exertion or fatigue
  • Sallow or pale complexion
  • Bleeding gums
  • Anorexia
  • Four limbs feel tired and heavy
  • Physical and mental exhaustion
  • Abdominal and epigastric distention after eating
  • Maybe acid regurgitation or vomiting
  • Loose or unformed stools
  • Shortness of breath
  • Lassitude
  • Weakness
  • Dizziness
  • Palpitations
  • Functional Uterine Bleeding
  • Epistaxis
  • Hematochezia
  • Hematuria
  • Menorrhagia - long and profuse with pale, watery Blood
  • Metrorrhagia
  • T: Pale and flabby - may have teethmarks
  • C: White
  • P: Thready and weak
Treatment Principle
  • Benefit Qi
  • Conserve Blood
Herb Formulas
Points
Clinical Manifestations
  • Purpura
  • Mild constant epigastric pain; relieved by warmth and pressure
  • Anorexia
  • Abdominal pain and fullness after meals
  • Nausea
  • Vomiting
  • Loose, unformed stools
  • Excessive salivation
  • Cold limbs
  • Lassitude
  • Weakness
  • Sallow or pale, dull complexion
  • Maybe edema
  • Maybe scanty urination
  • Maybe clear, watery, copious vaginal discharge
  • T: Pale
  • C: White and greasy
  • P: Deep, thready and forceless
Treatment Principle
  • Strengthen the Spleen
  • Warm Yang
  • Warm the Center
  • Dispel Cold
Herb Formulas
Points
Clinical Manifestations
  • Body cold
  • Limbs icy
  • Complexion white and shiny
  • Low back, knees and abdomen feel cold and painful
  • Lower abdomen feels cold and painful
  • Loose stools containing undigested food
  • “Cock-crow” diarrhea (occurs at about 5 am)
  • Edema of face and limbs
  • Dysuria
  • Severe:
    Abdominal ascites
  • T: Pale, moist and swollen
  • C: Thin and white or White and greasy
  • P: Deep, thready, weak and maybe slow
Treatment Principle
  • Warm and Reinforce the Spleen and Kidneys
Herb Formulas
Points
Clinical Manifestations
  • Sudden
  • Dark purpura
  • A flushed face
  • Burning Heat and pain in the epigastrium
  • Irritating thirst: drinks copious fluids and prefers cold drinks
  • Excessive appetite: hungry again quickly after eating (as if food vanishes)
  • Swelling, pain, ulceration and bleeding of gums
  • Foul breath
  • Toothache
  • Maybe vomiting right after eating
  • Vomiting acid or undigested food
  • Constipation
  • Maybe scanty, red urine or
  • Dark, yellow urine
  • T: Red
  • C: Thick, yellow and dry
  • P: Slippery, big, Excess and rapid or Large and wiry
Treatment Principle
  • Clear and Purge Stomach Fire
Herb Formulas
Points
Clinical Manifestations
  • Purpura
  • Toothache
  • Loose teeth
  • Bleeding gums
  • Frontal headache
  • Irritability
  • Fever
  • Thirst with a desire to drink cold beverages
  • Epistaxis
  • Dysphoria
  • Excess hunger
  • Hemoptysis
  • Dry throat
  • Hematemesis
  • Restlessness
  • Warm sensations
  • T: Red and dry
  • C: White or Yellow and dry
  • P: Superficial, full, slippery, deficient and large or Gigantic and rapid or Rapid
Treatment Principle
  • Drain Heat from the Stomach
  • Replenish Yin
Herb Formulas
Points
Clinical Manifestations
  • Vomiting immediately after eating
  • Indeterminate gnawing hunger
  • Acid regurgitation
  • Belching
  • May be epigastric pain
  • Dry heaves or spitting of clear fluids with vertex headache
  • Vomiting and diarrhea with cold hands and feet
  • Restlessness
  • Severe fidgeting
  • Irritability
  • So agitated, the patient wants to die
  • Habitual headache
  • Subcardiac distention
  • A feeling of fullness and distention in the chest and diaphragm
  • T: Pale
  • C: White and slippery
  • P: Slow and weak or Sinking or slow and thin or Slow and wiry
Treatment Principle
  • Warm and tonify the Spleen, Stomach, Liver and Kidneys
  • Descend Rebellious Qi
Herb Formulas
Points
  • General points
Clinical Manifestations
  • Palpitations
  • Shortness of breath
  • Excessive perspiration (daytime)
  • Above symptoms worse after exertion or when tired
  • Cold limbs
  • Fatigue
  • Weakness
  • Maybe chills
  • Cyanosis
  • Suffocating sensation in chest
  • Depression
  • Facial pallor
  • T: Pale and swollen
  • C: White
  • P: Thready and weak or Knotted or Intermittent
Treatment Principle
  • Warm and Clear Heart Yang
Herb Formulas
Points
Clinical Manifestations
  • Palpitations
  • Irritability
  • Anxiety
  • Easily startled
  • Insomnia
  • Much dreaming
  • Poor memory
  • Dizziness
  • Pale face and lips
  • T: Pale
  • P: Thready and weak
Treatment Principle
  • Nourish Heart Blood
  • Calm the Heart and Shen
Herb Formulas
Points
Clinical Manifestations
  • Palpitations
  • Insomnia
  • Much dreaming
  • Easily startled
  • Poor memory
  • Four limbs tired and lethargic
  • Loss of appetite
  • Distention and fullness of the epigastrium and abdomen
  • Loose stools
  • Sallow complexion
  • Copious, pale menses
  • Uterine bleeding or
  • Light menstrual flow or
  • Amenorrhea
  • T: Pale
  • P: Thready and weak
Treatment Principle
  • Reinforce and Benefit the heart and Spleen
Herb Formulas
Points
Clinical Manifestations
  • Palpitations
  • Insomnia with much dreaming
  • Easily startled
  • Eye dizziness
  • Both eyes dry and rough
  • Twitching of the eyes
  • Pain in the ribs and flanks
  • Numbness of the limbs
  • Stiffness and spasms of the tendons
  • Low grade fever
  • Night sweats
  • Irregular, scanty menses
  • T: Pale and thin
  • C: Little
  • P: Thready, choppy and forceless
Treatment Principle
  • Nourish Yin
  • Reinforce the Blood
  • Conceal Yang
  • Calm the Shen
Herb Formulas
Points
Clinical Manifestations
  • Purpura
  • Abdominal distention and pain
  • Gas
  • Borborygmus
  • Diarrhea
  • Distention and pain in the sides or flanks
  • Suffocating sensation in the chest
  • Tendency to sigh
  • Melancholy
  • Depression
  • Irritability
  • Inappropriate anger
  • Women:
    Irregular menses
    Dysmenorrhea
    Breast distention and pain before and during menses
  • T: Pink
  • C: White and greasy
  • P: Slippery and wiry
Treatment Principle
  • Soothe the Liver
  • Invigorate the Spleen
Herb Formulas
Points
Clinical Manifestations
  • Fresh, red purpura which are large and plaque-like
  • Epistaxis
  • Bleeding gums
  • Severe, splitting headaches with dizziness
  • Sudden tinnitus or
  • Sudden deafness
  • Flushed face
  • Red, swollen, painful eyes
  • Tension
  • Agitation
  • Irascibility with violent angry outbursts
  • Dry mouth
  • Bitter taste in mouth
  • Thirst
  • Vomiting sour or bitter liquid
  • Insomnia
  • Restlessness
  • Constipation or dry stools
  • Excessively profuse menstruation
  • Maybe rib pain
  • In severe cases:
    Mania
    Hemoptysis
    Hematemesis
    Epistaxis
  • Liver Fire Attacks the Lungs:
    Hemoptysis
    Rib pain which is severe when coughing
  • Liver Fire Attacks the Stomach:
    Hematemesis
  • T: Red tip and edges
  • C: Thick, yellow, dry and rough
  • P: Wiry, Excess and rapid
Treatment Principle
  • Clear the Liver
  • Purge Fire
  • Cool the Blood
  • Stop bleeding
Herb Formulas
Points
Clinical Manifestations
  • Hypochondriac and chest pain
  • Dry, parched mouth and throat
  • Bitter taste in mouth
  • Acid regurgitation
  • Dizziness
  • Epigastric and abdominal distention
  • Maybe constipation
  • T: Red and dry
  • C: Little or None
  • P: Thready and weak or Wiry and deficient
Treatment Principle
  • Enrich Kidney and Liver Yin
  • Spread Liver Qi
Herb Formulas
Points
Clinical Manifestations
  • Purpura with insidious onset or prolonged course
  • Skin purpura sometimes light, sometimes heavy
  • Purpura purple red or dark red
  • Epistaxis
  • Bleeding gums
  • Dizziness
  • Tinnitus or deafness
  • Poor memory
  • Aching, soreness or weakness of the low back
  • Spermatorrhea or
  • Premature ejaculation
  • Aching in the bones
  • Aching in the leg and heel
  • Dry mouth
  • Thirst
  • Night sweats
  • Five Sole Heat
  • Malar flush
  • Hot flashes in the face
  • Generalized lack of strength
  • Low grade fever in the afternoon
  • Dry throat, maybe recurrent sore throat
  • Dry stools and/or
  • Constipation
  • Urine short and red
  • Hemafecia
  • Hematuria
  • Dark, red blood
  • Heightened libido
  • Excessively profuse menstruation
  • Non-stop spotting of thick, dark red, sticky blood
  • Dry stools
  • T: Red
  • C: Little or None
  • P: Thready and rapid
Treatment Principle
  • Nourish Yin
  • Subdue Fire
  • Cool the Blood
  • Stop bleeding
Herb Formulas
Points
Clinical Manifestations
  • Fever
  • Night sweats
  • Red face
  • Dry mouth
  • Leukorrhagia with yellow, thick, foul discharge
  • Constipation
  • Dark, scanty urine
  • Irritation
  • Fidgeting
  • Insomnia
  • Both cheeks slightly red
  • Dizziness
  • Dry eyes
  • Blurred vision
  • Spots before the eyes
  • Numbness of limbs
  • Flaccid paralysis (Wei syndrome), weakness
  • Tinnitus
  • Deafness
  • Forgetfulness
  • Low back and knees sore and painful
  • Throat dry and painful
  • Five sole Heat
  • Low-grade fever
  • Irritability
  • Insomnia
  • Stools difficult to pass
  • Constipation
  • Men:
    Spermatorrhea
  • Women:
    Irregular menses or
Treatment Principle
  • Nourish and Reinforce the Liver and Kidneys
  • Clear Deficiency Fire
Herb Formulas
Points
Clinical Manifestations
  • Purpura
  • Hypochondriac pain
  • Headache
  • Dizziness
  • Red sore eyes
  • Hearing loss
  • Swelling in the ears
  • Bitter taste in the mouth
  • Irritability
  • Short temper
  • Difficult and painful urination with a heat sensation in the urethra
  • Swollen and itchy genitalia
  • Yellow, foul smelling leukorrhea
  • Short menstrual cycle with reddish-purple blood
  • Ear discharge
  • Yellow urine
  • Chest pain
  • Constipation
  • Turbid urine
  • Dry throat
  • Hematuria
  • Pain in the armpits
  • Sweating in the groin
  • T: Red or Red edges
  • C: Yellow or Yellow and greasy
  • P: Wiry, Excess and rapid
Treatment Principle
  • Clear and Drain Damp-Heat
Herb Formulas
Points
Clinical Manifestations
  • Large purple or red purpura
  • Hectic fever
  • A flushed face
  • Dizziness
  • Tinnitus
  • Epistaxis
  • Gum bleeding
  • T: Red and dry
  • C: Thin
  • P: Wiry, thready and rapid
Treatment Principle
  • Nourish Yin
  • Clear Fire
Herb Formulas
Points
Clinical Manifestations
  • Poor memory
  • Dizziness that is usually mild and postural and worse with fatigue
  • Fatigue
  • Lethargy
  • Low spirits
  • Depression
  • Loose stools
  • Poor appetite
  • Pale face
  • Weak voice
  • Reluctance to speak
  • Sweating with little or no exertion
  • Palpitations
  • Anxiety
  • Phobias
  • Panic attacks
  • Blurred vision
  • Spots before the eyes
  • Insomnia
  • Dry skin
  • Dry hair
  • Forgetfulness
  • Pale face, lips and nails
  • Scanty periods or
  • Bruises easily
  • T: Pale or Pale, thin and dry
  • C: Thin and white
  • P: Weak or Thin and choppy
Treatment Principle
  • Tonify Qi
  • Nourish the Blood
Herb Formulas
Points
Clinical Manifestations
  • Purpura
  • Amnesia
  • Palpitations
  • Feverishness
  • Anorexia
  • Emaciation
  • Pale face
  • Insomnia
  • Dyspnea on mild exertion
  • Fatigue
  • Shortness of breath
  • Weight loss
  • Dry skin
  • Dry mouth
  • Dry throat
  • Dry lips
  • Uterine bleeding
  • Irregular menstruation
  • May suddenly lose consciousness
  • Slack jaw
  • Restless at night
  • Lassitude
  • Tendency toward being frightened easily
  • Weakness
  • Sallow complexion
  • Dizziness
  • Tremors in the limbs
  • Spontaneous perspiration
  • Fever and severe chills
  • General debility
  • Mental instability
  • Coughing and gasping
  • Night sweats
  • Amnesia
  • Diarrhea
  • Turbid urine
  • Nocturnal emission
  • Impotence
  • Constipation
  • Feeble breathing
  • Tired limbs
  • T: Pale
  • C:White
  • P: Thready and weak or thready, rapid and weak or Deep and weak
Treatment Principle
  • Tonify Qi
  • Nourish the Blood
  • Strengthen the Spleen and Lungs
  • Nourish the Heart
  • Calm the Shen
Herb Formulas
Points
Clinical Manifestations
  • Purpura with an extended disease course and a non-healing nature
  • Static dark, purple macules
  • Macules disappear slowly
  • Excessively profuse menstruation with dark, purple Blood and clots
  • Bilateral flank aching, pain, swelling and lumps
  • Pain that is fixed, stabbing and/or severe
  • Pan is worse with pressure
  • Dark or soot-black complexion
  • Fixed, palpable masses
  • Bleeding with clots
  • Purple lips
  • Purple nails
  • Dry skin
  • Blue, dark or purplish discoloration of skin in small or large areas
  • Varicose and spider veins
  • Cold hands and feet
  • Tendency to hemorrhage dark blood or clots
  • Maybe a low-grade fever
  • Dry mouth with no desire to drink
  • Maybe black, tarry stools
  • T: Purple, possible purple or red spots
    Red purple if there is Heat
    Blue purple if there is Cold
  • C: White
  • P: Choppy or Wiry and choppy
Treatment Principle
  • Invigorate the Blood
  • Break up Stagnation
  • Cool the Blood
  • Stop bleeding
Herb Formulas
Points
Clinical Manifestations
  • Frequent purple lesions
  • Bruises easily
  • Bleeding gums
  • Epistaxis
  • Dizziness
  • Blurred vision
  • Five Sole Heat
  • Tidal fever
  • Night sweats
  • Flushed cheeks
  • A dry mouth
  • Dark urine
  • Constipation
  • Menorrhagia with purple Blood
  • T: Red
  • C: Little or None
  • P: Thready and rapid
Treatment Principle
  • Cool the Blood
  • Nourish Yin
  • Stop bleeding
Herb Formulas
Points
Clinical Manifestations
  • Purpura
  • Postpartum emaciation and weakness
  • Persistent, tight abdominal pain
  • Abdominal pain with spasms or radiates to back and waist
  • Cannot eat
  • Shortness of breath
  • Dyspnea
  • Pale face
  • Intermittent spasmodic abdominal pain which is better with Heat and pressure
  • Epigastric pain
  • Lusterless complexion
  • Fidgeting
  • Reduced appetite
  • Maybe low-grade fever
  • Palpitations
  • Irritability
  • Cold and sore extremities
  • Nonspecific discomfort
  • Dry mouth and throat
  • Nocturnal emission
  • Five sole Heat
  • Debilitated constitution in children
  • Enuresis in children
  • Insomnia
  • Fatigue
  • Anemia
  • Bleeding
  • Abdominal weakness
  • Epistaxis
  • Habitual constipation
  • Maybe warm extremities
  • Night sweats
  • Tired limbs
  • Frequent urination
  • Night crying
  • Diarrhea in children
  • Habitual headache in children
  • Hernia pain in children
  • Chronic constipation
  • Asthma
  • T: Pale
  • C: White
  • P: Weak and slow or Thready, wiry and even or Thready and weak
Treatment Principle
  • Warm and tonify the Spleen and Stomach
Herb Formulas
Points
Clinical Manifestations
  • Purpura
  • Hypochondriac pain
  • Headache
  • Dizziness
  • Red sore eyes
  • Hearing loss
  • Swelling in the ears
  • Bitter taste in the mouth
  • Irritability
  • Short temper
  • Difficult and painful urination with a heat sensation in the urethra
  • Swollen and itchy genitalia
  • Yellow, foul smelling leukorrhea
  • Short menstrual cycle with reddish-purple blood
  • Ear discharge
  • Yellow urine
  • Chest pain
  • Constipation
  • Turbid urine
  • Dry throat
  • Hematuria
  • Pain in the armpits
  • Sweating in the groin
  • T: Red or Red edges
  • C: Yellow or Yellow and greasy
  • P: Wiry, Excess and rapid
Treatment Principle
  • Clear and Drain Damp-Heat
Herb Formulas
Points
Clinical Manifestations
  • Lots of deep-colored purpura
  • Relatively acute onset with fever and chills
  • Thirst
  • Hypochondriac pain
  • Headache
  • Dizziness
  • Maybe epistaxis
  • Bleeding gums
  • Red sore eyes
  • Hearing loss
  • Swelling in the ears
  • Bitter taste in the mouth
  • Irritability
  • Short temper
  • Vexation
  • Agitation
  • Restlessness
  • Difficult and painful urination with a heat sensation in the urethra
  • Swollen and itchy genitalia
  • Yellow, foul smelling leukorrhea
  • Short menstrual cycle with reddish-purple blood or
  • Excessive menstruation like a flood with fresh, red blood
  • Ear discharge
  • Yellow or reddish urine
  • Chest pain
  • Constipation
  • Turbid urine
  • Dry throat
  • Hematuria
  • Hemafecia
  • Hematemesis
  • Pain in the armpits
  • Sweating in the groin
  • T: Red or Red edges or Crimson
  • C: Yellow or Yellow and greasy or Brownish
  • P: Wiry, Excess and rapid or Wiry and rapid or Slippery and rapid
    Children
    : Purple lines at the Feng or Qi Gates
Treatment Principle
  • Clear and Drain Damp-Heat
Herb Formulas
Points
  • KI-1, SP-6, SP-10, UB-17
    For epistaxis: + LU-6
    For bleeding gums: + LI-4
    For hemafecia: + ST-37
    For hematuria: + REN-3
    For hematemesis: + PC-4
    For menorrhagia: + LIV-6
    For fever: + LI-4, SJ-5
    For vexation, agitation and constipation: + SJ-6
    For severe Heat toxins with a red, painful, swollen throat: + LU-5, LU-10
    For Heat entering the Pericardium including restlessness, insomnia, deranged speech and confusion: + HT-7, PC-8
    For fatigue and weakness: + LIV-13, UB-20