Generally speaking, thrombocytopenic purpura can be divided into acute and chronic types; Acute type is common in children, accounting for 90% of cases of immune thrombocytopenia. 84% patients had respiratory tract infection or other virus infection within 1-3 weeks before onset, which was caused by the increase of platelet surface antibody. The onset is acute, and more than 80% of them relieve themselves. Chronic type, common in young women, has repeated bleeding, including nasal cavity, gums and oral mucosa bleeding, menorrhagia, and a few cases are anemia caused by repeated bleeding. It is caused by autoantibodies caused by changes in platelet structural antigens. 80-90% of patients have platelet surface antibody (PA Ig), of which 95% have increased PA Ig G, and the antibody directly acts on glycoprotein Ⅱ b/Ⅲ a on platelet membrane. A few acts on GBIB-IX complex, shortening life span and changing platelet function; It has been proved that spleen is the main place to produce platelet antibodies. Therefore, splenectomy in western medicine for thrombocytopenic purpura is its theoretical basis. Today we are going to discuss this medical topic, mainly to study and discuss the application of Chinese medicine theory in the treatment of thrombocytopenia, so there is no need to introduce more modern bleeding theory of western medicine to thrombocytopenic purpura. All the cases introduced in this paper belong to chronic refractory thrombocytopenia. The characteristics of these cases are: platelet is not continuously elevated, it is dependent or resistant to glucocorticoid or immunosuppressant, splenectomy is ineffective or the condition is aggravated, and more than 95% PA IgG is continuously elevated. We found that 89% of patients with thrombocytopenic purpura were accompanied by chronic infection in a certain part of the pharynx, especially in the case of long-term use of hormones or immunosuppressants, the infection persisted repeatedly and the immune regulation function was out of balance for a long time. The longer the hormone is used, the more difficult it is to treat, and finally the hormone becomes dependent or resistant, and the recovery is not good. We think this is mainly caused by the side effects of hormones and various western medicines. Let's talk about why we use traditional Chinese medicine to treat patients with chronic thrombocytopenic purpura who are hormone-dependent, drug-resistant or even splenectomy, and why we dare to reduce hormones or even stop using hormones. Anyone who has suffered from this disease will know that glucocorticoids, immunosuppressants and splenectomy are recognized as routine treatments in western medicine at home and abroad, but these treatments have unstable curative effects and great side effects, which make patients and their families talk about "discoloration due to hormone treatment". In order to maintain the number of platelets, patients take hormones, immunosuppressants and even splenectomy at all costs. Some patients suffer from osteoporosis, femoral head necrosis, hypertension, diabetes, aggravation of coronary heart disease and other related diseases, and patients and their families are miserable. Traditional Chinese medicine believes that thrombocytopenic purpura belongs to the category of "blood disease" and "hair spot" Its occurrence is closely related to vascular and visceral diseases, and both exogenous and internal injuries can induce thrombocytopenia. Acute thrombocytopenia is mostly caused by the accumulation of pathogens in the body and the invasion of exogenous pathogens. I feel that the pathogenic factors turn from yang to heat, and the pathogenic toxin fights with qi and blood, burning the pulse, and the blood seeps out of the pulse, resulting in purpura; If the evil toxin accumulates, the blood will rise with the fire, which is vomiting; If you move the heat to the lower jiao, it will burn the yin collaterals, and then you will see blood in the stool and urine. Chronic thrombocytopenic purpura, mostly in acute phase, turns into chronic type. Traditional Chinese medicine believes that a person's body is often yin deficiency and yang is often redundant. Chronic illness or fever damages yin and body fluids, leading to hyperactivity of fire due to yin deficiency, burning pulse due to deficiency of fire, forcing blood to rush to ren, and blood overflowing from pulse, showing bloody purpura; Qi deficiency, qi does not absorb blood; Qi can produce blood, taking qi and blood as handsome blood, blood moves with qi, and qi is static. Qi stagnation leads to blood coagulation, qi deficiency leads to blood loss, qi deficiency can't suck blood, spleen deficiency can't control blood, and blood overflows the pulse, resulting in "blood syndrome". Through clinical observation, patients with chronic thrombocytopenia are mostly caused by superficial weakness, superficial weakness, repeated susceptibility, heat entering the interior, body fluid consumption, spleen and kidney deficiency, qi deficiency or qi and blood deficiency that cannot be cured for a long time. Only in these two aspects, clearing away heat and toxic materials, cooling blood to stop bleeding, invigorating qi and nourishing yin, promoting blood circulation and removing blood stasis are the main methods, supplemented by tonifying liver and kidney, strengthening the body resistance and consolidating the foundation, and treating both the symptoms and root causes. Dialectical points: first, distinguish between excess and deficiency. If the onset is urgent, it is accompanied by fever, thirst and red tongue, which is mostly caused by excess fire; If the disease is relieved, the disease will stop, and the pulse rate is mostly yin deficiency, which belongs to deficiency fire; Long course of disease, repeated bleeding, dull complexion, listlessness, pale tongue and weak pulse belong to deficiency of qi and blood, and qi does not suck blood. After diagnosis, if purpura is accompanied by upper bleeding, it is mostly caused by deficiency fire; If purpura is accompanied by hematochezia and hematuria, it is mostly deficiency syndrome, which often belongs to spleen deficiency, spleen failing to control blood, kidney yin deficiency and fire excess deficiency. At the same time, we found that if we can combine modern immunology with clinical research, we can find unexpected gains. We found that most patients with thrombocytopenia in clinic are related to immune B and T cells, which we think should be caused by genetic defects in these two immune cells, leading to hematopoietic dysfunction. For some reasons, I found that some Chinese medicines can effectively restore this kind of immune cells, and combined with Chinese medicine treatment, it can achieve twice the result with half the effort. To this end, I call this therapy: DBT TCM immune balance recovery method. Traditional Chinese medicine treatment based on this principle has lower side effects than western medicine, no drug resistance and no rebound, and is more targeted, clear and greatly improved than traditional Chinese medicine treatment. To this end, the scientific research achievements of traditional Chinese medicine in treating thrombocytopenic purpura for many years are as follows: 1. Combination of clearing away heat and nourishing to avoid forced hemostasis. The most typical clinical symptoms of patients with primary thrombocytopenic purpura are bleeding, such as petechiae of skin and mucosa, ecchymosis, nosebleed, menorrhagia and gastrointestinal and urinary tract bleeding. It is generally believed that clearing away heat and toxic materials, cooling blood and stopping bleeding should be the most commonly used treatment methods. In fact, on the contrary, in chronic patients, the signs of blood-heat rash such as red face, dry mouth, constipation, red tongue with yellow fur and rapid pulse are really too few, but the symptoms of liver and kidney yin deficiency, such as excessive heat, thin pulse with little fur, red eyes and thirst, are more common. Therefore, it is useless to clear away heat and toxic materials, while nourishing yin and reducing fire can often play the role of immortality. In other words, the heat syndrome of chronic ITP patients must be combined with tonic and tonic. Clearing heat without bitter cold, nourishing yin without greasy diaphragm, and harmonizing stomach. The "DBT TCM immunotherapy" in our hospital is based on this principle. In the past ten years, our hospital has treated thousands of ITP patients on the basis of scientific research conducted by the Institute of Hematology, China International Institute of Biomedical Engineering, with TCM regulating immune balance as the main therapeutic principle, and achieved good results. Then there is the problem of stopping bleeding. Since it is a blood syndrome, it is essential to stop bleeding according to common sense, but it is an exception for ITP patients. Not only the birthplace of cooling blood and stopping bleeding, but also peony bark, salvia miltiorrhiza, Arnebia euchroma, buffalo horn, thistle and so on. It should not be abused, but Panax notoginseng, a kind of ginseng that removes blood stasis and stops bleeding, seems to be very inappropriate. For more than ten years, I have treated many ITP patients, some of whom have suffered from ITP for more than years, and the syndrome differentiation belongs to both qi and yin injuries. We have used the traditional Chinese medicine for clearing blood and cooling blood together with the traditional Chinese medicine for regulating immune function for more than a month, and the curative effect is still quite good. Platelets increased from 2 to 2 1, and most bleeding points disappeared. During the follow-up visit, 30g of Notoginseng Radix was added on the basis of the original prescription to speed up the progress of hemostasis. Unexpectedly, after one week, the bleeding spots on limbs and face increased greatly, and the platelets decreased to 1 1. Go to Sanqi in a hurry, increase the yellow by 5 grams with its dry stool, and the bleeding point will decrease day by day. After 10, the platelet count was 2 1 and reached 40 one month later. After that, the drug was taken continuously for half a year and stopped for three months. Platelet stability is between 170-240, which has not been repeated for more than ten years. In addition, we found that some Chinese medicines need to be used with caution, such as carbonized blood, which can stop bleeding peacefully, but it is difficult to be effective for ITP patients, and sometimes it will get worse. The mechanism here needs to be studied by everyone. Second, beware of qi and blood, why not be afraid of long-term illness and injury? Because of the prolonged course of chronic ITP patients, plus many factors such as untreated and improper treatment. No matter what causes the disease, deficiency of both qi and blood is often manifested as * * *. Mainly manifested as sallow complexion, mental fatigue, palpitation and spontaneous sweating, insomnia and dreaminess, pale tongue and weak pulse. For the deficiency of both qi and blood in patients with chronic ITP, I think we should start with the care of the heart and spleen according to the theory that the spleen does not control blood, combined with the specific characteristics of chronic ITP. This syndrome often coexists with the above-mentioned yin deficiency of liver and kidney, but different patients have different emphasis. As long as the syndrome differentiation is accurate, its curative effect is very exact. It should be emphasized that although we suggest that deficiency of both qi and blood is a feature of chronic ITP patients, this does not mean that this disease is pure nothingness. On the contrary, the connotation of evil excess is just another feature of this disease. We mentioned at the beginning that "ITP is caused by the destruction of platelets by a large number of anti-platelet antibodies in blood circulation", and this "anti-platelet antibody" is the real evil and should be removed rather than fixed. From the point of view that western medicine can temporarily control the disease by using immunosuppressants, especially toxic products such as vincristine and cyclophosphamide, this disease does have its evil side. I have a patient, a 36-year-old female, who suffered from chronic ITP for three years, and her platelet count fluctuated between 654.38+00,000-30,000. Due to the long-term use of glucocorticoid, she looks bloated, wheezing, palpitations and sweating when moving. Patients report that in recent years, "the more virtual, the more virtual"! The prescriptions used in the investigation are all products of invigorating qi and nourishing blood, nourishing the heart and strengthening the body resistance, and there is a fatal defect-staying up late. The dosage of each pair of Radix Astragali, Radix Codonopsis, Radix Rehmanniae Preparata and Colla Corii Asini is more than 30g, so the compatibility is not flexible. Along the pulse, there is a smooth image in weakness and a stagnation in the middle. This fever has something to do with hormones and many supplements! After we found it, we used heat-clearing to regulate deficiency, supplemented by immune regulation. After one week, the physical strength improved obviously, and after one month, the platelet rose to 42. After another three months, the platelet rose to 130, and the drug was stopped after one month of consolidation treatment. Up to now, platelets have been above 150 for two years. Thirdly, to reconcile the camp and the guards, to get to the point, disease is the key to ITP, and its symptoms are on the skin surface, which is a kind of blood syndrome (mainly subcutaneous hemorrhage). This camp is not harmonious with the guards (the guards are strong and the camp is weak), and evil spirits are depressed. According to our clinical experience for many years, liver and kidney yin deficiency, fire inflammation deficiency, qi and blood deficiency, spleen failing to control blood, etc. Its shortcomings are mentioned in the paper. The real side is "disharmony between camp and guard" and "stagnation of evil spirits". It is important to tonify deficiency and strengthen body resistance, which is the basis of treating this disease; The key to treat this disease is to remove depressed pathogen. If the pathogenic factors are not removed, what about radical treatment? Therefore, I think it is effective to start with harmonizing ying and Wei, purging ying and dispersing stagnation heat, and to get rid of its evil according to the condition. The so-called "anti-platelet antibody" in modern medicine has a great relationship with "pathogenic excess". According to our treatment experience, all diseases related to antigen-antibody reaction have their evil side. Such as urticaria, allergic purpura, even glomerulonephritis, rheumatism, rheumatoid disease and so on. These diseases often appear in virtual form, but in fact they are all internal pathogens, among which chronic ITP is the most representative. Let's take an example to illustrate the problem: A case, a 35-year-old male, was diagnosed as ITP in a city hospital in 2006. The platelet was at least 50,000. When vincristine and glucocorticoid were used, the platelet rose to 790,000, and it dropped to 300,000 after 30 days of drug withdrawal. Long-term repeated treatment has made patients lose confidence in treating this disease. He came to our hospital for treatment in August 2006 and took Chinese medicine. After treatment, the platelet changes were as follows: August 2 1 PLT 32, September 20 PLT 30,1October 222 PLT 25. Platelets showed a downward trend in the first three courses, and gradually increased after three months:1October 23rd 165438+PLT 49, February 20th, 65438+PLT 57,1October 23rd, 65438+PLT 69. After 7 or 8 courses of treatment, PLT hovered between 70 and 88, and the rising speed decreased. After careful inquiry, it was found that she had itchy skin and occasional urticaria recently, so she added traditional Chinese medicine to regulate her allergic and immune functions, February 23rd, 20071,February 3rd, 2007 124. After two months of intensive treatment, PLT was stable at 150-230, and there was no recurrence for three years. In the seventh and eighth course of treatment, the evil side of this case gradually appeared, and the evil was changed with the syndrome, so all the work was done. Fourthly, in order to eliminate hormones and cure ITP, we have to mention hormones. Objectively speaking, we strongly oppose the use of glucocorticoids, because once glucocorticoids are used, patients' immunity will be weaker, and their pathological manifestations such as excessive fire due to yin deficiency and excessive dampness due to spleen deficiency (edema) will be more complicated, artificially increasing the difficulty of treatment and prolonging the course of treatment. However, most of the patients we treated used hormones, and some even had a "buffalo back full moon". Fortunately, many traditional Chinese medicines have a good antagonistic effect on the side effects of hormones. It has an effect on adrenal cortex function and thyroid hormone level in vivo, and its nourishing yin effect is realized by regulating endocrine. "In addition, according to the characteristics of Cushing's syndrome caused by glucocorticoid, traditional Chinese medicine based on syndrome differentiation has been used to combat the side effects of glucocorticoid and achieved ideal results. We often call hormones "thief boats"-getting on the boat is easier than getting off! When using hormones, even if the dosage is large, it has no effect. Platelet levels are very low, and some are only a few thousand. After short-term (10-20 days) treatment with traditional Chinese medicine, platelets rose to 30 and 40. At this time, if hormones decrease, platelets will decrease. On June 6th, 2008, 65438+1October 65438, we treated an ITP patient who had been ill for three years and just came to our hospital from a provincial hospital, and the treatment effect was not good. Height 164CM, weight 9 1KG, full moon, acne, severe depressed edema of lower limbs, taking two and a half tablets of flumetasone every day (before intravenous drip of flumetasone 10mg qd). It is used for conditioning treatment in traditional Chinese medicine. After 10, PLT was increased to 34, and flumethasone was instructed to take two tablets a day. On March 8th, PLT decreased to 16. Let the original Chinese medicine continue to be used, and add a packet of antagonistic mixture every day. Flumethasone is still two tablets a day. Two weeks later, PLT rose to 30, and one month later, PLT rose to 48. Starting from April 1 1, flumethasone was changed to one and a half tablets a day, and the PLT rose to 5 1 on May 26th and 88 on May 6th. After that, the hormone was taken out smoothly. After taking traditional Chinese medicine for 7 months, the platelet has stabilized between 1 10- 180, and it has not been repeated for half a year, and its complications such as obesity, acne and hirsutism have basically been alleviated. There is a special hormone complication, which has occurred in some individuals and is quite difficult for doctors: people who use hormones for a long time and use a large amount will have paroxysmal epigastric pain after stopping or reducing to a certain amount, or take traditional Chinese medicine, that is, epigastric pain, and the symptoms will disappear after adding hormones. Although the disease is small, it affects the treatment plan. Fortunately, this kind of situation is relatively rare, so it is proposed here for everyone to discuss. Generally speaking, the use of hormones is not so terrible. As long as it is reduced in time and scientifically resisted, the harm can still be controlled to a minimum. It's just that when hormones decrease, the condition may be repeated. At this time, you should not be confused. You should respect the statutes and deal with them calmly. You can get through this difficult period in about a month. Of course, if hormone can be stopped at the beginning of treatment, it is naturally the best choice. Based on our four theories of traditional Chinese medicine and western medicine's immune theory, we summarized and created "DBT immunotherapy of traditional Chinese medicine" in clinic, which was successfully used to treat thrombocytopenic purpura, allergic purpura, allergic purpura, aplastic anemia, myelodysplastic syndrome and other blood diseases, and achieved ideal curative effect in clinic, with an effective rate of 93. More than 5%, the recurrence rate is less than 5%. After the paper was reported to China International Institute of Biomedical Engineering, the expert group of Institute of Hematology of the Academy of Engineering gave us the appraisal conclusion of scientific research results: "DBT Chinese medicine immune balance repair therapy" has been successfully applied to clinical treatment, and it is suitable for the treatment of refractory blood diseases such as thrombocytopenic purpura, allergic purpura, hemophilia, thrombocytopenia and aplastic anemia. The scientific research concept is clear and has strong clinical practicability. It organically combines the dialectical theory of Chinese medicine with the scientific theory of western medicine. Proficient in Chinese medicine theory, reasonable prescription of Chinese medicine, in line with traditional Chinese medicine theory, novel concept. Practice has proved that it is effective. The diagnosis of clinical cases is clear and the side effects of drugs are few, which is a phased progress in the treatment of difficult blood diseases with traditional Chinese medicine.